Exploring value conflicts between Islamic modesty and healthcare guidelines among nursing students and nurses in Jordan and the United Kingdom: a multi-phase study

Abstract

Background:
For many Muslim nurses and nursing students, modesty (ḥayāʾ) is an important part of their religious and moral beliefs and influences how they approach clothing, interactions with patients of the opposite gender, and physical care. At the same time, healthcare settings operate under professional rules that emphasise standardised practice, efficiency, and neutral clinical behaviour. This difference can create tension for Muslim healthcare workers. Although healthcare teams are increasingly diverse, there remains limited clear guidance or research explaining how Islamic modesty is understood in clinical work, how it is experienced in daily practice, or how nurses manage these challenges. This thesis aims to address this gap using a three-stage qualitative research approach.

Method:
This thesis was organised as a multi-phase design conducted across three connected phases. First, a scoping review guided by Joanna Briggs Institute methodology was undertaken to synthesise existing research on Islamic modesty in healthcare, identify areas where evidence remains limited, and summarise reported conflicts, challenges, and management strategies. Second, an in-depth qualitative study was carried out using focus groups and semi-structured interviews with nursing students, practising nurses, and nurse managers in Jordan and the United Kingdom. Data were analysed using thematic analysis, informed by Identity Negotiation Theory, Cognitive Dissonance Theory, and Face-Negotiation Theory. Finally, findings from the earlier phases were integrated to develop practical, context-sensitive guidance intended to support Muslim nurses and nursing students in clinical settings.

Results:
An early review of available scholarship revealed that discussions of Islamic modesty in clinical environments were sparse and lacked theoretical clarity, justifying the scoping review. By systematically surveying existing studies, the review exposed major deficiencies, including inconsistent conceptualisations of modesty and a limited body of empirical work examining the experiences of healthcare professionals. These deficiencies guided the subsequent qualitative inquiry. Evidence from this phase demonstrated that, in settings where formal guidance was absent, individuals reported confusion and uneven approaches to modesty-related situations in everyday practice. Points of tension most frequently arose around uniform policies, cross-gender caregiving, and necessary physical interaction during clinical tasks, giving rise to emotional, ethical, social, and occupational pressures. In response, nurses described a range of coping and negotiation approaches, from purposeful avoidance and modified conduct to hesitant compliance, full professional integration, and proactive advocacy.

In the concluding phase, guidance was developed to support healthcare providers and students in managing modesty-related tensions, informed by evidence from both the scoping review and empirical data.

Discussion:
This study shows that tensions around modesty are complex, influenced by individual faith commitments and the environments in which nurses work, and experienced both personally and socially. From a Cognitive Dissonance Theory perspective, internal difficulty arises when nurses feel pressure to act in ways that conflict with their personal beliefs, creating emotional and ethical strain. Identity Negotiation Theory helps explain how conflict also develops at the workplace level when religious identity is insufficiently acknowledged within professional interactions. Face-Negotiation Theory sheds light on how nurses respond to these situations by carefully managing how they are perceived and maintaining cooperative relationships. Taken together, these interpretations reveal weaknesses in existing healthcare guidance and point to the need for more responsive and context-aware frameworks.

Conclusion:
This thesis explores value-based tensions associated with Islamic modesty in healthcare across two national contexts. Drawing on evidence from a scoping review alongside qualitative investigation, the study explains how modesty is interpreted, identifies where tensions emerge in clinical practice, and outlines the ways nurses respond to these situations. The final phase of the study involved the development of inclusive and ethically grounded guidance, aimed at supporting practice that honours religious commitments while safeguarding patient safety and professional standards, thereby promoting culturally responsive nursing.

Thesis is embargoed until 31 December 2028.

Date of Award	Dec 2026
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Mutah University
Supervisor	Iseult Wilson (Supervisor) & Aideen Gildea (Supervisor)