This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only.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

Annex 1: TOPOI model - analysis

Questions to investigate interpersonal conversations, cultural differences, 'discriminations' and 'racism'.

'Places' questions

Tongue

Meanings What do the words and the non-verbal language mean?

  • in whose language does each person speak?
  • what does each person say?
  • what does the non-verbal language of each person mean?
  • what are the interpretations of each other's verbal and non-verbal language?
  • what is the influence of the environment on what each person says, does and understands?

Order

'Views' What is each person's 'view'?

  • what is each person's view or logic?
  • what is each angle, interest, role, or loyalty?
  • what is each frame of reference: opinions, values and norms?
  • what does everyone have in common?
  • what are the differences?
  • what is the influence of the environment on each person's view?

Persons

Identities Who is every one?

  • How does everyone see herself/himself?
  • How does everyone see the other person?
  • How is the relationship mutual?
  • What is the influence of the environment on how everyone sees the other person?

Organisation

'The organisation' What is the influence of the 'organisation'?

  • what is the influence of 'own organisation': - position of power, function, available time, agenda and aims, rules, agreements, procedures...etc...?
  • what is the influence of 'the organisation' of the other person?
  • what is the influence of 'the organisation' in the 'wider' environment: - positions of power, procedures, available services, organisation culture, facilities, regulations, legislation...etc...?

Intentions

'Doing one's best' For what does each person do her or his best?

  • for what and how does each person does his/her best?
  • does everyone notice how the other person is doing his/her best?
  • what does 'doing one's best' for the environment mean in practice?
  • how does each person let the other know that he/she perceives the other person is doing his/her best?
  • does everyone feel recognised in how she/he is doing her/his best?
  • does each person perceive the distinction between intentions and effects of how he/she is doing his/her best?

Annex 2: TOPOI model - interventions

Interventions to investigate and open up discussion in interpersonal conversations, cultural differences, 'discriminations' and 'racism'.

'Places' interventions

Tongue

Meanings what do the words and the non-verbal language mean?

  • perceive the words and the non-verbal language with several senses.
  • investigate the meanings. Explain the meanings.
  • give feedback. Ask for feedback.
  • investigate the influence of the environment on the meanings.

Order

'Views' what is each person's view?

  • ask/invite the other to tell his/her view.
  • listen actively.
  • empathy: identify with the story and experience.
  • tell or clarify one's own view.
  • mention the communality and put it foremost.
  • clarify the differences and accept them for what they are.
  • investigate the influence of the environment on each person's view.

Persons

Identities who is each person?

  • investigate or ask which role(s) ('as whom') the other speaks.
  • listen actively.
  • empathy: identify with the view and the experience of the other.
  • reflect and/or clarify which role(s) ('as whom') you are speaking.
  • investigate the influence of the environment on how everyone perceives themselves and the other person.

Organisation

'The Organisation' what is the influence of the organisation?

  • clarify, explain one's own 'organisation'.
  • re-organise (change) own 'organisation'.
  • enquire about 'the organisation' of the other person.
  • investigate the influence of 'the organisation' in the environment.
  • policy level: management of diversity.

Intentions

'Doing one's best' for what does each person do her or his best?

  • investigate/look at what the other person does his/her best for.
  • empathy: identify and feel your way into (recognise) what the other person is doing his/her best for.
  • show (recognise) that one perceives what the other person is doing his/her best for.
  • investigate what the other person experiences as recognition.
  • investigate where and by whom the other person feels recognised.
  • investigate the influence of the environment on what each other perceives as 'doing one's best'.
  • clarify what you are doing your best for.
  • examine (and encourage the other person to examine) the effects of each doing his/her best.

Annex 3: Feedback section

Section one: -

1. The four sources of non-verbal information identified by Hinton (1993) are:

  • physical characteristics - e.g. skin colour, height or shape of face;
  • physical appearance - e.g. hairstyle, choice of clothes, jewellery;
  • 'dynamic aspects of the body' - the way a person moves, talks and other characteristic actions; and
  • 'dynamic aspects of appearance' - e.g. a smile of a frown. (1993:7)

2. The five kinds of inference processes identified by Secord (1958) are:

  • temporal extension - whereby a momentary expression is taken as indicative of an enduring characteristic.
  • parataxis - in which we generalise personality characteristics from someone we know to someone we do not know.
  • categorisation - through we categorise someone as a member of a group (e.g. sex, age, race) and infer characteristics we believe are held by that group.
  • functional quality - based on the functions of the various parts of the face (e.g. thin lips pressed together indicated someone who is 'tight-lipped'.
  • metaphorical generalization - where inference is based on a number of physical attributes taken together - e.g. a woman with thin lips and her hair in a tight bun is taken as having a severe personality. (cited in Hinton 1993:10-11)

3. The underlying danger of making assumptions about a person's personality based on nonverbal information this that such judgements tend to be based on stereotypes as opposed to valid information or relationships. (Hinton 1993:26) Most commonly, these assumptions and associations are heavily influenced by cultural factors and expressive cues. (Secord cited in Hinton 1993:10)

The potential implications include adverse treatment of individuals because of their physical characteristics/appearance or their membership (or perceived membership) of certain groups (eg. age, sex, race, class, sexuality, disability). This can lead to discrimination in relation to jobs, salaries or other life experiences or opportunities based on inaccurate assumptions about individuals' attributes, knowledge, skills, histories, interests and abilities.

Section two: -

4. The 'subjective' axis refers to nurses' shared sense of identity; and sense of belonging to a 'community' of others like themselves. In other words 'a consciousness of kind' in which there are shared characteristics, shared values and common understandings; and to which nurses are emotionally, as well as intellectually, attached.

The 'structural' axis represents the institutional and managerial features of a particular community of practice - i.e. the resources, power, institutional routines and use of space and time in a specific setting.

These autonomous, but powerfully interactive, axes constitute the essence of a community of practice through shaping 'the status of nurse' and the nurse's experience of being a nurse. That is the nurse's subjective sense of identity and behaviour must operate within an institutional infrastructure heavily influenced by managerial ideologies, external economic parameters and contemporary health care philosophies.

5. Professional nurses negotiate their identities within the constraints of the institutional context through:

  • bringing a 'consciousness of kind' to work regardless of the physical properties of their specific community of practice;
  • developing the inclusive identity' of nurse which is 'compatible with, and indeed at the core of, all nurse identities' - an identity characterised by caring, compassion, empathy, controlled emotion and personal engagement with the patient;
  • cognitive creativity' which enables them to survive within the status quo through a process of developing 'high standards of clinical judgement by eliminating the desirable and defending the essential';
  • removing themselves from communities of practice which inhibit their lived expression of this identity and move toward ones which empower it.

6. The concept of authenticity is relevant to this process because, as Burkitt et al observe, nurses tend to be deeply committed to equating their own practice with their shared identity and values. As such, they are deeply distressed by situations where institutional constraints operate to inhibit their ability to provide quality nursing. The concept of authenticity is therefore central to each nurse's individual commitment to being true to herself/himself in honestly relating her/his own nursing practice to her/his shared values as nurses.

Section three: -

7. The 'semantic' aspect of communication refers to the conveying of information - the topic being discussed. The 'pragmatic' aspect of communication refers to the establishment of the social relationship between the communicator and his/her 'audience'.

8. The 'report/command' analogy is helpful because it clarifies the difference between 'reporting' information that is either true or false; and 'commanding' one's audience to engage in a particular kind of relationship. However, the term 'command' is unhelpful because it:

  • fails to convey the implicit and subtle ways in which individuals seek to establish or define a social situation in a certain way; and
  • ignores the fact that the majority of human interaction relies on people 'agreeing' to act in certain ways within the existing 'institutional or normative framework'.

9. Some of the dangers of thinking of life as a stage include:

  • the temptation of believing that people deliberately plan their behaviour in given situations;
  • the idea that there is a 'script' for social encounters;
  • the idea that social interaction is merely (or predominantly) about creating an impression.

However, as Danziger points out:

While people do indulge in more or less deliberate playacting at certain times, the constant feature of all social interaction is the spontaneous and unreflecting signification of the interpersonal relationship by means of a stream of verbal and nonverbal signs. Differences of status and various degrees of intimacy, for example, constantly codetermine the flow of communication between individuals without the slightest hint of a deliberate performance. (1976:33)

Section four: -

10. The tree types of communication discussed by Fraser are:

  • interaction regulation:- Before a conversation begins, participants tend to share some taken-for-granted assumptions, norms or rules about conversing - particularly if their cultural and social backgrounds are similar. Such rules or 'interaction regulations' are usually left implicit and form a prerequisite for conversation. However, as the conversation continues, initial interaction regulators may be supplemented by communication occurring during the interaction itself. (Fraser 1978:139)
  • interpersonal communication:- 'During an encounter a great deal of information is made available regarding the participants and their relations to each other. This information can be organised around three broad topics: (i) social and personal identities; (ii) temporary states and current attitudes; (iii) social relationships. (Fraser 1978:141)
  • representation communication:- What we normally think of when we talk simply of the 'meaning' of what was said. It is the core of linguistic communication and the most complex of the three types of communication. (Fraser 1978:146)

Section five: -

11. Different kinds of failure that can occur through the stages of the social skills cycle.

Motivation, goals and plans

  • goals may be contradictory when needs conflict (e.g. when social interaction is desired but feared);
  • goals may be suppressed or extinguished because of history of failure;
  • blocked goals may be converted into a different form;
  • the cognitive skills required for planning may be inadequate. (Trower et al 1978:9)

Perception

  • low level of discrimination and accuracy;
  • systematic errors - e.g. perceiving other as more hostile than they are;
  • inaccurate stereotypes, or over-use of stereotypes;
  • errors of attribution - e.g. attributing too much to person, too little to situation;
  • halo effects - e.g. perceiving people as either consistently good or bad. (Trower et al 1978:10)

Translation

  • failure to consider alternatives;
  • failure to discriminate appropriate and effective actions form ineffective ones;
  • making decisions too slowly or not at all;
  • failure to acquire the right knowledge for making decisions;
  • tendency to make negative decisions (e.g. due to poor self-esteem or negative self-instruction such as 'I can't do this'). (Trower et al 1978:10)

Motor responses

  • deficits in behavioural responses of discrete elements such as gaze, facial expression, voice and verbal devices;
  • deficits in behaviour responses at higher order levels such as warmth, assertiveness, social routines and basic conversation. (Trower et al 1978:11)

Feedback.

  • failure can occur for those reasons listed under the 'Perception' section above;
  • there may be lack of feedback due to lack of skill or with-holding of it for some reason;
  • feedback may be unrealistic or falsified.

Section six: -

12. Cultural communicative competence requires the understanding of cultural values, behavioural patterns and rules for interaction in specific cultures. This includes developing specific knowledge and insights into a specific culture; and being prepared to draw upon that knowledge to guide your actions and responses.

Cross-cultural communication is a complementary dimension to cultural communicative competence which involves:

  • the generic ability to recognise the challenges of communication across cultural boundaries; and
  • the capacity to respond to such challenges in an open and reflexive manner.

As such, skills in cross-cultural communication represent the essential perspective needed for the development of effective cultural communicative competence.