233. CCA Study Notes: How Culture Affects Family, Health Care, and Communication

The Big Picture

Culture can influence how a person understands family, religion, illness, health care, and communication. People from different cultures may have different expectations, beliefs, and ways of expressing themselves.

A support worker does not need to know every belief or practice from every culture. The important point is to recognize that differences exist and avoid assuming that everyone thinks or communicates in the same way.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

How Culture Can Affect Daily Life

Culture includes the shared language, values, beliefs, customs, habits, ways of life, rules for behaviour, music, and traditions of a group.

Culture can influence how people deal with daily situations and problems. It can affect beliefs and behaviours involving:

• family and social organization
• religion and worship
• health care and reactions to illness
• communication

You cannot completely understand every belief and practice from every culture. You do need to recognize that culture can influence how a person thinks, behaves, and responds.

Culture and Family Life

Culture can affect both family structure and the roles family members take during illness.

For example, some cultures expect adult children, especially daughters, to care for older parents.

Common Family Structures

A nuclear family consists of two partners and one or more children living together and sharing responsibility for raising the children.

Single-parent families, also called lone-parent families, have one adult head of the household without a partner sharing the home.

A blended family includes a couple with two or more children. At least one child is the natural child of one or both partners, and at least one is a stepchild of one partner.

A same-sex family consists of two adults of the same gender living together in a loving, intimate relationship. They may or may not have children.

Western Family Patterns

Western culture often emphasizes self-reliance and independence.

Children are generally encouraged to become self-sufficient. Most young adults leave the family home and live independently from their parents and siblings.

Care for relatives outside the nuclear family, such as grandparents, aunts, or uncles, is often given to people outside the family.

Extended Families

Extended families can include a couple, their children, parents, siblings, and the children of siblings.

In some Asian, South Asian, and Indigenous cultures, extended families commonly live in one household. The needs of the whole family may take priority over individual needs.

Older family members and people who are ill are often cared for within the family. In Vietnam and China, all family members are involved in caring for a family member who is ill. Family members bathe, feed, and comfort the person.

People from these and similar cultures continue this custom in Canada, and a person who is ill is often surrounded by family.

Cultural Conflict in Families

Children of first-generation immigrants sometimes reject the roles and behaviours expected by their parents and prefer those of the new culture. This can create stress within the family.

Cultural conflict refers to negative feelings and behaviour that can result when people from one culture try to impose their values and behaviours on people from another culture.

Culture, Religion, and Spirituality

Religion can influence many parts of daily life, including:

• habits and behaviour
• relationships
• diet
• times of worship
• beliefs about birth and birth control
• attitudes toward medicine and healing
• beliefs about death

During illness, some people rely on religion or spirituality for comfort and support. They may want to pray, follow religious or spiritual practices, or meet with a spiritual advisor or religious leader.

CCA action: If a client asks to see a spiritual advisor or religious leader, promptly report the request to your supervisor. Tidy the client’s room for the visit and provide privacy.

Clients may follow many different religions, or no religion at all. Their beliefs may differ from your own.

Respect Religious Beliefs and Items

Trying to convert a client to your own beliefs is spiritual abuse.

Refusing to allow a client to receive spiritual care is also spiritual abuse.

Respect the client’s:

• beliefs
• practices
• religious symbols
• religious items

Must not: Do not touch or move a client’s religious item unless the client gives you permission.

Examples of religious items include a rosary, yarmulke, prayer rug, icon, or religious medal.

All clients have a right to spiritual care. In most facilities, registered staff or a spiritual counsellor or chaplain is responsible for making sure a requested religious representative visits the client.

Culture, Health Care, and Illness

Culture can affect how people understand illness, what they believe caused it, and how they cope with being ill.

Different Beliefs About Illness

In Western culture, illness and disease are generally viewed as resulting from biological or environmental factors. There is also a general belief that illness can often be prevented and that scientifically proven methods can provide care or a cure.

Other cultures may connect illness with:

• supernatural forces
• an imbalance with nature
• a lack of harmony among mind, body, and spirit

People may use traditional practices such as:

• charms
• rituals
• alternative medicines
• traditional or folk medicine
• herbs
• traditional healers or shamans

These practices may have been passed from one generation to another.

Alternative and Folk Remedies

A folk remedy may help a person or have no effect on their health.

When a practice does not harm the client and supports emotional well-being, the nurse or case manager would likely include it in the care plan.

Some remedies may interfere with medical treatment. For example, some herbal medicines may interact with prescription drugs and cause harmful results.

Clients do not always tell their physician, nurse, or case manager that they use alternative therapies or cultural health practices.

Key fact: The health care team must know about all health care practices so the team can make sure they are not harmful.

Report: Tell your supervisor when:

• a client tells you they use alternative or folk remedies
• you observe a client using alternative or folk remedies

Culture and Communication

Communicating across cultures can be challenging because the same message, word, gesture, or behaviour may have different meanings.

A support worker needs to communicate clearly with clients and families and check that the intended meaning is understood.

Communication should follow DIPPS:

• dignity
• independence
• individualized care
• preferences
• privacy
• safety

Words and Phrases Can Carry Different Meanings

A word or expression that sounds harmless in one culture may sound insulting or vulgar in another.

Avoid words or expressions that the client might misinterpret.

Words may also carry painful historical meanings. This is especially important when communicating with Indigenous peoples in Canada because some language is connected with colonial policies ⓘ and residential school experiences.

Terms and Phrases to Avoid When Communicating With Indigenous Peoples

Pre-history: Avoid this term because it suggests Indigenous history began with European arrival. Indigenous cultures have creation stories from before European arrival. Avoid saying the Americas were “discovered.” An estimated 100 million Indigenous peoples were living in the Americas when Christopher Columbus arrived. Use precontact and postcontact when dividing the timeline.

“Canada’s Indigenous peoples”: This wording suggests ownership. Use “Indigenous peoples in Canada.” Apply the same approach to provinces and cities.

“Equality”: The Indian Act was designed to assimilate ⓘ Indigenous people. In practice, it segregated and marginalized Indigenous people, restricted participation in the local economy, forced children to attend separate schools, outlawed traditions and culture, and restricted contact with Euro-settlers.

People living on reserve have often faced poor housing and unsafe water, poorer health, lower education, lower employment, and higher incarceration ⓘ. Until 2008, the Canadian Human Rights Act did not give Indigenous people under the Indian Act full access to human rights protection. Before 1960, Indigenous people were denied the right to vote unless they gave up Indian status and Treaty Rights.

The words equality and equal carry a history in which equality was tied to giving up constitutionally protected rights or human rights to remain who they are as a people.

“We’re here to help”: Indian agents ⓘ used the longer government phrase to describe Indian Act policies intended to change Indigenous people into something other than who they were. For over 140 years, this history was connected with poorer health, unsafe housing and drinking water, lower education and employment, and higher incarceration and suicide rates.

A more respectful approach is to recognize that you have information to share while also having more to learn.

“Your file”: Do not refer to a person or community as a file. This wording has a dehumanizing effect and reduces people or communities to paperwork.

Interpreters and Language Differences

Some clients speak a different language or dialect ⓘ. Other clients may be deaf or hard of hearing.

An interpreter might be:

• a family member
• a staff member who speaks the client’s language or a similar language
• a paid translator

In some situations, a paid translator must be called to interpret for the client, especially when legal consent ⓘ is necessary.

Sometimes an interpreter is not available. In those situations, you still need to find ways to communicate with the client.

Communicating When You Do Not Share a Language

Use these approaches:

• Communicate comfort through your tone and body language.
• Do not shout or speak loudly. Loud speech does not help someone understand English.
• Speak slowly and clearly.
• Keep messages short and simple.
• Notice words the client appears to understand.
• Use gestures or pictures.
• Repeat the message in different ways.
• Avoid technical terms, abbreviations, and slang.
• Learn a few useful words or phrases in the client’s language.

Useful words might include “Toilet?”, “Pain?”, “Cold?”, or “Hungry?”

Check for Real Understanding

A client who nods or says “yes” to every question may not understand what you said.

Ask the client to repeat what you told them when you need to check understanding.

Before a procedure: Be certain the client understands what will happen and consents before you begin.

Body Language

Communication involves more than spoken language.

Body language includes gestures, posture, and facial expressions. These signals can communicate information about a person’s physical, mental, or emotional state.

Culture can influence both:

• the body language a person uses
• how a person interprets someone else’s nonverbal communication

Do not assume that the same nonverbal signal means the same thing to everyone.

Touch

Touch is an important type of nonverbal communication, but cultures have different expectations about:

• who may touch whom
• when touching is acceptable
• which parts of the body may be touched

Some Spanish, Italian, French, and South American cultures tend to use touch more freely.

Some English, German, and Chinese cultures tend to be less comfortable with casual touch from strangers.

Individual people within the same culture also differ in how comfortable they feel with touch.

Must: Obtain consent each time you need to touch a client while providing care.

Some cultural expectations about touch also involve gender. For example, men in Indian and Vietnamese cultures may shake hands with men but not with women.

Pay attention to the amount and type of touch the client appears comfortable with. Ask your supervisor for guidance and observe how the client interacts with family members and other people.

Safety: A support worker’s touch should be gentle, never hurried or rough, and never sexual in nature.

Personal Space

Personal space is the area immediately around a person’s body.

Personal-space preferences differ from person to person. Culture can influence these preferences, but life experiences can influence them too.

People from the same cultural group often have similar preferences, but exact distances still vary between individuals and situations.

In Western cultures, most people prefer about 90 cm (3 feet) of distance when speaking.

People from other cultures may prefer more or less distance.

A client may be telling you that you are standing too close if they:

• step backward
• turn so they do not face you directly
• move their chair away

Respect these signals and avoid invading the client’s personal space.

Eye Contact

Eye contact does not have one universal meaning.

In Western cultures, eye contact commonly communicates:

• openness
• interest
• attention
• honesty
• warmth
• a positive self-concept

A lack of eye contact may be interpreted as rudeness, guilt, dishonesty, shyness, or embarrassment.

In some Asian and Indigenous cultures, direct eye contact can be viewed as disrespectful or an invasion of privacy.

In Indian culture, eye contact with people from a higher or lower social and economic class is usually avoided.

Facial Expressions

Some facial expressions are similar around the world. Expressions linked with pain, surprise, embarrassment, and happiness are examples.

Cultures still differ in how much people use facial expressions.

Many Italian and Spanish people tend to use facial expressions and gestures frequently when communicating happiness, pain, or displeasure.

Many Irish, English, and northern European people tend to use fewer facial expressions, especially with strangers.

A facial expression does not always show what a person feels. In some Asian cultures, for example, a person may smile while hiding negative emotions.

Silence

Silence can also communicate different things.

• In some English and Arabic cultures, silence is commonly used for privacy.
• In Russian, French, and Spanish cultures, silence often indicates agreement.
• In some Asian cultures, silence may show respect, especially toward an older person.
• In some Indigenous cultures, silence is considered a virtue, with speaking reserved for matters of major importance.
• Among most Indigenous, Chinese, and Japanese people, silence is used as a communication aid and gives the listener time to think before the speaker continues.

The important lesson is not to assume that silence has one meaning for everyone.

Common Mix-Ups

Wrong Idea	Better Idea
Everyone from one culture has the same touch and personal-space preferences.	People within the same culture still differ in their comfort with touch and personal space.
A nod or “yes” always proves understanding.	The client may not understand. Check by asking them to repeat the message.
Eye contact always shows respect and attention.	Eye contact has different meanings across cultures.
Silence always means the same thing.	Silence may communicate privacy, agreement, respect, or time to think.
Folk remedies do not need to be mentioned.	Tell your supervisor when a client uses or reports using alternative or folk remedies.
Touch is acceptable if it is part of care.	Obtain the client’s consent each time touch is needed.