Chapter 5 Cultural Implications for Psychiatric Mental Health Nursing Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Objectives  Explain the importance of culturally relevant care in psychiatric mental health nursing practice.  2.Discuss potential problems in applying Western psychological theory to patients of other cultures.  3.Compare and contrast Western nursing beliefs, values, and practices with the beliefs, values, and practices of patients from diverse cultures.  4.Perform culturally sensitive assessments that include risk factors and barriers to quality mental health care that culturally diverse patients frequently encounter.  5.Develop culturally appropriate nursing care plans for patients of diverse cultures. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2

Importance of Culturally Relevant Care  Culture  Groups with shared beliefs, values, and practices  Influences their thinking and behavior  Cultural norms  Define what is normal or abnormal within a culture  Ethnic groups  Common heritage and history  Share worldview for thinking Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3

Western Tradition  Identity found in individuality  Values  Autonomy  Independence  Self-reliance  Mind and body separate entities  Disease has a cause, and treatment is aimed at the cause  Time is linear  Success is obtained in preparing for the future Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4

Eastern Tradition  Family basis for identity  Body-mind-spirit one entity  Time is circular and recurring  Born into a fate; duty to comply  Disease caused by fluctuations in opposing forces Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5

Indigenous Culture  Places significance on place of humans in natural world  Basis of identity is the tribe  Person is an entity only in relation to others  Disease – Lack of harmony between individual and environment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6

Culture and Mental Health  Enculturation  Ethnocentrism  Cultural imposition Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7

Barriers to Quality Mental Health Services  Communication barriers  Stigma of mental illness  Misdiagnosis  Culture-bound syndromes  Genetic variations in pharmacodynamics Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8

Populations at Risk of Mental Illness and Inadequate Care  Immigrants  Refugees  Cultural “minorities” Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9

Cultural Competence for Psychiatric Mental Health Nurses  Five constructs  1. Cultural awareness  2. Cultural knowledge  3. Cultural encounters  4. Cultural skill  5. Cultural desire Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10

Cultural Competence for Psychiatric Mental Health Nurses (Cont.) 1. Cultural awareness  Examine beliefs, values, and practices of own culture  Recognize that during a cultural encounter, three cultures are intersecting  Culture of the patient, nurse, and setting Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11

Cultural Competence for Psychiatric Mental Health Nurses (Cont.) 2. Cultural knowledge  Learn by attending cultural events and programs  Forge friendships with diverse cultural groups  Learn by studying  Learning cultural differences helps nurse  Establish rapport  Ask culturally relevant questions  Identify cultural variables to be considered Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12

Cultural Competence for Psychiatric Mental Health Nurses (Cont.) 3. Cultural encounters  Deter nurses from stereotyping  Help nurses gain confidence in cross-cultural interactions  Help nurses avoid or reduce cultural pain Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13

Cultural Competence for Psychiatric Mental Health Nurses (Cont.) 4. Cultural skill  Ability to perform a cultural assessment in a sensitive way  Use professional medical interpreter to ensure meaningful communication  Use culturally sensitive assessment tools  Goal  A mutually agreeable therapeutic plan  Culturally acceptable  Capable of producing positive outcomes Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14

Cultural Competence for Psychiatric Mental Health Nurses (Cont.) 5. Cultural desire  Genuine concern for patient’s welfare  Willingness to listen until patient’s viewpoint is understood  Patience, consideration, and empathy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15

Question 1.Which worldview would the nurse anticipate from a client who says, “It is important to save enough money to take care of yourself in your old age. We should not rely on anyone else to take care of us.” A. Eastern (balance) B. Western (science) C. Indigenous (harmony) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16

Question 2.Which term refers to individuals’ belief that their cultural values and practices are correct and superior to those of others? A. Assimilation B. Enculturation C. Ethnocentrism D. Somatization Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17

Question 3.A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client a. Has a major illness. b. Is expressing a culture-bound illness. c. Requires hospitalization to protect the neighbor. d. Will probably not respond to Western medical treatment. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18

Critical Thinking Questions for Discussion  1.Describe the cultural factors that have influenced the development of Western psychiatric mental health nursing practice. Contrast these Western influences with the cultural factors that influence patients who come from an Eastern or indigenous culture.  2.What do you think about the claim that mental illness, such as schizophrenia, is a cultural phenomenon and that individuals are judged to be mentally ill if they do not fit within the social definition of normal? What implications (good or bad) does a diagnosis of a mental illness have?  3.Analyze the effects cultural competence (or incompetence) can have on psychiatric mental health nurses and their patients.  4.How can barriers such as misdiagnosis and communication problems impede the promotion of competent psychiatric mental health care? What can the members of the health care team do to overcome such barriers? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19