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This presentation was awesome! The group did a great job at including valuable information about the Puerto Rican culture. The cultural background information and the discussion on language was particularly my favorite.

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You guys did a great job in your presentation. I loved the flow of the various items and the organization of your work. Not only did you read about the people but it seems like you have a great deal of understanding of the culture. This group members would not regret being assigned as one of your patients come June 2019. Go nurses!!!!

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                                        Puerto Rican Americans

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                                        Puerto Rican Americans

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Fawn Gallop
Chantel Miles
Whitney Torres

Hampton University
NURV 224

Dr. Gipson-Jones

July 17, 2018

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                                        Introduction and History

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                                        Introduction and History

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Puerto Rico a commonwealth located 1000 miles east-southeast of Miami in the Caribbean Sea, about the size of Rhode Island, times three. Puerto Rico is 3425 square miles in length. On the island it has a high central mountain terrain, the El Yunque rain forest, low eastern mountain range, and dry fertile northern coastal plains.

In the 1400s, this land was occupied by approximately 50,000 Taino Indians and they called their land Boriken or Borinquen which stands for “the great land of the valiant and noble Lord” or “land of the great lords.”  In 1493, Christopher Columbus arrived and claimed the land for Spain. During that time, the Taino Indians lived in small villages, grouped by clans and led by a single chief. The tribe lived off of tropical based crops; sweet potatoes, pineapples, cassava and seafood. The Taino welcomed the first group of colonizers with gold nuggets they picked by hand from the river. The seaside port that welcomed the colonizers was named San Juan and is still the capital today. San Juan was the most important seaside post for Spain’s military and they defended it massive fort on the harbor. Throughout the centuries, Spain fought off conquest attempts from the French, Dutch, and British.  Nonetheless, it was the Treaty of Paris, which was signed in 1898 after the Spanish-American War, that ceded Puerto Rico to the US. Puerto Rico gained its citizenship in 1917.  Presently, the people of Puerto Rico are undecided as to whether they want to become a state of U.S. or remain a commonwealth status. This is a major political conflict for the citizens of Puerto Rico that has been going on for decades.

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                                                San Juan Fort 

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                                                San Juan Fort 

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                                        Immigration to the US

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                                        Immigration to the US

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Borders between the US and Puerto Rico are open and Puerto Rico citizens aren’t required to have a visa to visit or work in the US. On average 40,000 Puerto Ricans had migrated to New York in the 1950s and by 1970 more than 1.4 million had settled in regions across the US. However, due to an US economy decline in 1970 thousands had returned to Puerto Rico and shortly following the Puerto Rican economy had declined and US provided social programs to help. In the US, Puerto Ricans are the second largest Hispanic group at 9.7% of the US Hispanic population. According to the Census Bureau, they are nearly 4.6 million Puerto Ricans who in the US in the northeastern region, predominantly in New York and New Jersey.

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                                            Demographics

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                                            Demographics

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· Median income $14,905 and family $27,017; compared to the US which stands at $57,000

·  Religious Practice: Catholic and Protestant

·   Family structure: Family is the foundation of the Puerto Rico social structure. Honor is the most importance within family and not induvial achievement. The basic support of an individual is the first and second generation within family (aunt, uncle, cousins, grandparents, close friends and god parents.)

·  Location of living: Most individuals are living in the coastal regions of Puerto Rico

·  Education level:  It is common for individuals to graduate from High school with 70% of those who attend and less than 25% proceed to gain college education. Puerto Rico education system is closed related to the US system starting at age 6 and processing through primary, middle and high school.

·   Types of jobs they occupy:  Major industries are pharmaceuticals, electronic manufactures, apparel and tourism.

Top three cause of death: Heart and Cardiovascular disease, Cancer and Diabetes

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Healthy People 20/20 and Social Determinants: Why Should  Healthcare Providers Be Familiar with 20/20?            

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Healthy People 20/20 and Social Determinants: Why Should  Healthcare Providers Be Familiar with 20/20?            

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Healthcare providers need to be familiar with 20/20 because Healthy people 20/20 was designed to identify ways to create promotion of good overall health for an individual with social and physical environment. Healthy people 20/20 focuses on 5 key areas(determinants) that affect an individual’s life:

· Economic stability (employment, food insecurity, housing instability),

· Education (early childhood and development, language and literacy and high school graduation),

· Social and community (discrimination, incarceration and civic participation),

· Health and health care (access to health care, access to insurance, and health literacy)

· Neighborhood and built environment (access to healthy foods, crime and violence, quality of housing)

This framework can help Healthcare providers develop tools and strategies that can improve health of all and close health gaps within the communities.

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                                        Implications for Nursing

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                                        Implications for Nursing

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Practice

It is valuable to offer health promotion and give explanation on how health prevention activities foster future health.

Essentially, nurses who plan to provide care and practice in Puerto Rico should undergo disaster training to efficiently deliver care to Puerto Rican Americans.

Nurses must be able to retain the knowledge learned from Puerto Rican culture and apply it into practice to deliver efficient treatment.

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                                      Implications for Nursing

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                                      Implications for Nursing

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Education

Nursing institutions and organizations should incorporate cultural education programs, and enforce continuing education classes that highlight culture.

Nurses should gain the knowledge of cultural differences by way of mandatory classes, in efforts to understand communication, treatment, and dietary prefernces of the Puerto Rican (PR) culture.

Health systems should actively facilitate culture change that elevates healthcare in education and practice.

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                                      Implications for Nursing

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                                      Implications for Nursing

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Research

For nurses, health outcomes research for Puerto Rican Americans can identify potentially effective strategies that can be implemented to improve the quality of care and the quality of life of patients. Research can be used to explore ways to assist lower income and less educated Puerto Ricans in efforts to improve health outcomes and prevent economic-related diseases. These studies should be conducted within the community and should directly involve the people who are affected.

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                             Provision of Culturally Competent Care

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                             Provision of Culturally Competent Care

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Family impact

The nurse must also be cognizant that Puerto Ricans have a great desire for family support and that many medical decisions are made collectively by the patient and their family. Finding a way to incorporate the entire family while respecting the desires of the patient can be challenging, therefore, nurses have to familiarize themselves with patient rights.

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                            Provision of Culturally Competent Care

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                            Provision of Culturally Competent Care

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Treatment

Puerto Ricans primarily pursue alternate forms of care when disease is exhibited with only 9% of parents choosing a physician first. Religion plays a significant role in the treatment options for Puerto Ricans. According to Giger (2018), Many Puerto Rican Americans are Catholic and believe in Santeria, a belief that originated among the Yoruba people in Nigeria and was brought to PR via slaves.” This belief helped to birth other untraditional treatment options such as hot and cold treatment concepts, and amulets worn to provide healing. It of benefit to the nurse to grasp these concepts in order to provide the best care.

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                             Provision of Culturally Competent Care

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                             Provision of Culturally Competent Care

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Communication

Puerto Ricans face more danger of poor health outcomes than any other Hispanic subgroup, however, limited studies have been conducted on this topic. As the population and service consumption escalates, nurses should be able to adapt and develop unique programs to advocate for this vulnerable community.

It is essential for the nurse to realize how pivotal communication is in providing optimal culturally competent care. A nurse must understand that the Spanish spoken by Puerto Ricans might vary considerably from the Spanish spoken by persons from other Hispanic cultures. Additionally, tone of voice is important for the nurse to recognize because Puerto Ricans characteristically exhibit a melodic and peaceable tone, and could misconstrue the nurse’s use of high pitch and voice inflection as aggressive.

As a sign of respect, many Puerto Ricans avoid eye contact when greeting elderly. Furthermore, there is a negative correlation with the lack of ability to speak English, and its connection to lack of adequate treatment of Puerto Ricans in the United States. Yet, the nurse should be aware that even with the assistance of a translator, vital messages may fail to be translated accurately and may result in poor outcomes.

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Things You Will Love & Hate About Puerto Rico

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Spanish in Puerto Rico: Pronunciation, Accent, etc.

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Interesting facts about Spanish in Puerto Rico: Pronunciation, Accent, etc..

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                                              Dietary Practices

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                                              Dietary Practices

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Individuals in the Puerto Rican community consume a wide variety of foods. The PR American diet is high in complex carbohydrates and calcium. This diet also includes incomplete protein that includes legumes, rice and beans. Meat choices include: chicken, pork, sausage, turkey, beef, pork chops and ribs. Fish is eaten, however, it is not eaten as much as other meats. Starchy vegetables are also commonly eaten (sweet potatoes, plantains, green bananas and squash).

Due to the richness of the foods and the flavorful preparation of the foods, most meals are high in carbohydrates, fats, calories and sodium. The richness of the foods has been a cause of high blood pressure.

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                              Alternative Medication and Therapy

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                              Alternative Medication and Therapy

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Acupuncture is an alternative therapy that many Puerto Rican Americans use to assist in the acceleration of healing as well as relaxation.

Another alternative therapy that individuals in the PR community use is herbal supplements. Herbal supplements are used for various ailments such as backaches, headaches, allergies, depression and high blood pressure. Common supplements used include: gingko biloba, echinacea, feverfew, garlic, kava, saw palmetto, ginseng, licorice and St. John’s wort.

The treatment with both prescription medication and alternative medication presents a possible problem, as some herbal/complementary medications interact with prescription medications. Patients who treat with both types of therapies may be placing themselves at an increased risk for herbal-drug interactions, which can cause a major adversative effect on their state of health.

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                                  CULTURAL CHARACTERISTICS 

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                                  CULTURAL CHARACTERISTICS 

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Biological Variation
According to the text (Giger, 2018), elderly Puerto Rican Americans have a lower percentage of body fat, as compared to middle aged Puerto Ricans. Because of low birth weight, PR infants are more susceptible to genetic deviations such as neural tube defects, hypothyroidism and abnormal hemoglobin level. Furthermore, Puerto Rican Americans are more prone to the development of the following diseases and/or conditions:

·       Asthma (particularly in children)- because of increased rates of asthma in children within this cultural group, more emergency room care and an increase in healthcare related treatment costs.

·       Visual Impairment (children and adolescents) greater in PR than in Mexican Americans, Cuban Americans and non-Hispanic White Americans. This condition was found to be correlated to the fact that many PR children and adolescents were not receiving the same corrective lens care, which increased the severity of the ocular condition. Poor visual acuity was found to be linked to poorer academic performance, learning and behavioral disabilities and increased acts of delinquent behavior among PR children and adolescents.

·       Obesity- is common within third and fourth generation PR children and adolescents. It was found that this condition has been shown to become more relevant with third and fourth generation individuals as a result of them becoming acculturated within the U.S. society. In adult PR women, obesity rates are high. This increased in body fat is a result of high intake of animal fat. Because of the toll that obesity takes on one’s body, obese PR individuals are more susceptible to diabetes, cardiovascular disease and some cancers. This concept is especially important in the nursing practice. The PR community believes that being thin is an indicator of ill health yet being overweight is a social status of health and wealth. Within the medical practice, nurses should be aware of this belief within this community and identify ways to education the PR patient on healthy weight, exercise and appropriate eating habits.

·       Diabetes- this condition was found to be more prevalent in the elders of the PR community. It was also found that the treatment of this condition was affected by the hampered communication between patient and health professional. As reported by Giger (2018), PR Americans have lower reading and proficiency levels, therefore, the communication barrier negatively impacted treatment. Another barrier to treatment was found to be low income.

·       Cancer- the most common reported cancers of the PR community include breast cancer, lung cancer and non-Hodgkin’s lymphoma. It was also found that PR women have higher smoking rates.

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                                  CULTURAL CHARACTERISTICS

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                                  CULTURAL CHARACTERISTICS

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Death Rituals

In the PR culture, many Catholic practices concerning death and mourning are followed. In some PR families, a “code of silence” is implemented. This means that the individual whose death is anticipated is not informed of their prognosis. It is also customary for the dying patient’s family to remain in the waiting room where they mourn the impending death by way of a vigil. It is expected that the religious leader be with the patient during the time of death. Furthermore, it is customary that the family spokesperson is the one who initially receives the report of death. The family of the deceased may desire to kiss and make physical contact with the body after the passing. After they are given intimate time with the deceased, a private space should be made available in order for the family to express their bereavement. Additionally, PR Americans usually are in support of organ donation, however, only certain family members (the spokesperson) should be the individual who makes and verbalizes this decision on behalf of the patient. In the PR community, autopsies are frowned upon as they are viewed as a violation of the body.

Understanding death rituals is important in the nursing practice as nurses must be aware and remain sensitive to the patient’s wishes, the family and customs which are routinely followed during this time.

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1. Puerto Rico is a(n)
a. Independent nation
b. Commonwealth
c. U.S. Territory

2. Puerto Rican Americans frown upon organ donation as it is viewed as an invasion and violation of the sanctity of the human body.
a. True
b. False

3. Many Puerto Rican Americans opt to take prescription medication rather than alternative complementary treatment, as prescriptive treatment is valued.
a. True
b. False

4. In what year was Puerto Rico ceded to the United States?
a. 1898
b.1902
c. 1800
d. 1915

5. Which of the following is not one of the determinants of health?
a. Communication
b. Neighborhood and built environment
c. Health and health care
d. Education and economic stability

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                                                    References

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                                                    References

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Barton, A. (2017). Role of the RN in primary care: Implications for nursing
education. Journal of Nursing Education, 56(3)

Giger, J.N.(2017). Transcultural nursing: assessment and intervention. St. Louis,
MO: Elsevier

Schmidt, N. & Rivera, O. 2018. Concurrent use of herbal supplements and
prescription drugs in northeastern Puerto Rico

Social determinants of health. 2018. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/social-
determinants-of-health