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Culture and Advanced Nursing Practice
Mrs. Demetilla Hernandez is a 63-year-old Cuban woman who seeks consultation at the Liberty health-maintenance organization (HMO) clinic because of weakness, lethargy, and fatigue that she has experienced for the last 2 months. A week ago, while cooking dinner at her daughter, Mariana’s house, she momentarily lost her balance and slipped on the kitchen floor. Although Mrs. Hernandez sustained only a mild bruise on her leg, her daughter insisted on taking her to the clinic for a check-up because of her persistent symptoms.
Mrs. Hernandez, widowed 4 years ago when her husband died of a heart attack, lives with Mariana, aged 40. Mariana is divorced and has three children: Luis, age 15; Carolina, age 10; and Sofia, age 7. Since moving into Mariana’s house, Mrs. Hernandez has been managing the household while Mariana is at work. Mrs. Hernandez prepares the family’s meals, attends to the children when they come home from school, and performs light housekeeping chores. Mariana is employed full-time as a supervisor at the local telephone company. The family, originally from Cuba, has been living in Miami for 12 years. Carolina and Sofia were born in Miami, but Luis came from Cuba with his parents when he was 3 years old. Mrs. Hernandez, who does not speak English, converses with her daughter and grandchildren in Spanish. Although the children and their mother occasionally speak English among themselves, the family’s language at home is Spanish.
At the Liberty HMO clinic, Mrs. Hernandez was diagnosed with essential hypertension and non–insulin-dependent diabetes mellitus. The physician prescribed an oral hypoglycemic drug and advised Mrs. Hernandez to exercise daily and to limit her food intake to 1500 calories a day. Mrs. Hernandez was concerned because she usually prepares traditional Cuban meals at home and was not sure whether she could tolerate being on a diet. Besides, she explained to Mariana, she thought the dishes she prepares are very “healthy.” Proof of that, she stated, is that her three grandchildren are plump and nice-looking. Mrs. Hernandez told her daughter that, instead of buying the prescribed medicine, perhaps she should go to the botanica and obtain some herbs that would help lower her blood sugar.
What are the typical Cuban communication patterns you need to be aware of in dealing with Mrs. Hernandez?
How would you assist Mrs. Hernandez in developing a plan for a 1500-calorie diet and regular exercise?
Would you encourage Mrs. Hernandez to go to the botanica to purchase some herbs? How would you approach her desire to use herbs instead of the prescribed oral hypoglycemic agent?
Discuss some common folk practices that Cuban families may use to maintain health or cure common ailments.
Sample Answer
Let’s address Mrs. Hernandez’s case with cultural sensitivity and a focus on effective communication and care.
1. Typical Cuban Communication Patterns:
Several key communication patterns are important to consider when interacting with Mrs. Hernandez:
- Respect for Elders (Respeto): Older adults hold a position of authority and wisdom. Address Mrs. Hernandez formally (e.g., “Señora Hernandez”) and show deference to her experience. Avoid being overly casual or familiar too quickly.
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