Introduction
Knowing that there are different types of culture is essential for every type of healthcare practitioner, especially for those who are required to treat and interact with patients. Examples of these professions are physical therapists, occupational therapists, medical technologist, physicians, and allied health nurses. These medical professionals treat their patients by either introducing an intervention to them, such as administering comprehensive exercise programs for rehabilitation specialists and prescribing medications and therapies for physicians and physiotherapist. Most, if not all, of these treatments require that the patient cooperates. In fact, patient cooperation is considered as an important determinant that medical centers use in formulating an accurate and realistic patient prognosis. Usually, the more cooperative the patient is, the better the prognosis would be and the more likely that he will positively respond to the administered treatments or medications. Now, a high level of patient cooperation is usually achieved when there is a positive interaction between the patients and let us say, his nurse, for example. The nurse on the other hand, in a way, is responsible to make the patient as comfortable with him and the treatment as much as possible. This way, patient rapport would be good and chances are the patient will cooperate.
Being familiar of a certain patient’s culture is generally considered as an important part of that process—establishing patient rapport. This paper will actually focus on building rapport by knowing a specific culture—the Amish Culture. There is a significant number of patients who belong to this kind of culture. Therefore, it would be important not only for nurses but also for other health professionals to be educated about the specifics of this culture. What is a family and a community for them? What are attitudes and beliefs that are unique to their culture? What are their dietary practices, perception of time and relationships, aging, typical patterns of communication, and basically everything that would be relevant in the clinics.
Amish Culture
The Amish culture is actually a group of people that is directly connected to the Amish religion. In fact, it is the Amish people that are behind the Amish religion. One of the most important thing to know about Amish people in the clinics perhaps would be their mandate to separate themselves from worldliness, especially sins that can either be mortal or not. For them, being able to resist temptation and pressure to commit sin is the key to salvation. Everything else that is related to the Amish culture is actually geared towards attaining that goal. People from other religions or cultures may notice that they have a separate way of life. Their way of life is primarily driven, and at some point, dictated by the Ordnung. If the Christians—Roman Catholics and Protestants have the Holy Bible, the Amish Culture has the Ordnung. It is like their holy book. One important thing to remember about the Ordnung is that it varies from community to community or even from district to district. It is common for people, even for some medical practitioners—especially those who are not aware of the specifics of this culture, find Amish people weird. But the reason why they find them weird is their lack of education. They do not know the rationale behind the Amish people’s actions and so they find it out of context.
Family Structure
The family is the basic unit and is sometimes regarded as the most important part of society. This same universal principle actually applies to the Amish culture as well. Nothing could be as important as their family and beliefs for the Amish. It is common among Amish families to be very large. The number of members in a single Amish family usually revolve around 9-12, including the mother and father. The Amish do not have a purely patriarchal society which our common society has, at least in their homes. Household chores, decision-making, and other types of responsibilities are usually divided equally between the mother and the father. The father usually does the heavier work—farm works, etc. The mother does the lighter tasks. She is usually in charge of washing the dishes, cleaning the house, cooking, and taking care of the kids. The male parent is also considered as the head of the family but even so, the mother still has some say when it comes to decision-making. All in all, the Amish family has a lot of similarities with a typical, old-school family mode.
The Amish considers their pregnancy as a blessing. They treat their children as a blessing of God. It is common among the Amish to show pure love and affection towards their kids. They believe that God is directly involved in planning the intended size of their family, the gender of their would-be kids, and the overall health of their offspring. They are totally against the idea and the act of aborting a pregnancy regardless whether it is a wanted or an unwanted one. For them, abortion is a mortal sin and is a direct form of disobeying the teachings of the Ordnung. Contrary to popular belief, the Amish believe on the power of medicine. However, they would opt to make the course of their pregnancy as natural as possible, with as few medical and scientific interventions as possible. However, in cases of problematic pregnancies, they often seek medical attention because they do not really want to risk losing an offspring. Taking care of their elders is also an important part of being an Amish. They view their elders as treasures and so the sons and daughters usually take good care of them as long as they live.
The Amish eats food from their own lands. So, we could assume that they only eat foods that are organic and not manufactured by factories and food processing centers. Typical Amish diet includes potatoes, rice, and other foods that are usually classified as filling and very low in fat. Some of the Amish community leaders highly advocate the intake of nutritious and non-damaging foods only.
Health is one of the Amish’s highest priorities. They know for a fact that health encompasses not only the physical aspect but also the mental, emotional, social and spiritual aspects of life as well. Whenever things get too problematic, they tend to seek medical attention. However, they do have the practice of not seeking medical attention as long as they can bear the pain which is the most common complaint of patients, in an effort to let the natural course of things occur as much as possible.
I would of course focus on diagnosing the patient while keeping in mind the No-Nos in their culture. Amish people are not necessarily bad and weird people. They just have their own way of life. For an 81 year old female CVA patient such as this one, I think being polite is the most important thing whenever administering a treatment or assessing the patient because the Amish are known for being respectful to their elders.
The most important thing I have to remember for a mother who just delivered a 28-week premature baby is their perception about pregnancy. As mentioned before, the Amish are known for their belief that a baby is a gift of God. I would keep that in mind. When it comes to examinations and interventions that need patient or family intervention, I would always prefer to ask the father first because in the Amish culture, the father is considered the head of the family.
Since it is the father we are talking about here, I would first ask whether he wants to disclose his diagnosis to his family, including his parents or to keep it as a secret. As a patient, he has the right not to disclose any objective findings during an assessment and he also has the same right as the head of the family. Nevertheless, I would try to incorporate my knowledge about the Amish culture when dealing with this patient and his family as much as possible.
Guide Questions
How should questions for you assessment be directed and adapted for your cultural group?
Questions should be individualized. The way of asking questions from an elderly should be different from the way of asking questions from a child. The questions should be as objective as possible although asking questions that are related to the patient’s life would also help establish rapport.
Identify three culturally sensitive nursing diagnoses from your client’s cultural perspective.
As far as patients’ rights are concerned, every nursing and medical diagnoses are sensitive not only to the Amish but to all other cultures because all patients have the rights to disclose whatever findings they want to disclose or to keep them private.
How should planning for care be adapted for your cultural group? How should care be adapted to your cultural group?
The general rule of formulating a plan of care and administering it is actually applicable to the Amish. The attending practitioner should just have to remember the dos and the don’ts with regards to this specific culture. The general rule for a plan of care and a treatment is that it should be individualized because patient outcomes and responses to interventions and medications typically vary from patient to patient.
References
Barish, R., & Snyder, A. (2008). Use of complementary and alternative healthcare practices among persons served by a remote area medical clinic. Family and Community Healt.
Bishop, F., & Lewith, G. (2008). Who uses CAM: A Narrative Review of Demographic Characteristics and Health Factors Associated with CAM use. Evidence Based Complement Alternative Medicine.
Carter, G. (2008). Food Intake, Dietary Practices, and Nutritional Supplement among the Amish. Ohio State University Dissertation Department.
Halverson, J., Ma, L., & Harner, E. (2009). An analysis of disparities in health status and access to health care in the Appalachian Region . ARC.
Umble, D., & Weaverzercher, D. (2008). The Amish and the Media. Johns Hopkins University Press, 288.
