Ch131.ppt

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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