+ General Country Information
+ History
+ Concept of Time
+ Family and friends
+ Gender
+ I or We Attitudes
+ Manners and Taboos
+ Spiritual care
+ Communication Style
+ Greetings
+ Language and Communication
+ Non-verbal Communication - Eye contact
+ Non-verbal Communication - Gestures
+ Non-verbal Communication - Personal Space
+ Attitudes and understanding of dementia and other health issues
+ Attitudes to end of life care
+ Attitudes to pain
+ Attitudes to residential care
+ Care information
+ Cultural Activities
+ Cultural Traits
+ Food and Diet
+ Music
+ Special Days - Christmas
+ Special Days - Easter
+ Special Days - New Year
+ Special Days - Other
+ Superstitions

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Generalist

  • Nepal is located in the continent of Asia.
  • Kathmandu is the capital of Nepal.
  • Nepal shares land borders with two countries; China and India.
  • Nepal ranks as the 94th largest country with a total area of 147,181 square kilometres (Central Intelligence Agency n.d.).
  • Nepal is thickly populated. The total population of Nepal in 2011 was 26,494,504 (Central Intelligence Agency, 2011).
  • There are over 40 different races and tribes in Nepal.
  • The major ethnic groups of Nepal include; Chhettri 16.6%, Brahman-Hill 12.2%, Magar 7.1%, Tharu 6.6%, Tamang 5.8%, Newar 5%, Kami 4.8%, Muslim 4.4%, Yadav 4%, Rai 2.3%, Gurung 2%, Damai/Dholii 1.8%, Thakuri 1.6%, Limbu 1.5%, Teli 1.4%, Sarki 1.4%, Chamar/Harijan/Ram 1.3%, Koiri/Kushwaha 1.2%, other 19% (Central Intelligence Agency, 2011).
  • The Nepalese population consists of three broad categories including; Indo-Nepalese, Tibeto-Nepalese and Indigenous Nepalese.
  • Nepal is comprised of extreme regions, such as the Tarai (or flat river plain) in the south and the central hill region (including the Himalayas) in the north.
  • The climate is variable with cool summers and severe winters in the north, and subtropical summers and mild winters experienced in the south. Summertime in Nepal is also the monsoon season so the weather is hot and wet at times.

Tips

  • Understand that a person’s country of birth does not define their culture. Whilst we are “born into culture” we are not “born with culture”. A person’s “culture” is something that is learnt from our environment and by our individual experiences. It continuously adapts to our changing circumstances throughout our lives.
  • Determine what culture or cultures your care recipient identifies with.
  • Keep in mind that the culture in metropolitan areas varies with culture in rural areas and that culture in different regions within a country may also vary significantly.
  • Learn about your care recipient’s life history, and who they identify with, to determine their individual cultural traits. Document any significant details.
  • Understand how your care recipient’s culture informs their values, behaviours, beliefs assumptions, likes, dislikes and sensitivities.

Resources

Generalist

  • Nepalese people have a recent migration history in Australia, with the majority having arrived since 2006.
  • Nepal-born migrants came to Australia predominantly as skilled, sponsored or business migrants, or as students.
  • Many of the Nepal-born migrants have settled in metropolitan areas of New South Wales.

Tips

  • Determine exactly where your care recipient was born and where they lived. For example; was your care recipient born in Australia, or did they migrate to Australia? If they migrated, how and why did your care recipient migrate to Australia? What experiences and associations do they have of their home country? If they have lived in other countries; where have they lived? How long did they spend in other countries and what did they do whilst they were there?
  • Be aware and sensitive to any stress that may have been experienced as a result of their history (this may include; family separation, homesickness, conflict, depression and isolation).
  • The knowledge of a person’s history may assist with a better understanding of the care recipient as well as any associated psychological issues resulting from their past.
  • Understand how your care recipient’s culture informs their values, behaviours, beliefs assumptions, likes, dislikes and sensitivities and document any significant details.

Resources

Generalist

  • Nepal is defined as a “collectivist” culture. This means that Nepalese act primarily in the interests of the group (The Hofstede Centre).
  • Nepal has a low score of 30 on the Individualism versus Collectivism Index (IDV).
  • The index scale ranges from 0-100 with 50 as a mid-level. The low numbers indicate “collectivist” cultures, and high numbers indicate “individualist” cultures.

Tips

  • Identify and document if your care recipient is an “individualist” with an “I” attitude of self and immediate family, or a “collectivist” with a “we” or group attitude, or if they have both “collectivist” and “individualist” traits.
  • Allow for a “collectivist” person to feel the comfort of doing most things in a group setting and for an “individualist” person to have more opportunities for themselves.

Resources

Generalist

In Australia

  • The major religious affiliations of Nepal-born Australians are predominantly Hinduism and Buddhism.
  • A small proportion of Nepal-born Australians indicated that they do not have a religion or did not state a religion in the Census.

In Nepal

  • The main religions in Nepal are; Hindu 81.3%, Buddhist 9%, Muslim 4.4%, Kirant 3.1%, Christian 1.4%, other 0.5%, unspecifed 0.2% (Central Intelligence Agency, 2011).
  • Religion in Nepal is more than a set of beliefs and rituals handed from one generation to the next, but rather it is the foundation of the entire Nepalese society and way of life.
  • Nepal is famous as the only Hindu Kingdom (meaning the monarch must be a Hindu and Hinduism is the source of power in the country).
  • Caste (a ranking system) is part of Hinduism.
  • Nepal has a caste system based on ethnic and tribal lines. Some Nepalese groups refuse to accept the caste rankings put on them by others.
  • Hindus say prayers and make offerings (known as doing ‘puja’) to a range of dieties (Gods) at designated occasions, as well as at other times.
  • Buddhism in Nepal follows the Theravadan form.
  • Religious traditions include; animisim (the belief that animals, plants and inanimate objects have a spiritual essence) and shamanism (the practice of reaching an altered sense of consciousness to conduct healing at a spiritual level).
  • Belief in the supernatural, such as; ghosts, spirits and witchcraft is common amongst people living in rural areas in Nepal.

Religious Practitioners

  • Brahmin priests read scriptures at key events such as weddings and funerals, however many forms of Hindu worship do not require a priest.
  • Buddhist monasteries teach meditation and philosophy.
  • There is a Buddhist clerical hierarchy where the lamas (Buddhist teachers) hold the most influential positions. Monks and nuns, irrespective of religious rank, shave their head and wear maroon robes, and live a life of celibacy and religious observance.

General

  • Different cultures and religions have different expectations of care in regards to toileting, dressing and feeding.
  • Every culture and religion vary greatly in spiritual needs and this may impact on the acceptability of certain treatments and medications. Therefore, it is paramount to identify the care recipient’s religion and cultural background to appropriately address the supports and services required.
  • For further information, refer to Spiritual care resources.

Tips

  • Accept and respect that customs, religious and spiritual beliefs vary from one culture to another and that the beliefs of your care recipient may significantly differ to your own beliefs.
  • Utilise resources and attend training sessions to increase your own knowledge about different religious and spiritual beliefs.
  • It is useful to ask care recipients a range of questions such as; ‘what helps you cope in difficult times’ and ‘what is important to you’ to determine ways to enhance their care.
  • Be aware of the significance of spiritual needs to your care recipient. Identify and document their religious beliefs and spiritual needs such as; any special requirements regarding food, personal care, linguistic needs or religious impacts towards treatments and/or medication.
  • Identify and provide access to relevant religious literature, radio, TV, live stream services, DVDs and CDs.
  • Support care recipients to maintain religious networks and religious representation and facilitate outings to places of worship.
  • Acknowledge and observe days of religious significance to your care recipients in a culturally appropriate manner.

Resources

Generalist

  • The extended family is important to Nepalese.
  • It is common in Nepal, for a person to be called your Brother, Sister, etc. even if you are not related. 

The domestic unit

  • Joint family living arrangements (where sons live with their parents, wives and children) are highly valued amongst Hindu castes.
  • Older family members have authority over young, and men hold authority over women.
  • New daughters-in-law will generally have the lowest position within the household, where she will have some of the hardest work and criticism until she has children.
  • Older women have an influential presence within the household.

Kin groups

  • Kin groups are based on the paternal family. For example, a man belongs to the kinship group of his father. A woman adopts the kin group of her husband when they marry, however she will remain in contact with her family.
  • Marriages are usually planned to expand kinship networks and to strengthen social networks.

Tips

  • Be aware and sensitive to the fact that some people may have become separated from family for a range of reasons including; Stolen Generations, war, conflict, disaster or migration.
  • Families and friends from different cultures will have a different understanding of dementia and their expectation of care for their loved one may vary significantly.
  • Provide communication and information in accordance with their language and literacy level and facilitate all achievable care expectations.
  • Gain an understanding of the dynamics of your care recipient’s family and friends and engage with them whenever required/needed.
  • Ensure that roles in decision-making about care of the person with dementia have been clearly established and documented.
  • Research indicates that carers of people living with dementia experience greater strain and distress than carers of other people.
  • It is important to be sensitive to the feelings of shame and guilt that family members and friends may be experiencing.

“Family and friends” resources

  • A range of information to help support family and friends is available in the “Family and friends, resources” section below.

Resources

Generalist

In Australia

  • The main languages spoken by Nepal-born people in Australia at home are predominantly Nepali, English and Hindi.
  • The majority of Nepal-born people who reported that they speak another language at home (93.1%) indicated that they speak English very well or well. Whilst a small proportion, (5.4%) indicated they do not speak English well or they do not speak any English (Australian Bureau of Statistics 2011).

In Nepal

  • Nepali is the official language of Nepal.
  • A national census revealed that Nepali is the mother tongue for 44.6% of the population.
  • The term given to the languages used in Nepal other than Nepali is “national languages” (known as minority languages in other countries). There are approximately 123 national languages in Nepal used by a range of ethnic groups.
  • There is 40% literacy in Nepal (Nations online).

Tips

  • Being able to communicate effectively is crucial to the physical and emotional well-being of the care recipient.
  • Be careful not to underestimate or assume the communication capacity of a person with dementia.
  • Ensure that the care recipient has participation in decisions that affect them.
  • The words you use when speaking to, and about, a person with dementia matters. It is important to always use positive and enabling language and to not use words that may cause offense.
  • Ensure the health care and personal care plans and reviews identify and support the linguistic needs of your care recipient and their family.  Be mindful that linguistic considerations should include the care recipients’ menu choices, food services, their religious and spiritual needs, and their ability to participate in activities. Determine what language(s) they are able to speak, read and write. Communicate with them and provide information according to their language preference and literacy level.
  • Identify and record and health issues such as poor hearing, poor eyesight, dehydration or problems with dentures to ensure there is no miscommunication with your care recipient.
  • Be aware that most people with dementia will revert back to their native tongue and/or other languages they have learnt.
  • Care recipients should always be given the choice to use professional translators and interpreters. Provide professional translators and interpreters to your care recipients and/or to their family whenever they request the need, when the care plan is developed, when the care plan is reviewed and at any time when “informed consent” is required.
  • Care recipients often prefer to communicate with a care worker from their own cultural background therefore the use of bilingual staff or volunteers should be always be considered and provided whenever possible. The care recipient should however be given this choice rather than it be assumed that this is their preference.
  • Provide visual aids, use gestures and physical prompts, and learn and use key words in the person’s own language to improve communication during routine care and other simple service interventions.
  • Ensure that communication is adapted to the care recipient’s level of dementia and understand the importance of allowing more time for those in later stages to understand and respond to you.
  • Support your care recipients' individual choices by providing access to media such as radio, TV, live stream services, DVDs, CDs and books in their preferred language.
  • All staff and volunteers should undertake training in cultural awareness, appropriate communication and the correct use of telephone and on-site interpreting services.

Language and Communication resources

  • Refer to the “Language and Communication, Resources” section below for a wide range of information (including communication cards, signage, health information in community languages, etc.)
  • Translating and Interpreter contact details and other relevant information is available in the "Links, Translating and Interpreting" section. 

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • All Nepalese greetings generally begin with the saying “Namaste,” which means, “I salute the god/goddess in you”. This is said whilst the palms of the hands are pressed together near the chest.
  • Nepalese that are familiar with western customs may give a handshake after Namaste.
  • Handshakes are not commonly a firm grip.
  • Nepalese only use their right hand when shaking hands, (as the left hand is considered “dirty”).
  • Men avoid initiating a handshake with women and instead they wait for the woman to initiate the greeting. This is so they do not offend the woman, because, for example; Nepalese do not believe that it is appropriate to touch a married woman.

Tips

  • Start building trust and rapport from the first time you meet your care recipient. Ensure you correctly pronounce their name. Smile and speak clearly. Be respectful and make sure the care recipient understands you.
  • Establish and document how your care recipient prefers to be greeted. Take into account; formality, titles, preferred name(s), any different greeting expectations from different genders or from people from a different generation, and the way(s) they like and dislike to be greeted. 
  • Understand that a person with severe dementia will think that each time they see you during the day is for the first time. Therefore ensure that you greet them in an appropriate, friendly and caring manner each time you meet.

Language and Communication resources

  • Translating and Interpreter contact details and other relevant information is available in the "Links, Translating and Interpreting" section. 

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Nepalese people often tell the other person what they think the person would like to hear, in an attempt to be polite.
  • Answers to questions from Nepalese may not be direct, so it is best to be patient, consider the actions that follow their response, and then determine their meaning.
  • ‘No’ is considered a harsh response by Nepalese so that may be replaced with evasive refusals. For example; people may say ‘yes’, in order to please and keep harmony, without actually meaning it.
  • Instructions repeated several times can help with understanding.
  • Nepalese conversations may begin with direct questions that people from western countries may consider personal.
  • Sometimes emotions such as thankfulness are shown by facial expressions rather than verbal expressions. One should not assume that a Nepalese person is ungrateful because they have not said thank you.
  • It is common for people to be referred to by their family role such as; Dad, Mum, Sister, Brother, Uncle etc. even when referring to a friend’s parents, for example; it is common to say ‘Amaa’ (for mother) and ‘Buba’ (for father), not their first names.
  • It is considered rude, or impolite, for a male to compliment a female on her beauty, as this is generally perceived as flirting.
  • Swearing is rare, even amongst friends.
  • There is a strong concept of friendship and hospitality amongst Nepalese people. Once a friendship is established, it is assumed that one has the privileges of a friend, including personal favours, extended unannounced visits, and the ability to look at personal belongings.
  • If a Nepalese taps you whilst they are talking to you, they are trying to get your attention, in a Nepali friendship kind of way.

The Writing Systems of the Languages of Nepal

  • Local languages in Nepal are predominantly unwritten.

Education

  • Nepali is the official language used in the education system. Consequently, parents may choose to use Nepali more frequently than their local languages to ensure their children can interact at school.
  • The loss of local languages may be attributed to the lack of education in these languages, as well as a lack of written form of the languages and due to the policy of “One Nation, One Language” that was implemented between 1961-1990.

Tips

Care recipient

  • Identify the communication style of your care recipient.
  • Be aware that communication styles vary from one culture to another.
  • Realise that physical, sensory, psychological and social issues can impact on the ability to communicate effectively. Make a note of any that are relevant to your care recipient.

Care worker

  • To ensure that the care recipient can understand you avoid speaking too quickly or using slang, acronyms or jargon. Also try not to give too much information at one time.
  • Be aware not to use patronising speech or a demeaning tone as this can lead to a communication breakdown.
  • Remember than non-verbal communication such as body language is just as important as verbal communication. Ensure that your tone matches your body language to avoid miscommunication.
  • Be kind and caring in your communication with the care recipient. Remember the person with dementia has a lifetime of experiences and is a person with feelings, even though may have lost the capacity to think or behave like they used to.

Language and Communication resources

  • Translating and Interpreter contact details and other relevant information is available in the "Links, Translating and Interpreting" section. 

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Direct eye contact is usually appreciated by Nepalese, when speaking with people of the same gender.
  • Indirect eye contact is more appropriate between Nepalese people of different genders.

Tips

  • Determine and document if the care recipient prefers direct or indirect eye contact and if there are any different expectations from different genders or from people from a different generation.

Generalist

  • Pointing at someone is usually perceived as wishing ill upon them. To indicate the direction or to gesture at someone, an upturned hand can be used, or the chin can be lifted and say ‘over there.’
  • Unlike in other societies shaking the head from side to side usually means “yes” whilst nodding the head up and down means “no.”
  • Blowing your nose when other people are present, is considered rude. If you must do so, it is expected to be done quietly and preferably alone.
  • Spitting is commonplace, particularly from chewing Betel Leaf (known as Paan) or chewable tobacco (known as Khaine).
  • It is considered bad manners to lick your fingers, even if they have food on them.
  • Slurping is acceptable, and it is common for people to slurp tea and other hot drinks in public and at home.
  • Burping after a meal is also acceptable and is regarded as a compliment to the chef.
  • Meals are usually eaten with the hands, especially for the Nepalese dishes such as Dal Bhat and Tarkari.

Tips

  • Any gestures you use need to be respectful to the person with dementia.
  • Body language can provide important clues and increased understanding for both the carer and the care recipient. However many gestures have different meanings in different cultures therefore take care to ensure there is no miscommunication.
  • Document any gestures that the care recipient prefers to use or any gestures they find offensive.
  • Determine if the care recipient has expectations from different genders or from people from a different generation in relation to the use of touch. For example; if they find it appropriate/comforting for someone to hold their hand when they are upset or in pain.

Resources

Generalist

  • Personal space is important and an arm’s length or greater is expected, especially between men and women.
  • Physical affection is rarely displayed in public areas, however friends of the same sex commonly hold hands or may walk with their arms wrapped around each other, as a sign of friendship.
  • Touch during conversations is not commonplace and may be misinterpreted.

Tips

  • Determine and document how the care recipient feels about their personal space and if there are any different expectations from different genders or from people from a different generation.
  • Allow for a “collectivist” person (with a “we” or group attitude) to feel the comfort of doing most things in the space with others (group settings) and for an “individualist” person (with an “I” attitude of self and immediate family) to have opportunities to have personal space for themselves.

Resources

Generalist

  • Nepalese people are not generally punctual. Instead, they tend to practice flexibility with time.
  • It is common for Nepalese to run late in both social and business settings.
  • The term “Nepali time” means Nepalese run late to everything.
  • Public transport, including buses, taxis and planes, are  also renowned for being unreliable in regards to time schedules.

Tips

  • Determine and document how the care recipient and the family view “the concept of time”. For example; do they like to be punctual? Do they expect others to be punctual?
  • Ensure the care recipient's concept of time does not adversely impact on meal times, activities and other scheduled events.
  • Be mindful that shaming and blaming someone for being late can cause feelings of guilt and low self-esteem. Instead, use positive communication. For example; you might ask “Would a different time would be more suitable”?

Resources

Generalist

Global Gender Gap Index 2016 rankings

  • Nepal was ranked 110th on a global index measuring gender equality out of 144 countries. (World Economic Forum, Global Gender Gap Report 2016).

Division of Labor by Gender

  • Most Nepalese have specific labor role expectations based upon their gender.
  • Men generally plow and perform the heavier agricultural tasks, engage in trade, and undertake other work outside their village.
  • Nepalese women collect water and firewood, as well as fulfilling traditional roles as caregivers involving domestic duties (especially in rural areas).
  • Women tend to work longer hours and have less free time than men.
  • There are some women in urban areas that work in family businesses in roles such as a shopkeeper or seamstress, however their salaries are lower and their opportunities are limited.

Women

  • Women often consider themselves as being less important than men.
  • The ethnic group and caste of the person dictates the freedoms and opportunities available to women. Women who are in the highest castes have limited public mobility to ensure their reputation (which impacts upon the family caste and honour) is upheld.
  • Women in lower castes and classes may be involved in the workforce, and have more mobility, and can be more outspoken in the presence of men than those in higher castes.
  • Urban areas are more progressive with gender roles and employment and education opportunities for women are greater.

Inheritance

  • It is a legal requirement that fathers leave equal proportions of land to each son.
  • Daughters do not generally inherit parental property unless they are unmarried beyond the age of thirty-five.
  • Ideally, sons manage their father’s land together and the land is divided over generations.

Tips

  • For many people with dementia the gender of the care workers is important, particularly in sensitive situations. Determine and document if they have any preferences, concerns or expectations regarding care provided by someone of a different gender.
  • Accept and respect that male-female roles in families may vary significantly among different cultures.

Lesbian, gay, bisexual, transgender or intersexed (LGBTI) people with dementia

  • Don’t assume the gender preference of the person with dementia.
  • Recognise that even those that have children may not be completely heterosexual and understand that it could take some time for a care recipient to gain enough trust to share personal information about their gender preference.
  • Begin by evaluating yourself and any assumptions, phobias, biases or beliefs that you might hold internally.
  • Utilise resources and attend training sessions to increase your own knowledge about LGBTI people.
  • Understand the importance of your first and immediate reaction or response. Be aware of your own reactions - not only what you think, but also be aware of what you say and what body language you use.
  • Most LGBTI people have experienced rejection, stigma, discrimination and abuse and therefore have a fear of receiving inadequate treatment, being denied services or facing further discrimination or prejudice. It is vitally important to create a non-judgmental open and caring atmosphere free from discrimination. Confidentiality is also a vital aspect of care for LGBTI care recipients.
  • Be careful with the terminology you use to the care recipient and their partners.
  • Provide partners of LGBTI care recipients with the same respect and privileges that you would give to a spouse or relative.      

Resources

Generalist

World Alzheimer’s Day

  • Alzheimer associations around the world unite for World Alzheimer’s Day on the 21st of September, to make a difference for people with dementia and their families and carers worldwide.

Dementia in Nepal

  • There is a low awareness of dementia and a lack of understanding of how it can be managed.
  • Diagnosis and support services are limited.
  • Nepal has an ageing population that is predicted to grow faster than average, and whilst dementia is not a normal part of ageing, it affects more people at an older age.
  • There is a social stigma around dementia and even around having a relative with dementia. This can prevent people from seeking a diagnosis.
  • In Nepal, dementia symptoms are often hidden within the family, rather than seeking support and care for the person.
  • People often avoid marriage into a family where there is dementia.

Attitudes to mental health

  • Mental illness has a strong social stigma associated with it in Nepal. It is generally considered the same as being mad, and that the person is unfit to remain in society.
  • There is also often the belief that a person with mental illness is possessed by black magic or by a holy spirit.
  • Severe mental disorders usually means that the individual and their family are targets of stigma and discrimination. This can be to the point that there is hesitation in seeking support services.
  • The Nepali Constitution regards health as a basic human right, however it has been criticised for its exclusion and neglect of psychological care.

Tips

  • The amount of understanding and acceptance of dementia may vary significantly among different cultures, families and individuals. Determine the understanding of dementia of the care recipient and their family, if they accept dementia and if stigma is associated.
  • Provide information to the care recipient and their family according to their language preference and literacy level.
  • Ensure that people with dementia and their families are aware of dementia information and of support services available.

Dementia resources

  • A wide range of information is available in the Attitudes and understanding of dementia disability and illness, resources section below.
  • Contact details for Alzheimer’s Australia offices are available in the “Links, Alzheimer’s Australia offices” section of this app.

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • Nepal is a developing country and as such, health care facilities, hygiene, sanitation and nutrition are limited, especially in rural areas.
  • Limited resources means that hospitals in Nepal may require family members to tend to their family member whilst they are in hospital, including duties such as; cooking, washing, collecting and implementing medication and cleaning up after the patient.

Tips

  • The meaning or value of residential or community care may vary greatly among cultures.
  • Be aware that many people will not want to hear about or talk about residential care until crisis point.
  • Understand that families and friends from different cultures will have different expectations for the care of people, particularly in regards to toileting, dressing, feeding and other self-help skills.
  • Allow the care recipient and their family to make choices to suit the individual’s care needs.
  • Ask care recipients questions about what can be done to achieve quality of life and help them have meaningful lives that enable them to pursue their cultural interests and passions in accordance with any frailty, disability or cognitive impairment.
  • Understand and facilitate all achievable care expectations of the care recipient and their family.

Resources

Generalist

  • Some people from Asian cultures, especially those with Buddhists beliefs, may show stoicism when experiencing pain. This is due to the belief that behaving in a dignified manner is important, and that those who complain have poor social skills.
  • Maintaining harmony is important in many traditional Asian cultures, so although someone may feel pain, they may not make it obvious.
  • Making demands from people of high status, such as health care professionals, is also not common in many Asian cultures. This may prevent Nepalese people asking for pain medications or expressing their discomfort to doctors and nurses.
  • Pain behaviour studies suggest there is a need to be cautious of ethnic or cultural stereotypes. Therefore, even though there are findings of general cultural differences, it is considered very important to evaluate the pain of each person individually.
  • Clinical recommendations regarding pain treatment are available in the “Attitudes to pain Resources” section of this app.

Tips

  • Research indicates that pain and discomfort are frequently under reported and under treated amongst people with dementia.
  • Ensure care recipients and their family understand pain relief medication and treatment options by providing information in their preferred language and in accordance with their language ability.
  • Religion and culture may influence your care recipients pain experience including; their pain expression, pain language, remedies for pain, social roles and expectations and perceptions of the medical care system.
  • Understand that for some religious or spiritual beliefs, fate and/or karma may mean that your care recipient also believes their illness and pain are caused by a higher power.
  • Care recipients may feel it is important to accept their pain in order to demonstrate their religious / spiritual faith. This may also impact their request for pain medication and treatment.
  • Identify and support the cultural and religious impact on the acceptability of certain treatments and medications.
  • Identify, respect and document how your care recipient and their family view and express pain.
  • Pay particular attention to verbal expressions of pain during later stages of dementia and ensure adequate treatment is provided.

Resources

Generalist

  • Reincarnation is a belief shared by both Hindus and Buddhists. How a person behaves in their life impacts upon their reincarnation to their next life. The goal in both religions is to act admirably in life to attain enlightenment, and stop the cycle of rebirth.
  • In Hindu tradition, the body is cremated. Where possible, cremation is performed on the banks of a river.
  • The son of the deceased customarily performs funeral rights.
  • Buddhists may also cremate bodies of the deceased. More traditionally, some Buddhists perform ‘sky burials’ whereby pieces of the corpse are left at sacred sites for vultures to carry away.

Tips

  • Understand that attitudes to end of life care, death and dying are diverse and may include a range of factors such as cultural and religious beliefs.
  • Be aware that the acceptance of certain treatments and medications are likely to be impacted upon by cultural and religious factors.
  • Identify and support “end of life choices” of care recipients and their family. Note: these are formally known as “Advanced Care Directives” or “Advanced Care Planning” depending on the state or territory in Australia that you are in. Ensure their choices are documented and strictly followed.
  • Ensure the linguistic needs of care recipients are addressed in end of life religious and spiritual support.
  • Ensure family members have access to appropriate resources and support in their preferred language and in accordance with their language ability.

Resources

Generalist

  • In many Asian countries the left hand is used for toileting and therefore only the right hand should be used for; giving, receiving, drinking and eating.
  • Hindus are sensitive about people who do not belong to their caste or religion touching their food.
  • Wait to be served, to ensure you do not offend.
  • Leftovers should not be served if anyone has had a bite or sip of it.
  • A water container may be shared within a Nepali household, however, when drinking people will avoid it touching their lips on the container.
  • Shoes should be removed before entering a temple, and if shoes are left outside a home one should follow suit.
  • Feet should never be placed on furniture.
  • It is considered rude to point at your feet or soles of your shoes at people.
  • One of the most humiliating forms of punishment is a shoe beating as contact with shoes is degrading.
  • If your feet accidentally touch another person, respect may be restored by tapping the person’s shoulder and then your forehead.
  • Public displays of affection between genders are highly discouraged.
  • Yelling in anger is considered poor form.

Key etiquette considerations in Nepal include:

  • Respectful dress. For example; women should wear long skirts that cover their legs and men should always wear a shirt and never be seen topless. Dressing inappropriately is considered extremely rude and disrespectful.
  • Avoid bargaining. Prices should not be contested as it is rude and offensive.
  • In Nepal, waste should be burnt as a sign of good etiquette (as there is a problem with waste in Nepal).
  • Prayer walls should be passed on the right and donations should be left if you visit a monastery.

Tips

  • “Manners” and “taboo” expectations and beliefs may vary greatly among cultures resulting in differing emotions and behaviours in your care recipient.
  • Be aware of your own beliefs and expectations of “manners” and “taboo” beliefs and how these may differ to those of your care recipient.
  • Be aware of judging other people's behaviour, expectations and beliefs according to the standards of your own culture.
  • Be aware that the care recipient may judge your behaviour according to the standard of their own culture.
  • It is important to recognise, accept and document individual interpretations of “manners” and “taboo” expectations and beliefs of your care recipient and their family.

Resources

Generalist

Nepal is a very superstitious country. Some common superstitions include:

  • The number three is an unlucky number so for example; if three people need to leave from the same place, they will leave one by one rather than at the same time.
  • People pray before travelling. It is common for bus drivers to have photos of Hindu goddesses, as well as incense and bells, and to conduct prayers before their first drive of the day.
  • Before leaving for a long journey from home, a senior family member will give you a sip of yoghurt and/or a red tika (coloured powder) on your forehead. The day of travel is also surrounded in superstition and the highly suspicious will only leave on specific days of the week.
  • Hanging dried red chili is believed to offer protection against bad spirits.
  • Shoes and sandals are placed the right way up because placing them upside down is believed to bring bad luck.
  • Babies should not be complimented on their health or weight, as there is a belief that this will cause them to fall sick afterwards.
  • One should never criticise the job of a priest, even if they do not agree with it.
  • It is considered an insult to the Hindu Goddess of Food to drop rice (especially cooked rice) on the floor and walk on it.

Tips

  • Superstitions may be considered as old wives’ tales, family traditions or have a significant meaning and be taken seriously.
  • Be aware of your own beliefs and how these may differ to those of your care recipient.
  • Be aware of judging other people's superstitious beliefs according to the standards of your own culture.
  • Be aware that the care recipient may judge your beliefs according to the standard of their own culture.
  • It is important to recognise, accept and document individual interpretations of superstitious beliefs.

Resources

Generalist

  • Nepalese cuisine is usually hot, spicy and nutritious.
  • Original Nepalese food includes Newari and Thakali cuisines, however Nepalese food also has Indian and Tibetan influences.
  • Rice is central to the Nepalese diet and most people will eat a large serve of rice at least twice a day.
  • Rice is often served with dal (a lentil dish) and tarkari (a cooked vegetable dish). The meal may also include a pickle achar (which is made of a fruit or vegetable).
  • Dhiro (a thick mash made of corn or millet) is the staple in areas where rice is scarce such as high altitude areas as well as in the poorest regions.
  • Roti (a wheat based flat bread) may be eaten in place of rice in areas where wheat is plentiful.
  • Momo (a South Asian dumpling) is a favourite amongst many Nepalese.

Dining Etiquette

  • Diets are often linked to caste. For example, the high-caste Hindus are strictly vegetarian and do not drink alcohol, whilst other castes may drink alcohol and eat pork and some even eat beef.
  • Rules regarding whom one may eat with and whom one can accept food from are also dictated by caste. For example, people of a higher caste may be reluctant to eat food prepared by strangers. As a result, dining out has not been a traditional part of Nepalese culture.
  • Caste rules are gradually being relaxed to meet the modern world and the tourist industry.
  • Hospitality is important. Food is always offered to guests and they are not permitted to assist with meal preparation or clean up.
  • Meals are usually eaten from individual plates.
  • Some Nepalese use utensils, however most eat their food with their right hand whilst seated on the floor.
  • Upon completion of the meal, hands are thoroughly washed prior to touching anything else.
  • Always accept the offer of food and drinks.
  • When drinking from a communal container the rim of the container must not touch the lips.

Tips

  • Food is an important aspect of cultural identity, therefore it is important to identify food preferences, likes and dislikes including eating habits, meal times, preferred setting, preferred eating utensils etc.
  • Identify and facilitate cultural food when possible and ensure the impact of religion on food services is documented, adhered to and regularly reviewed.
  • Provide menu choices and food services information in the preferred language of care recipients, or with pictures if the person has difficulty reading. 
  • Consider alternative ways to facilitate culturally appropriate food such as; obtaining recipes from family/friends, specific meal delivery services, community groups, seniors’ clubs, or and/or other clubs.
  • Ensure that the care recipient is given food choices throughout all stages of dementia.

Food and diet resources

  • A wide range of information (including religious food requirements, nutrition information and recipes) is available in the “Food and diet resources” section below.

Advice and Support

  • Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.

Resources

Generalist

  • A person-centred care approach helps organisations provide accessible, responsive and flexible services that meet the diverse needs and preferences of people living with dementia in our community. 
  • Many people with dementia want to remain independent for as long as possible and rely on the community care system to help them achieve this.
  • For most Nepalese, illness is thought to be both physical and spiritual.
  • There are food associations such as foods that should be eaten or avoided, associated with all types of illnesses.
  • Other illness signs and symptoms may be associated with witchcraft and the “evil eye”.

Medicine and Health Care in Nepal

  • Poverty, poor hygiene and a lack of health care results in poor health of the Nepalese people, where life expectancy is significantly lower than in more developed countries.
  • Hospitals are only available in the urban areas of Nepal and they are often poorly equipped and unhygienic.
  • Some western biomedical practices are available in Nepal, however most Nepalese are unable to afford this health care.
  • Shamans (a person with access and influence in the world of spirits, that practices healing and predictions typically in a state of trance) and other religious practitioners, may be sought for treatments.
  • Ayurvedic medicine (which considers illness a result of imbalances in the bodily humours) is common. Treatments include correcting the imbalance, usually by diet.
  • Health clinics in rural areas often lack in resources such as health practitioners, supplies and medicines.

Tips

  • Identify and document the care needs of your care recipient and continuously re-evaluate how their dementia progression affects their care needs.
  • Make every effort to understand a dementia behaviour before attempting to manage it, as you will often discover that what lies behind it is a genuine attempt to communicate an unmet need.  

Care information resources

  • A wide range of information is available (e.g. personal hygiene, sleeping, incontinence etc.) in the “Care information, resources” below.
  • Advice and Support - Seek advice and support from the Dementia Behaviour Management Advisory Service (DBMAS) if required – phone 1800 699 799.
  • Employee/employer resources - A range of information is available under “Links – Other useful weblinks”.

Resources

Generalist

  • Music, religion, literature and architecture form the basis of culture in Nepal.
  • Religion, music and languages are unique amongst the different ethnic groups.
  • There are a number of unique cultural groups including; Ahir, Newars, Tharu, Yadav, and others.

Symbolism

  • Nepal has many significant symbols, particularly from Hindu and Buddhist sources.
  • The ancient signs such as the Hindu swastika and Shiva's trident can be seen on buses, trucks and walls.
  • Symbols such as a tree, plow and the sun are used to designate political parties.
  • The national flower (the rhododendron), a bird (danfe), the Nepalese flag, the plumed crown worn by the kings, and the crossed kukhris (curved knives) of the Gurkhas are important national symbols.
  • Images of the royal family are commonplace in homes and in places of business.
  • A garden with different types of flowers is a metaphor used to symbolise national unity amongst cultural diversity.

Social hierarchy

  • Castes and class status were originally in line with one and other and those of the highest castes would hold the most land, capital and political influences, whilst those in the lowest castes could not own property or receive an education.
  • Distinction by castes is not supported by law anymore however caste and ethnic groups are still often identifiable by style of dress, traits and ornamentation.
  • The upper castes remain the wealthy and politically dominant, whilst those in the lowest castes are still the poorest sector of society.
  • The Hindu caste is the national “prestige culture”.
  • Land remains the principal measure of wealth. Castes that have specialist trade and commerce have fared better under modern capitalism than landowning castes.
  • The changes in economic and political systems have created better opportunities for members of the historically disadvantaged castes.

Tips

  • Everyone has “culture”. This includes a number of factors such as ethnicity, identity, age, gender, education, sexual orientation, ability/disability, values, beliefs, attitudes etc.
  • Recognise your own cultural traits and influences and be mindful not to judge other people’s behaviour and beliefs according to the standard of your own culture.
  • Be aware that your care recipient may judge your behaviour and beliefs according to the standard of their own culture.
  • Your care recipient may be “similar to others” but “no two people are the same” so take care not to generalise or make assumptions about them. Gain general cultural information from resources to assist with conversations to allow you to identify your care recipient’s individual cultural traits.
  • Understand and document how your care recipient’s individual cultural traits impact their care needs.
  • Increase your knowledge about different cultural practices and issues through resources, cultural background information sessions and/or cultural awareness training.

Cultural Traits resources

  • Find information (such as guides and cultural profiles created by other organisations) in the “Cultural Traits, resources” section below.
  • You will also find information including; links to community contacts, cultural profiles, useful weblinks etc. in the “Links” section of the app.

Resources

Generalist

  • Easter is not generally celebrated in Nepal, unless the person is Christian.

Tips

  • Understand the importance of Easter to your care recipient and accept and respect that customs and beliefs about Easter are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • Christmas is not generally celebrated in Nepal, unless the person is Christian.

Tips

  • Understand the importance of Christmas to your care recipient and accept and respect that customs and beliefs about Christmas are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • New Year is celebrated by Nepalese people.
  • Nepalese New Year’s Day, based on the lunar calendar ‘Nepal Sambat’, usually falls on the second week of April.
  • New Year is known as ‘Navavarsha’.
  • It is a time centred on religion and New Year is observed with deep respect and devotion. Early morning involves prayers and worship in temples to make Puja (a ritual devoted for the gods). Following Puja, people walk around the temple in an anti-clockwise direction as they ring bells.
  • New Year is a major festivity in Nepal when the country rejoices, colourful ornaments are displayed, and traditional games and sport are held.
  • New Year celebrations also include; parades, street dances, and reunions.

Tips

  • Understand the importance of New Year to your care recipient and accept and respect that customs and beliefs about New Year are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • Nepalese people follow the lunar calendar and therefore the dates of many of their special days vary year to year in accordance with the calendar.
  • Children’s Day

Marks when Nepal signed the UN Convention on Children’s Rights.

  • Constitution Day

Marks the date of the implementation of the Constitution.

  • Martyrs’ Day

Observes the memory of the four martyrs that sacrificed their lives to establish democracy in Nepal. Celebrations may last for seven days in some cities.

  • Democracy Day

Marks the end of the Rana rule and the day when Nepal became a democracy.

  • Loktantra Day

Marks the day when the King returned the state power and independence was given to the people.

  • Education Day - 8th September

Celebrating those who have contributed greatly in the field of education.

Tips

  • Understand the importance of any significant days to your care recipient and accept and respect that customs and beliefs about special days are different from culture to culture.
  • Identify, document and support any spiritual/religious needs of your care recipients.
  • Identify, document and facilitate any dietary requirements.

Resources

Generalist

  • Activities Nepalese seniors usually enjoy include; stretches, low impact exercises, meditation and group games.

Reminiscence 

  • Smell or taste - Using smell kits, different cultural foods. Suggestions include; Coriander, Cinnamon, Cloves, Ginger, Nutmeg and Turmeric.
  • Sight - Cultural Photographs, Slides, Films, Painting pictures, looking at objects. (Refer to the “Cultural activities resources” section for some visual ideas).    
  • Touch - Touching cultural objects, feeling textures, painting and pottery. Pampering, massage hands, etc. if it is considered culturally appropriate by the care recipient and they trust you to do this without being intrusive
  • Sound - Personalised playlists, listening to familiar music, C.D's, YouTube, listening to cultural performances, or making music using various instruments. (Refer to the “Music resources” section for some music ideas).

Tips

  • It is important to understand your care recipient’s activity likes and dislikes and their personal history to plan appropriate activities for them.
  • Your care recipient should be provided with a choice of activities to participate in.
  • Participating in suitable activities can help a person with dementia to achieve purpose and pleasure, help to improve their mood, responses, memory function, increase social interaction, sleep, improve verbal and non-verbal communication and restore a sense of identity. Activities also play a significant part in increasing the person’s wellbeing and confidence which will decrease responsive behaviours or ill-being.
  • It is important that activities are suitable to the level of ability of the person with dementia. People with dementia should be encouraged to participate as independently as possible and be given the choice to participate or to watch others.
  •  Always talk to the person’s doctor before starting them on a new exercise program and ensure the program designed for them takes into account their current health and ability.
  • Alzheimer’s Australia SA, local council libraries or community organisations may be able to loan suitable cultural activities such as music, games, videos etc.

Cultural activity resources

  • For cultural activity information and ideas refer to the “Cultural activities, resources” section below.
  • For local community contact details refer to the “Links, Community Contacts” section of this app.

Resources

Generalist

  • Music is a key component of every event in Nepal and it is an integral part of their life and culture. This includes; births, marriages, festivals and national festivities. For example; rice planting (‘Ropain’) is a significant event in Nepal, and it is always accompanied with song and dance.
  • Traditionally, there are castes of Nepalese known as ‘Damais’ and ‘Gaines’ whose role in life is to play musical instruments and sing for a range of functions and celebrations.
  • Folk music is popular in Nepal.
  • The ethnic diversity of Nepal brings with it musical instruments and dances that are unique to the various ethnic groups, such as ‘Lakhe’ dance of the Newars and ‘Rodi’ the dance of the Gurungs.
  • It is uncommon for Nepalese women be seen playing a musical instrument.

Tips

  • Music is the most powerful universal language.
  • Music provides an external rhythm and can restore a person back to themselves, and to others, at least for a while.
  • People tend to remain contactable as musical beings on some level right up to the very end of life.
  • It is important to understand your care recipient’s music likes and dislikes and to provide them with their choice of music to listen to.
  • Create a personalised music playlist for your care recipient for their maximum benefit and enjoyment.
  • Provide opportunities for the person with dementia to watch live music performances.
  • Providing music a person relates to can have a wide range of benefits to the care recipient. Benefits may include; helping to improve their mood, responses, memory function, increase social interaction, improve verbal and non-verbal communication and restore a sense of identity.

Resources