Introduction
Since 2000, the Hispanic population, i.e., persons of Latino descent, in the U.S. has grown by 43%, raising the demand for culturally appropriate nursing care for this cultural group (Sobel & Metzler, 2016). A disproportionate risk of high blood pressure, obesity, diabetes, TB, and HIV/AIDS has been observed among Hispanics (Sobel & Metzler, 2016). Nevertheless, Hispanics have limited access to health care due to cultural and linguistic barriers and socioeconomic disparities. In particular, differences in values affect the clinical outcomes for Hispanic patients. A culture-centric nursing care that includes Hispanic values of respect, understanding, friendly dispositions, and Spanish-speaking ability could improve patient outcomes. Further, the consideration of cultural factors such as gender roles, health beliefs, and worldviews of the people of Latino heritage can help support culturally competent care.
Background
Recent immigration trends account for the rise in the population of American Hispanics, mainly Mexicans. These trends mean that the number of Hispanics in need of nursing care is rising. However, linguistic hurdles and limited understanding of the Hispanic culture and values by nurses affect health care quality and adequacy (Cusi & Ocampo, 2011). Therefore, understanding the healthcare needs of this population could inform nursing care that meets their values and expectations.
The cultural values fundamental to nursing care for Hispanic patients include friendliness, a caring attitude, attentive care, confidence, Spanish-speaking ability, and knowledge of the patient’s culture (Cusi & Ocampo, 2011). Therefore, personal, linguistic, and cultural considerations are important in providing culturally competent care to Hispanic patients. Other considerations include “gender roles, folk medicine, and locus of control” (Sobel & Metzler, 2016, p. 228). Further, acknowledging practices such as alternative medicine and spiritual healing can help nurses build patient trust in the care received. Therefore, guidance is required for nurses providing care to Hispanics for improved patient outcomes.
Aim/Purpose
The purpose of the study reported in the article was to investigate “nursing care delivery for Hispanic patients” to suggest guidance for nurses providing care to patients drawn from Latin America (Sobel & Metzler, 2016, p. 226). The authors explored the cultural competencies required to provide care to Hispanic patients and specific nursing actions for culture-centric nursing care (Sobel & Metzler, 2016).
Research Methods
A qualitative, grounded theory approach was employed to explore cultural knowledge fundamental to nursing care for Hispanics. The study site was located in a rural town in the Southeastern part of the U.S. The town’s Hispanic population is 15.8% of the native population (Sobel & Metzler, 2016). A convenient sample of Hispanic participants (n=26) was interviewed on the kind of cultural knowledge they would expect from their caregivers. The participants drawn from four Latin American countries agreed to participate through informed consent. Subsequently, focus group interviews were held focusing on nine topics.
Data collection involved audio-recorded interview responses gathered from the participants over a span of six months. A prior pilot focus session was done to develop nine interview questions. The researchers also used probe questions to obtain clarifications and interpretations. The qualitative data processing involved transcription of the responses given in Spanish, consistency checks, data coding to identify subthemes, and development of a theoretic model to guide culturally competent care.
Review of Literature
Evidence shows that the language barrier is a major constraint in delivering adequate care to Mexican Americans (Spector, 2012). Most health facilities lack interpreter services and therefore utilize bilingual personnel to communicate with Hispanic patients. There is also the problem of false fluency, whereby non-Spanish clinicians misinterpret the implicit linguistic and cultural undertones in a patient’s communication (Spector, 2012). Another barrier relates to limited coverage for most Hispanic families due to their migration status that hampers health care accessibility by this population (Avila & Bramlett, 2013). A cultural mistrust also motivates Hispanic patients to seek alternative treatment before visiting a hospital. Additional factors, such as illiteracy and socioeconomic constraints, also affect help-seeking behavior among Latinos.
These barriers account for the healthcare disparity seen between Hispanics and other cultural groups. Bridging this disparity would require culturally competent care that recognizes Hispanic cultural values and interpreter programs in healthcare settings. Spector (2012) identifies three core values of the Hispanic culture, namely, “simpatia (kindness), personalismo (friendliness), and respeto (respect)” (p. 65). Integrating these values into nursing care through politeness, physical proximity, and respect by properly addressing older patients would improve patient outcomes. Spector (2012) suggests cross-cultural interviewing as a technique for bridging the cross-cultural differences and promoting physician understanding of the problem from the patient’s perception. This approach contributes to patient-centered care that increases patient safety and satisfaction.
A nursing action for addressing the language barrier is through the teach-back method. The technique involves requesting a patient to repeat medication information until he or she understands it (Spector, 2012). The nurse can give the information in English or have it translated into Spanish. Interpreter services would be required to transcribe or translate the care instructions to Spanish for the patient. Patient engagement through active dialogue is another way of overcoming the language barrier. Cusi and Ocampo (2011) note that “patient activation and motivation for change” through discussions can help prevent resignation and promote involvement (p. 5). Therefore, increased patient involvement is fundamental to providing patient-centered care for Hispanic patients.
A caring and culture-sensitive clinical environment also foster care that meets the Latino’s health care needs. Warm and friendly clinical practices include bilingual posters, medical instructions written in Spanish, hiring of Hispanic physicians and nurses, and serving culturally appropriate food for inpatients (Cusi & Ocampo, 2011). The use of interpreters in provider-patient communication also improves treatment outcomes. A culturally sensitive environment avoids stereotypes and assignment of negative attributes for successful treatment.
The implication for Nursing Practice
A range of cultural and linguistic hinders Latino patients from accessing quality and adequate care. Culturally sensitive care offered by a nurse versed with the cultural values and beliefs of Latinos can help meet the basic needs of the patient. The specific nursing actions with implications for practice include Spanish-speaking ability, friendly attitudes, using a person’s name when addressing him or her, employing interpretation services, knowledge of Latino cultural values, and family involvement, among others (Cusi & Ocampo, 2011).
Nurses can employ these strategies to deliver culturally competent care to reduce the existing health disparities. Cultural awareness coupled with respect for “patient values, preferences, and expressed needs” also improves patient outcomes and satisfaction levels (Spector, 2012, p. 93). Further, nurses must evaluate the patient’s linguistic skills and understanding of medical instructions to increase compliance. Culturally competent care must also consider the Hispanic self-care practices and alternative treatments. This approach would remove the cultural mistrust and increase the Latino’s health care utilization levels.
Conclusion
Language and cultural barriers limit the Hispanic’s access to quality healthcare that meets their needs. A caring environment that recognizes the cultural differences and their values and beliefs is crucial in providing culturally sensitive care. Such an environment helps build positive physician-patient relationships and improves patient engagement and satisfaction. Improved patient outcomes can also be achieved through nursing actions such as the use of interpretation services, friendliness, respect, and family involvement.
References
Avila, R., & Bramlett, M. (2013). Language and immigration status effects on disparities in Hispanic children’s health status and access to health care. Maternal Child Health Journal, 17, 415–423.
Cusi, K., & Ocampo, G. (2011). Unmet needs in Hispanic/Latino patients with type 2 diabetes mellitus. American Journal of Medicine, 124(10), 2–9.
Sobel, L., & Metzler, E. (2016). Guiding the process of culturally competent care with Hispanic patients: A grounded theory study. Journal of Transcultural Nursing, 27(3), 226-232.
Spector, R. (2012). Cultural diversity in health and illness (8th ed.). New York, NY: Pearson.