Copyright © 2014. F.A. Davis Company Cultural and Spiritual Concepts Relevant to Psychiatric/Mental...

Copyright © 2014. F.A. Davis Company

Cultural and Spiritual Concepts Relevant Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursingto Psychiatric/Mental Health Nursing

Chapter 6Chapter 6


Cultural ConceptsCultural Concepts

• Culture describes a particular society’s entire way of living; it encompasses shared patterns of beliefs, feelings, and knowledge that guide people’s conduct and are passed from generation to generation.


Cultural Concepts Cultural Concepts (cont.)(cont.)

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



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



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


How Do Cultures Differ?How Do Cultures Differ?

• Communication– Has its roots in culture– Is expressed through language,

paralanguage, and gestures• Space (the place where the

communication occurs)– Territoriality – Density– Distance


How Do Cultures Differ? How Do Cultures Differ? (cont.)(cont.)

• Social organization– Social organizations are the groups within which

individuals are enculturated, acquiring knowledge and internalizing values.

– Examples of social organizations are families, religious groups, and ethnic groups.



• 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.



• 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.


How Do Cultures Differ?How Do Cultures Differ? (cont.) (cont.)

• Biological Variations– Differences among people in various racial

groups include body structure, skin color, physiological responses to medication, electrocardiographic patterns, susceptibility to disease, and nutritional preferences and

deficiencies.


Application of the Nursing Process: Application of the Nursing Process: Background Assessment DataBackground 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.


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.

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



1. Which value of the Northern European American culture should a nursing instructor include when teaching about cultural diversity?

A. Northern European Americans are present oriented.

B. Northern European Americans are highly religious, and church attendance is critical.

C. Northern European Americans value punctuality and efficiency.

D. Northern European Americans emphasize family cohesiveness due to increased technology.



• Correct answer: C– Punctuality and efficiency are highly valued in

Northern European American culture.



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 organizations.



African Americans (cont.)

• Forty-seven percent of African American households are headed by a woman.

• They have large support groups of families and friends.

• Some African Americans (particularly from the rural South) practice folk medicine and receive their care from a “granny,” “old lady,” or “spiritualist.”



African Americans (cont.)• Hypertension and sickle cell anemia have

genetic tendencies within the African American community.



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 can be uncomfortable expressing

emotions.



Native Americans (cont.)

• Primary social organizations are the family and tribe. Children are taught to respect tradition.

• Native Americans are present-time oriented.



Native Americans (cont.)• A medicine man is called a shaman and uses

a variety of methods in practice; may work closely with conventional medicine to heal the sick.

• Health problems include diabetes, heart disease, tuberculosis, alcoholism, and nutritional deficiencies.



2. Which psychiatric diagnosis is common within the Native American culture?

A. SchizophreniaB. Alcohol use disorderC. Posttraumatic stress disorderD. Impulse control disorder



• Correct answer: B– A variety of physical, sociocultural, and

environmental causes have been linked to the high rate of alcoholism among Native Americans.



Asian/Pacific Islander Americans• A large group in the United States today, comprising more

than 4 percent of the U.S. population.• Includes immigrants (and their descendants) from Japan,

China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, 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.



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 appropriate by some Asian Americans.




• 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, Confucianism, Hinduism, Buddhism, Islam, and Christianity.




• Time orientation is both past and present.• Restoring the balance of yin and yang is the

fundamental concept of Asian health practices.



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.



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.



Latino Americans (cont.)

• Latinos tend to be 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).



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).

• The prevalence for psychiatric illness is higher among U.S.-born Latinos than it is for immigrants from the same cultural group.



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.


Application of the Nursing Process: Application of the Nursing Process: Background Assessment Data Background Assessment Data (cont.)(cont.)Western European Americans (cont.)• A strong allegiance to the cultural heritage is

common.• Father is head of the household. Traditional

Western European women view their roles as mother and homemaker. Children are prized and cherished, and the elderly are respected for their age and wisdom.

• Roman Catholicism is the predominant religion for the French and Italians, Greek Orthodox for the Greeks.


Application of the Nursing Process: Application of the Nursing Process: Background Assessment Data Background Assessment Data (cont.)(cont.)Western European Americans (cont.)• Western European Americans are present

oriented and view whatever happens in the future as God’s will.

• Most follow health beliefs and practices of the dominant American culture, but some folk beliefs and superstitions endure.

• Wine is the beverage of choice, but alcoholism rate is low.



Arab Americans•Ancestry and traditions are traced to the nomadic desert tribes of the Arabian Peninsula.•Arabic is the official language of the Arab world.



Arab Americans (cont.)• Conversants stand close together, maintain

steady eye contact, and touch (only between members of the same gender) the other’s hand or shoulder.



Arab Americans (cont.)• Speech is loud and expressive with lots of

gesturing.• Time is present oriented, and punctuality is

not taken seriously except in the case of business or professional meetings.

• The man is the head of the household, and women are subordinate to men.



Arab Americans (cont.)

•The family is the primary social organization, and children are loved and indulged.•Women value modesty and many observe the custom of hijab—covering the body except for one’s face and hands.



Arab Americans (cont.)• Cardiovascular disease is a common health

concern. Sickle cell anemia and the thalassemias are prevalent in the eastern Mediterranean.



Arab Americans (cont.)• Many spices and herbs are used in cooking.

Bread is served at every meal and is viewed as a gift from God. Lamb and chicken are the most popular meats. Muslims are prohibited from eating pork and pork products.



Arab Americans (cont.)• Islam is the religion of most Arab countries,

and there is no separation of church and state. Spiritual medicine is combined with conventional medical treatment.

• Mental illness is a major social stigma, and symptoms are likely to be presented as physical complaints.



Jewish Americans• The Jewish people came to the United States predominantly from Spain, Portugal, Germany, and Eastern Europe.• There are more than five million Jewish

Americans living in the United States, and most are located in the larger urban areas.



Jewish Americans (cont.)• Four main Jewish religious groups exist

today:—Orthodox —Reform—Conservative—Reconstructionists


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

• The primary language is English. Hebrew is used for prayers and is taught in Jewish religious education.



Jewish Americans (cont.)• Formal education is a highly respected value

among the Jewish people. Many hold advanced degrees and are employed as professionals.

• Time orientation is simultaneously to the past, present, and future.

• Children are highly valued and are expected to be forever grateful to their parents for giving them the gift of life.



Jewish Americans (cont.)• Jewish Americans are very health

conscious, and maintenance of mental health is as important as physical health.

• Genetic diseases common in the Jewish population include Tay-Sachs disease, Gaucher’s disease, and familial dysautonomia.



Jewish Americans (cont.)• Alcohol, especially wine, is an essential part

of religious holidays and festive occasions. It is viewed as appropriate and acceptable as long as it is used in moderation.

• Religious laws dictate how food is prepared, served, and consumed.


Culture-Bound SyndromesCulture-Bound Syndromes

• Symptoms associated with specific cultures that may be expressed differently from the American culture

• Most are considered to be “illnesses,” and most have local names.


Application of the Nursing Process: Application of the Nursing Process: Diagnosis/Outcome IdentificationDiagnosis/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.


Application of the Nursing Process: Application of the Nursing Process:

Planning/ImplementationPlanning/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 culture.

• Emphasis is also placed on developing a trusting relationship with the client and family and eliminating barriers to communication.


Application of the Nursing Process: Application of the Nursing Process: EvaluationEvaluation

• Evaluation is based on accomplishment of established outcome criteria.


Spiritual ConceptsSpiritual Concepts

• Spirituality– Refers to the human quality that gives meaning

and sense of purpose to an individual’s existence– Exists within each individual regardless of belief

system and serves as a force for interconnectedness between the self and others, the environment, and a higher power


Spiritual Concepts Spiritual Concepts (cont.)(cont.)

Spiritual Needs• Meaning and purpose in life

—Having a purpose in life gives one a sense of control and the feeling that life is worth living.



Spiritual Needs (cont.)

• Faith—The acceptance of a belief in the absence of

physical or empirical evidence—Studies show that faith, combined with

conventional treatment and an optimistic attitude, can be a very powerful element in the healing process.



Spiritual Needs (cont.)• Hope

—A special kind of positive expectation—an energizing force

—Hope may promote healing, facilitate coping, and enhance quality of life.



Spiritual Needs (cont.)

• Love— May be life’s most powerful force and the greatest

spiritual need.— May be an important key in the healing process by

having a positive effect on the immune system.— Studies have shown that individuals can overcome

the effects of a deleterious lifestyle if they have the benefit of a strong, loving relationship.



Spiritual Needs (cont.)• Forgiveness

—The ability to release from the mind all the past hurts and failures, all sense of guilt and loss

—Long-held feelings of bitterness and resentment can have a detrimental effect on an individual’s health.

—Forgiveness offers freedom and peace of mind, and enables a person to begin the pathway to healing.



Religion

• The practices are usually grounded in the teachings of a spiritual leader.

• There are more than 6500 religions in the world.

• Affiliation with a religious group has been shown to be a health-enhancing endeavor.



Religion (cont.)• Studies indicate that individuals who have a

religious faith or attend church regularly experience:

—Increased chance of survival following serious illness

—Less depression and other mental illness—Longer life—Overall better physical and mental health



Religion (cont.)• A religious commitment has been

correlated with:—Lower suicide rates —Lower drug use and abuse—Less juvenile delinquency—Lower divorce rates—Improved mental illness outcomes

• May be correlated with strong support network found in religious organizations



• Assessment of Spiritual and Religious Needs

—Nurses must consider spiritual and religious needs when planning care for their clients.

—A spiritual assessment tool may be used to gather needed information.



• Diagnosis/Outcome Identification– Nursing diagnoses that may be used when

addressing spiritual and religious needs of clients include:

• Risk for Spiritual Distress• Spiritual Distress• Readiness for Enhanced Spiritual Well-being• Risk for Impaired Religiosity• Impaired Religiosity• Readiness for Enhanced Religiosity



• Planning/Implementation– Nursing intervention for clients who have spiritual

and religious needs is aimed at helping the client achieve meaning and purpose in life that reinforces hope, peace, contentment, and self-satisfaction.



• Evaluation– Evaluation is based on accomplishment of

previously established outcome criteria.

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