Transcultural Health Care A Culturally Competent Approach, 4t.docx

Transcultural Health Care: A Culturally Competent Approach,
4th Edition
Copyright © 2013 F.A. Davis Company
Guatemalan Culture
Larry Purnell, PhD, RN, FAAN
4th Edition
Overview/Heritage
▪ People of Guatemalan heritage comprise a
growing number of Hispanic/Latino
populations in the United States.
▪ Guatemalans may share a common Spanish
language with other Hispanic ethnic groups.
▪ In Guatemala, 56 percent of the population
lives below the poverty level.
4th Edition

Overview/Heritage
▪ Guatemala is inhabited by Mestizo (mixed
Amerindian-Spanish - in local Spanish
called Ladino) and European 59.4 percent,
K'iche 9.1 percent, Kaqchikel 8.4 percent,
Mam 7.9 percent, Q'eqchi 6.3 percent,
other Mayan 8.6 percent, indigenous non-
Mayan 0.2 percent, other 0.1 percent.
4th Edition
Communication
▪ The major languages in Guatemala include the
official language, Spanish, which is spoken by 60
percent of the population, and Amerindian
languages, which are spoken by the remaining 40
percent.
▪ There are 23 officially recognized Amerindian
languages.
4th Edition

Communication
▪ Some Mayan men do not have a formal
education but are able to speak Spanish
because of frequent interactions with Spanish
speakers.
▪ Guatemalan people tend to value the past
and live in the present, being more concerned
with today than the future because the future
is uncertain for many.
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Communication
▪ Time is related to the natural environment,
such as sunrise, sunset, rainy season, etc.
▪ Punctuality is difficult for many because of
limited transportation and unexpected
family needs.
▪ Guatemalans who have a Hispanic heritage
use the Spanish format for names.
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Communication
▪ At birth, a child is given a first name (Ovidio) followed by
the surname of his father (Garcia), and then the surname
of his mother (Salvador), resulting in Ovidio Garcia
Salvador.
▪ Men’s names remain the same through their lifetime.
▪ However, when a woman named Jovita Garcia Salvador
marries Francisco Vasquez Gutierrez, she then becomes
Jovita Garcia de Vasquez or simply Jovita Garcia
Vasquez.
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Communication
▪ To convey respect, address the Guatemalan in a formal
manner unless otherwise requested by the patient.
▪ Male children and adults are referred to as Mr. (Señor).
Females are referred to as Ms. (Señorita) or Mrs.
(Señora).
▪ Guatemalans are customarily greeted with a handshake.
In rural areas, people shake hands softly.
▪ To give a firm handshake indicates aggressive behavior.
▪ In the cities, the handshake tends to be more firm.

4th Edition
Communication
▪ Guatemalans avoid direct eye contact with
others, including health-care providers, which is
a way of demonstrating respect and should not
be misinterpreted as avoidance, low self-esteem,
or disinterest.
▪ Guatemalans speak softly in public.
▪ Speaking loud is considered rude.
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Family Roles and Organization
▪ Many Guatemala families follow traditional roles for
husbands, wives, and children, although this is
changing for some.
▪ Traditionally, the man has been the head of
household and is the primary “breadwinner” and
provider for the family.
▪ Ultimate decision-making power resides with the
man of the house.
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▪ Women’s roles have traditionally involved raising
the children and caring for the home.
▪ Guatemalans place a high value on the family and
extended family.
▪ Most families are nuclear.
▪ Extended family is important and may include
grandparents, aunts, uncles, and cousins.
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▪ A young woman’s 15th birthday (quinceñera) is
celebrated as her passage to womanhood.
▪ Coming of age for a young man is age 18 years.
▪ Children are a gift from God and are highly valued
in Guatemalan society.
▪ Sons are more valued than daughters.
▪ Children are taught to be obedient and
demonstrate respect for older people.

4th Edition
▪ Among Mayan communities, family members and
other adults take an active part in raising a child.
▪ They believe it takes a village to raise a child to
become a productive member of the community
and to continue their culture.
▪ Values include being humble, content, and
respectful of others, working hard, avoiding
arguments, and placing the needs of the family
before one’s own individual needs.
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▪ When family members are unable to take care of
themselves, the expectation is that their family will
take care of them.
▪ Guatemalan families who migrate to the United
States do so with the hope of a better life for
themselves and their children.
▪ More opportunities are available in the United
States.

4th Edition
▪ Catholic, protestant, and evangelical Guatemalans
do not believe in homosexuality or sexual activity
among the unmarried, or infidelity.
▪ Indigenous women dress conservatively with a
woven long skirt (corte), blouse (huipil), a scarf
(tzute), and shawl (rebozo) that promote modesty.
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▪ A single woman is believed to be a prostitute if
she is out in public alone.
▪ Despite a prevailing macho attitude with a deep-
rooted homophobia, some inroads have been
made for gays, lesbian, and transgendered
populations in Guatemala with Lesbiradas, an
organization for lesbians and bisexual women.
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▪ Larger cities in the United States offer
organizations such as Ellas, a support group for
Latina lesbians; El Hotline of Hola Gay, an
organization with information and referrals in
Spanish; and Dignity, a gay Catholic support
organization.
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Workforce Issues
▪ During the civil war in Guatemala, residents were
permitted to migrate to the United States and
apply for political asylum.
▪ If granted, this allowed Guatemalans to stay
permanently in the United States, but they were
not permitted to ever return to Guatemala.
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Workforce Issues
▪ Guatemalans may miss work due to an illness of
a loved one, a need for transportation to an
appointment, or lack of childcare.
▪ When a Guatemalan learns that a loved one in
Guatemala is ill or has passed away, they feel
compelled to return to Guatemala for an

extended period of time, risking loss of their job
if a leave of absence is not possible.
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Workforce Issues
▪ Because punctuality is not valued in Guatemala,
the Guatemalan employee in the United States
may arrive for work late.
▪ They may not wear a timepiece, be able to tell
time, or understand the importance of punctuality
in the United States.
▪ Guatemalans tend to respect persons in
positions of authority.
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Workforce Issues
▪ Those of lower socioeconomic status and/or
with formal education and English language
skills usually acquire positions with responsibility
but little authority.
▪ They prefer to get along well with others and not
criticize or voice complaints when treated poorly.

▪ The Guatemalan is likely to remain in a position
equal to his peers rather than seek a promotion.
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Biocultural Ecology
▪ Most Guatemalans are a mixture of Spanish and
Mayan Indian heritage.
▪ There is a small population of Black Guatemalans
with ancestry from the Caribbean and Africa.
▪ This accounts for variations in skin color, facial
features, hair, body structure, and other biological
variations.
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Biocultural Ecology
▪ Guatemalans who are predominately Spanish
may have blonde or brown hair, fair complexion,
and blue eyes and be of average or taller height
with a medium to large build.
▪ Guatemalans with predominately Mayan Indian
ancestry tend to have black hair, brown skin,
and dark eye color and are of short height with a
petite build.

4th Edition
Biocultural Ecology
▪ The leading causes of mortality in Guatemala are
pneumonia, diarrhea, communicable diseases,
diseases of the circulatory system, perinatal
conditions, and tumors.
▪ Other major health problems for Guatemalans
include musculoskeletal pain, abdominal pain, upper
respiratory problems, headaches, rashes and itching,
and eye disorders.
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High-Risk Health Behaviors
▪ Alcohol is the most misused substance.
▪ Guatemalan families readily participate in
immunization programs for their children yet do
not participate themselves.

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Nutrition
▪ Food to Guatemalans signifies physical, spiritual,
and cultural wellness.
▪ Foods vary among Guatemalans based on
cultural traditions and accessibility.
▪ Corn is highly valued in the Mayan culture. Corn
is the chief crop and the basis for many food
products and meals. Foods bring strength, good
health, and a spiritual connection to the past.
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Nutrition
▪ The Mayan diet primarily consists of maize, black
beans, rice, chicken, squash, tomatoes, carrots, chilies,
beets, cauliflower, lettuce, cabbage, chard, leek, onion
and garlic.
▪ These foods are used to maketortillas, atole, (liquid corn
drink), pinol (chicken flavored corn gruel), pepi'an
(chicken stew with squash seeds, hot chilies, tomatoes,
and tomatillos [small green tomato]), and caldos (soups
made of chicken stock and vegetables.)

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Nutrition
▪ Guatemalan food is not served spicy. A spicy hot
sauce may be served alongside a meal for
individuals who prefer to add it.
▪ The diet of many Guatemalans is low in protein,
iron, and vitamin C.
▪ Lactose intolerance is especially prevalent
among indigenous populations.
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Nutrition
▪ Some Guatemalan families encourage their
children to drink coffee with sugar when they
refuse the poor tasting drinking water.
▪ This practice leads to gastritis, dehydration, and
dental caries.
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Pregnancy and Childbearing Practices
▪ Guatemalans value life beginning from

conception; a baby is a gift from God.
▪ Most do not believe in contraception or abortion
for religious reasons.
▪ A Guatemalan woman may bear 10 or more
children in her lifetime. In Guatemala, of these,
many die before the age of 5 years.
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▪ Mayan midwives (comadronas) deliver 80 percent of all
children born in Guatemala in the home. It is unknown
how widespread this practice is in the United States.
▪ If the baby dies during delivery, the family accept it as
God’s will.
▪ On the day a Guatemalan woman becomes pregnant, she
and her husband share the news with respected elders of
the village. Godparents are also selected at this time.
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▪ In the 7th month of pregnancy, the woman introduces her
fetus to the environment.

▪ She goes through her daily activities showing and telling
her fetus about the life she leads. The mother tells the
fetus to be honest and never abuse nature.
▪ If someone eats in front of the pregnant woman without
offering her food, she will have a miscarriage.
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▪ Children are permitted at the delivery.
▪ The woman’s husband, village leaders, and
parents of the couple may be present.
▪ A single woman must not observe the birth of
the baby.
▪ Mayan women do not believe in lying down to
give birth or delivering in a hospital.
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▪ A midwife and witch (brujo) may both attend the
birth.

▪ The midwife helps with delivery.
▪ The brujo prays for long life, good health, and
protection from the evil eye (mal ojo).
▪ A breech delivery or one in which the baby’s cord
is around the neck are considered good luck.
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▪ Following delivery, the placenta has to be burned,
not buried, because it is disrespectful to the earth
to do so.
▪ The placenta can be burned on a log and then
the ashes used for a steam bath, temascal.
▪ To celebrate the birth of a baby, the villagers
slaughter a sheep.
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▪ The mother and baby are kept separated from
others for 8 days.
▪ When the baby is born, the hands and feet are

bound for 8 days. This signifies that they are
meant for hard work, not for stealing.
▪ Guatemalan women may continue breastfeeding
until the child reaches the age of 5 years.
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▪ During the first 8 postpartum days, friends and
extended family bring food, clothing, small
animals, or wood as gifts for the newborn’s family.
▪ They also offer their services, like carrying water
or chopping wood.
▪ The family of the newborn does nothing for these
8 days; their needs are taken care of by others.
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▪ A bag with garlic, lime, salt, and tobacco is hung
around the baby’s neck and a red thread is used
to tie the umbilical cord to protect the baby,
provide strength, and denote respect for the
ancestors.

▪ If the baby is a female, the midwife pierces her
ears at birth.
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ClickerCheck
Juanita Juarez, is pregnant with her second child. The nurse
recommended that she increase her milk consumption,
which she has not done. He has been compliant with other
dietary recommendations. The most likely reason for not
increasing her milk consumption is that she
a. Does not like milk.
b. Cannot afford milk.
c. Has lactose intolerance.
d. Has fructose intolerance.
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Correct Answer
Correct answer: C
Many Guatemalans have lactose intolerance and
cannot drink milk or milk products because it
caused bloating and indigestion.

4th Edition
Death Rituals
▪ Many Guatemalans grow up experiencing far more death than
most North Americans.
▪ They see babies and children die of malnutrition and disease,
parents and grandparents die from violence, and loved ones
die because the health care they needed was too far away or
was too expensive.
▪ The family may decide the cost for treatment of one family
member is too much and decide against it because of the
financial strain on the entire family.
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Death Rituals
▪ When death occurs in Guatemala, it is
customary to place the deceased in a simple
wooden coffin/casket and conduct a funeral.
▪ Graves are decorated with flowers on All Saint’s
Day in memory of the deceased.
▪ Some Guatemalans relate their illness to
“punishment” or impending death to “God’s will”.

4th Edition
Death Rituals
▪ When a Guatemalan dies in the United States,
the family may request repatriation because it is
important for the final resting place to be the
home country.
▪ Guatemalans believe in burial; they do not
practice cremation.
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Death Rituals
▪ Yellow is the color of mourning.
▪ Yellow flowers are placed at the grave.
▪ Food is placed at the head for the spirit of the
departed.
▪ Church bells are rung to gain favor with the gods.
▪ Ladinos mourn the dead by wearing black.
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Spirituality
▪ Approximately 65-80 percent of Guatemalans

are Roman Catholic.
▪ Others continued to practice their Mayan
religion.
▪ Still other Guatemalans combined beliefs and
practices of the two.
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Spirituality
▪ Two practices influenced by the Spanish are
guachibal and cofradia.
▪ Guachibal involves the practice of keeping an
image of a Christian saint in the home and
celebrating on the particular saint’s day.
▪ Cofradia refers to a “religious brotherhood” that
serves to maintain the “cult” of a particular saint.
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Spirituality
▪ Family provides Guatemalans with meaning in
their lives.
▪ Spirituality helps to explain life and the

circumstances faced by Guatemalans.
▪ When illness occurs, many Guatemalans turn to
their faith for strength, wisdom, and hope.
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Health-care Practices
▪ The preferred mode of treatment among Ladinos
is medication administered by hypodermic
injection. For example, if an infant has a cold,
Ladinos believe an injection is necessary to treat
it effectively.
▪ If someone has the flu, they like an intravenous
infusion. Intramuscular medications are preferred
to those taken orally.
4th Edition
▪ Health-care seeking among Guatemalans
generally occurs by first seeking advice from a
mother, grandmother, or other respected elder.
▪ If this approach is unsuccessful, then the family
usually seeks health care from folk healers.

▪ Modern medical care may be the last resort.
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▪ Many are fearful of hospitals.
▪ In Guatemala, when hospital care is necessary,
patients are often seriously ill, resulting in death,
which perpetuates the belief that “hospitals are
places where patients go to die.”
▪ Guatemalans often delay seeking health care
until they are incapacitated by illness, disease,
or injury.
4th Edition
▪ Many times, they are unaware of the dangers
associated with working in agriculture in the
United States.
▪ They may be exposed to pesticides and
dangerous equipment without proper training.
▪ Some Guatemalans fear venipuncture because
taking blood leaves the body without enough

blood to keep them strong and healthy.
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▪ Guatemalans tend to view health and illness in relation to
their ability to perform duties associated with their roles.
▪ As long as women are functioning in their role of caring
for the home and family and men are functioning in their
job, then they feel “healthy”.
▪ Aches, pains, and minor illnesses that do not prevent
functioning are tolerated.
▪ When an illness prevents normal functioning required for
their roles, then Guatemalans view it seriously.
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▪ The cause of debilitating illness or disease may
be viewed as punishment from God rather than
lack of prevention or early detection.
▪ Sometimes, early warning signs of illness or
disease are ignored in hopes they will go away
on their own.

▪ Family members would rather care for their
loved one at home if at all possible.
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▪ Questions related to organ donation will be
puzzling and elicit fear and anxiety.
▪ The Guatemalan patient may think the health-
care provider is asking them to consent to organ
donation because they are going to die rather
than understanding the context to which the
question applies.
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ClickerCheck
Maria and Pedro bring their 3 day old male newborn baby to
the pediatric clinic because he is not nursing and they are
sure he is losing weight. The baby has his hands and feet
bound. The nurse recognizes this Mayan custom is so that
the baby will
a.Grow up to work and not steal.
b.Not get colic.
c. Be a religious person in adulthood.

d.Be safe from evil spirits.
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Correct Answer
Correct answer: A
Traditional Guatemalans bind the baby’s hands and
feet for the first 8 days of life so it will grow up to
be a good worker and not steal.
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Health-care Practitioners
Three distinct health care systems exist in
Guatemala:
1. Modern medicine
2. Ladino folk medicine
3. Indian folk medicine
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▪ Modern medicine refers to health care provided
by educated physicians and nurses.
▪ Ladino folk medicine is provided by Ladino
pharmacists, spiritualists, and lay healers
(curanderos).
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▪ Mayan Indians seek medical care from Mayan
shaman, herbalists, and comadronas.
▪ When Ladinos and Mayan Indians have access
to modern medicine, the utilization increases.
▪ Guatemalans have great respect and admiration
for health-care providers. They are viewed as
authority figures with clinical expertise.
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▪ Guatemalans expect their health-care provider to
have the appearance and manners of a professional.
▪ When this is not the case, Guatemalans lose
confidence in the provider.

▪ Guatemalans are very private and are not
accustomed to discussing issues and concerns
openly. It may take a while to develop the trust and
rapport.
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▪ They fear disclosure may result in deportation or
rejection.
▪ Patients also fear confidentiality will not be
maintained in the health-care setting.
▪ Guatemalan women are usually very modest.
▪ They may refuse to discuss personal issues or
receive an examination by a male health-care
provider.
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▪ A male Guatemalan patient may refuse a
female health-care provider.
▪ Because Guatemalans dislike conflict, they

may not actually refuse care instead they
may withhold personal information due to
discomfort with the health-care provider.
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Chinese American Culture
Larry Purnell, PhD, RN, FAAN
4th Edition
Chinese Overview/Heritage
▪ China’s population of over 1.3 billion people is
dispersed over 3.7 million square miles, with
cultural values differing according to
geographic location as well as other variant
cultural characteristics.
▪ Chinese in the United States exceed 1.6
million people with the largest communities in
California, New York, Hawaii, and Texas.

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▪ A university education is highly valued; however,
few have the opportunity to achieve this life goal
because of limited enrollment opportunities.
▪ Often, young adults come to Western countries
to attend universities seeking more advanced
prestigious educations.
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▪ Many newer immigrants are professionals from
Hong Kong.
▪ Chinese Confucian ideals emphasize the
importance family and neighbors and reinforce
the idea that all relationships embody power and
rule.
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▪ Other important values are filial piety, industry,

patriotism, deference to those in hierarchal
positions, tolerance of others, loyalty to superiors,
respect for rites and social rituals, knowledge,
benevolent authority, thrift, patience, courtesy,
and respect for tradition.
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Chinese Communication
▪ The official language of China is Mandarin (pu
tong hua), spoken by about 70% of the
population, but other major, distinct dialects
such as Cantonese, Fujianese, Shanghainese,
Toishanese, and Hunanese exist.
▪ The dialects are so different that often two
groups cannot understand one another verbally.
▪ The written language is the same.
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▪ Most Chinese people speak in a moderate to

low voice tone and consider Americans to be
loud.
▪ When asked whether they understand what
was just said, the Chinese invariably answer
in the affirmative to avoid loss of face.
▪ The Chinese share information freely once a
trusting relationship has developed.
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▪ Most Chinese maintain a formal distance
with each other as a form of respect.
▪ Many are uncomfortable with face-to-
face communications, especially when
there is direct eye contact.
▪ Titles are important to Chinese people.
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▪ The family name is stated first and then the
given name.
▪ Calling an individual by any name except his/
her family name is impolite. If a person’s family
name is Li and the given name is Ruiming, then
the proper form of address is Li Ruiming.
▪ Traditional women do not use their husband’s
name after they get married.
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▪ Many Chinese take an English name as an
additional given name because Chinese names
are often difficult for Westerners to pronounce.
▪ Some give permission to use only the English
name.
▪ Some switch the order of their names to be the
same as those of Westerners with the family
name last.

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Chinese Family Roles and Organization
▪ Traditionally the Chinese family was organized
around the male lines.
▪ Most believe that the family is most important
and, thus, each family member assumes changes
in roles to achieve this harmony.
▪ Children are highly valued because of the
Chinese government’s past mandate that each
married couple may only have one child.
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▪ Independence is not fostered. The entire family
makes decisions for the child even into young
adulthood.
▪ Children born in Western countries tend to adopt
the Western culture easily.
▪ Adolescents maintain their respect for elders
even when they disagree with them.
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▪ Children feel pressure to succeed to help
improve the future of the family; thus, most
children and adolescents value studying over
playing and peer relationships.
▪ Children are taught to curb their expression of
feelings because individuals who do not stand
out are successful.
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▪ Chinese children in the USA are becoming more
outspoken as they read more and watch
television and movies from the Western world.
▪ The perception of family is developed through
the concept of relationships. Each person is
identified in relation to others in the family.
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▪ The individual is not lost, just defined differently
from individuals in Western cultures.

▪ Extended families are important.
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▪ Children may live with their grandparents or
aunts and uncles so individual family members
can obtain a better education or reduce
financial burdens.
▪ Teenage pregnancy is not common, but it is
increasing among Chinese in America.
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▪ Older people are venerated and viewed as very
wise.
▪ Children are expected to care for their parents
when self-care becomes a concern; in China,
law mandates this.
▪ The Chinese word for privacy has a negative
connotation and means something
underhanded, secret, and furtive.

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▪ The one subject that is taboo is sex and anything
related to sex.
▪ Same-sex relationships are not condoned.
▪ In many provinces, they are illegal and punishable
by death.
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Chinese Workforce Issues
▪ True equality does not exist in the Chinese mind;
if more than one person is in power, then
consensus is important.
▪ If the person in power is not present at decision-
making meetings, barriers are raised, and any
decisions made are negated unless the person in
power agrees.
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▪ Chinese adapt to the culture in the workplace
quickly.
▪ They frequently call on other Chinese people to
teach them and to discuss how to fit into the new
culture more quickly.
▪ Autonomy is limited and is based on functioning
for the good of the group.
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▪ When a situation arises that requires
independent decision making, many times the
Chinese know what should be done but do not
take action until the leader or superior gives
permission.
▪ Language may be a barrier for some Chinese.
▪ The Chinese language does not have verbs that
denote tense, as in Western languages.
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Chinese Biocultural Ecology

▪ Skin color among Chinese is varied. Many have
skin color with pink undertones; some have a
yellow tone, and others are very dark.
▪ Hair is generally black and straight, but some
have naturally curly hair. Most men do not have
much facial or chest hair.
▪ Mongolian spots—dark bluish spots over the
lower back and buttocks—are present in about 80
percent of infants.
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▪ Bilirubin levels are usually higher in Chinese
newborns with the highest levels occurring on
the fifth or sixth day after birth.
▪ The Rh-negative blood group is rare.
▪ Chinese people generally have an increased
sensitivity to the effects of alcohol
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▪ Poor metabolism of mephenytoin occurs in 15
to 20 percent of Chinese.
▪ Sensitivity to beta blockers, such as
propranolol, is evidenced by a decrease in
overall blood levels accompanied by a more
profound response.
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▪ Atropine sensitivity is evidenced by an increased
heart rate. Increased responses to
antidepressants and neuroleptics occur at lower
doses.
▪ Analgesics have been found to cause increased
gastrointestinal side effects, despite a decreased
sensitivity to them.
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▪ Common health problems include lactose
intolerance Thalassemia, hepatitis b,
tuberculosis, liver cancer and pancreatic cancer,
diabetes, and cardiovascular disease.

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Chinese High-Risk Health Behaviors
▪ Smoking is a high-risk behavior for many
Chinese men and teenagers.
▪ Most women do not smoke.
▪ The numbers for Chinese women who smoke
are increasing, especially after immigration to
the United States.
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Chinese Nutrition
▪ Food habits are important, and food is offered to
guests at any time of the day or night.
▪ Foods served at meals have a specific order with
focus on a balance for a healthy body.
▪ The typical diet is difficult to describe because
each region in China has its own traditional diet.
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Chinese Nutrition
▪ Traditional Chinese medicine frequently uses food
and food derivatives to prevent and cure diseases
and illnesses and to increase strength in weak and
older people.
▪ Peanuts and soybeans are popular.
▪ Common grains include wheat, sorghum, and
maize (a type of corn.) Rice is usually steamed but
can be fried with eggs, vegetables, and meats.
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Chinese Nutrition
▪ Fruits and vegetables may be peeled and eaten
raw.
▪ Vegetables are lightly stir-fried in oil with salt
and spice.
▪ Salt, oil, and oil products are important parts of
the Chinese diet.
▪ Foreign-born and older people may not like ice
in their drinks.

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Chinese Nutrition
▪ Foods that are considered yin and yang
prevent sudden imbalances.
▪ A balanced diet is considered essential for
physical and emotional harmony.
▪ Chopsticks should never be stuck in the
food upright because that is considered
bad luck.
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Chinese Pregnancy and Childbearing
Practices
▪ Pregnancy is seen as women’s business,
although men are beginning to demonstrate an
active interest in pregnancy and the welfare of the
mother and baby.
▪ Women are very modest and may insist on a
female midwife or obstetrician.
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Chinese Pregnancy and Childbearing Practices

▪ Pregnant women usually increase meat in their
diets because their blood needs to be stronger
for the fetus.
▪ Pregnant women may avoid shellfish during the
first trimester because it causes allergies.
▪ Some may be unwilling to take iron: they believe
that it makes the delivery more difficult.
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▪ Traditional postpartum care includes 1 month of
recovery, with the mother eating foods that
decrease the yin (cold) energy.
▪ Many mothers do not expose themselves to the
cold air and do not go outside or bathe for the first
month postpartum because cold air can enter the
body and cause health problems.
▪ Drinking and touching cold water are taboo for
women in the postpartum period.
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▪ Raw fruits and vegetables are avoided because they are
considered “cold” foods. They must be cooked and be warm.
▪ Mothers eat five to six meals a day with high-nutritional
ingredients including rice, soups, and seven to eight eggs.
▪ Brown sugar is commonly used because it helps rebuild
blood loss.
▪ Drinking rice wine is encouraged to increase the mother’s
breast-milk production.
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Chinese Death Rituals
▪ Death is viewed as a part of the natural cycle of
life; some believe that something good happens
to them after they die.
▪ Death and bereavement traditions are centered
on ancestor worship, a form of paying respect.
▪ Many believe that their spirits will never rest
unless living descendants provide care for the
grave and worship the memory of the deceased.
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▪ The dead are honored by placing food, money
for the person’s spirit, or articles made of paper
around the coffin.
▪ The belief that the Chinese greet death with
stoicism and fatalism is a myth.
▪ The number 4 is considered unlucky because it
is pronounced like the Chinese word for death.
4th Edition
▪ The color white is associated with death and is
also considered bad luck.
▪ Mourners are recognized by black armbands on
their left arm and white strips of cloth tied
around their heads.
▪ The purchase of life insurance may be avoided
because of a fear that it is inviting death.
4th Edition
Chinese Spirituality
▪ The main formal religions among Chinese are

Buddhism, Catholicism, Protestantism, Taoism,
and Islam.
▪ Prayer is generally a source of comfort.
▪ Many use a combination of meditation, exercise,
massage, and prayer.
▪ As immigration increases, many who practice
Christian religions have become more visible.
4th Edition
Chinese Health-care Practices
▪ While many Chinese people have made the
transition to Western medicine, others maintain
their roots in traditional Chinese medicine, and
still others practice both types of medicine.
▪ Younger people usually do not hesitate to seek
healthcare providers when necessary unless they
believe that it does not work for them, then they
use traditional Chinese medicine.
4th Edition
▪ Older people may try traditional Chinese medicine

first and only seek Western medicine when
traditional medicine does not seem to work.
▪ The Chinese tend to describe their pain in terms
of more diverse body symptoms, whereas
Westerners tend to describe pain locally.
▪ The Western description includes words like
“stabbing” and “localized,” whereas the Chinese
describe pain as “dull” and more “diffuse.”
4th Edition
▪ Chinese cope with pain by applying oils and
massage, using warmth, sleeping on the area of
pain, relaxation, and aspirin.
▪ The balance between yin and yang is used to
explain mental as well as physical health. Because
a stigma is associated with having a family
member who is mentally ill, many families initially
seek the help of a folk healer.
4th Edition
Chinese Health-Care Practices

▪ Many Chinese still view mental and physical
disabilities as a part of life that should be hidden.
▪ Families may be reluctant to allow autopsies
because of their fear of being “cut up.”
▪ Most accept blood transfusions, organ donations,
and organ transplants.
4th Edition
Traditional Chinese medicine includes 5 basic
substances:
▪ qi, energy
▪ xue, blood
▪ jing, essence
▪ shen, spirit
▪ jing ye, body fluids
4th Edition
▪ Acupuncture and moxibustion are used in many
treatments. Acupuncture is the insertion of
needles into precise points along the channel
system of flow of the qi called the 14 meridians.

▪ The system has over 400 points. Many of the
same points can be used in applying pressure
(acupressure) and massage (acumassage) to
achieve relief from imbalances in the system.
4th Edition
▪ Moxibustion is the application of heat from
different sources to various points.
▪ For example, one source, such as garlic, is
placed on the distal end of the needle after it is
inserted through the skin, and the garlic is set on
fire. Sometimes the substance is burned directly
over the point without a needle insertion.
4th Edition
▪ Cupping: A heated cup or glass jar is put on the
skin creating a vacuum, which causes the skin to
be drawn into the cup. The heat that is generated
is used to treat joint pain.
▪ Herbal therapy falls into four categories of
energy (cold, hot, warm, and cool), five
categories of taste (sour, bitter, sweet, pungent,

and salty), and a neutral category.
4th Edition
Chinese Health-care Practitioners
▪ Traditional Chinese medicine practitioners are
shown great respect by the Chinese. In many
instances, they are shown equal, if not more,
respect than Western practitioners.
▪ Some distrust Western practitioners because of
the pain and invasiveness of their treatments.
4th Edition
Chinese Health-care Practitioners
▪ Older health-care providers receive more respect
than younger providers, and men usually receive
more respect than women.
▪ Physicians receive the highest respect, followed
closely by nurses with a university education.

Transcultural Health Care A Culturally Competent Approach, 4t.docx

Transcultural Health Care A Culturally Competent Approach, 4t.docx

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