STUDY GUIDE 14

Cultural Considerations for Therapeutic Communication

When answering communication questions the nurse needs to be aware of

certain cultural characteristics relating to the communication process that
may be different from her or his own cultural uniqueness. Questions on the
NCLEX-RN examination may address the concept of communication with a
patient from a specific cultural group. If you note that a question contains
information identifying a specific cultural group, you need to think about
specific cultural characteristics to answer the question correctly.

With regard to communication, there are three cultural characteristics to

consider. These include:
Communication style
Use of eye contact
The meaning of touch
It is important to review the characteristics associated with a specific culture
and to become familiar with them before taking the NCLEX-RN examination.
Identified below are some of the characteristics of specific cultural groups
that you need to consider.

Communication Style

The following sections provide some background information to consider

when developing your communication style with specific cultural groups.

African Americans
 Personal questions asked on initial contact with the patient may be
viewed as intrusive.
 Head nodding by the patient does not necessarily mean agreement.

Asian Cultures
 Asian cultures may believe that feelings and emotions are considered
to be private, and an open expression of emotion is unlikely to be
valued by the patient.
 Silence is valued by the patient.
 Criticism or disagreement is not expressed verbally by the patient.
 Head nodding by the patient does not necessarily mean agreement;
generally this indicates active listening.
 The patient may interpret the word “no” as disrespectful toward
others
 The patient does not use hand gestures.
European (White) Americans
 Silence can be used by the patient to show stoicism, respect, or
disrespect for another, depending on situation.
French and Italian Americans
 The patient may use expressive hand gestures and animated facial
expressions during conversation.

German and British Americans

 The patient may show little facial emotion because these patients
highly value the concept of self-control.

Hispanic Americans
 The patient may use dramatic body language such as gestures or
facial expressions to express emotion or pain.
 The patient may tend to be verbally expressive, yet confidentiality is
important.
 Hispanic Americans may believe that direct confrontation is
disrespectful, and the expression of negative feelings is impolite.

Native Americans
 To Native Americans, silence indicates respect for the speaker. They
are also comfortable with silence when no one is speaking.
 Many of these patients speak in a low tone of voice and expect others
to be attentive.
 Body language is important.
 Obtaining input from members of the extended family is important.

Use of Eye Contact

The following sections provide information regarding how the use of eye
contact is viewed by patients of specific cultural groups:

African Americans
 Direct eye contact may be interpreted as rude or aggressive behavior.

Asian Cultures
 Eye contact is limited and may be considered inappropriate or
disrespectful.

European (White) Americans

 Eye contact may be viewed as indicating trustworthiness.

Native Americans
 Eye contact may be viewed as a sign of disrespect.
 The nurse needs to understand that the patient may be attentive even
when eye contact is absent.

Hispanic Americans
 Some Hispanic Americans believe that avoiding eye contact with a
person in authority indicates respect and attentiveness.
Meaning of Touch
The following sections discuss how touch is viewed in specific cultural
groups:

African Americans
 African Americans may be comfortable with close personal space
when interacting with family and friends.

Asian Cultures
 These patients prefer a formal personal space except with family and
close friends.
 They usually do not touch others during conversation.
 Touching is unacceptable with members of the opposite sex; if
possible, a female patient prefers a female health care provider.
 The head is considered to be sacred; therefore, touching someone on
the head may be considered disrespectful.
 The nurse should avoid physical closeness and excessive touching and
should only touch a patient’s head when necessary, informing the
patient before doing so.

European (White) Americans

 European Americans tend to avoid close physical contact.
 The nurse needs to respect the patient’s personal space.

Hispanic Americans
 Hispanic Americans are comfortable with close proximity with family,
friends and acquaintances and value the physical presence of others.
 The nurse needs to protect the patient’s privacy.
 Hispanic Americans are very tactile and use embraces and
handshakes.
 The nurse needs to ask if it would be all right to touch a child before
examining her or him.