SYSTEMATIC REVIEW Immigrant and minority parents' experiences in a neonatal intensive care unit: A meta-ethnography review

SYSTEMATIC REVIEW Immigrant and minority parents' experiences in a neonatal intensive care unit: A meta-ethnography review

Abstract

Aims: To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experi- ences in delivering care to immigrant and minority families.

Design: A meta-ethnographic review informed by eMERGe guidelines.

Methods: We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority fami- lies in neonatal intensive care. Reporting followed ENTREQ guidelines.

Data Sources: Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualita- tive studies. No limitations on commencement date; the end date was twenty-third August twenty twenty-two. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies.

Results: Initial search yielded two thousand four hundred sixty-eight articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (one) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (two) Circles of Support, (subthemes: Individual Level-Spirituality; External Level-Connecting with Family; Structured Peer-to-Peer Support), (three) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme.

Conclusions: There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal inten- sive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care.

Implications for the Profession and/or Patient Care: Professionals should be encour- aged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units.

Reporting Method: The Preferred Reporting Items for Systematic Reviews and Meta- Analyses checklists were used to report the screening process.

One INTRODUCTION

The neonatal intensive care unit provides specialised medical care and often life-saving treatment to sick or premature infants. Preterm birth or the birth of a sick-term infant often leads to sepa- ration from family during the infant's admission to a neonatal intensive care unit. Parents with an infant requiring neonatal care report experiencing stress, anxiety, and depression due to and uncertainty of their infants' sur- vival and risk of future disabilities and their inability to perform in- fant care activities.

Increasingly, research has demonstrated the negative conse- quences of separating infants from parents soon after birth, in- cluding altered emotional and cognitive development of the infant, acute stress, and post-traumatic stress disorders for parents. The intensive care provided by healthcare professionals for the infant as well as the unit policies and interactions between parents and healthcare professionals may also result in parents feeling they do not have 'ownership' of their infant. New guidelines strongly recommend that kangaroo mother care be initiated as soon as possible after birth including preterm or low-birth-weight infants as it significantly improves survival rates. Kangaroo care is skin-to-skin contact between the parent or carer and infant by placing the undressed infant on the parent or carer's bare chest. Increasing research demonstrates the positive outcomes of facilitating continuous parent-infant contact in neonatal intensive care unit.

The experience of neonatal intensive care unit admission and separation is potentially more difficult for immigrant and minority parents for whom the health system is foreign. In some instances, limited proficiency in the local language may hamper their ability to communicate with health- care professionals, understand their infant's condition and their op- portunity to be involved in their infant's care or treatment. Family-centred care is a model of care that re- quires developing respectful and mutually beneficial partnerships between healthcare professionals, patients, and families in planning, delivering, and evaluating healthcare. The Institute for Patient and

What does this paper contribute to the wider global community?

This review can provide a foundation for further research exploring immigrant and minority neonatal intensive care unit care in both high and low-resource countries.

Findings from this review can also help guide and strengthen partnerships between healthcare profes- sionals and families from immigrant and minority popu- lations experiencing neonatal intensive care unit care.

Researchers, healthcare managers, and policymakers could build upon the findings to develop targeted in- terventions and policies for supporting immigrant and minority families in the neonatal intensive care unit.

Family-Centered Care emphasises that within the philosophy of family-centered care is the need to provide care honouring the racial, ethnic, and cultural diversity of families and to design health care that is cultur- ally appropriate and responsive to infant and family needs.

Previous studies have demonstrated the challenges that immi- grant and minority mothers experience accessing and engaging in services during pregnancy and birth, noting that these are influenced by the, at times, inflexible nature of the healthcare system as well as parent-embedded cultural values, traditions and expectations. Over the past decade, a small number of qualitative studies have explored the experiences of immigrant and minority parents with infants in a neonatal intensive care unit. This offers the opportunity to synthesise these existing studies to capture the aspects of experience that are common to this parent population, to identify research gaps, and where possible, to apply to the findings to inform policy in nurseries. Meta-ethnography was selected as the most appropriate approach to synthesise this literature.

Terms such as 'migrants', 'asylum seekers', 'refugees' or 'foreign-born' are often used interchangeably in the literature. For this review, the broad term 'immigrant' will be used. An immigrant can be defined as a 'person living in a country other than that of his or her birth'. Similarly, the consensus of what constitutes a minority group is lacking; therefore, for this review, a minority group is defined as 'an eth- nic, religious or linguistic minority is any group of persons that constitutes less than half of the population in the entire territory of a State whose members share common characteristics of cul- ture, religion or language, or a combination of any of these'. The focus of this review is on immigrant and minority families who differ from the majority population of the country they are now living in because of first language, culture, race or religion.