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Korean American

Transcultural Nursing presentation
by

Mary Miller

on 19 November 2012

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Transcript of Korean American

By Emily Smith, Maribeth Miller, and Rachel Carmichael Post WWII, North Korea was occupied by Soviet Union. South Korea was occupied by the United States. They divided the country along the 38th parallel.
North Korea has a totalitarian, communist government.
North Korea’s civil law is based on Japanese tradition and communist legal theory, in elections, candidates run unopposed (CIA world fact book)
South Korea is a republic and the president is elected through popular vote. They have a mixed legal system based on European civil law, Anglo-American law, and Chinese classical thought (CIA world fact book) Video NCLEX Question #4 A nurse is caring for a 22-year old Korean patient who has just been diagnosed with a terminal illness. The patient states that she wishes to not make any decisions about treatment options without first talking with his family. The nurse responds by...
A. Explaining to the patient there is no need because there are only a few choices anyway.
B. Telling the patient that the decisions are time sensitive and there is no time to wait for her family to arrive.
C. Waiting for the patient's family to arrive and including them in the plan of care.
D. Calling the family for the patient because she is still dealing with the shock of hearing the news of her terminal illness. Korean History Korean History 1950 to 1953-the Korean War, the Communist North invaded the South. We still have 40,000 American soldiers stationed along the border
North Korea has been dabbling with Nuclear Power
South Korea is 38,000 square miles (roughly the size of Indiana) and has 48 million residents
North Korea is 46,000 square miles (roughly the size of Pennsylvania) and has 23 million residents Korean Americans Biological Variation Skin Color: Golden-brown
Infants have Mongolian spot
Enzymatic and Genetic Variation
Lactose intolerance (90% of Orientals)
Bone density lower – higher risk for osteoporosis
Anemia d/t predominantly vegetarian diet
Insulin Autoimmune syndrome: spontaneous hypoglycemia without evidence of exogenous insulin administration( Sugunendran & Malik, 2010) The man on the left is Kim Jong-un, the leader of North Korea
The man on the right is Lee Myung-Bak, the president of South Korea Comparing North and South Korea Korean American

There are 1.3 million Korean Americans.

75% of Korean Americans live in CA, NY, NJ, IL, WA, TX, VI, MD, PA, or GA

The Korean Americans “maintain one of the highest levels of ethnic attachment.” This is due to the fact that they are from a homogeneous country, they go to ethnic churches, and they are tied to small businesses. Many of them run their own small businesses or work for entrepreneurs Kimchi-they eat so much of this that they say “kimchi” instead of “cheese” when they are getting their picture taken. Kimchi is fermented cabbage. (Health Magazine, 2012) Kimchi Communication: Language Speak Hanguel (there are 78 million people in the world who speak this language).
The language is highly influenced by Chinese. In fact , 50% of the characters/words in Korean books and newspapers are Chinese.
From 1910 to 1945 Korea was occupied by Japan, and Hanguel was banned.
Hanguel was created in 1446 and consists of 14 consonants and 10 vowels Communication: Language Language reflects the social hierarchy and familial obligations. There are different words used to speak to those who are above, below, or equal to you socially.
Many Elderly Koreans speak Korean, Chinese, and Japanese
Children should not be the translators in a health care setting because this can reverse the parent-child relationship Communication When meeting other Koreans, they will listen to them for a while before they decide to interact.
In public, they do not make eye contact or physical contact with strangers.
In one-on-one or acquaintance level situations, they interact much like the rest of American culture.
They are offended when the sole of a shoe or foot is pointed at them. Communication First names are only used for family and close friends
Some feel that using first names can invoke evil spirits and lead to bad luck
American Koreans are very sensitive to the feelings of others.
Some American Koreans will not say “no” to a request, even if it is impossible to fulfill, because they do not want to hurt their relationships Social Organization Confucian philosophy shapes their relationships and social hierarchy.
“In Confucian thought, family values, familial relationships, ancestor worship, and filial piety are the primary basis of the philosophical system, and these concepts are seen as virtues to be cultivated.” (Yi, D., 2011) Space American Koreans practice distal spacing, which means that space separates old and young, bosses and subordinates.
They can tolerate crowding, but some avoid physical and eye contact with strangers.
The nurse must try to establish a trusting and caring environment before touching the patient.
Korean Americans are very practical and will respond positively to someone who seems sincere. Social Organization Family Life
Father and son play a major part in decision making
Big emphasis placed on having a son to carry on the family name.
An average of four people to every Korean American family.
Girls will get little to no inheritance from her family.
Daughters will usually have an arranged marriage.
Elders are respected and care for (Geiger, 2011). Social Organization Family
Gender bias
Traditionally
Modernization of the culture
Close families have been strengthened.
More traditional-minded distant relatives relationships strained.
Males have more stress if their wives are able to find work and they cannot (Geiger, 2011).
Wives discouraged from progressing in careers.
Traditional thought vs. pragmatic and realistic thought. Social Organization Family
Pride of the past and assimilation with the culture.
Korean universities in major American cities.
Seek to ensure homogeneity
Desire to remember tradition and rich culture while still being immersed in American life. Social Organization Religion and Social Values
Seek to blend both old and new religious viewpoints (Geiger, 2011).
Buddhism
Biggest single religion.
22.9 million (47%) adherents (Geiger, 2011).
Originally not a religion but a doctrine of self-enlightenment (Geiger, 2011).
Confucianism
Four centuries after Buddhism
More of a social ideology
Rituals, ceremonies, and decorum.
Confucian philosophy shapes their relationships and social hierarchy.“In Confucian thought, family values, familial relationships, ancestor worship, and filial piety are the primary basis of the philosophical system, and these concepts are seen as virtues to be cultivated.” (Yi, D., 2011) Social Organization
Religion and Social Values (Con't)
Christianity
More recently in Korea
Missionaries were very appealing because of the modern learning they brought.
20% of Koreans go to church and are Christians (Geiger, 2011).
Korean Christians are fervent and devout.
Christianity has a big influence on the culture Social Organization Things Nurses Should Know
Korean Americans are very family oriented (Geiger, 2011).
Son and daughter-in-law are at an increased risk for feeling great guilt.
Strong sense of obligation and respect for authority balanced by affection.
Elders have a big part in decision making.
Family members must be included in decisions.
Counseling may be needed to aid in decision making.
"Adverse effects of caregiving may be greater among Korean caregivers than American caregivers because of lack of formal services designed for KAs and cultural or language barriers in accessing existing services" (Casado & Sacco, 2012). Time Life and living are harmonious.
In the world for only a short time must make the most of it.
Believe in a harmonious fusion of man and nature.
Others focused Time Time Orientation
Future time oriented.
Must finish one task before starting another.
Monochronic vs. Polychronic
Monochronic
Monochronically oriented people focus on being on time.
Accomplishments achieved during each task.
Increased need for closure.
Internally process things because of linear focus (Geiger, 2011). Time Monochronic vs. Polychronic (Con't)
Polychronic
Try to accomplish many tasks at once.
Mind can become overwhelmed and cloudy because of trying to process many things at once.
Tend to procrastinate.
Visually oriented.
Both monochronic/polychronic dependant on right/left brain orientation.
Most Korean Americans tend to be right-brain dominant and polychronically oriented. Time Parents focus on giving their child the best chance possible.
Believe in reincarnation
If good deeds are done and mercy is given, given new life.
If live a bad life, person will be punished. Time Things Nurses Should Know
Value an orderly, prompt schedule
Are against organ donation because of reincarnation.
Nurse must take time to communicate well with the patient or there will be a risk of non-compliance.
Must assess the patients needs. Environmental Control Illness and Wellness Behaviors
Equilibrium System: Harmony and Balance

Health: Balance between 2 forces:
-Eum : cold, dark (Chineses Yin)
-Yang : hot, bright (Chineses Yang)

Disruption of this balance will cause illness

Elderly Koreans might not accept getting blood drawn. Environmental Control Herbal Medication

Many herbal medicine shops available

Herbal Medical doctors have 4 principals:
-Herbal medicine
-Acupuncture
-Moxibustion
-Cupping

One or a combination of treatments

Because of this holistic approach that they offer many American are also accepting it more. Environmental Control Pregnancy and Postpartum Practices
Tae-kyo : Common Practice that Korean Americans use during pregnancy.
Women are supposed to think about “only about good things in life and to maintain a calm attitude to ensure a healthy baby” (Giger, 2007)

Eat right food Environmental Control Post-partum:
Women are instructed to have a 21 day bed rest period.

They eat a lot of seaweed soup: to clean the body and to provide enough fluid for lactation

Nursing Implications
Hypercoagulable
Dangers of long bed rest. Environmental Control General Preventive Health Practice
Many general preventative health practices-Ex: Summer sweat loss of energy ki .
Before the summer months eating dog meat soup is “believed to build stamina and strength by decreasing sweating.” (Giger, 2007)
Visit Fortune tellers who forecast a persons’ health for the year.
Visiting religious shrines “bring inner comfort and serenity and therefore a positive health measure” Environmental Control Death and Dying
-Illness or death is fated and that they have no control over nature.
-Associate admission to the hospital with a death sentence
Do not resuscitate orders are common because prolonging life is usually seen as unacceptable.
Discussing a terminal illness might be resisted by the patient and family Environmental Control Dying

Home
Warmest part of the bedroom
Obligation for the children to be at the bedside of a dying parent -Imjong
Most important rights of a traditional funeral is the Sup: washing of the body
Body is washed with a piece of cloth or cotton that has been soaked in warm water. After washing the body it is bound with a long cloth –yom Environmental Control Implications for Nursing Care
Multiple beliefs about health-illness systems
Essential to recognize that many Korean American will use bother herbal and medical treatments - Drug reactions and allergies etc.
Advocate for patients culture and use of herbal remedy with the collaboration of traditional medical practices Biological Variations Body size and structure
Shorter than Americans
Direct correlation between height and age
Long trunks and shorter extremities:genetic and cultural practices
Adipose tissue deposition is less than in Americans d/t less fatty diet
Less body hair some women do not need to shave their legs Biological Variation Diet
High fiber and spicy
Synonymous of Korean Kimchi and Bulgogi
Kinchi eaten with every meal
Typical mean: Rice, soup, vegetables, meat or fish and kimchi.
Bulgogi: Koren Barbecue
Lots of herbs and vegetables Biological Factor Drug Interactions and Metabolism
Alcohol work faster causing circulatory and unpleasant effects facial flushing and heart palpitations
Diverticulosis and IBS
Hypertension leading cardiovascular risk factors
Peptic Ulcer disease (d/t spicy foods) Biological Factors Influenced by Buddhist and Confucian philosophy
Proud and independent people .
View psychiatric illnesses as shameful.
Family shame and stigma
Depression is higher among Korean American than other ethic groups (lead to substance abuse, suicide etc)
Educate the treat the family Biological Factors Nursing Considerations
Bland diet: Rice soup
Talk little during mealtime- quiet meal time environment -without many interruptions
Lactose free
Calcium intake during childhood d/t bone density Biological Factors Korean women avoid sunlight to prevent their face from becoming dark- use parasols Yang-san to avoid sun .
Sensitive about skin color
Establish a relationship of trust with the pt. especially when dealing with mental illness NCLEX Question #1 If a Korean American had a low body temperature the nurse would make sure to include what types of food in his plan of care?
a.Rice
b.Hot foods like ginger, pepper
c.Cold foods like noodles
d. Hot tea NCLEX Question #2 When performing a physical assessment the Nurse should be aware of what biological variation of Korean Americans? (Choose all that apply)
a. Golden-brown skin
b.Shorter than americans
c.Gluten intolerant
d. Infants may have mongolian spots NCLEX Question #3 NCLEX Questions #5 A Korean client is admitted to the postpartum unit following the delivery of a 9 lb. infant. Although the client does not refuse to shower, the nurse notices that she stands in the shower, but does not allow the water to touch her. Which of the following should be the next action by the nurse?
A. Ask the client why she refuses to shower.
B. Call the doctor and report the client’s refusal to shower.
C. Tell the client that the nurse will obtain a heat lamp to assist in healing the perineum.
D. Turn the shower so that the water sprays on the client. RATIONAL Answer C is correct. Many in Asian cultures believe that the postpartal period is a “cold” time when the body is open. This is treated with heat, and a shower is thought to be a cold therapy that allows illness to enter the body. The nurse should comply with the client’s wish not to shower at this time. A heat lamp might be accepted because it is a hot therapy and will assist with healing. The answer is C. Korean Americans highly value the family. They do not wish to make plans regarding their health without the input of their family. Younger Koreans will abide by their elders input and wisdom, most often. Reference An elderly American Korean patient does not speak English. There are no Korean interpreters available. What should you do first?
A. Have his son translate
B. Pantomime before doing procedures
C. See if the patient can understand a Chinese or Japanese interpreter.
D. Do an interpretive dance to explain the procedure. NCLEX question #6 You run into a Korean American family member in the hospital's crowded waiting room. How should you respond?

A. Apologize
B. Ignore the incident
C. Hug them and apologize
d. Rub their bumped forehead. Casado, B., & Sacco, P. (2012). Correlates of Caregiver Burden Among Family Caregivers of Older
Korean Americans. Journals Of Gerontology Series B: Psychological Sciences & Social Sciences, 67B(3), 331-336.

Central Intelligence Agency. (2012a). The world fact book: Korea, north. Retrieved from
https://www.cia.gov/library/publications/the-world-factbook/geos/kn.html/

Central Intelligence Agency. (2012b). The world fact book: Korea, south. Retrieved from
https://www.cia.gov/library/publications/the-world-factbook/geos/ks.html

Giger, J. (2007). Transcultural nursing: Assessment and intervention, 5th edition . Mosby.
Health Magazine. (2012). World's healthiest foods: Kimchi (korea). Retrieved from http://www.health.com/health/article/0,,20410300_last,00.html/

Safari Books Online. (2012). Retrieved from:
http://my.safaribooksonline.com/book/medicine/9780768697377/cultural-practices-influencing-nursing-care/ch19lev1sec8

Sugunendran, S., & Malik, M. (2010). Insulin autoimmune syndrome: a rare case of hypoglycaemia .
Retrieved from http://www.endocrineabstracts.org/ea/0021/ea0021p70.htm

Yi, D. (April 20, 2011). Confucian and family values to chinese. Retrieved from
http://www.globalpartnersmba.com/confucian-and-family-values-to-chinese/ Social Organization Religion and Social Values (Con't)
Korean try to harmonize all of the religions they practice...creating a "best of both worlds."
Today, half of population practice Buddhism or Christianity while being overall influenced by Confucian thought (Geiger, 2011).
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