Chapter 07: Cultural Implications for Psychiatric Mental Health Nursing

Question 1

Which term refers to the sharing of common traits, customs, and race?

a. World view
b. Ethnicity
c. Ethnocentrism
d. Culture

Answer 1

ANS: B
Ethnicity refers to the sharing of common traits, customs, and race. World view is a major paradigm used to explain the world and its mysteries, inclusive of beliefs about health, illness, and the hereafter. Ethnocentrism is the perception that one’s own values, beliefs, and behaviours are superior. Culture comprises the shared beliefs, values, and practices that guide a group’s members in patterned ways of thinking and acting and includes factors such as religion, geography, socioeconomic status, occupation, ability or disability, and sexual orientation.

Question 2

A patient who speaks limited English has gotten upset with the nurse when she gestured with her foot towards the washroom as her hands were full and wanted to help the patient find the washroom. What should the nurse do?

a. Contact a translator.
b. Apologize for upsetting the patient and ask what happened that upset the patient.
c. Explain to the patient that you were pointing to the washroom with your foot.
d. Research the patients’ cultural background to assess what it was that may have been misinterpreted.

Answer 2

ANS: B
Nurses can become aware of signs of cultural pain (e.g., a patient’s feeling of alienation, emotional upset) and recover trust and rapport by asking what has caused the offence, apologizing for insensitivity, and expressing willingness to provide culturally sensitive care.

Question 3

To provide culturally competent care, the nurse should do which of the following?

a. Accurately interpret the thinking of individual patients
b. Predict how a patient may perceive treatment interventions
c. Formulate interventions to reduce the patient’s ethnocentrism
d. Identify strategies that fit within the cultural context of the patient

Answer 3

ANS: D
Cultural competence is the ability of nurses to apply knowledge and skill appropriately in cross-cultural situations. Having cultural sensitivity or awareness is an essential component of cultural competence. Culturally competent care goes beyond culturally sensitive care by adapting care to meet the patient’s cultural needs and preferences. Interpreting the thinking of individual patients does not ensure culturally competent care. Reducing a patient’s ethnocentrism may not be a desired outcome.

Question 4

A patient of Asian descent has a diagnosis of depression. A colleague tells the nurse, “This patient often looks down and is reluctant to share feelings. However, I’ve observed the patient spontaneously interacting with other black patients.” Select the nurse’s best response.

a. “Black patients depend on the church for support. Have you consulted the patient’s pastor?”
b. “Encourage the patient to talk in a group setting. It will be less intimidating than one-to-one interaction.”
c. “Don’t take it personally. Black patients often have a resentful attitude that takes a long time to overcome.”
d. “The patient may have difficulty communicating in English. Have you considered using a cultural broker?”

Answer 4

ANS: D
Asian immigrants underutilized health care services due to language barriers and cultural beliefs about health and treatment options. The use of translators is one strategy for overcoming communication barriers. Society expects a culturally diverse patient to accommodate and use English. Feelings are abstract, which requires a greater command of the language. This may be especially difficult during episodes of high stress or mental illness. Cultural brokers can be helpful with language and help the nurse to understand the Asian world view and cultural nuances.

Question 5

A patient diagnosed with depression tells the nurse, “There’s nothing you can do. This is a punishment. The only thing I can do is see a healer.” A religious world view perspective would indicate which of the following?

a. The patient has delusions of persecution.
b. The patient has likely been misdiagnosed with depression.
c. The patient may believe the distress is the result of a curse or spell.
d. The patient feels hopeless and helpless related to an unidentified cause.

Answer 5

ANS: C
Individuals of African, Haitian, and other cultures may hold fatalistic attitudes about illness, believe they are being punished for wrongdoing or are victims of witchcraft or voodoo. They may be reticent to share information about curses with therapists. No data are present in the scenario to support delusions. Misdiagnosis more often labels a patient with depression as having schizophrenia.

Question 6

A group activity on an inpatient psychiatric unit is scheduled to begin at 1000 hrs. A patient, who was recently discharged from the Canadian Navy, arrives at 0945 hrs. Which analysis best explains this behaviour?

a. The patient wants to lead the group and give directions to others.
b. The patient wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The patient does not want to be late.
d. The behaviour indicates feelings of self-importance that the patient wants others to appreciate.

Answer 6

ANS: C
World views shape perceptions about time, as well as health and illness, rights and obligations in society, and acceptable ways of behaving in relation to others and nature. Culture is more than ethnicity and social norms. In this instance, the patient’s military experience represents an aspect of the patient’s behaviour. The military culture values timeliness. The distracters represent misinterpretation of the patient’s behaviour and have no bearing on the situation.

Question 7

The nurse would increase the distance of personal space when interacting with a patient who is of which of the following origins?

a. Middle Eastern
b. Asian
c. Southern European
d. Latin American

Answer 7

ANS: B
When working with patients of Asian descent, it is important for the nurse to know that personal space is significantly further away than traditionally used in Western culture. People of Middle Eastern, Southern European, and Latin American descent generally have a closer personal space. Within these cultures, standing close indicates acceptance of the other.

Question 8

The sibling of an Asian Canadian patient tells the nurse, “My sister needs help for pain. She cries from the hurt.” Which understanding by the nurse will contribute to culturally competent care for this patient?

a. People of Asian descent often express emotional distress with physical symptoms.
b. People of Asian descent will probably respond best to a therapist who is impersonal.
c. People of Asian descent will require prolonged treatment to stabilize these symptoms.
d. People of Asian descent should be given direct information about the diagnosis and prognosis.

Answer 8

ANS: A
Among several cultures, body–mind–spirit is seen as a single entity. For example, such ideas predominate in Eastern world views, prevalent in many Asian Canadians, and are based on the ancient beliefs of Chinese and Indian philosophers and the spiritual traditions of Confucianism, Buddhism, and Taoism. Therefore, the nurse may observe Asian Canadians expressing somatic complaints when there is a psychological or spiritual problem. Treatment will likely be short. The patient will probably respond best to a therapist who is perceived as giving. Asian Canadians usually have strong family ties and value hope more than truth.

Question 9

Which communication techniques would be most effective for a nurse to use during an assessment interview with an adult Aboriginal patient?

a. Open and friendly; ask direct questions; touch the patient’s arm or hand occasionally for reassurance.
b. Frequent nonverbal behaviours, such as gestures and smiles; make an unemotional face to express negatives.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
d. Stern voice; unbroken eye contact; minimal gestures; direct questions.

Answer 9

ANS: C
Aboriginal culture stresses living in harmony with nature. Cooperative, sharing styles rather than competitive or intrusive approaches are preferred; thus, the more passive style described would be best received. The other options would be more effective to use with patients of a Western orientation.

Question 10

An Inuit patient sadly describes a difficult childhood. The patient abused alcohol as a teenager but stopped 10 years ago. The patient now says, “I feel stupid and good for nothing. I don’t help my people.” How should the treatment team focus planning for this patient?

a. Psychopharmacological and somatic therapies should be central techniques.
b. Apply a psychoanalytic approach, focused on childhood trauma.
c. Depression and alcohol abuse should be treated concurrently.
d. Use a holistic approach, including mind, body, and spirit.

Answer 10

ANS: D
Inuit peoples, because of their beliefs in the interrelatedness of parts and about being in harmony with nature, respond best to a holistic approach. No data are present to support a concurrent disorder because the patient has resolved the problem of excessive alcohol use. Psychopharmacological and somatic therapies may be part of the treatment, but the focus should be more holistic. Psychoanalysis is a long-term, expensive therapy; cognitive therapy might be a better choice.

Question 11

A First Nations patient describes a difficult childhood and dropping out of high school. The patient used many recreational substances as a teenager to escape feelings of isolation but stopped 13 years ago. The patient now says, “I feel stupid. I’ve never had a good job. There is nothing that I am good enough at doing to be able to work.” Which nursing diagnosis applies?

a. Risk for other-directed violence
b. Chronic low self-esteem
c. Deficient knowledge
d. Social isolation

Answer 11

ANS: B
Living in poverty subjects people to bias and discrimination that diminishes self-esteem and self-efficacy, contributing to exclusion and marginalization. Relative poverty refers to inequities in material resources across segments of the population—that is, between “the haves” and “the have-nots.” In Canada, this gap is widening, which is cause for concern. One of the most impoverished groups is Aboriginal peoples. The patient has given several indications of chronic low self-esteem. Forming a positive self-image is often difficult for Aboriginal individuals because these indigenous people must blend together different world views. No defining characteristics are present for the other nursing diagnoses.

Question 12

The nurse knows that the blueprint for guiding actions that impact care, health, and well-being is which of the following?

a. World view
b. Ethnicity
c. Ethnocentrism
d. Culture

Answer 12

ANS: D

Culture is the blueprint for guiding actions that impact care, health, and well-being.

Question 13

Which intervention best demonstrates that a nurse correctly understands the cultural needs of a hospitalized Asian Canadian patient diagnosed with a mental illness?

a. Encouraging the family to attend community support groups
b. Involving the patient’s family to assist with activities of daily living
c. Providing educational pamphlets to explain the patient’s mental illness
d. Restricting homemade herbal remedies the family brings to the hospital

Answer 13

ANS: B
The Asian community values the family in caring for each other. They view the family as central to one’s identity, and family interdependence and group decision making are the norm. The Asian community uses traditional medicines and healers, including herbs for mental symptoms. The Asian community describes illness in somatic terms. The Asian community attaches a stigma to mental illness, so interfacing with the community would not be appealing.

Question 14

Which world view is predominant in Western culture?

a. Holistic
b. Biomedical
c. Religious
d. Natural laws

Answer 14

ANS: B
The predominant world view in Western culture is the biomedical or scientific world view. The holistic world view is predominantly practiced by Asian and Aboriginal peoples and includes a belief about natural laws. Many Latino, African, Caribbean, and Middle Eastern cultures support the religious world view.

Question 15

A patient in the emergency department shows a variety of psychiatric symptoms, including restlessness and anxiety. The patient says, “I feel sad because evil spirits have overtaken my all of me—they think for me and they do things I would not normally do.” Which world view is most applicable to this individual?

a. Religious
b. Holistic
c. Scientific
d. Biomedical

Answer 15

ANS: B
People with an indigenous, holistic world view believe balance and harmony must be present for health. They consider an explanation of disharmony and imbalance in the cosmos, resulting in illness. The holism of body–mind–spirit is a key component of this view.

Question 16

A nurse prepares to teach important medication information to a patient of Middle Eastern descent. How should the nurse manage the teaching environment?

a. Stand very close to the patient while teaching.
b. Maintain direct eye contact with the patient while teaching.
c. Maintain a neutral emotional tone during the teaching session.
d. Sit 4 feet or more from the patient during the teaching session.

Answer 16

ANS:	A
Several cultures (Middle Eastern, Latin American, Southern European) use close personal space, closer than many other minority groups. Standing very close to the patient frequently indicates acceptance. Direct eye contact should not be prolonged with this patient as it can be associated with rudeness, arrogance, challenge, or sexual interest.

Question 17

When caring for a patient of Western culture, the nurse is aware that the personal space of this patient is which of the following?

a. up to 0.5 m
b. 0.5 to 1.0 m
c. 1.0 to 1.5 m
d. 1.5 to 2.0 m

Answer 17

ANS: B

Personal space in Western society is considered to be 0.5 to 1.0 metre. Intimate space is 0 to 0.5 metre.

Question 18

An experienced psychiatric nurse plans to begin a new job in a community-based medication clinic. The clinic sees culturally diverse patients. Which action should the nurse take first to prepare for this position?

a. Investigate cultural differences in patients’ responses to psychotropic medications.
b. Contact the clinical nurse specialist for guidelines regarding cultural competence.
c. Examine the literature on various health beliefs of members of diverse cultures.
d. Complete an online continuing education offering about psychopharmacology.

Answer 18

ANS: A
An experienced nurse working on a mental health inpatient unit would be familiar with the action and side effects of most commonly prescribed psychotropic medications. However, because the clinic serves a culturally diverse population, reviewing cultural differences in patients’ responses to these medications is helpful and vital to patient safety as there are ethnic variations in psychotropic drug metabolism. The distracters identify actions the nurse would take later.

Question 19

A psychoeducational session will discuss medication management for a culturally diverse group of patients. Group participants are predominantly members of minority cultures. Of the four staff nurses below, which nurse should lead this group?

a. Very young registered nurse
b. Older, mature registered nurse
c. Newly licensed registered nurse
d. A registered nurse who is very thin

Answer 19

ANS: B
People of minority cultures value age and wisdom. People with a Western world view tend to value youth. An older, mature registered nurse would be the most credible leader of this group. The nurse’s size has no bearing on credibility.

Question 20

A nurse wants to engage a translator for a severely anxious 21-year-old male who immigrated to Canada 2 years ago. Of the four translators below who are available and fluent in the patient’s language, which one should the nurse call?

a. A 65-year-old female professional translator
b. A 24-year-old male professional translator
c. A member of the patient’s family
d. The patient’s best friend

Answer 20

ANS: B
A professional translator will be most effective because he or she will be able to interpret both language and culture. When a translator is engaged, the translator should be matched to the patient as closely as possible in gender, age, social status, and religion. Translators should not be relatives or friends of the patient. The stigma of mental illness may prevent the openness needed during the encounter.

Question 21

A patient who has been hospitalized for 3 days with a serious mental illness says, “I’ve got to get out of here and back to my job. I get 60 to 80 messages a day, and I’m getting behind on my email correspondence.” What is this patient’s perspective about health and illness?

a. Fateful, magical
b. Eastern, holistic
c. Western, biomedical
d. Harmonious, religious

Answer 21

ANS: C
The Western biomedical perspective holds the belief that sick people should be as independent and self-reliant as possible. Self-care is encouraged; one gets better by “getting up and getting going.” An ability to function at a high level is valued. See relationship to audience response question.

Question 22

When completing an admission assessment on a patient with a diagnosis of depression, the nurse discovers that the patient is taking an herb that is believed to treat depression in their culture but is contraindicated with the pharmacological treatment the patient is receiving. What is the nurses’ initial action?

a. Respect the cultural need for the herb and alter the medication treatment.
b. Provide information to the patient as to why the herb is contradicted.
c. Inform the patient that she or he will not be able to take this herb while in hospital.
d. Do not address this with the patient but report it to the health care provider in charge of care.

Answer 22

ANS: B
When cultural patterns are determined harmful (e.g., if a patient is taking an herb that is contraindicated with the prescription medication), the nurse is responsible for alerting the patient and the mental health care team to these risks. The initial action would not include altering the medication treatment. Informing a patient that she or he cannot continue a cultural practice is not appropriate as the initial action. Although it is important that the health care team is aware of this information, the nurse would address it with the patient initially.

Question 23

A Vietnamese patient’s family reports that the patient has wind illness. Which menu selection will be most helpful for this patient?

a. Iced tea
b. Ice cream
c. Warm broth
d. Gelatin dessert

Answer 23

ANS: C
Wind illness is a culture-bound syndrome found in the Chinese and Vietnamese population. It is characterized by a fear of cold, wind, or drafts. It is treated by keeping very warm and avoiding foods, drinks, and herbs that are cold. Warm broth would be most in sync with the patient’s culture and provide the most comfort. The distracters are cold foods.

Question 24

A Mexican Canadian patient puts a picture of the Virgin Mary on the bedside table. What is the nurse’s best action?

a. Move the picture so it is beside a window.
b. Send the picture to the business office safe.
c. Leave the picture where the patient placed it.
d. Send the picture home with the patient’s family.

Answer 24

ANS: C
Cultural heritage is expressed through language, works of art, music, dance, customs, traditions, diet, and expressions of spirituality. This patient’s prominent placement of the picture is an example of expression of cultural heritage and spirituality. Spiritual practices are important to preserving or regaining health. The nurse should not move it unless the patient’s safety is jeopardized.

Question 25

A nurse begins work in an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after doing which of the following?

a. Identifying culture-bound issues
b. Implementing scientifically proven interventions
c. Correcting inferior health practices of the population
d. Exploring commonly held beliefs and values of the population

Answer 25

ANS: D
Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture. The other options have little to do with cultural competence or represent only a portion of the answer.

Question 26

A nurse cares for a first-generation Canadian whose family emigrated from Germany. Which world view about the source of knowledge would this patient likely have?

a. Knowledge is acquired through use of affective or feeling senses.
b. Science is the foundation of knowledge and proves something exists.
c. Knowledge develops by striving for transcendence of the mind and body.
d. Knowledge evolves from an individual’s relationship with a supreme being.

Answer 26

ANS: B
The Western world perspective of acquiring knowledge evolves from science. The distracters describe the beliefs of other world views

Question 27

The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics?

a. Patients of different cultural groups may metabolize medications at different rates.
b. Metabolism of psychotropic medication is consistent among various cultural groups.
c. Differences in hepatic enzymes will influence the rate of elimination of psychotropic medications.
d. It is important to provide patients with oral and written literature about their psychotropic medications.

Answer 27

ANS: A
Cytochrome enzyme systems, which vary among different cultural groups, influence the rate of metabolism of psychoactive drugs. Some genetic variations result in rapid metabolism, resulting in minimization of the therapeutic effects; others may result in poor metabolism. With slow metabolism, serum levels become high, increasing intolerable adverse effects. Current practice requires that nurses be aware of ethnic variations in drug metabolism and monitor for unwanted adverse effects. Renal function influences elimination of psychotropic medication; hepatic function influences metabolism rates. Information about medication is important but does not apply to pharmacokinetics.

Question 28

A nurse prepares to assess a newly hospitalized patient who moved to Canada 6 months ago from Somalia. The nurse should first determine which of the following?

a. If the patient’s immunizations are current
b. The patient’s religious preferences
c. The patient’s specific ethnic group
d. Whether a translator is needed

Answer 28

ANS: D
The assessment depends on communication. The nurse should first determine whether a translator is needed. The other information can be subsequently assessed.

Question 29

Which questions should the nurse ask to determine an individual’s world view? Select all that apply.

a. What is more important: the needs of an individual or the needs of a community?
b. How would you describe an ideal relationship between individuals?
c. How long have you lived at your present residence?
d. Of what importance are possessions in your life?
e. Do you speak any foreign languages?

Answer 29

ANS: A, B, D
The answers provide information about cultural values related to the importance of individuality, material possessions, relational connectedness, community needs versus individual needs, and interconnectedness between humans and nature. These will assist the nurse to determine a patient’s world view. Other follow-up questions are needed to validate findings.

Question 30

Why is the study of culture so important for psychiatric nurses in Canada? Select all that apply.

a. Psychiatric nurses often practice in other countries.
b. Psychiatric nurses must advocate for the traditions of the Western culture.
c. Cultural competence helps protect patients from prejudice and discrimination.
d. Patients should receive information about their illness and treatment in terms they understand.
e. Psychiatric nurses often interface with patients and their significant others over a long period of time.

Answer 30

ANS: C, D, E
One purpose of cultural competence is for the psychiatric nurse to relate and explain information about the patient’s illness and treatment in an understandable way, incorporating the patient’s own beliefs and values. A fundamental aspect of nursing practice is advocacy. Cultural knowledge helps nurses establish rapport, ask the right questions, avoid misunderstandings, and identify cultural variables that may need to be considered when planning nursing care. Psychiatric nurses often interface with patients and families over years and in community settings.

Question 31

The nurse should be particularly alert to somatization of psychological distress among patients whose cultural beliefs include which of the following? (select all that apply)

a. Mental illness reflects badly on the family.
b. Mental illness shows moral weakness.
c. Intergenerational conflict is common.
d. The mind and body are merged.
e. Food choices influence one’s health.

Answer 31

ANS: A, B, D
Physical symptoms are seen as more acceptable in cultural groups in which interdependence and harmony of the group are emphasized. Mental illness is often perceived as reflecting a failure of the entire family. In groups in which mental illness is seen as a moral weakness and both the individual and family are stigmatized, somatization of mental distress is better accepted. In groups in which the mind and body are holistically perceived, somatization of psychological distress is common. Somatization and food are not commonly related. Intergenerational conflict has not been noted as a risk factor for somatization.

Question 32

Patient’s Cultural Heritage

a. Navajo
b. Korean
c. Latin American
d. Chinese
e. Vietnamese

1. Ataque de nervios
2. Ghost sickness
3. Hwa-Byung
4. Susto
5. Wind illness

Answer 32

1. ANS: C DIF: Cognitive Level: Understand (Comprehension)
   REF: Page 106 (Box 7-2)
   OBJ: Culture-bound syndromes apply to selected population groups.
   TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
   2. ANS: A DIF: Cognitive Level: Understand (Comprehension)
      REF: Page 106 (Box 7-2)
      OBJ: Culture-bound syndromes apply to selected population groups.
      TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
   3. ANS: B DIF: Cognitive Level: Understand (Comprehension)
      REF: Page 106 (Box 7-2)
      OBJ: Culture-bound syndromes apply to selected population groups.
      TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
   4. ANS: C DIF: Cognitive Level: Understand (Comprehension)
      REF: Page 106 (Box 7-2)
      OBJ: Culture-bound syndromes apply to selected population groups.
      TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
   5. ANS: D DIF: Cognitive Level: Understand (Comprehension)
      REF: Page 106 (Box 7-2)
      OBJ: Culture-bound syndromes apply to selected population groups.
      TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity