The majority of Japanese immigrants began arriving in the United States toward the middle part of the 19th Century. These first Japanese immigrants passed down many characteristics of historic Japanese culture to subsequent generations, and these characteristics still abide in the Japanese American psyche (Easton & Ellington, 2010). Today, Japanese culture is prevalent in many areas of the Western U.S., most notably in the cities of Los Angeles, San Francisco, Portland, and Seattle. It is important for providers to understand that features of the historic Japanese culture remain within the mindset of Japanese Americans, and that these cultural characteristics influence the values, the communication practices, and the health care perspectives of Japanese Americans.
In order to deliver culturally congruent care, providers should be aware that certain cultures possess differing values systems, and these values can have an effect on how a particular client within the culture communicates with health care providers. For example, if a person highly values respect, it would be wise for a provider to show the utmost respect for his or her client, perhaps by simply calling the client “Mr. or “Mrs.,” lest the therapeutic relationship suffer. Providers should also be aware that culture has an effect on how a client perceives his or her own health, how a client views the causes of illness and disease, and how a client responds to particular health interventions (Potter & Perry, 2009). Some Japanese Americans possess deep-rooted patterns of communicating that they use when interacting with other people. Providers should be familiar with these communication patterns, as well as the attitudes that some Japanese Americans may have toward alternative and complimentary therapies and death and dying issues. Only when providers understand these particular issues pertaining to Japanese Americans can they be able to deliver the culturally competent care needed to ensure desirable outcomes for their clients. Japanese Values
Many health care providers are familiar with the core values associated with Japanese culture such as politeness, harmony, group orientation, and the desire for success. The Japanese also have three distinct words to characterize three traditional values that, although dismissed by some as archaic remnants of the past, still permeate the culture (Wood, 2006). The first value, on, illustrates indebtedness. When Japanese Americans perceive that they are receiving high quality care, they may show their indebtedness by profusely thanking the caregiver. The concept of giri translates into an obligation to the community. Providers caring for a Japanese American may perceive that the client is very demanding when it comes to the care they receive, as he or she may believe that it is the obligation of the caregiver to operate in a precise and professional manner. The last traditional Japanese value is ninjo. Ninjo refers to the desire to follow a path that one thinks feels the most natural, despite social obligations (Wood, 2006). A provider who does not deliver excellent care to a Japanese American may find that the client wishes to be cared for by another healthcare professional. Communication
All cultures can be categorized into two broad communication paradigms: low context and high context. People who operate in a low context culture tend to communicate in a direct manner, and they rely on the dissemination of explicit thoughts and ideas in order to give and obtain information. Conversely, people who function in a high context culture, like many people of Japanese decent, tend to be less likely to explicitly express their views, preferring instead to communicate in a less direct manner (Thill & Bovee, 2008). The fact that many Japanese Americans operate in a high context cultural environment has tremendous healthcare implications.
If a provider is attempting to assess the pain level of a Japanese American, the provider should take into account not only what the client actually says about his or her pain level, but also what the client may be saying with his or her eyes or through the use of body language. People of Japanese ancestry are likely to participate in a subtle exchange of messages with those in which they interact in order to attain a shared understanding. It often becomes important for a provider to look beyond what the client is actually saying, as it is not uncommon for Japanese Americans to suppress their emotions. According to Thill & Bovee (2008), the high context Japanese culture does not automatically change simply because someone from a low context culture is communicating with them.
Providers should be aware of the unique Japanese cultural communication and behavioral concept called amae. Although there is no English equivalent for this word, amae generally translates into a desire to be taken care of, along with the desire to depend upon another person’s benevolence. Providers should also be aware that amae often carries over into adult life in people of Japanese ancestry (Lebra & Lebra, 1986). A provider caring for a Japanese American client may notice that some clients may not wish to feed or bathe themselves, or walk to the bathroom, even though he or she is able to do so. Understanding the concept of amae can help providers develop a treatment plan for increased motility by encouraging a Japanese American client to do certain tasks on their own in order to become more independent and self-confident. Alternative and Complimentary Therapies
Many Japanese Americans rely upon alternative therapies that compliment traditional western medicine. These therapies include Kampo, Shiatsu massage, Japanese acupuncture, Japanese herbal medicine, and the popular therapy known as Reiki. A Japanese Buddhist Monk developed Reiki, the spiritual practice of palm healing, in the early 20th Century. The Japanese word Reiki means “universal life energy,” and this practice is used to reduce anxiety, stress, and pain; it is also used as a means to support overall well being (Mills, 2008). Providers should be aware that Japanese American clients are very open to this form of alternative and complimentary therapy. Understanding that some Japanese American clients may want a Reiki practitioner present in their room after a surgery procedure can help a provider better create a culturally sensitive health care plan for the client. Death and Dying
People of Japanese ancestry may look at the issue of euthanasia differently than those of other Americans. Whereas for the most part the Christian religious viewpoint on death and dying decries acts of euthanasia, many Japanese Americans, with their spiritual beliefs rooted in non-theistic or polytheistic religions such as Shintoism and Buddhism, may not see these issues in such unconditional terms. The country of Japan has practiced euthanasia for much of its history, and some Japanese view the prolongation of life by the use of artificial methods as an abhorrent action against life itself. A person’s right-to-die is engrained into the Japanese culture (Tanida, 2010). Providers should be culturally sensitive to the family of a Japanese American client who, for example, may be in a persistent vegetative state. Although a provider may adamantly disagree with the decision, if a Japanese American family chooses to not keep their loved one connected to artificial feeding tubes, a provider should not attempt to persuade or admonish the family simply because the family’s views on death and dying differ from his or her own views on the subject.
The Japanese culture also has a history of glorifying suicide. The belief that suicide is a respectable escape from this world can be traced back to the times of medieval samurai, and this belief is still embedded in the Japanese psyche (Fackler, 2009). A provider should take into consideration the possible propensity for Japanese Americans to romanticize suicide when he or she interacts with clients. This is especially important when providing grief counseling to a client who has recently lost a loved one, or when caring for a client attempting to recover from a debilitating disease. A Japanese American may not give outward verbal signs that he or she is severely depressed or is contemplating suicide. He or she may not express their belief that life is not worth living or that people would be better off without them, due to the high context nature of the culture.
Providers should pay particular attention to other common risk indicators, such as changes in physical activity, weight or sleeping patterns, as well less explicit cues, such as instances of a client giving away personal belongings or obtaining a weapon. Suicide is the third leading cause of death in people aged 15-24, men are four times as likely to kill themselves as are women, and the highest suicide rates occur among those who are over 65 years of age (Hoffman, 2009). In light of these facts, providers should pay particular attention to Japanese American clients in these demographics. Conclusion
In order to properly adapt care for Japanese American clients, it is important for providers to understand how people raised in the Japanese culture communicate and perceive health issues. By recognizing differences in communication style, providers can better interact with clients and in turn be in a better position to understand client needs. Understanding differences in views on alternative therapies and death can help a provider to better create care plans and to initiate appropriate interventions. This recognition and understanding helps providers provide culturally competent care to ensure the best possible health outcomes.
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