Persons who are supported emotionally and func-
tionally have been found to be healthier than those
who are not supported (Dickinson et al., 2002). Mean-
ingful social relationships with family or friends were
found to improve the health and well-being outcomes
for older adults (Bisconti & Bergeman, 1999). These re-
searchers also found that an essential element of these
improved outcomes was that the family or friends
responded with support when it was requested. In
other words, the person must be able to count on these
friends or family to help or support him or her by vis-
iting or talking on the phone. Thus the primary com-
ponents of satisfactory support are the person’s abil-
ity and willingness to request support when needed
and the ability and willingness of the support system
to respond.
Health care providers should encourage family
members and friends to maintain contact with clients
in institutional care. Studies have shown social sup-
port to be beneficial for older adults with chronic men-
tal illness in institutional settings. Beeler et al. (1999)
found that 75% of people living in the institution had
family contact, which is contrary to the stereotype that
people with mental illness in institutions lose family
ties. Siblings and mothers accounted for most of the
contacts. Residents with family contact were happier
and felt connected to their families even though they
lived in an institution.
Knisely and Northouse (1994) also found that
social support and help-seeking behaviors among
adult psychiatric inpatients were highly correlated:
in other words, having a social network and being
able to ask for and receive support when needed are
vital steps in the recovery process. Clients with social
support were more likely to seek help and participate
in their treatment and felt more satisfied with their
hospital stay.
Buchanan (1995) focused on the specific elements
required for a support system to be effective for the
client. In a study of social support in adults with schiz-
ophrenia, Buchanan found that two key components
were necessary: the client’s perception of the support
system and the responsiveness of the support system
(mobilization). The client must perceive that the social
support system bolsters his or her confidence and self-
esteem and provides such stress-related interpersonal
help as offering assistance in solving a problem. The
client also must perceive that the actions of the sup-
port system are consistent with the client’s desires
and expectations—in other words, the support pro-
vided is what the client wants, not what the supporter
thinks would be good for the client. Also the support
system must be able to provide direct help or material
aid (e.g., providing transportation, making a follow-up
appointment). Buchanan explained that some people
have the capacity to seek help when needed, while a
lack of well-being may cause others to withdraw from
potential providers of support. The nurse can help the
client to find support people who will be available and
helpful and can teach the client to request support
when needed.Family Support
Family as a source of social support can be a key fac-
tor in the recovery of clients with psychiatric illnesses.
Although family members are not always a positive
resource in mental health, they are most often an im-
portant part of recovery (Teschinsky, 2000). Health
care professionals cannot totally replace family mem-
bers. The nurse must encourage family members to
continue to support the client even while he or she is
in the hospital and should identify family strengths,
such as love and caring, as a resource for the client.CULTURAL FACTORS
According to the U.S. Census Bureau, 33% of U.S.
residents currently are members of nonwhite cul-
tures. By 2050, the nonwhite population will more
than triple. This changing composition of society has
implications for health care professionals, who are
predominantly white and unfamiliar with different
cultural beliefs and practices (Bechtel et al., 1998).
Culturally competentnursing care means being
sensitive to issues related to culture, race, gender,
sexual orientation, social class, economic situation,
and other factors (Kennedy, 1999).
Nurses and other health care providers must
learn about other cultures and become skilled at
providing care to people with cultural backgrounds
that are different from their own. Finding out about
another’s cultural beliefs and practices and under-
standing their meaning is essential to providing holis-
tic and meaningful care to the client (Table 7-3).Beliefs About Causes of Illness
Culture has the most influence on a person’s health
beliefs and practices (Campinha-Bacote, 2002). Cul-
ture has been shown to influence one’s concept of dis-
ease and illness. The two prevalent types of beliefs
about what causes illness in non-Western cultures
are personalistic and naturalistic. Personalisticbe-
liefs attribute the cause of illness to the active, pur-
poseful intervention of an outside agent, spirit, or
supernatural force or deity. The naturalisticview is
rooted in a belief that natural conditions or forces,
such as cold, heat, wind, or dampness, are responsi-
ble for the illness (Campinha-Bacote, 2002). A sick
person with these beliefs would not see the relation-7 CLIENT’SRESPONSE TOILLNESS 141