Cross-Cultural Communication

Last week I attended an End-of-Life Nursing Conference (ELNEC) and heard several excellent presentations regarding care for patients who are in the final stages of life.  One of the sessions dealt with cultural considerations.  I have posted blogs before on matters of cross cultural communication. Sometimes it has been in regard to interfaith dialogue, sometimes it has been on matters of immigration. The crucial fact to consider is that more and more we are living in a pluralistic society and communication across cultures is becoming more and more important.

During that ELNEC session on Cultural Considerations, we were given a model for cross cultural communication. I thought it was a good model that could actually apply to other fields than just healthcare. The model is taken from an article in The Western Journal of Medicine (1983), “A teaching Framework for Cross-cultural Health Care," by Elois Berlin and William Fowlkes. (You can read the entire article here). 

Berlin and Fowlkes use the acronym L-E-A-R-N to outline their model:

     L  -Listen with empathy and understanding for the patient’s perceptions of the problem

     E  -Explain your perceptions of the problem

     A  -Acknowledge and discuss differences and similarities

     R  -Recommend treatment

     N -Negotiate agreement

The starting point in cross cultural communication should be to realize that there are differences between cultures in terms of customs, values, interests, needs and priorities. We in the dominant culture should never assume that our way of seeing things is the best, especially for someone who is coming from a different culture.  For true communication to take place, we must indeed listen and try to understand the other’s perspective. 

In matters of healthcare there may be a treatment that the healthcare provider sees as beneficial, but there may be some aspect of the treatment that is misunderstood by (or even offensive to) someone coming from a different background. It is crucial for the healthcare provider to understand where the patient is coming from in order to explain why a particular treatment is recommended. It is also important to realize that our way may work just as well if it can be accommodated to their cultural practices or preferences.

I can see this as an important model for any cross-cultural interaction. Today more than ever we need to let down our barriers and defenses and truly listen to those from other backgrounds living among us. I can also see this model being beneficial when we are talking in terms of politics, lifestyles, and community action. Might we use this model in the so-called "culture wars" in the U.S. that we see referred to so often in the media? We must at some point lay down the polarization that comes when people insist that their way is best and no other way is acceptable.

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