VIETNAMESE CULTURE

According to the 2006 American Community Survey, the Vietnamese American population in the US grew from 245,025 in 1980 to 1,599,394 in 2006, representing the second largest Southeast Asian American group.

Mass immigration to the US began in 1975 at the end of the Vietnam War with the fall of Saigon. More than 125,000 Vietnamese who had ties with the government or Americans escaped from invading communists. In 1977, a second wave of refugees began fleeing Vietnam as a result of the new communist policies of re-education, torture, and forced relocation. More than two million Vietnamese, who came to be known as “boat people,” fled in small, overcrowded boats to other southeast Asian countries for asylum.

The following cultural patterns may represent many immigrants from Vietnam, but do not represent all people in a community.

Social Structure

The traditional Vietnamese family is patriarchal, with two to four generations and extended family often living in the same home. Family members are expected to work and behave for the good of the group. Traditionally, the father has ultimate responsibility and acts as leader, although due to Western influence household structures and gender roles now vary greatly. In the US, arranged marriages are declining. Parents today take more of an advisory role in the choice of a child’s mate. Divorce is uncommon and is considered shameful within this population, especially for women. Vietnamese people use the family name first, then the middle name, with the first name last. Most names often have a specific meaning and can be used for either gender.

Diet

A typical Vietnamese diet is generally healthy, with rice or noodles, fresh vegetables, and fish or meat. However, the diet also can be high in sodium from fish sauce and MSG, and low in fiber from lack of whole grains. Dairy and soy products are not part of a typical Vietnamese diet, although most children drink milk. Many adults are lactose intolerant and lack calcium. Women generally believe that formula is more nutritious than nursing for their infants.

Some Vietnamese people do not understand that rice and traditional desserts high in sugar and saturated fats from coconut milk and oil cause weight gain and high blood sugar. In Vietnamese culture, chubby children are considered healthy and a sign of prosperity. This population may be susceptible to weight gain, high cholesterol, and diabetes.

Religion

Vietnamese people follow a variety of religions. Prior to the Vietnam War (often referred to as the American War by Vietnamese), Buddhism was practiced by 90 percent of the population in Vietnam. Many Vietnamese are Roman Catholics, a remnant of Vietnam’s occupation by the French, Portuguese, and Spanish. They also may worship spirits and natural forces, or practice ancestor worship or astrology. Confucianism and Taoism have strongly influenced Vietnamese cultural traditions. Many customs are rooted in both the Confucian respect for education, family, and elders, and the Taoist desire to avoid conflict. Stoicism is a highly respected trait.

Medical Care

Vietnamese Americans are at risk of poor health due to language barriers, lack of financial resources, inexperience with American culture, and under utilization of health care services. Many Vietnamese had severe health problems on arrival in the US from poor living conditions, starvation, and abuse during the Vietnam War and in refugee camps. Medical problems seen in this population include TB, hepatitis B, malaria, malnutrition, trichinosis, anemia, leprosy, and intestinal parasites. The most common cancers seen are prostate, breast, lung, and colorectal. Because of exposure to Agent Orange during the war, older Vietnamese immigrants are potentially at risk for cancers, immune deficiency, endocrine disruption, and neurological damage.

Rates of smoking among Vietnamese men are very high with smoking-related cancer endemic in this population. Providers are encouraged to screen especially for cancers of infectious origins, smoking, and exposure to second hand smoke.

Many Vietnamese believe that Asian people are different physiologically than white people. Western medicines are thought of as “hot” and too potent for their physiology. As a result, they may not take medicines as prescribed. Many people attribute symptoms to a physical weakness; for example, a weak heart is expressed by panic, palpitations, and dizziness; a weak kidney is expressed by impotence; a weak stomach or liver is expressed by indigestion; and a weak nervous system is expressed by headache or lack of concentration. Many elders do not trust western medicine and use it only as a last resort. They use traditional remedies as well as western medicines but may not reveal this to a provider. Vietnamese patients often resist invasive procedures and immunizations, and see a provider who does not intrude on the body as the best healer. Some patients believe a physician should be able to diagnose a problem by looking at them and feeling their pulse. Vietnamese people also believe in the medicinal properties of specific foods, such as mung beans, green beans, and bitter melon, which is believed to help control high blood pressure. Acupuncture is used widely for arthritis pain, stroke, visual problems, and other ailments.

Health care providers should be aware of dermabrasive procedures used by Vietnamese patients that leave marks on the skin—and not misinterpret the marks as a sign of physical abuse. Dermabrasive procedures based on the Chinese philosophy of hot/cold physiology are often used to treat headache, cough, nausea, and other maladies. Cutaneous hematomas are made on the face and trunk by pinching and pulling the skin to release excessive air, by rubbing oiled skin with a coin or spoon, or by cupping—heating air in a cup with a flame, then placing the cup on the skin. As the air cools, it contracts and pulls on the skin, leaving a purple mark. Moxibustion, often combined with acupuncture, is the process of making circular superficial burns on the skin with ignited incense or other material placed directly on the skin.

In Vietnam, elders were afforded great respect and roles of authority, but have since lost this special status in the US, leaving many feeling depressed and lonely. However, because many traditional Vietnamese believe that emotional pain is a physical symptom, they avoid referrals to mental health clinics. Mental illness is traditionally considered a shameful thing, often feared or denied. In Vietnam, the mentally ill were hidden away. Although many older refugees may suffer from post traumatic stress disorder, anxiety, and depression, they may not wish to discuss these disorders.

Vietnamese patients may smile easily and often, regardless of underlying emotions in situations other cultures find inappropriate. Because Vietnamese people value politeness and respect for authority, patients may not ask providers questions or voice concerns. If they disagree or do not understand, they may simply listen and answer yes, then not comply with recommendations or return for further care. They may not take appointment times literally, arriving late so as not to appear overly enthusiastic.

Death and Dying

Many Vietnamese people believe medicine is connected to religion and that suffering and illness are an unavoidable part of life. They feel that the length of one’s life is predetermined, and that prolonging life is futile. When a person is dying, family members take turns at the bedside and attend the body after death. Buddhists may ask a monk or elderly person to pray at the bedside to make the person happy before they die. The family may object to autopsy and organ donation.

Arranging a proper funeral for a loved one is one of the most important things a person can do and helps the living grieve and go on with life. Death rituals in the Vietnamese community provide the bereaved a chance to fulfill obligations and complete unfinished business with the deceased. The elaborate details of Vietnamese death rituals require extensive involvement of the family and entire community over a period of two to three years. Death rituals communicate communal responsibilities and can also recreate social order by communicating who will take the place of the deceased.

Source: www.stratishealth.org

The Sunrise Enabler Model

Effective care is the ultimate task of nurses. We are the members of the health team who have direct patient/client interaction and therefore it is through our knowledge & understanding of the values, customs, beliefs & practices our patients’ culture that we can provide effective care. A better way of understanding the factors that influence a person’s perception of well-being is the sunrise enabler of Madeleine Leininger. Leininger’s model of cultural care can be viewed as a rising sun. When using this model, the nurse can begin anywhere depending on the focus of nursing assessment. The model reflects influences of one’s worldview on cultural and structure dimensions. The cultural and social structure dimensions include technological, religious, philosophic, kinship, social, value and lifeway, political, legal, economic, and educational factors. Each of these identified systems affects health. These cultural and social structure dimensions in turn influences environment and language, wherein emphasis should be placed since this is where the patient/client find themselves such as home conditions, access to particular types of food and family access to transport. Environment and language influence the involved health systems – the folk, professional and nursing systems. The folk health system includes the traditional beliefs and practices on health care while the professional health systems are those practices we learned cognitively through formal professional schools of learning. The combination of the folk health system and the professional health system meets the biological, psychosocial, and cultural health needs of the patient/client.

These factors influence the patterns and expressions of caring in relation to the health of individuals, families, groups, and communities. To be able to make sound nursing care decisions and actions, these factors should be assessed properly and always be taken into consideration.

To achieve culture congruent care, nursing actions are to be planned in one of three modes: culture care preservation/maintenance, culture care accommodation/negotiation, or culture care repatterning/restructuring.

A research project on health and social practices regarding dengue in 2008 on three countries in Southeast Asia could be used as an example on how Leininger’s sunrise enabler can be applied on the community level. Some of the cultural and social factors that were assessed are as follows: 

Cultural and Social Structure Dimensions
Technological	lack of awareness of first aid remedies and safety procedures on dengue prevention at home
Religious	community people view dengue as a bad omen
Kinship and Social	women are always the caregivers, thus more women are prone to psychological burden of caring for the sick member of the family
Cultural Values	health is of lesser priority; more priority is given to basic needs such as food
Political and legal	lack of policy programs by the local government regarding dengue prevention practices
Economic	more males acquire dengue since most of them are night shift and farms/plantation workers
Educational	low level of education is noted. Most are secondary level graduates, knowledge and comprehension on proper health practices on dengue prevention is low

Proper assessment of the cultural and social structure dimensions will lead to good planning and intervention, leading to a sustainable health care delivery to individual, families, or communities. 

Reference:

http://n207b.blogspot.com/2010/07/sunrise-enabler-model.html

Trans-Cultural Nursing

Trans-cultural nursing addresses how nurses interact with patients on a cultural level. There are many patients whose culture and background are an important part of who they are as individuals. When they face injuries or illnesses, their cultures play a part in how they deal with the emotional struggle, and may even impact how they choose to be treated by a health care team. A patient who is a Jehovah's Witness, for example, will not allow him or herself to receive a blood transfusion. A patient who is an Irish traveler may prefer a more holistic or homeopathic approach to treatment.

Nurses help a wide variety of patients when practicing in the health care field. Patients are likely to come from diverse backgrounds and cultures, and in order to best care for patients, a nurse must be prepared to adapt to his or her patients' cultural needs.

The best way for a nurse to work well with trans-cultural patients is for him or her to be open and attentive to the patients' needs. He or she can ask patients if they have any needs specific to their cultures or backgrounds. By knowing what cultural needs or desires a patient has, a nurse can accommodate those needs and work them into his or her nursing care plan, when possible. If any needs cannot be met, a nurse can speak with the patient about what else can be done to make the patient feel more comfortable.

Working with patients to be supportive of trans-cultural nursing is a way for a nurse to connect with his or her patient. It helps a nurse to get to know a patient on a more personal level, and helps him or her make sure the patient gets the best care possible. After all, a nurse is treating a whole person and not just an illness or injury, and the person's culture and background is included in that.

Nurses may also benefit from taking anthropology courses when possible. These courses will open nurses up to other cultures and give them information about culture practices and beliefs that could be helpful during day-to-day nursing practice. The more a nurse knows about other cultures, the better prepared he or she will be to help a wide range of patients.

While nursing is predominantly a health care field, there is an element of customer service to it, as well. Nurses must interact with patients and their families, and having a stronger understanding of trans-cultural nursing and how to use it on a daily basis will help nurses with the "people skills" and "bedside manner" they need to help patients work toward health.