Arabs are the people with a long history and strong cultural values and religious beliefs. These beliefs and values have profound effects on how they perceive various healthcare practices. Kulwicki (2013) writes that the manner of communication among Arab Americans differs considerably from that among western Americans and Europeans. Therefore, nurses should be prepared to deliver culturally competent care to Arab American patients.
The case of Mrs. Nasser is extremely complicated, since it seems to contradict the very fundamental principles of western medicine and nursing. Simultaneously, it reflects the most essential cultural and religious values of Arabs, and they expect that such values and beliefs will be strictly followed beyond the boundaries of their native culture. The nurse should realize that, in order to deliver culturally competent care and avoid medical and ethical complexities, she should respond to Mrs. Nasser in a manner that combines expertise and warmth (Kulwicki, 2013). The nurse may even offer a cup of coffee or tea to Mrs. Nasser, while they are clarifying the most painful aspects of the medical examination related to her daughter (Kulwicki, 2013). Simultaneously, most Arab Americans perceive nurses as merely medical assistants and may not recognize their status and authority in the western world (Kulwicki, 2013). Consequently, the best the nurse can do in the discussed situation is asking Mrs. Nasser to wait until she finds a physician. The reply should be delivered in a warm and reserved manner. The nurse should also persuade Mrs. Nasser that all medical procedures will be administered according to their cultural and religious beliefs. Instead of insisting on performing a vaginal examination, the nurse should say Mrs. Nasser that she will be able to discuss with the physician all possible diagnostic and treatment alternatives.
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Even in a situation as challenging as that of Mrs. Nasser, a number of culturally congruent strategies may help resolve the conflict. Basically, “Muslim and Arab women prefer women healthcare providers” (Hammoud, White, & Fetters, 2009, p. 1309). Consequently, the nurse must assure Mrs. Nasser that only a female physician will serve their medical needs. Furthermore, Arab patients normally refuse intimate examinations, if they are unmarried (Hammoud et al., 2009). Vaginal examinations have the potential to compromise the girl’s virginal status, which will definitely have far-reaching cultural implications for her personal and social future in the Arab community (Hammoud et al., 2009). Thus, the best the nurse can do is select and use those examination strategies, which do not contradict Mrs. Nasser’s religious and cultural convictions. English (2007) suggests that certain diagnostic techniques could be used to substitute for cystoscopy and vaginal examination, such as computed tomography or intravenous contrast media studies. The risks that the results of such diagnostic procedures will not be informative are quite high, but the nurse is not in a position to perform a vaginal examination against Mrs. Nasser’s will.
The nurse can certainly ensure that Mrs. Nasser’s concerns are addressed and that Samia receives the appropriate care, by serving as a cultural intermediary between the patient and the physician. The nurse’s mission is to communicate the patient’s cultural concerns to the physician in ways that will create a favorable cultural atmosphere and motivate the physician to use the arsenal of diagnostic tools available in the situations, when vaginal examination is either inappropriate or impossible. Simultaneously, she is expected to be open with Mrs. Nasser and provide comprehensive information on the nature of the diagnostic procedures to be used and their results (Kulwicki, 2013). The main expected outcome of the nurse’s culturally competent approach is the diagnosis and the development of an effective treatment strategy that will help Mrs. Nasser’s daughter relieve her symptoms and address their causes. Simultaneously, Mrs. Nasser should know that she can always contact the nurse and the physician, in case she or her daughter has questions regarding treatment or possible health complications.
To summarize, nurses face a variety of cultural challenges in their daily practice. An Arab woman who refuses vaginal examination for her daughter needs a comprehensive culturally competent and congruent approach to have her medical needs met. The nurse is in a position to provide alternatives that will shape a culturally sensitive model of work with Mrs. Nasser. Beyond diagnostic and treatment procedures, Mrs. Nasser will need emotional support and understanding on the side of the nurse.
