1. Cultural Diversity ELDER Project Fairfield University School of Nursing Hispanic/Latino Culture Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

2. 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

3. 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

4. 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

5. Hispanic/Latino Culture Examples of Acculturation: 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

6. 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: ethnic population level of acculturation religion formal/informal support Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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: 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

14. 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. Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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. 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

22. 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

23. 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

24. 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

25. Reference Heath and Healthcare of Hispanic/Latino American. Retrieved November 20, 2010 from http://stanford.edu/group/ethnoger/hispaniclatino.html. 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.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. 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%20care- latino.pdf. http://depts.washington.edu/pfes/pdfs/end%20of%20life%20care- latino.pdf Supported by DHHS/HRSA/BHPR/Division of Nursing Grant #D62HP06858

26. 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