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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


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


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.


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.


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.


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


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


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


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.


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.


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


Genetic Diseases Continued

Manic-depressive illness Bipolar effective disorders are higher than

general population Low rates of alcoholism, drug/alcohol abuse


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.


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


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


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


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


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


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


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.


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


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


Healthcare Practices Continued

Herbal treatments Self-medication Abwaarde—minister by being present Achtgewwe—helping others and is many times

gender- and age-related



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



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.


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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