The Hasidic Jew is an especially tightly-knit community. As such, providing care necessitates the consideration of cultural and religious beliefs to determine the best possible plan of care necessary for the provision of culturally correct services to Ivka. The Cohens are a family having this cultural and religious background, where Ivka is a growing child. Therefore, treating their daughter Ivka requires that the caregivers understand the necessity of consulting their cultural-religious background in providing a favorable care plan for Ivka. As the law states, care should be provided to every American citizen subject to their socio-cultural backgrounds and without being subjected to any discrimination (Scholes & Moore, 2000). This paper considers important aspects of the Hasidic Jew and their cultural-religious beliefs, health belief systems, the role of the family and religious quotas after which a favorable care plan can be developed.
Case Background
Cystic Fibrosis is a condition affecting the production of the CFTR protein leading to an excessive production of mucus in the digestive and respiratory systems. As a result of this, people with this condition will suffer poor weight gain, reduced sodium levels in one’s system, reduced fertility, chronic coughs and lung obstruction (Center for Jewish Genetics, 2014). Research shows that the frequency of CF among Jews varies depending on the origin of the Jew with a peak rate of one in 2400 Jews being affected to a low of one in 39,000 (Kerem, Chiba-Falek, & Kerem, 1997). In this case study, we look at the provision of culture-sensitive care to a Hasidic Jew patient affected by CF.
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Cultural-Religious Beliefs
The Hasidic Jew is considered one of the most tightly knit communities among the Jews. Cultural issues will largely affect their decision-making abilities as much of their decisions are based on the concept of being closer to god via their spiritual leader – the Rabbi (Schnall, 2006). Therefore, their cultural background is built on strict cultural observance of religious practice. As such, we see the Cohen family regularly engage in going to the synagogue and being in fellowships with other men there while they are spending time together. Additionally, Mr. Cohen can be seen to be quite religious, spending most of his time at the synagogue when he is not working. This is the same trend that is being taught to the children.
Moreover, the community largely believes in cultural seclusion (Coleman-Brueckheimer & Dein, 2011). Thus, a description of the same is given when the case study begins. The extended family lives together and intermarries within the community. This exposes them to possible health risks because of consanguinity that the doctors suspect. Cultural insularity is evidenced when the mother is not comfortable with caregivers at the school knowing the condition of her daughter and the necessity of her enzymes (Andrews & Boyle, 2008). Additionally, much stress is put on the reverence of their Rabbi, who is their spiritual leader. Confiding in the Rabbi and involving him in decision-making processes for the family is seen as intimacy with God. Therefore, regular resort is seen to their spiritual leader before making decisions, including allowing their daughter to take the drugs for her CF condition.
Health Belief Systems of the Hasidic Jew
Research in the area has proven that the Hasidic Jew may seek spiritual intervention when approaching health matters (Sublette & Trappler, 2000). This implies that when faced with health challenges, the Hasidic Jew will normally seek medical attention, albeit after seeking spiritual comfort. This explains the actions of the Cohens when they fail to accept their daughter’s admission to the hospital. Only when it got worse did they accept to take her. Even then, they wouldn’t allow her to stay too long, and neither would they entertain the visiting nurse to attend to their daughter. Healing is a large part of their explanation concerning health. As such, spiritual resolve for healing will work on their models of health as the higher being is considered the source of health. Therefore, it is highly unreasonable to engage the Hasidic Jew in a plan of care that doesn’t include their spiritual aspect, since it would be rejected (Sublette & Trappler, 2000).
Moreover, illness is an attraction for stigma among the Hasidic Jews. As such, illness will not be considered something of normal effect among them (Popovsky, 2010). This explains their approach to decline the visits of the visiting nurse. Apart from their exclusionary approach to living, a constantly visiting healthcare official means that their family would be the subject of stigma from their community. This attitude is extended to their daughter’s school where caregivers are not informed of Ivka’s condition. As such, she doesn’t take her enzymes during this time and only takes them after school. Therefore, socio-cultural factors play a role in the provision of healthcare as religion is the main basis upon which care is provided (Rozen, 2003). Subsequently, the development of a favorable care plan for Ivka involves creating a culture-friendly care plan that meets the needs of the family and caters for her best interests.
Approaches to Health
Having considered the various factors influencing healthcare, it is necessary to develop a proper healthcare plan that reflects the best interests of Ivka and her family, both at the healthcare level and at the cultural level. The effect on non-implementation means that there are frequent visits to the hospital that the Cohens make, which may be unnecessary. The objective of such a care plan would be to reduce the inconvenience to the family and the discomfort to the patient. As can be seen, most of these trips are as a result of the family’s reluctance to engage the full measure of treatments as suggested by the caregivers due to their seemingly restrictive religious beliefs. As such, the healthcare plan requires needs to meet the needs of the Cohens as a cultural-religious patient, as well as act in the best interests of the minor patient’s health.
Traditional Hasidic communities have reported the power of healing among rabbis (Rozen, 2003). As such, their spiritual leaders have been known to have powers that include healing the sick. Therefore, the role of healing (and its spirituality) in the concept of care for the Hasidic Jew is an especially important aspect for consideration. Since this “healing” is not coming from the rabbi, the involvement of their spiritual leader in all the aspects of care is important to having the child well taken care of. In the case of the child, the parent will “go into the Rabbi” and determine the cause of the child’s illness. The Rabbi will divine the cause in the presence of the prescribing doctor and offer the cure for the illness. As such, the Rabbi’s involvement is crucial to the administration of care to the Hasidic Jew (Rozen, 2003).
As Rozen (2003) suggests, the best approach to providing care for the Hasidic Jew, especially those with very close connections to their spiritual leader, would be to suggest the plan of care to the patient and her family in the presence of the spiritual leader. This would adequately allow discussions on the acceptable standards as guided by cultural-religious principle. As can be seen, the Rabbi had on previous occasions allowed Ivka to be put on certain medication because of her condition. Ensuring his presence during this discussion would eliminate the double consultations that the Cohens have been making with the doctor and the Rabbi on different occasions (Schnitzer, Loots, Escudero, & Schechter, 2009). Such a unified conversation would expose the gravity of the situation to both the parents and the spiritual leader, allowing for the treatment of Ivka with their religious backing.
Furthermore, the issue of stigma would be discussed as an action for the greater good. The stigma caused by the sickness of a child wouldn’t equal the stigma of worse consequences such as loss of life for failure to seek medical attention. Therefore, the discussion on acceptance would further be boosted by the need to act in the best interests of the child with due involvement of their cultural background.
The object of the care plan in this case would be to maintain lung function to as close to normal as possible, manage complications and administer nutritional therapy to boost growth. Therefore, the importance of Ivka’s consumption of pancreatic enzymes, multivitamins and bronchodilators need to be discussed with the patient’s parents and their religious leader. Additionally, previously discussed restrictions and allergies must be considered for the provision of culturally-sensitive care. Other approaches can be considered for example hypertonic saline inhalation in a bid to clean airway surface liquid and improve inhalation. Research has pointed to improved inhalation at 7% for patients using this treatment (Elkins, Robinson, & Rose, 2006; Donaldson, et al., 2006).
Furthermore, evidence-based practice recommends regular visits to the care institution every two to three months following admission to the hospital due to complications. Follow-up care must be sought for the parents for the best interests of the patient. Necessity is drawn for the case of Ivka who has been admitted twice over the condition. Seeking follow-up care and the administration of drugs at the prescribed times is especially key in maintaining her health. This would mean informing the school administration of the need to take her home during lunch times for the administration of enzymes and getting her back to school. This way, privacy on the part of the family will be maintained while Ivka is still being cared for regularly.
In conclusion, the plan of care involves bringing on board a limited number of parties to maintain the highest care standards for Ivka. This means that the parents could be taking the child home for medication at lunch times and returning her in time for school. As such, the objectives of the care plan would be met – providing good quality care and giving a culture-sensitive approach for the Cohens.
References
Andrews, M. M., & Boyle, J. S. (2008). Transcultural concepts in nursing care. Lippincott: Williams & Wilkins.
Coleman-Brueckheimer, J., & Dein, S. (2011). Health care behaviours and beliefs in Hasidic Jewish populations: a systematic review of the literature. Journal of Religious Health, 50(2) , 422-36.
Donaldson, S., Bennett, W., Zeman, K., Knowles, M., Tarran, R., & Boucher, R. (2006). Mucus clearance and lung function in cystic fibrosis with hypertonic saline. New England Journal of Medicine, 354(3) , 241-50.
Elkins, M., Robinson, M., & Rose, B. (2006). A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. New England Journal of Medicine, 354(3) , 229-40.
Popovsky, R. M. (2010). Special issues in the care of Ultra-Orthodox Jewish psychiatric in-patients. Transcultural psychiatry, 47(4) , 647-672.
Rozen, D. (2003). Biomedicine, Religion, and Ethnicity: Healing in a Hasidic Jewish Community. High Plains Applied Anthropologist, 2(23) , 112-24.
Schnall, E. (2006). Multicultural counseling and the Orthodox Jew. Journal of Counseling and Development: JCD, 84(3) , 276.
Schnitzer, G., Loots, G., Escudero, V., & Schechter, I. (2009). Negotiating the pathways into care in a globalizing world: help-seeking behavior of ultra-Orthodox Jewish parents. International Journal of Social Psychiatry .
Scholes, J., & Moore, D. (2000). Clinical exchange: one model to achieve culturally sensitive care. Nursing Inquiry, 7(1) , 61-71.
Sublette, E., & Trappler, B. (2000). Cultural sensitivity training in mental health: Treatment of Orthodox Jewish psychiatric inpatients. International Journal of Social Psychiatry, 46(2) , 122-134.
