Introduction
The primary purpose of Ethnonursing research is to acquire knowledge and gain a better understanding of the specific client and their community. Using Leininger’s Domain of inquiry, it is possible to obtain crucial information that influences the health of a particular person (in this case, Latin Americans). Leininger’s Domain of inquiry applies broad and open inquiry modes instead of direct confrontational questions, which ensures that the interview process flows naturally. In effect, the model is capable of deriving more information about the client. The inquiry areas stipulated by Dr. Leininger are pretty exhaustive and, in this case, can help assess a person, family, race, group, and other crucial elements (McFarland & Wehbe-Allamah, 2019). The model was selected for this case because of the various Domains of Inquiry outlined by Leininger. In this case, economic, political, legal factors, and cultural values focus on the individual, thus helping the interviewer to learn from the informant about his/her culture, values, and life way. Hence, this helps provide nursing care to such person, their families, and communities.
Significance of the Study
Various policies and practices in the country have led to inequalities in the access and delivery of healthcare, particularly among racial and ethnic minorities such as Latinos. This study focuses on Hispanics because they make up the biggest minority group making up close to 17.4% (55 million), with the population expected to swell to 28.6% by 2060 (Colen et al., 2018). Considering the vast population and continued importance of the Hispanic population in U.S society, it is of utmost importance for researchers, practitioners, and other relevant authorities to develop measures to protect the health of the above population. The significance of the study is to gain a better understanding of the healthcare disparities facing Hispanics/Latinos in the U.S, identify health gaps, and also come up with recommendations that can enhance healthcare equity in the country.
Conducting the above-described study is also essential as the evidence gathered will work to reduce inequity, discrimination, and the general disparities faced by Hispanics and other minorities in the country. Therefore, considering Hispanics are the most significant minority in the country, it is essential to understand the healthcare disparities the population faces and develop strategies that can enhance the health outcomes of the group. The study uses the principles of Leininger’s Utility Domains to attain an empathetic understanding of the Latin-American male, which reflects the general viewpoint of many people in his community. Thus, the study will, in general, enhance the health knowledge of the Hispanic community, their perceptions, and challenges regarding the political and legal factors, education factors, and general and specific nursing care factors.
Review of Literature
Historically, Hispanic people in the U.S have suffered racial, ethnic, and anti-immigrant discrimination. Despite its advances and enormous cost, the U.S. healthcare system is notoriously the best, with disparities disproportionately affecting racial minorities such as Hispanics. Such inequalities cause gaps in healthcare insurance coverage or accessibility to care services and poorer health outcomes among the affected communities. Additionally, the community and other racial minorities continue to suffer employment and housing discrimination, leaving many without a satisfactory means of livelihood necessary to afford healthcare (Colen et al., 2018). The above forms of discrimination and racism have had mental and physical implications on the community’s health.
The health of the Latino community has also suffered because of intentionally-biased federal and state programs. For example, the 1966 anti-immigration Act has forced many Hispanic immigrants to avoid interacting with healthcare professionals for fear of being deported. In effect, many illegal immigrants remain without healthcare insurance coverage, which is detrimental to their health (Yearby, 2018). Moreover, the above legislation has limited the Latino community’s employment opportunities, leaving many without the means to afford healthcare services. Another example is the forced sterilizations that Hispanic women were subjected to in the 1920s, causing trauma and mistrust of the U.S healthcare system (Colen et al., 2018). Hence, the above programs and other discriminatory factors have contributed to health issues among Hispanics, especially in poorer households.
Coverage Gains and Health Obstacles
The Affordable Care Act (ACA) has significantly improved healthcare insurance coverage in the country, with millions of poor people benefiting. After the implementation of the legislation, a significant percentage of low-income Latin Americans have acquired health insurance provided they are citizens who are legal immigrants (Colen et al., 2018). However, compared to whites, Latin Americans (particularly illegal immigrants) are more likely to be uninsured. The ACA has enhanced universal coverage in the country, but the continued high cost of additional coverage alternatives has left many Latin Americans without affordable or quality care (Yearby, 2018). Even worse, some states have introduced draconian work requirements for individuals willing to enroll in the Medicaid program, which has further denied affordable care to many. Such factors have also increased stigma and discouraged many community members from accessing the support they desperately need. Because of such challenges, the conservative states have the unhealthiest population in the country, with the black and Hispanic communities being the most affected.
Disparities in Health Outcomes
Despite the increased healthcare coverage because of the ACA, there are still numerous disparities across various health disorders primarily affecting Hispanics, including maternal mortality, infant mortality, diabetes, hypertension, and cancer. Social and economic issues, educational inequalities, and systemic racism have further affected the health outcomes of the Latino community (Colen et al., 2018). Minorities of the country, especially Hispanics who face racism and inequality in all aspects of life, suffer the greatest from social elements that influence health. Even with the better accessibility to healthcare insurance under the ACA, the odds are highly stacked against Latin Americans compared to their white counterparts. For example, Hispanic women in the country are more likely to die from pregnancy-related issues than white women (Yearby, 2018). A significant percentage of minorities such as Hispanics in the U.S are more likely to die from various chronic conditions than their white counterparts and other racial groups.
Shortages in Healthcare
Residential segregation has contributed to poor health outcomes among Hispanics, which makes location and neighborhood influential factors in health. In many cases, Latinos and other racial minorities tend to depend on community health centers, outpatient care, and emergency care because of the shortage of primary care and mental healthcare in their locations (Colen et al., 2018). Some people in such localities can travel outside for healthcare, but financial challenges constrain many. Healthcare professionals working in majority Hispanic neighborhoods also tend to provide lower-than-average care services. Therefore, Hispanics still face numerous disparities in healthcare, which in turn has resulted in relatively poorer health outcomes compared to white people.
Structural barriers have made Latinos and blacks poorer than other communities in the United States. Because of poverty caused by systemic racism and other economic challenges, Latinos face healthcare disparities compared to whites. Poverty leads to stress, depression, and other health conditions that affect health outcomes (Colen et al., 2018). Additionally, even when Hispanics get meaningful employment, they are more likely to work in low-income and risky sectors with minimal benefits such as health insurance and paid leave (Yearby, 2018). For this reason, Medicaid and other government-sponsored programs remain critical in ensuring that Latinos and other racial minorities more likely to be affected by poverty obtain quality and timely care.
Research and Analysis of Findings
Political and Legal Factors
The interview took place in the respondent’s home, where he was comfortable with his family. Mr. X refused the interview to take place outside his home as he is an illegal immigrant from Mexico. The domains of inquiry utilized in the interview were political, legal, economic, Cultural Values, beliefs, and Lifeway factors. The respondent, Mr. X, is a diabetic Hispanic male with a drug problem. The informant is an illegal immigrant who has lived in the U.S for seven years. He reported that the government is in denial of the plight of Hispanic immigrants, and many politicians, especially in conservative states, are oblivious to his community’s suffering. The respondent claimed that he believed the politicians did not care about immigrants and the Hispanic community and did whatever they could to keep his community down, a problem that escalated during Trump’s presidency. Consequently, he expressed optimism because more and more Hispanic community members and liberal politicians have gained elective seats.
The respondent praised the government for Obamacare, which he said had significantly helped his family and other poor people in his poor neighborhood access healthcare insurance. The respondent further believed that Democrats and liberal politicians, in general, are suitable for minorities as such politicians fight for progressive plans that can fight for the rights to insurance for illegal immigrants. Such plans aim to improve the welfare of poor people, which is in line with the observation that economic and social welfare has a significant impact on the health outcomes of poor Latinos and other racial minorities in the country (McFarland & Wehbe-Allamah, 2019). On the other hand, the rise of conservative ideologies, especially in conservative states, has negatively impacted the health outcomes of Hispanic people as they are more likely to be barred from accessing government-sponsored health insurance.
Economic Factors
As reported by the respondent, individuals’ economic background significantly impacts their health. Poverty affects a person’s ability to dance healthcare insurance, leading to poor health outcomes. The respondent reported that his financial background affected his ability to access diabetes medication when he complained about the high cost of insulin. Hence, it is correct to say that money is essential in enhancing health. Home-care cost practices are also more affordable to many poorer individuals, like the respondents. The community was significantly cheaper than hospital-based care and has been reported by the informant to be more appropriate for immigrants as it is more discrete than public facilities. The respondent also reported that he was the primary earner for the family and that his wife was jobless, which further affected the household’s income. He depends on community-based healthcare services and government programs (Colen et al., 2018). Therefore, the respondent’s answers show that poorer people are less likely to access quality and timely care, an issue that significantly affects more impoverished people.
Cultural Values, Beliefs, and Lifeways
The respondent claimed that most white nurses do not understand him or his family and the situations they face, hence suggesting that nurses should work to improve their cultural awareness. The respondent also reported that he does not trust white healthcare professionals. Research has shown that many white providers describe Hispanic and black patients as uncooperative (Yearby, 2018). The respondent noted that he believed that many white nurses do not understand Latino people and that they should work towards learning the Latino culture and the challenges Hispanics in the country people face to serve them better. He further suggested that Hispanic nurses and other practitioners who speak Spanish are better suited to serve the community (McFarland & Wehbe-Allamah, 2019). The interviewee reported that he was aware of historical cases of the exploitation of Hispanic patients in research by professionals that were supposed to take care of them. Thus, it is clear that there is a severe problem concerning white nurses and other healthcare practitioners working in poor Hispanic neighborhoods. Therefore, nurses should work on cultural competence to serve Hispanic people and other racial and ethnic minorities better.
Ethical Issues
During the interview, some of the critical ethical aspects considered included confidentiality. In this case, it was crucial to assure the interviewee that his private information would remain confidential, which is an essential aspect of research as it ensures the participant’s privacy. Moreover, the respondent could withdraw from the interview whenever he felt. The interviewee was also free to withhold any information they felt uncomfortable giving. The informant’s informed consent was also obtained, which is crucial to ensure they did not feel compelled to participate.
Recommendations
One recommendation to enhance the health outcomes of Hispanics is for nurses to work on their cultural competence to serve minorities better. Cultural awareness ensures that nurses understand their beliefs, health challenges, race, and values, all of which are crucial in developing the nurses’ empathy. A culturally competent nurse makes the patient more relaxed, and this promotes the delivery of care. Another recommendation to bridge the care gap and enhance the delivery of care to Latin Americans is to promote the availability of government programs (Colen et al., 2018). Government programs such as Medicaid have proved extremely important in increasing health insurance, particularly among poorer households. Eliminating such barriers can lead to better health outcomes for Hispanics and other racial minorities that face racial prejudice.
Conclusion
Latin-Americans face numerous disparities in accessing quality healthcare because of social-economic and political factors. Such factors include systemic racism, high poverty levels, and lower political representation. The healthcare disparities experienced in the country, mainly targeting racial and ethnic minorities like Hispanics, can be eliminated by promoting government programs such as Medicaid. Obama care and other related government programs have improved insurance coverage among poor Hispanics and minorities. However, their lack of citizenship and migration status still hinder their access to insurance coverage. Additionally, as shown in the paper, nurses and other healthcare providers must enhance their cultural awareness to serve better the Hispanic population and other racial minorities in the country.
References
Colen, C. G., Ramey, D. M., Cooksey, E. C., & Williams, D. R. (2018). Racial disparities in health among nonpoor African Americans and Hispanics: The role of acute and chronic discrimination. Social science & medicine, pp. 199, 167–180.
McFarland, M. R., & Wehbe-Allamah, H. B. (2019). Leininger’s theory of culture care diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 30(6), 540–557.
Yearby, R. (2018). Racial disparities in health status and access to healthcare: the continuation of inequality in the United States due to structural racism. American Journal of Economics and Sociology, 77(3-4), 1113–1152.