The religious and cultural beliefs of the Amish result in many health care beliefs and practices which are significantly different from the dominant American culture. For example, the Amish are excluded from social security and health insurance coverage; they have different perceptions of health and illness; they do not practice birth control; they often lack the preventive practices of immunizations and prenatal care; and they may use a variety of traditional and nontraditional health care providers. Only by understanding the religiocultural belief system of this minority religious sect can nurse practitioners effectively meet the health care needs of their Amish patients.
PIP: An understanding of the religiocultural belief system of the Amish religious sect is essential if nurse practitioners are to meet the health care needs of Amish patients. The Amish are exempted from social security and reject health insurance coverage, do not practice birth control, and often veto preventive practices such as immunization and prenatal care. A nonjudgmental, open attitude is required on the part of health professionals to encourage Amish families to attend clinics where health monitoring can be maintained and health education provided. As a result of a view of illness that defines it in terms of a failure to function in the work role rather than as a set of symptoms, there is often a delay in seeking medical treatment. Amish men outlive Amish women, in part because of the high birth rate (average of 7 live births/woman). 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.