Gina Ma Higginbottom

The transitioning experiences of internationally- educated nurses into a Canadian health care system: A focused ethnography

BackgroundBeyond well-documented credentialing issues, internationally-educated nurses (IENs) may need considerable support in transitioning into new social and health care environments. This study was undertaken to gain an understanding of transitioning experiences of IENs upon relocation to Canada, while creating policy and practice recommendations applicable globally for improving the quality of transitioning and the retention of IENs.MethodsA focused ethnography of newly-recruited IENs was conducted, using individual semi-structured interviews at both one-to-three months (Phase 1) and nine-to-twelve months post-relocation (Phase 2). A purposive sample of IENs was recruited during their orientation at a local college, to a health authority within western Canada which had recruited them for employment throughout the region. The interviews were recorded and transcribed, and data was managed using qualitative analytical software. Data analysis was informed by Roper and Shapiras framework for focused ethnography.ResultsTwenty three IENs consented to participate in 31 interviews. All IENs which indicated interest during their orientation sessions consented to the interviews, yet 14 did not complete the Phase 2 interview due to reorganization of health services and relocation. The ethno-culturally diverse group had an average age of 36.4 years, were primarily educated to first degree level or higher, and were largely (under) employed as Graduate Nurses. Many IENs reported negative experiences related to their work contract and overall support upon arrival. There were striking differences in nursing practice and some experiences of perceived discrimination. The primary area of discontentment was the apparent communication breakdown at the recruitment stage with subsequent discrepancy in expected professional role and financial reimbursement.ConclusionsExplicit and clear communication is needed between employers and recruitment agencies to avoid employment contract misunderstandings and to enable clear interpretation of the credentialing processes. Pre-arrival orientation of IENs including health care communications should be encouraged and supported by the recruiting institution. Moreover, employers should provide more structured and comprehensive workplace orientation to IENs with consistent preceptorship. Similar to findings of many other studies, diversity should be valued and incorporated into the professional culture by nurse managers.

“I have to do what I believe”: Sudanese women’s beliefs and resistance to hegemonic practices at home and during experiences of maternity care in Canada

BackgroundEvidence suggests that immigrant women having different ethnocultural backgrounds than those dominant in the host country have difficulty during their access to and reception of maternity care services, but little knowledge exists on how factors such as ethnic group and cultural beliefs intersect and influence health care access and outcomes. Amongst immigrant populations in Canada, refugee women are one of the most vulnerable groups and pregnant women with immediate needs for health care services may be at higher risk of health problems. This paper describes findings from the qualitative dimension of a mixed-methodological study.MethodsA focused ethnographic approach was conducted in 2010 with Sudanese women living in an urban Canadian city. Focus group interviews were conducted to map out the experiences of these women in maternity care, particularly with respect to the challenges faced when attempting to use health care services.ResultsTwelve women (mean age 36.6 yrs) having experience using maternity services in Canada within the past two years participated. The findings revealed that there are many beliefs that impact upon behaviours and perceptions during the perinatal period. Traditionally, the women mostly avoid anything that they believe could harm themselves or their babies. Pregnancy and delivery were strongly believed to be natural events without need for special attention or intervention. Furthermore, the sub-Saharan culture supports the dominance of the family by males and the ideology of patriarchy. Pregnancy and birth are events reflecting a certain empowerment for women, and the women tend to exert control in ways that may or may not be respected by their husbands. Individual choices are often made to foster self and outward-perceptions of managing one’s affairs with strength.ConclusionIn today’s multicultural society there is a strong need to avert misunderstandings, and perhaps harm, through facilitating cultural awareness and competency of care rather than misinterpretations of resistance to care.

Sociocultural and linguistic boundaries influencing intercultural communication between nurses and Moroccan patients in southern Spain: a focused ethnography

BackgroundDuring the last 25xa0years, cultural diversity has increased substantially with global migration. In more recent years this has become highly evident in the south of Spain with its steadily increasing Moroccan population. The accompanying differences in ethnocultural values and traditions between the host and newcomer populations may greatly impact healthcare interactions and thus also effective provision of care. This landscape provides for excellent exploration of intercultural communication in healthcare settings and elucidation of possible ways to overcome existing barriers to provision of culturally competent care by nurses. This study aimed to ascertain how nurses perceive their intercultural communication with Moroccan patients and what barriers are evident which may be preventing effective communication and care.MethodsA focused ethnography was conducted with semi-structured interviews of 32 nurses in three public hospitals in southern Spain. Interviews were audio-recorded and transcribed verbatim before undergoing translation and back-translation between Spanish and English. Data was managed, classified and ordered with the aid of AQUAD.6 (Günter L. Huber, Tübingen, Germany) qualitative data analysis software.ResultsAs an important dimension of cultural competence, findings from the interviews with nurses in this study were interpreted within the framework of intercultural communication. Various barriers, for which we have termed “boundaries”, seem to exist preventing effective communication between nurses and their patients. The substantial language barrier seems to negatively affect communication. Relations between the nurses and their Moroccan patients are also marked by prejudices and social stereotypes which likely compromise the provision of culturally appropriate care.ConclusionsThe language barrier may compromise nursing care delivery and could be readily overcome by implementation of professional interpretation within the hospital settings. Moreover, it is essential that the nurses of southern Spain are educated in the provision of culturally appropriate and sensitive care.

Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-cultural groups: an integrative review of the literature

BackgroundHigh income nations are currently exhibiting increasing ethno-cultural diversity which may present challenges for nursing practice. We performed an integrative review of literature published in North America and Europe between 1990 and 2007, to map the state of knowledge and to identify nursing assessment tools/models which are have an associated research or empirical perspective in relation to ethno-cultural dimensions of nursing care.MethodsData was retrieved from a wide variety of sources, including key electronic bibliographic databases covering research in biomedical fields, nursing and allied health, and culture, e.g. CINAHL, MEDline, PUBmed, Cochrane library, PsycINFO, Web of Science, and HAPI. We used the Critical Appraisal Skills Programme tools for quality assessment. We applied Torracos definition and method of an integrative review that aims to create new knowledge and perspectives on a given phenomena. To add methodological rigor with respect to the search strategy and other key review components we also used the principles established by the Centre for Reviews and Dissemination.ResultsThirteen thousand and thirteen articles were retrieved, from which 53 full papers were assessed for inclusion. Eight papers met the inclusion criteria, describing research on a total of eight ethno-cultural assessment tools/models. The tools/models are described and synthesized.ConclusionsWhile many ethno-cultural assessment tools exist to guide nursing practice, few are informed by research perspectives. An increased focus on the efficiency and effectiveness of health services, patient safety, and risk management, means that provision of culturally responsive and competent health services will inevitably become paramount.

Food choices and practices during pregnancy of immigrant women with high-risk pregnancies in Canada: a pilot study

BackgroundImmigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.MethodsThis four-phase study employed a case study design allowing for multiple means of data collection and different units of analysis. Phase one consists of a scoping review of the literature. Phases two and three incorporate pictorial representations of food choices with semi-structured photo-elicited interviews. This study was undertaken at a Prenatal and Obstetric Clinic, in an urban Canadian city. In phase four, the research team will inform the development of culturally appropriate visual tools for health promotion.ResultsFive themes were identified: (a) Perceptions of Health, (b) Social Support (c) Antenatal Foods (d) Postnatal Foods and (e) Role of Health Education. These themes provide practitioners with an understanding of the cultural differences that affect women’s dietary choices during pregnancy. The project identified building collaborations between practitioners and families of pregnant immigrant women to be of utmost importance in supporting healthy pregnancies, along with facilitating social support for pregnant and breastfeeding mothers.ConclusionIn a multicultural society that contemporary Canada is, it is challenging for health practitioners to understand various ethnocultural dietary norms and practices. Practitioners need to be aware of customary practices of the ethnocultural groups that they work with, while simultaneously recognizing the variation within—not everyone follows customary practices, individuals may pick and choose which customary guidelines they follow. What women choose to eat is also influenced by their own experiences, access to particular foods, socioeconomic status, family context, and so on.The pilot study demonstrated the efficacy of the employed research strategies and we subsequently acquired funding for a national study.

Food choices and practices during pregnancy of immigrant and Aboriginal women in Canada: a study protocol

BackgroundFacilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the womens ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners.Methods/DesignThis four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the citys most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated.DiscussionThe findings of this study will provide practitioners with an understanding of the cultural differences that affect womens dietary choices during maternity. We expect that the developed resources will be of immediate use within the womens units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

Immigrant women's experiences of postpartum depression in Canada: a protocol for systematic review using a narrative synthesis

BackgroundLiterature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women’s reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada?Methods/designOur synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al. (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors.DiscussionThe narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.

Health and Social Care Needs of Somali Refugees With Visual Impairment (VIP) Living in the United Kingdom: A Focused Ethnography With Somali People With VIP, Their Caregivers, Service Providers, and Members of the Horn of Africa Blind Society

Purpose: To explore the health and social care needs of Somali refugees with visual impairment (VIP). Design: We conducted a three-phased focused ethnography in collaboration with the Horn of Africa Blind Society (HABS) through all stages from research design to findings dissemination. Method: Engaging in participatory research, HABS members (n = 26), service providers (n = 10), and two Somali community groups (n = 8 and n = 7) whose members were sighted (Phase 1) took part in four focus group interviews. Phases 2 and 3 consisted of interviews with Somali refugees with VIP (n = 32) and their informal carers (n = 5). We used framework data analysis methodology. Findings: Four major themes emerged: (1) sociocultural perceptions of blindness and visual impairment, (2) access to services, (3) isolation and insecurity, and (4) mobility. Conclusion: Somali people with VIP experience profound unmet social and health care needs related largely to social support, awareness of mobility options, and the stigmatization of visual impairment. Appropriate community outreach may improve access to services and quality of life for Somali people with VIP. Tailored information is needed to increase awareness of mobility and security services. Significant considerations exist when planning discharge from acute care settings to ensure continuity of support.

Breast-Feeding Experiences of Women of African Heritage in the United Kingdom

This article explores the breast-feeding experiences of women of African descent in the United Kingdom. Although there is a limited evidence base that describes the breast-feeding experiences of these women, the small number of studies on this topic suggest that a tradition of breast-feeding exists within African communities in the United Kingdom. Cultural materialism is adopted as a theoretical framework to explore the sociocultural influences on breast-feeding in the United Kingdom for this group. The invisibility of this group is examined in relation to the health care research and policy agenda in the United Kingdom, and arguments are made for the urgent need to address this paucity of information to promote evidence-based nursing and midwifery practice.