Cultural competence in Healthcare: Amish Culture
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The document provides information on the Amish culture, including their origins in 16th century Switzerland, migration to the US in the 18th century, and lifestyle beliefs centered around their religious faith. It discusses Amish demographics, health risks such as genetic disorders and accidents, and their healthcare beliefs which incorporate alternative and complementary methods before seeking medical intervention. The document also outlines strategies for providing culturally competent care to the Amish community and challenges healthcare providers may face, such as language barriers and prejudice.
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Cultural competence in Healthcare: Amish Culture
- 1. The Amish Culture Presentation by: Tosin ola, Rn, Bsn
- 2. Amish Origins Called ‘Plain Folk’ 16th Century Origins Anabaptists Persecution Swiss Brethren/ Menonnites Jacob Amman Migrated to USA in 18th century Different fellowships
- 3. Amish Lifestyle & Beliefs Ordnung Communion Baptism Rumspringa Family roles Education The Simple Life
- 4. Demographics of Amish Population Location Number of settlements Population
- 5. Demographics: Health Risks Childbirth Genetic Disorders Immunizations Hemophilia Chicken pox Amish lethal Pertussis microcephaly Rubella Dwarfism (Ellis-van Creveld syndrome) Psychiatric disorders Unusual blood types Bi-polar affective disorder Metabolic Disorders Mental retardation Glutaric Aciduria Type I Chronic bed-wetting Diabetes
- 6. Environmental & Community Risk Factors Buggy Accidents Physical Labor Elder Care Child Labor Abuse External Violence Environmental pollution
- 7. Healthcare Beliefs •Lack of insurance •Community oriented •Family birthing centers and midwives for childbirth •Use alternative and complementary methods first •Seek medical intervention only in acute illness •See heroic measures as interfering with ‘God’s will’
- 9. Cultural Competence Model The Explanatory Model The Explanatory Model is a practical approach that can be as brief or complex as the clinician determines and it treats each encounter uniquely, helping to avoid stereotyping and the impossibility of knowing each patient’s culture (McLauren, 2002) . The point is simply to ask good, open-ended questions.
- 10. Strategies for Culturally Competent Care Ability Encounter Openness Flexibility
- 11. Challenges to Culturally Competent Care Language Barriers Prejudice/Racism
- 12. Healthy People 2010 offers a simple but powerful idea: provide health objectives in a format that enables diverse groups to combine their efforts and work as a team. It is a road map to better health for all and can be used by many different people, States, communities, professional organizations, and groups to improve health. The initiative has partners from all sectors (Healthy People 2010). Healthy People 2010 challenges individuals, communities, and professionals, indeed all of us to take specific steps to ensure that good health, as well as long life, are enjoyed by all (Healthy People 2010).
- 13. Watson’s Carative Factors • Humanistic–altruistic system of values • Faith–hope • Sensitivity to self and others • Helping–trusting, human care relationship • Expressing positive and negative feelings • Creative problem-solving caring process • Transpersonal teaching–learning • Supportive, protective, and/or corrective mental, • physical, societal, and spiritual environment • Human needs assistance • Existential–phenomenological–spiritual forces (Watson, 1999, p. 75).
- 14. Conclusion
- 15. References Allen, G. (2000, July 17). Accidents in Amish Lanes. Lancaster Daily News, pp. 11- 16. Armer, J. M., & Radina, M. E. (2006). Definitions of health and health promotions among Midwestern old order Amish families. Journal of Multicultural Nursing & Health, 12(3), 44-53. Armer, J., & Elise, R. M. (2006). Health promotion strategies with Old Order Amish. Journal of Multicultural Nursing, 12(3), 1-11. Baker, C. L. (2007). What Amish girls learn, that non-Amish girls don’t. Retrieved November 23, 2008, from http://myamishquilt.com/girls.html De Chesney, Mary. (2008). Caring for the Vulnerable: Perspectives in Nursing Theory, Practice, and Research (2nd ed.). Donnermeyer, JP., Kreps, GM., & Kreps, M.W. (1999). Lessons for Living: critical Approach to Daily Life from the Amish Community. Walnut Creek, Ohio: Carlisle Printing. Donnermeyer, J. F., & Friedrich, L. (2006). Amish Society: an overview reconsidered. Journal of Multicultural Nursing & Health, 12(4), 13-23.
Editor's Notes
- Welcome to Team B’s Cultural Competence presentation study of the Amish Culture. Our Team consists of Valencia, Tosin, Rosson and Shari. The term cultural competence consists of two words, culture and competence (Jirwe, Gerrish, & Emami, 2006). Culture is defined as the learned, shared and transmitted values, beliefs, norms and life practices of a particular group of people (Leininger & McFarland, 2002). Peoples' culture can be understood through their actions, that is, their behavioral patterns and through understanding why people act in the way they do; their functional patterns (Leininger & McFarland). Culture can also be understood through an interpretation of one's world, through one's cognitive processes, or through a person's understanding of their world, which is linked to their symbolic interactions (Jirwe, Gerrish, & Emami, 2006). “Since cultural background greatly affects several aspects of people's lives, i.e. their beliefs, language, religion, family structure and body image, this must be considered when caring for people from other cultures” (Jirwe, Gerrish, & Emami, p. 12). Cultural competence is a way of practicing one’s profession by being sensitive to the differences in cultures of one’s constituents and acting in a way that is respectful of the client’s values and traditions while performing those activities or procedures necessary for the client’s well-being (DeChesnay, 2008). It takes into account the cultural differences between the nurse and the patient, while meeting the needs of the patient. We have chosen to deliberate on the Amish culture because due to their beliefs, lifestyle and isolation from the modern world, much mystery surrounds their culture and many nurses are unable to relate to their culture, understand it, or practice culturally competent care (Jirwe, Gerrish, & Emami, 2006, ). Amish families have purposely separated themselves from the advancing modern society that surrounds them and refuse to depend on outside help in order to survive (Baker, 2007). This seems such a rebellious and alternative way of life that is hard for many people to understand (Baker).
- The word "Amish" is a term used by non-Amish; the Amish would refer to themselves as the “plain folk” (Jirwe, Gerrish, & Emami, 2006). The roots of the Amish begin in 1525 with a group of religious dissenters near the city of Zurich, Switzerland who believed the Protestant Reformation had not gone far enough formed a sect that believed in Anabaptism (the baptism of free will adults) which was in opposition to the then current belief of baptism of infants (Donnermeyer & Friedrich, 2006). The Anabaptists were persecuted and put to death by various governments aligned with the Roman Catholics, Lutherans and other Protestant groups (Donnermeyer & Friedrich). They hid in caves, woods, and by other means, devised ways to worship secretly and to avoid the authorities. All the original Anabaptist founders were put to death in only a few short years after the movement was founded, but it continued to grow and attract new followers (Jirwe, Gerrish, & Emami, 2006). The Anabaptist movement spread to various parts of Switzerland, France, Germany and the Netherlands mostly along areas of these countries bordering on the Rhine River (Donnermeyer & Friedrich, 2006). The Anabaptists soon came to be known as either the Swiss Brethren or the Mennonites (Donnermeyer & Friedrich). The followers of Jacob Amman split from the original sect of the Mennonites due to religious disputes (Donnermeyer & Friedrich, 2006). This group would later emigrate to the United States in the first half of the 18 th century (Donnermeyer & Friedrich). There are still various sects within the Amish culture today, the major disparities being the conservative (or liberal) aspects of their beliefs (Donnermeyer & Friedrich). For example, in the largest Amish settlement, located in northeast Ohio, there are five major fellowships, including the Schwartzentruber Amish, the Andy Weaver Amish, the Old Order Amish, the New Order Amish, and, the most recent arrival, the New Order Amish (Donnermeyer & Friedrich, 2006).
- “ Ordnung refers to "discipline" and "community." In sociological terms, the ordnung consists of the "norms" by which the baptized members of the Amish live on a daily basis” (Donnermeyer & Friedrich, 2006, p. 2). The Amish are divided into church districts, with a typical size of about 25-35 families (Donnermeyer & Friedrich). Leading a non-Amish life will get you shunned, ignored, or excommunicated from the ordnung as a type of severe discipline (Jirwe, Gerrish, & Emami, 2006). Twice each year, the Amish hold a communion service, which includes foot-washing. Before communion can be held, the church district must be in harmony (Donnermeyer & Friedrich, 2006). Daughters and sons born into Amish families must decide, upon reaching early adulthood, to be baptized into the faith (Donnermeyer & Friedrich). About four out of every five decide to become Amish, even after a period called rumspringa (running around) in which the adolescent children of many Amish families flirt with the lifestyle of mainstream American society (Friedrich, 2001). At the end of this period, Amish young adults are baptized into the church, and usually marry a spouse, with marriage only being permitted among church members (Friedrich). Mothers are homemakers, and fathers are the bread-winners (Jirwe, Gerrish, & Emami, 2006). Daughters help mothers with household chores, and sons help dads with work-related chores (whether it be farming or some other kind of job) or chores expected to be performed by fathers (home repairs etc.) (Jirwe, Gerrish, & Emami). All children are educated to an eighth grade level by single, unmarried women in a one-room schoolhouse (Hostleter, 1993). Amish children are able to pass examination with non-Amish children on all levels, the only lower markers are in vocabulary (Hostleter). The Amish have different rules which vary by sector. The most general are the value of hard work, none use of modern conveniences except in emergent situations, no electricity, farming & husbandry provides basic sustenance, no extravagant or flashy lifestyles (Jirwe, Gerrish, & Emami, 2006). Attire should be plain and unadorned, members should be humble, kind and exhibiting pacifist Christ-like virtues (Baker, 2007).
- Location : The Amish first settled in the Lancaster County, Pennsylvania area (Nolt, 1992). By the time of the Civil War over a century later, Amish settlements had spread into Ohio and Indiana, and several other states (Hostetler, 1993). The largest Amish settlement is located in Northeast Ohio (Nolt) . Currently, there are over 175 settlements in North America (Nolt, 1992). The largest settlements are located in Lancaster County, Pennsylvania, Holmes County, Ohio, and LaGrange County, Indiana, although smaller settlements dot the United States and Canada (Nolt). Population: Only adults are counted as full church members (Donnermeyer & Friedrich, 2006). As of 2000, over 165,000 Old Order Amish live in Canada and the United States (Jirwe, Gerrish, & Emami). A new study in 2008 suggests their numbers have increased to 227,000 (Donnermeyer & Friedrich). No Amish remain in Europe (Armer & Elise, 2006).
- “ The Amish are very health conscious and are quick to recognize individuals who are sick or incapacitated” (Hostetler, 2003, p. 327). To them, a healthy person is one who has a good appetite, looks physically well and can do rigorous, physical labor (Hostetler). Illness is recognized as the inability to function in one’s role (Hostetler). “In Amish culture, sickness is a socially accepted form a deviation” (Hostetler, p. 323). Amish people are allowed to seek out alternative remedies, medical intervention and treatment for their conditions without reprisals from the community. Since almost all Amish descend from about two hundred 18th century founders, genetic disorders from inbreeding exist in more isolated districts (Armer & Elise, 2006). Some of these disorders are quite rare, or unique, and are serious enough to increase the mortality rate among Amish children (Hostetler, 2003). So far “39 different inheritable disorders have been found Lancaster, PA among the Amish” (Hostetler, p. 329). Childbirth: “ 90% of first births occur in the hospital, and 59% of last births occur at home with a midwife” (Hostetler, 2003, p. 329). The Amish usually have their first child in the hospital, and if there are no complications, all other childbirths are at home. The Amish do not practice artificial forms of birth control (Hostetler). They are against abortion and also find "artificial insemination, genetics, eugenics, and stem cell research" to be "inconsistent with Amish values and beliefs" (Hostetler, p. 330). Immunizations: “Recent outbreaks of chickenpox and pertussis have brought to light that only 34% of Amish immunize their children” (Hostetler, 2003, p. 326). Although the “Amish account for less that 0.5% of the national population, they experienced nearly all rubella reported in the U.S. in 1991” (Armer & Elise, 2006, p. 45). Psychiatric disorders: Due to the concentrated genetic code and inbreeding, Amish people have been shown to have higher incidences of bi-polar affective disorder, mental retardation and chronic bed-wetting (Donnermeyer & Friedrich, 2006). Suicide rates for the Amish of Lancaster County were 5.5 per 100,000 in 1980, about half that of the general population and a third the rate of the non-religious population (Jirwe, Gerrish, & Emami, 2006). Genetic disorders: Most common illnesses among Amish Americans is as a result of their complex genetic code (Hostetler, 2003). Amish lethal microcephaly is contacted when both parents have the recessive genetic trait (Hostetler, 2003). With each pregnancy, they have a 50% chance of passing the disease to their offspring (Hostetler). This is chronic, has no cure, and often leads to the most unexplained childhood sudden deaths in the community (Hostetler). Dwarfism: “ Among the disorders afflicting the Amish is an unusually high incidence of dwarfism” (Jirwe, Gerrish, & Emami, 2006, p. 8). “This is the direct result of genetic limitation by intermarriage” (Jirwe, Gerrish, & Emami, p. 8). It is also a cause of mortality with double doses of the dwarfism gene causing either prenatal or perinatal death for the infants so affected (Jirwe, Gerrish, & Emami). In a larger pool, a dwarf might be much more likely to marry an average sized person who would not have the gene (Jirwe, Gerrish, & Emami). “With two dwarves, a quarter of pregnancies will result in lethal double dwarfism, a quarter will be average sized and 50% will be dwarves” (Jirwe, Gerrish, & Emami, p. 8). Glutaric Aciduria Type I: “ This disease occurs in a staggering one in each two hundred Amish children” (Armer & Elise, 2006, p. 44). “This is a metabolic disorder that causes severe nerve disorders among the Amish culture” (Armer & Elise, p. 44). With scant data on incidence, prevalence, mortality, and morbidity specific to the Amish population, Amish health risks related to cardiovascular disease, diabetes, cancer, and other diseases prevalent in the dominant population are largely unspecified (Armer & Elise, 2006). The unique combination of Amish lifestyle and genetic factors may lessen or increase the impact of certain risk factors (Armer & Elise).
- Buggy accidents are one of the leading causes of injury for Amish folk (Allen, 2000). Buggy with buggy accidents are rare, and accidents are usually caused by inconsiderate drivers in automobiles running into the buggy or scaring the horse (Allen). Other elements like foul weather conditions, horse error, alcohol, hitching/unhitching accidents, noise, vandalism and human error account for 15% of occurrences (Allen). Muscle tears, strains, aches and pains are common to Amish life, due to the hard physical labor that they engage in (Allen, 2000). Most minor problems are treated with poultices and traditional methods (Hostetler, 2003). Elderly: Grandparents still live with their children, or move into a smaller house right next door called the Grossdaadi Haus (Barker, 2007). They continue to help with work on the farm and in the home, working at their own pace as they are able (Barker). This allows them independence but does not strip them of family involvement. Child Labor: One of the basis of Amish lifestyle is hard work, and children are not exempt from this (Donnermeyer & Friedrich, 2006). As soon as they can walk, Amish children are assigned chores in the home, on the farm and in the community that range from feeding animals, small gardening tasks, household chores to dealing with animals and heavy machinery (Donnermeyer & Friedrich). Abuse: “ Because Amish keep discipline within the authority of the church, sexual abuse may be less-often reported to law enforcement” (Hostelter, 2003, p. 319). Since men dominate their society, women and children who have been mistreated have little recourse (Hostelter). In fact, they may be shunned (excommunicated) should they seek outside help (Hostelter). In the last decade, “several articles have been written in Pennsylvanian newspapers that have brought to light multiple cases of spousal abuse, child abuse, sexual abuse, rape and incest…all which had been concealed and covered up by the Amish leaders” (Rensberger, 2003, p. 218). Although the “rate of physical or sexual abuse does not appear to be higher in the Amish community than in the general public, their physical and social isolation from the outside world make it more difficult for victims to seek help” (Hostelter, 2003, p. 119). External Violence: Since the Amish are non-resistant and rarely defend themselves physically or even in court; they have been the brunt of many anti-Amish brutality (Allen, 2000). In the present day, anti-Amish sentiment has taken the form of pelting the horse-drawn carriages used by the Amish with stones or similar objects as the carriages pass along a road (Allen). Pollution: In 1993, it was brought to light that manure run-off (from horses and cows) contributed significantly to the decline of the ecosystem in the Chesapeake Bay (Rensberger, 2003). “Since many Amish that live in Lancaster county own large quantities of animals, they were estimated to have caused about 60% of the damage due to manure run-off, heavy rains and Hurricane Agnes” (Rensberger, p. 112). Some Amish families have taken steps to prevent future organic catastrophes by building run-off drains, fencing the cows in, and composting manure (Rensberger).
- Health costs are first paid by the family, and then by the church district. Families within each church district are assessed an amount corresponding, roughly, to the number of family members (Hostetler, 1993). This is the first line of defense against health insurance costs. If necessary, church districts from the same affiliation will pool resources in order to take care of expensive health care needs, such as Amish victims of a vehicular accident, or expensive surgery (Hostetler). The bottom line is that the need for the Amish to maintain a high sense of community, or social capital in the words of Putnam (2000) is reinforced by the cost-sharing necessary to afford to pay for of seeking out modem medical services. Many Amish still rely upon various folk remedies, mostly as a form of primary prevention (Quillen, 1995). Another expression of the way the Amish as a subculture address health issues is through their preferences for home-births with mid wives (Wasao & Donnermeyer, 1996). Amish women are more likely to receive healthcare and prenatal services if they trust a healthcare provider to respect and understand them. Since almost all married women do not work outside the home, and there is a strong extended family system of aunts, uncles, and grandparents from a previous generation, folk remedies are more highly valued and passed along from mothers to daughters, as a skilled required of all good homemakers (Quillen, 1995). As a result, the Amish have a tendency to wait until an illness is acute before seeking doctors and other medical specialists and care (Quillen). Folk medicine costs less and keeps the locus of control firmly rooted in the family and the faith (Quillen). Amish see artificial, heroic means of preventing death as thwarting God’s will (Baker, 2007). Thus treatments like dialysis, chemotherapy and radiation are only accepted for a limited amount of time (Hostleter, 1993). They accept death with the stoicism that they deal with everything else in their lives and view the deceased in heaven or ‘a better place’ (Baker) .
- The healthcare provider needs to consider the time of day, season of the year, and length of time that an appointment may require in scheduling services for these patients (Graham & Cates). It may be important to provide as many services as possible in a single visit - for example, not just a consultation, but also imaging and lab work (Graham & Cates). If a patient arrives via horse and buggy, arrangements for the care and safety of the horse need to be considered (Graham & Cates). Amish patients are likely to use alternative and complementary health services as primary healthcare (Graham & Cates, 2006). They may identify chiropractors as primary physicians, and often begin diagnosis of, or treatment for a disorder with herbs, minerals, vitamins, foot reflexology, or iridology, the specific remedy often chosen on the basis of traditional and personal experience (Nolt, 1992). If there is no improvement, they may then turn to a nursing or medical professional for services. For example, "Rescue Remedy" is an elixir composed of flower essence favored in the Grabill, Indiana area (Armer & Radina, 2006). In addition to a general tonic, its uses include treatment of colic, reducing bleeding, and prevention of infections. Amish women did not disdain technology, but were more likely to rely on herbs recommended by the midwives (Armer & Radina). Amish patients are also likely to venture outside the United States for healthcare. Mexico has become a frequent site for services, including elective surgeries and imaging techniques ( Donnermeyer & Kreps , 1999) . Even with the cost of transportation, comparable services are less costly than they would be in the United States ( Donnermeyer & Kreps) . The sensitive healthcare provider weaves western medicine and American practices into the fabric of this existing system of care ( Donnermeyer & Kreps , 1999) . The Amish were less likely to use tobacco, consumed less alcohol, ingested less salt, and more frequently used vitamin supplements ( Donnermeyer & Kreps) . However, more recent conversations with Amish leaders suggest concern among their communities that the nutritional quality of eating patterns is declining ( Donnermeyer & Kreps) .
- Using the Explanatory Model is a great cultural competence model to identify how the Amish or any culture think about their health. It is a great tool to learn about the Amish culture without getting too personal or being viewed as offensive (McLauren, 2002) . The term explanatory speaks for it’s self. It means the nurse is exploring everything they can about the patients and their culture (McLauren). The healthcare provider obtaining an accurate history from an Amish patient must ask questions in a gentle and nonjudgmental manner, and respect the answers, no matter how unusual (or counterproductive) they may seem for the malady in question (Patton, 2005). Interventions must work within the patient's framework. Some of the questions in the model include: What do you think caused your problem?, What does your sickness do to you?, what have you done to treat this?, What are some traditional ways of treating this?, What kind of treatment do you think you should receive?, and Does faith, religion or spirituality help you to be well? How? (McLauren, 2002). We believe that asking these questions will help speed up and improve the care of the Amish culture according to their answers and needs (McLauren) . In addition, understanding the beliefs and perspectives of each member will help in individualizing care, since not all Amish believe or act the same (Armer & Elise, 2006).
- There are several strategies that can be used to ensure culturally competent care. “The first attribute of cultural competence is ability. It is characterized as the nurses’ ability to effectively care for ethnically diverse populations” (Jirwe, Gerrish, & Emami, 2006, p19). In this situation the nurse should have the power to act or perform the duties of being culturally competent” (Jirwe, Gerrish, & Emami, p.19). Having a face-to-face encounter with Amish people is a good indicator of ability (Armer & Elise, 2006). The Amish consider plain-speaking and honesty more highly than degrees on the wall (Jirwe, Gerrish, & Emami, 2006, p. 12). Word of mouth spreads fast through the community, and a good encounter can yield multiple opportunities for interaction with the Amish (Jirwe, Gerrish, & Emami). Another strategy to ensure culturally competent care is openness. The nurse would have to be open minded about the Amish culture by accepting the culture, being non-judgmental and showing respect (Jirwe, Gerrish, & Emami, 2006). Being open minded is a sure way to show that your are culturally competent, it’s showing that you have the willingness to learn about another culture (Jirwe, Gerrish, & Emami). Having the flexibility is another characteristic of cultural competence. “Flexibility is an implicit attribute of cultural competence, which broadly means an ability to adapt oneself to different situations” (Jirwe, Gerrish, & Emami, 2006, p. 19). Specifically, flexibility related to cultural competence embraces culturally relativistic perspective, and commitment to and appreciation of other cultures (Jirwe, Gerrish, & Emami).
- Language Barrier: The Amish culture speaks some English, but also speak predominantly in a Swiss German dialect (Baker, 2007). This language barrier can affect communication in the healthcare setting. Elderly Amish revert to Dutch German when under stressful conditions (Baker). Know what language client speaks at home. If the client uses English as a second language, providers may want to ascertain the level of actual versus assumed language comprehension early in the encounter (Baker). Allowing a family member or friend to accompany the patient during the examination so they may translate should be last resort . Another challenge could include the nurse being prejudiced against the Amish culture or beliefs, or racism (Armer & Elise, 2006). Having negative feelings about another culture would make it difficult to deliver culturally competent care (Armer & Elise). If the nurse was willing to incorporate the attribute of openness by being open minded and educated about the Amish culture, it might possibly change the nurses feelings (Armer & Elise). The healthcare provider working in areas populated by the Amish needs to question religious background as part of the patient's history (Armer & Elise, 2006). The professional nonjudgmental attitude requires not only caution about negative, but also about positive comments on the Amish way of life (Hostelter, 2003)
- Healthy People 2010 is designed to achieve two overarching goals (Healthy People 2010 website). Goal 1 : Increase Quality and Years of Healthy Life “ The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life” (Healthy People 2010 website) Kreps (1997) mention the needs to involve the Amish community in planning for services, channel ideas through their leadership, and include Amish perspectives in communication of information and education. For example, a birthing center in Topeka, Indiana, is administered by the Amish and staffed by nurse midwives; a dental clinic in Shipshewana, Indiana, has an Amish board of directors; and a group of Amish and Mennonites have developed a group home for Amish persons with serious and persistent mental illness who need a transition to or from the community in LaGrange, Indiana (Jirwe, Gerrish, & Emami, 2006). Goal 2 : Eliminate Health Disparities “ The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population” (Healthy People 2010 website). One goal to help the Amish population would be: “ Promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities in the U.S. population” (Healthy People 2010 website). Since the Amish have a high incidence of genetic disorders, programs beneficial to the early diagnosis, treatment and care of young children with these conditions should be encouraged (Armer & Radine, 2006). Amish women (with or without their husbands), have shown interest in birth control after their fourth pregnancy (Hostelter, 1993, p. 314). Creating more awareness around this would be another key goal. The Amish have shown interest in early immunization of their children (Jirwe, Gerrish, & Emami, 2006). Creating awareness and education surrounding immunizations will help to combat other outbreaks of polio, rubella and other diseases with vaccines (Baker, 2007). “ The Leading Health Indicators (LHIs) established by Healthy People 2010 will be used to measure the health of the Nation over the next 10 years” (Healthy People 2010).
- The Amish people are a holistic and family centered community (Jirwe, Gerrish, & Emami, 2006) . A nurse developing and incorporating teaching methods should have some understanding of the Amish beliefs. Watson’s carative factor of being sensitive to self and others is one role a nurse can use before and during the process of decreases some of the health issues associated with the Amish (De Chesney, 2008). The use of appropriate terms while communicating will avoid creating an uncomfortable atmosphere for both parties. Without a basic understanding of the client’s culture, the client and nurse may experience cultural conflict and confusion, and the client may not return for care (De Chesney). This leads to another role in nursing using creative problem solving methods in a caring process to help the patient’s (the Amish) understand the health consequences that are affecting their population (Watson, 1999). Conveying to the family in a caring way while offering suggestions on how to decrease illnesses in children by educating them on childhood immunizations is a start (De Chesney). The nurse should also acknowledge during the teaching process to the family the understanding of their cultural beliefs. The nurse’s role in educating the patient would be more effective if she remains open and honest without incorporating her own beliefs in the session (De Chesney). This promotes an environment in which a therapeutic relationship can develop and also assists the nurse in developing care plans in concert with patients and families rather that for them (De Chesney).
- The Amish have kept a distinctive language, a distinctive dress, a distinctive means for travel, a distinctive variation on the Christian faith, a distinctive social organization - built on the four pillars of the nuclear family, the extended family, the church district, and the community - and distinctive ways of considering when and how much change will occur (i.e., the ordnung) (Donnermeyer & Friedrich, 2006) This presentation of the Amish population has allowed our team to research the history, culture, beliefs, and lifestyles of this vulnerable class of people. The health risks and environmental factors associated with the Amish was discussed while incorporating methods of teaching using Watson’s Theory of Human Caring (De Chesney, 2008). The Amish accept alternative therapies and forms of treatment in their culture. Our team detailed these services provided and included the healthy people 2010 challenges as available programs for this population to take interest in. The Amish face challenges of prejudice in their communities of people not understanding their way of life often. This however effects the people from seeking outside health care delaying treatment for those who are ill. The Amish have shown interest in pursuing medical interventions and accepting healthcare from established providers (Hostelter, 19993). Being culturally competent in their care will increase their comfort and bridge the gap between their culture and medical needs.
- Graham, L. L., & Cates, J. A. (2006). Healthcare and sequestered cultures: A Perspective from the old order Amish. Journal of Multicultural Nursing & Health , 21(3), 60-66. Hostelter, J. (1993). Amish Life . Baltimore, MD: John Hopkins University Publishers. Hostelter, J. (2003). Amish Society (4th ed.). Baltimore, MD: John Hopkins University Publishers. Jirwe, M., Gerrish, K., & Emami, A. (2006). Theoretical Framework of Cultural Competence. Journal of Multicultural Nursing & Health , 12 (4), 12-19. Rensberger, Susan. (2003) The Complete Idiot's Guide to Understanding the Amish. New York, Alpha Books (Penguin Group), p. 181 – 183 Nolt, S.M. (1992). A History of the Amish. Intercourse , PA.; Good Books. O’Neil, D. J. (1997). Explaining the Amish. International Journal of Social Economics , 24(10), 1132. Patton, M. A. (2005). Genetic studies in the Amish community. Annals of Human Biology , 32(2), 163-167. Putnam, R. (2000). Bowling Alone: The Collapse and Revival of American Community . New York: Simon & Schuster. Ritzer, G. (2000). The McDonaldization of Society . (3rd edition). Thousand Oaks, Ca: Pine Forge Press. Watson, J. (1999 ). Nursing: Human science and human care, a theory of nursing . Sunbury, MA: NLN Press, Jones and Bartlett http://www.healthypeople.gov/