Create a poster and respond based on the library assignment attached.
Running head: ARTICLE CRITIQUE
1
Supporting the Self-Management of Hypertension: Patients’ Experiences of Using a Mobile
Phone-Based System
ARTICLE CRITIQUE
2
Abstract
The study by Hallberg, Ranerup, & Kjellgren explores patient perceptions of the use of
technology and experiences using a mobile phone-based intervention to control blood pressure.
The study was conducted in a sample of 49 hypertension patients. Data analysis was done
through thematic analysis. The results of the study echo those of others done in the same area.
Mobile phone-based interventions are indeed useful in BP control and can be applied in
improving adherence. The study is relevant to current healthcare issues as there is increased
adoption of mobile-based interventions in the management of chronic conditions. Using a more
diverse sample and the process by which the themes were selected are some of the ways the
study could be improved. Also, further studies are needed as the current research focuses on
adherent patients. It is, therefore, essential to determine if the results would be the same for nonadherent patients.
Keywords: BP, mobile phone-based interventions, research, hypertension
ARTICLE CRITIQUE
3
Supporting the Self-Management of Hypertension: Patients’ Experiences of Using a Mobile
Phone-Based System
Hypertension is one of the primary chronic diseases affecting patients across the globe.
Despite its high prevalence, it is also one of the most poorly controlled conditions. The
management of hypertension often involves strict adherence to preventive behavior, as well as
the management of risk factors. Consequently, self-management is indispensable in hypertension
control. With the advancements made in technology, m-health has been gaining popularity as a
method of promoting the self-management of chronic diseases. The study, therefore, seeks to
establish and evaluate the effectiveness of the mobile phone-based approach in the management
of hypertension. The results of the study have showed that patients perceive mobile health-based
initiatives as being essential in the management of hypertension. To arrive at this conclusion, the
authors have conducted a study and analyzed the data through the qualitative thematic analysis.
The Problem
Poor self-management has been linked to poor outcomes in hypertension control.
According to the authors, there is a need for efforts that promote self-management in
hypertension patients. Overall, the study aimed at exploring client experiences and how patients
perceived the mobile-based intervention. The study applied two research questions. The first one
was on what patients’ experiences were when it came to using technology in the management of
chronic conditions. The second research question was on whether or not patients perceived the
mobile-based initiative as being helpful in hypertension management and what the reasons for
the perception were. The authors hypothesize that actively engaging patients through mobile
health technology is one of the ways of promoting the self-management of hypertension.
ARTICLE CRITIQUE
4
“Patient-centered” is one of the key terms used in the study. This term emphasizes offering care
that is in line with the values of patients.
The research on the use of mobile phone-based interventions on hypertension selfmanagement correlates with today’s health issues. The study was conducted in 2016, making it
current and, as such, relevant to existing healthcare issues. The healthcare sector has been
evolving, and with this evolution, the use of technology-based interventions comes. At the same
time, there has been an increased inclination to improving self-management not only for
hypertension, but also for other chronic health conditions. According to Lee et al. (2018), mobile
phone-based health interventions are an effective tactic for encouraging health promotion. These
findings concur with those of the current study. When it comes to health promotion behavior,
mobile phones have been instrumental in facilitating effective communication. Today, mobile
phones are commonly used, as they are cost-effective and make it easy to reach the target
population. Moreover, mobile phone apps provide real-time feedback. Therefore, the research on
the use of the mobile phone-based intervention in managing hypertension is relevant to current
healthcare issues.
Literature Review
The authors do not provide the literature review section for the study. Nevertheless, they
quote some of the previously conducted studies on M-health-based interventions in selfmanagement. According to the authors, one of the studies reported improvements in BP control
with the use of the mobile phone-based solution. This information supports the authors’
assertions that mobile phone-based initiatives are effective in improving hypertension selfmanagement.
ARTICLE CRITIQUE
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Design and Procedures
The study is a replica study. It is in the line of research dedicated to exploring the
effectiveness of mobile phone-based initiatives in promoting self-management in patients with
hypertension. Therefore, it did not involve a pilot study. The variables used in the study are
patients’ experiences, mobile-based initiatives, and hypertension. The measurement tools used
for the study were interviews and observation. The procedural structure is well articulated. The
authors provide the important sections required for studies.
The study utilized a non-experimental design. The authors sought to collect data on the
experiences of patients and their perceptions of the mobile phone-based intervention. Nonexperimental designs are mainly used in instances where the research variables cannot be
manipulated. These variables cannot be quantified, and as such, the relationship is mainly nonstatistical. In the current study, the research questions used in the study are exploratory in that
they explore patients’ perception of using the mobile-based intervention in controlling
hypertension. Furthermore, to conclude, the researches depended on the interpretation of patient
experiences with mobile-based intervention through the thematic analysis. Therefore, nonexperimental design is appropriate for the study.
The sample included 49 participants. They were 30 years old and above that age and were
taking hypertension medication. These patients were referred to the study by their healthcare
providers and were from four primary healthcare facilities in Southern Sweden. Even though the
authors state that the sample was reflective of the Swedish population with hypertension in
relation to gender and age, the sample of 49 participants was quite small to guarantee the
generalizability of the study to other populations. Moreover, the methods used to recruit the
participants led to a rather homogeneous sample. The reason for this is that all participants were
ARTICLE CRITIQUE
6
from the same geographical location and adhered to their hypertension medication. This
selection method introduced biases in the sample. Therefore, the results of the study may not
apply to other patients, such as non-adherent patients.
Data Analysis and Presentation
Utilizing appropriate data analysis methods is essential in ensuring the accuracy of the
results. In the current study, the authors conducted the thematic analysis. They analyzed the data
along with two major themes: usefulness associated with the self-management system and
insights and benefits from the system, each theme with various subthemes. This method of data
analysis is suitable for the study, as the authors sought to investigate patient experiences and
perceptions concerning the mobile-phone-based intervention in controlling hypertension. The
findings of the study supported the hypothesis, as the research revealed that patients had a
positive perception of the intervention and that it helped manage hypertension. To this extent, the
study analysis supported the purpose of the study. The authors discussed the strengths of the
study, as well as its weaknesses. The strengths of the study refer to the data analysis method,
while its major weakness is in its sample.
Conclusion and Implications
The research findings support the hypothesis. The results indicate that patients found the
mobile phone-based intervention easy to use and, therefore, useful in promoting the selfmanagement of hypertension. These results are also in line with the purpose of the study which is
to evaluate the use of mobile-phone based interventions in controlling hypertension. The results
of this study have implications for various parties. One of these is patients suffering from
hypertension, as well as care providers and health institutions that seek to promote hypertension
control. The authors therefore recommend that this intervention could be used in encouraging
ARTICLE CRITIQUE
7
health-promoting behavior in patients with hypertension. The writing in the article is clear. The
information presented is easy to understand, as the researchers avoid the use of complicated
jargon. Also, the authors present the information clearly and logically, making it easy for the
readers to connect various sections. Given how the information is presented, the reader can
understand the authors’ conclusions. Further research on the topic is possible and is, in fact,
necessary. The current study used a small and a homogenous sample from Sweden. However,
hypertension is a global pandemic. Therefore, further research on the applicability of mobilebased intervention in populations across different countries is necessary. Such studies should
also evaluate the effects of other factors, such as social-economic disposition, gender, age, and
education, among other factors that could affect the effectiveness of mobile phone basedinterventions. Moreover, further research is needed to understand how non-adherent patients
perceive the intervention and whether such intervention can improve self-management in this
class of patients.
Even though the study addresses the issues of credibility through the authors’ critical
judgment and the use of an appropriate method to negate information on patients’ experiences, I
believe that it could be improved. One of the ways by which the researchers could improve the
study is by adopting a different sampling technique. The study uses a homogeneous sample,
excluding the generalizability of the study results to other patients (Faber & Fonseca, 2014). To
address this issue, the authors should have used a diverse sample. In the recruitment process,
they should have also included patients with different degrees of adherence to treatment. By
having a diverse sample, the researchers would have addressed the issue of the generalizability
of the study results to other population groups. Additionally, I believe that the researchers should
have provided an in-depth analysis of how they arrived at the selected themes. While there is a
ARTICLE CRITIQUE
8
brief explanation, it does not explain how the authors arrived at the two themes used in the study.
Creating transparency on this issue is essential, as it helps address the issue of researcher bias in
which the authors try to justify a specific theme. By considering these factors, the study could
have been improved.
The current study is part of the ongoing research on the effectiveness of mobile phonebased initiatives in hypertension control. The study uses the sample of 49 participants, and data
analysis is done through a thematic analysis. From the study, it is evident that patients view the
application as both easy-to-use and beneficial. The study is therefore relevant and practical, and
the results can be applied in improving the control of hypertension. The information is presented
in an easy-to-understand way and has a logical flow. Nevertheless, a small sample used makes it
difficult to generalize the results to other populations. Therefore, further research is necessary.
References
ARTICLE CRITIQUE
9
Faber, J., & Fonseca, L. M. (2014). How sample size influences research outcomes. Dental Press
Journal of Orthodontics, 19(4), 27-29. doi:10.1590/2176-9451.19.4.027-029.ebo
Hallberg, I., Ranerup, A., & Kjellgren, K. (2016). Supporting the self-management of
hypertension: Patients’ experiences of using a mobile phone-based system. Journal of
Human Hypertension, 30(2), 141-146. doi:10.1038/jhh.2015.37
Lee, M., Lee, H., Kim, Y., Kim, J., Cho, M., Jang, J., & Jang, H. (2018). Mobile app-based health
promotion programs: A systematic review of the literature. International Journal of
Environmental Research and Public Health, 15(12), 2838. doi:10.3390/ijerph15122838
Title of Project
Presenter Name
University name
Introduction and Problem
Several studies have shown the benefits of the use of
electronic health records (EHR) for patients’ safety, as well as
their ability to improve efficiency in primary care settings
(Porterfield, Engelbert, & Coustasse, 2014). Regardless of
the positive effects of the implementation of EHR, health care
providers have moved slowly to adopt this technology (King,
Patel, Jamoom, & Furukawa, 2014). Practitioners who do not
want to adopt EHR, especially electronic prescription, can
endanger patient safety.
Medication errors, in turn, are a serious issue that causes
numerous safety incidents in primary care. Studies have
shown that the use of EHR significantly reduces the number
of prescription errors that can harm patients (Liao et al.,
2017). Palabindala, Pamarthy, and Jonnalagadda (2016)
showed that the use of EHR could reduce medication error
while also resulting in improved communications between
patients and healthcare teams
Purpose of the Project
The purpose of this quantitative quasi-experimental project
was to determine if there was a relationship between the
application of an educational program and the improvement
of practitioners’ perception of EHR usability, as well as the
reduction of the number of prescription medication errors,
at a medical group practice in the Southeastern of the
United States (US).
Clinical Questions/PICOT
The PICOT question created for the project was as follows:
(P) Among healthcare practitioners, (I) how does the
implementation of an educational program in a primary care
medical center in the Southeast of the US (C) compared to
the pre-intervention measurements in the prior four weeks
(O) influences primary care practitioners’ perceptions of the
usability of EHR and the incidence of prescription
medication errors (T) within four weeks of participating in
the program?
The following clinical questions guide this quantitative
project:
Q1: How does the implementation of an educational
program influence the perceptions of primary care
practitioners regarding EHR usability?
Q2: How does the implementation
Variablesof an educational
program influence prescription medication error incidence?
Variable 1: Quality improvement educational program
(independent)
Variable 2: Primary care practitioners’ perception of EHR
usability (dependent)
Variable3: Number of prescription medication errors
(dependent).
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Results (cont.)
Data Analysis
The data analysis was in line with the needs of the project:
statistical tests, including t-test and Wilcoxon signed ranks,
were employed to determine if there were statistically
significant differences between pre- and post-test
measurements. This way, the relationships between the
independent and dependent variables were reliably inferred
(Polit & Beck, 2017)
Data types:
• Survey: quantitative, ordinal (Likert scale).
• Reports: quantitative, ratio (number of mistakes).
Data analysis approaches:
• Software: SPSS.
• Survey: Wilcoxon signed ranks test.
• Reports: paired t-test.
Descriptive Data
Figure 3.
Gender of
the
participant
s.
Figure 1. The
occupations
of the
participants.
Figure 2.
Age of the participants.
The project employed four Advanced Practice
Registered Nurses, three Medical Doctors, and one
Physician Assistant who exhibited significant resistance
to the use of EHR.
Results
.
As had been
planned, the data
were collected
before and after the
intervention using
an already
established survey
tool and the clinic’s
pharmacy call
reports regarding
medication errors.
Table 1
Survey Summary
Item
Pre-Test
Post-Test
Mean
St. Deviation
Mean
St. Deviation
Q1
2.25
0.707
4.75
0.463
Q2
2.13
0.991
4.38
0.744
Q3
1.75
0.707
4.38
0.744
.
Total Errors Analysis Results: Paired Samples Test
Sig. (2-tailed)
Figure 4. Example changes in survey results before and after the
intervention.
Example changes in pre- and
post-test scores can be
found in Figure 4. Table 2
summarizes the results of
analyzing the survey items
with the Wilcoxon signed
ranks test. Items 1, 3, 4, 5, 6,
7, 8, 9, and 10 demonstrate
statistically significant results
(p0.05). Thus, the findings do not suggest that the
program had an impact on medication error rates; a
relationship between the independent variable and
medication errors was not found.
Q2
Number
31
.846
0.04
Error Data Summary
Total
.587
Pair 2
Q1
Table 3
Error Type
Pair 1
Table 2
Incorrect Drug
The survey contained 11 individual items and used a
Likert scale in which 1 stood for an extremely
negative assessment of an aspect of usability or
usefulness and 5 referred to an extremely positive
one. The summary of the mean and standard
deviation for each of the items before and after the
intervention is presented in Table 1.
Discussion
Table 4
32
2. The data collection process was limited by the short
time allocated to observing the results (4 weeks)
3. The project employed a quasi-experimental design.
Since its sample was so small, trying to split it further
was not feasible.
. The raw
data indicate
that the most
common
errors for the
clinic include
incorrect
dosage,
incorrect
drug, and
drug-drug
interaction,
as well as
incorrect
frequency
and drug
omission.
Some of the research recommendations include the proposal
to increase the sample size, have a greater timeframe for
future projects, and consider randomizing the sample into
two groups.
The project can also be used to recommend educational
EHR efforts for the reduction of EHR resistance and the
References
specific program that has been tested for the same purpose.
King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2014). Clinical benefits of electronic
health record use: National findings. Health Services Research, 49(1pt2), 392–404. doi:
10.1111/1475-6773.12135
Liao, T. V., Rabinovich, M., Abraham, P., Perez, S., DiPlotti, C., Han, J., … Honig, E. (2017).
Evaluation of medication errors with implementation of electronic health record technology in
the medical intensive care unit. Open Access Journal of Clinical Trials, 9, 31-40. doi:
10.2147/OAJCT.S131211
Porterfield, A., Engelbert, K., & Coustasse, A. (2014). Electronic prescribing: Improving the
efficiency and accuracy of prescribing in the ambulatory care setting. Perspectives in Health
Information Management, 2014, 1-13
Palabindala, V., Pamarthy, A., & Jonnalagadda, N. R. (2016). Adoption of electronic health
records and barriers. Journal of Community Hospital Internal Medicine Perspectives, 6(5), 13. doi: 10.3402/jchimp.v6.32643
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for
nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Title of Project
Presenter Name
University name
Introduction and Problem
Results (cont.)
Data Analysis
Discussion
.
Descriptive Data
Project Limitations
Purpose of the Project
.
Clinical Questions/PICOT
Results
Conclusion and Recommendations
.
References
.
Variables
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www.PosterPresentations.com
Poster Presentation
Students this project will allow you to formulate and hypothetically develop your own research project. The purpose
of this project is for the student to follow all of the different steps in a research project on an already published
article and presented as a poster presentation. A poster session or poster presentation is the presentation of research
information by an individual or representatives of research teams at a congress or conference with an academic or
professional focus. The work is usually peer reviewed. Poster sessions are particularly prominent at scientific
conferences such as medical congresses.
Students will select a nursing research already published and following the article information you will create a
poster presentation that include the below information:
The outline of the poster should include the following tabs (minimum requirements)
Abstract Outline:
-Title of Project
-Problem Statement: what is the problem that needs fixing?
-Purpose of the Project
-Research Question(s)
-Hypothesis
-Methodology (Qualitative vs. Quantitative)
-Steps in implementing your project
-Limitations
Results (Pretend results)
-Conclusion
-References
I have attached an example of a poster presentation for guidance. The due date for the poster presentation is WEEK
13. Please feel free to be artistic and provide graphs and data. You are welcome to use any poster template. Please
submit it via turn it in.
Criterion
Completeness
Outstanding 4
Complete in all
respects; reflects all
requirements
Understanding
Demonstrates
excellent
understanding of the
topic(s) and issue(s)
Analysis
Presents an
insightful and
through analysis of
the issue (s)
identified
Makes appropriate
and powerful
connections between
the issue(s) identified
and the concept(s)
studied
Evaluation
Opinion
Supports opinion
with strong
arguments and
evidence; presents a
balanced and critical
view; interpretation is
Very Good 3
Complete in most
respects; reflects
most
requirements
Demonstrates an
accomplished
understanding of
the topic(s) and
issue(s)
Presents a
thorough analysis
of most of the
issue(s) identified
Makes
appropriate
connections
between the
issue(s) identified
and the
concept(s)
studied
Supports opinion
with reasons and
evidence;
presents a fairly
balanced view;
interpretation is
Good 2
Incomplete many
respects; reflects
few requirements
Demonstrates an
acceptable
understanding of
the topic(s) and
issue(s)
Presents a
superficial
analysis of some
of the issue(s)
identified
Makes
appropriate but
somewhat vague
connections
between the
issue(s) identified
and the
concept(s)
studied
Supports opinion
with limited
reasons and
evidence;
presents a
somewhat one-
Unacceptable 1
Incomplete in
most respects;
does not reflect
requirements
Demonstrates an
inadequate
understanding of
the topic(s) and
issue(s)
Presents an
incomplete
analysis of the
issue(s)
identified.
Makes little or no
connection
between the
issue(s) identified
and the
concept(s)
studied.
Supports opinion
with few reasons
and little
evidence;
argument is onesided and not
Score
Recommendations
both reasonable and
objective
Presents detailed,
realistic, and
appropriate
recommendations
clearly supported by
the information
presented and
concepts studied
Grammar and
Spelling
Minimal spelling and
grammar errors
APA guidelines
Uses APA guidelines
accurately and
consistently to cite
sources
both reasonable
and objective
Presents specific,
realistic and
appropriate
recommendation
supported by the
information
presented and
the concepts
studied
Some spelling
and grammar
errors
sided argument
objective.
Presents realistic
or appropriate
recommendation
supported by the
information
presented and
the concepts
studied
Presents realistic
or appropriate
recommendation
with little, if any,
support from the
information and
the concepts
studied.
Noticeable
spelling and
grammar errors
Uses APA
guidelines with
minor violations
to cite sources
Reflects
incomplete
knowledge of
APA guidelines
Unacceptable
number of
spelling and
grammar errors
Does not use
APA guidelines
Total
7th Edition
Reference Quick Guide
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Name of the Periodical, volume(issue), #–#. https://doi.org/xxxx
Capitalize all major words in the
periodical name. Follow with a
comma. Italicize the periodical
name (but not the comma after).
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Book
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Include the article page
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DOI? Include a DOI for all
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put a period after the DOI.
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Chapter in
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audiobooks) can be found in the Publication Manual of the American Psychological Association (7th ed.) and in the Concise Guide to APA Style (7th ed.):
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before the page range. If both, show edition
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SOURCE: American Psychological Association. (2020).
Publication manual of the American Psychological Association
(7th ed.). https://doi.org/10.1037/0000165-000
CREDIT: MELANIE R. FOWLER, FLORIDA SOUTHERN COLLEGE
Chapter 20
People of Korean Heritage Chapter 17 EUN-OK IM Overview, Inhabited Localities, and Topography
OVERVIEW This chapter focuses on the commonalities among people of Korean heritage, with historical
reference to the mother country, South Korea. The word Korea limitedly refers to the Republic of Korea.
Because some information may not be pertinent to every Korean, this chapter serves as a guide for
health-care providers rather than as a mandate of facts. Differences in beliefs and practices among
Koreans in Korea, the United States, and other countries vary according to the primary and secondary
characteristics of culture as presented in Chapter 1. An understanding of Korean culture and history
gives health professionals the insight needed to perform culturally appropriate assessments, plan
effective care and follow-up, and work effectively with Koreans in the workforce. South Korea is a
peninsula separated by North Korea to the north at the 38th parallel and surrounded by the former
Soviet Union to the northeast, the Yellow Sea to the west, and the Sea of Japan to the east. South Korea
has a landmass of 98,480 square kilometers (38,031 square miles), which is about the size of the state of
Indiana, and a population of 48 million (CIA, 2007). South Korea has 1 percent of the landmass of the
United States, but has onesixth as many people, making it 16 times more densely populated than the
United States (Kohls, 2001). The mega-modern metropolitan area of Seoul, the capital, has a population
of 10.3 million people (Asianinfo, 2007a). A new international state-of-the art airport is located in
Incheon, 60 kilometers from the center of Seoul. Other large cities are Busan (Pusan) and Daegu (Taegu).
Planes, trains, and buses link all South Korean major cities, making travel easy and efficient. With the
recent increase in the number of automobiles and the construction of highways, motorways are
becoming more congested. Major industries are electronics, telecommunications, automobile
production, chemicals, shipbuilding, and steel (CIA, 2007). South Korea is now well known as riding on
the “hallyu movement” or the “Korean wave,” which is the globalization of Korean dramas throughout
Singapore, Malaysia, Japan, China, and the United States. Since the 1990s, the entertainment industry of
South Korea has grown explosively, producing Asia-wide successes in music, television, and film. The
continental and monsoon climate of Korea is fairly consistent throughout the peninsula, except during
the winter months. North Korea has cold, snowy winters, with an average temperature in January of
17°F. South Korea is milder, with an average January temperature of 23°F. During the summer months,
the monsoon winds create an average temperature of 80°F, with high humidity throughout the
peninsula. Precipitation occurs mostly during the summer months and is heavier in the south. The
peninsula is mountainous; only 20 percent of the terrain is located in lowlands. Such topography
encourages the development of concentrated living areas. Most cities and residential areas are located
along the coastal plains and the inland valleys opening to the west coast. HERITAGE AND RESIDENCE
Korea is one of the two oldest continuous civilizations in the world, second only to China. Koreans trace
their heritage to 2333 B.C. In the 1st century A.D., tribes from central and northern Asia banded
together to form this “Hermit Kingdom,” littering the countryside with palaces, FABK017-C17[293308].qxd 12/12/2007 10:45am Page 293 Aptara Inc. © 2008 F A Davis pagodas, and gardens. Over the
ensuing centuries, Mongols, Japanese, and Chinese invaded the Korean peninsula. Japan forcibly
annexed Korea in the early 20th century, ruling it harshly and leaving ill will that persists to this day. As a
result of the Potsdam Conference after World War II, the United States took over the occupation of
South Korea, with the USSR occupying North Korea. By 1948, Korea’s new government was recognized
by the United Nations, only to be followed by the North Korean Communist forces invading South Korea
in 1950. The result was the Korean War, which lasted until 1953 and caused mass devastation, from
which the country has made a remarkable recovery. Open aggression between North and South Korea
again occurred in 1998 and 1999. In 2000, the two Koreas signed a vague, yet hopeful, agreement that
the two countries would be reunited. However, North Korea’s recent resumption of its nuclear weapons
program has set its neighbors and much of the rest of the world on edge (CNN, 2007). In 1988, the year
Seoul hosted the Olympic Games, elections were held, and relations were re-established with China and
the Soviet Union. Intermittent corruption among political officials has continued to surface, threatening
internal relationships and the economy. In 1997, South Korea’s economy tumbled dramatically, resulting
in economic and democratic reforms. With unwavering persistence, Koreans have rebuilt their major
world economy, reflecting a 4 percent annual growth rate with moderate inflation (CIA, 2007). The
United States continues to maintain a strong military presence throughout South Korea (Fig. 17–1).
REASONS FOR MIGRATION AND ASSOCIATED ECONOMIC FACTORS Koreans are one of the most rapidly
increasing immigrant groups in the United States (Korean American Coalition, 2003). The first major
immigration from Korea to the United States occurred between 1903 and 1905, when the Korean
government prohibited further emigration: About 10,000 Koreans had entered Hawaii and 1000 reached
the U.S. mainland. The U.S. Immigration Act of 1924 practically closed the door to Japanese and
Koreans. During the civil rights movements of the 1950s and 1960s, new immigration laws repealed the
earlier limitations on Asian immigration. Koreans continue to immigrate to America to pursue the
American dream, to increase socioeconomic opportunities, and to attend colleges and universities. In
addition, many Koreans and Americans marry, making both Korea and America their homes. Korea ranks
fourth in the number of Asian immigrants to the United States, with 1.3 million, closely following the
Philippines, China, and Vietnam (Shin & Shin, 1999). According to the 2003 Statistical Yearbook of the
Immigration and Naturalization Service, 12,512 Koreans were admitted to the United States in 2003
(U.S. Department of Homeland Security, 2004). EDUCATIONAL STATUS AND OCCUPATIONS Most of the
population pursues higher education, and South Korea has more citizens with PhDs per capita than any
other country in the world. Owing to Confucian cultural influence, education is emphasized as a virtue of
human beings (all human beings should be educated) and is highly valued in the Korean culture (Im,
2002). Before the late 19th century, education was primarily for those who could afford it. State schools
educated the youth from the yangban (upper class), focusing on Chinese classics in the belief that these
contained the tools of Confucian morality and philosophy that also apply in politics. In the late 1800s,
the state schools were opened to all citizens. Early Christian missionary work introduced the Western
style of modern education to Korea. Initially, many Koreans were skeptical of the radical curriculum and
instruction for females, but the popularity of this style grew rapidly. After the takeover of Korea by the
Japanese in 1910, two types of schools emerged, one for Japanese and another for Koreans. The Korean
schools focused on vocational training, which prepared Koreans for only lowerlevel positions. Japanese
colonial education was designed to keep Koreans subordinate to ethnic Japanese in all ways (Sorensen,
1994). In 1949, South Korea allowed for the implementation of a educational system similar to that of
the United States. This 6–3–3–4 ladder (6 years in elementary school, 3 years in junior high, 3 years in
high school, and 4 years in college) continues today in contemporary South Korea. Anti-Communism and
morality are taught throughout elementary and secondary schools. In the United States, many Koreans
own their own small businesses, which vary from mom-and-pop stores and gas stations to grocery
stores and real estate agencies to retail shops. Their reputation for hard work, independence, and selfmotivation has given them the reputation of the “model minority.” However, this has caused a backlash
in some communities, such as Washington, DC, where they have been compared with other minority
groups. The message has become: “If the Koreans can do it, why not other groups?” The turmoil and
riots that took place in Los Angeles in April 1992 between the African American community and the
Korean American merchants is another example of conflicts that arise from such labeling. Many Korean
small businesses are located in African American neighborhoods because of low capital investment
requirements and limited resources of the owners. Korean merchants begin dealing in inexpensive
consumer goods as a practical way to start a business in a capitalistic society. Koreans often assist each
other in establishing 294 • CHAPTER 17 FIGURE 17–1 Traditional Korean dancers. FABK017-C17[293308].qxd 12/12/2007 10:45am Page 294 Aptara Inc. © 2008 F A Davis businesses by pooling their money
and taking turns with rotating credit associations to provide each family with the opportunity for
financial success. Communication VIGNETTE 17.1 Ho Park and Ok Park, ages 58 and 57 years,
immigrated to New York from South Korea in 1984. They arrived with their four children and lived with
Ok’s sister and her family for 2 years. They saved their money and eventually moved into a small twobedroom apartment where they lived for 10 years. Later, they moved into a three-bedroom house in
New Jersey where they have now lived for the past 12 years. Ho is a college graduate from one of the
top universities in South Korea, and Ok is a graduate from a prestigious women’s college in South Korea.
Despite their college degrees, they have been working as housekeepers in a hospital. The three sons and
one daughter have matured without any problem. The daughter, Teresha, is a nurse and works in
Michigan. The oldest son, Eugene, is a military officer and lives with his wife in Maryland. The third son,
Phyllip, is a graduate student in biology at the University of Minnesota. However, their second son,
David, is not doing well. Since he graduated from high school, 3 years ago, he has lived with Ho and Ok
without getting a job. He sits on the couch and spends most of his time watching TV or playing computer
games and gaining weight. Ho and Ok are concerned about him, but are unsure how to help him. Ok has
developed allergies and has difficulty breathing when exposed to chemicals used in her cleaning job at
the hospital. In addition, she is having serious backaches that she links to using heavy equipment.
However, she can not quit her job because her husband’s salary will not meet their financial needs,
which include university tuition for Phyllip and a home mortgage. Despite her health problems, Ok takes
full responsibility for household tasks such as cooking, dishwashing, and laundry. With Ok’s health
problems and David’s unemployment, Ho is thinking about opening a small Korean grocery store.
However, he has heard many strories of Koreans who opened small businesses and went bankrupt or
got killed by robbers. Considering that he is not a friendly person who easily smiles or welcomes
customers, he believes that he would not be good at operating a Korean grocery store. Even thinking
about the new business makes him smoke more than usual: He has smoked a pack of cigarettes daily for
the past 30 years, and now smokes more than a pack a day. Recently, he is experiencing frequent
coughing and shortness of breath. 1. How does the Park family fit the “model minority” culture and
work ethic? 2. Identify three health concerns for the Park family and describe culturally congruent
strategies for resolving them. 3. Identify how Korean traditional gender roles are affecting Ok’s health
problems and family dynamics. 4. Describe Koreans’ traditional attitudes toward smoking and discuss
interventions for Ho’s smoking. DOMINANT LANGUAGE AND DIALECTS The dominant language in Korea
is Korean, or han’gul, which originated in the 15th century with King Se Jong, and is believed to be the
first phonetic alphabet in East Asia. The Korean language belongs to the Ural-Altaic language family,
which includes Turkic, Mongolian, and Tungusic as major branches (Comrie, Matthews, & Polinsky,
1996). Dialects do not exist in Korean, but slang terminology is characteristic of specific age groups and
regions. Korean language has four levels of speech that are determined based on the degree of intimacy
between speakers. These varying levels reflect inequalities in social status based on gender, age, and
social positions. Use of an inappropriate sociolinguistic level of speech is unacceptable and is normally
interpreted as intended formality to, disrespect for, or contempt to a social superior. Chinese and
Japanese have influenced the Korean language, which has 14 consonants and 10 vowels. During their
annexation in the early 20th century, the Japanese forbade public use of the Korean language, requiring
the use of the Japanese written and spoken language. Most Koreans in the United States can speak,
read, write, and understand English to some degree. However, some Americans may have difficulty
understanding the English spoken by Koreans, especially those who learned English from Koreans who
spoke with their native intonations and pronunciations. CULTURAL COMMUNICATION PATTERNS The
sharing of thoughts, feelings, and ideas is very much based on age, gender, and status in Korean society.
Traditionally, the Korean community values the group over the individual, men over women, and age
over youth. Those holding the dominant position are the decision-makers who share thoughts and ideas
on issues. Koreans prefer indirect communication because they perceive direct communication as an
indication of intention or opinions as rude. Moreover, Koreans may agree with the health-care provider
in order to avoid conflict or hurting someone’s feelings, even if something is impossible (Im, 2002). Thus,
it is important to read between the lines when working with these families and remember those
growing up in the United States may adopt the dominant American communication style. Koreans tend
to avoid eye contact especially with older people, perceived authorities (e.g., health-care providers), and
strangers. Avoiding direct eye contact with older people and perceived authorities indicates respect, and
women’s avoiding direct eye contact with men shows modesty. Younger generations of Koreans
educated in the United States may adopt the dominant communication style of eye contact. Koreans are
usually comfortable with silence owing to Confucian teaching, “silence is golden.” Silence was
traditionally emphasized as a virtue of educated people. Even among Korean Americans, people who are
silent, especially men, are viewed as humble and welleducated. However, the social fabric and cultural
norms of Koreans are changing as they interact with Western societies and culture. Younger generations
of Koreans, PEOPLE OF KOREAN HERITAGE • 295 FABK017-C17[293-308].qxd 12/12/2007 10:45am Page
295 Aptara Inc. © 2008 F A Davis even in South Korea, are noted as being very sociable and kind to
visitors (Asianinfo, 2007b). Close personal space (less than a foot) is shared with family members and
close friends, but it is inappropriate for strangers to step into “intimate space” unless needed for health
care (Im, 2002). Visitors from America may be uncomfortable with Koreans’ spatial distancing in public
spaces. Koreans stand close to one another and do not excuse themselves if they bump into someone
on the street. This may be due to the high population density in the metropolitan areas of South Korea
(1274 per square mile) and Koreans’ cultural attitudes toward strangers (e.g., they usually do not speak
with strangers). Among family members and close friends, touching, friendly pushing, and hugging are
accepted. However, among strangers, touching is considered disrespectful unless needed for care. Also,
touching among friends and social equals of the same sex is common and does not carry a homosexual
connotation as it might in Western societies. However, more social etiquette rules apply when it comes
to touching older family members or those of higher social status. Hugging and kissing recently have
become common among parents and young children as well as among young children and aunts or
uncles. Feelings are infrequently communicated in facial expressions. Smiling a lot shows a lack of
intellect and disrespect. One would not smile to a stranger on the street nor try to joke during a serious
conversation. Joking and amusement have their designated times. In Korea, men frequent bars after
work and may express their sense of humor in this setting. Men and women alike appreciate and
encourage jokes and laughter in appropriate settings. Koreans generally do not express their emotions
directly or in public; expressing emotions in front of others, including family members, is regarded as
shameful, especially among men (Im, 2002). A common Korean belief related to men’s emotions is that
men should cry only three times in their lives: (1) When they are born, (2) when their parents die, and
(3) when their country perishes (Im, 2002). Given these cultural communication patterns, health-care
providers should not interpret these nonverbal behaviors as meaning that Korean clients are not
interested in, or do not care about, information presented during health teaching and health promotion
interventions. TEMPORAL RELATIONSHIPS Traditional Koreans are past-oriented. Much attention is paid
to the ancestry of a family. Yearly, during the Harvest Moon in Korea, chusok (respect) is paid to
ancestors by bringing fresh fruits from the autumn harvest, dry fish, and rice wine to gravesites.
However, the younger and more-educated generation is more futuristic and achievement oriented. In
Korea, palm readers are visited to determine the best home to purchase, the date for having a wedding,
and when new businesses should open. The busiest time of the year for the palm reader is just before
the Chinese New Year. Koreans are eager to know their fortune for the coming year. Many believe that
misfortunes occur because ancestors are unhappy. During these times, families show respect to
ancestors by more frequent visits to their gravesites in the hope of appeasing the spirits. Shamans are
also used in Korea to rid homes and new places of business from spirits, and they may be used by
Koreans of all socioeconomic levels. The Korean conception of time depends on the circumstances.
Koreans embrace the Western respect for time for important appointments, transportation
connections, and working hours, all of which are recognized as situations in which punctuality is
necessary. Yet, socially, Korean Americans arrive at parties and visit family and friends within 1 to 2
hours later than the agreed-upon time. This is socially acceptable when the person or family is waiting at
home. If the social meeting is being held in a public setting, a half-hour time span for arrival at the
meeting place can be expected. FORMAT FOR NAMES The number of surnames in Korea is limited, with
the most common ones being Kim, Lee, Park, Rhee or Yi, Choi or Choe, and Chung or Jung. Korean
names contain two Chinese characters, one of which describes the generation and the other the
person’s given name. The surname comes first; however, because this may be confusing to many
Americans, some Koreans in the United States follow the Western tradition of using the given name
first, followed by the surname. Adults are not addressed by their given names unless they are on friendly
terms; individuals should be addressed by their surname with the title Mr., Mrs., Ms., Dr., or Minister.
Given the diversity and acculturation of Korean Americans, health-care providers need to determine the
Korean clients’ language ability, comfort level with silence, and spatial-distancing characteristics. In
addition, Koreans should be addressed formally until they indicate otherwise. Family Roles and
Organization VIGNETTE 17.2 Kay and Sook Lim, ages 55 and 57 years, immigrated from Korea in 1988 at
the invitation of Kay’s brother who lived in Chicago. They came to Chicago with only $200 and began
working as clerks in a Korean laundry. Owing to Kay’s excellent management skills and Sook’s diligent
work ethic, they have been able to establish a real estate business. They now live in a prestigious home
and regularly donate money to their church. Their fellow church members frequently tell them that they
are role models for the many Korean immigrants in the area. The Lims have two children: one daughter
and one son. Their daughter, Grace, of whom they were very proud, was one of the top students in her
high school and entered Cornell University, a special honor for them. However, she married a white
man, became pregnant, and abandoned her studies. Kay and Sook had to accept her marriage because
of her pregnancy, but they did not let other relatives and friends know about her marriage. Grace
moved to Los Angeles with her husband and does not want to see her parents again 296 • CHAPTER 17
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do not heartily approve of her marriage and pregnancy. Their son, John, has recently been a family
concern. Until Kay and Sook received a telephone call from a policeman, they did not know that he had
been skipping classes. In addition, they were unaware that he was coming home very late at night
because they also came home late at night. John was involved in a gang fight in which a victim was badly
hurt, necessitating additional expenses for an attorney. Because of the circumstances of both children,
Kay became very depressed and could not go to work. Moreover, they could not get help from a healthcare provider or emotional support from relatives or church friends because they did not want others to
know about these unfortunate occurrences with their children. Furthermore, whenever John comes
home late at night, he and Sook quarrel, which frequently results in physical altercations. Thus Kay
becomes more depressed and separates herself from others. 1. What cultural strategies can a publichealth case manager employ for Kay’s depression? 2. If the Lim family were to seek health care, what
type of care provider would they most likely seek? 3. What cultural barriers exist for the Lim family in
seeking mental-health counseling and obtaining social support? 4. Discuss traditional Korean
prescriptive, restrictive, and taboo practices for adolescents and young adults. How does the Kim family
vary from these traditional practices and values? HEAD OF HOUSEHOLD AND GENDER ROLES
Fundamental ideas about morality and the proper ordering of human relationships among Koreans are
closely associated with kinship values derived mainly from Confucian concepts of filial piety, ancestor
worship, funerary rites, position of women, the institution of marriage, kinship groups, social status and
rank, and respect for scholars and political officials. Although constitutional law in South Korea declares
equality for all citizens, not all aspects of society have accepted this. Korean culture is largely based on
patriarchal and Confucian norms that subordinate women (Im, 2002). In Confucian traditional Korean
families, the father was always the head of the family; he had power to control the family, and the
family had to obey any order from the father. Wives did not share household tasks with their husbands,
so they tended to be physically overloaded and psychologically distressed. Wives’ exploitation was
hidden under Confucian norms that praised women who sacrifice themselves for their families and
nation (Im & Meleis, 2001). Also, the wife was confined to the home and bore the major responsibility
for household tasks; the husband was the breadwinner. Among Korean immigrants in the United States,
women hold the family together and play a vital role in building an economic base for the family and
community, often sacrificing themselves in the immigration process. The Korean immigrant woman may
have started as a cleaning woman or seamstress, then worked at a fast food restaurant, and then in a
small shop owned with her husband. However, the women’s financial contributions to the family usually
do not change the gender roles: Their husbands still occupy center stage, exercise the authority, and
make the major family decisions (Im & Meleis, 2001). PRESCRIPTIVE, RESTRICTIVE, AND TABOO
BEHAVIORS FOR CHILDREN AND ADOLESCENTS In contrast to the Western culture, in which mothering is
individually fashioned and relies on the expertise of health-care providers, in the highly ritualistic Korean
culture, mothering is molded by societal rules and information is less frequently sought from health-care
providers. In this context, mothers tend to view infants as passive and dependent, and they seek
guidance from folklore and the extended family (Choi, 1995). In Korea, children over the age of 5 years
are expected to be well behaved because the whole family is disgraced if a child acts in an embarrassing
manner. Most children are not encouraged to state their opinions. Parents usually make the decisions.
Korean families have high standards and expectations for their children, and “giving a whip to a beloved
child” is the basis for discipline of children (Im, 2002). Thus, the pressure of high performance in school
and entering a highly ranked university is prevalent among Korean children and adolescents (Im, 2002).
Usually, Koreans are not happy with very masculine girls or very feminine boys (Im, 2002). “Teaching to
the test” is also common in Korea, but the role of teachers is also to encourage self-study. The future of
Korean students is determined by their teachers’ recommendations, and this pressure can be extremely
intense for students who are not doing well. The teaching style is one in which students listen and learn
what is being taught. Regardless of private doubts, a student rarely questions a teacher’s authority.
Korean children in America must be taught the teaching style in American schools, in which questioning
is positive and is valued as class participation. Even if Korean American students understand the style of
teaching, it can be difficult to know the appropriate timing for asking questions. The pressure of doing
well in school and attending a university of high quality leaves Korean adolescents little room for social
interactions. Activities that interfere with one’s education are considered taboo for adolescents. In
Korea, students frequently attend study groups after school or special tutoring sessions paid for by their
families in preparation for examinations to enter a university. Short coffee breaks or snacks at local
coffee shops or noodle houses are permissible, but then it is “back to the books.” Dating is uncommon
among high school students in Korea, although it is allowed. Adolescent girls are usually not allowed to
spend the night at their friends’ houses, virginity is emphasized, and sexual activities and pregnancy at
puberty stigmatize the family across social classes. Although talking about sexuality, contraception, or
pregnancy in public is taboo, close girlfriends or boyfriends exchange information on these topics or get
their information from women’s magazines. Neither the school system nor the family assumes
responsibility for sex education. Girls in elementary school are given a class PEOPLE OF KOREAN
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Davis regarding their menstrual cycle, but no information is given about sexual relations. Once young
adults have entered a university, they receive their freedom and are then permitted to make their own
decisions about personal and study time. Group outings are common for meeting the opposite sex.
Dating may occur from these group meetings and consists of movies, dinner, and walks in the park.
Issues arise between the first-generation Korean immigrant parents and the second-generation children
in relation to conflicting values and communication. With rapid acculturation, the second generation
often takes on the values of the dominant society or culture. Thus, parents who are of the first
generation in most cases are challenged when their second-generation children do not accept
traditional values and ideals that they may still hold dear. The different cultures between the firstgeneration parents and the second-generation children are sometimes the cause of domestic violence.
Most of the first generation of Korean immigrants were educated in Korea, and they have a strong
stereotype of Korean patriarchal culture. However, because the second generation is educated in the
United States (some of them never visited Korea), most second-generation individuals feel a spirit of
insubordination and often quarrel. For some, physical abuse might be involved if they do not follow
orders (Kim, Cain, & McGubbin, 2006; Kim & Chung, 2003; Park, 2001). FAMILY GOALS AND PRIORITIES
In Korea, the family is described as “corporate,” in which family members have specific rights and duties
within their family. A Korean cannot belong to more than one corporate family, and a family member
replaces the roles of another family member who dies. This traditional corporate family is dissolving
among both Koreans and Korean Americans. Usually, both parents work to provide every opportunity
possible for their family. As each family member learns to adjust to the changing roles, conflict can
result. Children adapt most easily to the new culture and may even take on the dominant culture’s
values. Lee and Lee (1990) studied the adjustment of Korean immigrant families in the United States in
relation to roles, values, and living conditions between husbands and wives and parents and children.
The findings showed a transition from an independent family structure, in which the woman had little
knowledge of the man’s activities outside the home, to a joint family structure. Many activities were
carried out together with an interchange of roles at home. Conflict centered on undefined role
expectations. In Korea, the roles of men and women were very clear. However, upon immigrating to the
United States, men and women were faced with conflicting roles in the new culture and had to struggle
to redefine them. Other conflict areas were the couple’s ability to speak English, the woman’s inability
to drive, the degree of acculturation, the limited social contact, and the stressors of living in a new
culture. In Korea, education is a family priority. The outcome of having a highly educated child was a
secure old age for the parents. Because of the dependent relationship between parents and their
children, parents were more willing to make drastic sacrifices for the advancement of their children’s
education. Today, status is achieved rather than inherited in Korea. Education in Korea is a determinant
of status, independent of its contribution to economic success. Traditionally in Korea, parents expected
their children to care for them in old age. Hyo (filial piety), which is the obligation to respect and obey
parents, care for them in old age, give them a good funeral, and worship them after death, was a core
value of Korean ethics. The obligation to care for one’s parents is written into civil code in Korea. The
burden was on the eldest son, who was obliged to reside with his parents and carry on the family line.
Such an arrangement made the generations dependent on each other. The son felt obligated to care for
his parents because of the sacrifices they made for him. Similarly, he made the same sacrifices for his
children and expected them to provide for him and his wife in their old age. Many of these traditions in
Korea have changed. Some of the eldest children emigrated, leaving the responsibility for their parents
to the siblings who remained in Korea. Some older Koreans were brought to the United States without
their friends and with minimal or no English skills. They often felt obligated to assist the family in any
way possible by preparing meals or taking care of the children when the parents were not home.
Decision-making for older people was hampered in their new culture. Korean older people were
frequently consulted on important family matters as a sign of respect for their life experiences. Older
people’s roles as decision-makers in the United States have shifted with the younger generation of
Korean Americans wanting the final decision-making authority in their young families. Traditionally,
Koreans give great respect to their older people. Old age begins when one reaches the age of 60 years,
with an impressive celebration prepared for the occasion. The historical significance of this celebration is
related to the Chinese lunar calendar. The lunar calendar has 60 cycles, each with a different name. At
the age of 60, the person is starting the calendar cycle over again. This is called hwangap. This
celebration was more significant in the past when life expectancy in Korea was much lower than it is
today. Despite a change in the direct role of older people in their families, older Koreans are socially well
respected in Korea. In public, an older woman is called Halmoni (grandmother), and those who are not
blood relatives call an older man Harabuji (grandfather). Older people are offered seats on buses out of
respect and honor. Traditionally, the extended Korean family played an important role in supporting its
members throughout the life span. With the break up of the extended family, Korean Americans support
each other through secondary organizations such as the church. The church assists new immigrants with
the transition to life in the United States. The church is a resource for information about child care,
language classes, and social activities (Im & Yang, 2006; Tritto, 2004). Korean Americans without family
support may seek other Korean Americans who live in the area. With Korean Americans dispersed
throughout the United States; however, this task can be difficult. Whereas some Koreans inherit social
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Traditional Korean culture espouses respect not only for older people but also for those of valued
professions. In modern Korea, professors, bureaucrats, business executives, physicians, and attorneys
receive a high level of respect. Historically, those with the highest education were handsomely paid.
Even though the salary differences between university professors and other professions have narrowed
significantly in recent years in Korea, the status of the intellectual remains high. Similarly, the
bureaucratic officer has a high social status, wielding much respect and influence. ALTERNATIVE
LIFESTYLES Alternative lifestyles are usually frowned upon in Korean culture. Women who divorce suffer
social stigma, the degree of which depends on the situation. However, recent changes in the Family Law
in South Korea now permit women to head a household, recognize a wife’s right to a portion of the
couple’s property, and allow a woman to maintain greater contact with her children after a divorce (U.S.
Department of State, 2006). Partially owing to the law change, South Korea now has one of the highest
divorce rates in the world, with 47.4 percent of marriages ending in divorce (U.S. Department of State,
2006). Yet, the stigma of divorce remains strong among Koreans in both South Korea and the United
States, and there is little government or private assistance for divorced women (U.S. Department of
State, 2006). Mixed marriages, between a Korean and a non-Korean, are highly disregarded by some,
and the Korean government makes it very difficult for these marriages to occur. Korean women who
have married American servicemen are often the objects of Korean jokes and are ridiculed by some.
Living together before marriage is not customary in Korea. If pregnancy occurs outside marriage, it may
be taken care of quietly and without family and friends being aware of the situation. In the United
States, pregnancy outside of marriage may not carry such a great stigma among the more acculturated.
As in other Asian cultures, homosexuality has not been accepted in Korean culture (Kimmel & Yi, 2004).
Also, Korean’s understanding and knowledge of homosexuality are ambigous and limited (Kim & Hahn,
2006): Koreans think that homosexuality is an abnormal and impure modern phenomenon. Despite the
recent coming out of several Korean homosexual entertainers in South Korea, those who have relations
with a person of the same sex still remain “in the closet.” Personal disclosure to friends and family
usually jeopardizes the family name and may lead to ostracism. The community may stigmatize both the
family and the individual, making it difficult to conduct their personal lives. Workforce Issues CULTURE
IN THE WORKPLACE Korean Americans come from a culture that places a high value on education. Many
Korean immigrants are college educated and held white-collar jobs in Korea. Moreover, it is difficult for
Korean immigrants to obtain work in the United States commensurate with their experience because of
language difficulties, restricted access to corporate America, and unfamiliarity with American culture (Im
& Meleis, 2001). The skills and work experiences they had in Korea are often not accepted by American
businesses, forcing them to take jobs in which they may be overskilled while they save money to start
their own businesses. Korean American women frequently need to find jobs to assist the family
financially, which may cause role conflicts between more traditional husbands and wives. Korean
Americans have a strong work ethic. They work long hours each week for the advancement of family
opportunities. Family is the priority for Korean Americans, but on the surface, this may not always be
apparent when long hours are devoted to work. The goal is to save money for education and other
opportunities, so the family can provide for their children in the future. The number of Korean medical
personnel working in the American health-care system is unknown. Significant numbers of Korean
nurses and physicians are practicing in the United States and Canada; many have received part or all of
their education in the United States. Yi and Jezewski’s study (2000) of 12 Korean nurses’ adjustment to
hospitals in the United States identified five phases of adjustment. The first three phases, relieving
psychological stress, overcoming language barriers, and accepting American nursing practice, take 2 to 3
years. The remaining two phases, adopting the styles of American problem-solving strategies and
adopting the styles of American interpersonal relationships, take an additional 5 to 10 years.
Accordingly, orientation programs need to address language skills, practice differences, and
communication and interpersonal relationships to help Koreans adjust to the American workforce.
These same phases may occur with other Korean health professionals. ISSUES RELATED TO AUTONOMY
Those in supervisory positions need to recognize the roles and relationships that exist between Koreans
and their employers. A supervisor is treated with much respect in work and in social settings.
Informalities and small talk may be difficult for Korean immigrants. For an employee to refuse an
employer’s request is unacceptable, even if the employee does not want or feel qualified to complete
the request. Supervisors should make an effort to promote open conversation and the expression of
ideas among Korean Americans. Asking Korean employees to demonstrate procedures is better than
asking them whether they know how to perform them. Those who have adjusted to the American
business style may be more assertive in their positions, but an understanding of this work role gives
supervisors the tools to more readily use Korean Americans’ skills and knowledge. As with any new
language, it is often difficult to understand American slang and colloquial language. Employers and other
employees should be clear in their communication style and be understanding of miscommunications.
Ethnic biases are often directed at Korean Americans who speak English with an accent. Employers’ and
coworkers’ preconceived notions of immigrants can also be a deterrent to Korean Americans in the
workforce. PEOPLE OF KOREAN HERITAGE • 299 FABK017-C17[293-308].qxd 12/12/2007 10:45am Page
299 Aptara Inc. © 2008 F A Davis Biocultural Ecology SKIN COLOR AND OTHER BIOLOGICAL VARIATIONS
Koreans are an ethnically homogeneous Mongoloid people who have shared a common history,
language, and culture since the 7th century A.D. when the peninsula was first united. Common physical
characteristics include dark hair and dark eyes, with variations in skin color and degree of hair darkness.
Skin color ranges from fair to light brown, with those residing in the southern part of South Korea being
darker. Epicanthal skin folds create the distinctive appearance of Asian eyes. DISEASES AND HEALTH
CONDITIONS Schistosomiasis and other parasitic diseases are endemic to certain regions of Korea.
Therefore, health-care providers should consider parasite screening with Korean immigrants, when
appropriate. South Korea continues to manufacture and use asbestos-containing products and has not
taken the precautions necessary to adequately protect employees and meet international standards.
Thus, Koreans emigrating to the United States need to be assessed for asbestos-related health problems
(Johanning, Goldberg, & Kim, 1994). The high prevalences of stomach and liver cancer, tuberculosis,
hepatitis, and hypertension in South Korea predispose recent immigrants to these conditions. High rates
of hypertension lead to an increase in cardiovascular accidents and renal failure. The high incidence of
stomach cancer is associated with environmental risks, such as diet and infection (Helicobacter pylori),
and in some cases, genetic predisposition (Kim, 2003). As with other Asians, a high occurrence of lactose
intolerance exists among people of Korean ancestry. Dental hygiene and preventive dentistry have
recently been emphasized in health promotion in South Korea. Because of the high incidence of gum
disease and oral problems, however, these conditions deserve attention. VARIATIONS IN DRUG
METABOLISM Growing research in the field of pharmacogenetics has found variations in drug
metabolism among ethnic groups. Studies suggest that Asian populations require lower dosages of
psychotropic drugs (Levy, 1993). Other studies have shown variations in drug metabolism and
interaction with propranolol, isoniazid, and diazepam among Asians in comparison with those of
European Americans and other ethnic groups (Meyer, 1992). Although these studies primarily focus on
people of Chinese and Japanese heritage, health-care professionals should be aware and attentive to
the possibility of drug metabolism variations among Korean Americans (Munoz & Hilgenberg, 2005).
High-Risk Behaviors Because Koreans place great emphasis on education, many subject their children to
intense pressure to do well in school. A survey conducted among middle and high school students in
Korea demonstrated such pressures. Three-quarters of the students reported having considered running
away or committing suicide because of their lack of success in school (Sorensen, 1994). Another study
conducted at Seoul National University, the apex of universities in South Korea, reported that 14 percent
of the students admitted to the class of 1980 experienced nervous disorders, character blocks, or
nervous breakdowns (Sorensen, 1994). Similar pressures have been seen in the United States, where
suicide has occurred in Korean high school and college students because of intense pressure to do well
in school. Korea has a high incidence of alcohol consumption, up from 7.0 L in 1980 to 8.1 L per adult per
capita, which is similar to that of the United States and Ireland at 7.8 L per adult per capita. However,
among adult men in Korea, consumption is 18.4 L per capita, one of the highest rates of alcohol
consumption in the world (Park, Oh, & Lee, 1998). Korean business transactions commonly occur after
the decision-makers have had several drinks. Koreans believe that people let their masks down when
they drink and that they truly get to know someone after they have had a few drinks. Socioeconomic
changes in Korea have resulted in differences in alcohol-related social and health problems, with a
change from drinking mild fermented beverages with meals to drinking distilled liquors without meals.
In the United States, 62 percent of Korean American men and 39 percent of Korean American women
drink alcoholic beverages, with beer the alcoholic beverage most commonly consumed (Yu, 1990b). In
Korea, women drink far less than men. Sons’ drinking patterns are similar to their fathers’ patterns. A
substantial generational difference exists among females, with daughters abstaining from alcohol less
frequently than their mothers and drinking more, and more often, than their mothers (Weatherspoon,
Park, & Johnson, 2001). In the United States and Korea, drinking and vehicular accidents among Koreans
and Korean Americans are a cause for concern. One-third of Korean Americans living in the Los Angeles
area smoke, and Korean American men (37 percent) smoke more than Korean American women (20
percent) (Yu, 1990b). In their study, Lee, Sobal, and Frongillo (2000) found that bicultural Korean men
were least likely to smoke, whereas acculturated and bicultural women were more likely than traditional
women to smoke. In Korea, a few women do smoke, and for those who do, smoking in public, such as on
the street, is considered taboo. Cho and Faulkner (1993) studied the cultural conceptions of alcoholism
among Korean and American university students. Students had to decide whether the person described
in a vignette was an alcoholic or not and why. The results showed that American-born students tended
to define alcoholism in terms of social and interpersonal problems related to drinking, whereas Koreanborn students defined alcoholism in terms of physical degeneration and physiological addiction. The
authors cautioned against the misuse of American concepts and diagnostic scales in the cross-cultural
arena. Cultural factors should be examined closely in relation to the study, diagnosis, and treatment of
alcohol problems. 300 • CHAPTER 17 FABK017-C17[293-308].qxd 12/12/2007 10:45am Page 300 Aptara
Inc. © 2008 F A Davis HEALTH-CARE PRACTICES Seat belts are infrequently worn in South Korea,
although there has been recent pressure to use them. Korean Americans understand the legal mandates
in the United States and comply with seat-belt and child-restraint laws. Hobbies such as hiking and golf
are enjoyed in South Korea. Korean Americans do not identify hiking as a frequent pastime, either
because of environmental constraints or because of living situations. Golf remains a significant activity
among those Korean Americans who are financially able to play the sport. Nutrition MEANING OF FOOD
Food takes on a significant meaning when one has been without food. Many Koreans over the age of 50
who fought in the Korean War experienced a time when their next meal was not guaranteed. Because of
a devastated economy and agricultural base, barley and kimchee, a spicy pickled cabbage, were dietary
staples during the war. COMMON FOODS AND FOOD RITUALS Korean food is flavorful and spicy. Rice is
served with 5 to 20 small side dishes of mostly vegetables and some fish and meats. The variety of
seasonings in Korean cooking includes red and black pepper, garlic, green onion, ginger, soy sauce, and
sesame seed oil. The traditional Korean diet includes steamed rice; hot soup; kimchee; and side dishes
of fish, meat, or vegetables served in some variation for breakfast, lunch, and dinner. Breakfast is
traditionally considered the most important meal. Kimchee is made from a variety of vegetables but is
primarily made from a Chinese, or Napa, cabbage (Fig. 17–2). Spices and herbs are added to the
previously salted cabbage, which is allowed to ferment over time and is served with every meal in a
variety of forms. Some common Korean American dishes: Beebimbap is a combination of rice, finely
chopped mixed vegetables, and a fried egg served in a hot pottery bowl. Hot pepper paste is usually
added. Bulgolgi is thinly sliced pieces of beef marinated in soy sauce, sesame oil, green onions, garlic,
and sugar, which is then barbecued. Chopchae are clear noodles mixed with lightly stirfried vegetables
and meats. Rice is usually served in individual bowls, set to the left of the diner. Soup is served in
another bowl, placed to the right of the rice. Chopsticks and large soupspoons are used at all meals.
Korean Americans may use forks and knives, depending on their degree of assimilation into American
culture. Meals are frequently eaten in silence, using this opportunity to enjoy the food. When Koreans
migrate to the United States, they increase their consumption of beef, dairy products, coffee, soda, and
bread as well as decrease their intake of fish, rice, and other grains. However, incorporating a larger
quantity of Western foods does not make a less-healthy diet. They consume diets consistent with their
traditional Korean food patterns, with 60 percent of calories coming from carbohydrates and 16 percent
of calories from fat (Kim, Yu, Chen, Cross, & Kim, 2000). To increase compliance with dietary
prescriptions, health teaching should be geared to the unique Korean American food choices and
practices. Understanding the ritual offering of food and drink to guests is important. Koreans offer a
guest a drink on first arriving at their home. The guest declines courteously. The host offers the drink
again and the guest again declines. This ritual can occur three to five times before the guest accepts the
offer. This interaction is done out of respect for the hosts and their generosity to share with their guest
and to express an unwillingness to impose on the hosts. Accepting an offer when first asked is
considered rude and selfish. DIETARY PRACTICES FOR HEALTH PROMOTION Most dietary practices for
health promotion apply to pregnancy, discussed later in this chapter. Someone suffering from the
common cold is served soup made from bean sprouts. Dried anchovies, garlic, and other hot spices are
added to the hot soup, which assists in clearing a congested nose. NUTRITIONAL DEFICIENCIES AND
FOOD LIMITATIONS Kim, Yu, Liu, Kim, and Kohrs (1993) examined the nutritional status of older Chinese,
Korean, and Japanese Americans. Along with a dietary interview and anthropometric measurements, a
24-hour recall technique was used to obtain dietary data. The results of the study showed that older
Korean Americans had the poorest diets, particularly with regard to inadequate amounts of vitamins A
and C. Korean American women had a low intake of protein. The results also suggested that older Asian
Americans are at high risk for calcium deficiencies. The authors concluded that a large-scale national
nutritional survey is needed for Asian Americans to plan health programs based on the specific needs of
selected populations. PEOPLE OF KOREAN HERITAGE • 301 FIGURE 17–2 Kimchee, a spicy pickled
cabbage that is a staple of the Korean diet. FABK017-C17[293-308].qxd 12/12/2007 10:45am Page 301
Aptara Inc. © 2008 F A Davis A study by Park, Murphy, Sharma, and Kolonel (2005) indicated that the
proportion of overweight or obesity was 31.4 percent in U.S.-born Korean women and 9.4 percent in
Korean-born Korean women. They also reported that U.S.-born Korean women had higher intakes of
total fat and fat as a percentage of energy and lower intakes of sodium, vitamin C, beta-carotene, and
carbohydrate as a percentage of energy than Korean-born women. In addition, Cho and Juon (2006)
reported that of 492 Korean American respondents, 38 percent were overweight and 8 percent were
obsese according to the World Health Organization for Asian populations. These findings suggest that
acculturation of Korean immigrants affects dietary intakes in ways that may alter their risks of several
chronic diseases. Korean Americans, as with most other Asians, are at a high risk for lactose intolerance.
Thus, milk and other dairy products are not part of the traditional Korean diet, emphasizing the need to
assess them for calcium deficiencies. Korean Americans living in or near large metropolitan cities have
access to Korean markets and restaurants. When no Korean stores are available, Chinese or Japanese
markets may contain some of the foods Koreans enjoy. When no Asian markets are available, the
American grocery store suffices. Pregnancy and Childbearing Practices VIGNETTE 17.3 Jay and Sue Kim,
ages 29 and 26 years and married for 2 years, immigrated from South Korea and settled in Los Angeles.
They have lived in a small one-bedroom apartment since their arrival. Both of them graduated from the
same Korean university with baccalaureate degrees in English literature. They have one child, Joseph,
age 1 year. When they arrived in the United States, Jay was unable to find a job because of his poor
proficiency in English, despite his major in English Literature. He eventually obtained a job with a moving
company through a church friend. Sue is not working because of their son. Although the Kims did not
attend a church before immigration, they are now regularly attending a Korean Protestant church in
their neighborhood. Sue is pregnant again, determined by a home pregnancy kit, with their second child
and concerned about the medical costs. They did not use any contraceptives because she was
breastfeeding. Because of financal limitations, Sue did not initially have prenatal care with her first
pregnancy. However, she did keep up with the Korean traditional prenatal practice, tae-kyo. Eventually,
she received help from her church and delivered a healthy son. She is not sure whether she can get
financial help from her church again but is confident that her second child will be healthy if she follows
the Korean traditional prenatal practices. Jay is concerened about job security because he recently
heard from colleagues that the moving company might soon go bankrupt. Although Jay has not been
satisfied with his current job (he thinks that he is overqualified), this news is still a cause for concern.
Moreover, Sue’s recent pregnancy has made Jay more stressed, and he has started drinking alcohol.
Joseph cannot stand up by himself and still wants to be breastfed. Although Sue has tried to give foods
such as oranges, apples, steamed rice, and milk (because she is now pregnant), Joseph refuses to eat
them and cries for breastfeeding. Joseph’s weight is low normal for same-age babies. 1. How might Jay
have improved his English langage skills to increase his opportunities to obtain a position for which his
education qualifies him? 2. Describe the Korean cultural practice tae-kyo. Is this practice congruent with
allopathic recommendations for prenatal care? 3. How do food choices among Koreans differ with
pregnancy and postpartum? 4. Describe cultural attitudes toward drinking among Koreans. 5. Identify
two or three culturally congruent strategies for addressing Jay’s drinking. FERTILITY PRACTICES AND
VIEWS TOWARD PREGNANCY To curtail population growth in Korea, the government promotes the
concept of two children per household. The government supported the use of contraception when a 10year family planning program was adopted in the early 1960s, resulting in a mass public education
program on contraception. When contraceptive devices became easily available in Korea, fertility
control spread widely among married women. Contraceptive devices are covered by the present
national health insurance of Korea. Recently, South Korea’s fertility rate fell to a new record low in 2005
as more women engaged in economic activities and got married at older ages (Hankyoreh, 2007). The
average number of babies per woman of child-bearing age was 1.08 in 2005, down from 1.16 in 2004,
and the number of newborn babies fell by 38,000, or 7.9 percent, to 438,000 (Hankyoreh, 2007). As part
of efforts to address those issues, the South Korean government is to spend a total of 30.5 trillion won
(U.S. $432.8 billion) over the next 5 years to strengthen the country’s social safety net and boost its
record-low birth rate (Hankyoreh, 2007). Before the 1950s, abortion was illegal in Korea, although
induced abortions were performed widely. Today, abortion is legal and is widely used in Korea. Abortion
is not highly publicized in Korea, yet there is an unspoken acceptance of the practice. The government
keeps a handsoff policy, which has not met with major opposition. Women are not expected to get their
husband’s consent, nor are underage youth required to have their parents’ acknowledgment. The
government does not pay for abortions; rather, patients pay a set price from personal funds. Pritham
and Sammons (1993) investigated Korean women’s attitudes toward pregnancy and prenatal care with
regard to their beliefs and interactions with healthcare professionals from the United States. The survey
was conducted of 40 unemployed Korean women between the ages of 18 and 35 at an American
military medicalcare facility in a major metropolitan area of Korea. 302 • CHAPTER 17 FABK017-C17[293308].qxd 12/12/2007 10:45am Page 302 Aptara Inc. © 2008 F A Davis Attitudes toward childbearing
practices and relationships with health-care providers were elicited. The results indicated that these
women were happy about their pregnancies. Only one-third of the respondents agreed with the
traditional preference for a male child. About 40 percent of the women reinforced strong food taboos
and restrictions and acknowledged the need to avoid certain foods during pregnancy. Twenty percent
disagreed with the use of prenatal vitamins, and 25 percent indicated needing only a 10- to 15-lb weight
gain in pregnancy. The women generally had sound health habits in relation to physical activity and
recognized the harm of smoking while pregnant. The study sample was homogeneous and small, limiting
the ability to generalize about the findings. Pregnancy in the Korean culture is traditionally a highly
protected time for women. Both the pregnancy and the postpartum period have been ritualized by the
culture. A pregnancy begins with the tae-mong, a dream of the conception of pregnancy. Once a woman
is pregnant, she starts practicing tae-kyo, which literally means “fetus education.” The objective of taekyo is to promote the health and well-being of the fetus and the mother by having the mother focus on
art and beautiful objects. If the pregnant woman handles unclean objects or kills a living creature, a
difficult birth can ensue (Howard & Barbiglia, 1997). Some women wear tight abdominal binders
beginning at 20 weeks’ gestation or work physically hard toward the end of the pregnancy to increase
the chances of having a small baby (Howard & Barbiglia, 1997). In addition, expectant mothers should
avoid duck, chicken, fish with scales, squid, or crab because eating these foods may affect the child’s
appearance. For example, eating duck may cause the baby to be born with webbed feet (Howard &
Barbiglia, 1997). Kendall’s study (1987) in Honolulu supported the belief that Korean women attribute a
variety of complaints to naeng (chill), a cold imbalance of the womb that brings on a heavy vaginal
discharge and can make women who experience it sterile. The researcher emphasized that an intimate
condition such as naeng may be lost in translation in non-Korean contexts. PRESCRIPTIVE, RESTRICTIVE,
AND TABOO PRACTICES IN THE CHILDBEARING FAMILY Ludman, Kang, and Lynn’s study (1992) explored
the food beliefs and diets of 200 pregnant Korean American women. The food items most frequently
consumed were kimchee (82.5 percent), rice or noodles (81.5 percent), and fresh fruit (79 percent).
Foods avoided during pregnancy included coffee (19.8 percent), spicy foods (9.9 percent), chicken (6.9
percent), and crab (6.9 percent). A list of 20 food items was then given to the women, who were asked
to respond whether they consumed the food or not and, if not, to indicate their reasons. A number of
respondents indicated that they did not eat rabbit (91.5 percent), sparrow (91.5 percent), duck (89.5
percent), goat (84 percent), or blemished fruit (63 percent) because of dislike or lack of availability. The
reason most frequently given for not eating blemished fruit was that it might produce a skin disease on
the infant or cause an unpleasant face. The study showed that, although many Korean American women
were aware of traditionally taboo foods, they did not avoid consuming them. An awareness of these
beliefs can give health professionals a basis for nutritional education for Korean American women.
Birthing practices among both Koreans and Korean Americans are highly influenced by Western
methods. Women commonly labor and deliver in the supine position. After the delivery, women are
traditionally served seaweed soup, a rich source of iron, which is believed to facilitate lactation and to
promote healing of the mother. Bed rest is encouraged after pregnancy for 7 to 90 days. Women are
also encouraged to keep warm by avoiding showers, baths, and cold fluids or foods. The postpartum
period is seen as the time when women undergo profound physiological, psychological, and sociological
changes; this period is known as the Sanhujori belief system. In this dynamic process, postpartum
women should care for their bodies by augmenting heat and avoiding cold, resting without working,
eating well, protecting the body from harmful strains, and keeping clean (Howard & Barbiglia, 1997). In
Western society in which they may lack extended family members from whom to seek assistance,
Korean women may be faced with a cultural dilemma. Park and Peterson (1991) studied Korean
American women’s health beliefs, practices, and experiences in relation to childbirth. Using structured
questions, they interviewed in Korean a nonrandom sample of 20 female volunteers. Those interviewed
subscribed to a holistic view, which emphasized both emotional and physical health. Only one-half of
the women interviewed rated themselves healthy. The authors related this to the stresses of
immigration and pregnancy. Preventive practices were not found among members of this group. Only
one woman regularly received Pap smears and did breast selfexaminations. A common finding was that
most women participated in a significant rest period during puerperium. Those who did not rest lacked
help for the home. All the women ate brown seaweed soup and steamed rice for about 20 days after
childbirth to cleanse the blood and to assist in milk production. Because pregnancy is a hot condition
and heat is lost during labor and delivery, some women avoided cold foods and water after childbirth to
prevent chronic illnesses such as arthritis. The baby should be wrapped in warm blankets to prevent
harm from cold winds. Herbal medicines are also used during puerperium to promote healing and health
(Howard & Barbiglia, 1997). Health-care professionals can improve the health of Korean American
women by providing factual information about Pap smears and teaching breast self-examination.
Pregnant Korean American women should be asked about their use of herbal medicine during
pregnancy so that harmless practices can be incorporated into biomedical care. Recommendations for
improving postpartum care among Korean American women include (1) developing an assessment tool
that health-care providers can use to identify traditional beliefs early in a pregnancy, (2) developing a
bilingual dictionary of common foods, (3) developing pamphlets with medical terms used in the U.S.
health-care system, and (4) providing time for practicing English skills (Park & Peterson, 1991). PEOPLE
OF KOREAN HERITAGE • 303 FABK017-C17[293-308].qxd 12/12/2007 10:45am Page 303 Aptara Inc. ©
2008 F A Davis Death Rituals DEATH RITUALS AND EXPECTATIONS Traditionally, in Korea, it was
important for Koreans to die at home. Bringing a dead body home if the person died in the hospital is
considered bad luck. Consequently, viewing of the deceased occurred at home if the individual died at
home and at the hospital if the person died at the hospital. Several days or more were set aside for the
viewing, depending on the status of the deceased. The eldest son was expected to sit by the body of the
parent during the viewing (Martinson, 1998). Friends and relatives paid their respects by bowing to a
photograph of the deceased placed in the same room in which the body rested. The guests were then
offered the favorite foods of the deceased. Today, most Korean Americans are not accustomed to
viewing the body of the deceased. More commonly, relatives and friends come to pay their respect by
viewing photographs of the deceased. Although Korean Americans view life support more positively
than European Americans, the majority in one study did not want such technology (Blackhall et al.,
1999). In addition, they were less likely to have made a prior decision about life support. Older and more
educated Koreans were less likely to favor truth telling, believing that patients should not be told that
they have a terminal illness. An ancestral burial ceremony follows, with the body being placed in the
ground facing south or north. Both the place and the position of the deceased are important for the
future fortune of the living relatives. Koreans believe that if the spirit is content, good fortune will be
awarded to the family. Unlike Western graves, a mound of dirt covers the gravesite of the deceased in
Korea. Cremation is an individual and family choice and is practiced more commonly in Korea for those
who have no family or die at a young age. For example, when unmarried people die without any
children to perform ancestral ceremonies, they are often cremated and their ashes scattered over a
body of water. Rice wine is traditionally sprinkled around the grave. Korean families bow two to four
times in respect at the gravesite, and then the men, in descending order from the eldest to the
youngest, drink rice wine. Some Korean Americans dedicate a corner of their home to honor their
ancestors because they cannot go to the gravesite. Circumstances in which “do not resuscitate” orders
are an issue need to be addressed cautiously. Families trust physicians and may not question other
options. Because death and dying are fairly well accepted in the Korean culture, prolonging life may not
be highly regarded in the face of modern technology. Korean hospitals focus on acute care. Families are
expected to stay with family members to assist in feeding and personal care around the clock. Thus,
many Korean Americans may expect to care for their hospitalized family members in health-care
facilities. RESPONSES TO DEATH AND GRIEF Mourning rituals, with crying and open displays of grief, are
commonly practiced and socially accepted at funerals, and they signify the utmost respect for the dead.
The eldest son or male family member who sits by the deceased sometimes holds a cane and makes a
moaning noise to display his grief. The cane is a symbol of needing support. Health-care personnel may
need to provide a private setting for Korean Americans to be able to grieve in culturally congruent ways.
Spirituality DOMINANT RELIGION AND USE OF PRAYER Confucianism was the official religion of Korea
from the 14th to the 20th century. Buddhism, Confucianism, Christianity, shamanism, and Chondo-Kyo
are practiced in Korea today. Chondo-Kyo (religion of the Heavenly Way) is a nationalistic religion
founded in the 19th century that combines Confucianism, Buddhism, and Daoism. Among Korean
Americans, the most recent estimates of organized religions include no affiliation, 46 percent;
Christianity, 26 percent; Buddhism, 26 percent; Confucionism, 1 percent; and other, 1 percent, of which
the majority are Chondo-Kyo (CIA, 2007). In the United States, the church acts as a powerful social
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