The Family Environment Of Muslim Patients And Its Implications For Health Care

Abstract

As a result of migratory movements, many families of foreign origin have settled in the province of Almería (Spain), which now has an estimated 100,000 inhabitants of Muslim tradition. Objetives :1. To determine the importance of the family environment for patients living within the Muslim culture. 2.To consider the implications for nursing practice of the relationship between healthcare personnel and Muslim patients and their families. Method . In this qualitative study, data were compiled by means of open-ended interviews and discussion groups with people from a Muslim background admitted to public hospitals in the province of Almeria. Discourse analysis was applied to the data obtained. Results . Thirty-six patient interviews took place and two discussion groups were conducted. The participants emphasised the value they placed on the family environment as a fundamental aspect of their life experience and development. Being accompanied by relatives in the hospital was considered to be important, contributing to a more satisfactory recovery, and similarities in this respect were observed with cultural values in Andalusia. The participants appreciated it when medical staff involved the family in the patient’s health care, viewing this as an expression of cultural respect. Conclusions . Nursing staff should be aware of the importance granted by Muslim patients to the family environment and should be encouraged to involve the family in patient care, as an ally during the hospital experience.

Keywords: Careinterculturalitymuslimnursing

Introduction

During the last thirty years, spurred by the demand for workers in the agricultural sector (especially intensive cultivation, under plastic, the main economic driver of the area), the province of Almería has become transformed into a multicultural society. The province now has a population composed of over 130 nationalities, a characteristic that impacts on all aspects of society, including public health services. The arrival and establishment of cultures from all parts of the world, with idiosyncratic customs, values and beliefs, poses a new challenge for health professionals, whose patients have widely varying outlooks on life, death, health and sickness, and the origin and treatment of diseases (Plaza del Pino, Plaza del Pino, & Martínez, 2005).

In the natural evolution of the migratory process, the profile of the typical migrant has changed. Formerly, most were male, young and single, but today there are many families of immigrant origin that are permanently settled in Almería and elsewhere, either following family reunification or from the formation of new families.

Health care is a social environment in which people from different cultures are obliged to interact. However, this meeting point of diverse cultures seems to receive less research attention in studies of intercultural communication than other areas, such as education and employment (Plaza del Pino, 2010, p. 49), despite the significant role it plays in shaping feelings and life experiences.

It would be highly interesting (albeit arduous) to obtain first-hand accounts in this respect from patients of all types of migrant background, but in the present study we preferred to focus on one specific group, those of Muslim origin. This population constitutes one of the most numerous groups of foreigners resident in Almería. It is estimated that around 100,000 Muslims live in the province, accounting for 17-20% of the population. Among these migrants, the most numerous national groups is that composed of Moroccans (INE, 2017). In Spain, the migrants who are least appreciated by the host community are those from the Maghreb, followed by Roma and arrivals from sub-Saharan countries (Navas et al., 2004). By nationalities, Moroccans are believed to be located at the greatest cultural distance from the native population, mainly because of their Muslim religion.

This research forms part of a larger study supported by the Health Research Fund (PS09/1449) of the Spanish Ministry of Health.

Objectives

• To determine the importance of the family environment for patients living within the Muslim culture.

• To consider the implications for nursing practice of the relationship between healthcare personnel and Muslim patients and their families.

Methods

This study uses a qualitative approach, that of discourse analysis, which is considered the most appropriate means of achieving a detailed understanding of the phenomena addressed, taking into account both the circumstances of the participants and their culture (De la Cuesta, 2006).

This study was conducted in full awareness that in qualitative investigations the researcher has an unavoidable influence on the process and, ultimately, on the results obtained; it is acknowledged that the researcher is a human instrument of the investigation (Higginbottom & Serrant-Green, 2005). Nevertheless, all possible care was taken not to ‘contaminate’ the study with our own ideas on the subject.

Results

It should be emphasised that Muslims do not constitute a homogeneous group. The Muslim faith is practised worldwide, in all kinds of societies, which present widely varying cultural, political, socio-economic and ethnic origins (Plaza del Pino, 2010, p. 29). It is one of the world’s majority religions and, like Christianity, has several main branches, which in turn are divided into different sub-groupings and schools of belief. The participants in our study and, in general, the majority of immigrants in Spain of Muslim origin, come from North and Central Africa, where the Sunni faith is predominant, and within this, the Maliki school of law is most commonly observed. We do not know whether our informants were all aware of which school they belonged to, since this question was not asked. The significant degree of heterogeneity within Islam is evidenced in the festivities that are celebrated, in the legal practices observed and in adherents’ acceptance of different sources on which to base their beliefs.

It is sometimes difficult to discern between religious practices and specific traditions, such as the use of the veil. Furthermore, not all persons of Muslim origin practise their religion in the same way (Plaza del Pino & Veiga, 2013). Indeed, some of our informants stated they were non-believers, or did not practise their religion, despite having been educated and culturalised in this context:

• Neither believer nor practitioner; 2%

• Not stated; 18%

• Believer and practitioner; 65%

• Believer; 15%

In view of these considerations, we approached the practices and beliefs of the informants in this study exclusively through their testimonies and did not seek to determine whether these practices and beliefs were purely religious or not.

As illustrated above, most of the interviewees identify themselves as believers and practitioners of Islam. Others declare themselves to be believers but not practitioners. As Lacomba (2009) points out, many immigrants of Muslim origin might use religion and participation in collective rituals as a sign of group identity, thus reaffirming their beliefs and traditions and expressing their outlook on religion more overtly than in their country of origin, not because they feel more religious in Spain, but because these beliefs and practices allow Muslim immigrants to situate themselves within their new society. In other words, these expressed beliefs connect migrants with their origins, and provide a quick and accessible means of forming a group of equals, distinguishing them from other groups and individuals in the same society.

Conclusions

The study results show that for patients from the Muslim tradition, the family plays an important role in their lives. They consider it important to be accompanied by the family in hospital, to ensure a more satisfactory recovery. Therefore, it is an additional impediment to recovery if the family is not there, but in the country of origin. The medical staff, too, are in favour of letting the family take part in caring for the patient; they consider this an expression of cultural respect. For the study participants, there are many similarities between the Islamic and Andalusian cultures as regards the bond with the family and the importance of the family being there, too, in the hospital. This outlook is quite natural, as both communities form part of the Mediterranean culture.

However, it should be noted that the role of the family differs greatly from one cultural group to another. Thus, in the Mediterranean and Latin cultures, the family connection is very important, and so their presence in the hospital is almost constant, sometimes too much so, hindering the proper functioning of the service. On the contrary, in Anglo-Saxon and Slav cultures, patients may be totally unaccompanied and/or their families only pay brief visits. Far from criticising these forms of behaviour (so different from our own), we should respect them (Plaza del Pino, 2017, p. 127).

For Muslim patients and their families, guidelines should be set for family visits, to avoid too many relatives being present at the same time. Moreover, it is very important for all medical staff to follow the same criteria when dealing with patients’ families; this will greatly reduce conflicts in this regard.

Healthcare personnel should be aware of the importance of the family for Muslim patients. If hospital authorities respect the family, and if their culture and the roles they play are valued, they can provide excellent support for patient care. Given these conditions, the family will be cooperative, respecting the hospital rules and following the advice given for the patient’s recovery. The family, thus, will become an excellent ally for the hospital during the patient’s stay.

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