In this case study, two cultures cross paths in a hospital in Germany, raising cultural
and ethical issues. Anna, the nurse, struggles to accept the requests and needs of Abdul a
Muslim patient, who does not fit her cultural model of the typical German patient. It is worth
to note, that the same situation could have happened in reverse, with Anna being a German
patient in any Islamic country, needing immediate attention from a doctor for a sudden pain,
but possibly not receiving prompt care because time would be lost seeking a female doctor.
The cultural issue described here is therefore applicable to any country in the world.
Case Description and Major Issues
Abdul Hadi is a Muslim patient in a hospital in Germany, that just underwent surgery.
Because of post-surgical limitations in movements he needs special assistance to bath himself.
Bathing and cleaning himself are particularly important to him since he cannot pray
otherwise. Anna, the hospital nurse responsible for Abdul, is offering help, but she is
becoming increasingly intolerant of Abdul requests. Abdul also has issues with the hospital
food since he cannot eat pork or drink alcohol. He has very few options in the hospital
cafeteria. Other patients in Abdul’s room complain that Abdul receives too many visitors
which increase the noise level beyond what they think it would be fair to tolerate.
The major issues in this case are:
• Anna is developing negative emotions and intolerance towards Abdul and as a result,
she is lowering the care level that she grants him;
• Abdul is feeling discriminated by Anna’s behavior, and by the hospital policies. He
feels that he is barely receiving the cures but not the care he needs.
The hospital appears not equipped to deal with a patient from a different culture, with
special needs, and might be engaging inadvertently in discriminatory practices. At the same
time, Abdul has the right to expect the best level of cures and care from the hospital and its
personnel regardless of his religion or ethnic origin. Different cultural values are at play in
this case, in particular at national, regional, and individual levels.
National Level
National cultural values are shared unconsciously by the majority of a population
(Cultural Intelligence for Leaders, 2012) and developed since childhood. The Globe study
from House, Hanges, Javidan, Dorfman, and Gupta (2004) can be used here to see already
that the German nurse comes from the geographic cluster “Germanic Europe” which is high
in the “uncertainty avoidance” dimension, defined as strong in the “need for established social
norms, rituals, and practices” (2012, p. 60), which leads to behaviors such as “show strong
resistance to change, rely on formalized policies and procedures, use formality in interactions
with others” (2004, p. 618). While Abdul, assuming he is originally from the geographic
cluster identifiable as “Middle East.” is most likely low on “gender equality” defined as “the
degree to which a collective minimizes gender inequality” which leads to behaviors related to
“[support] fewer women in position of authority, more occupational sex segregation, afford
women little or no decision-making role in community affairs” (2004, p. 359). Therefore
Abdul is unwilling to accept help from a woman for cultural and religious reasons, and Anna
is naturally uninclined to change her behavior and accommodate new practices.
Regional Level
The case study does not mention any influence from regional cultural values.
However, it is likely that in the region Abdul is not the only Muslim since he receives many
visits from his relatives. The hospital should then increase its awareness of the cultural issue.
Individual Level
Anna and Abdul seem to express the behaviors and expectations that are born with,
and make little effort to adapt to the different culture. Each of them expects the other to
eventually, comply with the culture of the other. Their resistance to change is turning into conflict with a potential negative consequence on Abdul’s psycho-physical recovery.
Case Analysis - The Five Behaviors – Issues and Solutions
Behavior #1 – Abdul needs to shower or bathe himself, but cannot receive help from a
woman. Male nurses seem to work on different shifts. Solution: rearrange shifts to guarantee
at least one male nurse during at least half of the day.
Behavior #2 – Abdul medication should not contain pork or alcohol derivatives.
Solution: the hospital should make available alternative medications.
Behavior #3 – Abdul diet is jeopardized by the hospital cafeteria that does not offer a
wide enough choice. Solution: reserve a portion of the cafeteria offering for Muslims.
Behavior #4 – Abdul visits disturb the patients in his room. Solution: limit the number
of visitors allowed in each room at once for all patients, or allocate rooms for Muslims only.
Behavior #5 – Abdul needs to get out of bed to pray, and Anna was not always ready
to help him. Solution: find a volunteer that would be trained to assist Abdul religious needs.
Case Analysis – Hospital Possible Actions to Improve
The hospital should survey what ethnicities more frequently require their services, and
develop a transcultural nursing program as first developed by Leininger (2002). Maier-
Lorentz stated “nurses must be culturally competent in order to provide optimal care for their
patients. Most important, nurses need to maintain cultural competency in their daily practice
to instill in their patients a feeling of being known and cared for as individuals” (2008, p. 2).
Anna’s supervisor could also offer her some support, through coaching in order to advance
her cognitive level of what is happening within herself, and on Abdul as a result.
Solutions Recap
As previously discussed, the best solution that Anna’s supervisor and the Hospital
administration can implement is to recognize they have a cultural issue when it comes to
dealing with patients of different ethnical origins. At nurses supervisor level, they could take
note of the struggles happening, and initiate a discussion to identify the critical concerns. At
Hospital administration level, they should consider training their nurses on transcultural
nursing, to expose every nurse to Leininger’s (2002) principles and to her “sunrise model” as
depicted in Appendix A.
Conclusion
Through this case study, I learned about the impact of different cultural dimensions in
the healthcare sector and how ignoring them could be detrimental not just to the workplace
wellbeing but to the ethically superior value of a patient’s health. Transcultural nursing
awareness should be spread among all hospitals, to respond to the increasing cross-cultural
challenges that patients and health practitioners face as a result of globalization.
References
Cultural Intelligence for Leaders. (2012). Saylor Academy. Creative Commons by-nc-sa 3.0.
Grove, C. N. (2005). Worldwide differences in business values and practices: Overview of
GLOBE research findings. GroveWell LLC. Global Leadership Solutions.
House, R. J., Hanges, P. J., Javidan, M., Dorfman, P. W., & Gupta, V. (2004). Culture,
leadership, and organizations: The GLOBE study of 62 societies. Sage publications.
Leininger, M. (2002). Culture Care Theory: A Major Contribution to Advance Transcultural
Nursing Knowledge and Practices. Journal of Transcultural Nursing, 13(3), 189–
192. https://doi.org/10.1177/10459602013003005
Maier-Lorentz, M. (2008). Transcultural nursing: its importance in nursing practice. Journal
of Cultural Diversity, 15(1), 37–43.
FAITH AND HEALTH 7
APPENDIX A
FIGURE 1. Leininger’s Sunrise Model to Depict Dimensions of the Theory of Culture Care
Diversity and Universality. Reprinted from Leininger (2002).
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