University of San Agustin General Luna St., 5000 Iloilo City, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS DEPARTMENT OF NURSING JAPANESE CULTURAL CARE Group 2 JAPANESE CULTURAL BELIEFS -Shintoism is Japan's indigenous spirituality. It is believed that every living thing in nature (e.g. trees, rocks, flowers, animals - even sounds) contains kami. Kami are not God or gods. They are spirits that are concerned with human beings - they appreciate our interest in them and want us to be happy - and if they are treated properly they will intervene in our lives to bring benefits like health, business success, and good exam results. -Shinto is an optimistic faith, as humans are thought to be fundamentally good, and evil is believed to be caused by evil spirits. Consequently, the purpose of most Shinto rituals is to keep away evil spirits by purification, prayers and offerings to the kami. Shinto is not a way of explaining the world. What matters are rituals that enable human beings to communicate with kami. Value Orientations - Time is VALUED Time is considered valuable and must be used wisely. The basic idea of punctuality in Japan is that you should be ready to go with whatever is planned at the starting time. This means, for example, if your work shift starts at 9:00 you should be in the office, at your desk with your computer on at 9:00. Hard work in the present is seen as important for future successes. Polychronic time is associated with doing many things at once and is concerned with relationship rather than task completion. They suggest that the Japanese tend to use monochronic time when dealing with outsiders but polychronic time in their interpersonal relations. Communication Practices - Japanese: Use much non-verbal language; may understand written communication better than conversational language. Emotions are often hidden. Silence is often used. The Japanese culture is a relatively non–eye contact culture, and this is quite noticeable in public speaking and in the communication process. Most Asian Americans consider it disrespectful to look someone directly in the eyes, especially if that person is in a superior position. For some Japanese Americans, emotional expression of anger is unusual, and a stoic reaction is often manifested as a response to pain. Gaman is a Japanese concept that stems University of San Agustin General Luna St., 5000 Iloilo City, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS DEPARTMENT OF NURSING from the verb gamansuru, which translates as “to bear, to endure, to tolerate” and which has to do with self-control and endurance. Japanese elders found that gaman had importance in help-seeking behaviors among nisei who tended to value enduring pain and discomfort with perseverance and dignity. Gaman is also considered a valuable social skill to be learned in childhood and used later in life when facing hardships, such as when in pain. Kinesics. Estimates that, for Japanese, communication of feelings and attitudes is 5% verbal, 38% vocal, and 55% facial expression. Thus, facial expression plays a crucial role in communicating emotions and attitudes. It is essential to remember that the traditional behavior of some Japanese is to control emotions, especially in formal and public situations. This value is believed to have originated in heijo-shin (“ordinary state of mind”) in Zen Buddhism, which advocates controlling emotions and maintaining a neutral presence. An inappropriate smile may sometimes be seen as an unconscious and reflective attempt to avoid troubling others by showing one’s true feelings. Touch Japanese culture is viewed as a non-touch culture. A hug is rarely offered and hugging is not common practice. There is close contact with infants but less touch or physical contact among adults. found that Japanese touch family members less frequently than people in other cultures do. Physical contact may be perceived negatively and introduce tension into relationships Communication Practices Implication to Nursing Care Because it is impolite to think of personal needs, some Japanese Americans, when asked if they want something to eat or drink, may respond negatively. In such instances, if the nurse does not try to persuade the client to eat or drink, the nurse may be perceived as insensitive. The nurse should offer at least two to three times, even after receiving a negative reply the first time. The nurse can learn to anticipate needs and accurately assess discomforts by relying on astute interpretation of the meaning of nonverbal expressions and behaviors. It is essential to remember that subtle facial expressions and gestures are expected to be understood. Japanese clients may wait silently rather than ask questions because they believe health care providers know best and will meet their needs without being asked. This relates to a high regard for “anticipatory care” and the concept of omakase. Omakase refers to a coping style that allows the patient to place his or her trust in the physician or nurse; University of San Agustin General Luna St., 5000 Iloilo City, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS DEPARTMENT OF NURSING therefore, the health care provider carries the burden for the patient. For the Japanese, health professionals are authority figures and are to be trusted. Family System -Strong intergenerational family structure is practiced. Intergenerational relations are close among most Japanese. There continues to be a flow of goods, money, and services among the generations. The general pattern of the Japanese family is the vertical family structure, with the father and other male members in the topmost position. “Vertical” social structure means that relationships are clearly defined to those above or below, a clearly determined line of social status. The phrase kodomo no tame ni (“for the sake of the children”) reflects the sacrifices and hardships families would endure to ensure the success of the next generation. Many of the activities in the Japanese family occur in both the nuclear family and the extended family. Problems are handled within this structure, and the achievement or accomplishment of the individual member is a reflection on the entire family. - Self-control and self-reliance are valued. The younger generation continues to be willing to assist and give more than what is requested and expected by the older generation. Yet despite a long-standing tradition of family connection and caregiving, Japanese American families face challenges similar to those of other populations—aging parents, fewer available caregivers, more women in the workforce, and geographic mobility. Elders tended to want contact and connection with family but did not want to be burdensome. Their worries that there could not be reciprocation of support, and a sense of self-reliance on the part of the elder. For some Japanese, the self is viewed as part of a set of interpersonal relationships, of which the family system is the central core. In this sense, the self is subordinate to the family social unit, and consequently most Japanese find it difficult to stand out publicly as individuals. This difficulty is evidenced by the reluctance of some Japanese to give speeches, talk about themselves in casual conversations, or engage in self-serving behaviors. Fostering of amae, or “interdependency,” is also seen as a method of enhancing group solidarity and social relationships. This concept is also based on preservation of harmony and the suppression of conflic. Amae (“passive love”), as defined by , means “to depend and presume upon the benevolence of others” and is often associated with the Japanese word for “sweet” ( amai ). Family System Implication to Nursing Care University of San Agustin General Luna St., 5000 Iloilo City, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS DEPARTMENT OF NURSING Because many Japanese place a high value on the family system, the nurse should be aware of the significant role the family plays in providing support, interdependence, and the fulfillment of duties. Respect is also greatly valued, and the linear relationship apparent in families and in casual relationships should be maintained and supported when providing care for the Japanese client and family support system. Although these values are the strength of the Japanese family, they can create stress and disharmony not only for the client but also for the family unit, especially with inter-racially married offspring. They found that health care providers could play a more active role in assisting families with service identification, information, and evaluation. Because family name and honor are important for this group, the nurse should be especially cognizant of the issue of confidentiality and respect. Information should not be shared with outsiders, even with extended family members who may appear close to the client. Information concerning illness is often kept within the immediate family. Japanese Health Beliefs and Practices - Health is maintained through harmony with the world. Poor health may be caused through contact with impure elements such as corpses, blood, or skin disorders. Major beliefs that have contributed to medicine in Japan influence the Japanese-American person’s view of health and illness. In the Shinto religion, people are seen as inherently good. Evil is caused by outside spirits that cause humans to succumb to temptation and harm, which can be alleviated through purification rites. Disease is believed to be caused by contact with polluting agents, such as blood, corpses, and skin diseases, which accounts for the emphasis on cleanliness Another important belief held by some Japanese Americans is based on the traditional Chinese concept of harmony and balance among oneself, society, and the universe. Some Japanese believe disharmony (with society or family) or imbalance (as from lack of sleep or exercise or because of poor diet) can cause disease. Therefore, restoration of balance should be the major focus of treatment. - Individuals may also utilize acupuncture, acupressure, moxibustion, and herbal medicine, as well as traditional Western medicine to restore the flow of energy. Assessment of pain may be difficult since emotions are often suppressed. Some food combinations may be avoided to avert poor health. For those who still subscribe to the Old World traditional health care practices brought with them from Japan, the basis for health practices may include a mixture of traditional medical practices ( kampo ) brought to Japan from China, Shinto beliefs, and Western medical practices. University of San Agustin General Luna St., 5000 Iloilo City, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS DEPARTMENT OF NURSING Certain foods have special symbolic meaning for Japanese Americans. Special foods, such as soft boiled rice and miso soup (a soup made with fermented soybean paste), may be eaten during illness as well as to promote good health. Traditionally, on their most important holiday, New Year’s Day, most Japanese Americans eat special foods that have symbolic meaning for good health, prosperity, and happiness. Such foods include kazuno-ko (dried herring roe) for fertility, mochi (steamed rice cake) for longevity and prosperity, soba (buckwheat noodles) served in clear broth for longevity and prosperity, and kuromame (black beans) for good health. Other symbolic foods include ozoni (a soup with mochi, vegetables, and/or meats) for prosperity, gobo (burdock root) symbolic of deep family roots, and tai (sea bream, a large red fish served whole) for happy occasions. Dietary Considerations - Asians have a high degree of lactose intolerance. Use of seasonings such as soy sauce, monosodium glutamate, pickled vegetables and fruits, may cause significant challenges when placing clients on high calcium or low sodium diets. - Common maladies and their dietary treatments "Hot" illnesses include, among others fevers, infections, diarrhea, sore throats, and constipation. These can be treated with "cold" foods such as vegetables, fruits, dairy products, and chicken. "Cold" illnesses include, among others, cancer, pneumonia, colds, headaches, and stomach cramps. These can be treated with "hot" foods such as chocolate, cheese, eggs, beef, cereal grains, chili peppers, and hard liquor. Japanese Health Beliefs and Practices Implication for Nursing Care The nurse must also remember that some Japanese Americans value self-control, particularly in areas they believe may reflect weakness or inadequacy. The loss of “face” and dignity should be especially considered in procedures and treatment. The desire to gaman may affect the Japanese American’s willingness to request pain medications. Nurses can offer their time and practice attentive listening skills. Nurses also can make sure the patients and their families understand that it is expected that they express concerns and feelings. The nurse should inquire about treatments the client is using at home and what measures are most helpful. Special foods, tea, or herbal decoctions may be important for the client to have if there are no contraindications. University of San Agustin General Luna St., 5000 Iloilo City, Philippines www.usa.edu.ph COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS DEPARTMENT OF NURSING
