Abdul Hadi is a muslim patient at a German hospital. He has recently had surgery and requires assistance from a nurse as he recovers. His nurse, Anna, has encountered various cultural challenges as she has tried to fulfill her responsibilities to provide care in a responsible and culturally sensitiveway.
One of the main risks in this situation is that Anna tries so hard to consider all the cultural nuances and respect all cultural conventions that she ceases to prioritize Hadi’s care in favor of Hadi’s sensitivities. While it is important to provide care in a culturally sensitive way, Anna’s priority is Hadi’s care. As care provider at a hospital with other patients, Anna needs to manage her time and resources to serve many patients at once. It is therefore important for Anna to seek support from her supervisor in terms of managing patient expectations. As other nurse’s devoted to patient care, there is only so much Anna can do as a cultural interpreter before she has to move to other patients who need her assistance as well. She must focus most of her time on activities that will help improve Hadi’s health. If developing cultural awareness can further these objectives, wonderful, but Anna must also be firm in presenting her position and explaining her own situation. Sometimes, effective cross-cultural communication means articulating your own cultural perspective and priorities as firmly as your counterparts.
Cultural Intelligence approach
Acquire: While Anna does need to develop cultural awareness about Islam don’ts in healthcare service provision for general reference, it is doubtful that she will build this knowledge in time to provide the care that Hadi needs to recover this time around. Anna
needs to understand what is practically allowable in hospitals that treat devout Muslims on a regular basis. Instead of trying to follow Hadi’s lead and creating special conditions to meet all his request, Anna needs to reach out to hospitals that serve majority Muslim communities to inquire about how they provide the care that their patients require.
There are numerous resources that provide guidance on practical aspects of delivering health care services to Muslim patients such as these guidelines: http://www.ispi-usa.org/guidelines.htm
Build: Anna needs to develop a framework for striking the right balance between providing Hadi with the care he needs and being respectful of his cultural perspectives. A matrix that cross references top health and cultural priorities could serve as a basis for negotiating trade-offs.
Contemplate: Anna should use the matrix to reflect on areas that could offer the biggest potential for compromise and focus her cultural efforts on those. Ideally, she should select a few actions that demonstrate respect for Hadi’s cultural perspective without jeopardizing his care needs. Beginning conversations with a customary greetings or punctuating phrases with traditional acknowledgements to God would go a long way without sacrificing any care or requiring too much effort. Following protocols for washing and examining a patient would probably save more time than having to negotiate with the patient and explain the importance of washing and examination every day. These gestures of respect would help build a bridge that Anna can use to ensure that Hadi understands that she means it when she says something is essential to his care regardless of objections coming from cultural considerations.
Do: The first action is to engage the patient to explain that her priority is to save his life and ensure he receive proper care. Anna can begin by facilitating adequate prayer space for Hadi and making sure he knows she, too, is grateful that he has survived surgery and that she is doing God’s work by providing care that will ensure that Hadi’s recovery is complete. Using the health-faith matrix to identify priorities and trade-offs and using guidelines and examples from hospitals in a majority Muslim areas would help Anna conduct a productive discussion.
For each of the five behaviors and needs outlined above, find a strategy, or strategies, to resolve the issues.
1. Anna needs to ensure that Hadi knows she is doing her best to be respectful. While using a male nurse to help bathe Hadi on occasion may provide a quick fix, it will also end up undermining Anna’s position and mismanaging Hadi’s expectations. Hadi must understand that Anna is his nurse and that she understands his concerns but will do her very best to address them.
2. Anna needs to take the initiative in providing Hadi information about food and medication and finding culturally relevant alternatives. Efforts in this respect will help build much needed trust.
3. Anna needs to work with the hospital to facilitate meals that are acceptable to devout Muslims. This is another low-hanging fruit that will help Anna build trust to accomplish other more challenging tasks. Hospitals must accommodate special diets for recovering patients anyway so additional accommodations for a devout patient should be relatively simple.
4. This will depend on additional space available for mingling between patients and visitors. If no other space is available and noise persists, Hadi should understand that the quicker he recovers, the sooner he will be back with his family. A quick recovery entails receiving the care that Anna is trained to provide.
5. Muslim prayers are held at predictable times. Anna can schedule prayer times with Hadi and work around those predetermined slots. However, Hadi must understand that he is not Anna’s only patient. A room/bed orientation that could facilitate prayer rituals with greater ease may also go a long way in building trust.
Determine what your hospital needs to do to ensure patients are addressed with care and compassion.
First, it is important to understand that the most compassionate approach is the one that ensures delivery of optimal health care services to the patient and results in a quick and sustainable recovery.
Second, the hospital needs a cultural awareness framework for care that requires specific cultural sensitivities so that nurses understand exactly what they can address with flexibility and what elements are indispensable to the performance of their duties, regardless of a patient’s religious objections. This framework would be enshrined in policies and regulations that offer clear guidance and clarification mechanisms so that care providers know where to turn in case they have any doubts or concerns.
Third, the hospital should manage patient expectations up front by providing a commitments document to patients where it explains what it currently offers, what it intends to develop in the future and what it definitely cannot do. Ideally, patients should have access to the pledge to patients document so that they can make informed decisions about their care provider before they request services.
Fourth, the hospital should have a referral document for all patients or families of patients that read the hospital’s cultural pledges and decides they will refrain from seeking services there.
Conclusion and recommendation
Anna’s position is not easy and it’s made even more difficult by the implicit expectation that she must accommodate all of Hadi’s cultural needs. There must be a discussion, mediated if necessary, to let both parties explain their positions and try to find middle ground. While religion is indeed a very important part of many people’s lives, medicine and proper care is what will ultimately save them. I am reminded of the story of the man who ends up on the roof of his house during a terrible flood that covers everything. The man prays and prays for God to help him. A log floats by and the man prays and prays some more. A door floats by and the man prays and prays some more. Finally, a neighbor sails by on a boat and offers help and the man says that he is waiting for God to intervene so the neighbor sails off. The man ultimately drowns and when he arrives in heaven he says to God, “Lord, why did you let me die? I prayed and prayed and you didn’t save me?” And God says, “I answered your prayers by sending a log, a door and a neighbor on a boat but you were too busy praying to see my hand reaching out to help.” Nurses are doing God’s work every day and devout religious people should have always have them in their prayers.
My recommendation is that the hospital develop specific policies and regulations to provide guidance to nurses dealing with these cases and a patient bill of rights with specific provisions on religious accommodations to inform patients of what they can and cannot expect when seeking medical attention at that facility.
References
Cultural Intelligence for Leaders (2012). Saylor Academy. Creative Commons by-nc-sa 3.0. Retrieved from: https://saylordotorg.github.io/text_leading-with-cultural-intelligence/index.html
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