Behavioral Objectives
After reading this chapter, the nurse will be able to:
- 1.
Describe the communication patterns of Korean Americans and the difficulties encountered when communicating in an English-speaking society.
- 2.
Identify patterns of spatial behavior found among Korean Americans.
- 3.
Relate family and social values commonly held by Korean Americans.
- 4.
Describe the effect of cultural perspectives on time on the behavior of Korean Americans.
- 5.
Relate the significance of Oriental herbal medicine for the health care of Korean Americans in the United States.
- 6.
Describe the biological variations that affect health care for Korean Americans.
Overview of Korea
Often referred to as the “Land of the Morning Calm” (in Japanese, Chōsen ) because of its spectacular mornings, Korea is a nation with one of the richest and most original cultures in East Asia and is one of the world’s leading economic powers ( ). A peninsula in the East Sea (Sea of Japan), Korea is bordered by thousands of islands, with China and Russia to the north and neighboring Japan to the east. The peninsula is 125 miles wide at its narrowest point and extends 625 miles from north to south.
Korean history dates back to 2333 b . c ., with the founding of the state of Ancient Choson by Tan-Gun ( ). Korea was united as a kingdom under the Silla Dynasty, 668 a . d . At times Korea was associated with the Chinese empire. A treaty that concluded the Sino-Japanese war of 1895 recognized Korea’s complete independence. However, in 1910 Korea was forcibly annexed by Japan. Following World War II, Korea was occupied by the Soviet Union in the north and the United States in the south, with the thirty-eighth parallel designated as the line dividing the areas of occupation. North Korea became totalitarian like the Soviet Union and Communist China. South Korea became a free society like the United States; both aspired to erase the boundary and reunite Korea into a single state. These attitudes burst into flames on June 25, 1950, when the armed forces of North Korea invaded the Republic of Korea ( ). In 1953, following 4 years of battle between the North and the South in the Korean War, an armistice was declared. Today the country remains one of the few nations in the world still affected by the Cold War. About 40,000 U.S. troops continue to guard South Korea at the thirty-eighth parallel demilitarized zone against another Communist invasion. In 2006, North Korea began a proliferation of missile testing. While this situation appeared to put the world at large in an extremely vulnerable position, in July 2007, the United Nations verified that North Korea had closed all five of its major nuclear facilities, which was a milestone in the efforts expended to get the country to give up its nuclear weapons program ( ). Since that time, North Korea has reconstituted its nuclear programs, tested nuclear weapons and defied the free world’s demands to cease nuclear armament. This situation remains unresolved. In 2010, a North Korean submarine torpedoed a South Korean naval vessel (verified), raising tension to new levels. North Korea continues to threaten South Korea and allied nations.
The South Korean landmass is only 38,486 square miles, slightly larger than Indiana. In contrast, the North Korean landmass is 46,541 square miles, slightly smaller than Pennsylvania. The population of North Korea is 22,912,177. In contrast, the population of South Korea is 48,636,068, which approximates the populations of California and Florida combined ( ; ). If South Korea and North Korea were reunited, the country would be about the same size as Iceland or Portugal.
North Korea was ruled by Kim Jong Il from 1994 until his death in December of 2011. Kim Jong Il succeeded to this leadership position at the death of his father, Kim Il Sung. He was not only the head of state for North Korea, but also chairman of the National Defense Commission, a position accorded to the nation’s highest administrative authority. As this text goes to press, speculation suggests that North Korea may move to a collective leadership model, with experienced advisors sharing power with designated successor Kim Jung Eun, son of Kim Jong Il. However, the ultimate political leadership of this tightly ruled Communist country is unclear at this time ( ). Similarly, the president of the Presidium of the Supreme People’s Assembly, Kim Yong-nam, serves as the nominal head of state. Since June 7, 2010, the premier is CHOE Yong Rim ( ). In North Korea, the labor force is 36% agricultural, with many dependent on the scarce farmland (14% arable land) for a basic subsistence. The per capita income is $1700 ( ; ).
The president of South Korea, at this writing, is Lee Myung-bak (2008– ) and the Prime Minister is Chung Un-Chan (2009– ). In contrast to North Korea, South Korea has made great strides in developing its potential as one of the Far Eastern powers by blending nationalism, administrative efficiency, and semiauthoritarian rule ( ). The war left South Korea with virtually no natural resources ( ). However, South Korea’s export successes have been the result of the labor and skills of its people, with 67.7% of the labor force involved with services, 25.1% in industry, and 7.2% in agriculture ( ). South Korea has made a remarkable economic transformation in the past several decades, with its per capita gross national product increasing from $87 in 1962 to $23,000 in 1987 ( ) to $28,000 in 2009 ( ). Today, South Korea enjoys a hitherto undreamed of standard of living and is the sixth largest trading partner of the United States. The United States is the second largest export recipient of Korean goods, with major exports including electronic products, machinery, and passenger cars ( ). Sponsorships of the Twenty-Third World Olympics in 1988, the International Council of Nurses Nineteenth Congress in Seoul in 1989, and the World Cup soccer matches in 2002, as well as winning gold medals in the 2008 Beijing Olympics represent a few examples of the economic confidence of the people of South Korea.
Unification of the peninsula is a hope held very close to the hearts of most Korean people ( ). South Koreans have not forgotten the United Nations’ commitment of the 1950s (Korean Conflict) and continue to partner with the ideals and democratic philosophy of the United States, a staunch economic, political, and military ally. In recent years, there have been unification demonstrations in South Korea by those who did not experience the previous aggression of the North. At an unprecedented summit meeting in Pyongyang in 2000, South Korean President Kim Dae Jung and North Korean leader Kim Jong Il agreed to work at reconciliation and reunification of their two countries. Kim Dae Jung was named winner of the 2000 Nobel Peace Prize for his efforts ( ). In 2007, a second North/South summit took place between South Korean president Roh Moo-Hyun and the North Korean leader. However, unwillingness by the North to engage new President Lee Myung-Bak following his 2008 election left inter-Korean relations strained ( ).
Mountains, valleys, and streams dominate the terrain of both North and South Korea. North Korea is almost completely covered by a series of north–south mountain ranges that are separated by narrow valleys. In North Korea, the Yalu River forms a part of the northern border with Manchuria ( ). South Korea is approximately 70% mountainous. In the north and east of South Korea, more than 10% of the land is 3000 feet above sea level. In South Korea, narrow plains and hills between the mountains provide the major land area for agriculture and other economic activities. Approximately 16.58% of the land is arable and is cultivated for rice, root crops, barley, soybeans, and vegetables ( ).
South Korea has a clear delineation of four seasons, and its climate is characterized by cold winters and hot summers. The average temperature in the coldest winter month is below 28° F and in the warmest month is over 86° F. A humid summer monsoon from the Pacific lasts about 6 weeks in June and July. South Korean weather has been described by many as similar to that in Virginia.
The population density in South Korea is 501 people per square kilometer, with 81% of the people living in cities ( ). The population of Seoul, the capital (the term Seoul also means “capital city”), is 10,287,847, and Pusan ( Cauldron-mountain ) has 3,504,900 inhabitants ( ). In North Korea, the majority of the population is urban (61.1%), with the capital city of Pyongyang having the largest population of 3,228,000 ( ).
Overview of Korean Americans
Although Korean immigration to the United States dates back to 1885, when three Korean men claimed to be political refugees, it was not until after the Korean War when sustained immigration started. Early immigrants during this time principally came to Hawaii to work as laborers in the sugar plantations solely for the purpose of making money and with the intention to return home. They had a “sojourner” mentality, never fully participating in American life.
The Immigration Act of 1965, the rapidly rising population level in Korea, and Korea’s urbanization and rapid industrialization led to a dramatic increase in Korean immigration to the United States. In addition, the connection through the political-military alliance with the United States and the stationing of large numbers of U.S. military personnel allowed more female immigrants to the United States. These Koreans were largely well-educated professionals and students who wanted more freedom to live in a democratic society and who had no intention of going back ( ). This created a “brain drain” phenomenon. However, dramatic improvements in economic and living standards in South Korea and the establishment of a civilian-controlled government in the 1990s caused a drop in immigration rates. Even some people who had immigrated to the United States earlier returned home during this period. It is interesting to note that the emergence of a favorable political, economic, and social climate in South Korea had an immediate effect on Koreans’ decisions to immigrate.
Life in the United States Today
According to the , 1,754,354 Korean Americans reside in the United States, representing 0.4% of the total U.S. population and 9.5% of the Asian-American population. The growth rate for Korean Americans has slowed from 134.8% between 1980 and 1990 to 35.1% between 1990 and 2009 ( ). Koreans are the fifth largest ethnic group among Asian Americans, following the Chinese, Filipinos, Indians, and Vietnamese ( ). Of all Korean Americans residing in the United States, 44% live on the West Coast, 23% in the Northeast, 19% in the South, and 14% in the Midwest, which is a typical historical settlement pattern for Asian Americans ( ). More than 75% of Korean Americans live in just 10 states: California, New York, New Jersey, Illinois, Washington, Texas, Virginia, Maryland, Pennsylvania, and Georgia ( ; ).
Of the Korean Americans who resided in the United States between 1975 and 1979, 15.3% were foreign-born; between 1980 and 1990, 41.0% were foreign-born; between 1990 and 2000, 60% were foreign-born, and from 2000 to the present, 29.2% were foreign-born ( ). Immigration has obviously contributed immensely to the growth of the Korean-American population over the past four decades. However, the percentage of Korean Americans who are foreign born differs considerably across time periods.
The median age of Korean Americans is 36.3 years, compared with 35.4 for other Asian Americans, and the national median age of 36.8 years for the general U.S. population. In addition, only 9.3% of Korean Americans are 65 years of age or older, compared with 12.7% of the general U.S. population ( ).
Korean Americans maintain one of the highest levels of ethnic attachment of any Asian ethnic group. An extremely high percentage of Korean immigrants speak Korean, eat Korean food, and practice Korean customs a majority of the time. Further, a larger population of Korean Americans belong to ethnic associations (75%) than Filipino (50%) or Chinese (19%) do ( ).
There are three major reasons Korean Americans maintain high levels of ethnic attachment. First, Korea is a small, homogeneous country with one language ( ). Second, most Korean Americans (55%) were affiliated with Korean ethnic churches prior to immigration, and 75% affiliate with Korean churches after settling in the United States, probably for practical and social reasons ( ). Third, Korean Americans tend to concentrate in small businesses, which strengthens Korean ethnicity. Many Koreans who do not operate small businesses are employed in these enterprises. This ties many Korean Americans together socially and culturally.
Although the ethnic bonds within the Korean-American communities provide a high level of nationalistic satisfaction, the same ethnic bonds have hindered Korean-American assimilation into the American society. American-born Korean Americans assimilate proportionately according to length of residence and education. Older immigrants cling to Korean food, language, customs, and newspapers, thus slowing assimilation compared with other Asian immigrant groups ( ; ). Korean Americans who have the opportunity to move through the American educational system, including universities, enhance the rate of assimilation while retaining pride of heritage.
Korean Americans are noted for high educational standards. In 2009, 61.1% of Korean-American males and 46.5% of their female counterparts had completed 4 or more years of university-level studies. Similarly, among Korean-American males, 91.5% as compared with 95.8% of their female counterparts 25 years of age or older held a high school diploma.
Children excel in school, particularly in math and science ( ; ), which can be related to the struggle to achieve economic development after the Korean Conflict and the importance of education, which was emphasized in the home. Each year, over 99% of Korean students move from elementary school into middle school, and about 95% graduate from high school ( ). Korean children go to school more than 220 days a year for 5.5 days per week ( ). Stress and competition to go to the top-rated schools have created some problems, such as loneliness ( ), depression ( ), and suicide.
Many Korean Americans view entering the workforce after college graduation as a serious lifetime commitment. Because of limited job opportunities, some Korean Americans do not look favorably at moving from job to job. In addition, some Korean Americans believe that attendance at the right school plays a major role in landing a prestigious position because many elite companies scout only capable people from the top-rated schools. Korean Americans, like other Asian Americans, are more likely to participate in the U.S. labor force than the U.S. population as a whole. Of the number of Korean Americans in the United States, 60.2% participate in the workforce. In general, 52.8% of Korean-American women participate in the labor force compared with 59.5% of all other women ( ). Korean Americans are represented in various work occupations such as in management, professional, or related occupations (6.2%); service occupations (14.2%); sales or office occupations (27.7%); farming, fishing, or forestry occupations (0.1%); construction, extraction, maintenance, or repair occupations (3.6%); and production, transportation, or material moving occupations ( . In 2009, the median family earnings for Korean Americans was $64,142, compared with $62,367 for the rest of the general U.S. population ( ). Korean Americans fare better than their counterparts regarding median individual income. In 2009, the median per capita income for Korean-American women was $38,791, as compared with women in the rest of the general U.S. population at $35,299. Likewise, the median per capita income for Korean-American men was $50,659, as compared with $45,320 for men in the rest of the general U.S. population ( ). Among Korean Americans, 11.4% live below the federally defined poverty level as compared with the 14.0% of the general U.S. population ( ).
One major issue that prompted Korean adults to immigrate to the United States was consideration for their children’s future. However, many elderly Koreans came over without a thorough awareness of their future or a plan ( ). Many Koreans found difficulty in leaving behind old cultural and social norms and adjusting to new ones ( ). Many of these individuals faced problems, including financial struggles, poor health, poor care practices, difficulty with social interactions, and mental problems such as Hwa-byung, which is a Korean culture-bound syndrome of suppressed anger and depression ( ; ). Another major issue involves Korean-American men who suffer from loss of control and a sense of not belonging ( ). Many men followed their spouses who were nurses or physicians (it was easier for females to immigrate because of their professions) without adequate preparation for their own professional future and “equalization” of the male–female relationship.
Communication
Language and Culture
Koreans use their own unique language, Hangeul. Hangeul is spoken by more than 78 million people in 31 different countries, including large groups in the former Soviet Union, Australia, United States, Canada, Brazil, and Japan ( ). Hangeul is related to the Mongolian and Japanese languages and a large number of Chinese cognates (around 1300) exist in the Korean language ( ). The Korean language is entirely different and capable of standing on its own (14 consonants and 10 vowels), and the language and literature have been greatly influenced by the Chinese ( ). As noted, more than half of the words now used in Korean are of Chinese origin. With continued emphasis on learning Chinese because of the ruling Neo-Confucian philosophy of the earlier Chosun Dynasty, Chinese characters and Chinese words still occupy more than 50% of the text of Korean newspapers, magazines, and books today. Nevertheless, the Hangeul language was created in 1446 during the Joseon Dynasty to give the Korean people an alphabet that was learnable and usable by all ( ). The unique simplicity of Hangeul is reinforced by the fact that illiteracy is almost non-existent in Korea. Most Korean children have mastered their language by the time they reach school age ( ).
The forced annexation of Korea by Japan from 1910 to 1945 prohibited the public use of the Korean language and forced Koreans to learn Japanese ( ). Thus, many words used in Korean also have a Japanese origin (many of which are also from Chinese). However, the Korean language has a well-developed and extensive vocabulary, and Hangeul has been at the root of the Korean culture, helping to preserve its national identity and independence. Because of the simplicity and accessibility of the Korean alphabet, Hangeul is easy to learn, which has resulted in 100% literacy in Korea. Scientific design makes it easy to mechanize for computer utilization ( ). During the Japanese occupation, many Korean scholars worked to preserve the national language, which was critical in forging a strong national identity ( ). The Japanese occupation, historical Chinese influence, and other foreign contacts have led to the integration of many indigenous words and loan words into the Korean language, mostly technological and scientific terms ( ).
Dialect and Style
The usual commentary on dialect, style, emotional context, and kinesics does not apply to Hangeul as spoken by Koreans. Breadth of full language use and preciseness of pronunciation are most often the discriminators that identify and delineate higher-class (educated) from lower-class (less-educated) Koreans.
Verbal Communication
When abroad, a Korean being introduced to other Koreans, whether socially or professionally, will listen quite attentively before deciding to interact. This reserved behavior is related to the Korean equation of “reserved familiarity” until the individual has mastered the language and learned to know the individual. During conversation with an unfamiliar person, if there is a match between individuals, the individual is “in” and conversation will ensue. Of the Korean Americans residing in the United States, 79.2% speak only Korean at home, 46.7% do not speak English well, and 20.6% speak only English ( ).
Use of Eye Contact and Kinesics
In public situations, Koreans are a “noncontact” group. In this sense, some Koreans have difficulty making eye contact or engaging in physical contact on streets, at markets, on subways, and in the workplace. However, in one-on-one and “acquaintance” situations, Koreans are very similar to Americans in interactions. With a familiar acquaintance, some Korean Americans will engage in eye contact. When conversing with familiar individuals, they will speak in the first person. Some Korean Americans are comfortable in face-to-face situations. However, some Koreans are still offended if, for instance, the sole of a shoe or foot is directed at them. Most Koreans who subscribe to this belief are willing to forgive “lack of knowledge” on the part of some Westerners in this regard. Basic courtesy, when sincerely exhibited by all parties, is a good-faith gesture that overcomes traditional Korean mores.
Confucian philosophy forms the basis for behavior and position within the social hierarchy ( ). Etiquette is very important to Koreans, and it is a mistake to appear too familiar or informal. First names are used only within a family or a circle of close friends. For some Korean Americans, addressing or referring to people by name is considered a lack of proper respect and is believed to invoke evil spirits and lead to ill fortune.
Social Rank and Language
The idea of filial piety ( Hyo: eternal indebtedness to the parents who gave children life) is so pervasive in Korean culture that the language itself is structured to reflect the junior–senior relationship of the parties in any given conversation ( ). Different vocabulary and verb endings are used according to whether the person being addressed is of higher, equal, or lower rank or socioeconomic status than the speaker. Koreans accept filial obligations as part of life; these obligations set the patterns for getting along with other people and make it easier to know how to act in daily situations. Parents have a duty to their own ancestors to be wise, and it is children’s duty to obey their parents and to repay them with loyalty and sincere effort ( ).
Relationships outside the family are also modeled by filial piety. People understand how to behave toward others who are above or below them on the social scale ( ). Many Korean Americans are very sensitive regarding the feelings of others. In most instances, Korean Americans are generous and agreeable and rarely say no to even an “impossible” request to prevent overt conflict and a breakdown of relationships ( ; ).
Implications for Nursing Care
More than 60% of Korean Americans were not able to speak English prior to immigration ( ). Many elderly Korean Americans who immigrated late in life may be quite intelligent and trilingual (Korean, Chinese, and Japanese), but they may not be able to communicate with health care professionals. Some elderly Korean Americans may have an attitude of “giving up on learning English.” It is essential for the nurse to assess the linguistic abilities of the client. When translators are needed and Korean interpreters are not available, sometimes a Japanese or Chinese interpreter may be used to communicate with the client. If the client speaks and understands only Korean, a Japanese or Chinese interpreter might not be helpful. In these instances, the nurse may seek the assistance of a family member who speaks English to serve as a translator. However, children should not be used as translators, because this may create a reversal in the parent–child relationship and cause conflict. When communicating with a Korean-American client who has some knowledge of English, it is essential that the nurse speak slowly because this aids understanding. However, it is not necessary to speak loudly. Understanding and applying filial piety are of utmost importance during interaction with Korean Americans, be it polite body posture showing respect to elders or a sincere appearance of attentive listening.
Space
Distal spacing—between elderly and young, seniors and juniors, bosses and subordinates—is very subtle but quite distinct within the Korean community. If this spacing is ignored through ignorance or “cockiness,” the person is considered a “black sheep” and will not be accepted socially.
Korean Americans, like some other Asian Americans (Chinese Americans, Japanese Americans), have a high tolerance for crowding in public spaces. For Korean Americans who immigrated from Korea, the ability to tolerate crowding probably developed in Korea as a result of the density of the population. South Korea is so crowded that its 47 million people live with 501 people per square kilometer ( ).
Although Korean Americans can tolerate crowding, some avoid physical contact if possible. These individuals are uncomfortable in situations where physical contact is likely to occur. In addition, although some Korean Americans can tolerate higher degrees of crowding, they do not necessarily desire to engage in eye contact with unfamiliar persons.
Implications for Nursing Care
Because Korean Americans are basically a “noncontact” cultural group, until a relationship has been established, the nurse should attempt to establish an environment of trust and caring. Korean Americans are often perceived as extremely practical and thus, when confronted with sincerity, will respond in a manner of “Let’s get the job done.” When interacting with an elderly Korean who does not speak the language, an interpreter who can convey sincerity should be used. It is essential for the nurse to remember that, although some Korean Americans are reported to have a higher tolerance for crowding, physical contact may not be acceptable, despite the closeness to the individual.
Social Organization
Family
The average family size for Korean Americans is 3.6 people. The percentage of Asian-American families maintained by a husband and wife is 82%, which is slightly higher than the national average of 79%. Of the number of Korean-American families, only 12% are female-headed households, compared with the national average of 17%. A watershed percentage of women in the workforce has both enhanced tradition and extended opportunity to family unit members, especially females ( ).
Historically, the Korean-American family has been the cornerstone of the culture. In most cases, father and sons have enjoyed preeminence as the leaders and undisputed decision makers ( ). The traditional Korean family has been fixated on the need for a male heir, who is needed to guarantee the family line and lead the family in rituals that pay homage to ancestors, both in the home and at burial sites. The firstborn son inherits the mantle of family leadership and a greater property inheritance. Other sons receive lesser portions. Daughters receive very little, if any, inheritance. However, investigated women receiving prenatal care in Korea and noted that only 35% felt having a male son was “important.”
In Korea, marriages of daughters have been traditionally arranged, and elders have been respected and cared for. Gender biases may be held by some Korean Americans. However, since the Republic of Korea has leaped into the forefront of industrial export and partnership with the Western world, there has been a demand for qualified citizens with bachelor’s, master’s, and doctoral degrees, regardless of gender. This surge of national output and pride saw the competitive Korean educational system pushing those with potential to the top, regardless of gender. The movement toward equality in rights for women has threatened tradition both domestically and internationally. Although pure tradition is still found in the larger Korean rural society, the profound effect of this change is clearly visible in the matriculation picture at Korean universities. Essentially, modern mobility has strengthened relationships between couples and immediate family and has weakened traditional extended family obligations.
For some Korean-American families, problems have arisen when the wife has experienced professional upward mobility and the educationally prepared husband has not been able to find employment. Some Korean-American males have not been able to accept this situation and as a result have experienced enormous stress and anxiety. Some Korean-American males have discouraged their partners from continuing in competitive job tracks. This reaction appears to be adjusting with time because Koreans not only are rooted in tradition but also are very pragmatic and realistic.
Koreans as a whole are determined to increase their stock as an international economic partner. Korean Americans are an impressive example of how people can both assimilate and remain true to national heritage and family values. Korean-American communities have both become a part of the greater American society and begun to internalize to ensure homogeneity. Almost every major Korean community in the United States (that is, Los Angeles, San Francisco, New York, Baltimore, and Atlanta) and almost every city with a major university have organized local Korean schools to ensure that the culture, history, language, and tradition are not lost. Korean Americans today strive to balance American opportunity with knowledge and pride of heritage.
In a study on perceptions of elder abuse, elderly Korean-American women were substantially less likely to perceive a situation with an elder as abusive as were African-Americans or Caucasian Americans ( ). Korean-American elderly were more likely to define abuse in a narrow context and were significantly less likely to seek help than the other groups.
Religion and Social Values
The social values of modern Korea reflect a blend of both old and new religious viewpoints. Shamanism, Taoism, Buddhism, and Confucianism were practiced in Korea long before Christianity ( ; ).
Although Buddhism is not the dominant influence in Korean life that it once was, it is still the biggest single religion, with 22.9 million (47%) adherents ( ). Buddhism was originally not a religion but rather a doctrine of self-enlightenment, attainment of which would result in a deep understanding of one’s own nature and place in the universe. This, in turn, engendered a way of “being-in-the-world” in which suffering would cease to exist and a timeless peace would be enjoyed.
Confucianism, entering Korea four centuries after Buddhism, was not so much a religion as a social ideology, exacting subordination of the son to the father, of the younger to the elder, of the wife to the husband, and of the subject to the throne. It inculcated filial piety, reverence for ancestors, and loyalty to friends, with strong emphasis on decorum, rites, and ceremony. With Japanese rule in 1910, the Confucian system disappeared. However, its basic values and premises lived on and continue to serve as the moral backbone of Korea ( ).
Christianity in Korea, although more recent, has been accentuated by the presence of 40,000 to 60,000 Westerners for more than 40 years. With the Westerners have come missionaries, astutely armed with modern learning, which isolated and withdrawn Korea badly needed. They had a powerful appeal to Koreans. As a result, approximately 20% of Koreans are church-going Christians. In addition, even more are influenced by the “Christian way.” Unlike many Buddhists, Korea’s Christians are fervent and devout to a point where they would probably feel quite out of place in a Western congregation ( ).
Many Koreans honor and practice a blend of traditional and modern religion, since Korea does not have one national religious creed. Although certain conflicts are recognized—that is, Confucianism versus Christianity—Korean Americans are able to harmonize the “best of both worlds.” Korean Americans are generally more oriented to the future than to the ancient past and will adopt consistent, provable change, whether religious or political. Today, approximately half of the Korean population is affiliated with Buddhism or Christianity, while essentially the whole population is profoundly influenced by Confucian thought ( ).
Implications for Nursing Care
Although contemporary changes in traditional family customs have weakened the kinship and family structure, there is no question that Korean Americans are family oriented. Hospitalization of one becomes an entire family concern. The increasing importance of conjugal family relationships rather than the son–parent relationship has put sons and daughters-in-law at risk of great guilt if the parents become ill. Some Korean Americans may blame the illness of the father or mother on inadequate attention and care on the part of the child.
Although Koreans are exposed to many religions, it is important to note that Confucianism became the philosophical basis of family life as well as government and society. Respect for authority, balanced by affection and a sense of obligation toward one’s subordinates, is central to the Korean way of life ( ). This may affect health care decision making for Korean Americans: for example, if an elder family member believes a medical procedure is necessary, the client will usually accede. Of course, the reverse may also be true. If culturally appropriate care is to be rendered, it is essential to remember that the family is a primary social unit and family members must be included in the plan of care. In some instances, the client and the family may need counseling services to ensure proper intervention with the family.
Time
According to , time is an element of culture that belongs to a unique category in a nonverbal communication system. The organization of time is essential for some cultural groups. In other words, perceptions of time are culturally determined and are not culturally free ( ). Some Korean Americans believe that a person is in this world for only a brief time. For persons subscribing to this belief, life and living are viewed as a harmonious relationship between nature and the human being. Some Korean Americans, like some other Asian Americans, believe that every individual needs to learn to use time wisely. Thus, they are likely to believe that time should be used for activities such as performance of service for another person ( ).
Many Korean Americans are future oriented, which is derived from a Confucian belief in reincarnation. In this sense, many individuals who subscribe to this belief are likely to believe that it is essential to finish a task before beginning another one.
By virtue of culture, individuals can be either polychronic or monochronic in the organization of time. described the time orientation of Asians as polychronic in contrast to the monochronic orientation of Westerners. Monochronically oriented individuals believe that it is essential to do one thing at a time. Persons who are monochronically oriented believe that accomplishments should be achieved during each task ( ). These individuals have an increased need for closure (finishing a task, ending a relationship). Monochronically oriented individuals generally think in a linear fashion. People who think in a linear fashion tend to internally process information in a sequential, segmented, orderly fashion ( ). For example, these individuals would sequence a meeting in this order: arrival, meeting, conclusion, action. They are likely to cycle through this sequence all day ( ). In contrast, polychronic individuals tend to think about and attempt to do many things at one time ( ). Persons who are polychronic can experience a high degree of information overload because they are trying to process so many things at one time. These individuals may also procrastinate because of information overload ( ). They may also tend to struggle harder to articulate abstractions without visualizations. concludes that polychronic individuals are very visually oriented. This orientation appears to be in concert with some research that indicates that these individuals may have either a right-brain or left-brain orientation. Right brain–dominant people tend to think more creatively, visually, and artistically than left brain–dominated individuals do, whereas left brain–dominant people tend to think more mathematically and linearly ( ). Because Korean Americans tend to be polychronically oriented and appear to be visually oriented, they are very likely to be right-brain dominant.
For some Korean Americans, having children is an essential life task. Sacrifice to bring up children in the best possible environment is an indescribable quest. For example, parents may be maintaining their living at the fish market, but they may send their children to the best private institution possible.
Many Koreans believe that people are reincarnated. They believe that those who perform good deeds and provide mercy for others in this world will be reborn as another human being, and that those who are bad in this world will be punished and be reborn as some sort of animal. Because of this belief, an intact body is necessary. Organ donation and transplantation are not seen as a virtue but as a threat to reincarnation.
Westerners tend to prioritize and schedule their lives. Compartmentalization of time occurs even in clinical settings such as the hospital. For example, in the hospital, rounds are made, temperatures taken, meals served, medicines dispensed—all on schedule.
Implications for Nursing Care
Time as viewed by Koreans is obviously a concept not held by Westerners in general. Nurses can expect cooperation in matters involving time, but when the client is suffering from anxiety and stress, the nurse must take time to communicate with the client to determine the client’s needs.
Environmental Control
Illness and Wellness Behaviors
Several theories can explain the perceptions of illness by Korean people. One predominant health–illness theory governing Korean people is the equilibrium system, which emphasizes harmony and balance. Health derives from the harmonious relationship among elements of the universe, the human environment, and the supernatural world. Health also derives from the balance of the two major forces: eum (cold/dark, Chinese yin ) and yang (hot/bright, Chinese yang ). Disruption in the harmony of nature and imbalance between the two forces causes illness.
Dominance of eum creates problems related to cold, which makes a person depressive, hypoactive, and hypothermic. Examples of diseases from this dominance of eum are abdominal cramps, indigestion, and vaginal discharge. In contrast, dominance of yang causes a person to be hyperactive, hyperthermic, and irritable. Febrile seizures, stroke, and pimples are some examples of conditions related to yang dominance. Treatment for a person with dominant eum includes its replacement with yang to achieve balance, which includes providing hot food such as onions, peppers, ginger, and scallion roots. Giving cold food such as ice water, myung bean curd, cold noodles, and crab are some of the treatment modalities for those who have dominant yang problems ( ; ).
Elderly Korean Americans consider drawing blood for laboratory work a very unfortunate event and may refuse. This idea stems from the fact that blood is considered life and removing blood from the body is considered as removing ki (Chinese ch’ì ), which is the very essence of life energy ( ).
Oriental Herbal Medicine
The use of herbal medicines ( Han-yak, “Chinese medicines”) dates back to ancient Chinese practices. However, traditional Korean medicine has developed with its own characteristics ( ). There are 396 distinct herbs and spices commercially available that are used either singly or in blended mixtures such as herbal decoctions ( ).
Today the power and influence of herbal medicine are evident in every city with a large Korean community, where many wholesale and retail herbal medicine shops may be found ( ; ). Oriental herbal medicine doctors practice their trade by four common treatment methods: herbal medicine shops, acupuncture, moxibustion, and cupping. They may use one method singly or several in combination to treat clients.
Oriental medicine is based on the visual observation of behavior, physical properties of the body such as build, illness history, verbal responses, and radial pulses. After assessment, symptoms of disease are interpreted, and the treatment plan is devised on the basis of the metaphysical and cosmological philosophy of the concepts of eum and yang ( ; ).
If properly trained, Oriental medicine doctors have completed at least 6 years of education, with 2 years of premedical school and 4 years of Oriental Medical School. To practice in Korea, they also must pass a national licensing examination. Because of the popularity of holistic and alternative forms of health care, not only Oriental people are seeking herbal medicinal treatment in the United States, but also many Americans are seeking to have their health monitored by “herbal doctors” ( ).
Oriental medicine doctors who have been assimilated into the American culture may incorporate biomedical technologies in making diagnoses. They may explain and make an analogy of their Oriental treatment in biomedical terms. It is likely that the number of Oriental medical doctors will increase as Korean communities become larger. In Atlanta alone, at least 20 Oriental medicine doctors are in official practice ( ).
Because of the popularity and consumer demand, schools of acupuncture and Oriental medicine are increasing all over the United States, mainly in large metropolitan cities, and enrollment in these schools is expanding. Currently in the United States, these schools are 3 years in length for these who possess prior degrees. The curriculum includes at least 240 credits of theory and 1400 supervised clinical hours. Upon completing the curriculum, students must take national certification examinations to apply for state license to practice as a Licensed Acupuncturist (LAc), Acupuncture Physician (AP), or Doctor of Oriental Medicine (OMD or DAOM). The National Certification Commission on Acupuncture and Oriental Medicine administers the examinations, and the eligible candidates must pass the entire four-part examination, consisting of Biomedicine, Foundations of Chinese Medicine, Acupuncture, and Chinese Herbology. Some states (e.g., California) have their own licensing examination.
Nationally, the National Institutes of Health (NIH) established a National Center for Complementary and Alternative Medicine (NCCAM) to provide research funding related to complementary and alternative medicine, which includes herbs and acupuncture. The NCCAM is one of 27 centers within the NIH with a 2011 budget of $132 million. This sends a powerful message that the influence of Oriental herbal medicine in the American health care system is no longer minor and that insurance coverage for these services is quite probable in the near future.
Pregnancy and Postpartum Practices
Tae-kyo (prenatal training) is commonly practiced among some Korean-American women during pregnancy ( ). Using tae-kyo, women are supposed to think only about good things in life and to maintain a calm attitude to ensure having a healthy baby. Pregnant Korean-American women are taught to eat only the right food in the right form, for example, an apple without nicks or spots ( ). note that in an investigation of Korean women receiving prenatal care at a U.S. military facility, the women reported that they had followed traditional beliefs in tae mong, a conception dream, and tae-kyo rituals for safe childbirth, as well as food taboos, including protein sources. The responses included positive maternal and paternal perceptions of pregnancy.
The nurse should appreciate that the possibility of not having a husband for support during delivery can cause anxiety, particularly when the husband can serve as translator. Limited language ability has been an obstacle for health care for Korean women, which can be enhanced by assistance from a more English-fluent husband ( ).
During the postpartum period, women were instructed to have 21 days of bed rest with lots of seaweed soup for cleansing the body and providing fluid for adequate lactation ( ). However, this practice may be a dysfunctional health care practice because after delivery, a woman is in a hypercoagulable state ( ). However, many women nowadays go back to work and, because of the dangers of immobility, they do not stay on bed rest for long periods.
General Preventive Health Practices
Koreans have many general preventive health patterns. For example, during the hot summers in Korea, individuals tend to sweat more. Too much sweating is considered a loss of energy ( ki ) and negative to good health. Eating dog meat soup just before summer is believed to build stamina and strength by decreasing sweating ( ). Restaurants specializing in dog meat soup are abundant and busy in Korea.
Sex is regarded as a high energy consumer; therefore, sex drains ki from the body. Traditionally, both Korean men and women have been highly considerate of their partner’s state of health; if one’s health was not at its best or if one was “weak,” sex might be abstained from in consideration of the situation.
The influence of Oriental herbal medicine on preventive health is very strong. Many Koreans take bo yak (an Oriental herbal medicine that tonifies the body and raises stamina and general health status) regularly at the beginning of spring for the purpose of enjoying health for the rest of the year. It is common for sons to present bo yak as their gesture of filial piety to their elderly parents each spring. Frequently, if daughters-in-law do not appear to be as vibrant, energetic, and obedient as they used to be soon after marriage into the family, it is the mother-in-law who suggests that the daughter-in-law take some bo yak. These rituals are often practiced in mostly well-to-do families, since bo yak is expensive and considered a luxury to many struggling families, although they know and appreciate the power of bo yak.
Another preventive health measure many Korean Americans practice is to visit fortune tellers, who may, in turn, forecast a person’s health for the year. Visiting various religious shrines brings inner comfort and serenity and therefore is a positive health measure for the supplicant.
In general, Korean Americans have transformed from a culture of family-oriented caregiving and treatment to a culture of outreach to those who need to seek medical attention in which prevention is emphasized. Studies have shown that among Korean Americans, those who are more proficient in English, are more highly educated, and have health insurance are more likely to seek out available community health resources ( ). Culturally appropriate educational programs reaching out to the older, less-educated, less-English-proficient Korean-American populations should be developed. Nurses involved in community-focused interventions and outreach can play a significant role in acceptance of available services by Korean Americans.
Death and Dying
Many Korean Americans also believe that illness or death is fated and that they have no control over nature ( ). Many Korean Americans equate admission to a hospital with a death sentence and may refuse to be admitted. This refusal may occur particularly with elderly Korean Americans, which, in turn, delays treatment. Among many Korean Americans, a do-not-resuscitate order is common because prolonging life might be viewed as unacceptable. In stark contrast, discussing a terminal illness with Korean Americans might be resisted by both the client and the family. Even today, some Korean Americans view the donation of organs and transplantations as a disturbance in the body. Health care professionals must broach such subjects with care ( ).
Many Korean Americans believe that dying should occur at home ( ). This concept is considered to be a “good death” among many Korean Americans. When a Korean or Korean American is dying, it is essential to bring that individual to the warmest part of the bedroom. Next, it is the obligation of the children, or Imjong, to watch at the deathbed of their parents. Often, a piece of cotton sokkweng will be placed on the dying person’s mouth as this helps to check the last breath of the person ( ). In the past, it was the practice of some Koreans and Korean Americans to take a white shirt of the deceased out into the garden and, if possible, climb up to the roof and repeat the word bok (“return”) three times. The purpose of this traditional ceremony, which is called kobok, refers to its literal translation: “calling back the spirit of the dead.” Today, the kobok ceremony is not practiced as much as it once was ( ).
In Korea, the practice of embalming is not observed ( ). Because embalming is required in the United States, and a certified affidavit from five licensed embalmers is required for shipment of the body to any foreign country, this may cause concerns for a Korean American who is attempting to ship the body of a loved one to Korea ( ). Even today, the most important rites in the traditional funeral remain the sup (washing of the body) and the yom (binding). In a traditional Korean ritual with the body of the deceased, the body is washed with a piece of cloth or cotton that has been soaked in warm water. After washing, the body is bound with a long cloth known as a yom ( ).
Implications for Nursing Care
Many Korean Americans embrace more than one belief about their health–illness systems. As a result of these multiple beliefs, a variety of health care practices may be encountered by nurses. Persons who believe that sickness is from the action of a supernatural being may delay seeking health care until it is too late. They also may project a guilty conscience about their past behavior and act as though they have given up on recovering from the present illness. Nurses must be very authoritative in carrying out treatment plans for Koreans who exhibit such attitudes. Healing practices used by Korean clients should not be rejected automatically. Careful assessment is essential to provide culturally appropriate care.
It is essential for the nurse to recognize that many Korean Americans who are admitted to acute care or other health care facilities may be using both modern and herbal remedies simultaneously ( ). This creates a problem of allergic and synergistic effects. Several specific cases of herbal-use conflicts have been reported ( ). Some herbal decoctions contain mistletoe, shave grass, horsetail, or sassafras and are certainly unsafe. Mistletoe contains viscotoxin, a mixture of toxic proteins that can produce anemia, hepatic and intestinal hemorrhage, and fatty degeneration of the thymus in experimental animals ( ). Most of these ingredients are crude complex mixtures that are neither uniformly prepared nor assayed for purity. Many contain a variety of unidentified allergens that may cause many potentially adverse effects. Some of the known allergenic materials include pollen (particularly from flower herbs), insect parts, and mold spores. Nurses must monitor the clients closely for potential side effects as well as synergistic effects of medicines in case they are dual users.
Health care practices that are based on the client’s cultural beliefs must be honored when possible to ensure client compliance. If a client desires and truly believes in herbal medicine, some sort of collaborative health supervision may be the best solution for the client. Open discussion to enhance rapport and trust is a key ingredient for successful client-oriented care. One of the herbal medicine ingredients that is gaining tremendous popularity in the United States is ginseng ( Panax quinquefolius and P. ginseng ). Ginseng is used to raise stamina and power of thoughts, improve the tone of body organs, and increase longevity. The long-term properties of ginseng have been poorly researched. It is postulated, however, that long-term abuse of ginseng can cause hypertension. Other, but less frequently seen, side effects of ginseng include nervousness, sleeplessness, skin eruptions, morning diarrhea, and edema ( ). Nonetheless, despite the many hazards that have been alluded to, it should be understood that the majority of herbal products on the U.S. market are safe when properly used ( ).
In assessing the predictive factors of social context and ethnicity on childhood hepatitis B immunization status among Korean-American children in an urban area, found that the mother’s history of adequate prenatal care was significantly related to immunization status. They found that major perceived barriers in accessing preventive health care were burdens of cost, language barrier, and difficulty in remembering the immunization schedule. Preventive health care providers must look beyond the mother’s health beliefs and include beliefs and knowledge of the mother’s social network.
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