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Doherty C, Quinn J, Lowe DJ, Khanolkar A. Views of emergency care providers in providing healthcare for asylum seekers and refugees. Emerg Med J 2024:emermed-2024-213899. [PMID: 38908860 DOI: 10.1136/emermed-2024-213899] [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: 01/09/2024] [Accepted: 06/06/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND The number of asylum seekers awaiting decisions on their claims in the UK has more than tripled since 2014. How we meet international obligations to provide appropriate healthcare to asylum seekers and refugees (ASRs) is therefore an increasingly important issue. The views of frontline healthcare workers are vital to ensure the development of sustainable and effective health policy when it comes to caring for this group. METHOD A single-centre qualitative study in the form of semistructured interviews was conducted at the Queen Elizabeth University Hospital ED in Glasgow, Scotland, between January and March 2023. Volunteering ED care providers (EDCPs)-doctors and nurses-working in the ED were interviewed and the data analysed and presented through a thematic analytical framework. RESULTS 12 semistructured interviews were conducted-6 doctors and 6 nurses. Analysis revealed four themes: (1) 'staff attitudes' highlighted in particular the positive views of the participants in providing care for ASRs; (2) 'presentation patterns' revealed significant variations in opinion, with one-third of participants, for example, believing there was no difference in presentations compared with the general population; (3) 'challenges to optimal care' outlines multiple subthemes which impact care including the unique challenge of the ED triage system; and (4) 'transition in care' discusses participant concerns regarding arranging safe and appropriate follow-up for ASR patients. Ethical dilemmas in providing care, as highlighted in previous studies, did not feature heavily in discussions in this study. CONCLUSION This study provides an insight into the views of EDCPs in providing care to ASRs in the ED. Study findings can potentially contribute to the development of ED-specific guidelines as well as inform wider health policy and provide a focus and direction for further research.
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Affiliation(s)
| | | | - David John Lowe
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
- Emergency Department, Queen Elizabeth University Hospital, Glasgow, UK
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Nenko I, Baranowska B, Szlendak B, Sahraoui N, Węgrzynowska M. "We were left to our own devices": Midwives' experiences of providing maternity care to Ukrainian women in Poland after the outbreak of the full-scale war in Ukraine. Women Birth 2024; 37:101629. [PMID: 38901366 DOI: 10.1016/j.wombi.2024.101629] [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: 03/01/2024] [Revised: 04/27/2024] [Accepted: 05/25/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND After the outbreak of the full-scale war in Ukraine, about 2 million people sought protection in Poland. Providing high-quality care for migrants and refugees, especially in times of significant arrivals, can be particularly challenging. AIM To learn about the experiences and strategies of midwives providing maternity care to Ukrainian migrant women in Poland after the outbreak of the full-scale war in Ukraine. METHODS Five focus group interviews with 32 midwives providing maternity care in Poland were conducted. The interviews were thematically analysed. RESULTS We identified the barriers experienced by midwives in providing high quality care to migrants to be mainly on the individual and interpersonal levels and levels of management and organization. First, at the individual and interpersonal level, we have identified: fear for life and well-being related to the threat of war in a neighbouring country, depleting resources and post-pandemic fatigue, language barriers, lack of knowledge on caring for women fleeing war. Second, at the management and organizational level we have identified: lack of organizational support, and interpreting services. In the first months after the outbreak of the full-scale war in Ukraine, most strategies to improve the provision of maternity care for women fleeing the war took the form of grassroots initiatives by the staff of individual care units. CONCLUSIONS The Polish health care services need systemic solutions prepared jointly by state and local authorities and taking into account the voices of midwives to support the provision of high-quality care to migrant population.
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Affiliation(s)
- Ilona Nenko
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Beata Szlendak
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Nina Sahraoui
- Centre for Sociological and Political Research, Paris, France
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland.
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Hayba N, Cheek C, Austin E, Testa L, Richardson L, Safi M, Ransolin N, Carrigan A, Harrison R, Francis-Auton E, Clay-Williams R. Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01876-z. [PMID: 38117444 DOI: 10.1007/s40615-023-01876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. METHODS An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. RESULTS Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. CONCLUSIONS The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. REGISTRATION PROSPERO registration number: CRD42022379584.
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Affiliation(s)
- Nematullah Hayba
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, Aabenraa, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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Elsas Parish B, Dogra N, George RE. A discourse analysis of General Medical Council (GMC) guidelines for the inclusion of cultural diversity issues in medical education and practice. MEDICAL TEACHER 2022; 44:679-687. [PMID: 35037557 DOI: 10.1080/0142159x.2021.2020738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Several studies have highlighted the insufficient inclusion of cultural diversity in medical schools' curricula and the extent of health inequalities highlighted by the COVID-19 pandemic. This study aimed to critically review a range of GMC publications to identify the inclusion of cultural diversity topics in their guidelines, as according to recent studies, doctors are inadequately prepared to serve a diverse population. METHODS Twenty-four relevant GMC publications were analysed. An inductive thematic analysis was conducted to review the content of the guidelines; and discourse analysis was used to critically understand the linguistics used whilst also considering the cultural and social context. RESULTS The GMC publications primarily focused on discouraging discrimination and promoting equality. Themes around diversity in medical practice were less commonly covered. There was considerable internal inconsistency across the guidelines. Guidelines aimed at medical schools and medical students were more likely to consider cultural diversity issues compared to those intended for doctors. CONCLUSIONS Cultural diversity teaching can only be as effective as the policy that drives it. Despite the inclusion of cultural diversity issues in GMC guidelines, this study suggests considerable ambiguity in how these issues are represented and understood. The guidelines require careful revision and should be written to reduce the likelihood of variable interpretation, thereby promoting better cultural diversity inclusion in medical schools' curricula, and consequently better patient care.
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Affiliation(s)
- Bheatriz Elsas Parish
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
| | - Nisha Dogra
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Riya Elizabeth George
- Clinical and Communication Skills Unit at Barts and The London School of Medicine and Dentistry, Robin Brook Centre, St Bartholomew's Hospital, London
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Granero-Molina J, Jiménez-Lasserrotte MDM, Fernández-Medina IM, Ruiz-Fernández MD, Hernández-Padilla JM, Fernández-Sola C. Nurses' experiences of emergency care for undocumented migrants who travel by boats. Int Nurs Rev 2021; 69:69-79. [PMID: 34628657 DOI: 10.1111/inr.12723] [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: 02/25/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of our study is to describe and understand the experiences of nurses providing emergency care to undocumented migrants who arrive in Spain in small boats. BACKGROUND Spain receives thousands of undocumented migrants every year who arrive by sea. Provision of appropriate emergency care to undocumented migrants is a public health problem. INTRODUCTION Nurses, along with other health care providers, such as doctors or cultural mediators, make up the Spanish Red Cross Emergency Response Team. Nurses, in particular, are associated with all phases of emergency care to undocumented migrants who arrive in small boats, offering first aid as well as clinical and humanitarian care. METHODS Qualitative descriptive study. Seventeen nurses from the Spanish Red Cross Emergency Response Team participated in face-to-face interviews. Thematic analysis was used to analyse the qualitative data. FINDINGS Three main themes emerged: (i) guaranteeing comprehensive emergency care, (ii) the nurse, the key member of the multidisciplinary care team for undocumented migrants and (iii) 'making a difference', volunteering as a nurse's role. CONCLUSIONS Nurses try to guarantee comprehensive care provision for undocumented migrants, even though they face stigma, ethical concerns or an impossibility to prescribe pharmacological treatments. Personalised care, more time and protocols, better training and the incorporation of debriefing are elements that are required to improve the emergency care given to undocumented migrants. IMPLICATIONS FOR NURSING AND HEALTH POLICY Institutions must develop policies to support provsion of emergency care to undocumented migrants. A public health issue cannot depend upon volunteer healthcare providers. Governments must guarantee funding, training and established care teams. Understanding nurses' experiences could increase awareness of the problem, reduce stigma and improve the comprehensive emergency care provided to undocumented migrants.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Research Associate, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | | | | | | | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Research Associate, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
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Granero-Molina J, Jiménez-Lasserrotte MDM, Ruiz-Fernández MD, Hernández-Padilla JM, Fernández-Medina IM, López-Rodríguez MDM, Fernández-Sola C. Physicians' experiences of providing emergency care to undocumented migrants arriving in Spain by small boats. Int Emerg Nurs 2021; 56:101006. [PMID: 33989922 DOI: 10.1016/j.ienj.2021.101006] [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: 07/07/2020] [Revised: 12/30/2020] [Accepted: 03/26/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Access to emergency care for undocumented migrants (UMs) is a public health problem. Spain receives thousands of UMs who arrive by sea. A multidisciplinary team of the Spanish Red Cross, made up of physicians, nurses, police, and cultural mediators, developed emergency care for UMs. AIM The aim of our study is to describe and understand the experiences of physicians in emergency care for UMs who arrive in Spain by small boats METHODS: Qualitative study, based on Gadamer's phenomenology. Convenience and purposive sampling was carried out and included sixteen in-depth interviews with physicians, between June 2019 and March 2020 in Spain. RESULTS Three main themes emerged: 1) Rediscovering humanistic medicine; 2) Leaving the personal and professional comfort zone; 3) Improving medical emergency care. CONCLUSIONS Triage, pharmacological prescription, and the closure of the emergency care process are the key contributions of medical care. Cultural, language and security barriers make emergency care difficult.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain; Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile.
| | | | | | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain; Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK.
| | | | | | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain; Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile.
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Tanner B, Doherty AM. Suicidal Ideation and Behaviors Among Irish Travellers Presenting for Emergency Care. CRISIS 2021; 43:149-156. [PMID: 33620256 DOI: 10.1027/0227-5910/a000769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Suicide is a serious problem in the Traveller community, with rates estimated at 11%: over 6 times that of the general population. Aims: We aimed to establish the prevalence and correlates of suicidal ideation (SI) and self-harm (SH) among Irish Travellers. Method: This was an observational cross-sectional cohort study of patients presenting with SH and SI to a tertiary hospital in Ireland, in an area with a large local Traveller population. Data were analyzed from the anonymized database (n = 2,016), comparing characteristics of Travellers and the general population. Results: This study found that Travellers (1.6% of the local population) represent 4.3% of the population seen in hospital with SH and SI, and 14.8% of episodes. There was a significant difference in SH methods used: Travellers were significantly more likely to present following attempted hanging, (OR = 21.8; p = .004). Travellers were more commonly diagnosed with depression or substance abuse, referred from critical care, and transferred for inpatient psychiatric treatment. Limitations: Limitations include the use of retrospective data from a service activity database rather than clinical information collected prospectively. Conclusion: There are significant differences in patterns of suicidal behaviors between Irish Travellers and the general population. Further research is required to understand and address the high rates of suicidal behaviors in this population.
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Affiliation(s)
- Bryan Tanner
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Anne M Doherty
- Department of Psychiatry, School of Medicine, University College Dublin, Ireland.,Department of Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
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