Experiences of nurses caring for involuntary migrant maternal women: a qualitative systematic review
Authors: Kassam Shahin , Butcher Diane , Marcellus Lenora 
Published: August 2022

ABSTRACT

Objective:
The objective of this review was to identify, critically appraise, and synthesize qualitative evidence on the experiences of nurses providing care within various health care delivery environments to involuntary migrant women who are experiencing pregnancy, birth or postpartum.

Introduction:
Nurses are central to providing care to populations experiencing inequities. These populations include forcibly displaced, pregnant and/or mothering women who have migrated involuntarily. Most of these women are ethnically diverse and often experience poverty and low literacy. This review is focused on the experiences of nurses providing care to these women.

Inclusion criteria:
The authors of this review considered qualitative, peer-reviewed studies published in academic journals between January 2000 and January 2021. Studies and study abstracts published in English that examined nurses providing care to involuntary migrant maternal women were included.

Methods:
Information sources that were systematically searched for this review included: CINAHL (EBSCO), PsycINFO (EBSCO), and MEDLINE (EBSCO). Final searches were conducted in January 2021 using language within database thesauruses such as CINAHL headings and MeSH terms as well as keywords related to qualitative inquires on experiences of nurses caring for involuntary migrant maternal women. An intersectionality lens was applied within all review methods. Study selection was conducted by two reviewers screening titles and abstracts that aligned with the inclusion criteria. The review followed the JBI approach for critical appraisal, data extraction, and data synthesis.

Results:
Twenty-three qualitative studies were included in this review. Qualitative methodologies within these studies included case study, ethnography, interpretive descriptive, and grounded theory. Nine studies considered the sex of participating nurses and three studies considered participant history of migration. One hundred and fifteen verbatim findings were pooled into four categories and aggregated into the following two synthesized findings: i) Nurses integrate cultural and linguistic diversity within practice; and, ii) Nurses assess for inequities resulting from forced migration on maternal women. Study quality was rated as moderate on ConQual scoring where dependability was rated as moderate and credibility was rated as high.

Conclusions:
Key implications are made within nursing education programming, nursing practice, and policy analysis. In the realm of nursing education, integration of migrant status as a health determinant will enhance nurses’ skills in assessing migrant status and understanding how varying statuses contribute to barriers among involuntary migrant women accessing health services. Providing ongoing education to nurses centered on trauma and violence-informed practice is recommended. With regard to nursing practice, review findings revealed the need for creative solutions to overcome language barriers. Innovative approaches for nurses working across language barriers in acute and community health contexts when interpreter services are not available needs further exploration and protocol integration. Examination of clinical care pathways is needed for inclusion of involuntary migrant women, and exploring assessment strategies targeting how migrant status contributes to limited health service accessibility. For policy, organizations need to build policies that promote examination of migrant status and its health impacts among involuntary migrant maternal women exposed to migration-related trauma and violence to support nurses in their care provision.

Systematic review registration number:
PROSPERO CRD42019137922