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The Vaginal Examination of a Young Unmarried Muslim Woman

Your primary obligation is first caring for the patient. If you thought that perhaps Samia had been sexually active and been afraid to disclose this to her mother, would you try to distract the mother away from the room and question Samia alone? What would be your concern if you did?

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The nurse’s task is to convince the mother and Samia that the vaginal examination is necessary for supporting the young woman’s reproductive health. If the vaginal examination is realized by the female doctor and with the mother or the other member of the family present in the room, the procedure is possible, and it does not violate the religious beliefs of Muslims (Amir et al., 2012; Kulwicki & Ballout, 2013). The problem is in the fact that the vaginal examination of a young unmarried woman can become a controversial ethical issue if the young woman was sexually active before the marriage (Hasnain, Connell, & Menon, 2012; Kulwicki & Ballout, 2013).

Thus, sexual relationships before marriage are prohibited. If Samia has sexual relations before or outside the marriage, she can be punished and even humiliated significantly in her family (Khawaja et al., 2009; Zeilani & Seymour, 2010). As a result, the nurse should prevent the situation of disclosing Samia’s sexual activity, if her refusal to be examined by the doctor is based on this problem.

To plan further actions, it is necessary to solve the next ethical question. The nurse should protect the interests of the patient. That is why, if the nurse knows the definite secret aspects of the patient’s life, this information should be shared only by the patient, the nurse, and the doctor who is responsible for treating the patient (Kulwicki & Ballout, 2013; Yanikkerem et al., 2009). From this point, the nurse can conceal the information about Samia’s sexual activity and not inform her mother. However, the doctor should learn this aspect to provide a careful vaginal examination and conclude the diagnosis. That is why the nurse should learn this information independently and without the mother’s participation.

The problem is in the fact that there are few chances that Samia can answer the direct questions about her sex life because of the religious beliefs and ethical concerns associated with the reaction of her family. Thus, it is better not to distract the mother away from the room to learn the information, but it is necessary to warn the doctor about such a possibility. That is why, it is possible to realize the vaginal examination with the mother present in the room, but without informing her about the aspect of the daughter’s sexual activity. This information will be protected by the ethical code of conduct and the principle of medical secrecy between a doctor and a patient.

These principles should be spoken aloud to inform the daughter and mother about the ethical aspects of the procedure (Marcia & Inhorn, 2011; McLean, Al Ahbabi, & Al Ameri, 2010). This tactic along with the accents on the necessity of the vaginal examination and its positive role for reproductive health can be effective to prevent Samia from being afraid of the procedure and its consequences and convincing the mother to allow the examination (Cohen & Azaiza, 2010; Lyberg et al., 2012).

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.

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

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.

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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Yanikkerem, E., Ozdemir, M., Bingol, H., Tatar, A., & Karadeniz, G. (2009). Women’s attitudes and expectations regarding gynaecological examination. Midwifery, 25(5), 500-508.

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.

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