These Individuals are referred to as Muslims, and In conjunction, they constitute approximately 23% of the globes 6. 8 billion population (The Pew Forum, 2009).
Currently, Australia is regarded as one of the greatest ethnically diverse nations worldwide (Australian Bureau of Statistics, 2007). This extensive ariation in nationalities poses a complex issue in regards to the treatment of culturally and linguistically diverse (CALD) individuals within the health care system – primarily in the mental health sector (Elder, Evans & Nizette, 2009).
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Although Islam is a sole religion, it is imperative for nurses to comprehend that Muslims are not a homogeneous group (Taheri, 2008). Each mentally ill Muslim client will be required to liaise with their psychiatric nurse in order to construct a pertinent, culturally appropriate care plan, that enables the expression and practice of their Islamic faith hroughout the duration of their illness (Charles & Daroszewskl, 2012).
Consequentially, the ensuing academic essay will alm to not only describe the applicable nursing care and assessment of thirty-eight year old Mrs Katl]ah Ahmed, but to also discuss the nursing actions and their necessary alterations with consideration to Mrs Ahmed’s Islamic background, to enable the provision of patient- centred, culturally competent care in the treatment of her diagnosis of Borderline Personality Disorder.
Although there is an expectation of nurses to provide personalised, patient-centred are to all physiologically and psychology unwell patients (Dempsey, French, Hillege & Wilson, 2009), the treatment of culturally diverse individuals must be particularly modified to ensure their religious and cultural beliefs, values, behaviours and rituals are accommodated and understood (Andrews & Boyle, 2008). Failure to customise Mrs Ahmed’s nursing care to Incorporate her Islamic rellglon may Inadvertently prove detrimental to her treatment outcomes (Elder et al, 2009). onsideration to various nursing actions must be given when organising and preparing the treatment plan for Mrs Ahmed, as her religious background and migration experiences may have considerable implications for the duration of her in-hospital stay (Edward, Munro, Robins & Welch, 2012). Communication, physical assessments, dietary demands and medication, religious requirements, family participation, social support and suicidal intentions, are all elements of Mrs Ahmed’s care plan that must be altered in order to provide empathetic, culturally competent care. As stated by Elder et al. 2009), the cornerstone of all mental health nursing practice Is the ablllty of nurses to communicate effectively with clients – to engage In urposeful Interactions with the aim of therapeutic outcomes. However, as previously mentioned, Australia is an exceptionally diverse nation, accommodating a multitude hundred separate languages (Australian Bureau of Statistics, 2007). This ethnic variance can ultimately hinder the development of a therapeutic nurse to client relationship, thus directly influencing the degree of treatment that Mrs Ahmed can receive (Elder et al, 2009).
Upon admission, Mrs Ahmed’s capability to comprehend, and communicate in, English must be ascertained in order to determine whether the use of an interpreter will be necessary. It is essential to select a culturally appropriate and certified interpreter, taking into account that the ethnicity, cultural principles and gender of interpreters all impact on the interpretation process (Paulanka & Purnell, 2008). Same gender interpreters are preferred, as Muslim woman are commonly reluctant to disclose personal information and experiences with a male healthcare professional (Taheri, 2008).
Furthermore, interpreters must comply with section 120A of the Mental Health Act 1986 (VIC), ensuring all interviews are conducted ethically and that client confidentiality is respected throughout the rocess (Callister e al, 2009). This should be verbalised to Mrs Ahmed, as it reinforces the notion of a secure and private milieu in which she can express her honest thoughts, emotions and concerns (Charles & Daroszewski, 2012).
It is essential that nurses remain present throughout the interpretation procedure; this enables them to monitor and evaluate the clients’ non-verbal language whilst simultaneously providing the interpreter with assistance when necessary (Callister et al, 2009). If it is established that Mrs Ahmed can communicate successfully in English, the use of an nterpreter is redundant. During conversation, an emphasis should be placed on avoiding technical Jargon, colloquial expressions, excessive medical terminology and abbreviations.
Refraining from such interactions will aid in preventing exacerbating the potential nurse to client language barrier (Elder et al, 2009). In conjunction, Davidhizar and Giger (2007) state that asides from verbal exchanges, significant communication prompts are obtained from a clients voice rhythm, quality, intonation and pace. Alternative non- verbal messages such as facial expression, touch, eye behaviour, body language and patial utilisation are all supplemental cues, whose importance and significance differ among dissimilar cultures (Davidhizar & Giger, 2007).
Due to Mrs Ahmeds’ Islamic background, touching and direct eye contact should be minimal (Charles & Daroszewski, 2012). Nurses should be acquainted with the Islamic communication requirements to ensure they remain culturally respectful of Mrs Ahmed. A comprehensive physical assessment encompasses several distinct procedures – some of which require inspection, auscultation, palpation and percussion of specific body parts (Dempsey, French, Hillege & Wilson, 2009). Consequentially, this requires nurses to enter a client’s personal space.
This proximity, in Muslim culture, is often regarded as inappropriate (Charles & Daroszewski, 2012), and when feasible, it should be avoided to prevent being perceived as discourteous. Complications may arise when conducting physical assessments, as Islam requires women to conceal their head, body, face or a combination of these features in a myriad of Islamic coverings (Taheri, 2008), however, a Hijab is most commonly worn among Muslim healthcare professionals should acquire consent prior to exposure of particular egions of Mrs Ahmed’s body – regardless of the intended medical purpose (Chand et al, 2010).
It is paramount that considerable attention be directed at providing access to gender appropriate healthcare professionals (Elder et al, 2009), as Muslim woman are often unwilling to receive medical and psychological treatment from healthcare professionals of the opposite gender (Chand, 2010). Some Muslim women may also request that a relative or partner be present during all physical examinations (Chand, 2010). Although the fulfilment of Mrs Ahmed’s dietary requirement is perhaps not an issue hat is acknowledged as an immediate concern upon hospital admission, it is one that must be organised forthwith (Charles & Daroszewski, 2012).
In Islamic culture, food that is approved for consumption is referred to as Halal, and in contrast, prohibited food products are labelled as Haram (Charles & Daroszewski, 2009). Haram foods incorporate products such as lard, pork, gelatine derived from pork products, meat derivatives killed absent ritual, alcohol and the use of narcotics (Taheri, 2008). Prior to the consumption of food, Muslims are required to complete a ritual referred to as Wudu (Taheri, 2008).
This is a partial ablution that incorporates cleaning of the hands; rinsing of the mouth, nose and ears; and to conclude, washing both feet with uncontaminated water (Lawrence & Rozmus, 2008). Furthermore, Muslims primarily consume food and liquids with their right hand, and this practice should be emulated if Mrs Ahmed requires assistance with the consumption of her meal (Chand, 2010). Obtaining Mrs Ahmeds’ customary dietary intake will aid in determining her specific in-hospital dietary requirements, as not all Muslims unconditionally abide by the Islamic dietary regulations (Taheri, 2008).
Extreme care should also be taken in the preparation of a Muslims meal to avoid cross contamination with Haram food products (Chand, 2010). To ensure Mrs Ahmed is ingesting adequate nutrition, a select of fresh fruit should also be made readily available for her consumption (Charles & Daroszewski, 2012). Moreover, Muslims are also prohibited from receiving medications incorporating alcohol, narcotics and derivatives of animal by-products (Chand, 2010). If the use of medication containing these elements is deemed necessary to treatment Mrs Ahmeds’ Borderline
Personality Disorder, alternatives must be utilised – this will ensure she is not deprived of basic pharmacological therapy due to their religious beliefs (Taheri, 2008). An additional Islamic dietary sensitivity that nurses treating Muslim patients must be conscious of is the month of Ramadan, which occurs during the ninth month of the Islamic lunar calendar (Taheri, 2008) – it requires Muslims to refrain from consuming any food products between dawn and dusk (Taheri, 2008).
It is a requirement of Ramadan, that each day Muslims consume a meal prior to dawn (Charles & Daroszewski, 2012). In Islam, fasting is an integral aspect of the religion, as it is perceived as a method of decontaminating and purifying the soul and body (Chand, 2010). If Mrs Ahmed is present at hospital throughout Ramadan, medication (Charles & Daroszewski, 2012). In order to conduct several vital nursing interventions, Mrs Ahmed will require allocation to a solitary room, as this will enable her to conduct self caring routines and religious practices in an undisturbed, private setting.
The location of Mrs Ahmeds’ room should be with regard to Mecca, as this is the direction that Salat is conducted toward (Charles & Daroszewski, 2012). Additionally, ensuring Mrs Ahmeds’ room is located in close proximity to the nurses’ station will allow various staff members to monitor her frequently, since she has threatened suicide in the past. Cleanliness is often regarded as “half the faith” of a Muslim, as a clean physique symbolises a pure Islamic soul (Lawrence & Rozmus, 2008).
Not to be confused with Wudu, Ghusl is the complete ablution of a Muslims body, and for Mrs Ahmed, will solely be performed succeeding the cessation of menstruation (Taheri, 2008). In addition to the rituals Wudu and Ghusl, Muslims are required to rinse their genitals nd anal region after toileting with water acquired from a satisfactory source (Charles & Daroszewski, 2012). This ritual is to be performed solely with Mrs Ahmed’s left hand, as her right is considered clean and solely utilised during eating (Charles & Daroszewski, 2012).
Providing Mrs Ahmed with a sterilised Jug and basin will enable her to perform Wudu and Ghusl in a timely manner, free of complications. Nurses must be mindful however, to refrain from offering objects to Mrs Ahmeds’ left hand, as it is considered contaminated (Taheri, 2008). Failure to accommodate this may elicit an unfavourable response from Mrs Ahmed. Due to her Islamic background, Mrs Ahmed will have several religious requirements that must be accommodated throughout her hospital duration.
Islam bestows the onus of religious practice on the individual (Chand, 2010) and, consequentially, it is vital that all healthcare professionals discuss religious observance requirements with their clients (Chand, 2010). Daily prayer, or Salat, is the “ceremonial recitation” (Lawrence & Rozmus, 2008) of prescribed passages in Arabic, whilst simultaneously performing several distinct body positions incorporating bending, standing and kneeling (Taheri, 2008).
Salat is performed five times each day, commencing at sunrise and concluding one hour post sunset (Taheri, 2008). Communicating with Mrs Ahmed will assist in comprehending the extent of her dedication to Salat – this will ultimately dictate the time frame in which she may receive treatment (Taheri, 2008). These prayers must be conducted in the direction of Mecca – the holy city located in Saudi Arabia (Lawrence & Rozmus, 2008). Prior to Salat, Mrs Ahmed will perform Wudu, as cleanliness is paramount in Islam (Taheri, 2008).
To preserve cleanliness, an object such as a prayer rug should be placed upon he floor prior to prevent Mrs Ahmed touching the contaminated ground (Chand, 2010). Alternatively, if a prayer rug is unattainable, a fresh towel may substitute a rug (Lawrence & Rozmus, 2008). In addition to Salat, it is widely considered that reciting and reading the Islamic bible, the Qur’an, precipitates blessings to individuals who are both psychologically and spiritually distressed (Taheri, 2008). Thus, supplying Mrs nursing intervention (Taheri, 2008).
However, it is advised that the Qur’an remain unhandled by any individual who is ritually unclean, and that no object is positioned top of the Qur’an (Andrews & Boyle, 2008). As explained by Mrs Ahmed’s husband, prior to admission Mrs Ahmed had been experiencing difficulties sleeping – ultimately resulting in the exhausted nature exhibited by Mrs Ahmed during admission. Allocating Mrs Ahmed to an unaccompanied room will facilitate the formation of a consistent pattern of sleep, as it eliminates any potential interference she may have experienced whilst residing in an integrated room.
In addition to providing Mrs Ahmed with a private room, Taheri (2008) states that it is often beneficial to provide Muslim patients’ of both genders ith signs to be placed on their door, that solicits all healthcare professionals to knock prior to entering the room or to return in a designated period of time. This will enable Mrs Ahmed with sufficient privacy to change outfits and conduct her daily prayers (Charles & Daroszewski, 2012). Throughout her treatment, knowledge of Mrs.
Ahmeds’ kinship structure will assist in ascertaining the values, decision making patterns and overall level of communication amongst her family (Davidhizar & Giger, 2007). It is not uncommon for decisions related to healthcare to be decided in consultation with several members of an Islamic family (Lawrence & Rozmus, 2008). Moreover, it is beneficial to directly involve male relatives, particularly partners, in the decision making process as this process has been associated with female clients experiencing uncomforting distress (Lawrence & Rozmus, 2008).
Psychiatric nurses, and mental health professionals, are in an extremely advantageous position of personally collaborating with a vulnerable cohort of clients (Edward et al, 2011). However, the exponentially growing cultural, religious and linguistic diversity in Australia signifies that to administer safe holistic care, health ervices nationwide need to be culturally appropriate and prepared, as research indicates a pronounced correlation between abysmal standard health outcomes and culture incompetence (Chand et al, 2010).
All nurses must demonstrate an unprejudiced approach to providing care when dealing with CALD individuals, or they may be perceived to have an ethnocentric orientation (Elder et al, 2009). Cultural competency is a continuous, multidimensional learning process Oefferys, 2010) that all nurses must comprehend, and practice, in order to provide cultural congruent care to all individuals that are ethnically, culturally or religiously diverse.