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Healthcare facilities provide care for many different diverse cultures whose beliefs may affect the medical treatment in which they need to receive. In todays time the increased racial and ethnic diversity can bring some new challenges for healthcare providers, there is a need for healthcare organizations to provide culturally competent care this is essential to reduce healthcare disparities among the minority population. Providing culturally competent care to patients of all different cultures is something that nurses and other healthcare providers must familiarize themselves as well as practice. Healthcare providers should obtain knowledge, understanding, and skills related to the treatment of different cultures. Nurses being more involved with patient care need to avoid making assumptions, have a better awareness, and practice active listening to build trust and rapport. Mexican and Japanese cultures have an extremely diverse outlook on healthcare practices. Cultural concepts such as communication, healthcare practices, spirituality, death rituals, nutrition, and family roles & organization aspects all affect how the Mexican and Japanese perceive culturally competent care.
Cultural competence is the ability to understand, appreciate, and work with people from cultures other than your own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of the patients culture and adaption of skills to meet the patients needs. (Lewis, 2020). Mexican and Japanese cultures are the two cultures I have chosen to compere and contrast. Texas has grown by more than two million since 2010, the Hispanic population pushed the count to more than 11.5 million. Tarrant county had a 28% growth rate for the Hispanic population. (Novak & Ura, 2020). Asian Americans represent 20.32% of the total population with 57,825 residents in Plano this city being the closest to the East Texas community. (Kolmar, 2019).
Japanese is the primary language spoken within the Japanese culture. Nisei are the second generation of Japanese immigrants to North America and are usually bilingual speaking and understanding both Japanese and English. Newly immigrated Japanese usually can understand and speak some English. Mexico has 62 living languages, accultured persons often speak only English, but some speak what is referred to as Chicano Spanish. The most recent immigrants that have arrived in Texas prefer Spanish but attempt to learn English for occupational advancement, however their children struggle to learn English in school but once they master English, they prefer to speak it. Many are bilingual. Both Japanese and Mexican cultures immigrate here speaking their own language but attempt to learn the English language. In both cultures they seem to struggle to either learn English or have difficulty communicating in English.
Women in the Mexican culture tend to be more expressive using dramatic body language. Mexicans who are more acculturated, have more education and come from a higher social class are less expressive with their emotions, they remain in control. Japanese do not condone expressions of anger or loss of temper, as it reflects negatively on the family. The traditional persons control their emotions in public or formal situations. They tend to avoid conflict within the family. Face or saving face is an important concept. In comparison both cultures tend to favor remaining in control of their emotions in public situations. Regarding healthcare the nurses role with these cultures would be to understand that in both cultures the non-emotional expression may not be looked upon as a disregard for ones health or the health of a their loved one.
In the Japanese culture the elder Japanese paved the way for the younger generation on their expression of nonverbal communication. They feel a soft tone is polite when speaking and the older and younger generation avoid direct eye contact with authority figures. Physicians and nurses may be perceived as authority figures in a healthcare setting and may have difficulty with the English language and understanding medical jargon. They also tend not to be overly expressive with gestures, they maintain self-control and self-restraint during interactions.
On the other hand, the Mexican culture tend to have a loud firm voice when it comes to discipline with their children but consider loudness to be rude and inappropriate when addressing someone. They do tend to carry on with loud friendly banter between family and friends. From a healthcare perspective you must speak to them in a nonconfrontational tone of voice if you want them to be engaged and follow through with their treatment plan. Staring at them may be a bit intimidating or seen as a challenge, to approach them a handshake would be acceptable but pointing or approaching with your hands on your hips may be viewed as hostility. The use of silence may indicate disapproval, disappointment or anger. Like the Japanese, the Mexicans may also perceive a physician or a nurse of the same sex or opposite sex an authoritative figure and avoid sustained eye contact.
A nurse should always ask for permission to touch any of their patients, any procedure or care, needs to be explained to all patients of any culture. In both Mexican and Japanese cultures strangers invading personal space may be uncomfortable in new situations. In the Mexican culture permission is needed to touch any area of the body especially intimate areas. The Japanese are a relatively low touch culture however, they are acceptable to the touching of most pars of the body when necessary for care. They do not question authority when it comes to healthcare professionals, they will consent to examinations, but the older Japanese women tend tome less comfortable than the younger women.
Japanese are family oriented with well defined roles, the father being head of household and major authority. Their values include the importance of the family as one unit, duty to family responsibility, obligation and maintain family harmony. Respect for age, authority, duty, obedience to parents, and duty of parents to children are influenced strongly. The oldest male member of the family tends to be the family spokesperson, here recently the women of the younger generation are usually involved in the decision making. In the older more traditional Japanese culture families consider women to be more subordinate, now in the younger familys women have more equality with males. Men are usually pampered by the women. Women are always the primary caregivers and tend to continue household activities even when they are sick themselves. Children are expected to act in accord with a set of standards, they are taught to be polite, shy, humble, and deferent to elders. Family values emphasize education leading to a valued occupation such as a medicine, law, teaching or pharmacy. Grown children are expected to care for their parents if necessary. When elders are sick the eldest sons family traditionally cares for them at home. Sexual activity outside of marriage is frowned upon, if a woman is to become pregnant out of wedlock it is expected for the couple to marry. The older Japanese frown upon sex before marriage, the younger generation are more acceptable but keep it a secret.
Traditionally in the Mexican culture the man is the head of household and woman is subservient to him, however in todays time there are more single women raising children as a single parent and head of household. The family unit consist of parents, children, grandparents, aunts, uncles and cousins. Immigrant parents may leave their children, move in with established family members and start work immediately with the hopes of eventually bringing their children to the United States, legally or illegally. The decisions are usually made as a family unit but seeking outside counsel from the extended family is not uncommon. More families are becoming more equal in their gender roles, men are taking a more active role in the care of their children as women move into the job market. There is great value placed on the family name, children area expected to behave honorably toward elders and family, a childs future depends on socioeconomic resources. Due to poverty, discrimination and racism academic skills lack and the high school drop out rate is high, families foster independence in boys and dependence in girls. Families often consult elders for important family decisions. Unwed sexual experimentation is discouraged especially among females; however, birth rate is high in adolescence due to social and economic factors.
Obesity as a comorbidity is a common health problem within the Mexican culture as well as diabetes with hypertension and HIV/AIDS. This culture greatly values modesty both men and women often seek a clinician of the same gender, they feel uncomfortable exposing their body to someone of the opposite gender. Clinicians need to avoid unnecessary exposure of their bodies and offer a cover for their lower extremities.
Traditional Mexicans believe in the hot / cold theory. The belief is that they preserve their health by balancing hot and cold foods, cold foods such as fresh tropical fruits and vegetables, dairy products and fish or chicken. They believe they should treat a cold illness with hot foods such as chocolate, eggs, oil, red meat and onions. They Acculturated persons may not believe in the hot / cold theory. When feeling ill an elder may recommend herbal teas such as spearmint and chamomile, or to avoid dairy products that increase the acidity causing nausea. Traditional foods include rice, beans, meat, chicken and corn or flour tortillas. The elder Mexican generation use to prepare their foods with lard, this practice has since decreased as they have learned that limiting fats in their foods is needed for health purposes. Cool drinks in the summer are preferred, fresh fruit coolers such as cantaloupe, watermelon and tamarind. Men tend to consume lots of alcohol. Encouragement to drink more water should be emphasized.
The Japanese have a completely different nutritional beliefs than the Mexican culture. The Japanese have their own food and rituals, they will prepare special foods during New Years holiday and other times of the year. New Years they will prepare ozone, a soup containing mochi (a pounded rice) that they feel brings them good luck, fortune and health to themselves and family throughout the year. Their usual diet consists of foods lower in fat, animal protein, cholesterol, and sugar but high in salt. Depending on their setting they prefer to use chopsticks to eat their meals, they usually have rice with dinner every night and feel their they get their source of protein from fish, soybeans with vegetables. Many of the Japanese are lactose and alcohol intolerant. They believe in combining certain foods for certain illnesses, pickled plums and hot tea for the prevention of constipation. When feeling ill they will often eat rice gruel or porridge with pickled vegetables. They feel when these foods are combined, they cause illness: eel and pickled plums, watermelon and crab, and cherries and milk. They enjoy drinking green tea most often without cream and sugar.
Death rituals in the Mexican culture are greatly influenced by religious beliefs, they often view death from any cause as Gods will, they also believe in the afterlife and heaven. Many prefer to die at home but if they are in the healthcare setting and die, clinicians should give the family private space to deal with the loss. If the death happens to occur in the hospital setting it is often thought that the spirit may get lost in the hospital. Family members may ask to view body before it is moved to the mortuary; some may want to help prepare it. Rosary beads or religious medallions at the bedside is not an uncommon site, the family may also request a visit by their priest or if unavailable the hospital chaplain to administer a sacrament.
Death is not openly discussed amongst the Japanese. Like the Mexican culture the Japanese view death depending on religious beliefs. Buddhists believe that death is natural where Shinto believe the soul has an eternal life. The entire family will decide if the ill will be a do-not-resuscitate, but imminent death will be discussed with the spouse or eldest son or daughter. In this culture they prefer to die at home if they can have the care provided, most will not accept hospice services. Most of the time a family member will stay at the bedside of the ill, when the passing occurs it is very important for the body to be clean and that dignity and modesty is preserved for viewing. Many Buddhists and Shinto have the body of the deceased cremated. Because the Japanese culture tend to control their emotions it is important for the clinician to assess any special needs, they may not request for help and deny the need for assistance.
Buddhism and Shintoism are most practiced by the older generation whereas the Japanese Americans practice Christianity. They often join churches of whatever religion that have the largest number of Japanese American or immigrant members. Japanese often combine Western medicine with prayer and offerings. Prayers and offerings prevalent in Buddhism and Shintoism. Besides the prayer at a temple or church, offerings and small shrines are made at home.
Most of the Mexican culture are Roman Catholic, in the most recent years Protestant and Pentecostal missionaries have converted Mexicans. The more-acculturated people may not attend church regularly but practice new aged practices such as yoga or Eastern mysticism. The traditional Mexicans that attend church light candles and pray to God, Jesus, the Virgin Mary and the saints. As a family they may pray together visit shrines throughout Mexico or have their own shrines in their home. The Bible or sacred scriptures that the Protestant and Evangelical churches focus on are believed to have special healing powers. Some Mexicans believe in a healer (curandero) or spiritualist (espiritusista)
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