Culture in Nursing

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Transcultural Perspectives in Mental Health Nursing #1

Transcultural nursing:

Examines mental illnesses within a transcultural perspective

Assists in understanding how culture influences the ways in which we interpret and behave with mental illnesses

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Transcultural Perspectives in Mental Health Nursing #2

Mental disorders are defined according to “cultural, social, and familial norms and values” (DSM-V, 2013, p. 14).

Culture provides the framework that is used to interpret “the experience and expression of the symptoms, signs, and behaviors that are criteria for diagnosis” (p. 14)

Cultural norms shape what is considered normal versus abnormal.

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Defining Mental Health Within a Transcultural Nursing Perspective #1

According to the World Health Organization (2013):

“… there is no health without mental health.”

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

Determinants of mental health at any given point in time: “social, psychological and biological factors.”

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Defining Mental Health Within a Transcultural Nursing Perspective #2

Transcultural nurses should:

Understand patterns of values, beliefs, and practices for mental health care

Avoid stereotypes and ethnocentrism

Be aware of “norms”

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Question #1

Is the following statement true or false?

Ethnocentrism can manifest as feelings of superiority or discrimination with respect to one’s own group or culture over another group or culture.

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Answer to Question #1

True

Rationale: Ethnocentrism presents as subconscious disregard for cultural differences; it may also present as authoritative.

Example: believing that one’s own health care beliefs and practices are superior to another culture’s.

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Population Trends and Mental Health

Mental illnesses are identified as “common” in the United States.

Approximately 43.7 million adults (~19%), aged 18 or older, were currently, or within the past year, diagnosed with a mental, behavioral, or emotional disorder.

Mental health care is moving from state and general “mental” hospitals to community-based service centers.

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Decision Making and Mental Health Care

Support and clear communication can be key to favorable outcomes for all clients.

Shared decision making (SDM) as a practice to advance mental health care encourages providers and consumers to collaborate on mental health care for the consumer.

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Disparities in Mental Health Care

Reducing and eliminating disparities can be accomplished through:

Professional organization initiatives

Caring

Reducing stigma

Identifying disparities

Recognizing cultural pain: feeling “insecure, embarrassed, angry, confused, torn, apologetic, uncertain, or inadequate because of conflicting expectations of and pressures from being a minority”

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Question #2

Is the following statement true or false?

American biases and prejudges have made it difficult for individuals of diverse cultures to have their beliefs and values acknowledged.

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Answer to Question #2

True

Rationale: Historically, racism in America has led to difficulties in acknowledging and/or discussing differences in cultural values and lifeways for diverse cultural groups.

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Mental Health Care for Immigrants

Regarding immigrants, health care providers should be sensitive to:

Offensive terms, ex. “illegal alien”

Culture shock

Degree of acculturation

Feelings of depression, guilt, shame, anxiety

All of these factors put individuals at risk for depression, anxiety, substance abuse, and mental health problems.

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Cultural Criteria Changes in DSM-V

Culture-bound syndromes that have routinely been used by mental health professionals have now been replaced with three cultural concepts:

Cultural syndrome

Cultural idiom

Cultural explanation

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Culture-Bound Syndromes

Culture-bound syndromes, also called folk illnesses, culture-specific illnesses, or culture-specific syndromes, often are localized to a particular cultural group.

Many of these patterns are indigenously considered to be “illnesses,” or at least afflictions, and most have local names.

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Cultural Values, Beliefs, and Practices of Specific Cultural Groups

Health care providers want to help clients of all cultures achieve their optimal level of human functioning.

An individual’s optimal level of human functioning can be specifically tied to the meanings and expressions of care of one’s culture.

The transcultural nurse is encouraged to understand the diversity within cultural groups with respect to mental health beliefs and practices.

A thorough history and cultural assessment can achieve this.

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Culturally Competent Mental Health Care #1

Behavior can be misinterpreted and/or distorted if health care providers are not knowledgeable about caring for clients from diverse cultural groups.

Cultural competence is defined as a process in which nurses strive to work successfully within the cultural context of individuals, families, and communities.

Cultural competency can have a positive impact on the mental health care that is provided to clients of diverse cultural groups.

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Culturally Competent Mental Health Care #2

Developing cultural competence through:

Mutual trust

Moving beyond cultural sensitivity to competency-based cultural care

Intrapersonal reflection: a personal inventory of one’s own cultural values, beliefs, and practices to begin to identify, understand, and remove personal cultural bias, ethnocentrism, and prejudice

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Important Factors to Consider in Transcultural Mental Health Nursing #1

Three important factors:

Communication and language

Spirituality

Experiences of pain

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Important Factors to Consider in Transcultural Mental Health Nursing #2

Communication

Verbal and nonverbal

Developing trust

Availability of a certified translator/interpreter

Empathy

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Question #3

Is the following statement true or false?

Researchers have shown that speaking the same language is the most important element in communicating with patients from diverse cultural backgrounds.

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Answer to Question #3

False

Rationale: Research has shown that speaking the same language, while important, is not the most important element in communicating with patients from diverse cultural backgrounds. The attitude of the care provider is instrumental in helping the client be open to treatment options. Communicating an understanding of cultural diversity helps facilitate the client–nurse relationship.

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Important Factors to Consider in Transcultural Mental Health Nursing #4

Spirituality

Spirituality refers to a broad sense of the inner experience of the self and a search for meaning; religion generally involves an institution with a given set of rules and observances involving devotion and ritual.

May enhance mental health and emotional stability.

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Important Factors to Consider in Transcultural Mental Health Nursing #5

Pain

Pain has a component that includes emotional elements.

Pain and depression linked.

Psychosomatic pain, or pain with psychological components.

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Question #4

There is increasing evidence to suggest that pain can be a physical symptom of which mental health illness?

Paranoia

Alcoholism

Drug abuse

Depression

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Answer to Question #4

D. Depression

Rationale: There is increasing evidence to suggest that pain can be a physical symptom of depression and that pain and depression are common comorbidities.

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