Nursing care for Roma patients

Multicultural nursing - Specifics of nursing care for Roma patients
We live in a society that takes advantage of its own territory, common language and common history. Therefore, when meeting other people, we usually expect mutual understanding and pleasant behavior.



Roma
Roma - are a population that has a common origin in Northern India, from where a group of their ancestors not exceeding 1000 people came out eight hundred to a thousand years ago. Today they represent several linguistically and culturally related ethnicities. They live scattered in Europe, North Africa, Southwest Asia, North America and Australia. Today, their total number is estimated at 8 - 10 million people.

Cultural values ​​and lifestyle
The presence of the Roma ethnic group on the territory of Europe dates back to the Middle Ages. From approximately the 14th century, they appeared on the territory of Spain, Portugal, Germany, France, Russia, Hungary and Romania, then in other European and non-European countries. The Roma population is the main ethnic minority in Europe. According to current estimates, approximately seven to nine million Roma live in Europe today, approximately two-thirds of them in Central and Eastern Europe.

The Roma population can rather be characterized as diverse. By settling in different areas, they often adopted the customs and language of the host country. Some customs have also permeated the host country's culture, such as folk dances, musical rhythms and words from their native language.

Their original homeland is the province of Punjab in northern India. According to the genetic diversity, it is estimated that the total number of ancestors of today's Roma who made the journey to Europe was less than 1000 people.

The different origins and behavior of the Roma population have caused persecution in Europe throughout history. Difference and discrimination caused economic and social exclusion that continues until now, especially in the poorer countries of the continent and in the countries of the former communist bloc. Even in today's developed times, you can meet racist individuals who still exclude them because of their poverty and inadequate living conditions. The Roma are mostly distrustful of anything that lies outside their circle, and therefore social exclusion is not surprising.

Roma in the Czech Republic
The beginnings of the settlement of the Czech Republic by the Roma community date back to the 15th century. Over the centuries, they gradually settled, until in the 50s of the 20th century, a decree was issued banning nomadic life. During the Second World War, as a result of the fascist holocaust, part of the community then living on the territory of the Czech Republic was exterminated. However, after the end of the war, the population was supplemented by other migrants of Roma origin, especially from the Slovak Republic. Currently, approximately 300,000 individuals live in the territory of the Czech Republic. The highest concentration of population is especially in northern and western Bohemia and in northern Moravia.

Several groups of Roma live in the Czech Republic:


 * Czech and Moravian Roma (they were physically almost exterminated by the Nazis during World War II).
 * Slovak Roma, who came to the territory of today's Czech Republic after World War II, make up about three quarters of the Roma population in Bohemia today.
 * The Olaš Roma (Vlachika Roma – about 10%), who differ from the rest of the Roma ethnic group in, for example, their customs and way of living.
 * Sinti - German Roma.

The value system of the Roma and the specifics of their lifestyle
There are differences between the way of life of Czechs and Roma, which result from a different concept of life and life values. These differences are already evident from the demographic characteristics.

For example: average life expectancy, higher female fertility, marriage rate of both women and men at a younger age, lower divorce rate, etc.

Value System

 * 1) Life – the highest value;
 * 2) Family;
 * 3) Children – the greatest wealth of a Roma family.

Life – the highest value


 * Everything that leads to the preservation, reproduction, and continuation of life is of high value.
 * Everything that threatens or limits life is perceived negatively.
 * "It's important that he's alive" is the Roma reaction to the news that someone has been seriously injured and will remain disabled until death.

Family


 * It is more important to them than focusing on their work.
 * The family is a source of sustenance for them, it has an educational as well as a protective function.
 * The highest penalty for Roma is expulsion from the family.

Children – the greatest wealth of a Roma family


 * Small children are served longer (they do not learn independence).
 * At an early age, the child is supervised by the mother and grandparents, at puberty by the father, who is stricter. Gender is taken into account in education.
 * Childhood and adolescence end with the founding of a family. Girls often have to marry men chosen by their parents and are traditionally married very young. The custom was usually to give a daughter in marriage to a man within the same tribe.
 * The mental and physical immaturity of Roma parents in today's individualistic world causes several problems.

Traditional Roma family

 * A different structure and size compared to the current Czech family is evident.
 * The family is distinctly patriarchal and there are strong family ties within.
 * The highest position is held by a man (elders), then a woman (according to the number of children), sons (from the oldest), daughters, the wife of the youngest son (however, she can rise higher according to the number of children born).
 * They do not allow divorce and would never put children in a children's home or parents in a retirement home.
 * Everyone helps and supports each other.

Man vs. woman


 * A woman ensures the running of the family, raises children, obeys her husband. He must provide food for the family in any way he can. A woman usually occupies a subordinate position.
 * The man is the head of the family, the bearer of prestige. He makes decisions and is responsible for the family. His income is rather casual, so he spends most of his time looking for orders, working and maintaining good relations with relatives and friends.

Religious and philosophical factors
The Roma adapted to the religion of the local population. In the Czech Republic, they are mostly formal Catholics. Their patron is Černá Sára. In the Czech Republic, Romani traditions are disappearing in some families, but the traditions associated with death and birth are preserved the longest. The originally Slovak Roma have great respect for the spirits of the dead (mules). Mules can appear to them, possibly warning them of imminent danger. Part of the Slovak Roma are also worried about guny daj, which can bewitch their newly born child if they leave it alone and it is not baptized.

Technological factors
Technological factors for the Roma community are fully accessible as for any citizen, but due to their unemployment, they cannot afford the general luxuries that life offers today.

Political and legal factors
Roma who have a registered permanent residence in the territory of the Czech Republic have the same rights as all citizens living in the territory of the Czech Republic, which also means the right to choose a political party, freedom of action, thought and reasoning.

Economic factors
Employment is rather tied to high unemployment. Due to their level of education, they are more of a marginalized or auxiliary workforce, which is reflected in 80% unemployment and the filling of unstable jobs without contracts. Earnings are therefore rather occasional, and spare time is spent maintaining good relations with relatives and friends. Therefore, even their financial situation is not at a high level.

Roma usually have a harder time finding housing than other citizens precisely because of unemployment and the inability to pay regular rents, as well as because of persistent discrimination. They prefer living in ghettos, which are characterized by insufficient infrastructure and services, which is caused by their segregation from the surroundings and coexistence in communities.

Educational factors
For them, education is not exactly of general value, and the level of education is paid very little attention. In the value system, it lies deep below the desire to get the most money. Almost 20% of Roma have not even completed primary education, and this is reflected in the high level of illiteracy in this group, the rest mostly only finish primary school, which is roughly 70% of Roma. A frequent negative phenomenon is truancy, which is mainly influenced by prioritizing the household and caring for siblings over the importance of education and the children's future. Furthermore, the difference in language from their mother tongue and the complete absence of pre-school preparation also contribute to truancy. Their vocabulary is barely half that of other children, which is why they are often sent to special classes.

Roma and attitude to health

 * Health is high on their value list.
 * Health is not only a good physical condition, but also a certain social security and, to a certain extent, the tolerance of the surrounding majority group.
 * The oldest women in the family usually have the main say in the treatment of the disease, their experience gained through practice is important. In the past, they used observed knowledge from natural medicine and so-called merciful magic, which was based on incantations, prayers and incantations.
 * The Roma believed that demons were the cause of illness.
 * Roma people have a weaker will, endurance, and patience.
 * Without their family, they typically feel alone, they are afraid, which is sometimes the cause of increased aggression and reluctance to cooperate with health professionals.
 * They are spontaneous, have a lively temperament, great sensitivity to injustice.
 * Roma people perceive health as a holistic individual, social, physical, mental, cultural and multicultural unity.
 * Treating Roma patients is psychologically quite challenging for healthcare professionals due to Roma's mistrust of healthcare professionals.
 * Roma feel a considerable fear of pain and death, even if their health condition is not serious. They tend to be very emotional, moaning often and loudly. Councils can feel like an injustice and feel aggrieved. Women tend to be anxious and may not tolerate hospitalization.
 * The doctor should expect that a Roma patient who is ill for a short period of time will take medication and follow the prescribed measures only until the symptoms of the disease subside. Sufficiently draw attention to the consequences, especially for children.
 * Each Roma patient must be approached individually, health professionals should try to explain the cause and course of the disease. In every explanation, doctors and nurses should make sure that Roma patients understand them.
 * Gaining their trust – the most important thing. Building a good relationship is long and difficult, and the results do not come for a long time. However, after a long time, the situation usually breaks down.
 * When one family member is hospitalized, we can observe their care, when the entire extended family comes to ask about the patient's condition.
 * They can wait for hours until the end of the operation or examination.
 * They often demand visits outside visiting hours and congregate in the patient's room.

Roma in the hospital
Higher morbidity (chronic diseases) – leads to more frequent and repeated hospitalizations in nursing units.

The reason for non-compliance with the long-term treatment regimen is:


 * weak will – non-compliance with treatment measures that are necessary to stabilize their health condition;
 * refusal of treatment that does not have an immediate effect;
 * failure to comply with later follow-up treatment, when the symptoms and problems caused by the disease disappear.

 If the nurse wants to provide quality care:


 * He must not forget to communicate with his family.
 * He must establish contact mainly with the head of the family (usually the oldest male of the family).
 * Patience and empathy are important when communicating with the client - Roma.
 * She should not forget about expressions of interest, respect and dignity.
 * If she suspects a problem with a client, she should notice it, not follow it.

Communication
Because family is the second-highest value for Roma after life, he will do anything for its sake. He doesn't have to come to a regular appointment or examination because someone in the family needs him more at that moment. Their communication contains a high proportion of emotions during their actions. Roma does not know coldness on the outside, even in the case of a raging inside. If he's desperate, it shows from a distance – unfortunately, in this state of mind, he doesn't see other things that are positive and non-threatening. He is incapable of any kind of overview, rational analysis and systemic approach. Therefore, it is often necessary to take some information as relative and to be able to work with it. However, they can also openly experience joy and success, not only for themselves. Another specific feature of Roma communication is related to these features, namely low generalization. Nor does their language have generalizing terms, and therefore the expectation, that the model clearly results in instructions for a specific situation is not appropriate. It is therefore important to frequently repeat information and demonstrate the situation.

Main tips when dealing with a member of the Roma community:

►	Take your time, be patient, don't expect immediate results. ►	Perceive non-verbal communication, be able to provide information also through body language. ►	Do not criticize negatively in front of a large group, rather in private. ►	Don't be afraid of closeness, touch. ►	Don't be afraid of emotions – it shows a person's commitment. ►	Speak clearly, matter-of-factly, briefly, concretely, repeat essential things several times and verify feedback. ►	Differentiate – approach everyone according to individual needs ►	Respect the value system of the Roma ethnicity. ►	The Roma consider expressions of disagreement or refusal to be impolite. ►	They are not used to thanking and begging.

Pregnancy and childbirth
Mostly young mothers – 14–16 years old – reason: continuation of the family, temporary solution to the financial situation.

The immaturity of Roma mothers leads to:


 * disorders in accepting their role as a parent (they cannot establish a relationship with their child and cannot accept full responsibility);
 * insufficient preparation for childbirth (prenatal consultations, lifestyle).

A pregnant woman is blessed and brings good luck.

He must obey the rules to protect the fetus – he must not look at disabled people, at the deceased – it could be transferred to the child. During the entire pregnancy, the woman hardly goes out to society. Her husband always accompanies her outside. Throughout pregnancy, a woman does not wear jewelry around her neck (wrapping the umbilical cord around the baby's neck). Expectant mothers are not prohibited from eating any foods. On the contrary, they should consume whatever they feel like, even if it is alcohol. The only restriction that pregnant women have is in taking a small amount of acidic foods. However, the pregnant woman works until the last moment. To ease labor pains, the mother was given tea or alcohol and her forehead was wiped with cool water. After giving birth, the mother was given schnapps to drink. It used to be the custom to give birth at home, and although today Romani mothers have given in to the majority society and give birth in maternity wards, they very much lack the support and attention of their own family at this moment. Therefore, it is typical for Roma that most of the family spends time in the vicinity of the maternity hospital.

The most important first bath of the baby – water, in which the Roma put money so that the child would be rich in the future. They then held the child over the fire to purify it. It was necessary to baptize the child as soon as possible because they believe that an unbaptized child would have bad luck throughout his life and would be accompanied by evil spirits that would harm him. A red ribbon is tied around the child's wrist to protect him from evil. Children under the age of 1 were not allowed to have their hair cut, were not allowed to look in the mirror and were not allowed to be given dolls to play with.

Links

 * Gypsies. In: Wikipedia: the free encyclopedia [online]. San Francisco (CA): Wikimedia Foundation, 2001- [cit. 2012-05-31]. Available from: https://cs.wikipedia.org/wiki/Romov%C3%A9