Julie is a 35-year-old with bipolar II disorder

1. Julie is a 35-year-old with bipolar II disorder. After her third child was born, she had a severe depressive episode. She attempted suicide by taking 25 Xanax pills. She is back in the hospital with depression after having a 2-week hypomanic episode. She has not been taking her medications.

Julie is a 35-year-old with bipolar II disorder

a. What responsibility does the health care organization have to Julie?
b. What structures are needed at a hospital to ensure that Julie will get the care she needs?
c. What is the nurse’s responsibility regarding the health promotion activities directed toward Julie?

2. Stephane, a 15-year-old Haitian refugee who is living at a center for children of refugees, has a severe cough and fever. She is curled up in a corner of the community room wrapped in a towel. She looks like she has been crying.

a. How can the nurse ensure culturally competent care?
b. List three priorities for the nurse regarding the cultural values, beliefs, and possible practices that Stephane may have.

Submission Instructions:

Your initial post should be at least 500 words
APA style
2 academic sources.

Chapter 10: Transcultural Perspectives in Mental Health Nursing

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

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.

Defining Mental Health Within a Transcultural Nursing Perspective #1

According to the World Health Organization (2013):

“Mental health is an integral and essential component of 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.”

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”

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.

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.

Population Trends and Mental Health

Mental illnesses are identified as “common” in the United States.

Approximately 44.7 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 had difficulty moving to community-based service centers. Many clients end up in emergency rooms.

Decision Making and Mental Health Care

Offering 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.

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”

Question #2

Is the following statement true or false?

American biases and prejudges have made it difficult for individuals of diverse cultures to have their beliefs and values acknowledged.

Answer to Question #2

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.

Mental Health Care for Immigrants

Regarding immigrants, health care providers should be sensitive to:

Offensive terms, for example “illegal alien”

Culture shock

Degree of acculturation

Feelings of depression, guilt, shame, anxiety

These factors put individuals at risk for depression, anxiety, posttraumatic stress disorder, substance abuse, and mental health problems.

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

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.

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.

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.

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

Important Factors to Consider in Transcultural Mental Health Nursing #1

Three important factors:

Communication and language

Spirituality

Experiences of pain

Important Factors to Consider in Transcultural Mental Health Nursing #2

Communication

Verbal and nonverbal

Developing trust

Availability of a certified translator/interpreter

Empathy

Question #3

Is the following statement true or false?

Researchers have shown that speaking the same language is the most important element in communicating with patients from diverse cultural backgrounds.

Answer to Question #3

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.

Important Factors to Consider in Transcultural Mental Health 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 involving devotion and ritual.

May enhance mental health and emotional stability.

Important Factors to Consider in Transcultural Mental Health Nursing #5

Pain

Pain has a component that includes emotional elements.

Pain and depression linked.

Psychosomatic pain, or pain with psychological components.

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

Answer to Question #4

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.

Chapter 9: Creating Culturally Competent Health Care Organizations

Defining a Culturally Competent Health Care Organization #1

A culturally competent organization is an organization that provides services that are respectful of and responsive to the cultural and linguistic needs of the clients they serve.

Defining a Culturally Competent Health Care Organization #2

Cultural competence includes providing respectful care that is consistent with cultural health beliefs of the clients and family members, with consideration of:

Age, culture, ethnicity, gender, language, race, religion, sexual preference, gender identity, and socioeconomic status

Question #1

Is the following statement true or false?

To be culturally competent, an organization should provide respectful care that is consistent with cultural health beliefs of the clients, family members, and staff.

Answer to Question #1

True

Rationale: Humans need care to survive, thrive, and grow. According to Leininger (1996), organizations need to incorporate universal care constructs, including respect and genuine concern for clients and staff.

The Need for Culturally Competent Organizations: External Motivations

The need for culturally competent organizations has been recognized by many external agencies, including:

Transcultural Nursing Society (TCNS)

American Nurses Association (ANA)

Sigma Theta Tau International (STTI)

American Organization of Nurse Executives (AONE)

The Joint Commission

The Institute of Medicine (IOM)

National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards)

The Need for Culturally Competent Organizations: Eliminating Health Disparities #1

Racial and ethnic disparities influence unequal health care treatment.

Disparities in health are “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” (Healthy People, 2020).

The Need for Culturally Competent Organizations: Eliminating Health Disparities #2

Key factors in achieving good health outcomes include:

Access (getting into the health care system)

Quality care (receiving appropriate, safe, and effective health care in a timely manner)

Question #2

Which of the following would support Access and Quality of Care issues in eliminating health disparities?

Universal health care coverage

Organizational culture

Joining TCNS

External auditing of health care organizations (e.g., Joint Commission)

Answer to Question #2

B. Organizational culture

Rationale: Organizational culture is one area that may influence both cultural competence and health disparities. Individuals must deliver culturally competent health care that focuses on risk reduction, vulnerability reduction, and promotion and protection of human rights.

Assessing Organizational Culture #1

Organizational culture: the goals, norms, values, and practices of an organization in which people have goals and try to achieve them in beneficial ways.

Assessing Organizational Culture #2

An organization’s culture:

Consists of shared beliefs, assumptions, perceptions, and norms leading to specific patterns of behaviors

Results from an interaction among many variables including mission, strategy, structure, leadership, and human resource practices

Is self-reinforcing; once in place, it provides stability and changes are resisted by organizational members

Assessing Organizational Culture #3

An inclusive workplace is characteristic of a caring organization.

Inclusive workplaces:

Encourage members of the workforce to become active in the community and participate in state and federal programs

Draws staff members who are committed to cultural competence and who value diversity and mutual respect for differences

Assessing Organizational Culture #4

Assessment tools:

The Magnet Hospital Recognition Program for Excellence in Nursing Services

Evidence-based practice

Leininger’s culture care model

Andrews’ assessment tool

Building Culturally Competent Organizations #1

Specific areas are critical to fostering culturally competent health care organizations:

Governance and administration

Board members, mission/vision/values, budget

Internal evaluation of adherence to cultural competence standards

Availability, accessibility, affordability, acceptability, and appropriateness

Building Culturally Competent Organizations #2

Fostering culturally competent health care organizations:

Staff competence

Organizational support, orientation, and ongoing education

Physical environment of care

Assessment of environment and barriers

Building Culturally Competent Organizations #3

Fostering culturally competent health care organizations (cont.):

Linguistic competence

Complete, accurate, timely, unambiguous, and understood by the patient

Community involvement

Partnerships

Culturally congruent services and programs

Design and implement effective programs

Question #3

Is the following statement true or false?

Building culturally competent organizations may result in increased patient satisfaction rates.

Answer to Question #3

True

Rationale: Research found that inpatients reported higher satisfaction with hospitals that had greater cultural competency.

Overcoming the Barrier of Institutional Racism in Health Care

Institutional racism is defined as differential access to goods, services, and opportunities based on race, including differential access to health insurance.

More often done unintentionally.

Cultural differences must be acknowledged and celebrated.

The strategies outlined build culturally competent health care organizations.

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Julie is a 35-year-old with bipolar II disorder

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