At her diabetic follow-up appointment at a local clinic, Ana,* a middle-aged Hispanic woman, sat frozen and silent in the exam room, with two younger women at her sides. “She's not able to speak because she found out today that her brother died,” explained one younger woman, a daughter. Ana stared wide-eyed at the nurse, who realized diabetes wasn't the primary need at present.
The nurse and a clinic interpreter expressed their sadness and concern for Ana. Seeing a cross on a chain around Ana's neck, the nurse asked, “I see you're wearing a cross necklace. Do you believe in God?” All three nodded. “Would you like me to pray for you?” Ana solemnly nodded. The interpreter translated the nurse's short prayer for strength, comfort, and an awareness of God's presence for this family.
During the visit, the nurse spoke to Ana primarily through her daughters, respecting their involvement in their mother's care. By the end of the appointment, Ana was nonverbally participating during interactions and nodded that she was able to go home and rest, believing in God's strength to carry her into the next day.
Ana and her family are members of the largest ethnic minority in the United States; as of 2016, Hispanics represented 17.8% of the population (United States Census Bureau, 2017). Also called Latinos, Hispanics are persons from Cuba, Mexico, Puerto Rico, Central and South America. Although many speak Spanish, not all do. Their cultures, though regionally distinct, have commonalities, including spiritual and religious values and practices (Peterson-Iyer, 2008). The Pew Research Center's 2013 National Survey of Latinos and Religion (2014) revealed that 55% of U.S. Hispanic adults identify as Catholic, whereas 22% are Protestant. The report also stated that 6 out of 10 say religion is very important.
Many Hispanic persons consider both conventional and folk medicine important. Older adults in this culture may be especially responsive to spiritual care. Physical, spiritual, and cultural components are interwoven in their concept of illness and recovery (University of Washington Medical Center, 2007). Nurses who respect this view establish a foundation for spiritual caregiving.
For most Latinos, family and relationships are highly important. Conversing and getting to know the patient, including acknowledging family members who are present, is vital. Any type of spiritual care should include those family members who are interested to participate in every element of the healthcare practice.
Praying with patients and their families is generally well accepted and appreciated. About 6 in 10 Hispanics say they pray at least once a day outside of attending worship services, according to the Pew Center's research (2014). Hispanics may pray to Mary and to various saints, and a nurse's prayer to Jesus or God the Father is acceptable.
When possible, use an interpreter of similar age and the same gender as the patient. Nurses should assess if the patient is comfortable with eye contact. Be aware of nonverbal cues—avoidance of eye contact or turning away could indicate a patient's emotional or spiritual distress (Lujan, 2010).
Hispanic people tend to be warm and emotional. Overt emotional responses to grief and loss should be expected. Responding to high emotion, such as crying, with a calming touch and a relaxed presence can be helpful.
A sense of fatalism and submission to God's will that the course of disease cannot be changed is part of Hispanic culture (Peterson-Iyer, 2008). A Christian response can be to affirm that God is sovereign and shows lovingkindness to his people. Also convey the reality of the hope that we find in Scripture, such as Psalm 3:2-5; Lamentations 3:21-23; Romans 15:13; and 1 Peter 1:3-6.
When working with Hispanic clients, take advantage of the opportunity to acknowledge Jesus and his presence in clients' lives.