This document provides an overview of Appalachian cultural characteristics and considerations for nursing care. It describes key aspects of Appalachian culture including independence, an ethic of neutrality, familism, and personalism. It also outlines common health issues, beliefs, and barriers to care for this population. The document emphasizes the importance for nurses to establish trust, incorporate family input, and provide culturally competent care that respects Appalachian values when caring for patients from this ethnic group.

1. CULTURAL/SPIRITUALCULTURAL/SPIRITUAL
PRESENTATIONPRESENTATION
Sheryl Super RNSheryl Super RN
Metropolitan State University of DenverMetropolitan State University of Denver
RN to BSN Role Transition, Nursing 3800RN to BSN Role Transition, Nursing 3800
Fall 2012Fall 2012

2. INTRODUCTIONINTRODUCTION
• Appalachians
• 27 million people
• Overlooked as an American ethnic minority
• Not awarded the status of a federally defined
ethnic/minority group
• Poverty rate is 15.3%

3. CULTURAL CHARACTORISTICSCULTURAL CHARACTORISTICS
• Independence
• Ethic of Neutrality
• Familism
• Personalism

4. INDEPENDENCEINDEPENDENCE
• Personal space
• Solitude
• Live in the moment, are not concerned
with exact times
• Unhurried adaptive patterns
• Focus on being, rather than doing

5. ETHIC OF NEUTRALITYETHIC OF NEUTRALITY
• Avoid assertiveness and aggression
• Mind their own business
• Avoid domineering behavior
• Seek agreement and avoid arguments

6. FAMILISMFAMILISM
• A sense of family, nuclear and extended
• A love of the land
• Rarely move more than 30 miles from family
• Patriarchal, but mothers and grandmothers
make health care decisions
• Children have a sense of belonging
• Elders are respected and pass on cultural values

7. PERSONALISMPERSONALISM
• Person focused
• Trust with outsiders must be established
• Interpersonal relationships are more
important than individual accomplishments

8. ETHNIC BACKGROUNDETHNIC BACKGROUND
• Settlers from northern Europe
• 1% Native American
• 8% African American
• Recent increase in African American and
Hispanic population

9. NURSING INTERVENTIONNURSING INTERVENTION
• Take time to “sit and talk a spell”, establish trust
• Direct eye contact is rude or aggressive
• Allow personal space
• Solicit advice from family members, and
incorporate into plan of care
• Use a direct approach, offering the facts

10. NURSING INTERVENTIONNURSING INTERVENTION
• Family education
• Promote collaboration
• Avoid confrontation
• Make use of healthcare and church
partnerships

11. BARRIERS TO CAREBARRIERS TO CARE
• Lack of heath care resources
• Lack of education
• Lack of telephones/reception
• Lack of transportation

12. HIGH RISK BEHAVIORSHIGH RISK BEHAVIORS
• High fat, high carbohydrate diets
• High rate of tobacco use
• Lack of regular exercise
• Low rate of seat belt use
• Poor oral health

13. COMMON HEALTH PROBLEMSCOMMON HEALTH PROBLEMS
• Black lung disease
• Brown lung disease
• Hearing loss
• Traumatic injuries
• Coronary artery disease
• Heart disease and
• Cancer
• High infant mortality rate

14. HEALTH BELIEFSHEALTH BELIEFS
• High Blood and Low Blood indicate blood
viscosity and blood volume
• Nerves indicate distress, anxiety, sleeping
disorders
• Running off indicates diarrhea
• Sweet Blood and Sugar Blood indicate diabetes

15. HEALTH PRACTICESHEALTH PRACTICES
• Folk healers and Granny healers
• Herbal medicine
• Personal responsibility for health (diabetes is
caused by eating sweets)
• Many do not believe in illness prevention
• Manage illness well, adaptive acceptance

16. NURSING INTERVENTIONNURSING INTERVENTION
• Encourage healing folk remedies
• Encourage taking personal responsibility
for health
• Educate illness prevention and offer health
screenings

17. NURSING INTERVENTIONNURSING INTERVENTION
• Patients become interdependent during
illness
• Family surrounds the patient and provides
care. Family stays in close proximity.
• Educate the family and enlist their help

18. SPIRITUALITYSPIRITUALITY
• Local nondenominational churches
• Believe in the authority of the Bible
• Prayer requests concerning health
• Anointing for health
• Church/healthcare partnerships

19. QUALITY AND SAFETYQUALITY AND SAFETY
EDUCATIONEDUCATION
• Establish trust with the patient and family
• Listen to the patient and family and
identify their concerns
• Educate the patient and family, speaking
in clear terms
• Encourage them to be part of the
healthcare team and ask for feedback

20. PROFESSIONAL VALUESPROFESSIONAL VALUES
• Be aware of my own personal values and
understand they are not better than
others, just my own
• Be considerate and respectful of values
that differ from my own
• Respect cultural values
• Respect societal values
• Practice culturally appropriate and
competent nursing care

21. REFERENCESREFERENCES
• Chitty, Kay Kittrell and Black, Beth Perry
(2011). Professional nursing Concepts &
challenges. Maryland Heights, Missouri:
Saunders Elsevier.
• http://www.ffne.org/file_library/Integratring
_QSEN_concepts_Sim_conf_HO.pdf