Transcript Hispanic/Latino Culture

Cultural Diversity
ELDER Project
Fairfield University School of Nursing
Hispanic/Latino Culture
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Objectives: Upon completion of this session, the
participants will be able to ….
 Define the term acculturation and its impact on providing
culturally competent care.
 Discuss the role of religion, traditional health care beliefs,
social values, and family structure of Hispanics/Latinos
and the impact these factors have on health care.
 Identify specific culturally sensitive practices that can be
incorporated into you work with Hispanic/Latino patients.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Introduction:
The U.S. Bureau of the Census uses the term “Hispanic” to
mean an ethnicity category referring to “a person of:
 Cuban
 Mexican
 Puerto Rican
 South or Central America or
 other Spanish culture of origin
regardless of race”.
The term “Spanish origin” in addition to Hispanic or Latino
can be used.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Acculturation:
 Can be defined as a continuum.
 At one end the retention of values and beliefs from one’s own
culture of origin is maintained.
 Moving towards the center of the continuum, one can become
bilingual and bicultural, easily shifting from traditional
practices to adopting practices of the mainstream society.
 At the end of the continuum, individuals may fully adopt the
values and beliefs of the mainstream thus no longer
identifying with their own culture.
 Higher levels of acculturation increase the likelihood for
access to certain screenings or healthcare.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Examples of Acculturation:
 In a study of breast cancer screening of Columbian,
Ecuadorian, Dominican and Puerto Rican woman ages 1874; those who were more acculturated had more recently
received breast screening and mammography.
 Another study looked at health practices of Mexican
American elder population and found that women who
were highly acculturated tended to be current smokers and
heavy drinkers. As acculturation increased, subjects were
more likely to participate in regular exercise.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
 General information that can be helpful in assessing
people with regards to their culture includes:
 Learning about how they define their ethnicity
 Learning about the degree of affiliations they have with
their:
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ethnic population
level of acculturation
religion
formal/informal support
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Communication:
 Respect is key:
 People of this culture do not appreciate familiarity and/or
physical touch by strangers or verbal casual use of first names.
 Attention to building rapport will go a long way to facilitate
communication.
 Rapport begins through exchange of pleasantries.
 Healthcare providers are expected to be warm and
personal.
 A nod “yes” will be utilized even if they do not understand.
 It does not signify agreement; rather that they are listening.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Communication:
 Silence is a sign of not understanding or disagreement.
 Disagreement will foster noncompliance.
 Failures in communication can be viewed as due to
prejudice.
 Authority will not be questioned (i.e. the doctor).
 Eye contact with healthcare providers is avoided as a sign of
respect.
 An appropriate interpreter is needed as family members
may not be comfortable discussing certain topics with the
opposite sex or younger members of their families.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Suggestions for respectful communication:
 Address the older person by their last name.
 Avoid gestures, they may have adverse connotations.
 Carefully evaluate if questions or instructions have been
understood.
 Encourage the patient to ask questions.
 Communicate with the patient that you realize that
some things are not normally discussed, but are
necessary so that the best care can be planned.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Family and Social Structure:
 “Familismo” is characterized by interdependence,
affiliation and cooperation.
 Family (nuclear and extended) and community (friends
and neighbors) are the most important social and
supportive entities.
 Families tend to live close to each other
 The needs of the family take precedence over individual
needs.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Family and Social Structure:
 Older Hispanics expect the children to provide support and
mutual reciprocity.

They may rely on informal support networks post
hospitalization more than formal support.
 Important decisions involve the whole family.
 The family prefers to bear bad medical news before the
patient is told and then the family spokesperson delivers
the news.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Family and Social Structure:
Family Roles:
 The father is responsible to provide for and be in charge of the
family.
 “Machismo” or macho is the sense of honor that is vital to the
Hispanic sense of self, self-esteem and manhood.
 The mother determines when medical care is needed.
 The male head of the house gives permission; often the oldest
adult male.
 The wife is expected to show respect and submission to the
husband.
 The woman is the primary force holding the family together, the
primary caregiver and responsible for most of the parenting.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Family and Social Structure:
It is critical for healthcare providers to assess social and
family networks to determine the extent of support that is
being provided. This can be done by:
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organizing family meetings,
helping the family identify needed resources
providing necessary education related to current disease
processes
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
View of Illness:
Illness is seen as an imbalance between internal and external
sources (person and environment) expressed as too much “hot”
or “cold”.
 Cold diseases/conditions
characterized by vasoconstriction and low metabolic rate
 for example: menstrual cramps, rhinitis, pneumonia and colic
 cold conditions are treated with hot medications to bring back
balance
 Hot diseases/conditions
 characterized by vasodilatation and high metabolic rates
 for example: pregnancy, high blood pressure, diabetes, and
indigestion
 Hot conditions are treated with cold medications to bring back
balance.
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Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
View of Illness:
 Conditions that are primarily spiritual in nature are treated
with prayers and ritual.
 Patient is seen as an innocent victim and is expected to be
passive when they are ill. The family may even provide
support for ADLs while sick.
 Depression is not seen as an illness, but is often viewed as
weakness and an embarrassment to the family. These issues
need to be treated with respect. Services of the clergy may
be helpful.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
View of Illness:
 The idea that illness is punishment for past deeds may
inhibit participation in preventive or therapeutic
procedures.
 Disease prevention is not valued. There is a high incidence
of chronic illness such as high blood pressure and diabetes.
 Asking about and listening to cultural beliefs helps to
establish rapport and shows respect.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Folk Medicine:
 Use of folk medicine is learned in early childhood,
adolescence or early adulthood. As a person ages, they tend
to have less faith in folk medicine and rely more on
conventional health providers, self-medications, home
remedies or God’s divine will.
 Folk healing shows a cultural blend in religion.
 There is use of complementary and alternative medicine,
such as chiropractic, acupuncture, massage and herbal use.
 Herbal remedies are sought to treat diabetes, colic, bowel
problems, fright and pink eye.
 Herbal remedies may include spices and fruits in teas/foods.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Folk Medicine:
 Home remedies or over-the-counter medication may be
preferred because of the high cost of medicines.
 Standard prescriptions may be more acceptable if traditional
remedies can continue to be taken.
 Tend to share medicines within their social networks.
 Healing systems and techniques include:
 Curanderismo – Mexican folk healing. Practitioners are
called Curanderos. (not used as much in the US)
 Espiritismo –Puerto Rican faith healers. Practitioners are
called Espiritistas.
 Santaria –Cuban faith healers. Practitioners are called
Santeros.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Folk Medicine:
 It is believed that the spirit world can intervene in the
human world. This is widely practiced in Puerto Rico.
 In times of need, a person may turn to a Yerbero (herbalist)
or a Sobador (massage therapists) or a Partera (midwife
who treats children).
 May see a naturalist doctor who prescribes natural
remedies but does not treat the spiritual component of
care.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Time Orientation:
 Emphasis is on the present.
Dietary Habits:
 Foods are defined as hot or cold.
 Diet consists largely of rice and beans prepared with lard
and tortillas.
 Meals tend to be large and heavy.
 Frequent use of fast foods.
 Obesity is a significant problem.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Religious Beliefs:
 Spiritual and religious influences play a major role in
health and illness
 Religion has an important impact on the patient’s
participation in health care recovery.
 Church is central to the life of the family and community.
 Faith and church are powerful resources of hope and strength.
 Prayer and faith are important values, beliefs and coping
mechanisms
 Alters are used in living rooms or bedrooms.
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Candles with pictures of saints have specialized and general
meanings for Catholics. They burn 24 hours a day to signify
sustaining of worship.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Religious Beliefs:
 Belief is that good and evil spirits can affect the well-being
and spirit of the dead person.
 The majority of Hispanics are Catholics and then
Christians.
 Important rites include the baptism of infants and the
anointing of the sick (last rites).
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Cultural Themes:
 Family (Familismo)-importance of family at all levels:
 Needs of the family take precedence over individual needs
 Mutual reciprocity
 Mutual respect/ trust-building (Personalismo)
 Respect for hierarchy (Jerarquismo)
 Emphasis on present (Presentismo)
 Belief that good/evil spirits can affect well being and the
spirit of the dead person (Espiritismo).
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Hispanic/Latino Culture
Constraints in Care:
 Familism
 Spanish language
 Faith in God
 Difficulty accessing care
Conclusion:
It is important for healthcare providers to be familiar with the
range of belief systems found in the U.S., yet it is
imperative not to assume based on ethnic background that
any individual maintains traditional beliefs.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Reference
 Heath and Healthcare of Hispanic/Latino American. Retrieved
November 20, 2010 from
http://stanford.edu/group/ethnoger/hispaniclatino.html.
 Talamantes, M. and Sanchez-Reilly, S. (2010). Health and Healthcare of
Hispanic/Latino American Older Adults. Retrieved November 20, 2010
from http://geriatrics.stanford.edu/ethnomed/latino.
 University of Washington Medical Center. (2007). Communicating with
Your Latino Patient. Retrieved November 7, 2010 from
http://depts.washington.edu/pfes/pdfs/latinocultureclue.pdf.
 University of Washington Medical Center. (2007). End of Life Care: The
Latino Culture. Retrieved November 7, 2010 from
http://depts.washington.edu/pfes/pdfs/end%20of%20life%20carelatino.pdf.
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858
Power Point Presentation
Created By:
Joyce Cunneen, MSN, RN
Fairfield University School of Nursing
ELDER Project Education Coordinator
Monica Starr, BSN, RN
Fairfield University School of Nursing
ELDER Project Program Coordinator
Supported by DHHS/HRSA/BHPR/Division of
Nursing Grant #D62HP06858