Sikhs: Inpatient Care
For a Sikh, life in general – and human life in particular – is one of the greatest of God's gifts and should be treated with respect. This places a duty on a patient to seek treatment for any illness, disease or infirmity they suffer; God is merciful and benevolent, but Sikhs have a duty to make an effort too.
Sikhism originated in the Punjab region of North India, and still retains some of the traditional cultural practices found across Asia. For example, although men and women are considered to be equal by Sikhs, in public the genders are segregated as far as possible to ensure that they are not distracted from more important business. Both men and women have a great deal of quiet modesty, and prefer to remain as covered up as possible when in public.
If possible, men and women must be placed on separate wards, use separate changing rooms in clinics and have as little contact with each other as possible. Where it is not possible to place a Sikh on a single-gender ward, then try to put them on a side ward or into an area where they will be surrounded by their own sex. Only in an emergency is it acceptable for a Sikh to be placed on a mixed ward.
As with many Asian religions, Sikhs have high standards of personal hygiene. They prefer to use running water for washing, and so if a shower is not available (or the patient is not able to use the shower), a bowl and jug of water is an acceptable alternative. Sikhs will wash their face and hands before eating and after using the toilet. They will also use running water to wash themselves after using the toilet in preference to using toilet paper. Both men and women will wash their hair on a regular basis, using conditioner to keep it smooth and glossy. Men will also wash and condition their beards regularly. Patients may need help with their ablutions, in particular hair washing.
Meat that has been prepared in a ritualistic way for another religion is taboo for Sikhs, and will not be eaten. Although there is no specific rule about not eating other meats, many Sikhs will be vegetarian and may not even eat fish or eggs. Ask your patients whether they would prefer to have vegetarian meals during their stay in hospital. If hospital policy and the patient's medical condition allows, it may be best to permit the friends and family of the patient to bring in food for them; in this way, the patient will be eating familiar foods and also retain some links with their community.
Although alcohol is taboo for Sikhs, there is no problem with taking medication that contains traces of alcohol as long as the intention is not to intoxicate. Older Sikh patients may feel ambivalent about taking pain relief, believing that pain and suffering can be useful lessons to learn from.
Despite not having a holy day of the week, or restrictions on behaviour during specific festivals, Sikhs spend a lot of time in meditative contemplation of God. They wake early and clean themselves before spending time meditating on the name of God. Prayers taken from the wide variety of the writings of the Gurus are recited. During the day, a patient might read from the Adi Granth or other texts, and they will pray again in the evening and before retiring to bed. Before each of these prayers, Sikhs will wash themselves and dress in clean clothes if necessary. A patient may need help to get washed or dressed, and male Sikhs may need a hand to remove and retie their turban (which has to be done at least once a day).
Sikh patients may also play tapes of holy music (keertan) during the day; if this disturbs other patients, suggest the patient uses a pair of headphones. Small, 'in-the-ear' headphones are likely to be best as other types may not fit over turbans.
visitors and family
Any Sikh patient staying in hospital or visiting a clinic will receive plenty of visitors or be accompanied by a family member or friend. Caring for and visiting the sick is a religious duty that is enthusiastically taken up by the Sikh community, and a patient will often be overwhelmed by food and little gifts during their illness. It is important to monitor the situation and make sure a patient does not become over-tired by the visits, or that they do not disturb other patients.
Family members will expect to be consulted about the diagnosis and treatment of a relative, and to take a major part in their care whether at home or in hospital. It is important that they are consulted about treatments; a patient (especially an elderly Sikh or a woman) may refuse to be treated if their family does not agree with the procedure. Discuss care plans with the patient and their family to establish what healthcare staff will have to do, and what tasks can be performed by family (feeding and grooming may be best left to family members while healthcare staff carry out medical tasks).
This subject is covered in more depth in the section on 'physical examinations'. Essentially, both men and women from the Sikh community will try to remain as covered up as possible even during an examination. They would also prefer to be examined by a member of staff of the same gender as themselves unless there is no other choice. It is a good idea to allow a chaperone (for example, husband, wife, family member or friend) to stay in the room during an examination as this may help the patient to feel more relaxed.
preparation for surgery
When preparing a Sikh patient for surgery, two issues may need to be discussed with them. The first is what clothing can or cannot be worn in the theatre. Will the patient be allowed to keep on their turban, or will they have to remove it and replace it with a theatre cap? Will they be allowed to keep on their kacchera under their gown, or will these too need to be removed? The patient will need to be assured that care and respect will be shown to their clothing.
The second issue is the removal of body or other hair from the operation site. Wherever possible, it would be best simply to clean the operation site and not to remove hair, but of course this approach is not always possible. It is imperative that you discuss this issue with the patient. If they agree to hair removal, they may wish to have the hair returned to them so that they can dispose of it themselves.
For a non-Amritdhari Sikh, one of the most treasured possessions they will have with them in hospital is a copy of the Guru Granth Sahib. Always ask permission before touching this book, and make sure you have washed your hands before doing so. If possible, wear disposable gloves when touching it, or wrap the book in a clean cloth. The book must never be placed on the floor or close to someone's feet (this includes putting it down at the foot end of a bed).
For a baptised Sikh, there is the addition of the five Ks to take care of. A male Sikh has to tie a new turban every day, and may need help with this. Before touching the cloth, make sure you wash your hands. Treat all of the possessions of a Sikh with great care and keep them safe if the patient has to remove them. Never place any of them on the floor or next to someone's feet; this is considered to be a great insult.