Category: Asian American

Growing up Asian American, I never felt inordinately out of place, until I grew up to see the world from another perspective and understood how to world saw me. I was born in Hong Kong which means my ethnic makeup is Chinese-American. My adoptive mother is also Chinese. In many Chinese adoption cases, both the adoptive parents are Caucasian and of older age; but, my story is exceptionally different, from how I got to America and how I experienced this comparatively new culture. By virtue of my mom having the same ethinic background as me, I was too naive to realize my difference in appearance to my family, as well as other people did not have strong inclination to point out it out either. Since my mother has family back in Hong Kong, throughout my childhood I had amazing opportunities to visit my hometown, allowing me to create nostalgic memories and learn about who I could have been. However, as I matured, so did my knowledgeability, and I began to recognize that I do not fit into the mold of a pure Chinese or a pure American. Feeling more insecure and being more conscious of discrimination, I started to seach for outlets of acception. For me, these outlets came in the form of various fine arts – music, film, and visual arts. Visual art in particular, has been proven to be a powerful resource for mental and physical well-being.

While taking art appreciation in college, I was lucky enough to come across a remarkable Asian-American artist named Roger Shimomura. Shimomura’s art style ranges from ukiyo-e woodblock prints, a popular media art that developed during the Edo period, to the flat colors of American pop art. Roger Shimomura is a third generation (sansei) Japanese-American, who was born in Seattle, Washington. Although having a Japanese background, Shimomura does not describe his culture as Japanese culture due to the lack of experience living in Japan and him living in Kansas, where Asian Americans are scarce. That being said, Roger did travel to Japan in 1986, but quickly realized, without really knowing the language, his experience of his ‘hometown’ was limited. He did not feel at home in Asia, describing the difference of being in America versus Japan as, “I could stand on a street corner in Japan and be anonymous, which I couldn’t do here, but the lack of language was crucial”.

Roger did not have the brightest early childhood, as he, along with 120,000 Americans of Japanese descent in Washington, Oregon, and California, were sent to internment camps. The Shimomura family, under President Roosevelt’s 1942 Executive Order 9066, that stated people who posed a “potential threat to national security”, was relocated to Camp Minidoka in Hunt, Idaho. To put into context, this executive order was put in place after the bombing of Pearl Harbor, therefore the tensions between the Japanese and Americans was high; consequently, many Americans grew accustomed to fearing and discriminating anyone who depicted of Asian physiognomy. Of the 120,000 Japanese incarcerated, about two-thirds were native-born citizens. Living through Minidoka at such a young age, the internalizing effects of everyday life heavily seeps into Shimomura’s work. For example, some of his most well known artwork series and exhibitions rooted from the painful repercussions of the Japansese internment – Minidoka a canvas painting series (1978-79), and the Diary series (1980-83), the Minidoka on My Mind exhibition at the Flomenhaft Gallery (2007-2008), and the Yellow Terror exhibition at the Monroe Brown Gallery (2010) and the The Wing Luke Asian Museum (2009). From the Diary series, his grandmother wrote many Haiku poems that celebrated artful protests, ultimately motivating Roger by leaving him with unforgettable advice: ‘When you have information like that, you’ve got to find a way of sharing it’.

Before diving deeper into his artwork, I would like to establish a quick biography of Roger Shimomura, more specifically his credentials. Shimomura earned his bachelors of art in Commercial Design at the University of Washington in 1961; and after serving two years of U.S. military service in Korea, returned to obtain his masters of fine arts in Painting at Syracuse University in 1969. With his MFA, Shimomura taught at the School of Fine Arts at the University of Kansas, being the first fine arts faculty member of KU to be honored as a ‘University Distinguished Professor’. On top of his academic degrees, he has proven himself to be a well-rounded artist, having had over 125 solo exhibitions of paintings and prints, presented his experimental theater pieces at venues such as the Walker Art Center and the Smithsonian Institution as well as has several of his work in permanent collections in over 90 museums nationwide, including the Metropolitan Museum of Art. Mr. Shimomura has been highly recognised by many and has been rewarded more than 30 grants and in 2002, the ‘Artist Award for Most Distinguished Body of Work’ from the College Art Association. Despite retiring in 2004, Roger continues to create artwork, splitting between his studios in Lawrence (Kansas), Seattle, and New York City.

Extracting from the Yellow Terror exhibition, is my chosen artwork of Mr. Shimomura’s, a 60” by 72” acrylic on canvas, finished in 2008, titled Yellow Terror. On that premise, my first encounter with Roger Shimomura’s work is an untitled acrylic on a 60” by 72” canvas that depicts a mix of Western and traditional Japanese superheroes. Both paintings represent Shimomura’s bright, jocose blend of pop art from the West and cartoon imagery from the East that address the sociopolitical issues of Asian American stereotyping. I think that is the primary reason why Shimomura’s artwork resonates with me, because at the heart of his work, is a voice that relates with many Asian Americans and represents our perception of asiatic stigmatizing. Many of his other works include icons I grew up with, like Hello Kitty, Pikachu, Astroboy, Mickey Mouse, Superman, Marilyn Monroe, etc. or at least associate to their respective cultures. Roger Shimomura has even borrowed images from well-known pop artist Andy Warhol, whom was one of his biggest influences, both visually, historically, and stylistically, and Roy Lichtenstein. Shimomura uses nostalgia to capture the audience’s attention for more or less positive purposes; he exploits familiarity to compel viewers to confront their reaction to the underlying visual language of racism. The more I was drawn into researching his illustrations, the further I became enamoured of the stories behind the canvases, hence my decision on Yellow Terror over the untitled artwork.

Given that Roger Shimomura appointed ‘Yellow Terror’ to be the title of his painting but also his exhibition, really shows the significance of the concept behind the two words. Just as the title says, this piece of work emcompasses a large collage of yellow characters meant to represent foreigner notion that Asians have ‘yellow’ skin. Like the game of ‘Where’s Waldo’, Shimomura will place himself in his own art work, giving the spectators more opportunity to see art. In Yellow Terror, Mr. Shimomura is placed in the center of the chaos, seen to be slanting his eyes upwards to impersonate the stereotype of small Asian eyes. In other paintings, like ‘American Mouse’, Shimomura clearly interchanged Mickey Mouse’s cartoon-like features with his own caricature peculiarities. What strikes me more from this painting is not the obvious satire, but the vivid yellow background, a color that seems to be a recurring theme to represent the ‘yellow peril’ conception. The term ‘yellow peril’ is used to “describe the perceived menace and threat of the hordes from the East to the Christian morals, values, way of life, and the social order in the West”. The yellow peril especially emerged when Asian countries posed a political threat to the West from World War II, the Russo-Japanese War, and the Korean and Vietnam War.

Yellow Terror also an exhibition, encompasses what Shimomura could not fit on a 60” x 72” canvas. Before dedicating his life to art, Roger Shimomura was a prolific collector of tchotchkes and memorabilia, the majority of them dealing with Asian and Asian American stereotypes. Alongside the artwork in the exhibition, Shimomura also has displays for his more profound collector’s items, such as salt and pepper shakers, masks, song sheets, movie posters, buttons, magazines, and comics. Shimomura enjoys the hobby of collecting as he says, “My life can practically be measured by what I was collecting at the time”. Collecting started in the 1990’s when he discovered eBay and began to earnestly muster anything related to the internment of Japanese during World War II. It was this particular collection of World War II mementos that lead him to launch the Yellow Terror exhibition. Shimomura includes physical, three-dimensional items to create a unique framework through which the public can view his paintings and prints.

Comics in particular play a role in several of his works, as a child he adored characters like Dick Tracy and Captain Marvel, however many thought he used them as painting the enemy. One returning character in Shimomura’s work is Dick Tracy’s sidekick Joe Jitsu, who was stereotyped with yellow skin tone, slanted eyes, and was a martial arts master who spoke in pigeon English. Many of the characters in the painting Yellow Terror can be interpreted as Shimomura’s take on the character Joe Jitsu, as they share similar features, namely the slanted eyes and black, round eyewear. If you look close enough, you can find the real Joe Jitsu left of the worn Japanese flag in the fourth quadrant. Objects or characters that come from specific social and cultural milieu are often recontextualized in Roger Shimomura’s art, yielding stimulating dialogue between art and subject, in hopes to further engage the viewer. This way, as Shimomura said, “the line between life and art becomes blurred”.

In conclusion, Shimomura’s life experiences and dedication to his works suggest that adherence to racial categories is not necessarily a true reflection of a person’s identity and social relationships. By incorporating tough topics, Shimomura urges onlookers to consider questions that can be difficult to address; and, sometimes people are still uncomfortable with additions like the barbed wire detailing on several works in the Minidoka series, showing that humans are not ready to accept the work based on its real intention. The multicolored and even cheery veneer of Shimomura’s paintings of stereotyping is not a form of acceptance to these atrocities, but response and reshaping. Proof through his World War II trinkets and others, demonstrate the notable role that American popular culture has in evolving and circulating stereotypes as they give a palpable form to racists views. Above all, physical appearance is one of the primary themes of Shimomura’s art and how other individuals perceive Asians, rightly or wrongly. For instance, the pressing color yellow that is our Asian skin that overwhelms Yellow Terror. On behalf of Shimomura, his art and what they hold “serve as a constant reminder of who I once was and from where I have escaped”. To Roger, the importance of remembering the past, specifically towards the younger generation, is that they are lessons of history and American culture. “Those who cannot remember the past are condemned to repeat it”.

The second leading cause of death in the United States for the Asian and Pacific Islander populations is cardiovascular disease. Centers for Disease Control and Prevention (2017) state that about 22.2% of the Asian and Pacific Islander population die from heart disease. The reduction of mortality rates associated with heart disease can be prevented with the control of modifiable risk factors. Modifiable risk factors that contribute to heart disease include prevention and control of high blood pressure, smoking cessation, and diet control (Hinkle, 2017, p.752).

As the Asian and Pacific Islander populations continue to grow, many are faced with difficulties managing their health, receiving access to health care, and overcoming communication barriers in patient education. With the increase in diversity of the Asian and Pacific Islander population, this paper will discuss the largest Asian and Pacific Islander sub-groups from the Philippines, Vietnam, Hawaii, and Japan. Moreover, the purpose of this paper is to discuss the effectiveness of diet restriction and smoking cessation in relation to the reduction of heart disease within the Asian and Pacific Islander population with hypertension. The importance of reducing this health disparity include advantages of cost reduction in preventable hospitalizations and reduced mortality rates will also be further discussed.

Disease Overview

Pacific Islanders and Asian Americans are one of the fastest growing populations in the United States today. According to the U.S. Census Bureau (2017), the Asian American population increased by 3.0% from 17.3 million to 21.4 million and the Pacific Islander population grew by 2.1% with 1.3 million to 1.5 million from 2015 to 2016 alone. The three leading causes of death for the Asian American and Pacific Islander populations include cancer, heart disease, and stroke as stated by the Centers for Disease Control and Prevention (2017). The four causes of hypertension and risk for cardiovascular disease in Pacific Islander and Asian American populations include smoking and physical inactivity, which leads to obesity and diabetes mellitus. Approximately 55.9% of Pacific Islanders and Asian Americans were diagnosed with hypertension in 2013 per the American Heart Association (2016). As mentioned by Hinkle and Cheever (2017), modifiable risk factors for cardiovascular disease include hypertension, cigarette smoking, diabetes, obesity, and physical inactivity (p. 752).

According to Healthy People 2010 (2019), factors that may contribute to hypertension and risk for cardiovascular disease in Pacific Islander and Asian American populations include economic stability, geographic location, language fluency and literacy, and provider availability secondary to provider linguistic and cultural competency. According to Ramkrishnan and Ahmad (2014), the average median household income among Asian Americans is an estimated $72,000 while Pacific Islanders have an estimated median household income of $55,000 from 2008 to 2012. In addition, Ramkrishnan and Ahmad (2014) indicate about 19% of the Asian American population can speak English well while 4% does not speak English at all. On the other hand, about 9% of the Pacific Islander population speak English well. Many Asian Americans and Pacific Islanders come from first generation families that have migrated from remote geographic locations such as the Philippines, Vietnam, Hawaii nad Japan. Most immigrants bring their cultural beliefs as well as difficulties speaking English. As a result, they have a difficult time understanding patient education in order to improve their health.

Advantages of addressing hypertension and its role in preventing heart disease in the United States include the reduction of preventable hospital visits and reduction of cost burden towards patients, especially in low income populations. Centers of Disease Control and Prevention (2017) states that heart disease alone cost $200 billion each year, including loss of productivity, health care services, and medications. Disadvantages of uncontrolled hypertension and heart disease include increased morbidity and mortality rate, and increased number of preventable hospital visits. Approximately 17.6 million deaths in 2016 occurred from cardiovascular disease per American Heart Association (2019). Therefore, the importance of addressing hypertension and cardiovascular disease can greatly reduce the cost as well as morbidity and mortality rates in America.

CARS Analysis of Yoo Et Al. (2015)

Yoo, Musselma, Lee, and Yee-Melichar (2014) examined the different health care disparities that affect the Asian elderly American populations ages 65 years and older. The peer-reviewed article was published on Winter 2014-2015 from the Journal of the American Society of Aging. The article was written by four authors from the San Francisco State University in California: Grace J. Yoo, M.P.H., Ph.D., Elaine Mussellman, R.N., Ph.D., C.N.E., Yeon-Shim Lee, M.S.W., Ph.D., and Darlene Yee Melichar, Ed.D, C.H.E.S. These authors are professors at the San Francisco State University from different departments, such as the School of Nursing, the School of Social Work, and from the College of Health and Social Sciences. In this article, there is a total of 30 references with most resources within six years. This article is relevant because it explores the diversity of Asian American populations and solutions to reduce health care disparities including heart disease and diabetes. The content did not show bias, remained factual and consistent with the supported research throughout the article.

CARS Analysis of Sentell Et Al. (2015)

Sentell, Ahn, Miyamura, and Juarez (2015) explored the cost burden of preventable hospitalizations from diabetes and cardiovascular disease for Asian Americans, Pacific Islanders, and Whites. The peer- reviewed article was published by the Journal of Health Care for the Poor and Underserved in 2015. Three out of four authors of this article hold a PhD and ScD. The author is an Associate Professor at the Office of Public Health Studies at the University of Hawai’i at Manoa with available contact information on the first page. This article contains 40 references with most within six years. This article is relevant because it examines preventable hospitalizations in Asian American and Pacific Islander populations with diabetes and cardiovascular disease. The content remained factual without bias and stated statistics and evidence on the cost of preventable hospitalizations in Asian Americans and Pacific Islanders.

CARS Analysis of Ma Et Al. (2017)

Ma et al. (2017) examined the risk assessment and prevention of hypertension in Filipino Americans. The peer-reviewed article was published on February 2017 by the Journal of Community Health. The author Grace X. Ma, PhD is an Associate Dean for Health Disparities at Temple University, School of Medicine. The five other authors are Academic Researchers and a Board-Certified Doctor specializing in Nephrology, Hypertension, and Kidney Transplantation. The article contains 25 references with most references within a six-year period. This article does not contain any bias and remained consistent and factual throughout. The content was relevant as it contained factors such as lifestyle modifications, hypertension status, acculturation, and health behaviors to improve hypertension and prevent cardiovascular disease in the Filipino, Asian American population.

Nursing Level Interventions

Nurses play a pivotal role in patient education by providing specific patient and family education towards prevention and reduction of disease such as heart disease. Aside from patient education, nurses also conduct assessments to determine patients’ risk in developing complications. Ma et al. (2017) conducted a risk assessment of hypertension in 200 Filipino Americans in the Pennsylvania and New Jersey area. The risk assessment noted that about 66.5% of participants had hypertension, 86.3% were acculturated, 8.5% were smokers, 76.1% were physical active, and majority of 75% reported adding salt to food. Ma et al. (2017) noted that the it is vital to encourage patients to change their dietary pattern including salt reduction to reduce and manage blood pressure. In the study, individuals reported to be more motivated after being told that they have high blood pressure. Therefore, a nurse level intervention would be an assessment of risk factors associated with heart disease. Risk assessments in high-risk minority communities are essential to increase awareness and education. Although patient education is an important tool in promoting awareness towards enhanced self-care and disease prevention effective communication is still an essential factor in creating change. Therefore, the use of translators and translated patient educational resources are helpful in providing high quality care.

Hinkle and Cheever (2018) state that promoting patient education towards modifiable risk factors and promoting self-care are vital in the prevention of heart disease (p. 753). Patient teaching focuses on dietary modifications from controlling cholesterol intake and following dietary measures such reading nutritional data on product labels. Educating patients about nutritional intake of home-cooked meals versus eating at restaurants or fast food chains minimize uncontrolled diet and weight gain. Additional patient education would also emphasize the importance of increased physical activity and weight reduction to decrease coronary events. Ma et al. (2017), also states that Filipino Americans are the only Asian American subgroup with lower control rates of treated high blood pressure with only 38.4% of treated patients with optimal blood pressure control. Prevention of risk factors associated with heart disease also include the promotion of smoking cessation, management of hypertension, and controlling diabetes. Thus, enforced medication reconciliation teaching including the discussion of benefits and side effects of medications is also included in patient education provided by nurses.

Organizational Interventions

Because patient education is important in increasing awareness and education regarding health conditions, organizational interventions can help build a bridge towards individuals who do not have access to health care or lack health insurance. The Centers for Disease Control and Prevention (2017) state that the percentage of the Asian population without health insurance coverage under the age of 65 is 7.4% and is 12.9% in the Pacific Islander population. Therefore, organizational level interventions to reduce health care cost and improve quality of life will engage the public in health educational programs such as free cultural health fairs, free basic health check-ups, and basic screenings. For example, Lee, Chen, Deng, and Parasurama (2015) conducted a study to analyze 377 Asian Immigrants in Michigan and their benefits during a free health fair. The free health fair included volunteer community health workers and bilingual health care providers and doctors, who were able to engage about basic health care screenings. Such screenings including blood pressure, cholesterol, and glucose checks as well as a BMI assessment. Of the 377 participants at the health care, approximately 42.4% did not have health care coverage. Many participated in the free health fair due to lack of insurance and found the health fair as an opportunity to receive free medical attention.

As a result, providing free health care fairs to the public and offering single-ethnic group fairs, gives non-profit organizations, health care organizations, and community and public services the opportunity to reach out to minority populations such as the Asians and Pacific Islanders. Data can be collected during health fairs which will contribute to studies in understanding sub-ethnic Asian and Pacific Islander groups and can be used to help acquire additional resources. The use of free basic screenings such as BMI, blood glucose, blood pressure, and cholesterol checks are useful tools in increasing awareness and educating about prevention for heart disease. In fact, Yoo, Musselma, Lee, and Yee-Melichar (2014) concluded that effective communication is an important key factor in the management of chronic conditions which include increasing awareness and education in diverse populations.

Policy Interventions

To further reduce risk factors associated with hypertension and heart disease, policy and environmental changes are vital in the promotion of health. Policy level interventions to promote environmental and social impact include increasing access of nutritious foods through local farmers’ markets and community gardens while promoting an active lifestyle. Kwon et al. (2015), examined how community-based organizations implemented culturally adapted gardens and farmers markets to expand access to healthy foods across underserved communities. Policy interventions included applying nutritional policies such as incorporating traditional foods, herbs, and vegetables into the diet and implementing worksite policies of increased physical activities during breaks.

In comparison, effective policies in the promoting smoking cessation and decreased tobacco use include implementing peer-education programs and public education. Golechha (2016), examined the effectiveness of a peer-led intervention to stop smoking initiation at schools known as ASSIST, A Stop Smoking in Schools Trial. The study showed effectiveness with a reduction of 22% of students and faculty from smoking in a two-year period. Health and social initiatives such as community-based organizations and peer-led programs are resources that health care providers promote to encourage a healthy lifestyle.

As the population of Asian and Pacific Islanders continue to grow in the United States, the prevention and reduction of risk factors associated with hypertension and heart disease is vital in the prevention mortality and morbidity rates. Sentell, Ahn, Miyamura, and Juarez (2015) state that the estimated average cost of preventable hospitalization is about $87.2 million in Hawaiians and $65.4 million in Japanese. Community health clinics play an important role in the management and prevention of hospitalizations. With fewer risk factors and healthier behavioral changes, potential for preventable hospitalizations improve health equity.

Conclusion

In conclusion, the evidence and research examined shows diet restriction interventions such as patient teaching with the use of free community resources, is effective in reducing heart disease compared to smoking cessation. Whereas, more research and data regarding smoking cessation in Asian and Pacific Islander populations is needed to further analyze its effectiveness in preventing heart disease. Interventive measures to reduce risk of heart disease and promote health equity among Asian American and Pacific Islander populations include nurse-led risk assessment for hypertension and nutritional education, organizational interventions of free health fairs with basic screening and health checkups, and policy interventions of community gardens, local farmers markets, and smoking prevention a school setting.

Furthermore, to understand the health disparity of heart disease within the Asian American and Pacific Islander population obtaining data and statistics from sub-ethnic groups would be essential in providing resources and preventing risk factors. With free access to health care screenings from culturally and linguistically competent health care providers and volunteers, individuals without health care insurance or access can be assisted in preventing chronic conditions such as hypertension, diabetes, and heart disease.

Our America is full of diversity and multiple ethnic groups, this is what makes us unique. How does this help us, if we do not understand the basics about each other? Everyone in healthcare needs to establish and understand their own cultural beliefs before trying to understand those of a different ethnic group. The purpose of this paper is to discuss cultural variations related to terminal illness, death and dying in the Asian American community. The paper discusses my beliefs versus the Asian American beliefs and how the research will impact the future of my nursing career. According to (Wilkinson & Treas, 2011, p. 222), by the year 2050 an estimated nine percent of the United States of America will consist of the Asian American population. As nurses we will provide care to a diverse group of individuals, and with the Asian American population growing it is imperative that we understand how our culture and beliefs relate to and differ from other ethnic groups. This will not only allow health care providers to provide quality individualized care, but it will assist in cutting the cost of health care. “The health care professional who recognizes and appreciates cultural diversity can positively impact financial outcome” (Nishimoto & Foley, 2001). With furthered education and a nonjudgmental attitude, we as nurses can assist in breaking the barrier between different ethnic groups, thus allowing quality care to be given and received.

In order to receive quality health care, the patient must understand what is occurring, why it is occurring, and having a rapport with the health care provider. The same is true for the health care provider and or health care professionals. If we are going to provide adequate quality nursing care, we must understand different cultures and their beliefs towards health care, terminal illness, and death. With the Asian American population at an increased rate we as health care providers should be prepared to provide adequate care based on the culture and beliefs of the Asian American ethnic group. With over 28 ethnic groups inside of the Asian American population, not all the ethnic groups share the same cultural beliefs. Most of the groups practice some of the basic’s Asian beliefs as their ancestors, such as the ‘Yin and Yang’ theory where two forces work together to create harmony within the mind and body. If the ‘Yin and Yang’ is off, disharmony can occur causing an illness (Zhao, Esposito, & Wang, 2010). Another belief that many Asian Americans believe in the power of hot and cold foods. Hot foods aiding with circulation and blood flow to the organs, thus increasing energy. Having to many hot foods may cause illness such as ulcers, increased thirst, and headaches. Cold foods assist with reducing temperatures and removing toxins. Ingesting to many cold foods could lead to gastrointestinal issues, fluid overload, overall cold feeling, and decreased energy. The perfect balance of the hot and cold food is also believed to assist the Asian American’s with a healthy harmony within their body (Wilkinson & Treas, 2011, p. 231). Many Asian American’s do not believe in making eye contact or verbalizing the amount of pain they are in. This is something that we as nurses must know as well as pick up on. In order to break barriers and provide correct and adequate care. Many of the Asian American ethnic groups believe God is punishing them for something they have done when they have a terminal illness, many will not sign an advanced directive since they believe this would be taking it out of God’s hands and putting in to their own (Nishimoto & Foley, 2001). Not all Asian Americans have the same concept on terminal illness, death, and dying. The Cambodian Americans believe that thinking about the death or dying will cause headaches and dizziness, so they try not to focus on the issue. Filipino Americans have the belief of seeking healthcare for acute care but if they or the family member become terminal during the process, they prefer to take them home to care for them. They believe in extended family, if the elders are sick the entire family may come to their bedside. Filipino Americas also believe in the Curer, someone who coms in to assess them to determine their diagnosis by checking their pulse. The head of the family usually make the decisions regarding the patient’s health. The patient usually will not talk openly about dying but will make funeral arrangements. When death occurs, the family will take time to wash the body and dress the body. We as healthcare providers must be understanding of this tradition. It gives the family proper time to grieve with their loved one. When the body is carried out of the room, the feet must go first because they believe that someone in their family will die next if the head goes first. Japanese Americans do not believe in being placed with a room that has a four, this means death in their language. They do not believe in writing wills or signing advanced directives, since this will occur in the future and they cannot predict God’s will. They do not believe in talking about death because talking about may cause death to occur. Japanese Americans also believe that the family should make decisions regarding terminal illness and dying. This takes place to allow the patient to die in peace. This is a direct conflict in healthcare, because the patient has the right to know what is going on regarding their health. Their grief is subtle and silent, which may come of as lacking emotion. They do not belief in autopsy or organ donation, because they believe in dying with the entire body intact. The last ethnic group we will discuss are the Korean Americans. They prefer care for their terminally ill or dying family member at home. They believe this allows their spirit to be at peace. The father of the family makes healthcare decisions regarding the patient’s health. They believe that terminal illness is caused by something they have done wrong and may use herbal medicine to try and cure their illness. In general, take a indirect approach when speaking of terminal illness and death. The majority of Asian American ethnic group believe that illness is God’s will, and God will heal them if that is his will (Nishimoto & Foley, 2001).

In each ethnic group there are differences and similarities. In both the Asian American and African American there is a small percent that believe healthcare works are rude, not understanding, and do not like answering questions. Both groups believe in a higher power and pray for comfort and wellness. Asian Americans do not believe in making eye contact and African Americans do. Asian Americans do not believe in hospice care, where African Americans do. My beliefs and those in my ethnic group believe in making our own decisions regarding terminal illness, death, dying. As an African American we believe in acute care for dying and terminal illness. African Americans believe that the nurse or doctor should tell us what we need to know about our healthcare issues. When one dies the family gets together to grieve, some may cry, and others may sit in silence. Both groups believe that death is will occur but neither like to discuss it in open. Both ethnic groups believe in folk medicine to cure certain terminal illnesses (Wilkinson & Treas, 2011, p. 222). As we research different ethnic groups it is clear to see how different we are and how much we have in common with each other.

Understanding different ethnic groups will allow healthcare providers to provide the best care possible to the patient. Performing research and furthering our education will assist in understanding different cultures. Many Asian Americans believe that the nurse should tell them everything they need to know, and they should not have to ask questions. They find nurses to be cold and sometimes judgmental because we do not understand their culture. Normally healthcare providers believe the patient understands what is being said if they no their head. This is not true in the case of Asian Americans, they shake their head when one is talking to be polite, but they may not understand what is being said (Nishimoto & Foley, 2001). We as nurses must understand how other cultures communicate and learn how to communicate with them. In the future and my practice, I will make sure I know whom to discusses information with regarding healthcare issues, give proper time to grieve, be sensitive to having many family members present, and incorporate other learnings from my research when caring for the Asian American ethnic group. This includes making eye contact, understanding what each nod means, and have an interpreter present if needed.

Although we share some beliefs with other ethnic groups, we are all different at the same time. We as individuals must first understand our culture and beliefs before we can try to learn others. This will allow us to remove any bias and gain a higher understanding of ourselves and others. It is imperative that we as healthcare workers embrace and incorporate furthering our education and knowledge on other ethnic groups and their belief on terminal illness, death, and dying. There should be further research conducted on understanding cultural variations within different ethnic groups. This will allow healthcare workers to provide culturally competent care, give a more open form of communication, increased knowledge that will be incorporated in to practice, increased respect for other beliefs and customs. Thus, improving the perception of healthcare providers, increased knowledge and awareness of health care issues for the patient, and understanding how to prevent illness. We do our patients an injustice when we are ignorant to what they believe in, as well as how we feel about their culture and beliefs. It is our duty to be non-bias and provide quality culturally competent healthcare to any population regardless of color or ethnicity.

References

1. Nishimoto, P. W., & Foley, J. (2001). Cultural beliefs of Asian Americans associated with terminal illness and death. Seminars in Oncology Nursing, 17(3), 179-189. doi://doi.org/10.1053/sonu.2001.25947
2. Wilkinson, J., PhD, ARNP, & Treas, L., PD, RN, CPNP-PC, NNP-BC. (2011). Fundamentals of nursing (2nd ed.). Philadelphia, PA: F.A. Davis Company.
3. Zhao, M., Esposito, N., & Wang, K. (2010). Cultural beliefs and attitudes toward health and health care among Asian-born women in the united states. Journal of Obstetric, Gynecologic & Neonatal Nursing, 39(4), 370-385. doi://doi.org/10.1111/j.1552-6909.2010.01151.x