Caring for Patients of Japanese and Jewish Heritage

People of Japanese and Jewish Heritage
Yoda Lllorente
Florida National University
BSN Student 0517
NUR 3655 – Culture in Nursing Practice
Prof. Eddie Cruz, RN MSN
February 25, 2018
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.
Chapter 18:
Inferential Statistics
Educational Research:
Competencies for Analysis and Application
11/E
Geoffrey Mills and Lorraine Gay
© 2016, 2012, 2009, 2006 Pearson Education, Inc. All Rights
Reserved
Gay & Mills
Educational Research, 11e
© 2016 Pearson Education, Inc. All rights reserved.
18-‹#›
After reading Chapter 18, you should be able to do the

following
Explain the concepts underlying inferential statistics.
Select among tests of significance and apply them to your study.
Gay & Mills
18-‹#›
Concepts Underlying Inferential Statistics
Inferential statistics are data analysis techniques for
determining how likely it is that results obtained from a sample,
or samples, are the same results that would be obtained from the
entire population.
Gay & Mills
18-‹#›
Descriptive statistics show how often or how frequent an event
or score occurred.
Inferential statistics help researchers known whether they can
generalize their findings to a population based upon their
sample of participants.
Inferential statistics use data to assess likelihood—or
probability.
Gay & Mills

18-‹#›
Standard Error
Inferences about populations are based on information from
samples.
There is very little chance that any sample is identical to the
population.
The expected variance among sample means and the population
mean is referred to as sampling error.
Sampling error is expected.
Sampling error tends to be normally distributed.
Gay & Mills
18-‹#›
Standard Error
A distribution of sample means is normally distributed and has
its own mean and standard deviation.
The standard deviation of the sample means is referred to as the
standard error of the mean.
Our ability to estimate standard error of the mean is affected by
size of sample.
As the sample size increases the standard error of the mean
decreases.
Our ability to estimate the standard error of the mean is also
affected by the size of the population standard deviation.

Gay & Mills
18-‹#›
Standard Error
The standard error of the mean can be calculated by:
SEx = the standard error of the mean
SD = the standard deviation for a sample
N = the sample size
Gay & Mills

18-‹#›
Hypothesis Testing
Hypothesis testing is the process of decision making in which
researchers evaluate the results of a study against their original
expectations.
Null hypothesis: Predicting no difference in scores
Research hypothesis: Predicting a difference in scores
We want to assure differences we observe between groups are
‘real’ differences and did not occur by chance.
Gay & Mills
18-‹#›
Hypothesis Testing
If the groups are significantly different we reject the null
hypothesis.
We do not accept a research hypothesis, we cannot prove our
hypothesis.
We instead report that our research hypothesis was supported.
If there are not expected differences, we report that the null
hypothesis was not rejected; and that our research hypothesis
was not supported.
Gay & Mills
18-‹#›

Tests of Significance
Tests of significance allow us to inferentially test if differences
between scores in our sample are simply due to chance or if
they are representative of the true state of affairs in the
population.
To conduct a test of significance we determine a preselected
probability level, known as level of significance (alpha or α).
Usually educational researchers use alpha .05 or 5 out of 100
chances that the observed difference occurred by chance (α
=.05).
Gay & Mills
18-‹#›
Tests of Significance
Two-tailed and one-tailed tests
Tests of significance are almost always two-tailed.
Researchers will select a one-tailed test of significance only
when they are quite certain that a difference will occur in only
one direction.
It is ‘easier’ to obtain a significant effect when predicting in
one direction.
Gay & Mills
18-‹#›
Type I and Type II Errors
Based upon a test of significance the researcher will either
reject or not reject the null hypothesis.

The researcher makes a decision that the observed effect is or is
not due to chance.
This decision is based upon probability, not certainty.
Gay & Mills
18-‹#›
Type I and Type II Errors
Sometimes the researcher will erroneously reject the null
hypothesis or will erroneously retain the null hypothesis.
When the researcher incorrectly rejects the null hypothesis she
has committed a Type I error.
When the researcher incorrectly fails to reject the null
hypothesis but a true difference exists, she has committed a
Type II error.
Gay & Mills
18-‹#›
Type I and Type II ErrorsTrue status of null hypothesis:
True
(should not be rejected)True status of null hypothesis:
False
(should be rejected)Researcher’s decision: True (does not
reject)Correct DecisionType II ErrorResearcher’s decision:
False (rejects)
Type I ErrorCorrect Decision

Gay & Mills
18-‹#›
Degrees of Freedom
After determining whether the significance test will be two-
tailed or one-tailed and selecting a probability level (i.e.,
alpha), the researcher selects an appropriate statistical test to
conduct the analysis.
Degrees of freedom are the number of observations free to vary
around a parameter.
Each test of significance has its own formula for determining
degrees of freedom (df).
The value for the df is important in determining whether the
results are statistically significant.
Gay & Mills
18-‹#›
Selecting Among Tests of Significance
The use of a specific significance test is determined by several
factors.
Scale of measurement represented by the data (nominal, ordinal,
interval, ratio)
Participant selection
Number of groups being compared
Number of independent variables
Significance tests applied incorrectly can lead to incorrect
decisions.

Gay & Mills
18-‹#›
The first decision in selecting an appropriate test is to
determine whether a parametric or nonparametric test will be
used.
Gay & Mills
18-‹#›
Parametric tests require that the data meet several assumptions.
Variable must be normally distributed
Interval or ratio scale of measurement
Selection of participants is independent
Variance of the comparison groups is equal
Most parametric tests are fairly robust.
If assumptions are violated, nonparametric tests should be used.
Gay & Mills
18-‹#›
The t test

The t test is used to determine whether two groups of scores are
significantly different from one another.
The t test compares the observed difference between means with
the difference expected by chance.
Gay & Mills
18-‹#›
The t test for independent samples is a parametric test of
significance used to determine if differences exist between the
means of two independent samples.
Independent samples are randomly formed.
The assumption is that the means are the same at the outset of
the study but there may be differences between the groups after
treatment.
Gay & Mills
18-‹#›
The t test for nonindependent samples is a parametric test of
significance used to determine if differences exist between the
means of two groups that are formed through matching.
When scores are nonindependent, they are systematically
related.

Gay & Mills
18-‹#›
The comparison of gain or difference scores are not generally
tested with a t-test.
There are other better strategies for analyzing such data.
e.g., t test on posttest scores (if there are no differences on
pretest scores).
e.g., Analysis of covariance (if there are differences in pretest
scores).
Gay & Mills
18-‹#›
Analysis of variance
A simple (one-way) analysis of variance (ANOVA) is a
parametric test used to determine whether scores from two or
more groups are significantly different at a selected probability
level.
ANOVA is used to avoid the error rate problems of conducting
multiple tests.
Gay & Mills

18-‹#›
Analysis of Variance
An F ratio is computed to determine if sample means are
significantly different.
The F ratio is calculated based upon variance between
groups/variance within groups.
The larger the F ratio the more likely there are differences
among groups.
Gay & Mills
18-‹#›
If there are significant differences among groups based upon an
ANOVA; the researcher then must determine where these
differences exist.
Multiple comparisons are used to determine where differences
between groups are statistically significant.
Comparisons planned before collecting data are referred to as a
priori.
Comparisons after are referred to as post hoc.
Gay & Mills
18-‹#›

When a factorial design is used and there are two or more
independent variables analyzed, a factorial or multifactor
analysis of variance is used to analyze the data.
MANOVA is an analytic procedure used when there is more
than one dependent variable and multiple independent variables.
Gay & Mills
18-‹#›
Analysis of covariance (ANCOVA) is a form of ANOVA that
allows for control of extraneous variables and also is used as a
means for increasing power of an analysis.
Power is increased in an ANCOVA because the within-group
error variance is decreased.
When a study has two or more dependent variables, and a
covariate, MANCOVA is used.
Gay & Mills
18-‹#›
Multiple Regression
Multiple regression is used to determine the amount of variance
accounted for in a dependent variable by interval and ratio level
independent variables.
Multiple regression combines variables that are known to
predict the criterion variable into an equation.
Stepwise regression allows the researcher to enter one variable
at a time.

Gay & Mills
18-‹#›
Multiple Regression
Multiple regression is also the basis for path analysis.
Path analysis begins with a predictive model.
Path analysis determines the degree to which predictor variables
interact with each other and contribute to variance in the
dependent variables.
Gay & Mills
18-‹#›
Chi Square
Chi square (χ2) is a nonparametric test used to test differences
between groups when the data are frequency counts or
percentages or proportions converted into frequencies.
A true category is one in which persons naturally fall.
An artificial category is one that is defined by the researcher.
Gay & Mills
18-‹#›
Other Investigative Techniques
Data mining uses analytical tools to identify and predict

patterns in datasets.
Factor analysis is a statistical procedure used to identify
relations among variables in a correlation matrix.
Factor analysis is often used to reduce instruments to scales or
subscales.
Gay & Mills
18-‹#›
Other Statistical Procedures
Structural Equation Modeling (SEM)
Structural equation modeling is a combination of path analysis
and factor analysis.
SEM is a powerful analytic tool.
Gay & Mills
18-‹#›
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Caring for Patients of Japanese and Jewish Heritage

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