Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Culture

Larry Purnell, PhD, RN, FAAN

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Overview/Heritage

• Puerto Ricans are the 3rd largest Hispanic cultural subgroup with a population of approximately 3 million living in the continental United States.
• Most Puerto Ricans on the mainland live in metropolitan areas in the northeastern United States, such as Connecticut, Florida, Illinois, and New York.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Overview/Heritage

• Puerto Ricans have a unique pride in their country, culture, and music.
• They self-identify as Puertorriqueños or Boricuans (Taíno Indian word for Puerto Rican), or Niuyoricans for those born in New York.
• Puerto Ricans have been migrating to mainland United States for decades to seek employment, education, and a better quality of life.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Overview/Heritage

• In 1917, Puerto Ricans were granted U.S. citizenship through the Jones Act, and in 1952 Puerto Rico became a Commonwealth.
• From the jíbaros (peasants) to educated political leaders, the perception of many is that the Americanos, their culture, and politics are a potential threat to the Puerto Rican culture, language, and political future.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Overview/Heritage

• Puerto Ricans select geographic areas to reside where they can preserve their culture, enhance assimilation into the US dominant culture, and increase employment and social support opportunities.
• Citizenship status has created a controversial Va y Ven (go and come) migration. Individuals and families are often caught in a reverse cycle of immigration.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Overview/Heritage

• Historically, many Puerto Ricans have valued private rather than public education.
• Many parents make great financial sacrifices to enable their children to attend private educational organizations, which most often are Catholic schools.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Overview/Heritage

• Private schools are often referred to as colegios (colleges), creating confusion with the American English translation of undergraduate institutions.
• Instead of “college,” the term universidad (university) is most commonly used to refer to 4-year college institutions.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Children, beginning in kindergarten, learn to read and write English and Spanish.
• The issue of two official languages, English and Spanish, is a sensitive one for some Puerto Ricans who, after the U.S. occupation in 1898, were forced to learn English.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Puerto Ricans use the standard form of Spanish, speaking with no dialects or indigenous languages, although some rural people may speak with a different accent.
• Puerto Ricans frequently use the phrase !Ay bendito! to express astonishment, surprise, lament, or pain.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Puerto Ricans speak with a melodic, high-pitched fast rhythm.
• This pitch and these inflections are maintained when speaking English.
• Puerto Ricans are known for their hospitality and the value placed on interpersonal interaction, such as simpatia, a cultural script where an individual is perceived as likeable, attractive, and fun loving.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• They often expect the health-care provider to exchange personal information when beginning a professional relationship.
• The health-care provider may wish to set boundaries with discretion and personalismo, emphasizing personal rather than impersonal and bureaucratic relationships.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Most Puerto Ricans readily express their physical ailments and discomforts to health-care providers with the exception of taboo issues, such as sexuality.
• If confianza (trust) is established, health-care providers can establish open communication channels with individuals and family.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Spatial distancing varies with age, gender, generation, and acculturation.
• Personal space may be a significant issue for some older women, particularly those from rural areas of Puerto Rico who may prefer to maintain a greater distance from men.
• Puerto Ricans born on the mainland may be less self-conscious about personal space.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Young Puerto Rican women may take offence to verbal and nonverbal communications that portray women as nonassertive and passive.
• Most Puerto Ricans are very expressive, using many body movements to convey messages.
• During conversations, hand, leg, head, and body gestures are commonly used to augment messages expressed by words.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Greeting Puerto Ricans with a friendly handshake is acceptable.
• Puerto Rican women greet each other with a strong familiar hug and, if among family or close friends, a kiss is included.
• Men may greet other men with a strong right handshake and a left hand stroking the greeter’s shoulder.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Nonverbal communications may include an affirmative nod with an aha response, but this does not necessarily mean agreement or understanding related to the conversation.
• Most Puerto Ricans are present oriented, having a relativistic and serene view and way of life.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Among younger Puerto Ricans and those born on the mainland, eye contact is maintained and is often encouraged among those who believe in a nonsubmissive and assertive portrayal.
• However, among more traditional Puerto Ricans born and raised in rural areas of Puerto Rico, limited eye contact is preferred as a sign of respect, especially with older people who are seen as figures of respect and great wisdom.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Rather than Señora (Mrs.) and Señor (Mr.), children and adults are expected to use the term Doña (Mrs.) and Don (Mr.) for most adults. Aunts and uncles have their name preceded by tití or tío (auntie/uncle) and madrina or padrino (godmother or godfather).
• These prefixes are symbols of respect and position in the family.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• A single woman may use her name as follows: Sonia López Mendoza with López being her father’s surname and Mendoza her mother’s.
• When she is married, the husband’s last name, Pérez, is added with the word de to reflect that she is married. This woman’s married name would be Sonia López de Pérez; the mother’s surname is eliminated.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Puerto Rican Communication

• Younger or more acculturated women may change their last names to that of their husbands.
• The importance and respect given to the above prescriptive name formalities are perpetuated when friendly verbal and nonverbal gestures accompany the greeting.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• Despite many socioeconomic changes and changes in the position and role of Puerto Rican women, many traditional patriarchal values still define women in terms of their reproductive roles.
• Gender role expectations are strikingly different among more acculturated families
• Traditional men demand respect and obedience from women and the family.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles
& Organization

• The Puerto Rican family is moving toward more egalitarian relationships.
• More Puerto Rican families are sharing the economic and social responsibilities of the household.
• Machismo and gender roles continue to be the source of confrontations.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• From childhood through adolescence, children are socialized to have respect for adults, especially the elderly.
• Great significance is given to the concept of familism, and any behavior that shifts from this ideal is discouraged and may be perceived as a disgrace to the family.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• Many families believe that a healthy child is one who is gordita or llenito (diminutive for fat or overweight) and has red cheeks.
• Young mothers are often encouraged to add cereal, eggs, and viandas to their infant’s milk bottles.
• Many families socialize male children to be powerful and strong.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• Girls are socialized to be modest, sexually ingenuous, respectful, and subservient to men, a cultural script related to marianismo.
• Discussions about sexuality are considered taboo for many families.
• Modesty is highly valued: menstruation, birth control, impotence, sexually transmitted diseases, and infertility, are rarely discussed.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• Most families expect their children to stay home until they get married or pursue a college education.
• Children are expected to follow family traditions and rules.
• The mother is expected to assume an active role disciplining, guiding, and advising children.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• La familia is the nucleus of the community and the society.
• The family structure may be nuclear or extended.
• Family includes grandparents, married children, aunts, uncles, cousins, and even divorced children with their children.
• Two families may live in the same household.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• Most Puerto Rican families want a daughter because traditionally daughters are caretakers when parents reach advanced ages.
• Male children, who are usually more independent, are valued because they continue the family name.
• Grandparents assume an active role in rearing grandchildren.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Family Roles and Organization

• During the past 2 decades, Puerto Rican families have experienced an increased incidence of pregnancy among teenagers and unmarried women.
• Homosexuality continues to be a taboo topic that carries a great stigma among Puerto Ricans.
• Same-sex behavior is often undisclosed to avoid family rejection and preserve family and support.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Workforce Issues

• In general, Puerto Rican men and women readily assimilate into the dominant U.S. work environment.
• Most Puerto Ricans are hardworking, like competition, and often make extended efforts to please their employers.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Workforce Issues

• While most migrant Puerto Ricans are task oriented and meticulous about the presentation of their work, some have a relativistic view of time and may not value regular attendance and punctuality in the workforce.
• Most Puerto Ricans are cheerful, have a positive attitude, and value personal relationships at work.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Workforce Issues

• Men are socialized to display confidence at work and assume leadership positions with autonomy.
• Less educated immigrants are more likely to conform to the behavioral norms of the workplace and avoid personal conflict or confrontations in an effort to maintain positive relationships.
• Some women find themselves in conflict with traditional values when in a competitive, assertive work environment.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Biocultural Ecology

• Given the heritage of Puerto Ricans, who are a mixture of Native Indian, African, and Spanish heritage, some may have dark skin, thick kinky hair, and a wide flat nose; others are white skinned with straight auburn hair and hazel or black eyes.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Biocultural Ecology

• Puerto Ricans on the mainland face a high incidence of mental illness among younger adults, and cardiopulmonary and osteomuscular diseases afflict the elderly.
• Acute conditions among Puerto Ricans include a disproportionate number of acute respiratory illnesses, injuries, infectious and parasitic diseases, and diseases of the digestive system.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Biocultural Ecology

• Puerto Rican women in the United States have a high incidence of being overweight.
• Dengue, a mosquito-transmitted disease caused by any of the four viral serotypes of the Aedes aegypti mosquito, is an endemic disease that migrants may bring to the mainland.
• Puerto Rico has a higher HIV infection rate than any state in the United States.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Biocultural Ecology

• Because of the African heritage of many Puerto Ricans, drug absorption, metabolism, and excretion differences experienced by African Americans and Native Americans may hold true for black Puerto Ricans.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican High-risk Health Behaviors

• Alcoholism is the precursor of increased unintentional injuries, family disruption, spousal abuse, and mental illness among Puerto Rican families.
• The prevalence of smoking among Puerto Ricans is lower than that of European Americans, but higher than that for other Hispanic subgroups.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican High-risk Health Behaviors

• Acculturation, as measured by language use, is significantly associated with marijuana and cocaine use.
• Many studies have shown that the longer one lives in the United States and the more acculturated one becomes, the higher the use of marijuana, smoking, and cocaine.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• Food is used (a) to honor and recognize visitors, friends, family members, and health-care providers; (b) as an escape from everyday pressures, problems, and challenges; and (c) to prevent and treat illnesses.
• Some Puerto Ricans believe that being overweight is a sign of health and wealth.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• Traditional Puerto Rican families emphasize having a complete breakfast that begins with a cup of strong coffee or café con leche (coffee with milk).
• Some drink strong coffees such as espresso with lots of sugar; others boil fresh milk (or use condensed milk) and then add the coffee.
• Many families introduce children to coffee as early as 5 or 6 years of age.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• A traditional Puerto Rican breakfast includes hot cereal, such as oatmeal; corn meal; or rice and wheat cereal cooked with vanilla, cinnamon, sugar, salt, and milk.
• Although less common, traditional Puerto Ricans may eat corn pancakes or fritters for breakfast.
• Lunch is served by noon, followed by dinner at around 5 or 6 o’clock in the evening.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• Rice and stew beans) are main dishes.
• Rice may be served plain or with as many as 12 side dishes.
• Rice cooked with vegetables or meat is considered a complete meal.
• Gandules (green pigeon peas), a Puerto Rican bean is rich in iron and protein.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• Tostones, fried green or ripe plantains, are a favorite side dish served with almost every meal.
• Puerto Rican families eat a variety of roots called viandas, vegetables rich in vitamins and starch.
• Common viandas are celery roots, sweet potatoes, yams, breadfruit, breadnut, plantains, green bananas, tanniers, cassava, and chayote squash.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• Many Puerto Ricans ascribe to the hot-cold classifications of foods for nutritional balance during menstruation, pregnancy, the postpartum period, infant feeding, lactation, and aging.
• Chicken soups and caldos (broth) are used as a hot meal to provide essential nutrients during illness.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• A mixture of of honey, lemon, and rum are used as an expectorant and antitussive.
• A malt drink, malta (grape juice), or milk is often added to an egg yolk mixed with plenty of sugar to increase the hemoglobin level and provide strength.
• Ulcers, acid indigestion, and stomach illnesses are treated with warm milk, with or without sugar.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Nutrition

• Herbal teas are used to treat illnesses and to promote health.
• Most herbal teas do not interfere with medical prescriptions.
• Incorporating their use with traditional Western medicine may enhance compliance.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy and Childbearing Practices

• Puerto Rican women do not commonly use birth control methods such as foams, creams, and diaphragms because the Catholic Church.
• Pregnancy is a time of indulgence for Puerto Rican women.
• Favors and wishes are granted to women for their well-being and the health of their babies.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy and Childbearing Practices

• Men are socialized to be tolerant, understanding, and patient regarding pregnant women and their preferences.
• Pregnant Puerto Rican women are encouraged to rest, consume large quantities of food, and carefully watch what they eat.
• Many young Puerto Rican families prefer to attend birthing classes.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy and Childbearing Practices

• Some expect women to “get fat” and place little emphasis on weight control.
• Strenuous physical activity and exercise are discouraged and lifting heavy objects is prohibited.
• Women are strongly discouraged from consuming aspirin, Alka Seltzer, and malt beverages because these substances are believed to cause abortion.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy and Childbearing Practices

• Many women refrain from tener relaciones, sexual intercourse, after the first trimester to avoid hurting the fetus or causing preterm labor.
• Some men view this time as an opportunity for extramarital sexual affairs.
• Women welcome their husbands, mothers, or sisters to assist during labor.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy and Childbearing Practices

• During labor, women may be loud and verbally expressive, a culturally accepted and an encouraged method for coping with pain and discomfort.
• Pain medications are welcomed.
• Most women oppose having a cesarean section because it portrays a weak woman.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy and Childbearing Practices

• The first postpartum meal should be homemade chicken soup to provide energy and strength.
• Women are encouraged to avoid exposure to wind and cold temperatures, not to lift heavy objects, and not to do housework for 40 days after delivery (the cuarentena).
• Some traditional women do not wash their hair during this time.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy
& Childbearing Practices

• Because the mother is believed to be susceptible to emotional and physical distress during the postpartum period, family members try not to contribute to stress or to give bad news to the new mother.
• Fathers may be reluctant to tell the new mother about a problem with the newborn.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Pregnancy and Childbearing Practices

• Because some Puerto Rican women believe that breastfeeding increases their weight, disfigures the breast, and makes them less sexually attractive, they undervalue the benefits of breast-feeding.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Death Rituals

• Death is perceived as a time of crisis in Puerto Rican families.
• The body is considered sacred and guarded with great respect.
• Death rituals are shaped by religious beliefs and practices and family members are careful to complete the death rituals.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Death Rituals

• News about the deceased should be given first to the head of the family, usually the oldest daughter or son.
• Because of cultural, physical, and emotional responses to grief, health-care providers should use a private room to communicate such news and have a clergy or minister present when the news is disclosed.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Death Rituals

• Traditionally, some Puerto Rican families keep the body in their home before burial. Cultural traditions and financial limitations influence this decision.
• For some, funeral homes are viewed as impersonal, financially unnecessary, and detrimental to the mourning process because they detract from family intimacy.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Death Rituals

• Cremation is rarely practiced among Puerto Ricans.
• Among Catholics, the head of the family or other close family member is expected to organize the religious ceremonies, such as the praying of the rosary, the wake (velorio), and the novenas, the 9 days of rosary following the death of the family member.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Death Rituals

• Family may meet at the deceased’s home for several days, sometimes weeks, to support the family and talk about the deceased.
• Family of the deceased to freely express themselves through loud crying and verbal expressions of grief.
• Some may talk in a thunderous way to God.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Death Rituals

• Some believe that not expressing their feelings could mean a lack of love and respect for the deceased.
• Similar to other crisis events, some may develop psychosomatic symptoms, and others may experience nausea, vomiting, or fainting spells as a result of a nervousness attack (ataque de nervios.)

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Tania Miranda has been in labor for 12 hours. The physician is recommending a cesarean section, which she is reluctant to have because some Puerto Rican believe a C-section

Makes the woman appear weak.

Leaves an unattractive scar.

Means that she can never have another child.

Leave the baby weak.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: A

Some Puerto Rican women believe that having a cesarean section makes them appear weak.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Spirituality

• Most Puerto Ricans on the mainland are Catholic (85 percent); however, over the past 4 decades, Protestant Evangelical religious movements have converted 35 percent of the Puerto Rican population in the United States.
• A few practice espiritismo, a blend of Native Indian, African, and Catholic beliefs that deal with rituals related to spiritual communications with spirits and evil forces.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Spirituality

• Many join Evangelical churches because they offer a more personal spiritual approach.
• These religious groups provide social support and promote harmony and spiritual–physical well-being.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Spirituality

• Espiritistas treat clients with mental health conditions and are often consulted to determine folk remedies compatible with Western medical treatments.
• Older adults, those who have limited access to health care, and those who are dissatisfied with or distrust the Western medical system commonly use spiritual healers.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Spirituality

• To provide timely and appropriate interventions to Catholic families, health-care practitioners should inquire about the family’s wishes regarding the Sacrament of the Sick.
• Special prayers and readings are believed to be necessary at the moment of death, and families expect to be present to recite these prayers.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Spirituality

• Many see the quality of life as a harmonious balance among the mind, body, and spirit.
• Most Puerto Ricans are very religious and, when confronted with situations related to health, illness, work, death, or the prognosis of a terminal illness, they maintain their trust in spiritual forces.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Spirituality

• Rather than a fatalistic approach to life during illness, death, or health promotion, Puerto Ricans use coping mechanisms such as religious practices.
• God, who is their highest source of strength, guides life.
• For some, scripture readings, praise, and prayer bring inner spiritual power to the soul.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Spirituality

• Clergy and ministers are a resource for spiritual wisdom and help with a host of spiritual needs.
• An azabache (small black fist) or a rabbit’s foot might be used for good luck, to drive away bad spirits, and to protect a child’s health.
• Rosary beads and patron saint figures may be placed at the head or side of the bed or on the client to protect him or her from outside evil sources.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Most have a curative view of health.
• They tend to underuse health promotion and preventive services, such as regular dental examinations, physical examinations, and pap smears.
• Good hygiene is a basic concept for health promotion among Puerto Ricans.
• Daily showers are essential for good health and for personal appearance.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Most Puerto Ricans believe in “family-care” rather than self-care.
• Women are seen as the main caregivers and promoters of family health and are the source of spiritual and physical strength.
• Natural herbs, teas, and over-the-counter medications are often used as initial interventions for symptoms of illness.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Many consult family and friends before consulting a health-care provider.
• Although Puerto Rico is subject to U.S. drug administration regulations and practices, many Puerto Ricans are able to obtain controlled prescriptions from their local pharmacist in Puerto Rico.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Over-the-counter medications and folk remedies are often used by Puerto Ricans to treat mental health symptoms, acute illnesses, and chronic diseases.
• Puerto Ricans have become accustomed to the use of extended-care facilities and nursing homes. However, they prefer to keep chronically or terminally ill family members at home.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Espiritistas solve problems by communicating with spirits.
• Santería focuses on health promotion and personal growth and development.
• Clients who use folk practices visit bótanicas, folk religious stores, and use natural herbs, aromatic incenses, special bathing herbs, prayer books, and figurines for treating illness and promoting good health.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Fanning the face or blowing into the client is believed to provide oxygen and relieve dyspnea.
• Some may use tea from an alligator’s tail, snails, or savila (plant leaves) for illnesses such as asthma and congestive heart failure.
• Some place a damp cloth on the forehead to refresh the hot inside the body and relieve nausea.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practitioners

• Mint, orange, or lemon tree leaves are boiled and used as tea to relieve nausea and vomiting.
• Puerto Ricans may be loud and outspoken in expressing pain.
• This expressive behavior is a socially learned mechanism to cope with pain. Ay! is a common verbal moaning expression for pain (dolor).

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Most people prefer oral or intravenous medications for pain relief rather than intramuscular injections or rectal medications.
• Herbal teas, heat, and prayer are used to manage pain.
• Because mental illness carries a stigma, obtaining information or talking about mental illness with Puerto Rican families may be difficult.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• A mental illness may result from a terrible experience, a crisis, or the action of evil forces or spirits.
• Mental illness results from nerves or failing God’s commandments.
• Organ donation is an act of goodwill and a gift of life. Autopsy may be seen as a violation of the body.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practices

• Although there are no proscriptions against blood donation and blood transfusion, many Puerto Ricans may be reluctant to engage in these procedures for fear of contracting HIV.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practitioners

• Some espiritismo practices are used to deal with the power of good and evil spirits in the physical and emotional development of the individual.
• Santeros, individuals prepared to practice santería, are consulted in matters related to the belief of object intrusion, diseases caused by evil spirits, the loss of the soul, the insertion of a spirit, or the anger of God.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practitioners

• Modesty is a highly valued quality.
• Men prefer male physicians for care and may feel embarrassed and uncomfortable with a female physician.
• A few discount the academic and intellectual competencies of female physicians and may distrust their judgment and treatment. Some Puerto Rican women feel uncomfortable with a male physician while a few prefer a male doctor.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Puerto Rican Health-care Practitioners

• Older Puerto Ricans may prefer older health-care providers because they are seen as wise and mature in matters related to health, life experiences, and the use of folk practices and remedies.
• Puerto Ricans hold health-care providers in high regard; that is, they are seen as wise figures of authority.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

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Mr. Perez, age 76, is seeing his nurse practitioner as followup for asthma. He tells the nurse practitioner that he is also seeing an santero. The nurse recognizes that a santero

Treats gastrointestinal disorders.

Cardiovascular disorders.

Sexual dysfunction disorders.

Evil spirits.

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: D

Santeros are consulted in matters related to the belief of object intrusion, diseases caused by evil spirits, the loss of the soul, the insertion of a spirit, or the anger of God.

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