Transcultural Nursing Communication

Transcultural Nursing © 2014 Novantiqua Multimedia
I.P.A.S.V.I. Frosinone 5 settembre 2014
I.P.A.S.V.I. Latina 6 settembre 2014
newcomers
and health linguistic hindrances
multiple non - standard languages ‘under’ a language
h as to make their use
alse sense of security
inority Health (1999)
Strip from: A. Bischoff - l. Lautan, Due lingue un colloquio, 1999
dr. Paolo Tentori - Novantiqua Multimedia
“The components of clinical assessment, including observation of the patient, history-taking, physical exami-
nation, and laboratory testing, all may be influenced by cultural factors. The cultural issues are most obvious
if the patient has distinctly different background from the healthcare provider.”
W.S. Tseng, J. Streller, Cultural Competence in Health Care- A Guide for Professionals, 2008

communication aims
to promote the health of the immigrant population
translation skills: a duty for healthcare providers?
Translation is a professional activity and the purpose of this work isn’t to
disqualify expert knowledge but increase the use of passive language
competence. Our aim is to valorise interrelated competences and extra-linguistic
sub-competences (management of precompiled documentation resources; use
of linguistic automatic tools for use by nurses, doctors and other health care
professionals when thay encounter a patient who does not speak a usually
common language, especially when a translator is not immediately available).
Anthony Pym, Alternatives to Borders in Translation Theory, in: Susan Petrilli (ed.), Translation Translation,
Amsterdam/New York, Rodopi, 2003, 660 pp.
http://usuaris.tinet.cat/apym/on-line/intercultures/alternatives.pdf

communication aims
Machine or computer-aided translation tools
“The availability of on-line translation tools makes them tempting to use and
they can seem like an efficient short-cut to providing material in different
languages. But, as with many short-cuts, there can be hidden dangers and
unpredictable results. When using these tools, you may not really know what
you are sending out to your patients, or what you are really saying” (WHRA
French Language Service). However, multicultural communication is problem
solving and we will see later that IT-based program information can be helpful
in the context of “low risk messages” (e.g. daily patients interaction).
Anthony Pym, A Theory of Cross-Cultural Communication, 2003.
http://usuaris.tinet.cat/apym/on-line/intercultures/cross-cultural.pdf
http://www.ingenuitor.com/thesolution.html

communication aims
Communicative success conditions (Pym model)
COMMUNICATION ACT
COOPERATION
BENEFITS FOR
ALL PARTICIPANTS
LOW RISK
MESSAGES
HIGH RISK
MESSAGES
Reduction to effort in health back-
ground messages. E.g. patient daily
procedures and interaction.
Tools: automatic translation
MANY MESSAGES
MANY LEVELS
Particular attention to them in terms of:
production, reception, mediation. E.g.
informed consent, medical procedures,
instructional input.
Standardised forms and procedures

communication aims
COMMUNICATION
PARTICIPANTS
SENDER IN
A SOURCE CULTURE
RECEIVER IN
TARGET CULTURE
The mediator may more normally be seen as an active member of the communication
group, usually member who uses specialized knowledge of communication norms in one or
several receiving cultures, multilinguistic written materials and IT-based program informa-
tion combined whit oral interaction. In our health care context mediator can be a healthcare
provider in hospital ward. He is able to decode a communication properly.
MEDIATOR

communication aims
REDUCTION
OF COMPLEXITY
UNDERSTANDING
Anthony Pym declare “Success conditions” as criteria that make the communicative act
beneficial for all or some of the participants concerned. Such criteria may be simple, subtle
and multiplex.
E.g.: (in our health context) explication and comprehension of a multilingual informed con-
sensus and his purpose.
INTERPRETATION:
linguistic,
cultural,
denotative/connotative
message.

communication aims
TRANSACTION
COST
SUM OF THE EFFORTS
PUT INTO
The selection of cheaper communication (in our health context precompiled medical proce-
dures, medical app) does not in itself ensure the minimal ethical requirement that benefits
ensure for all participants. However, the lowering of transaction costs may allow for looser
success conditions, greater general benefits, and thus a greater probability of mutual be-
nefits.
E.g.: (in our health context) the project “mDiabetes” that has launched in Senegal just in
time for the month of Ramadan (2014).
production,
reception,
mediation
GIVEN
COMMUNICATION ACT

Nursing transculturale © 2014 Novantiqua Multimedia
communication aims
The cooperative principle in communication (Grice’s maxims)
Betty J. Birner, Introduction to Pragmatics, Wiley- Blackwell 2013.
http://en.wikipedia.org/wiki/Cooperative_principle
The maxim of
quantity
Communication, either orally or in writing, can work only because both people are traying
to be cooperative - trying to make their contribution appropriate to the interchange at
hand. Health provider may use interpretable communication instruments in a reasonably
concise and articulate way.
The maxim of
quality
The maxim of
relation
the maxim of
manner
Say enought,
but don’t say too much.
Say only you have reason to
believe is true.
Say only
what is relevant.
Be brief, clear,
and unambiguous.
In the healthcare arena, where the transfer of accurate and of-
ten complex information is critical, make your utterances ap-
propriate and straightforward to their conversational context.

Nursing transculturale © 2014 Novantiqua Multimedia
communication aims
Health literacy
AA.VV., Attributes of a Health Literate Organization, National Academy of Sciences, 2012
http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_HLit_Attributes.pdf
Health literacy is the ability to obtain, process, and understand basic health information and
services needed to make appropriate decisions (HRSA).

communication aims
translation skills in the cross-cultural situations
“Cross-cultural communication might be characterized by a relatively high
degree of effort required to reduce complexity, by relatively high transaction
costs, by relatively low trust, and by relatively narrow or restrictive success
conditions. In short, it is harder to meet success conditions between cultures
than within just one culture...” (Anthony Pym).
Anthony Pym, A Theory of Cross-Cultural Communication, 2003
http://usuaris.tinet.cat/apym/on-line/intercultures/alternatives.pdf

communication aims
translation skills in the cross-cultural situations
It is vital to understand the importance of cultural competence while providing
information about medical procedures. Information given in a proper way
can create better understanding, acceptance and tolerance towards the
procedure. The patient who is having this procedure is given feelings of safety
and trust. This means that cultural differences are taken into consideration
when informing the patients (Chen, Wang, Gilala 2013).
Pingying Chen, Ruilan Wang, Sonja Gilala, Informing patients about intermittent urinary catheterization in tran-
scultural patient-nurse interactions, Bachelor thesis, 2013

communication aims
The foreign citizen’s guide of the district of ASL Frosinone
The “guida multilingue” is a concise and practical tool, as comprehensive as
possible, available in 6 different languages: Italian, English, French, Arabic,
Russian, Albanese.
http://www.oltreloccidente.org/guida/en/index.htm

communication aims
The foreign citizen’s guide of the district of Frosinone
The guide for foreign citizens wants to solve practical problems as, for example,
to enrol to the regional health system, booking for tests and examinations, to
access to the Emergencies department, hospitalization, but, more importantly,
to provide information and essential knowledge to protect the health of
individuals and of the whole community.

communication aims
We can use the guide as a basis for practical examples of translation , knowledge
of alphabets other than the Latin (Arabic, Devanagari, Chinese, Cyrillic).

communication aims
Latin alphabet: health information in English. Copy and paste in Google.

communication aims
Cyrillic alphabet: health information in Russian. Copy and paste in Google.

communication aims
Latin alphabet: health information in French. Copy and paste in Google.

communication aims
Latin alphabet: health information in Albanian. Copy and paste in Google.

communication aims
Arabic alphabet: health information

communication aims
Arabic alphabet: health information. Copy and paste in Google
https://translate.google.it

communication aims
Arabic alphabet: health information. Copy and paste in Google. Lessan
Wörterbuch word occurrences.
http://www.lessan.org/ https://translate.google.it

communication aims
become more digitally literate
Language learning is defined according to basic concepts:
- Mother tongue (L1)
- Second language or target language (L2)
- Foreign Language (FL)
- Interlingua.
With the new computer resources you can focus on vehicular tools that approach
the learner to multi- FL in the contest of reading and writing by: automatic
translators based on mathematical algorithms; relations of ontological concepts
translated.
Our primary purpose is not spoken communication, but the use of written
translations on the basis of clear objectives.
Sadananda Meher, Using Learner’s Home Language in Teaching English at the Secondary Level in West Odisha,
British Council, 2013
http://www.britishcouncil.in/sites/britishcouncil.in2/files/tec_13_publication_final_version.pdf

communication aims
translation competence (technical and instrumental)
“Predominantly procedural knowledge related to the use of documentation
resources and information, and communication technologies applied to tran-
slation” (PACTE, “Investigating translation competence. Conceptual and methodological issues”, Meta,
vol. 50, no. 2, 2005, p.208).
“Knowing how to search for appropriate information to gain a better grasp of
the thematic aspects of a document” (EMT expert group, Competencies for professional tran-
slators, experts in multilingual and multimedia communication, Brussels, European Commission, 2009., p. 7)
Gary Massey et Maureen Ehrensberger-Dow, Technical and Instrumental Competence in the Translator’s Wor-
kplace: Using Process Research to Identify Educational and Ergonomic Needs , ILCEA, 2011
http://ilcea.revues.org/pdf/1060

communication aims
translation competence (technical and instrumental)
http://www.healthtranslations.com/aspx/topics/topics.aspx?topicid=12
English - Farsi Admission agreement

communication aims
translation competence (instrumental sub-competence)
“The ability to use translation-specific conventional and electronic tools” (GÖP-
FERICH Susanne, “Towards a model of translation competence and its acquisition: The longitudinal study
TransComp”, in S. Göpferich, A. L. Jakobsen, and I. M. Mees (eds), Behind the Mind: Methods, Models and
Results in Translation Process Research (= Copenhagen Studies in Language 37),Copenhagen, Sam fundslit-
teratur, 2009).
Gary Massey et Maureen Ehrensberger-Dow, Technical and Instrumental Competence in the Translator’s Workplace:
Using Process Research to Identify Educational and Ergonomic Needs , ILCEA, 2011 http://ilcea.revues.org/pdf/1060

AA..VV., “Results of the Validation of the PACTE Translation Competence Model: Acceptability and Decision Making,
Across Languages and Cultures, Vol. 10 núm. 2, PACTE 2009
communication aims
translation competence (instrumental sub-competence)
“Predominantly procedural knowledge related to the use of documentation
resources and information and communication technologies applied to transla-
tion (dictionaries of all kinds, encyclopaedias, grammars, style books, parallel
texts, electronic corpora, search engines, etc.).”
www.mdbg.net
www.qutrub.de
https://ddd.uab.cat/pub/artpub/2009/67883/PREI2010_acrlanculv10n2.pdf

Ioannis E. Saridakis, Georgia Kostopoulou, “Methods and the role of revision in academic and professional environ-
ments of translation”, 4th FEDER.CEN.TR.I. Conference, Bologna 10-11 October 2003
communication aims
translation competence (seven textlinguistic factors)
Translation is considered to be both
a mental process
and a practical procedure.
Kostopoulou & Saridakis 2003
www.mhcs.health.nsw.gov.au
http://www.academia.edu/2589325/Methods_and_the_role_of_revision_in_academic_and_professional_environments_of_translation

communication aims
translation competence for health practioner
- Efficient resource and desktop management;
- knowledge of (automated) tool features and
effective interaction with user interfaces;
- familiarity with resource features and capabilities, and adequate evaluation,
selection and manipulation of resources.
Gary Massey et Maureen Ehrensberger-Dow, Technical and Instrumental Competence in the Translator’s Wor-
kplace: Using Process Research to Identify Educational and Ergonomic Needs , ILCEA, 2011
http://ilcea.revues.org/pdf/1060

communication aims
digital tools: example for Roma (Romani čhib) language use
Dieter W. Halwachs, Roma and Romani in Austria, in Romani Studies 5; 15/1 (2005).
Webref: http://translationromani.net
Romani is a heterogeneous bundle of dialect’s varieties (Sinti, Lovara, Kalde-
rash, Gurbet, Arlijie...) with a homogenous lexical and morphological core, but
without a homogenizing standard.

communication aims
digital tools: example for Roma (Romani čhib) language use
Use of Romlex Lexical Database.
Basic question in Sinte Romani:
What’s your name? har = how khareh be called tu = you
Webref: http://romani.uni-graz.at/romlex/lex.xml
har = come
khareh = 3° sing.
sei chiamato
tu = tu

communication aims
digital tools: example for information in a variety of languages.
Webref.: http://www.mylanguage.gov.au/translated-information.html

communication aims
Webref.: http://www.mylanguage.gov.au/translated-information/health.html

Webref.: http://www.healthtranslations.vic.gov.au/bhcv2/bhcht.nsf/pages/topics
communication aims

Webref.: http://www.health.qld.gov.au/multicultural/health_workers/support_tools.asp
communication aims

communication aims
actively, passively and interactively multilinguism
A multilingual person can communicate in more than one language,
be it actively through
speaking and writing
or passively and interactively
through reading, listening and perceiving.
Exploration and experimentation are two key terms in any health provider’s
activity.
New interactive tools usage allows at least passively and interactively lingui-
stic interaction between the patient and the healthcare provider.
Multicultural communication is a problem-solving activity.
Sadananda Meher, Using Learner’s Home Language in Teaching English at the Secondary Level in West Odisha,
http://www.britishcouncil.in/sites/britishcouncil.in2/files/tec_13_publication_final_version.pdf

communication aims
actively, passively and interactively multilinguism
Efficient health practitioners are able to choose an effective technology tool
from many options that meets the needs of the opereting task (Google Tran-
slator, mdgb.net, nciku.com; written multilinguistic material precompiled on
line or off line: e.g. for informated consensus, medical procedures, hospital
dismission).
Dawn Bikowski, The Pedagogy of Collaboration: Teaching Effectively within an Evolving Technology Landscape,
Making these choices effectively requires
practice using a variety of types of techno-
logies and moving beyond multilingual writ-
ten tests.
In contexts with a wide penetration of mobi-
le devices, apps provide an opportunity for
health practitioners to explore multilingual
resources creatively. The task is work toge-
ther using interactive technologies in inno-
vative interlanguage knowledge.
http://www.britishcouncil.in/sites/britishcouncil.in2/files/day_1_-_dawn_bikowski.docx

communication aims
how languages differ
We may find a relatively exact fit for the English “pain” in other languages:
Italian “dolore”; Spanish “dolor”; Arabish “Ālm”; Turkish “ağrı”; Persian “dard”.
But we have e.g. in Italian and English many synonims as shown in Google:
Dawn Bikowski, The influence of the mother tongue on second language vocabulary acquisition and use, In Voca-
bulary: Description, Acquisition and Pedagogy, ed. Schmitt and McCarthy, CUP 1997
http://www.mikeswan.co.uk/elt-applied-linguistics/influence-second-language.htm

communication aims
strategic and operational objectives
Understanding cultural and linguistic barriers to health literacy and procedu-
res allow health operators to be able to overcome properly obstacles to good
health.
In the article ‘Potential barriers to the use of health services among ethnic minorities: a
review’ (2005) published in oxfordjournal.com (Vol. 23, Issue 3, Pp.325-348)
authots emphasize that
“potential barriers occurred at three different levels: patient level, provider
level and system level.
The barriers at patient level were related to the patient characteristics: de-
mographic variables, social structure variables, health beliefs and attitudes,
personal enabling resources, community enabling resources, perceived illness
and personal health practices. The barriers at provider level were related to
the provider characteristics: skills and attitudes. The barriers at system level
were related to the system characteristics: the organisation of the health care
system”.
Emmanuel Scheppers, Els van Dongen, Jos Dekker, Jan Geertzen and Joost Dekker,
Potential barriers to the use of health services among ethnic minorities: a review, 2005
http://fampra.oxfordjournals.org/content/23/3/325.full

communication aims
Potential barriers to the use of health services among migrant patient
three different levels:

patient level provider level system level
Demographic variables,
social structure variables,
health beliefs and attitudes,
personal enabling resources,
community enabling resources,
perceived illness,
personal health practices.
Emmanuel Scheppers, Els van Dongen, Jos Dekker, Jan Geertzen and Joost Dekker,
Potential barriers to the use of health services among ethnic minorities: a review, 2005
Skills and attitudes. Organisation
of the health care
system”.
http://fampra.oxfordjournals.org/content/23/3/325.full

communication aims
patient level
low health literacy cultural barriers limited local
Kate Singleton, MSW, LCSW, Elizabeth M. S. Krause, AB, SM,
Understanding Cultural and Linguistic Barriers to Health Literacy, OJJN (Vol. 14, n.3, 2009)
Health literacy:
the degree to which indi-
viduals have the capacity
to obtain, process, and
understand basic health
information and services
needed to make appropria-
te health decisions.
Purpose:
decision making
Cultural background:
patients’ perceptions of locus of
control, preferences, communi-
cation norms, and prioritization
of needs, as well as in their
understanding of physical and
mental illness and of the roles
of the individual, family, and
community.
Purpose:
dialog for efficient care
Language background:
language is a body of words and the
systems for their use common to a
people who are of the same commu-
nity or nation, the same geographical
area, or the same cultural tradition.
Purpose:
comprehension
language proficiency
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/
Vol142009/No3Sept09/Cultural-and-Linguistic-Barriers-.htm

communication aims
patient level
Languages barriers
- face to the health promotion/prevention;
- face to the contact with a variety of providers and health services;
- reduce comprehension in prescribed medication or to obtain informed con-
sensus.
Sarah Bowen, B. A., M. Sc., Language Barriers in Access to Health Care, Health Canada, 2001
http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/2001-lang-acces/index-eng.php

communication aims
patient level
Negative effects of language barriers on a range of services
Physician and hospital care; long-term care; speech and occupational therapy;
counseling and rehabilitation; community health nursing; pharmacy services;
emergency/ambulance services; participation in cardiopulmonary resuscitation
(CPR) classes; home care; access to out-ofhours services; abuse prevention
and intervention services; support for caregivers of the elderly and disabled;
health promotion and prevention on a variety of topics.

communication aims
patient level
Cultural barriers
Language and culture are inextricably intertwined. Establishing communication
enables all parties in a health encounter to participate in the exploration of the
illness or condition, and to determine together what aspects of the “culture”
of both patient and provider must be considered in diagnosis and treatment.

communication aims
provider level
Languages barriers
It is not feasible to offer even primary care to all communities by a provider
of the same ethnic or language background. Initiatives to increase the number
of physicians speaking a minority language are inadequate as the sole respon-
se, as physician access is only one component of health care. Comprehensive
health system access necessitates dealings with many different health care
providers (e. g. nurses, health educators, imaging technicians, dentists, phy-
siotherapists, and psychologists).
Increasing the number of providers who manage multilinguistic tools for mino-
rity languages develops capability instruments in different settings.
Effective “make-do” solutions in the absence of a formal, defined service.

communication aims
provider level
Models of service language provision
Such services may be provided by:
family members or friends of the client,
bilingual personnel within the health care system,
community language bank volunteers,
medical interpreters who are trained and employed by the health institution,
paraprofessionals with health, outreach, or educational responsibilities, who
include interpretation as part of their role,
other programs or services that address language barriers.

communication aims
provider level
Languages barriers
Interpreter functions or heatlh operator language interventation may take
many forms:
- gain language fluency and proficiency (but... in how many languages?...);
- use of simple, easily accessible products, which can be “understood” by he-
alth care providers (e.g. Translingo, Google Translator, multilingual tools).

communication aims
provider level
Languages barriers
- Increase the number of encounters where client and provider share the same
language (i. e. the number of “language-congruent” encounters);
- provide some form of interpretation.
Increasing the number of language congruent encounters can be accompli-
shed either by:
Increasing the number of providers who speak other languages, or
Increasing the number of providers who manage automatic tools (Google tran-
slator, precompiled multilingual health procedures).

Transcultural Nursing Communication

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