Chapter 10 Transcultural Perspectivesin Mental Health Nur

Chapter 10:
Transcultural Perspectives
in Mental Health Nursing
Copyright © 2016 Wolters Kluwer Health | Lippincott Williams
& Wilkins
Copyright © 2016 Wolters Kluwer • All Rights Reserved
1
Transcultural Perspectives in Mental Health Nursing #1
Transcultural nursing:
Examines mental illnesses within a transcultural perspective
Assists in understanding how culture influences the ways in
which we interpret and behave with mental illnesses
2
Transcultural Perspectives in Mental Health Nursing #2
Mental disorders are defined according to “cultural, social, and
familial norms and values” (DSM-V, 2013, p. 14).
Culture provides the framework that is used to interpret “the
experience and expression of the symptoms, signs, and

behaviors that are criteria for diagnosis” (p. 14)
Cultural norms shape what is considered normal versus
abnormal.
3
Defining Mental Health Within a Transcultural Nursing
Perspective #1
According to the World Health Organization (2013):
“… there is no health without mental health.”
“Health is a state of complete physical, mental, and social well -
being and not merely the absence of disease or infirmity.”
Determinants of mental health at any given point in time:
“social, psychological and biological factors.”
4
Defining Mental Health Within a Transcultural Nursing
Perspective #2
Transcultural nurses should:
Understand patterns of values, beliefs, and practices for mental
health care
Avoid stereotypes and ethnocentrism
Be aware of “norms”

5
Question #1
Is the following statement true or false?
Ethnocentrism can manifest as feelings of superiority or
discrimination with respect to one’s own group or culture over
another group or culture.
6
Answer to Question #1
True
Rationale: Ethnocentrism presents as subconscious disregard
for cultural differences; it may also present as authoritative.
Example: believing that one’s own health care beliefs and
practices are superior to another culture’s.
7

Population Trends and Mental Health
Mental illnesses are identified as “common” in the United
States.
Approximately 43.7 million adults (~19%), aged 18 or older,
were currently, or within the past year, diagnosed with a mental,
behavioral, or emotional disorder.
Mental health care is moving from state and general “mental”
hospitals to community-based service centers.
8
Decision Making and Mental Health Care
Support and clear communication can be key to favorable
outcomes for all clients.
Shared decision making (SDM) as a practice to advance mental
health care encourages providers and consumers to collaborate
on mental health care for the consumer.

9
Disparities in Mental Health Care
Reducing and eliminating disparities can be accomplished
through:
Professional organization initiatives
Caring
Reducing stigma
Identifying disparities
Recognizing cultural pain: feeling “insecure, embarrassed,
angry, confused, torn, apologetic, uncertain, or inadequate
because of conflicting expectations of and pressures from being
a minority”
10
Question #2
American biases and prejudges have made it difficult for
individuals of diverse cultures to have their beliefs and values
acknowledged.

11
True
Rationale: Historically, racism in America has led to difficulties
in acknowledging and/or discussing differences in cultural
values and lifeways for diverse cultural groups.
12
Mental Health Care for Immigrants
Regarding immigrants, health care providers should be
sensitive to:
Offensive terms, ex. “illegal alien”
Culture shock
Degree of acculturation
Feelings of depression, guilt, shame, anxiety
All of these factors put individuals at risk for depression,
anxiety, substance abuse, and mental health problems.
13
Cultural Criteria Changes in DSM-V

Culture-bound syndromes that have routinely been used by
mental health professionals have now been replaced with three
cultural concepts:
Cultural syndrome
Cultural idiom
Cultural explanation
14
Culture-Bound Syndromes
Culture-bound syndromes, also called folk illnesses, culture-
specific illnesses, or culture-specific syndromes, often are
localized to a particular cultural group.
Many of these patterns are indigenously considered to be
“illnesses,” or at least afflictions, and most have local names.
15
Cultural Values, Beliefs, and Practices
of Specific Cultural Groups
Health care providers want to help clients of all cultures
achieve their optimal level of human functioning.
An individual’s optimal level of human functioning can be
specifically tied to the meanings and expressions of care of
one’s culture.

The transcultural nurse is encouraged to understand the
diversity within cultural groups with respect to mental health
beliefs and practices.
A thorough history and cultural assessment can achieve this.
16
Culturally Competent Mental Health Care #1
Behavior can be misinterpreted and/or distorted if health care
providers are not knowledgeable about caring for clients from
diverse cultural groups.
Cultural competence is defined as a process in which nurses
strive to work successfully within the cultural context of
individuals, families, and communities.
Cultural competency can have a positive impact on the mental
health care that is provided to clients of diverse cultural groups.
17
Culturally Competent Mental Health Care #2
Developing cultural competence through:
Mutual trust
Moving beyond cultural sensitivity to competency-based
cultural care

Intrapersonal reflection: a personal inventory of one’s own
cultural values, beliefs, and practices to begin to identify,
understand, and remove personal cultural bias, ethnocentrism,
and prejudice
18
Important Factors to Consider in Transcultural Mental Health
Nursing #1
Three important factors:
Communication and language
Spirituality
Experiences of pain
19
Nursing #2
Communication
Verbal and nonverbal
Developing trust
Availability of a certified translator/interpreter
Empathy

Question #3
Researchers have shown that speaking the same language is the
most important element in communicating with patients from
diverse cultural backgrounds.
21
False
Rationale: Research has shown that speaking the same language,
while important, is not the most important element in
communicating with patients from diverse cultural backgrounds.
The attitude of the care provider is instrumental in helping the
client be open to treatment options. Communicating an
understanding of cultural diversity helps facilitate the client–
nurse relationship.
22

Nursing #4
Spirituality
Spirituality refers to a broad sense of the inner experience of
the self and a search for meaning; religion generally involves an
institution with a given set of rules and observances i nvolving
devotion and ritual.
May enhance mental health and emotional stability.
23
Nursing #5
Pain
Pain has a component that includes emotional elements.
Pain and depression linked.
Psychosomatic pain, or pain with psychological components.
24
Question #4
There is increasing evidence to suggest that pain can be a
physical symptom of which mental health illness?
Paranoia
Alcoholism
Drug abuse
Depression

25
D. Depression
Rationale: There is increasing evidence to suggest that pain can
be a physical symptom of depression and that pain and
depression are common comorbidities.
26
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