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  • University : Autralian Catholic University
  • Subject Name : Nursing

Nurses’ Role in Mental Health of Refugee Community

Nurses are often the first point of contact for the patients within the healthcare system and they have the responsibility to make sure that they are able to get the help that is required (Townsend & Morgan, 2017). Nurses can be seen to be working in institutional care, hospital care, residential care setting, and community care setting. The type of people that nurses’ face in each of the setting is different and the roles of the nurses and the way in which the people can be helped vary as per the setting and people seeking help (Salmond & Echevarria, 2017).

In a community care setting nurses have more autonomy compared to a hospital care setting and the nurses take the role of a leader, educator, and responsible for maintenance of record of health and illness in a community. Due to reasons like being of socio-economic disadvantage or belonging to a different cultural background few of the groups of the society can be called a disadvantaged community (Haslam et al., 2018). One such community that will be considered for the present essay is the refugee community. The aim of the present essay is to discuss how a nurse will work in a disadvantaged community by using a strength-based approach to tackle a medical issue which is considered as a national health priority.

Background

A refugee is someone who is not originally of the country whose context is being discussed. In the present context, a refugee is someone who is not of Australian origin and has fear of persecution due to race, religion, nationality, due to belonging to a particular social group (Parliament of Australia, 2016). A refugee is someone who does not wish to return back to his/her country due to the fear of being persecuted. An asylum seeker is different from refugee as a refugee has the claims mentioned above assessed and satisfied.Though Australia is one of the countries that come under the United Nations to accept refugees the ultimate decision to grant the visas to them lies with the immigration department of Australia (Parliament of Australia, 2016).

There are four different categories of offshore refugee visa that is provided that is, refugee; in-country special humanitarian; emergency rescue and women at risk. In the year 2012-13, Australia has accepted 6,500 visas out of the 35,000 applications. There is also a provision of onshore visa in Australia depending on the visa application. The duration for the visa application that takes to get granted the refugees are often kept in detention centres (Miller & Rasmussen, 2017). These detention centres are both onshore and offshore. The main aim of these detention centres is to know the health statistics of the refugee in terms of vaccination schedule of pregnant women and children.

Also, if there is any communicable or non-communicable disease prevalent among them. It is seen that being in these detention centres are considered a traumatic event and the worst affected among them are the children. This affects them on a psychological level and it is the basis of mental health problem among the refugees (Miller & Rasmussen, 2017). Once they are granted visas, the refugees of the same cultural or belonging to the same country often seek dwelling together making them communities. In the year of 2017, it was seen that the maximum refuges were from Malaysia followed by China and similar numbers were seen from India and Vietnam as well.

Mental Health in Refugees

There are many things that have an impact on the mental health of people who are called refugees. Refugees, before they are given residency in the country, are kept in detention centres either onshore as well as offshore. There are many things that are in a detention centre which affect the mental health which is similar and often called as post-traumatic stress disorder (Shawyer et al., 2017). Children are the most affected by this as there can be separation from family and this stress does not get over at the detention centre but it is seen throughout life. It was seen that when compared to the families and people who are from the Australian background, the refugees reported to have poor overall health and faced more psychological stress (Giallo et al., 2017).

The adults who have been living in Australia from a long time or they migrated when they were kids have faced discrimination and racism. These act as social determinants in the mental health of the people and there is an existent obvious health disparity. Mental health problems are profound in the world and it is seen that almost everyone at some point in their life face mental health problems (Giallo et al., 2017). In Australia, almost 50% of people have faced mental illness at some point of life and it is proportionately more in the refugee community. Refugees often face social exclusion and it is attributed to many things and social media is one such thing (Miller & Rasmussen, 2017).

The impact is seen in the health of the refugees. It is due to factors like global politicization and backlash that is seen against refugees, negative perception of Australians towards refugees and partial increased reporting of violence by refugee youths (MacDonald, 2017).A study was conducted where a self-administered questionnaire was given to refugees from Bhutan and Nepal to assess their mental health status. It was seen that the participants reported that there was a high level of anxiety and a moderate level of depression (Lumley et al., 2018). These were attributed to acculturation, maladaptive coping style, their age and education.

Role of Nurses

Nurses are expected to work in the setting that they have been kept in so that the better health outcomes of these people can be achieved. There are various roles that a nurse is supposed to fulfill while working for the mental health of the refugee community as it can come as a role of a psychiatric nurse or community health nurse or even in emergency care (Wylie et al., 2019). One of the expectations from the nurse is in such a way that the approaches taken by the nurses are strength-based. The strength of the community is to be recognized and it has to be taken towards the empowerment and the elements of the community are used for its betterment.

One such health initiative that is present and that as a nurse can be utilized for the betterment of mental health of children from refugee background is a school-based refugee clinic.This is already in function since 2012 in New South Wales which is a refugee health service which is operative once a week in the high school in Southwestern Sydney (Yayan, 2018). It was seen that with the commencement of this clinic there was the development of trust between the children, their families and the healthcare system. A nurse working in the community can utilize the refugee health clinic to reach the children to gain trust and rapport is created so that they can gain access to healthcare services (McBride et al., 2017). It is an apt environment in which a nurse can work with the children which can be considered as one-stop of healthcare for the children and it is required as they are the one who is most affected by the refugee-like environment.

As suffering from refugee status, it is seen that the children missed education and as a result, they would not want to miss school days for mental health. This school in NSW is an example which is opened in collaboration with the local community (Yayan, 2018). For children from refugee background, school often acts as the main support system and as they gave attention and such environment to the children in which they can be more relaxed and open about their feelings and how things affect their mental health (Ziersch et al., 2017). Nurses can act as a leader to suggest such refugee oriented clinics in other parts of Australia as well where the refugee community is seen more. As a nurse working with the refugee community, a nurse is expected to be a bridge between the community as well as the policymakers so that the health problems can be identified and necessary decisions can be made.

Another thing that the nurse in a community setting can do to provide appropriate referral to the children and adults in the community when and if required. The healthcare facilities for the disadvantaged community are fragmented such that often many mental health problems are undiagnosed (Boyle et al., 2019). The problem is more profound in the children and nurses being the first point of contact play most important role in the identification of mental health problems and to give appropriate referrals. Psychiatric help is one of the specialist areas which require care and referral to a general practitioner is important.

The actions taken by the nurses should be such that it is in accordance with the needs and the resources that are present in a particular community (Turda, 2017). There are many actions that are taken by the governments of Australia to reduce the health disparity including mental health between the refugee population and people with an Australian background. One such measure is the establishment of primary health centres in areas where the refugee communities are more. It is seen that there is the inequitable distribution of healthcare services including the infrastructure of primary healthcare centres and also the maldistribution of the healthcare professionals (Turda, 2017). In a community setting, the nurses often have more autonomy and play more roles for the better provision of care as in many refugee communities nurses are the only healthcare professionals.

Role of Nurses as An Educator

Nurses are often the most prominent form of healthcare to the refugee and a nurse working in the community with refugees should work in such a way that they provide education to the refugees (Ogunsiji et al., 2018). Education should be such that people become aware of the importance of good mental health. This education can be provided to adults and children in a different setting. The nurse can take measures to collaborate with the sectors of education and health so that children can be educated about mental health so that they are able to recognize the signs of mental illness and they can seek help as when it is required.

Educating children can help in the education of the whole family. For the education of the adult population, the nurse should work in collaboration with the local community so that more people can attend the state-run primary health centre where counselling and education can be provided (Stanhope et al., 2019). By taking lessons from Aboriginal liaison, there is a nurse-led initiative that is started which is refugee health nurse liaison which can cater to the mental health needs of the refugee population (McBride et al., 2016).

Nurses often do not get adequate support from the systems, stakeholders and acceptance from the community for which the care is being catered to. Another challenge that is faced by nurses working in the community with refugees is that the role of nurses in not defined and it should change as per the requirement of the community (Ogunsiji et al., 2018). It is important that these challenges are addressed so that care for the disadvantaged community is appropriate.

In conclusion, the disadvantaged community can be called so due to various reasons including socioeconomic conditions and it is often seen that they have health disparity. Nurses are the first point of contact in the community and they play a variety of role in a community. In the present essay, the disadvantaged community that is considered is a refugee and the national health action area is mental health. Every year many refugees migrate to Australia and they are subject to many factors which may lead to mental health problems like anxiety and depression in adults as well as children. As a nurse working with the community education can be provided to children and adults. The clinic can be associated with schools so that children can seek mental health relief without the feeling of threat. Nurses should work in collaboration with community and such that community is empowered to give the required services to the community of refugees.

References

Boyle, J. A., Willey, S., Blackmore, R., East, C., McBride, J., Gray, K., ...& Gibson-Helm, M. (2019). Improving mental health in pregnancy for refugee women: protocol for the implementation and evaluation of a screening program in Melbourne, Australia. JMIR Research Protocols, 8(8), e13271. https://www.researchprotocols.org/2019/8/e13271/.

Giallo, R., Riggs, E., Lynch, C., Vanpraag, D., Yelland, J., Szwarc, J., ...& Brown, S. J. (2017). The physical and mental health problems of refugee and migrant fathers: Findings from an Australian population-based study of children and their families. BMJ Open, 7(11).http://dx.doi.org/10.1136/bmjopen-2016-015603.

Haslam, C., Jetten, J., Cruwys, T., Dingle, G., &Haslam, A. (2018).Social status and disadvantage.In The New Psychology of Health (pp. 56-82).Routledge.

Lumley, M., Katsikitis, M., & Statham, D. (2018).Depression, anxiety, and acculturative stress among resettled Bhutanese refugees in Australia. Journal of Cross-Cultural Psychology, 49(8), 1269-1282. https://doi.org/10.1177/0022022118786458.

MacDonald, F. (2017).Positioning young refugees in Australia: Media discourse and social exclusion. International Journal of Inclusive Education, 21(11), 1182-1195. https://doi.org/10.1080/13603116.2017.1350324.

McBride, J., Block, A., & Russo, A. (2017). An integrated healthcare service for asylum seekers and refugees in the south-eastern region of Melbourne: Monash health refugee health and wellbeing. Australian Journal of Primary Health, 23(4), 323-328. https://doi.org/10.1071/PY16092.

McBride, J., Russo, A., & Block, A. (2016). The refugee health nurse liaison: A nurse led initiative to improve healthcare for asylum seekers and refugees. Contemporary Nurse, 52(6), 710-721. https://doi.org/10.1080/10376178.2016.1238774.

Miller, K. E., & Rasmussen, A. (2017). The mental health of civilians displaced by armed conflict: An ecological model of refugee distress. Epidemiology and Psychiatric Sciences, 26(02), 129–138. https://doi.org/10.1017/S2045796016000172.

Ogunsiji, O., Ng Chok, H., Mashingaidze, G., & Wilkes, L. (2018). “I am still passionate despite the challenges”: Nurses navigating the care for refugees. Journal of Clinical Nursing, 27(17-18), 3335-3344.https://doi.org/10.1111/jocn.13863.

Parliament of Australia. (2016). Refugee resettlement to Australia: What are the facts?.https://apo.org.au/sites/default/files/resource-files/2015-02/apo-nid52632.pdf.

Salmond, S. W., &Echevarria, M. (2017).Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(1), 12.https://doi.org/10.1097/NOR.0000000000000308.

Shawyer, F., Enticott, J. C., Block, A. A., Cheng, I. H., & Meadows, G. N. (2017). The mental health status of refugees and asylum seekers attending a refugee health clinic including comparisons with a matched sample of Australian-born residents. Bmc Psychiatry, 17(1), 76. https://doi.org/10.1186/s12888-017-1239-9.

Stanhope, M., Faan, R. D., Lancaster, J., &Faan, R. P. (2019). Public Health Nursing E-Book: Population-Centered Health Care in the Community. Mosby.

Townsend, M. C., & Morgan, K. I. (2017). Psychiatric mental health nursing: Concepts of care in evidence-based practice. FA Davis.

Turda, I. M. (2017). Strength-based approach in social work: professionals' experiences in working with refugee youth in Nakivale refugee settlement, Uganda (Doctoral dissertation). T&D-DM - Dissertações de mestrado. http://hdl.handle.net/10071/16754.

Wylie, L., Corrado, A. M., Edwards, N., Benlamri, M., & Murcia Monroy, D. E. (2020). Reframing resilience: Strengthening continuity of patient care to improve the mental health of immigrants and refugees. International Journal of Mental Health Nursing, 29(1), 69-79. https://doi.org/10.1111/inm.12650.

Yayan, E. H. (2018). Post-traumatic stress disorder and mental health states of refugee children. Archives of Psychiatric Nursing, 32(6) P885-889. https://doi.org/10.1016/j.apnu.2018.07.003.

Ziersch, A., Walsh, M., Due, C., &Duivesteyn, E. (2017). Exploring the relationship between housing and health for refugees and asylum seekers in South Australia: A qualitative study. International Journal of Environmental Research and Public Health, 14(9), 1036.https://doi.org/10.3390/ijerph14091036.

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