Five Finnish nursing students and their English teacher took up a challenge of learning intercultural competences together with fifteen French, Spanish and Hungarian nursing students in an Erasmus+ programme summer school in Southern France. The participants came both from high-contact and low-contact cultures, which offered an interesting insight into how close one can be to a new friend in these two different cultures.

The space between people creates and defines the social dynamics of our interactions with others, and we know that some of our most meaningful interactions in the world take place with objects that are of emotional and motivational significance to us (e.g. Lloyd, 2008). It was surprising to discover how much this space or interpersonal distance between culturally diverse participants affected their collaboration at first, and how strongly they reacted to being too close to each other or to the lack of closeness.

Exploring one’s own cultural and professional background

When travelling abroad it is very easy for a Finn to recognise another Finn even at a world’s busiest airport. However, why is this so easy for us because it is not necessarily so easy to do a self-examination on one’s own Finnishness traits. One student reflected her experiences in the learning diary:

“We had a school day at the Red Cross Institute in Saint-Étienne where we played various familiarization games with other students. I noticed at the end of the day that I’m very Finnish because I didn’t feel comfortable when I had to get very close to other people in the game. The Spanish students said that it is very normal for them to be close to another person and they think that if someone keeps a distance from them, that person does not like them. At the end of the day, the Red Cross teacher took a stance on the day’s games by saying that everyone can be themselves and you can never question others’ culture and backgrounds, because what is not normal for one person is normal for the other.”

Cultural awareness is crucial in the nursing profession, and it is the first component in several intercultural competence models in health care, e.g. Campinha-Bacote (2002) and Papadopoulos, Tilki and Taylor (2003) model for the development of cultural competence in nursing. Cultural awareness signifies the self-examination and in-depth exploration of one’s own cultural and professional background, and for a nurse this involves the recognition of one’s biases, prejudices, and assumptions about clients who can be different. Without being aware of the influence of one’s own cultural or professional values the nurse may take part in cultural imposition. Cultural imposition refers to the tendency of an individual to impose their beliefs, values, and patterns of behavior on another culture. (Leininger, 1978)

But what does our own national culture consist of really? Saarikivi (2022) states that there is no original Finnishness, nor any other nations, because nations and their people are processes, and they are in progress. We should be aware that culture is not indicative of nations or ethnic groups, but cultural groups can take extremely diverse forms. There are no homogeneous cultures, because all cultures are constantly changing, and there is a constant transition between each culture. Every person carries inside themselves more cultures, and culture is not like a shoebox, but it can be imagined as a backpack, because we always take it with us, we fill it with new content, while we leave some content out of it. The role of culture in the development of human behaviour is not exclusive, and we have to take into account many other contextual factors and personality traits. We need to realise that we are not culturally neutral and become more open to a discussion and dialogue, where prejudices play a much smaller role. (Resch et al., 2018)

Campinha-Bacote (2002) model for the process of cultural competence in the delivery of healthcare services is a model that views cultural competence as an ongoing process in which the nurse continuously strives to achieve the ability to work effectively within the cultural context of the client. This model requires nurses to see themselves as becoming culturally competent rather than already being culturally competent. Cultural awareness in health care implies being alert to the potential cultural differences that should be considered in patient assessment and care management. Cultural awareness begins with an examination of one’s own personal value base and beliefs. Getting to know oneself is not necessarily an easy task, because we cannot always see the features of our own culture and we might even be surprised to discover how other people perceive us.

Before developing intercultural competences, learners need to be aware about their own culture and cultural identity as well as cultural diversity and different health beliefs and behaviours. According to the Papadopoulos, Tilki and Taylor (2003) model, cultural awareness consists of self-awareness, cultural identity, heritage adherence and ethnocentricity. Someone’s cultural awareness is their understanding of the differences between themselves and people from other countries or other backgrounds, especially differences in attitudes and values. Nurses need to understand the basic principles for developing cultural competence and be aware about their own culture and cultural identity to be able to provide culturally competent health care. They need to become aware of their own prejudices and values, and to examine critically the concepts of ethnocentricity and stereotyping. It is important for a nurse to realise how their own culture will affect their intercultural encounters in a clinical environment.

A broken heart

How could Finnishness then affect Finnish nurses’ intercultural encounters in a clinical environment? One of the first things Finns often notice abroad, e.g. in Southern Europe, is the small proximity or distance to other people, when people come nearer than we are used to. The students reported in their learning diary on the arrival to Lyon:

“Culture shock: The people here come really close, in the queue and walking past.”

Finns belong to low-contact culture where the interpersonal distance is very long, whereas Southern Europeans belong to high-contact culture and prefer small proximity. As mentioned above in the students’ diary, Finns might find this close interpersonal distance even uncomfortable, which in turn by Southern European people might be interpreted as rejection or showing dislike.

We use idioms ”hurt someone’s feelings” or ”break someone’s heart” as if rejection would cause physical pain. Current evidence suggests, e.g. Eisenberger & Lieberman (2004), that this probably is partly true as there is a common neural alarm system for physical and social pain and that human brain processes both kinds of pain in an overlapping manner. Accordingly, when collaborating closely with new culturally diverse colleagues or taking care of patients from a different culture, it would be good to discuss whether you are comfortable with hugs or not and explain that you like them even though due to a different cultural background you would like to maintain a bit larger personal proximity at first.

Conclusion

Feelings of otherness can cause social pain and even hurt, especially in intercultural communication, and we need to consider how to avoid hurting the feelings of culturally different people and become close with them. Finnish writer Rosa Liksom has explored this theme in her work and explained in Niinivuo’s article (2022) the underlying themes of her novel Compartment no 6: “Both the book and Kuosmanen’s film show how human connection is possible despite culture, fears and strong dislikes. The story starts from the premise that two people meet and have nothing in common. In fact, they hate each other. But when they enter into dialogue with each other, they eventually begin to grow closer”.

Erasmus+ programme has enabled more than 300,000 Finns to study and train abroad over the past 30 years (Tikkanen, 2022). Currently, students can study through this programme in Belgium, Bulgaria, Czech Republic, Denmark, Germany, Estonia, Ireland, Greece, Spain, France, Croatia, Italy, Cyprus, Latvia, Lithuania, Luxembourg, Hungary, Malta, Netherlands, Austria, Poland, Portugal, Romania, Slovenia, Slovakia, Sweden, North Macedonia, Serbia, Iceland, Liechtenstein, Norway and Turkey. International student mobility forms a cornerstone of the internationalisation in higher education promoting understanding, empathy and change through dialogue and friendship between students from different cultures. More information on Erasmus+: https://erasmus-plus.ec.europa.eu/

References:

• Campinha-Bacote, J. 2002. The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care. Journal of Transcultural Nursing, 13.
• Eisenberger, N. & Lieberman, M. 2004. Why rejection hurts: a common neural alarm system for physical and social pain, Trends in Cognitive Sciences, 8 (7).
• Healthy Diversity Erasmus+ programme resources. Retrieved on 15th August at: https://healthydiversity.eu/resources/
• Leininger, M. 1978. Transcultural nursing: Concepts, theories, and practices. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
• Lloyd, D. 2009. The space between us: A neurophilosophical framework for the investigation of human interpersonal space, Neuroscience & Biobehavioral Reviews 33 (3).
• Niinivuo, S. 2022. Harras toive rauhasta. Helsingin Sanomat 17.7.2022.
• Papadopoulos, I., Tilki, M. & Taylor, G. 2003. The Papadopoulos, Tilki and Taylor model for the development of cultural competence in nursing. Journal of Health, Social and Environmental issues 4 (1).
• Resch, K. & Raschauer A. (Eds.) 2018. The Healthy Diversity Curriculum. A diversity training programme for professionals in the health and social sector.
• Saarikivi, J. 2022. Keitä me olemme? Helsingin Sanomien kuukausiliite 7.
• Tikkanen, T. 2022. Ei lyödä ovia kiinni. Opettaja 13/22.