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chinese and japanese

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Complete the following:

Chinese case study #1

Japanese case study #1

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An elderly, Asian-looking man is admitted

to the emergency room with chest pain;

difficulty breathing; diaphoresis; vomiting; pale, cold, clammy skin; and apprehension.

Three people, speaking a mixture of Englis

h and a foreign language to one another,

accompany him. The nurse tries to speak E

nglish with the man, but he cannot understand

anything she says. Accompanying the elderly

man are two women (one elderly and very

upset and one younger who stands back from the other three people) and one younger


The younger man states that the elderly ma

n, whose name is Li Ying Bin, is his

father; the elderly woman, his mother; and

the younger woman, his wife. The son serves

as the translator. Li Ying Bin comes from a sm

all village close to Beijing. He is 68 years

old, and he has been suffering with minor ch

est pain and has had trouble breathing for 2

days. He is placed in the cardiac room, and the assessment continues.

Mr. Li is on vacation, visiting his son and

daughter-in-law in the city. His son and

daughter-in-law have been married for only 1 ye

ar, but the son has lived in the West for 7

years. Mr. Li’s daughter-in-law looks Chin

ese but was born in the United States. She

does not speak very many words of Chinese.

Further physical assessment reveals that Mr

. Li has a history of “heart problems,”

but the son does not know much about them. Mr. Li had been to the hospital in Beijing

but did not like the care he

received there and returned home as soon as possible. He goes

to the local clinic periodically when the pa

in increases, and the h

ealth-care provider in

China used traditional Chinese medicine,

herbs, and acupuncture. In the past, those

treatments relieved his symptoms.

Medications are ordered to relieve

pain, and Mr. Li undergoes diagnostic

procedures to determine his cardiac status. The

studies reveal that he

did sustain massive

heart damage. Routine interventions ar

e ordered, including heart medications,

anticoagulants, oxygen, intravenous fluids, be

drest, and close mon

itoring. His condition

is stabilized, and he is sent to the cardiac intensive-care unit.

In the cardiac unit, the nurse finds Mrs.

Li covering up Mr. Li until he sweats, and

Mrs. Li argues with the nurse every time

her husband is supposed to dangle his legs. She

complains that he is too cold and brings in

hot herbal beverages for him to drink. She

does not follow the nurse’s and physician’s orde

rs for dietary restrictions, and she begins

to hide her treatments from the staff. Her

son and daughter-in-law tr

y to explain to her

that this is not good, but she continues the

traditional Chinese medicine treatments.

Mr. Li is a very quiet patient. He li

es in bed and never calls for help. He

frequently seems to be meditating and exercisi

ng his arms. When he does talk to his son,

he speaks of the airplane ride and the probl

ems of being so high. He believes that may

have caused his current heart problem. Mr. Li

also wonders if Western food could be bad

for his system. Mr. Li’s condition gradually de

teriorates over the next few days. Nurses

and physicians attempt to tell the family a

bout his condition and po

ssible death, but the

family will not talk with them about it. Mr. Li dies on the 5th day.

Study Questions


If you were to go to China on a business trip, how would you design your

name card so that the Chinese would not be confused?


If you wished to have a meeting with

a Chinese delegation of health-care

providers, would you expect them to be on time? Why?


If the meeting included a meal w

ith Chinese food, what kinds of food

would you expect to be served? How

would it be presented? If something

were served that you do not lik

e, would you eat it anyway?


Compare and contrast the Chinese

meaning of life and way of thinking

with the Western meaning of life and way of thinking.


What are the common health risks for the development of chronic

obstructive pulmonary disease among Chinese people?


What are some of the reasons that

Mr. Li waited so long to enter the



Mr. Li did not complain of chest pain

in the cardiac intensive-care unit. Is

this a common behavior? Why?


True or False: The Chinese family will expect health-care providers at the

hospital to provide most of the care for Mr. Li.


Why must the physician be careful

with the amounts of medication



Mrs. Li is curt, demanding, and disagreeable toward her daughter-in-law.

Why does she act this way?


Explain why Mr. Li blames the airpla

ne ride and the Western food for his

heart attack. Why does he meditate and do exercises?


Is Mr. Li’s stoicism during dying surprising? Why do the family members

refuse to discuss his health and possible death?


What is the preferred method for

handling the remains of a deceased

Chinese person?


Describe common mourning rituals for the Chinese.


Describe bereavement in a Chinese family.


Describe a common view of death among Chinese.

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This case study is a composite of actual situ

ations. Marianne, who is American, and Ken

Shimizu, who is Japanese, have worked

in Tokyo for over 30 years as Methodist

missionaries. They have annual furloughs and

occasional sabbaticals, during which they

visit relatives and sponsoring

organizations and engage in

continuing education in the

United States. They met as college students

in the United States, and their three grown

children have established their ow

n careers in the United States.

Ken’s 98-year-old mother resides with

Marianne and Ken. She is not Christian

but has always been extremely supportive of

Ken and Marianne’s work. Ken teaches at

a large Christian university, whereas Marian

ne has served in various church-related

positions over the years. As missionaries, they live in subsidized post–World War II

housing near Ken’s university. Marianne has

been a frugal housewife, preparing local

foods in the Japanese style for her family.

Ken, who is nearly 60, recently learned

that he has glaucoma. By the time it

was discovered, he had lost a signific

ant amount of peripheral vision. Although

Marianne delivered all three

children at a Christian hos

pital in Tokyo, she gets her

annual physical examination when visiting rela

tives in the United States. She has never

believed that the Japanese health system is

as proactive as that in the United States.

On her most recent visit to the United

States, Marianne learned that she has

hypertension. Her physician prescribed a medica

tion that is readily available in Japan,

but the physician was concerned about the leve

l of stress in Marianne’s life. Mother

Shimizu is quite confused and requires considerable care, but it is unthinkable for Ken,

the only child, to put his mother in a long-

term-care facility. Even if he would, the

quality of facilities in Japan l

eaves much to be desired. Most of the responsibility for

Mother Shimizu falls on Marianne, in addi

tion to her work. Marianne’s relatives are

urging her to consider placing Mother Shimiz

u in a church-related life-care community

near Marianne’s family in the United Stat

es, where Marianne and Ken would like to

retire. Marianne’s own parents

lived in this facility at the end of their lives. She is

considering these issues

as she returns to Tokyo.

Study Questions

1. Identify some of the cultural issues that

may lead to conflict in this international


2. What are the family resources for this international family?

3. What factors within the Ja

panese health system may account for the late diagnosis of

Ken’s glaucoma?

4. What practical issues might arise for th

e Shimizus if Mother Shimizu were placed in

a long-term-care facility in the United States?

5. What dietary factors may cont

ribute to Marianne’s hypertension?

6. In what ways might you consider Ken to

be countercultural as a Japanese man?

7. What social pressures might Marianne ha

ve faced, given some of her choices, as a

housewife in Japan?

8. What pressures will Ken likely experience

as he considers how to meet the needs of

both his mother and his wife?

10. compare and contrast the fertility and mortility rates of japan and the united state.

11. To which drugs might Japanese people have greater sensitivity than that of white

ethnic populations?

12. How do most Japanese people meet their need for calcium?

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chinese and japanese


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