States readily seek health care from Western physi-
cians as well (Lee et al., 2001).VIETNAMESE
Vietnamese greet with a smile and bow. A health care
provider should not shake a woman’s hand unless she
offers her hand first. Touch in communication is more
limited among older, more traditional people. Viet-
namese may consider the head sacred and the feet
profane, so the order of touching is important. As a
sign of respect, many of these clients avoid direct eye
contact with those in authority and elders. Personal
space is more distant than it is for European Ameri-
cans. Typically the Vietnamese are soft-spoken and
consider raising the voice and pointing to be dis-
respectful. They also may consider open expression
of emotions or conflict to be bad taste. Punctuality
for appointments is usual (Jamin et al., 1999).
Vietnamese believe mental illness to be the re-
sult of individual disharmony or an ancestral spirit
returning to haunt the person because of past bad be-
havior. When sick, clients assume a passive role and
expect to have everything their way.
The two primary religions are Catholicism and
Buddhism. Catholics recite the rosary and say prayers
and may wish to see a priest daily. Buddhists pray
silently to themselves.
Vietnamese people believe in both Western med-
icine and folk medicine. Some believe that traditional
healers can exorcise evil spirits. Other health prac-
tices include coin rubbing, pinching the skin, acupunc-
ture, and herbal medicine (Jamin et al., 1999).
Nurse’s Role in Working
With Clients of Various Cultures
To provide culturally competent care, the nurse must
find out as much as possible about a client’s cultural
values, beliefs, and health practices. Often the client
is the best source for that information, so the nurse
must ask the client what is important to him or her—
for instance, “How would you like to be cared for?”
or “What do you expect (or want) me to do for you?”
(Andrews & Boyle, 2003).
At the initial meeting, the nurse may rely on
what he or she knows about a client’s particular cul-
tural group such as preferences for greeting, eye con-
tact, and physical distance. Based on the client’s be-
havior, the nurse can alter that approach as needed.
For example, if a client from a culture that does not
usually shake hands offers the nurse his or her hand,
the nurse should return the handshake. Variation
among members of the same cultural group is wide,
and the nurse must remain alert for these individual
differences.150 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIPA client’s health practices and religious beliefs
are other important areas to assess. The nurse can
ask, “Do you follow any dietary preferences or re-
strictions?” and “How can I assist you in practicing
your religious or spiritual beliefs?” The nurse also can
gain an understanding of the client’s health and ill-
ness beliefs by asking, “How do you think this health
problem came about?” and “What kinds of remedies
have you tried at home?”
An open and objective approach to the client is
essential. Clients will be more likely to share per-
sonal and cultural information if the nurse is gen-
uinely interested in knowing and does not appear
skeptical or judgmental.
The nurse should ask these same questions even
to clients from his or her own cultural background.
Again, people in a cultural group vary widely, so the
nurse should not assume that he or she knows what
a client believes or practices just because the nurse
shares the same culture.SELF-AWARENESS ISSUES
The nurse must be aware of the factors
that influence a client’s response to illness including
the individual, interpersonal, and cultural factors
discussed above. Assessment of these factors canMaintain cultural awareness