Cross-cultural promotion of health: a partnership process? Principles and factors involved in the culturally competent community based nursing care of asylum applicants in Scotland.
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Date
2010Author
Quickfall, Julia
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Abstract
The aim of this study was to investigate the principles and factors underlying the
culturally competent nursing care of asylum applicants. Asylum applicants are a
highly vulnerable group, whose health is often severely compromised prior to arrival
in the UK due to exposure to torture, violence and rape. Although they are entitled to
primary health care services whilst their asylum claim is under consideration, their
level of welfare support has been significantly eroded over the last decade.
An analysis of the nursing literature revealed mainly US notions of cultural
competence, which were based on a private health care insurance system rather than
a universal health care system of equitable, accessible and non-discriminatory
service provision, such as the NHS. A Five Steps Model of cultural competence
(Quickfall 2004) was later revised to provide a theoretical framework for this
research study.
Data for this ethnographic study were collected during 2005-2007 with asylum
applicants and community nurses within one Health Board in Scotland, using
participant observation, individual, narrative and group interview methods. The data
were analysed for their categorical content. The findings are presented as vignettes to
highlight cultural competence issues.
Three major themes emerge from the study findings, which highlight the
intermediary function of community nursing. The provision of equitable, accessible
and non-discriminatory services remains pertinent in the 21st century. Secondly, the
cross-cultural promotion of health involves a partnership process to ensure effective
communication and the negotiation of person centred care. Thirdly, the delivery of
socially inclusive services requires the aiding of asylum applicant adaptation to a
new host environment. This study contributes to community nursing knowledge in
explaining, through synthesis of the literature and study data, a model of cultural
competence for the care of asylum applicants. It also provides a set of best practice
statements, which require further investigation.