Category: Cultural competence

Introduction

“A nation’s culture resides in the hearts and in the soul of its people.” -Mahatma Gandhi

America is a land where immigrants and minorities from different cultural backgrounds and heritages come together to adopt one common culture. From the beginning of time, the term ‘culture’ has often been associated with social behavior, norms, values, identities and the way in which different people react to different circumstances. It is because of these very attributes that organizations including the healthcare industry gives high priority to cultural diversity. It encourages its employees to foster good ethical values and adopt professional communication to render quality care to patients coming from diverse cultural backgrounds.

“Culturally discordant care arises from unaddressed cultural differences between health care providers and patients” (DeNisco & Baker, 2016). As a nurse one of the most essential skills that I had to learn was addressing the needs of immigrant patients with cultural sensitivity. For two decades I worked in a hospital where I was assigned the task of dealing with Hispanic patients. Being an immigrant myself I found this experience quite daunting mainly due to language barriers. Nevertheless, it was this experience that broadened my horizons and enabled me to learn the importance of professional communication when dealing with people from diverse cultural backgrounds. Since most of my experiences involved dealing with Hispanic patients, I decided to focus on the Hispanic community to state the importance of professional communication and cultural sensitivity.

Summary

Effective communication skills are a fundamental necessity in transcribing quality care to diverse communities. In the healthcare care industry, it is this very skill that keeps the team informed, motivated and enables them to deal sensitively with people of other cultural orientations. Miscommunication can lead to harmful outcomes in patient care. “The Purnell Model of Cultural Competence is proposed as an organizing framework to guide cultural competence among multidisciplinary members of the healthcare team in a variety of primary, secondary and tertiary setting” (Purnell, 2005) The twelve domain of this concept helps in assessing the cultural attributes of an individual, family, and community.

Cultural sensitivity can be followed along with Cultural Competence. Most Hispanics living in The United States share a common language. This being said they do however differ in their extension of acculturation which in turns relates to their level of education and income. While some prefer to be identified as Latinos, others prefer to be called Hispanics while there are few others who like to be identified as neither Latinos nor Hispanics. Most of them have a patriarchal family system and live with extended family. They are separated by their origins, customs, and traditions. They are sympathetic towards one another and take pride in their cultural heritage.

Although the Hispanic community shares a common language, it is important to note that their cultures, values, and beliefs differ from one another. Each of them have their own beliefs and ideologies when it comes to illnesses and treatments. While some rely on drugs and medication prescribed by a doctor there are others who do not prefer drugs and rely on herbs or natural ingredients to cure ailments. It is due to this belief that many Hispanic patients tend to be non-compliant to their treatment plan. This is where a clear understanding of a patient’s culture and ideology helps healthcare professionals to take the necessary steps to educate the patients so that they can make an informed decision.

Application of Practice

The issues of stereotyping and generalizations have been a common occurrence in the healthcare industry especially because a large number of patients are addressed at once. Hispanics have a common language but are separated by their area of origin. American Mexicans do not like to be identified as Puerto Ricans or associated to any other place of origin. They take pride in their heritage, which is why it is important for all healthcare personnel to take an interest and learn more about every patient’s cultural background before addressing them. A clear understanding of an individual’s background, heritage, and specific characteristics helps professionals to create a healthcare plan that is customized to meet the needs of every individual patient.

Knowledge about culture and orientation helps nurses and other healthcare professionals to render special attention to things that may seem trifle but can mean a great deal to their patients. One such instance took place during the flu season in the year 2005 where children were not allowed to visit the hospitals as a preventive measure. As most Mexicans tend to live with their extended families, it so happened that a patient’s extended family came to visit their loved one. Since the hospital that I worked with gave high priority to rendering nursing care that is non-judgmental, respectful and sensitive to people from different cultural backgrounds we were able to make special accommodations so that children could visit their loved ones.

Cultural competence and sensitivity not only enhance communication but also leads to professional growth and improved patient-family satisfaction. Culturally driven care can help address the needs and concerns of many patients. Since many Hispanic patients come from a poor socio-economic situation there are several instances where they may not be eligible for insurance policies and end up resorting to home remedies for treatment. As it is the responsibility of a nurse to ensure the betterment of a patient, there is a need to understand their practices which can help nurses recommend a more suitable medication regimen that can prevent adverse side effects.

Apart from cultural sensitivity, another essential skill is effective communication while dealing with Hispanic patients. The use of interpreters, verbal and nonverbal forms of communication can help enhance the care given to patients. Instruction written in a language that patients are familiar with can enable them to take their medication in a way that has been prescribed by the doctors thereby avoiding risks. Today technology is so advanced that we can use Google translation in communication with our patients. It is because of technological advancements like these that we are no longer just citizens of our country of origin, but rather global citizens since we now possess the necessary knowledge, skills, and attitudes to function in a cultural community thereby maintaining our uniqueness, diversity, and unity.

Conclusion

“Achieving cultural competence indicates the ability to respond effectively to the cultural needs of our patients.” (DeNisco & Baker, 2016). Today Nurse educators acknowledge the importance of cultural competence and ensure that every graduate student practices culturally competent care towards their patients. Effective communication between the caregiver and the patient can help contribute towards the betterment of the healthcare system and the society at large. After all, it is culturally based care that builds a healthcare system founded on trust, mutual respect, comfort, and holistic healing.

References

1. DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential Knowledge for the Profession. 3rd ed. Burlington, Mass: Jones & Bartlett Learning.
2. Grady, A. M. (2014). Enhancing Cultural Competency in Home Care Nurses Caring for Hispanic/Latino Patients. Home Healthcare Nurse, 32(1), 24-30.
3. Purnell, L. D. (2005). Purnell Model for Cultural Competence: The Journal for Multicultural Nursing & Health. Retrieved from: https://search-proquest-com.lopes.idm.oclc.org/docview/220301419?accountid=7374

Abstract

In the past five to ten years, American medical system has not only become technologically advanced but multiculturally diverse. That is why being culturally competent is very important in the healthcare field. One reason cultural competency is important is that it allows healthcare professionals to better provide patient centered care to those whose beliefs and values are different than their own. Another reason is that it gives them an opportunity to gain knowledge and new perspective of the patient’s culture. In my essay, I will go into depth of two cultures: Chinese and Arabian. I will compare the cultures and analyze how will the nurse provide care to these patients. My goal for this essay is to not only gain knowledge about these cultures but to understand the role of the nurse when assigned a patient of a diverse ethnic background. Although working with different ethnic background groups can be challenging, it can provide an interesting dimension in one’s work that can lead to patient satisfactory.

Cultural Competence

As mentioned before achieving cultural competence is very essential in today’s healthcare field, especially in nursing. Before becoming competent in taking care of people with different culture a nurse should first understand their own beliefs, values, and biases before taking care multicultural patients. By self-reflection, it allows the nurse to understand themselves and become sensitive in face of other beliefs, values, and biases. The goal is to be more empathetic and embrace different cultures, so quality healthcare is being done (Galanti, 2008). During this essay, I will examine two cultures: Chinese and Arabian.

Communication

In Chinese culture, the primary language and dialect are Cantonese and Mandarin (Lipson & Dibble, 2005). When expressing emotion with close friends and family, they provide a lot of facial and body expressions. However, when in contact with a healthcare provider he or she are very private and -conservative with disclosing information. In their culture, asking questions to authority figures is considered disrespectful. Chinese people avoid making eye contact as a sign of respect; they prefer four to five feet of personal space (Lipson & Dibble, 2005). It is uncommon for them to touch others unless it is among close family and friends.

In Arabian culture, the primary language is Arabic (Lipson & Dibble, 2005). When expressing emotion with close family and friends they are more vocal and use a lot of non-verbal gestures. When interacting with a healthcare provider, he or she value modesty and privacy. In this culture, he or she prefer to speak with same gender clinician. For example, a male patient may prefer a male nurse or doctor. Unlike the Chinese culture, sustained eye contact is considered a sign of trust (Lipson & Dibble, 2005). With personal space, Arabian families expects very little of it. However, someone who is of same gender, the closeness can between 10-12 inches. Touching is more appropriate when it is of the same gender as well.

To take care of both cultures successfully, I should make sure to build a level of trust. For my Chinese patient, I will make sure that I avoid eye contact to establish respect. For my Arabian patient, I need to be mindful that if they are male, they may refuse my care because I am a woman. If there is not a male nurse who I can switch with, I will inform the patient and ask permission in providing care to him.

Family Roles and Organization

In Chinese culture, family is placed above any individual values or beliefs. It is not uncommon to see two or three generations living in the same household (Lipson & Dibble, 2005). Also, extended families are very common. In fact, the wife is expected to become part of the husband’s family. The head of the household is usually the woman. The eldest male is usually the decision-maker (Lipson & Dibble, 2005). When it comes to gender roles, males are highly more respected than their female counterparts and expected to make more money than them. The elders of the family are honored and respected. In extended families, they are usually the caretakers of their grandchildren. Adult children are obligated to take care of their parents unless they are working. As it comes to lifestyle choices, Chinese people are very modest and unwilling to discuss anything sexually, therefore they do not discuss birth control. They do not frown upon women having abortion because pregnancy out of wedlock is considered a dishonor to the family (Lipson & Dibble, 2005). Chinese families do not acknowledge gay or lesbian sexual orientation or relationships (Lipson & Dibble, 2005).

As for Arabian families, they are family oriented. They embraced extended families such as uncles, nieces, nephews, and grandparents in their household (Lipson & Dibble, 2005). The women are the head of the household. The eldest male makes the decisions; however, the parents and siblings are still involved. Elders in Arabian families are expected to be respected. The sons of these families are responsible of taking care of their parents. Elderly women, especially those with children gain more power in the family as they grow older (Lipson & Dibble, 2005). Children of the elderly parents are always expected to be at the bedside to support them. As far as lifestyle choices, Arabs accepts birth control only for married couples after their first or second child is born. Birth control pills or diaphragms are method of choice. Sexual transmitted infections are feared upon. Due to the rise of religious influence, abortion is the least practiced option. For women, sex before marriage is forbidden. Although men are discouraged to have sex before marriage, it is tolerated more than women (Lipson & Dibble, 2005). As far as sexual orientation, homosexuality is strictly forbidden and never acknowledged.

In all, with these two cultures, as a nurse, I should expect family to be at the bedside supporting and being apart of the patient’s care. I would make sure that I respect both cultures family dynamics and discuss updates about the patient to the patient’s point of contact. Also, I will have family involved in assisting the patient with activities of daily living.

Biophysical Aspects

Health conditions that are common to people of the Chinese heritage include Lactose Intolerance, Hepatitis B, Tuberculosis, and Diabetes (Purnell, 2014). For activities of daily living, Chinese people express an extreme sense of modesty, especially women. They value good hygiene, however, patients may not want to wash their hair while they are sick. Privacy is very important while toileting. They may prefer a toilet than a bedpan or urinal. While hospitalized, some may wear articles such as jade or rope to ensure good health and good luck (Purnell, 2014). Most Chinese people prefer to handle their handle their own daily self care, but some older men expect family or staff to care for them. One high risk behavior that Chinese people are associated with is smoking. It occurs in many men and teenagers.

Health conditions that are common in the Arabian culture include malaria, sickle cell disease, epilepsy, and phenylketonuria (Purnell, 2014). For activities of daily living, great modesty is expected of both men and women. For skin care, it varies by country of origin, however, some women may wish to wear makeup in the hospital. Arabs prefer to wash their hair weekly while hospitalized because they are afraid of catching a cold. When toileting, patients of Arabian heritage may prefer to wash after having a bowel movement or urination instead of using toilet paper (Purnell, 2014). Depending on the country of origin, many women may consider their head scarves. Some patients may want a Koran or bible next to the bed or under the pillow (Purnell, 2014). For self-care, they believe in complete rest during illness so their energy can be reserved and restored.

As the nurse, because both cultures are very modest, I will make sure that I maintained their privacy. When toileting, if the patient is unable to ambulate to use the bathroom, I will close the curtains as he or she is toileting. In addition to maintaining their privacy, I would allow the family to take part of their care. For people of Chinese heritage who has a history of smoking, for secondary prevention, I will conduct screening for smoking related health conditions. For people of Arabian heritage that insist on resting all the time, I, the nurse, would clearly explain to the patient the rationale and importance for self-care such as exercise in their road to recovery.

Nutrition

In Chinese culture, food is served to guests at any time of the day or night. These meals are served in a specific order with a focus on a balanced heathy body. Common foods include beans, peanuts, rice, noodles, shrimp, and chicken. They also eat Tofu, which provides a rich source of protein (Lipson & Dibble, 2005). Fruits and vegetables are peeled and eaten raw (Lipson & Dibble, 2005). Vegetables are stirred fried lightly with oil, spice, and salt. Drinks with dinner include tea, soda, juice, and beer. When using chopsticks, they should never be stuck in the food upright because it is considered bad luck (Lipson & Dibble, 2005).

On the other hand, in Arabian culture, their cooking includes many spices and herbs such as cinnamon, cloves, ginger, and bay leaves (Lipson & Dibble, 2005). Favorite fruits and vegetables include bananas, mangos, spinach, tomatoes, and melon (Lipson & Dibble, 2005). Bread is served with every meal because it is viewed as a gift from God (Lipson & Dibble, 2005). Lamb and chicken are the most popular meats. Skewer cooking and slow simmering are typical modes of preparation. Due to their religious practices, they are forbidden to eat pork and pork products. Food is eaten with the right hand because it is regarded as clean (Purnell, 2014). Eating and drinking at the same time is considered unhealthy (Purnell, 2014). During Ramadan, the Muslim month of fasting, abstinence from eating and drinking during the daylight hours is enforced (Lipson & Dibble, 2005).

To achieve optimal health for my patient, I would provide and inform my Chinese patient about diets that are high in fats and salt. I will also be mindful that with Chinese culture, they consider yin and yang to prevent imbalances and indigestion. It is important for their physical and emotional harmony. As for my Arabian patients, I would, if necessary, feed them with the right hand regardless of dominant hand. I will serve their beverages after their meal has been eaten. Although individuals that are sick during Ramadan are not required to fast, some will still practice of respect of their culture. If a patient decides to do so, I would have to adjust their mealtimes and medications after the sunset.

Death Rituals

Death is considered a natural part of life to the Chinese culture. Death and bereavement traditions are centered around ancestor worship, which is a form of paying respect (Lipson & Dibble, 2005). The dead are honored by placing food, money, or articles around the coffin. The purchase of life insurance may be avoided because they fear that invites death. Organ donations are not common in this culture because they believe that the body should be kept intact (Lipson & Dibble, 2005). If the body is not intact, the spirit may not have a place to go.

For Arabs, it is considered God’s will. Muslim death rituals include turning the patient’s bed to face the holy city of Mecca and reading from the Koran (Lipson & Dibble, 2005). After death, the deceased is washed three times a day and wrapped in white cloth (Lipson & Dibble, 2005). Prayers for the deceased are recited either at home, a mosque, or at the cemetery. Weeping is allowed but beating the cheeks or tearing garments are prohibited (Lipson & Dibble, 2005). Organ donations are not allowed because they want to bury the body so they can meet the Creator with integrity (Lipson & Dibble, 2005).

Death can be very devastating to family especially when they are unexpected. For both cultures, I will respect the families for privacy by closing the doors and blinds on the windows. Also, if the hospital floor has an available, I would invite the family in that room so they can pray and mourn in peace.

Spirituality

The main formal religions in China are Buddhism, Catholicism, Protestantism, Taoism, and Islam. Prayer is considered a source of comfort (Lipson & Dibble, 2005). The individual may use meditation, exercise, massage, and prayer. Some may use herbalists or acupunctures before seeking help (Lipson & Dibble, 2005). Drugs, herbs, food, good air, and artistic expression may also be used. The family are usually a source of strength (Lipson & Dibble, 2005).

Most Arabs how up unless are Muslim; Islam is the official religion (Lipson & Dibble, 2005). Islam believe in God (Allah) and His messenger Prophet Mohammed, fast during the month of Ramadan, give back to the poor, make pilgrimages to Mecca, and pray five times a day in silence. Muslims do not expect a Muslim religious leader to someone has died (Lipson & Dibble, 2005).

As a nurse, spirituality for both cultures should always be respected. When assisting families with this aspect, I should consult with a chaplain to help me accommodate to their needs such as finding a bible or Koran. In addition, privacy should be appreciated, especially in times of prayer.

Health Care Practice

According to the Chinese culture, good health is a balance of body and its environment. When there was a physical and mental illness, the Chinese believed their overall harmony has been interrupted (Lipson & Dibble, 2005). For example, some fear to have their blood drawn because they believe it will give the body less energy (Lipson & Dibble, 2005). Before finding a primary care provider, they will first adjust their diet. However, for complex disease processes such as cancer, the Chinese will seek out biomedical physicians (Lipson & Dibble, 2005). Traditional practitioners of Chinese medicine prescribe herbs and acupuncture based on diagnosis an imbalance of yin and yang. They are accepting of immunizations but do not consent to diagnostic tests because they are invasive. They do not complain of pain because they do not want to bother the nurse or doctor (Lipson & Dibble, 2005). To relieve the pain, they will utilize with acupressure or acupuncture. If having dyspnea, they usually treat it with hot soup and broth (Lipson & Dibble, 2005).

On the other hand, their concept of health is a gift of God to eat well, be socially involved, be in a good mood, be strong, and not in pain (Lipson & Dibble, 2005). To improve their health, Arabians avoid hot/cold and dry/moist shifts, avoiding wind and drafts, staying warm, being well fed and resting well (Lipson & Dibble, 2005). They will accept diagnostic testing if they trust the provider and his or her expertise. When it comes to pain, they are very expressive, especially with family. Some manage it with by self-medication or reading with the Koran or bible. Arabian control their dyspnea, nausea, and vomiting by medication. They tend to take it because they trusted the prescribing doctor (Lipson & Dibble, 2005).

Although the nurse respects the wishes of patients when refusing care due to cultural differences, it is important to educate them on health care practices and promotion. The reason it is important to teach is because the patient may not fully understand what procedure is being done. That is why having an available licensed interpreter is valuable because he or she can explain the care the healthcare team is trying to give them in their native language.

Conclusion

Overall, cultural competence demonstrates a knowledge and understanding of the patient’s culture, accepting and respecting cultural differences and adapting care like the patient’s culture (Giddens, 2017). The nurse’s role in regards of this is that he or she must show a culture desire, a sense of awareness, respect, and empathy. Once the nurse accepts and values the patient’s culture, the outcome can be great quality care, positive patient satisfactory, and newfound trust towards that caregiver (Giddens, 2017). However, if the nurse does not respect that patient’s culture, it can cause the patient to not trust them, patient dissatisfaction, and lack of therapeutic communication.

References

1. Galanti, G.-A. (2008). Caring for Patients from Different Cultures. Philadelphia: University of Pennsylvania Press.
2. Giddens, J. F. (2017). Concepts for Nursing Practice. St. Louis: Elsevier.
3. Lipson, J. G., & Dibble, S. L. (2005). Culture and Clinical Care. San Franscisco: UCSF Nursing Press.
4. Purnell, L. D. (2014). Guide to Culturally Comptent Health Care. Philadelphia: FA Davis Company.

Healthcare facilities provide care for many different diverse cultures whose beliefs may affect the medical treatment in which they need to receive. In today’s time the increased racial and ethnic diversity can bring some new challenges for healthcare providers, there is a need for healthcare organizations to provide culturally competent care this is essential to reduce healthcare disparities among the minority population. Providing culturally competent care to patients of all different cultures is something that nurses and other healthcare providers must familiarize themselves as well as practice. Healthcare providers should obtain knowledge, understanding, and skills related to the treatment of different cultures. Nurses being more involved with patient care need to avoid making assumptions, have a better awareness, and practice active listening to build trust and rapport. Mexican and Japanese cultures have an extremely diverse outlook on healthcare practices. Cultural concepts such as communication, healthcare practices, spirituality, death rituals, nutrition, and family roles & organization aspects all affect how the Mexican and Japanese perceive culturally competent care.

Cultural competence is the ability to understand, appreciate, and work with people from cultures other than your own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of the patient’s culture and adaption of skills to meet the patient’s needs. (Lewis, 2020). Mexican and Japanese cultures are the two cultures I have chosen to compere and contrast. Texas has grown by more than two million since 2010, the Hispanic population pushed the count to more than 11.5 million. Tarrant county had a 28% growth rate for the Hispanic population. (Novak & Ura, 2020). Asian Americans represent 20.32% of the total population with 57,825 residents in Plano this city being the closest to the East Texas community. (Kolmar, 2019).

Japanese is the primary language spoken within the Japanese culture. Nisei are the second generation of Japanese immigrants to North America and are usually bilingual speaking and understanding both Japanese and English. Newly immigrated Japanese usually can understand and speak some English. Mexico has 62 living languages, accultured persons often speak only English, but some speak what is referred to as Chicano Spanish. The most recent immigrants that have arrived in Texas prefer Spanish but attempt to learn English for occupational advancement, however their children struggle to learn English in school but once they master English, they prefer to speak it. Many are bilingual. Both Japanese and Mexican cultures immigrate here speaking their own language but attempt to learn the English language. In both cultures they seem to struggle to either learn English or have difficulty communicating in English.

Women in the Mexican culture tend to be more expressive using dramatic body language. Mexicans who are more acculturated, have more education and come from a higher social class are less expressive with their emotions, they remain in control. Japanese do not condone expressions of anger or loss of temper, as it reflects negatively on the family. The traditional persons control their emotions in public or formal situations. They tend to avoid conflict within the family. “Face” or “saving face” is an important concept. In comparison both cultures tend to favor remaining in control of their emotions in public situations. Regarding healthcare the nurse’s role with these cultures would be to understand that in both cultures the non-emotional expression may not be looked upon as a disregard for one’s health or the health of a their loved one.

In the Japanese culture the elder Japanese paved the way for the younger generation on their expression of nonverbal communication. They feel a soft tone is polite when speaking and the older and younger generation avoid direct eye contact with authority figures. Physicians and nurses may be perceived as authority figures in a healthcare setting and may have difficulty with the English language and understanding medical jargon. They also tend not to be overly expressive with gestures, they maintain self-control and self-restraint during interactions.

On the other hand, the Mexican culture tend to have a loud firm voice when it comes to discipline with their children but consider loudness to be rude and inappropriate when addressing someone. They do tend to carry on with loud friendly banter between family and friends. From a healthcare perspective you must speak to them in a nonconfrontational tone of voice if you want them to be engaged and follow through with their treatment plan. Staring at them may be a bit intimidating or seen as a challenge, to approach them a handshake would be acceptable but pointing or approaching with your hands on your hips may be viewed as hostility. The use of silence may indicate disapproval, disappointment or anger. Like the Japanese, the Mexicans may also perceive a physician or a nurse of the same sex or opposite sex an authoritative figure and avoid sustained eye contact.

A nurse should always ask for permission to touch any of their patient’s, any procedure or care, needs to be explained to all patients of any culture. In both Mexican and Japanese cultures strangers invading personal space may be uncomfortable in new situations. In the Mexican culture permission is needed to touch any area of the body especially intimate areas. The Japanese are a relatively low touch culture however, they are acceptable to the touching of most pars of the body when necessary for care. They do not question authority when it comes to healthcare professionals, they will consent to examinations, but the older Japanese women tend tome less comfortable than the younger women.

Japanese are family oriented with well defined roles, the father being head of household and major authority. Their values include the importance of the family as one unit, duty to family responsibility, obligation and maintain family harmony. Respect for age, authority, duty, obedience to parents, and duty of parents to children are influenced strongly. The oldest male member of the family tends to be the family spokesperson, here recently the women of the younger generation are usually involved in the decision making. In the older more traditional Japanese culture families consider women to be more subordinate, now in the younger family’s women have more equality with males. Men are usually pampered by the women. Women are always the primary caregivers and tend to continue household activities even when they are sick themselves. Children are expected to act in accord with a set of standards, they are taught to be polite, shy, humble, and deferent to elders. Family values emphasize education leading to a valued occupation such as a medicine, law, teaching or pharmacy. Grown children are expected to care for their parents if necessary. When elders are sick the eldest son’s family traditionally cares for them at home. Sexual activity outside of marriage is frowned upon, if a woman is to become pregnant out of wedlock it is expected for the couple to marry. The older Japanese frown upon sex before marriage, the younger generation are more acceptable but keep it a secret.

Traditionally in the Mexican culture the man is the head of household and woman is subservient to him, however in today’s time there are more single women raising children as a single parent and head of household. The family unit consist of parents, children, grandparents, aunts, uncles and cousins. Immigrant parents may leave their children, move in with established family members and start work immediately with the hopes of eventually bringing their children to the United States, legally or illegally. The decisions are usually made as a family unit but seeking outside counsel from the extended family is not uncommon. More families are becoming more equal in their gender roles, men are taking a more active role in the care of their children as women move into the job market. There is great value placed on the family name, children area expected to behave honorably toward elders and family, a child’s future depends on socioeconomic resources. Due to poverty, discrimination and racism academic skills lack and the high school drop out rate is high, families foster independence in boys and dependence in girls. Families often consult elders for important family decisions. Unwed sexual experimentation is discouraged especially among females; however, birth rate is high in adolescence due to social and economic factors.

Obesity as a comorbidity is a common health problem within the Mexican culture as well as diabetes with hypertension and HIV/AIDS. This culture greatly values modesty both men and women often seek a clinician of the same gender, they feel uncomfortable exposing their body to someone of the opposite gender. Clinicians need to avoid unnecessary exposure of their bodies and offer a cover for their lower extremities.

Traditional Mexicans believe in the “hot”/ “cold” theory. The belief is that they preserve their health by balancing “hot” and “cold” foods, “cold” foods such as fresh tropical fruits and vegetables, dairy products and fish or chicken. They believe they should treat a “cold” illness with “hot” foods such as chocolate, eggs, oil, red meat and onions. They Acculturated persons may not believe in the “hot”/ “cold’ theory. When feeling ill an elder may recommend herbal teas such as spearmint and chamomile, or to avoid dairy products that increase the acidity causing nausea. Traditional foods include rice, beans, meat, chicken and corn or flour tortillas. The elder Mexican generation use to prepare their foods with lard, this practice has since decreased as they have learned that limiting fats in their foods is needed for health purposes. Cool drinks in the summer are preferred, fresh fruit coolers such as cantaloupe, watermelon and tamarind. Men tend to consume lots of alcohol. Encouragement to drink more water should be emphasized.

The Japanese have a completely different nutritional beliefs than the Mexican culture. The Japanese have their own food and rituals, they will prepare special foods during New Year’s holiday and other times of the year. New Year’s they will prepare ozone, a soup containing mochi (a pounded rice) that they feel brings them good luck, fortune and health to themselves and family throughout the year. Their usual diet consists of foods lower in fat, animal protein, cholesterol, and sugar but high in salt. Depending on their setting they prefer to use chopsticks to eat their meals, they usually have rice with dinner every night and feel their they get their source of protein from fish, soybeans with vegetables. Many of the Japanese are lactose and alcohol intolerant. They believe in combining certain foods for certain illnesses, pickled plums and hot tea for the prevention of constipation. When feeling ill they will often eat rice gruel or porridge with pickled vegetables. They feel when these foods are combined, they cause illness: eel and pickled plums, watermelon and crab, and cherries and milk. They enjoy drinking green tea most often without cream and sugar.

Death rituals in the Mexican culture are greatly influenced by religious beliefs, they often view death from any cause as God’s will, they also believe in the afterlife and heaven. Many prefer to die at home but if they are in the healthcare setting and die, clinicians should give the family private space to deal with the loss. If the death happens to occur in the hospital setting it is often thought that the spirit may get “lost” in the hospital. Family members may ask to view body before it is moved to the mortuary; some may want to help prepare it. Rosary beads or religious medallions at the bedside is not an uncommon site, the family may also request a visit by their priest or if unavailable the hospital chaplain to administer a sacrament.

Death is not openly discussed amongst the Japanese. Like the Mexican culture the Japanese view death depending on religious beliefs. Buddhists believe that death is natural where Shinto believe the soul has an eternal life. The entire family will decide if the ill will be a do-not-resuscitate, but imminent death will be discussed with the spouse or eldest son or daughter. In this culture they prefer to die at home if they can have the care provided, most will not accept hospice services. Most of the time a family member will stay at the bedside of the ill, when the passing occurs it is very important for the body to be clean and that dignity and modesty is preserved for viewing. Many Buddhists and Shinto have the body of the deceased cremated. Because the Japanese culture tend to control their emotions it is important for the clinician to assess any special needs, they may not request for help and deny the need for assistance.

Buddhism and Shintoism are most practiced by the older generation whereas the Japanese Americans practice Christianity. They often join churches of whatever religion that have the largest number of Japanese American or immigrant members. Japanese often combine Western medicine with prayer and offerings. Prayers and offerings prevalent in Buddhism and Shintoism. Besides the prayer at a temple or church, offerings and small shrines are made at home.

Most of the Mexican culture are Roman Catholic, in the most recent years Protestant and Pentecostal missionaries have converted Mexicans. The more-acculturated people may not attend church regularly but practice new aged practices such as yoga or Eastern mysticism. The traditional Mexicans that attend church light candles and pray to God, Jesus, the Virgin Mary and the saints. As a family they may pray together visit shrines throughout Mexico or have their own shrines in their home. The Bible or sacred scriptures that the Protestant and Evangelical churches focus on are believed to have special healing powers. Some Mexicans believe in a healer (curandero) or spiritualist (espiritusista)

Introduction: Identify the scenario and its context, the role you are providing, and the purpose of your report

XBR Minerals is a global mining company that has experienced a decline in productivity because of arising challenges in cooperation between their Japanese and Australian staff. The video illustrates the challenges arising from the different culture, common sense and worldviews that impacted on the interaction between the staff. This report aims to identify and analyse the existing cultural competence issues in the clip.

Analysis of the cultural competence issues present in this scenario, using relevant theory and literature to discuss the problems

In analysing this clip, several cultural competence issues may be found. Australian staff Sandi Edwards displays a lack of cultural awareness as she has failed to align her actions with Hiromitsu’s values and expectations of her as the welcoming staff member. The clip exhibits her failures on being punctual, understanding and respecting Hiromitsu’s gesture and prompting communication. As explained by Dr Nick Cooling (2019, p. 1), values and expectations are part of the different layers of culture, which are built upon worldview as the centre. It is highly implied that Hiromitsu values punctuality and formality and has expectations of Sandi as his chauffeur which stems from his worldview and culture.

As everyone has a tendency of interpreting and evaluating the world according to one’s own worldview (Anderson 2014, p. 16), this can elicit unreasonable subjective expectations and assumptions towards others. If Sandi and Hiromitsu had however, become aware of their own worldview and reflected on them, they would have been able to mediate each other’s perspective and acquire tolerance and comprehension towards others with a dissimilar worldview.

The scenario reveals that both the Japanese and Australian staff acted in an ethnocentric way, which sociologists defined as occurring when a person uses his or her own culture to judge another culture (Carl & Baker 2014, p. 220). Ethnocentrism in Sandi is further established by her monolingual mindset which is viewing everything based on one language (Clyne 2008, p. 348). It is detrimental for cultural competence to be cultivated when a monolingual mindset is set, because it hinders the awareness of how languages affect people’s thoughts. Differences in the way of thinking are larger for languages that are structurally further apart (Hofstede 1991, p. 27), a fact that is especially true between Japanese and English language. It may be wise for Sandi to learn some Japanese phrases or use simpler words and structures when trying to engage Hiromitsu to communicate.

Another concern lies in not grasping the notion of common sense as culturally-based, as discussed by University of Tasmania lecturer Dr Kaz Ross (2019, p. 4). For Sandi, it is common sense in her culture to be laid-back and exchange pleasantries between colleagues. In contrast, it is common sense for Hiromitsu to be formally respectful between co-workers and adhere to a certain rule of business exchange. Both had flawed assumption of their own common sense being shared and universal, resulting in misconception when one doesn’t act according to the ‘obvious’ common sense. Common sense is only common for those who share a given culture, thus it is more appropriate to call it ‘cultural sense’ (Saphiere 2014). Having an understanding that common sense as an unspoken rule is not sensible for others objectively will prevent future misunderstandings.

These issues highlight the staff’s lack of cultural competence, which is the ability to understand, communicate with and effectively interact with people across cultures (Rhonda 2014). Being culturally competent means being aware of a person’s own worldview and acknowledging other people’s worldview, values, and expectation which may or may not align with one’s own. It is interesting to note that the executive of the company is culturally competent, although at first failing to greet Hiromitsu properly, he is quick in observing culturally-appropriate behaviours and adapt. The problem is then shifted to the matter of XBR Minerals not providing the appropriate briefing and training to develop the company’s overall cultural awareness that could lead to cultural competence in the end.

Conclusion: Sum up what you have discussed, and the main findings.

Before XBR Minerals can attain a smooth collaboration between Japanese and Australian staff members, it would be wise to tackle several cultural competence issues shown in the scenario by cultivating cultural awareness. Staffs need to be aware of their own worldview that would lead them to an understanding of their own values and expectations, allowing them to accommodate others with different worldviews. Stripping away from ethnocentrism and monolingual mindset to attain understanding of different cultures and language and comprehending the concept of common sense as a cultural sense which is relative will further aid in the cultivation of cultural awareness and competence.

References

1. Anderson, JN 2014, What’s your Worldview?, Crossway, Illinois, USA.
2. Carl, JD, & Baker, S, et al 2011, Think Sociology, Pearson Education, Australia.
3. Clyne, M 2008, The Monolingual Mindset as an Impediment to the Development of Plurilingual Potential in Australia, Sociolinguistic Studies 2(3).
4. Cooling, N 2019, Worldview, University of Tasmania, Hobart.
5. Hofstede G 1991, Culture’s Consequences: International Differences in Work-Related Values, 7th edn, SAGE Publications, Newbury Park, California.
6. Ross, K 2019, Common Sense, University of Tasmania, Sandy Bay.
7. Saphiere DH 2014, There is no such thing as common sense, Culture Detective, viewed 15 August 2019,
8. We Hear You 2014, What does it mean to be culturally competent?, ACECQA, viewed 12 August 2019,

The report conducted by the United nation in June 2019 reveals world population is 7.7 billion. In this situation, there are more than “two billion users” (Crystal, 2008, cited in Baker, 2009, p. 569) of English in the world and Noack and Gamio (2015, April 23) reports there are 1.5 billion English learners in the world. Regardless of the global scale, it is indeed that in the proportion of the number of the students, it indicates there are so many English teachers in the world. Though each teacher can do a small thing, if each teacher has the passion to nurture students in English educational settings, that power would influence invaluableness toward English as a Lingua Franca.

No matter where people would be in the world, reading competence is the significant factor to communicating with others, which help understand the message the writer tells. In essence, there is no doubt that it leads to playing an important role in understanding the culture embedded by the language. Williams (1983, cited in Storey, 2018) defines the term culture; firstly “a general process of intellectual, spiritual and aesthetic development”, secondly “a particular way of life, whether of a people, a period or a group, lastly “the works and practices of intellectual and especially artistic activity” (pp. 1,2). Furthermore, Kramsch (2011) defines that “culture today is associated with ideologies, attitudes and beliefs, created and manipulated through the discourse of the media, the Internet, the marketing industry” (p. 2).

This report will pay attention to three key concepts: schema theory, intercultural competence and CLIL, which plays an important role of a bridge between culture and reading in English pedagogical practice today. Firstly, Schema theory is denoted as “to give a brief overview of schema theory as part of a reader-centered, psycholinguistic processing model of EFL/ESL reading” (Carrell & Eisterhold, 1983). “The terms schema and background knowledge will be used synonymously and interchangeably” (Erten & Razi, 2009, p. 61). Schema theory is classified “language schema, content schema, and form schema, which have a great influence on reading comprehension” (Li & Zang, 2016, p.15). Language schema is required understanding of foundation language, such as, lexical and sentences structure to read the text. Content schema is distinguished as “the background knowledge of language” (Carrell, 1987, cited in Li & Zang, 2016, p. 15), which is based on people’s prior experience and cultural awareness. As for form schema, it is necessary for leaners to understand a complexed structure in which it is used within diverse genres of context (Li & Zang, 2016). These three types of schema contribute to activating learners’ reading capabilities by means of connecting information students will encounter with what they have already understood. If the teachers can provide appropriate background knowledge about the content before reading, it will pave the way for students to be successful readers when schema activates their cultural knowledge. (Burt, Peyton & Adams, 2003, p. 31).

Secondly, the term intercultural competence is the proficiency to understand different cultures and accept cross-cultural diversity from different angles. Sercu (2004) points out that intercultural competence is categorised three different kinds of abilities; “intercultural sensitivity, intercultural awareness and intercultural skills” (cited in Haneda & Alexander, 2015, p. 151), which aims at improving learners’ intercultural capabilities effectively. Developing intercultural skill is an incremental process for learners to live as a member of a society they associate.

Lastly, content and language integrated learning (CLIL) originated from European foreign language settings in the 1990s, Coyle et al. (2010) articulate “a dual-focused educational approach in which an additional language is used for the learning and teaching of both content and language” (cited in Cenoz, Genesee & Gorter, 2014, p. 243). Brown, & Bradford (2014) states that CLIL is a teaching method to give the students opportunities for both input and output meaningfully in second language and worthwhile involvement with text they read. Furthermore, more additional activities can be practiced in CLIL, which is related to the selected texts, such as role-playing, discussion of the situations, and creative writing letters (Rodríguez & Puyal. 2012).

In terms of schema theory, according to research conducted by Erten & Razi (2009) in Turkey, they divided university students into 4 groups, the first group composed of students who read the original material without being provided any background knowledge, second group composed students who read the original material with being provided some background knowledge. The third students’ group read nativized text, in which pronouns and proper nouns are transformed into familiar ones in Turkey without any background, and the fourth students’ group read the nativized text with activities the same as the second group. As for the result of the research, the fourth group showed the highest average score was the fourth group, followed the 3rd group, then second group and the first group and 79.18, 69.91,64.55 and 60.45, respectively. Nativized vocabularies of the context leads to facilitate students reading overall comprehension to improve. Furthermore, this reveals that the schema theory activates the process of students’ reading proficiencies. Without background knowledge, it is assumed to be less effective for students to understand texts in second language settings as autonomous readers.

However, it is not always possible and practical for teachers to provide students with nativized stories in the classroom. Rodríguez & Puyal. (2012) mention the drawbacks of course books made for English exercises, which seem impersonal, arbitrary and grammar-oriented, most teachers don’t consider them as useful intercultural communicative materials. Besides, Yang (2017) warns there have been main 3 types of issues that prevent the teachers from the efficient attempt of cultural approach in the Chinese educational environment. The first issue attributes to the English examination; is teachers and students tend to neglect cultural knowledge because exam paper doesn’t contain cultural context. The second is a lack of communication circumstance and the time pressure; students don’t have enough opportunities to communicate with teachers and classmates in English even in English lessons. English is a mere school subject so they mainly pay attention to memorizing words and phrases. Over and above that, the English teachers don’t have enough quality and literacy accomplishment toward cross-cultural consciousness. Sherlock (2016) also states the problem of English textbooks in Japan, which is there is no doubt that the White North American standpoint dominated on it used as cross-cultural communication.

Regardless of these controversies in strategies of schema theory, Yang (2017, p. 371) indicates that many teachers advocate the advantages of two aspects to improve students’ reading skills; “the first one is the degree and speed of brain’s perception of word symbols, it means the reader’s linguistic knowledge in other words; the other one is the effect of “something behind the eyes”, it applies to students’ background knowledge of the text. She also expounds that it enforces students’ long-term memory held by empathy and intellectual perceptions they meet. The effective literary materials will support in the area of both linguistic acquisition and content and then which broaden students’ interculturally ability when they read content from foreign viewpoints (Rodríguez & Puyal, 2012). Interestingly, it is plausible that adult language learners are superior because when they have already had high possibility to encounter the story related to their past experiences (Richards, 2015).

With regard to intercultural competence, Murai (2016) clarifies it to develop English competence as follows.

1. “empathy / imagination”: attitude of putting someone’s shoe and imagination the situations, such as if I were a refugee or evacuee
2. “relativizing”: subjective attitude as a third party
3. “attitudes against discrimination and prejudice”
4. “cross-cultural tolerance”

*4 is defined by Byram（1997）“Curiosity and openness, readiness to suspend disbelief about other cultures and belief about one’s own” (cited in Murai, 2016, p. 119). Moreover, Rodríguez & Puyal (2012) consider intercultural competence as proof of cross-cultural values not provide simple attitudes but dictates how students can behave as a member of society they belong to.

Notwithstanding in terms of its assessment, there are some arguments on how to evaluate students’ intercultural competence appropriately. Sinicrope, Norris & Watanabe (2007) delineate the way teachers can define students’ intercultural communicative ability, identify people’s quality or attitude, and assess specific area’s culture in both good and bad norms (p. 10). Furthermore, they also point out the difficulty of how to adapt individual skills toward an unknown culture and describe the seven kinds of dimensions of the norms, such as, “about the respondent, personal characteristics, motivation and options, language proficiency, communication style, intercultural areas, and Intercultural abilities” (p. 21).

Following the various practice, much attention has been drawn to cultural understanding in current English educational settings. CLIL plays a new role “as a holistic approach which engages students intellectually and cognitively in both language and content” (Martyniuk, 2008, cited in Rodríguez & Puyal, 2012, p.109). The practice of CLIL aims at nurturing students’ accurate academic comprehension of the literacy used real-world materials when they make use of their background knowledge and cognitive abilities (Rodríguez & Puyal, 2012).

It is my view that teachers should give their students culturally familiar texts to a significant extent, because “students’ reading comprehension competence will have great improvement if they are well known of the cultural background knowledge” (Lia, 2001, cited in Yang, 2017, p. 374). Concerning the case if teachers provide students with culturally unfamiliar text, it is inevitable for teachers to give efficient background information effectively and intentionally before students deal with the topic. In order to achieve this goal, teachers are required to pay the closest attention to providing pertinent background information taking into account not only the text but also students’ age, ability, curiosity, classroom settings, family and social relationships and so on. As Elie Wiesel’s saying goes, “The opposite of love is not hate, it’s indifference.”, teachers cannot be indifference toward the literacy they share with the students, moreover have a great responsibility to improve leaners’ well-balanced qualities as well as enrich their cultural open-minded awareness.

Culture is a pattern of ideas, customs, and behavior shared by a particular people, community, or society. These patterns identify members as part of a group and distinguish members from other groups. Culture is constantly evolving. One way of thinking about cultures is whether they are primarily ‘collectivist’ or ‘individualist’. Knowing the difference can help health professionals with diagnosis and with tailoring a treatment plan that includes a larger or smaller group. The influence of culture on health is vast. It affects perceptions of health, illness, and death, beliefs about causes of disease, approaches to health promotion, how illness and pain are experienced and expressed, where patients seek help, and the types of treatment patients prefer.

Health is a cultural concept because culture shapes how we perceive the world and our experiences. Along with other determinants of health and disease, culture helps to define how patients and healthcare providers view health and illness and what patients and healthcare providers believe about the causes of disease. For example, some patients are unaware of germ theory and may instead believe in fatalism, a djinn (in rural Afghanistan, an evil spirit that seizes infants and is responsible for tetanus-like illness), the ‘evil eye’, or a demon. Which diseases or conditions are stigmatized and why? In many cultures, depression is a common stigma, and seeing a psychiatrist means a person is ‘crazy’. Culture also influences how illness and pain are experienced and expressed. In some cultures, stoicism is the norm, even in the face of severe pain. In other cultures, people openly express moderately painful feelings. Culture also affects health in other ways, such as:

• Acceptance of a diagnosis, including who should be told, when, and how.
• Acceptance of preventive or health promotion measures (e.g., vaccines, prenatal care, birth control, screening tests, etc.).
• Perception of the amount of control individuals have in preventing and controlling the disease.
• Perceptions of death, dying and who should be involved.
• Willingness to discuss symptoms with a healthcare provider, or with an interpreter present.
• Influence of family dynamics, including traditional gender roles, filial responsibilities, and patterns of support among family members.
• How accessible the health system is, as well as how well it functions.

Healthcare providers are more likely to have positive interactions with patients and provide better care if they understand their patient’s cultural values, beliefs, and practices.

The healthcare system in Australia is now focusing on ‘culturally safe care’. This approach has been taken by NMBA for nurses by setting expectations around culturally safe practice and reflects the current expectations of governments to provide a culturally safe health system. Many health services already provide cultural safety training for their staff. Cultural safety is about the person who is providing care reflecting on their own assumptions and culture in order to work in a genuine partnership with Aboriginal and Torres Strait Islander people. The principle of cultural safety in the new Code of Conduct for Nurses provides simple, common-sense guidance on how to work in partnership with Aboriginal and Torres Strait Islander people. The Code does not require nurses to declare or apologies for white privilege.

The guidance around cultural safety in the Code sets out clearly the behaviors that are expected of nurses, and the standard of conduct that patients and their families can expect. It is vital guidance for improving health outcomes and experiences for Aboriginal and Torres Strait Islander people. The Code was developed through an evidence-based and extensive consultation process conducted over a two-year period. Its development included literature reviews to ensure they were based on the best available international and Australian evidence, as well as an analysis of complaints about the conduct of nurses to ensure they were meeting the public’s needs.

In nursing education, most of the current teaching practices perpetuate an essentialist perspective of culture and make it imperative to refresh the concept of cultural competence in nursing. In Australia, indigenous cultural training has a role in the development and provision of healthcare that contributes to the health of Aboriginal and Torres Strait Islander people. Patient-family-centered care is yet another approach that has been used to support culturally safe healthcare practices.

Critically reflecting on culture in nursing, I believe that nursing has come a long way in terms of recognizing and being diligent in incorporating culture as an inherent component of practice. There is a need for nurses to shift their thought from cultural competence to cultural safety for better ethical nursing practices. The CNA Code of Ethics holds nurses’ commitment to ethical practice in the highest regard. However, it has been suggested that Aboriginal people suffer a great burden of ill health, in addition to being one of the fastest-growing and most diverse populations in Canada. Becoming culturally competent is an individual process for nurses; cultural competence is also a marker of the attitude, knowledge, and skills required to work with other cultural groups. However, the need for cultural safety emphasizes the importance of understanding the influence of culture on relationships in healthcare. There must be a convergence of various fields of healthcare to create an environment that promotes culturally safe nursing care to guide ethical decision-making, as well as to heighten nurses’ awareness and expand their understanding of the moral actions in their relationships with others from different cultural backgrounds. As nurses continue to struggle in meeting the diverse needs of society, one of the most important reminders and teaching is to always be respectful to all human beings. Respectful practice means: R – reflect deeply on your own cultural values and beliefs; E – examine and question assumptions and biases in practice; S – share and recognize the ethical space of the nurse-patient relationship; P – participate and celebrate cultural uniqueness; E – engage in relationship building; C – create open, and trusting environments; and T – treat people with dignity and compassion.

References

1. Adelson, N. (2005). ‘The Embodiment of Inequity: Health Disparities in Aboriginal Canada’. Canadian Journal of Public Health. doi: 10.1007/bf03403702.
2. Hackett, P. (2005). ‘From Past to Present: Understanding First Nations Health Pattern in a Historical Context’. Canadian Journal of Public Health. Springer, pp.S17–S21. doi: 10.1007/bf03405311.
3. How Culture Influences Health| Culture & Health| Caring for Kids New to Canada (no date). Available at: https://www.kidsnewtocanada.ca/culture/influence (Accessed: 2 April 2020).
4. Kowal, E. (2014). ‘Putting Indigenous Cultural Training into Nursing Practice’. doi: 10.5172/conu.2011.37.1.010.
5. Lisa, R. and Bearskin, B. (2011). ‘A Critical Lens on Culture in Nursing Practice’. doi: 10.1177/0969733011408048.
6. Nurses Association, C. (2017). ‘Code of Ethics for Registered Nurses’. 2017 Edition.
7. ‘Nursing and Midwifery Board of Australia – Cultural Safety’. (no date). Available at: http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD18%2F25108&dbid=AP&chksum=rUoevBUF2wIJy%2FkYRor4qw%3D%3D (Accessed: 2 April 2020).

Culture is the customary beliefs, social forms, and material traits of a racial, religious, or social group (Virkus, 2009). In the field of nursing, we deal with various cultures regularly. We as health care professionals, need to be able to provide culturally competent care to the patients we care for. Self-assessment to acknowledge strengths and weaknesses within your cultural competency is key to discover and make changes to prevent cultural destructiveness.

In the cultural competency continuum, I believe that I function at a culturally competent level. In my practice, I make it my duty to research my patient’s culture before I have any type of interaction with the patient. Upon my first entry, I interview and learn more about the patient’s culture on their level. I have learned in my experience, that just because someone is of a certain race or background, does not mean they adhere to those cultural practices. For example, I have cared for patients from an Indian background that do not follow a vegetarian or lactovegetarian diet. I do not make assumptions about other cultures and their practices. Many people have migrated from one country to another, and overtime incorporate or even adopt other cultures. It is important to me to always make it my duty to learn more about a culture if I am not familiar with it. Thus being why I believe I function at a culturally competent level on the continuum.

Assuming that everyone is the same cultural wise, would be a grave mistake. Not only is the assumption false, but it also contributes to cultural blindness. Subjectively, one of the elements of cultural diversity I possess is valuing diversity. I need to accept, acknowledge, and celebrate diversity. We all bring different elements to society. For everyone to be from the same culture wouldn’t be therapeutic. It promotes ethnocentrism. Ethnocentrism is seeing one’s own culture as the correct way of living (Tracy Evans, Santa Ana College, n.d.). Ethnocentrism is extremely toxic and can cause cultural incapacity. Another strength I feel I possess if the ability to adapt to diversity. It is important to be able to adapt to diversity so you don’t make others feel uncomfortable. Adapting to diversity means that you are inclusive towards others that are different from you. Valuing diversity and adapting to diversity are important strengths to have to continuously promote inclusion.

One of the weaknesses I possess is cultural knowledge. There is a vast amount of cultural knowledge that I do not possess. Individuals from different cultural backgrounds follow different customs making it hard to have complete knowledge of every culture there is. I also am not in control of institutionalized changes that occur. I always make sure to advocate for others of different cultures and backgrounds, however, I cannot make changes on an institutional level. Another weakness of mine would be culture assessment. There are a lot of cultures that I just don’t understand. Some cultures I don’t even understand their methods or concepts of communication. When dealing with issues of communication, I make sure to get an interpreter to help with the language barrier. Even though a person may have weaknesses within their cultural competency, doesn’t mean they don’t posses cultural competency. An individual with weaknesses makes it their duty to strengthen those said weaknesses. That is what I set out to do with each of my weaknesses in order to be a strong well rounded nurse.

Conclusively, it is always the health care professional’s job to person a self assessment to ensure they are not culturally blind. It is our job to ensure we are providing the best cultural competent care to make everyone in your care feel welcomed and accepted. We all have strengths and weaknesses within the cultural competency continuum. As professionals, it is important we self assess frequently to ensure we are not contributing to cultural destructiveness.

Literature Review

“Multiculturalism is often used to refer to one or more particular minority, racial, and/or ethnic groups in the United States” (Stockman, Boult, & Robinson, 2004). Using the word ‘multicultural’ refers to the wide range of co-existing cultural groups within society. Due to the growth of diversity in society, multicultural instruction has been introduced into education. Multicultural instruction is important to have in the curriculum to meet the needs of growing cultural differences and to prepare the future professionals to succeed in this pluralistic society.

The presence of multiculturalism in society creates a montage of identities held by several different groups; these identities are influenced by values, as well as other cultural factors, related to the group’s culture (Fatima Oliveira, 2013). The culture that one prescribes to influences the way communication is interpreted. The reason communication can be interpreted differently among groups is due to the fact that meaning is filtered through an individual’s values and identity. For this reason, it is mandatory in our society to be educated in cultural diversity and tailor communication to the audience.

“Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations” (American Speech-Language-Hearing Association, 2017). Clinicians must understand that cultural differences do not characterize a disorder, and they must follow the Code of Ethics when delivering therapy treatment. Services should be respectful of individuals values, preferences, and language. Quality of service should not be based on ethnicity, age, socio- economic background, or any other factors.

For a healthcare provider to display cultural competence, basic values must be present: “Openness, awareness, desire, knowledge, sensitivity, and encounter” (Henderson, Horne, Hills, & Kendall, 2018, p. 590). Openness is characterized as the clinician not only having the desire to examine one’s own culture, but also look past their own culture and to acknowledge and digest other cultures. Clinician’s must also make themselves aware of the consequences that this world has created and the war fought between differing cultures, such as prejudice. The desire mentioned refers to clinical desire; the desire to learn about other cultures to further one’s clinical expertise in providing the best treatment for diverse populations. Cultural knowledge, the cornerstone of cultural competence, is a deep, intricate understanding of culture that can be gained from first-hand experience and through education, such as learning a foreign language. A clinician must show sensitivity and knowledge towards culturally delicate areas, which can include the area of healthcare. Lastly, the clinician must be immersed in an environment that allows the encounter of cultural diversity.

These six basic prerequisites for acquiring cultural competence are attainable as most clinicians today must have training in multicultural content as part of their American Speech-Language and Hearing Association (ASHA) certification requirements. ASHA accredited programs do not have a specific course about multicultural issues but instead infuse multicultural content within the existing curriculum. Stockman et. al., (2004) advocates for the use of integral infusion which requires multicultural issues to be embedded throughout the content of a given course and academic curriculum. Integral infusions objective is to blend existing knowledge with knowledge about the culture.

Cultural intelligence (CQ), one component of cultural competence, is defined as “a person’s capability to adapt effectively to new cultural contexts (Earley & Ang, 2003, p. 59)” (Griffer & Perlis, 2007). Cultural intelligence has four aspects for aspiring educators and clinicians. They include strategy, which is understanding one’s culturally diverse experience, knowledge, the act of learning the similarities, and differences of the parameters of cultural groups. The third aspect is motivation, which is a person’s interests in learning about different cultures and how to function in a culturally diverse setting. Lastly, behavior is the use of appropriate responses in various situations.

Aspiring educators and clinicians should see themselves as multiperspective, meaning to see one’s identity in many perspectives, such as age, race, gender, and socio-economic status. In doing this leads to cultural intelligence. (Griffer et. al., 2007). It is important for aspiring clinicians and educators to interact with individuals with different multiperspective identities from themselves, take courses with diverse faculty, complete clinical practicums and field placements with diverse individuals, and offer diverse persons to give guest lectures. When clinicians and educators immerse themselves in these multicultural environments, they grow their cultural intelligence, which carries over into their interaction with their students or clients.

The development of cultural competence is in part attributed to the immersion of the clinician into the workplace saturated with a culturally and linguistically diverse (CLD) population, but this is not the only factor that grows a clinician’s cultural competence. Howells, Barton, and Westerveld (2016) experimented the effects of not only experience with diverse populations in clinical placement, but also the effects of students’ backgrounds on cultural competence. The study consisted of 60 participants from two cohorts of students pursuing their master’s degree in speech-language pathology. The participants demographics varied in age, country of birth, and number of languages spoken. The use of surveys, written reflections, and focus groups measured the impact of the student’s background and clinical placement on student’s cultural awareness. Howells et. al., (2016) concluded that cultural competence increasingly developed in speech-language pathology students during the student clinical placement, and the background of the student even more so influenced the level of cultural competence. The interpretation for determining this influence was based on the measured qualitative information and compared to a previous study, Wells’ (2000) cultural development continuum. The qualitative information gathered regarding student’s desire to work with CLD populations and their confidence to work with CLD populations showed improvement as the students attended clinical placement, and the students from diverse backgrounds showed even greater improvement towards cultural competence after attending the clinical placement.

Due to populations becoming more diverse culturally and linguistically, the necessity for cultural competence grows (Matthews & Van Wyk, 2018). Facilities experience shortages of culturally competent healthcare workers, which leads to several consequences. Cultural incompetence leads to ethical dilemmas of the mistreatment of clients, such as giving preference to a particular individual based on their culture or showing intolerance towards a particular race. Miscommunications regarding health information also occur daily in healthcare settings, often due to a language barrier, when a lack of cultural competence is present and necessary measures are not taken on behalf of the client. Cultural incompetence can cause a barrier that impacts the client and family more than the effect of socio-economic or structural barriers (Matthews & Van Wyk, 2018).

Therapy ought to be delivered to CLD children in a culturally competent manner. Assessments should be non-biased such as dynamic assessments, portfolio assessments, narrative assessments, and structured observation. Assessments must be performed in each language the child speaks. Interventions also must be performed in the language the child speaks. If the clinician does not know the language, the clinician needs to use a bilingual support to assist in the manner.

The study consisted of nine speech language therapist (SLT) from Central Valley, California. There were no exclusionary criteria for race, ethnicity, or gender. SLT’s caseloads averaged 52 children with 25 being CLD. SLT’s participated in a recorded interview with the same set of core questions. The questions were transcribed and summarized using an open coding method. The codes were reviewed to notice commonalities across questions. The findings showed four themes including language being a barrier and a bridge, working with interpreters helped or hindered assessment and treatment of CLD children, having respect for cultural differences, and positive interactions with CLD family members (Maul, 2014). Through this study therapy techniques were developed to better assist SLT’s treatment of CLD children. Clinicians should be culturally sensitive by learning about cultural traditions of their students and understand cultural norms and how different cultures view importance of disorders in everyday life. An effective way to begin a rapport with CLD students and family members would be to learn some phrases of the languages the client speaks (Maul, 2014). The clinician must show cultural understanding to establish trust and open communication to successfully treat individuals from diverse backgrounds (Lemmon & Jackson-Bowen, 2013). Brunett and Shingles (2018) studied the effects of the cultural competence of healthcare professionals on the satisfaction of patients, and determined that patients tended to be more forthcoming and trusting of the professionals if they showed cultural competence. Patients who perceived their provider as being culturally competent also were more likely to follow the medical advice of the provider (Brunett & Shingles, 2018).

Purpose of the Study

The purpose of this study is to examine if cultural diversity has an impact on speech therapy treatment. This determination is important because speech-language pathologists have diverse caseloads and should be delivering treatment appropriately, which is explicitly stated in ASHA’s Code of Ethics. The study is to determine if additional cultural competence training is required to be taught to graduate students before becoming practicing clinicians.

Research Question

Does cultural diversity have an impact on speech therapy treatment?

Hypothesis

It is hypothesized that no changes will be present in the delivery of therapy due to the presence of cultural diversity. This belief is based on the grounds that the undergraduate and graduate curriculum of speech-language pathology students is embedded with cultural diversity. Additionally, according to ASHA’s Code of Ethics, every practicing speech-language pathologist must have cultural competence and the participating students have all attended schools accredited by ASHA.

Methods

Participants

Due to the study focusing on cultural competence and the diversity of future clients within the speech-language pathologist caseload, our participants will derive from two ethnicities. The ethnicities chosen to study are African American and Causcasian. There will be four different groups being studied; these groups include an African American clinician with a Caucasian client, an African American clinician with an African American client, a Caucasian clinician with an African American client, and lastly a Caucasian clinician with a Caucasian client. THIS WILL BE EXPANDED UPON ONCE PARTICIPANTS ARE OBTAINED (e.g. Each group will have _____ participant pairs selected from Valdosta State University Speech and Hearing Clinic). The inclusionary criteria are participants who attend Valdosta State University Speech and Hearing Clinic and are of the two ethnicities being used in the study. The exclusionary criteria are certified speech-language pathologist, any client not attending the Valdosta State Clinic, and other ethnicities besides African American and Caucasian. Gathering of participants will be completed by the professor from the Valdosta State Clinic.

Procedures

Our participants in the study carried out therapy typically, as if the participant was not participating in the study, and the session was recorded with a tape recorder. The recording is obtained one time for each participant. The recording was examined for a five minute period. The duration of the recording examined began 10 minutes into the session and stopped 15 minutes into the session. The first 10 minutes of the recording was eliminated from examination to allow for warm-ups to be completed and treatment to begin. If an interruption, such as a bathroom break, occurred during the five examined minutes of therapy, the time was paused prior to the interruption and continued once therapy continued to reach the five full minutes of therapy.

Measures

Three measures were obtained for each five minute recording of treatment. The first measure observed the talk time of the clinician, talk time of the client, and the length of silence. The number of total words (NTW) were calculated for both the clinician and the client. Lastly, the lexical diversity, number of different words (NDW), were measured for the clinician and the client to determine the complexity of speech. The independent variable for this study was the cultural diversity amongst the clinician and the client. The dependent variable was the manner that the therapy was carried out by the clinician.

Analysis

After reviewing the recorded therapy sessions, the data was analyzed using a calculation of the NTW and NDW. These data findings were compared to the norms of their peers. THIS WILL BE EXPANDED UPON (the norms of NTW and of NDW will be gathered by the professor overseeing the study). Finally, the results will be compared to the four different groups to show either an effect or no effect on therapy treatment.

References

1. American Speech-Language-Hearing Association. (2017). Issues in ethics: Cultural and linguistic competence. Retrieved from https://www.asha.org/Practice/ethics/Cultural-and-Linguistic-Competence/
2. Brunnett, M., & Shingles, R. R. (2018). Does having a culturally competent health care provider affect the patients’ experience or satisfaction? A critically appraised topic. Journal of Sport Rehabilitation, 27(3), 284-288. Retrieved from http://sdearch.ebscohost.com/login.aspx?direct=true&db=sph&AN=130572072&site=eds-live&scope=site
3. Fatima Oliveira, M. de. (2013). Multicultural environments and their challenges to crisis communication. Journal of Business Communication, 50(3), 253–277. doi:10.1177/0021943613487070
4. Griffer, M. R., & Perlis, S. M. (2007). Developing cultural intelligence in preservice speech-language pathologists and educators. Communication Disorders Quarterly, 29(1), 28-35. doi:10.1177/1525740107312546
5. Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & Social Care in the Community, 26(4), 590–603. doi:10.1111/hsc.12556
6. Howells, S., Barton, G., & Westerveld, M. (2016). Exploring the development of cultural awareness amongst post-graduate speech-language pathology students. International Journal of Speech-Language Pathology, 18(3), 259-271. doi:10.3109/17549507.2016.1154982
7. Lemmon, R., & Jackson-Bowen, D. (2013). Reality versus perception of cultural competency in speech-language pathology students. Journal of the National Society of Allied Health, 61-74. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=128282192&site=eds-live&scope=site
8. Matthews, M., & Van Wyk, J. (2018). Towards a culturally competent health professional: A South African case study. BMC Medical Education, 18(1), 112. doi:10.1186/s12909-018-1187-1
9. Maul, C. A. (2015). Working with culturally and linguistically diverse students and their families: Perceptions and practices of school speech–language therapists in the United States. International Journal of Language & Communication Disorders, 50(6), 750-762. doi:10.1111/1460-6984.12176
10. Stockman, I. J., Boult, J., & Robinson, G. (2004). Multicultural issues in academic and clinical education: A cultural mosaic. The ASHA Leader, 9(13), 6-22. doi:10.1044/leader.FTR5.09132004.6

Culture refers to the developed spiritual values as well as all materials created in the line of social development, including the tools engaged in creation as well as in the handing over of social values to the upcoming generations, showing the extent of people’s authority and control based on their social and natural development. Culture is a term that diversifies in every community; hence, it is perceived differently in every community. Culture also interferes with people’s perception of different phenomena, such as health, sickness, joy or happiness, and sadness, as well as the manner of experiencing these emotions.

Every community has a different cultural perception of the term health. The meaning of this term varies across various cultures; thus, it requires attention in involving the recognition of cultural values as well as cultural practices. The profession of nursing plays a vital role in the health sector in different communities based on their cultural beliefs. The patient’s cultural beliefs, methods, and values are incorporated into holistic nursing care. Nursing aims to provide a compact as well as humanistic service that recognizes the cultural values as well as the lifestyles of the people. Nurses are required to provide affordable and acceptable healthcare to people based on their prevailing conditions. Therefore, nurses are expected to explore current ways of providing healthcare to different cultures based on multicultural societies by understanding the effects of culture on health illnesses. This enables them to establish a bridge for the existing spaces between the process of care as well as people based on different cultures.

Healthcare behaviors of individuals, as well as their perceptions towards health, can’t be separated from each other. Various types of healthcare behaviors include the primary disease, disability, injuries, or defects prevention, the second healthcare behavior is an asymptomatic disease, defect, or injury detection, the third type of healthcare behavior is enhancing the promotion of healthcare, wellness as well as the quality of life levels, and the last type healthcare behavior is protective behaviors suitable for ensuring safe environmental transactions. The communities which have tried to maintain their cultural behaviors for several decades have experienced this in their behavioral health, thus striving to find solutions to the problems about their health based on their artistic lives. Some of the healthcare behaviors are based on the foods they eat, methods used to cook, sleeping habits, patterns of dressing, methods used to treat diseases, residence as well as housing, disease perception, and finally, the modes of innovations acceptance. These healthcare behaviors vary depending on different cultures; thus, individuals are unable to act against their lifestyles.

Various challenges and barriers are facing transcultural healthcare. The humility of the cultural health professionals in identification, as well as meeting the client’s healthcare needs from the marginalized groups based on the cross-cultural interactions, help them to persevere these challenges. Even though cultural competence has been incorporated into the educational curriculum for healthcare workers, studies indicate that cultural bias, as well as stereotypical views about people’s health, are still being experienced in the workforce. This indication is essential since the individuals are most likely to lack some of the needs of psychological care. They are also isolated in-home care concerning their counterparts from the cultural mainstream.

Barriers to terminating these disparities in healthcare were identified in various studies from various nations. Recently, a comprehensive leadership healthcare study conducted in Australia indicated that cultural humility is a suitable attribute for all healthcare leaders at all levels. Linguistic assets can be used by the family as well as staff members to bridge the barriers to communication in healthcare homes (Leininger et al., 2017). There are different cultural backgrounds; thus, cultural staff, as well as linguistic assets, can be ranked systematically by assembling cultural opportunities to act as barrier brokers. The continued worldwide racial discriminations indicate that insensitive cultural barriers still exist. Despite the literature wealth, which shows the various global nursing challenges in dealing with patients based on multiple cultures, there is little information about those issues, as well as how those issues are practically addressed on a daily basis. The research does not fully explore the specific challenges faced by the nurses as well as the factors that influence their morale, behaviors, also practices when handling these challenges.

According to research, nurses use their experiences, such as referring to the likely challenges, which include language barriers in the exercise of caring for various cultures. Other researchers indicate that nurses make references to cultural differences, which leads to the emergence of fear among themselves in handling caring practices in those areas. For transcultural healthcare to be improved, cultural factors, as well as healthcare services, must be recognized. Another challenge and barrier to healthcare is the mass migration of people, especially young people from rural to urban centers, the act which has a direct impact on the nursing healthcare exercise (Ryan et al., 2015). The issue of poor roads among different communities, especially those linking homes to hospitals, leads to delays for patients to obtain care. Some of the outcomes of these challenges is that: comparing the healthcare behaviors between residents in different communities indicates that the gap between the check-up routines differs, whereby this factor contributes to some of the discussed challenges, health insurance status is essential for people to receive healthcare coverage cards, this is another outcome which has been identified, and finally, personal-reported overall health.

According to the general public, technology is suitable for the improvement of healthcare efficiency, healthcare cost, safety, as well as quality of healthcare. Some cultures believe that technology can lead to some health errors as well as adverse health events. In the modern world, the medical treatment devices used by different healthcare providers globally are inevitable technological device-related problems. There are some pitfalls that make some benefits of technology not to be realized. These pitfalls include: the unfortunate designation of technology that does not comply with ergonomic attributes as well as human factors, the second pitfall is a poor technological layout with patients, and finally insufficient plan suitable for implementing new technology. Therefore, technology is a good plan for improving healthcare outcomes as well as healthcare access.

In conclusion, this paper has assessed transcultural beliefs, which include language, preferences of dietary, and risky behavioral practices, among others. The article has further identified and discussed healthcare behaviors, barriers, and challenges to healthcare, as well as outcomes related to the difficulties presented. Finally, it has explored technology as an evidence-based plan that can be employed to improve the outcomes of healthcare as well as healthcare access. This topic is vast such that its content cannot be exhausted in this paper alone; therefore, further research on this topic can provide more information about this paper.

Chapter I

Introduction

A. Background

Intercultural interaction and communication have witnessed a considerable increase in the world. Globalization necessitates the ability to interact efficiently with people across cultures. The social, economic, cultural and technological shifts in the modern world namely the increase of migration, the professional and educational mobility in addition to the exponential growth of technology, have yielded fertile settings in which EFL learners have to implement the target language in multi-ethnic contexts. Contemporary EFL teachers’ response to the mounting increase of globalization as well as multiculturalism is the implementation of Intercultural Approach to foreign language teaching (Byram 1997, Byram 2003). According to Byram’s view (1997; 2008) the advisable model of competence in the contemporary world is a mixture of both types of competence: Communicative competence and Intercultural competence. The latter involves four main elements that are supposed to foster effective and efficient cross-cultural interaction a) Attitudes b) Knowledge c) Skills d) Critical Cultural Awareness.

The goal of language learning is to develop the learners’ language competence in the target language, and equally important, the Intercultural competence as Byram (1997) recommended. Intercultural communicative competence, be it global or international, is now an integral part of our lives. Therefore, furthering the learners’ intercultural communication competence is a prerequisite for EFL teachers. Equally important, ICT provides an authentic learning environment by developing the learners’ interaction through involving them in a variety of communicative task. Fostering Intercultural Communication Competence by means of Information and Communication Technology has become a necessity as ICT offers an opportunity to EFL learners to get involved in a learning format which includes a set of varied hyperlinked multimedia resources. They provide a relevant projection of the cultural phenomena that they discover through intercultural incidents that they deal with. Hence, the learners become more involved in the discovery process.

Several studies have been carried out on various aspects of intercultural communication competence in the EFL contexts. Luis Fernando (2012) focused on fostering intercultural communicative competence through reading authentic literary texts in an advanced Colombian EFL classroom. Jen Jun Chen (2014) tackled the issue of fostering foreign language learning through technology-enhanced intercultural projects. Mahdjouba Chaouche (2016) dealt with incorporating intercultural communicative competence in EFL classes. Qun YU & Jan Van MAELE (2018) placed an exclusive emphasis on fostering intercultural awareness in a Chinese English reading class. Yet, no attention has been given to Moroccan EFL teachers’ perceptions of fostering cross-cultural communication competence through ICT-mediated teaching. Simply put, no research paper has dealt with investigating EFL learners’ perceptions of fostering intercultural communication competence through ICT –mediated language teaching. This study, however, will attempt to fill in the gap. The results will certainly offer language teachers’ or educators insights on learners’ attitudes toward fostering intercultural communication competence through ICT to advance new practices and methodologies embedding technological tools for making a difference for learning in a multi-cultural world.

B. Research Problem

The problem in this study is that no attention has been given to EFL teachers’ perceptions of the use and effectiveness of ICT as a means of fostering intercultural communication competence so that there is a lack of appropriate data to to prepare the grorund for a more reseasoned use of ICT-mediated teaching in fostering EFL leearners’ intercultural communication competence.

According to the discussion we have made earlier, we will address the following questions:

1. What are EFL teachers’ views on fostering intercultural communication competence through ICT –mediated teaching ?
2. What are the challenges facing EFL teachers while using ICT as a tool to foster intercultural communication competence?

C. Research Objectives :

The goal of this research is:

1. To explore EFL teachers’ views on experiences in fostering intercultural communication competence through ICT –mediated teaching
2. To investigate EFL teachers’ views on the challenges facing their implementation of ICT-mediated teaching in fostering the EFL learners’ intercultural communicative competence.

D. Significance of the Study:

This study will give deep insights for many educational stakeholders.

1. To teachers, police makers, curriculum and syllabus designers, the results of the study will offer valuable information regarding the teachers’ perceptions of fostering intercultural communication competence through ICT –mediated teaching.
2. To potential researchers, this study will pave the way for further research studies on the same area.

E. Research Scope:

This research attempts to investigate EFL teachers’ perceptions of fostering intercultural communication competence through ICT –mediated teaching. Owing to time constraint, this study will be limited to Moroccan EFL teachers’ who have taken part in the project of Connecting Classrooms Version 3.

Chapter II

A. Literature Review

Intercultural Communication Comptence

The first concept to be considered in this study is intercultural communication competence.

According to (Bachman,1990,Savignon, 2001) Intercultural Communication Competence (herafter ICC) is seen as the ability of the speakers to interact efficiently with people from other cultures. That is, the ability to deal with one’s own cultural background while interacting with others. Hymes establishes the relashionship between linguistic and socio-cultural competences as he perceives language as another form of cultural knowledge through which speakers interpret social life.

Information and Communication Technology in Foreign Language Teaching

Several authors view ICT as an important tool in teaching languages as it offers learners a more individualized experience and back-up during the learning process (Pardo, 2013). Equally important, Ruthven (2003), states that ICT augments the learners’ involvement in a stress-free context. Further, the author affirms that through ICT tools, the teacher can promote the learners’ autonomy and collaborative learning.

Likewise, another important contribution to the literature in the field of ICT is

ICC and Language Teaching

According to Byram language teaching should be geared towards developing the learners’ ability to cope with their own cultural meanings along with the other cultures. ICC primarily involves the acquision of language competence and cultural competence. Sihui (1996) confirms that language and culture are inseparable parts because people use language as a means of imparting their ideas, interests, beliefs and identitites.

ICT and Intercultural Communication Competence

Wayan (2019) affirms that the ICC model can be used as good reference and guideline for teachers in discussions to

Sandra ( , in her study on developing intercultural communication competence using digital storytelling, reveals that digital storeytelling is able to engage students in a serious and productive debate revolving around technology-enhanced learning and cultural differences empowering them to construct new personal and group meanings and improve their cultural competence.

Alyssa; Anders (2010) discuss a curriculum developed to make innovative use of collaborative digital technologies, including video conferences, collaborative blogs, writing on a Wiki, and dynamic chat as part of an activity-based research project to foster intercultural competencies among students in golobally-distributed teams. They present qualitative and quantitative data that indicate successful implementation of the curriculum for facilitating global learning via communication technology tools.

Dorothy (2011) Based on Byram’s definition of intercultural communicative competence and on specific types of discourse analysis proposed by Kramsch, Thorne and Ware, this article explores how online exchanges can play a role in language learners’ development of pragmatic competence and ICC. With data obtained from an intercultural exchange between students learning German in an American university and students studying English at a German university, it illustrated how culture is embedded in language as discourse, how advanced learners of German as a foreign language and English as a foreign language employ different discourse styles in their online postings as they seek to understand the discourse genres of their partners. (2012)

Robert (2013) looked at the ways in which technology could support teachers and learners as they seek to understand language through culture and culture through language. This study looked at the growing interest in moving beyond traditional representations of culture in the classroom to the concept of intercultural communication competence , defined by Alvino Fantini as the ‘complex of the abilities needed to perform effectively and appropriately when interacting with others who are linguistically and culturally different from oneself’.The study also focused on looking at the most common approach to providing intercultural experience and learning to students through telecollaboration.

Lina ; Alfred (2014) report a Spanish-American telecollaborative project through which students use Twitter, blogs and podcasts for intercultural exchange over the course of one semester. Their research outlines the methodology for the project including pedagogical objectives, task design, selection of web tools and implementation. Using qualitative and quantitative data collection, the study explores how the application of Web 2.0 facilatates cross-cultural communication. The findings of their study reveals that students view online exchange as a superb venue for intercultural communication with native speakers. Through social engagemants, students not only gain cultural knowledge but also become more aware of their own beliefs and attitudes toward their own culture.

Kamila (2015) ICT in Intercultural Competence Training views ICT through teaching modules or simulation software help teachers build more attractive content and more convincing messages. The e-learning course can support the acquisition and development of intercultural competence. Special attention is put to internet communication technology for academic purposes in form of e- learning platforms.

Luana, Maria, Iciar (2018) focused on proposing a theory-informed task sequence to facilitate the integration of telecolloaboration into university courses for the development of intercultural competence. Based on the typology of tasks from O’Dowd and Ware (2009) and enriched with contributions from other authors, the task sequence facilitates the development of intercultural Competence according to EMIC model and adds a new block to its composition in order to approach the specificities of virtual teamwork; the seqauence also contains detailed instructions for each task and provides guidelines on implementation, on the selection of technology and on the integration of tasks to the syllabi and it offers an assessment plan that is accompanied by a list of learning evidences that are expected to be manifested by students per task.

Shii-Yin, Robert (2019) to create a brand new opportunity to boost the the target language interactions, this study utilses two computer-mediated tools, namely email and Skype, to involve Taiwanese students’ reflective journals, as a post-project questionnaire, and interviews. The results of the study indicate that despite encountering numerous problems initially, Taiwanese students eventually have strong positive perceptions and attitudes toward intercultural CMC learning experiences , which can facilitate efficient online discussions with native speakers of English as a foreign language and can promote intercultural competence.

Ayse (2020) this study has intended to gain insights about the learners’ experience following a 5-week telecollaboration activity between 100 English as a foreign language (EFL) students from Jiangxi University of Finance and Econonomics in China and Anadolu University in Turkey. The telecollaboration activity included three different stages in which learners from both countries were expected to be able to communicate using different channels synchronously, to analayse and compare their own and their peers’ culture to build understanding of each other’s identities and to collaborate together to produce a cultural piece of work. At the end of the activity Turkish EFL students were invited to answer a questionnaire that aimed to gain insights about their experience related with telcollaboration activity. Results revealed that the participants mostly enjoyed the activity. They also believed the activity contributed to their language learning process, motivation and intercultural communicative competence.

Chapter III

Method

A. Research Purpose

The chief aim of this study is to investigate the perceptions of Moroccan EFL teachers on the use of ICT as a tool in fostering the EFL learners’ intercultural communicative competence. The findings of this study will help policy makers and and all the educational stakeholders in designing programs in relation with the use of ICT as a means of fostering the EFL learners’ intercultural communication competence.

B. Research Design

Given that this study is dealing with the individual experiences that he or she faces and that may affect his or her development ,the methodology selected for this study,which ,in turn, focuses on the teachers’perceptions and how they make sense of their experience is the Interpretive Phenomenological Analysis.

C. Participants

The participants in this study will include Moroccan EFL teachers who have taken part in Connecting Classroom Project: a global education program for schools, delivered by the British Council in partnership with the Ministry of Education.

D. Materials

Semi-structured interviews with purposefully selected EFL teachers as participants from different regions and who have experienced the use of ICT as a tool to foster EFL learners’ intercultural communicative competence. The reason for using semi-structured interviews is to gauge the participants’ attitudes and perceptions and gather relevant qualitative input.

E. Procedures

After obtaining the permission from Directorate where the EFL teachers are working, the data will be gathered. To analayze the data, according to Smith and Osbon’s suggestions on Analysis of Interpretive Phenomenology, semi-sructured interviews will be transcribed, coded, and emergent themes will be noted.