Cultural Concepts Relevant to PsychiatricMental Health Nursing

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Chapter 6

• Cultural Concepts Relevant to Psychiatric/Mental
  Health Nursing

2
Introduction

• Culture describes a particular societys entire
  way of living, encompassing shared patterns of
  beliefs, feelings, and knowledge that guide
  peoples conduct and are passed from generation
  to generation.

3
Introduction (cont.)

• Ethnicity relates to people who identify with
  each other because of a shared heritage.

4
Introduction (cont.)

• Nurses must understand these cultural concepts
  because cultural influences affect human
  behavior, interpretation of human behavior, and
  response to human behavior.

5
Introduction (cont.)

• Caution must be taken not to assume that all
  individuals who share a culture or ethnic group
  are clones. This constitutes stereotyping and
  must be avoided. All individuals must be
  appreciated for their uniqueness.

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How Do Cultures Differ?

• Communication
• Has its roots in culture
• Is expressed through language, paralanguage, and
  gestures
• Space (the place where communication occurs)
• Territoriality
• Density
• Distance

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How Do Cultures Differ? (cont.)

• Social organization
• Social organizations are the groups within which
  individuals are acculturated, acquiring knowledge
  and internalizing values.
• Examples of social organizations are families,
  religious groups, and ethnic groups.

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How Do Cultures Differ? (cont.)

• Time
• Some cultures place great importance on values
  that are measured by time, whereas others are
  actually scornful of clock time.
• Whether individuals perceive
• time in the present orientation
• or future orientation influences
• many aspects of their lives.

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How Do Cultures Differ? (cont.)

• Environmental control
• Has to do with the extent to which individuals
  perceive they have control over their environment
• Cultural beliefs and
• practices influence how
• individuals respond to
• their environment during
• periods of wellness or
• illness.

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How Do Cultures Differ? (cont.)

• Biological variations
• Differences among people in various racial
  groups include body structure, skin color,
  physiological responses to medication,
  electrocardiography patterns,
• susceptibility to disease, and
  nutritional preferences and
• deficiencies.

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Application of the Nursing Process Background
Assessment Data

• Northern European Americans
• Language has roots in the first English settlers.
• Descendants of these immigrants comprise what is
  considered the dominant cultural group in the
  United States.
• They value territory personal
• space is about 18 inches
• to 3 feet.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Northern European Americans (cont.)
• Less value is placed on marriage and religion
  than once was.
• Punctuality and efficiency are valued highly.
• They are future-oriented.
• Most value a healthy lifestyle but still
  enjoy fast food.
• Medium body structure and fair skin.

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Application of the Nursing Process Background
Assessment Data (cont.)

• African Americans
• Language dialect thought to be a combination of
  various African languages and the languages of
  other cultural groups present in the United
  States at the time of its settlement.
• Some African Americans
• are completely assimilated
• into the dominant culture
• others find it too difficult and
• prefer to remain in their own
• social organization.

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Application of the Nursing Process Background
Assessment Data (cont.)

• African Americans (cont.)
• About one-third of African American households
  are headed by women.
• There are large support groups of families and
  friends.
• Some African Americans
• (particularly from the deep
• South) practice folk medicine
• and receive their care from
• a granny, old lady, or
• spiritualist.

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Application of the Nursing Process Background
Assessment Data (cont.)

• African Americans (cont.)
• The body structure is similar to that of the
  dominant culture. Skin color varies from white to
  very dark brown.
• Hypertension and sickle cell
• anemia have genetic
• tendencies within the
• African American
• community.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Native Americans
• Less than half of Native Americans live on
  reservations.
• Touch is not highly regarded
• by Native Americans, and a
• handshake may be viewed
• as aggressive.
• They sometimes appear
• silent and reserved.
• They are uncomfortable
• expressing emotions.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Native Americans (cont.)
• Primary social organizations
• are the family and tribe.
• Children are taught to
• respect tradition.
• Native Americans are
• present-time oriented.
• Medicine man is called a shaman and uses a
  variety of methods in practice may work closely
  with traditional medicine to heal the sick.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Native Americans (cont.)
• They have average height, with reddish-tinted
  skin that may be light to medium brown.
• Health problems include tuberculosis, alcoholism,
  and nutritional deficiencies.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Asian/Pacific Islander Americans
• Very large group in the United States today, with
  11 million immigrants and their descendants from
  Japan, China, Vietnam, the Philippines, Thailand,
  Cambodia, Korea, Laos, and the Pacific Islands.
• Although they are viewed as
  one (Asian) culture, they
  constitute a
  multiplicity of differences
  regarding attitudes, beliefs, values,
• religious practices, and language.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Asian/Pacific Islander Americans (cont.)
• Many younger-generation Asian Americans have
  become almost totally acculturated into the U.S.
  culture.
• Asian Americans are
• soft-spoken to raise the
• voice indicates a loss of control.
• Touching is not considered
• totally appropriate by some
• Asian Americans.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Asian/Pacific Islander Americans (cont.)
• The family is the ultimate social organization,
  and loyalty to family is emphasized above all
  else.
• Education is highly valued, although many
• remain undereducated.
• Religious practices and beliefs
• are diverse and exhibit
• influences of Taoism,
• Buddhism, Islam, and Christianity.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Asian/Pacific Islander Americans (cont.)
• Time orientation is both past and present.
• Restoring the balance of yin
• and yang is the fundamental
• concept of Asian health practices.
• Generally small of frame and build.
• Obesity is very uncommon. Skin
• color ranges from white to medium
• brown, with yellow tones.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Asian/Pacific Islander Americans (cont.)
• Rice, vegetables, and fish are main staple foods.
• Psychiatric illness is viewed as
  behavior that is out of control and
  brings great shame
  to the family.
• Incidence of alcohol dependence
• is low, perhaps because of a
• possible genetic intolerance of
  the substance.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Latino Americans
• Ancestry is traced to Mexico, Spain, Puerto Rico,
  Cuba, and other countries of Central and South
  America.
• The common language is Spanish.
• Touch is a common form of
• communication.
• Latinos are very group-oriented,
• and the primary social organization
• is a large extended family.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Latino Americans (cont.)
• Latinos tend to be very present-oriented.
• Roman Catholicism is the predominant religion.
• Folk medicine combines
• elements of Roman Catholicism
• and Indian and Spanish ancestries.
• The folk healer is called a
• curandero (male) or
• curandera (female).

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Application of the Nursing Process Background
Assessment Data (cont.)

• Latino Americans (cont.)
• Many still subscribe to the hot and cold
• theory of disease (a concept similar to
• the yin and yang beliefs of Asian Americans).
• Latinos tend to be somewhat shorter than those
  from the dominant cultural group. Skin color can
  vary from light tan to dark brown.
• A strong cohesiveness within the family is
  thought to explain the fact that there is less
  mental illness
• among Latino Americans than in
• the general population.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Western European Americans
• Origin is France, Italy, or Greece.
• Each has a unique language, with unique dialects
  within each language.
• Warm and affectionate, very
• physically expressive use a lot
• of body language including
• hugging and kissing.
• Very family-oriented.
• Interact in large groups.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Western European Americans (cont.)
• A strong allegiance to the cultural heritage is
  common.
• Father is head of the household. Women view their
  roles as mother and homemaker. Children are
  prized and cherished, and elderly are respected
  for their age and wisdom.
• Roman Catholicism is the
• predominant religion for the
• French and Italians Greek
• Orthodox for the Greeks.

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Application of the Nursing Process Background
Assessment Data (cont.)

• Western European Americans (cont.)
• Western European Americans are present-oriented
  and view whatever happens in the future as Gods
  will.
• Most follow health beliefs and practices of the
  dominant American culture, but some folk beliefs
  and superstitions endure.
• Western Europeans are of average
• stature. Skin color ranges from
• fair to medium brown.
• Wine is the beverage of choice,
• but alcoholism rate is low.

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Application of the Nursing Process
Diagnosis/Outcome Identification

• Nursing diagnoses for individuals with varied
  cultural influences may include
• Impaired verbal communication
• Anxiety (moderate to severe)
• Imbalanced nutrition, less than body
  requirements
• Spiritual distress
• Outcome criteria are identified for measuring
  effectiveness of nursing care.

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Application of the Nursing Process
Planning/Implementation

• Nursing intervention with clients whose beliefs
  are culturally influenced is aimed at ensuring
  that those beliefs are not misunderstood and that
  nursing care includes elements that are important
  to the individual within his or her own culture.
• Emphasis is also placed
• on developing a trusting
• relationship with the client
• and family and eliminating
• barriers to communication.

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Application of the Nursing Process Evaluation

• Evaluation is based on accomplishment of
  established outcome criteria.