Tuesday, June 17, 2014

Cultural Competence in Caring for the Hispanic/Latino Communities

By Lea Hernandez-Vespe, MSW, LSW, I Choose Home New Jersey

Our society is increasingly diverse and enriched with various cultural influences.  All cultures and subcultures have their own sets of values, beliefs, traditions, and customs that they prescribe to as a way life.  The Hispanic and Latino population in the United States is currently the largest minority and is expected to reach just under a third of the U.S. population by 2050 (Pew Research, 2008).  At the OOIE, we are committed to serving the elderly population 60 years and older living in institutions – including persons of all races, genders, religions, sexual orientations, etc.  We recognize that understanding cultural differences strengthens our ability to advocate for and protect long-term care residents of all walks of life.

As I travel the State of NJ as an Outreach and Advocacy Coordinator, I enjoy working with and on behalf of individuals of various cultural backgrounds.  A common question that many people have about the Hispanic/Latino culture is whether there is a difference between “Hispanic” and “Latino. ” Although the terms are often used interchangeably, they have different meanings.  A person is Hispanic if they come from or have ancestry from countries that are Spanish-speaking (Puerto Rico, Mexico, Cuba, etc.). Latino refers to individuals who are from or have ancestry from a geographical location in Latin America that is not necessarily Spanish-speaking.  A Brazilian American, for example, is Latino but not Hispanic because they are from South American (Latin America) but their language is Portuguese (not Spanish).  A Puerto Rican American is considered to be both Latino and Hispanic because they are from Latin America and their primary language is Spanish. 

Every culture has its distinctions that make it unique to others.  I will summarize six key Hispanic/Latino values that provide the foundation for their way of life (Carteret, 2011.)

In Hispanic/Latino culture, the family is highly valued.  The family in this culture is inclusive of grandparents, aunts/uncles, and cousins and even close friends.  Important decisions are made as a collective unit.  Individualistic decision-making is viewed as disrespectful and selfish.  (Carteret, 2011).  Important decision-making may be delayed until all key family members are available for discussion.  The intent is not to be uncooperative but rather to respect the family process of decision-making within their culture.  

Another important value is respect and reverence to authority. Within the family structure, authority is granted based on gender and age.  The oldest male in the family has the greatest decision making authority.  In the community, reverence to authority is provided based on age, gender, social position and economic status.  For example, doctors and clergy are viewed as authority figures and given such reverence that communication with them is reduced to one of listening rather than engaging, as a sign of respect.  It is helpful for someone in a position of authority working with individuals from the Hispanic/Latino culture to make an effort to engage the person by asking questions of them.

In this culture, respect is expected to be reciprocal.  A Hispanic/Latino individual prefers to be addressed formally by their last name until given permission to use their first name.  A greeting such as “good morning/good afternoon/good evening” accompanied by a smile demonstrates a professional friendliness that helps to build rapport and cooperation.

Many Hispanics/Latinos have a strong belief in spirituality and/or karma.  Many accept uncertainty as a part of life and believe destiny cannot be changed.  Many Hispanics/Latinos have a strong belief that God’s will controls their lives.  They may believe that bad things happen to them as punishment for their actions.   They may choose not to be treated for an aliment and allow that God’s will be done.  This may set the stage for ethical dilemmas, specifically in healthcare settings such as hospitals and long-term care facilities.  Being mindful that every person with decision-making capability has the right to self-determination and to make decisions according to their religious/spiritual values even if it differs from that of the conventional norm, would help mediate many ethical dilemmas.  Encouraging Hispanic and/or Latino patients to complete advance directives is a great way to have their wishes known and respected.

The values of kindness and professional friendliness may seem to be fundamental at first glance to all people.  In the United States, however, the value of maintaining a professional, business-like demeanor while maintaining strict professional boundaries can be perceived as indifferent and callous for individuals who place a greater value on relationships than professional or business protocol. To gain trust, cooperation and compliance, it is important for medical professionals to establish rapport by imparting compassion, benevolence, and friendliness when working with the Hispanic/Latino community.  The act of shaking hands, greeting with a smile, using a friendly tone, asking questions and engaging in friendly conversation makes members of this community feel valued. 

Many in the Hispanic/Latino community (old and young) have traditionally used alternative medical practices to cure the sick of physical and emotional ailments.  They have used herbal remedies to cure sickness and/or disease.  They have sought the help of folk healers, spiritual healers or witchdoctors to help them spiritually ward off or cure affliction.  Current practices can be viewed as another extension of the holistic medical movement in United States today inclusive of hypnotism, acupuncture, herbal remedies, etc. As a service provider to Hispanic/Latino communities, it would be sensible to inquire about such practices to not only demonstrate culture competence but to avoid any clinical adverse reactions during prescribed treatment.  

In summary, when dealing with Hispanic/Latino residents, please remember:

  • Health care decision-making might be more collective than individualized.
  • Residents may give great deference to health care professionals and may feel uncomfortable asking questions/challenging them.
  • Respect is highly valued, given and expected to be received in return.
  • Religious and spiritual views might grant more power over a health care situation/decision to God or a higher being.
  • Strict professionalism (without friendliness or compassion) may create barriers.
  • Natural/holistic/non-Western health remedies are more common and should be investigated.
I have provided a framework for professionals to use when working with individuals and families from the Hispanic/Latino community.  As professionals, we must be cautious to not over-generalize about any group or subgroup.  We must recognize that individuals belonging to any culture or subculture have varying beliefs and values shaped by many factors including education, socio-economic status, degree of assimilation, language proficiency and personal experiences (Carteret, 2011). We can strengthen our communities by systemically incorporating values, attitudes, goals, objectives and practices that are inclusive of individuals/groups that prescribe to different sets of beliefs, customs, traditions and values.


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