People of Korean Heritage and People of Mexican Heritage.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean American Culture Larry Purnell, PhD,

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RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Overview/Heritage ▪ This presentation focuses on the commonalities among Koreans from the Republic of South Korea, although some information may be congruent with North Koreans.. ▪ The first major immigration from Korea occurred between 1903 and 1905, when more than 7,000 men arrived in Hawaii. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Overview/Heritage ▪ South Koreans immigrate to America to increase socioeconomic opportunities and improve educational opportunities. ▪ They place a high value on education. ▪ Their reputation for hard work, independence, and self-motivation has earned them the label of the “model minority.” Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Communication ▪ The dominant Korean language, han’gul, was the first phonetic alphabet in East Asia. ▪ Most Koreans in America can speak, read, write, and understand English to some extent. ▪ Some Americans may have difficulty understanding their English, especially those who learned English from Koreans who spoke with their native intonations and pronunciations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Communication ▪ A high value is placed on harmony and the maintenance of a peaceful environment. ▪ Most are comfortable with silence. ▪ Small talk may appear senseless and insincere. ▪ Most stand close when conversing. ▪ Touch in the realm of health care is readily accepted. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Communication ▪ Touching among friends and social equals is common and does not carry a sexual connotation, as it might in Western societies. ▪ Hugging and kissing are uncommon among parents and children as well as among children and older aunts or uncles. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Communication ▪ Age, gender, and social status determine the use of eye contact. ▪ Respect for those in senior positions is shown by not looking them directly in the eye. ▪ Feelings are infrequently communicated in facial expressions. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Communication ▪ More traditional Koreans are past-oriented. Much attention is paid to the ancestry of a family. ▪ Yearly, during the Harvest Moon in Korea, chusok (respect) is paid to ancestors by bringing fresh fruits from the autumn harvest, dry fish, and rice wine to gravesites. ▪ The younger and more educated generation is more futuristic and achievement-oriented. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Communication ▪ Punctuality is the norm for keeping important appointments, making transportation connections, and reporting to work. ▪ The number of surnames in Korea is limited: the most common ones are Kim, Lee, Park, Rhee or Yi, Choi or Choe, and Chung or Jung. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Korean Communication ▪ Korean names contain two Chinese characters, one of which describes the generation and the other the person’s given name. ▪ The surname comes first. ▪ However, because this may be confusing to many Americans, some Koreans in the United States follow the Western tradition of Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Family Roles and Organization ▪ Men are the primary financial providers. ▪ Women are expected to stay home and care for the children and domestic affairs unless they are professionals. ▪ Women have long been degraded in Korean society and seen as appendages of male family members. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Family Roles and Organization ▪ In earlier times, a woman’s identity was determined by her role as someone’s daughter, wife, or mother. While many still practice these gender relationships, more educated women and men no longer adhere to these Confucian values. ▪ Parenting in Korea is authoritative, although class differences play a more influential role in determining parenting styles and family roles. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Family Roles & Organization ▪ Children are expected to be well behaved because the whole family is disgraced if a child behaves in an embarrassing manner. ▪ Discussing domestic violence violates Korean cultural norms. ▪ Dating is uncommon among high school students, although it is gaining in the US. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Family Roles & Organization ▪ Once young adults have entered a university, they receive their freedom and are permitted to make their own decisions about personal and study time. ▪ With rapid acculturation, children often take on the values of the dominant society or culture and challenge parents who support traditional values and ideals. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Family Roles & Organization ▪ Parents expect their children to care for them in old age. ▪ Hyo (filial piety) is the obligation to respect and obey parents, care for them in old age, give them a good funeral, and worship them after death. ▪ The obligation to care for one’s parents is written into civil code in Korea. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Family Roles & Organization ▪ Older people are frequently consulted on important family matters as a sign of respect for their life experiences. ▪ Old age begins when one reaches the age of 60 years. ▪ Women who divorce may suffer social stigma. ▪ Living together before marriage is not customary in Korea. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Family Roles & Organization ▪ If pregnancy occurs outside marriage, it may be taken care of quietly and without family and friends being aware of the situation. ▪ Lesbian and gay relationships are frowned upon. ▪ Personal disclosure to friends and family jeopardizes the family name and may lead to ostracism. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Workforce Issues ▪ The skills and work experiences Koreans bring from their home country are often not accepted in the American workforce, forcing them to take jobs in which they may be over skilled. ▪ A supervisor is treated with much respect in work and in social settings. ▪ Informalities and small talk may be difficult for Korean immigrants. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition ClickerCheck An older adult Korean American man does not maintain eye contact with the nurse who is teaching him insulin injection. The nurse recognizes that lack of eye contact means he a. Does not understand the instructions. b. Does not care about the instructions. c. Is demonstrating respect. d. Is hard of hearing. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Correct Answer Correct answer: C Many traditional Koreans do not maintain eye contact with people in authoritative positions as a means of demonstrating respect. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Workforce Issues ▪ For an employee to refuse a request of an employer is unacceptable, even if the employee does not want or feel qualified to complete the request. ▪ American slang and colloquial language is difficult for Koreans to understand. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Biocultural Ecology ▪ Common physical characteristics include dark hair and dark eyes, with variations in skin color and hair darkness. ▪ Skin color ranges from fair to light brown, with those residing in the southern part of South Korea being darker. ▪ Epicanthal skin folds create the distinctive appearance of Asian eyes. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Biocultural Ecology ▪ Common health conditions occurring with Koreans include the following: schistosomiasis, renal failure, asbestosis, hypertension, tuberculosis, hepatitis, stomach cancer, lactase deficiency, osteoporosis, peptic ulcer disease, and insulin autoimmune deficiency disease. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean High-Risk Health Behaviors ▪ Korea continues to manufacture and use asbestos-containing products ▪ Smoking by women in public is taboo, but some women smoke at home. ▪ Men have a high incidence of alcohol consumption. ▪ Seat belts are worn infrequently in South Korea. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Nutrition ▪ The traditional Korean diet includes steamed rice; hot soup; kimchee; and side dishes of fish, meat, or vegetables served in some variation for breakfast, lunch, and dinner. ▪ Breakfast is traditionally considered the most important meal. ▪ Rice is served with 5 to 20 small side dishes of mostly vegetables and some fish and meats. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Nutrition ▪ Food is flavorful and spicy. Cooking includes a variety of seasonings: red and black pepper, garlic, green onion, ginger, soy sauce, and sesame seed oil. ▪ Most Korean Americans are at high risk for calcium deficiencies due to lactose intolerance. ▪ A cultural treatment for the common cold is soup made from bean sprouts, anchovies, garlic, and other hot spices Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Pregnancy & Childbearing Practices ▪ Pregnancy is a highly protected time for women. ▪ Both pregnancy and the postpartum period are ritualized. ▪ Once a woman is pregnant, she starts practicing Tae-Kyo, which literally means “fetus education.” Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Pregnancy & Childbearing Practices ▪ The objective of Tae-Kyo is to promote the health and well-being of the fetus and mother by having the mother focus on art and beautiful objects. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Death Rituals ▪ Death and dying are fairly well accepted in the Korean culture. ▪ Prolonging life may not be highly regarded in the face of modern technology. ▪ Families are expected to stay with family members and assist in feeding and personal care around the clock. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Death Rituals ▪ Many believe that patients should not be told they have a terminal illness. ▪ Crying and open displays of grief are common and signify the utmost respect for the dead. ▪ Relatives and friends pay respect by viewing photographs of the deceased instead of viewing the body. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Death Rituals ▪ An ancestral burial ceremony follows death, with the body being placed in the ground facing south or north. ▪ Rice wine is sprinkled around the gravesite. ▪ The eldest son or male family member sits by the deceased, sometimes holds a cane, and makes a moaning noise to display his grief. ▪ The cane is a symbol of needing support. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Spirituality ▪ Organized religions include Christianity, Buddhism, and Chondokyo. ▪ The church is a powerful social support group for Korean immigrants. ▪ Christians believe the spirit goes to heaven; Buddhists believe the spirit starts a new life as a person or an animal. ▪ Family and education are central themes that give meaning to life. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Health-care Practices ▪ Herbal medicine may be used in conjunction with Western biomedicine. ▪ Herbal remedies include ginseng, seaweed soup, and haigefen (clamshell powder), which has high levels of lead, causing abdominal colic, muscle pain, and fatigue. ▪ Acupuncture, acumassage, acupressure, and moxibustion therapy are commonly used. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Health-care Practices ▪ Some Korean Americans are stoic and are slow to express emotional distress from pain. ▪ Others are expressive and discuss their smallest discomforts. ▪ Organ donation and organ transplantation are rare, reflecting traditional attitudes toward integrity and purity. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Health-care Practices ▪ Mental illness may be stigmatized. Hwa-Byung, a traditional Korean illness, occurs from the suppression of anger or other emotions. ▪ These emotions are expressed as physical complaints, ranging from headaches and poor appetite to insomnia and lack of energy. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Korean Health-care Practitioners ▪ More traditional individuals frequently prefer health-care providers who speak Korean and are older. ▪ Because of modesty, women prefer women health care providers to perform Pap smears, mammography, and breast examinations. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition ClickerCheck Mrs. Kim brings her 15 year old daughter to the parish nurse because she is having abdominal cramps and fatigue that have worsened since she began giving her haigefen. The nurse should request a blood test for a. Iron levels. b. Lead levels. c. Calcium levels d. Potassium levels. Transcultural Health Care: A Culturally Competent Approach, 3rd Edition Correct Answer Correct answer: B Haigefen is an herbal compound that is made with clamshells which has a high lead content. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Mexican Americans Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage ▪ Mexican, Mexican American, Latino(a), Chicano(a), la gente de la raza, Hispanic, etc. are commonly used terms. ▪ Second largest Spanish speaking group in the world ▪ 500+ different dialects and ethnic groups in Mexico ▪ Mexico City is one of the largest cities in the world Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage Continued ▪ 60% of the population is mestizo—a blend of Spanish white and Indigenous Indian ▪ The majority of the Hispanic population in the United States ▪ Hispanic is the largest “minority” group in the United States surpassing African Americans in 1999 Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview/Heritage Continued ▪ Original inhabitants, along with Native American Indians, of southwest United States ▪ Majority of newer immigrants come to the United States for economic opportunities and are poorer than previous immigrants ▪ Low educational rates in the United States ▪ Ninth-grade educational level required in Mexico —mean is 5 years Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications ▪ Dialect varies by region of Mexico, including Mayan ▪ Rapid speech pattern with apocopation (e.g., como esta usted = com-esta-sted) ▪ Idiomatic and slang expressions are common— like English Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications Continued ▪ Concepts of personalismo is important. ▪ Touch between the men and between women is acceptable. ▪ Men and women greet with a hug and kiss to the cheek. ▪ Eye contact with staring is expected for peers. ▪ Many avoid direct eye contact with superiors as a sign of respect. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications Continued ▪ Intense eye contact can cause the “evil eye,” a folk illness common in all Hispanic and Mediterranean cultures. ▪ Children are more susceptible to the evil eye than are women who are more susceptible than men. ▪ Healthcare provider should greet men with a firm handshake. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Communications Continued ▪ Temporality varies via socioeconomic level ▪ Clock time is not categorically imperative; events begin when they begin and not until then ▪ Name format: First name, middle name, father’s surname followed by mother’s maiden name. ▪ A woman takes her husband’s last name which is place before her maiden name.. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles ▪ Traditional families are patriarchal but vary greatly. ▪ Current research is dispelling the myth of machismo and patriarchal decision-making. ▪ Children are closely protected and are not expected to work or do many chores in middleclass families—children are supposed to be allowed to be children. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles Continued ▪ Children are taught to respect parents, elders, and teachers, etc. ▪ Multigenerational families in Mexico, less so in the United States. ▪ Children have comadres, compadres (godparents). ▪ Single parenting somewhat stigmatized, severely so in some groups. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles Continued ▪ Significant number of Unido until at which time the family has the money for a religious wedding ceremony. ▪ Academic and professional degrees are highly respected. ▪ A good education also means having good manners. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles Continued ▪ If family and close friends are aware of gay/lesbian relationships, they are not talked about. ▪ Stigma continues to be a significant problem with many. ▪ Dignity, Hola, and Ellas are support groups and they all have 800 numbers and are located in Washington, DC. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology ▪ Intestinal parasites and diarrhea are major health problem among immigrants; also tuberculosis, STIs, and HIV/AIDS. ▪ Hypertension, cardiovascular disease, diabetes, malaria, cholera, typhoid, dengue fever, and high suicide rates. Incidence varies from point of migration and living conditions. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Biocultural Ecology Continued ▪ Alcohol metabolism is slowed, especially among those with an Indigenous Indian ancestry. ▪ Require lower doses of antidepressants and are poor metabolizers of debrisoquinine. ▪ Greater toxicity from tuberculosis drugs. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition ▪ Large percentage of women are overweight— seen as positive and is a sign of health, fertility, wealth, and beauty. ▪ Anytime is a time to celebrate with food. ▪ Food choices vary by area of immigration— mountains, metropolitan areas, seaports, etc. ▪ Staples include tacos and rice and plantains. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition Continued ▪ Lactose intolerance, especially from adults so calcium obtained from soups with bones and bone marrow, leafy greens, and corn tortillas treated with calcium carbonate. ▪ Many ascribe to the hot/cold theory of foods, although they may not speak to it directly. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition Continued ▪ Not all foods are spicy! And Nachos are American—not Mexican ▪ Meal times vary, but many continue with the afternoon siesta if job permits ▪ Many foods are deep fried or fried in some manner—high-fat diet mostly ▪ Iron and Vitamin A deficiency—especially among lower socioeconomic groups Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Family ▪ Birth rate in Mexico and United States is higher among Mexican Americans than among other United States groups. ▪ Wide range of contraceptives when used, but not always admitted. ▪ Condom use: used mostly with prostitutes for infection prevention. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Many Hispanic Americans have lactose intolerance. A good source of calcium if the diet is a. Flour tortillas. b. Corn tortillas. c. Chicken d. Pork. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: B Corn tortillas are high in calcium because they are made with calcium carbonate. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Family Continued ▪ Pregnancy is natural so why see a healthcare provider for prenatal care? ▪ Many are not used to prenatal care in their home country because it is not available—thus, advice comes from older females in the family. ▪ Hot and cold theory extends to foods and practices during pregnancy and postpartum. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Family Continued ▪ Do not walk in moonlight while pregnant because it may cause a birth deformity. ▪ Man not to see wife or baby until several hours after birth because harm can come to the baby or mother. ▪ Do not reach over your head while pregnant because it can cause the cord to wrap around the baby’s neck. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Family Continued ▪ Some do not bathe or wash hair for 40 days postpartum – do take a sponge bath. ▪ Cutting the baby’s nails before 3 months of age may cause blindness and/or deafness. ▪ Umbilical belt and/or coin or key placed on abdomen to keep it from protruding when crying. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals ▪ Death seen as a natural part of life ▪ Sit vigil over the dying and after death with the family ▪ Children are not shielded from death ▪ El dia de muerte celebrated at the gravesite of family members ▪ Velorio—festive watch over the dead before internment and may be a long procession Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Continued ▪ El ataque de nervios (nervous attack) occurs with death and other strong emotions ▪ A few may still hire llorandos (criers) for the funeral Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality ▪ Family is foremost among Mexicans and most other Hispanic families ▪ Take great pride in their heritage and family lineage ▪ Religiosity supports fatalism—it is God’s Will Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality Continued ▪ Majority are Catholic with Indigenous variation practices. ▪ Priests are major sources of support for the individual and family and may be sought before seeking advice from a healthcare professional. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices ▪ External focus of control works against prevention measures. ▪ To express negative feelings is not considered polite—therefore do not complain of health ailments until symptoms are severe. ▪ Good health means being free of pain. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Mrs. de la caza, 32 year old pregnant Mexican American, is pregnant. The nurse recommends walking for exercise for weight control. The patient works at a sedentary job during the day and tells the nurse she cannot walk at night the baby will be born a. Too large. b. Too small. c. With a cleft-palate. d. With a birth mark. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C Walking at night, especially in the moonlight, is believed to cause the baby to have a cleft-lip or palate. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued ▪ Many do not protect themselves from environmental hazards because they are not knowledgeable about the hazards. ▪ Seek over-the-counter drugs and indigenous healers before seeing a Western healthcare provider. ▪ All socioeconomic levels seek traditional healthcare providers. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Hot and Cold Illnesses ▪ See book chapter with hot and cold illnesses and their treatments—varies greatly among families because they are handed down within the family and community—need to specifically ask! ▪ Barriers in the United States include money, access, appropriateness, language, limited knowledge, and gender. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Responses ▪ Accept and expect pain as a necessary part of life. ▪ Obliged to endure pain in the performance of duties. ▪ Ability to endure pain stoically is valued. ▪ Pain and suffering may be due to immoral behavior. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Cultural Responses Continued ▪ Physical and mental illnesses are readily accepted but may keep family member at home to protect others, not the patient. ▪ Can enter the sick role readily without stigma. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Organ Donation and Transplantation ▪ Not morally averse to organ donation. ▪ Hesitant to donate while alive because the body should be buried whole. ▪ If abdominal surgery, bad air may enter the body and increase the potential for cancer or other problems. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Traditional Hispanic Healthcare Providers ▪ ▪ ▪ ▪ ▪ ▪ ▪ Curanderos: folk healers Masijistas: massage therapists Brujos: witches Sobadoros: manipulate bones Padres: priests Espiritistas—Espiritualistas—Espiritus (spiritualists) Jerberos—yerberos: herbalists
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