Transcultural Health Care A Culturally Competent Approach 4

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Appalachians Larry Purnell, Ph. D, RN, FAAN Copyright © 2013 F. A. Davis Company

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Overview § Heritage from England, Wales, Scotland, Ireland, France, and Germany § Came to the United States for religious freedom and better economic opportunities § Purposely isolated themselves in the mountains to live and practice their religions as they chose

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Overview Continued § Appalachia includes 410 counties in 13 states and extends from southern New York to northern Mississippi. § Continuous migration from the country to the city and vice versa § High proportion of aging in Appalachia § Farming, mining, textiles, service industries, etc.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Overview Continued § High poverty and unemployment rates § Originally most educated group in America, now some of the least educated due to isolation § Area still lacks infrastructure

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Communications § § Carry over from Elizabethan English Spellin for spelling Warsh for wash Badder for bad

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Ethic of Neutrality § § § Avoid aggression and assertiveness Do not interfere with others’ lives Avoid dominance over others Avoid arguments and seek agreement Accept without judging—use few adjectives and adverbs, resulting in less precise description of emotions and thoughts

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Communications § Sensitive about direct questions and personal issues § Sensitive to hints of criticism. A suggestion may be seen as criticism. § Cordiality precedes information sharing so “sit a spell” and chat before doing business, which is necessary for developing trust

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Communication Continued § A few may avoid direct eye contact because it can be perceived as aggression, hostility, or impoliteness § More being than doing oriented, more relaxed culture and being in tune with body rhythms § Be formal with name format until told to do otherwise.

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Communication Continued § Healthcare provider must be flexible and adaptable § Come early or late for an appointment and still expect to be seen § Family lineage is important § Formality with respect—Miz Florence or Mr. John

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Family § Varied decision-making patterns but the more traditional Appalachian family is still primarily patriarchal § Women make decisions about health care and usually carry out the herbal treatments and folk remedies § Women marry at a young age and have larger families than the other white ethnic groups

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Family Continued § Children are accepted regardless of what they do § Hands-on physical punishment is common § Motherhood increases the status of the woman in the eyes of the community § Take great pride in being independent and doing things for oneself

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Family Continued § Family rather than the individual is the treatment unit § Having a job is more important than having a prestigious position § Consistent with the ethic of neutrality, alternative lifestyles are accepted, they are just not talked about § Extended family is the norm

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Biocultural Ecology § High incidence of respiratory conditions due to occupations § Increase of parasitic infections due to lack of modern utilities in some areas § High incidence of cancer, otitis media, anemia, obesity, cardiovascular disease, suicide, accidents, SIDS, and mental illness

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition High-Risk Behaviors § Tobacco is a main farming crop in some areas of Appalachia § Smoke at a young age § Alcohol use at a young age—binge drinking § Believe in the mind, body, spirit connection

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Ten Steps in Seeking Health Care § Use self-care practices learned from mother or grandmother § Call mother or grandmother if available § Then trusted female family member, neighbor, or a nurse § Then go to OTCs they saw on TV § Then use a neighbor’s prescription medicine

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Ten Steps in Seeking Health Care Continued § § § Pharmacist or nurse for advice Physician or Advanced Practice Nurse Then to a specialist Then to the closest tertiary medical center DO NOT BE JUDGMENTAL, if you want to keep them in the system

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Nutrition § Food may be synonymous with wealth § Wide variety of meats, do not trim the fat—low-fat wild game is also eaten § Organ meats are common § Bones and bone marrow used for making sauces § Preserve with salt

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Nutrition Continued § Lots of frying (using lard or bacon grease) and pickling § Anytime is the time to celebrate with food, especially in the rural areas § Many teens have particularly poor health § Status symbol to have instant coffee and snack foods for some

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Nutrition Continued § Early introduction of solid foods § May feed babies teaspoons of grease to make them healthy and strong § Diet is frequently deficient in Vitamin A, iron, and calcium

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Childbearing Family § Must eat well to have a healthy baby § Do not reach over your head when pregnant to prevent the cord from wrapping around the neck of the fetus § Being frightened by a snake or eating strawberries or citrus can cause the baby to be marked § Use bands around the belly and asafetida bags

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Death Rituals § Must stay with the dying person § Family should not be left alone § Funerals with personal objects at the viewing and buried in their best clothes § May take the deceased for viewing at home § After the funeral there is more food and singing and for some a “wake” to celebrate life

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Death Rituals Continued § Flowers are more important than donations to charity § Particularly good at working through the grieving process § Funeral directors are commonly used for bereavement § Cremation is acceptable and ashes may be saved or dispersed on the “land”

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Spirituality § Baptist, Pentecostal, Episcopalian, Jehovah’s Witness, Methodist, Presbyterian § Each church adapts to the community § Most are highly religious even though they do not attend church § Common to attend Sunday and other days § Preacher has a calling to “preach” § Ministers are trained

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Spirituality Continued § Meaning in life comes from the family and “living right with God, ” which varies by the specific religious sect § Nature is in control—fatalism § Religion and faith is important in a hostile environment § I will be there if the “creek does not rise” or if “God is willing”—fatalism

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Healthcare Practices § § Good health is due to God’s Will Self-reliance fosters self-care practices Family important for health care May be very ill before a decision is made to see a professional resulting in a more compromised health condition § Direct approaches are frowned upon

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Healthcare Practices Continued § Herbal medicines, poultices, and teas are common § See Table 8– 1 in the textbook; these practices are still alive and well § Folk medicines used in conjunction with biomedical treatments

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Barriers § § § § Fatalism Self-reliance Lack of infrastructure Health profession shortages Culture of “being” Poverty and unemployment Care not acceptable from outsiders

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Responses to Health and Illness § Take care of our own and accept the person as whole individual § Not mentally ill, the person has “bad nerves” or are “odd turned” § Having a disability with aging is natural and inevitable—if you live long enough § Must establish rapport and trust

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Responses to Health and Illness Continued § Pain is something that is to be endured § Some may be stoical § Pain legitimizes not working or fulfilling one’s responsibilities § Withdraw into self when ill § Culture of being works against rehabilitation

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Healthcare Practitioners § Lay and trained nurses and midwives still provide much of the care in some parts of Appalachia § Breckenridge Frontier Nursing Service § Prefer people known to the family and community —the insider versus outsider concept

Transcultural Health Care: A Culturally Competent Approach, 4 th Edition Healthcare Practitioners Continued § Culture of “being” says the healthcare provider should not give the perception of being rushed § Physicians may not be trusted due to outsidedness, not to being foreign § Must ask the clients what they think is wrong