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CHAPTER

16

Arab Muslims and
Culture Care
Linda J. Luna

aring for Arab Muslims poses a real challenge to most
nurses today since Western awareness of their unique
cultural beliefs, values, and life- •• ways is just
beginning to develop. Muslim religious values and the
worldview of Islam are markedly different from the values
that underpin life in the Western world. Understanding these
values requires that nurses learn about jhe religious and
cultural factors, social structure features, and health care
features, as well as their own cultural background. The central
and important goal of transciiltural nursing necessitates
learning about the culture and then developing care practices
that are culturally congruent with the values of the people.
Delivering culturally congruent care further requires
becoming aware of one’s own culturally learned assumptions.
To be unaware of our culturally learned assumptions is not
consistent with the notion of culturally competent care and
transcultural nursing practices. -.
Today, more nurses are Beginning to recognize the
importance of transcultural nursing and the evolving body
of knowledge about the influence of cultural factors on
health and care behaviors and lifeways. Such knowledge is
extremely imperative in professional practice to bridge the
gap between the experiences and worldview of the nurse
and that of the client or the family whose cultural values,
lifeways, and worldview may be quite different from those
of the nurse.
In this chapter some fundamental transcultural
concepts and ethnonursing insights will be presented to
help nurses understand and care for Arab Muslim clients.
Leininger’s Culture Care Theory with a focus on
worldview, ethnohistory, social structure (especially
religion and kinship), language, cultural values and beliefs,
and environment will be presented. 1,4 Transcultural
nursing care guidelines and practical applications to
support ways to provide culturally congruent

care will be offered as derived from the literature, from the
author’s research of Middle Eastern people, and from direct
field experience with several Arab cultural groups in a large
community in the United States. :'_5<These experiences, as
well as almost 15 years’ residence in the Middle East, have
been most valuable in understanding the importance of transcultural nursing knowledge and in developing clinical skills to
care for and communicate with Arab Muslim clients.
Leininger’s Theory of Culture Care Diversity and
Universality provided the theoretical frame of reference for
this chapter and the author’s research. 6 The theory was used to
discover and understand cultural values and lifeways of the
A.rab Muslims through an analysis of social structure,
worldview, language, and environmental features. With the
theory, Leininger holds that care is essential to human health
and wellbeing and is the major feature that distinguishes
nursing from other disciplines. 7 The goal of the theory is to
provide culturally,congruent care to individuals, families, and
cultural groups. While the concept of care is central to
Leininger’s theory, the concept of health is also studied in
relation to cate to discover the relationship of health (wellbeing) to care. Health and care behaviors are held by
Leininger to vary transculturally and to take on different
meanings in different cultures.8,9 Leininger postulates that if
one understands the meanings and forms of care, one can
predict the health or well-being of human beings.

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the terms “Arab” and “Muslim” are used as being synonymous. Bahrain. Haddad contends that the first major influx of Arab Muslims to the United States occurred between 1875 and 1912. and return to Yemen. Algeria Tunisia. since the term implies divinity to Muhammad. To provide effective nursing care. as well as an expanding American economy and changes in the United States immigration laws. The term “Islam” is an Arabic word meaning “the act of submission or resignation to God. Jordan. Somalia. Accordingly.13 With the expansion of Islam in the 7 lh century. etcetera. The Sunni constitute the largest group of Muslims. as well as an increasing number of earlier arrivals. that is. Yet many misunderstandings and myths continue to exist in the West about Islam and the Arab culture. 10% (or 200. but rather a number of separate Arab states. save money. Iraq. it lacks any tampering or changing by human leaders.” 24 As such. followed by a third wave from 1947 to 1960 and a fourth from 1967 to the present. A commonly accepted meaning for the term “Arab” is “any person who resides in the area stretching from Moroccq to the Arabian Ghlf. and 3) culture care repatterning and/or restructuring. nurses need to bc’aware of the worldview of Islam as a cultural influence on the daily life of the people.21 The early growth of Islam in America showed an adaptation of traditional practices to a new environment. some ideas may not be directly applicable or relate specifically to all Arab Muslim groups in the world. 18 During these periods various political and economic factors in the Arab world such as wars and coups d’etat. Today. One aspect of worldview is the role of religion. and under standing this tenet is essential to understanding Arab Muslim clienjs.16 There appears to be a consensus among Arab writers that such figures are a conservative estimate. Islam is the fastest growing religion in the world with an interesting and important ethnohis. The points of divergence revolve around the issue of early leadership following the death of the Prophet Muhammad.”23 For the Muslim believer. rather than focusing on all Arab Muslim cultures and their variabilities worldwide. provided incentives for Arab Muslims to migrate. As the presence of more and more Muslims in urban American communities grew. plus a number of smaller orders. a fact that surprises most people. <. Actually. It is important to realize that considerable variability exists within the Arab Muslim culture as Arabs come front a number of countries throughput the Middle East and North Africa. while others approximate the total number of Muslims. and Mauritania.17 The incentive for migration at this time was to: achieve financial success similar to that reported by the earlier arriving Christians. including Morocco. as well as to the smaller groups. Muslims resent reference to Islam as Muhammadanism. Naff attempts to separate the two by citing the approximate number of Arabs in the United States to be roughly two million. Djibouti. Many of these early arriving Muslim males did return home. The three nursing care decisions or actions that Leininger holds to provideculturally congruent care for clients and that were studied by the author were 1) culture care preservation and/ or maintenance. With regard to the major beliefs and practices of Islam. A second wave of Muslims came to the United States before World War II. In this chapter only some knowledge about Arab Muslims in the United States will be discussed. 10 |U Learning About Arab Muslims At the outset it is important to state that a review of nursing care literature reveals limited research related specifically to the Arab Muslim culture and to nursing care phenomena. and the states and territories bordering the southern and eastern edge of the Arabian peninsula such as Yemen. the Sunni and the Shi’a. however.depth knowledge and direct experiences with cultural groups. the nurse needs to know which groups are represented by the term “Arab Muslim. and the maintenance of health and care practices. " f The World View of Islamic Culture and Nursing Considerations To care for Arab Muslim clients effectively. are reaffirming their total commitment to Islam as a way of life. and who takes pride in the Arab culture and the Arabs’ historical accomplishments. Egyptian Muslims. _ however. To Muslims.15 Muslims are divided into two major and legitimate religious orthodoxies. to the Prophet Muhammad. the Sunni and the Shi’a. 14 Pakistani and Indonesian Muslims. Haddad notes that such a distinction may be exaggerated. the Qur’an (or holy book of Islam) is the absolute authority of the word of God. Most of the early Muslim immigrants were single males who planned to return to their homeland after accumulating a certain amount of wealth. nurses need to be aware of these changes and the increased religious awareness on the part of many Arab Muslims. a Muslim is a practitioner of the faith of Islam. Leininger predicts there will be fewer signs of cultural conflict and stress between the nurse and client and fewer negative responses from clients in nursing care practices. and Saudi Arabia. The worldview of a cultural group is their way of looking at reality and the world around them. Egypt. Congruent and effective nursing care needs to be grounded in transcultural knowledge to achieve care congruence and health.” there exists no single Arab nation. There has been a movement in many Muslim communities in the United States toward reform or reviving traditional Islamic practices. | Ethnohistorical Aspects of Arab Muslim Immigration There are currently no reliable statistics on the number of Arab Muslims in the United States. If these modes of action are used. since many later immigrants were not professionals. mosques. RESEARCH. but rather were part of the flew of “chain immigration” of relatives joining other family members in the United States. Most Muslims. Although reference is made to the “Arab world. Countries that make up the Arab world are the countries of North Africa. 20 Chain migration continues to characterize the migration patterns of most Arab Muslims with the exception of the Yemenis. AND PRACTICE IN DIVERSE CULTURES Culturally congruent nursing care requires in.tory. who are primarily men who come to work. These three modes or patterns of care are helpful to consider as the nurse uses knowledge from Arab Muslim clients to plan and give nursing care. 2) culture care accommodation and/or negotiation. Clients will find nursing care more acceptable and satisfying. Early Arab immigrants to the United States were primarily Christian. Arab Muslims are Muslims who originate from any of the previously mentioned countries that comprise the Arab world. who transmitted it to the people. To begin. and not all Muslims are Arab. 11 Although most inhabitants of these Arab countries are Muslim. According to . as it gives meaning to living. whereas the Shi’a are a minority. the largest Muslim states are situated outside the Middle East in Indonesia and the Indian subcontinent. which is not accurate. Gabriel. are not Arab.nizations'to preserve the Islamic faith. Most Arab scholars view the Arab world as stretching from Morocco to the Arabian Gulf. dying. Culturally congruent care will reflect the nurse’s knowledge of and sensitivity to clients’ cultural lifeways. since several regional wars in the Arab world during the past decade have motivated many Arab Muslims to migrate.2 Section III / CULTURE CARE THEORY. and other educational institutions developed to teach and perpetuate the faith to the next generation. Arabs constitute only 25% of the world’s Muslim population. let us explore further the differences and some ethnohistorical facts. including Maronites of Lebanon and the Chaldeans of Iraq." Frequently. Many new immigrants. however. Kuwait and the United Arab Emirates.”12 In contrast. a significant number stayed on in America and were instrumental in establishing institutions and orga. Various sources give estimates on the number of Arabs as a whole. who . The nursing concepts and research findings addressed in this chapter apply to both groups of Arab Muslims. Libya. are not Arab Muslims. Not all Arabs are Muslim. speaks Arabic. “the Qur’an is the actual word of God transmitted by the angel of prophecy. events in the Middle East have precipitated a strong tendency among many Muslims to return to the essential teachings of Islam. Islamic centers. there are similarities and differences. Because of such variability. 19 Many Arab Muslim scholars tend to emphasize a distinction between early arriving immigrants and those who came in later years. Lebanese Muslims.000) of whom are Muslim. the nurse will feel more satisfied arid rewarded in her or his care practices. there are several million Christian Arabs who reside within these boundaries. the religious culture moved out of the Arabian peninsula in all directions to embrace many cultural groups. Saudi Muslims.22 Since the early 1970s. Sudan. the Middle Eastern countries of Lebanon Syria. with the latter identified as better educated and with greater numbers from the professional class. The religion of Islam began in the center of Arabia during the 7 lh century and is a monotheistic religion— to associate other gods with Allah (God) is a capital crime. To understand this statement.

Muhammad was merely a man and the messenger of God. the Supreme Being (Allah) The single most important feature of the worldview of Islam is the concept of tawhid.Chapter 16 / ARAB MUSLIMS AND CULTURE CARE 3 Muslim belief. carries the mean- . a verbal noun derived from the root wahada. Tawhid.” 25 The idea of unity refers to the unity of was in no sense divine. but he ing of “unity” or “intense unification.