You make a home visit to a 32-year-old single woman who has worked for the same company for 22 years and has lived with her parents all of her life

Question

She has been referred for psychiatric consultation by a home health nurse because she looks almost continuously at the floor, exhibits very little range or spontaneity of affect, and waits for her parents to comment or direct her before she responds to any questions or comments. The parents have always been present throughout the home health nurse's visits. When you interview her by herself, she maintains eye contact, displays animated affect, readily answers all questions, and voices contentment with her life circumstances. As a culturally competent psychiatric nurse, you view this referral as having occurred primarily because: a. the client displayed objective signs of mental illness as defined by the DSM-IV
b. of family dynamics that require a referral for adult protective services investigation
c. the client needs help to integrate the home health care treatment culture
d. of the home health nurse's cultural norms related to mental illness and treatment

Answer 1

D
The home health nurse made the referral based on her own beliefs regarding normal behavior and indications of mental illness. In many cultures, behaviors such as not making direct eye contact to those senior and taking on an explicitly subordinate role when in the presence of one's elders not only is considered normal but to do otherwise would be considered highly aberrant. The client may have learned to adjust her behavior depending upon whether she is in the presence of her parents, who may expect such submissive behavior, and when she is not in their presence.