Cultural Diversity in Nursing Care of Filipino Americans

Family Life, Sense Of Time, And Personal Space

Influences In Mental Healthcare
By Lara P. Fieschi-Corso
AND-1 Fall 2008
Prof. N. Katz

Cultural diversity is growing very quickly in the United States, and it plays an
important part on the healthcare of its population. Health care providers should educate
themselves about the differences of identities in each culture; so the whole treatment
process, from assessment to discharge planning, can be as effective as possible. Here I will
give an overview of Filipino Americans cultural factors and the influences which those
factors exert on this population.
Emie S. is a Filipino American and a technologist in the R&D Silicone Fluids
department in the same company that I work. Her parents migrate from Philippines
approximately 55 years ago, and she is the first generation born in the United States. Last
year Emie graduated as a nurse; and now she also works as a per diem nurse on the
weekends. I interviewed her about her culture and its influences on the health care practices
of the Filipino population in general. It was just the perfect time for the interview as she
had just returned from the Philippines, where she went with her 3 siblings for almost a
month to meet with the whole family and discuss decisions that should be made in relation
to her mother care, who is 91 years old and was going to be discharged from the hospital.
The information that she offered was very relevant and she also offered information from
the Philippine nurse side; and following is a summary of all she said.
“Family is the most important structure in the Philippine culture, where one
depends and helps each other, and they are very private about what happens within the
family. The ties are so strong that an important decision can not be made without a family
meeting, and the weight that each one exert on the decision is directly related to the
hierarchy that that person has in the family, with the elderly been the most respected.” This
information is really relevant to healthcare as sometimes there are important decisions to be
made, such as end-of-life care or mental illness treatment plan, which is a very delicate
issue, besides it alerts us for the fact that what the patient communicate might not be what
he/she is feeling or wishing. A good example of how much the family is important on
major decisions, especially in healthcare decisions, is the fact that Emie and her siblings
traveled to Philippines to meet with the family and plan what and how care will be
provided to their mom. “Family is the most relevant factor influencing healthcare in the
Filipino Americans in every way.”
“Mental illness is viewed as shame in the family, and so the family hides the fact
from anyone. This view about mental illness leads to the neglect treatment and planning of
care by professionals as this would expose the shame of the family to the world. The search
for professional help only happens as a last resort.”
“The Philippine culture influence the Filipino nurses’ practice, especially in respect
to the relation nurse-patient, as they fall in sympathy with the patient getting emotionally
involved with the patient instead of just been empathetic (the right thing to do).” Emie told
me that this aspect of her culture touches her deep inside and she is constantly watching
herself to don’t fall into this trap.
“Some things the healthcare provider should also know when caring for the Filipino
patients is that they will always agree with the healthcare provider even when they don’t
understand what the healthcare provider explained or asked. The first reason is because
they feel ashamed for seeking help as a sign of weakness, and the second reason if because
they believe that it is disrespectful to ask questions. In consequence it is important for the
healthcare provider to look for clues and also to explain to them the implications of each
symptoms, signs and treatment.” An informed patient is more likely to cooperate. “Another
important thing is to keep some distance when interacting with Filipino patient as they
value they space and feel quite uncomfortable when approached too close, and also eye
contact is not kept because it is a sign of disrespect.”
After my conversation with Emie I turned to some articles and found supporting
data to the information that she gave me. The first article is “Mental Health Care of Filipino
Americans”, which looked in depth into Filipino Americans as they “is the second-fastest-
growing Asian immigrant group in the United States” (Sanchez, and Gaw, 2007). It
expands the view of the Filipino as one group by emphasizing that with in the Filipino
population they also have cultural differences among them due to religion (Catholic or
Muslim) and their beliefs which includes many different forms of alternative medicine
including treatment of mental and physical conditions that “during the pre-colonialist
period and through most of the Spanish era, would involve rituals aimed at reversing
punishment from the spiritual world and restoring balance in the physical world” (Sanchez,
and Gaw, 2007) and with the arrival of the Western medicine progresses to “instead of
going to physicians, many approach “albularyos” (faith healers)” (Sanchez, and Gaw,
2007), but it known that many Filipinos “consult faith healers because of the compassion
they display” (Sanchez, and Gaw, 2007); and regionalism. It emphasizes the importance of
family and how is their support family as they have strong ties with family and the group
which there are part of and how Filipino families function “in a complex process of a
natural support system of reciprocity and mutual caring to which their individual’s concept
of self is strongly subsumed” 812. The Filipinos’ views on mental illness, such as their
notions of mental illness were “Perceived ridicule encourages hesitance to accept having
mental illness and avoidance of services” (Sanchez, and Gaw, 2007). Mental illness is
“associated with shame and stigma” (Sanchez, and Gaw, 2007). When treating Filipino
Americans it is important to understand their culture and doing so become more assertive
and effective.
Below is a table extracted from the article “Mental Health Care of Filipino
Americans” by Francis Sanchez, M.D. and Albert Gaw, M.D.

Guidelines for a culturally sensitive approach to treatment of Filipino American

• Pay attention to immigration history and regional orientation

• Determine the underlying reason for treatment
• Ensure adequate understanding of the diagnosis and treatment plan, bearing in mind that
social inhibitions and nonverbal cues can mislead the practitioner
• Use visual cues and communicate in a collaborative manner
• Facilitate dialogue, inquiring about physical as well as mental health complaints
• Utilize the family and identify the patient’s power hierarchy
• Allow the patient time to process any information given
• Respect personal space
• Note mannerisms without making assumptions about their meaning
• Do not be misled by the presenting affect
• Maintain judicious use of medications
• Engage the patient by actively focusing of the individual’s symptoms
(Sanchez, and Gaw, 2007)

A study published by The Canadian Journal of Psychiatry, “Use of Health Care

Services for Psychological Distress by Immigrants in an Urban Multicultural Milieu”
provided a data the clearly result from the Filipino culture implications. It interviewed
randomly 4 different cultural groups (Canadian-born individuals, Caribbean, Vietnam and
Philippines) and concluded that “Immigrant status is associated with lower rates of use of
mental health services, even with universal health insurance. This lower rate of use likely
reflects cultural and linguistic barriers to care” (Kirmayer et al., 2007). Within those 4
culturally different groups the Filipino group had the lowest percentage rate of service use
in the last year on any medical services for mental health.
Filipino 2.1%
Anglo-Canadian 7.3%
Franco-Canadian 4.8%
Anglo-Caribbean 5.6%
Vietnamese 3.0%
(Kirmayer et al., 2007)
The same trend of results was true for any especially mental health services, any
service for mental health, and also for use of traditional or alternative medicine.
Those results directly translate the cultural implications discussed before and re-
enforce the necessity to have healthcare providers educated on cultural diversity.

Citation

Sanchez, F., Gaw, A. (2007). Mental Health Care of Filipino Americans.

Psychiatric Services, 58 (6), 810 – 815. Retrieved from
<http://ps.psychiatryonline.org/cgi/content/full/58/6/810?
maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexa
cttitleabs=and&fulltext=mental+health+care+of+filipino&andorexactfulltext=and&searchi
d=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT>

Kirmayer, L., Weinfeld, M., Burgos, G., du Fort, G. G., Lasry, C. J., Young, A.
(2007). Use of Health Care Services for Psychological Distress by Immigrants in an Urban
Multicultural Milieu. The Canadian Journal of Psychiatry, 52 (5), 295 – 304. Retrived from
<http://publications.cpa-apc.org/media.php?mid=393>