Culturalizing health care for a culturally diverse population: the Amish

Advanced practice nurses (APNs) are often the major source of primary care for culturally diverse groups. Working with patients who have values that differ from the mainstream culture can make delivery of health care complex and challenging. The purpose of this qualitative study was to use grounded theory methods to explore the process by which APNs develop and maintain therapeutic relationships with a culturally unique group, the Amish. Nine APNs who practiced primarily with Amish patients were interviewed about their strategies to promote therapeutic relationships. The process of culturalizing health care emerged as the strategy used by the APNs. Specific themes were learning the culture, developing a relationship, individualizing care, being comfortable with abilities, and working two systems. Rather than expecting patients to conform to the mainstream cultural beliefs and practices, APN informants used a variety of methods that allowed Amish patients to blend self-care practices with conventional (i.e., English care).