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Chapter 9: Mexican Americans Linda McMurry, Huaxin Song, Donna C. Owen, Elizabeth W. Gonzalez, Christina R. Esperat
Mexican Americans
The southwest region of the United States was settled by Spaniards in 1598 in what is today New Mexico. Later, citizens of the United States began settling in what was then Mexican territory.
Mexicans helped establish many southwestern cities and taught the settlers skills in mining, farming, and ranching. After the U.S.–Mexican War, which separated Mexico, a treaty provided land and cultural rights to those of Mexican descent.
Unfortunately, these rights were never fully honored, and Mexican Americans living in these areas have tended to become an economically segregated working-class group (Moore & Pachon, 1985).
Cont…
The Mexican immigrant populations have been concentrated mostly in the south and western portions of the United States, but more recently, the Midwest and East Coast have seen sizable increases in their populations.
Thirteen states now have 100,000 or more residents who are Mexican immigrants, and California has the heaviest concentration (39%). Most Mexican Americans have rural agricultural backgrounds (U.S. Department of Commerce, Bureau of the Census, 2013).
The proximity of Mexico to the United States has resulted in a noteworthy amount of drug trafficking.
The practice of smoking cannabis leaves came to the United States with Mexican immigrants who came north during the 1920s (Musto, 1991).
Much of the cocaine that reaches the United States from Colombia comes by way of Mexico (Booth, 1996).
Along with the drugs has come an increase in violence for border cities, creating problems for the judicial system by overcrowding jail cells, and for the health care system, which is often unprepared for the influx of health and socially related problems (Zong & Batalova, 2014).
Communication
Spanish, the primary language for many Mexican Americans, is the fourth most commonly used language in the world, the second most commonly spoken language in the United States, and one of the six languages used by the United Nations (Lewis, Simons, & Fennig , 2014).
Of the people in the United States who speak a second language, over 50% speak Spanish. Of U.S. Latinos, almost 90% speak Spanish (Lewis et al., 2014).
Touch
Adult Mexican Americans can be characterized as tactile in their relationships.
Embracing or holding hands while walking is common among close friends of the same gender.
Although female Mexican Americans may initiate more tactile behavior in communicating, there is a contradiction where modesty is concerned.
Mexican American women have been taught to highly value female modesty and not to expose their bodies to men or even other women.
Nakedness is avoided and will cause embarrassment, even among close family members.
English as a Second Language
Most Mexican Americans can also speak some English and for those of Mexican descent born in the United States, 98% are fluent in English.
The inability to speak English fluently has led to increased failure rates for school-aged Mexican Americans (Taylor, Lopez, Martinez, & Velasco, 2012).
Lack of language fluency has a negative impact on psychological well-being and diminishes quality of life (Zhang, Hong, Takeuchi, & Mossakowski, 2012).
The longer Mexican immigrants stay in the United States, the less likely they are to retain the mother language, which probably is most directly attributable to the fact that English is the language used in schools and at work.
Implications for Nursing Care
Because some Mexican Americans rely on Spanish to communicate with other people, it may be very frightening for them to participate in the American health care system, and it is frustrating for the nurses giving them care.
Nurses caring for clients who do not speak English need to develop and use strategies that show respect for and comfort with cultural differences of these clients (Cioffi, 2003).
In a metasynthesis of qualitative studies, having a translator present was not sufficient for nurses to connect with their Mexican American clients (Coffman, 2003).
Friendly facial expressions, facing the client, and talking directly to the client even when using the services of an interpreter were found to be important (Coffman, 2003).
It is important for the nurse to remember that language is a cultural factor that influences health care practices (Oliva, 2008).
Mexican American clients view nurses who attempt to speak some Spanish as caring and respectful.
It is uncommon for Mexican Americans to be aggressive or assertive when interacting with health care providers.
One of the most important roles of the nurse in caring for the Mexican American client is that of teacher. Teaching should begin with an assessment of the client’s ability to communicate and understand, which will guide the nurse in deciding which other family members should be included in the teaching process.
Space
Mexican Americans as a group demonstrate a great need for group togetherness.
Some Mexican Americans think of Anglos as distant because they require more personal space during conversation than Mexican Americans (Juckett , 2005).
Ford and Graves (1977) found that when Mexican American second graders related to others, there was closer interpersonal distance and more touching among girls. Touching was of longer duration when spatial distances were closer.
Social Organization
Within the Mexican culture, the family is the most valued institution and the main focus of social identification.
Most Mexican Americans have nuclear families who live separately, although some extended family or other relatives often live in the same household (Glick, 1999).
According to Chávez (1986), new immigrants (especially those who are undocumented) tend to live in a multiple-family arrangement, which offers the advantages of social and economic support.
As the length of residency increases and the family becomes more financially independent, the nuclear family tends to find a singular arrangement for its household.
Mexican Americans
The male is considered the decision maker (Bonder, Martin, & Miracle, 2002).
The mother of the family has the primary role of keeping the family cohesive.
Although the mother may influence family decisions, she does not have a dominant role in the family.
Increasing numbers of Mexican American women are finding work outside the home.
Women who live in a rural setting often help with the family farming activities.
Divorce is uncommon, but stable out-of-wedlock relationships are common in the lower socioeconomic levels.
Beliefs and Practices in Death and Dying
Death is a prevalent theme in Mexican culture, which may be influenced by the Aztec and Catholic beliefs that death is not the end but rather an entry into a new way of life (Paz, 1961).
In a landmark study that examined the thoughts and behaviors about death, dying, and grief among Mexican American immigrants, Kalish and Reynolds (1981) found that religious symbols and rituals are important and that large, supportive Mexican American family networks provide comfort and practical aid while grieving.
This is consistent with other findings that support the importance of familismo when coping with the death of a loved one.
Time
Mexican Americans are usually characterized as having a present orientation of time and as being unable or reluctant to incorporate the future into their plans.
An example of this orientation is that some Mexican Americans may spend several years’ savings on an important religious festival.
Also, the Mexican custom of the siesta in some ways represents the belief that rest (or the present) has a priority over continued work that could produce monies to safeguard the future.
Implications for Nursing Care
Flexibility and creativity may be needed in order to work with differences in time orientation.
It is important for the nurse to remember that personal ethnocentric attitudes toward time may negatively affect the planning of care for clients with a different time orientation.
In the Western culture, health care settings tend to be future oriented, with weekly appointments, long-term treatment goals, and strict adherence to schedules.
Scheduling can pose a barrier because patients and their families may not be able to leave work during the day to attend regular appointments.
Environmental Control
Many Mexican Americans have an external locus of control, believing that external forces operate in many social and individual circumstances.
Some Mexican Americans perceive life as being under the constant influence of the divine will.
There is also a fatalistic belief that one is at the mercy of the environment and has little control over what happens.
Health Care Beliefs
Theory of Hot and Cold and Perception of Illness. One category of disease is hot and cold imbalance, in which illness is believed to be caused by prolonged exposure to hot or cold. To cure the illness, the opposite quality of the causative agent is applied to assimilate the hot or cold. Included in this category are illnesses that, rather than being caused by temperature itself, are associated with hot or cold aspects of substances found in medicines, elements, air, food, and bodily organs.
Theory of Hot and Cold and Effects on Growth and Development.
Hot and cold have symbolic significance for the nature and process of reproduction (Greene, 2007). During pregnancy, a woman may be advised not to eat hot foods.
On the other hand, during menstruation or after childbirth, a woman might be told to avoid cold foods or avoid taking a bath. Infertility is associated with a “cold” womb, lack of intimacy, and rejection.
A pregnant woman is believed to have an especially warm body, and to dissipate the warmth, she should bathe often and take short walks (Currier, 1966).
Folk Medicine
Use of folk medicine and folk practitioners is considered one of the most important variables leading to the underutilization of Western medicine by Mexican Americans (Ericksen, 2006; Lopez, 2005).
The belief that health is a matter of chance and controlled by forces in nature is the basis of folk medicine.
Folk medicine as practiced by Mexican Americans combines elements of the European Roman Catholic view and the view of the original Indians of Mexico.
These beliefs have led to unique ways of accounting for physical and mental illnesses and their consequences and to unique methods of dealing with illnesses.
Types of Folk Practitioners.
Family Folk Healer.
Yerbero.
Curandero and Curandera.
Brujos and Brujas (Witches).
Folk-Related Illnesses.
Caída de la Mollera.
Mal Ojo (Evil Eye).
Empacho (Obstacle).
Susto (Magical Fright).
Nervios.
Implications for Nursing Care
It is important for the nurse to be aware that use of alternative therapies from Mexico is prevalent among Mexican Americans. Lopez (2005) reported that 44% of Mexican Americans in a study in the Texas Rio Grande Valley reported using alternative practitioners one or more times during the previous year.
The most commonly sought therapies are herbal medicine, spiritual healing and prayer, massage, relaxation techniques, chiropractic, and visits to a curandero.
The majority (66%) indicated that they never reported visits to alternative practitioners to their established primary health care provider.
Skin Color
The skin color of Mexican Americans can vary from a natural tan to dark brown.
Persons with lighter color have more Spanish ancestry, whereas darker-skinned persons have more Indian ancestry.
It is more difficult to recognize vasodilatation or vasoconstriction in the darker-skinned client, in whom vasoconstriction and anemia are manifested as an ashen color rather than a bluish coloration.
Biological Variations and Susceptibility to Disease
Diabetes. On average, Mexican Americans are 1.9 times more likely to have diabetes than non-Hispanic Whites of similar age.
Hypertension. A new statistics report in 2015 indicates Mexican Americans have lower risk of developing hypertension than non-Hispanic Whites and Blacks
Communicable Diseases. Approximately 85% of the health problems common to Mexican Americans involve communicable diseases
Psychological Characteristics
Ethnic pride is an important cultural factor that needs to be considered in working with ethnic minority populations.
Ethnic pride reflects positive feelings of connectedness and belongingness with regard to an individual’s ethnic and cultural background, identity, and group.
Although research on the relationship of ethnic pride to physical and mental health outcomes is limited, especially for Latino samples, a study involving ethnically diverse adolescents, including Mexican Americans, found that ethnic identity and cultural orientation mediate the relationship between perceived discrimination and depression.
Implications for Nursing Care
In providing health care education for the Mexican American, the nurse must remember to address cultural differences such as health values, ethnic care practices, family life patterns, dietary practices, the presence of insurance, and a usual source of care.
It is also important to communicate the necessity of commitment by the whole family to making lifestyle changes if they are to be successful.
Hispanic Americans in the San Antonio Heart Study were found to be less knowledgeable about preventing heart attacks and not engaging in risk-reducing behaviors as often as non-Hispanic Whites (Hazuda, Stern, Gaskill, Haffner, & Gardner, 1983).
CASE STUDY*
George García, a 23-year-old migrant farmworker, and his wife, Anita, age 20, bring their 4-month-old daughter to the emergency room of a small community hospital. They speak only broken English. They have another small child with them, as well as two older women. They are very worried about the infant, who they say has been unable to retain feedings of diluted cow’s milk. Now, because of poor sucking and increased sleeping, the infant has not had anything by mouth for the past 24 hours.
Case Study
When asked, the parents indicate that the infant has had only three wet diapers since yesterday. The nurse notices that the infant’s eyes are sunken, she is listless, and her fontanels are depressed. When asked, the parents say the infant has been sick for 3 or 4 days. One of the older women makes a pushing-up motion with her hand as she points to the infant’s mouth. Further assessment reveals a rectal temperature of 103° F. The family has not taken the temperature at all in the past 3 to 4 days. Skin turgor is good; mucous membranes are tacky.
Case Study
Diarrhea is not present. The infant’s heart rate is 120 and regular but thready. Respirations are 12 per minute at rest. The infant does not cry during rectal temperature taking or when touched with a cold stethoscope. *Stacie Hitt, RN, MSN, assisted in developing this case study and care plan.
Care Plan
Nursing Diagnosis: Fluid Imbalance related to active fluid loss (vomiting and no intake for 24 hours) Client Outcome Nursing Interventions Infant will exhibit signs of adequate hydration.
1. Offer appropriate fluids as tolerated. Maintain accurate record of intake.
2. Weigh daily.
3. Assess all parameters (such as vital signs, skin character) for hydration.
4. Apply urine collection device if indicated.
5. Measure urine volume and specific gravity.
Care Plan
Nursing Diagnosis: Impaired Low Nutritional Intake related to inability to ingest nutrients Client Outcome Nursing Interventions Infant will consume and retain appropriate number of calories per weight per day.
1. Gradually reintroduce foods as indicated—clear liquids, then formula (give samples) or breast milk.
2. Determine family’s source of water and refrigeration for milk products.
3. Determine if mother had been breastfeeding prior to giving diluted cow’s milk.
4. Encourage her to resume breastfeeding.
5. Observe infant while feeding.
6. If unable to suck, consult physician for intravenous order.
Care Plan
Nursing Diagnosis: Impaired Infant Feeding Behaviour related to neurological impairment as evidenced by listlessness Client Outcome Nursing Interventions Infant will progress to normal feeding pattern.
1. Assess infant’s oral reflexes (root, gag, suck, swallow).
2. Record intervals of sleep and wakefulness; observe infant’s level of activity when awake.
3. Provide pacifier to encourage sucking if infant must receive hyperalimentation.
4. Assess ease of arousal.
5. Encourage family to participate in holding, caring for, and talking with infant.
Care Plan
Nursing Diagnosis: Communication Barrier related to cultural differences (foreign-language barriers) Client Outcome Nursing Interventions Family will be able to communicate basic needs and understanding of infant’s condition and care.
1. Assess language spoken best by family.
2. Assess family’s ability to comprehend English.
3. Talk more slowly than normal to family.
4. Use gestures or drawings for clarity.
5. Be careful to touch children after looking directly at them.
6. Make a conscious effort to address father when explaining care.
7. Show respect to older women. 8. Obtain a fluent, consistent, certified translator.
Care Plan
Nursing Diagnosis: Impaired Health Maintenance related to inability to make thoughtful judgments in regard to health of infant Client Outcome Nursing Interventions Family will demonstrate understanding and ability to perform skills necessary for care of infant at home.
1. Determine what information the family needs.
2. Determine folklore beliefs related to health care. Initiate the teaching.
3. Determine influence older women have on family’s health care beliefs.
4. Determine medication practices, including use of self-prescription of antibiotics.
5. Determine equipment needed for home care.
6. Seek social service referral.
7. Seek assistance from agencies.
Care Plan Questions
1. Which family member is likely to make the decision about whether to allow the infant to be hospitalized?
2. What might the nurse do to encourage the best communication with this family?
3. What kinds of data should be obtained in the history?
4. What folk disease does the family probably believe the infant has?
Care Plan Questions
5. How should the nurse explain to the family why the infant needs to be hospitalized?
6. Why would it be advantageous for the nurse to touch both the infant and the other child while relating to them?
7. How could the nurse show acceptance of the folk remedies that may have already been tried with the infant?
8. The infant is admitted to the hospital. What could be expected in terms of family visitation?
9. What teaching goals should the nurse have for this family?
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