NUR 3010
Prof. Okumakpeyi
NYCCollege of Technology
Giannela Beltrame
10/9/2013
The United States is a diverse country composed of many different cultures. The Merriam-Webster dictionary defines culture as "the beliefs, customs, arts, etc., of a particular society, group, place, or time." With that said, these many cultures introduce their practices, beliefs, and customs into the society to have a sense of feeling at home. Although they may not be the exact as back in their country, the basic principle is still present. They adapt their culture to the new environment.
The meaning of health and illness varies from culture to culture. For example, people of a certain culture may avoid eye contact at all costs because they believe it is disrespectful, whereas others will joyfully and willingly speak about their past medical history. This may impact the interview and/or health history data collection process because accurate information may not be fully collected if we do not know how to approach people of distinct cultures.
Being knowledgeable of each and every culture is very important and will reflect how we will treat our patients. Every nurse should be culturally competent in delivering care to patients of different cultures. Nurses have to be mindful of what the practices and beliefs are regarding medical care in each patient and how to talk to people of different cultures. Putting our competence in culturally specific beliefs and practices in action will help nurses deliver the appropriate and necessary care to our patients.
Muslim Americans have many beliefs and practices that may interrupt the health care delivery but by carefully analyzing each and every aspect regarding health care, health care professionals can incorporate measures that can meet this cultures standards, and thereby provide the appropriate care without violating their principles.
Practices, beliefs, values, and customs
Many of the practices and beliefs are derived from the holy book of Islam, the Quran. To be called a Muslim, a person "must accept five primary obligations, called the Five Pillars of Islam," which are: to profess the faith stating that there is one God and one Messenger of God, Mohammed; praying five times a day, at dawn, noon prayer, afternoon prayer, sunset prayer, and evening prayer; Zakah, or giving a certain percentage to charity every year; fasting from dusk to dawn during the ninth month of the Muslim year, Ramadan; and pilgrimage to Makkah, or the Hajj which Muslims are required to do once in their lifetime (Odef, 2008). Because a clean body reflects a pure soul, it is very important for Muslims to cleanse before a prayer. This involves properly washing their hands, rinsing their mouth, nose, and ears, and lastly, washing their feet. In addition to purifying their external body, it is crucial to have a prayer rug while performing the prayer.
Other beliefs and practices are also taken from principles in the Quran, but may vary from individual to individual. Abortion is strictly prohibited with the exceptions of a few situations. If the fetus is less than 120 days and is diagnosed with a deformity that cannot be treated or reversed, then it is permissible to abort the fetus. On the other hand, if the fetus with a permanent deformity is more than 120 days old, then it is not permitted to perform an abortion, unless this situation puts the mother's life at risk. However, if the fetus continues to reside in the mother's womb and becomes a living being, the religious custom is that shortly after birth, an elder or the father whispers the Islamic prayer call in the infant's ear. Another practice commonly known worldwide is the circumcision of the male infant, performed for its health benefits such as, preventing infections, cancer, and sexually transmitted diseases (STD's) (Lowdermilk, 2010).
Because health and life are considered a gift from God, Muslims are exhorted to live a healthy lifestyle abstaining from certain foods and contaminants. The food they consume should be Halal, meaning the meat is to be slaughtered or prepared in conjunction with Islamic law. This entails refraining from anything containing pork and/or alcohol. Smoking is strongly discouraged, as it contaminates the body. Another contaminant that should be avoided is alcohol because of its effects, such as acting in a dangerous manner.
As discussed before, many cultures have different meanings of health and illness. Muslims view their body as a gift and will do anything to preserve its health. They believe in predestination, that God has planned out their future and that if they are suffering from a disease it is because he has preordained it for them (Miklancie, 2007). Therefore, some may opt out from receiving treatment and/or taking prescribed medications and instead be very patient and pray a lot. Patience and prayer is very important because it helps them maintain a close relationship with God during difficult times. Illnesses are considered God's will; therefore they cannot cultivate negative attitudes such as anger, because that would be considered rebellious against God.
Generally, in the Muslim culture the male will take the lead in making medical decisions for the woman. When planning specific treatment plans, it is important to involve the family and offer them time to come to an agreement regarding the treatment. In case the woman is alone, the male husband will have to be contacted and the decisions regarding treatment may have to be delayed until he is present. It is also advisable for the health care professional to respect the cultural arrangement the family has of allowing the male to make all the decisions for the woman.
Access to Health Services
In 2008, 83.2% of people had health insurance. This leaves 16.8% of Americans without insurance. The goal for 2020 is for 100% of people to have full coverage and "improve access to comprehensive, quality health care services” (Healthy People, 2013).
When it comes to the Muslim population, many decide not to seek care for a variety of reasons. Most are immigrants who have recently come to this country and do not know English very well and so they are not very well informed about the health care system offered here. Others are embarrassed, as is the case of some pregnant woman who avoid prenatal visits. Depending on the area and the availability, only male doctors may be present and this makes it extremely difficult and not to mention uncomfortable for these women to seek care. Oftentimes, they will demand to be examined by a female doctor and when this is not immediately possible, they prefer not to be seen at all.
Choosing not to be seen by a medical practitioner can lead to a decreasing quality of life. Some may be physically and not even know it because they were not up to date with their check-ups and screenings. The goal of Healthy People 2020 to access to health care is for people with no health insurance to be able to access medical services that will meet their needs and provide them with a quality of life enough to sustain them.
Considerations for the Interview and Health History
It is crucial for nurses and practitioners to be culturally competent when assessing the patient and asking about their health history. Particularly with the Muslim population, modesty is extremely important. Because many women of this culture are dressed in a hijab, it is appropriate to knock on their door prior to entering the examination room and awaiting their response and allowance to enter. Another circumstance where the medical team should be modest is when physically examining the woman. They do not “tolerate unnecessary exposure of their bodies” (Hammoud, 2005). Therefore, it is reasonable to uncover only the part being examined (Ex: the arm).
Interconnected with modesty, are the staff provided for the patient. Generally, Muslim women will prefer to see a female practitioner and/or nurse. When this is not possible, it would be appropriate to approach the patient and inform her about the situation and advise her about alternatives she might want to take, such as having her family present or having a female staff member present in the room (Hammoud, 2005). However, this will not always be the case for all women. Some, who strictly adhere to their culture and religious beliefs, will refuse to be seem by the opposite sex and thus, delay the assessment process. This concept not only applies to women, but to men as well.
Given that most Muslims are immigrants and are not very familiar with the language spoken in the United States, it would be very appropriate to provide a reliable interpreter. This is important when asking the patient about their health history. The health care provider wants to obtain the most accurate information possible, but if the patient does not understand what the doctor and/or practitioner is asking, then the information will not be complete or accurate. Providing an interpreter is also important when making decisions about the treatment plan being proposed. The patient must fully understand what the treatment implies and the benefits, alternatives, and risks associated with the treatment. With that resource provided, the patient will be able to make a decision to the best of his or her ability.
Another important consideration to keep in mind while interviewing the patient is to keep eye contact to a minimum and limit touching the patient unless direct care is given. These points correlate with their level of modesty and should be respected. It is important to have complete understanding of the culture’s meaning of health and how it is provided in order to make the patient feel comfortable and satisfied with the care given. This might influence future decisions to seek care. If they are overall satisfied with the respect given during visits, they will be more willingly to seek health care advice and screening and this will potentially increase their quality of life.
Health Promotion Plan for Access to Health Services
Since many Muslim-Americans do not have health insurance or choose not to seek medical help, I have decided to open a federally funded community health center which will be situated in an area where the Muslim population is greatest. To let the public know about this new clinic, I feel that handing out flyers and posting them in businesses they mostly visit, like supermarkets, would be enticing. These flyers will contain the purpose of this clinic and the people that are encouraged to attend – those not insured. Another way to promote this clinic would be to have medical staff reach out to people in the community by laying out a table in a commercial area and encouraging Muslim people to take invitations to this clinic and explaining to them that is a “no strings attached” clinic, meaning they do not need to pay out of pocket or have specific insurances.
The ideal clinic would be one in which many patients would feel at home. Given that prayer is really important for this population, I plan to have a designated area where they can go and pray peacefully with no environmental distractions. Rugs and appropriate bathroom facilities will be provided for them to cleanse prior to prayer. Along with prayer areas, the Quran will also be provided, that way also promoting their spirituality and showing them respect.Another measure to be taken into account is staffing. The health care team will have the competence necessary to take care of these patients. There will also be an equal and adequate amount of female and male medical staff so that basic cultural needs will be met (Ex: female nurse for a female patient). In addition, I would also like to have staff that share the same culture, that way patients can feel more comfortable and trust can be built with the team. Along with fostering trust, this will be an important influence when it comes to follow-up visits.
The purpose of this clinic is to promote health activities and detect and prevent any complications. Therefore, screenings of all types will be provided. Screenings like blood pressure, blood glucose, and cholesterol will be provided, and the staff will be encouraged to explain the meaning of the results and what measures they can take to decrease or increase levels. Also, for women, female nurses and practitioners will encourage breast self-examination (BSE) and explain why it is necessary and what to look out for (Ex: lumps, bloody discharge). The medical staff will also encourage patients to role play what they have just been taught to make sure they understand how to perform screenings, such as blood glucose measurements. This will promote health and will get the patients to be more active and start taking measures to increase their health. In addition to these health screenings, a nutritionist will be present at the clinic. Patients will be encouraged to visit the nutritionist and gain knowledge on what dietary measures they should adapt to – of course not violating the principle of eating halal foods. Adjusting the diet and including more fruits and vegetables into their diet and decreasing carbohydrates will promote their health by significantly decreasing their risk of diabetes, coronary artery disease, and hypercholesterolemia.
With these measures, I believe the clinic will a very successful place. Many Muslims are reluctant to seek medical care and/or advice because they are embarrassed or simply do not have the means, like insurance. Having staff that the patients can relate to will definitely cultivate that trust that is needed in their health. This trust will enable patients to want to come back and maintain a regular schedule in their follow-ups. These measures will help close the existing gap in this culture. Since this culture is very family oriented, they will be more likely to “spread the word” to their family members and friends, that way reaching out more to that culture.
Cultural competency is having the knowledge of each and every culture and applying it to patients. This entails respect for their beliefs and cultural practices. Having done so much research, I have gained even more knowledge on the Muslim American culture that I had not known before. This will definitely help me in the work field because like other cultures, Muslims are a rapidly expanding community. They will need the appropriate care even when there are no nurses with the same background, and that is why cultural competency is of major importance. This will prove to them that we have knowledge and respect towards them and they will be more willing to accept the care that we have to offer.
References
Access to Health Services. (2013, April 10). Healthy People. Retrieved September 25, 2013, from
Hammoud, M. M., White, C. B., & Fetters, M. D. (2005). Opening cultural doors: Providing culturally sensitive healthcare to Arab American and American Muslim patients. American Journal Of Obstetrics & Gynecology, 193(4), 1307-1311.
Lowdermilk, D.L. (2010). Maternity Nursing. Maryland Heights, MO: Mosby Elsevier.
Miklancie, M. (2007). Caring for patients of diverse religious traditions: Islam, a way of life for Muslims. Home Healthcare Nurse, 25(6), 413-417.
Odeh Yosef, A. (2008). Health Beliefs, Practice, and Priorities for Health Care of Arab Muslims in the United States. Journal Of Transcultural Nursing, 19(3), 284-291.