C CMN 552 C
M M
N N
5 5
5 5
, CMN/552/–/Module/5/Reading/Study/Guide
Transcultural/Nursing/ D
SM/5:
1. Define/culture.
Culture/refers/to/systems/of/knowledge,/concepts,/values,/norms,/and/practices/t
hat/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/sy
stems/that/undergo/continuous/change/over/time;/in/the/contemporary/world,/most/ indivi
duals/and/groups/are/exposed/to/multiple/cultural/contexts,/which/they/use/to/fashion/thei
r/ own/identities/and/make/sense/of/experience./This/process/of/meaning-
making/derives/from/ developmental/and/everyday/social/experiences/in/specific/context
s,/including/health/care,/which/ may/vary/for/each/individual./Much/of/culture/involves/ba
ckground/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,/in
cluding/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/ro
oted/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/grou
ps/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/va
lues,/ orientations,/knowledge,/and/practices/of/the/diverse/social/groups/(e.g.,/ethnic/group
s,/faith/groups,/ occupational/groups,/veterans’/groups)/and/communities/in/which/they/parti
cipate.
● Aspects/of/individuals’/background,/developmental/experiences,/and/current/social/contexts/
and/ position/that/affect/their/perspective,/such/as/age,/gender,/social/class,/geographic/orig
in,/migration,/ language,/religion,/sexual/orientation,/disability,/or/ethnic/or/racialized/backgr
ound.
● The/influence/of/family,/friends,/and/other/community/members/(particularly,/the/individual’s/s
ocial/ network)/on/the/individual’s/illness/experience.
● The/cultural/background/of/the/health/care/providers/and/the/values/and/assumptions/embedd
ed/in/the/ organization/and/practices/of/health/care/systems/and/institutions/that/may/affect/th
e/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/recog
nized/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/huma
nkind,/ all/living/creatures,/and/the/environment./Philanthropists/and/those/who/selflessly/feed/the/hun
gry,/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/a
ccrued/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/grou
p/of/ people./These/values/include/social/relationships,/language,/nonverbal/expression/of/thoughts/an
d/emotions,/ moral/and/religious/beliefs,/rituals,/technology,/and/economic/beliefs/and/practices,/amon
g/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/v
alidity/ of/the/concept/is/now/considered/highly/questionable,/its/impact/on/individuals/and/groups,/how
ever,/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/accultura
tion,/and/the/degree/of/affiliation/with/the/individual’s/group/of/origin./Cultural/ identity/emerges/through
out/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/s
upport/ 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/ma
y/be/addressed/ during/treatment./These/conflicts/can/be/between/the/various/aspects/of/the/patient’s/i
dentity/and/between/ traditional/and/mainstream/cultural/values,/as/well/as/behavioral/expectations/aff
ecting/the/individual.
Knowledge/of/the/patient’s/cultural/identity/allows/the/clinician/to/avoid/misconceptions/based/on/inade
quate/ background/information/or/stereotypes/related/to/race,/ethnicity,/and/other/aspects/of/cultural/id
entity./In/ addition,/it/assists/in/building/rapport/because/the/clinician/is/attempting/to/understand/the/in
dividual/as/a/ person/and/not/just/as/a/representative/of/the/cultural/groups/that/have/shaped/the/patie
nt’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/gr
oup,/ community,/or/context./The/syndrome/may/or/may/not/be/recognized/as/an/illness/within/the/cultu
re/(e.g.,/it/ might/be/labeled/differently)/but/may/nevertheless/occur/and/be/recognized/by/an/outside/ob
server./DSM-5/ includes/in/its/Appendix,/nine/more/or/less/well-
delineated/cultural/syndromes/(Ataque/de/nervios,/Dhat,/ syndrome,/Khyâl/cap,/Kufungisisa,/Maladi/m
oun,/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,/commun
icate,/or/ comment/on/distress/in/general./An/idiom/of/distress/need/not/be/associated/with/specific/sy
mptoms,/ 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,/ill
ness,/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,/as
similation,/ and/marginalization.
Separation/is/characterized/by/individuals’/wishes,/both/conscious/and/intuitive,/to/maintain/their/c
ultural/ integrity,/whether/by/actively/resisting/the/incorporation/of/the/values/and/social/behavior/patter
ns/of/another/ cultural/group/or/groups/with/whom/they/have/regular/contact,/or/by/disengaging/themse
lves/from/contact/with/ and/the/influence/of/those/other/cultural/groups./Some/religious/cults/are/examp
les/of/separation.
Integration,/as/an/outcome/of/acculturative/stress,/derives/from/the/wish/to/both/maintain/a/firm/se
nse/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/en
ough/of/the/value/system/ and/norms/of/behavior/of/the/other/cultural/group/with/which/they/interact/clo
sely,/to/feel/and/behave/like/ members/of/that/cultural/group,/principally/the/majority/host/culture./Accor
, dingly,/the/defining/feature/of/ integration/is/psychological:/It/is/the/gradual/process/of/formulation/of/a/b
icultural/identity,/a/sense/of/self/that/ intertwines/the/unique/characteristics/of/two/cultures./Examples/a
re/found/among/the/large/number/of
M M
N N
5 5
5 5
, CMN/552/–/Module/5/Reading/Study/Guide
Transcultural/Nursing/ D
SM/5:
1. Define/culture.
Culture/refers/to/systems/of/knowledge,/concepts,/values,/norms,/and/practices/t
hat/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/sy
stems/that/undergo/continuous/change/over/time;/in/the/contemporary/world,/most/ indivi
duals/and/groups/are/exposed/to/multiple/cultural/contexts,/which/they/use/to/fashion/thei
r/ own/identities/and/make/sense/of/experience./This/process/of/meaning-
making/derives/from/ developmental/and/everyday/social/experiences/in/specific/context
s,/including/health/care,/which/ may/vary/for/each/individual./Much/of/culture/involves/ba
ckground/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,/in
cluding/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/ro
oted/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/grou
ps/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/va
lues,/ orientations,/knowledge,/and/practices/of/the/diverse/social/groups/(e.g.,/ethnic/group
s,/faith/groups,/ occupational/groups,/veterans’/groups)/and/communities/in/which/they/parti
cipate.
● Aspects/of/individuals’/background,/developmental/experiences,/and/current/social/contexts/
and/ position/that/affect/their/perspective,/such/as/age,/gender,/social/class,/geographic/orig
in,/migration,/ language,/religion,/sexual/orientation,/disability,/or/ethnic/or/racialized/backgr
ound.
● The/influence/of/family,/friends,/and/other/community/members/(particularly,/the/individual’s/s
ocial/ network)/on/the/individual’s/illness/experience.
● The/cultural/background/of/the/health/care/providers/and/the/values/and/assumptions/embedd
ed/in/the/ organization/and/practices/of/health/care/systems/and/institutions/that/may/affect/th
e/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/recog
nized/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/huma
nkind,/ all/living/creatures,/and/the/environment./Philanthropists/and/those/who/selflessly/feed/the/hun
gry,/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/a
ccrued/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/grou
p/of/ people./These/values/include/social/relationships,/language,/nonverbal/expression/of/thoughts/an
d/emotions,/ moral/and/religious/beliefs,/rituals,/technology,/and/economic/beliefs/and/practices,/amon
g/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/v
alidity/ of/the/concept/is/now/considered/highly/questionable,/its/impact/on/individuals/and/groups,/how
ever,/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/accultura
tion,/and/the/degree/of/affiliation/with/the/individual’s/group/of/origin./Cultural/ identity/emerges/through
out/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/s
upport/ 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/ma
y/be/addressed/ during/treatment./These/conflicts/can/be/between/the/various/aspects/of/the/patient’s/i
dentity/and/between/ traditional/and/mainstream/cultural/values,/as/well/as/behavioral/expectations/aff
ecting/the/individual.
Knowledge/of/the/patient’s/cultural/identity/allows/the/clinician/to/avoid/misconceptions/based/on/inade
quate/ background/information/or/stereotypes/related/to/race,/ethnicity,/and/other/aspects/of/cultural/id
entity./In/ addition,/it/assists/in/building/rapport/because/the/clinician/is/attempting/to/understand/the/in
dividual/as/a/ person/and/not/just/as/a/representative/of/the/cultural/groups/that/have/shaped/the/patie
nt’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/gr
oup,/ community,/or/context./The/syndrome/may/or/may/not/be/recognized/as/an/illness/within/the/cultu
re/(e.g.,/it/ might/be/labeled/differently)/but/may/nevertheless/occur/and/be/recognized/by/an/outside/ob
server./DSM-5/ includes/in/its/Appendix,/nine/more/or/less/well-
delineated/cultural/syndromes/(Ataque/de/nervios,/Dhat,/ syndrome,/Khyâl/cap,/Kufungisisa,/Maladi/m
oun,/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,/commun
icate,/or/ comment/on/distress/in/general./An/idiom/of/distress/need/not/be/associated/with/specific/sy
mptoms,/ 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,/ill
ness,/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,/as
similation,/ and/marginalization.
Separation/is/characterized/by/individuals’/wishes,/both/conscious/and/intuitive,/to/maintain/their/c
ultural/ integrity,/whether/by/actively/resisting/the/incorporation/of/the/values/and/social/behavior/patter
ns/of/another/ cultural/group/or/groups/with/whom/they/have/regular/contact,/or/by/disengaging/themse
lves/from/contact/with/ and/the/influence/of/those/other/cultural/groups./Some/religious/cults/are/examp
les/of/separation.
Integration,/as/an/outcome/of/acculturative/stress,/derives/from/the/wish/to/both/maintain/a/firm/se
nse/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/en
ough/of/the/value/system/ and/norms/of/behavior/of/the/other/cultural/group/with/which/they/interact/clo
sely,/to/feel/and/behave/like/ members/of/that/cultural/group,/principally/the/majority/host/culture./Accor
, dingly,/the/defining/feature/of/ integration/is/psychological:/It/is/the/gradual/process/of/formulation/of/a/b
icultural/identity,/a/sense/of/self/that/ intertwines/the/unique/characteristics/of/two/cultures./Examples/a
re/found/among/the/large/number/of
