NCM 119 - TRANSCULTURAL NURSING

PUERTO RICAN - AMERICAN

CULTURE: A BRIEF DISCUSSION
OVERVIEW
Puerto Ricans and Migration
Puerto Rico has been occupied by the USA for more than a
century.
Since 1917 Puerto Ricans have been considered as a US Citizen.
In mainland United States, Puerto Ricans make up the second
largest Hispanic subgroup in the United States and represent
9.7% of the country’s Hispanic population
Among the Puerto Rican population in the United States, 25.7%
live in poverty, compared with 14.3% of the total population
Puerto Ricans in the main land United States encounter
prejudice not experienced on an island where racial diversity is
the norm.
Location
 Spanish and english are designated
as the official language of Puerto
Rico.
Sensitive people, quick to express
feelings of love and affection
Expresses gratitude by giving
Puerto Rican - gifts
Tone is very important, its
Americans on melodic and peaceable
Communication: Used to shaking hands,
when greeting.
Close friends may kiss each
other in greeting
Self - respect is communicated in
the way one dresses.
Use titles to show respect
 NURSING IMPLICATIONS:
When getting an interpreter, consider the topic, gender of interpreter.
Assure the patient regarding the confidentiality of topics being
discussed.
Essential to understand the nonverbal communication and symbolism
they convey with hand gestures and facial expressions.
Give adequate privacy to patient especially when they would be using
bedside commode.
Puerto-Rican Americans also highly value saving face.
PUERTO RICAN- AMERICAN'S
ORIENTATION TO TIME
Puerto Rican -Americans on TIME:
relaxed and more social than clock
oriented
more focused on PRESENT social interaction
and time.
the social interaction occurring at the
moment is considered more important than
scheduled appointments.
 NURSING IMPLICATIONS:
social orientation to time often sometimes serves
as a barrier to punctuality with scheduled health
care appointments
important for the nurse to emphasize to the
patient that the office schedule is often not
flexible and arriving late may mean that the
appointment will have to be rescheduled.
 Puerto Rican -Americans on
SPACE:
Puerto Ricans are used to standing close together when talking.
A Puerto Rican may feel insulted if the other person whether in a social or
personal interaction moves away even slightly during the coversation. (Culture-
Grams, 2002).
Personal space can also be a significant issue for some Puerto Rican women, who
are conscious of maintaining a reasonable distance with persons of the opposite
sex.
Younger Puerto Ricans may relate distance to being stereotyped as nonassertive.

NURSING IMPLICATIONS
Since special needs and interpretations vary, it is
important to assess each individual in relation to
special needs.

Spatial needs will vary with sex, age, and position.

PUERTO RICAN- AMERICAN'S
SOCIAL ORGANIZATION
The family, including both nuclear and extended
members, is highly valued in the Puerto Rican
culture.
Older Puerto Ricans are often rejecting of non-
heterosexual preferences, and subsequently gay
and lesbian choices may not be revealed to older
family members.
Puerto Ricans tend to rely on older
adults and elder family when
decisions.
Family members generally prefer to
provide support for individuals needing
care in the home themselves rather
than involving home care or
homemaking services.
Mothers assume the greater role in physical care of children, and a
father’s role is for financial needs.

Although most Puerto Ricans and Puerto Rican Americans are Christians,
many also practice espiritismo, or spiritualism, a blend of Indian, African,
and Catholic beliefs. The belief that good and evil spirits are present
and can be encouraged or warded off with the proper herbs and rituals
is often still present among Puerto Ricans who live in the United States.
 NURSING IMPLICATIONS:
The nurse should be aware that Puerto Ricans have a strong need for family
support and that decision making usually occurs in a family context.
The nurse should also be aware that Puerto Ricans in the United States are also
likely to be strongly loyal to their country and to feel a strong sense of
nationalism. Rather than calling themselves “Americanos,” many Puerto Ricans
prefer to call themselves “Puertorriquenos” or “Boricuas.”
Assessment of mother–child interactions must be understood in terms of cultural
beliefs about parenting and child development.
Male partners must be included in a comprehensive approach to contraceptive
counseling and preparation for parenting.
 PUERTO RICAN- AMERICANS
on ENVIRONMENTAL CONTROL
Illness may be attributed to heredity, sin, lack of personal attention to
health, an evil spirit, or a disharmony of environmental forces within the
individual

Most Puerto Ricans feel that destiny, a Deity, spirits, or spiritual forces
control events that occur, health, and death (Juarbe, 2005).

A person under the control of an evil spirit or forces will seek a

spiritualist to perform an intervention.

Puerto Ricans have traditionally placed great faith in the power of the
santero to listen and to perform an appropriate treatment that makes
the person feel “special” and thus restores damaged self-esteem.
Santeria can be practiced in any location, for example, the individual’s
home, a storefront, or a college dormitory,
Wearing amulets is a traditional healing practice that
some Puerto Ricans still practice. A small black fist
(azabache) or small black rabbit foot may be tied on a
child to protect him or her from evil. Removal of the
object may be thought to produce illness, misfortune, or
even death, so it should not automatically be done by the
nurse in the process of giving care.

The nurse should also ask permission before removing

rosary beads from a patient’s neck. The family or patient
may agree to allow the rosary beads to be moved to the
patient’s hand if they interfere with care. The family or
patient may also desire to have other items of religious
significance near the patient, including candles, pictures or
statues of saints, or holy water. The family may want to
use aromatic oils and lotions to rub the body as a way to
ward off evil spirits.
 Puerto Ricans have further classified remedies (food and
medications) as hot (caliente), cold (frio), and cool (fresco).
Hot disease is with a cold or cool remedy, whereas treatment of a
cold disease is with a hot remedy.

HOT DISEASES:
Constipation- treated with cool medicine such as Milk of Magnesia.
Diarrhea- treated with bicarbonate, a cool medicine.
These conditions are not treated with ampicillin as it is considered
as hot remedy.

COOL DISEASES
Ear disorders or aches- treated with olive oil, a hot remedy

hot and cold food and medications should not be combined

Rituals related to Death and Dying
In some Hispanic families, there is a code of silence in which the dying individual
is not informed of the impending death.
If a family member is dying, the family may want to keep constant vigil in a
waiting area.
Puerto Ricans usually support organ donation since this is a way to help others
Autopsies are generally viewed as a violation of the body.
Since a large proportion of Puerto Ricans are Catholic, death rituals are
described as heavily influenced by Catholic beliefs, wherein spirituality is
important and there is a continuing relationship between the living and the
deceased through prayer and visits to the gravesite
 NURSING IMPLICATIONS:
The crucial role of family must be recognized by the nurse since strong family
ties and high levels of instrumental and affective support are characteristic in
Hispanic sub-groups.
It is important, when responding to the concerns of Puerto Rican patients and
their families, to explore what types of treatment interventions have already
been attempted to relieve symptoms.
In many cases, because of belief about the causes of illness, it is essential to
combine both home remedies and other beliefs with use of Western medicine to
obtain an optimal outcome.
 NURSING IMPLICATIONS:
When providing health teaching about health promotion activities, it is important
to explain how the relationship works between health prevention activities and
future health.
The nurse should be aware that being underweight and thin tends to be
associated with ill health, whereas being overweight is associated with health.
The nurse should be sensitive to which family members in the family structure
should provide authorization.
On matters of end-of-life decision making, the nurse must be aware that
collectivist rather that individualist decision making is supported
by the values of familismo and espiritismo.
BIOLOGICAL VARIATIONS
Body size and Structure Genetic Deviations

Susceptibility to diseases
Major Causes of Death
Heart and Cardiovascular Diseases
Malignant Neoplasm
Diabetes
Cerebrovascular Diseases
Alzheimer's Disease
Accidents
Chronic lower Respiratory Diseases

Pneumonia and Influenza

PUERTO RICANS HAVE HIGH SUSCEPTIBILITY TO:

Asthma

Visual Impairments

Obesity

Diabetes

Cancer

 IMPLICATIONS FOR
NURSING CARE
Quality of Life for people who are less fortunate are
reportedly decreased while at the same time, it increases
the risk for both Physical and Mental illnesses
 Puerto Rican
White Black
American American
 Puerto Rican

White Black
American American
Thank you!