Migrant and Refugee Youth's Sexual and Reproductive Health and Rights: A Scoping Review to Inform Policies and Programs.

Objectives: Migrants and refugee youth (MRY) in Western nations are less likely to participate in sexual reproductive health (SRH) services. Consequently, MRY are more likely to encounter adverse SRH experiences due to limited access to and knowledge of SRH services. A scoping review was conducted to examine MRY's understanding of and the implications for inclusive sexual and reproductive health and rights (SRHR) programs and policies. Methods: A systematic search of literature across seven academic databases was conducted. Data were extracted following Partners for Dignity and Rights' Human Rights Assessment framework and analysed using the thematic-synthesis method. Results: 38 literature (peer-reviewed, 24 and grey, 14) were considered eligible for inclusion. The findings highlighted significant barriers and the under-implementation of SRHR support and services by MRY. Key policy implications include a need for programs to support MRY's SRHR education, diversity, equity and inclusiveness and privacy protections. Conclusion: The review shows that the emerging evidence on MRY SRHR suggests gaps in practices for resourcing policies and programs that promote sustainable SRH for vulnerable populations. Policies for MRY's SRHR should prioritise programs that focus on diversity, equity and inclusion with targeted education and community resourcing strategies for sustainability.

The Role of Culture and Religion on Sexual and Reproductive Health Indicators and Help-Seeking Attitudes amongst 1.5 Generation Migrants in Australia: A Quantitative Pilot Study.

In Australia, 1.5 generation migrants (those who migrated as children) often enter a new cultural and religious environment, with its own set of constructs of sexual and reproductive health (SRH), at a crucial time in their psychosexual development-puberty/adolescence. Therefore, 1.5 generation migrants may thus have to contend with constructions of SRH from at least two cultures which may be at conflict on the matter. This study was designed to investigate the role of culture and religion on sexual and reproductive health indicators and help-seeking amongst 1.5 generation migrants. An online survey was completed by 111 participants who answered questions about their cultural connectedness, religion, sexual and reproductive health and help-seeking. Kruskall-Wallis tests were used to analyse the data. There was no significant difference between ethnocultural groups or levels of cultural connectedness in relation to sexual and reproductive health help-seeking attitudes. The results do suggest differences between religious groups in regard to seeking help specifically from participants' parents. Notably, participants who reported having 'no religion' were more likely to seek help with sexual and reproductive health matters from their parent(s). Managing cross-cultural experiences is often noted in the extant literature as a barrier to sexual and reproductive health help-seeking. However, while cultural norms of migrants' country of origin can remain strong, it is religion that seems to have more of an impact on how 1.5 generation migrants seek help for SRH issues. The findings suggest that 1.5 generation migrants may not need to adapt their religious beliefs or practices, despite entering a new ethnocultural environment. Given that religion can play a role in the participants' sexual and reproductive health, religious organizations are well-placed to encourage young migrants to adopt help-seeking attitudes.

Medicine in Context: ten years' experience in diversity education for medical students in Greater Western Sydney, Australia.

Objective: This paper describes the Western Sydney University School of Medicine (WSUSoM) diversity education program, Medicine in Context (MiC). MiC implements community-engaged learning and partnership pedagogy in teaching diverse social determinants of health to first clinical year medical students. Central to MiC content and delivery methods is the local region's diversity which is also reflected in the student population and MiC staff. Methodology: This is a descriptive report about how the WSUSoM staff with community and General Practice (GP) partners have co-designed, co-delivered, co-assessed and co-evaluated the MiC program in 2009-2018. In keeping with the community-engaged learning and partnership pedagogy, the report is co-authored by a cross section of MiC stakeholders: the WSUSoM staff members, community partners and an alumna. Results: Ten weeks' immersion in community-based services, with debriefing and scaffolding in tutorials and workshops, exposes students to the complex interplay between social determinants of health and clinical practice. Sharing of experiences, insights and reflections in safe environments enables students to overcome the uneasiness of diversity education. Quality assurance reviews identified positive trends in students' quality of learning and satisfaction in the program following evidence-based continuous improvements of the program design and delivery. Conclusion: Implementation of community-engaged learning and partnership pedagogy in the MiC program, supported by ongoing commitment from the WSUSoM and its community and GP partners, has been successful in engaging students in diversity education. The synthesis of diversity education and clinical learning throughout the MiC program is an important step toward building competency in patient-centred care.

Culture Clash: Shona (Zimbabwean) Migrant Women's Experiences with Communicating about Sexual Health and Wellbeing across Cultures and Generations.

This paper discusses the influence of cross-cultural modes of communication on perceptions of sexual health and wellbeing for Shona (Zimbabwean) women living in Australia and their children. Data was collected using focus groups in South Australia with fourteen women, between the ages of 29 and 53. Transcripts were analysed thematically. The women primarily constructed sexual health and wellbeing in customary Shona ways, which not only maintain secrecy about sexual health and wellbeing discourse, but also prohibit parents from talking to children about sexual health as such talk is reserved for particular kin and non-kin relationships. These constructions however became more fluid the longer the women resided in Australia. For these women the notions of sexual health and wellbeing are a negotiation between Australian constructs and those from Shona culture, especially when applied to their children. This research highlights the potential influence of various cultural world views on sexual health communication among African migrant women and their children and questions the appropriateness of sexual health and wellbeing campaigns and their responsiveness for cross-cultural youth.

Conceptualizing nurses' night work: an inductive content analysis.

AIM: To develop a conceptual model of nurse-identified effects of night work. BACKGROUND: Studies designed to predict shift work tolerance are frequently unsuccessful in incorporating the intersections between physiological, psychological and social issues involved in such work. Where nurses have been the participants of such studies they have rarely been involved in ways that would allow their points of view to be heard directly. Consequently, the issues of personal importance to nurses as shift and night workers in 24/7 organizations are rarely identified in discussions about that work. DESIGN: Inductive qualitative content analysis. METHODS: Survey responses were provided by 1355 night working RNs employed in a state/public health system in 2012. Data derived from open-ended questions about nurses' own perceptions of the advantages and disadvantages of night work are analysed here. RESULTS: Four main categories providing a descriptive summary of the major elements of nurses' night work were identified: 'Lives' and 'Bodies' of night working nurses, the 'Work' of nurses at night and the nurses' 'Workplace' at night. CONCLUSION: The work nurses undertake at night, and the demanding organizational and clinical environments where they do this are uniquely related to the time of day that this work occurs. The Nurses' Night Work model deconstructs the established binary considerations of the lives and bodies of workers to permit a 24/7-based consideration of nurses' night work and its frequently unacknowledged relationship with the day work required of the same nurses when working a rapidly but randomly rotating shift work schedule.

The Fly-in Fly-out and Drive-in Drive-out model of health care service provision for rural and remote Australia: benefits and disadvantages.

CONTEXT: Rural Australians experience poorer health and poorer access to health care services than their urban counterparts, and there is a chronic shortage of health professionals in rural and remote Australia. Strategies designed to reduce this rural-urban divide include fly-in fly-out (FIFO) and drive-in drive-out (DIDO) services. The aim of this article is to examine the opportunities and challenges involved in these forms of service delivery. This article reviews recent literature relating to FIFO and DIDO healthcare services and discusses their benefits and potential disadvantages for rural Australia, and for health practitioners. ISSUES: FIFO and DIDO have short-term benefits for rural Australians seeking healthcare services in terms of increasing equity and accessibility to services and reducing the need to travel long distances for health care. However, significant disadvantages need to be considered in the longer term. There is a potential for burnout among health professionals who travel long distances and work long hours, often without adequate peer support or supervision, in order to deliver these services. A further disadvantage, particularly in the use of visiting medical practitioners to provide generalist services, is the lack of development of a sufficiently well-resourced local primary healthcare system in small rural communities. LESSONS LEARNED: Given the potential negative consequences for both health professionals and rural Australians, the authors caution against the increasing use of FIFO and DIDO services, without the concurrent development of well-resourced, funded and staffed primary healthcare services in rural and remote communities.

Night work and the reproductive health of women: an integrated literature review.

INTRODUCTION: The aim of this review was to synthesize current evidence on the effects of night work on the major stages of women's reproductive health, specifically the menstrual cycle, fertility, pregnancy, and menopause. Current understanding suggests that night work (work that causes disruption of a worker's circadian [day/night] rhythms) adversely affects workers' health and well-being. A complex relationship exists between circadian rhythms and reproductive hormones, and this may potentially increase the vulnerability of women to the detrimental effect of night work, including during menopause. METHODS: A systematic search was conducted (March-May 2011) via CINAHL, MEDLINE, Sociological Abstracts, and Business Source Premier for primary research studies written in English using the key words "shift-work" and "female/women." Findings of identified articles were themed to pregnancy, fertility, aspects of menstrual cycles, and menopause. RESULTS: Twenty articles were identified, (13 articles concerning pregnancy, 3 addressing fertility, and 4 addressing aspects of the menstrual cycle) but no studies addressing menopause were located. All identified articles demonstrated problematic approaches to the determination of night-work exposure. DISCUSSION: Evidence of the impact of night work on female reproductive health as presented in the current literature is inconclusive. Moreover, available evidence needs to be interpreted with caution, given the various limitations and inconsistencies among the studies in the measurement of night-work exposure and shift-work patterns. Studies that focus specifically on night work are needed to facilitate an understanding of the impact of circadian disruption on the reproductive health of women undertaking night work.

Black nurse in white space? Rethinking the in/visibility of race within the Australian nursing workplace.

This article presents an analysis of data from a critical qualitative study with 14 skilled black African migrant nurses, which document their experiences of nurse-to-nurse racism and racial prejudice in Australian nursing workplaces. Racism generally and nurse-to-nurse racism specifically, continues to be under-researched in explorations of these workplaces; when racism is researched, the focus is nurse-to-patient racism and racial prejudice. Similarly, research on the experiences of migrant nurses from a variety of ethnicities in Australia has tended to neglect their experiences of the social dynamics of the workplace, thus reinforcing their racialisation. When racialised, the migrant nurse becomes 'the problem' through a focus on English language competency and ensuing communication barriers. This paper applies Essed's framework of 'everyday racism' to theorise narratives of racism by black African migrant nurses in Australia. In so doing, it not only brings to the fore silenced discussions of nurse-to-nurse racism in Australia, but also exposes the subtle, mundane nature of contemporary racism. For this reason, while the data we present must be read within their context, that is, the Australian nursing workplace, it has significance for advancing a critical analysis of racialised minority groups' experiences of racism within seemingly 'race-less' nursing workplaces internationally.

Rethinking shiftwork: mid-life nurses making it work!

Many current analyses of shiftwork neglect nurses' own voices when describing the dis/advantages of a shiftworking lifestyle. This paper reports the findings of a critical re-analysis of two studies conducted with female mid-life Australian nurses to explore the contention that the 'problem-centred' focus of current shiftwork research does not effectively address the 'real' issue for mid-life nurses, that is, how to develop and maintain shiftwork tolerance. Participants used shiftwork to: (i) manage, navigate and negotiate various aspects of their nursing work and the workplace itself; (ii) facilitate more manageable work/life negotiations; and (iii) self-identify opportunities to engage in their own self-care (body work and mind work). The findings thus went beyond simply exposing what nursing bodies do in time and space by bringing to the fore discussions of 'time-body' relationships, the embodiment of time and nurses re/configuration of that time demonstrating that the frequently unacknowledged positive aspects of shiftwork, when centred in discussions, give voice to other ways to think about shiftwork and a shiftworking lifestyle. Thus, our contention is that the 'problem-centred' focus of current shiftwork debates does little to address the 'real' issue for shiftworking mid-life female nurses - the development and maintenance of shiftwork tolerance.