Scholarly article on topic 'Nurses and Muslim Patients: Two Perspectives on Islamic Culture in the Hospital'

Nurses and Muslim Patients: Two Perspectives on Islamic Culture in the Hospital Academic research paper on "Sociology"

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Abstract of research paper on Sociology, author of scientific article — Fernando Jesús Plaza del Pino

Abstract Objectives 1) To find out nurses’ perspectives on their Muslim patients’ cultural aspects. 2) To find out Muslim cultural and religious aspects in the hospital setting from the Muslim patients’ point of view. 3) To contrast nurses and Muslim patients’ perceptions of Muslim religion and culture. Method Grounded Theory is performed using thorough interviews to collect data. Informants: nurses in hospital units (N=32), Muslim patients admitted into a public hospital in Almería (Spain) (N=37). Results Nurses. Stereotypes determine their perspectives on Muslim patients’ cultural aspects. Despite not understanding them, they respect them. They perceive great cultural distance from Muslims. Muslim patients. Two main categories arise: variability in the way Islam is interpreted and followed and the fact that religion is left “in a second place”, putting a full recovery from illness before the precepts of Islam. Similarities with Andalusian culture are found. Conclusions Healthcare providers’ interpretation of Muslim characteristics is determined by stereotypes and prejudice. This contrasts with the heterogeneity found in terms of how the precepts of Islam are followed. In general, nurses are willing to learn about Muslim culture and they deem it positive to have greater cultural understanding and respect in order to improve healthcare.

Academic research paper on topic "Nurses and Muslim Patients: Two Perspectives on Islamic Culture in the Hospital"

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ELSEVIER Procedía - Social and Behavioral Sciences 237 (2017) 1131 - 1137

Social and Behavioral Sciences

7th International Conference on Intercultural Education "Education, Health and ICT for a Transcultural World", EDUHEM 2016, 15-17 June 2016, Almena, Spain

Nurses and Muslim patients: two perspectives on Islamic culture in

the hospital

Objectives: 1) To find out nurses' perspectives on their Muslim patients' cultural aspects. 2) To find out Muslim cultural and religious aspects in the hospital setting from the Muslim patients' point of view. 3) To contrast nurses and Muslim patients' perceptions of Muslim religion and culture. Method: Grounded Theory is performed using thorough interviews to collect data. Informants: nurses in hospital units (N=32), Muslim patients admitted into a public hospital in Almería (Spain) (N=37) Results: Nurses. Stereotypes determine their perspectives on Muslim patients' cultural aspects. Despite not understanding them, they respect them. They perceive great cultural distance from Muslims. Muslim patients. Two main categories arise: variability in the way Islam is interpreted and followed and the fact that religion is left "in a second place", putting a full recovery from illness before the precepts of Islam. Similarities with Andalusian culture are found.

Conclusions: Healthcare providers' interpretation of Muslim characteristics is determined by stereotypes and prejudice. This contrasts with the heterogeneity found in terms of how the precepts of Islam are followed. In general, nurses are willing to learn about Muslim culture and they deem it positive to have greater cultural understanding and respect in order to improve healthcare. © 2017PublishedbyElsevierLtd. Thisisanopenaccess article under the CC BY-NC-ND license (http://creativecommons.Org/licenses/by-nc-nd/4.0/).

Peer-review under responsibility of the organizing committee of EDUHEM 2016. Keywords: Nursing; Muslim; Migration; Interculturality; Culture.

1. Introduction

The increase in cultural diversity of western countries is a challenge for the healthcare system and professionals. The difficulties of caring for foreign patients not only have to do with occasional communication problems because

* Corresponding author. E-mail address: ferplaza@ual.es

1877-0428 © 2017 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.Org/licenses/by-nc-nd/4.0/).

Peer-review under responsibility of the organizing committee of EDUHEM 2016. doi:10.1016/j.sbspro.2017.02.167

Fernando Jesús Plaza del Pino*

University of Almería, Spain

Abstract

of language barriers, but also with cultural differences between the healthcare practitioner and the patient, who may not share the same rules, values or behaviour models. Without a doubt, discrimination and racism must never be present in healthcare (Boladeras et al, 2007), where the UNESCO (2011) premise should always be respected: defence of cultural diversity is an ethical imperative indissociable from respect for the dignity of the individual.

This multicultural context has lead to this research into the healthcare received by the immigrant population and the relation between nurses and these patients (Plaza del Pino, 2010). First, the relation between nurses and Muslim patients has been analysed from the professionals' perspective. Later, the patients' point of view on this a spect has been analysed.

The study focused on Muslim patients since they make up the largest community in Almería (Spain), where the study was conducted. It is estimated that around 100 000 Muslim inhabitants, between 17% and 20% of the total population, live in Almería (Spain), and the largest group come from Morocco (Spanish Statistical Office, 2015). It must be noted that according to several studies, Maghrebian immigrants receive the most negative judgement in Spain (Cea D'Ancona, 2002; Navas et al. 2004).

The present paper compares some of the results and discussions of the two studies already mentioned focusing on the Islamic culture.

2. Objectives

- To find out nurses' perspectives on the their Muslim patients' cultural aspects.

- To find out Muslim cultural and religious aspects in the hospital setting from the Muslim patients' point of view.

- To contrast nurses and Muslim patients' perceptions of Muslim religious and cultural aspects.

3. Method

A qualitative approach is used since it is the most suitable method to analyse statements and to fully understand the events, taking into account the participants' situation and culture (de la Cuesta, 2006). The Grounded Theory was used and, following Strauss and Corbin's methodology (1998), the aim was to understand what is happening and how the actors play their roles (Dick, 2005) in the research situation.

3.1. Data collection

Thorough interviews were carried out where informants chose. In the case of nurses, most of them took place in the hospital, whereas patients were interviewed in their homes. Interviews were recorded and the average duration was 25 minutes both for patients and nurses.

3.2. Informants

First study: Nurses of public hospitals. Participants were selected from nurses with more than one year of seniority trying to include the different hospital departments. Participation was voluntary. Age and sex distribution of the informants can be found in Table 1.

Tablel : Age and sex distribution of the informants.

Sex Age Total

Younger than 31 Between 31-40 Older than 40

Women 5 13 8 26

Men 1 3 2 6

Total 6 16 10 32

Second study:Muslim men and women admitted into a public hospital in Almería (Spain). Informants of different nationalities, with different levels of Spanish and immigration status, etc. were selected. Participation was voluntary.

Distribution of the informants by sex and level of Spanish can be found in Table 2. Table 3 shows distribution by country of origin and sex.

TABLE 2: Distribution of the informants by sex and level of Spanish.

Level of Spanish/ Sex Men Women Total

Yes 11 9 20

No 5 4 9

Elementary 5 3 8

Total 21 16 37

TABLE 3: Distribution of the informants by country of origin and sex.

Country of origin/Sex Men Women TOTAL

Morocco 13 10 23

Senegal 4 1 5

Mali 2 0 2

Guinea Bissau 1 2 3

Other 1 3 4

TOTAL 24 16 37

3.3. Data analysis.

Both studies were analysed likewise. After transcribing the first interviews, open coding was performed and topics and key patterns were identified (Coffey and Atkinson, 2003). The aim was to obtain the first categories on which to work. Later, following aconstant comparison method with the following interviews, axial coding was used to make connections and reduce the number of categories and create a system of core categories representing the research situation. This system guided the selection and coding of new information (selective coding) in order to finish the analysis.

4. Results

Following the above-mentioned data analysis, up to 32 codes were found in the first study and 23 in the second (first categories) as a result of open coding. An outline of the main categories can be found below.

First study: The nurses

First categories:

- Interpretation of Muslims. They describe aspects of Muslim people from the interviewees' perspective.

- Awareness of one's prejudice.

- Ability to judge. Muslims are judged from the point of view of the interviewee's culture. Core categories:

- Ability to interpret. This group of categories include all contents describing aspects of Muslim patients from the interviewees' perspective.

- Gender relations.

...Muslim women are submissive and are subject to what Muslim men say. Some, not all but most of them, let's say... Muslim women are not important, they, let's say that they march to the beat of men (...) it seems that men do not let women have their own opinion, they are very authoritative and their orders must be respected (female aged 33) - Interpretation of Muslim customs.

When they are given food from outside the hospital it isn 't properly served (...) they eat a lot with their hands, not paying attention to hygiene, the boy is stretched out on the bed and she's feeding him and if they have siblings she also feeds them... this is... well... not very good (male aged 43) ... in the afternoon they put a mat on the floor and start to pray (female aged 39)

- Perspective on parent-child relation

What I know is that they 're usually very good parents, very family loving, families are usually close and parents, grandparents and grandchildren live together, they are not thrown out so, leaving aside their peculiarities, parents are affectionate towards their children (female aged 52)

- Sense of privacy.

I remember once when a patient did not let a male paramedic remove the urinary catheter and did not let me look at her wound dressing because there was a male paramedic in the same room making the bed with the curtains open. She said that because there was a man in the room I could not do that... that happened to me twice or three times with women (female aged 39)

- Attitude towards illness, death and pain.

(talking about how they stand pain) ... they curl up (imitating foetal position) and they do not scream or anything (female aged 29)

I think it's a bit like Catholics, the resignation because it is God's will and all that (...) in situations with strong pain, and in general they do not show the pain and you have to keep asking if they're in pain because they won't say anything (male aged 37)

- Perspective on the care given by Muslim people.

... when they have relatives, well, they behave like us; they get worried, they ask for information, they help them, I don't see any differences (female aged 35)

- Perspective on culture.

- Judging the culture as a part of the individual.

(+) I do not know if it is because they feel they are a little out of their culture (...) I know they usually follow their traditions (female aged 41)

(-) You are in a country where girls cannot wear the scarf at school (female aged 37)

- Awareness of cultural difference.

What I do perceive is a big difference between our culture and theirs (male aged 41). ...their customs are different from ours (female aged 31)

- Perspective on and knowledge about Islam.

I don't know much but from what I've seen I can say that the religion is totally different (male aged 47) Well... I do know a bit; about their prayers, their customs when eating, I know they do not eat meat; you always have to ask for a meal withoutpork.I know a little about Ramadan (female aged 43)

- Awareness of one's own prejudice.

I don't know, I don't know if it is something that has become so inherent in us, I sometimes think that we could feel more rejection against black people than against Muslims, because of how different they are from us. However, I feel more rejection against Muslims (female aged 53)

- Breaking down cultural barriers.

- Cross-cultural healthcare.

... I think cross-cultural nursing is very interesting. I hope it starts being used here (female aged 35)

- Willingness to learn about cultural aspects.

(+) I think so, I think it's interesting to learn about their traditions, because then we could understand why things happen (female aged 37)

(-) Well, to be honest, I don't have time for that (female aged 54)

- Judgement of cultural knowledge.

When you know more about people you can obviously improve (female aged 38)

The relation between healthcare professionals, patients and their families would improve (female aged 35)

- Overrating one's effort of understanding the culture

... I think we already do an awful lot compared with what they do because we have to adapt to their likings, their traditions while they do nothing (female aged 53)

- Behaviour patterns to break down cultural barriers.

... talking to her about what she thought... (female aged 47)

On several occasions I wanted to tell them about my life, how many children I have... but I can't (female aged 43)

- Respect for culture and customs. Mutual respect.

If they want to wear the scarf, I do not mind, it is the way they see life (female aged 46)

... I respect their traditions, their customs, their lifestyle but I do not share it (female aged 35)

The second study: Muslim patients.

First Categories.

The first codes found were divided into two main categories.

- Religious practice and beliefs.

- Healthcare professionals' attitudes.

Core categories.

Two main categories were found, they were called variability and religion left in a second place. Two aspects stand out: how informants perceive the professionals' attitude on their traditions and customs and the cultural similarities found with the host society.

- Variability i.e. the wide range of practices in terms of religion, culture and tradition followed by the informants. Daily prayer.

I am a Muslim and I observe Ramadan and all that although I don't pray or attend the Mosque (Moroccan male aged 34)

There are Muslims who pray and Muslims who do not (Moroccan male aged 41) Eating habits. In Islam some food and substances such as pork or alcohol are forbidden.

Khalifo (pork)no, we do not eat. But if I am hungry and I am given khalifo and there is nothing else, if you are hungry, you have to eat, there is no problem (Senegalese male aged 38)

It is hospital food, it is not the food you cook at home. You are given food, eating is not compulsory, you eat, I did not like it, but you have to eat (Moroccan male aged 29) One of the most common stereotypes of Muslim people is that they refuse to be treated by professionals of the opposite sex.

No, I don't mind because both men and women work in the hospital (Moroccan male aged 50)

No, I don't mind. As long as they treat me well... What can you do? There 's no problem (Moroccan female

aged 39)

I don't mind. In Morocco people are Muslim and we have male gynaecologists, nurses and all that (Moroccan female aged 43)

Only a minority showed a clear preference for being treated by professionals of the same sex. Others expressed that they would like to be treated by staff of the same sex but did not impose their opinion or refuse treatment.

Yes, because I am embarrassed (Bissau-Guinean female aged 37)

We think that for women another woman is better than a male doctor [...] I'm afraid of taking my wife to hospital and that there's a male doctor, this could be a bit close-minded, couldn 't it? (Moroccan male aged 44)

Regarding the habit of wearing a scarf, in many cases it is understood as a symbol of belonging to their community and an important link to their families.

It is in my religion, but everyone is free to do what they want to, I, as a Muslim, like to wear it, but if other women do not want to wear the scarf, I do not mind (Moroccan female aged 38)

I have worn the scarf for seven years already, I made my own decision because all my family wear it and I also want to wear it (Moroccan female aged 28) However, in many cases it is not used or it is used on some occasions.

I wear the scarf some days and other days I do not, for example, when I go to the hospital I like to wear it (Moroccan female aged 50)

- Religion is left in a second place. A large number of our informants put making a full recovery before religion and adapt their religious practices and beliefs to the hospital setting.

Regarding praying

No, not in the hospital. When everything finished, the surgery, I mean, I did pray at home (Moroccan male aged 42)

After the surgery I could not get up so I prayed in bed, later on the floor, in the hospital premises there is nowhere for Muslims to pray (Senegalese male aged 35) Regarding being treated by professionals of the opposite sex

If you are ill you have to be treated, if it is a man who has to treat you, it is necessary. Giving birth is something natural and "merciful", you cannot feel embarrassed. (Moroccan female aged 36) Or regarding wearing a scarf

While I was giving birth they took my scarf and I was given a cap that came together with the nightgown. Q: and, was it all right? A: Yes, because I felt less hot wearing the cap, after childbirth I put on my scarf again (Moroccan female aged 31)

- Healthcare professionals' attitude. In many cases healthcare professionals presuppose that their patients belong to a certain religion on the basis of their origin or name:

I think that they suspect I am a Muslim. It seems to me that they think that all black people are Muslims (Senegalese male aged 38)

To my mind they think that if you come from Morocco, you can only be a Muslim, but that is not true (Moroccan male aged 29)

The participants in our study quite often pointed out that they were not asked about their religion or whether they had special eating habits.

I was not asked about that, and I should have. (Bissau Guinean male aged 49) In some other cases, nurses did ask about religion and eating habits.

When she came for the first time she asked me: "What food would you like? I told her that I ate only fish when I was in hospital (Moroccan male aged 28)

They asked me if I eat meat, they respect my religion (Moroccan female aged 27) When the interviewees were asked about their perception of how much healthcare professionals know about Islam and their interest in having better understanding of Muslims' customs and beliefs, they said:

I think they are not interested in finding out and learning or speaking about our eating habits and all that (Moroccan female aged 32).

Some of them do not understand aspects of our culture, I took one woman to hospital once, her son interpreted her and the doctor asked the child to ask his mother if she had the period, how could a boy ask his mother such a thing? It doesn't make sense (Moroccan male aged 33)

- Perspective on cultural similarities.

Moroccan families are always with the patient to help them with anything they need, it is the same for you, Spaniards are the same as Moroccans (Moroccan female aged 50).

5. Discussion

The results show that nurses have a lack of knowledge of Islam due to preconceptions based on their own culture and on prejudice and social stereotypes that lead them to have a negative perspective on Muslim patients. They are aware of cultural differences and they think it is difficult that nurses and patients can overcome them.

This lack of knowledge does not prevent nurses from explaining Muslims' behaviour or what they are like and they do it mainly from their own culture. In fact, the participants in this study had a stereotypical view of Muslim people:

sexism and lack hygiene are stereotypes that come up again and again. It is also true that several professionals tend to empathize with Muslim patients and manage to interpret them better.

In general, they are willing to learn about culture and they deem positive to have better understanding of Islamic culture and to respect itin order to offer better services.

When analysing the results of the interviews with Muslim patients, the two core categories caught our attention: variability and the fact that religion was left in a second place.

Our data show that not all Muslim people follow their religion in the same way and some of our informants even claimed that they do not believe in or practice religion.

In general, a full recovery from illness is put before some pillars of Islam.

These findings contradict what some authors have stated regarding Muslims, how their beliefs and traditions become stronger and how they express their religiosity in a more evident way than in their home countries (Lacomba, 2009). The real situation of Muslim patients is very different from the stereotyped view offered, which describes them as a homogeneous group composed of people who follow religion in the same way and put it before any other aspect in life.

Regarding their opinion about whether nurses respect their beliefs and traditions, the following conclusions must be highlighted:

- Healthcare professionals often assume patients follow a certain religion on the basis of their name, appearance or country of origin. They do not ask about the patients' religion or religious practices they follow in order to adapt the treatment.

- Patients feel that professionals do not have any interest in learning about their culture or religion.

- Some professionals question some of the patients' religious practices.

- Our informants consider that their cultural and religious identity is recognised when the hospital staff ask them about their customs or make it easier for them to follow their practices in the hospital setting.

Our informants, despite the great cultural distance from Muslim people perceived by Spanish society (Cea D'Ancona, 2002), find cultural similarities between Muslim and Andalusian culture.

6. Conclusions

Nurses' opinions and ideas, like those of other members of society, are determined by prejudice and stereotypes which are deeply rooted in western culture. They share the feeling of rejection against Muslims. This study shows that social stereotypes about Muslims are not real. Nurses have the opportunity to get away from these preconceptions and have a closer relation, i.e. a professional relation, which is accidental so to speak, because it is not something chosen or wanted in many cases. However, it is still a relation which allows them to compare and contrast their prejudice with the reality. It cannot be forgotten that these stereotyped views have an impact on the relation nurses establish with these patients (Kessar, 2010)

In Spain, healthcare authorities and nurses did not expect to work with foreign patients and, consequently, they were not trained for that. It is necessary to raise awareness of the negative opinions and to work to change them. Specific training is also required to encourage a greater understanding and respect of the patients' culture and to develop nurses' intercultural skills. It is necessary to improve the attention offered to Muslim patients, taking the person as a holistic being. Specific training in cultural competence is essential.

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