FILIPINOS
Smiles rather than handshakes are a common form
of greeting. Facial expressions are animated and
clients may use them rather than words to convey emo-
tion. Filipino clients consider direct eye contact impo-
lite, so there is little direct eye contact with authority
figures such as nurses and physicians. Typically
Filipinos are soft-spoken and avoid expressing dis-
agreement (de la Cruz et al., 2002); however, their
tone of voice may get louder to emphasize what they
are saying or as a sign of anxiety or fear. They are
likely to view medical appointments as business and
thus be punctual.
Causes of mental illness are both religious and
mystical. Filipinos are likely to view mental illness as
the result of a disruption of the harmonious function
of the whole person and the spiritual world. These
causes can include contact with a stronger life force,
ghosts, or souls of the dead; disharmony among wind,
vapors, diet, and shifted body organs; or physical and
emotional strain, sexual frustration, and unrequited
love. Most Filipinos are Catholic; when very ill, they
may want to see a priest and a physician. Prayer is
important to the client and family, and they often
want to receive the religious sacraments while sick.
Filipinos often seek both Western medical treatment
and the help of healers who help remove evil spirits.
The ill client assumes a passive role, and the eldest
male in the household makes decisions after confer-
ring with family members (de la Cruz et al., 2002).
HAITIANS
Haiti has two official languages, French and Creole,
and a strong oral culture that uses stories as educa-
tional tools. In Haiti, 80% of the people neither read
nor write, but literacy may vary among Haitians in the
United States. Videos, oral teaching, and demonstra-
tions are effective ways to communicate information.
Haitians are polite but shy, especially with authority
figures, and may avoid direct eye contact. Hand-
shakes are the formal greeting of choice. Haitians
may smile and nod as a sign of respect even when
they don’t understand what is being said. Verbal
tone of voice and hand gestures may increase to em-
phasize what is being said. There is little commit-
ment to time or schedule in Haitian culture, but
clients may be on time for medical appointments if
the provider emphasizes the need for punctuality
(Colin & Paperwalla, 1996).
Mental illness is not well accepted in Haitian
culture. These clients usually believe mental illness
to have supernatural causes. The sick person as-
sumes a passive role, and family members provide
care for the individual. Home and folk remedies are
often the first treatment used at home, and clients
seek medical care when it is apparent the person
needs medical attention. Haitians are predominately
Catholic and have a very strong belief in God’s power
and ability to heal (Colin & Paperwalla, 1996).JAPANESE AMERICANS
Japanese Americans identify themselves by the
generation in which they were born. Issei, the first
generation of Japanese Americans in the United
States, have a strong sense of Japanese identity.
Nisei, second-generation Japanese Americans born
and educated in the United States, appear West-
ernized but have strong roots in Japanese culture.
Sansei (third generation) and Yonsei (fourth genera-
tion) are assimilated into Western culture and are less
connected to Japanese culture (Shiba & Oka, 1996).
Greetings tend to be formal such as a smile or
small bow for older generations and a handshake for
younger generations. There is little touching and eye
contact is minimal, especially with authority figures.
These clients control facial expressions and avoid
conflict or disagreement. Elders may nod frequently,
but this does not necessarily indicate understanding
or agreement. Self-disclosure is unlikely unless trust
has been established, and then only if the informa-
tion is directly requested. Nurses should phrase ques-
tions to elicit more than just a yes or no answer.
Promptness is important, so clients are often early for
appointments.
Mental illness brings shame and social stigma to
the family, so clients are reluctant to seek help. Evil
spirits are thought to cause loss of mental self-control
as a punishment for bad behavior or failure to live a
good life. These clients expect themselves and others
to use will power to regain their lost self-control and
often perceive those with mental illness as not trying
hard enough. Western psychological therapies based
on self-disclosure, sharing feelings, and discussing
one’s family experiences are very difficult for many
Japanese Americans. The nurse might incorrectly
view these clients as unwilling or uncooperative.
Buddhism, Shinto, and Christianity are the most
common religions among Japanese Americans, and
religious practices vary with the religion. Prayer and
offerings are common in Buddhist and Shinto reli-
gions and are usually done in conjunction with West-
ern medicine (Shiba & Oka, 1996).MEXICAN AMERICANS
Diversity is wide among Mexican Americans in
terms of health practices and beliefs, depending on
the client’s education, socioeconomic status, gener-
ation, time spent in the United States, and affinity
to traditional culture. It is best for the nurse to ask
the client how he or she would like to be identified148 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP