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Cross-Cultural Communication: Applying Concepts to Service Learning

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08/02/20 Organisations Reference this

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 What started out as a required class for graduation, Culture and Health 1025 uncovered many different facets of my volunteering at Aurora Medical Center Summit. In the past five years of filling in the shoes of many different volunteer roles at AMC, including a lobby ambassador, physical therapy, post-surgical and post-anesthesia, clinic, and emergency department, I have been exposed to variety of patients and healthcare providers through my observation and service. Recently, I created the role of an emergency department liaison after spending a year at another local, urban hospital in the heart of Milwaukee – Aurora Mt. Sinai. The cultural differences in both verbal and non-verbal communication have been prevalent as I have noticed in the past few months at AMC. Volunteering at AMC has been a delight since the start, enriching my experience as a pre-medical student with various patients and cases, however, because of this class’s content and service learning component, I have realized a new lens to the things I encounter and learn from each shift of volunteering.

Cultural Competence in Healthcare Settings

During week three of the class’s online discussions, the class and appropriately assigned groups discussed the importance and prevalence of the basics of intercultural communication through a variety of resources. In a PowerPoint, called Basics of Intercultural Communication (Boaz, 2018), cultural competence can be used to define someone that is an “expert in the culture” and is able to react in the culture “as comfortably as one’s culture of origin.” It may be impossible to expect someone to be culturally competent in all the cultures seen in workplaces, schools, and healthcare settings, however, healthcare providers can be said to be culturally competent in the   hospital and in the field of medicine. The culture here is the culture of how the roles of the patients, physicians, nurses, and supporting members behave and speak in medically-related situations. Cross-cultural communication is a skill that can benefit a clinician because it can help to enhance the quality of care, increase the efficiency of the treatment, and improve the patient-caregiver relationship.

 Between Mt. Sinai and Summit, the cultural competence is different for both patient-caregiver populations despite being in the same state with cities only thirty minutes apart. As a volunteer, we are trained in the ‘Aurora Way’ in which we are told to greet everyone we encounter with a smile and a greeting. Despite this short greeting, the person in an Aurora facility is relaxed and informed of the friendly atmosphere of the hospital and clinic. At Mt. Sinai, I tried to implement the same training but due to the sensitivities of both verbal and non-verbal communication styles of the patient population, I acted more professionally and modestly. When it came to be answering a patient or visitor’s questions, I also had specific guidelines that I had to follow before I could answer. When calls come through at the ED, I have a set greeting and even if I know the answer to a hospital or legal policy, I always ask the caller if I may transfer them to a nurse to ensure that I don’t step outside of my limitations as a volunteer and that the caller received the correct information. This is only true of my role at Summit; answering calls, answering questions, and communicating with nonpatients was explicitly not part of my role or expectations as a volunteer at Mt. Sinai. The urban patient population of Mt. Sinai did not understand the role and duties of volunteers, often leading to difficult patient interactions.

Especially due to my restricted role as a volunteer, apologies are a greater part of my experience than are compliments or greetings. For American and European culture, apologies are perceived as “passivity and lack of resolve” whereas not apologizing in Asian culture is perceived as “arrogance and insensitivity” (Boaz, 2018). In American healthcare systems, apologies send a different sort of message especially in the way that they are presented. Many calls come through asking for patient information, and my experience as a volunteer has given me the ability to judge when and how to allow/deny information. Admitted patient information is often restricted to me anyway, but I still have enough knowledge to transfer the correct call regarding a patient to the correct nurse for efficiency purposes. Every shift I am given a patient information sheet, and for ‘high-risk’ patients, there is a comment in the margins that informs me if I can either confirm or deny their admittance to this facility if someone asks. In this case, we are given a script in the exact way we are to speak to a caller asking for a specific restricted patient. The words of that statement neither confirms or denies the presence of that patient, and that allows the volunteer to defuse the situation and provide an acceptable response to the caller. I would apologize to the caller, but the way I say it really impacts the meaning the caller perceives. This is important especially due to HIPAA and general hospital confidentiality laws. Additionally, this statement would need to be taught to someone if they are working in healthcare. My six-year experience has allowed me to smoothly handle situations with callers and patients over the years, especially in highly-emotive situations arising in the emergency department.

Cultural Discovery with Edward. T Hall – in Healthcare

The healthcare setting has its own set of principles, internal dynamics, and laws under which the facility operates smoothly between patients and caregivers. These facets stem from the societal and cultural norms formed by the ‘outside’ community but are additionally fashioned in accordance to HIPAA and proper medical manner. Fitting in the hospital, especially as a student-volunteer with no real degrees to speak for, it is very important to have “attention to everything” the healthcare providers do “to survive, advance, and gain satisfaction” (Hall & Bennett, 2013). This is inherently important because I have not been medically or professionally trained in anything so having the proper manner needed of someone working in a healthcare setting is crucial to the patient experience. Having the cross-cultural communication of being someone my age and connecting it with older people with degrees and more experience allows me to ensure that I “release the right response than the “right message”” (Hall & Bennett 2013), due to the sensitive nature of the patients during illness. During my patient-rounds, there is protocol I must follow not only to decrease the spread of infection but to also appear as a professional to both the patients and caregivers. Scrub in, knock, ask, greet, scrub out. This allows to me to have nearly full awareness of any reactions I may have because of any sort of communication I display.

 During my last shift at AMC emergency department, I was instantly presented with a case of a distressed, elderly dementia patient. In my six years, this was the first time I directly was entrusted the responsibility to directly communicate with the patient, and this was different than my patient rounds. I had never dealt with a dementia patient, much less an elderly and distressed one. The patient was yelling and crying, confused to why the doctor was not attending to them. The nurses could not continue calming the patient just due to the sheer busy environment of the emergency department, so I had to calm down my own nerves (mainly of excitement as a pre-medical student) and entered the room with my ‘Aurora Way’ smile and greeting. Observing the sensitivity of the situation, I had to ensure the patient would not be threatened by a new face. I did so by asking them every small thing even if I thought it was something implicitly for me to do. Distress usually causes someone’s personal space to feel even more threatened, especially in North America, where personal space is “used as a sort of mobile territory” (Hall & Bennett, 2013). Through this experience, I used a childlike demeanor with the dementia patient, and through communication I learned that the patient thought they were in the 1940s which I realized when the patient said that their husband died last year in WWII. The situation, as a volunteer and a pre-medical student, changed drastically. Time became polychronic and involved with many things at a time – a patient psychologically stuck in the 1940s, me as a non-trained volunteer but an actively engaged pre-medical student, and twenty minutes waiting for the paramedics seeming like the longest twenty minutes.

This was a complex learning experience for me in both service learning and my clinical exposure because this was a different patient case than I had ever encountered since most people I speak with are calm, post-anesthesia, or generally emotive enough for me to easily handle. Here, I not only held the patient’s hand, but got them to stop crying and screaming in under five minutes when they had been for the past two hours. I learned this tactic through observing nurses and additionally applying that a smile and a touch can go a long way especially in a hospital where everything seems to be surrounded by protocol, needles, tests, and procedures.


 Culture in healthcare settings is observed and learned and implemented, and it is important to learn this culture to appropriate behave and enhance the patient experience. As an aspiring physician, my service learning at Aurora has been furthered analyzed thanks to the importance of culture and cross-cultural communication concepts learned in class. I hope to have more enriching learning experiences as the semester progresses.



  • Bennett, M. J., & Hall, E. T. (2013). Basic Concepts of Intercultural Communication Paradigms, Principles, and Practices (2nd ed.). New York: Nicholas Brealey Publishing.
  • Used “The Power of Hidden Differences” article written by Edward T. Hall found in the back of the book
  • Boaz, L. (2018, September 9). Basics of Intercultural Communication [PPT]. Desire2Learn Marquette.
  • Used slides 7-13
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