The patients religious and cultural beliefs and practices are critical factors that usually affect the healthcare providers in making ethical decisions. Patients who have strong cultural and religious beliefs pose a challenge in their uptake of healthcare services, especially those considered as holy or taboo. Among the Arabs, almost every aspect of life, including healthcare uptake, is determined by the culture, which is almost synonymous with the traditional Muslim creed. Therefore, the nurse must first be conversant with basic Arabic cultural and religious beliefs. In the Arab culture, modesty and purity are the key values that must be upheld by women (Purnell, 2013, ch. 9, pp. 159-177); some illnesses can be a source of shame to the females family and may negatively influence their marriageability.
Young unmarried girls are considered holy, and they are not supposed to be touched before they are married. Virginity must be preserved until marriage (Abboud, Jemmott, & Sommers, 2015). Hence, it is sensitive to have a physical examination in the young girls vagina for fear of compromising the virginity. However, it does not mean that the health of the young girl should also be compromised because of the parents cultural beliefs. The nurse should inform the mother that physical examination would not affect her daughter's virginity, and therefore there is no need to worry. Additionally, the nurse should inform Mrs. Nasser that taking medications without a physical examination is dangerous. The reason is that drugs might make the condition even worse because they would be given based on the information provided by the patient and the physicians assumptions about the health status. It is against the evidence-based practice that requires sufficient arguments gathered before prescribing medications to a patient.
The nurse should also explain to the mother that it is for her daughters benefit to have the examination. In fact, losing virginity means that one has had coital sexual activity. The physical exam on the vagina is similar to any other medical exam; therefore, it cannot affect the girls virgin status. According to her culture, losing virginity means breaking the hymen. Consequently, it will be essential for the nurse to inform Mrs. Nasser that the doctor is well trained to perform the vaginal exam without interfering with the hymen. Moreover, she should instruct Mrs. Nasser that there are chances that the hymen may break though it varies from one girl to another. Finally, the nurse should inform Mrs. Nasser that she has a right to refuse or accept her daughters medical examination provided which does not pose serious consequences for the health of the latter.
Identify Culturally Congruent Strategies That May Be Most Effective in Addressing the Needs of Mrs. Nasser
The needs of Mrs. Nasser should be addressed by first acknowledging and appreciating her cultural beliefs. There are four main strategies that may be employed to address this issue. First, if there is a healthcare worker at the hospital who is from the same cultural background as Mrs. Nasser is, he or she should be asked to talk to her about the importance of a physical exam before being given the medications. It has been proved that culturally-bound patients are more likely to comply with healthcare provision if a person from their cultural background addresses their concerns. In addition, the consultation should be sought from a member of the Arab community such as a religious leader to give an explanation on how such an issue should be dealt with respectfully. In the Arab community, Muslim leaders play a key role in interpreting the cultural beliefs and their limitations (Walton, Akram, & Hossain, 2014). They may also play a crucial role in educating mothers concerning the way physical examination can be done in line with observation of Islamic beliefs.
Being objective is another helpful strategy that can contribute to a mutually benefiting eventuality for the patient. The aim is to avoid any stereotypes towards the Arab community which usually have a negative impact on the patients uptake of the healthcare services (Walton et al., 2014). It would not be advisable to make assumptions on Mrs. Nassers concerns; for example, stating all Arabs have these problems, and they are hard to deal with. Such assumptions may hinder appropriate care to the patients. Considering that men are the key decision makers in the Arab community, the nurse should seek advice from Mrs. Nassers husband or a senior male family member. She should explain to him the importance of performing the medical exam. If the male family member is convinced about the essentiality of the examination, he would be able to pass it to Mrs. Nasser.
How Might the Nurse Ensure that Mrs. Nassers Concerns Are Addressed Appropriately and that Saima Received the Appropriate Care?
An effective way to address Mrs. Nassers concerns is to respect her culture while at the same time educating her about the importance of the physical exam. She should also be informed about the pros and cons of withholding her daughter from receiving the appropriate care to make informed decisions. The counseling should be done in a compassionate way, which respects the client's opinions. For example, the nurse or the person giving the counseling must acknowledge the importance of maintaining virginity before marriage in the Arab culture. In case a girl is not married and is found not being a virgin, the consequences can be very brutal, including being considered a prostitute and an outcast (Walton et al., 2014). It is, therefore, critical to explain Mrs. Nasser that these concerns are understood. The nurse must guarantee the mother that her daughters virginity would not be compromised in any way. A person who had undergone similar examination should be presented to her and give an account of how the process took place. However, it must be noted that individuals may have different experiences though it does not mean that Saimas case would be the bad one.
The nurse should also inquire whether there is any other person from the same cultural background who had a similar condition to understand how the problem was addressed. Mrs. Nasser would be more willing for her daughter to undergo the examination if she gets a testimony from a fellow Arab who had similar experience. If the concern is more about the breaking of the hymen, the nurse should explain to the mother that hymen can also break due to other activities such as riding bike or intense sporting activities (Abboud et al., 2015). Thus, it does not mean that the vaginal exam could be the sole cause of the hymen breakage. It would therefore be necessary to ask Samia whether she had engaged in such activities to rule out their impact. Though Saima is still a child, at the age of 16, she is old enough to be an active party in her health care. The nurse should allow her to explain how she is feeling and what she expects from the examination. However, the examination should not be performed without the mother's consent. The Arab culture values the patients informed consent before the uptake of a healthcare service (Purnell, 2013, ch. 9, pp. 159-177). The nurse must have an open mind to wisely accommodate the mothers and daughters views before the physical medical exam.
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