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MODULE I DECENT WORK & EMPLOYMENT
LESSON 1 : DECENT WORK BY ILO
What is Decent Work Employment?
• Decent Work Employment is a concept that promotes social justice in the
workplace.
• It seeks to ensure workers have fair wages, safe working conditions, and
freedom of association
• It also works to provide equal access to employment opportunities for all.
Decent Work Employment
• is a concept that was created by the International Labour Organization
(ILO).
• The ILO has put forward 8 core labour standards that are related to Decent
Work Employment.
• In 2019, the ILO adopted a new set of principles and rights at work that is
aimed at protecting vulnerable workers.
Concept of Decent Work
• Social justice: The fair and just distribution of resources and
opportunities in a society.
• Fair wages: A payment amount given to an employee for their services
which allows them to maintain a decent standard of living.
• Freedom of association: The right of individuals to come together and
collectively express, promote, pursue and defend common interests.
• 15 June 1999, the 87th Session of the International Labor Conference,
commenting on ILO Director-General Juan Somavia's ground-breaking
report Decent work. (Decent Work Agenda)
Historical Background of ILO
• Established in 1919, the ILO advocates international standards as essential
for the eradication of labor conditions involving "injustice, hardship and
privation" According to the ILO, international labor standards contribute to
the possibility of lasting peace, help to mitigate potentially adverse effects
of international market competition and help the progress of international
development.
• The International Labor Organization (ILO) is the United Nations agency
for the world of work. It sets international labour standards, promotes rights
at work and encourages decent employment opportunities, the enhancement
of social protection and the strengthening of dialogue on work-related
issues.
Historical Background of ILO
• The ILO has a unique structure (tripartite governing structure), bringing
together governments, employers' and workers' representatives. The ILO
has 187 member States and is one of the oldest UN agencies.
• The ILO's Secretariat has its headquarters in Geneva, Switzerland, and a
global network of technical experts and field offices in more than 40
countries.
• The International Labour Conference (ILC) meets once a year to adopt
new international labour standards and to approve the ILO's work plan and
budget.
• The Governing Body is the executive council of the ILO and meets three
times a year in Geneva.
Roles/Functions of the ILO
+ Full employment and the raising of standards of living;
+ Employment of workers in the occupations for which they are best suited
and where they can make their greatest contribution to the common well-
being;
+ Facilities for training and the transfer of labor, including migration for
employment and settlement;
+ Policies in regard to wages and earnings, hours, and other conditions of
work calculated to ensure a just share of the fruits of progress to all and a
minimum living wage to all employed and in need of such protection
Roles/Functions of the ILO
+ Effective recognition of the right of collective bargaining, the cooperation
of management and labor in the continuous improvement of productive
efficiency, and the collaboration of workers and employers in the
preparation and application of social and economic measures;
+ Extension of social security measures to provide a basic income to all in
need of such protection and comprehensive medical care; adequate
protection for the life and health of workers in all occupations;
+Child welfare and maternity protection;
Adequate nutrition, housing, and facilities for recreation and culture; and
assurance of equality of educational and vocational opportunity
ILO and the Health Service Sector
• Health services are one of the fundamental sectors of society and the
economy. The ILO endorses the fundamental principles of the human right
to health and social protection. Providing social health protection and equal
access to quality health care has significant positive effects on individual
and public health, economic growth and development. The health sector is
also a major employment sector, with important potential in job creation.
• Decent work for health workers is essential to provide quality health care.
The ILO supports improvement of working conditions and labor relations
in the health sector through sectoral labor standards and social dialogue,
and collaborates with World Health Organization (WHO ) to promote
supportive, enabling and healthy work environments for the health
workforce, including through the ILO-OECD-WHO Working for Health
Programme.
•Organization for Economic Co-operation and Development
ILO and the Philippines
PHILIPPINES ILO MEMBERSHIP since 1948, 2 years after gaining
independence from the U.S.
Four strategic objectives at the heart of the Decent Work agenda
I. Set and promote standards and fundamental principles and rights at work.
Il. Create greater opportunities for women and men to decent employment
and income.
III. Enhance the coverage and effectiveness of social protection for all.
IV. Strengthen tripartism and social dialogue.
LESSON 2 : NATURE OF EMPLOYMENT
• The nature of employment in the
• Philippines is regulated by the
• Department of Labor and Employment (DOLE). According to DOLE, the
nature of employment refers to the type of relationship between an
employer and an employee.
• The nature of employment can be either regular, casual, project-based,
seasonal, or fixed-term, and each type of employment has different rights
and benefits attached to it.
• Nature of employment in the Philippines
• + Regular employment: is a permanent type of employment where the
employee is expected to work for an indefinite period of time. Regular
employees are entitled to a wide range of benefits, including security of
tenure, social security benefits, and the right to form a union.
• Casual employment: is a type of employment where the employee is
expected to work on a temporary basis. Casual employees do not have the
same rights and benefits as regular employees and are not entitled to
security of tenure or social security
• + Project-based employment: is a type of employment where the
• Sources CNN Philippines employee is hired for a specific project or a
limited period of time. Project-based employees are entitled to the same
rights and benefits as regular employees, but their employment ends once
the project is completed.
• Seasonal employment: is a type of employment where the employee is
hired for a specific season, such as the harvest season or the tourist season.
Seasonal employees are entitled to the same rights and benefits as regular
employees, but their employment is limited to the specific season for which
they were hired.
• Fixed-term employment: is a type of employment where the employee is
hired for a specific period of time, and the employment is terminated at the
end of that period. Fixed-term employees are entitled to the same rights and
benefits as regular employees, but their employment is limited to the
specific period for which they were hired.
LESSON 3 : CONDITIONS OF EMPLOYMENT
The BLR Book III & Policies
• The Bureau of Labor Relations (BLR) Book III of the Philippines outlines
the conditions of employment of all workers in the country.
• The primary standard to determine regular employment is the reasonable
connection between the particular activity performed by the employee in
relation to the employer's business or trade. This means that an employee's
activities must be directly related to the business for them to be considered
a regular employee.
The BLR Book III & Policies
• + The Bureau of Labor Relations (BLR) Book III of the Philippines is
essential for both employers and employees to understand their rights and
responsibilities in the workplace. It is important to consult with the BLR
and take into account the relevant laws and regulations to ensure the
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protection of workers' rights and the smooth functioning of labor-
management relationships.
• provides guidelines on the formation of labor unions, the rights of workers
in a union, and the election and appointment of union officers. It outlines
the rights and obligations of employers and workers, as well as procedures
for the resolution of labor-management disputes through voluntary
arbitration or conciliation and mediation.
• also provides regulations on working conditions, safety and health
requirements, and standards for wages and other benefits. It also outlines
other labor-related laws and regulations, such as the Minimum Wage Law,
the Occupational Safety and Health Law, the Social Security Law, and the
Labor Relations Law.
Probationary Periods
probationary period is a term of employment given to a new employee in
order to evaluate his/her fitness for permanent employment. The maximum
probationary period is 6 months for regular employees, and may be
extended for another 6 months for managerial employees.
Performance Review Requirement
• the purpose of the performance review is to determine an employee's
efficiency, productivity, and the quality of their work, as well as their
potential for growth and advancement within the company.
• The performance review may also be used as a basis for determining an
employee's eligibility for salary increases, promotions, or other benefits.
Nurses' Working Policies
+ Dress Code:
Nurses in the Philippines musi adhere ro a strict dress code and professional
code of conduct. According to the BLR Book III, nurses in the Philippines
shouldweara uniform that is appropriate for the premises, and this should
include a white lab coat, a suitable scrub uniform, and a pair of comfortable
but appropriate shoes.
+ Discipline: nurses must abide by the code of ethics set out by the
Philippine Nurses Association This includes:
prioritizing patient safety and welfare,
-maintainingprofessionalstandards,and
- adhering to the rules and regulations set out by the Nursing Law
Nurses must also be aware of their own limitations in practice, and must
keep up-todate on new regulations, protocols, and laws.
Any violations of the code of condin'a would result in disciplinary action,
including warnings, suspension, or even dismissal.
LESSON 4 : WORKING CONDITIONS & REST
EMPLOYEES' RIGHTTO WEEKLY REST DAYS,
COMPESATION FOR REST DAYS, SUNDAY OR
HOLIDAY.
+ According to the BLR, all employees must not work more than eight
hours a day and 48 hours per week. If an employee is made or permitted to
work on his scheduled rest day, they will be entitled to an additional
payment of at least 30%.
+ The International Labour Organization (ILO) also provides guidance on
weekly rest days through its labor standards. The ILO's Recommendation
No. 106 on Weekly Rest in Industry, adopted in 1952, recommends that
workers should have a weekly rest period of at least 24 consecutive hours,
This rest period should preferably be on Sundays, but if this is not possible,
it should be on another day agreed upon between the employer and the
worker.
+Book III of the Labor Code, which deals with working conditions and rest
periods, provides that all employees are entitled to a weekly rest day, which
should be a regular holiday unless the employer and the employee have
mutually agreed to a substitute holiday.
+ an employee who is required to work on a rest day is entitled to an
additional compensation of not less than 30% of his or her regular wage for
work performed on that day.
+ most common weekly rest day in the Philippines is Sunday.
+ It is important to note that the rights of employees to weekly rest days
under the Labor Code of the Philippines are not limited to regular holidays,
but also apply to special non-working days declared by the government. In
such cases, employees are still entitled to an additional compensation for
work performed on these days, unless they are on leave with pay.
Service incentive leave
+ all employees who have rendered at least one year of service are entitled
to service incentive leave of five days with pay. This means that employees
who have worked for their employer for at least one year are entitled to take
five days of leave with pay, in addition to their regular holidays and sick
leave.
The purpose of the service incentive leave is to provide employees with a
benefit for their long term service to the company, and to encourage them
to continue their employment with the same employer.
+ It is important to note that the service incentive leave is cumulative,
meaning that it accumulates from year to year and can be used at any time
during the year. However, if the employee has not used the leave by the end
of the year, it cannot be carried over to the next year, and is fortified.
LESSON 5 HOURS OF WORK, SALARY, WAGES
HOURS OF WORK, SALARY & WAGES
+ the payment of wages must be in legal tender, meaning that employers
must pay their employees in the form of currency that is recognized and
accepted by the government as a valid means of payment.
The law provides that employers may choose the method of payment, such
as cash, check, or direct deposit into the employee's bank account, as long
as it is agreed upon by the employee and complies with the relevant
regulations and laws.
Prohibitions regarding wages: the Labor Code of the Philippines provides
several protections to ensure that employees receive their full and fair
wages.
* ex. the law prohibits employers from making deductions from an
employee's wages, except in specific circumstances such as deductions for
taxes, Social Security contributions, and other lawful deductions.
Prohibitions regarding Wages
Prohibitions regarding wages: the Labor Code of the Philippines provides
several protections to ensure that employees receive their full and fair
wages.
• ex. the law prohibits employers from making deductions from an
employee's wages, except in specific circumstances such as deductions for
taxes, Social Security contributions, and other lawful deductions.
• prohibits employers from requiring employees to make deposits or
advances, or from requiring them to purchase goods or services as a
condition of employment.
• prohibits employers from requiring employees to work on rest days and
legal holidays without proper compensation.
Tripartite Wages & Productivity Board
+ The Tripartite Wages and Productivity Board (TWPB) is an agency
established under the Department of Labor and Employment to promote
and maintain a balanced and sustainable growth in wages, productivity, and
employment.
- The TWPB is a tripartite body is composed of representatives from:
A. government,
B. workers, and
C. employers,
The TWPB serves as a forum for the discussion and resolution of labor and
employment issues.
Tripartite Wages & Productivity Board Functions
+ to formulate and implementing policies and programs aimed at improving
wages, productivity, and working conditions in the country.
responsible for monitoring and adjusting minimum wage rates for different
industries and regions in the Philippines, taking into account the needs of
workers and the ability of employers to pay.
+ provides recommendations on the implementation of productivity-based
incentives and other forms of compensation for workers.
Working Time
+ maximum normal working time of 48 hours per week and eight hours
perday as the international norm. In exceptional cases, working time is
allowed to exceed these limits, as long as daily and weekly maximums are
respected.
ILO has identified five significant dimensions of decent work in the area of
working time, or "decent working time".
The five dimensions focus on:
1. promoting health and safety;
2. advancing the productivity and sustainability of enterprises;
3. being "family-friendly" and improving work-life balance;
4. promoting gender equality; and
5. offering workers a degree of choice and influence over their hours of
work.
The five dimensions focus on:
1. Promoting health and safety; Enterprises should avoid unhealthy working
times and regular long working hours to prevent negative short-and long-
term health effects, increased safety risks, higher rates of absenteeism, and
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reduced productivity.
2. Productive working time: Decent working time arrangements, in
particular reductions in long working hours, lead to increased productivity.
By having more time for rest and recovery from work, employees are more
alert, motivated and productive.
3. Family-friendly working time: Long weekly hours and "nonstandard"
working hours in the evenings, at nights and on weekends reduce work-life
compatibility. Flexibility in working hours allows workers to attend to their
personal lives. This can lead to better individual and organizational
performance as well.
4. Gender equality through working time: Working time policies need to
both promote gender equality in employment through gender-neutral
measures, as well as ensure that policies advancing other dimensions of
decent working time do not negatively impact gender equality.
5. Choice and influence regarding working time: Offering workers a degree
of choice regarding their working hours creates a win-win situation for both
workers and enterprises. Flexible working time arrangements such as
"flexi-time" and compressed workweeks can have positive effects on
employee attitudes and workplace morale.
Balanced working time arrangements (WTAs) can benefit firms in
many ways including:
"balanced" WTAs that are mutually beneficial for workers and enterprises.
• Reduced stress levels
• Better sleep and lifestyle habits
• Decrease risk of cardiovascular disease, gastrointestinal and reproductive
disorders, musculoskeletal disorders, chronic infections and mental illness
• Fewer workplace accidents and injuries
• Increased productivity
• Higher job satisfaction and motivation
• Lower rates of absenteeism and staff turnover
LESSON 6: EMPLOYMENT BENEFITS
EMPLOYMENT OF WOMEN
• the Labor Code of the Philippines provides comprehensive protections
and benefits for women in the workplace, aimed at ensuring equal treatment
and promoting the rights of women workers.
• / Entitled for maternity leave, and prohibition of night work for women
engaged in hazardous occupations.
• / Women should not be required to work overtime, except in exceptional
circumstances.
• Women should be given adequate facilities and rest periods during their
working day.)
• The law prohibits discrimination based on gender, and provides for a
range of protections and benefits to ensure that women are able to work in
safe and secure conditions, with access to the same opportunities as male
workers.
Employment of Minors
+ minors (persons below 18 years of age) are considered as children and are
therefore entitled to special protection from economic exploitation and any
work that is hazardous, oppressive, or otherwise prejudicial to their health,
morals, or welfare.
+ Minors are prohibited :
x from working in certain types of establishments, such as bars, nightclubs,
and other entertainment or leisure establishments.
x from working in hazardous or deleterious occupations, such as those
involving exposure to dangerous machinery, equipment, and chemicals, as
well as work in underground mines, deep sea fisheries, and construction
work.
/ Minors are allowed to work may only do so with the permission of their
parents or legal guardians and with a work permit issued by the DOLE.
/ The employer is also required to provide adequate supervision, working
conditions, and protection to the employee.
Employment of Home-based workers
+ Homeworker/ home-based workers - those who perform work in or about
their homes for an employer who is not their immediate family member.
+ are entitled to the same rights and privileges as those enjoyed by other
workers, including the right to just and humane conditions of work, security
of tenure, security and welfare benefits, and the right to form and join labor
organizations.
+ Employers of homeworkers are also required to comply with labor
standards, including the payment of minimum wage, overtime pay, holiday
pay, and night-shift differential pay, as well as compliance with
occupational health and safety standards
Unfair Labor Practices
any act that interferes with the exercise of the right to self-organization and
collective bargaining, as well as other labor rights guaranteed by the
constitution and bylaw.
+ Under Article 248 of the Labor Code, the following acts are considered as
unfair labor practices:
Interfering with, restraining, or coercing employees in the exercise of their
right to self organization;
Dominating or interfere with the formation or management of any labor
organization or contribute financial or other support to it;
Discriminating against an employee or worker by reason of membership in
any labor organization;
Discharging or dismissing an employee or worker for having given or being
about to give testimony under the Labor Code
Civil & Criminal liability for ULPs
+ Civil liability for unfair labor practices may result in the payment of
damages to the affected employee or worker, including back wages, moral
damages, and exemplary damages.
+ Criminal liability for unfair labor practices may result in imprisonment
and/or the payment of fines, depending on the nature and severity of the
offense. The individual or entity found guilty of committing unfair labor
practices may also be required to reinstate the affected employee or worker.
Unfair Labor Practices that an employer may commit against nurses in
the Philippines:
1.Interfering with the formation or administration of a labor union: It
is an unfair labor practice for an employer to interfere with the formation or
administration of a labor union by nurses, such as by coercing or
intimidating employees who seek to join a union or by discriminating
against employees who are members of a union.
2. Discriminating hiring or promotion: An employer who discriminates
against nurses based on their union membership, age, gender, religion, race,
or other prohibited grounds, is commit ing an unfair labor practice.
3.Retaliation for engaging in protected concerted activity: An employer
may not retaliate against nurses who engage in protected concerted activity,
such as participating in a strike or advocating for improved working
conditions.
4 Refusing to bargain in good faith: An employer who refuses to engage
in good-faith collective bargaining with a recognized nurses 'union is
committing an unfair labor practice.
5. Violating collective bargaining agreements: An employer who violates
the terms of a collective bargaining agreement, such as by failing to
implement agreed-upon wages and benefits or by changing working
conditions without proper negotiations, is committing an unfair labor
practice.
Unfair Labor Practices that an employer may commit against nurses
in the Philippines:
If a nurse believes that their employer has committed an unfair labor
practice, they may file a complaint with the Department of Labor and
Employment (DOLE) or with the National Labor Relations Commission
(NLRC). The DOLE or NLRC will investigate the complaint and determine
whether the employer has violated the provisions of the Labor Code of the
Philippines. If the employer is found to have provisions an of unfair the
Labor wirdmitlabor Code practice, and of determine the they Philippines.
may whether be ordered If the the employer employer to rectify has is the
found violated violation, to havethepay
committed damages, and/or face other penalties as provided by law.
LESSON 8: LAWS PROTECTING WORKERS
Magna Carta for Public Health Workers
+Republic Act No. 7305 - provides for the rights and benefits of public
health workers, including nurses, and seeks to improve the delivery of
health services in the country.
The law provides for security of tenure, reasonable working hours, humane
workingconditions, benefits and incentives, self-organization, and
continuous professional development opportunities.
Salary Standardization Law of 2019 or SSL V, series of 2020
+ Republic Act No. 11466 - provides for the standardization of
compensation and position classification in the national government,
including the salaries of nurses working in public health institutions. The
SSL V aims to harmonize the salaries of government employees and align
them with prevailing market rates, in order to attract and retain highly
qualified and competent personnel in the public sector.
+ Under the SSL V, nurses working in the public sector are assigned to
specific salary grades, based on their position, education, and length of
service. The SSL
V also provides for cost-of-living allowances, performance-based bonuses,
hazard pay, night shift differential, and other benefits for government
employees, including nurses.
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Forty-Hour Week Law
Republic Act No. 5901 - the 40-hour workweek is a standard established
by law in the Philippines, but the actual number of hours that nurses work
may vary depending on the needs of their employer and the nature of their
work.
Anti-Age Discrimination in Employment Act
+Republic Act No. 10911 - Anti-Age Discrimination in Employment Act
is a law in the Philippines that prohibits discrimination in employment
based on age. The law aims to ensure that individuals of all ages have equal
opportunities in the workplace and are protected from harassment and
abuse based on their age.
• The Mental Health Act (2018)
• Republic Act No. 11036 - governs the delivery of mental health services
in the country. It provides a comprehensive framework for the promotion,
protection, and delivery of mental health services in the Philippines.
• The Anti-Sexual Harassment Act
• Republic Act No. 7877 - sexual harassment is prohibited in the
workplace, including hospitals, clinics, and other healthcare facilities.
Employers are also required to establish policies and procedures to prevent
and address sexual harassment, including the appointment of a person
responsible for receiving and investigating complaints. Nurses and other
healthcare professionals are also protected by ethical codes and guidelines
established by professional organizations, such as the Philippine Nurses
Association.
TERMS HEALTH
➢ “A state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity” (WHO,1948)
INTERNATIONAL HEALTH
➢ Refers to the interlocking and interrelated health status of people
throughout the world and to efforts to improve the health of all people of
every country.
GLOBAL HEALTH
 Is defined as “the area of study, research and practice that places
a priority on improving health and achieving equity in health for
all people.”
 It is an important new term, and important new concept.
 It emphasizes transnational health issues, determinants and
solutions. It involves multiple disciplines collaborating.
GLOBAL HEALTH
“Health problems, issues and concerns that transcend national
boundaries, may be influenced by circumstances or experiences in
other countries and are best addressed by cooperative actions and
solutions” – The Institute of Medicine
GLOBAL NURSING
The adoption of a global health perspective by nursing professionals
interested in seeking collaborative and sustainable solutions to health
problems irrespective of national boundaries. Request respect for
differences in language, culture, customs and health beliefs.
Effects of Globalization
 Globalization has led to growing interdependence of the
world’s population
 Potential for infectious diseases to spread rapidly in a
world with extensive travel.
 Includes food, insects, animals and other vectors.
 Bioterrorism necessitates surveillance for suspicious
clusters at a global level.
 Unhealthy populations can destabilize economies
 Shift in health conditions from an acute care focus to
chronic care
OBJECTIVES OF GLOBAL HEALTH CARE
1. A high life expectancy and ageing populations. An
expansive health and medical care system.
2. A rapidly growing private health market 3. Health as a
dominant theme in social and political discourse
4. Health as a major personal goal in life
WHY SHOULD MEDICAL STUDENTS LEARN ABOUT GLOBAL
HEALTH?
• Medical schools have very few lectures on global health in their curricula
• Health is becoming a global problem, with chronic diseases being number
on killer around the globe
• By learning more about global health research, medical students will be
better equipped to face challenges of their unique profession
• Know the differences between global and international health research
• Identify key challenges to global health.
• Recognize the importance of information sharing in
the area of global health
• Recognize the importance of preventive activities in improving global
health
• Recognize the need for global networking to improve global health
locally and globally.
“If a health outcome is seen to a greater or lesser extent between
populations, there is disparity. Race or ethnicity, sex, sexual identity, age,
disability, socioeconomic status and geographic location all contribute to an
individual’s ability to achieve good health.”
- According to Healthy People .gov.,Published on July 31, 2020
HEALTH DISPARITIES inequities in the quality of health, health care
and health outcomes experienced by groups based on social, racial, ethnic,
economic and environmental characteristics—persist across the nation.
are inequitable and are directly related to the historical and current unequal
distribution of social, political, economic, and environmental resources.
FACTORS THAT CONTRIBUTE HEALTH DISPARITIES
INCLUDES:
● Genetics
● Access to care
● Poor quality of care
● Community features (e.g. inadequate access to healthy foods, poverty,
limited personal support systems and violence)
● Environmental conditions (e.g. poor air quality)
● Language barriers and health behaviors These social, economic and
environmental conditions where people live, learn, work and play are
known as social determinants of health.
WHO has identified several critical global health inequalities,
including (but not limited to) the following: • Early childhood mortality
caused by preventable diseases such as malaria, tuberculosis, and
pneumonia
• Maternal mortality, particularly in developing countries
• Premature death or disability from non-communicable diseases such as
high cholesterol, hypertension, and Type 2 diabetes
MORBIDITY
➢ It is the state of having a specific illness or condition. ➢ It can refer to
an acute condition, such as a respiratory infection, it often refers to a
condition that’s chronic (long-lasting).
➢ The morbidity rate measures the portion of people in a specific
geographical location who contracted a particular disease during a specific
period of time. It indicates the frequency of the disease appearing in a
population.
EXAMPLES OF COMMON MORBIDITIES INCLUDE:
• Diabetes
• High blood pressure (hypertension)
• Heart disease
• Obesity
• Lung diseases, such as asthma and chronic obstructive pulmonary
disorder (COPD)
• Stroke
• Chronic kidney disease
• Infections, such as the flu, COVID-19, and HIV
• Cancer
• Alzheimer’s disease
• Mental health conditions, such as anxiety and depression
MORTALITY
➢ Refers to the number of deaths that have occurred due to a specific
illness or condition.
➢ This is the number of deaths due to an illness divided by the total
population at that time.
➢ Often expressed in the form of mortality rate.
➢ A mortality rate is a measure of the frequency of occurrence of death in
a defined population during a specified interval.
EPIDEMIOLOGY
➢ It is branch of medical science that studies the distribution of disease in
human populations and the factors determining that distribution, chiefly by
the use of statistics.
➢ Unlike other medical disciplines, epidemiology concerns itself with
groups of people rather than individual patients and is frequently
retrospective, or historical, in nature.
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➢ It developed out of the search for causes of human disease in the 19th
century, and one of its chief functions remains the identification of
populations at high risk for a given disease so that the cause may be Anthropology- an academic discipline that is concerned with the scientific
identified and preventive measures implemented. study of humans, past and present.
➢ In epidemiology, a rate is a measure of the frequency with which an Four areas of Anthropology
event occurs in a defined population over a specified period of time. 21 1. Sociocultural anthropology,
STATISTICS 2. Biological/physical anthropology,
3. Archaeology, and
➢the science of collecting, analyzing, presenting, and interpreting data.
4. Linguistics
➢Statistics are a vital part of public health's assessment function, used to One of the central concepts that anthropologist’s study is culture.
identify special risk groups, detect new health threats, plan public health
programs and evaluate their success, and prepare government budgets. “ Leininger defines culture as the “learned, shared, and transmitted values,
➢Health statistics are used for all aspects of public health policy beliefs, norms, and lifeways of a particular group of people that guide
development and evaluation. thinking, decisions, and actions in a patterned way.”
➢Uses of the data include health need identification, analysis of problems Cultures are dynamic and not static as they change in different ways over
and trends, epidemiologic research, program evaluation, program planning, time and under different circumstances or conditions. (M. Leininger,
budget preparation and justification, administrative decision making and McFarland 2002)
health education.
➢ There is ample evidence that social factors, including education, Culture is where “care” is embedded
employment status, income level, gender and ethnicity have a marked What culture does:
influence on how healthy a person is. ✔Culture influences
➢ In all countries – whether low-, middle- or high-income – there are wide ✔Culture determines
disparities in the health status of different social groups
. ➢ The lower an individual’s socio-economic position, the higher their risk "the way of life for an entire society.” -defined as all the ways of life
of poor health. including arts, beliefs and institutions of a population that are passed down
➢ Health inequities are systematic differences in the health status of from generation to generation. -it includes codes of manners, dress,
different population groups. language, religion, rituals, art.

➢ These inequities have significant social and economic costs both to Elements of Culture
individuals and societies. ❑ Values, Beliefs, principles
OUTBREAKS FROM 2000 TO PRESENT ❑ Customs, rituals & activities
2012 – Whooping Cough ❑ Marriage and Family
2012 – MERS-CoV ❑ Government and Law
2014 – Ebola 2016 – Zika Virus ❑ Games and Leisure
2020 – COVID-19
❑ Economy and Trade
2012 – WHOOPING COUGH ❑ Language
● Also known as pertussis, this respiratory disease surmounted to 48,277 ❑ Religion
cases in the U.S. in 2012. Culture connotation :
● Coughing fits last up to 10 weeks or more and can be lifethreatening for ETHNIC / RACE
infants. NON-ETHNIC :
● Worldwide, the estimation of whooping cough cases is 24.1 million with ➢ SOCIO-ECONOMIC STATUS
about 160,700 deaths per year according to the National Center for ➢ ABILITY/ DISABILITY
Biotechnology Information. 24 2012 – MERS-CoV ➢ SEXUAL ORIENTATION
● Middle East Respiratory Syndrome was first found in the Arabian
➢ AGE
Peninsula in 2012 and was also associated with the coronavirus once the
illness became viral. ➢ OCCUPATION/ PROFESSION “
● Only two cases were found in the U.S. in 2014, one in Indiana and Other terms linked to culture :
another in Florida, linked to health care providers who previously worked ╺ Subculture ╺ refers to groups that have values and norms that are distinct
in Saudi Arabia. from those held by the majority within a wider society.
● Up until 2019, 2,494 cases have been reported, including 858 deaths. ╺ Ethnicity is defined as the perception of one- self and a sense of
belonging to a particular ethnic group or groups.
2014 – Ebola ╺ Race refers to a group of people who share such genetically transmitted
Ebola was found in Africa near the Ebola River in 1976, but the outbreak traits as skin color, hair texture, and eye shape or color
that recently caught the world’s attention started in Guinea before spreading “ Three levels of Culture by Edward Hall (1984) 19
to neighboring countries, with the highest cases in Sierra Leone of 14,124 I. Primary level of culture - the implicit rules known and followed
and 3,956 deaths. by members of the group, but seldom stated or made explicit, to
● Ebola reached the U.S. but only recorded four cases and one fatality, and outsiders.
in 2015 the CDC announced a vaccine against the disease. II. Secondary level - underlying rules and assumptions that are
● The most recent outbreaks of Ebola occured in the Democratic Republic known to members of the group but rarely shared with
of Congo in 2018. 26 2016 – Zika Virus outsiders.
● The most at threat potential victims for this mosquito-transmitted disease III. Tertiary level
are pregnant women, whom if bitten, their pregnancy could result in
stillbirth, preterm birth or fetal loss. Historical and Theoretical Foundations of TCN
● In November of 2016, 84 countries were reported to have Zika virus Transcultural Nursing
cases in the Americas, with the first cases reported in Brazil, then spreading ❑ Leininger used the term Transcultural nursing (TCN) to describe the
in high numbers to New York, Florida and Texas. 27 2020 – COVID-19 blending of nursing and anthropology into an area of specialization within
● On Jan. 30, the World Health Organization declared a “public health the discipline of nursing.
emergency of international concern” for the new coronavirus, COVID-19, ❑ “Nursing and Anthropology: Two Worlds to Blend,” Leininger (1970)
originating from Wuhan, Hubei Province in China. Like SARS and MERS, ❑ TCN is interchangeable with cross-cultural, intercultural, and
this virus originates from certain animals before infecting humans, and has multicultural nursing.
spread quickly. Goal of TCN is to develop a scientific and humanistic body of knowledge
● The confirmed locations of the virus’ presence are in Asia, the U.S., in order to provide culture-specific and culture-universal nursing care
Canada, Australia, Europe and Russia. practices for individuals, families, groups, communities, and institutions of
similar and diverse cultures.
Decent Work Employment and Transcultural Nursing Culture – Specific
Introduction to Transcultural Nursing refers to particular values, beliefs, and patterns of behavior that tend to be
“Nurses who are prepared to deal with differences are prepared to deal with special or unique to a group and that do not tend to be shared with members
diversity. The more sensitive we are to cultural differences in our patients, of other cultures.
the more sensitive we are to all differences in our patients, making us better Culture – Universal
at providing the unique care each of them deserves.” – Malone, 1998
PRELIM NCM120 DET
refers to the commonly shared values, norms of behavior, and life patterns
that are similarly held among cultures about human behavior and lifestyles.
Dr. Madeleine M. Leininger
(July 13, 1925 – August 10, 2012) The first nurse anthropologist and the
“mother” of transcultural nursing. Theory: Culture care theory of diversity
& universality
TCN exists today as an evidence-based, dynamic area of specialization
within the nursing profession because of the visionary leadership of its
founder, Madeleine Leininger, and many other nurses committed to the
provision of care that is consistent with and “fits” the cultural beliefs and
practices of those receiving it
Dr. Leininger’s contributions (overview)
I. Culture care theory of diversity & universality (1950s) ╺ -
describes, explains, and predicts nursing similarities and
differences in care and caring in human cultures
(Leininger, 1991).
Culturally congruent nursing care
refers to those cognitively based assistive, supportive, facilitative, or
enabling acts or decisions that are mostly tailor-made to fit with an
individual’s, group’s or institution’s cultural values, beliefs, and lifeways in
order to provide meaningful, beneficial, satisfying care that leads to health
and well-being.
II. Sunrise Enabler Originally developed as a model. -depicts
multiple factors predicted to influence culture care
expressions and their meanings.
Ethnonursing Research
A qualitative research method to investigate phenomena of interest in
TCN
➢ is the first research methodology developed by a nurse for use in
studying topics relevant to nursing.
Dr. Leininger’s Protégés
 Marilyn (Dee) A. Ray
 Marilyn R. McFarland
 Margaret M. Andrews
Margeret Andrews & Joyceen Boyle’s ( overview )
Transcultural Interprofessional Practice (TIP) Model -its goal is to
provide a patient- or client-centered systematic, logical, orderly, scientific
process for delivering safe, culturally congruent and competent, affordable,
accessible, evidence-based, and quality care for people from diverse
backgrounds across the life span
Key components of the TIP model
▪ Cultural Context
▪ Interprofessional health care team
▪ Effective verbal and nonverbal communication among all team members
▪ Five-step systematic, scientific problem-solving process