The Importance of Culture in Nursing Care

Korean-Americans are the fastest growing subgroup of Asian Americans. In a 10 mile radius of the hospital I work in the Korean population varies from about 10 to more than 50 of the population comprising some of the surrounding towns (Holy Name Medical Center Korean Medical Program, 2013). Therefore, it is very important for healthcare providers to be able to communicate with this culture. In response to the needs of the patients, our hospital has created the Korean Medical Program. The program provides Korean speaking doctors and support staff that can assist in coordinating all their healthcare needs. They provide Korean translators, menus, television channels for inpatients and a shuttle service with Korean speaking drivers from surrounding town for outpatients. Through this program and research for this paper I have gained a significant insight into the Korean culture. Physiologically, Koreans have very distinctive physical characteristics. A few of these characteristics include small slanted eyes, a yellow skin tone, and a flat face (Barkauskas et al., 2002). These characteristics differ greatly from the physical characteristics of Americans and can make it difficult for American practitioners to determine abnormalities in the Korean people. The health care provider must be very careful in checking for many diseases in all people but it is vitally important in diseases that must be determined by skin coloring.

Dealing with light skinned people is very different than dealing with darker skinned people. When people are ill, their skin loses its richness and becomes dull. Since the health care provider does not know what a persons normal complexion is, they must rely on several factors. In the Korean population, factors to check would be their palms, tongue, and beds of the fingernail. In some cases one may need to ask them to remove nail polish (Henley, 1999). One disease that is difficult to diagnose in Koreans is jaundice because it causes the skin to become yellow and many Koreans are naturally a jaundice color. Their skin may become an orange or greenish instead of yellow. If possible they should be checked in daylight and if necessary after removing any yellow clothing. If outward signs of disease fail to indicate the problem, the health care provider must rely on other signs such as restlessness, nausea, and lifelessness. Religion is an important influence in the Korean culture.

In the United States many Koreans practice Christianity, and their churches are very important in their lives. Even those who do practice Christianity are still heavily influenced by the Eastern religions such as Buddhism, Confucianism and Taoism (Shin, Shin Blanchette 2013). Confucianism teachings include social harmony, the importance of family and high regards for education. Koreans strongly equate monetary success with social status and view education as the gateway to all monetary success. Buddhism teaches Koreans to be humble, non-confrontational, patient, disciplined and selfless. Taoism teaches the Yin and Yang balance which is especially important in the healthcare of Koreans (Lee et al., 1999). From the belief in Taoism the Korean culture has been greatly influenced by their beliefs in Ying and Yang, good and evil. Everything to the Koreans, including health and life, is a balance between good and evil. Traditionally, the vital force of life is chi, which is related to energy and breath. In order to maintain health, chi must flow freely within body and blood must be strengthened through nourishment.

The Koreans believe that a disease occurs when there is an imbalance between hot and cold states, known as yin and yang, and hence the flow of chi is impeded. Factors such as food intake can aid in restoring this imbalance. Hot, or yang, conditions, such as cold sores and hypotension, can be treated by consuming foods with a cold, or yin, quality. Examples of yin foods include bland and boiled foods and most types of vegetables. Similarly, consuming hot, or yang, foods treat illnesses caused by an excess of yin. Foods exhibiting hot properties include fried foods and fatty meats. Understanding the Koreans traditional dietary beliefs of yin and yang are also very important to the health care provider (Liou Contento, 2004). In LDRP in my hospital we have added Miyeok guk, a traditional seaweed soup to our menu. Korean women consume this soup as the first food after the birth of their newborns. It is high in iodine and calcium and is thought to be very important for nursing mothers in order to pass on the nutrients to the newborn. Later, miyeok guk is often consumed on the birthday of the infant as a reminder of the first food the infant consumed from the mother. The healthcare provider must be knowledgeable of the Korean understanding of the use of medicine.

Traditional Korean medicine includes many herbal remedies, and these are not thought to be drugs. When asking a Korean patient about a drug history it is important to ask about any herbs they may be taking. For example, a prescription for antihypertensive drug should be monitored closely if the patient is using the herb Ginseng. Ginseng, while generally safe, can cause arrhythmias, which will be problematic for people with existing cardiac problems. Another widely used herb is Dong-Quai. It suppresses menstruation, cleanses the blood, and protects the liver from toxins however, large doses can cause dermatitis. Most Koreans only take medicine as long as symptoms exist. Healthcare providers must be aware of this belief when prescribing drugs that must be taken in their entirety, such as antibiotics. Healthcare providers must also be aware of alternative therapies that are often used by Koreans such as acupuncture and massage. One such practice called cupping is the use of heat and suction to draw toxins believed to be causing illness out of the body. The act itself causes large welts and bruises, which was often misconstrued as evidence of abuse (and sometimes reported) when the practice was less recognized (Shin et al., 2013).

Pain is another major cultural differential in the Korean culture. Korean patients may often exemplify stoicism in the face of pain, which relates directly to strong cultural values about self-conduct. Behaving in a dignified manner is considered very important, and a person who is assertive or complains openly is considered to have poor social skills. This behavior might be tolerated in very small children, but not in adolescents and adults. In traditional Korean culture, preserving harmony in interactions with others is very important, so an individual should never draw attention to himself, especially in negative ways. Though an individual may feel sadness or pain, it is not customary to make this obvious (Henley, 1999). The clinician should remember this when dealing with Korean patients and never assume that they are not in pain, or that no pain reliever will be needed. Korean-Americans have many beliefs that relate to both verbal and non-verbal communication. The eye contact is often used in the United States to signal to the other party that you are listening and interested in what they are saying for Koreans the belief is almost the opposite.

Koreans believe that keeping eye contact with someone is rude, so they tend to look down and nod, which can be perceived by Americans as rude. Additionally, their use of nodding or smiling does not indicated agreement or understanding, which can also be confusing to healthcare providers. The use of nods and smiles are but an expression of appreciation for the assistance of the clinician (Andrews, 2003). The health care provider should never
assume understanding based on these gestures (Barkauskas et al., 2002). Another area related to this is the issue of touching. Koreans consider it a violation of personal space to be touched by non-family members. The healthcare provider must foster a level of trust and understanding in order to be able to treat their patients properly. Even when treating a patient, avoid touching the top of a patients head. This is a sign of disrespect for many Koreans because it is thought to be the source of a persons strength (Andrews, 2003).

There are many other issues that will affect how a clinician will provide healthcare to Korean-Americans, but they are too numerous to go through each one in the confines of this paper. As a worker in the healthcare profession, one will come in contact with many different types of people from different backgrounds. For this reason, it is necessary for nurses to know important facts about other cultures such as their beliefs, values, patterns of behavior, and their physical characteristics. These factors are so important for the nurse because she is the provider who will care for not only physical needs but also the emotional and psychological needs. Having knowledge of the various cultures living within a healthcare providers area is a very important part of taking care patients and ensuring quality and culturally competent healthcare.

References

Andrews, M. M. Boyle, J. S. (2003). Transcultural concepts in nursing care. Philadelphia, PA Lippincott Williams Wilkins. Barkauskas, V. H., Baumann, L. C., Darling-Fisher, C. S. (2002). Health physical assessment. St. Louis, Missouri Mosby, Inc. Henley, A. Scott, J. (1999). Handbook for health professionals. Retrieved from http//www.alixhenley.co.uk/patient.htm. Holy Name Medical Center (2013). Korean Medical Program. Retrieved from http//www.holyname.org/koreanmedicalprogram/ Lee, Y. T., McCauley, C. R., Draguns, J. G. (1999). Personality person perception across cultures. Mahwah, NJ Lawrence Erlbaum Associates, Inc. Shin, K.R., Shin, C., Blanchette, P.L. (2013). Health health care of Korean- American elders.