Overcoming Cross-Cultural Communication Barriers in Nursing

A nurse holding a clipboard hugs a child while another person smiles and looks on.
People from diverse backgrounds have unique ways of perceiving situations, as well as particular attitudes about health care. These differences affect how people communicate with health care providers. To address the needs of patients from all backgrounds, nurses strive to bridge gaps in cultural understanding and ways of communicating.

Strong cross-cultural communication helps build trust between patients and nurses, and it’s fundamental to delivering high-quality patient care.

Why Cross-Cultural Communication in Nursing Matters

Cross-cultural communication allows nurses to better understand patients and respond more effectively to their needs. It plays a vital role in nursing by improving a nurse’s ability to:

  • Accurately assess patient conditions
  • Successfully explain medical issues to patients
  • Give patients crucial instructions about medications
  • Educate patients about a diagnosis or prognosis

Cross-cultural communication also empowers patients to participate in and help direct their own care according to their needs and preferences. This often improves health outcomes and patient satisfaction.

However, sometimes nurses and patients confront barriers that make communication challenging. Language differences, for example, can create problems. With an interpreter, however, nurses and patients can overcome language differences. Still, addressing language differences alone doesn’t account for other gaps in how people communicate and understand one another.

Verbal and Nonverbal Communication

Spatial distance, tone of voice, physical contact, gestures, and eye contact are examples of verbal and nonverbal forms of communication that play a role in how people interpret one another and express themselves. Different cultures have distinctive verbal and nonverbal forms of communicating.

For this reason, nurses benefit from knowing essential details about their patients’ cultural backgrounds. This familiarity helps nurses effectively communicate with and understand patients — a key ingredient to building thorough and empathetic approaches to patient care.

For example, if nurses understand that people from certain cultures feel reluctant to openly discuss sensitive health issues, they can find alternative ways to communicate with them. Nurses can share informational pamphlets and videos, or they can ask questions in a private setting.

This cross-cultural communication fosters a comfortable environment for patients that will likely encourage continued openness.

Interpreting Nonverbal Cues

Nurses may encounter patients who respond to questions with silence, shakes of the head, or a downward gaze. In these situations, they need to recognize that these nonverbal cues can indicate a patient’s discomfort or perception of a power differential. Perhaps the nonverbal cues represent a difference in cultural norms for the patient regarding appropriate levels of assertiveness.

They might also mean a question has caused anxiety or is not understood. Rather than pushing forward with immediate follow-up questions, nurses can look for additional nonverbal communication, such as facial expressions, to better interpret the situation before continuing.

In some cultures, indirect communication, such as facial expressions or body language, is considered a response. When nurses encounter such situations, they can improve cross-cultural communication by approaching conversations with an attitude of curiosity. They might:

  • Ask questions that demonstrate respect and concern
  • Ask questions that help reveal the patient’s understanding of the health issue at hand
  • Explain their own perceptions
  • Acknowledge differences in perceptions
  • Begin to negotiate treatment plans

Benefits of Cross-Cultural Communication

Cross-cultural communication benefits both patients and nurses. Whether consulting parents about how to include enough iron in their baby’s diet or addressing pain management with a cancer patient, cross-cultural communication strengthens nurses’ ability to deliver the highest-quality care and thrive as a professional.

With cross-cultural communication, nurses form deeper relationships with their patients and experience more satisfaction on the job as a result. They also avoid needless frustration and overwhelm that can result from poor communication.

Patients receive better care because of cross-cultural communication. They experience fewer misdiagnoses and repeat visits to the hospital. They also follow treatment plans and medical advice more reliably. Additionally, cross-cultural communication can reduce health disparities in marginalized communities.

Cross-Cultural Communication Challenges

Nurses can unwittingly contribute to communication breakdowns by using complex jargon or slang that confuses patients. However, nurse leaders can teach their staff to overcome these and other potential stumbling blocks to successful cross-cultural communication.

For example, nurse leaders can work with their teams to devise ways of explaining procedures, concepts, and diagnoses in the clearest terms possible. By using simplified and direct language alongside visual cues or materials, nurses can make information more accessible and reduce misunderstandings.

Nurses nurture cross-cultural communication when they keep in mind ways to:

  • Discover patients’ cultural beliefs and practices
  • Involve patients in decision-making
  • Practice active listening

Racial and Cultural Bias

Racial and cultural biases also obstruct successful cross-cultural communication. Unconscious biases based on patients’ race, ethnicity, religion, gender identification, sexual orientation, or disability hamper a nurse’s ability to "practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person," as outlined in the Code of Ethics for Nurses.

Unconscious biases can influence what nurses assume about their patients’ health, willingness to comply with medical advice, and level of health literacy. Such assumptions often reflect nothing less than distortions of reality.

The false impressions created by unconscious bias hurt cross-cultural communication and health outcomes. Unconscious biases may affect the questions practitioners ask, how they interpret patients’ answers, and the level of empathy they offer. In turn, this:

  • Adversely influences patient assessments
  • Leads to incorrect diagnoses
  • Results in inappropriate treatment decisions
  • Diminishes the quality and amount of time spent on a patient’s care
  • Reduces the level of follow-up with patients

However, nurses can tackle this problem and help ensure greater equity in care delivery by engaging in self-interventions that disarm unconscious bias, such as the examples below.

Counter-Stereotypic Imaging

This strategy involves recognizing one’s biases and adjusting them. Nurses intentionally look for individuals of a group who defy the stereotypical images assigned to people of that group. Nurses then intentionally replace the implicitly biased image with a positive or neutral one.

Emotional Regulation

Emotional regulation focuses on challenging a nurse’s seemingly negative gut reaction to patients from marginalized groups. Nurses reflect upon any snap judgments they make toward patients of particular backgrounds. Next, they intentionally deliver the most empathetic and compassionate care that they can to those patients.


Individuation relates to mindfully looking at patients as singular persons with their own ideas, experiences, hopes, and dreams. Nurses mentally erase stigmatized images of patients as merely members of marginalized groups, remembering the inherent uniqueness of each person.

Cross-Cultural Communication Tools and Resources

Nurse leaders can use various resources to build effective cross-cultural communication strategies in the health care environment.

Cross-Cultural Communication Guidebooks

Nurse leaders striving to improve cross-cultural communication and instill cultural humility in their teams can find a wealth of information in both online and print guides. Cultural humility involves assuming a respectful attitude toward other cultures, challenging one’s cultural biases, recognizing one’s limited ability to know everything about other cultures, and trying to learn about other cultures with openness and curiosity. Cultural humility goes hand in hand with strong cross-cultural communication.

Some guides focus on improving cross-cultural communication with LEP (limited English proficiency) patients. They may include toolkits that feature:

  • Tips on how to find and work with interpreters
  • Common phrases and greeting in many languages
  • Language-learning flashcards

These tools can help nurses avoid common pitfalls when using interpreters. They can also help nurses build stronger rapports with LEP patients, because even a few words or a greeting in a patient’s native language can make a positive first impression and signal caring.

Other guides may offer valuable pointers on how to approach pain management discussions or conversations that touch on sexual issues across diverse cultural groups.

Still other guides may include mnemonics that help nurse leaders support their staff’s cross-cultural communication skills. For example, LEARN (listen, explain, acknowledge, recommend, negotiate) offers an effective framework for interviewing patients in a way that nurtures cross-cultural communication.

Additionally, nurse leaders can find guides that teach:

  • Implementing interviews to identify staff with knowledge of diversity and cultural humility
  • Tailoring services to patients’ linguistic and cultural preferences
  • Working with immigrant and refugee patient populations
  • Overcoming cultural and racial biases
  • Delivering culturally sensitive care during emergencies

Nurse leaders can apply the knowledge and skills taught in these guides to other forms of care delivery, such as population health. For example, services to LEP patients can also help improve their health outcomes and engagement.

Language Apps for Cross-Cultural Communication

Successful nurses build trust. Language apps serve as a useful cross-cultural communication tool for nurse leaders by complementing the work of human translators and interpreters. Developers designed these digital translators expressly for practitioners and patients. They assist with communication during daily activities, such as patient examinations, and emergencies. Useful apps include Care to Translate and UniversalNurse Speaker.

Care to Translate

This digital application gives medical translations in text and audio and offers a list of commonly used medical phrases. It’s available in 38 languages, ranging from Albanian to Vietnamese. It also features patient and practitioner modes.

UniversalNurse Speaker

UniversalNurse Speaker offers hundreds of medical translations verified by health care professionals. The translations have audio in the voices of native speakers in eight different languages. Pop-up windows appear to help guide conversations with patients. After downloading the app, nurses can access all of the tool’s services without an internet connection.

Strive for Equity in Health Care

Building trust and rapport with patients takes finesse and skill — all the more so when cultural and linguistic differences exist. However, with a strong commitment to cross-cultural communication, nurse leaders deepen connections and understanding with patients. This raises the level of care delivery and chips away at health disparities among marginalized patient populations.

Discover how Hawai‘i Pacific University’s online BSN to DNP program prepares nurse leaders to advance equity in health care through its three concentrations:

  • Family Nurse Practitioner
  • Psychiatric Mental Health Nurse Practitioner
  • Adult-Gerontology Acute Care Nurse Practitioner

Take a look at the program and learn more about how Hawai‘i Pacific University can help you prevent cultural misunderstandings and contribute to better health care for everyone.

Recommended Readings
The Benefits of Advanced Nursing: What Is the Expected MSN Salary Range
Careers in Advanced Nursing: What Is a Family Nurse Practitioner?
How Family Nurse Practitioners Can Play a Major Role in Addressing the Growing Physician Shortage in the U.S.

AJN, "Addressing Implicit Bias in Nursing: A Review"
American Association of Colleges of Nursing, Cultural Competency in Nursing Education
American Nurses Association, "Code of Ethics for Nurses With Interpretive Statements"
BMC Health Services Research, "The Challenge of Cultural Competence in the Workplace: Perspectives of Healthcare Providers"
Care to Translate
Centers for Disease Control and Prevention, Health Literacy: Culture & Language
Collegian, "Culturally Sensitive Communication in Healthcare: A Concept Analysis"
Community Health Collection, Culturally Competent and Effective Healthcare
Houston Chronicle, "What Is Effective Communication in Nursing?"
Pediatric Child Health, "Cross-Cultural Communication: Tools for Working With Families and Children"
U.S. Department of Health & Human Services, National CLAS Standards