QUIZ 3 Study Guide

🌎 I. Transcultural Nursing and Cultural Competence

A. Core Concepts and Definitions

  • Culture: Defined as explicit or implicit. It is primarily learned and transmitted within a family, starting right after birth. Culture is shared by most members of a group, is largely unconscious, and is a powerful influence on health and illness.

  • Cultural Diversity: The coexistence of different groups (ethnic, racial, socioeconomic) within one social unit. This includes differences in religion, language, physical size, sexual orientation, disability, occupational status, and geographical location.

  • Subculture: A large group within a broader culture whose members have certain characteristics (ethnic, occupational, or physical) not common to the larger culture, and differentiates itself by developing its own norms and values (e.g., nursing, "Swifties").

  • Dominant Group: Usually the largest group, which has the most authority to control the values and sanctions of society.

  • Minority Group: Identified by a physical or cultural characteristic that makes them different from the dominant group.

  • Ethnicity: A sense of identification with a collective cultural group, based largely on common heritage, and developed through day-to-day life with family and friends.

  • Race: Typically based on specific physical characteristics like skin pigmentation, body stature, facial features, or hair texture. Physical characteristics are no longer considered a reliable way to determine a person’s race.

B. Cultural Dynamics and Attitudes

  • Ethnocentrism: The belief that one’s own ideas, beliefs, and practices are the best or superior and should be followed by everyone else.

  • Cultural Humility: The recognition of diversity and power imbalances, where one acknowledges that one's own beliefs are not superior and that one does not know everything about another culture. Key aspects include avoiding assumptions, being curious, waiting for answers, and learning.

  • Acculturation: When two cultures come into contact, exchange ideas, and adapt to some new values without requiring the rejection of the original home culture. Acculturation over a long period generally leads to assimilation.

  • Cultural Assimilation: The process where a minority group absorbs the dominant culture’s values, behaviors, or beliefs, and meshes into one.

  • Implicit Bias: Pervasive, with people often unaware of their biases, which nonetheless predict behavior. Implicit bias can lead to failures in patient-centered care and impacts equity in care.

C. Cultural Influences on Healthcare

Culture strongly influences health and illness care, affecting areas such as:

  • Reactions to pain and the choice of pharmacological vs. non-pharmacological interventions.

  • Mental health, where seeking help may carry a large stigma in certain cultures.

  • Assigned sex roles in the household.

  • Language and communication, including the need for translators and appropriate non-verbal cues (e.g., eye contact).

  • Food and nutrition, which is highly influenced by culture, especially during holidays.

  • Family support (e.g., multigenerational homes).

D. Transcultural Nursing Models

  1. Lininger’s Sunrise Model: Provides a holistic view, showing how socio-cultural factors (technology, religion, values, politics, economics, etc.) influence a person's culture and health, including generic folk care and professional nursing systems.

  2. Purnell Model for Cultural Competence: Offers a systematic framework to understand culture, linking the individual, family, community, and global society across 12 domains:

    • Overview/Heritage

    • Communication

    • Family roles and organization

    • Workforce issues

    • Biocultural ecology

    • High-risk behaviors

    • Nutrition

    • Pregnancy and childbearing practices

    • Death rituals

    • Spirituality

    • Health care practices

    • Health care professionals.

  3. RESPECT Model for Cross-Cultural Communication:

    • Rapport

    • Empathy

    • Support

    • Partnership (patient autonomy)

    • Explanations (using methods like Teach Back)

    • Cultural Competence

    • Trust.

E. Spiritual Needs in Healthcare

  • Spirituality is a relationship with something non-material (God, nature, etc.), while religion is an organized system of beliefs.

  • Three Spiritual Needs: Need for meaning and purpose, love and relatedness, and need for forgiveness.

  • Nurses meet spiritual needs by offering compassionate presence, helping patients find meaning in their illness, fostering nurturing relationships, and facilitating religious beliefs (e.g., ensuring kosher meals, calling religious leaders, or turning a patient's bed to face East for prayer).

✡ II. Jewish Heritage and Orthodox/Hasidic Practices

A. Identity, Values, and Principles

  • Identity: Judaism is both a culture and a religion. The religious and spiritual leader is the Rabbi. The House of Worship is the Synagogue (Shul or Temple).

  • Beliefs: Jews believe in one God/one creator and pray directly to God. They follow the teachings of the Torah (Old Testament).

  • The Homeland: Israel is considered the "Homeland" regardless of where one is born.

  • Preservation of Life: The greatest priority and source of strength is the preservation of life.

    • Pikuach Nefesh: Rules are created to be lived by, not die by; therefore, many rules can be broken if it is life-saving. Examples include using phones/driving on Shabbat to call 911 or get to the hospital, diabetics using medical technology, or eating on a fast day or eating non-kosher food if medically necessary or to avoid starvation.

  • Community: Jews tend to live in tight-knit communities with kosher grocery stores and synagogues within walking distance.

    • An Eruv is a physical boundary that allows observant Jews to carry needed items (and push strollers) in public on Shabbat.

  • Ancestry and Language: Ashkenazi Jews trace ancestry to Eastern Europe and Russia; Sephardic Jews trace ancestry to Spain, Portugal, and the Middle East. Hebrew is the official language. Yiddish is a combination of Hebrew and German, used primarily in Ashkenazi communities.

B. Religious Observances

  • Shabbat (Sabbath): Begins 18 minutes before sunset on Friday and ends 42 minutes after sunset on Saturday. Observant Jews do no work, which includes answering phones, driving, handling money, operating electrical devices (like call bells or pushing elevator buttons).

  • Kosher (Kashrut): Means "fit to eat".

    • Avoid mixing milk and meat (requiring different plates, utensils, and preparation areas).

    • Avoid pork and pork products.

    • Avoid shellfish and non-scaled fish (fish must have fins and scales).

    • Meat must come from animals that chew cud and have split hooves (cows, sheep, goats, deer) and be slaughtered in a specific, humane, and blessed way that drains the blood.

  • Holidays: Jewish day and holidays start at sunset. Important holidays include:

    • Rosh Hashana (Jewish New Year): When they believe God opens the Books of Life and Death.

    • Yom Kippur (Day of Atonement): A fast day 10 days after Rosh Hashana, when the Books are sealed.

    • Passover: 8 days long, commemorating the Exodus from Egypt; no unleavened bread (yeasted bread) is eaten, which is why matzah is eaten.

C. Orthodox/Hasidic Practices in Healthcare

  • Negiach Touch: Hasidic/Orthodox men are not permitted to touch women other than their wives and immediate family. They may keep hands in pockets to avoid accidental touch and may not look women directly in the eye.

    • Healthcare providers should only touch Hasidic men when providing direct care; therapeutic touch is NOT appropriate.

  • Pregnancy and Childbearing: Baby showers and naming the baby are considered bad luck before the baby’s arrival.

  • During Delivery: A Hasidic husband may not touch his wife during delivery because she is considered "dirty" due to bleeding, and he may choose not to attend. He is not able to view his wife’s genitals.

  • Circumcision/Naming: Male infants are circumcised and named at 8 days old by a mohel (a trained rabbi or OBGYN), typically at home, not in the hospital. Female infants are also named at 8 days.

D. Health Conditions and Death Rituals

  • Genetic Conditions (Higher Incidence): Tay-Sachs Disease (usually short life expectancy), Gaucher’s Disease (most prevalent), and Torsion Dystonia.

  • Health Concerns: Higher rates of Ulcerative colitis/Crohn’s Disease (2-8 times more often), Colorectal cancer (6%), and carry the BRCA1 & 2 genes (1 out of 50).

  • Death Rituals:

    • The body is traditionally never left alone between death and burial.

    • Bodies are not refrigerated or embalmed.

    • Burial typically happens quickly, within 48 hours.

    • Shiva, or 7 days of mourning, is held following the funeral. The mirrors in the house are covered during Shiva.

    • A Minion is an evening service often held during Shiva that officially requires 10 adult men to be present.

🩸 III. Jehovah's Witness (JW)

A. Beliefs and Practices

  • Deity: God’s name is Jehovah.

  • Jesus: JWs view Jesus as the son of Jehovah, a Savior, and the Son of God, but they do not adhere to the Holy Trinity doctrine.

  • Organization: The Holy Book is the Bible (New and Old Testament). The place of prayer is the Kingdom Hall. Religious leaders are Elders, who are unsalaried and not considered clergy; income is based off donations.

  • Afterlife: JWs believe God created the earth to be mankind’s eternal home. People who die pass out of existence and do not suffer in a fiery hell; God will bring billions back via resurrection.

  • Marriage: JWs adhere to the standard of marriage as the union of one man and one woman, with sexual immorality being the only valid basis for divorce.

  • Holidays: Jehovah’s Witnesses do not celebrate holidays. This includes birthdays (as they tend to give excessive importance to an individual, and only sinners' birthdays are mentioned in the Bible), Christian holidays (based on Pagan traditions), and secular holidays (seen as immortalizing people above God).

B. Healthcare Restriction: Blood

  • Jehovah's Witnesses will not receive any blood products.

  • This belief stems from God viewing blood as representing life, and the Bible stating to abstain from blood.

  • Avoiding blood shows respect to God as the Giver of Life.

  • Nurses must respect this belief and patient autonomy. Patients may be asked to sign a blood refusal consent form, verifying they refuse blood even if it means death.

This detailed study guide provides enhanced information regarding transcultural nursing concepts, specific Jewish religious practices, and the critical beliefs of Jehovah's Witnesses, drawing exclusively from the provided sources.

🌎 I. Transcultural Nursing and Cultural Competence (Detailed Review)

A. Foundational Concepts

  • Culture is both explicit and implicit. It is primarily learned and transmitted within a family, starting right after birth. Culture is usually shared by most members of a group and is a powerful, unconscious influence on health and illness.

  • Race is typically based on characteristics like skin pigmentation or hair texture, but physical characteristics are no longer considered a reliable way to determine a person’s race. The five major categories often listed are American/Alaska Native, Asian, Black/African American, Native Hawaiian/Other Pacific Islander, and White.

  • Ethnicity is a sense of identification with a collective cultural group, based on common heritage, which develops through day-to-day life with family and friends within the community.

B. Cultural Dynamics and Bias

  • Ethnocentrism is the belief that one’s own ideas, beliefs, and practices are superior and should be followed by everyone else.

  • Cultural Humility requires recognizing diversity and power imbalances, being open, self-aware, and respectful. Key aspects of cultural humility are avoiding assumptions, being curious, waiting for answers, and dismantling power dynamics in conversation.

  • Acculturation involves two cultures exchanging ideas, where one may adopt some new beliefs without rejecting the original home culture. Assimilation is the process where a minority group absorbs the dominant culture’s values and meshes into one.

  • Implicit Bias is pervasive, meaning people are often unaware of their biases, which nonetheless predict behavior. Implicit bias leads to failures in patient-centered care and interpersonal treatment, affecting communication, trust, and contextual knowledge of a patient’s values.

    • Examples of implicit bias impacting care: Non-white patients receive fewer cardiovascular interventions and renal transplants; Black women are more likely to die after a breast cancer diagnosis; and non-white patients are less likely to be prescribed pain medications.

  • Individualism encourages self-expression and values autonomy, where the most important person in society is the self. Collectivism prioritizes the larger group and is bound by loyalty.

C. Spiritual Needs and Assessment

  • Spiritual Needs include the need for meaning and purpose, the need for love and relatedness, and the need for forgiveness.

  • Nurses facilitate spiritual beliefs by offering compassionate presence, fostering nurturing relationships, and ensuring appropriate religious accommodations. For example, turning a patient’s bed to face East is 1,000% acceptable if requested for prayer, as Muslim people face East when they pray.

  • Agnostic refers to someone who holds that nothing can be known about the existence of a higher power. Atheist refers to someone who denies the existence of a higher power.

D. Transcultural Models

  • The Purnell Model for Cultural Competence provides a systematic framework linking the individual, family, community, and global society. The 12 domains include Communication, Nutrition, Pregnancy and Childbearing Practices, Death Rituals, and Spirituality.

  • The RESPECT Model is a guideline for cross-cultural communication:

    • Rapport

    • Empathy

    • Support

    • Partnership (patient autonomy)

    • Explanations (using Teach Back)

    • Cultural Competence

    • Trust.

✡ II. Jewish Heritage and Orthodox/Hasidic Practices (Detailed Review)

A. Pikuach Nefesh (Preservation of Life)

  • The preservation of life is the greatest priority and source of strength.

  • Pikuach Nefesh dictates that rules are made to be lived by, not die by, so many rules can be broken if it is life-saving.

  • Specific examples of rules broken for life preservation:

    • Phones can be used on Shabbat and holidays to call 911.

    • Paramedics can drive to the hospital on Shabbat and holidays. Ambulances with Hebrew letters may be seen in Jewish communities for this purpose.

    • Diabetics can use medical technology on Shabbat and holidays.

    • One can eat on Yom Kippur (a fast day) if medically necessary (e.g., pregnant women or those taking required medication).

    • One can eat non-kosher food if the only alternative is starvation.

B. Language and Community

  • Yiddish is a combination of Hebrew and German, used in Ashkenazi communities and the first language of many ultra-orthodox Jews. It was devised so that the Germans (Nazis) couldn't understand what they were saying during the Holocaust.

  • Ashkenazi Jews originate from Eastern Europe and Russia, while Sephardic Jews originate from Spain, Portugal, and the Middle East.

  • The Eruv is a physical boundary (often a wire) that allows observant Jews to carry needed things (and push strollers) in public on Shabbat, despite the traditional prohibition on carrying or work.

C. Kosher Dietary Laws (Kashrut)

  • Kosher means "fit to eat".

  • The law requires attention to food preparation.

  • One must avoid mixing milk and meat. This means avoiding items like cheeseburgers, lasagna, or meatballs with graded cheese.

  • Separate utensils, plates, knives, and even dishwashers are used for dairy and meat preparation.

  • Avoid pork, pork products, and shellfish. Fish must have fins and scales (shrimp and crabs are avoided).

  • Meat must be from an animal that chews cud and has split hooves (like cows, sheep, goats, or deer) and must be slaughtered in a particular, humane, and blessed way that drains the blood.

  • Kosher items in the grocery store are often marked with a 'K' or 'U' symbol with a circle. The basis of Kashrut originated because people noticed they would die after eating certain raw or improperly cooked foods (like pork, shrimp, or crabs).

D. Orthodox/Hasidic Practices in the Healthcare Setting

  • Shabbat (Sabbath) begins 18 minutes before sunset on Friday and ends 42 minutes after sunset on Saturday.

    • Observant Jews do no work. This includes operating a call bell, answering phones, driving, or handling money.

    • In hospitals, elevators may automatically stop at every floor during Shabbat so observant Jews do not have to push buttons.

  • Negiach Touch: Hasidic/Orthodox men are not permitted to touch women other than their wives and immediate family. They may keep hands in their pockets to avoid accidental touch and should not be looked directly in the eye by women, nor should they engage in idle talk.

    • Therapeutic touch is NOT appropriate. Healthcare providers should only touch Hasidic men when providing direct care.

  • Childbirth: Baby showers and naming the baby are considered bad luck before the baby’s arrival.

    • A Hasidic husband may choose not to attend delivery or may not touch his wife because she is considered "dirty" due to bleeding. He is not supposed to view his wife’s genitals, requiring the patient to be draped.

  • Male infants are circumcised and named at 8 days old by a mohel (a trained rabbi or OBGYN) at home, not in the hospital. Wine is given to the baby as an analgesic during the procedure. Female infants are also named at 8 days old.

E. Death Rituals and Health Concerns

  • The body is never left alone between death and burial.

  • Bodies are not refrigerated or embalmed.

  • Burial typically occurs quickly (within 48 hours).

  • Shiva, or 7 days of mourning, follows the funeral, acting as an open house where people bring food.

  • Mirrors in the house are covered during Shiva as a time to reflect and not worry about oneself.

  • A Minion is an evening service often held during Shiva that requires 10 adult men to be present.

  • Genetic Conditions: Conditions with a greater incidence include Tay-Sachs Disease, Gaucher’s Disease (most prevalent), and Torsion Dystonia. One out of 50 carries the BRCA1 & 2 genes that cause ovarian and breast cancer.

🩸 III. Jehovah's Witness (JW) (Detailed Review)

A. Core Religious Structure

  • JWs refer to God as Jehovah.

  • They view Jesus as the son of Jehovah, a Savior, and the Son of God, but do not adhere to the Holy Trinity doctrine.

  • The place of prayer is the Kingdom Hall.

  • Religious leaders are Elders who are unsalaried and not considered clergy; their income is based on donations.

  • They believe that 144,000 will be resurrected to heaven to rule with Jesus. People who die pass out of existence and do not suffer in a fiery hell; God will bring billions back via resurrection.

  • They adhere to the standard of marriage as the union of one man and one woman, with sexual immorality being the only valid basis for divorce.

B. Refusal of Celebrations

  • Jehovah’s Witnesses do not celebrate holidays.

  • They do not celebrate birthdays because celebrations tend to give excessive importance to an individual, and the only birthdays mentioned in the Bible were of sinners.

  • They avoid Christian holidays (Christmas, Easter) because they are based on Pagan traditions, folklore, and mythology.

  • They avoid secular holidays (New Year's, Veteran's, Independence Day) because they are viewed as immortalizing people above God.

C. Absolute Refusal of Blood Products

  • Jehovah's Witnesses will not receive any blood products.

  • This is due to the belief that God views blood as representing life, and the Bible states to abstain from blood. Avoiding blood shows respect to God as the Giver of Life.

  • Nurses must respect this belief and patient autonomy.

  • In critical situations like labor and delivery, JW patients are required to sign a blood refusal consent form, verifying that they refuse blood even if it means they may die. As a healthcare provider, one must respect the patient's decision, even if it is difficult.