Assessing the psychosocial work environment of migrant and non-migrant workers in inpatient mental health centres: A feasibility study.

The number of migrant workers in Germany has increased over the last decades and will probably further increase in the context of a growing cultural diversity of the population and shortage of skilled professionals. Since migrant workers face different challenges, they may experience poorer psychosocial work environments than non-migrants. A negative psychosocial work environment can increase burnout and depression symptoms. To this date no study has investigated differences in the perceived psychosocial work environment in the mental health field. The aim of this study is to evaluate the feasibility of a cross sectional study comparing the perceived psychosocial work environment of migrants and non-migrant workers in inpatient mental health centres in Germany. The study was conducted in four inpatient mental health centres in Germany using the Copenhagen Psychosocial Questionnaire. All staff members (N = 659) categorized in seven professional groups were invited to participate in the study. The feasibility of the study was determined by four criteria (1) Implementation of the study in inpatient mental health centres (2) Representativity of the sample (3) Reliability and usability of the questionnaire and (4) Variability of collected data. Three of four feasibility criteria were achieved. The study was successfully implemented in four mental health centres, the usability of the used questionnaire was confirmed as well as the variability of the data. The targeted response rate was partially met, and the total number of migrant workers could not be provided, which limits the representativity of the sample. In conclusion, a main study is feasible, but an effort must be put in an effective recruitment strategy to obtain valid results.

[Barriers and Resources in Inpatient Psychosomatic Rehabilitative Care of Migrant Patients]. / Barrieren und Ressourcen in der Behandlung von Patient/innen mit Migrationshintergrund in der psychosomatischen Rehabilitation.

Patients from migrant descent access inpatient psychosomatic rehabilitative care less and achieve less treatment success than patients from the host populations. They are confronted with different process barriers in the healthcare system which combined with individual barriers can inhibit successful treatment. Studies have shown that working with migrant patients may also be challenging for healthcare providers.This study aims to assess and compare barriers and resources faced by migrant and non-migrant patients during their treatment in inpatient psychosomatic rehabilitative care. Also, the aim is to assess and compare barriers and resources faced by healthcare providers in treating migrant and non-migrant patients in order to identify barriers and resources specific to working with migrant patients.A total of 77 semi-structured interviews were conducted (20 migrant and 19 non-migrant patients as well as 14 migrant and 24 non-migrant healthcare providers). Data were transcribed and analyzed applying the method of qualitative content analysis (Mayring) with inductive categories.Migrant and non-migrant patients stated that they profit from the treatment in inpatient psychosomatic rehabilitative care. The greatest barriers for both migrant patients and healthcare providers are language barriers, cultural differences, differences in expectations regarding the treatment and limited organizational cultural competences. As far as organizational cultural competences are implemented, they are profitable for migrant patients and non-migrant healthcare providers. However, migrant healthcare workers seem responsible for implementing culturally competent care and suffer from increased workload.

Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision.

BACKGROUND: Culturally and linguistically diverse patients access healthcare services less than the host populations and are confronted with different barriers such as language barriers, legal restrictions or differences in health beliefs. In order to reduce these disparities, the promotion of cultural competence in healthcare organizations has been a political goal. This scoping review aims to collect components and strategies from evaluated interventions that provide culturally competent healthcare for culturally and linguistically diverse patients within healthcare organizations and to examine their effects on selected outcome measures. Thereafter, we aim to organize identified components into a model of culturally competent healthcare provisions. METHODS AND FINDINGS: A systematic literature search was carried out using three databases (Pubmed, PsycINFO and Web of Science) to identify studies which have implemented and evaluated cultural competence interventions in healthcare facilities. PICO criteria were adapted to formulate the research question and to systematically choose relevant search terms. Sixty-seven studies implementing culturally competent healthcare interventions were included in the final synthesis. Identified strategies and components of culturally competent healthcare extracted from these studies were clustered into twenty categories, which were organized in four groups: Components of culturally competent healthcare-Individual level; Components of culturally competent healthcare-Organizational level; Strategies to implement culturally competent healthcare and Strategies to provide access to culturally competent healthcare. A model integrating the results is proposed. The overall effects on patient outcomes and utilization rates of identified components or strategies were positive but often small or not significant. Qualitative data suggest that components and strategies of culturally competent healthcare were appreciated by patients and providers. CONCLUSION: This scoping review used a bottom-up approach to identify components and strategies of culturally competent healthcare interventions and synthesized the results in a model of culturally competent healthcare provision. Reported effects of single components or strategies are limited because most studies implemented a combination of different components and strategies simultaneously.

Work-related barriers and resources of migrant and autochthonous homecare nurses in Germany: A qualitative comparative study.

BACKGROUND: There is substantial research about the occupational health of nurses worldwide. However, empirical evidence about the psychosocial health of migrant and minority nurses in outpatient settings in Germany in comparison to that of autochthonous nurses is lacking. OBJECTIVES: This study aims to identify work-related stressors, resources and the corresponding coping strategies of migrant and minority nurses in comparison to autochthonous nurses. DESIGN: 24 migrant and 24 autochthonous nurses employed in the German homecare sector were interviewed in qualitative explorative manner while a distinction was made between non-commercial and private-commercial services. SETTINGS: The interviews took place in the nursing services' premises or in the nurses' private homes. PARTICIPANTS: Services were randomly chosen among all homecare providers in the second largest German federal city-state Hamburg. Nurses were invited for an interview, once their management agreed to participate in the study. Registered nurses and nursing assistants as well as those with a foreign certificate but validated or in process were eligible to participate. METHODS: Relevant literature findings formed the base for the semi-structured interview guide. Key areas in the interview guide were barriers, resources and coping strategies in the collaboration with colleagues, superiors and clients as well as in the collaboration within a linguistically and culturally diverse team and clients. The conventional approach to qualitative content analysis by Hsieh and Shannon guided the analysis. RESULTS: Regardless of their origin or culture, nurses perceive time pressure, lifting patients, lack of appreciation or the client's personal fate as burdening. In the intercultural context, the divergent understanding of behavioral patterns as well as of nursing care and a non-functioning communication impede the collaboration within a diverse nursing workforce. Migrant and minority nurses suffer prejudices, verbal and sexual harassment proceeding from their clients. However they keep it to themselves and don't broach it to their supervisors or colleagues. The interaction with humans, the verbal exchange with colleagues and supervisors at eye level as well as the sensemaking of being a nurse helps nurses to cope with occupational stressors. CONCLUSIONS: Differences in language is a main stressor which impedes a functioning team collaboration as well as a positive nurse-client relationship. Migrant and autochthonous nurses share similar coping strategies to master occupational burdens. A good collaboration within the team and having an appreciative supervisor are resources that support migrant and minority nurses as well as autochthonous nurses to face the stressors and to cope with those. Migrant nurses of different origin perceive their status as migrants as a sense of community by sharing commonalities. CONTRIBUTION OF THE PAPER: What is already known about the topic?

Health situation of migrant and minority nurses: A systematic review.

INTRODUCTION: Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses' workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses' health. MATERIALS AND METHODS: A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT). RESULTS: Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries. DISCUSSION: Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses.