Indian beliefs about birth
• Birth in the eighth month of pregnancy is thought
to be the cause of a cat entering the pregnant
mother’s room in a previous confinement. A child
born in this month is believed to die on the eighth
day, eighth month, or the eighteenth year after
• Lucky and unlucky births are especially believed
by the Indian society.
• Monday is an unlucky day for birth. As a
remedy, the child’s ear or nose is bored.
• Jatakarma is the ceremony that welcomes the baby
into the world.
• The objective of the ceremony is to install good
values in the child, even though the child does not
understand the importance.
• Before the umbilical cord is severed, the father
touches the baby’s lips with a gold spoon dipped in
honey, curds, and ghee.
• The word “vak” (meaning speech) is whispered into
the baby’s right ear three times, while mantras are
chanted to ensure a long life.
• Applying ghee or oil to the baby’s head protects it
from cold and catarrh.
• The father is usually not in the delivery room
at the time of birth.
• Pain medications are usually not used during
birth. They are believed to complicate the
process. Therefore, the nurse should be
prepared to assist the woman with alternative
breathing or relaxation techniques.
• The sex of the baby is not told until the
placenta has been delivered. Because of the
high preference for having a boy, it is believed
that having a girl will upset the mother and
delay delivery of the placenta.
• Once the placenta has been delivered, the
baby is first shown to the mother, then to the
father and other family members.
• In nursing practice, it is important to accept
and respect the Indian customs; as it will help
the patient feel more comfortable.
NANDA Nursing diagnosis
Related to labor
Acute Pain related to uterine contractions,
stretching of cervix and birth canal as
evidenced by a change in vital signs
Death and Dying
•Death is viewed as acycle of reincarnation
• Timing of death isdetermined by karma
• prefer to die at home
•Believed to result in bad effects if one dies on a bed, prefer to be
placed on floor, indicating oneness with earth
• Life support not favored, if decision to end it arises, timing is
important because of the belief death should come without
interference, peaceful, gracefully, and quietly
•Usuallyopen to oroppose medical treatments, rarely in between
• When one dies, a priest is brought in to release the soul, perform puja (worship),
tie a yellow string around wrist, site verses from holy book “Geeta”, and place
drops of water from a holy river in mouth.
• Nurses should allowfor this to take place,as this is animportant part of Indian
Death and Dying
• Modesty and dignity remain
• Body bathed and dressed byperson of same sex only
• In nursing this could pose a strainfor the staff, if nurse wasof different sex than
pt, also causingstress for the family
• Body dressed in Indian clothing of certain colors
• Family will pray around body, preferably immediately after death
• Touching the body isconsidered polluting
• Grieving - common visible expressions are looked upon ashelpful to cope
• Preferred method is cremation over burial, and should be performed within
24 hours of death. This releases the spirit.
• Organ donation is not accepted due to the
soul not being able to be released
• Autopsies are considered disrespectful
• Oldest son is in charge of ceremonies
• After the funeral service everyone will undergo a purifying bath and change
Defensive coping r/t conflict between self-perception and
value system AEB the holy Bhagvad Gita,
“For death is certain to one who is born; to who is dead, birth is
certain; therefore, thou shaltnot grieve for whatis
• Many are strict vegetarians … some also
consume eggs and fish
• Hindus do not consume any foods that may
slow spiritual or physical growth
• Eating of meat is not prohibited but those who
do eat meat are forbidden from eating beef due
to the cow being considered sacred
• Pork, fowl, ducks, snails, & crabs are avoided
• The thali is typically served in small bowls on a round tray. The
round tray is typically made with steel with multiple
• Meaning “plate” is an Indian meal with varying contents … usually
yogurt, rice, chutney or pickle, and vegetables
Many devout Hindus fast on the 18 major Hindu
holidays, as well as numerous personal days, such
as birthdays and anniversaries of deaths and
Hindus also fast on Sundays and on days that are
Nutrition: Less than body requirements, imbalanced-
related to metabolic changes and inadequate intake as
manifested by patient fasting during a time of illness and
physical and mental stress of hospitalization
• Approximately 80% of the Indian population follows Hinduism
•It has been estimated that there are about 900 million Hindus
worldwide, nearly 2.5 million of which reside in the United States.
•Major beliefs include:
• Samsara (the cycle of rebirth)
• Karma (the universal law of cause & effect)
These lead to the belief that one’s actions & thoughts directly determine
one’s current and future lives.
• Dharma one of the most complex all-encompassing terms in all of Hinduism.
• Can mean religion, law, duty, order, conduct, morality, justice.
• Data: 1300 – Patient observed holding abdomen and crying after
family departed. Reports pain level 8 on scale of 1-10
• Action: 1300 Repositioned patient and
educated on guided imagery
• Response: 1330 – Patient reports 6 on
pain scale of 1-10
• It is difficult for nurses to see their
patients in pain. However, it is important to
respect the wish of the patient who will
not accept narcotic pain medication and do
anything in our power to help lessen their
pain in a way that is acceptable to the
Beliefs on Illness and Death
• Narcotic use Discouraged
• Choose DNR status due to belief that
prolonging life conflicts with Karma
• Time of death determined by Karma
• Death accepted as a natural part of life
• When death is imminent, a priest may adorn the
Head with sandle wood paste, holy ash and
kum kum powder.
• After death, the family may prefer to clean and prepare the body for cremation,
the preferred method for Indian funeral ceremonies.
Related to Spirituality
Related to fear of being placed on
life support AEB patient statement
“If the doctor feels he can’t
save me and puts me on life
support against my wishes, then
my Karma will be altered.”
Risk for Spiritual Distress:
• High value placed on independence and privacy.
• Family issues including healthcare decisions discussed within
immediate family BEFORE seeking outside help.
• Men have a dominant and authoritative role because they
are the primary point of contact with society.
• Modesty is highly valued
among Indians and patients are
decidedly more comfortable and
secure with same-sex care
Related to Communication
Related to inability to participate in
usual activities, limited contact with
significant others and decreased
exposure to events in the outside
world associated with prolonged
Risk for Loneliness:
Family & Community
•Hindu'sare a collectivist society. Collectivism emphasizes family
integrity, familyloyalty, and unity. Decisions affectingmost aspects
of life result from a collaboration of inputfrom the entirefamily.
• Based on caste system which divides
society into rigid classes. Hindu's view their
predeterminedlot in lifethe result of their
deeds in a prior existence, or Karma.
Family & Community
• The Indian family is considered strong, stable, close, resilient
• Family life is patriarchal in ideology and patrilocal.
• There is often 3-4 generations, including aunts, uncles,
nephews, and nieces, living under one roof.
•Males are brought up to be assertive, less tolerant,
independent, self-reliant, demanding, and domineering.
•The oldest son is in charge of finances and family matters.
The oldest daughter-in-law generally runs the household.
Family & Community
• Females are raised to be self-serving, docile,
accommodating, nurturing, tolerant, religious, and to
value family above all.
• When caring for a patient who is of this culture, it is
important for the nurse to remember that medical
care and decisions need to involve the entire family
structure to work through a problem.
• The elderly are obeyed, revered,
considered to be fountains of
knowledge and wisdom, and treated
with respect and dignity by family
and community members.
Related to Family
Family processes, interrupted r/t
powershift of family members a.e.b. the
eldest son being incapacitated
• Access plays a large role in the number of patients who receive
treatment and medication for pain; palliative care estimates show
that very few (around 4%) of cancer patients are receiving proper
• Doctors are not trained properly; medical practitioners and students
receive little to no training about pain management/treatment
• Some Indian states follow strict regulations regarding narcotics, so
medications for pain may be scarce
Pain In India
Hinduism’s role in pain
• Some patients who practice Hinduism may believe that
suffering is necessary to reduce or do away with past karma
• Some will choose to endure suffering and pain so that the
mind remains clear as they go through the process of death
• Both of these beliefs may cause patients to refuse treatment
or medication for pain
Where nursing plays into pain
• Respecting patients’ wishes is important,
but it can take a toll on a nurse when a patient’s
health is being compromised.
• It is important that nurses, who are caring
for a patient whose culture differs from the
nurse’s own culture, are aware and try to
correct biases that they may be showing.
• It may also be easier for a nurse to understand
her patient’s decisions if the nurse does some research
on the culture of the patient.
• One of the most important things to remember where pain, in
any culture, is concerned is what McCaffery suggested--'pain is
whatever the person experiencing it says it is’
Related to Pain
• Chronic pain r/t disease progression
aeb self-report by patient
• It’s a national problem
• Water shortages in all states
• Widespread public defecation due to lack of
private and public bathrooms
• Results in preventable disease and death with the very young at
• Poverty and lack of education and resources, limit
clean up efforts
Educating the Population
• 1999 – Total Sanitation Campaign
• Goal – To build toilets so that 100% of India has access by 2012
• Educating public on the benefits of sanitation
• Women are leading the Reformation!
• Swajaldhara – 5 year plan to reform
drinking water accessibility in
October 15th 2010
School children across India involved
Reinforce proper technique and
benefits of hand washing on health
Ineffective Health Maintenance
Related to Insufficient Resources
• Convey resource information:
• Medical/Dental care
• Financial resources
• Assess for lice & evidence of other parasites
• Patient teaching of proper hygiene to promote health
• Free hygiene items
• Short Term Goal:
Patient will report a decrease in pain level from an 8 to a 6 on a pain
scale of 0-10 by 11/30/10.
A male who handles family matters is hospitalized with terminal
Chronic pain related to disease progression as evidenced by self-report
Care Plan (cont.)
1) Anticipate need for pain relief.
One can most effectively deal with pain by
preventing it. Early intervention may decrease the
total amount of analgesic required.
2) Respond immediately to complaint of pain.
In the midst of painful experiences a patient’s perception of time may
become distorted. Prompt responses to complaints may result in
decreased anxiety in the patient. Demonstrated concern for patient’s
welfare and comfort fosters the development of a trusting relationship.
3) Eliminate additional stressors or sources of discomfort whenever
Patients may experience an exaggeration in pain or a decreased ability
to tolerate painful stimuli if environmental, intrapersonal, or intra-
psychic factors are further stressing them.
Slide #1: Chakarapani, S., Water Shortage in India and Diseases Caused.
Galbraith, C. & Thomas, A., Community Approaches to Total Sanitation.
Slide #2: Mohandas, P., Swajaldhara Guidelines: Foreword
Slide #3: Retrieved Nov, 12, 2010 from
Slide #4: Ackley, B.J. & Ladwig, G.B. (2011). Ineffective Health Management.
Nursing Diagnosis Handbook (pp. 425-430) St. Louis: Mosby
Death and Dying
Pain and Comfort
Family and Community
Watchtower Bible & Tract Society. (1990). Mankind's Search for God. Brooklyn, NY.