Rema Angela Bulatao
 Similarly, a nurse’s worldview is influenced by the
Patient’s Bill of Rights
Patients’ Bill of Rights and Obligations
The Patient has the right to:
1. Considerate and respectful care;
2. Relevant, current and understandable information
concerning diagnosis, treatment prognosis, specific
procedures, treatment, risk involved, medically
reasonable alternative benefits needed to make
informed consent;
3. Make decisions regarding his plan of care, in case
of refusal, he is entitled to other appropriate care
and service or be transferred to other hospital;
4. Have advance directive (such as living will)
concerning treatment or designating a surrogate
decision maker;
5. Every consideration of his privacy such as in case
discussion, consultation and treatment;
6. Confidentiality of communications and records;
7. Review his records concerning his medical care and
have these explained to him except when
restricted by law;
8. Be informed of business relationship among the
hospital, educational institution, health care
providers that may influence the patient’s
treatment and care;
9. Consent to decline to participate in experimental
research affecting his care;
10. Reasonable continuity of care when appropriate
and be informed of other care options when
hospital care is no longer appropriate; and
11. Be informed of hospital policies and practices that
relate to patient care.
Communication and Teaching with Children and Families
 TO BE DISCUSSED BY STUDENTS
Nursing Care Planning: Interprofessional Care Maps
 TO BE DISCUSSED BY STUDENTS
Related Studies on Maternal and Child Nursing
 Researchable Topics/ Problem
 Related Literature Search
Filipino Culture, Values and Practices in Relation
to Maternal and Child Care
Introduction
 Nursing care is holistic and encompasses the
client’s perspectives on health, which are greatly
influenced by the client’s culture. Each person is
born into a culture influenced by the place of birth
and the family of origin. A child learns the family’s
customs and beliefs, which shape his or her
worldview.
 An individual’s culture is dynamic and shifts over
the course of a lifetime, influenced by many other
factors, such as communities, schools, migration
patterns, career choices, and religion.
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culture of the nursing profession and the culture of
the organization that he or she represents.
Therefore, every nurse–client interaction is a
cultural encounter.
 A nurse cannot assume sameness of values, even if
the client appears to resemble the nurse in
outward appearance.
 It is the nurse’s responsibility to recognize the
client’s cultural perspectives
CULTURALLY RESPONSIVE CARE
 Culturally Responsive Care is care that is centered
on the client’s cultural point of view and integrates
the client’s values and beliefs into the plan of care.
 To deliver such care, the nurse must first develop
self-awareness of his or her own culture, attitudes,
and beliefs, and examine the biases and
assumptions he or she holds about different
cultures.
 Next, the nurse needs to gain the necessary
knowledge and skills to create an environment
where trust can be developed with the client.
 This knowledge must include an understanding of
health disparities as well as the historical and
current portrayals of racial and ethnic groups in
society.
 Additionally, cultural knowledge can help the nurse
to better understand different perspectives, while
recognizing that cultural generalizations may not
hold true at the individual level.
 Cultural assessment skills are essential in
understanding the client’s viewpoint more fully,
and learning what the client values as important.
 The nurse must partner with the client in a caring
and respectful relationship that honors the client’s
differences and perspectives.
 In culturally responsive care, the nurse must
respond to the client’s needs, not vice versa. Only
through self-awareness, deliberate cultural
assessment, and incorporation of the client’s
culture into the plan of care can a nurse optimally
care for a client.
CULTURAL CONCEPTS
 Culture is complex, with multiple definitions, and
the term is often used interchangeably with other
terms such as race, ethnicity, and nationality.
CULTURE
 Culture is the “thoughts, communications, actions,
customs, beliefs, values, and institutions of racial,
ethnic, religious, or social groups” (U.S.
Department of Health and Human Services
[USDHHS], Office of Minority Health [OMH], 2005).
 It has been described as the learned and shared
patterns of information that a group uses to
generate meaning among its members. These pat-
terns include nonverbal language and material
goods.
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CULTURAL MODELS OF NURSING CARE
 Culturally responsive care takes into account the
context in which the client lives as well as the
situations in which the client’s health problems
arise.
 Culturally responsive care is essential and nurses
must be able to assess and interpret a given
client’s health beliefs, practices, and cultural
needs.
 The term transcultural nursing has been
promulgated by nurse Madeleine Leininger since
the 1950s.
 Transcultural nursing focuses on providing care
within the differences and similarities of the
beliefs, values, and patterns of cultures (Leininger
& McFarland, 2010).
 Leininger created the theory of culture care
diversity and universality.
CULTURAL COMPETENCE
Cultural competence has five constructs:
1. Cultural desire:
 the motivation to “want to” engage in the process
of becoming culturally aware, culturally
knowledgeable, culturally skillful, and seeking
cultural encounters
2. Cultural awareness:
 self-examination of one’s own prejudices and
biases toward other cultures, and an in-depth
exploration of one’s own cultural/ethnic
background
3. Cultural knowledge:
 obtaining a sound educational foundation
concerning the various worldviews of different
cultures
4. Cultural skills:
 the ability to collect culturally relevant data
regarding the client’s health in a culturally sensitive
manner
5. Cultural encounters:
 engaging in face-to-face cultural interactions with
persons from diverse backgrounds, and learning to
modify one’s existing beliefs and prevent possible
stereotyping
FILIPINO CULTURE, VALUES AND PRACTICES IN RELATION
TO MATERNAL AND CHILD CARE
INTRODUCTION
 The provision of culturally competent health care
is an important professional issue recognized by
nurses in the Philippines.
 Being an archipelago consisting of 7,107 islands,
the Philippines has approximately 175
ethnolinguistic groups with their own unique
cultural identity and health practices.
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 The emphasis on culture in our training as nurses
recognizes its crucial role in molding an individual’s
conceptualization of health, as well as other life
aspects, especially since the Filipino culture is a
mixture of indigenous as well as imported and
borrowed elements.
SEVEN COMMON FILIPINO CULTURAL BELIEFS IN RELATION
TO MATERNAL AND CHILD CARE
 As part of this endeavor, this presentation will
discuss seven (7) common Filipino cultural beliefs:
namamana, lihi, sumpa, gaba, pasma, namaligno,
and kaloob ng Diyos.
1. NAMAMANA
 Namamana is the Filipino language translation of
acquiring a behavioral or disease trait from a
parent. It is a belief that when a relative has the
condition, it is possible that he/she will pass on the
trait to the younger generation.
 In a study conducted to explore cleft lip with or
without cleft palate found out that the most
frequent explanation given by the respondents as
an etiology of the condition is inheritance (Daack-
Hirsch and Gamboa 2010).
 The concept of namamana is not limited only to
the occurrence of cleft lip with or without cleft
palate. Like the case example, genetic conditions
with accompanying physical deformities such as
achondroplasia—unano, maliit na tao, and pandak
are the colloquial terms—are also explained by
namamana.
 In the Philippines, another example of a disorder
believed to be namamana is neural tube defects.
 In an informal discussion, parents of children with
neural tube defects admitted at a tertiary
government hospital acknowledged genetic
inheritance as a possible etiology of the condition
(Abacan 2011, unpublished research).
 They verbalized that birth defects, especially those
manifesting with physical deformity, are said to be
namamana or nasa lahi (in the blood).
 Although recent literature suggests that there is
conflict in this popular belief of neural tube defects
among women with affected, the concept of
namamana is still an important issue.
2. LIHI
 Like namamana, lihi is a concept used to explain
why some children are noted to have certain
specific characteristics.
 An ethnographic study done in a municipality in
the Philippines referred to lihi as a term for
conception (Jocano 1973), while some literature
referred to it as maternal cravings (Daack-Hirsch
and Gamboa 2010).
 During the lihi period, also referring to the first
trimester of pregnancy, the pregnant woman
experiences a number of physical discomforts
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including feelings of dizziness, nausea, irritability,
and general weakening of the body (Jocano 1973).
 It is also during this time that the pregnant
woman develops intense craving for certain foods
and intense liking for certain objects.
3. PASMA
 The interaction of hot and cold elements is the
basis of the pasma concept (Tan 2008).
 Pasma is roughly defined as an “exposure illness”
which occurs when a condition considered to be
“hot” is attacked by a “cold” element and vice
versa (Tan 2008).
 An individual’s homeostasis is attained by a
balance between the hot and cold elements, and
an illness is caused by a dominance of either hot or
cold.
 Specifically, childbirth and the process of delivering
a baby are considered by the Filipino folk belief as
“dangerously hot” in nature (Tan 2008). This
means that a woman who recently gave birth
should not be exposed in hot environment and
must not eat “hot” foods because these would just
aggravate her condition (Tan 2008). Similarly, she
should not be exposed to extremely cold
environment (e.g., taking a bath).
 It is a belief that childbirth leaves the woman with
open pores making the mother susceptible to the
entrance of “lamig” or “hangin” which are
elements of cold.
 Manifestations of this will depend on where the
lamig settles in the woman’s body and results in
pasma or the palpable “knots” in muscles or
subcutaneous tissues (Jocano 1973; Tan 2008).
 In post-partum psychosis, or colloquially known
among Filipinos as nabaliw, the cold elements of
lamig or hangin settles in the mind causing post-
partum depression and psychosis disrupting well-
being.
4&5. SUMPA AND GABA
 Sumpa and gaba are beliefs in the Filipino culture
pertaining to a curse.
 In sumpa, the curse is inflicted by a human being.
In contrast, gaba is a curse inflicted by a divine
being and it is usually God.
 This is inflicted to a person because he/she
committed a social sin. A medical family history is
noted to have numerous cases of cancer because
of the belief that their ancestors were not giving
back to the community.
 This means that a family is perceived to be
“business sharks” and exploits the less fortunate.
 Gaba is predominantly a belief of Filipinos in the
central islands of Visayas
 The impact of sumpa and gaba is shared with the
whole family and extends to the next generation
(Tan 2008). To end its effect, the inflicted person
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and family members may pursue ritualistic
activities and wear amulets.
 Gaba and sumpa are two interrelated concepts. As
discussed earlier, gaba is a curse that is inflicted by
a higher being when one commits a social
wrongdoing. Sumpa, on the other hand, is a curse
that is inflicted by another human being, i.e., when
one does foul things to another who is capable of
inflicting a curse.
6. NAMALIGNO
 Beliefs in supernatural beings are widespread in
the Philippines. Specifically, namaligno is a Filipino
belief that a disease is caused by an intervention of
a supernatural or a mystical being (Abad 2013).
 A genetic condition which has been associated
with having a mystical etiology is Marfan
syndrome. In an informal interview, the
respondents verbalized that a person with Marfan
syndrome looked like a kapre, a mythical tree giant
of Philippine folklore.
 A kapre is a dark giant who likes to smoke huge
rolls of cigars and hide within and atop large trees
such as an old acacia and mango trees. A person
with Marfan syndrome was said to be born of a
mother who was impregnated by a kapre.
 The kapre must have been in love with the mother
and sneaked into her bed when the father was out
or asleep. Another theory was that the kapre
possessed the husband, thus impregnating the
wife with his own physical characteristics, such as
long limbs and hands.
 Usually, namaligno is used as an explanation in
conditions which remain to be mysteries because
of the absence of an apparent cause.
 One of this is the occurrence of sudden
unexpected nocturnal death syndrome (SUNDS)
which is common in the Philippines (Gervacio-
Domingo et al. 2007).
 Locally, it is known as the bangungot. Current
literature about bangungot refers to it as the
Brugada syndrome, but this is still contentious
because of lack of molecular and genetic studies to
prove this claim (Gaw et al. 2011).
 Filipino folklore tells that the cause of bangungot
as a deed of a mythical creature called batibat, a
huge dark monster covered with thick black hair.
Batibat is known to attack unsuspecting victims at
night, oftentimes, torturing them by sitting on
their chest until the victims helplessly gasps for his
breath eventually succumbing to death. It is
important to note that bangungot is described
similar to nightmares, and it is oftentimes
accompanied by tightening of the chest.
7. KALOOB NG DIYOS
 Kaloob ng Diyos means God’s will.
 When a Filipino individual experiences an
unexpected event in their life, whether negative or
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positive, it is typically attributed to the grace of
God.
 This concept helps families cope and accept their
life experiences. It provides access to personal
empowerment and hope to families. As a means
for coping, this concept allows affected families to
emotionally move toward acceptance.
 It is common among Filipinos, especially those
devout to their religion, to surrender their
problems to a higher being, usually God.
 This highlights the Filipino value of religiosity and
faith to a higher being, as someone who is all-
knowing and almighty.
 This, however, should not be seen as a weakness
on the part of the patient but willingness to offer
his/her predicament to God to attain a higher level
of enlightenment.
 This is quite similar to the Filipino attitude of
bahala na. For both kaloob ng Diyos and bahala
na, what actually happens is that people do
whatever they can and then resign themselves to
whatever will happen (Tan, 2008).
 This attitude recognizes the limitations of the
human being such that the intercession of a higher
being is sought when humanly skills are not
enough to overcome a problem.
IMPLICATIONS TO NURSING
 The selected Filipino cultural beliefs discussed in
this presentation can guide in the provision of
psychosocial support as it provides clues on the
coping mechanisms of Filipino patients and their
families.
 For example, when a genetic condition appears to
have no apparent cause, the patient and the family
may resort to use these beliefs as a form of
rationalization to explain why they are affected.
 This is also illustrated in the study of Barragan et
al. (2011) where they suggested that cultural
health practices may help patients comprehend
and make sense of a disease condition that is
otherwise overwhelming, and to have a perceived
sense of control of the eventual outcomes of the
condition.
 Sometimes, patients may also resort to these
beliefs because these offer an explanation that is
external to them which is easier to accept rather
than to resort to an explanation that is internal to
them (i.e., genetic mutation)
FILIPINO VALUES IN RELATION TO HEALTHCARE
1. SPIRITUALITY
 Filipino are very religious people. There is a deep
faith in God that is reflected in the expression of
bahala na—“it is up to God” or “leave it to God.”
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 This tends to be incorrectly equated with an
expression of fatalism and a passive acceptance of
or resignation to fate.
 Bahala na may also apply to acceptance of illness
or malady. Although it is an indication of
acceptance of the nature of things including one’s
own inherent limitations, bahala na operates
psychologically to elevate one’s courage and
conviction to persist in the face of adversity and
improve one’s situation (Okamura & Agbayani,
1991).
2. SENSITIVITY
 Unmarried Filipino nurses recoil at the question,
“Are you pregnant?” when they go for a medical
checkup. Because the Philippine society considers
sexual relationships not to occur outside of marriage,
it
seems odd to them that they would be questioned,
although they are aware that this is part of a routine
health assessment.
 Filipinos are generally sensitive and equally
sensitive to the feelings of others, so they try to
find a way to say things diplomatically.
3. INTERPERSONAL RELATIONSHIP
 Filipinos are generally quiet. Very conservative
families do not allow their younger members to
join the conversation of adults without an
invitation.
 They are sometimes hesitant to articulate their
views, especially if it is different from the majority,
as it might indicate discordance with the team or
group.
 By their culturally determined nature, Filipinos are
shy and appear timid, especially women. They are
reluctant to express their opinions for fear of
offending others.
 They are used to a culture of maintaining cordial
relationships and group harmony. Raising
questions may be considered offensive. In class,
most Filipinos would rather ask the classmate
sitting next to her or him to clarify ideas or
instructions rather than asking the teacher.
 In terms of health assessments of Filipinos in
general, health care providers are encouraged to
probe more to ensure accuracy and completeness
of health information and validate if the Filipino
patient can actually demonstrate understanding of
provided instructions regarding their care.
 Most Filipinos would answer, “Yes,“ to most
questions without giving serious thought. “Yes”
does not necessarily mean that she or he
understands the discussion, nor is it intended to
agree with the decision or opinion of the health
care provider. In most cases, “yes” merely means,
“I heard you.”
 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