Nursing an Hispanic Patient

1. History of Hispanic American Immigration

v Early History 

In the Southeast 

In the Southwest 

Mexican Independence and Free Trade 

v Conflict With the United States 

Problems For Landowners 

v Immigration in the Early 1900’s 

Immigration Restrictions 

Growing Discrimination 

v Effects of World War II 

v Immigration In the Mid-1900’s 

Puerto Rican Migration 

Cuban Migration 

Problems With Cuban Migration  

Living Conditions for Cuban Americans  

v Immigration in the Late 1900’s  

Hispanic Americans Today 

2. Understanding the Hispanic Culture 

v Cultural Backgrounds of Hispanic Americans

Cultural Bonds 

National and Ethnic Origins 

Where Hispanics Live 

Settlers in the West Indies 

Spanish and African Influences in Puerto Rico and Cuba 

Aztec Influence in Mexico 

Spanish and Indian Cultures in Mexico 


v The Day of the Dead–Mexico Honors Those Gone But

Not Forgotten

v Hispanic Values 

Family Values 


Rituals and Religions 

Celebrations and Holidays 

Eating Habits 

Teaching and Learning Implications 


3. What It Means to Be Latino 

v On Terminology: Hispanic or Latino?  

v ‘Hispanic’ vs ‘Latino’  

4. Getting to Know The Hispanic/Latino Culture 

La Familia  





Family Structures  

Communication and Social Interaction  

Time Orientation  

Concept of Health  


v Mexican-American  

Food Habits and Their Relationship to Dietary Guidelines 

Eating Practices, Food Preferences and Food Preparation Techniques 

Teaching Implications 


v Puerto Rican  

Food Habits and Their Relationship to Dietary Guidelines 

Eating Practices, Food Preferences 
and Food Preparation Techniques 

Teaching Implications 


v La Cocina—Southwestern Cuisine  

5. Hispanic Health Status

Key Facts 

v Mortality and Morbidity




Weight and Exercise

Alcohol and Substance Abuse

Violence and Unintentional Injuries


v Key Areas of Concern



Coronary Heart Disease, Stroke, and Hypertension


Environmental Health

Mental Health


v Health Beliefs and Practices

Concept of Health

Potential Culture-Related Health Concerns Among Hispanic

Health Promotion, Prevention, and Treatment

Folk Beliefs of Some Hispanics About Health and Illness 
That Can Affect Care and Treatment

Major Folk Illnesses Among Hispanic Populations

Major Systems of Folk Healing Among Hispanic Populations

Sources for Further Reading

v Health Culture Sketch


Geographic Distribution in U.S.

General Characteristics

Health Care Decision-Making

6. Cultural Diversity: Eating in America

v Mexican-American

Food Habits and Their Relationship to Dietary Guidelines

Eating Practices, Food Preferences and Food Preparation

Teaching Implications


v Puerto Rican

Food Habits and Their Relationship to Dietary Guidelines

Eating Practices, Food Preferences and Food Preparation Techniques

Teaching Implications


v La Cocina—Southwestern Cuisine 88

7. Acculturation Erodes the Diet Quality of U.S. Hispanics 

Status of Hispanics Varies by Origins 

Table 1. U.S. Hispanic Populations Vary Widely in Age, 
Earnings, Level of Schooling, and Household Size 

Disease and Mortality Puzzle Policymakers 

Hispanics Surpass Non-Hispanics in Diet Quality 

. . . Especially Spanish-Speaking Hispanics 

Table 2. Hispanic Spanish Speakers Score Highest on Healthy

Eating Index 

Table 3. Hispanic Attitudes and Knowledge About Nutrition Diverge 


v Nutrition Counseling Tips For Hispanic-American Clients 

8. Folk Medicine in Hispanics 

Concept of Disease 

Origins of Hispanic Folk Medicine 

Utilization of Lay Healers Among Hispanics 


Diabetes Mellitus  

Folk Medicine-Treatments-Upper Respiratory Infection 

Folk Medicine-Treatments-Osteoarthritis/Rheumatism 

v Treatment of Folk Illnessess  


Folk Remedies Everyone Should Know 

Illustrations: Plants and Herbs Commonly Used as Folk Remedies 

Curandera Preparing for a Barrida 

9. The Influence of Ethnicity on the Use of Herbal Remedies 

v Introduction  



Table 1. Herbal Users by Perceived Health Problems 

Table 2. Botanical Nomenclature for Commonly Used Herbal Remedies 

Table 3. Herb Users’ Sources of Information on Herbal Remediesa 

Table 4. Frequency of Use of the Top 10 Herbs Used by Herbal Users 

Table 5. Most Frequently Used Herbal Remedies forTop Five Perceived Health Problems 


10. Hispanics/Latinos: Health Disparities Overview 


v Demographics  

Size and Origin of Population 



Family Size 

Underlying Causes of Health Disparities: Income and Education 


Socioeconomic Status and Health Status 

Income and Economic Status 


v Health Status  

Leading Causes of Mortality 

Specific Health Concerns 

Traditional Health Beliefs and Practices 

Traditional Illnesses 

v Risk Factors and Challenges  


Environmental and Occupational Hazards 

Health Insurance Coverage and Access to Quality Care 

Language and Communication 



Alcohol Use 

Physical Activity 

Practical Tips For Treating Hispanic Patients 

Strengths and Protective Factors 


v Adherence Factors  



v Complementary and Alternative Medicine  

References and Resources 

v Quality & Culture Quiz 

v Quality & Culture Quiz Answers 

11. Cancer Health Disparities 

v Cancer Rates  

Overall Incidence and Mortality Rates 

African -Americans 


Asian Pacific Islanders 

American Indian/Alaska Natives 

v What Are Cancer Health Disparities?  

Financial Issues  

Minorities Are More Likely Not to Have a Regular Doctor  

Minorities Face Greater Difficulty in Communicating  With Physicians

Transportation Can Limit Access  

Accurate Information is Not Universally Available

Percentage of Adults Who Have Problems Communicating With Their Doctor

Percentage of U.S. Women Who Had Screening Tests 

Available Information Does Not Reach All Populations  

Potential Biases Can Affect Cancer Health  

Not Everyone Receives the Screening Equally  

Higher Percentage of Whites Receive Medicare Services in Managed Care Plans

Older African Americans Receive Lower Rate of Surgery And Have Lower Resulting Survival Rate

12. Disparities in Cardiovascular Disease (CVD) 

v Eliminate Disparities in Cardiovascular Disease (CVD)  

What is the burden of cardiovascular disease in the United States?  

Where are the disparities?  

What is the goal?  

What is the strategy?  

What can healthcare providers do to help reduce the burden of CVD?  

What can individuals do to decrease their risk of developing CVD?  

For More Information About Cardiovascular Disease: 

13. Unequal Treatment: What Healthcare Providers Need to Know 

v Do Racial and Ethnic Minorities Receive a Lower Quality of


v What Are the Sources of Healthcare Disparities?  

Clinical Uncertainty

The Implicit Nature of Stereotypes

Healthcare Provider Prejudice or Bias

Medical Decisions Under Time Pressure with Limited Information

Patient Response: Mistrust and Refusal 

v What Can Healthcare Providers Do to Help Eliminate

Disparities in Care?  

Guide to Information Sources 


Did You Know...

14. Diabetes in Hispanic Americans 

v Major Studies of Diabetes in Hispanic Americans 

v How Many Hispanic Americans Have Diabetes?  

Table 1. Hispanic American Populations in the United States and
Percentage With Diabetes 

v What Factors Increase the Chance of Developing Type 2 Diabetes? 

Genetic Risk Factors 

Figure 1. Prevalence of Diagnosed and Undiagnosed Diabetes in Mexican Americans, U.S., 1988-94 

Figure 2. Genetic Origins of the Major Hispanic Subgroups in the United States

Medical and Lifestyle Risk Factors 

Prediabetes (Impaired Glucose Tolerance and Impaired Fasting Glucose)

Gestational Diabetes  

Hyperinsulinemia and Insuln Resistance  


Figure 3. Prevalence of Overweight Individuals Among Whites, 
Blacks, and Mexican Americans in the Population, 1988-91 

Physical Activity  

v How Does Diabetes Affect Hispanic Young People? 

v How Does Diabetes Affect Hispanic Women During Pregnancy? 

v How Do Diabetes Complications Affect Hispanic Americans?  

Eye Disease 

Kidney Disease

Nerve Disease 

Peripheral Vascular Disease

Heart Disease 

Diabetes and Diet 

v How Is NIDDK Addressing the Problem of Diabetes in Hispanic

Diabetes Prevention Program 

National Diabetes Education Program 

v Points to Remember  


15. Minority Women’s Health Concerns 

v What Health Problems Affect a Lot of Hispanic Americans/Latina

Obesity and Overweight  

Heart Disease  



Maternal and Infant Health  

Smoking and Pregnancy: A Critical Risk Factor for Pregnant Females 


Cultural Attitudes

Gender Roles

Attitudes About Sex 

Other Sexually Transmited Diseases

Diabetes Mellitus


Psychiatric Disorders

v Violence Against Women 

Hispanic American/Latina Women 

Leading Causes of Death for Women in the United States, 2000 

v Getting Health Care  

What types of care coverage exist? How do I find 
out about them?

For More Information 

16. Factors Affecting The Health of Women of Color

v Adolescent Females of Color 

Access to Services 


Health Risk Behaviors

Sexual Intercourse  

Substance Abuse  

Unsafe Moter Vehicle Operation

Healthful Behaviors 

v Elderly Women of Color 


Native Americans  


Black Americans  

Asians and Pacific Islanders

Access to Health Care 

Health Assessment 

17. Maternal Health of Hispanic Women 

Folic Acid Knowledge and Use Among Hispanic Women 

Preventing Alcohol-Exposed Pregnancies Among Hispanic Women 

v Maternal Health Risks of Immigrant Women From  Latin America 

v Maternal & Reproductive Health Beliefs  

v Understanding the Health Culture of Recent Immigrants to the United
    States: A Cross-Cultural Maternal Health Information Catalog 

Examples of Cultural Beliefs Held by Certain Immigrant Groups  

Examples of Epidemiological Data Affecting the Health of Childbearing Women  

Examples of Proposed Links Between Epidemiological Data and Cultural Beliefs/Practices; and Associated Health Risks to Pregnant Women and Infants

Lessons for Health Care Professionals From Knowledge of Cultural Beliefs or Immigrant Experiences  


18. Violence and Minority Women

v Screening for Abuse in Spanish-Speaking Women  

Women Abuse Screening Tool 

19. Hispanic American Elders 

v Introduction  

v The Older Hispanic Population: Past, Present, and Future  


Educational Level

Living Arrangements  



Self-Rated Health Status  

Access to Medical Care  

Diversity of Hispanic Elders  

Health and Chronic Illnesses  

Hispanic Americans and Family Caregiving  

Older Hispanic Americans and Poverty  


v Elderly Abuse in Hispanic Families 

20. Alcohol and Minorities 

v Ethnic Differences in Drinking Patterns  

v Ethnicity and Alcohol Problems  

Medical Consequences

Social Consequences 

v Contributors to Ethnic Differences  

Social Factors  

Biological Factors  

v Prevention  

School-Based Prevention  

Family-Based Prevention  

Alcohol Availability  

v Treatment  

v NIAAA Analysis Reveals Increased Risk for Liver Cirrhosis Death Among
    Hispanic Americans


21. Hispanics and Tobacco

v Health Effects  

v Cigarette Smoking Prevalence  

Prevalence of Other Forms of Tobacco Use  

Tobacco Industry Influence  


22. Mental Health 

v Latinos/Hispanic Americans  

Need For Mental Health Care  

High-Need Populations

Availability of Mental Health Services  

Access to Mental Health Services  

Use of Mental Health Services  

Appropriateness and Outcomes of Mental Health Services 

Culturally Specific Mental Health Resources


Learning Objectives

After completing the course you’ll be able to:

History of Hispanic American Immigration

    1.  Recount the history of Hispanic immigration in the United States.

Understanding the Hispanic Culture

    2.  Describe the core values and norms of the Hispanic culture.

What It Means to Be Latino

    3.  Describe what it means to be a Latino.
    4.  Explain what the terms Latino and Hispanic imply.

Getting to Know The Hispanic/Latino Culture

    5.  Explain the concepts of la familia, respeto, personalismo, and confianza in
         the context of Hispanic culture.

Hispanic Health Status

    6.  Describe mortality and morbidity in Hispanic population.
    7.  List top ten leading causes of death for Hispanics of all age groups.
    8.  Describe the impact of various lifestyle and health behavioral factors on 
         Hispanics’ health status. 
    9.  Describe the concept of health and preventive medicine in the context of 
         Hispanic culture.
   10.  Explain typical Hispanic health beliefs and practices.
   11.  Explain major folk illnesses among Hispanic populations, defining 

Cultural Diversity: Eating in America

    12.  Describe the eating practices, food preferences and cultural implications
          of Mexican-American and Puerto Rican diet.

Acculturation Erodes the Diet Quality of U. S. Hispanics

    13.  Discuss how acculturation erodes the diet quality of U.S. Hispanics.
    14.  Discuss Hispanic attitudes and knowledge about nutrition among various
          population groups.

Folks Medicine in Hispanics

    15.  Describe the origins and applications of Hispanic folk medicine.
    16.  Identify common Hispanic folk illnesses and their remedies.
    17.  Incorporate the knowledge of Hispanic folk medicine beliefs into the
          development of effective patient management and counseling plans.

The Influence of Ethnicity on the Use of Herbal Remedies

    18.  Distinguish between non-Hispanic whites and Hispanics in their use of
          herbal remedies.

Hispanics/Latinos: Health Disparities Overview

    19.  Describe the socioeconomic and health status of Hispanics and compare
          it with that of other population groups.
    20.  Follow recommendations to confirm patient teaching and treatment with
          the traditional health beliefs and practices.
    21.  Implement recommendations to improve communication with Hispanic

Cancer Health Disparities

    22.  Cite statistics that show cancer health disparities among various racial
          and ethnic groups.
    23.  Discuss various sources of disparities in cancer treatment for minority
          population groups.

Unequal Treatment: What Healthcare Providers Need to Know

    24.  Discuss how bias, prejudice, and stereotyping can contribute to unequal
          treatment of patients on the basis of race and ethnicity.

Diabetes in Hispanic Americans

    25.  Discuss the epidemiology of diabetes in Hispanic Americans.
    26.  Identify the factors that increase the chance of developing type 2

Minority Women’s Health Concerns27. Discuss the health
                      problems affecting minority women.

    28.  Describe the health impact of sexually transmitted diseases on minority
    29.  Discuss the prevalence of psychiatric disorders among various women

Factors Affecting The Health of Women of Color

    30.  Discuss factors affecting the health of women of color and their access
          to services.
    31.  Discuss health risk behaviors that place adolescent females of color at
          increased risk of morbidity or death.
    32.  Describe the demographics of elderly women of color.
    33.  Discuss the access to health care available to elderly women of color and
          its impact on morbidity and mortality.

Maternal Health of Hispanic Women

    34.  Discuss the key findings of the report dealing with pregnancy-related
          mortality in Hispanic women in the United States.
    35.  Describe maternal health beliefs and practices that are common to
          Hispanic culture.
    36.  Cite examples of epidemiological data affecting the health of childbearing
          women from various immigrant groups.
    37.  Make a link between epidemiological data and cultural beliefs and health
          risks to pregnant women and infants.
    38.  Apply the knowledge of cultural beliefs and immigrant experience to
          providing effective health care.

Violence and Minority Women

    39.  Define terms such as intimate partner violence, sexual assault, dating
          violence, elder abuse.

Hispanic American Elders

40.  Describe the special problems faced by Hispanic elders.
    41.  Describe the prevalence of elderly abuse in Hispanic families.

Alcohol and Minorities

42.  Identify social and biological factors that contribute to ethnic differences
          in drinking.
    43.  Describe ethnic differnces in drinking patterns.

Hispanics and Tobacco

    44.  Discuss the use of tobacco in the Hispanic population.

Mental Health

    45.  Discuss the need for mental helth care in Hispanic Americans.


Learning Objectives

To assess the effectiveness of the course material, we ask that you evaluate your achievement of each learning objective on a scale of A to D (A=excellent, B=good, C=fair, D=unsatisfactory). Please indicate your responses next to each learning objective and return it to us with your completed exam.



"I liked the layout of the test questions & the titles in the book with explainations." - J.J., RN, CA



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