Note: This section about the Asian culture is abbreviated and does not provide comprehensive coverage about all Asian cultures.

1. Value Orientations (Seidel, Ball, Dains, & Benedict, 1995, pp. 39, 47)
   1. Time--Past oriented, traditions meaningful.
      Japanese: Time is valued.
      Vietnamese: Punctuality less important.
   2. Activity--Self-development important.
   3. Human Nature--Views others neutrally; in harmony with nature.
   4. Relation--Group goals take priority over individual goals; family hierarchy important.
2. Health Beliefs (Seidel et al., pp. 46-47):
   1. Chinese: Health is maintained through a balance between "yin" (cold) and "yang" (hot) forces. A lack of "chi" (energy) causes illness. The body is viewed as a gift and must be valued through proper care.
   2. Japanese: Health is maintained through harmony with the world. Poor health may be caused through contact with impure elements such as corpses, blood, or skin disorders.
   3. Vietnamese: Health is maintained through a balance of "yin" and "yang" and by leading a harmonious life. Rituals are used to ward off illness.
   4. There are several web sites which detail health care beliefs of the Asian culture. For detailed information about Cambodian, Laotian, and Vietnamese beliefs the following web sites are available.
      Cambodian Health
      Laotian Health
      Vietnamese Health
3. Health Practices (Jarvis, 1996, pp. 51, 53; Seidel et al., p. 46)
   1. Chinese: In efforts to recover the balance between "yin" and "yang" individuals may utilize acupuncture, acupressure, or moxibustion. Herbal medicine is also utilized and folk healers may be consulted. Meals may also be used to restore balance. Emotions may be expressed through bodily symptoms. Diagnostic tests may cause upset especially if painful; hospitalization is feared. Since bodies are viewed as gifts surgical procedures may be refused; it is best to die with bodies intact. There is belief in reincarnation.
   2. Japanese: Individuals may also utilize acupuncture, acupressure, moxibustion, and herbal medicine, as well as traditional Western medicine. Assessment of pain may be difficult since emotions are often suppressed. Some food combinations may be avoided to avert poor health.
   3. Vietnamese: Individuals are hesitant to seek health care but utilize divine instruction, astrologers, and other healers. Diet also plays a part in maintaining good health.
   4. Women healers from the Asian culture practice fo'fo (massage), acupuncture, and herbal medicine.
4. Dietary Considerations ( Jarvis, p. 54; Seidel et al., p. 46; Chan, 1995, pp. 31-34)
   1. Asians have a high degree of lactose intolerance. Use of seasonings such as soy sauce, monosodium glutamate, pickled vegetables and fruits, may cause significant challenges when placing clients on high calcium or low sodium diets.
   2. Common maladies and their dietary treatments
      "Hot" illnesses include, among others fevers, infections, diarrhea, sore throats, and constipation. These can be treated with "cold" foods such as vegetables, fruits, dairy products, and chicken."Cold" illnesses include, among others, cancer, pneumonia, colds, headaches, and stomach cramps. These can be treated with "hot" foods such as chocolate, cheese, eggs, beef, cereal grains, chili peppers, and hard liquor.
   3. Chinese prefer meals of rice and seafood, meat, or vegetables. Since home cooking is preferred friends and relatives may provide food for hospitalized clients. Specially cooked soups are utilized to help clean the system.
5. Family Aspects (Seidel et al., p. 47)
   1. Chinese: Extended families are important with respect for the elderly. Maintaining honor and self-reliance are considered important. Females are less valued than males.
   2. Japanese: Strong intergenerational family structure is practiced. Self-control and self-reliance are valued.
   3. Vietnamese: Strong family relationships are evident. Extended families may be seen. Family goals are more important that individual goals. Fathers are seen as decision makers while females are subordinate family members.
6. Communication Practices (Seidel et al., p. 47)
   1. Chinese: Emotions are often hidden. Smiles may indicate lack of comprehension rather than agreement.
   2. Japanese: Use much non-verbal language; may understand written communication better than conversational language. Emotions are often hidden. Silence is often used.
   3. Vietnamese: Making queries is considered impolite and is a sign of disrespect for authority. Avoiding eye contact signifies respect. Indirect statements may indicate disagreement rather than comprehension.
7. Physical Assessment (Jarvis, pp. 217, 224, 306, 356, 391, 431, 468, 655)
   (Note: The following characteristics may be found more frequently in individuals of this minority group.)
   1. Skin/Hair: Yellow pigmentation to darker skin coloration related to melanin with darker pigmentation in perineal areas and nipples. Little to no body odor noticeable. Hair texture is generally smooth and straight. Pubic hair is sparse and fine.
   2. Eyes: Narrowed palpebral fissures leading to almond shaped eyes.
   3. Ears: Dry cerumen predominant.
   4. Nose/Mouth/Throat: Partially or totally split uvula, cleft lip/palate, protruding jaw, absence of third molar.
   5. Thorax/Lungs: Smaller chest volume than Blacks or Caucasians.
   6. Musculoskeletal: Bone density less in Chinese and Japanese populations. Women have smaller pelvises and are shorter than Caucasian and Black individuals.
8. Common Health Conditions
   1. Chinese: Higher rates of diabetes than native born Chinese (Jarvis, p. 527).
   2. Japanese: Lower incidence of hypertension (Jarvis, p. 527), lower incidence of high cholesterol levels (Jarvis, p. 527), higher incidence of diabetes than the population in Japan (Jarvis, p. 527).
   3. Filipino: Hypertension (Jarvis, p. 527).
   4. Cancer is the leading cause of death in Asian women; heart disease is the second most frequent cause of death. The web site listed below provides detailed statistics by Asian ethnicity for these common diseases and others.
   5. If one considers both genders of Asian/Pacific Islanders common health problems include cancer (second leading cause of death). Thyroid cancer is prevalent in Hawaii among Chinese men and Filipino women. Renal cancer is frequent among Filipino women with nasopharyngeal cancer being the most prevalent in the Chinese. Chinese individuals have a poor survival rate for leukemias and liver cancer. Hepatitis B is frequently diagnosed in Asian/Pacific Islanders and parasitic illnesses are reported frequently in Southeastern Asians. They also suffer from post-traumatic stress syndrome. (Louie, 1995, p. 42).
   6. Needs assessment information for South Asian women (in Northern California).
9. "Culture-Bound Syndromes" (Jarvis, p. 55)
   1. Chinese: "Koro" or fear of penis retracting into body.
   2. Japanese: "Wagamama" or childish behaviors with outbursts.
   3. Korean: "Hwa-byung" a combination of symptoms including palpitations, flushing, headache, and anxiety.
10. Genetic Disorders (Jarvis, p. 56)
    1. Chinese: Alpha thalassemia, G6PD, lactase insufficiency.
    2. Japanese: Acatalasemia. cleft lip/palate, Oguchi disease, lactase insufficiency.
    3. Thai: Lactase insufficiency, hemoglobin E disease.
11. Pharmacological Considerations
    1. Chinese: May require lower doses of benzodiazepines (diazepam, alprazolam), atropine, and propranolol (Davidhizar, R, Dowd, S, & Giger, J. N., 1997, p. 347; Zhou, Adeloyin, & Wilkinson, as cited in Levy, 1993, p. 9).
    2. Chinese: Pulse rate increases more than Caucasian using atropine (Levy, p. 25). Two times more sensitive to effects of propanolol on blood pressure and pulse (Levy, p. 25).
    3. Chinese: Less sensitive to cardiovascular and respiratory effects of morphine but more sensitive to GI effects (Levy, p. 26).
    4. Asians require lower doses of psychotropic drugs than Caucasians. These drugs include lithium, antidepressants (e.g., imipramine, desipramine, amitriptyline, clomipramine), and neuroleptics (e.g., haloperidol). Side effects may be exhibited at lower doses (Davidhizar et al., p. 347; Levy, p. 9, 26).
    5. Asians more sensitive to the effects of alcohol (Levy, p. 9).
    6. Asians tend to metabolize tranquilizers, caffeine, cardiac medications, and drugs used to treat tuberculosis more slowly than Caucasians ( Kalow; Lin et al.; Menodoza et al.; Meyer; Wood & Zhou; Zhou et al. as cited in Levy, 1993, p. 18).

References

• Chan, J. Y. K. (1995). Dietary beliefs of Chinese patients. Nursing Standard, 9 (27), 30-34.
• Davidhizar, R., Dowd, S., & Giger, J. N. (1997). Cultural differences in pain management. Radiologic Technology, 68, 345-348.
• Jarvis, C. (1996). Physical examination and health assessment (2nd ed.). Philadelphia, PA: W. B. Saunders.
• Levy, R. (1993). Ethnic & racial differences in response to medicines. Reston, VA: National Pharmaceutical Council.
• Louie, K. B. (1995). Cultural considerations: Asian-Americans and Pacific Islanders. Imprint, 42, (5), 41-44.
• Seidel, H. M., Ball, J. W., Dains, J. E., & Benedict, G. W. (1995). Mosby's guide to physical examination (3rd ed.). St. Louis, MO: Mosby.

Photo Credits

Photographs courtesy of P.A. Miya and M.J. McNamee, College of Nursing, UNMC.

Bibliography

• Callister, L. C. (1995). Cultural meanings of childbirth. JOGNN, 24, 327-331.
  
  Various cultures' practices about childbirth are briefly discussed. Included in the narrative are the beliefs of a Laotian woman who does not breast-feed her child until the third day postpartum. Initiating breast-feeding earlier than this will cause the baby to be upset.
  
  
• Choudry, U. K.  (1997).  Traditional practices of women from India:   Pregnancy, childbirth, and newborn care.  JOGNN, 26, 533-539.
  
  Women immigrants from India most often come from authoritarian environments.  Pregnancy is of great importance to mothers from India especially if it results in the birth of a son.  Many women do not believe they have control over pregnancy outcomes and adopt a fatalistic attitude.  Customs however, do play a role in pregancy (e.g., "hot and cool" foods which vary by regions within India).  "Hot" foods are considered bad for both the mother and fetus while "cold" foods are beneficial, especially during the first trimester.  While some women seek give birth in hospitals others prefer home deliveries.  Women delivering in  are considered untouchable and are, therefore, isolated during labor and deliver in India and for a portion of the postpartum period.  Certain items, such as fire, sickles, and water are kept nearby to ward off evil spirits.  Women giving birth in India are usually confined to the home for 40 days postpartum.  She avoids consuming cold foods. Breastfeeding usually commences on the 5th day postpartum. It is believed that newborns may fall victim to the "evil" eye therefore admirationof the newborn is discouraged.  A black spot composed of soot and butter may adorn the infant's forehead  and items of iron are placed beneath the infant's bed to ward off evil spirits.
  
  
• Downs, K, Bernstein, J., & Marchese, T. (1997). Providing culturally competent primary care for immigrant and refugee women. A Cambodian case study. Journal of Nurse-Midwifery, 42, 499-508.
  
  A case study  approach, centering around Cambodian women, is utilized to explore barriers to health care for immigrant and refugee women. The importance of culturally competent care is delineated. The author lists key components of culturally competent care as insuring accessibility . . . fostering accountability . . .developing a sustained partnership . . .providing health care in the context of family . . . and providing health care within the context of community" (p. 500).
  
  
• Hall, S. L., Giger, J. N., & Davidhizar, R. E. (1996). Cultural beliefs, values, and healing practices: Impact on the perinatal period. Journal of Nursing Science, 1, 99-104.
  
  During labor and delivery Chinese women may prefer to be in a side-lying position to decrease potential trauma to the infant. Following childbirth Chinese women may stay in bed and avoid wind, cold food, drink, and medication. Vietnamese women may view pictures of happy, healthy families during pregnancy believing this will have a positive outcome for the health of the fetus. They will avoid funerals while pregnant. In the Vietnamese culture the head is viewed as the center of life which should not be touched.. This, therefore, presents some challenges to health care professionals during labor and delivery procedures. In the Vietnamese culture infants may be dressed in old clothes so the child does not grow up to be vain and attract evil spirits. Both Chinese and Vietnamese women may avoid cutting infants' hair until one year of age because this may cause harm; infants' nails are often bitten off rather than neatly manicured as well. Navajo women believe the umbilical cord is the fetus' only link to the world; they exercise frequently. To prevent blindness babies may not view themselves in mirrors until age one. Cornmeal may be sprinkled around beds of ill individuals. Mexican women may believe that staring at an infant places evil spells upon the child. They may place an egg mixed with water under the infant's crib to ward off evil and break any spells.
  
  
• Holroyd, E., Katie, F. K. L., Chun, L. S., and Ha, S. W. (1997). "Doing the month": An exploration of postpartum practices in Chinese women. Health Care for Women International, 18, 301-313.
  
  Content analysis was used to determine the cultural practices of Chinese women in Hong Kong. Lochia is seen as bad blood which could contaminate others; food is used to restore good blood. Chicken, a cold food, restores this balance. Wine is also consumed to help restore women and eliminate bad blood. Ginger marinated in vinegar is introduced on the twelfth day post delivery to minimize harm done by the bad blood. Certain dried fungi or flowers are also used to strengthen postpartum women. Bathing and hair washing is taboo for the first month postpartum since pores may open, let wind in, and cause harm in later life. Rest, for as long as one month following delivery, is practiced. However, if the woman does venture out hats are worn to prevent the wind from getting in. If infants are taken outside during this time the "placenta god" may be angry and cause harm to infants' souls. Women prefer not to do housework during this recovery period because rest is deemed important. Intercourse is avoided for at least one month postpartum because the act is unclean. Mothers-in -law, husbands, and older relatives were driving forces in following traditional practices rather than Western medicine.
  
  
• Holroyd, E., Yin-king., L, Pui-yuk, L. W., Kwok-hong, F. Y., & Shuk-lin, B. L. (1997). Hong Kong Chinese women's perception of support from midwives during labour. Midwifery, 13 (2), 66-72.
  
  This article reports a quantitative study of Hong Kong Chinese females. A questionnaire was utilized. Women reported praise as being the most helpful action of midwives with touch being the least helpful during labor.
  
  
• Howard, J. Y., & Berbiglia, V. A. (1997). Caring for childbearing Korean women. JOGNN, 26, 665-671.
  
  An overview of the Korean culture is provided reviewing religious practices, educational levels, food, health, and childbearing, Koreans respect authority including individuals providing health care. They are interested in disease prevention. Pregnant women guard their modesty during prenatal visits and may prefer female health care providers. Ineffective methods of birth control may be used because of limited sex education. Pregnancy may restore imbalance of the body. Giving birth to a son is important in the culture. Certain rituals and taboos are followed to insure giving birth to a healthy baby. The "dos and don'ts" in caring for Korean childbearing women are provided.
  
  
• Kuss, T. (1997). Family planning experiences of Vietnamese women. Journal of Community Health Nursing, 14, 155-168.
  
  This article reports research examining factors influencing contraception in immigrant Vietnamese women. The socioeconomic stress of living in the United States was a factor in delaying pregnancy. Community did not affect family planning. Methods of contraception were discussed with husbands rather than other family members. Some women believed that oral contraceptives are "hot" so this method was avoided. Norplant and Depo-Provera caused women to be more argumentative and therefore were not readily used. IUDs may have been placed while the woman was residing in Vietnam since the government provided them for free and limiting family size was encouraged.
  
  
• Leininger, M. (1995). Transcultural nursing concepts, theories, research & practices. New York, NY: McGraw-Hill.
  
  The culture of Southeast and Eastern Asians including the Chinese, Korean, and Vietnamese, among others, are discussed. Historical and geographic aspects, commonalities of worldview and philosophies, educational aspects, family structures, technology, economics, politics, health and illness beliefs, health care, and communication are reviewed. In this last section the author points out that while an Asian client may provide an affirmative response "yes" or nod the head, the client may not really be agreeing with the health care professionals statement. Direct eye contact is avoided because it indicates disrespect, hostility or has other negative connotations. Nonverbal hand gestures may also hold negative meaning for Asian clients. The use of a finger to summon someone or crossing fingers for luck are seen respectively, as hostile and sexual. Silence is important in these cultures and personal space is about twelve inches.
  
  
• Narayan, M. C., & Rea, H. (1997). The South Asian client. Home Healthcare Nurse, 15, 461-469.
  
  This article uses a case study about a prenatal client from India. The authors outline steps towards culturally competent care including awareness of values, obtaining information about cultures, eliciting client beliefs/problems/solutions, utilizing Leininger's cultural care diversity and universality modes, avoiding/reducing client resistance, and recovering from cultural mistakes. A table provides a nice summary of Hindu, Muslim, and Sikh beliefs.
  
  
• Shanahan, M., & Brayshaw, D. L., (1995). Are nurses aware of the differing health care needs of Vietnamese patients? Journal of Advanced Nursing, 22, 456-464.
  
  The authors provide background on the Vietnamese culture in this research report. Family goals supersede individual goals. Buddhism prevails for most individuals with some being Roman Catholic. Universal order is important as is social harmony. Health is important as this maintains harmony and balance. Both traditional and Western medicine is practiced. Water is often limited when illness strikes because it is considered "cold" and would cause further imbalance. This includes both oral intake and bodily contact with water. Individuals are stoic and may not express pain openly. Death at home is desirable so that the soul has a resting place. The authors report the results of their study which utilized a semi-structured questionnaire. Nurses had a limited knowledge about the Vietnamese culture.
  
  
• Weber, S. E. (1996). Cultural aspects of pain in childbearing women. JOGNN, 25, 67-72.
  
  This article provides an overview of research conducted on pain during childbirth. Chinese women bear labor in silence because overt expressions of pain may bring dishonor to the family.

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