Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese American Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Overview/Heritage ▪ In the Japanese language, Japan is called Nihon or Nippon. ▪ The over 500,000 Japanese citizens residing in North America tend to locate in large commercial and educational centers. ▪ Education is highly valued; the illiteracy rate in Japan is nearly zero. About 40 percent of all young people go on to higher education. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Overview/Heritage ▪ Issei (first-generation Japanese immigrants) vary widely in their English-language ability. ▪ Nisei (second-generation immigrants) and sansei (third-generation) were primarily educated under the American educational system. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ Japanese is the language of Japan, with the exception of the indigenous Ainu people. ▪ In Japan students complete 6 years of English, even newer Japanese immigrants and sojourners can speak, understand, read, and write English to some extent. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ Men tend to speak more coarsely and women with more gentility or refinement. ▪ Light social banter and gentle joking are a mainstay of group relations, serving to foster group cohesiveness. ▪ Polite discussion unrelated to business, often over o-cha (green tea), precedes business negotiations. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ Open communication is discouraged making it difficult to learn what people think. In particular, saying “no” is considered extremely impolite; rather, one should let the matter drop. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ A high value is placed on “face” and “saving face.” ▪ Asking someone to do something he or she cannot do induces loss of face or shame. For people to be shown wrong is deeply humiliating. ▪ People feel shame for themselves and their group, but they are respected when they bear shame in stoic silence. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ Traditional Japanese exhibit considerable control over body language. Anger or dismay may be quite difficult for Westerners to detect. ▪ Smiling and laughter are common shields for embarrassment or distress. ▪ Prolonged eye contact is not polite even within families. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ Social touching occurs among group members but not among people who are less closely acquainted. ▪ In general, body space is respected. ▪ Intimate behavior in the presence of others is taboo. ▪ When people greet one another, whether for the first time or for the first time on a given day, the traditional bow is performed. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ An offer to shake hands by a Westerner is reciprocated graciously. ▪ Overall orientation is toward the future. ▪ Punctuality is highly valued. ▪ Family names are stated first, followed by given names. Seki Noriko would be the name of a woman, Noriko, of the Seki family. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Communication ▪ Women generally assume their husband’s family name upon marriage. ▪ Elders are referred to respectfully. ▪ The designation sensei (master) is a term of respect used with the names of physicians, teachers, bosses, or others in positions of authority. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Family Roles and Organization ▪ The predominant family structure is nuclear. The role of wife and mother is dominant. ▪ Children are socialized to study hard, make their best effort, and be good group members. ▪ They are taught to take care of each other, and girls are taught to take care of boys. Selfexpression is not valued. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Family Roles and Organization ▪ The primary relationship within a family is the mother-child relationship, particularly that of mothers and sons. ▪ It is customary for a mother to sleep with the youngest child until that child is 10 years old or older, and when a new baby is born, the older sibling may sleep with the father or a grandparent. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Family Roles and Organization ▪ Babies are not allowed to cry; they are picked up instantly. Women constantly hold their babies in carriers on their chests and sleep with them. ▪ Corporal punishment is acceptable in Japan. ▪ Traditional teens and college students generally do not date. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Family Roles and Organization ▪ Older people are respected and cared for by the family in the home, if at all possible, with the eldest son being the responsible family member. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Family Roles and Organization ▪ There is less tolerance for marriage of a Japanese person to a foreigner than in the United States. ▪ The existence of a gay and lesbian social network and of cross-dressing clubs is evident, although they are not generally talked about. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Workforce Issues ▪ American practices designed to avoid liability, such as informed consent, are not routinely implemented in Japanese health-care settings. ▪ Japanese workers are sensitive to colleagues and superiors. ▪ Saying “no” or delivering bad news is extremely difficult; they may avoid issues or indicate that everything is fine rather than state the negative. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Workforce Issues ▪ A high value is placed on “face” and “saving face.” ▪ Asking someone to do something he or she cannot do induces loss of face or shame. ▪ For people to be shown wrong is deeply humiliating. ▪ Prolonged eye contact is not polite even within families and among friends. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Biocultural Ecology ▪ Racial features include the epicanthal skin folds that create the distinctive appearance of Asian eyes, a broad and flat nose, and “yellow” skin that varies markedly in tone. ▪ Hair is straight and naturally black with differences in shade. ▪ Negative blood types account for less than 1 percent of the population. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Biocultural Ecology ▪ Commonly occurring health conditions for Japanese include heart disease, tuberculosis, renal disease, asthma, Vogt-Koyanagi-Harada syndrome, Takayasu disease, acatalasemia, cleft lip/palate, Oguchi disease, lactase deficiency, and stomach cancer. ▪ Asthma, related to duct mites in tatami (straw mats) is one of the few endemic diseases. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Biocultural Ecology ▪ Drug dosages may need to be adjusted for the physical stature of Japanese adults. ▪ Many Asians are poor metabolizers of mephenytoin and related medications, potentially leading to increased intensity and duration of the drugs’ effects. ▪ Most individuals require lower doses of some benzodiazepines and neuroleptics. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Biocultural Ecology ▪ Opiates may be less effective analgesics, but gastrointestinal side effects may be greater than among Whites. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese High-Risk Health Behaviors ▪ Smoking rates are high among Japanese and Japanese Americans. ▪ Alcohol (rice wine) is part of many social rituals, such as picnics, to celebrate cherry blossoms, autumn leaves, or moon viewing. ▪ Once alcohol is consumed, one can relax and speak freely; they are forgiven for what they say because of the alcohol. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese High-Risk Health Behaviors ▪ Mothers’ time-honored strategy of rewarding academic diligence with candy and other treats contributes to the issue of the fitness of youth. ▪ Public safety consciousness is high. ▪ The Japanese readily use seatbelts and other safety measures, such as child safety seats and helmets. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Nutrition ▪ Dietary staples include rice, beef, poultry, pork, seafood, root vegetables, cabbage, persimmons, apples, and tangerines. ▪ Rice is the mainstay of the traditional diet and is included in all three meals as well as snacks. ▪ Rice has a symbolic meaning related to the Shinto religion, analogous to the concept of the “bread of life” among Christians. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Nutrition ▪ A staple of schoolchildren’s o-bento (lunch box) is a white bed of rice garnished with a red plum pickle, reminiscent of the Japanese flag. ▪ A popular lunch among working people is a steaming bowl of ramen (noodles) in broth or cold noodles on a hot summer day. ▪ Instant broth, although high in sodium, is another popular quick lunch. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Nutrition ▪ A traditional dinner is a pot of boiled potatoes, carrots, and pork seasoned with sweet sake, garlic, and soy sauce or a stir-fried meat and vegetable dish. ▪ The daily intake of sweets can be high and often includes European-style desserts, sweetbreads and cookies, sweet bean cakes, soft drinks, and heavily sweetened coffee. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Nutrition ▪ Increasingly, Westernized food tastes, resulting in higher fat and carbohydrate intake, have contributed to the rise in obesity and associated increases in diabetes and heart disease. ▪ There is growing public awareness that the sodium content of the traditional soups and sauces contributes to the high rate of cerebrovascular accidents. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Nutrition ▪ Green tea, although high in caffeine, is a good source of vitamin C. ▪ Garlic and various herbs are used widely for their medicinal properties. ▪ Many individuals have difficulty digesting milk products due to lactose intolerance. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Pregnancy and Childbearing Practices ▪ Oral contraceptives became legal in Japan in 1999. ▪ Condoms remain the most common contraceptive method. ▪ Most women have several abortions during their married fertile lives. ▪ Pregnancy is highly valued within traditional culture as a woman’s fulfillment of her destiny. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Pregnancy and Childbearing Practices ▪ Pregnant women may enjoy attention and pampering that they get at no other time. ▪ They may prepare themselves for the possibility of pregnancy when they become engaged and eliminate alcohol, caffeine, soft drinks, and tobacco. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Pregnancy and Childbearing Practices ▪ Loud noises, such as a train or a sewing machine, are thought to be bad for the baby. ▪ Shinto shrines sell amulets for conception and easy delivery. ▪ Husbands do not commonly attend the births of their children. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Pregnancy and Childbearing Practices ▪ Vaginal deliveries are usually performed without medication. ▪ To give in to pain dishonors the husband’s family, and mothers are said to appreciate their babies more if they suffer in childbirth. ▪ Traditionally, postpartum women do not bathe, shower, or wash their hair for the first week. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Pregnancy and Childbearing Practices ▪ Breast-feeding is taken seriously. ▪ Maternal rest and relaxation are deemed essential for success. ▪ If the mother is asleep, the grandmother feeds the baby formula. ▪ Women who give birth in the US may resent the expectation of resuming self-care quickly. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Death Rituals ▪ The taboo against open discussion of serious illness and death is evident. ▪ Hospice patients or those with a terminal illness may not want to be told their diagnosis and prognosis in order to allow a peaceful death and to spare both the patient and the family the difficulty of having to discuss the situation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Death Rituals ▪ When a person is dying, the family should be notified of impending death so they can be at the dying person’s bedside. ▪ Traditionally, the eldest son has particular responsibility during this time. ▪ The mourning period is 49 days, the end of which is marked by a family prayer service and the serving of special rice dishes. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Death Rituals ▪ When death occurs, an altar is constructed in the home. ▪ Photographs of the deceased are displayed, and floral arrangements are placed within and outside the home. ▪ A bag of money is hung around the neck of the deceased to pay the toll to cross the river to the hereafter. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Death Rituals ▪ Perpetual prayers may be donated through a gift to the temple. In addition, special prayer services can be conducted for the 1st, 3rd, 7th, and 13th annual anniversaries of the death. ▪ Beliefs are common that the dead need to be remembered and that failure to do so can lead the dead to rob the living of rest. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Spirituality ▪ Shinto, the indigenous religion, is the locus of joyful events such as marriage and birth. ▪ Many festivals are marked by offerings, parades, and a carnival on the grounds of the shrine. ▪ Very few people regularly attend services, but most are registered temple members, if only to ensure a family burial plot. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Spirituality ▪ 1% of Japanese people is Catholic or Protestant. ▪ Most do not identify themselves solely with one religion or another, and even a baptized Christian might have a Shinto wedding and a Buddhist funeral. ▪ Buddhist belief in reincarnation and the eternal life of the soul. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Spirituality ▪ Kampo (healers) often set up shop in the vicinity of the temple or shrine, and a person might be seen scooping incense smoke onto an ailing body part. ▪ Prayer boards might bear requests for special healing. ▪ Newborns are taken to a shrine for a blessing. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ Because Japanese people are less likely to express feelings verbally, this indulgence may be a way for people to affirm caring for one another nonverbally. ▪ Termination of pregnancy when the health of the fetus is in doubt is common. ▪ Most parents want medically compromised neonates to be treated aggressively when prognoses are not favorable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ The concept of ki, the life force or energy and how it flows through the body, is integral to traditional Chinese healing modalities, including acupuncture. ▪ Good health requires the unobstructed flow of ki throughout the body. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ Yin and yang are reflected in the need to balance five energy sources: water, wood, fire, earth, and metal. Strategies that help to restore balance include use of herbal medicines, bed rest, bathing, and having a massage. ▪ One traditional form of massage, shiatsu (acupressure), involves redirection of energy along the Chinese meridians by application of light pressure to acupuncture points. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ Whereas Chinese tradition calls for a restoration of balance when one is ill, Shinto calls for purging and purification. ▪ Preoccupation with germs and dirt is not likely to interfere with daily life. ▪ Many pharmacies stock traditional herbal kampo preparations. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ Most individuals make liberal use of both modern medical and traditional providers of health care. ▪ Residents in the United States have Internet and mail-order access to traditional medications, if they are not available locally. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices Common Japanese therapies include: ▪ Morita therapy–indigenous strategy for addressing shinkei shitsu, excess sensitivity to the social and natural environment. Introspection is seen as harmful. ▪ Morita therapy–focuses on constructive physical activity to help clients accept reality as it is ▪ Naikan therapy–reflection on how much goodness and love are received from others. ▪ Shinryo Naika– focuses on bodily illnesses that are emotionally induced. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ Japanese high regard for the status of physicians decreases the likelihood of their asking questions or making suggestions about their care. ▪ The idea that clients should be given care options may be alien. ▪ Itami (pain) may not be expressed: bearing pain is a virtue and a matter of family honor. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ Addiction is a strong taboo in Japanese society, making clients reluctant to accept pain medication. ▪ Mental illness is taboo. Because emotional problems cannot be discussed freely, somatic manifestations are common and acceptable. ▪ Handicapped people may bring shame to the family, although they are treated kindly.. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practices ▪ The sick role is highly tolerated by families and colleagues, and a long recuperation period is encouraged Organ transplantation and donation issues need to be approached sensitively. ▪ People rely more heavily on the physician’s opinion, and the family may have difficulty negotiating cessation of treatment Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practitioners ▪ Physicians, referred to as sensei, are highly esteemed. ▪ Self-care as a philosophy is not evident among most. Being told what to do by the physician or kampo practitioner is expected, and his (or, occasionally, her) authority is not questioned. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Japanese Health-care Practitioners ▪ Currently in Japan, nurses are well respected, even though women in general are not. ▪ In the past, nurses were not highly respected because “good women” did not touch people with an illness unless they were immediate family members. If she did touch “sick bodies,” the woman would become tainted and less pure. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Culture Larry Purnell, PhD, RN, FAAN Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Overview/Heritage ▪ The term Jewish refers to a people, a culture, and a religion; it is not a race. ▪ The religion is practiced along a wide continuum that ranges from liberal Reform to strict Orthodox. ▪ Instances occur within the ultra-Orthodox communities when individuals cannot make decisions without consulting their rabbis. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Overview/Heritage ▪ A child born from the union of a Jewish father and a non-Jewish mother is recognized as Jewish by those in the Reform movement but not by those in the Orthodox movement. ▪ Over 6 million Jews live throughout the United States. The migration of Jews from Europe began to increase in the mid-1800s because of the fear of religious persecution. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Overview/Heritage ▪ The greatest influx of Jews occurred between 1880 and 1920. ▪ Many came from Russia and Eastern Europe after a wave of pogroms (religious persecutions.) Most families in America today are descendants of these eastern European and Russian immigrants and are referred to as Ashkenazi Jews. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Overview/Heritage ▪ Sephardic Jews, on the other hand, are from Spain, Portugal, the Mediterranean, North Africa, and South and Central America. ▪ A Sabra is a Jew who was born in Israel. ▪ Falasha are black Jews from Ethiopia. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Overview Heritage ▪ In general, this population is well educated. A high percentage has succeeded in professional vocations. ▪ Throughout their history, Jews have placed a major emphasis on education and social justice through social action. Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Communication ▪ English is the primary language of Jewish Americans. ▪ Although Hebrew is used for prayers, it is generally not used for conversation. ▪ Many elderly Ashkenazi Jews who immigrated early in the 20th century or who are firstgeneration Americans speak Yiddish, a JudeoGerman dialect. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Communication ▪ Many Yiddish terms have worked their way into English: kvetch (someone who complains a lot); chutzpah (clever audacity); bagel (a circular roll of bread with a hole in the middle); tush, tushie, or tuchus (buttocks); ghetto (a restricted area where certain groups live); klutz (a clumsy person); shlep (drag or carry); kosher (legal or okay); and oy, oy vey (oh my), and veys mir (woe is me). Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Communication ▪ Hebrew is read from right to left, and books are opened from the opposite side compared with English books. ▪ As a way to cope/communicate, Jews frequently use humor, but jokes are considered to be insensitive when they reinforce mainstream stereotypes, such as implying that Jews are cheap or pampered (eg, Jewish American princess). Any jokes that refer to the Holocaust or concentration camps are also inappropriate. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Communication ▪ Modesty especially among the Orthodox is seen in the Orthodox style of dress. ▪ Jews are encouraged not to “show off” or constantly try to impress others. ▪ Hasidic men are not permitted to touch a woman other than their wives. They often keep their hands in their pockets to avoid touch. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Communication ▪ Because women are considered seductive, Hasidic men may not engage in idle talk with them nor look directly at their faces. ▪ Non-Hasidic Jews may be much more informal and may use touch and short spatial distance when communicating. ▪ Jewish time orientation is simultaneously to the past, the present, and the future. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Communication ▪ The Jewish format for names follows the Western tradition. The given name comes first and is followed by the family surname. Only the given name is used with friends and in informal situations. ▪ In more formal situations, the surname is preceded by the appropriate title of Mr., Miss, Ms., Mrs., or Dr. ▪ In ultra-Orthodox circles, children are not Copyright © 2013 F.A. Davis Company Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Family Roles and Organization ▪ Jewish school-age children typically attend Hebrew school at least two afternoons a week after public school throughout the school year. ▪ Children play an active role in most holiday celebrations and services. ▪ Respecting and honoring one’s parents is one of the Ten Commandments. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Family Roles and Organization ▪ In Judaism, the age of majority is 13 years for a boy and 12 for a girl, at which age children are deemed capable of differentiating right from wrong and capable of committing themselves to performing the commandments. Recognition of adulthood occurs during a religious ceremony called a bar or bat mitzvah (son or daughter of the commandment). Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Family Roles and Organization ▪ The goal of the Orthodox family is to live their lives as prescribed by halakhah (Code of Jewish Law), which emphasizes maintaining health, promoting education, and helping others. ▪ Ultra-observant women must physically separate themselves from all men during their menstrual periods and after for 7 days. No man may touch a woman or sit where she sat until she has been to the mikveh, a ritual bath, after her period is over. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Family Roles and Organization ▪ Older people receive respect, especially for the wisdom they have to share. ▪ Honoring one’s parents is a lifelong endeavor and includes maintaining their dignity by feeding, clothing, and sheltering them, even if they suffer from senility. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Family Roles and Organization ▪ The Bible, as interpreted by the Orthodox, prohibits homosexual intercourse; it says nothing specifically about sex between lesbians. ▪ Some of the objections to gay and lesbian lifestyles include the inability of these unions to fulfill the commandment of procreation and the possibility that acting on the recognition of one’s homosexuality could ruin a marriage. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Family Roles and Organization ▪ The liberal movement within Judaism supports legal and social equality for lesbians and gays. ▪ Jews who observe the Sabbath must have off Friday evening and Saturday. They may work on Sundays. ▪ Judaism’s beliefs are congruent with the values of the dominant American society. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Biocultural Ecology ▪ Skin coloring for Ashkenazi Jews ranges from fair skin and blonde hair to darker skin and brunette hair. ▪ Sephardic Jews have slightly darker skin tones and hair coloring. ▪ There are also Jewish groups throughout Africa who are black, most notably the Falasha from Ethiopia. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Biocultural Ecology ▪ Genetic risk factors vary based on whether the family immigrated from Ashkenazi or Sephardic areas. ▪ There is a greater incidence of some genetic disorders among Ashkenazi individuals. ▪ Most of these disorders are autosomalrecessive, meaning that both parents carry the affected gene. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Biocultural Ecology ▪ Common genetic, hereditary, and other health conditions of the Jewish population include Tay-Sachs disease, Gaucher’s disease, Canavan’s disease, familial dysautonomia, torsion dystonia, Niemann-Pick disease, Bloom syndrome, Fanconi’s anemia, mucolipidosis IV, lactase deficiency, Werdnig-Hoffmann disease, kaposi sarcoma, Phenylketonuria, ataxia-telangiectasia, metachromatic leukodystrophy, myopia, polycythemia vera, cardiovascular diseases, diabetes mellitus, breast, ovarian, and colorectal cancer, and inflammatory bowel disease. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish High-Risk Health Behaviors ▪ Any substance or act that harms the body is not allowed. This includes smoking, suicide, illegal medications, and permanent tattooing. ▪ Most Jews are health-conscious and practice preventive health care with routine physical, dental, and vision screening. ▪ This is also a well-immunized population. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ For Jews who follow the dietary laws, much attention is given to the slaughter, preparation, and consumption of food. ▪ Perhaps the food identified as “Jewish” that receives the most attention is chicken soup, which has frequently been referred to as “Jewish penicillin.” Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition Common foods include: ▪ Gefilte fish (ground freshwater fish molded into oblong balls and served cold with horseradish) ▪ Challah (braided white bread) ▪ Kugel (noodle pudding) ▪ Blintzes (crepes filled with a sweet cottage cheese) ▪ Chopped liver (served cold) ▪ Hamentashen (a triangular pastry with different types of filling) ▪ Lox (a cold smoked salmon) is served with cream cheese and salad vegetables on a bagel. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ Religious laws regarding permissible foods are referred to as kashrut. ▪ The term kosher means “fit to eat.” Foods are divided into those that are considered kosher (permitted or clean) and those considered (forbidden or unclean). ▪ A permitted animal may be rendered treyf if it is not slaughtered, cooked, or served properly. All blood is drained from the animal before eating it. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ Milk and meat may not be mixed together in cooking, serving, or eating. ▪ To avoid mixing foods, utensils used to prepare foods and the plates used to serve them are separated, requiring two sets of dishes, pots, and utensils. One set is reserved for milk products and the other for meat. ▪ Because glass is not absorbent, it can be used for either meat or milk products, although religious households still usually have two sets. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ Therefore, cheeseburgers, lasagna made with meat, and grated cheese on meatballs and spaghetti is unacceptable. ▪ Milk cannot be used in coffee if served with a meat meal. Nondairy creamers can be used instead, as long as they do not contain sodium caseinate, which is derived from milk. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ Some foods are parve (neutral) and may be used with either dairy or meat dishes. These include fish, eggs, anything grown in the soil (vegetables, fruits, coffee, sugar, and spices), and chemically produced goods. ▪ Mammals are considered clean if they meet the requirements for their slaughter and have split (cloven) hooves and chew their cud. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ The pig is an example of an animal that does not meet kosher criteria. ▪ Although liberal Jews decide for themselves which dietary laws they will follow, many still avoid pork and pork products out of a sense of tradition and symbolism. ▪ Poultry is acceptable as well as fish if it has both fins and scales. ▪ Nothing that crawls on its belly is allowed, including shellfish, tortoises, and frogs. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ In religious homes, meat is prepared for cooking by soaking and salting it to drain all the blood from the flesh. ▪ Broiling is acceptable, especially for liver, because it drains the blood. ▪ One must always wash one’s hands before eating. Religious Jews wash their hands while reciting a prayer. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ A U with a circle around it ( U ) is the seal of the Union of Orthodox Jewish Congregations of America and is used on food products to indicate that they are kosher. ▪ A circled K ( K ) and other symbols may also be found on packaging to indicate that a product is kosher. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ During the week of Passover, no bread or product with yeast may be eaten. Matzoh (unleavened bread) is eaten instead. Any product that is fermented or that can cause fermentation (souring) may not be eaten. ▪ Rather than attend synagogue, the family conducts the service (seder) around the dinner table during the first two nights and incorporates dinner into a service that includes all participants and retells the story of Moses and the exodus from Egypt. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ The Jewish calendar has a number of fast days. The most observed is the holiest day of the year, Yom Kippur (Day of Atonement). ▪ Jews abstain from food and drink as they pray to God for forgiveness for the sins they have committed during the past year. They eat an early dinner on the evening the holiday begins and then fast until after sunset the following day. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Nutrition ▪ Ill people, the elderly, the young, pregnant and nursing women, and the physically incapacitated are absolved from fasting and may need to be reminded of this exception to Jewish law. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Religious laws regarding permissible foods are referred to as a. Kashrut. b. Halal. c. Kosher. d. Treyf. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: A The religious laws regarding permissible foods are referred to as kashrut. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ Couples who are unable to conceive should try all possible means to have children, including infertility counseling and interventions, including egg and sperm donation. ▪ Orthodox opinion is virtually unanimous in prohibiting artificial insemination when the semen donor is not the woman’s husband. ▪ When all natural attempts have been made, adoption may be pursued. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ Unless pregnancy jeopardizes the life or health of the mother, contraception is not looked on favorably among the ultra-Orthodox. ▪ Condom use is supported, especially when unprotected sexual intercourse poses a medical risk to either spouse. ▪ To the Orthodox, barrier techniques are not acceptable because they interfere with the full mobility of the sperm in its natural course. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ The birth control pill does not result in any permanent sterilization, nor does it prevent semen from traveling its normal route. ▪ Sterilization implies permanence, and Orthodox Jews probably oppose this practice, unless the life of the mother is in danger. ▪ Reform Judaism allows free choice. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ The fetus is not considered a living soul or person until it has been born. ▪ Birth is determined when the head or “greater part” is born. If the physical or mental health of a pregnant woman is endangered by the fetus, all branches of Judaism consider the fetus an aggressor and require an abortion. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ Random abortion is not permitted by the Orthodox branch because the fetus is part of the mother’s body and one must not do harm to one’s body. ▪ Reform Judaism believes that a woman maintains control over her own body and that it is up to her whether to abort a fetus. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ A Hasidic husband may not touch his wife during labor and may choose not to attend the delivery because he is not permitted to view his wife’s genitals. ▪ These behaviors should never be interpreted as insensitivity. ▪ Pain medication during delivery is acceptable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ For male infants, circumcision, which is both a medical procedure and a religious rite, is performed on the 8th day of life by a mohel, an individual trained in the circumcision procedure, asepsis, and the religious ceremony. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Pregnancy and Childbearing Practices ▪ Although a rabbi is not necessary, it is also possible to have the procedure completed by a physician with a rabbi present to say the blessings. ▪ Attending a brit milah is the only mitzvah for which religious Jews must violate the Sabbath so that the brit can be completed at the proper time. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Traditional Judaism believes in an afterlife where the soul continues to flourish, although many dispute this interpretation. ▪ A dying person is considered a living person in all respects. ▪ Active euthanasia is forbidden for religious Jews. ▪ Passive euthanasia may be allowed depending on its interpretation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Taking one’s own life is prohibited. To the ultrareligious, suicide removes all possibility of repentance. ▪ The dying person should not be left alone. ▪ Any Jew may ask God’s forgiveness for his or her sins; no confessor is needed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Some Jews feel solace in saying the Sh’ma in Hebrew or English. This prayer confirms one’s belief in one God. ▪ At the time of death, the nearest relative can gently close the eyes and mouth, and the face is covered with a sheet. ▪ The body is treated with respect and revered for the function it once filled. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ For the ultra-Orthodox, after the body is wrapped, it is briefly placed on the floor with the feet pointing toward the door. ▪ A candle may be placed near the head. However, this does not occur on the Sabbath or holy days. ▪ Autopsy is usually not permitted among religious Jews because it results in desecration of the body. ▪ The body is be interred whole. Allowing an autopsy might also delay the burial. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Autopsy is allowed if its results would save the life of another patient who is immediately at hand. ▪ Many branches of Judaism currently allow an autopsy if a) it is required by law, b) the deceased person has willed it, or c) it saves the life of another, especially an offspring. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Cremation is prohibited because it unnaturally speeds the disposal of the dead body. ▪ Embalming is prohibited because it preserves the dead. However, in circumstances when the funeral must be delayed, some embalming may be approved. ▪ Cosmetic restoration for the funeral is discouraged. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Funerals and burials usually occur within 24 to 48 hours after the death. ▪ The funeral service is directed at honoring the departed by only speaking well of him or her. It is not customary to have flowers either at the funeral or at the cemetery. ▪ The casket should be made of wood with no ornamentation. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ The body may be wrapped only in a shroud to ensure that the body and casket decay at the same rate. ▪ There is no wake or viewing. ▪ The prayer said for the dead, kaddish, is usually not said alone. ▪ After the funeral, mourners are welcomed at the home of the closest relative. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Outside the front door is water to wash one’s hands before entering, which is symbolic of cleansing the impurities associated with contact with the dead. ▪ The water is not passed from person to person, just as it is hoped that the tragedy is not passed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Shiva (Hebrew for “seven”) is the 7-day period that begins with the burial. ▪ Shiva helps the surviving individuals face the actuality of the death of the loved one. ▪ During this period when the mourners are “sitting shiva,” they do not work. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ In some homes, mirrors are covered to decrease the focus on one’s appearance. No activity is permitted to divert attention from thinking about the deceased. Evening and morning services may be conducted in the closest relative’s home. ▪ Condolence calls and the giving of consolation are appropriate during this time. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Crying, anger, and talking about the deceased person’s life are acceptable. ▪ A common sign of grief is the tearing of the garment that one is wearing before the funeral service. ▪ In liberal congregations, a black ribbon with a tear in it is a symbolic representation of mourning. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Death Rituals ▪ Within Orthodoxy, when a limb is amputated before death, the amputated limb and bloodsoaked clothing are buried in the person’s future gravesite because the blood and limb were part of the person. ▪ No mourning rites are required. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ Jews consider only the Old Testament as their Bible. ▪ Judaism is a monotheistic faith that believes in one God as the creator of the universe. ▪ No physical qualities are attributed to God; making and praying to statues or graven images are forbidden. ▪ The spiritual leader is the rabbi (teacher). He (or she, in liberal branches) is the interpreter of Jewish law. All Jews pray directly to God. They do not need the rabbi to intercede, to hear confession, or to grant atonement Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ The practice of Judaism spans a wide spectrum. ▪ Although there is only one religion, there are three main branches or denominations of Judaism. ▪ The Orthodox are the most traditional. They adhere most strictly to the halakhah of traditional Judaism and try to follow as many of the laws as possible while fitting into American society. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ The Orthodox observe the Sabbath by attending the synagogue on Friday evening and Saturday morning and by abstaining from work, spending money, and driving on the Sabbath. ▪ Orthodox Jews observe the Jewish dietary laws; men wear a yarmulke or kippah (head coverings) at all times in reverence to God. Women wear long sleeves and modest dress. ▪ In many Orthodox synagogues, the services are primarily in Hebrew, and men and women sit separately. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ Ultra-Orthodox men wear a special garment under their shirts year-round. ▪ A mezuzah is a small container with scripture inside. Jewish homes have a mezuzah on the doorpost of the house. Some Jews wear a mezuzah as a necklace. ▪ Other religious symbols include the Star of David, a six-pointed star that has been a symbol of the Jewish community, and the menorah (candelabrum.) Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ Whereas Conservative Jews observe most of the halakhah, they do make concessions to modern society. ▪ Many drive to the synagogue on the Sabbath, and men and women sit together. Many keep a kosher home, but they may or may not follow all of the dietary laws outside the home. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ For conservative Jews, women are ordained as rabbis and are counted in a minyan, the minimum number of 10 that is required for prayer. ▪ While a yarmulke is required in the synagogue, it is optional outside of that environment. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ The liberal or progressive movement is called Reform. Reform Jews claim that post-biblical law was only for the people of that time and that only the moral laws of the Torah are binding. ▪ They may or may not follow the Jewish dietary laws, but they may have specific unacceptable foods (for example, pork), which they abstain from eating. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ Of the many small groups of ultra-Orthodox fundamentalists, the Hasidic (or Chasidic) Jews are perhaps the most recognizable. ▪ They usually live, work, and study within a segregated area. They are usually easy to identify by their full beards, uncut hair around the ears (pais), black hats or fur streimels, dark clothing, and no exposed extremities. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ A relatively new denomination, Reconstructionism, is a mosaic of the three main branches. ▪ Reconstructionists view Judaism as an evolving religion of the Jewish people and seek to adapt Jewish beliefs and practices to the needs of the contemporary world. ▪ The Jewish house of prayer is called a synagogue, temple, or shul. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ Orthodox Jews pray three times a day: morning, late afternoon, and evening. They wash their hands and say a prayer on awakening in the morning and before meals. ▪ The Sabbath begins 18 minutes before sunset on Friday. During this time, religious Jews do no manner of work, including answering the telephone, operating any electrical appliance, driving, or operating a call bell from a hospital bed. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Spirituality ▪ Orthodox client’s condition is not lifethreatening, medical and surgical procedures should not be performed on the Sabbath or holy days. ▪ A gravely ill person and the work of those who need to save him or her are exempted from following the commandments regarding the Sabbath. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Health-care Practices ▪ All denominations recognize that religious requirements may be laid aside if a life is at stake or if an individual has a life-threatening illness. ▪ In ultra-Orthodox denominations of Judaism, taking medication on the Sabbath that is not necessary to preserve life may be viewed as “work” and is unacceptable. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Health-care Practices ▪ The verbalization of pain is acceptable and common. Individuals want to know the reason for the pain, which they consider just as important as obtaining relief from pain. ▪ The sick role for Jews is highly individualized and may vary among individuals according to the severity of symptoms. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Health-care Practices ▪ Judaism opposes discrimination against people with physical, mental, and developmental conditions. ▪ The maintenance of one’s mental health is considered just as important as the maintenance of one’s physical health. ▪ Mental incapacity has always been recognized as grounds for exemption from all obligations under Jewish law. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Health-care Practices ▪ Jewish law considers organ transplants from four perspectives: those of the recipient, the living donor, the cadaver donor, and the dying donor. ▪ Because life is sacred, if the recipient’s life can be prolonged without considerable risk, then transplant is ordained. ▪ For a living donor to be approved, the risk to the life of the donor must be considered. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Health-care Practices ▪ Conservative and Reform Judaism approve using the flat EEG as the determination of death so that organs, such as the heart, can be viable for transplant. ▪ Burial may be delayed if organ harvesting is the cause of the delay. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Health-care Practices ▪ The use of a cadaver for transplant is usually approved if it is to save a life. ▪ No one may derive economic benefit from the corpse. ▪ Use of skin for burns is also acceptable, although no agreement has been reached on the use of cadaver corneas. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Jewish Health-care Practitioners ▪ Physicians are held in high regard. Although physicians must do everything in their power to prolong life, they are prohibited from initiating measures that prolong the act of dying. ▪ The more traditional Orthodox prefer that care be delivered by a same-gender health-care provider. Transcultural Health Care: A Culturally Competent Approach, 4th Edition ClickerCheck Jewish people with the highest number of hereditary/genetic conditions are a. Sephardic.. b. Copts. c. Ashkenazi. d. Falasha. Transcultural Health Care: A Culturally Competent Approach, 4th Edition Correct Answer Correct answer: C The Ashkenazi Jewish population has the highest incidence of genetic/hereditary conditions. 
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