Mental Health Nursing II NURS 2310

Unit IV Cultural Considerations for the Psychiatric/Mental Health Client

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

Objective 2

Analyzing various cultures to determine the impact of perceptions, practices, and behaviors on mental health and illness

Northern European Americans

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 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 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 Americans

Raising ones voice is interpreted as a sign of loss of control Different meaning assigned to nonverbal cues Touching during communication traditionally considered unacceptable Eye contact considered rude and disrespectful Appear shy, cold, or uninterested Believe mental illness is out-of-control behavior

Latino Americans
Touch is a common form of communication Outwardly agreeable to avoid confrontation Family is the primary social organization Interactions are 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 Americans

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 (Gods will)

Arab Americans
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 May require hospital bed to be turned to face Mecca Illness often considered punishment for sins Mental illness is a major social stigma; somatic complaints most likely

Jewish 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 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 4

Discussing theories related to the provision of culturally competent care

Transcultural Nursing Theory

Madeleine Leininger founded the worldwide transcultural nursing movement. The basic tenet of the Transcultural Nursing Theory is as follows: In order to be culturally competent, the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge.

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 5 Identifying strategies for the nurse in dealing with differing client values

Knowledge formation
Learn about clients value system Subjective interpretation of beliefs

Empathy
Imagine yourself in anothers position

Acceptance
Embrace admirable qualities

Objectivity
Focus on clients needs

Professional distance
Neutral territory

Objective 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 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 expectation Love = the projection of ones own good feelings onto others Forgiveness = 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 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