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Nursing with Dignity Part 3: Christianity I

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VOL: 98, ISSUE: 11, PAGE NO: 37

Maxine Christmas, BSc, RGN, RSCN, PGCE, is a professional and practice facilitator, Birmingham Children's Hospital NHS Trust

There are an estimated seven million practising Christians in the UK and many more who would describe themselves as Christians (Henley and Schott, 1999). Christianity is found in almost every country around the world but, although the core beliefs remain the same, the interpretation of its teachings may be modified by local customs and cultures.

There are an estimated seven million practising Christians in the UK and many more who would describe themselves as Christians (Henley and Schott, 1999). Christianity is found in almost every country around the world but, although the core beliefs remain the same, the interpretation of its teachings may be modified by local customs and cultures.

There are many different branches of Christianity. These include the Church of England, Catholicism, Orthodox Christianity, Presbyterianism, Methodism, Pentecostalism, Seventh Day Adventism and many others. Each takes a different approach to the core teachings and reflects different traditions of discussion and interpretation of the scriptures.

It is impossible to include every branch of Christianity in this series, but in this and next week's articles we hope to help nurses to develop their understanding of the diversity within Christianity and the implications for nursing care. These articles address branches of Christianity that some readers may be less familiar with.

The Afro-Caribbean community
Many people in Afro-Caribbean communities try to live their lives according to the Bible. They believe that Jesus Christ was the son of God and that he was resurrected, and that all people will have to answer to God. Those that have lived a good Christian life, according to the Bible, will go to heaven and be with Jesus Christ.

A significant proportion of the UK's Afro-Caribbean community are Christians, particularly the older generation. Within this community there is a range of Christian faiths and variations in religious practices. The main churches are Methodist, Anglican, Pentecostal and Church of God. Like many other cultures, there is conflict between the older and younger generations over the latter's reluctance to continue with cultural and traditional ways of life.

Birth control/termination of pregnancy
With the exception of Rastafarians, most religions that are practised by Afro-Caribbean people do not object to any form of birth control.

However, members of the older community in particular may consider the termination of pregnancy as murder and others may see it as morally wrong. In the past, few mothers would have encouraged their teenage daughters to terminate a pregnancy, but nowadays there is greater freedom of choice and individuals are more aware of their legal rights.

Hair/skin
The specific hair type of Afro-Caribbean people requires regular moisturising. The hair and scalp are moisturised every other day, or more often if required, and the skin should be moisturised once or twice a day, otherwise it becomes dry and white patches appear.

Hygiene
In general, an Afro-Caribbean person would be viewed as unclean if he or she left the house without having had a bath, shower or a wash. Some men consider their wives or partners as unclean when they are menstruating.

Diet
Although there are no dietary restrictions, most of the community will not eat pork. Traditional foods include rice and peas, chicken, curried goat or mutton, yam and green bananas. Some hospitals, such as Birmingham's City Hospital, provide Caribbean dishes for patients and staff. Older people prefer traditional foods, which may present problems when they are admitted to hospital.

Traditionally, Christians are supposed to refrain from eating meat during Lent, a forty-day period before Easter which begins on Ash Wednesday. Fish should be served instead.

Marriage
According to the Bible and religious teachings, marriage is sacred and Christians should not have sex outside of it.

Like the rest of society, although having a child out of wedlock was considered a disgrace in the past, nowadays many parents do not marry. A study by the Commission for Racial Equality (1999) found that the West Indian community had the largest proportion of one-parent families in the UK (45%), compared with 21% among whites and 8% among south Asians.

However, family influence remains strong and grandparents play an important role in family life, and will often bring up their grandchildren.

Homosexuality
Many Afro-Caribbean people believe that homosexuality is expressly forbidden by the Bible, so it can be difficult for homosexuals to acknowledge their sexual preferences, even among their own families.

Mental health
Mental health is an emotive subject in the Afro-Caribbean community, which has a high incidence of schizophrenia. One study of Afro-Caribbean people in Barbados (Mahy et al, 1999) shows a lower incidence of schizophrenia (3.2 per 10,000) among those living on the island than among those who have moved to the UK (6.6 per 10,000). Poor quality housing, unemployment and living alone have been suggested as contributing factors.

The behaviour of Afro-Caribbean people is often misinterpreted and may be misdiagnosed as mental illness, and they are more likely than most in the UK to have been detained under the Mental Health Act (Davies, 1996).

Nurses may find that older people are embarrassed when a member of their family is diagnosed with a mental illness.

Organ donation
Although there are no religious beliefs banning organ donation, members of the older generation are highly unlikely to agree to donate any organ because of their belief that the body should be intact for the resurrection. The younger generations are more receptive to the idea.

Blood transfusions
There are no particular religious objections to blood transfusion, but many Afro-Caribbean people fear contamination by blood products. For this reason many older people would prefer to receive blood from members of their own families in the belief that it is less likely to be contaminated.

There is no evidence to support this, but hospital policies should be in place to accommodate such cases and patients should be given the choice of receiving alternative blood products. In an emergency, saving the patient's life must take precedence.

Suicide
Christians in the Afro-Caribbean community see suicide as a terrible waste of life. The Bible teaches that God creates life and that at no point in life, no matter what the circumstance, should an individual take his or her own life.

Death rituals
Visitors are extremely important to the sick and dying, and large numbers of them are seen as a mark of respect. Apart from visits by family members, it is common for the pastor and members of the church or community to visit people in hospital.

Nurses should be sensitive to the needs of the patient and his or her visitors, who may wish to pray and sing hymns. Ideally, patients should be allocated a side room so that visitors can conduct a prayer meeting and sing, as this is not feasible on an open ward because of the disruption it could cause.

Older people are unlikely to agree to a post mortem unless it is a legal requirement, and burial is preferred to cremation. It is customary for members of the deceased's family to receive visitors from the community every night until after the funeral, and for most of the community to attend the funeral as a mark of respect.

Conclusion
The NHS must be sensitive and responsive to the diversity of cultures, languages and religions in the Afro-Caribbean community. Equality of care is important to most nurses, but equality should not mean that we treat everyone in the same way. What is important is negotiated care giving, and all nurses have a responsibility to deliver culturally competent health care.

Performing a nursing assessment involves gathering a wide range of information on the patient's current and past health, family circumstances, lifestyle and preferences. The object of an assessment is to focus on the patient and his or her family as individuals. The information gathered should serve as the basis for providing care that meets the individual's needs. As a public service, the NHS has a responsibility to ensure that it provides health care in a way that is accessible and relevant to the population it serves.

USEFUL ADDRESSES AND WEBSITES
Commission for Racial Equality, 10-12 Allington Street, London SW1E 5EH; tel: 0207 828 7022; website: www.cre.gov.uk

The Sickle Cell Society, 54 Station Road, London NW10 4UA; tel: 020 8961 4006/7795; website: www.sicklecellsociety.org

- This series has been endorsed by the Transcultural Nursing and Healthcare Association

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