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Fluctuating power: an exploration of refugee health nursing within the resettlement context in Victoria, Australia

Hughes, Emma; Kean, Susanne; Cuthill, Fiona

Authors

Susanne Kean

Fiona Cuthill



Abstract

Background: The Refugee Health Program (RHP) is a nurse-led community initiative, introduced in 2005 with the aim of responding to complex health issues of refugees arriving in Victoria, Australia. Little is known about refugee health nursing in the resettlement context and the impact of dedicated refugee healthcare. Aim: To explore the experiences and perspectives of Refugee Health Nurses (RHNs), Refugee Health Managers (managers) and refugees, gaining insight into professional relationships and the complexities of offering a specialised refugee health service. Method: A focused ethnographic approach incorporated semi-structured interviews with five RHNs, two managers and eight refugees, two focus groups with refugees and participant observation within the RHP during April 2017 to December 2017. Data collection was undertaken across two sites and interviews, focus groups and observations were transcribed and thematically analysed. Social constructionism asserts that the focus of enquiry should be on interaction, group processes and social practices. Emphasis is placed upon relationships between RHNs, managers and refugees, with knowledge viewed as relational and interactional. Results: Professional relationships between RHNs and refugees are complex, with power oscillating between them. Contrary to discourses of 'vulnerability' of refugees, both RHNs and refugees demonstrated power in their relationships with each other. Nurses also suggested that these relationships were stressful and could lead to burnout. Key themes were developed: (1) nursing autonomy and gatekeeping; (2) vicarious trauma and burnout; and (3) refugee negotiation of care. Conclusions: The balance of power is central to therapeutic relationships. In relationships between RHNs and refugees, power fluctuates as RHNs are exposed to vicarious trauma and symptoms of burnout, while refugees exercise agency by recognising benefits to specialised care. In developing effective therapeutic relationships between RHNs and refugees, attention should be paid to how care is delivered to protect RHNs from burnout while ensuring that refugees receive appropriate care.

Journal Article Type Article
Acceptance Date Apr 1, 2022
Online Publication Date Jun 14, 2022
Publication Date 2022-05
Deposit Date Jul 27, 2022
Publicly Available Date Jul 28, 2022
Journal Journal of Research in Nursing
Print ISSN 1744-9871
Electronic ISSN 1744-988X
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 27
Issue 3
Pages 217-228
DOI https://doi.org/10.1177/17449871221083786
Keywords community nursing, ethnography, power, public health, refugee health, specialist practice
Public URL http://researchrepository.napier.ac.uk/Output/2883503

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