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Assignment:

Complete the following:

• Chinese case study #1
• Japanese case study #1

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CHINESE CASE STUDY #1
An elderly, Asian-looking man is admitted
to the emergency room with chest pain;
difficulty breathing; diaphoresis; vomiting; pale, cold, clammy skin; and apprehension.
Three people, speaking a mixture of Englis
h and a foreign language to one another,
accompany him. The nurse tries to speak E
nglish with the man, but he cannot understand
anything she says. Accompanying the elderly
man are two women (one elderly and very
upset and one younger who stands back from the other three people) and one younger
man.
The younger man states that the elderly ma
n, whose name is Li Ying Bin, is his
father; the elderly woman, his mother; and
the younger woman, his wife. The son serves
as the translator. Li Ying Bin comes from a sm
all village close to Beijing. He is 68 years
old, and he has been suffering with minor ch
est pain and has had trouble breathing for 2
days. He is placed in the cardiac room, and the assessment continues.
Mr. Li is on vacation, visiting his son and
daughter-in-law in the city. His son and
daughter-in-law have been married for only 1 ye
ar, but the son has lived in the West for 7
years. Mr. Li’s daughter-in-law looks Chin
ese but was born in the United States. She
does not speak very many words of Chinese.
Further physical assessment reveals that Mr
. Li has a history of “heart problems,”
but the son does not know much about them. Mr. Li had been to the hospital in Beijing
but did not like the care he
received there and returned home as soon as possible. He goes
to the local clinic periodically when the pa
in increases, and the h
ealth-care provider in
China used traditional Chinese medicine,
herbs, and acupuncture. In the past, those

treatments relieved his symptoms.
Medications are ordered to relieve
pain, and Mr. Li undergoes diagnostic
procedures to determine his cardiac status. The
studies reveal that he
did sustain massive
heart damage. Routine interventions ar
e ordered, including heart medications,
anticoagulants, oxygen, intravenous fluids, be
drest, and close mon
itoring. His condition
is stabilized, and he is sent to the cardiac intensive-care unit.
In the cardiac unit, the nurse finds Mrs.
Li covering up Mr. Li until he sweats, and
Mrs. Li argues with the nurse every time
her husband is supposed to dangle his legs. She
complains that he is too cold and brings in
hot herbal beverages for him to drink. She
does not follow the nurse’s and physician’s orde
rs for dietary restrictions, and she begins
to hide her treatments from the staff. Her
son and daughter-in-law tr
y to explain to her
that this is not good, but she continues the
traditional Chinese medicine treatments.
Mr. Li is a very quiet patient. He li
es in bed and never calls for help. He
frequently seems to be meditating and exercisi
ng his arms. When he does talk to his son,
he speaks of the airplane ride and the probl
ems of being so high. He believes that may
have caused his current heart problem. Mr. Li
also wonders if Western food could be bad
for his system. Mr. Li’s condition gradually de
teriorates over the next few days. Nurses
and physicians attempt to tell the family a
bout his condition and po
ssible death, but the
family will not talk with them about it. Mr. Li dies on the 5th day.
Study Questions
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 w
ith Chinese food, what kinds of food
would you expect to be served? How
would it be presented? If something
were served that you do not lik
e, would you eat it anyway?
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
hospital?
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
ordered?
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 airpla
ne 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. 

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APANESE CASE STUDY #1
This case study is a composite of actual situ
ations. Marianne, who is American, and Ken
Shimizu, who is Japanese, have worked
in Tokyo for over 30 years as Methodist
missionaries. They have annual furloughs and
occasional sabbaticals, during which they
visit relatives and sponsoring
organizations and engage in
continuing education in the
United States. They met as college students
in the United States, and their three grown
children have established their ow
n careers in the United States.
Ken’s 98-year-old mother resides with
Marianne and Ken. She is not Christian
but has always been extremely supportive of
Ken and Marianne’s work. Ken teaches at
a large Christian university, whereas Marian
ne has served in various church-related
positions over the years. As missionaries, they live in subsidized post–World War II
housing near Ken’s university. Marianne has
been a frugal housewife, preparing local
foods in the Japanese style for her family.
Ken, who is nearly 60, recently learned
that he has glaucoma. By the time it
was discovered, he had lost a signific
ant amount of peripheral vision. Although
Marianne delivered all three
children at a Christian hos
pital in Tokyo, she gets her
annual physical examination when visiting rela
tives in the United States. She has never
believed that the Japanese health system is
as proactive as that in the United States.
On her most recent visit to the United
States, Marianne learned that she has
hypertension. Her physician prescribed a medica
tion that is readily available in Japan,
but the physician was concerned about the leve
l of stress in Marianne’s life. Mother
Shimizu is quite confused and requires considerable care, but it is unthinkable for Ken,
the only child, to put his mother in a long-
term-care facility. Even if he would, the

quality of facilities in Japan l
eaves much to be desired. Most of the responsibility for
Mother Shimizu falls on Marianne, in addi
tion to her work. Marianne’s relatives are
urging her to consider placing Mother Shimiz
u in a church-related life-care community
near Marianne’s family in the United Stat
es, where Marianne and Ken would like to
retire. Marianne’s own parents
lived in this facility at the end of their lives. She is
considering these issues
as she returns to Tokyo.
Study Questions
1.    Identify some of the cultural issues that
may lead to conflict in this international
family.
2.    What are the family resources for this international family?
3.    What factors within the Ja
panese health system may account for the late diagnosis of
Ken’s glaucoma?
4.    What practical issues might arise for th
e Shimizus if Mother Shimizu were placed in
a long-term-care facility in the United States?
5.    What dietary factors may cont
ribute to Marianne’s hypertension?
6.    In what ways might you consider Ken to
be countercultural as a Japanese man?
7.    What social pressures might Marianne ha
ve faced, given some of her choices, as a
housewife in Japan?
8.    What pressures will Ken likely experience
as he considers how to meet the needs of
both his mother and his wife?
10. compare and contrast the fertility and mortility rates of japan and the united state.

11.   To which drugs might Japanese people have greater sensitivity than that of white
ethnic populations?
12.   How do most Japanese people meet their need for calcium?

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