Question

1. Give an overview of the African American and the Amish culture and mention any difference. 2. What are the healthcare culture beliefs of the African American and the Amish cultures and mention if there is any similarity in their beliefs. 3. How these two cultures healthcare beliefs affect the delivery of evidence based nursing care. Please give an example.

Answer 1

1. Overview of the African American and Amish culture:

African-American culture refers to the cultural contributions of African Americans to the culture of the United States, either as part of or distinct from mainstream American culture. The distinct identity of African-American culture is rooted in the historical experience of the African-American people. The culture is both distinct and enormously influential on American culture as a whole.

African-American culture is primarily rooted in West and Central Africa. Although slavery greatly restricted the ability of African-Americans to practice their original cultural traditions, many practices, values and beliefs survived, and over time have modified and/or blended with European cultures and other cultures such as that of Native Americans. African-American identity was established during the slavery period, producing a dynamic culture that has had and continues to have a profound impact on American culture as a whole, as well as that of the broader world.

In the beginning of the eighteenth century, Christianity began to spread across North Africa; this shift in religion began displacing traditional African spiritual practices. The enslaved Africans brought this complex religious dynamic within their culture to America. This fusion of traditional African beliefs with Christianity provided a common place for those practicing religion in Africa and America . For many years African-American culture developed separately from European-American culture, both because of slavery and the persistence of racial discrimination in America, as well as African-American slave descendants' desire to create and maintain their own traditions. Today, African-American culture has become a significant part of American culture and yet, at the same time, remains a distinct cultural body.

The Amish are a group of traditionalist Christian church fellowships with Swiss Anabaptist origins. The Amish are known for simple living, plain dress, and reluctance to adopt many conveniences of modern technology. The history of the Amish church began with a schism in Switzerland within a group of Swiss and Alsatian Anabaptists in 1693 led by Jakob Ammann. Those who followed Ammann became known as Amish.

In the early 18th century, many Amish and Mennonites immigrated to Pennsylvania for a variety of reasons. Today, the Old Order Amish, but also the New Order Amish and the Old Beachy Amish continue to speak Pennsylvania German, also known as "Pennsylvania Dutch". Amish church membership begins with baptism, usually between the ages of 16 and 25. The rules of the church, the Ordnung, must be observed by every member and cover most aspects of day-to-day living, including prohibitions or limitations on the use of power-line electricity, telephones, and automobiles, as well as regulations on clothing. Most Amish do not buy commercial insurance or participate in Social Security. As present-day Anabaptists, Amish church members practice nonresistance and will not perform any type of military service. The Amish value rural life, manual labor and humility, all under the auspices of living what they interpret to be God's word.

2. Healthcare beliefs:

African American culture

Some African Americans equate good health with luck or success. An illness or disease, viewed as undesirable, may be equated with bad luck, chance, fate, poverty, domestic turmoil, or unemployment, and in such case, African Americans will consult a physician only after attempts with home remedies have failed.A natural illness is considered as a result of a physical cause, such as infection, disease, weather, and other environmental factors. Treatments of natural illnesses emphasize the uses of herbs, barks, teas, and similar natural substances. An occult illness is a result of supernatural forces, such as evil spirits, and their agents, such as conjurers. Finally, spiritual illness is a result of a willful violation of sacred beliefs or of sin, such as adultery, theft or murder. Like the occult, spiritual forces can affect all aspects of life, ranging from the physical to the spiritual characteristics of the person. In many small societies, conjurers are believed to have the ability to summon a supernatural force, such as a devil or evil spirit, either to do harm, such as inducing an illness or to expel a disorder. By the use of spells, sacred names, incantations and other magical media, the conjurer is able to summon the expression of supernatural forces. Finally, it is the power of a god acting through a religious healer or medium that is required to diminish spiritual illness or induce a return to health in the character of a person believed to be suffering from spiritual illness.

Blood is a key concept in the African American traditional health belief system. Women eliminate the used blood in their bodies through menses men eliminate through sweat.  They also believe impurities in the blood are manifested cutaneously.  Skin lesions represent impurities that are trying to come out.Preventative health practices also combine practical, magical and religious roots such as: keeping the body clean, well fed and warm. These are believed to keep away certain illnesses. Customs such as wearing a string with nine knots around the appropriate part of the body, reciting a certain psalm, carrying a High John the Conqueror root in the pocket or burning a certain type candle were traditional ways to maintain health.

Amish culture

• The Amish believe in folk medicine: faith healing, pow-wows, and herbal treatments. They believe that a higher level of medical science is simply not necessary. However, they also believe that good health (mental and physical) is a gift from God, and needs to be taken care of. They believe that medicine helps, but God heals.
• The Amish are very careful medical consumers. If an Amish person is seeking medical treatment, it indicates that it is an emergency or a very important concern.
• The Amish religion does not forbid its people to seek modern medical care. When necessary, the Amish can have surgical procedures, dental work, anesthesia, or blood transfusions. Organ transplants are permitted, except for the heart. The Amish believe the heart is the soul of the body. (Exception: Pediatric patients who have not been baptized can receive a heart transplant.)
• In some Amish districts, all forms of insurance are discouraged, including medical insurance. The Amish believe insurance is a "worldly product," and purchasing it shows a lack of faith in God.
• The Amish pay little attention to preventative care. It is hard to impress upon them the importance of immunizations, cancer screenings, PAP smears, and mammograms. This is largely because they believe that God heals them, but also because they might not be able to afford preventative care.
• Many Amish will refuse an autopsy.
• The Amish do not believe in birth control.
• Most Amish need to have church permission to go to a hospital because the church pays for such care.

Similarities between African American and Amish healthcare beliefs:

a. Both the cultures believe in folk medicine and use modern healthcare services only if traditional methods have failed.

b. Both the cultures believe in a spiritual force and that good health is a gift from God, and that God can heal the diseases.

3. Effects of the healthcare beliefs on evidence based nursing care:

In Amish culture birth control and abortion are forbidden by religious doctrine, even when pregnancy is life threatening. The Amish church has no rule against immunization, but only 16-26% of Amish children have received immunizations against the common childhood diseases. Reinforcing the rejection of preventive medicine is the low educational status of the Amish people; higher education is prohibited. This further implies that health instructions must be given in simple, clear language. Nurse practitioners must accept the fact that no amount of education will persuade Amish women to practice contraception. To continue to advocate family planning in the Amish community is to risk alienating couples from the health care system.​

To quote an example, a study was conducted on the influence of culture and discrimination on care-seeking behavior of elderly African Americans. This was a qualitative phenomenological study that involved in-depth interviews with15 African American men and women aged 60 and older in Alabama. The following themes emerged from the analysis of the data:

1)perception of health as ability to be active

2) reluctance toward prescription medicines use

3) lack of trust in doctors

4) avoidance of bad news

5) race of doctors

6)use of home remedies

7) importance of God and spirituality on health, illness and healing.