A PMHNP is evaluating a 55-year-old Hmong woman brought by her family for 'not sleeping and talking to spirits.' The family reports she has been performing rituals and speaking to deceased relatives. The patient's culture recognizes spirit communication as a normal spiritual practice. The patient denies distress and maintains her daily functioning. The family is concerned because a neighbor suggested she might be 'crazy.' The PMHNP must integrate cultural context into the diagnostic assessment.