Session 6: Hispanic/Latino Culture



ELDER ProjectFairfield University School of NursingCultural DiversityHispanic/Latino CultureObjectives:At the end 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/Latino culture and the impact these factors have on health care.Identify specific culturally sensitive practices that can be incorporated your work with Hispanic/Latino patients.Food Presentation……………………………………….…….……….………5-10 minutesDepending on one or two presentersIntroduction……………………………………………………………………….....5 minutesThe 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 or origin regardless of race”.The term “Spanish origin” in addition to Hispanic or Latino can be used.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.Examples: In a study of breast cancer screening of Columbian, Ecuadorian, Dominican and Puerto Rican woman ages 18-74; 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.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:ethnic populationlevel of acculturationreligionformal/informal supportAreas of Focus…………………………………..………………………………...30 minutesCommunicationRespect 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.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.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 municate with the patient that you realize that some things are not normally discussed, but are necessary so that the best care can be planned.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 otherThe needs of the family take precedence over individual needs.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.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.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:organizing family meetings, helping the family identify needed resourcesproviding necessary education related to current disease processesView of IllnessIllness is seen as an imbalance between internal and external sources (person and environment) expressed as too much “hot” or “cold”.Cold diseases/conditionscharacterized by vasoconstriction and low metabolic ratefor example: menstrual cramps, rhinitis, pneumonia and coliccold conditions are treated with hot medications to bring back balanceHot diseases/conditionscharacterized by vasodilatation and high metabolic rates for example: pregnancy, high blood pressure, diabetes, and indigestionHot conditions are treated with cold medications to bring back balance.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.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. Folk MedicineUse 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.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.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.Beliefs Regarding End of Life Care and DeathReligion, faith and spirituality hold important role in the acceptance of death.Die at home more frequently than other ethnic groups.Believe the hospital is impersonal and disrupts the family’s ability to care for the patient.May hold the belief that the person’s spirit is lost if they die in the hospital rather than at home.May want to honor the deceased relative by cleansing the body.Religion, faith and spirituality hold important roles in the acceptance of death.Draw on inner resources, cultural expectations of treatment, familial supports and spiritual or religious beliefs.Hospice care denotes “giving up hope and faith” in the life of the dying patient. They also hold distrust in the provider and healthcare system.Autopsies and organ donation is usually resisted.Stoicism is valued. See pain as something that needs to be lived with.See death as a natural part of life. God determines the outcomes of illnesses.Grieving is considered a natural part of the life process.Wailing and demonstrations of strong emotions at the time of death is a sign of respect.Last rites are importantEl Dia de Los Muertos (Day of the Dead) is a holiday that is celebrated in Mexico and Hispanic communities. People bring food and other symbols to the graves of deceased family to honor their lives and celebrate the unity of the family. Decorated altars with pictures of the deceased and symbols representing death and dying are also displayed in numerous places during this holiday.Time Orientation: Emphasis is on the present.Dietary HabitsFoods 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.Religious BeliefsSpiritual 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 mechanismsAlters are used in living rooms or bedrooms.Candles with pictures of saints have specialized and general meanings for Catholics. They burn 24 hours a day to signify sustaining of worship.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).Cultural ThemesFamily (Familismo)-importance of family at all levels: Needs of the family take precedence over individual needsMutual reciprocityMutual 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).Constraints in Their Care FamilismSpanish languageFaith in GodDifficulty accessing careActivity ……………………………………………………………….…………..…15 minutesJeopardy GameConclusion 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.References:Heath and Healthcare of Hispanic/Latino American. Retrieved November 20, 2010 from , M. and Sanchez-Reilly, S. (2010). Health and Healthcare of Hispanic/Latino American Older Adults. Retrieved November 20, 2010 from of Washington Medical Center. (2007). Communicating with Your Latino Patient. Retrieved November 7, 2010 from of Washington Medical Center. (2007). End of Life Care: The Latino Culture. Retrieved November 7, 2010 from . ................
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