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Nur 401 PPT Draft Hispanic Cultural Assessment
- 1. Hispanic Groups UtilizingtheTransculturalNursingAssessment Guide Nur 401 Coastal Carolina University By: Rachel Fogarty, Jacqueline, Janelle, Leslie Granger, Ashton Haney, Christine, Mary, and Jennifer
- 2. Introduction Cultural congruence is the distance between the cultural competence of healthcare institutions and the perceptual cultural neediness of the client. • Hispanics are the largest growing group of minorities, numbering 2 million in 2003, and projected to grow to 8 million by 2030. (citation) • By 2050, minorities are projected to overtake the non-Hispanic Caucasian population, yet Hispanics shoulder a disproportionate amount of ethnic and racial disparities compared to all ethnical groups. (citation) Ethnic related disparities are related to English fluency. 52% of Hispanic citizens speak English fluently. 74% of Hispanic non-citizens speak little to no English. (citation) Racial related disparities include: • Delayed care • Lack of cultural and ethnic knowledge of caregivers • Lack of insurance.
- 3. Family and Kinship Systems • Hispanics families have larger household size and greater prevalence of extended families. • One of most significant changes in family behavior is the decrease in marriages. • Co-habitation has become widespread offsetting the decrease in marriages. • Extended family network, family cohesions, and high level of social support reduce the effect of adverse consequences.
- 4. Family and Kinship Systems Cont’d • U.S. Hispanics consistently emphasizes their relatively high level of familism. • Familism is define as multi-dimensional concept that reflects both values and behaviors that emphasize needs of family over individual needs. • Familism declines as Hispanics groups spend more time in the U.S.
- 5. Social Life and Networks • Hard work and the pursuit of a better life are key components to their motivation to migrate (Guidorizzi, 2006). • The most important social structure is family and kinship, also known as “familism”(Andrews, 2012). • Many Latinos feel that Hispanic communities are isolated in the United States (Guidorizzi, 2006)
- 6. Social Life and Networks Cont’d • La cuarentena is the 40 day period of mother-child bonding after birth. • Approximately only 1/3rd of Hispanics are members of community-based organizations (DeSipio, 2004). • In accordance with the Catholic faith, most Hispanics observe the use of alcohol and tobacco in moderation (Andrews, 2012). • 80% of Hispanic adults in the U.S. say they use social networking sites like Facebook and twitter (Pew Research Center for the People & the Press, 2012a).
- 7. Political & Government Systems • Only 47% of Latino U.S. citizens voted in 2004 (DeSipio, 2005). • Many Hispanics live in substandard housing and rarely own homes. • Factors such as fear of deportation may lead to isolation within communities. Perceptions of laws and justice, housing, opportunities, and community response:
- 8. Political & Government Systems Cont’d • Overcrowding of housing units and poverty result in unsafe living conditions (e.g. holes in walls, pests, and exposed wiring). • Lack of accessible government and community services to migrants contribute to the disparity of environment (trash pick-up, noise pollution, odors, police and fire response).
- 9. Language & Traditions • Spanish is the 4th used language in the world and recognizes many dialects that vary depending on proximity to the Mexican border. • “Codeswitching” is known as a mixture of English and Spanish (Giger, 2013). • Greater than ¼ of the Hispanic population have less than a 9th grade education. • DHEC creates and provides bilingual education material and resources for non-English speaking clients.
- 10. Language & Traditions Cont’d La Semana Santa “Holy Week” • Religious holiday occurring a week before Easter. Quince Anos • Right of passage from girlhood to womanhood. • Girls dress up and dance with their fathers and brothers. Dia de los Muertos “Day of the Dead” • November 2nd is for celebration of deceased family and friends. • Altars are erected and decorated with flowers, pictures, and food.
- 11. Worldviews, Value Orientations, and Cultural Norms
- 12. Worldviews, Value Orientations, and Cultural Norms Cont’d
- 13. Religious Beliefs and Practices Influence of Religion in daily life: • God is an active force in life • Church & Faith are central to family • Daily Prayer Symbolism • The cross • Images of Saints • The rosary • Images of the Virgin • Family member mourns in black Practices surrounding major life events: Weddings: • Marriage-prep classes • Mass in Catholic Church • Bible/Church- Spiritual • Coins/lazo • Fruitcake soaked in Rum Grief/ Luto (mourning 9 days): • Vigils • Last rites: sacraments • Baptism before death • Rosary throughout the day • Wakes
- 14. Religious Beliefs and Practices Cont’d Health Care Practices: Medical/surgical interventions: • benefit vs risk Reproduction: • Abstinence, temperature/ovulation method Abortion: • Morally wrong • Amniocentesis: Not objectionable • Permanent sterilization: Forbidden • Genetic/Stem cell: Objectionable Death/dying: • Ordinary means of Preserving life Euthanasia: Not permitted Autopsy/Donation: Permissible Disposal of body & burial: • Burial/cremation (Andrews & Boyle, 2012)
- 15. Health Beliefs and Practices Attitudes regarding health and illness Home remedies/folk practioners Biological Variations Primary Health concerns
- 16. Health Beliefs and Practices Cont’d Magico-Religious Paradigm • Health & sickness determined by supernatural forces Culture-bound Syndromes • Susto, Mal ojo, Emphaco Curandero (healers) • Knowledgeable in the use of herbs • Use massage and rituals • Utilize hot/cold therapies Primary Biological Concerns Obesity Diabetes Liver, stomach, and cervical cancers HIV/AIDS Addiction
- 17. Healthcare Systems • In 2012, the percentage of Hispanics lacking insurance was 29.1%. • Lack of healthcare coverage along with limited English and health literacies are barriers that face the Hispanic population. • Interpreters and education materials in Spanish are available in many hospital systems.
- 18. Healthcare Systems Cont’d • There are facilities available to the Hispanic population within the community setting. • Some facilities offer specialized hours of operations to accommodate the Hispanic population
- 19. Conclusion
- 20. References Giger, J. N. (2013). Transcultural Nursing Assessment and Intervention (6th ed.). www.ncbi.nih.gov www.explore-hispanic-culture.com Guidorizzi, M. C. (2006). The Journey of Healing: A Narrative Approach. Journal Of Latino-Latin American Studies (JOLLAS), 2(2), 96-111. Hispanic families in the United States and Family Structure. www.ncbi.nlm.nih.gov. Andrews, M. & Boyle, J. (2012). Transcultural concepts in nursing care (6th ed). Philidelphia, PA: Lippincot Williams & Wilkins Mitrani, V. (2009). Reducing health disparities for Hispanics through the development of culturally tailored interventions. Hispanic Health Care International, 7(1), 2-4.
Editor's Notes
- This presentation will focus on the cultural characteristics of Hispanic groups and will offer interventions to be used by the nurse to provide culturally congruent care to this group. Research supports that culturally competent care is not in itself EFFECTIVE! The trend in healthcare is towards the implementation of culturally congruent care. Three elements were observed as key to SUCCESSFUL culturally congruent care. Matching ethnicity/race of the treatment provider to the cultural/racial characteristics of clients.). 2. Matching the modality to the perceived cultural characteristic of the client (eg. Family therapy is congruent to Hispanic cultural practice of “familism”. 3. Adapt treatment to clients culture (eg. Folktale therapy for young children).
- El sueño Americano is the what Latinos call the “American Dream” (Guidorizzi, 2006). The nurse should encourage and cultivate her patient’s strength to help accomplish such goals as the “American Dream”. This is an example of cultural congruence, in which the nurse and patient’s goals are congruent with the individual’s cultural needs. The nurse should provide family-focused care to ensure the support of the client’s family and friends (Andrews, 2012). In providing care, the nurse should recognize that members of some Latino communities my feel isolated. A cultural assessment by the nurse should identify any feelings of isolation within the community as well as the structure.
- During this 40 day period, other female family members and friends assist the mother in caring for the baby, preparing food, and daily household chores (Andrews, 2012). Also, spicy foods are often avoided during pregnancy and “la cuarentena” (Andrews, 2012). It is always important to know the client’s religious practices to tailor care. However, the nurse should be mindful about the use of contraceptives in Hispanic women, since the majority are Catholic and Catholics do not use birth control (Andrews, 2012). The nurse should perform a thorough assessment to determine the use or absence, including frequency of any alcohol or tobacco abuse in all clients, regardless of religious affiliation.
- Hispanics primarily speak Spanish. It’s the fourth most commonly used language in the world. They are the least educated in the U.S. More than ¼ of Hispanic adults have less than a ninth-grade education. There are many places including DHEC where Hispanics are able to receive pamphlets and reading materials in Spanish. It is ideal to be taught English at an early age. There should be programs to help the older Hispanics be able to learn
- The different Hispanic cultures share many holidays and traditions, including Navidad, La Semana, Las Pinatas, Quince Anos. Navidad is Spanish for Christmas. Navidad emphasizes the religious nativity scene.
- Coins represent physical element and lasso represents emotional element. 13 coins represent a pledge of his support and signof trust acceptance of the coins signifies she will be faithful; The coins are said to represent Christ and his 12 disciples. Rosey beads (Lazo) placed at the necks of the couple after they exchange vows to show the union and protection of the marriage. References: L. Vallejo, 2011. Hispanics have many traditions for weddings. Intermountain Catholic; April 17, 2015 ed., Retreived from http: //icatholic.org ; Latinos deeply religious & rely on faith , grief may present with physical discomfort of stomach, headache, nervous breakdown, mourning may last 9 days with devotion of prayers, children become angels, Rosary throughout the day, close family may wear black and abstaining from parties or festivities . Crawford, A., Moore, L.S., & Simmons, J., (2008). Understanding bereavement in Latino families, A practical guide for practitioners. North Carolina Healthy Start Foundation, 2(2), Retreived from: http://www.nc.healthystart.org/aboutus/maternidad/vol2no2.htn
- The Roman Catholic Church; A.D. 30, Priest, Nuns, Deacons & Brother ( men who have taken religious vows). Deacons are able to marry; Holy days: Sundays’, Services are usually held between 4 pm Saturday – Sunday evening. Other Holy Days: Christmas, Solemnity of Mary, Mother of God, Ascension Thursday, Feat of Assumption, All Saints Day, Feast of Immaculate Conception. Seven Sacraments: Baptism, Confirmation, Eucharist, Anointing of the Sick, Penance, Holy Order, Matrimony. Days of Fasting: for ages 18-62 yrs, no meat or meat products, Fast for Ash Wednesday and Good Friday & all Fridays of Lent, the sick are not bound. ETOH & tobacco permissible if used in moderation. Amniocentesis: morally objectionable if used to decide on termination of pregnancy. Genetics/stem cell: Violation of moral rights of individuals and interferes with Gods right as the master of life and human beings. Autopsy/donation of body permissible if body treated with respect. References: Andrew, M.M., & Boyle, B. (2012) Transcultural Concepts in Nursing Care (6th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott, Williams & Wilkins; Leyva, B. (2014). Religion, fatalism, and cancer control: a qualitative study among Hispanic Catholics. American Journal of Health Behavior, 38(6):839-49. doi: 10.5993/AJHB.38.6.6.
- Health beliefs and practices of a community determine how members view health and illness, and how and who they seek healthcare from. When assessing health beliefs and practices, one needs to ascertain the group’s attitude regarding health and illness. As well as, what the are major health concerns among residents? Are they biologically predisposed to certain illnesses? How does the group treat illness? Do they seek folk healers, or use home remedies? (Andrews & Boyle, 2012
- Culture-bound syndromes are comprised of beliefs regarding specific symptoms unique to specific cultures. Susto is precipitated by frightening experiences and symptoms include nervousness, loss of appetite and sleep. Empacho is caused by undigested food and symptoms include bloating and excessive thirst (Andrews, 2012, pg. 139). Hispanics may first seek care from folk healers. In the Hispanic culture, Curandero’s are traditional healers versed in the use of herbal medicine, diet, massage and rituals. Hispanics also prescribe to the hot/cold theory of disease to illnesses. Diseases are treated by counterbalancing the “hot” or “cold” disease with associating “hot” or “cold” food items, drinks or herbs (Andrews, 2012, pg. 77). Hispanics also are more likely to suffer behavioral rooted health conditions such as HIV/AIDS, substance abuse, depression and domestic violence. The National Center on Minority Health and Health Disparities, part of the National Institute for Health, funds research dedicated in eliminating health disparities within the Hispanic-American culture. El Centro: Center of Excellence for Hispanic Health Disparities Research at the University of. The aim of El Centro is to develop interventions culturally tailored to Hispanics to decrease incidences of the disproportionately behavior induced illness such as HIV/AIDS, addiction, depression and violence ( Mitrani, 2009). As we have learned from our cultural assessment of Hispanics, Hispanics have unique values, practices, worldviews and beliefs that directly impact their health and by increasing our cultural competence we can better care for the Hispanic community and increase their overall health and well being.
- According to the Centers for disease Control and prevention, the percentage of Hispanics in the United States lacking healthcare coverage was 29.1% (2014). Lack of healthcare coverage is one the barriers facing the Hispanic population. The U.S. Department of Health and Human Services states that lawful immigrants have access to either Medicaid or private insurance, those of mixed status have access to Medicaid, and those who are not lawful immigrants have access to coverage for emergency services (2014). It is important to educate the Hispanic population of healthcare coverage that is available. According to Andrews and Boyle, the Joint Commission on Accreditation of Healthcare organizations and the American Hospital associations both require accommodations be made for patients who lack proficiency in English (2012). These services include interpreters and education materials.
- There are facilities within the community setting that offer services to the Hispanic population. One local service is Little River Medical Center. LRMC offers a migrant clinic along with other services that are offered for anyone with little to no insurance coverage. The migrant clinic offers after hour services to accommodate migrant worker schedules, a bilingual physician, and bilingual staff (LRMC, 2013).