HOME HEALTH CARE MANAGEMENT & PRACTICE / December 2004
Integrating Traditional Beliefs and
Modern Medicine: Filipino Nurses’
Health Beliefs, Behaviors, and Practices
Rosalia V. Ordonez, MEd, RN
Noemi Gandeza, MSN, RN
As the diversity in the patient population is grow-
ing, there is also an increasing number of diverse
caregivers. Among them are the Filipino health
care providers, most of whom are nurses. Under-
standing the culture, health care beliefs, and
practices of Filipino nurses is important, as it
affects the way they assess the needs and provide
care for their clients. This article provides a gen-
eral profile of the health care beliefs, behaviors,
and practices of Filipino nurses in the United
States within the context of the general Filipino
culture. Like any other ethnic group, Filipinos
have become acculturated at various levels after
coming to work and live in this country over the
years. It is the integration of their cultural beliefs,
values, and behaviors that affects their caregiv-
ing attitudes and practices.
M
uch can be said about “you are a product of
your past.” One’s past is, of course, a con-
glomeration of factors or influences ranging
from family, community, school, religion, government,
society, environment, political events, and experiences.
This article examines the health care beliefs, behaviors,
and practices of Filipino nurses in the United States
within the context of the general Filipino culture and
how the integration of their cultural beliefs, values, and
behaviors affects their caregiving attitudes and
practices.
The Philippines is a small country consisting of
7,000 islands and several dialects; Tagalog is the
Home Health Care Management & Practice / December 2004 / Volume 17, Number 1, 22-27
DOI: 10.1177/1084822304268152
©2004 Sage Publications
22
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national language. This country of 70 million inhabit-
ants is located just above the equator. It was colonized
by Spain for more than 300 years and was under the
American rule for almost half a century (Limson et al.,
1992). This explains the heavy Spanish influence and
why the major religion is Catholic. This also explains
the American influence on the educational system. The
Philippines has also been involved in international
commerce over the years and, as a consequence, has
been influenced by European political thoughts. All of
these events and exposure to different peoples led to the
diversified Filipino culture.
The majority of Filipinos in the United States work
in health-related fields, and most of them are nurses.
The cultural background of Filipino nurses may have a
strong influence on their selection of nursing as a pro-
fession, because caring for others is emphasized and
valued, especially among females. The migration of
Filipino nurses to the United States has been in prog-
ress for 50 years. Filipino nurses comprise the majority
immigrant nurses in this country in response to the
cyclic nursing shortage. The Philippines is also one of
Asia’s main exporters of nurses for foreign employ-
ment causing brain drain to the country. Brain drain is
the immigration of professionals to other countries
leading to their shortage in the home country. Filipino
nurses are targeted because of the relative surplus of
nursing graduates who are eager to gain foreign
employment. Also, the nursing curriculum is patterned
after American nursing education. Tuazon (2002)
explained,
Key Words: Filipino; values; culture; women
 Ordonez, Gandeza / FILIPINO NURSES’ HEALTH BELIEFS
The curriculum revision in 1977 resulted in one entry
level for nursing—a four year bachelor science in
nursing program. The curriculum is comparable to the
U.S. and includes both didactic courses and clinical
rotations. Almost all of the textbooks used in colleges
of nursing are authored and published by Americans.
(p. 2).
According to Amy de la Paz (2001), executive director
of the Filipino Nurses Association in America, “The
Philippine Overseas Employment Agency approxi-
mates that there are about 50,000 Filipino nurses work-
ing in America’s health care system” (p. 1). However,
there are no exact statistics on Filipino nurses from
either the Philippines government or the U.S. Immigra-
tion and Naturalization Services (Joyce & Hunt, 1982).
The United States is experiencing yet another cycle
of a nursing shortage. According to Mary Foley (2001),
president of the American Nurses Association,
The increasing demand for nursing services, coupled
with the imminent retirement of today’s aging nurse,
will soon create a systemic nursing shortage. A recent
study published in the Journal of the American Medi-
cal Association estimates that the overall number of
nurses per capita will begin to decline in 2007, and that
by 2020 the number of nurses will fall nearly 20 per-
cent below requirements. (p. 8)
It is not unusual for the United States to again recruit
nurses from abroad, including Filipino nurses. On the
other hand, employment in the United States is attrac-
tive to Filipino nurses primarily for economic reasons.
Once employed in the United States, Filipino nurses
can earn as much as 20 times what they were making
back home (Chang, 2001; Prystay, 2002).
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 finan-
cial rewards, job security, and personal advancement
that U.S. jobs provide to Filipino nurses are valued.
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23
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 prac-
tice 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 limi-
tations, 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 sex-
ual 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 ineffec-
tive, an alternative is called for. Being sensitive to the
feelings of others is also reflected in the way Filipino
24 HOME HEALTH CARE MANAGEMENT & PRACTICE / December 2004
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 misun-
derstood 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 argu-
ments, especially with someone who is older or holds
an authority position, is considered uncivilized. Filipi-
nos also have difficulty turning down requests from
supervisors to whom they feel obligated (Joyce &
Hunt, 1982).
By their culturally determined nature, 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 con-
cern 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 Fili-
pinos 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 gen-
eral, 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 seri-
ous 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.
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Respect and Reverence
One’s position in society, professional achieve-
ments, and age carry a lot of weight in the Philippine
society. Physicians, lawyers, priests, engineers, teach-
ers, and nurses are among the well-respected profes-
sionals in the Philippines. Hence, their opinion is gen-
erally 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 em-
barrassing the other party. “Filipinos generally are nei-
ther assertive nor aggressive and may often appear
guarded or reticent. Nurses often misunderstand this need
for passivity and do not appreciate the culturally in-
duced motivation to maintain harmonious balance be-
tween 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 phy-
sician 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 sen-
tence when speaking with an older or elderly person.
This kind of cultural value and corresponding behav-
iors may hinder some Filipino nurses from performing
their patient advocacy role. For this reason, assertive-
ness training is very beneficial for Filipino nurses so
that they can exercise patient advocacy in a more
effective way.
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 back-
ground gave them the framework to be proficient
 Ordonez, Gandeza / FILIPINO NURSES’ HEALTH BELIEFS
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 com-
passionate 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 obliga-
tion and personal fulfillment in caring for one’s par-
ents. Elderly individuals are given high respect and
revered. Family commitment fosters a sense of pride,
and therefore, caring for others is embedded in the cul-
ture. “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 fam-
ily 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 barri-
ers 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 Philip-
pines, 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. Refer-
ence 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 Fili-
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25
pino accent is recognizable by the inflection on the
second syllable of a polysyllabic word. For example,
penicillin is pronounced as peNIcilin. It is also interest-
ing to know that there is a common pronoun for the sin-
gular 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 bur-
den (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 Filipi-
nos” (p. 1224). They tend to eat the same food and min-
gle with individuals of the same ethnic background.
Hence, the old health beliefs and practices continue.
HEALTH BELIEFS, BEHAVIORS,
AND PRACTICES
Preventive Health
Because most of their time is devoted to work, going
for preventive health checkups takes a backseat. Yet,
one may hear a Filipino extolling the importance of
preventive health to her patients or clients.
Filipino nurses have a tendency to self-diagnose,
self-medicate, and seek alternative therapies. In rural
areas in the Philippines, 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 mas-
sage for the diagnosis and treatment of musculo-
ligamentous and musculoskeletal ailments (Stuart,
1977).
Home remedies in the form of medicinal plants are
also popular for Filipino nurses who believe that plants
can heal common ailments. The practice of self-healing
and self-treatment prevents them from getting early
formal medical access and interventions. This poses a
great concern to most health care providers, as Filipino
nurses only seek medical care when their medical con-
dition is already very serious or in an advanced stage.
26 HOME HEALTH CARE MANAGEMENT & PRACTICE / December 2004
Home Remedies
Three concepts underlie Filipino American health
beliefs and practices: flushing, heating, and protection.
Each identifies a basic process used to promote good
health. Flushing keeps the body free from debris, heat-
ing maintains a balanced internal temperature, and pro-
tection guards the body from outside influences.
Although Western and scientific concepts are similar,
Filipino theories are founded on different premises.
Flushing is based on the notion that the body is a con-
tainer that collects impurities, heating means that hot
and cold qualities must be balanced in the body, and
protection involves safeguarding the body’s bound-
aries from supernatural as well as natural forces
(McKenzie & Chrisman, 1977).
Although this belief is practiced in the Philippines,
first-generation Filipino immigrants still carry with
them the understanding that the above theories can help
alleviate any medical illness, and they thus seek home
remedies rather than getting professional health ser-
vices from a medical doctor. Another reason is that
home remedies are readily available and cheap. An
example is the consumption of tea for stomachaches,
boiling ginger and drinking water for a sore throat, and
boiling corn hair and drinking water to promote urina-
tion. Although the approach might be benign, it is the
delay of medical attention that may worsen the medical
ailment and miss the optimal treatment opportunity.
For health care providers, it is important to establish
rapport with the Filipino patient to gain trust to elicit
information on the use of home remedies. Having a
working knowledge of the culture can improve health
assessment and interventions from health care provid-
ers as well as promote understanding of a culture that,
although Westernized, still believes in the power of
home remedies to correct ailments.
Pain Tolerance
Generally speaking, Filipino nurses have a high tol-
erance to pain. For example, one of the author’s sisters
has severe arthritis, yet she continues to do housework
regardless of her pain. Filipino nurses normally use
home remedies such as liniments and topical ointments
and manage pain before seeking medical care or while
under medical treatment. Health care providers need to
probe more into the cause and degree of pain from Fili-
pino patients to elicit more information. The elderly
group, in particular, is unlikely to complain about their
pain because they do not want to have extra burdens
being imposed on caregivers.
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The belief in the bahala na attitude predominates
pain management, especially for first-generation Fili-
pino immigrants. They value the opinion of elder fam-
ily members regarding their condition or the opinion of
a trusted friend before seeking medical attention. The
elderly are also secretive of their ailments and the types
of home remedies used to control their conditions. Such
secrecy poses greater risks of herbal or medicinal inter-
actions. Again, careful probing with increased sensitiv-
ity facilitates rapport and trust between caregivers and
Filipino patients and the attainment of accurate health
information.
Privacy
Filipinos are mostly reserved and private people. As
patients, they may not readily reveal their personal and
health information. Women in particular are sensitive
to touching another individual as well as being touched.
“Young female service providers should practice dis-
cretion with regard to touching older Filipino male
patients such as laying one’s hand on the patient’s hand
or shoulder to reassure comfort in moments of distress”
(McBride, n.d., p. 13). So, in gathering information for
a more comprehensive health assessment, Filipino
nurses would know how to probe without being aggres-
sive. They would know how to express compassion
without the perceived unnecessary physical intrusion.
Filipino women, especially the first generation of
immigrants, are usually very reserved in terms of sub-
jecting themselves to medical testing related to female
body parts. Some deeply religious women may con-
sider touching their breasts to be a sin. Other traditional
women may consider self-examination a violation of
respect for their body. For these types of examinations,
a female provider is usually preferred, although a male
physician who communicates sensitivity, respect, and
gentleness would be acceptable (McBride, n.d.). In rec-
ognition of the heightened sense of modesty on the part
of Filipinos, health care providers should ask permis-
sion before examinations and avoid rushing through.
Explanation should be offered before, during, and after
procedures.
CONCLUSION
Although Filipino nurses are being acculturated in
the U.S. health care system, traditional values and the
Filipino culture continue to influence their health
beliefs, behaviors, and practices. Instead of being a dis-
advantage, this enhances their cultural competence,
 Ordonez, Gandeza / FILIPINO NURSES’ HEALTH BELIEFS
because understanding one’s own culture facilitates
understanding that of others. Together with their flexi-
bility and adaptability, their open attitude to learn and
understand others can only lead to increasing confi-
dence and satisfaction of the patient.
As hardworking health care professionals, Filipino
nurses have made a name for themselves and have
achieved professional success as supervisors, manag-
ers, hospital administrators, and entrepreneurs. Many
Filipino nurses are seeking higher education; others
hold executive-level positions in hospitals and acade-
mia. As a result, Filipino nurses are being recognized
for their contributions in various arenas.
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Rosalia V. Ordonez, MEd, RN, is the chief of patient services edu-
cation in the Department of Veterans Affairs—New York Harbor
Healthcare System and a member of the Philippine Nurses Associa-
tion, the Global Society for Nursing and Health, the National Nurs-
ing Staff Development Organization, the American Association of
Critical Nurses, and the Preventive Cardiovascular Nurses Associ-
ation. She can be reached via e-mail at rosalia.ordonez@
med.va.gov.
Noemi Gandeza, MSN, RN, is a nurse educator in the Department
of Veterans Affairs—New York Harbor Healthcare System and a
member of the Philippine Nurses Association, the American Associ-
ation of Critical Care Nurses, and the Emergency Nurses Associa-
tion. She can be reached via e-mail at noemi.gandeza@med.va.gov.