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Cultural Diversity in Nursing

India's Culture and Background

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India's National Flag:
Flag of India


Cultural Diversity is becoming more and more prodominent in the United States. Not only are we taking care of patients of different cultural backgrounds, but people of different cultures are also becoming our co-workers in the Health Care system. One of the many different cultures that we are coming in contact with is the Indian (Asian) culture.

India’s history is one of many dynasties, religions, and conquering invaders. The invaders exerted power and imposed their own cultural institutions, resulting in cultural blending. Today there are as many as six different racial strains present in India, making attempts to trace origins of people very difficult.

Among the major influences in India’s history are Hinduism/Brahmanism, Hellenism, Buddhism, and Islam (Bhungalia, 2006)


15 August 19 from the British (India, 2007)


Hindu 80.5%, Muslim 13.4%, Christian 2.3%, Sikh 1.9%, other 1.8%, unspecified 0.1% (India, 2007)

It is crucial to keep in mind the of the importance of religion to the Indain culture. By recognizing the different aspects of their religion, treating Indian people will be more successful.

Aspects of Hinduism that commonly affect health decisions and communications between patient, family, and provider include:

  • Karma is a law of behavior and consequences in which actions in past live(s) affects the circumstances in which one is born and lives in this life. Thus a patient may feel that his or her illness is caused by karma (even though there may be complete understanding of biological causes of illness).
  • The Bindi is a sign worn by many women of the Hindu faith as a red dot on the forehead. Traditionally a symbol of honor and intelligence, today it is common for women to wear it as decoration. The care provider should assess the client’s personal reasons for wearing the Bindi, since it may vary for women depending on age, and assimilation into American culture. 


  • Meditation and prayer are used by many Hindus. Some meditate silently, while others chant "Om" and other prayers aloud.
  • Vegetarianism is universal among devout Hindus. Vegetarianism among Hindus is based on belief in reincarnation, the idea that the soul of a person enters back into creation as a living being. Hindus pray a specific prayer before eating, in which one asks forgiveness for eating a plant or vegetable in which a soul could dwell.

It must be noted that these religious beliefs are not universal among all Hindu Indians. In the health care setting, it is helpful to have a basic understanding of the individual patient’s chosen religion and how the person practices and lives out that faith.

Other religions among Indians are Islam, Christianity, Sikhism, and Zorastrianism (the latter practiced by Parsis, most of whom are from the Bombay area). The 1991 census of India reported 12.12% of the Indian population was Muslim, 2.34% Christian, and most of the rest Hindu (Bhungalia, 2006).


While there are more than three hundred languages and dialects spoken in India, Hindi, the national language, is predominant, spoken by over forty percent the population. There are two main groups categorizing language in India, including the Indo-Aryans in the north and the Dravidians in the south. Indo-Aryans predominantly speak Hindi, but have numerous dialect variations;. However, in this age, English is becoming a popular second language for many Indians (Bhungalia, 2006)

Family Life

Within Indian society, extended family members usually live together as a single-family unit which includes grandparents, parents, children, as well as the families of parental uncles. With increased mobilization to urban areas, this structure is slowly moving towards that of the nuclear family comprised of parents and their children.

Because of the value placed on independence and privacy in Indian culture and the desire to save face, family issues, including healthcare decisions, are frequently discussed within the immediate family before seeking outside help. Because of the close-knit family structure, a family can expect many visitors when a family member is in the hospital (Bhungalia, 2006).


In the Indian culture, the whole family is involved in the care of the children. Grandparents play an important role in rearing the children, and if the grandparents do not live with the couple, they will come before the birth and stay to help out for first few months to several years. The children often sleep with the parents from the time of birth to early childhood. If the grandparents are part of care taking, the children may be as attached to the grandparents as to the parents. This may cause some attachment issues with the child and parents. During an invasive procedure, the healthcare worker may want to give the child a choice for support: grandparent or parent – or better, both (Bhungalia, 2006).


Education is second only to respect. In India, education is based primarily on financial capabilities, so that an intelligent, but poor child will not attend college. Many families migrated from India to America for better education for their children. Parents sometimes encourage their children to excel beyond their capabilities. Some children are pressured to the extent that psychological problems, such as depression and suicide result (Bhungalia, 2006).


Traditional Beliefs and Natural Remedies


India has several alternative systems of Medicine including (Health: Alternative systems of medicine, 2005):

Ayurveda:  The term Ayurveda means ‘Science of Life’. It deals elaborately with measures for healthful living during the entire span of life and its various phases. Besides, dealing with principles for maintenance of health, it has also developed a wide range of therapeutic measures to combat illness. These principles of positive health and therapeutic measures relate to physical, mental, social and spiritual welfare of human beings.

Yoga: Yoga is not a religion; It’s a philosophy of life based on certain psychological facts and it aims at the development of a perfect balance between the body and the mind that permits union with the divine i.e. perfect harmony between the individual and the cosmos.

Naturopathy: Nature Cure believes that all the diseases arise due to accumulation of morbid matter in the body and if scope is given for its removal, it provides cure or relief. It also believes that the human body possesses inherent self constructing and self healing powers.

Homeopathy: The word ‘Homoeopathy’ is derived from two Greek words, Homois meaning similar and pathos meaning suffering. Homoeopathy simply means treating diseases with remedies, prescribed in minute doses, which are capable of producing symptoms similar to the disease when taken by healthy people.

Unani: Unani medicine believes in Promotion of Health, prevention of diseases and cure.

Sidda: Siddha system is one of the oldest systems of medicine in India .  The term Siddha means achievements and Siddhars were saintly persons who achieved results in medicine.  Eighteen Siddhars were said to have contributed towards the development of this medical system.  Siddha literature is in Tamil and it is practised largely in Tamil speaking part of India and abroad.  The Siddha System is largely therapeutic in nature.

Common Natural Remedies

Botanical Name

Common Name


Andriograohis paniculata

King of Bitters


Boswellia serrata

Olibanum, Farnk incense

Antiarthritic, Antihyperlipid

Cassia angustifilia

Indian senns


Coleus forskohlii



Garcinia camogia, Calcium

Garcinia, Kokum


Garcinia cambogio, Potassium

Garcinia, Kokum


Gynema sylvestris


Aphrodisiac, Antioxidant



Potent Aphrodisiac

Tribulus terrestris

Puncture vine

Potent Aphrodisiac

Taxus baccata


Taxol, Ovarian cancer

In Ayruveda medicine common health problems include fever, headache, common cold, stomachache, diarrhea, constipation, arthritis and joint pains. The following section describes the causes, remedies and diet regimen of each illness.


The essence of good Indian cooking revolves around the use of aromatic spices. Two great influences on Indian cooking and food habits are the Hindu and Muslim religions. Hindus are vegetarians and believe that food was created by a Supreme Being for the benefit of man. Muslims have several food restrictions discussed in the Refugee Health section on religions. Regional variations in diet and cooking also exist.

Nutritional deficiencies vary depending on region and other factors, especially socio-economic. Nutritional deficiencies such as thiamine deficiency, pellagra, and lathyrism are common in India. Thiamine deficiency is common among people mostly dependent upon rice. Thiamine is lost through the washing, cooking of rice, and allowing it to remain in water overnight. Pellagra is common in rural areas among the very poor in urban areas. Lathyrism is a crippling disease causing paralysis of leg muscles in adults who consume large quantifies of seeds of the pulse khesari and Lathyrus Sativus over a long period of time. Goiter is prevalent as a result of iodine deficiency in food and water. The concept of the sacred cow has an impact on adequate nutritional management, and osteomalacia is common related to deficient calcium and vitamin D in regions were the cow is sacred (Bhungalia, 2006).

Diseases and Health Conditions

World Health Organization Statistics for India:

Total population: 1,103,371,000

Life expectancy at birth m/f (years): 61.0/63.0

Healthy life expectancy at birth m/f (years, 2002): 53.3/53.6

Child mortality m/f (per 1000): 81/89

Adult mortality m/f (per 1000): 275/202

Total health expenditure per capita (Intl $, 2003): 82

Total health expenditure as % of GDP (2003): 4.8

In India, "the expected number of years to be lived in what might be termed the equivalent of "full health'" is 53.3 years for men and 53.6 years for women. India is thus 134th among 181 nations ranked by the World Health Organization.

Health problems prevalent among Indians include malaria (especially in South India), respiratory infections such as tuberculosis and pneumonia, hypertension and cardiovascular disease, rheumatic heart disease, nutritional deficits, and high risk behavior such as alcoholism and cigarette smoking. Dental caries and periodontal disease affect most of the adult population. Sickle-cell disease is prevalent, with the gene detected in 16.48 percent of selected populations. Prostitution is common and HIV infection is a growing problem. Communicable diseases relatively common in India include the below (Bhungalia, 2006).

  • Boutonneuse fever
  • Cholera (especially after flooding in the monsoon season)
  • Dengue fever (including dengue hemorrhagic fever)
  • Encephalitis (Japanese)
  • Filariasis
  • Hepatitis
  • HIV
  • Hookworm
  • Hymenolepiasis
  • Leishmaniasis, visceral (kala azar) and cutaneous
  • Leprosy
  • Malaria
  • Strongyloidiasis
  • Typhus
  • Trachoma
  • Tuberculosis

Bhungalia, S., Kelly, T., Van De Keift, S., Young, M., & Kemp, C. (2006). 
                    Indian Health Care. In Refugee and Immigrant Health. Retrieved March 11, 2007, 
Health: Alternative Systems of Medicine.
                  (2005). National Portal of India. Retrieved March 12, 2007, from
India. (2007). The World Factbook. Retrieved March 11,
                  2007, from 

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