“Her blood pressure reads 142/90 with a pulse of 72,” my cousin gasped, as we both centered our attention on my grandmother and the home blood pressure monitor. I looked up and quietly whispered to her, “That’s really high. I think we should call the nurse.” She stared back, with a face of bewilderment before asking, “How do you know?”
How did I know these things? I am by no means a practicing nurse nor an attending medical school student to have such knowledge at ready’s notice. Simply, I was quickly becoming one of my grandmother’s primary caregivers as she fought her dementia and recovered from a critical fall that impacted her heart and brain’s performance. My family is compromised of mostly Mujeres- strong, hardworking and fearless ones- who, when it came time to become caregivers, paused from their day to day to do everything in their capacity to be there. In the days following her hospitalization, I had never in my wildest dreams thought that I would ever need to know or translate medical terminologies such as agnosia, dysphagia, troponin, full code, and DNAR. But there we were, standing as a family unit (literally) since the hospital room was too small for all 16 of us. The undertaking of understanding the gravity of my grandmother’s condition while translating concerns and questions to her assigned nurses was gradually taking a toll on us.
According to a 2018 report from AARP, 38 percent of Hispanic family caregivers are between the ages of 18 and 34, making us the youngest ethnic group to provide care while taking on added responsibilities that could potentially have lasting impacts as we build our own careers and relationships. Do these numbers really matter when it ultimately comes to your Abuela’s or family’s health? Not really. My grandmother or ‘Ita,” as we called her cariñosamente, was a strong and hard-headed woman by nature. But when she wanted to be kind, her dementia would tell her that she was not safe. When she wanted to communicate and relate to the nurses attending her, her dementia would tell her they were a threat. When she wanted to let us know that she was hurting, her dementia would tell her not to trust us.
At this point, we had yet to come across a nurse or doctor who spoke fluent Spanish and would be able to understand the cultural significance of why her children and grandchildren needed to be with her at all times.
Ita was one of a kind. Anyone who came to know her can attest to her charismatic nature and unending zest for life. One unforgettable, routinely morning, however, Nurse Ed came in to change her sheets and the ambiance in the room immediately changed! Ed was a Latino, male nurse and the first to fully comprehend the cultural exchange necessary to make sure my grandmother felt comfortable enough during his round. Ed made the effort to bond with her over novelas, traditional Latino dishes, and deserts they both loved, as he turned her over to place a set of clean sheets. Prior to this, every morning we witnessed Ita’s aggression towards the nurses because it seemed that few of them really honored the obligation of “providing psychological support to patients.” But was it their fault? Not really.
A 2019 report from the Kaiser Family Foundation states that there are a total of 15, 414 active nurse practitioners in California, making it the number one state to have the most professional practicing nurses. There is no data concluding the racial or ethnic composition of this total in California or per state. Ita’s doctor suggested hospice care following her discharge. At this point, our priority became her comfortability and assuring that the hospice company was fluently bilingual to understand her and our needs as a family. Growing up Catholic implied that things happened to us by the “grace of God.” Whether it does or not, I do believe that every single event in our lives has a greater significance. Ita got the best hospice care possible to see her through her journey.
This, by no means, is to discredit the hard work nurses face in their everyday responsibilities with providing general care. I know it’s laborious. I am simply highlighting our struggle as a Latino family and the importance of having culturally relative healthcare today. Although she was in one of the most prestigious hospitals in the county of Los Angeles, there seemed to be a huge disconnect between patient, doctor and staff relationships. Of course, one doesn’t go to the hospital to make friends and sit around in group circles to discuss life’s intricacies, but I think there should be a significant importance on the human aspect that comes with offering compassionate, culturally competent care in a timely fashion to those who need it most, especially patients of older age.
Serving as a gateway country for many immigrant families coming to fulfill their dream of living in North America, our nation is drastically changing with regards to population, demographics, and professions. I am continuing to review data concerning health care disparities and diversity problems within the American Association of Nurse Practitioners (AANP) that could help me further understand this concern and why this workforce does not reflect the growing diversity of the population of California, and the United States as a nation. Unfortunately, Ita was not able to see this new year emerge, but, arising from this experience and seeing her caregiving at the hospital and through hospice care, I am motivated to continue researching how healthcare professionals can enhance their aims to provide culturally competent care to all patients.