Rema Angela Bulatao BSN-2B

 Similarly, a nurse’s worldview is influenced by the

Patient’s Bill of Rights culture of the nursing profession and the culture of
the organization that he or she represents.
Patients’ Bill of Rights and Obligations Therefore, every nurse–client interaction is a
The Patient has the right to: cultural encounter.
1. Considerate and respectful care;  A nurse cannot assume sameness of values, even if
2. Relevant, current and understandable information the client appears to resemble the nurse in
concerning diagnosis, treatment prognosis, specific outward appearance.
procedures, treatment, risk involved, medically  It is the nurse’s responsibility to recognize the
reasonable alternative benefits needed to make client’s cultural perspectives
informed consent;
3. Make decisions regarding his plan of care, in case CULTURALLY RESPONSIVE CARE
of refusal, he is entitled to other appropriate care  Culturally Responsive Care is care that is centered
and service or be transferred to other hospital; on the client’s cultural point of view and integrates
4. Have advance directive (such as living will) the client’s values and beliefs into the plan of care.
concerning treatment or designating a surrogate  To deliver such care, the nurse must first develop
decision maker; self-awareness of his or her own culture, attitudes,
5. Every consideration of his privacy such as in case and beliefs, and examine the biases and
discussion, consultation and treatment; assumptions he or she holds about different
6. Confidentiality of communications and records; cultures.
7. Review his records concerning his medical care and  Next, the nurse needs to gain the necessary
have these explained to him except when knowledge and skills to create an environment
restricted by law; where trust can be developed with the client.
8. Be informed of business relationship among the  This knowledge must include an understanding of
hospital, educational institution, health care health disparities as well as the historical and
providers that may influence the patient’s current portrayals of racial and ethnic groups in
treatment and care; society.
9. Consent to decline to participate in experimental  Additionally, cultural knowledge can help the nurse
research affecting his care; to better understand different perspectives, while
10. Reasonable continuity of care when appropriate recognizing that cultural generalizations may not
and be informed of other care options when hold true at the individual level.
hospital care is no longer appropriate; and  Cultural assessment skills are essential in
11. Be informed of hospital policies and practices that understanding the client’s viewpoint more fully,
relate to patient care. and learning what the client values as important.
 The nurse must partner with the client in a caring
Communication and Teaching with Children and Families and respectful relationship that honors the client’s
 TO BE DISCUSSED BY STUDENTS differences and perspectives.
Nursing Care Planning: Interprofessional Care Maps  In culturally responsive care, the nurse must
 TO BE DISCUSSED BY STUDENTS respond to the client’s needs, not vice versa. Only
through self-awareness, deliberate cultural
Related Studies on Maternal and Child Nursing assessment, and incorporation of the client’s
 Researchable Topics/ Problem culture into the plan of care can a nurse optimally
 Related Literature Search care for a client.

Filipino Culture, Values and Practices in Relation CULTURAL CONCEPTS

to Maternal and Child Care  Culture is complex, with multiple definitions, and
the term is often used interchangeably with other
Introduction terms such as race, ethnicity, and nationality.
 Nursing care is holistic and encompasses the
client’s perspectives on health, which are greatly CULTURE
influenced by the client’s culture. Each person is  Culture is the “thoughts, communications, actions,
born into a culture influenced by the place of birth customs, beliefs, values, and institutions of racial,
and the family of origin. A child learns the family’s ethnic, religious, or social groups” (U.S.
customs and beliefs, which shape his or her Department of Health and Human Services
worldview. [USDHHS], Office of Minority Health [OMH], 2005).
 An individual’s culture is dynamic and shifts over  It has been described as the learned and shared
the course of a lifetime, influenced by many other patterns of information that a group uses to
factors, such as communities, schools, migration generate meaning among its members. These pat-
patterns, career choices, and religion. terns include nonverbal language and material
goods.

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Rema Angela Bulatao BSN-2B
 The emphasis on culture in our training as nurses
CULTURAL MODELS OF NURSING CARE recognizes its crucial role in molding an individual’s
 Culturally responsive care takes into account the conceptualization of health, as well as other life
context in which the client lives as well as the aspects, especially since the Filipino culture is a
situations in which the client’s health problems mixture of indigenous as well as imported and
arise. borrowed elements.
 Culturally responsive care is essential and nurses
must be able to assess and interpret a given SEVEN COMMON FILIPINO CULTURAL BELIEFS IN RELATION
client’s health beliefs, practices, and cultural TO MATERNAL AND CHILD CARE
needs.  As part of this endeavor, this presentation will
 The term transcultural nursing has been discuss seven (7) common Filipino cultural beliefs:
promulgated by nurse Madeleine Leininger since namamana, lihi, sumpa, gaba, pasma, namaligno,
the 1950s. and kaloob ng Diyos.
 Transcultural nursing focuses on providing care
within the differences and similarities of the 1. NAMAMANA
beliefs, values, and patterns of cultures (Leininger  Namamana is the Filipino language translation of
& McFarland, 2010). acquiring a behavioral or disease trait from a
 Leininger created the theory of culture care parent. It is a belief that when a relative has the
diversity and universality. condition, it is possible that he/she will pass on the
trait to the younger generation.
CULTURAL COMPETENCE  In a study conducted to explore cleft lip with or
Cultural competence has five constructs: without cleft palate found out that the most
frequent explanation given by the respondents as
1. Cultural desire: an etiology of the condition is inheritance (Daack-
 the motivation to “want to” engage in the process Hirsch and Gamboa 2010).
of becoming culturally aware, culturally  The concept of namamana is not limited only to
knowledgeable, culturally skillful, and seeking the occurrence of cleft lip with or without cleft
cultural encounters palate. Like the case example, genetic conditions
2. Cultural awareness: with accompanying physical deformities such as
 self-examination of one’s own prejudices and achondroplasia—unano, maliit na tao, and pandak
biases toward other cultures, and an in-depth are the colloquial terms—are also explained by
exploration of one’s own cultural/ethnic namamana.
background  In the Philippines, another example of a disorder
3. Cultural knowledge: believed to be namamana is neural tube defects.
 obtaining a sound educational foundation  In an informal discussion, parents of children with
concerning the various worldviews of different neural tube defects admitted at a tertiary
cultures government hospital acknowledged genetic
4. Cultural skills: inheritance as a possible etiology of the condition
 the ability to collect culturally relevant data (Abacan 2011, unpublished research).
regarding the client’s health in a culturally sensitive  They verbalized that birth defects, especially those
manner manifesting with physical deformity, are said to be
5. Cultural encounters: namamana or nasa lahi (in the blood).
 engaging in face-to-face cultural interactions with  Although recent literature suggests that there is
persons from diverse backgrounds, and learning to conflict in this popular belief of neural tube defects
modify one’s existing beliefs and prevent possible among women with affected, the concept of
stereotyping namamana is still an important issue.

2. LIHI
FILIPINO CULTURE, VALUES AND PRACTICES IN RELATION  Like namamana, lihi is a concept used to explain
TO MATERNAL AND CHILD CARE why some children are noted to have certain
specific characteristics.
INTRODUCTION  An ethnographic study done in a municipality in
 The provision of culturally competent health care the Philippines referred to lihi as a term for
is an important professional issue recognized by conception (Jocano 1973), while some literature
nurses in the Philippines. referred to it as maternal cravings (Daack-Hirsch
 Being an archipelago consisting of 7,107 islands, and Gamboa 2010).
the Philippines has approximately 175  During the lihi period, also referring to the first
ethnolinguistic groups with their own unique trimester of pregnancy, the pregnant woman
cultural identity and health practices. experiences a number of physical discomforts

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Rema Angela Bulatao BSN-2B
including feelings of dizziness, nausea, irritability, and family members may pursue ritualistic
and general weakening of the body (Jocano 1973). activities and wear amulets.
 It is also during this time that the pregnant  Gaba and sumpa are two interrelated concepts. As
woman develops intense craving for certain foods discussed earlier, gaba is a curse that is inflicted by
and intense liking for certain objects. a higher being when one commits a social
wrongdoing. Sumpa, on the other hand, is a curse
3. PASMA that is inflicted by another human being, i.e., when
 The interaction of hot and cold elements is the one does foul things to another who is capable of
basis of the pasma concept (Tan 2008). inflicting a curse.
 Pasma is roughly defined as an “exposure illness”
which occurs when a condition considered to be 6. NAMALIGNO
“hot” is attacked by a “cold” element and vice  Beliefs in supernatural beings are widespread in
versa (Tan 2008). the Philippines. Specifically, namaligno is a Filipino
 An individual’s homeostasis is attained by a belief that a disease is caused by an intervention of
balance between the hot and cold elements, and a supernatural or a mystical being (Abad 2013).
an illness is caused by a dominance of either hot or  A genetic condition which has been associated
cold. with having a mystical etiology is Marfan
 Specifically, childbirth and the process of delivering syndrome. In an informal interview, the
a baby are considered by the Filipino folk belief as respondents verbalized that a person with Marfan
“dangerously hot” in nature (Tan 2008). This syndrome looked like a kapre, a mythical tree giant
means that a woman who recently gave birth of Philippine folklore.
should not be exposed in hot environment and  A kapre is a dark giant who likes to smoke huge
must not eat “hot” foods because these would just rolls of cigars and hide within and atop large trees
aggravate her condition (Tan 2008). Similarly, she such as an old acacia and mango trees. A person
should not be exposed to extremely cold with Marfan syndrome was said to be born of a
environment (e.g., taking a bath). mother who was impregnated by a kapre.
 The kapre must have been in love with the mother
 It is a belief that childbirth leaves the woman with and sneaked into her bed when the father was out
open pores making the mother susceptible to the or asleep. Another theory was that the kapre
entrance of “lamig” or “hangin” which are possessed the husband, thus impregnating the
elements of cold. wife with his own physical characteristics, such as
 Manifestations of this will depend on where the long limbs and hands.
lamig settles in the woman’s body and results in  Usually, namaligno is used as an explanation in
pasma or the palpable “knots” in muscles or conditions which remain to be mysteries because
subcutaneous tissues (Jocano 1973; Tan 2008). of the absence of an apparent cause.
 In post-partum psychosis, or colloquially known  One of this is the occurrence of sudden
among Filipinos as nabaliw, the cold elements of unexpected nocturnal death syndrome (SUNDS)
lamig or hangin settles in the mind causing post- which is common in the Philippines (Gervacio-
partum depression and psychosis disrupting well- Domingo et al. 2007).
being.  Locally, it is known as the bangungot. Current
literature about bangungot refers to it as the
4&5. SUMPA AND GABA Brugada syndrome, but this is still contentious
 Sumpa and gaba are beliefs in the Filipino culture because of lack of molecular and genetic studies to
pertaining to a curse. prove this claim (Gaw et al. 2011).
 In sumpa, the curse is inflicted by a human being.  Filipino folklore tells that the cause of bangungot
In contrast, gaba is a curse inflicted by a divine as a deed of a mythical creature called batibat, a
being and it is usually God. huge dark monster covered with thick black hair.
 This is inflicted to a person because he/she Batibat is known to attack unsuspecting victims at
committed a social sin. A medical family history is night, oftentimes, torturing them by sitting on
noted to have numerous cases of cancer because their chest until the victims helplessly gasps for his
of the belief that their ancestors were not giving breath eventually succumbing to death. It is
back to the community. important to note that bangungot is described
 This means that a family is perceived to be similar to nightmares, and it is oftentimes
“business sharks” and exploits the less fortunate. accompanied by tightening of the chest.
 Gaba is predominantly a belief of Filipinos in the
central islands of Visayas 7. KALOOB NG DIYOS
 The impact of sumpa and gaba is shared with the  Kaloob ng Diyos means God’s will.
whole family and extends to the next generation  When a Filipino individual experiences an
(Tan 2008). To end its effect, the inflicted person unexpected event in their life, whether negative or

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Rema Angela Bulatao BSN-2B
positive, it is typically attributed to the grace of  This tends to be incorrectly equated with an
God. expression of fatalism and a passive acceptance of
 This concept helps families cope and accept their or resignation to fate.
life experiences. It provides access to personal  Bahala na may also apply to acceptance of illness
empowerment and hope to families. As a means or malady. Although it is an indication of
for coping, this concept allows affected families to acceptance of the nature of things including one’s
emotionally move toward acceptance. own inherent limitations, bahala na operates
 It is common among Filipinos, especially those psychologically to elevate one’s courage and
devout to their religion, to surrender their conviction to persist in the face of adversity and
problems to a higher being, usually God. improve one’s situation (Okamura & Agbayani,
 This highlights the Filipino value of religiosity and 1991).
faith to a higher being, as someone who is all-
knowing and almighty. 2. SENSITIVITY
 This, however, should not be seen as a weakness  Unmarried Filipino nurses recoil at the question,
on the part of the patient but willingness to offer “Are you pregnant?” when they go for a medical
his/her predicament to God to attain a higher level checkup. Because the Philippine society considers
of enlightenment. sexual relationships not to occur outside of marriage,
 This is quite similar to the Filipino attitude of it
bahala na. For both kaloob ng Diyos and bahala seems odd to them that they would be questioned,
na, what actually happens is that people do although they are aware that this is part of a routine
whatever they can and then resign themselves to health assessment.
whatever will happen (Tan, 2008).  Filipinos are generally sensitive and equally
 This attitude recognizes the limitations of the sensitive to the feelings of others, so they try to
human being such that the intercession of a higher find a way to say things diplomatically.
being is sought when humanly skills are not
enough to overcome a problem. 3. INTERPERSONAL RELATIONSHIP
 Filipinos are generally quiet. Very conservative
families do not allow their younger members to
IMPLICATIONS TO NURSING join the conversation of adults without an
 The selected Filipino cultural beliefs discussed in invitation.
this presentation can guide in the provision of  They are sometimes hesitant to articulate their
psychosocial support as it provides clues on the views, especially if it is different from the majority,
coping mechanisms of Filipino patients and their as it might indicate discordance with the team or
families. group.
 For example, when a genetic condition appears to  By their culturally determined nature, Filipinos are
have no apparent cause, the patient and the family shy and appear timid, especially women. They are
may resort to use these beliefs as a form of reluctant to express their opinions for fear of
rationalization to explain why they are affected. offending others.
 This is also illustrated in the study of Barragan et  They are used to a culture of maintaining cordial
al. (2011) where they suggested that cultural relationships and group harmony. Raising
health practices may help patients comprehend questions may be considered offensive. In class,
and make sense of a disease condition that is most Filipinos would rather ask the classmate
otherwise overwhelming, and to have a perceived sitting next to her or him to clarify ideas or
sense of control of the eventual outcomes of the instructions rather than asking the teacher.
condition.  In terms of health assessments of Filipinos in
 Sometimes, patients may also resort to these general, health care providers are encouraged to
beliefs because these offer an explanation that is probe more to ensure accuracy and completeness
external to them which is easier to accept rather of health information and validate if the Filipino
than to resort to an explanation that is internal to patient can actually demonstrate understanding of
them (i.e., genetic mutation) provided instructions regarding their care.
 Most Filipinos would answer, “Yes,“ to most
questions without giving serious thought. “Yes”
FILIPINO VALUES IN RELATION TO HEALTHCARE does not necessarily mean that she or he
understands the discussion, nor is it intended to
1. SPIRITUALITY agree with the decision or opinion of the health
 Filipino are very religious people. There is a deep care provider. In most cases, “yes” merely means,
faith in God that is reflected in the expression of “I heard you.”
bahala na—“it is up to God” or “leave it to God.”  Because Filipinos in general tend to respond with
“yes” or “no” without explaining or amplifying
their condition, health care providers need to be

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Rema Angela Bulatao BSN-2B
more careful when inquiring about health and in spoken English. Frequently, this leads to
personal information to ensure its validity. confusion.
 The Filipino accent is recognizable by the inflection
4. RESPECT AND REVERENCE on the second syllable of a polysyllabic word. For
 One’s position in society, professional example, penicillin is pronounced as peNIcilin.
achievements, and age carry a lot of weight in the  It is also interesting to know that there is a
Philippine society. common pronoun for the singular third person
 Physicians, lawyers, priests, engineers, teachers, regardless of gender.
and nurses are among the well-respected  Filipinos use siya (pronounced as /sha/ in shadow)
professionals in the Philippines. Hence, their in referring to another person. As a result, Filipinos
opinion is generally accepted without question may inadvertently interchange he and she (Tuazon,
 Filipino values and traditions provide a framework 2002).
for conduct and mode of communication. Because  Birth Practices of Selected Cultural Groups
of a high regard for the elderly and authority,  (Students’ participation- 4 groups will have to
Filipinos tend not to oppose or contradict other select their own selected cultural group)
views for fear of embarrassing the other party.
 “Filipinos generally are neither assertive nor
aggressive and may often appear guarded or
reticent. Nurses often misunderstand this need for
passivity and do not appreciate the culturally
induced motivation to maintain harmonious
balance between man and nature” (Vance &
Davidhizar, 1999, p. 16).
 Filipinos highly value their elderly. This may be
influenced by the way they feel toward elderly
parents and relatives. There is a sense of obligation
and personal fulfillment in caring for one’s parents.
Elderly individuals are given high respect and
revered.
 Family commitment fosters a sense of pride, and
therefore, caring for others is embedded in the
culture. “Concern for the welfare of the family is
expressed in the honor and respect bestowed on
parents and older relatives, the care provided to
children, and the individual sacrifices that are
made on behalf of family members” (Okamura &
Agbayani, 1991, p. 1).

5. MODESTY
 Filipinos find it uncomfortable to accept even a
well-deserved compliment.
 For example, if someone gives a complement like,
“Your dress is beautiful!” the answer might be,
“Not really. I bought it cheap.”
 Or if someone says, “You are so knowledgeable,”
the answer might be, “Not really, I just happen to
know it.”
 Yet they are proud of their accomplishments in a
sort of quiet way. As a result, many have culture-
based barriers to marketing themselves.

6. LANGUAGE
 Respect is integrated in the Filipino language.
Reference to the elderly is the use of the third
person. Hence, when spoken to assertively in a
direct way, Filipinos feel offended.
 There is no gender differentiation in the Filipino
language. Although they are fully aware of the
male and female genders, their native language is
what hinders them from precisely using he or she