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Running Head: NO MORE STRANGERS

No More Strangers:
Definition and Exhibit of Cultural Diversity
Jack L. Kaczmarczyk
Baker College

Definition of Cultural Diversity


Roughly since Babel, divisions have existed between nations, peoples, and communities,
between languages, customs, and beliefs. Crossing a border can be like discovering another
planet. Neighbor does not talk, act, or think like neighbor. Cultural diversity, as a guiding
principle of medical practice, is not saying this pluralism of peoples is a bad thing. The world
would be impoverished beyond recognition if, like Americas melting pot taken literally, every
culture within were reduced to one bland whole. What cultural diversity means is that, despite
our differencesbecause of our differenceswe should respect one another equally.
This is no less true in a healthcare community. Good healthcare happens when everyone,
from the janitorial team to the board of directors, works together harmoniously toward a single
purpose: the betterment of the patient. Given the endless variety of patients coming through the
doors, the medical practice administered must transcend cultural distinctions. Care is directed
toward a person, after all, and not a demographic. Certainly the healthcare professional must

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consider the risks associated with certain subcultures (indeed, this will be one of the aims of the
proceeding exhibit) however, this is not discrimination. Discrimination, is defined broadly as an
individuals perception of being treated unfairly by other people due to some personal attribute,
like race, ethnicity, or gender (Ayalon & Gum, 2011). Bias can never be eradicated from the
bosom of man, since everyone is born with bias like a defect of the heart, yet it can be
definitively stated that prejudice can be allowed no place in healthcare.
Individualization of care necessarily takes into consideration patient needs. Patient needs
often stem from cultural values. Cultural values can define what health is, and how medicine can
get a patient there. For example, many people who have settled in western society do not want to
be treated with orthodox medical practices, as practised by doctors who have undergone
training in medical schools that are approved by medical associations, but instead prefer
alternative medicines like Chinese acupuncture, Indian ayurveda, Yorb medicine and the
healing aspects of Sufism, (Abmbl, 2007).
Nurses must provide culturally competent healthcare. To do so, a nurse cannot dismiss
diverse practices like alternative medicine, but must treat them as viable substitutes to western
practice. Dismissal can insult the patient and increase his or her dissatisfaction in the healthcare
received, to be sure, but more is at stake when nurses are non-adaptive to diverse practices.
Purnell (who wrote the book, literally) says that the effect of cultural incompetence is patient
and family care are compromised, resulting in not only poorer health outcomes, but also an
increase in cost, (2009, p. xiv). More specifically to the practice of the nurse, who serves as a
nexus between the patient and the healthcare team, the ability to effectively communicate with
culturally diverse peoples is pivotal. Nobody who is different wants to be treated like an artifact;
nor do they want to be set aside offhandedly. Culturally competent nurses, Purnell says, need to
know enough information about the cultures with which they will have meaningful interactions.

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Without specific knowledge of cultural groups for whom they provide care, practitioners will
not even know what questions to ask to provide culturally competent care, (2009, p. 2).
Following this advice, even a cursory investigation of a single subculture reveals a belief
system too rich to ever fully comprehend its depths. All anyone without a doctorate in sociology
can do (this includes the well-intentioned nurse) is to familiarize oneself as much as possible
with the subcultures most prevalent within ones local community. Low-familiarity with cultural
diversity can be daunting, no less especially for the author, but it presents a learning process that
will have a positive impact upon the nurses standard of care, and therefore the patients health.
Beginning with the subsequent exhibit, the author firmly resolves by the help of Gods
grace to have a respect for his patients that is continually informed by this cultural investigation.
Exhibit of Cultural Diversity
Now, therefore, you are no more strangers and foreigners: but you are fellow-citizens
with the saints, and the domestics of God. The spirit of St. Pauls words applied just as well to
Ephesus as they have applied to the cultural climate into which every American citizen has been
born or naturalized. We are a nation described as a melting pot because representatives from
nearly every conceivable background can find belonging here. Of the 316,577,969 residents of
the United States, only .08% comprise the people this essay discusses, but since this peoples
immigration in the 17th and 18th centuries, thanks to the freedoms offered by Americas
foundations, they have been able to make this land their home (U.S. Census Bureau, 2013).
Exclusively, tooit speaks well of our national hospitality that not a single Amish person lives
in their continent of origin, Europe. Estimates are not readily available as to how many Amish
crossed the Atlantic, back then, but their descendants now total just over 250,000 living in large
communities based mostly in Ohio, Indiana, and Pennsylvania (Caldwell, 2012).
The Amish are an insular farming community that interacts with the world outside it with
a marked caution. However, as anyone who shops at a supermarket in close proximity to an
Amish community knows, voluntary sequestration does not mean total isolation. Supplies are

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needed; they are bought. Medical attention is needed; it is sought. Within reason, the Amish will
certainly delay visiting the doctors office (Purnell, 2009, p. 42). Certain folk remedies are used
within their community, most extensively in midwifery. Here, as little modern medical
interference is allowed as possible, given this cultures value of traditional practices. Black
cohosh root, red raspberry leaves, and dong quai root are used to cure morning sickness, ease
labor pains, and calm the baby. Should natural remedies fail or become useless, as in the case of
a premature birth, the Amish will not hesitate to elicit the assistance of a medical professional.
They will also visit the hospital at the incidence of other catastrophes, like farming accidents, or
collisions involving horse-drawn carriages (Lemon, 2006, pp. 55-57).
Given the unique lifestyle the Amish enjoy, their health is both susceptible and resistant
to different disease processes in a way that is markedly different than the majority of the U.S.
population. Genetically, given the prevalence of consanguinity in their populations, they are at
risk for several recessive birth defects. These include dwarfism, Ellisvan Creveld syndrome,
cartilage hair hypoplasia, pyruvate-kinase anemia, hemophilia B, phenylketonuria (PKB),
polydactylism, and glutaric aciduria (Purnell, 2009, p. 41). Medical interventions, like
therapeutic abortion, are rejected by the Amish in these cases, who view all children as gifts
from God to be loved and accepted equally (Lemon, 2006, p. 56). The Amish have a 7% allergic
sensitization. In average Americans, allergic sensitization is at 53%. The low incidence of atopic
Amish individuals is attributed to their nearly lifelong exposure to barnyards and the fact that
they drink raw cows milk (H., 2012). They are also at a higher risk for cardiovascular disease
(CVD), hyperlipidemia, and obesity (Gillum, Staffileno, Schwartz, Coke, & Fogg, 2010).
It has been previously noted how detached the Amish community can be to the outside
world. However, a carpenter of Amish descent, self-employed in the business of mini-barn
manufacture, was readily found to conduct an interview. He was found to be more than willing to
describe Amish beliefs in relation to healthcare resources.

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We dont do healthcare as far as insurance. We pay our own hospital bills. We have our
own circles, our church districts. To pay for large bills, we join together, the different
communities we might belong to, and well do an auction. (Personal communication,
October 21, 2013)
He spoke of a project that he was involved with that was initiated by his community for
the benefit of a lady whose house exploded. She sustained major injuries in the blast. Medical
expenses totaled $1.2 million.
The community came together and rebuilt her home, which was four or five years old.
We put everything back as it was, plus better. We had a benefit auction where people
were coming from other states. We were able to pay her doctor bill, rebuild the home, and
had money left over, which we donated to a similar cause elsewhere. (Personal
communication, October 21, 2013).
It is remarkable that, just as their ancestors banded together to flee the religious
persecution they experienced in Europe from their progenitors, the Mennonites, modern Amish
can respond so charitably in a prescribed, ritualistic response to human tragedy, with an
immediate response of both emotional and financial support from their community, (Lemon,
2006, p. 55).
The man whom the author interviewed showed great reticence to advise a healthcare
professional how best to maintain cultural competence when caring for the Amish. We dont
have any cultural differences to be treated differently, he ventured (personal communication,
October 21, 2013). Since the Amish have a humble, modest affect, let us assume he was being
reserved. The literature entertained in this essay suggests several ways for nurses to give
culturally competent care to the Amish.
First, inquiries need to be made as to what herbal supplements the Amish patient might be
taking. Granted, for some of the more obscure folk remedies, little is known about the effects of
them in the body or its interaction with other prescription or alternative medications, but other

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herbs are taken that might have drug interactions (Gillum, Staffileno, Schwartz, Coke, & Fogg,
2010). Second, to promote wellness, the nurse can make the Amish more aware of child
endangerment around the farm as related to accidents. The nurse can suggest the inclusion of
more nutritionally-dense foods in their diets to reduce CVD, hyperlipidemia, and obesity. Third,
to improve patient satisfaction, successful plans of care must involve the Amish patients support
system, with both elders and family leaders, with careful attention to identified community,
family, and individual priorities voiced by these decision-makers, (Armer & Radina, 2006).
This last competence is the most applicable to other cultural groups. For whatever other
subcultures the nurse will encounter in practice, no matter how different their beliefs, no matter
what risk factors they present, interpersonal relationships are universally important. Nobody is an
island. The more that the nursing process involves family, friends, and community, the more
successful will that patients outcomes be, because their support system will help them get there.

References
Abmbl, K. (2007). Medicine and culture: transcultural needs in modern Western societies.
Clinical Risk, 13(3), 112-117.
Ayalon, L., & Gum, A. M. (2011). The relationships between major lifetime discrimination,
everyday discrimination, and mental health in three racial and ethnic groups of older
adults. Aging & Mental Health, 15(5), 587-594. doi:10.1080/13607863.2010.543664
Armer, J., & Radina, M. (2006). Definition of health and health promotion behaviors among
midwestern Old Order Amish families. Journal Of Multicultural Nursing & Health
(JMCNH), 12(3), 44-53.

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Caldwell, E. (2012). Estimate: A New Amish Community is Founded Every 3 1/2 Weeks in U.S.
Research and Innovation Communications. The Ohio State University. Retrieved from
http://researchnews.osu.edu/archive/amishpop.htm
Gillum, D. R., Staffileno, B. A., Schwartz, K. S., Coke, L., & Fogg, L. (2010). 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 & Health Care, 10(2), 2837.
H., T. T. (2012). The Amish and Allergies. School Health Alert, 28(1), 8.
Lemon, B. (2006). Amish health care beliefs and practices in an obstetrical setting. Journal Of
Multicultural Nursing & Health (JMCNH), 12(3), 54-59.
Purnell, L. D. (2009). Guide to Culturally Competent Health Care. Philadelphia: F.A. Davis Co.
U.S. Census Bureau. (2013). Monthly Population Estimates for the United States: April 1, 2010
to September 1, 2013. Retrieved from
http://www.census.gov/popest/data/national/totals/2012/index.html