New York City College of Technology
NUR 3010
Cultural Health Promotion
Hazel J. Ashby
Professor McManus
March 30th 2011
Since 1990, United States of America has experienced the largest waves of new immigration in its history. Due to the migration of people of different cultures, the nation recognizes that understanding the health status and needs of such immigrants is vital to their large population and their contribution towards the health of the whole nation. Gaps in national databases, uncertainty on how migration affects health and heterogeneity of immigrants have posed a great challenge as seen basing on Indian Hindu culture below. However, by learning the practices, beliefs, values and customs of Hinduism, will strengthen cultural competencies of healthcare providers in a diverse clinical settings. (Zanchetta, 2006)
There are six key rites of passages in Hinduism; these rights of passages are held in temple or a home shrine. These practices stem from before conception all the way to death and are imperative in Hindu culture. Called samskara (religious ceremony) these rites follow their growth physically and emotionally. Knowing them will aid a healthcare provider by giving them insight on the background of their culture.
“Karnavedha, Ear-piercing. This is done for both sexes on the first birth day, Health benefits are said to derive from this ceremony.
Chudakana, Head-shaving. This is performed before the end of year three. The shaven head denotes purity and egolessness and is said to mitigate past karma.
Vidyarambha, Learning Commencement. The official beginning of the child’s education id sometime during the fourth year of life, when he/she writes the first letter of the alphabet in a tray filled with uncooked rice.
Upanayana, Initiation. This is performed between the ages of nine and fifteen, when a boy begins the study of the Vedas. Thereafter he is considered “twice born.”
Vivaha, Marriage. This ceremony is performed in temple or a special hall around a sacred homa fire. Lifetime views and the seven steps before God and the Gods consecrate the holy union of husband and wife.
Antyesti, Funeral. This ceremony is performed by relatives according to local traditions which include preparation of body, cremation, rites of mourning, purification and remembrance.” (Himalayan, pp. 323-325)
The Hindus have numerous rites of passages. Here are a few more important ones to follow:
“Keshanta Kala, is when a boy first shaves his facial hair, this indication that he has come of age.
Ritu Kala, as puberty dawns for a young girl, the ceremony acknowledges her first menes.
Samavartana, this ceremony marks the end of studentship and the young person must now choose one of two paths: the family path or the monastic path.
Vagdana, this is the betrothal ceremony in which a man and woman are declared formally engaged by their parents.
Jatakarma, this is performed during the later days in pregnancy. This rite was designed to yield blessings for life as well as protection from harm for both mother and child.”(Himalayan, P. 325)
Cultural beliefs will assists in interviewing and history taking in Hindu clients is truly helpful. The important ones are as follows: Greetings are in a two-handed handshake. In doorways, it is inauspicious to converse or give/lend an object before stepping into the same room or space. An example would be going out to the waiting area to greet your clients instead of calling them from behind your desk into your office. Body language is very important and can be easily misunderstood. You must take care in sitting; it is insulting to sit with your legs stretched towards another someone. Also, prideful postures should definitely be avoided such as one foot placed on opposite thigh, arms folded; chin held exceedingly high, hands on hip with head cocked to the side. Those are all considered signs of arrogance and a superiority complex. The left hand is considered unclean because it is used for personal hygiene and giving anyone something with that hand is an insult. Pointing with the index finger or the shaking it, with the right hand, is considered aggressive and should never be practiced. You may use your whole hand with your palm facing up and put the thumb against the forefinger. Shoes are also unclean, if someone touches you with their shoes to express regret you must apologize by using your right hand to touch your shoe and then touching your hand lightly to the left eye and then right eye. There are some positive gestures as well. Kinds word with a smile should be used to convey throughout your entire day. Covering your month when talking to someone older is a sign of respect. (Himalayan, pp 319-321) By incorporating these beliefs into the interview process this will help the client to respect the caretaker’s knowledge of them and in turn make them more comfortable to discuss personal issues with a stranger.
The Hindus live meat-free. Here are five main reasons why:
“Reason 1. Dharma – Vedic scripture proclaims that ahisma, nonhurtfulness, is a primary religious obligation in fulfillment of dharma, divine law
Reason 2. Karman – By involving oneself in the life cycle of inflicting injury, pain and death, even indirectly, by eating other creatures, one must in the future experience and equal measure of suffering caused.
Reason 3. Consciousness – By ingesting the grosser chemistries of animal foods, one introduces into the body and mind anger, jealousy, fear, anxiety, suspicion and a terrible fear of death, all of which are locked into the flesh of the butchered creatures.
Reason 4. Health – Vegetarians are less susceptible to all major diseases that afflict contemporary humanity. Thus they live longer, healthier more productive lives. They have fewer physical complaints, less frequent visits to the doctor, fewer dental problems and smaller medical bills.
Reason 5. Environment – In large measure, the escalating loss of species, destruction of ancient rain forests to create pasture for livestock, loss of topsoil and the consequent increase of water impurities and air pollution have all been traced back to the single act of meat in the human diet.” (Himalayan, pp. 343-347)
Being that Hindus consume a vegetarian diet, they will need to have a diet rich in legumes, to provide them with adequate proteins. Legumes are important because they to promote optimal healing, anti-body production and rejuvenation of body cells. (Cataldo et. al., P. 77) Without sufficient protein, the body cannot maintain resistance to diseases. Protein helps maintain the body’s fluid and electrolyte balance. It is necessary for growth and body tissues. Health care providers should consider these restrictions to provide cultural congruent care.
The Hindu culture contains nine important spiritual values called ‘The nine P’s, they promote a healthy mental state:
*Positive Self-Concept
*Perceptive Self-Correction
*Powerful Self-Control
* Profound Self-Confidence
*Playful Self-Contentment
*Pious Character
*Proficiency in Conflict Resolution
*Parental Closeness
*Prejudice-Free Consciousness (Himalayan, pp. 304-317)
Even though the caste system in India is now illegal it is still widely practiced. It is very hard to change something that has been in practiced for millennia. The first level of caste Brahmins these are your scholars, philosophers, scientist and spiritual advisors. Second level consist of politicians, bankers, military personnel, law enforcement worker called the Kshatriyas. In the next caste, Vaishyas contains the working class people such as farmers, store owner, and nurses. The last level Shudras are factory workers, housekeepers, locksmiths, and plumbers. (Rosen, pp. 39-43)
Women play an extremely important role in Hindu culture. She is responsible for her house, her family and the entire family’s spiritual well being. Hindu women have traditional domestic duties:
“Collecting Water – In the morning, women meet at the well to gather water for the day and to clean cooking utensils.
Bathing – The women bathe in the river at hidden places specially reserved for them. They apply fresh tumeric root to the skin as a toner, skin color enhancer and antibacterial.
Sanctifying the Doorway – Here, the woman’s entryway is adorned with tumeric paste and red kumkuma powder, this daily morning decoration ia a blessing intended to beseech the guardian devas to allow positive entry to the home.
Decorating the Entry – As the day begins, kolams are painted at the home entrance.
Caring for Clothing – Some women bath in the temple tank, after they wash their saris and other garments and spread them on the steps so they are dried once the bath is complete.
Preparing Rice – Each day a small quantity of rice paddy is taken from the reservior and pounded into separate husk to provide grain for the day’s meal.
Temple Worship – Before the noon meal, wives must visit the temple, bringing an offering basket of coconut, ghee for the temple lamps, betel leaves, flower garlands and fruits.
Preparing Meals – This is done in a seated fashion with a board affixed to a wooden platform to make this activity effortless and cause minimal fatigue.
Making Garland – Garlands are used in the shrines and to decorate the pictures of the Gods throughout the home.
Grooming – This is done in the evening the wife dons casual or formal dress, combs and braids hair, mark forehead with kuma and applies jewelry.
Care of Children – Children are attended to first in the hours before sunrise. Oil is applied to their skin and hair, the rinsed off.
Caring for the Home Shrine – Evening time is for cleaning of one’s home’s oil lamps, adding fresh ghee or oil and lighting them in the shrines. The woman prostrates to receive the blessings from the Deities and devas who guide her family’s life of dharma.”(Himalayan, pp. 328-331)
Hindus make use of all means of healing. Be they medical, astrological, or metaphysical. The knowledge obtained by knowing and understanding these practices nurses along with other healthcare providers will be able to advise their clients on safe practices of these diverse activities through edifying their clients. (Himalayan, P. 367) Understanding the culture, practices and the religion as a whole; puts health workers at an advantage to helping their clients of Hindu decent obtain and secure proper healthcare services.
Leading Health Objective: Nutrition and weight status
Due to vegetarian diet this culture may be prone to insufficient protein which may be harmful to their well-being. Efforts should be made to promotes healthy eating habits and nurse should advise client to eat a diet rich in legumes, to provide them with adequate proteins. Legumes are important because they to promote optimal healing, anti-body production and rejuvenation of body cells. Without sufficient protein, the body cannot maintain resistance to diseases. Protein helps maintain the body’s fluid and electrolyte balance. It is necessary for growth and body tissues. (Cataldo et. al., P. 77) Health care providers should consider these restrictions to provide cultural congruent care.
OUTLINE
- Dietary Ethics
Q: Do you have any dietary restrictions?
Hindus consume a vegetarian diet. They will need to have a diet rich in legumes, to provide them with adequate proteins to promote optimal healing, anti-body production and rejuvenation of body cells. (Cataldo, P. 77) Without sufficient protein, the body cannot maintain resistance to diseases. Protein helps maintain the body’s fluid and electrolyte balance. It is necessary for growth and body tissues. Health care providers should consider these restrictions to provide cultural congruent care. They should make sure that there are a variety of food choices available to the Hindu clients. Also allow their relatives to prepare food choices for them once they comply with the dietary restriction that the doctor orders.
- Pain Control
Q: Do you use any other pain medications or other remedies than what your doctor prescribed?
Hindus regard pain management of an important duty of care takers. If an individual opts to undergo the pain one must respect the cultural wishes. Generally the Hindu population believes that it’s the duty of the people around them to help reduce pain. They feel that if they are pain free their thoughts will be sublime with gratitude and feeling of amity. (Himalayan, P. 351) A culturally competent nurse uses this insight to assess whether homeopathic remedies may interfere or aids with the doctor orders. Initiating a good pain assessment and ensuring that the client’s pain is adequately managed will promote a sense of comfort to the Hindu client. This will assure him that the health care provider actually cares about him and bridge the gap between client and nurse.
- Religious Faith Healing
Q: Are there any other methods of healing that you practice?
Hindus make use of all means of healing. Be they medical, astrological, or metaphysical. Yoga and the guidance of gura, which means performance of temple ceremonies, are metaphysical practices. Physical strength is vital role to healing process, being aware of these practices nurses will be able to advise their clients on safety practices of these diverse activities through edifying their clients. (Himalayan, P. 367) Providing the client with the opportunity to practice their faith will allow them to continue their daily routine while hospitalized. Give them the time and privacy to pray and practice yoga if they desire. This won’t hurt, daily exercise is recommended and praying will give them a spiritual connection with their God and promote a home away from home atmosphere.
- Organ Transplants
Q: How do you feel about organ donation or being a transplant recipient?
Hindus believe that recipients of a major organ such as the heart, liver or kidneys takes on some of the karma of the donor (Himalayan, P. 356) In other words the deeds of the donor will be transferred over the recipient whether good or bad. Conscious nurses should know this maybe a concern, client may prefer to know the donor or if the donor was pure of mind, body and spirit prior to making any commitments. Allowing the Hindu client the opportunity to know something about the donor will give him or an opportunity to make a decision based on their belief or custom. This gives them a sense of control over their life.
- Preparation for Death
Q: Is there any rites of passage you need to inform me of in regards to death and your religious practices?
A wise Hindu facing death looks over all of his deeds during the present life and tries to make amends for his wrong actions. If wrongful deeds are beyond correction he will repent and pray for forgiveness. Once physical conditions worsen and client is bed bound and death is eminent, his or her child gather around offer holy water from the Ganges River, sings holy songs, and chants mantras, this usually occurs within a 24 hour day vigil, this signifies a joyous separation of life from the world which Sarlguru Subramunyaswam’s notes as “Bless with the knowledge of impeding transition.” Each culture has their own rites of passage; a nurse should be knowledgeable about her clients’ specific end of life cultural norms. (Himalayan, P. 351) Allowing the Hindu client an opportunity to perform their rites of passage will bridge the gap between the client and health care provider. This will promote cultural congruent care.
Hindu American Leading Health Objective Health Promotion Plan
Nutrition and weight status
Due to vegetarian diet this culture may be prone to insufficient protein which may be harmful to their well-being. Efforts should be made to promote healthy eating habits and nurse should advise client to eat a diet rich in legumes, to provide them with adequate proteins. Legumes are important because they to promote optimal healing, anti-body production and rejuvenation of body cells. Without sufficient protein, the body cannot maintain resistance to diseases. Protein helps maintain the body’s fluid and electrolyte balance. It is necessary for growth and body tissues. (Cataldo et. al., P. 77) Health care providers should consider these restrictions to provide cultural congruent care.
Developing a health plan for the Hindu American culture is not such an easy task as it may seem. One has to face many possibilities that this group encounter with their dietary practices. Their knowledge will need to be enhanced at all levels. The majority of Hindu Americans eat a meat free diet they may not be making to appropriate food choices that will provide them with the necessary dietary intake. The younger generation has conformed to carnivorous and has strayed towards less healthier food choices. They now eat foods prepared from fast food restaurants which are fried or lack some of the needed nutrients to make a complete meal. A lack of these necessary nutrients can contribute to health issues; they need to supply the body with adequate amount of energy. A teaching plan will have to be incorporated into their culture from an early stage, the parents will need to be educated on the importance of having a well balance diet and institute these food choices from infancy. Hospitals and health care facilities can do health fairs to promote this approach. This can be done in the community setting, clinics or at a Hospital. Having a variety of healthy snacks such as celery and carrots with peanut butter, broccoli and celery with a dip will introduce the younger generation to be exposed to healthier food choices at an earlier stage instead of offering foods like processed fried chicken nuggets. These items should be made available at these health fairs. The older children can also be introduced to a wider variety of healthy food choices. They can be given a picture of the food pyramid in a simplified form and have cartoons available for viewing which promote good eating habits. Most priest or elder will welcome the support from well-established institutions for the wellbeing of their culture or congregation and will allow them to supply flyers and pamphlets on nutritional intake. These educational items must be available in both English and Hindi in order for the clients to understand. If the clients are not able to read there should be a translator made readily available to prevent them from going away without the needed information. That might have been the only opportunity the person might have ever gotten to this type of service so there should not be a delay to cause the client to lose interest in the topic.
Yoga is one of the Hindu’s practices which can be incorporated along with proper nutrition to restore them back to their optimal health. Physical exercises such as yoga and other sedimentary lifestyles like taking walks and using the stairs instead of the escalators or elevators can contribute to the wellbeing of the members of the Hindu community. They can also be taught to walk to the store if it is in close proximity to the home. The children can be encouraged to have active play outside the home. Playing games like jump rope, kick ball, and riding their bikes with helmets. Instead of sitting in front of the television and playing computer or electronic games. Encouraging family walks can be a good form of exercise or can also be a form of relaxation to then. Yoga is now used widely in America to promote a sense of physical wellbeing. According to the author in the article what can yoga do for you? He stated “Rather than building muscle, yoga builds muscle tone,” says Shakta Kaur Khalsa, author of the K.I.S.S. Guide to Yoga. “Because yoga helps maintain a balanced metabolism, it also helps to regulate weight. Additionally, yoga stretches muscles lengthwise, causing fat to be eliminated around the cells, thus reducing cellulite.”
With the incorporation of yoga, the Hindu clients will feel that we know the value of the techniques and will be more likely to adapt to or embrace other concepts of American exercise regimens to promote their health. These types of exercises will contribute to the enhancement of this population’s health. If they practice proper diet and exercise regimen at an early stage can alleviate negative health care outcome like malnutrition, obesity, hyper cholesterol, and cardiovascular disease.
Reference
Zanchetta, P. (2006). Health literacy within the reality of immigrants’ culture and language. Canada: J Public Health
Himalayan Academy, (2007). What is Hinduism? Modern Adventures into a Profound
Global Faith. (1st ed.) India: Himalayan Academy.
Rosen, S. (2006). Essential Hinduism. Connecticut: Praeger Publishers.
Cataldo, C., DeBruyne, L., Whitney, E. (2003). Nutrition and Diet Therapy. California: nm Wadsworth/Thomson Learning
http://www.yogamovement.com/resources/benefits.what can yoga do for you.html 4/12/2011
