Providing Culturally Competent Care to Patients with Religious Sensitivity. APTA-CSM February 21-24, 2018 New Orleans, LA Session Objectives 1. Explain basic unique beliefs/practices of Judaism, Christianity & Islam. 2. Recognize differences in outlook on health, wellness, sickness, and death between each Abrahamic religion. 3. Analyze influence of religious beliefs and practices on health care decision-making for each monotheistic religion. 4. Create a religiously sensitive plan of care for patients of Jewish, Christian & Muslim heritage. Session Outline • Explore: – unique beliefs/practices of Judiasm, Chritainity, and Islam, – outlook on health, wellness, sickness, and death, – influences on health care decision-making; and • Create a religiously sensitive plan of care the patient with Jewish, Christian, & Islamic heritage 1 Cultural Considerations for People of Jewish Heritage Ronnie Leavitt Ph.D., MPH, PT Cultural Competence • Acknowledges and incorporates – at all levels - the importance of culture • Assesses cross-cultural relations • Vigilant towards the dynamics that result from cultural differences • Expands cultural knowledge • Adapts services to meet culturally unique needs. What does it mean to be Jewish? • Being Jewish can be a personal and/or group identity having to do with one’s religion, culture, ethnicity, or lifestyle • Huge INTRACULTURAL VARIATION with a wide variety of beliefs and practices within and across “streams” of Judaism • Orthodox, Conservative, Reform, secular 2 Jewish Sub-Cultures • Orthodox – (~10% in USA) – most traditional and serious with regard to practicing rules of observance and piety. – Ultra orthodox (Chasidic, Lubavich); modern orthodox • Conservative (~18%) – middle ground alternative • Reform – (~35%) – • Secular – (30%) -identify as Jews but do not practice organized religion. May be without a belief in God. Likely to be highly assimilated in mainstream society. 2013 Pew Research Center Survey of U.S. Jews. A “Minority” Group Within the USA • ~ 2% of population or ~6.6 million people – ~85% born in USA Greatest number of immigrants from Soviet Union, Israel • ~17 million Jews in the world, including ~6.6 million in Israel • Ashkenazi Jews (~82% of Jewish population worldwide and ~ 90+% in USA) • Sephardic Jews • Sensitive to anti-Semitism • Zionist movement – led to founding of Israel in 1948 The oldest monotheistic faith • Belief in one god who entered into a covenent with Abraham and his descendants • The heart of Judaism are the words “Hear O Israel, the Lord is our God, the Lord is One” • The Jewish conception of God is of a moral God who demands moral, ethical living and justice for all humankind • The writings of Judaism, or Hebrew Bible, include the five books of Moses which were handed down from God at Mt. Sinai – Christians refer to this as the “old testament” 3 Religious Life • based on the commandments (mitzvot) that are found in the Torah 5 books of Moses) and other Jewish literature – Mishnah (written code/ commentary by Maimonides, a 12th C sage) • A compendium of what Jews should and should not do with regard to all aspects of living – Talmud - (oral tradition based on Mishnah) – Halacha – Rabbinic interpretation of Jewish law Religious Life • Synagogue, shul, temple – Jewish house of worship and cultural center – A synagogue will have Torahs – handwritten, parchment scrolls of Hebrew writings in the “holy ark” under an “eternal light” • Rabbi – spiritual leader of a congregation • Cantor – leads chanting at services • Sabbath – A day of rest and spiritual reawakening – Saturday is the holy day (sundown to sundown) Jewish Living through Mitzvot and Jewish Values • Love of family and community (ahavat mishpachah) • Learning and education (study of Torah) • Tikun olam – to better the world • Justice and charity (Tzedakah) • Kindness (Chesed) • Joyfullness (Simcha) 4 Language and Communication • American Jews primarily speak English • Tend to speak openly and be informal and lively • Among ultra-orthodox, no touching between non-married men and women • Hebrew – the language of rituals and prayers and the spoken and written language of Israel • Yiddish – a Judeo-German dialect nosh, bagel, pastrami, mensch, meshugaa, kibitz, shlepp, tuchus, kvetch, schmata, yenta, and more Multiple spelling alternatives -eg. Shabbat or Shabbos; Hanukah, Channukah Major Jewish Holidays • “High Holy Days” • Rosh Hashona – celebrates creation of the world – our “new Year” • Yom Kippur – “Day of Atonement” (fasting) • Sukkot – signifies the end of harvest and remembers 40 years wandering in the desert on way to “promised land” • Hanukkah – symbolizes time when Macabees led a successful revolt against anti-semetic oppression in 167 B.C.. – Light candles in a menorah, for 8 nights • Passover or Pesach – commemorates miracle of the exodus from Egypt and the beginning of Jewish nationhood. – Sedar – read the Hagaddah which tells the story of the exodus. – Many rituals associated with the sedar such as eating Matzah or unleavened bread (no time for bread to rise during the exodus) • Purim – signifying the deliverance from Haman • Shavuot – giving of the Torah 5 Shabbat • Generally Orthodox Jews must: • Be home before sundown on Fri. evening • (may be willing to work on Sunday) • Home based rituals – Lighting of candles; reciting Kiddush, Motzi (prayer over wine and Challah) and berachot (over food) • May not “work” or travel – Can not drive; use money; turn electric appliances or lights on or off • Havdalah ceremony ends Shabbat – separates holy from ordinary Family and Gender Roles • Historically a patriarchal society • Judaism passed down through mother (Reform movement no longer “requires” this) • Marriage is considered a sacred covenant and couples are expected to build a Jewish home – Mixed marriages are common among reform and conservative streams – Gay and lesbian lifestyle accepted by reform and conservative streams • Women traditionally responsible for home and children • Procreation encouraged and adoption supported – Every child is created pure – All children are to be treated equally including a child with a disability • Contraception and abortion allowed for Reform and Conservative movements • Rituals associated with children – Bris – circumcision of boys – Bar or Bat Mitzvah ceremony (usually 13 years old) to mark the rite of passage for children into adult religious responsibility 6 • Elders are treated with deference, honor and respect • General equality between men and women and increasing blurring of gender roles within the Conservative and Reform movements • More restrictions for women among Orthodox Food and the Practice of being Kosher • Foods commonly associated with Jewish living – Chicken soup, bagels and lox, knaidle, chopped liver, kugel, blintzes, tsimmis/brisket • Jewish dietary regulations are defined according to Jewish laws of kashrut • Certain permitted foods must be prepared in a specific way and labeled “kosher” • Meat (fleishik) and dairy (milchik) foods are separated in preparation, serving, and eating • Certain foods are restricted – Pork, shellfish or nonscaled fish Hereditary and Genetic Conditions • Ashkenazi Jews have genetic link to: – Tay-Sachs, Niemann-Pick, and Canavan’s diseases – Familial dysautonomia, torsion dystonia, cystic fibrosis – Gaucher’s disease • Increased predisposition to breast cancer 1 gene mutation • Higher rate of side effects with clozapine • Protective gene effect against alcoholism by genetic mutation (ADH2*2) • Greater than expected frequency of inflammatory bowel diseases, colorectal Ca 7 Healthcare Practices • Sanctity of life is core tenet • Health maintenance and care of the body are human responsibilities – Permanent tattooing, illegal drugs, suicide are illegal – Life-saving medical ministrations are expected but generally permissible to let nature run its course if a cure is not possible • Receiving blood and blood products is OK • God is recognized as the ultimate healer • Social supports are an adaptation to stress Death and Associated Rituals • Death is when one is “brain dead” • Autopsies and organ donation generally allowed if it will give life to/ benefit another individual • Sacredness of grief, sympathy and memory but not “obsessive” • Specific rituals for Orthodox • Burial is as soon as possible – cremation is forbidden but is increasing among reform and conservative Jews • Funeral Services is in a synagogue or chapel – Prayers, eulogy, mourner’s kaddish • Dress is modest – many will cover their heads • Return to the home for a traditional meal • “Sitting shiva” - ~one week mourning and consolation period, with visits by friends and family 8 Folk Practices • To prevent “evil eye”, may say kayn aynhoreh after a compliment or expression of luck • May touch mezuzot to ward off disease People of Jewish Heritage • Reflect a very wide array of beliefs and behaviors, both religious and cultural • Are generally cognizant of the fact that many do not know much about Judaism • Will likely welcome your questions • Appreciate your efforts at becoming culturally competent Reflective Questions • What is your level of familiarity with people of ____ heritage? • What stereotypes and biases do you hold toward individuals from ____ heritage? • What do you believe are the values of people who are of the _____ faith? • What values and traditions do you hold dear from your religion? • How often do you make an effort to learn about a different faith or go to a cultural event related to a different faith? 9 Providing Culturally