Intercultural Communication Strategies for Hospice Staff Gail Henson, Ph. D. Hospice Institute December 14, 2004.

Intercultural Communication Strategiesfor Hospice Staff

Gail Henson, Ph. D.

Hospice Institute

December 14, 2004

Human beings draw close to one another by their common nature, but habits and customs keep them apart.

Confucius

Objectives Identify 2 attitudes, behaviors that indicate

intercultural communication competence Identify 2 barriers and challenges to

intercultural communication with Hospice patients and families

Verbalize an understanding of reasons for barriers and challenges to effective intercultural communication

Objectives, continued Describe 3 strategies for effective

intercultural communication to enhance intercultural work in hospice role

Demonstrate behaviors that indicate intercultural communication competence.

Intercultural contact occurs Where?

Client base Staffing in nursing homes, hospitals Home setting Where else?

What experiences can you share?

Objective 1

Why is there an increasing amount of intercultural contact? Immigration & refugee patterns International interaction—e.g. through

business, media Social contact—again through business,

internet, media

Objective 1

Bosnians

Somali Bantu

Cubans

Who are Hospice’s culturally diverse clients?

Indians

Iraquis Mexicans

Vietnamese

Objective 1

Definition of intercultural communicationCircumstance in which people from diverse

cultural backgrounds interact with one another

Crucial element-culture and its impact on cultural behavior

Objective 1

Definition of Intercultural Communication Competence

Communication behavior that is appropriate and effective in a given context.

From Samovar & Porter

Communication between Cultures, 5th Ed

1

Objective 1

Indicators of intercultural communication competence Motivation Knowledge—cultures, communication,

language Attitudes—self-awareness, client’s

attitudes Skills—listening, speaking, empathy

Objective 1From Samovar & Porter Communication between Cultures, 5th Ed

What are some barriers & challenges to in the Hospice setting? Language Gender roles, family structure History of the culture, e.g. tribal warfare, ethnic

cleansing Views of causes of illness Experience with medical systems Understanding, acceptance of treatment Ethnocentrism, prejudice, stereotyping Nonverbal communication patterns

Objective 2

Barriers & challenges may arise at any point during interaction: reasons Motivations, goals and

plansContradictory goals when

needs conflict

Cognitive skills inadequate

Goals change if there’s a history of failure

Perception: Low level of accuracy,

discrimination Inaccurate stereotypes Errors of attribution—

too much, too little Halo effects—

perceiving people as consistently good, bad

From Transcultural Communication and Health Care Practice: RCN.

Objective 3

Barriers arise because….. Translation

Technical language Idioms, slang Dialect Limited English

Proficiency No linguistic equivalent

Feedback Lack of skill Withholding Unrealistic or falsified Perception errors

From Transcultural Communication and Health Care Practice: RCN.

Objective 3

Barriers may arise due to culture shock Client/family may experience anxiety that

results from losing familiar signs and symbols We all feel more comfortable with the

familiar Stages of culture shock: honeymoon phase,

culture shock, recovery, adjustment

Objective 3

The chief barrier to effective intercultural communication is ethnocentrism

Notion that one’s culture is superior to any other.

Ethnocentrism helps members of the culture associate and identify with culture’s ideas, ethics, pride, sense of personal worth

Consequences of ethnocentrism—negative or derogatory evaluations of anything that’s different. Political, moral, religious---

Objective 3From Samovar & Porter Communication between Cultures, 5th Ed

So what do we need to do to develop intercultural communication skills? Develop knowledge of other cultures and

their understandings of illness, life and death, and their communication styles.

Develop attitudes open to others and to understanding them.

Develop skills.

Objective 4

Develop knowledge of other cultures’ views of illness, life, death Cultures differ in the

way they explain, treat, and prevent illness,

suffering, death, dying,

life itself

Categories of systems:

biomedical

personalistic

naturalistic

Objective 4

Knowledge of causes of illness Biomedical-terms Spirits-personalistic Naturalistic—

imbalance of humors, yin and yang

Disharmony with nature

From Samovar & Porter Communication between Cultures, 5th Ed

Objective 4--handout

Knowledge of Treatments

Medicine

Alternative medicines

Cupping

Acupuncture

Shamans

Objective 4

Know the values that cause conflict majority, minority culture Future orientation

Informality Direct, open, honest Practical, efficiency Materialism

Past, present orientation

Formality Indirect, “face,” ritual Idealism Spiritualism,

detachment

Objective 4From Samovar & Porter Communication between Cultures, 5th Ed

Knowledge that culturally determined family roles affect communication Dominance patterns Modesty Female purity Pregnancy Childbirth End of life

From Samovar & Porter Communication between Cultures, 5th EdObjective 4

Knowledge of Prevention Immunizations Healthy living Avoid violating cultural taboos Astrology Fatalism Charms and amulets

From Samovar & Porter Communication between Cultures, 5th Ed

Objective 4

Knowledge of interplay of religion, spirituality + healthcare Very strong Biomedical model—limited Has profound effect on outcomes How does the client answer the question,

“Which is more important, the body or the soul?”

Objective 4

From Samovar & Porter Communication between Cultures, 5th Ed

Healthcare practices must accommodate cultural diversity

Attitudes from culture, religion Attitudes to pain Belief systems

Objective 4: handout

Develop strategies for effective intercultural communication with Hospice

clients and families. Step 1 Recognize one’s reactions to differences Consider the origins of these reactions Consider how might the specific

communication barriers, challenges affect the ability to provide services

Consider how the clients/families might perceive one’s behavior.

From Samovar & Porter Communication between Cultures, 5th Ed

Objective 4

We can all change The brain is an open system We have free choice to respond Our communication behavior influences other

people.

Objective 4

Ward off potential problems Reasons for

communication problems vary

Seek similarities Reduce uncertainty Address withdrawal –

interpersonal, intercultural, international

Check stereotyping

Confront prejudice

Confront racism Power

Objective 4

Recognize diversity medical systems treatment ethnocentrism

Objective 4

Effective strategies Develop strategies that are

Culture specific—knowing client base Context specific—to Hospice Culture general-common across all cultures

Learn the culture-specific norms for nonverbal communication

Understand the communication style Ask questions

Objective 4

From Samovar & Porter Communication between Cultures, 5th Ed

Improving intercultural effectiveness Know yourself Know your culture Know your personal attitudes Know your communication style Monitor yourself Consider the physical and human settings—

Timing, physical setting, customs

Objective 4 From Samovar & Porter Communication between Cultures, 5th Ed

Know your communication style in intercultural settings Do I seem tense or at

ease? Do I smile often? Do I repeatedly

interrupt? Do I show sympathy

when there’s a crisis or problem?

What does my tone of voice suggest?

How do I react to being touched by a client?

How do I handle silence?

In this setting, do you appear rushed?

Communication style involves vocal, verbal, non verbal

Objective 4 From Samovar & Porter Communication between Cultures, 5th Ed

Effective strategies Understand the communication style

Direct or indirect Collectivist—group members weigh in on

decisions or Individualistic Appropriateness of language for expressing pain,

emotion, dealing with ambiguity Amount of conversation—high context, low

context

Objective 4

Improving intercultural effectiveness Seek to understand diverse message systems

Learn different languages Understand cultural variations in language use Remember words are culture bound

Idioms Ambiguity Expressions Subcodes Nonverbal codes

Objective 4

Improving intercultural effectiveness Achieving clarity State your information clearly and precisely Adjust to listener’s level of understanding without being

demeaning Explain jargon Use idioms carefully Slow down speaking Speak in smaller units Repeat key points Encourage listener to ask questions Check for understanding

Objective 4

Develop empathy Empathy is the bedrock of effective

intercultural communication

(Calloway-Thomas, Cooper, Blake)

Objective 4

Effective strategies Learn the culture-specific norms for

nonverbal communication Body behavior—attire, gestures, posture, facial

expressions, eye contact, touch, smell, vocalizations (qualifiers), volume, noises, laughing, accents, dialects

Space & distance Timing Silence

Objective 4From Samovar & Porter Communication between Cultures, 5th Ed

Strategies for effective intercultural communication: Ask questions—

What do you call the problem? What do you think has caused the problem? Why do you think it started when it did? What does the illness do? How does it work? What kind of treatment should the patient receive? What

are the most important results you hope the patient receives from the treatment?

What are the chief problems the sickness has caused? What do you fear most about the sickness?

Arthur Kleinman, Patients and Healers in the Context of Culture. Berkeley, Univ of California Press, 1980.Objective 4

Practice strategies Which is more important to your client, the

body or the soul? Case studies

Objective 5

Values of majority, minority cultures Master over nature Personal control over

environment Doing/ activity Time dominates Human equality Youth valued Competition

Harmony with nature Fate determines one’s

destiny Being orientation Personal relationships Group welfare Elders valued Cooperation

Values of majority, minority culture Future orientation

Informality Direct, open, honest Practical, efficiency Materialism

Past, present orientation

Formality Indirect, “face,” ritual Idealism Spiritualism,

detachment

Objective 4

Intercultural Communication Strategiesfor Hospice Staff

Gail Henson, Ph. D.

Hospice Institute

December `4, 2004