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Transcultural Nursing

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Julieanne Gillispie

on 7 April 2017

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Transcript of Transcultural Nursing

Transcultural Nursing
According to Giger and Davidhizar's Transcultural Assessment Model there are six cultural phenomena that must be looked at when providing culturally competent care (Giger, 2017). This presentation will explore these phenomena in the Mexican culture.

Julieanne

Gillispie

Six Cultural Phenomena
Communication
Space
Social Organization
Time
Environmental Control
Biological Variations
Dia De Los Muertos
According to Giger (2017) there are significant health disparities that have been found among Mexican Americans.
Diabetes
- 10.2% of all Mexican Americans were diagnosed with diabetes in 2007 (Giger 2017)

-Mexican Americans are almost two times more likely to have diabetes than non-Hispanics Whites (Anderson et al., 2016)

-Risk factors for diabetes are more common in Hispanics than white non-Hispanics (Giger, 2017)

-Mexican Americans have been found to have higher rates of diabetic complications (except heart attacks) (Giger, 2017).

-The longer Mexican-Americans live in the United States, the greater their risk for diabetes (Anderson et al., 2016).

-The number of Mexican-Americans who have prehypertension has increased from 23.7% in 2003/2004 to 31.4% in 2011/2012

-On the other hand, the number of Mexican-Americans with Stage I and Stage II hypertension has decreased during the same period
-Believed to be due to increased treatment

(Giger, 2017)

-“Approximately 85% of the health problems common to Mexican Americans involve communicable diseases…” (Giger, 2017, p. 227).

-Like other immigrants that have recently arrived to the United States, Mexican-Americans are at increased risk for contracting and transmitting tuberculosis

-Mexico has an increased incidence of tuberculosis

(Giger, 2017)

- 1.5% of Whites in the United States have hepatitis C compared to 2.1% of Mexican-Americans (Giger, 2017).

- “Nationwide, AIDS cases among Hispanics are occurring at triple the rate among non-Hispanics.” (Giger, 2017, p. 228)

- Migrant farm workers, like those from Mexico, have an increased risk of contracting HIV due to unsanitary living and working conditions (Giger, 2017).

- Young, male migrant farmers from Mexico reported having low education regarding protection against HIV (Martinez-Donate, 2015)

- Latinos, especially Mexicans, are less likely to receive HIV testing; therefore, they typically have more complications related to the virus (Ruiz, Guilamo-Ramos, McCarthy, Muñoz-Laboy, & de Lourdes Rosas López, 2014)
o “In 2011, for example, 31% of Latinos diagnosed with HIV in NYC were concurrently diagnosed with AIDS, compared with only 15% of Whites” (Ruiz, et al., 2014, p. 1036).

- 25% of the population in NYC are Latino and they account for 33% of the population living with HIV/AIDS there as well (Ruiz et al., 2014)

- In 2011 and 2012 the number of Hispanic children who had a body mass index for age greater than or equal to 85 (which means they were overweight or obese) was 46.2%
o More than non-Hispanic Whites and non-Hispanic Blacks (Giger, 2017).

o Mexican mothers believe a baby is healthy if the baby is fat, and they overly encourage food intake (Giger, 2017)

- In 2009 and 2010 Mexican American children were more than one and a half times more likely to be overweight than non-Hispanic White children (DiMaria, 2016).

- Family relationships in the Mexican culture are related to depression
o When the relationship is strong, there is less association between depression and discrimination

- Immigration to the United States causes a lot of stress for Mexican Americans

- 17% of Mexican American pregnant women are found to suffer from depression, compared to 10-15% of the general population

- Alcohol in the Mexican culture is associated with celebrations
o Alcohol and drug comorbidity is a challenge

o High rate of binge drinking, drunk driving, alcohol abuse, and dependence on alcohol

o Creates a racial stigma associated with Mexicans and alcohol

- Mexican Americans born in the U.S. have increased rates of psychiatric disorders and PTSD than immigrants that were born in Mexico

- Unless symptoms are a problem, Mexican Americans are not as likely to seek treatment for mental illnesses
o Women more likely than men to seek help

(Giger, 2017)

References
Anderson, C., Hua, Z., Daniel, C. R., Hromi-Fiedler, A., Qiong, D., Elhor Gbito, K. Y., ... Wong-Ho, C. (2016). Acculturation and diabetes risk in the Mexican

American mano a mano cohort.
American Journal Of Public Health, 106
(3), 547. doi:10.2105/AJPH.2015.303008

Andrews, M.M & Boyle S.J. (2012).
Transcultural concepts in nursing care, 6
. Philadelphia: Wolters Kluwer Health

DiMaria, F. (2016). Battling childhood obesity in Hispanics, still.
Hispanic Outlook In Higher Education Magazine, 26
(10), 10. Retrieved from http://

eds.a.ebscohost.com.db12. linccweb. org /ehost/detail/detail?sid=f4446a2b-1ffb-4238-a37a f902379bf236%40sessionmgr4009&vid

=0&hid=4102&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=118516844&db=f6h

Giger, J.N. (2017).
Transcultural nursing: assessment & intervention, 7
. St. Louis, MO: Elsevier, Inc.

Godoy, M. (2016). Sugar skulls, tamales and more: why is that food on the day ff the dead altar? Retrieved from http://www.npr.org/sections/

thesalt/2016/11/01/500242132/sugar-skulls-tamales-and-more-why-is-that-food-on-the-day-of-the-dead-altar

Harrison, J. (2011). I Miss You [Recorded by Alturas]. On Caminos [mp 3 file].

Juckett, G. (2013, January 1). Caring for Latino patients.
American Family Physican , 87
, 48-45. Retrieved from http://www.aafp.org/afp/2013/0101/p48.html

Maribel. (2013, April 5). Sopa de fideo: authentic Mexican soup [Web log post]. Retrieved from https://azucarandspice.com/2013/04/05/sopa-de-fideo-

authentic-mexican-noodle-soup/

Martinez-Donate, A. P., Hovell, M. F., Rangel, M. G., Xiao, Z., Sipan, C. L., Magis-Rodriguez, C., & Gonzalez-Fagoaga, J. E. (2015). Migrants in transit: the

importance of monitoring HIV risk among migrant flows at the Mexico–US border.
American Journal Of Public Health, 105
(3), 497. doi:10.2105/

AJPH.2014.302336

Ruiz, Y., Guilamo-Ramos, V., McCarthy, K., Muñoz-Laboy, M. A., & de Lourdes Rosas López, M. (2014). Exploring migratory dynamics on HIV transmission: the

case of Mexicans in New York City and Puebla, Mexico.
American Journal Of Public Health, 104
(6), 1036-1044. doi:10.2105/AJPH.2013.301770

Tafoya-Barraza, H. (2014). The day of the dead – November 2nd . Retrieved from http://www.unm.edu/~htafoya/dayofthedead.html

2017. On Mexican Music & Mariachi Music: The Best Funny Traditional Music of Mexico [Audio file]. Retrieved from
Hepatitis C & HIV/AIDS
Hypertension
Communicable Disease
Childhood Obesity

Psychological Characteristics
Family is the main focus of social identification
Many Mexican-Americans live in multiple family arrangements for social and economic support
The male is the main decision maker and the female's main objective is to keep family together
"Familismo" is the sharing by extended family the responsibility of disciplining children, nurturing children, providing financial aid, and companionship
The Mexican-American family values to succeed as a unit, takes pride in family, and rarely seeks assistance from anyone other than family
Older children aid the family by caring for the younger children
Men have less structure and more frequently end up in gangs while women are expected to return home and assist with the house
Culture affects communication by how
feelings are expressed and what verbal or non-verbal
cues are appropriate.

DIALECT
There are more than 50 dialects of spanish
majority of spanish words have the same meaning
dialects can change with the region's proximity to the mexican border
fun fact: texan-mexican-americans strictly use proper spanish
codeswitching is the term for when someone can systematically mix the spanish & english languages
calo' is a "hip" code of new terms when mixing spanish and english by boys in their own groups
TOUCH
the mexican people are characterized as tactile in their communication efforts
although tactile, women are very modest & protective of their bodies
generally in males & females, exposing their bodies is deemed as embarrassing, especially in the healthcare setting & being touched by healthcare workers is often embarrassing as well
women prefer to be cared for by other women in healthcare
CONTEXT
mexicans may enlighten their situation by often making small talk prior to intervention by a healthcare member; this is facilitating in their process & should not be deemed as a waste of time - it accomplishes nursing objectives
mexicans practice diplomacy & tactfulness
direct confrontations & arguments are considered rude & disrespectful
may seem courteous & agreeable on the surface but hiding feelings of anger or frustration
KINESICS
Mal Ojo (evil eye) is a folk illness in the mexican culture described as a condition that infants & children contract from individuals who possess special powers either intentionally or inadvertently
contraction occurs when someone looks at or admires the young child without touching them
the child's symptoms include crying, fever, vomits, & no appetite
this illness is believed to be prevented by touching the child's head or arm as you admire them or look into their eyes
(Giger, 2017)
Implications for nursing!!!
Maintain modesty & gender preference among both genders
initiate objectives through smalltalk to facilitate your work flow
acknowledge your admiration for young children by gently touching the child's arm or head to prevent fear of mal ojo
always, always, always use an interpreter if there is doubt or questioning on communication barrier
remember that what is socially acceptable among americanized/young mexicans may not always be what is acceptable to their elders
(Maribel, 2017)
Mexican Americans value their culture and traditions, which are essential to life and society. Mexican people are warm vivacious individuals with a zest for life and family. In caring for Mexican Americans, Simpataia plays a significant role. Simpataia is defined as smooth harmonious interpersonal relationships described by courtesy, respect, and absence of judgement and confrontational behavior.
(Giger, 2017, p. 215)
• Mexican Americans desire a need for group togetherness

• Socially, Mexicans are not big on personal space

• Sense of close interpersonal distance and more tactile and touching among females

• Males tend to be less tactile and allowed to be more informal in social settings to help develop “Machismo” which is masculinity and manliness


(Giger, 2017, p. 215-216)
Nursing Implications
Approaching care to a Mexican patient starts with kindness and Personalismo, which is a personal connection and establishing a rapport with the patient. Asking the patient about his or her family shows friendlessness and compassion. Shaking hands is also an appropriate greeting and older patients should be addressed as señor or señora rather than by their first names. Using don or doña with the given or full name indicates even greater respect for older patients.
(Juckett, 2013, p. 51)
Nursing Implications
Nurses must also be aware of modesty and respect for gender conflicts. Mexican Americans may have cultural biases and prohibit care being administered by the person of the opposite sex. For example female patient may be uncomfortable with male nurses, especially when labor and delivery is involved. The family and husband of the female patient will feel that the only male exposed to the patient’s private area should be her husband. Although same sex health care providers are preferred, exceptions will be made as long as the healthcare providers are sensitive to the modesty needs of the patient.
(Giger, 2017,p.216).
Present Orientation
• Mexican’s tend to be oriented to present time only. They are often unable to incorporate the future into their plans.
• They can put off plans for future for instant self-gratification.
• According to Giger (2017), “Many investigators believe that this orientation restrains Mexican Americans from upward social mobility" (p.219).
• Mexican’s place more importance on the quality of interpersonal relationships and don’t put a time limit on quality time.

(Giger, 2017)
Nursing Care
• As nurses caring for Mexican patients, flexibility is important. Scheduling appointments for future dates can be difficult. A Mexican American could be late to an appointment due to concern with a current activity.
• A nurse may have difficulty teaching Mexican Americans the importance of taking medications in a timely manner. Explaining to them the short term effects can help them take their medication on time. It’s easier to focus on the short term problems compared to future problems.

(Giger, 2017)


(Godoy, 2016, p. 1-8)
(Tafoya-Barraza, 2014, p. 1-5)
(Harrison, 2011)
Mandalyn Gupton
Lauren Aldridge

Dia De Los Muertos
Fun with clay skulls
Personal Reflection
Mexican culture and Dia de los muertos was fascinating to learn about and I really appreciated the rich family culture this holiday provides. From a nursing stand point we deal with the grief process and we are exposed to death more than the average person. Having a day to honor our deceased ancestors and put a positive concept behind death is quite inspirational. My father in law actually just passed away in February of this year and the pictures on my sample altar were in honor of him. Have to say the altar was quite difficult to put together at first but this personal project actually brought comfort to me at a time of great mourning.
In loving memory of Donald Smith
This video presentation gives a step by step tutorial on how to make sopa fideo, or noodle soup. This is a simple, traditional Mexican soup. It is essentially noodles and tomato sauce, but there are secrets to make the soup taste great!

(Giger,2017)
Locus of Control
• Many Mexicans have an external locus of control. They believe that external forces operate in many social and individual circumstances.
• They believe that one is at the mercy of the environment.
• Often times Mexican Americans may not believe that they are responsible for failures or successes.
• A Mexican with new medical diagnosis could accept it and not try to change or cure the disease because it’s their fate.

(Giger, 2017)


Health Care Beliefs
• Some Mexican’s believe their health is a result of good luck and some believe it represents a state of equilibrium in the universe wherein the forces of “hot”, “cold”, “wet”, and “dry” must be balanced (Giger, 2017).
• The concept is believed to come from the Hippocratic theory. “According to the Hippocratic theory, the body humors-blood, phlegm, black bile, and yellow bile- vary in both temperature and moisture (Giger, 2017, p. 221).”
o The Theory of Hot and Cold and Perception of Illness
 Illness is believed to be caused when a person is exposed to hot or cold for a long period of time.
 To heal you use the opposite of the causative agent.
 Excess heat within the body is thought to cause diseases such as cancer, rheumatism, tuberculosis, and paralysis.
 The heat focus in the body is the stomach. The focus of cool is the head, arms, and legs.
 Digestive issues are believed to be caused by the imbalance of hot and cold foods and can be healed with the balance of hot and cold foods.
• Example: "If stool is green or yellow, the diarrhea is hot and the remedy is cold tea; if the stool is white, then diarrhea is cold and the remedy is hot tea (Giger, 2017, p. 221).”
• Hot and cold can have an effect on growth and development as well. It is often used during pregnancy.

(Giger, 2017)



Folk Medicine
• “Folk medicine as practiced by Mexican American combines elements of the European Roman Catholic view and the view of the original Indians of Mexico (Giger, 2017, p. 222).”
• Illness is viewed from a religious and social context rather than a medical perspective.

Types of Folk Practioners:
A key family member practices folk medicine. The healing practices are passed down from family members.
o Yerbero- healer who specializes in herbs and spices.
o Curandero and Curandera- If a family member is suffering from a serious physical and mental or emotional illness they are brought to a Curandero (male) or a Curandera (female). “The central focus of these healers’ treatment is relieving clients of their sins (Giger, 2017, p. 223).” The Curandero believes that water, food, and air are important to the maintenance of health. “Imbalance of these elements, imbalance between God and man, and imbalance between hot and cold are believed to contribute to illness. Curandero is thought to have a gift from God to heal others and are thought to have power over witches.

Folk-related Illnesses
• Caida del la Mollera- is referred to a fallen fontanel in infants caused by a fall, by bouncing the child roughly, or by removal of the nipple from the baby’s mouth with too much force. When this happens they believe there is an imbalance between the fontanel and the palate that blocks the passage of foods and liquids (Giger, 2017).
• Mal Ojo (Evil Eye)- this occurs when an individual who is believed to possess a special power admires or covets the child of another and looks at but does not touch the child (Giger, 2017). It is associated with witchcraft and black magic. Symptoms may include headaches, high fever, diarrhea, restlessness, loss of weight, sunken eyes. The cure is to mix a hen’s egg with water and place this under the head of the child’s bed. It drives out the bad influence.
• Empacho- It is abdominal pain of a child that has a chunk of food he or she is unable to pass.
• Susto (Magical Fright)- It is caused by a frightening experience or event that leads to temporary loss of one’s spirit from their body. Often associated with epilepsy. Treatment includes “barrida” which a curandero sweeps the body with fresh herbs while the healer recites ritual prayers (Giger, 2017).
• Nervios- It is referred to as restlessness, insomnia, loss of appetite, headaches, and nonspecific aches and pains.

Religious Views
Roman Catholicism is the dominant religion for Mexican Americans. They rely on the priest and family for prayers during times of distress.

(Giger, 2017).



Nursing Implications
It is important for nurses to realize that alternative therapies are usually more prevalent before medicine. They often have more respect for health care providers who accept spiritual and folk basics. There could be issues with following smoking cessation programs or prenatal care, due to their belief of external control. Self-management of chronic diseases may also be harder for nurses to implement. They need to be closely monitored. The nurse should also pay close attention to the temperature of food being served to the patient. They may want food from family members and not from hospital. The overall goal for a nurse caring for a Mexican American is to understand the belief of folk medicine and try establishing a relationship with the curandero in the hope of influencing acceptance of modern medicine. Often times when treating Mexican children touch can help heal evil eye, therefore it’s important to touch when assessing the child.

(Giger, 2017)


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Taylor Wright
Adrian Alayon
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