Operation Safe Haven: the needs of nurses caring for refugees

Culture as both a risk and protective factor for vicarious traumatisation in nurses working with refugees: a literature review

Background

There are an estimated 25.9 million refugees worldwide, who require health services while living in host countries. To effectively treat refugee patients, nurses must document their history which requires hearing about their traumatic journeys. Listening to trauma has been shown to cause vicarious traumatisation.

Aims

To identify the risk and protective factors involved in the development of vicarious traumatisation.

Methods

After searching four databases, nine studies were selected for review. Key words ‘vicarious trauma’, ‘refugee’ and ‘nurse’ formed the search. Articles were appraised using the Critical Appraisal Skills Program and Mixed Methods Appraisal Tool.

Results

Vicarious traumatisation is common amongst nurses working with refugees. Aspects of culture formed the principal risk and protective factors. Differences between cultures made for strained communication while similarities created better understanding. Some cultures provided more resilience than others. Vicarious resilience, a feeling of personal growth resulting from hearing about and helping patients overcome trauma, was also highlighted. The development of vicarious resilience was a protective factor.

Conclusions

Further investigation into how to minimise risk and establish protective factors is required. Some coping recommendations include personal reflection, comprehensive training and better access to counselling.

Uncovering re-traumatization experiences of torture survivors in somatic health care: A qualitative systematic review

Little research has focused on torture survivors' re-traumatization experiences in health and hospital units that treat somatic diseases, though any medical procedure can re-traumatize survivors. This study's purpose was to summarize qualitative research evidence on torture survivors' somatic healthcare experiences and to identify "triggers" or "reminders" that can lead to re-traumatization. The study's search strategies identified 6,326 citations and eight studies, comprising data from 290 participants, exploring encounters with healthcare providers from torture survivors' perspectives, which were included in the present research. Dallam's Healthcare Retraumatization Model was used as a framework for data extraction and analysis. Five main themes were elicited from the findings: (1) invisibility, silence, and mistrust; (2) healthcare providers' attitudes and a lack of perceived quality in healthcare; (3) disempowerment; (4) avoidance; and (5) satisfaction and gratitude. An analysis of the study's findings revealed that torture survivors do not receive adequate healthcare and may experience challenges during treatment that can result in re-traumatization. The findings of this literature review provide a basis for understanding the difficulties that survivors experience in receiving somatic healthcare, as well as an explanation of the re-traumatization process.

Perspectives of Registered Nurses on refugee healthcare in Lebanon and Jordan (PROfILE): A multi-site cross-sectional study protocol

AIM

This is a study protocol to investigate nurses' perspectives on refugee health care in two countries. The aims are to: (a) explore self-reported work environment factors, including work stressors, self-rated leadership, staffing and resources adequacy, and teamwork among Jordanian and Lebanese nurses caring for refugees; (b) investigate the relationship between nurse related outcomes (physical health; emotional exhaustion) and their psychosocial work environment; and (c) assess the association between nurses' perceived work environment factors and implicit rationing of care and quality of patient care.

BACKGROUND

Globally, the care of refugees is achieving increased attention. Over 6.3 million people are internally displaced and 4.8 million recorded Syrian expatriates are residing in and receiving healthcare services in the neighbouring host countries.

DESIGN

This is a cross-sectional, comparative study using a survey design.

METHOD

The study setting involves both private and public hospitals and primary healthcare centres that provide care to refugees on regular basis in Lebanon and Jordan. The estimated sample size includes 3,000 Registered Nurses from Lebanon and 2,500 nurses and midwives from Jordan.

DISCUSSION

Workplace factors affecting quality of nursing care and psychosocial status of nurses caring for refugees will be identified. Potential findings will help leaders design interventions to support nurses who are serving refugees for safer care and better patient outcomes. Findings will assist in more efficient resource allocation and management.

IMPACT

New knowledge on the impact of providing health care for refugees will be generated based on the structure of nursing care (e.g., work environment), on the nursing process (e.g., implicit rationing of care), and nurse outcomes (health) in two hosting communities. Moreover, factors enabling resilience in patients, providers, and systems will be identified and be of potential use in addressing the growing global problem of caring for displaced persons.

"I am still passionate despite the challenges": Nurses navigating the care for refugees

AIMS AND OBJECTIVES

To report the challenges faced by the nursing workforce in refugee health.

BACKGROUND

Nurses are in the forefront of care provision for refugees who are recognised as one of the most vulnerable population groups in the world. The number of refugees in Australia is increasing, and more nurses are needed as care providers. Research on the challenges faced by refugee health nurses is sparse.

DESIGN

Qualitative research methodology was used to study the experience of refugee health nurses. Using a descriptive qualitative research approach, a better understanding of the ongoing challenges of caring for refugees is presented.

METHOD

Semi-structured interview with a convenience sample of registered nurses who worked in New South Wales refugee health services was conducted and digitally recorded in 2013. Responses were transcribed verbatim and analysed for themes.

RESULTS

Six refugee health nurses who have been working in New South Wales refugee health services between 1-8 years participated in this study. A thematic analysis of the data led to three main themes: caring for clients with challenging needs; challenges in the course of caring for refugees; and passion in caring for refugees. Participants reported what it means to be refugee health nurses, they explored their roles and emphasised the need to understand refugee health issues.

CONCLUSIONS

This study provides more insight into the unique experiences nurses have when caring for refugees. More debriefing opportunities and resources may reduce the challenges of caring.

RELEVANCE TO CLINICAL PRACTICE

The refugee health nurses' stories support the need for further role refinement for nurses caring for refugees in the community, rural areas and health clinics. This is essential in promoting their well-being and that of the vulnerable population they are caring for.

Challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries: a systematic review and thematic synthesis of qualitative research

OBJECTIVES

To thematically synthesise primary qualitative studies that explore challenges and facilitators for health professionals providing primary healthcare for refugees and asylum seekers in high-income countries.

DESIGN

Systematic review and qualitative thematic synthesis.

METHODS

Searches of MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science. Search terms were combined for qualitative research, primary healthcare professionals, refugees and asylum seekers, and were supplemented by searches of reference lists and citations. Study selection was conducted by two researchers using prespecified selection criteria. Data extraction and quality assessment using the Critical Appraisal Skills Programme tool was conducted by the first author. A thematic synthesis was undertaken to develop descriptive themes and analytical constructs.

RESULTS

Twenty-six articles reporting on 21 studies and involving 357 participants were included. Eleven descriptive themes were interpreted, embedded within three analytical constructs: healthcare encounter (trusting relationship, communication, cultural understanding, health and social conditions, time); healthcare system (training and guidance, professional support, connecting with other services, organisation, resources and capacity); asylum and resettlement. Challenges and facilitators were described within these themes.

CONCLUSIONS

A range of challenges and facilitators have been identified for health professionals providing primary healthcare for refugees and asylum seekers that are experienced in the dimensions of the healthcare encounter, the healthcare system and wider asylum and resettlement situation. Comprehensive understanding of these challenges and facilitators is important to shape policy, improve the quality of services and provide more equitable health services for this vulnerable group.

When and why health care personnel respond to a disaster: the state of the science

OBJECTIVE

Emergency response relies on the assumption that essential health care services will continue to operate and be available to provide quality patient care during and after a patient surge. The observed successes and failures of health care systems during recent mass-casualty events and the concern that these assumptions are not evidence based prompted this review.

METHOD

The aims of this systematic review were to explore the factors associated with the intention of health care personnel (HCP) to respond to uncommon events, such as a natural disaster or pandemic, determine the state of the science, and bolster evidence-based measures that have been shown to facilitate staff response.

RESULTS

Authors of the 70 studies (five mixed-methods, 49 quantitative, 16 qualitative) that met inclusion criteria reported a variety of variables that influenced the intent of HCP to respond. Current evidence suggests that four primary factors emerged as either facilitating or hindering the willingness of HCP to respond to an event: (1) the nature of the event; (2) competing obligations; (3) the work environment and climate; and (4) the relationship between knowledge and perceptions of efficacy.

CONCLUSIONS

Findings of this study could influence and strengthen policy making by emergency response planners, staffing coordinators, health educators, and health system administrators.

Nurses' perceptions of quality end-of-life care on an acute medical ward

AIM

This paper reports the findings of a study that generated a conceptual model of the nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of nurses working in an acute care setting.

BACKGROUND

The majority of research examining the issue of quality end-of-life care has focused on the perspectives of patients, family members and physicians. The perspective of nurses has generally received minimal research attention, with the exception of those working within palliative or critical care. The vast majority of hospitalized patients, however, continue to be cared for and die on medical units. To date, little research has been conducted examining definitions and determinants of quality end-of-life care from the perspective of nurses working in acute adult medical settings.

METHOD

Grounded theory method was used in this study of 10 nurses working on acute medical units at two tertiary university-affiliated hospitals in central Canada. Data were collected during 2002 by interview and participant observation.

FINDINGS

The basic social problem uncovered in the data was that of nurses striving to provide high quality end-of-life care on an acute medical unit while being pulled in all directions. The unifying theme of 'Creating a haven for safe passage' integrated the major sub-processes into the key analytic model in this study. 'Creating a haven for safe passage' represents a continuum of behaviours and strategies, and includes the sub-processes of 'facilitating and maintain a lane change'; 'getting what's needed'; 'being there'; and 'manipulating the care environment'.

CONCLUSION

The ability of nurses to provide quality end-of-life care on an acute medical unit is a complex process involving many factors related to the patient, family, healthcare providers and the context in which the provision of end-of-life care takes place.