Chapter 7
Culturally Relevant Mental
Health Nursing: A Global
Perspective
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Importance of Culturally
Relevant Care
• Culture
– Groups with shared beliefs, values, and practices
– Influences thinking and behavior
• Cultural norms
– Define what is normal or abnormal within a
culture
• Enculturation
– Learning the rules of right and wrong
– Preparing a child to live within his or her culture
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Culturally Relevant Care
• Concept of mental health and illness is
formed within a culture.
• Deviance from cultural expectations can be
defined as illness by other members of the
group.
• Diversity of United States and the rest of the
world is increasing.
• Culturally relevant nursing is becoming more
important.
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Mental health is seen as the degree to
which a person fulfills the expectations
of the individual’s culture.
Good nursing adapts care to the client's
cultural needs and preferences.
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Western Psychological Theory
• Basis for theories in psychiatric mental
health nursing
• Barrier when caring for culturally
diverse clients
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Western Tradition
• Based on Greek, Roman, and Judeo-Christian
thought
– Identity found in individuality
– Values
• Autonomy
• Independence
• Self-reliance
– Mind and body viewed as separate entities
– Disease has a cause and treatment is aimed at cause
– Time is linear
– Success means preparing for the future
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Eastern Tradition
• Chinese and Indian philosophy
• Confucianism, Buddhism, and Taoism
– Family = basis for identity
– Body-mind-spirit one entity
– Disease caused by fluctuations in opposing
forces
– Time is circular and recurring
– Individual born into a fate with duty to comply
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Ethnocentric Tendencies
• Nurses influenced by their own
professional and ethnic cultures
• Ethnocentrism
– Assuming one's own beliefs, values, and
practices are the best, preferred, or only
way
• Cultural imposition does not promote
client health and well being.
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Barriers to Culturally Competent
Mental Health Nursing
• Communication barriers
– Different languages
– Use of interpreter
– Nonverbal communication patterns
– Need to interpret from client's cultural
perspective
• Client has the right to a professional
medical interpreter.
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Barriers to Culturally Competent
Mental Health Nursing
• Misdiagnosis
• Use of culturally inappropriate psychometric
instruments
• Culture-bound syndromes
– Effectively treated in culturally prescribed ways
• For nurse to provide culturally competent
care:
– Take time to study client's culture.
– Learn the cultural perspective from the client.
– Adapt care to meet the client's cultural needs.
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Barriers to Culturally Competent
Mental Health Nursing
• Ethnic variation in pharmacodynamics
– Genetic variations in drug metabolism
– Assess clients with medication to achieve
maximal effectiveness with tolerable side
effects
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Risk Factors for Mental Illness
• Immigrant status
– Difficulty in acculturation
– Culture shock
– Intergenerational conflict
• Refugee status
– Entry into new culture not by choice
– Trauma by experiences in homeland
– Vulnerable to posttraumatic stress disorder
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Risk Factors for Mental Illness
• Minority status
– Socioeconomic disadvantages
– Poverty
– Limited opportunities for education and jobs
– Residence in disadvantaged neighborhoods
• Higher incidence of mental health problems
in minority groups is related to poverty, not
ethnicity.
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Barriers to Mental Health Care
• Stigma of mental illness
– Mental illness associated with moral
weakness
• Cultural group's emphasis on
– Interdependence
– Harmony of the family
– Mental illness perceived as failure
of the family
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Barriers to Mental Health Care
• Stigma and shame
– Lead to reluctance to seek care
– Advanced stage of illness when
client/family does seek mental health
care
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Culturally Competent Care
• Attitudes and behaviors that enable a
nurse to work effectively within the
client's cultural context
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Cultural Competence
Nurses must constantly see themselves as
learners throughout their careers: always
open to, and learning from, the immense
cultural diversity they will see among their
clients.
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Cultural Competence for Psychiatric
Mental Health Nurses
• Five constructs
1. Cultural awareness
2. Cultural knowledge
3. Cultural encounters
4. Cultural skill
5. Cultural desire
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Cultural Competence for Psychiatric
Mental Health Nurses
1. Cultural awareness
• Examine beliefs, values, and practices of own culture
– Which are cultural and which are universal?
• Recognize that during a cultural encounter three cultures are
intersecting
– Culture of the client
– Culture of the nurse
– Culture of the setting
• As client advocate
– Nurse negotiates and advocates on behalf of the client's cultural
needs and preferences
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Cultural Competence for Psychiatric
Mental Health Nurses
2. Cultural knowledge
• Learn by attending
– Cultural events
– Inservice programs
• Learn by studying
– Books, articles, Internet sources
• Learning cultural differences helps nurse
– Establish rapport
– Ask culturally relevant questions
– Avoid cultural insensitivity
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Cultural Competence for Psychiatric
Mental Health Nurses
3. Cultural encounters
• Stereotyping
– Believing every member of a group is like all other members
of the group
• Learn by asking client about his or her cultural norms.
• Develop sensitivity to cultural norms and differences.
• Gain confidence in cross-cultural interactions.
• Encounters that inflict cultural pain
– Ask if client offended
– Apologize for lack of sensitivity
– Express willingness to learn from client
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Cultural Competence for Psychiatric
Mental Health Nurses
4. Cultural skill
• 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
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Cultural Competence for Psychiatric
Mental Health Nurses
5. Cultural desire
• Genuine concern for client's welfare
• Willingness to listen until client's viewpoint
understood
• Patience, consideration, and empathy
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