Nursing Considerations

"In sha Allah- God willing"

Saudi Arabians have a very positive view about illness. For them it is a test of one's endurance, perseverance, or capacity to bear. When someone is sick, he or she responds with humbleness and acceptance. Health and wellness are all from God therefore, every process of life starting from conception/pregnancy is out of their control.

    There is no certain age that a women should start bearing children. It can happen as soon as they get their first menstruation.

Cultural considerations in Saudi Arabian health care approaches

•  Male and female interaction is limited to family units only. It is inappropriate to make a casual greeting with a non-family.
• Separation of male and female is observed among the adolescent and adult wards.
• A handshake is not generally accepted between non-related male and female in the Islamic norms. So do not be offended when a patient refuses.
•  Patient prefer to have physicians of the same sex. Therefore as a nurse you may sometime be required to act as mediator between a patient and an opposite sex doctor.
• Staring or admiring the opposite sex is a equivalent to adultery.

Here are some more things to consider with a Saudi patient...

• Don’t offer alcoholic drinks to an Arab, unless you’re certain that he drinks alcohol. This can cause great offence.
• Don’t walk on a prayer mat or in front of any person at prayer and try not to stare at people who are praying.
• Avoid blasphemy, particularly in the presence of Muslims.
• Avoid putting an Arab in a position where he might suffer a ‘loss of face’ in front of other Arabs. He will appreciate this, if he notices your action.
• Don’t beckon to people with a finger, as this is considered particularly impolite. Arabs might use such a gesture to summon a dog.
• Avoid shouting and displays of aggression or drunkenness at all times, as such behaviour is rarely tolerated.

Ways of life in Saudi Arabia

       Saudis have a very unique and strict culture. There is a vivid line separating the roles of males and females in the home, community, religious functions, and politics. Saudi Arabia has been considered a male dominating country. As evidenced, no females are allowed to go to the mosques, go to school, handle an independent role, to work, to drive and so on. It is always the male who handles major decision-making.

However, recent stories on the media are telling the world that Saudi Arabia supports their women and that women now have freedom and pretty much equal rights with the men.

      In 2002 the Kingdom's powerful "mutaween" police, the Saudi media has accused them of hindering attempts to save 15 girls who died in the fire on Monday.

Saudi Arabia's religious police stopped schoolgirls from leaving a blazing building because they were not wearing correct Islamic dress, according to Saudi newspapers.

      In a rare criticism of the king

About 800 pupils were inside the school in the holy city of Mecca when the tragedy occurred.

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Health/wellness perceptions and practices, including biological variations and processes of grieving, aging, dying.

•       Arabians believe in the evil eye that brings sadness and bad luck to their home. To ward off bad luck, their babies wear blue beads pinned on their clothes.
• Arabians value health and wellness by building hospitals and hiring foreign health professionals to work in their health facilities. While that is straightforward, an interesting finding states that Arabians are not good messengers of bad news such as death to their family or relatives. 
• Biologically, women tend to age faster as they hold the roles of a mother at a very early age.
•     Muslims bury their dead the same day he or she died. Women are not allowed at the burial site, although sometimes this social expectation is lax for the royalty.

Communicating patterns, verbal, and non-verbal practices.



Verbal 
       The love of talk stems from the rich nomadic oral tradition of
greeting travelers and exchanging information.
       Low literacy rates increase the importance of verbal
communication.
      Arabs love poetry and creative speech.  They are fond of
bestowing flowery blessings and colorful swearing.
     When speaking with Arabs keep in mind that they believe that
words have power.  Arabs shun speaking about unpleasantries
out of fear that negative speech compels negative results.
       Also, they will use euphemisms when discussing the plight of
others.  For instance, say a mutual acquaintance is ill and near
death.  Should you inquire about recent news he will likely
respond, “he is well, but a little tired.”  In an operational
situation check the facts after being briefed by an Arab soldier
because he may be sugar coating a bitter pill.

Written 
       Muslims, particularly Arab Muslims, consider the Arabic
Language holy as the Qur’an is written in Arabic.  The written
word has special meaning to them and is respected by the
literate and the illiterate alike.
       Arabs consider advanced education a remarkable achievement
and greatly respect scholars and learned men and women.
       Avoid using newspapers in “unclean” ways as many Arabic
newspapers usually have some reference to Allah and some
Arabs could be insulted in how the printed name of Allah is
treated.

Gestures and what they mean...

Warning!  Gestures indicating obscenities or insults 

should not be used by non-Arabs.  Arab gestures of this 

type have varying degrees of intensity.  Depending upon 

the circumstances and country, incorrect usage could lead 

to serious offenses and cause diplomatic incidents.   

•  Shake Hands with right hand only and at the beginning and end of any visit. Shake hands longer but less firmly than in the West. Left hand grasps elbow.
•  Close friends or colleagues hug and kiss both cheeks upon greeting.  During the Hajj (pilgrimage), people may kiss only on the shoulders as a gesture of friendship and greeting.
• Touching noses together three times when greeting is a Bedouin gesture of friendship and respect.

• Placing a hand on your heart along with a slight bow is a sign of respect.  This is usually done during greeting. US soldiers should limit physical contact to a handshake.
•  “It’s my Obligation” - The gesture of placing the right hand or its forefinger on the tip of the nose, on the right lower eyelid, on top of the head, on the mustache or beard has the meaning of "it’s in front of me, I see it or it’s on my head to accomplish."  
• ”Come Here” -Right hand out, palm down, with fingers brought toward oneself repeatedly in a clawing motion, is the sign for calling someone to come.
• ”I’m thinking” - Grasping the chin with the thumb side of the right fist is a sign of wisdom or maturity.
• “Slow down” - By holding the fingers in a pear shaped configuration with the tips pointing up at about waist level and moving the hand slightly up and down signals "wait a little bit" or "be careful. " This gesture can be observed extensively when driving in the crowded streets of the Arab cities. In such a locale, it may be accompanied by curses from an anxious taxi driver or a pedestrian trying to cross the street. 
• ”Thank You” - Placing the palm of the right hand on the chest, bowing the head a little and closing one’s eyes connotes "Thank
• "You" (in the name of Allah). 
• “No” – A quick snap of the head upwards with an accompanying click of the tongue connotes: "No", "Unlikely", or "What you say is false."
• “I wish evil upon you” - Biting the right forefinger, which has been placed sideways in the mouth, may be a threat or an expression of regret.  In Western culture the "A-OK" sign is a positive gesture. However in the Arab world, if the gesture is shaken at another person it symbolizes the sign of the evil eye.  An Arab may use the sign in conjunction with verbal curses. 
• ”I wish you harm” -Hitting the right fist into the open palm of the left hand indicates obscenity or contempt.  
• ”You’re lying” - Placing a half closed hand in front of the stomach, and then turning it slightly connotes that the person to whom the gesture is made is a liar. 
• ”I insult you” - Placing the tips of the left fingers and thumb together so that the hand faces right, then placing the tip of the right forefinger directly on the left fingertips indicates an obscenity or insult directed at one’s birth or parentage.   
• ”You are unimportant” - Showing soles while sitting is considered rude. and symbolic of  “you being beneath my feet”.  Sit instead with soles toward or on ground to be polite.  Also maintain eye contact; lack of eye contact strongly conveys “you are unimportant” as well.  

Perceptions of time and its influence on day to day living patterns within the community 

• Time is not regarded as much value by young Saudi females who just graduated from a bachelors program, compared to their western counterparts. 
• They are more relaxed and carefree according to a blogger in the article “Saudi Girls and too much time in their hands.” This can be due to a very easy laid back lifestyle in Saudi Arabia. There are maids that serve them.  In addition, their climate changed their perception of time as no one is seen out working or doing anything during the peak of the day. There are two work shifts: nice A.M. to one P.M. then there is a four hour break. Work resumes from five P.M. to eight P.M.

Family as pivotal influence in the life of the individual, community and larger society

• Family is many things to the Saudis. At a larger picture, it is the family, the dynasty of the Sauds that rules the land since its founding. It is like an institution that grants power to the males and sense of servitude to the females.
• When their children are ready, the parents send them out to start their own. This is the expected role of every family in Arabian society. Lastly, a family is an individual’s blessing or curse. Some families have a good reputation, values and standards in life. This could mean a person’s freedom from the bondage of horrible fate.

              This video offers a glimpse of life for a married middle-class Saudi woman. She wears the Abayah - the traditional black dress with black head covering as this video is available to the general public.

                Women generally do not receive guests in the Saudi households, unless there is a male relative/husband present. Women also have their own separate living rooms where they can entertain friends or family.
At social gatherings, women and men are usually segregated as well.

               Another thing of importance that she mentions is that music of any kind is forbidden, although they can have singing at weddings.

Traditional roles in Saudi Arabia

       Traditions are found within every culture. Tradition can be defined as a ritual or belief that is passed within a specific religion, culture, or society. Rituals are actions that are preformed mainly for their symbolic value. Rituals can be preformed on certain occasions, or daily. Rituals can be preformed in a group setting or by a single individual. The reason for rituals and traditions differ and vary depending upon religious obligations or spiritual and emotional needs of the individual.

      The people in Saudi Arabia respect their culture and uphold their traditions.
Saudi Arabians follow and often dictates the Quran and consider it to be their book of guidelines for everyday life.

      According to the Quran consumption of alcohol is forbidden. Eating of pork too is prohibited. There traditions are very different from what we as americans are used to.

     The Saudi Arabian traditions state during formal meets guests should be offered black tea as a sign of cordiality. So when tourists visit local households they should drink a cup of tea to acknowledge the hospitality of the housemates.

     A very important guideline in regards to Saudi arabian tradition is their dress codes of both men and women. Each person will usually wear long flowing very loose garments. They are usually covered from head to toe. Shorts, Jeans, or tight clothing is a sign of disrespect. This is in accord of the hijab custom that believes in modesty.

      Men mainly wear an ankle length cotton shirt called thwab with a check-shirt which is known as the keffiyeh or a ghutra. For women it is compulsory to wear a niquab, which is a veil. It is very important to uphold to these traditions, even if you are a tourist. Saudi Arabians see it as a sign of disrespect if when visiting their country your actions both physically and mentally don't somewhat reflect their ways of life.

      Traditionally men and women in Saudi Arabia do not date. Marriage is something that is usually arranged by the couples parents. Wedding Parties are usually separate for the bride and groom, they often take place at different locations and usually on different nights.

      Funerals in Saudi Arabia as with most other religions traditionally have observances after death, however in Saudi Arabia are a person has passed their body is bathed three times and after the third bathing is scented with oil. While the bathing process is taking place prayers are said. After this process is completed the body is then wrapped in white shroud. No embalming materials are used, therefor burials usually occur the same day depending upon the time of death. The dead are buried five to six feet deep, with their head facing Mecca.

Tombs and headstones are prohibited. Through out the service very often god is praised and forgiveness is asked for the deceased’s sins. One very known and recited prayer is as follows:

"Allah, do forgive him and have mercy on him and make him secure and overlook his shortcomings, and bestow upon him an honored place in Paradise, and make his place of entry spacious, and wash him clean with water and snow and ice, and cleanse him of all wrong as Thou dost clean a piece of white cloth of dirt, and bestow upon him a home better than him home and family better than him family and a spouse better than his spouse, and admit him into Paradise, and shield him from the torment of the grave and the torment of the Fire"

      The traditional role of women is much different then the role of women in America. Women are allowed one husband, while men are allowed up to four.  By law women are not allowed to use any of form transportation (car, bicycle, or public transportation) if they are not accompanied by a male escort. Women are not allowed out of the country unless they are given verbal permission from their father or husband.

Religion in Saudi Arabia

The major religion in Saudi Arabia is Islam.

Upto 85% of the Muslim population are Sunni and only 10-15% are Shi'ite.

While there are up to 1.2 million believes of other faiths, they are not allowed to openly practice their faith. Coversion to another religion from Islam is punishable by death.

The Saudi Mutaween ( religious police) prohibits the any other religion other than Islam.

                Islam follows a lunar calender and therefore have religious holidays that do not have definite set dates on the regular Gregorian calendar. Their main religous feasts are Eid and Ramadan.

Ramadan is a month of fasting for Muslims where they do not eat or drink all day as long as the Sun is in the sky, once the Sun sets. they have small gatherings in their homes to eat.

The month of fasting ends with Eid, where they have huge celebrations and festitivies.

Excerpt from Interview...

Rabi Haddad

To provide a first hand account of life and traditions in Saudi Arabia we’ve interviewed Rabi Haddad, a 20 year old art student who was mostly raised there. We decided to meet at a Starbucks Cafe on a breezy Friday afternoon to talk for a while and catch up before we went about interviewing her.
After finding a table, we place our orders and wait.
For all her upbringing, Rabi doesn’t look Arab. She’s white with dark blonde hair and brown eyes, and could pass off as American, if her accent didn’t give her away. After discussing our cultural project with her, we settle in to talk. Here’s what we learnt:

How do you identify yourself? Who you are/Where you come from etc..
Rabi: My name is Rabi and I’m from Saudi Arabia.

Where do you live now?
Rabi: My family and I moved to America 4 years ago. We moved right after my 16^th birthday with my parents and siblings.

How do you like living here?
Rabi: I didn’t like it at first. Although I speak English, I didn’t understand what people were saying. Sometimes my classmates would laugh at me, but soon I learnt to laugh too. I have made friends since then so now I am happy.

Do you miss your friends in Saudi Arabia?
Rabi: Yes! All the time! When I first came here, I would send them e-mails every week! But then that soon turned into months and then now maybe a few times a year for the holidays. I still miss them though.

You mentioned holidays. Did you celebrate Christmas and Thanksgiving?
Rabi: (laughs) People always find it surprising that I celebrate the holidays. Even after 4 years they ask me that. Yes I did celebrate Christmas, but not Thanksgiving – I think that is American. I am Christian, so Easter and Christmas were huge celebrations in my house. We also had Islamic holidays as well, since Saudi Arabia is a Muslim country.

You’re Christian? Aren’t all Saudis Muslim?
Rabi: No, that is a common mis-conception. A lot of Saudis are Muslims, yes but not all. I’m not Saudi, though. I am Jordanian. My parents moved to Saudi Arabia from Jordan when I was 2 for my father’s job. But I have friends who are Saudis, who are also christian.

How is Christianity accepted in Saudi Arabia?
Rabi: Umm, they do not prohibit you from practicing your faith, but you cannot hold services in the open. For example, there are no churches that I know of. Therefore if my family attended mass, it was usually in a large hall or auditorium. Also you are not allowed to distribute any media about different religons.

Do all the women there have to wear veils over their heads, and why is that?
Rabi: Yes all women do, irrespective of race or religion. Even girls as young as 10 must wear them. They say a woman’s hair is a reason for a man’s desire and therefore a woman must cover her hair to avoid this. Muslim women cover their faces as well. They wear a burka, that hides everything but their eyes. In the Muslim faith, a woman’s body is for her husband and he alone can witness her form.

Describe religion in Saudi Arabia
Rabi: That is a very broad topic! SA is very Islamic. The Sharia (the Islamic police) makes sure that everyone follows the rules in the Quran. Muslims pray five times a day. And therefore, no matter where you are in Sam you will always hear the preacher in a mosque calling out for people to being the prayers – in the morning, afternoon, evening. Religion is a very key aspect to how the country is run. The Royal family usually participates in Islamic celebrations to show that they are still connected to the people. This is how, I think they still manage to have one of the few dominant monarchies in the world.

How is the family life in Saudi Arabia?
Rabi: Since my family was Jordanian, we did not observe strict family codes, but I have seen differences in the homes of my Saudi friends. For example, my friend Safina is an Muslim Saudi. As children when I went over to play at her house, I would see how life was different for her. The women in her family never receive visitors, unless they are first seen my the oldest male in the house. The women always need a male guardian with them at all times, a father, brother or husband. It has to be a blood relation or a marriage related. Although people here in America may see that as oppressive, many Saudi women prefer this relationship.
When I lived there, women were not allowed to drive on their own and therefore always needed a male relative with them to take them anywhere. This has changed recently with a new rule, allowing women to drive. This changed in the June of this year, I think.
Women are also not allowed to get married or divorced, or apply for jobs without their male relative/husband’s consent.

Are men allowed to have more than one wife?
Rabi: Yes, according to the Quran a man may have upto four wives at any one time.

Does that become a problem in the family? Having several wives and children for one man?
Rabi: Not all Saudis follow this. While the thought of having many wives may be appealing to some, it also comes with the responsibilities of talking care of the welfare for all these people. I have only seen a few polygamous families. It is a luxury for the rich.

Can you elaborate on some spiritual customs from SA?
Rabi: Ok, as I mentioned before Muslims pray five times day. The prayer lasts only 10-15 minutes, but it is observed by all businesses, TV channels, radio broadcasts etc. For those 10-15 minutes, five times a day all the shops are briefly closed and the television and radio stations do not transmit anything.
I have actually heard it enough times to repeat it now.
All those who pray must face toward Mecca, the holy Muslim city. There are signs pointing to the direction of Mecca almost everywhere, in hospitals, government offices, schools etc so that no matter where you are, you can always follow the law.
A person who has passed away if turned to face Mecca as well, in order to show reverence for Allah

Daily Prayer - "Azan"

This is an example of an "Azan" a call to prayer for all Muslims. It is sung five times day and can be heard anywhere within a Muslim city.