Culturally Competent Care for the Amish Community

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Amish Larry Purnell, PhD, RN, FAAN

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Came to the United States in 1693 for the same reason many other groups came to America persecution and to practice their lifestyle as they so chose. No reference group in other parts of the world. Adapt to dominant society slowly and selectively

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued Mutuality and sharing rather than individual achievement and competition All speak English and are taught English in school, but most speak Deitsch and various dialects (Pennsylvania German) at home Healthcare providers by definition are outsiders

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued Majority of men work on farms or in carpentry If women work outside the home, they work in restaurants, sewing, and teach in their schools If they work far away from home, prefer to live with another Amish family. Shared finances are the norm.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued A few have telephones, including cell phones for business but do not let it ring in the house. Some are using communally shared computers because of the necessity of ordering online instead of mail order catalogues. A few may drive cars but only out of necessity for work and never on the Sabbath.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued Some illnesses and symptom expression do not have direct translations into English Highly contexted culture What is common knowledge regarding health matters to most are not to the Amish due to no TV, major newspapers, etc.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued New communities are being formed in the United States due to lack of land in immediate community New communities in Kentucky, Tennessee, and Belize, Central America

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Overview Continued Demut humility and demureness Gelassenheit quiet acceptance, reassurance, and resignation Temporality is grounded into present time and guided by natural rhythms Seek health care from afar when needed

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Myths They do ride in cars and may even own a car out of necessity but severe restrictions as to when and where it can be driven. Do use the telephone but do not have them in the home. May be located in a neighborhood grocery or deli. Kerosene refrigerators and gas hot water heaters no electricity generators instead

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Family Roles Man is head of the family. Women are accorded high respect and status. In private they are partners, in public, women assume a retiring role. Freindschaft three-generation families. Grandparents live in separate house or separate quarters of the home.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Alternative Lifestyles Singleness is not stigmatized Same-sex couple may live together out of necessity when away from home. Pregnancy before marriage is rare, couple encouraged to marry, or the child can be adopted. Abortion is unacceptable. Gays/Lesbians remain closeted and can cause concern for healthcare provider.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Genetic Diseases High rates because of a closed gene pool Ellis-van Creveld Syndrome Cartilage hair hypoplasia Pyruvate kinase anemia Hemophilia B Phenylketonuria Glucaric aciduria

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Genetic Diseases Continued Manic-depressive illness Bipolar effective disorders are higher than general population Low rates of alcoholism, drug/alcohol abuse

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Nutrition Mostly home-grown foods Local storage lockers Increasing trend for junk/snack food Diet is high in fat and carbohydrates leading to obesity, especially in women. Food has a significant social meaning during visiting.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices Children are a gift from God and large families are an asset usually Start families early to mid to late 20s Have lay-midwives but use allopathic practitioners if necessary Some women are interested in birth control as are men, but rarely talked about

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Childbearing Practices Continued Will attend live prenatal classes May use herbs, blue cohosh pills to enhance labor Grandmothers provide much assistance Older children help care for younger children

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Exceptionally rare to be in a long-term care facility If at all possible, prefer to die at home If family member is caring for the ill at home, neighbors may do the cooking and farm chores Do use visiting nurses and therapists when needed

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Continued Visiting during illness and after death is an obligation Neighbors take care of family and friends coming from afar Wakelike sitting up all night is not uncommon Plain wooden coffin for burial

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Death Rituals Continued Burial in home cemetery or in community church cemetery Death is a normal transition of life May present as stoic although loss is keenly felt

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality No regional or national church Districts divided into 30 to 50 families or 200 to 300 people All religious leaders are male, volunteered, and untrained National committee may be used for some decisions affecting other communities

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality Continued Corporate worship is the norm with faith-related behavior, not individual wishes. Salvation is ultimately individual. If engaged in sinful activity, can rejoin the church after proper penitence. Church officials may be sought in healthcare matters.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Spirituality Healthcare decisions are ultimately an individual matter Want to have a decision in healthcare matters just ask me/us Health promotion is a family/individual affair

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Healthcare knowledge is passed among and between families by the women No health insurance but communities share and have the Amish Aid Society Some places give a discount because of cash payment Cost of procedures may be a deciding factor to have the procedure done

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued Herbal treatments Self-medication Abwaarde minister by being present Achtgewwe helping others and is many times gender- and age-related

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued Brauche or sympathy curing, laying on of warm hands, or powwowing and is similar to Native American practices Abnemme failure to thrive and child is taken to a healer who may perform incantations Aagwachse or livergrown, grown together caused by jostling buggy rides

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practices Continued Usually stoical with pain and physical discomfort Physically or mentally different are fully accepted into the community without stigma. Time off for illness is acceptable.

Transcultural Health Care: A Culturally Competent Approach, 4th Edition Healthcare Practitioners Braucher or traditional healer first and may be men or women Use reflexology and massage as well as herbal therapies Western healthcare practitioners, nurses, physicians, dentists are outsiders, but use them when needed and trusted