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Appalachian Americans

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by

Lindsay Holst

on 19 November 2013

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Transcript of Appalachian Americans

Appalachian Americans
Quiz time!!
Question #1
When first entering the room of a patient from the Appalachian culture, what kind of communication would you try to incorporate in order to gain the most information?
A: low-context communication
B: Direct communication
C: High-context communication
D: Direct eye contact with communication
Question #3
Which time orientation are most Appalachian Americans?
A: Past
B: Present
C: Future
D: Present and Future
Question #2
When having an encounter with an Appalachian American, it is important to remember all of the following except:
A: Personal space is important
B: They maintain personal distance when interacting
C: They take pride in their land and homestead
D: They maintain personal space with their family
Question #5
Risks for coronary artery disease include all of the following except:

A: Diet high in fat
B: Lack of exercise
C: Excessive smoking
D: Serum triglycerides level of 175
Question #6
A nurse is caring for a patient with very traditional Appalachian roots. When the patient was asked what herbal therapies she is currently using, the patient lists several. The nurse notes that:

A: The use of herbal therapy is culturally relevant and should be accepted with an open mind.
B: Herbals such as pokeweed and pine have been found to be harmful and should be avoided.
C: The use of herbal originated from the regions lack of finances and regional isolation.
D: A correlation between a high number of herbals used and premature death has been found to be a concern.
Question #4
The typical Appalachian family would be described as: (Select all that apply)

A: Both immediate and extended families are important
B: Children are considered insignificant
C: Mothers are the main decision makers for family health
D: Families like to live in close proximity to one another
Introduction
Approximately 27 million people live in federally defined
Appalachian
region
200,000 square miles: 410 counties in 13 different states
For the most part, Appalachian region is classified as
rural
, non-farming area
Some larger cities are encompassed in the area
Common Stereotypes
“Hillbilly”
“Redneck”
“Mountain men”
One leg shorter than the other
Love beer
Uneducated
Poor
"The Redneck Song"
Communication
English-speaking people
; however, they have several idiomatic differences in meanings of specific words
Various dialects with high concentration of words of Scottish and Elizabethan English heritage
Ex: “running off to many" could be running away or leaving home, but may actually mean “diarrhea”
This example is a rare opportunity where miscommunication may occur
Nonverbal communication patterns may also vary
Direct eye-contact
is often viewed as impolite or lacking good manners, or even aggressive or hostile

Communication Implications
Use a direct approach; do not “sugar coat it” or “get preachy”
Trusting relationships must first be established
Strategies include making the time to listen and talk about matters that are important to the individual and family
Take special care to understand what clients truly mean in their use of illness categories
Space
Very important and always maintain a personal distance when interacting
Familism and the sense of self are intimately linked to the land and homestead
Love the land; many prefer to live apart from the rest of society in the privacy of the
hills
Present oriented
Focus on “being” rather than “doing”
Motto: Tomorrow is not promised, therefore, they must live for today

Space Implications
When ill, their personal space collapses inwardly
Expect to be cared for and waited on by others
The focus of the nurse and family is on the ill person; not unusual for several family members
#1 Answer
B: Direct communication
#2 Answer
D: They maintain personal space with their family
#3 Answer
B: Present
#4 Answer
A: Both immediate and extended families are important
C: Mothers are the main decision makers for family health
D: Families like to live in close proximity to one another
#5 Answer
D: Serum triglycerides level of 175
#6 Answer
A: The use of herbal therapy is culturally relevant and should be accepted with an open mind.
Social Organization - Family
Appalachians find their sense of community within their family
Both immediate and extended family are very important to them
Appalachians are typically closer to their
extended family
members than most middle-class Americans
Most Appalachian family units live within 30 miles of each other
"Mountain Talk"
Social Organization - Family
Appalachian families are typically
patriarchal
, but mothers and grandmothers are sought for advice on most health decisions
Appalachian mothers are usually the health care educators and decision makers for family health
Children are viewed as security for the future
Elderly family members are usually respected and they live either with their children, or very close by
Appalachians show honor to elders living in their community
Rural Areas
Non-denominational
churches are prevalent
Teachings: centrality of grace, authority of the Bible, religious experience, a call to preach & local church governance
Social Organization - Religion
Social Organization - Religion
Urban Areas:
Southern Baptist and
United Methodist
are more prevalent
Generally, these churches are attended by those who are more economically well off
Social Organization Implications
Relatives are sought for advice, validation & support on health care
Mothers are the main decision makers for family health
In the hospital/clinic setting, there may be a large number of family members with the patient and they will expect to be close to the patient while they are in the hospital
It's important to involve family in care of the patient and
incorporate
their ideas and opinions into the plan of care
Nurses must recognize that the changes the patient is feeling affects the whole family unit. Therefore, it is important to include the family in health education
Social Organization Implications
Perform a spiritual assessment on admission and make sure to include health beliefs, practices and religion in their plan of care
Church-related partnerships may be useful in the delivery of health promotion information
These religious health
partnerships
may influence the health promotion effects greatly and be beneficial to those who are economically depressed/residing in rural locations
Time
Present-time oriented
Appalachians focus on the present to meet needs and uncertainty of what tomorrow will bring
View modern man as having lost the technique of enjoying time for oneself, visiting with each other or cherishing a moment of peace
Live at a pace that facilitates an awareness of body rhythms as opposed to clock time
Many Appalachians establish their own
individualized
patterns of work, leisure, self-care and rest
Nursing Implications - Time
Nurses should gently assess personal & emotional space by visiting with the patient before examining/treating them
It is common for Appalachians to arrive at a time different from the time their appointment was scheduled
Nurses can implement different alternate ways to facilitate client access to health care
Family involvement in care
teleconferencing/telehealth
assisting with transportation
flexible
scheduling/clinic hours
open home visits/parish nursing
Environmental Control
Barriers and Threats:
Poor working conditions with jobs available
Textile mills (cotton, hemp dust) leading to “Brown lung disease”
Coal mining leading to
pneumoconiosis
or commonly called “Black lung disease” and hearing problems
Low income families and lack of health insurance
Geographic isolation

Health Practices & Death/Dying
Death ritual of a vigil or a “death watch” is held where loved ones will gather around the dying person
Look for visions, premonitions, and the death rattle
With terminal illness and death, a lot of times a will be called.
The day before the funeral, there is a visitation time located at church or at the home used to pay respects
Funeral services are generally held in funeral homes or churches. They generally include prayer, music, scripture reading, sermons or eulogy
Locus of Control
• Fatalistic view with a strong connection to their religion.
-Example: “God is in Control, it was the
Lord’s will

Resilience and strength
Explanation not found through science
• God is to be praised for health; however, it is not my responsibly to stay healthy
• If nothing can be done about it, patients prefer not to be diagnosed
• When hospitalized, patients may want to avoid making decisions
• Cope through supporting and optimism; confrontation, self-reliant, fatalistic
Folk Health System
• Believe that lack of self care and contact with the cold can cause illness
• View drinking fluids, keeping strong, and eating right as key to staying healthy
• Tradition of folk healers commonly referred to as “
herb doctors
” or “granny women”
• They are very concerned with the characteristics of
blood
Health
Blood:
Thickness, high blood, low blood, bad or good
High blood: caused by diet of fatty, salty foods and emotions
S/S dizziness, nervousness, red face, and nausea
Treat through staying calm
Not to be confused with hypertension
Nerves:
Stressful situations
S/S shortness of breath, anxiety attack
Sugar or sweet blood:
Accumulating sugar particles in the blood over the course of one’s life
S/S hazy vision, dizziness, and aching feet
Long term- sugar settle in the eyes
Diagnosis- contusions that do not heal and ants attracted to urine
Bitter herbs are used as a temporary treatment
Herbals
• Herbals have been used as a tradition stemming from 3 primary sources
Native Americans
Ancestral practices from Northern Europe
19th century medical practices
Common Examples:
• Pokeweed--- Rheumatism
• Pine --- Antiseptic
• Windroot--- Pleurisy
• Boneset teas---- flu
Risk Factors
Tobacco is common
Made and used in house hold
Second hand smoke
Health screening is rare
Religious beliefs
Not a priority
Not educated about it enough to see its importance
Illness Behaviors
Family:
Aid and encouragement from family members
High incidents of complaints are due to doctors not formally recording histories
Patient:
Strong character and belief
Stoic and non assertive
Nursing Implications
Their health system is changing, yet there is a great need for additional health knowledge
Some folk therapies are beneficial and should be encouraged, while others are not
Nurses should refrain from having an condoning attitude
Biological Variables
One of the areas in the US with the high mortality, morbidity, and disability
Highest concentration of regional Social Security Administration Disability claims and Supplemental Security Income
Disability rate is high because of dangerous occupations and insufficient insurance
Traumatic Injuries
• Males across all age groups have a higher risk of death from traumatic injury
• Children under 1 have frequent cases of burns and child abuse
• The most frequent traumatic injury for children older than 1 is motor vehicle accidents
• This is due to delayed acute care and geographic isolation
Respiratory Tract Diseases
• Mortality from tuberculosis is 50% higher than the national average
• Occupations increase the number of respiratory tract disease, like mining, timber, and textiles
• These can lead to disease like Black Lung, which is incurable, progressive, and debilitating

Tobacco
is a local industry and widely used
Coronary Artery & Coronary Heart Disease
• The incidence for this and all that comes with it exceeds the national average
• The key risk factors that these people are linked to relating to heart disease are excessive smoking, lack of exercise, high-fat diet, and abnormal serum lipid levels
• Those were at higher risk when they were not taught about the risk factors and how to prevent it
Cancer
• Breast cancer is lower than national average, but cervical cancer is higher for all Appalachian women
• Cervical cancer incidence is twice the amount for white women, which is close to the percent of black women across the nation
• A major issue is that insurance will not often pay for the cost of health screening, but the women will participated if it is required to requested
Infant Mortality
• The rate is a high 9.3%
• The deaths relate to sudden infant death syndrome, congenital malformations, and infections
• This is due to the poverty level and lack of maternal education
Nutrition
• High in fat, carbs, and salt
• Staple is cornbread, biscuits and gravy, fried potatoes, and beans
• Obesity is an issue for all ages
Nursing Implications
Be sure to go over the common medical issues with the patient – risk factors and how to prevent and treat
• Encourage the patient to come in for preventive check-ups and
health screenings
• Stress the importance of maternal knowledge and infant care
• Discuss a healthy and well balanced diet
Thank you!! :)
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