Introduction
With the globalization of the modern world, the question regarding the provision of culturally sensitive care becomes more and more acute. In the current socio-economic environment, medical professionals commonly have to care for patients belonging to cultures and religions different from their own (1). Depending on the degree of religious and cultural devotion, differences may not significantly change how nurses should provide care. On the other hand, possible divergences can restrict the use of some medical interventions. This paper aims to outline how a patient’s culture will impact care and determine its acceptability and adequacy.
Firstly, the Hindu notion of death and surrounding rites and practices will be detailed. This step is required to contextualize the case study, as including information about Hinduism should help determine what was done correctly and incorrectly from the standpoint of culturally sensitive care. Secondly, a detailed description of the case study will be given: the paper will demonstrate how the patient (a Hindu structural engineer diagnosed with brain hemorrhage resulting from a traumatic event at work) was cared for initially. Thirdly, the information will be applied to the case in question. Lastly, it will be established whether the provided care was culturally sensitive.
The Concept of Death and Dying Rites in Hinduism
Despite being a universal concept and an experience that each individual undergoes, the attitudes towards death diverge worldwide. Different cultures developed specific coping mechanisms and mourning norms that can be expressed in rituals, traditions, and ceremonies. How terminal patient views their pending demise largely depends on their cultural heritage. In nursing, the understanding of differences in attitudes towards death is part of culturally appropriate care.
Hinduism is a religion with a rich surrounding culture and a complex system of beliefs regarding death. Given that Hinduism is one of the world’s oldest religions and its literature is more extensive than that of any other religion, multiple schools emerged from it, each with its peculiarities, rendering the faith quite diverse (2). Hinduism has six orthodox and a number of unorthodox schools. Although these schools have common ground, they may diverge in how they view cornerstone notions such as karma and samsara (cyclic nature of life) (3).
Additionally, the culture’s intricacies and considerable age may have resulted from the claim that many Hindus have lost the initial understanding and the capability to decode their practices (2). Overall, Hinduism can be characterized as continuous, extensive, accumulative, and diverse. The abundant variety present in Hinduism possibly complicates the provision of culturally sensitive care since the uniformity characteristic of some other religions and cultures is not present in it.
Hindus have a particular perception of death and what happens to a person in the afterlife, shaping the appropriate for them end-of-life care. Biological death in this culture does not indicate the demise of an individual’s spirit (atman), which is constant (4). The physical body is viewed as a transient, disposable vessel that is abandoned when a person dies. Religious Hindus strive to achieve moksha, the end of the reincarnation cycle, where they do not have to undergo earthly life again (4). Karma serves as the determinant of whether a person can attain moksha or should be reborn and not necessarily in human form. However, it is one of the notions upon which not all Hindu schools necessarily agree (2). Another such notion is cremation, which seems to be the most common way to dispose of a body, which for Hindus serves no more purpose after death. Nonetheless, several casts in Hinduism favor burying their dead instead (5). Thus, cremation is the prevalent method of the final disposition, but not the only one practiced.
Furthermore, in Hinduism, a concept of “good death” exists and possibly predetermines the norms of culturally sensitive end-of-life care for this population group. Even though there is no overarching ideal, Hindu terminal patients or relatives of dying patients may be preoccupied with a “good death” or dying with dignity (6). For instance, Hindus vastly prefer to die at home rather than in a hospital (7). Additionally, they favor passing away while surrounded by family members and free of pain (6). Traditional rites and ceremonies can accompany a patient’s death and the post-death period, explaining the strong preference to die at home where patients are closer to their shrines (7). According to Singaram and Saradaprabhananda, “these include the regular rituals held by Hindus during the mourning period of either thirteen or sixteen days, depending on individualized family traditions” (8 p. 17). The rituals are viewed as a proper closure to life (8). Hence, in Hinduism, good death commonly presupposes the familial environment, close relatives, painlessness, and religious ceremonies – the conditions that a nurse should help to satisfy.
The rites, their duration, and specificities may depend on a person’s belonging to a cast, school, or family traditions, yet a generalized picture can still be painted. The generalized image of Hindu death is as follows: a dying person is placed on the ground while sacred scripture is chanted. After the body is washed and dressed, it is carried from home preferably to a funeral pyre to be cremated (9). If such a ceremony occurs nearby a river, afterward, the remains are thrown in it (9). Additionally, family members may wish to pour consecrated water into the patient’s mouth. (10). Since Hindus commonly cremate the dead, pujas and other rituals are performed on the deceased before the departure to a crematorium or a funeral pyre (9). These practices are meant to facilitate the release of a person’s atman from this world (11). All in all, Hinduism is a diversified religion with a varied system of beliefs regarding death and attitudes towards it.
Culturally Appropriate Care in the Case Study
The person in the case study is a 48 years old Indian man who fell from a fifth-floor on a construction site where he worked as a structural engineer. After several days spent in a neurological unit with a brain hemorrhage, the patient was diagnosed with brain death. The Hindu man was put on full ventilator support, which later was discovered to be against his religious beliefs. In Hinduism maintaining a patient for a prolonged time on life-support is not perceived as an appropriate practice, particularly if the prognosis is discouraging (12). Moreover, a study performed by Chakraborty et al. illustrates that life-support withdrawal is compatible with Hindu religious beliefs (13). Blood transfusion is another intervention that was effectuated in the case study. Contrary to life-support, in the case of blood transfusion, Hindus normally do not protest (14). It can be seen that some of the medical decisions made could not classify as culturally sensitive.
Consequently, the patient’s brother requested to discharge the dying patient home so that he could pass away in accordance with the notion of a good death, which is being surrounded by family members, in peace, and accompanied by traditional Hindu chants and rites. As the request was denied, the patient’s brother expressed the desire to perform some of the rituals in the hospital. In order to do so, he should have been given a more private room. It is critical to accommodate individual requests, as when a Hindu person is on the brink of death, their relatives might want to follow traditions. For instance, they might want to assign a bedside vigil and bring clothes to be touched by a dying patient and later distributed among the poor – all these rituals require a more private setting (15). Hence, it is critical for a nurse to provide the necessary conditions for family members to perform the rites so that culturally appropriate end-of-life care can be ensured.
Two days later, the patient died, and his brother requested to transfer the body to another room to conduct Hindu rituals. Additionally, he asked the medical staff not to touch the deceased patient. The last demand could be explained by the attitude towards death in the culture. In Hinduism, death is seen as “a process through which the soul migrates to the next life or afterlife. Dying is also typically seen as natural and cyclic, which leads to more support for nonaggressive end-of-life care” (16 p. 478). Moreover, it is recommended that a family of a Hindu patient that may be dying is alerted several days or weeks in advance, which allows them to be adequately prepared for the final rituals (10). In the case in question, the patient’s family was not given the necessary resources to conduct ceremonies in conformity with Hindu beliefs despite being asked for several times. The main cause of the refusal was my lack of experience and my, my manager’s, and the responsible physician’s cultural incompetence.
Nonetheless, while the literature suggests that clinicians should warrant all the necessary conditions for a culturally appropriate death, the existing policies do not facilitate the provision of culturally sensible end-of-life care. A comprehensive code of conduct, laws, or guidelines regarding the death of patients whose culture differs from medical professionals’ home-culture seemingly does not exist. Without a law supporting culturally appropriate medical practices, the extent to which a nurse can adjust the care to a patient’s cultural background is limited.
This situation demonstrates a lack of cultural competence possibly present in multiple facilities. Given the considerable number of Indians in the UAE who work on construction sites and other workplaces with high trauma rates, this problem becomes especially poignant (17). Even though the country becomes more tolerant of other religions and demonstrates it by constructing places of worship, cultural competence may need additional enhancement in healthcare settings. For example, the case study indicates that medical professionals should be aware of the limitations of life-support usage in Hinduism and if possible consult patients and their families.
Conclusion
Numerous socio-economic and technological processes allowed the movement of masses of people, increasing cultural diversity on the global level. The present state of the world in which multiculturalism blossoms exacts that medical professionals adjust to the situation. Yet, the multicultural environment seems to spread faster than culturally sensitive care is adopted, as is exemplified in the case study. In order to demonstrate cultural incompetence in the case study, the Hindu notion of death and accompanying rites and ceremonies were investigated at the outset. It was established that Hindu culture is not unified in how it approaches certain death practices, yet a generalized vision was reached. The examined case study shows how a limited understanding of Hinduism can deteriorate the provision of appropriate care since, for example, ventilator support that was initially provided is discouraged in the patient’s culture. Additionally, cultural incompetence impeded an appropriate death in line with Hindu traditions in the patient’s case. Overall, it could be suggested that cultural incompetence is not only a problem of individual health workers but whole institutions, as on the official level it seems that a lacuna in policies and guidelines has emerged.
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