Feature Article

Understanding the Culture of Chinese

Children and Families
Ruth Cheung, RN, BSN; Warren Nelson, RN; Luzelle Advincula, RN, BSN;
Virginia Young Cureton, RN, DPH; and Daryl L. Canham, RN, EdD, C

ABSTRACT: Providing appropriate health care to a client can be accomplished only in an envi-
ronment that is sensitive to the cultural values and beliefs of the client. As the population of first-
and second-generation Chinese immigrants increases in the United States, the need to develop
culturally sensitive health care becomes significant. Chinese immigrants and their families have
become an important part of American society, including the school setting. The school nurse,
who regularly works with students and families, should work in a manner that allows Chinese
immigrants to maintain their cultural values and beliefs, while providing appropriate care for the
student. The Chinese culture is unique and holds values and beliefs that contrast with those of
the Western culture. A school nurse who understands and incorporates the Chinese culture will
be better able to develop a positive interaction with the family and make arrangements for cul-
turally appropriate care.
KEY WORDS: children, Chinese, culture, health care, school nurse

INTRODUCTION ed States will be non-White. Currently, first- and sec-

More than 1 billion people live in China today, and
many additional Chinese people live in other coun-
tries, making the Chinese the most populous ancestry
in the world (Jayne & Rankin, 2001). It is estimated
that by the year 2010, 35% of the children in the Unit-
Ruth Cheung, RN, is a graduate student at San Jose State Univer-
sity, San Jose, CA, and a school nurse with the Fremont Unified
School District, Fremont, CA.
Warren Nelson, RN, is a graduate student at San Jose State Uni-
versity, San Jose, CA, and a school nurse with the Fremont Unified
School District, Fremont, CA.
Luzelle Advincula, RN, BSN, is a graduate student at San Jose State
University, San Jose, CA; a school nurse with the Fremont Unified
School District, Fremont, CA; and a nurse in the medical-oncology
unit at Lucile Salter-Packard Children’s Hospital in Palo Alto, CA.
Virginia Young Cureton, RN, DPH, is a professor at San Jose State
University School of Nursing, San Jose, CA. She was the first reader
of this project.
Daryl L. Canham, RN, EdD, C, is an associate professor at San Jose
State University School of Nursing, San Jose, CA. She was the second
reader of this project.
This article was based on a student project in the Clinical Nurse
Specialist in School Nursing class at San Jose State University, San
Jose, CA.
ond-generation immigrant children under age 15 are
the fastest-growing group in the United States (Chen
& Rankin, 2002). Twenty-five percent of the 12 mil-
lion Americans who report themselves as being of
Asian descent are under the age of 18 (Yu, Huang, &
Singh, 2004).
Schools in the United States serve a diverse popu-
lation of children of Asian origin, both new immi-
grants and second-generation immigrants whose par-
ents are from other countries. Many studies have dis-
cussed the importance of culturally sensitive care for
patients in hospitals, but few have emphasized such
care for nurses working in schools and the community
(Fralicx & Bolster, 1997; Haffner, 1992). Because Chi-
nese Asian immigrant children are coming to the
United States in increasing numbers, it is important
for school nurses to be aware of the students’ cultural
differences.
In demographic representations of communities,
Asians are commonly categorized as one culture or
ethnicity. However, families and communities of
Asian origin are in fact quite different from one an-
other, depending on the country of origin, and where
in the country they are from, such as north or south,

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east or west, urban or rural. For example, cultural prac-
tices are different among Asians from Hong Kong, Tai-
wan, or mainland China. Perhaps no other profession-
al group in society has recognized the impact of cul-
tural diversity as much as the health profession (Pur-
nell & Paulanka, 1998). ‘‘Nurses constitute the biggest
group of health care providers who can potentially de-
liver culturally competent care to large populations of
diverse patients’’ (DiCicco-Bloom & Cohen, 2003, p.
26). Acknowledgment of and respect for these differ-
ences are needed to provide culturally sensitive care.
As school nurses encounter more Chinese families,
they will have an opportunity to increase their knowl-
edge of families of Chinese descent while heightening
their respect for and valuing of the culture. Providing
some basic features that are relevant in the Chinese
culture and facilitating understanding of the differ-
ences within the culture will enhance the ability of
school nurses to incorporate more receptive interac-
tions with these families as they deliver health care in
the school setting.
Chinese people may speak a variety of
different languages and dialects. There
are seven major language groups, each
with many dialects.
LANGUAGE
Chinese people may speak a variety of different lan-
guages and dialects. There are seven major language
groups, each with many dialects. The national lan-
guage, putonghua, which means ‘‘common speech,’’ is
also called Mandarin (Chinese Languages, 2004). Over
2 million Americans speak Chinese regularly at home,
making it second to Spanish as the most common for-
eign language spoken in the United States, according
to the 2000 census (Fetto, 2003; U.S. Census Bureau,
2000). A study of the effects of Chinese residents’ in-
come, language, and citizenship status found that flu-
ency in English can strongly affect health care access
for this population (Jang, Lee, & Woo, 1998). For
Asian children, health issues are compounded by the
problem of adaptation to an unfamiliar culture, par-
ticularly for children with limited English. In addi-
tion, a study of Asian adolescents revealed significant
psychosocial deficits in school and a lack of parental
support among those who do not speak English at
home (Yu et al., 2004). Health professionals’ unfamil-
iarity with another culture can affect interpretation of
important health data. For example, the practitioner
may misinterpret a client’s pain because of differing
personal cultural practices. With such a large number
of people in the United States speaking Chinese, ad-
vocating for a trusted interpreter may be helpful in
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overcoming language barriers that may arise when
communicating with Chinese community members.
COMMUNICATION PRACTICES
Traditional Chinese communication practices differ
from Western communication practices, which may
lead to misunderstanding. Chinese people tend to be
more passive, polite, and attentive, with a friendly de-
meanor. The Chinese believe this type of behavior is
virtuous and reflective of practicing and demonstrat-
ing Confucian principles. These principles play an im-
portant role in forming Chinese character and behav-
ior. Their purpose is to achieve harmony, the most im-
portant social value. It is interesting that there is no
Chinese equivalent for the word self.
Chinese people tend to be subtle when explaining
or discussing something, whereas Westerners appre-
ciate more direct and clear explanations. This is an
example of the Confucian principle of behavior in
which one is to avoid raising issues unless the other
party does so. In addition, one is not to tell the other
party things that may upset him or her (O’Keefe &
O’Keefe, 1997). Because of this principle, some Chi-
nese families might avoid sharing a health concern
such as a chronic illness, mentioning a health practice
that they adhere to, or consulting with unfamiliar
health professionals about a specific health issue. Be-
cause of the lack of access to and understanding of the
U.S. health care system, many Chinese immigrant
families do not benefit from needed services that may
be available in their community (Yu et al., 2004).
School nurses can assist such families in accessing care
and educating them about the U.S. health care system.
Because Westerners are willing to openly
give and accept comments and rebukes,
they assume that everything is all right
when Chinese people give no response.
Many Westerners may not understand Chinese
communication practices and may misinterpret them.
Westerners might become upset because they consider
Chinese communication to be indirect and offensive.
Westerners handle issues directly, whereas the Chinese
may find being direct offensive and insulting. Because
Westerners are willing to openly give and accept com-
ments and rebukes, they assume that everything is all
right when Chinese people give no response. When
speaking openly, the Chinese may be reluctant to offer
their opinion if someone will be embarrassed as a re-
sult (O’Keefe & O’Keefe, 1997). To prevent misunder-
standings, it is important for school nurses to be aware
of these differences.
Another difference in behavior that Chinese people
may display that Westerners may misinterpret relates
to taking initiative. Chinese people tend to avoid tak-
Volume 21, Number 1
ing initiative because this behavior would not main-
tain harmony and peace. Westerners may see this be-
havior as being negligent and avoiding responsibility.
Westerners also tend to think ahead and act indepen-
dently, whereas the Chinese view this proactive in-
dependence as showing disrespect to the group and
being too individualistic (O’Keefe & O’Keefe, 1997).
The Chinese defer to authority. As a collectivist so-
ciety, each person’s duty is to conform. Clients or their
caregivers may not verbalize their anxiety or doubts
about the care they receive. The Chinese want to
avoid conflict and will not challenge anyone whom
they regard as an expert. For example, if a doctor pre-
scribes a medication incorrectly, instead of saying
something, Chinese people will accept the doctor’s
prescription but not follow the order (Chen, 2001). As
a result, they may be perceived as noncompliant in
following the prescribed treatments. By nodding dur-
ing the instructions given by a health care profession-
al, the Chinese American may be deferring to author-
ity rather than actually understanding and agreeing
with the instructions, because disagreement with
health care professionals is considered disrespectful
and distrustful (Chen & Rankin, 2002). Not challeng-
ing the professional may also be perceived as a man-
ner of saving face for both the client and the health
care provider.
Chinese people tend not to discuss their concerns
with health care professionals. They consider their
concerns to be personal, to be shared only with the
family. As school nurses provide the family with sup-
port and treat them with honesty, compassion, and
respect in a manner consistent with the family’s cul-
ture, nurses can discover the family’s concerns in a
more personal way. Parents are very concerned about
their child’s future when the child has a chronic ill-
ness. Trust and empathy can bring the bond between
nurse and family closer, enhancing compliance with
treatment plans. Reassuring families that it is appro-
priate to ask the nurse or physician questions will help
ease family members’ concerns regarding health care
provided during the course of illness (Chen & Rankin,
2002).
HOLISM AND CARING
Holism is a valued concept in the Chinese culture.
Incorporating this concept can be challenging to nurs-
es who work according to the biomedical or task-based
model of care (Wong & Pang, 2000). There have been
many studies over the past two decades examining
how different cultures conceptualize holism and car-
ing. Having knowledge in this area is helpful in estab-
lishing nurse–client interactions. According to Wong
and Pang, holism and caring influence every aspect of
the health care culture of the Chinese. Health is per-
ceived from the viewpoint that a human being is a
dynamic entity. The person is in dynamic interaction
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with the world, and ‘‘illness is perceived as dishar-
mony at the individual or social level’’ (Wong & Pang,
p. 13). For example, while caring for a student with a
stomachache, the school nurse would also address the
emotional aspect of the student’s not being in balance
with the environment.
Because illness is seen as an imbalance
between the person and the natural and
social environments, both curative and
caring processes are important to return
the client to optimal health.
Because illness is seen as an imbalance between the
person and the natural and social environments, both
curative and caring processes are important to return
the client to optimal health. The manner in which
people are cared for is important to helping them
achieve health. A common belief among the Chinese
states that ‘‘thirty percent of healing depends on cu-
rative means and seventy percent on nursing care’’
(Wong & Pang, 2000, p. 14). Therefore, caring is seen
as more important than medicine among Chinese
families. The nature of nursing parallels the Chinese
concept of caring. Although the Western culture
might view nursing as a servant’s work, nurses cherish
‘‘treating the patient as their own family member.’’
School nurses provide holistic care as they focus on
the student and the family as the unit of care, based
on the knowledge that health includes physical, psy-
chological, social, and spiritual well-being.
IMPORTANCE OF FAMILY RELATIONSHIPS
The family is the basic unit of society for the Chi-
nese. People practice Confucian principles within the
family, and these Confucian principles are the basis
for Chinese values and lifestyles (Xing, 1995). There
are five hierarchical relationships, those between (a)
father and son, (b) ruler and ruled, (c) husband and
wife, (d) elder brother and younger brother, and (e)
friend and friend. For example, one principle is to
make family needs a priority over the needs of oneself,
and children are expected to make sacrifices for the
needs of their parents. Traditional Confucian roles and
responsibilities are taught and passed to younger gen-
erations through stories and proverbs told by mothers
in the family (Holroyd & Mackenzie, 1995).
Chinese women have other teachings by which
they abide. The ‘‘Four Books for Women’’ teach wom-
en their duties and responsibilities. Women are taught
to be submissive to their husbands; to be obedient to
parents and parents-in-law; to work hard at cooking,
cleaning, and sewing; and to avoid public affairs
(Zhan, 2002). Women’s moral behavior is viewed as a
symbol for the well-being of community and state.
February 2005 The Journal of School Nursing 5
Women can be subject to serious penalties if they do
not abide by these teachings and societal expecta-
tions. Women’s crimes against men are punished
much more severely than men’s crimes against wom-
en. With the women being expected to obey and
maintain a lower status than men, the power of the
patriarchal society or culture will remain stable (Zhan
2002). Gender roles were promoted in pre-modern
China, and still apply in some cultures today. Boys are
expected to play with other boys and do school work,
while girls are expected to help the mother with
household chores (Zhan 2002). Because the family
structure is patriarchal, girls are valued less than boys.
Most problems among family members
are handled within the family and
controlled by the extended family,
because social and legal structures
recognize the family as a unit, but not
individuals (Zhan, 2002).
The extended family also plays a role in ensuring
that its members behave properly. Most problems
among family members are handled within the family
and controlled by the extended family, because social
and legal structures recognize the family as a unit, but
not individuals (Zhan, 2002). Personal integrity is de-
termined by the way a person treats his or her family.
It is a moral obligation to care for a family member,
and this care cannot be performed by someone out-
side the family (Wong & Pang, 2000). The obligation
of family members to care for each other, especially
children and those who are ill, is fundamental in the
Chinese culture (Chen & Rankin, 2002; DiCicco-
Bloom & Cohen, 2003). School nurses working with
Chinese families need to keep this concept in mind
and develop nursing interventions and teachings that
pertain to the family as a unit and not solely to the
children.
THE HOME VISIT
School nurses may make home visits from time to
time, especially to a child who is chronically ill. There-
fore, it is important to be aware of cultural differences
in the home environment. DiCicco-Bloom and Cohen
(2003) observed nurses in 14 home visits and found
that even though some nurses attended to the family’s
cultural needs, none integrated the family’s lifestyle
into the actual care provided. Acknowledging cultural
differences and integrating these differences into the
nursing care plan can improve the quality of care. Be-
cause the home environment is the main living en-
vironment, it is most likely that school nurses who
visit the child’s home will develop insights about the
family’s cultural practices and assess the child and
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family holistically. Assessment of the child’s and fam-
ily’s concept of health is valuable, because knowledge
of clients’ concepts of health is necessary. This knowl-
edge allows the nurse to plan interventions that are
acceptable and meaningful to the family and the child
(Hwu, Coates, Boore, & Bunting, 2002).
FAMILY NEEDS DURING A CHILD’S ILLNESS
The Chinese culture is a collectivist culture, shun-
ning individualism for the more important collective
groups, such as family and society. When a child is ill,
parents and healthy children may keep information
from one another to avoid causing anxiety and dis-
tress. This behavior is characteristic of a selfless culture
that displays its roots in Buddhism and Taoism. Bud-
dhist teachings emphasize ‘‘face,’’ or dignity. When
something wrong happens to a family member, he or
she brings shame to the family. Therefore, the indi-
vidual may not admit having health problems, espe-
cially mental health problems, because it would bring
shame to the family.
In contrast, the United States is more of an individ-
ualistic culture in which the individual is seen as more
important than the collective group, family, or society.
Individualism and individual accomplishment are re-
vered in the United States. This can lead to cultural
struggles between Chinese American children and
their immigrant families, in which one group is in
need of being individualistic, whereas their families
are more sensitive to the culture and value the em-
phasis on the family unit.
When something wrong happens to a
family member, he or she brings shame
to the family. Therefore, the individual
may not admit having health problems,
especially mental health problems,
because it would bring shame to the
family.
The family is the primary social unit in the Chinese
culture. Any decisions that affect the family are made
with the family, either by the father, who is the house-
hold leader, or by the elder son. Roles are based on
‘‘the proper way’’ or ‘‘Li.’’ In this system, great value
and importance are placed on emotional control, obe-
dience, conformity, and ‘‘face’’ (McLaughlin & Braun,
1998; Ow & Katz, 1999). Face is a mutually protective
behavior that enables all individuals involved to end
any potentially embarrassing situation with no loss in
prestige. The immediate family loses face if a family
member does something that is considered ‘‘wrong.’’
The actions taken to save face are important in the
resolution of problems. This is especially true within
the family’s interpersonal relationships in saving one’s
Volume 21, Number 1
own face or another’s face, and by enhancing one’s
own face or another’s face. The interaction can also be
negative, with actions causing the loss of one’s own
face or hurting another’s face. The Chinese may with-
hold information or keep secrets in order to save face
and to protect family members (Ow & Katz, 1999).
When parents keep the diagnosis of an ill child con-
fidential from other siblings or family members, it is
because the parents do not want siblings to worry
about the situation that parents and trusted family
members are attempting to resolve (Ow & Katz, 1999).
In addition, outsiders are not told about the illness,
because a loss of face would occur by showing a weak-
ness or bringing shame to the family because of the
flawed health of the child. This practice also relates to
karma, in that it is considered unlucky to talk of ill-
ness or death for fear that it may occur (McLaughlin
& Braun, 1998). Saving face must be respected when
working with a Chinese family who have a chronically
ill child. The family does what is necessary to protect
both the child and the family while making health
care decisions. School nurses must work with the fam-
ily in the same fashion so that they suffer no loss of
prestige or status.
Yiu and Twinn (2001) reported that Chinese par-
ents have a great need for information when their
child has a chronic illness. They experience anxiety
from lack of resources and social support, especially if
they are faced with a language barrier. It is important
for nurses to assess the depth of their language ability
and to consider obtaining a qualified interpreter when
needed. Determining the extent of communication to
other siblings regarding a child’s illness is also essen-
tial if nurses are to avoid frustration and stress from
disclosing information to inappropriate members of
the family. School nurses need to be sensitive to each
individual family group, because there may be differ-
ences within the same culture. Understanding the
family system makes it possible to provide help in
dealing with the stress of coping with an illness in the
family and to assist the family members to meet their
needs.
SELF-CARE
In any cultural group, when a child becomes ill, re-
gardless of whether it is an acute or chronic illness,
both parents might need to take time off from work
to care for the child. Missing work can affect family
income and increase stress levels. As mentioned ear-
lier, it is important to know that in Chinese families,
parents and family members provide care for each
other’s illnesses as an obligation to show respect. How-
ever, encouraging children with a chronic illness to
learn self-care can reduce financial burdens as well as
the ‘‘physical, emotional, and economical burdens of
the disease’’ (Luo, 2003, p. 82). Orem’s self-care theory
is appropriate in the Chinese culture, because many
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families have more than two children and need to di-
vide their attention among the children; the oldest
children might be expected to perform self-care and
be more proficient compared with the younger sib-
lings. Luo’s study of 66 school-age children with ne-
phrotic syndrome revealed that high levels of self-care
were seen in the majority of the children.
Because the family may limit the amount
of information shared with outsiders about
the ailing child, they may not have
enlisted all the services available to the
child or the family.
Hwu and colleagues (2002) examined the concept
of health among Chinese people with chronic illness.
These individuals described ‘‘health’’ as relating to fac-
tors of independence, physical functioning, and the
ability to interact socially. Questions on topics relating
to independence included: (a) being able to move free-
ly to perform most activities of daily living, (b) being
able to take care of oneself, (c) not being sick enough
for hospitalization, and (d) not relying on others.
School nurses who work with Chinese children should
encourage and foster the highest level of self-care pos-
sible.
Because the family may limit the amount of infor-
mation shared with outsiders about the ailing child,
they may not have enlisted all the services available
to the child or the family. A culturally knowledgeable
social worker could help establish support services for
the family. Not only the child with the illness, but the
siblings and family members may receive services that
will help resolve the family issues related to the ill-
ness, as well as increase the health care services avail-
able to the child. Resources may be limited because of
communication barriers and limited support net-
works.
HEALTH PRACTICES AND MEDICINE
In identifying the health practices and medicine
used by the Chinese American community, there is a
need to identify some of the health problems that may
affect this ethnic population. Even as a child with a
specific illness is treated, health care professionals
need to be aware of other family members with ill-
nesses or conditions that may affect the recovery of
the child or those members who may be negatively
affected by the child’s illness. In Chinese American
women aged 65 and older, depression is widespread.
The suicide rate among Chinese American women is
three to seven times the rate of suicide in European
American women. Also, in the elder Chinese Ameri-
can population, vascular dementia is prevalent. Al-
though alcoholism tends to be low in prevalence
February 2005 The Journal of School Nursing 7
among the Chinese, it, along with depression, is prob-
ably underestimated (Tom, 1999).
Hepatitis B and tuberculosis have higher incidence
rates in the Chinese American population than in the
overall population of the United States, with hepatitis
B affecting 1 in 10 Asian Americans. Because of the
high incidence of hepatitis B in Chinese Americans,
this ethnic group also has the highest rate of liver can-
cer. Other cancers of significance in the Chinese Amer-
ican population are nasopharyngeal cancer, breast
cancer, prostate cancer, colon cancer, and lung cancer.
According to the Centers for Disease Control (n.d.)
statistical data in 2001, rates of tuberculosis were dra-
matically higher for Asians/Pacific Islanders (32.7 per
100,000), African Americans (13.8 per 100,000), His-
panics (11.9 per 100,000), and American Indians/Alas-
ka Natives (11.0 per 100,000) than for Whites (1.6 per
100,000). Making sure that Chinese American stu-
dents receive the complete series of hepatitis B vacci-
nations, assessing for any risks for tuberculosis, and
following up on positive skin tests should be a priority
for school nurses. Referring families to screening re-
sources and providing appropriate health education is
another important responsibility of the school nurse.
As with the general population, there is a trend to-
ward the increase of diabetes mellitus and cardiovas-
cular disease (Tom, 1999). The striking rise in type 2
diabetes diagnoses is a concern in ethnic immigrant
groups that have undergone lifestyle changes and live
in industrialized nations. It is estimated that more
Chinese people living in the United States are diag-
nosed with type 2 diabetes than Chinese people living
in China (Jayne & Rankin, 2001).
The health practices among Chinese Americans
vary with the generation of acculturation in the Unit-
ed States. Individuals born in China are more likely to
follow the traditional health practices, such as the
concept of yin and yang, and be more skeptical of
Western medicine than those Chinese individuals
who were born in the United States. Yin and yang
have a basis in the five fundamental concepts: metal,
wood, fire, water, and earth, and qi or chi concepts
(Feng, 2002). Yin and yang are opposing forces. Yin is
identified as female, negative energy, and cold. Yang
is identified as male, positive energy, and hot. It is the
balance of yin and yang forces that sustains the body
and maintains the health of the individual; a hot or
cold imbalance brings about illness. An excess of yin
(cold) results in fever and dehydration. An excess of
yang (hot) results in gastric and other disorders. Yang
represents the external organs, including the small in-
testine and stomach. Yin represents the internal or-
gans, including the lungs and spleen (Feng). Foods are
described as ‘‘hot’’ or ‘‘cold.’’ For example, meats, sea-
food, and fried foods are ‘‘hot,’’ whereas vegetables
and fresh fruits are ‘‘cold.’’ Climates and seasons may
require adjustments in food choices. For example, par-
ents may not recommend ‘‘cold’’ foods to their child
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after surgery, because the child needs to rebuild the
warmth of the body because of the blood loss (Chen
& Rankin, 2002). In the school setting, a student may
eat particular foods for lunch that have been packed
or prepared by the parents with respect to the weather
or health situation.
Qi or chi is the vital energy flowing in the person.
When it is absent, the body dies. Chi can be gained
from three sources: genetics, air, and food. It can be
lost through aging and neglect. When chi is in bal-
ance, it promotes the function of the heart and lungs.
To maintain the chi balance, tai chi, a series of slow,
precise, specific exercises, is performed, nourishing all
body parts by improving the blood flow (Feng, 2002).
Acupuncture is a common Chinese practice based
on the principles of yin and yang and chi. Modern
acupuncture may include the use of lasers or electric-
ity. Moxibustion, the practice of applying heat to the
acupuncture points, treats conditions such as asthma,
arthritis, and bronchitis (Feng, 2002). Chinese people
use several other traditional healing methods or prac-
tices during illness. Cupping is used to decrease stress
and congestion by placing heated cups on parts of the
body. This rids the body of unwanted chi by bringing
it to the surface of the body and then letting it diffuse
away. These therapies work against the imbalances
that are thought to cause the illness rather than re-
ducing the symptoms as in Western medicine. Her-
bology, the use of plant and animal matter, stimulates
chi in the body to treat ailments. Meditation helps
relax the body to reduce stress (Tom, 1999). Although
underestimated in scientific medicine, meditation en-
ables people with chronic illnesses to maintain a total
sense of mind, body, and spirit (Bonadonna, 2003).
For over 40 years, the Chinese government has re-
quired an integrated practice of Western and Chinese
medicine in their medical schools. Combined Western
and Chinese therapies have in some cases been more
effective than either practice alone. Chinese herbs and
radiation therapy boost the immune response and in-
hibit developing tumors more effectively than either
therapy by itself (Feng, 2002). Chinese Americans may
have different physiologic and psychological respons-
es to Western medicine (Tom, 1999). Some medica-
tions, such as psychotropic medicines, are required in
lower doses. This is because of smaller body size and
differences in the metabolism or clearance of the med-
ication by Chinese Americans. Psychotherapy may
make Chinese patients anxious or uncomfortable and
subject to somatization (Tom, 1999).
IMPLICATIONS FOR SCHOOL NURSING PRACTICE
School nurses have a unique opportunity to work
with culturally diverse populations, based on the fact
that the number of immigrant children is increasing
each year. School nurses consistently interact with
children and their families, many of whom have con-
Volume 21, Number 1
trasting views and cultural beliefs about health care.
Because these values, beliefs, and practices may vary
even in families from the same country of origin, an
assessment of their culture and family system at the
beginning of a nurse–family interaction is an impor-
tant initial step of the nursing process.
School nurses have a unique opportunity
to work with culturally diverse populations,
based on the fact that the number of
immigrant children is increasing each
year.
School nurses need to be aware of major concepts
in the Chinese culture such as holism and the Con-
fucian teachings. Awareness of Chinese cultural beliefs
will benefit the child and the family, as well as the
school nurse. Understanding and respecting the Chi-
nese culture supports the delivery of meaningful and
satisfying health care in the school setting.
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