Culturally Competent Approach

Culturally Competent Approach

Read chapter 20 and 21 of the class textbook and review the attached PowerPoint presentation.  Once done answer the following questions;

1. Describe the heritage of the Korean and Mexican people and discuss if there is any similarity in their roots.

2. Describe some healthcare beliefs of the Korean and Mexican heritage and how they influence the delivery of evidence-based health care.

3. Mention some customs practice by the Korean and Mexican to cure diseases.

You must use at least two evidence-based references (excluding) the class textbook. A minimum of 700 words is required.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage

Mexican, Mexican American, Latino(a), Chicano(a), la gente de la raza, Hispanic, etc. are commonly used terms.
Second largest Spanish speaking group in the world
500+ different dialects and ethnic groups in Mexico
Mexico City is one of the largest cities in the world
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

60% of the population is mestizo—a blend of Spanish white and Indigenous Indian
The majority of the Hispanic population in the United States
Hispanic is the largest “minority” group in the United States surpassing African Americans in 1999
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

Original inhabitants, along with Native American Indians, of southwest United States
Majority of newer immigrants come to the United States for economic opportunities and are poorer than previous immigrants
Low educational rates in the United States
Ninth-grade educational level required in Mexico —mean is 5 years
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications

Dialect varies by region of Mexico, including Mayan
Rapid speech pattern with apocopation (e.g., como esta usted = com-esta-sted)
Idiomatic and slang expressions are common—like English
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Concepts of personalismo is important.
Touch between the men and between women is acceptable.
Men and women greet with a hug and kiss to the cheek.
Eye contact with staring is expected for peers.
Many avoid direct eye contact with superiors as a sign of respect.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Intense eye contact can cause the “evil eye,” a folk illness common in all Hispanic and Mediterranean cultures.
Children are more susceptible to the evil eye than are women who are more susceptible than men.
Healthcare provider should greet men with a firm handshake.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Temporality varies via socioeconomic level
Clock time is not categorically imperative; events begin when they begin and not until then
Name format: First name, middle name, father’s surname followed by mother’s maiden name.
A woman takes her husband’s last name which is place before her maiden name..
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles

Traditional families are patriarchal but vary greatly.
Current research is dispelling the myth of machismo and patriarchal decision-making.
Children are closely protected and are not expected to work or do many chores in middle-class families—children are supposed to be allowed to be children.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Children are taught to respect parents, elders, and teachers, etc.
Multigenerational families in Mexico, less so in the United States.
Children have comadres, compadres (godparents).
Single parenting somewhat stigmatized, severely so in some groups.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Significant number of Unido until at which time the family has the money for a religious wedding ceremony.
Academic and professional degrees are highly respected.
A good education also means having good manners.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

If family and close friends are aware of gay/lesbian relationships, they are not talked about.
Stigma continues to be a significant problem with many.
Dignity, Hola, and Ellas are support groups and they all have 800 numbers and are located in Washington, DC.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

Intestinal parasites and diarrhea are major health problem among immigrants; also tuberculosis, STIs, and HIV/AIDS.
Hypertension, cardiovascular disease, diabetes, malaria, cholera, typhoid, dengue fever, and high suicide rates. Incidence varies from point of migration and living conditions.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued

Alcohol metabolism is slowed, especially among those with an Indigenous Indian ancestry.
Require lower doses of antidepressants and are poor metabolizers of debrisoquinine.
Greater toxicity from tuberculosis drugs.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

Large percentage of women are overweight—seen as positive and is a sign of health, fertility, wealth, and beauty.
Anytime is a time to celebrate with food.
Food choices vary by area of immigration—mountains, metropolitan areas, seaports, etc.
Staples include tacos and rice and plantains.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued

Lactose intolerance, especially from adults so calcium obtained from soups with bones and bone marrow, leafy greens, and corn tortillas treated with calcium carbonate.
Many ascribe to the hot/cold theory of foods, although they may not speak to it directly.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued

Not all foods are spicy! And Nachos are American—not Mexican
Meal times vary, but many continue with the afternoon siesta if job permits
Many foods are deep fried or fried in some manner—high-fat diet mostly
Iron and Vitamin A deficiency—especially among lower socioeconomic groups
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family

Birth rate in Mexico and United States is higher among Mexican Americans than among other United States groups.
Wide range of contraceptives when used, but not always admitted.
Condom use: used mostly with prostitutes for infection prevention.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Many Hispanic Americans have lactose intolerance. A good source of calcium if the diet is

Flour tortillas.

Corn tortillas.

Chicken

Pork.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: B

Corn tortillas are high in calcium because they are made with calcium carbonate.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Pregnancy is natural so why see a healthcare provider for prenatal care?
Many are not used to prenatal care in their home country because it is not available—thus, advice comes from older females in the family.
Hot and cold theory extends to foods and practices during pregnancy and postpartum.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Do not walk in moonlight while pregnant because it may cause a birth deformity.
Man not to see wife or baby until several hours after birth because harm can come to the baby or mother.
Do not reach over your head while pregnant because it can cause the cord to wrap around the baby’s neck.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Some do not bathe or wash hair for 40 days postpartum – do take a sponge bath.
Cutting the baby’s nails before 3 months of age may cause blindness and/or deafness.
Umbilical belt and/or coin or key placed on abdomen to keep it from protruding when crying.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

Death seen as a natural part of life
Sit vigil over the dying and after death with the family
Children are not shielded from death
El dia de muerte celebrated at the gravesite of family members
Velorio—festive watch over the dead before internment and may be a long procession
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals Continued

El ataque de nervios (nervous attack) occurs with death and other strong emotions
A few may still hire llorandos (criers) for the funeral
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

Family is foremost among Mexicans and most other Hispanic families
Take great pride in their heritage and family lineage
Religiosity supports fatalism—it is God’s Will
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality Continued

Majority are Catholic with Indigenous variation practices.
Priests are major sources of support for the individual and family and may be sought before seeking advice from a healthcare professional.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices

External focus of control works against prevention measures.
To express negative feelings is not considered polite—therefore do not complain of health ailments until symptoms are severe.
Good health means being free of pain.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Mrs. de la caza, 32 year old pregnant Mexican American, is pregnant. The nurse recommends walking for exercise for weight control. The patient works at a sedentary job during the day and tells the nurse she cannot walk at night the baby will be born

Too large.

Too small.

With a cleft-palate.

With a birth mark.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: C

Walking at night, especially in the moonlight, is believed to cause the baby to have a cleft-lip or palate.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued

Many do not protect themselves from environmental hazards because they are not knowledgeable about the hazards.
Seek over-the-counter drugs and indigenous healers before seeing a Western healthcare provider.
All socioeconomic levels seek traditional healthcare providers.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Hot and Cold Illnesses

See book chapter with hot and cold illnesses and their treatments—varies greatly among families because they are handed down within the family and community—need to specifically ask!
Barriers in the United States include money, access, appropriateness, language, limited knowledge, and gender.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Cultural Responses

Accept and expect pain as a necessary part of life.
Obliged to endure pain in the performance of duties.
Ability to endure pain stoically is valued.
Pain and suffering may be due to immoral behavior.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Cultural Responses Continued

Physical and mental illnesses are readily accepted but may keep family member at home to protect others, not the patient.
Can enter the sick role readily without stigma.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Organ Donation and Transplantation

Not morally averse to organ donation.
Hesitant to donate while alive because the body should be buried whole.
If abdominal surgery, bad air may enter the body and increase the potential for cancer or other problems.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Traditional Hispanic Healthcare Providers

Curanderos: folk healers
Masijistas: massage therapists
Brujos: witches
Sobadoros: manipulate bones
Padres: priests
Espiritistas—Espiritualistas—Espiritus (spiritualists)
Jerberos—yerberos: herbalists

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