Arab Case Study For Discussion

Question

Mrs. Nasser arrived at the urgent-care center with her 16-year-old daughter, who had been experiencing burning upon urination, itching around her genital area, and a high fever. Mrs. Nasser appeared very anxious, explaining to the nurse that her daughter had never had these symptoms before. The nurse tried to calm Mrs. Nasser and asked that her daughter, Samia, get undressed in preparation for a physical examination. Mrs. Nasser appeared concerned and requested that the nurse inform the doctor that she will not allow the doctor to perform a vaginal examination on her daughter.

The nurse explained to Mrs. Nasser that it will be necessary for the doctor to examine Samia so that she can determine the cause of Samia’s discomfort. Mrs. Nasser became extremely agitated and explained to the nurse that in her culture, young girls are not allowed to have vaginal examination for fear that their virginity will be compromised. Mrs. Nasser insisted that she would not allow her daughter to be examined by the female doctor on duty. Mrs. Nasser requested that the nurse ask the doctor to write a prescription for her daughter’s infection, or else she would leave the clinic immediately.

1. How should the nurse respond to Mrs. Nasser’s request? Explain your rationale.
2. Identify culturally congruent strategies that may be most effective in addressing the needs of Mrs. Nasser.
3. How might the nurse ensure that Mrs. Nasser’s concerns are addressed appropriately and that Samia has received the appropriate care?

Answer

In modern conditions the principle of doctors' observance of professional skills and moral norms acquires special urgency. A particular position on the list of medical disciplines is occupied by pediatric gynecology, which includes medical and moral problems, involves the interrelationship of an individual and society, and deals with the reproductive and spiritual health of the younger generation. Given that a nurse participates in the most intimate aspects of a girl's life, overcomes a sense of shame, and often faces resentment of the patient and parents, the role of ethical and psychological moments is very important in the work of a pediatric gynecologist.

Arab Case Study presents cultural difficulties that are faced by nurses. In order to persuade Mrs. Nasser that her daughter should have physical examination, a nurse needs to explain the procedure itself. First, the nurse should assure the parent that there is no danger of compromising girl’s virginity. The nurse needs to reassure Mrs. Nasser that it will not happen, as the gynecologist examines a girl completely differently than a woman. As a rule, a doctor uses manual examination, which is performed not through the vagina, but through the rectum. If the cervix and vagina also need examination then pediatric and adolescent gynecologists use special children's mirrors and vaginoscopes, which are carefully inserted through the holes in the hymen without damaging it. The nurse should explain that pediatric gynecologist has all necessary tools for a painless and safe examination and testing. The nurse should answer patient’s questions and explain how important it is to examine Samia’s symptoms seriously. The main thing Mrs. Nasser should understand is that gynecological pathologies can have serious consequences for her daughter’s health, so it is extremely important to treat them properly.

The nurse can apply several culturally congruent strategies for addressing a challenge of delivering care to a patient with different health care beliefs and practices. Douglas et al. (2011) present twelve strategies for successful implementation of nursing duties. In this case the nurse needs to use the following standards: his/her knowledge of cultural diversity (Standard 3); culturally sensitive skills in implementing culturally congruent nursing care (Standard 4); practice in culturally competent care (Standard 8); cross-cultural communication, realized through verbal and nonverbal communication skills in order to satisfy patient’s values, beliefs, practices, and perceptions (Standard 9); and, most importantly, cross-cultural leadership, as the ability to influence diverse patients and to persuade them to have necessary treatment (2017). The nurse should try to understand clients’ health care needs by the means of effective listening, considerate body language, and eye contact (Douglas, 2014). Furthermore, the nurse can apply knowledge from associated disciplines such as anthropology, sociology, phycology, and communication arts (Douglas, 2014).

In order to ensure that Mrs. Nasser’s concerns regarding the appropriate treatment of her daughter are satisfied, the nurse could propose her to be present during Samia’s physical examination. In this way mother may support her daughter during the procedure. It is also essential to provide a female doctor for conducting the examination of Samia in order to make her feel more comfortable (Jeffreys, 2014).

In conclusion, in the recent years, the ethical role of nurses has been important in providing patients with detailed information about the nature of disease, the prognosis, the methods of diagnosis and treatment, possible complications, associated with it, etc. Modern pediatric gynecology requires nurses to discuss the plan of examination and treatment of a girl with her parents, indicate possible complications, as well as provide a detailed explanation of the regime and hygiene of a girl.

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