Attitudes of polish nurses towards representatives of certain religions

Polish society is relatively homogeneous when it comes to religion. Apart from Catholics, the adherents of Orthodoxy constitute the largest group of over half a million people. There are rather many representatives of Protestantism, the number of which is estimated at 150,000 people. The most numerous religious groups also include Jehovah’s Witnesses, whose number exceeds 125,000 [1]. Nurses are an occupational group that daily experiences contact with people representing different religious beliefs that perceive health and illness differently. This dissimilarity can cause curiosity, fascination, admiration, but it can also be a source of aversion, fear, frustration, and a feeling of threat. Seeing a representative of different religious beliefs as interesting and valuable conduce interactions based on mutual recognition and respect, aims at cooperation and stimulates. On the other hand, seeing them as unimportant and backward triggers aggressive behaviors, antagonisms, and domination making nursing more difficult [2]. Lack of understanding for being different and lack of basic information about cultural differences make it challenging to communicate with the patient, which is extremely important when it comes to providing healthcare services for a patient [3]. Not knowing the foundations of the doctrines of other religions and different views on ethical matters related to medical activities may lead to conflicts resulting from misunderstanding the intentions of patients. Conflicts between healthcare workers and patients, resulting from differences in attitudes and values determined by religious diversity, require discussion on the scope of this phenomenon and its consequences for healthcare. Thus, the problem of the coexistence of various religious communities should be examined and also analyzed in relation to healthcare. Research on attitudes of nurses towards religious diversity seems to be necessary and empirical analysis-worth. Evaluation of these attitudes is important not only for anticipation of the opportunities for cooperation in terms of healthcare for various communities and the quality of nursing care, but also for noticing the possible risk of mutual conflicts that affect communication, identifying needs and health problems, and consequently, the satisfaction of nursing care by representatives of different religions.

The group of nurses who participated in the study reliably represents the population of nurses in Poland, where the average age of nurses is equal to 50.79 years (in own studies 46.13 ± 10.09 years of age), the majority, i.e., 97.93% of nurses are women (in own studies 96.7%), and 13.69% of nurses have specialization (in own studies 16.44%) most often having secondary vocational education [12]. The overwhelming majority, i.e., 92.29% of respondents were Catholics, while according to the National Census of 2011 [1], 87.7% of Polish society declared themselves as Catholics. Therefore, it can be assumed that the results concerning the social distance of nurses from Lesser Poland towards representatives of different religions will also apply to nurses in Poland. In recent years, the interest in cultural competences in medicine has increased. There are many articles that significantly contribute to knowledge on this matter, unfortunately, not referring to the attitudes of health care workers/nurses towards representatives of different cultures.

In order to find the results of other researchers for the discussion, keywords: nurses, attitudes, religion, social distance, domination orientation were entered (without time limit) into three reference databases MEDLINE - PubMed, Scopus, and Google Scholar. The titles and abstracts were checked, but no articles that could be used in the discussion were found. Due to the inability to compare attitudes of Polish nurses with attitudes towards representatives of other religions of nurses of other nationalities, it was decided to compare the results obtained by the CBOS [13] surveys of Polish society. This comparison will allow deducing whether the occupational group of nurses differs in terms of attitudes towards Others from Polish society. However, it should be noted that this comparison is subject to certain limitations. First, the CBOS research concerned only attitudes towards Muslims, Orthodox, Jehovah’s Witnesses, Protestants, Jews, and Buddhists. Second, there were no average results obtained, but only a percentage of answers to specific questions. Third, the Bogardus scale, modified to four items, was used. The scale used in the CBOS survey included the following questions: What would your attitude be towards .... (name of religion) was your colleague at work; the nearest neighbor; employer; daughter-in-law or son-in-law. This corresponds to the modified Bogardus scale applied in the own research in the sphere of distance in the micro-social public sphere (accepting Other as a co-worker, neighbor, employer) and distance in the intimate sphere (accepting that family member of the respondent is in a relationship with Other).

In the presented studies, the nurses showed moderate social distance towards representatives of other religions. The social distance above the mid-point of the Bogardus scale, indicating a small predominance of positive and neutral attitudes over the negative ones, was noted towards the Orthodox, Protestants, SDA, Jehovah’s Witnesses, and Jews. On the other hand, the distance below the mid-point of the scale, indicating a small predominance of negative and neutral attitudes over positive ones, was noted towards Muslims, Buddhists, and Hindus. In the micro-social public sphere, the respondents showed the smallest distance towards the Orthodox, and then towards the Protestants, SDA, Jehovah’s Witnesses, and the largest towards Muslims, Hindus, Buddhists, and Jews. The majority of adult Poles surveyed by CBOS [13] would have no objection that people of different religions would work with them or would be their closest neighbors. Likewise, it would generally be accepted for the followers of other religions to be their superiors. In the intimate sphere, the smallest distance was showed by nurses that we surveyed towards the Orthodox - only Orthodox obtained results above the mid-point of the scale. The largest distance was noted towards Muslims, then Hindus, Buddhists, Jehovah’s Witnesses, Protestants, SDA, and Jews. Also, for those surveyed by CBOS [13], the most difficult to accept would be the marriage of one’s own child with a person of a different religion. Also, almost three-quarters of the respondents would have no objections if their son or daughter would marry a follower of the Orthodox Church. The majority of respondents would also accept the marriage of their child with a Protestant (61%) or a follower of Judaism (58%). Almost half of the respondents (49%) would have no objection to having a Buddhist for a daughter-in-law or son-in-law. Considerable controversy was for their child to be in a relationship with Jehovah’s Witness (46%) and Muslim (40%). It seems that attitudes towards representatives of other religions of the Polish society are better than the attitudes of the surveyed nurses.

As a result of the religious homogeneity of Polish society, Poles often do not know the followers of other religions and religious associations in person. The only religious association whose members are known by most of the Poles in person are Jehovah’s Witnesses (60%). Less than one-third of the respondents know an Orthodox, and a little bit more than one-fifth a Protestant. When it comes to followers of Judaism and Islam, it was 13 and 8% for followers of Buddhism [13]. Similarly, in the presented study, surveyed nurses had most frequent private or professional contact with Jehovah’s Witnesses - 89.27% and the followers of Orthodox Church - 56.45%; followers of Judaism - 43.62%; Protestants - 41.77%; Muslims - 30.11%, and Buddhists - 20.36%.

The own research shows that there is a significant dependency when it comes to the level of social distance of respondents on age, seniority in the profession, place of residence, level of education, frequency of having contact with people of different religions, living and working abroad in the past, providing healthcare services for a person of other religion, participation in religious practices, religiousness, participation in training on transcultural nursing. CBOS [13] surveys showed that the attitudes of the respondents differentiate: towards Orthodox – age and contact; towards Protestants – the level of education, frequency of participation in religious practices and knowing follower of Protestantism in person; towards the followers of Judaism – the level of education; towards Muslims - age; towards Buddhists – age, and level of education; towards Jehovah’s Witnesses - contact and frequency of participation in religious practices.

According to the results of the report on Social Diagnosis 2011 [14], nurses that we surveyed are not a representative group for Polish society, as the own research, based on the SDO showed that the majority of respondents had a low violence score (85.75%), anti-egalitarianism (83.04%) and oppressiveness (69.28%). On the other hand, the results of the Social Diagnosis 2011 stated that 79% of respondents showed an egalitarian attitude and 51% dominant attitude. However, the comparison of the results obtained by the authors with the results of Social Diagnosis 2011 should be treated with caution, as the authors of the Social Diagnosis used only 4 questions of the SDO and made their conclusions on their basis.

Although the attitudes of Polish nurses were not compared with the attitudes of nurses from other countries towards representatives of other religions, the literature review by Van der Kluit and Goossens (2011) provides information on the factors that may influence the attitudes of nurses towards patients [15].

Parrillo and Donoghue (2005, 2013), while studying American students, showed that the average level of social distance towards all ethnic groups and the gap between the groups with the highest and the lowest levels of distance decreased compared to previous studies. Moreover, it has been shown that gender, race, and country of origin are significant determinants when it comes to the level of social distance towards all groups [16, 17].

The Segev, Mor, Even-Zahav (2020) study analyzed cultural intelligence (CQ) and social distance among students (of nursing, social work, behavioral sciences) from the majority (Jewish) and minority (Arab) groups. The results revealed a negative relationship between CQ and social distance. Higher CQ was found among students from the minority group. It found that students from the minority group were more open to intercultural exchanges [18]. Hadar-Shoval, Alon-Tirosh, and Morag (2019) revealed less negative stereotypes among Jewish nursing students than among Arab nursing students. Nevertheless, Jewish students were less likely to reduce social distances. They found no differences between students starting and in the process of studying in terms of stereotypes. However, the advanced students expressed a greater desire to reduce the social distance than the beginning students. The researchers concluded that the perception of social relationships is influenced by different contexts, including the specific context of students (studying together and working together in the future) and the broader overall context of relationships between groups. The results of their research indicate that programs aimed at developing cultural sensitivity and improving relationships in a divided society should provide different answers for each group and focus on the willingness to cooperate and reduce social distance rather than on trying to eliminate stereotypes [19].

The study by Nyaupane, Timothy, and Poudel (2015) analyzes the role of social distance in relations between people of different faiths visiting the holy place of Buddha’s birth. The result of this study suggests that Hindus and Christians visited the site because they considered the Buddhas more concerned with their faith than other groups. Moreover, this article shows that people perceive themselves as tourists, pilgrims, tourists and pilgrims, or as none of these groups. The research indicates that those who identify as pilgrims have higher religious motivations, and those who identify as tourists have higher recreational or cultural motivations. In this study, a social distance determined relational structures, similarities and differences between travelers of different religions using the same tourist areas. Belonging to groups is one of the elements of identity. However, while we may choose some groups to which we should belong, categories such as race and ethnicity - along with gender and religion to some extent - are something we cannot choose [20]. The analysis of the results of the research by Rajagukguk et al. (2018) allowed to conclude that the social distance in religiosity and empathy is negatively correlated [21].

Ghanean, Nojomi and Jacobsson, 2014 conducted research to assess attitudes towards mentally ill patients from Islamic countries. It has been shown that the level of negative attitudes in Iran was similar to that in other countries and cultures, although taking into account the fact that illness, including mental illness, is the result of Allah’s will, it could suggest less stigmatization of people with mental disorders [22].

Negative perceptions and distancing attitudes towards people with mental illnesses and victims of sexual violence are common in societies and cultures of Sub-Saharan Arica, for example, among students from Nigeria [23, 24]. The study by Akinbobol, Zugwaj (2019) examined the relationship between emotional empathy, social distance, and the attitude towards mental illness of police officers who contacted mentally ill people during their service. It turned out that emotional empathy and its dimensions, as well as social distance, had a significant impact on the attitude towards people with mental illnesses [24].

Adegboyega et al. (2021) started a discussion on social distance and its socio-behavioral consequences at the time of COVID-19. Social distancing has had positive effects on religious contacts, such as reducing the spread of the disease among the faithful and enabling the use of technological innovations. Conversely, it negatively affected social cohesion and left its mark on religious practice. It should be suspected that it may also influence the shaping of attitudes towards followers of various religions, which would undoubtedly be worth examining [25].

In the opinion of the authors of the manuscript, as in the opinion of Feliksiak [26], the attitudes towards the followers of other religions that function in Poland in society and among nurses are largely mediated, i.e. they are based mainly on information obtained from the media, and to a small extent on the contact with the followers of a particular religion. These contacts may take place sporadically, usually during trips abroad or during integration meetings. The attitude is also fostered by the associations of particular religions or stereotypes functioning in a society that occur in a significant part of the respondents. Personal acquaintance with a follower of a different religion may not thaw the relations but may also make the religion or, more broadly, culture perceived less critically.