Cultural Competence in Healthcare: Understanding Orthodox Judaism

Task:

This Cultural Perspectives content set is a point-of-reference tool to help health care professionals provide culturally competent care to diverse patient populations across the care continuum as they interact within the U.S. health care system. When speaking of culture, health care practitioners must not only be aware of the general cultural characteristics of patients but also avoid stereotyping. Individual patient differences must always be considered. Cultural competency in health care isn't static; rather, it is an ongoing process in need of continual improvement to adapt to changing needs. (See the entry A Cultural Perspectives Overview for more detailed information.)

Culture / Ethnicity / Community Orientation

· Orthodox Jews comprise 10% of the overall U.S. Jewish population.

· Orthodox Judaism is considered one denomination of the three major denominational movements of the Jewish religion.

· Orthodox Jews may have different degrees of observance, from Modern Orthodox to Ultra-Orthodox.

· Orthodox Jewry, as a whole, observes strict adherence to Jewish law (halacha).

· Observance of religious practices varies.

· Some Jews who do not consider themselves Orthodox are nevertheless observant of some or all Orthodox Jewish practices.

· Ultra-Orthodox Jews are divided into Chassidic and non-Chassidic sects.

· Orthodox Jews consider education to be an important endeavor.

· Orthodox Judaism places great importance on religious higher education.

· Many Orthodox Jews pursue higher secular education.

· The population of Orthodox Jews is concentrated in urban and suburban areas of major U.S. cities.

· Orthodox Jewish beliefs and practices may be considered both cultural and religious.

What you should do

· Perform a cultural assessment that includes the patient's communication style and needs, personal space needs, degree of acculturation and patterns of cultural behavior, concept of time, and ability to control the environment and biocultural variation. Needs may include the following:

o Dietary needs for a kosher diet

o Observance on the Sabbath (Friday at sundown through Saturday at sundown) and Jewish holidays

o Prayer

o Communication

o Modesty needs

o Patient's religious needs concerning the specific health issue (for example, childbirth, death, dying).

· Ask about the patient's and family's cultural orientation and document their responses.

o Example: “I noticed that you listed your religion as Orthodox Jew on your patient information form. Tell me something about yourself.”

o Example: “Do you see yourself as holding views and beliefs that lean more toward your cultural traditions or more toward the general American culture?”

· Project a sensitive, respectful, interested demeanor.

· Recognize that decision making for health and illness issues may differ because of individual choice and/or specific rabbinic guidance.

o Although health and illness issues may necessitate a change in the usual cultural and religious practices, Jewish law is observed as much as possible.

o Do not expect all Orthodox Jews to have the same cultural or religious practices.

o Do not make generalizations regarding the Orthodox Jewish population's beliefs and practices.

o Respect individual cultural and religious practices.

o Ask whether anyone else besides a family member is assisting the patient with health care decisions, and offer to speak directly with this person.

§ Many Orthodox Jews seek rabbinical advice for health and illness issues.

o Understand that Orthodox Jewish practices include health care decisions that comply with Jewish law.

o Do not presume anyone's religious observance based on appearance.

· Assess and document socioeconomic and other factors and beliefs that may affect the patient's ability to access health care.

Cultural Values / Beliefs

· Judaism is both a religion and a culture.

· In the Old Testament, God promised the Land of Israel (the “Promised Land”) to the biblical forefather Abraham.

· Jews have lived continuously in the Land of Israel for more than 3,700 years.

· The Land of Israel is the Jewish homeland and central to Jewish life.

· After the destruction of the First and Second Temples (in 586 BCE and 70 AD, respectively), for those Jews expelled from Israel their area of destination and local culture influenced them. In the United States, the largest Jewish ethnic groups are the Ashkenazim and the Sephardim.

o Jews whose ancestors lived in European countries (for example, France, Germany, Eastern Europe) are known as Ashkenazi Jews.

o Jews whose ancestors lived in the Middle East, North Africa, Spain, or Portugal are known as Sephardic Jews (Edot Mizrach).

o Ashkenazi and Sephardic Jews observe the same Jewish laws, but some of their customs and practices may differ.

What you should do

· Ask about the patient's preferences regarding family member involvement in care. Document whom to involve and their role. Make sure that this information is included in the patient's Health Insurance Portability and Accountability Act documentation.

o Example: “For some patients, it is important to have family members present. Would you like to have any family members present, and if so, whom? Would you like to have family helping with your care? Is there a family member whom you wish to keep informed of your progress and treatment”?

· Be sensitive and nonjudgmental when collecting sensitive health information and assessing patients.

· Take a holistic perspective when assessing the patient and family. Consider their intellectual, emotional, spiritual, and environmental needs.

· Be sensitive and nonjudgmental when collecting health information and assessing patients.

· When discussing sensitive health information with the patient, provide privacy.

· Take care to develop a trusting relationship with the patient and family.

· Understand that Ashkenazi and Sephardic cultural values/beliefs and religious and spiritual beliefs are in accord with Orthodox Jewish law but may differ in their interpretation and practice.

· Understand that individual practices may differ