Culturally Competent Approach

Filipino Americans Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage

Almost 2 million in the United States

Literally all speak English and Tagalog (Pilipino), and many speak Spanish and another language

Predominantly from Malayan ancestry with influence and mixtures from other Asian groups, Spanish, and Arab

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

Americanization of the Philippines began after the Spanish–American War

Immigrant Filipinos make up the majority of Filipinos in the United States

Unrestricted immigration in the early 1900s then very restricted in 1924 because of the Exclusionist policies of Immigration Act of 1924

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

Immigration and Nationality Act of 1965 eliminated the quota system for the Philippines resulting in large numbers of middle class and professionals coming to the United States

Included relatives of Filipinos living in the United States

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

First group were primarily single men who were brought to the United States to work in Alaskan canneries, farms in California, and plantations in Hawaii and endured much discrimination

Most were restricted from owning or leasing land and could not become US citizens

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Overview/Heritage Continued

After WW II, many Filipino Veterans immigrated and settled on the West Coast

Now more women than men immigrate to the United States

Well educated immigrants continue to have difficulty in finding similar work in the United States unless they are in the healthcare field

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications

Tagalog is the national language with English the second official language

Eight other dialects are spoken as well as Spanish

Taglish is common among immigrants and American born Filipinos

Highly contextual communication patterns

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Pakikisama—smoother interpersonal relationships and sacrifice exact meaning

External or outsider communication and internal or one-of-us communication proceeds on different levels

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Interacting level

Participating level

Conforming level

Adjusting level

Understanding and acceptance level

Getting involved level

Being one with level

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

An exclusive “we” and an inclusive “we”

Eye contact varies with age, education, and acculturation

Many ways to say yes, but how do you say no?

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications Continued

Respect the past, enjoy the present, and hope for the future

Filipino time for social events, clock time if really important events, business, and work usually

Many names are Spanish in origin

One of the middle names is the mother’s maiden name

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Many Filipinos speak Tag-Lish, which is

a. A combination of Tagalog and English.

b. The indigenous language of the Philippines.

c. The official language of the Philippines.

d. A combination of Spanish and English.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: A

Tag-Lish is a combination of Tagalog and English.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles

Matriarchal before Spanish, then Patriarchal, now more egalitarian in decision making

Gender neutral pronouns causing confusion with he and she in English

Respect is a dominant family value and older children may assume the role of parent

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Honor and care for parents or brings shame to the family

Nuclear family is dominant although polygamous families exist among Moslem Filipinos

Extended family members are important

Education is paramount for children and parents sacrifice so at least one child will become educated and help the others if necessary

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Respect is shown to elders with deferential behavior

Grandparents become surrogate parents for their grandchildren in the United States especially

Advance degree brings higher social status

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Family Roles Continued

Filipino organizations targeted to gays and lesbians

Chastity is valued premaritally

Single parenting becoming more common in the United States

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology

Varying skin tones of brown and tan with dark eyes, flat nose bridges, and mildly flared nostrils

Most are of smaller stature than European Americans

More difficult to determine age than in European Americans because of youthful face

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Biocultural Ecology Continued

Endemic conditions in the Philippines include malaria, tuberculosis, gastrointestinal disorders, due to parasitosis, cardiovascular related disease, cancer, respiratory diseases, nutritional diseases, HTN, and diabetes

Sensitive to the effects of alcohol and require lower doses of neuroleptics

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition

Fundamental form of socialization

Any occasion is an occasion for food

Wide variety of foods and prepared in a variety of ways

Outsiders are served western food

Insiders are served Filipino food

To help in the kitchen you are really an insider

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued

Rice may be served at every meal, most common meats are fish, chicken, and pork

Diet varies among urban and rural areas

Lactose intolerance among adults

Milk in cooked desserts is tolerated well

Salt and vinegar are used frequently

Moderation in food is considered important

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Nutrition Continued

Considered polite to leave some food on your plate

Herbs are grown in many homes to be used for cooking and for medicinal purposes

Newer immigrants are at risk of nutritional deficiencies if unfamiliar with American foods

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family

Catholic religion influences birth control practices —rhythm method only

Abortion is considered a sin, carries a stigma, and leads to back door abortions

Pregnancy is a time for pampering and attention from entire family

Mother of pregnant woman has a very special role

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Consult healthcare provider plus a massage therapist for advice

Reluctant to take any medicine during pregnancy, even vitamins for fear of harming the fetus

Satisfy cravings so baby will not be marked with the craving

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Childbearing Family Continued

Should be protected from a sudden fright for fear it will harm the fetus

Mother rather than husband may be the coach during birthing

Traditional may not want to bathe but engage in sponge bath and aromatic oils

Soup increases lactation

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals

Three days to week for wake after death to await for family to come together—varies in United States because of work schedules

Plenty of food available and family support

Nine days of novenas in the home or church are common

Ritualistic mourning wearing black for one year

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Death Rituals Continued

Burial is the most common but cremation is okay

Body or ashes may be returned to the Philippines

Open expression of emotions and may include fainting

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality

80% Christian with 90% of them Roman Catholic

5% practices Islam

Many returning to Bathala, ancestral religion with a spiritualist guide who is usually a woman

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Spirituality Continued

Novenas and prayers are commonly said for the sick person

Good health comes to those who are in good with God and is the “Will of God”

Many are considered fatalistic, life is up to God, there is little one can do to change life circumstances and the forces of nature, monsoons, tides, volcanoes, earthquakes, etc.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices

Adhere to Western medicine and traditional practices simultaneously

Health is the result of balance and moderation and God’s Will

Adequate sleep, rest, nutrition, and cleanliness are important for good health

Aromatic baths restore balance

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued

In the Philippines many medicines can be purchased over-the-counter

May hoard and share medicine

Many do not seek care until the illness is advanced

Many distrust the healthcare environment

In the Philippines, one pays for testing before the testing is done

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued

Protect oneself from wind and cold

Avoid extremes of hot and cold—balance

Introduce changes gradually

Pain is part of life and may be atonement for immoral behavior and leads to stoicism

Mental illness carries a stigma, is hereditary and may affect one’s ability for a spouse

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Healthcare Practices Continued

Mental illness may be severe before help is sought —take care of family member at home

Somatization of symptoms is common

Important to maintain self-esteem and self-image for self and family

Able to enter the sick role easily

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

ClickerCheck

Mrs. Lino, age 38 years, has been seeing a traditional Filipino healer for her pregnancy complications. A Filipino traditional healer is

Galang.

Utang na loob.

Hilot.

Hiya.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Correct Answer

Correct answer: C

A hilot is a traditional Filipino healer.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition