AN EVALUATION OF NURSES' INVOLVEMENT IN PROVIDING SELF-CARE COUNSELING TO MIGRANT PATIENTS WITH HEART FAILURE

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Proper self-care plays a vital role in managing chronic illnesses such as heart failure (HF). Patients are expected to actively engage in various self-care behaviors, such as adhering to prescribed medication, recognizing warning signs of health deterioration, and maintaining regular physical activity (Riegel, Jaarsma & Stromberg, 2018). Studies have shown that individuals with heart failure who practice effective self-care tend to experience a better quality of life, as well as lower rates of hospital readmissions and mortality, compared to those who struggle with self-care (Lee et al., 2018). However, despite the clear benefits of proper self-care, many patients find it difficult to follow these recommendations. This difficulty may stem from a lack of motivation, knowledge, capability, or adequate support systems. To effectively support these patients, it is essential that healthcare professionals, particularly nurses, share their medical expertise and also acknowledge and integrate patients’ own knowledge and lived experiences (Rees & Williams, 2019). The recent rise in global migration and the impact of the COVID-19 pandemic have further complicated healthcare delivery systems. In Sweden, for instance, the country’s previously lenient asylum policies led to a significant rise in immigration, reaching 163,000 new arrivals in 2016 (Population Statistics, 2019). While migrants and individuals with low socio-economic status often face similar health challenges, migrants are additionally affected by the conditions associated with the migration process itself. Migration alone isn’t inherently harmful, but the surrounding circumstances—such as displacement, stress, and lack of access to healthcare—can lead to numerous physical, emotional, and social health issues. In Nigeria, the healthcare system is currently grappling with the unique challenges involved in providing medical care to refugees and migrants. Existing studies have revealed that perceptions of health and illness vary across migrant populations, particularly among those with chronic conditions like diabetes (Sadarangani et al., 2018). Furthermore, increased levels of acculturation—the process of adapting to a new cultural environment—have been linked to a higher risk of cardiovascular diseases (CVDs). This is because the stress and lifestyle changes involved in acculturation can negatively affect health outcomes (Abraído-Lanza et al., 2016). Many migrants also have limited awareness of CVD risk factors, and their vulnerability is further exacerbated by poor socio-economic conditions, language barriers, low income, and chronic health issues such as hypertension and diabetes. Studies have highlighted that older migrants with such risk factors are 50% to 80% more likely to experience a disadvantaged lifestyle compared to the native Swedish population (Pudaric et al., 2020). Helgesson and colleagues (2019) argue that migrants, especially those from non-Western countries, tend to live under more adverse socio-economic conditions than the native population. These include higher unemployment rates, substandard housing, and restricted access to quality healthcare services (Skifter et al., 2016). To improve healthcare for migrant populations, the World Health Organization (WHO) has emphasized the importance of implementing intercultural strategies. Nurses have a particularly significant role to play when it comes to caring for migrants with chronic illnesses like heart failure. Their responsibilities include educating patients, addressing individual needs, and involving them in shared decision-making processes. According to Spitzer and colleagues, self-care education tailored to the diverse backgrounds of immigrants is essential for improving their health outcomes (Skifter et al., 2016). A patient’s approach to self-care is influenced by a combination of personal characteristics, coping mechanisms, and the emotional and informational support they receive from nurses and family members. A meta-synthesis of 19 qualitative studies emphasized the importance of recognizing how heart failure is uniquely experienced by each patient in order to guide the development of personalized self-care strategies (Brandenberger et al., 2019). For patients to effectively navigate the healthcare system and follow self-care advice, they must possess adequate health literacy—a skill that varies based on content and situation. Low health literacy remains a hidden barrier to effective self-care education, especially in culturally diverse societies. Nurses are increasingly faced with the challenge of providing culturally sensitive care to migrants. A comprehensive review of healthcare delivery for migrant populations in high-income countries identified three major cultural-related issues: communication gaps, lack of continuity in care, and insufficient clinician confidence (Brandenberger et al., 2019). While several studies have explored self-care among migrant heart failure patients, little is known about nurses’ perspectives and experiences in delivering intercultural self-care counselling. Therefore, this study aims to explore the extent of nurses’ exposure to self-care counselling for migrant patients suffering from heart failure. 1.2 Statement of the Problem Heart failure is a long-term health condition that requires ongoing self-care strategies to improve patient health outcomes and minimize hospital readmissions (Grady et al., 2017). Migrant populations often face additional obstacles when managing heart failure due to language differences, cultural disparities, socioeconomic challenges, and limited access to healthcare services (Yancy et al., 2016). Nurses serve a critical function in providing self-care education, equipping patients with the tools they need to manage their condition effectively. However, there is a lack of research examining how well nurses are exposed to and prepared for providing self-care counselling specifically targeted at migrant heart failure patients. Evidence suggests that when delivered effectively, self-care education can significantly improve the health outcomes of individuals with heart failure (Riegel et al., 2019). Unfortunately, migrant communities are frequently overlooked in healthcare planning and often do not receive care that is adapted to their unique cultural and linguistic needs (Fleury et al., 2015). The shortage of research on nurses’ readiness and experience in delivering culturally relevant self-care guidance highlights a pressing gap in the field. Understanding these gaps is vital for improving the quality of care and reducing inequities in the management of heart failure among migrants. As such, this study seeks to assess nurses’ exposure to self-care counselling for migrant patients living with heart failure. 1.3 Objectives of the Study The main objective of this research is to evaluate the extent to which nurses are exposed to providing self-care counselling for migrant patients with heart failure. The specific objectives are: i. To evaluate the level of exposure nurses have to self-care counselling in managing heart failure among migrant patients. ii. To examine how nurses’ education and training influence their ability to deliver effective self-care counselling to migrant heart failure patients. iii. To identify the challenges nurses encounter when providing self-care counselling to migrant heart failure patients. 1.4 Research Questions The study will be guided by the following research questions: i. What is the level of exposure nurses have to self-care counselling in managing heart failure among migrant patients? ii. How does nurses’ training and educational background affect their ability to provide self-care counselling to migrant heart failure patients? iii. What obstacles do nurses face when delivering self-care counselling to migrant patients with heart failure? 1.5 Significance of the Study This research will offer valuable insights for nursing educators, healthcare institutions, and policymakers. By shedding light on the realities of nurses' involvement in self-care education for migrant patients, the study can inform strategies to improve care delivery and reduce healthcare disparities. Equipping healthcare professionals with the skills to deliver culturally sensitive, patient-centered care can significantly enhance patient experiences and outcomes. Additionally, the study contributes to academic knowledge by enriching the existing literature and serving as a useful reference for future researchers interested in migrant health and nursing practices. 1.6 Scope of the Study The research focuses on evaluating the level of exposure that nurses have in delivering self-care counselling to migrant patients diagnosed with heart failure. Specifically, it will investigate nurses’ exposure, examine how their training and education influence their ability to provide such care, and identify the barriers they face in doing so. Geographically, the study will be limited to the General Hospital in Gbagada, Lagos State, Nigeria. 1.7 Limitations of the Study As with any academic endeavor, the researcher encountered some limitations while conducting this study. The key challenges included: Time Constraints: Balancing research activities with academic commitments such as attending lectures posed a challenge to time management. Financial Limitations: The study required considerable financial resources for activities like printing, typing, data collection, and accessing relevant materials. Availability of Materials: Finding existing literature relevant to the topic was difficult due to its specialized nature and the scarcity of local studies in this specific area. 1.8 Definition of Terms Self-Care Counselling: This refers to the advice and educational support given by healthcare providers—mainly nurses—to help patients independently manage their conditions through activities such as medication adherence, monitoring symptoms, and lifestyle modifications. Heart Failure: A chronic condition in which the heart cannot pump blood efficiently, leading to symptoms like breathlessness, fatigue, and fluid retention. It typically requires long-term management. Migrant Patients: Individuals who have moved from their home region or country to another, often facing unique challenges such as cultural differences, language barriers, and limited access to health services. Nurses’ Exposure: This term denotes the extent to which nurses have hands-on experience or involvement in providing a particular type of healthcare service, such as self-care counselling for migrant patients. Cultural Sensitivity: The ability of healthcare professionals to understand, respect, and appropriately respond to the diverse cultural backgrounds of their patients. Quality of Life: A multidimensional concept that includes emotional, physical, and social well-being. It reflects the overall impact of illness and treatment on an individual’s daily life and satisfaction