Decent Work Employment and Transcultural Nursing
Module #14 Student Activity Sheet
Name: _________________________________________________________ Class number: _______
Section: ____________ Schedule: ___________________________________ Date: _______________
Lesson title: THE INFLUENCE OF CULTURAL AND HEALTH Materials:
BELIEF SYSTEM ON HEALTH CARE PRACTICES Electronic gadget, pen, & notebook
Learning Targets:
At the end of the module, students will be able to:
1. Describe the major cultural belief systems of people from
diverse cultures;
2. Compare and contrast professional and folk healing
systems;
3. Identify the major complementary and alternative health References:
care therapies;
4. Describe the influence of culture on symptoms and illness Andrews, M. M. & Boyle, J. S. (2016).
behaviors; and, Transcultural concepts in nursing care (7th
5. Critically analyze the efficacy of selected herbal remedies in ed.). Philadelphia, PA: Wolters Kluwer.
the treatment of health problems.
A. LESSON PREVIEW/REVIEW
Let us have a quick review of what you have learned from the previous session. Kindly answer the posted task on the
space provided. You may use the back page of this sheet, if necessary. Here is the task:
In your own words, describe the key components of a comprehensive cultural assessment.
B. MAIN LESSON
HEALTH BELIEF SYSTEMS
Generally, theories of health and disease or illness causation are based on a group’s prevailing worldview. These
worldviews include a group’s health-related attitudes, beliefs, and practices, frequently referred to as health belief
systems.
People embrace three major health belief systems or worldviews: magico-religious, scientific (or biomedical),
and holistic, each with its own corresponding system of health beliefs.
In two of these worldviews (magico-religious and holistic), disease is thought of as an entity separate from self,
caused by an agent external to the body but capable of “getting in” and causing damage.
This causative agent has been attributed to a variety of natural and supernatural phenomena. Furthermore, many
people sometimes adhere to or believe in aspects of two or even three of the systems at any one time.
For example, a person who is ill may understand that the illness has an identified causative agent; at the same
time, the person may pray to recover quickly and perhaps embark on a sacred journey to see a vortex specialist
to unite body, mind, and spirit.
Magico-Religious Health Paradigm
In the magico-religious paradigm, the world is an arena dominated by supernatural forces. The fate of the world
and those in it, including humans, depends on actions of God, gods, or other supernatural forces for good or evil.
In some cases, the human individual is at the mercy of such forces regardless of behavior. In other cases, the
gods punish humans for their transgressions.
Many Latino, African American, and Middle Eastern cultures are grounded in the magico-religious paradigm.
Magic involves the calling forth and control of supernatural forces for and against others.
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Some African and Caribbean cultures, such as Voodoo, have aspects of magic in their belief systems. In Western
cultures, there are examples of this paradigm in which metaphysical reality interrelates with human society.
For instance, Christian Scientists believe that physical healing can be effected through prayer alone.
Throughout the world, five categories of events are believed to be responsible for illness in the magico-religious
paradigm. These categories, derived from the work of Clements (1932), are sorcery, breach of taboo, intrusion of
a disease object, intrusion of a disease-causing spirit, and loss of soul.
One of these belief categories, or any combination of them, may be offered to explain the origin of disease.
Alaska Natives refer to soul loss and breach of taboo (breaking a social norm, such as committing adultery).
West Indians and some Africans and African Americans believe that the malevolence of sorcerers is the cause of
many conditions.
Malojo, or the evil eye, common in Latino and other cultures, can be viewed as the intrusion of a disease-causing
spirit.
Scientific or Biomedical Health Paradigm
In this paradigm, life is controlled by a series of physical & biochemical processes that can be studied &
manipulated by humans. Several specific forms of symbolic thought processes characterize scientific paradigm.
o The first is determinism, which states that a cause-and effect relationship exists for all-natural
phenomena.
o The second, mechanism, assumes that it is possible to control life processes through mechanical,
genetic, and other engineered interventions.
o The third form is reductionism, according to which all life can be reduced or divided into smaller parts;
study of the unique characteristics of these isolated parts is thought to reveal aspects or properties of the
whole, for example, the human genome and its component parts.
o The final thought process is objective materialism, which states that what is real can be observed and
measured. There is a further distinction between subjective and objective realities in this paradigm.
Holistic Health Paradigm
In the holistic paradigm, the forces of nature itself must be kept in natural balance or harmony. Human life is only
one aspect of nature and a part of the general order of the cosmos.
Everything in the universe has a place and a role to perform according to natural laws that maintain order.
Disturbing these laws creates imbalance, chaos, and disease.
The holistic paradigm seeks to maintain a sense of balance between humans and the larger universe.
Explanations for health and disease are based on imbalance or disharmony among the human, geophysical, and
metaphysical forces of the universe.
The term holistic, coined in 1926 by Jan Christian Smuts, defines an attitude or mode of perception in which the
whole person is viewed in the context of the total environment.
o Its Indo- European root word, kailo, means “whole, intact, or uninjured.” From this root have come the
words hale, hail, hallow, holy, whole, heal, and health. The essence of health and healing is the quality of
wholeness we associate with healthy functioning and well-being.
Yin and Yang
A strong metaphor in the holistic paradigm is exemplified by the Chinese concept of yin and yang, in which the
forces of nature are balanced to produce harmony.
o The yin force in the universe represents the female aspect of nature. It is characterized as the negative
pole, encompassing darkness, cold, and emptiness.
o The yang, or male force, is characterized by fullness, light, and warmth. It represents the positive pole.
An imbalance of forces creates illness.
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Hot/Cold Theory
Another common metaphor for health and illness in the holistic paradigm is the hot/cold theory of disease. This is
founded on the ancient Greek concept of the four body humors: yellow bile, black bile, phlegm, and blood.
Humors are vital components of the blood found in varying amounts. The four humors work together to ensure
the optimum nutrition, growth, and metabolism of the body.
o When the humors are balanced in the healthy individual, the state of ecrasia exists.
o When the humors are in a state of imbalance, this is referred to as dyscrasia.
Health and Illness Behavior
The series of behaviors typifying the health-seeking process have been labeled health and illness behaviors.
These behaviors are expressed in the roles people assume after identifying a symptom. Related to these
behaviors are the roles individuals assign to others and the status given to the role players.
People assume various types of behaviors once they have recognized a symptom. Health behavior is any activity
undertaken by a person who believes himself or herself to be healthy for the purpose of preventing disease or
detecting disease in an asymptomatic stage.
Illness behavior is any activity undertaken by a person who feels ill to define the state of his or her health and
discover a suitable remedy. Sick role behavior is any activity undertaken by a person who considers himself ill to
get well or to deal with the illness.
Three sets of factors influence the course of behaviors and practices carried out to maintain health and prevent
disease: (1) one’s beliefs about health and illness; (2) personal factors such as age, education, knowledge, or
experience with a given disease condition; and (3) cues to action, such as advertisements in the media, the
illness of a relative, or the advice of friends.
Types of Healing Systems:
The term healing system refers to the accumulated sciences, arts, and techniques of restoring and preserving
health that are used by any cultural group. In complex societies in which several cultural traditions flourish,
healers tend to compete with one another and/or to view their scopes of practice as separate from one another.
In some instances, however, practitioners may make referrals to different healing systems.
For example, a nurse may contact a rabbi to assist a Jewish patient with spiritual needs, or a curandero may
advise a Mexican American patient to visit a health care provider for an antibiotic when traditional practices fail to
heal a wound.
Self-Care
For common minor illnesses, an estimated 70% to 90% of all people initially try self-care with over-the-counter
medicines, megavitamins, herbs, exercise, and/or foods that they believe have healing powers. Many self-care
practices have been handed down from generation to generation, frequently by oral tradition.
Self-care is the largest component of the American health care system and accounts for billions of dollars in
revenue. The use of over-the-counter medications, or nonprescription medications, is a common form of self-care.
Dietary supplements such as herbs, vitamins, minerals, or other substances are very popular and used
extensively in the United States.
When self-treatment is ineffective, people are likely to turn to professional and/or folk (indigenous, generic,
traditional) healing systems.
Professional Care Systems
According to Leininger, professional care systems, also referred to as scientific or biomedical systems, are
formally taught, learned, and transmitted professional care, health, illness, wellness, and related knowledge and
practice skills that prevail in professional institutions, usually with multidisciplinary personnel to serve consumers.
Professional care is characterized by specialized education and knowledge, responsibility for care, and
expectation of remuneration for services rendered. Nurses, physicians, physical therapists, and other licensed
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health care providers are examples of professionals who comprise professional care systems in the United
States, Canada, Europe, Australia, and other parts of the world.
Folk Healing System
A folk healing system is a set of beliefs that has a shared social dimension and reflects what people actually do
when they are ill versus what society says they ought to do according to a set of social standards.
According to Leininger and McFarland, all cultures of the world have had a lay health care system, which is
sometimes referred to as indigenous or generic.
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Most cultures have folk healers (sometimes referred to as traditional, lay, indigenous, or generic healers), most of
whom speak the native tongue of the client, sometimes make house calls, and usually charge significantly less
than health care providers in the professional care system.
In addition, many cultures have lay midwives (e.g., parteras for Hispanic women), doulas (support women for new
mothers and babies), or other health care providers available for meeting the needs of clients.
If clients use folk healers, these healers should be an integral part of the health care team and included in as
many aspects of the client’s care as possible. For example, a nurse might include the folk healer in obtaining a
health history and in determining what treatments already have been used in an effort to bring about healing.
In discussing traditional remedies, it is important to be respectful and to listen attentively to healers who combine
spiritual and herbal remedies for a wide variety of illnesses, both physical and psychological in origin.
Complementary, Integrative, and Alternative Health System
This is an umbrella term for hundreds of therapies based on health care systems of people from around the world.
Some of these therapies have ancient origins in Egyptian, Chinese, Greek, and American Indian cultures. Others,
such as osteopathy and magnet therapy, have evolved more recently.
Allopathic or biomedicine is the reference point, with all other therapies being considered complementary (in
addition to), integrative (combined with selected magico-religious or holistic therapies whose efficacy has been
scientifically documented), or alternative to (instead of).
Integrative health care is defined as a comprehensive, often interdisciplinary approach to treatment, prevention,
and health promotion that brings together complementary and conventional therapies. The use of an integrative
approach to health and wellness has grown within care settings across the United States, including hospitals,
hospices, and military health facilities (National Center for Complementary and Integrative Health, 2014).
o The NCCIH’s mission is to define, through rigorous scientific investigation, the usefulness and safety of
complementary and integrative health approaches and their roles in improving health and health care.
Complementary Health Approaches the National Institutes of Health categorizes complementary and integrative health
approaches as follows:
1. Alternative medical systems are built on complete systems of theory and practice. Often these systems have
evolved apart from and earlier than the conventional medical approach used in the United States or Canada.
Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and
naturopathic medicine. Examples of systems that have developed in Eastern cultures include traditional Chinese
medicine and Ayurveda, which originated in India.
2. Natural Products include herbs (also known as botanicals), vitamins, minerals, and probiotics. They are often
marketed to the public as dietary supplements. Interest in and use of natural products has continued to grow each
year for the past decade. Data from the 2012 National Health Survey (Centers for Disease Control and Prevention
[CDC], 2014) reveal that 17.7% of US adults reported they had used non-vitamin, non-mineral dietary supplements
during 2012.
3. Mind and body practices include a diverse group of techniques administered by a trained practitioner that are
designed to enhance the mind’s capacity to affect bodily functions & symptoms. The most commonly used mind &
body practices include deep breathing, meditation, massage, yoga, progressive relaxation, hypnosis, & guided
imagery.
4. Manipulative and body-based methods are based on manipulation and/or movement of one or more parts of the
body. Some examples include chiropractic or osteopathic manipulation and massage therapy.
5. Energy therapies involve the use of energy fields in two ways:
o Biofield therapies are intended to affect energy fields that surround and penetrate the human body. (The
existence of such fields has not yet been scientifically proven.) Some forms of energy therapy manipulate
biofields by applying pressure and/ or manipulating the body by placing the hands in, or through, these fields.
Examples include qigong, Reiki, and Therapeutic Touch.
o Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed
fields, magnetic fields, or alternating-current or direct-current fields.
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Selected Complementary and Alternative Therapies
Refers to a family of procedures involving stimulation of anatomical points on the body by a variety
of techniques. The acupuncture technique that has been most studied scientifically involves
Acupuncture
penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by
electrical stimulation. When heat is applied to the needles, it is referred to as moxibustion.
Involves the use of essential oils (extracts or essences) from flowers, herbs, and trees to promote
Aromatherapy
health and well-being.
Includes diet and herbal remedies and emphasizes the use of body, mind, and spirit in disease
Ayurveda
prevention and treatment.
Focuses on the relationship between bodily structure (primarily that of the spine) and function, and
Chiropractic how that relationship affects the preservation and restoration of health. Chiropractors use
manipulative therapy as an integral treatment tool.
Are products (other than tobacco) taken by mouth that contains a dietary ingredient intended to
supplement the diet. Dietary ingredients may include vitamins, minerals, herbs or other botanicals,
Dietary
amino acids, and substances such as enzymes, organ tissues, and metabolites. Dietary
supplements
supplements come in many forms, including extracts, concentrates, tablets, capsules, gel caps,
liquids, and powders.
Refers to a wide variety of techniques, including simple visualization and direct suggestion using
imagery, metaphor and story-telling, fantasy exploration and game playing, dream interpretation,
Guided imagery
drawing, and active imagination where elements of the unconscious are invited to appear as
images that can communicate with the conscious mind.
An alternative medical system. In homeopathic medicine, there is a belief that “like cures like,”
Homeopathic meaning that small, highly diluted quantities of medicinal substances are given to cure symptoms,
medicine even though the same substances given at higher or more concentrated doses would actually
cause those symptoms.
Therapists manipulate muscle and connective tissue to enhance function of those tissues and
Massage
promote relaxation and well-being.
An alternative medical system based on the premise that there is a healing power in the body that
establishes, maintains, and restores health. Practitioners work with the patient with a goal of
Naturopathy
supporting this power through treatments such as nutrition and lifestyle counseling, dietary
supplements, medicinal plants, exercise, homeopathy, and traditional Chinese medicine.
A form of conventional medicine that, in part, emphasizes diseases arising in the musculoskeletal
system. There is an underlying belief that all of the body’s systems work together, and
Osteopathic
disturbances in one system may affect function elsewhere in the body. Some osteopathic
medicine
physicians practice osteopathic manipulation, a full-body system of hands-on techniques to
alleviate pain, restore function, and promote health and well-being.
A component of traditional Chinese medicine that combines movement, meditation, and regulation
Qigong
of breathing to enhance the flow of qi (pronounced “chee” and meaning vital energy) in the body,
(“chee-GUNG”)
improve blood circulation, and enhance immune function.
A Japanese word representing Universal Life Energy. Reiki is based on the belief that when
Reiki
spiritual energy is channeled through a Reiki practitioner, the patient’s spirit is healed, which in
(“RAY-kee”)
turn heals the physical body.
Based on the premise that the healing force of the therapist affects the patient’s recovery; healing
Therapeutic touch is promoted when the body’s energies are in balance. By passing their hands over the patient,
healers can identify energy imbalances.
The current name for an ancient system of health care from China. TCM is based on a concept of
Traditional Chinese
balanced qi, or vital energy, which is believed to flow throughout the body. Qi regulates a person’s
medicine (TCM)
spiritual, emotional, mental, and physical balance, and is influenced by the opposing forces of yin
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(negative energy) and yang (positive energy). Disease is proposed to result from the flow of qi
being disrupted and yin and yang becoming imbalanced. Among the components of TCM are
herbal and nutritional therapy, restorative physical exercises, meditation, acupuncture, and
remedial massage.
A term derived from a Sanskrit word meaning yoke or union. Yoga involves a combination of
Yoga breathing exercises, meditation, and physical postures that are used to achieve a state of
relaxation and balance of mind, body, and spirit.
Check for Understanding
After studying the main lesson, you may now answer the following multiple choice questions and provide the rationale for
each item.
1. In the magico-religious paradigm regarding health, the world is an arena dominated by
a. Health workers
b. Traditional healers
c. Supernatural forces
d. Alternative medicine
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Which of the following cultures is not grounded in the magico-religious paradigm regarding health?
a. Latino
b. African-Americans
c. Caucasians
d. Middle Eastern culture
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3. Latinos view that disease is caused by a demonic possession or a disease-causing spirit. This is with regard to their
belief in which of the following
a. Voodoo
b. Malojo
c. Encanto
d. Djinn
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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4. Which of the following theories is found on the Greek concept of the four body humors?
a. Yin and Yang c. Hot/Cold
b. Chi d. Ecrasia
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. The concept of Yin and Yang, in which the forces of nature should be balanced in order to produce harmony came
from which of the following
a. Japan c. Korea
b. China d. Mongolia
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. When a patient consults a “mangtatawas” in the Philippines due to a belief that a spirit may be causing his or her
illness. This set of beliefs would be under
a. Folk healing system
b. Complementary health system
c. Integrative health system
d. Alternative health system
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. The practice of acupuncture on the other hand would be under
a. Complementary health system
b. Integrative health system
c. Alternative health system
d. Any of the above
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
8. Ayurveda, a natural system of medicine, originated in
a. China c. Philippines
b. India d. Middle East
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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9. Reiki, a healing technique based on the principle that the therapist can channel energy into the patient by means of
touch, to activate the natural healing processes of the patient's body and restore physical and emotional well-being is
under which of the following?
a. Biofield therapies
b. Alternative medicine
c. Bioelectromagnetic-based therapies
d. Manipulative and body-based methods
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
10. Massage therapy and chiropractic manipulation would be under
a. Bioelectromagnetic-based therapies
b. Natural products
c. Manipulative and body-based methods
d. Biofield therapies
Answer: ________
Rationale:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. LESSON WRAP-UP
Thinking about Learning
THE OUTCOME SENTENCES STRATEGY
This strategy is an excellent way to show your grasp of learning and to give you time to reflect about what you have
learned. Complete each phrase with what you have deemed to express:
I was surprised that _____________________________________________________________________________
I have a question about __________________________________________________________________________
I would still like to know more about _________________________________________________________________
I learned a great deal about _______________________________________________________________________
Today, I understood _____________________________________________________________________________
I am still confused about __________________________________________________________________________
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