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Culturally Competent Care for the South Asian Community
by Divya Kulshreshtha, BSN Minority Nurse Writer
South Asians comprise one of the fastest growing ethnic groups in the United States. While their numbers begin to climb steadily, less than 5.5% of all nurses are South Asian. In an effort to better serve the population, it is critical to have a cultural understanding of this rising demographic.
As a nurse, you may be wondering what qualifies someone as South Asian. Although most South Asians come from India, individuals from Pakistan, Bangladesh, Sri Lanka, Bhutan, Maldives, and Nepal are also categorized as South Asian. While each country has unique culturally specific practices, we will explore health matters common to all South Asian countries that influence your nursing practice.
What should I look for in my nursing assessment?
South Asians develop heart disease 10 to 15 years earlier than other ethnic groups. It is therefore critical to monitor their heart rate and blood pressure at an earlier stage to allow for earlier interventions. Moreover, assessing their risk factors for heart disease can be a great preventative measure. Be sure to ask about cholesterol, blood pressure, Body Mass Index (BMI), blood sugar, smoking, and stress levels.
Furthermore, type 2 diabetes rates are four times higher in South Asians than other ethnic groups. South Asians tend to have a higher refined sugar intake, which contributes to the higher incidence of diabetes. Part of the reason South Asians consume more carbohydrates is because of their vegetarian diet. Although many South Asians are not vegetarian, a large portion is. They rely on white basmati rice and atta flour for bread as their staple food source. Cutting down on carbohydrates or perhaps substituting whole grains in place of refined carbohydrates can lower blood sugar levels and prevent diabetes.
Body weight is also something to monitor in South Asians, specifically. South Asians may appear to have normal weight, but they have a tendency to deposit fat in the abdominal area, leading to central obesity. In fact, the fat deposition pattern for South Asians is so different from the normal population that there is a modified BMI for them entirely. Although they may have slender arms and legs, the increased abdominal fat deposition is correlated with a higher incidence of heart disease and diabetes.
What cultural elements should I consider in my dietary interventions?
In South Asian culture, food is the cultural glue that brings families together. Do not be surprised if South Asian families bring their own food during hospital stays. If dietary adjustments need to be made, try to adjust the diet using culturally relevant food. The American Association of Physicians of Indian Origin has culturally specific nutritional information online that can be useful in dietary assessments and interventions. For more information, visit www.aapiusa.org/resources/nutrition.aspx.
Many people emigrating from India, but not all, will have a vegetarian diet. Although in recent medical literature vegetarian diets have been shown to reduce the risk of obesity and related diseases, it is important to make sure essential nutrients are not lacking. Oftentimes, vegetarians overcompensate low protein by having high carbohydrate consumption, which can lead to diabetes. Check to see if they are receiving enough protein in the diet. If not, suggest increasing protein consumption through lentils, beans, and nuts. Vegetarians may also have lower iron and vitamin B12, which can be increased by eating cooked spinach and cheese, respectively. Use your nutritional knowledge as a nurse to provide the most balanced diet within the cultural boundaries.
Diet in South Asian culture is seen as part of medicine. For example, turmeric, a yellow colored spice that has been used for thousands of years, has now been studied and shown to ameliorate Alzheimer’s disease by clearing the amyloid-beta plaque buildup in the brain. South Asians tend to hold a holistic view of medicine. After all, ayurvedic medicine originated in India. Because of their tendency to hold a holistic perspective on healing, dietary interventions may be more effective. Nurses have always (and still do) approach the body holistically, which resonates with the values of South Asians. Be sure to tap into the holistic perspective of nursing when working with the South Asian population.
What psychosocial factors should I incorporate into my nursing care?
Like many Eastern cultures, South Asian culture can be described as collectivist. Collectivist cultures value the power of groups more so than an individual. The family unit becomes critical in collectivist cultures such as South Asians. In hospitals and patient visits, you may find that aunts, uncles, cousins, second cousins, and friends may be visiting or joining the patient for support. Every hospital has unique visiting policies, but as a nurse you can be culturally sensitive and accommodating to the best of your ability. Simple interventions such as providing extra chairs during visits can be beneficial for the patient. After all, studies have shown that those with social support have better immune functioning and therefore heal at a faster rate.
South Asians may also have different religious beliefs depending on where they came from. Some patients may hold more traditional religious beliefs and may prefer nurses of the same gender. Be sure to ask the patient for his or her preferences. Patients who have faith in religion have been shown to recover at faster rates. It is therefore important to provide religious support services. In hospitals, priests are often accessible. However, it is more difficult to find an Islamic imam or a Hindu pundit. As a nurse, you are the patient’s advocate. If these support services are not available at the hospital, perhaps you can suggest getting them at your hospital or refer patients to a nondenominational chapel where people of all faiths can pray.
Across all cultures, including Western culture, there is a stigma against mental health concerns. While mental health conditions such as depression exist cross-culturally, they are often not talked about or stigmatized. If you recognize symptoms of depression or anxiety in your patients, you can provide therapeutic care as a nurse by suggesting meditation and yoga. Meditation and yoga is viewed quite positively and is practiced often in the South Asian community since it originated in India. Additionally, meditation and yoga have been shown to have a wide variety of psychological benefits and are widely accepted forms of treatment.
Every patient is different. As a nurse, you may come across an 80-year-old woman who just immigrated to the United States from Pakistan, or you may come across a 17-year-old boy who has parents from India but was born and raised in the United States. The care you provide for the first patient will be quite different from the care you provide for the second patient. Although both of these patients are technically classified as South Asian, their values, belief systems, and practices will vary drastically. While there may be some overlapping values between the two patients, use your clinical judgment to tailor your care to the specific needs of each patient.
Divya Kulshreshtha recently received her BSN from Columbia University. She was inspired to pursue a career in nursing after her father was hospitalized and has since done volunteer medical work in Kenya. In the future, she hopes to work with underserved populations and be involved with international health.