Core components in the care of immigrants with psychoses: A Delphi survey of patients, families, and health-care staff

Abstract

The aim of the present study was to identify core components in the care of immigrants with psychosis in Sweden. Experts (n=43) from different perspectives (immigrants, families, and health-care staff) were assembled and used to score the importance of statements regarding components in the care for a person with psychosis in three questionnaire rounds. After each round, the opinions were consolidated and compared to identify whether consensus was reached. Consensus was reached about the importance of being treated on equal terms, regardless of country of birth. Staff interest and respect, shown in different ways of understanding, was valued. Consensus could not be reached on approximately half of the statements, of which four tended to be ranked towards unimportant. Those included that staff should have specific cultural knowledge or that the patient should be allowed to decide whether to be cared for by male or female staff. Nor was it regarded as important to identify a person's religious or ethnic background. The results illustrate the importance of fundamental psychiatric nursing, which should enable nurses to identify and meet the basic needs of all patients, regardless of country of origin. Areas for which consensus was not reached illustrate a future challenge for health-care staff to identify situations when cultural clashes could appear. Staff should have strategies to accomplish cultural negotiations to build an effective treatment alliance with the patient, as well as the family, to meet individual needs.

The wishes of outpatients with severe mental disorders to discuss spiritual and religious issues in their psychiatric care

“…Th ose results are in line with those obtained in Qu é bec in a quite similar population: 22% of subjects had S/R goals unmet by the off ered services (Lecomte et al 2005). Such discrepancies were also elicited in a Swedish study of immigrants with psychosis showing that the greatest diff erences between health-care staff , patients, and families involved religious issues (Hultsj ö et al 2011). In psychiatric hospitals, patients ' spiritual needs may be even greater, 88% in US (Fitchett et al 1997) and 85% in Brazil (Lucchetti et al 2012).…”

“It is a challenge to do it the right way”: an interpretive description of caregivers’ experiences in caring for migrant patients in Northern Sweden

“…These challenges are said to influence medical encounters and can result in mistrust that may lead to sub-optimal utilization of health services, frustrations and calamitous errors in diagnosis and treatment regimens [7-10,15,16]. Literature on cross-cultural health care indicates that migrant populations present unique challenges to health professionals, and can be a source of frustration for health professionals as they may struggle with uncertainty and apprehension when caring for these patients [6-13,15,17,18].…”

“…Previous studies suggest that caring for patients who speak a different language is difficult because of lack of or unavailability of interpreters or problems in accessing interpreter agencies, which in some cases force care providers to use family members as interpreters. Even when interpreters are used communication problems persist due to cultural differences and low professional status of interpreters [6,7,10,18,19]. …”

“…Some authors, however, acknowledge that health care professionals working among migrant communities are increasingly challenged to provide health care that is responsive to the special health needs of these populations [7,10,11,13-16]. Identifying potential challenges is thus important for successful healthcare delivery to these populations.…”

“…After this first contact, migrants are expected to make contact and interact with health care providers like other Swedish residents when they need care. Despite the recommendation to offer language assistance and use interpreters when caring for patients who do not speak or understand Swedish, studies have shown that care providers still face complex challenges identifying and meeting the basic needs of patients from culturally diverse populations [6,7,10,19,25,26]. According to Szczepura, in countries and regions with diverse population, there is extensive evidence on the need for cultural and linguistic competence in health care organizations [10].…”