Mental Health Mental Health Nursing IINursing II

NURS 2310NURS 2310

Unit 4Unit 4

Cultural Considerations Cultural Considerations for the for the

Psychiatric/Mental Psychiatric/Mental Health ClientHealth Client

Objective 1Objective 1

Reviewing the concepts of culture and ethnicity

Culture = shared patterns of belief, feeling, and knowledge that guide conduct and are passed down from generation to generation

Ethnicity = identification with others due to a shared heritage

Race = a class or kind of people unified by shared interests, habits, or characteristics

Prejudice = injury or damage resulting from some judgment or action of another in disregard of one’s rights

Stereotyping = assuming that all individuals who share a culture or ethnic group are identical

Objective 2Objective 2

Analyzing various cultures to determine the impact of

perceptions, practices, and behaviors on mental health

and illness

Northern European AmericansNorthern European Americans

Originating from England, Ireland, Sweden, Norway, Germany, etc

Personal space: 18 inches to 3 feet Less emphasis placed on family and

religion Punctuality and efficiency highly valued Preventive medicine and primary health

care frequently utilized Financially capable of maintaining a

healthy lifestyle

African AmericansAfrican Americans Personal space tends to be smaller than

the dominant culture Large social support systems, primarily

headed by women Little planning for the future due to

encounters with racism and discrimination

Folk medicine used due to unavailability of mainstream medical treatment

High incidence of alcoholism

Native AmericansNative Americans Most involved with the tribe to some extent Consider handshake aggressive May appear silent and reserved as culture

encourages keeping private thoughts to self Need for extended space Wisdom and tradition greatly honored Concept of time is very casual, and tasks

are accomplished within a “present-minded” time frame

Religion and health practices intertwined Alcoholism, depression, & suicide prevalent

Asian/Pacific Islander Asian/Pacific Islander AmericansAmericans

Originating from Japan, China, India, Phillipines, Pacific Islands, etc

Raising one’s voice is interpreted as a sign of loss of control, as is mental illness

Different meaning assigned to nonverbal cues

Touching during communication traditionally considered unacceptable

Eye contact considered rude and disrespectful

Appear shy, cold, or uninterested

Latino AmericansLatino Americans Originating from Mexico, Spain, Puerto Rico Touch is a common form of communication Outwardly agreeable to avoid confrontation Family is the primary social organization,

with large groups of relatives Present-oriented; punctuality not

emphasized Less mental illness than in the general

population, possibly due to strong familial support in times of stress

Western European AmericansWestern European Americans

Originating from France, Italy, and Greece

Warm, affectionate, and physically expressive

Family-oriented; interact in large groups Strong allegiance to cultural heritage Elderly respected and cared for at home Present-oriented; fatalistic view of the

future (God’s will)

Arab AmericansArab Americans Originating from Egypt, Iraq, Jordan,

Morocco, Saudi Arabia, etc Unspoken expectations more important

than spoken words, so communication can pose a problem in health care settings

Speech is loud and expressive; may appear argumentative, confrontational, aggressive

Illness often considered punishment for sins

Mental illness is a major social stigma; somatic complaints most likely

Jewish AmericansJewish Americans Orientation simultaneously to past,

present, and future Respectful toward parents Children loved and cherished; expected to

be grateful to parents forever for gift of life Preventive health care practiced, as well as

maintenance of a healthy mind and body Physicians held in high regard Higher incidence of side effects from the

medication clozapine due to specific gene

Objective 3Objective 3

Differentiating behaviors that are accepted cultural mores

from those that are representative of mental illness

What is considered normal in one culture may be deemed abnormal in another

One may be considered to have boundary issues for standing too close during a conversation, or fear of intimacy for excessive distance

Rituals and practices used by certain cultures may be considered detrimental in the mainstream– “self-harming” behaviors (tattooing, facial

designing)– child “abuse” (coining)

Objective 4Objective 4

Discussing theories related to the provision of culturally competent care

Transcultural Nursing TheoryTranscultural Nursing Theory

Madeleine Leininger founded the world-wide transcultural nursing movement.

The basic tenet of the Transcultural Nursing Theory is as follows:

In order to be culturally competent, the nurseneeds to understand his/her own world viewsand those of the patient, while avoidingstereotyping and misapplication of scientificknowledge.

Provision of Culturally Competent Care

Use of an interpreter Awareness of nonverbal communication Acknowledgement of family support

systems Meeting of spiritual needs, to include

rituals Understanding of altered time concepts Cognizance of different beliefs regarding

health care among various cultures Establishment of trust and rapport

Objective 5Objective 5

Identifying strategies for the nurse in dealing with differing client values

Knowledge formation– Learn about client’s value system– Subjective interpretation of beliefs

Empathy– Imagine yourself in another’s position

Acceptance– Embrace admirable qualities

Objectivity– Focus on client’s needs

Professional distance– Neutral territory

Objective 6Objective 6

Exploring personal values of the nurse that impact nursing

care

Any beliefs the nurse holds that are in conflict with those of the client may interfere with the provision of appropriate and objectively sound nursing care

It is best for the nurse to be aware of potential conflicts to avoid barriers to providing optimal patient care

Objective 7Objective 7

Examining the importance of spirituality in psychiatric/mental health nursing

Spirituality = finding meaning and purpose in life

Faith = acceptance of a belief in the absence of physical or empirical evidence

Hope = positive expectationLove = the projection of one’s own good

feelings onto othersForgiveness = the ability to release from

the mind all the past hurts and failures, all sense of guilt and loss

Religion = a set of beliefs, values, rites, and rituals adopted by a group of people

Objective 8Objective 8

Identifying clients with whom the nurse would avoid the

discussion of religion

The discussion of religion should be avoided specifically with clients who have a religious preoccupation (i.e. paranoid schizophrenic with grandiose religiosity)

Religion, politics, and other controversial issues (i.e. stem cell research, abortion) are typically topics that can be inflammatory and therefore would be best to be avoided as a general rule-of-thumb