individual. Loss of country, family, or friends also
may cause mental illness. Such clients may seek
mental health care only as a last resort after they
have exhausted all family and community resources.
When sick, these clients expect family or health care
professionals to take care of them. The client will re-
serve his or her energy for healing and, thus, will be
likely to practice complete rest and abdication from
all responsibilities during illness. The clients view
mental illness more negatively than physical illness
and believe mental illness to be something the per-
son can control. Although early immigrants were
Christians, more recent immigrants are Muslims.
Prayer is very important to Muslims: strict Muslims
pray five times a day, wash before every prayer, and
pray in silence.
Western medicine is the primary treatment
sought, but some may use home remedies and amulets
(charms or objects used for their protective powers)
(Meleis, 1996).
CAMBODIANS
The preferred term for people from Cambodia is
Khmer (pronounced Kami) or Sino-Khmer (if Chinese-
Cambodian). Those who have assimilated into West-
ern culture use a handshake for greeting, whereas
others may slightly bow, bringing the palms together
with the fingers pointed upward, and make no contact
with the person they are greeting. Many Asians speak
softly, so it is important to listen carefully rather than
asking them to speak louder. Cambodian clients highly
value politeness. Eye contact is acceptable, but women
may lower their eyes to be polite. Silences are common
and appropriate; nurses should avoid meaningless
chatter. These clients may consider it impolite to dis-
agree so they say yes when not really agreeing or in-
tending to comply. It is inappropriate to touch some-
one’s head without permission because some believe
the soul is in the head. Cambodian clients usually in-
clude family members in making decisions. Orienta-
tion to time can be flexible (Kulig, 1996).
Most Khmer immigrated to the United States
after 1970 and believe that mental illness is the re-
sult of the Khmer Rouge war and associated brutali-
ties. When ill, they assume a passive role, expecting
others to care for them. Many may use Western med-
icine and traditional healing practices simultane-
ously. Buddhism is the primary religion, although
some have converted to Christianity. An accha(holy
person) may perform many elaborate ceremonies in
the person’s home but will not do so in the hospital.
Healers may visit the client in the hospital but are
unlikely to disclose that they are healers, much less
what their practices are. Some still have a naturalis-
tic view of illness and may be reluctant to have blood
drawn, believing they will lose body heat needed for
harmony and balance (Kulig, 1996).CHINESE
The Chinese are often shy in unfamiliar environ-
ments, so socializing or friendly greetings are helpful.
They may avoid direct eye contact with authority fig-
ures to show respect; keeping a respectful distance is
recommended (Chin, 1996). Asking questions can be
a sign of disrespect; silence is a sign of respect. Chi-
nese is an expressive language, so loudness is not
necessarily a sign of agitation or anger. Traditional
Chinese societies tend not to highly value time ur-
gency. Extended families are common, with the eldest
male member of the household making decisions and
serving as the spokesperson for the family.
Mental illness is thought to result from a lack of
harmony of emotions, or evil spirits. Health prac-
tices may vary according to how long immigrants
have lived in the United States. Immigrants from 40
to 60 years ago are strong believers in Chinese folk
medicine, whereas immigrants from the last 20 years
combine folk and Western medicine. First- and second-
generation Chinese Americans are mostly oriented
to Western medicine (Chin, 1996). Many Chinese use
herbalists and acupuncture, however, either before or
in conjunction with Western medicine. Rarely these
clients will seek a spiritual healer for psychiatric
problems to rid themselves of evil spirits. Many Chi-
nese are Buddhists, but Catholic and Protestant re-
ligions are also common.CUBANS
Cubans, or Cuban Americans if born in the United
States, are typically outgoing and may speak loudly
during normal conversation. Extended family is very
important, and often more than one generation resides
in a household. These clients expect direct eye contact
during conversation and may view looking away as a
lack of respect or honesty. Silence indicates awkward-
ness or uncertainty. While orientation to social time
may vary greatly, these clients view appointments as
business and are punctual (Varela, 1996).
Cuban clients view stress as a cause of both phys-
ical and mental illness, and some believe mental ill-
ness is hereditary. Mental illness is a stigma for the
family; thus, Cuban clients may hide or not publicly
acknowledge such problems. The person in the sick
role often is submissive, helpless, and dependent on
others. While Cuban clients may use herbal medicine
to treat minor illness at home, they usually seek West-
ern medicine for more serious illness. Most Cubans
are Catholic or belong to other Christian denomina-
tions, so prayer and worship may be very important.7 CLIENT’SRESPONSE TOILLNESS 147