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Cultural competence and the Hispanic population.

Because the United States is a melting pot of cultures and ethnicities, nurses must be able to provide competent care by incorporating a patient's cultural beliefs and practices into the plan of care. The American Nurses Association (ANA, 2010) recognized the need for nurses to provide culturally competent care, noting that "nurses should practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual" (p. 11). Culture touches every part of life. Values such as caring, empathy, and truthfulness, as well as promoting health and autonomy, and respecting the patient's choices reflect the culture of the nursing profession (National League for Nursing, 2011).

As society became increasingly multicultural, Madeleine Leininger (1991) proposed nurses were not equipped to provide nursing care that was congruent with patients' cultural beliefs and practices. Leininger also suggested nurses must be able to understand illness from the patients' point of view. Leininger's Culture Care Theory and Sunrise Model provide a framework for nurses to give culturally competent care (McHenry, 2007). Leininger defined culture as the "learned, shared, and transmitted knowledge of values, beliefs, norms, and life ways of a group that are transmitted intergenerationally and influence thinking, decisions and actions in a particular way" (as cited in Leininger & Farrell, 2006, p. 13).

Culturally competent nurses must not only understand the culture of the patient, but also develop awareness of their own cultures (Collins, Decker, & Esquibel, 2006). The Office of Minority Health (OMH, 2005) indicated a person's culture identity is based upon the following attributes: language, sexual orientation, age, sex, religion, and social class. Cultural sensitivity refers to nurses' ability to adjust their perceptions, behaviors, and practice style to meet the needs of patients from different ethnic groups (Foronda, 2008). Cultural sensitivity is gained through the process of cultural competence, which is defined as a set of behaviors, attitudes, and skills that enables nurses to work effectively in cross-cultural situations (OMH, 2009). Cultural competence is the ability to view every person as an individual including taking into account his or her cultural background and experiences (Campinha-Bacote, 2011).

According to Berry-Caban and Crespo (2008), language often is cited as the main obstacle to health care. Health care providers should understand and respond with sensitivity to the needs and preferences that culturally and linguistically diverse patients bring to each health care encounter. Standards for culturally and linguistically appropriate services (CLAS) provide guidelines for full access to care and require providers to recognize health-related beliefs, cultural values, incidence and prevalence of disease, and the efficacy of treatment. The CLAS standards address cultural competence, language access services, and organizational support. Providing culturally and linguistically appropriate services to patients enables improved access to care, improved quality of care, and better health outcomes (Hoffman, 2011). Logan (2007) noted nurses have a crucial role in providing culturally and linguistically appropriate services because nurses are responsible and accountable for patient safety regardless of diversity. In addition, understanding CLAS and advocating for patients help nurses provide improved services and safe, quality care.

Caring for Hispanic Clients

According to the U.S. Census Bureau (2010), 308.7 million people reside in the United States; 50.5 million (or 16%) are Latino. The Hispanic population in the United States increased by 15.2 million between 2000 and 2010. McHenry (2007) reported the Hispanic community is the fastest growing minority population in the United States. According to the Office of Minority Health (2009), Hispanics' health often is shaped by multiple factors, including language barriers, lack of access to preventive care, and lack of health insurance. The Centers for Disease Control and Prevention (2010) cited the leading causes of illness and death among Hispanics, which include heart disease, cancer, accidental injuries, stroke, and diabetes. Other health conditions and risk factors that significantly affect Hispanics are asthma, chronic obstructive pulmonary disease, HIV/AIDS, obesity, suicide, and liver disease (OMH, 2009).

Family, religious beliefs, communication, and health beliefs have been noted in the literature as important cultural influences for Hispanic patients. According to Knoerl (2007), the valuing of la familia over individual or community needs is a strong aspect of the Hispanic community. The family often assists in making critical or important decisions. Respect should be shown both to the patient and family. Respeto implies a mutual and reciprocal respect, and it dictates appropriate deferential behavior toward others based on age, sex, social position, economic status, and authority. Knowledge of these concepts is important for the provider-patient relationship. Out of respect for authority, Hispanic patients may not ask important questions. Trust or confianza is also important. Hispanic patients need to feel a sense of trust with the health care provider before they will discuss personal health issues (Berry-Caban & Crespo, 2008). According to Maddalena (2009), interactions between cultures often result in conflict, which may impact patient care. If a nurse fails to respect the patient's cultural wishes, the patient and family may begin to mistrust the medical team and not share information.

Persons of Hispanic culture are influenced by their spiritual beliefs (Clutter & Zubieta, 2009). Many members of the Hispanic community are Catholic. Daily rituals, such as prayer, devotions, and wearing religious medals, may be important to them. Anointing of the sick is the final sacrament families may request for a gravely ill or dying patient (Knoerl, 2007). It is the nurse's responsibility to advocate for patients in including their cultural desires in the plan of care.

Communication can be an issue due to the language barrier. Medical translators that are the same sex as the patient should be used as needed. Knoerl (2007) suggested providers can communicate respect and create trust by formally addressing patients, sitting close to them, and using indirect eye contact. The use of direct eye contact often is seen as a sign of disrespect. Any miscommunication can cause issues with medication regimen adherence or follow-up appointments (Berry-Caban & Crespo, 2008).

Hispanic culture tends to view health from a synergistic point of view. This view is expressed as the continuum of body, mind, and spirit. Knoerl (2007) noted folk healers may be the first choice of health care for some Hispanic patients. Practices of Hispanic folk medicine are based on a belief that disease is caused by an imbalance between hot and cold principles. For health maintenance, avoidance of exposure to extreme temperatures is important. Examples of "hot" diseases or states are pregnancy, hypertension, diabetes, and acid indigestion. "Cold" conditions include menstrual cramps, pneumonia, and colic. The goal of treatment is to restore harmony and balance, therefore, "hot" diseases are treated with "cold" remedies, and "cold" diseases are treated with "hot" remedies (Knoerl, 2007; Ortiz, Shields, Clauson, & Clay, 2007).

Nursing Implications

The goal of nursing practice is to help patients regain their independence and return to their optimal level of health, or to die with dignity at the end of life. Nurses help the patient attain optimal health by treating each person as an individual, taking into account that person's cultural and spiritual experiences. Nurses can provide culturally and linguistically appropriate care for Hispanic patients by including the family members in the plan of care, using Spanish interpreters, and providing patient education in Spanish (Maddalena, 2009). The lines of communication must be kept open to provide the best possible care to all patients.


Because culture affects all aspects of life, cultural competence is an essential set of skills for nurses in order to provide effective patient care across the continuum (Campinha-Bacote, 2011). To provide culturally competent care, nurses must not impose their own cultural values onto their patients. Instead, they must respect the uniqueness of the individual, and incorporate patients' values and beliefs into the plan of care (ANA, 2010).


American Nurses Association (ANA). (2010). Code of ethics for nurses. Retrieved from

Berry-Caban, C., & Crespo, H. (2008). Cultural competency as a skill for health care providers. Hispanic Health Care International, 6(3), 115-121.

Campinha-Bacote, J., (2011). Delivering patient-centered care in the midst of a cultural conflict: The role of cultural competence. OJIN: The Online Journal of Issues in Nursing, 16(2), Manuscript 5.

Centers for Disease Control and Prevention. (2010). Health statistics United States: Hispanic or Latino population. Retrieved from http://

Clutter, A.W., & Zubieta, A.C. (2009). Understanding the Latino cultures. Retrieved from

Collins, C., Decker, S., & Esquibel, K. (2006). Definitions of health: Comparison of Hispanic and African-American elders. Journal of Multicultural Nursing & health, 12(1), 14-18.

Foronda, C. (2008). A concept analysis of cultural sensitivity. Journal of Transcultural Nursing, 19(3), 207-212.

Hoffman, N (2011). The requirements for culturally and linguistically appropriate services in health care. Journal of Nursing Law, 14(2), 49-58.

Knoerl, A. (2007). Cultural considerations and the Hispanic cardiac client. Home Healthcare Nurse, 25(2), 82-86.

Leininger, M. (1991). Culture care universality and diversity: A theory of nursing. New York, NY: National League for Nursing Press.

Leininger, M., & Farrell, M. (2006). Culture care diversity and universality: A worldwide theory. Sudbury, MA: Jones & Bartlett Publishers.

Logan, D. (2007). Culturally and linguistically appropriate services: An overview of policy and safe acute care nursing practice in the United States. Gastroenterology Nursing, 30(1), 29-36.

Maddalena, V. (2009). Cultural competence and holistic practice: Implications for nursing education, practice, and research. Holistic Nursing Practice, 23(3), 153-157.

McHenry, D. (2007). A growing challenge: Patient education in a diverse America. Journal for Nurses in Staff Development, 23(2), 83-88.

National League for Nursing (2011). Mission/goals/core values. Retrieved from

Office of Minority Health (OMH). (2005). What is cultural competence? Retrieved from aspx?lvl=2&lvlid=11

Office of Minority Health (OMH). (2009). Hispanic/Latino profile. Retrieved from aspx?lvl=3&lvlid=31

Ortiz, B., Shields, K., Clauson, K., & Clay, P. (2007). Complementary and alternative medicine use among Hispanics in the United States. The Annals of Pharmacotherapy, 41(6), 994-1004.

U.S. Census Bureau. (2010). The Hispanic population: 2010. Retrieved from

Darlene Hicks, MSN, RN, is Unit Coordinator of General Surgery, Alamance Regional Medical Center, Burlington, NC.
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Title Annotation:Professional Issues
Author:Hicks, Darlene
Publication:MedSurg Nursing
Article Type:Essay
Geographic Code:1USA
Date:Sep 1, 2012
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