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Introduction
Hinduism is one of the oldest major religions in the world, with approximately one billion followers. The majority of the Hindu population resides in South-Central Asia, representing 52.9% compared to only 0.5% in Northern America (ARDA, 2010). Hindus believe in dharma, which represents duties and obligations that an individual must comply with to be an active member of the community (Knott, 2016, p. 75). Dharma was especially important for a Hindu woman because often women were considered low-caste and had to resort to performing demeaning tasks such as sweeping, working with leather, and removing excrement and the dead (Knott, 2016, p. 75). Some women were considered high-caste and would be under the protection of a male figure such as a husband, father, or brother. Male authority was of the utmost importance and it was the duty of the husband to keep his wife focused on her domestic duties, which primarily was bearing children (Knott, 2016, p. 75).
Hinduism is responsible for the idea of Ayurvedic medicine, also known as the science of life (Spector, 2017, p. 182). Ayurvedic medicine is a holistic balance that integrates the body, mind, and spirit in the healing process that brings harmony and balance back to the individual. Using Ayurvedic medicine is a method that can be used to restore health back to the individual in a way that is preferable to the patient. The Registered Nurse (RN) should take this into consideration while caring for a Hindu patient. It is the responsibility of the RN to provide alternative therapies including herbs, metals, massage, and other products and techniques, with the intent of cleansing the body and restoring balance (Spector, 2017, p. 183).
In regards to nursing care, the RN must be mindful that the patient may be practicing the older traditions of Hinduism. If this is the case, the RN will need to primarily incorporate the husband or another male authority that would be making important medical decisions on behalf of the patient. The RN will have to individualize care by asking the patient and family what their beliefs are and if there are any accommodations the RN should be aware of while caring for the patient.
Health Care and Wellness/Illness Practices Related to Patient Care
Although Hindus share many beliefs and values with each other, there are still differences that can be found based on other variables, such as age and gender. Hindus have no issues seeking medical attention in a hospital; however, an older patient may be more familiar to Ayurvedic medicine compared to a younger patient. In Ayurvedic medicine, there is a heavy reliance on treatments based on herbs and plants, oils [sesame oil], common spices [turmeric], and other naturally occurring substances (Spector, 2017, p. 84).
When caring for a Hindu woman in the developmental stage of thirty-five to fifty-five years old in the United States (U.S.), many factors need to be considered by the RN, such as beliefs, practices, and family role. These factors are important because they impact the overall care of the patient. One factor is that Hindus pray multiple times a day for their health protection (Holland, 2018, p. 62). If the patient informs the RN that praying is a daily practice, the RN should provide for privacy, as well as accommodate any objects that are part of this practice while determining whether or not it is within hospital policy, such as the burning of an incense.
According to Holland (2018), many older people refuse to eat any hospital food and prefer their food to be brought by their relatives because they are uncertain whether the food or drink is somewhat polluted or not (pp. 250-251). This is a belief that must be taken into account because food and drink are physiological needs. If the patient refuses to eat hospital food, the RN must take this very seriously especially since starvation and dehydration may hinder their progress. The patient may be more comfortable with family bringing in familiar food. The RN will have to provide education on what is appropriate for the patients diet per the MD order.
Another factor that must be taken into consideration is modesty. Exposure of a female patients genitals to a male health care provider is considered demeaning (McKinney, James, Murray, Nelson, & Ashwill, 2018, p.246). Women are expected to cover their legs, breasts and upper arms, and would prefer female health care staff (Holland, 2018, p. 250).
Providing water for a Hindu patient during certain times is another variable that the RN must consider. According to Holland (2018), toilet paper is not traditionally used, which makes the availability of running water essential for the patient. If running water is not available, water in a container may be provided (p. 250). The RN needs to be flexible if the patient is not able to go to the bathroom and use running water alone. For example, if the patient is using a bedpan, the RN may offer a perineal bottle to allow the patient to properly rinse.
Eriksons Developmental Theory
Eriksons Developmental theory branches off the work of Sigmund Freud. He viewed development as a lifelong process of conflicts that involved social and cultural factors, which must be resolved in order for the child to progress into adulthood (McKinney et al., 2018, p. 69). The theory consists of eight stages ranging from birth to death. According to Yoost and Crawford (2016), birth to eighteen months is a time where trust versus mistrust occurs (p. 238). The caregiver must meet all the needs of the infant in order for the infant to develop and trust that their needs will be met and not ignored. Eighteen months to three years is a stage where autonomy versus shame and doubt is present when the child strives to make decisions for themselves. During this time, it is important for the parents to allow the child to make decisions like picking what clothes they will wear for the day or what they want to eat. Initiative versus guilt takes place in ages three to six years. The child develops the sense of play and exploring the world around them without fear or reprimand from caregivers. From six to twelve years of age, industry versus inferiority, a child begins to develop a peer and social network that can help them find a sense of self-worth while avoiding feelings of failure. Twelve to eighteen years of age is the developmental stage identity versus role confusion. This is a time where the adolescent takes on multiple roles; student, athlete, child, adult. During this stage, the adolescent struggles with finding their identity but will emerge from this stage with a strong sense of individuality. Intimacy versus isolation, age eighteen to thirty-five years, is when a person is searching for a partner. They are seeking love and family relationships. Ages thirty-five to fifty-five, generativity versus stagnation, is the stage where a person seeks meaning in their work and culture to pass down to the future generations. The last stage of development, between ages fifty-five and beyond, integrity versus despair, is a time where an individual begins to accept the finality of death and achieves a sense of fulfillment over their life accomplishments.
Generativity Versus Stagnation
The seventh stage of development is a time in a persons life where they will seek involvement in the community and meaning in their work. Traditions are passed onto their children and when the children leave the home, they begin to develop a sense of self-worth. Generativity refers to an individual being fulfilled with the sense that they have made their mark on the world by caring for their family or being involved in making the world a better place. Key characteristics of generativity include making commitments to other people, developing relationships with family, mentoring others and contributing to the next generation (Sherry, 2018). Stagnation refers to the feeling of disconnect from society because they have not found a way to leave their mark on the world. Some characteristics of stagnation include being self-centered, failure to get involved with others, not taking an interest in productivity, no efforts to improve the self and placing ones concerns over above all else (Sherry, 2018). A problem that may surface during this time in a persons life is a midlife crisis . When people reflect back on the years, they may feel a sense of regret for not pursuing certain career paths, continuing their education, and in some cases not having children. People who experience midlife crisis can use this as a way to kick start their lives and make adjustments to their goals, while others may feel a sense of defeat and become bitter about their situation.
Discussion
For a Hindu woman in the Eriksons stage of generativity vs. stagnation, dharma would be especially significant due to the need for self-fulfillment and self-worth. For this age group, continuing tradition through generations is essential. During this stage of development, marital status and family planning are very important to a Hindu female. Similar to Christian religions, the primary purpose of sexual intercourse is procreation within marriage. The Hindu belief system could impact the developmental stage in a negative way because it is centered on being a caretaker for their children and husbands, but when the children leave the household it may be a shock to the mother as the primary care provider. This can cause a midlife crisis and they may develop a sense of disconnect with their primary role. One way to feel connected with their culture after feeling a sense of stagnation is to find ways to be involved in the community and restore and maintain their health with healthy habits such as yoga and finding ways to pass on their cultural beliefs to the community.
Comparing and Contrasting Hindu Health Practices Versus the Traditional Majority
Hinduism came to the U.S. by way of Indian emissaries and immigrants. Many of the early Hindu emissaries that came to the U.S. drew on ideological influences between Christian and Hindu beliefs. Their ideas resulted in reducing the importance of temples, rituals, sacrifice, and personal devotion to the multiple Hindu deities to appeal to their North American audiences.
In the twentieth century, there was an increase in the population of Indian Hindus immigrating to the U.S. These immigrants were families concerned with maintaining their cultural and religious freedom (Lucia, 2017, p. 1). Today, people of the Hindu faith account for 0.7% of the 5.9% non-Christian faith population in the U.S. Within the 0.7% Hindu population, 38% are female. In contrast, 70.6% of the U.S. population are Christian, 55% being female, with 54% of females being within this developmental stage (Cohan, 2015). These overall statistics identify the Christian faith as the traditional majority of the U.S. With a drastic difference in population between the two religions, Hinduism has managed to provide a significant impact on key health practices that influenced many others in the U.S.
One health practice is the implementation of yoga as a form of exercise. Derived from Hinduism, it is considered a form of religious practice among Hindus in the U.S; in particular, Bhakti yoga is defined as the path of devotion. It is described by the God Krishna that this path is the best path in preserving ones age. In contrast, the U.S. yoga community defines yoga as a fitness and health-oriented activity. Modern yoga in the U.S. was further popularized in the early twentieth century from Indian immigrated influences. This transformation was the result of combining ancient Indian philosophies, meditation, and physical movements derived from traditional Indian wrestling, bodybuilding, and Swedish gymnastics (Lucia, 2017, p. 17).
Fasting and a vegetarian diet are other forms of religious health practices derived from Hinduism. Being a Hindu vegetarian is composed of a diet without meat or eggs. In contrast, the Christian traditional majority accepts eating eggs and sometimes meat (chicken or fish). Being vegetarian in the U.S. can be categorized in four different ways: vegan (no animal product), lacto-ovo vegetarian (includes dairy and eggs), semi-vegetarian (includes chicken and fish, but no red meat), and pescatarian (fish only). For Christians, being a vegetarian is not required by their religion because the Bible does not prohibit eating meat. It is a lifestyle choice for health purposes both ethical and spiritual. By contrast, the vegetarian diet in India includes a wide range of vegetables, fruits, cereals, pulses, spices seasonings (Karla, 2015), and it is bound by their religion, even if only 35% of the Indian population are vegetarians.
Fasting in Hinduism is not mandatory, however it is common among its followers. The type of fasting and length vary and depend on the region, family, and individual. Adverse effects can appear for people with health conditions like diabetes and gastrointestinal diseases. Intermittent fasting is beneficial based on a study done in India called the Indian Migration Study which states, if utilized properly, intermittent fasting can provide multiple health-related benefits, apart from the socio-religious goals that it aims for (Karla, 2015).
Conclusion
In order to maximize outcomes in maintaining, protecting, and restoring health for a female of the Hindu religion in Eriksons generativity vs. stagnation stage in the U.S., the RN must consider the religious practices and beliefs of the individual. Cultural diversity and understanding are crucial as not every individual is the same. It is the RNs responsibility to provide accommodations regardless of religion, race, age, and gender by advocating for the patient. As an active member of the health care team, the RN will be able to assist in the maintenance, protection, and restoration of health. This can create a positive difference in the well-being of the patients who receive care.
References
- ADRA. (2010). The Association of Religion Data Archives. Retrieved from http://www.thearda.com/QL2010/QuickList_108.asp
- Cherry, K. (2018, November 16). The Differences and Characteristics of Generativity and Stagnation. Retrieved March 28, 2019, from https://www.verywellmind.com/generativity-versus-stagnation-2795734
- Cohan, A. (2015, May 11). Religion in America: U.S. Religious Data, Demographics and Statistics. Retrieved from https://www.pewforum.org/religious-landscape-study/
- Kalra, S., Bajaj, S., Gupta, Y., Agarwal, P., Singh, S. K., Julka, S., . . . Agrawal, N. (2015, April). Fasts, feasts and festivals in diabetes-1: Glycemic management during Hindu fasts. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319259/
- Knott, K. (2016). Hinduism: A very short introduction. New York, NY: Oxford University Press.
- Lucia, A. (2017, January). Oxford Research Encyclopedia of Religion [PDF]. New York: Oxford University Press.
- McKinney, E. S., James, S. R., Murray, S. S., Nelson, K. A., & Ashwill, J. W. (2018). Maternal-Child Nursing (5th ed.). St. Louis, MO: Elsevier.
- Roberts, D. H. (2014, April). Health Information and Medical Information. Retrieved from http://www.health.harvard.edu/
- Spector, R. E. (2017). Cultural Diversity in Health and Illness (Ninth ed.). New York, NY: Pearson.
- Yoost, B., & Crawford, L. (2016). FUNDAMENTALS OF NURSING: Active learning for collaborative practice. St. Louis, MO: Elsevier
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