Research Methodology Human Health and Life

Question: Describe about the Research Methodology for Human Health and Life. Answer: Introduction It is vital for the health care providers to preserve human health and life. However, death is inevitable. The role of the health care providers does not end rather is modified in situation where the patient recovery is hopeless. Pioneers such as Raymond Moody and Elisabeth Kubler-Ross in the west have addressed the subject of death and dying (Abolfathi et al., 2012). Their work showed that the nurses can ensure a peaceful death to the patient with unconditional love and enlightened attitude towards their profession (Lovering, 2012). The medical professionals need good understanding of the patient who is at the end of life care from psychological, social, cultural, medical, and spiritual point of view (Arritt, 2014). The end of life experiences is universal. However, the behaviour associated with grief or bereavement are culturally bound. In this world, different countries have societies that have become a rich melting pot of religions, cultures and ethnicities. Different cultures ha ve developed different ways to cope with the death and grief which are the normal life events (Galanti, 2014). Interfering with these respective cultural attitudes towards death may hamper an individuals ability to cope up with the grieving process. It is difficult for the health care providers to know and understand the mourning ceremonies and traditionsof each and every culture. However, gaining a basic concept of how different cultures prepare or respond to death is essential for the care providers. In order to deliver individualised, patient centered care nurses need a culturally diverse knowledge base (Qureshi, 2012). There are various countries in the world such as Malaysia, India, Nigeria and others, which accommodates multiple faiths. Therefore, the health care providers not only need to know the religious and cultural beliefs of the patient but also the rationale supporting them as it my greatly influence the care plan of the patient (Velayudhan, 2012). The paper particular ly focuses on the cultural attitudes of Hindus, Muslims, and Christians towards death in Malaysia. Cultural attitude of Muslims towards death in Malaysia and its impact on nursing profession When caring for the Muslim patients, the factors that influence the nursing practice are Muslims belief, faith and preferences during the dying process. Nurses need to take care of matter such as to ensure there is someone with the patient to prompt Shahadah (Arritt, 2014). It means bearing witness that Allah is true God and Muhammad is his servant. Nurses need to have knowledge of importance of Quran and ensure the patient with a person to recite the chapters of the holy book at the beside. Most important challenge for the nurses is to devise a care plan for Muslim patents in the holy month of Ramadan, which is the fasting month. It is highly challenging for nurses to care for diabetes patients in this month and hence they may devise nutrition plan that does not compromise the health (Velayudhan, 2012). According to Lovering (2012) many Muslims and the health care providers in Malaysia do not recognise the importance of the good death. Based on Islamic perspective it is explained th at the human dignity and privacy are respected and each on is treated as fundamental pillar of Shari'a. Muslims highly value the spiritual and emotional support. The nurses therefore must address the care needs expected of them since Muslims appreciate the importance of the access to the needed spiritual or emotional support. Avoiding this factor which are crucial for Muslims may create dissatisfaction among the patients and lead to loss of trust in the health care providers. It is challenging and stressful for the health care team to met specific demands of Muslims such as care from same sex caregiver. Thus, nurses must ensure male or female caregiver to honour their request. Nurses must be highly careful when it comes to contacting patient of opposite sex even if it is matter of making eye contact or shaking hands particular when dealing with the observant Muslims (Qureshi, 2012). The additional burden of cost on the health care team is due to provision of separate room for their rituals. The observant Muslims prefer to offer prayers five times a day and wash before, after meals, and before prayers. Thus, the health care team must be diligent in helping the patients to meet their spiritual needs. The team must ensure that of the procedures interfere with neither the treatments nor administration of medication. According to Farooqui et al. (2012) the Muslim patients may refuse medication containing pork products, gelatine, or alcohol. It is complex task for the nurses and physicians to provide full disclosure of medicines containing these ingredients so as to help patients in making informed decision. Rassool, (2014) highlighted that most people want a control over pain and others stressful symptoms. However, the Muslims patients perceive suffering as a punishment for ones sins. This belief and interpretation motivates the patient and the families to cope up with the disease. Harford and Aljawi (2013) argued that it does not belittle the fact the suffering should be relieved by making every single effort. It is a common cause of discomfort for the nurses in Malaysia to convince the Muslim patient to uptake a pain management. The patients deny the pain medication as they anticipate that by suffering more and showing high patient, they will receive more rewards form Allah and attain more purity. This leads nurses into dilemma as they have to respect the patients wishes to accept or refuse the medical intervention. Most nurses treating the Muslim patients face this dilemma inspite of the encouragement from Islamism to seek treatment. It greatly influences the nursing care plan as nur ses undergo mental conflict with the moral and the ethical dilemmas (Lovering, 2012). The study executed by Al-Jahdali et al., (2013) discussed that majority of the Muslim participants prefer to issue advance directives. It is the means to accept or refuse medical intervention. However, some medical staff are not aware of this preference. However, this system is underused in the several hospitals. It is suggested for hospitals to adopt the system off advance directives as it is widely accepted by the Muslims. It is a common practice in the Islamic and Arabic societies to contact the loved ones and relatives before death of a person. However, a physician or a nurse are to be given this suggestion when death of a patient is inevitable or is about to take a last breath. This standard practice is observed in west and in some cases the health care providers are required to demonstrate high level of sensitivity particularly when the visitors are exceeding the amount of space available. Rassool (2014) described that the Muslims do not consider their life to be pointless despite tremendous suffering. This is in contrast to most patients who opt to quit their life instead of prolonging with advanced technology pointlessly. The Muslims believe in the ultimate wisdom of Allah even when inflicted with serious disorder and tend to withdraw from life sustaining treatment. It emphasises the medical professionals to be honest with the patient specifically about the prognosis, and the details and explanations related to the Do Not Resuscitate orders. It may give reassurance to the patients and help them to feel more comfortable that the intervention will not be futile. Many Muslims perceive that the time of death is only known to Allah. However, Al-Jahdali et al. (2013) that many Muslims prefer to know how near the death is so that they can repent for their sins and seek forgiveness. The nurses and the physicians in this situation are required to provide less definitive answe rs to the patient and the family. The challenge for the nurses is to build good rapport with the patient and family. Most patients prefer to die in a holy place like Makkah or Mosque when given a choice. Nurses must respect the patients wishes. Nurses are requested by many patients to persuade their family for granting their wish. At this stage the nurses must be honest and open with them regarding the care goals. This eliminates the stress among the nurses and the family members as they do not have to feel guilty to let patients die out of the hospital (Galanti, 2014). Muslims pay great importance to the appearance and hygiene. They have strict principles related to self esteem and body image. Muslims belief in having good image in eyes of friends and relatives and tend to avoid deformities, post-mortem distortions, bad odors, septic wound, by maintaining continence. They prefer to maintain cleanliness such as having clean clothes, free of urine, vomit, stool, and want the health care providers to make their body appear normal after death (Harford Aljawi, 2013). It is stressful for health care providers as they need to take additional care keeping these factors in view. Nurses may put extra effort to meet these demands of patients and particularly pay more attention to appearance and hygiene. It creates additional burden as they may have to bath the patient more than the recommended times. To reduce the post-mortem disfigurement the health care providers must perform eye closing and jaw fixation immediately at the time of death (Abolfathi et al., 2012). These practices may affect other patients in the ward and hence nurses may assure them that it is common for all the Muslim patients in the hospital. The health care providers must be particular in regards to rites of washing, shrouding, and funeral prayers. Burial process should be followed as soon as possible. The major role for the health care team at this stage is timely documentation to prevent delay in funeral ceremonies (Rassool, 2014). During the time of death, nurses must be highly empathetic and the health care team must provide comprehensive care. The hospital must arrange for religious officer to address faith related concerns of relatives and ask additional queries to reduce their worries. It is challenging for the palliative care team to identify families having suboptimal resources, support them in bereavement and assure of economic support (Walpole et al., 2013). Cultural attitude of Hindus towards death in Malaysia and its impact on nursing profession Most Hindus in Malaysia come from western India. Since Hindus divide into different sects, there is a difference in their beliefs and philosophies. There is no standard form of worship to God as there hundred of deities (Ezat et al., 2014). The Hindu patients are highly concerned about modesty. They demand for same sex caregivers. Hindus prefer family members to nurses for basic physical care such as changing clothes, combing hair, and bathing. On the contrary, in Malaysian culture combing hair may is a heartfelt demonstration of care and love. They prefer same sex caregiver for repositioning. During complicated pregnancy cases husband may be asked to present while providing the genitourinary care due to close relationship between the husband and the patient. Nurses must be highly sensitive and avoid disregard of modesty. Nurses and the physicians in Malaysia must be aware of minute details such as using right hand for shaking with clients. Hindus mainly use the left hand for unclean tasks such as toileting (Badrolhisam Zakaria, 2012). Further, it is highly complicated for the nurses to communicate with the patients as most Hindus avoid communicating undeclared problems such as constipation. Therefore, nurses need to b e highly sensitive to understand the patients discomfort during end of life care (Ezat et al., 2014). During the time of crisis, it is common practice for the Hindus to practice fasting (Eriksson et al. 2013). Several Hindu patients refuse to intake pork or beef by-products particularly those patients who are strict vegetarians. It is complex task for the nurses and physicians to provide full disclosure of medicines containing these ingredients so as to help patients in making informed decision. Nurses may enter into dilemma when the patients deny eating egg, which is essential for them to have during particular illness. This may affect the care plan. Hence, the nurses must develop alternate nutritional plan that does not compromise the health of the patients due to fasting or having only vegetarian diet. According to David (2013), Hindus highly value physical purity and prefer to take bath twice daily anticipating it would render them spiritually and physically clean. In this condition, nurses may assist the patient with these rituals after highlighting the patient about the consequ ences of illness for example, excess bathing may not be beneficial in that given situation. Some Hindus prefer to extend their life when diagnosed with life threatening illness such as cancer for completing unfinished matters for their young children and family. On the other hand, there are Hindus who strictly believe in the law of karma. Therefore, they prefer to suffer assuming it is a punishment from God for their past sins. Therefore, when dealing with the Hindu patients, the key components of the palliative care or end of life care team is truthtelling and informed consent particularly in decisions related to artificial hydration and nutrition, cardiopulmonary resuscitation, intravenous infusion and oxygen administration (Abubakar, 2013). The observant Hindus prefer to die at home than at hospital therefore, it is necessary for the nurses to openly communicate the about the prognosis, and the details and explanations and take consent from the patient before initiating life sustaining treatment (Badrolhisam Zakaria, 2012). Although against the hospital norms or care standards, the nurses may have to allow the patients to lie on floor as it is ritual in Hinduism when patient is about to take last breath. According to the Hindu culture as many family member as possible may want to stay in the hospital before the patients death. Allowing accommodation for huge crowd leads nurses and care team into ethical and moral dilemma. Further, Hindu families prefer to perform last rites, which are known as Puja. They may wish to use lamps, incense or candles for praying. Nurses must consider this after ensuring that it may not lead to any accidents in the hospitals such fire or burn. Addressing these concerns is vital because it gi ve a deeper meaning and purpose to living and dying. Making this decision is often complicated for the nurses. Hindu patients prefer not to remove their religious adornments even in hospitals such as thread around wrist or neck without prior consent. During the end of life care nurses may have to provide for separate room or space for daily prayers and maintain privacy. Patients before death may prefer to have Tulsi leaves and water from Ganges as comfort. This process is known as Hindu sacraments or samskara and is considered to have practical utility. Hindus believe that these practices before death will help them get moksha meaning release from the cycle of birth, death and rebirth. (Tomkins et al., 2015). During the time of death the Hindus may prefer to have spiritual music or video or statue of the favourite God and a family member is requested near the patient for reciting the lines of the holy books Ramayana, Mahabharata and Bhagavad Gita . Therefore, it constitutes an integ ral part of the care associated with the dying people and the bereaved. Further, family demands to handover the dead body to wash and constantly attend to the deceased and accompany the body to the mortuary (Ezat et al., 2014). Just like in Hindu culture, the Malaysian nurses too must honour the wishes of the dead. The family want the non-Hindus to avoid touching the dead body. Therefore, use of gloves by the nurses may be appreciated. According to Galanti (2014), most Hindus object post mortems as they always cremate the body the very next day after death. On the other hand, there is objection when demanded by law. In order to complete all the rituals the health care team must return all the organs and remains. Cultural attitude of Christians towards death in Malaysia and its impact on nursing profession The Christians in Malaysia mainly visit from United States. Depending on the type of Christians there are different beliefs and attitudes towards death observed. When dealing with the Christian Scientist patients, the nurses faces challenge in convincing the patient to take treatment necessary before entering the end of life phase. According to Tiew et al. (2013) the Christian scientists the material world is the minds distorted view of reality. In terms of health care they recognise bacterial infections but belief the underlying cause to have a spiritual aspect. Hence, they oppose the medication, as they do not believe that it has no real power or value. Therefore, it is imperative for the nurses and the physicians to focus on treating the physical symptoms of the patient. In this situation, discussing about the cause and effect may only lead to contention between the nurses and the patient. Many patients favour prayer so much that they reject surgery. Some other patients prefer to receive medication and treatment in their house and visit hospital only when deemed necessary (Bonelli et al., 2012). During the end of life care, the Christian m ay prefer to keep a cross with themselves or under the bed. A family member or a church minister is requested near the patient to recite the lines from the holy book Bible. In depression, most Christians prefer pastoral counselling an spiritual programs (Ellis Wahab, 2013). The Christian Scientist patients strictly avoid tea, coffee and food containing caffeine and alcohol. On the other hand, the protestant Christian do not follow specific dietary requirements but choose to fast to gain spiritual strength. Hence, the nurses must develop alternate nutritional plan that does not compromise the health of the patients due to fasting (Bonelli et al., 2012). Christians belief that death is a transition to the spiritual realm. It is believed in Christianity that the after death people reach heaven to be with God. Hence, end of life care is a time of joy for the patients despite the sadness of going away from the loved ones. The church minister is allowed to visit the patient and the family and help the client prepare for death. Depending on the form of Christianity such as Presbyterian or Anglican, the customs vary (Vail et al., 2012). At the time of death, the Christians are more dependent on the church minister for comfort and assistance to cope up with the death and the funeral ceremonies. It is imperative for the nurses to allow the family to implement their choice and cooperate in the bereavement. Christian ceremonies related to burial or cremation are typically held at deceased persons church and conducted by the minister, but it could also be held at a funeral home. As the dead is laid in the casket the families and the friends get the last opportunity to say their last goodbyes before it i buried. The Christian Science do not have specific doctrine to the last rights upon death, mourning or burial. However, they prefer cremation to burial but is not prohibited. They do not prefer autopsies and do not believe in organ donation. Christian scientists consider unethical to donate their bodies to science (Jong et al., 2013). However, in some cases it is left upon the families to make decision. After burial the grave is marked with a gravestone to remember the deceased. In all the three religions, the attitude towards death is different therefore, nurses need to be culturally competent. It is difficult to go against the personal beliefs but they must refrain from imposing personal beliefs on the patients. They must avoid broaching the subject of religion in depth. In case a nurse is finding very difficult in assisting patients with procedure that is violating personal beliefs she may request the concerning physician for alternate assignment. They need to be highly collaborative with the families and the health care team to make decisions that are observant of both medical needs and religious preferences (Arritt, 2014). Conclusion It is difficult for the nurses and other care providers to deliver culturally sensitive end-of-life care or bereavement. For medical professionals this is an issue of high discomfort. Patients and families need guidance, advice and compassion from the doctors and nurses. However, the realities of a given situation include a press for time and result in both emotional and physical exhaustion. When nurses have to make critical decision they may fail to express sensitivity and warmth. The paper has implications for practioners for both practice and education. The health care providers must respect the needs of the patients belonging to diverse culture regardless of their personal believes. The health care practioners in Malaysia must have a self-awareness to recognise the diversity between the themselves and their patients. They must exhibit curiosity and openness to learn. It is vital to explore and understand the way families and the patient with to be treated before, during and after death. Merely interpreting the actions and wishes of the patients through own understanding may lead to error in the care plan. The cultural practices may not be significant in every individuals life however; these practices, rituals and beliefs take a vital place when a life threatening illness strikes or facing death. Therefore, it is imperative to understand the meaning of care to the dying patient for delivering individualised palliative care. In conclusion, the hospitals, hospices and the nursing homes must provide training and education to the nurses to address multicultural issues and deliver culturally congruent care. References Abolfathi Momtaz, Y., Hamid, T. A., Ibrahim, R., Yahaya, N., Abdullah, S. S. (2012). Moderating effect of Islamic religiosity on the relationship between chronic medical conditions and psychological well?being among elderly Malays.Psychogeriatrics,12(1), 43-53. Abubakar, I. (2013). The religious tolerance in Malaysia: an exposition.Advances in Natural and Applied Sciences,7(1), 90-97. Al-Jahdali, H., Baharoon, S., Al Sayyari, A., Al-Ahmad, G. (2013). 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