Transcript Transcultural Competency

Transcultural Competency:
Applying
Principles to
Patient Care
E. Scott King, Director / Atlanta Academy of Languages
“Transcultural”
The relatively new word “transcultural” implies
reaching across cultural boundaries with one
“foot” planted in the familiar ground of one’s own
life experiences…reaching across the sometimes
explicit but often implicit space between ourselves
and another human being. It validates both a
deeper awareness of and a growing appreciation
for one’s own culture, as well as a willingness to
learn about another’s culture in the process of
seeking true communication!
- E. Scott King
Bafá Bafá
A Cross Culture Simulation
Welcome!
You are about to
play a game!
The name of the
game is Bafá
Bafá
Don’t worry…you’ll understand the title of the game later!
The purpose of
this game is to:
–Create a situation
where you can
explore the idea of
culture
–Create feelings
similar to traveling to
a different culture
Let you have the
experience in observing
and interacting with a
different culture
Get ready!
We’re going to
divide you all into
2 groups!
One group will be the
ALPHAS
The other group will be
the
BETAS
Now it’s time to divide
into teams and follow
your group leader!
Discussion and Analysis
Now it’s time to discuss
what we discovered in
the game…please sit
together with your own
group!
for the BETAS…
Please give me words
which describe the
Alpans:
now for the ALPHANS…
Please give me words
which describe the
Betans:
…for you Betans:
How did the Alphans appear
to you when they visited
your group?
…for you Alphans:
How did the Betans appear to
you when they visited your
group?
Betans, please answer:
Describe your feelings
and thoughts when you
visited the Alpha culture?
Alphans, please answer:
Describe your feelings
and thoughts when you
visited the Beta culture?
To any one member of the Alpha
Culture:
Explain the Beta Culture
to all of us!
To any one member of the Beta
Culture:
Explain the Alpha Culture
to all of us!
Now, one of you Alphans:
Please explain the Alpha
Culture to the entire
group…and answer
questions about the
Alpha culture…
Now, one of you Betans:
Please explain the Beta
Culture to the entire
group…and answer
questions about the
Alpha culture…
To all of you:
In which culture would you
prefer to live? Why?
to Women:
If you said you prefer the Alpha
culture…why do you do so when the rules
discriminate against women?
Are there indeed situations and
conditions in the “real world”
which make it difficult to ask
about the rules of another
culture?
A few possibilities:
Language may be a barrier!
Reluctance to ask so as not to appear rude!
Sometimes people within a culture aren’t
even aware of the reasons or behaviors seen
by others as different.
Example: Personal Space
Example: Expression of Thanks to Customers
Thanks for playing!
Remember that real cultures are infinitely
more complex that either of our “pretend”
cultures.
Remember today that as we discuss other
cultures, we’ll be making references to our
experiences together in the game of Bafá
Bafá to help us learn about others from
new perspectives!
What is Culture?
The word culture implies an integrated pattern of
human thoughts, communications, actions, customs,
beliefs, values and institutions of a racial, ethnic,
religious or socioeconomic group.
It’s tempting to think of culture only in terms of what
experts refer to as “Culture with a Capital C” – in other
words, art, music, & literature!
But culture with a “little c” includes the daily routines and expectations
in a society, and might include how to order food from a drivethrough, use an ATM machine, order a meal, appear to an interview,
drive a car, or act in a hospital! These things are often the more
implicit behaviors of a group of individuals, and therefore are
frequently viewed as the most mysterious barriers between us!
Cultural Knowledge
Cultural knowledge involves increased
familiarization with selected cultural
characteristics, history, values, belief
systems, and behaviors of the members
of another ethnic group. (Adams, 1995)
It’s a life-skill!
Cultural Sensitivity
Cultural sensitivity is knowing that
cultural differences as well as
similarities exist without automatically
assigning values to those differences,
i.e., better /worse, right /wrong.
(National Maternal & Child Health Center on Cultural Competency, 1997)
Competency
Competency implies the capacity to
function effectively.
Developing sensitivity and understanding
of another ethnic group usually involves
internal changes in attitudes and values
and development of openness and
flexibility in relation to others. Cultural
awareness must be supplemented with
cultural knowledge. (Adams, 1995)
How do we really communicate
with others?
Objective words with explicit but possibly
multiple meanings (shot, tire, cold, sick) and
subjective words with implicit and deeper
meanings (“pretty” bad, “severe” pain,
“horrible” headache)
Idiomatic expressions (“run down”, “all out”,
“get to”, “get in”, “get down”)
Body Language (Gestures,Eye Contact, and
Personal Space)
Barriers to Transcultural
Competency
Barriers may be expected to exist,
therefore, in all three areas of
communication:
Language Barriers – “A different language is a
different view of the world!” –Federico Fellini
Shades of meaning in words even when we have
learned the language of the patient
Body Posture and Gestures may mean one thing
in one culture and something entirely different in
another (or nothing at all!)
Suggestions
Ask about words (whether in English or
another language!) whose meaning or
implications are not quite clear to you…
What exactly do you mean by “--------” ? is a great question
to ask the patient
Observe consciously and carefully the body
language (eye contact and gestures, as well as
personal space allowed) that the patient
exhibits…these are clues to their thoughts!
Distance may indicate either distrust or respect in other
cultures!
Hot versus Cold Climate Cultures
Sarah Lanier’s theory of Hot and Cold
climate cultures (Lanier, 2002) offers easy to
understand frames of reference when
working or living with others. The
generalizations found in this explanation of
cultural differences can serve as a solid basis
for “first-impression” insights into the
behavior of others.
My Own Concept of Hot/Cold Climate Cultures
C OLD C LIMATE C ULTURES
HOT C LIMATE C ULTURES
Lanier points out that there are
exceptions found to solely a geographical
interpretation of the Hot/Cold-Climate
Cultures.
Hot Climate Cultures
People in and from hot climate cultures tend
to be:
relationship oriented rather than task oriented
indirect communicators rather than direct communicators
group-identity seekers rather than individual-identity
seekers
inclusive of many others rather than highly regarding of
individual privacy
high-context members of their society (everything matters)
rather than low-context members of their society (not
much matters; anything goes-within reason)
not highly oriented to the clock rather than time oriented.
Cold Climate Cultures
People in and from cold climate cultures tend
to be:
task oriented rather than relationship oriented
direct communicators rather than indirect communicators
individual-identity seekers rather than group-identity
seekers
have high regard of individual privacy over the inclusive
of many others in affairs
low-context members of their society (not much matters;
anything goes-within reason) rather than low-context
members of their society (everything matters)
time oriented to the clock rather than flexible in their
concept of time
Our Patients
Patients from Cold-Climate Cultures seem to
appreciate logic, efficiency, and informationloaded atmospheres. Respect for others is best
expressed by respect for another’s time and
privacy.
Patients from Hot-Climate Cultures seem to
thrive on being relationship based where a
“feel good” atmosphere is created. People take
priority over efficiency and time, and “small
talk” is an well-developed and highly valued
art!
Our Patients
Patients from Cold-Climate Cultures seem to
use short and direct questions and answers,
and a “yes” is usually a “yes”, and a “no” a
“no”. If they say nicely what they really think,
you won’t be expected to take it too personally!
Patients from Hot-Climate Cultures seem to
value being friendly above being honest, and
even avoid taking any chance of offending or
embarrassing others. Their “yes” or “no” may
simply be an indication that they will consider
further the situation, not that they will
comply, act upon, or are answering honestly
your request or question.
Our Patients
Patients from Cold-Climate Cultures seem to
cherish their own right to an opinion and to
independence, and take initiative within a
group, making decisions on their own. Their
“own space” is important.
Patients from Hot-Climate Cultures seem to
seek their identity within a group, avoid
appearing “pushy” by taking too much
initiative, seek the support and protection of
many others, and expect clear direction from
the provider. One’s possessions should be
shared, and one rarely desires solitude.
Our Patients
Patients from Cold-Climate Cultures seem to
appreciate planning and advanced notice.
Spontaneity must be brought under control.
Hospitality is a special event and a serious
matter.
Patients from Hot-Climate Cultures seem to
believe that hospitality is a spontaneous gift,
and is the context for all relationships. Gifts
are usually expected. Food and drink play a
major role in kindness and appreciation.
In a Cold-Climate culture, who you
know matters, but not nearly so much as
what you know. Cold-Climate cultures
usually do not expect Hot-Climate
Cultures to know their rules of behavior,
nor are they that interested in knowing
the rules of the other culture.
In a Hot-Climate culture, honor and
respect often outweigh freedom and
casualness. Manners are of the utmost
importance for success!
When working with patients from another culture,
misunderstandings may occur if you and your patient
have a different understanding of:
the epidemiological and etiological factors within a culture or
people
a directive versus an options-oriented treatment and patient
care
the family involvement expectations of a culture
pain and the expression of pain
the standards of modesty and personal space
the true language barriers between you
the diet and food preparation norms and preferences within
culture
body language and gestures
the purpose of the interpreter
the religious customs and beliefs of this specific patient
the socioeconomic impacts and implications of a treatment
10 Brief Tips for Providing Culturally Competent Care
1.
Know where the patient was born
2.
Know what language they speak, and their true level
of English…be careful to avoid confusing idioms
3.
Know about any specific dietary patterns
4.
Know the role of spirituality in the patient’s life and
any specific prohibitions of their religion
5.
Know the level of independence the patient is
accustomed to having and if it’s a problem or an
asset
10 Brief Tips for Providing Culturally Competent Care
6.
Know the support system that exists in the patient’s
life and surroundings and its implications.
7.
Have the patient describe how the illness is handled at
home.
8.
Know the importance of individualizing each case,
based on the myriad of cultural issues that can arise.
9.
Assess the emotional state of the patient and if there is
a cultural dimension that support this current state of
emotions.
10. Allow the patient to assist you in learning words that
describe his/her illness.
Thank you for participating!
Additional resources:
www.ggalanti.com
www.culturaldiversity.org
www.nccccurricula.info/resources.html
www.diversityrx.org
www.hispanichealth.org
www.pewhispanic.org
Foreign to Familiar, by Sarah A. Lanier
ISBN# 1-581580-022-3, McDougal
Publishing
Towards Transcultural
Competency in the Treatment
of Hispanic / Latino Patients
What is “transcultural competence”
in dealing with Hispanic/Latino
healthcare issues?
Transcultural competency implies effective
communication !
Not just Spanish words !
Cultural knowledge/awareness is crucial !
These knowledge-based skills can be learned !
“Hispanic” versus “Latino”
Hispanic is defined as Spanish-speaking
– Definitely NOT a racial term!
Latino is defined as being related to or
from the Spanish-speaking countries of
North America, or from Central, Latin, or
South America
Identity / Nationalism
Of extreme importance and significance to
almost every Spanish-speaker is the country
from which they or their family have
immigrated !
Both country and region are important because the culture
and expectations of each may differ significantly from one
area to another.
Example : MEXICO has three (3) distinct regions and 31
states! Northern, Central (City), and Southern states vary
in history, ethnic background, and culture.
There are many cultures represented in the
broad terms “Hispanic” and “Latino” !!!
How well do we really
communicate with each other?
Communication is more than simply
words. In fact, words do “often get in the
way”!
Communication is often non-verbal!
What are some examples of Latin nonverbal communication that might convey
unspoken messages of discomfort or fear?
Gestures and Body Language
Hand signs – these differ so be careful
“OK” gesture
“Come here” gesture
Personal Space – extremely different!
Latin versus Anglo “personal space”
Other Body Language Signals
The so called “Latin nod” – don’t make presumptions!
Eye contact
Potential Areas of
Misunderstanding
Epidemiological and Etiological Understanding
Directive versus Options-oriented healthcare
Family Involvement
Perception of symptoms and expression of pain
Standards of modesty and Personal Space
Linguistic challenges and barriers
Diets and food issues
Folkloric Medicines
Did you know?
Mexican Americans have a
higher incidence of
diabetes, heart disease,
hypertension, pernicious
anemia and tuberculosis
exposure.
Did you also know?
‘Small talk’ before serious discussion may
ease tension and increase comfort level
with Spanish-speakers.
Courtesy is valued; arguments are
considered rude. One does not openly
question authority without fear of
offending. Question: What implications
are there for the physician?
What do you know about
Latins/Hispanics and…
directive care versus “options”?
attitudes towards Physicians?
attitudes toward diseases?
gender expectations?
the implications of the gender of the
interpreters?
their formal educational level ?
…about Latinos/Hispanics
and…
their true knowledge of English?
the cultural “baggage” they bring with them
that might affect healthcare?
the folklore medicine and home remedies
that they have seen used or have
experienced themselves?
their general tastes in clothing, styles, foods,
and cosmetics/appearance?
their “polychronic” versus our
“monochronic” view of events and time?
And What’s More…
Many Spanish-speakers consider it either rude
or humiliating to indicate that they do not
completely understand you (in both Spanish and
in English). Be sure to always clarify and get a
positive response from a Spanish-speaker
before you assume that they understood you
completely!
This will accomplish the very effective but blunt,
non-Latino style discourse among Americans
expressed aptly by the word “Huh???”!
It’s all in learning about the details!
Touch is very important, especially in caring for
children.
Have narrowed ‘personal space’ & may see
one’s distancing as aloof and unfriendly.
Smiling & handshakes are important, trustestablishing interactions.
Modesty is valued.
Family life
Mexican and Latin American culture is mainly a
nuclear family culture. 73% of families are
married-couple families.
Matriarchal /matriafocal society with oldest
female responsible for family cohesiveness,
most health matters and family names.
Father, however, is often the decision-maker. ut
Mother most approve or there will be little
enforcement of decisions.
….more about the family
The elderly are highly respected and live
with their children.
Extended family also plays visible role in
health and illness situations.
People of this culture may be hesitant to
seek help / support outside of the family.
Other issues…
Working with Interpreters
Family member versus professional
Seasoned professional versus “convenience”
Issues of accuracy
Issues of sharing and discussing
Unauthorized recommendations/guidance
Standards do exist!!!
Refer to the Massachusetts Medical Interpreter
Association (MMIA)
Illness and Disease
Good health may be seen as good luck, a reward from God
or a universal equilibrium with balanced forces of hot/cold,
wet/dry, etc.
When family member is ill, may practice religious rituals,
i.e., lighting candles, praying.
When in pain, many are stoic and exhibit great self-control;
perceived as having high pain tolerance.
Prefer company of others, especially family, when in pain.
Folk medicine is practiced by some. “Curanderos”
Illnesses /Death / grief are considered “God’s will;” saying
the rosary with family is common for several evenings after
a death.
Now let’s practice what we’ve
learned or need to learn!
Situation 1:
You’re interviewing a patient and reminding
them of how important it is to “stick with”
the diet you prescribed for them during
their last visit. The patient will most likely
think that………………………
More fun!
Situation 2
You struggle to communicate that a patient
needs to be sure to advise you
immediately should their symptoms return
or worsen. The patient smiles and nods
their head
indicating……………………………………
……..
Even more!
Situation 3
Your interpreter, Pablo, is assisting you
with Mrs. Rodríguez, who is in her third
trimester of pregnancy and experiencing
some bleeding and pain.
Pablo will
…………………………………………
More situations…
Situation 4:
You notice that a child patient has what
appear to be ashes in his/her ears. Most
likely…………………………..
Another…
Situation 5:
You are visiting a Hispanic/Latino patient
for Home Healthcare. S/he offers you
something to drink. You do not want
anything because you just had a large
drink before arriving. You should explain
that……………………………
More situations
Your patient walks into the lobby and/or
waiting/reception area. You are busy taking
information or explaining how to complete forms
to another patient. The Hispanic/Latino
will/may……………………………………………
Your nurses notice that all the Latino children
seem to be running “wild” in the waiting
room/reception area. The best way to correct
this is
by……………………………………………………..
Cultural Diversity
Transcultural Snapshots
African – American Culture…
The African-American culture is rooted in the 16th – 19th centuries when
millions of Africans were brought to the US and bonded as slaves. The culture
uniquely developed as a blend of African and American traditions displayed in
the art, music, language, literature, diet and health practices of its people.
Spirituality is very important and most are Protestant. This culture comprises
about 15 percent of the US population.
There is an increased incidence of hypertension and sickle cell anemia. The two leading causes of death are
coronary artery disease and diabetes.
The African-American culture is celebrated during the month of February – “Black History Month.” Kwanzaa,
or “first-fruit” in Swahili, is celebrated from December 26 – January 1 in recognition of African harvest
festivals.
At a Glance…
Communication:
Perceptions of Illness:
•Use of “Mr., Mrs., Ms.” and last name is a sign of
respect.
•May feel illness due to bad luck, natural or evil forces or
punishment from God.
•Some have different words for medical conditions,
(i.e. ‘sugar’ for diabetes).
•Some believe herbs and spices are required to treat some
illness.
•Expressive use of gestures, facial expressions or
other body language.
•May believe the body’s health is related to nature, (i.e.,
moon phases, seasons).
Family:
•Some practice folk medicine, voodoo and may use folk
medicine ‘practitioners’ or ‘Hougans’.
•Nearly ½ of all African-American families are
headed by females and the woman is primary
protector and decision maker although the man is to
be included.
•Many have large extended families who are very
supportive during crisis or illness.
Religion:
•Often have strong religious system.
•Church plays important role in support, maintenance of
self-esteem and promotion of culture.
•May believe prayer is the main treatment for illness.
Cultural Diversity
The
Asian Cultures…
Asia is a vast continent comprised of many different
nationalities of people, each with their own cultures
and traditions. These nations include Chinese,
Japanese, Filipinos, Vietnamese and Korean people to
name a few. Asians are the fourth largest patient
population at GHS. The majority of Asian people in
our area are Vietnamese, and therefore, will be the
focus of this discussion.
At a Glance…
Communication:
Perceptions of Illness:
•Vietnamese is the national language; some speak
English or Chinese.
•Illness due to many causes: natural (spoiled food), supernatural
(demons, spirits), metaphysical (imbalance of hot/cold) and germs
•Prefer formal, polite communication.
•Some may practice folk medicine: rubbing coins on skin, pinching
skin, aromatic oils, ointments, herbal teas, etc.
•Touch is limited. Many believe touching the head is
disrespectful.
•Avoiding eye contact when talking with someone of
higher standing, older age or opposite gender is a sign of
respect as is slightly bowing the head in front of the
elderly.
•Nodding / smiling may reflect desire for personal
harmony rather than agreement or understanding.
Family:
•Family is the basic unit of society; often extended
family to help support.
•Family loyalty and obedience / honor toward parents
are valued. 73% families are married-couple families.
•Children’s education highly valued.
•Emphasis on social harmony; may prevent full
expression of concerns / feelings.
•Drawing blood may cause much anxiety as some believe the body
will suffer a permanent loss.
•Unexplained clergy visits / flowers to the sick may be interpreted as
serious sign & associated with death.
•Some expect authoritative, direct and detached communication from
healthcare professionals.
•Tendency to deny pain; believe this may make pain go away.
Hesitant to ask for pain meds because it inconveniences the caregiver.
Diet:
•Common staples include rice, salty fish and dark green, leafy
vegetables.
•Meat is rare in traditional diet, but fairly common for US
Vietnamese.
•Lactose intolerance is more common among VietnameseAmericans, therefore use of milk/milk products may be limited.
Korea
Vertical Society
– Six levels of status, three up and three down
– Status determined by age (10,20,30 years
older; 10,20,30 years younger)
– Status determines level of speaking
Great respect for elders (even one year
older)
Korea
Many beliefs can be traced back
to Tangun myth.
– This story of the son of god of Heaven
delineates the importance of harmony, human
welfare, and national identity
Korea
A strong bond exists among
family and extended family
–responsible for each other
–see themselves as a cohesive unit
–ancestors are honored (Chu-sok
holiday)
Korea
Buddhism
- as seen in
architecture
Confucianism – as seen in
calligraphy and paintings
Christianity – introduced in
mid 1890’s
Korea
A smile does not always mean
happiness in Korea. It can be
used as a greeting or to mean
“I’m sorry.” It is not typical to smile
at strangers.
Korea
Korean women are commonly
seen holding hands. Boys and
men may put arms around
shoulders.
Korea
Korean men typically bow then
shake hands when greeting each
other. Women bow but do not
shake hands with men.
Korea
Women often cover their mouths
when laughing.
Korea
Koreans do not usually apologize
for burping, sneezing, coughing,
or even accidentally passing gas.
However, none of these
occurrences is considered
appropriate.
Korea
Often Koreans will not look an
authority figure in the eye because
doing so is considered rude.
Striving not to offend, it is common
that Koreans remain silent even if
they do not understand. Koreans
often believe that “silence is golden”
and that it is better to remain silent
than to encourage conflict.
Korea
It is risky to write a person’s
name in red ink. This may be
taken as a sign that the other
person’s mother will die.
Korea
Kimchi is the national food of
Korea. It is a very spicy pickled
cabbage.
Korea
In general, Koreans are addressed by
last name plus any appropriate title.
First names are very important in the
Korean culture but it is not typical to
call someone by first name until given
permission to do so. This is reserved
for friends of the same age.
“Older brother” is used by younger siblings!
Korea
Children show respect to their
parents by demonstrating
obedience to them
Take off shoes in Korean home
Offer seat to elderly and rise
when they come into the room
VIETNAM
Great importance on family. Family
members and extended family members
are a team, and will first seek one
another’s advice in times of need, and
family interests are considered when
making even individual decisions. Family
celebrations form the basis of Vietnamese
social life.
Vietnam
Influenced by Confucianism, Buddhism,
Taoism, and Christianity.
Great honor given to elders and parents.
Vietnam
Traditional Vietnamese family roles are
clear; the wife is subordinate to the
husband, the children are subordinate to
their parents, and younger children are
subordinate to elder children. The man is
the provider, the woman ensures a
smoothly run household, including
managing the family finances. A wife is
supposed to care for the husband’s
parents.
Vietnam
Sometimes three generations are in one
household.
Ancestor veneration is common.
– Homes may have altars to ancestors.
– Ancestors desires considered in decisions
– Attempt to bring honor to ancestors
Vietnam
Having children is important
– They will take care of the elderly
Vietnam
The Vietnamese people love to sing.
– Long tradition of putting literature and poetry
into song to be passed down form generation
to generation.
– Workers often sing in the fields.
– Even in urban areas, workers tend to hum at
work and make up songs.
– Karaoke is popular therefore!
Vietnam
In general, very polite and reserved
Known for hard work and resourcefulness.
Tendency to be trustworthy
A broken promise is a serious social
offense.
Great deal of emphasis on education
Vietnam
Rare to ask questions during interview, but
usually afterward. May be reluctant to ask.
Bow when greeting. A simple head nod is
OK when person is of equal social status;
however is much more formal (with
crossed arms) when greeting people of
greater authority and stature.
Vietnam
Women do not shake hands in Vietnam,
neither with women nor with men. Men
may shake hands when greeting each
other.
Males and females have little or no
physical contact with one another in
public. It is rare to see a couple holding
hands and kissing in public is unheard of.
Women may link arms to other women.
Vietnam
Smiling is the same as with Korean
culture, often NOT indicating pleasure.
anger
embarrassment
acceptance of a compliment
attempt to cover up a display of emotion, which is
considered a private matter.
Vietnam
Direct eye contact often considered disrespectful
and can be interpreted as a challenge.
Touching the head is considered disrespectful.
Only an elder can touch a child’s head.
Standing in an upright position with a raised
chest and squared shoulders is considered
arrogant. Vietnamese prefer a humble posture
with lowered shoulders.
Vietnam
Rude to summon a person of equal status
with an upright hand or finger. Use entire
hand with fingers down.
Use two hands to offer things to and to
accept things from a respected person.
Handing something to someone with just
one hand is considered disrespectful.
Excessive gestures = impolite
Vietnam
Family name comes first, then the middle
name, followed by the given name.
Women tend to keep their maiden name.
Speaking in a loud voice is rude.
Personal questions are OK
Very few Vietnamese women smoke or
drink
Arriving late is not rude. They may not
want to appear too enthusiastic or
Medical Interpreting
It’s an meaningful art!
The Challenge
You need to be able to provide a complete
and convincing argument for the use of
professional interpreters in the medical
field as opposed to non-trained speakers
of languages!
What is involved in interpreting for
the patient and the healthcare
professional?
A keen and real recognition that yours is
also a profession, not just a skill!
A calm attitude that responds to stress in
helpful ways, using practiced, learned
skills.
A good sense of each situation…i.e.,
“sizing up the situation”
Skills-Based
Becoming an Effective
Interpreter in the Medical Field
is a learned, lifelong, skillsbased process.
Skill Areas Required to be a
Professional Medical Interpreter:
Linguistic Expertise
– Spanish and English and “Spanglish”
– Grammar and Common Usage
– Colloquialisms/Slang/Some Jargon
– Ever-Increasing Knowledge of Regional
Differences
– Circumlocution
– Awareness of Contextual Clues
– Awareness of Some Limitations
Colloquialisms
A colloquialism is an expression not used in formal speech or writing. Colloquialisms
can include words (such as "gonna" or "grouty"), phrases (such as "ain't nothin'" and
"dead as a doornail"), or sometimes even an entire aphorism ("There's more than one
way to skin a cat"). Dictionaries often display colloquial words and phrases with the
abbreviation colloq. Colloquialisms are often used primarily within a limited
geographical area.
In some areas, overuse of colloquialisms by native speakers is regarded as a sign of
substandard ability with the language. However, in the mouth of a non-native
speaker, they are sometimes taken as signaling unusual facility with the language as
they may be more difficult for non-native speakers to understand.
A colloquialism can sometimes make its way into otherwise formal speech, as a sign
that the speaker is comfortable with his or her audience, in contrast to slang, which if
used in formal speech is more likely done so consciously for humorous effect.
Words that have a formal meaning may also have a colloquial meaning that, while
technically incorrect, is recognizable due to common usage.
Slang
Slang is the non-standard or non-dialectal use of words in a language of a particular social
group, and sometimes the creation of new words or importation of words from another
language. It is a type of neologism. Slang can be described as way of deviating from
standard language use, and is very popular with teenagers. Slang functions in two ways;
the creation of new language and new usage by a process of creative informal use and
adaptation, and the creation of a secret language understood only by those within a group
intended to understand it. As such, slang is a type of sociolect aimed at excluding certain
people from the conversation. Slang initially functions as encryption, so that the non-initiate
cannot understand the conversation, or as a further way to communicate with those who
understand it. Slang functions as a way to recognize members of the same group, and to
differentiate that group from the society at large. Slang terms are often particular to a
certain subculture, such as musicians, skateboarders, and drug users. Slang generally
implies playful, informal speech. Slang is distinguished from jargon, the technical
vocabulary of a particular profession, as jargon is (in theory) not used to exclude non-group
members from the conversation, but rather deals with technical peculiarities of a given field
which require a specialized vocabulary.
Four now widely accepted characteristics of slang were identified in the paper "Is Slang a
Word for Linguists," 53 American Speech 5, 14-15 (1978), by Bethany K. Dumas and
Jonathan Lighter. Slang usually shares at least two of the following traits.
First, it is markedly lower in dignity than Standard English.
Second, it tends to first appear in the language of groups with low status, meaning they
may have little power or little responsibility.
Third, it is often taboo and would be unlikely to be used by people of high status.
Fourth, it tends to displace a conventional term, either as a shorthand or as a defense
against perceptions associated with the conventional term.
Jargon
Jargon is terminology, much like slang, that relates to a specific activity, profession,
or group. It develops as a kind of shorthand, to express ideas that are frequently
discussed between members of a group, and can also have the effect of
distinguishing those belonging to a group from those who are not. Newcomers or
those unfamiliar with a subject can often be characterized by their incorrect use of
jargon, which can lead to amusing malapropisms. The use of jargon by outsiders is
considered by insiders to be socially inappropriate, since it consitutes a claim to be a
member of the insider group.
Jargon can be distinguished from terminology in that it is informal and essentially part
of the oral culture of a profession, with only limited expression in the profession's
publications. Many jargon terms have non-jargon equivalents which would be used in
print or when addressing non-specialists; other jargon terms, particularly those which
are used to characterise or even ridicule non-specialists, have no such equivalents.
The everyday use of the word jargon to describe any technical terminology
incomprehensible to the lay person ignores this distinction between jargon and
terminology.
Oftentimes, people will use jargon derisively, meant to indicate disapproval with the
use of words whose meaning is esoteric, and thus exclusionary of people who do not
understand their meaning and background, for example in The Jargon of Authenticity
by Theodore Wiesengrund Adorno. To describe an idea as jargon accomplishes in
Bourdieu's terms several tasks. It maintain's the speaker's "distinction" and social role
as critic and judge, while at time excusing the speaker from listening or reading with
attention, and it also expresses a safe, egalitarian attitude.
Idioms
An idiom is an expression (i.e. term or phrase) whose meaning cannot be
deduced from the literal definitions and the arrangement of its parts, but
refers instead to a figurative meaning that is known only through
conventional use. In linguistics, idioms are figures of speech that contradict
the principle of compositionality.
Take the English expression to kick the bucket. A listener knowing only the
meaning of kick and bucket would be unable to deduce the expression's
actual meaning, to die. Although kick the bucket can refer literally to the act
of striking a bucket with a foot, native speakers rarely use it that way.
Idioms hence tend to confuse those not already familiar with them; students
of a new language must learn its idiomatic expressions the way they learn
its other vocabulary. In fact many natural language words have idiomatic
origins, but have been sufficiently assimilated so that their figurative senses
have been lost.
Skill Areas Required to be a
Professional Medical Interpreter:
Cultural Competency
many cultures within a broader linguistic culture
diverse “mini” cultures within one culture
attitudes toward healthcare issues may vary from
attitudes the interpreter is exposed to in other
areas of life
etiological and epidemiological facts
Skill Areas Required to be a
Professional Medical Interpreter:
Medical Terminology
The Body and The Diseases
The Systems and Their Function
The Symptoms and The Assessments
The Actions in Examination Process
The Procedures
The Treatments
The Follow-up
The Medications