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.

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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

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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.

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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.

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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.

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