Culturally competent care for amish

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
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