Group project

1. Chinese Culture
VIRGINIA PEOPLES, ERIN HARRELL, TAMARA QUINONES, JENNIFER WADE, AND
ROBERT KITE

2. Overview of Chinese Ethnicity and
Culture
 According to the Centers for Disease Control, the Chinese are the largest ethnic group in the
world and is continuing to grow. In the United States alone, there is an estimated population of
1.6 million Chinese immigrants (Purnell, 2009).
 Many do not realize that within the Chinese ethnicity the Hans Chinese is the largest group, but
that there are also other subsets of Chinese groups, each subset unique in their own dialect.
 Mandarin is spoken by approximately 70% of the Chinese, however, there are many other
dialects such as Cantonese, Hakka, Hokkien, Xian, Min, Gan, and Wu. Although, all written
dialect is the same across these subsets (Centers for Disease Control and Prevention [CDC],
2014).
Retrieved from : www.prchinese.com

3. Communication
 When communicating with someone of Chinese descent, it is important to
remember that the Chinese people are usually soft spoken, and prefer
conversations in quieter tones.
 It is also considered to be disrespectful to maintain direct eye contact, and
direct eye contact with a member of the opposite sex may be considered as
flirtatious (CDC, 2014).
 Although a handshake is appropriate, most Chinese prefer not to be touched.
It is important to give an explanation as to the reason that touch is needed
before actually touching someone of this ethnicity (Purnell, 2009).
 Also, in many families, the eldest male is the one who makes all the decisions
for the family, so it is important to understand who needs to be involved in
conversations regarding decision making (CDC, 2014).

4. Chinese Percentage of the U.S.
Population
 According to the Migration Policy Institute, in 2010 there were 1.8 million Chinese immigrants,
although 4.3 million persons reported themselves of being of Chinese or Cantonese ethnicity.
 In 2010, more than half of the reported Chinese immigrants lived in California or New York,
although South Dakota had the highest percentage of Chinese immigrants nationwide at 9.7%.
 Other heavily populated areas of persons of Chinese descent were North Dakota, New Jersey,
Philadelphia, and Hawaii (McCabe, 2012).
Retrieved from: www.flickr.com

5. Chinese Poverty Rate
 According to the World Bank, China has an estimated GDP of 8.227 million US dollars as of 2012.
 Also out of a population of 1.35 billion, only 98.99 million fell below the national poverty line in 2012.
 In the United States in 2010, the percentage of Chinese immigrants living below the poverty level was 16.1%
compared to all foreign born immigrants living below the poverty level at 18.7% (McCabe, 2012).
Retrieved from: www.xinhuanet.com

6. Biocultural Variations
 According to Andrews, in general, Chinese men and women are shorter
in stature and smaller in frame than persons of other ethnicities. Men
reach an average height of 65.7 inches, and women reach an average
height of 60.3 inches (2012).
 Most persons of Chinese descent have black straight hair, although some
do have naturally curly hair. They have brown eyes and distinct
epicanthal eye folds (Andrews, 2012).
 Mongolian spots are also present in the majority of the population and
should not be confused with bruises (Andrews, 2012).

7. Lifespan
 According to the Central Intelligence Agency in 2012, the average
lifespan of an individual of Chinese descent is:
 Males average of 73.09 years
 Females average of 77.43 years
 Total Population average of 75.15 years
Retrieved from: www.boloji.com

8. Incidence of Disease
 The Chinese have an increase in pre-disposition to certain diseases and
disorders such as:
 α-thalassemia
 G-6-PD deficiency, Chinese type
 Lactase deficiency, adult (Andrews, 2012).
Retrieved from: www.English.cctv.com

9. Communication Styles
 First generation Chinese Americans speak either Mandarin or Cantonese (National Hospice and
Palliative Care Organization, 2009).
 Chinese is second only to Spanish as the most frequently used non-English language in homes in
the US. (NAMI, 2011)
 Healthcare workers need to know more than the language to communicate effectively with
Chinese.
Retrieved from: www.blog.dnevnik.hr

10. Communication Styles
 Factors other than verbal language to consider:
 Guarded disclosure (Wang & Kerney, 2013)
 Highly recognized personal space (Andrews & Boyle, 2011)
 Limited eye contact and touching (Andrews & Boyle, 2011)
 Written language virtually universal. (National Hospice and Palliative Care Organization, 2009)
Retrieved from:
www.businessetiquettearoundtheworld.com

11. Affiliations
 Religious:
 Unaffiliated = 52%; Protestant = 22%; Buddhist = 18%; Catholic = 8% (Pew
Research Center, 2010)
 Political:
 Democrat = 52%; Republican = 32%; No leaning = 16% (Pew Research
Center, 2010)

12. Sanctions and Restrictions
 Divorce: Traditionally, divorce is frowned upon by society and
discouraged by the state (Xu, Zang, & Amato, 2011).
 Homosexuality: Although lagging behind the US, China is more accepting
today (USC, 2014). Asian American attitudes similar to general American
population in thinking homosexuality should be accepted rather than a
rejected behavior (Pew Research Center, 2010).
 Emotional Outburst: Asian culture encourages emotional discipline and
discourages outbursts. Biological differences can be seen between
Eastern and Western groups that suppress emotions (Murata, Moser, &
Kitayama, 2011).

13. Developmental Differences
 Research on comparative differences between Chinese and Western
populations is scarce and misleading (Wang et al., 2011).
 Developmental differences may be a reflection of culture (Vermont
Department of Health, 2014).
 Language- Differences may be related to SES rather than COO (Zhang,
Jin, Hoff, Shen, & Zhang, 2008).

14. Economics in China
 China has one of the world’s fastest growing economies with approximately 10% growth
per year since 1978. However, the average per capita income per family is still much
lower in China than it is in other industrialized countries such as the United States and
Japan (Guo, 2013).
 China has a Socialist Market Economy. A market economy is regulated by it’s means of
production. In a market economy, public ownership takes dominance. It is a mutual
ownership by the working citizens (Ding, 2009).
 There has been a recent growth of private ownership while the public ownership has
started to decline. This has caused a rising income gap between the wealthy and the
poor (Ding, 2009).
 Families depend on their young adults to enter the workforce as soon as they complete
high school. They usually live with their families and contribute to the household finances
well into adulthood. They are often married and still living at home (Purnell, 2009).
Retrieved from:
www.banknotes.com

15. Education in China
Childhood Education
 The schools in China have large classroom sizes.
 Both the teachers and the students are enthusiastic about
learning.
 English is required beginning in the 2nd grade, chemistry and
physics are introduced in the 3rd grade, and visual and
performing arts are emphasized in middle school.
 In China, they place importance on physical activity and all
students are required to participate in daily exercise. There is
very little prevalence of obesity.
 In high school, the Chinese student chooses a career path and
begins to focus on that path. They either go to college
preparatory schools or trade high schools.
(Mijares,2009)
University Education
 Education is extremely important in China and teenagers
are expected to stay focused and study.
 There are limited enrollment opportunities in China.
Therefore, Chinese students often come to the United
States in order to achieve a more respected education.
 They may also enroll in American schools that have
moved campuses to China.
(Purnell, 2009)
Retrieved from:
www.click2houston.com

16. Health Related
Beliefs and
Practices in China
Other common health concerns in China:
• Many men and teenagers smoke
• Common conditions include: Hepatitis B,
pancreatic cancer, lung disease,
tuberculosis, diabetes, nasopharyngeal
cancer, liver disease, cardiovascular disease,
and stomach cancer
(Purnell, 2009)
Retrieved from: www.fic.nih.gov

17. Health Related Beliefs and Practices
 Communication considerations in relation to health care:
 It is important to give very specific instructions using short, concise sentences.
 If you have to touch a patient, give an explanation for the touch and do so
minimally.
 Make sure the head of the family is present when making health-related
decisions.
 The topic of sex is taboo. Do not disclose same-sex relationships as it is
sometimes punishable by death.
( Purnell, 2009)

18. Pregnancy in
Chinese Women
• Chinese women are very modest
and may insist on a female
provider.
• Teenage pregnancy is not very
common, but is growing.
• It is believed that pregnancy is the
woman’s business.
• After delivery, Chinese women
increase their meat intake, but do
not take iron supplements.
• Cold air is taboo and they avoid it
for one month. This includes: not
going outside, not bathing,
wearing layers of clothes, and not
eating raw fruits and vegetables.
(Purnell, 2009)
Retrieved from: www.chinesemedicinebristol.blogspot.com

19. Health: Traditional Chinese Medicine
 Some older Chinese use both traditional Chinese medicine as well as Western
medicine. They will usually only resort to Western medicine if the traditional
medicine has not worked. They may not disclose to the provider that they
have used traditional medicine.
 In traditional medicine, pain is described as diffuse body symptoms. They use
oils for massages, sleeping on the area, relaxation, and aspirin to treat pain.
 They search for a balance between yin and yang for both physical and
mental health.
 Mental illness is taboo and is hidden. Often, a folk healer is used for this.
 The Chinese are reluctant to allow autopsies because they do not want the
body to be cut up.
(Purnell, 2009)

20. Kinship and Social Networks
 The Chinese family is structured around the male lines. The head of the family, usually the
father, holds great authority and typically assumes all major responsibilities in the household.
 The father often does the cleaning, cooking, and other housework while the spouse goes to
work.
 The Chinese believe family is very important and they often shift in roles to maintain harmony in
the home.
 The children are significantly valued and the parents usually invest their resources in their
children.
 The family makes decisions as a unit.
 The children are pressured to be successful and spend a lot of time focusing on their studies.
 The Chinese also value their extended family and sometimes live with them in order to help out
financially.
(Purnell, 2009)

21. Nutrition
 Food habits are important to the Chinese and focus on being well-balanced to promote a healthy body, both
physically and emotionally (Purnell, 2009).
 The Chinese almost never eat “ready meals”. Food is typically freshly cooked at each meal. They eat a large
amount of vegetables, which they cook quickly in order to maintain the nutritional value.
 Instead of eating large meals at one sitting, they tend to eat small, frequent meals, which is why they are
usually slim (Flower, 2010).
 Peanuts, soybeans, rice, noodles, and tofu are a few of the main staples in the Chinese diet (Purnell, 2009).
Retrieved from: www.news.asiaone.com

22. Nutrition
 To limit the incidence of calcium deficiencies, green
vegetables are heavily incorporated in their diet.
 Traditional Chinese medicine often uses food and food
derivatives to help avoid and heal diseases and illnesses and
to also strengthen the weak and elderly (Purnell, 2009).
 Chinese cuisine often times uses a large amount of
Monosodium Glutamate (MSG) to enhance the flavor of the
food. Consumption of MSG has been positively linked to
weight gain in otherwise healthy adults (Flower, 2010).

23. Religion and Spirituality
 China’s main formal religions are Buddhism,
Catholicism, Protestantism, Taoism, and Islam.
 Some Chinese people do not recognize a religion, but
will burn incense and offer prayers if they go to a shrine.
 Prayer is primarily used as a source of comfort.
 Chinese people often use meditation, exercise,
massage, prayer, herbs, and artistic expression as
modes to express their spirituality. They also have
cherished good luck charms (Purnell, 2009).

24. Religion and Spirituality
 Sources of strength come from “life forces”. These forces come from within the individual, the
environment, and society.
 The family and ancestors are considered sources of strength for an individual from before birth
and to death and beyond (Purnell, 2009).
Retrieved from: www.worldhistorycbad.wikispaces.com

25. Values Orientation
 Principles based on the teachings of Confucius play an important part in
Chinese values and beliefs.
 These teachings put emphasis on the significance of accountability to
family and neighbors, and also strengthens the idea that all relationships
embody power and rule (Purnell, 2009).
Retrieved from:
www.ancientcivilizationsbyme.wi
kispaces.com

26. Values Orientation
 Industry
 Patriotism
 Respect for those in hierarchal
positions
 Tolerance of others
 Courtesy
 Respect for tradition
 Loyalty to superiors
 Respect for rites and social
rituals
 Knowledge
 Compassionate authority
 Frugality
Other important values include:
(Purnell, 2009)
Retrieved from:
www.amfete.wordpress.com

27. Normal Physical Assessment Findings in
Chinese Patients
 Dark, straight hair
 Dark colored eyes
 Epicanthic fold – skin fold of upper eyelid
covers inner corner of eye
 Narrow eye slits
 Medium nose with straight bridge, nasal
base turned up in most men
 Thin lips
 Long facial length
 Medium stature
(Zheng et al., 2013)
Retrieved from: http://www.topchinatravel.com/ china-guide/traditional-
chinese-clothing/

28. Cultural Values
 The traditional cultural values that influence Chinese people are:
 Harmony
 Benevolence
 Righteousness
 Courtesy
 Wisdom
 Honesty
 Loyalty
 Finial piety (respect for one’s parents and ancestors)
 Modern Chinese society tries to maintain harmony between:
 humankind and nature
 people and society
 members of different communities
 mind and body
 Sensitive to social hierarchy
 Public display of emotion is seen as a sign of immaturity or weakness.
(Lihua, 2013)
Retrieved from http://traditions.cultural-china.com/en/15 traditions5187.html

29. Implications for Clinical Practice
 Ask the patient how they would like to be addressed (Chinese culture is more formal than American culture and the
patient may prefer to be called a specific name).
 Patients may tend to not speak up for themselves because assertiveness is seen as being poorly socialized, so paying
close attention for clues is important in the treatment and care of patients from this cultural group.
 Chinese culture is about family, not self. Patients may want discussions regarding treatment and diagnosis to occur when
family is present in the room so that a decision on care can be made together.
 Chinese culture involves self-reliance. Chinese patients may look for ways to self manage their symptoms or disease
without the help of treatment. It is important to educate patients, as well as their families, on the need for medical
treatment. Though, if they refuse treatment, we must respect their wishes, but document the discussion and outcome.
 Chinese patients may believe that improvement of symptoms means that their disease is cured. It is important to have
detailed conversations with these patients that treatment is often a process. Patients may be more understanding and
continue with care. On the other hand, no resolution of symptoms may leave the patient feeling that there is no cure for
them and that it is their fate to die because of the disease. Again, explaining the process of treatment may make them
more apt to continuing with the treatment regimen, as well as open to trying new treatments.
 It is important to explain all procedures and what they are used to diagnose. Chinese culture believes that blood is the
source of life and that it can never be renewed. So, when drawing blood for testing, it is imperative to explain in depth
the reasons.
(Kwan, Chun, & Chesla, 2011) and (Zu, Ho, & Sit, 2012)

30. References
Andrews, M.M. & Boyle, J.S. (2011). Transcultural concepts in nursing care (6th ed.). Philadelphia: Lippincott Williams &
Wilkins
Andrews, M. M. (2012). Cultural competence in the health history and physical exam. In M. Andrews & J. Boyle (Eds.),
Transcultural concepts in nursing care (pp. 38-71). Philadelphia, PA: Wolters Kluwer Health/Lippincott, Williams, & Wilkins.
Chapter 2. Overview of Chinese culture (2014). CDC Toolkit. Retrieved from
http://www.cdc.gov/tb/publications/guidestoolkits/Ethno- graphic/Guides/China/chapters/chapter2.pdf/
China overview (2013, April). The World Bank. Retrieved from www.worldbank.org/en/country/china/overview
Ding, X. (2009). The socialist market economy: China and the world. Science and Society, 73(2), 235-241.
Flower, K. (2010). Food and drink. In G. Chelser (Eds.), China: the ultimate guide to customs & culture (pp. 106-118). New York,
NY: Random House Distribution.
Guo, R. (2013). China in the new millennium. In R. Guo, Understanding the Chinese Economies. Waltham, MA: Academic Press.
Kwan, C., Chun, K., & Chesla, C. (2011). Cultural Norms Shaping Research Group Interviews with Chinese American Immigrants.
Asian American Journal of Psychology, 2(2), 115-127. doi:10.1037/a0024184
Lihua, Z. (2013). China’s Traditional Cultural Values and National Identity. Retrieved from
http://carnegietsinghua.org/2013/11/21/china-s-traditional-cultural-values-and-national-identity/gucp

31. References continued…
McCabe, K. (2012, January). Chinese immigrants in the United States. The Online Journal of the Migration Policy Institute. Retrieved from
http://migrationpolicy.org/article/Chinese-immigrants-united-states
Mijares, A. (2009). Understanding education in China. Leadership, 38(5), 24-25.
Murata, A., Moser, J. S. & Kitayama, S. (2011). Culture shapes electrocortical responses during emotion suppression. Social Cognitive &
Affective Neuroscience. 8. (5). 595-601
NAMI. (2011). Chinese American Mental Health Facts. Retrieved from
http://www.nami.org/Template.cfm?Section=Fact_Sheets1&Template=/ContentManagement/ContentDispla
y.cfm&ContentID=129323
National Hospice and Palliative Care Organization. (2009). Chinese-American Outreach Guide. Retrieved from
http://www.caringinfo.org/files/public/outreach/chinese_american_outreach_guide.pdf
Pew Research Center. (2010). Religious affiliation of Asian Americans. Pew Research Religion and Public Life Project. Retrieved from
http://projects.pewforum.org/2012/07/18/religious-affiliation-of-asian-americans-2/asianamericans_affiliation-4-2/
Purnell, L.D. (2009). Peoples of Chinese heritage. In J. Joyce & K. Depaul (Eds.), Guide to culturally competent health care (pp. 88-101).
Philadelphia, PA: F.A. Davis Company.

32. References continued…
The world fact book. (updated 2014, June). Central Intelligence Agency. Retrieved from https://www.cia.gov/library/publications/the-
world-factbook/fields/2012.html
University of Southern California. (2014). Homosexuality in China. US-China Today. Retrieved from
http://www.uschina.usc.edu/w_usci/showarticle.aspx?articleID=14740&AspxAutoDetectCookieSupport=1
Wang, D., Li, Y., Lee, S. G., Wang, L., Fan, J., Zhang, G., Wu, J., Ji, Y., Li. S. (2011). Ethnic Differences in Body Composition and Obesity
Related Risk Factors: Study in Chinese and White Males Living in China. PLoS ONE. 6. (5). 1-5. 5. DOI: 10.1371/journal.pone.0019835.
Wang, J. & Kearney, J. A., (2013). The experience of Chinese American parents of children with life Limiting illness: A comprehensive review.
International Journal of Palliative Nursing. 19. (7).347-354.
Xu, A., Zhang, Y., & Amato, P. R. (2011). A Comparison of Divorce Risk Models in China and the United States. Journal of Comparative
Family Studies. 42. (2). 289-295.
Zheng, L. , Li, Y., Lu, S., Bao, J., Wang, Y., Zhang, X., Xue, H., & Rong, W. (2013). Physical characteristics of Chinese Hakka. Science China: Life
Sciences. 56 (6), 541-551. doi:10.1007/s11427-013-4471-7.
Zhu, L., Ho, S., & Sit, J. (2012). The experiences of Chinese patients with coronary heart disease. Journal of Clinical Nursing, 2102/30, 476-484.
doi:10.1111/j.1365-2702.2011.03909.x