What training is necessary for health care providers to become effective intercultural communicators? Since we have lived in a globalized world we need to be aware of the cultural diversity in the worldviews of other people. This is especially true in the health care. People from different cultures hold their own special beliefs about health care, illness and even about death. The ignorance of different cultural orientations of various groups in society may cause many misunderstandings between the health care providers, patients and their families.

The health care organizations should try hard to provide their patients effective and respectful care that is compatible with their cultural health care beliefs (Like, 2011: 196-206). My essay is focused on those skills that are absolutely necessary for the health care providers to be able to work and communicate with the patients from different cultural backgrounds. First of all the term of cultural competence is explained. Another part of the essay deals with various health care beliefs and the third part focuses on the communication itself.

Cultural competence Cultural competence is now important for the health care policy makers, providers, educators etc. because of the need to improve a quality of patient service and also to eliminate racial and ethnic disparities in the health care (Betancourt, et al. , 2005: 499-505). Nursing staff that is culturally competent has got the ability to understand cultural differences. They are “sensitive to issues related to culture, race, ethnicity, gender and sexual orientation.

Furthermore, culturally competent nurses have achieved efficacy in communication skills, cultural assessments, and knowledge acquisition related to health practices of different cultures” (Maier-Lorentz, 2008: 38). Being informed about different cultural perspectives of the patients is useful and necessary in many situations. It helps the health care providers to understand for example the process of patient? s decision making about a blood transfusion. Culturally competent nurse would know that Jehovah? s Witness cannot accept the blood transfusion because of his belief (Maier-Lorentz, 2008: 37-43).

Cultural issues should be a part the curriculum of nursing schools. Students of medicine and nursing schools should be trained in cultural competence since the very beginning of their studies. There should be workshops that would enable them to try to solve these kinds of issues in practice before they face them in a real professional experience (Britt, 2010: 84-96). Understanding of own culture If the health care providers want to be really culturally competent, it is necessary to point out the importance of the knowledge and understanding of their own culture.

Nursing staff must understand their own beliefs and attitudes first to know in which way their worldview is influenced by their own culture values. They should be also aware of the cultural bias that may arise from the worldview. Understanding the culture in which they were raised, decoding their worldview and being aware of the personal orientations will help the health care providers to avoid stereotyping (Samovar, et al. , 2013: 340). Stereotyping and discrimination could jeopardize the ability of nursing staff to understand and accept cultural beliefs of their patients that differs with their own convictions.

It is necessary to realize that to think for example that all Muslim women are subordinate to their husbands so the doctor should consult the woman? s health condition with her husband first is also a stereotype (Maier-Lorentz, 2008: 37-43). Learning about different health care beliefs Culture influences what meaning we give to the illness and health. The best way how to learn more about the health care beliefs and practices is to have experiences from different cultures. The physicians and the nursing staff should be supported to go for the internships abroad during their studies.

The different health care beliefs of the physicians, nurses and the patients are strongly influenced by the different worldviews. The different convictions and attitudes to the health care can undermine the cooperation of the physicians and the patients and they may disrupt their mutual trust. If the health care providers work in a multicultural environment and if they want to provide a complete transcultural health care, they should first understand the patient? s beliefs and they should also know from which cultural background the patients and their families come from.

According to what the patient and his or her family believe in the physicians should draw up a treatment plan (Samovar, et al. , 2013: 338 – 343). It is very important to find out how big role the patient? s family plays in his life and health care. In fact there are some cultures, in which the family as a whole does the health care decisions. These are usually collectivistic cultures, where people were born to the extended families. The nursing staff should be informed about this fact and they should also know who the authority in the family is.

Those persons are then considered as the spokespersons and they will mainly communicate with the health care providers (Samovar, et al. , 2013: 338 – 343). The relationship of the patient and his or her family is also closely associated with the cultural diversity in beliefs about death and dying. In some cultures, the family is the first one who should be informed about patient? s unpleasant diagnosis. It is up to family members then to tell the patient the truth about his or her health condition. In individualistic societies as the USA the patient?

s right to know is respected. The patients in these cultures must be informed about their condition first and it is prohibited to share their medical information with someone else without patient? s written consent. The health care providers should ask the patient first who should be given the information about his or her condition. Some cultures rather avoid this topic, because they believe that if the patient knew about his or her desperate situation, it could make the process of dying faster. In some cultures talking of death is even taboo.

The culturally competent nursing staff has to know how to lead discussion with the patients about death and dying (Samovar, et al. , 2013: 341 – 342). It is also important to realize if the patient comes from the high-context or low-context society. The communication with the patient from the low-context perspective can be open and the physicians can directly tell the patient what the problem is. However, people from the high-context cultures would rather get just cues from the context of the situation (Samovar, et al. , 2013: 194-340).

These various beliefs also include the ideas about control of life events. People, who believe that they have some control of what is going on in their lives, will tend to believe they have a control over the healthcare too. It will be easier to develop their positive health care habits. However, some patients could feel they have less control of their lives, so they could be more fatalistic in their worldview and in the view about health. The cooperation with these patients will be much more difficult, because they will probably have a problem with complying with a medication regime.

These patients will need to be taught about diet and medications more than the first mentioned group (Maier-Lorentz, 2008: 37-43). Another thing that must be considered is the fact if the patient believes in a Western biomedical view of illness or if he or she believes in some alternative view of illness. The health care belief systems can be divided into these categories: scientific/biomedical, holistic and supernatural, which means religious attitudes to the health care. Each of these systems has its own ideas about illness, its causes, treatment and prevention (Samovar, et al. , 2013: 330-340).

The culturally competent nursing staff will be aware of all these differences and they will include the consideration of them in the treatment plan. The treatment plan should be tailored for each patient individually. The nursing staff for example should also know which foods are acceptable in each culture, because for example Muslim patients are not allowed to eat pork. All of these little things are very important for being good at providing a transcultural health care. Cross-cultural communication Cultural competence also consists of the ability to have a dialogue with the patients about their cultures (Staton, et al.

, 2013: 1-6). To conduct the interview is the easiest way to elicit important information about the patient and his or her health care beliefs and to determine effective treatment (Samovar, et al. , 2013: 340). Qualitative studies that have been written about this topic have shown that communication problems cause the incompetence of the health care staff to provide culturally competent health care (Maier-Lorentz, 2008: 37-43). Language barriers make the communication with patients from the different cultural backgrounds much more difficult. However, effective communication is essential to determine accurate diagnose and health care.

If the patient and the physician do not speak the same language and it is impossible to communicate, an interpreter is necessary (Taylor, et al. , 2013: 35-43). It would be much better if health care providers spoke more languages by all means. However, when the doctors and nurses do not master many languages, it is very useful to understand at least nonverbal cues used by different cultures. Nonverbal meanings of the communication Eye contact is one of the most important nonverbal means of communication and it is also something that is accepted differently in all cultures.

For example American nurses are supported to look in the eyes of the patients. On the other hand “Hispanics use eye contact only when deemed appropriate by their cultural standards. In a health care environment, Hispanic patients expect that nurses and other health care providers give direct eye contact when interacting with them, but it is not expected that Hispanic patients reciprocate with direct eye contact when receiving medical and nursing care” (Maier-Lorentz, 2008: 39). Another important part of nonverbal communication is touching. American nursing staff is taught to use a touch as a therapeutic method.

However, they must be aware of the fact that for example in Arabic and Hispanic cultures the male physicians are not allowed to touch certain parts of female bodies (Maier-Lorentz, 2008: 37-43). It is very similar case as the space and distance nonverbal means of communication. Sometimes it is very difficult for the health care providers to distance themselves from the patients, because to nurse the patients is almost impossible from afar. The only thing the nursing staff can do is to be informed about space and distance issue in different cultures and to respect the needs of the patients (Maier-Lorentz, 2008: 37-43).

Being good at nonverbal communication also enables the nursing staff to assess pain of the patient. “Pain Assessment is especially important for nurses to conduct on persons from diverse backgrounds. Pain is a very subjective feeling because patients describe the sensations differently and have different tolerance levels for pain” (Maier-Lorentz, 2008: 40). This is the reason why it is very important for the physicians and nurses to examine their own beliefs about pain and pain control first. Without doing this they cannot be objective in pain assessments of their patients.

Nonverbal communication is very useful in this case, because the health care providers can read from the facial expressions and body language how their patients feel (Maier-Lorentz, 2008: 37-43). Caring of elderly Chinese patients We can use Chinese patients as an example, what the culturally competent health care providers must take into account when they are caring of them. Concepts of health care and disease are bonded with the majority of Chinese religious and cultural beliefs. Many of old Chinese people will seek Western medicine just when their situation is really serious.

They usually delay seeing a Western doctor, because the fact they need him is in their eyes a sign of failure. They usually believe in the alternative Chinese medicine in which the prevention plays a major role. If the Chinese patients fail in paying attention for their health status, they need to see the Western doctor. The understanding of illness is also strongly influenced by the Chinese medicine view and qi and yin-yang concepts, so the patients probably won? t have a compatible language to discuss their body and health condition. It will be very hard for the nursing staff to get some deep patient?

s feelings, because Chinese people tend to perceive expressing their opinion as a danger they could lose their face. (Visscher, 2006: 1448-1449) The most important thing the health care providers must respect is the patient? s close relationship with his or her family. The family must be allowed to provide as much care as possible, because they will want to regain harmony of the patient. The health care providers may expect the request from the family members to not reveal the diagnosis or bad prognosis to the patient (Visscher, 2006: 1448-1449).

Death is an important issue in Chinese culture and Chinese families too. However, Chinese people believe that talking about death openly can make the process of dying faster. The health care providers should rather use the metaphors or euphemisms instead of talking about death and dying directly. The nonverbal communication is also extremely valuable to advance further communication with patient and his or her family (Visscher, 2006: 1448-1449). If the death occurs the Chinese family will want to pray and they will probably seek for example the Buddhist monk to help them with rituals.

The family will need privacy and they should not be hurried out of the hospital and the health care providers should not interrupt them. However, if it is possible the patient will want to die at home (Visscher, 2006: 1448-1449). The most important issue in caring of Chinese patients is to lead a careful communication with the patient and his family who must be taken as a whole (Visscher, 2006: 1448-1449). Conclusion We live in the escalating multicultural societies so it is vitally important to create a solid base of culturally competent nursing staff that will be skilled in identifying particular cultural patterns.

At the very beginning of the training there must be the willingness and the determination to get to know new cultures. It is undoubtedly a big challenge for the health care providers to take the path of transcultural health care, but it is not impossible to deal with this issue. Even though the culture competence requires lots of skills, the most important of them are not so special. It is sufficient to be mainly humble and open-minded. In short if the health care providers manage to take off their own cultural glasses and if they learn to listen to others, the gateway to success in communicating with patients from other cultures is open.