is related strongly to honor. In individualist cultures (Australian, Canadian and American), on the other hand, the concept of face rarely goes beyond the social self-worth of the person.15-17


Communication styles Diverse communication styles also affect the workplace. Formal versus informal and direct versus indirect communication styles are examples of these differences. Formal versus informal: U.S. culture is becoming more informal.


North Americans tend to refer to and address others by their first names because they consider this a demonstration of openness, friendship and acceptance.18


This practice occurs in business as well as in healthcare


settings. In many cultures, however, this level of informality is seen as presumptuous and rude. In situations dealing with coworkers and patients of other cultures, it’s always a good idea to either address people by their family name or ask, “How would you prefer to be addressed?” Informality also pervades nonverbal communication. For example, in


North American society, we feel comfortable and at ease when visiting with a healthcare provider who is dressed casually. Casual dress gives us a feeling of openness and accessibility. In contrast, Latino, Asian and many other cultural groups may view a casual appearance as lacking in professionalism and respect, resulting in a lack of confidence and trust. In cultures where hierarchical structure is important, communi-


cation tends to be more formal in the work situation. For example, people in Latino cultures show respect by not only addressing those in positions of seniority or those they don’t know well by their family name, but also by shaking their hands each time they meet. Personalismo (behaving like a friend), a highly valued trait, also dictates that one politely asks people something about the well-being of their family before getting to the business at hand.17 Although many Asians are not comfortable with shaking hands, they


may also expect that one “establish a relationship” before getting down to the business of working together. To whites of European ancestry, who tend to be task-oriented and value “getting right down to business,” this kind of social “chit chat” may seem like a waste of time. But these signs of courtesy, common in other societies, are important to developing a comfortable working relationship with culturally diverse coworkers. For some cultures, while task accomplishment is important, rela-


tionships among workers are highly valued and a priority. Tasks are achieved within a context in which rapport and relationships are emphasized.18,19


In other cultures, tasks predominate, and personal


relationships are not fostered in the work setting. For example, Amanda, an outgoing, well-liked African-American nurse, enjoys friendly, in- formal relationships with her working peers. She is talkative, offering up ideas freely and generally speaking her mind. On the other hand, June, a reserved European-born nurse, is quiet, and focuses on tasks. She considers informal banter between colleagues rude and a waste of time. She has no interest in developing friendships with people from the workplace. When June disregards Amanda’s comments, Amanda feels hurt and rejected. These differences in styles can also occur within cultures due to individual differences in people’s personalities. In either case, these differences can lead to misunderstandings and conflicts. In the above situation, a supervisor could help the nurses understand and appreciate their culturally based differences. Direct versus indirect: Communication in mainstream U.S.


culture tends to be direct. For example, if a nurse disagrees with a supervisor about a work schedule, he or she might approach


the supervisor and ask to speak about the schedule. When sitting with the supervisor in the office, the nurse might say, “I worked on the last holiday, so I think it’s unfair that you’ve now sched- uled me for the next holiday. Could you change my schedule?” This communication is clear and direct. A direct communication style occurs in what has been called low-context cultures. In low-context cultures, it’s necessary to spell things out because explicit verbal communication, rather than the context of the situation, is the way meaning is transferred.4


Direct eye contact


is important, as well as getting directly to the business at hand. In many other cultures, including Asian, Latino and Native Amer-


ican, communication tends to be more indirect. These are considered high-context cultures, where the situation in which an utterance is made carries great meaning. Nonverbal communication, such as gestures, body language, voice tone and register, and the nature of the interpersonal relationship, are just as or even more important than the content of a verbal communication.4


In a high-context culture,


the nurse in the example above might use an entirely different ap- proach to communicate with the supervisor. First, the nurse might talk about the unfair scheduling among coworkers. He or she might enlist a couple of colleagues to eat lunch with a trusted intermediary, such as the charge nurse or a person who has informal leader- ship power, rather than going directly to the supervisor to complain about holiday scheduling. After pointing out the need for a better system for holiday scheduling, they would encourage the intermediary person to take action. For lower-level workers to confront a supervisor directly would seem inappropriate in a high-context culture. Direct, sustained eye contact may be considered disrespectful. Although many individual differences coexist within low- and high-context cultures, communication style is learned within a cultural context. Healthcare providers must know their own and coworkers’ styles of communication and be able to communicate effectively in the work setting. Conflict management styles: The concept of face, discussed


earlier, also has a strong influence on how people manage con- flict. Afzalur Rahim, a professor at West Kentucky University, identified five different types of conflict management styles: integrating, compromising, dominating, obliging and avoiding. In general, members of individualist, U.S. mainstream culture tend toward a dominating conflict management style, which emphasizes strategies that push for one’s own position or goal rather than those of the other person or group. This style is direct and linear, and because members of an individualist culture are usually able to separate the issue of the conflict from the party or parties involved, they normally get over the conflict relatively easily and can assume friendship or at least a friendly manner as soon as the conflict is resolved.15


Members of collectivist


cultures (for example, Asians, who make up a large proportion of the nonmainstream culture nursing population) tend to use strategies such as avoiding, obliging, and integrating to maintain interpersonal harmony.15


They often try to maintain public face by


using collaborative or passive strategies during conflict, avoiding open and direct conflict at all costs to display group harmony. The communicative style used by most Asians is indirect and circular or spiral. Because the conflict issue cannot be separated from the


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