By Megan M. Krischke, contributor
February 8, 2013 - That kindly Hispanic grandmother who smiles at you and nods in agreement may not understand the care instructions she was just given or why she shouldn’t eat certain foods that could lead to diabetes. Or she may be uncertain how to get the medication that she needs and take it properly. In fact, a new study says her cultural differences are likely to interfere with her care.
According to the Administration on Aging, there were 2.7 million elderly Hispanics residing in the United States in 2008, and that number is expected to grow to over 17 million by 2050--indicating a growing need to meet the health care needs of this vulnerable population.
And it appears we already have a long way to go.
A study published in the January 2013 issue of MEDSURG Nursing found that there are currently significant disparities in care for this population. “The Aging Hispanic in America: Challenges for Nurses in a Stressed Healthcare Environment” points out that elderly Hispanics are more likely to suffer from injury, disease, disability and death than their non-Hispanic, white counterparts. For instance, they are about twice as likely to be diabetic.
Language is a barrier in many cases when caring for this population, but there are also issues around cultural understandings about health care, lack of health insurance, and immigration status, to name a few.
There are a number of steps health care leaders and nurses can take to improve care to their elderly Hispanic populations.
Julie A. Strunk, PhD, RN, says nursing schools have a significant responsibility to offer cultural diversity training.
“First of all, health care leaders need to hire individuals who have knowledge in cultural diversity,” recommended Julie Strunk, PhD, RN, assistant professor of nursing in James Madision University’s (JMU) Department of Nursing and co-author of the study. “There are a plethora of Hispanics coming into our country with healthcare backgrounds who could care well for the elderly; unfortunately they also have language barriers to overcome. For instance, nurses have to pass both the Test of English as a Foreign Language and their state boards of nursing. Offering better adult ESL classes could help meet this health care need.”
Co-author Judith Townsend Rocchiccioli, PhD., RN, professor at JMU’s Department of Nursing, added that it is important for healthcare providers to provide translators who are not family members.
Judith Townsend Rocchiccioli, PhD, RN, emphasizes the importance of a mental health assessment for elderly Hispanic patients.
Other steps that health care leaders and providers can take include: offering literature in Spanish, ideally with helpful illustrations to assist those with limited literacy; taking the extra step to make sure that the patient understands the information they are receiving and to provide follow-up; and taking the role of being a patient advocate seriously.
“For individuals who are not from a Hispanic background, it is the nursing school’s responsibility to train leaders who are culturally aware, who are familiar with different cultural beliefs and who have a grasp of the language that is being spoken,” added Strunk.
JMU integrates cultural competencies throughout their curriculum, as well as offering a few electives that deal specifically with cultural competencies.
Strunk recommends that nurses who anticipate working in areas with significant Hispanic populations take two years of medical Spanish.
“Elderly Hispanics are more hesitant than their counterparts to ask for help, so they are generally much sicker and have comorbidities by the time they seek care,” explained Rocchiccioli.
“The best step any nurse can take is to offer them a thorough assessment of both their physical and emotional health,” she continued. “People who have been uprooted from their homes have a higher rate of depression, so a mental health assessment should not be overlooked. Additionally, it is important to have clear communication about medications. Because of financial limitations, older populations tend to share pills.”
“It is important to be knowledgeable of the health care practices of different cultures,” Strunk asserted. “When we come across as judgmental, patients can become non-compliant, or falsely compliant--nodding their heads but not agreeing or understanding.”
For nurses looking to increase their cultural competencies, there is a myriad of literature looking at cultural differences in vulnerable populations, as well as some CE courses. Rocchiccioli recommends simply doing a Medline search or to search “cultural competencies” in Google Scholar.
“Having an understanding of how Hispanics view the world and of their life experiences, can be extraordinarily helpful,” said Rocchiccioli. “So many in this elderly Hispanic population have had difficult lives and are dealing with the challenge of migrating from one culture to another.”
“We need to be constantly learning new techniques and looking for those resources that are available to help these individuals,” concluded Strunk.
NurseZone’s Online Continuing Education Center connects you with the latest online CE courses from our partner, RN.com, including Cultural Competence and Pain Assessment in Your Spanish-speaking Patients. Learn more.
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