TRaNSforM - Training Requirements and Nursing Skills for Mobility in health careEuropean Comission - Lifelong Learning Programme
University of Nottingham

TRaNSforM working definition of adaptability

Co-ordinating partner United Kingdom

Adaptability in health care is the ability to integrate a patient’s cultural values and beliefs into any encounter. Health care professionals should have awareness and skills to assess verbal and non-verbal cues and adapt individual care to maximize the patient’s comfort and minimise misunderstandings. This means there needs to be sufficient cooperation and communication between individuals to decrease the risk of harm to the patient.

Explanation from partners


In the context of culture shock models and theories, adaptability plays a major part and is described as the final stage in culture shock. The term culture shock was initially coined by Kalvero Oberg (1960), and all other further developments are based on this model. Culture shock models and/or theories generally focus on the outgoing person and their adjustment to the new environment. They can differ in the number and description of their stages which are usually pictured as a U-model, describing the emotional state and/or cultural competence in relation to time (the W-models describe a similar process on return to the home country).

Wagner (2006) looks at the culture shock model with regards to the unification of East- and West Germany. In his variation of the culture shock model, he labels the last stage the phase of understanding (following the phase of misunderstandings). However, he describes the phase of understanding resulting in either adaptation (Anpassung) or settledness in the unsettledness (Gewöhnung) in the sense of getting used to the still strange. According to Wagner (2006), (self-) reflection, willingness and freedom are essential for possible positive adaptation.

Adaptability in health care means being skilled at integrating a patient's cultural values or beliefs into any encounter with the awareness and ability to adapt behaviours to maximize the patient‟s comfort, reconcile misunderstandings, and be responsive to the patient’s needs Teal and Street (2009). Adaptability means there will be sufficient cooperation and communication to minimise the risk of harm to the patient (Weller et al, 2011).

Adaptability is skills in assessing verbal and non-verbal cues communicated by individuals and interpreting those cues in the context of culture (Majumdar et al, 1999).

Further information

  • Majumdar, J., Keystone, F. S. and Cuttress, l. A. (1999) Cultural sensitivity training among foreign medical gaduates Medical Education 33 (6), pp.177-184.
  • Neves, J.G. (2000) Clima organizacional, cultura organizacional e gestão de recursos humanos. Lisboa: Editora RH.
  • Oberg, K. (1960): Culture Shock: adjustment to new cultural environments. Practical Anthropology, 7 (42): pp.177-182.
  • Teal, C. R. and Street, R. L. (2009) Critical elements of culturally competent communication in the medical encounter: A review and model. Social Science and Medicine.  68(3): pp. 533–543.
  • Wagner, W. (2006): Kulturschock Deutschland - revisited. Available at: %20Deutschland%202005.pdf [accessed 22 November 2011].
  • Weller, J., Barrow, M. and Gasquoine, S. (2011) Interprofessional collaboration among junior doctors and nurses in the hospital setting. Medical Education.45(5): pp.478–487.

Training Requirements and Nursing Skills for Mobility in Health Care


Dr Carol Hall
Telephone: +44 (0)115 8 230 906