Topic 2

COMMUNICATION AND SELF-

AWARENESS
The World Health Organization defines
interprofessional collaboration as multiple health
workers from different professional backgrounds
working together with patients, families, caregivers,
and communities to deliver the highest quality of
care (World Health Organization, 2013)
Derived from the Latin verb communicare, meaning
to share, communication refers to the meaningful
exchange of information between one or more
participants.
1. Verbal Communication Whereas language refers to what is said,
paralanguage refers to how it is said and relates to
2. Non- Verbal Communication all aspects of the voice that are not part of the verbal
message.
Being respectful and polite, using language that is
understood by the other(s), and speaking clearly
will facilitate verbal (or spoken) communication.
Nonverbal communication refers to how people
convey meaning without words, for example,
through the use of facial expressions, gestures,
posture (body language), and the physical distance
between the communicators (proxemics).
Important Aspects of Communication
1. Language
2. Interpreters
3. Greetings
4. Silence
5. Eye Contact and Facial Expressions
6. Gestures
7. Posture
8. Chronemics
9. Modesty
10. Technology-assisted Communication
11. Literature, Arts, Music, Dance
  Maintain a computerized list of interpreters,
including those certified in sign language,
who may be contacted as needed.
 Network with area hospitals, colleges,
universities, and other organizations that
may serve as resources.
What To Do When There Is No Interpreter
 Be polite and formal.
 Greet the person using the last or complete
Using an Interpreter
name. Gesture to yourself and say your
 Before locating an interpreter, determine the name. Offer a handshake or nod. Smile.
language the client speaks at home; it may  Proceed in an unhurried manner. Pay
be different from the language spoken attention to any effort by the patient or
publicly (e.g., French is sometimes spoken family to communicate.
by well- educated and upper-class members  Speak in a low, moderate voice. Avoid
of certain Asian or Middle Eastern cultures). talking loudly. There is often a tendency to
 After assessing client’s health literacy, use raise the volume and pitch of your voice
electronic devices such as cell phones, when the listener appears not to understand,
tablets, and laptop computers to connect but this may lead the listener to perceive that
client with Web-based translation programs. the nurse is shouting and/or angry.
 Avoid interpreters from a rival tribe, state,  Use any words known in the patient's
region, or nation (e.g., a Palestinian who language. This indicates that the nurse is
knows Hebrew may not be the best aware of and respects the client's culture.
interpreter for a Jewish client).  Use simple words, such as pain instead of
 Be aware of gender differences between discomfort. Avoid medical jargon, idioms,
interpreter and client. In general, the same and slang. Avoid using contractions. Use
gender is preferred. nouns repeatedly instead of pronouns. For
 Be aware of age differences between example, do not say, “He has been taking his
interpreter and client. In general, an older, medicine, hasn't he?” Do say, “Does Juan
more mature interpreter is preferred to a take medicine?”
younger, less experienced one.  Pantomime words and simple actions while
 Be aware of socioeconomic differences verbalizing them.
between interpreter and client.  Give instructions in the proper sequence.
 Ask the interpreter to translate as closely to For example, do not say, “Before you rinse
verbatim as possible. the bottle, sterilize it.” Do say, “First, wash
 Expect an interpreter who is not a relative to the bottle. Second, rinse the bottle.”
seek compensation for services rendered.  Discuss one topic at a time. Avoid using
conjunctions. For example, do not say, “Are
you cold and in pain?” Do say, “Are you
cold [while pantomiming]?” “Are you in
pain?”
Recommendations for Institutions
 Validate whether the client understands by
 Keep pace with assistive equipment and having hirn or her repeat instructions,
technology for people who are deaf, hard of demonstrate the procedure, or act out the
hearing, blind, visually impaired, and/or meaning.
disabled.
  Write out several short sentences in English, Among some African American and White cultures,
and determine the person's ability to read occulistics (eye rolling) takes place when someone
them. speaks or behaves in a manner that is regarded as
 Try a third language. Many Southeast inappropriate. Strongly influenced by a person's
Asians speak French. Europeans often know cultural background, facial expressions include
three or four languages. Or, try Latin words affective displays that reveal emotions, such as
or phrases. happiness through a smile or sadness through
 Ask if any of the client's family and friends crying, and various other nonverbal gestures that
could serve as an interpreter. may be perceived as appropriate or inappropriate
 Obtain phrase books from a library or book- according to the person’s age and gender. These
store, make or purchase flash cards, contact nonverbal expressions are often unintentional and
hospitals for a list of interpreters, and use can conflict with what is being said verbally.
both formal and informal networking to GESTURES
locate a suitable interpreter.
Gestures that serve the same function as words are
GREETINGS referred to as emblems. Examples of emblems
Some cultures value formal greetings at the start of include signals that mean okay, the “thumbs up”
the day or whenever the first encounter of the day gesture, the “come here” hand movement, or the
occurs—a practice found even among close family hand gesture used when hitchhiking.
members. When communicating with people from Gestures that accompany words to illustrate a verbal
cultures that tend to be more formal, it is important message are known as illustrators. Illustrators
to call a person by his or her title, such as Mr., Mrs., mimic the spoken word, such as pointing to the
Ms., Dr., Reverend, and related greeting as a sign of right or left while verbally saying the words right or
respect, and until such time as the individual gives left. Regulators convey meaning through gestures
permission to address them less formally. The such as raising one’s hand before verbally asking a
recommended best practice at the time the nurse question. Regulators also include head nodding and
initially meets a client or new member of the health short sounds such as “uh huh” or “Hmmmm” and
care team is to state his or her name and then ask other expressions of interest or boredom. Without
the client or team member by what name he or she feedback, some people find it difficult to carry on a
prefers to be called. conversation.
Adaptors are nonverbal behavior that either satisfy
SILENCE some physical need such as scratching or adjusting
eyeglasses or represent a psychological need such
A pause following a question signifies that what has as biting fingernails when nervous, yawning when
been asked is important enough to be given bored, or clenching a fist when angry.
thoughtful consideration. In traditional Chinese and
Japanese cultures, silence may mean that the POSTURE
speaker wishes the listener to consider the content Another form of nonverbal communication is
of what has been said before continuing. manifested in closeness and personal space. The
EYE CONTACT AND FACIAL study of space and how differences in that space can
EXPRESSIONS make people feel more relaxed or more anxious is
referred to as proxemics, a term that was coined in
Eye contact and facial expressions are the most the 1950s by the anthropologist and cross-cultural
prominent forms of nonverbal communication. Eye researcher Edward T. Hall.
contact is a key factor in setting the tone of the
communication between two people and differs Distances have been identified based on the
greatly between cultures and countries. relationship between or among the people involved:
(1) Intimate space (touching to 1 foot) is typically Traditional Muslim women beyond the age of
reserved for whispering and embracing; nurses and puberty wear a headscarf to cover their head and
other health care providers, however, sometimes hair as a sign of modesty and religious faith. The
need to enter this intimate space when providing word hijab describes the act of covering up
care for clients. generally but is sometimes used to describe the
headscarves worn by Muslim women.
(2) Personal space (ranges from 2 to 4 feet) is
used among family and friends or to separate people These scarves come in many styles and colors and
waiting in line at the drug store or ATM machine. have different names around the world such as
niaah al mira Shavila khimar chador and burka
(3) Social space (4 to 10 feet) is used for
communication among business or work associates
and to separate strangers, such as those taking a
course on natural childbirth.
(4) Public space (12 to 25 feet) is the distance
maintained between a speaker and the audience
(Hall 1984 1990)

The type of hijab most commonly worn in the

CHRONEMICS
United States, Canada, Australia, and Western
There are cultural variations in how people Europe covers the head and neck but leaves the face
understand and use time. Chronemics is the clear.
perceives and values time, structures time, and
In various parts of the Arab world, cultural
reacts to time contributes to the context of
expectations for women may include covering the
communication. Social scientists have discovered
head, face, neck, or the entire body in order to
that individuals are divided in two major groups in
conform to certain standards of modesty established
the ways they approach time: monochronic or
by various Islamic denominations and groups.
polychronic
The burka is the most concealing of all Islamic
A monochronic culture functions on clock time.
coverings. It is a one-piece veil that conceals the
People tend to focus on one thing at a time and
face and body, often leaving just a mesh screen to
usually prefer to complete objectives in a systematic
see through.
way.
There are differences between modesty at home and
People in polychronic cultures, such as some groups
modesty in public. At home, Muslim women
in Southern Europe, Latin America, Africa, and the
typically do not wear veils, scarves, or other
Middle East, take a very different view of time.
coverings in the presence of male family members
People from these cultures often believe that time
such as their fathers, husbands, sons, and other male
cannot be controlled, and it is flexible.
or female relatives.
MODESTY
Women from observant Orthodox and Hasidic
Modesty is a form of mixed nonverbal and verbal Judaism, Amish, Mennonite, and some conservative
communication that refers to reserve or propriety in Catholics cover their heads, arms, and/or legs as a
speech, dress, or behavior. It conveys a message cultural and/or religious expression of modesty and
that is intended to avoid encouraging sexual often as a sign of their affiliation with a particular
attention or attraction in others (aside from a religious order within Catholicism.
person’s spouse).
The Hebrew word tznius or tzniut means modesty.
It is generally used in reference to women and also
relates to humility and general conduct, especially
between men and women.
Hasidic, Sikh, and Amish men often cover their
heads and/or wear clothing that conveys modesty.
For Buddhists, modesty is the quality of being
unpretentious about one’s virtues or achievements.
The most important thing is not what type of clothes
an individual wears or their color, but the quality of
HUMAN CARE AS ESSENCE IN NURSING
his or her heart. Buddhist monks have modesty
guidelines pertaining to the manner in which they Human Caring is part of the human condition and a
wear their robes, never allowing skin to show on way of being Human. Caring is found throughout
both sides of the body. time. Moreover, the notion of ‘caring’ in nursing
has been a given throughout its history.
The Church of Jesus Christ of Latter-day Saints
(LDS), also known as the Mormon Church, has In the past 3 decades or so, professional human
issued official statements on modesty and dress for caring has been increasingly acknowledged as the
its members. Modesty is an attitude of propriety and essence and core of professional nursing.
decency in dress, grooming, language, and
This focus is evident in nursing practice, nursing
behavior. Clothing such as “short shorts” and short
theories, nursing curricula, and nursing’s
skirts, shirts that do not cover the stomach, and
philosophical and ethical perspective toward
clothing that does not cover the shoulders or is low
humanity and patient caring relationships.
cut in the front or the back are discouraged.
CULTURE IN NURSING
The creative products, in the form of books, poems,
artwork, music, and dance, describe the social Culture: is defined as the totality of socially
climate of the day; portray religious, racial, gender, transmitted behavioral patterns, arts, beliefs, values,
political, class, and other perspectives; and serve as customs, lifeways, and all other products of human
unique historical documents and artifacts to help work and thought characteristics of a population of
people better see, hear, know, understand, and people that guide their worldview and decision-
appreciate the richness of the world’s diverse making.
cultures as they are communicated through the
literary works, artistic and musical creations, and QUESTIONS:
dance of people from cultures around the world. 1. Who in your family had the most influence in
teaching you cultural values and practices?
2. Outside the family, where else did you learn
about your cultural values and beliefs?
3. What cultural practices did you learn in your
family that you no longer practice?

IMPORTANCE TERMS RELATED TO

CULTURE
  Attitude is a state of mind or feeling about  However, generalizations can lead to
some aspect of a culture. Attitudes are stereotyping, an oversimplified conception,
leamed; for example, some people think that opinion, or belief about some aspect of an
one culture is better than another. individual or group. Although generalization
 A Belief is something that is accepted as and stereotyping are similar, functionally,
true, especially as a tenet or a body of tenets they are very different.
accepted by people in an ethnocultural  Generalization is a starting point, whereas
group. stereotyping is an endpoint.
 Ideology consists of the thoughts and beliefs
Everyone engages in stereotypical behavior to some
that reflect the social needs and aspirations
degree. We could not function otherwise. If
of an individual or an ethnocultural group.
someone asks you to think of a nurse, what image
 Cultural knowledge is all we know that
do you have? Is the nurse male or female? How old
characterize a particular culture. It can
is the nurse? How is the nurse dressed? Is the nurse
include descriptions such as those known as
wearing a hat? How do you distinguish a stereotype
cultural dimensions and can also include
from a generalization?
other information that may explain why
people conduct themselves in a particular  In sociology, anthropology, and cultural
way. studies, a subculture is defined as a group of
 Cultural awareness has to do with an people with a culture that differentiates them
appreciation of the external signs of from the larger culture of which they are a
diversity, such as the arts, music, dress, part.
foods, and physical characteristics.  Countercultures, on the other hand, are
 Cultural sensitivity has to do with personal cultures with values and mores that run
attitudes and not saying things that might be counter to those of established society and
offensive to someone from a cultural or whose norms and values may be
ethnic background different from that of the incompatible with prevailing cultural norms.
health- care provider's cultural or ethnic  Cultural humility, another term found in
background. cultural literature, focuses on the process of
intercultural exchange, paying explicit
Cultural competence in health care is having the
attention to clarifying the professional's
knowledge, abilities, and skills to deliver care more
values and beliefs through self-reflection
congruent with the patient’s cultural beliefs and
and incorporating the cultural characteristics
practices. Increasing one’s consciousness of cultural
of the health-care professional and the
diversity improves the possibilities for health-care
patient into a mutually beneficial and
practitioners to provide culturally competent care.
balanced relationship (Trevalon and
QUESTIONS: MurrayGarcia 1998)
 Cultural safety is a popular term in
 What activities have you done to increase Australia, New Zealand, and Canada,
your cultural awareness and competence? although it is used elsewhere. Cultural safety
How do you demonstrate that you are expresses the diversity that exists within
culturally sensitive? cultural groups and includes the social
 Any generalization—reducing numerous determinants of health, religion, and gender,
characteristics of an individual or group of in addition to ethnicity (Guidelines for
people to a general form that renders them Cultural Safety 2005).
indistinguishable—made about the  Cultural leverage is a process whereby the
behaviors of any individual or large group of principles of cultural competence are
people is almost certain to be an
oversimplification.
 deliberately invoked to develop
interventions.
 Acculturation occurs when a person gives
up the traits of his or her culture of origin as
a result of contact with another culture.
 Assimilation is the gradual adoption and
incorporation of characteristics of the
prevailing culture (Portes 2007).
 Enculturation is a natural conscious and
unconscious conditioning process of
learning accepted cultural norms, values,
and roles in society and achieving
competence in one’s, culture through
socialization.
CULTURE AND NURSING
“Cultural competence is the bedrock of a great
nurse-patient relationship. Every nurse should make
it a priority in their care.”
Cultural competence in nursing aids the growth and
development of nurses while also incorporating
relevant societal values. Nursing as a career is
versatile—from caring for the sick, providing
treatment plans, taking care of the elderly in a
home, and more.
The best nurses are not only technically sound but
also experts in cultural competence.
CULTURE AND NURSING: WHAT IT
MEANS?
Cultural competence in nursing implies the ability
of health care workers to give the best medical care
to patients while demonstrating cultural awareness
for their beliefs, race, and values. It entails having
knowledge of patients’ cultural diversity and
treating them with this in mind.
Cultural competence prepares nurses to empathize,
relate more to patients, and attend more deeply to
their needs. Hospital patients can often be agitated
or stressed. Having someone on their care team who
speaks their language or understands their unique
background may help them to relax, leading to
greater therapy and overall care.