The purpose of the study was to explore the encounters with the health care system in Sweden of women from Somalia, Eritrea, and Sudan who have been genitally cut. A qualitative study was performed through interviews with 22 women originally from Somalia, Sudan, and Eritrea who were living in Sweden. The women experienced being different and vulnerable, suffering from being abandoned and mutilated, and they felt exposed in the encounter with the Swedish health care personnel and tried to adapt to a new cultural context. The results of this study indicate a need for more individualized, culturally adjusted care and support and a need for systematic education about female genital cutting for Swedish health care workers.
Unparalleled challenges currently face the Native American health care system. These challenges are a result of several factors, including (a) external pressures to reduce the overall cost of health care in the United States, (b) increased assumption of responsibility for delivery of health care by tribal governments, (c) decreased direct supervision by the Indian Health Service (IHS), (d) insufficient funding for Indian health care, and (e) increased interest of managed care to contract with tribal service units for health care. This article explores the opportunities and challenges facing Native American health care delivery and examines nursing policy issues pertinent to the current state of the IHS.
Cultural challenges in end-of-life care: reflections from focus groups' interviews with hospice staff in Stockholm During the past few decades, Swedish society has changed from a society with a few ethnic groups to one with over a hundred groups of different ethnic backgrounds, languages and religions. As society is becoming increasingly multicultural, cultural issues are also becoming an important feature in health care, particularly in end-of-life care where the questions of existential nature are of great importance. However, cultural issues in health care, especially at hospices, have not been studied sufficiently in Sweden. The purpose of this study was to gather reflections about cultural issues among hospice staff after a 3-day seminar in multicultural end-of-life care, by using a qualitative focus groups method. The 19 participants (majority nurses) were divided into three groups, one per hospice unit. A discussion guide was developed with the following themes: 1) post-training experiences of working with patients with multicultural background; 2) experiences gained by participating in the course of multicultural end-of-life care; 3) post-training reflections about one's own culture; 4) ideas or thoughts regarding work with patients from other cultures arising from the training; and 5) the need for further training in multicultural end-of-life care. One of the study's main findings was that to better understand other cultures it is important to raise awareness about the staff's own culture and to pay attention to culture especially in the context of the individual. The findings from focus groups provide insight regarding the need for planning flexible training in cultural issues to match the needs of the staff at the hospice units studied.
The Association of American Indian Physicians, the only national organization of its kind, conducted a series of focus groups to gather input from tribal leaders, Indian health professionals, and American Indian community members to guide the development of culturally appropriate diabetes education materials for the National Diabetes Education Program.
During the focus groups, participants shared their experiences with and recommendations for a variety of diabetes education materials.
Overall, 95% of participants expressed a strong preference for diabetes education materials relevant to their specific tribe or culture.
Recommendations from these focus groups were used to develop a national diabetes education campaign for American Indian communities.
Refugees needing long-term health care must adapt to new healthcare systems. The aim of this study was to examine the viewpoints of nine refugees in a county in Sweden, with a known chronic disease or functional impairment requiring long-term medical care, on their contacts with care providers regarding treatment and personal needs.
Semi-structured interviews with nine individuals and/or their next of kin. Inductive content analysis was used to identify experiences.
''Care organisations/resources'' and ''professional competence'' were the categories extracted. Participants felt cared for due to accessibility to and regular appointments with the same care provider. Visiting different clinics contributed to a negative experience and lack of trust. The staff 's interest in participants' lives and health contributed to a sense of professionalism. Most participants said the problems experienced were not related to their backgrounds as refugees. Many patients did not fully understand which clinic they were attending or the purpose of the care that the specific clinic provided. Some lacked knowledge of their disease.
Health care was perceived as equal to other Swedish citizens and problems experienced were not explained by refugee backgrounds. Lack of information from care providers and being sent to various levels of care created feelings of a lack of overall medical responsibility.
The aim of the study was to describe how foreign-born and Swedish born families living in Sweden perceive psychosis care. Eleven foreign-born and 15 Swedish-born family members were interviewed and the data were analyzed using a phenomenographic approach. The findings showed three main descriptive categories: taking responsibility, access to care, and attitudes to psychosis. The degree of responsibility in the family decreased if there was easy access to care and support from health-care staff. Knowledge of psychosis was considered to be important in order to counteract prejudiced attitudes in the family and the community. Foreign-born families did not want to be treated differently from Swedes and stressed the importance of finding ways to communicate despite communication barriers. Foreign-born families also were affected by their experiences of psychiatric care and different beliefs about psychosis in their home country. The results indicate how important it is that health-care staff members treat families on equal terms. It is necessary to take the time to identify how to communicate in a good manner and to identify families' previous experiences of and beliefs about psychosis care in order to help families face prejudice in society and to see beyond the psychosis.
BACKGROUND: During the past few decades Sweden has developed into a multicultural society. The proportion of patients with different cultural backgrounds increases, which naturally makes new demands on health care staff. AIM: To identify whether staff in somatic and psychiatric emergency care experienced problems in the care of migrants, and if so to compare these. METHOD: The study design was explorative. Focus group interviews of 22 women and 13 men working as nurses and assistant nurses at an emergency ward, an ambulance service and a psychiatric intensive care unit were held. FINDINGS: The results showed that the main problems experienced in all wards were difficulties related to caring for asylum-seeking refugees. Some dissimilarities were revealed: unexpected behaviours in migrants related to cultural differences described by staff working in the emergency ward; migrants' refusal to eat and drink and their inactive behaviour in the psychiatric ward; and a lot of non-emergency runs by the ambulance staff because of language barriers between the emergency services centre and migrants. CONCLUSION: The main problems experienced by the health care staff were situations in which they were confronted with the need to care for asylum-seeking refugees. PRACTICE IMPLICATIONS: These emphasize the importance of support from organizational structures and national policies to develop models for caring for asylum-seeking refugees. Simple routines and facilities to communicate with foreign-language-speaking migrants need to be developed. Health care staff need a deeper understanding of individual needs in the light of migrational and cultural background.
Indigenous people are among the ethnic minorities who encounter palliative care services. This research shows that Irish Travellers have little experience of specialist palliative care and that specialist palliative care providers have little knowledge or experience of Irish Travellers. Characteristics of Irish Travellers culture including the importance of hope, avoidance of open acknowledgment of death, the importance of family and the avoidance of the place of death (including moving away or burning caravans where death has occurred) challenge the provision of specialist palliative care. Individualisation of patient care, a feature of specialist palliative care can help staff provide appropriate care.
The study investigates the occurrence and character of skepticism and resistance towards ethnic minority care workers among older care recipients in a municipality in Sweden. Twelve representatives of caregiver organizations were interviewed about their experience of this phenomenon. Three additional interviews were conducted with ethnic minority care workers. Representatives described the problem as rare and mostly occurring as language difficulties or as a temporary problem characterized as a fear of the unknown among some care recipients. They tended to apply a pragmatic or pathologizing approach when talking about causes of and solutions to the problem. These approaches enabled care providers to comply with "potential racism" without challenging an official ideology of anti-racism. In contrast, staff of foreign descent described the problem as more frequent and severe, particularly for short-term employees who experience many first-time encounters with care recipients.