Perception of Nursing Care in Long-Term Care Facilities: A Comparative Perspective Between Mexico and the United States

Enrique Pérez Cruz, BSN
Nursing Manager
Serena Senior Care, Mexico

The perception of nursing care is a central indicator of care quality in long-term care facilities. Scientific evidence shows that this perception depends not only on technical competence, but also on the staff’s ability to establish therapeutic relationships based on effective communication, empathy, and cultural competence.

In geriatric care, these elements directly influence residents’ trust, satisfaction, and emotional well-being.

This article presents a comparative narrative review between Mexico and the United States, highlighting strengths of the Mexican context in terms of cultural alignment, family integration, and humanization of care.

Perception of Care and Cultural Competence in Nursing

Cultural competence is defined as the ability of nursing professionals to provide respectful and personalized care, considering residents’ values, beliefs, language, and customs. Recent systematic reviews confirm its association with improved outcomes in care perception, particularly in communication, trust, and overall satisfaction (Haqawi et al., 2024; International Journal of Nursing Studies, 2025).

Resident trust acts as a key mediator between cultural competence and a positive care experience, even in complex clinical scenarios.

United States: Diversity, Standardization, and Relational Challenges

The U.S. healthcare system serves a highly diverse population. Among Latino populations, the literature documents that care perception may be negatively affected when cultural or language barriers exist, even when care is technically appropriate. Residents value being listened to without rush, receiving clear explanations, involving family in decision-making, and having cultural expressions of pain or dependency understood.

High levels of protocolization and administrative burden—common in long-term care settings—can limit time for direct therapeutic interaction, contributing to a more impersonal perception of care.

Mexico: Relational Approach and Humanization of Care

In Mexico, studies highlight a relational approach to nursing care, where residents and their families value not only the execution of procedures but also how they are performed.

Respectful and warm treatment, emotional support, availability to listen, and staff continuity are associated with a positive perception of care, especially in geriatric facilities (Chen et al., 2016; Enfermería Clínica, 2023).

Cultural proximity facilitates the interpretation of nonverbal cues and the early identification of emotional and physical needs (Leininger & McFarland, 2006).

Strengths of the Mexican Context from a Cultural Competence Perspective

The Mexican context presents structural advantages for a positive perception of care among older adults:
(1) cultural and linguistic alignment that reduces barriers and fosters trust;
(2) implicit communication and culturally informed interpretation of nonverbal cues; and
(3) family integration as part of the care process, a highly valued element among Latino patients.

Continuity of care strengthens the therapeutic bond and the resident’s sense of security.

Institutional Geriatric Approach

In older adults with cognitive impairment, such as Alzheimer’s disease and related conditions, the care experience is primarily shaped by relational elements: tone of voice, patient repetition of instructions, familiarity with staff, and consistency of the assigned caregiver.

Stability within the nursing team reduces anxiety and strengthens trust, even when verbal comprehension is limited.

In long-term care facilities, the quality of the therapeutic relationship may influence care perception more than some structural indicators—an aspect particularly relevant in the Mexican context.

Implications for Nursing Management and Leadership

For nursing management, these findings underscore the need for person-centered care models that prioritize continuity of care, staff stability, and the strengthening of cultural competence as key quality indicators.

Integrating the family as a partner in care improves service perception and institutional trust. Strategically, the humanization of care positively impacts resident satisfaction, staff retention, workplace climate, and institutional reputation.

Conclusions

There is no intrinsically superior care model; positive perception is enhanced when care is culturally sensitive, humanistic, and person-centered.

In the United States, standardization and clinical safety coexist with relational challenges derived from cultural diversity and administrative burdens. In contrast, the Mexican context offers advantages in continuity, relational closeness, and family integration—factors particularly relevant for older adults of Latino origin.

Recognizing and strengthening these elements contributes to the dignity, emotional well-being, and trust of residents and their families.

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