After reading this chapter, the nurse will be able to:
Describe verbal and nonverbal communication behaviors of persons of Cuban descent.
Have an awareness of Cuban Americans’ spatial comfort zone.
Discuss family values that are commonly held by Cuban Americans.
Discuss the past-, present-, and future-time orientation that may be held by Cuban Americans, depending on generation of immigration.
Describe beliefs held by persons who espouse the cult of Santeria.
Discuss health problems that may be related to biological variations of persons of Cuban descent.
Overview of Cuba
Cuba is located in the Caribbean on the westernmost part of the West Indies. To the north are Jamaica and the Bahamas, and to the south are the Cayman Islands and Haiti. Havana, on the northwest coast, is 90 miles from Florida’s Key West, while the Pinar del Rio Province on the west coast is 130 miles from Mexico’s Yucatan Peninsula. Cuba, an island of 42,803 square miles, is the largest island in the Caribbean and the fifteenth largest island in the world. Cuba also lays claim to a small island, Isla de la Juventud, and some 4200 coral cays and islets. Mountain ranges separate the country into three regions ( ).
When Columbus reached Cuba in 1492, some 50,000 Indians, primarily fishermen and hunters, occupied the island. The island was conquered for the Spanish crown, and seven settlements were founded. In the early sixteenth century, the first Black slaves from Africa arrived in Cuba. These slaves were primarily Yoruba, from the southwestern part of Nigeria. The slaves brought aspects of their culture that are still present in food, music, and practices of spiritualism. Chinese workers were also brought to work in the sugarcane fields. Some of these workers were able to earn enough money to start their own businesses and married women from other ethnic groups, particularly criollo women (Spaniards born in the New World). Except for the British occupation of Havana in 1762–1763, Cuba remained under control of Spain until 1898. An economy driven by the slave-based sugar plantations was aided by mechanization of milling. Sugar continues to be the chief product and chief export to this day.
Despite numerous uprisings throughout the 1800s, Cuba remained under Spanish rule until José Martí, a Cuban national hero, championed a revolution in 1895. At that time the United States joined the international protest over Spain’s treatment of Cuba. In 1898 the United States officially declared war on Spain in response to the sinking of the USS Maine in Havana. The Spanish–American War resulted in the defeat of Spain, and Cuba was granted its independence. During that period, an agreement was struck between the United States and Cuba that has had long-lasting effects in the minds of many exiled Cuban Americans. More specifically, according to the Platt Amendment to the Cuban constitution, the United States agreed to provide a military presence on the island to assist in maintaining the governmental stability initiated by the revolution. The U.S. peacekeepers remained in Cuba until 1934. However, a 99-year lease permits the United States to maintain a strategic naval base at Guantánamo Bay, on the southeast side of Cuba. To this day, many exiled Cuban Americans find comfort in knowing that the U.S. military (whom many Cubans and Cuban Americans perceive as anti-Castro) still resides on the island.
In 1952, Fulgencio Batista seized control of the government, and a harsh dictatorship was established. However, Batista was overthrown in 1959, when Fidel Castro and a rebel band seized control. With Castro serving as the official head of state, sweeping economic and socialistic changes were initiated, and a system of cooperatives was instituted. Cattle, tobacco lands, banks, and other American interests were nationalized, with little provision for compensation to their former owners. Subsequently, relations with the United States were broken off, and a trade embargo, which remains in effect, was initiated. Poor sugar crops and the embargo further damaged the economy, and, in spite of aid from Communist countries, rationing practices were enacted. While civil unrest and various efforts to overthrow the regime occurred, Castro maintained control. In 1962, the United States discovered that the Soviet Union had brought nuclear missiles into Cuba. After a stern ultimatum from President John F. Kennedy on October 22, the missiles were removed. In 1967, in an overture to enhance relations, the United States and Cuba signed an agreement to exchange diplomats and to regulate offshore fishing. However, full ties were not restored, and some sanctions continued.
Throughout the 1970s and much of the 1980s, Cuba enjoyed the financial and political support of many Communist countries. Steady economic growth and advances were made in social security, public health, and education. However, the economy was severely hampered by the collapse of the Communist bloc in the late 1980s and the subsequent withdrawal of Soviet subsidies, worth $4 to $6 billion annually ( ). Increased trade sanctions by the United States also contributed to a deteriorating economic situation throughout the early 1990s. Trade sanctions were tightened even further in 1996, after two aircraft operated by an anti-Castro exile group based in Miami were shot down by Cuban Air Force pilots off the shores of Cuba. In an apparent humanitarian effort, Pope John Paul II visited Cuba in 1998 and called for an end to the U.S. economic sanctions. The pope urged Castro to release political prisoners and increase political and religious freedom. A softening of relations did occur, and sanctions were eased in 1999.
Cuba again made international news in 2000, when a Cuban child, Elián González, survived a capsized boat accident and was rescued off the Florida coast. After a 7-month legal battle, the U.S. government agreed, over the protestations of his relatives and the Cuban-American community in Miami, to return Elián to his father in Cuba ( ). This decision by the U.S. government led to subsequent changes. These included the passage of a bill allowing food and medicine sales to Cuba, somewhat relaxed travel regulations that allowed more Cuban Americans to visit Cuba, and Castro’s decision to spend $120 million over a specified period to purchase food and agricultural products from key farm states. These actions energized pro-Cuba attitudes in the U.S. Congress, and the lifting of the trade embargo became a topic of debate ( ). The U.S. government tightened travel restrictions significantly in 2004 and again in 2006, allowing Cuban Americans to return to the island only once every 3 years instead of every year and restricting the amount of U.S. cash that can be spent there to $50 per day. In response, Cuba banned the use of dollars, which had been legal currency in the country for more than a decade ( ; ).
In 2006, Fidel Castro began transferring many powers over to his brother, Raul, because of personal illness. In February 2008, Fidel Castro formally resigned from office, ending an almost 50-year rule. Despite renewed U.S. economic interest in Cuba and some policy shifts under President Barack Obama (including legal travel to Cuba by students, churches, and cultural groups), experts agree that normalization of U.S.–Cuban relations was unlikely in the near future ( ). But when the Archbishop of Buenos Aires, Jorge Mario Bergoglio, was elected as Pope Francis in March 2013, he reached out to American President Barack Obama and Cuban leader Raul Castro in hopes of mending the diplomatic relations between the two countries. The Pope personally followed up and offered to mediate between the two countries as they held secret talks that spanned 18 months ( ). On December 17, 2014, Presidents Obama and Castro announced a deal to restore diplomatic relations and the liberalization of travel and remittances between their respective countries ( ).
Although the Obama administration would like to normalize relations with Cuba, there are still major hurdles to overcome. The president would like to lift the trade embargo, move Cuba toward democracy, and increase diplomatic presence in Cuba. But Congress is not likely to lift the embargo soon, and Cuba appears to have the goal of maintaining the status quo while maximizing the economic gain of the agreement and to be removed from the State Sponsors of Terrorism list ( ).
In 2014, Cuba had a population of 11,047,251 residents, representing ethnic groups that include mulatto and mestizo (26.6%), Black African (9.3%), and White (64.1%) ( ; ). The population was growing annually at a rate of 0.22% until 2008, when it began decreasing slightly ( ). Cuba has an aging population; 19.6% are over the age of 60 years, and this percentage is growing as the birthrate remains low ( ). Havana has a population of 2.116 million people. Some 75% of the Cuban population is urban, with a population density of 262 per square mile ( ).
The island has 2500 miles of coastline. Low hills and fertile valleys cover more than half of the country, with 24% arable land. The chief crops include sugarcane, tobacco, rice, coffee, and citrus. There are 6000 plant species in Cuba, and land fauna includes crocodiles, lizards, and 15 species of snakes ( ; ; ). Other resources include timber, cobalt, nickel, iron, copper, manganese, and salt. Pharmaceutical production is another source of Cuban development. More than 1000 people work at Cuba’s Genetic Engineering and Biotechnological Center in Havana. Cuba’s biotechnical products and technology currently reach markets in more than 40 countries and generate about $100 million annually ( ). The labor force of Cuba is 23% agricultural and 53% services. The gross domestic product is U.S. $72.3 billion, with a per capita gross domestic product of U.S. $10,200 ( ). Major trading partners are Canada, China, Venezuela, the Netherlands, and Spain and a major shift away from Russia, China, Iran, and North Korea ( ).
The tourism income is $1.846 billion ( ), and numerous travel guides outline opportunities in Cuba (e.g., ) as a vacation spot for cycling, travel, hiking, and swimming. Cuba is advertised as the Caribbean’s largest and least commercialized island. The relative political isolation has prevented it from being overrun with tourists, a selling point used to promote Cuban travel in Canada and Europe ( ). The peak tourist time is in the dry season from December to April, when planeloads of Canadians and Europeans arrive to enjoy the sun and beaches. Christmas, Easter, and the period around July 26 (the anniversary of the revolution) are also peak tourist times. The hotter wet season lasts from May to October and is also the time when hurricanes are most prevalent. The average annual temperature is 75° F.
Many Cuban citizens are experiencing an easing of political and religious restrictions. On the other hand, Cubans currently get by on an average monthly income in pesos equal to $8 to $20 a month, and state-rationing exacts a daily struggle ( ; ). Cubans use their monthly income and ration cards for subsistence items in government peso stores in order to purchase rice, sugar, peas, cooking oil, tobacco, coffee, beans, and soap. Children under 7 may receive milk, some eggs, and meat, but otherwise meat and vegetables are not available at the government peso store. Other goods, including meat and more expensive items, are available at state-run stores. Many Cubans receive money from family members in other countries or a private income from pedaling bicycle rickshaws for tourists, running gypsy cabs, engaging in black market sales, opening small cafés in their homes, or renting rooms ( ). There is less poverty in Havana than in rural areas, since in Havana enterprising individuals can more easily supplement their peso income with personal and tourist-related enterprises.
Despite the U.S. embargo and the challenges faced after the fall of the Soviet Union, Cuba has produced better health outcomes than most Latin American countries ( ; ). In Cuba, the median age is 37.8 years; the life expectancy is 77.2 years for males and 81.2 years for females; and there are 11.02 births per 1000 and 7.29 deaths per 1000. The infant mortality rate is 4.5 per 1000. The number of persons in Cuba with human immunodeficiency virus (HIV) or acquired immunodeficiency virus (AIDS) is 3300 (>0.1%). There are 67.2 physicians per 10,000 inhabitants ( ; ). Cuba spends 10.0% of the gross domestic product on health care, significantly less than the United States (17.9%) and most European countries. The positive health outcomes are probably more related to the focus on health and prevention of disease than on the amount of money spent ( ; ).
Immigration to the United States
Opportunities in the tobacco industry in Tampa and Miami between 1895 and 1905 resulted in the establishment of small, tight Cuban communities in these Florida cities ( ; ). By settling within these communities, it became possible for these Cubans to retain a strong ethnic identity and maintain cultural values and practices. Another wave of immigrants came to the United States in the 1940s and 1950s for jobs related to military production and because increased trade and commerce between the United States and Cuba facilitated immigration.
When Castro assumed control in 1959, opponents were imprisoned or executed. Lack of promised liberties and the threat of Communist rule caused many middle- and upper-class individuals who had supported the Castro regime to immigrate to Miami, Tampa, and New York, thus expanding already existing Cuban settlements. It is estimated that, in the initial years of rule by Castro, some 700,000 Cubans emigrated, primarily to the United States ( ). It is significant to note that many of these individuals had grown accustomed to receiving high-quality health care as a result of their socioeconomic status prior to Castro’s revolution. In contrast, some later immigrants who did not hold middle- and upper-class positions prior to the revolution were not accustomed to being benefactors of health care and did not come to the United States with the expectation of high-quality health care.
In 1978, as a result of pleas for liberation, Castro agreed to release political prisoners to the United States. Some 120,000 Cubans immigrated in 1980 in what was referred to as the Mariel Boat Lift ( ; ). It was later determined that among these immigrants were mentally ill patients and criminals. Some of the criminals remained in jails in the United States until 1987, when Castro agreed to take back some 2500 Cuban prisoners. The 1987 agreement allowed 20,000 Cubans to immigrate to the United States each year. Many were relatives of those already in the United States. Cuban Americans represent one of the few minority groups in the United States who are predominantly refugees, not immigrants, many of them professionals and entrepreneurs.
In the 1990s, Cubans, desperate to get out of Cuba, increasingly tried to bypass the immigration regulations and make their way to Florida on small boats. Finally, in 1994, demonstrations against the Cuban government prompted loosening of the immigration restrictions, and a United States–Cuba accord was signed to end the illegal and dangerous exodus of “boat people.” In 1995, U.S. policy shifted again with the announcement that 20,000 Cuban refugees held at the Guantánamo base would be admitted to the United States; however, any more boat people caught fleeing the island would be sent back to Cuba ( ). By 1999, it was estimated that 1550 Cubans had been repatriated under the immigration agreement ( ). Nevertheless, illicit migration to the United States using homemade rafts, alien smugglers, or falsified visas continues. In 2013, it was estimated that 14,251 Cubans crossed the straits to Florida and set foot on U.S. soil, with only 25% being deterred by the U.S. Coast Guard ( ).
In 2010, 1.8 million people of Cuban descent were residing in the United States ( ). The largest number of Hispanics in Florida are Cuban American ( ). In a relatively short time, Cubans have been able to advance economically and obtain a higher standard of living in the United States than other Hispanic groups. Compared with other Hispanic groups, Cuban Americans have higher average educational attainment, larger family incomes, and lower poverty rates ( ). For example, in 2011 the median annual individual income was $24,400, higher than the median earnings for all U.S. Hispanics ($20,000) but lower than the median earnings for the U.S. population ($29,000) ( ).
Many Cuban Americans maintain the political stance of exiles waiting for Fidel Castro, and now his brother, to die or be overthrown ( ). In fact, many identify themselves as “Cuban” despite having been born in the United States ( ). investigated “feelings of being American” among White-American, African-American, and Cuban-American women. In contrast to other groups, Cuban Americans reported neither feeling they were American nor believing that they were perceived as such by White Americans. However, feelings of inclusion increased with length of residence. The majority of the Cuban Americans in Miami-Dade County tend to be conservative, Republican, and anticommunist, though there may be a change away from the Republican party in the future ( ).
In spite of their exiled history, Cubans have tended to make the necessary adjustments to fit into the United States, preferring to use dialoguing, rather than resorting to violence, to address Cuba’s problems. The retention of cultural values and practices from their Cuban heritage has not diminished and in some cases would appear to have enhanced success in the United States as musicians, poets, athletes (particularly in the sport of baseball), and business executives ( ; ).
It is noteworthy that Cuban Americans have become successful in politics. Today, the Miami Cuban Americans are a powerful political force in the United States. Approximately 90% of Miami-Dade County Cuban Americans are registered to vote ( ). It has even been suggested that the impact of sending Elián González back to Cuba influenced the defeat of the Democratic party in the 2000 election in Florida since the presidential nominee, George W. Bush, opposed sending Gonzalez home and thus received strong support in Florida ( ).
Spanish is the official language of Cuba, although Cubans often shorten words by dropping letters. The accent and some expressions are similar to the Spanish of Andalusia, although the accents tend to vary by the three main regions of Cuba ( ; ). Cuban Spanish has an African influence and also incorporates some words from the Taino Indians and some English words ( ). Today, English is a required course in secondary schools and is increasingly learned by persons interested in the tourist industry.
identified that not speaking English is a significant problem for some first-generation Cubans in the United States. However, second-generation Cubans are more likely to speak both Spanish and English. However, unlike other non-English immigrant groups, Spanish is more likely to still be spoken in the home, within the Cuban community, and by elderly persons who do not have much reason to interact with an English-speaking community. Many Cuban Americans have incorporated English words into spoken Spanish ( ).
A common greeting among Cuban men entails a firm handshake. Handshakes are often used when entering or leaving a home or greeting a group. On the other hand, women tend to kiss each other once on the cheek and offer a verbal greeting. Kissing on the cheek can be observed between younger members of the opposite sex. Elderly people are greeted with gestures indicative of respect.
Cubans commonly address others by first names. Among friends or co-workers, nicknames may be used. Strangers may address each other using the word Companero / Companera (Comrade), Señor (Mr.) or Señora (Mrs.). Common verbal greetings include “Buenos días!” (Good morning), “Buenas tardes!” (Good afternoon), and “Buenas noches!” (Good evening). “Buenas” (hello) is commonly used as a greeting when passing another on the street, while “Hasta luego!” (So long) is used in parting ( ).
Nonverbal communication by Cubans includes use of hand gestures when talking to reinforce ideas and emotions. Conversation is lively and frequently loud and forceful. Most Cubans consider maintaining eye contact important, particularly in formal situations. Some Cuban individuals consider lack of eye contact a sign of insincerity or perhaps spite. Beckoning may occur by waving fingers inward with the palm down. Holding a palm up when beckoning is considered a hostile gesture ( ). Silence can mean uncertainty or awkwardness.
Music has been an integral part of Cuban culture since the African slaves brought rhythms and ritual dances from the Santeria religion. Over time, rhythms and dances were blended with Spanish guitars and melodies. In the 1920s, much of the United States was enamored of rumba rhythms, which became fused with jazzy horn sections into big-band sounds. Cuban music is a combination of instruments including guitars, tres (a small Cuban stringed instrument with three pairs of strings), double bass, bongos, claves, maracas, and voice. Mambo, bolero, salsa, and cha-cha-cha music also have contributed to the popularity of Cuban music today ( ).
Implications for Nursing Care
Although Cuban Americans tend to be educated, literate, and bilingual, it is important for the nurse to assess comprehension of the English language. The elderly Cuban American is more likely to speak only Spanish ( ). The nurse should ascertain if it is easier for the patient to understand information, patient teaching, or consent materials in Spanish. It is important when materials are translated from English to Spanish to ascertain the reliability and validity of the translation, since research has shown direct translation from one language to another may change the meaning of a message ( ).
When the patient does not speak English, a Spanish-speaking person (preferably a Cuban interpreter) who speaks the dialect of the patient should be used. The patient may prefer interpretation to be done by a family member. When issues related to a terminal prognosis or sexuality are involved, the patient may prefer to speak only with older members of the immediate family. However, if an HIV/AIDS diagnosis is to be discussed, the Cuban patient may not want this information discussed with another family member. In this situation, if a translator is needed, it is important to find a translator who is preferably a health provider outside the family. The nurse should be aware that Cubans often use a loud tone of voice in normal conversation and that commands or requests may seem to be direct and aggressive. The nurse should not interpret loudness as rudeness. It is also helpful to be aware that Cubans typically are spontaneous and outgoing. It is generally not considered impolite to interrupt others during conversation. The nurse should be aware that privacy is an important consideration. Highly sensitive or personal information may be withheld from the nurse.
The family may prefer that certain information regarding illness and prognosis be withheld from the patient. In some cases, it is important to discuss information with the family to determine what information should be shared with the patient and by whom. Whereas more acculturated patients will be more likely to want to be informed of serious information, less acculturated patients may prefer that information be given to family members who will share it as they see fit.
Cubans tend to stand close to others when talking. Touching or tapping another person may be done to make a point. In the United States, Cubans have tended to choose to live in tight communities, close to other Cubans. This facilitates a high level of identity with Cuban culture. When persons in the family are sick or in need, when possible, other family members will physically appear as a means of support. Cubans may take advantage of the travel authorized by the U.S. Treasury Department’s Office of Foreign Assets Control, which allows persons to travel to Cuba to visit close relatives ( ).
Implications for Nursing Care
The nurse should not be surprised when a Cuban American who learns of an ill family member feels a sense of urgency to be at that person’s side. Physical presence of family members to provide support is highly valued, so hospital rooms filled with family and friends are common.
Although Cuban Americans often feel strongly about a variety of social organizations, for most, the family is the most important social unit. Cubans share the Latino value of familismo, in which families are seen as an important source of support and identity. In addition, the cultural importance attached to personalismo indicates an emphasis on trust, respect and warmth in social relationships ( ). Traditionally, the Cuban family has been patriarchal, with a dominant male and a dependent female ( ). These roles have changed somewhat as a result of women entering the work force in larger numbers ( ). Although younger couples may develop more egalitarian relationships, traditional family roles and values persist. Women often take the role of emotional provider and mediator, which can be burdensome when combined with the other roles in the family ( ). Children tend to have strong relationships with parents and to be supported long after becoming adults. Whether in Cuba or in Miami, when a daughter becomes 15 years old, an extravagant birthday party announces arrival at the age of courting. Elderly people are offered respect by children and extended family. Elders assist in care of younger generations, and in turn when they need care, they are usually cared for within the home. Traditionally, nursing homes are used for the sick or elderly only if the family is unable to provide care.
In a classic study by , feeding and weaning practices of Cuban and Haitian immigrant mothers in South Florida were assessed. Findings revealed that social, economic, and political factors in both Cuba and Florida affected beliefs and practices. Cuban mothers expected and encouraged weaning from the breast to the bottle and introduction of solid foods at an early age. These expectations, as well as prolonged bottle-feeding, relate to the common Cuban belief that a healthy child is a chubby child ( ). Often the overweight child, by medical standards, is seen as normal or even underweight ( ; ). Another factor that contributes to early weaning is the Cuban concept of femininity and sexual attractiveness, which associates breastfeeding with deformity of the breast and therefore decreased female attractiveness to men ( ). An additional cultural value that promotes early and prolonged bottle-feeding is that crying is decreased because the bottle acts as a pacifier. Crying is considered an unacceptable behavior for infants and preschool children, with quietness being associated with happiness and contentment. Latina women associate crying by a child with the inability to meet a child’s physical and psychoemotional needs ( ). Last, the impact of women entering the work force and the convenience of bottle-feeding cannot be overlooked ( ). It is important for the nurse to be aware of cultural beliefs that promote early weaning and prolonged use of the bottle for Cuban-American children. Patient teaching needs to address criteria for defining a “healthy” baby, the meaning of crying, and alternative ways to respond to crying.
Prior to Castro, 85% of the population was cited as Roman Catholic ( ). However, until recently the society was highly secularized, with most people showing little interest in organized religion. Until 1991, governmental policy excluded persons with religious beliefs from membership in the Communist party. Today, there exists a resurgence in religion, and there is growth in many congregations. Some 1800 churches and chapels are present on the island. The population is currently listed as 47% Catholic, 5% Protestant, and 22% nonreligious. Although Catholicism is the most prevalent faith group, many Cubans combine ideas of African voodoo origin to form beliefs known as Santeria into their customs and practices. The practice of Santeria combines practices from the worship of Orisha, with its associated rituals, animal sacrificing, wearing of amulets, incantations, magic, and spirit possession practiced by the Yoruba tribe of Nigeria, and the cult worship of Roman Catholic saints or santos. It has been estimated that approximately 5% of Cubans practice Santeria ( Time Almanac, 2011).
Small numbers of people in Cuba practice spiritualism, which emphasizes communication with the dead, and brujeria, a form of witchcraft ( ). Churches are required to register with the Cuban government and to adhere to rules of association. Religious beliefs are not discussed in school.
It is estimated that 85% of Cubans in South Florida are professing Catholics. However, Cuban Americans tend to practice a personalized religion, with many families having shrines at the entrance to their homes, yards, or place of business. Crucifixes, pictures, or statues of saints are common inside the home. The religious holidays of Christmas, Three Kings Day ( Los Tres Reyes Magos ), and the festivals of La Caridad del Cobre (September 8) and Santa Barbara (December 4) are occasions for celebration ( ). Christmas Eve ( Noche Buena ) is also celebrated, with a pig cooked over charcoal and followed by attendance at midnight Mass. Some holidays that Cuban Americans recognize honor both a Catholic saint and an African god, such as St. Lazarus’s Day (December 17). Cuban Americans may celebrate other Cuban holidays, including Liberation Day (January 1), Labor Day (May 1), the Anniversary of the Attack on the Moncada Garrison in Santiago de Cuba in 1953 (July 26), and the beginning of the War of Independence from Spain (October 10). Mother’s Day is recognized on the second Sunday in May ( ).
Castro increasingly advanced education as a priority in Cuban society and as a way to promote Communist thinking ( ). Primary, secondary, technical, and higher education are provided to all citizens free of cost. Preschool is available in urban areas. Education is considered mandatory by the state for children between ages 5 and 12. Some 90% of children continue to secondary school, even if it means leaving a rural area to live at a boarding school. Graduates of secondary school may take college entrance exams or attend a technical training institute. Special schools are available for the mentally or physically challenged and for students gifted in the arts and sports. It is estimated that there is one teacher for every 45 inhabitants in Cuba ( ). The literacy rate in Cuba is 95% ( ).
Students in secondary school are likely to live in a boarding school in a rural area, dividing their time between school and agricultural labor. However, even though most boarding schools are often combined with farm work, food may be limited and supplemented by parental gifts. While education is free, the lack of incentive of higher wages for professionals prompts some students in universities to drop out of school. While a doctor, engineer, or lawyer may earn twice as much as a laborer, a waiter or guide without much education may easily earn more money by obtaining “tips” ( ). In the United States, among Cuban-American males, 75% are high school graduates or higher, compared with 76.0% of Cuban-American females. Similarly, 24.6% of Cuban-American males held at least a bachelor’s degree, compared with 25.0% of Cuban-American females ( ).
Implications for Nursing Care
It is important for the nurse to appreciate that an immigrant from Cuba will have experienced a different level of care, depending on social class and time of immigration. More recently, Cubans have become accustomed to a system of primary health care and to the delivery of health care services to the community. However, the family is still central to health practices. Since Cuban families often care for the elderly in their homes, it is important for the nurse to use creative and culturally appropriate strategies to assist family members to be caregivers. Both professionals and caregivers reported that the “online discussion” was valuable and useful in facilitating the provision of care in the home setting.
Death is also an event that occurs in a community context. Tangible aid is offered to the family by providing assistance with doing household chores, making funeral arrangements, giving gifts of candles and floral wreaths, and providing hospitality for family and friends who have traveled from afar. Memories are kept alive by remembering the dead on birthdays, the anniversary of the death, and visits to the grave. The nurse should be aware that when death occurs, it is normal for Cuban Americans to express grief openly and with loud crying. Immediate female family members will usually wear black during mourning.
The nurse should be aware that Cubans and Cuban Americans may take opposite political positions about the present Cuban government and the position of the United States toward Cuba. Cuban Americans who supported Batista and who emigrated from Cuba may still be considered counterrevolutionary by the present supporters of Castro. Cubans in America may have opposite ideas on the best future for Cuba, with some thinking the United States should intervene with military force while others advocate for a more peaceful resolution to the conflict ( ). Thus, information available to the nurse about Cuba and from Cubans may appear irreconcilable. The nurse should be aware that a Cuban American may have family in Cuba that could receive retaliation for a position that does not support the prevailing government.
The nurse should be aware that Cuban Americans may belong to a variety of church groups. Since religious beliefs vary, the nurse should assess a Cuban patient for religious orientation and needs. The predominant religion of Cuban Americans continues to be Catholic. For Catholics, praying and reciting a rosary, worship of important saints, confession, and communion may be important practices to be included in the plan of care ( ). The nurse should also appreciate and respect that Cuban Americans, much like many other Americans, may use an eclectic approach to health-seeking practices, combining Western medicine with folk medicine, home remedies, and use of santeros and spiritualists ( ). Santeria and a santero priest may be used when Western medicine and the church fail to offer healing. While most ceremonies conducted by a santero are held in the home, if the patient desires the ceremony to be conducted in the hospital, health care professionals should respect this choice. The nurse should not assume that a Cuban American will practice the Santeria religion. It is estimated that while Cuban Americans may be familiar with the Santeria religion, only a relatively small percentage (5% to 10%) of more recent immigrants in Miami may actually practice the Santeria religion.
It is important to note that as in any culture where slavery has been part of the nation’s history, there is a likelihood of prejudice. Nurses need to be aware of the possibility of discriminatory racial dynamics, especially among the elderly of this community. Given that prior to the Castro revolution the “well-to-do” in Cuba were accustomed to having black servants, many elderly Cubans continue to harbor attitudes and values of a more antiquated period. However, those Cuban Americans who have become acculturated and have internalized mainstream values related to class and race are less likely to subscribe to such attitudes and discriminating behaviors.