Ethical challenges in organ transplants for refugees in a healthcare system

BACKGROUND

Several ethical issues are associated with providing living organ transplantation services, and there is limited information on these issues faced by the teams providing service to refugees or asylum seekers.

AIM

To determine the challenges healthcare professionals face in organ transplant centers providing services to Syrians under temporary protection status and discern whether these difficulties align with ethical issues in living organ transplantation.

RESEARCH DESIGN

This study employed a qualitative design and conducted individual semi-structured, in-depth interviews with 18 transplant team members in Istanbul between September and November 2022. Data analysis was based on Braun and Clarke's thematic analysis.

PARTICIPANTS AND RESEARCH CONTEXT

The participants comprised 18 healthcare professionals, including 6 physicians and 12 nurses working in organ transplant teams in Istanbul.

ETHICAL CONSIDERATIONS

The University's Ethics Committee provided approval. Participants were informed regarding confidentiality and signed an informed consent form.

RESULTS

Three themes emerged from the data on ethical issues faced by organ transplantation services to Syrians: (a) beneficence or double equipoise, (b) autonomy, and (c) justice. Transplant teams experience problems related to preserving double equipoise in the provision of living donor organ transplantation because of language barriers, poor socioeconomic conditions, and cultural factors, which increases transplant teams' individual and indirect social burden. Although problems arise from the language barrier when obtaining informed consent in the autonomy theme, institutional and national policies in preventing donor abuse have a comforting effect. Health workers had the least problems with the justice theme, wherein national health policies are determined.

CONCLUSION

Fewer issues related to autonomy and justice were reported in providing organ transplantation services to Syrians, with the most intense reported issues being maintaining double equipoise. The results revealed the need to develop institutional, national, and international policies with individual solutions to prevent difficulties healthcare professionals face in this process.

Experiences and Suggestions of Nurses Involved in Caring for Migrant Populations in Italy: A Qualitative Study

The aim of this research is to explore nurses' experiences in caring for migrants, regular and non-regular, within outpatient clinics in Italy.

MATERIALS AND METHODS

Thirteen nurses have been interviewed through online semi-structured interviews, conducted with the support of a questionnaire, made by researchers, consisting of open-ended questions on legislative issues, cultural issues, and regarding best practices. Purposive sampling has been used, along with phone and email recruitment. The audio recordings of the interviews were verbatim transcribed, then examined. This study is a qualitative descriptive fundamental research project.

RESULTS

Interviewees highlight migrants' difficulties in accessing care, critical points of legislation, transcultural skills crucial to nurses, and good practices. A total of 105 labels were developed and grouped into 23 categories under 7 themes (Italian legislation and migrants; structural difficulties in assistance; the influence of politics; the work of NGOs and associations; nursing care; winning strategies; and the role of the Family and Community Nurse).

CONCLUSION

The research highlights how access to care for migrants is hindered by legislative, structural, and cultural barriers, with consequences on the NHS (improper accesses to the emergency room, increased workload, and economic expenditure). For the full realization of the right to health, as enshrined by Art. 32 of the Constitution, changes are needed with respect to regulations and professionals' training.

First Contact With Transcultural Care: A Phenomenological Study of Practical Turkish Nursing Students' Experiences in a Migrant Health Center

INTRODUCTION

This study examines the subjective experiences of Turkish students who work in immigrant health facilities providing nursing care to people of different cultures. Nurses are often encountered by immigrants in these centers. Although qualitative research on nurses' experiences assisting immigrants has been often cited in the literature, the literature on nursing students' experiences is limited.

METHODOLOGY

The study has a descriptive qualitative design. Data were collected using a face-to-face, in-depth, and semistructured interview form. The data were evaluated using a content analysis method.

RESULTS

The study yielded four themes: (a) inability to control emotions, (b) barriers to care involvement, (c) benefits of intercultural care, and (d) recommendations.

DISCUSSION

Learning intercultural care is critical in these years of increased immigration. Understanding nursing students' experiences is essential for improving the quality of intercultural care.

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.

Understanding lived experiences of nurse managers about managerial ethics

INTRODUCTION

Expressions of Managerial ethics as a clinical phenomenon in Nursing Ethics as expressed by nurse managers were investigated. A coherence could be detected between the concepts and phenomena of Managerial ethics and nurse managers as a context.

BACKGROUND

Managerial ethics as a new approach has emerged in the perspective and by prioritizing ethics in the organization has provided the basis for creating and promoting individual and organizational effectiveness. Managers' and staff's adherence to professional ethics helps hospitals to achieve their intended goals.

AIM

The present study aimed to explain nurse managers' experience of managerial ethics.

RESEARCH DESIGN

This qualitative study was conducted based on a phenomenological design in 2022.

PARTICIPANTS AND RESEARCH CONTEXT

The participants included 20 nurse managers working in hospitals in Arak, Iran. They were selected by the purposive sampling method which continued until data saturation. Data were collected through semi-structured individual interviews (30-90 min); subsequently, the obtained results were analyzed using the Van Manen six-step approach.

ETHICAL CONSIDERATIONS

The confidentiality and the right of participants to take part or withdraw from the study were observed during this research.

RESULTS

The results of the present study were able to demonstrate nurse managers' lived experience of managerial ethics in the form of five themes of professional ethics, people-oriented management, professional empowerment, excellencism, and patient-centered care.

CONCLUSIONS

As evidenced by the obtained results, nurse managers held a positive view of managerial ethics. They were striving to strongly adhere to ethical principles in nursing management since they contribute greatly to the improved quality of nursing services in care and health settings. Therefore, appropriate policy-making and planning for managerial ethics training are indispensable for all nurses and nursing students.

The Perception of Nurses about Migrants after the COVID-19 Pandemic: Close Contact Improves the Relationship

Nurses have faced during the COVID-19 pandemic a tough professional situation in which they have had to work in a resource-limited context and with a high probability of COVID-19 transmission. In today's multicultural societies, care for immigrant patients is also included. In our study, we have delved into the perception of hospital nurses towards migrant people in the context of the COVID-19 pandemic. We used a qualitative methodology with a phenomenological approach. Semi-structured interviews were conducted with 16 nurses. Seven categories emerged and were distributed in the three blocks of the interviews: (a) perception before the pandemic: prejudices make a mark and communication problems; (b) perception after the pandemic: prejudices weaken and communication worsens; and (c) how to improve care: improve communication, more nurses, and no need for training. The approach in the interpersonal relationship between nurses and patients during the pandemic has improved health care. Proposals arise to overcome the language barrier such as the incorporation of intercultural translators-mediators and professionals of foreign origin. There is a lack of awareness of the need for training in cultural competence on the part of the nurses in the study.

Nurses' Experiences as Care Providers for Syrian Refugees With Noncommunicable Diseases: A Qualitative Study

INTRODUCTION

Noncommunicable diseases (NCDs) are the leading cause of disability and death in the world. In Syria, the incidence of NCDs in refugees is 45%. Cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and other NCDs are the most common causes of morbidity in Syria. Nurses have challenges caring for Syrian refugees with NCDs. The purpose of the study was to explore nurses' experiences of caring for Syrian refugees with NCDs in Turkey.

METHODOLOGY

A phenomenology design was used. Inclusion criteria were nurses working experience of more than 1 year, caring for Syrian refugees with NCDs, and willingness and ability to participate in an individual interview. The participants were 20 nurses who worked with Syrian refugees at a public hospital in Kilis Province the border with Syria. Data were collected using semistructured interviews and analyzed by the thematic analysis method of Braun and Clarke.

RESULTS

Three major themes and six subthemes were identified. Major themes included the communication experience, cultural differences, and Syrian refugees' lack of knowledge about NCDs.

DISCUSSION

The results provide insight related to nursing care in Turkey for Syrian refugees with NCDs. The study revealed that nurses encountered challenges when caring for Syrian refugees with NCDs. Culturally competent assessment and interventions for refugees with NCDs should be encouraged considering these three themes.

Nursing Care Experiences With Syrian Refugees in Southern Turkey: A Metaphor Analysis

BACKGROUND

Healthcare professionals' "cultural prejudices" toward individuals' cultural beliefs, attitudes, and perceptions affect the care they provide. Their awareness of their bias is closely associated with the quality of healthcare provided.

PURPOSE

This study was designed to assess nurses' perceptions regarding providing care to Syrian refugee patients using metaphors and to evaluate their views based on these metaphors.

METHODS

The participants in this qualitative study consisted of 80 nurses who worked in Level 1 and Level 2 health institutions. Data were collected using an interview form prepared by the researchers. The form included descriptive characteristics of the nurses and two expressions used to determine the nurses' opinions on providing care for Syrian refugee patients. The nurses were given an incomplete sentence, which was "Providing care for a Syrian refugee patient…because…," and were asked to complete the blanks. The data were analyzed using the content analysis method.

RESULTS

On the basis of "providing care for Syrian refugee patients," four categories of metaphors were determined: occupational awareness, health promotion, a difficult process/resistance, and providing service in vain. The participants generated 50 metaphors, with "humanity," "a baby/little child," and "a barrier" as the three most used metaphors, belonging to the "occupational awareness" and "a difficult process/resistance" categories, respectively.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The metaphors of nurses regarding giving care to Syrian refugee patients were mostly concentrated in the categories of "occupational awareness" and "a difficult process/resistance." Metaphors generated by the nurses offer a powerful research tool to reveal, understand, and explain nurses' personal perceptions and to develop and support nursing care accordingly. In addition, the subject of transcultural nursing should be discussed more extensively in nursing education programs. Understanding the social context of refugees is very important during the nursing care process.

Investigation of the Cultural Competence Levels of Diabetes Nurses

Objective: It is important for nurses to have cultural competence in order to keep up with the cultural diversity brought by globalization. In this study, we aim to examine the cultural competence levels of diabetes nurses in diabetes education and care in accordance with the cultural characteristics of individuals with diabetes. Methods: This study was conducted in a cross-sectional descriptive type with 183 diabetes nurses between September 15 and December 15, 2020 in Turkey. The data were collected using the Introductory Information Form and the Nurse Cultural Competence Scale. Results: We determine that almost all of the diabetes nurses had cultural competence above the average. We find that having a postgraduate degree from diabetes nurses, receiving cultural education before, and having a diabetes nurse experience of 6 years or more affected the cultural competence levels (p

Cultural Competence of Turkish Nurses and Nursing Students: An Integrative Literature Review

INTRODUCTION

Turkish population is characterized by its great cultural diversity, thus, Turkish nurses and nursing students often interact with patients of different cultural backgrounds from theirs. Cultural competence is needed to provide qualified contemporary nursing care. This study aimed to explore the literature on the cultural competence of Turkish nurses and nursing students.

METHODOLOGY

The Whittemore and Knafl review methodology was used to extract, summarize, and synthesize data of 15 primary research articles published between January 2011 and January 2021. The search was done in the Turkish Academic Network and Information Center-ULAKBIM (PubMed, TRDizin, DergiPark).

RESULTS

Three themes were identified: cultural competence, cultural-related problems, and importance of training on transcultural nursing.

DISCUSSION

Appropriate educational courses on transcultural nursing should be implemented in Turkish nursing schools as well as in continuing education programs for Turkish nurses.

Challenges and approaches to transcultural care: An integrative review of nurses' and nursing students' experiences

BACKGROUND

Provision of transcultural care is an essential nursing competency. It is important to comprehensively understand the challenges nurses and nursing students face while striving to provide transcultural care in clinical settings.

PURPOSE

The purpose of this review was to develop a comprehensive understanding of nurses' and nursing students' challenges and approaches to the provision of transcultural care to people with diverse ethnicities.

METHODS

An integrative review was conducted. Literature was searched within five databases, and 30 studies published from January 2010 to January 2021 were reviewed and appraised using mixed methods critical appraisal tool. Literature summary tables and inductive approaches were used for data extraction and synthesis.

RESULTS

The challenges to the provision of transcultural care were intrapersonal struggle, cultural conflicts, varied expressions of pain and suffering, and navigation of personal and organizational constraints. Addressing these challenges required nurses and students to practice self-criticism and tolerate differences, develop interpersonal and psychological skills, and collaborate with peers and patients' families.

CONCLUSIONS

Provision of transcultural care is a complex task for nurses and students because of different interpretation of personal and organizational factors. Health care institutions should proactively provide resources to nurses and students to strengthen their interpersonal and psychological skills to provide effective transcultural care.

A Phenomenological Analysis of Experiences and Practices of Nurses Providing Palliative and End of Life Care

The aim of this study was to describe the experiences and practices of nurses providing palliative and end of life care. The study was conducted in the palliative care unit of a territory hospital in Turkey. The sample consisted of 11 nurses who had been working as palliative care nurses for at least one year. The face to face interview method was used to collect data, with a semi-structured in-depth individual interview. 5 main themes and 24 sub-themes were emerged in relation to the experiences and practices of the nurses. The majority of participant nurses pointed that inadequacy in the number of nurses, secondary nursing care activities, refusal of treatment, cultural and ethical problems were barriers in the provision of nursing care. They frequently experienced ethical issues when caring for end of life patients, and for this reason they felt the need for ethics counselling which they could consult.

Nursing students learning to care for refugee patients: a qualitative study†

BACKGROUND

Nursing students should gain cultural knowledge and skills necessary for providing care to all types of patients.

AIM

This study aimed to determine problems faced by nursing students who care for refugee patients.

METHOD

The study used phenomenological qualitative design. The sample comprised 25 nursing students who cared for refugee patients in a clinic. Data were analysed using Colaizzi's seven-step method following focus group interviews.

RESULTS

Two themes were identified for the interviews: (i) language barrier: insufficient care and (ii) students' perspectives on being a refugee. Furthermore, three subthemes were also identified by analysis of the interviews: (i) superficial communication and insufficiency in psychological support, (ii) health problems in difficult living conditions and (iii) unchanged basic human needs and unmet care needs.

CONCLUSIONS

Nursing students find it difficult to care for refugee patients, but nursing education programmes based on culture care improve their knowledge and perceptions and the quality of care they provide to patients from different cultures.

IMPLICATION FOR NURSING AND HEALTH POLICY

In a multicultural society, nursing students must recognize cultural differences. Consequently, a multicultural education programme helps lay the groundwork for successful integration of nursing students in new cultures.

The Role of Culture in Shaping Health Perceptions and Behaviors of Resettled Karen Refugees

Introduction: While the many health vulnerabilities and challenges experienced by refugees have been previously documented, few studies have addressed the strengths-focused response strategies that women refugees, in particular, engage to navigate health systems and experiences associated with displacement. Our study attempts to document this among members of one group, the Karen, who represent a significant proportion of refugees resettled in the United States over the past decade. The purpose of this study was to explore how a sample of resettled Karen refugee women construct meaning around health, particularly in the context of cultural values, community, and migration. Methodology: This research took place in a series of ethnographic case studies documenting experiences of resilience, identity construction, and mothering among Karen refugee women from Burma. Data were collected through participant interviews with 12 Karen refugee women living in the United States. Interviews were transcribed, coded, and analyzed to identify themes relating to culturally influenced and newly emerging perceptions of health, identity, motherhood, and migration. Results: Participants identified correlates of doing, such as the ability to work and physical energy, as positively related to health, while the inability to do things was negatively related to health. Personal health also encompassed the health of family and community. Discussion: Women in this sample drew on broad, culturally informed ways of being to explain their health experiences. Implications of these findings are presented regarding how organizations and health providers can approach their work with refugees in culturally informed and relevant ways.

Knowledge, attitudes and prejudices of nursing students about the provision of transcultural nursing care to refugees: A comparative descriptive study

OBJECTIVES

The aim of this study was to determine the knowledge, attitudes, and prejudices of nursing students regarding the provision of transcultural nursing care to refugees.

METHODS

The sample of this comparative descriptive study was composed of 317 volunteering nursing students living in Ankara, Turkey. Descriptive statistics were presented as number, percentage, and mean ± standard deviation. The relationships among dependent and independent variables were analyzed with Pearson chi-square test. p ≤ 0.05 was accepted as statistically significant.

RESULTS

The mean age of the students was 21.19 ± 1.66 years; 88.6% were female. Only 30.0% (n = 95) of students (predominantly seniors) were educated on transcultural nursing. Statistically significant differences were found among grades of nursing students on the answers to the items, "Refugees are under coverage of general medical insurance system," "The concept of 'Health' differs from culture to culture," "Cultural features of the patient are important for caring nurse," "In order to provide care to only refugees and foreign patients, nurses from other cultures should be employed in hospitals," "Interpreters should be employed in hospitals 24 hours for services for refugees," and "According to my observations, refugees and their relatives admitted to the hospital are not respecting the healthcare workers and hospital rules." In addition, there was a statistically significant difference in students' comfort level with nursing care activities between those students who were literate in a foreign language and those who were not literate in a foreign language.

CONCLUSIONS

Our findings show that attending lectures on transcultural nursing in a curriculum of seniors and being literate in a foreign language had a positive impact on the attitudes of students in terms of the provision of medical care to refugees. It is recommended that nursing programs integrate lectures on transcultural nursing into the curricula of all four grades of nursing education and encourage students in language learning to better serve our disadvantageous guests.

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.