Chapter 5 Culture and Gender Issues in Patient-Safe Communication

1. Chapter 5Culture and Gender Issues in Patient-Safe Communication

2. Cultural Beliefs North American Values vs Other Cultures Personal control over environment Fate Change Tradition Time and it’s control Human interaction Equality Hierarchy/rank/status Individualism/privacy Group’s welfare Self-help Need help Competition Cooperation Future orientation Past orientation Action/work orientation “Being” orientation Informality Formality Directness/openness/honesty Indirectness/subtlety Practicality/efficiency Idealism Materialism/acquisitiveness Spirituality

3. Cultural Assessment • Heritage: What is the patient’scountry of origin? Is the patient familiar with the health-care system and health-care providers in this country? • Communication: Are there language barriers? Will the patient feel comfortable sharing thoughts and feelings?

4. Cultural Assessment • Family roles and organization: Who is the dominant member of the household, the person in the family who is the spokesperson and decision maker? • Biocultural ecology: What are the specific genetic or environmentally transmitted diseases that cause health problems in the different cultural groups?

5. Cultural Assessment • High-risk behaviors: Does the cultural group use tobacco, alcohol, or recreational drugs? Is participation in high-risk physical activities common? Is there a lack of adherence to important health safety practices? • Nutrition: What are the basic ingredients of native food dishes and preparation practices?

6. Cultural Assessment • Pregnancy and childbearing practices: What are the preferences for birth control methods, the roles of men in childbirth, the positions for delivering a baby, and the preferred types of health practitioners (male or female, midwife or obstetrician)? • Death rituals: What is the patient’s view of death, dying, and an afterlife?

7. Cultural Assessment • Spirituality: What is the patient’s dominant religion and views regarding the meaning and purpose of life? • Health-seeking beliefs and behaviors: What are the patient’s beliefs about pain, mental and physical handicaps, chronic illness, and folklore practices?

8. Gender Differences in Styles of Speech • Purpose of recognizing gender differences in styles of communication: 1. Understand ourselves and members of the opposite gender 2. Apply the knowledge to facilitate communication with members of the opposite gender

9. Gender Differences in Styles of Communication Women focus communication on intimacy and forming communal connections. Goal: Establish and negotiate intimate, sympathetic, and harmonious relationships. Men focus communication on hierarchy and attaining and demonstrating status in a group. Goal: To be independent, to demonstrate importance, and to attain high status. Compete to be the best in the group.

10. Most women use a “rapport” style of communication for everyday conversation • Communicate to establish connection, display similarities, and match experiences • Female friendships: Talk about how they think and feel • Call each other to “chat” and make “small talk” • Pay attention to intimate and personal details, what happened, who was there….

11. Women’s Rapport Talk • Most comfortable with private conversations due to the intimate and personal exchanges • As a result, women are very good at expressing themselves: thoughts & feelings • Women are much better at expressing themselves than many men

12. Rapport Talk vs Gossip • “Gossiping women”….negative connotation • Gossip is destructive: Rumors, slander, and defamation of character; does not create rapport • The purpose of rapport talk is to establish and facilitate relationships

13. Most men use a “report” style of communication for everyday conversation • To assert independence and to maintain or augment status in social group • Freely announce and state facts to give an account • “Skip-the-details” • Straightforward and direct

14. Men and Report Talk • Like to tell others what to do: increases independence and status • Taking orders lowers status and decreases independence • Like to talk about their knowledge and skill • Like to tell success stories about their accomplishments

15. Men and Report Talk • Like to hold center state through a verbal performance • Like to impart information, appear knowledgeable, and give advice • More comfortable talking in groups made up of people they don’t know well

16. Who Talks More….. Men talk more than women…..Women spend more time listening

17. How Have We Learned to Manage Conflict? • Boys’ games: Complex rules, specific roles, relied-upon skills • Girls’ games: Focused on verbally managing interpersonal relationships, popularity contests

18. Conflict and Women • Threat to connection and should be avoided • Strive for peace and harmony in conversation • Prefer to settle disputes without direct confrontation • Some women avoid conflict at all costs; unable to express anger • Sacrifice personal needs for the needs of the group

19. Women at Work • Place higher value on affiliation and collective goals than personal achievement • When making decisions, tend to take into account more factors, with a higher sensitivity to personal and moral aspects of problems

20. Men and Conflict • Comfortable with conflict and competition • Friendships involve competition and friendly aggression • Thrive on team sports, golfing, fishing, and “who’s the best”

21. Men at Work • Recognize some people are on top and some are on the bottom when it comes to status • Everyone has a function to perform and everyone is not equal • More interested in being respected than in being liked

22. Cooperative Overlapping vsTalking Alone Communication overlapping: • Listener talks along with speaker • Speaker not annoyed by the intrusion • Purpose of overlapping is to show support, interest, cooperation, and emotional ties

23. Overlapping vs Interruption • Interruption: Violation of speaking rights; inconsiderate • Individual’s intended overlap may be perceived as interruption by another • Cultural pattern: Italians, Asians, and Filipinos talk together

24. Many women overlap more than men: Build relationships • Many men may consider overlap an interruption: Want center stage to demonstrate independence and status

25. Who interrupts more? • Women say their messages are often interrupted with “Get to the point!” • Men often consider efforts to show support by interruption • Research indicates men interrupt women more

26. Seek a balanced conversation • If one speaker overlaps and the other gives way, the conversation is not balanced • If the person overlaps, you can overlap also • If the person does not overlap, let him/her speak

27. If you feel you are being interrupted: “Please let me finish want I was saying.” “I’m not done yet; let me finish.”

28. If you are in the habit of interrupting: Take a deep breath, hold it a second, and really listen to what the other person is trying to say as you exhale

29. Listener vs Information Provider • Women listen more Active listening; play down expertise to promote harmony • Men seek opportunities to give information Value center stage while speaking; gives them feeling of knowing more, having importance & status

30. Aim for balanced listening and providing information Men speaking together • Challenge the content of the message • Match information with their own expertise • Sidetrack the speaker to a different topic

31. If you do not challenge or match information… • Person knows nothing about the topic • May feel obliged to keep on lecturing

32. Women view… • Sidetracks as rude, not listening • Listening to a lecture as boring Both men and women mutually dissatisfied with women listening and men providing information

33. Men vs Women in Listening Women: • Nod head in encouragement • Say “yes” as encouragement Men: • Focus on the message and literal meanings • Nod only if they agree

34. Men & Women Listening vsTalking • Women tend to ask more questions, encouraging further verbal expressions • Women attempt to draw quieter members of a group into conversation • Men assume that anyone who has something to say will volunteer it

35. Are You Listening? • Many men avoid eye contact because it makes them uncomfortable • If a speaker expects verbal and nonverbal feedback, it is very frustrating not to have eye contact

36. If the purpose of speech is to express intimacy… The speaker will become frustrated with a listener making statements or issuing challenges rather than asking questions

37. Some people do not like to listen at length… • Listening makes them feel subordinate • The act of giving information is dominant and is given higher status than listening Interesting: a person who is an unwilling listener will listen quietly to a lecture from a supervisor with higher status

38. Listening/speaking is out of balance… If you find yourself talking a lot, and the other person is doing all the listening….. Stop talking; ask a question to draw the other person into the conversation

39. If the other person is doing all the talking…. • Challenge • Match information • Sidetrack

40. Storytelling All people, regardless of gender, like to tell stories

41. Men and Storytelling • Human contests • Act alone • Are successful • Rarely receive advice • Hunting, fishing, golf, etc.

42. Women and Storytelling • Personal experiences • Revolve around relationships • Peculiar people • Dramatize abnormal behavior • Violation of social norms • Who did what to whom under what circumstances

43. Gender Differences in Language UsageTag Questions:Adding a phase at the end of a sentence to turn it into a question

44. Women: Tag Questions Woman works hard all day and says: Woman: “I’d like to go out to eat, wouldn’t you?” Man: “I’d rather stay in tonight.” Woman’s interpretation: “He doesn’t care about me because he doesn’t want to go out even when he knows I do.”

45. Purpose of Tag Question • Hear another’s thoughts • Encourage the expression of opinions • Men prone to respond more literally to a question • Men give opinions and honest answers

46. Tag questions: What do you think? Why? Purpose: • Make others feel involved • Ask opinions before a decision is made • Decisions based on consensus Misinterpretation: • Make the decision for me • Speaker lacks confidence to make a decision

47. Net effect of tag questions: Speaker appears less intelligent

48. To Communicate Clearly • Do not ask tag questions; make statements. • Do not give a person a choice if there really isn’t one. • Pose questions carefully and clearly: “I need your insight into this problem.”

49. Women’s conversational rituals —phrases to promote harmonious relationships “I’m sorry”— to show empathy, not meaning the speaker did something wrong Man wonders — What is she sorry for? “ Thanks”— often tacked on the end of a conversation, when there is nothing to be thankful about Man wonders — Why is she thanking me?

50. Women’s Rituals: Compliments • Women offer more compliments • Give more compliments to other women than to men • People like praise, but it becomes annoying if habitual