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Transcultural Health Care

Transcultural Health Care

Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Copyright © 2013 F.A. Davis Company

Appalachians
Larry Purnell, PhD, RN, FAAN

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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.

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Communications

  • Carry over from Elizabethan English
  • Spellin for spelling
  • Warsh for wash
  • Badder for bad

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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.

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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”

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th Edition

Barriers

  • Fatalism
  • Self-reliance
  • Lack of infrastructure
  • Health profession shortages
  • Culture of “being”
  • Poverty and unemployment
  • Care not acceptable from outsiders

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

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Transcultural Health Care: A Culturally Competent Approach, 4th 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

 

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Transcultural Health Care: A Culturally Competent Approach, 4th 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 outsided-ness, not to being foreign
  • Must ask the clients what they think is wrong

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