“Seva with Akal Purkh’s Grace”
The purpose of this chapter is to present the foundations of the Sikh tradition that inform health practices and issues of ethical concern, with the aim of providing guidance to health care professionals who care for Sikh patients, or who themselves are Sikh. The ethical constructs of justice and selflessness are strong for the Sikh, and are rooted in the code of conduct that orchestrates the life of the Sikh follower, whether in India or in one of the diasporic Sikh communities found around the world.1 The chapter begins with an overview of the Sikh religion, including the sociopolitical context in which the religion originated 500 years ago, and the location of Sikh communities around the world today. After outlining key tenets of the faith as developed by the 10 Gurus, the chapter proceeds to provide the link between these foundations and present Sikh practices that relate to health care and nursing ethics. Findings from a Canadian study conducted with South Asian women’s perceptions of respect within a clinical setting will be used to illustrate how women from this population experienced respect when in relationships with health professionals.2
Currently, there are 20 million Sikhs in the world, most of who live in the Punjab region of India. The Sikh diaspora has spread over England, Australia, United States of America, and Canada, with the majority of migration taking place over the period of 1940–1980s.3
Guru Nanak Dev Ji founded the Sikh religion in the 15th century with the belief in Ek Ong Kar (one creator) who is Nirankar (without form). A succession of 10 Gurus, each named by the former Guru himself, established the core tenets of the Sikh faith. Collectively, the 10 Sikh Gurus acknowledged themselves as human beings with the capacity and wisdom to share the universal teachings of the one creator. They gave the Sikhs spiritual, social, economic, and political guidance during the period of 239 years from the 1st to the 10th Guru. Table 13.1 provides an overview of the Gurus and their individual contributions in the creation of the Sikh religion. In the Sikh tradition, the title Guru is extended beyond the Hindu understanding of a wise, authoritative, and knowledgeable person who guides others. In Sikhism, a Guru includes understanding or knowledge imparted through any medium.
Further understanding of the Sikh religion is offered by the symbolism embedded in the Khanda. This Sikh emblem speaks to how a Sikh will conduct his or her life within the realms of moral and ethical responsibilities to the self, family, community, and humanity at large (see Table 13.2).
This symbol represents Sikhism as a religion based on the integrative individual identity of the constructs of miri and piri that correlate to the “warrior and saint” philosophy of the religion.4 The moral authority of the warrior includes acts of social justice and being a competent protector, and the saint as the compassionate healer. The warrior and the saint connectedness bring the togetherness as a whole person who is a learner, a seeker, and is striving to achieve balance or harmony.
Sikh virtues and ethics are taught by Sri Guru Granth Sahib Ji (SGGSJ), the holy book of Sikhs. To quote the holy teachings:
Virtues are Priceless and are not for sale for any price at any store.
O Nanak, their weight is full and perfect.5
Five moral virtues form the ethics of the Sikhs namely kindness/compassion (daya); righteousness and morality (dharma); courage (himat); selfconfidence, organization (mokham); and nobility and grace (sahib). These virtues have a historical significance from the Amrit ceremony of 1699 by Guru Gobind Singh Ji when the five beloved (panj pyare) names of the first five initiates to the khalsa corresponded to these virtues.6 Building on these virtues, the khalsa code of conduct (Rehat Maryada) is held as core to the faith: not cutting one’s kesh (hair); refraining from meat, alcohol, and other stimulants; remaining celibate until married and maintaining a monogamous relationship with one’s spouse; respecting all other women as mothers, daughters, or sisters according to their age; and committing to naam simran (daily meditation and prayers).7 Seva (volunteering for humanity) and simran (meditation) guide the service to community and the importance to seek connection to Guruji and the Universal God. The five inner moral virtues that a Sikh is to refrain from are lust, jealousy, greed, attachment, and anger. Quoting from the SGGSJ:
TABLE 13.1 Sikh Gurus and Their Contributions
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It is through reflection that awareness; mind and intellect are created and formed.
The seeker develops discrimination and differentiation of evil from noble.8
The warrior–saint teachings are reflected in the bana and bani, which are central to the moral teachings of Sikhism. The bani symbolizes the baptized Sikh’s inner self that signifies the ethical values and virtues that a Sikh person embraces.9 The bani involves the recitation of kirtan, which is the singing of shabads or sacred hymns in a complex musical structure.10 Guru Nanak Dev Ji, the first Guru introduced the daily practice of the recitation of a collection of five banis (prayers) in the ambrosial hours after taking a bath, rehraas sahib (evening prayer) at dusk (before dinner), and kirtans Sohila (night prayer) before bed. Bana symbolizes the baptized Sikh’s outer dress code that signifies the moral and ethical code of conduct, which a baptized Sikh abides by and is referred to as the five Ks:
Kesh (uncut hair, usually tied and wrapped in the Sikh Turban, dastar. A symbol of saintly qualities).
Kanga (wooden comb, usually worn under the dastar. A symbol of cleanliness).
Kachhera (characteristic shorts, usually white in color. A symbol of chastity/sexual morality).
Kara (iron bracelet, which is a symbol of eternity, strength, and restraint. A reminder of the Sikh’s bond with the Guru).
Kirpan (curved sword, from 1 to 3 feet in length. A symbol of justice and protection).
As with other religious communities, especially those with histories of migration, a range of diversity exists within Sikh communities. Sikhs today have migrated from various parts of the world, bringing with them the cultural and traditional practices of their previous homeland. With migration, they may adapt cultural nuances of the new social environment while retaining the foundational code of conduct and principles of Sikh religion. Stereotypical notions of all Sikhs observing the same traditional and cultural practices need to be understood from the individual perspective.
Along with migration, another variation within the Sikh community pertains to baptism. Sikhs are baptized in the Gurudwara (temple) at any age, with similar rituals as the first baptism of the khalsa that was performed by Guru Gobind Singh Ji in 1699. Sikhs who take the Amrit (baptism) commitment aspire to the highest level of self-discipline and dedication to SGGSJ. Being baptized also involves following a strict dietary, dress, and social khalsa code of conduct of Sikhism. Adherence to the bana, the outer dress code, and bani, the recitation of SGGSJ, strengthens one’s inner morals and ethics. A compilation of daily prayers are found in the Gutka (small book of holy prayers), which Sikh patients may carry with them. Because the practice of the daily prayers is a part of the code of conduct and the Gutka is a holy book, the Sikh patient will want to prepare for these prayers with cleanliness and to place the Gutka in a clean space. In this practice, nurses will need to respect the Gutka by providing a clean place for it and handling it with clean hands.
However, not all Sikhs are baptized. The last names of Singh and Kaur, originally indicating baptism, are now used by many non-baptized Sikhs as well. It is therefore important to confirm with the patient if he or she is baptized since the nurse will have to care for the patient accordingly to facilitate religious observance. A Sikh could abide by all the five visible outer dress code Ks and not be a baptized Sikh. In fact, almost all Sikhs wear the Kara (steel or iron bangle). It is important to respect the religious observations of all Sikh patients; however, it is even more critical for a nurse to ask the patient or his/her family about their religious requirements. There is much diversity among the subgroups of this population, and therefore nurses must go beyond dress and outer appearance to avoid making assumptions.
In view of the Sikh ethics outlined above, the topics that we have chosen to focus on—selfless service, karma cycle and fate, treatment decision making, and respect in the contexts of the profession of nursing and gender more generally—are germane to the social relational context of health care services and nursing practice in any setting, whether clinical or community nursing practice.
The principle of selfless service (seva) is voluntary, intertwined with community unity, and is a large part of the underlying philosophical principle for Sikhs; it is the moral and social ethical duty of being a Sikh. The concept of seva is also the underlying motivation for the Sikh individual to choose the nursing profession. Serving humanity, and thus a fellow human in need of health care, speaks to the mindset of the nurse.
This concept of service to the community, inclusivity, and equality for all is the Gurudwara, the door of peace, door of livelihood, door of learning, and the door of grace, which are always open to the community, regardless of denomination, race, caste, sex, or religion for food, rest, and shelter at any time. The sense of the Gurudwara as the anchor to the individual and community is actualized when the hospitalized patient’s family have prayers conducted at the Gurudwara along with other community members.
Gurudwara is not only the place of worship, as other religious places of worship, but is also the place of social, economic, political, and community gatherings for the individual and their families and encapsulates the philosophy of humanitarism and selflessness of Sikhism. It is the temporal place where the warrior and the saint identity come together to integrate the warrior and saint principles of faith by acquiring spiritual knowledge and wisdom and to provide care for the sick, elderly, and handicapped. The Gurudwara is also a place for discussing problems facing the Sikh community. Infringement of the Sikh code of discipline may be considered and suitable seva decided upon by the panjpyare (five baptized leaders, either male or female).11
Communitarianism is valued over individualism in the Sikh tradition.12 This value has implications for moral agency in contrast to the individualistic ethical and humanistic responsibility that presides in Western cultures. For nurses, this may mean that they have to advocate for families at visiting hours, in the palliative ward or the intensive care unit, because the patient may receive condolences from the community at large.
The philosophy of universality is practiced in the Sikh community to provide service (seva) and monetary contributions (dasvandh) in local and global communities. These principles form the basis for daily prayers and earnings—where a 10th of one’s 24-hour day and earnings shared with the community. To illustrate the enactment of these principles, we draw on recent examples from Canada.
The case of Mr. Libar Singh, a Sikh from Punjab, India, who was a visitor to Canada in 2007–2008, exemplifies the Sikh sense of community and justice.13 Singh was paralyzed when he suffered a stroke during his stay in Canada. Because he would ultimately receive better medical attention in Canada, he sought refuge at the Gurudwara where he was cared for by the Sikh community. His supporters were concerned about visits by Canadian Border Services Agents to the Sikh temple where he sought sanctuary. The community at large became involved in supporting his cause. In 2008, 11 cities across Canada participated in actions, delegations, and events in solidarity with Mr. Laibar Singh, demanding that the Canadian Border Services Agency (CBSA) and Minister Stockwell Day respect Mr. Laibar Singh’s sanctuary, and that Mr. Laibar Singh be granted permanent residency. Across Canada, protesters showed their solidarity, inspiring mobilizations, led by the South Asian community.
The Sikh community residing in Surrey, British Columbia, Canada has together donated their time and money to fund the expansion of the Surrey hospital, which will serve one of the largest Sikh communities in Canada. “For three years in a row, the South Asian community has shown its generosity through the radiothon fundraiser for Surrey Memorial Hospital,” said Red FM owner Kulwinder Sanghera, who is also a board member at Surrey Memorial Hospital Foundation. “This was a very moving experience to witness the number of people who came together to give generously. What a powerful show of generosity,” says Foundation President/CEO Jane Adams. “We saw children donating piggy banks, businesses joining forces to give, and families contributing what they can.”14
Also exemplifying the moral concepts of seva and dasvandh, here expressed in global humanitarianism, the Sikh community, the Gurudwara, and three South Asian radio stations in the Metro Vancouver area raised $1.5 million in donations and pledges for victims of the Haitian earthquake.15 In these ways, the teachings of Sikhism regarding universality and communitarianism provide clear guidance for service for the individual as well as for local and global communities.
The notion of karma and rebirth is important for the Sikh patient, with ramifications for nursing ethics. This is visible in the fundamental idea that each person is repeatedly reborn so that his or her soul may be ultimately purified and eventually join the divine cosmic consciousness.16 In fact, the belief that what a person does in each life influences the circumstances and predispositions experienced in future life; therefore, action, thought, or behavior whether good or evil, leave a trace in the unconsciousness that is carried forward into future lives17 and translates into the practice of ethical principles and actions that a Sikh strives for in life. As we read in the SGGSJ, “Those who understand the Lord’s Court, never suffer separation from him. The True Guru has imparted this understanding. They practice truth, selfrestraint and good deeds; their comings and goings are ended.”18
Sikh women diagnosed with breast cancer in a study conducted in Canada accepted suffering related to the psychosocial impact of breast cancer as a part of life, as part of the karmic cycle and of fate.19 Most Sikh women in this study believed that suffering and pain are things that every human being goes through. One woman explained:
We all want God to look after us and keep us healthy, it is our fate, but we have to do our part. God listens to us as we go through this life and we are reborn after this life depending on how we have been in this life. We are all part of the same God
Whatever was in my karma, if after giving pain god gives us happiness, even then whatever happens, happens, what would I get by shouting it out to everyone and crying about it, it is our suffering.20
Religion and fatalism went hand in hand for some of the women, both older and younger, because of the high value they placed on doctors’ advice and their strong belief in God.21 Such beliefs seemed to form a contextual part of these women’s previous health care experiences. Both for participants who were English speaking, and for those who were non-English speaking it seemed important that, although they believed that God and their own fate might play a part in their cancer conditions, their belief in God alone would not get them through the cancer condition.
Women related their personal belief in fatalism and God to the importance they placed on their relationships with health professionals. Some women felt nurtured by health professionals who were attentive and listened to their stories unconditionally while caring for them during their clinical visits.22 On the other hand, some of the women’s previous health care experiences in Canada included receiving unclear explanations about their illnesses, and perceptions of being “brushed off” by some physicians.23 They stated their physicians did not always take the time to provide them with information needed to explain their symptoms, but rather referred them to yet another specialist. Women suggested that some health care providers stereotype South Asian women, assuming most do not speak English and know little about their health care. Previous unpleasant health care experiences with a few health care providers left some women untrusting and uncertain about accessing health care in the future.
Suffering may be considered a part of health and illness and of the karmic cycle of birth, death, and rebirth.24 This will also reflect on the concept of death and dying. A Sikh understands that it is the physical body that perishes and the spirit or soul is undying. This concept is elaborated during the Amrit ceremony where the body, mind, and soul are offered to the Guru. This practice of the philosophy encourages the nurse to be present for the family at the time of imminent death of a patient and to provide space for the Sikh family to perform kirtansohila (prayer for bed time), ardas (formal prayer), and hymns for a peaceful journey of the soul.
The concepts of communitarism and karmic cycle come together to influence treatment decisions for the Sikh patient and family, especially in light of the extended family. It is common practice for the Sikh family to provide family members with social support and financial security. The concept of extended family as community extends to the honor given to the elderly and extended family connectedness provides help and support to elders of the family. When the patient is intimately integrated with his or her extended family and community, a holistic approach to ethical consent is required. This concept of communitarism goes hand in hand with selflessly serving the needs of the family and community.
The following quote from the Canadian study illustrates the caregiving role of the family.25 The excerpt also illustrates the influence of the notion of karmic cycle/fate on treatment decision making, and the family’s involvement. It also exemplifies how, despite the concept of communitarianism and the involvement of the extended family, there are situations where the practical realities of work mean that the extended family cannot be presumed to provide care to their loved one.
I didn’t tell my sons for two weeks, then my daughter called me after two weeks and said “mummy, have you told your sons?,” and I said, “no, daughter, why should I tell anyone, even my sons of what problem I have.” My daughter then phoned my son and told him that in two weeks mummy is going to have her surgery. My son came out crying from his room and hugged me and said, “Mummy, you have such a big problem, and you didn’t even tell us?” I said, “What was there to tell, whatever was in my karma will happen, if after giving pain god gives us happiness, even then whatever happens, happens, what would I get by shouting it out and crying?” He then called my other sons, who were at work and they all came home and were crying and I was consoling them. My sons said, “You are consoling us and you are suffering.” I said “Son, if mother starts to cry, then what would happen to the children?” After the surgery, I had to stay at home alone since everyone has to work. Two weeks after the surgery, I got up and bathed by myself, cooked for myself, ate by myself because everybody was working.26
This example emphasizes the need for nurses to pay close attention to the detailed discharge assessment because the patient might be left alone to take care of themselves, even in an extended family.
Abide in truth and contentment, O humble Siblings of Destiny.
Hold tight to compassion and the Sanctuary of the True Guru.
Know your soul, and know the Supreme Soul; associating with the Guru, you shall be emancipated.27
In research with South Asian women, ethical care was understood as the conjoining of respect and competency.28 These two values of the health professional–client relationship can be understood as mapping back to the warrior and saint principles as the balance between the competent protector and compassionate healer. Sikh women being treated for cancer experienced respect as being friendly accepting one for whomever the person is being helpful and giving space to be. They stated that everyone is a human being, so therefore we have to be civil to each other, talk to each other with politeness, and treat each other well. This bears its roots from the Sikh code of conduct, or Rehat Maryada, which describes the relationship of Sikhs as being respectful of the other, regardless of gender. Fears of being in the “patient role” were alleviated as Sikh women felt their expectations of respect being granted during their relational experiences with health professionals who acknowledged their basic human emotions.29 The following example describes Sikh woman’s experiences of being vulnerable but felt that the health professionals’ approach created a “safe” place in a strange environment while she was going for her first X-ray session:
Respect is when any human being has come over to your home to visit; you should talk to them with politeness and kindness. You talk with love, and acknowledge them, regardless of who comes to your home. I always talk to everyone with respect because they are all human beings. I want others to speak to me in the same way as well. I am so afraid inside sometimes, especially when they did the x-ray the first time, but the nurses and therapists were very kind and stayed on both sides of me and told me that it was going to be all right. They told me not to be afraid and told me that they were together with me and that they were there for me.30
In some instances the patient may refer to the nurse as “daughter” or “son” or “sister” or “brother”; the nurse may refer to the patient as “auntie” or “uncle.” Upon taking the Amrit, a Sikh commits to respecting one as daughter, sister, mother, son, brother, or father as appropriate to the age of the person, reflecting the universal and community connection and respect.
The importance of respect is underlined in two recent Canadian examples where nurses cut the beards of Sikh clients without taking into account the Sikh prohibition against cutting hair.31 This prohibition relates to the historical sacrifice of Bhai Taru Singh, a Sikh martyr, who agreed to have his scalp removed rather than having his hair cut. This principle of sacrificing for humanity without giving up one’s faith forms the identity of a Sikh, as Kesh (hair) is one of the five K’s. By application, the Sikh patient will need an explanation for any medical procedures that might require cutting, trimming or shaving hair. It is crucial that the nurse seek prior permission by informing the Sikh patient or family in order to provide information and prepare the Sikh patient for what needs to be done, rather than assuming that cutting hair is acceptable. A patient’s reluctance to certain medical procedures must be interpreted as a prompt to understand the moral code of conduct for the patient of Sikh faith.
Spiritual hero, who fights for the principle, is recognized.
He may be cut apart, piece-by-piece, but he never leaves the battlefield.32
As an individual of Sikh faith, the nurse brings the concept of community and seva into the health professional–client relationship, especially when providing care for the patient who may need interpretation of language and more information for procedures. The Sikh nurse will also bring the principles of caring for elders and an understanding of how to interact respectfully, regardless of the patient’s ethnicity as illustrated by the following excerpt from the study with South Asian in relationship with health professionals in a clinical setting.
The Indian nurse who is there she speaks to me in my own language and is very kind and calls me “aunty” and I feel good because it is respectful to me when she calls me “aunty” whereas the other nurses call me by my name which is the way that the other nurses and therapists call me because it is the normal way to do for them.33
In a different vein, Reimer-Kirkham describes the ambiguities of intra cultural interactions when nurses who spoke Punjabi were placed at a disadvantage and burdened with extra work when they were called upon to translate for Sikh patients.34 Sometimes these nurses chose to downplay intra-group connections (e.g., as in the case of a nurse who chose not to reveal her ability to speak Punjabi to South Asian patients in order to avoid extra demands on her time).
Equality is very apparent in the Sikh scripture; the first Guru brought this notion into the foreground as one of the principles of the religion (as mentioned earlier in Table 13.1). During the Amrit ceremony, the Sikh is addressed as gender neutral and the Rehat Maryada (the Sikh Code of Conduct and conventions) guides men and women. Traditionally, women may prefer a female physician and vice versa for men when being examined; however, this is not a mere preference, but arises from modesty which is embedded into the Sikh woman/man’s cultural and spiritual upbringing, as part of the social, ethical, and moral conduct of respect for the other woman/man who is not your spouse.
In cases of domestic and sexual violence, it is important for the nurse to be aware of the possible difference among Sikh women and children. Violence is not condoned in the religion as the equality and respect of women are primary tenets of the faith. In the cases of domestic violence, it is important to note the cultural and social implication of such situations. The role of the family may be critical and decisions will have to be made by the woman based on her needs and safety. The risk assessment will have to be considered in approaching the issue of questioning or assuming what the woman needs. It will be important to involve the women in any decisions that are required. Often, the community resources of community-based victim service workers and interpreters will play a critical role.
In sexual assault cases, it is not to be assumed that the woman will want her family or spouse informed without her consent. The implications of such decisions are often based on the woman’s social, educational, and cultural beliefs. It has to be approached with safety of the woman as priority. The cultural belief that sexual assault will bring shame and blame to the woman and her family needs to be recognized. All women, irrespective of religious beliefs experience shame, blame, and guilt when subjected to such crimes.35
This chapter on Sikhism, nursing, and ethics has underscored the complex factors at play when English-speaking health care providers within the mainstream health care system provide health care to diverse ethnic populations, and how language is not the only barrier that most health care professionals as well as Sikh patients have to overcome. Although addressing the language barrier and use of interpreters are pivotal aspects of institutional health policies and guidelines, there are humane ways of providing respectful care for the individual. Recognizing the individual for his or her personal life experiences as someone who has not only mastered his or her own language along with an understanding of English, but is a person with his or her own values can foster respect within health professional– client relationships. This strategy of recognizing the individual with his or her own standpoint and acknowledging his or her social identity bestows respect for the individual’s religion, social identity, location, and life experiences that he or she brings to the health care relationship. This respectful care allows individuals to be seen for who “they are” as human beings, not as stereotypes of a particular “other” ethnic group. The nurse shares humanity with the “other” people and creates respect by acknowledging the others’ identity and personal life experiences, which will inform how they journey through the illness experience. Understanding the ways in which people’s responses to health and illness are shaped by their religion, beliefs, and values can help health professionals adapt their practices to be more responsive to specific groups.
In conclusion, in the context of today’s diverse societies, all nurses, regardless of their personal belief system, need to be self-aware and attuned to the influence of their own world view. The nurse’s responsibility is to create a healing environment for the patient and the family by being critically conscious of any personal biases while respecting and accommodating the values and beliefs of the patient and family.
1. Nayar, Kamala E. The Sikh Diaspora in Vancouver: Three Generations Amid Tradition, Modernity, and Multiculturalism. Toronto: University of Toronto Press, 2004.
2. Singh-Carlson, Savitri, Anne Neufeld, and Joanne Olson. “South Asian Immigrant Women’s Experiences of Being Respected within Cancer Treatment Settings.” Canadian Oncology Nursing Journal 20.4 (2010): 188–92.
3. British Broadcasting Corporation. “Religions. Sikhism.” Web. 9 Aug. 2011. www.bbc.co.uk/religion/religions/sikhism/.
4. Siri Singh Sahib Bhai Sahib Harbhajan Singh Khalsa Yogiji. Originally published in Beads of Truth. 1.35 (Summer 1977). http://www.sikhdharma.org.
5. Ad Sri Guru Granth Sahib, M 1, p1087, cited in Singh, Jodh. “Ethics of the Sikhs.” Understanding Sikhism – The Research Journal, January-June 7.1 (2005): 35–38.
6. Puri, Shamsher Singh. Sikh Philosophy and Spiritual Life. National Book Shop, USA: Delhi and Academy of Sikh Studies, 1999.
7. Ibid.
8. AGGS, Jap 13. 3, cited in Singh, Jodh. “Ethics of the Sikhs.”
9. Singh, Gurbachan. The Sikhs: Faith, Philosophy and Folk. New Delhi, India: Lustre Press Pvt. Ltd., 1998.
10. Sikh Ragas. SikhiWiki. 2004. Web. 9 Aug. 2011. http://www.sikhiwiki.org/index.php/Sikh_Ragas.
11. Gurdwara – The Sikh Temple. Search Sikhism. nd. Web. 9 Aug. 2011. http://www.searchsikhism.com/temple.html.
12. Coward, Harold, Tejinder Sidhu, and Peter A. Singer. “Bioethics for Clinicians: 19 Hinduism and Sikhism.” Canadian Medical Association Journal 163.9 (2000): 1167–1170.
13. No One is Illegal. “Report Back: National Days of Action in Support of Laibar Singh: No One Is Illegal.” Feb. 08 2008. Available at http://noii-van.resist.ca/?cat=41.
14. Surrey Memorial Hospital Foundation. “South Asian Community Surpasses $2 Million Fundraising Goal.” Media release November 2, 2009. Available from http://www.smhfoundation.com/cms/page1672.cfm.
15. Canadian Broadcasting Corporation. “B.C. Sikh Community Raises $1.5M for Haiti.” Available from http://www.cbc.ca/news/canada/british-columbia/story/2010/01/22/bc-vancouver-surrey-sikh-haiti-donations.html#ixzz0pixHvYej.
16. Coward, Harold, Tejinder Sidhu, and Peter A. Singer. “Bioethics for Clinicians: 19 Hinduism and Sikhism.”
17. Ibid.
18. Singh, Jodh. “Ethics of the Sikhs.” Siri Guru Granth Sahib Ji, M 3: 1234.
19. Gurm, Balbir Kaur, Joanne Stephen, Gina Mackenzie, Richard Doll, Maria Cristina Barrotavena, and Susan Cadell. “Understanding Canadian Punjabi-speaking South Asian Women’s Experience of Breast Cancer: A Qualitative Study.” International Journal of Nursing Studies 45 (2008): 266–276. See also: Singh-Carlson, Savitri. “South Asian Immigrant Women’s Perceptions of Respect within Health Professional-Client Relationships While Journeying through Cancer.” Unpublished doctoral dissertation, University of Alberta, Edmonton, Alberta, Canada (2007). See also: Singh-Carlson, Savitri, Anne Neufeld, and Joanne Olson. “South Asian Immigrant Women’s Experiences of Being Respected within Cancer Treatment Settings.”
20. Singh-Carlson, Savitri. “South Asian Immigrant Women’s Perceptions of Respect within Health Professional-Client Relationships While Journeying through Cancer.” 91.
21. Gurm, Balbir Kaur, Joanne Stephen, Gina Mackenzie, Richard Doll, Maria Cristina Barrotavena, and Susan Cadell. “Understanding Canadian Punjabi-speaking South Asian Women’s Experience of Breast Cancer: A Qualitative Study.” See also: Singh-Carlson, Savitri. “South Asian Immigrant Women’s Perceptions of Respect within Health Professional-Client Relationships While Journeying through Cancer.” See also: Singh-Carlson, Savitri, Anne Neufeld, and Joanne Olson. “South Asian Immigrant Women’s Experiences of Being Respected within Cancer Treatment Settings.”
22. Singh-Carlson, Savitri. “Creating Informal Support within the Clinical Setting.” Canadian Oncology Nursing Journal 19.3 (2009): 136.
23. Singh, Savitri W. “An Exploration of South Asian Women’s Experiences Following Abnormal Pap Smear Results.” Unpublished Masters Thesis, University of British Columbia, 2002.
24. Coward, Harold, Tejinder Sidhu, and Peter A. Singer. “Bioethics for Clinicians: 19 Hinduism and Sikhism.”
25. Singh-Carlson, Savitri. “South Asian Immigrant Women’s Perceptions of Respect within Health Professional-Client Relationships while Journeying through Cancer.”
26. Ibid., 130
27. Singh, J. “Ethics of the Sikhs.” Siri Guru Granth SahibJi 1030.
28. Singh-Carlson, Savitri, Anne Neufeld, and Joanne Olson. “South Asian Immigrant Women’s Experiences of Being Respected within Cancer Treatment Settings.”
29. Singh-Carlson, Savitri, Anne Neufeld, and Joanne Olson. “South Asian Immigrant Womens’ Experiences of Being Respected within Cancer Treatment Settings.”
30. Singh-Carlson, Savitri. “South Asian Immigrant Women’s Perceptions of Respect within Health Professional-Client Relationships While Journeying through Cancer.” 106.
31. Apology Issued after Nurse cuts Sikh’s Beard. CBC.ca CBC, 24 Mar. 2010. Web. 9 Aug. 2011. http://www.cbc.ca/news/canada/british-columbia/story/2010/03/24/bc-sikh-beard-cut-fraser-health.html.
32. Singh, J. “Ethics of the Sikhs.” Siri Guru Granth Sahib Ji Kabir, 1105.
33. Singh-Carlson, Savitri. “South Asian Immigrant Women’s Perceptions of Respect within Health Professional-Client Relationships While Journeying through Cancer.” 150.
34. Reimer-Kirkham, Sheryl. “The Politics of Belonging and Intercultural Health Care.” Western Journal of Nursing Research 25.7 (2003): 762–780.
35. Detailed information on the short and long-term impact of sexual assault and domestic violence on women and the services are available at www.endingviolence.org.
