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Culture Care Worldview of Mexican Americans About Diabetes Mellitus Jesus Antonio Hernandez

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Culture Care Worldview of Mexican Americans About Diabetes Mellitus Jesus Antonio Hernandez Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 2013 The trS uggle for Balance: Culture Care Worldview of Mexican Americans About Diabetes Mellitus Jesus Antonio Hernandez Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Hernandez, J. (2013). The trS uggle for Balance: Culture Care Worldview of Mexican Americans About Diabetes Mellitus (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/650 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. THE STRUGGLE FOR BALANCE: CULTURE CARE WORLDVIEW OF MEXICAN AMERICANS ABOUT DIABETES MELLITUS AN ETHNONURSING STUDY A Dissertation Submitted to School of Nursing Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Jesus A. Hernandez August 2013 Copyright by Jesus A. Hernandez 2013 THE STRUGGLE FOR BALANCE: CULTURE CARE WORLDVIEW OF MEXICAN AMERICANS ABOUT DIABETES MELLITUS AN ETHNONURSING STUDY By Jesus A. Hernandez Approved June 27, 2013 ________________________________ ________________________________ Rick Zoucha William K. Cody Associate Professor of Nursing Professor of Nursing (Committee Chair) (Committee Member) ________________________________ ________________________________ Shirley P. Smith L. Kathleen Sekula Assistant Professor Retired Professor of Nursing (Committee Member) (PhD Committee Chair) ________________________________ ________________________________ Mary Ellen Glasgow Joan Such Lockhart Dean and Professor, Associate Dean and Professor School Nursing Academic Affairs School of Nursing iii ABSTRACT THE STRUGGLE FOR BALANCE: CULTURE CARE WORLDVIEW OF MEXICAN AMERICANS ABOUT DIABETES MELLITUS AN ETHNONURSING STUDY By Jesus A. Hernandez August 2013 Dissertation supervised by Rick Zoucha DNSc, APRN-BC, CTN The purpose of this study was to describe, explain, and interpret perspectives, perceptions, meanings, symbols, and lifeways to explicate the culture care worldview about Diabetes Mellitus (DM) for Mexican American participants. Leininger‟s Culture Care Diversity and Universality Theory served as an organizing framework Interviews were conducted with thirty Mexican American key participants without DM. Four phases of analysis of ethnonursing method revealed thirteen categories, five patterns and three themes. The categories were: Health; faith and religion; natural living; tranquility and stress; strong emotions; susto; immigration; life in US; family advice and support; cultural beliefs; treatments of diabetes; care; and communication. The patterns were a pattern of: Concern about DM with much confusion and uncertainties about the disease; maintaining balance and body defenses towards health; integrating self-care, generic and iv professional values in care; adaption to change and stressors; and valuing nursing and professional care. The themes American participants value balance and health yet have many uncertainties and concerns about Diabetes Mellitus that impact their culture care worldview; Mexican American participants‟ culture care worldview of Diabetes Mellitus integrates self-care with generic and professional care values, beliefs and practices; and Mexican American participants‟ culture care worldview of professional care of Diabetes Mellitus, emphasizes culturally acceptable, compassionate, personalized care, based on communication, mutual trust and respect, provided within the context of the family that supports the person‟s struggle for balance, health, wellbeing and function. The Struggle for Balance: Culture Care Worldview of Mexican Americans about Diabetes Mellitus Pictorial Model, Hernandez © 2013 was abstracted by author, from study literature, findings and themes. Implications and recommendations for nursing theory, practice, education, policy and research were described. Keywords: Nursing, Leininger, Culture Care, Worldview, Mexican American, Diabetes Mellitus Dissertation v DEDICATION This dissertation is dedicated to my life-partner, Oscar Hull whose love, care, patience, and friendship were instrumental to overcoming the rigor and many obstacles along this journey, giving me the ability to prevail with faith, hope and resilience. I also dedicate this dissertation to my son, Brandon Samples whose love, talent, sweet spirit and determination motivated me to persevere. I would not have been able to succeed without the love and support of my parents Adis and Jesus, and brother, Carlos and his family Belkis, Christian and Carolina. I also dedicate this dissertation to all my family, friends and colleagues who stood with me and did not give up hope that this process would come to fruition. In memoriam, thanks to my grandmother Lucia, whose love, wisdom and faith have been my source of strength and inspiration. I dedicate this dissertation to Nursing and all nurses that provide compassionate nursing culture care, to ennoble persons to reach their optimum health and potential. All honor to God, who lifts me up with unconditional love, leads my journey, and has guided me to be who I am today and will determine who I‟m to become. vi ACKNOWLEDGEMENTS Thank you to Queens University of Charlotte administrators, faculty, and staff who facilitated this journey and provided me with guidance, support and inspiration. To my Presbyterian School of Nursing students, whose perseverance and determination challenge me to pursue lifelong-learning. My deep gratitude to the clients and wonderful administrators, staff and volunteers at the Charlotte Community Health Clinic (CCHS), whose compassion for providing healthcare with dignity and respect to vulnerable populations have been a fountain of joy and professional fulfillment. Heartfelt thanks to my team of cheerleaders; Melinda Armstrong, Oneida Bergstrom, Gerald Berkowitz, Janie Best, Martha Brinsko, Grace Buttriss, Jill Carey, Coleman Carter, Jolene Correll, Gayle Casterline, Courtney Danner, Donna Ferraro, Terry Forsythe, Carey Friedrich, Abiodun Goke-Pariola, Judy Grubbs, Linda Hammaker, Tracy Heberling, Annette Hines, Denise Howard, David Hudson, Nancy Hudson, Elizabeth Leonard, Terri Lynch, Janice McRorie, Debbie Miles, Terry Moorman, Tama Morris, Joanne Norris, Judy Osborn, Tracy O‟Neil, Peggy Patton, Tracy Petleski, Trudy Pollock, Judy Poole, Heather Roberts, Maria Rouco, Laree Schoolmeesters, Donna Shepherd, Daphne Tench, Felicia Washington, Liz Williams and Tamara Withers-Thompson who pushed me to never give up and see this dream fulfilled. Thanks to my dissertation committee Dr. William K. Cody and Dr. Shirley P. Smith for sharing their knowledge, encouragement and guidance to help me do my best. To all others at Duquesne University, that developed my worldview, supported my efforts with patience and care, cleared my path, opened my eyes, made learning come alive and made me humble to realize how much there is to vii learn and how little I‟m capable of learning, I thank you all for your contributions and belief that in the end I would reach my dream. Eternal gratitude is especially given to my chair, mentor, counselor, adviser and cheerleader, Dr. Rick Zoucha, who nurtured me during my times of despair and always cared for me as I would like to be cared for. Your expertise, patience, compassion and unrelenting belief in me, helped to make this dream a reality instead of an aspiration. viii TABLE OF CONTENTS Page Abstract…..……………………………………………………………………….………iv Dedication…...……………………………………………………………………….…....v Acknowledgements………...……………………………………………………………..vi Introduction……….…………………………………………………………………...…..1 1.1 Goal………………………………………………………………………...….1 1.2 Diabetes Mellitus…………………………………………………………...…1 1.3 Background…………………………………………………………………....7 1.4 Purpose……………………………………………………………………….11 1.5 Domain of Inquiry……………………………………………………………11 1.6 Research Questions……………………………………………….………….11 1.7 Orientational Definitions…………………………………………………….12 1.8 Significance for Nursing……………………………………………………..14 1.9 Assumptions….……………………………………………………………....19 1.10 Summary……………………………………………………………………20 Review of Literature……………………………………………………………………..21 2.1 Introduction…………………………………………………………………..21 2.2 Ethnohistory of the Mexican Culture………………………………………...21 2.3 Colonial History……………………………………………………………...24 2.4 People of Mexico…………………………………………………………….24 2.5 Religion and Ethnicity……………………………………………………….24 2.6 Artistic Traditions and Holidays…………………………………………….27 ix 2.7 Political Traditions with US………………………………………….………29 2.8 Mexican Americans………………………………………………………….32 2.9 Synthesis of Literature……………………………………………………….46 2.10 Summary…………………………………………………………..………..51 2.11 Discussion………………………………………………………..…………54 2.12 Research Gaps……………………………………………………………..60 2.13 Summary………………………………………………….………………..60 2.14 Guiding Framework………………………………………………….…….60 2.15 Culture Care: Diversity and Universality……………………….………….62 2.16 Conclusion……………………………………………………………….....67 Methodology……………………………………………………………………………..69 3.1 Introduction…………………………………………………………………..69 3.2 Use of Enablers………………………………………………………………70 3.3 Setting………………………………………………………………………..71 3.4 Inclusion Criteria…………………………………………………………….72 3.5 Human Subjects Consideration………………………………………………73 3.6 Procedure for Data Collection……………………………………………….74 3.7 Data Analysis………………………………………………………………...75 3.8 Phases of Ethnonursing
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