Cultural Sensitivity in Professional Communication With the Amish It is a well-known fact that disparities in healthcare exist among minority groups. The nursing profession, in an effort to deliver more appropriate and individualized patient care, is continually gathering data that can influence the patient’s experience. One very important arena is that of culture. Culture can be a determining factor in the care delivered, and therefore should be included in the approach to maintaining and restoring health (Barker, 2009).
One such minority culture is that of the Amish. In the article, “The Prevalence of Cardiovascular Disease and Associated Risk Factors in the old Order Amish in Northern Indiana: A Preliminary Study (Gilllum, Staffileno, Schwartz, Coke & Fogg, 2010), a study of Northern Indiana Amish risks factors and prevalence rates of cardiovascular disease is undertaken. A better understanding of this data coupled with the traditional values and beliefs held by the Amish can make care planning individualized and lead to improved patient outcomes. The purpose of this paper is to explain how care and outcomes can be affected by the appropriate use of professional communication in those groups with different cultures, in particular the Amish of Northern Indiana. Cultural competence among nurses helps them gather useful information regarding customs and traditions of cultural groups (where safe practice and effective approaches are expected outcomes), and adds to the art of nursing (Barker, 2009).
The Amish are a quickly growing rural group in America. They are best known for their religious sect, but not much is known about the prevalence and risk factors of cardiovascular disease (CVD) (Gillum et al, 2011). A lot can be learned with a better understanding of their traditions and values,
especially when it relates to health care. This culturally distinct group was chosen for this paper because of their differing views of health care and illness from that of societal norms and how clinicians who are culturally competent can use this information to provide appropriate and mutually congruent care. Summary of Article
In the article, “The Prevalence of Cardiovascular Disease and Associated Risk Factors in the old Order Amish in Northern Indiana: A Preliminary Study” by Gillum et al, (2011), a retrospective patient chart review looked at two hundred randomly selected Amish from a primary health care center in a large Amish settlement from Northern Indiana. Demographic information as well as patient and family histories were obtained to gather data. The outcomes of this study prove that cardiovascular disease and risk factors are concerning for the Amish. Comparisons of these results to that of the national average of whites greater than 20 years, show a higher prevalence of the risk factors; hypothyroidism, hyperlipidemia, depression, and anxiety in both male and female Amish. Hypertension and congested heart failure was greater in the female Amish than that of males, while cardiovascular disease, and cerebrovascular accidents were more prevalent compared to the national average. It is important to understand the culture of the Amish if one were to explain some of the differences found in this study.
This private group lives amongst themselves outside societal norms. Some cultural differences include the overall lack of insurance among this group. The Amish most often pay out of pocket or receive money from the church to pay for healthcare expenses, which can be expensive. In addition, Amish cultures rely heavily on alternative treatments for their health care. First choices for healing are natural remedies over man-made and they often self-prescribe. The typical Amish will only have an eighth grade education and they have rules against the use of technology and electricity (Gillum et al, 2011). Phone calls are most often made from a central location at a phone booth. Their primary mode of transportation include the horse and buggy, and the bicycle. Application to Practice
The nursing profession, in its journey to professionalism, is finding new ways to provide excellence in patient care. The influence and significance of culture intertwined in a plan of care will be an intervention for improved health (Barker, 2009). The advanced practice nurse must use professional communication skills to convey cultural sensitivity for a therapeutic and trusting relationship to occur. One way to carry this out is by using an education appropriate, culturally based assessment tool that will capture relevant data regarding one’s cultural preferences. This will contribute in an individualized care plan. Other pertinent data needed by the clinician will be regarding the known prevalence and/or risk factors among the Amish people and what strongly held belief and values they hold.
The assessment and treatment options should be guided by this information. Understanding that the Amish usually do not have health insurance, the clinician can offer information regarding needed treatment versus routine testing. Asking questions to obtain data about any alternative treatments and/or self-prescribed medication is demonstrating cultural competence. It is possible for culture and biomedicine to co-exist and the plan of care starts with communication from both parties. With a deeper understanding of one’s beliefs and values the plan of care can be negotiated. The advanced practice nurse who is culturally competent will strive for a goal to maximize prevention strategies that will improve health and prevent further complications among the Amish. Conclusion
In order for nursing to move forward in an ever-changing society, it will be essential to have some knowledge about the clients they serve. Cultural competence is demonstrated by the use of professional communication skills and professional behaviors that aid in the preservation of one’s values and beliefs (Barker, 2009). It can serve a huge purpose in the nursing profession as it allows for a trusting, therapeutic relationship between clinician and patient. In this way it provides for a holistic approach to care. This article demonstrates that the prevalence and risk factors for cardiovascular disease are present among the Amish of Northern Indiana. The nurse who cares for this group of people would benefit from a cultural assessment of their values, beliefs and way of life. Cultural competence can be conveyed through the understanding of the Amish way of life; with care being provided that is as individualized as the patient himself. Being sensitive to one’s culture and incorporating this in their care can lead to better compliance, improve health and increase the use of health care services.
References
Barker, A.M. (2009). Advanced practice nursing: Essential knowledge for the profession. Sudbury, MA: Bartlett and Jones
Gillum, D.R., Staffileno, B.A., Schwartz, K.S., Coke, L. & Fogg, L. (2011) The prevalence of
cardiovascular disease and associated risk factors in the old order Amish in northern
Indiana: A preliminary study. Online Journal of Rural Nursing and Health. Volume 10:
(2). Retrieved on May 5, 2012 from
http://rnojournal.binghamton.edu/index.php/RNO/article/view/44
