Cultural Ethnicity and Nursing Education An Overview of Asian/Pacific Islander Culture

Asian/Pacific Islanders represent a diverse ethnic group in the United States, with origins in over 52 countries across East Asia, Southeast Asia, the Pacific Islands, and the Indian subcontinent. Despite being classified as a single ethnic group, there is significant diversity in their languages, dialects, cultural practices, and religious beliefs. These people have settled primarily along the West Coast, particularly in California and Washington, but also in New York, New Jersey, Texas, and other states.

As of 2015, approximately 21 million Asian/Pacific Islanders resided in the U.S., accounting for 5.8% of the total population. This group is not homogenous and includes people from countries such as China, Japan, the Philippines, India, Vietnam, and Korea, among others. They speak over 800 languages and dialects and follow a variety of religions, including Buddhism, Confucianism, Taoism, Hinduism, and Christianity.

In the healthcare setting, understanding the basic cultural values of the Asian/Pacific Islander group is essential for nurses to provide culturally sensitive care. The supply of registered nurses from this ethnic group has grown, increasing from 3.1% in 2004 to 5.8% in 2008, which closely matches the population percentage of this group in the U.S.

Common Values and Beliefs of Asian or Pacific Island Subcultures

While Asian/Pacific Islanders are highly diverse, several common values across subcultures influence their healthcare practices and social behaviors. The major philosophical orientations of this group are shaped by Buddhism, Confucianism, Taoism, and other indigenous philosophies. Some of the core values include:

1. Male Authority and Dominance: Traditional gender roles place men in positions of authority within the family and community, influencing decision-making in healthcare settings.
2. Saving Face: Maintaining one’s reputation and dignity, known as “saving face,” is critical. Asian patients may avoid expressing discomfort or dissatisfaction to preserve harmony and avoid shame.
3. Strong Family Ties: Family plays a central role in decision-making, and health-related decisions are often made collectively rather than individually.
4. Respect for Elders and Authority Figures: There is a deep respect for parents, elders, teachers, and other authority figures, which can affect how patients respond to healthcare providers and advice.

Review of the Beliefs and Healthcare Practices of the Asian/Pacific Islander People

The beliefs and healthcare practices of the Asian/Pacific Islander people are rooted in their religious and philosophical traditions. Each philosophy shapes the worldview, health behaviors, and responses to illness and treatment.

Buddhism

Buddhism is one of the central philosophies among many Asian ethnic groups, particularly in countries such as Cambodia, Thailand, and Vietnam. The fundamental belief in Buddhism is that all life is suffering, which stems from desires and passions. Life is viewed as a cycle of suffering that can only be escaped through reaching nirvana, a state free from suffering.

Buddhists believe in reincarnation, where death is not the end of life but the beginning of a new existence based on one’s actions (karma). To accumulate good karma, individuals must perform good deeds, such as generosity, sharing, and kindness, which are highly valued in this culture. In healthcare settings, patients may see illness as a result of their karma and may accept suffering with a sense of resignation. Nurses should approach such patients with empathy, acknowledging their beliefs and supporting their spiritual practices.

Confucianism

Confucianism, originating in China, emphasizes moral values, social harmony, and the importance of relationships. The two core principles in Confucianism are humaneness, the way one treats others, and a sense of moral duty and obligation, the way one treats oneself.

The social structure under Confucianism is hierarchical, with five key relationships dictating behavior:

1. Child to parent (son to father)
2. Wife to husband
3. Younger sibling to older sibling
4. Friend to friend
5. Subject to ruler

These hierarchical relationships influence healthcare decisions. For instance, a woman may defer decisions about contraception or treatment to her husband or other senior family members, in line with Confucian values of respect and obedience.

Confucianism also emphasizes the importance of harmony with the universe. This belief often leads to a passive acceptance of information, with individuals reluctant to ask questions or challenge authority. In the healthcare setting, this can lead to misunderstandings, as patients may nod or agree without fully understanding the treatment. Nurses should ensure understanding by asking patients to explain or demonstrate their comprehension of health instructions.

Ancestor worship is another important aspect of Confucianism. Rituals surrounding death and mourning are critical, with funerals often involving elaborate ceremonies. The collective sharing of meals and other traditions with the deceased reflects the ongoing connection between the living and the dead. Nurses should be sensitive to these practices, especially when dealing with terminal illness or death in the family.

Teaching Strategies for Asian or Pacific Islander Culture

When educating patients from Asian or Pacific Islander backgrounds, nurses should tailor their approaches to accommodate cultural beliefs and values. The following teaching strategies can help deliver culturally sensitive education:

1. Respect for Authority: Acknowledge the importance of family and hierarchy in decision-making. When delivering health education, include family members in discussions, especially the elders or heads of the family.
2. Saving Face: Be mindful of the importance of saving face. Avoid putting patients in situations where they may feel embarrassed or ashamed. Provide constructive feedback in a manner that preserves their dignity.
3. Clear Communication: Since many Asian patients may not actively ask questions, use the teach-back method to ensure they understand the information. Ask them to explain the instructions in their own words.
4. Respect for Spiritual and Religious Beliefs: Acknowledge and support patients’ spiritual practices. For example, Buddhists may see illness as a result of karma and may need to perform religious rituals. Nurses should accommodate these practices whenever possible.
5. Holistic Health Views: Many Asian cultures emphasize balance, such as the yin-yang philosophy in Chinese medicine. When teaching about illness prevention or treatment, nurses should consider incorporating these holistic health views.
6. Use of Interpreters: Given the linguistic diversity among Asian/Pacific Islanders, language barriers can be a significant issue. Use professional interpreters when needed, rather than relying on family members, to ensure accurate communication and protect patient confidentiality.
7. Non-Verbal Communication: Pay attention to non-verbal cues, as many Asian patients may express discomfort or dissatisfaction through subtle body language rather than verbal complaints. Observing these cues can help nurses gauge patients’ true feelings and concerns.
8. Incorporate Traditional Healing Practices: Be open to integrating traditional healing practices, such as herbal remedies or acupuncture, with Western medical treatments, as long as they are not harmful. Many Asian patients place a high value on these traditional methods and may be more likely to comply with care if these practices are respected.

Conclusion

Understanding the cultural values and healthcare practices of Asian/Pacific Islanders is essential for delivering effective and respectful nursing care. By recognizing the influences of Buddhism, Confucianism, and other philosophical traditions on health behaviors, nurses can better tailor their educational strategies to meet the needs of this diverse group. Through clear communication, respect for family hierarchy, and sensitivity to spiritual beliefs, nurses can provide culturally competent care that enhances health outcomes for Asian/Pacific Islander patients.