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Cultural competence involves being aware that there are differences from ones own cultural and that of others culture. To be culturally competent also requires one to respect the differences, obtain knowledge and self-educate on the differences, and anticipate needs based on the differences. Cultural competence and sensitivity are imperative to provide good health care. The goal of this paper is to assist in building cultural competence for providing quality health care in relation to childbearing families. Some of the areas within this discussion include communication, health related beliefs and practices, pregnancy, birth, afterbirth, infant feeding, infant care, and patient/family teaching based on their needs. The Chinese culture will be the cultural focus of this paper. It is important to keep in mind, even the Chinese culture has many subcultures that can influence different beliefs, practices, and even language. The very basic of providing good care is being able to effectively communicate with a patient.
Communication
The Chinese have many different languages and dialects. Some of these dialects include Mandarin, Cantonese, Hokkein, Hakka, and Teo-chieu (Faculty of Monash University, 2009). Many communication practices are guided by Confucian principles. The purpose of Confucian principles is to achieve harmony and it assists in building Chinese behavior and character. Avoiding raising issues unless another party does is an example of a Confucian principle that affects communication. Another principle affecting communication is that someone should not tell another person something that may upset them. This may drive why Chinese people tend to be subtle when discussing something. This is also why some Chinese may avoid sharing health concerns. People within the Chinese culture may also avoid taking initiative due to it could be viewed as not maintaining harmony and peace. To maintain peace and harmony, the Chinese will also defer to authority and conform to avoid conflict and maintain respect (Cheung, Nelson, Advincula, Cureton, Canham, 2005).
Many of these cultural differences in communication compared to Western communication can cause misinterpretations. As an example, the Chinese may nod during a health providers instruction just to show respect for authority rather than necessarily understanding and agreeing with the information. This can lead to a misinterpretation of noncompliance. Another example is Westerners may consider some of the above communication techniques as indirect and offensive. No response by a Chinese person may be interpreted as nothing being wrong due to assumptions of Western culture; if something was wrong it would just be stated (Cheung, et al, 2005). These communication differences can clearly affect health care for the Chinese American. The Chinese also have their own health related beliefs and practices that can affect their health care.
Health Related Beliefs and Practices
Chinese health beliefs are very holism based. Illness is perceived as disharmony at the individual or social level (Cheung, et al, p.5, 2005). In the Chinese culture both curative and caring care are needed for optimal health. Although Western health care is making a move towards holistic care, there is still an emphasis on a biomedical or task-based model of care (Cheung, et al, 2005). Another main factor in Chinese health is the belief of the balance of positive (yang) and negative (yin) energy in the body. The Chinese classify certain foods, illnesses, and medications as hot or cold. This classification drives what foods and care they believe to be appropriate to balance an unwell person. Illness itself can be attributed to a few different things. Imbalance of body elements such as too much of hot or cold foods or imbalance/disharmony cosmically is believed to cause illness. Interference from evil sources or moral reprisal by deities or ancestors for transgressions or negligence can also cause illness. Another explanation of illness in the Chinese culture is poor Feng Shui (Faculty of Monash University, 2009). Feng Shui is described as the impact of the natural and built environment on the fortune and wellbeing of inhabitants (Faculty of Monash University, p. 1, 2009). For wellness, many Chinese will use traditional Chinese medicine which includes Chinese herbs, dietary therapy, acupressure, acupuncture, and forms of supernatural healing (Faculty of Monash University, 2009). Many of these basic health beliefs carry over into pregnancy beliefs and practices.
Pregnancy
In Chinese culture there are guidelines and restrictions for pregnancy that are used to avoid complications including miscarriage, stillbirth, maternal death, and any abnormalities in the baby. These guidelines are derived from the basic concept of yin and yang. There are dietary and behavioral restrictions to ensure balance, harmony, and a healthy pregnancy. As discussed before, the Chinese put an emphasis on holistic care. For pregnancy this means anything that affects the mothers mind or spirit can in turn affect the fetus. For example, strong emotions such as worry, fear, and anger can affect the mothers organs and affect the fetus. This is not to say the focus is just on strong negative emotions. Too much joy is an example of a positive emotion they would still believe to affect the mother and the fetus in a negative way. The key is balance. Pregnant Chinese women are also restricted from strenuous physical work due to the belief this would weaken the mother and weaken the fetus. Some Chinese mothers also worry about symbolic activities (Lau, 2012). In this instance, using sharp objects such as scissors in bed is believed to cause the baby to have a cleft lip. Posting or taping objects to the wall of their bed is believed to cause unwanted birth marks on the face of their baby (Do, 2000). The main food restriction pregnant women are told to abide by is avoiding cold foods. It is believed cold foods can cause poor blood circulation in the uterus and lead to bleeding or miscarriage. Foods that are considered wet-hot are said to have a poisonous energy and can lead to skin eruptions on the baby (Lau, 2012). Moreover, some symbolic foods are avoided because they will affect the babys character or appearance: Snack can be bad for the babys skin, making it take on a scaly appearance; mutton will cause epilepsy because the disease is sheep-like (faat yeung); and dark foods (fermented soybeans, chocolate, coffee, and Coca Cola) are thought to give a baby a dark complexion (Lau, p. 28, 2012). The birth experience also has a few differences in the Chinese culture.
Birth
Before going into labor Chinese women want to eat to gain energy. On the other hand, in Western culture it is advised to avoid eating to reduce the risk of nausea and vomiting during labor. Western culture will typically offer ice chips to a delivering mother who is thirsty. A Chinese mother will not want this due to it would upset their internal hot/cold balance (Do, 2000). It has been reported that during labor family support is preferred over pain medications (Sullivan, 2012). A Chinese laboring mother is traditionally expected to not cry out or scream during labor and may favor sitting or squatting to give birth. Another tradition practice is for the father to not be involved with the labor process, but female family members such as the mother or mother-in-law would play a major support role during the labor. Some distress could occur if the mother is not given choices in relation to cultural traditions versus western practices (Faculty of Monash University, 2009). The postpartum period for Chinese women also has a few contrasts to western culture.
Afterbirth
Some superstitious beliefs for the baby after birth are apparent in Chinese culture. One belief is if the baby is dressed in used clothes it can inherit characteristics of the previous owner. It is also believed the gods may take a baby away if one were to call the baby heavy or beautiful. One emphasized Chinese postpartum tradition is called sitting the month. This tradition involves the mother spending a month focusing on rest but includes some very strict restrictions. During the month the mothers are not supposed to go outside, visit others, eat at the table with the rest of the family, eat raw or cold foods, wash herself or her hair, get sick, read, cry, have sex, or burn incense. They are also told to avoid the wind, avoid walking or moving a lot, and wash their rice bowl in boiling water (Sullivan, 2012). It was discussed earlier that the female family members play a major role in the labor process, but they continue this major role throughout infant care.
Infant Care
When it comes to how to care for an infant the Chinese women will typically look for advise from the older female relatives. In fact, the older female relatives tend to take over the caregiver role for the infant during the first 24 hours after birth and during the time the mother practices sitting the month. This vital role is typically filled by a grandmother who is also seen as having an authoritative position. For this reason, it is important for the grandmother to be included in patient teachings (Faculty of Monash University, 2009). At the end of sitting the Month the Chinese consider this time as the childs first birthday or its full moon. This 30th day celebration is called man yue. On this day the ritual of shaving the hair of the baby is performed. Some traditions call for the baby to be dressed in new, preferably red, clothes with gold accessories to be presented to deities and ancestors. During this celebration the baby is also shown to relatives and friends for the first time. Hard-boiled eggs, dyed red, are given as gifts to family and friends and symbolize the renewal of life (Yeo, 2013). Infants in the Chinese culture may be over-wrapped and are put to sleep in the prone position. A superstition that continues into infancy is the belief that if an infant is praised, the child may become ill or be taken away by evil spirits (Faculty of Monash University, 2009). Another important part of infant care is infant feeding.
Infant Feeding
Within the Chinese culture colostrum can be considered dirty or stale. Due to this belief the infant is not typically fed colostrum. Instead of colostrum, Chinese mothers may feed their infants with boiled rice water or formula during the first 2 days (Faculty of Monash University, 2009). Chinese traditions also call for an infant to be fed honeysuckle herbs and rice drink at 7 days old. At 30 days old they may begin feeding the infant adult food (Lee & Brann, 2014). There has been a decrease in breast feeding rates in immigrant women living in western countries. This decrease has been attributed to many things including: the transition from an extended to a nuclear family, an increased interest in Western norms, a need to work or study, the social isolation caused by language barriers, the availability of infant formula, an inability to access and consume traditional confinement foods, conflict between their traditional practices and those of the host culture, and acculturation (Zhou, Younger, & Kearney, p.2, 2018). There are many things that can be addressed with patient/family teaching that have been discussed in this paper.
Patient/Family Teaching
Assisting and promoting clients about self-advocacy and what is appropriate to discuss with a health care provider can be beneficial in any health care setting. This can help in some misinterpretations from communication differences. Discussing nutrition options to ensure pregnant women are getting the nutrition they need while practicing the strict dietary restrictions is also an important teaching point. After birth, if a woman needs an episiotomy, she may not want to use ice packs to reduce swelling due to the need to balance hot/cold. Due to this, it would be important to discuss other options to reduce swelling. It may also be beneficial to teach the new mother of the benefits of colostrum. It would be important to discuss with the new mother the availability of staff during the first 24 hours after birth if the patient wants to adhere to the cultural tradition of not being around the infant if there is not family available. When the Chinese mother plans to practice the tradition of sitting the month it is important to discuss options for leg exercise and other techniques to reduce DVTs. Many women reported the difficulty of practicing sitting the month and addressing ways to support emotional health as well as signs of postpartum depression is also important. As with any patient, any need they state or you notice, should be addressed.
Conclusion
Cultural competence plays a vital role in effective health care. Cultural competence includes knowing how to communicate, verbally and nonverbally, to effectively treat a patient. Being aware of what health means to each culture and providing care on this basis to the best of your ability. Pregnancy can be a vulnerable time for any woman and knowing someones culture and catering to that can make a huge difference. Afterbirth, infant care, and infant feeding are all parts of parenting that should be addressed before a new family heads home from the hospital. Individualizing patient teaching to each culture, family, and person and eliminating ethnocentrism is the key to providing excellent care. If a health care provider did not focus on cultural competency there would be so many missed opportunities for patient teaching before the patient is discharged. Family-centered, culturally competent, holistic, evidence-based practice is the kind of care that is expected of every health care provider and deserved by every patient.
References
- Cheung, R., Nelson, W., Advincula, L., Cureton, V. Y., & Canham, D. L. (2005). Understanding the Culture of Chinese Children and Families. The Journal of School Nursing, 21(1), 39. doi: 10.1622/1059-8405(2005)021[0003:utcocc]2.0.co;2.
- Do, H. (2000, June 1). Chinese Cultural Profile. Retrieved November 2, 2019, from http://ethnomed.org/culture/chinese/chinese-cultural-profile.
- Faculty of Medicine, Nursing and Helath at Monash University. (2009). Chinese Dimensions of Pregnancy, Birth, and Post-Natal Care- Chinese Profile. Retrieved November 2, 2019, from https://www.health.qld.gov.au/__data/assets/pdf_file/0027/158661/chinese-preg-prof.pdf
- Lau, Y. (2012). Traditional Chinese Pregnancy Restrictions, Health-Related Quality of Life and Perceived Stress among Pregnant Women in Macao, China. Asian Nursing Research, 6(1), 2734. doi: 10.1016/j.anr.2012.02.005.
- Lee, A., & Brann, L. (2014). Influence of Cultural Beliefs on Infant Feeding, Postpartum and Childcare Practices among Chinese-American Mothers in New York City. Journal of Community Health, 40(3), 476483. doi: 10.1007/s10900-014-9959-y.
- Sullivan, D. H. (2012). Culturally Sensitive Insight into Chinese Immigrants Childbearing Traditions. International Journal of Childbirth Education, 27(1), 2326.
- Yeo, T. R. (2013, June 14). Chinese birth rituals. Retrieved November 2, 2019, from http://eresources.nlb.gov.sg/infopedia/articles/SIP_2013-05-14_113920.html?s=chinesebirth-rituals
- Zhou, Q., Younger, K. M., & Kearney, J. M. (2018). Infant Feeding Practices in China and Ireland: Ireland Chinese Mother Survey. Frontiers in Public Health, 6. doi: 10.3389/fpubh.2018.00351.
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