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

The relationship between ethnocentrism and xenophobia level and predictors: A descriptive and correlational study of nurses working in two cities where refugees live intensively in Turkey

Determining the ethnocentrism and xenophobia levels of nurses contributes to nurses' awareness regarding their attitudes on the issue and providing quality care. This descriptive and correlational study aimed to determine the relationship between ethnocentrism and xenophobia levels of nurses working in hospitals located in two different border regions where refugees live intensively in Turkey. The study was conducted with 386 nurses who were working in two different hospitals located in two cities in the south of Turkey. Data were collected using the "Personal Information Form," "Ethnocentrism Scale," and "Xenophobia Scale." About half of the nurses did not want to care for foreign patients. There was a positive and statistically significant relationship between mean scores of the Ethnocentrism Scale and the Xenophobia Scale (p < 0.05). The regression analysis indicated that the level of ethnocentrism explains the level of xenophobia by 9%. Nurses had a high level of xenophobia and moderate ethnocentric attitudes. The level of xenophobia increased as the ethnocentrism level of nurses increased. It is recommended to conduct further studies to determine different predictors of xenophobia among nurses.

Factors affecting the quality of working life among nurses caring for Syrian refugee camps in Jordan

OBJECTIVES

The global refugee crisis, exacerbated by the Syrian war, has placed tremendous strain on Jordan's healthcare system and infrastructure, notably impacting nurses working in refugee camps. The aim to identify factors influencing nurses' Quality of life at work (QWL) and understand their significance in crisis healthcare environments.

METHODOLOGY

A cross-sectional study was conducted in multiple healthcare facilities within Syrian refugee camps. A convenient sample of 166 nurses participated, and data were collected using the Brook's Quality of Nursing Work Life Survey. Data analysis included descriptive and inferential (one-way ANOVA) statistics. Significance level was set at 0.05.

RESULTS

Nurses in this study generally reported a moderate QWL, with an average score of 152.85, indicating that their overall work experience falls into the moderate range. The study found that nurses perceived their work-life/home-life balance (mean score 25.79), work design (mean score 35.71), work context (mean score 71.37), and work world (mean score 19.96) at levels indicative of moderate satisfaction. There were no statistically significant differences in QWL among participating nurses, suggesting that factors other than demographic characteristics may play a more influential role in determining nurses' QWL in the unique context of refugee caregiving.

CONCLUSION

This study underscores that working within refugee healthcare missions and recommends targeted interventions to enhance their well-being.

The Challenges in the Care of Immigrant Children in the Clinic: A Phenomenological Study

INTRODUCTION

The aim of this study is to thoroughly examine the challenges experienced by pediatric nurses providing care for the children of immigrant families and to contribute to the solutions that can be provided.

METHOD

Phenomenological research design was used in this qualitative study. Semi-structured interviews were performed with face-to-face technique and individually.

RESULTS

Four categories, ten main themes and twenty-four sub-themes were obtained in the analysis of data. The themes included communication barriers and cultural differences in the category of difficulties that the nurses experienced with immigrant patients or their relatives, nurses' practices, communication barriers and cultural differences in the category of problems that the nurses experienced in the care.

DISCUSSION

It was determined that nurses experienced difficulty, especially in the areas of communication, culture and education. These difficulties were reported to cause disruptions in the care and treatment process of immigrant patients.

Difficulties of nurses and midwives in caring for refugee mothers: A qualitative study

OBJECTIVE

The aim of the study was to describe the difficulties of nurses and midwives experience in caring for refugee mothers in obstetrics and gynecology clinics.

METHODS

This study had a descriptive phenomenological approach. Between 1 September 2020 and 1 April 2021, data were collected from 6 nurses and 7 midwives working in obstetrics and gynecology clinic who had previous experience in caring for refugee mothers. The data were collected through in-depth semi-structured interviews. Consolidated criteria for reporting qualitative research checklist were used in the reporting of the study.

RESULTS

Two themes and five subthemes emerged from the qualitative analysis. The first of the two themes identified was difficulties with cultural differences, which had the sub-themes of preference for female doctors or interpreters and harmful cultural practices. The second theme was difficulties with communication, which consisted of three subthemes, namely, taking anamnesis, giving nursing/midwifery care, and giving education.

CONCLUSION

It is very important to determine the difficulties experienced by nurses and midwives while caring for refugee women to increase the quality of health services and to find solutions.

Structural Origins of Poor Health Outcomes in Documented Temporary Foreign Workers and Refugees in High-Income Countries: A Review

Despite growing evidence of racial and institutional discrimination on minoritized communities and its negative effect on health, there are still gaps in the current literature identifying health disparities among minoritized communities. This review aims to identify health barriers faced by relatively less studied migrant subgroups including documented temporary foreign workers and refugees residing in high-income Organisation for Economic Co-operation and Development (OECD) countries focusing on the structural origins of differential health outcomes. We searched Medline, CINAHL, and Embase databases for papers describing health barriers for these groups published in English between 1 January 2011 and 30 July 2021. Two independent reviewers conducted a title, abstract, and full text screening with any discrepancies resolved by consensus or a third reviewer. Extracted data were analyzed using an inductive thematic analysis. Of the 381 articles that underwent full-text review, 27 articles were included in this review. We identified housing conditions, immigration policies, structural discrimination, and exploitative labour practices as the four major emerging themes that impacted the health and the access to healthcare services of our study populations. Our findings highlight the multidimensional nature of health inequities among migrant populations and a need to examine how the broader context of these factors influence their daily experiences.

Fluctuating power: an exploration of refugee health nursing within the resettlement context in Victoria, Australia

Background

The Refugee Health Program (RHP) is a nurse-led community initiative, introduced in 2005 with the aim of responding to complex health issues of refugees arriving in Victoria, Australia. Little is known about refugee health nursing in the resettlement context and the impact of dedicated refugee healthcare.

Aim

To explore the experiences and perspectives of Refugee Health Nurses (RHNs), Refugee Health Managers (managers) and refugees, gaining insight into professional relationships and the complexities of offering a specialised refugee health service.

Method

A focused ethnographic approach incorporated semi-structured interviews with five RHNs, two managers and eight refugees, two focus groups with refugees and participant observation within the RHP during April 2017 to December 2017. Data collection was undertaken across two sites and interviews, focus groups and observations were transcribed and thematically analysed. Social constructionism asserts that the focus of enquiry should be on interaction, group processes and social practices. Emphasis is placed upon relationships between RHNs, managers and refugees, with knowledge viewed as relational and interactional.

Results

Professional relationships between RHNs and refugees are complex, with power oscillating between them. Contrary to discourses of ‘vulnerability’ of refugees, both RHNs and refugees demonstrated power in their relationships with each other. Nurses also suggested that these relationships were stressful and could lead to burnout. Key themes were developed: (1) nursing autonomy and gatekeeping; (2) vicarious trauma and burnout; and (3) refugee negotiation of care.

Conclusions

The balance of power is central to therapeutic relationships. In relationships between RHNs and refugees, power fluctuates as RHNs are exposed to vicarious trauma and symptoms of burnout, while refugees exercise agency by recognising benefits to specialised care. In developing effective therapeutic relationships between RHNs and refugees, attention should be paid to how care is delivered to protect RHNs from burnout while ensuring that refugees receive appropriate care.

Empowering refugee families in transit: the development of a culturally competent and compassionate training and support package

Background

Refugee parents who fled conflicts suffered violence and traumas and face huge challenges in supporting the health and welfare of their children while in transit.

Aims

To describe the development of a culturally competent and compassionate training and support package (TSP) for nurses, social and health care workers and volunteers, with a focus on parenting needs among unsettled refugees fleeing conflict.

Methods

The multi-method approach included: a scoping review covering parenting needs of refugees fleeing conflict zones; collection of stories from refugee parents, healthcare workers and volunteers via a mobile application; discussions between team members; a piloted and evaluated curriculum.

Results

High levels of family distress and deterioration of parental identity were identified. Informed by these results, the curriculum is articulated along 20 bite-sized learning units, covering four age stages of childhood as well as targeting adults’ well-being. Pilot training was evaluated positively, confirming feasibility and usefulness of the TSP.

Conclusions

Unsettled refugee parents fleeing conflicts face psycho-social and practical difficulties negatively affecting their parenting skills. The care workforce should be trained in order to provide culturally competent and compassionate support to help these families. Open access digital platforms are promising as autodidactic and self-help tools among hard-to-reach populations.

The Care Ethics of Child Health Nurses in Danish Asylum Centers: An Ethnographic Study

Child health nurses play an important role in promoting the health and well-being of children and families seeking asylum. However, little is known about how they establish caring partnerships with families in asylum centers. In this article, we examine the ethical care practices that child health nurses within Danish asylum centers adopt to overcome barriers, related to culture, language and migration history, in delivering care. We conducted ethnographic fieldwork in four Danish Red Cross asylum centers, involving participant observation and individual interviews with 20 families and six child health nurses. A thematic analysis of the material reveals five ethical care practices; compassionate care, humanitarian care, flexible care, collaborative care, and supportive care. We show how the confluence of these types of care enables child health nurses to promote health and well-being of children seeking asylum, and discuss the enabling role of the humanitarian culture that prevails within the asylum centers.

Providing care to refugees through mainstream general practice in the southern health region of New Zealand: a qualitative study of primary healthcare professionals' perspectives

OBJECTIVE

To explore the perspectives of primary healthcare (PHC) professionals providing care to refugees through mainstream general practice.

DESIGN

Qualitative exploratory design with semistructured interviews subjected to inductive thematic analysis.

SETTING AND PARTICIPANTS

Nine general practices enrolled in the Dunedin Refugee Resettlement Programme, in New Zealand (NZ)'s southern health region. Participants included nine general practitioners and six practice nurses.

RESULTS

Three analytical constructs were identified: relational engagement with refugees, refugee healthcare delivery and providers' professional role shaped by complexity. Building meaningful relational connections involved acknowledging refugees' journeys by getting to know them as people. This was instrumental for the development of an empathetic understanding of the complex human trajectories that characterise refugees' journeys to NZ. Participants encountered challenges in providing care to refugees with respect to time-limited consultations, variable use of interpreter services, fragmentation of care between agencies and need for improved health infrastructure to ensure a fluid interface between PHC, secondary care and community support services. The current business model of NZ general practice was perceived to interfere with value-driven care and discouraged tailoring of care to specific patient groups, raising concerns about the 'fit' of mainstream general practice to address the complex healthcare needs of refugees. Meeting the needs of refugees across the social determinants of health involved a lot of 'behind the scenes work' particularly in the absence of shared information systems and the lack of well-established referral pathways to connect refugees to services beyond the health sector. This led to providers feeling overwhelmed and uncertain about their ability to provide appropriate care to refugees.

CONCLUSIONS

This study provides rich context-specific findings that enhance PHC responsiveness to the needs of refugees in NZ.

A model explaining refugee experiences of the Australian healthcare system: a systematic review of refugee perceptions

Background

Refugees have significant unmet health needs. Delivering services to refugees continues to be problematic in the Australian healthcare system. A systematic review and thematic synthesis of the literature exploring refugee perceptions of the Australian healthcare system was performed.

Methods

Titles and abstracts of 1610 articles published between 2006 and 2019 were screened, and 147 articles were read in full text. Depending on the type of study, articles were appraised using the Modified Critical Appraisal Tool (developed by authors), the Mixed Methods Appraisal Tool, or the JBI Appraisal Checklist for Systematic Reviews. Using QSR NVivo 11, articles were coded into descriptive themes and synthesised into analytical themes. An explanatory model was used to synthesise these findings. Confidence in the review findings were assessed with GRADE-CERQual approach.

Results

The final synthesis included 35 articles consisting of one systematic review, 7 mixed methods studies, and 27 qualitative studies. Only one study was from a regional or rural area. A model incorporating aspects of engagement, access, trust, and privacy can be used to explain the experiences of refugees in using the Australian healthcare system. Refugees struggled to engage with health services due to their unfamiliarity with the health system. Information sharing is needed but this is not always delivered effectively, resulting in disempowerment and loss of autonomy. In response, refugees resorted to familiar means, such as family members and their pre-existing cultural knowledge. At times, this perpetuated their unfamiliarity with the broader health system. Access barriers were also encountered. Trust and privacy are pervasive issues that influenced access and engagement.

Conclusions

Refugees face significant barriers in accessing and engaging with healthcare services and often resorted to familiar means to overcome what is unfamiliar. This has implications across all areas of service provision. Health administrators and educators need to consider improving the cultural competency of staff and students. Policymakers need to consider engaging communities and upscale the availability and accessibility of professional language and cultural supports. Research is needed on how these measures can be effectively delivered. There is limited research in remote areas and further evidence is needed in these settings.

Electronic supplementary material

The online version of this article (10.1186/s12914-019-0206-6) contains supplementary material, which is available to authorized users.

Resettled Bhutanese Refugees in Ottawa: What Coping Strategies Promote Psychological Well-Being?

Background

Since 2008, Bhutanese refugees have been resettled in Canada, including Ottawa. This relocation and resettling process is associated with significant physical and psychological stress, as individuals acclimatize to a new country.

Purpose

To assess the relationship between coping strategies and psychological well-being of Bhutanese refugees resettled in Ottawa.

Methods

A cross-sectional survey utilizing a convenience sample of adults (n = 110) was conducted in the fall of 2015 in Ottawa. Two tools, Brief COPE and general well-being schedule were used.

Results

Bhutanese refugees were in moderate distress. Using multiple linear regression, age, education, and three coping strategies (positive reframing, self-blame, and venting) were identified as predictors of general well-being ( F (11, 96) = 3.61, p < .001, R2 = 21.2%). Higher levels of education and positive reframing were associated with greater general well-being scores, while self-blame and well-being between ages 41 and 50 years were inversely associated with general well-being.

Conclusions

Findings suggest that a broad intersectorial approach between nurses and partner agencies is needed to enhance the mental health of this population for better adjustment in the host country. Nurses could provide support and counseling to minimize the use of self-blame and venting and promote positive coping strategies.

Nursing students' experiences with refugees with mental health problems in Jordan: A qualitative content analysis

OBJECTIVES

The aim of this study was to describe Jordanian nursing students' experience of caring for refugees with mental health problems.

BACKGROUND

According to refugees' experiences of crisis, a well-educated staff is needed to provide high quality of care due to mental health problems. Therefore, health professionals play an important role in creating an environment that promotes human rights regardless of ethnic origin.

SETTINGS, PARTICIPANTS, METHOD

The study comprised eight interviews and was analysed using content analysis, a qualitative method that involves an inductive approach, to increase our understanding of nursing students' perspective and thoughts regarding caring for refugees with mental health problems.

RESULTS

The results formed one category: to be challenged by refugees' mental health issues and three subcategories: managing refugees' mental health needs, affected by refugees' mental health, and improve mental healthcare for refugees.

CONCLUSION

Language problems could be managed by using interpreters to decrease cultural clashes to facilitate equal healthcare. In addition, well-educated (theoretical knowledge) and trained (practical knowledge) nursing students have potential to fulfil refugees' care needs regardless of ethnicity or background by using nursing interventions built on communication skills and cultural competences (theory, practice) to facilitate high quality of healthcare.