Intercultural Communication Strategies for Hospice Staff

1. Intercultural Communication Strategiesfor Hospice Staff Gail Henson, Ph. D. Hospice Institute December 14, 2004

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

3. 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

4. Objectives, continued • Describe 3 strategies for effective intercultural communication to enhance intercultural work in hospice role • Demonstrate behaviors that indicate intercultural communication competence.

5. Intercultural contact occurs • Where? • Client base • Staffing in nursing homes, hospitals • Home setting • Where else? • What experiences can you share? Objective 1

6. 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

7. Who are Hospice’s culturally diverse clients? Vietnamese Bosnians Indians Cubans Somali Bantu Objective 1 Iraquis Mexicans

8. Definition of intercultural communication Circumstance in which people from diverse cultural backgrounds interact with one another Crucial element-culture and its impact on cultural behavior Objective 1

9. 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

10. Indicators of intercultural communication competence • Motivation • Knowledge—cultures, communication, language • Attitudes—self-awareness, client’s attitudes • Skills—listening, speaking, empathy • From Samovar & Porter • Communication between Cultures, 5th Ed Objective 1

11. 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

12. Motivations, goals and plans Contradictory 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 Barriers & challenges may arise at any point during interaction: reasons From Transcultural Communication and Health Care Practice: RCN. Objective 3

13. Translation Technical language Idioms, slang Dialect Limited English Proficiency No linguistic equivalent Feedback Lack of skill Withholding Unrealistic or falsified Perception errors Barriers arise because….. From Transcultural Communication and Health Care Practice: RCN. Objective 3

14. 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

15. 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--- • From Samovar & Porter • Communication between Cultures, 5th Ed Objective 3

16. 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

17. Cultures differ in the way they explain, treat, and prevent illness, suffering, death, dying, life itself Categories of systems: biomedical personalistic naturalistic Develop knowledge of other cultures’ views of illness, life, death Objective 4

18. Knowledge of causes of illness • Biomedical-terms • Spirits-personalistic • Naturalistic—imbalance of humors, yin and yang • Disharmony with nature Objective 4--handout From Samovar & Porter Communication between Cultures, 5th Ed

19. Medicine Alternative medicines Knowledge of Treatments • Acupuncture Shamans Cupping Objective 4

20. Future orientation Informality Direct, open, honest Practical, efficiency Materialism Past, present orientation Formality Indirect, “face,” ritual Idealism Spiritualism, detachment Know the values that cause conflict majority, minority culture • From Samovar & Porter • Communication between Cultures, 5th Ed Objective 4

21. 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 Ed Objective 4

22. Knowledge of Prevention Immunizations Healthy living Avoid violating cultural taboos Astrology Fatalism Charms and amulets Objective 4 From Samovar & Porter Communication between Cultures, 5th Ed

23. 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?” • From Samovar & Porter • Communication between Cultures, 5th Ed Objective 4

24. Healthcare practices must accommodate cultural diversity • Attitudes from culture, religion • Attitudes to pain • Belief systems Objective 4: handout

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

26. We can all change • The brain is an open system • We have free choice to respond • Our communication behavior influences other people. Objective 4

27. Reasons for communication problems vary Seek similarities Reduce uncertainty Address withdrawal –interpersonal, intercultural, international Check stereotyping Confront prejudice Confront racism Power Ward off potential problems Objective 4

28. Recognize diversity • medical systems • treatment • ethnocentrism Objective 4

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

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

31. 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? Know your communication style in intercultural settings Communication style involves vocal, verbal, non verbal Objective 4 • From Samovar & Porter • Communication between Cultures, 5th Ed

32. 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

33. 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

34. 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

35. Develop empathy • Empathy is the bedrock of effective intercultural communication (Calloway-Thomas, Cooper, Blake) Objective 4

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

37. 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

38. Practice strategies • Which is more important to your client, the body or the soul? • Case studies Objective 5

39. 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 cultures

40. Future orientation Informality Direct, open, honest Practical, efficiency Materialism Past, present orientation Formality Indirect, “face,” ritual Idealism Spiritualism, detachment Values of majority, minority culture Objective 4

41. Intercultural Communication Strategiesfor Hospice Staff Gail Henson, Ph. D. Hospice Institute December `4, 2004