Working with Chinese Americans

mhy12784 · Apr 15, 2014

This is just my opinion, and maybe it makes me "ignorant" but I feel like this stuff is nonsense and racist.

Treat all your patients kindly, smile, be friendly and polite.

Im not saying dont respect a patients beliefs, but I dont think its realistic to expect (or for schools to teach) you to memorize a list of every single cultures personal preferences and how you can best cater to them.

Especially since there are SOME countries and cultures out there that are inherently racist and or sexists.

AmyRN303, BSN, RN · Apr 15, 2014

There are a lot of great resources online....I'm not at home right now so I don't have my bookmarks, but there are some great journal articles on different cultures and why learning about diversity is very important.

One thins I would add is that some Chinese Americans practice Traditional Chinese Medicine (TCM) so the implications of that need to be assessed, particularly when obtaining a medication history.

jennifer_app · Apr 15, 2014

Another thing is to be aware of some of their medical beliefs and concepts. Such as when they are sick they believe its because there's an imbalance of " hot and Cold air" in the bodies, so they would try to cure themselves by correcting that imbalance. They also believe in " cupping" to cure trivial sicknesses (a simple cold or fever for example). I've also heard that they drink rice water to alleviate constipation. Keep in mind that these concepts are more predominant in the older generations of Chinese/Americans .

BeachsideRN, ASN · Apr 15, 2014

This is just my opinion, and maybe it makes me "ignorant" but I feel like this stuff is nonsense and racist.
Treat all your patients kindly, smile, be friendly and polite.
Im not saying dont respect a patients beliefs, but I dont think its realistic to expect (or for schools to teach) you to memorize a list of every single cultures personal preferences and how you can best cater to them.
Especially since there are SOME countries and cultures out there that are inherently racist and or sexists.

There is a difference between catering and being aware of cultural differences. I think it is good practice to try to understand values that your patient might hold in order to create your best care plan. In addition to TCM some Chinese Americans are still "old school" in so much as Daddy/husband makes all the "rules" and has the ultimate say in what happens, which can be very important to understand especially when it comes to women's health issues.

lxpatterson · Apr 15, 2014

I am a Chinese-Canadian and I have had many asian patients in an urban acute care setting. There are certainly some unique food and lifestyle preferences based on culture, but I have to say one of the biggest differences may be the approach to autonomy. In contemporary North American clinical practice and in our nursing education there is a strong emphasis on individual autonomy (eg. privacy, medical paternalism v. patient's right to choose, conflict of interests and individual consent, etc). However, many Asian cultures believe that the sick person ought to be "protected" from many of the decisions involved in care because having to deal with these decisions might be a stressor that will make them worse. This may manifest itself in outright paternalism, as described by the above poster, or in other ways like multiple family members (including a clinician in the family) being fairly aggressive in seeking patient information. Therefore, the family may need to be accommodated in treatment planning.

The most important thing to remember is not to assume, because every family is different. Many people who identify as Chinese, such as myself, have grown up in North America and may not feel the same way. In addition, there are many Chinese diaspora communities that have varying cultural beliefs. It is still important to find out what each patient prefers and is comfortable with.

mhy12784 · Apr 15, 2014

I am a Chinese-Canadian and I have had many asian patients in an urban acute care setting. There are certainly some unique food and lifestyle preferences based on culture, but I have to say one of the biggest differences may be the approach to autonomy. In contemporary North American clinical practice and in our nursing education there is a strong emphasis on individual autonomy (eg. privacy, medical paternalism v. patient's right to choose, conflict of interests and individual consent, etc). However, many Asian cultures believe that the sick person ought to be "protected" from many of the decisions involved in care because having to deal with these decisions might be a stressor that will make them worse. This may manifest itself in outright paternalism, as described by the above poster, or in other ways like multiple family members (including a clinician in the family) being fairly aggressive in seeking patient information. Therefore, the family may need to be accommodated in treatment planning.
The most important thing to remember is not to assume, because every family is different. Many people who identify as Chinese, such as myself, have grown up in North America and may not feel the same way. In addition, there are many Chinese diaspora communities that have varying cultural beliefs. It is still important to find out what each patient prefers and is comfortable with.

A huge part of what you said is a legal issue though, more so than a cultural issue.

I dont care what a patients culture demands, if it expects me to violate the law (ie HIPAA)

Been there,done that, ASN, RN · Apr 15, 2014

I have had the pleasure of working in the most diverse culture in the world.

That was in Honolulu.

It was no different than working in another diverse culture of downtown Detroit.

The nurse recognizes and works with the culture of the patient.

Defining that culture.. should not be a issue.

studentnurseASN · Apr 16, 2014

I run into this problem too when I have to work with cultural groups. I've notice that resources for groups vary from location to location. In class, I learned that community assessment gives an overview of understanding how to care for different people.

lxpatterson · Apr 17, 2014

A huge part of what you said is a legal issue though, more so than a cultural issue.
I dont care what a patients culture demands, if it expects me to violate the law (ie HIPAA)

Of course you have to figure out what the patient's preferences are, without assuming they are ok with stuff because they are from a certain culture. But once you have established that someone is ok with a family member making decisions for them and having access to their information, it's a matter of documenting it well. It's that documentation that protects you.

Secondly, it's mostly people from an older generation that prefers heavy family involvement. And it is very unlikely that an 80 year old Chinese granny with minimal cultural fluency and English competency, uninterested in learning about the intricacies of CHF pathology and treatment, is going to sue you; much more likely it is the scenario where the children of the granny, who may be well-off professionals, are going to sue you if they feel mistreated.

I worked in the medicolegal field writing briefs for malpractice and casualty before becoming a nurse. I have never seen a malpractice or privacy case that was the result of cultural misunderstanding (although I'm sure it is a possibility), however I have seen many cases where personal dislike/animosity between patient and clinician, in combination with a minor or even questionable medical error, snowballed into a full blown malpractice case.