Culture, Communication and Nursing

Philip Burnard, Paul Gill

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9781138837577
• eBook ISBN: 9781317904038
• Topic: Medicine
• Subtopic: Health Care Delivery

Good communication is an essential part of delivering effective nursing care. Nursing students work in a variety of multicultural settings and therefore it is imperative that they fully understand their own cultural context and that of others.

This text illustrates the important differences between cultures and how these differences can enhance practical nursing. Through the comprehensive use of case studies and interactive exercises, the book invites students to reflect on their own knowledge and skills about culture so that they can learn to communicate in a more effective and culturally sensitive way. All theory is applied to nursing practice to demonstrate how situations can arise and be dealt with appropriately whilst working on clinical placement.

This text is written for students studying the CFP at Year 1. Communication will be studied either as part of a Professional Issues module, or Nursing Practice.

Chapter 1

Thinking about culture

Learning outcomes

At the end of this chapter, you should be able to:

define culture

relate culture to nursing practice

think about how culture defines you, your family, friends, patients and colleagues

identify different types of culture

Introduction

This opening chapter first offers some general ways of thinking about culture. It examines different uses of the term, from ‘popular culture’ to ‘anthropological views of culture’. The second half of the chapter identifies more formal definitions of culture, and discusses some of the key issues and debates surrounding the concept of culture.

Culture

Culture, and an understanding of it, is an essential part of nursing, particularly in multicultural societies such as the UK. As nurses, we come from a particular cultural background, as do those with whom we work and those we care for. In the process of meeting and caring for others, we come face to face with the meeting of cultures.

The term ‘culture’ is used the world over. Newspapers report that people coming to the UK should learn about UK culture. There is now even a ‘culture test’ for those who want to become UK citizens. Politicians, community leaders and sections of the media also emphasise the importance of UK citizens respecting other cultures. In other contexts, phrases such as ‘drug culture’ or the ‘rap culture’ may be referred to. But are all of these concepts referred to in the same or similar ways? It might be useful to explore some of the different ways in which the word culture is used. Before that, consider the following:

Question for reflection

How would you define the word ‘culture’?

The term and the concept of ‘culture’ are often used in different ways. For example:

High culture This is usually used to refer to the arts – music, painting, sculpture, dance and so on (Gans, 1999). Different styles of art exist in different parts of the world, and what is considered beautiful in one country may not necessarily be viewed that way in others. Sometimes, in history, attempts have been made to censor or direct what may pass as art. In the Stalinist period of Russian communism, for example, composers and painters were encouraged to produce works that appealed to ‘the people’, and were sometimes condemned for producing work that was considered too highbrow (Gans, 1999). In some languages this is the only definition of the word ‘culture’: in those languages, culture refers only to the arts.

Popular culture This is usually seen as part of academic studies into the everyday and changing patterns of what ordinary people are interested in. Thus a person who studies popular culture might be interested in comics, pop, rock and other sorts of music, fashions, language styles and so on (Collins, 2002). Interestingly, for a discipline that concentrates on the everyday lives of people, the literature that arises out of popular culture studies is often extremely difficult to read because of the complex language chosen by many of those who write in that field.

Subcultures This refers to subsections of any particular society. Thus, in the UK, examples of subcultures may be ‘Goths’, those who take drugs, those who are very religious (or even those of a particular religious sect). A broader example of subculture (and one that overlaps with popular culture) is the idea of a ‘youth subculture’, a means of grouping together all young people as likely to be interested in certain things that older or much younger people may not be interested in.

Culture from an anthropological perspective This is the sense in which culture is being discussed in this book. As we shall see from the next section, called ‘Formal definitions of culture’, the use of ‘culture’ in this way refers to the ways in which people in a given society live together, and how they communicate with each other (Hendry, 2008). Culture in this sense also refers to how people behave, interact, and live together in a social sense: their religious views (or lack of them) and practices, the ways in which they organise their society, make laws, educate others, even how they talk to each other (Rapport and Overing, 2006). We can, for example, talk about the culture of the UK or the culture of Japan, and in doing so notice some similarities but also some considerable differences. We will probably find that if we visit a culture that is very different from our own, we simply will not always know what is going on. We do not know why people do or say the things that they do.

However, it is important to remember that culture is something we all have: it is not confined to ‘other people’, and it is certainly not confined to ethnic minority groups, even if their culture appears to be vastly different from our own (which is when we tend to notice ‘culture’ most). If the cultural beliefs and practices of others seem strange to us, then the converse is also likely to be true, i.e. our own beliefs and practices may seem strange to others. The point to remember here, particularly in a nursing context, is that we are all cultural beings. For example, in a nursing context, we may be surprised at the ways in which patients, doctors or nurses are treated. All of these things happen, perhaps, because we constantly compare other cultures with our own. There is often an expectation among people that others will be like ‘us’, and of course sometimes they are and sometimes they are not.

One of the key issues in understanding another culture is being able to speak the language of the country in which that culture is located. Language is an important way in which culture is conveyed (Barnard and Spencer, 2002). However, even in countries where the language is the same, the cultural use of that language may lead to misunderstandings. A simple example of this is a comparison of the UK and the US senses of humour. Sometimes, both groups can understand each others’ humour. At other times, however, things that people in the US find funny do not seem in the least bit funny in the UK, and vice versa.

Social anthropologists, like psychologists and sociologists, study people, albeit usually in a social context (Hendry, 2008). This will be discussed further later, but it is worth making a few points here. Anthropology has changed over many decades. Traditionally, anthropologists tended to be from the West (particularly the UK, France and North America), and primarily conducted research with people from ‘exotic’, small-scale, nonwestern societies (Kuper, 1996), which tended to be very different from their own. In conducting such research (described as ethnographic fieldwork), anthropologists would visit a particular country for varying lengths of time – often several years – make notes of their observations and conversations, and then write up an explanation of what was occurring in that society, particularly in relation to human beliefs and behaviours. Because of the frequent differences between the society of the anthropologist and that of the people they were studying, anthropologists were able to take an objective outsider view of that society. This would effectively allow them to compare and contrast beliefs, views and behaviours between the two cultures (Evans-Pritchard, 1962). However, modern social anthropology is now equally concerned with conducting research among people in western societies.

A more recent debate among anthropologists has concerned the appropriateness and ability of a person from outside a culture to enter that culture and really understand it. This has led to accounts of cultures being obtained as a process of negotiation between an ‘insider’ (i.e. a person who lives within the society being studied) and a cultural outsider from another culture (e.g. the anthropologist). Most recently, however, there has been debate about the appropriateness and relevance of the very notion of ‘culture’ itself (Agar, 2006) – this is discussed further later on in the chapter. There is certainly a danger in thinking that all people in a particular culture will behave in the same or similar ways, and this leads to debate about whether cultural influences are the main things that motivate people (Barnard and Spencer, 2002) or whether other factors, including individual choice, influence human behaviour and can also, perhaps, even override a person’s cultural conditioning.

That last point may usefully be elaborated a little. Many children, as they move into adolescence, challenge their parents’ views and the cultural norms that those parents, and even their society, live by. When, in turn, those children become adults and have children themselves, they usually find that their offspring also question, in the same sorts of ways. Does this mean that the culture is constantly changing, or that, as individuals grow, they choose to think for themselves? There is probably a middle ground here. Humans are certainly influenced by the culture in which they grow up and live, but we are conscious, thinking beings, who can either go along with society and cultural norms or choose to live differently. We will return to this issue later in this chapter, but first it may be useful to explore other opinions about culture.

Some formal definitions of culture

As already noted, all humans live within and are influenced by culture, yet most of the time our own culture is taken for granted. We usually only notice culture when we see someone else’s, particularly if it is different from our own. This chapter explores the notion of culture and relates it to international differences in interpersonal communication.

The term ‘culture’ is used widely, albeit often inappropriately and, occasionally, incorrectly. Leach (1982) maintains that, over the years, culture as an anthropological concept has undergone many transformations, to the extent that there is now no consensus about how the term should be used. Although many definitions of culture exist, the concept, much like health, is somewhat difficult to define unequivocally. Many people have an idea of what culture is, but would probably find it hard to describe.

Sapir (1948), defines culture as embodying any socially inherited element in the life of man, material and spiritual. In Linton’s (1945) terms, the culture of society is the way of life of its members: the collection of ideas and habits which they learn, share and transmit from generation to generation. Harris (1999) asserts that a culture is the socially learned ways of living found in human societies, and that it embraces all aspects of social life, including both thought and behaviour. In the field of nursing, Leininger (1991) provides a more concise definition for the concept of culture as the ‘learned, shared and transmitted values, beliefs, norms, and lifeways of a particular group that guides their thinking, decisions, and actions in patterned ways’.

Kluckhohn (1969) offers a breakdown of possible definitions, as follows. First, culture covers the total way of life of a particular set of people. Second, it refers to what individuals acquire from the group they belong to. Third, it is about ways of feeling, thinking and behaving. Fourth, it is an abstract way of looking at behaviour. Fifth, it is anthropological theory (and more will be said about this later). Sixth, it is a collection of pooled learning. Seventh, it is a set of responses to recurrent problems in a particular group. Eighth, it is about learned behaviour. Ninth, it refers to a way of regulating behaviour. Tenth, it is a set of ways for adjusting to the environment and to other people. Eleventh, it is what emerges from history; and twelfth, it is a map of behaviour.

Culture is often described as that which includes knowledge, belief, morals, laws, customs and any other attributes acquired by a person as a member of society (McLaren, 1998). Nemetz Robinson (1985) made the following distinction about definitions of culture: some definitions refer to culture as observable phenomenon and behaviour, and some definitions reflect the idea of culture as not observable – something that is going on ‘under the surface’.

Thus culture may involve observable behaviours but also a felt sense – a sense, perhaps, of identity, of who we are. When we communicate interculturally, we not only communicate words and ideas but also something of ourselves and of our roots.

The value of the study of culture to nursing is fairly clear, and it is a study that is usually undertaken under the umbrella of the discipline of anthropology. Ellsworth (1994) offers a useful summary of some of the reasons why we might apply a study of culture to nursing. She suggests that cultures differ in their definitions of thi...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Publisher’s Acknowledgements
• Introduction
• Chapter 1. Thinking about culture
• Chapter 2. Communication, nursing and culture
• Chapter 3. Communication skills
• Chapter 4. Culture and communication in Thai nursing: an example of a different culture
• Chapter 5. Learning culture
• Chapter 6. Beliefs and religion
• Chapter 7. Cultural pitfalls, advice on working in the UK, and culture and stress in nursing
• Chapter 8. Developing cultural awareness
• Glossary
• References
• Index