Understanding how Eastern European migrants use and experience UK health services: a systematic scoping review.

BACKGROUND: The UK has experienced significant immigration from Eastern Europe following European Union (EU) expansion in 2004, which raises the importance of equity and equality for the recent immigrants. Previous research on ethnic health inequalities focused on established minority ethnic groups, whereas Eastern European migrants are a growing, but relatively under-researched group. We aimed to conduct a systematic scoping review of published literature on Eastern European migrants' use and experiences of UK health services. METHODS: An initial search of nine databases produced 5997 relevant publications. Removing duplicates reduced the figure to 2198. Title and abstract screening left 73 publications. Full-text screening narrowed this down further to 10 articles, with three more from these publications to leave 13 included publications. We assessed publications for quality, extracted data and undertook a narrative synthesis. RESULTS: The included publications most commonly studied sexual health and family planning services. For Eastern European migrants in the UK, the most commonly cited barriers to accessing and using healthcare were limited understanding of how the system worked and language difficulties. It was also common for migrants to return to their home country to a healthcare system they were familiar with, free from language barriers. Familial and social networks were valuable for patients with a limited command of English in the absence of suitable and available interpreting and translating services. CONCLUSIONS: To address limited understanding of the healthcare system and the English language, the NHS could produce information in all the Eastern European languages about how it operates. Adding nationality to the Electronic Patient Report Form (EPRF) may reveal the demand for interpretation and translation services. Eastern European migrants need to be encouraged to register with GPs to reduce A&E attendance for primary care conditions. Many of the issues raised will be relevant to other European countries since the long-term outcomes from Brexit are likely to influence the level of Eastern European and non-Eastern European migration across the continent, not just the UK.

Managing COPD using pulmonary rehabilitation: a literature review.

This article presents a literature review of the benefits of pulmonary rehabilitation in the management of chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation has been shown to decrease patient mortality and hospital admissions. The literature search resulted in 13 articles being selected for review. Three themes were identified: improvement in exercise tolerance, improvement in breathlessness and improvement in health-related quality of life. This review enhances our knowledge of the mechanisms through which pulmonary rehabilitation benefits patients and provides an evidence base to guide nursing decisions regarding patient education, health promotion and psychological support.

Experiencing transformation: the case of Jordanian nurse immigrating to the UK.

AIMS AND OBJECTIVES: This study explored how Jordanian nurses experienced the transition from home to host country to illuminate the elements of transformation. BACKGROUND: Much research has been conducted on topics such as the current international nursing shortage and the recruitment of nurses from various countries. International nurses have unique needs with regard to adapting to new host cultures and workplaces; furthermore, the literature has revealed little evidence of nurses' professional and personal experiences related to migration. DESIGN: A qualitative study was conducted, collecting data via individual interviews. METHODS: Twenty-five face-to-face and telephone interviews with Jordanian migrant nurses. RESULT: This study showed that living and working in a host country changes the personal, social and professional attributes of migrant nurses. When nurses migrate, they encounter opportunities and significant challenges in their professional and personal lives. Although Jordanian nurses contributed their knowledge and skills to the UK healthcare system, they encountered enormous professional adaptation demands. Work setting discrepancies between source and host country are likely a major element behind the required nursing profession alteration. nurses' lives are transformed in terms of their personal and social networks in the host country. CONCLUSIONS: Social transformation is an integral and inseparable part of engagement with professional organisation(s) in the host community. Professional integration likely has far-reaching effects and consequences involving not only the individual but also their home and host country families and their professional networks. RELEVANCE TO CLINICAL PRACTICE: To provide high-quality nursing care, we must learn about the transformation experience, expand our sense of who we are and gain a degree of control over how we perform our nursing roles when we move away from our home.

Learning to promote patient dignity: an inter-professional approach.

The promotion of patient dignity is an important aspect of healthcare provision. However, there is evidence to suggest that patient dignity is not being promoted as expected and a number of attributing factors have been suggested in the literature. This article proposes that healthcare educators should incorporate the subject of dignity in its own right within the curriculum. Attempts in teaching the concept of dignity have tended to adopt an uni-professional approach: this paper proposes that inter-professional education (IPE) is the most suitable approach in teaching the issues relating to dignity in healthcare.

How does it really feel to be in my shoes? Patients' experiences of compassion within nursing care and their perceptions of developing compassionate nurses.

AIMS AND OBJECTIVES: To understand how patients experience compassion within nursing care and explore their perceptions of developing compassionate nurses. BACKGROUND: Compassion is a fundamental part of nursing care. Individually, nurses have a duty of care to show compassion; an absence can lead to patients feeling devalued and lacking in emotional support. Despite recent media attention, primary research around patients' experiences and perceptions of compassion in practice and its development in nursing care remains in short supply. DESIGN: A qualitative exploratory descriptive approach. METHODS: In-depth, semi-structured interviews were conducted with a purposive sample of 10 patients in a large teaching hospital in the United Kingdom. Interviews were digitally recorded and transcribed verbatim. Thematic networks were used in analysis. RESULTS: Three overarching themes emerged from the data: (1) what is compassion: knowing me and giving me your time, (2) understanding the impact of compassion: how it feels in my shoes and (3) being more compassionate: communication and the essence of nursing. CONCLUSION: Compassion from nursing staff is broadly aligned with actions of care, which can often take time. However, for some, this element of time needs only be fleeting to establish a compassionate connection. Despite recent calls for the increased focus compassion at all levels in nurse education and training, patient opinion was divided on whether it can be taught or remains a moral virtue. Gaining understanding of the impact of uncompassionate actions presents an opportunity to change both individual and cultural behaviours. RELEVANCE TO CLINICAL PRACTICE: It comes as a timely reminder that the smallest of nursing actions can convey compassion. Introducing vignettes of real-life situations from the lens of the patient to engage practitioners in collaborative learning in the context of compassionate nursing could offer opportunities for valuable and legitimate professional development.

Patients' expectations of the maintenance of their dignity.

AIMS AND OBJECTIVES: To explore patients' views regarding the factors that contribute to the maintenance of their dignity while in hospital, together with their perceptions of whether or not these were realised. BACKGROUND: It has long been recognised that a consideration of patients' dignity in the hospital setting is of paramount importance and its maintenance can contribute to the 'emotional comfort' that may assist recovery. There have been several attempts to define dignity as a theoretical concept, but few studies of the factors that contribute to its maintenance from the patients' perspective. DESIGN: A phenomenological hermeneutic approach was used. METHOD: Interviews were conducted with 102 patients in three hospitals in the UK over 18 months. The intention was to interpret what was being said and also the underlying meaning of how patients considered that their dignity was compromised. RESULTS: The findings revealed that although many patients were satisfied with the maintenance of their dignity while in hospital, a significant number were not. Six key themes that contribute to the preservation of their dignity were identified -- privacy; confidentiality; communication and the need for information; choice, control and involvement in care; respect and decency and forms of address. Patients provided details of their expectations with respect to these factors. CONCLUSIONS: Patients, irrespective of their situation and degree of health have their own expectations in relation to their dignity. These need to be assessed and matched by relevant nursing activities to assist recovery. RELEVANCE TO CLINICAL PRACTICE: Nurses have an important role in meeting patients' expectations of how they would like their dignity to be maintained. The identification of the most important factors that contribute to this from patients' perspective will help develop dignified nursing practice.

Promoting patient dignity in healthcare settings.

Dignity is important to every individual, irrespective of the situation in which they find themselves, including healthcare settings. This article aims to heighten awareness of patient dignity, encourage readers to reflect on the concept and apply it to practice. Self-awareness of knowledge, skills and attitude is a prerequisite for supporting patient dignity. Using personal and professional knowledge, readers will reflect on practice to identify factors that influence the maintenance of patient dignity and develop strategies to promote and support it in clinical practice.

The enquiry-based learning experience: An evaluation project.

A research and nursing development initiative group consisting of health lecturers and lecturer practitioners set out to evaluate how learners and teachers felt about the introduction of an enquiry based learning (EBL) approach to education. Five focus groups, teachers (1 group) post-registration students (1 group) and pre-registration diploma students (3 groups) were interviewed. Discussions were tape recorded, transcribed, and analysed. The results revealed that students and teachers held disparative views on the efficiency of EBL. Teachers, surprisingly, felt more doubtful and discouraged than learners. Several concerns were raised over the ability of EBL to establish a foothold in a curriculum more noted for a pedagogical stance on learning.

Perceptual adjustment levels: patients' perception of their dignity in the hospital setting.

Dignity is an important concept which lies at the heart of nursing. Despite the statements made by various international bodies, as a concept it remains complex and under researched. This is because it needs to be understood from the patient's point of view and experience. This empirical study explores the concept in terms of the actual circumstances of patients in hospital. Through a large number of semi-structured interviews it reveals the relationship between 'normal' ideas of self-respect and self-esteem, and those experienced during the trauma of being ill and helpless, and the ways in which patients adjust to these circumstances. Through the realisation of the importance of 'necessary submission' to the power of others, the evidence creates a concept of 'perceptual adjustment level' through which we can understand the importance of matching patient needs to nursing care. This has crucial relevance to nursing.