Mental Health Nursing II NURS 2310

1. Mental Health Nursing IINURS 2310 Unit 4 Cultural Considerations for the Psychiatric/Mental Health Client

2. Objective 1 Reviewing the concepts of culture and ethnicity

3. 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

4. Objective 2 Analyzing various cultures to determine the impact of perceptions, practices, and behaviors on mental health and illness

5. Northern 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

6. 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

7. 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

8. Asian/Pacific Islander Americans • 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

9. Latino 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

10. Western 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)

11. Arab 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

12. 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

13. Objective 3 Differentiating behaviors that are accepted cultural mores from those that are representative of mental illness

14. 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)

15. Objective 4 Discussing theories related to the provision of culturally competent care

16. Transcultural 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 nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge.

17. 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

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

19. 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

20. Objective 6 Exploring personal values of the nurse that impact nursing care

21. 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

22. Objective 7 Examining the importance of spirituality in psychiatric/mental health nursing

23. 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 one’s 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

24. Objective 8 Identifying clients with whom the nurse would avoid the discussion of religion

25. 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