Transcript Psych Mental Health Power Point CH 7

Chapter 7
Client’s Response to Illness
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Individual Factors
• Age, growth, development
– Effect on coping with illness
– Expression of illness
– Erikson’s states of psychosocial development (see
Table 7.1); each stage dependent on successful
completion of previous one
– Adult developmental tasks (see Table 7.2)
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Individual Factors (cont.)
• Genetics, biologic factors
• Physical health, health practices
– Healthier = better coping with stress or illness
• Response to drugs
– Differences in ethnic groups related to metabolism,
efficacy
– Slower metabolism = need for lower doses
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Individual Factors (cont.)
• Self-efficacy
• Hardiness (commitment, control, challenge)
• Resilience
• Resourcefulness
• Spirituality
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Interpersonal Factors
• Sense of belonging
– Value
– Fit
• Social networks, social support
• Family support
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Cultural Factors
• Beliefs about causes of illness
• Factors in cultural assessment
– Communication
– Physical space or distance
– Social organization
– Time orientation
– Environmental control
– Biologic variations (see Box 7.1 and Table 7.4)
• Socioeconomic status, social class
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Cultural Patterns and Differences
• Knowledge of expected cultural patterns as starting point
when relating to people from different ethnic
backgrounds
• Wide variations among people from any culture
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Question
• Is the following statement true or false?
• Cultural factors include hardiness and resilience.
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Answer
• False
• Rationale: Cultural factors include the patient’s beliefs
about health and illness.
– Hardiness and resilience are individual factors.
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African Americans
• Different terms; patient preference for term important
• Family support; maintenance of patient independence
• Comfortable with public demonstration of affection;
conversation possibly animated, loud
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African Americans (cont.)
• Handshake for greeting; direct eye contact shows
interest and respect; silence possibly indicates lack of
trust
• Church important support; prayer for healing
• View of mental illness as spiritual imbalance or
punishment for sin
• Use of folk remedies with Western medicine
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American Indians or Native Americans
• Communication slow with many pauses
– Rushing speaker or interrupting viewed negatively
• Flexible orientation to time
• Reluctance of family members to provide patient
information (violation of patient’s privacy)
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American Indians or Native Americans
(cont.)
• Greeting via light-touch handshake, minimal direct eye
contact
• Patients typically quiet, stoic
• Mental illness as due to ghosts, breaking taboos, or loss
of harmony with environment
• Medicine bag or healing objects (not to be removed or
touched)
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Arab Americans
• Greet with smile, direct eye contact, social comment
about family or patient
• Family as collective decision maker (father, eldest son,
uncle, husband as family spokesperson)
• Human concerns valued more than adhering to schedule
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Arab Americans (cont.)
• Mental illness due to fear, manipulation, God’s will, or
loss of country, family, or friends
• Mental illness has stigma; treatment sought only when
all other remedies fail
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Cambodians
• Handshake or slight bow with palms together, fingers
pointed upward as greeting; no contact with person
being greeted
• Politeness highly valued; silence common; eye contact
acceptable (lowering of eyes by women to be polite)
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Cambodians (cont.)
• Inappropriate to touch head without permission
• Family members included for decision making
• Flexible orientation to time
• Passive role when ill; mental illness due to war or
brutalities
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Chinese
• Shy in unfamiliar surroundings
• Avoid eye contact with authority figures; silence
respectful; asking questions a sign of disrespect
• Time urgency not highly valued; respectful distance
important
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Chinese (cont.)
• Eldest male may be family decision maker, spokesperson
• Mental illness due to disharmony of emotions or evil
spirits
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Question
• Is the following statement true or false?
• It would be inappropriate to touch the head of a patient
who is from Cambodia.
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Answer
• True
• Rationale: It would be inappropriate for the nurse to
touch the head of a patient from Cambodia without his or
her permission.
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Cubans
• Outgoing, animated in conversation
• Direct eye contact as sign of respect or honesty
• Extended family important
• Mental illness inherited or caused by stress; stigma for
family
• Ill person submissive, helpless, dependent
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Filipinos
• Smile (rather than handshake) for greeting
• Animated facial expressions
• Little direct eye contact with authority figures
• Disagreement rarely voiced
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Filipinos (cont.)
• Mental illness due to religious, mystical causes
– Disruption in harmonious function of whole person,
spiritual world
• Ill person passive; eldest male as decision maker after
conferring with family
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Haitians
• Handshake as formal greeting
• Polite but shy, especially with authority figures
• Smile, nod even when not understanding
• Mental illness not well accepted; due to supernatural
causes
• Home, folk remedies used first
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Japanese Americans
• Formal greetings; light touching; minimal eye contact
especially with authority figures
• Self-disclosure unlikely; use of open-ended questions
appropriate
• Promptness important
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Japanese Americans (cont.)
• Mental illness shameful; reluctance in seeking help
• Mental illness due to evils spirits as punishment for bad
behavior or failure to live good life
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Mexican Americans
• Touching prevalent among family; not always welcomed
from strangers
– Handshake acceptable as polite greeting
• Avoidance of direct eye contact with authority figures
• Silence often a sign of disagreement
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Mexican Americans (cont.)
• Flexible time orientation
• No clear separation of physical, mental illness
– Due to imbalance between person and environment
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Question
• A patient from which of the following cultures most likely
would smile instead of using a handshake to greet the
nurse?
– A. Filipino
–
B. Haitian
–
C. Mexican American
–
D. Native American
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Answer
•
A. Filipino
• Rationale: Filipinos use smiles rather than handshakes
for greeting.
– Handshakes are used by the Haitian, Mexican
American, and Native American cultures.
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Puerto Ricans
• Elders less direct eye contact; younger people preference
for direct eye contact
• Religious, spiritual practices important
• Gratitude via homemade cooking
– Refusal is an insult
• Physical illness hereditary or punishment
• Mental illness hereditary or due to suffering; highly
stigmatized
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Russians
• Formal greeting or handshake with direct eye contact;
touching, embracing, kissing on cheek for close friends
and family
• Mental illness due to stress, moving to new environment
• Ill persons on bed rest
• Home remedies tried first; reluctant to take medications
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South Asians
• Oral greetings, gestures; handshakes among men
• Touching not common; feelings via eyes, facial
expressions
• Direct eye contact, loudness disrespectful
• Silence indicates approval, acceptance, tolerance
• Mental illness due to spells cast by enemies or evil spirits
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Vietnamese
• Greeting with smile, bow
• Touch limited among older, traditional people
• Head is sacred, feet profane
• Avoidance of eye contact with authority figures, elders
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Vietnamese (cont.)
• Mental illness due to disharmony or punishment by
ancestral spirits for past bad behavior
• Ill person passive
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Question
• Is the following statement true or false?
• Patients of the Russian culture often welcome the use of
medications for treatment of mental illness.
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Answer
• False
• Rationale: Patients of the Russian culture use home
remedies first and are often reluctant to take
medications.
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Nurse’s Role in Working with Patients
from Various Cultures
• Knowledge seeking about patient’s cultural values,
beliefs, health practices
• Patient as best source of information
• General cultural knowledge to guide nurse in initial
meetings, decisions about what questions to ask
– Preferences, health practices, beliefs
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Nurse’s Role in Working with Patients
from Various Cultures (cont.)
• General knowledge not replacement for patient
assessment
• Wide variations in individuals in culture
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Self-Awareness Issues
• Maintain genuine, caring attitude
• Ask how nurse can promote or assist with spiritual,
religious, health practices
• Recognize own feelings, possible prejudices
• Remember that patient’s response to illness is complex,
unique
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