Chinese case study and Japanese case study


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 English and a foreign language to one another,
accompany him. The nurse tries to speak English 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 man, 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 small village close to Beijing. He is 68 years
old, and he has been suffering with minor chest 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 year, but the son has lived in the West for 7
years. Mr. Li’s daughter-in-law looks Chinese 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 pain increases, and the health-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 are ordered, including heart medications,
anticoagulants, oxygen, intravenous fluids, bedrest, and close monitoring. 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 orders for dietary restrictions, and she begins
to hide her treatments from the staff. Her son and daughter-in-law try 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 lies in bed and never calls for help. He
frequently seems to be meditating and exercising his arms. When he does talk to his son,
he speaks of the airplane ride and the problems 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 deteriorates over the next few days. Nurses
and physicians attempt to tell the family about his condition and possible death, but the
family will not talk with them about it. Mr. Li dies on the 5th day.
Study Questions
1. 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?
2. If you wished to have a meeting with a Chinese delegation of health-care
providers, would you expect them to be on time? Why?
3. If the meeting included a meal with 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 like, would you eat it anyway?
4. Compare and contrast the Chinese meaning of life and way of thinking
with the Western meaning of life and way of thinking.
5. What are the common health risks for the development of chronic
obstructive pulmonary disease among Chinese people?
6. What are some of the reasons that Mr. Li waited so long to enter the
7. Mr. Li did not complain of chest pain in the cardiac intensive-care unit. Is
this a common behavior? Why?
8. True or False: The Chinese family will expect health-care providers at the
hospital to provide most of the care for Mr. Li.
9. Why must the physician be careful with the amounts of medication
10. Mrs. Li is curt, demanding, and disagreeable toward her daughter-in-law.
Why does she act this way?
11. Explain why Mr. Li blames the airplane ride and the Western food for his
heart attack. Why does he meditate and do exercises?
12. Is Mr. Li’s stoicism during dying surprising? Why do the family members
refuse to discuss his health and possible death?
13. What is the preferred method for handling the remains of a deceased
Chinese person?
14. Describe common mourning rituals for the Chinese.
15. Describe bereavement in a Chinese family.
16. Describe a common view of death among Chinese.

This case study is a composite of actual situations. 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 own 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 Marianne 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 significant amount of peripheral vision. Although
Marianne delivered all three children at a Christian hospital in Tokyo, she gets her
annual physical examination when visiting relatives 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 medication that is readily available in Japan,
but the physician was concerned about the level 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 leaves much to be desired. Most of the responsibility for
Mother Shimizu falls on Marianne, in addition to her work. Marianne’s relatives are
urging her to consider placing Mother Shimizu in a church-related life-care community
near Marianne’s family in the United States, 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 Japanese health system may account for the late diagnosis of
Ken’s glaucoma?
4. What practical issues might arise for the Shimizus if Mother Shimizu were placed in
a long-term-care facility in the United States?
5. What dietary factors may contribute 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 have 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?
9. Compare and contrast the fertility and mortality rates of Japan and the United States.
10. Do the traditional Japanese maintain sustained eye contact with strangers? Why or
why not?
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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