Transcript Transcultural Nursing - A Collaborative Learning Community

Transcultural Nursing
Providing Culturally Congruent Care
for Muslims
Providing Culturally Congruent Care for
the Muslim
 Review of the Literature
 Cultural Assessment Data
 Culture Care Theory
 Discussion
Review of the Literature
Cultural Expectations of Muslims and Orthodox
Jews in Regard to Pregnancy and the Postpartum
Periods: A Study in Comparison and Contrast
Cultural Expectations of Muslims and Orthodox Jews in Regard to
Pregnancy and the Postpartum Periods: A Study in Comparison and
Contrast
 Traditionally childbirth is viewed as a female event and
many Muslim men are not accustomed to being overly
involved in this experience.
 These views are changing however as greater assimilation
occurs into western society.
 Muslims may have special dietary needs. Many Muslims
also fast during certain times of the year.
Cultural Expectations of Muslims and Orthodox Jews in Regard to
Pregnancy and the Postpartum Periods: A Study in Comparison and
Contrast
 Muslims may recite verses from the Koran or use a blue
stone to ward off evil spirits in regards to the newborn.
 Modesty is important to consider when performing
procedures.
 Muslim women traditionally are expected to adhere to a
period of confinement for forty days after childbirth.
Typical Prayer Rug and Prayer Beads
Review of the Literature
Caring for Patients of Islamic Denomination:
Critical Care Nurses' Experiences in Saudi
Arabia
Caring for Patients of Islamic Denomination: Critical Care Nurses’
Experiences in Saudi Arabia
 Research-based descriptive study of six critical-care nurses’
experience with caring for Muslim patients in Saudi Arabia.
 Findings included three major themes: family and kinship
ties, cultural and religious influences, and nurse-patient
relationship
Family and Kinship Ties
 Family involvement in care was found to be a major factor in both
providing nursing care as well as the overall emotional, social, and
psychological well-being of the patient.
 The family unit often “dictated the care” of the patient, even to the
extent that the physician would discuss treatment options and decision
making solely with the family, without the patient’s involvement.
 Visitors often came in great numbers, as many as 20 at a time. Many
times visitors would bring food, drinks, and rugs to lay down in the
room. This heightened level of visitation was found by many of the
nurses to interfere with providing care as well as reduce patient
involvement in their own care.
Cultural and Religious Influences
 The role of Islam was found to be all encompassing and intertwined in
every aspect of care.
 Patients who were instructed to rest would often insist on getting out of
bed to pray five times a day. (Remember, this is on a Critical Care Unit)
 Patients accepted any change in condition as “the will of God” and were
seemingly apathetic towards any good or bad news. This lead to many
nurses reporting a feeling of powerlessness in the care for their patients.
 Care was found to be highly gender specific. Older male patients were
found to dislike being cared for by female nurses, and female patients
often refused to allow male nurses or caretakers to be in the room. This
was specifically found to be a problem for female nurses when moving
patients who refused to allow males to help.
Nurse-Patient Relationship
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Since this study was conducted in Saudi Arabia, language was a huge barrier to
communication.
It was found that patients were eager to converse with nurses in their native language, even
though they knew the nurses did not understand. Nurses admitted to often simply smiling
and trying to listen.
Many nurses found it difficult to form patient bonds and develop the family’s trust when
communication was limited and attempts to do so often resulted in frustration.
Cultural differences in application of care, such as one example where a young boy had
third-degree burns over 80% of his body yet his parents refused to allow him pain
medication, were a cause of great frustration and stress for many nurses.
Nurses often felt powerless in helping sad or depressed patients since comforting was not
seen as part of the nurse’s role. Attempts to be emotionally sensitive, especially through
caring touch, were not welcomed or appreciated by most patients.
Review of the Literature
Neonatal End-of-Life Care in Sweden:
The View of Muslim Women
Neonatal End-of-Life Care in Sweden: The View of Muslim Women
 Research-based study exploring the views of Muslim
women’s views of neonatal end-of-life care in Sweden
 Participants: Eleven immigrant Muslim women living in
Sweden
 The study was divided into sections regarding care before
birth, care directly after birth, and during and after the death
of the infant.
Care Before and After Birth
 Most of the women would like to be informed of potential problems with
the baby before birth; however several felt that information contradicted
their idea that God was giving them this child to take care of regardless
of its condition.
 The majority of the women agreed that the nurses and medical staff were
trying to do what was best for the mother during the phase directly
following birth, including describing the infant to the mother.
 Visitation from family was important and most did not want to be left
alone to deal with their own thoughts regarding the newborn.
During and After the Death of the Infant
 During the dying phase of the infant, the mothers were given
information regarding terminating life support or withholding medicines.
 Most chose to stop ventilator support or medicines if there was suffering
involved.
 Most of the women agreed that memories aggravated grief. They only
would take mementos or photos of the infant from when they were alive.
 Another member of the family should take care of the religious dressing
and care of the dead infant for burial. The infant was usually sent home
with the family in order to bury within their religious beliefs.
 It was believed this was God’s will for the baby to not survive.
Review of the Literature
Globalization and the Cultural Safety of an
Immigrant Muslim
Globalization and the Cultural Safety of an Immigrant Muslim
 Research-based study focusing on the social health of
immigrant Muslims following terrorist attacks of September
11, 2001 (9/11).
 Sample of 26 Muslims residing in the province of New
Brunswick, Canada were interviewed in 2002-2003.
 Participants experienced a sudden transition from cultural
safety to cultural risk following 9/11.
Cultural Safety Before 9/11
 Participants indicated they had a sense of well-being in the
respective communities.
 They had friends among mainstream residents and
participated in local life.
 Participants emphasized the peacefulness of the area.
Cultural Risk in the Aftermath of 9/11
 Participants sense of security altered abruptly.
 Most attributed to intense media coverage with unfair attention on their
religion.
 Muslims became a visible minority.
 Greatest source of cultural risk involved the feeling of being under
constant surveillance and that they would be falsely reported for
terrorist activity.
Conclusions: Cultural Safety
 Social disadvantage of a cultural minority has been
linked to culturally unsafe health services.
 The findings should alert the international
community of nurses to be aware of the cultural
safety of this particular group.
Cultural Assessments
Cultural Assessment Data
Assessment #1 and Application of Culture
Care Theory
Assessment #1
 A. S. is a modern American Muslim that immigrated from
Pakistan in 1978.
 A. S. is involved with his children more so than his father.
 A. S. is the head of the household and the primary
breadwinner for the family.
 A. S. has a Bachelors degree in computer science.
Assessment #1
 The family is vegetarian.
 The family speaks fluent English and are bilingual with
Urdu the national language.
 His wife does not wear traditional Muslim dress but does
wear a Hijab, head wrap, in public.
 Doctors and nurses are viewed positively by A. S. and his
family.
Assessment #1
 Illness is perceived as a test or punishment by God.
 A. S. believes in abstaining from things that are forbidden in
Islam and views the body as a temple.
 Western medicine is to be taken advantage of but the family
also has home remedies that they practice for common
illnesses.
Culture Care Theory
Assessment #1
 The preservation of modesty should be a priority for the Muslim patient
as well as showing respect.
 Nurses should accommodate for these patients to bring in their own food
and allow a place for storing these items if possible or discuss the special
dietary needs with the physician to allow for vegetarian meals.
 Based on the assessment with A. S., no aspects are found to need
restructuring or repatterning.
Cultural Assessment Data
Assessment #2 and Application of Culture Care
Theory
Assessment #2
 B.A. is a modern American Muslim born in the United
States, residing in Chicago, Illinois. She is married with two
children.
 B.A. and her husband work as a team although he is
considered the head of the household. He works from home
and she is a stay at home mother.
 B.A. and her husband have many friends who are Muslim
and many who are not. There are many mixed religion
marriages in their family.
Assessment #2
 B.A. attended Mosque for three years for Muslim schooling.
 She does not formally pray 5 times a day however she prays
before each meal and before bed. She also prays before
driving an automobile.
 She does not wear traditional Muslim clothing. She can wear
short sleeved shirts and a bathing suit in public. She does not
cover her head.
 Her family observes all Muslim holidays and she fasts one
day a year. These are traditions she was taught growing up.
Assessment #2
 B.A. and her family believe cleanliness is very important.
 They do not eat pork or drink alcohol.
 B.A. does not believe illness is a test or punishment. She
believes God does not give you more than you can handle
and that illness and trying times make you stronger.
 She prefers female healthcare workers and her husband
prefers males. They will accept care from either if necessary.
Assessment #2
 B.A. and her husband were married in a Mosque with a
Hodha presiding who instructed them in their marital rights
and obligations.
 B.A. states that her husband says a blessing in a new baby’s
ear as they come home for the first time.
 A red bracelet is placed around a new baby’s wrist to protect
from the evil eye.
 Her family follows traditional Muslim ceremonies regarding
death and burial.
Red Bracelet around a Child’s Wrist to ward off Evil Eye
Culture Care Theory
Assessment #2
 Preservation/Maintenance
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Question patient in advance as to special needs regarding religion and
culture.
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Take care to preserve modesty and privacy for patient.
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Provide pork- and alcohol-free meals and medications.
 Accommodation/Negotiation
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Allow time for patient to pray daily as necessary.
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Provide male or female health care workers for patient as requested if
available.
 Repatterning/Restructuring
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Based on B.A.’s assessment, no repatterning or restructuring is necessary.
Cultural Assessment
Assessment #3 and Application of Culture Care
Theory
Assessment #3
 M. is a 51-year-old Muslim woman originally from the Ivory Coast, in
Africa. She now lives in the middle Tennessee area and works as a nurse
at Vanderbilt.
 M. considers herself relatively conservative in her adherence to the
Islamic faith and abides by most of its traditional teachings.
 M. insists that her cultural values and beliefs were largely influenced by
the area of Africa in which she was raised and lived most of her life, in
addition to her continuing faith.
Assessment #3
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M. wears the traditional head covering, but DOES NOT cover her entire
face like some other regional Muslim cultures.
M. does not eat pork or drink alcohol and highly prefers medications
that do not contain products of either if at all possible.
M. adheres to the five daily prayers that are typical of Islam.
In M’s family, the male is the head of the household but NOT to the
extent that other members are excluded from decision making.
For M. and her culture, gender is sometimes an important issue
surrounding patient care, especially involving the placement of urinary
catheters. Many patients prefer to have a same-sex nurse place their
catheter and, as a nurse, M. prefers to have another male nurse place
catheters on her male patients, if at all possible.
Assessment #3
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Typically in M’s culture, elders are respected for their experience and wisdom. As they
grow older, they are often brought to live with and be cared for by the younger adults in
the family. Due to this cultural trend, there are NO nursing homes in M’s area of Africa.
Fasting, in M’s culture, can often include refusal of not only food but also medications
and even IV fluids.
It is common in M’s community for many, many visitors to come visit people who are
sick and in the hospital. They often bring food, not only for the patient, but also for the
family in their time of need.
M. emphasized that it would be considered very disrespectful for a nurse, or anyone else,
to come into a patient’s room and touch their Quran, even if simply to move it slightly.
M. also stressed the importance of respect for her homeland of Africa, and avoidance of
the stereotype that Africa is full of poor people and starving children, as being crucial to
providing culturally competent care to African natives of any faith.
Culture Care Theory
Assessment #3
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Preservation/Maintenance
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Provide pork- and alcohol-free meals and medications.
Refrain from touching patient’s Quran without express permission.
 Accommodation/Negotiation
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Provide a prayer rug, or if patient is unable to get out of bed to pray, assist in
facing bed toward Mecca and provide privacy for praying.
If fasting, discuss options with patient and possibility of postponing fasting
until healthier or making allowances for medications and fluids.
 Repatterning/Restructuring
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If excessive visitation begins to interfere with patient care, nurse may have to
more diligently enforce visiting hours and family/friends may have to visit in
smaller, less disruptive groups.
Compare and Contrast of Various Muslim
Cultures
 After several personal cultural assessments and reviewing multiple research
articles, many similarities and differences were found throughout various
Muslim sub-cultures. A few example are as follows:
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For many Muslims, modesty is VERY highly valued. However, many
Muslims choose not to wear the traditional head coverings that are so highly
regarded by many others.
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Most Muslims do not eat pork, but many have assimilated so greatly into
American culture that they will make exceptions out of convenience. Many
others choose to be completely vegetarian.
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The five daily prayers are, for many, a cornerstone of Islamic faith.
In contrast, some Muslims have incorporated a less formal system of
daily prayer into their Western lifestyle
Compare and Contrast Cont.
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The assessment of several Muslim individuals in combination with
research into Muslim culture has shown a large spectrum of values,
beliefs, and levels of adherence to Islamic teachings.
 Members of the broad Muslim culture can be highly Americanized, or
very traditional in their beliefs and daily practices. Within this culture,
members can vary from each other as much as they do from members of
other cultural groups.
 This level of diversity makes providing culturally competent care for
Muslim patients a dynamic and individualized process that involves the
continual assessment of your patient, their needs, and your progress as a
nurse in meeting those needs.
Discussion
Despite all of the cultural differences that we as nurses might
encounter when caring for Muslim patients, one resounding
commonality is that most Muslims, especially those in
America, place a high level of trust and respect in our
healthcare system. We as healthcare professionals must earn
that trust and respect by, in turn, respecting individuals and
their culture as well as educating and preparing ourselves to
provide the utmost of culturally competent care and
constantly striving for “the highest attainable standard of
health” (Transcultural Nursing Society Position Statement).
References
Baker, C. (2006).Globalization and the cultural safety of an immigrant Muslim. Journal of
Advanced Nursing. 57, 296-305.
Cassar, Linda. (2006). Cultural expectations of Muslim and Orthodox Jews in regard to
pregnancy and the postpartum periods: A study in comparison and contrast. International
Journal of Childbirth Education, 21, 2, 27-30.
Halligan, P. (2006, December). Caring for patients of Islamic denomination: critical care
nurses' experiences in Saudi Arabia. Journal of Clinical Nursing, 15(12), 1565-1573.
Lundquist, A., & Dykes, A. (2003). Neonatal end of life care in Sweden: the views of Muslim
women. Journal of Perinatal and Neonatal Nursing. 17, 77-86.