Professional Nursing in Oman

Professional nursing in the Middle Eastern nation of Oman has grown rapidly since the country’s 1970 modernization of its health care system. In fact, over the last 10 years nursing has become one of the fastest-growing professions in the country. Previously, nursing education was primarily vocational training, but since 1990 nurses must earn a diploma to practice as an RN. Despite many recent efforts to improve nursing education and practice, the profession is still attempting to catch up with nursing practices in the United States and other nations.

Oman is currently struggling with a rapidly growing population, rapid expansion of health care services and severe shortages of well-trained nurses to meet the demands. The Ministry of Health has made great strides by supporting nurses’ educational preparation, establishing and funding educational institutions and offering free education to individuals who choose nursing as a profession.

The Sultanate of Oman is located in the Persian Gulf region, bordered by the United Arab Emirates and Saudi Arabia on the west and by the Republic of Yemen on the south. It is divided into four governorates (country subdivisions) and eight administrative regions. About 82% of the country consists of sandy desert and rugged mountains with small agricultural areas. Muscat City, inhabited by more than 600,000 people, is the capital and the center of political, economic and commercial affairs. Nizwa, Salalah, Sohar and Sur are other large cities. Oil is the main source of the country’s income, followed by industry and natural gas. According to the 2004 national census, Oman’s total population was 2.57 million, with 33.3% of the population under 15 years old and only 2.2% aged 65 and older. Life expectancy is 74.3 years.

Oman is an Islamic Arabic country that developed its own branch of Islam, called Ibadhism. It is the only country in the Islamic world with a majority Ibadhi population. There are no major variations in the Muhammadan law between Ibadhism and other branches of Islam, such as Shia and Sunni. However, Ibadhism is known for its moderate conservatism and its choice of ruler by communal consensus.2 Although other branches of Islam exist in Oman, there is a unity in the society between all branches, and the country is known for its tradition of religious broadmindedness.3 In addition to the largely Muslim population, there is also a minority of expatriate non-Muslim groups, primarily Christians and Hindus.

Religion and culture play important roles in Oman’s health care practices, regulations and professional roles. Most hospital treatment areas are divided into male and female sections. In outpatient facilities, male patients are treated in the men’s allocated areas and female patients are treated in a different designated area. Inpatient care is similar, with male and female patients admitted into separate wards. However, exceptions sometimes occur in areas such as adult intensive care, coronary care and dialysis units.

Oman’s Health Care Renaissance

Before 1970, Oman’s health care system was one of the poorest in the world. The mortality rate was high, especially among infants and children, with infant deaths estimated at 159 per 1,000 live births.4 Many people suffered from infectious and communicable diseases due to lack of health care services, inappropriate treatment and poor sanitation. Malaria, mumps, trachoma, diphtheria, neonatal tetanus, polio, gastroenteritis and diarrhea were among the most common diseases at that time.5

In July 1970, Oman’s ruler, Sultan Qaboos bin Said, began to take steps to relieve his people’s suffering by seeking to establish an excellent health care system. He issued a royal decree to create the Ministry of Health (MoH), which was charged with the responsibility of providing high-quality health care to all Omani citizens. In the years that followed, the MoH established hospitals and health centers across the country and brought modernization into all health care professions.6

As a result, in less than four decades health care services in Oman have expanded throughout all regions of the country, greatly increasing people’s access to care. In addition, the MoH has initiated many public health programs, including a national birth spacing program and health education programs. Since the ministry’s Expanded Immunization Program (EPI) was introduced in 1981, diphtheria, neonatal tetanus and polio have been eradicated.

Oman has a government-funded National Health Service that includes general and speciality hospitals. The MoH is the main health care provider, followed by the Ministry of Defense and the Sultan Qaboos University Hospital (SQUH). According to the 2005 World Health Organization census, the country has 17 physicians per 10,000 population and the proportion of nursing and midwifery professionals is 37 per 10,000 population. Today, nearly 100% of the total Omani population has access to health services, depending on where they live.7

Currently, Oman has 58 hospitals, which are classified as primary, secondary, tertiary or referral. Combined, these hospitals contain 5,270 inpatient beds, which equates to 21 beds per 10,000 population. Fifty-four hospitals are government-supported and provide free health care services for Omani citizens and for foreign nurses working in the governmental sectors. Fee-for-service care is common for foreign workers in the private sector. Royal, University, Sultan Qaboos, Khoula, Al Nahda, Nezwa and Sohar are the largest tertiary teaching hospitals in the country. Royal Hospital is Oman’s largest health care institution, with about 700 beds and continued expansion to incorporate new facilities.

Other tertiary hospitals have inpatient capacity that ranges from 200 to 532 beds. Khoula Hospital is the Sultanate’s central referral hospital for orthopedic, neurological, cosmetic surgery and burn care. Al Nahda Hospital is the main specialty treatment center for ear, nose and throat surgery, eye care, dental and jaw surgery and skin diseases. Royal Hospital is the referral hospital for heart disease, heart surgery and cancer.7

The tertiary hospitals serve as specialty centers, receiving patients from primary and secondary health care services, emergency patients and patients referred from other hospitals for medical management. The secondary hospitals provide primary and secondary health care services with some specialty care, such as gynecology and orthopedic care. Primary care hospitals provide general health services and refer patients to facilities with higher levels of care when specialized treatment is needed.

In addition to the hospitals, there are 897 health centers, dispensaries and clinics spread across the country. These facilities provide primary health care services with a few specialized care units. Health centers, which are usually located in low-populated areas, are staffed by general practice physicians and nurses, who provide services such as vaccinations and pre- and post-natal care.

History of Nursing in Oman

Nursing in Oman is widely recognized as an admirable, caring profession. For centuries, nursing was practiced by untrained household women who used natural remedies to treat the sick and assist with the delivery of babies. In 1904, the first missionary nurses from America arrived in Oman to work in an organized health center. In the 1950s, a small group of U.S. nurses serving in the American Missionary Association in Muscat began training Omani nationals to become nurses. This marked the beginning of modern nursing in Oman.

At that time, the capital city had only two small hospitals to meet the health care needs of the entire population. The American nurses joined the staffs of the two hospitals and in 1959, a six-to-nine-month training program was established at Al Rahma Hospital for 16 Omani nurse trainees. That training center continued to educate nurses until 1970, when the American Missionary Association established a two-year nursing program, Al Rahma School of Nursing, in Muttrah.7

Oman’s modernization opened a gateway for the nursing profession. In 1972, Al Rahma School of Nursing was taken over by the Ministry of Health. The MoH increased the number of nurse trainees at the school and upgraded it to a three-and-a-half-year program offering a certificate in nursing. In 1980, the Directorate of Nursing was established at the MoH headquarters, an official acknowledgement that professional nursing was now seen as a vital aspect of health care.

From the beginning, the Sultanate’s ambitious plans to improve and expand health care services have been hindered by an insufficient supply of nurses, nursing education programs and nursing educators. Therefore, the MoH began recruiting nurses from abroad. Until very recently, most nursing jobs in Oman were held by foreign nurses, primarily from India, the Philippines and Sri Lanka.

For the last 15 years the Sultanate has been working to Omanize the nursing profession by increasing the number of homegrown nurses and nursing schools. In 1998 Oman had 7,453 nurses, of which less than a quarter (24%) were Omani. By 2006, however, the total number of nurses serving in the MoH had grown to 8,278 and 63% of them were Omani. In addition, the nurse-to-population ratio has risen from 32.6 nurses per 10,000 population in 1998 to 37 nurses per 10,000 by 2005. However, despite ongoing efforts to increase the numbers of both national and foreign nurses, Oman’s health care services still have a 30% shortage in nursing staff.

Nursing Education

At the present time, Oman has 12 basic nursing institutes that offer a three-year diploma program. These institutes operate under the administration of the MoH’s Directorate General of Education and Training. Muscat Nursing Institute (MNI) and Oman Nursing Institute are the largest nursing education programs in the country; each graduates about 100 new nurses a year. The other 10 schools, located in different regions of the country, each produce about 35 new nursing graduates per year.

MNI was the first school to graduate diploma nurses and is considered the heart of nursing education in Oman. MNI assists other institutes with curriculum design and educational resources. To ensure consistent quality of nursing education throughout the country, all nursing schools share an identical curriculum with some minor course plan variations. The Nursing Education Board regulates nursing programs, licenses schools and also helps establish curriculum content.

The country’s first baccalaureate nursing program was launched in 2002. The MoH continues to strive to prepare highly educated nurses and improve the quality of nursing care. Currently, there are two nursing schools in Oman that have BSN programs: Sultan Qabos University (SQU) and Niswa University. In addition to the four-year program, both schools also offer a two-year RN-to-BSN program.

Neither master’s nor doctoral programs in nursing are currently available in Oman, but the MoH and SQU intend to begin offering them soon. In the meantime, Omani nurses who earn BSN degrees are sent abroad to gain a graduate degree. Every two years, the MoH sends a group of 20 nurses to the U.S. to do graduate study at Villanova University in Pennsylvania. The majority of these graduate students major in nursing education and the rest study nursing administration. The education specialties emphasized include adult medical-surgical care, pediatrics, community health, and mental health, depending on the student’s area of interest and the MoH’s faculty needs. After completing their graduate degrees, the students return home to either join nursing institutes as faculty members or work at hospitals as nursing administrators or staff development officers.

The MoH also sends nurses to the United Kingdom and Australia for preparation as advanced practice nurses in specialties such as adult critical care, pediatrics, neonatology, nephrology, midwifery and emergency nursing. Graduates of these programs work as nursing educators and clinical instructors in the Oman Specialized Nursing Institute and teach post-basic nursing courses.

Oman currently has approximately 180 bachelor’s-prepared nurses, about 40 of whom have also completed master’s degrees. Many of these nurses who did their master’s studies abroad say they gained tremendous knowledge and experience from being exposed to education and health care systems in other countries. These growing numbers of nurses with graduate degrees are playing important roles in advancing the nursing profession in Oman. They are introducing new ideas in clinical and educational practice and they’re helping to increase the supply of highly skilled nurses available to meet the nation’s health care needs.

However, there are still not enough nurses with advanced degrees to meet Oman’s urgent demand for more nursing faculty. Because of the severe shortage of nursing educators, about 50% of current faculty positions are held by nurses recruited from other countries, such as Jordan, India, the Philippines and England. These foreign faculty work under temporary contracts with the educational institutions. Even with good pay for nursing educators, the faculty shortage continues to be a challenge. Frequent vacancies resulting from the end of these short-term job contracts, and from resignations of foreign educators who want to return home, exacerbate the problem.

Students’ admission to nursing institutes and university nursing programs is based on secondary school grades, passing an English proficiency exam and admissions interviews in Arabic and English. Each year, the Directorate General of Training and Education sets a predetermined number of slots for male and female applicants. Female students usually account for 80% to 85% of the typical nursing class. In fact, the proportion of female to male nurses in Oman is about seven to one.

This uneven gender distribution in nursing classrooms has created problems for men who are interesting in nursing careers. Although male students want to become nurses, they lack opportunities to enter nursing. The MoH’s justification for favoring female students is that female nurses can generally work in any area of health care, including obstetric and gynecology wards or delivery suites, whereas male nurses are prohibited from employment in some practice areas.

All nursing courses are taught in English by nurse educators prepared at the doctoral, master’s or baccalaureate level. The curriculum is designed to prepare nurses for a variety of roles in hospitals, health centers and community health settings. The coursework addresses content areas that prepare students to practice basic nursing—e.g., adult medical-surgical care, pharmacology, obstetrics/gynecology, pediatrics, community health and psychiatric health. Nursing students also take English language courses, nutrition and other basic science courses. The fall and spring semesters are a blend of theory and practicum experiences, while the summer is extensively practicum with few class meetings.

Licensing, Specialization and Research

Currently, the registered nurse is the only qualified level of nursing practice in Oman. To become an RN, students must graduate from a three-year diploma program or a four-year BSN program. After graduation, they are awarded a licensed RN certificate and are eligible to practice nursing. Nurses who graduate from one of Oman’s nursing education institutions are waived from taking the national licensing exam, because passing the course exams and successfully completing the nursing program are considered measures of clinical performance. However, the licensing exam is mandatory for nurses who graduate from programs outside Oman.

Newly graduated nurses employed in most health care services must work under the direction of a supervisor for six months and complete an internship period before they are allowed to work independently. During the internship, novice nurses are assigned to work with experienced RNs who continue to teach, mentor and perform periodic evaluations. These preceptors have at least five years of nursing experience and have taken some specialized training courses.

Recognizing that continuing education is an important part of maintaining high-quality nursing care, in 1977 the MoH began to establish post-basic training programs—i.e., a two-to-three-year clinical for RNs who have completed a basic nursing program.7 These post-basic programs prepare nurses to specialize in specific practice areas that will improve their performance in clinical settings. The first post-basic specialty program offered was in nephrology. To expand specialized nursing education across the country, the MoH has also initiated a four-month on-the-job training program in which nurses work in teaching hospitals to gain practical experience and theoretical knowledge.

In 2001, the MoH opened the Oman Specialized Nursing Institute (OSNI) in Muscat to increase the supply of nurses with specialized skills. OSNI provides an 18-month program of post-basic speciality courses for nurses across the country and awards certificates in several nursing specialities. These include emergency care, midwifery, mental health, nephrology, nursing administration, adult critical care, neonatal and pediatric critical care. The MoH has also expanded the midwifery program, adding three additional programs to train nurse-midwives in other parts of the country. Selection of nurses for these specialized study programs is based on community health needs, MoH priorities, nurses’ clinical achievements and employer recommendations.

At present, there are no formal nursing research organizations in Oman, but the MoH has several research committees that oversee local studies and surveys. These research projects are conducted by teams of health care professionals, including doctors, nurses and other practitioners. Nurses in Oman generally lack the skills, experience, motivation or financial support to undertake research studies in clinical or academic settings on their own. Although there is a great need for research studies about nursing issues in Oman, few such studies have been published. Increasing the number of nurses with advanced degrees would help remedy this deficit.

Nursing Employment

Nurses in Oman work in all types of health care settings. Thanks to the nursing shortage, newly graduated nurses have 100% job availability in one of the country’s health care systems or nursing institutes. Nurses employed by the MoH are guaranteed a job until the age of retirement (60 years).

In most cases, nurses do not have a choice of where they will work. Because most educational institutions and health care facilities are government-owned, graduating nurses are assigned to employment locations based on staffing needs. Furthermore, most graduating nurses cannot express a preference for a particular clinical area or unit. However, nurses who have specialized post-basic training are assigned to work in specialty units, such as intensive care, burns, renal care and dialysis.

Many nurses in Oman work full time in governmental health care facilities, such as hospitals, health centers and clinics. Most of these nurses have a diploma in basic nursing from one of the country’s nursing institutes and some have post-basic program certificates. Few baccalaureate-prepared nurses work in clinical settings.

Most nurses employed in health care facilities work 140 hours per month with eight days off each month. Duty roster plans vary depending on the facility. In some facilities, the work hours are distributed equally among three shifts, but in most cases nurses work more evening and night hours. Due to staff shortages, some employers often demand that nurses work more than the required hours. Extra work hours are generally compensated with time off. Overtime is rarely paid because most nurses prefer time off instead.


Nursing, like any other governmental job in Oman, has a salary-based pay system. All nurses employed by the MoH are paid equally according to educational degree and years of experience, regardless of the work location. In other words, nurses working in Muscat earn the same salary as those working in rural areas, and critical-care nurses make the same money as those employed in outpatient clinics. RNs with less than five years’ experience are designated as staff nurses and paid the same wherever they work. Nurses are entitled to receive pay raises and job promotions every five years, starting at staff nurse and moving up to senior staff nurse, supervisor and, finally, nurse adviser.

Nurses in Oman often complain about staffing shortages, heavy workloads, lack of job choice and the difficulties of trying to meet their family obligations while working inconvenient shifts. In some hospitals, nurses have no formalized job descriptions and are therefore required to perform tasks that have nothing to do with nursing, such as dispensing drugs after midnight in the pharmacy and completing statistical reports.

While the Sultanate’s continued expansion of health care services, building of new hospitals and population growth are positive signs of progress, there is no denying that these factors also contribute directly to the nursing shortage. When foreign nurses working in Oman return home to care for family members or leave to take positions in other nations, the result is severe understaffing. The MoH has made significant strides in increasing the number of nursing education programs, nursing students and RN graduates, but these measures still seem inadequate to deal with the looming shortages. Professional nursing in Oman has come a long way in the last 38 years, yet it still has a long way to go.


1. World Health Organization (2003-2005). “Oman Demographic Indicators.”

2. U.S. Department of State, Bureau of Near Eastern Affairs (2006). “Background Note: Oman.”

3. Oman Information Center. “Primary Health Care in Sultanate of Oman.”

4. Hill, A.G. and Chen, L.C. (1996). Oman’s Leap to Good Health: A Summary of Rapid Health Transition in the Sultanate of Oman. World Health Organization/United Nations Children’s Fund, 1996.

5. Scrimgeour, E.M., Mehta, F.R. and Suleiman, A.J. (1999). “Infectious and Tropical Diseases in Oman: A Review.” American Journal of Tropical Medicine and Hygiene, Vol. 61, No. 6, pp. 920–925.

6. “The Celebration of the Omani Renaissance Day on the 23rd of July 1970.” Ain-Al-Yaqeen magazine, August 11, 2006.

7. Sultanate of Oman, Ministry of Health. “Oman’s Nursing Profession Comes of Age.”

Meeting Jewish and Muslim Patients’ Dietary Needs

“We are what we eat.” It’s a statement we’ve all heard, but as nurses we need to understand what it really means for us and for our patients. Simply, we eat what we believe is good for us and what we think tastes good–attitudes that are primarily shaped by our family upbringing, our culture and our personal preferences. And if we are people who practice a particular religious faith, we eat what is most in agreement with our beliefs.

Many religions forbid certain food items, have strict requirements about how food should be prepared and have special dietary practices that must be observed. Adhering to these guidelines helps followers of these religions feel assured that they are eating what is best for their physical, mental and spiritual well-being. Therefore, when caring for a multicultural patient population, nurses need to be aware that some patients’ special dietary needs play a major role in their healing process. For the patient who is a strict observer of his or her religion, any violation of their dietary requirements can be perceived as an actual challenge to the utmost supreme authority–whether it be God, Buddha or Allah–and can impact negatively on their recovery and their level of satisfaction with the health care facility.

To be culturally competent health care providers, nurses must not only be aware of patients’ religious dietary mandates but work very hard to accommodate them. The challenge for us as caregivers and patients’ advocates is that in many health care facilities with rigid policies, efforts to meet these special dietary needs may require a creative twist and a team effort to make it happen.

Eating food is not only a necessity of life but also a pleasant and social practice that everyone expects to enjoy. Eating during sickness needs to be a very positive experience for all patients. Therefore, health care organizations must adjust their often inflexible policies to be more people-oriented, rather than system-oriented. For example, some hospitals are beginning to rethink their approach to food services by including menus that accommodate the dietary requirements of America’s growing Muslim population.

As a resident of the Washington, D.C. area, I enjoy visiting the cafeteria at the World Bank to sample its array of international foods and its “eat around the world” atmosphere. This is an excellent example of an organization displaying what we can call true cultural sensitivity and multicultural customer service.

Understanding Judaism and Islam

The religions of Islam and Judaism share many similarities. Muslims believe in only one God (Allah), the creator and sustainer of all creatures and the universe, who prescribes the Muslim’s way of life. Following Islam and obeying its teachings, as set forth in the holy book the Quran, is the most important thing in a Muslim’s life and requires adherence to mandatory practices that may not tolerate violations. Observant Muslims believe that the best way to maintain their mental, physical and spiritual well-being is to adhere to the Islamic teachings and the rules of Allah through practice and moderation in all aspects of life.

Muslims consider their health a religious matter and they believe that good nutrition is one of the essential steps toward maintaining good health. For Muslims, health and food are considered acts of worship for which Allah must be thanked.

Similarly, in Judaism the Hebrew Scriptures, which include the holy book the Torah, emphasize one God, the creator and the author of everything in the universe. The Torah contains religious laws set forth by God that address all aspects of Jewish life. Books such as the Talmud are used to interpret and apply these Jewish laws in daily life.

Both Muslims and Jews consider eating to be a worshiping matter that requires following the dietary practices and requirements set forth in their respective holy books. I will discuss some of these specific dietary needs in the next two sections of this article. As always, however, care providers must be sure to view each patient as a unique individual and not make blanket assumptions or generalizations about the patient’s religious needs. How strictly a Jewish or Muslim patient chooses to follow his/her religion’s dietary practices can vary widely. The best way to determine a patient’s religious, cultural and/or dietary needs is simply to ask the patient and/or family members.

Islamic Dietary Practices

Islam prohibits Muslims from consuming any of the following items:

Alcohol. This includes alcoholic beverages such as wine and liquor, as well as any food items that contain alcohol. Islam forbids the use of any mind-altering substances, whether in the form of food, drink or smoking. Muslims believe that maintaining health, Allah’s gift, requires mastering full control over one’s mind, body and spirit at all times.

Pork or any pork products, such as lard, ham and pepperoni. This includes consuming any food that contains these items in any concentration or amount. Therefore, all foods containing animal shortening are forbidden, since this shortening is usually made from pork fat. It is permissible to eat foods containing vegetable shortening.

Blood. Raw meat must be soaked in water to drain out the blood before cooking. Muslims are permitted to eat only well-done cooked meat where no trace of blood can be found after cooking.

Islam also forbids cooking, eating or drinking from any pans, dishes, cups or table utensils that were used to prepare food containing pork or alcohol. They cannot be used to prepare or serve food for Muslims until they are thoroughly washed.

Animals and poultry must be slaughtered by cutting both the neck artery and vein to cause instant death and decrease animal suffering. The name of Allah must be mentioned during the slaughtering of the animal to bless it and make it Halal (lawful) to eat.

Islam also stresses certain hygienic measures such as washing hands before and after eating, and cleaning the teeth frequently. A Muslim who has eaten onions will pray at home, rather than in the mosque, so as not to offend others and the angels.

Jewish Dietary Practices

Jewish dietary laws are known as kashrut and food that adheres to these standards is called kosher. Many mandates of the kosher diet are similar to those found in Islam. For example:

• Eating any pork or pork products, including animal shortening, is prohibited.

• All blood must be drained from meat and poultry before cooking.

• Dairy products and meat products cannot be eaten together, because this is considered unhealthy. Cooking equipment and eating utensils that have come into contact with dairy products cannot be used with meat, and vice versa.

• Animals and poultry must be slaughtered in accordance with Jewish law.
Other Jewish dietary restrictions include the following:

• Eating certain types of animals, birds and fish is prohibited. Specifically, the only mammals that may be eaten are those that have cloven hooves and chew their cud, such as cows, sheep and goats. This explains why pork is forbidden, since pigs do not have these characteristics.

• The only type of fish that may be eaten are those that have fins and scales. Therefore, shellfish, such as lobster, shrimp, oysters and crab, are prohibited.

• Birds of prey and birds that are scavengers may not be eaten. Typical fowl, such as chicken, ducks and turkeys, are permissible.

• Certain parts of permitted animals may not be eaten. In the case of forbidden animals, their eggs and milk also cannot be consumed.

Before eating, observant Jews will recite a blessing (bracha) acknowledging God as the creator of the food they are about to enjoy. This is done by holding the food in one hand, reciting the blessing and immediately taking a bite or a sip. One must not speak or make any interruption before finishing the first bite or sip. Another commandment of the Torah requires that a blessing also be recited after the meal.

There are also special bracha that are recited for specific foods. For example, certain fruits and nuts, such as almonds, apples, apricots, blackberries, cashews, cherries, chestnuts, coconut, cranberries and dates, require a blessing known as a Ha’etz. A blessing called a Ha’adamah is required before eating vegetables such as asparagus, beans, beets, broccoli, Brussels sprouts, whole buckwheat, cabbage, etc.

Ancient Foods for Modern Health

In today’s health-conscious times, it is very interesting to note that many Islamic and Judaic dietary traditions dating back to 1,400 years ago have been confirmed by modern scientific evidence to have a healthy effect on the human body. For example, consider the prohibitions against eating pork in both Muslim and Jewish dietary laws. We now know that:

• Pork fat is the most saturated type of fat in the animal kingdom and can increase the risk of high cholesterol and cardiovascular disease.

• Its salty meat is an additional risk for the kidneys, heart and for hypertensive patients.

• Pigs will eat anything and everything, including their own excreta. This makes their bodies an ideal host for several microorganisms that are known to be hazardous to human health if consumed regularly.
In addition, many foods that have long been staples of the traditional Middle Eastern diet are being recognized today for their healing properties, especially in the fields of alternative medicine and herbal medicine. Here are a few examples:

Honey is a natural remedy for conditions such as coughs, stomach ulcers and skin ulcers. Many cough medicines sold today include honey as an ingredient. I have personally witnessed the use of honey to heal bedsores in some health care centers in the U.S.

Virgin (unprocessed) olive oil is cited in the Bible, Quran and Torah as a holy food item. It helps dissolve bad cholesterol in the human body and is also an excellent topical treatment for skin conditions such as severe dryness and eczema.

Black caraway seed (also known as nigella sativa or black cumin) was used as a medicinal herb by the ancient Egyptians and Greeks. Today, practitioners of alternative medicines such as ayurvedic medicine are continuing that tradition. It is used to boost the metabolism and the immune system. Also, some research studies have suggested that extracts from these seeds may have some effect in slowing the growth of certain types of cancer.

Dates, which are high in natural sugar and protein, are a healthy food for breaking one’s fast. For pregnant women, eating dates can strengthen the uterine contractions during labor and delivery and assist in preventing postpartum bleeding. According to the Quran, Allah asked Maryam (Jesus’ mother) to shake the date tree and eat from it to ease her birth process. Muslims faithfully follow this practice.

Garlic and onions are very ancient preventive measures for conditions such as infections, cardiovascular disease and diabetes. These foods contain powerful chemicals that can help lower cholesterol, lower blood pressure, reduce the risk of blood clots, attack infection-causing bacteria and even reduce the risk of developing certain cancers, if eaten on a regular basis.

Editor’s Note: Minority Nurse’s cultural competence expert, Gihan ElGindy, MSN, RN, is an internationally recognized authority on cross-cultural issues in nursing. Her advice column is designed to answer your questions about incorporating cultural competence into your nursing practice and resolving cultural conflicts in today’s diverse health care workplace. Do you need expert advice on how to provide culturally sensitive care to patients from a particular ethnic or religious background? Are you looking for ways to increase understanding and acceptance of cultural differences in your work environment? Our expert can help!

Treating Muslims with Cultural Sensitivity in a Post-9/11 World

Q: I am a Muslim nurse who wears Hijab [the Islamic dress requirement that women’s bodies must be completely covered except for their face and hands]. I am frustrated because infection control staff are always asking me to wear short sleeves or roll up my sleeves. How can I avoid this situation and make them understand that this is an important religious requirement in my culture? In my opinion, my long sleeves do not pose a considerable infection hazard.–A Muslim RN

A: Muslim working women, including nurses and other health care professionals, often face challenges because of their attire, which is in adherence to Islamic regulations. Many times, these challenges originate from misconceptions and limited knowledge about Islam and Muslims. To be culturally sensitive to the needs of Muslims in the health care workplace, it is essential to understand that in Islam, both men and women are mandated to wear modest clothes and follow the Islamic dress code. It is even more important to understand that Hijab is much more than simply a way of dressing–it cannot be separated from the “big picture” of Islam as a entire way of living and believing.

For Muslim women, wearing a headscarf, veil, long sleeves, loose-fitting clothing and other elements of Hijab is necessary to obey the Islamic dictate that they must cover the body in the presence of male non-family members. They may, however, dress as they please in the privacy of their homes, or in areas where no male non-family members are present. Yet it is important to keep in mind that Islam, like all other religions, has those who do not practice or adhere to the requirements of the religion, as evidenced by Muslim women who do not wear Hijab. This is often a source of confusion to non-Muslims.

It’s also worth noting that wearing the veil and covering the body are traditional religious practices that are not unique to Islam; they are found in other faiths as well. For example, in Christianity, nuns wear the “habit” and many Jewish women cover their hair before going to synagogues.

So how should this Muslim RN handle her conflict with the infection control staff? First, let me say I admire your strength and pride in standing up for what you believe in and your right to freedom of choice in this land of freedom. I would suggest sitting down with the infection control staff to try to educate them about your cultural and religious requirements in a non-confrontational way. It would be helpful to make information about Muslim culture and Islam available to them–such as this column and other articles you may find in magazines or on the Internet–so they can build their cultural competency. Also, if there is a diversity director or coordinator at your facility, I encourage you to bring this matter to his or her attention.

Sadly, since September 11 cultural insensitivity toward Muslims in the workplace has become a widespread problem throughout the country. We all need to learn to be open-minded and try very hard to understand and respect each other’s views and beliefs. Hopefully, we can learn from each other and focus on the work Muslim nurses do, rather than on what they wear.

Q: I have found caring for Muslim patients to be a very demanding and frustrating assignment. They ask for many things that we nurses are unfamiliar with and that can create problems in a hospital setting. For example, asking for lots of water to wash themselves before and after using the bathroom, which can make a mess, especially if bed rest was ordered. Can’t they delay all these special requests until after they are discharged?–J. S., Arkansas

A: It is quite common for care providers who are not familiar with Muslims and their practices to be confused and even bewildered by their requests. Here are a few tips that can make your job easier and more pleasant.

First of all, it would be culturally insensitive to ask Muslim patients to put their religious practices “on hold” until after they are discharged. Adherence to the teachings of Islam governs every aspect of Muslim life and must be practiced every day, regardless of the physical setting in which Muslims may find themselves. (See “Understanding Islam.”)

What’s behind the requests for water? Muslims are religiously responsible for their lives, health and well-being. Islam requires Muslims to stay healthy by focusing on preventive medicine and good hygienic practices. Maintaining cleanliness is considered a required act of worship. Muslims must pray to Allah several times a day; in preparation for prayers, they must start with the cleansing process known as “ablution.” This consists of washing the face, hands, arms, legs and feet, using running water–even if the person is in a hospital bed.

There are also other situations in which mandatory cleansing actions with running water are required for all Muslims:

• After elimination, for removal of all traces of urine, stool, and/or blood;

• After the cessation of menstrual and postpartum bleeding, and after sexual intercourse. In these instances, the person must shower to clean and purify her/his body in order to resume religious practices.

When Muslims are hospitalized, they are very sensitive to traces of urine, stool or blood on their clothes, body or linen because they believe it interferes with their ability to pray and read the Quran. It decreases their sense of cleanliness and purity, which is necessary for worshiping practices–practices that are essential and comforting during illness, hospitalization or crises. Indeed, performing ablution, praying and reading the Quran are among the most important spiritual resources for Muslims during sickness or stressful times. As in many other religions, prayers can erase bad deeds and make entry to paradise easier, as well as improve the patient’s mindset to enable a speedy recovery.

You will be happy to learn that nurses can easily accommodate Muslim patients’ religious cleansing needs in ways that will not turn the hospital room into a wet mess or interfere with the patient’s medical treatment. You can simply escort the patient to the bathroom sink or shower. If the person is confined to bed or has other special conditions that limit mobility, a full pitcher of water with a basin as a receiver can meet the running water requirement. If water is medically contraindicated and/or can cause harm to a wound or damage to a cast, for example, you need to explain this clearly to the patients so that they can modify their cleansing practices accordingly. In these situations, Muslims know how to dampen a hand with water and wipe the affected body part with it.

Understanding Islam

For nurses as well as the health care facilities that employ them, understanding Muslim culture is an essential part of building required cultural competency. Muslims are one of the fastest-growing populations, both globally and in the United States. Many U.S. cities, such as New York, Los Angeles, Chicago, San Francisco and Detroit, have large and dynamic Muslim communities. An important part of understanding the cultural needs of Muslims is understanding the role of Islam in their lives and how their adherence to the teachings of Islam shapes their beliefs about health, illness, preventive medicine, birth and death.

“Islam” can be defined as submission and surrendering to Allah (God) by following and obeying his orders. For Muslims, Islam is not just a religion but a complete way of life, guiding and governing all their life aspects. Therefore, adhering to Islamic teachings is much more important than anything else in a Muslim’s life, to the extent that Muslims will sacrifice their own welfare–such as possibly losing their jobs–rather than violate Islamic regulations. This is because Muslims place the greatest value in accountability on the Day of Judgment, which will determine one’s fate in the hereafter. For Muslims, adherence to Islam is not limited to just this short earthly life; rather, it is a test to escape hellfire and achieve eternal paradise.

Prayer is the highest form of worshipping in Islam, in which Muslims communicate with Allah while reciting from the Quran (the holy book of Islam). Muslims must pray five mandatory prayers every day. It is important for health care providers to understand that Muslims do not speak or respond to anyone but Allah during prayers.