Abstract
The Chinese are one of the most conservative people today. Their nature has led to the existence of various barriers, especially when it comes to communication which is vital in the healthcare industry. It has become quite problematic for nurses and doctors who do not understand Chinese culture to properly assist these people. The research aims to conduct an analysis of their culture and the extent to which their communication norms affect the healthcare industry in order to make the best practice recommendations. The methods applied in this study are mainly extraction of information from previous researches and articles and comparison of Chinese health practices to the Western health practices, as well as an analysis of the questionnaires given to various patients for evaluation. The findings indicate that Chinese people believe in various concepts such as Yin Yang and prior to communication, they also require an intimate connection between them and their health practitioners. The recommendations offered were the inclusion of culture brokers who would bridge the gap between the Western and Chinese culture.
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The Chinese Culture
The Chinese people have a broad and dynamic culture that has been passed from generation to generation. Ching-Chu et al. (2017) explain that this culture is the foundation of the Chinese way of life, affecting every sphere of their existence regardless of where in the world they are. Khlystov (2016) insightfully explains that the root of having successful communication with Chinese people is by maintaining an established relationship, which then allows one to communicate freely within the group. However, it also requires strict adherence to the role and status differences, with the goal of conserving harmony amongst the community. In such a way, patients and health practitioners would be able to communicate effectively, which is a purely physiological factor. The first step of ensuring successful interaction with the Chinese people is by understanding the way they communicate. The process of understanding a community entails many factors and variables. For instance, different communities have various cultures according to the level of knowledge and the cultural diversity of the given society. In addition, the language and the cultural practices that are common among the majority of the citizens greatly vary. In a specific case, one would be able to determine some of the cultural factors that affect the growth of the community one way or another. The models would help to evaluate the form of communication, culture, and environment and how it affects the growth of the community.
The physiological factors that affect communication for the Chinese include variables such as eye contact. For example, when communication is taking place between an elder and a younger person, the young person is expected to refrain from maintaining eye contact – he/she is should look down. What is more, the physical distance is also an important factor according to the Chinese, one is expected to maintain the minimum body contact with his/her interlocutors, which is a crucial component to note when it comes to the healthcare industry.
The environment that one is in would also determine the extent of adhering to these factors. In crowded spaces, for example, people would have no alternative but to minimize space. The Chinese also tend to communicate indirectly, since they generally try to avoid conflicts. Unlike Westerners who would openly differ if not in agreement, the Chinese would tend to nod as a sign of acknowledging the other person’s sentiments and not to appear rude.
Psychological factors involve several beliefs. First, according to Fuqin and Harrel (2015), the Chinese believe in Chi (life force) and body balance, which dictate that they should live a certain lifestyle and adhere to a certain diet to maintain a good body balance, which translates into good health. Second, the Chinese believe in the “Yin Yang” – a complex phenomenon that can be best rendered as “hot and cold.” Owing to this phenomenon, they believe that one extreme requires the other extreme to balance it. For example, if one has a cold, hot soup will work to treat the cold. The Chinese also believe that spiritual and supernatural factors will affect one’s health. Things like fate and karma are considered as part of life and determiners of one’s health. Western explanations for the cause of illnesses are believed in but in most cases are accepted when the case is extreme or critical.
Barrier Factors
Language Barrier
The existing language barriers that affect the Chinese and make it problematic for western health practitioners to communicate with them include the fact that the Chinese nod even when in disagreement to avoid conflict, which becomes very confusing for the doctors who might assume that their patients understand and agree. The western doctors rarely have any training in Chinese dialect or their writing, which makes it difficult to communicate with a Chinese patient who is not good at English.
Language efficiency means that having an effective communication channel between a healthcare worker and a client is a key component of providing qualitative, safe, and effective treatment and care. The patient and the healthcare provider need to have common ground to begin to tackle the issues affecting the patient. The language barrier will be frustrating for both parties, which may result in inefficiency of the provided care. For the Chinese culture, the language barrier is coupled with nonverbal communication where body language and nonverbal cues may be misinterpreted. Apart from that, the Chinese have different dialects, with major ones being Mandarin and Cantonese (Liu & Harrell, 2015). Therefore, the health practitioner is advised to enquire about the dialect of his/her patient before getting an interpreter. Both verbal and nonverbal communication plays a critical role in Chinese communication; for this reason, it would be advisable for doctors to take into consideration patients’ nonverbal ques as well. Furthermore, age difference greatly determines how people communicate within and outside the group. A younger person should show respect by, for example, avoiding eye contact; doctors and nurses should consider this especially when treating the elderly Chinese people. While this may be a symbol of low self-esteem or even disrespect in other cultures, it is a symbol of respect within the Chinese culture. Societal status also plays a critical role in the way people communicate. Community leaders as well as religious and opinion leaders are treated and spoken to with respect and bowing, since it is required in Chinese culture when talking to influential members of the society. There are key nonverbal components that should also be considered (Liu & Harrell, 2015). For example, the Chinese people prefer not to be touched and prefer maintaining some space during communication. Thus, the difference in language exacerbates the situation and prevents them from having access to the proper health care. The language barrier makes it even difficult for emergencies, since the patients may need medical attention immediately. Written communication, however, is also frequently used in large medical institutions (Purnell, 2014). The problem consists in the fact that some of the institutions cannot translate Chinese writings into foreign languages.
Cultural Differences
As highlighted in a study by Jeffrreys and Zoucha (2017), dissatisfaction may also arise from the cultural differences between the clinician and the patient. For example, discussions of certain topics like sexuality are considered a taboo. This may be a challenge if the diagnosis is sexually related. Disagreements or conflicts on such ground may create mistrust between the patient and the health caregiver. For this reason, work with the Chinese community requires a careful explanation of what the illness is, what causes it, and what the treatment entails (Li, Hsu, Chen, & Shu, 2017). The healthcare provider should not assume anything and analyze the issue from different perspectives, given all the information. This is crucial for the effective treatment of the patient. It is essential to remember that culturally, they avoid confrontation, so nodding with a smile does not necessarily mean that they agree with the doctor’s recommendations. The Chinese culture belongs to the most conservative cultures around the globe. This is probably because this culture is closely related to the religion. Most of the Chinese are conservatives and usually affected by their culture when making the decision to seek medical services. In fact, the Chinese are one of the ethnic groups in the world that have been able to successfully preserve their culture and pass it from one generation to another. However, the culture becomes a barrier as some of the medical services run contrary to it. Occasionally, one would find the Chinese not using health services or facilities that are not compatible with their beliefs. The culture also promotes more traditional methods of seeking medical attention, making it difficult to enhance health care in the country. The issue is more evident in the rural areas, compared to the urban areas, since the laws of the culture are stricter in the rural areas. It is also obvious as most of the individuals in the rural areas do not have enough awareness to seek medical services apart from that offered and accepted by their specific culture.
Traditional Practices and Treatment Methods
The Chinese firmly believe in traditional medicine and herbs. Jeffrreys and Zoucha (2017) also explain that practices such as acupuncture, coining, scraping, moxibustion, and herbal and dietary therapy are most popular treatment in the event of an illness. Western medicine is often sought after when the situation is dire. Issues such as mental health are stigmatized and often go untreated. Sometimes, traditional medicines used may interfere with the recommended treatment. Therefore, the healthcare provider should determine whether there has been any prior intervention before administering the treatment (Liu & Harrell, 2015). It is also important to mention that some of the remedies like coining and moxibustion may leave marks on the patient’s body, which the clinician may understand as abuse, which is often not the case. Many of the Chinese due to their cultural beliefs resort to the above-mentioned traditional methods, which makes it difficult for them to engage in advanced health care. For instance, in relation to the medicine, most of the Chinese use traditional medicine which does not correlate with the advanced health care. The mere fact makes it more challenging for doctors and nurses to be able to ensure quality health care. It is thus crucial for the nurses and doctors to search for the patient’s history and be aware of the traditional methods used before. Nonetheless, most of the Chinese do not seek medical attention, since they live in the rural areas and prefer traditional medicine and other forms of treatment. The issue affected the mortality rate as most of them died due to some diseases that could have been treated with the help of the current healthcare machinery and medicine.
In an effort to comprehend the cultural implications in providing health care, an ethical dilemma may arise from cultural contradictions and conflicts. The three barriers reduce the growth of the healthcare systems, making it even challenging for the specific sector to grow in China.
Ethical Dilemma
One of the very common ethical dilemmas that doctors and nurses have to face is providing the patients with informed consent. The Chinese people are very conservative and particularly cautious about their cultural beliefs. It had been stated earlier that they believe in concepts such as karma and therefore, there are certain health defects that might occur. It can be, however, misinterpreted as karma, even though the doctor can establish an exact diagnosis. The doctor might be faced with the challenge of conducting a certain procedure without telling the patient about it, because he/she may know that doing so might make the patient resort to other traditional practices that will not bring any positive results. It is thus advisable for the doctor to provide full details of a condition and explain it to the patient, using the best terms and try to convince him/her of the success of a particular procedure.
Analysis of the Culture Using a Culturally Competent Model
A transcultural assessment model is an effective tool in examining and analyzing the cultural values, beliefs, and systems of patients as these affect their perception of health, diseases, and treatment, as well as the consequences of their perception. The model explains that this can be understood in six cultural dimensions: space, communication, time, social organizations, environmental control, and biological variation. Space refers to the physical distance that may dictate intimacy or location – private or the public. Rules that dictate appropriate personal distance vary from culture to culture (Holland, 2017). For the Chinese culture, space is very important when it comes to the manner in which people communicate. Individuals should maintain a considerable distance between them as a sign of respect for the Chinese convictions. However, this factor can change depending on the situation and surrounding.
Holland (2017) also describes communication as one of the modules. He claims that communication is critical to determine how people will interact within and outside their culture. The scholar further explains that finding common ground allows sharing information and ideas as wells as communicating emotions, which is an important requirement for patients and healthcare providers. Bringing the Chinese culture into focus, it has been noted that the issues such as language barrier, interpretation of touch, and nonverbal cues will determine the success or failure of the given health care.
Social organization plays a critical role in providing transcultural care. The transcultural assessment model explains that the group dynamics within the family influences perception and choices in health care. For example, considering the superstitious nature of the Chinese, if a child in the family is sick and the mother strongly believes that it is an act of karma, then the chances are they will not seek any help from the traditional medicine. Karabudak, Tas, and Basbakkal (2013) explain that the family is the backbone of the society and mental illness and academic failure are considered a disgrace to the society. The other component explained in this model is the aspect of time (Karabudak, Tas, & Basbakkal, 2013). The authors of the model explain that different cultures place importance on different phases of time: past, present, or future (Cai, Kunaviktikul, Klunklin, Sripusanapan, & Avant, 2017). The emphasis on one particular aspect may ignore the consequences of other factors. Environmental control, which should be considered when an individual feels they have the ability to plan and control factors in the environment that will affect them, is another important component in the model.
In addition to that, the followers of Chinese culture strongly believe in cosmic disharmony or harmony, supernatural forces, and superstitions as determinants of one’s health. That is why things like amulets for protection are popular. A mother may decide not to take her sick child to the hospital because she believes that the amulet will bring wellness eventually. This affects the health seeking behavior of the family. The final component is biological variations, where genetic differences and developmental growth may vary among racial groups, owing to genetics and cultural and environmental influences. Nurses are advised to be aware of these differences amongst the various groups.
Plan of Care
|
Healthcare need |
Goal (Desired outcome) |
Intervention |
Responsibility |
|
Diagnosis |
The patient should be able to effectively communicate their beliefs, traditions, and customs, revealing traditional treatments used in the past and allowing the nurse to better understand this custom and contextualize care. |
The nurse should assess the level of patient’s understanding of the English language and their ability to communicate effectively.
The nurse should talk clearly and slowly when explaining the issues. Enunciation is thus a matter of the utmost importance. It is highly recommended to use gestures where possible.
The nurse should use simple language.
The nurse should refrain from touching the patient unless it is required.
There should be enough space between the client and the nurse.
If there’s a language barrier, the nurse should find an appropriate translator. |
Nurses, doctors, clinicians, hospital administration. |
|
Treatment |
The patient will be satisfied with the treatment prescribed and can satisfactorily demonstrate an understanding of the procedures used. |
The nurse should first determine whether the patient has any fears regarding the treatment based on their cultural beliefs.
The nurse should provide a clear explanation of the choice of the prescribed treatment, its relation to the illness, as well as its effects and outcome. The nurse should put emphasis on the importance of adhering to the prescribed dose. The nurse should explain the treatment plan step by step and involve the family if support is needed. In case the treatment involves any dietary changes, the people who surround the patient should also be involved in the discussion.
|
Nurses, doctors, clinicians, hospital administration, family members. |
Interdisciplinary Approach
Community resources that should be used to address these issues include social media platforms such as Twitter that has the capability of reaching many people. Moreover, the platform can be used to spread information on best practices, and other people can also provide insightful suggestions on how to tackle the cultural differences barrier in the health sector. Governmental organizations can also launch exchange programs where a doctor from China would be invited and western doctors taken to China so that they can learn each other’s cultures and return with helpful knowledge obtained from other countries.
Implementation
As a cultural broker, the role will consist in education and coordination. It is my responsibility to educate other healthcare providers about the Chinese culture and its influence on the effectiveness of care that we provide to the community. Similarly, it will be my responsibility to conduct health education to the Chinese community on the intervention of western medicine. I will also act as a coordinator between the relevant organizations and institutions that need to work together for the wellness of the Chinese community. Therefore, I must attempt to bridge the gap and unite the communities: the patients, the practitioners, and other parties that are involved in the issue. The cultural broker will be the main role in reducing the effect of cultural diversity in China (Jeffreys & Zoucha, 2017). One of the ways to improve the situation with the cultural diversity with the advanced forms of health care is to raise people’s awareness. The process includes increasing civic education, which will allow the growth of the community in relation to modern health care and the way it affects the Chinese culture. Most of the Chinese do not use the current health care because they do not know its advantages and disadvantages compared to non-traditional means. Thus, civic education will help in the process of increasing the awareness, which will gradually eliminate the barrier. The cultural broker will also be able to bridge the gap between the different forms of health care. In addition, it will help in developing a structural foundation and framework to support the correlation between the culture and the healthcare system.
Strategies for Culturally Sensitive Care
Betancourt, Green, Carrillo, and Ananeh-Firempong (2003) identify tackling the language barrier and education as key strategies for being culturally sensitive. One of the strategies to ensure that quality care is delivered entails tackling the language barrier issue by simply ensuring that the healthcare institution has an interpreter available, especially at hospitals or health centers that are frequently accessed by the Chinese community. Breaking the language barrier is a critical first step in providing quality care. Another strategy is commitment to understand the culture, beliefs, and traditions of the Chinese community and raise people’s awareness of the issues related to the health facilities. Having a background in the Chinese belief system will help eliminate unnecessary conflicts. The process will also include an effectively written communication plan framework (Francis, Haines, & Nagro, 2017). Translated written communication helps in reducing the language barrier, since most of the people can read that carefully, especially in urban areas. In addition, it will also be quite helpful in rural areas to have interpreters who will be able to interact with locals and ensure efficiency in communication. The model explains that one of the effective ways to guarantee sensitive health care is ensuring proper interaction between the patients and the medical staff. It helps in the process of ensuring effective healthcare services so as to increase their efficiency and provide long-lasting effects.
Evaluation
A simple questionnaire will be used to determine the effectiveness of the plan. The questionnaire will be distributed amongst the patients, and the results will be collected to make some improvements and determine the effectiveness of the plan in providing quality health care. It will help in the process of data collection and at the same time, it will result in effective communication. Collecting the data one would be able to know some of the vital factors affecting communication between the patients and the medical staff. In the process, most of the individuals will be able to make a recommendation on how to promote a sensitive healthcare system. In addition, it would facilitate an effective process of cultural interaction (Khlystov, 2016). First, it would enable to collect data to examine different types of cultural interaction. It will also allow to establish effective communication, so that the doctors will be able to correlate the modern medical system with the Chinese culture.
Conclusion
The transcultural assessment model is an effective tool for nurses in developing processes to ensure efficient and quality health care amongst the Chinese community. Components such as space, time, environmental factors, social organization, and biological factors all contribute to the preexisting factors that dictate the Chinese health-seeking behaviors. This shows that if healthcare providers take into account these factors, they are able to communicate, build trust, and, as a consequence, provide good care. Communication is crucial in providing transcultural care. Therefore, investing in interpreters is the first step in creating a favorable environment for communicating. Education is also important for both parties. The healthcare provider should possess some background knowledge in order to be culturally sensitive, while the patient should also be educated on prescribed treatment. Having a good evaluation tool is advantageous when it comes to seeking ways to improve the quality of care provided.
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