Jewish Culture
Although all people experience death, dying and bereavement in all cultures, everyone’s dying process is unique and different. Some people may think of dying as a physical process, but dying is an experience of the whole person and is influenced by a combination of physical, psychological, social, cultural, and spiritual factors. Culture, identity and personal beliefs all have a profound impact on an individual’s choices in the context of dying process. Ethnicity, cultural differences, religion, personal beliefs, individual preferences and choices etc can all affect care needs and social practice at the end of life. People’s experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patient’s cultural background. This assignment will provide a brief discussion of the beliefs, customs and rituals associated with death, dying and the grieving process in the Jewish culture and discuss the associated theoretical principles of a grief and loss theorist named J. W. Worden. Also while discussing the challenges in applying this theory to the Jewish culture, in an acute care setting.

Jewish cultural beliefs have developed a traditional system of mourning concerning death and burial. The Jewish community views deaths as an ending of life, rather than as a beginning of another. Jewish funeral and mourning rituals are centered around respect for the dead. The body is buried within 24-48 hours, so the soul can be returned to God and the body is never left alone until burial (Smith-Gabai & Ludwig, 2011). The body is not cremated, but left to decay in a natural process to return it to God in the best condition possible. Traditional Jewish funeral and burial rituals stem from the importance of honoring the dead and the process of life and death. When a member of the Jewish community dies, it is considered very honorable to take care of the body of the decreased and perform the necessary rituals (Smith-Gabai & Ludwig, 2011). Doing this honors not only the person who performs the rituals, but the deceased as well.

After a death has occurs in a Jewish family it is tradition after returning home after the funeral to place a bowl of water and cup at the entrance of the home. Its purpose is to rid the mourners and guests of spirits of uncleanness from the burial. Each person washes their hands by pouring water over each hand three times starting with the right hand. After entering the home the mourners eat a meal of condolence (Smith-Gabai & Ludwig, 2011). This is the first meal after the funeral and is usually prepared for the family by neighbors and friends. Like many other cultures, Judaism uses food in a ritual here. The mourners eat before others. The meal usually consists of round foods such as hard boiled eggs to symbolize the cyclical nature of life. The hard boiled eggs also symbolize the natural process of death and rebirth that has occurred (Smith-Gabai & Ludwig, 2011).

There are three beautiful, structured stages to mourning in Judaism. The first period of mourning is called Shiva. Shiva means seven, and last seven days. It is an intense period of controlled grieving. There are many customs that are followed in the household while the mourners are sitting Shiva that honor the deceased (Palatnik, 2012). Mourners sit low on stools or cushions, as a symbol of being brought low into grief. They do not wear leather shoes or sandals, but replace them with cotton shoes or slippers. Mourners do not partake in any sexual relations while sitting Shiva. They do not cut their hair or beards, and there is no luxurious bathing or vanity permitted. All mirrors in the household are covered to prevent vanity. Mourners also do not make any business transactions during this time. Cooking and cleaning is permitted and morning and evening religious services are held in the home.

Shiva lasts seven days, in the event that sitting Shiva will hurt a mourner’s livelihood; three days of Shiva may be observed (Palatnik, 2012). If any Jewish Festivals arrive during a time of Shiva the mourning period is over. If a burial occurs during a festival, Shiva starts when the festival is over. A Shiva candle is lit when the family returns from the cemetery. The light from the candle is symbolic of the soul of the deceased. The Shiva candle is a ritual of continuity, showing that the person that died continues to be part of the lives of family. Shiva ends on the morning of the seventh day. The candle is blown out in silence and the family leaves the house and walks around the block (Palatnik, 2012). Leaving the house takes the soul out of the house and releases it from its worldly home. This is a ritual of transition, acknowledging that things have changed, and letting go of the soul of the deceased (Palatnik, 2012).

The next mourning period is called Sheloshim, meaning thirty. Sheloshim lasts for the time of Shiva, plus twenty-three days, thirty days in all. During Sheloshim mourners go about their daily regular lives. They avoid places with music and dancing out of respect for the loss in their lives. The next stage of mourning is called Avelut, which means mourning. It lasts one year and is only observed by those who have lost a parent (Palatnik, 2012). The word Yahrzeit in Yiddish means a year's time. Yahrzeit marks the anniversary of the death of a Jewish community member. Yahrzeit is a solemn day of remembrance to honor the dead. The first year the yahrzeit is observed on the anniversary of the funeral. After the first year it is observed on the anniversary of the death (Palatnik, 2012). A candle is lit in the home on the eve of the date to honor the soul and spirit of the deceased. The Yahrzeit is a ritual of continuity, the candle and the remembrance showing that the deceased may have left the world, but has not left the minds and hearts of family and friends.

Although many people come to accept their own deaths they are also familiar with the five stages of grief (denial, anger, bargaining, depression, and acceptance) that’s greatly influenced by Elisabeth Kubler-Ross (Hoffnung et al., 2010). Another model that helps people deal with their grief was developed by a psychologist J. W. Worden, who noted four tasks of grief. Worden believed that grieving people had to work through tasks to cope with bereavement (Emmanuel, 2012). The four tasks to mourning, which may take place in any order, are: Task 1: to accepting the reality of loss, Task 2: to work through the pain of the grief, Task 3: to adjust to an environment in which the deceased is missing and Task 4: to emotionally relocate the deceased and move on with life (Emmanuel, 2012). The Jewish ritual for grieving is a lot like Worden’s model. They accept the reality of the loss by the mourning period Shiva, they work through the pain of grief and adjust to the environment in which the decease is missing by the next mourning period call Sheloshim and then emotionally relocate the deceased and move on with life by the last stage of mourning Avelut. For the Jewish religion it is tradition that when the time to die has come this has to be respected (Baeke, Wils, Broeckaert, 2011). The Jewish religion believes in a God who created human beings according to his image and all humans are equal and are not to be messed around with. Judaism treats life and body respectfully, because their bodies are not their property, but are on loan from God. This is in order so they can give it back to God intact at the moment God decides (Baek, Wils, Broeckaert, 2011). A Nurse can facilitate culture in acute care setting by using their good listening and observational skills to help those experiencing types of loss or grief by talking, exploring their thoughts, feelings about their loss and providing research-based support to assist them in beginning a healthy grieving process. Promote trust by showing empathy and care and demonstrate respect for their cultural values, offer support and reassurance.

Spiritual care, counseling and other needed help is available for visiting, Jewish patients should be made aware of this on arrival. Observant Jewish people do not travel, work, use electricity, handle money or bathe on the Sabbath or special holidays, they may request for automatic sensors to be turned off (Singh, Dr H, 2009). Friday nights is special prayers and rituals performed at sundown; they involve bread, wine and lighting candles. Jewish patients should be made aware of some medication that are made with non-kosher products and encouraged to discuss alternatives with their doctor (Singh, Dr H, 2009). Exemptions to the Sabbath rules must be made to save a life (Singh, Dr H, 2009).

In dealing with the death and dying where there are cultural differences, it is important that health care workers do not try and predict or know in advance the meaning of ethnicity and culture at the end of a person’s life (Bodell & Weng, 2000). Instead it is important that health care workers engage in dialogue with the dying person and be open and responsive to their needs. It is also important that health care workers do not presume what a client needs however be open to having their pre-conceived ideas and notions challenged.

The challenges facing Health care workers could be resources available at the time when someone health deteriorates quickly. An example could be that additional support at home may be required resulting in family members having to assist due to demands and limited services in the area the person stays in. Another example could be for Health care workers is due to a person’s culture/belief that they may want to burn a candle at the side of their bed, this could prove to be difficult, as they wouldn’t be able to leave a person at risk due to health and safety reasons and policies and procedures they have to follow even if it is in a person’s own environment (Bodell & Weng, 2000).

The process of reflection is often associated with a search for meaning. It is better for nurses to come to terms, on a personal and professional level, with the reality of pain and loss by providing support and positively reinforce the patient’s efforts to go on with his or her cultural life and normal activities of daily living, stressing the strength and the reserves that must be present for the patient and family to feel enabled to do this (Smith-Gabai & Ludwig, 2011).

In conclusion, there are many challenges facing health care workers in dealing with the death and dying and it is important to challenge the notion of what constitutes a ‘good heath’, particularly for those groups which are social and cultural differences and that each person’s experience of death and dying is unique and being provided at a high standard. Health care workers need to respect difference and diversity and challenge stereotypes and prejudices. Health care workers need to be aware that communication with the dying person is the key source and that social and cultural differences can lead to different approaches for apparently similar situations. These differences can enrich social care practice and end-of-life care to people who wish to die at home or in a hospital.
Word Count: 1906

References
Baeke, G., Wils, J., Broeckaert, B. (2011). Nursing Ethics. Orthodox Jewish perspectives on withholding and withdrawing life-sustaining treatment, 18(6), 835-846. Doi: 10.1177/0969733011408051
Bodell, J., & Weng, M. (2000). American Journal of Hospice and Palliative Medicine. The Jewish patient and terminal dehydration: A hospice ethical dilemma.17(3), 185-188. Doi: 10.1177/104990910001700312
Emmanuel, E. (2012). NS2112: Grief in unusual context and Grief and Cultural Considerations, week 3 notes. [PowerPoint slides]. Retrieved from https://learnjcu.jcu.edu.au
Hoffnung, M., Hoffnung R. J., Seifert, K. L., Burton Smith, R., Hine, A., Ward, L., Quinn, A. (2010). Lifespan Development. Milton, Queensland: John Wiley & Sons Australia, Ltd.
Palatnik, L. (2012). The stages of Jewish Mourning: A Practical Guide. Retrieved from http://articles.aish.com/The-Stages-of-Jewish-Mourning.pdf
Singh, Dr H. (2009). Alberta Health Services. Health Care and Religious Befiefs. Retrieved from http://www.albertahealthservices.ca/ps-1026227-health- care-religious-beliefs.pdf
Smith-Gabai, H., & Ludwig, F. (2011). The Journal od Occupational Science Incorporated. Observing the Jewish Sabbath: A Meaningful Restorative Ritual for Modern Times, 18(4), 347-355. doi:10.1080/14427591.2001.595891