Module 1 – Case
Culture and Communication
Background: In this first module, we are going explore barriers to communication and consider the advice of the California Endowment (2003) as we immerse ourselves in the study of culture. According to this group:
“Self-awareness and self-knowledge are the first types of knowledge cross-cultural training would seek to establish. This involves bringing to the learner’s awareness internalized beliefs, values, norms, stereotypes and biases. They should be made aware of how ethnocentrism, that is, the belief that one’s own culture is superior to others, operates in all cultures and encouraged to be attentive to the possibility of ethnocentrism in their own thinking. They should be made aware of how ethnocentrism may influence their own interaction with patients” (p. 4).
Having considered this, let’s begin module 1 by considering how we “react” to a description of actions taking place in another culture. In August of 2006, Jane Perlez reported in the New York Times about changes that have taken place in Indonesia since the tsunami. These changes include the embracing of Islamic law AND the practice of caning. Please read the article entitled Indonesian Province Embraces Islamic Law, and Canings and in a three to five page paper, address the following questions:
1. Discuss the feelings this article evoked
2. Discuss the external forces that impact the evolution of this culture, including factors beyond the information presented in the article.
3. Discuss the impact that barriers to communication had on your reaction including
o Ethnic Glossing
4. Discuss the how this information can assist you as a health practitioner?
Note: In your write-up use section headings for each question and subheadings for each of the sub-categories.
Use information from your module readings/articles as well as appropriate research to support your selection.
Length: The SLP assignment should be 3-5 pages long (double-spaced).
References: At least three references must be included from academic sources (e.g., peer-reviewed journal articles). Required Reading is included. Quoted materials should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. Materials copied verbatim from external sources must be enclosed in quotation marks. In-text citations are required as well as a list of references at the end of the assignment. (APA format is recommended.)
Organization: Subheadings should be used to organize your paper according to the questions.
Format: APA format is recommended for this assignment.
Grammar and Spelling: While no points are deducted for minor errors, assignments are expected to adhere to standard guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.
Your assignment will not be graded until you have submitted an Originality Report with a score <20%. Papers not meeting this requirement by the end of the session will receive a score of 0 (grade of F).
The following items will be assessed in particular:
• Achievement of learning objectives for SLP assignment.
• Relevance – All content is connected to the question.
• Precision – Specific question is addressed. Statements, facts, and statistics are specific and accurate.
• Depth of discussion – Points that lead to deeper issues are presented and integrated.
• Breadth – Multiple perspectives and references, and multiple issues/factors are considered.
• Evidence – Points are well supported with facts, statistics, and references.
• Logic – Discussion makes sense; conclusions are logically supported by premises, statements, or factual information.
• Clarity – Writing is concise and understandable, and contains sufficient detail or examples.
• Objectivity – Avoids the use of first person and subjective bias.
Link to the Purnell Model of cultural competence: Purnell Model of Cultural Competence
Module 1 – Background
Culture and Communication
Health care practitioners often misinterpret patient cues regarding values, beliefs, behaviors, and symbols that affect treatment seeking and compliance with treatment interventions leading to less than optimal outcomes. This is at least in part due to a focus on static pictures of race and ethnicity during the patient encounter. Misreading patient cues based on stereotypes can create special challenges for practitioners. Such miscommunication may lead to significant negative outcomes for the patient.
The inability to understand a patient’s needs from the patient’s perspective can result in miscommunication that in turn may lead to inappropriate care and may decrease the quality and outcomes of services provided (Hayes, 2012). Many health care professionals lack the necessary skills and knowledge to identify, understand, and bridge differences in cultural values and practices that influence the medical encounter (Hayes, 2012). Thus the quality of care may be unintentionally compromised by health care professionals who may focus on the larger cultural mores while ignoring other key beliefs, such as religious beliefs, that may interfere with care.
Some of the most commonly noted challenges referenced by Hayes (2012) include (a) personal prejudices, suggest is based on fear of those who are different or who challenge certitude and values; ethnocentrism, which is a tendency to see reality through one’s own cultural perspective, a culture deemed necessary, normal, and desirable; (b) stereotyping, which is defined as a simplification of a wealth of information, but which, if effectively considered, can generate accurate predictions about others to the extent that the stereotypes contain accurate generalizations; and (c) ethnic glossing, a term used to describe the overgeneralization or simplistic categorical label referring to an ethnocultural group, which provides little information on the richness and cultural variation within ethnocultural groups and ignores the unique cultural differences found in individuals. Finally, one of the most prominent and noticeable challenges to effective provider patient relationship is language. The inability to communicate due to different primary languages, the lack of trained interpreters, and inappropriate non-verbal communication are cited as the most significant barriers to care (Hayes, 2012).
Patient interactions present several other challenges for the provider and organization. Research has identified several factors that patients report impacted on medical encounters. These include the use of, and openness to complementary and alternative medicine, interpersonal styles that are sensitive to modesty and submissiveness, understanding the potential role of the family and spirituality in medical decision-making and the healing process, and the deductive and objective culture of medicine which may be viewed by some patients as insensitive to their individual needs. Moreover, interpretations of issues of poverty, conflicting cultural values, folk medicine, skin color, and illiteracy are factors repeatedly noted for separating the patient from the health care professional (Hayes, 2012). The interaction of patient characteristics, beliefs, and language and those of the provider create a complex communications web that needs to be clarified for effective services to be provided.
Session Long Project Background
Cross-cultural competence (sometimes called multicultural, transcultural or intercultural competence) should be considered a journey and NOT a destination. Many books and articles have been written on the topic of cross cultural competence. Several of these resources have focused on individual groups by making sweeping generalizations about the members of the culture about which they are written. Unfortunately texts of this nature do not dispense much practical advice in terms of “how to” learn cultural competence. According to the California Endowment (2003), “While factual information is important, educators should focus on process-oriented tools and concepts that will serve the practitioner well in communicating and developing therapeutic alliances with all types of patients” (p. 2). Having said this, in this course, we will not focus on “generalizations”; instead we will explore methods that will enable us to effectively learn about other cultures.
Research on cultural competence dating back to the 1950s has underscored a number of desired outcomes related to the phenomenon. Early research on cultural competence suggests that the desired outcome was to recognize cultural differences within one’s environment considering an individual’s origin, education, social class, and religion to assist in explaining their behavior in medical treatment. In a review of literature by Hayes (2012) four major themes were identified across nine frameworks of cultural competence including: (1) an awareness of diversity among human beings, (2) an ability to care for individuals, (3) nonjudgmental openness for all individuals, and (4) the long-term process involved in enhancing cultural competence.
As of August 12, 2009, there were 6,777,249,674 individuals on the face of the Earth (U.S. Census Bureau, 2009). When one considers this number we quickly come to the realization that it is impossible to know all that there is to know about every single cultural group in the world. How then can we attain cross-cultural competence?
Numerous theories of multicultural and cross-cultural competence have been proposed. Under the background readings of this module, specifically, the “optional reading” section, you will be able to explore some of the different models that have been used in the study of culture.
Cultural Competence using the Purnell Model
In this course, we are going to focus on one model for studying culture. By learning how to use a model for the study of culture we can apply the models constructs (or parts) to any culture and explore it in a systematic manner. The model I have selected for our use is the Purnell model. In addition to serving as the framework for this course, this model will serve as the underpinning for our session long project.
Dr. Purnell’s model is a conceptualization of cultural competence. He built his model using different theories as well as research from many disciplines. Under the required reading section of this module, we will learn more about the Purnell model. In each module of this course, we will consider two to three constructs of the Purnell model and apply it to our study of culture. Our work with the model will be reinforced by readings that echo key themes of the model.
We shall begin our study of the Purnell model by considering the totality of the Purnell model. Before moving on with your reading, you should click on this link in order to refer to the model as we explore its parts.
The outer circle of the model represents the “Global society”. This encompasses such ideas as “world communication and politics; conflicts and warfare; natural disasters and famines; international exchanges in education, business, commerce, and information technology; advances in the health sciences; space exploration; and the expanded opportunities for people to travel around the world and interact with diverse societies” (Purnell&Paulanka, 2003, p. 9).
Within this outer circle we find another circle that represents the concept of “Community”. A community is a group of people who have either a common interest or live in a specific geographic location. Sharing a language or a specific dialect, lifestyle or history are symbolic characteristics of a community (Purnell&Paulanka, 2003, p. 9).
Within the circle of community, we find the circle of “Family”. In its simplest terms a family is “two or more people who are emotionally connected”. People who make up a family may (but do not have to) live with or in close geographic proximity to one another (Purnell&Paulanka, 2003, p. 9). These people share an “emotional” bond that holds them together despite their geographic proximity. In addition to emotional bond, there can also be a biological relationship in a family (such as a mother and daughter) or it can also exist in the absence of a biological relationship (such as a woman and her fiancé). However defined, the concept of “family” has a powerful impact upon the next circle that comprises the model—“person”.
Although it seems like a simple definition, the concept of “Person” is quite a complex. We are biological (or those aspects that make up our bodies), psychological (those aspects that encompass our thoughts and feelings), social (those aspects that deal with how we relate to one another in society) and cultural beings. We will focus on the cultural aspects of persons throughout this course.
Within the circles, we find what appears as “pieces of a pie” which represent what Purnell refers to as the “12 Domains of Culture”. In each module, we will explore two or three of these domains (or constructs) in depth and they will be used to inform our session long project. In this first module, we are going to begin with an exploration of “Overview/Heritage” and “Communication”.
Sub-constructs of this domain include:
Sub-constructs of this domain include:
• Dominant language
• Contextual use
• Spatial distancing
• Eye contact
• Facial expression
With an increasing emphasis on using science to improve treatment outcomes; health care providers must also improve their capacity to better understand individual culture as it affects patient decisions to access and use care and to follow treatment recommendations. If not, better and more targeted treatments may be undermined leading to poorer health outcomes and increased costs for some of the most vulnerable. This process begins with first understanding the barriers to communication between patients and providers.
California Endowment (n.d.).Principles and Recommended Standards for Cultural Competence Education of Health Care Professionals (Gilbert, J. M., ed.)
California State University at Chico. (2007, June 19). What is a Scholarly Journal? Retrieved from http://www.csuchico.edu/lins/handouts/scholarly.html
Perlez, J. (2006, August 1). Indonesian province embraces Islamic law, and canings. The New York times, A. 3.
Purdue University (1995-2011). APA formatting and style guide. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/
Purnell, L. (n.d.). The Purnell model for cultural competence. Retrieved from http://www.tcns.org/society/PurnellModel2.pdf
Purnell, L. (2005). The Purnell model for cultural competence [Electronic version].Journal of multicultural nursing & health, 11(2), 7-15.
U.S. Department of State (n.d.). Countries. Retrieved from http://www.state.gov/countries/
Hayes, E. D. (2012). The impact of organizational culture, climate, and provider characteristics on perceived cultural adaptability of disaster health care providers. TUI University).ProQuest Dissertations and Theses, 199. Retrieved from proquest.
Jirwe, M., Gerrish, K., &Emami, A. (2006).The theoretical framework of cultural competence.Journal of Multicultural Nursing & Health (JMCNH), 12(3), 6-16.