Purnell’s introduction of the Purnell Model of Cultural Competence presents a better a better chance for health workers to offer services meet the client’s cultural beliefs, desires, and expectations. Calls to be culturally competent and awareness are increasing as the need to embrace multiculturalism and diversity increases in healthcare practice. The study is an application of Purnell’s twelve domain of cultural assessment to the Jewish people and their traditions. The model that can be applied to all other cultural groups requires caregivers to approach a Jewish patient in a holistic way while understanding how their culture may impact on their health and perception towards treatment. Using the model presents a better chance to achieve the targeted goals when it comes to attending to a Jewish patient. Purnell 12 domains provide a suitable structure for examining the Jewish culture and to show how the information presented in the model can be utilized to create culturally competent healthcare intervention for a health problem affecting members of this cultural group.
Purnell Model’s Twelve Domains of Cultural Assessment
Larry Purnell acknowledges that communities and societies are increasingly embracing diversity and multiculturalism in many aspects, including healthcare. Purnell (2005) asserts that the 21st century has introduced an era of diversity and multiculturalism in healthcare delivery. Thus, Purnell proposes the Purnell Model of Cultural Competence to guide cultural competence among multidisciplinary teams within healthcare givers in a variety of tertiary, secondary, and primary settings. According to Purnell, it is imperative for healthcare workers to provide services that match the cultural needs of their clients (Purnell, 2005). Thus, the theorist believes each caregiver should be conversant with the concept of cultural competence that he describes as encompassing various aspects, including having skills and knowledge on how to deal with a people of a particular culture when offering care (Purnell, 2005). Cultural competence entails creating an awareness about one’s culture, thoughts, existence, and environment, and demonstrating competence in relating to the client’s culture, perceptions of illness and health, and health-related requirements (Purnell, 2005). A cultural competent caregiver us open to cultural encounters and accepts and appreciates cultural competence.
In addition to emphasizing on multiculturalism and diversity in healthcare provision, Purnell proposes that caregivers should abide by the guidelines of the 12 domains of culture and their concepts. The theorist asserts that the domains are fundamental in evaluating the cultural features and practices of a group, family, or individual (Purnell, 2005). Purnell argues that concepts, constructs, and domains in the framework are common to all ethnic groups, subcultures, and cultures. The twelve domains according to Purnell are interrelated and have significant impact on health. The framework emanates from its precise outline, which can be utilized in any context and used in a wide range of empirical encounters and can promote deductive and inductive reasoning in the evaluation of cultural domains (Purnell, 2005). The framework provides a suitable chance to assess the Jewish culture and its related beliefs and practices.
Family role and organization: In Jewish traditions and families, parents and children take care of each other as a way of honoring God’s teachings. Parents are perceived as equal partners in God’s creation of all human beings, so honoring one’s parents is honoring God. In the same manner, being violent or showing disrespect to other family members is disrespecting God (Fairchild, 2010). The father plays the role of providing food and other necessities but this does not imply that they enjoy a higher status than other members of the family. The belief that men should respect their women has played fundamental functions in fostering peace in Jewish families.
Communication: Overall, the Jews express themselves in an expressive way, coupled with many non-verbal cues, especially hand gestures. Members of this cultural group usually speak in high tone or volume and their pace is relatively faster, which may create an impression that they are either offended or yelling. However, one should not confuse them because this may be their normal tone of communicating. Members of the Jew community also happen to have overlapping speech structures, which means that another speaker may commence speaking before another finish expressing their point (Fairchild, 2010). Therefore, it is not uncommon to encounter interruptions during communication when interacting with a Jewish client.
Heritage and residence: The Jews relate their heritage to ancient Hebrews and share an ethnic heritage aligned on Judaism. It is believed that Abraham, his son Isaac, Isaac’s son Jacob were the initial ancestors of the Jewish culture. The Jewish people in many instances ascribe to ethnoreligious groups and their religion, nationhood, and ethnicity are interconnected (OSCE, 2016). Today, the U.S. has the highest population of Jews followed by Israel, Canada, and France. However, even as members continue to abide by their heritage their numbers continue to grow in other areas.
High-risk health behaviors: The Jews engage in certain practices and behaviors that increase their risk to illness. One particular concern is smoking. Many Jewish people smoke believing that it plays a religious purpose. Many Jews who do not smoke either due to health reasons or individual preferences are likely to some on certain holidays, especially during Purim when people celebrate the freedom the Jews got from Haman, an official from the Achaemenid Persian Empire who planned to slaughter all Jews in his empire. The number of those who smoke is likely to shift upwards during the festive season because people believe that the practice has spiritual significance, and usually relate it to the smoke emanating from the temple’s alter.
Biocultural ecology: The Jews migrated as a religious and ethnic group in the Middle East during the 2nd millennium BCE. It also believed that the Jews originated from the Land of Israel, and have upheld their religious, cultural, and physical features over the years (OSCE, 2016). The Jews originally inhabited the hills differentiating the Mediterranean coastline of the modern day Israel from the deserts in Arabia that was first inhabited by pagan groups in what later came to be called the land of Canaan.
Workforce: The Jewish tradition places significant emphasis on developing a robust workforce that contributes towards the economic well-being of individuals and the society. It is the reason why Jewish societies since the ancient time develop regulations to define labor practices (OSCE, 2016). Employers have an obligation to safeguard their workers and to ensure they enjoy their rights and privileges. Similarly, the tradition expects workers to respect their employers and abide by other regulations determining work practices at the firm. Even though men have dominated the workforce for many years, increased calls to achieve gender equality has increased the number of women in the job market.
Pregnancy and childrearing: The Jews perceive pregnancy as a blessing and a woman is likely to attract much respect from the community during this phase of life. The Jews have their own unique way of congratulating a pregnant woman. Thus, when a person meets a pregnant woman they say “in good time” as a way of appreciation. It is the reason why the birth of a baby in the tradition is welcomed with great jubilation and prayerfulness. Every member of the Jewish tradition is free to marry and bear children. Members oppose use of artificial birth control measures, including abortion, arguing that they are contrary to God’s commandment.
Nutrition: The Jews believe that sticking to a suitable nutrition presents a better chance to safeguard the body against any possible harm and healthy issues. Members of the group understand that what they consume may affect their overall well-being and health. Moreover, for the Jewish, knowing the cultural importance of food during holidays is essential in offering person-centered care. Traditionally, the Jewish consume foods such as shakshuka, which is the staple cuisine in many places dominated by the Jewish people. However, people also eat fish, baked foods, soups, vegetable, and fruits among other types of foods. Jews pay much attention to the foods they consume during cultural and religious holidays. Jews pay attention to other critical elements when considering what to consume. The animals they consume must have split hooves (Benjaminson, 2019). The animals must also chew cud (Benjaminson, 2019). It is the reason why the Jews do not eat pork. They believe that because pigs have cloven hooves and do not chew cud they are not suitable for consumption (Benjaminson, 2019). Overall, all Jews are required to adhere to the Kosher diet that people in this cultural group believe was a directive by God.
Health care practices: The Jews believe that God owns everything in the body and people only have an obligation to safeguard it from potential harm. Actually, one of Jewish traditions requires people to take adequate care of their bodies. Thus, the culture views health care practices as suitable ways for protecting the body from harm and keeping it healthy (My Jewish Learning, 2021). From the ancient years, the Jewish community assigned high status to scholars, rabbis, and physicians who played fundamental roles in providing healthcare. However, not until recently, the Jewish culture was not against smoking, which most health researches identify as health risk behavior.
Healthcare providers: The same way the Jews acknowledge health care practices is the way they appreciate healthcare providers. The group believes that divine presence and healing are significant to the healing and overall health of the patient. Specifically, Orthodox Jews adhere to the belief that physicians act as healers with divine impact and are representatives of God’s will.
Death rituals: The Jewish people conduct their death ritual in accordance with the Jewish Law. The guiding structure requires that the body of the deceased is washed properly before the burial that should take place in a simply made coffin, often made of pine wood. Jewish culture about death rituals requires that the body of a dead person should not be left alone from death and until burial. It further directs that the burial should not extend beyond twenty-four hours after death. Typically, the deceased person is dressed in a simple white cloth as a show of purity.
Spirituality: The Jewish ascribe to the four fundamental principles of Jewish spirituality. The first element is brit or covenant, which is the sacred relationship the Jewish have with their creator. Other than the covenant the Jewish have with God, they also acknowledge the relationships they have with others such as marriage. The second key component of the Jewish tradition is Torah, which are the vows the Jewish people have made to God to fulfil their covenant. Holding to Torah enable the Jewish people to find more adequate responses to the critical questions regarding what it entails to be in a covenant. The third aspect is mitzvah, which requires members to act as if they are in a covenant. The fourth component of Jewish spirituality is teshuvah, which requires each believer to question what would become of them if they do not abide by provided guidelines.
Another critical aspect about Jews’ spirituality is that they take the Sabbath day very seriously. According to the Jewish religious belief, the Sabbath is part of deal between God and the group and an opportunity to rejoice in keeping the deal. Most Jews look forward for the Sabbath day the entire week (BBC, 2009). They view the day as the gift God offers to his people to be free from other duties and feel special. Families spend most of their time together during this holy day, and members of the society have a special way of greeting each other during this day. Typically, one would greet the other by saying Shabbat Shalom (BBC, 2009). Thus, a practitioner attending to a Jew should consider letting the client feel significance that comes with the day, such as allowing them mingle with their families.
Health Risk Common to the Cultural Group
The study already identifies high rate of smoking as a major health risk for the Jewish people, which means that many people are likely to suffer smoking-related problems such as lung cancer. The Jewish people are at high risk of developing lung cancer because evidence suggest that smoking puts one at the risk of developing the condition (Pinchas-Mizrachi et al., 2021). Health practitioners believe that smoking leads to lung cancer by affecting the cells that surround the lungs (Bach, 2009). When a person inhales cigarette smoke, which is often full of substances that cause cancer known as carcinogens, the lung tissues undergo significant transformation almost immediately (Bach, 2009). Initially, the body may be able to rectify the damage but this may become difficult with prolonged smoking. Particularly, smoking affects the tiny air sacs in the lungs called alveoli that enable oxygen exchange (Bach, 2009). When a person smokes, they are damaging some of the air sacs. An important factor to consider when smoking, therefore, is that it is impossible to repair destroyed alveoli, so when a person destroys them due to smoking, they have permanently tampered with part of their lungs. When a lot of alveoli are tampered with, a person is at risk of developing lung cancer or other respiratory ailments such as emphysema or chronic obstructive pulmonary disease (COPD). The mechanisms and changes that happen to regular smokers is the reason why Jews who are largely smokers may develop lung cancer.
Based on the assessment of the cultural lifestyle of the Jews, the most suitable intervention for the health problem (lung cancer) is to educate people about the negative effects of smoking and how the practice puts them at the risk of developing other serious problems. Through public sensitization on the dangers of smoking, people are able to make wise decisions about whether to continue with the practice or not. The awareness programs should remind smokers to seek medical attention as soon as they suspect something abnormal with their body. Early screening may present a better chance to avoid a major health problem such as lung cancer that affects many Jewish people. However, the sensitization programs should take into account the twelve domains of cultural assessment to avoid clashing with the target audience.
Jews are also at risk of genetic diseases that affect many people, which may require effective intervention. One particular concern is the Ashkenazi Jewish genetic diseases that comprise of rare diseases that mostly affect people of the Jewish origin. Whereas some diseases in this group can be fatal and result in early death, it is possible to manage others using some of the available remedies (National Gaucher Foundation, 2021). Some of the prevalent conditions in this group are Bloom syndrome, which is characterized with babies being born with smaller bodies and remain that way for the rest of their lives and Canavan disease that destroys the brain gradually (National Gaucher Foundation, 2021). The best way to address the problem is engage in continuous researches that will find long-lasting remedies to the genetic complications.
The study uses the Purnell Model of Cultural Competence to examine key components and preferences of the Jewish people. Applying Purnell’s twelve domains of culture presents a suitable chance for healthcare practitioners to know how to handle patients based on Jewish cultural traditions. Deploying the model requires the caregiver to be conversant with Jewish traditions concerning food, pregnancy and birth, communication, family role, spirituality, health care practice, health care providers, and nutrition. A health worker should also consider other key elements such as high-risk behavior, workforce, biocultural ecology, and heritage and residence. The study identifies lung cancer as a major concern for members of the culture because of the high rate of smoking among individuals who relate the practice with spiritual beliefs.
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