Jehovah\'s Witnesses - A cultural competence for jevovah witness patients PDF

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A cultural competence for jevovah witness patients...

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11/28/21, 1:35 AM

© 2021 Lippincott Advisor for Education - Cultural Perspectives: Jehovah's Witnesses

Jehovah's Witnesses Revised: January 08, 2021

Introduction This Cultural Perspectives content set is a point-of-reference tool to help health care professionals provide culturally competent care to diverse patient populations across the care continuum as they interact within the U.S. health care system. When speaking of culture, health care practitioners must not only be aware of the general cultural characteristics of patients but also avoid stereotyping. Individual patient differences must always be considered. Cultural competency in health care isn't static; rather, it is an ongoing process in need of continual improvement to adapt to changing needs. (See the entry A Cultural Perspectives Overview for more detailed information.)

Culture / Ethnicity / Community Orientation Jehovah's Witnesses are a Christian sect founded in 1872 in Pittsburgh, PA, by the American clergyman Charles Taze Russell. There are now Jehovah's Witnesses congregations throughout the world. The international headquarters of Jehovah's Witnesses was in Brooklyn, NY, but is now in Warwick, NY. There are 8.23 million Jehovah's Witnesses actively involved in preaching around the world. Only those who preach (referred to as publishing) are counted in the statistics. Jehovah's Witnesses report approximately 1.2 million active publishers in the United States (including some children), whereas the Pew Research Center reports that Jehovah's Witnesses make up 1% of the U.S. population (approximately 2.5 million). Roughly 65% of Jehovah's Witnesses are women, and approximately 65% of all Jehovah's Witnesses are converts from another faith. Witnesses acknowledge allegiance solely to the Kingdom of Jesus Christ. Consequently, they refuse to salute any flag, vote, perform military service, or otherwise signify allegiance to any government. This protocol has brought them into conflict with government authorities in many countries, including the United States. The sect maintains an extensive publishing program, issuing books and pamphlets in many languages. Its main periodical,The Watchtower, was first published in 1879 and is printed in many languages. Witnesses come from many racial, ethnic, and socioeconomic backgrounds. According to Pew research, 63% of Jehovah's Witnesses have no more than a high school diploma.

What you should do Perform a cultural assessment that includes the patient's communication style and needs, personal space needs, degree of acculturation and patterns of cultural behavior, concept of time, ability to control the environment, and biocultural variation. Ask about the patient's and family's cultural orientation, and document the response. Example: “I noticed that you listed that you are a Jehovah's Witness on your patient information form. Tell me something about yourself.” Example: “Do you see yourself as holding views and beliefs that lean more toward your cultural traditions or more toward the general American culture?” Be aware that practicing Jehovah's Witnesses come from many cultures and backgrounds and that their religious practices and their beliefs often supersede other traditional cultural practices. Project a sensitive, respectful, and interested demeanor. Develop a trusting relationship with the patient and family. Assess and document socioeconomic and other factors and beliefs that may affect the patient's ability to access health care.

Cultural Values / Beliefs Jehovah's Witnesses place a high value on moral living and cleanliness (including physical, spiritual, and mental cleanliness). Jehovah's Witnesses form strong communities informed by their religious beliefs and separate from their ethnic heritage. They are required to surround themselves with other Jehovah's Witnesses for social interactions. Jehovah's Witnesses communities are patriarchal. Only men can hold positions of responsibility and teaching in the congregation. Friendliness, peacefulness, and respect for others are cultural values. Jehovah's Witnesses hold conservative views on sexuality, marriage, and lifestyle issues. They do not participate in reiki, “laying on of the hands,” or yoga or attend any functions at other churches. They do not celebrate Christian, secular, or national holidays, including birthdays, and they do not give or receive gifts. They do not believe in superstitions or miracles outside of those mentioned in the Bible and they do not consult psychics. Gambling and smoking cigarettes or cigars isn't allowed. Jehovah's Witnesses do not attend social events at other churches, employer social functions, or Alcoholics Anonymous meetings. Jehovah's Witnesses do not become involved in politics and do not serve in the military.

What you should do Ask about whether the patient would like family members or others to be involved in care. Document whom to involve and their role. Make sure that this information is included in the patient's Health Insurance Portability and Accountability Act documentation. https://advisor-edu.lww.com/lna/pages/printPage.jsp

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Example: “For some patients, it is important to have family members or others present. Whom would you like to have with you? Would you like to have family or others helping with your care? Is there someone whom you wish to keep informed of your progress and treatment?” Take a holistic perspective when assessing the patient and family. Consider their intellectual, emotion, spiritual, and environmental needs. Take care to develop a respectful and trusting relationship with the patient and family. Be sensitive and nonjudgmental when collecting health information and assessing patients. When discussing sensitive health information with the patient, provide privacy. Avoid saying “good luck,” because this is considered offensive.

Religious and Spiritual Beliefs and Practices Members believe in the second coming of Christ; they consider themselves as practicing original first-century Christianity, in which each Witness is considered a minister. Bible study and absolute obedience to Biblical doctrine are stressed. Religious teachings are spread primarily by members who preach from door to door and distribute literature to passersby. Witnesses believe that furthering God's Kingdom and spiritual matters should come first, before secular and recreational activities. They believe that they should avoid any pursuit that contradicts religious doctrine. Bible study classes are often conducted in private homes. The meeting places of Jehovah's Witnesses are called Kingdom Halls. Worship occurs midweek, on weekends, and in larger groups approximately four times per year. In addition, there is an annual international meeting. Independent thinking is avoided, and Witnesses are taught to be “like-minded.” They believe that they should be separate from “Satan's world.” They are taught to completely trust the guidance provided by church leaders because church leaders are believed to be informed by God. Members who voice disagreement with doctrine, criticize the faith, or fail to repent wrongdoing may be excommunicated (also known as disfellowshipped). Disfellowshipped individuals are shunned by family and friends, usually for the rest of their lives. Female Witnesses (“sisters”) are taught not to pray in front of male Witnesses (“brothers”). Female Witnesses are required to wear head coverings when praying in front of unbaptized men or when conducting a meeting of “sisters.” Religious articles such as statues, crosses, and religious art are considered idolatrous.

What you should do Ask about the patient's and family's religious preferences, and document their responses. Example: “Tell me about your religion and the religious practices of members of your household.” Example: “Tell me how your spiritual beliefs help you during times of illness or stress.” Provide opportunities for the patient and family to practice their religion. Example: “What can we do to help you practice your religion?” Demonstrate acceptance of the patient's religious beliefs, attitudes, and practices. Identify ways to integrate religious practices and preferences into the patient's health care plan. Remove religious symbols from the patient's room.

Communication and Language Considerations Witnesses come from all backgrounds and speak the languages of their geographic communities.

What you should do Evaluate and document the patient's preferred language, level of understanding of instructions and explanations, linguistic style, and nonverbal behaviors, such as body language and tone of voice. Ask whether the patient uses communication aids, such as hearing aids or text readers. Identify and document the patient's and family's written and oral language preferences. Assess the patient's and family's oral and written English literacy. Assess for and provide access to interpretive services, if needed; document any service provided. Observe and reflect the patient's style of communication, both verbal and nonverbal. Ask how the patient prefers to be addressed. Example: “Some people like to be addressed as Mr. (or Mrs. or Ms., as appropriate) followed by their last name. Others prefer to be addressed by their first name. What do you prefer?” Be aware of your communication style, because the patient may make assumptions about your attitude based on both verbal and nonverbal communication.

Family / Gender Roles and Relationships Family structure is patriarchal, and men have authority over their wives. Wives are taught to submit to their husbands. Children are taught to obey their parents and are discouraged from socializing with outsiders. Dating is expected to lead to marriage. Sex before marriage is forbidden. https://advisor-edu.lww.com/lna/pages/printPage.jsp

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Jehovah's Witnesses are traditionally intolerant of sexual minorities.

What you should do Ask whether the patient has a preferred spokesperson and decision maker. Example: “How are decisions made in your family? Whom do you want to choose as the person who communicates decisions to the health care team?” Actively involve the spokesperson or decision maker in the patient's care. Identify and document the patient's support system. Include them in the care plan, as appropriate. Demonstrate acceptance of the patient's wishes and adherence to religious beliefs and practices.

Health / Illness Beliefs and Practices Some may view illness to be caused by sin or Satan. Jehovah's Witnesses actively seek medical care when needed and accept most treatments available. Jehovah's Witnesses consider most medical decisions to be a matter of personal choice. Members of the congregation and older adults may visit to pray with the sick person and read scriptures. Jehovah's Witnesses may practice daily prayers and reading of scriptures, which provides mental and spiritual comfort. Jehovah's Witnesses do not practice faith healing. Abortion is considered sinful and is prohibited. Jehovah's Witnesses may accept organ transplants if blood is not administered.

What you should do Ask the patient, “What do you think caused this illness?” Ask the patient about the illness and all of the interventions and practices being used to treat it, and document the responses. Example: “What do you call your problem? When did it begin? What steps have you taken to help yourself? What has been helpful?” Assess and document the patient's and family's beliefs about Western interventions and medications. Ask the patient about beliefs regarding the treatment plan. Ask whether prescribed medications and treatments are seen as helpful or harmful. Honor and demonstrate acceptance of the patient's beliefs. Ensure that the patient's preferences for treatment are communicated and documented in the medical record. Ask the patient about cultural practices as treatments. Example: “Do you practice any cultural or ritual healing practices?” Be sure to document all of the medications and supplements that the patient is taking on admission. Educate the patient and family about appropriate medication and supplement use, including the importance of taking drugs as prescribed, what adverse effects to watch for, and what to report. Assess the patient's and family's understanding and readiness for teaching. Avoid using highly technical terms and medical jargon. Use easily understood terms and language and materials written at an appropriate grade level. If possible, use teaching materials designed to address the specific cultural characteristics of this community. Ask the patient about preferred methods for teaching. Use pictures or illustrations when needed to convey teaching concepts. Use the teach-back method to assess the patient's understanding. Identify and document the patient's preferred spokesperson, and actively involve that person in the patient's care. Identify barriers to accessing health care resources, and provide referrals, as appropriate.

Special Health / Illness Concerns Believers follow the Biblical command to “abstain from blood” and will request the use of nonblood medical alternatives. Witnesses believe that accepting blood (whole blood, red blood cells, white blood cells, platelets, plasma) or reinfusion of banked autologous blood will lead to their excommunication and eternal damnation. A health care provider recommending a blood transfusion is considered by many Jehovah's Witnesses to be acting through the devil's influence. Because the Bible makes no clear statement about the use of minor blood fractions or the immediate reinfusion of a patient's own blood during surgery (a medical process known as blood salvaging), the use of such treatments is considered a matter of personal choice. Each Witness is required to carry a legally binding advance directive card or document that states wishes regarding transfusion of blood or of blood components such as plasma. The governing body of Jehovah's Witnesses has established a committee called Hospital Information Services (also known as Hospital Liaison Committees), which provides resources for nonblood patient care management.

What you should do Identify socioeconomic and other factors that may influence the patient's health outcomes, such as limited education, lack of health insurance, lack of a primary care physician, inability to purchase medications, or an unsafe environment. Explain the importance of and encourage preventive health screening. https://advisor-edu.lww.com/lna/pages/printPage.jsp

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Encourage facility partnerships with the Jehovah's Witnesses Hospital Liaison Committees to help with nonblood patient care management. Work with facility resources to develop patient blood management programs with the goal of minimizing blood loss, avoiding transfusions, managing anemia, and enhancing hematopoiesis. Identify and manage anemia to avoid the need for transfusion. Provide information on a blood alternative program, as dictated by individual facility protocol. Provide licensed independent practitioners with appropriate consent/refusal forms for procedures/blood products for their review with the patient. Determine which, if any, derivatives of the primary blood components are acceptable to the individual patient. These derivatives include: albumin coagulation factors fibrinogen globulins, including immunoglobulins hemoglobin interferons interleukins wound healing factors (for example, von Willebrand factor). Determine whether patients would accept any procedures involving their own blood and, if so, which methods for handling this blood are acceptable. Such procedures include: all forms of intraoperative blood salvage (cell saver) acute normovolemic hemodilution postoperative blood salvage (for example, wound drains) hemodialysis cardiopulmonary bypass. Ensure privacy, especially if a Jehovah's Witness patient has chosen to accept blood donation and does not want to disclose it to others in the community for fear of disfellowship.

Activities of Daily Living (ADLs) Normal activities of daily living vary among individuals and are not specific to Jehovah's Witnesses as a cultural group.

What you should do Assess the patient's preferences for ADLs; document these preferences and any care given. Encourage family members and others to assist the patient with ADLs and health care as appropriate and as the patient desires. Allow open visiting for spiritual practices.

Food, Nutrition, and Dietary Considerations Jehovah's Witnesses are prohibited from consuming blood or blood products, which include meat from animals not bled properly and extremely rare meat or foods (such as black pudding or blood sausage prepared from blood). Hence, some Jehovah's Witnesses prefer not to eat meat at all.

What you should do Assess and document the patient's food preferences; provide foods and fluids at the time desired by the patient. Assess and document any special dietary restrictions or requirements that the patient is following; consult the dietitian to coordinate and incorporate any special dietary needs or preferences into the patient's care. Collaborate with the dietitian to assist in developing a suitable nutritional plan for the patient during hospitalization and after discharge, if needed.

Birth and Postpartum Beliefs and Concerns Professional prenatal care is accepted and valued. Traditionally, Jehovah's Witnesses will refuse blood or blood product transfusions for either the mother or child. Deliberately induced abortion to end life is not acceptable, but if a decision needs to be made to save the child or mother, an individual decision may be made by the parents or legal guardian. Preventive contraception is acceptable. In vitro fertilization with egg and sperm from individuals who are not married to each other is not accepted. Gestational surrogacy is also not accepted.

What you should do Encourage the patient to verbalize any beliefs, attitudes, and concerns regarding pregnancy and birth. Demonstrate acceptance of these beliefs, and provide emotional support and teaching, as needed. https://advisor-edu.lww.com/lna/pages/printPage.jsp

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Assess and document any special preferences for care during labor, during birth, or for the newborn. Provide for the patient's desired birth attendant. Provide teaching and resources for contraception, if desired.

End-of-Life Care and Concerns The religious beliefs of Jehovah's Witnesses promote respect for life. Decisions surrounding end-of-life care are made by the patient and family. Prolongation of life by artificial means is generally not supported. Members of the congregation and older adults may visit to pray with the sick person and read scriptures. Jehovah's Witnesses may practice daily prayers and scripture reading, which provides mental and spiritual comfort. Jehovah's Witnesses may not wish to donate organs because another's blood would flow through them. Cornea donations are acceptable. All blood must be removed from the organ and tissues before being transplanted. Jehovah's Witnesses do not observe special rituals for the sick or those dying. Autopsies are acceptable only if required by law and no body parts are removed.

What you should do Assess, document, and accommodate any special patient or family preferences or religious traditions at the end of life or after death, as appropriate. Demonstrate acceptance of the family's decisions regarding issues related to end-of-life care. Assess and document the patient's and family's attitude toward advance directives and orga...