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Facilitating a healthy transition for involuntary migrant families within primary health care
Kristianstad University, School of Health and Society. Kristianstad University, Forskningsmiljön Arbete i skolan (AiS).
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The refugee families face a complex transition due to the nature of the migration. This exposes them to vulnerability in cohesion and family function. Primary Health Care Nurses (PHCN) and Interpreters in Primary Health Care (PHC) play a vital role in their promotion of health because migrant health care is mainly carried out within PHC. The overall aim of this thesis was to reach a comprehensive understanding of involuntary migrant family health in order to facilitate a healthy transition for the aforementioned families in Sweden from a systems perspective. These findings are based on interviews representing 16 members from ten families from the Balkans, Kurdistan and Africa (study I), 34 PHCNs (study II & III) and ten Interpreters working within PHC and originating from the same countries as the families (study IV). This study was carried out in two municipalities in Sweden. Contextual analysis with reference to phenomenography was used in interpreting the data in studies I-III. A qualitative method and contextual analysis was used in study IV. The Neuman Systems Model was used to unravel environmental influences in all the four studies. The findings of study I & II illustrate the families’ transition experience through four different family profiles respectively describing the families’ wellbeing: A distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted (study I). Further, a mentally distressed family within the asylum-seeking process; an insecure family with immigrant status; a family with internal instability and being segregated from society; and a stable and well functioning family integrated in society (study II). Stress factors such as living in uncertainty, having traumas, change in family roles, frequent negative attitudes of the host country and social segregation was detrimental to the wellbeing of the family. In promoting their health, PHCNs approached the families through: an ethnocentric approach, an empathic and culturally relative approach, and a holistic approach enabling families to function well in their everyday life (study III). From the Interpreters’ perspective, promoting health was to improve psychological wellbeing by: promoting positive thoughts of a future, promoting consideration of one’s worth and promoting stability of the family unit. Social interactions within the host country together with the recognition and appreciation of the families’ cultural values and beliefs, and competence and proper and elucidative information regarding the functioning of the host country, was considered necessary. Facilitating a healthy transition is possible within PHC. This can be done through cooperation of the family, with other health professionals, community and ethnic organisations. A model was developed in order to help the aforementioned. Competence in intercultural communication and family focused nursing is required. Adequate skills ought to be included in the education of nurses.

Place, publisher, year, edition, pages
Lund: Department of Health Science, Lund University , 2007. , 69 p.
Series
Lund University, Faculty of Medicine doctoral dissertation series, ISSN 1652-8220 ; 2007:50
Keyword [en]
contextual analysis, culture, health promotion, interpreter, involuntary migration, nursing, phenomenography, Primary Health Care, refugee family, Sweden, transition.
National Category
Nursing
Identifiers
URN: urn:nbn:se:hkr:diva-7095ISBN: 978-91-85559-28-2 (print)OAI: oai:DiVA.org:hkr-7095DiVA: diva2:345498
Public defence
, Lund (Swedish)
Opponent
Supervisors
Available from: 2010-08-30 Created: 2010-08-25 Last updated: 2013-09-30Bibliographically approved
List of papers
1. Primary health care nurses' conceptions of involuntarily migrated families' health
Open this publication in new window or tab >>Primary health care nurses' conceptions of involuntarily migrated families' health
2006 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 53, no 4, 301-307 p.Article in journal (Refereed) Published
Abstract [en]

Background: Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care.

Aim: To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs.

 Method: Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data.

 Findings: Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from  society, and (4) a stable and wellfunctioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family.

 Conclusion: Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.

Keyword
Family, Involuntary Migration, Nursing, Phenomenography, Primary Health Care, Sweden, Transition
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-7004 (URN)10.1111/j.1466-7657.2006.00498.x (DOI)000241736300021 ()17083420 (PubMedID)
Available from: 2010-08-24 Created: 2010-08-21 Last updated: 2010-10-19Bibliographically approved
2. Primary health care nurses' promotion of involuntary migrant families' health
Open this publication in new window or tab >>Primary health care nurses' promotion of involuntary migrant families' health
2010 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 57, no 2, 224-231 p.Article in journal (Refereed) Published
Abstract [en]

Background: Involuntary migrant families in cultural transition face a number of challenges to their health and to family cohesion. Primary health care nurses (PHCNs) therefore play a vital role in the assessment and promotion of their health.

Aim: The aim of this study was to describe the promotion of health in involuntary migrant families in cultural transition as conceptualized by Swedish PHCNs.

Method: Interviews were conducted with 34 strategically chosen PHCNs covering the entire range of the primary health care sector in two municipalities of Southern Sweden. A contextual approach with reference to phenomenography was used in interpreting the data.

Findings: There are three qualitatively different descriptive categories epitomizing the characteristics of the PHCNs' promotion of health: (1) an ethnocentric approach promoting physical health of the individual, (2) an empathic approach promoting mental health of the individual in a family context, and (3) a holistic approach empowering the family to function well in everyday life.

Conclusions: For nurses to promote involuntary migrant families'health in cultural transition, they need to adopt a holistic approach. Such an approach demands that nurses cooperate with other health care professionals and community authorities, and practise family-focused nursing; it also demands skills in intercultural communication paired with cultural self-awareness in interacting with these families. Adequate knowledge regarding these skills should therefore be included in the education of nurses, both at under- and at post-graduate level.

Keyword
Competence, Cultural Transition, Health Promotion, Involuntary Migration, Nursing, Phenomenography, Primary Health Care, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-7005 (URN)10.1111/j.1466-7657.2009.00790.x (DOI)000277796500015 ()20579158 (PubMedID)
Available from: 2010-08-24 Created: 2010-08-21 Last updated: 2010-10-01Bibliographically approved
3. "It is a different war to fight here in Sweden": the impact of involuntary migration on the health of refugee families in transition
Open this publication in new window or tab >>"It is a different war to fight here in Sweden": the impact of involuntary migration on the health of refugee families in transition
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 3, 292-301 p.Article in journal (Refereed) Published
Abstract [en]

Involuntary migration and adaptation to a new cultural environment is known to be a stress factor. The aim of the study was to explore the impact of involuntary migration on the family health in order to identify specific health care issues related to refugee families in transition living in Sweden. Data was collected through interviews with 16 members of 10 different refugee families from Balkan countries, Kurdistan and Africa for which permission was obtained from the chairman of the local ethnic organizations in a municipality in the southern part of Sweden. In interpreting the material, analysis was made using a contextual approach with reference to phenomenography. The analysis resulted in four qualitatively different descriptive categories characterizing the health of the families: a distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted. Stressors seeking asylum, facing unemployment and changed roles, interacted negatively within the family. A friendly and understanding attitude from the host country was the main factor in promoting the health of the refugee families. Nursing interventions should therefore assist the families accordingly in order to promote the stability of the family system.

Keyword
involuntary migration, health, refugee families, transition, Sweden, phenomenography
National Category
Nursing
Identifiers
urn:nbn:se:hkr:diva-7002 (URN)10.1046/j.1471-6712.2002.00089.x (DOI)000177832200013 ()12191042 (PubMedID)
Available from: 2010-08-24 Created: 2010-08-21 Last updated: 2010-10-27Bibliographically approved
4. Promoting health in involuntarily migrated families in cultural transition from the perspective of interpreters working within Primary Health Care
Open this publication in new window or tab >>Promoting health in involuntarily migrated families in cultural transition from the perspective of interpreters working within Primary Health Care
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Refugee families face a complex transition due to involuntary migration exposing them to vulnerability in cohesion and family function. Since migrant health care is mainly managed by the Primary Health Care sector, interpreters play a critical role in bridging the gap amongst these families and the Primary Health Care system. Aim: To explore and describe interpreters’ experiences of promoting health in involuntarily migrated families in cultural transition living in Sweden. Method: Ten interpreters from five ethnic groups were interviewed and contextual analysis was used in analysing the data. Result: Promoting health in refugee families was conceived as improving family members psychological wellness despite past experiences by promoting a future, promoting consideration of one’s worth and promoting stability of the family unit. Social interactions within the host country, recognition and appreciation of the families’ cultural values and beliefs as well as competence and proper and elucidative information regarding the functioning of the host country was considered necessary in the promotion of health of these families. Conclusion:  Promoting health in involuntarily migrated families will have to facilitate a healthy transition. Primary Health Care Nurses can do this by proper cooperation with community and ethnic organisations and by adopting a family system perspective in communicating the family’s transition experiences in a sensitive manner.

Identifiers
urn:nbn:se:hkr:diva-7094 (URN)
Available from: 2010-08-25 Created: 2010-08-25 Last updated: 2010-10-27Bibliographically approved

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