Table of Contents
Assessment of health conditions of African refugee and nurses role in working with them
The health issues and disparity in the community of African refugee is the major issues of health inequality in Australia. Nurses have a crucial role in addressing their health needs and promoting health outcomes using good communication and interpersonal relationship. The primary aim of the essay is to critically analyse the health and illness of the African refugee in Australia and address the way nurses can utilise a strength-based approach to develop partnership and collaboration for health promotion. The essay will discuss the key characteristic of African refugees followed by providing a rationale for their consideration. The essay will evaluate the role of nurses in using a strength-based approach and working in partnership with the African refugee community.
Key characteristics of African refugee
The main focus of the paper is on the community of African refugees living in Australia. Australia has a fast-growing African population which have migrated through the skilled and family program and humanitarian program of Australia. According to the census conducted in the year 2006, 248,699 African born people are living in Australia as refugees and in 2008, 3493 Africans were given humanitarian visas (Mapedzahama& Kwansah-Aidoo, 2017). In 2009, the number of African refugees that migrated to Australia outside the humanitarian program was 8025 people from the skilled stream and 2290 from the family stream (Addo et al., 2022). However, Budarick (2017) also mentions that majority of the migrated Africans came to Australia through a non-humanitarian migration program. Thus, this indicates that African refugee is a crucial community in Australia.
Rationale for the choice
African refugee has been chosen as the community for investigation based on the psychological, cultural and social issues experienced that makes them vulnerable to health issues. The research of Wood et al. (2019) has shown that African refugees experience health disparity compared to the general population of Australia evidenced by the high burden of mental illness and physical health issues like cardiovascular complications and diabetes. Chen et al. (2017) noted 4 times more incidence of mental illnesses like depression and anxiety among African refugees than general people of Australia. Ziersch et al. (2017) have found that 30% of the African refugee are reported with diabetes and above 60% are undiagnosed. The main reason for the poor health and well-being of the African refugee is the inability to access healthcare services and difficulty in adjusted a new life. The report of Ikafa and Perry (2021) emphasised service providers of Australia are unaware of their daily life due to different cultural backgrounds and they overlook their health needs in terms of a healthy diet; thereby increasing the risk of heart disease and diabetes secondary to poor nutrition. Further, African refugees are unfamiliar with the way to make appointments to access healthcare services, and major barriers noted are associated with low socioeconomic status, poor help-seeking behaviour and lack of trust in the respectfulness of the healthcare service and its provider (Changaira, 2022). Consequently, African refugees are reluctant towards timely care and treatment for a health issue that causes poor health outcomes.
Ziersch et al. (2020) reported that 2/3rd of the African refugee have unmet health needs and abrupt withdrawal of service. Onsando and Billett, (2017) also reported that healthcare services provided to African refugees are not culturally safe and noted with discrimination which also makes them non-complaint with maintaining good health. In turn, it causes a high level of stress, depression and anxiety. Chen et al. (2017) stated that 40% of the African refugees experience PTSD, psychosis and anxiety due to culturally unsafe care and discrimination by the healthcare professionals. A high rate of PTSD, trauma, and substance abuse is found in the community of African refugees due to poor housing, poor education and high rate of employment (McCann et al., 2018). Thus, African refugees’ health needs to be addressed in a culturally and socially appropriate manner.
The African refugee faces several barriers in the health system of Australia. Abdi et al. (2020) stated that African refugees have poor health literacy and a low level of understanding of the healthcare system. Further, 20% of African refugees are unemployed secondary to poor English skills and lack of recognition of overseas qualifications which cause financial constraints (Uribe Guajardo et al., 2018). Thus, African refugees are unable to understand the working norms of Australian healthcare services associated with the inability to access health information which results in low help-seeking behaviour. For example, the bulk billing system of Australia is different from the pay upfront model in Africa (Ellabban& Alassi, 2019).Thus, the majority of African refugees avoid using health services secondary to poor health literacy and low affordability power. Thereby, they are not able to maintain their good health resulting in the high prevalence of diseases like kidney, reproductive and sexual health issues and others. Okoro and Whitson (2017) mention that discussion on reproductive and sexual health is taboo in Africa due to which they are unable to access information related to this and results in the development of issues like STDs and HIV.
In addition, Chen et al. (2017) stated that African refugees have poor housing with moulds and poor sanitation which is the risk factor for asthma and infections. Inability to get proper care gives rise to health complications like respiratory disease and poor health outcomes. Further, the healthcare system of Australia has certain limitations(Uribe Guajardo et al., 2018). Nurses are untrained, unequipped and unfamiliar to handle the complex health concerns of African refugees. Thus, it is crucial for healthcare professionals like nurses to provide adequate care for African refugees in Australia.
Role of nurse
The role of nurses in health promotion is extended to the wider community and is not limited to certain patients. Bvumbwe and Mtshali (2018) suggest that nurse works collaboratively to provide adequate health care service and community development. Nurses working for the underprivileged community like African refugee shows the role of advocacy, education and meeting the health need of the population (Sangaleti et al., 2017). African refugees having a high prevalence of mental and physical illness given adequate primary care can be an approach to alleviate the poor health outcome. The inability to access healthcare services, limitations of the Australian health system, the existence of discrimination, language barrier, low income, cultural barrier and poor health literacy are the major identified aspects of the poor health of the African refugee that required be addressed by the nurse (Ziersch et al., 2020).
The nurse can work as a community health worker and provide service and support to the African refugee in collaboration with mental health counsellors and mental health professionals to address the issue of mental illnesses like depression and anxiety. O’Mahony and Clark(2018) found that the culturally safe model adopted by the nurses in giving service resulted in better health outcomes for the migrants due to their better participation in the care process secondary to gaining respect and trust in healthcare services. Thus, nurses working in the community need to adopt leadership roles to provide culturally safe care without signs of discrimination and this requires partnership with nurse leaders, managers and others (Ogbolu et al., 2018). It will increase access to health services and provide motivation to learn about the health issue. Further, addressing the language barrier is crucial when working with African refugees so that they better gain awareness and knowledge on the health issue and needs and are able to self-manage illness (Chun Tie et al., 2018). Therefore, the nurse needs to collaborate with the language interpreter to provide safe care to African refugees.
The nurses to execute their role require partnership with the African refugee which could be achieved by the strength-based approach. It is the approach that focuses on appropriate interpersonal connections with the patients to promote health at the biological to family level (Babatunde‐Sowole et al., 2020). It aims to assist patients and families in self-manage their health issues and taking control of their good health (Babatunde‐Sowole et al., 2020). It has the assumption that strength and limitation coexist in the person and gaining an understanding of their personal lives gives the ability to solve the issues; thus, it is used by the nurse to gain information on the live experience of African refugee-related health complications. Turda(2017) justifies the use of a strength-based approach to working with African refugees based on its capability to promote utilitarian justice and rectify negative stereotypes and discrimination against them. Using a strength-based approach, nurses develop a relationship with the African refugee by practising good interprofessional communication skills, showing respect for their views and health belief and providing culturally safe care.
Establishing a relationship will help the nurse to gain more information on the health issue experienced like heart disease and kidney failure which is because of social factors like low income, language barrier and poor education (Wood et al., 2019). Thus, it is the role of the nurse to address the social cause of the poor health of the African refugee. Therefore, nurses need to advocate for the issue of social factors like unemployment, poor education and housingleading to low quality of health by directly associating with the African refugee community people. It will help the government to be aware of the barrier faced by the community of African refugees in terms of access to healthcare services so that needed steps can be taken for its alleviation.
Based on the strength-based approach, the nurse also collaborates with the African refugee, community and health service and healthcare providers to structure culturally responsive care. They can show effort to form community capacity by developing regular community forums and involving African refugees in the delivery of local healthcare services for mental and physical illnesses. Such type of community collaboration and partnership can be better addressed by the African refugee in utilising health services like discriminatory environment, social exclusion and transport and language barriers. Further, showing accountability for the action performed by the nurses is suggestive of an effective community development process (Khawaja et al., 2021). It is significant for the nurse to be accountable for their action in developing a partnership with theAfrican refugee and addressing their health issue which can be done by providing quality education on health needs and ways to access health services in Australia.
The African refugee’s poor health evident from the high rate of mental illness is PTSD, sexual disease and undiagnosed health complications are mainly due to poor communication and poor help-seeking behaviour from a health provider. With the use of the health and healing concept by the nurse for the promotion of health and overcoming barriers, the African refugee can develop their capacity for regulation, coping and attachment (Gunderson et al., 2018). For example, African refugees may restrict from seeking help for their mental and physical illness due to poor communication accompanied by discrimination may cause them to live with the illness untreated. Therefore, the nurse can communicate with the African refugee to identify the major barrier and provide motivation and empowerment to seek help for their identified health issues(Henderson et al., 2019). The nurse can have a session of counselling with the African refugee to provide a sense of security, and a way to surge their coping skills by focusing on the development of spiritual and emotional aspects of the health and well-being like positive coping mechanisms and strength of concept partnership (Henderson et al., 2019). Education can also be given on the positive coping mechanism like gathering information on maintaining a good diet, adhering to medication and performing physical activities and others.
Another way nurses can utilise a strength-based approach is by showing respect for the uniqueness of each African refugee. To identify the strength of the people, the nurse should assess how their strengths are used to manage illness and as research suggests that African refugees have great value to their personal health beliefs and culture (Shishehgar et al., 2017), such aspects need to be understood by the nurse. Further, they can also provide holistic care by incorporating their cultural values in the care process. Thus, it will help in promoting partnership, collaboration and communication in the health management of African refugees.
Conclusion
It can be concluded that African refugee experiences disparity in mental and physical illness due to the inability to access healthcare service, discrimination, poor education, unemployment, poor housing, language barrier and poor help-seeking behaviour. The utilisation of the strength-based approach helps the nurses to develop respectful and interpersonal relationships for the effective establishment of partnership and collaboration with African refugees and other stakeholders. It is recommended for the nurse to undertake training to work with a culturally diverse population and meet their health needs.
