Mrs. Nasser arrived at the urgent-care center with her 16-year-old daughter, who had been experiencing burning upon urination, itching around her genital area, and a high fever. Mrs. Nasser appeared very anxious, explaining to the nurse that her daughter had never had these symptoms before. The nurse tried to calm Mrs. Nasser and asked that her daughter, Samia, get undressed in preparation for a physical examination. Mrs. Nasser appeared concerned and requested that the nurse inform the doctor that she will not allow the doctor to perform a vaginal examination on her daughter.
The nurse explained to Mrs. Nasser that it will be necessary for the doctor to examine Samia so that she can determine the cause of Samia’s discomfort. Mrs. Nasser became extremely agitated and explained to the nurse that in her culture, young girls are not allowed to have a vaginal examination for fear that their virginity will be compromised. Mrs. Nasser insisted that she would not allow her daughter to be examined by the female doctor on duty. Mrs. Nasser requested that the nurse ask the doctor to write a prescription for her daughter’s infection, or else she would leave the clinic immediately.
How should the nurse respond to Mrs. Nasser’s request? Explain your rationale.
Identify culturally congruent strategies that may be most effective in addressing the needs of Mrs. Nasser.
How might the nurse ensure that Mrs. Nasser’s concerns are addressed appropriately and that Samia has received the appropriate care?
Full Answer Section
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- Complying with Mrs. Nasser's request would violate this obligation and potentially put Samia at risk.
- Legal Implications:
- Providing a prescription without a proper examination could expose the nurse and the clinic to legal liability.
- In many jurisdictions, it is illegal to prescribe medication without a valid medical examination.
Rationale:
The nurse's priority must be Samia's well-being. While respecting Mrs. Nasser's cultural beliefs is essential, it cannot supersede the need for appropriate medical care. The nurse must find a way to balance cultural sensitivity with professional responsibility.
Culturally Congruent Strategies:
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Empathy and Active Listening:
- Acknowledge and validate Mrs. Nasser's concerns.
- Listen attentively to her explanations of her cultural beliefs and fears.
- Express empathy and understanding.
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Cultural Broker/Interpreter:
- If available, involve a cultural broker or interpreter who can help bridge the communication gap and explain the medical necessity of the examination in a culturally sensitive manner.
- This person can help explain the difference between a medical examination and a sexual act.
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Education and Explanation:
- Provide clear and concise information about Samia's symptoms and the potential causes.
- Explain the purpose of the vaginal examination and how it will help determine the appropriate treatment.
- Emphasize that the examination will be conducted in a respectful and professional manner.
- Explain that the examination does not break the hymen, and that the hymen can be broken through other means, such as sports, and other physical activities.
- Explain that the doctor is bound by confidentiality laws, and that the results of the exam will not be shared with anyone without Mrs. Nassers consent.
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Alternative Examination Techniques:
- If possible, explore alternative examination techniques that may be less intrusive, such as a urine test or a swab of the external genitalia.
- If a visual exam is needed, explain that only the external genetalia will be examined if that is possible.
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Involve a Female Physician:
- Reassure Mrs. Nasser that the examination will be conducted by a female physician, which may alleviate some of her concerns.
- Ensure that the female physician is culturally competent.
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Family Involvement:
- If appropriate, involve other family members or community leaders who may be able to provide support and guidance.
- If available, a female elder in the community may be able to explain the importance of the examination.
Ensuring Appropriate Care:
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Documentation:
- Thoroughly document all interactions with Mrs. Nasser, including her concerns and the explanations provided.
- Document Samia's symptoms and the rationale for the recommended examination.
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Collaboration:
- Collaborate with the physician and other healthcare professionals to develop a care plan that addresses both Samia's medical needs and Mrs. Nasser's cultural concerns.
- If needed, involve social work.
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Advocacy:
- Advocate for Samia's right to receive appropriate medical care.
- If necessary, involve hospital administration or ethics committees to resolve the conflict.
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Follow-Up:
- Ensure that Samia receives appropriate follow-up care and that Mrs. Nasser's concerns are addressed throughout the process.
By combining cultural sensitivity with professional responsibility, the nurse can navigate this challenging situation and ensure that Samia receives the necessary medical care.
Sample Answer
This scenario presents a complex ethical and cultural dilemma that requires a sensitive and culturally competent approach. Here's a breakdown of how the nurse should respond:
How Should the Nurse Respond to Mrs. Nasser’s Request?
The nurse should not comply with Mrs. Nasser's request for a prescription without an examination. Here's why:
- Patient Safety:
- Providing a prescription without a diagnosis is medically irresponsible and potentially harmful. The symptoms could indicate a range of conditions, some of which require specific treatment.
- Ignoring the need for an examination could lead to misdiagnosis, delayed treatment, and worsening of Samia's condition.
- Professional Responsibility:
- Nurses have a professional obligation to advocate for patient safety and provide evidence-based care.
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