Cultural Implications for Psychiatric Mental Health Nursing

Psych Lecture

Minority

• Refers to a group of people who differ from the majority in some significant way, such as ____________, ____________, ____________, or ____________ 

• Focus is on the collective identity of the group itself 

• Racially, ethnically, or culturally distinct groups that coexist, but are subordinate in some way to a dominant group

Minority Status

• Refers to the condition or position of being a member of a ____________ group 

• Focus is on the individual's social, legal, or demographic classification 

• Not always fewer in numbers, but lacking political and social power; may be treated differently and discriminated against

Race

• Can be defined biologically, anthropologically, or genetically

• Races can often be distinguished visually from one another based on physical characteristics

Ethnicity

• Common heritage and history 

• Share a worldview for thinking

Culture

• Shared beliefs, values, and practices

Measuring Race and Ethnicity in the United States

• U.S. Census Bureau 

— Combined race-ethnicity categorization system 

• Purpose 

— Racial-ethnic descriptions helps the government understand the needs of its citizens 

— The Census helps identify disparities in health care along racial-ethnic lines 

Basic Worldviews

• Worldview shapes how cultures perceive reality, the person, and the person in relation to the world and to others.

• Worldview also shapes perceptions about time, health and illness, and rights and obligations in society

Western Traditions

• Identity found in individuality

• Values
  ➢ Autonomy
  ➢ Independence
  ➢ Self-reliance

• Mind and body = separate entities

• Disease has a measurable cause, and treatment is aimed at the cause

• Time is linear (you have to be on time)

• Success is obtained in preparing for the future

Eastern Traditions

• 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

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

Impact of Culture

• Nonverbal communication and etiquette

• Beliefs and values: Enculturation

• Deviance from cultural expectations can be defined as illness by other members of the group

• Ethnocentrism

• Cultural imposition

Impact of Culture

Health beliefs and definitions of illness 

• Enculturation is the process by which an individual learns and internalizes the values, beliefs, norms, customs, and behaviors of their own culture 

Health-seeking behaviors 

• Culture affects when and whether someone seeks care, who they see first, and treatment preferences 

Communication patterns 

• Verbal and nonverbal communication styles vary widely; language barriers can impact assessment accuracy 

Decision-making structures 

• Individual, family consensus, or designated authority figure 

Health disparities and access 

• Cultural and socioeconomic factors intersect with systemic barriers to create disparities in access and quality of care

Cultural Barriers to Mental Health Services

• Communication barriers 

• Stigma of mental illness 

• Misdiagnosis 

• Genetic variations in pharmacodynamics 

• Cultural concepts of distress

— Cultural, or culture-bound, syndromes
— Cultural idioms of distress
— Cultural explanations or perceived cause
— Cultural syndromes

Examples of Cultural Syndromes

• Ataque de nervios (Latino/Caribbean cultures): episodes of intense emotional distress including uncontrollable shouting, crying, trembling, and sometimes dissociative experiences 

• Susto (Latin American cultures): illness attributed to a frightening or traumatic event believed to cause the soul to leave the body 

• Taijin kyofusho (Japan): intense fear that one's body, appearance, or behavior is offensive or embarrassing to others 

• Hwa-byung (Korea): a syndrome associated with suppressed anger, presenting with chest tightness, a feeling of a mass in the epigastric area, and heat sensations 

At-Risk Population

• Immigrants: people who choose to move to a new location, hoping to benefit from a change 

• Refugees: people who are forced to leave their homeland to escape intolerable conditions 

• Cultural minorities: people who are vulnerable to discrimination and disadvantage 

• Common contributing factors: poverty and lack of insurance, language and literacy barriers, discrimination and implicit bias, limited health literacy, geographic and transportation barriers, lack of culturally competent providers, historical trauma and mistrust of the healthcare system.

Culturally Congruent Care and Associated Competencies

• Culturally congruent practice (care) is applying evidence-based nursing care that corresponds with clients' values, beliefs, practices, and worldview.

• Cultural competence is the process of demonstrating culturally congruent practice

• Five constructs of culturally effective care
  1. Cultural awareness
  2. Cultural knowledge
  3. Cultural encounters
  4. Cultural skill
  5. Cultural desire

Culture Awarness

• The process of the registered nurse conducting self-examination of their own yours, the clients, and the hospital setting about other cultures 

• Prevents imposing one's own beliefs onto the client (cultural imposition)

• 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

Culture Knowledge

• The process of seeking out and obtaining a sound educational foundation about different cultural and ethnic groups 

• Ways to learn: by attending cultural events and programs, forging friendships with diverse cultural groups, and studying 

• Helps the nurse establish rapport, ask culturally relevant questions, and identify cultural variables to be considered

Culture Encounters

• The process of directly engaging in face-to-face interactions with clients from culturally diverse backgrounds 

• Repeated, meaningful encounters help refine or modify existing beliefs and prevent stereotyping

1. deter nurses from sterotyping

2. help nurses gain confidence in cross-cultural interactions

3. help nurses avoid or reduce cultural pain

Culture Skill

• The ability to collect relevant cultural data regarding the client's presenting problem and perform a culturally sensitive assessment 

• Involves using tools such as the Culture Formation Interview (CFI)

• 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

Cultural Desire

• The intrinsic motivation of the registered nurse to want to engage in the process of becoming culturally aware, knowledgeable, skillful, and to seek cultural encounters

• Genuine concern for patient’s welfare

• Willingness to listen until patient’s viewpoint is understood

• Patience, consideration, and empathy 

• Considered the most critical element 

• All five constructs work together and reinforce one another