Ch07
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Transcript of Ch07
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural Health Care: A Culturally Competent Approach, 4th Edition
Copyright © 2013 F.A. Davis Company
Amish
Larry Purnell, PhD, RN, FAAN
Transcultural Health Care: A Culturally Competent Approach, 4th EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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 EditionTranscultural 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