Culture, Health & Lifestyle: 705:202

Study Guide Chapter 2

Communication
Learning Objectives
After reading this chapter, the nurse will be able to:
1. Describe the importance of communication as it relates to transcultural nursing
assessment.
2. Delineate barriers to communication that hinder the development of a nurseclient
relationship in transcultural settings.
3. Understand the importance of dialect, style, volume, use of touch, context of speech, and
kinesics and their relationship to transcultural nursing assessment and care.
4. Describe appropriate nursing intervention techniques to develop positive communication
in the nurseclient relationship.
5. Understand the significance of nonverbal communication and the use of silence and their
relationship to transcultural nursing assessment and care.
6. Explain the significance of the structure and format of names in various cultural groups.
7. Explain the significance of variations in word meanings across and within various
cultural and ethnic groups.

Define Key Terms/Know these Terms

Communication

Healthy People 2010

Culture

& 2020

Cultural patterns
of
communication

Culture
influences

Unique

Linguistics

communication

Variations in
communication

communication
practices of
persons

Communication of an Variations in
individual

communication

Functions of

communication

Communication

structure

patterns
Process of

Sender

Signals

Feedback

Communication
Factors influencing

Optimal

Verbal

Language

communication
Transcultural

Communication
Body Language

Combination

Therapeutic

communication
Vocabulary

denotative

messages
Names

communication
grammatical structure

Small talk, social

connotative
verbal rambling

Paralinguistics, or

Intonation

chitchat

Voice qualities

paralanguage

Touch

Rhythm
Facial Expression
Warmth
Dialect

Speed
Eye Movement
Humor
Non-threatening

Pronunciation
Eye Contact
Hand gestures
Cultural influences

Silence
Body Posture
Context of speech
Ethnomethodology

Linguistic Isolation

manner
Transmitter

Receiver

Nonverbal

Factors Influencing Communication

1.
2.
3.
4.

Physical health and emotional well-being

The situation being discussed and its meaning
Distractions to the communication process
Knowledge of the matter being discussed

5. Skill at communicating
6. Attitudes toward the other person and toward the subject being discussed
7. Personal needs and interests
8. Background, including cultural, social, and philosophical values
9. The senses involved and their functional ability
10. Personal tendency to make judgments and be judgmental of others
11. The environment in which the communication occurs
12. Experiences that relate to the current situation
VERBAL AND NONVERBAL COMMUNICATION
Language or Verbal Communication
Vocabulary
Grammatical structure
Voice qualities
Intonation
Rhythm
Speed
Pronunciation
Silence
Nonverbal Communication
Touch
Facial expression
Eye movement
Body posture
Communications that Combine Verbal and Nonverbal Elements
Warmth
Humor

Meanings of Touch
Touch may:
1.

Connect one individual with another, both literally and figuratively, by indicating
availability.

2.

Provide affirmation and approval.

3.

Be reassuring by providing empathy, interest, encouragement, nurturance, caring, trust,

concern, gentleness, and protection.

4.

Decrease loneliness by indicating a relationship with another.

5.

Share warmth, rapport, love, intimacy, excitement, and happiness.

6.

Provide stimulation by being a mode of sensation, perception, and experience.

7.

Increase self-concept.

8.

Communicate frustration, anger, aggression, or punishment.

9.

Invade personal space and privacy by physical and psychological assault or intrusion.

10.

Convey a negative type of relationship with another.

11.

Cause sexual arousal.

12.

Allow a person to perform a functional or professional role, such as a physician, barber,

or tailor, and be devoid of personal message.

13.

Reflect cordiality, such as a handshake by business associates and among strangers and
acquaintances.

Guidelines for Relating to Patients from different cultures

1.

Assess your personal beliefs surrounding persons from different cultures. Review your
personal beliefs and experiences.

2.

3.

Set aside any values, biases, ideas, and attitudes that are judgmental and may
negatively affect care.

Assess communication variables from a cultural perspective. Determine the ethnic

identity of the patient, including generations in the United States.

Use the patient as a source of information when possible.

Assess cultural factors that may affect your relationship with the patient and
respond appropriately.

Plan care according to the communicated needs and cultural background. Learn as much
as possible about the patient's cultural customs and beliefs.

Encourage the patient to reveal cultural interpretation of health, illness, and health
care.

Be sensitive to the uniqueness of the patient.

Identify sources of discrepancy between the patient's and your own concepts of
health and illness.

Communicate at the patient's personal level of functioning.

Evaluate effectiveness of nursing actions and modify nursing care plan when
necessary.

4.

5.

6.

7.

Modify communication approaches to meet cultural needs. Be attentive to signs of fear,

anxiety, and confusion in the patient.

Respond in a reassuring manner in keeping with the patient's cultural orientation.

Be aware that in some cultural groups discussion with others concerning the
patient may be offensive and impede the nursing process.

Understand that respect for the patient and communicated needs is central to the
therapeutic relationship. Communicate respect by using a kind and attentive approach.

Learn how listening is communicated in the patient's culture.

Use appropriate active listening techniques.

Adopt an attitude of flexibility, respect, and interest to help bridge barriers

imposed by culture.

Communicate in a nonthreatening manner. Conduct the interview in an unhurried manner.

Follow acceptable social and cultural amenities.

Ask general questions during the information-gathering stage.

Be patient with a respondent who gives information that may seem unrelated to
the patient's health problem.

Develop a trusting relationship by listening carefully, allowing time, and giving

the patient your full attention.

Use validating techniques in communication. Be alert for feedback that the patient is not
understanding.

Do not assume meaning is interpreted without distortion.

8.

Be considerate of reluctance to talk when the subject involves sexual matters. Be aware
that in some cultures sexual matters are not discussed freely with members of the
opposite sex.

9.

Adopt special approaches when the patient speaks a different language. Use a caring tone
of voice and facial expression to help alleviate the patient's fears.

Speak slowly and distinctly, but not loudly.

Use gestures, pictures, and play acting to help the patient understand.

Repeat the message in different ways if necessary.

Be alert to words the patient seems to understand and use them frequently.

Keep messages simple and repeat them frequently.

Avoid using medical terms and abbreviations that the patient may not understand.
Use an appropriate language dictionary.

10.

Use interpreters to improve communication. Ask the interpreter to translate the message,
not just the individual words.

Obtain feedback to confirm understanding.

Use an interpreter who is culturally sensitive

Assess Personal Beliefs of Persons from Different Cultures

1. Awareness of the nurses personal beliefs

Conscious and unconscious attitudes

Set aside personal values, biases, ideas, and attitudes that are judgmental and may
negatively affect care
Control personal reactions
Broadened understanding of others beliefs and behaviors

2. Understanding of other cultures

Immersion in another culture

Use of cultural assessment tools (assess personal attitude)

3. Plan Care Based on the Communicated Needs and Cultural Background

Improve personal knowledge about customs and beliefs of the culture of the clients
receiving care
Encourage the client to communicate interpretations of health, illness, and health care
since culture influences what are considered appropriate approaches to health,
wellness, illness, and death
A client's perception of illness will affect not only communication
but also the care that is planned
Sensitivity to the uniqueness of each client is required if the nurse is
to work effectively, particularly with clients from different cultures.
Best teacher in learning about culture is people themselves
Individuals must be communicated with at their personal level of
functioning.
Values and beliefs of persons from different cultures may affect the
way care is delivered.
Evaluate the effectiveness of nursing actions with clients from
diverse culture groups

4. Modify Communication Approaches to Meet Cultural Needs

Nurse must be attentive to signs of anxiety and respond in a reassuring manner in keeping
with the client's cultural orientation
Nurse should be alert to the fact that meanings of words and how facts
are presented may vary according to the family and culture of origin

When interacting with individuals from an oral culture, the nurse must
remember that if the teachinglearning process is to be effective,
instruction must be oral
Nurse must appreciate the impact of this cultural belief on health
behavior in order to think of communication strategies to respond to
health needs

5. Understand that Respect for the Client and Communicated Needs Is Central to the
Therapeutic Relationship

Respect for clients is communicated by a kind and attentive approach

in which the client is heard
Active listening techniques are used, such as encouraging clients to
share thoughts and feelings by reflecting back what has been heard
Nurse should be attentive to how listening is communicated in the
client's culture
Listening communicates genuine interest and caring.
Feeling of being heard is powerful, reducing distance and drawing
people together into positive interpersonal interactions
Attitude of flexibility, respect, and interest can bridge the artificial
barriers of distance imposed by culture and role

6. Communicate in a Nonthreatening Manner

Interview should be started in an unhurried manner, with adherence to

acceptable social and cultural amenities.
Start with general social topics and to make some connection with the
individual before asking questions
Being aware of and using cultural information provides a valuable base
from which to proceed
During the information-gathering stage, general rather than specific
questions should be asked.
Interviewer should allow time for the respondent to give what appears
to be unrelated information.
Use non-directive approach with open-ended questions rather than
direct questions with some cultures
Also, Storytelling, photography and literature can provide important
information to assist in understanding individuals and their cultural
orientation

7. Use Strategies to Develop Trust

When discussing personal matters allow time to develop a relationship

Do not appear to be in a hurry or to busy to listen, gives the
appearance of cutting off the client

Racial and ethnic minorities have lower levels of trust in health care
providers than do White Americans
Astute nurses must recognize that the communication process may be
impeded by hesitancy to speak to Westerners about health concerns
Some cultural groups may find questions from healthcare workers as a
violation of dignity and thus inappropriate.
It is critical that the nurse serve as a client advocate to provide
culturally sensitive care.
The nurse learns to appreciate a value held by some Ojibway that
espouses deep-rooted ideals of noninterference, which may be found
among some Native and ethnic groups

8. Use Validating Techniques in Communication

The nurse should be alert for feedback that the client is not
understanding and should use restating and validating techniques,
such as Did I hear and understand you correctly?
When the nurse has difficulty understanding, it may help to find out
precisely what the topic is, such as Are you telling me where you're
having pain?
By determining the topic, the number of words can be decreased.
If the message is not understoodpeople usually know when they are
understoodit may be helpful to have the client try to convey the
message in another way, such as through pointing or imitation.
Never pretend to understand a message; in doing so, the nurse
conveys that the message is not really important

9. Be Considerate of Reluctance to Talk When the Subject Involves Sexual

Matters

Some clients may be willing to talk about sexual matters with

someone of the same gender
Some cultures prefer for the father to be present when the nurse is
talking to a young male client

10. Adopt Special Approaches When the Client Speaks a Different Language

The nurse should be alert for the client who pretends to understand to
please the caregiver and gain acceptance
Without the availability of words, the nurse must relate to a client at an
affective level.
A tone and facial expression of caring can be vital in alleviating a
client's fear
Speaking slowly and distinctly, using a lot of gestures, acting out, using
pictures

Repeating the message several times in different ways may enable the
client to understand what is being said
The nurse should be alert for words that the client seems to
understand so that these words can be used more frequently
Messages should be kept simple and stated sentence by sentence, not
paragraph by paragraph.
Clients who appear to be having difficulty understanding should be
asked to provide feedback on what they have heard to provide
opportunity for further clarification.
Avoid using medical terms and jargon when speaking to a client with
only a partial understanding of the language. Abbreviations such as
TPR and BP should be avoided
Select a dictionary that has both the language the nurse speaks and
the language the client speaks
Assess how much English the clients knows, verbal and written

11. Use Interpreters to Improve Communication

Use a medical interpreter first

Family member may be used if medical interpreter is not available;
Avoid using a child who may not understand or explain technical
information
The nurse should evaluate whether having a family member interpret
is satisfactory to the client because some clients may not be willing to
confide certain information to a family member
The interpreter should be able to translate not only the literal meaning
of the words but also the nonverbal messages that accompany the
communication
Interpreters who act out their message through intonation, facial
expression, or gestures are more likely to be effective in getting the
message across.
Communication through a third party compounds the problem of
sending a message clearly.
An interpreter must have transcultural sensitivity, understand how to
impart knowledge, and understand how to be a client advocate to
represent the client's needs to the nurse
When the health professional can speak the language of the client,
cultural barriers will be lowered. Even if the nurse knows only key
words or phrases, this can significantly affect communication and
satisfaction with care

CLINICAL DECISION MAKING

1.

Describe at least two problems encountered by the nurse when giving

nursing care to persons who do not speak English as their primary
language.

2.

Describe four communication approaches that the nurse can use to

give culturally appropriate care.

3.

Describe approaches the nurse can use when relating to a client whose
primary language is not English.

4.

Describe at least two nonverbal indicators of anxiety the nurse may

encounter when dealing with a client who does not speak English.

5.

List at least two problems encountered by the nurse who assumes that
speaking louder will improve communication.

REVIEW QUESTIONS
1.

2.

While assessing a client who does not speak English, the nurse is
aware of nonverbal indications of anxiety that include which of
the following?
A.

Being uncooperative and withdrawn.

B.

Looking directly at the nurse and nodding yes.

C.

Looking at the blood and nodding no.

D.

Being cooperative and outgoing.

When analyzing the assessment data on the admissions of a

client with limited English skills, the nurse realizes the client has
answered yes or nodded the head indicating yes to all questions.
The nurse interprets this as indicating which of the following?
A.

The client intended to answer all questions yes.

B.
The client nodded the head and responded yes to indicate
cooperation.
C.
The nurse should repeat the questions more loudly so the
client will hear.
D.
The nurse should get an interpreter to assist with the
assessment.
3.

The nurse plans to use an interpreter when teaching a Spanishspeaking client about diabetes mellitus. The best interpreter for
the nurse to select is which of the following?

A.

A family member who lives with the client.

B.
One who translates not only the words but the nonverbal
messages too.
C.
D.
format.

One who can translate the words into Spanish.

One who can translate the words into oral and written