AN ASSESSMENT OF NURSES’ EXPOSURE  OF SELF-CARE COUNSELING IN MIGRANT PATIENTS WITH HEART FAILURE

CHAPTER ONE

INTRODUCTION

Background of the study

Effective self-care is essential for managing chronic conditions like heart failure (HF), necessitating patient engagement in various behaviours, including adherence to prescribed medications, recognising symptoms of deterioration, and maintaining physical activity [Riegel, Jaarsma & Stromberg, 2018]. Patients with heart failure who demonstrate superior self-care behaviours have enhanced quality of life and reduced mortality and readmission rates compared to those with inferior self-care practices [Lee, Bidwell, Paturzo, Alvaro, Cocchieri & Jaarsma, 2018]. Nonetheless, despite the clear correlation between effective self-care and favourable health outcomes, some patients struggle to comply with self-care recommendations owing to insufficient desire, capability, or support. To assist patients in self-care management, the dissemination of medical and nursing expertise, together with acknowledgement of the significance of patients' knowledge and experiences, is essential [Rees & Williams, 2019]. The current surge in immigration and the COVID-19 outbreak have presented a challenge to the healthcare sector. A study's findings indicated that Sweden had some of the most liberal asylum rules in the European Union until 2016. Consequently, immigration rose for many years, culminating in 163,000 persons moving to Sweden in 2016 [population statistics, 2019]. Migrants and those with poor socio-economic status face analogous health issues; however, migrants have an additional risk factor: movement itself. Migration in se is not a health risk factor; nonetheless, the conditions surrounding migration often correlate with physical, mental, and social health concerns.The provision of medical treatment for refugees and migrants is a significant and unprecedented challenge for healthcare systems in Nigeria. Prior research has shown that perceptions of health and sickness vary across migrant diabetic populations [Sadarangani, Chyun, Trinh-Shevrin, Yu & Kovner, 2018]. Enhanced acculturation of migrants to their host nation correlates with a rise in cardiovascular disease (CVD). Acculturation assesses the extent of cultural change experienced by a person, with worse outcomes linked to a higher degree of acculturation being ascribed to the stresses involved with cultural transformation [Abraído-Lanza, Armbrister, Florez & Aguirre, 2016]. A research indicated that migrants had a greater lack of understanding about cardiovascular disease risk factors. Additionally, increased cardiovascular disease risk correlates with poor socio-economic position, inadequate language proficiency, low income, hypertension, and diabetes mellitus. Consequently, the challenges faced by senior migrants with these risk factors elevate the likelihood of experiencing a disadvantaged lifestyle by 50% to 80% in comparison to Swedes [Pudaric, Sundquist & Johansson, 2020]. Helgesson et al. [2019] contend that migrants, particularly those from non-western backgrounds, experience adverse conditions in their host nation, often living in poorer socio-economic circumstances relative to the local population. They exhibit elevated unemployment rates, worse living conditions, and less access to healthcare [Skifter, Andersen, Andersson, Wessel & Vilkama, 2016]. The WHO emphasises the significance of intercultural strategies for migrants to enhance health care provision. Nurses play a vital role in the treatment of migratory populations with severe chronic diseases like heart failure, by educating patients, addressing individual needs and capabilities, and including them in shared decision-making. Spitzer et al. contended that self-care counselling designed to enhance the welfare of immigrants must take into account their varied situations [Skifter, Andersen, Andersson, Wessel & Vilkama, 2016]. The personal traits and coping techniques of patients, together with the emotional and informational support provided by nurses and families, influence their self-care practices. A metasynthesis of 19 qualitative research on heart failure patients revealed the need of acknowledging patients' unique perspectives of heart failure to effectively promote their self-management strategy formulation [Brandenberger, Tylleskar, Sontag, Peterhans & Ritz, 2019]. Patients must possess health literacy to effectively navigate the system and adhere to self-care recommendations, enabling them to use the information it provides. Health literacy is a dynamic construct that is particular to both content and situation, and low health literacy is an unseen obstacle to self-care counselling. In a culturally varied culture, nurses are increasingly faced with the difficulty of delivering appropriate intercultural care to migrant patients. A comprehensive analysis found three primary issues in healthcare delivery to migrant populations in high-income countries, all pertaining to cultural context: communication, continuity of treatment, and clinician confidence [Brandenberger, Tylleskar, Sontag, Peterhans & Ritz, 2019]. Prior studies have thoroughly investigated self-care management in migrant populations with heart failure. To yet, the literature has not illuminated nurses' viewpoints about intercultural self-care counselling programs for migrant patients with heart failure. Therefore, the researcher sought to assess nurses’ exposure  of self-care counseling in migrant patients with heart failure. 

Statement of the problem

Heart failure is a persistent illness necessitating continuous self-care treatment to enhance patient outcomes and decrease hospital readmissions (Grady et al., 2017). Migrant populations have heightened difficulties in treating heart failure attributable to cultural and language obstacles, socioeconomic determinants, and restricted access to healthcare facilities (Yancy et al., 2016). Nurses are essential in delivering self-care counselling to patients, assisting them in efficiently managing their illness. Nonetheless, research on the degree of nurses' exposure to self-care counselling explicitly aimed towards migrant patients with heart failure is scarce. Research indicates that effective self-care counselling may significantly enhance health outcomes for people with heart failure (Riegel et al., 2019). Migrant communities are commonly neglected, with distinct healthcare requirements that often remain unaddressed owing to communication barriers and insufficient culturally appropriate treatments (Fleury et al., 2015). The insufficiency of data about nurses' readiness and exposure to delivering self-care education underscores the need for more research. Comprehending these deficiencies is crucial for enhancing treatment quality and mitigating inequities in heart failure management among migrant populations. Hence, the study assess nurses’ exposure  of self-care counseling in migrant patients with heart failure.

1.3 Objective of the study

The broad objective of the study is to assess nurses’ exposure  of self-care counseling in migrant patients with heart failure. The specific objectives is as follows

To assess the level of exposure nurses have to self-care counseling in the management of heart failure among migrant patients.

To examine the influence of nurses’ training and education on their capacity to provide self-care counseling to migrant heart failure patients

To identify the challenges nurses face in providing self-care counseling to migrant heart failure patients.

1.4 Research questions

The following questions have been prepared to guide the study

What is the level of exposure nurses have to self-care counseling in the management of heart failure among migrant patients?

What is the influence of nurses’ training and education on their capacity to provide self-care counseling to migrant heart failure patients?

What are the challenges nurses face in providing self-care counseling to migrant heart failure patients?

1.5 Significance of the study

Findings of this study will benefit nursing educators, healthcare institutions, and policymakers by providing evidence-based insights on how to improve the quality of care for migrant populations, ultimately reducing health disparities and enhancing patient quality of life. By focusing on the role of nurses in delivering self-care education, the research emphasizes the importance of equipping healthcare professionals with the necessary skills to provide personalized, culturally appropriate care. Findings of the study will also be significant to the academic community as it will contribute to the existing literature, add to library resources and serve as a guide to future academic researchers

1.6 Scope of the study

The study focus on nurses’ exposure  of self-care counseling in migrant patients with heart failure.  Empirically, the study will assess the level of exposure nurses have to self-care counseling in the management of heart failure among migrant patients, examine the influence of nurses’ training and education on their capacity to provide self-care counseling to migrant heart failure patients and identify the challenges nurses face in providing self-care counseling to migrant heart failure patients.

Geographically, the study will be delimited to general hospital Gbagada, Lagos State.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint are: 

Time: The researcher encountered time constraint as the researcher had to carry out this research along side other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study.

1.8 Definition of terms

Self-Care Counseling: Refers to the guidance and education provided by healthcare professionals, particularly nurses, to patients on how to manage their health conditions independently through behaviors such as medication adherence, lifestyle changes, symptom monitoring, and appropriate decision-making .

Heart Failure: A chronic medical condition in which the heart is unable to pump blood effectively, leading to symptoms such as fatigue, shortness of breath, and fluid retention. It often requires long-term management through medication and lifestyle adjustments.

Migrant Patients: Individuals who have relocated from their country or region of origin to another, often for economic, social, or political reasons. Migrant patients may face unique healthcare challenges due to cultural, language, and socioeconomic barriers.

Nurses’ Exposure: The extent to which nurses are involved in or have experience with providing specific health-related counseling or care. In this study, it refers to how frequently and thoroughly nurses engage in self-care counseling for migrant heart failure patients .

Cultural Sensitivity: The ability of healthcare providers to recognize and respect the cultural differences and needs of their patients, ensuring that care is tailored to the individual's background and values .

Quality of Life: A broad concept that includes physical, emotional, and social well-being, often used to measure the overall impact of a disease and its treatment on an individual's life.

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