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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Filipino Americans
Larry Purnell, PhD, RN, FAAN
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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
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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
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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
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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
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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
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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
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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
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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
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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?
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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
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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.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: A
Tag-Lish is a combination of Tagalog and English.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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.
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Transcultural Health Care: A Culturally Competent Approach, 4th Edition
Correct Answer
Correct answer: C
A hilot is a traditional Filipino healer.
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