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Nursing with dignity. Part 7: Hinduism

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VOL: 98, ISSUE: 15, PAGE NO: 38

Dev Jootun, MPhil, BA, RNT, RNCT, RGN, ONC, is lecturer, Bell College, School of Health Studies, Hamilton

Hinduism is India’s oldest religion, dating from about 2500BC. A fusion of traditions and shared beliefs have shaped its culture. The words Hindu and Hinduism are geographical, derived from the name of the river that is now called the Indus.

A Hindu was originally an Indus-valley dweller. Hindus call hinduism sanata dharma, the eternal tradition or religion. This refers to the idea that its origins lie beyond human history, and its truth has been divinely revealed (shruti) and passed down the ages to the present in the most ancient of the world’s scriptures, the veda.

Hinduism has no one founder, holy book, central authority or hierarchy. There is a tremendous diversity within the religion, which depends on people’s region of origin, group and family. A person’s own religious beliefs and duties are clear and very important.

Settlement in the UK

Migration from India in the early years was mainly confined to the Punjab and Gujarat. The first evidence of Indians arriving in the UK was in the 1920s (Deakin, 1970). After the Second World War, Britain had a severe labour shortage and its empire provided a ready-made source of labour. In 1998, government figures put the number of Indians living in the UK at one million.

Religious beliefs and practices

Customs, beliefs and values are grounded in religion and culture. Hindu religious belief begins with the assumption that all living things have a soul, which passes through successive cycles of birth and rebirth. Hinduism includes ideas of karma and rebirth, collective versus individual identity, an emphasis on purity and a preference for sons.

Belief in karma and rebirth will be important to many Hindu patients and will influence their care. The core idea of karma is that each person is reborn so that the soul may be purified and ultimately join the divine cosmic consciousness (Radhakrishnan, 1968). Every action or thought, whether good or evil, leaves a trace in the unconscious that is carried into the next life. The belief in reincarnation and transmigration of the soul encourages Hindus to avoid killing even the smallest insect.

Many Hindus worship in temples (mandir), dedicated to a particular god or goddess. The resident priest (pandit) offers support and advice to community members. Many Hindus will also worship at home, setting aside a special place as a shrine. Shoes are removed before entering a Hindu home to avoid bringing dirt into the house.

In western secular society the individual is viewed as having autonomy in decision-making. In Hinduism the person is viewed as a combination of mind, soul and body in the context of family, culture and environment (Kakar, 1982). Thus, the person is seen as intimately integrated within the family, social group (caste) and environment.

This necessitates a holistic approach to nursing interventions. Purity (Suddha) is a very important value in Indian culture. It evokes the image of the human body in the most pure, perfect and desired state of being and reinforces personal cleanliness. The most impure substances are bodily discharges. Some Indian patients are meticulous about personal hygiene. A Hindu woman is traditionally regarded as unclean during menstruation, at the end of which she may take a special shower.

Social divisions

Indian society is divided according to a caste (jati) system. There are four inclusive castes: the Brahmins, or priests; the Kshatriaya, or warriors; the Vaisya, or merchants; and the Sudra, or peasants and workers. There are also the untouchables, who have been expelled from their caste either themselves or through the actions of their ancestors, for violations of rigidly enforced codes of caste behaviour.

The castes are further divided into sub-castes. It is a very rigid social order with clear-cut distinctions. Social status is ascribed at birth and virtually unchangeable. Members of the higher caste tend to enjoy better social privileges. Unlike the class system, the caste system is not based on wealth, but those at the top tend to have more wealth and better access to resources. In the 1950s, the Indian government tried to dismantle this rigid hierarchical system, but change has been slow.

Hindu rites or practices (samskaras) are enshrined and ordained in Hindu scriptures to guide an individual towards a proper sense of duty and obligation during various stages of life. There are ceremonies to mark major events in a Hindu’s life. Some of the most significant samkaras are childbirth (jatakarma), marriage (vivaaha) and cremation (anthyeshti).

Pregnancy and childbirth

After marriage there is often fervent prayer for a child. Owing to the notion of karma, Hindus believe that the moment of conception is the rebirth of a person who has lived many previous lives. Prayers will be offered regularly during pregnancy for the healthy development of a child.

The foetus protection ceremony (Punsavana) is performed in the third or fourth month of pregnancy to invoke divine qualities in the child. In the seventh month, prayers (Simantonnayana) are offered. According to Hindu belief, this is when the soul enters the body.

If a woman miscarries before this time, there are no special religious requirements but after seven months the baby should be given a proper religious funeral. Abortion is disapproved of but individual attitudes vary. Hindus believe termination will break the cycle of birth and rebirth (karma).

Customs and ceremonies may vary between different groups after birth. In some, a member of the family writes ‘Om’, a mystical sound representing the Supreme Spirit, on the baby’s tongue with honey or clarified butter (ghee). The person who does this may take on a role similar to that of a Christian godparent. In the UK, this ceremony may be delayed until mother and baby return home.

Some families may wish to wrap the baby in a special cloth after the birth. The mother usually stays in bed for a few days to build up her strength, while other female family members help care for the baby. Ten days after the birth, a naming ceremony is held, where the priest draws up the baby’s horoscope and chooses the first letter of his or her name.

Families and relationships

Hindus are expected to marry and have children, with both men and women taking an active part in their upbringing. Parents remain responsible for their children all their lives. Children are expected to obey and show respect for elders. Most children will look after their parents rather than allow them to be cared for in a care home.

Often it is the duty of Hindu parents, grandparents, aunts and uncles to arrange the marriages of younger family members. Divorced people may be strongly disapproved of or even rejected. In most Hindu families, although men have ultimate authority, both sexes generally share decisions.

Women are mainly responsible for the comfort and well-being of their families, and the upbringing and moral education of their children. Motherhood is probably one of the highest accolades accorded to a Hindu woman. A woman’s most sacred duty is to honour and obey her husband who, in turn, has a duty to treat her with kindness and respect.

Dietary requirements

Many Hindus restrict what they eat and drink on religious grounds. Some may refuse food prepared by other people because they cannot be sure that the cooking methods have adhered to the purity code of the religion. They may also avoid processed foods or any containing animal products.

Vegetarianism is highly regarded as an indication of spirituality. A strict Hindu vegetarian who eats any food containing meat, fish or egg products is likely to feel spiritually polluted. Hindus will not eat beef and pork. The cow is a sacred animal, generally revered and protected, and the pig is seen as a scavenging animal whose meat is dirty.

A minority from the higher caste may avoid alcohol and smoking. Some Hindus may fast on certain occasions as they believe it has physical and spiritual benefits. Close relatives, especially women, often fast and say special prayers for the recovery of someone ill. Some may fast in thanksgiving for a successful operation or recovery.

Certain foods are classified as ‘hot’ or ‘cold’, in terms of their effect on the body and emotions (Henley, 1983). Hot foods are usually salty, sour or high in animal protein. They are believed to raise body temperature and excite the emotions, rather like alcohol. Cold foods are generally sweet or bitter and are believed to cool body temperature, calm the emotions and make the person cheerful and strong. An imbalance of hot or cold foods can disturb the body’s energy equilibrium and lead to ill health.

Illness is thought to be a punishment for bad behaviour in a former existence. Suffering has meaning, and most Hindus won’t ask: ‘Why me?’ The family elders, rather than the patient, may make all decisions relating to treatment.

Most Hindus who are ill believe their doctors and family will act in their best interests. Relatives sometimes place blessed items of jewellery on a black string round a patient’s neck, arm or body. This is intended to protect and help the patient, and should not be removed. Second and third-generation Hindus may want more input in decision-making but may be hindered by their culture.

Although they passively accept their situation, Hindus have hope during an illness even when they feel helpless. Prayers, rituals and conforming to duty might favourably influence the outcome, even if this is death. Hope also stems from Hindus’ belief in the supernatural. Illness can be explained in terms of sorcery and evil spirits. In some cases, faith healers qualified to deal with spirits will be brought in.

Death and dying

If death is imminent, the patient’s family may wish to stay near the bedside and be involved in care. They may also insist on the patient’s eldest son being present before, during and after death, even if he is a small child. It is important to the patient that all close family members are present.

The family may bring clothes and coins for the patient to touch before they are given to the poor to symbolise the dead person’s generosity. Families who have not carried out the essential rituals may become distressed and anxious, both about the long-term well-being of the soul of the dead person and about the spiritual consequences for themselves.

It is vital to ensure that relatives know that death is imminent and that they can be present. They may wish to pray by the bedside and ensure that all religious rituals are carried out properly. Any jewellery or religious object on the patient should not be removed. There is often a wish to die at home, which has a religious significance.

A Hindu priest (pandit) may pray with the dying person and relatives to help the soul transmigrate into another body. They may recite hymns (bhajans) from holy books. A sacred thread may be tied around the neck or wrist, and holy water sprinkled over the person or used to wet his or her lips. A dying person is placed on the floor on a clean sheet or mat, symbolising closeness to Mother Earth, freedom from physical constraints and the easing of the soul’s departure.

Some Hindus are very strict about who touches the body after death. Some families may feel distressed if a non-Hindu touches it. Close family members usually wash the body and may wish to do so on the ward. The eyes are closed and legs straightened. The hair or beard should not be trimmed without first checking with the family. Some may wish to light a clay lamp using a piece of cotton wool soaked in ghee, while others may wish to burn an incense stick in the room.

A death is registered as soon as possible and the body cremated within 24 hours. Close relatives of the same sex may wish to prepare the body. Many people may wish to pay their last respects - this is a binding duty and should be accommodated on the ward. The eldest son or another male relative traditionally deals with the funeral arrangements.

Nursing implications

Second and third-generation Hindus may happily adapt to ward routines and procedures, but parents may wish to adapt them to suit their customs. Hindus are modest and women may prefer to wear a sari. They may be reluctant to undress in front of a male doctor and could ask to be examined by a woman. Sometimes, grandparents or parents will ask to be present. Hindu women may refuse to wear open-back gowns. If possible, longer closed gowns should be provided.

Hindus prefer a shower to a bath. The body and hair is particularly important to Hindu women. Many have long hair and may refuse to cut it without their husband’s permission. They may also be unwilling to sign a consent form without first consulting their husband or father.

It is important for the nurse to recognise the concept of karma and rebirth. The foetus is considered a person from the moment of conception so, in most cases, abortion is unacceptable except when necessary to save the mother’s life.

In matters of diagnosis, treatment and consent, the senior elder and, in some cases, the extended family, will expect to be involved. It is vital for the nurse to involve the family while ensuring that the patient’s wishes are respected.

Many Hindu patients may continue to take traditional Indian medicines while in hospital. These are largely herbal and are used along with changes in diet, habits and thoughts to overcome an imbalance in the three bodily humours: wind (vata), bile (pitta) and phlegm (kapha).

Every effort should be made to find an interpreter familiar with the patient’s traditions and culture. It is vital in issues of consent to ensure that information given to, or received from, the patient is not censored or altered by the interpreter.

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

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