Advice for providing culturally competent nursing care to an Arab patient

[chocolateocean, BSN]

I'm completing a senior preceptorship and I have an adult patient who told me his parents are from Iran. I know that there culture is very conservative or Arabic, so I've been trying to communicate with the patient in Arabic. It hasn't been working and I don't know if it's because I don't speak the whole language. I also want to know how do you deal with Middle Eastern people, if they don't want to be touched or assessed because their culture restricts it? And is it appropriate to speak to this patient only in English like my preceptor does? Thanks. 

[hppygr8ful, ASN, RN, EMT-I]

There are many ways to provide culturally competent care without speaking the language. In fact unless you have a decent command of the language in question this type of communication can lead to insults and misunderstandings. I have had two patients in 20 years who had religious stickures to being touched specifically by the opposite sex. In both cases I was able to explain why the touch was necessary and then perform my duties efficiently and respectfully. 

Hppy

[DavidFR, BSN, MSN, RN]

Is your patient really Arab? Only 2% of Iranians are ethnically Arabs:

https://en.wikipedia.org/wiki/Iranian_Arabs

Most Iranians are not Arabs and their language is not Arabic, it's Farsi (sometimes known as Persian). Maybe that's why your're not getting anywhere.

If your patient speaks any English it's approriate to speak to him in the national language of the country where you are (I'm assuming you're in an Anglophone country, though you don't say). If he can't communicate in English are there no interpreting services available? 

Is there a local Iranian communiuty centre or mosque who may send out somebody to interpret? Or even a telephone translating service? 

If something is culturally unacceptable to him, which is highly unlikely, explain its necessity. It's more often muslim women that don't want to be touched by men than the other way round. Often the women themselves are OK but occasionally their husbands are iffy about male nurses, though they don't seem to mind doctors! I've had muslim women expose their bits to me because they usually don't mind when it's medical, and if they're that ill, why should they care? Approach with sensitivity, tact and professionalism and consent is usually forthcoming.

Has this patient expressed that something is not acceptable to him? If not then treat him like any other patient and don't make a big deal about him being in any way different. You say his parents were from Iran, but him? Any special needs should have been identified in his initial nursing assessment.

[Corey Narry, MSN, RN, NP]

@DavidFR, I have to give you props for your response.  I was actually surprised when the OP stated that patient's parents are from Iran yet referred to the culture as Arabic rather than Persian.  I have no strong experience caring for patients of Persian ethnicity but I do know that not all people from the Middle East identify as Arabic nor speak the same Arabic language.  Back in Michigan, we have a population of Chaldeans mostly from Iraq who spoke their own language and were Catholic. 

[JKL33]

@chocolateocean, your first step is to get to know your patient. Maybe you have tried to do this, but your post sounds as if you are simply going off what you think you know.

You are way less likely to be able to provide culturally competent care to this patient and any future patients if your approach is centered around what you think you know and placing patients into large categories and then making assumptions about their lifeways and preferences. I'm not trying to criticize you but I'm very surprised with the tone of your post as a senior nursing student; I fear you have missed a major tenet of providing culturally congruent care.

[chocolateocean, BSN]

12 hours ago, JKL33 said:

@chocolateocean, your first step is to get to know your patient. Maybe you have tried to do this, but your post sounds as if you are simply going off what you think you know.

You are way less likely to be able to provide culturally competent care to this patient and any future patients if your approach is centered around what you think you know and placing patients into large categories and then making assumptions about their lifeways and preferences. I'm not trying to criticize you but I'm very surprised with the tone of your post as a senior nursing student; I fear you have missed a major tenet of providing culturally congruent care.

 

On 1/24/2021 at 2:34 PM, juan de la cruz said:

@DavidFR, I have to give you props for your response.  I was actually surprised when the OP stated that patient's parents are from Iran yet referred to the culture as Arabic rather than Persian.  I have no strong experience caring for patients of Persian ethnicity but I do know that not all people from the Middle East identify as Arabic nor speak the same Arabic language.  Back in Michigan, we have a population of Chaldeans mostly from Iraq who spoke their own language and were Catholic. 

Weird. I had a nursing professor tell me Iranians are Arab and speak Arabic. It was something I learned in my first semester of nursing school. 

[DavidFR, BSN, MSN, RN]

1 hour ago, chocolateocean said:

 

Weird. I had a nursing professor tell me Iranians are Arab and speak Arabic. It was something I learned in my first semester of nursing school. 

He was wrong!

I think your professor has made the mistake of lumping people together as "middle eastern" and assuming they're all the same. This is at best clumsy, and at worst xenophobic.

People make mistakes and it's no crime to not know, but you should never assume that all the peoples of a given region, religion, skin tone or even country are "the same" which is what I believe your professor has done. You will find Egyptian and Lebanese Christians, North African Jews, Kabyles whose women are unveiled and many of whom indulge in alcohol, Moroccans and Saudis who officially both speak Arabic but often can't even communicate because their Arabic is so different (contemporary Arabic as opposed to literary Arabic). It's like assuming all black people are the same or all east Asians are Chinese, or that a Christian Indian from Kerala will share the same language and culture as a Hindu Indian from the Gujarat - no!   

That you are interested and want to find out shows that your intellectual curiosity is faced in the right direction. I'm sure you've been prompted to read up on Iranians. Now go back and educate that professor!   

 

[oldie, CNA, LVN]

Oh dear they are not ARABS!! They are Persians! They are not Sunni either They are Shia! If he is extremely conservative muslim then he won't want a female to touch him because its considered almost like zina/adultery its forbidden.If he had a problem with you being the opposite gender he would have said so.I am so curious where do you live?! I can't believe this is your first ethnic patient wow!! But people from Iran are usually cool and relaxed about religion other then that I don't see what you have to worry about. Don't be afraid of us we are just people ?

[Ash]

Hey there, 

Iranians are not Arabs, they speak Farsi!! You have been trying to communicate with him in Arabic and this is the reason why it hasn't been working. As far as providing culturally competent care is concerned, if you are unsure you should find out what language they speak and if possible call a medical translator who speaks Farsi. You are simply implying what you think you know instead of getting to know the patient. How do you know that the patient does not want to be touched to get assessed by you. Unless they are showing you through their nonverbal communication. It is true that some Muslims do not want get assessed by the opposite gender but not everyone that looks Middle Eastern is Muslim and not everyone that looks Muslim is religious.  

[Orca, ADN, ASN, RN]

When I attended college, I was around a number of Saudi and Iranian students. I had interesting conversations with both, but there are definite cultural differences.

[chocolateocean, BSN]

On 8/12/2021 at 4:17 PM, Orca said:

When I attended college, I was around a number of Saudi and Iranian students. I had interesting conversations with both, but there are definite cultural differences.

Agreed. As nurses we must keep cultural differences in mind when dealing with Arab people. 

[Tenebrae, BSN, RN]

On 1/27/2021 at 4:04 PM, chocolateocean said:

 

Weird. I had a nursing professor tell me Iranians are Arab and speak Arabic. It was something I learned in my first semester of nursing school. 

Main language of Iran is Farsi. 

At the risk of being snarky, I have concerns about a nursing professor giving out such incredibly incorrect information, its literally setting up nurse/patient relationships to fail

Prior to doing my nursing training, I worked as a community support worker in mental health. One day I was assigned a male patient from Afghanistan. I said to my supervisor "is he OK with having a female support worker?" Supervisor didn't know but suggested I ask so I did. I said something along the lines of "Ahmed (not his real name) apologies this seems like a weird question, are you OK with having a female support worker, because I know for many men of your culture being alone with a woman to who they are not related is haram. We do have a couple of male support workers"

Ahmed replied "I am fine to work with you, thankyou so much for asking" and we did work together until I left to start my nursing training. 

I think often nursing training makes such a complicated mess of cultural safety. Often a nurse can get further by acknowledging their lack of knowledge and asking the patient and their family how they can best work together