Think of a typical adult Filipino head of the family who has an uncontrolled chronic condition. How would you approach your comprehensive health assessment and care in your setting while applying the principles of person-centeredness and holism? What values, beliefs, and practices would you consider throughout your interaction?
Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Jenniffer Paguio -
Number of replies: 20
In reply to Jenniffer Paguio
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
In conducting a thorough health assessment, I would begin by introducing myself, and establish rapport and trust through respectful communication. Then, I would explain the assessment process to the patient, including what to expect, and reassure them that their confidentiality will be respected and maintained at all times; utilizing simple and concise questions, with as little medical jargons as possible. Proximics should be observed, assess both verbal and non-verbal cues (Ernstmeyer & Christian, 2021), and use honorifics as needed.
Recognizing the Filipino value of close family ties, I would involve family members in discussions about the patient’s health, respecting their role in caregiving and decision-making. I would also consider the patient’s religion, or if the person is a part of an ethnic or cultural minority group, because these influence their health practices, such as dietary restrictions, use of traditional medicine, or views on medical interventions.
A holistic assessment would include not only the physical aspects of the chronic condition but also the patient’s emotional well-being, financial challenges, and daily responsibilities as a family provider. I would acknowledge the patient’s possible hesitation to seek medical help due to financial constraints and provide guidance on accessing affordable care options.
Additionally, I would respect traditional health practices they may follow, such as the use of herbal remedies, self-medication, or consultations with albularyo, while educating them on the importance of adhering to medical treatments. and provide clear, trustworthy guidance. It also allows us to tailor our health education to their needs. For example, if a patient values traditional medicine, we can help them balance it with modern treatments in a safe way. By exploring their sources, we can also improve their understanding of their condition and build trust. Holistic care respects human dignity: The relationship between the providers of health care and the patients is based on respect, relative openness, equality, and mutuality and patients participate in decision making in this kind of caring (Zamanzadeh et al, 2015).
Throughout the interaction, I would demonstrate empathy, cultural sensitivity, and respect, ensuring that the patient feels heard and valued. By considering these factors, I would aim to create a personalized care plan that balances medical needs with the patient’s values and realities, ultimately improving their quality of life and health outcomes.
REFERENCES:
Ernstmeyer, K., & Christman, E. (Eds.). (2021). Nursing fundamentals (Chapter 2: Communication). Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK591817/
Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research. Nursing open, 11(3), e2140.
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: A qualitative study. Indian Journal of Palliative Care, 21(2), 214–224. https://doi.org/10.4103/0973-1075.156506
In reply to Kryschelle Anne May Ramoneda
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Ericson Candelaria -
Thank you for this, Ma’am Kryschelle. This is greatly written discussing a culturally sensitive approach to our health assessments during patient interactions. It is indeed important for us nurses to consider their cultural beliefs. However, a question I would like to discuss is how would you handle it if the patient strongly prefers the traditional way of healing that comes in conflict with evidenced-based treatment?
In reply to Ericson Candelaria
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
Well, we can compromise Sir Ericson. I will try my best to find a middle ground. This is a difficult challenge to overcome, as elderly individuals often resist change, preferring what’s familiar to them. If all else fails, as patient advocates, we should respect their autonomy. If they refuse medical treatment, ensure they are fully informed of the risks and provide support as needed.
In reply to Kryschelle Anne May Ramoneda
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Jems Mercano -
I agree that establishing a rapport is very important especially when initiating interaction especially doing comprehensive assessment. This will allow the person being cared for to establish trust and cooperation. Understanding cultural background, practices, and beliefs will allow the nurse to plan, and provide culturally congruent care that will work both for the nurse and the person being cared for.
In reply to Kryschelle Anne May Ramoneda
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Mary Ann Rodriguez -
I totally agree that establishing rapport is the fundamentals and pivotal in conducting comprehensive health assessment. Introducing one self, explaining the purpose of health assessment in a respectful manner and ensuring privacy and confidentiality of the given data will encourage participation. Establishing rapport involves more than just using a respectful tone, nurses should be able to explore and understand person's interests, values, and preferences in order to plan and implement individualized care. Important data and considerations when conducting a health assessment through a verbal interview include knowing the person’s educational background, religion, culture, and values in order to align interventions and goals respectfully. One should also use concise, clear, and understandable terms to establish good communication, shared ideas, and shared decision-making.
Filipinos are known to be family-oriented, and as nurses, it is our responsibility to engage the family in the care plan in order to encourage participation and support that will strengthen and motivate the individual. A strong support system empowers an individual to combat illness and live life to the fullest because of their sources of hope and motivation which is their - “Family”.
I believe that as an Advanced Practice Nurse, it's essential to focus not only on the physical aspect but also on the other aspect of health. Understanding individual’s needs, how the illness impacts their daily life both prior to and following the diagnosis, and knowing what are coping strategies they are employing to regain or maintain good quality of life will serves as a guide for nurses in constructing or formulating standard nursing care plan that is applicable and appropriate to a unique individual.
Filipinos are known to be family-oriented, and as nurses, it is our responsibility to engage the family in the care plan in order to encourage participation and support that will strengthen and motivate the individual. A strong support system empowers an individual to combat illness and live life to the fullest because of their sources of hope and motivation which is their - “Family”.
I believe that as an Advanced Practice Nurse, it's essential to focus not only on the physical aspect but also on the other aspect of health. Understanding individual’s needs, how the illness impacts their daily life both prior to and following the diagnosis, and knowing what are coping strategies they are employing to regain or maintain good quality of life will serves as a guide for nurses in constructing or formulating standard nursing care plan that is applicable and appropriate to a unique individual.
In reply to Kryschelle Anne May Ramoneda
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Jenniffer Paguio -
Great exchange in this thread, everyone.
Let's avoid using 'Ma'am' and 'Sir' in the future and call each other by our first names.
Let's avoid using 'Ma'am' and 'Sir' in the future and call each other by our first names.
In reply to Jenniffer Paguio
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Ericson Candelaria -
Since the patient is known to have an uncontrolled chronic condition, adopting the PPC model and holistic approach is vital enabling us to engage in the person’s lived experiences and goals. We can start by having conversation inviting him to open up and share his narrative by giving the opportunity to share his story as a provider, his responsibilities, relationship and support system, challenges, and how his chronic condition affects his daily life. Through this, we can explore not just the physiological state of the person but also his emotional, social, and spiritual well-being. Exploring his beliefs and understanding of his condition, resources, barriers to health seeking behavior, cultural health practices, and his health goal/s is crucial since this might be one of the reasons why his condition is uncontrolled. By assessing these, we can make him an active partner taking into consideration his capacity, understanding, personal goal, and resources into formulating evidence-based health goals.
Moreover, we must also acknowledge potential barriers during our interactions. One key challenge is the risk of not eliciting a thorough or credible narrative from the patient which can compromise our plan of care. This can stem from a deeply ingrained cultural perspective in which many Filipinos, guided by the principle of kapwa, tend to view healthcare professionals as ‘ibang-tao’ rather than trusted allies. Another potential barrier is called ‘hiya’ where a person fears discrimination of his condition.To overcome these, we should try to establish a comfortable middle ground between providers and the patient, one that encourages openness and fosters trust.
Although in the heart of nursing, it is guided by a holistic approach, we often forget that our “patients” are also someone’s father, mother, sibling, or friend. There are times that we become so task oriented to the point that we see our “patients” as merely objects of care. In the end, it is essential to remember that true healing comes from seeing and caring for the person as a whole beyond their illness.
Moreover, we must also acknowledge potential barriers during our interactions. One key challenge is the risk of not eliciting a thorough or credible narrative from the patient which can compromise our plan of care. This can stem from a deeply ingrained cultural perspective in which many Filipinos, guided by the principle of kapwa, tend to view healthcare professionals as ‘ibang-tao’ rather than trusted allies. Another potential barrier is called ‘hiya’ where a person fears discrimination of his condition.To overcome these, we should try to establish a comfortable middle ground between providers and the patient, one that encourages openness and fosters trust.
Although in the heart of nursing, it is guided by a holistic approach, we often forget that our “patients” are also someone’s father, mother, sibling, or friend. There are times that we become so task oriented to the point that we see our “patients” as merely objects of care. In the end, it is essential to remember that true healing comes from seeing and caring for the person as a whole beyond their illness.
In reply to Ericson Candelaria
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
The concept of "ibang-tao" really is a barrier when it comes to caring. When I was just starting in the hemodialysis unit, some patients refused that I perform the cannulation. They also give short and insufficient answers during assessment because they still see me as "ibang-tao" so I worked hard to earn their trust and provided a comfortable space for them. Now, they're very open about what they're feeling—physically, mentally, or emotionally. Establishing rapport and providing a safe environment is truly crucial, especially with patients who may see us as “ibang-tao”. It encourages open communication and participation from the patient.
In reply to Jenniffer Paguio
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
In performing a comprehensive health assessment and providing care for a typical FIlipino head of the family, it is important to consider their values, beliefs, and practices, as well as their individuality and holistic well-being since Filipinos have a unique perspective when it comes to healthcare.
FIlipinos value respect so it is important to talk to them with courtesy and kindness. They are more trusting with healthcare staff who have positive tones and body language. Moreover, communicating with a language that they can easily understand and relate to helps establish rapport and promote better participation (Jose et al., 2024). Assessing their current condition, management strategies, their perception of health and health-seeking practices, as well as their socioeconomic status, lifestyle, beliefs, and values will be a great way to start the process. This will help us understand the patient better and will aid us in identifying areas to work on. Studies show that Filipinos often relied on their family and close friends for health information (Kawi et al., 2024) and health decisions. It is vital that we include the patient's family in decision-making and providing care such as following treatment plans, scheduling future appointments, planning meals, and reminding the patient regarding their due medications. Filipinos are also known to be self-reliant and resilient, even more so when they are the head of the family. They tend to put others before themselves and will not seek help until their condition gets worse. Financial constraints and fear of medical expenses are one of the main reasons why they refuse to seek healthcare. Hence, it is crucial to assess their financial limitations to find a way to work around it; referring them to government programs and community health resources might help. Moreover, since Filipinos still rely on herbal medicines and traditional healing, respectfully inquiring about it will help us understand them more and will aid us in providing appropriate health education without disregarding their beliefs.
By understanding and addressing the distinctive needs of our fellow Filipinos, we can be certain that the assessment and healthcare interventions we provide are both clinically effective and culturally acceptable.
References:
FIlipinos value respect so it is important to talk to them with courtesy and kindness. They are more trusting with healthcare staff who have positive tones and body language. Moreover, communicating with a language that they can easily understand and relate to helps establish rapport and promote better participation (Jose et al., 2024). Assessing their current condition, management strategies, their perception of health and health-seeking practices, as well as their socioeconomic status, lifestyle, beliefs, and values will be a great way to start the process. This will help us understand the patient better and will aid us in identifying areas to work on. Studies show that Filipinos often relied on their family and close friends for health information (Kawi et al., 2024) and health decisions. It is vital that we include the patient's family in decision-making and providing care such as following treatment plans, scheduling future appointments, planning meals, and reminding the patient regarding their due medications. Filipinos are also known to be self-reliant and resilient, even more so when they are the head of the family. They tend to put others before themselves and will not seek help until their condition gets worse. Financial constraints and fear of medical expenses are one of the main reasons why they refuse to seek healthcare. Hence, it is crucial to assess their financial limitations to find a way to work around it; referring them to government programs and community health resources might help. Moreover, since Filipinos still rely on herbal medicines and traditional healing, respectfully inquiring about it will help us understand them more and will aid us in providing appropriate health education without disregarding their beliefs.
By understanding and addressing the distinctive needs of our fellow Filipinos, we can be certain that the assessment and healthcare interventions we provide are both clinically effective and culturally acceptable.
References:
- Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research. Nursing open, 11(3), e2140.
- Martinez, A. B., Co, M., Lau, J., & Brown, J. S. L. (2020). Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review. Social psychiatry and psychiatric epidemiology, 55(11), 1397–1413.2024)
- Jose, C. G., Lucy, R., Parker, A. M., Clere, J., Montecillo, L., & Cole, A. M. (2024). Pakikisama: Filipino Patient Perspectives on Health care Access and Utilization. The Journal of the American Board of Family Medicine, 37(2), 242–250. https://doi.org/10.3122/jabfm.2023.230165r2
In reply to Alessandra Louise Lamug
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
This is so true Ma'am Louise. Filipinos value respect, you really need to say your "po" and "opo", or else you will get an earful from your elders.
Traditional ways of healing like going to "espiritistas", or "hilot", are deeply embedded in our culture. They've been there for a long time. Herbal medicines have been their go-to when they had illnesses way back then. We can't force our beliefs on them: we can only listen and support our patients in their healthcare decisions, and correct any misconceptions about seeking medical attention.
In reply to Alessandra Louise Lamug
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Mary Ann Rodriguez -
I totally Agree with the given statement that respect is highly valued by Filipinos, so it's essential to communicate with them politely and with kindness when conducting a comprehensive health assessment and care. As stated in the study entitled Pakikisama: Filipino Patient Perspectives on Health Care Access and Utilization. By Jose 2024. The results show that Filipinos consider culture and language as a crucial element in accessing healthcare. They are more likely to trust healthcare providers who used a positive tone, display appropriate body language, and promote health communication and education that is clear, relatable and easily understood by the use of “layman’s term”. These qualities are part of Pakikisama, - a Filipino value that emphasizes that comfort and building good relationships with others by the sense of relatability. the study also emphasize that Filipinos' trust in healthcare providers was strengthened by a sense of familiarity, awareness and an understanding of intercultural values. Concluding that culture and language are the fundamental components of health access among Filipino community. I Agree with the statement given by Ms. Lamug: “By understanding and addressing the distinctive needs of our fellow Filipinos, we can be certain that the assessment and healthcare interventions we provide are both clinically effective and culturally acceptable”. Considering Filipinos culture, values, understanding and exploring their coping strategies, establishing rapport through pakikisama, emphasizing the significance of integrating family, friends, media, and public healthcare professionals in delivering evidence-based health information as supported in the study entitled: Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research. By Kawi 2024. Will lead to an effective intervention that will eventually lead to a positive health outcome and increased person and families satisfaction.
And I believed that by the use of person-centred-care, holistic-integrative approach, pakikisama and with the help of government through its various programs and policies will eventually lead a reduction in morbidity and mortality rate of some chronic disease among medically underserved Filipinos.
Reference:
Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research.
Jose, C. G., Lucy, R., Parker, A. M., Clere, J., Montecillo, L., & Cole, A. M. (2024). Pakikisama: Filipino Patient Perspectives on Health care Access and Utilization. The Journal of the American Board of Family Medicine, 37(2), 242–250. https://doi.org/10.3122/jabfm.2023.230165r2
And I believed that by the use of person-centred-care, holistic-integrative approach, pakikisama and with the help of government through its various programs and policies will eventually lead a reduction in morbidity and mortality rate of some chronic disease among medically underserved Filipinos.
Reference:
Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research.
Jose, C. G., Lucy, R., Parker, A. M., Clere, J., Montecillo, L., & Cole, A. M. (2024). Pakikisama: Filipino Patient Perspectives on Health care Access and Utilization. The Journal of the American Board of Family Medicine, 37(2), 242–250. https://doi.org/10.3122/jabfm.2023.230165r2
In reply to Alessandra Louise Lamug
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Kathleen Regis -
I agree on your statement regarding involvement of the person’s family member in the decision-making and care process. Being family-oriented, we Filipinos often see family as an important motivator in self-care and in making healthy life choices. Chronic disease conditions, like hypertension and diabetes, always require dietary and lifestyle modifications, and members of the family can hugely influence the patient’s health habits. Family members also actively support patients’s during acute phases of the illness until discharge and at home. As immediate carer of the patient, I think it is necessary as well to assess the coping mechanisms of the family members because caregiving burden is common in chronic illnesses.
In reply to Alessandra Louise Lamug
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Jems Mercano -
I love this “ Communicating with a language that they can easily understand and relate to helps establish rapport and promote better participation (Jose et al., 2024). Assessing their current condition, management strategies, their perception of health and health-seeking practices, as well as their socioeconomic status, lifestyle, beliefs, and values will be a great way to start the process.”
I think we are on the same page when it comes to understanding a person's health situation. It is one of the best strategies to start a caring moment because it allows the nurse to look at the person as a whole- not merely a sick role it assumes. This action alone is caring and is important for the person being cared for in appreciating nursing moments as caring which eventually leads in establishment of trust and participation.
I think we are on the same page when it comes to understanding a person's health situation. It is one of the best strategies to start a caring moment because it allows the nurse to look at the person as a whole- not merely a sick role it assumes. This action alone is caring and is important for the person being cared for in appreciating nursing moments as caring which eventually leads in establishment of trust and participation.
In reply to Jenniffer Paguio
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Mary Ann Rodriguez -
In the study entitled: Elaboration of the Gothenburg model of person-centered care. By Britten 2017. develop and implement person-centered care in clinical practice base on three routines. Typical adult Filipino with uncontrolled chronic condition- example is a person with End stage renal disease. Chronic Kidney Disease is a slow, progressive, irreversible damage in the physiology of the kidney, with a glomerular filtration rate less than or equal to 60 mL/minute for 3 months or longer. Chronic kidney disease occurs in stages with loss of 75% of functioning nephrons, the client becomes symptomatic and eventually results in uremia or end-stage kidney disease with loss of 90% to 95% of functioning nephrons. (Elsevier, 2017.) According to the National Kidney and Transplant Institute (NKTI) - approximately one Filipino develops chronic renal failure every hour, this translates to approximately 120 Filipinos per million people each year. Unfortunately, underdiagnosis continues to be a persistent issue. Emphasizing that the incidence of chronic kidney disease (CKD) among Filipinos requiring dialysis is increasing.
In the study entitled: Quality of life in patients with chronic kidney disease. By Cruz, 2011. Reveals that patient with chronic kidney disease regardless of its stages has decreased quality of life. As evidenced by a reduction in physical functioning and a gradual decreased in independent role function. Another study entitled: Mental health of hemodialysis patients in the Philippines amid COVID-19 crisis: A call for action by Aruta, 2023. Stated that COVID-19 pandemic has worsened the already dangerous and costly situation for hemodialysis patients, as they are immunocompromised and highly vulnerable. Emphasizing that mental health is often not seen as a priority or urgent concern. Concluding that declining health condition of patient with chronic kidney disease has a negative impact on their mental well-being and are aggravated by the financial burden to received hemodialysis treatment. And in a developing country like the Philippines, Financial difficulties have been identified as a significant factor contributing to higher levels of depression, anxiety, and stress, along with reduced well-being. this study is supported by another study entitled: Health information sources and health-seeking behaviors of Filipinos living in medically underserved communities: Empirical quantitative research. By Kawi, 2024. reveals that just 61% of people in medically underserved regions of the Philippines sought healthcare professionals for wellness care, and only 69% consulted a physician when they were unwell. This means approximately one-third of individuals do not seek medical help when necessary due to several factors including: self-medication, lack of knowledge and privileges in health care services and facilities, and prayers.
By using the three routines of Person-Centred Care, first routine is to established rapport by introducing one self and the purpose of health teaching and gathering of data from the person standpoint or point of view in a holistic approach that will not cover only physical aspect of health but see the person as a whole. The first routine in Person-centred-care is to initiate patients’ narrative, on how the person see him/herself continuing life having that chronic condition, affecting their perspective in course of care and treatments, health progress, motivation and quality of life, by asking an open-ended question that help professionals (Nurses) to explore more. Nurse assessing a comprehensive health assessment should always consider persons- culture, values, beliefs that can be a significant factor that affects behaviors towards health perception and preferences.
The second routine helps to build partnership through collaborative decision-making between professionals and the person receiving the care. GPCC refrained from using the term (Patient-centred care) -contending that the word 'patient' often objectifies individuals as merely receipt of medical service. In regards to shared-decision making, Professional should set aside personal beliefs to avoid bias in order to reach agreement about shared goals, however goals that are detrimental to patient’s health Should not be supported, and Nurses should take an action in order to change persons perspective and behavior. One example given in the study was “To be able to drink as much alcohol as I can get”- this are personal goal that should not be tolerated, and reinforcement of health teaching is needed until understood and performed.
The third routine serves to protect the partnership by documenting the narrative in the form of patient preferences and values, as well as their participation and involvement in the decision making in regards to treatment plans and intervention.
In summary each and everyone of us is a unique being, regardless if the group of people having the same diagnosis, because not everyone will have the same response to the same health condition. therefore, nurses should apply individualized nursing care plan and assessment on all aspect of health in order to achieve person preferred goals and promote positive outcome and increases satisfaction. Holistic approach is very important, to be able to see beyond isolated symptoms and recognize other factors that affect the patient health. therefore, good communication and good clinical eye leads to a positive outcome. In regards to shared decision-making, - Patient and families have the right to be involve in the care, because understanding the purpose and treatment plan leads to cooperation and participation. Moreover, this study emphasizes “patients are expert in themselves and in their experiences of illness.” and “person is capable and resourceful despite their health problems”.
In relation to my current practice patient/ person and family engagement is very important in comprehensive health assessment especially in Coronary Care Unit because we always practice to consistently include patient and their families in planning patients’ goal through nursing care plan and in reinforcement of health teaching that involves transparent updates in providing regular and honest details about the patient’s condition and progress, depending on the situation if veracity or beneficence should be applied specifically on “Denied Patient” / “Confidential Patient” – relative and Doctor decides not to disclose patient condition to the patient to prevent complication secondary to emotional factors. Family engagement also includes providing support systems that offers resources for emotional support that involves encouraging patient and families to ask questions that create a safe space to express their concerns and feelings towards nursing care. Health communication includes providing clear explanations such as use of layman’s terms to explain the diagnoses, procedures, and treatment plans to patients and families because I believed that person narrative and insight regarding their health , person involvement to care plan , and holistic approach by the professionals will improve patient outcomes, reduce anxiety, and enhance the overall care experience and have a positive effect on the quality of life especially to people with uncontrolled chronic condition.
References
Mental health of hemodialysis patients in the Philippines amid COVID-19 crisis: A call for action. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC9843140/
Quality of life in patients with chronic kidney disease. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC3130152/
Rising incidence of chronic kidney disease in the Philippines sparks call for kidney health awareness subtitle: The Philippine Society of Nephrology urges Filipinos to take proactive measures. (2024, March 1). Philippine Society of Nephrology. https://psn.org.ph/2024/03/01/rising-incidence-of-
Silvestri, L. A. (2016). Saunders comprehensive review for the NCLEX-RN® examination - E-book: Saunders comprehensive review for the NCLEX-RN® examination - E-book. Elsevier Health Sciences.
Britten, N., Moore, L., Lydahl, D., Naldemirci, O., Elam, M., & Wolf, A. (2017). Elaboration of the Gothenburg model of person-centered care. Health Expectations.
Frisch NC, Rabinowitsch D. What’s in a Definition? Holistic Nursing, Integrative Health Care, and Integrative Nursing: Report of an Integrated Literature Review. Journal of Holistic Nursing. 2019.
Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research.
In the study entitled: Quality of life in patients with chronic kidney disease. By Cruz, 2011. Reveals that patient with chronic kidney disease regardless of its stages has decreased quality of life. As evidenced by a reduction in physical functioning and a gradual decreased in independent role function. Another study entitled: Mental health of hemodialysis patients in the Philippines amid COVID-19 crisis: A call for action by Aruta, 2023. Stated that COVID-19 pandemic has worsened the already dangerous and costly situation for hemodialysis patients, as they are immunocompromised and highly vulnerable. Emphasizing that mental health is often not seen as a priority or urgent concern. Concluding that declining health condition of patient with chronic kidney disease has a negative impact on their mental well-being and are aggravated by the financial burden to received hemodialysis treatment. And in a developing country like the Philippines, Financial difficulties have been identified as a significant factor contributing to higher levels of depression, anxiety, and stress, along with reduced well-being. this study is supported by another study entitled: Health information sources and health-seeking behaviors of Filipinos living in medically underserved communities: Empirical quantitative research. By Kawi, 2024. reveals that just 61% of people in medically underserved regions of the Philippines sought healthcare professionals for wellness care, and only 69% consulted a physician when they were unwell. This means approximately one-third of individuals do not seek medical help when necessary due to several factors including: self-medication, lack of knowledge and privileges in health care services and facilities, and prayers.
By using the three routines of Person-Centred Care, first routine is to established rapport by introducing one self and the purpose of health teaching and gathering of data from the person standpoint or point of view in a holistic approach that will not cover only physical aspect of health but see the person as a whole. The first routine in Person-centred-care is to initiate patients’ narrative, on how the person see him/herself continuing life having that chronic condition, affecting their perspective in course of care and treatments, health progress, motivation and quality of life, by asking an open-ended question that help professionals (Nurses) to explore more. Nurse assessing a comprehensive health assessment should always consider persons- culture, values, beliefs that can be a significant factor that affects behaviors towards health perception and preferences.
The second routine helps to build partnership through collaborative decision-making between professionals and the person receiving the care. GPCC refrained from using the term (Patient-centred care) -contending that the word 'patient' often objectifies individuals as merely receipt of medical service. In regards to shared-decision making, Professional should set aside personal beliefs to avoid bias in order to reach agreement about shared goals, however goals that are detrimental to patient’s health Should not be supported, and Nurses should take an action in order to change persons perspective and behavior. One example given in the study was “To be able to drink as much alcohol as I can get”- this are personal goal that should not be tolerated, and reinforcement of health teaching is needed until understood and performed.
The third routine serves to protect the partnership by documenting the narrative in the form of patient preferences and values, as well as their participation and involvement in the decision making in regards to treatment plans and intervention.
In summary each and everyone of us is a unique being, regardless if the group of people having the same diagnosis, because not everyone will have the same response to the same health condition. therefore, nurses should apply individualized nursing care plan and assessment on all aspect of health in order to achieve person preferred goals and promote positive outcome and increases satisfaction. Holistic approach is very important, to be able to see beyond isolated symptoms and recognize other factors that affect the patient health. therefore, good communication and good clinical eye leads to a positive outcome. In regards to shared decision-making, - Patient and families have the right to be involve in the care, because understanding the purpose and treatment plan leads to cooperation and participation. Moreover, this study emphasizes “patients are expert in themselves and in their experiences of illness.” and “person is capable and resourceful despite their health problems”.
In relation to my current practice patient/ person and family engagement is very important in comprehensive health assessment especially in Coronary Care Unit because we always practice to consistently include patient and their families in planning patients’ goal through nursing care plan and in reinforcement of health teaching that involves transparent updates in providing regular and honest details about the patient’s condition and progress, depending on the situation if veracity or beneficence should be applied specifically on “Denied Patient” / “Confidential Patient” – relative and Doctor decides not to disclose patient condition to the patient to prevent complication secondary to emotional factors. Family engagement also includes providing support systems that offers resources for emotional support that involves encouraging patient and families to ask questions that create a safe space to express their concerns and feelings towards nursing care. Health communication includes providing clear explanations such as use of layman’s terms to explain the diagnoses, procedures, and treatment plans to patients and families because I believed that person narrative and insight regarding their health , person involvement to care plan , and holistic approach by the professionals will improve patient outcomes, reduce anxiety, and enhance the overall care experience and have a positive effect on the quality of life especially to people with uncontrolled chronic condition.
References
Mental health of hemodialysis patients in the Philippines amid COVID-19 crisis: A call for action. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC9843140/
Quality of life in patients with chronic kidney disease. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC3130152/
Rising incidence of chronic kidney disease in the Philippines sparks call for kidney health awareness subtitle: The Philippine Society of Nephrology urges Filipinos to take proactive measures. (2024, March 1). Philippine Society of Nephrology. https://psn.org.ph/2024/03/01/rising-incidence-of-
Silvestri, L. A. (2016). Saunders comprehensive review for the NCLEX-RN® examination - E-book: Saunders comprehensive review for the NCLEX-RN® examination - E-book. Elsevier Health Sciences.
Britten, N., Moore, L., Lydahl, D., Naldemirci, O., Elam, M., & Wolf, A. (2017). Elaboration of the Gothenburg model of person-centered care. Health Expectations.
Frisch NC, Rabinowitsch D. What’s in a Definition? Holistic Nursing, Integrative Health Care, and Integrative Nursing: Report of an Integrated Literature Review. Journal of Holistic Nursing. 2019.
Kawi, J., Fudolig, M., Serafica, R., Reyes, A. T., Sy, F., Leyva, E. W. A., & Evangelista, L. S. (2024). Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research.
In reply to Jenniffer Paguio
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Kathleen Regis -
Nursing assessment is an integral component of nursing practice and critical within every nurse–patient encounter. Data from assessment guides clinical decision-making and enables nurses to identify areas in which nursing interventions can be used to improve patient outcomes. Often, nursing assessment is guided by the use of tools or instruments to capture the patients’ health data and story. However, they are concentrated primarily on medical context, and do not always assess socioeconomic, psychological, spiritual, and cultural determinants of health. In the Philippine setting where traditional medicine is still widely practiced especially in rural areas and where religion holds an essential place in the majority of Filipino lives, a comprehensive health assessment should be encompassing.
Utilizing person-centered and holistic approaches in care of persons with chronic illnesses, nurses should obtain the patient’s narrative of family dynamics and influence, socioeconomic status, health practices such as alternative medicine and faith healing, and religious beliefs. Filipino families are typically close-knit, and a typical adult Filipino acting as the head of the family often bears a lot of familial responsibilities, mainly providing financial support. Much of the family’s income is allocated for everyday necessities, and a day out of work due to illnesses is costly and burdensome to the entire family, thus, they do not seek help immediately for health concerns. It’s not uncommon that they prioritize other’s needs over their own. Men, in particular, being stigmatized as “weak” discourage help-seeking behaviors. Yet, the family can also influence their health actions, as their welfare is linked to the entire family’s welfare. Economic barriers are common in Filipino households, and many healthcare services remain poorly integrated and are often difficult to access, particularly for lower-income groups. In addition, it is essential to acknowledge alternative medicine (herbal medicine, dietary supplements, etc.,) that they believe in, and encourage its use alongside conventional medicine as long as deemed safe. Religious practices, including prayers and rituals, should be assessed and respected. Filipinos, especially older adults, tend to cope with illness by relying on faith in God. In fact, experiencing a complete recovery from an illness is often regarded as personally witnessing a miracle—greatly influencing how Filipinos view healthcare. Many Filipino beliefs still exist and continue to shape the opinions, decisions, values, and actions of Filipinos in modern times. While it may seem harmless, they may sometimes interfere with how Filipinos cope with illnesses and respond to mental health issues.
In conclusion, all these domains should be considered in assessments and interventions. Structural, social and cultural conditions that support health need to be present for effective health promotion.
Utilizing person-centered and holistic approaches in care of persons with chronic illnesses, nurses should obtain the patient’s narrative of family dynamics and influence, socioeconomic status, health practices such as alternative medicine and faith healing, and religious beliefs. Filipino families are typically close-knit, and a typical adult Filipino acting as the head of the family often bears a lot of familial responsibilities, mainly providing financial support. Much of the family’s income is allocated for everyday necessities, and a day out of work due to illnesses is costly and burdensome to the entire family, thus, they do not seek help immediately for health concerns. It’s not uncommon that they prioritize other’s needs over their own. Men, in particular, being stigmatized as “weak” discourage help-seeking behaviors. Yet, the family can also influence their health actions, as their welfare is linked to the entire family’s welfare. Economic barriers are common in Filipino households, and many healthcare services remain poorly integrated and are often difficult to access, particularly for lower-income groups. In addition, it is essential to acknowledge alternative medicine (herbal medicine, dietary supplements, etc.,) that they believe in, and encourage its use alongside conventional medicine as long as deemed safe. Religious practices, including prayers and rituals, should be assessed and respected. Filipinos, especially older adults, tend to cope with illness by relying on faith in God. In fact, experiencing a complete recovery from an illness is often regarded as personally witnessing a miracle—greatly influencing how Filipinos view healthcare. Many Filipino beliefs still exist and continue to shape the opinions, decisions, values, and actions of Filipinos in modern times. While it may seem harmless, they may sometimes interfere with how Filipinos cope with illnesses and respond to mental health issues.
In conclusion, all these domains should be considered in assessments and interventions. Structural, social and cultural conditions that support health need to be present for effective health promotion.
In reply to Kathleen Regis
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
Very well said, Ma'am Kath! Family dynamics, religious beliefs, socioeconomic status, and alternative medicine can really affect health-seeking behaviors. I agree that understanding these factors is vital in providing culturally sensitive care. By acknowledging and respecting these influences and working with them instead of opposing them, we can make our patients trust us more and improve health outcomes.
In reply to Jenniffer Paguio
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
by Jems Mercano -
How would you APPROACH a typical adult Filipino head of the family who has an uncontrolled chronic condition for comprehensive health assessment and care considering principles of person-centeredness and holism?
Person- centered nursing deals with a person as a whole, not merely a patient role during a phase of illness (McCormack & McCance, 2006). This includes understanding a person’s health experience, empowering the person being cared for through various mechanisms like involving the person as well as the significant others in planning care. In my opinion, the Person- centered care approach goes the extra mile in caring, making a clear difference in the traditional medical model which treats a person as biological systems with predefined numbers that determines health and illness.
First, let’s consider the Filipino culture.The head of the Family is commonly the primary provider, and decision maker hence, the head is expected to be strong and be able to provide family needs. From this perspective, we can anticipate possible resistance to care because of the financial burden. On top of this, being “sick” reflects weakness. Let’s face the reality (no need to cite reference for this), the typical head of the family (and by means of typical, I mean poor Filipino) will prioritize basic family needs like food, water and shelter over health unless they perceive their health situation as life/death.
From this Idea, I would start my preliminary assessment by asking a person's view/ experience on his/her current health situation as this would give important data on how to approach the following steps of assessment. I would ask questions like, “ Kumusta po, Nakatulog ba ng maayos?, nakakain/nakakain ba ng tubig ng maayos?, nakakaihi/nakakadumi ba ng maayos?, Nahihirapan sa paghinga? Komportable ba/May masakit sa katawan?”
These are simple but powerful questions. Simple enough to understand by a typical and kapwa Filipino and provide important information about the health experience/situation of the person being cared for. This question reflects basic Filipino needs- understanding these needs reflects shared identity. This common ground helps me to establish trust and cooperation to start a full comprehensive health assessment and develop a plan of care. Allow me to end my discussion with an important take away from a blog on Filipino Pyschology which states that “To practice "Kapwa" means to embrace our shared identity and to genuinely care for one another” (Enrile, 2024).
References:
Enrile, A. (2024). Understanding the Psychology of Pilipinos What we can learn from culturally-specific psychologies like Sikolohiyang Pilipino. Psychology Today. https://www.psychologytoday.com/intl/blog/ordinary-magic/202409/understanding-the-psychology-of-pilipinos
McCormack, B., & McCance, T. V. (2006). Development of a framework for person-centred nursing. Journal of Advanvanced Nursing, 56(5), 472–479. https://doi.org/10.1111/j.1365-2648.2006.04042.x
In reply to Jems Mercano
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
I agree with the view that Person-Centered Nursing treats the whole person, not just their illness, which is a significant shift from the traditional medical model. In Filipino culture, the head of the family often prioritizes basic needs over health due to cultural expectations of strength and financial constraints. Starting the assessment with simple, culturally relevant questions helps build trust and understanding. The concept of Kapwa—shared identity—reinforces the importance of empathy and connection in providing care, making it more effective and aligned with the values of Filipino families.
In reply to Jems Mercano
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
I agree that adopting the Person-Centered Care (PPC) model and a holistic approach is crucial for patients with uncontrolled chronic conditions. By exploring the patient’s narrative, including their emotional, social, and spiritual well-being, we can create a collaborative care plan that aligns with their personal goals. Cultural barriers like kapwa and hiya is vital for building trust and encouraging openness. It's also important to remember that patients are more than just their illness—they are connected to families and communities, and true healing comes from treating them as whole individuals.
In reply to Jenniffer Paguio
Re: Assessing an Adult Filipino Patient with an Uncontrolled Chronic Condition
Since this case involves the head of the family, my approach will consider not only the individual but also the entire family system, as the chronic condition may significantly impact family dynamics and functioning. I will apply the Family Health Nursing (FHN) framework, which assesses both the health and overall well-being of individuals and their families. During the first meeting, I will introduce myself and explain the purpose of my visit clearly, using simple, layman’s terms to ensure the family understands the health issues at hand. Since Filipino families often rely on traditional methods of communication, it’s essential to ensure that information is accessible to everyone, not just the patient.
To guide the health assessment, I will apply several theoretical frameworks. First, the Family Systems Theory views the family as an interconnected system, meaning the health of one member affects the whole family. The Interactional Approach will help assess communication patterns, decision-making, conflict resolution, and how the family responds to stress related to the chronic condition. Lastly, the Structural-Functional Perspective will explore roles, value systems, and power structures within the family, helping to understand how the family makes decisions about healthcare and caregiving.
Additionally, I will utilize the Family Health Nursing approach, which includes assessing five key areas: family structure, characteristics, and dynamics; socio-economic and cultural characteristics; home environment; health status of each family member; and the family’s values and practices regarding health promotion and disease prevention. I will gather information on demographic data, income, education, household facilities, and health status of each family member. This comprehensive data will help assess the family’s daily routines, how they cope with the chronic condition, and any cultural or traditional health practices that influence their care approach.
This holistic and person-centered approach will allow me to address the health needs of the individual while considering the broader impact on the family. By understanding the family context, I can create a care plan that is culturally sensitive, collaborative, and empowering.
References
Maglaya, A. S., Cruz-Earnshaw, R. G., Lao-Nario, M. T., Dones, L. L., De Leon, W. O., & Rabuco, L. B. (2009). Nursing Practice in the Community 5th Edition. Marikina City: Argonauta Corporation.
To guide the health assessment, I will apply several theoretical frameworks. First, the Family Systems Theory views the family as an interconnected system, meaning the health of one member affects the whole family. The Interactional Approach will help assess communication patterns, decision-making, conflict resolution, and how the family responds to stress related to the chronic condition. Lastly, the Structural-Functional Perspective will explore roles, value systems, and power structures within the family, helping to understand how the family makes decisions about healthcare and caregiving.
Additionally, I will utilize the Family Health Nursing approach, which includes assessing five key areas: family structure, characteristics, and dynamics; socio-economic and cultural characteristics; home environment; health status of each family member; and the family’s values and practices regarding health promotion and disease prevention. I will gather information on demographic data, income, education, household facilities, and health status of each family member. This comprehensive data will help assess the family’s daily routines, how they cope with the chronic condition, and any cultural or traditional health practices that influence their care approach.
This holistic and person-centered approach will allow me to address the health needs of the individual while considering the broader impact on the family. By understanding the family context, I can create a care plan that is culturally sensitive, collaborative, and empowering.
References
Maglaya, A. S., Cruz-Earnshaw, R. G., Lao-Nario, M. T., Dones, L. L., De Leon, W. O., & Rabuco, L. B. (2009). Nursing Practice in the Community 5th Edition. Marikina City: Argonauta Corporation.