Transcript Communicating with Clients & Families: Interviewing Skills Emily Eckley MS, RD [email protected] Celebrating Diversity Conference April 28, 2006

Communicating with
Clients & Families:
Interviewing Skills
Emily Eckley MS, RD
[email protected]
Celebrating Diversity Conference
April 28, 2006
Objectives
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Describe the steps to take when preparing to interview
a client & their family.
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List the skills needed to conduct culturally appropriate
interviews.
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Ask culturally appropriate questions when working with
a client & families from another culture.
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Describe the cultural influences on verbal and non
verbal communication.
Plan
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Define culture
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Discuss components of a culturally appropriate
interview
Before the interview
 During the interview
 After the interview
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Skill Building: Case Study
Culture
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Integrated pattern of human behavior that
includes:
Thoughts, communications, languages
 Practices, beliefs, values, customs
 Courtesies, rituals, manners of interacting and roles,
 Relationships & expected behaviors
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Of racial, ethnic, religious or social group
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The ability to transmit the above to succeeding
generations
National Center for Cultural Competence, 2006.
An Iceberg Concept of Culture
Dress • Age
Race/Ethnicity
Gender • Language
Eye behavior • Facial expressions
Adapted by the
Body language • Sense of self
NCCC
Notions of modesty
Concept of cleanliness • Emotional response patterns
Rules for social interaction • Child rearing practices
Decision-making processes
Approaches to problem solving• Concept of justice
Value individual vs. group • Perceptions of mental health, illness,
disability • Patterns of superior and subordinate role in relation to
status by age, gender, class
And much more……
National Center for Cultural Competence, 2006
An Iceberg Concept of Culture
The iceberg concept of
culture is widely used and
available in the public
domain, for example see:
Culture Matters www.peacecorps.gov
Or
www.genderandpeacekeeping.org
National Center for Cultural Competence, 2006
Culturally Sensitive Interviewing
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Before the Session
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During the Session
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Develop self-awareness
Increase knowledge of commonly held cultural beliefs &
interacting styles of patients/clients
Complete an assessment by conducting a cultural interview
After the Session
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Make a plan to negotiate between the culture of the
patient/client & the medical culture
Pachter & Harwood, 1996
The First Step – Increase Your
Own Awareness
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“Know Thyself ”
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Beliefs
Values
Lifestyles
Practices
Complete Cultural Self-Assessment
National Center for Cultural Competence
http://gucchd.georgetown.edu/nccc/
Campinha-Bacote, 2003.
Pederson, 2002.
Ways to Increase Self Awareness
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Recognize communication styles
Learn about cultural & linguistic differences
Develop interest in other cultures
Become sensitive to myths and stereotypes
Be able to discuss your own culture
Explore your own values
Learn about relationships
Pederson, 2002.
Preparing for the Interview
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Seek to increase Cultural Knowledge
 Process of learning about basic world views of different
cultures
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World view is:
 The set of explanations used by a group of people to explain
life’s events
 Includes explanations about nature of:
 reality
 knowledge
 reason or logic
 relationships
Boyle & Andrews, 1995.
What Knowledge Is Needed?
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History of culture
Roles of:
 Education
 Money
 Values
 Attitudes
 Behaviors
Communication styles
Language & slang
Resources for teaching & learning
How culture is perceived
Other information
Pederson, 2002.
How To Prepare
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Read
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Ask
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Engage
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Observe
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Analyze
Meaningful Exchange, 2005.
During the Session
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Develop & utilize culturally appropriate
interviewing skills
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Conduct a cultural interview
Client centered interviewing
 Understanding a client’s social situation
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Navigate the complexities of communicating
across cultures
Cultural Interviewing Skills
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Awareness
Solid knowledge foundation
Clear communication
Sense of humor
Honesty & genuineness
Innovation
Flexibility
Empathy
Respect, value , care, & trust
Bauer & Sokolik, 2002
Utilizing the Skills
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Listen respectfully
Use the teaching & learning techniques of other
cultures
Establish empathic rapport with persons from
other cultures
Analyze feedback accurately
Develop new ideas
Make it fun!
Pederson, 2002
Conducting Cultural Assessments
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EVERY client should have a cultural interview
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Information from the interview should be used
to form a culturally relevant treatment plan
Campinha-Bacote, 2003
Client Centered Interviewing
Model
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Focuses on client experiences
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4 dimensions of this experience:
Ideas about what is wrong
 Feelings, especially fears, about being ill
 Impact of problems on own functioning
 Expectations about what should be done
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Stewart, 1995
Questions for Client Centered
Interviewing
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“What do you call the problem?”
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“What do you think caused the problem?”
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“How bad is it?”
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“Why do you think it started when it did?”
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“How does it affect your life?”
Kleinman, 1978
Questions for Client Centered
Interviewing
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“What kind of treatment do you think will
work?”
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“What do you fear most about the problem?”
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“How can I be of most help to you?”
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“What other remedies or treatments for your
problem have you used?”
Kleinman, 1978
Learning More About the Client
How Environment has
Changed
Control Over
Environment
Social Stressors &
Support Networks
Literacy & Language
How to Learn about Client’s Social
Experience
How Environment has
Changed
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“Where are you from?”
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“Why did you decide to come to this country?”
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“When did you come?”
Source: Carrillo, 1999
How to Learn about Client’s Social
Experience
Control Over
Environment
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“How much of a problem is money in your life?”
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“Are you ever short of food or clothing?”
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“How do you keep track of appointments?”
Carrillo, 1999
How to Learn about Client’s Social
Experience
Social Stressors &
Support Networks
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“What is causing the most stress in your life?”
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“How do you deal with the stress?”
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“Do you have family or friends that you can call on for
help?”
Carrillo, 1999
How to Learn about Client’s Social
Experience
Literacy & Language
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“What trouble do you have reading your medication
bottles or appointment slips?”
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“What language do you speak at home?”
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“Do you have a hard time communicating what you
want to say to your healthcare providers?”
Carrillo, 1999
Navigating the Complexities of
Communication
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Most people assume that the most important aspect of
communication is verbal
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Much of our meaning is communicated nonverbally
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Interpreting nonverbal communication can be
challenging when interacting with someone of a
different culture
Mutha, 2002
Verbal Communication
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Language
 Spoken
 Written
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Degree of directness
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Loudness/Pitch
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Appropriate subjects for conversation
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Emotional expressiveness
Randall-David, 1989
Nonverbal Communication
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Facial expressions
Gestures
Eye contact
Distance
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Touch
Silence
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Body movements
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Randall-David, 1989
Ways to Become Actively Involved
in the Communication Process
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Learn proper forms of addressing in the client’s
language
Learn basic words & sentences in the client’s language
Work effectively with interpreter
Use a positive tone of voice
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Repeat important information more than once
Reinforce verbal instructions with written materials
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Watch the client’s non verbal communication
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Randall-David, 1989
After the Interview
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Debrief & analyze
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What went right?
What went wrong?
How can I improve?
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Seek additional information
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Put together ALL the information
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Form a plan
Forming a Plan
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Goal: Negotiate between the culture of the
client & the medical culture
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Tailor the treatment/intervention to meet the
client & family’s needs
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Make the client & family feel comfortable &
part of the process
Wrap Up
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We live & work in very culturally diverse
environments
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Through preparation & directed use of skills, we
can work effectively cross-culturally
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This is a continual process
Skill Building:
Case Study
Questions???
References
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Preventive Health Branch, Division of Maternal & Child Health, North Carolina Department of
Environment, Health, & Natural Resources; 1994.
Bauer K, Sokolik C. Basic Nutrition Counseling Skill Development. Belmont, CA: Wadsworth/Thompson
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Boyle J, Andrews M. Transcultural Concepts in Nursing. Boston: Scott Foresman; 1995.
Campinha-Bacote J. The Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent
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Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann of Intern
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Eckley EE, Haughton B. Meaningful Exchange: Enhancing Cultural Competence of Public Health Personnel.
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Georgetown University. National Center for Cultural Competence. Available at:
http://gucchd.georgetown.edu/nccc/. Accessed February 20, 2006.
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