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

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

Copyright © 2013 F.A. Davis Company

Cuban American Culture

Larry Purnell, PhD, RN, FAAN

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

Cuban American Overview/Heritage

• The Republic of Cuba is a multiracial society with people of primarily Spanish and African origins.
• Other ethnocultural groups include Chinese, Haitians, and Eastern Europeans.
• Spain, the United States, and the Soviet Union significantly influence Cuba’s history and culture.

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

Cuban American Overview/Heritage

• Mistrust of government has reinforced a strong personalistic tradition and sense of national identity evolving from family and interpersonal relationships.

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

Cuban American Overview/Heritage

• Desire for personal freedom, hope of refuge, political exile, and promise of economic opportunities prompted migration.
• Cubans in the United States take great pride in their heritage and tend to be conservative, Republican, and anticommunist.

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

Cuban American Overview/Heritage

• Many possess a strong ethnic identity, speak Spanish, and adhere to traditional Cuban values and practices..
• The highest concentration of Cubans is in Florida, although significant numbers live in New Jersey, New York, Illinois, and California.

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

Copyright © 2013 F.A. Davis Company

Cuban American Communication

• Many Cubans live and transact business in Spanish-speaking enclaves.
• While the second generation speaks Spanish, many converse with friends or peers in “Spanglish,” a mixture of Spanish and English.
• The highly educated are more likely to speak English at home.

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

Copyright © 2013 F.A. Davis Company

Cuban American Communication

• Many value simpatía and personalismo in their interactions with others.
• Simpatía, the need for smooth interpersonal relationships, is characterized by courtesy, respect, and the absence of criticism or confrontation.
• Personalismo, the importance of intimate interpersonal relationships, is valued over impersonal bureaucratic relationships.

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

Copyright © 2013 F.A. Davis Company

Cuban American Communication

• Choteo, a lighthearted attitude with teasing, bantering, and exaggerating is often observed in their communications with others.
• Conversations are characterized by animated facial expressions, direct eye contact, hand gestures, and gesticulations.
• Voices tend to be loud, and the rate of speech is fast.

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

Copyright © 2013 F.A. Davis Company

Cuban American Communication

• Touching, handshakes, and hugs are acceptable among family, friends, and acquaintances and may be used to express gratitude to the caregiver.
• Touch is common between people of the same gender; older men and women rarely touch in public.

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

Copyright © 2013 F.A. Davis Company

Cuban American Communication

• Most tend to emphasize current issues and problems rather than future ones.
• Hora cubana (Cuban time) refers to a flexible period that stretches 1 to 2 hours beyond designated clock time.
• Most Cubans use two surnames representing the mother and father’s family names.
• Married women may also add the husband’s name.

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

Cuban American Family Roles and Organization

• Traditional family structure is patriarchal, characterized by a dominant and assertive male and a passive, dependent female.
• Traditionally, Cuban wives stay at home, manage the household, and care for children, whereas husbands are expected to work, provide financially, and make major decisions for the family.

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

Cuban American Family Roles and Organization

• Honor is attained by fulfilling family obligations and treating others with respeto (respect).
• Vergüenza, a consciousness of public opinion and the judgment of the entire community, is considered more important for women than for men.
• Machismo dictates that men display physical strength, bravery, and virility and be the spokesperson, even though they might not make the decisions.

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

Cuban American Family Roles and Organization

• La familia (the family, nuclear and extended, including godparents) is the most important source of emotional and physical support.
• Multigenerational (3 to 4 generations) households are common, including a high proportion of people 65 years and older who live with their relatives.

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

Cuban American Family Roles and Organization

• According to U.S. standards, Cuban parents tend to pamper and overprotect their children.
• Children are expected to study, respect their parents, and follow el buen camino (the straight and narrow).
• Boys are expected to learn a trade or prepare for work and to stay away from vices.
• Girls are expected “to remain honorable while single,” to prepare for marriage, to avoid the opposite sex, and not to go out without a chaperone.

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

Cuban American Family Roles and Organization

• When a daughter reaches 15 years, a quinceaneras, or elaborate 15th birthday party, is typically held to celebrate this rite of passage for the daughter.
• Adolescents may undergo an identity crisis and reject their heritage causing parents to feel their authority is being challenged.

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

Cuban American Family Roles and Organization

• Little information is available on homosexuality.
• Same-sex behaviors among men may be regarded as a sign of virility and power rather than homosexual behavior.
• The gay lifestyle is contradictory to the machismo orientation of this culture. Same-sex couples may be alienated from their families.

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

ClickerCheck

A 22-year-old from Cuba comes to the prenatal clinic for the first time. She introduces herself as Elena Florencia Gonzalez Portillo. The receptionist should ask what

Is your husband’s surname?

Is your husband’s last name?

Name do you wish to be called?

What is your legal name?

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

Correct Answer

Correct answer: D

The legal name is what should be used for record-keeping.

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

Cuban American Workforce Issues

• Cuban ethnic enclaves with a familiar language and culture have created numerous employment opportunities for recent Cuban immigrants.
• A source of tension is the tendency of Cubans to speak Spanish with other Cuban or Hispanic coworkers. Speaking the same language allows them to form a common bond, relieve anxieties at work, and feel comfortable with one another.

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

Cuban American Workforce Issues

• Traditional Cubans recognize supervisors as authority figures and treat them with respect and deference.
• Cubans value a structure characterized by personalismo, one that is oriented around people rather than around concepts or ideas.
• Personal relationships at work are considered an extension of family relationships.
• Because of the emphasis on the job or task in the American workplace, many Cubans view this workplace as being too individualistic, businesslike, and detached.

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

Cuban American Biocultural Ecology

• Most Cubans are white, and only 5 percent are black with physical features similar to those of African Americans.
• Cuban Americans tend to have lower incidences of diabetes mellitus, obesity, and hypertension than other Hispanic groups or whites.
• Because of their diet, which is high in sugar, many exhibit a high prevalence of tooth loss, filled teeth, gingival inflammations, and periodontitis.

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

Cuban American Biocultural Ecology

• • Commonly occurring health conditions of Cubans are hypertension, coronary artery disease, obesity, diabetes mellitus, and lung cancer.
  • Specific information related to drug metabolism is limited; however, in general, many require lower doses of antidepressants and experience greater side effects than non-Hispanic white populations.

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

Cuban American High-risk Health Behaviors

• Cuban Americans tend to exhibit a higher incidence of smoking than other Hispanic or European groups.
• Alcohol use is greater among males than females and among younger versus older groups.
• Violent deaths account for high mortality rates among adolescents and young adults.
• Suicide rates also exceed those of the white non-Hispanic population.

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

ClickerCheck

• The nurse is using an interpreter to interview the parents of a 6-year-old Cuban, Leonardo, who has stomach pain. The nurse should direct questions to
• A. The father.
• B. The mother.
• C. The interpreter.
• D. Both parents.

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

Correct Answer

Correct answer: D

The nurse should address the questions to both parents to demonstrate respect to both of them.

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

Cuban American Nutrition

• Food allows families to reaffirm kinship ties, promotes a sense of community, and perpetuates customs and heritage.
• Staple foods include root crops like yams, yuca, malanga, and boniato; plantains; and grains.
• Many dishes are prepared with olive oil, garlic, tomato sauce, vinegar, wine, lime juice (sofrito), and spices.

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

Cuban American Nutrition

• Meat is usually marinated in lemon, lime, sour orange, or grapefruit juice before cooking.
• A leisurely noon meal (almuerzo) and a late evening dinner (comida), sometimes as late as 10 or 11 PM, are often customary.
• Being overweight is seen as positive, healthy, and sexually attractive.
• Food allows families to reaffirm kinship ties, promotes a sense of community, and perpetuates customs and heritage.

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

Cuban American Pregnancy and Childbearing Practices

• Cuban women’s fertility rate is lower than that of other Hispanic American women. Cuba’s current reproductive rate is among the lowest in the developing world.
• Even before the revolution, Cuba had the lowest birthrate in Latin America.
• The low fertility rate has been attributed to many women in the workforce.

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

Cuban American Pregnancy and Childbearing Practices

• Preterm births and neonatal and post-neonatal deaths are lower among Cuban American women than among other Hispanic American groups.
• Prenatal care is higher than among other Hispanic and white non-Hispanics.
• Mothers tend to use advice about child health given by their spouses, mothers, mothers-in-law, and clerks and pharmacists.

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

Cuban American Pregnancy and Childbearing Practices

• Childbirth is a time for celebration with family members and friends congregating in the hospital.
• Traditionally, men have not attended the births of their children, but younger, more acculturated, fathers are frequently present.

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

Cuban American Pregnancy and Childbearing Practices

• During the postpartum period, ambulation, exposure to cold, and bare feet place the mother at risk for infection.
• Family members and relatives often care for the mother and baby for about 4 weeks postpartum.
• Most women consider breast-feeding better than bottle feeding; approximately half choose to breast-feed.

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

Cuban American Pregnancy and Childbearing Practices

• Cutting the infant’s hair or nails in the first 3 months is believed to cause blindness and deafness.

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

Cuban American Death Rituals

• In death, as in life, the support of the extended family network is paramount.
• Bereavement is expressed openly as loud crying with other physical manifestations of grief.
• Death is often seen as a part of life and some, especially men, may approach death stoically.

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

Cuban American Death Rituals

• The dying person is typically attended by a large gathering of relatives and friends.
• In Catholic families, individual and group prayers are held for the dying to provide a peaceful passage to the hereafter.
• Religious artifacts such as rosary beads, crucifixes, or estampitas (little statues of saints) are placed in the dying person’s room.

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

Cuban American Death Rituals

• For adherents of Santería, death rites may include animal sacrifice, chants, and ceremonial gestures.
• Candles are lighted after death to illuminate the path of the spirit to the afterlife.
• A velorio (wake) lasts 2 to 3 days and is usually held at a funeral parlor or in the home where friends and relatives gather to support the bereaved family.

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

Cuban American Death Rituals

• Burial in a cemetery is common practice, although some may choose cremation.
• The deceased are customarily remembered and honored on their birthdays or death anniversaries by lighting candles, offering prayers or masses, bringing flowers to the grave, or gathering with family members at the grave site.

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

Cuban American Spirituality

• Approximately 85 percent of Cuban Americans are Roman Catholic; the remaining 15 percent are Protestants, Jews, and believers in African Cuban Santería.
• Roman Catholicism is personalistic and characterized by devotion and intimate, confiding relationships with the Virgin Mary, Jesus, and the saints.

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

Cuban American Spirituality

• Significant religious holidays include Noche Buena (Christmas Eve), Christmas, Los Tres Reyes Magos (Three Kings Day), and the festivals of the La Caridad del Cobre and Santa Barbara.
• Santería is a 300-year-old African Cuban religious system that combines Roman Catholic elements with ancient Yoruba tribal beliefs.

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

Cuban American Spirituality

• Followers of Santería believe in the magical and medicinal properties of flowers, herbs, weeds, twigs, and leaves.
• Sweet herbs such as manzanilla, verbena, and mejorana are used for attracting good luck, love, money, and prosperity.
• Bitter herbs such as apasote, zarzaparilla, and yerba bruja are used to banish evil and negative energies. Santería is viewed as a link to the past and is used to cope with physical and emotional problems.

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

Cuban American Spirituality

• Physical complaints may be diagnosed and treated by a physician, whereas the santero may assist in balancing and neutralizing the various aspects of the illness.
• Deeply held religious beliefs provide guidance and strength during the long and difficult process of migration and adaptation and continue to play an important role in their day-to-day lives.

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

Cuban American Spirituality

• Belief in a higher power is evident in practices used to maintain health and well-being or cure illness, such as using magical herbs, special prayers or chants, ritual cleansing, and sacrificial offerings.
• Many tend to be fatalistic, believing that they lack control over circumstances influencing their lives.

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

Cuban American Health-care Practices

• African Cubans may seek biomedical care for organic diseases but consult a santero for spiritual or emotional crises.
• Conditions such as decensos (fainting spells) or barrenillos (obsessions) may be treated solely by a santero or simultaneously with a physician.
• Many tend to seek help only in response to crisis situations.

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

Cuban American Health-care Practices

• Many Cuban Americans rely on the family as the primary source of health advice.
• Older women provide traditional home remedies such as herbal teas or mixtures to relieve mild or moderate symptoms or cure common ailments.
• Older Cuban Americans were socialized into a strong health ideology and successful primary care system while still in Cuba.

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

Cuban American Health-care Practices

• Use of preventive services in the US is generally determined more by access to care than by acculturation.
• Many Cuban Americans use traditional medicinal plants in the form of teas, potions, salves, or poultices. In Cuban communities, stores called botanicas sell herbs, ointments, oils, powders, incenses, and religious figurines to relieve maladies, bring luck, drive away evil spirits, or break curses.
• Santería necklaces and animals used for ritual sacrifice are often available at botanicas.

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

Cuban American Health-care Practices

• Blood transfusions and organ donations are usually acceptable.

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

Cuban American Health-care
Practitioners

• Both traditional and biomedical care are acceptable.
• Folk remedies may be used at home, but if the condition persists, folk practitioners such as santeros and biomedical practitioners may be used either simultaneously or successively.
• Santeros may prescribe treatment or perform rituals to enable ill people to recover by invoking supernatural deities to intervene to help make them well.

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