General Information: Introduction | Format/Directions
Sections: Asian Culture | Hispanic
Culture | Native American Culture | Shiite
Muslim Culture| Russian Culture| Zambian
Activities: Asian Case Study | Hispanic
Case Study | Native American Case Study |
Muslim, Russian & Zambian Case Study
Note: This section is abbreviated and does not provide comprehensive
coverage of all Hispanic populations. This section generally concentrates on the
- Value Orientations (Seidel, Ball, Dains, & Benedict, 1996, p. 39):
- Time--Present oriented; lives by the day; relaxed sense of time.
- Activity--Expresses self spontaneously.
- Human Nature--Need to exhibit self-control to avoid evil orientation; little control
- Relation--Group goals take precedence over individual goals.
- Health Beliefs
- Health is strongly related to religion. Illness is caused by an imbalance of caliente
(hot) and frio (cold) and is seen as punishment from God (Seidel et al., pp. 48, 50).
- Good behavior is rewarded by good health (e.g., eating properly, engaging in work,
practicing religion) (Seidel, et al., pp. 48, 50).
- Beliefs about illnesses affecting the gravid woman and infants include:
- empacho (blocked intestine)/improper or poorly cooked foods stick to the intestine
- susto (fright sickness)/real or imagined traumatic events cause illness,
- mal de ojo (evil eye)/illness affecting children caused by admiration of others,
- caida de mollera (fallen fontanel)/caused by improper handling of infant,
- antojos (cravings)/infants may have characteristics of certain foods if cravings not
satisfied during pregnancy (e.g. strawberry birth mark),
- cuarentena (40 days)/dietary and activity restrictions are followed during the 40 days
postpartum to promote bonding and prevent future illnesses (Burk, Wieser, & Keegan,
1995, p. 44)
- Other beliefs related to health care include:
- mal de aire (bad/cold air)/causes imbalance leading to premature labor, cramps, and some
neurological symptoms; in infants, this may cause respiratory difficulties,
- encono (festering wounds)/wounds and scars may become infected by exposure to certain
individuals (DePacheco & Hutti, 1998, pp. 16).
- Health Practices (Seidel et al., pp. 48-50)
- Treats illness through promises with God and prayers.
- Seek help from others such as folk healers (curandero/curandera) rather than Western
medicine. Utilizes herbal medicine and rituals in treatment.
- Modesty may serve as a barrier to medical care.
- The National Alliance for Hispanic
Health web site
provides facts about breast cancer in Hispanic women. It speaks to the delay between
abnormal mammograms and follow-up as well as the standard of practice for treatment.
- Dietary Considerations
- Prevention and treatment of illness may include dietary considerations for
"hot" and "cold" foods. Cool foods are medications are not consumed
during the postpartum period. This promotes the emptying of the uterus which is considered
to be "warm". The diet may also include clear soups, chicken, and herbal teas
(DePacheco et al., p. 20).
- Folk remedies may have "negative" consequences. For example baking soda may be
prescribed to avoid heartburn. Mannitol tea may be used but can act as a diuretic leading
to dehydration (DePacheco et al., p. 18).
- During the menstrual period and during the postpartum period women avoid spicy and
acidic foods believing this will cause increased flow or cramps (DePacheco et al., p. 19).
- May suffer from lactose intolerance.
- Family Aspects
- Extended families are important (Seidel et al., p. 49).
- Females are subordinate to males who financially support the family (Seidel at al., p.
- Deference to the elderly, especially elderly males, is important. Nurses should seek
permission from the head of the family for treatment of individual members (Zoucha &
Zamarripa, 1997, p. 272).
- Communication Practices
- May prefer to Spanish especially when under stress. (Seidel et al., p. 49)
- Care is seen as time and attention therefore nursing care should not be rushed and
conversation is important (Zoucha et al., p.272).
- Physical Assessment (Jarvis, 1996, pp. 217, 356) (Note: The following characteristics
may be found more frequently in individuals of this minority group.)
- Skin/Hair: Melanin causes darker skin tones especially noticeable in the perineal area
- Common Health Conditions
- High incidence of hypertension (and smoking) (Jarvis, p. 527). Heart disease and strokes
are numerous (Burk et al, p. 44).
- Relatively high cholesterol levels (Jarvis, p. 527).
- Obesity among women (Jarvis, p. 527). Obese women are more likely to develop gallstones
(Burk et al., pp. 44).
- High risk of developing diabetes (Jarvis, p. 527). Type II non-insulin dependent
diabetes is two or three times more prevalent with progression to retinopathy and renal
disease (Burk et al., p. 44).
- Latinos comprise 12% of the U.S. population and 18% of those with AIDS. Tuberculosis, as
a consequence of AIDS, is four times greater than non-Hispanics (Burk et al., p. 44).
- Rice University offers information
about common diseases
affecting Hispanic individuals. Heart disease is prevalent. Cancer is the second leading
cause of death. Diabetes is also frequently seen.
- Embarrassment, use of cold speculums believed to be unclean, and discomfort were beliefs
influencing Latino women in obtaining Pap smears (Jennings, 1997, p. 827).
- "Culture Bound Syndromes" (Jarvis, p. 55)
- "Empacho"--food forms balls in the intestinal track leading to cramps.
- "Fatique"--symptoms mimicking asthma.
- " Mal ojo" ("Evil eye")--sleep disorder, crying, diarrhea.
- Genetic Disorders
- None noted.
- Pharmacological Considerations
- May require lower doses of antidepressants such as imipramine, desipramine,
amitriptyline, and clomipramine. Side effects are greater than for Caucasians (Levy, 1993,
- "Hot" medications are avoided during pregnancy. These include, among others,
aspirin, iron, penicillin, and prenatal vitamins. Prenatal vitamins may be balanced by
taking them with a "cool" liquid such as fruit juice, with the exception of
orange juice (DePacheco et al., p. 19).
- Burk, M. E., Wieser, P. C., & Keegan, L. (1995). Cultural beliefs and health
behaviors of pregnant Mexican-American women: Implications for primary care. Advances
in Nursing Science, 17, 37-52.
- DePacheco, M. R., & Hutti, M. H. (1998). Cultural beliefs and health care practices
of childbearing Puerto Rican American women and Mexican American women: A review of the
literature. Mother Baby Journal, 3 (1), 14-25.
- Jarvis, C. (1996). Physical examination and health assessment (2nd ed.).
Philadelphia, PA: W. B. Saunders.
- Jennings, K. M. (1997). Getting a Pap smear: Focus group responses of African American
and Latina women. Oncology Nursing Forum, 24, 827-835.
- Levy, R. (1993). Ethnic & racial differences in response to medicines.
Reston, VA: National Pharmaceutical Council.
- Seidel, H. M, Ball, J. W., Dains, J. E., & Benedict, G. W. (1995). Mosbys guide
to physical examination (3rd ed.). St. Louis, MO: Mosby.
- Zoucha, R., & Zamarripa, C. (1997). The significance of culture in the care of the
client with an ostomy. Journal of Wound, Ostomy, and Continence Nursing, 24,
- Photographs courtesy of A. Gray and C. Todero, College of Nursing, UNMC.
Click on an image to view it. For a description of the image position the mouse pointer
over the picture for a few seconds.
- Campbell, J. C., & Campbell, D. W. (1996). Cultural competence in the care of abused
women. Journal of Nurse-Midwifery, 41, 457-462.
Issues related to the assessment and care of abused women of various cultures are
reviewed. A large number of Spanish speaking individuals live in the
United States. When these individuals seek health care, and abuse/violence is suspected,
the clinician should not rely on a family member to act as an interpreter.
- Jimenez, S. L. M. (1995). The Hispanic culture, folklore, and perinatal health. The
Journal of Perinatal Education, 4 (1), 9-16.
Diabetes is frequently found in the Hispanic
population so pregnant women with diabetes must be addressed. Health care may be difficult
to access because of economics, lack of transportation/child care/release time from work,
and language barriers. Pregnant women believe that health and illness are controlled by
God. Mexican women call this fatalismo or destino. Nothing can be done to
intervene. Women also hold dependent relationships and may view health care personnel as a
parent-like figure. Families are important support systems as well; families play an
important role in decision making about health care. Health beliefs and folk healing are
briefly discussed. During childbirth touch is appropriate. Some women also accept massage,
acupressure, and therapeutic touch. Herbal teas are frequently used for the discomforts of
pregnancy. During labor, the Mexican woman may express her discomfort vocally. Heat
and cold are concerns, with neonates and postpartum women being susceptible to
"cold". If the feet are wet then the head must be wet or "cold"enters
the body. This has implications for bathing. During the postpartum period women are seen
as vulnerable and bed rest is often practiced. Infants often have abdominal binders in
place, sometimes holding a coin over the navel, to prevent hernias.
- Miller, M. A. (1995). Culture, spirituality, and womens health. JOGNN, 24,
Relationships between culture, religious beliefs, and women's health are
explored. A variety of cultures and beliefs are reviewed. Hispanic individuals cope
with illness through their belief about God's will. Motherhood is important within this
culture. These beliefs have implications for health promotion and teaching about
- Rajaram, S., & Rashidi, A. (1999). Cultural issues & breast cancer
screening. Olson Center for Women's Health, 4(4), 1,3.
Latinos, African Americans, and Native Americans have a higher incidence
of breast cancer than Caucasians and are less likely to use mammograms. This is, in
part, related to cultural beliefs. Latinos may believe that
"bad behavior" causes breast cancer and that compression of the breast and the
use of radiation may cause cancer. Modesty is also a factor for Latinos
and Asians. Some Latinos also believe that only
husbands/lovers should touch breasts. African Americans may believe
that the mental stress of a breast cancer diagnosis is worse than the disease itself.
In the Navajo culture discussion of cancer conflicts with health
maintainence through positve "ritual" language.
- Sheridan-Leos, N. (1995). Women's health Loteria: A new cervical cancer education
tool for Hispanic females. Oncology Nursing Forum, 22, 697-701. A tool, modeled
after a popular Hispanic card game is described. The tool is used to teach women
about cervical health.
- Villarruel, A., & Leininger, M. (1995). Culture care of Mexican Americans. In M.
Leininger, Transcultural Nursing Concepts, Theories, Research & Practice (pp.
365-382). New York, NY: McGraw-Hill.
Detailed facts about the Mexican-American culture are provided including the
historical aspects. Beliefs about folk medicine such as the oneness of body and mind are
addressed. Religious and supernatural aspects are important in this culture as well as
communication between the natural and supernatural worlds. Patients are viewed as victims
and healers are used. Nursing interactions should include the participation of other
family members in the care plan, support of cultural beliefs, emphasis upon the present
rather than future, the use of touch, the protection of modesty, and facilitation of
Hispanic individuals will represent the largest minority group in the United
States by the year 2000. The National Hispanic Health Symposium was convened to
review the needs of the Hispanic community for health and human services. Regional
plans were developed. Recommendations
are shared in this web
Recommendations from the National
Hispanic Health Symposium for Iowa, Kansas, Missouri, Nebraska,
Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming.
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