MODULE 8

CURRENT TRENDS IN PUBLIC HEALTH: GLOBAL AND NATIONAL

A focus on public health

The health of an individual is the health of the community. This is what government and private institutions have
reckoned in the past year, and Filipinos can cross their fingers for the state's universal healthcare plans to actually work.

Since early 2020, our world has been grappling with a devastating global pandemic. The spread of COVID-19 has caused
an estimated 2.5 million deaths around the globe. Nearly half a million of those losses were in the United States alone.
Even more, the coronavirus has infected roughly 28 million Americans and over 110 million people worldwide. At its
worst moments, it has overwhelmed our healthcare facilities and workers. While infectious disease experts continue to
learn about new strains and treatment options, the COVID-19 pandemic is a top public health concern of 2021. However,
it is not the only one.

Every day, there are health epidemics affecting our populations. Some of these public health concerns have been made
even more challenging thanks to COVID-19. While the novel coronavirus continues to take center stage, issues like
climate change, opioid abuse, and childhood obesity continue to impact our society. These public health issues have not
taken a break during the pandemic. Some have escalated. However, there is good news. Thanks to the advancements of
modern medicine and rapid technology, progress is being made. Research is being done. Treatment plans are being
implemented, and lives are being saved. Public health professionals are the ones to thank for this improvement.

So what are the biggest challenges confronting progress in global health? The six global health issues detailed below help
illustrate the breadth and depth of this complex field.

1. PANDEMICS
According to an article published in the Bulletin of the World Health Organization, pandemics are defined as global
disease outbreaks. Examples of pandemics include certain influenza outbreaks, COVID-19, and other viral threats that
reflect our vulnerability to widespread diseases—many of which originate in animals.
Every year, there are newly emerging pandemic threats. Vaccination efforts can help, but it’s critical to address issues at
the source by addressing important areas like health education and responsible agricultural practices.

2. ENVIRONMENTAL FACTORS
How can air pollution and climate change affect the health of the human population? In most cases, the answer lies in
water sources and sanitation.
Storms, flooding, droughts, and air pollution make it easier for diseases to spread across large groups of people. The
immediate solution is to provide resources like bottled water and sanitation technology, but global health must also focus
on the prevention of environmental challenges in the first place.

3. ECONOMIC DISPARITIES AND ACCESS TO HEALTH CARE

Despite relentless progress in the field of medicine, communities across the world still lack access to basic health
education and health care. This results in health disparities, such as high infant mortality rates, which are often related to
geography. Other disparities are the result of income inequality, with individuals and families simply unable to afford
health care that is otherwise unavailable.

To solve these economic challenges, global health professionals must explore opportunities to uplift underrepresented
communities in public health forums, encourage physicians to practice in remote areas, and introduce policies that reduce
barriers and increase access to health care.

4. POLITICAL FACTORS
Inadequate access to health care is exacerbated when international politics enter the mix. As conflicts within or between
nations destroy critical infrastructure, average citizens become more vulnerable to diseases. This leads them to seek
opportunities to flee the dangerous situations that threaten their well-beings.

Migration can allow illnesses to quickly spread, but organizations like the WHO stress that solutions should aim to
improve refugee and migrant health through efforts like organizing across borders to endorse policies that bridge short-
term humanitarian crisis responses with long-term health care access improvements.

5. NON-COMMUNICABLE DISEASES
Heart disease, stroke, cancer, diabetes, and other noncommunicable diseases (NCDs) account for 70 percent of all
deaths worldwide, according to the WHO.

Education plays a role in the prevention of NCDs, helping populations understand and change lifestyle factors, such as
poor diets, inactivity, tobacco use, and alcohol consumption. But there is also a correlation between income level and the
prevalence of NCDs.
1
The WHO notes that 85 percent of premature NCD-related deaths occur in low- and middle-income countries. Reducing
the number of NCDs globally means reducing the factors that disproportionately arise in lower-income communities.

A. ROLE OF A COMMUNITY HEALTH NURSE IN THE NATIONAL AND GLOBAL HEALTH CARE
DELIVERY
SYSTEM

A community health nurse helps the ill patient to manage physical needs, prevent illness, and treat the health condition.
She/he also prepares patients for exams or treatments and making assessments, including helping to perform diagnostic
tests and analyzing results.

The role of the community health nurse is evolving as the mode of delivery of health care services has undergone major
changes both locally and internationally in the past decades. In line with international trends, they are providing lifelong
holistic care, promote health, and enhance the quality of life, and enables human development. The presence of qualified
and competent health care professionals is the key to the delivery of quality care in a health care delivery system.

As registered nurses play a pivotal role in the promotion, maintenance, and restoration of health, we need to develop
competent nurses who can take up extended and expanded roles in the delivery of primary, secondary, and tertiary care.

A community health nurse or public health nurse identifies people in need and reaches out to them. Whether they are
helping young pregnant women, the elderly or victims of crime, community health nurses spearhead efforts to aid
vulnerable groups of people. They may also apply their medical expertise to specialize in a variety of fields:

>Case management
>Clinical practice
>Corporate or school nursing
>Home care
>Pharmaceutical sales

As of 2002, the role of community health nurses expanded to include their participation as first responders. Community
health nurses must be trained to contain, manage and administer immediate care in case of catastrophic events like natural
disasters.

WHAT ARE THE ROLES OF A COMMUNITY HEALTH NURSE

A community health nurse focuses not only on helping individuals but also on increasing positive outcomes for an entire
group. For community health nurses to make a difference, they have to understand the needs of a society’s inhabitants.
They may do this by following a systematic process, which includes the following:

>Assessing the needs of the community

>Exhibiting awareness and sensitivity to a community’s cultural, religious, political and socioeconomic
makeup
>Pinpointing available resources
>Coordinating healthcare
>Applying current scientific research to healthcare

WHY IS THE JOB OF A COMMUNITY HEALTH NURSE IMPORTANT?

Community health nurses use their nursing skills to provide care to patients and guide them to the necessary healthcare
that is beyond the nurse’s scope of practice. They provide assistance to pregnant women, the elderly, homeless or disabled
by directing them to social services. They may carry out preventive patient care in communities by administering
vaccinations and health exams. They may also distribute birth control and information about proper nutrition and they
educate communities about ways to reduce the likelihood of contracting and spreading these types of diseases:

>Flu
>Hepatitis
>HIV/AIDS
>Measles
>Sexually transmitted diseases
>Tuberculosis

2
Community health nurses work toward providing successful outcomes for critical situations. In performing their duties,
they serve as agents of healthful changes in communities. Because of their interaction with underserved populations,
community health nurses can advocate for better services and inform policy makers about needed reforms in healthcare.

The healthcare delivery system in the Philippines is dominated by the public sector (regional, provincial, municipal,
and barangay level) while being supported by private healthcare service providers. The private sector is playing a huge
role in helping the government address the gaps in healthcare services. The implementation of Universal Health Care
(UHC) is already driving the demand across all sectors of healthcare. However, the Philippines still requires a strong
focus on infrastructure and skilled manpower.

DELIVERY OF THE HEALTH CARE TO THE FILIPINO FAMILY AND COMMUNITY

A. FILIPINO CULTURE

Located between the South China Sea and Philippine Sea, the Republic of the Philippines contains a diverse set of
landscapes, languages and cultures. Various countries – such as Spain, China and the United States – have interacted with
and impacted Filipino culture. A sense of national identity and pride emerged out of struggles for Philippine
independence. However, loyalties remain foremost with one’s family and place of birth. Key values such fellowship,
respect and acceptance are found throughout the culture, with many Filipinos displaying a warming and hospitable
demeanor.

Geographic and Linguistic Diversity

The Philippines is made up of over 7,000 islands, of which approximately 2,000 are inhabited. The islands are categorized
into three main clusters – namely Luzon in the north, Visayas in the center and Mindanao in the south. The island clusters
vary in terms of cuisine, languages and culture. One of the main distinctions is in respect to religion. The population in the
northern islands generally identify as Christian while it is much more common to find those who identify as Muslim in the
southern parts of the Philippines.

The country is also linguistically diverse, with eight major dialects and over 170 languages spoken throughout the
inhabited islands. The official language of the Philippines is Filipino, which is mainly Tagalog (the dialect from central
and southern Luzon) combined with words from various other languages. For example, English is widely spoken
throughout the Philippines, and it is common to hear Filipinos use a mixture of English and Tagalog (known informally as
‘Taglish’) in everyday conversations. Depending on their location, Filipinos may not speak the national language. As a
way to retain their local identities, many Filipinos will often choose to speak in their regional languages and dialects.
Indeed, it is common to find Filipinos who are from different parts of the Philippines conversing in English rather than in
Filipino.

National and Local Identity

Given the diversity of the Philippines, the unifying element of Filipino culture is a complex matter. A sense of national
identity emerged out of the long- standing struggle for independence. In contemporary Philippines, many Filipinos are
acutely aware of the colonial history of their country. For example, José Rizal, a national hero in the struggle for
Philippine independence, is a highly revered and well-known figure whom many Filipinos look up to as a role model of a
virtuous person.

However, the sense of a national identity is fragile, with loyalty residing firstly to their  kin group, province or
municipality. The Philippines is a collectivist society and individuals tend to understand themselves as a part of a group.
For Filipinos, the interests of the collective often override the interests of the individual. Filipinos generally feel a strong
sense of pride towards their group and will celebrate their pride through sharing stories or facts about their
family, barangay (village) or town.

The long history of contact with Spain and the United States continues to have a significant impact on the Filipino
identity. One example is the influence of American standards of beauty, which are often measured in the Philippines by
the possession of Western physical traits – such as fair skin and curly hair. Another example is the prominence of
Christian ideology since the introduction of Christianity by the Spanish. Indeed, when compared to other countries on the
Asian continent, the Philippines has one of the highest Christian populations.

Social Interactions and ‘Hiya’

3
Social hierarchy in the Philippines is determined according to age and social status. Nearly all Filipinos are taught from an
early age about the importance of the underpinning social hierarchy. Gestures, terms of address and communication styles
vary depending on who one interacts with and their relative positions in the social hierarchy. For example, it is expected
that, if you are referring to someone who is older than you but within the same generation, you use the terms kuya for
males and ate for females (for example, ‘Ate Jess’). Failing to do so is considered highly disrespectful and a lack of
acknowledgment of the established hierarchy.

Kapwa (fellowship or togetherness) is a core value that explains Filipinos’ interpersonal behavior. The term generally
refers to a shared identity whereby people bond together despite differences in wealth or social status. Kapwa is related to
the collectivistic nature of Filipino society. It is believed that what is good for one person will be good for the collective
and ought to be shared with fellow people. Being branded as not having any kapwa is an insult as it implies that the
person does not belong to a community.

The concept of ‘hiya’ is also one of the underpinning factors influencing how Filipinos behave and interact with others.
While hiya translates roughly into English as ‘shame’ or ‘embarrassment’, on a deeper level it refers to one’s sense of self,
propriety and respect. Filipinos may be more motivated to succeed by a fear of shame rather than fear of failing the task at
hand. To avoid experiencing shame, they may try to give face to those around them through complimenting them and
avoiding direct criticism. Individuals will often try to be generous and hospitable to avoid hiya and to maintain kapwa.

Warmth and Acceptance

Filipinos are usually very warm and friendly people who enjoy conversing with those around them. It is common to find
strangers engaging in conversation or sharing stories to family, friends or foreigners about their hometown, family or
country. Filipinos are often expressive and sentimental while maintaining a light-hearted demeanor. For example, the
word ‘hugot’ (‘to pull out’) is often used to describe someone drawing out deep sentimental memories or experiences.
Indeed, Filipinos are often willing to share stories of their past that may be considered personal.

Alongside their warming and light-hearted demeanor, the general approach to life is of acceptance. ‘ Bahala na’ (come
what may) captures the strong belief among many Filipinos that whatever may happen is a part of God’s will. Any
individual or group success is often attributed to fate or God rather than efforts. This indicates a  fatalistic attitude
throughout society whereby Filipinos are generally accepting of theirs and others circumstances. However, this does not
mean Filipinos are passive. Rather, they are hardworking and will often do their best to help themselves and their family.

B. FILIPINO CUSTOMS AND TRADITIONS

Like any other culture, the Philippines prides itself of customs and traditions that can be classified as something that is
truly Filipino. 
Here are some unique traditions that embody the local beliefs and values inculcated through the centuries.  
Pagmamano

Practiced as a sign of respect to elders, pagmamano is one of the oldest and most notable Filipino tradition there
is. Mano means hand in Spanish, fittingly so as pagmamano is done by gently tapping the hand of the elder to a younger
person’s forehead. The elder in return says “God bless you” hence why the act is also often referred to as “bless”. 

Kamayan

4
FIlipinos love to eat and when the food is especially sumptuous, they eat kamayan-style. From the Filipino word  kamay or
hand, kamayan is the traditional way of dining using one’s bare hands. 

Fiesta Celebrations

If there’s a celebration you wouldn’t wanna miss out on while you’re in the Philippines, it would be the colorful fiestas
happening all-year round. Celebrating fiesta is another influence of the Spanish colonizers and was mainly done to honor
the patron saints. 

Harana

The traditional Filipino courtship is an extremely long process and one way to “woo” a girl is through doing a  harana or
serenading. With his friends in tow, the guy goes to the girl’s house (usually at night) and sings classic kundiman or folk
love songs to her until she opens her window and invites him inside her house. 

Pamamanhikan

Once the panliligaw (courtship) stage has been surpassed, all the possible harana (serenade) has been sung, and the
couple finally gets together, next comes the pamamanhikan. Well, if the couple decides to marry, that
is. Pamamanhikan is the formal act of a guy asking the girl’s family for her hand in marriage. It usually involves the guy’s
family bringing over gifts and discussing the couple’s plans for marriage.

Bayanihan

5
Although not as evident as it was before, bayanihan truly captures the strong sense of community Filipinos have and is
usually exemplified through helping a neighbor transfer houses. Traditionally, bayanihan meant your neighbors literally
carrying your entire kubo (native nipa hut) to your new home location.  

C. FILIPINO VALUES, TRAITS AND BELIEFS

Compassionate

A Filipino trait of being sympathetic to others even if the person is a stranger. An example of this is giving alms to beggar.
This is observed when we hear Filipinos saying “kawawa naman or nakakaawa naman”.

Hard Work and Industry

With resourcefulness comes hard work. Filipinos are very determined and persevering in accomplishing whatever they set
their minds to.

Filipinos over the years have proven time and time again that they are a people with an industrious attitude. Sadly, this is
seen by others as Filipinos being only useful as domestic helpers, working abroad to help their families in the country.
This is also present in the country’s workforce particularly the farmers. Even with little support, technological weaknesses
and the country’s seasonal typhoons, the Filipino farmer still strives to earn their daily meal.

Spirit of Kinship and Camaraderie

A Filipino community spirit and cooperation wherein a group of individuals extends a helping hand without expecting any
remuneration. It is characterized by communal work towards one goal exemplified in carrying a nipa house or pushing a
passenger jeepney.

Ability to Survive

The Filipinos as a people who have been constantly under the rule of numerous powerful countries has over time,
developed a sense of resourcefulness or the ability to survive with whatever they have. They have the extraordinary ability
to make something out of almost nothing. If a Filipino was given just a screwdriver, plastic bags, and some tape, he would
still be able to build a bird tree, especially for the sake of survival, and provided that he be allowed to hunt for some
needed surrounding material.

Faith and Religiosity

The Philippines is approximately 85 percent Christians (mostly Roman Catholic Christians), 10 percent Muslim, and 5
percent ‘other’ religions, including the Taoist-Buddhist religious beliefs of Chinese and the ‘indigenous’ animistic beliefs
of some peoples in upland areas that resisted 300 years of Spanish colonial rule. This is a reflection of the Filipinos’
strong faith in God as seen in their various practices. This includes the numerous Church Holidays they observe, the
customary (and obligatory) Sunday Mass, the individual’s basis of their moral standpoints, the influence of the Church on
the minds, actions, and opinions of the majority, importance of the Sacraments, Praying at almost any possible time of the
day, the extreme practices during Holy Week.

Pakikipagkapwa-tao

This is the shared sense of identity and consciousness of the ‘other’. It means treating others with respect and dignity as an
equal, not someone below the individual.

Flexibility, Adaptability, Creativity

Studies show that Filipinos often have an aversion to a set of standardized rules or procedures; They are known to follow
a Natural Clock or Organic sense of time- doing things in the time they feel is right. They are present-oriented: which
means that one attends to a task or requirement at the time it is needed and does not worry much about future
engagements. This allows the Filipino to adapt and be flexible in doing the tasks at times not bound to a particular
schedule or timeframe. This allows them think on their feet and be creative in facing whatever challenge or task they have
even when it is already right in front of them.

Joy and Humor

6
This famous trait is the ability of Filipinos to find humor in everything. It sheds light on the optimism and positivity of
Filipinos in whatever situation they are in so as to remain determined in going through struggles or challenges. It serves as
a coping technique, the same way a child who has fallen laughs at himself/herself to hide his/her embarrassment.

Family Orientation

The basic and most important unit of a Filipino’s life is the family. Unlike in Western countries, young Filipinos who turn
18 are not expected to move out of their parents’ home. When a Filipino’s parents are old and cannot take care of
themselves, they are cared for in their children’s homes and are very rarely brought by their children to Homes for the
Aged. The practice of separating the elderly from the rest of the family, while common in Western countries, is often
looked down upon in Filipino society. Family lunches with the whole clan with up to 50 people, extending until the line of
second cousins, are not unusual. The Filipino puts a great emphasis on the value of family and being close to one’s family
members.

Hospitality

Foreigners who come to visit the Philippines speak of Filipinos going out of their way to help them when lost, or the
heartwarming generosity of a Filipino family hosting a visitor in their poverty-stricken home. Meanwhile, most foreigners
who attend Filipino gatherings abroad (which are frequently organized for hundreds of reasons) testify to the warmth and
friendliness of Filipinos as they experience that feeling of “belongingness.” Indeed, the legendary Filipino hospitality is
not limited to the Philippines. It is everywhere wherever there are Filipinos.

 GENERAL VALUES OF FILIPINO NURSES

Work Ethic
As a group, Filipino nurses are well liked because they are hardworking. They place high value on responsibility and
seldom complain. Joyce and Hunt (1982) commented, “Many [Filipino nurses] work nights, holidays and/or overtime. So,
during this time of nursing shortage, one can rely on a Filipino nurse to volunteer to cover the shift” (p. 1226). It is not
unusual to find Filipino nurses who work two jobs. The financial rewards, job security, and personal advancement that
U.S. jobs provide to Filipino nurses are valued. This leads to an attitude of perseverance, tolerance to poor working
conditions, and accepting less pay for jobs offered to them. At work, sick call is a rarity for Filipino nurses. A joke among
some Filipino nurses is to call in sick when one is dying, not before. In other words, they do not call in sick for casual
reasons. They feel guilty if they call in sick, especially when the workplace is busy. Although management may favor
such a work ethic, such practice may expose coworkers to communicable diseases such as the flu and upper respiratory
tract infections when they prefer to work rather than nurture their bodies.

Spirituality
Filipino nurses 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.” 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).

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. On one trip by one of the
authors, she noted a Filipino nurse say to her Caucasian husband, “Would you like to turn on the next road sign?” as if
giving him the choice instead of a declarative command. The husband appreciated it very much. This approach, coming
from an individual who holds a position of authority, may be misinterpreted as being soft, especially at work. On the other
hand, this is one way of valuing feelings and the temperament of another human being. If such an approach is ineffective,
an alternative is called for. Being sensitive to the feelings of others is also reflected in the way Filipino nurses conduct
patient teaching, especially with the elderly, immigrants, and the less fortunate.

Interpersonal Relationships
Filipinos are generally quiet. Very conservative families do not allow their younger members to join the conversation of
adults without an invitation. Once they are here in the United States, Filipinos are often misunderstood when they do not
give feedback. 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. Engaging in arguments, especially with someone who is older or holds

7
an authority position, is considered uncivilized. Filipinos also have difficulty turning down requests from supervisors to whom they feel obligated
(Joyce & Hunt, 1982).

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 this situation, the shyness predominates more than the concern of asking the teacher. The
concern arises from the fact that the student is troubled by letting the teacher know that he or she is not following the class discussion. However,
acculturated Filipinos in the United States are likely to be less shy. Also, as Filipinos are exposed to the culture of assertiveness, they can adopt the
same openness as their American counterparts. 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 more careful when inquiring about health and personal information to ensure its validity.

Respect and Reverence

One’s position in society, professional achievements, and age carry a lot of weight in the Philippine society. Physicians, lawyers, priests, engineers,
teachers, and nurses are among the well-respected professionals in the Philippines. Hence, their opinion is generally accepted without question.
Filipino values and traditions provide a framework for conduct and mode of communication. Because of a high regard for the elderly and authority,
Filipinos tend not to oppose or contradict other 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). This nonconfrontational behavioral pattern
accounts for the perception of Filipinos as being passive or timid. Few are cognizant that this conflict-management style stems from a culture of
agreement and a virtue of pleasing others. When a female Filipino nurse goes for a medical appointment, she is more likely to accept what her
physician says. A second opinion is seldom sought, because that would mean questioning the wisdom of her physician. On the other hand, if there is
a lingering doubt, it is discussed with friends and relatives who are likely to influence the decision on whether to seek a second opinion. This is an
area where a Filipino nurse may readily advise her patient but rarely practice what she preaches. Filipino nurses who have recently come to the
United States would never call a supervisor by his or her first name. It is always Ms. ____ or Mr. ____. Someone older is spoken to in the third
person, which is perceived as a sign of respect. This is not even enough. The word po is a suffix added to practically every sentence when speaking
with an older or elderly person. This kind of cultural value and corresponding behaviors may hinder some Filipino nurses from performing their
patient advocacy role. For this reason, assertiveness training is very beneficial for Filipino nurses so that they can exercise patient advocacy in a more
effective way.

Compassionate
In a study of Filipinos working in health care fields in the United States, Castillo (n.d.) explained, All informants seemed to agree that their cultural
background gave them the framework to be proficient nurses or health care workers. Of those who were nurses, one stated: “I see my patients as my
relatives and this influences the way I care for them. I feel that my upbringing helps me see people and care for them.” Another nurse indicated that
Filipinos are very compassionate and this helps when working with people. (p. 69) Filipino nurses highly value their elderly clients. 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).

Modesty
Filipino nurses 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. Filipino nurses are less likely to use I to express what they have achieved. More than likely, they will use we to acknowledge
others’ contributions no matter how insignificant the contributions might be. This may explain why they work well with others. This may come from
the practice of Bayanihan. In the Philippines, if you want something done, it is easy to get a group together to work on a project so that it will get
done faster and better.

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 in spoken English. Frequently, this leads to confusion. The
Filipino accent is recognizable by the inflection on the second syllable of a polysyllabic word. For example, penicillin is pronounced as peNIcilin. It
is also interesting to know that there is a common pronoun for the singular third person regardless of gender. Filipinos use siya (pronounced as /sha/
in shadow) in referring to another person. As a result, Filipinos may inadvertently interchange he and she (Tuazon, 2002).

Close Family Ties

Filipino nurses have strong family ties. While in the United States, their close friends become their family members. As a result, they perpetuate the
cultural burden (as a downside) thus making it more difficult and taking them longer to assimilate into the mainstream culture of their adopted
country. Joyce and Hunt (1982) found that “in the first year in the U.S., social contact with Americans outside of work setting is infrequent and most
of their social interaction is with other Filipinos” (p. 1224). They tend to eat the same food and mingle with individuals of the same ethnic
background. Hence, the old health beliefs and practices continue.

All these Filipino beliefs, values and traditions greatly influence the Filipino community health nurses’ behavior and demeanor in dealing with their
clients and greatly impacted their roles both in national and global health care delivery system.