The document provides an overview of cultural practices and beliefs related to health and healthcare among people of Chinese heritage. It discusses topics like family roles, communication styles, nutrition, pregnancy, death rituals, spirituality, and traditional and western health practices. The role of advanced practice nurses is to address healthcare issues and disparities in the Chinese American population by improving access to care, building trust, providing education to encourage earlier treatment-seeking, and collaborating with community leaders.

1. People of Chinese Heritage (Wang Y., Purnell L.D, 2008) Presented by: Mariel Gonzalez, RN, BSN Sun Nguyen RN, BSN, CCRN Nurs 608: Spring 2011

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3. 12 Health Care Practitioners 4 Workforce Issues 3 Family Roles and Organization 2 Communication 7 Nutrition 6 High-Risk Behaviors 9 Death Rituals 5 Biocultural Ecology 1 Overview and Heritage 11 Health Care Practices 10 Spirituality Pregnancy 8 8 8

4. Overview and Heritage The Chinese culture dates back as far as 2200 B.C. Ideals and values based on Confucius teachings Importance in relationships (family and neighbors) Values family, elders, and higher education 1

5. Overview and Heritage 1

6. Overview and Heritage 1

7. 9.6 million square kilometers 23 provinces 5 regions 3 municipalities 1 1.31 billion people

8. People of Chinese Heritage in the United States The U.S. is slightly larger than China and has a significantly smaller population Approximately 310 million people are living in the United States of which 2.8 million are of Chinese descent Majority of the Chinese Population are residing in CA, NY, FL, and TX 1

9. Immigration of the Chinese in historical context People of Chinese Heritage in the United States 1

10. Educational Status and Occupations

11. Communication 2

12. Communication 2

14. Does not openly display emotions Openly shares information when trust is established Appreciates any attempt at speaking their language Touching should be kept to a minimum Maintaining distance is a sign of respect Direct eye contact may be uncomfortable Smiles are limited in formal situations Laughing and joking is common when comfortable

15. May say yes even if they don’t understand (to save themselves from embarrassment) Reputation of the family is very important The Chinese American may feel that they are always being evaluated

16. Build a trusting relationship Watch for cues of discomfort Instructions should be short, direct and specific Chinese clients should be addressed by either: Their family name Their full name (first and last) And always with their title (Mr., Mrs.)

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18. Education and success Family Love and marriage Children

19. The average family size is 3.46 in 2006 (One child per couple law) Male headed households Women beginning to fill more than ½ of the workforce (i.e. engineering, aviation) Children are valued by parents who often sacrifice and are willing to work harder if it would benefit the child’s future Younger generations adopt “double income, no kids” lifestyle because of a want in a higher standard of living More elderly parents are cared by society as children are focused on careers often in other countries The whole is greater than its part Group support is greater than privacy Personal independence not valued “ Re-education camps” “ Guan Xi” societal bank where funds are withdrawn that “demands payback” Chinese mothers (emotional atmosphere of the family) Chinese fathers (leaders) Chinese elders (wisdom)

20. Higher education linked with success Extended family members often assist in taking care of children to reduce financial hardship or improve education attainment of individual family members Family emphasizes on education and many exempt their children from working and household chores Competitiveness of education has caused many parents to spoil their children Pressured to succeed to improve the future of the family

21. Financial stability and security are considered before having children Divorce is legal but frowned upon Same sex partner are illegal and punishable by death in China

23. Male children are more valued than female children in rural areas Family members make all decisions for children in China (may continue into young adulthood) Expected to do well in school and achieve high grades Radical thoughts are discouraged Independence of children are increasing Determination of career goals are considered during adolescents Many Chinese children who adopt Western views may feel that expectations of older family members are too demanding Teenage pregnancy is not common but increasing in Chinese Americans Enters workforce immediately if education is not continued

24. Male children are more valued than female children in rural areas Family members make all decisions for children in China (may continue into young adulthood) Expected to do well in school and achieve high grades Radical thoughts are discouraged Independence of children are increasing Determination of career goals are considered during adolescents Many Chinese children who adopt Western views may feel that expectations of older family members are too demanding. Teenage pregnancy is not common but increasing in Chinese Americans Enters workforce immediately if education is not continued 4 1 2 3

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26. SKIN HAIR FRAME OTHER Generally shorter Light skin with pink undertone Black Dark skin Yellow tone Varies Usually Straight Sometimes naturally Curly Ulna longer than radius Bone density less Hips smaller Chinese men have less facial and chest hair compared to other men Twins are not common Rh negative blood is rare Biocultural Ecology 5

27. Malignant neoplasms Pancreatic cancer Cervical Liver Lung Stomach Multiple myeloma Esophageal Nasopharyngeal Heart diseases Respiratory Diseases CVA Tuberculoisis Hepatitis B 5 Men Women Both New immigrants

28. 5 5 Poor metabolism Mephenytoin (i.e. diazepam) Increased Sensitivity Beta-blockers Atropine Antidepressants Neuroleptics Alcohol Decreased sensitivity Analgesia but causes increased GI side effects

29. 5 5 Most data collected, group the Chinese population into the Asian American category The author suggest more research should be done to identify specific cultural differences 2009 Health care disparities report Identified that being uninsured is the strongest descriptor to effect the quality of care received. The report also identified that there is a disparity in the amount of pneumonia vaccination given and a worsening number of recommended hospitalizations for the Asian population with diagnosed pneumonia. The Chinese population in America were also specifically identified as having a large proportion of socioeconomic difficulties with being uninsured as one of the problems. Respiratory issues have also been identified in the Chinese population, giving room for improvement to serve the Chinese American population .

30. Tobacco use in Chinese men and teenagers Increasing Tobacco use in women High Behavior risk factors High Incidence of Traumas related to alcohol use 6

31. 12 Health Care Practitioners 4 Workforce Issues 3 Family Roles and Organization 2 Communication 6 High-Risk Behaviors 9 Death Rituals 5 Biocultural Ecology 1 Overview and Heritage 11 Health Care Practices 10 Spirituality 8 8 7 Nutrition Pregnancy 8

32. Nutrition Food is meaningful Celebrations centered around food Well balanced diet to promote health and well being Yang, “hot” & yin, “cold” style of eating Warm or hot drinks at meal times to maintain balance within body and promote healing Cold drinks thought to shock body 7

33. Nutrition Common foods Peanuts, soybeans, wheat, sorghum, maize, rice, beans, noodles, vegetables Meats: pork most common, chicken, beef, duck, shrimp, fish, scallops, mussels and tofu Foods high in fat and salt Lack of dairy products in diet due to genetic tendency of lactose intolerance Obtain Calcium from wide variety of green vegetables 7

34. Pregnancy Enforcement of one-child law Intrauterine device most common birth control Sterilization common Oral contraceptives free in China Abortions common Not ready for child or gender specific Boys still favored over girls 8

35. Pregnancy Pregnancy seen as a blessing Women modest Prefer female midwife/obstetrician Consume more meat to strengthen blood May refuse Iron; thought to make delivery difficult Postpartum practices: Only cooked warm meals Taboo to drink or touch cold water Prevent cold air from body Dressed head to toe Won’t bathe for first month Breastfeeding important Encouraged to drink rice wine to promote milk production 8

36. Death Rituals Stoic acceptance of death as part of life Worship Ancestors Form of respect Dead visited at hospital or family’s house Dead honored by surrounding coffin with items that symbolized deceased life Black armband worn on left arm and white cloth tied around head to symbolize mourning Fear death Avoid mentioning it or words that sound like it in Chinese No life insurance – seen as inviting death Colors white and black associated with death; considered bad luck 9

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38. Spirituality Minimal religious services Ideas and values practiced alone Main practices are Buddhism, Catholicism, Protestantism, Taoism and Islam Churches in Chinese community important Provide support and services for immigrants Comforted through prayer Goal is to live a happy and healthy life 10

39. Spirituality “ Life forces” are interconnected and provide strength Individual, environment, past and future of individuals and society Call upon ancestors Dependence on family Practices that provide strength Meditation, exercise, massage and prayer Drugs, herbs, food, good air and artistic expression 10

40. Health-care practices Use of Western medicine and traditional Chinese medicine Younger generations seek care when necessary; usually seek Western medicine first then traditional Chinese medicine Older Chinese generations use traditional Chinese remedies and only seek Western medicine when not responding to treatment Value stoicism May not discuss all ailments or alternative medicines being used 11

41. Health-care practices in China Centered on preventative care Focusing on Infectious diseases i.e. Schistosomiasis, TB, childhood diseases, cancer, heart disease, malaria, and maternal-infant care Regulation on AIDS prevention and control plan Free HIV testing HIV carriers and AIDS patients encouraged to inform spouses/sexual partners Local prevention authorities will inform spouses/sexual partners of patients’ statuses if not done so by patient 11

42. Health-care practices Language barrier prevents the seek of medical care Frustration of not being able to freely express/explain symptoms Do not trust healthcare providers Self medicate and share medicine Accept blood transfusion and organ donations when necessary 11

43. Traditional Chinese Medicine Practices Acupuncture and Moxibustion are used to restore imbalances in the body system Acupuncture – use of needles inserted into various pressure points to restore the balance of the bodies energy flow Moxibustion – application of heat to various points to draw out illness (i.e. cupping) Herbal therapy Depending on the illness herbs are drank, eaten, applied topically or worn on the body Herbs may also be given cold, hot, warm or cool Sense of interconnectiveness of the body systems One systems effects the other Must maintain the balance for good health and happiness Dao = balance of yin and yang 11

44. Health-care Providers Practice Western medicine and traditional Chinese medicine Education is similar to Western for physicians, nurses and pharmacists Practice Mid-wifery Physicians trained in universities Physicians use traditional Chinese pharmacies Chinese physicians are well respected Men respected more than women providers Women prefer female providers due to modesty 12

45. The Role of the Advanced Practice Nurse

46. CULTIVATE Role of the APN e

47. Health related issues in the Chinese American population The Chinese American population frequently alternates and at times incorporate both traditional Chinese medicine with Western medicine without fully understanding the implications for choosing one method over the other. With language and cultural barriers, distrust in Western medicine may have deterred Chinese American patients from receiving care until symptoms worsen and disease are in advanced stages, leading to poorer prognosis.

48. To identify and address what needs are (i.e. healthcare funds) and to gain acceptance of the community Increase comfort of patient and decrease language barriers Decrease the number of preventative diseases while improving in outcomes due to early interventions Increasing access and providing convenient and community based care THE ROLE OF THE APN Collaborate with community leaders and traditional healers of the community Hire staff who are proficient in English and the more common Chinese dialects of the area Educate community on the importance of early treatment and routine check-ups Healthcare clinic based in Chinatown, serving all primary care duties

49. Focus of the Nurse Practitioner's Role Improve health outcomes related to improved health-seeking beliefs and behaviors Build and strengthen community trust Patients will seek care sooner Patient will be more open with sharing information (especially about self-medication) Patient will be more open to education. Health outcome will ultimately improve and preventive diseases will decreases with patients more willing and open to seek care Improve healthcare disparities related to received vaccinations and appropriate hospitalization recommendations Clinic Improves access

50. Considerations for the Nurse Practitioner

51. The End Thank You [email_address] [email_address] References Wang, Y. & Purnell, L.D., (2008). People of Chinese heritage. In L. Purnell & B. Paulanka (3 rd Ed.), Transcultural health care: A culturally competent approach (pp. 129-144). Philadelphia: Davis Agency for Healthcare Research and Quality. (2009). National healthcare disparities report. Retrieved from http://www.ahrq.gov/qual/nhdr09/nhdr09.pdf