Japanese Cultural Interview and Assessment

Japanese: Cultural Interview and Nursing Assessment

Presentation of client and scenario

This interview was conducted with a Ms. X, a Japanese national visiting friends in another country. She was, over the course of the interview, asked about a number of personal and culturally sensitive factors about her native culture that might affect a nursing intervention.

It is important for a nursing practitioner to keep this in mind as, in the 2000 census, 796,700 residents of the U.S. identified their "race" as Japanese,

Thus it is useful for all nursing practitioners, particularly those residing on the West Coast to keep abreast of Japanese cultural traditions. (Tanabo, 2001) Also, even when residing in Japan, Japanese first-generation immigrants have traditionally seemed less eager than other immigrant groups to assimilate into the hegemonic culture. One measure of this is that compared to other Americans of Asian background, a lower percentage of Japanese elders speak English. "In 1990, only 36% said they did not speak English very well." (Tanabo, 2001)

This difficulty in English communication is one of the first and perhaps most obvious factors to consider techniques and subjects in nursing interventions with members of this population

Socioeconomic factors in cultural assessment guidelines and culturally sensitive interventions

The subject of this interview still resided most of the time in Japan. Although Ms. X was from a relatively affluent Japanese home, and was twenty-three, she was still living with her parents, and intended to do so until she married. This is quite common in Japanese culture, she assured the interviewer, and not seen as evidence of immaturity, but respect, regardless of her own personal state of affluence. She said parents bridled at any attempts upon Ms. X to perhaps share an apartment with a friend, even though Ms. X's friends were 'nice girls,' according to the admittance of her parents. Most of Ms. X's income was thus disposable, and used for her own pleasure.

Increased income and job security was thus not connected, for this unmarried woman, to greater familial independence, as it might be in America. It has been noted that "the Japanese concept of filial piety," which stems from Confucianism and was brought to Japan in the seventh century and has been passed down through the ages still holds strong culturally. Japan is often described, as a society where the 'tall peg' or the nonconformist is nailed down to keep harmony with the whole, and family and social order, filial piety was felt to extremely important. Children are expected to obey and respect their parents, bring honor to their parents by succeeding in work, and support and care for parents in their old age. (Tanabo, 2001)

Thus, an individual, particularly a female individual should not be immediately construed as immature during an intervention, despite a more dependant lifestyle dynamic not dependant upon economics from this culture.

Lifestyle in cultural assessment guidelines and culturally sensitive interventions

Ms. X was dependant upon her family for shelter and emotional sustenance, although she had an active adult social life. At times, this caused conflict with her parents. One potential source of intervention if this was unduly conflict-ridden might be an exchange of Ms. X taking on more financial responsibility in exchange for more freedom -- but culturally, this seems to be incompatible with the family's accepted way of life.

Additionally, for many Japanese "kodomo no tame ni" or "for the sake of the children" is the motto -- in exchange for familial control over many spheres of life that American children might bridle at, given the value of independence in American culture, Japanese children both male and female are seldom required to do chores around the house -- Ms. X's mother, she said, performed most household tasks, despite the presence of the elderly Mr. X's grandmother in the home.

Mrs. X's difficulties with her mother-in-law, while not directly related to her daughter's issues, might be another potential source of intervention, as it seemed to cause conflict in the family dynamic, despite the stress upon taking care of one's elders in the culture.

Family Values in cultural assessment guidelines and culturally sensitive interventions

When discussing family decision-making and how physicians conducted themselves in working with families, Ms. X noted that according to the traditional hierarchy is maintained, the father of the house would preside, then the oldest adult son, although Ms. X's elder brother was no longer living with the family, but attending school. Then the mother, and only then the daughter would have seniority. She noted that in Japan when health decisions were made traditionally, away from the family, and the physician would usually withdraw to allow open discussion and possible arguments to ensue, about serious issues.

Religious preferences in cultural assessment guidelines and culturally sensitive interventions

Ms. X quoted what she said was a common saying in her native land, that the Japanese are born Shinto but die Buddhist. In Shinto, the emphasis is on purity and cleanliness. Terminal illnesses, dying and death are considered "negative" or impure and akin to "contamination." (Tanabo, 2001) This is one reason frank discussions that occur with informed consent procedures, choices in treatment, and advance directives are difficult, and in some cases the elderly patient, as was the case with Ms. X's grandmother, are not fully kept abreast of the seriousness of a potentially dangerous medical condition, for fear of alarming them. But still, Shinto's impurity discourse should not be confused with a fear of death or construing death as bad.

Buddhism also has a substantial impact upon Japanese culture; a religion with a more positive view of death is considered a natural process, a part of life. Life continues after death in the form of rebirth. However, Traditionally, organ donation is not favored because of the importance of dying intact. In the presence of a terminal illness or the need for an abortion discussions may be a little easier since often the "shikata ga nai" view may be held. The meaning of "Shikata ga nai" is "it cannot be helped." This view takes any blame or feeling of failure off of the person and his or her family. It embodies an almost stoic acceptance of a difficult circumstance -- for instance, although abortion and euthanasia are both considered a willful termination of life, they are not viewed punitively against the individual. (Tanabo, 2001)

Heath beliefs and practices in cultural assessment guidelines and culturally sensitive interventions

The traditional Japanese diet has been found to lead much lower risks of heart and cardiovascular diseases than the traditional 'American' counterpart diet. But with increasing adaptation to the western diet of higher meat and less roughage consumption in the form of seaweed, however, "there appears to be an increase in coronary artery disease," although still "breast cancer in older Japanese-American women is lower than in most other U.S. populations." (Tanabo, 2001) However, Ms. X said she ate very little red meat, although seemed more concerned about maintaining her figure and attractiveness than improving her diet for health concerns. She did note that in America, several of her friends had commented how high traditional Japanese food was in salt, one reason that Japanese nationals may often be at risk for hypertension, and she had never realized how high in salt soy sauce and traditional Japanese preserved meat and fish with pickled vegetables were considered. Also, she admitted her female American friends criticized her calcium intake in terms of prevention of osteoporosis, which her mother suffered from -- although, as is typical of many Japanese, Ms. X as well as her mother was lactose intolerant.