Caroline E. Ortiz, MS, MPH, RN, NC-BC
Caroline E. Ortiz, MS, MPH, RN, NC-BC, Associate Professor, Holistic Nursing, Pacific College of Health and Science, grew up in a bicultural and bilingual household. So it’s not surprising that she learned a great deal about traditional healing practices of Mexican-American women —especially from her grandmother.
When Ortiz decided to pursue a PhD, she chose this topic to study. We interviewed her about it to see what all nurses could learn from her research.
How did you get interested in the traditional healing practices of Mexican-American Women? Why did you choose this for your PhD topic?
Growing up in deep South Texas on the coastal border with Mexico, I was raised in a bicultural/bilingual region where Mexican culture and traditions mixed with those considered American. My mom was a nurse, so when we were sick, she would take us to the pediatrician. However, if we were staying with our grandmother—my mom worked a lot—she would either administer home remedies or take us one block down the road to the local traditional healer.
As a child, I did not understand the difference between Western biomedicine and traditional medicine. I just knew that receiving care from my grandmother and the local healer felt so much more love-infused than when taken to the doctor. As I further explored complementary and alternative medicine and holistic nursing, the childhood memories of my grandmother’s healing rituals and remedies and the feelings of being deeply cared for returned.
My decision to study traditional healing practices among Mexican-American women of deep South Texas is more an act of honor and gratitude to my ancestral medicine-keepers than being strictly an intellectual endeavor. Through this work, I am returning home to learn from caregivers and healers with the intention of sharing what the traditional medicine from ancient Mesoamerica by way of Mexico can teach us today about well-being and healing in mind, body, spirit, and emotions.
Have you or anyone you know actually practiced these traditional healing techniques? If so, please say which ones and explain.
- Plática – an organically unfolding heart-centered talk for arriving at the root of a problem and mutually working it through to resolution
- Limpia – an energetic spiritual cleansing using various tools, such as healing herbs or a whole, uncooked egg, meant to harmonize imbalanced physical, emotional, mental, or spiritual aspects
- Botanicals – the use of healing herbs and botanicals for numerous ailments (physical, emotional, or spiritual) in a variety of preparations, including infusions, tinctures, or in natural form; Commonly used are rue, basil, rosemary, chamomile, rose, sage, lavender, fever few, cinnamon, and aloe vera.
These practices are commonly noted in Mexican-American communities today, whether used by informal caregivers independently or with the assistance of a traditional healer.
How do you think that your research may help the nursing field? Should some of these practices be used in Western medicine? Or are you focusing more on how and why nurses should be aware of these practices?
My intentions are to share with nurses and health care practitioners and leaders what so many patients are practicing and have kept as valuable cultural expressions for improving health, healing, and well-being individually and collectively.
Why is it important for the health care field to be aware of these traditional healing practices?
Research shows that medical pluralism is commonplace, especially in geographical regions where cultures intersect, as they do along the U.S.-Mexico border. This means that people are utilizing more than one medical system or paradigm of care at a time. However, patients of Mexican ancestry are often not disclosing their home treatments to health care providers, and their providers are often not exploring those practices beyond a superficial level, if at all.
The standard of high-quality health care includes being effective, safe, and culturally responsive. Knowing more about traditional medical practices in U.S. communities of Mexican origin and leveraging their potential for improving health expands opportunities for meeting those standards. Moreover, the U.S. medical system may come to learn additional approaches to health, healing, and well-being practiced by other cultures with positive outcomes. The World Health Organization’s Traditional Medicine Strategy has the incorporation of traditional medicine into Western health care systems as one of its goals for increasingly accessible and equitable health care worldwide.
Is there anything I haven’t asked you about that is important for our readers to know?
Curanderismo is the Spanish term describing traditional medicine from ancient Mesoamerica and currently practiced by many communities in Mexico, Central America, the Andes, and the Amazon. It comes from the word curar, meaning “heal.” In curanderismo, the health state means being in harmony internally and externally. Internal harmony balances the physical, mental, spiritual, and emotional aspects, while external harmony balances the self in relationship with others, the natural world, and the greater, multi-dimensional universe. However, this paradigm, in essence, acknowledges no separation between any of these elements.
Cervical health is an essential part of well-health screenings and can help detect cervical cancer, one of the more preventable types of cancer. January is Cervical Health Awareness Month and highlights the steps that can help prevent cervical cancer.
According to the National Cervical Cancer Coalition, more than 13,000 people are diagnosed with invasive cervical cancer every year. And while any case of cancer is one too many, cervical cancer rates were once much higher and more deadly than they are now. Cervical cancer used to be the leading cause of cancer deaths among women in the United States, but several developments have led to dramatic positive change.
Most cases of cervical cancer are caused by the human papilloma virus (HPV). According to the Centers for Disease Control and Prevention (CDC), most men and women will be infected with one of the strains of HPV at some point. Currently, 80 million Americans are infected with HPV, with 14 million additional infections yearly. In most cases, the virus will stay present in the body and will go away, like many viruses do, within a couple of years. There are more troublesome strains that will remain in the body and can cause different types of cell changes that can lead to cancer.
According to the CDC, there are a few ways the medical community can approach prevention detection, and treatment. The introduction of the HPV vaccine, regular Pap smears, and tests to detect the presence of HPV have dramatically reduced the incidence of cervical cancer in the United States.
Development of the HPV vaccine was a game-changer for preventing this kind of disease. Nearly all cervical cancers are caused by HPV, a virus with many strains. Some strains of the virus can cause genital warts while other strains cause few or no symptoms but can lead to changes in the cervix over time that cause cancer if left undetected and untreated.
Although adults can get the HPV series of vaccinations up until age 45 (it is most recommended up until age 26), it is highly recommended for youths beginning around age 11 or 12. Receiving the vaccine before any potential exposure to HPV can prevent infection with the virus, but isn’t a treatment if the virus is already present.
Increasing attention to screening for cancerous changes in the cervical cells with Pap smears and for detection of any HPV levels in cells (two separate tests that can be done at the same visit) has upped the detection rate of more treatable precancerous changes. If cervical cell changes are detected, treatment options are available and will depend on the findings. Removal of the precancerous cells may be recommended to prevent cancerous changes. And a positive HPV test with a normal Pap smear offers valuable information that may lead to more frequent screening to catch changes early.
Talking to Patients and Families
Despite its effectiveness, rates of HPV vaccination lag behind what many medical professionals consider ideal. If patients and families in your practice seem hesitant, it might help to offer a few facts. The vaccine is to prevent cancer, but because HPV is transmitted sexually, some families relate the vaccine with condoning sex. The more you can separate the two so that the concern is for long-term health and is for potential exposure, the more success you might have. The American Academy of Pediatrics’ HPV Champion Toolkit is another resource to help increase vaccination rates which will lead to fewer cases of cervical cancer.
The most important prevention for preventing cervical cancer is to keep up with regular screenings. If you haven’t had a Pap smear in a while or have been postponing your annual visit because of a packed schedule, put it back on your high-priority, staying healthy list. Outcomes are drastically different when these changes are caught at a treatable stage.
What comes to mind when you hear the words, “Physical Activity”? For some, it might conjure up a negative connotation while for others, they may already be a go getter for an active lifestyle. Believe it or not, physical activity and exercise are two different terms although used interchangeably. Physical activity is any movement of the body done through skeletal muscle contraction that causes the energy expenditure to go beyond its baseline. Simply stated, physical activity is movement, in any form.
Sadly, less than 5% of adults participate in 30 minutes of physical activity, and 28-34% of adults aged 65-74 are physically active in the United States. It is important to gather some perspective on the impact of a sedentary lifestyle and how it is more common than physical activity. According to the Center for Disease Control, physical inactivity is even more common among ethnic and racial groups in most states. The CDC’s January report from 2020 showed overall, Hispanics had the highest prevalence of physical inactivity (31.7%), followed by non-Hispanic blacks (30.3%) and non-Hispanic whites (23.4%).
We all have heard of vital signs. Part of that assessment should also involve the type of physical activity one engages in. As nurses, we are the largest body of the health care workforce, and studies show that we are not following healthy practices when it comes to our self-care and well-being. The American Nurse Association even launched a Healthy Nurse, Healthy Nation initiative to address the core elements that address nurse’s self-care and well-being, Activity, being one of them which goes to show that this is a pressing concern.
Some of the challenges posed as to why people do not take part in physical activity is location. The neighborhood in which people live may not have access to outdoor parks, paved streets, or recreation centers. Depending on your home environment, you may not have the space to exercise in.
The good news is just doing any activity, especially one in which you enjoy doing is acceptable in burning calories. Anything is better than being sedentary. The risks of sedentary behavior are universal and it is important for nurses to adopt a more active lifestyle. Physical inactivity is closely related to premature death, preventable disease, and health care costs.
Exercise is a subset of physical activity and is defined as an activity that is organized, planned, and reoccurring which is done with the intent of improving or maintaining one or more components of one’s health. Having said this, physical activity can involve any movement and does not have to involve a schedule or with an “all or nothing” attitude. For those who are trying to lose weight, exercise is not as important as much as your food intake. There needs to be a calorie deficit in order to lose weight. Nutrition and physical activity work in tandem but about 80% is based on nutrition and 20% should be focused on physical activity.
Physical activity come with benefits such as: heart health and prevention of diabetes, improved strength and mobility, release of dopamine, endorphins and serotonin (the “feel good” hormones), increased lifespan, and increased insulin sensitivity. Carrying on extra weight can contribute to joint pain. For every additional pound that you are overweight, an extra 5 pounds of pressure is exerted on your joints.
It cannot be argued that the majority of nurses are female and women tend to hold onto more fat than men; that is how nature intended us to be designed. As we age, we are also at risk for bone loss. For that reason, we do not want to lose weight too quickly because we also want to protect our bones, which is why muscle resistant training is so important. Half a pound per week of weight loss is the ideal; it is all very specific to how much weight the person needs to lose. Even a 5-10% weight loss can reap positive effects on overall health.
Nurses, especially those of other ethnicities can become role models and advocates for system changes at the workplace as well as at home. Even if nurse leaders are not fully on board, it is important to heighten awareness on the benefits of physical activity which would improve morale as well as productivity. Identifying barriers is the first step and serving as a role model would also provide an impetus for behavior change.
Just like with patients, we need to assess our readiness and meet ourselves where we are at. We need to give ourselves permission to work on our fitness regimen so it can be more sustainable. The best exercise to lose weight is the exercise you will do. If you have to ask yourself, “Should I work out today?” hopefully, the answer is yes. If you choose “No”; well, yes you should.
The thyroid gland might be small, but any changes to its function can pack a huge wallop on how you feel every day. During January’s national Thyroid Awareness Month, pay attention to any possible symptoms that could indicate problems in you or any of your patients.
According to the American Thyroid Association (ATA), some of the more common diseases of this small gland include an overactive thyroid (hyperthyroidism), an underactive thyroid (hypothyroidism), and even thyroid cancer. Symptoms of these endocrine diseases can overlap with each other and can be mistaken for many other conditions.
Symptoms of hypothyroidism are frequently dismissed by patients. As a nurse, your patients may complain about being excessively tired or lacking energy or even that they have a worsening mood. They may have noticed their hair is thinning or falling out or seems especially brittle. Hypothyroidism can cause people to gain weight and to feel cold in temperatures that were previously comfortable. Often, people will attribute these symptoms to stress, a particularly busy time, or seasonal changes.
It might seem that symptoms of hyperthyroidism would be the polar opposite of having hypothyroidism, but that’s not always the case. Because hyperthyroidism can speed up the metabolism, patients might also pass off symptoms like a racing heart, more-than-normal sweating, or mood changes to job stress, lots of activity, or even an increased fitness routine. But they can also experience the fatigue and hair loss that hypothyroidism presents. Some patients may notice more prominent eyes (Graves’ disease) or even feel their thyroid gland itself is enlarged.
According to the American Cancer Society, rates of this cancer have increased in the last decade in young adults (3 percent increase annually) and adolescents (4 percent increase annually), and even those who have had no prior thyroid problems can have thyroid cancer. This highly treatable cancer often presents as a lump in the neck rather than with symptoms like those of hyperthyroidism or hypothyroidism, and even blood tests don’t show anything abnormal.
If any of your patients mention these symptoms, a blood test may be in order. According to the ATA, a simple lab test will check thyroid hormone levels. If the levels of thyroxine (T4) or triiodothyronine (T3) or of the thyroid-stimulating hormone (TSH) are too high or too low, follow up will help determine next steps of medication, treatment, and referral to a specialist. If you or they notice any kind of lump in the thyroid gland, follow up tests are necessary to check for cancer.
Thyroid problems are fairly common and approximately 20 million Americans have some kind of thyroid disease. Listen to your patients as they describe any physical, cognitive, or emotional changes they have experienced to help detect any changes in the early stages.
The contributions of a nurse in today’s crisis – stricken society are countless, especially in the midst of this pandemic. For that reason, thorough explanation of the nurses’ role is imperative for greater appreciation. Nurses have well known responsibilities including but not limited to recording medical history, vital signs and symptoms, patient advocacy, monitoring patient health and administering medications and/or treatments. Nurses collaborate with members of the interdisciplinary team for better patient outcomes and educate patients and their families about the management of illnesses. In academic settings, we educate aspiring nurses and propel them to achieve their goals in the midst of challenging life circumstances. As they say, nurses wear many hats, and as a result, nurses are burning out.
A nurse must advocate for patients beyond the health care environment while utilizing a holistic care approach; a patient may be admitted to a hospital or other health care setting for a particular ailment. However, the nurse must question this patient’s ability to care for themselves on their own, and if incapable, ensure that adequate support is in place upon discharge. Nurses also care for patients’ families. Often times, difficult conversations must occur and nurses are challenged to interact with those on the receiving end. Nurses are usually the first to notice irregularities due to the first phase of the nursing process – assessment. Nurses are the punching bags for the frustration of others on a daily basis. While nurses ought to possess qualities of resiliency, they are also human, and if empathic in nature, easily carry the stress of others on their shoulders. Hence, while taking work load, work environment, and coping mechanisms into consideration, nurses are at increased risk for burnout.
Burnout is defined as a state of emotional, physical, and mental exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed, emotionally drained, and unable to meet constant demands. It has many physiological effects. In a recent study conducted by Salvagioni et al (2017), burnout was a significant predictor of the following physical consequences: hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, changes in pain experiences, prolonged fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality below the age of 45 years. Specific to nurses, in a 2019 study, 14.4% were found to be unengaged with their work, 41% of those respondents reporting feelings of burnout. Due to the physical and emotional demands of the job, nurses ought to be cognizant of the warning signs of burnout (anxiousness, chronic fatigue, insomnia, and frequent illness) because they are putting their health in jeopardy. Please take into account that these statistics are not reflective of the impact COVID-19 has had in the nursing industry. Therefore, in 2019 – 2020, these statistical figures are presumed to be more alarming.
In September 2018, I recall being transported by an ambulance from a clinical setting to the hospital. Runs of atrial fibrillation and ventricular tachycardia flooded the heart monitor as I struggled to maintain my strength, oxygenation and my life. “Look! You can show these rhythms to your students!” said the EMT as life threatening rhythms printed from the monitor. My usually jovial self immediately thought, “Did he really have to say that and could this get any worse?”
At the time, I was a nursing education supervisor for a technical school. The program grew exponentially and I was expected to supervise both day and evening programs. This not only meant overseeing and executing the curriculum’s development and application, but also subbing for instructors as necessary, which was quite often. I was a single mother in need of more support. My divorce was recently finalized. Ageism and racism were also my contenders in the work environment. I was challenged when giving direction to a group of women, my staff, who were older and looked different from me. I was expected to provide hope for my students who had lost hope in themselves due to extenuating life circumstances. Inadvertently, I experienced the warning signs of burnout such as anxiousness and chronic fatigue, but ignored them, leading to my experience in September 2018.
In the year of 2019, I went on a quest to find a work environment that was more holistic and welcoming. The familiar saying, “Nurses eat their young” resonated within me. My mental health suffered as I experienced feelings of being unappreciated and belittled. Nonetheless, in the midst of all of this rain, the sun did shine again. I decided to return to my home district as a school nurse, which gave me an opportunity to give back to my community and encouraged healing for my broken soul.
As a survivor of burnout and the consequences that came with it, I feel the need to bring awareness to the fact that nurses need to be nursed. So, who nurses the nurse? If possible, nurses must nurse themselves by doing the following:
Evaluate Your Own Personal Life.
Ask yourself, have I recently experienced life changing events and have I taken enough time to ride life’s emotional rollercoaster? Trying to balance work and these emotions can lead to a very bumpy ride (burnout). One may need to request time off from work or even take a leave of absence. Taking these actions does not mean that you are weak. It just means that you are taking a step closer to healing.
Identify Sources of Support.
As John Donne said, “No man is an island. No man stands alone.” It is impossible to navigate through these difficult times in solitude, so finding a trusted confidant is important. It may be a family member or a close friend. For some, it may involve getting help from a licensed therapist. Once having adequate support systems, you will come to the realization that you are not alone. This notion generates healing thoughts and behaviors.
Ask For Help.
Nurses have a tendency to practice autonomy and often forget about asking for help. We always give but do not want to receive.
Diet and Exercise.
You are what you eat, therefore in order to promote feelings of wellness, we need to eat foods and participate in activities that support wellness. Overall, one should base their diet on whole grains, increase fruit and vegetable consumption, and reduce fat, salt, and sugar intake. We should also aim for 30 minutes of moderate physical activity daily.
Watch Your Water Intake.
Men and women need approximately 3 liters of fluid daily, however water requirements vary depending on weight. As it pertains to burnout, water can help maximize physical performance. Water also significantly affects energy levels and brain function.
Make Time For Hobbies.
Do not forget about your interests. Make time for these activities. It could be as simple as listening to music or watching an interesting TV show. I’ve always loved dancing. Since my experience in 2018, I joined a ballroom dancing/social community.
Practice Mindfulness Meditation.
This is the practice of actually being present in the moment which in turn trains you to become more mindful throughout the day, particularly during stressful situations. There are an abundance of mindfulness meditation exercises that can be found on the internet. I do these exercises daily.
Get Enough Sleep.
We need at least seven to nine hours of sleep daily to function at our best. If you are having a hard time achieving this, talk to your doctor. You can consider non-pharmacological methods such as teas and lavender oils. According to the National Sleep Foundation, obtaining healthy sleep is important for both physical and mental health, improving productivity, and overall quality of life.
Watch Your Appearance.
If you think you look good, chances are you will feel good too. Participate in practices that enhance positive feelings about personal appearance. Do a facial. Get your eyebrows waxed and your hair done. Do you!
The above recommendations highlight the importance of self-care. I urge each and every nurse to take part in such practices before it is too late. The disease processes that result from lack of self-care are probable, but preventable. So before you become dependent on a caretaker due to illness, remain independent by being your own best nurse.
Special Thanks: Desmond & Lillieth Gayle; The Wong Family; Nayomi Walton, PhD, RN; Therelza Ellington, RN; Anisa Cole, LCSW; Bloomfield Public Schools
In the spring of 2020, the coronavirus pandemic first gripped the world by the throat and its deadly menace continues to unfurl with renewed ferocity. In the United States, medical and scientific experts issued a series of early recommendations to slow or halt the spread of the virus that causes the disease COVID-19. Such public health measures are clearly warranted. As of this writing, over 285,000 Americans have perished from COVID-19 and the infection numbers are soaring across much of the country. Recommendations to combat the virus spread include handwashing, covering the face when coughing and sneezing, wearing a mask when in public spaces, and social distancing. The most challenging anti-virus measure was the lockdown or stay-at-home orders issued by state and local governments. In many communities, people rushed out to stock up on food, water, and household supplies before they began sheltering in place. The lockdown preparations and implementation clearly highlighted the pervasive and persistent inequalities impacting every aspect of American life that are attributable to social determinants of health (SDH). The World Health Organization defines SDH as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.” During the current public health crisis one key question for researchers, policymakers, and clinical providers alike to ask is: Which populations in the U.S. are most likely to experience adverse effects from SDH?
As an academic nurse researcher with expertise in health disparities, I closely monitored news about how the spring lockdowns were impacting various population groups. I paid special attention to the dramatically different experiences of white-collar employees, many of whom had the privilege of safely sheltering in place while working from home, and front-line essential workers who had no such option. This later group, often employed in grocery stores, meat-packing plants, bus stations, and other crowded environments, had higher risk of exposure to the coronavirus. Many of these essential workers are people of color and the devastating consequence of this reality was all too predictable. According to the U.S. Centers for Disease Control and Prevention, communities of color have experienced considerably higher rates of infection, severe illness, and death from COVID-19. This population includes approximately 100,000 individuals, largely African American, with sickle cell disease (SCD), an inherited red blood disorder. The major symptom of this disease is persistent, disabling pain, including excruciating episodes known as a pain crisis. SCD is a lifelong illness with a life expectancy of 48 years for women and 42 years for men.
With a primary research focus on pain management disparities experienced by SCD patients, I worry how coronavirus-related stressors are exacerbating the considerable pain already endured by these individuals. My research indicates that systematic stressors such as healthcare injustice—defined as unfair treatment an individual receives from important medical figures such as healthcare providers — predicts increased pain in patients with SCD. They are particularly vulnerable at this time because the coronavirus pandemic can magnify the negative SDH already experienced due to their race and disease trajectory.
I am concerned about how SCD patients are coping with today’s magnified societal stressors, particularly when trying to avoid a stress-related pain crisis that would require hospitalization and potential exposure to the coronavirus. Given the comprised hematologic profile of patients with SCD, which reduces oxygen circulation, these individuals are at elevated risk for both COVID-19 severity and mortality. Statistics from early in the pandemic document this grim reality. A recent study found that between March and May 2020, 178 infected individuals were entered into the SCD-coronavirus disease case registry. Of these, 122 (69%) were hospitalized and 13 (7%) died. (These hospitalization and death rates are much higher than for infected individuals in the general population.) Healthy stress management techniques that decrease emotion-triggered pain crises could greatly improve the well-being of SCD patients and potentially reduce their hospitalizations and deaths. Healthcare professionals can play a key role in encouraging patients to consistently utilize non-drug coping strategies to complement medication regimens for pain management.
Our research team found that patients with SCD who experienced healthcare injustice from nurses reacted to this psychological stressor by isolating themselves. Meanwhile, those who experienced healthcare injustice from doctors reacted by both isolating and pain catastrophizing. These negative coping strategies are associated with poor health outcomes. For example, pain catastrophizing corresponds to lower health-related quality of life for patients with SCD. On a more positive note, patients who experience healthcare justice also cope with prayer and hopeful thinking. These healthy strategies have long been endorsed within African American communities, where deep spiritual beliefs and regular religious practices have helped them deal with the harsh realities of slavery and the systemic racial discrimination and injustice that sadly remains a powerful force in American culture.
Another coping strategy for SCD patients dealing with stress and pain is guided relaxation. This can include deep breathing and counting backwards from 10 to 1 while focusing on a specific spot within an object. This technique has been shown to effectively reduce stress and pain for adults with SCD. Another recent study found that music therapy also reduces pain and improves mood. It is important that these vulnerable patients know there are a number evidence-based drug-free strategies they can utilize during this unprecedented and pressure-filled coronavirus pandemic.
Unfortunately, SCD patients in the United States, like other citizens the world over, cannot individually control the course of the pandemic and the havoc it is wrecking. However, these patients do wield tremendous control over how they choose to cope with coronavirus-related stressors that can intensify their SCD pain. In addition to the non-drug options described above, individuals can explore and try other safe coping strategies to better manage their physical and emotional health challenges. It is vital that patients are proactive on an ongoing basis to reduce their stress and pain and improve their overall well-being as the world awaits better coronavirus treatments and an effective vaccine.