There are many characteristics that comprise the Chinese culture that contribute to its uniqueness. Their many customs influence their religion, language, food, art, science, technology, and celebration (Zimmerman, 2017). Those of the Chinese culture are typically one of five possible religions; this includes Buddhism, Taoism, Islam, Catholicism, and/or Protestantism (Zimmerman 2017). China has the world’s largest Buddhist population and their religion is the country’s largest institutionalized religion (Albert, 2018). However, 21% of Chinese still practice folk religions, which blend Buddhism and Daoism (Albert, 2018). The Chinese and their government are most tolerant of Buddhism, and as a result, its number of constituents continues to grow while new temples are built, old ones are restored (Albert, 2018). This tolerance is seen because Buddhism has increased philanthropic activity throughout the country and improved the overall well-being of those in need (Albert, 2018).
Although Buddhism’s popularity has increased in China, Tibetan Buddhists continue to endure religious persecutions (Albert, 2018). The Tibetan Buddhists often face the harshest of punishments because they often challenge the inequalities between Tibetans and Han Chinese (Albert, 2018). Despite Buddhism’s influence amongst the Chinese, Christianity continues to grow and inspires roughly 5% of the population in China (Albert, 2018). Despite Christianity’s growth, religious persecutions on Chinese Christians are on the rise (Albert, 2018). In addition to Christianity, Islam has also impacted Chinese culture and currently boasts ten Muslim ethnic groups, the largest of these being the Hui (closely related to the Han people) and Uighurs (Turks from the Xinjiang region) (Albert, 2018). Even though there are many religious groups throughout China, some have been banned, such as the Church of Almighty God and Falun Gong (Albert, 2018). The government believes that these groups endanger society by promoting political upheaval and violence. Hence, it is important to be knowledgeable of one’s religion and cultural background in order to make the necessary religious/cultural accommodations and allow patients to practice their rituals as desired.
There are several languages spoken by the Chinese culture including Mandarin, Wu, Yue/Cantonese, Xiang, Min, Hakka, and Gain (Zimmerman, 2017). The Old Chinese language first originated from the Sino-Tibetan language and developed during the 11th century (Collum, 2016). Although it was mostly spoken by only scholars and other wealthy citizens, as many as 5 subsets formed (Collum, 2016). Following this period, the Middle Chinese language began to develop throughout the 7th and 10th centuries (Collum, 2016). Rebus writing, and polysemy also soon spread during this era and helped to produce the contemporary language (Collum, 2016). Today, the Mandarin dialect is spoken by 71.5 percent of the population, followed by Wu of 8.5 percent of the population, Yue/Cantonese of 5 percent, Xiang of 4.8 percent, Min of 4.1 percent, Hakka of 3.7 percent and Gan of 2.4 percent of the population (Zimmerman, 2017).
Not only knowing the patient’s language, but also the dialect is crucial in ensuring cultural competence. Until the creation of the People’s Republic of China in the 1940s, most Chinese throughout the different provinces continued to speak in their local dialect (Collum, 2016). As a result, the use of an interpreter or interpreter phone is necessary when a language-barrier exists between the nurse and patient. It is inappropriate to rely on a family member or friend to translate due to violations of patient privacy and/or the inability of the family member/friend to understand particular medical terminology. In other instances, the family member/friend may on translate messages that he/she believes to be important or that he/she agrees with causing many issues. Therefore, discovering the patient’s primary spoken language and providing an interpreter is essential in facilitating communication between the nurse, patient and other medical providers.
In addition to acknowledging a patient’s religion and language, understanding their food preferences are also important. Unfortunately, much of what we know about Chinese cuisine was not shared with the rest of the world until the 1960s/70s when China began to increase its transparency (Rodgers, 2018). The main style of cooking for Chinese food is stir-fried dishes, with the use of peanuts, sesame paste and ginger, while a major food source is rice, which they include in almost all of their meals (Zimmerman, 2017). Although many Americans are familiar with ‘Chinese food’ and believe to know what it encompasses, dishes such as sweet and sour chicken or fried rice are only a small portion of Chinese cuisine (Rodgers, 2018).
Many of the Chinese dishes that we have grown familiar with derive from the Chinese immigrants that came to California from the province of Guangdong (Rodgers, 2018). Nevertheless, according to Dan Gentile, there are multiple red flags we must avoid before indulging in ‘authentic’ Chinese cuisine (Gentile, 2016). Sweet and sour sauce tastes sugary, along with soy sauce being the mainstay of a dish, are two indicators of low-end and unhealthy Chinese food (Gentile, 2016). Soy sauce contains a high content of sodium and can be detrimental to one’s health with every day use. Cooking with ingredients such as soy sauce can lead to excess use and effect one’s health such as cause hypertension. This implication is important to take note of when assessing patients and their dietary intake. Gentile also notes that when deciding on a Chinese restaurant to visit, always avoid those that advertise meals such as egg foo young, mu shu pork, crab rangoon, the infamous fortune cookie, and American desserts (Gentile, 2016). In addition to these troubling signs, the use of the term potstickers, stereotypical Asian font welcoming you through the front door, and pictures of dragons throughout the restaurant are all false advertisements of authentic food from China (Gentile, 2016).
These particular customs are imperative to be knowledgeable of. Considering their typical diet is high in carbohydrates, sugars and salt, we must be mindful of the implications and the effects to one’s health. Although it may or may not be possible to make permanent changes because of one’s culture and beliefs, the use of education in a nonjudgmental and caring manner is crucial and can truly make a difference in one’s future choices. For example, one may not be willing to remove a food item from their diet entirely, however, can be willing to reduce the consumption. Even a reduction in unhealthy choices can make a positive change to one’s overall health and longevity.
Chinese cuisine first began to popularize amongst Americans in San Francisco, California during the 1950s (Rodgers, 2018). In fact, due to the inexpensive meals that were offered, many of the Beatniks soon became fans of Chinese foods after frequenting restaurants throughout Chinatown (Rodgers, 2018). However, the Chinese fusion foods that soon developed differed from authentic Chinese cooking because of available food sources and taste preferences (Rodgers, 2018). American-Chinese foods are usually less spicy than the way in which the Chinese are accustomed to enjoying their meals (Rodgers, 2018). For example, broccoli will rarely be seen in authentic Chinese cuisine, but because this vegetable is grown in the United States, it eventually was added into many Chinese dishes (Rodgers, 2018). Also, authentic Chinese dishes that contain chicken will only feature the ‘dark meat,’ however, since many Americans prefer the ‘white meat,’ this is often seen instead (Rodgers, 2018). On the other hand, there are quirks in Chinese dining, such as chopsticks, that some have thought were Americanized, but in fact not the case. Thus, knowing the typical diet of one’s culture is not only important in understanding their lifestyle, health and dietary choices, but also to ensure we can provide the necessary accommodations during a hospital stay.
Another main aspect of Chinese culture is the use of art (Zimmerman, 2017). Many of the sculptures and paintings created by the Chinese depict spiritual figures of Buddhism (Zimmerman, 2017). Chinese art uses symbolism to convey the artist’s motive and will often display the impact that nature has on people (Kellaway, 2014). This may be why artists will ‘rotate’ their works into and out of the public eye so that we are given a gentle reminder on how art affects us all (Kellaway, 2014). Recently, Contemporary Chinese art experienced a boom due to more focus on a traditional Chinese form, but it has begun to plateau (Kellaway, 2014). As a result, there was a time when Chinese and Western art did not interact with each other. Europeans imported many goods from China between the 13th and 17th centuries, but none of them being works of art. Not until the arrival of the Jesuits in the 17th century did we begin to see a western influence on Chinese art (Kellaway, 2014).
Nevertheless, Chinese and western art continued to diverge from one another in that while western artists used wood or canvas, Chinese artists used silk or paper (Kellaway, 2014). Also, western artists would depict science or technological advancements in their works, while the Chinese would focus on the humanities and poetry (Kellaway, 2014). Hence, these differing styles call into focus the freedom that Chinese artists enjoyed and explored for centuries before the West began to experiment (Kellaway, 2014). Even though the Chinese were considered more-free in their art forms, they also did not stray from their strict culture and would recycle similar pieces (Kellaway, 2014).
Although artistic works were and continue to be an important part of the Chinese culture, conservation of the aforementioned is highly debated. Many believe in editing pieces of artwork to make them look refurbished and new, while others prefer to embellish their age and give the works a more tarnished and aged affect (Kellaway, 2014). At the same time, we should avoid generalizations when examining Chinese art because of the nation’s size and differing opinions on political and social issues. On the other spectrum of art and culture, martial arts are a common practice in China where the techniques mimic animal movements (Zimmerman, 2017). Similarly, to most popularized aspects of Chinese culture, those that do not try to inject a western spin on this art form will find that it is very interesting and fulfilling. Thus, many Kung Fu Masters will hesitate to take students under their tutelage because they solely want to educate those that not only want to learn but foresee a future in or with martial arts (Li, 2015). As a result, there are a variety of schools that one can attend, whether it be to become a Master or simply learn the basics to quench their interest (Li, 2015).
In addition to traditional Chinese artworks of paintings, drawings, and martial arts, Chinese music dates-back to the early ruling dynasties (Moore, 2009). During the Shang-dynasty, bronze bells and drums were used in the practice of rituals, while other complex instruments during the Zhou-dynasty showed an understanding of acoustics and physics (Moore, 2009). Other musical instruments, such as a flute-like instrument called xun, and gugin, continue to be an integral part of Chinese culture (Zimmerman, 2017). The Zhou scholars also created the first classification system for musical instruments so that it would coincide with astrological assumptions and ideas (Moore, 2009). Thankfully, the Yuefu (imperial music bureau) was formed during the Han-dynasty and with the help of the Zhou system, were able to collect and preserve the many forms of music that were lost during the Qin-dynasty (Moore, 2009). Therefore, Chinese artwork, the martial arts, and the use of instrumentation can be a nonpharmacological method in which one chooses to relax and destress in a hospital setting. Incorporating features of one’s culture into the delivery of care is essential in providing culturally competent and congruent care. Encouraging patients to perform rituals in which they enjoy and that are part of their culture allow the facilitation of a trusting and open nurse-patient relationship.
A huge aspect integrated into the Chinese culture is Chinese Medicine, and Complementary Alternative Medicine. Traditional therapy, known as Western Medicine, is a system that involves a multitude of healthcare professionals such as nurses, doctors, pharmacists, therapists, etc. (Feleke, 2016). It incorporates the use of pharmacological therapy such as drugs, radiation, chemotherapy, etc. to treat and/or cure illness (Feleke, 2016). On the other hand, Chinese Medicine, or Complementary Alternative Medicine (CAM), involves the use of nonpharmacological methods such as diet therapy, herbal remedies, acupuncture, massage, exercise, meditation, etc. (Feleke, 2016). The Chinese use the complementary therapies as a way to treat any imbalance of the human body (Feleke, 2016). Any imbalance disrupts their homeostasis and causes a disruption in one or more of the five essential elements of the human body (Feleke, 2016).
These five essential elements include wood, fire, earth, metal, and water (Feleke, 2016). The five elements of the body are aspects of qi, which is their life force energy (Feleke, 2016). This energy field flows within the body and maintains a unique balance within the body (Feleke, 2016). If any of the elements become unbalanced, hence, in the presence of illness, there is a disruption in the flow of qi causing a health problem to occur (Feleke, 2016). In this event, alternative therapies such as CAM are used. The use of alternative therapies aims at restoring qi’s flow, restoring balance within the body, and allows the body the ability to heal itself (Feleke, 2016). Acknowledging the use of Chinese Medicine, it uttermost important in our encounter with patients. We must ensure we assess a patient(s) use of complementary medicine and complementary modalities to better understand one’s culture. CAM can include various therapies such as Acupuncture, diet therapy, Moxibustion, herbal remedies, cupping, massage, exercise, meditation and thus, must be made known (Feleke, 2016).
Acupuncture is a modality that involves injecting small needles into various parts throughout the body called meridians (The Healing Modalities of Traditional Chinese Medicine, 2017). The meridians, or acupoints are channels of the body where qi, an energy, flows to allow the body to restore harmony (The Healing Modalities of Traditional Chinese Medicine, 2017). Tui na, is a Chinese massage that uses specific techniques to balance one’s qi (The Healing Modalities of Traditional Chinese Medicine, 2017). Techniques such as deep-tissue massage, joint manipulation, vibration and pinching are used to treat injuries, improve circulation, increase flexibility and reduce scar tissue (The Healing Modalities of Traditional Chinese Medicine, 2017). Herbal Therapy is also used as a form of alternative medicine and a natural remedy to cure certain diseases and illnesses. The remedies used include plants, minerals, fungi, and animal and insect parts, rather than the use of drugs as seen with Western Medicine (The Healing Modalities of Traditional Chinese Medicine, 2017). Moxibustion is also used as a form of heat therapy to stimulate the flow of qi in the body (The Healing Modalities of Traditional Chinese Medicine, 2017). Dried herbs known as moxa are burned near the surface of the skin to allow qi to flow freely (The Healing Modalities of Traditional Chinese Medicine, 2017). Cupping is also a popular Chinese Therapy used as heat therapy to stimulate the flow of qi (The Healing Modalities of Traditional Chinese Medicine, 2017). The heated cups are suctioned to the skin at meridian points and help to restore balance (The Healing Modalities of Traditional Chinese Medicine, 2017). Hence, the Chinese modalities aim at restoring qi in belief to restore health and remove illness. Those of a different culture may be bias and assume that these modalities act as a placebo and do not actually work, however, those of the Chinese culture passionately believe in qi, energy fields and Yin and Yang (opposites attracting).
As a future nurse, it is very important to assess the use of alternative modalities and respect the patient’s beliefs of complementary medicine. It is also important to take note of the herbal remedies used because many different herbs can interact with pharmacological therapy and cause adverse reactions. Therefore, assessing the use of Chinese Medicine and Complementary Alternative Methods (CAM) is crucial. After the nurses assesses the use of complementary modalities, the nurse should inquire about the results and effects of the alternative medicine used. It would be important to assess the patient’s response to the alternative modality and understand the benefit of the modality or herbal remedy used. If the nurse was unaware of a specific modality used, the nurse should respectfully explain that he/she is not knowledgeable of the particular modality and ask for guidance. It would also be significant to research any modalities that the nurse is unknowledgeable of. While researching the alternative healing modality, the nurse could inquire about its uses, benefit, harms, and healing implications. He/she would also have to research its interactions with any medications or other potential treatments. Thus, Chinese Medicine and Complementary Alternative Medicine is a huge part of the Chinese culture and must be better understood to facilitate culturally competent and congruent care.
As future nurses, it is our duty to promote wellness, good health and positive outcomes. One way in which those of the Chinese culture believe to promote wellness is through the practice of Tai Chi. “Tai Chi is often described as ‘meditation in motion,’ but it might well be called ‘medication in motion” (“The Health Benefits of Tai Chi,” 2015). Tai Chi involves slow, mindful movements that integrate the mind, body and soul (Heid, 2017). The practice of Tai Chi integrates ancient Chinese Medicine, philosophy, and martial arts to improve one’s overall health (Heid, 2017). It is a low-impact, slow-motion exercise that uses animal and art movements (“The Health Benefits of Tai Chi,” 2015). Through the performed movements, the focus of attention is on breathing deeply and bodily sensations (“The Health Benefits of Tai Chi,” 2015). The bodily sensations derive from Qi and Yin and Yang (“The Health Benefits of Tai Chi,” 2015). Qi, the flowing energy force is promoted, and Yin and Yang, opposing elements of the universe are kept in harmony to promote balance and equilibrium within all the body’s systems (“The Health Benefits of Tai Chi,” 2015). Tai Chi has been extensively researched and shows to improve overall health ranging from improvements in blood pressure to improvements in cognitive function (Heid, 2017).
The many research studies performed revealed a decrease in the rates of depression, insomnia, illness and inflammation with those who practice Tai Chi (Heid, 2017). Tai Chi has a soothing and calming influence on the body because of its effect on the Sympathetic Nervous System (SNS) (Heid, 2017). The Sympathetic Nervous System activates when the body is under stress, leading to an increased heart rate, respirations and blood pressure (Heid, 2017). Similar to the effects of aerobic exercise, Tai Chi decreases Sympathetic activity allowing better function of the heart and lungs (Heid, 2017).
