Beyond biopolitics: the importance of the later work of Foucault to understand care practices of healthcare workers caring for undocumented migrants

Healthcare providers' advocacy approaches and ethical challenges in delivering healthcare to undocumented migrants: a scoping review

Delivering healthcare to undocumented migrants presents a complex challenge for healthcare providers. Integrating advocacy efforts into their daily practices can be ambiguous in practical terms, stemming from the intricate task of addressing the health needs of this population while simultaneously advocating for their health rights within the constraints imposed on them. This study seeks to consolidate findings from literature regarding the advocacy approaches employed by healthcare providers and the correlated ethical challenges. We conducted a scoping review of qualitative literature by systematically searching four databases-PubMed/Medline, Embase, Cinahl, and Cochrane Library. For developing our search strategy, we employed the PICO (Population, Intervention, Comparison, Outcome) scheme. Our analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman. 30 studies were included, revealing a cumulative total of 915 healthcare providers who were interviewed. A total of 30 themes emerged comprising 14 advocacy approaches and 16 ethical challenges. Healthcare providers made a deliberate choice to engage in advocacy, responding to injustices experienced by undocumented migrants. The spectrum of advocacy initiatives varied, encompassing voluntary participation in healthcare provision, empathetic understanding, and healthcare-focused strategies. We also identified numerous correlated ethical challenges, necessitating healthcare providers to strike a balance between their eagerness to assist and their professional competence, respect the autonomy of undocumented migrants, and establish trust with them. These findings not only offer practical guidance for healthcare providers to enhance accessibility to healthcare services for undocumented migrant patients but also foster awareness of the ethical challenges that may arise in their advocacy roles.

Intensive Care Nurses' Experience of Caring in Greece; A Qualitative Study

BACKGROUND

Whilst nurses and critical care services have been at the forefront of the COVID-19 pandemic, it has become more apparent that intensive care nurses are presented with challenging ethical and clinical decisions and are required to care for individuals with critical illnesses under high-pressure conditions. This is not a new phenomenon. The aim of this study, which was conducted before the outbreak of COVID-19, was to explore the experience of caring through the narratives of intensive care nurses in Greece.

METHODS

A qualitative study was conducted through in-depth, semi-structured interviews with nineteen ICU nurses in Athens. Transcripts were subjected to Braun and Clarke's thematic analysis and organised with Atlas.ti v8 QDA software.

RESULTS

The intensive care nurses' experience of caring in Greece encompassed four themes: (A) being "proximal", "co-present" and caring with empathy, (B) being "responsible" for your patient and negotiating with the doctors, (C) technology and "fighting with all you've got", and (D) "not being kept informed" and disappointment.

CONCLUSIONS

The narratives of this study highlight that ICU nurses in Greece provide patient-centred and compassionate care. Nurse leaders should develop appropriate healthcare policies so as to ensure the adequate provision of staff, specialist education, and support to nurses working in critical care. Failure to address these issues may lead to poor quality of care and negative patient outcomes.

Barriers to healthcare for Venezuelan migrants: physicians' perspective

Purpose

Increased migration to small island developing states poses major challenges on receiving countries' healthcare systems. Due to public health policy on treating migrants in Trinidad and Tobago, Venezuelan migrants are experiencing less than optimal care. This paper examines the retrospective accounts of physicians treating Venezuelan migrants with limited access to healthcare.

Design/methodology/approach

Ten in depth, semi-structured interviews were conducted with physicians working in primary healthcare and emergency departments about their clinical decision-making process in providing care for Venezuelan migrants. A narrative approach was used to highlight the personal experiences of participants. Participants were recruited by their response to an online advertisement on social media (i.e. Facebook and Instagram) and via email invitations. Interviews were transcribed verbatim and coded using NVIVO-12 software.

Findings

Findings revealed language barriers between Venezuelan migrants and Trinidad and Tobago-based physicians hindered providing optimal care coordination. Physicians indicated the use of a translator app to bridge the service gap but questioned their ethics. Participants noted tensions between junior and senior physicians regarding referrals of Venezuelan migrants to outpatient care. The data suggests physicians' felt constrained providing additional services such as primary care due to the Provision of Public Healthcare Services Policy which forbids primary care services to migrants.

Originality/value

Sparse research on the barriers to accessing healthcare for Venezuelan migrants residing in the small island states.