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Individual Factors
• Age, stage of growth and development
• Genetics and biologic factors
• Physical health and health practices
• Response to drugs
• Self-efficacy (belief that personal abilities and efforts affect
life events.
• Hardiness (ability to resist illness when under stress)
• Resilience (healthy response despite stressful or risky
situations) and resourcefulness (problem solving and faith in ability to
deal with new and adverse situations)
• Spirituality (essence of being and beliefs about
purpose/meaning of life).
Interpersonal Factors
• Sense of belonging
• Connectedness in a social system
• Social networks (connected with one another)
• Social support (emotional sustenance from family, friends,
others)
• Family support
Sheila L. Videbeck 32
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins
Cultural Factors
• Customs and meanings of communication
• Beliefs about causes of illness
• Physical space or distance
• Social organization
• Time orientation
• Environmental control
• Biologic variations
• Socioeconomic status and social class
American Indians
Sheila L. Videbeck 33
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins
• Slow speech with many pauses. Communication is telling a
story and shouldn’t be rushed.
• Prefer a light-touch handshake and minimal direct eye
contact
• Family members are reluctant to provide information
unless necessary preferring to let the client speak for him or herself.
• View mental illness as resulting from ghosts, breaking
taboos, or loss of harmony with the environment.
• May be reluctant to discuss spiritual beliefs and practices
with strangers.
• Allow client to keep medicine bag or other healing objects,
and do not touch or question them.
Arab Americans
• Greet others with a smile and handshake
• Loud voice denotes importance of subject.
• Expressions of agreement may indicate respect, not
intended compliance.
• Eldest male may be family spokesperson.
• View mental illness as caused by fear, manipulation, God,
or loss of country, family or friends
• Mental illness has a stigma; treatment is sought only when
all other remedies fail.
Cambodians
• May not include physical contact in greetings
• Soft voices
• Politeness highly valued
• Silence common
Sheila L. Videbeck 34
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins
• Avoid social chatter or touching the person’s head.
• Mental illness viewed as caused by war or brutalities
• Passive in sick role
• May use healers as well as Western medicine
• May resist having blood drawn
Chinese
• Shy in unfamiliar surroundings
• Keep a respectful distance.
• Asking questions may be seen as disrespectful; silence is
respectful.
• Eldest male may be family spokesperson.
• Mental illness viewed as caused by disharmony of
emotions or evil spirits.
• Herbalists and acupuncture may be used.
• Health practices greatly influenced by length of time in the
U.S.
Cubans
• Outgoing, animated in conversation
• Expect direct eye contact as sign of respect or honesty
• Extended family important
• Mental illness viewed as inherited or caused by stress; is a
stigma for family.
• Seek Western medicine for serious illness
Filipinos
• Greet others with smiles, rather than handshake
Sheila L. Videbeck 35
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins
• Facial expressions animated
• Direct eye contact impolite, especially with authority
figures
• Mental illness viewed as having religious and mystical
causes
• Client is passive.
• Decisions made by eldest male
• Prayer important
Haitians
• Polite but shy, especially with authority figures
• Greet with handshake
• May smile and nod, even when not understanding
• Gestures and tone of voice used for emphasis
• Mental illness not well accepted, viewed as having
supernatural causes.
• Client is passive.
• Home and folk remedies are first choice of treatment.
Japanese Americans
• Identified by the generation in which they were born (Isei,
Nisei, Sansei, Yonsei) with each generation more accustomed to
Western belief and practices.
• Greetings are formal.
• Facial expressions are controlled.
• Nodding indicates politeness, not necessarily agreement.
• Self-disclosure is minimal; ask open-ended questions.
• Mental illness is shameful, reluctant to seek treatment
Sheila L. Videbeck 36
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins
• Evil spirits cause mental illness; client is expected to use
will power to overcome it.
Mexican Americans
• Wide variation
• Touching prevalent among family but not necessarily
welcome from strangers.
• Direct eye contact with authority figures avoided
• Silence denotes disagreement.
• Only a few questions will elicit much information.
• Social conversation should precede questions.
• Illness comes from imbalance between person and
environment.
• Spiritual and psychic aspects of care may be very
important.
Russians
• Greet strangers formally, but kiss and embrac close friends
and family.
• Mental illness viewed as caused by stress and moving into
a new environment.
• Sick people go to bed, may be reluctant to take
medications
South Asians
• Greet others with words and gestures
• Touching not common
• Express emotions through eyes and facial expressions
• Direct eye contact and loudness disrespectful
Sheila L. Videbeck 37
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins
• Mental illness viewed as caused by spells cast by enemies
or evil spirits.
• Sick people assume passive role.
• Spiritual healing practices common
Vietnamese
• Greet others with smile and bow
• Touch is limited.
• Head is sacred, feet profane.
• Direct eye contact with elders and authority figures
disrespectful
• Soft-spoken
• Open expression of emotions may be seen as being in bad
taste.
• Mental illness viewed as caused by disharmony or
punishment by ancestral spirits
• Folk medicine and practices common
Sheila L. Videbeck 38
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins
Self-Awareness Issues
• Maintain a genuine, caring attitude.
• Ask how the nurse can promote or assist with spiritual,
religious, and health practices.
• Recognize own feelings and possible prejudices.
• Remember that the client’s response to illness is complex
and unique.
Sheila L. Videbeck 39
Psychiatric Mental Health Nursing
Lippincott Williams & Wilkins