Vol. 5 Issue 25
Care of the Orthodox Jewish Patient
Learning Sabbath and dietary customs of Jewish Orthodox patients can help nurses in providing for their special needs
In today's healthcare arena we are more aware of cultural diversity with the populations we serve. But once we have identified what is different, do we have the skills and ability to meet and be sensitive to the needs of those who are different from us?
At Deborah Heart and Lung Center, Browns Mills, NJ, we care for Orthodox Jewish patients, among the many cultural and ethnic populations we serve. The Cultural Diversity Committee at Deborah recently hosted a presentation to increase staff awareness that Orthodox Jewish patients may require unique care. Rabbi Herbert Bialik, affiliated with Van Dyke and Jewish Hospices, Toms River, NJ, explained that Orthodox Jewish patients follow religious observances that may affect their care in a healthcare setting.
The Sabbath (Holy Day) is observed by Orthodox Jews from Friday at sundown through Saturday sundown. During their observance of no work on the Sabbath, Orthodox Jewish patients are forbidden to perform certain tasks, and cannot request anyone to perform work for them. However, it is permissible for them to indirectly hint to a gentile (non-Jewish person). For example, if a light is on in the patient's room, the patient will not turn off the light, but may say to the healthcare provider, "It seems to be light in here." The healthcare provider needs to be able to ascertain that the comment is a cue to act upon and do so, by turning off the light.
If a family member is visiting a patient or if someone is seeking care in the ED on the Sabbath, the electric doors to enter the facility are obstacles. Initiating use is a breach of the electrical system, and therefore is prohibited and offensive to the faith. In a highly populated Jewish Orthodox community the hospital removes the electronic function from one of the main doors and indicates it with large Hebrew signage.
Emergencies and Sabbath Restrictions
The sanctity of human life is supreme for Orthodox Jews, as it is for other faiths. It is neither breach nor violation of Hebrew law for a Jewish layperson or healthcare provider to care for a patient in need. Any life-threatening situation overrides Sabbath restrictions. If a patient requires care from a family member, that person will refer to his own rabbi for questions regarding religious practice.
While some restrictions pertain only to the Sabbath, there are other daily restrictions that are practiced by the Orthodox Jew. Healthcare providers need to be aware of general customs that affect the Orthodox Jewish population. There is a gradient of attitudes with the comfort of shaking hands. The best intervention is to ask if shaking the Jewish Orthodox person's hand is permissible before pursuing the course of action.
Also, food to be served to Jewish Orthodox patients must be prepared in a kosher manner. That means that meat and poultry are not mixed with milk products, and a rabbi must inspect and approve the kitchen area for compliance. Many hospitals now use a frozen prepared dinner for patients requesting a kosher meal. In facilities where the populations of Jewish patients are significant, there may be an exclusive kitchen complying with kosher guidelines.
Maintaining kosher for Passover also requires that there be no use of bread or bread products. All food preparation must be done with cookware, dinnerware and utensils that have never come in contact with bread. For this reason, plastic utensils are widely used during Passover.
When help is needed with washing a patient, personal hygiene should be performed by the same sex person when possible. Hand washing is necessary before eating.
Yarmulkes, worn by Jewish Orthodox males on their head, are a material sign that God is above them. They believe that God is looking over them, protecting them and observing their conduct. Yarmulkes are of any color or size. Many Orthodox Jewish women may also cover their heads. Many cover their hair in public once they are married. This is achieved by wearing a wig or scarf. Both sexes must have their head covered even in the OR, but not necessarily with the head covering with which they came to the hospital. A paper OR cap is appropriate.
Candle lighting is traditional during the Sabbath and on other religious observances. Since flames from the candles are a fire hazard in the hospital, electric light bulbs simulating the flame may be used instead of candles.
Often, family members visiting a patient don't live near the hospital; and their beliefs don't permit them to drive or be driven on the Sabbath. The hospital may have a hospitality suite available for visitors to rest and sleep. The suite should be equipped with a kosher-designated refrigerator.
Autopsy Generally Not Permitted
If an Orthodox Jewish person should die, burial is done expeditiously, within 24 hours if possible. Autopsies are not permitted, but if a highly unusual or suspicious situation exists it may warrant an autopsy. Autopsies cause a disfigurement of the body, and when done, care should be taken to ensure it is minimally invasive. Organ donation, a gift of life, is considered a mitzvah a good deed.
When caring for a Jewish Orthodox patient and interacting with family members, the best course of action is to ask what special needs they may have. Offer to assist them with adhering to Sabbath laws. Effective communication, understanding and tolerance are key to ensuring that the Jewish Orthodox patient's healthcare and spiritual needs are met.
Laura Gebers is the patient care services prorams and health education coordinator for Deborah Heart and Lung Center, Browns Mills, NJ. She can be reached at Gebersl@deborah.org.