Believes About Disease In Sub Cultural Ethic Groups and Nursing Education
The Four Major Sub Cultural Ethnic Groups,Illness According to Hispanic Group,Teaching Strategies Sub Cultural Ethic Groups,General Suggestions for Sub Cultural Ethic Groups Nursing Education.
The Four Major Sub Cultural Ethnic Groups
The US Census Bureau (2011) defines the major su-bcultural ethnic
groups in this country as follows: Hispanic/Latino (of Mexican, Cuban, Puerto
Rican, and other Latin descents), Black/African American (of African, Haitian,
and Dominican Republic descents), Asian/Pacific Islander (of Japanese, Chinese,
Filipino, Korean, Vietnamese, Hawaiian, Guamanian, Samoan, and Asian Indian
descent), and American Indian/ Alaska Native (descendants of hundreds of tribes
of Native Americans and of Eskimo descent ).
Given the fact that there are many ethnic minority groups in the United States, and hundreds worldwide, it is impossible to address the cultural characteristics of each one of them. Instead, this section reviews the beliefs and health. practices of the four major subcultures in this country as identified by the US Census Bureau. Based on the latest 2010 census data available (a full national census is conducted every 10 years), these groups account for approximately one third (34.09%) of the total US population.
The Hispanic/Latino and Asian/Pacific Islander groups are the fastest growing ethnic subcultures in this country (US Census Bureau, 2011).One of the most important roles of the nurse is to serve as an advocate for patients. To do so effectively, nurses must be aware of the customs, beliefs, values, and lifestyles of the diverse populations they serve. Although nurses can learn about the different cultures, ideally nurses who belong to minority groups can best identify with and understand cultural nuances.
However, the numbers of registered nurses (RNS) who are from the four ethnic subcultures as compared to the dominant white culture are highly underrepresented in the US workforce (see FIGURE 8-3). If the ethnic profile of RNs is to more closely mirror the ethnic percentages of people in this country, then a concerted effort must be made to attract and retain culturally diverse nursing students to provide culturally appropriate and sensitive health care for better health outcomes (Muronda, 2015).
In addition to information provided here on the four major ethnic
subcultures, libraries and the World Wide Web provide an array of resources
that describe the beliefs and practices of tribes or minority groups
specifically not ad-dressed. No one nurse is expected to be fully aware of all
the belief systems and customs of every ethnic and racial minority group,
Hispanic/Latino Culture
According to the US Census Bureau, the Hispanic/Latino group is the
largest and the fastest growing subculture in the United States. As of the last
full census survey in 2010, there were approximately 50.5 million people
(approximately 15%) of Hispanic/Latino origin in this country, an increase of
43% since the start of the 21st century. Because of immigration and a high
birth rate, this group is expected to occupy an even greater proportion of the
population in the coming decades (Ennis, Ríos-Vargas, & Albert, 2011).
Hispanic or Latino Americans derive from diverse origins. Members
of this heterogeneous group of Americans with varied backgrounds in culture and
heritage are of Latin American or Spanish origin and use Spanish (or a related
dialect) as their dominant language. Those of Mexican heritage account for the
largest number of people (approximately 60%) of this subculture, followed by
Puerto Ricans, Central and South Americans, and Cuban Americans (Peterson-Iyer,
2008).
Hispanic/Latino Americans are found in every state but are concentrated in just nine states. California and Texas together are home to half of the Hispanic population, but other large concentrations are found in New York, New Jersey, Florida, Illinois, Arizona, New Mexico, and Colorado (US Census Bureau, 2010a).
Nurses who practice in the Southwestern states are most likely to encounter patients of Mexican heritage, those practicing in the Northeast states will most likely be caregivers of patients of Puerto Rican heritage, and nurses in Florida will deliver care to large numbers of Cuban Americans .
Although Hispanic Americans have many common characteristics, each subgroup has unique characteristics. The people of Hispanic heritage have special healthcare needs that must be addressed. They are disproportionately affected by certain cancers, alcoholism, drug abuse, obesity, hypertension, diabetes, adolescent pregnancy, tuberculosis, dental disease, and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS).
Homicide, AIDS, and perinatal conditions rank in the top 10 as causes of
mortality of Hispanic/Latino Americans, Hispanics are less likely to receive
preventive care, often lack health insurance, and have less access to health
care than whites living in the United States (CDC, 2011; Chen, Bustamante,
& Tom, 2015; Fernandez & Hebert, 2000; Hebert & Fernandez, 2000,
Hosseini, 2015; Juckett, 2013; Pacquiao, Archeval, & Shelley, 2000;
Peterson-Iyer, 2008; Purnell , 2013; USDHHS, 2012).
Fluency in Spanish as a foreign language for nurses is highly recommended when delivering care to this growing, underserved, culturally diverse ethnic group. Spanish-speaking people represent 62% of all non-English-speaking persons in the United States (US. Census Bureau, 2010a). Language (less than 25% speak English well), degree of acculturation, and immigration status are the biggest barriers to access of health care by the Hispanic population (Escarce & Kapur, 2006).
In proportion to their share
of the nation's population, those of Hispanic heritage are underrepresented in
the professional nursing workforce. Only 3.6% of all graduates of basic nursing
programs are of Hispanic descent (Figure 8-3)-far too few to satisfy the
increasing need for Hispanic healthcare professionals.
Access to health care by Hispanics is limited both by choice and by unavailability of health services. Only one fifth of all Puerto Rican Americans, one-fourth of Cuban Americans, and one-third of Mexican Americans see a physician annually. Even when Hispanic people have access to the healthcare system, they may not receive the care they need.
Difficulty in obtaining services, dissatisfaction with the care provided, and inability to afford the rising costs of medical care are major factors that discourage them from using the healthcare system (Fernandez & Hebert, 2000; Juckett, 2013; Purnell, 2013; Whittemore , 2007).Approximately 25% of Hispanic families live below the poverty line.
Hispanic Americans, along with African Americans, are approximately twice as likely to be below the poverty level than members of other subcultural groups in the United States (CDC, 2011). Their general economic disadvantage leaves little disposable income for paying out-of-pocket expenses for health care.
When they do seek a regular source of care, many people in this minority group rely on public health facilities, hospital outpatient clinics, and emergency rooms (Kaplan & Inguanzo, 2011; Purnell, 2013; Wright & Newman-Ginger, 2010). Also, they are very accepting of health care being delivered in their homes, where they feel a sense of control, stability, and security (Pacquiao et al., 2000).
The health beliefs of Hispanic people also affect their decisions to seek traditional care. Many studies dating from the 1940s to the current day on Hispanic health beliefs and practices stress the existence of folklore practices, such as this group's use of herbs, teas, home remedies, and over-the-counter drugs for treating symptoms of acute and chronic illnesses.
In
addition, Hispanic/Latino Americans place a high degree of reliance on health
healers, known as curanderos or spiritualists, for health advice and treatment
(Fernandez & Hebert, 2000; Purnell, 2013). In addition to being culturally
appropriate, these health healers are more likely to speak Spanish than
traditional healthcare providers, and their services can be obtained at lower
cost (Titus, 2014).
Illness According to Hispanic Group
Illnesses of Mexican Americans as a Hispanic subgroup can be
organized into the following categories (Juckett, 2013; Purnell, 2013):
1.Diseases of hot and cold, believed to be caused by an imbalanced
intake of foods or ingestion of foods at extreme opposites in temperature. In
addition, cold air is thought to lead. to joint pain, and a cold womb results
in barrenness in women. Heating or chilling is the traditional cure for parts
of the body afflicted by disease.
2.Diseases of dislocation of internal organs, cured by massage or
physical manipulation of body parts.
3.Diseases of magical origin, caused by mojo, or evil eye, a
disorder of infants and children resulting from a woman looking admiringly at
someone else's child without touching the child, resulting in crying, fitful
sleep, diarrhea, vomiting, and fever.
4.Diseases of emotional origin, attributed to sudden or prolonged terror
called susto.
5.Folk-defined diseases, such as latido.
6.Standard scientific diseases.
The overall health status of Hispanic Americans can be determined by examining key health indicators of infant mortality, life expectancy, and mortality from cardiovascular disease and cancer and measures of functional health. Research findings indicate that the health of people of Hispanic heritage is much closer to that of white Americans than to that of African Americans, even though the Hispanic and black populations share similar socioeconomic conditions.
Concerning the incidence of diabetes and infectious and parasitic
diseases, however, Hispanic people are clearly at a disadvantage in relation to
white people. Possible explanations for the relative advantages and
disadvantages in health status of Hispanic Americans involve such factors as
the following (Juckett, 2013; Purnell, 2013):
Cultural practices favor reproductive success. Early pregnancies and high fertility rates contribute to low breast cancer incidence but increased cervical cancer rates.
Dietary habits are linked to low cancer rates but a high prevalence of obesity and diabetes,
Genetic heritage contributes to the susceptibility to certain
diseases, such as diabetes.
Extended family support reduces the need for psychiatric
services.
Low SES contributes to increased infectious and parasitic
diseases.
Alcoholism also represents a serious health problem for many
Hispanic Americans. Chronic liver disease and cirrhosis are among the leading
causes of death for this population (CDC, 2012). Furthermore, as the Hispanic
population becomes more acculturated, certain risk factors for cardiovascular
disease and certain cancers are expected to play larger roles in this group
(Purnell, 2013).
Knowing where people get their health information can provide clues
to nurses as to how to best teach specific population groups. For example,
Mexican Americans, like other Latin American groups, tend to rely on family as
the primary source of credible health information. Therefore, when teaching a
patient, health information should be shared with significant others within the
family unit (Eggenberger, Grassley, & Restrepo, 2006; Purnell, 2013).
Because the family is the center of Hispanic people's lives, the extended family serves as the single most important source of social support (Peterson Iyer, 2008). This culture is characterized by a pattern of respect and obedience to elders as well as a pattern of male dominance. The focus of patient education by nurses, therefore, needs to be on the family rather than on the individual.
It is likely, for example, that a woman would be reluctant to make decisions about her or her child's health care without consulting her husband first (Purnell, 2013). Gender and family member roles are changing, however, as more Hispanic women take jobs outside the home. Also, children tend to pick up the English language more quickly than their parents and often end up in the powerful position of acting as interpreters for their adult relatives.
The heavy reliance on family has been linked to this minority group's low utilization of healthcare services. In addition, levels of education correlate highly with access to health care.
The less educated members within a household have, the poorer the family's health status and access to health care (Purnell, 2013; USDHHS, 2012), Hispanic Americans are more likely than the general US population to read English below the basic health literacy level and to have lower educational attainment than non-Hispanic whites (National Center for Education Statistics, 2006).
Teaching Strategies Sub Cultural Ethic Groups
Only approximately 40% of the Hispanic population has completed 4 years of high school or more, and only 10% have completed college, as compared with approximately 80% and 20%, respectively, of the non-Hispanic population (Fry, 2010). Both the educational level and the primary language of Hispanic patients need to be taken into consideration when selecting instructional materials (National Center for Education Statistics, 2006).
Sophisticated teaching methods, such as self-instruction and simulation, and instructional tools, such as computer resources and high-literacy print materials, likely would be inappropriate for those who have minimal levels of education.The age of the population also can affect health and patient education efforts. According to the US Census Bureau (2009), the Hispanic population is young as a total group (34% of this group is younger than 18 years of age).
Thus, the school system is an important setting for educating members of the Hispanic community. For Hispanic students, education programs in the school system on alcohol and drug abuse and on cardiovascular disease risk reduction have proven successful when the following criteria were met by the nurse in the role of patient educator:
Cultural beliefs were observed.
An individual accepted and respected by the group introduced the
nurse. Family members were included.
The community was encouraged to take responsibility for resolving
the health problems discussed.
Morbidity, mortality, and risk factor data also provide clues to the areas in which patient education efforts should be directed. As mentioned earlier, Hispanic people have higher rates of diabetes, AIDS, obesity, alcohol-related illnesses, and mortality from homicide compared to the general population. These topics should be targeted for educational efforts at disease prevention and health promotion (CDC, 2012).
General Suggestions for Sub Cultural Ethic Groups Nursing Education
The following general suggestions
are useful when designing and implementing education programs for Hispanic
Americans (Fernandez & Hebert, 2000; Hebert & Fernandez, 2000; Juckett,
2013; Pacquiao et al., 2000; Peterson-Iyer, 2008; Purnell, 2013 ; Schouten
& Meeuwesen, 2006):
1. Identify the Hispanic American subgroups/any other cultur (eg, Mexican, Cuban,
and Puerto Rican) in the community whose needs differ in terms of health
beliefs, language, and general health status. Design education programs that
can be targeted to meet their distinct ethnic needs.
2. Be alert to individual differences within subgroups as to age,
years of education, income levels, job status, and degree of acculturation.
3. Account for special health needs with respect to incidences of
diseases and risk factors to which they are vulnerable-breast cancer in women
(Borrayo, 2004), diabetes, AIDS, obesity, alcohol-related illnesses, homicide,
and accidental injuries.
4. Recognize the importance of family in supporting one another, so
be sure to direct education efforts to include all interested members and
remember that decision making typically rests with the male and elder authority
figures in homes where tradition is strong.
5. Provide adequate space for teaching to accommodate family
members who typically accompany patients seeking health care.
6. Be aware of the importance of the Roman Catholic and other religion in
their lives when dealing with such issues as contraception, abortion, and
family planning.
7. Demonstrate cultural sensitivity to health beliefs by respecting
and taking time to learn about their ethnic values and beliefs.
8. Consider other care practices, such as home remedies that they
might be using before entering or while within the healthcare system.
9. Be aware of the modesty felt by some women and girls, who may be
particularly uncomfortable in talking about sexual issues in mixed company.
10. Display warmth, friendliness, and tactfulness when developing
relationships because they expect nurses and other health providers to be
informal. and interested in their lives.
11.Determine whether Spanish(or other Native Language) is the language by which the patient
best communicates, but remember that even though speaking Spanish may be
preferred, the patient and family members are not always literate in their
native language.
12. Speak slowly and distinctly, avoiding the use of technical
words and slang if the patient has limited proficiency in the English language.
13. Do not assume that a nod of the head or a smile indicates
understanding of what has been said. Members of this heritage respect authority
and, therefore, it is not uncommon for them to display nonverbal cues that may
be misleading or misinterpreted by the nurse. Ask patients to repeat in their
own words what they have been told using the teach-back method to determine
their level of understanding (Weiss, 2007).
14.If interpreters are used, be sure they speak the dialect of the
learner and that they interpret instructions rather than just translate them
verbatim, so that the real meaning gets conveyed. Also, be sure to talk to the
patient. not to the interpreter. If an interpreter is not available, use a
telephone interpreting service.
15. Provide written and audiovisual materials in Spanish that
reflect linguistic appropriateness and cultural sensitivity (Borrayo, 2004).
As discussed previously, nurses must account for the cultural
beliefs and health and education needs of Hispanic Americans. By ex- tending
themselves to Hispanics in a culturally sensitive manner, nurses have the
opportunity to effectively and efficiently address the needs of this rapidly
growing segment of the US population (Borrayo, 2004).
Give your opinion if have any.