Japanese culture

1. Japanese culture Angela adams, Stephanie cheers, pietrochristofoli, Emmanuel ayim, kev’annjarman

2. Introduction • According to Jones (2012), the 2000 Census found that there were 11,898,828 Asian Americans in the United States • 797,700 of which were Japanese American. • The 2010 Census found an increase in the Asian American population to 17,320,856. • California was the most populated state • Honolulu, HI being was the most populated city

3. Introduction • How project was broken up: • Determination of Culture • Researched different cultures in United States and determined Asian Americans are a growing demographic. • Discovered a lot of information on Chinese culture but little on Japanese. • Division of Labor • Group members volunteered for separate sections to focus research on • Strategies used for research: • CINAHL • EBSCOhost • Google • Census Bureau • 18 different sources were utilized ranging from websites, scholarly journals, and textbooks

4. Background • Geography • Japan is located in the continent of Asia and it consists of four major islands (Japan, 2013). • Population • Current population of 127.515 million • Language • The main language spoken in Japan is Japanese (Japanese Language History, 2013). • Religion • Shintoism • Buddhism

5. Cultural characteristics • Cultural Beliefs • The Japanese are known to be very conscious of age and status • Japanese people attach much importance to harmony • They place great emphasis on politeness, personal responsibility and working together for the universal, rather than the individual good • Japanese culture is group oriented • Communication • Japanese believe that words can have several meanings • Non-verbal communication expressions all have interpretations • Frowning while someone is speaking is interpreted as a sign of disagreement • Housing • Traditional Japanese homes are made of wood and supported by wooden pillars Shoes are never worn inside Japanese homes. (Explore Japan: Housing, Food, and Clothes) • Japanese practiced the extended family system but they are gradually transitioning into the nuclear family system

6. Cultural characteristics • Common Fashion • Japanese are known to dress modestly. • The traditional Japanese dress is the Kimono. • In everyday life, young Japanese prefer to wear clothing that are easy to move around like T-shirts, jeans, polo shirts, and sweat suits • Food • The major food in Japan is rice • A typical Japanese meal consists of a serving of plain white rice, a main dish of fish or meat, a side dish usually cooked vegetables, a soup and some pickled vegetables • Chopsticks are mostly used for eating instead of spoons and forks. • Other common traditional Japanese foods include noodles, pasta, Sushi, Tempura, and Sukiyaki (Explore Japan: Housing, Food, and Clothes).

7. Birth and death practices • Japanese are born Shinto (purity and cleanliness) but learn to embrace Buddhism later on in life • During childbirth, Japanese women believe it is all natural and having a C-section is considered to be hardship • Fathers are not to be in the delivery room during childbirth • After death, a funeral ceremony is from a Buddhist approach, during the ceremony, they believe that the spirits of the dead are being revived • Terminal illnesses, dying and death are considered “negative” or impure…also considered contaminated • Believe that there is life after death also known as rebirth • Organ donation not favored very important for the person to die “intact” • They view a terminal illness as “skikataganai” meaning “it cannot be helped” • It takes the blame off of the patient or their family

8. Health and illness • Believe that it is dependent upon maintaining harmony with the universe • Also believe that the mind and body are one • Believe that being diagnosed with an illness is beyond their control • Believe in “Kampo” which is an herbal medicine used to treat various illnesses

9. Cultural care “Professional healthcare that is culturally sensitive, culturally appropriate and culturally competent” (Spector, 2009, p. 195) (Spector, 2009, p. 195)

10. Cultural Sensitivity & Awareness Promotion for the Clinician • Determine preferred method of communication • Identify patient’s culture • Inquire about culture-specific dietary habits • Encourage two-way communication • Other than the patient, is there someone they would like you to discuss their medical information with • Assess their comprehension of the situation (Seibert, Stridh-Igo, & Zimmerman, 2002)

11. Japanese Verbal Communication • Languages spoken: Japanese (primary), American English • Soft spoken and reserved • May hesitate to ask questions • It is best to ask questions that require more than a simple yes or no answer • May only disclose information if trust is established • May want communication concerning treatment to take place only with family present • May not verbalize pain or emotion, particularly the elderly (HealthCare Chaplaincy, 2013) (University of Michigan, 2013)

12. Japanese Nonverbal Communication • Tend to have little direct eye contact • Touching is uncommon, • Nodding does not necessarily indicate understanding or agreement • Smile and bow/Handshake • Stoic demeanor when in pain • Respect, politeness, and courtesy are of high importance (HealthCare Chaplaincy, 2013) (Children's Mercy Family Health Partners, 2010)

13. Working with an Interpreter Translators are often used to ensure information is conveyed and received accurately. When utilizing an interpreter, some things to remember are: • Keep speech short and simple • Have patience with the process • Speak in first person • Listen to the patient • Always check the patient’s comprehension (University of Michigan, 2013)

14. Family Structure and Decision Making • Family oriented culture • Father is the head of the family hierarchy • Decisions/consents may be made by father; in the case of elders, decisions are made by children • Discussions of death and dying, including advance directive and informed consent, must be approached with courteous respect • Family members, particularly spouse may wish to stay at the bedside (HealthCare Chaplaincy, 2013) (Children's Mercy Family Health Partners, 2010) (Tanabe, 2013)

15. Japanese Dietary Considerations • Traditional Japanese diets are high in sodium which can put them at risk for hypertension • There is a high prevalence of lactose intolerance • The typical Japanese diet consists of three meals a day, most served with rice, low fat animal protein, and is low in cholesterol and sugar, but high is sodium (Tanabe, 2013) (Children's Mercy Family Health Partners, 2010)

16. Attributes Necessary for Administering Culturally Competent Care • Understand the differences between Western culture and the culture of others • Have empathy • Display patience • Build a trusting relationship • Be respectful of the views of other cultures • Always display courtesy and thoughtfulness (University of Michigan, 2013) (Tanabe, 2013)

17. conclusion • Suggestions for Health Care Professionals • Pose questions regarding care to father of family • Be aware that just because patient nods, it doesn’t mean they understand • Do not take the fact that patient is not looking you in the eye as a sign that they are not listening or paying attention. • Be aware of their feelings concerning touching. • Understand that the Japanese patient may not be very expressive concerning pain • Influence on Current/Future practices • Our area has a large Latin American influence so being aware of different beliefs and cultures are already being practiced. • Understand more about the Japanese culture allows us to become more culturally aware. • Practice conducting interviews utilizing an interpreter • Be aware of herbal remedies and alternative methods of care can help to provide more holistic care.

18. References • Asian Culture. (2002). Japanese Health Beliefs. Retrieved from: http://personal.uncc.edu/macurran/2002/webproject/asi.htm#_Japanese_Health_Beliefs • Children's Mercy Family Health Partners. (2010, May). Cross-Cultural Health Care Resource Guide. Retrieved May 25, 2013, from Children's Mercy Family Health Partners: http://www.fhp.org/fhpdocs/CrossCulturalResourceGuide.pdf • Denison, B. (2002). A Basic Overview of Japanese Culture. Retrieved from Mizukan Dojo: http://www.mizukan.org/articles/culture.htm • East and Southeast Asia: Japan. (2013). Retrieved from Central Interlligence Agency: https://www.cia.gov/library/publications/the-world-factbook/geos/ja.html • Explore Japan: Housing, Food, and Clothes. (n.d.). Retrieved from Kids Web Japan: http://web-japan.org/kidsweb/explore/housing/ • Ford, J. B., & Honeycutt Jr, E. D. (1992). Japanese national culture as a basis for understanding.. Business Horizons, 35(6), 27. • HealthCare Chaplaincy. (2013). Handbook of Patients’ Spiritual and Cultural Values for Health Care Professionals. Retrieved May 25, 2013, from http://www.healthcarechaplaincy.org • Japan. (2013). Retrieved from Countries and their Culture: http://www.everyculture.com/Ja-Ma/Japan.html • Japan’s population falls by record level. (2013). Retrieved from The Japanese Times: http://www.japantimes.co.jp/news/2013/04/17/national/japans-population-falls-by-record-level/#.UasCsmzD_mR • Japan - Language, Culture, Customs and Etiquette. (n.d.). Retrieved from Kwintessentials: http://www.kwintessential.co.uk/resources/global-etiquette/japan-country-profiles.html • Japanese Language History. (2013). Retrieved from ForeignTranslations: http://www.foreigntranslations.com/languages/japanese-translation/japanese-language-history/ • Jones, N. A. (2012). The Asian Population in the United States: Results from the 2010 Census. Retrieved from: http://www.ssa.gov/aapi/2010census-data.pdf • Seibert, P., Stridh-Igo, P., & Zimmerman, C. (2002). A checklist to facilitate cultural awareness and sensitivity. J Med Ethics, 28, 143-146. • Spector, R. (2009). Cultural diversity in health and illness (7th ed.). Upper Saddle River, NJ: Prentice Hall. • Tanabe, M., Marianne, K. G. (2013). Health and Healthcare of Japanese-American Elders. Retrieved May 24, 2013, from Stanford University: http://www.stanford.edu/group/ethnoger/japanese.html • The Japanese Family System. (n.d.). Retrieved from Nakasendoway: http://www.nakasendoway.com/?page_id=1082 • University of Michigan. (2013). Enhancing Your Cultural Communication Skills. Retrieved May 26, 2013, from University of Michigan Health Systems: http://www.med.umich.edu/pteducation/cultcomp.htm