Cultural & Spiritual Considerations
It is always important to take into account the specific ethnic background of the patient when a nurse is planning care. The nurse needs to assess cultural and spiritual beliefs and develop goals and interventions that respect those preferences or customs. For Type 2 Diabetes, the preference or cultural food choices is very important. Diet and glucose control are very closely related and the nurse needs to know what the patient typically eats. Also for diabetes, some patients of different cultures view disease differently. Some may not want to take medications or injections for cultural or spiritual reasons. Others may have specific rituals, beliefs, or family roles that can change the way healthcare is delivered.
For example, for the Hispanic culture, which incidentally have a higher rate of Type 2 Diabetes than caucasians: According to Parada, Horton, Cherrington, Ibarra, & Ayala (2012):
In the United States, the incidence of diabetes in adults aged 18 to 79 has almost doubled in the past decade. While rates have increased in the general population, the prevalence remains unevenly distributed, with 11.8% of Hispanics, 12.6% of non-Hispanic blacks, and 8.4% of Asian Americans diagnosed with diabetes compared to 7.1% of non-Hispanic whites. (p. 553)
Furthermore, the authors assert that Latinos have less blood glucose control than other ethnic groups, for these reasons: language and cultural barriers to health information, lack of access to health care, and sociocultural barriers to adherence with treatment and diabetes management. The study found that noncompliance in the Latino population is associated with being male, having depression, and engaging in less “personal actions.” The most common reason given for non-adherence was forgetting to take the prescribed oral medication. The nurse can address this issue by instructing the client to link taking the diabetes medication to daily events, with the use of email or note reminders, or dosing cups (Parada et al., 2012).
According to Silvestri (2011), patients of Hispanic origins tend to be verbally expressive, may avoid eye contact out of respect, and tend to use gestures or facial expressions to show pain and emotions. The importance of extended family and the Catholic religion are also common considerations. A barrier to effective communication might be language, as Spanish is usually their primary language, and if there is a possibility of any misunderstanding on either side, an interpreter should be used. Written educational literature in the primary language of the patient should be provided. Some folk beliefs related to health may be present depending on the age and cultural orientation of the patient. It is important that the nurse understands different beliefs and that some patients may believe health to be connected to a reward or punishment from God (Silvestri, 2011). Some older Mexican patients may believe that diabetes is related to “nerves” or emotional stress, and some may wish to practice folk remedies for their illness (Palmquist, A., Wilkinson, A., Sandoval, J. M., & Koehly, L., 2012). It is important to evaluate these remedies with the current medical treatment plan and instruct as appropriate.
Mexican Americans are almost twice as likely as non-Hispanic whites to be diagnosed with Type 2 Diabetes (Health Education Research Advance, 2012). It is imperative to stress diet and exercise as effective means of controlling blood glucose. Another barrier often seen in this cultural group is medication costs and lack of health insurance in this country. Ngo-Metzger, Sorkin, Billimek, Greenfield, & Kaplan (2012) assert, “Mexican-American patients reported having more financial barriers to receiving medical care, more perceived financial burden related to their diabetes, and more cost-related medication non-adherence, compared to Vietnamese and non-Hispanic white patients (p. 436).” Nurses as care providers should initiate a conversation with patients about medical costs and financial pressures. Strategies to reduce medication costs should be looked into and options for affordable medications, possibly by involving an MSW in patient care.
