Addressing the health care needs of a 21st-century nation that is experiencing increased diversity and disparity will require new models of educating future providers. The cultural competence and confidence model was the guiding framework in a study evaluating the influence of cultural educational offerings on the transcultural self-efficacy (TSE) perceptions in baccalaureate nursing students. The Transcultural Self-Efficacy Tool was used to measure perceived TSE in a pretest (N = 260), posttest (N = 236) study over an academic year. Significant changes were demonstrated in overall self-efficacy and on the cognitive, practical, and affective subscales. A classification and regression tree analysis identified social orientation as the demographic variable most predictive of the TSE level. This study supports previous research where positive changes were found in students' TSE based on the inclusion of cultural interventions in the nursing curriculum.

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The first major attempts to categorize psychiatric disorders in the United States occurred in the mid-1800s, when census data were collected that included "insanity" and "idiocy" of household members. In Europe, Florence Nightingale promoted the use of non-fatal disease classification for morbidity and treatment in 1860. By the late 1800s, Kraepelin categorized disorders, and his sixth edition of the Compendium der Psychiatrie was widely adopted by both Europeans and Americans. In 1952, the American Psychiatric Association published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Since then, the manual has been periodically updated, expanded, and edited to reflect social and scientific beliefs about the etiology and categorization of psychiatric illness and care. In this article, we explore the historical and ongoing development of the DSM and its implications for psychiatric nurses.

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