Watchfully checking rapport with the Primary Child Health Care nurses - a theoretical model from the perspective of parents of foreign origin

Immigrant parents' experiences of accessing child healthcare services in a host country: A qualitative thematic synthesis

AIM

To explore voluntary immigrant parents' experiences of child healthcare services in host countries.

DESIGN

Thomas and Harden's qualitative thematic synthesis method.

DATA SOURCES

Five electronic databases (CINAHL, Medline, PubMed, Psych INFO and Web of Science), were systematically searched from January 2000 - October 2018.

REVIEW METHODS

Included studies focused on voluntary migrant/immigrant parents' experiences of child healthcare services. Data were abstracted independently by two authors. Critical Appraisal Skills Programme tools were applied, and qualitative thematic synthesis was performed.

FINDINGS

Nine studies were eligible for inclusion. Five descriptive themes were identified: (a) seeking information and reassurance, (b) seeking information from "people like me", (c) comparison between child healthcare services in home and host countries, (d) effective communication, and (e) cultural isolation and perceived discrimination. Three analytical themes emerged: navigation of parenting in a health context in a new environment; trust; and balance.

CONCLUSIONS

Many immigrant families reported positive experiences, others felt patronized and disrespected, leading to a lack of trust and making them less willing to access universal child health care. Trusted advocates, who are culturally competent, have a role in helping immigrant parents navigate the child healthcare system and negotiate with healthcare professionals. Health registration of children of immigrants may encourage the uptake of universal healthcare services. More research is required into the specific health needs of voluntary immigrants.

IMPACT

Less is known about the experiences of voluntary immigrants than those of refugees/asylum seekers in accessing child healthcare. Navigating health systems is difficult. This can be due to language difficulties, differences in systems of healthcare, and differences in culture/health beliefs. When both parties have some understanding of the others' healthcare practices and beliefs, balance can be found; helping the families to positively compare healthcare and incentivising them to engage in universal child healthcare.

Encounters between children's nurses and culturally diverse parents in primary health care

The objective of this study was to analyze the healthcare encounters between nurses and parents of different cultural backgrounds in primary health care. An ethnographic study was carried out using participant observations in health centers and interviews with nurses. Data were analyzed using thematic content analysis and constant comparative method. Four main themes were identified when nurses met parents of other cultural backgrounds: lack of mutual understanding, electronic records hamper the interaction, lack of professionals' cultural awareness and skills, and nurses establish superficial or distant relationships. The concepts of ethnocentrism and cultural imposition are behind these findings, hampering the provision of culturally competent care in primary health services. There were difficulties in obtaining and registering culturally related aspects that influence children's health and development. This was due to e-records, language barriers, and the lack of cultural awareness and skills in health professionals making the encounters difficult for both nurses and parents. These findings show that there is a clear threat for health equity and safety in primary care if encounters between nurses and parents do not improve to enable nursing care to be tailored to any individual family needs.

Strengthening resilience through an extended postnatal home visiting program in a multicultural suburb in Sweden: fathers striving for stability

BACKGROUND

To improve prerequisites for better health development among children growing up in multicultural suburbs in Stockholm County, where poorer health is displayed in several aspects including child health, early support was initiated for first-time parents in one of the suburbs. An extended postnatal home visiting program during the child's first 15 months was offered to families with first-time mothers during 2013-2014 and consisted of six home visits by a child health care nurse and a parental advisor from social services. Almost all invited families (94%) participated in the program and the program evaluation. Fathers' participation in two or more home visits within the program was 53%. The aim of this study was to explore the experiences of fathers participating in the program, with respect to their role as a first-time parent from a resilience perspective.

METHODS

In-depth interviews were conducted with nine fathers. Constructivist grounded theory (GT) was applied in the analysis.

RESULTS

The fathers' experiences formed the core category of the study, 'striving for stability in living conditions', as well as three categories: 'everyday life conditions', 'adjustment to fatherhood in Sweden' and 'channels of support'. The fathers perceived that the home visiting program strengthened their parental confidence and increased their knowledge of societal services and local resources for their family.

CONCLUSIONS

In terms of resilience, the extended postnatal home visiting program benefitted the interviewed migrant fathers on an individual level by meeting part of their need for support regarding knowledge and parental confidence; on a structural level the program helped fathers gain information about available societal services and resources in their local area.

TRIAL REGISTRATION

The study was retrospectively registered (11 August 2016) in the ISRCTN registry (ISRCTN11832097 DOI: https://doi.org/10.1186/ISRCTN11832097 ).

Psychometric characteristics of a modified Sympathy-Acceptance-Understanding-Caring competence model questionnaire among foreign-born parents encountering nurses in primary child health care services

AIM

To determine the psychometric properties of the Sympathy-Acceptance-Understanding-Caring Competence (SAUC) model questionnaire for foreign-born parents evaluating nursing encounters in the Swedish Primary Child Health Care (PCHC) services.

BACKGROUND

Multicultural encounters in child health care from the nursing perspective are challenging and problematic worldwide. A suitable theory-based and validated questionnaire is needed for foreign-born parents to assess the quality of their encounters with nurses.

METHODS

The SAUC questionnaire, modified for use by new, foreign-born parents using the Swedish PCHC services, was evaluated for its congruence with the theory of Confirming Encounter. The study was ethically approved and data were collected between March and August 2009 from 83 new, foreign-born parents seen at 50 clinics. Exploratory factor analysis was used to identify related factors, and goodness-of-fit tests were used to estimate theoretical consistency. Confirmatory Factor Analysis was used to verify the results.

FINDINGS

The questionnaire had satisfactory theoretical consistency with the theory of Confirming Encounter. Three factors identified by exploratory factor analysis and confirmed by confirmatory factor analysis - person support, self-support, and self-perspective support - indicated internal consistency and validated the three factors implicit in the theory Confirming Encounter. In addition, a new factor, concordance, was identified that is compatible with the theory. To conclude, despite the fact that a modified questionnaire have its limitations results demonstrate that the SAUC-model questionnaire seems to be a reliable and valid nursing quality-control measure with which foreign-born parents can evaluate the qualities of a confirming encounter with nurses. However, we suggest the need for testing the questionnaire in a larger population.

How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas

BACKGROUND

Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure.

METHOD

Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels.

RESULTS

Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased.

CONCLUSION

The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.

Patients in 24-hour home care striving for control and safety

BACKGROUND

This article concerns Swedish patients receiving 24-hour home care from health care assistants (HC assistants) employed by the municipality. Home care is a complex interactive process involving the patient, family, HC assistants as well as professional care providers. Previous studies exploring patient perspectives on home care have been based mainly on patient interviews. In contrast, the present study took a broad perspective on patients' experiences and thoughts by combining field observations on care situations with patient and HC assistant interviews. The aim of the study presented in this article was to promote a new and broadened understanding of patients receiving 24-hour home care by constructing a theoretical model to illuminate their main concern.

METHODS

Field observations and semi-structured interviews were conducted with four patients receiving 24-hour home care and their HC assistants. Grounded theory methodology was used.

RESULTS

The core process identified was Grasping the lifeline, which describes compensatory processes through which patients strived for control and safe care when experiencing a number of exposed states due to inadequate home care. Patients tried to take control by selecting their own HC assistants and sought safe hands by instructing untrained HC assistants in care procedures. When navigating the care system, the patients maintained contacts with professional care providers and coordinated their own care. When necessary, a devoted HC assistant could take over the navigating role. The results are illuminated in a theoretical model.

CONCLUSIONS

The results accentuate the importance to patients of participating in their own care, especially in the selection of HC assistants. The model illustrates some challenging areas for improvement within the organisation of 24-hour home care, such as personnel continuity and competence, collaboration, and routines for acute care. Furthermore, it may be used as a basis for reflection during the planning of care for individual patients within home care.