2. Case Study
Maria Abuelo is a 39 year old Mexican-American woman who lives with her husband
(Hector, 40) and his extended family in a small migrant community in Southern
Chester County, Pennsylvania. She has 5 children, all of whom attend public schools
and speak English. Maria and her husband speak minimal English. Maria travels by
bus to take her children to see the nurse practitioner at a community health clinic in
nearby Delaware. She herself has never sought health care. While in the clinic one of
her teenage daughters mentions to the nurse practitioner that her mother has been
sleeping a lot lately and sometimes is “sick to her stomach”. The NP convinces Maria
to be examined and then orders follow –up lab work. Upon review Maria’s fasting
glucose level is 322. Her Hemoglobin A1C is 11.
You are the home care nurse assigned to visit Maria and help her manage her newly
diagnosed diabetes.
Based on your investigation about health beliefs and practices of this cultural group,
address the following questions as you plan for her post-op care and follow-up.
3. Nursing Diagnosis
Impaired verbal communication related to foreign language barrier as
evidenced by the inability to speak or understand English as a primary
language and the need for an English/Spanish translator.
Knowledge deficit related to Type II Diabetes as evidenced by new
diagnosis and need for diabetes education.
Risk of complications related to unstable blood sugars related to
potential non-compliance.
4. Areas of Health for Nurse to Assess
An area of health that will need to be assessed by the nurse is proper
nutrition/diet since high-fat foods are a big part of Mexican
culture. Educating on daily exercise and the potential complications of
Type 2 Diabetes would be important as well.
The Mexican culture is known for cooking big meals for their families
and communities. These meals mostly consist of rice and beans, which
are a staple for almost every meal. When discussing type 2 diabetes,
carbohydrates are a food group to be cut down or taken in moderation.
This is very important to be discussed with the family.
The other areas of health that need to be addressed are patient and family
diet, lifestyle adjustment, nutrition education for patient and family,
encouraging exercise, and coordinating follow-up visits with these
suggestions.
5. Interventions to provide Culturally
Competent Care
In the Mexican culture, people use the term “confianza” to refer to
trust or confidence. It is important to gain trust by spending time,
being friendly and respectful, recognizing the importance of family
within the Mexican culture, and even attempting to speak Spanish
(Jones, 2015).
It would be to the best interest of the patient to have a family member
who speaks English to be present and to help with translation of the
severity the patient’s diagnosis of new onset diabetes treatment.
Consulting a case management worker to help establish health
insurance to pay for total care and maintenance for the patient.
Including family and close members of the community in the plan of
care and education would also be beneficial.
6. Family/Community Inclusion
“Social support is instrumental in affecting diabetes self management
and clinical outcomes” (Morris-Mcwan, Pasvogel, Gallegos, & Barrera,
2010, p. 311).
The teenage daughter should be the primary consultant. The patient’s
teenage daughter could let the health care worker know if there are other
close family members or close friends who could help translate to the
patient when she is not available.
The Mexican culture is very involved in their community as well as
treating extended family as their immediate family. Sometimes extended
families all live within one home. Because of this, it is important to
include immediate family, extended family, and close community
members in the plan of care. In addition, Mexican households are
typically patriarch driven and the man of the house makes all of the
decisions and is in charge of the household. It is important to ensure they
are educated on the plan of care as well.
7. Evaluation of Plan of Care
You will know if you’ve established trust if your patient and her family feel
comfortable enough to ask questions, confide in you, and ask for help when
needed.
To evaluate the plan of care, it is necessary to make sure the patient has a primary
health care provider to monitor her diagnosis. I will evaluate the living situation,
and help the patient proceed with follow up care.
8. Individual Conclusions
I will provide culturally safe care by being friendly and attempting to speak the
little bit of Spanish that I know. I would include the family and any suggested
community members in the plan of care and education sessions. This will help
with translation as well as support the patient. I will continue to stress the
importance of improving diet while still respecting that food is an important part
of their culture. I will continue to follow up and continue to ask if they have any
questions or concerns. Wendi Murphy
Upon my home care visit to the patient, I would like to keep a journal and
document the daily meals and concerns of the patient and her family. I would
encourage the patient and family to discuss their daily dietary intake with me in
order to promote a healthy menu plan. In case there is an emergency with the
patient, family members need to know emergency contact information to assist in
a life-threatening situation. It is also important to ask the patient and family open
ended questions to grasp a better understanding for what is necessary for proper
patient care. I would keep close contact with at least one family member or close
friend of the patient who speaks English to help translate with the patient to assist
with any concerns. Margaux Charney
9. Individual Conclusions
To provide culturally safe and competent care, I will include as many of the family
members as possible. I will provide all of my communication with the daughter
present to make Ms. Abuelo feel as comfortable as possible and to help with
translation. I will formulate a diet plan with the help of the patient and her family
to keep the diet culturally appropriate but healthy as well. It's important to assess
what values are important to the patient to provide patient-centered care.
Taylor Stephenson
10. References
Jones, S. M. (2015). Making me feel comfortable: Developing trust in the nurse
for Mexican Americans. Western Journal of Nursing Research, 37 (11), 1423-
1440.
Morris-McEwan, M., Pasvogel, A., Gallegos, G., & Barrera, L. (2010). Type 2
diabetes self-management social support intervention at the U.S.-Mexico border.
Public Health Nursing, 27(4), 310-319.
