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In spite of the large immigration from Latin American since the 1960's, data from 1994 show that 55.6 percent of Hispanics were born outside the U.S. mainland and 4.2 percent in Puerto Rico. The 38.5 percent of the Hispanic population that is foreign-born translates to nearly 10.3 million people. The majority of persons born in the United States are Mexican and Puerto Rican. In the Cuban Central and South American populations, foreign-born individuals represent almost three-fourths of the population. There are more than eight million Hispanics who are not citizens living in the United States although many of them are eligible for citizenship.
According to the U.S. Bureau of Census (1993b), there were approximately 22 million people of Hispanic origin living in the United States out of a total population of 248.7 million. The Hispanic population is expected to more than double between now and 2025. The United States is already adding more Hispanics than any other group including non-Hispanic Whites. By 2005, Hispanics will be our largest minority. Two-thirds of Hispanics will be immigrants or children of immigrants. In 1997, Hispanics constitute the second largest minority group in the country with 9.0 percent of the population, after African-Americans with 12.1 percent.
Social needs of Hispanics are underlined by their standing in four indexes:
The Hispanic family remains strong. More than 80 percent of Hispanic households consist of a family unit. This is a significantly high percentage compared to non-Hispanic white or African-American households. Of all the Hispanic sub-groups, Mexican origin households are the most likely to be constituted by a family unit.
While family is important for all Hispanic sub-groups, the prevalence and stability of the two-parent nuclear family varies greatly among them. Mexican-American households are more likely to have both parents than other Latino, non-Hispanic White or African American group. On the other hand, Puerto Ricans have fewer two-parent households than any group except African-Americans. As for divorce, Cubans have a relatively high rate in comparison to other Latino groups living in the United States.
The Hispanic family resilience may be one factor that explains a consistent finding that has puzzled scientists for years. For most populations, high rates of poverty are associated with poor health. But Hispanics living in the United States have relatively good health, despite high rates of poverty. Strong families may be the factor contributing to better health in Hispanics and may help cushion poverty's effects.
The following is a summary of Hispanic family relationships that can help the transcultural nurse understand the dynamics of providing healthcare services to Hispanic clients.
Mexican American culture consists of a complex melding of the history, traditions, and beliefs of three distinct populations from Mesoamerica, Spain, and the United States. First there existed an Indian or native heritage of Mesoamerica that spanned thousands of years before Christ until the arrival and eventual conquest of this region by the Spanish in the sixteenth century. The blending of Spanish and Indian heritage created the major strand of tile culture of contemporary Mexico.
The history of the relationship between Hispanics and White America began in 1848 with the Treaty of Guadeloupe Hidalgo, which formally ended the Mexican-American War. The treaty gave Mexicans the right to remain or withdraw to Mexico in two years, the option of either Mexican or American citizenship, and the guarantee of property rights belonging to Mexicans in Texas, New Mexico, Arizona, and California. However, Mexicans lost their land because the burden of proof of ownership fell on Mexican landholders, and the United States government vigorously suppressed any form of armed resistance by Mexicans fighting to keep their land.
Mexican American then became second-class citizens deprived of land and social status. Some became bandits; others worked as laborers in agriculture or took unskilled jobs. After the Mexican Revolution at the turn of the 20th century, the Mexican economy was poor while me southwestern United States was in the midst of economic growth. Many Mexicans were forced to immigrate across the border to escape poverty.
Originally concentrated in the West and Southwest, Mexican-origin communities have been growing in the mid-West for several decades. More recently, the number of Mexicans has been growing in places such as New York City and central Florida. The sheer size of the Mexican population ensures that it will have the greatest political and economic impact and the greatest influence on the image of the Hispanic community.
Traditionally, Mexico has provided a source of cheap labor for agriculture and unskilled work. Braceros are contract laborers who enter the United States with legal work permits, while illegal aliens are those people who, without proper authorization, cross the border in search of jobs. The living conditions, wages, safety', and benefits of farm laborers have been major issues between the produce growers and union representatives.
Pesticides provide a dangerous hazard to all farm workers and are especially hazardous to the youngest farm workers, between the ages of 14 and 17. A few dozen studies have looked at the rates of cancer and birth defects among children whose parents work with pesticides. The results indicate that where there was exposure to pesticides, children were more likely to develop leukemia, brain tumors, lymphoma, and soft-tissue sarcomas.
There is also the issue of safety for farm workers of all ages. When considering the most vulnerable population of farm workers, there is a total of 200.000 Hispanic children injured on the job annually. These children are injured or killed because they are inexperienced in their work, or because employers don't provide safety or skills, training, don't know child labor laws. or don't check the age of their youngest laborers. (St. Paul Pioneer Press. 1997) Nurses working with Hispanics need to be aware of the political issues that surround their clients and be willing to act as an advocate whenever possible.
Among Latino groups, there are 1.1 million Cubans living in the United States. The Castro regime during the 60s and 70s has resulted in a large Cuban American population in Florida, particularly in Miami. The first wave of Cubans were the professional class and the intelligentsia who formed a close-knit business and professional community in a section of Miami, Florida, called "Little Havana." However, the second wave of Cuban immigrants were poor, uneducated, had a high rate of crime and were dependent on government social services to assist them with basic survival needs including housing, employment, and health care.
Despite this fact, Cubans on the average have more education, higher incomes, better jobs, and lower rates of poverty, compared to other Hispanic populations living in the United States. Although Cubans are relatively affluent, they face some tough challenges. In a population marked by its youth (the median age of Hispanics is 25, compared with 34 for non-Hispanics) Cubans are by far the oldest group with a median age of forty-one. There are more Cubans age 65 to 74 than there are children 9 years old or younger. For Cubans, problems related to elder care, illness and death are more severe than those related to child care or problems relating to street gang violence.
Puerto Rico is a commonwealth of the United States that is equivalent to a territorial possession. (There is now a drive in Congress to make Puerto Rica a state.) Ever since Puerto Rico became a part of the United States in 1917, Puerto Ricans have migrated from the island to the eastern coast of the United States in order to seek employment. New York City has been the gateway to the United States for Puerto Ricans and it represents job opportunities in the garment industry and commercial and tourist services. Unfortunately, many Puerto Rican migrants have lived in poverty, inhabiting substandard apartments in congested inner city neighborhoods of New York City. High rates of unemployment, drug use, and crime exist among Puerto Rican youth and male adults. The Puerto Rican population has been experiencing a geographical dispersion since its initial heavy concentration in New York City. They have elected a United States Congressman in Chicago and large communities have sprung up in the South, for example. Orlando, Florida.
The Puerto Rican population (a mixture of Spanish, Indian, and African ancestry) living on the United States mainland number nearly 2.8 million and is approximately three-fourths as large as the population of Puerto Rico. In contrast, the United States Mexican population is less than one-fifth the size of Mexico's population. Cubans are about one-tenth the number living in Cuba. The reason for the high proportion of Puerto Ricans who have migrated to the mainland is that they are United States citizens by birth and the only Hispanic population who have free access into this country.
The Puerto Rican population is socially and economically diverse. Among Puerto Ricans ages 25 and older, 12.3 percent have a college degree or more about twice the percentage among the Mexican-origin population. Ironically, Puerto Ricans exceed all other Hispanics and African-Americans in the percentage of children younger than 15 who are living in poverty (Castro. 1995).
Many Central American Hispanics in the United States have been displaced by war and unrest in Nicaragua, Haiti, and El Salvador. Many have fled as refugees and have entered the country through Florida and Texas. Some have been forced to return to their own countries, while others have remained, and their needs have often overloaded the limited resources of the states in which they reside. Central American refugees must deal with the ravages of war and the inherent psychological and physical problems that are result of their experiences.
Considering the various cultural groups of Hispanics in the United States, it is difficult to organize a set of value orientations across all groups. Below is a framework that one could consider using when working with Hispanics, keeping in mind individual and group differences.
The concept of curanderismo is described in transcultural nursing literature as an eclectic, and holistic mixture of beliefs derived from Mesoamerican, Spanish spiritualistic, homeopathic, and "scientific medicine". The curanderismo is a system based on the knowledge of herbal remedies, Spanish prayers, altered states of consciousness, and healing rituals. The curandera (folk practitioner) combines Ills skills and familiarity with empirical and ritualistic remedies and God is seen as providing the ultimate power to heal. The use of candles, altars, charms, confession, and statues of the saints Christ and His mother Mary are used to strengthen the client and encourage him or her to accept the suffering. It is the belief in the curandera's connection to the sacred that supports the client and enables him or her to benefit from the healing powers of God and the saints. Failure to facilitate a cure is viewed as the will of God rather than a weakness on the part of the curandera. Religious symbols are combined with the use of herbs, me regulation of diet, the manipulation of joints and bones, as well as massage. The curandera works towards restoring balance and harmony within the individual's body and life. Because illness is considered a family matter in Mexican American culture, the involvement of family members is promoted, supported, and often times requested by me curandera during a healing session.
The following guidelines may be helpful throughout the initial assessment for Hispanic clients who have recently immigrated to the United States.
Was the choice anticipated?
Did the individual or family leave the homeland seeking economic improvement, educational opportunities, political or religious freedom, or family reconnection?
Was the decision to emigrate unanticipated or forced?
Where there life-threatening conditions or natural disasters that forced the individual or family to immigrate to the United States?
What are the language barriers?
What is the relationship between the client's homeland and the United States?
What are the economic conditions?
What are the prejudices and acts of discrimination faced after arrival in the United States?
When nurses are working with recently immigrated Hispanic clients, it would be well to consider the fact that they are in the process grieving over the loss of loved ones left behind, the loss of their homeland, and to a certain degree, a loss of identity. The following framework presents a comparison between the stages of loss that nurses are quite familiar with and the stages of immigration as observed in Hispanics as they attempt to adjust to living in the United States. Knowledge of these phases can help the transcultural nurse understand the underlying dynamics of immigrant and refugee clients.
| GRIEF/LOSS STAGES | IMMIGRATION |
|---|---|
| PHASE I | PHASE I |
| numbness | estrangement |
| shock | excitement |
| disbelief | confusion |
| PHASE II | PHASE II |
| pain | homesickness |
| despair | idealization of homeland |
| disorganization | disappointment, anger |
| PHASE III | PHASE III |
| sense of hope | commitment to stay |
| optimism, acceptance | hidden pain |
The following suggestions are offered to facilitate more effective, ethically competent nursing care for Hispanic clients. The extent to which this information is relevant will depend upon the level of acculturation of the individual. Acculturation varies by the individual's physical characteristics, socioeconomic status, generational standing, level of education, family configuration, birth order, attitude toward host country, fluency in English, and reference group.