Concept of Human Rights Discussion Response

Jewish Discussion Initial Post 1

How do you feel about Lisa’s request?

The concept of human rights has been at the center of different debates since the end of World War II. For many scholars, they are considered inalienable rights that are inherent to a person. Tiedemann (2014) said that those rights must be directly reflected in the condition under which someone is recognized as a person with equal protection of his or her personhood. Aiming to increase the awareness of those rights throughout the world, in 1948, the General Assembly of the United Nations (U.N.) adopted a solemn document called the “Universal Declaration of Human Rights. As noted by Annas and George (1998), no other document has so caught the historical moment, achieved the same moral and rhetorical force, or exerted so much influence on the human rights movement. Among the different rights that are mentioned in this document, the right to freedom of religion is of particular importance. From that perspective, we can say that Lisa’s request must be welcome. It is a legitimate request because Lisa has the right to observe her religious practices without any fear.

How might this request be honored?

The case of Lisa revealed the importance of cultural competence in the workplace. Nowadays, considering the composition of modern societies with multiple cultures with different religious beliefs, the healthcare system of a country should not be composed of homogenous personnel. That is being said, diversity in the workplace must be the norm, especially when it comes to health care. Diversity in the workplace is important because it contributes to the organization’s collective decision-making, effectiveness, and responsiveness to societal healthcare needs (Andrews & Boyle, 2016). Considering those advantages from workplace diversity, the request of Lisa must be honored accordingly. Then, the manager should be more considerate about Lisa’s request. He/she should see Lisa’s request as an opportunity to show respect to the culture of minority groups. He/she should honor Lisa’s request by allowing her to be off Friday and Saturday so she can practice her religious observances as dictated by her Jewish religion.

Was the supervisor culturally competent in this situation?

As the modern healthcare system is trying to incorporate the philosophy of cultural competency in the workplace, it is also necessary to envision some barriers that can prevent its application. One of those barriers to cultural competency is ethnocentrism. Andrews and Boyle (2016) defined it as a human tendency to view one’s group as the center of and superior to all other groups. In other words, an ethnocentric is someone who thinks that his/her culture is more important than anyone else’s culture. When ethnocentrism is manifested at work, no one cares about the cultural values and beliefs of their peer. However, if an organization wants to prosper, cultural competence must be the norm, but not an exception. It is considered a complex integration of knowledge, attitudes, values, beliefs, behaviors, skills, practices, and cross-cultural interactions among staff from different backgrounds (Andrews & Boyle, 2016).

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In the case of Lisa, we can boldly say that the supervisor was not culturally competent to appreciate the cultural values of Lisa’s beliefs. This supervisor was ethnocentric because his/her behavior showed no respect for Lisa’s cultural values. He/she used an alibi to reject the request of Lisa. He/she had no right to tell Lisa to go back to New Jersey where she could be more comfortable. It is not up to the supervisor to determine the best place for Lisa to work. Denying her right to practice her religious observances is not acceptable and showed that the supervisor was not culturally competent.

If Lisa were to discuss the issue at a team meeting, how could she present her concerns?

The best way for Lisa to present her concerns in the meeting is to show the leaders of the organization that her rights were violated and the tendency of the supervisor and the staff to deny her cultural values is not beneficial for the organization. As we can see from the case study, that tendency was the norm inside the organization because both the supervisor and the staff perceived Lisa as “standoffish”. Then, we can certainly conclude that the organization itself was not promoting cultural competence in its environment.

The second concern that Lisa could present in the meeting is her right to freedom of religion was violated. As a human being, Lisa has the right to work in an environment where her human rights are respected. One of the modern ethical theorists who gave a clear account of human rights is the British philosopher John Locke (1632-1704) who thought that human rights are permanent features of who we are (Fieser, 2011). Lisa must be seen as a Jewish employee with inalienable rights. Those rights are considered inalienable because they cannot be cast aside or given to someone else. They are inherent to human life. Violating those rights is like violating the dignity of human beings. Then, Lisa is a Jew, and she must be respected as a Jew.

The third concern that Lisa can point out in the meeting is the behavior of the supervisor and the staff that can be considered as discriminatory. In the workplace, it is not fair to discriminate against an employee based on his/her religious beliefs. That can jeopardize the reputation and benefits of the organization, can lead to bullying in the workplace, and have negative consequences in terms of healthcare outcomes for the patients. Then, those attitudes and practices must not be acceptable in any form.

What does EEOC say about honoring employees’ requests for time off for holidays?

To fight discriminatory attitudes in the workplace, legal actions were undertaken to establish anti-discrimination policies that can protect all employees. Among those policies, the U.S. Equal Employment Opportunity Commission (EEOC) laws can never be overemphasized. In section 12 of the EEOC laws, the Title VII of the Civil Rights Act of 1964 was used as a reference to request that all employers reasonably accommodate the religious beliefs and practices of an employee unless doing that will cause hardship to the employer on the employer’s business conduct (EEOC, n.d). In Title VII of the Civil Rights Act of 1964, it is clearly stated that an employer is prohibited from discriminating because of religion in hiring, promotion, discharge, compensation, or other “terms, conditions or privileges” of employment, and also cannot “limit, segregate, or classify” applicants or employees based on religion “in any way which would deprive or tend to deprive any individual of employment opportunities or otherwise adversely affect his status as an employee ( EEOC, n.d).

References

Andrews, M. M & Boyle, J. S. (2016). Transcultural concepts in nursing care (7th ed.). Wolters Kluwer

Annas, J., George, D. (1998). Human rights and health–the universal declaration of human rights at 50. The New England Journal of Medicine, 339(24), 1778-1781.

Fieser, J. (2011). Moral Philosophy through the Ages. University of Tennessee at Martin. Mountain View, CA: Mayfield Publisher

Tiedemann, P. (2014). Is There a Human Right to Freedom of Religion? Human Rights Review (Piscataway, N.J.), 16(2), 83–98.

U.S Equal Employment Opportunity Commission. (n.d). Section 12: Religious discrimination.

Post 2

How do you feel about Lisa’s request?

Lisa’s request to have designated time off each week to observe her religious practices is valid and should have been considered by her supervisor. Working in healthcare, especially in this era of hospitals being short-staffed with registered nurses as well as the mass exodus of nurses due to the Covid pandemic, I can understand the apprehension or worrisome feelings that her supervisor/manager might have when reviewing her request. Nonetheless, the supervisor’s response could have been more professionally appropriate, and less dismissive. According to a blog posting on PrimePay discussing the rules for giving employees time off for religious holidays, there is no federal law that requires an employer to give employees days off for religious holidays; however, under Title VII of the Civil Rights Act of 1964, employers may not treat employees differently because of their religious affiliations, and employees cannot be required to participate or not participate in a religious activity as a condition of employment. Under Title VII, employers have an affirmative duty to provide a reasonable accommodation to employees for religious observances, such as requesting a day off to observe a religious holiday, unless the employer can demonstrate that providing such a reasonable accommodation would result in an “undue hardship” on the employer. Lisa has the right to her request and also has the right to be responded in a culturally sensitive manner.

How might this request be honored?

As per Title VII of the Civil Rights Act of 1964, reasonable accommodations should be made by Lisa’s supervisor or management to allow her to fulfill her religious duties and get time off, as long as there aren’t any hardships that compromise the area Lisa works in. The first step is having the supervisor read the letter that Lisa provided to elaborate on why she needs that day off. This would be able to give the supervisor some insight as to how important this time off is to Lisa. If the supervisor is not acknowledging the request, the next step is to go above her and have management intervene. Management could also be notified of the inappropriate comments that were made by the supervisor and address her feeling. To also offer a comprise, maybe Lisa could offer to work the days that she is already scheduled during the transitional period before she is granted the time off. Another initiative that Lisa could do is find any policies put in place at her facility or state laws that could support her request.

Was the supervisor culturally competent in this situation?

Cultural awareness and sensitivity help to overcome one’s personal ethnocentrism, primarily by learning about other cultures and the various methods and expectations of ethical, religious, and social perspectives in various fields to body language and other nonverbal communication (Impactly, 2021). In the workplace, this is extremely important, especially in curating an environment that makes employees feel comfortable, yielding employee satisfaction and increasing effective job performance. Lisa’s supervisor did not display cultural competency in this situation. Her comments of “consider going back to New Jersey where she’d be more comfortable” and also “try to fit in” dismisses and demeans her culture/religious beliefs. The supervisor may not be familiar with Jewish heritage and/or religious practices, but being open to learning and understanding the differences presented in the workplace amongst individuals allows bias to be addressed, learning opportunities to be had, as well as allowing employees to openly express themselves within their rights.

If Lisa were to discuss the issue at a team meeting, how could she present her concerns?

In a team meeting, Lisa could bring up the need of allowing employees to take time off for religious purposes. This would introduce an open dialogue and allow the team members to gain some insight into Lisa’s personal life. One of the concerns that the supervisor raised to Lisa is that she is perceived as “stand-offish,” and voicing her concerns publicly could allow the staff to gain some understanding, allowing them to empathize with her. This could spark interest in learning about her culture/religion, promoting a culturally sensitive work environment. Lisa could also take the time to bring up the comments that her supervisor said to bring awareness to how it is important to be culturally sensitive and respectful in the workplace, and the need for respect in the area. Lastly, Lisa could use her seniority in the area to try to leverage her time. She had dedicated 12 years of her nursing career to the emergency department at her hospital, and should at least give her the curiosity of seeing how they can work together to achieve a schedule that satisfies her and the area’s needs.

What does EEOC say about honoring employees’ requests for time off for holidays?

The Equal Employment Opportunity Commission (EEOC) is responsible for enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person’s race, color, religion, sex (including pregnancy, transgender status, and sexual orientation), national origin, age (40 or older), disability or genetic information. Title VII of the Civil Rights Act of 1964 prohibits employment discrimination based on religion. This includes refusing to accommodate an employee’s sincerely held religious beliefs or practices unless the accommodation would impose an undue hardship (more than a minimal burden on the operation of the business), including religious holidays (U.S, Equal Opportunity Commission, 2014).

References

Cultural insensitivity and its impact in the workplace. Impactly. (2021, November 2). Retrieved February 27, 2022, from

Experts, A. P. P. (2012, October 23). Rules for giving employees time off for religious holidays. PrimePay. Retrieved February 27, 2022, from https://primepay.com/blog/rules-giving-employees-t…

U.S, Equal Opportunity Commission. (2014, March 3). What You Should Know: Workplace Religious Accommodation. What You Should Know: Workplace Religious Accommodation | U.S. Equal Employment Opportunity Commission.

Assignment 3

Thought Questions:

• Based on a research article which has tested a middle range theory, identify the evaluative criteria that inform the support or refutation of the theory based on the research findings (this may be discussed in the discussion or implication section of the article).

Assignment 4

Thought Questions:

• Based on principles and guidelines for APRNs in a clinical encounter based on the Purnell Model, identify how these principles and guidelines would inform your encounter with the Mendez family?

“Mrs. Mendez”

Mrs. Maria Mendez is a 72-year-old Hispanic patient with advanced left breast cancer

with metastasis to the lungs and bones. She is referred to your home care agency for

wound care services. She has seven children: five daughters and two sons (all living in

California). Her five daughters live within the Los Angeles area. Her eldest son lives in

San Diego and the younger son has been distant from the family and has not had contact

with the family for the last 18 months. Mrs. Mendez’s husband died seven years ago of

lung cancer. Since that time she has lived with her youngest daughter, Maria.

Initially, Mrs. Mendez discovered the breast lump herself but did not seek medical care

for over a year. When Mrs. Mendez was diagnosed, her disease was considered

advanced. She refused to have a mastectomy based in part by her cultural belief that the

soul resides in the breast and should not be removed. At the urging of her children, she

did undergo chemotherapy but recently has experienced increased bone pain and decided

to discontinue the treatment regimen. The tumor in the left breast is now approximately

the size of an orange with malodorous, purulent drainage. Home care was initiated for

wound care and other symptom management services. Under the terms of her managed

care/Medicare insurance plan, her care is referred back to her family care practitioner in

her local community rather than her oncologist since she is no longer receiving cancer

treatment.

Mrs. Mendez’s condition continues to decline and her physician encourages her to seek

hospice care. Mrs. Mendez has become very close to the home care nurses who provided

the wound care and requests that her care continue with the home care agency rather than

a referral to hospice. At this time, changes in her living arrangements are also made.

Living with Maria over the last seven years has been very positive, but Maria has three

young children and the intensive care of her mother at this stage of the illness is

becoming a problem. The family emphasizes that Mrs. Mendez should move in with her

eldest daughter, Gloria, who no longer has children living at home. Although her

daughters have always been close to their mother and more involved in her care, the

eldest son of the family, José, who resides in San Diego, is consulted for all decisions and

has been the father figure of the family since Mr. Mendez’s death. Mrs. Mendez’s

managed care plan allows for only two RN visits per week and must be reevaluated every

three weeks by the case manager. In addition to the symptom management provided by

the home care agency, Mrs. Mendez and her daughters use many alternative therapies

which includes “cat’s claw”, herbs, and visits by a healer. Mrs. Mendez is religious and

uses prayer to help cope with her illness. Her middle daughter, Christina, is devout in her

religion and is in absolute denial that her mother will die. Christina comes nightly and

holds a prayer vigil with her mother and also brings herbs and remedies that “will cure

the disease”. Mrs. Mendez becomes increasingly withdrawn as conflicts arise among her

children. Gloria and Christina are at odds because Gloria is most accepting of her

mother’s impending death. Gloria was also the primary caregiver during her father’s

illness with lung cancer.

After three weeks of care by the home care agency (HCA), Gloria calls requesting that a

nurse come as soon as possible because her mother’s pain is worse. On physical

assessment, the nurse notes that the breast tumor remains dry, however the tumor mass

has increased and the breast is inflamed. The pain is described by Mrs. Mendez as an

intense pressure pain at the site of the tumor in the base of the breast. She also describes

a sharp stabbing pain in the left upper quadrant of the breast. In addition, Mrs. Mendez

complains of intense pain in her mid-back which has made it very difficult to lay in bed

and she has been unable to sleep for the last week. She has been taking one to two

Vicodin every four hours PRN although yesterday Gloria reports that out of desperation

the Vicodin was given approximately every two hours until Mrs. Mendez became

extremely nauseated. The nurse recalls that morphine was ordered for the patient a few

weeks ago in anticipation of increased pain not controlled with the Vicodin. Upon

questioning, the daughter states that they have not used the morphine as they were

“Saving it for the end.” Gloria also reports that the family is trying to minimize the use

of the medicine since their mother is extremely constipated. Gloria continues to relate

that the reason her mother is constipated is because Mrs. Mendez has not been able to

continue her herbal remedies due to nausea. Mrs. Mendez appears very stoic with

minimal expression of pain. Her only complaint is that she no longer is able to have her

grandchildren over to visit due to her declining condition.

Mrs. Mendez is initiated on a regimen of long-acting morphine, 60 mg at bedtime with 15

mg morphine immediate release (MSIR) for rescue dose. Over the next week, the long-

acting morphine is increased to 120 mg BID supplemented with Imipramine 50 mg BID

and Ibuprofen 800 mg TID. Christina has now moved into Gloria’s home and continues

her evening prayer vigils. José calls several times a day to dictate his wishes regarding

his mother’s care but has not been able to visit often from San Diego as he is in risk of

losing his job. Gloria seems increasingly burdened with her mother’s care and her

siblings’ involvement. Gloria follows the home care nurse to the car weeping because of

the stress.

Approximately one week later, the nurse receives a call from Gloria reporting that her

mother has seemed to decline rapidly over the weekend. Mrs. Mendez awoke during the

night with difficulty breathing and has been terrified of the possibility of suffocation. On

exam, the nurse notes that Mrs. Mendez has developed extreme shortness of breath. She

is also increasingly fatigued and the combination of exhaustion, dyspnea, and general

decline has resulted in minimal intake of foods or fluids. José called this morning with

strict orders that his sisters continue to feed their mother at all costs. He hopes to be able

to come up from San Diego the following weekend to visit. Mrs. Mendez relates to the

nurse that she knows she is dying and does not want to continue being a burden to her

family.

Mrs. Mendez’s physical condition has greatly improved due to aggressive symptom

management by the HCA. The morphine dose has increased to 240 mg BID

supplemented with 40 mg of MSIR approximately every two hours for dyspnea. With

her breathing improved, she as been able to take sips of water and occasional amounts of

other liquids. Mrs. Mendez’s condition, however, continues to decline and the home care

nurse anticipates that she will die within the next two weeks. The HCA schedules a

meeting with the primary nurse and social worker to discuss the growing tension in the

family. Four of the daughters are now present in the home taking shifts to be at Mrs.

Mendez’s bedside at all times. To make the family situation more difficult, Jose has

learned that the young brother Pablo is living in Los Angeles and asks Pablo that he

please visit his mother before she dies. Christina continues her prayer vigils and has

asked members of her church to visit daily to hold prayer meetings with her mother. Mrs.

Mendez tells the nurse that she cannot discuss her impending death with her family

because they do not want to talk about it or hear that she is dying. At this point, Mrs.

Mendez is very withdrawn and has little interaction with her family. Mrs. Mendez has

now developed a pressure ulcer on her buttocks and requires a Foley catheter due to

incontinence, which has intensified the physical care demands of her care.

The HCA receives a call on Saturday evening requesting assistance with Mrs. Mendez as

her condition is declining rapidly. The younger son, Pablo, arrived two days ago and has

had a very tearful reunion with his mother and his sister, Gloria. The social worker and

the nurse were very successful in the family meeting with facilitating communication

among the children and establishing common goals for Mrs. Mendez’s comfort. All of

the children with the exception of Christina, seem accepting of the impending death.

Gloria’s husband, Michael, has been quite supportive of his mother-in-law’s care

throughout her illness, but has strong feelings against death occurring within his home.

The priest is called to give Mrs. Mendez communion and the Anointing of the Sick. The

extended family is at Mrs. Mendez’s bedside, except for Christina who is in the kitchen

crying.