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Cultural Variations Related to Death, Dying and Terminal Illness in the Asian American Community
Our America is full of diversity and multiple ethnic groups, this is what makes us unique. How does this help us, if we do not understand the basics about each other? Everyone in healthcare needs to establish and understand their own cultural beliefs before trying to understand those of a different ethnic group. The purpose of this paper is to discuss cultural variations related to terminal illness, death and dying in the Asian American community. The paper discusses my beliefs versus the Asian American beliefs and how the research will impact the future of my nursing career. According to (Wilkinson & Treas, 2011, p. 222), by the year 2050 an estimated nine percent of the United States of America will consist of the Asian American population. As nurses we will provide care to a diverse group of individuals, and with the Asian American population growing it is imperative that we understand how our culture and beliefs relate to and differ from other ethnic groups. This will not only allow health care providers to provide quality individualized care, but it will assist in cutting the cost of health care. The health care professional who recognizes and appreciates cultural diversity can positively impact financial outcome (Nishimoto & Foley, 2001). With furthered education and a nonjudgmental attitude, we as nurses can assist in breaking the barrier between different ethnic groups, thus allowing quality care to be given and received.
In order to receive quality health care, the patient must understand what is occurring, why it is occurring, and having a rapport with the health care provider. The same is true for the health care provider and or health care professionals. If we are going to provide adequate quality nursing care, we must understand different cultures and their beliefs towards health care, terminal illness, and death. With the Asian American population at an increased rate we as health care providers should be prepared to provide adequate care based on the culture and beliefs of the Asian American ethnic group. With over 28 ethnic groups inside of the Asian American population, not all the ethnic groups share the same cultural beliefs. Most of the groups practice some of the basics Asian beliefs as their ancestors, such as the Yin and Yang theory where two forces work together to create harmony within the mind and body. If the Yin and Yang is off, disharmony can occur causing an illness (Zhao, Esposito, & Wang, 2010). Another belief that many Asian Americans believe in the power of hot and cold foods. Hot foods aiding with circulation and blood flow to the organs, thus increasing energy. Having to many hot foods may cause illness such as ulcers, increased thirst, and headaches. Cold foods assist with reducing temperatures and removing toxins. Ingesting to many cold foods could lead to gastrointestinal issues, fluid overload, overall cold feeling, and decreased energy. The perfect balance of the hot and cold food is also believed to assist the Asian Americans with a healthy harmony within their body (Wilkinson & Treas, 2011, p. 231). Many Asian Americans do not believe in making eye contact or verbalizing the amount of pain they are in. This is something that we as nurses must know as well as pick up on. In order to break barriers and provide correct and adequate care. Many of the Asian American ethnic groups believe God is punishing them for something they have done when they have a terminal illness, many will not sign an advanced directive since they believe this would be taking it out of Gods hands and putting in to their own (Nishimoto & Foley, 2001). Not all Asian Americans have the same concept on terminal illness, death, and dying. The Cambodian Americans believe that thinking about the death or dying will cause headaches and dizziness, so they try not to focus on the issue. Filipino Americans have the belief of seeking healthcare for acute care but if they or the family member become terminal during the process, they prefer to take them home to care for them. They believe in extended family, if the elders are sick the entire family may come to their bedside. Filipino Americas also believe in the Curer, someone who coms in to assess them to determine their diagnosis by checking their pulse. The head of the family usually make the decisions regarding the patients health. The patient usually will not talk openly about dying but will make funeral arrangements. When death occurs, the family will take time to wash the body and dress the body. We as healthcare providers must be understanding of this tradition. It gives the family proper time to grieve with their loved one. When the body is carried out of the room, the feet must go first because they believe that someone in their family will die next if the head goes first. Japanese Americans do not believe in being placed with a room that has a four, this means death in their language. They do not believe in writing wills or signing advanced directives, since this will occur in the future and they cannot predict Gods will. They do not believe in talking about death because talking about may cause death to occur. Japanese Americans also believe that the family should make decisions regarding terminal illness and dying. This takes place to allow the patient to die in peace. This is a direct conflict in healthcare, because the patient has the right to know what is going on regarding their health. Their grief is subtle and silent, which may come of as lacking emotion. They do not belief in autopsy or organ donation, because they believe in dying with the entire body intact. The last ethnic group we will discuss are the Korean Americans. They prefer care for their terminally ill or dying family member at home. They believe this allows their spirit to be at peace. The father of the family makes healthcare decisions regarding the patients health. They believe that terminal illness is caused by something they have done wrong and may use herbal medicine to try and cure their illness. In general, take a indirect approach when speaking of terminal illness and death. The majority of Asian American ethnic group believe that illness is Gods will, and God will heal them if that is his will (Nishimoto & Foley, 2001).
In each ethnic group there are differences and similarities. In both the Asian American and African American there is a small percent that believe healthcare works are rude, not understanding, and do not like answering questions. Both groups believe in a higher power and pray for comfort and wellness. Asian Americans do not believe in making eye contact and African Americans do. Asian Americans do not believe in hospice care, where African Americans do. My beliefs and those in my ethnic group believe in making our own decisions regarding terminal illness, death, dying. As an African American we believe in acute care for dying and terminal illness. African Americans believe that the nurse or doctor should tell us what we need to know about our healthcare issues. When one dies the family gets together to grieve, some may cry, and others may sit in silence. Both groups believe that death is will occur but neither like to discuss it in open. Both ethnic groups believe in folk medicine to cure certain terminal illnesses (Wilkinson & Treas, 2011, p. 222). As we research different ethnic groups it is clear to see how different we are and how much we have in common with each other.
Understanding different ethnic groups will allow healthcare providers to provide the best care possible to the patient. Performing research and furthering our education will assist in understanding different cultures. Many Asian Americans believe that the nurse should tell them everything they need to know, and they should not have to ask questions. They find nurses to be cold and sometimes judgmental because we do not understand their culture. Normally healthcare providers believe the patient understands what is being said if they no their head. This is not true in the case of Asian Americans, they shake their head when one is talking to be polite, but they may not understand what is being said (Nishimoto & Foley, 2001). We as nurses must understand how other cultures communicate and learn how to communicate with them. In the future and my practice, I will make sure I know whom to discusses information with regarding healthcare issues, give proper time to grieve, be sensitive to having many family members present, and incorporate other learnings from my research when caring for the Asian American ethnic group. This includes making eye contact, understanding what each nod means, and have an interpreter present if needed.
Although we share some beliefs with other ethnic groups, we are all different at the same time. We as individuals must first understand our culture and beliefs before we can try to learn others. This will allow us to remove any bias and gain a higher understanding of ourselves and others. It is imperative that we as healthcare workers embrace and incorporate furthering our education and knowledge on other ethnic groups and their belief on terminal illness, death, and dying. There should be further research conducted on understanding cultural variations within different ethnic groups. This will allow healthcare workers to provide culturally competent care, give a more open form of communication, increased knowledge that will be incorporated in to practice, increased respect for other beliefs and customs. Thus, improving the perception of healthcare providers, increased knowledge and awareness of health care issues for the patient, and understanding how to prevent illness. We do our patients an injustice when we are ignorant to what they believe in, as well as how we feel about their culture and beliefs. It is our duty to be non-bias and provide quality culturally competent healthcare to any population regardless of color or ethnicity.
References
- Nishimoto, P. W., & Foley, J. (2001). Cultural beliefs of Asian Americans associated with terminal illness and death. Seminars in Oncology Nursing, 17(3), 179-189. doi://doi.org/10.1053/sonu.2001.25947
- Wilkinson, J., PhD, ARNP, & Treas, L., PD, RN, CPNP-PC, NNP-BC. (2011). Fundamentals of nursing (2nd ed.). Philadelphia, PA: F.A. Davis Company.
- Zhao, M., Esposito, N., & Wang, K. (2010). Cultural beliefs and attitudes toward health and health care among Asian-born women in the united states. Journal of Obstetric, Gynecologic & Neonatal Nursing, 39(4), 370-385. doi://doi.org/10.1111/j.1552-6909.2010.01151.x
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