The increase in disquiet for cultural competence forms a part of integral changes within the health care system of America over the past ten years. Health and medicine have shifted from the traditional Equanimeous methods of scientific shrewdness to those that enhance a simple integration of medical science with empathy (Purnell, 2012) . The shift in occurrence has been mainly due to the rising wave of population diversity in the U.S especially through immigration. Support for culturally proficient systems is fuelled by the concern of harm to patient safety and quality outcomes. The disparities of patient outcomes across economic, social and ethnic groups offer a persuasive case to guarantee that health care pays attention to these gaps (Purnell, 2012) . Hence, this article focuses on Mexican and Puerto Rican heritage and on how these two cultures structure the social world and theatrical effect these cultures have on how community, medicine, family and health care interact.
Mexican case study II
Socioeconomic elements affecting Gaborra’s family health
Education, Income and social status, and physical environment
Health teaching strategies a practitioner can use to advise Olga to pursue treatment
Include family members, stimulate a patient’s interest, and listen to Olga's individual concerns.
Delegate your assignment to our experts and they will do the rest.
Interventions to help Gabborra family to communicate in English
Gaborra ought to encourage Olga and his children to attend the free English lessons provided by the community.
The family of Gaborra should shift from the policy of exclusively speaking Spanish at home and allow communication in English too, therefore increases the desire for the family members to learn English.
Since Pablo is better at speaking and writing English, the family can adopt homeschooling, whereby Pablo can teach the family members English at home if going for community classes is a challenge.
Health Teaching objectives for the family of Gaborra
To promote decision making on matters health.
To work within the framework of the hot-and-cold theory of disease management and prevention in prescribing medicines and diet.
To minimize the occurrence of life-threatening illnesses (Shen, 2015) .
What Olga must learn concerning infant fluid balance
Rehydration for children should be done using oral rehydration fluids, having replacement electrolytes.
She should be able to identify signs of dehydration.
IV replacement should be used when the child cannot be administered the fluids orally (Papadopoulos et al. 2016) .
Health prevention teaching interventions that are in line with Gabbora’s standpoint on the hot and cold theory of disease treatment
The practitioner must question a Mexican American if he or she is using folk medicine. Hence, to offer culturally proficient, the health professional must know the cold-and-hot theory of illness when recommending treatment regimens (Brody, 2015) .
As a practitioner, it’s crucial to comprehend that a person of Mexican origin believes in the theory of hot-and-cold; it implies that a person doesn't believe or use western medicine. Hence, a degree of trust needs to be established for a patient to reveal this to the medical professional (Brody, 2015) .
Tactics for acquiring health records for the family of Gaborra
To collect data, the family is the most trusted informant of health details and the greatest hurdle to successful health-seeking behaviour (Purnell, 2012) . By building trust with the Gaborra family, a practitioner can ask the members of the family questions about health to obtain each family member's medical history.
Significant health challenges Mexican Americans face that impact Gaborra family
Gaborra family are working poor and cannot afford insurance.
Gaborra family are immigrants and are not qualified for Medicaid.
Fear of applying for health insurance due to their undocumented status.
Though insurance is present in the native homeland of Mexican Americans, it is usually expensive, and it’s not an element of their culture (Purnell, 2012) .
If Olga was to look for a folk practitioner
She would consult folk practitioners dealing with hot diseases and conditions which are managed using cold foods such as fresh fruits and vegetables, barley water, fish, chicken, and dried fruits (Purnell, 2012) .
Notion of familyism as portrayed in the Gaborra family
The idea of the family presented is Machismo, where females assume the duties within the home and sustaining the health of the family while the man is a symbol of strength and valour (Purnell, 2012) .
Distinguish between susto and El Ataque
Susto is the magical fright or loss of souls and linked to tuberculosis, epilepsy, and other illnesses that result from the escape of spirit from the body (Purnell, 2012) . While El ataque is simply an attack on either the nervous system or the blood vessels.
Culturally informed healthcare advice that are coherent with health belief activities of an expectant American woman.
Expectant females should consume hot foods to maintain the foetus warm, and for the baby to be given birth in a warm and loving milieu (Purnell, 2012) .
Pregnant women should not walk under moonlight or during a lunar eclipse to prevent the foetus from developing deformities. Also, to wear metal key, safety pins on their belly to prevent such deformities (Purnell, 2012) .
Pregnant women to nap on their back not to harm the baby, and continuously have sex to enable easier birth, warrant a small baby, and reduce amniotic fluid quantity (Purnell, 2012) .
Strategies to motivate Mexican American patients having TB
Practitioners should adopt the notion of personalismo , and respect in their methods to provide care for Mexican American TB clients. Hence, the clients will gain confidence in the practitioner and come back for more assessments.
For TB patients who follow the idea of cold and hot treatment interventions, the practitioner should prescribe medication strategies that suit such patients for them to adhere to the prescribed medication regime (Purnell, 2012) .
Places of residence in the U.S for most of Mexican Americans
A large number of Mexican Americans live in California, Arizona, Texas, Illinois, Florida, Colorado, and New Mexico.
Puerto Rican Case Study II
The attitude of Mrs. Medina’s
She has a contemplative attitude as she finds it challenging to deal with her Rosa's development and behavioural problems
Interventions that will guarantee that Rosa pursues prenatal care
Rosa, since she is close to the grandmother, she can disclose the information to her. Grandmothers are mandated with supporting the family. Hence, this will prevent Rosa from escaping home, thereby being able to undergo prenatal care from home.
Barriers to accessing medical care and high-risk behaviours
Barriers include insufficient financial resources, inadequate knowledge of existing medical services, language difficulties, and failure to adopt preventive care with more preference for emergency care.
High-risk behaviours include smoking of cigarette and consumption of alcohol (Purnell, 2012).
Communication barriers preventing delivery of care
The parents of Mrs. Medina are not conversant with english hence providing care for them is a challenge because it requires somebody who understand their language. Rosa has spent much of her time with her grandparents and rarely talked to her parents. Rosa was, therefore, unable to disclose her pregnancy to her parents for advice. Mr. Medina rarely gets into conversations regarding his kids; therefore, he knows little about his kid’s undertakings.
Gender and family roles
Grandparents take up the active duty to take of children, babysitting, supporting the family, disciplining, and enacting educational practices (Purnell, 2012) .
Women are the primary care providers and enhancers of family health and the origin of physical and spiritual strength while men are in charge of the financial aspects of the family (Purnell, 2012).
Sociodemographic elements
Income: the family earns only $28500 annually; hence, can only manage to stay in a low-income society.
Education: Rosa and Miguel are struggling with education, and Rosa even wants to quit school.
Age: The parents of Mrs. Medina are elderly and sickling forcing her to quit her job. Rosa also gets pregnant at sixteen, disrupting her mental state, making her contemplate escaping from home (Shen, 2015).
Puerto Rican folk habits for Medina family
Medina family are skeptical of scientific medical care and rely on the cultural phenomena of spiritualism, which plays a major part in retarding their health. For instance, Mrs. Medina is a Catholic and frequently attends church to air the concerns of the family (Purnell, 2012) .
Medina family also believe in the hot-and-cold theory of disease management and deterrence.
Which folk healer will they visit and why
Santeros : Because the healer is consulted on matters diseases as a result of illnesses brought by evil spirits, inclusion of an evil spirit, or God’s anger. Mrs. Medina is worried by his children's behaviour, her ailing parents, husband, and herself and financial constraints and frequently visits the church may be because of the though the family angered God (Purnell, 2012) .
Espiritismo : is used to handle the force of evil and good spirit in the physical and emotional development of a person (Purnell, 2012) . Mrs. Medina can go to the healer to find out what got into Rosa and Miguel.
Mrs. Medina's parents expectation when they visit a healthcare professional
The parents of Mrs. Medina may expect the health professional to discuss individual details when starting a professional association. The practitioner is to establish demarcations with prudence personalismo , stressing on individual instead of bureaucratic and impersonal relationships.
Congruent interventions for Mr. Medina
The health practitioner should advise Mr. Medina to carry the fork remedies and over-the-counter medications to all visits. The health provider should also involve Mr. Medina's family members in the treatment program since in Puerto Rico concept of family care is dominant.
Significance of respe ct and familism in the family of Medina
Adolescents are trained right from childhood to respect adults, particularly older people. However, this does not apply to the Medina family as Rosa, and Miguel is openly rebellious to their parents. Immense significance is bestowed to the notion of familism , and any conduct that deviates from this ideal is prohibited and may be remarked as a shame to the family (Purnell, 2012) . Rosa getting pregnant at 16 brings disgrace to the family. The value of unity in the family also lacks, with Mr. Medina abandoning matters of discipline to Mrs. Medina. Lack of unity also makes it difficult for Rosa to disclose her pregnant status with fear of the consequences.
Culturally relevant intervention for Rosa’s pregnancy
Rosa ascribes to the hot-and-cold grouping foods for dietary activities and balanced nutrition during her pregnancy, postpartum duration, and lactation. Hence, a health professional should be acquainted with these foods when organizing culturally compatible dietary options (Purnell, 2012) . Hence, she should be given hot foods to keep the baby warm and be born in a loving environment.
Jose’s health enhancement and disease deterence
Jose should have enough rest to allow the body to fight the infection and heal quickly. Jose's father Mr. Medina experiences respiratory diseases too and therefore, should avoid contact with Jose. However, upon contact, Jose's hands should be rinsed with soap and water. Mr. Medina should also stop smoking when Jose is around.
To conclude, it is important to note how cultural beliefs of Mexican and Puerto Ricans affect the provision of transcultural healthcare among these two cultures. Therefore, there is a need to train medical practitioners on culturally competent techniques so as to efficiently serve these diverse cultural groups without infringing the cultural beliefs. In addition it will ensure better patient outcomes and adherence by combining both the Western and traditional methods of disease treatment and prevention.
Reference
Brody, J. E., (2015, May 17). Doctors Ignored on 'Hot ‐ Cold' Dosing. Retrieved from https://www.nytimes.com/1971/05/17/archives/doctors-ignored-on-hotcold-dosing.html
Papadopoulos, I., Shea, S., Taylor, G., Pezzella, A., & Foley, L. (2016). Developing tools to promote culturally competent compassion, courage, and intercultural communication in healthcare. Journal of Compassionate Health Care , 3 (1), 2.
Purnell, L. D., (2012). Transcultural health care: A culturally competent approach . FA Davis.
Shen, Z., (2015). Cultural competence models and cultural competence assessment instruments in nursing: a literature review. Journal of Transcultural Nursing , 26 (3), 308-321.
