AMISH AMERICAN CULTURE Cassandra Benoit RN JoElena Prestigiacomo

AMISH AMERICAN CULTURE Cassandra Benoit, RN Jo-Elena Prestigiacomo, RN Sheila Samuels, RN

WHAT IS CULTURE? v Culture is the sum total of ways of living built up by a group of human beings and transmitted from one generation to another (Culture, 2014). v. Explaining the Amish Way of Life: ttp: //youtu. be/PAg. SCTdnrhk

OVERVIEW v The Amish is a variant of the Anabaptists of 16 th Century in Europe (Purnell, 2013). v The Anabaptists movement originated in Switzerland in 1525 (Purnell, 2013). v The Amish embraced some of the Anabaptists views of faith, but separated from the larger Anabaptist group (the Mennonites) because the Amish strictly avoided any members that were not members of their church (Purnell, 2013).

v Today the Amish live in rural areas of Pennsylvania, Ohio, Indiana, and Montana and as far as Canada (Purnell, 2013). v The Amish are known as the “plain people” (Rearick, 2009). v The Amish value inner harmony, mutual caring and pace (Purnell, 2013).

COMMUNICATION v Amish speak three languages, each for certain situations (Purnell, 2013). v Spoken and written English is the language for school, and for contacts with non-Amish (Purnell, 2013) v Within the Amish home and communities, Deitsch, or Pennsylvania German aka Pennsylvania Dutch is spoken. Hochdeitch or Amish High German, the third language is considered the sacred language. It symbolic of the way of life that reaches back to the Amish’s European heritage (Purnell, 2013).

v Verbal communication between the Amish is low in context and more reliance is placed on the unspoken language (Purnell, 2013). v Affection between family members are extremely private. They are not assertive or aggressive (Purnell, 2013). v The Amish are not outwardly expressive or emotional, they are very modest, and they dress in plain clothing that lacks any fashion (Purnell, 2013). v It is appropriate to address the Amish with their first, however, first names are so common that individuals are identified by “nicknames, residence, a spouse’s given name or patronymic name which reflects three or more generations of patrilinieal descent” (Purnell, 2013, p. 120).

FAMILY ROLES AND ORGANIZATION v The Amish believes in the tenet the man is the head of the woman. However due to the woman’s role and contributions to the household, women are highly respected (Purnell, 2013). v The husband wife make decisions together regarding the family and business, however, in public, she defers to her husband (Purnell, 2013). v The Amish family on average has seven children, the mother is expected to provide food, clothing, and nurturing. The father is expected to contribute to guidance, be a role model and discipline the children (Purnell, 2013).

v Healthcare information is shared within the family (Purnell, 2013) v Family ties are extremely close, most Amish families are nuclear and live on the farm with grandparent nearby. This creates frequent interactions between generations (Purnell, 2013).

WORKFORCE ISSUES v The Amish traditionally works in agriculture and they place high value on hard work (Purnell, 2013). v The Amish believe that current technology, while it may be helpful, can be detrimental the Amish culture, beliefs and values (Purnell, 2013).

BIO CULTURAL ECOLOGY v Dwarfism is common among the Amish (Purnell, 2013). v Ellis-van Creveld syndrome is a common disorder found among the Amish in Lancaster County, PA (Purnell, 2013). v The syndrome is characterized by short stature, having an extra digit on both hand. Some have congenital heart defects and nervous system involvement (Purnell, 2013). v Pyruvate Kinase Anemia is a rare blood disease found in the Amish. It’s characterized by jaundice and anemia soon after birth (Purnell, 2013).

v Due to bio cultural ecology, healthcare providers must provide education on genetic counseling and screening of newborns (Purnell, 2013).

HIGH-RISK BEHAVIOR v The Amish tends to have a diet high in carbohydrate and fat with a high intake of sugar (Purnell, 2013). v While the Amish are physically active due to their agrarian life-style, obesity is a prevalent among Amish women (Purnell, 2013). v Farm and traffic accidents are a health concern due to the use of horse-draw vehicles, falls from ladders and down hay holes, and farm equipment (Purnell, 2013).

NUTRITION v The Amish grow their own food for cost efficiency and because of their spiritual connection with the earth (Purnell, 2013). v “They believe that God expects people to be caretakers of the ear and to make it flourish” (Purnell, 2013, p. 126). v Food has a significant social meaning because it brings family and friends together. Food is also prepared for church functions (Purnell, 2013).

PREGNANCY AND CHILD BEARING v Children are viewed as gift from God (Purnell, 2013). v The average number of children is seven (7), and household size varies from 0 -15 or more (Purnell, 2013). v The Amish do not believe in birth control, it is rarely discussed among themselves or with healthcare providers (Purnell, 2013). v The Amish believe in the natural child bearing process, they prefer a midwife, limited, and the use of perinatal services in their community (Purnell, 2013).

v The Amish women do not discuss their pregnancy until the physical changes are obvious (Purnell, 2013). v Fathers are expected to be present and involved in the prenatal classes and during the childbirth (Purnell, 2013). v The Amish woman are tolerant of pain. During labor the woman cooperates quietly and rarely expresses her discomfort (Purnell, 2013). v Healthcare providers need to keep in mind that the woman might use an herbal remedy to promote labor (Purnell, 2013).

DEATH RITUALS v It is expected that the family will take care the aging and the ill at home (Purnell, 2013). v When a member of the community dies, the church community takes care of funeral arrangements as well as visitors from distant locations to help the family bereave appropriately (Purnell, 2013). v There are no verbal expressions of grief and sadness because they have accepted the death (Purnell, 2013). v The Amish believes that life in this world is a preparation for eternal life (Purnell, 2013).

SPIRITUALITY v Honesty, order, responsibility, obedience to parents, nonviolence, humility and the belief that the human body is a temple of God are the tenets of the Amish religion (Purnell, 2013). v Praying and silent praying is practiced in the Amish religion (Purnell, 2013). v It is the intent to be simple and unadorned in the Amish religion (Purnell, 2013). v “Death is considered part of life and a portal to a better life” (Purnell, 2013, p. 130).

v The Amish practice the need to forgive to express love for an enemy which is the practice of “The Golden Rule” (Purnell, 2013, p. 130). v The Amish believes in leaving tragedies in “God’s hands” without question or explanation (Purnell, 2013, p. 130). v is important that healthcare providers be aware of the Amish socio-religious routines, so that they can appropriately care for and respect the needs of the community (Purnell, 2013).

HEALTH-CARE PRACTICES v The body is the temple of God, therefore it is believed that God heals, not necessarily medicine or healthcare (Purnell, 2013). v The Amish are usually not forthcoming regarding medical information. The use of complementary medicine is not discussed to healthcare providers because the Amish feels that the doctor would not be interested (Purnell, 2013). v The saying “The Amish Way” means that members of the culture aware of the needs of others. This fulfills the religious order to carry or bear another’s burden (Purnell, 2013, p. 156).

v Because the Amish self-medicates, it is important that healthcare providers question the patient about all medications and remedies being used (Purnell, 2013). v Most herbal remedies are passed down from generation to generation (Purnell, 2013). v However, due to modern healthcare, some Amish opt for a more modern treatment (Purnell, 2013).

v Some barriers to healthcare include delays in seeking medical treatment and the cost of healthcare without insurance (Purnell, 2013). v The Amish are very tolerant of pain, therefore, it is important that healthcare providers check the vital signs for pain and prescribe pain medication (Purnell, 2013). v The Amish accepts the practice of blood transfusions or organ donation or transplantation (Purnell, 2013). v The Amish places great trust, respect in healthcare providers and follows doctors orders. They believe that the doctor know more about regarding medical science. v Therefore it is very important that healthcare providers fully educate and make sure their patients understand the orders (Purnell, 2013).

EVALUATION v Purnell’s (2013) Guide to Culturally Competent Health Care is an excellent tool for the evaluation of the Amish Culture. • Unlike other models, Purnell is able to give an understanding of the important aspects of the Amish Culture. v Kraybill’s (2013) Countries and their Culture Amish, was another tool that allowed for an excellent insight to the Amish culture. v Weyer’s (2004) A Look Into the Amish Culture: What Should We Learn? , is another excellent tool. • This is a case study that was performed, which allows for exploration into the Amish culture/community with more detail.

CRITIQUE v Rearicks (2009), Amish Culture and Healthcare was a good tool. • This article included an interview performed by an advanced practice nurse who tends to people of the Amish Culture. • It could have given us a better insight to the Amish Culture if more interviews were performed. • By interview more than one person from the Amish Culture, we could get a better understanding of their views.

STRENGTHS FOR MAINTAINING HEALTH v The Amish grow their own food, this allows them to know exactly what they will be eating, and know for sure that there has not been anything else added (Kraybill, 2013). v The Amish rarely use Alcohol or any other substances, which is beneficial to their health (Kraybill, 2013). v The Amish appreciates healthcare providers that take into their consideration their culture, cost of services, transportation, and family influences (Kraybill, 2013).

v The Amish primarily work as a team; therefore a person with a disability can perform tasks that are contributory yet less physically demanding (Weyer, 2004). v Elderly live with their adult children, this places less emphasis on individual function and more emphasis on group function (Weyer, 2004). • This allows for families to take care of each other.

CHALLENGES FOR MAINTAINING HEALTH v Most of the time, the Amish believe in using folk medicine when it comes to health issues (Kraybill, 2013). • • This can cause problems to arise, depending on the type of health care needed. Healthcare Providers need to be referred. Access to healthcare may be delayed due to use of alternative medical treatments. The Amish must trust a provider before accepting them as their healthcare provider.

v Transportation is a very important factor when it comes to challenges for maintaining healthcare (Weyer, 2004). • A medical appointment may be missed because their horse does not want to leave the barnyard. • The horse and buggy usually travel up to 10 miles per hour, which can make travelling to hospitals or other healthcare settings a difficult task.

v The Amish are excluded from Social Security and Health Insurance coverage (Adams & Leverland, 2009). v The Amish define illness as a failure to function in the work role instead of in terms of symptoms (Weyer, 2004). • • This allows them to be more likely to seek care for acute traumatic conditions as opposed to chronic illnesses. They often have severe symptoms and increased risk of mortality secondary to delay in seeking care.

PICO QUESTION Among Amish Americans, will a well balanced diet prevent diabetes and control obesity?

REFERENCES v Adams, C. , & Leverland, M. (2009). The effects of religious beliefs on the health care practices of the Amish. v Nurse Practice, 11, 58, 63, 67. Culture. (2014). Dictionary. com. Retrieved April 14, 2014, from http: //dictionary. reference. com/browse/ culture v Kraybill, D. (2013). Countries and Their Cultures. Amish. Retrieved April 14, 2014, from http: //www. everyculture. com/multi/A-Br/Amish. html v Purnell, L. D. , (2013). Transcultural health care: A culturally competent approach (4 th ed) Philadelphia, PA: F. A. v Davis Company. Rearick, E. (2012). Amish Culture and Healthcare. Retrieved April 14, 2014, from http: // www. juns. nursing. arizona. edu/articles/Fall%202003/rearick. htm v Weyer, S. (2004). A Look Into the Amish Culture: What Should We Learn? . Journal for Transcultural Nursing, 14, 139 -145.