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Erschienen in: Health Care Analysis 3/2013

01.09.2013 | Original Article

Understanding and Coping with Diversity in Healthcare

verfasst von: J. Jhutti-Johal

Erschienen in: Health Care Analysis | Ausgabe 3/2013

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Abstract

In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients.
Fußnoten
1
Race relations laws, such as the Race Relations (Amendment) Act 2000 place a legal duty on healthcare providers to tackle racism in service delivery and respect the needs of citizens from all cultures [27].
 
2
There are approximately 400,000 Sikhs in the United Kingdom. Gurharpal Singh and Darshan Tatla had the figure at 336,000 in 2006 [32, p. 2].
 
3
Keshdhari Sikhs follow very similar practices to the Amritdhari Sikhs; however there is diversity in their adherence to ‘orthodox’ Sikh principles. They keep their hair uncut and possess either all or some of the 5 K’s and will follow the Sikh way of life, as outlined in the Rehat Maryada [29]. The only issue is that they have not been baptized and therefore they are not members of the Khalsa brotherhood. What is important to note is that non-baptized Sikhs are distinguished by their commitment to the 5 K’s, especially unshorn hair; which somehow implies that Keshdharis observe all of the 5 K’s [36]. Tatla, reassesses this statement in Singh and Tatla [32], changing the statement to ‘most’ of the 5 K’s. A Keshdhari may uphold all of the 5 K’s but still use their family/caste name. Alternatively, they may go purely by the Khalsa name of Singh or Kaur but only uphold one or two of the K’s, mainly Kesh and Kara. The only unifying factor in ‘Keshdhari’ identity is that they all observe unshorn hair, hence the name ‘Kesh-dhari’ [32, p. 18].
 
4
Mona Sikhs, like Keshdhari Sikhs, are diverse; some use the Khalsa names of Singh and Kaur only, some use only their family/caste names, however, the majority will use both, taking on the Khalsa name as a ‘middle name’. They will wear the Kara, so they can be identified as Sikh, and observe the teachings of the Gurus. Some Keshdhari Sikhs can also be referred to as Mona Sikhs because there is an increasing trend to trim beards, this is particularly so among caste groups such as: Tarkhan, Ramgarhia and Jat. The element of practicality that surrounds Sikhism means that Sehajdhari and Mona Sikhs view themselves as Sikhs because they practice the religion according to the practical actions that the Guru Nanak introduced: nam japna(meditation on God’s name), kirat karna (honest labour) and vand chakhna (giving to those in need) [16, p. 91].
 
5
WHO [38].
 
6
National Council of Palliative Care (NCPC) [23].
 
7
Sikhs believe in reincarnation. This means that a person’s soul may be reborn many times as a human or an animal. Sikhs believe that there are 8,400,000 forms of life and that many souls have to travel though a number of these before they can reach Waheguru (God). When something dies their soul is reborn. It is only when one becomes a human that there is a chance of the cycle being broken because only humans know the difference between right and wrong [16, pp. 129–30].
 
Literatur
1.
Zurück zum Zitat Ballard, R. (Ed.). (1994). Desh Pardesh. The South Asian presence in Britain. London: Hurst & Co Publishers Ltd. Ballard, R. (Ed.). (1994). Desh Pardesh. The South Asian presence in Britain. London: Hurst & Co Publishers Ltd.
2.
Zurück zum Zitat Berger, A., Badham, P., Kutscher, A., Berger, J., Perry, H., & Beloff, J. (Eds.). (1989). Perspectives on death and dying—cross cultural and multi-disciplinary views. Philadelphia: Charles Press, Publishers. Berger, A., Badham, P., Kutscher, A., Berger, J., Perry, H., & Beloff, J. (Eds.). (1989). Perspectives on death and dying—cross cultural and multi-disciplinary views. Philadelphia: Charles Press, Publishers.
3.
Zurück zum Zitat Cole, W. O., Sambhi, P. S., & Bumra, P. S. (1985). The Sikhs: Their beliefs and practices. London: Routledge and Kegan Paul. Cole, W. O., Sambhi, P. S., & Bumra, P. S. (1985). The Sikhs: Their beliefs and practices. London: Routledge and Kegan Paul.
4.
Zurück zum Zitat Field, D. (1914). The religion of the Sikhs. London: EP Dutton and Co. Field, D. (1914). The religion of the Sikhs. London: EP Dutton and Co.
5.
Zurück zum Zitat Firth, S. (1989). The good death. Approaches to death, dying and bereavement among British Hindus. In A. Berger, et al. (Eds.), Perspectives on death and dying—cross cultural and multi-disciplinary views. (pp 66–75). Philadelphia: Charles Press Publishers. Firth, S. (1989). The good death. Approaches to death, dying and bereavement among British Hindus. In A. Berger, et al. (Eds.), Perspectives on death and dyingcross cultural and multi-disciplinary views. (pp 66–75). Philadelphia: Charles Press Publishers.
6.
Zurück zum Zitat Firth, S. (1997). Dying, death and bereavement in a British Hindu community. London: Peters. Firth, S. (1997). Dying, death and bereavement in a British Hindu community. London: Peters.
7.
Zurück zum Zitat Firth, S. (2001). Wider horizons: Care of the dying in a multicultural society. London: National Council for Palliative Care. Firth, S. (2001). Wider horizons: Care of the dying in a multicultural society. London: National Council for Palliative Care.
8.
Zurück zum Zitat Gatrad, A. R., & Sheikh, A. (2002). Palliative care for Muslims and issues before death. International Journal of Palliative Nursing, 8, 526–531.PubMed Gatrad, A. R., & Sheikh, A. (2002). Palliative care for Muslims and issues before death. International Journal of Palliative Nursing, 8, 526–531.PubMed
9.
Zurück zum Zitat Gatrad, A. R., Brown, E., Notta, H., & Sheikh, A. (2003). Palliative care needs of minorities. British Medical Journal, 327, 176–177.PubMedCrossRef Gatrad, A. R., Brown, E., Notta, H., & Sheikh, A. (2003). Palliative care needs of minorities. British Medical Journal, 327, 176–177.PubMedCrossRef
10.
Zurück zum Zitat Gatrad, A. R., Brown, E., & Sheikh, A. (Eds.). (2007). Palliative care for South Asians: Muslims, Hindus and Sikhs. London: Quay Books. Gatrad, A. R., Brown, E., & Sheikh, A. (Eds.). (2007). Palliative care for South Asians: Muslims, Hindus and Sikhs. London: Quay Books.
11.
Zurück zum Zitat Gatrad, A. R., Notta, H., Panesar, S., Brown, E., & Sheikh, A. (Eds.). (2007). Palliative care for Sikhs. In Palliative care for South Asians: Muslims, Hindus and Sikhs (pp. 95–100). London: Quay Books. Gatrad, A. R., Notta, H., Panesar, S., Brown, E., & Sheikh, A. (Eds.). (2007). Palliative care for Sikhs. In Palliative care for South Asians: Muslims, Hindus and Sikhs (pp. 95–100). London: Quay Books.
12.
Zurück zum Zitat Gomes, B., & Higginson, I. J. (2008). Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Medicine, 22, 33–41.PubMedCrossRef Gomes, B., & Higginson, I. J. (2008). Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Medicine, 22, 33–41.PubMedCrossRef
13.
Zurück zum Zitat Gott, M., Seymour, J., Bellamy, G., Clark, D., & Ahmedzai, S. (2004). Older people’s views about home as a place of care at the end of life. Palliative Medicine, 18, 460–467.PubMedCrossRef Gott, M., Seymour, J., Bellamy, G., Clark, D., & Ahmedzai, S. (2004). Older people’s views about home as a place of care at the end of life. Palliative Medicine, 18, 460–467.PubMedCrossRef
14.
Zurück zum Zitat Gunaratnam, Y. (2006). Ethnicity, older people and palliative care. London: National Council for Palliative Care. Gunaratnam, Y. (2006). Ethnicity, older people and palliative care. London: National Council for Palliative Care.
15.
Zurück zum Zitat Higginson, I. (2003). Priorities and preferences for end of life care in England, Wales and Scotland. London: National Council for Palliative Care. Higginson, I. (2003). Priorities and preferences for end of life care in England, Wales and Scotland. London: National Council for Palliative Care.
16.
Zurück zum Zitat Jhutti-Johal, J. (2011). Sikhism Today. London: Continuum Press. Jhutti-Johal, J. (2011). Sikhism Today. London: Continuum Press.
17.
Zurück zum Zitat Jhutti-Johal, J., & Johal, S. S. (2007). The Sikh Grand Narrative. In A. R. Gatrad (Ed.), Palliative Care for South Asians: Muslims, Hindus and Sikhs (pp. 83–94). London: Quay Books. Jhutti-Johal, J., & Johal, S. S. (2007). The Sikh Grand Narrative. In A. R. Gatrad (Ed.), Palliative Care for South Asians: Muslims, Hindus and Sikhs (pp. 83–94). London: Quay Books.
18.
Zurück zum Zitat McLeod, W. H. (1989). Who is a Sikh? The Problem of Sikh Identity. Oxford: Clarendon Press. McLeod, W. H. (1989). Who is a Sikh? The Problem of Sikh Identity. Oxford: Clarendon Press.
19.
Zurück zum Zitat McLeod, W. H. (1997). Sikhism. London: Penguin. McLeod, W. H. (1997). Sikhism. London: Penguin.
20.
Zurück zum Zitat McPherson, C., Wilson, K., & Murray, M. (2007). Feeling like a burden to others: a systematic review focusing on the end of life. Palliative Medicine, 21(2), 115–128. McPherson, C., Wilson, K., & Murray, M. (2007). Feeling like a burden to others: a systematic review focusing on the end of life. Palliative Medicine, 21(2), 115–128.
21.
Zurück zum Zitat National Audit Office. (2008). End of life care. London: The Stationery Office. National Audit Office. (2008). End of life care. London: The Stationery Office.
22.
Zurück zum Zitat National Audit Office. (2008). Patient and carer experiences regarding end of life care in England. London: Ove Arup & Partners Ltd. National Audit Office. (2008). Patient and carer experiences regarding end of life care in England. London: Ove Arup & Partners Ltd.
24.
Zurück zum Zitat National Institute for Clinical Excellence (NICE). (2004). Improving supportive and palliative care for adults with cancer. London: National Institute for Clinical Excellence. National Institute for Clinical Excellence (NICE). (2004). Improving supportive and palliative care for adults with cancer. London: National Institute for Clinical Excellence.
25.
Zurück zum Zitat Nesbitt, Eleanor. (2000). The body in Sikh tradition. In S. Coakley (Ed.), Religion and the body. Cambridge: Cambridge University Press. Nesbitt, Eleanor. (2000). The body in Sikh tradition. In S. Coakley (Ed.), Religion and the body. Cambridge: Cambridge University Press.
26.
Zurück zum Zitat Owens, A., & Randhawa, G. (2004). ‘‘It’s different from my culture; they’re very different’’: Pro- viding community-based ‘‘culturally competent’’ palliative care for South Asian people in the UK. Health and Social Care in the Community, 12, 414–421.PubMedCrossRef Owens, A., & Randhawa, G. (2004). ‘‘It’s different from my culture; they’re very different’’: Pro- viding community-based ‘‘culturally competent’’ palliative care for South Asian people in the UK. Health and Social Care in the Community, 12, 414–421.PubMedCrossRef
28.
Zurück zum Zitat Seymour, J., et al. (2005). End of life care. Bristol: Policy Press. Seymour, J., et al. (2005). End of life care. Bristol: Policy Press.
29.
Zurück zum Zitat SGPC. (1950). Sikh Rehat Maryada. Amritsar: Shiromani Gurdwara Parbandhak Committee. SGPC. (1950). Sikh Rehat Maryada. Amritsar: Shiromani Gurdwara Parbandhak Committee.
30.
Zurück zum Zitat Sheikh, A., & Gatrad, A. R. (2000). Death and bereavement: an exploration and a meditation. In A. Sheikh & A. R. Gatrad (Eds.), Caring for Muslim patients (pp. 97–107). Oxford: Radcliffe. Sheikh, A., & Gatrad, A. R. (2000). Death and bereavement: an exploration and a meditation. In A. Sheikh & A. R. Gatrad (Eds.), Caring for Muslim patients (pp. 97–107). Oxford: Radcliffe.
31.
Zurück zum Zitat Singh, Gopal. (1978). Sri Guru Granth Sahib: English Version (Vol. 4). Chandigarh, India: World Sikh University Press. Singh, Gopal. (1978). Sri Guru Granth Sahib: English Version (Vol. 4). Chandigarh, India: World Sikh University Press.
32.
Zurück zum Zitat Singh, Gurharpal, & Tatla, D. S. (2006). Sikhs in Britain: The making of a community. London, UK: Zed Books Ltd. Singh, Gurharpal, & Tatla, D. S. (2006). Sikhs in Britain: The making of a community. London, UK: Zed Books Ltd.
33.
Zurück zum Zitat Smaje, C., & Field, D. (1997). Absent Minorities? Ethnicity and the use of palliative care services. In D. Field, J. Hockey, & N. Small (Eds.), Death, gender and ethnicity (pp. 142–165). London: Routledge. Smaje, C., & Field, D. (1997). Absent Minorities? Ethnicity and the use of palliative care services. In D. Field, J. Hockey, & N. Small (Eds.), Death, gender and ethnicity (pp. 142–165). London: Routledge.
35.
Zurück zum Zitat Takhar, Opinderjit Kaur. (2005). Sikh Identity: An exploration of groups among Sikhs. UK: Ashgate. Takhar, Opinderjit Kaur. (2005). Sikh Identity: An exploration of groups among Sikhs. UK: Ashgate.
36.
Zurück zum Zitat Tatla, D. S. (2001). Imagining Punjab—narratives of nationhood and homeland among the Sikh Diaspora. In C. Shackle, et al. (Eds.), Sikh religion, culture and ethnicity (pp. 161–185). London: Curzon Press. Tatla, D. S. (2001). Imagining Punjab—narratives of nationhood and homeland among the Sikh Diaspora. In C. Shackle, et al. (Eds.), Sikh religion, culture and ethnicity (pp. 161–185). London: Curzon Press.
37.
Zurück zum Zitat Ward, S., et al. (2004). Improving supportive and palliative care for adults with cancer: Economic review. London: National Institute for Clinical Excellence. Ward, S., et al. (2004). Improving supportive and palliative care for adults with cancer: Economic review. London: National Institute for Clinical Excellence.
39.
Zurück zum Zitat Worth, A., et al. (2009). Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: Prospective longitudinal qualitative study. British Medical Journal, 338. doi:10.1136/bmj.b183. Worth, A., et al. (2009). Vulnerability and access to care for South Asian Sikh and Muslim patients with life limiting illness in Scotland: Prospective longitudinal qualitative study. British Medical Journal, 338. doi:10.​1136/​bmj.​b183.
Metadaten
Titel
Understanding and Coping with Diversity in Healthcare
verfasst von
J. Jhutti-Johal
Publikationsdatum
01.09.2013
Verlag
Springer US
Erschienen in
Health Care Analysis / Ausgabe 3/2013
Print ISSN: 1065-3058
Elektronische ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-013-0249-0

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