Culture Paper

Culture Paper Jason Harrison , RN St. Josephs College Professional Nursing With Individuals NU-350 May 2, 2012 Michele Caccavano, DNP, ANP, RNBC

Culture Paper Abstract Transcultural nursing involves recognizing unique individuals while maintaining

culturally sensitive environments. It involves having knowledge of the patients health and health status in relation to culturally specific illness and wellness behaviors. A goal of transcultural healthcare is continuous gathering of culturally relevant knowledge and application of that knowledge to provide care tailored to the individual patient with respect to the specific cultural differences that may be present.

Culture Paper Culture Paper-Healthcare of the Chinese patient Introduction Culturally appropriate healthcare to an individual can best be delivered when the practitioner possesses a working knowledge of norms, social structures, beliefs, family &

societal values, ethnicity and religion (to an extent) of the relevant culture. Care for the Chinese patient, while continuing to recognize them as an individual, may be enhanced by utilizing the cultural assessment framework created by Joyce Newman Giger and Ruth Davidhizar (Giger & Davidhizar, 2002). This guide serves to provide structure when developing tactics for caring for a culturally diverse populace. At the core of the framework are six areas where cultures gain identity and become diverse from other cultures. These six observable phenomena are: Communication Space Time Social Organization Environmental Control Biological Variations

Part A Communication One of the first and primary considerations when the Western provider interacts with the Chinese patient is the differences in communication and the ensuing difficulties that may arise. There are approximately 250 languages spoken in China, with 9 or 10 being the primary dialects. Even when interpreter services are utilized, language barriers may still exist. Family members

Culture Paper are often utilized to assist in communicating the patient. This has the potential benefits of the patient being more forthcoming when speaking to the family member due to the inherent familiarity. The tactic of using the patients family members is not without its own disadvantages and possible negative consequences. A moral value present in Chinese culture is that of face or dignity. If a symptom or

complaint may seem to cause the patient to feel shame or lose face, such as hepatitis C, an HIV+ status, pubic lice, etc., that patient may be reluctant to admit it to the family member speaking for them. When the patient does speak English, misinterpretations related to cultural differences in the manner of communication to may still occur. While explaining discharge instructions, the patient may nod intently. In western culture, this would signify understanding and agreement. On the contrary, the patient may simply just be nodding out of politeness or complying with perceived authority figures. This may also be the reasoning when a patient may not explicitly express their doubts or concerns regarding planned medical treatment, but choose to not carry out the instructions received. Another belief shared by many Chinese is that of karma. Patients or family members may choose to not directly mention serious or terminal illnesses in belief that speaking about them may hasten death or simply worsen the current condition. Speaking about a condition that is not present is believed to increase the chances that it may occur. Younger family members may purposefully neglect to tell the elderly about negative prognoses for fear that the information may cause hopelessness and quicken death.

Culture Paper Space

Chinese culture views touching from strangers as rude. This can be troublesome when a significant portion of healthcare involves frequent touch by the provider. Traditionally, upon greeting, a small nod is acceptable although shaking hands has become more common. Hugging, back-slapping, or other unnecessary touching should be avoided. Contrarily, the generally accepted amount of personal space needed while in conversation is much less than that of an American. While in direct conversation, the patient or family member may stand at a distance perceived as uncomfortable by western standards. The physical surroundings are believed to have influence on the well-being of a person. The idea of feng shui is that energy flows throughout the immediate surroundings and balance in that flow is needed to achieve harmony. The concepts of feng shui include colors that are associated with various types of energies. An example is that green is representative of growth. This color would not be preferred in the room of a cancer patient as the tumor would benefit from that energy. There is also a flow of energy that occurs within the body according to traditional Chinese belief. Known as qi (or chi or chi), this energy travels throughout the body along pathways known as meridians. When ill, the Chinese patient may seek healing through the practice of acupuncture, where needles are strategically placed at various points on the body in order to correct or otherwise alter qi flow.

Time The concept of time is perceived rather differently than in Western cultures. The Western idea of time is that it moves in a linear fashion. There is a beginning and an end to nearly everything. Providing healthcare within this culture focuses on the results of treatment or death,

Culture Paper with either being the end of therapy. Two of the prevailing philosophies in Chinese culture, Confucianism & Taoism, teach that time, and life to a degree, is cyclic. Each experience is succeeded by another and another, eventually leading back to the initial point, creating a seamless cycle. An example would be the hypoglycemic patient who presents as sluggish, then develops an increased energy level after being given a dosage of sugar, followed by another period of lethargy upon the end of the sugar rush and the subsequent crash. Another example would be the patient experiencing an abundance of stress in their life. Due to the

amount of stress being experienced, the patient has an insufficient amount of quality sleep. Rest is needed to help the body cope with the stress and lack of sleep, but that same stress prevents the person from sleeping soundly through the night and recovering. This thought process is also used in the views on health & wellbeing. Placing a substantial value on tradition is commonplace in China. It has also been surmised that China is past oriented as opposed to the Westerners future oriented thought processes. The older Chinese patient may be hesitant to participate in new, unfamiliar treatments. These groups of people are likely to prefer things the way theyve always been done (Fernandez & Fernandez, 2008).

Social Organization If the elder Chinese person still has the ability to make decisions, their influence can weigh heavily on decision-making processes. While the culture is generally patriarchal in nature, the eldest woman in the family does frequently have the pivotal opinion when decisions need to be made. Children are also expected to perform in certain roles. It is customary for the eldest daughter or daughter-in-law to care for the parents in their later years.

Culture Paper As mentioned previously, Confucianism has a wide, deep-seated influence in Chinese culture to this day, even to those families or individuals who do not choose a religious or philosophical alignment. Modern culture still resonates with some traditional characteristics such as paying heed to The Five Bonds as described in Confucianism. These bonds are: ruler to ruled, father to son, husband to wife, elder to youth, friend to friend. This is evidenced by the

inclination of parent to teach the youth to be utterly respectful to the older generations. It is also shown by the husband dominated household that is still the standard for marriages.

Environmental Control

The western definition of health is likely to amount to the absence of disease, pain or illness. The Chinese definition, however, would describe achieving harmony within the body and with the outside environment. Traditional Chinese culture incorporates numerous methods of achieving this harmony. The previously mentioned system of feng shui utilizes the persons surroundings to help attract positive energy (qi) from Heaven and Earth. The belief of Yinyang is that of reciprocal energies that are neither bad nor good. Sickness occurs when there is an imbalance in the qi. Common healing practices include internal treatments such as herbal medicines, calming/meditative practices such as the martial art T'ai chi ch'uan (commonly known as tai chi), and simple meditation. External therapies include: massage acupressure: manual pressure is applied to defined spots over the body in order to alter qi flow acupuncture

Culture Paper coining: a coin or other object is rubbed vigorously over an area on the body in efforts to draw out negative energy cupping: applying small heated jars to areas of acupuncture site which create vacuums as they cool

Biological Variations Persons of Chinese decent have been shown to have a genetic disposition toward developing nasopharyngeal carcinoma. The likelihood of a Chinese born person developing this cancer can be as high as 118 times that of Caucasians, while a Chinese person born in North America is still 7 times as likely to develop NPC. The definite cause of this high incidence has not been proven, but a strong link to the Epstein-Barr virus has been noted. Recent surveys have shown that approximately 50% of Chinese men smoke. This number shows that smoking cessation program s would be beneficial to their healthcare system. A peculiar aspect about those with Chinese genes is the frequency of a mutation that causes a reaction to drinking alcohol. Colloquially known as Asian Flush, it is said to affect roughly 50% of East Asians. Its effects range from the skin turning slightly pink to nausea and rapid heartbeat. This could contribute to relatively low rates of alcohol abuse, although further studies are needed.

Part B When caring for the Chinese patient, there are numerous actions that can be taken to ensure culturally competent care. Most facilities offer interpreter services for assistance in those instances when language competency isnt adequate. Other facilities offer a Language Line

Culture Paper where the provider and the patient can speak to an interpreter at a remote location over the phone. Being mindful of the family structure when addressing the family unit can help earn respect from the heads of the family as opposed to intently speaking to the inappropriate

members. Also, recognizing minor details such as the typical preference for room temperature or warm water as opposed to cold water can show the patient that their culture is being accounted for by their providers.

Culture Paper 10 Bibliography Aung, S., & Chen, W. (2007). Clinical Introduction to Medical Acupuncture. New York: Thieme. Fernandez, V., & Fernandez, K. (2008). Retrieved 11 2011, from Cultural Diversity: http://www.culturediversity.org/assesmnt.htm Giger, J. N., & Davidhizar, R. (2002, July). The Giger and Davidhizar Transcultural Assessment Model. Journal of Transcultural Nursing, 13(3), 185-188. Mengyu, L. (2008). The Unique Values of Chinese Traditional Cultural Time Orientation: In Comparison with Western Cultural Time Orientation. Qingdao. Tom, L. A. (n.d.). Health and Health Care for. Honolulu: University of Hawaii.