Transcultural Health Care

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Amish
Larry Purnell, PhD, RN, FAAN

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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

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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

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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.

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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.

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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

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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

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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

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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.

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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.

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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

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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.

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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