Consider the importance to integrating cultural assessments into mental health evaluation and care. Also, discuss how providing culturally congruent care

Transcultural Nursing (Part 2) As a nurse in a transcultural setting, you will be able to provide culturally sensitive care to patients belonging to diverse ethnic backgrounds around the world. The transcultural nursing profession (TCN) is designed to serve individuals, groups, communities, and societies as a theory-based humanistic discipline that provides health care to all. As far as the definition of human care/caring is concerned, culture plays a significant role. Cultural care is only possible when cultural values are recognized and serve as a foundation for a meaningful and respectful relationship between the patient and the caregiver.

Due to the development of a scientific and humanistic body of knowledge, nursing care practices are provided in a culturally specific and universal way. It is an area of nursing that plays a vital role in analyzing and studying caring behavior, nursing care, and values, beliefs, and patterns of behavior associated with the health and illness of cultures all over the world in the context of transcultural nursing. Due to the growing diversity within those populations, there is an increasing need for transcultural nursing in our local, national, and global communities.

1. Culturally Approach to Mental Health Care Healthcare providers need to be culturally competent so that they can be able to interact effectively with people from a variety of cultures, incorporating their beliefs, behaviors, and needs into their diagnosis and treatment plans. In addition, a culturally competent mental health provider is aware of how a person's culture, race, and ethnicity may affect their mental health. It is also essential to understand how these obstacles and additional stigmas affect the mental health of people of color daily. Therefore, what happens when a healthcare provider lacks cultural competency or exhibits bias? A lack of knowledge or asking about a person's culture, history, beliefs, and intergenerational trauma can result in devastating mental health consequences. It includes misdiagnosis, underdiagnosis, discrimination, and ineffective and misguided treatment, particularly for Black Americans (Fountain House, 2022).

The diagnosis and treatment of patients with psychiatric disorders should be made culturally sensitive. There are many culturally specific syndromes and pharmacological considerations that a diligent physician should consider when treating patients from diverse cultures. There is a possibility that inappropriate or ineffective treatment measures may be prescribed to patients if cultural concerns are not addressed during the assessment process. Mental health diagnosis and treatment must be understood and explained to the patient and the patient's family to ensure proper management of the patient's symptoms. Patients and their families who come from diverse cultures may not have a complete understanding of how mental health treatment is administered. Engaging in open discussions with patients to cultivate a thorough understanding of their mental health concerns should not be underestimated. The patient's family will also be able to establish a positive working relationship with you in this manner (Konstantakopoulos, 2019).

African Americans are more likely to be identified with schizophrenia than other people. Frequently, clinicians misdiagnose affective disorders as schizophrenia when they present as affective disorders. There is also a significant increase in the number of African American clients prescribed higher doses of antipsychotic medications, and they may be susceptible to their effects. Additionally, they receive far fewer second-generation antipsychotics and are twice as likely to suffer from tardive dyskinesia as Caucasians.

In contrast to other populations, Hispanic Americans tend to focus more on physical complaints when depressed. They also require half the dose of antidepressants as compared with Caucasians. In addition, Hispanics are more likely to experience anticholinergic side effects due to psychopharmacological agents.

Asians commonly deny depressive moods, and somatic complaints are more prevalent than psychological complaints. There is a greater likelihood of extrapyramidal side effects occurring in Asians due to psychotropic medications. There is a 52% increase in plasma haloperidol levels in Chinese compared to other populations. The serum levels of haloperidol and prolactin are significantly different between Caucasians and Asians (both Americans and foreign-born).

Alcohol metabolism differs according to culture. It has been observed that 80 percent of Asians, particularly women, and 50 percent of Native Americans flush after drinking alcohol due to genetic polymorphisms of alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ADHD), both of which are essential for alcohol metabolism.

The cytochrome P450 enzyme structure is accountable for the metabolism of psychotropic and non-psychotropic drugs. Some ethnic groups are susceptible to drug toxicity due to genetic defects in specific isoenzymes of this system.

Four principles should be considered to develop a better understanding of how cultural issues should be addressed:

1. Stereotypes should be avoided by individuals and groups 2. Asking the right questions will help the clinician to listen actively and elicit culturally relevant information 3. Assisting trainees in developing their cultural competence while complementing their developing clinical skills in other

9/4/24, 6:39 PM Module 4: Lecture Culturally Approach to Mental Health Care: Transcultural and Global Health Disparities_NRSE707_SF001_MIAMI…

https://agmu.instructure.com/courses/30801/pages/module-4-lecture-culturally-approach-to-mental-health-care?module_item_id=1779709 1/4

disciplines 4. Achieving cultural competence in clinicians and accepting it as an integral part of patient assessment and clinical care.

A culturally sensitive approach is essential to diagnosing and treating patients from diverse backgrounds and ethnicities. During the treatment of Hwa-Byung, a diligent physician can demonstrate the finesse necessary for adequately managing this condition. It is well established that healthcare disparities can be attributed to cultural influences on providers' attitudes during clinical encounters. The healthcare team must respond appropriately to patients' cultural differences and concerns. When it comes to eliminating bias and improving healthcare delivery, one must examine implicit assumptions about the culture of the patient. The patient's family should also be delicately elicited for information about their culture to improve rapport with the patient (Fogel et al., 2022).

There are four ways in which culture can affect mental health:

1. Stigma associated with culture.

Every culture views mental health differently. The stigma surrounding mental health is rising, and mental health challenges are often viewed as weaknesses and as something to be hidden. Some struggling individuals may find it difficult to ask for assistance or speak openly about their situation.

2. Identify symptoms.

How individuals describe and feel about their symptoms may be influenced by their cultural background. It is possible for an individual to recognize and discuss only physical symptoms or to recognize and discuss both physical and emotional symptoms.

3. Support from the community.

Regarding mental health, cultural factors can influence the amount of support a person receives from their family and community. It is common for minorities to face stigma associated with mental health treatment and support, which often leaves them searching for these services independently.

4. The resources available.

It may be difficult or time-consuming to find treatment options and resources that are culturally sensitive (National Council for mental Wellbeing, 2022). You should seek mental health treatment from someone who has experience and understanding of your concerns.

Diversity within groups is often overlooked. Several examples are provided below:

Several Asian American countries are represented among Asian Americans, such as Afghanistan, China, India, Syria, and Japan.

Afro-American is a term that refers to a group of 33.9 million people that share the same characteristics as those living in Africa, where seven hundred and seventy-seven million people live in 54 countries and speak more than two thousand languages. Those who qualify as Native Americans may have mixed ancestry or only a fraction of Native American heritage, rooted in more than 500 tribes or not, and may or may not identify with tribal culture.

Approximately 44.3 million Hispanic Americans live in the United States, according to the 2006 Census Bureau report. This "group" consists of 64 percent Mexicans, 9 percent Puerto Ricans, 3.5 percent Cubans, 3 percent Salvadorans, and 2.7 percent Dominicans. Most of the remaining people are Latin American, Central American, or another Hispanic or Latin origin. In the United States, the population is becoming increasingly diverse, making it imperative that mental health providers understand the impact of culture on psychological processes, mental illnesses, and treatment preferences. It is also necessary for them to be aware of the various subgroups within the same group.

Mental health services are provided in disparate ways. There are considerable behavioral health disparities among members of racial and ethnic minorities, as described in Mental Health: Culture, Race, and Ethnicity, released by the Surgeon General. The following populations fall into this category:

1. Mental health services are less accessible to these individuals. 2. There is a lower likelihood of them receiving mental health care. 3. There is often a lack of satisfactory treatment for them; and 4. The number of women participating in mental health research is significantly underrepresented.

African Americans and Latinos are less likely than other racial minorities to seek mental health services. They are also more likely to delay seeking treatment. Therefore, it is common for such individuals to seek mental health services when experiencing acute symptoms. If treatment is delayed, the illness may worsen, and the number of involuntary

9/4/24, 6:39 PM Module 4: Lecture Culturally Approach to Mental Health Care: Transcultural and Global Health Disparities_NRSE707_SF001_MIAMI…

https://agmu.instructure.com/courses/30801/pages/module-4-lecture-culturally-approach-to-mental-health-care?module_item_id=1779709 2/4

services may increase. The mental health of members of most ethnic minorities is like that of Caucasians. However, minorities are more likely to experience factors that may exacerbate mental illnesses, including racism, discrimination, violence, and poverty (Cultural Competence in Mental Health, 2022).

2. Legal and Ethical Aspects of Genetic Testing. A genetic disorder counseling session involves communicating about human issues associated with its occurrence and recurrence. In this process, a qualified counselor guides medical facts about genetic disorders, the role of heredity in such conditions, the impact on other family members, preventive measures for the recurrence of such diseases, and determining the best course of action for the individual or family. To cope with the problem of genetic disorders, affected individuals and their families must be provided with adequate social and psychological support. Providing genetic counseling to individuals and their families is a beneficial way of reducing psychological distress and improving control over the situation. It includes information about the specific disease, its course, management, recurrence risk, and prenatal diagnosis or other preventive measures (Muthuswamy, 2011).

Suppose the patient is being evaluated because of a cancer diagnosis in a biological relative and is also found to be genetically susceptible to cancer. In that case, she must receive counseling, follow-up, and referrals if necessary, ensuring that the patient receives appropriate medical care according to current standards. The consultation and referral of an expert are required when dealing with these issues by obstetrician-gynecologists.

Whenever genetic screening is undertaken for any clinical purpose, there should be a link between genetic screening and interventions that may help improve outcomes, which include prenatal diagnosis, counseling, reproductive decision-making, lifestyle changes, and enhanced phenotyping, among other interventions. Before considering whether another “medical” test, for which consent may not always be obtained, is to be done to obtain genetic consent, a critical question that requests to be responded is whether the impact of genetic tests on those who undergo them differs substantively from those who undergo other “medical” tests for which consent may not always be obtained. It has been argued that some ethicists have criticized genetic tests because of their "exceptionalism." As far as their argument is concerned, many medical tests are also associated with similar effects on patients that genetic tests do on them. Insurance companies can discriminate against individuals suffering from genetic diseases or diseases unrelated to any gene, for example. Nongenetic and genetic tests may reveal information about family members (The American College of Obstetricians and Gynecologists, 2020).

Studying living organisms is one of the most challenging endeavors in science. As the DNA in its cells duplicates constantly, mutations are possible at any time. There may be little value in understanding how these strands of DNA function. Even though the human genome project can be beneficial, it presents several complex social, political, and cultural challenges for society. The public is concerned about several ethical dilemmas. If information derived from DNA's structure is used for discrimination purposes, it may be possible to discriminate against people based on information contained in DNA's design. Additionally, the possibility of choosing a fetus during pregnancy is a controversial issue. Due to this, there has been considerable commotion among pro-life advocates. I am also troubled by the idea of creating a “ perfect “ child. Our research would also lead to advancements in medical science that are unparalleled at this time, such as the discovery of cures for hereditary diseases (University of Washington, 2022).

In the last few decades, the field of medical genetics has been overgrown, leading to an array of new treatments for genetic diseases. As technology advances, we often find ourselves confronted with unique and significant ethical dilemmas that must be resolved by those providing genetic services, those who receive genetic services, and society. Increasingly, there are a variety of reproductive options available today. These options include artificial insemination by donor, genetic testing, in vitro fertilization, prenatal sex screening, surrogate motherhood, fetal tissue transplantation, and gene therapy. These options have raised significant ethical concerns. Families at risk and the public benefit significantly from genetic counselors' understanding and addressing legal issues concerning genetics and reproduction.

It is the responsibility of counselors to adhere to the following principles as part of their ethical responsibilities:(i) respecting patient autonomy, which implies respect for the patient's right to be informed and to make their own decisions; nonmaleficence, (ii) beneficence, which is taking action to benefit others and to prevent harm, both physically and mentally, and (iii) justice, which is the equitable distribution of services.

In addition to honesty, there is a responsibility to provide information, be truthful, and respect patients’ privacy. To the principles of autonomy and other ethical principles, non-directive counseling is a hallmark of the genetics profession (Muthuswamy, 2011).

References

Cultural Competence in Mental Health (2022). http://tucollaborative.org/wp-content/uploads/2017/01/Cultural- Competence-in-Mental-Health.pdf

9/4/24, 6:39 PM Module 4: Lecture Culturally Approach to Mental Health Care: Transcultural and Global Health Disparities_NRSE707_SF001_MIAMI…

https://agmu.instructure.com/courses/30801/pages/module-4-lecture-culturally-approach-to-mental-health-care?module_item_id=1779709 3/4

Fogel,A. et al.(2022). Cultural Assessment and Treatment of Psychiatric Patients. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK482311/

Fountain House (2022). Why is Cultural Competence Important in Mental Health Care? https://www.fountainhouse.org/news/why-is-cultural-competence-important-in-mental-health- care#:~:text=Cultural%20competency%20means%20that%2C%20as,their%20diagnosis%20and%20treatment%20plan.

Konstantakopoulos G.(2019). Insight across mental disorders: A multifaceted metacognitive phenomenon. Psychiatriki. 2019 Jan-Mar;30(1):13-16.

Muthuswamy, V. (2011). Ethical issues in genetic counseling with special reference to hemoglobinopathies. Indian J Med Res. 2011 Oct;134(4):547-51. PMID: 22089619; PMCID: PMC3237255. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237255/

National Council for mental Wellbeing (2022). Four Ways Culture Impacts Mental Health. https://www.mentalhealthfirstaid.org/2019/07/four-ways-culture-impacts-mental-health/

The American College of Obstetricians and Gynecologists ( 2020). Ethical Issues in Genetic Testing. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2008/06/ethical-issues-in-genetic- testing

University of Washington (2022). The Ethical Issues of Genetics. https://www.washington.edu/doit/ethical-issues- genetics

9/4/24, 6:39 PM Module 4: Lecture Culturally Approach to Mental Health Care: Transcultural and Global Health Disparities_NRSE707_SF001_MIAMI…

https://agmu.instructure.com/courses/30801/pages/module-4-lecture-culturally-approach-to-mental-health-care?module_item_id=1779709 4/4