Mental Health Nursing II
NURS 2310
Unit 4
Cultural Considerations for
the Psychiatric/Mental
Health Client
Objective 1
Reviewing the concepts of culture
and ethnicity
Culture = shared patterns of belief, feeling,
and knowledge that guide conduct and are
passed down from generation to generation
Ethnicity = identification with others due to a
shared heritage
Race = a class or kind of people unified by
shared interests, habits, or characteristics
Prejudice = injury or damage resulting from
some judgment or action of another in
disregard of one’s rights
Stereotyping = assuming that all individuals
who share a culture or ethnic group are
identical
Objective 2
Analyzing various cultures to
determine the impact of
perceptions, practices, and
behaviors on mental health and
illness
Northern European Americans
Originating from England, Ireland, Sweden,
Norway, Germany, etc
 Personal space: 18 inches to 3 feet
 Less emphasis placed on family and religion
 Punctuality and efficiency highly valued
 Preventive medicine and primary health
care frequently utilized
 Financially capable of maintaining a healthy
lifestyle

African Americans
Personal space tends to be smaller than the
dominant culture
 Large social support systems, primarily
headed by women
 Little planning for the future due to
encounters with racism and discrimination
 Folk medicine used due to unavailability of
mainstream medical treatment
 High incidence of alcoholism

Native Americans
Most involved with the tribe to some extent
 Consider handshake aggressive
 May appear silent and reserved as culture
encourages keeping private thoughts to self
 Need for extended space
 Wisdom and tradition greatly honored
 Concept of time is very casual, and tasks
are accomplished within a “present-minded”
time frame
 Religion and health practices intertwined
 Alcoholism, depression, & suicide prevalent

Asian/Pacific Islander Americans
Originating from Japan, China, India,
Phillipines, Pacific Islands, etc
 Raising one’s voice is interpreted as a sign
of loss of control, as is mental illness
 Different meaning assigned to nonverbal
cues
 Touching during communication
traditionally considered unacceptable
 Eye contact considered rude and
disrespectful
 Appear shy, cold, or uninterested

Latino Americans
Originating from Mexico, Spain, Puerto Rico
 Touch is a common form of communication
 Outwardly agreeable to avoid confrontation
 Family is the primary social organization,
with large groups of relatives
 Present-oriented; punctuality not
emphasized
 Less mental illness than in the general
population, possibly due to strong familial
support in times of stress

Western European Americans
Originating from France, Italy, and Greece
 Warm, affectionate, and physically
expressive
 Family-oriented; interact in large groups
 Strong allegiance to cultural heritage
 Elderly respected and cared for at home
 Present-oriented; fatalistic view of the
future (God’s will)

Arab Americans
Originating from Egypt, Iraq, Jordan,
Morocco, Saudi Arabia, etc
 Unspoken expectations more important
than spoken words, so communication can
pose a problem in health care settings
 Speech is loud and expressive; may appear
argumentative, confrontational, aggressive
 Illness often considered punishment for sins
 Mental illness is a major social stigma;
somatic complaints most likely

Jewish Americans
Orientation simultaneously to past, present,
and future
 Respectful toward parents
 Children loved and cherished; expected to
be grateful to parents forever for gift of life
 Preventive health care practiced, as well as
maintenance of a healthy mind and body
 Physicians held in high regard
 Higher incidence of side effects from the
medication clozapine due to specific gene

Objective 3
Differentiating behaviors that are
accepted cultural mores from
those that are representative of
mental illness
What is considered normal in one culture
may be deemed abnormal in another
 One may be considered to have boundary
issues for standing too close during a
conversation, or fear of intimacy for
excessive distance
 Rituals and practices used by certain
cultures may be considered detrimental in
the mainstream

– “self-harming” behaviors (tattooing, facial
designing)
– child “abuse” (coining)
Objective 4
Discussing theories related to
the provision of culturally
competent care
Transcultural Nursing Theory
Madeleine Leininger founded the worldwide transcultural nursing movement.
The basic tenet of the Transcultural Nursing
Theory is as follows:
In order to be culturally competent, the nurse
needs to understand his/her own world views
and those of the patient, while avoiding
stereotyping and misapplication of scientific
knowledge.
Provision of Culturally Competent
Care
Use of an interpreter
 Awareness of nonverbal communication
 Acknowledgement of family support
systems
 Meeting of spiritual needs, to include rituals
 Understanding of altered time concepts
 Cognizance of different beliefs regarding
health care among various cultures
 Establishment of trust and rapport

Objective 5
Identifying
strategies for
the nurse in
dealing with
differing client
values

Knowledge formation
– Learn about client’s value system
– Subjective interpretation of beliefs

Empathy
– Imagine yourself in another’s position

Acceptance
– Embrace admirable qualities

Objectivity
– Focus on client’s needs

Professional distance
– Neutral territory
Objective 6
Exploring personal values of the
nurse that impact nursing care
Any beliefs the nurse holds that are in conflict
with those of the client may interfere with
the provision of appropriate and objectively
sound nursing care
It is best for the nurse to be aware of
potential conflicts to avoid barriers to
providing optimal patient care
Objective 7
Examining the
importance of
spirituality in
psychiatric/mental
health nursing
Spirituality = finding meaning and purpose in
life
Faith = acceptance of a belief in the absence of
physical or empirical evidence
Hope = positive expectation
Love = the projection of one’s own good
feelings onto others
Forgiveness = the ability to release from the
mind all the past hurts and failures, all sense
of guilt and loss
Religion = a set of beliefs, values, rites, and
rituals adopted by a group of people
Objective 8
Identifying clients with whom the
nurse would avoid the discussion of
religion
The discussion of religion should be avoided
specifically with clients who have a religious
preoccupation (i.e. paranoid schizophrenic
with grandiose religiosity)
Religion, politics, and other controversial issues
(i.e. stem cell research, abortion) are typically
topics that can be inflammatory and therefore
would be best to be avoided as a general
rule-of-thumb