ASSESSING THE INFLUENCE OF CULTURAL BELIEFS ON NURSES COMPLIANCE WITH ETHICAL PRACTICES IN RURAL  HEALTHCARE SETTINGS IN CAMEROON

CHAPTER ONE

INTRODUCTION

Background of the Study

Healthcare communities have recently chosen to codify their norms and values as codes of ethics (Heymans et al., 2019). The examination of different cultures has generated significant interest in the ethical values of nursing and healthcare, which are centred around human welfare (Shahriari et al., 2022). Nurses are facing considerable concerns and challenges due to technological advancements, rising healthcare expenses, and societal and organisational changes in the healthcare system. Therefore, in order to make accurate judgements in their work, individuals require both professional competence and a framework established by a code of ethics. This is why the creation of ethical codes is regarded as crucial (Heikkinen et al., 2019; Verpeet et al., 2018). 

Ethical codes are sets of rules and value systems that are used to judge the ethical conduct of individuals within a profession (Numminen et al., 2021). The International Council of Nurses (ICN) developed the initial framework for the professional ethics code for nurses in 1953. This code delineates the nurses' professional obligations towards patients, the nursing profession, colleagues, other healthcare professionals, and society as a whole (Heikkinen et al., 2019). Nursing is a distinct field within the medical sciences that aims to deliver healthcare services of the utmost quality to ensure, sustain, and enhance community health. Nurses, being the most extensive category of healthcare workers, exert a substantial influence on healthcare quality and the observance of professional ethics in delivering top-notch care (Tabarroei et al., 2021; Hassanian, 2019; Joolaee et al., 2018). 

Furthermore, nursing ethics is a branch of medical ethics that has been shaped by advancements in the medical industry. The advancements in the modern world have incorporated characteristics that make it absolutely necessary to demand an ethical approach in the medical field. Nurses should possess knowledge of ethical terminology and acquaint themselves with relevant concepts, however it is not necessary for them to attain expertise in ethics. Individuals must possess the ability to identify instances of immoral behaviour or situations that could potentially compromise individual rights (Omidi, 2018). Cultural views have a substantial impact on nurses' adherence to professional ethical procedures in rural healthcare settings in Cameroon. Cultural norms have the ability to influence the behaviours, attitudes, and decision-making processes of healthcare professionals, such as nurses, which in turn affects their compliance with ethical standards. 

Patients and their families frequently seek guidance from traditional healers prior to or in conjunction with receiving medical treatment from modern healthcare institutions. Nurses may encounter morally complex situations when they are required to balance the community's expectations of incorporating traditional methods with the ethical standards of modern medicine. According to Ndongmo et al. (2019), nurses may encounter pressure from patients or their families to endorse or engage in customary rituals that may contradict medical ethics, such as the utilisation of unverified herbal remedies or spiritual interventions that could impede or complicate medical treatment . 

Moreover, the cultural attitudes pertaining to illness and health can have an impact on the way nurses perceive and address ethical challenges. Within several Cameroonian cultures, illness is frequently interpreted from a spiritual or supernatural perspective, with disorders being ascribed to curses, witchcraft, or divine retribution. 

In numerous societies, there exists a profound reverence for the elderly and traditional authorities, whose viewpoints and judgements are frequently prioritised. Younger or less experienced nurses feel obligated to comply with the requests of authoritative persons, even if those requests go against ethical principles (Tangwa, 2019). This respect might result in ethical compromises, as the nurse may prioritise cultural conformity over their professional ethical responsibility.Therefore, this study seeks to assess the influence of cultural beliefs on nurses compliance with ethical practices in rural  healthcare settings in Cameroon.

Statement of the Problem

In rural healthcare settings in Cameroon, cultural beliefs significantly influence the practices and behaviors of healthcare professionals, including nurses. Nurses, many of whom may share the same cultural background as their patients, can find themselves torn between adhering to professional ethical standards and respecting the cultural practices of the community. This tension can lead to ethical dilemmas, where nurses might either compromise on ethical standards or face resistance from patients and their families if they strictly follow professional guidelines (Ngong & Bannerman, 2020). However, research has indicated that nurses find it challenging to effectively implement and utilise ethical guidelines in their practice (Numminen et al., 2019). A significant number of nurses do acknowledge the code of professional ethics when confronted with ethical dilemmas, yet fail to take appropriate action in accordance with it. Often, they lack the authority and resources to respond in accordance with the code, and occasionally they are unsure of the appropriate course of action (Woods, 2018). Several studies have examined the degree of compliance with ethical guidelines among nursing students and nurses, however, the findings are inconsistent. A study conducted by Momennasab et al. (2021) found that 70% of patients, 86% of nurses, and 53% of nurse managers reported that nurses' adherence to ethical guidelines was adequate. A recent study conducted by Mohajjel et al. (2023) revealed that a mere 41.8% of patients expressed satisfaction with nurses' compliance with ethical guidelines. According to Joolaee et al. (2018), a mere 39.7% of patients expressed a high level of satisfaction with nursing services. Borhani et al. (2019) found that while the majority of nurses and nursing students had knowledge of nursing ethics and recognised its importance in their field, they expressed significant apprehension regarding their capacity to effectively apply ethical principles in real-world clinical environments. The improvement of the nursing profession relies on the training of competent nurses who possess the ability to deliver comprehensive and holistic care. As a result, the nurse's impact on the healthcare system will grow, leading to increased satisfaction among healthcare recipients (Jafari et al., 2019). Hence, it is in the light of these challenges, the study seeks to assess the influence of cultural beliefs on nurses compliance with ethical practices in rural  healthcare settings in Cameroon.

 1.3  Objectives of the Study

The main purpose of this study is to assess the influence of cultural beliefs on nurses compliance with ethical practices in rural healthcare settings in Cameroon. Specifically, the study will;

Examine how cultural beliefs influence nurses' adherence to professional ethical practices in rural healthcare settings in Cameroon.

Identify specific cultural beliefs that may conflict with or support ethical nursing practices.

Assess the impact of these cultural beliefs on patient care and ethical decision-making among nurses.

Investigate strategies for integrating cultural sensitivity into ethical training and practice in rural healthcare settings.

1.4  Research Questions

The following questions have been prepared for the study:

Do cultural beliefs in rural Cameroon influence nurses' compliance with professional ethical standards?

What specific cultural beliefs pose challenges to the adherence to ethical practices among nurses?

What are the impact of these cultural beliefs on patient care and ethical decision-making among nurses?

What strategies can be implemented to harmonize cultural beliefs with ethical standards in nursing practice?

1.5 Research Hypotheses

H0: Cultural beliefs do not significantly influence nurses' compliance with ethical practices in rural healthcare settings in Cameroon.

Ha: Cultural beliefs significantly influence nurses' compliance with ethical practices in rural healthcare settings in Cameroon.

1.6 Significance of the Study

The study will provide valuable perspectives on the challenges and conflicts that emerge when conventional beliefs connect with contemporary healthcare ethics. The results of this study will be crucial in creating training programs and ethical guidelines that are culturally sensitive and consider the local cultural environment. This will assist nurses in effectively managing ethical challenges. The study will provide healthcare administrators and policymakers with ideas on how to establish conducive conditions that support cultural beliefs while encouraging adherence to professional ethical standards. This study aims to investigate the influence of traditional beliefs, community norms, and cultural values on nurses' compliance with ethical principles, including patient autonomy, confidentiality, and non-maleficence, in rural locations.

The research will also make a valuable contribution to the wider discussion on how cultural contexts influence ethical behaviours in healthcare, especially in low- and middle-income countries (LMICs), where cultural views frequently have a substantial impact on daily living. Moreover, the study will aid nursing schools in tailoring their curricula to better prepare students for the ethical demands of the profession.

1.7 Scope of the study   

The scope of this study is boarded on the influence of cultural beliefs on nurses compliance with ethical practices in rural healthcare settings in Cameroon. Geographically, the study will be delimited to nurses in Cameroon.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Nurses: Healthcare professionals who are trained to provide medical care, support, and education to patients. 

Compliance: refers to following protocols, regulations, and ethical standards to ensure proper conduct and high-quality care.

Ethics: a set of principles and standards that guide the behavior and decision-making of professionals in a particular field.

Cultural belief: A set of shared values, norms, customs, and practices that are passed down through generations within a specific community or society.

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