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Cultural competence refers to the ability of the medical practitioners to be able to offer quality services to people from different cultural dimensions. Cultural competence among the medics is essential since it ensures that patients receive quality services regardless of their cultural background. This paper looks at cultural competence among the nurses in the USA and how this affects the quality of services offered to the patients, especially those who come from the minority. The paper focuses on the Mexicans who are considered to be a minority group in the country; they constitute the Latino American group. The group is composed of people from South America. The paper will also discuss the culture of Mexicans as it affects the quality of services that they receive from the medical facilities and the various factors that can be put into consideration to ensure that these individuals get the quality healthcare (Geographia, n.d).
Mexican culture is a blend of various traditions of native Americans and their Spanish colonial masters. They are well known for their ceramics, painting, sculpture, textile, and poetry. There are various customs, language, dresses, and foods in the Mexican culture. Their official language is Spanish. Catholicism is the main religion there. People living in the villages are still putting on pants, sombreros cotton shirts, and ponchos. The individuals in the cities dress according to the European and USA fashions (Geographia, n.d).
Mexicans are usually socialists and believe in their family and religion. The importance of family and religion is seen in the way they value greetings that are considered an important social etiquette. Mexicans are very hardworking, but their beliefs do not allow them to be very rich. They believe in enjoying a quiet life while taking pleasure in their siestas (Geographia, n.d).
Mexicans form a hierarchical community, and they respect the individuals who are on the top of this hierarchy. In relation to this, they have a belief commonly referred to as ‘machismo’ which refers to masculinity. According to this principle, making remarks to a woman is considered normal and should not be deemed as a form of harassment. Due to this, the Mexican males think that nothing should be allowed to tarnish their image of a man (Geographia, n.d).
The migration of the Mexicans to the United States mainly took place during the displacement of the Mexican people in their home country as a result of economic, social, and political displacements of the Mexican revolutionary period. Additionally, the industrial and agrarian revolution encouraged their migration to the country. They migrated both through the direct and indirect routes. Immediately after arriving into the country, Mexicans began to work as unskilled and semiskilled laborers in agriculture and other industries.
It is believed that most of the Mexican immigrants were from the middles class but not the poorest (peasant) group. In the 1920s, the laborer recruiters from the U.S started to employ workers from Mexico, which accelerated the rate of their immigration. Housing conditions were substandard, congested, and very expensive; due to this, they begun to live in groups so that they could manage to pay for the rent of the houses. Congestion in some locations resulted in the increase in health and sanitation problems. Similar to black Americans, Mexicans experienced segregation, but this was not pronounced as in the case of black Americans. They adopted Roman Catholicism, but later, they begun to come up with their churches resorting to their cultural practices. People from the Mexican community participated in certain activities related to their culture. For instance, they had separate baseball games for men and women (Kwintessential, n.d).
During the times of the Great Depression (1929-1940), Mexicans were barred from migrating into the country. As a result, they suffered high rates of unemployment. In some states such as Chicago where most of them were living, they were caught in trains and deported to the U.S.-Mexico border, which resulted in the reduction of their population in Mexico by half. The commencement of the Second World War created an opportunity for them to continue immigrating back into the country (Kwintessential, n.d).
Hicks (2012) suggests that the Mexican population is influenced by their spiritual beliefs. “Some people describe health as a reward for good behavior and that the protection of health is an accepted practice that should be done through prayers and keeping relics in the home” (Spector, 2009) Hicks (2012) states that daily rituals, such as prayers, devotions, and wearing religious medals are of major importance. It is believed the protection of health is accomplished by prayer. “They view health from a synergistic point of view” (Hicks, 2012). According to Spector (2009), Mexicans think that in order to maintain one’s equilibrium in the universe, one must eat properly and work the right amount of time. Mexicans believe in balance; that is why “illness is seen as an imbalance in an individual’s body or as punishment meted out for wrongdoing” (Spector, 2009). Hicks (2012) states that they have much faith in their folk medicine, which is based on the belief that disease is caused by imbalance of hot and cold principles (Kwintessential, n.d).
Many people of the Mexican background would seek folk healers first before resorting to the Western health care system. Most Mexicans believe in Curanderismo. “Curanderismo is the art of folk healing” (Graham, 2013); it is performed by a curandero which can be either male or female. A curandero is usually sought after by people that need social, physical, and/or psychological help. It also involves natural herbs. Spector (2009) states that plants, herbs, and minerals are also used to prevent illness.
Mexicans’ strong belief in their traditional medicine and religious faith make them object medical services. They do not believe in the modern medication and thus do not have much trust in it. It should also be noted that in their culture, they value etiquette; however, this is not observed while attending to them, as they tend to be uncooperative and unable to disclose the necessary information required for treatment. Men are deemed superior in their community; thus, the ladies need to show respect to them. In some instances, there are things that the ladies cannot attend to, and they are not required to interact with the males at some point. In this case, the medic needs to consider such factors while attending to the Mexican patients since it has a great influence on their treatment process.
Language barrier is another cultural factor that negatively influences the access to quality medical services by Mexicans. Their official language is Spanish, yet most medics do not speak it, which hinders good understanding between a practitioner and a Mexican patient. Even if translators are involved into the communication between doctors and patients, the treatment process is affected to some extent.
The U.S. government has identified cultural competence as an important approach to providing a quality medical care to the members of the society. However, there are various factors that may affect the success of the effort to provide a culturally competent healthcare. Some of the factors include poverty, culturally incompetent personnel, and lack of adequate funds. Other factors may include beliefs and values.
Poverty is one of the things that can affect achieving cultural competence. The poverty level of the individuals particularly the minority group in the nation is a barrier for these individuals to access medical services. Poverty has made some individuals unable to access quality healthcare services in the country. In relation to this, insurances play a great role. The prices fro insurance have continued to escalate over the years, thus continuing to bar the poor people from accessing quality medical services.
According to Ransford, Carrillo, and Rivera (2010), poverty, especially the lack of insurance is considered to be the most significant barrier in health care delivery for the Mexican community. The poverty level of Mexicans can be associated with their low paying jobs and cultural beliefs. They are thus unable to pay the insurance premium which is very essential in their healthcare access. Medical centers that put into consideration the cultural factors are very expensive; thus, the Mexicans, who are mostly poor, are unable to access these hospitals. They have no option, but to go to the substandard hospitals that do not consider cultural competence (as cited in Rivers & Patino, 2006).
Incompetence is the other factor that bars Mexicans from getting professional medical services. Cultural competence extends from the understanding of the patient’s language to cultural beliefs and values. This is because the values and beliefs have a great influence on what patients think about the services that they are receiving from the medics. There is a significant lack of cultural competence among the practicing medics in the nation. In the case of Mexicans, it is evident that these groups of individuals have a problem in speaking their problems out. Due to this, it is important for the medics to be considerate when taking care of them. However, medics often do not have the necessary level of cultural competency to understand them.
Culture as a barrier relates to how these individuals perceive sickness and the approach that they consider appropriate to deal with sickness. Mexicans believe that sickness is a form of punishment to wrongdoers and, as a result, this makes them reluctant to look for the required intervention when they fall ill. As part of their culture, Mexicans value herbal treatment, which also prevents them from seeking the modern treatment interventions whenever they get ill. Some of them will even refer to their homeland healthcare practitioners. The way the practitioners communicate to them is another aspect of their culture. They prefer to be addressed in a certain way that the medical medics may not be aware of, which results in poor interpersonal relationship between them.
According to Mexicans, they prefer being given attention from doctors and would like medical staff to spend more time spent with them. However, due to the number of patients to be attended to in most of the public healthcare services, this is not achievable (Ransford et. al, 2010). In fact, the long queues, lack of physical proximity, and the short amount of time spent with these clients have a negative impact on their healthcare seeking behavior within the US traditional healthcare system. The Mexican values such as kindness, friendliness, and respect are essential behaviors within the clinical setting (Juckett, 2013). With a more objective and distant approach, the short amount of time spent with these clients by the US physicians has a harmful effect on these patients’ decision to seek for their help.
Ethical dilemma that may arise while attending to the Mexican patients comes as a result of their traditional family beliefs as well as religion. One of the dilemmas that might occur is related to seeking the consent of the patient’s close relatives. It is expected that the relatives of a patient are supposed to be told everything concerning the progress of their family member’s health. However, Mexicans believe that when one is in critical conditions, some members of the community should not be aware of this, and this is against the principle of healthcare provision. Another form of conflict is when a patient refuses to take some medication because of their cultural belief even though the medicine or medical procedure is thought to be the only remedy to their condition. The patients have a right to make their decision regarding a medical procedure, but according to the doctor’s hypocritical oath, it is their duty to do no harm. Accepting the patient’s decision will violate the oath, particularly if the procedure or the medication is purported to be the only option.
Transcultural Nursing Model by Madeleine Leininger is Aacultural assessment model that appropriately evaluates the Mexican community. The Transcultural Nursing Model is an essential area of study and practice. It focuses on the comparative cultural values, beliefs as well as practices. The main goal of the technique is to provide customized nursing practices depending on the culture of an individual thus promoting the well-being of patients (Nursing Theories, 2013). According to Leininger (1991), the main goal of Transcultural Nursing is to provide healthcare services in line with the culture of a specified patient. The model is based on anthropology, and it is a specialty in nursing that focuses on global cultures.
In order to ensure culturally congruent care, Madeleine Leininger suggests the following three nursing decision and action modes. They are aimed at assisting people of a particular culture and include:
It is essential for medics to consider values that may help health care providers to understand a particular patient’s behaviors and actions in the context of cultural inclinations. For example, a doctor could perceive a patient who does not maintain direct eye contact as evasive when, in fact, this could signify that the patient may be demonstrating respect for the doctor’s authority. As stated by Hicks (2012), nurses must incorporate patient’s cultural beliefs and practices into their plan of care to be able to provide competent treatment. Nurses must also help the patient attain optimal health by treating his/her as an individual. The nurse must take into account the patient’s cultural and spiritual experiences.
When applying the Transcultural Nursing Model to the Mexicans population, nurses should be aware of certain behaviors and practices regarding distance, eye contact, touch, and communication. Latin people tend to be more expressive and fatalistic when it comes to their health beliefs and practices. They expect to be pampered when ill, because it is how the family shows love and concern. Therefore, it is the nurse’s responsibility to be sensitive towards these feelings and make the patient feel comfortable as much as possible to avoid barriers that might hinder their care.
Distance is among the different areas of concern for proper cultural care. Mexican people do not need as much space between themselves and others. They feel comfortable standing close to one another. The nurse must keep in mind that too much distance in this case might be interpreted in the wrong way by a Mexican patient. Regarding eye contact, a Mexican patient may look down or away from a person based on their age, sex, social position, or authority. Even though nurses are taught to keep eye contact with patients, in Transcultural Nursing, the nurse must not maintain constant eye contact with the patients of a Mexican origin in order to avoid disrespect towards those patients.
In the Mexican culture, touch is about privacy and respect. Male health care providers may not touch or examine certain parts of the female body. It is advantageous for nurses to be aware of this cultural practice in order to avoid barriers in giving appropriate health care and disrespecting the patient and the patient’s family members.
Communication is also of great concern in every culture. This is especially true about the Mexican community, because the issues of language barriers often shape their health. Latin people sometimes do not get the care they need or seek for due to language and communication barriers. According to Hicks (2012), Transcultural Nursing is about being sensitive to cultural differences. It implies focusing on the individuals, their needs and preferences. It is always a good idea to ask patients about their cultural beliefs and health care practices instead of making incorrect assumptions. It is important to remember to maintain an environment in which there are respect and effective communication between patient and health care provider through spoken words and body language.
According to the Centers for Disease Control and Prevention and Hoyert (2011), heart disease, cancer, accidental injuries, stroke, and diabetes are among the leading illnesses and causes of death within the Mexican community. Because care plans are created using NANDA diagnosis, developing a plan of care for Mexicans implies considering their chief complaint. If we were to develop a care plan for treating a patient with diabetes, for example, the nurse should have some kind of knowledge about what a Latin diet consists of. As stated by Mitchell (2004), the rate of Type II Diabetes is three times higher in Mexican-Americans than in non-Mexican whites. It is believed that the Latin diet contains a lot of carbohydrates and sugar. According to Flegal, Ezzati, and Harris (1991), Mexicans tend to eat more rice and ready-to-eat cereals. They eat more fruits than vegetables. They are more likely to consume whole milk rather than low-fat milk, and they prefer to eat more beef rather than processed meat. The following is an example of a plan of care for a Mexican patient with diabetes.
Whether the nurse has Transcultural Nursing knowledge or not, she should be able to understand that there might be a huge possibility that the Mexican patient has a great deal of difficulty following a diet plan to control diabetes. The nurse must show cultural sensitivity towards the patient of Mexican origin and try to accommodate him/her as well as possible in order to have successful health outcomes. Many Mexicans may be discouraged to follow a strict diet, because they may feel it is culturally unacceptable and too hard for them to commit to. According to the Transcultural Nursing Model, the nurse must make adjustments so that the Mexican patient is able to achieve the set goals in order to control their diabetes.
Health care of Mexicans is influenced by factors such as language and cultural barriers among others. The lack of access to preventive care and health insurance as well as language fluency vary within the Mexican subgroups. Census 2009 and 2010 prove that 76 % of Mexicans speak their traditional language other than English, and 35% of Mexicans state that they are not fluent in English. Census 2010 also reported that 24.8% of Mexicans in comparison to 10.6% of non-Mexican Whites were living in poverty. It is also important to realize that Mexicans represent the highest rate as an uninsured cultural group within the United States; according to the 2010 Census report, 30.7% of the Mexicans population had no insurance as compared to 11.7% of the non-Mexican White population (United States Census, 2010). The Center for Disease Control and Prevention has noted that the most common diseases among Mexicans include coronary diseases, various types of cancer, unintentional injuries (accidents), diabetes, and HIV/ AIDs among others( CDC, 2012). There is a higher number of obesity cases among Mexicans than non-Mexican caucasians. Mexicans think that “the chubbier, the healthier a person is” and it is not until the late 2000’s that the Mexicans population started to realize the risks of developing diseases related to obesity as well as high-caloric and high-sugar intake consequences (CDC, 2012).
From statistics, it is evident that the Mexican community is one of the ethnic groups with the least access to health care. This could probably be explained by heritage beliefs or access to healthcare and transportation although we have selected a meticulous list of resources and organizations that make Mexicans health care a more plausible reality;
As mentioned above, our plan will be focused on the nursing diagnosis of Risk for Ineffective Therapeutic Regimen Management due to the sudden modification of diet in response to health problems in the Mexican population. Mexicans are raised since very early age with the idea that all three meals should include a greater amount of carbohydrates than any other food choice. They have a false belief that drinking whole milk is healthier than reduced or skimmed milk among other diet concerns (Braxton, 1999). What they are not taught is the nutritional value of food intake choices and the possible consequences they might have later in life. Many Mexicans come to realize that what they thought was healthy eating at the end turned out to be harmful. For Mexicans to hear after many years that they need to modify or change their diet completely is not as easy pill to swallow; thus, often they are not willing to change their lifestyle. Therefore, this process needs a very prepared and specialized team to intervene involving a doctor, nurse, dietician, case manager, social worker, family priest and with great participation and support of friends and family that can conform with the new lifestyle their loved one needs to embark on in order to live a long-lasting healthy life. It is clear that such a change needs all parts to play their role, because if one part of the chain is not strong and willing to collaborate, the stubborn Mexican will most likely not change until it is too late or too hard to repair the damage done to their health. Thus, we understand that health care matters are not to be taken lightly by the patient, patient’s family, and the healthcare team in charge. For the plan to be a success, all members involved need to be culturally competent and yet, very firm and persuasive about the needed change in lifestyle.
A barrier in delivering quality medical services to clients is a serious problem in the clinical setting. Many patients go under-diagnosed and do not get the appropriate care, because they cannot connect to or understand the healthcare provider. In order to be effective and ensure adequate care, the healthcare provider must be aware of the patient’s cultural beliefs and practices. The healthcare provider must be understanding, must have an open mind, and be responsive towards other cultures. Our society today calls for more culture awareness and sensitivity. We see how being not culturally competent can create massive problems for people and their health. Through literature and education, healthcare providers can acquire the knowledge to provide the necessary care to each individual.
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