Transcultural Concepts in Nursing Care

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Part Three Healthcare Systems

help nurses anticipate and work with challenges experienced by refugees and immigrants seeking healthcare. The Baird/Boyle Assessment Guide for Refugees (Appendix D) is recommended for use with refugee clients and their families. Assessment of these factors will assist the nurse in planning healthcare for refugee and/or immigrant families. Health services, preventive care, and health education have repeatedly been identified as important needs in health surveys that have been conducted in refugee communi ties. Conflicts worldwide continue to generate refugees fleeing violence and war. The stress of resettlement is often a significant problem of refugees. Stress is related to the refu gee experience and also to inadequate income, work-related problems, and loss of culture and traditions. The lack of mental health services is a real concern in refugee and immigrant com munities and requires creative and innovative solutions. In refugee communities, a church, synagogue, or mosque can play a positive and important role—religion is often identified as a protective factor by refugees in facilitating well ness and increasing quality of life. Refugees from some cultures may be reluctant to seek mental health services because of the stigma of mental illness (Xin, 2020). Postmigration stress may be exacerbated by unemployment or underemploy ment and may contribute to depression, PTSD, alcohol and substance misuse, and poor general health status. Refugee families need particular support to raise their children in a new country and culture. The children are often exposed to different val ues and norms in a new society that clash with traditions of the parents and elders. This can cre ate conflict and may result in a breakdown of the family structure. Community-based interven tions such as A Family Strengthening Program for Refugees (see Evidence-Based Practice 11-2) can help newly resettled refugee families adjust to strain of facing families in a new environment. Many refugees come from resource-­ constrained countries with limited availability of healthcare services, and the idea of preventive

care is foreign to them. Preventive health prac tices such as dental care, breast self-examination, mammography, and Papanicolaou (Pap) smears, and regular prostate and testicular examina tions are important for refugees. Many barriers to good preventive care for newcomers to the United States are environmental and social rather than cultural. Constraints are based on the refu gee’s individual situations as well as language, economic, occupational, and transportation problems. Cultural groups differ in regard to the priority given to individual goals versus those of the larger group. For example, many refugee com munities are collectivist societies that value the good of the group, traditional values, and group loyalty. This often conflicts with the individual istic American society. Many refugees, such as those from African countries, may suffer from racism and discrimination when they resettle in the United States, and this too impacts mental health and successful resettlement.

Health education, including information about access to care, is always important in planning services for refugee and immigrant communities. Many refugees and immigrants do not use health education services, not necessarily because of cultural barriers but because of difficulties with language and access, the need for translation and transportation, the desire for same-sex healthcare providers, and other barriers such as child care. Healthcare institutions and agencies serv ing refugee and immigrant communities should include multicultural healthcare providers on their staff. Further, community health work ers should be trained to serve as interpreters and translators, as it is often problematic for healthcare providers to use family members as interpreters because of divisions along age and gender lines. Children learn English more quickly than do their parents and could conceiv ably serve as interpreters, but it would be inap propriate to expect a young boy to interpret a conversation about his mother’s Pap smear. The healthcare provider’s gender is also important, as many refugee women are not comfortable with male doctors or nurses and might avoid Copyright © 2023 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.