Korean American
Peterson Germain
New York City College of Technology
NUR 4030 Section 8533
December 13, 2013
Dr. K. Falk
In an increasingly diverse society, case managers must be aware of the cultural beliefs and practices of the people they serve in order to effectively coordinate their care and help patients or clients adhere to their treatment plan (Case Management Advisor, 2011). According to the U.S. Bureau of the Census (2000), over 30% of the total population, or one out of every three persons in the United States, is comprised of various ethnicities other than non-Hispanic Whites (Maier-Lorentz, 2008). Furthermore, Maier-Lorentz stated that the U.S. Department of Commerce (2000) projects a steadily growing population of persons from ethnicities other than non-Hispanic Whites, comprising 50% of the whole population by 2050 (Maier-Lorentz, 2008). In this paper, I will discuss transcultural nursing for Korean American in relation to case management. The three main ideas I will address are perceptions about end of life care, mental health and cancer screening.
Due to the patient self determination act in the United States, patients are expected to be the final decision maker of their own health by actively participating in the process of end of life decision (Kim & Foreman, 2011). But unlike whites, Korean American prefers family centered decision making to self determination because they hold unique cultural beliefs, value and practice (Kim & Foreman, 2011). Contrary to the American culture which is based on individualism and autonomy, traditional Korean culture stress “familism and filial piety”. The latter and former are defined by Kim and Foreman as devotion or loyalty to family, it stresses family harmony, family solidarity and family reciprocity; and filial piety entails respecting, caring, obeying one’s parents, is an underlying value in the care for older adults (Kim & Foreman, 2011).
In traditional Korean culture, adult children are expected to have sole responsibility in caring for their parents not only as the primary caregiver but also as their parents’ proxy agents (Kim & Foreman, 2011). Furthermore, the family is deeply involved in individual health care decisions; and at times the family decision prevails over the individual decision (Kim & Foreman, 2011).
Traditionally, Korean people believe that the children should do everything to prolong a parent’s life (Kim & Foreman, 2011). Due to the high value of filial piety, if the children stop life support treatment for their parents it could dishonor the family in the Korean community even if it was the parent wishes to discontinue life support (Kim & Foreman, 2011). Another area of concern for Korean American is their perception about mental illness.
According to Jang and Al. many Asian American consider symptoms of depression as a sign of weakness or lack of disciplines and willpower (2009). Based on Confucian ethics, Korean American tends to believe that self concealment of emotional problem is the right way to go (Jang & Al., 2009). They do not accept the medical model of depression that portrays it as a disease requiring professional treatment (Jang & Al., 2009). Due to their culture, they hide their emotional symptoms and distress and they use stoic approaches instead (Jang & Al., 2009). In addition, they perceive mental illness not only as a personal matter but also as a threat to the equilibrium and harmony of the whole family because it brings dishonor to the family name (Jang & Al., 2009). The last among other concerns I will address about Korean American is their perception about cancer screening.
Korean American is at a high risk for cancer mortality and morbidity due to late diagnosis of the disease. The latter is caused by relatively low rates of breast and cervical cancer screening (Lee, 2007). It has been reported that only 22%–75% of Korean American women had ever had a Papanicolaou (Pap) test, and only 26%–63% had had the test in the prior two to three years. For breast cancer screening, 48%–78% of Korean American women had ever had a mammogram and 34%–61% were estimated to have had a mammogram in the prior two years (Lee, 2007). The above screening rate is far lower compare to the national random sample rates which show that 94 % of women age 18 and older had a Pap test and 84% had it in the last two years; and 87% women age 40 and older had a mammogram and 75% did it in the last two years (Lee, 2007).
According Lee, Korean American women may attribute unique meanings to body parts in their social and cultural contexts (2007). In their culture, sexuality, especially in women, is associated with taboos (Lee, 2007). As a result the symbolic meanings of their bodies, particularly their breasts and cervix, may influence their beliefs about cancer as well as their cancer screening behaviors (Lee, 2007).
Korean women are prohibited to talk openly about the breast or cervix. They refer to the breast or cervix indirectly by name. For instance the Korean word for breast is “You-bang or Ab-gasum” which means “milk room” or “front chest” and for the cervix they use “Kyung-Bu” which means “entrance site” (Lee, 2007). In addition, it is a shame to have big breasts in Korean culture, so women have to wear clothes that are tight around their chests, which flattened their breast in order to avoid public display (Lee, 2007). Some of them saw the breast as instruments for breastfeeding and they feel guilty when they are unable to do so; and the uterus as a place for lovemaking and producing babies.
For Korean American women a family history of cancer, improper diet, and stress are the major causes of breast and cervical cancer (lee, 2007). As a result, they think since they don’t have any family history of such disease, they are not at risk for developing breast or cervical cancer (2007). With regard to diet Korean American believe sweetened food and high protein diet and high fat diet and being obese are risk factors for breast or cervical cancer; and that eating Korean food will prevent them from having cancer because it is not high in fat (Lee, 2007). In addition, they believe that stress, such as paying too much attention to their health could cause cancer and that they would not get cancer as long as they were not too sensitive about health related issue (Lee, 2007). They also stated that being old, and not breastfeeding, and not having a small breast and having an inverted nipple put them at risk for getting breast cancer (Lee, 2007).
For cervical cancer they believed that having multiple sexual partners, having poor hygiene, having sex with uncircumcised men, having too many abortions or too many children, and having irregular periods or having a large quantity of blood or pain during menstruation can cause you to have breast cancer (Lee, 2007).
They also associated breast and cervical cancer to their beliefs in God, fate and destiny. As Lee stated, they believed that having faith in God will lower their risk or prevents them from getting cancer and that if it is God will, they will get cancer no matter what they did; and they will not seek treatment if they were to get cancer because they want to accept reality (2007). In addition, for Korean American women getting cancer is bad luck or it is part of their destiny (Lee, 2007).
For end of life care, children can be confused about what to decide and the parents may be at risk of receiving unwanted treatment. So, case manager assessment of and interventions with Korean American older adults should include their children. The case manager assessment should include the values and preferences about life-sustaining treatment at the end of life and the role of children in decision making for their parents (Ko & Berkman, 2010). Case managers can play an important role in educating older adults and their children about life-sustaining treatment and advance care planning (Ko & Berkman, 2010). In addition, case manager may also help the older adult complete an advance directive that is detailed, comprehensive, and targeted to the context of their conditions.
In addition, to avoid conflict between parents and children, and among children, case managers can play a role in facilitating discussion and reducing conflict (Ko & Berkman, 2010). The case manager may help the children to understand, respect, and support the parent’s wishes and to view this as the better way to honor their filial duty (Ko & Berkman, 2010). After the parent death, the case manager may help the children avoid or reduce guilt that they may feel in having accepted their parent’s preference to avoid life-sustaining treatment, and or not requesting that everything possible be done to prolong their parent’s life (Ko & Berkman, 2010).
For mental health, in order to help Korean American feel at ease to seek services, case manager need to minimize concern about stigmatization by discussing them with the patient (Wu & Al., 2009). They need to keep assuring the patient that their confidentiality will be maintained. Case manager, can also assesses patient’s attitudes and beliefs in dialogue about mental health problem and provide them with translated materials about them (Wu & Al., 2009). The case manager need to assess the family relationship for Korean American before developing and implementing any intervention because Korean American prefer to solve problem with family being involves ( Wu & Al., 2009).
For cancer screening, since Korean American women are indirect and subjective when they talk about breast and the cervix, case manager needs not to use the correct medical words when interacting with them so that they will understand what the case manger is saying (Lee, 2007). Case manager need to help them understand that even if they don’t have a family history of cancer, eat healthy or have no stress, or don’t have any abortions they can still have cancer and screening is the only way to detect it early(Lee, 2007). If they are ashamed to display their body parts to others, case manager can arrange for a female provider to examine them instead (Lee, 2007). And even if it is God will or destiny that they have cancer, case manager can let them know that God has put the medical staff to help them by getting screening for cancer and detect any early sign of the disease (Lee, 2007).
According to Ansuya (2012), culture influences how people seek health care and how they behave toward health care providers. In addition, the perception of illness and disease and what causes them varies by cultures, which as a result affect care providers approach to health care; and how we care for patients and how patients respond to this care is greatly influenced by culture. By being culturally competent case managers have knowledge of others cultural ways and are skilled in identifying particular cultural patterns so that an individualized care plan is formulated that will help meet the established healthcare goals for that patient. With the projected health care reform of Affordable Care Act, millions more people will have access to care and having the ability and knowledge of others culture can eliminate barriers to the delivery of health care which will result in better patient outcome and reduce cost of care.
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Lee, E. E. & Reimer, T. T. (2007). Korean American Women’s Beliefs About Breast and Cervical Cancer and Associated Symbolic Meanings. Oncology Nursing forum, (34)3, 713-720.
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