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Introduction
Culturally competent care in nursing practice is critical for delivery of an effective health service. Comprehensive guidelines can help nurses to treat minority populations within community settings competently. Hispanics compromise approximately 57 million or 16% of the United States population which is the largest minority in the country (Centers for Disease Control and Prevention, 2015). Hispanics are a rapidly growing population that is increasingly vulnerable to health disparities due to socioeconomic and cultural barriers. A culturally competent approach that focuses on chronic illness management and access to health care ensures the well-being of the Hispanic population.
Health Care Needs
Hispanics are faced with various health disparities as a population, exhibiting disproportionate rates of acute and chronic illnesses. Socio-economic factors have a compound effect on the health care needs of the population. Adverse health effects are created by environmental stressors which are further exacerbated by the limited access to health care and education. Lacking the knowledge and resources to address these issues, mental health problems may arise which require specialized care. The status quo of the health care situation for Hispanics and many other minorities leaves the population stranded in a vicious cycle of morbidity.
Acute and Chronic Illnesses
As immigrants, Hispanics are faced with adverse socio-economic conditions regarding integration, housing, job opportunities, and xenophobia. It puts the population in a relatively hostile environment which directly affects lifestyle behaviors. Living conditions are often at the level of poverty, creating physical stressors that reflect on health. For example, the grouping of Hispanic communities near major transportation hubs results in dangerous levels of pollutant levels in those households. In addition, unhealthy behaviors that are adopted in response to stress, such as poor diet and sedentary lifestyle, present significant health risks.
The Hispanic epidemiologic profile presents cancer and cardiovascular disease as the leading causes of mortality. Obesity and diabetes are common occurrences of morbidity with approximately 24% higher incidence than the white population (Centers for Disease Control and Prevention, 2015). Cardiovascular disease and diabetes share common risk factors exemplified in the form of the metabolic syndrome such as elevated blood pressure and fasting glucose.
Cardiovascular risk factors include hypertension, hyperlipidemia, and tobacco use. This is directly tied in with obesity and diabetes. Hispanics are disproportionately affected by the disease with a 12.8% diagnosis rate. There is a significant risk of associated comorbidities including diabetic neuropathy and chronic renal disease. Cancer is extremely prevalent amongst Hispanics, resulting in a 30% case-fatality rate.
The most common is prostate cancer amongst men and breast cancer amongst women. The lack of access to preventive screenings results in later-stage diagnoses, therefore in higher mortality rates (Velasco-Mondragon, Jimenez, Palladino-Davis, Davis, & Escamilla-Cejudo, 2016). As these health problems progress within the population, it directly impacts the health system which must take the burden of medical expenses for uninsured Hispanics. It impacts the well-being of the community as well due to lost productivity and use of health resources for culturally competent care.
Mental Health
Difficult socio-economic conditions and environmental stressors create a pattern of mental health issues amongst the population. The pressures of acculturation that come with contradicting values and various language barriers cause high levels of emotional distress. Approximately 15.9% of Hispanics reported a mental illness in 2011 while fewer than 1 in 11 saw a specialist for it. There is a high rate of depression with a reported 1 in 7 people attempting suicide.
Substance abuse and severe psychological disorders are often left untreated as well (Rodriguez, 2013). These statistics are considered incomplete due to a general lack of resources or culturally competent analysis directed towards exploring mental health issues within the Hispanic cultural group.
Disparities in mental health amongst Hispanics exist due to lack of cultural understanding and the inability to find appropriate specialists. The culture is not accepting of any mental health illnesses, creating a stigma around seeking help. People choose to ignore early warning signs, regarding it as temporary stress for the protection of their own status within the community. Thus, a person cannot gain help or support, even from family, until they reach a breaking point (Rodriguez, 2013).
However, gaining access to mental health help is a challenge as well. There are practically no specifically developed programs for the population or culturally trained bilingual professionals. Mental health services are not integrated into primary care. Hispanic youth that is commonly vulnerable to mental health problems are not offered appropriate resources in educational institutions (Finlayson, Gonzalez, & Gozalez-Ramos, 2013). Overall, the severe stigma and shame in the Hispanic culture around mental health should be addressed through education and culturally competent community outreach in order to provide opportunities for treatment.
Access to Health Care
Hispanic communities are faced with substandard and underutilized health care services around the country. Socio-economic factors lead to low participation rates in health programs that cause chronic and acute illnesses to go untreated. The overall social status of Hispanics results in lower salaries and educational attainment, creating barriers to financing health needs and navigating the complex health care system.
A sizeable portion of the Hispanic population does not maintain a legal immigration status in the United States, often forcing to avoid any process of identification. Undocumented immigrants rarely qualify for any federal assistance and cannot access many types of services. Meanwhile, Hispanic families may avoid seeking health care services due to the nationwide stigma against undocumented immigrants and the possibility of deportation if their status is discovered by the officials (Hacker, Anies, Folb, & Zallman, 2015). A safety net should be created for undocumented immigrants who would seek to mediate some of the barriers to seeking health care.
Adult Hispanics with limited English proficiency have difficulties in obtaining health care. Information presented in the media and open resources about public health issues and recommendations is rarely translated or targeted towards the Spanish-speaking population. Meanwhile, the actual process of health care delivery is formed around communication between the patient and their provider.
Health systems on a vast scale have been found to be discriminatory and lacking cultural competency. This results in various negative consequences from lack of proper treatment to lack of understanding about medications or follow-up recommendations. A lack of a usual source of health care complicates the complex process of delivery. A stable source of health care facilitates medical contact, focuses on specialized treatment, and overcomes many cultural barriers.
However, the financial barriers due to lack of insurance coverage are one of the primary reasons Hispanics lack access to health services. In the United States, out of pocket health care expenses are astronomical, and insurance is a direct predictor of utilization (Escarce & Kapur, 2006). Due to their socio-economic status, Hispanics usually rank very low in terms of access to health care because of these barriers.
Approach to Care and Reducing Health Disparities
The socio-cultural barriers present various challenges to addressing the health concerns of the Hispanic population. It is critical to consider beliefs, community structure, and demographics when developing a culturally competent plan of care. Environmental and lifestyle factors affecting the population expose the desperate need for a reform of health care services for this specific minority. In addition, more than 62% of households included underage children who are more susceptible to adverse conditions troubling the population.
Overall, Hispanics have a longer lifespan compared to white Americans (Centers for Disease Control and Prevention, 2012). However, the high rate of morbidity becomes a grave concern as it places a more considerable strain on the community and health care system despite a higher age of mortality. This has been noticed by researchers, explaining it as the low median age of the Hispanic population. The strange epidemiologic occurrence is being studied and has become known as the Hispanic Mortality Paradox.
In practice, cultural aspects can be implemented directly into intervention programs. The male-dominated family structure should be considered when targeting health messages in order to instill the value of timely intervention rather than waiting until conditions deteriorate. It should be emphasized that by maintaining their health, adults in the family can be more productive in supporting the family. In turn, it will be less costly for both families and hospitals in the long-term.
Community outreach can be established through trusted organizations and health advisors that can appropriately guide its members through the process of receiving accredited health services (Centers for Disease Control and Prevention, 2012). It should be considered that despite assimilating into the US society, the Hispanic population maintains a unique course of acculturation with tradition defining most health habits.
The highly traditional and religious folk medicine that is the primary health decision of Hispanics should be acknowledged. It can be seen as disrespectful of the culture if the traditions are condemned. Often, these practices have no negative consequences, and standard conventional treatments should be implemented. While working with Hispanics, nurses should be aware of values that the population places on community, family, respect, and modesty (Juckett, 2013). The purpose of delivering culturally competent is to improve patient outcomes, access, and utilization to medical resources that can limit health disparities.
While the health needs of the Hispanic population are undoubtedly critical, they are preventable with proper disease management, intervention, and education. These can be implemented if language and literacy barriers are overcome through written material, translators, and culture-specific training for nurses (Rines, 2015). As nurses are on the frontlines of working with minority populations directly, through medical practice and social activism, the health needs of the population can be addressed.
Conclusion
As a rapidly growing minority, Hispanics are a vulnerable population in the United States. A culturally competent approach to nursing practice and policy ensures a focus on the population needs of chronic disease management as well as access to essential health care services. The socio-cultural, environmental, and behavioral aspects of life in Hispanic communities are impacting the overall well-being of the population. These issues are critical but preventable through culturally competent interventions and education.
References
Centers for Disease Control and Prevention. (2012). Building our understanding: Culture insights communicating with Hispanic/Latinos. Web.
Centers for Disease Control and Prevention. (2015). Hispanic health. Web.
Escarce, J., & Kapur, K. (2006). Access to and quality of health care. In M. Tienda & F. Mitchell (Eds.), Hispanics and the future of America (pp. 134-146). Washington D.C., United States: National Academies Press.
Finlayson, M., Gonzalez, M., & Gonzalez-Ramos, G. (2013). Mental health care for new Hispanic immigrants: Innovative approaches in contemporary clinical practice. New York, NY: Routledge.
Hacker, K., Anies, M., Folb, B., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: A literature review. Risk Management and Healthcare Policy, 8, 175-183. Web.
Juckett, G. (2013). Caring for Latino patients. American Family Physician, 87(1), 48-54. Web.
Rines, M. (2015). Culturally competent nursing of the Hispanic population. Web.
Rodriguez, C. (2013). Latinos struggle to find help for mental health issues. Web.
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A., Davis, D., & Escamilla-Cejudo, J. (2016). Hispanic health in the USA: a scoping review of the literature. Public Health Reviews, 37(31), 1-27. Web.
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