Andreas W Gold, Clara Perplies, Louise Biddle, Kayvan Bozorgmehr
{"title":"Primary healthcare models for refugees involving nurses: a systematic review and narrative synthesis.","authors":"Andreas W Gold, Clara Perplies, Louise Biddle, Kayvan Bozorgmehr","doi":"10.1136/bmjgh-2024-018105","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Primary healthcare (PHC) is key to addressing the health and social needs of refugees. Nurses are often part of multidisciplinary teams in PHC, but little is known about their roles and responsibilities in refugee healthcare. We aimed to synthesise the existing knowledge about models of care (MoC) for refugees in primary care settings which involve nursing professionals.</p><p><strong>Methods: </strong>Systematic review, searching PubMed, CINAHL and Web of Science for scientific literature, as well as Google Search and Scholar, Microsoft Bing and DuckDuckGo for grey literature. We included publications that reported MoC for refugees in primary care which involve nursing professionals. Following a relevancy rating, we extracted information about structural components (setting, target population, available services, funding and workforce composition), and inductively coded the roles and responsibilities of nurses within these models. Data were synthesised using qualitative and narrative synthesis.</p><p><strong>Results: </strong>We included 120 publications in the review. Of these, 67 (56%) provided in-depth insights into MoC and nurse involvement and were included for narrative synthesis, yielding 49 MoC mainly from high-income countries. Most MoCs identified to set up parallel healthcare structures (specialised-focus services) that refugees can access for a limited period of time or targeting specific conditions in a vertical approach. However, some of the MoCs we studied focus on referral support as gateway services or are embedded in mainstream services. Nurses in these models typically experience a high degree of autonomy within defined responsibilities, encompassing clinical, administrative, educational and coordinating tasks.</p><p><strong>Conclusions: </strong>Nurses take on key roles in parallel healthcare structures for refugees, and specially trained nurses are well positioned to facilitate the integration of refugees into mainstream healthcare. Future research into the long-term impact of existing models, identifying best practices and defining competency requirements for healthcare workers/nurses in refugee care may foster evidence-based policy and practice improvements.</p><p><strong>Prospero registration number: </strong>CRD42020221045.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1000,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931958/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Global Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjgh-2024-018105","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Primary healthcare (PHC) is key to addressing the health and social needs of refugees. Nurses are often part of multidisciplinary teams in PHC, but little is known about their roles and responsibilities in refugee healthcare. We aimed to synthesise the existing knowledge about models of care (MoC) for refugees in primary care settings which involve nursing professionals.
Methods: Systematic review, searching PubMed, CINAHL and Web of Science for scientific literature, as well as Google Search and Scholar, Microsoft Bing and DuckDuckGo for grey literature. We included publications that reported MoC for refugees in primary care which involve nursing professionals. Following a relevancy rating, we extracted information about structural components (setting, target population, available services, funding and workforce composition), and inductively coded the roles and responsibilities of nurses within these models. Data were synthesised using qualitative and narrative synthesis.
Results: We included 120 publications in the review. Of these, 67 (56%) provided in-depth insights into MoC and nurse involvement and were included for narrative synthesis, yielding 49 MoC mainly from high-income countries. Most MoCs identified to set up parallel healthcare structures (specialised-focus services) that refugees can access for a limited period of time or targeting specific conditions in a vertical approach. However, some of the MoCs we studied focus on referral support as gateway services or are embedded in mainstream services. Nurses in these models typically experience a high degree of autonomy within defined responsibilities, encompassing clinical, administrative, educational and coordinating tasks.
Conclusions: Nurses take on key roles in parallel healthcare structures for refugees, and specially trained nurses are well positioned to facilitate the integration of refugees into mainstream healthcare. Future research into the long-term impact of existing models, identifying best practices and defining competency requirements for healthcare workers/nurses in refugee care may foster evidence-based policy and practice improvements.
初级保健是解决难民健康和社会需要的关键。护士通常是初级保健多学科团队的一部分,但人们对她们在难民医疗保健中的作用和责任知之甚少。我们的目的是综合现有的关于初级保健机构中涉及护理专业人员的难民护理模式(MoC)的知识。方法:系统综述,科学文献检索PubMed、CINAHL、Web of Science,灰色文献检索谷歌Search and Scholar、Microsoft Bing、DuckDuckGo。我们纳入了报告初级保健中涉及护理专业人员的难民MoC的出版物。根据相关性评级,我们提取了有关结构成分(环境、目标人群、可用服务、资金和劳动力组成)的信息,并在这些模型中归纳编码护士的角色和责任。数据采用定性和叙述性综合方法进行综合。结果:我们纳入了120篇文献。其中67项(56%)提供了对产妇护理和护士参与的深入见解,并纳入叙述综合,其中49项产妇护理主要来自高收入国家。大多数MoCs确定建立平行的保健结构(专门重点服务),难民可以在有限的时间内使用,或以垂直方式针对特定情况。然而,我们研究的一些moc将转诊支持作为网关服务或嵌入到主流服务中。在这些模式中,护士通常在明确的职责范围内具有高度的自主权,包括临床、行政、教育和协调任务。结论:护士在难民平行医疗结构中发挥着关键作用,受过专门培训的护士能够很好地促进难民融入主流医疗保健。未来对现有模式的长期影响的研究,确定最佳做法和确定保健工作者/护士在难民护理方面的能力要求,可能会促进基于证据的政策和实践改进。普洛斯彼罗注册号:CRD42020221045。
期刊介绍:
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.