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intercultural communication

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Intercultural Communication
For Health Professionals:
Impact on Quality of Care
Ayman Hamdan-Mansour RN PhD
School of Nursing- The University of Jordan
Human beings draw close to one another by
their common nature, but habits and
customs keep them apart.
Confucius
 Objectives
 Define culture and intercultural communication
 Identify skills of intercultural communication
competence
 Identify barriers and challenges to intercultural
communication
 Identify impact of intercultural communication of
patients and quality of care
 Describe strategies for effective intercultural
communication to enhance intercultural work
3
"Intercultural Communication"
 "Intercultural Communication" credit is
often given to American anthropologist
Edward T. Hall, who used it for the first
time in his book The Silent Language in
1959. The book is sometimes called "the
field's founding document" (Hart 1998).

4
Definitions
 Singer (1998) defined culture as:
a pattern of learned, group-related perceptions –
including both verbal and nonverbal language,
attitudes, values, belief systems, disbelief
systems and behaviors that is accepted and
expected by an identity group (Singer, 1998:5)

5
Culture
 is a human creation (Freire, 1970)

 is the human part of the environment

(Wang, Brislin, Wang, Williams, & Chao, 2000).

In general it is the non-biological aspects of life.

6
Common Cultural Differences

 Perception of Time
 Perception of Space
 Fate and Personal Responsibility
 Nonverbal Communication
 Verbal communication

7
Definition
 Intercultural communication is:
 the study of communication between people
whose “cultural perceptions and symbol
systems are distinct enough” to alter their
communication. (Samovar and Porter, 1997:
70).
 Circumstance in which people from diverse
cultural backgrounds interact with one
another 8
Why ICC
 In some cultures, there may be certain stigmas
associated with communicating about health
issues, making it difficult to discuss these
concerns.
 Much medical practice, particularly diagnosis,
relies heavily on patient communication.
“nothing about me without me” patients said

9
Why do we need ICC …
 Immigration & refugee patterns
 International interaction
 Social contact

10
 More….among health care professionals
 Current research indicates that ineffective
communication among health care professionals is one
of the leading causes of medical errors and patient harm
 Ineffective or insufficient communication among team
members is a significant contributing factor to adverse
events
 Poor collaborative communication among nurses and
physicians, contributed to as much as a 1.8-fold increase
in patient risk-adjusted mortality and length of stay
11
Intercultural competence
 Intercultural competence is a communication
behavior that is appropriate and effective in a
given context …
 To recognize their own cultural norms
 To understand the patient’s unique viewpoint
 To effectively adjust their behaviors to
maximize care.

12
 Indicators of intercultural communication
competence
 Motivation
 Knowledge—cultures, communication,
language
 Attitudes—self-awareness, client’s
attitudes
 Skills—listening, speaking, empathy

13
Intercultural effective person
1. An ability to communicate with people in a way
that earns their respect and trust
2. The capacity to adapt his/her professional skills
(both technical and managerial) to fit local
conditions and constraints
3. The capacity to adjust personally so that s/he is
content and generally at ease in the host culture.
(IEP,2000:4):

14
Intercultural effective person
 Tolerance of ambiguity
 Behavioral flexibility
 Goal orientation
 Sociability and interest in other people
 Empathy- nonjudgmental perspective
 Meta-communication skills.

15
Bennett's Developmental Model of Intercultural
Sensitivity
Cultural sensitivity: involves a willingness to use
cultural knowledge while interacting with patients
and considering culture during discussions and
recommendations for treatment
From ethnocentric stages to ethnorelativistic
 Denial

 Defense

 Minimization

 Acceptance, Adaptation and Integration

16
Impact of cultural conflicts or differences on
quality of health care :

 Inaccurate diagnosis and treatment (patients

safety)
 Ineffective team communication is the root cause for nearly 66 % of all
medical errors

 Exacerbated illnesses
 Noncompliance
Institute of Medicine, 2002

 lack of trust, understanding, and loyalty in the

relationship
Fredericks, Miller, Odiet, & Fredericks, 2006
17
Impact on patients’ satisfaction
 Expectations
 Communication
 Control
 Decision-making
 Time spent:
 Clinical team
 Referrals
 Continuity of care
 Dignity 18
Impact of cultural conflicts or differences on
quality of health care
 A direct relationship found between
clinicians’ level of satisfaction and their
ability to build rapport and express care and
warmth with patients
Larson and Yao (2005)

19
“Cultural and linguistic barriers are posing a
problem for an industry that is already
financially strained. If strategies to provide
more culturally appropriate care are not
implemented, financial pressures will
continue to rise, and quality of care will
suffer”
(Reynolds, 2004, p. 237).

20
What are some barriers & challenges in
health care settings
 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
21
Barriers to patients care
 A different understanding of patient regarding the
role and function of the health care system and
health care providers
 The patient’s level of comfort with the practitioner
and fear of what he or she may find upon
examination
 A fear of rejection of personal health beliefs
 Differing expectations regarding the patient’s ability
to choose treatments
22
Barriers arise because…..
 Translation
 Technical language
 Idioms, slang
 Dialect
 Limited language
Proficiency
 No linguistic equivalent
 Feedback
 Lack of skill
 Withholding
 Unrealistic or falsified
 Perception errors
23
 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---

24
Why cultural conflict??
Why?? What to do
 Reasons for  Check stereotyping
communication problems  Confront prejudice
vary  Confront racism
 Seek similarities
 Power
 Reduce uncertainty

 Address withdrawal –
interpersonal,
intercultural, international 25
Resolving cultural conflicts
 Cultural sensitivity
 Cultural preservation
 Compromise and accommodation
 Education about the patient’s frame of
reference and reasoning

26
Improving intercultural effectiveness
Cultural self-awareness
 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 27
Ask yourself…in intercultural settings
 Do I seem tense or at  What does my tone of
ease? voice suggest?
 Do I smile often?  How do I react to being
 Do I repeatedly touched by a client?
interrupt?  How do I handle
 Do I show sympathy silence?
when there’s a crisis or  In this setting, do you
problem? appear rushed?

28
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

29
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

30
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

31
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

32
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?

33
 Culturally competent model of care
 The culturally competent model of care, developed
by Josepha Campinha-Bacote (2002), was developed
specifically for the health care industry. Cultural
competence consists of several critical elements,
including:
 Cultural awareness
 Cultural knowledge
 Cultural skills
 Cultural encounters. (Campinha-Bacote & Padgett, 1995, p. 33).
34
Developing 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.

35
Knowledge that culturally determined
family roles affect communication
 Dominance patterns
 Modesty
 Female purity
 Pregnancy
 Childbirth
 End of life

36
Knowledge of Prevention
 Immunizations
 Healthy living
 Avoid violating cultural taboos
 Astrology
 Fatalism
 Charms

37
 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?”

38
Working with multicultural patients & families

 Be sensitive to patients’ cultural beliefs and practices

 Convey respect for their cultural values through
effective communication and linguistics approach.
 providers recognize individual differences and do not
participate in "cultural stereotyping".
 understand the particular circumstances of the patient or
family by obtaining information on: place of origin;
social and economic background; degree of
acculturation; and personal expectations concerning
health and medical care 39
Working with multicultural patients & families

 Understanding
 Empathy
 Patience
 Respect:
 Trust

40
Arabian experience .. HCP in Arab world
 Healthcare workers demonstrate low cultural
competency ( Almutairi , 2015) .
 Main issue is:
 language difference including clarity of
language use by health care providers in
giving information and providing adequate
explanation regarding their activities.

41
Arabian experience .. HCP in Arab world
 Factors that influence intercultural
communication that influenced patient
dissatisfaction and poor quality of care
included:
 Low health literacy
 Language differences
 Cultural misunderstanding between patients and
HCP
.
42
Pitfalls… be ware of:
 Stereotype: as a set of inaccurate, simplistic
generalizations about a group of individuals
which enables others to categorize members
of this group and treat them routinely
according to these expectations.
 Perception: the internal process by which we
select, organize and interpret information”
from the outside world
43
Pitfalls
 Beliefs: the judgments we make about what is
true or probable. usually linked to objects or
events that posses certain characteristics that we
believe to be true with or without proof
 Values: an enduring set of beliefs that serve to
guide or direct our behavior.

44
We can all change
 Cultural is a dynamic
 Consider interaction between values, beliefs and
perceptions
 The brain is an open system
 We have free choice to respond
 Our communication behavior influences other people.

45
 When thinking about communication
between cultures, rather than thinking of
them as entirely separate and static it is
more useful to consider them as dynamic
and interconnected

46
References
 Fawaz, M. & Hamdan-Mansour, A. (2016). Lebanese Student’s Experience of
Benefits of High Fidelity Simulation in Nursing Education: A Qualitative
Approach. Open Journal of Nursing, 6(10), 853-862
 Hamdan-Mansour, A. (2016). Social support and adolescents’ alcohol use: An
integrative literature review. Health, 8 (12), 1166-1177.
 Fawaz, M. & Hamdan-Mansour, A. (2016). Effect of using HFS on motivation
and clinical; judgment among nursing students in Lebanon. Nurse Education
Today. 46 (2) 36–42.
 Abdul Kader, R., Arabiat D.H., Holmes, S., Hamdan-Mansour A., (2016).
Socio-demographic Correlates of Parents Participation in Care of a Hospitalized
Child: A Perspective from a Developing Country. Journal of Child Health Care.
20 (3), 374-383.
 Ghannam, B., Hamdan-Mansour, A., Al Abaiat, D. (2016). Psychosocial
predictors of burden among caregivers of patients with serious mental illness in
Jordan. Perspectives of Psychiatric Care, doi: 10.1111/ppc.12179.
47
 Hamdan-Mansour, A. (2016). Psychosocial and sociodemographic
predictors of depression among older persons in Jordan. Open Journal of
Nursing, 6, 532-540.
 Hamdan-Mansour, A., Malkawi, A., Sato, T., Hamaideh, S., &
Hanouneh, S. (2016). Males' perception of family planning in Jordan.
Eastern Mediterranean Health Journal, 22 (2), 124-132.
 Hamdan-Mansour, A., Nawafeh, D., Hanouneh, S., & A l Omari, H.
(2016). Psychosocial aspects of patients diagnosed with Diabetes Mellitus
type –II in Jordan. International Journal of Diabetes in the Developing
Countries. 36 (1), 65-69. DOI 10.1007/s13410-015-0423-z.

48
 Nawafeh, D., & Hamdan-Mansour, A. (2015). Correlates of Health locus
of control among patients diagnosed with Diabetes mellitus type –II in
Jordan. Journal of Diabetes Mellitus, 5 (3), 190-197.
 Arabiat DH., Hamdan-Mansour A., Al Jabery MA., Wardam L., &
Altamimi A (2015). The Refined Family Inventory of Needs- Paediatric
(FIN-PED II): Translation and Validation Study of the Arabic Version.
Journal of Nursing Measurement, 23 (2). 255-270
 Hamdan-Mansour, A. Al Abeiat, Alzoghaibi, I., Ghannam, B.,
& Hanouneh, S. (2015).Psychosocial and Sociodemographic correlates of
life satisfaction among patients diagnosed with cancer in Jordan. Journal of
Cancer Education, 30, 31-36.
 Hamdan-Mansour, A., Aboshaiqah, A., Thultheen, I., & Salim, W.
(2015). Psychological wellbeing of Saudi patients diagnosed with chronic
illnesses. Psychology, 6, 55-62.
 Hamdan-Mansour, A., Hamaideh, S., Azzeghaiby, S., Hanouneh, S., &
Aboshaiqah, A. (2015). Psychosocial correlates of motivation for academic
accomplishment among university students. Open Journal of Medical
Psychology , 4, 1-8
49
 Hamdan-Mansour, A., Constantino, R, Farrell, M., Doswell, W., Gallagher, M.E.,
Safadi, R. Shishani, K., & Banimustafa, R. (2011). Evaluating the Mental Health of
Jordanian Women in Intimate Partner Abuse. Issues in Mental Health Nursing,
32:614–623.
 Hamdan-Mansour, A., El-Gamal, E., Puskar, K., Marini, A. (2011). Mental health
nursing in Jordan: an investigation into experience, work stress, and organizational
support. International Journal of Mental Health Nursing, 20, 86–94.
 Banimustafa, R., Hamdan-Mansour, A., Arabiat, D., Sato, T., Imoto, A., Obiad, B.
(2011). Empowerment and Psychological Wellbeing of Women in the Southern
Region of Jordan: in the context utilization of reproductive health care services.
Arab Journal of Psychiatry, 22 (2), 139-147.
 Hamdan-Mansour, A., Arabiat, D., Sato, T., Imoto, A., Obiad, B. (2011). An
Investigation into Marital Abuse and Psychological Wellbeing among Women in
the Southern Region of Jordan. Journal of Transcultural Nursing. 22(3), 265-273.
 Arabiat, D., ALqaissi, N., & Hamdan-Mansour, A. (2011). Children’s knowledge
of their cancer diagnosis and treatment: Jordanian mothers’ perceptions and
satisfaction with the process. International Nursing Review. 58, 4, 443-449.
 2010

50
 Hamdan-Mansour, A., Farhan, N., Othman, E., & Yacob, M. (2010).
Knowledge and Nursing Practice of Critical Care Nurses Caring for
Patients with Delirium in Intensive Care Units in Jordan. Journal of
Continuing Education in Nursing. 41 (12), 571-576.
 Hamdan-Mansour, A. (2010). Predictors of hostility among university
students In Jordan. Scandinavian Journal of Caring Sciences, 24(1), 125-
130.
 Mahadeen, A., Arabiat, D., Abdul-Qader, R., & Hamdan-Mansour, A.
(2010). Maternal distress in mothers of children with cancer. Jordan
Medical Journal, 44(4), 404-412

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