Psychiatric Mental Health Nursing by Videbeck

142 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP

ship between his or her behavior or health practices
and the illness. Thus he or she would try to counter-
act the negative forces or spirits using traditional
cultural remedies rather than taking medication or
changing his or her health practices.

Factors in Cultural Assessment

Bechtel et al. (1998) recommend a model for assess-
ing clients using six cultural phenomena: communi-
cation, physical distance or space, social organization,
time orientation, environmental control, and biologic
variations (Box 7-1) (Table 7-4). Each phenomenon is
discussed in more detail below.

COMMUNICATION

Verbal communication can be difficult when the client
and nurse do not speak the same language. The nurse
should be aware that nonverbal communication has
different meanings in various cultures. For example,
some cultures welcome touch and consider it support-

Table 7-3

CULTURALBELIEFSABOUTHEALTH ANDILLNESS

Illness Beliefs: Causes of

Culture Mental Illness Concept of Health

African American

American Indians

Arab Americans

Cambodians

Chinese

Cubans

Filipinos

Haitians

Japanese Americans

Mexican Americans

Puerto Ricans

Russians

South Asians

Vietnamese

Lack of spiritual balance

Loss of harmony with natural world,

breaking of taboos, ghosts

Wrath of God, sudden fears, pretending

to be ill to manipulate family

Khmer Rouge brutalities

Lack of harmony of emotions, evil spirits

Heredity, extreme stress

Disruption of harmonious function of

individual and spirit world

Supernatural causes

Loss of mental self-control caused by

evil spirits, punishment for behavior or

not living good life

Humoral, God, spirituality, and interper-

sonal relationships all can contribute

Heredity, follows sufriamientos (suffering)

Stress and moving into new environment

Spells cast by enemy, falling prey to

evil spirit

Disruption of harmony in individual;

ancestral spirit haunting

Feelings of well-being, able to fulfill role ex-

pectations, free of pain or excess stress

Holistic and wellness-oriented

Gift of God manifested by eating well, meet-

ing social obligations, good mood, no

stressors or pain

Health as equilibrium, individually maintained

but influenced by family and community

Health maintained by balance of yinand

yang,body, mind, and spirit

Fat and rosy-cheeked (traditional); fitness

and staying trim (acculturated)

Maintaining balance; good health involves

good food, strength, and no pain

Maintenance of equilibrium by eating well,

attention to personal hygiene; prayer and

good spiritual habits

Balance and harmony between oneself,

society, and universe

Feeling well and being able to maintain role

function

No mental, spiritual, or physical discomforts;

being clean and not being too thin

Regular bowel movements and no symptoms

Balance of digestive fire, bodily humors, and

waste products; senses functioning nor-

mally; body, mind, and spirit in harmony

Harmony and balance within oneself

Box 7-1

➤ IMPORTANTFACTORS INCULTURAL

ASSESSMENT

Communication

Physical distance or space

Social organization

Time orientation

Environmental control

Biologic variations

Bechtel, G., Giger, J. N., & Davidhizar, R. (1998). Case

managing patients from other cultures. Journal of Care

Management,4(5), 87–91.

ive, while other cultures find touch offensive. Some

Asian women avoid shaking hands with one another

or men. Some Native American tribes believe that vig-

orous handshaking is aggressive, whereas people from