Intercultural Communication in Healthcare 1

CASE STUDY: INTERCULTURAL COMMUNICATION IN HEALTHCARE

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 Intercultural Communication in Healthcare 2

Case Study: Intercultural Communication in Healthcare

Introduction
Communication is an important element within an organization since it enables

sharing of information and instructions. The best clinical outcomes can be achieved in

situations where all sensor elements are incorporated in practice (Cote, D. 2013). In this

case, there can be communication between the care provider and the patients. Also, another

level includes communication among professionals. All these levels of communication

demand professionalism since a lot of critical issues are reliant on the types of information

relayed. Cultural competency is another significant consideration in the delivery of healthcare

(Horňáková, A. n.d). Professional health service providers are expected to tailor their services

on the cultural background of a patient. Other vital issues that have to be considered include

gender of the patient, age, ethnicity as well as socio-economic statuses. Cultural competence

helps a patient in the shaping of perception regarding healthcare. In addition, it helps in

attracting positive energy in the healing process.

Many nurses and other medical practitioners often face the challenge of

communicating with patient or professionals from other cultures. This calls for intercultural

competence where professionals have a task of exceeding high tolerance and understanding.

In some cases, nurses may be required to seek the services of interpreters, especially where

there is a language barrier. While translation may be a valid option for countering language

barrier, some terms may not be accurately communicated, and this can lead to errors. Such

misfortunes that arise from language barrier can have adverse effects on the patient outcome.

Therefore presence or lack of cross-cultural communication in healthcare is mandatory. This

paper will delve into a case where cultural competency proved to be a great issue of concern

in the patient outcome.

Case Review
This case has been retrieved from Association of Schools and Colleges of Optimetry

(2016). In the case, a nurse explains a situation faced while working at a hospital facility in
 Intercultural Communication in Healthcare 3

India. In the case, an issue arose where there was conflict in the traditional religious beliefs

and the professionally approved medical intervention. The patient that the nurse was

attending to was 83 years old who strictly adhered to the norms and tradition of her Navajo

tradition. This proved to be a major challenge to all the medical attendants responsible for the

patient’s case. It must be noted that the Navajo community is one of the indegenous groups

that make up the Indian tribes living along the Colorado River.
According to the information provided by the nurse, the 83-year old patient had

complained of low vision six years ago. This low vision was accompanied by severe and

boring pain in the eye. In addition, the patient's health history revealed evidence of

hypertension as well as rheumatoid arthritis that had never been treated over the years. The

lack of treatment has been attributed to the patient’s strict adherence to the traditional norms

and culture.
During all sessions, it was required to have a translator to help in the communication

process. The was a language barrier which meant that the patient could not understand the

nurses and the vice versa was also true. The translator had a responsibility of enabling the

flow of information between the patient and the care provider. This also made it possible for

the nurse to understand the ethnic and religious background of the 83-year-old. It was

revealed that the old lady was never keen to adhere to the prescriptions made by nurses and

opted for the instructions given by a native expert. These varying situations made it hard to

for the nurse to convince the patient. Furthermore, it was hard for the nurse to express

specific opinions in the manner he desired. The nurse later revealed that the mission was a

success and the old lady was able to consider the nurse's prescriptions after numerous failed

attempts to stick to the native doctor’s instructions. The care provider had to make sure that

the patient adheres to medication without compromising her traditional beliefs.

Critical Communication Issues in the Case
Language Barrier
Various cultural communication issues can be identified in the case above. The nurse,

a foreigner, expected to deliver healthcare services to an old lady who speaks a different
 Intercultural Communication in Healthcare 4

language. According to Mueter, R. et al. (2015), the lack of correct communication in

healthcare can be threatening to a life of a patient. It has also been indicated by Mueter, R. et

al. (2015) that linguistic differences are a delicate issue in the field of health that has to be

addressed using correct steps. In this case, the nurse was not conversant with the language of

the patient, and the patient was not familiar with the language of the care provider.
In this case, a nurse is required to communicate with a patient to facilitate the healing

process. However, there will be no communication due to the differences in the languages. It

has been established that the services of a translator were considered. However, this does not

guarantee that every single word from the nurse was accurately translated into the native

language that the old lady understood. For instance, some words in one language may not

have a meaning in another language due to other elements such as cultural differences. For

example, lifestyle management is critical in diabetes control. On the other hand, the old lady

may have a different interpretation of lifestyle management to imply strict adherence to her

cultures and traditions.

Cultural Misunderstanding
The care provider made a tremendous effort to clarify the need for medical

consideration without compromising cultural beliefs of the aged lady. However, this was

challenging since the woman had been loyal to her tradition for many years. She believed that

everything prescribed in her culture is the best. This creates a situation known as a cultural

misunderstanding which is critical in multicultural communication. According to Community

Door (2018), conflict may arise between the care provider and a patient if former fails to

respect and recognize and respect the beliefs and traditions of the former. For instance, the

woman, in this case, the study had a different societal lifestyle. This belief oriented the old

lady to a native doctor as compared to medical nurses. It explains the reason why it was easy

for the patient to trust in a traditions nurse’s instructions and not that of a qualified med

practitioner.
 Intercultural Communication in Healthcare 5

The difference in cultural practices is another vital consideration in intercultural

communication (Holliday, A., Kullman, J., & Hyde, M. 2016). For instance, some signs used

to communicate in one language can be insulting in other cultures. For example, most Asian

women do not prefer to shake hands for long with people of different sex. This

conservativeness can have a greater impact on the communication process between a nurse

and a patient. This situation has not been illustrated in the case being discussed, but some

women in other cultures are not allowed to mingle with men as this is considered immoral.

The discordance of cultural practices can have many sensitive elements that can hamper the

patient-nurse relationship.
According to Admin INSCOL Healthcare (2015), people from different cultures have

varying interpretetion of signs made during a communication process. For example, the Arab

culture requirs one to avoid eye contact whenever talking to their superiors or seniors. This is

considered as a sig of respect for the seniors. Therefore, a challenge may arise whenever a

young female nurse is expected to attend to and elderly patient of the Arab culture. Admin

INSCOL Healthcare (2015) has also identified that pocketing while talking is considered

disrespectful in most cultures from the South American region. It has also been stated that

most patients from Russia would offer the nurse a kiss on the cheek as a sign of appreciation.

Therefore, the non-verbial elements of communication should be applied with caution. The

following are critical elements to be considered.

Eye Contact
According to Bernstein, R. (2017), eye contact is undoubtedly one of the most

sensitive non-verbal sign. In addition, it has varying interpretations across different cultures

in the world. Sensitivity often arises when it comes to the person making the eye contact and

the lasting period. On the one hand, some cultures from Latin America expect one to maintain

eye contact as a sign of respect to a conversation. On the other hand, other traditions from

Asia expect juniors to avoid this type of sign whenever talking to seniors who are also
 Intercultural Communication in Healthcare 6

considered as respect. Therefore, healthcare providers must understand the impact of their

eye contact on the patients they handle.

Touch
Admin INSCOL Healthcare (2015) has indicated that cultural expressions can also be

made through touch. For example, a firm handshake in the US is considered an appropriate

gesture. In France, it is normal to give a kiss on a cheek whenever greeting and touching on

the head of a South American child is fine. However, in Asia, the head is considered as a

consecrated part of the body that must be respected, and this includes avoiding to touch the

head of another person. Most parts of the Middle-East, as well as members ascribed to the

Islam religion, consider the left hand as a body part responsible for handling hygiene of the

body. This means that the left hand cannot be used to offer or accept gifts in this culture. The

significance of touch between male and female also varies across cultures.
Gestures
Gestures can bear different meaning during a conversation [ CITATION Adm15 \l

1033 ]. For instance, nodding the head in the US is a sign of acceptance or rejection

depending on the direction of nodding. A thumbs up gesture in the US implies that something

is fine, on the other hand, the same symbol in Japan means money. It has also been

established that the same sign means a zero in Belgium, Argentina, France and Portugal.
Facial Expression
Facial expressions such as winking and mouth movement may have different

meanings depending on cultures (Bernstein, R. 2017). Winkking in South America is viewed

as a romantic gesture that may allso imply a sexual invitation.On the other hand, the winking

among the Chinese is considered as a rude gesture. Therefore, such signs cannot be

transferred from one culture toanother.

Posture
The posture of a person during a conversation can have a lot of implication on the

mood, and concetration (Bernstein, R. 2017). The slouching postuure in Taiwan is viewed as

a sign of disrespect. In the US, if one stands with his or her arms on the waist is considered as
 Intercultural Communication in Healthcare 7

a sign of power. The same posture in Argentina can be regarded as a challenge or invitation

for a challenge.
Sign Languag in Medical Care
The deaf and dumb may also are sensitive to the various body movements, and they

often interpret such gestures. The interpretation may be base on previous training, cultural

values or past experiences. Therefore, signs may also be important whenever communicating

with a deaf patient. A nurse must be sure to use the correct sign or use the services of an

expert. According to Yani, F. H. (2017), care providers must learn a sign language to facilitate

the PCC for the deaf. Also, a deeper understanding of the sign language makes it possible for

the patient and the physician to understand each other without difficulties. This ensures that

information is accurately conveyed and interpreted (Nicodemus, B., & Metzger, M. 2014).

Perception and Culture

In an effective communication in healthcare, there is need to have a common

perception of the approach (Yang, P. 2017). However, the case of the old woman presents a

unique situation with two different viewpoints with regards to treatment. The patient believes

in the native doctor who makes the communication process futile. On the other hand, the

nurse has to challenge this negative belief without polarizing the patient.
Community Door (2018) has illustrated that the difference in the perception of illness

can affect patient outcome. This variance can arise from the difference in culture between the

care provider and the care-recipient. In this case, the native doctor has always been the

priority for the old lady. However, this belief did not benefit the health of the patient, and as a

result of the eye condition, rheumatoid and hypertension worsened.

Different perceptions may not only exist between the care provider and the patient but

also among professionals (Paternotte, E. et al., 2016). For instance, the approaches used by

one nurse may not auger well with the beliefe of another professional. However, in this

particular situation, the nurse and the translator had similar perceptions which resulted in a

seamless communication. It implies that the information provided by the nurse was
 Intercultural Communication in Healthcare 8

accurately translated to a language that the old lady understands. Therefore the two care

providers had a similar perception which reduced the probability of conflict of interest in the

treatment plan.
ICC Between Patient and Nurse
According to Paternotte, E. et al. (2016) intercultural communication (ICC) is an

important factor between the nurse and a patient. This was justified through a research that

was conducted by Paternotte, E. et al. (2016). In their research, the primary focus was on

Dutch nurses handling non-Dutch patients in Netherlands. While most of the nurses in the

study had ICC skillls, it was concluded that many ICC skills are known to physicians. It was

also concluded that there is an overlap between the aspect of ICC and patient centered

communication (PCC). Paternotte, E. et al. (2016) have argued that the relevance of ICC in

practice has increased in the past decade. It has been determined that several factors can have

a greater influence on the levels of ICC. For instance, the role of the family in the PCC, as

well as ICC, is fundamental.

Another critical factor that influences ICC is the patient's expectation of the nurse. For

instance, in the case of the 83-year-old lady, it is clear that the levels of hope of the patient are

low. This is because the patient has a cultural bias opinion regarding health remedies which

involves seeking the help of a native doctor. It took time and intervention from people who

understand the culture to help change the levels of expectations of the woman.
Paternotte, E. et al. (2016) have further highlighted the significance of ICC skills in

the reflection of patients feelings. Nurses are expected to listen, apply concrete language and

empathize with patients. However, this a can be a more significant challenge in case of

language or cultural barrier. For instance, in the case of the old lady, the nurse could only

show empathy and facial expressions after the translator had performed his or her job.
According to an an argument documented by Cote, D. (2013), evident cultural

differences between a patient and a nurse or nurse can lead to conflict during the presentation

of illness and therapy related issues. This can negatively affect the healing process of a

patient. It is possible to argue that divergence of interest was vivid in the initial stages of the
 Intercultural Communication in Healthcare 9

case being reviewd in this paper. The old lady had divided opinions regarding remedies to

health and this made her reluctant to adopt medicaly proven remedies. Hoowever, the right

approaches were adopted by the new nurse to ensure that convergence was attained and that

the patient agreed to follow the nurse’s instructions.

While ICC may require the efforts of an individual care provider handling a case,

Cote, D. (2013) reveals that cultural competence in the sphere of healthcare is multifaceted.

This implies that the orgaanization as well as health policies must highilght the vital nature of

ICC in PCC.The multifaceted nature of ICC has also been recognized by (Kirschbaum, K.

2017) who has also indicated that both verbal and non-verbal communication can be sources

of barriers in paatient outcome. It should be understood that these two tools of

communication are culturally linked. For instance the verbal and non-verbal communication

elements often vary from one culture to another.

According to Kirschbaum, K. (2017), the absence of well-informed interpreters can

have negative impacts on ICC. For instance, if the interpreter in the case of the 83-year-old

lady lacked adequate knowledge regarding the job, the nurse's message could not have been

passed across. Alternatively, part of the message could have been exacerbated due to

unprofessional issues such as bias. Therefore, in case a translator is required to facilitate ICC

process, he or she must be competent. The competence entails a primary understanding of the

role and the impact of the communication process on PCC as well as the outcome. In

addition, the translator must have a deeper understanding of the two cultures likely to

conflict. In this case, he or she will exercise caution whenever sensitive issues arise. Finally,

it is vital to adequately train the translators and enhance their understanding in the field

(Kirschbaum, K. 2017).
Healthcare and Religion
According to Intercultural communication and healthcare (n.d), illness and death are

associated with both healthcare as well as religion. However, there is always a tendency of

people to turn to religion or healthcare professionals depending on circumstances. Therefore,

 Intercultural Communication in Healthcare 10

it should be noted that this religion is an important determinant of healthcare. It has been

established that the old lady would initially prefer the services of a native doctor or a

religious specialist. This is always a case in many primitive societies as they have more belief

in a theological prowess compared to nurses intelligence. Such cases have to be approached

with care as they may have a more significant impact on a patient’s perceptions.
While medication can always be the best option, the power of non-medical

intervention cannot be ignored. Religion is psychologically associated which implies that it is

a significant determinant of the treatment process of any patient (Jeter, B. R. 2016). It has

been recommended that caregivers take time to understand and appreciate the religion of a

patient. A patient should understand that a nurse only plays a part that does not substitute the

supremacy of their faith. For instance, a nurse should respect the idea held by most Christians

that ‘physicians treat, but God heals.’ This understanding will help reduce intercultural

conflicts.
Recommendations
It has been evident that the case of the 83-year-old was successful due to the excellent

approaches to facilitate ICC. However, not all cases may be similar to errors may occur due

to lack of ICC knowledge. A mistake may also arise from the transfer of values from one

culture to another. To avoid such instances, Horňáková, A. (n.d) has presented several

recommendations that can be considered by care providers to help in improving ICC.

Language of Communication
A nurse must determine and understand the language to use in communicating with a

patient. At times, this can be determined by looking at the name of the patient or inquiring

from other professional. Nurses in who have been posted in a completely new environment

must make an effort to understand the culture of the people they expect to serve.
Learn Foreign Language
Nurses can take a personal initiative to learn a foreign language as well as culture

(Yang, P. 2017). This knowledge will help them during interaction with patients. In situations

where sensitive information has to be shared between the nurse and a patient, an interpreter

may be considered an intruder. Therefore, a nurse who learns a foreign language can
 Intercultural Communication in Healthcare 11

comfortably handle his or her patients without third party intervention. In addition, the nurse

who understands a specific culture of a patient can help them later in expressing ideas as well

as feelings. Patients can always be contented in an occasion where they are handled with

nurses who appreciate the former’s cultural values. This can be best achieved by beginning to

learn the basic terms used in communication such as greeting phrases. Learning can also be

facilitated with the aid of a dictionary or internet enabled translators.

Learn to use signs and gestures Correctly
It has been determined that gestures can have different interpretations across cultures.

Therefore, nurses must be able to understand the appropriate symbols and gesture that will

make the patient comfortable. For instance, a male nurse working in Argentina cannot wink

to a female patient as this may be misinterpreted.

Listening
Listening should be considered as a vital skill for care providers. This can be one way

to learn and understand a patient from a different culture. In PCC approach, the patient's

preferences are prioritized and integrated into the treatment plan. This implies that the

information held by the patient or family members of a sick person is critical. In addition, it is

paramount to encourage care-seekers to express themselves as this will enhance the

confidence of the patients which will, in turn, improve PCC.

Tolerance
In the case of the 83-year-old Indian, the nurse in charge exhibited high tolerance and

professionalism. Despite the fact that the patient was reluctant to accept the physician’s

diagnosis, the nurse in charge kept trying. Therefore, careproviders who encounter different

cultures must understand that religion is not universal. It is also essential to respect that fact

that every culture is vital in its own right. To this effect, nurses must recognize the fact that

these cultures create different perceptions that must be tolerated.

Apart from the mentioned recommendations, Admin INSCOL Healthcare (2015) has

suggested that nurses should use simple terms or common words. Such words are easy to

understand, learn or interpret. Care providers should adhere to the basic rules of grammar and

remain composed during a conversation with a patient.

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Conclusion
The input of intercultural communication in patient-centered care cannot be

underestimated. Nurses will always face these challenges whenever required to handle

patients from different cultural backgrounds. In some instances, there can be variation in

language, culture and signs or gestures used in communication. This requires care providers

to understand the sensitiveness of verbal and nonverbal tools of communication. A case of an

83-year-old lady from India has been reviewed. It has been established that the nurses that

patient were from different cultures. On her part, the old lady was keen to practice her

cultural values which did not advocate for medical intervention in case of illness. Another

challenge was the language barrier which required the intervention of an interpreter. The

success of the process highlights the significance of correct application of ICC techniques.
 Intercultural Communication in Healthcare 13

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