I. IntroductIon A. This chapter presents cultural concepts and principles essential to effective cross-cultural communication. B. It focuses on building cross-cultural communication skills, critical in transcultural nursing and health care. c. A case study is presented at the end of the chapter to enhance application of cultural knowledge and communication. II. nAture of cross-culturAl communIcAtIon A. Cross-cultural communication skills are critical in a global society where encounters with diverse groups are part of everyday life. All interactions are cross-cultural, as human beings tend to be bounded by a set of symbols and meanings that have been culturally imprinted in time (Samovar, Porter & McDaniel, 2004). B. Communication is a process that occurs whenever meaning is attributed to behavior or the residue of behavior. 1. Cross-cultural or intercultural communication is between individuals and groups whose perceptions and symbol systems are distinct enough to alter the communication event (Samovar & Porter, 1995). Differences can occur across and within the same groups. 2. Communication is symbolic, as it uses verbal, nonverbal, and visual representations to create shared meanings. 3. Culture and communication are intricately bound; one cannot understand communication without understanding its social and cultural context. 4. Communication is a complex process; language is at best an approximation of reality. 5. In communication, one can only infer about the other; hence, seeking and giving feedback, facilitating comfort in the exchange, listening and observing, and using other resources, such as interpreters, are critical. c. Elements of Cross-Cultural Communication 1. Perception (Singer, 1987) a. Process by which an individual selects, evaluates, and organizes stimuli from the external world. b. Based on beliefs, values, and attitude systems 2. Verbal processes-how we talk to each other and think 3. Nonverbal processes-use of actions to communicate III. culturAl context of cross-culturAl communIcAtIon A. Cultural values and beliefs 1. Influence perceptions of the other's credibility, trustworthiness, and acceptance 2. For example, belief in a person's capacity to bear pain as a sign of moral strength is likely to be associated with intolerance of patients overtly complaining of pain.