1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 4Spiritual, Cultural, and Ethnic Issues

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Care Organizations should ensure that patients/consumers receive effective, understandable and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred languages. Office of Minority Health (2000)

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Articulate the importance of understanding the meaning of the following terminology when providing care for culturally diverse clients: religion, spirituality, and spiritual distress, ethnocentrism, and ethnopharmacology Cite examples of responses by nurses that dissuade clients from expressing spiritual distress Discuss the relationship among culture, ethnicity, and human behavior Identify how ethnocentrism and stereotyping can affect nursing care Differentiate the three modes of culturally congruent care according to Leininger Discuss the use of mental health services by ethnic groups

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Explain how the different perceptions of mental health by providers and clients can affect the use of mental health services Compare and contrast different cultural beliefs about mental illness Discuss nursing implications derived from research on ethnopharmacology Articulate how the nurse uses knowledge about spirituality and culture in caring for clients from various ethnic groups

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Spirituality The core of who one is and entails issues of meaning and purpose, healthy relationships and connectedness with others, transcendence of self, and belief in a relationship with God or a divine being A person’s belief in a “power,” not necessarily a Creator, apart from his or her own existence

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurses May Fail to Provide Spiritual Care to Culturally Diverse Clients Because of the Following They view religious and spiritual needs as a private matter between the client and his or her Creator. They deny the existence of spiritual needs or feel uncomfortable about their own religious beliefs. They lack knowledge about the religious beliefs or spirituality of others. They mistake spiritual needs for psychosocial needs. They believe that the spiritual needs of clients are the responsibility of a family or pastor.

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The goal of spiritual nursing care is to promote the client’s physical, emotional, and spiritual health. The nurse who addresses spiritual issues and provides spiritual interventions recognizes that the balance of physical, psychosocial, and spiritual well-being is essential to overall good health.

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Culture and Nursing Culture Subculture Ethnicity Ethnocentrism Stereotyping Cultural sensitivity requires the nurse to develop awareness of his or her attitudes, beliefs and values, and communication style (DiCicco-Bloom, 2000). Values and beliefs that are not examined and analyzed can influence the nurse’s judgment about clients, thereby affecting the nurse–client relationship.

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Culturally Congruent Nursing Care If nurses are to deliver culturally diverse care effectively, they need to reflect upon their values, beliefs, and communication style; maintain awareness of cultural differences; seek direction from their professional organizations regarding differences within cultural groups; and modify their own behavior.

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care Modes According to Leininger, the nurse who plans and implements care for clients from diverse ethnic groups will do so using one of three culturally congruent nursing care modes: Cultural care preservation/maintenance Cultural care accommodation/negotiation Cultural care repatterning/restructuring

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Population Groups

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Use of Mental Health Services by Ethnic Groups Nature of the mental health system Socioeconomic status of ethnic groups

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Perceptions Mental illness as a spiritual concern –A supernatural event caused by an offense to deities or spirits –A “hex” or “spell” put on the affected person –Integration of spiritual rituals Mental illness as an imbalance or disharmony in nature –Imbalance with the natural world (broader than homeostasis) –Yin-yang

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Expressions of Mental Illness and Nursing Implications Primary symptoms are similar across cultures. Secondary features of these disorders can be strongly influenced by culture. Example: somatization among some groups Culture-bound syndrome

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Nursing of Ethnic Groups Ethnopharmacologic considerations Role of the family Role of healers Role of translators

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses and outcome identification Implementation –Establishing a trusting relationship –Communicating with the client and family –Incorporating cultural beliefs Evaluation

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Acculturation Culture Culture-bound syndrome Cultural care accommodation/negotiation Cultural care preservation/maintenance Cultural care repatterning/restructuring Ethnic group Ethnicity Ethnocentrism Ethnopharmacology Religion Spiritual distress Spirituality Stereotyping Subculture Yin-yang

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Research the nursing care plan of a culturally diverse client. ? Do the nursing interventions facilitate effective transcultural mental health care? If not, what changes can be made to implement culture-specific care?