Background and purpose
Health care strategies have modernized the patient care system. But significant areas that fall under cultural/ethic categories remain unexplored or poorly addressed. This might affect the overall nurse care policies in western countries. Possible disparities or misconceptions may be the consequences that would continue to build. This process requires a check. There is a need to better evaluate the practices that are aimed at providing care for a culturally diverse group of people especially Arab Americans.
For this purpose, three pertinent articles were retrieved from the biomedical databases. All three studies employed a good number of study participants.
The first article has identified six themes that reflect the cultural influences on the patient care system. It has produced reliable findings that ensure the foundation for implementing system-wide changes to include culturally competent care. The second article has focused on highlighting the critical care nurses’ experiences in caring for patients of Muslim denomination in Saudi Arabia. This article has shed light on various important cultural issues such as family values, language-oriented communication problems, and patient-nurse relationships. The third article investigated the relationships among critical care nurses’ attitudes, subjective norms, perceived behavioral control, and intentions to provide culturally congruent care to Arab
Muslims. Although their certain discrepancies, significant relationships among critical care nurses’ behavioral beliefs, normative beliefs, control beliefs, intentions, and demographic variables strengthened the need for culture-specific debriefing sessions and the importance of collaborative practice and interdisciplinary learning models.
It can be concluded that the research findings have contributed to a better understanding of the delicate cultural elements surrounding the patient care system for Arab Americans. They may have better implications if additional studies were carried out and refined.
The health care system contributes to the betterment of patient life. This field would require input from all the departments of medical sciences and an up-to-date awareness of evidence-based research. The strategies adopted by the health care professionals or nurses tremendously influence the patient’s recovery following an illness. In certain instances, ethnic or cultural differences might interfere with patient care delivery. It is essential to understand such delicate elements that might constitute a barrier between the care providers and the patients. For this purpose, special interventions may also be required in order to make the underlying problems more apparent and amenable to diverse patient care policies.
In the present context, considerable focus was centered on Arab Americans keeping in view of the mentioned issue. This is because of the incongruence between this group of patients and the nurse care from several unexplored perspectives. Various themes have already been identified that depict the perceptions, experiences, and patterns of health care behavior among Arab Americans In order to evaluate the nurses’ perception regarding care delivery for these populations, there is also a necessity of additional investigation. So, exploring the experiences of critical care nurses who provide care for patients of Muslim denomination may be an advantage.
However, understanding the association between nurses and their overall intention to ensure culturally congruent care to Arab Muslims may be the ultimate objective in the face of existing concerns. Marrone (2008) recently highlighted the importance of significant relationships that would influence the interdisciplinary learning models and nurse practice.
Therefore, there is a need to make an in-depth review of the available literature to make clear the misconceptions prevailing in society regarding health care delivery to Arab Muslims.
Review of the literature
The execution of a refined nurse care practice for addressing the problems that arise from ethnic or cultural disparities may need a study on cultural competence and workforce diversity.
For this purpose, earlier workers initially centered their attention on discovering the awareness and models of health care behavior among Arab Americans in an urban Midwestern area of the United States (Anahid Dervartanian Kulwicki, June Miller, & Stephanie Myers Schim, 2000).
This study was carried out through a partnership of nurse researchers, health care system administrators, and Arab Americans. They have actually designed a qualitative study to explore perceptions, experiences, and expectations of a select group of Arab Americans and perceptions and experiences of select groups of Arab American and non-Arab American health care providers to find out how local health care organizations provided care and whether they perceived this care as culturally competent for Arab Americans. They have followed focus group methodology to make it useful for inquiry purposes in their satellite ambulatory primary health care setting.
Here, this method appears very useful because it might cover a large population of Arab Americans from various corners of the society and also suggests its applications for various similar studies. There have conducted 10 focus groups and included 67 study participants after making them agreed to the verbal consent approach. The Arab and non-Arab health care professionals were the largest of the groups with 10 participants each. It was revealed that most of the Arab participants were found to express great satisfaction over the complexity of the U.S. health care system indicating its superiority as compared to their homelands. Poor education of most women has added to the problem of unawareness of the ongoing health care system.
This may also indicate the need for education among Arab American women.
The article could have highlighted more about the incorporation of education in nursing interventions of patient care; which it has not made.
Next, family caring values and behaviors were among the important characteristics of the Arab culture. Therefore, it is imperative that nurse care providers focus on these values by initial familiarization. This might later help them to build communication and facilitate a smooth patient care delivery. The other problem was the communication barrier found across all focus groups.
It can be inferred that health care providers should take every possible step to eliminate language-oriented problems by learning basic Arabic. Here, it is reasonable to mention that treating Arab participants without addressing Arab cultural values would harm the practice of nursing with regard to culturally competent care.
Further, most Arab American participants emphasized the problems arising from the health care system access like long waiting, irregular services, nonphysician care and, financial and transportation problems. The other concern was discrimination and stereotypes and prejudice among employees which stress the health care systems to develop cultural diversity training in the workforce and address these issues. Therefore, this study has shed light on the concerns surrounding Arab Americans that might otherwise interfere with the health care service and suggests an early intervention after studying them from all corners.
Another investigation has better addressed this scenario by considering the daily experiences of nurses who would provide the essential truths about the reality of caring for patients of Islamic denomination. This article mentioned that studies relating to caring from an Islamic perspective were not well documented in the nursing literature. This could be the reason that might have contributed to the previous disparity or incongruence between Arab Americans and health care providers (Phil Halligan, 2006). This study was conducted in Saudi Arabia. The selection of the participants involved a non-probability purposive sampling design.
The employed participants were all females and the qualified Muslim nurses were all males. The study was conducted after obtaining the permission grant in writing form from the nursing and administrative authorities and informed consent from all of the participants. As found in the previous study, this article also highlighted the need for family involvement as a significant contributor to the emotional, social, and psychological well-being of the patient. This is a worth supporting description.
Therefore, there is a need to give significant emphasis on the family in taking care of patients of Islamic denomination. This has strengthened the Muslim family as ‘the cornerstone in caring’. One of the flaws is that there are certain discrepancies as far as nurses’ perceptions towards families and patient care are concerned. This is because, as mentioned in the study nurses viewed families as a distraction to the nursing staff.
But the same nurses preferred to care for sedated or unconscious patients, as they are considered ‘less demanding’. Hence, this may need further clarification. The other vital element is the well-known communication problem arising from lack of Arabic language, interpreters who might help in that process, and accepted gestures that were considered rude and unprofessional in Western countries. This may indicate that there is a need to gain cultural awareness related to these problems which might help the health care providers to minimize any cases of frustration. Further, religious attitudes of patients, especially for prayer were regarded as a source of stress as it is thought to create a feeling of ‘powerlessness’ in the nurses.
Hence, it was inferred that healthcare professionals become knowledgeable about Islamic culture so that they would be better able to integrate it into their patient’s care planning. Nurse–patient relationship is the other identified element to focus on in the context of physical touch which is regarded as offensive if happens with a member of the opposite sex. Therefore, although it is essential for health care management to employ genders of both sexes for patients of various ethnic groups, it was reported to be far from implementation due to a shortage of nurses. Here, it appears that this article seems narrow in considering evidence-based research.
However, this study has provided valuable insights on how religious and cultural differences influence patient care and how it could be extended to health service planners and administrators, for making it easily approachable to competent health services. Finally, there is also a need to determine the overall attitudes of nurses whether they are having real intentions to provide culturally compatible care to Arab Muslims keeping in view of the well known Theory of Planned Behavior (TPB) (Marrone, 2008) This article deserves credit because, in this study, researchers have used a descriptive correlation study design.
They recruited 208 registered nurses with a minimum of 2 years of critical care nursing experience. The parameters that were analyzed were subjective norms, perceived behavioral control, and demographic data in addition to nurses’ attitudes. It is important to note that the study asked participants to complete the four instruments used to collect information such as the Cultural Attitude Scale, Culture Care Intention Questionnaire (CCIQ), Control Over Nursing Practice Scale, and a Demographic Survey.
The results have strengthened the connection between critical care nurses’ race, attitudes, subjective norms, certification in critical care nursing, and past attendance in a transcultural nursing course. It was revealed that critical care nurses’ attitudes towards caring for Arab Muslims, and the attitudes of relevant others had a significant influence on their intentions to provide culturally compatible care. Therefore, it was inferred that this study could help nursing professionals to develop better practice models that could be integrated into the overall infrastructure of care delivery systems. This might further enable them to design models that would offer culturally congruent care to Arab Muslims.
It was found that critical care nurses’ perceptions of control over nursing practice were high compared to perceived behavioral control toward providing culturally congruent care to Arab Muslims. But these findings were not reported to be satisfactory statistically. Hence, further studies on evaluating these relationships may be required. However, this study could better offer a structural framework for the development of critical care nursing competencies and the associated performance which would be otherwise possible through the understanding of the factors that influence nurses’ decisions that support values, beliefs, and meanings of care of culturally diverse patients and families.
In conclusion, all three studies have furnished valuable insights on the cultural issues that are reported to interfere with patient care delivery in various forms and warrant further studies.
Anahid Dervartanian Kulwicki, June Miller, & Stephanie Myers Schim. (2000). Journal of Transcultural Nursing, 11, 31-39.
Phil Halligan. (2006). Caring for patients of Islamic denomination: critical care nurses’ experiences in Saudi Arabia. Journal of Clinical Nursing, 15, 1565–1573.
Stephen R. Marrone. (2008). Journal of Transcultural Nursing, 19, 8-15.