Transcultural Concepts in Nursing Care


Part Three Healthcare Systems

immigrant to relocate, and these differences can have distinct health implications. In recent times, refugees fleeing war, famine, and other social upheavals have come to the United States from all continents including the Middle Eastern coun tries of Afghanistan, Iraq, and Syria, as well as Myanmar (Burma); the African nations of Sudan, Somalia, the Democratic Republic of the Congo; and most recently European country of Ukraine. Most refugees arrive from countries undergoing violent political and social conflicts (Igielnik & Krogstad, 2017; Krogstad, 2017). Evidence-Based Practice 11-1 presents a study about the consequences of forced migra tion among Syrian refugee families resettled to Jordan. The United Nations High Commissioner for Refugees (UNHCR) has suggested that vio lence against displaced women and children is considered the most pervasive human rights vio lation in the world (Gaynor, 2015). Intimate part ner violence is exacerbated in war-torn countries, with a high incidence of rape and other physical/ sexual abuse during armed conflicts. Women and girls, often unaccompanied by family members, are particularly at high risk. Many refugees who come to the United States have experienced these human rights violations (Meffert et al., 2016; Musalo & Lee, 2017). Many immigrants and refugees face chal lenges integrating into countries of resettlement. There is pressure to acculturate into societies that may have very different cultural values and social structures. In addition, immigrants may experi ence prejudice or racism in their new commu nity and feel unwelcome. Many arrive with scant economic resources and must learn English and become economically self-sufficient as quickly as possible. Certain factors, such as settlement patterns, that is, living near family, friends, or others from their home region, communica tion networks, social class, and education, have helped many immigrants maintain their cultural traditions. Immigrant or refugee communities provide support for newcomers and opportuni ties for cultural continuity because these ethnic communities reflect the identities of the home

countries. At the same time, belonging to such a community tends to set immigrants and refugees apart and isolate them from the larger commu nity. For example, newcomers from Mexico real ize that they need to learn English to get better jobs, but they often join expanding Latino com munities where most residents speak Spanish. Learning English well enough to obtain employ ment in the English-speaking world is difficult and takes time. In addition to the legal entrance of immigrants and refugees, other persons seeking political asy lum have entered the United States from all over the world. Regardless, those seeking asylum or those who enter the country legally or illegally are at considerable risk for health and social prob lems. In particular, healthcare along the United States–Mexico border, where many individuals are undocumented, poses special problems and challenges for healthcare providers (Ayón, 2018; McEwen et al., 2015). Immigrants, refugees, and asylees face language and employment barriers, often with little or no economic reserve to draw from. Some have experienced rapid change and traumatic life events with few resources available to assist them. Refugees, asylees, and immigrants in general have special health risks that health care clinicians must be aware of and sensitive to so that appropriate care can be provided. Planning Nursing Care for Refugee Families and Communities Before being admitted to the United States, refu gees undergo extensive background checks and are mandated to receive both physical and men tal health screenings within 30 days of arrival through a public health department or a primary care agency contracted with the Office of Refugee Resettlement (2013, 2022). Many refugees experi ence mental health issues as a result of the trauma they experience during their relocation journey, including anxiety, depression, and posttraumatic stress disorder (PTSD) (Shawyer et al., 2017; Wong et al., 2017). To address these issues, careful assessment of cultural backgrounds and individual factors can

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