Meeting Religious Needs of Hispanic Clients to Provide Culturally Competent Care
As I prepare to join the large percentage of the approximately 200 million US Christians who observe one of the most widely acknowledged religious times of the year, Holy Week or in the culture of Mexican Americans, the fastest growing group of Hispanics in the US. Therefore, it is vital that we, as healthcare providers acknowledge religion as a critical component of the culture of Mexican Americans who depend on us to facilitate meeting their religious needs as a part of culturally competent healthcare.
Eighty percent of the Mexican Americans in the US are Catholic, although Protestantism is growing rapidly.1 In spite of the large percentage of self-reported Catholicism among Mexican Americans, few (an estimated 59%) officially enroll in parish rosters.1 Some of the causes that have been suggested for this behavior include: little appreciation and poor understanding of parish membership, a general distrust for documents that require signatures, a low literacy rate and transient residency.2 However, when Mexican Americans are confronted with health challenges such as childbirth, illness and death, religion often becomes increasingly important, regardless of their parish enrollment status. For the purposes of this discussion, religion is defined as: the belief in, practice of, or participation in the rituals and activities of an organized religion.
Culturally competent care demands that the religious beliefs and activities of Mexican American clients be assessed by healthcare providers who acknowledge and respect this important dimension of culture. Inquiring about clients religious beliefs and needs can have substantial clinical benefits.3 The benefits of assessing clients religious status include the following:
- An increased understanding of the clients perceptions of the causation of disease and associated health beliefs so that the delivery of relevant health care teaching may be modified.
- Rapport with clients by demonstrating respect and concern for what they see as important aspects of their lives.
- Increased support of the religious needs of clients through appropriate referrals to clergy or pastoral care in a timely manner.
The assessment of Mexican American clients healthcare provider relationships
The assessment should be framed in the context of the clients coping and self-management of disease. The assessment should be conducted with expectation and preparedness for referral to clergy or pastoral care when appropriate. Healthcare providers who perform a religious status assessment must focus on four particular areas: verbal communication, behavior, immediate environment and relationships.
The religious status assessment of the needs of Mexican American clients could include the following basic questions:
- Do you identify with any organized religion? If so, what religion?
- If you do not identify with a particular religion, do you have a belief system that provides comfort and strength?
- How do your religious or spiritual beliefs influence how you care for yourself?
- Who are your support people?
- What provides you with strength and hope?
- What gives your life meaning and purpose?
- How has your life changed since you became ill?
- How might we (your healthcare providers) best address any needs in this area?
The answers to these questions can reveal potentially vital information that can be used to tailor the healthcare plan for Mexican American clients resulting in culturally competent, mutually beneficial healthcare provider-client relationships. Healthcare providers need to recognize their own spiritual beliefs and biases, while assessing the religious status of Mexican American clients. This will help healthcare providers maintain their objectivity and be as open as possible when assessing the religious status of their clients.
Linguistic barriers can complicate the effective assessment of the religious status of Mexican American mono-lingual Spanish-speaking clients. An interpreter may be needed, even with Mexican American clients who speak some English, because these clients may misinterpret some words or expressions that may convey a totally different meaning to them.3 An interpreter is preferred over a translator because a translator merely restates the words, while an interpreter translates the words with meanings.
The effectiveness of an interpreter can be improved by using several strategies. A region-specific interpreter should be used whenever possible. This is especially important when assessing Mexican American clients on the US-Mexico border because these clients often speak Spanglish (the linguistic blending of Spanish and English). A region-specific interpreter would be familiar with Spanglish and convey clients
Allowing time for the interpreter and the client to become acquainted is an important strategy that mandates extra time be allocated to the assessment procedure. The interpreter should be matched with the client by age and gender, when possible, to promote client disclosure. The use of relatives should be avoided because conscious or subconscious distortion of the interpretation by the interpreter or the client could occur. The use of children as interpreters, a common practice in Mexican immigrant families, should definitely be avoided because of client confidentiality and privacy concerns. Furthermore, children are unnecessarily burdened by requiring them to interpret in a healthcare context.1
Healthcare providers should use of culturally-sensitive therapeutic communication techniques when they are working with an interpreter. Healthcare providers should make every effort to maintain eye contact with both the client and the interpreter. Healthcare providers also need to be attentive to nonverbal cues. Healthcare providers should speak clearly, slowly, and in an appropriate volume. Exaggerating enunciation or speaking too loudly can hinder the communication process. The use of active rather than passive tense clarifies questions that can be difficult to interpret. Healthcare providers should also use as many words as possible in the client.3
Healthcare providers also need to be aware of their body language. Clients may understand more than they can express verbally. Healthcare providers may have to rely on nonverbal communication, diagrams, or pictures to complete the assessment of the religious status of Mexican American clients when an interpreter is not available.1
A religious status assessment includes the observation of relevant behavior. Healthcare providers need to be attentive to their clients in relation to praying or exhibiting religious practices during the assessment interview. Some of these behaviors in Mexican American clients may include the use of their hands to make the sign of the cross or looking toward heaven as they respond. Other clients may hold rosary beads, crucifix or religious postcards with their patron saint
Mexican Americans with high religiosity obtain comfort from an environment that expresses their religious beliefs. It is common for these clients to place religious statues and articles by their hospital bed or infantem to the ill client Some family members may request permission to burn candles at the ill client. Healthcare providers need to be attentive to these behaviors, as powerful indicators of a high degree of religiosity that should be acknowledged respectfully.
A religious status assessment also includes being attentive to the relationships of their clients. Healthcare providers need to be attentive to the presence of clergy or spiritual deacons who can be an important part of the clients religious support system. Many Mexican Americans derive great comfort from clergy visits, to include priests, nuns or deacons. Therefore, it is critical for healthcare providers to facilitate appropriate clergy referrals. Religion is central to Mexican Americans and its influence must be acknowledged and assessed consistently in a culturally-competent by healthcare providers so that positive outcomes may be maximized.
- Purnell, L.D., & Paulanka, B.J. (2003). Transcultural health care: A culturally competent approach (2nd ed.). Philadelphia, PA: F.A. Davis Company. 2003.
- Franzini, L., et al. Effect of religiosity and spirituality on self-perceived health among Hispanics, African-Americans and non-Hispanic whites. 130th Annual Meeting of the American Public Health Association. 2002.
- Dillon P.M.Nursing health assessment: A critical thinking, case studies approach. Philadelphia F.A. Davis. 2003.
Lujan J. Meeting Religious Needs of Hispanic Clients to Provide Culturally Competent Care. The Internet Journal of Allied Health Sciences and Practice. 2010 Apr 01;8(2), Article 4.