Application of Nursing Knowledge to Deliver Culturally Competent Care

1. Migratory history, demographics

There have been Jewish communities in the United States since colonial times. Early

Jewish communities were primarily Sephardi, composed of immigrants Spanish and Portuguese

descent. Nowadays, the Jewish population of the U.S. is the product of waves of immigration

primarily from diaspora communities in Europe; emigration was initially inspired by the pull of

American social and entrepreneurial opportunities, and later was a refuge from the peril of

ongoing European antisemitism (Diner, 2006).

In the late 1800s and the beginning of the 1900s, many Jewish immigrants arrived from

Europe. During this period there was an almost hundred-fold increase in America's Jewish

population from some 3,000 in 1820 to as many as 300,000 in 1880. Between 1881 and 1924, the

migration shifted from Central Europe eastward, with over two-and- one-half million East

European Jews arriving to the USA.This period of immigration came to an end with the passage

of restrictive laws in 1921 and 1924. Refugees arrived from diaspora communities in Europe

after World War II and, after 1970, from the Soviet Union. The largest Jewish population centers

are the metropolitan areas of New York (2.1 million), Los Angeles (617,000), Miami (527,750),

Washington, D.C. (297,290), Chicago (294,280) and Philadelphia (292,450) (Dashefsky &

Sheskin, 2021).

Today the Jewish community in the United States consists primarily of Ashkenazi Jews,

who descend from diaspora Jewish populations of Central and Eastern Europe and comprise

about 90–95% of the American Jewish population. During the colonial era, prior to the mass

immigration of Ashkenazi Eastern European Jews, Sephardic Spanish and Portuguese Jews

represented the bulk of America's then-small Jewish population, and while their descendants are

a minority today, they, along with an array of other Jewish communities, represent the remainder

of American Jews, including other more recent Sephardi Jews, Mizrahi Jews, Beta Israel-

Ethiopian Jews, various other ethnically Jewish communities, as well as a smaller number of

converts to Judaism. The American Jewish community manifests a wide range of Jewish cultural

traditions, encompassing the full spectrum of Jewish religious observance (McKee, 2000).

2. Identify physiological, environmental, psychosocial factors that influence

communication within members of the group and with persons outside the group.

Jews were recognized over the ages as a people of a distinct religion, or as a people with

unique socio-cultural bonds, in various contexts and at different times. In terms of physiology,

interestingly, it has now became evident that this group includes various genealogical linkage

(Falk, 2015). However, some Orthodox Jews have very distinct way of clothing and appearance.

They are recognizable by their distinctive garments worn for reasons of ritual, tradition or

modesty. In particular, Orthodox men cover their heads with kippot, and some cover these with

black hats or a shtreimel, a type of fur hat. More stringently Orthodox men often wear black

suits, and many Hasidic men wear suits that are reminiscent of the style Polish nobility wore in

the 18th century, when Hasidic Judaism began. Women are discouraged from wearing bright,

attention-getting colors. Once married, most Orthodox women cover their hair, whether with a

hat, wig or scarf.

In terms of environment, many jewish people live in bid cities such as New York and

Florida. Several other major cities have large Jewish communities, including Los Angeles,

Baltimore, Boston, Chicago, San Francisco and Philadelphia. In many metropolitan areas, the

majority of Jewish families live in suburban areas. Education plays a major role as a part of

Jewish identity; as Jewish culture puts a special premium on it and stresses the importance of

cultivation of intellectual pursuits, scholarship and learning, American Jews as a group tend to be

better educated and earn more than Americans as a whole (Heilman, 1995).

In terms of the psychosocial component, it’s important to take into consideration the

history of this cultural group. For example, holocaust survivors and their families may manifest

the pain of their traumatic past in the form of various psychiatric symptoms, according to an

analysis of 44 years of global psychological research. They have poorer psychological well-

being, more post-traumatic stress symptoms and more psychopathological symptoms (Barel et

al., 2010). Additionally, they may experience mental health disorders, including PTSD and

survivor guilt. Even second and third generation descendants of Holocaust survivors also show a

higher prevalence of PTSD and other psychiatric symptoms. Debates about biologically based

epigenetic changes in survivors persist, but there is consensus that survivor behavior impacts

family dynamics and molds family members’ stress responses.

All the above mentioned factors may contribute to misunderstanding during to

communication with people outside the group. Moreover, different groups may have

misunderstandings between each other since not every Jewish person has the same background

and traditions.

3. Explain the influence of their beliefs on their health practices.

The beliefs shape the behaviors and health practices of this group in a number of ways.

For those families who practice arranged marriages, for example, underreporting of illnesses and

avoidance of seeking care is a big problem. Stigma about mental illness as its link with marriage

arrangements in some Jewish community may lead to under-reporting of the illness and delayed

treatment. Therefore, the Jewish community—especially Orthodox women—may be at risk for

eating disorders and other mental health issues and may also face barriers to treatment.

Additionally, stress from emphasis on high academic achievement may lead to many health

issues. Jewish-Americans who are not academically inclined or who have learning disorders

(such as ADHD or dyslexia) may feel shame or loss of social status in a community that stresses

high academic achievement (American Psychiatric Association, 2021). Moreover, Jewish law

requires that the patient’s rabbi be included as a decision-maker to ensure that decisions are

acceptable under Jewish law.

4. Identify 3-4 barrier factors that influence the provision of culturally competent health

care.

Some of the barriers this cultural group faces when it comes to receiving culturally competent

health care are: lack of knowledge about Jewish beliefs related to healthcare, stigma associated

with having an illness, and language barrier (American Psychiatric Association, 2021).

5. Identify at least one ethical dilemma that may occur in the delivery of health care.

One ethical challenge we have chosen to discuss is patient’s self-determination. A central tenet of

Jewish law and tradition is the sanctity of all human life. There is thus a widespread perception

that Jewish law mandates that all measures be taken to extend a dying person’s life regardless of

financial cost, emotional burden to the family, and prolonged suffering of the patient. This duty

to preserve life applies to healthcare providers and to the patient. A person’s life is not seen as his

or hers to dispose of as he or she wishes but as having intrinsic sanctity or, to put it in religious

terms, as belonging fully or partly to God. Not only suicide, but also any form of self-injury, is

prohibited. This raises important questions about the permissibility according to Jewish law of a

patient’s refusing life-saving treatments, given that the key consideration is not that of self-

determination but of the duty - of the doctor and the patient - to protect life. Additionally, in

many cases Rabbi must be included in decision making. Therefore, patient’s self-determination is

an ethical issue that needs to be considered when caring about this group of patients (Treatment

of Terminally Ill Patients According to Jewish Law, 2013).

References

Barel, E., van IJzendoorn, M. H., Sagi-Schwartz, A., & Bakermans-Kranenburg, M. J. (2010).

Surviving the Holocaust: A meta-analysis of the long-term sequelae of a genocide.

Psychological Bulletin, 136(5), 677–698. https://doi.org/10.1037/a0020339

Dashefsky, A., & Sheskin, I. M. (2021). American Jewish Year Book 2020

(American Jewish Year Book, 120) (1st ed. 2021 ed.). Springer.

Diner, H. R. (2006). The Jews of the United States, 1654 to 2000 (Volume 4). University of

California Press.

Falk, R. (2015). Genetic markers cannot determine Jewish descent. Frontiers in Genetics, 5.

https://doi.org/10.3389/fgene.2014.00462

Heilman, S. C. (1995). Portrait of American Jews: The Last Half of the Twentieth Century

(Samuel and Althea Stroum Lectures in Jewish Studies). University of Washington Press.

McKee, J. O., Airriess, C., Arreola, D. D., Boswell, T. D., Brown, C. L., Brunn, S. D., Clawson,

D., Cruz-Báez, A. D., Goodman, J. M., Heffington, D., Miyares, I. M., Noble, A. G.,

Paine, J. A., Pannell, C. W., Rose, H. M., Sheskin, I., & Zeigler, D. J. (2000). Ethnicity in

Contemporary America: A Geographical Appraisal (Subsequent ed.). Rowman &

Littlefield Publishers.

Treatment of Terminally Ill Patients According to Jewish Law. (2013). AMA Journal of Ethics,

15(12), 1081–1087. https://doi.org/10.1001/virtualmentor.2013.15.12.msoc2-1312