Culture and Advanced Nursing Practice
Mrs. Demetilla Hernandez is a 63-year-old Cuban woman who seeks consultation at the Liberty health-maintenance organization (HMO) clinic because of weakness, lethargy, and fatigue that she has experienced for the last 2 months. A week ago, while cooking dinner at her daughter, Mariana’s house, she momentarily lost her balance and slipped on the kitchen floor. Although Mrs. Hernandez sustained only a mild bruise on her leg, her daughter insisted on taking her to the clinic for a check-up because of her persistent symptoms.
Mrs. Hernandez, widowed 4 years ago when her husband died of a heart attack, lives with Mariana, aged 40. Mariana is divorced and has three children: Luis, age 15; Carolina, age 10; and Sofia, age 7. Since moving into Mariana’s house, Mrs. Hernandez has been managing the household while Mariana is at work. Mrs. Hernandez prepares the family’s meals, attends to the children when they come home from school, and performs light housekeeping chores. Mariana is employed full-time as a supervisor at the local telephone company. The family, originally from Cuba, has been living in Miami for 12 years. Carolina and Sofia were born in Miami, but Luis came from Cuba with his parents when he was 3 years old. Mrs. Hernandez, who does not speak English, converses with her daughter and grandchildren in Spanish. Although the children and their mother occasionally speak English among themselves, the family’s language at home is Spanish.
At the Liberty HMO clinic, Mrs. Hernandez was diagnosed with essential hypertension and non–insulin-dependent diabetes mellitus. The physician prescribed an oral hypoglycemic drug and advised Mrs. Hernandez to exercise daily and to limit her food intake to 1500 calories a day. Mrs. Hernandez was concerned because she usually prepares traditional Cuban meals at home and was not sure whether she could tolerate being on a diet. Besides, she explained to Mariana, she thought the dishes she prepares are very “healthy.” Proof of that, she stated, is that her three grandchildren are plump and nice-looking. Mrs. Hernandez told her daughter that, instead of buying the prescribed medicine, perhaps she should go to the botanica and obtain some herbs that would help lower her blood sugar.
What are the typical Cuban communication patterns you need to be aware of in dealing with Mrs. Hernandez?
How would you assist Mrs. Hernandez in developing a plan for a 1500-calorie diet and regular exercise?
Would you encourage Mrs. Hernandez to go to the botanica to purchase some herbs? How would you approach her desire to use herbs instead of the prescribed oral hypoglycemic agent?
Discuss some common folk practices that Cuban families may use to maintain health or cure common ailments.
Sample Solution
1. Typical Cuban Communication Patterns
Several communication patterns common in Cuban culture could influence Mrs. Hernandez's interaction with healthcare providers:
- Respect for Elders: Older adults are highly respected in Cuban culture. Mrs. Hernandez may be hesitant to directly question or challenge the physician's recommendations, even if she has concerns. It's crucial to approach her with deference and acknowledge her experience and wisdom.
- Family-Centered Decision-Making: Decisions about health are often made collectively within the family. Mrs. Hernandez's reliance on her daughter, Mariana, for communication and her concern for her family's well-being highlight this. Involving Mariana in the conversation and respecting her role as a key decision-maker is essential.
- High-Context Communication: Cuban communication tends to be high-context, meaning that much of the meaning is conveyed through nonverbal cues, shared understanding, and implicit messages. Paying attention to Mrs. Hernandez's body language, tone of voice, and facial expressions is important. Directly asking about her feelings and concerns may be more effective than relying solely on explicit verbal communication.
- Personalismo: Cubans value personal relationships. Taking the time to build rapport with Mrs. Hernandez, showing genuine interest in her life and family, can strengthen the therapeutic relationship and increase her willingness to adhere to the treatment plan.
- Expressiveness: Cubans are generally expressive and passionate in their communication. Mrs. Hernandez's animated discussion of her cooking and her grandchildren's appearance reflects this. Allowing her to express herself freely, even if it takes time, can be therapeutic.
- Use of Folk Medicine: As evidenced by her interest in the botanica, traditional healing practices and herbal remedies are common in Cuban culture. It's crucial to acknowledge the validity of these beliefs and integrate them respectfully into the overall care plan.
2. Assisting with Diet and Exercise Plan
- Cultural Sensitivity: Acknowledge the importance of food in Cuban culture and the potential difficulty of changing long-held dietary habits. Avoid making judgmental statements about her current diet.
- Collaboration: Involve Mrs. Hernandez and Mariana in developing the plan. Ask about their preferred foods and cooking methods. Explore ways to adapt traditional Cuban dishes to fit the 1500-calorie limit. Perhaps smaller portions of traditional meals can be consumed.
- Practical Strategies: Provide concrete examples of portion sizes and healthy food choices. Consider using visual aids, such as pictures or food models, to illustrate portion control. Offer culturally appropriate recipes that are low in calories but still palatable.
- Gradual Changes: Suggest making gradual changes to her diet and exercise routine, rather than drastic overnight alterations. This can increase her adherence to the plan.
- Family Support: Encourage Mariana and other family members to support Mrs. Hernandez in her efforts to adopt a healthier lifestyle. Perhaps the entire family can adopt some of these practices to show their support.
- Language Accessibility: Ensure that all educational materials and instructions are provided in Spanish, using clear and simple language.
- Community Resources: Connect Mrs. Hernandez with Spanish-speaking dietitians or diabetes educators who can provide culturally relevant guidance and support.
3. Addressing Herbal Remedies
- Respectful Inquiry: Approach the topic of herbal remedies with respect and curiosity. Ask Mrs. Hernandez about the specific herbs she is considering and her understanding of their effects.
- Open Dialogue: Explain the importance of evidence-based medicine and the potential risks of using unproven herbal remedies, especially in the context of diabetes. Emphasize that some herbs can interact with prescription medications or have adverse effects.
- Integration, Not Replacement: Instead of dismissing herbal remedies outright, explore the possibility of integrating them safely with conventional treatment. Encourage Mrs. Hernandez to discuss any herbs she is using with her physician to ensure there are no contraindications.
- Focus on Safety: Emphasize the importance of monitoring her blood sugar levels regularly, regardless of whether she is using herbs or medication. Explain that this is the best way to ensure her diabetes is being managed effectively and to prevent complications.
4. Common Cuban Folk Practices
Cuban families may use various folk practices for health maintenance and healing, including:
- Herbal Remedies (Botanica): As mentioned, herbal teas, poultices, and other preparations are commonly used to treat a range of ailments.
- Santería: A syncretic religion with African roots, Santería involves spiritual rituals and offerings to deities for healing and protection.
- Espiritismo: Belief in spirits and communication with the deceased is prevalent. Spirit mediums may be consulted for guidance on health and well-being.
- Home Remedies: Traditional remedies passed down through generations, such as using specific foods or spices for medicinal purposes.
- Prayer and Religious Practices: Faith plays a significant role in many Cuban families. Prayer and religious rituals may be used to seek healing and comfort.
It is crucial for healthcare providers to be aware of these practices and to approach them with cultural sensitivity. Understanding the patient's beliefs and integrating them respectfully into the care plan can improve adherence and promote better health outcomes. Open communication and a willingness to learn about the patient's cultural background are essential for providing culturally competent care.