Transcultural communication & health care practice

This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information

Author: Charles Husband, Edwin Hoffman

Introduction

This module is concerned with the content and the process of communication. It concerns all of those things that we say, do, and feel about each other when we are in the presence of other people.

It is our intention that in the course of this module you will experience an increasing awareness of the complex social structures within which we exchange meaningful messages with each other. It is also hoped that you might feel yourself comfortable and competent with some terminology that is new to you, and thus be able to think more clearly about the process of communication.

For the most part, most of us feel fairly confident, or at least competent, in making ourselves understood, making people feel comfortable, getting our feelings across to others and so on; and we are. However, there are occasions on which we do not feel so comfortable. Indeed, in some situations, such as interviews, arriving late, or being reprimanded for a mistake, we might feel very ill at ease; perhaps even a little defensive.

This module will introduce you to some of the elements constituting the communicative process, and to some of the levels on which we might analyse and possibly improve that process. It will consider the notions of communicative competence and social skills acquisition in order that you might become familiar with a concept that we call Transcultural Communicative Competence. All of these terms will probably be new to you but you will soon come to understand them.

You will find that there is a good deal of content on the basic processes of communication and on the nature of social interaction. It may well seem that there is rather more social psychology in this module than you expected. This is because this module aims to prepare you to be able to develop your transcultural communication skills. Good transcultural communication is essentially just good communication, and hence this module will provide a broad foundation for the understanding of interpersonal communication, on the basis of which you will be able to develop your transcultural skills.

Aims

The aims of this module relate directly to the real-world context of delivering health and social care. This will also demand a good deal of reflection and thought from you. As such, the aims can be identified as follows.

To encourage the development of a general understanding of the basic components of Interpersonal Communication
To understand and become fluent with the basic social psychological terminology of the communication process
To apply this knowledge and understanding to the nursing context
To increase awareness of communicative competence and to encourage fluency and authenticity in relationships with clients, their families, and other members of the multi-disciplinary team with which one works
To explore the role of interpersonal communication and the role of authenticity in the nursing and social care context.

To introduce the notion of Transcultural Communicative Competence through an assessment of cross-cultural complexity.

Module outline

In the course of this module you will develop both a deeper understanding of these aims and the ability to achieve tangible outcomes. In the process, you will become more attentive to relationships in the world around you and develop the language with which to describe the processes involved.

The module is designed to build your knowledge in stages, and is thus separated into seven sections. Remember, even as you read this first section, the importance of bringing your own experiences to mind and reflecting on the relevance of what you learn to the practice setting. Immediately following this introduction, at the beginning of Section One is an exercise designed to set the scene, so that you can begin immediately to contextualise your developing knowledge.

The processes involved in interpersonal communication inform the very heart of our humanity. Section One of this module therefore delineates some of the ways in which we define our social and personal natures, through an exploration of roles, identities and norms. These are the elements that constitute who we think we are, and how others might perceive us.

Section Two focuses on the issue of social identity - its social construction and the importance of 'personality', self concept and role.

Section Three offers a model of interpersonal communication and analyses the significance of social context, identities and perception in the development of effective interpersonal communication.

Section Four is an exploration of the essential building blocks of communication. This section explains the importance of both verbal and non-verbal communication and examines the different 'levels' of communication in which we are all involved.

Section Five explores Argyle's Social Skills Model in order to demonstrate how individuals can integrate their communicative skills to meet changing social environments.

Section Six revisits the transcultural perspective emphasising the importance of developing transcultural skills within a broader understanding of contemporary ethnic relations in Britain. The intention is not that individuals should be 'politically correct' but rather that they should develop the understanding, skills, and attitudes needed to become transculturally competent in communication.

Section Seven introduces a systems approach to intercultural communication and invites you to analyse a range of interpersonal conversations using the model presented. Thus, this section introduces a model which draws together much of what you now know and invites you to engage in some practical ways of developing your transcultural competence.

The Challenge of transcultural Communication

All interpersonal communication contains the possibility of ambiguity and misunderstanding. Indeed the early sections of this module aim to provide an understanding of the complex processes that underpin interpersonal communication: so that we can see where things may go wrong. The possibilities of misunderstanding and poor communication become much greater when we communicate across a cultural boundary.

Experience routinely makes us anxious about the appropriateness and adequacy of our behaviour in cross-cultural contexts. Consequently, at the outset it is important that we explicitly recognise the normality of such anxieties and the challenge faced by us all in operating effectively in a multi-ethnic context. Gerrish et al, in their study Nursing for a Multi-Ethnic Society (1996), demonstrated how, in the earlier 1990s, nurses in England were inadequately prepared through their education to address the challenge of delivering multiethnic nursing care.

As the nursing profession and the NHS more generally have moved to address the requirements for delivering health care to a multiethnic clientele, so too new demands are being made on individual nurses to demonstrate appropriate transcultural sensitivity. This is often an uncomfortable experience and a painful critique of current practice. If not managed carefully this critique of practice can make it more difficult to develop new skills, rather than facilitate the development of new learning. Gerrish et al (1996) explicitly acknowledge this dilemma.

In this module we aim to:

recognise the many pressures that can make a lack of competence deeply threatening; and
reject individual 'nurse-bashing' that makes individual nurses responsible for the historical failure of the NHS to recognise the significance of the changing demography of British society.

The primary objective is to enable everyone to have the confidence to begin to develop new skills and to have the understanding to sustain themselves through periods of anxiety as they develop new confidence and competence in transcultural communication.