Scholarly article on topic 'Traditional and Religious Death Practices in Western Turkey'

Traditional and Religious Death Practices in Western Turkey Academic research paper on "Sociology"

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Asian Nursing Research
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{"attitude of health personnel" / "attitude to death" / nurse}

Abstract of research paper on Sociology, author of scientific article — Zuhal Bahar, Ayşe Beşer, Fatma Ersin, Aygül Kıssal, Nihal G. Aydoğdu

Summary Purpose To investigate death-related traditional and religious practices in Narlıdere, a district of Izmir province in Turkey. Methods A descriptive design was used (n = 181). The interview form was composed of 28 open-ended questions. The data were collected through face-to-face interviews by the researchers. Descriptive statistics and chi-square significance test were conducted. Results Of all the participants, 36.5% described death as the end of life. Praying took place first among the religious practices following death. A total of 42.0% said that relatives and friends who joined the burial ceremony shovel some soil into the pit over the corpse in order to express that they would not claim any rights from the deceased person thereafter, and 55.2% stated that they visited the deceased person's home to give social support to his or her relatives. Conclusion We recommended that nurses and physicians be closely acquainted with the prevailing traditions and religious beliefs in the communities where they served.

Academic research paper on topic "Traditional and Religious Death Practices in Western Turkey"

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Asian Nursing Research

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Research Article

Traditional and Religious Death Practices in Western Turkey

Zuhal Bahar, PhD, RN, Ay§e Be§er, PhD, RN,* Fatma Ersin, PhD, RN, Aygul Kissal, MSc, Nihal G. Aydogdu, PhD, RN

Faculty of Nursing, Dokuz Eylul University, Inciralti-Izmir, Turkey

ARTICLE INFO

Article history:

Received 15 December 2011

Received in revised form

30 July 2012

Accepted 1 August 2012

Keywords:

attitude of health personnel attitude to death

SUMMARY

Purpose: To investigate death-related traditional and religious practices in Narlidere, a district of Izmir province in Turkey.

Methods: A descriptive design was used (n = 181). The interview form was composed of 28 open-ended questions. The data were collected through face-to-face interviews by the researchers. Descriptive statistics and chi-square significance test were conducted.

Results: Of all the participants, 36.5% described death as the end of life. Praying took place first among the religious practices following death. A total of 42.0% said that relatives and friends who joined the burial ceremony shovel some soil into the pit over the corpse in order to express that they would not claim any rights from the deceased person thereafter, and 55.2% stated that they visited the deceased person's home to give social support to his or her relatives.

Conclusion: We recommended that nurses and physicians be closely acquainted with the prevailing traditions and religious beliefs in the communities where they served.

Copyright © 2012, Korean Society of Nursing Science. Published by Elsevier. All rights reserved.

Introduction

Islam is the world's fastest growing religion, predominantly in southeast Asia. Traditional Islam is a way of life in which an individual devotes himself or herself entirely to Allah and follows Allah's basic rules in every part of life from business matters to personal matters such as relationships, dress code, hygiene, and death (Kirkpinar, 2001). Every religion or culture has its own views and perspectives regarding traditional concepts and normal behaviors. Recognition of the culturally and religiously different meanings of some of these key concepts is very useful for health professionals who serve in community health settings (Smith & Maurer, 2000).

Death is not only a biological phenomenon but also a sociocul-tural event with resultant behaviors, ceremonies, and beliefs (Thomas, 2003). Preparing for death, burial practices, and bereavement behaviors are some of the most important transition periods of life. A variety of traditional and religious practices are observed in almost all cultures. Cultural differences exist within Turkey and in the world in terms of death-related traditional and religious practices. In general terms, knowing these practices is of crucial importance in order to evaluate whether mourning and any

* Correspondence to: Ayse Bejer, PhD, RN, Dokuz Eylul University, Faculty of Nursing, 35340 Inciralti-Izmir/Turkey.

E-mail address: ayse.beser@deu.edu.tr (A. Bejer).

other reaction (especially after the death of a close or beloved person) displayed after a loss are "normal" and "natural". The available studies provide information concerning the preparation of the deceased for funeral and the funeral and burial practices.

Literature review

The following paragraphs focus on preparations of the body after death, the funeral ceremony, and mourning practices. The majority of the literature review is on death rituals and practices in Turkey where the primary religion is Islam.

Bathing the dead body

Most Jewish and African American people regard preparing the body for the funeral as a sign of respect. The body is bathed and prepared in accordance with the directions given by family members. Relatives of the dead person may prefer a haircut, clothing, and shrouding. Asian Indian people use crocuses and rub the body. They also burn frankincense to avoid evil spirits (Lobar, Youngblut, & Brooten, 2006).

In Buddhism, there are no special practices related to the care of the body. Buddhists from different countries perform their own traditions regarding the care of the body. Local traditions also determine whether the body is buried or cremated (Open University, 1992).

1976-1317/$ — see front matter Copyright © 2012, Korean Society of Nursing Science. Published by Elsevier. All rights reserved. http://dx.doi.org/10.1016/j.anr.2012.08.003

Burial

A common belief is that if the burial is delayed, the deceased person may be late for giving accounts of his or her deeds in the Hereafter. Polish, West Indians, and African Americans usually do not bury the deceased until all family members arrive, while Jewish people believe that burial should take place within 1-2 days of their death (Lobar et al., 2006; Purnell & Selekman, 2008).

Funeral ceremony

In African American, Jamaican cultures, and some Protestant religions, pregnant women and children are not usually allowed to attend funerals because it is believed that the dead body may release toxic substances. In the East Indian culture, wives are discouraged from attending their husbands' funerals (Lobar et al., 2006). In Christianity in certain regions, it is customary to hold a prayer ceremony in the house of the deceased before the funeral. According to Orthodox and devout Roman Catholics and some Anglicans, the funeral involves a church service with Mass or Communion. The body is sometimes taken to the church for 1 night; the casket remains open throughout the service in Orthodox funerals. Protestant traditions are simpler and the body is usually kept in a closed casket. In Buddhism, a ceremony may take place in the house of the deceased for 3-7 days before going to the cemetery or crematorium (Open University, 1992).

Mourning practices

In Christianity, there is not a generally accepted mourning period or mourning dress code but memorial and thanksgiving ceremonies can be held several months after the funeral. In Buddhism, practices show a great variety according to the country of origin. For instance, Sri Lankan Buddhist mourners may return to work in 3-4 days, and there are no religious restrictions for widows (Open University, 1992). Mourning in Orthodox Judaism continues with shiva for 7 days during which time the bereaved remains at home and friends visit them. The mourning dress code is in effect until the 30th day after the death while recreational and amusement activities are forbidden for a year (O'Gorman, 1998; Purnell & Selekman, 2008).

Turkish practices

There is a limited number of studies regarding the religious and traditional practices observed in Turkey after the death of a person. In this section, information is provided regarding Turkish customs and traditions, and death-related Islamic beliefs and practices . Behavioral patterns that the public adapts in all regions of Turkey show similarity with Islamic traditions. However, in western Turkey, there are no studies on the traditional and religious practices regarding death. Existing studies state that there are differences in the aim of making traditional and religious practices from region to region (Albayrak & Arici, 2007; Bas^etin^elik, 2001; Keskin, 2003). For example, in some regions, closing the eyes of the deceased is carried out so that the deceased shall not go with their eyes open. However, in other regions it is practiced so that the deceased shall not take anyone after them. Another study from eastern Turkey states that there are seasonal differences in the burial process. In hot months, the deceased is bathed and buried right away so that he or she will not stink because of the hot weather. Moreover, the belief that "if the burial is delayed, the deceased may be late for giving accounts of their deeds in the Hereafter" is common. It is stated that "if the dead is buried right after, they can answer the questions in the grave rightly." Studies

conducted in Turkey so far reveal that death-related practices are generally associated with bathing, dressing the dead body with a shroud and burying it.

Blindfolding and tying up the jaw of a dead person. Studies carried out on Caferis (people who belong to one of the two great religious sects of Islam and who regard Ali as the first Imam and consider him and his descendants as the rightful successors of Islamic prophet Muhammad) living in eastern Turkey have indicated that the deceased are blindfolded so that they rest in peace. Their jaws are tied so as to prevent the jaws from dropping and looking ugly (Albayrak, 2006; Albayrak & Arici, 2007; Tapucu & Aksoy, 2004).

Wrapping the corpse with a shroud and placing it on the bed. According to Islamic principles, the right side of a dead body should point to Qibla, the direction of Kaaba, which is located in Mecca, birthplace of Muhammad and the direction a Muslim faces while praying. Children are not allowed to enter in the room where the dead person lies and the lights are kept on in that room (Keskin,

2003). Certain practices such as keeping the lights on in the house where the funeral is so that "the dead shall see the house lighted" and cooking Helva so that "the dead shall like the smell" these practices are done to prevent the evil part of the deceased from entering the house in traditional Turkish beliefs (Albayrak & Arici, 2007). In addition, a cup containing some flour, salt, and sugar is put on the body or on the bedside to help the person acquire merit in God's sight (Keskin; Tapucu & Aksoy, 2004; Yildiz, 2007).

Bathing the dead body. The body is directed toward Qibla and bathed in a room or in the garden. Perfumed soap is used so that the body smells nice before the angels (Keskin, 2003; Tapucu & Aksoy,

2004).

Burying the body. As stated by Bas^etin^elik (2001), it is widely believed that if the burying of the dead is delayed, the deceased would be late for giving accounts of all their deeds in the Hereafter. In Turkish culture, dead people are buried as soon as possible. While dead people are being buried, the 36th sura (section) of Quran is recited. If the dead is a maiden or a newly married woman, a red wreath is put on top of the grave. If the dead is a young man or a soldier, the flag of the country is raised.

Traditions performed after burial. Money is distributed to the poor in order to lessen the sins of the deceased and to pay for the fasts that they could not observe and prayers that they could not perform (Tapucu & Aksoy, 2004). In a study by Albayrak and Arici (2007), a dessert made of flour is cooked immediately after the funeral so that the dead can smell it. All women present in the house can help with the cooking. During cooking, the 112th sura of the Quran is recited three times and the first sura of Quran is recited once for the spirit of the deceased. Throwing away the shoes of the deceased is believed to relieve the distress suffered in the grave.

Lamentations. According to Akbaba (2008), following the funeral, people go to the house of the deceased, recite suras from the Quran and lament for the dead. People wail. Laments are sung in the house and people who are wailing stop wailing to listen to these laments. The people who wail are called bozlayci, while laments are called bozlav.

Condolences. People offer their condolences to the spouse, children, relatives, and friends of the deceased. Offering condolences is a widespread tradition and a way of commiserating with the relatives of the recently deceased on their grief, deep mental anguish, and misfortune. People who offer their condolences pray to God. Neighbors, relatives, and other people who come to express their condolences usually bring food. Nothing is cooked in the house of the deceased during condolences (Albayrak & Arici, 2007; Keskin, 2003).

Mourning period. Relatives of the deceased do not have a haircut or shave during mourning, which may last for 40 days if

the dead person is young. They do not wear fancy dresses, watch TV, talk loudly, or laugh. They only talk about the positive characteristics of the dead person. Wedding ceremonies, engagement ceremonies, and circumcision ceremonies are not held for 40 days (Albayrak & Arici, 2007).

These death-related practices help people accept the death of their beloved ones and help alleviate grief. Social support is of great importance for people in bereavement. Although these practices vary from one region to another, the aims are the same. Expressing the sadness resulting from the death of a beloved person plays an important role in mental health. Therefore, religious and cultural practices should be identified (Oltjenbruns, 1998; Yick & Gupta, 2002). Identifying these practices and determining their aims will help health professionals understand the community and facilitate adaptation to death. Health professionals should collect data about death-related cultural features of individuals, be aware of differences among individuals, offer culturally congruent care and obtain resources for social support (Clements et al., 2003; Lobar et al., 2006).

Social support plays an important role in the coping process. If health professionals know whether factors such as age, education, and income have an effect on death-related religious and cultural practices, it may be easier for them to assist with the coping processes. Healthcare providers cannot possibly know all the specific mourning rituals and traditions within each family and culture; however, understanding some basic principles of how different cultures may prepare for and respond to death is important. Individuals and families should be considered as a source of knowledge for their special or cultural needs and norms. However, healthcare professionals are sometimes at loss as to what to ask under such trying circumstances. There is a limited number of nursing studies regarding death-related practices in Turkey and in the world (Lobar et al., 2006; Ross, 2001; Tapucu & Aksoy, 2004). Religious and traditional practices about death show varieties in the same society and different regions. While providing care, nurses should be sensitive to the religious and traditional practices of individuals. They will gain this sensitivity when they become aware of both their beliefs and cultural practices and those of the individuals they look after. It is important for nurses to know the reactions of individuals towards losses such as death, as well as their methods of mourning and coping. Nurses can help individuals overcome these processes in a healthy way and plan interventions aimed at their pathological conditions by increasing social support. When the nurses recognize the beliefs and practices of individuals regarding death and support the positive behaviors, this will enable the individuals to overcome this process in a healthier way and accept the loss. The aim of this study was to identify death-related traditional and religious practices performed in a Western province inTurkey where most of the people emigrated from other parts of the country. We are interested in addressing the question of what are the traditional and religious practices performed after the death of a person.

Methodology

Research design

This descriptive study was conducted in a western province of Turkey where the School of Nursing at Dokuz Eylul University provides public health services. No study has been done here on this subject. This region has been selected to use the obtained results in services to be provided and for ease of transportation.

Sample and setting

Sampling was selected as described by the World Health Organization for surveys (Bahar, 1988; Rothenberg, Labanov, Singh, &

Stroh, 1985). Sample size was not counted as the World Health Organization determined the sample size as 210 for field surveys. There were 570 streets in 10 districts in this province. Streets were numbered on the basis of data from the district administration. Thirty streets were randomly selected. A total of 210 people, 7 from each street, were included in the sample. However, 29 of these 210 participants elected not to participate in the study; thus, 181 (86.2%) individuals were interviewed in Turkish. In Turkish society, women who do not work spend their time at home during the day and death practices are usually performed by women; thus, the sample consisted of only women, all of whom were muslim.

Questionnaires

In order to evaluate the belief and cultural practices about death, studies directed at the traditional and religious practices made after a death were examined and questions were formed based on behavioral patterns presented in these studies. After the development of the questions, they were sent to two instructors who were experts at public health nursing and had conducted studies related to the religious, cultural and traditional practices; their opinions were taken into account, and content validity was thus obtained. The questions were then revised according to their suggestions and content validity was established. There were 28 questions in total. Five were close-ended while the rest were open-ended. Open-ended questions were about religious beliefs and traditions on the meaning of death, bathing and burying of the dead, mourning, visits to the grave and offering of condolences. Religious practices were solely based on Islam while traditional practices reflected the culture of the individuals. Therefore, death-related traditional practices and religious beliefs were asked separately (e.g., what are the first religious practices performed after a death? What are the first traditional practices performed after a death?).

Procedures

The study was conducted between March and April 2009. Data were collected by research assistants majoring in public health nursing. Data were collected through face to face interviews in Turkish. Interviews were not recorded; the responses were written on the questionnaires without any additions or comments. Three research assistants were trained by a lecturer in the Department of Public Health Nursing, School of Nursing at Dokuz Eylul University before data collection. Following the training, the questionnaire was piloted on 10 families selected from a different district and revised accordingly. Each interview lasted for 35 minutes on average.

Ethical considerations

Approval was obtained from the Municipality and Ethics Committee of Dokuz Eylul University School of Nursing. The information consisted of the study's aim and the method of data collection. Participants were also informed that participation was voluntary, and that they could withdraw at any time without the need to explain their reasons for this. Oral informed consent was obtained from each research participant.

Data analysis

In line with the answers that the attendants gave to open-ended questions, the frequencies of traditional and religious practices made related to death was determined. Death-related religious beliefs and traditional practices were also recorded with answers of "yes" or "no" and then compared with the sociodemographic

characteristics of the participants by using the chi-square significance test. Data were analyzed with SPSS 11.0 (SPSS Inc., Chicago, IL, USA).

Results

A total of 181 women with a mean age of 50.50 ± 13.86 years were included in the study. Of these, 52.5% were between 40 and 59 years old; 39.8% were primary school graduates; 56.4% had an income less than their expenses (Table 1 ).

Of all participants, 36.5% (n = 66) defined death as the end of life; 22.1% (n = 40) defined it as going to the real world; 12.7% (n = 23) defined it as immigration to the other world; 10.5% (n = 19) defined it as salvation; 9.9% (n = 18) de fined it as breaking away; 6.1% (n = 11 ) de fined it as pain of the body and 2.2% (n = 4) defined it as deep sleep.

Religious practices performed after death

In answer to the question, "What are the first religious practices observed after death?", 84.5% of the participants (n = 153) said that people prayed so that the sins of the deceased were forgiven, and 15.5% (n = 28) said that they did not know anything about religious practices.

Religious practices regarding bathing

When the participants were asked about the religious practices performed during the bathing of the deceased, 36.5% of the participants (n = 66) noted that people prayed, 21.0% (n = 38) of them noted that the dead person was washed to perform ablutions (washing the corpse thoroughly while saying prayers), and 16.6% (n = 30) noted that people both prayed washed the body to perform ablutions. The deceased had to be washed according to rules of Islam. Finally, 26.0% (n = 47) had no knowledge of the religious practices performed when the deceased is bathed.

Religious practices regarding enshrouding

When the participants were asked about the religious practices related to enshrouding the deceased, 34.8% of the participants (n = 63) reported that people prayed during the enshrouding so that the sins of the deceased could be forgiven, 1.1% (n = 2) reported that openings of the body (e.g., vagina) were closed with cotton so that no discharge was released, and 1.1% (n = 2) reported that a special cloth was used to cover genitals so that the dead could go

Table 1 Distribution of Participants by Sociodemographic Features (N = 181 )

Sociodemographic features n %

Age (yr)

20-39 37 20.4

40-59 95 52.5

> 60 49 27.1

Education

Illiterate 35 19.3

Primary school 72 39.8

Junior high school 21 11.6

Senior High school 40 22.1

University 13 7.2

Income

Equal to expenses 70 38.7

Less than expenses 102 56.4

Higher than expenses 9 5.0

to the hereafter with his/her genitals covered. Finally, 63.0% (n = 114) of the participants did not know of any religious practices related to enshrouding the deceased.

Religious practices related to burial

When the participants were asked about whether there are any religious practices regarding the burial, 82.9% of them (n = 150) reported that prayer was performed at the funeral, and 5.0% of them (n = 9) reported that the body was placed in a manner with the right side facing Qibla. Finally, 20.2% (n = 22) did not know anything about religious practices concerning the burial.

Traditional practices performed after death

Responses given to the question regarding the traditional practices carried out after death were as follows: 64.7% (n = 117) of the participants said that a knife or scissors were placed on the abdomen of the deceased so that that his/her body would not swell and burst; the shoes of the deceased were put in front of the door so that another person living in the same house would not die; the lights were kept on in case the spirit of the dead visited the home. Next, 7.2% (n = 13) of the participants reported that TV and radio were turned off and 4.4% (n = 8) reported that someone stayed with the deceased throughout the night. Finally, 23.7% (n = 43) said that they were not aware of any traditional practices observed after death.

Traditional practices regarding bathing

Responses given to the question about the traditional practices concerning the bathing of the deceased were as follows: 18.2% (n = 33) of the participants reported that they put a twig of myrtle or laurel leaves in the bath water, 3.9% (n = 7) of them reported that they preferred using soap, and 37.6% (n = 68) reported that female dead bodies were bathed by females and that male dead bodies were bathed by males. Finally, 40.3% (n = 73) of the participants reported that they had never taken part in traditional practices concerning bathing the deceased.

Traditional practices regarding enshrouding

Traditional practices on enshrouding were as follows: 39.8 % (n = 72) of participants said that they had not taken part in any traditional practices related to enshrouding; 30.9% (n = 56) of them said that black cumin seeds, cinnamon, and henna were sprinkled so that the deceased smelled good in the Hereafter; 18.8% (n = 34) reported that female dead persons were dressed in a skirt with three pieces called degre in Turkish and that male dead persons were dressed in a kind of pajamas called iflik; 5.5% (n = 10) of the participants reported that zam-zam water (water from Masjid al-Haram in Mecca and which is a miraculously-generated source of water from God) or rosewater was sprinkled on the deceased so that they smelled nice; 3.4% (n = 6) reported that the deceased were dressed in their own clothes and that flowers were put in the shroud. Finally, 1.7% (n = 3) of the participants reported that the scarf loved most by the deceased was put in the shroud.

Traditional practices related to burial

Responses to the question about the traditional burial practices were as follows: 42.0% (n = 76) of the participants reported that relatives of the deceased poured soil onto the grave to say their farewells; 5.0% (n = 9) explained that the deceased were buried by being dressed in the clothes they liked most and wrapped in

a blanket as a sign of respect; 4.4% (n = 8) noted that a flag-like blanket made of small pieces of colorful cloth was put in the shroud to prevent animals like dogs from scratching the grave; 3.9% (n = 7) explained that women did not participate in the funeral procession because they may have a menstrual cycle and 6.6% (n = 12) reported that the deceased was buried with a blanket and pillow and then the relatives lamented. Finally, 38.1% of the participants (n = 69) said that they did know any burial-related traditional practices.

Traditional practices observed after burial

Responses to the question about practices performed after the burial were as follows: 55.2% of the participants (n = 100) said that people visited the relatives of the deceased to offer their condolences, to give support and to relieve their suffering. Next, 28.2% (n = 51) of the participants said that the imam stayed by the grave and explained to the dead under what conditions people go to heaven or hell. Following the burial, the imam recites sections of Quran, addresses the dead person, and reminds him/her about the five cardinal principles of Islam. In addition, 7.7% of the participants (n = 14) reported that food was offered to those present at the funeral in the graveyard so that the God would forgive the deceased for his or her possible bad deeds; 3.9 % (n = 7) said that a lantern was left in the graveyard, and 3.3% (n = 6) said that people offered their condolences to relatives of the deceased in the graveyard. Finally, 1.7% of the participants (n = 3) reported that they did not perform any traditional practices after the burial.

Traditional condolence practices

Traditional condolence practices were reported as follow: 91.7% (n = 166) of the participants said that visitors brought meals to support the relatives of the dead, 6.1% (n = 11) said that visitors brought food such as packets of tea and sugar, and 1.1% (n = 2) said that visitors prayed. Lastly, 1.1% (n = 2) of the participants reported no traditional practices.

Traditional practices performed in the house of the deceased

Traditional practices carried out in the home of the dead person were as follows: 38.7% (n = 70) of the participants reported that meals brought by the visitors were offered; 20.4% (n = 37) noted that the visitors prayed so that sins of the deceased could be forgiven; 9.9% (n = 18) explained that a "mourning meal" (fried eggs) was offered; 4.4% (n = 8) noted that a sweet with sesame oil (called Helva in Turkish) was offered, and 1.7% (n = 3) reported that wealthy people sacrificed farm animals such as goats and lamb and that poor people sacrificed chickens. Finally, 24.9% (n = 45) of the participants noted that they did not perform any traditional practices in the house of the deceased.

Lamentations

The questions regarding whether there are any lamentations sung for the death person, what kinds of lamentations there are, how they are sung, and whether participants could give an example were responded to as follows: 56.4% (n = 102) of the participants reported that no lamentations were sung because they were considered sinful and 43.6% (n = 79) of the participants said that lamentations were sung and the lyrics of the lamentations were spontaneous. Examples of lyrics of lamentations included the following: "Why did you abandon us and where are you?" "My dear mom, we can't live without you." "Mom, have you gone? Have you gone?"

Traditional mourning practices observed in the house of the deceased

The question of "Is it acceptable to mourn in the house of the deceased?" was responded to as follows: 76.2% (n = 138) of the participants said that people mourned for their dead relatives but 23.8% (n = 43) said that people did not mourn. Next, 46.4% (n = 84) of the participants attributed mourning to sadness while 17.1% (n = 31) of them attributed it to anguish. Five percent (n = 9) of the participants noted that mourning was a way of coping. Finally, 31.5% (n = 57) of the participants did not specify any reason for mourning.

Another question was how long the mourning lasted. The answer ranged from 3 days for 7.2% (n = 13) of the participants, 1 week for 11.6% (n = 21) of the participants, 1 month for 7.7% (n = 14) of the participants, 40 days for 29.8% (n = 54) of the participants, to 1 year for 14.9%(n = 27) of the participants . Five percent (n = 9) of the participants noted that it depended on the age of the deceased. Lastly, 23.8% (n = 43) of the participants had no idea about the duration of mourning.

When participants were asked about what was not done during mourning, 65.2% (n = 118) of them noted that entertainment activities such as watching TV, listening to music, and attending wedding ceremonies were avoided; 11.6% (n = 21) noted that nothing was avoided; 2.2% (n = 4) noted that bathing was avoided, and 0.6% (n = 1) noted that black clothing was preferred. Finally, 20.4% (n = 37) of the participants had no idea about the type of activities avoided during mourning.

When the participants were asked about what they did to ease the acceptance of death, 65.7% (n = 119) of the participants reported that nothing was done, while 34.3% (n = 62) of the participants reported that there were some practices. Next, 26.5% (n = 48) stated that they used social support from family, friends, neighbors and so forth, while 4.4% (n = 8) stated they recited Quran and said prayers, and 3.3% (n = 6) changed their environment.

Traditional practices related to Quran and Mawlid recitations

Mawlid is an eulogy written by Suleyman ^elebi and refers to the birth of the Islamic Prophet, Muhammad. When asked if Mawlid and Quran are recited, 84% (n = 152) of the participants noted that Mawlid and Quran were recited on the 3rd, 7th, 40th, and 52nd days and on the anniversary of the death; 11% (n = 20) noted that they were recited on the 40th day of the death, and 3.9% (n = 7) noted that they were recited on the 52nd day of the death. In addition, the participants added that Mawlid and Quran were recited in order to relieve the suffering of the deceased. Participants in the study believed that flesh and bones separated on the 40th day of death and the nose of the deceased fell away on the 52nd day of death. Thus, Quran was especially recited on these days.

Traditional practices to compensate for prayers not performed by the deceased

In total, 57.5% (n = 104) of the participants reported no relevant practices. As for the practices performed in order to alleviate the sins of the deceased due to unfulfilled religious duties, 22.1% (n = 40) reported that compensations (e.g., giving away money to the poor, sacrificing an animal, providing someone with financial support for a pilgrimage to Mecca) could be made; 11% (n = 20) of the participants reported that relatives of the dead prayed, 7.2% (n = 13) reported that donations (e.g., food, clothing) were made, and 2.2% (n = 4) reported that animals were sacrificed.

Table 2 Religious Practices Performed at Time of Death and During Bathing, Enshrouding and Burying According to Sociodemographic Features (N = 181)

Variables

Time of death

Bathing

Enshrouding

Burying

Available Unavailable c2 P Available Unavailable c2 P Available Unavailable c2 P Available Unavailable c2 P

n(%) n(%) n(%) n(%) n(%) n(%) n(%) n(%)

Age (yr)

20-39 32 (31.3) 5 (5.7) 2.51 .284 23 (27.4) 14 (9.6) 4.20 .122 8 (13.7) 29 (23.3) 5.21 .074 32 (32.5) 5 (4.5) 1.00 .606

40-59 83 (80.3) 12 (14.7) 71 (70.3) 24 (24.7) 37 (35.2) 58 (58.8) 82 (83.5) 13 (11.5)

>60 38 (41.4) 11 (7.6) 40 (36.3) 9(12.7) 22 (18.1) 27 (30.9) 45 (43.0) 4 (6.0)

Education

Illiterate 31 (29.6) 4 (5.4) 0.77 .942 30 (25.9) 5(9.1) 6.09 .193 12 (13.0) 23 (22.0) 1.60 .808 32 (30.7) 3 (4.3) 5.33 .254

Primary school 61 (60.9 11 (11.1) 53 (53.3) 19(18.7) 29 (26.7) 43 (45.3) 60 (63.2) 12 (8.8)

Junior high school 17 (17.8) 4 (3.2) 15 (15.5 6 (5.5) 9 (7.8) 12 (13.2) 17 (18.4) 4 (2.6)

Senior High school 33 (33.8) 7 (6.2) 25 (29.6) 15 (10.4) 12 (14.8) 28 (25.2) 37 (35.1) 3 (4.9)

University 11 (11.0) 2 (2.0) 11 (9.6) 2 (3.4) 5 (4.8) 8 (8.2) 13 (11.4) - (1.6)

Income

Equal to expenses 55 (59.2) 15 (10.8) 4.12 .127 46 (51.8) 24(18.2) 4.12 .127 28 (25.9) 42 (44.1) 1.13 .567 57 (61.5) 13 (8.5) 5.00 .082

Less than expenses 89 (86.2) 13 (15.8) 81 (75.5) 21 (26.5) 37 (37.8) 65 (64.2) 93 (89.6) 9(12.4)

Higher than expenses 9 (7.6) - (1.4) 7 (6.7) 2 (2.3) 2 (3.3) 7 (5.7) 9 (7.9) - (1.1)

Traditional practices regarding visits to the graveyard

When asked about visiting the graveyard, 68% (n = 123) of the participants said that visits were made during religious festivals and on the eve of religious festivals; 20.4% (n = 37) said that visits could be made anytime; 7.2% (n = 13) said that they could be made during religious festivals, on the Spring Equinox (during which activities to celebrate the arrival of spring are observed) and on the 6th of May when the immortal persons Hizir and Ilyas (two prophets thought to fulfill people's wishes) are believed to come together, and 4.4% (n = 8) of the participants noted that visits could be made on every Thursday and Friday. Practices performed during visits to the graveyard are praying, planting flowers, watering the grave and serving sweets to people around (74%, n = 134), plucking wild plants from the grave and painting the grave (21.5%, n = 39), serving food to people around (2.8%, n = 5). Finally, 1.7% (n = 3) reported no relevant practices. With regard to the question of what to do with the belongings used by the deceased, 97.2% (n = 176) noted that they were donated to other people or charities within 40 days of his or her death; 2.8% (n = 5) noted that they kept the clothing.

No significant difference was found between age, education, income, and religious practices performed at the time of death and

during bathing, enshrouding and burial. In addition, there was no significant difference between age, education, income, and traditional practices conducted at the time of death and during bathing, enshrouding and burying the dead body (Tables 2 and 3).

Discussion

Although there are different social structures in western Turkey, they all maintain death-related traditional and religious practices. Results of this study are consistent with other studies conducted in Turkey and demonstrate that traditional and religious practices observed following death still exist (Albayrak, 2006; Albayrak & Arici, 2007; Basqetinqelik, 2001; Keskin, 2003; Tapucu & Aksoy, 2004).

Most of the participants defined death as the end of life and going to the real world. Keskin (2003), reported that the Alawites, who were members of a religious, sub-ethnic, and cultural community primarily in Turkey, defined death as reuniting with God. Beliefs such as going to the real world and reuniting with God can help people accept the death of their relatives and adapt to the changes due to the loss of relatives.

This study reports that people pray and perform ablutions during bathing, put a twig of myrtle in water used to bathe the dead person, and use a new bar of soap. If the deceased is female, she is bathed by females. If the deceased is male, he is bathed by males. In

Table 3 Traditional Practices Performed at Time of Death and During Bathing, Enshrouding and Burying According to Sociodemographic Features (N = 181)

Variables Time of death Bathing Enshrouding Burying

Available Unavailable Available Unavailable Available Unavailable Available Unavailable

_ n(%) n(%) c2 P n(%) n(%) c2 P n(%) n(%) c2 P n(%) n(%) c2 P

Age (yr) 20-39 40-59 >60

Education Illiterate Primary school Junior high school Senior High school University

Income Equal to expenses Less than expenses Higher than expenses

28 (27.6) 9 (9.4) 0.05 .972 22 (21.7) 15 (15.3) 0.06 .968 14(22.1) 23 (14.9) 13.8 .001 24 (23.3) 13 (13.7) 0.42 .810

71 (70.9) 24 (24.1) 55 (54.6) 38 (38.4) 55 (55.6) 38 (37.4) 6 61 (59.8) 34 (35.2)

36 (36.5) 13 (12.5) 28 (28.7) 21 (20.3) 38 (29.3) 11 (19.7) 29 (30.9) 20(18.1)

27 (26.1) 8 (8.9) 4.10 .392 19 (20.5) 16(14.5) 0.97 .913 23 (20.9) 12 (14.1) 9.31 .054 25 (22.0) 10(13.0) 4.64 .325

49 (53.7) 23 (18.3) 42 (42.2) 30 (29.8) 47 (43.0) 25 (29.0) 44 (45.3) 28 (26.7)

16(15.7) 5 (5.3) 13 (12.3) 8 (8.7) 15 (12.6) 6 (8.4) 16 (13.2) 5 (7.8)

31 (29.8) 9 (10.2) 22 (22.3) 16(25.7) 15 (22.7) 23 (15.3) 21 (25.2) 19(14.8)

12 (9.7) 1 (3.3) 9 (7.6) 4 (5.4) 7 (7.8) 6 (5.2) 8 (8.2) 5 (4.8)

54 (52.2) 16 (17.8) 0.51 .774 38 (39.9) 30 (28.1) 1.37 .504 45 (40.6) 23 (27.4) 1.86 .393 44 (44.1) 26 (25.9) 5.73 .057

74(76.1) 28 (25.9) 63 (59.8) 39 (42.2) 57 (61.0) 45 (41.1) 61 (64.2) 41 (37.8)

7 (6.7) 2 (2.3) 4 (5.3) 5 (3.7) 5 (5.4) 4 (3.6) 9 (5.7) - (3.3)

a literature review by Bas^etin^elik (2001) in eastern Turkey, it was reported that people used a new sponge, a new bar of soap and new towels to bathe the dead person. According to Islam, there is another life after death. In fact, it is believed that the dead will resurrect and they will be questioned about their deeds in this world. Therefore, dead people are bathed with fragrant water carefully so that they start a nice life in the other world (Uyanik, 2010). Moreover, one study (Bas^etin^elik) reported that people burned harmal and incense and swept the house to deal with the fear of the deceased in bringing new death with him or herself. To cast aside the death spirit and other evil spirits wandering around the house, people also threw things such as a roller (rolling pin) or knife after the deceased while the body is taken out of the house or break a roller on the deceased while he or she is being bathed. Finally, people also washed their hands and face to stop death from spreading and to prevent its continuation (Bas^etin^elik).

The most common practices performed during enshrouding and burials are praying, positioning the head of the dead towards Mecca, and sprinkling black cumin seeds, cinnamon, and henna into shrouds. The participants noted that deceased women and men were dressed with degre and iflik respectively so that they would not be naked in the other world. Similarly, Bas^etin^elik (2001) reported that zam-zam water, henna (plant powder believed to smell like heaven), and perfume was sprinkled into shrouds and prayers were said. In a study carried out in Sanliurfa, Turkey, the participants noted that a headscarf was used for women and that a long light robe (a kind of underwear) and shrouds were used for both men and women (Tapucu & Aksoy, 2004).

In this study, people who wanted to offer their condolences brought meals to the relatives of the deceased, which was consistent with the results of other studies carried out in Turkey (Albayrak & Arici, 2007) because they enhanced social support.

Visits made to offer condolences demonstrate the importance placed on sharing by Turkish culture and should also be encouraged. Religious elements are also effective upon condolence practices and showed the courage of why nurses should promote positive coping strategies.

Most of the participants in this study noted that lamenting was not acceptable as it was believed to be a sin. This indicates that lamenting has recently lost ground. However, Keskin (2003) reported that people cried and lamented because of sorrow and grief. Likewise, in a study on Death related beliefs and laments among Nogay Turks, Akbaba (2008) noted that lamenting continued but being frantic with sorrow was considered unpleasant. Other studies also emphasized that lamenting was usual on the condition that it was not excessively loud (Albayrak & Arici, 2007; Cihan, 2006; Lobar et al., 2006; Ross, 2001). The present study revealed that lamenting was considered a sin. However, this tradition continues in the Mediterranean, Middle Anatolia, Southeastern Anatolia, Aegean, Marmara, Black Sea, and East Anatolia regions of Turkey (Gorkem, 1993). Lamentations vary according to the characteristics of dead people (according to the age and sex of the person who died) (Gorkem) and are accepted without judgement.

The participants noted that people mourned after the death of their relatives because they felt sad and were in anguish. They also noted that mourning was a mechanism by which to cope with sorrow, but did not seem to hinder daily life activities. We found that mourning lasted for 40 days and this finding was consistent with that of other studies (Cihan, 2006; Keskin, 2003). According to Islamic belief, it is neither approved nor prohibited to mourn for a dead person for more than 3 days, except for the wife of whom the husband is dead (Cihan), mourning reveals that there are a lot of practices that are different from the Islamic theoretical thought. Relatives of the deceased express their pain and sorrow with certain behaviors. The wearing of black clothes which symbolizes

sorrow and staying away from joyful and fun activities all fall within this scope (Cihan), but one must keep in mind there are individual differences in practice.

Reciting Quran and Mawlid after the death of a person is accepted in islam. However, limiting this practice to certain days such as the 3rd, 4th, 7th, 40th and 52nd days after death and several other rituals are traditional practices not associated with Islam. This demonstrates accepted practices on an individual basis. These practices are important because they make the relatives of deceased come together and say prayers, help them share their feelings of the departed person and adapt to the loss of a loved one (Bayat & Cicioglu, 2008). Religious and traditional practices such as mourning, praying, and reciting the Quran, relax people and relieve sadness. This can also be a kind of social support.

In this study, we found that belongings of dead are either given away or kept, in line with the current literature (Albayrak, 2006; Cihan, 2006; Keskin, 2003). It can be attributed to the belief that sins of the dead will be forgiven. Similar to the findings of this study, another study from eastern Turkey (Cihan) reported that money and wheat were distributed "for the forgiving of the dead's sins" for the worships that they did not perform when alive, and for their negative behaviors such as drinking alcohol and smoking. Moreover, it is stated that for non-performed pilgrimage worship, a man is sent to the pilgrimage by their relatives and ovine and bovine are sacrificed (Cihan).

In the present study, lack of a significant difference between age, education, income, and religious and traditional practices performed during bathing, enshrouding, and burial show that religions and traditions have a strong effect on people. It also indicates that traditions and elements of Islamic culture still exist and are transmitted from generation to generation despite small individual variations. These practices help promote positive mental health for the family and friends of the deceased.

Health professionals should recognize cultural elements affecting the health of the people on an individual basis. In this manner, they can promote good mental and physical health. Traditional practices, beliefs and attitudes play an important role in holistic health care (Tortumluoglu, 2004).

Limitations

Death-related traditional and religious practices differ from one country to another and even in different parts of a country. This study cannot be generalized to Turkey as a whole since it was carried out in a specific part of western Turkey. Individuals belonging to different religious sects live together in the region where the study was conducted. As a consequence, there are also cultural differences specific to these sects. If the study was conducted using focus group interviews, deeper qualitative information could have been obtained regarding the death-related practices specific to a culture.

Conclusion

Death-related religious and traditional practices continue in western Turkey. The findings in the study support what has been found in the scientific literature. In line with these findings nursing curricula should include content from sociology, psychology, anthropology, religion and culture. Nurse researchers should continue to conduct comparative and qualitative research because death-related religious and traditional practices do vary on an aggregate and individual basis. Nursing studies focusing on the positive and/or negative effects of religious and traditional practices made after death can improve the mental and physical health of patients and families.

Our study results show that religious and traditional rituals regarding death are still valid. There is no significant difference found between age, education, income, and religious practices performed at the time of death and during bathing, enshrouding, and burial. In addition, there is no difference between age, education, income, and traditional practices conducted at the time of death and during bathing, enshrouding and burying the dead body in these study.

These findings will enable the nurses, who will render service for individuals and societies in different cultures, to understand the traditional and religious practices regarding death and the period after death, and activate the social support systems. Nurses may find the means to respond to the complexities of the particular spiritual needs of people from diverse cultures with whom they come into contact on a daily basis by employing a range of meanings attached to their spirituality.

Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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