People of Japanese and Jewish Heritage

Caring for a Jewish patient can be complex in that providing holistic care encompasses meeting physical, psychological, social, and spiritual needs as they arise.How patients approach a life threatening illness may or may not be founded in or influenced by, their religion or belief system. Often, clinicians assume that because a person identifies him or herself as Jewish, he/she adheres to the Jewish religion. It is not uncommon for people to think of Judaism as a monotheistic world religion like Christianity and Islam, which define themselves primarily by adherence to a certain creed or set of beliefs. Judaism on the other hand, begins with an ethnic identity as most Jews are Jewish by virtue of being born into a Jewish family.

Nurses need to understand every aspect of patient religion in order to provide accurate care and be able to create a trusting and respectful relationship with the patient. Being Jewish refers to both a person and a religion, not a race. Judaism is more than a religion; it is a people and a culture.

Understanding some specific practices related to death and dying may have an impact on other aspects of heath care, including the death of premature infants and the care of amputated limbs. The period of time between the death and the burial is short, and it is the time for the emotional reaction to the death. The burial may be delayed only if required by law, if relatives must travel great distances, or if it is the Sabbath or a holy day. Mourners are absolved from praying during this time. Crying, anger, and talking about the deceased person’s life are acceptable.

The nurse should also be aware of Jew’s religious holidays since in some occasions they will interfere with medical treatment. For example, the Sabbath serves as a release from weekday concerns and pressures. During this time, religious Jews engage in congregational study and do no manner of work, including answering the telephone, operating any electrical appliances, handling money, driving, or operating a call bell from a hospital bed. If an Orthodox patient’s condition is not life-threatening, medical and surgical procedures should not be performed on the Sabbath or holy days.

Religious Jews start each day with a prayer of appreciation for having lived another day.The goal is to appreciate things and people while one still has them. Traditional Judaism believes in an afterlife in which the soul continues to flourish, although it is not mentioned in the Torah. A dying person is considered in a living person in all respect. Therefore a dying person should not be left alone, it’s considered respectful to stay with a dying person. The nurse should expect to have a lot of people in the dying patient room. Some Jews feel solace in saying the Shema in Hebrew or English. This prayer confirms one’s belief in one God. At the time of death, the nearest relative can gently close the eyes and mouth; the face is covered with a sheet. The body is treated with respect and revered for the function it once filled. The dead body is not left alone from the time of death until the funeral, so as not to leave defenseless.

-Traditional Japanese customs regarding health and health care are very different from the medical mores of Westerners. The concept of “hazukashii” or shame, is linked to all aspects of Japanese life: family, business and health. Great importance is placed on achieving success and maintaining health and close family ties. Poor health can be a very shameful experience for the Japanese and great care is taken to approach a patient and the patient’s family about illness in a blameless, indirect way. For example, the concept of “ shikata ga nai” which means “it cannot be helped” is often used to explain a case of terminal illness.

The Japanese approach to health and health care stem largely from religious and philosophical beliefs. The dominant faiths in Japan are Shintoism and Buddhism and most Japanese believe in both. Shintoism is an ancient religion based on the belief that the gods are represented in natural surroundings such as rivers, trees and mountains with shrines built to honor these gods. One of the most important ways to show respect for the gods upon entering a shrine is by washing your hands. Cleanliness is akin to spiritual purity. According to Shintoism, illness and disease are considered unclean and impure. Buddhism, however, treats aging and illness as a natural process and many Japanese embrace Buddhism later in life. End of life treatment and funeral rituals are often practiced according to Buddhist beliefs in Japan.

-After death fir Japaneses, there is a ceremony called “Water of the last moment” or “Matsugo-no-mizu” where lips of the deceased are moistened with little bit of water.

Most Japanese have a household shrine. After death the shrine is closed and covered with a piece of white paper. It is done to keep out the impure spirits of death. Japanese call this Kamidana-fuji.

A small table is put next to the bed with deceased. On such table there are some flowers, incense and a candle. Some people put a knife on the chest of deceased. This knife should defend her or him from the evil spirits.

Family of the deceased then informs cousins and friends. As a sign that someone died family puts a white paper lantern in front of the house. A death certificate is issued. Family also contacts the local temple to make arrangements for the funeral.

Body of the deceased is washed. Little bit of cotton or gauze is put in the orifices. The deceased female wears are a kimono. Men sometimes wear it too. But usually dead male wears a suit. To improve the look of the deceased a make-up may be applied.

The body is then put on a dry ice in the casket. It is a tradition that few other things are placed in the casket too. They are a white kimono, six coins for the crossing of the Sanzu River (“Sanzu-no-kawa”) or River of Three Crossings and several objects the deceased used to love like for example sweets.

-United States, which see disease as a result of natural scientific phenomena, advocate medical treatments that combat microorganisms or use sophisticated technology to diagnose and treat disease. Other societies believe that illness is the result of supernatural phenomena and promote prayer or other spiritual interventions that counter the presumed disfavor of powerful forces. Cultural issues play a major role in patient compliance. One study showed that a group of Cambodian adults with minimal formal education made considerable efforts to comply with therapy but did so in a manner consistent with their underlying understanding of how medicines and the body work.

References

Purnell, L. (2013). Transcultural health care: A culturally competent approach (4th ed.). Philadelphia: F.A. Davis.

Bisignani, J. D. (1993). Japan handbook (2nd ed.). Chico, CA: Moon.

Goldstein, B. Z., & Kyoko, T. (1975.) Japan and America: A comparative study in language and culture. Rutland, VT, and Tokyo: Charles E. Tuttle.