Mental Health/Cultural Considerations in Mental Health Nursing
Cultural competency is essential in all aspects of nursing. Culture includes beliefs, morals, laws, customs, behavior, speech, norms, boundaries and family dynamics. Culture affects behavior: the distance that people prefer to stand when talking, the words they choose to use, body language, demeanor, the foods a person will eat, and the health care treatments they will accept. Cultural competency, according to the U.S. Dept. of Health and Human Services, is “a set of behaviors, attitudes, and skills that enables nurses to work effectively in cross-cultural situations”.
(Culturally Competent Nursing Care: A Cornerstone of Caring. (n.d). Retrieved from: https://ccnm.thinkculturalhealth.hhs.gov/).
We are most familiar with culture that comes from nationality, ethnicity and religion. However, culture can also be specific to a particular neighborhood or part of a town. Culture can also develop among groups that are not necessarily close geographically, such as those who find common ground due to sexual orientation or gender identification. There are also cultures that develop around a lifestyle: a few such examples are living off the grid, veganism or communal housing.
A culturally competent nurse will be aware of the wide variety in humanity and the impact that differing beliefs and practices may have when individuals connect with the health care system. A culturally competent nurse will have an open mind, be professional, respectful and attempt to become knowledgeable about another culture – and make sure that a cultural assessment is part of the nursing process. A culturally competent nurse will ask questions when she is unfamiliar with a patient’s beliefs or practices, but also decline to make assumptions based on apparent culture.
The U.S. Department of Health and Human Services has a web site devoted to this topic, entitled “Culturally Competent Nursing Care: A Cornerstone of Caring”. This web site provides good resources for future practice. Once registered, you can review different theories of cultural competency, such as Madeline Leininger?s Theory of Cultural Care and The Purnell Model for Cultural Competence.
Book that my class uses: Essentials of Psychiatric Mental Health Nursing, Chapter 2 (Page 20), Chapters 6 & 7
Chapter 2 page 20
Introduction to Culture and Mental Illness
The DSM includes information specifically related to culture in three areas:
? 1.A discussion of cultural variations for each of the clinical disorders
? 2.A description of culture-bound syndromes
? 3.An outline designed to assist the clinician in evaluating and reporting the impact of the individual’s cultural context
Health care providers must consider the norms and influence of culture in determining the mental health or mental illness of the individual. Throughout history, people have interpreted health or sickness according to their own cultural views. People in the Middle Ages, for example, regarded bizarre behavior as a sign that the disturbed person was possessed by a demon. To exorcise the demon, priests resorted to prescribed religious rituals. During the 1880s, when the ?germ theory? of illness was popular, physicians interpreted bizarre behavior as stemming from attacks by biological agents.
Cultures differ not only in the way they view mental illness but also in the types of behavior categorized as mental illness. For example, the content of a person’s delusions, hallucinations, obsessional thoughts, and phobias often reflects what is important in the person’s culture.
A number of culture-related syndromes appear to be more influenced by culture alone and are not seen in all areas of the world. For example, one form of mental illness recognized in parts of Southeast Asia is running amok, in which someone (usually a male) runs around engaging in furious, almost indiscriminate violent behavior. Pibloktoq is an uncontrollable desire to tear off one’s clothing and expose oneself to severe winter weather; it is a recognized form of psychological disorder in parts of Greenland, Alaska, and the Arctic regions of Canada. In our own society, we recognize anorexia nervosa as a psychobiological disorder that entails voluntary starvation. This disorder is well-known in Europe, North America, and Australia, but unheard of in many other parts of the world.
What is to be made of the fact that certain disorders occur in some cultures but are absent in others? One interpretation is that the conditions necessary for causing a particular disorder occur in some places but are absent in other places. Another interpretation is that people learn certain kinds of abnormal behavior by imitation. However, the fact that some disorders may be culturally determined does not prove that all mental illnesses are so determined. The best evidence suggests that schizophrenia and bipolar affective disorders are found throughout the world. The symptom patterns of schizophrenia have been observed among indigenous Greenlanders and West African villagers, as well as in our own Western culture.
Many believe that the helpers of choice for many people from minority cultures are their traditional helpers/therapists. This is particularly true for problems that have psychological or psychosocial aspects. One example would be people of Central and Latin American cultures. Many people from this area of the world may prefer curanderos (male healers) or curanderas (female healers), who would be sought for healing a number of symptoms that are perceived to originate from psychological components, such as susto (fright) and mal de ojo (evil eye) (Falicop, 1998, p. 173; Hays, 2008). Another example is that of the Mexican and Mexican Americans who primarily prefer female healers. The practices employed by these healers are a mixture of Catholicism, ancient Mayan and Aztec cultures, and herbology (Hays, 2008; Novas, 1994).
A traditional helping strategy that we use in American mainstream therapies, especially with children, is that of storytelling. It is also one that is common to many indigenous cultures. The ?therapist? uses a metaphor in the form of a ?story? that offers a social message, but does not directly give advice or tell the person what to do. The listeners are then left to draw their own conclusions and make changes if they are ready to do so (Swinomish Tribal Community, 1991).
Indeed, psychotherapy would be considered the treatment of last resort in many cultures because (1) it is unavailable, (2) shame is attached to using therapies in the dominant culture, or (3) there are more effective or preferred treatments in their own culture (Hays, 2008; Yeh et al., 2006). The most effective therapists will be those who are eclectic in their knowledge, come from a background of working with different cultures, have a broad knowledge of coping strategies, and are flexible in their approach (Hays, 2008).
EXAMINING THE EVIDENCE
What is stigma?
The American Heritage Dictionary (1991) defines stigma as ?a mark of infamy, disgrace or reproach.? People often feel that stigma disqualifies one from full social acceptance. Many groups are stigmatized in our society, but we will focus on the stigma of mental illness to illustrate the effects of stigma.
What are the effects of stigma?
Stigma and discrimination against people with mental illness are often major barriers to success in relationships, employment, and treatment programs (Gill, 2008). Even worse, efforts to achieve rehabilitation and recovery from mental illness can be sabotaged by prejudice and negative assumptions (Hinshaw & Stier, 2008). The availability of health care in general is also affected by the stigma of mental illness. People with mental illness receive fewer medical services than those not labeled in this manner (Thornicroft et al., 2007).