Beliefs and challenges held by medical staff about providing emergency care to migrants: an international systematic review and translation of findings to the UK context

Abstract

ObjectiveMigration has increased globally. Emergency departments (EDs) may be the first and only contact some migrants have with healthcare. Emergency care providers’ (ECPs) views concerning migrant patients were examined to identify potential health disparities and enable recommendations for ED policy and practice.DesignSystematic review and meta-synthesis of published findings from qualitative studies.Data sourcesElectronic databases (Ovid Medline, Embase (via Ovid), PsycINFO (via OVID), CINAHL, Web of Science and PubMed), specialist websites and journals were searched.Eligibility criteriaStudies employing qualitative methods published in English.SettingsEDs in high-income countries.ParticipantsECPs included doctors, nurses and paramedics.Topic of enquiryStaff views on migrant care in ED settings.Data extraction and synthesisData that fit the overarching themes of ‘beliefs’ and ‘challenges’ were extracted and coded into an evolving framework. Lines of argument were drawn from the main themes identified in order to infer implications for UK policy and practice.ResultsEleven qualitative studies from Europe and the USA were included. Three analytical themes were found: challenges in cultural competence; weak system organisation that did not sufficiently support emergency care delivery; and ethical dilemmas over decisions on the rationing of healthcare and reporting of undocumented migrants.ConclusionECPs made cultural and organisational adjustments for migrant patients, however, willingness was dependent on the individual’s clinical autonomy. ECPs did not allow legal status to obstruct delivery of emergency care to migrant patients. Reported decisions to inform the authorities were mixed; potentially leading to uncertainty of outcome for undocumented migrants and deterring those in need of healthcare from seeking treatment. If a charging policy for emergency care in the UK was introduced, it is possible that ECPs would resist this through fears of widening healthcare disparities. Further recommendations for service delivery involve training and organisational support.

Suicidal Ideation and Behaviors Among Irish Travellers Presenting for Emergency Care

“…The over-representation of Travellers in the population seen in hospital with SH and SI reflects other studies that suggest Travellers engage with emergency care, but do not avail of routine or preventative services as frequently as the general population (Van Cleemput et al, 2007). Reliance on unscheduled rather than scheduled care is a characteristic of other marginalized groups (Harrison & Daker-White, 2019). Van Cleemput et al (2007) suggested this may be due to societal and gender expectations placed on Traveller men, with emphasis on stoicism, resulting in reluctance to seek care until at crisis point.…”

Nurses’ experiences of emergency care for undocumented migrants who travel by boats

“…The objective of our study was to explore and describe nurses' experiences of providing emergency care to UMs who arrive in Spain by small boats. The increase of migration to the EU comes with caring for UMs (Fotaki, 2019;Sesti et al, 2019), and the need to understand how healthcare providers' experiences can improve care provision (Harrison & Daker-White, 2019;Sevinç et al, 2016). After UMs disembark the small boats, nurses carry out a clinical, humanitarian and social assessment (Kelly, 2019;WHO, 2018).…”

“…This would also be useful for students learning about UM care (Evgin & Muz, 2020). As other studies demonstrate (Harrison & Daker-White, 2019), participants propose having more time to provide care, promoting clinical autonomy, exploring stigma, defending patients (UMs) and safeguarding the care history of UMs as ways to improve the issue (Chiarenza et al, 2019).…”

“…Nurses are in a good position to provide care and satisfy the needs of UMs (ICN, 2015) by performing triage, providing first aid, healing wounds and contributing to their physical and mental wellbeing (Ponce-Blandón et al, 2020). UMs with life-threatening conditions are transferred to the hospital to be cared for by specialists in emergency or critical care (Harrison & Daker-White, 2019). Although there are epidemiological (Eonomopoulou et al, 2016;Ponce-Blandón et al, 2020), demographic (Kadir et al, 2019) and cultural studies focused on UMs (Granero-Molina et al, 2019), little is known about nurses' experiences related to the emergency care provision to UMs who arrive in small boats (López-Domene et al, 2019).…”

Healthcare (im)mobilities and the Covid-19 pandemic: Notes on returning to the field

“…Emergency Rooms, Accident and Emergency services). There is a strong argument for linking these differences with structural and cultural barriers to health: studies in Italy and the UK found that emergency care services were frequently the first (and sometimes only) contact migrants had with the national health system (Di Napoli et al, 2022; Harrison and Daker-White, 2019). This may in part be related to the fact that, for many origin countries, the hospital is the first (or only) point of access to the healthcare system, but it also speaks to these services’ greater flexibility and responsiveness.…”