Culturally Sensitive Care of the Muslim Patient

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  • of Transcultural Nursing online version of this article can be found at:

    DOI: 10.1177/104365960101200307

    2001 12: 228J Transcult NursPaul Lawrence and Cathy Rozmus

    Culturally Sensitive Care of the Muslim Patient

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    On behalf of:

    Transcultural Nursing Society

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    Culturally Sensitive Care of the Muslim Patient

    PAUL LAWRENCE, MSN, RNUniversity of Alabama at Birmingham

    CATHY ROZMUS, DSN, RN, FACCEGeorgia Southwestern State University

    The number of Muslims in the United States is growing. Thisarticle outlines a few of the major beliefs in Islam. Religiousand philosophical factors that affect health care are dis-cussed, and practical suggestions are made for nursingactions that lead to culture care preservation, culture careaccommodation, and culture care restructuring. Major topicscovered include the need for cleanliness, preparation forprayer, modesty, family structure, fasting and diet, and care ofthe dying.

    For nurses who have not cared for a Muslim patientrecently, there is a growing chance that they soon will. Thereare around 6 million Muslims in the United States, and thatnumber is increasing steadily. At current growth rates, thenumber of Muslims in the United States will surpass the num-ber of Jews by 2010 to make Islam the nations second largestreligion (Power, Joseph, & Rhodes, 1998). A monotheisticfaith, the word Islam means submission to the will of God(Ali, 1996). A person who practices Islam is a Muslim orMoslem. (Variations in spelling come from the transliterationof the Arabic words.) The Middle East was the birthplace ofIslam, and around 90% of Arabs are Muslim (Zahr &Hattar-Pollara, 1998). To most Westerners, Arabs and Mus-lims are synonymous, but that linkage is not necessarily accu-rate. Only 20% of the Muslims in the world are Arab(McKennis, 1999). Muslims are scattered all over the world.In fact, there are more than 100 million more Muslims on theIndian subcontinent alone than there are in all the Arab coun-tries combined (Blank, 1998). In the United States, only 12%of the Muslims are of Arab descent. About 25% of AmericanMuslims are immigrants from south Asia, and around half areconverts to Islam, primarily African Americans (Blank, 1998;Power et al., 1998).


    Islam respects the prophets who are revered in Judaismand Christianity such as Abraham, Moses, and Jesus (Athar,1999b). Mohammed is the seal of the prophets or finalprophet. He lived in Saudi Arabia and founded Islam in theearly seventh century (Ahmed, 1988). The Muslim holy bookis the Koran, and it is believed that the Koran is the uncreatedand eternal word of God that God revealed to Mohammed inArabic (Braswell, 1996). The sayings and traditions of theProphet, the Hadith, are also accepted as truth. This collec-tion, which was gathered into 97 books, is second only to theKoran in authority (Ahmed, 1988; Braswell, 1996). Shortlyafter the death of Mohammed, Islam split into two mainbranches. The Sunni account for the vast majority of Muslimstoday. Where present, the Shiite are minorities except in Iranand Lebanon (Luna, 1989). Table 1 provides a brief summaryof the five basic articles of faith, which are often called thePillars of Islam.


    The Sunrise Model, which illustrates Leiningers theoryof culture care diversity and universality, provides a theoreti-cal framework for the nursing care of Muslim clients(Leininger, 1995, p. 108). This theory helps to guide nursesthoughts and actions as they work with people from a varietyof cultures. The goal of this article is to provide knowledgeabout Islam that can provide a holistic way to know, explain,interpret, and predict nursing care needs of the Muslim client.This information can provide a basis for all three modes ofnursing actions and decisions including culture care preserva-tion, culture care accommodation, and culture care restruc-turing. As the Sunrise Model illustrates, religious and philo-sophical factors are only one of many cultural and socialstructure dimensions that affect the care expressions, pat-terns, and practices of a culture. These various dimensions,such as kinship and social factors, cultural values and


    Journal of Transcultural Nursing, Vol. 12 No. 3, July 2001 228-233 2001 Sage Publications


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  • lifeways, political and legal factors, and educational factors,are also interrelated.

    The reader should keep in mind that Muslims are not ahomogeneous group of people. This is especially true inNorth America where Muslims come from a wide range ofcultural, political, and racial backgrounds and from differingeducational and socioeconomic levels. Their faith is only oneinfluencing factor in their lives. Therefore, their generic carepractices, as well as their openness to professional care knowl-edge, will be different. This article concentrates on the reli-gious and philosophical factors and their impact on other cul-tural and social structure dimensions. A cultural assessmentis recommended so that care is based on the individualsneeds and preferences. The appendix accompanying this arti-cle illustrates how one group of nurses was able to meet thespecial needs of their Muslim patient.

    Religious and Philosophical Factors

    Cleanliness has been called half the faith (Athar,1999b). It is very important because a clean body implies apure soul (Luna, 1989). This value of cleanliness is true at alltimes, but it is especially important during prayer. Prior toprayer, each individual must perform ritual ablutions orcleansing. The ablution consists of washing the hands; rins-ing out the mouth, nose, and ears; and finally, washing the feetwith clean water.

    Because the body and clothing must be free of urine andstool, the nurse may be asked to assist with bathing or the

    changing of clothing prior to prayers if there is any doubtregarding cleanliness. The prayer rug is also important inmaintaining cleanliness during prayers. Prayers are donewhile standing and kneeling on the rug. The patient may bringhis or her own prayer rug. If not, a towel or any clean materialcan be used as a floor covering (McKennis, 1999).

    During prayers, an individual assumes several differentpositions including standing straight, bending over at thewaist, and kneeling with the head to the floor. These positionsmay be difficult for some people. Therefore, the sick may beexempt from prayer, or they are allowed to pray sitting or evenlying down.

    In addition to the ritual purification before prayers, thereare other strict practices regarding cleanliness. Having themost impact on nursing care is cleansing after using the toilet.Water is used to cleanse the anus after defecation. If available,water should also be used for cleansing after urination. Ifwater is not readily available, both men and women can usetoilet paper for cleaning the meatus.

    Muslims believe that God causes everything that happensto people and in nature. A major illness is considered Godswill (Zahr & Hattar-Pollara, 1998). Therefore, anger is aninappropriate response (Ali, 1996). For many people, illnessis received with patience and prayers and is considered atone-ment for sins (Athar, 1999b). Illness may be perceived asGods punishment. Therefore, only he can bring healing(Zahr & Hattar-Pollara, 1998). Although most Muslim peo-ple appreciate modern medicine and will seek health care, the


    TABLE 1Basic Islamic Beliefs

    Although there are many tenets and regulations, there are five basic articles or pillars of faith in Islam (Ahmed, 1988).

    1. The profession of faith: There is no god but Allah, and Mohammed was the messenger of Allah. (La Allah illa Allah wa Mohammedrasul Allah.) It is this profession that makes one a Muslim. Allah is simply the Arabic word that is translated the God. ChristianArabs also use the word Allah.

    2. Daily prayers with the individual facing toward the holy city of Mecca in Saudi Arabia: Sunni Muslims pray five times per day (Suther-land & Morris, 1995). The times for prayer change as the season changes. The first prayer of the day is before sunrise and the finalprayer an hour after sunset. Prayer is the ceremonial recitation of prescribed words in Arabic accompanied by different body posi-tions from standing to kneeling with the head to the floor. Prayers can be