Dr Gloria Likupe – Faculty of Health Science, University of Hull
Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say and do and essential for “no decision about me without me”. Communication is the key to a good workplace with benefits for those in our care and staff alike.’(Cummings and Bennett, 2012: 13)
According to the 2011 census, the minority ethnic population of the United Kingdom (UK) increased from 8-16.5% from 2001 – 2011 (UK Census 2011) and is expected to keep on increasing. Effective communication in nursing is seen as one of the key factors in determining healthcare needs of ethnic minorities. The Government’s Social Care white Paper Caring for our Future: reforming care and support (July 2012) reaffirmed its commitment to hear the voices of people who use care services – as well as those of carers – to improve the quality of care and support. Nurses are key to patients’ experiences in the caregiving environment as they are with patients more than any other professionals. Therefore, if the government’s objective and priorities are to be achieved, effective communication between nurses and patients needs to be at the heart of caregiving. It is therefore important for nurses to have skills that will enable them to care effectively for people of different cultures.
However, in situations where the culture of the patient and the culture of the nurse are different, this relationship can be challenging. Likupe (2011) demonstrated that healthcare workers can find it challenging to communicate with people from different ethnic groups. To overcome these challenges, nurses need to develop sensitivity to cultural diversity, stereotyping and prejudice, general skills of good communication, and specific skills to negotiate communication barriers.
Most literature on communication with minority elders is concerned with translation of either the spoken or the written word. Age Concern, for example, promotes the practice of producing translated materials from English to other languages for patients who may not be fluent in English. Barriers to communication originate with both seekers and providers of information (Eriksson-Backa, 2008). These include use of medical technology, lack of communication skills amongst healthcare practitioners, as well as lack of time. Patients often report not receiving answers to their questions, not asking for clarification to misunderstood information for fear of being labelled ‘difficult’.
It is recognised in the literature that people communicate in different ways, through verbal and nonverbal means. In general, people from a specific culture tend to communicate in a similar manner. Cultural communication styles are said to be along a continuum from openly expressive to reserved (Yehieli et al 2004). Body spacing is usually close to one another in most minority cultures. Cultures which are openly expressive tend to be more passionate, use gestures more, and express more emotion in their communication. Conversely, some cultures are more reserved and tend to have formal and refined communication. They may also follow specific cultural protocols – for example, body spacing tends to be further from each other with reduced eye contact.
Therefore, nurses need to become culturally sensitive to the culture of ethnic minority patients they are caring for. This includes being aware of their own values and beliefs and recognizing how these influence attitudes and behaviours. In addition, nurses should recognise the historical events that have affected particular ethnic groups, and understand how oppression, discrimination, and stereotyping may affect people differently both professionally and personally. Moreover, nurses should take note of the general style of communication in a particular culture and of the respect afforded to different age groups. Above all, Nurses need to be aware that people are individuals, and that stereotypes should be avoided in order to avoid causing offence (Likupe 2014).
Poor communication, stereotyping, lack of understanding and derogatory attitudes are often cited by minority patients as key issues in care (Likupe 2014). There can be differences in seeing and explaining things in and between cultural groupings. There can also be differences in understanding health and illness. Ethnic minorities may regard health in a holistic fashion and may have greater awareness of spiritual and mental well-being in their assessments. Factors such as racism, poverty and the desire for cultural maintenance may be difficult to communicate to authority figures who are usually white, and this may also lead to stress.
Although human caring is seen as a universal phenomenon, patterns and expression of caring vary among cultures and within cultures. Therefore, nurses need to develop an in-depth understanding of different cultures to provide individualistic care. Effective, culturally aware communication is the cornerstone of patient-centred care for ethnic minority patients, and nurses must ensure that they develop, maintain and enhance the skills required to deliver this.
Cummings J, Bennett V for the Department of Health (2012) Compassion in Practice: Nursing, Midwifery and Care Staff: Our Vision and Strategy. https:// tinyurl.com/jcx9yrh (accessed 07 Dec 2019)
DoH (2012) Caring for our future: reforming care and support. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/136422/White-Paper-Caring-for-our-future-reforming-care-and-support-PDF-1580K.pdf (accessed 07 Dec 2019)
Likupe, G. (2011) Motivations, migration and experiences of Black African Nurses in the United Kingdom, on line available from: http://www.rcn.org.uk/data/assets/pdf/file/0004/458977/glorialikupethesis2011.pdf accessed 19/11/2012
Likupe, G. (2014) Communicating with older minority patients. Nursing Standard Vol 28 (40) 37- 43
UK Census (2011) available at: http://www.ons.gov.uk/ons/guide-method/census/2011/index.html
Yehieli P H, Grey M A and Vander Werff A (2004) Caring for Divers seniors: A health provider’s pocket guide to working with elderly minority immigrant, and refugee patients, University of Northern Iowa