Case Study #2 Rabbi Silverstein
New York City of Technology Nursing 4050 Case study #2 Professor Lynda Konecny Ammiel Callum 04/24/2013
Introduction:
There are many cultures that views spiritually competent care and religious practices differently. As healthcare providers, we must ensure all aspects of spiritual care is respected and provided to the individual. What changes could the nurse make within this healthcare system to provide spiritually competent care for the client?
“Spiritual care is so much more than religious care.
Spiritual care discovers, reverences, and tends the spirit- that is energy or place of meaning and values-of another human beings.” (Matzo & Sherman, 2010) For a nurse to complete a spiritual competent care on an individual, a spiritual assessment must be assessed and completed. In order to do so, the nurse must comprehend and respect Rabbi Silverstein’s spirituality, values, practices, and beliefs. The objective of a spiritual assessment is to bring information about the core of spiritual needs and how the nurse and other members of the healthcare team can respond to them. (ppt. 52, Meeting Responses of the Spiritual Domain) Spiritual competent care can provide information on how the individual is coping with their illness. In order to make changes, the nurse can ask several questions about his spiritual needs: What is his religion?
Does he have any practices and beliefs that can be implemented in his care?
Are there any practices/ restrictions which hospital personnel should be aware of?
Is he part of any religious group(s)?
Are there any advance directives that needs to be addressed?
Is he at peace, or feeling hope and despair?
Is he suffering physical, emotional, social or spiritual?
Does he have a special diet that he follows?
What are his views on death and dying?
It is imperative to ask the patient about preferences of staff.
Does he prefer male staff only or mixed gender? The nurse should facilitate the observation of religious practices/rituals but never participate in them unless asked too. Once these questions are answered and reviewed, now interventions can be provided.
The nurse can provide this information to the interdisciplinary team, which can give spiritual support. Actively listening to the Rabbi Sliverstein shows support and allows him to express his feelings and thoughts. According to Palliative Care of Nursing (2010), silent witnessing and presencing can serve as a liaison with other members of the healthcare team in addressing physical, emotional, and spiritual needs. Another change that can be done to provide spiritual competent care is suggesting watching spiritual/religious programs on television, reading a spiritual book (ie: Torah), provide favorite secular or sacred music, and ensure private and quiet time for prayers or mediations. Another change would be is to notify a rabbi who is affiliated with the hospital to assist in prayer and discussion. In general hospital settings, with no religious affiliation, what limitations are presented to the nurse in providing spiritual care for a client of Jewish faith?
As healthcare providers, we have to be aware of Jewish customs and beliefs in order to provide spiritual care to an individual of Jewish faith.
“All body language and behavior should be modest and proper among observant Jewish people.” (Fralich, 2005) Laura Gebers, BSN, RN, BC wrote an article “ Care of the Orthodox Jewish Patient”, which expressed on how to care for a client who is of Orthodox Jewish descent. If providing care to an Orthodox Jewish individual we must ask if it is permissible to shake hands. Some Orthodox Jews do not shake hands with members of the opposite sex unless it is their spouse or family member. Another limitation that can present a problem is personal hygiene. A female nurse cannot provide personal hygiene to an Orthodox Jewish male and vice versa. The Yarmulkes is very important to an Orthodox Jewish male individual. It represents “God is above them; believe the God is looking over them, protecting them and observing their conduct.” The Yarmulkes must be worn at all times especially in public. Even if the individual of Jewish faith must have a procedure done in the OR, the Yarmulkes stay on. An OR cap will provided and placed on the head with Yarmulke intact. Sabbath or Shabbat, which is considered the “Holy Day” is an important ritual to an individual of Jewish faith. Sabbath starts from Friday at sundown to Saturday sundown. According to “Caring of the Orthodox Jewish Patient”, on the day of Sabbath, Orthodox Jewish people are not allowed to perform certain tasks (i.e. cooking, use of electricity, sowing, plowing, reaping, baking, selecting, pinning, typing, untyping, or hitting a hammer) On the Sabbath day, in most hospital setting, the elevator would stop on every floor to avoid touching the button. An Orthodox Jewish person may say the light is on the room and the nurse must be aware and adhere to the cue of turning off the lights. On the Sabbath day, a person of Jewish faith must not order to non-gentile (non Jewish person) to complete any tasks. Kosher food is very important to person of Jewish faith and it is a dietary law that must be abided. We, as healthcare provider, must ensure that the dietary department is aware of the special meal for that person. What religious practices would the nurse expect to see in this case?
Shabbat is considered the holy day for an individual of Jewish descent.
It is considered the day of rest and “spiritual enrichment.” Shabbat is incorporating from The Ten Commandments. The nurse will observe the Rabbi praying or reciting a prayer every morning and three times a day. Prayer is seen as a form of control by believing that through prayer they can influence their medical outcomes. (Matzo & Sherman, 2010) Prayer is imperative to Jewish worship. During prayer, the head must be covered with a Yarmulke and may use a prayer shawl called “Tallit”. Tallit must be worn while reciting morning prayers, on Sabbath, and on religious holiday. The nurse may observe the person reading the Torah or other spiritual materials. They believe God gave Moses the whole Torah at Mount Sinai. The whole Torah is consisting of the first five books of the Bible and an Oral Torah, which interprets and explains the purpose of the Written Torah. In case of an emergency, there are allowed to break Sabbath. They believe that it is God’s will that they do everything they can to protect their health. What dietary practice would be expected?
For every culture, we have value their beliefs, cultural practices, and preference of food.
Kosher meals are very important for the Orthodox Jewish population. Cleanliness is very important to this culture. Kosher is a Hebrew word and it’s translated as fit, legal or right. It is food that is allowed for Jewish people to eat in according to Jewish law. According to Orthodox-Jews.com, Jewish people are not allow to eat fish that has fins or scales, meat (and milk) from animals that don’t chew their cud and have split hooves (i.e. cows and sheep), and birds of prey. The Kosher dietary law forbids eating blood of an animal and any animals that wasn’t slaughtered under the Jewish law. Frozen prepared meals can be given to an individual who is an orthodox Jew. During Passover, bread or bread products are not used. All kosher food must be prepared with cookware, dinnerware, and utensils that never came in contact with bread. Plastic forks, spoons, and knives are given out during Passover. What accommodations could immediately be made to make the client feel more comfortable?
To facilitate and accommodate the client needs, addressing all vital information to the healthcare staff is crucial to provide support and show respect of one’s culture.
The client can be moved to a private room to accommodate for visitors, prayers, and any rituals that may be performed. Modesty and privacy are important in the Jewish culture. During Sabbath and other religious observances, candle lighting is traditionally used. In a hospital setting, candle lighting is prohibited. In order to accommodate this practice, an electric light bulb can be provided. Extending visit hours may be needed if friends or family of the client would like to visit the client after Sabbath is over. Orthodox Jews perform washing rituals before and after eating, and before prayers. Running of the water is required during this practice. Most Jewish holidays require fasting. Healthcare providers should avoid setting operations, appointments, visits, and other procedures. A private room can be provided to the client’s family member if medical care is done on Sabbath. The room should contain a refrigerator with kosher food, television, and religious texts for prayers. Healthcare providers can encourage sitting outside or taking a walk a garden so the client wouldn’t feel depressed or lonely. Also, we can accommodate transportation to a local synagogue where the client can worship during religious observances and holidays. A rabbi can be involved in the client’s care where they can establish communication and develop a trusting relationship. How should the nurse approach teaching the client about his condition?
“ You ask me why I do not write something.
I think one’s feelings waste themselves in words, they ought all to be distilled into actions and into actions which bring results” – Florence Nightingdale. Teaching is essential during any care in a hospital setting. The purpose of teaching is to promote patient healthy outcomes, answering questions or concerns, and being honest about health conditions outcomes. Teaching involves patient and patient family knowing about the health care status and healthcare decision-making. Orthodox Jewish people trust the medical and nursing staff and expect nothing but honest answers. They expect their questions and concerns to be answered in an appropriate manner. All members of the healthcare team should be involved in teaching especially nurses. Nurses are always at the bedside observing, assisting needs, teaching, active listening, and participating in the client’s care. When approaching the client on teaching materials, we must be culturally sensitive to their responses and we should have a non-judgmental attitude. Meeting the Responses of spiritual domain ppt. 74 stated “thinking about what gives your own life meaning and value helps in developing your spirituality and assists you in being able to support the patients.” Greeting the individual preferably by Mr, Mrs, Ms, or Rabbi is important. We should ask what would he or she prefers. Orthodox Jews prefer to be greeted verbally. Hand shaking may be prohibit unless of the same-sex. If teaching occurs on a Sabbath day, the client may/may not reply due to their religious observance. As nurses, we should not take it as a rude behavior. When bringing up the issues of end of life, resuscitation, life support, or organ donation, we must consider that the client may speak to a Rabbi or a spiritual counselor before consulting with the healthcare team. According to the Wimba lecture of Meeting the Responses of spiritual domain, ppt. 61 states nurses have to keep in mind the overall goals of fostering meaning, hope, connection, and recognizing transcendence, which is beneficial on approaching the client when teaching occurs. Interventions in completing this would include: Relief physical discomfort Comforting touch if it is allowed by the client Authentic presence Attentive listening Listening to life stories Sharing caring words Fostering reconciliation Respect religious traditions Refer the person to a spiritual counselor
Conclusion In conclusion, spirituality is an important factor when caring for an individual.
As healthcare providers, we must respect and value one’s practices, beliefs, and remember we live in a cultural diversity world. References:
Gebers, Laura, BSN, RN,BC.
Care of the Orthodox Jewish Patient. Vol. 5.Issue 25. Page 37; November 24, 2003www.orthodox-jews.com.
Everything you need to know about Orthodox Jews. 2010http://nursing322sp10.wordpress.com/jewish-culture
www.jewfaq.org (1995-2011) Tracey R.
RichMatzo, M., & Sherman, D.W.
(2010). Palliative Care Nursing. Quality Care to the End of Life (3th ed., pp. 23-25). New York, NY:Springer Publishing CompanyKonecny, L.M.
(2009). Meeting Responses in Spiritual Domain [PowerPoint slides]. Retrieved from https://bbhosted.cuny.edu//@0DBC92E7015BA7524CB5C3E251809E7E/courses/1/NYCTC_NUR_4050_2742_201109/content/_6931886_1/