A Culturally Competent Approach

Chinese American Culture

Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Overview/Heritage ▪ China’s population of over 1.3 billion people is

dispersed over 3.7 million square miles, with cultural values differing according to geographic location as well as other variant cultural characteristics.

▪ Chinese in the United States exceed 1.6 million people with the largest communities in California, New York, Hawaii, and Texas.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Overview/Heritage

▪ A university education is highly valued; however, few have the opportunity to achieve this life goal because of limited enrollment opportunities.

▪ Often, young adults come to Western countries to attend universities seeking more advanced prestigious educations.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Overview/Heritage

▪ Many newer immigrants are professionals from Hong Kong.

▪ Chinese Confucian ideals emphasize the importance family and neighbors and reinforce the idea that all relationships embody power and rule.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Overview/Heritage ▪ Other important values are filial piety, industry,

patriotism, deference to those in hierarchal positions, tolerance of others, loyalty to superiors, respect for rites and social rituals, knowledge, benevolent authority, thrift, patience, courtesy, and respect for tradition.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Communication ▪ The official language of China is Mandarin (pu

tong hua), spoken by about 70% of the population, but other major, distinct dialects such as Cantonese, Fujianese, Shanghainese, Toishanese, and Hunanese exist.

▪ The dialects are so different that often two groups cannot understand one another verbally.

▪ The written language is the same.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Communication ▪ Most Chinese people speak in a moderate to

low voice tone and consider Americans to be loud.

▪ When asked whether they understand what was just said, the Chinese invariably answer in the affirmative to avoid loss of face.

▪ The Chinese share information freely once a trusting relationship has developed.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Communication ▪ Most Chinese maintain a formal distance

with each other as a form of respect. ▪ Many are uncomfortable with face-to-

face communications, especially when there is direct eye contact.

▪ Titles are important to Chinese people.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Communication ▪ The family name is stated first and then the

given name. ▪ Calling an individual by any name except his/

her family name is impolite. If a person’s family name is Li and the given name is Ruiming, then the proper form of address is Li Ruiming.

▪ Traditional women do not use their husband’s name after they get married.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Communication ▪ Many Chinese take an English name as an

additional given name because Chinese names are often difficult for Westerners to pronounce.

▪ Some give permission to use only the English name.

▪ Some switch the order of their names to be the same as those of Westerners with the family name last.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ Traditionally the Chinese family was organized around the male lines.

▪ Most believe that the family is most important and, thus, each family member assumes changes in roles to achieve this harmony.

▪ Children are highly valued because of the Chinese government’s past mandate that each married couple may only have one child.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ Independence is not fostered. The entire family makes decisions for the child even into young adulthood.

▪ Children born in Western countries tend to adopt the Western culture easily.

▪ Adolescents maintain their respect for elders even when they disagree with them.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ Children feel pressure to succeed to help improve the future of the family; thus, most children and adolescents value studying over playing and peer relationships.

▪ Children are taught to curb their expression of feelings because individuals who do not stand out are successful.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ Chinese children in the USA are becoming more outspoken as they read more and watch television and movies from the Western world.

▪ The perception of family is developed through the concept of relationships. Each person is identified in relation to others in the family.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ The individual is not lost, just defined differently from individuals in Western cultures.

▪ Extended families are important.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ Children may live with their grandparents or aunts and uncles so individual family members can obtain a better education or reduce financial burdens.

▪ Teenage pregnancy is not common, but it is increasing among Chinese in America.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ Older people are venerated and viewed as very wise.

▪ Children are expected to care for their parents when self-care becomes a concern; in China, law mandates this.

▪ The Chinese word for privacy has a negative connotation and means something underhanded, secret, and furtive.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Family Roles and Organization

▪ The one subject that is taboo is sex and anything related to sex.

▪ Same-sex relationships are not condoned. ▪ In many provinces, they are illegal and punishable

by death.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Workforce Issues

▪ True equality does not exist in the Chinese mind; if more than one person is in power, then consensus is important.

▪ If the person in power is not present at decision- making meetings, barriers are raised, and any decisions made are negated unless the person in power agrees.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Workforce Issues

▪ Chinese adapt to the culture in the workplace quickly.

▪ They frequently call on other Chinese people to teach them and to discuss how to fit into the new culture more quickly.

▪ Autonomy is limited and is based on functioning for the good of the group.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Workforce Issues

▪ When a situation arises that requires independent decision making, many times the Chinese know what should be done but do not take action until the leader or superior gives permission.

▪ Language may be a barrier for some Chinese. ▪ The Chinese language does not have verbs that

denote tense, as in Western languages.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Biocultural Ecology ▪ Skin color among Chinese is varied. Many have

skin color with pink undertones; some have a yellow tone, and others are very dark.

▪ Hair is generally black and straight, but some have naturally curly hair. Most men do not have much facial or chest hair.

▪ Mongolian spots—dark bluish spots over the lower back and buttocks—are present in about 80 percent of infants.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Biocultural Ecology ▪ Bilirubin levels are usually higher in Chinese

newborns with the highest levels occurring on the fifth or sixth day after birth.

▪ The Rh-negative blood group is rare. ▪ Chinese people generally have an increased

sensitivity to the effects of alcohol

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Chinese Biocultural Ecology

▪ Poor metabolism of mephenytoin occurs in 15 to 20 percent of Chinese.

▪ Sensitivity to beta blockers, such as propranolol, is evidenced by a decrease in overall blood levels accompanied by a more

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A Culturally Competent Approach

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