Por Que Yo? Why Me?

Contributor – Maribel Alcala

This brief introduction encourages the development of the nursology knowledge on cultural diversity and inclusion. It focuses on the vulnerability of the Spanish-speaking population in the United States who immigrated to this country looking for a better quality of life, leaving behind what they have been taught for generations, their homes, families, and, most importantly, their rich culture. The question, “Por Que Yo,” means Why Me? This a question that most of the population ask themselves when an illness has reached near mortality.

The Spanish-speaking population is the most significant ethnic minority living in a predominantly English language, modern Western healthcare system. Spanish-language speakers represent 13.5% of the U.S. population, making Spanish the second most spoken language in the U.S. (United States Census Bureau, 2019; Christy et al., 2021). The Hispanic population contributes to the economy, cultural diversity, and the nation’s health. Among the Spanish-speaking adult population, 41% have below basic health literacy, 25% have fundamental health literacy, and 31% have intermediate health literacy (Christy et al., 2021). According to the U. S. Department of Health and Human Services (Housten et al., 2019), health literacy (HL) is defined as the “degree to which individuals can obtain, process, and understand the basic health information and the services needed to make appropriate health decisions.” A new definition of health literacy by Healthy People 2030 emphasizes personal health literacy as “ the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others”(Christy et al., 2021 p. 344).

Nurses are the first healthcare provider. Spanish-speaking patients or families spend more time with the nurse, and nurses advocate for all patients. It is essential for the nurses in the Nation to understand and learn to respect and include the diversity of the Spanish culture. Madeleine Leininger predicted that culture and care were embedded in each other and needed to be understood and provide culture-specific care that would be culturally congruent, safe, and beneficial to people of diverse cultures for their health and healing. Madeleine Leininger’s theory of Transcultural Nursing, also known as Culture Care Theory, identifies nursing decisions and actions that achieve culturally friendly care for the patient, specifically for nurses who are not Spanish-speaking.

It is fundamental to improve the nurse’s knowledge and strengthen theory-based approaches to the nurse-patient relationships by emphasizing the sensitivity of the culture of the whole person rather than viewing the patient as a set of symptoms or an illness. There are many reasons for nurses to use the cultural understanding of patients’ cultural backgrounds in their assessments. It facilitates nurses to know how the patient’s culture and faith support their experiences when dealing with illness, suffering from pain, and death.

A call out to all nurses is essential to pay attention to how we as nurses engage with Spanish-speaking patients or with people of other ethnicities. Still, by implementing cultural care knowledge in the patient’s assessment and treatment plan, the patient will start to contribute by advocating for themselves and, in turn, helps the nurse be open-minded to treatments considered non-traditional but spiritually-based therapies in some cases. Nurses and other practitioners must understand how important it is for families to be included in healthcare decision-making. For many Spanish-speaking patients, families are important and necessary. What do we as nurses or practitioners need to consider and do to recognize and respect this in our interactions with Spanish-speaking patients? We can improve the nursing practice from the perspective of Leininger’s Theory!


Christy, S. M., Cousin, L. A., Sutton, S. K., Chavarria, E. A., Abdulla, R., Gutierrez, L., Sanchez, J., Lopez, D., Gwede, C. K., & Meade, C. D. (2021). Characterizing health literacy among spanish language-preferring latinos ages 50–75. Nursing Research, 70(5), 344–353. https://doi.org/10.1097/nnr.0000000000000519

Fawcett, J. (2018). Leininger’s theory of culture care diversity and universality. Nursology. https://nursology.net/nurse-theories/leiningers-theory-of-culture-care-diversity-and-universality/

Housten, A. J., Hoover, D., Correa-Fernández, V., Strong, L. L., Heppner, W. L., Vinci, C., Wetter, D. W., Spears, C. A., & Castro, Y. (2019). Associations of acculturation with english- and spanish-language health literacy among bilingual latino adults. HLRP: Health Literacy Research and Practice, 3(2), e81–e89. https://doi.org/10.3928/24748307-20190219-01

Ray, M. D. (2018). Transcultural caring dynamics in nursing and health care. Nursology. http://nursology.net/nurse-theories/transcultural-caring-dynamics-in-nursing-and-health-care/
United States Census Bureau. (2021). Quick facts statistics. https://www.census.gov

About Maribel Alcala

Maribel Alcala is a bilingual Patient Education Liaison for Alnylam, a biopharmaceutical company in the RNAi scientific space. Mari is a healthcare professional with outstanding clinical leadership in the hospital setting and expertise in nursing clinical research for best practices, integration, education, system redesign, and quality improvement in Spanish-speaking patient-focused. Mari’s passion for solid scientific and strong interest in emerging treatment modalities and helping Spanish-speaking patients/ families with innovative best practices utilizing the nursing philosophy of Leininger’s Culture Care.

3 thoughts on “Por Que Yo? Why Me?

  1. Thank you Maribel for writing such a thoughtful and important piece. This topic is so timely and important for our community and for everyone caring for our families. Muchisimas gracias!

  2. Maribel,

    As a first generation Mexican American PhD Nursing student, I believe we (Nurses) have the responsibility and the power to make a significant difference in patient lives, especially those that are most vulnerable. Thank you for bringing a light to this very important topic.


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