Diverse Mexico over the Centuries

TABLE OF CONTENTS

1. HEALTHCARE BELIEFS AND PRACTICES OF ASSIGNED CULTURE
2. POPULATION PREVALENCE IN THE WORCESTER COUNTY AREA
3. AREAS IN WORCESTER COUNTY WHERE POPULATION ACCESSES HEALTHCARE
4. VIEWS/BIASES/EXPERIENCES OF WORCESTER COUNTY HEALTHCARE
5. PROFESSIONALS WORKING WITH THE CULTURE
6. SPECIFIC INTERVENTIONS TO UTILIZE IN CARING FOR THIS POPULATION (BASED ON RESEARCH)
7. RESOURCES
8. PIE CHARTS

I. HEALTHCARE BELIEFS AND PRACTICES OF ASSIGNED CULTURE

Hispanics are a fast-growing minority in the United States, of which Mexicans are a large sub-group (Cultural Insights: Communicating with Hispanics/ Latinos, 2018). Cultural awareness surrounding health care practices and beliefs within the Mexican culture is an important aspect of providing quality care.

The language, religion, medicine, and folk healing remedies shape the rich cultural heritage deeply rooted in Mexican traditions and customs. First and often second generation Mexican-Americans have brought much of their Mexican heritage and traditions with them to the United States. Even third generation Mexicans and beyond are noted to retain traditional practices from their Mexican heritage. The Mexican culture is uniquely tenacious throughout generations, seemingly more so than other ethnicities (Sobel & Sawin, 2014).

Personal relationships are important in the Mexican culture. Health care providers should try to be attentive both to the patient and their family members (Sobel & Sawin, 2014). Nurses should provide the patient and family privacy as well as ample time to express their religious beliefs/concerns (Padilla & Villalobos, 2014). With the Mexican population, family is the center of existence and is usually included with care (Sobel & Sawin, 2014). In the broadest sense, culture includes how people think, what they do, and how they use things to sustain their lives (Cultural Insights: Communicating with Hispanics/ Latinos, 2018).

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Spanish is the predominant language of the Mexican culture however; multiple dialects and lack of bilingual healthcare workers can make it difficult for Mexican patients to communicate with staff. Many hospitals and offices lack trained interpreters and rely on ad hoc interpretation from bilingual staff or even the children of patients (Juckett, 2013). Language barrier was discussed in an interview conducted with Daniela Vela Hernandez, a Licensed Marriage and Family Therapist. She currently works as a regional manager for a private medical group and was able to provide ‘her’ experiences. Daniela is a second generation Mexican-American whose parents emigrated to the United States to seek better job opportunities.

Daniela states both her parents and grandparents specifically search for healthcare providers that speak Spanish. Daniella often sees this behavior in elder Mexican immigrants because of the language barrier. Healthcare workers who may know some Spanish can create a sense of false fluency, furthering the barrier between the provider, and the patient as well as losing a trusted relationship. A consequence of these problems is a marked disparity in the quality of care that Hispanic patients receive (Juckett, 2013). Daniella and her family live in Imperial, California which very close to the Mexican border.

Daniella’s parents and grandparents prefer their medical treatments in Mexico as opposed to receiving care in the United States. Daniela states “healthcare and treatments in Mexico are much more affordable for the same or better care. My family prefers speaking in their native language because they do not understand English.” Her grandmother is uncomfortable using telemedicine when discussing her health issues, especially if it is something personal. Her elderly grandfather has difficulty comprehending speaking through a translation device to discuss his medications when the provider is present in front of him.

While more options have become available to aid in translation, Daniella does not find these devices to be particularly patient friendly and feels they can add to the language barrier. She notes “the language barrier could lead Spanish speaking patients to gravitate to Spanish speaking providers which then narrows patient options for care.” Understanding the role that language plays in generating barriers to quality medical care is critical for healthcare organizations. There has been a steady increase of Spanish speaking Mexican immigrants in the United States (Cultural Insights: Communicating with Hispanics/ Latinos, 2018).

Mexican Americans and Mexicans value many common religious roots however, Mexican Americans are not as heavily Catholic as those who immigrated from Mexico or live in Mexico currently (Donoso, 2014). In regard to religious affiliation, there are differences among Mexicans and Mexican-Americans with 81% of Mexicans identifying as Catholics, and only 61% of Mexican-Americans identifying as Catholic. About 18% of Mexican Americans are identifying as Protestant versus only nine percent of Mexicans identifying as Protestant. Additionally, 17% of Mexican- Americans do not practice a religion, whereas only 7% of Mexicans claim to have no religious affiliation (Donso, 2014). However, in the interview with Daniella, she points out that several other members of her family practice different religions so to never assume a persons’ religion by their nationality.

The Posadas pay tribute to Mary and Joseph’s long and difficult journey from Nazareth to Bethlehem. They were seeking a location for the Christ Child to be born. Posadas was a tradition brought to Mexico from Spain in the 1500s by Catholic Missionaries (Farfaglia, 2014). The Posada begins with reciting the prayer to Mary, the Mother of Jesus, called the Holy Rosary. During the interview conducted with Daniella Vazquez, she states “I often incorporate rosary into my clients care. I assign praying the rosary as homework for my clients who need to meditate or do deep breathing. This is a good grounding exercise. It is repetitive, gives tactile stimulation with the beads and takes about 20 minutes which is the ideal time to exercise.” Daniella also notes “the Virgin Mary is the patron saint of Mexico. Many pray to her more than a traditional prayer.”

Death is a cause for celebration in the Mexican culture and is viewed as an important event (Bravo, 2014). Death isn’t just about the heart stopping or a person’s breathing ceasing; it is about beginning a new journey (Donso, 2014). A traditional custom in preparation for the afterlife of a deceased family member requires living family members to wrap the deceased in a mat in which they died on prior to cremation. The deceased family members ashes are then put into a hut for nine days until they are ready to pass into the next life and meet God (Bravo, 2014).

The eight days in between cremation and the passing into the afterlife, family members gather around the ashes to eat, drink, talk, and pray (Donso, 2014). Ashes are then buried on the ninth day with a celebration of dancing and music (Donso, 2014). This along with many other traditions have been passed down through generations with slight variations. For example, the current custom surrounding death in the Mexican American culture is to make a cross with lime or dirt According to these traditions’ death is the beginning of the afterlife (Donso, 2014). A slight variation from the traditional custom, family and friends gather around the cross they draw for nine days to pray, drink, and eat tamales (Donso, 2014). On the ninth day, they perform the ceremony known as the levantacruz, which means ‘lifting the cross.’ The ceremony completes the rite of gathering God’s steps and ends the persons earthly experience allowing God and the deceased to find each other (Bravo, 2014).

Communication is a key factor in establishing a trusting relationship with Mexican patients and people of Mexican descent. The Hispanic culture has several important values that healthcare workers should be mindful of which include simpatía (kindness), personalismo (friendliness), and respeto (respect) (Juckett, 2013). Simpatía is a general tendency toward avoiding personal conflict (Juckett, 2013). It emphasizes positive behaviors in agreeable situations and discourages negative behaviors in difficult circumstances. Personalismo, means a personal connection.

This can be achieved by showing interest in the patient and family (Juckett, 2013). Physical proximity is also perceived as being more personable and healthcare personnel should understand in an attempt to achieve personalismo, one may stand closer when communicating (Cultural Insights: Communicating with Hispanics/ Latinos, 2018). Since Mexicans grant respect to their superiors, they expect their superiors to reciprocate by demonstrating personalismo by showing kindness, warmth, and a friendly demeanor. Respeto is the Spanish term for respect. It implies attentive concern for the patient and respect of personhood and age (Juckett, 2013).

Mexicans offer respect more readily to people in a position of power, or those perceived as experts. Daniella noted during her interview that this form of respect offered to people in a position of power can actually cause a barrier to providing care to patients and refers to it as a “double edged sword.” Stating “they [patients] will either comply with treatment because of cultural norms or if they don’t agree, they won’t tell the provider thus hindering treatment.” What she suggests is being in tune with body language and asking questions about preferences to get the patient to talk and open up about their concerns with their plan of care.

She has found Mexican patients will just nod their heads yes in the office and not work with the provider to develop an alternative treatment plan. She also finds patients who disagree with the plan of care will agree with the plan in the office to adhere to respeto however, when they leave the office they do not adhere to the medical advice. Daniella also suggests asking open ended questions to better understand the patient’s thought process and understanding of the disease process and treatments.

A person’s elder regardless of their position are granted respect and should be addressed as señor or señora rather than by their first names (Juckett, 2013). Double or hyphenated surnames may seem complicated and make addressing patients properly a challenge. If there is any question about the appropriate way to address a patient it is best to ask the patient how they prefer to be addressed (Juckett, 2013).

Caring for Mexican patients poses a unique set of challenges surrounding cultural values which may differ from traditional Western medicine. Machismo is a characteristic of a man defined as prominently excessive masculinity or toughness needed (Cultural Insights: Communicating with Hispanics/Latinos, 2018). Machismo can range from a personal sense of virility to the more intense form of male chauvinism (Evason, 2018). While many of the unique traits of Mexican- American men are admirable, health care workers should pay special attention to a man of Mexican descent who may need help to cope with emotions during a difficult situation needed (Cultural Insights: Communicating with Hispanics/Latinos, 2018).

True to these values, men are often reluctant to consult physicians for health problems until he is so ill that a visit to an emergency room is needed (Cultural Insights: Communicating with Hispanics/Latinos, 2018). Holding true to Machismo the man may also attempt to ‘tough it out’ during illness that may require medical attention. The female’s serve as the maternal powerhouse in their home. In the Mexican culture women are sacred and often protected because the family unit depends on her good health and maternal skills (Evason, 2018). The Hispanic population show great concern for ill family members through excessive care and attention (Evason, 2018). This at times can extend to the point of interfering with rehabilitation and proper medical care (Cultural Insights: Communicating with Hispanics/Latinos, 2018).

Mexican women can view pregnancy as a normal condition and may not attend prenatal visits or receive proper prenatal care (Gress-Smith et al., 2013). Pregnant women commonly look to their elders to provide support and advice during pregnancy. A common belief is that pregnant woman should avoid all contact surrounding anything death-related and is forbidden to attending funerals or burials (Gress-Smith et al., 2013). Hispanic women adhere strongly to familism and value the nuclear and extended family (Gress-Smith et al. 2013). It is common practice for a pregnant woman to prefer that their mother attend to her during labor. Traditionally it is believed tending to a woman during delivery is a woman’s job, ideally by her mother and a midwife (Gress-Smith et al., 2013). Cultural tradition is that a husband should not see his wife or child until the delivery is completed and both the mother and infant have been cleaned and dressed (Gress-Smith et al., 2013).

‘Lying in’ also known as a confinement period or la cuarenta lasts 40-days. It is considered essential to caring for the child and aid in prevention of diseases and complications. During this period the woman’s body is thought to be extremely weak and vulnerable to external forces and she is prohibited from bathing or exercise during this time (Chou, 2017).

Many Mexican women choose not to breastfeed until they return home from the hospital following the belief that they have no milk (Chou, 2017). Until a mother’s breasts enlarge and are visibly full, she may not feel she has sufficient milk to feed her infant. Some mothers view colostrum as ‘bad milk’ or ‘spoiled’ and therefore not good for the baby, not understanding that nursing stimulates milk production and colostrum is full of nutrients (Chou, 2017). Educating mothers during this time is important to successful experience with breastfeeding.

Many aspects of modern western medicine are a last resort for health, wellness and preventative care in the Mexican culture and some treatments are based off of the “hot and cold” theory. Preventative care is not typically sought out in the Mexican culture, believing much of a person’s health is based on fate (Sobel & Sawin, 2014). During a period of illness, cultural influences as well as socioeconomic influences dictate that home remedies are to be tried first. They will also take the advice of the elderly for herbal or natural healing methods to aid in healing (Hernandez-Morin, 2018).

Then possibly a folk healer also known as a curandero will be traditionally used (Hernandez-Morin, 2018). Modern western medicine is commonly the last resort for illness which is strongly influenced by a lower socioeconomic status (Sobel & Sawin, 2014).

Daniella discussed in her interview the financial hardships her family experienced which determined what they used for their medical care. Often her family would use herbal teas and folk healing passed down from generations since they could not afford to pay for modern medicine. She also noted coming from a low-income family which played a role in where her medical care was going to take place. If she needed to be seen by a doctor, then her parents would take her back to Mexico where both Daniela and her parents felt the care was more heartfelt and warmer as well as financially feasible.

Curanderos is a traditional healer and will distinguish between “hot” and “cold” illnesses as well as determine a treatment. The theory suggests that when there is an imbalance or illness which is labeled either hot or cold then a person can then eat the opposite foods to balance the problem. Proper balance is considered necessary for good health and any imbalance results in an illness (Juckett, 2013).

Folk healing and the use of herbal remedies is common practice for both the population in Mexico and the Mexican American population. Traditional folk medicine and home herbal remedies may delay treatment and possibly reduce positive outcomes (Juckett, 2013). Physicians and healthcare personnel may be perplexed or not understand the importance of traditional folk healing.

Patients often utilize brujos or brujas (wizards or witches), yerberas (herbalists), hueseros (bone setters), parteras (midwives), and sobradores (similar to physical therapists) prior to seeking traditional western medicine practices (Juckett, 2013). Symptoms and disease processes can be perceived differently in the Mexican culture. For example, posttraumatic shock or anxiety may be associated with susto or soul loss rather than posttraumatic stress disorder. A patient may link their abdominal pain to empacho or food being stuck in the intestine (Juckett, 2013). Commonly a child’s failure to thrive is attributed to mal de ojo or the evil eye which is a hex conveyed by an envious glance (Juckett, 2013).

Given the frequent use of herbal remedies Nurse to patient communication is vital in terms of avoiding the dangers of herb and drug interactions. Andrea Saiden is an LPN who works in the Infectious Disease Department at Brigham and Women’s Hospital in Boston. She was born in Mexico and immigrated to the United States six years ago in search of better job opportunities. Both Andrea and Daniella speak highly of herbal remedies and how they play an important role in their own healthcare and treatment as well as their families. While Andrea and Daniella both work in healthcare and understand herbal treatments should not replace modern medicine, they both often utilize herbal remedies first or in conjunction with modern medicine.

Furthering the importance of the nurse to outwardly ask patients if they are using any herbal treatments or remedies. Andrea states tea being the most common herbal remedy she uses for various illnesses. Daniella reports her mother and grandparents have many options for herbal treatment and states “we have a remedy for every condition in the book, you should see my cabinet!” Most commonly she uses hot teas with different additives to aid in healing.

Daniella pointed out “These remedies are in conjunction with prescriptions. For example, if I take my daughter Raquel to Mexicali for an appointment when she has a cold with phlegm. The MD will prescribe the typical Tylenol and loratadine for congestion, but we will also give her mint tea.” Following the Mexican culture Daniella also uses cinnamon for sore throats and corn silk to rid kidney stones. Mix corn silk in boiling water and allow it too steep for ten minutes this is supposed to help break down the stones to pass them. She also suggests after delivering a baby, a mother commonly soaks in a rosemary bath to help with inflammation. Given the potential for adverse reactions and interactions associated with herbal remedies, it is important to identify the prevalence of herb use in Mexican population.

The language, religion, medicine, and folk healing remedies play an important factor in how a patient will understand and respond to medical advice as well as how they will utilize the information provided to them. Many of the ancient traditions and customs of Mexican ancestors have been preserved and are still commonly practiced today. Personal relationships and incorporating family in care are necessary in order form trust with the patient.

II. POPULATION PREVALENCE IN THE WORCESTER COUNTY AREA

Worcester County encompasses a total of 60 cities and towns in Massachusetts. Its total population is 818,249. Latinos make up 10.8%, or 88,370, of that population in Worcester County (Worcester County MA Demographics data, 2019). There are many subgroups of the Latino population, and of that 88,370 there are about 2,354 Mexicans that are living in the city of Worcester, Massachusetts alone (Granberry & Rustan, 2014). Most of the Mexican population of Worcester County resides in the city of Worcester, as this is where many jobs can be found and people of this ethnicity tend to stay close together (Evason, 2018).

Mexicans have been migrating to Worcester and the surrounding areas for decades. Most people come for jobs and better opportunities, like Daniella and Andrea, and others come to be with family that came before them. Some of these people never even had the intention of staying in the Worcester County area. For a few it was only a matter of staying here in the area for a short while, whether it was staying with family or just coming to visit Massachusetts, only to realize this is where they wanted to be and live out their lives.

In the past there has been a trend of Latinos having a low homeownership rate, and that still holds true to this day. The White population has an ownership rate of 61.1%, while Latinos only have a 20.5% rate. Of that 20.5% only about 40% of Mexicans own their homes. The other 59.9% of that group rent places to live, whether that be renting a section of a house or an apartment (Granberry & Rustan, 2014).

Numerous people of this ethnicity also often have many generations living under one roof and living off of only one or two incomes making it harder financially (Evason, 2018). As of 2019, the average pay for a Mexican is about $45,588 per year. This comes to about $3,799 a month. This is only an average as there are many who were paid as little as $17,889 a year, and some paid as high as $74,110 a year, which is very few (Mexican Annual Salary in Worcester, MA, 2019). The average monthly mortgage payment for the people of Mexican descent came to about $1,074. On the other hand, the monthly rent payment averaged about $837 in Worcester County (Granberry & Rustan, 2014). Knowing this, it is easier to understand why many people of this background choose to rent rather than to buy and own a home.

People of Mexican ethnicity like to stay close together, in the same neighborhood or vicinity, even when they have moved out and are living on their own. This is another reason why renting places is more popular. Being able to live in apartment complexes close to one another is beneficial to them as they are able to support each other and maintain close family bonds, which is very important for people of this ethnicity (Evason, 2018).

III. AREAS IN WORCESTER COUNTY WHERE POPULATION ACCESSES HEALTHCARE

The Mexican population in Worcester County has a variety of opportunities and resources when it comes to healthcare. There are many options such as; primary care physicians, emergency rooms, urgent cares, clinics, and self-treatment. The type of healthcare Hispanics utilize depends on a multitude of factors such as; insurance, the severity of illness, language barriers, and cultural practices. Whether Hispanics can afford a primary care physician, or they utilize free clinics, Worcester country has a variety of options for people with a Mexican background.

In Worcester County, there are dozens of hospitals such as UMass Memorial Medical Center, UMass Memorial Medical center, University campus, St. Vincent Hospital, and many more. One of the biggest determining factors which influences the ability to receive healthcare is insurance. In the United States, Hispanics have the highest uninsured rates of any racial or ethnic group in the United States (Minorityhealth, 2019).

A few ways uninsured Hispanics access healthcare is through the Worcester free clinic coalition, Edward Kennedy community health center, urgent cares, and emergency departments. In many places throughout Worcester such as the Worcester free clinic coalition and Edward Kennedy community health center, these places attempt to bill them based on their income or attempt to provide individuals with insurance. For Hispanics in Worcester county who do have health insurance, they utilize some of the same places such as urgent cares, emergency departments, and the major hospitals in Worcester. In an interview done with the owner of Sol of Mexico, Emma Acevedo, she described her healthcare as she only goes to her doctor if she is sick, otherwise, she relies on family remedies.

When Hispanics are reluctant to go to the doctor, they use their own form of healthcare by using family remedies and alternative therapies. In an interview with Andrea Saiden, a Mexican American working as an LPN, she described some of her home remedies such as mint with chamomile and honey for colds or flu, coke with lime and baking soda for an upset stomach, and ginger and cinnamon tea for headaches and nausea.

In another interview done with Daniela Vela Hernandez who is a second generation Mexican American, she described some of her various home remedies her family taught her. Some of her home remedies include oregano tea for coughs, chamomile for stress/anxiety, passionflower for anxiety/depression, boiled corn silk for kidney stones, hibiscus for UTIs, and many more.

Many Mexican Americans use alternative therapies as their source of healthcare for a variety of different reasons. Herbal remedies and alternative therapies are sometimes used for a cultural reason but sometimes they are used for economic reasons. In a study conducted in 2015, researchers found that ethnic minorities were two times more likely to use CAM when they did not have healthcare insurance (Hernandez-Morin, 2015). The use of alternative remedies by individuals in Worcester county show the wide scope of healthcare options Mexican Americans are utilizing.

IV. VIEWS/BIASES/EXPERIENCES OF WORCESTER COUNTY HEALTHCARE PROFESSIONALS WORKING WITH THE CULTURE

When working in a Worcester County hospital, one can expect to have various encounters with the Mexican population. When interviewing nurses on the Cardiovascular Intensive Care Unit at UMASS Memorial Medical Center, a common theme with many of the nurses was that they could not specifically recall a time when they took care of a Mexican patient. This says a lot about the Mexican culture and how they do not usually accept medical help readily. The fact that this unit is a specialized intensive care unit adds to the decreased Mexican population admitted to the floor.

When someone from Mexico does get sick enough to need to be admitted to the hospital, they have many people there with them. These people are very family oriented and consider everyone even slightly related to them to be their “immediate family”. This poses some difficulty and can be the cause of bias against Mexican people, especially in the intensive care unit. This unit is a place where patients are critically ill and can be attached to at least a dozen different pumps and machines.

Due to the high stress environment, some nurses find it is less distracting to work without familial involvement; tending to the critical patient as opposed to the whole family unit. Another aspect of the Mexican culture of being in the hospital that could cause tension with the nurse is how loud the family tends to be. The Mexican culture is passionate, and they are most likely scared about the wellbeing of their loved one. Some nurses find this level of noise a distraction and might ask the family to leave, but there needs to be a certain level cultural awareness involved so the patient and family can heal in a way that best suits them.

Some of the interventions suggested by the interviewed nurses seemed very helpful. When treating Mexican patients, one must make sure if the patient is acutely ill and the nurse must be in there all the time that the family understands the policy of two visitors at a time in the intensive care unit. The nurse needs to be compassionate and empathetic when explaining this policy, stating that family members are more than welcome to take turns visiting with the patient, but in order for the nurse to take the best care of the patient, the family must only visit two people at a time. This is very hard for a Mexican family to understand because they are so family-oriented, but they respond very well to empathy. Another intervention commonly used is keeping a religious item nearby such as a bible or item of their religion.

If the patient is critically ill, one might find that the family has pinned a cross to the patient’s clothing or to the pillow by their head. As the nurse, it is good practice to keep these objects visible in a presentable manner. This helps to establish a good rapport with both the family and the patient; it shows that the nurse is empathetic and cares about the patient’s religious beliefs.

Another aspect the nurse may encounter is patient dissatisfaction with bland hospital food. Unless medically contraindicated, family members may bring in cultural flavorful foods with no added salt. As previously discussed, language can impact the nurse patient relationship. Often times a family member is able to translate for basic communication needs such as bathing and food preferences. Medical translators are required for more serious conversations such as treatment plans, diagnoses, and medication management. At UMASS there are in-house translators available as well as translator phones that can be used to relay information.

During the interview, the nurse stated that bias is present in the healthcare setting to her knowledge. She stated that nurses she works with rarely showcase their personal bias to their patients, even if one exists. In her experience, nurses discuss their bias amongst each other and never allow it to interfere with their obligation to the patient. It has been this nurse’s personal observation that certain surgeons appear to give better care to the white population. Minorities of any ethnic background, not just Mexican, appear to wait longer for care.

She states that “when surgeons are faced with the task of speaking to families, they spend far less time talking to ethnic groups as opposed to whites. Unfortunately, this is the sad reality of our healthcare system and we as nurses need to provide optimal compassion to our patients” (Worster, 2019).

V. SPECIFIC INTERVENTIONS TO UTILIZE IN CARING FOR THIS POPULATION (BASED ON RESEARCH)

Health promotion, by definition, involves influencing behaviors, attitudes, and knowledge, all of which rest on the foundation of culture. Thus, all health promotion activities practiced by healthcare professionals are filtered through the unique cultural interpretation of the target group (Padilla & Villalobos, 2014).

To provide services in a way that is meaningful to the populations served, it is important to offer choices and counsel in a way that culturally makes sense to them (Padilla & Villalobos, 2014). Mexican American culture has been characterized in the literature by a relatively accepted framework of values: familism, respect and congeniality, folk healing, religiosity/spirituality, and the importance of language, among the most important (Padilla & Villalobos, 2014).

Recent research suggests a richer, more dynamic conceptualization of the cultural interpretations of health in this population (Padilla & Villalobos, 2014). Communication is a rather obvious barrier to caring for these clients. In today’s society, many of the healthcare personnel are proficient in Spanish and interpreters are made readily available. However, research has shown; Mexican women in one ethnographic study related their desire to have unhurried interactions with healthcare providers, social greetings, and gentleness of technique (Padilla & Villalobos, 2014). The women considered these strategies to be signs of respect because the healthcare professionals demonstrated

To effectively treat these patients, nurses need to be aware of the practices and traditions that may act as a barrier to standard nursing care measures without formulating bias or stereotypes. Thorough medical and holistic assessments of the patient, including spirituality, prove invaluable when caring for the Mexican population. The literature reveals that social support among the family unit is a key component when it comes to aging.

Family members will tend to have a strong presence in caring for their ill members even if it becomes a burden. Institutions and outside help are considered a last resort. Should the family member require long term placement, the family tends to remain highly involved with all aspects of care (Padilla & Villalobos, 2014). Nurses need to be mindful of this cultural aspect to incorporate family into their plan of care as well as work with the family for the best possible patient outcome.

Another area that should be evaluated by the nurse is the use of folk healing remedies. A review of ethnographic studies conducted across the life span reveals how Mexicans consistently integrate cultural strategies, such as folk remedies with conventional health methods and Western medicine in everyday life, which means that people do not view said remedies and modern medicine as incompatible (Padilla & Villalobos, 2014).

To make an effective diagnosis and treatment plan, the medical professionals need to be aware of all medications consumed. Nurses need to dive deeper with their interview questions and ask about specific herbs and methods since this population does not view it as medically pertinent to their overall health. This will help the nurse formulate a plan that these patients may be more willing to adhere to. Having knowledge of these folk healing remedies can be an asset to the nurse to incorporate if safe to do so. This will build trust and show respect to these clients. Below is an example of a quick data collection that could be utilized to better assist with assessment.

Social Organization

1. Tell me about your family.

Follow up:

• Nuclear & extended family relationships
• Traditions & rituals
• Beliefs

1. What are the important things to teach children?

Follow up:

• Health/Sickness
• Growing up

1. When a person is sick do you think the person can make themselves well?
2. What do you teach your family/children about being (Mexican? Hispanic?)

Environmental Control

1. Who or what do you think has control over a person’s health? (When a person is sick do you think the person can make himself well?)
2. What do you think makes a person sick?
3. Do you know anyone who has been to a folk healer or used folk medicine or remedies?

Health Beliefs

1. What does being healthy mean to you?
2.  What does a healthy person look like to you?

Follow up:

• Do you think you are a healthy person?
•  When a person says you’re healthy, what does that mean?

1.  How do you keep yourself healthy?
2.  What do you do differently from your ancestors to stay healthy?
3.  What do you do when you are sick?
4. Who do you talk to when you are sick?
5. Where do you get your health information?

Mexican communities are a key source for informal information. The literature reveals that they are more likely to seek information from their neighbors, friends, and church groups before seeking it from a health professional. In recent years, community outreach programs have been initiated to educate and encourage visits to health centers. Nurses have utilized mobile health units, nursing care in the home, and small group gatherings to target specific issues. The goal is to provide culturally appropriate interventions for participants by promoting critical awareness of social and cultural forces that impact and shape their social lives (Padilla & Villalobos, 2014).

Communication is a rather obvious barrier to caring for these clients. In today’s society, many of the healthcare personnel are proficient in Spanish and interpreters are made readily available. However, research has shown; Mexican women in one ethnographic study related their desire to have unhurried interactions with healthcare providers, social greetings, and gentleness of technique (Padilla & Villalobos, 2014). The women considered these strategies to be signs of respect because the healthcare professionals demonstrated a willingness to listen to their interpretation of what was happening to them and to include them in the treatment process (Padilla & Villalobos, 2014). Allowing extra visit time for patients with limited English proficiency would build trust and confidence, as well as ensure understanding of education (Juckett, 2013). Hiring bilingual staff and providing cultural sensitivity training for existing staff members with culturally specific interventions would be beneficial to both worker and patient (Juckett, 2013). Table 2 identifies small ways to make a connection with the Spanish speaking client.

In conclusion, nurses should strive to understand the social and cultural influences that affect one’s health. Proper assessments need to be conducted in order to proceed with planning and appropriate interventions for optimum patient outcomes. Building meaningful connections with clients to incorporate their way of life can help build the framework to a positive health seeking behavior in the future.

References

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2. Chou, C. (2017). “Traditional postpartum practices and rituals: a qualitative systematic review”, by Cindy-Lee Dennis, Kenneth Fung, Sophie Grigoriadis, Gail Erlick Robinson, Sarah Romans and Lori Ross | The Embryo Project Encyclopedia. Retrieved from https://embryo.asu.edu/pages/traditional-postpartum-practices-and-rituals-qualitative-systematic-review-2007-cindy-lee
3. Cultural Insights: Communicating with Hispanics/Latinos. (n.d.). Retrieved February 22, 2019, from https://www.cdc.gov/healthcommunication/pdf/audience/audienceinsight_culturalinsights.pdf
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14. Mexican Annual Salary in Worcester, MA ($45,670 Avg | Feb 2019). (2019, February 12).
15. Retrieved February 18, 2019, from https://www.ziprecruiter.com/Salaries/How-Much-Does-a-Mexican-Make-a-Year-in-Worcester,MA
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VI. RESOURCES

1. Worster, A. (2019, February 17). Personal Interview.
2. Saiden, A. (2019, February 6). Email interview
3. Hernandez, D. (2019, January 31). Phone interview
4. Acevedo, E. (2019, January 17). Personal Interview.