People of Japanese Heritage and People of Jewish Heritage.Read chapter 18 and 19 of the class textbook(Transcultural Health Care. A Culturally Competent Approach (4th ed.)Purnell, L.D.Publisher: F.A. Davis Company; 4th edition)and review the attached PowerPoint presentation. Once done answer the following questions;1. Discuss the cultural development of the Japanese and the Jewish heritage.2. What are the cultural beliefs of the Japanese and Jewish heritage related to health care and how they influence the delivery of evidence-based healthcare?A minimum of 2 evidence-based references (besides the class textbook) no older than 5 years is required. A minimum of 600 words (excluding the first and references page) is required.
culrural_nursing_ch18.ppt
cultural_nursing_ch19.ppt
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese American Culture
Larry Purnell, PhD, RN, FAAN
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Overview/Heritage
▪ In the Japanese language, Japan is called
Nihon or Nippon.
▪ The over 500,000 Japanese citizens residing in
North America tend to locate in large
commercial and educational centers.
▪ Education is highly valued; the illiteracy rate in
Japan is nearly zero. About 40 percent of all
young people go on to higher education.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Overview/Heritage
▪ Issei (first-generation Japanese immigrants)
vary widely in their English-language ability.
▪ Nisei (second-generation immigrants) and
sansei (third-generation) were primarily
educated under the American educational
system.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ Japanese is the language of Japan, with
the exception of the indigenous Ainu
people.
▪ In Japan students complete 6 years of
English, even newer Japanese immigrants
and sojourners can speak, understand,
read, and write English to some extent.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ Men tend to speak more coarsely and women
with more gentility or refinement.
▪ Light social banter and gentle joking are a
mainstay of group relations, serving to foster
group cohesiveness.
▪ Polite discussion unrelated to business, often
over o-cha (green tea), precedes business
negotiations.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ Open communication is discouraged making
it difficult to learn what people think. In
particular, saying “no” is considered
extremely impolite; rather, one should let the
matter drop.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ A high value is placed on “face” and “saving face.”
▪ Asking someone to do something he or she cannot
do induces loss of face or shame. For people to be
shown wrong is deeply humiliating.
▪ People feel shame for themselves and their group,
but they are respected when they bear shame in
stoic silence.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ Traditional Japanese exhibit considerable
control over body language. Anger or dismay
may be quite difficult for Westerners to
detect.
▪ Smiling and laughter are common shields for
embarrassment or distress.
▪ Prolonged eye contact is not polite even
within families.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ Social touching occurs among group members
but not among people who are less closely
acquainted.
▪ In general, body space is respected.
▪ Intimate behavior in the presence of others is
taboo.
▪ When people greet one another, whether for
the first time or for the first time on a given
day, the traditional bow is performed.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ An offer to shake hands by a Westerner is
reciprocated graciously.
▪ Overall orientation is toward the future.
▪ Punctuality is highly valued.
▪ Family names are stated first, followed by
given names. Seki Noriko would be the name
of a woman, Noriko, of the Seki family.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Communication
▪ Women generally assume their husband’s
family name upon marriage.
▪ Elders are referred to respectfully.
▪ The designation sensei (master) is a term of
respect used with the names of physicians,
teachers, bosses, or others in positions of
authority.
Copyright © 2013 F.A. Davis Company
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Family Roles and
Organization
▪ The predominant family structure is nuclear. The
role of wife and mother is dominant.
▪ Children are socialized to study hard, make their
best effort, and be good group members.
▪ They are taught to take care of each other, and
girls are taught to take care of boys. Selfexpression is not valued.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Family Roles and
Organization
▪ The primary relationship within a family is the
mother-child relationship, particularly that of
mothers and sons.
▪ It is customary for a mother to sleep with the
youngest child until that child is 10 years old or
older, and when a new baby is born, the older
sibling may sleep with the father or a
grandparent.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Family Roles and
Organization
▪ Babies are not allowed to cry; they are picked
up instantly. Women constantly hold their
babies in carriers on their chests and sleep with
them.
▪ Corporal punishment is acceptable in Japan.
▪ Traditional teens and college students generally
do not date.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Family Roles and
Organization
▪ Older people are respected and cared for by
the family in the home, if at all possible, with the
eldest son being the responsible family
member.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Family Roles and
Organization
▪ There is less tolerance for marriage of a
Japanese person to a foreigner than in the
United States.
▪ The existence of a gay and lesbian social
network and of cross-dressing clubs is evident,
although they are not generally talked about.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Workforce Issues
▪ American practices designed to avoid liability,
such as informed consent, are not routinely
implemented in Japanese health-care settings.
▪ Japanese workers are sensitive to colleagues
and superiors.
▪ Saying “no” or delivering bad news is extremely
difficult; they may avoid issues or indicate that
everything is fine rather than state the negative.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Workforce Issues
▪ A high value is placed on “face” and “saving
face.”
▪ Asking someone to do something he or she
cannot do induces loss of face or shame.
▪ For people to be shown wrong is deeply
humiliating.
▪ Prolonged eye contact is not polite even within
families and among friends.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Biocultural Ecology
▪ Racial features include the epicanthal skin folds
that create the distinctive appearance of Asian
eyes, a broad and flat nose, and “yellow” skin
that varies markedly in tone.
▪ Hair is straight and naturally black with
differences in shade.
▪ Negative blood types account for less than 1
percent of the population.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Biocultural Ecology
▪ Commonly occurring health conditions for
Japanese include heart disease, tuberculosis,
renal disease, asthma, Vogt-Koyanagi-Harada
syndrome, Takayasu disease, acatalasemia,
cleft lip/palate, Oguchi disease, lactase
deficiency, and stomach cancer.
▪ Asthma, related to duct mites in tatami (straw
mats) is one of the few endemic diseases.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Biocultural Ecology
▪ Drug dosages may need to be adjusted for the
physical stature of Japanese adults.
▪ Many Asians are poor metabolizers of
mephenytoin and related medications, potentially
leading to increased intensity and duration of the
drugs’ effects.
▪ Most individuals require lower doses of some
benzodiazepines and neuroleptics.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Biocultural Ecology
▪ Opiates may be less effective analgesics, but
gastrointestinal side effects may be greater
than among Whites.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese High-Risk Health Behaviors
▪ Smoking rates are high among Japanese and
Japanese Americans.
▪ Alcohol (rice wine) is part of many social rituals,
such as picnics, to celebrate cherry blossoms,
autumn leaves, or moon viewing.
▪ Once alcohol is consumed, one can relax and
speak freely; they are forgiven for what they say
because of the alcohol.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese High-Risk Health Behaviors
▪ Mothers’ time-honored strategy of rewarding
academic diligence with candy and other treats
contributes to the issue of the fitness of youth.
▪ Public safety consciousness is high.
▪ The Japanese readily use seatbelts and other
safety measures, such as child safety seats and
helmets.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Nutrition
▪ Dietary staples include rice, beef, poultry, pork,
seafood, root vegetables, cabbage, persimmons,
apples, and tangerines.
▪ Rice is the mainstay of the traditional diet and is
included in all three meals as well as snacks.
▪ Rice has a symbolic meaning related to the
Shinto religion, analogous to the concept of the
“bread of life” among Christians.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Nutrition
▪ A staple of schoolchildren’s o-bento (lunch box)
is a white bed of rice garnished with a red plum
pickle, reminiscent of the Japanese flag.
▪ A popular lunch among working people is a
steaming bowl of ramen (noodles) in broth or
cold noodles on a hot summer day.
▪ Instant broth, although high in sodium, is another
popular quick lunch.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Nutrition
▪ A traditional dinner is a pot of boiled potatoes,
carrots, and pork seasoned with sweet sake,
garlic, and soy sauce or a stir-fried meat and
vegetable dish.
▪ The daily intake of sweets can be high and often
includes European-style desserts, sweetbreads
and cookies, sweet bean cakes, soft drinks, and
heavily sweetened coffee.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Nutrition
▪ Increasingly, Westernized food tastes, resulting
in higher fat and carbohydrate intake, have
contributed to the rise in obesity and associated
increases in diabetes and heart disease.
▪ There is growing public awareness that the
sodium content of the traditional soups and
sauces contributes to the high rate of
cerebrovascular accidents.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Nutrition
▪ Green tea, although high in caffeine, is a good
source of vitamin C.
▪ Garlic and various herbs are used widely for
their medicinal properties.
▪ Many individuals have difficulty digesting milk
products due to lactose intolerance.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Pregnancy and Childbearing
Practices
▪ Oral contraceptives became legal in Japan in
1999.
▪ Condoms remain the most common
contraceptive method.
▪ Most women have several abortions during their
married fertile lives.
▪ Pregnancy is highly valued within traditional
culture as a woman’s fulfillment of her destiny.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Pregnancy and Childbearing
Practices
▪ Pregnant women may enjoy attention and
pampering that they get at no other time.
▪ They may prepare themselves for the possibility
of pregnancy when they become engaged and
eliminate alcohol, caffeine, soft drinks, and
tobacco.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Pregnancy and
Childbearing Practices
▪ Loud noises, such as a train or a sewing
machine, are thought to be bad for the baby.
▪ Shinto shrines sell amulets for conception and
easy delivery.
▪ Husbands do not commonly attend the births of
their children.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Pregnancy and Childbearing
Practices
▪ Vaginal deliveries are usually performed
without medication.
▪ To give in to pain dishonors the husband’s
family, and mothers are said to appreciate their
babies more if they suffer in childbirth.
▪ Traditionally, postpartum women do not bathe,
shower, or wash their hair for the first week.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Pregnancy and Childbearing
Practices
▪ Breast-feeding is taken seriously.
▪ Maternal rest and relaxation are deemed
essential for success.
▪ If the mother is asleep, the grandmother feeds
the baby formula.
▪ Women who give birth in the US may resent the
expectation of resuming self-care quickly.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Death Rituals
▪ The taboo against open discussion of serious
illness and death is evident.
▪ Hospice patients or those with a terminal illness
may not want to be told their diagnosis and
prognosis in order to allow a peaceful death and
to spare both the patient and the family the
difficulty of having to discuss the situation.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Death Rituals
▪ When a person is dying, the family should be
notified of impending death so they can be at
the dying person’s bedside.
▪ Traditionally, the eldest son has particular
responsibility during this time.
▪ The mourning period is 49 days, the end of
which is marked by a family prayer service and
the serving of special rice dishes.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Death Rituals
▪ When death occurs, an altar is constructed in
the home.
▪ Photographs of the deceased are displayed,
and floral arrangements are placed within and
outside the home.
▪ A bag of money is hung around the neck of the
deceased to pay the toll to cross the river to the
hereafter.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Death Rituals
▪ Perpetual prayers may be donated through a gift
to the temple. In addition, special prayer services
can be conducted for the 1st, 3rd, 7th, and 13th
annual anniversaries of the death.
▪ Beliefs are common that the dead need to be
remembered and that failure to do so can lead
the dead to rob the living of rest.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Spirituality
▪ Shinto, the indigenous religion, is the locus of
joyful events such as marriage and birth.
▪ Many festivals are marked by offerings,
parades, and a carnival on the grounds of the
shrine.
▪ Very few people regularly attend services, but
most are registered temple members, if only to
ensure a family burial plot.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Spirituality
▪ 1% of Japanese people is Catholic or
Protestant.
▪ Most do not identify themselves solely with one
religion or another, and even a baptized
Christian might have a Shinto wedding and a
Buddhist funeral.
▪ Buddhist belief in reincarnation and the eternal
life of the soul.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Spirituality
▪ Kampo (healers) often set up shop in the
vicinity of the temple or shrine, and a person
might be seen scooping incense smoke onto an
ailing body part.
▪ Prayer boards might bear requests for special
healing.
▪ Newborns are taken to a shrine for a blessing.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ Because Japanese people are less likely to
express feelings verbally, this indulgence may be
a way for people to affirm caring for one another
nonverbally.
▪ Termination of pregnancy when the health of the
fetus is in doubt is common.
▪ Most parents want medically compromised
neonates to be treated aggressively when
prognoses are not favorable.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ The concept of ki, the life force or energy and
how it flows through the body, is integral to
traditional Chinese healing modalities, including
acupuncture.
▪ Good health requires the unobstructed flow of ki
throughout the body.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ Yin and yang are reflected in the need to balance
five energy sources: water, wood, fire, earth, and
metal. Strategies that help to restore balance
include use of herbal medicines, bed rest, bathing,
and having a massage.
▪ One traditional form of massage, shiatsu
(acupressure), involves redirection of energy along
the Chinese meridians by application of light
pressure to acupuncture points.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ Whereas Chinese tradition calls for a
restoration of balance when one is ill,
Shinto calls for purging and purification.
▪ Preoccupation with germs and dirt is not
likely to interfere with daily life.
▪ Many pharmacies stock traditional herbal
kampo preparations.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ Most individuals make liberal use of both
modern medical and traditional providers
of health care.
▪ Residents in the United States have
Internet and mail-order access to
traditional medications, if they are not
available locally.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
Common Japanese therapies include:
▪ Morita therapy–indigenous strategy for addressing
shinkei shitsu, excess sensitivity to the social and natural
environment. Introspection is seen as harmful.
▪ Morita therapy–focuses on constructive physical
activity to help clients accept reality as it is
▪ Naikan therapy–reflection on how much goodness and
love are received from others.
▪ Shinryo Naika– focuses on bodily illnesses that are
emotionally induced.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ Japanese high regard for the status of physicians
decreases the likelihood of their asking questions
or making suggestions about their care.
▪ The idea that clients should be given care options
may be alien.
▪ Itami (pain) may not be expressed: bearing pain is
a virtue and a matter of family honor.
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ Addiction is a strong taboo in Japanese society,
making clients reluctant to accept pain
medication.
▪ Mental illness is taboo. Because emotional
problems cannot be discussed freely, somatic
manifestations are common and acceptable.
▪ Handicapped people may bring shame to the
family, although they are treated kindly..
Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Japanese Health-care Practices
▪ The sick role is highly tolerated by families and
colleagues, and a long recuperation period is
encouraged Organ transplantation and donation
issues need to be approached sensitively.
▪ People rely more heavily on the physician’s
opinion, and the family may have difficulty
negoti …
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