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TransculturalNursingCareforHaitianClients1.pptx
Haitian Americans Transcultural Nursing care
Joyce Nealey
Jasmine Garrison
April Ruethemann
Cultural Health Issues
Dr. Barry Eugene Graham
November 24, 2023
The Haitian Client in Healthcare
Haitians are from an island that is in the pathway of many natural disasters often.
1. Leading to extreme poverty because of the destruction of their primary economic resources.
2. Poor living conditions lead to infectious diseases and contribute to chronic illnesses.
3. The need to work to support the family leads to illiteracy.
Adding political unrest to the above stressors creates stress-related diseases such as depression and HTN.
In 2010 there were destroyed homes, schools, hospitals, etc. Results were an estimated 587,000 Haitian immigrants in the United States, which increased by 89,000 in 2015”(Schultz & Batalova 2017, as quoted by Namara, 2020).
“In 2022, there were approximately 731, 000 Haitians living in the US. The greatest percent (49%) live in Florida (Dain & Batalova 2023).
Cultural Aspects - Communication
Communication: • Most Haitians speak Haitian Creole. Due to limited Creole speaking providers and limited translators, there is a fear of miscommunication and mistreatment (Namara, 2020)
1. French and Creole (Comprehension is not inclusive)
2. May agree to avoid conflict.
3. Pointing may be considered rude.
Anatomical cultural terms differ, leading to fear and distrust (Namara 2020)
Cultural Aspects – Socioeconomic
“Haitian adults ages 25 and older tend to have lower educational attainment than both native-and overall foreign-born populations” (Dain &Batalova 2023).
Haitians tend to have significantly lower incomes than overall foreign-and-native born populations...median income 65,000 in 2022 (Dain & Batalova 2023).
“In 2022, 17 percent of immigrants from Haiti lacked health insurance”(Dain & Batalova 2023).
Haitians have a mistrust of health care providers because of a prevailing stigma and bias (example:HIV, Voodoo), and fear of detainment or deportation (Namara, 2020)
“Haitians prefer to use traditional cultural remedies over traditional western medicine which limits their use of health services, and often seek help from voodoo practitioners or family members first. (Namara, 2020)
Cultural Aspects – Family/Spiritual
Family dynamics:
1. Reputation can affect family image.
2. Obedience to their elders.
3. Male head of household.
4. Female decision-making in regard to children.
Haitian families are more likely to live in urban communities
Most Haitian Americans are Roman Catholic, with Protestant communities being the second largest religious group.. Some individuals practice Vodoun while officially following one of the main religious groups. Religion is very important in the life of Haitian Americans.
Cultural Aspects - Health
Most Haitians believe that illnesses like depression are “caused by God and other Spirits; therefore, they believe medical professionals cannot manage the signs and symptoms” (Namara, 2020).
Physical symptoms of depression are attributed to:
1.malnutrition
2. voodoo magic of jealous people.
Additionally, psychotic symptoms such as hallucinations and delusions are “a way to communicate with spirits…”(Namara, 2020).
Therefore, Haitians turn to their own personal and religious support systems instead of health professionals. Understanding these beliefs is necessary to avoid misdiagnosis and also to allow their support system.
“Haitians prefer to use traditional cultural remedies over traditional western medicine which limits their use of health services, and often seek help from voodoo practitioners or family members first. (Namara, 2020)
Theoretical Transcultural Care
Dr. Josepha Campinha-Bacote coined the term ‘cultural competemility’ to capture the synergistic nature between knowledge, awareness, desire, and humility (Transcultural C.A.R.E Associates, n.d.).
Modeling Campinha-Bacote’s Transcultural Theory for the Haitian Client
Align with the client’s cultural values. Ex: your baby will be STRONG vs. ‘healthy’ (Themes, 2009).
Produce consistent, sustained care: Scheduling follow up appointments, including referrals, assisting with transportation needs (bus passes and maps), and direct handoff to medical assistants and techs (Mason & Burga, 2019).
Be respectful: education needs to be specific to their cultural norms. Be mindful of tone and avoid demanding or authoritative language (Magny-Normilus et. al., 2019).
Be delivered with an earnest desire to engage openly: start interactions with “Good day, Miss” and ask them about their day. It is considered to be polite and they will come back with the same energy” (Burnedetta Fergus, BSN, RN)
Disparities
Fear of deportation in undocumented populations.
Access or awareness of free healthcare services.
Affordability of health insurance.
Language barriers and shortage of creole interpreters.
Healthcare Challenges
These patients often have higher acuity rates, due to; lack of insurance, limited experience in modern healthcare systems, legal status, and cultural reliance on traditional healers as first tier care (Themes, 2019).
Communication Challenge
Communication barriers both linguistically and culturally are immense.
Lack of culturally congruency.
NDX: Ineffective communication by discrepant Creole-English languages of client and nurse.
The long term goal is to assist the client in finding and maintaining a medical home, by building trust through positive medical interactions.
Communication - Interventions
Use the language line with a Creole (not French) speaking interpreter, for language and cultural mediation(Themes, 2019a).
Offer the inclusion of family/friend in discussions and education. The client may feel supported, and the friend can ask pertinent questions that are culturally important. It has been noted, the patient will likely make independent decisions, after conferring with family(Magny-Normilus et al., 2019).
Maintain direct eye contact and use touch as appropriate( Magny- Normilus, 2019).
Socioeconomic Status Challenge
Basic Needs: Per Maslow, must be met before any further personal progress can be made. Survival basics are prioritized before health concerns or prevention.
NDX: Risk of non-adherence to a care plan related to limited support as evidenced by lack of permanent housing or financial self-support.
The long term goal is for the client to preserve a locus of control, which is a protective factor against stress, even as one is navigating multiple obstacles (Bonmatí-Tomás et al., 2016).
Socioeconomic Status Intervention
Provide a list of food banks, be mindful to remove programs that require legal status, avoiding safety/security concerns for the client.
Provide infographic flyer for NGOs that offer health and dental services with Haitian medical assistants and/or providers (such as Caridad Center or FAU extension in Palm Beach County.)
Provide a map for churches with Haitian congregations; 80% of Haitians are Catholic. Even if the client is not religious, a church may also function as a community; assisting with assimilation, combating loneliness, and offering a sense of security and belonging.
Ask the client how she learned Spanish and assist in locating congruent methods. ESOL classes are often available offered locally at community centers, libraries, or schools.
Health Literacy Challenges
Health literacy is generally low for Haitians, as many have had little to no healthcare in their native country.
NDX: Knowledge deficit related to limited education and experience within healthcare systems as evidenced by lack of preventative care, medical home or prior health visits.
The long-term goal is teaching the client tools to use for self-management of their condition, and self-empowerment.
Health Literacy Interventions
Give a simplified 1-page of medical treatment, medication, and discharge instructions(DeSai et al., 2021), and remove all superfluous information.
Coach the client regarding medication(Magny-Normilus et al., 2019):
help them identify the various pills noting color and shape
purpose of the pill such as “high or low sugars”, use the clients own words
time of day to the pill; AM – 6/PM – 6 (ambiguous: 2 x day)
use a marker to note agreed purpose and time; clients have confused the identication for medication
Give rationales for all the steps in the plan. Many Haitians find it respectful, collaborative, and leads to better management (Magny-Normilus et al., 2019)
Future Needs
Further research is needed to determine which specific cultural interventions not only lead to greater patient satisfaction(Govere & Govere, 2016, para. Implications), but also to better health outcomes(Mason & James-Burga, 2019) especially for cardiovascular, diabetic, and maternal evidence-based practices
Collaboration between Public Health, Non-government agencies, and social services needs to be streamlined, and a mentor assigned to assist with bridging the health literacy gap(Mason & James-Burga, 2019) and to navigate health systems(Tan et al., 2021).
Healthcare leadership must focus on hiring, maintaining, and mentoring a diverse workforce, as culturally congruent care improves patient satisfaction and medical plan adherence (Brunett & Shingles, 2018).
Conclusion
Through self-reflection, cultural education, experiences, skills training and desire to engage, healthcare professions can become culturally competent. As providers of nursing care, we cannot abandon the individual by focusing solely on the cultural label. Make time, every time, for the client themselves. Put the client first and “address social amenities before the information gathering”(Graham, n.d.).
“Fòk ou bat tanbou a pou tande son l” – You have to beat the drums to hear it’s sound. This saying means that you need to talk to a person to understand who they truly are.
- Haitian Creole Quote (lingalot.com)
References
Allen, J. D., Mars, D. R., Tom, L., Apollon, G., Hilaire, D., Iralien, G., Cloutier, L. B., Sheets, M. M., & Zamor, R. (2013). Health beliefs, attitudes and service utilization among Haitians. Journal of health care for the poor and underserved, 24(1), 106–119. https://doi.org/10.1353/hpu.2013.0015
Brunett, M., & Shingles, R. (2018). Does having a culturally competent health care provider affect the patients’ experience or satisfaction? a critically appraised topic. Journal of Sport Rehabilitation, 27(3), 284–288. Retrieved November 23, 2023, from https://doi.org/10.1123/jsr.2016-0123
DeSai, C., Janowiak, K., Secheli, B., Phelps, E., McDonald, S., Reed, G., & Blomkalns, A. (2021). Empowering patients: Simplifying discharge instructions. BMJ Open Quality, 10(3), e001419. Retrieved November 24, 2023, from https://doi.org/10.1136/bmjoq-2021-001419
Govere, L., & Govere, E. M. (2016). How effective is cultural competence training of healthcare providers on improving patient satisfaction of minority groups? a systematic review of literature. Worldviews on Evidence-Based Nursing, 13(6), 402–410. Retrieved November 23, 2023, from https://doi.org/10.1111/wvn.12176
Graham, B. E., DNP, MSN-Ed., RN. (n.d.). NUR4047 culture and diversity - Week one [PowerPoint].
Magny-Normilus, C., Mawn, B., & Dalton, J. (2019). Self-management of type 2 diabetes in adult haitian immigrants: A qualitative study. Journal of Transcultural Nursing, 31(1), 51–58. Retrieved November 23, 2023, from https://doi.org/10.1177/1043659619841586
Mason, P., & James-Burga, J. (2019). Framework for collaborative teaching: Strengths and challenges for a different service paradigm in haiti. Journal of Global Education and Research, 3(1), 1–9. Retrieved November 23, 2023, from https://doi.org/10.5038/2577-509x.3.1.1034
Pardo, C., Brutus, N., Labatte, D., Saint-Jean, F., Tribié, S., Joseph, I., Clare, C. A., Su, J., & Sánchez, J. (2021). An introduction to structural competency for haitian-identified patients: History, culture, and access to care. MedEdPORTAL. Retrieved November 24, 2023, from https://doi.org/10.15766/mep_2374-8265.11207
Tan, S., Low, P., Howard, N., & Yi, H. (2021). Social capital in the prevention and management of non-communicable diseases among migrants and refugees: A systematic review and meta-ethnography. BMJ Global Health, 6(12), e006828. Retrieved November 23, 2023, from https://doi.org/10.1136/bmjgh-2021-006828
Themes, U. (2019, December 29). Haitian americans. Nurse Key. Retrieved November 22, 2023, from https://nursekey.com/haitian-americans/
Transcultural C.A.R.E Associates. (n.d.). The process of cultural competence in the delivery of healthcare services - transcultural c.a.r.e associates. Retrieved November 10, 2023, from https://transculturalcare.net/the-process-of-cultural-competence-in-the-delivery-of-healthcare-services/
Southeastern National Tuberculosis Center’s Haiti - University of Florida. (n.d.). https://sntc.medicine.ufl.edu/Content/Products/Downloads/04%20Haiti%202021_102021.pdf
Wikipedia (2023). Haitian Americans. https://en.wikipedia.org/wiki/Haitian_Americans
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