University of California Irvine, USA.
University of Nevada, Las Vegas, USA.
Clin Nurs Res. 2024 Jun;33(5):292-300. doi: 10.1177/10547738241253655. Epub 2024 May 30.
Healthcare providers working with forcefully displaced populations often have limited knowledge and skills regarding the care of this population. The reasons are twofold. First, most of the research on refugee health does not consider refugees' adaptive skills, diversity of experiences, and daily life context. Second, healthcare providers' knowledge of how the sociopolitical environment shapes health research and practice in the context of refugee care is often limited. This work aims to specify gaps in refugee healthcare and research by applying a relational approach to three theoretical frameworks. The relational approach supports a pragmatic, in-depth understanding of healthcare practices by shifting the focus of the inquiry from description of social structures toward exploration of processes and relations that propagate and sustain such structures. The focus is on the threefold interaction between refugees, healthcare providers, and healthcare institutions. The three theoretical frameworks are as follows: First, using concepts from the Theory of Practice by Bourdieu, we examine how gaps in care can result from a mismatch between the dispositions and skills that refugees develop through life experience and the cultural-professional practices of healthcare providers in host countries. Second, the Cultural Determinants of Help Seeking by Saint Arnault is applied to posit that gaps in care can result from differences in the meanings that healthcare providers and refugees assign to their interactions. Finally, we use the concept of Othering as described in nursing by Canales to explain how power dynamics inherent in the interaction between refugees and healthcare systems can affect refugee healthcare and research. This relational approach helps to elucidate some of the culture-bound mechanisms of health maintenance and help-seeking and brings attention to the sociopolitical context that shapes the way we care to refugees.
医疗服务提供者在为被迫流离失所的人群提供服务时，往往对这部分人群的护理知识和技能有限。原因有二。首先，大多数关于难民健康的研究都没有考虑到难民的适应能力、经历的多样性和日常生活背景。其次，医疗服务提供者对社会政治环境如何影响难民护理健康研究和实践的了解往往有限。本研究旨在通过应用关系方法来确定难民医疗保健和研究中的差距，该方法将研究的重点从对社会结构的描述转移到对促进和维持这些结构的过程和关系的探索上，从而支持对医疗保健实践的务实、深入理解。重点关注难民、医疗服务提供者和医疗机构之间的三重相互作用。这三个理论框架如下：首先，使用布迪厄的实践理论中的概念，我们考察了由于难民通过生活经验发展的性格和技能与东道国医疗服务提供者的文化专业实践之间的不匹配，护理差距是如何产生的。其次，圣阿诺尔特的求助文化决定因素被应用于假设护理差距可能是由于医疗服务提供者和难民对其互动赋予不同的意义而产生的。最后，我们使用护理中坎纳尔斯描述的“他者化”概念来解释难民和医疗系统之间的互动中固有的权力动态如何影响难民的医疗保健和研究。这种关系方法有助于阐明一些健康维护和求助的文化束缚机制，并引起对塑造我们为难民提供护理方式的社会政治背景的关注。
