CMN 552
Module 5
Primary Study Guide
University of South Alabama
, CMN 552 – Module 5 Reading/Study Guide
Transcultural Nursing
DSM 5:
1. Define culture.
Culture refers to systems of knowledge, concepts, values, norms, and practices that are
learned and transmitted across generations. Culture includes language, religion and spirituality,
family structures, life-cycle stages, ceremonial rituals, customs, and ways of understanding
health and illness, as well as moral, political, economic, and legal systems. Cultures are open,
dynamic systems that undergo continuous change over time; in the contemporary world, most
individuals and groups are exposed to multiple cultural contexts, which they use to fashion their
own identities and make sense of experience. This process of meaning-making derives from
developmental and everyday social experiences in specific contexts, including health care, which
may vary for each individual. Much of culture involves background knowledge, values, and
assumptions that remain implicit or presumed and so may be difficult for individuals to describe.
These features of culture make it crucial not to overgeneralize cultural information or stereotype
groups in terms of fixed cultural traits. In relation to diagnosis, it is essential to recognize that all
forms of illness and distress, including the DSM disorders, are shaped by cultural contexts.
Culture influences how individuals fashion their identities, as well as how they interpret and
respond to symptoms and illness.
2. Define ethnicity.
Ethnicity is a culturally constructed group identity used to define peoples and communities. It may be rooted in
a common history, ancestry, geography, language, religion, or other shared characteristics of a group, which
distinguish that group from others. Ethnicity may be self- assigned or attributed by outsiders. Increasing
mobility, intermarriage, and intermixing of cultural groups have defined new mixed, multiple, or hybrid ethnic
identities. These processes may also lead to the dilution of ethnic identification.
3. What does culture refer to in the Cultural Formation Interview (CFI)?
The processes through which individuals assign meaning to experience, drawing from the values,
orientations, knowledge, and practices of the diverse social groups (e.g., ethnic groups, faith groups,
occupational groups, veterans’ groups) and communities in which they participate.
Aspects of individuals’ background, developmental experiences, and current social contexts and
position that affect their perspective, such as age, gender, social class, geographic origin, migration,
language, religion, sexual orientation, disability, or ethnic or racialized background.
The influence of family, friends, and other community members (particularly, the individual’s social
network) on the individual’s illness experience.
The cultural background of the health care providers and the values and assumptions embedded in the
organization and practices of health care systems and institutions that may affect the clinical
interaction.
4. Identify the components of culture.
5. What are culture syndromes?
Cultural syndromes are clusters of symptoms and attributions that tend to co-occur among individuals in
specific cultural groups, communities, or contexts and that are recognized locally as coherent patterns of
experience.
Sadock:
6. What is altruism?
Altruism is a secular term referring to a selfless obligation of benevolence, respect, and caring for humankind,
all living creatures, and the environment. Philanthropists and those who selflessly feed the hungry, clothe the
naked, preserve and improve the environment, shelter the homeless, care for the sick, protect the defenseless,
assist the weak, and enlighten the uneducated rightfully feel that they have accrued spiritual merits for their
good deeds and attain a sense of meaningfulness in their lives.
7. Define culture.
, Culture is defined as a set of meanings, norms, beliefs, values, and behavior patterns shared by a group of
people. These values include social relationships, language, nonverbal expression of thoughts and emotions,
moral and religious beliefs, rituals, technology, and economic beliefs and practices, among other items.
8. Discuss the relationship between race and physiognomy.
Race is a concept that entails people being grouped primarily by physiognomy. Although the scientific validity
of the concept is now considered highly questionable, its impact on individuals and groups, however, is intense,
due to its reference to physical, biological, and genetic underpinnings, and because of the intensely emotional
meanings and responses it generates.
9. What are models of mental illness?
10. What factors comprise cultural identity?
Cultural identity refers to the characteristics shared by a person’s cultural group. Identity allows for a self-
definition. Factors that comprise an individual’s cultural identity include race, ethnicity, country of origin,
language use, religious and tradition-nourished beliefs, socioeconomic status, sexual orientation, migration
history, experience of acculturation, and the degree of affiliation with the individual’s group of origin. Cultural
identity emerges throughout the individual’s life and in social context. It is not a fixed trait of an individual or of
the group of which the individual is part. An individual may have several cultural reference groups.
Evaluating the cultural identity of the patient allows identification of potential areas of strength and support
that may enhance treatment effectiveness, as well as vulnerabilities that may interfere with the progress of
treatment. Eliciting these data permits identification of unresolved cultural conflicts that may be addressed
during treatment. These conflicts can be between the various aspects of the patient’s identity and between
traditional and mainstream cultural values, as well as behavioral expectations affecting the individual.
Knowledge of the patient’s cultural identity allows the clinician to avoid misconceptions based on inadequate
background information or stereotypes related to race, ethnicity, and other aspects of cultural identity. In
addition, it assists in building rapport because the clinician is attempting to understand the individual as a
person and not just as a representative of the cultural groups that have shaped the patient’s identity
11. What three concepts assist in a culturally competent evaluation?
Cultural Syndrome defined as a cluster or group of cooccurring symptoms found in a specific cultural group,
community, or context. The syndrome may or may not be recognized as an illness within the culture (e.g., it
might be labeled differently) but may nevertheless occur and be recognized by an outside observer. DSM-5
includes in its Appendix, nine more or less well-delineated cultural syndromes (Ataque de nervios, Dhat,
syndrome, Khyâl cap, Kufungisisa, Maladi moun, Nervios, Shenjing shuairuo, Susto and Tajin kyofusho), that
are connected to conditions in other cultural contexts and specific diagnoses in DSM-5.
Cultural Idiom of Distress is a linguistic term, phrase or way of talking about suffering, shared with other
people from the same culture (i.e., ethnicity, religion, community) and used to express, communicate, or
comment on distress in general. An idiom of distress need not be associated with specific symptoms,
syndromes, or causal explanations. It may be used to convey a wide range of uncomfortable, emotional pain or
social shakiness including subclinical conditions or everyday experiences that do not necessarily constitute
mental disorders.
Causal attribution is a label, an attempt at explaining or ascertaining the causes of the symptoms, illness, or
distress. Causal explanations may be part of folk classifications of disease used by laypeople or healers, which,
in a good number of cases, may provide temporary relief.
12. Distinguish between the potential outcomes of acculturative stress: separation, integration, assimilation,
and marginalization.
Separation is characterized by individuals’ wishes, both conscious and intuitive, to maintain their cultural
integrity, whether by actively resisting the incorporation of the values and social behavior patterns of another
cultural group or groups with whom they have regular contact, or by disengaging themselves from contact with
and the influence of those other cultural groups. Some religious cults are examples of separation.
Integration, as an outcome of acculturative stress, derives from the wish to both maintain a firm sense of
one’s cultural heritage and not abandon those values and behavioral characteristics that define the uniqueness of
one’s culture of origin. At the same time, such individuals are able to incorporate enough of the value system
and norms of behavior of the other cultural group with which they interact closely, to feel and behave like
members of that cultural group, principally the majority host culture. Accordingly, the defining feature of
integration is psychological: It is the gradual process of formulation of a bicultural identity, a sense of self that
intertwines the unique characteristics of two cultures. Examples are found among the large number of
Module 5
Primary Study Guide
University of South Alabama
, CMN 552 – Module 5 Reading/Study Guide
Transcultural Nursing
DSM 5:
1. Define culture.
Culture refers to systems of knowledge, concepts, values, norms, and practices that are
learned and transmitted across generations. Culture includes language, religion and spirituality,
family structures, life-cycle stages, ceremonial rituals, customs, and ways of understanding
health and illness, as well as moral, political, economic, and legal systems. Cultures are open,
dynamic systems that undergo continuous change over time; in the contemporary world, most
individuals and groups are exposed to multiple cultural contexts, which they use to fashion their
own identities and make sense of experience. This process of meaning-making derives from
developmental and everyday social experiences in specific contexts, including health care, which
may vary for each individual. Much of culture involves background knowledge, values, and
assumptions that remain implicit or presumed and so may be difficult for individuals to describe.
These features of culture make it crucial not to overgeneralize cultural information or stereotype
groups in terms of fixed cultural traits. In relation to diagnosis, it is essential to recognize that all
forms of illness and distress, including the DSM disorders, are shaped by cultural contexts.
Culture influences how individuals fashion their identities, as well as how they interpret and
respond to symptoms and illness.
2. Define ethnicity.
Ethnicity is a culturally constructed group identity used to define peoples and communities. It may be rooted in
a common history, ancestry, geography, language, religion, or other shared characteristics of a group, which
distinguish that group from others. Ethnicity may be self- assigned or attributed by outsiders. Increasing
mobility, intermarriage, and intermixing of cultural groups have defined new mixed, multiple, or hybrid ethnic
identities. These processes may also lead to the dilution of ethnic identification.
3. What does culture refer to in the Cultural Formation Interview (CFI)?
The processes through which individuals assign meaning to experience, drawing from the values,
orientations, knowledge, and practices of the diverse social groups (e.g., ethnic groups, faith groups,
occupational groups, veterans’ groups) and communities in which they participate.
Aspects of individuals’ background, developmental experiences, and current social contexts and
position that affect their perspective, such as age, gender, social class, geographic origin, migration,
language, religion, sexual orientation, disability, or ethnic or racialized background.
The influence of family, friends, and other community members (particularly, the individual’s social
network) on the individual’s illness experience.
The cultural background of the health care providers and the values and assumptions embedded in the
organization and practices of health care systems and institutions that may affect the clinical
interaction.
4. Identify the components of culture.
5. What are culture syndromes?
Cultural syndromes are clusters of symptoms and attributions that tend to co-occur among individuals in
specific cultural groups, communities, or contexts and that are recognized locally as coherent patterns of
experience.
Sadock:
6. What is altruism?
Altruism is a secular term referring to a selfless obligation of benevolence, respect, and caring for humankind,
all living creatures, and the environment. Philanthropists and those who selflessly feed the hungry, clothe the
naked, preserve and improve the environment, shelter the homeless, care for the sick, protect the defenseless,
assist the weak, and enlighten the uneducated rightfully feel that they have accrued spiritual merits for their
good deeds and attain a sense of meaningfulness in their lives.
7. Define culture.
, Culture is defined as a set of meanings, norms, beliefs, values, and behavior patterns shared by a group of
people. These values include social relationships, language, nonverbal expression of thoughts and emotions,
moral and religious beliefs, rituals, technology, and economic beliefs and practices, among other items.
8. Discuss the relationship between race and physiognomy.
Race is a concept that entails people being grouped primarily by physiognomy. Although the scientific validity
of the concept is now considered highly questionable, its impact on individuals and groups, however, is intense,
due to its reference to physical, biological, and genetic underpinnings, and because of the intensely emotional
meanings and responses it generates.
9. What are models of mental illness?
10. What factors comprise cultural identity?
Cultural identity refers to the characteristics shared by a person’s cultural group. Identity allows for a self-
definition. Factors that comprise an individual’s cultural identity include race, ethnicity, country of origin,
language use, religious and tradition-nourished beliefs, socioeconomic status, sexual orientation, migration
history, experience of acculturation, and the degree of affiliation with the individual’s group of origin. Cultural
identity emerges throughout the individual’s life and in social context. It is not a fixed trait of an individual or of
the group of which the individual is part. An individual may have several cultural reference groups.
Evaluating the cultural identity of the patient allows identification of potential areas of strength and support
that may enhance treatment effectiveness, as well as vulnerabilities that may interfere with the progress of
treatment. Eliciting these data permits identification of unresolved cultural conflicts that may be addressed
during treatment. These conflicts can be between the various aspects of the patient’s identity and between
traditional and mainstream cultural values, as well as behavioral expectations affecting the individual.
Knowledge of the patient’s cultural identity allows the clinician to avoid misconceptions based on inadequate
background information or stereotypes related to race, ethnicity, and other aspects of cultural identity. In
addition, it assists in building rapport because the clinician is attempting to understand the individual as a
person and not just as a representative of the cultural groups that have shaped the patient’s identity
11. What three concepts assist in a culturally competent evaluation?
Cultural Syndrome defined as a cluster or group of cooccurring symptoms found in a specific cultural group,
community, or context. The syndrome may or may not be recognized as an illness within the culture (e.g., it
might be labeled differently) but may nevertheless occur and be recognized by an outside observer. DSM-5
includes in its Appendix, nine more or less well-delineated cultural syndromes (Ataque de nervios, Dhat,
syndrome, Khyâl cap, Kufungisisa, Maladi moun, Nervios, Shenjing shuairuo, Susto and Tajin kyofusho), that
are connected to conditions in other cultural contexts and specific diagnoses in DSM-5.
Cultural Idiom of Distress is a linguistic term, phrase or way of talking about suffering, shared with other
people from the same culture (i.e., ethnicity, religion, community) and used to express, communicate, or
comment on distress in general. An idiom of distress need not be associated with specific symptoms,
syndromes, or causal explanations. It may be used to convey a wide range of uncomfortable, emotional pain or
social shakiness including subclinical conditions or everyday experiences that do not necessarily constitute
mental disorders.
Causal attribution is a label, an attempt at explaining or ascertaining the causes of the symptoms, illness, or
distress. Causal explanations may be part of folk classifications of disease used by laypeople or healers, which,
in a good number of cases, may provide temporary relief.
12. Distinguish between the potential outcomes of acculturative stress: separation, integration, assimilation,
and marginalization.
Separation is characterized by individuals’ wishes, both conscious and intuitive, to maintain their cultural
integrity, whether by actively resisting the incorporation of the values and social behavior patterns of another
cultural group or groups with whom they have regular contact, or by disengaging themselves from contact with
and the influence of those other cultural groups. Some religious cults are examples of separation.
Integration, as an outcome of acculturative stress, derives from the wish to both maintain a firm sense of
one’s cultural heritage and not abandon those values and behavioral characteristics that define the uniqueness of
one’s culture of origin. At the same time, such individuals are able to incorporate enough of the value system
and norms of behavior of the other cultural group with which they interact closely, to feel and behave like
members of that cultural group, principally the majority host culture. Accordingly, the defining feature of
integration is psychological: It is the gradual process of formulation of a bicultural identity, a sense of self that
intertwines the unique characteristics of two cultures. Examples are found among the large number of
