Hispanic Culture

Alex Schroeder
Calley Buckley
Jason Rausch
Jesse Hyde
Tyler Miller
Objectives:

Identify what ethnic groups and communities make up the Hispanic Culture

Explain the communication, belief, and value systems important within the Hispanic
culture

Define the roles in which culture influences health care when caring for Hispanic
patients
Personal Identity

Who is Hispanic?

Should we say Hispanic or Latino?

Largest minority group in America

Mexican Heritage
Image retrieved from Wisegeek.com
Language

Spanish is the native language

Many are bilingual and also speak English

Not speaking Spanish is leaving behind a part of their cultural identity

Communication

Respect (Respeto) is valued and shown by using formal titles

Show affection through touching

Very little direct eye contact

Avoid conflict
Communication

Very polite to others

Common phrases utilized daily:

A sus ordenes: at your command

para servile a Usted: at your service

Thoughts

Patriarchal structure

Group activities are dominant, responsibility is shared and accountability is collective

Thoughts

Healthcare providers viewed as incapable of making mistakes

Not aggressive in healthcare interactions

Getting a disease is a bigger concern than dying

Actions

Very touch oriented

A warm, soft handshake is the customary greeting

Patience in upsetting situations

Customs

Traditions

Altars

Da de los Muertos - day of the dead

Navidad - Christmas

Quinceanera - 15th Birthday

Pinatas
Customs

Special Observances

Cinco de Mayo - celebration

Hispanic heritage month - Sept. 15th - Oct.15th

Sports
Beliefs

Religion

Identify with religion

Christianity

Catholics

Evangelical

Protestant

Other
Beliefs

Religion

Very active in their religion

Spiritual pieces

Prayer

Saints

Magico religion

Fatalism
Beliefs

Importance of religion to community

Family participates in practices together

Baptism

Anointing of the sick

Christian holidays
Values

Family (familismo) - loyalty to family, placing family needs over personal

Family Identity

Family Dynamics - Men vs. Women

Machismo
Values

Respect for elders

Hard Work - need to provide for family

Ambition - strive to improve self and family

Pride in Heritage - celebrate

Hispanic Culture and Healthcare

Many Hispanics combine traditional healthcare practices with Western medicine.

Although the use of Western medicine tends to be more prevalent, Hispanics who
cannot afford these services often resort to traditional practices.

Traditional practices include using home remedies and seeking care from relatives or
neighbors

The matriarch often provides most in home care

Insurance

Hispanics have the highest uninsured rates (32%) of any racial or ethnic group within
the United States. They are twice as likely as the overall U. S. population (15%) to
lack health insurance coverage

Lack of health insurance results in fewer visits to primary care physicians and more
emergency room visits

(CDC, 2015)
Chronic Disease

For the Hispanic community, issues of morbidity rather than mortality are of greatest
concern, which include lifestyle and behaviors affecting health

Significantly higher rates of diabetes and chronic liver disease

Hispanic average life-expectancy is longer than the average american

Prevalent Diseases in Hispanic Population
The top ten leading causes of death for Hispanics

1. Cancer

2. Heart Disease

3. Accidents

4. Stroke

5. Diabetes

6. Chronic Liver Disease

Predisposition to Diabetes & Liver Disease

PNPLA3- gene for enzymes involved in lipid metabolism

Variation of this gene commonly found in hispanics linked to higher rates of non-
alcoholic fatty liver disease

Number of genetic and environmental factors increase risk for diabetes

Hispanics have different degrees of illness or health risks than
average Americans.

35% lower rate of heart disease

24% more uncontrolled hypertension

23% higher rate of obesity

A lower overall mortality rate

(CDC, 2015)
Foreign vs. US-born Hispanics

Foreign born hispanics have-

About half as much heart disease

48% lower cancer rate

29% less high blood pressure

Belief Systems and Health Care

Traditional Medical Practices

Greek and traditional native beliefs

Spanish colonization

Four humors - blood, phlegm, black bile, yellow bile

Balance - hot and cold

Belief Systems and Health Care

Hot and Cold Balance

Hot illnesses - more visible symptoms

Cold illnesses - no visible symptoms

Treatment with opposite quality of illness.

Hot treated with cold, cold treated with hot

Applies to foods, herbs or medications.

Penicillin - hot medication

Hot and Cold Illnesses

Hot Illnesses Cold Illnesses

Cancer
Bilis (anger) Colic
Empacho (indigestion)
Diabetes mellitus Frio de la matriz (decreased libido)
Headache
Diaper rash Menstrual cramps
Pneumonia
Upper respiratory infections
Hypertension

Mal de ojo evil eye

Pregnancy

Sore throat or infection

Belief Systems and Health Care

Supernatural Powers and Illness

Mal de ojo - evil eye

Mal puesto - disease due to hex or witchcraft

Susto - fright illness

Poor compliance with non-supernatural treatment

Education

Establish the natural cause for the illness

Belief Systems and Health Care

Traditional Healers

Main traditional healer

Curanderas- have power from god

Hot and cold or sorcery related illnesses

Belief Systems and Health Care

Other Traditional Healers

Brujo or brujas - witches or wizards (sorcery)

Yerberas (herbalists)
Huseros (bone setters)
Parteras (midwives)

Sabradores (similar to physical therapists)

Belief Systems and Health Care

Traditional Diseases

Empacho (upset stomach d/t undigested food)

Caida de Mollera (sunken fontanel)

Susto (PTSD or fright sickness)

Mal de ojo (evil eye)

Mal puesto (disease from a hex or witchcraft)

Belief Systems and Health Care

Traditional Remedies for Common Ailments

Fever

Cough

Diarrhea

Vomiting

Conjunctivitis

Skin rash
Belief Systems and Health Care

Tradition and Health Care in Hispanic Countries

Small villages and poor population - traditional medicine (less expensive)

Larger cities - healthcare systems comparable to US

Combination of western and traditional medicine

Belief Systems and Health Care

Tradition and Health Carein the United States - Hispanic Experience

Self treatment, traditional healers, and health care professionals

Folk remedies

Herbs and supplements

Values and Healthcare

Familismo (family)

Respeto (respect)

Personalismo (relationship)

Modestia (modesty)
Familismo (Family)
Immediate and extended family are extremely important
Traditional family is foundation of society
Loyalty, unity, and support
Family needs before individual
Precedence over all other aspects of life

Family plays a key role in healthcare

Accompany to visits/hospital
Extended family and decision making
Example: Grandmothers influence on children
Familismo Hierarchy
Patriarchal, egalitarian or matriarchal

Extended family involved in health decisions

Family unit consulted/considered
Machismo
Not accurate for all Hispanic Heritage
Applying Familismo
Include patient and family in plan of care
Builds trust and confidence
Increased adherence to health-care regimens

Ask specifically who makes what decisions for the family

Allow family meetings to discuss serious health issues
Provide a space
Applying Familismo

Treat family as extension of patient

Relax strict visitor policies

Respeto (respect)
Attentive concern and respect of position and age
Deference to authority
Knowing ones place in hierarchy

Respect is both given and expected in return

Patient respects provider
Viewed as authority figure

Provider should return respect

Respeto
Show respect to elders
Elders highly respected for their wisdom
Never address by first name
Avoid direct eye contact
Avoid physical touch early on
Respeto
Formal names may be extensive (3-4 surnames)
Greet adults formally with Senor, senora, senorita (unless told to do
otherwise)
Ask which name is preferred
Ask which name is used (legal purposes)
Show good manners
Form of respect
Instilled in children
Ties in with simpatia
Applying Respeto
Gaining rapport
Greet patient and family with handshake and smile
Avoid direct eye contact with superiors/elders
Encourage patient to ask questions
Hesitant to ask due to fear of being disrespectful
Spanish speaking only patients
Utilize interpreter or interpreter services
Last resort: use younger family member to translate
Helps develop confidence and trust with provider
Personalismo (behaving like a friend)
Becoming personal with patient/family
Can be difficult due to taught boundaries between caregiver and patient

Gaining trust
Make small talk before addressing medical concerns
Inquire about family members
Encourages open communication and belief sharing
Sharing Beliefs
What do you think caused your problem?
Do you have an explanation for why it started when it did?
What does your sickness do to you; how does it works?
How severe is your sickness? How long do you expect it to last?
What problems has your sickness caused you?
What do you fear about your sickness?
What kind of treatment do you think you should receive?
Applying Personalismo
Helps build confidence and gain trust
Allows for assessments
Allows patient to share beliefs

Ensures best care plan for patient is met

Better outcomes
Modestia (modesty)
Hispanic populations are very conservative

Touch is a form of personalismo

Touch is common between same sex

Opposite sexes rarely touch in public

Applying Modestia
Explain the necessity of exam
Allow for same sex provider if possible

Ask permission

Negotiate physical exposure as the exam warrants

Chaperone if same-sex provider is not available

Case Study
Mrs. Garcia is a 70 year-old Mexican-American woman who will be
undergoing coronary artery bypass grafting. She has 5 children:
sons ages 45, 40, and 36; daughters ages 43 and 38. Her youngest
son lives with the mother, and his wife and 3 children live there as
well. You are going to see the patient in the preoperative setting.
You walk into the room to find the patient, all of her children, and 3
grandchildren.
Case Study
How would you address the patient? Explain.

What actions could you take in order to gain rapport with this
patient and family?
Case Study
Would you be strict on number of visitors in the room? Explain.

During the preoperative assessment the family invites you to join

in on prayer? What would you do? Explain.
Case Study
Should you stop her from drinking herbal tea when you see her 4-
6 hours pre-op?

Who should be included in post-op teaching? Why?

Questions?
References

Allison, B. N., & Bencomo, A. (2015). Hispanic Families and Their Culture: Implications for FCS Educators. Journal of Family &

Consumer Sciences, 107(2), 56-61.

Caring for Latino Patients. (2013, Jan.) Retrieved 15 September 2016, from http://www.aafp.org/afp/2013/0101/p48.html

Centers for Disease Control (CDC): Hispanic Health Infographic. (2015). Retrieved 18 September 2016, from

http://www.cdc.gov/vitalsigns/hispanic-health/infographic.html#infographic2

Explore Hispanic Culture: Hispanic Traditions. (n.d.) Retrieved 12 September 2016, from

http://www.explore-hispanic-culture.com/hispanic-traditions.html

Pew Research Center: Hispanic Trends. (2016). Retrieved 10 September 2016, from http://www.pewhispanic.org
References continued

Purnell, L. D. (2012). Transcultural health care: A culturally competent approach (4). Philadelphia, PA: F. A. Davis Company.

Purnell, L. D. (2014). Guide to culturally competent health care (3). Philadelphia, PA: F. A. Davis Company.

Romeo, S., Kozlitina, J., Xing, C., Pertsemlidis, A., Cox, D., Pennacchio, L. A., ... & Hobbs, H. H. (2008). Genetic variation in

PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nature genetics, 40(12), 1461-1465.

Sotomayor-Peterson, M., Figueredo, A. J., Christensen, D. H., & Taylor, A. R. (2012). Couples' cultural values, shared parenting, and

family emotional climate within mexican american families. Family Process, 51(2), 218-233.