Assignment | Online AssignmentCross-cultural communication: Tools for working with families and children

About this assignment

Review the following TWO resources and write a Critical Reflection Journal for each. Critical reflection is not just about what you think – it is about taking all information and viewpoints into consideration, and then providing a justifiable and informed point of view. This means you need academic references to support your arguments and you may incorporate your own responses to the materials.

The assignment addresses Unit Objective 4: Select, appraise and display strategies for communicating with patients from culturally diverse backgrounds and/or for whom English is a second language.

Task requirements

Review the following two resources and write a 750 word Reflective Journal for each (2 X 750 = 1500 words).

1. Cross cultural communication: Tools for working with families and children. Pdf attached.

2. ‘Delivering health care for Aboriginal people in a person-centred way’ (view Part 1) youtube video below

https://www.youtube.com/watch?v=X8kx-MRtSGM

In each journal, address the following

Summary – Your summary should:

• Identify the health issues addressed in the resources;
• Identify (past and current) strategies employed to address the issues;

Analysis – In your analysis of the two articles, consider:

• How the strategies address (or fail to address) cultural competence.
• Whether the strategies identified are context/ issue specific, or whether they are applicable across different cultural contexts.

Reflection – In your reflection consider:

• What have you taken away as good advice from the strategies?
• Do you have further questions about the strategies? What would you do to address these questions?

Journal structure

Your journals should have a standard essay structure of introduction, body and conclusion followed by a references section that incorporates a minimum of three (3) additional references to support your work with at least one (1) scholarly, peer-reviewed source. In-text citations and end-of-text references should be in APA Style.

Formatting

• Document type: Microsoft Word document
• Font type: Times New Roman or Arial
• Font size: 12 pt
• Line spacing: double-spaced

Writing

Your journal must be written in an appropriate academic style, and with attention paid to grammar, punctuation and spelling. Visit the Academic Skills Centre link for resources and tips on academic writing. The word limit does not include references.

CRITICAL REFLECTION JOURNALS (40%)
Criteria
Fail (0-49%)
Pass (50-59%)
Credit (60-69%)
Distinction (70-79%)
High Distinction (80-100%)
Summary of issues and strategies (8 marks)
Identify the health issues addressed in the resources.
Identify (past and current) strategies employed to address the issues.
Fails to consider the topic question and/ or neglects to offer an informed perspective.
Health issues and strategies are provided as a list with little or no further explanation.
An attempt to link issues and strategies is made.
Links between health issues and health strategies are clearly presented.
The relationship between health issues and strategies are clearly described. A description of how or whether contemporary strategies are similar or different to previous strategies is presented.
Analysis of cultural competence and context (12 marks)
Evaluates how the strategies address (or fail to address) cultural competence.
Describes whether the strategies identified are context/ issue specific, or whether they are applicable across different cultural contexts.
Lacks comment on how the strategies address cultural competence.
Fails to describe how or whether the strategies are context specific or more broadly applicable.
A statement that the strategies address cultural competence is made but with little associated explanation. The applicability of strategies is commented on but with little additional explanation.
A basic attempt to explain how strategies address cultural competence is provided. A basic explanation of how the strategies are either context specific, or more broadly applicable is provided.
A clear evaluation and explanation of how the strategies address cultural competence is provided. A nuanced consideration of whether the strategies are broadly applicable or more context specific is provided. Examples may be used to help illustrate the point.
An evaluation of whether the strategies address cultural competence is provided. The evaluation uses relevant literature to clearly inform the assessment of strategies. A discussion of how strategies are context specific or more broadly applicable is presented. Example(s) are effectively used to illustrate the point.
Reflection on strategy value (12 marks)
What have you taken away as good advice from the strategies?
Do you have further questions about the strategies? What would you do to address these questions?
Reference to advice is minimal or unclear.
Questions are unclear.
Plan to address questions is absent or unclear.
Good advice is presented as a list repeated directly from the resources. Questions are presented but lack context. A basic plan of how to address them is presented.
Advice is explained in relation to an issue or problem. Questions arising from the strategies are presented along with a basic plan of how they could be addressed.
Advice is presented in the writer’s terms and is presented with context in mind. Questions are included with relevance to potential workplace scenarios.
Advice may be presented as an amalgamation of strategies, or the consolidation of elements from various strategies in a form that best addresses the professional needs and/ or cultural competence development. A clear statement of how questions will be addressed is provided, including details of sources or sites to be consulted

Practice Point
Cross-cultural communication: Tools for working with families
and children
Tehseen Ladha, Mohammad Zubairi, Andrea Hunter, Tobey Audcent, Julie Johnstone
Canadian Paediatric Society, Global Child and Youth Health Section Executive, Ottawa, Ontario
Correspondence: Canadian Paediatric Society, 100–2305 St. Laurent Blvd., Ottawa, Ontario K1G 4J8. E-mail info@cps.ca,
website www.cps.ca
Abstract
The ability to communicate effectively with patients and families is paramount for good patient care.
This practice point reviews the importance of communicating effectively in cross-cultural encounters.
The concept of cultural competence is introduced, along with the LEARN (Listen, Explain,
Acknowledge, Recommend, Negotiate) model for cross-cultural communication. Three vignettes, one
each in Indigenous, global, and newcomer child health, are used to illustrate challenges in cross-cultural
communication and effective application of the LEARN model. Practical tips are provided for
communicating across cultures.
Keywords: Communication; Culture; Global health; Immigrant health; Indigenous health
CONTEXT
Canada has a long-standing history of immigration and ethnic
diversity (1). In addition to a diverse range of Indigenous
populations, there are more than 200 distinct ethnic origins
represented in Canada and more than 50,000 newcomer children
and youth arrive every year (2–4). Culture—which may
include language, values, beliefs and behaviours in any community—
can also shape interactions between families and health
care providers.
Physicians need to be aware of the personal values they bring
to the patient–provider relationship as well as how a patient’s
culture may be impacting their health or management of an illness
(5). Ineffective cross-cultural communication can affect
patient outcomes adversely through misdiagnosis, repeated hospital
admissions or lower treatment adherence (5). By applying
the LEARN model to three patient vignettes, this practice point
provides a practical framework for patient interactions (6).
WHAT IS CULTURAL COMPETENCE?
Cultural competence includes providing effective health care
across diverse cultures by working collaboratively and communicating
effectively (5). Physicians who are aware of their
own and their patients’ cultural backgrounds, along with the
values that are often implicit in current medical models, are
better able to achieve mutual understanding within the patient
encounter and to focus on culturally appropriate health care
interventions (5–7).
THE LEARN MODEL FOR CROSS-CULTURAL
COMMUNICATION
The LEARN (Listen, Explain, Acknowledge, Recommend,
Negotiate) model is a framework for cross-cultural communication
that helps build mutual understanding and enhance patient care (6).
Listen: Assess each patient’s understanding of their health condition,
its causes and potential treatments. Elicit expectations
for the encounter, and bring an attitude of curiosity and humility
to promote trust and understanding.
Explain: Convey your own perceptions of the health condition,
keeping in mind that patients may understand health or
illness differently, based on culture or ethnic background.
Acknowledge: Be respectful when discussing the differences
between their views and your own. Point out areas of agreement
as well as difference, and try to determine whether disparate
belief systems may lead to a therapeutic dilemma.
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Paediatrics & Child Health, 2018, Vol. 23, No. 1 67
Recommend: Develop and propose a treatment plan to the
patient and their family.
Negotiate: Reach an agreement on the treatment plan in partnership
with the patient and family, incorporating culturally relevant
approaches that fit with the patient’s perceptions of health
and healing.
APPLYING THE LEARN MODEL IN CROSSCULTURAL
SITUATIONS
The role of silence and shared meanings
You are a paediatrician working in an outpatient clinic in an urban
centre. Myna is a 10-year-old Inuit girl from a northern Inuit community.
You are seeing her for symptoms of depression and oppositional
behaviour. You ask Myna’s mother about these behaviours
and find that she is not sharing much information. You ask Myna,
“How things are going at home?” Your question is greeted by silence.
Her mother looks away.
Knowing how to interpret and respond to silences is a skill
that requires understanding of the role of silence in an
interaction (8). Silence may stem from discomfort with a
question, uncertainty about its meaning or apprehension
about the reasons for the question. Also, in Inuit and other
cultures, facial expressions may be used to respond to questions.
It is essential that the health care provider not jump
in to fill a silence (9). Paying attention to nonverbal cues
can help to bridge perceived power differentials that sometimes
hinder development of the provider–patient relationship
(5). Establishing trust and mutual understanding
is key to empowering families and optimizing patient care
(10).
Some common challenges can arise when negotiating health
care plans with caregivers, including: parental absence from
hospital, limited opportunities for dialogue, and the involvement
of community members apart from the patient’s family
in medical decision-making. Some cultures encourage broader
decision-making authority beyond the nuclear family in medical
decision-making. In collectivist cultures, it may be important
to involve members of the community when devising the
treatment plan.
Back to our case…
Applying the LEARN model, you start by assessing Myna’s family’s
expectations for this visit. Inquire about the family’s background,
their concerns, and their understanding of the purpose
of the visit. Explain why specific questions are being asked and
how the answers help. This approach may alleviate family stress
and concern. Based on information obtained in the history, recommend
further evaluation and/or treatment, involving family
and other community members through a culturally appropriate
negotiation.
NONVERBAL COMMUNICATION AND
AVOIDING GENERALIZATION
You are volunteering with a medical organization overseas, in
India. You see a 9-month-old boy, Ayaan, who has severe iron deficiency
anemia and is being breastfed, with no solid food intake.
You advise his mother on the importance of iron supplements and
of transitioning to iron-rich solid foods. As you counsel, she lowers
her gaze and shakes her head. You assume that Ayaan’s mother is
worried about the side effects of a foreign medication and begin to
reassure her. She responds that she will try to follow your directions,
but still averts her gaze.
Communication styles differ greatly among cultures.
Traditionally, Western cultures use direct (low-context) forms
of communication, which do not rely heavily on background,
nonverbal cues or context to convey meaning (11). Many cultures
rely on indirect (high-context) forms of communication,
in which meanings are conveyed but not explicit, using body
language, tone of voice and other cues (12). For such interactions,
diplomacy and tact are highly valued, and perceived
differences in status can interfere easily with frank communication.
Being aware of such diverse forms of communication can
facilitate shared understanding.
While culture may be an important influence on communication
styles and health care beliefs, broad diversity can also exist
within cultural groups. It is essential to try to understand each
individual patient’s beliefs and to avoid cultural generalizations.
In some situations, issues arise from personal values or familial
or environmental factors (12).
Back to our case…
Realizing that something is wrong, you begin to apply the LEARN
model. You ask the mother whether she has concerns about the
anemia or iron supplements. You also reassure her that it is okay
for her to express concern or disagree. She divulges that her concern
lies with your recommendations for solid food, rather than
iron supplements. She explains that her son has no teeth yet and
she is worried about him choking. You acknowledge her concern
and explain the reason for transitioning to solid foods, including
Ayaan’s need to learn to mouth first foods safely. You discuss some
common family foods eaten in her home and agree on introducing
a few iron-rich soft mashed foods and cereals that she is comfortable
trying, along with an iron supplement.
WORKING WITH INTERPRETERS
You are seeing Waseem, a 2-year-old boy who has recently arrived
as a refugee from Iraq. His parents speak mainly Arabic. Waseem’s
eldest brother, Fariz, a 13-year-old, agrees to translate for you.
Using the LEARN model, you start by asking open-ended questions
about the family’s migration history and their prior and current living
conditions. Fariz tells you most of the story without asking his
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68 Paediatrics & Child Health, 2018, Vol. 23, No. 1
parents questions. When you ask about challenges with acculturation,
Fariz replies that the family is “doing fine.” You later learn that
Waseem says only a few words and is not yet walking. You wonder
how you might gain a clearer understanding of the issues contributing
to Waseem’s developmental delay.
Providing care in a language that a family does not speak well
is a known risk factor for negative effects on health outcomes
(13). Cultural interpreters are trained to help newcomer
families navigate medical conversations. They can provide
clear, precise translations that include nuances in meaning
and nonverbal cues, while being careful not to ‘lead’ the
conversation.
Using a family member or friend (particularly a child) to
translate, should be avoided. They are more likely to edit or
reinterpret information to avoid conflict or protect family
members (14). The patient and family may also be less forthcoming
if community members are present to translate. It is
recommended practice to use a cultural interpreter or language
service by telephone.
Translation applications, such as ‘Google Translate’ can help
with simple questions but are unreliable aids for history-taking.
They cannot communicate the nuances of language or culture
that are essential for effective medical care. See Box 1 for useful
tips on working with interpreters, and the CPS Caring for Kids
New to Canada website (www.kidsnewtocanada.ca) for more
information on this topic (14).
Providing written materials to newcomer families whose
command of English or French may be limited can be confusing.
Whenever possible, use materials that are translated into
the languages spoken by your patient population (15). Asking
families how they prefer to receive information can also mitigate
concerns around literacy.
Appropriate cultural interpretation takes extra time, as does
exploring sensitive issues, such as acculturation or a family’s understanding
of health and illness. Booking longer visits and repeat
visits with the same health care provider—as well as (ideally) the
same interpreter—can help with developing a mutual understanding
of health issues and mutually acceptable management plans.
PRACTICE POINTS TO REMEMBER
• Try to identify influential cultural differences in yourself and
your patients. Be self-aware of biases and values that you may
be bringing to medical encounters.
• Use a trained interpreter rather than a family member to
translate, when needed.
• Build awareness of differences in communication style (e.g.,
verbal and nonverbal) that may influence care.
• Consider the role of silences in each patient encounter. They
may represent discomfort with a topic or uncertainty about a
question being asked. Paying attention to nonverbal cues can
help determine whether a differential power relationship is
hindering communication.
• Building trust and understanding helps empower families
and optimize patient care.
• Booking longer and repeat visits with the same interpreter
can forge trust and understanding around child and youth
health issues and management plans.
• Devise a tailored treatment plan that involves the patient’s
immediate family, extended family or other community
members, as appropriate.
• Recognize that a ‘high-context’ communication style may be a
family’s cultural norm and stay attuned to tone, body language
and other nonverbal cues.
• Recognize that diversity exists within ethnic and cultural
groups as much as between groups, and avoid generalizing or
stereotyping cross-cultural encounters.
• Assess the literacy levels of patients or families and adjust the
use of written materials accordingly.
Acknowledgements
This practice point was reviewed by the Community Paediatrics, Fetus
and Newborn, and First Nations, Inuit and Métis Health Committees
of the Canadian Paediatric Society.
References
1. Crockett M. New faces from faraway places: Immigrant child health
in Canada. Paediatr Child Health 2005;10(5):277–81.
2. Citizenship and Immigration Canada. Facts and figures 2014 –
Immigration Overview: Permanent Residents. <www.cic.gc.ca/
english/resources/statistics/facts2014/permanent/05.asp>
(Accessed March 13, 2017).
Box 1. Tips for working with interpreters
• Familiarize yourself with professional interpreter services
in your area.
• Speak with the interpreter before each appointment to
clarify expectations, such as whether to directly translate
all communication among family members during
the visit.
• Use the interpreter to arrange the next appointment and
confirm transportation arrangements.
• Arrange for triangular seating, so everyone present can
see nonverbal cues.
• Introduce everyone who is present.
• Ask who is the most appropriate person to address your
questions to.
• Look at family members as you speak, and try to speak
directly with them.
• Debrief with interpreter afterward to ensure communications
were fully translated.
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Paediatrics & Child Health, 2018, Vol. 23, No. 1 69
3. Statistics Canada. Immigration and Ethnocultural Diversity in
Canada. <www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/99-
010-x2011001-eng.cfm> (Accessed March 13, 2017).
4. Allan B, Smylie J. First Peoples, Second Class Treatment: The Role
of Racism in the Health and Well-being of Indigenous Peoples in
Canada. Toronto, Ont.: The Wellesley Institute, 2015.
5. Canadian Medical Protective Association. March 2014. Duties
and Responsibilities: When Medicine and Culture Intersect.
<www.cmpa-acpm.ca/-/when-medicine-and-culture-intersect>
(Accessed March 13, 2017).
6. Berlin EA, Fowkes WA Jr. A teaching framework for cross-cultural
health care. Application in family practice. West J Med
1983;139(6):934–38.
7. Health Canada. January 2015. First Nations Mental Wellness Continuum
Framework. <health.afn.ca/uploads/files/24-14-1273-fn-mental-wellness-
framework-en05_low.pdf> (Accessed March 13, 2017).
8. Johnstone MJ, Kanitsaki O. Culture, language, and
patient safety: Making the link. Int J Qual Health Care
2006;18(5):383–88.
9. Kelly L, Brown JB. Listening to Native patients. Changes in physicians’
understanding and behaviour. Can Fam Physician 2002;48:1645–52.
10. Williamson M, Harrison L. Providing culturally appropriate care:
A literature review. Int J Nurs Stud 2010;47(6):761–9.
11. Hall ET. Beyond Culture. Gloucester, MA: Peter Smith, 1981:91.
12. Canadian Paediatric Society, Caring for Kids New to Canada; Vo
D, Mayhew M. July 2014. Cultural Competence for Child and
Youth Health Professionals. <www.kidsnewtocanada.ca/culture/
competence> (Accessed March 13, 2017).
13. Cohen AL, Rivara F, Marcuse EK, McPhilips H, Davis R. Are language
barriers associated with serious medical events in hospitalized
paediatric patients? Pediatrics 2005;116(3):575–9.
14. Canadian Paediatric Society, Caring for Kids New to Canada; Hilliard
R. December 2016. Using Interpreters in Health Care Settings. <www.
kidsnewtocanada.ca/care/interpreters/> (Accessed March 13, 2017).
15. Canadian Paediatric Society, Caring for Kids New to Canada.
October 2016. Online Health Information for Parents in Other
Languages. <www.kidsnewtocanada.ca/care/parent-info>
(Accessed March 13, 2017).
CPS GLOBAL CHILD AND YOUTH HEALTH SECTION EXECUTIVE
Members: Dominic Allain MD (President), Tobey Audcent MD (past member), Robert Bortolussi MD (past President), Mahli
Brindamour MD (President-Elect), Andrea Evans MD (Member at Large), Tehseen Ladha MD (past Member at Large), Jennifer Turnbull
MD (Secretary-Treasurer), Ashley Vandermorris MD (Member at Large)
Liaisons: Sara Citron MD, Alyson Holland MD (CPS Residents Section)
Principal authors: Tehseen Ladha MD, Mohammad Zubairi MD, Andrea Hunter MD, Tobey Audcent MD, Julie Johnstone MD
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