Amish Healthcare in the 21st Century

Amish Healthcare in the 21st Century

 Amish culture is very intriguing in the way that they shy away from modern society.  They believe that God will hold interest in their lives, families, and communities that will keep them together in spite of the pressures of today’s civilization.  When caring for the Amish in a healthcare setting, the nurse must provide competent nursing care and be able to present knowledge and skills adapting to patients of varied cultures.  Nurses need to offer care that is planned and implemented in a way that is sensitive to the needs of the individual, family, or group of a diverse population.  “Cultural diversity can be defined as the coexistence of different ethnic, biological sex, racial, and socioeconomic groups within one social unit” (Taylor, Lynn, & Bartlett, 2019, p. 81).  Amish differ in many ways from other cultures given their statistics, nutrition, healthcare resources, death, and family structure. 

Statistics

 “The Amish first made their way to the United States during the 18th century when faced with religious persecution in Europe.  However, this religious group was first established in the 17th century based on the teaching of Jakob Amman, for whom the Amish is named” (World Population Review, 2019, Amish population 2019, para 2).  As of 2018 there were nearly 325,000 Amish people living in 31 states throughout the U.S.  Pennsylvania is called home to the largest population, estimating over 76,000 Amish.  Running right behind Pennsylvania is Ohio calling home to over 75,000 people and coming in third is Indiana with nearly 55,000 living within its boundaries (World Population Review, 2019).  Approximately 63% of all Amish live in one of these three states (From Idaho to Argentina, 2019). 

The Amish culture doesn’t have a specific age range.  If you are born into the Amish community and join the church and follow the Amish lifestyle, you are then considered Amish.  People who choose not to join the church or follow the lifestyle are no longer Amish (Amish, 2019).  As a child you are expected to follow in your parents’ footsteps in all issues, but when they are old enough, they must make the choice of whether or not they want to commit to the church (Amish, 2019).

Nutrition

Most Amish families are able to have home grown gardens that provide their own produce.  Fresh fruits and vegetables are used for canning, pickling, and storage for use during the winter months.  Almost all of the Amish cuisine is homemade.  Food preparation not only includes canning and pickling, but also consuming meats from their own farm.  A high percentage of the meat is then smoked or cured for storage or made into sausages (Cuyun Carter et al., 2011).  Family meals are high in carbohydrates, including meat, potatoes or noodles or both, a cooked vegetable, bread, usually something pickled, dessert, and coffee (Purnell, 2014).  Amish do not have any certain restrictions on food, but alcohol consumption is highly discouraged. 

 Amish tend to have large family dinners with one another.  During mealtimes, all family members are expected to be present unless they are working away from home (Purnell, 2014).  Just like a lot of other cultures, the Amish enjoy special meals during the holidays and special occasions, such as Thanksgiving, Christmas, Easter, and birthdays (Scottsdale, 2017). 

 When it comes to the nursing aspect of nutrition in Amish, nurses must provide competent care when doing any type of assessment.  Since Amish cuisine is high in carbohydrates and sugars, the nurse should, “suggest reducing portion size, decreasing the amount of sugar used in baking, limiting fatty meats, and altering food preparation practices” (Purnell, 2014, p. 82). 

Death

 Every culture has the hardship of experiencing death.  When it comes to taking care of the aging and the ill, Amish families are expected to care for them.  If hospitalization is required, “a wake-like “sitting up” through the night is expected for the seriously ill and dying” (Purnell, 2014, p.83).  During hospitalization, the nurse should, “make private arrangements for family members to stay overnight in the hospital” (Purnell, 2014, p.83). 

 When preparing for funeral arrangements, the Amish community is very helpful in alleviating the immediate family of farm, business, and household chores.  Arrangements include food preparation, seating arrangements, and accommodating a large number of horses and carriages (Funerals, 2019).  The body is then taken to funeral services to be embalmed without cosmetic improvements, and returned home in a simple, hardwood coffin.  Family members of the same sex dress the body in white.  Deceased women are able to wear their white cap and apron worn from their wedding (Funerals, 2019).  

 Two days before the funeral, friends and family are able to visit and view the body in a room on the first floor of the home.  When the funeral ceremony is taking place, hundreds of guests attend the service while ministers read hymns and scriptures, offer prayers, and preach a sermon (Funerals, 2019).  After the burial takes place close friends and family are then invited to return to the home for a meal (Funerals, 2019).   

Family Structure

Many Amish families are big in size averaging about seven births per family (Purnell, 2014).  Since Amish families are so big there is a role for almost everyone to take part in. 

Usually the mother does all of the housekeeping and motherhood, and the father takes care of the family’s financial well-being.  As like many family’s roles can change depending on personality.  The mother of the household is able to help in decision-making, child discipline, and are very nurturing in the spiritual life of their children.  The father of the family serves as the spiritual head of the home and is responsible for religious matters related to the church and the outside world (Family, 2019).  When it comes to health care situations, “the health-care provider should not assume that the spokesperson for the family is the primary decision maker” (Purnell, 2014, p. 78).  

Children also have chores of their own around the house and must obey both mother and father.  Children begin having responsibilities at a very young age especially if they live on a farm.  Farm animals and caring for their pets are included in their daily chores.  Even Amish children that do not live on a farm have the responsibility of taking care of a driving horse which they have to feed and water.  Once Amish children have completed eighth grade, gender roles become more prominent that point towards adulthood.  Teenage boys will begin working full time in a woodworking shop or apprenticing as a welder.  Teenage girls will start spending time canning food, sewing, or working in an aunt’s quilt shop (Cates, 2014). 

 The elderly Amish provide for the family household as well in helping with odd jobs around the farm or family business, provide valuable advice, material support, and assist with childcare.  Most elders will move in to a Dawdyhaus next to their children and grandchildren.  It is very rare that an elder will be placed in a nursing home.  It only occurs if medical care becomes technical that they would have to move into a professional care setting (Cates, 2014).  It is important to, “include the extended nuclear family in health educational activities” (Purnell, 2014, p.79) 

Since Amish women average about seven births per family, they practice giving birth fairly different than today’s society.  Birth control is something that should be avoided because it is viewed as interfering with God’s will (Purnell, 2014).  Talking about birth control may not be an easy subject for the health-care provider.  A way to show respect for Amish values when it comes to discussing birth control may be, “when you want to learn more about birth control, I would be glad to talk to you” (Purnell, 2014, p. 82). 

Most Amish women like to give birth in the comfort of their own homes with either an Amish or non-Amish midwife.  There are no major birthing requirements, which allows the midwife to promote natural childbirth.  Most husbands choose to be involved in the labor of their child but may not show much affection verbally or physically during the procedure.  The midwife or healthcare provider (if hospitalized) will want to ask the father how involved he would like to be during labor and delivery (Purnell, 2014). 

After the mother has returned home with her child, she resumes everyday life continuing household chores, cooking, and caring for her children.  Extended family such as Grandmothers or female relatives may offer to stay with the family for a few days to help with support of the new mother and caring for the infant (Purnell, 2014).

Healthcare Practices

Amish healthcare and medicine practices are very different compared to the outside world.  Many Amish use Western or allopathic medicine, and even though their way of life and belief systems are supported, they are hesitant in disclosing information to outsiders.  Amish see healthy people as someone with a good appetite, look like they are physically well, and find satisfaction in a hard day’s work (Spiritual and alternative healthcare practices of the Amish, 2010).  When someone is ill the patient’s family may seek prayers from the bishop, deacon, extended family, and friends (Purnell, 2014).  As Amish continue to practice folk medicine, they also might include a form of faith healing called brauche.  Since the Amish culture is very limited in their beliefs, it makes it difficult to address alternative healthcare practices for this community (Spiritual and alternative healthcare practices of the Amish, 2010).   

There is nothing that forbids the Amish from using preventive or curative medical services.  Natural vitamins and food supplements are acceptable for Amish to take, but they are reluctant to prescription medications.  The father of the household is involved in major healthcare decisions and are willing to take the family to the chiropractor, physician, or hospital (Purnell, 2014).  When healthcare providers are working with the Amish culture, it might be helpful that, “nurse practitioner programs integrate concepts and information about spiritual beliefs and more adequately to treat the whole person and provide for culturally competent nursing care” (Spiritual and alternative healthcare practices of the Amish, 2010, p. 71).  It’s important to show respect for the Amish way of life, and to create a partnership between the patient and healthcare provider. 

Summary

In conclusion, the Amish choose to live a very simplistic lifestyle.  They show respect for not only their immediate family, but also their extended family.  Religion beliefs, work, and spirituality are a part of their everyday lives.  Being able to have the choice between spiritual or alternative healthcare choices promotes a positive well-being and quality of life.  It is important for the nursing care community to be respectful of the Amish culture, and acknowledge that their mind, body, and soul are intertwined.  Even though the Amish culture is supported and encouraged, they are very hesitant with sharing information to the outside world.  

References

• Amish. (2019, March 25). Retrieved from https://www.newworldencyclopedia.org/entry/Amish.
• Cates, J. A. (2014). Serving the Amish: A cultural guide for professionals. Baltimore: Johns Hopkins University Press. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=waukesha&db=e000xna&AN=778019&site=ehost-live&scope=site
• Cuyun Carter, G. B., Katz, M. L., Ferketich, A. K., Clinton, S. K., Grainger, E. M., Paskett, E. D., & Bloomfield, C. D. (2011, November). Dietary intake, food processing, and cooking methods among Amish and non-Amish adults living in Ohio Appalachia: relevance to nutritional risk factors for cancer. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800012/.
• Family. (2019, September 24). Retrieved from Amish studies website: https://groups.etown.edu/amishstudies/social-organization/family/.
• From Idaho to Argentina: The Amish population in 2019. (2019) Retrieved from http://amishamerica.com/amish-population-2019/.
• Funerals. (2019, September 24). Retrieved from Amish studies website: http://groups.etown.edu/amishstudies/religion/funerals/.
• Purnell, L.D. (2014). Guide to culturally competent health care. Philadelphia, PA: F. A. Davis Company
• Scottsdale, B. (2017, November 21). The Amish diet & beliefs on food. Retrieved from https://classroom.synonym.com/amish-diet-beliefs-food-5788.html.
• Spiritual and alternative healthcare practices of the Amish: Holistic nursing practice. (2010). Retrieved from https://journals.lww.com/hnpjournal/fulltext/2010/03000/Spiritual_and_Alternative_Healthcare_Practices_of.3.aspx?casa_token=K5NVXDqd4a4AAAAA:q93hD4wBnkxId44HFLXGIQ4o_YfFHsYsL4B3QJHTRLZHnen_qjYhaBv9XMFY6uqltQ8xu7L_TrrMlKEIJTe1qO121Q#pdf-link.
• Taylor, C., Lynn, P., & Bartlett, J.L. (2019). Fundamentals of nursing: The art and science of person-centered care. Philadelphia, PA: Wolters Kluwer.  
• World Population Review. (2019). Retrieved from http://worldpopulationreview.com/states/amish-population/