nursing culture india

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INDIA Courage Truth Faith Wheel of Life Hayley Shields Miriam Humphrey Jennifer Blumberg Blayne Murrell Whitney Pate Teri Schneweis Brittany Spears Karri Wingfield

Indian beliefs about birth : 

Indian beliefs about birth Birth in the eighth month of pregnancy is thought to be the cause of a cat entering the pregnant mother’s room in a previous confinement. A child born in this month is believed to die on the eighth day, eighth month, or the eighteenth year after birth. Lucky and unlucky births are especially believed by the Indian society. Monday is an unlucky day for birth. As a remedy, the child’s ear or nose is bored.

Jatakarma : 

Jatakarma Jatakarma is the ceremony that welcomes the baby into the world. The objective of the ceremony is to install good values in the child, even though the child does not understand the importance. Before the umbilical cord is severed, the father touches the baby’s lips with a gold spoon dipped in honey, curds, and ghee. The word “vak” (meaning speech) is whispered into the baby’s right ear three times, while mantras are chanted to ensure a long life. Applying ghee or oil to the baby’s head protects it from cold and catarrh.

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The father is usually not in the delivery room at the time of birth. Pain medications are usually not used during birth. They are believed to complicate the process. Therefore, the nurse should be prepared to assist the woman with alternative breathing or relaxation techniques. The sex of the baby is not told until the placenta has been delivered. Because of the high preference for having a boy, it is believed that having a girl will upset the mother and delay delivery of the placenta. Once the placenta has been delivered, the baby is first shown to the mother, then to the father and other family members. In nursing practice, it is important to accept and respect the Indian customs; as it will help the patient feel more comfortable. BIRTH

NANDA Nursing diagnosisRelated to labor : 

NANDA Nursing diagnosisRelated to labor Acute Pain related to uterine contractions, stretching of cervix and birth canal as evidenced by a change in vital signs

Death and Dying : 

Death and Dying • Death is viewed as a cycle of reincarnation • Timing of death is determined by karma • prefer to die at home • Believed to result in bad effects if one dies on a bed, prefer to be placed on floor, indicating oneness with earth • Life support not favored, if decision to end it arises, timing is important because of the belief death should come without interference, peaceful, gracefully, and quietly

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• Usually open to or oppose medical treatments, rarely in between • When one dies, a priest is brought in to release the soul, perform puja (worship), tie a yellow string around wrist, site verses from holy book “Geeta”, and place drops of water from a holy river in mouth. • Nurses should allow for this to take place, as this is an important part of Indian culture Death and Dying

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After death • Modesty and dignity remain • Body bathed and dressed by person of same sex only • In nursing this could pose a strain for the staff, if nurse was of different sex than pt, also causing stress for the family • Body dressed in Indian clothing of certain colors • Family will pray around body, preferably immediately after death • Touching the body is considered polluting

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After death • Grieving - common visible expressions are looked upon as helpful to cope • Preferred method is cremation over burial, and should be performed within 24 hours of death. This releases the spirit. • Organ donation is not accepted due to the soul not being able to be released • Autopsies are considered disrespectful • Oldest son is in charge of ceremonies • After the funeral service everyone will undergo a purifying bath and change

NANDA Diagnosis : 

NANDA Diagnosis Defensive coping r/t conflict between self-perception and value system AEB the holy Bhagvad Gita, “jaathasya hi dhruvo mr .thyur dhr .uvam janm mr .thasya cha thasmaad aparihaarye’rthe’ na thvam Sochi hum-arhasi” “For death is certain to one who is born; to who is dead, birth is certain; therefore, thou shalt not grieve for what is unavoidable”

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• Many are strict vegetarians … some also consume eggs and fish NUTRITION • Hindus do not consume any foods that may slow spiritual or physical growth • Eating of meat is not prohibited but those who do eat meat are forbidden from eating beef due to the cow being considered sacred • Pork, fowl, ducks, snails, & crabs are avoided

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• The thali is typically served in small bowls on a round tray. The round tray is typically made with steel with multiple compartments. • Meaning “plate” is an Indian meal with varying contents … usually yogurt, rice, chutney or pickle, and vegetables Thali

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Hindus view other products from cows as naturally pure…milk, yogurt, and butter. These products are thought to promote purity of the mind, spirit, and the body.

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Many devout Hindus fast on the 18 major Hindu holidays, as well as numerous personal days, such as birthdays and anniversaries of deaths and marriages. Hindus also fast on Sundays and on days that are associated with various positions of the moon and the planets

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NANDA DIAGNOSISNutrition Nutrition: Less than body requirements, imbalanced- related to metabolic changes and inadequate intake as manifested by patient fasting during a time of illness and physical and mental stress of hospitalization

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• Approximately 80% of the Indian population follows Hinduism •It has been estimated that there are about 900 million Hindus worldwide, nearly 2.5 million of which reside in the United States. Spirituality •Major beliefs include: • Samsara (the cycle of rebirth) • Karma (the universal law of cause & effect) These lead to the belief that one’s actions & thoughts directly determine one’s current and future lives. • Dharma one of the most complex all-encompassing terms in all of Hinduism. • Can mean religion, law, duty, order, conduct, morality, justice.

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Impact on Nursing Practice • Data: 1300 – Patient observed holding abdomen and crying after family departed. Reports pain level 8 on scale of 1-10 • Action: 1300 Repositioned patient and educated on guided imagery • Response: 1330 – Patient reports 6 on pain scale of 1-10 • It is difficult for nurses to see their patients in pain. However, it is important to respect the wish of the patient who will not accept narcotic pain medication and do anything in our power to help lessen their pain in a way that is acceptable to the individual patient.

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Beliefs on Illness and Death • Narcotic use Discouraged • Choose DNR status due to belief that prolonging life conflicts with Karma • Time of death determined by Karma • Death accepted as a natural part of life • When death is imminent, a priest may adorn the Head with sandle wood paste, holy ash and kum kum powder. • After death, the family may prefer to clean and prepare the body for cremation, the preferred method for Indian funeral ceremonies.

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NANDA Diagnosis Related to Spirituality Related to fear of being placed on life support AEB patient statement “If the doctor feels he can’t save me and puts me on life support against my wishes, then my Karma will be altered.” Risk for Spiritual Distress:

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Communication India Style • High value placed on independence and privacy. • Family issues including healthcare decisions discussed within immediate family BEFORE seeking outside help. • Men have a dominant and authoritative role because they are the primary point of contact with society. • Modesty is highly valued among Indians and patients are decidedly more comfortable and secure with same-sex care providers.

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Ayruveda “Knowledge of Life” • Indian medicine mixes religion with secular medicine in Ayruveda. •Observation of patient and the environment is essential to providing exceptional care. • Customs that do not allow female to male contact must be accepted and honored by nursing staff. Indians wish to be with the ailing patient in great numbers, this should be understood to avoid the patient feeling isolated. •The key to understanding other cultures is to be cognizant and open to communication in nursing practice.

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NANDA Diagnosis Related to Communication Related to inability to participate in usual activities, limited contact with significant others and decreased exposure to events in the outside world associated with prolonged immobility. Risk for Loneliness:

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Family & Community • Hindu's are a collectivist society. Collectivism emphasizes family integrity, family loyalty, and unity. Decisions affecting most aspects of life result from a collaboration of input from the entire family. • Based on caste system which divides society into rigid classes. Hindu's view their predetermined lot in life the result of their deeds in a prior existence, or Karma.

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Family & Community • The Indian family is considered strong, stable, close, resilient and enduring.• Family life is patriarchal in ideology and patrilocal. • There is often 3-4 generations, including aunts, uncles, nephews, and nieces, living under one roof. • Males are brought up to be assertive, less tolerant, independent, self-reliant, demanding, and domineering. • The oldest son is in charge of finances and family matters. The oldest daughter-in-law generally runs the household.

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Family & Community • Females are raised to be self-serving, docile, accommodating, nurturing, tolerant, religious, and to value family above all. • When caring for a patient who is of this culture, it is important for the nurse to remember that medical care and decisions need to involve the entire family structure to work through a problem. • The elderly are obeyed, revered, considered to be fountains of knowledge and wisdom, and treated with respect and dignity by family and community members.

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NANDA Diagnosis Related to Family Family processes, interrupted r/t powershift of family members a.e.b. the eldest son being incapacitated

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Access plays a large role in the number of patients who receive treatment and medication for pain; palliative care estimates show that very few (around 4%) of cancer patients are receiving proper pain management Doctors are not trained properly; medical practitioners and students receive little to no training about pain management/treatment Some Indian states follow strict regulations regarding narcotics, so medications for pain may be scarce Pain In India

Hinduism’s role in pain : 

Hinduism’s role in pain Some patients who practice Hinduism may believe that suffering is necessary to reduce or do away with past karma Some will choose to endure suffering and pain so that the mind remains clear as they go through the process of death Both of these beliefs may cause patients to refuse treatment or medication for pain

Where nursing plays into pain : 

Where nursing plays into pain Respecting patients’ wishes is important, but it can take a toll on a nurse when a patient’s health is being compromised. It is important that nurses, who are caring for a patient whose culture differs from the nurse’s own culture, are aware and try to correct biases that they may be showing. It may also be easier for a nurse to understand her patient’s decisions if the nurse does some research on the culture of the patient. One of the most important things to remember where pain, in any culture, is concerned is what McCaffery suggested--'pain is whatever the person experiencing it says it is’

NANDA DiagnosisRelated to Pain : 

NANDA DiagnosisRelated to Pain Chronic pain r/t disease progression aeb self-report by patient

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HYGIENE • It’s a national problem • Water shortages in all states • Widespread public defecation due to lack of private and public bathrooms • Results in preventable disease and death with the very young at greatest risk • Poverty and lack of education and resources, limit clean up efforts

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Educating the Population • 1999 – Total Sanitation Campaign • Goal – To build toilets so that 100% of India has access by 2012 • Educating public on the benefits of sanitation • Women are leading the Reformation! • Swajaldhara – 5 year plan to reform drinking water accessibility in rural areas

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October 15th 2010 80 Countries! School children across India involved Reinforce proper technique and benefits of hand washing on health

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Nursing Diagnosis Ineffective Health Maintenance Related to Insufficient Resources Nursing Implications: • Convey resource information: • Medical/Dental care • Financial resources • Assess for lice & evidence of other parasites • Patient teaching of proper hygiene to promote health • Free hygiene items

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• Short Term Goal: Patient will report a decrease in pain level from an 8 to a 6 on a pain scale of 0-10 by 11/30/10. Care Plan • Scenario: A male who handles family matters is hospitalized with terminal pancreatic cancer. • Diagnosis: Chronic pain related to disease progression as evidenced by self-report by patient

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Care Plan (cont.) Interventions: 1) Anticipate need for pain relief. One can most effectively deal with pain by preventing it. Early intervention may decrease the total amount of analgesic required. 2) Respond immediately to complaint of pain. In the midst of painful experiences a patient’s perception of time may become distorted. Prompt responses to complaints may result in decreased anxiety in the patient. Demonstrated concern for patient’s welfare and comfort fosters the development of a trusting relationship. 3) Eliminate additional stressors or sources of discomfort whenever possible. Patients may experience an exaggeration in pain or a decreased ability to tolerate painful stimuli if environmental, intrapersonal, or intra-psychic factors are further stressing them.

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Childbearing / Birth: http://hinduism.about.com/od/basics/a/rites_rituals_3.htm http://www.indianetzone.com/27/indian_custom_child_birth.htm http://www.indianetzone.com/22/jatakarma_hindu_ceremony.htm http://bearspace.baylor.edu/Charles_Kemp/www/indian_health.htm http://www.yogsandesh.org/articles/45/1/Jatakarma-Samskara-The-Birth-Ceremony/Page1.html Nutrition: http://www.faqs.org/nutrition/Pre-Sma/Religion-and-Dietary-Practices.html Spirituality: http://www.patheos.com/Library/Hinduism/Ethics-Morality-Community/Principles-of-Moral-Thought-and-Action.html http://www.angelfire.com/az/ambersukumaran/medicine.html

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HYGEINE Slide #1:  Chakarapani, S., Water Shortage in India and Diseases Caused.http://www.ananthapuri.com/article.asp?title=Water-Problem-in-India&id=48Galbraith, C. & Thomas, A., Community Approaches to Total Sanitation.http://www.unicef.org/spanish/evaluation/files/CATS_field_note.pdf Slide #2: Mohandas, P., Swajaldhara Guidelines: Forewordhttp://ddws.nic.in/popups/swajal_pop.htm Slide #3: Retrieved Nov, 12, 2010 fromhttp://callezee.net/blog/global-handwashing-day-2010-wash-your-hands-with-soap/http://www.globalhandwashingday.org/ Slide #4: Ackley, B.J. & Ladwig, G.B. (2011). Ineffective Health Management.Nursing Diagnosis Handbook (pp. 425-430) St. Louis: Mosby

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Communication http://bearspace.baylor.edu/Charles_Kemp/www/indian_health.htm http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=52 Death and Dying http://www.omi.wa.gov.au/Publications/cr_diversity/hinduism.pdf http://en.allexperts.com/q/Indian-Culture-2871/2009/8/India-rituals-taboos-hospitalized.htm http://hinduism.about.com/od/deathdying/a/condolence.htm http://atheism.about.com/od/hindusandhinduism/a/IndiaRituals.htm http://hinduism.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=hinduism&cdn=religion&tm=59&gps=127_668_1259_552&f=11&tt=14&bt=0&bts=0&zu=http%3A//www.staffspasttrack.org.uk/exhibit/ilm/Mourining%2520and%2520Remembrance/Types%2520of%2520funerals/Hindu%2520Funerals.htm http://www.angelfire.comaz/ambersukumaran/medicine.html/

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http://www.nursingcenter.com/prodev/ce_article.asp?tid=1085798 http://pdc.ceu.hu/archive/00006276/ http://www.deathreference.com/Nu-Pu/Pain-and-Pain-Management.html Pain and Comfort Family and Community http://family.jrank.org/pages/859/India-Family-Life-Family-Values.html> Watchtower Bible & Tract Society. (1990). Mankind's Search for God. Brooklyn, NY.