CRNA Perspectives
  • You Speak Spanish? A Spanish-Speaking CRNA's Viewpoint

    By Jorge A. Valdes, DNP, CRNA

     

    It’s 8:00 a.m. Monday morning and your first patient is a 40-year-old Spanish-speaking only patient with a history of irritable bowel syndrome, who is in for a bowel resection. As you approach the patient, you overhear him explaining to the circulating nurse that he cannot remove his bracelet because it was made especially for him. The patient tells you he takes Cosimiento de anis (anis herbal mixture) daily to relieve stomach aches and nothing else. He neglects to tell you he is also taking antihypertensive medication. As far as any family history after anesthesia, the patient comments how his mother passed away two weeks after anesthesia from un aire (an air).

    As a Cuban-American CRNA, I can safely make the assumption that your Spanish-speaking patient is more than likely of Cuban descent. The bracelet is a consecrated object given to him by a shaman or padrino. The Cosimiento de anis is an herbal mixture used for stomach aches made from an aniseed plant usually made into a tea sometimes combined with sugar which can be consumed hot or cold. The reason he omitted the hypertension when discussing his medical history is because, as far as he is concerned, he no longer suffers from hypertension since he is now taking medicine for it. As for his family history, the patient’s mother died from a respiratory ailment. As a healthcare provider your understanding of his culture can greatly influence his surgical outcome and his family’s perception of healthcare.

    Spanish-speaking patients can come from more than 20 different countries. Spanish is the fourth most-spoken language in the world with an estimated 442 million speakers.1 Cultural, ethnic, and regional differences vary greatly from country to country. A common misconception in the United States equates Spanish speaking with being of Mexican descent. In fact, Spanish is spoken in European, African, Caribbean, and South and Central American countries. Coincidently, the United States is home to the world’s second largest Spanish-speaking population, second only to Mexico.1

    Cultural sensitivity and humility require people to possess a willingness to learn and seek out information. Sometimes terms we think we understand are actually not what they seem. For example, not all Hispanics are Latinos. The term Latino as used in the United States, refers to people of Latin American descent and the term Hispanic refers to people from Spanish-speaking countries. Therefore, Spaniards are not Latino, but Brazilians are. However, the term Latino is actually a broader term than the United States definition. The term Latino comes from any language derived from the romance language that evolved from Latin such as Portuguese, French, and Italian.2 People in Portugal consider themselves Latino and do not speak Spanish. Even the term Latino itself no longer deemed appropriate by many as it implies masculine dominance; hence, Latinx is used as a gender-neutral alternative.2

    Why is this important? As healthcare providers, we play a significant role in reducing health disparities and inequities. When we deliver care from a culturally sensitive standpoint, we can improve health outcomes in underrepresented and underserved populations.

    Recognizing that all Spanish-speaking patients are different, with different religious, cultural, and ethnic backgrounds is important. Each Hispanic or Latino country has a completely different view on healthcare and the role healthcare providers should and should not play.

    One of the recommendations from the 2002 Institute of Medicine report on ways the United States can reduce racial dipartites is to increase the number of minority healthcare providers, because minority healthcare professionals are more likely to practice in medically underserved communities.3 Minority patients are also more likely to seek care from providers who are themselves part of a minority.

    With the current lack of diversity among the nurse anesthesia profession, all providers regardless of race, religion, or sexual orientation, should be open to learning about other cultures in an attempt to better relate to others. Patients who communicate in their native language are more likely to give more detailed medical histories and thus have fewer adverse effects.4

    Tools to increase our knowledge do exist. I was recently asked to write a chapter in a textbook titled, Transcultural HealthCare: A Population Approach.5 My contribution to this textbook resulted in a chapter that focused on the Cuban community and how they view healthcare and equally important, health as a whole. This textbook and others like it serve as resources for healthcare providers when caring for people from different cultural backgrounds.

    Educating ourselves as to other cultures, and people who are different from ourselves and the communities in which we live and practice is paramount if we are to provide our patients with the best possible care and outcomes.


    Sources
    1. https://worldpopulationreview.com/country-rankings/sapnish-speaking-counties Accessed August 22, 2021
    2. https://time.com/5191804/latinx-definition-meaning-latino-hispanic-gender-neutral/ Accessed August 22, 2021
    3. Institute of Medicine. Unequal Treatment: Understanding Racial and Ethnic Disparities in Healthcare. https://www.nap.edu/catalog/10260/unequal-treatment-confronting-racial-and-ethnic-disparities-in-health-care 1999. Accessed August 22, 2019
    4. Valdes, JA Chapter 10: The Role of the DNP in Reducing Health Disparities and Advocating from the viewpoint of a CRNA: Benson, L (2021) The DNP Professional: Translating Value from Classroom to Practice. First, New Jersey: SLACK Inc; 2021:22
    5. Valdes, JA, & Delgado, V. Chapter 12: People of Cuban Heritage Chapter Purnell, L.D. & Fenkl, E.A. (Eds.) (2020). Textbook for Transcultural Health Care: A Population Approach. , Springer: Cham, Switzerland. ISBN 978-3-030-51399-3.