Minority nurses can play a crucial role in helping Asian patients bridge the gap between East and West, old and new
By Jean Ann Cantore
In a world where the latest is often considered to be the greatest, many health care professionals are returning to ancient healing practices. Asian remedies such as acupuncture, acupressure, herbs and meditation are being used alongside more modern health care practices. As this holistic approach to health care continues to grow in the U.S., career opportunities will increase for nurses of Asian and Pacific Islander descent because of their unique understanding of Asian cultural beliefs and their familiarity with Eastern medicine.
“Asian beliefs about health are very popular today,” says Kem Louie, R.N., Ph.D., CS, FAAN, associate professor at the William Paterson University Department of Nursing in Wayne, N.J., and president of the Asian American Pacific Islander Nurses Association, Inc. “Eastern practices are popular because health consumers are more informed and are taking more responsibility for and control of their health. In addition, these practices and remedies assist the body in maintaining health and aid the body in natural healing.”
Combining Eastern and Western remedies has become quite common in America, especially in areas of the country where there are large populations of people of Asian and Pacific Islander descent. For years, patients interested in traditional Asian remedies had to seek out these treatments on their own, visiting independent acupuncturists or purchasing herbs from Asian markets. Although those choices are still available for patients, an increasing number of modern health care clinics have begun to offer traditional treatments or refer patients to practitioners who use them. Some major insurance carriers even cover treatments such as acupuncture.
Ancient Remedies
In clinics and hospitals that serve diverse Asian populations, there is a critical need for Asian-American nurses who can combine their nursing school training with the additional ability to understand the value of traditional remedies. Not only are these nurses caregivers of modern medicine, but they also know how to integrate Eastern and Western beliefs.
The roots of holistic nursing are found in ancient practices first used in Asia thousands of years ago. But today, many schools and certification programs in the United States prepare nurses to practice holistic nursing, including opportunities in clinics that integrate holism with modern health care procedures.
Many health care professionals who are not of Asian descent practice this approach to integrated medicine, Louie points out. For example, the well-known medical advisor Andrew Weil, M.D., discusses herbal remedies in his books. In addition, physicians may prescribe acupuncture to treat pain or injuries. The technique involves inserting flexible needles into pressure points on the body to release energy. Acupressure, which is non-invasive, involves massaging certain pressure points in the body to release energy and relax the patient. It can be used to stimulate sleep or digestion or to increase mental stability. In addition, many doctors recommend meditation and yoga to relax patients undergoing modern procedures such as chemotherapy or surgery.
Most acupuncturists in the United States have been trained in Asia, but there are schools in this country that teach the technique as well. Learning to apply acupuncture is quite involved and requires extensive knowledge of human physiology. Clinics that offer this service are commonly found in communities with large populations of Asian Americans. Although insurance companies are beginning to cover acupuncture when a physician prescribes it, the treatment is not commonly found in hospitals. Most practitioners of this technique work in independent health care centers or clinics.
Belief Systems
“The Asian American/Pacific Islander population in the U.S. is mostly foreign-born. Therefore, these families continue to hold on to traditional views of health and illness,” Louie comments. As a result, modern health care clinics that treat people of Asian descent have become more sensitive to cultural differences and beliefs, and recognize the key role Asian nurses can play in bridging cultural gaps.
Some nurses who work with Asian populations find that their patients want the best of both worlds. Nurses of Asian or Pacific Islander descent can appreciate their patients’ desire to hold on to traditional treatments and beliefs and understand why their patients prefer Eastern treatments or a combination of Eastern and Western remedies. To be able to combine these treatments effectively, though, health care providers must know what treatments patients are receiving elsewhere. For example, patients often come to a modern health care clinic while they are taking herbs they bought at a market or from an herbalist.
“We try to get patients to tell us what they’re taking on the outside,” says Dominic Koh, R.N., PNP, ANP, a nurse practitioner with Asian Pacific Health Care Venture, Inc., in Los Angeles. “I usually have them bring their medication with them so we can look at it together. Some of it I’m familiar with. We want to be sure the herbs don’t contain lead or mercury; very few do, but we have found a couple. Certain herbs can cause hypoglycemia. Also, we tell them it is best not to mix traditional medications with Western medications. If, however, the products pose no harm, they are free to use them.”
Often, people of Asian descent view Western medicine as “too strong” and not something to be taken for very long. Koh notes that some patients believe that taking too much Western medicine can cause irreparable damage to the liver or kidneys. In Asian culture, the liver and kidneys are considered dominant organs in the body, controlling all bodily functions.
“Yesterday, a patient came in and said, ‘I became very dizzy and went to an Eastern medicine herbalist to get medicine. He said I had a weak pulse and was having problems with weakness in the liver and kidney. I have a gall bladder removal scheduled, but I’m not going to go,’” says Jean Song, R.N., a clinic nurse at International Community Health Services in Seattle, who is also studying to be a family nurse practitioner. “I have to find a way to convince her that she needs to have the surgery.”
Beliefs about food may also affect a patient’s health care. Koh says that many older patients who are told to reduce their food intake for health reasons may not cooperate because food, and especially meat, is a sign of prosperity in many Eastern cultures. Being able to eat meat or meat products is a sign of wealth because meat is often expensive. People who cannot afford to eat meat eat vegetables more often and generally eat less, and therefore are thinner. Although there is an increased awareness that being overweight is unhealthy, Koh also notes that food is not to be wasted in Asian countries. When a patient on a restricted diet lives with a family, he or she may have trouble refusing portions that are served.
“Diet and the effects of diet [foods] play a major role in maintaining health,” Louie explains. “Specifically, it is believed that certain foods are either ‘cold’ or ‘hot,’ and when the body is out of balance or during certain conditions such as childbirth, specific foods are prescribed, and others are avoided.”
Hand in Hand
Nurses in the U.S. who are of Asian descent may not be trained in traditional treatments, but many of them know or have grown up around caregivers who use them. In addition, many of these nurses and their family members have received traditional treatments themselves. Such immersion into the world of Eastern medicine gives these nurses a better understanding of these remedies.
International Community Health Services in Seattle is affiliated with an acupuncture clinic. While a large number of patients of the acupuncture clinic are American-born, the majority are Asian immigrants and often have not lived in the United States for very long. In their native countries, they may have visited acupuncturists for treatments without seeing a physician first.
“Mostly it is patients with chronic pain or injuries that receive acupuncture treatments,” Song says. “Their common belief is that if the problem is acute, or one that takes time to cure, they need to have Western medicine; if the problem is chronic, they need Eastern medicine. The patients come here and ask for acupuncture first, and we say, ‘No, you have to see a primary care physician first.’”
Susan Park, R.N., clinical services manager for Asian Health Services, located in Chinatown in Oakland, Calif., says the clinic where she works has a unique niche. They serve the Asian/ Pacific Islander population, regardless of a patient’s income, insurance or immigration status. Park comments that many of their patients prefer traditional medicine to modern medicine.
“We see a lot of patients who are recent immigrants and who don’t speak English,” Park notes. “It’s difficult to refer these patients to outside sources because they are not able to communicate with providers outside of Asian Health Services. There’s a lack of linguistically and culturally appropriate health care services for the Asian/Pacific Islander community.”
Park emphasizes the importance of establishing relationships with patients so that they will feel comfortable at the clinic. She says that nine different languages are spoken by patients who visit the clinic, so having trained medical interpreters who can communicate in these languages is crucial in establishing a therapeutic relationship. Park explains that for patients to begin to trust modern health care procedures, which can be quite different from the health care system of their country of origin, they must first trust their care providers.
To educate patients about the Western health care system, many larger clinics employ health educators who are familiar with, and well known in, the Asian community. These people play a key role in allaying patients’ fears about modern health care and in getting patients to comply with prescribed care.
“At the clinic where I work, probably 75% to 80% of our patients are of Thai descent,” Koh explains. “Other groups we treat include people from Cambodia, the Philippines and Vietnam. It helps if you have someone who is in touch with the community. We have really good outreach workers who have been in touch with the Vietnamese community, so we’re starting to get more Vietnamese patients.”
Overcoming Fears
In many communities where Eastern medicine is practiced, traditional medicine and modern medicine coexist harmoniously. Health care providers, however, still face challenges in helping Asian patients overcome fears about Western medicine. Nurses of Asian or Pacific Islander descent share their patients’ appreciation for Eastern medicine, which gives them an advantage in caring for patients who hold on to traditional beliefs about healing.
“For many old folks here, Eastern medicine is No. 1,” Song says. “But they know they have to go to Western medicine for certain treatments. Still, a lot of them are afraid of it. For example, many people with kidney failure will not go for dialysis until the last minute.”
Even when common languages are spoken, getting a point across to a patient may be difficult. Koh says that when nurses at his clinic discuss medication with their patients, the patients will often nod their heads in agreement and say “yes” when they really don’t understand or intend to follow the instructions. They are simply being polite and showing respect for the nurses by agreeing.
“Another problem is that in Asia, people may be used to being able to access health care whenever they want,” Koh adds. “We use an appointment system, and they don’t understand that they can’t just walk in. They also may not understand how insurance works.”
Interestingly, although many people of Asian descent seek Eastern treatments for themselves, they will allow their children to be treated with Western techniques. Song comments that among the patients at the clinic where she works, there is a very high immunization rate for children—as high as 90%.
Yet non-compliance with prescribed health care still presents a problem. “One difficulty we encounter a lot is that parents carry on the belief that what worked in China will work here,” Song says. “It depends on how much influence a person has in a family. Recently, I had a patient who was two or three years old and had chronic diarrhea. The grandmother in the family had the say as to what the kids in the family were fed. She was giving him herbs. An herb used to treat a virus in China may not work on a virus here because the viruses are different.”
Song explains that many of the herbs Asian immigrants take on their own are imported from China or Japan and that the contents are written on the label in those languages. Nurses who received their health care training in the United States may not be familiar with the Chinese or Japanese medical terms or know the ingredients that are listed on the labels.
“We try to keep up to date as much as possible,” Park says. “Sometimes it’s difficult because patients insist on taking traditional medicine only, or they mix traditional and Western medications, which can be quite hazardous. We have to keep educating our patients.”
She notes that the Asian Health Services clinic is hoping to establish a link with a traditional medicine school in the area. The partnership would enable the providers in her clinic to have a better understanding of the various traditional treatments patients are receiving.
Although combining traditional and modern health care is a relatively new practice, it seems to be working. Education—for both patients and caregivers—is key to effective treatment. Because nurses of Asian or Pacific Islander descent are ahead of others when it comes to understanding patients’ preferences for treatments such as acupuncture, demand for their services will continue to increase. The ability to see the value in both modern and traditional medicine is an example of how everyone benefits when East meets West.Jean Ann Cantore is a free-lance writer in Lubbock, Texas.
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