Chapter 6
Cultural and Spiritual Concepts Relevant
to Psychiatric/Mental Health Nursing
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Cultural 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.
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Cultural Concepts (cont.)
•
Ethnicity relates to people who
identify with each other because of a
shared heritage.
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Cultural Concepts (cont.)
• Nurses must understand these cultural
concepts because cultural influences
affect human behavior, the
interpretation of human behavior, and
the response to human behavior.
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Cultural Concepts (cont.)
• 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.
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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 the
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 enculturated, 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,
electrocardiographic 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.
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Application of the Nursing Process:
Background Assessment Data
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
• Correct answer: C
– Punctuality and efficiency are highly valued in
Northern European American culture.
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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 organizations.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.”
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Application of the Nursing Process:
Background Assessment Data (cont.)
African Americans (cont.)
•
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 can be 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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
2. Which psychiatric diagnosis is common
within the Native American culture?
A.
B.
C.
D.
Schizophrenia
Alcohol use disorder
Posttraumatic stress disorder
Impulse control disorder
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Application of the Nursing Process:
Background Assessment Data
• Correct answer: B
– A variety of physical, sociocultural, and
environmental causes have been linked to the
high rate of alcoholism among Native Americans.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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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 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, Confucianism,
Hinduism, 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.
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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 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).
• The prevalence for psychiatric illness is higher
among U.S.-born Latinos than it is for
immigrants from the same cultural group.
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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. 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.
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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 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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
Arab Americans (cont.)
• Cardiovascular disease is a common health
concern. Sickle cell anemia and the
thalassemias are prevalent in the eastern
Mediterranean.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
Jewish Americans (cont.)
• Four main Jewish religious groups exist
today:
—Orthodox
—Reform
—Conservative
—Reconstructionists
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Application of the Nursing Process:
Background Assessment Data (cont.)
Jewish Americans (cont.)
• The primary language is English. Hebrew is
used for prayers and is taught in Jewish
religious education.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Application of the Nursing Process:
Background Assessment Data (cont.)
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.
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Culture-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.
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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 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.
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Spiritual 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
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Spiritual Concepts (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.
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Spiritual Concepts (cont.)
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.
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Spiritual Concepts (cont.)
Spiritual Needs (cont.)
• Hope
—A special kind of positive expectation—an
energizing force
—Hope may promote healing, facilitate coping,
and enhance quality of life.
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Spiritual Concepts (cont.)
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.
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Spiritual Concepts (cont.)
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.
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Spiritual Concepts (cont.)
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.
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Spiritual Concepts (cont.)
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
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Spiritual Concepts (cont.)
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
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Spiritual Concepts (cont.)
• 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.
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Spiritual Concepts (cont.)
• 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
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Spiritual Concepts (cont.)
• 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 selfsatisfaction.
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Spiritual Concepts (cont.)
• Evaluation
– Evaluation is based on accomplishment of
previously established outcome criteria.
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