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Arab Heritage: Patient-Centered Care

Arab Heritage Case Study

Mrs. Nasser arrived at the urgent-care center with her 16-year-old daughter, who had been experiencing burning upon urination, itching around her genital area, and a high fever. Mrs. Nasser appeared very anxious, explaining to the nurse that her daughter had never had these symptoms before. The nurse tried to calm Mrs. Nasser and asked that her daughter, Samia, get undressed in preparation for a physical examination. Mrs. Nasser appeared concerned and requested that the nurse inform the doctor that she will not allow the doctor to perform a vaginal examination on her daughter.

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The nurse explained to Mrs. Nasser that it will be necessary for the doctor to examine Samia so that she can determine the cause of Samia’s discomfort. Mrs. Nasser became extremely agitated and explained to the nurse that in her culture, young girls are not allowed to have vaginal examinations for fear that their virginity will be compromised. Mrs. Nasser insisted that she would not allow her daughter to be examined by the female doctor on duty. Mrs. Nasser requested that the nurse ask the doctor to prescribe for her daughter’s infection, or else she would leave the clinic immediately.

The nurse response to Mrs. Nasser’s request

Mrs. Nasser has requested to provide her with the prescription for Samia to relieve the pain without doing the vaginal examination. In this situation, the nurse is challenged by the controversial ethical problem because of the necessity to respond to Mrs. Nasser’s religious visions and to provide the necessary medical help for Samia. Mrs. Nasser’s request is based on many religious and traditional beliefs such as the idea that the other person cannot see the naked woman, and medical treatment should provide immediate relief (Amir et al., 2012; Kulwicki & Ballout, 2013).

That is why Mrs. Nasser’s refusal to permit the vaginal examination and her request for the medication which could provide immediate help is based on her strong religious and cultural visions. The nurse’s task is to find the balance between two opposite resolutions of the problem and meet Mrs. Nasser’s expectations (Hasnain, Connell, & Menon, 2012).

On the one hand, the nurse is challenged by the principle of respect for the patient’s autonomy which should be followed strictly (Ziad et al., 2012). On the other hand, the nurse should create conditions according to which Samia could receive all the possible help without violating her religious beliefs. The nurse should try to persuade Mrs. Nasser to permit the vaginal examination by the female doctor because such cases are presented in the medical practice concerning Muslim women (Redshaw & Heikkila, 2011; Zeilani & Seymour, 2010). Moreover, it is necessary to state the arguments that the procedure is not risky for Samia (Marcia & Inhorn, 2011).

Nevertheless, the absence of the necessary vaginal examination is a real risk for the girl’s health. If Mrs. Nasser rejects any arguments, it is necessary to propose the abdominal ultrasound examination or computer tomography provided by the female doctor (Cohen & Azaiza, 2010). Furthermore, it is important to insist on urinalysis and alternative methods of diagnosing to prescript the medications. The details of all the diagnosing procedures should be carefully described by the nurse.

Culturally congruent strategies that may be most effective

Urinalysis, abdominal ultrasound examination, and computer tomography are only additional techniques to provide information about the patient’s health if the vaginal examination is necessary. That is why the nurse should draw Mrs. Nasser’s attention to the fact that there are ways to resolve the problem ethically and without violating the Muslims’ beliefs. It is important to note that many Muslim women receive inadequate medical help because of following some religious principles (Grose & Pravikoff, 2013).

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To avoid this, it is necessary to propose Mrs. Nasser be present in the cabinet of the gynecologist during the procedure. Moreover, the effective technique is to rely on the help of the female doctor who is Muslim or who knows the aspects of the Muslim culture well enough to answer all Mrs. Nasser’s questions concerning the ethical aspect of the procedure because all the practical elements of the procedure should be explained by the nurse, paying much attention to the religious feelings and beliefs of the Muslims (Hatefnia et al., 2010; Khawaja et al., 2009).

Furthermore, the procedure should be confirmed by the male representative of Samia’s family (father or brother) to follow all the Muslim ethical and religious principles (Lyberg et al., 2012). Thus, the emphasis on the role of a female doctor who knows the Muslim traditions and does not intend to harm Samia is important.

Ensuring that Mrs. Nasser’s concerns are addressed appropriately

The nurse should know that Mrs. Nasser’s concerns are addressed appropriately, and she should provide the necessary support for Mrs. Nasser and Samia. If the male representative of the Muslim family can’t be present during the procedure as the third party, the nurse should be present herself and allow the mother to be present in the cabinet of the gynecologist (Hasnain, Connell, & Menon, 2012).

There are situations when medical help and the vaginal examination of the girl are extremely necessary, but only a male doctor can be available. In this situation, the female nurse should be the main assistance of the doctor to provide all the possible procedures which are controversial from the ethical or religious point of view (McLean, Al Ahbabi, & Al Ameri, 2010; Rubini, Mills, & Gazeley, 2011). Thus, the presence of the nurse in the cabinet of the gynecologist is obligatory from this perspective.

Furthermore, the nurse can ensure that Mrs. Nasser’s concerns are addressed and that Samia can receive the appropriate care based on the alternative methods of diagnosing (Othman et al., 2012). The main task of the nurse is to persuade the mother to permit the vaginal examination or other medical examinations without breaking the principle of respect for the patient’s autonomy (Kulwicki & Ballout, 2013). It is possible to stress the mother’s right to choose the method of diagnosing and treatment, but diagnostics should be provided to avoid any risks for Samia’s health, respond to Mrs. Nasser’s request and receive the medication and possible treatment according to the test results.

References

Amir, H., Tibi, Y., Groutz, A., & Amit, A. (2012). Unpredicted gender preference of obstetricians and gynecologists by Muslim Israeli-Arab women. Patient Education and Counseling, 86(2), 259-263.

Cohen, M., & Azaiza, F. (2010). Increasing breast examinations among Arab women using a tailored culture-based intervention. Behavioral Medicine, 36(3), 92-9.

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Grose, S., & Pravikoff, D. (2013). Kurdish patients: Women’s health care concerns — Providing culturally competent care. CINAHL Nursing Guide, 25(1), 2-15.

Hasnain, M., Connell, K., & Menon, U. (2012). Patient-centered care for Muslim women: provider and patient perspectives. Journal of Women’s Health, 20(1), 73-83.

Hatefnia, E., Niknami, S., Bazargan, M., Mahmoodi, M., Lamyianm, M., & Alavi, N. (2010). Correlates of mammography utilization among working Muslim Iranian women. Health Care for Women International, 31(6), 499-514.

Khawaja, M., Kaddour, A., Zurayk, H., Choueiry, N., & El-Kak, F. (2009). Symptoms of reproductive tract infections and mental distress among women in low-income urban neighborhoods of Beirut, Lebanon. Journal of Women’s Health, 18(10): 1701-1708.

Kulwicki, A. D., & Ballout, S. (2013). People of Arab heritage. In L. D. Purnell (ed.), Transcultural Health Care: A Culturally Competent Approach (pp. 159-177). Philadelphia, PA: F. A. Davis Co.

Lyberg, A., Viken, B., Haruna, M., & Severinsson, E. (2012) Diversity and challenges in the management of maternity care for migrant women. Journal of Nursing Management, 20(2), 287-95.

Marcia, C., & Inhorn, G. (2011). Islam, medicine, and Arab-Muslim refugee health in America after 9/11. The Lancet, 378(9794), 935-943.

McLean, M., Al Ahbabi, S., & Al Ameri, M. (2010). Muslim women and medical students in the clinical encounter. Medical Education, 44(3), 306-15.

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Othman, A., Kiviniemi, M., Wu, Y., & Lally, R. (2012). Influence of demographic factors, knowledge, and beliefs on Jordanian women’s intention to undergo Mammography Screening. Journal of Nursing Scholarship, 44(1), 19-26.

Redshaw, M., & Heikkila, K. (2011). Ethnic differences in women’s worries about labour and birth. Ethnicity & Health, 16(3), 213-23.

Rubini, M., Mills, K., & Gazeley, S. (2011). Health is a spiritual thing: perspectives of health care professionals and female Somali and Bangladeshi women on the health impacts of fasting during Ramadan. Ethnicity & Health, 16(1), 43-56.

Zeilani, R., & Seymour, J. (2010). Muslim women’s experiences of suffering in Jordanian intensive care units: A narrative study. Intensive and Critical Care Nursing, 26(3), 175-184.

Ziad, A., Fadi, H., Cury, E., & Brandeis, G. (2012). Muslim nursing homes in the United States: Barriers and prospects. Journal of the American Medical Directors Association, 13(2), 176-179.

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