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Mexican American/Hispanic End-of-Life Care

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On a day to day basis within the medical field, it is likely to encounter patients from a variation of ethnical and cultural backgrounds. Within each culture, there are beliefs, values, traditions, and maybe even rituals that shape their expectations and actions regarding medical care. It is imperative as a healthcare professional to know how to work specifically with people from each one of these cultures, in order to gain trust and provide adequate care based off of and according to their beliefs. Some of these beliefs arise from religious views and values, emphasis on familial connections, and working around communication barriers that may be present. Therefore, the purpose of this paper is to explain the cultural beliefs of the Mexican American/Hispanic cultures, and how those beliefs affect end-of-life care. This will be explained by how people from the Hispanic culture manage symptoms, how communication barriers effect csare, how grief is expressed, how religious beliefs influence palliative care, and how healthcare providers are viewed from the eyes of a person from Hispanic culture.

Cultural Group Belief

Within the Mexican American/Hispanic culture, there are many beliefs and values that affect their behavior, views, and goals according to end-of-life care. These values encompass the importance of family, devout religious beliefs, and the influence and emphasis of communication in all aspects of life, including when it comes to medical interventions. All of these things help the people of this culture celebrate life, perpetuating it, rather making arrangements and provisions for death. People of the Hispanic culture often times believe in good and evil influences on life and in the world, and in the importance of keeping not just their bodies alive and well, but also doing the same for their spirit. These beliefs lead the people of the Hispanic culture to not always desire conventional medicinal intervention, such as visiting a hospital, but instead they view their pain, hardship, and discomfort due to illness as a test of their faith (O’Mara, Zborocskaya, 2016).

Symptom Management

When it comes to symptom management within the Hispanic culture, being able to reach out to and rely on family members is essential in order to properly cope with and find comfort in their situation (Contro et al., 2010). Within the Hispanic culture, families are very tight knit and view it as a privilege to help one another within their time of need, rather than it being an obligation or duty (O’Mara, Zborocskaya, 2016). Another way that managing of symptoms is done is by relying on their religious and spiritual influences. Most people of the Hispanic culture are highly religious and a very large percentage are Roman Catholic. Therefore, they can incorporate those beliefs into their symptom management and end-of-life care, with rituals such as one that they call anointing of the sick. This ritual helps them focus on the mental aspect of healing rather than the physical pain and symptoms that they are experiencing (Contro et al., 2010).

Communication

When it comes to people of the Hispanic community, it is a very common occurrence for the people to hold off on seeking out medical care. The largest, and most urgent reason behind this is the communication barrier, and the fear of not receiving adequate medical care because of the inability to express their beliefs and pains, and the inability to understand all aspects of palliative and end-of-life care. Within this community, it is very important that there is a translator available so that information and concerns do not get lost in translation. This is very important since if there is a lack of understanding and clarity revolving medical interventions and end-of-life care, it is very difficult to gain the trust of Hispanic families (Quinones-Gonzalez, 2013). Due to the belief of Familismo, which places an emphasis on the aspect of family cohesion to where the whole family is consulted with every medical decision, it is very important that trust is established with the family of the patient (Del Río, 2010). Within this belief, it is common that imperative medical decisions are put off until the extended family can be informed, and their input can be gained, since the decisions regarding end-of-life care and medical interventions usually come from the family (Del Río, 2010).

Expressions of Grief

Within the Hispanic culture, life is celebrated even beyond death and communication still continues with the deceased after they have passed. People of the Hispanic culture, use rituals in order to maintain connections, and find comfort within death (Contro et al., 2010). Families of this decent regularly talked about visiting the grave of their loved one, stressing the importance of constant visits, ensuring that the site of the burial clear, constantly decorating it with fresh flowers. Another way that grief is expressed is by participating in the Day of the Dead to where they make alters for their loved ones and also participate in a multitude of other activities and celebrations that honor and celebrate who they have lost. These alters are adorned with flowers, pictures, food, and many items that were important to the deceased, and also those that they want to give to their loved ones in death. The Day of the Dead helps people of the Hispanic culture annually celebrate the lives of their deceased family members, believing that the deceased comes back to visit the alter in which their picture is placed, which ultimately makes the grieving process easier (Arrendondo, Capistrán-López, 2017).

Religious/Spiritual Beliefs

As was mentioned earlier, a large majority of the people within the Hispanic culture are of Roman Catholic decent, and therefore all beliefs about end-of-life care stem from teachings and religious influences from the church (Contro et al.,2010). However, even those who do not claim Catholicism are usually also highly religious, having a strong belief in and connection with God. By having this relationship with God, they believe that uncertainty and ambivalence is an important part of life and that individuals cannot and should not try to do anything to modify their fate. This makes people of the Hispanic culture take each day as it comes, even in regards to illness (O’Mara, Zborocskaya, 2016). As mentioned earlier, Hispanic individuals also put large emphasis on the idea of up keeping their spirit, and because of this idea they desire to die in their home rather than within a hospital. This is because they believe that if they die in a hospital, their spirit may be lost (O’Mara, Zborocskaya, 2016).

Roles of HealthCare Workers

Another significant cultural value of the Hispanic culture is the ideas of respect and specifically the respect for hierarchy, which leads them to view healthcare professionals as authority figures due to their merit and socioeconomic status. Due to this recognition, Hispanics expect healthcare workers to return this respect by keeping family members informed on medical findings, and they also expect family members to be included within the decision making process. However, since people of the Hispanic culture do not perceive the respect as mutual, they are more likely to ignore the caregiver’s judgement (Del Río, 2010). Due to this, care-givers must acquaint themselves with each family and the specific circumstances that they are in, in order to obtain and maintain trust within the healthcare setting. The caregiver also must start conversations about end-of-life care early within the disease process to better understand the ideals surrounding death and medical interventions from the position of the patient, because the idea of autonomy does not exist within the Hispanic community, so they have complete confidence and credence in the healthcare provider (O’Mara, Zborocskaya, 2016). Healthcare providers must also be aware that older Hispanics typically do not hold eye contact, rather than noting it as an abnormal finding. Also it is important to note that touch is only acceptable among people of the same sex, so healthcare professionals must put extreme emphasis on the importance of touch during a physical assessment, and must always ask permission to do so (O’Mara, Zborocskaya, 2016).

Conclusion

To conclude, when it comes to end-of-life care, it is very important to consider and understand the culture in which the patient is included. Depending on the culture, beliefs regarding end-of-life care differ greatly depending on religious beliefs, cultural influences, communicative barriers, and many more aspects. So, to better care for a patient and gain trust as their caretaker, it is important to include their beliefs and cultural values within medical interventions, treatment, and assisting them with end-of-life care. Therefore, when it comes to the Mexican American/Hispanic culture, their beliefs about end-of-life care comes from their religious views from their involvement in Catholicism, learning to adapt to and work past communication barriers, celebrating the deceased after they have passed through rituals and the Day of the Dead, the involvement of the family in all aspects of care and within their lives, and their respect for authority figures.

References

  1. Arrendondo, A., & Capistrán-López, C. (2017). Pedagogy of death in popular traditions and in the institutionalization of the day of the dead in México [Abstract]. History of Education & Children’s Literature,297-319. doi:1971-1131
  2. Contro, N., Davies, B., Larson, J., & Sourkes, B. (2010). Away from home: Experiences of mexican american families in pediatric palliative care. Journal of Social Work in End-
  3. Of-Life & Palliative Care,6(3-4), 185-204. doi:10.1080/15524256.2010.529020
  4. O’Mara, S. K., & Zborovskaya, Y. (2016). End-of-life care in the Hispanic community. Journal of Hospice & Palliative Nursing,18(1), 53-59.doi:10.1097/njh.0000000000000210
  5. Quinones-Gonzalez, S. (2013). Bridging the communication gap in hospice and palliative care for hispanics and latinos. OMEGA – Journal of Death and Dying,67(1-2), 193-200. doi:10.2190/om.67.1-2.w
  6. Río, N. D. (2010). The influence of latino ethnocultural factors on decision making at the end of life: Withholding and withdrawing artificial nutrition and hydration. Journal of Social Work in End-Of-Life & Palliative Care,6(3-4), 125-149. doi:10.1080/15524256.2010.529009
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