The following section gives brief guidelines on care for patients from Ethnic Minority backgrounds as well as from different faith-traditions. These seek to draw staff's attention to some relevant points pertinent to the care patients receive while being a patient within the Hospital. Further information or advice can be sought where necessary from the Trust's Religious and Culture Policy from the Hospital's Administration or the Hospital Chaplaincy Team.
AFRO-CARIBBEAN COMMUNITY the main religion is some form of Christianity usually Anglican, Methodist and Pentecostal. prayer is important for those who are regular churchgoers : the opportunity of privacy for prayer and even hymn-singing, would be appreciated. Families often feel emotionally-restricted and inhibited in hospitals in the United Kingdom. Ward staff should anticipate the need for a single room for a dying patient as visitors are important to the dying person. Family will probably not give consent for a post-mortem examination as the body must be intact for after-life and will therefore be deeply offended by its disfigurement. no religious objection to others handling the body as long as respect is shown at all times.
BUDDHISTS may seek counselling from a fellow Buddhist or seek the help of the Hospital Chaplain in arranging for a time of peace and quiet for meditation. some form of chanting from the patient's family and friends may be used to influence the state of mind at death so that it may be peaceful. are encouraged to meditate for as long as they are able, resist unconsciousness. Because wakefulness is important drugs which may depress the C.N.S. may be discouraged. at death a Buddhist monk or priest should be informed as soon as possible- ideally, he should be of the same school of Buddhism (there are a number) as the deceased. Often this will be done by the patient's family. the body should be wrapped in a sheet without symbols in order not to upset the surviving relatives. there is a calmness and acceptance of death amongst Buddhists. there is usually no objection to post-mortem examination being carried out.
CHINESE Western medicine is now accepted by the majority of Chinese as the most advanced form of treatment.
Traditional herbal remedies given by Chinese physicians are still used by a minority who are accustomed to this when they fall ill. Most Chinese now can reconcile aspects of traditional and Western medicine. Chinese women have a comparatively shy and modest nature and may therefore prefer to be treated by a female healthcare professional. often Chinese are embarrassed/shy about their condition so reassurance and explanation on the various treatment procedures involved will help to gain their co-operation and trust. on the death of an adult, the body is bathed. Some Chinese still follow the custom of clothing the body in white or in old-fashioned Chinese clothing. due to the differing customs nursing staff should consult with family members to ensure that particular requests and family wishes are acknowledged wherever possible. Chinese have no objections to Blood Transfusions.
CHRISTIANITY The Hospital Chaplaincy Team seek to respond to people's personal spiritual needs as they are able and will try to respond to specific requests from patients, relatives and staff e.g. requests for prayer. confession, Bible readings, anointing the sick, Holy Communion, or simply to talk. Holy Communion is available on request for members of any denomination. This can be administered by the Hospital Chaplain, the Roman Catholic Chaplain or the patient's own minister or priest. Terminally ill patients of all denominations should be aware that the support of a chaplain is available to them should they feel that it might be helpful. Whenever possible this should be done well before death is imminent so that a relationship can be established between Chaplain and patient. The Roman Catholic Chaplain may administer the 'Sacrament of the Sick' which is a symbol of forgiveness, healing and reconciliation. This sacrament is greatly significant for Catholics and contact should be made with the Chaplain as early as possible. The relatives or carers of a dying or deceased patient may also welcome contact with a chaplain.
HINDUISM Nursing staff should anticipate that many visitors will want to be with the Hindu patient, which will require support and understanding in the interest of the patient's well-being. A dying Hindu patient may wish to die at home. This has religious significance and may cause great distress to the dying person and to the family if he or she dies in hospital. Where circumstances permit, this should be facilitated to enable the patient to go home to die. Some Hindu families will not follow any specific last offices and nursing staff will be able to proceed as usual with their care. For others the relatives will perform the duties led usually by the eldest son.
If a Hindu patient is dying in hospital, relatives may wish to bring money and clothes for him/her to touch before distribution to the needy. Some devout Hindus when they are dying may wish to lie on the floor, symbolising closeness to mother earth. The family should be consulted before the body is handled. Relatives may ask for special grooming or dressing of the deceased. The body is usually dressed in new clothes before leaving the hospital. Jewellery, sacred threads and other religious objects should not be removed. The body is usually wrapped in a plain sheet. Because there is a great respect for the deceased Hindus will only accept post-mortems if they are legally required. Expressions of grief can be very demonstrative e.g. crying loudly, hugging and embracing others. This is regarded as healthy and for the restoration of peace of mind.
JEHOVAH'S WITNESSES will want reassurance that blood will not be used against their wishes. Blood represents life itself and must be handled with respect. This can have particular implications for oncology patients as many of the current treatments available often cause anaemia and thrombocytopenia. The stated 'Protocol for Treating Jehovah's Witnesses' is as follows: 1. Pursue non-blood medical alternatives and treat the patient without using homologous blood. 2. Consult with other doctors experienced in non-blood medical management at the same facility, and treat without using homologous blood. 3. Contact local Hospital Liaison Committee of Jehovah's Witnesses to locate co-operative doctors at other facilities for consultation on alternative medical care. Contact can be made on urgent cases 24 hours a day. Refer to the Hospital Chaplain if necessary. Nursing staff are able to carry out their normal care according to hospital policy. Family, friends and elders of the congregation will wish to visit, and there are usually no formal ritualistic processes for the dying. Jehovah's Witnesses would not wish a doctor to strive to further life when death is clearly imminent.
JEWS Judaism is a religion with a strong life-affirming principle. However, since degrees of Jewish observance vary greatly within the Jewish Community it is important for nursing staff to consult with the patient and his/her family. Any act which might precipitate death is forbidden by Jewish law including shutting the eyes, removing the pillow or oiling the body. There can be an unwillingness on the part of the families and Jewish doctors to admit to a dying person that he or she is in fact dying. As a mark of respect for these principles steps should be taken by nursing staff to make the dying person comfortable e.g. if a patient is unable to drink then perhaps crushed ice could be given by spoon to moisten the mouth. Reducing the level of noise around the patient and perhaps the possibility of a single room would also be respectful to the Jewish patient. In all forms of Judaism the body is treated with great respect and there is a strong tradition of modesty. Any contact by the nursing staff with the body of a Jewish patient should be with disposable gloves. It may be requested that females are attended by female doctors. The family should be asked if this is appropriate. In the event of the death of a Jewish person, the following guidelines should be followed: 1. Do not wash the body - this will be done ritually prior to burial. 2. Do not remove false teeth or other prosthesis. 3. Close the eyes. 4. Straighten the body, lying flat with feet together towards the door, and arms by the side. 5. Cover the body with a plain white sheet without emblems. 6. If no family, notify the Hebrew Burial Society or local Jewish Community. If it is the Sabbath or a Festival, the body cannot be removed. In hospital the body is best moved to a room where it can remain until the representatives can remove it. It is integral to Judaism to try to heal the sick and to tend to them and cherish them.
MORMONS Those Mormons who have undergone a special Temple ceremony wear a sacred undergarment. This intensely private garment will normally be worn at all times, in life and death. It may be removed for hygiene purposes/laundering and for surgical operations but at all times it must be considered private and be treated with respect. Mormons are concerned over the effects of stimulants, including caffeine, so do not drink tea or coffee. In hospital, water, milk or fruit juice will be acceptable. Alcohol and tobacco are forbidden. There are no religious objections to blood transfusion or organ transplantation or post-mortem. Death, if inevitable, is regarded as a blessing and a purposeful part of eternal existence. There is no ritual for the dying but spiritual contact is important. Church members will know how to get in touch with their faith community for ministration to the sick. Routine last offices are appropriate. The sacred garment, if worn, must be replaced on the body.
MUSLIMS Muslims attach great importance to cleanliness. Hands, feet and mouth are always washed before prayer. If a bedpan is to be used, a bowl of water should be provided for washing. Social interaction between physically mature men and women is restricted, especially if they are unrelated. Muslim women therefore may prefer to be seen or treated by a female doctor and consideration should be given to their privacy and modesty if requested. This should be respected by both medical and nursing staff. Muslims would not wish a doctor to strive to further life when death is imminent.
Islam stresses the importance of regular prayers for remembrance of Allah, which may provide strong psychological support and comfort to the Muslim patient. When a Muslim patient is dying it will be a time when it is important for the patient’s family to be in attendance at the bedside. The dying person should be laid onto their right side, facing towards the Kaaba (the direction of prayer). If this is not convenient, the person can be laid on their back with their feet pointing towards the Kaaba. The head should be slightly raised so that it also faces this direction. A relative may whisper the call to prayer into the dying person's ear and family members may recite portions of the Qur"an quietly and prayers around the bed. Muslims believe that it is important to treat the body of the deceased with the same care and respect as was given to the individual during the lifetime. At no point should the body of the deceased be left in the nude or exposed. Muslims like to bury their dead as soon as possible. Family members and the Muslim Community will undertake the funeral arrangements themselves.
SIKHISM Sikh women are likely to have a strong preference to be seen or treated by a female doctor and so consideration should always be given to their desire for modesty. Similarly a request for the removal of the turban or 'Kach' (breeches) in public will cause embarrassment to a male Sikh. If a bedpan has to be used, then a bowl of water should also be provided for washing. Sikhs have no objection to blood transfusion. Generally speaking, Sikh patients will be willing to accept the authority of the professional, whether male or female. They tend to favour home remedies for ailments such as coughs, and be slow to seek professional attention. Death/Dying Generally Sikhs are happy for non-Sikhs to tend to the body, and health workers may perform the normal last offices if the family wishes it. In Sikh tradition the family is responsible for all ceremonies and rites connected with death, and many families will wish to wash and lay out the body themselves. If the family is available they must be consulted. If no family is available, the following guidelines may be of help: Under normal circumstances - where a death certificate will be issued by the attending doctor, special regard should be given to the five Ks.
Kesh – uncut hair Khanga – the wooden These are worn and comb should not be Kara – iron wrist band } disturbed unless it is Kirpan – a short sword absolutely Kach – short necessary trousers/breeches
In particular Kesh (unshorn hair) is felt to contribute to a Sikh's personality and should be left intact at all costs. Do not trim hair and beard. The hair on the head is sanctified at an initiation ceremony and should therefore be kept covered. The face of the deceased may be displayed on numerous occasions prior to the funeral, and a peaceful expression is desired. It is therefore appreciated if the face is cleaned, straightened if necessary, and the eyes and mouth closed. Limbs should also be straightened, and the body should be covered in a plain white sheet or shroud, without religious emblems.