Free Literature Review About Nursing Care Considerations For The Islamic (Specifically Muslim Women) Patients In Canada

Introduction: Culture refers to every thing about people, the way they live, view things and communicate. Culture is an integration of human thoughts, communication, actions, customs, belief and values. It shapes the individuals experience, perception, decisions and the way they relate to others. Canada was declared a multicultural society in 1971. Multicultural Act was passed in 1988, with the aim to preserve and enhance multiculturalism in the country. It describes multiculturalism as the fundamental characteristic of our Canada.
Islam is a monotheistic religion, which originated in Arabian countries and later spread to rest of the world. The followers of this religion are called Muslims and they account for 2% of Canadian population. Majority of them are settled in Ontario and Quebec. People of Islam, especially the women, have different world views, communication style and expectation. Canadian government is committed to religious pluralism. However majority (over 77%) of Canada’s population are Christians and Muslims represent only 2% of the whole population. Being a minority, and most of the nurses who attend to them being from a different community, Muslim women often face disparity in the health care sector.

Review of literature:

Johnson, 1990 comments about palliative care like this: “Sensitive care means giving respect and incorporating the basic value of human freedom and religious diversity.” In once career, nurses have to relate to people of special faith which is different from their own. On this Johnson (1990) comments “The care giver need not agree with the belief of the patients to serve them seriously. Support however needs to be non-sectarian, non-dogmatic and appropriate to the patient’s view of the world”. Most nurses in Canada are educated on western medical model, which emphasis on biophysical causes of diseases and related scientific treatment. This model is usually reinforced on the nurse’s original values and belief. It is quite natural that this can affect the nurse’s attitude and the way they relate to people of different religion. This become’s a concern, particularly, while treating followers of Islam, who are zealous about maintaining and adhering to the religious and cultural practices even while availing health care services. It becomes necessary that the nurse appreciate and respect these patient’s as an individual and assist in maintaining the traditional practices important them.(Griffith,1996)
Understanding the basic practices in this religion will help nurses to avoid stereotyped assumption and behavior while dealing with the patients. In a culturally heterogeneous population like Canada, it is necessary that the health care personal poses necessary knowledge about the basic belief and practices of different religions. Members of Islam prefer to identify themselves with the community and are very committed in following the rituals and practices pertaining to the religion. Muslims have food restrictions like they don’t take pork, carnivorous meat and Non-Halal food. While eating outside home, they prefer vegetarian food and fish. The Halal meat taken by Muslims is rich in sodium. They use right hand for eating and wash their mouth after taking food. During the month of Ramadan, they do not eat or drink, from sunrise to sunset. Sometimes it may be difficult to pursue patients to give up fasting, in which case a help of a local religious leader Iman, would be required. Muslim’s pray five times a day and may require a private, quite and clean place for kneeling down, which is a part of the ritual. They prefer same sex care givers and some may find the hospital gown immodest and indecent as their legs are not covered. The women of this faith cover head to toe, only revealing their hands from the ankles down. Men wear long trousers and do not reveal their legs. Circumcision is performed in all male children. Their culture requires them to wash their hands before meal, before prayer and after using bathroom. Terminally ill patients prefer to sit or lie down facing the direction of Mecca. Relatives and family members may recite prayer for the diseases at his bed side. Autopsy is forbidden after death, except when required by the law, and when foul play is suspected. The non-Muslim personnel handling the dead-body should wear disposable gloves and be of the same gender as the deceased. All these religious practices are important in the life of a Muslim and are way of showing respect for their Supreme God. Muslim women, often require the consent and permission of the head male of the family for any treatment. (Siddiqui,2012)
It is not necessary that these religious practices are applicable to scientific principle of treatment, but they will nevertheless influence the person’s response to care. Quite often nurses are not satisfied with the moral justification in heeding to the belief and practices of a particular religion that does not comply with the modern method of medicine. According to Leever, 2011, the moral justification for the need for cultural competence in nurses is: to respect the autonomy of the patients. She describes a case when a pregnant woman of Islam faith, does not agree to be examined by a male physician and constantly defers all her decisions to her husband. Unless a nurse is culturally competent, he/she cannot make a sensitive response in such a situation. Women of Islam prefer to identify themselves with the religion rather than as an individual. Even when the patient is deferring the decision making to her husband, she does it on free will and in full possession of her cognitive ability and is thus autonomous. A person’s culture shapes what a person is and, health care should respect the autonomy of the patients. Cultural liberty is a human right and an important part of human development. People must feel free to express their identities and not be discriminated for it. Healthcare’s acceptance of this diversity is important for effective patient welfare. (Hasnain 2006 & Hasnain,2011)
Bacote, 2002 identifies four step towards achieving cultural competence. The first step is ‘cultural awareness’; where the nurse or the organization identifies one’s own cultural biases. The second stage is about attaining knowledge on different cultures and practices that are likely to affect patient care. The third stage is developing the necessary ‘cultural skill’. In this stage, the health care personal is made competent in collecting data, which is relevant to the patient’s culture, and translate them into effective patient care. The last stage is ‘cultural encounter and desire’, where the hospital and the staff should have genuine desire to encounter patients from different culture and handle them. To be successful, the healthcare personnel should be willing to face the multicultural challenges and try to be accommodative. Accommodation can be done as long as such accommodation does not compromise the quality of healthcare to other patients, violate the integrity of the professional involved and conflict with the mission of the hospital. (Graham, Bradhaw & Trew, 2010)
Problem Identification: Due to the dramatic rise in the Islamic population, it is likely that more patients will sort to health care facilities. Considering the advancement in technology, shortage of resources, growing client acuity, the nurses will face the new challenge of addressing the healthcare needs of the growing and diverse Muslim community. To meet the health care needs of this community, it is essential that the nurses acquire the necessary skill, knowledge and attitude to provide effective care (Zellani & Seymour,2011 ). Nursing care can be felt unsafe if the patients are humiliated and alienated or are directly and indirectly dissuaded from accessing necessary healthcare. Developing mutual respect for oneself and toward patients of other community will help in being compassionate, which is the basic quality of a nurse (Zellani & Seymour, 2011).
Muslim patients are quite often caught between the commitment to honor their culture and a health care system that does little to recognize the values, belief and social structure of the religion. Very less data is available to understand how Muslim view health and healing. The current research proposal will help in understanding the inequities and disparities in the health care provided to Muslim women and this in-turn can be applied to improve nursing care for this community.
Variable of Interest: The study has two variables, namely the patients and the nurses. The study focuses mainly of the Muslim women and their health care disparity. The following are some of the grievance noticed by patients and nurses treating Muslim women.
i. Low awareness to antenatal and post natal classes: There is insufficient involvement of the patient and her family members in these classes. Ante natal classes educate the women on labor, child birth, the procedure involved in it. Sometimes they are not told about these classes. These classes are in English language which, most Muslim women, find difficult to understand. Muslim women also find tremendous discomfort in attending such classes in the presence of other men. Muslim men, avoid attending classes as they feel that child birth is an all women sphere. Men are usually not present beside women at the time of delivery. It is the patient’s mother who comes for her support during these times. (THE MATERNITY ALLIANCE, 2004)
ii. Shortage of translators: Muslim women experience difficulty is communication, as most of them don’t speak nor understand English. Lake of translators in the health care set-up requires a relative or family member to act as a translator. Poor communication undermines the ability of a Muslim woman to make proper choices and decision about her treatment.
iii. Requirement for a same sex nursing personnel: Islam permits women to be seen by a male doctor, when doctor of the same sex is not available. However many women, regardless of their religious community, usually prefer female nurses and physician for gynaecology purposes. Having to see a male physician causes them a lot of stress associated with discomfort and embarrassment.( (THE MATERNITY ALLIANCE,2004)
iv. Privacy is yet another concern for this community. Women normally follow Hilja and Purda which requires them to be appropriately dressed, covering from head to foot, only exposing their hands from the ankle down. They don’t take off the Purda in the presence of other men. However ,due to lack of privacy in wards, they often left to encounter embarrassing situation like facing male members without Purda. Many prefer separate room to protect their modesty. In common wards, women prefer to keep the curtain/screen shut, however complain about hospital staff constantly pulling open the curtain while breast feeding the child and making them feel uncomfortable. (THE MATERNITY ALLIANCE,2004)
v. All Muslims are bound to pray 5 times a day, for which they require a quite and clean room without any disturbances. They need to wash themselves before the prayer, which is a part of their cleanliness ritual. Most hospitals don’t have such facility for the patients.
vi. Muslim women also complain insufficient involvement and choices in health care. One particular lady wanted a epidural during delivery of baby, but she had to stick with gas, because no other choices was provided to her. Sometimes the health care personnel do not bother to ask for consent. (Institute for Social Policy and Understanding., 2015)
v. Muslim women had also faced unfair, stereotyping and racist comments from nurses. Most often the healthcare staff responds to the patients question in a rigid and inappropriate manner.
v. Muslim or Asian midwifes are preferred and most sought by this Muslim community. They find them understanding and easy to communicate with.
The success of culture competence in hospital depends on the preparedness of the organization and the nursing staff in accommodating the needs of Islam community. Good accommodation can influence the health care seeking pattern. The following are some of the factors which the health care provider to Muslim can incorporate to provide better health care services:
i. Provide a welcoming atmosphere to all patients regardless of their religious belief and practices,
ii. Ask the patients if they will require a same gender provider, and also be able to provide same gender nurse. Inform the patients well in advance if a same gender nurse is not available.
iii. The nurse can knock and wait for permission before entering the patients room, so that the patients has time to dress in accordance with their perception of modesty.
iv. Provide hospital gowns and clothing’s that accommodate patient’s preference for modesty.
v. Provide Halal food and medication that will help alleviate stress and discomfort associated with violating religious belief.
vi. Allocate space for Muslims to pray. If the patient prays in the hospital room, staff should be made aware of the practice and told not to disturb praying patient.
vi. Health care can form partnership with the mosque and the local religious teachers to mitigate religious and culturally sensitive health care awareness campaigns and there by reach out to the Muslim community.

Research question: How do Muslims women view modern health care?

Sampling frame: A broad search was done in Google Scholar using the words “Islam women health” , “Muslim women health”, “Muslim Canada” , “culture competence and nursing” and “culture and health care”. Among all the literature listed, five articles which are most relevant to address the topic of interest were chosen. Articles that did not address any aspect of Islam, Muslim culture, health care were excluded.
Material and Methods: A critical analysis of the data was done using a Integrative review method as described by Souza, Silva & Carvalho, 2010. The data were organized based on the template in given in Appendix 1 of this article.
Integrative Literature review data analysis:

Appendix 1: Example of a data collection instrument

References:
1. Campinha-Bacote,J.(2010).A culturally conscious model of mentoring .Nurse Educator, 35(3), 130-135 .doi:10.1097/nne.0b013e3181d950bf
2.Graham,J., Bradshaw,C., & Trew,J. (2010). Cultural Considerations for Social Service Agencies Working with Muslim Client .Social Work, 55(4),337-346. doi:10.1093/sw/55.4337.
3. Griffith,K.(1996).Religious aspect of Nursing care. Vancouer.p.29-31. print
4. Hasnanin,M (2006). PATIENT–CENTRERED HEALTH CARE FOR MUSLIM WOMEN IN THE UNITED STATES. Chicago: University of Illinos at Chicago Press.
5. Hasnain,M., Connel,K.,Menon,U.,& Tranmer,P.(2011).Patient-Centered Care for Muslim Women: Provider and Patient Perspective. Journal of Women Health ,20(1),73-83. doi: 10.1089 /jwh.2010.2197.
6. Institute for Social Policy and Understanding.,. (2015). MEETING THE HEALTH CARE NEEDS OF AMERICAN MUSLIMS:. Washington DC: ISPU. Retrieved from http://www.ispu.org/pdfs/620_ispu_report_aasim%20padela_final.pdf
7. Johnston, C. (1990). Spiritual Aspects of Palliative Cancer Care. A working paper prepared for the Expert Committee on Cancer Pain Relief of the World Health Organization.
8. Leever, M. (2011). Cultural competence: Reflection on patient autonomy and patient good. Nursing Ethics, 18(4), 560-570.doi:10.1177/0969733011405936
9. Soueza,M., Silva, M., & Carvelho, R.(2010). Integrative review: what is it ? how is it?. Einstein, 8(1Pt1):1206
10. THE MATERNITY ALLIANCE, (2004). Experience of Maternity Services: Muslim Women’s Perspective. Retrieved from http://www.maternityaction.org.uk/sitebuildercontent/site builderfiles/ muslimwomenexperiencesofmaternityservices
11.Zeilani, R., & Seymour, J. (2011). Muslim Women’s Narrative About Bodily Change and Care During Critical Illness: A Qualitative Study. Journal of Nursing Scholarship, 44(1),99-107.doi:10.1111/j.1547-5069.2011.01427x