Have a cultural sensitivity question:

[SmilingBluEyes]

Background: We had a lovely, devout Muslim couple who had a baby a while back in my hospital. Their requests were clear but simple; no meat diet and no male care providers other than the ones already assigned to their care. (meaning no lab techs, nurses, housekeeping, etc). I passed this on in report but apparently poorly and ineffectively, as two days later, to their their horror, a male doctor entered the room to examine the baby. The baby was under the care of a female dr at first, but on-call assignments changed and and this gentleman took over, entering the room unaware of the situation. (He was not told and we had nothing on the door/chart, unfortunately, indicating the situation). The lady did not have time to cover her head/face before he entered, which was the main problem for them.

They handled this very well and politely--- but were extremely upset, understandably. Obviously, this is not information to be left to report alone, as such facts can and (were) lost as the days passed.

So, here is my question. We want to avoid a similar situation in the future. How do you handle such cases, where as you know, staff change by day, and housekeeping/lab/other personnel may enter care and need to be made aware of such mandates or preferences made by patients based on cultural or religious reasons? Do you use signage on the door? Kardex reports that spell it out clearly? Mark charts? My concern is NO ONE enter such rooms before we gain permission, yet there are administrators who feel signage may be inappropriate or offensive to such patients.

SO, what do you do to avoid the faux pas I caused this couple?

We did apologize and they were very understanding and accepting......... we just never want this to happen again and I have to come up with a plan of action that is spelled out clearly in writing, in time for our next staff meeting in 2 weeks.

Thanks in advance for your suggestions!

[dedream]

Hi this is just a thought ...but when there are contact, droplet of other precautions to be taken by staff, there is a big red stop sign with the words report to nurses station on it. Vital information is passed to caregivers assigned to the individual. Maybe a modified version be set up for a situation like this; of course it should be stated in the chart at the begining of the pts stay.....like I said just a thought

[caliotter3]

I agree that a b ig red stop sign with the instruction to report to nurses station for info would be appropriate.

[Elvish, BSN, DNP, RN, NP]

I had a very similar thing happen to me a few years back, and the family was, like yours, understandably upset. It made me feel about an inch tall.

Now, when I have a Muslim patient, I just ask what her/their preferences are regarding male providers. Just as with any other people group, not all prefer things the same way (which I know that you know, SBE, just making the point).

If they do not want male providers, we have signs that we put on the door that say "No Male Providers Please". You could tweak yours to perhaps say, "Males, please check with nurse before entering" to give Mom a chance to cover up.

[live4today, RN]

Elvish gave a very reasonable suggestion that I would implement if it were me. :)

[SmilingBluEyes]

So, so far, signage seems a reasonable solution. I thought so and yes, thanks for the reminder about infection control precautions. We don't hesitate to put such precautions up with people who are on isolation of some sort, and certainly that could be "offensive" to some, if we think about it.

I just think there is no way to get around putting a sign on the door that requests nobody enter the room without seeing the assigned nurse FIRST, under any circumstances. Then, we can explain the situation if need be, if questions do arise. We don't need to put specifics on there, just that no one enter room, period.

Any other ideas?

[SmilingBluEyes]

PS-------I sure did feel an inch tall; I felt terrible about what happened, and yes I am at least a large part to blame. I took responsiblity, contacted the unit manager and CNO and told themr what happened and owned it. I also agreed to work on a solution to prevent further such occurences. This was the only way I could feel better. I also plan to contact the affected family and thank them for their feedback and give them a brief description of what measures are being taken in the future. They did say we could contact them.

[KateRN1]

A word about signage: As a Muslim woman, I can tell you without a doubt that I would *NOT* want a sign on my door. You have no idea how many well-meaning people feel that they need to witness to me as soon as they discover that I'm Muslim. Or feel the need to make terrorist jokes. Or ask how I feel about being so oppressed. The list goes on. I am happy with my religion and don't hide it. But at a time of stress, such as hospitalization, the last thing I want is for it to be the major factor in my care. Not saying that Muslim women don't have special circumstances, but I question whether obvious signage is a good idea.

Have you thought about asking the imam at your local masjid? Perhaps a focus group of Muslim women arranged by the imam could help your facility come up with some other alternatives that would work for everyone.

[SmilingBluEyes]

I thank you for the suggestion. I have a friend whose husband is an imam; I will ask them! Good suggestion!

PS I would suggest a sign that would be a general precaution not to enter the room; nothing to indicate specifically WHY.....just to check with primary nurse FIRST.

[Elvish, BSN, DNP, RN, NP]

Kate, I don't know that anyone is advocating putting a sign on the door saying the pt is Muslim. I think there is a huge difference between a sign that says "Pt is Muslim and requests no male providers" and a sign that says, "No males please."

For what it's worth, any patient of any faith would get the same treatment were she to request no male care providers, for whatever reason.

That said, your perspective is most appreciated, and the idea to consult with an imam or a focus group is awesome! :)

[KateRN1]

No, of course the sign wouldn't say "Muslim patient" but it wouldn't take long for the male staff to ask what's up and it would be all over the hospital in about as long as a coffee break, ykwim? So whether it stated it or not, it would be obvious to anyone working at the facility.

How patients are treated would also depend a lot on the location of the facility, too, I think. Having lived 14 years in the buckle of the Bible Belt, I can assure you that there are staff members (male and female) who would've (and did) make an effort to persuade me, although not while I was a patient, thank goodness. In areas that are a bit more diverse, it may not be an issue at all.

Please let me know how it turns out. I would love to know the ultimate decision and be able to suggest it in case *I* need something myself. :)

[SmilingBluEyes]

I am suggesting a sign that simply reads something like this:

"Please do not enter this room without first checking with patient's nurse.".