When Stella Kwong, MPA, sees an elderly Chinese patient, she brings with her a sense of familiarity and comfort. Kwong, who speaks Cantonese, understands not only the patient's language, but also the cultural beliefs shaping his character and concerns.
As director of the Asian Home Care Program, Visiting Nurse Service of New York, Kwong with her team of multilingual Asian staff nurses can help combat the underlying health disparate issue related to Asian-Americans - language - all 250-some dialects.
It is important to note, however, that the term "Asian" encompasses a wide region, many cultures and sub-cultures, and thus it is incorrect to apply a one-size-fits-all mentality when talking about this population.
Growing Population, Concerns
Overcoming language barriers will be as much as a growing concern for the U.S. healthcare industry as it is for the Asian-American population.
According to the Association of Asian Pacific Community Health Organizations and National Association of Community Health Centers Inc., Asian-Americans and Pacific Islanders (AAPI) are among the fastest growing minority populations in the United States. From 1999-2000, the AAPI population increased by 46 percent, according to the associations.
Kwong added that San Francisco and New York City are the major hubs for this growing group; New York alone has three booming Chinatowns.
"If you are unable to communicate in English, you will not know about the many healthcare services available to you," Kwong said. "In Chinatown, immigrants tend to stay within that community where everyone speaks the same language because they feel more comfortable."
Nurses in the Visiting Nurse Service of New York Asian Program often see the city's large Chinese and Korean populations. Kwong noted that the Chinese who immigrated to Manhattan's Chinatown 40-50 years ago mainly speak Chinese dialects, Toisanese and Cantonese. Back then, they did not feel the need to learn the language. Today's schoolchildren and younger generations from immigrated families are more likely to be English-speaking, Kwong said.
Even so, addressing a patient's language needs and providing a nurse who knows their culture improves patient-nurse communications and often results in better patient outcomes, Kwong said.
Diversify the Workforce
In San Francisco, Jyu-Lin Chen, PhD, RN, agrees. The number of culturally competent healthcare providers has not matched the increasing rate of Asian immigrants, she said. Lack of culturally competent care relates to decreased health status of Asian immigrants, said Dr. Chen, who is assistant professor, Department of Family Health Care Nursing, University of California, San Francisco. Her solution is to increase diversity in healthcare professions and offer educational programs to providers regarding culturally competent care.
"Nurses play an important role in decreasing health disparities among Asians, as they are often the healthcare providers who provide routine and intensive care," she said. "Nurses, nursing educators and leaders should incorporate sensitive and culturally appropriate care into daily patient care, especially for under-represented minorities."
SeonAe Yeo, PhD, RN,C, incorporates cultural sensitivity into her routine care. A Japanese nurse midwife, Dr. Yeo knows the beliefs and anxiety that surround a woman's pregnancy. She noted that if the Japanese patient does not speak English, her anxiety increases exponentially. Find a Japanese patient a translator if she is having difficulty with the English language, Dr. Yeo recommended.
"It is a federal law that any healthcare must be provided in the patient's language," said Dr. Yeo, who is associate professor, University of Michigan School of Nursing, Division of Health Promotion and Risk Reduction, Ann Arbor. "If you go to any big hospital they have either a volunteer or a professional translator. Avoid using their family member, if you can, as a translator."
And, she noted, applying stereotypes is bad medicine. When in doubt, if a nurse does not understand what a patient is trying to communicate, she should ask for help.
"Asking questions never can be rude," Dr. Yeo noted. "It is better than making a stereotypical assumption and causing serious conflict between two ethnic groups."
Erin James is assistant editor at ADVANCE.