Cultural Competence Q&A

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Understanding Islam

For nurses as well as the health care facilities that employ them, understanding Islam and its practices is an essential part of building required cultural competency. Muslims are one of the fastest-growing populations, both globally and in the United States. Many U.S. cities, such as New York, Los Angeles, Chicago, San Francisco and Detroit, have large and dynamic Muslim communities. An important part of providing culturally appropriate care to Muslims is understanding Islam as their way of life and how their adherence to the teachings of Islam shapes their beliefs and practices regarding health, illness, preventive medicine, birth, death, etc.

"Islam" can be defined as submission and surrendering to Allah (God) by following and obeying his orders. For Muslims, Islam is not just a religion but a complete way of life, guiding and governing all their life aspects. Therefore, adhering to Islamic teachings is much more important than anything else in a Muslim's life, to the extent that Muslims will sacrifice their own welfare-such as possibly losing their jobs-rather than violate Islamic teachings. This is because Muslims place the greatest value in accountability on the Day of judgment, which will determine one's fate in the hereafter. For Muslims, adherence to Islam is not limited to just this short earthly life; rather, it is a test to escape hellifire and achieve eternal paradise.

Prayer is one of the highest forms of worship in Islam, in which Muslims communicate with Allah while reciting from the Quran (the holy book of Islam). Muslims pray five mandatory prayers every day on a time schedule. It is important for health care providers to assist Muslim patients in performing their prayers on time and to be aware that Muslims do not speak or respond to anyone but Allah during prayers.

Treating Muslims with Cultural Sensitivity in a Post-9/11 World

From respecting patients’ religious needs to accommodating Muslim nurses’ dress requirements, understanding the role of Islam in Muslims’ lives is an essential cultural competency skill

with Gihan ElGindy, RN, MSN

Gihan ElGindy, RN, MSN

Editor's Note: Meet Minority Nurse's new cultural competence expert: Gihan ElGindy, RN, MSN, an internationally recognized authority on cross-cultural issues in nursing. Her new advice column is designed to answer your questions about incorporating cultural competence into your nursing practice and resolving cultural conflicts in today's diverse health care workplace. Do you need expert advice on how to provide culturally sensitive care to patients from a particular ethnic or religious background? Are you looking for ways to increase understanding and acceptance of cultural uniqueness in your work environment? Our expert can help!

Send your Cultural Competence Q&A questions to pam.chwedyk@careermedia.com or post them on the new Cultural Competence section of the Discussion Forum.

Q:

I am a Muslim nurse who wears Hijab. I am frustrated because infection control staff are always asking me to wear short sleeves or roll up my sleeves. How can I avoid this situation and make them understand that my long dress, long sleeves and headscarf are mandatory religious practices for Muslim females? In my opinion, my long sleeves do not pose a considerable infection hazard.—A Muslim RN

A:

Muslim working women, including nurses and other health care professionals, often face challenges related to their attire. Many times, these challenges originate from misconceptions and/or limited knowledge about Islam and Muslims. To be culturally sensitive to the needs of Muslims in the health care workplace, it is essential for employers to understand that Islam is a religion that governs all aspects of a Muslim’s life. Muslim employees who practice Islam must adhere to its mandatory religious practices, such as following the Islamic dress code by wearing Hijab.

The Islamic dress code is mandatory for both women and men. For females, wearing the veil or Hijab means covering all body parts except for the face and hands upon reaching puberty. Men are required to grow a beard and refrain from wearing gold and silk. Both sexes must wear clothing that is modest, loose-fitting and does not distinguish specific parts of the body, such as the hips.

For Muslim women, wearing a headscarf, long sleeves and long, loose-fitting clothing is a way to obey Allah according to Islamic teachings, especially in the presence of male non-family members. They may, however, dress as freely as they wish in the privacy of their homes. Yet it is important to keep in mind that Islam, like all other religions, has those who do not practice or adhere to the requirements of the religion, as evidenced by Muslim women who do not wear Hijab and Muslim men who don’t have beards. This is often a source of confusion to non-Muslims.

It’s also worth noting that wearing the veil and covering the body are traditional religious practices that are not unique to Islam; they are found in other faiths as well. For example, in Christianity nuns wear the “habit.” In Judaism, women cover their hair before going into synagogues and men wear a yarmulke.

So how should this Muslim RN handle her conflict with the infection control staff? First, let me say I admire your strength and pride in standing up for what you believe in and your right to freedom of choice in this land of freedom. I would suggest sitting down with the infection control staff to try to educate them about your dress requirements in a friendly, non-confrontational way. It would be helpful to make basic information about Muslim culture and Islam available to them—such as this column and other articles you may find on Islamic Web sites or in mosque libraries—so they can build their cultural competency. Also, try to discuss your situation with the diversity director or coordinator at your facility, if there is one. He or she could prove to be a great asset to you in this matter.

Sadly, since September 11 cultural insensitivity toward Muslims in the workplace has become a widespread problem throughout the country. We all need to learn to be open-minded and try very hard to understand and respect each other’s views and beliefs. Hopefully, we can learn from each other and focus on the work Muslim nurses do, rather than on what they wear.

Q:

I have found caring for Muslim patients to be a very demanding and frustrating assignment. They ask for many things that we nurses are unfamiliar with and that can create conflicts in a hospital setting. For example, asking for lots of water to wash themselves before and after using the bathroom, which may make a mess, especially if bed rest was ordered. Can't they delay all these special requests until after they are discharged?—J.S., Arkansas

A:

It is quite common for care providers who are not familiar with Muslims and their practices to be confused and even bewildered by their requests. Here are a few tips that can make your job easier and more pleasant.

First of all, it would be culturally insensitive to ask Muslim patients to put their religious practices “on hold” until after they are discharged. Adherence to Islamic teachings governs every aspect of Muslim life and must be practiced every day, regardless of the physical setting in which Muslims may find themselves. (See “Understanding Islam.”)

What's behind the requests for water? Muslims are religiously responsible for their lives, health and well-being. Islam requires Muslims to stay healthy by focusing on preventive medicine and good hygienic practices. Maintaining cleanliness is considered a required act of worship. Muslims must pray to Allah five times a day; in preparation for prayers, they must start with the cleansing process known as “ablution.” This consists of washing the face, hands, arms, legs and feet, using running water—even if the person is in a hospital bed.

Mandatory cleansing practices using running water are also required in these situations:

After elimination, for removal of all traces of urine, stool and/or blood.

After the cessation of menstrual and postpartum bleeding, and after sexual intercourse.

When Muslims are hospitalized, they are very sensitive to traces of urine, stool and/or blood on their clothes, body or linen because they believe it interferes with the status of purity that is required for prayer and reading the Quran. To Muslims, this sense of cleanliness and purity is not only necessary for worship but also essential for spiritual comfort during illness, hospitalization or crises. Indeed, performing ablution, praying and reading the Quran are among the most important spiritual resources for Muslims during sickness or stressful times. As in many other religions, prayers can erase bad deeds and make entry to paradise easier, as well as improve the patient's mindset to enable a speedy recovery.

You will be happy to learn that nurses can easily accommodate Muslim patients' religious cleansing needs in ways that will not turn the hospital room into a wet mess or interfere with the patient's medical treatment. You can simply escort the patient to a source of water, such as a sink or shower. If the person is confined to bed or has other special conditions that limit mobility, a full pitcher of water with a basin as a receiver can meet the running water requirement. If water is medically contraindicated and/or can cause harm to a wound or damage to a cast, for example, you need to explain this clearly to the patients so that they can modify their cleansing practices accordingly. In these situations, Muslims know how to dampen a hand with water and wipe the affected body part with it to maintain their needed cleanliness before worshipping practices.

Gihan ElGindy, RN, MSN, is an educator and independent consultant on health, nursing, cultural competence, education and business entrepreneurship issues. She is the executive director of Transcultural Educational Center (TEC) in McLean, Virginia. For more information about TEC, visit www.TECenter.org.

Send your Cultural Competence Q&A questions to pam.chwedyk@careermedia.com or post them on the new Cultural Competence section of the Discussion Forum.