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Nursing with dignity. Part 8: Islam

Islam for Muslims is not only a religion but a complete way of life that advocates peace, mercy and forgiveness. A Muslim can be defined as a person who accepts the Islamic way of life and complies with the will of Allah (God) without question.

Islam for Muslims is not only a religion but a complete way of life that advocates peace, mercy and forgiveness. A Muslim can be defined as a person who accepts the Islamic way of life and complies with the will of Allah (God) without question.

There are one billion Muslims worldwide and, according to the 1991 census, there are 1.6 million Muslims in the UK with the number expected to rise to two million by 2010.The 10 most common languages spoken by Muslims apart from English are Farsi, Arabic, Bengali, Punjabi, Urdu, Gujarati, Hausa, Pushto, Malay and Turkish.

Most British Muslims come from the Indo-Pakistani continent but there are also Muslims from the Middle East, Iran, Malaysia, Indonesia, Cyprus, East Africa and the Caribbean, as well as Britons who have converted to Islam.

Muslims use a universal greeting to each other, Asalam-a-lay-kum, to which the response is Walay-kum salaam. Although there are common beliefs and acts of worship, each patient’s needs will vary, depending on their level of orthodoxy. Health care professionals should be encouraged to use interpreters, but should be aware of the considerable variations in their availability and appropriateness.

Beliefs

All Muslims have to fulfil five essential religious duties:

  • To declare that there is no other god but Allah, and that the Prophet Mohammed is his messenger;
  • To offer prayers five times a day: at dawn, midday, late afternoon, after sunset and late evening. Prayers are performed facing Mecca (south-east in the UK). Praying involves physical movements of standing, bowing and prostration. During illness, prayers can be performed sitting up or lying down, providing that the chair or bed is facing Mecca. A person is exempt from prayer if seriously ill;
  • To fast in the month of Ramadan, which falls in November this year. People eat and drink before sunrise and then signify their intention to keep the fast by rinsing their mouth with water. No food or drink is consumed during daylight hours. The fast is broken at sunset usually by eating a date or a piece of fruit, followed by a main meal. Children are expected to start praying and observing the fast when they reach puberty. Muslims who are ill are exempt from fasting, but some still do and will omit or refuse medication. Simple measures can be taken to accommodate fasting, such as rescheduling the times that medicines are given to the patient and possibly changing the dosage;
  • To give money to charity, amounting to 2.5% of an individual’s annual income and savings;
  • To go on a pilgrimage to Mecca, known as Hajj, at least once in a lifetime if they can afford it. 

The Holy Quran

The Quran is the sacred book of Islam. Written in Arabic, it is the essential guide for all aspects of a Muslim’s life. It is placed above all other books, both philosophically and literally - it is never put on the floor. 

Gender and modesty

Muslims prefer to be cared for by someone of the same sex. This reflects the separateness of men and women in all aspects of Muslim life. However, men are not seen as superior to women. Muslims appreciate that it is not always possible to be cared for by somebody of the same sex, so during medical examinations certain restrictions are waived. 

Cleanliness

The Islamic faith emphasises cleanliness, so before any type of worship, Muslims must ensure their clothes are clean and perform a cleansing ritual: Ghusal or Wusu.

Ghusal is a complete body wash with clean water. A shower is preferred to bathing in a tub of water, which is seen as inappropriate. Ghusal must be performed after love-making and at the end of menstruation.

Wusu is a partial wash with clean water, performed before offering prayers. It comprises of washing:

  • The palms of both hands up to the wrist three times;
  • Inside the mouth three times;
  • The nose three times;
  • The face three times;
  • Each arm from wrist to elbow three times, starting with the right;
  • Rubbing the head with wet hands from front to back;
  • Washing the ears by placing the index finger inside each ear, leaving the thumbs outside;
  • Washing both feet up to the ankle, right one first. 

Wusu becomes void after urination, defecation, passing wind or vomiting and therefore needs to be repeated. Muslims prefer to wash their genitals with running water after using the toilet. This process is called Istinja. Therefore, a jug in the bathroom/toilet is appreciated. 

Nurses and non-Muslims are allowed to wash people who are ill. However, social conventions often prevail in respect of modesty, gender and body parts. What is acceptable varies according to what is socially permissible and whether it is culturally acceptable to be touched by another person. 

In most cases, a close family member of the same sex may be allowed to wash the sick person. However, an initial assessment of the patient should establish baselines for such care. 

Family and marriage

Muslims view the family as the building block of society. Marriage is sacred and the foundation of Islamic society, providing stability and security. Men are seen as the protectors of women, and important decisions, such as giving consent for treatment, require that they be consulted.

The patient’s immediate and extended family structure should be considered when there are important treatment issues. For example, in some cases the community elders may also have a say in treatment. In life-threatening situations, or when there is no immediate male family member, a female relative may be able to give consent.

Homosexuality

Homosexuality is condemned, as homosexual acts are considered sinful and punishable by Allah. However, as in every community, there are homosexuals. There are also issues about whether homosexuals, covert or not, can be considered truly Muslim. There is a range of views on this issue in western societies. 

Children

Muslims believe it is their duty to marry and have children. A child born into a Muslim family is regarded as a gift from Allah. A small amount of honey is placed on the baby’s tongue to make it realise it is no longer in the mother’s womb. It is believed that some of the qualities of the person giving the honey are also transferred.

Any hair the baby is born with is considered unclean after the passage of birth and is shaved off. This signifies the baby’s innocence and is done on the third day after birth, or any time up to the seventh day.

Contraception

Muslim couples are encouraged to have children, who are even referred to as their ‘wealth’. Sex outside marriage is discouraged. However, contraception and family planning are allowed, and health care professionals should discuss appropriate methods with either the woman or the couple.

The coil and emergency contraception (the morning-after pill) are considered unsuitable as they effect abortion. Instead, barrier methods are advocated, as they do not interfere with the body’s natural function (Khattab, 1993). The contraceptive pill is also acceptable.

Abortion

Islam values human life so abortion is not permitted. However, the procedure is allowed if the pregnancy threatens the mother’s life.

It is recommended that abortion takes place before the foetus is 120 days old as Muslims believe that this is when the soul is breathed into the foetus.

Islam does not allow abortion in cases of rape or incest because Muslims believe the child has the right to live.

Circumcision

Baby boys are circumcised as it enables them to maintain Wusu by preventing urine from collecting in the foreskin (Sheikh and Gatrad, 2000).

The practice of female genital mutilation by some Muslims in African countries, Asia and the Middle East is not supported by Islamic faith. Although it is banned in the UK under the Prohibition of Female Circumcision Act 1985, a recent all-party parliamentary report estimates that there are 3,000-4,000 new cases in the UK each year.

The practice, which has also been condemned by the World Health Organization, is mainly found in UK communities of Eritreans, Ethiopians, Somalis and Yemenis. The number of cases is growing as immigrant and refugee communities increase.

Diet

Muslims eat with their right hand and consider it rude to be handed anything in the left hand, especially a glass of water, as the left hand is used for washing the genital area.

Muslims refer to permissible food as halal. Non-permissible food is called haram. Halal meat comes from an animal that has been slaughtered during a prayer ritual. Halal foods include halal meat, fish, fresh fruit and vegetables, eggs, milk and cheese.

Haram foods include pork, non-halal meat, alcoholic drinks and gelatine products.

Great care should be taken when serving food to ensure that halal food does not become contaminated with haram food.

Organ donation and blood transfusion

Muslims are allowed to donate their organs for transplant providing they are not compromising their own life. They are also allowed to receive organs. However, opinions differ, so tact is necessary; some Muslims believe that the physical body should not be ‘mutilated’, but should remain ‘intact’ in order to pass easily into the next life.

Muslims have no objections to blood transfusions.

End-of-life issues

Suicide and euthanasia

The Islamic faith does not differentiate between killing yourself or asking someone else to do it for you. Human life is regarded as precious and taking a life is considered a major sin.

Life support

Muslims believe that a person certified as brain-stem dead should not be kept alive artificially. Resuscitation is allowed, but in some cases the will of Allah should be allowed to prevail, particularly if the person has said they do not want to be resuscitated. Ultimately, resuscitation can be carried out for medical reasons, overriding religious ones.

Death/rituals

Muslims believe in life after death. When they die - the Day of Judgement - they know they will be judged by their actions: good deeds will be rewarded with everlasting life in heaven, and bad deeds with everlasting life in hell.

However, sickness and suffering in this life are also seen as a form of purification or recompense for wrong deeds. Instead of being subjected to everlasting punishment in the next life, it can be a time to make peace with Allah.

Islam advocates that terminally ill people should be treated with sympathy and compassion, and that their spiritual as well as physical needs should be accommodated.

When dying, privacy is appreciated while the person declares their faith. Sometimes they are comforted by a recital from the Quran.

When a person dies, the following rituals should be observed:

  • Close the eyes and mouth;
  • Straighten the body and limbs;
  • Turn the head towards the right shoulder, facing Mecca;
  • The body should not be washed but covered completely with a plain sheet;
  • A complete Ghusal should be performed by the family as soon as possible;
  • Some Muslims may request that non-Muslims do not touch the body. If this is the case, use disposable gloves.

This series has been endorsed by the Transcultural Nursing and Healthcare Association

Readers' comments (2)

  • This article is very interesting for nurses to provide care focused on cultural and spiritual needs of clients and their families

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  • The current globalization has to provide the nursing profession to new challenges. So the scientific evidence based knowledge about other cultures and beliefs is relevant for the nurse to have better tools for diagnosis and nurse care focused on cultural and spiritual needs of clients and their families.

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