The United States has often been referred to as a “melting pot” nation. A melting pot refers to a sociocultural situation in which people cast off parts or all of their ethnic differences and blending their ethnic identities into a single large “macroculture” (Chaney & Martin, 2003).
The idea that immigrants from any nation can arrive and share in the blending of cultures has long been a selling point for the country. In the early 20th century the melting pot represented the new “liberal and radical vision of American society” (Hirschman, 1983). Furthermore, this symbol was used to reinforce the belief that America is a land of opportunity where a person’s identity would not hinder their pursuit of happiness (Hirschman, 1983).
While studying the three faiths Protestantism, Catholicism, and Judaism, social scientists began to notice the melting pot or assimilation theory beginning to fail as early as the 1950’s (Herberg, 1983). Indeed the notion that an individual can arrive in the U.S. and be adopted into a new identity is simply not the case:
The result has not been the melding of various cultures into one cultural group as idealists believed would happen. Because we have cultures within cultures (microcultures), communication problems often result. In reality, the United States is a salad bowl of cultures. While some choose assimilation, others choose separation. (Chaney & Martin, 2003, p. 3)
Likewise the salad bowl idea acknowledges not only how people groups differ culturally but also and “unequal status of different groups in society” (Airhihenbuwa & Pineiro, 1988, p.
241). The same researchers go on to explain that “if a nation’s people share common customs, origins, history, and languages, then the U.S. could be considered a country of many nations including African Americans, Hispanic Americans, Asian Americans, and Native Americans”
(Airhihenbuwa & Pineiro, 1988, p. 241). Immigrants don’t fully blend with their host country but rather exist alongside, and even a little separate from, the contemporary culture (Gordon, 1964).
8
Diversity in the U.S.
The United States has not only remained a diverse country in spite of perceptions of assimilation, but has actually increased in its levels of diversity. While looking at data from over the last thirty years Lee, Iceland, and Sharp found that “virtually all types of communities have become more racially and ethnically diverse since 1980” (2012, p. 1). Furthermore they revealed that since 1980 Caucasian communities have dropped in proportional representation by over 10%, Hispanic communities surpassed Black communities as the second largest minority, and the Asian representation has tripled (Lee, Iceland, & Sharp, 2012). Figure 2.1 shows the changes in these values.
Figure 2.1 Values of community level diversity. Adapted from “Racial and ethnic diversity goes local: Charting change in American communities over three decades” by B.A. Lee, J. Iceland, and G. Sharp 2012, p. 5, New York: Russell Sage Foundation.
This increase has been attributed to two forces. Historically speaking, individuals are more likely to risk immigration during their younger years, but also U.S. immigration policy has encouraged these newcomers to bring their relatives and other family members along with them (Shrestha, 2011). For instance, the years ranging from 1966 to 1980 saw 718,000 refugees entering the U.S. (Wasem, 2005). However, after the Refugee Act of 1980 the U.S. experienced an influx of 1.6 million refugees over the following five years (Wasem, 2005). Furthermore,
9
racial and ethnic groups “are aging at different rates, depending upon fertility, mortality, and immigration within these groups” (Shrestha, 2011). The United States is a collection of growing cultural pockets inlaid in a contemporary society. From 2009 to 2010, the foreign-born population of the U.S. grew by 1.4 million (Batalova & Terrazas 2010). As globalization increases, more immigrants are arriving in the United States and adding to the size and diversity of the salad bowl.
Culture
The literature offers a multiplicity of definitions for culture and they are of varying depth and utility. Firstly Bullock and Stallybrass (1977) specify culture as the
‘Social heritage’ of a community: the total body of material artifacts (tools, weapons, houses; places of work, worship, government, recreation, works of art, etc.); of collective mental and spiritual “artifacts” (systems of symbols, ideas, beliefs, aesthetic perceptions, values, etc.); and of distinctive forms of behavior created by a people (sometimes deliberately, sometimes through unforeseen interconnections) and transmitted from generation to generation. (p 150)
Culture is a culmination of all aspects of a community’s history and method of living. In 1966, Hall described culture as a set of deeply significant experiences which sets up the criterion against which all other things are judged (Hall, 1966). However, more recently social scientists have shifted culture from this experiential viewpoint of culture to a more psychologically based description. Hofstede (1980), more simply describes culture as the “collective programming of the mind which distinguishes the members of one group or category from others.” (p. 25) Some researchers view culture as being a state of mind or thinking such as a concept of beliefs, shared pattern of thinking learned from an early age (Cullen & Parbotteah, 2005; Xing, 1995). Other researchers posit that culture is a people group’s collective opinion concerning what is important in life and how a person should behave. Table 2.1 lists the various definitions of culture.
10 Table 2.1
Definitions of Culture
Definition Year Author
Culture is a concept of the pervasive and shared beliefs, norms, and values that guide everyday life.
2005 Cullen &
Parbotteeah Culture is a shared pattern of being, thinking, and behaving;
something learned from childhood through socialization; something deeply rooted in tradition that permeates all aspects of any given society.
1995 Xing
Culture [is] those deep, common, unstated experiences which members of a given culture share, which they communicate without knowing, and which form the backdrop against which all other events are judged.
1966 Hall
Culture is the coherent, learned, shared view of a group of people about life’s concerns that ranks what is important, furnishes attitudes about what things are appropriate, and dictates behavior.
2003 Beamer &
Varner
Culture is the collective programming of the mind which
distinguishes the members of one group or category from others.
1980 Hofestede
Culture is the ‘Social heritage’ of a community: the total body of material artifacts (tools, weapons, houses; places of work, worship, government, recreation, works of art, etc.); of collective mental and spiritual “artifacts” (systems of symbols, ideas, beliefs, aesthetic perceptions, values, etc.); and of distinctive forms of behavior created by a people (sometimes deliberately, sometimes through unforeseen interconnections) and transmitted from generation to generation.
1977 Bullock
&Stallybrass
These definitions help to understand what culture is. Culture, however, is more than a description of identity but also acts as a mechanism for human functioning. The National Association of Social Workers (2001) describes culture as the “integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and
11
institutions of a racial, ethnic, religious, or social group” (p. 61). Of all the literature defining culture, the authors Chaney & Martin (2003) put forth a practical and accurate use of the term as
“the structure through which the communication [process] is formulated and interpreted” (p.
268). This idea of culture being the conduit of communication is also supported by foreign language learning researchers: “Language is the most typical, the most representative, and the most central element in any culture. Language and culture are not separable” (Brooks, 1964, p.
85). The researchers Samovar, Porter, and Jain (1981) explained in more detail why the two are so intertwined:
Culture and communication are inseparable because culture not only dictates who talks to whom, about what, and how the communication proceeds, it also helps to determine how people encode messages, the meanings they have for messages, and the conditions and circumstances under which various messages may or may not be sent, noticed, or interpreted... Culture...is the foundation of communication.
(p. 24)
Therefore for the purposes of this study the definition of a foreign culture or a culture different to that of the respondents will refer to any culture whose primary language of communication is not English.
Competency
The literature offers many useful descriptions of competency. Competency is generally agreed as pertaining to an individual’s KSAO’s. KSAO’s is a common term in the literature and refers to the knowledge, skills, abilities, and other traits such as personality type and interests (Peters, Greer, & Youngblood, 1997). Furthermore, a competency is the application of those KSAO’s (International Standard, 1999). A competency can also be a measurable or immeasurable characteristic that causes a person to be highly effective in a given situation (Spencer &Spencer, 1993). Other researchers describe competency as a set of skilled behaviors or at least measurable behaviors leading to effective handling of unique situations (Bowden &
Marton, 1998; Spitzberg, 1994). No matter how a competency is described, the existence of a
12
competency can always be recognized because it “leads to or causes effective or superior performance” (Boyatzis, 1982). Table 2.2 lists other useful descriptions of competency found in the literature.
Table 2.2
Definitions of Competency
Definition Year Author
Group of measurable bits of workplace behavior and a person’s ability to handle unique situations in an effective manner.
1998 Bowden & Marton
A kind of ability or a set of skilled behaviors. 1994 Spitzberg An application of knowledge, skills, and behaviors in
performance.
1999 International Standard ISO 10015
An underlying characteristic of an individual that is causally related to criterion referenced effective and/or superior performance in a job or situation.
1993 Spencer &Spencer
Competency in fact includes both an internal or mental factor as well as an external factor.
The external element is the observable behavior while the internal element is the intent, or motivation, of the behavior (Boyatiz, 1982). For instance, while speaking with a new acquaintance, a person might continue the conversation by asking interesting questions for the sake of ingratiating themselves to with the new contact. This would be an example of political or social competency. On the other hand, the same behavior might be observed by a person genuinely interested in what the new acquaintance has to say and would like to get to know them better. This shows the person is applying a competency like emotional self-awareness (Boyatiz, 1982). This theme of competency having internal as well as external elements can be extended into different types of competency such as intercultural competency.
13
Intercultural Competency
Cross, Benjamin, and Isaacs (1989) described intercultural competency as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations” (p. 13). This definition outlines the major outward characteristics and end result of effective ICC. Onyoni and Ives (2007) take the definition further by explaining that the behavior is a combination of “knowledge, awareness, sensitivity, attitudes, skills, and encounters by individuals and programs to acknowledge and respect the cultural traditions of their clients and their communities” (p. 1). The intent, therefore, of intercultural competency behaviors is to show acknowledgement and respect to the individuals with whom one is interacting. The same sentiment of respect is expressed by Alvarez et al. (2008) along with the idea that cultural competency is a process that improves over time.
Icebergs have long been used for analogous purposes and illustration of cultural competencies is just one of them. Icebergs are unique in that, at first glance, their cap or “tip”
catches the eye and can distract one from investigating what lies below the waterline. In fact, only 10 percent of an iceberg is observable (Briney, 2012). Likewise, the observable aspects of cultural competency are only a fraction of an entirety. Spencer & Spencer explain that in this sense the iceberg has four layers of descending degrees of discernibility. The first layer is knowledge that can be taught and learned in a structured format such as training courses (Spencer & Spencer, 1993). For example, one can easily teach a new employee to bow their head slightly when greeting Asian business associates. The second layer is less specific skills that can’t necessarily be taught in a classroom but are learned from situational experience and can be transferred from one scenario to another (Spencer & Spencer 1993). For instance, gauging the appropriate moment to make a toast at a dinner party is a hard skill to teach objectively and can only be learned through experience. The third layer of the iceberg is the relationship between a person’s values and beliefs and their perception of social and political expectations (Spencer &
Spencer, 1993). A person with high cultural competency might be more able to understand the other side of a hot-button political topic and therefore more likely to gracefully respond in accordance with their private beliefs. The final layer of the iceberg consists of personal traits
14
such as their motivation and self-image (Spencer & Spencer, 1993). This last layer is very difficult to observe and measure. For instance, a boss from a detailed oriented culture double checking numbers and figures might come across as untrusting or doubtful of an employee’s hard work.
There is no such thing as a completely culturally competent person: “Cultural competence is never fully realized, achieved, or completed, but rather a lifelong process for social workers who will always encounter diverse clients and new situations in their practice”
(NASW, 2001, p. 11). Chang (2007) echoes this sentiment but includes that an individual is not left unchanged by pursing ICC because it is “an integrative and transformative process” (p. 189).
On a different note Whaley and Davis (2007) describe ICC as “set of problem solving skills” in an intercultural situation. Taylor (1994) takes this problem solving ability further by stating that intercultural competency is “an adaptive capacity based on an inclusive and integrative world view which allows participants to effectively accommodate the demands of living in a host culture” (p. 1). This idea is ultimately the goal of healthcare practitioners with respect to their intercultural competencies: to effectively and smoothly operate in multicultural scenarios.
ICC and Job Performance
Factors affecting workers’ job performance are always of great interest to employers.
The link between a person’s ability to communicate effectively in multicultural work environments and their occupational performance is strongly supported across various professional fields. Mol et al., (2005) showed that an employee’s intercultural sensitivity was significantly related to job performance. While studying corporate employees considering overseas assignment researchers found that job effectiveness was strongly tied to intercultural adjustment (Tucker et al., 2004). Other correlations between job performance and the different sections of ICC have been shown in multiple studies (Cui &Awa, 1992; Hawes & Kealey, 1981;
Ruben,1977; Sizoo, Plank, Iskat, & Serrie, 2005). The effect ICC has on job performance extends beyond individual level. Managers from the U.S. and Russia expressed that transparent communication and cultivating cross-cultural rapport among teammates was essential to team performance (Matveev & Milter, 2004). Researchers exploring the inter-workings of
self-15
managed work teams (SMWTs) discovered that the root of team inefficiency was a lack of cultural understanding amongst teammates (Kirkman & Shapiro, 1997).
ICC and Healthcare
Racial and ethnic groups in the US suffer disproportionally from health problems. The socio-economic status of these groups contributes to this disparity in ways such as poor living conditions and lack of medical insurance (Betancourt et al., 2003). Many of the health problems for these people groups are due to a lack of consistent, if any, access to healthcare. There are, however, cultural problems contributing to the situation:
Racial/ethnic disparities in quality of care for those with access to the health care system are equally concerning. These disparities have been shown to exist in the utilization of cardiac diagnostic and therapeutic procedures, prescription of analgesia for pain control, surgical treatment of lung cancer, referral to renal transplantation, treatment of pneumonia and congestive heart failure, and the utilization of specific services covered by Medicare. (Betancourt et al.,2003, p.294)
The authors explain that the root of these problems is likely attributed to patient’s cultural beliefs concerning patient recognition of symptoms, thresholds for seeking care, ability to be understood when describing symptoms, ability to understand treatment plans, and adherence to care (Betancourt et al., 2003). These factors affect a healthcare provider’s ability to interact with their patients during a treatment and recovery thereby increasing the disparities in racial and ethnic group health problems (Betancourt et al., 2003). A nursing supervisor from Pensacola, Florida, while being interviewed for a qualitative study parallel to this research, commented on the barrier created by a nurse’s low intercultural communication skills with cultural different patients: “Every time she walked into the room they asked for someone else—They didn’t want her. So if you’re not able to cross that barrier, even if you’re the best nurse in the world, you can’t provide good care” (Vaughan & Yeh, 2013, p. 626). If medical providers are more attuned
16
to the cultural lens through which a patient views their health then the provider “can address patient concerns more adroitly, leading to improved clinical outcomes” (Chansky, 2011, p. 88).
Striving for a more culturally competent health care system should be a priority among healthcare providers and health educational institutions. Researchers explain that a culturally competent healthcare system “acknowledges and incorporates—at all levels—the importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs” (Betancourt et al., 2003, p. 294). This means that healthcare providers should not only increase their cultural knowledge of their patients’ backgrounds but also be actively aware of the interplay of cultures during communication. To prevent cultural competence stagnation, providers shouldn’t think of themselves as culturally competent but only as always becoming more culturally competent (Campinha-Bacote, 1998).
Intercultural Sensitivity
There is a gap between simply noticing the asynchronies of a culturally different person and appropriately responding to those differences in order to achieve effective interaction.
Intercultural Sensitivity bridges that gap. It has been generally described as “sensitivity to the importance of cultural differences and to the points of view of people in other cultures” (Bhawuk
& Brislin, 1992, p. 414). The same authors continue to describe cultural sensitivity, or the ability to detect cultural differences, as a part of a trio of attributes needed for effective intercultural communication. The other members of the trio, awareness and adroitness, are having an interest in other cultures and the willingness to modify one’s behavior during interactions respectively (Bhawuk & Brislin, 1992). Chen and Starosta further clarified this trio by explaining that all of ICC can be described in one of the following three categories:
intercultural awareness, intercultural sensitivity, and intercultural adroitness (1996). Intercultural awareness is the cognitive aspect of ICC which consists of culture knowledge and understanding cultural conventions that drive behavior (Chen &Starosta, 1996). Intercultural sensitivity is the affective ingredient for ICC which is driven by an “active desire to motivate themselves to understand, appreciate, and accept differences among cultures.” (Chen & Starosta, 1998, p. 231).
17
It has also been defined as “sensitivity to the importance of cultural differences and to the points of view of people in other cultures” (Bhawuk & Brislin, 1992, p. 1). Finally, intercultural adroitness is the behavioral side of ICC which describes a person’s ability to successfully complete tasks and reach communication goals during intercultural interactions (Chen &
Starosta, 1996). Furthermore Bennett describes intercultural sensitivity as process of developing one’s self in the three ICC aspects by moving through six stages of experiencing cultural differences from a state of ethnocentrism to ethnorelativism (Bennett, 1986). The first stage is denial in which the subject simply rejects the existences of differences. During the second phase, defense, the subject seeks to protect their own world view by countering the differences. The subject then tries to conceal differences to protect their world view during the third stage. In the fourth stage the subject has now crossed into a more ethnorelative perspective and they begin to accept cultural differences. In the fifth stage the subject now openly recognizes cultural differences and changes their behavior to become multicultural. When the subject reaches the
Starosta, 1996). Furthermore Bennett describes intercultural sensitivity as process of developing one’s self in the three ICC aspects by moving through six stages of experiencing cultural differences from a state of ethnocentrism to ethnorelativism (Bennett, 1986). The first stage is denial in which the subject simply rejects the existences of differences. During the second phase, defense, the subject seeks to protect their own world view by countering the differences. The subject then tries to conceal differences to protect their world view during the third stage. In the fourth stage the subject has now crossed into a more ethnorelative perspective and they begin to accept cultural differences. In the fifth stage the subject now openly recognizes cultural differences and changes their behavior to become multicultural. When the subject reaches the