Highlights
Scenario 1 – Religious Culture
You are responding to a callout to a 46-year-old woman who is a practicing Jehovah Witness. presenting with severe upper right quadrant abdominal pain.
She also reports having vomited in the past 2 hours. And has been had several similar ‘less intense ‘episodes of the same over the past 2 weeks that she has not sought any prior medical consultation. Your initial examination identifies:
• Pallid in appearance,
• pain scale is 8 out of 10,
• temperature is 38.1°
• BP 150/110 mmHg,
• pulse is 110 bpm and
• respirations 23 per minute.
Additionally, you identify she has significant tenderness in her upper right quadrant radiating to her lower quadrant. Your head to toe examination additionally identifies she has significant tenderness in her upper right quadrant radiating to her lower quadrant and supports symptoms of appendicitis. You determine she required immediate transportation to an emergency (hospital) for an accurate diagnosis. On arrival at the emergency department and following testing, the appendicitis diagnosis is confirmed, the patient will need an emergency appendectomy. One of the important ethical and cultural issues is to consider is that the patient has identified herself as a practicing Jehovah Witness. *You may conduct research to support your responses, however you must reference the source of your research for your answers or information
Scenario Questions for Response
1. The 46-year-old woman you are attending has identified she is a practicing Jehovah Witness (JW). There are issues of concern related to her Jehovah Witness beliefs and religious culture around the topic of ‘blood’. You are required to conduct some research to identify and explain the issues of concern, including but not limited to:
a. What are the acceptable and unacceptable health management practices related to the Jehovah Witness belief system.
b. Discuss your duty of care responsibilities
c. What are the patients moral and legal rights to accept or refuse care
d. What are the acceptable transfusion treatments and alternatives that may be used for practicing Jehovah Witness patients
e. Discuss the concept of the ‘right to die’ related to the Jehovah Witness faith
Scenario 2– Communication and Language Diversity and Religious Culture
It is a busy night and you and your partner have been called to a pregnant young female patient. Base Communications informs you that this patient’s family made a telephone call for help, they had stated they had difficulty understanding the message communicated due to the language being very broken English, however, they believe the patient is pregnant, in pain, bleeding and distressed and that the baby is not due yet. On arrival, you identify the family are all in attendance on your arrival. They are all non-English speaking practicing Muslims and have limited capacity to communicate with you. You manage to find out the patient is from an Egyptian heritage and culture and a practicing Muslim. The mother, father, husband and other relatives are gathered around the patient, who appears to be clothed in strict traditional Muslim attire and the atmosphere is somewhat hysterical with everyone appearing quite upset. You attempt to examine the patient; however, she becomes highly distressed as do the relatives around her and she is resisting your interventions. You do manage to establish using picture-word charts that her pregnancy is at approximately 22
weeks’ gestation.
Questions for response.
2. In the Muslim faith, preservation of life overrides guidelines; in a life-threatening situation, there are no restrictions on medications or surgical interventions. Conduct some research to identify the cultural health related issues that you must be aware of and that may impact on this situation. You must consider the following areas of concern.
a. Muslim beliefs on health care
b. Acceptable and unacceptable medications
c. Gender issues related to the examination of patients
d. Privacy, permission and touch
e. Body language specifically issues to be aware of related to the Muslim belief systems
f. Ramadan and fasting considerations
g. Folk remedies and herbal treatments and interactions
h. Muslim belief system related to pregnancy
3. Given scenario 2, consider ‘what’ would you do to support communication and gain the required history and current clinical information. Specifically, as the patient and family are from a CALD background. You must also identify ‘how ‘you will need to communicate in consideration of the cultural and religious beliefs.
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