Culturally Competent Care of the Hispanic Patient

What is cultural competence? What is culturally competent care? These are very important questions to consider. Nurses are exposed to diverse cultures constantly in today’s society and need to be able to provide appropriate care while still respecting a patient’s cultural background.

Cultural competence in nurses is a combination of culturally congruent behaviors, practice attitudes, structures and policies that allow nurses to work effectively in cross-cultural situations. Cultural competence reflects a higher level of knowledge than cultural sensitivity, which was once thought to be all that was needed for nurses to effectively care for their patients (Stanhope & Lancaster, 2004).

Culturally competent care should be the foundation for all care that a nurse provides, especially when caring for a patient whose cultural background differs from that of the nurse. Care designed for a specific patient that is based on the uniqueness of his or her culture, including the culture’s norms and values is culturally competent care. This care should include strategies to empower the patient in making decisions related to his or her health behavior. Culturally competent care should be provided with sensitivity and respect to the cultural uniqueness of the patient (Stanhope & Lancaster, 2004).

LD – A Hispanic WomanLD is a 35 year old Hispanic female who has agreed to answer questions regarding her cultural background. She is a first generation Mexican-American whose parents and grandparents immigrated to the United States from Mexico in the late 1960s. LD was raised with what she believes are traditional Hispanic beliefs and values. She answered questions about socioeconomic factors, family values, religion, and health beliefs and practices. LD based her answers on the cultural beliefs and values that were instilled in her by her parents and grandparents.

Socioeconomic FactorsLD believes that her family falls into the middle-class socioeconomic group. She believes that the Hispanic community represented in all socioeconomic groups. In the community where she grew up, LD’s family was considered to be very affluent because they owned their own business. LD believes that in the local community the majority of the Hispanic population falls just above the poverty level to below the poverty level. When asked why she thinks this way LD replied, “We have large families and support our extended families. When you earn $60,000 a year and are only supporting a family of three or four you can live comfortably but when you earn that same $60,000 and are supporting ten to twelve people it is hard to make ends meet.”LifestyleWhen asked about lifestyle, LD stated that most activities revolve around religion and the family.

She did say that Hispanics have a tendency to want to maintain eye contact, touch frequently and be in close proximity when talking to another person. Garrido (2004) states, “Spanish speakers tend toward formality in their treatment of one another. A firm handshake is a common practice between people as a greeting and for leave-taking. A hug and a light kiss on the check are also common greeting practices between women who are close friends or family. In non-formal settings, conversations between Spanish speakers are usually loud, fast, and adorned with animated gestures and body language to better convey points.”. LD also said, “We like to dress up and look good, even if we are just going to the store on the corner to get milk.

I never leave the house without spending a long time dressing, fixing my hair, and doing my make-up. That is just the way we are.” Hispanics usually give great importance to and place great value on looks and appearance as a sense of honor, dignity, and pride. Hispanics tend to be more relaxed and flexible about time and punctuality than U.S. people. For instance, people who are invited for an 8 a.m. event may not begin to arrive until 8:30 a.m. or later. Within the Hispanic community, not being on time is a socially acceptable behavior (Garrido, 2004).

Family ValuesLD believes that family values are very important to the Hispanic culture. While she was growing up her household consisted of 10 people: her parents, three siblings, an unmarried aunt, an unmarried uncle, both of her mother’s parents, and herself. She stated that her childhood home was always open to visiting relatives and friends; at times there were as many as 15 people in the home. LD is already planning on having her parents live with her family when they are older. When asked why they would live with her and not one of her siblings her answer was, “I am the oldest child so I am the one who is responsible for caring for them.

If my brothers or sister need a home, then they will live with my family as well. That is what family is supposed to do, take care of each other.” Elders have a prestigious status in the Hispanic family because of their experience. Family members look to elders for advice. In the traditional household, the man is the head of the family and makes all major decisions. The truth is women are sacred and revered, often protected, not because she can’t handle herself or has no voice, but because the solidarity of the family unit depends on her well being (Culturaldiversity.org, 2005).

ReligionLD is a practicing Catholic and states that everyone in her family is a practicing Catholic. When asked about the religious preferences of the Hispanic community she is a part of, LD replied that 90% of the Hispanics she knows are Catholic but not all are practicing Catholics.

The majority of Hispanics are Catholic, with an increasing presence of Pentecostals. Health is a gift from God and should not be taken for granted. The prevention of illness is an accepted practice that is accomplished with prayer, the wearing of religious medals, or amulets, and keeping relics in the home. Visiting shrines, offering medals and candles, offering prayers and the lighting of candles is a frequently observed practice. Many homes have shrines with statues and pictures of Saints. The candles are lit here and prayers are recited (Culturaldiversity.org, 2005).

Health Beliefs and PracticesWhen LD was questioned about her health beliefs and practices she stated, “I don’t know about any specific Hispanic health beliefs because my family has always followed American health practices. My grandmother has always said that American medicine is better than the herbs that were used when she was young.”According to Culturaldiversity.org (2005) an individual who becomes sick will turn first to family members, especially elders, for support, comfort and advice. They may recommend safe, simple home remedies. Hispanics are far more emotionally expressive.

They expect to be pampered when ill; it is one way the family shows love and concern. This is a present oriented society, and as such they may neglect preventive health care, and may also show up late, or not at all, for appointments. Most Hispanics are Catholic, and birth control methods other than rhythm are unacceptable. Most Latin Americans see thinness as a problem and plumpness as the ideal. Hispanics are not accustomed to the profession of social workers, and rely on their families, other relatives and close friends for support and help (Culturaldiversity.org, 2005).

Curanderismo is defined as a medical system. It is a coherent view with historical roots that combine Aztec, Spanish, spiritualistic, homeopathic, and scientific elements. The curandero is a holistic healer; the people who seek help from him do so for social, physical, and psychological purposes. Since the curandero has a religious orientation, much of the treatment includes elements of both the Catholic and Pentecostal rituals and artifacts: offerings of money, penance, confessions, lighting candles, wooden or metal offerings in the shape of the afflicted anatomic part and laying on of hands.

To attend a woman during delivery is a woman’s job, ideally the job of her mother and midwife. Cultural tradition dictates that a husband not see his wife or child until the delivery is over and both have been cleaned and dressed. In general, Hispanic women prefer that their mothers attend them in labor (Culturaldiversity.org, 2005).

Cultural Assessment GuidelinesThe cultural assessment is a tool to help providers better understand what shapes patients’ ideas about health, illness, and disease. Cultural assessments can help determine patients’ beliefs, values and practices that might affect care and behaviors.

Several areas to consider when doing a cultural assessment include:•language and communication process•level of ethnic identity•views about the role that ethnicity plays•influence of religion/spirituality on the belief system and behavior patterns•views and concerns about discrimination and institutional racism•importance and impact associated with physical characteristics•migration experience, if applicable•use of informal network and supportive institutions in the ethnic/cultural community•values orientation•cultural health beliefs and practices•habits, customs, beliefs•current socioeconomic status•educational level and employment experiences•self concept and self esteem (University of Michigan Health System, 2007)Culturally Sensitive InterventionsWhen determining what nursing interventions to apply to a patient it is important to take this or her cultural values, beliefs, and expectations into consideration. Nurses in clinical practice must use their knowledge of cultural diversity to develop and implement culturally sensitive nursing care. Nurses take pride in their role as client advocates. Recognizing cultural diversity, integrating cultural knowledge, and acting, when possible, in a culturally appropriate manner enables nurses to be more effective in initiating nursing assessments and serving as client advocates (ANA, 1991).

ConclusionTo be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes (Culturaldiversity.org, 2005).

References

ANA. (1991). Ethics and human rights position statements: Cultural diversity in nursing practice. [Electronic version]. Retrieved June 25, 2007, from ANA NursingWorld website: http://www.nursingworld.org/readroom/position/ethics/etcldv.htmCulturaldiversity.org. (2005). The Hispanic American community. [Electronic version]. Retrieved June 24, 2007, from Cultural Diversity in Nursing Website: http://www.culturediversity.org/hisp.htmDavila, L. (2007). Interview of LD. [Interview conducted by Leslie Chambers]. Conversation held with LD.

Garrido, J. (2004). Understanding Hispanic culture. [Electronic version]. Retrieved June 24, 2007, from Hispanic News website: http://www.hispanic.cc/hispanic_culture.htmStanhope, M., & Lancaster, J. (2004). Community & public health nursing (6th) [Electronic version]. St. Louis, Mo: Mosby, Inc.

University of Michigan Health System. (2007). The cultural assessment.
[Electronic version]. Retrieved June 25, 2007, from University of Michigan Health System Website: http://www.med.umich.edu/multicultural/ccp/assess.htmDavila, L. (2007). Interview of LD. [Interview conducted by Leslie Chambers]. Conversation held with LD.

Garrido, J. (2004). Understanding Hispanic culture. [Electronic version]. Retrieved June 24, 2007, from Hispanic News website: http://www.hispanic.cc/hispanic_culture.htmStanhope, M., & Lancaster, J. (2004). Community & public health nursing (6th) [Electronic version]. St. Louis, Mo: Mosby, Inc.

University of Michigan Health System. (2007). The cultural assessment. [Electronic version]. Retrieved June 25, 2007, from University of Michigan Health System Website: http://www.med.umich.edu/multicultural/ccp/assess.htm