Meeting Jewish and Muslim Patients’ Dietary Needs

“We are what we eat.” It’s a statement we’ve all heard, but as nurses we need to understand what it really means for us and for our patients. Simply, we eat what we believe is good for us and what we think tastes good–attitudes that are primarily shaped by our family upbringing, our culture and our personal preferences. And if we are people who practice a particular religious faith, we eat what is most in agreement with our beliefs.

Many religions forbid certain food items, have strict requirements about how food should be prepared and have special dietary practices that must be observed. Adhering to these guidelines helps followers of these religions feel assured that they are eating what is best for their physical, mental and spiritual well-being. Therefore, when caring for a multicultural patient population, nurses need to be aware that some patients’ special dietary needs play a major role in their healing process. For the patient who is a strict observer of his or her religion, any violation of their dietary requirements can be perceived as an actual challenge to the utmost supreme authority–whether it be God, Buddha or Allah–and can impact negatively on their recovery and their level of satisfaction with the health care facility.

To be culturally competent health care providers, nurses must not only be aware of patients’ religious dietary mandates but work very hard to accommodate them. The challenge for us as caregivers and patients’ advocates is that in many health care facilities with rigid policies, efforts to meet these special dietary needs may require a creative twist and a team effort to make it happen.

Eating food is not only a necessity of life but also a pleasant and social practice that everyone expects to enjoy. Eating during sickness needs to be a very positive experience for all patients. Therefore, health care organizations must adjust their often inflexible policies to be more people-oriented, rather than system-oriented. For example, some hospitals are beginning to rethink their approach to food services by including menus that accommodate the dietary requirements of America’s growing Muslim population.

As a resident of the Washington, D.C. area, I enjoy visiting the cafeteria at the World Bank to sample its array of international foods and its “eat around the world” atmosphere. This is an excellent example of an organization displaying what we can call true cultural sensitivity and multicultural customer service.

Understanding Judaism and Islam

The religions of Islam and Judaism share many similarities. Muslims believe in only one God (Allah), the creator and sustainer of all creatures and the universe, who prescribes the Muslim’s way of life. Following Islam and obeying its teachings, as set forth in the holy book the Quran, is the most important thing in a Muslim’s life and requires adherence to mandatory practices that may not tolerate violations. Observant Muslims believe that the best way to maintain their mental, physical and spiritual well-being is to adhere to the Islamic teachings and the rules of Allah through practice and moderation in all aspects of life.

Muslims consider their health a religious matter and they believe that good nutrition is one of the essential steps toward maintaining good health. For Muslims, health and food are considered acts of worship for which Allah must be thanked.

Similarly, in Judaism the Hebrew Scriptures, which include the holy book the Torah, emphasize one God, the creator and the author of everything in the universe. The Torah contains religious laws set forth by God that address all aspects of Jewish life. Books such as the Talmud are used to interpret and apply these Jewish laws in daily life.

Both Muslims and Jews consider eating to be a worshiping matter that requires following the dietary practices and requirements set forth in their respective holy books. I will discuss some of these specific dietary needs in the next two sections of this article. As always, however, care providers must be sure to view each patient as a unique individual and not make blanket assumptions or generalizations about the patient’s religious needs. How strictly a Jewish or Muslim patient chooses to follow his/her religion’s dietary practices can vary widely. The best way to determine a patient’s religious, cultural and/or dietary needs is simply to ask the patient and/or family members.

Islamic Dietary Practices

Islam prohibits Muslims from consuming any of the following items:

Alcohol. This includes alcoholic beverages such as wine and liquor, as well as any food items that contain alcohol. Islam forbids the use of any mind-altering substances, whether in the form of food, drink or smoking. Muslims believe that maintaining health, Allah’s gift, requires mastering full control over one’s mind, body and spirit at all times.

Pork or any pork products, such as lard, ham and pepperoni. This includes consuming any food that contains these items in any concentration or amount. Therefore, all foods containing animal shortening are forbidden, since this shortening is usually made from pork fat. It is permissible to eat foods containing vegetable shortening.

Blood. Raw meat must be soaked in water to drain out the blood before cooking. Muslims are permitted to eat only well-done cooked meat where no trace of blood can be found after cooking.

Islam also forbids cooking, eating or drinking from any pans, dishes, cups or table utensils that were used to prepare food containing pork or alcohol. They cannot be used to prepare or serve food for Muslims until they are thoroughly washed.

Animals and poultry must be slaughtered by cutting both the neck artery and vein to cause instant death and decrease animal suffering. The name of Allah must be mentioned during the slaughtering of the animal to bless it and make it Halal (lawful) to eat.

Islam also stresses certain hygienic measures such as washing hands before and after eating, and cleaning the teeth frequently. A Muslim who has eaten onions will pray at home, rather than in the mosque, so as not to offend others and the angels.

Jewish Dietary Practices

Jewish dietary laws are known as kashrut and food that adheres to these standards is called kosher. Many mandates of the kosher diet are similar to those found in Islam. For example:

• Eating any pork or pork products, including animal shortening, is prohibited.

• All blood must be drained from meat and poultry before cooking.

• Dairy products and meat products cannot be eaten together, because this is considered unhealthy. Cooking equipment and eating utensils that have come into contact with dairy products cannot be used with meat, and vice versa.

• Animals and poultry must be slaughtered in accordance with Jewish law.
Other Jewish dietary restrictions include the following:

• Eating certain types of animals, birds and fish is prohibited. Specifically, the only mammals that may be eaten are those that have cloven hooves and chew their cud, such as cows, sheep and goats. This explains why pork is forbidden, since pigs do not have these characteristics.

• The only type of fish that may be eaten are those that have fins and scales. Therefore, shellfish, such as lobster, shrimp, oysters and crab, are prohibited.

• Birds of prey and birds that are scavengers may not be eaten. Typical fowl, such as chicken, ducks and turkeys, are permissible.

• Certain parts of permitted animals may not be eaten. In the case of forbidden animals, their eggs and milk also cannot be consumed.

Before eating, observant Jews will recite a blessing (bracha) acknowledging God as the creator of the food they are about to enjoy. This is done by holding the food in one hand, reciting the blessing and immediately taking a bite or a sip. One must not speak or make any interruption before finishing the first bite or sip. Another commandment of the Torah requires that a blessing also be recited after the meal.

There are also special bracha that are recited for specific foods. For example, certain fruits and nuts, such as almonds, apples, apricots, blackberries, cashews, cherries, chestnuts, coconut, cranberries and dates, require a blessing known as a Ha’etz. A blessing called a Ha’adamah is required before eating vegetables such as asparagus, beans, beets, broccoli, Brussels sprouts, whole buckwheat, cabbage, etc.

Ancient Foods for Modern Health

In today’s health-conscious times, it is very interesting to note that many Islamic and Judaic dietary traditions dating back to 1,400 years ago have been confirmed by modern scientific evidence to have a healthy effect on the human body. For example, consider the prohibitions against eating pork in both Muslim and Jewish dietary laws. We now know that:

• Pork fat is the most saturated type of fat in the animal kingdom and can increase the risk of high cholesterol and cardiovascular disease.

• Its salty meat is an additional risk for the kidneys, heart and for hypertensive patients.

• Pigs will eat anything and everything, including their own excreta. This makes their bodies an ideal host for several microorganisms that are known to be hazardous to human health if consumed regularly.
In addition, many foods that have long been staples of the traditional Middle Eastern diet are being recognized today for their healing properties, especially in the fields of alternative medicine and herbal medicine. Here are a few examples:

Honey is a natural remedy for conditions such as coughs, stomach ulcers and skin ulcers. Many cough medicines sold today include honey as an ingredient. I have personally witnessed the use of honey to heal bedsores in some health care centers in the U.S.

Virgin (unprocessed) olive oil is cited in the Bible, Quran and Torah as a holy food item. It helps dissolve bad cholesterol in the human body and is also an excellent topical treatment for skin conditions such as severe dryness and eczema.

Black caraway seed (also known as nigella sativa or black cumin) was used as a medicinal herb by the ancient Egyptians and Greeks. Today, practitioners of alternative medicines such as ayurvedic medicine are continuing that tradition. It is used to boost the metabolism and the immune system. Also, some research studies have suggested that extracts from these seeds may have some effect in slowing the growth of certain types of cancer.

Dates, which are high in natural sugar and protein, are a healthy food for breaking one’s fast. For pregnant women, eating dates can strengthen the uterine contractions during labor and delivery and assist in preventing postpartum bleeding. According to the Quran, Allah asked Maryam (Jesus’ mother) to shake the date tree and eat from it to ease her birth process. Muslims faithfully follow this practice.

Garlic and onions are very ancient preventive measures for conditions such as infections, cardiovascular disease and diabetes. These foods contain powerful chemicals that can help lower cholesterol, lower blood pressure, reduce the risk of blood clots, attack infection-causing bacteria and even reduce the risk of developing certain cancers, if eaten on a regular basis.

Editor’s Note: Minority Nurse’s cultural competence expert, Gihan ElGindy, MSN, RN, is an internationally recognized authority on cross-cultural issues in nursing. Her advice column is designed to answer your questions about incorporating cultural competence into your nursing practice and resolving cultural conflicts in today’s diverse health care workplace. Do you need expert advice on how to provide culturally sensitive care to patients from a particular ethnic or religious background? Are you looking for ways to increase understanding and acceptance of cultural differences in your work environment? Our expert can help!

Treating Muslims with Cultural Sensitivity in a Post-9/11 World

Q: I am a Muslim nurse who wears Hijab [the Islamic dress requirement that women’s bodies must be completely covered except for their face and hands]. I am frustrated because infection control staff are always asking me to wear short sleeves or roll up my sleeves. How can I avoid this situation and make them understand that this is an important religious requirement in my culture? In my opinion, my long sleeves do not pose a considerable infection hazard.–A Muslim RN

A: Muslim working women, including nurses and other health care professionals, often face challenges because of their attire, which is in adherence to Islamic regulations. Many times, these challenges originate from misconceptions and limited knowledge about Islam and Muslims. To be culturally sensitive to the needs of Muslims in the health care workplace, it is essential to understand that in Islam, both men and women are mandated to wear modest clothes and follow the Islamic dress code. It is even more important to understand that Hijab is much more than simply a way of dressing–it cannot be separated from the “big picture” of Islam as a entire way of living and believing.

For Muslim women, wearing a headscarf, veil, long sleeves, loose-fitting clothing and other elements of Hijab is necessary to obey the Islamic dictate that they must cover the body in the presence of male non-family members. They may, however, dress as they please in the privacy of their homes, or in areas where no male non-family members are present. Yet it is important to keep in mind that Islam, like all other religions, has those who do not practice or adhere to the requirements of the religion, as evidenced by Muslim women who do not wear Hijab. This is often a source of confusion to non-Muslims.

It’s also worth noting that wearing the veil and covering the body are traditional religious practices that are not unique to Islam; they are found in other faiths as well. For example, in Christianity, nuns wear the “habit” and many Jewish women cover their hair before going to synagogues.

So how should this Muslim RN handle her conflict with the infection control staff? First, let me say I admire your strength and pride in standing up for what you believe in and your right to freedom of choice in this land of freedom. I would suggest sitting down with the infection control staff to try to educate them about your cultural and religious requirements in a non-confrontational way. It would be helpful to make information about Muslim culture and Islam available to them–such as this column and other articles you may find in magazines or on the Internet–so they can build their cultural competency. Also, if there is a diversity director or coordinator at your facility, I encourage you to bring this matter to his or her attention.

Sadly, since September 11 cultural insensitivity toward Muslims in the workplace has become a widespread problem throughout the country. We all need to learn to be open-minded and try very hard to understand and respect each other’s views and beliefs. Hopefully, we can learn from each other and focus on the work Muslim nurses do, rather than on what they wear.

Q: I have found caring for Muslim patients to be a very demanding and frustrating assignment. They ask for many things that we nurses are unfamiliar with and that can create problems in a hospital setting. For example, asking for lots of water to wash themselves before and after using the bathroom, which can make a mess, especially if bed rest was ordered. Can’t they delay all these special requests until after they are discharged?–J. S., Arkansas

A: It is quite common for care providers who are not familiar with Muslims and their practices to be confused and even bewildered by their requests. Here are a few tips that can make your job easier and more pleasant.

First of all, it would be culturally insensitive to ask Muslim patients to put their religious practices “on hold” until after they are discharged. Adherence to the teachings of Islam governs every aspect of Muslim life and must be practiced every day, regardless of the physical setting in which Muslims may find themselves. (See “Understanding Islam.”)

What’s behind the requests for water? Muslims are religiously responsible for their lives, health and well-being. Islam requires Muslims to stay healthy by focusing on preventive medicine and good hygienic practices. Maintaining cleanliness is considered a required act of worship. Muslims must pray to Allah several times a day; in preparation for prayers, they must start with the cleansing process known as “ablution.” This consists of washing the face, hands, arms, legs and feet, using running water–even if the person is in a hospital bed.

There are also other situations in which mandatory cleansing actions with running water are required for all Muslims:

• After elimination, for removal of all traces of urine, stool, and/or blood;

• After the cessation of menstrual and postpartum bleeding, and after sexual intercourse. In these instances, the person must shower to clean and purify her/his body in order to resume religious practices.

When Muslims are hospitalized, they are very sensitive to traces of urine, stool or blood on their clothes, body or linen because they believe it interferes with their ability to pray and read the Quran. It decreases their sense of cleanliness and purity, which is necessary for worshiping practices–practices that are essential and comforting during illness, hospitalization or crises. Indeed, performing ablution, praying and reading the Quran are among the most important spiritual resources for Muslims during sickness or stressful times. As in many other religions, prayers can erase bad deeds and make entry to paradise easier, as well as improve the patient’s mindset to enable a speedy recovery.

You will be happy to learn that nurses can easily accommodate Muslim patients’ religious cleansing needs in ways that will not turn the hospital room into a wet mess or interfere with the patient’s medical treatment. You can simply escort the patient to the bathroom sink or shower. If the person is confined to bed or has other special conditions that limit mobility, a full pitcher of water with a basin as a receiver can meet the running water requirement. If water is medically contraindicated and/or can cause harm to a wound or damage to a cast, for example, you need to explain this clearly to the patients so that they can modify their cleansing practices accordingly. In these situations, Muslims know how to dampen a hand with water and wipe the affected body part with it.

Understanding Islam

For nurses as well as the health care facilities that employ them, understanding Muslim culture is an essential part of building required cultural competency. Muslims are one of the fastest-growing populations, both globally and in the United States. Many U.S. cities, such as New York, Los Angeles, Chicago, San Francisco and Detroit, have large and dynamic Muslim communities. An important part of understanding the cultural needs of Muslims is understanding the role of Islam in their lives and how their adherence to the teachings of Islam shapes their beliefs about health, illness, preventive medicine, birth and death.

“Islam” can be defined as submission and surrendering to Allah (God) by following and obeying his orders. For Muslims, Islam is not just a religion but a complete way of life, guiding and governing all their life aspects. Therefore, adhering to Islamic teachings is much more important than anything else in a Muslim’s life, to the extent that Muslims will sacrifice their own welfare–such as possibly losing their jobs–rather than violate Islamic regulations. This is because Muslims place the greatest value in accountability on the Day of Judgment, which will determine one’s fate in the hereafter. For Muslims, adherence to Islam is not limited to just this short earthly life; rather, it is a test to escape hellfire and achieve eternal paradise.

Prayer is the highest form of worshipping in Islam, in which Muslims communicate with Allah while reciting from the Quran (the holy book of Islam). Muslims must pray five mandatory prayers every day. It is important for health care providers to understand that Muslims do not speak or respond to anyone but Allah during prayers.