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Wahlström E, Wallander F, Stier J. Vacillating between "strange" and "familiar" - representations of children in migrant families and their health in Swedish school health services. Soc Sci Med 2024; 348:116809. [PMID: 38547808 DOI: 10.1016/j.socscimed.2024.116809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024]
Abstract
Representations of migrants influence how they are perceived by others. Hence, how children who have migrated or whose parents have migrated (Children in Migrant Families: CMFs) are represented in clinical practice guidelines (CPGs) for Swedish school health services (SHS) may influence how they are perceived by school nurses. Thus, this study aimed to explore representations of CMFs in school nurses' CPGs. Data consisted of 130 CPGs from municipalities in Sweden. Documents were analyzed using the "What is the Problem Represented to be" (WPR) approach - an analytic strategy for investigating embedded assumptions of "problems". In the analysis, Sarah Ahmed's work on "strangers" and "strangeness" was applied. In the CPGs, the CMFs and their health were repeatedly mentioned in conjunction with the need for particular or additional actions, efforts, or routines when assessing or discussing their health, to a degree beyond what is "usually" provided. This need was motivated by representing the CMFs and their health as being the same, yet different in relation to "Swedish" children in general. Thus, the children were not only represented as different, but they were "foreignized". These representations of difference and foreignness placed the children on a continuum in relation to what is recognized as "familiar" in their health, and constructed elastic boundaries between the strange and the familiar. By illustrating how these boundaries were used for difference-making between "familiar" and "strange", this study showed how CMFs are alternately represented as similar and different, and foreignized while provided with SHS aiming to make them "familiar".
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Affiliation(s)
- Emmie Wahlström
- ChiP research group, School of health, care and social welfare, Mälardalen University, Västerås, 721 23, Sweden; School of health, care and social welfare, Mälardalen University, Västerås, 721 23, Sweden.
| | - Frida Wallander
- ChiP research group, School of health, care and social welfare, Mälardalen University, Västerås, 721 23, Sweden
| | - Jonas Stier
- ChiP research group, School of health, care and social welfare, Mälardalen University, Västerås, 721 23, Sweden; School of health, care and social welfare, Mälardalen University, Västerås, 721 23, Sweden
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Nekouei Marvi Langari M, Lindström J, Heponiemi T, Kaihlanen A, Hietapakka L, Heidarian Miri H, Turunen H. Integrated care competencies and their association with cross-cultural competence among registered nurses: A cross-sectional questionnaire survey. Nurs Open 2024; 11:e2062. [PMID: 38268264 PMCID: PMC10840592 DOI: 10.1002/nop2.2062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/25/2023] [Accepted: 11/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To examine the association between the integrated care competencies and cross-cultural competence of registered nurses prior to the integration of social and healthcare services in Finland. DESIGN A descriptive correlational cross-sectional questionnaire survey was conducted. METHODS A simple random sample of 10,000 registered nurses was drawn from the Finnish Central Register of Valvira (National Supervisory Authority for Welfare and Health); 7000 of them were sent the online questionnaire, and a total of 1232 registered nurses participated in the study. We collected data using background questions, revised versions of the Competent Workforce for the Future tool in the four domains of client orientation, responsibility for personal or relative's welfare, fluency and clarity of services and access to the services and of the Cross-Cultural Competence of Healthcare Professional tool in the four domains of motivation/curiosity, attitude, skill and emotion/empathy. RESULTS Participants demonstrated a high level of integrated care competencies (mean = 4.00, SD ± 0.49). An association was observed between integrated care competencies and their domains of skills, motivation/curiosity, emotions/empathy, and cross-cultural competence (p < 0.001). Female sex, older age, more working experience, employment in the private sector, and higher self-rated competence for working in a multicultural environment were positively associated with higher integrated care competencies. CONCLUSION It is recommended that nurse managers and nurse educators emphasize the development of registered nurses' cross-cultural competence alongside integrated care competencies to meet the needs of different individuals and communities when providing integrated care. PATIENT OR PUBLIC CONTRIBUTION Finnish registered nurses including all types of nurses, midwives and paramedics working the public and private healthcare, were involved in this study by responding to the online survey.
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Affiliation(s)
| | - Jaana Lindström
- Population Health Unit, Department of Public Health and WelfareFinnish Institute for Health and WelfareHelsinkiFinland
| | | | | | | | | | - Hannele Turunen
- Department of Nursing ScienceUniversity of Eastern FinlandKuopioFinland
- Kuopio University HospitalKuopioFinland
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Wahlström E, Golsäter M, Holmström IK, Larm P, Harder M. In search of factors related to migration affecting children's health - an analysis of documents guiding health visits within the Swedish school health services. Arch Public Health 2023; 81:103. [PMID: 37312228 DOI: 10.1186/s13690-023-01125-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Migration affects the health of children worldwide. Therefore, school nurses who encounter these children as part of their everyday practice need support from guidelines on how to promote the health of children who have migrated or whose parents have migrated. Yet knowledge regarding such content in guidelines of school nursing practice is sparse. Therefore, this study aims to investigate how municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include factors related to migration that affect children's health. METHODS A document analysis of municipal and regional guidelines and health questionnaires guiding school nurses' practice in health visits was conducted during the autumn of 2020. In total, 687 guidelines and health questionnaires were analyzed using deductive content analysis. RESULTS The results show that municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include content on many factors related to migration that affect children's health. Yet the content was limited, and none was found on factors related to discrimination based on ethnicity or origin. CONCLUSION Guidance related to promoting the health of children who have migrated or whose parents have migrated should include all factors affecting these children's health. Therefore, to strengthen school nurses' evidence-based practice, guideline development might be needed, although guidelines and health questionnaires exist and include content on many factors related to migration affecting the health of children in order to provide equitable healthcare for all children, regardless of country of origin.
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Affiliation(s)
- Emmie Wahlström
- ChiP Research Group, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
| | - Marie Golsäter
- CHILD-Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Child Health Services and Futurum, Region Jönköping County, Jönköping, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Larm
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Maria Harder
- ChiP Research Group, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
- Child Health Care Services, Region Västmanland, Västerås, Sweden
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Golsäter M, Karlsson Fiallos M, Olsson Vestvik S, Anefur H, Harder M. Child health care nurses' cultural competence in health visits with children of foreign background. Nurs Open 2023; 10:1426-1436. [PMID: 36180979 DOI: 10.1002/nop2.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 09/14/2022] [Indexed: 12/13/2022] Open
Abstract
AIM The aim of this study is to investigate child health care nurses' cultural competence in health visits with children and their families of foreign background. DESIGN A cross-sectional design combined with a qualitative explorative design. METHODS The nurses assessed their cultural competence using a modified version of the Clinical Cultural Competency Questionnaire. Interviews were used to obtain a detailed description of the nurses' cultural competence. RESULTS The nurses assessed themselves as rather culturally competent. They scored above mid-score in the total score for cultural competence and on all subscales. Education in cultural diversity at the nurses' workplace had the highest association to cultural competence. The nurses described their awareness as recognizing each child and her/his family rather than their cultural background, and viewing the child as a unique part of her/his cultural context. Despite their high scores on cultural competence, the nurses described a lack of cultural knowledge and explained their need of further knowledge.
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Affiliation(s)
- Marie Golsäter
- CHILD-Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Child Health Services, Region Jönköping County, Jönköping, Sweden
| | | | | | - Hilda Anefur
- Pediatric Outpatient Clinic, Region Jönköping County, Jönköping, Sweden
| | - Maria Harder
- ChiP-Research Group, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Sahamkhadam N, Andersson AK, Golsäter M, Harder M, Granlund M, Wahlström E. Testing the Assumptions in the Process of Cultural Competence in the Delivery of Healthcare Services Using Empirical Data, Focusing on Cultural Awareness. J Transcult Nurs 2023; 34:187-194. [PMID: 36759971 PMCID: PMC10114250 DOI: 10.1177/10436596231152212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Encounters with children of foreign origin call for school nurses' cultural competence during the health visits. This study aimed to investigate the statistical associations between the cultural constructs described by the Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS) model and whether school nurses' cultural encounters, cultural knowledge, and cultural skill could statistically predict their cultural awareness. METHODOLOGY Spearman correlation and hierarchical regression analyses were conducted using cross-sectional secondary data from 816 Swedish school nurses. The cultural constructs in the theoretical description of the PCCDHS model guided the selection and sorting of the items on cultural competence. RESULTS The constructs of cultural knowledge, cultural skill, cultural encounters, and cultural awareness were positively correlated with each other. However, becoming culturally aware was not statistically predicted by included cultural constructs (R2 = 13.4, p = .06). DISCUSSION Despite the interrelations between the investigated cultural constructs of the PCCDHS model, understanding cultural awareness development requires further empirical testing.
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Affiliation(s)
| | - Anna Karin Andersson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Marie Golsäter
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Child Health Services and Futurum, Region Jönköping County, Jönköping, Sweden
| | - Maria Harder
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Child Health Care Services, Region Västmanland, Västerås, Sweden
| | - Mats Granlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Emmie Wahlström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Mangrio E, Enskär K, Ramji R, Sjögren-Forss K, Tengland PA, Theodoridis K, Zdravkovic S, Rämgård M. The Need for Parental Support for Migrant Parents in Transition Into Sweden: A Perspective. Front Public Health 2022; 10:680767. [PMID: 35570884 PMCID: PMC9100399 DOI: 10.3389/fpubh.2022.680767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents. The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.
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Wahlström E, Golsäter M, Granlund M, Holmström IK, Larm P, Harder M. Adjusting and doing the same: school nurses' descriptions of promoting participation in health visits with children of foreign origin. BMC Public Health 2021; 21:111. [PMID: 33422045 PMCID: PMC7797110 DOI: 10.1186/s12889-020-10144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022] Open
Abstract
Background School nurses in the school health services are assigned to promote health and participation among children when conducting health visits. Still, for children of foreign origin this promotion of participation might be hampered by challenges related to cultural diversity and language barriers. Therefore, knowledge needs to be developed regarding how these children’s participation can be promoted, to support them in sharing and describing matters important for their health. The aim was to investigate school nurses’ descriptions of promoting participation for children of foreign origin in health visits. Methods A content analysis of 673 Swedish school nurses’ answers to eight open-ended questions regarding promotion of participation for children of foreign origin was conducted. The open-ended questions were part of a larger web-based cross-sectional survey distributed to school nurses in Sweden. Results The results show that school nurses use three main approaches during the health visit: adjusting according to the child’s proficiency in Swedish and/or cultural or national background, adjusting according to the child’s individual needs, and doing the same for all children regardless of their origin. Yet, adjustments according to the child’s proficiency in Swedish and/or cultural or national background were the most common. Conclusions By combining the approaches of adjusting, a child-centered care that contributes to children’s participation in health visits and equity in health could be provided.
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Affiliation(s)
- Emmie Wahlström
- ChiP research group, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden. .,School of health, care and social welfare, Mälardalen University, Västerås, Sweden.
| | - Marie Golsäter
- CHILD-research group, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Child Health Services and Futurum, Region Jönköping County, Jönköping, Sweden
| | - Mats Granlund
- CHILD-research group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Inger K Holmström
- School of health, care and social welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Larm
- School of health, care and social welfare, Mälardalen University, Västerås, Sweden
| | - Maria Harder
- ChiP research group, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.,School of health, care and social welfare, Mälardalen University, Västerås, Sweden.,Child Health Care Services, Region Västmanland, Västerås, Sweden
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