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Culture Assessment: Chinese
1. C h in e s e C u lt u r e
As s e s s me nt
Dorothy Alford, Jen Banfield,
Kitti Johnson, Jo-Anne
McInnes,
Denette Moon
University of Phoenix
Dominic Koh
July 14, 2008
2. T h e C h in e s e
C u lt u r e G r o u p
One billion people live in China
today
2010 35% of population will be
non-white
Speak a variety of different languages
and dialects.
There are seven major language
groups, each with many dialects.
3. T h e C h in e s e C u lt u r e
G roup
Holism is a valued
concept in the
Chinese culture
Acupuncture
Lasers and/or
electricity
Moxibustion
Applying heat to the
acupuncture site
Herbology
Use of plant and food
4. T h e C h in e s e C u lt u r a l
G roup
Cupping
Decrease stress
and congestion
Méditation
Maintain a total
sense of mind,
body, and spirit
(Bonadonna,
2003).
5. C h in e s e B e lie f s o f
H e a lt h a n d Illn e s s
H e a lt h is g u id e d b y t h r e e
p h ilo s o p h ic a l v ie w s
C o n f u c ia n is m
social interaction
loyalty to family
respect for parents
unselfishness
T a o is m
harmony with nature
Chi defined by “Ying” and “Yang”
B u d d h is m
love, faith, compassion for the living
“Inn” and “Ko”, cause and effect system
T o r e m a in in g o o d h e a lt h , o n e m u s t
r e m a in in h a r m o n y w it h t h e
e n v ir o n m e n t
6. C h in e s e B e lie f s o f
Illn e s s
Illness
Viewed as an imbalance of opposing forces
Yin and Yang
Negative and positive forces
May bring shame to the family
“Saving Face” may delay seeking
treatment
7. C h in e s e S p e c if ic H e a lt h
a n d Illn e s s n e e d s
DepressionTB
Alcoholism Cancers
Dementia Smoking
Hepatitis B
8. Ma na g e me nt of
C h in e s e H e a lt h a n d
Illn e s s
A 1985 survey found
Asian Americans in
general were more
likely than white
Americans to be
without health
insurance.
Socioeconomic status
tends to be lower in
certain Asian American
groups.
9. C h in e s e D o m in a n t H e a lt h
C a r e P r a c t ic e s
May treat minor and chronic
illnesses with Chinese medicine and
acute and serious problems with
Western medicine.
May also use both herbal medicines
and Western medicines concurrently
for the same condition
10. C h in e s e D o m in a n t H e a lt h
C a r e P r a c t ic e s – F o r
E ld e r ly C h in e s e
May hesitate to r i c a n s
Ame
make direct eye
contact, ask
questions or voice
opinions.
Elder patients
should be
permitted time to
“talk story” before
beginning the
clinical interview.
Address patient
11. C h in e s e D o m in a n t H e a lt h
C a r e P r a c t ic e s – F o r
E ld e r ly C h in e s e
A m e r ic a n s
Treat traditional
Chinese Medical
treatments with
respect.
Frequently
extend an
invitation for
questions
12. C u lt u r e A s s e s s me nt
Th e o r y fo r th e
C h in e s e C u lt u r e
Leininger’s Transcultural Theory
Care is universal and varies
transculturally
Goal is to provide care consistent
with the nursing’s emerging science
and knowledge with caring as
central focus
13. Assessment of Client
Information on culture
Cultural assessment
Accurate
Catered to the individual
Unbiased
Knowledge about cultural dynamics and
social structural dimensions
14. S tre ng ths a nd
Strengths: a k n e s s e s
We
Holistic approach
Considered both a vital and
discipline component of
daily nursing practice
Only theory that explicitly
focus on the relationship
between culture and care
on health and wellness
Weakness
Failure of the healthcare
15. C o n c lu s io n
More than 1 billion people live in China today, and many
additional Chinese people live in other countries,
making the Chinese the most populous ancestry in
the world. A common belief among the Chinese states
that "thirty percent of healing depends on curative
means and seventy percent on nursing care“
Chinese medicine defines health as a state of balance
between spiritual, physical, and psychological
harmony. When this system is not in balance, illness
and disease occur. Illness is viewed as an imbalance
between a person and nature and their social
environment. A Chinese-American may treat minor
and chronic illnesses with Chinese medicine and
16. R e fe re n c e s
Chen, Y., D. (1996). Conformity with nature: A theory of
chinese american elders’ health promotion and illness
prevention process. Advances in Nursing Science, 19(2)
17-26. Retrieved July 11, 2008 from Journals@OVID
database.
Chen, M. S. (1994). Health status of Chinese Americans:
Challenges and Opportunities. Paper presented at the
7th International Conference of HealthProblems
Related to the Chinese. July 1-3, 1994.
Cheung, R., Nelson, W., Advincula, L., Cureton, V., &
Canham, D. (2005). Understanding the culture of Chinese
children and families. Journal of School Nursing, 21(1), 3-9.
Retrieved July 12, 2008, from CINAHL Plus with Full Text
database.
17. R e fe re n c e s
Friedman, M., M., Bowden, V., R., & Jones, E., G. (2003).
Family nursing: Research, theory, and practice (5th ed.).
Upper Saddle River, NJ: Pearson Prentice Hall.
Hsu, W. C., Yoon, H. H. (2007). Building Cultural Competency
for Improved Diabetes Care: Asian Americans and Diabetes.
Supplement to The Journal of Family Practice. September.
Maier-Lorentz, M. (2008). Transcultural nursing: its
importance in nursing practice. Journal of Cultural
Diversity, 15(1), 37-43. Retrieved July 12, 2008, from
University of Phoenix, ProQuest database.
Potter, P., & Perry, A. (2001). Fundamentals of nursing. (5th
ed.). St. Louis, MO: Mosby.
18. R e fe re n c e s
Tom, L. (1998). Health and Health Care for
Chinese-American Elders. Department of
Geriatric Medicine, University of Hawaii.
Retrieved July 10, 2008 from website:
www.stanford.edu/group/ethnoger/chinese.html.
Yu, Mimi. (1993). National Cancer Institute of
health- Epidemiology and Genetics Research.
Singapore cohort of diet and cancer. Retrieved
on July 11, 2008 from website:
http://epi.grants.cancer.gov.
Notes de l'éditeur
More than 1 billion people live in China today, and many additional Chinese people live in other countries, making the Chinese the most populous ancestry in the world (Jayne & Rankin, 2001). It is estimated that by the year 2010, 35% of the children in the United States will be non-White. Currently, first- and second-generation immigrant children under age 15 are the fastest-growing group in the United States (Chen & Rankin, 2002). Twenty-five percent of the 12 million Americans who report themselves as being of Asian descent are under the age of 18 (Yu, Huang, & Singh, 2004). In demographic representations of communities, Asians are commonly categorized as one culture or ethnicity. However, families and communities of Asian origin are in fact quite different from one another, depending on the country of origin, and where in the country they are from, such as north or south. east or west, urban or rural. For example, cultural practices are different among Asians from Hong Kong, Taiwan, or mainland China. Perhaps no other professional group in society has recognized the impact of cultural diversity as much as the health profession (Purnell & Paulanka, 1998). "Nurses constitute the biggest group of health care providers who can potentially deliver culturally competent care to large populations of diverse patients" (DiCicco-Bloom & Cohen, 2003, p. 26). Acknowledgment of and respect for these differences are needed to provide culturally sensitive care. As school nurses encounter more Chinese families, they will have an opportunity to increase their knowledge of families of Chinese descent while heightening their respect for and valuing of the culture. Providing some basic features that are relevant in the Chinese culture and facilitating understanding of the differences within the culture will enhance the ability of school nurses to incorporate more receptive interactions with these families as they deliver health care in the school setting. Chinese people may speak a variety of different languages and dialects. There are seven major language groups, each with many dialects. The national language, putonghua, which means "common speech," is also called Mandarin {Chinese Languages, 2004). Over 2 million Americans speak Chinese regularly at home, making it second to Spanish as the most common foreign language spoken in the United States, according to the 2000 census (Fetto, 2003; U.S. Census Bureau, 2000). A study of the effects of Chinese residents' income, language, and citizenship status found that fluency in English can strongly affect health care access for this population Gang, Lee, & Woo, 1998). For Asian children, health issues are compounded by the problem of adaptation to an unfamiliar culture, particularly for children with limited English. In addition, a study of Asian adolescents revealed significant psychosocial deficits in school and a lack of parental support among those who do not speak English at home (Yu et al., 2004). Health professionals' unfamiliarity with another culture can affect interpretation of important health data. For example, the practitioner may misinterpret a client's pain because of differing personal cultural practices. With such a large number of people in the United States speaking Chinese, advocating for a trusted interpreter may be helpful in overcoming language barriers that may arise when communicating with Chinese community members.
Holism is a valued concept in the Chinese culture. Incorporating this concept can be challenging to nurses who work according to the biomedical or task-based model of care (Wong & Pang, 2000). There have been many studies over the past two decades examining how different cultures conceptualize holism and caring. Having knowledge in this area is helpful in establishing nurse-client interactions. According to Wong and Pang, holism and caring influence every aspect of the health care culture of the Chinese. Health is perceived from the viewpoint that a human being is a dynamic entity. The person is in dynamic interaction with the world, and "illness is perceived as disharmony at the individual or social level" (Wong & Pang, p. 13). For example, while caring for a student with a stomachache, the school nurse would also address the emotional aspect of the student's not being in balance with the environment. Because illness is seen as an imbalance A common belief among the Chinese states that "thirty percent of healing depends on curative means and seventy percent on nursing care" (Wong & Pang, 2000, p. 14). Therefore, caring is seen as more important than medicine among Chinese families. The nature of nursing parallels the Chinese concept of caring. Although the Western culture might view nursing as a servant's work, nurses cherish "treating the patient as their own family member.“ School nurses provide holistic care as they focus on the student and the family as the unit of care, based on the knowledge that health includes physical, psychological, social, and spiritual well-being. The health practices among Chinese Americans vary with the generation of acculturation in the United States. Individuals born in China are more likely to follow the traditional health practices, such as the concept of yin and yang, and be more skeptical of Western medicine than those Chinese individuals who were born in the United States. Yin and yang have a basis in the five fundamental concepts: metal, wood, fire, water, and earth, and qi or chi concepts (Feng, 2002). Yin and yang are opposing forces. Yin is identified as female, negative energy, and cold. Yang is identified as male, positive energy, and hot. It is the balance of yin and yang forces that sustains the body and maintains the health of the individual; a hot or cold imbalance brings about illness. An excess of yin (cold) results in fever and dehydration. An excess of yang (hot) results in gastric and other disorders. Yang represents the external organs, including the small intestine and stomach. Yin represents the internal organs, including the lungs and spleen (Feng). Foods are described as "hot" or "cold." For example, meats, seafood, and fried foods are "hot," whereas vegetables and fresh fruits are "cold." Climates and seasons may require adjustments in food choices. For example, parents may not recommend "cold" foods to their child after surgery, because the child needs to rebuild the warmth of the body because of the blood loss (Chen & Rankin, 2002). In the school setting, a student may eat particular foods for lunch that have been packed or prepared by the parents with respect to the weather or health situation. Qi or chi is the vital energy flowing in the person. When it is absent, the body dies. Chi can be gained from three sources: genetics, air, and food. It can be lost through aging and neglect. When chi is in balance, it promotes the function of the heart and lungs. To maintain the chi balance, tai chi, a series of slow, precise, specific exercises, is performed, nourishing all body parts by improving the blood flow (Feng, 2002). Acupuncture is a common Chinese practice based on the principles of yin and yang and chi. Modern acupuncture may include the use of lasers or electricity. Moxibustion, the practice of applying heat to the acupuncture points, treats conditions such as asthma, arthritis, and bronchitis (Feng, 2002). Chinese people use several other traditional healing methods or practices during illness. Cupping is used to decrease stress and congestion by placing heated cups on parts of the body. This rids the body of unwanted chi by bringing it to the surface of the body and then letting it diffuse away. These therapies work against the imbalances that are thought to cause the illness rather than reducing the symptoms as in Western medicine. Herbology, the use of plant and animal matter, stimulates chi in the body to treat ailments.
Chinese people use several other traditional healing methods or practices during illness. Cupping is used to decrease stress and congestion by placing heated cups on parts of the body. This rids the body of unwanted chi by bringing it to the surface of the body and then letting it diffuse away. These therapies work against the imbalances that are thought to cause the illness rather than reducing the symptoms as in Western medicine. Meditation helps relax the body to reduce stress (Tom, 1999). Although underestimated in scientific medicine, meditation enables people with chronic illnesses to maintain a total sense of mind, body, and spirit (Bonadonna, 2003). To maintain the chi balance, tai chi, a series of slow, precise, specific exercises, is performed, nourishing all body parts by improving the blood flow (Feng, 2002).
Chinese medicine defines health as a state of balance between spiritual, physical, and psychological harmony. When this system is not in balance, illness and disease occur (Friedman, Bowden, & Jones, 2003). The Chinese views of health and illness are based on three philosophical views. The first philosophical view is Confucianism. The key principles of Confucianism guide the Chinese culture in their social interactions. Harmony is achieved when one is loyal to their family, respects their parents and remain unselfish. Taoism is the next philosophical view that guides the Chinese culture. Taoism teaches humans should be in harmony with nature. Harmony between health and illness is explained by Ying and Yang within the body and the environment. Ying and Yang make up the Qi or Chi. Chi is define as the energy that encompasses the human body. The disruption of this energy has been used in traditional Chinese medicine as the basis for the diagnosis and treatment of both illness and health promotion (Chen, 1996). The third philosophical view is that of Buddhism. Love, faith, and compassion for the living are key concepts of Buddhism. This view also involves Inn and Ko. Inn and Ko is a cause and effect system. When people do good, good is what they will receive in turn. When people do not act good, negative consequences occur (Chen, 1996). Based on these three philosophical views the concept of balance within the environment and remaining in harmony are key to the Chinese culture.
Illness is viewed as an imbalance between a person and nature and their social environment (Cheung, Nelson, Advincula, Cureton, & Caham, 2005). A person’s energy, the Yin and Yang are imbalanced during times of illness. Yin is viewed as a negative and cold energy. Yang is a positive and hot energy. Illness, treatments and food are classified into opposing forces of hot and cold. The family unit in the Chinese culture is based on Confucian principles. Based on these principles, the needs of the family are seen as a priority over the needs of an individual. Since illness is viewed as a disruption of balance, family member may avoid medical treatment based on the belief the illness may bring shame to the family. This is especially true within the culture when dealing with mental illness. The individual may not seek treatment for mental illness in order to save face for their family. That is they want to maintain their respect, dignity and status (Friedman, Bowden, & Jones, 2003).
The myth of Asian people being healthy is misleading. Many Chinese-Americans especially those who live in poverty lack health insurance and access to health care. This can greatly affect the risk of diseases to Chinese people. Depression- The Chinese- American woman that is age 65 year or older has a three times high rate of suicide than White women. Unfortunately, the Chinese-American diagnoses for depression is under treated and diagnosed. Alcoholism- Chinese- American consume more alcohol than the migrant Chinese person but the over statistics show that Chinese- Americans consume a high rate of alcohol. Dementia- Vascular Dementia is diagnosed at a higher rate then Alzheimer's in the Chinese- American where as Alzheimer's is often the diagnosis for American white people. Hepatitis B- The Chinese- American people have a higher rate of Hepatitis B then others and thus have a higher rate of liver cancer (Chen, 1994). TB- Chinese- Americans has a 10 times higher rate of TB then the general population (Chen, 1990). Cancers- There are several cancers that are relevant in the Chinese culture. Liver cancer seems to be very high as 80% of all Hepatitis B cases are diagnosed with liver cancer. The Chinese living in the US have the highest rate of nasopharyngeal cancer then if living in China. Breast cancer is the most common cancer for Chinese-American females living in the US. Many Chinese-American females have fewer children, do not use estrogens, have children later in life, and are more likely to be obese which are all factors that increase the risk of breast cancer in Chinese- American females. Prostate cancers is three to five times higher in Chinese males living in the US then in Chinese males living in the mainland of China. Colon cancer risks are based on the diet consumed. The rates of colon cancer is higher in the US and Hong Kong for the Chinese- American then if these people lived in China. Lung cancer rates increase based on the Chinese-American person’s smoking habits. Many Chinese-Americans smoke and 30% of the US people smoke whereas 28% of the Chinese males smoke. These habits greatly increase the risk of lung cancer in the Chinese male. The Chinese-American female has a low risk of lung cancer due to a low rate of smoking. According to US National Institute of Health Epidemiology and Genetics research states that an increase of soy has an adverse effect on bladder cancer, these is an inverse association of soy intake and breast cancer, an adverse effect of n-6 fatty acids with the consumption of fish or n-3 marine fatty acids on breast cancer risks, and these is an association of angiotensin-converting enzyme genotype and breast cancer (Yu, 1993).
Despite the considerable diversity within the Asian American population, certain factors are common to many groups. A 1985 survey found Asian Americans in general were more likely than white Americans to be without health insurance – which limits their access to health care. Socioeconomic status tends to be lower in certain groups – which is an independent risk factor for poor health. The degree of language barriers may contribute to disparities in care. (Hsu, Yoon, 2007) Studies prior to 1985 suggested a lower risk for death and disease in Asians and Pacific Islanders as a whole. Newer studies see a trend towards poorer health status for this group in general. Although Asians are often seen as affluent and healthy, the reality is that the micro-environment of large segments of this ethnic group live in poverty, lack insurance, and do not have access to healthcare (Tom, 1998).
Asian-Americans often use both Western and Eastern medical services (predominantly herbal medicine). For instance, a Chinese-American may treat minor and chronic illnesses with Chinese medicine and acute and serious problems with Western medicine. Asian-Americans may also use both herbal medicines and Western medicines concurrently for the same condition (Friedman, 2003).
There may be generational differences in how health care practices depending on the amount of acculturation. For elderly Chinese-Americans, the following practices are suggested when health care providers are caring for them (Tom, 1998); May hesitate to make direct eye contact, ask questions or voice opinions - so as not to inconvenience others or appear disrespectful. Elder patients should be permitted time to “talk story” before beginning the clinical interview. Address patient with respect by using Mr. or Mrs. With their surname. Pronounce names correctly.
There may be generational differences in how health care practices depending on the amount of acculturation. For elderly Chinese-Americans, the following practices are suggested when health care providers are caring for them (Tom, 1998); Treat traditional Chinese Medical treatments with respect. Frequently extend an invitation for questions multiple times during the interview. Recognizing the basic precepts of Chinese-American culture and examining the personal and family beliefs, values, and behaviors can aid in the development of a template for nursing care (Hsu, Yoon, 2007). A better understanding of a person’s cultural beliefs can improve patient compliance and the relationship with care providers (Tom, 1998).
Leininger’s Transcultural Theory was develop in 1978 by Madeleine M. Leininger with the intent of providing care that is universal and varies transculturally ( Potter & Perry, 2001, p. 91). The goal of nursing is to provide care consistent with nursing’s emerging science and knowledge with caring as central focus (Chinn and Kramer, 1999 as cited in Potter & Perry, 2001, p. 95). With the transcultural theory, caring is central and unifying domain for nursing knowledge and practice. The intended focus on the methods of approach to care is that it means something to the people to whom the care is given. Culture is viewed as framework people use to solve human problems and care always occurs in a cultural context.
Information on culture is essential for holistic assessment of an individual, family, or community. Nurse invites an individual, family, or community to describe their own experience about health and caring. The assessment process must be comprehensive, accurate, and systemic. Individual’s, family’s, or community’s perspective of their culture is needed for an accurate assessment. Assessment needs to unbiased and catered to the individuals’ needs. Nurses needs to approach the individual, family, or community with the intent to gain understanding of the expressions, patterns of health, and care. Nurse also needs to obtain knowledge and document the descriptions about the dynamic cultural and social structural dimensions influencing health, health patterns and concerns of the patient or family.
Leininger’s Transcultural Theory was “the first attempt in the nursing profession to highlight the need for culturally competent nurses” (Maier-Lorentz, 2008, p. 2). This theory when used as a tool to assess the cultural aspect of the patient either as an individual or a family addresses the patient in a holistic approach. This tool is also considered both a vital and a discipline component of the daily nursing process which continues to contribute to new researched-bases and advanced knowledge of transcultural nursing (Maier-Lorentz, 2008, p. 2). Leininger’s theory is the only theory that explicitly focus on the relationship between culture and care on health and wellness. The theory poses to be very vital in the practice of nursing as it addresses the patient may it be individual or family according to their own set of culture they are accustomed. There seems to be no weakness identified regarding the theory itself, the weakness lies on the health care providers who fail to eliminate personal biases during assessment of patients of different culture. In relation to the culture in focus, the Leininger Transcultural Theory is appropriate in the assessment of the Chinese Culture. The growing population of Chinese nationals that migrated to the United States poses a need to understand their culture to better accommodate their healthcare needs. Leininger’s Assessment Tool is very well suited to address the Chinese culture as it addresses the different aspect of the culture and uses it in a positive manner to better address the healthcare needs of the patient may it be the individual of the family.
