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Presentation at the
International Conference on Medicine and Health held at the Islamic Science
University in Kuala Lumpur Malaysia on 20th May 2012 by Prof Dr Omar Hasan Kasule, Sr.
MB ChB, MPH, DrPH (Harvard) Department of Bioethics Faculty of Medicine and
Chairman of the Institutional Review Board King Fahad
Medical City, Riyadh
ABSTRACT
The presentation is a repeat of
previous presentations[1],[2]
by the author and is in two parts. The first part reviews the history and
challenges of the nursing profession. discusses standard nursing operating
procedures from the Islamic point of view. The paper reviews the historical
development of professional nursing from its informal beginnings in the family
and community through its acceptance as a supportive profession in the 19th
century to its present status of an independent profession that is growing and
is developing specializations. The following trends in nursing in the 21st
century are extrapolated from the historical review: increasing
professionalization and specialization, wider use of technology, relative
decline of the nurturing & human touch aspects of early nursing, and equal
gender representation in the profession.
Three challenges in nursing that
are of interest to Muslims have been identified by the paper: (a) Technology:
has given the nurse ability to give comfort and care to patients that was not
imaginable a few decades ago. It has however created new problems: the caring
and nurturing nurse, who in the beginning was an extension of the
family-centered parental (maternal & paternal) loving into medical care,
has been turned into a technician using sophisticated equipment. This threatens
to marginalize the human aspect of nursing. Islam emphasizes the dignity of the
human and puts high value on direct human contact and interaction not mediated
through technology. (b) Specialization: Increasing specialization in
nursing in tandem with technological development is marginalizing the previous
holistic nursing role that looked at the patient as a whole human being with
needs, feelings and aspirations and not a case of pathological diagnoses and
medical procedures. Very water-tight specialization runs counter to the Islamic
teachings of an integrated approach to human problems based on the tauhidi paradigm (c) Gender:
nursing has traditionally been a female occupation but need not continue so.
There is no evidence that males cannot be good nurses. In the context of the
Muslim world, the emphasis on equal gender representation in the nursing
profession is a crucial issue. The Muslim society is bisexual and not
unisexual. It requires that except in cases of unavoidable necessity, dharurat, intimate matters like medical
care and nursing should be segregated by gender. This requires that equal
numbers of male and female nurses be trained to fully serve the needs of the
Muslim community.
The paper does not pretend to
rewrite existing nursing SOPs but rather tries to provide an Islamic
perspective to them so that they can be relevant to an Islamically oriented
nursing environment and practice. The general ethico-legal guidelines for
nursing practice can be summarized as maqasid
al shari’at, the general purposes of the Law; qawa’id al shari’at, the general principles of the Law, and specific
legal rulings, ahkaam al shari’at.
Islam has a parsimonious and rigorously defined ethical theory of medical
practice based on the 5 purposes of the Law. The five purposes are preservation
of ddiin, life, progeny, intellect,
and wealth. Any medical action must fulfill one of the above purposes if it is
to be considered ethical. Legal axioms or principles, qawa’id al shari’at, guide reasoning about specific ethico-legal
issues and are listed as intention, qasd;
certainty, yaqiin; injury, dharar; hardship, mashaqqat; and custom or precedent, ‘urf or ‘aadat. The nurse must have a general knowledge of
specific legal rulings, hukum, that
relate to nursing practice so that she can advise her patients accordingly.
Regarding patient hygiene, the nurse must know what body products are
considered impurities, najs, and
advise the patients accordingly regarding their wudhu and salat. The
paper gives details of both physiological and pathological secretions and
fluids with special emphasis that fresh blood is not najs. The paper describes how a nurse can help patients perform
their ‘ibadat obligations under
various disease conditions. It explains regulations of puasa for the sick and what medical procedures can be carried out
without nullifying puasa. The
regulations of foods and drinks for the sick are reviewed. The Islamic
viewpoint is given on ethico-legal issues of artificial life support, euthanasia,
privacy, confidentiality, and consent. Legal guidelines are provided on how to
navigate the fine line between benefit and injury in medical interventions. The
paper the covers issues of general nursing etiquette of: bed-side visits, etiquette of medical / surgical
procedures, interaction with patients
of the opposite gender, interaction with healthcare givers of the opposite
gender, interaction between genders in
nursing education, covering awrat,
dealing with the family, teaching & learning in the health care team,
care delivery in the health care team, and health care team group dynamics.
Islamic guidelines are discussed regarding the etiquette of clinical history
taking and examination, nursing care and counseling for specific diseases,
nursing the terminally ill, and coping with stress in nursing practice.
REFERENCES
[1] Presented
at the 3rd International Nursing Conference "Empowerment and
Health: An Agenda for Nurses in the 21st Century" held in
Brunei Dar as Salam 1-4 November 1998
[2] Presented at a series of training workshops for
Kashmiri nurses at King
Fahad
Medical City
September – October 2009 at the Faculty of Medicine King Fahad
Medical City Riyadh