NCM103 – Fundamentals of Nursing Practices
 Observing and being conscious of similarities
Filipino Cultural Characteristics and Health Care
Beliefs and Practices in Health Education
Culture
 “Totality of socially transmitted pattern of
thoughts, values, meanings, and beliefs”
(Purnell 2005).
 It is not limited to any specific ethnic group,
geographical area, language, religious belief,
manner of clothing, sexual orientation, and
socioeconomic status (Fisher 1996).
 “Culture is inscribed in our bodies and in our
minds” (Tan 2008).
 “The relationship of culture and health is
important to understand as it impacts an
individual’s worldview and decision-making
process (Purnell 2005).
 Like in other fields of medicine, the impact of
cultural beliefs is increasingly being recognized as
an essential component in the genetic
counselling process (Cohen et al. 1998; Edwards
et al. 2008; Penn et al. 2010).
Filipino Culture
 Being an archipelago consisting of 7,107 islands,
cultural influence in the Philippines is important
to recognize given the existence of 175
ethnolinguistic groups each with their own
unique cultural identity and health beliefs and
practices (Summer Institute of Linguistics 2012).
 Evolved as a mixture of indigenous as well as
imported and borrowed elements.
 The cultural background of Filipino nurses may
have a strong influence on their selection of
nursing as a profession, because caring for others
is emphasized and valued, especially among
females.
Cultural Awareness
 Cultural awareness is a prerequisite prior to
achieving cultural competency. It is the
understanding that a cultural divide exists
between the patient and health professional
(Winkelman 2009).
 Cultural awareness is the first step towards
gaining intercultural competences.
and contrasts between cultural groups. In
medicine, we are especially interested in the way
in which culture may affect different people's
approach to health, illness and healing.
Cultural Sensitivity
 Being aware that cultural differences and
similarities between people exist without
assigning them a value – positive or negative,
better or worse, right or wrong.
 Is a set of skills that enables us to learn about and
understand people who are different from
ourselves, thereby becoming better able to serve
them within their own communities
Cultural Competence (also known as
cultural responsiveness, cultural
awareness, and cultural sensitivity)
 Refers to a person’s ability to interact effectively
with persons of cultures different from his/ her
own.
 With regard to health care, cultural competence
is a set of behaviours and attitudes held by
clinicians that allows them to communicate
effectively with patients of various cultural
backgrounds and to plan for and provide care
that is appropriate to the culture and to the
individual.
 Cultural competence is a key aspect of nursing
practice because nurses care for patients of many
different cultural backgrounds. Nurses should
have knowledge of cultural beliefs, attitudes, and
traditions of the patients and families they serve
in order to communicate effectively and plan and
provide appropriate, individualized patient care
Cultural safety
Is an approach to medicine that goes beyond cultural
sensitivity and competence to include several additional
layers of commitment:
 (1) Self-reflection on the part of the practitioner,
which is fundamental to understanding the power
differentials inherent in health service delivery. It
acknowledges that we are all bearers of culture
and that our actions can easily damage culture,
just as a callous remark can cause emotional
harm.
  (2) Taking a cultural safety approach implies a
health advocacy role: working to improve health
care access; exposing the social, political, and
historical context of health care; and interrupting
unequal power relations.
 (3) It also implies awareness that the patient exists
simultaneously within several health care
systems: the influence of their family, community
and traditions. These will interact with, and
possibly conflict with, your interventions.
Cultural humility
 Redefines cultural competency as an ongoing
process, involving a life-long commitment to self-
evaluation and self-critique: we must be willing to
learn and to maintain humility in our approach to
patients.
 Cultural humility also implies a desire to fix power
imbalances: recognizing and addressing the
possibly divergent perspectives at play in a
physician-patient encounter.
Transcultural Nursing
 A humanistic and scientific area of formal study
and practice in nursing which is focused upon
differences and similarities among cultures with
respect to human care, health, and illness based
upon the people's cultural values, beliefs, and
practices, and to use this knowledge to provide
cultural specific or culturally congruent nursing
care to people. Leininger (1991) notes the main
goal of transcultural nursing is to
provide culturally specific care.
Explanatory models (EM) of
Illness
 Provides a framework on the understanding of a
patient on the cause of his/her illness, and this
may include the meanings and values he/she
associates with the condition (Winkelman 2009;
Kleinman et al. 1978).
 Eliciting the EM of genetic illnesses is an
important first step since it ensures that the
patient and the health care provider (e.g.,
genetic counsellor) are communicating in the
same contextual framework, thus minimizing the
cultural barrier that initially exists between the
two (Winkelman 2009; Abad 2012).
Traditional Perceptions of
Health and Illness (Philippines)
 Definition of health is considered to be in a state
of balance.
- Factors that play a role in balance include hot
and cold factors, food, and diet.
Balance is a key concept in the Filipino culture. It is also
referred to as Timbang and relates to hot and cold shifts
and diet. When there are too many hot and cold shifts,
then the person may become ill (McBride, n.d.).
Balance is disrupted when a person becomes ill. Another
factor that can affect the balance of someone is sudden
changes in weather patterns (McBride, n.d.)
 Illness is when the body, mind, and spirit are out
of balance or when the person and the
environment are in a sense of disharmony
(Spector, 2013, p. 86).
According to the Filipino population, illness is also defined
as the body being out of balance which usually pertains
to a rapid change in hot and cold (McBride, n.d.)
Three Theories of Illness
 Mystical Theory
- Is that if there are unfulfilled obligations from ancestors
then this could result in mystical experiences and
behaviours. It also goes as far to say that during sleep the
soul can be lost or if you are having nightmares then they
are often the result of consuming a heavy meal and it
could eventually lead to death (McBride, n.d.).
 Personalistic Theory
- is that evil spirits or witches seeking retribution or social
punishment can cause illness. This theory can be
protected by wearing religious objects or using holy oils
(McBride, n.d.).
 Naturalistic Theory
- This theory states that stress, infection, food and drugs,
and natural events such as thunder, lightning, and drafts
are all causes of illness (McBride, n.d.).
Birthing and Postpartum Beliefs
and Rituals
 Taking vitamins could deform the fetus and
therefore many women do not take any vitamins
while they are pregnant (Purnell, 2009, p. 137).
 Another belief is that certain foods can cause the
baby to develop different ways or have skin marks.
An example of this is the belief that if women eat
MAXINE BARTOLABA
1ST YEAR BSN
 blackberries while they are pregnant, the baby will
have black spots on them (Purnell, 2009, p. 137).
 There are also many beliefs about spirits and bad
luck. For example, funerals are often avoided while
pregnant because there is a belief that the spirits of
the dead possibly affecting the baby (Purnell, 2009,
p. 137).
 Another belief is that if you either name the baby
before it is born or name it after a dead person then
it is bad luck (Purnell, 2009, p. 137).
 It is a common belief for women that the delivery will
be difficult if they sit by a doorway (Purnell, 2009, p.
137).
 Along with this, many women who are from rural
regions prefer the squatting position during the
birthing process (Purnell, 2009, p. 137).
 Mothers are encouraged to eat hot soups around the
time of breast feeding because it is believed to
promote milk production (Purnell, 2009, p. 138). This
ritual goes along with the hot and cold beliefs that
are important for maintaining health in the Filipino
population.
 For the first month after the baby is born, the only
place that the mother and baby are supposed to go
is to the doctor (Purnell, 2009, p. 138).
 In order to ward off evil spirits, a rosary, garlic, or salt
is placed near the baby's crib (Purnell, 2009, p. 138).
Common Filipino Cultural
Beliefs
Filipino word English translation
depicting
cultural beliefs
Namamana Inheretance
Lihi Conception or
maternal cravings
Pasma Hot and cold
syndrome
Sumpa and gaba Curse
Namaligno Mystical and
supernatural causes
Kaloob ng Diyos God’s will
Inheritance (Namamana)
 Acquiring a behavioural 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.
 The passing on of a trait to the younger
generation.
Conception or maternal
cravings (Lihi)
 During the lihi period, also referring to the first
trimester of pregnancy, the pregnant woman
experiences a number of physical discomforts
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.
 It is believed that an offspring will take the
features of the food that the mother has craved
for while she is in the lihi period.
Hot and Cold Syndrome (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.
 Childbirth and the process of delivering a baby
are considered by the Filipino folk belief as
“dangerously hot” in nature (Tan 2008).
 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.
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1ST YEAR BSN
Curse (Sumpa and Gaba)
 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.
 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
and family members may pursue ritualistic
activities and wear amulets.
Mystical and Supernatural
Causes (Namaligno)
 Namaligno is a Filipino belief that a disease is
caused by an intervention of a supernatural or a
mystical being (Abad 2013).
 Namaligno is used as an explanation in
conditions which remain to be mysteries because
of the absence of an apparent cause.
God’s Will (Kaloob ng Diyos)
 When a Filipino individual experiences an
unexpected event in their life, whether negative
or positive, it is typically attributed to the grace of
God.
 Highlights the Filipino value of religiosity and
faith to a higher being, as someone who is all-
knowing and almighty.
 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 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.
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.
Filipino Health Practices
 Traditional forms of self-medication
- Oils or ointments, which serve as cure in relaxing,
heating, and comforting the muscles or providing relief
for dizziness, colds, headaches, sore throats, and so forth.
 Folk healing techniques
- Ventosa is used for treating joint pains believed to be
caused by the presence of bad air.
 Alternative therapy
- People go for Hilot for relief of pain and aches instead
of seeking medical attention. In an alternative context,
Hilot may refer to a practitioner or the practice of
chiropractic manipulation and massage for the diagnosis
and treatment of musculoligamentous and
musculoskeletal ailments.
 Home remedies
- Form of medicinal plants are also popular for
Filipino nurses who believe that plants can heal
common ailments.
- Readily available and cheap.
- Seeking the help of a local healer who may utilize
a variety of treatments including the use of herbs
and roots (McKenzie and Chrisman, 1977)
- Various types of healers common throughout the
Philippines include midwives, masseurs, and specialists for
supernaturally caused ailments.
 Hilot
- Uses three forms of treatment: faith healing through
prayer, herbal medicines, and massage and body
manipulation
NOTE: Folk healers may serve as indigenous allies whose
work can complement modern health practitioners and
who can provide the psychological, emotional, and spiritual
well-being necessary to the healing process
Health Beliefs and Behaviours: Health
Promotion/Treatment Concepts
 Flushing
- The body is thought to be a vessel or container that
collects and eliminates impurities through physiological
processes such as sweating, vomiting, expelling gas, or
having an appropriate volume of menstrual bleeding.
 Heating
- Adapts the concept of balanced between “hot” and
“cold” to prevent occurrence of illness and disorders.
 Protection
- Safeguards the body’s boundaries from outside
influences such as supernatural and natural forces.
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1ST YEAR BSN
Health Beliefs and Behaviours:  Difficulty in utilizing mental health services during
Health Behaviours usual hours because of the unavailability of
 Response to Illness working adult family members.
- Filipino older adults tend to cope with illness with  Mental illness connotes a weak spirit, and may be
the help of family and friends, and by faith in God. attributed to divine retribution as a consequence
- Before seeking professional help, Filipino older of personal and ancestral transgression.
adults tend to manage their illnesses by self-  Lack of culturally oriented mental health services.
monitoring of symptoms, ascertaining possible
causes, determining the severity and threat to
functional capacity, and considering the financial
and emotional burden to the family.
- Utilizing traditional home remedies such as
alternative or complimentary means of treatment
(Yeo, 1998)

Coping Styles
 Patience and Endurance (Tiyaga): the ability to
tolerate uncertain situations
 Flexibility (Lakas ng Loob): being respectful and
honest with oneself
 Humor (Tatawanan ang problema): the
capacity to laugh at oneself in times of adversity
 Fatalistic Resignation (Bahala Na): the view
that illness and suffering are the unavoidable and
predestined will of God, in which the patient,
family members and even the physician should
not interfere.
 Conceding to the wishes of the collective
(Pakikisama) to maintain group harmony.

 Responses to Mental Illness

- Devastating shame (Hiya)
- Sensitivity to criticism (Amor Propio)
Common Perceptions of Filipinos
about Mental Illness
 Unwillingness to accept having mental illness,
which leads to the avoidance of needed mental
health services due to fear of being ridiculed.
 Involvement of other coping resources such as
reliance on family and friends or indigenous
healers, and dependence on religion which can
diminish the need for mental health services.
 Prioritizing of financial and environmental needs
which preclude the need for mental health
services.
 Limited awareness of mental health services
resulting in limiting access.
MAXINE BARTOLABA
1ST YEAR BSN