Person Centered Care: Diversity & Health, Immigrant & Refugee Canadians

Key Text: Doane & Varcoe, Patient-Centered Care: Diversity and Health, Immigrant & Refugee Canadians, Chapter 38
Objectives of the Chapter:
- Describe the history and context of Canadian immigration, diversity, and multiculturalism.
- Define and differentiate between the terms:
- Immigrant
- Refugee
- Permanent and temporary resident
- Migrant
- Identify current patterns of migration to Canada and their implications for nursing care.
- Evaluate structural factors such as Social Determinants of Health (SDOH) that shape nursing practice with immigrant and refugee populations.
- Describe the relational understanding of culture and its importance in healthcare.

Population Statistics:
- As of 2021, over 8.3 million individuals, or 23.0% of Canada's population, were, or had ever been, a landed immigrant or permanent resident, marking the largest proportion since Confederation.
- By 2041, it is projected that immigrants will represent between 29.1% and 34.0% of Canada's population.
- Over 1.3 million new immigrants settled in Canada between 2016 and 2021, the highest recorded number for a census.
- Immigration accounted for 79.9% of the growth in Canada’s labor force during this period.

Population Growth: In 2023, 97.6% of Canada’s population growth stemmed from international migration (both permanent and temporary), with only 2.4% from natural growth.
Permanent Immigration:
- A record 471,771 permanent immigrants moved to Canada in 2023, meeting the target range set by Immigration, Refugees and Citizenship Canada (IRCC).
- A total of 804,901 non-permanent residents (NPRs) were added, marking continued growth in temporary immigration.
- The majority of NPRs were temporary workers, followed by international students and asylum claimants.

Migration Motivations:
- Economic and employment opportunities.
- Social prospects reflect historically motivated labor sector shortages.
- Humanitarian factors increasingly influence migration patterns.

Visible Minority: Non-Caucasian, non-Indigenous individuals living in Canada.
Diversity: Differences among individuals related to traits such as gender, sexual orientation, country of origin, and religion.
Ethnicity: Shared identity based on heritage, language, beliefs, and values.
Race: Social categorizations based on skin color and biological characteristics.
Racialization: The assignment of social and economic value based on fabricated racial categories causing systemic inequities.
Multiculturalism: A societal value promoting ethnic diversity and cultural heritage preservation.

Immigrant: An individual accepted into another country for permanent residency.
Permanent Resident: Individuals authorized to live and work in Canada indefinitely.
- Rights include all guaranteed under the Canadian Charter, except for voting.
- Categories include:
1. Economic immigrants: Selected for skills relevant to Canada’s economy (e.g., skilled workers, business immigrants).
2. Family class immigrants: Sponsored by Canadian citizens or residents for reunion purposes.
3. Refugees: Individuals with accepted refugee claims or government-assisted refugees.
Temporary Residents: Individuals authorized for limited stay in Canada (includes temporary workers, students).
Undocumented Migrant: Individuals lacking formal authorization due to permit expiration or other issues.
Migrant: A person who has relocated from their country/region of origin either temporarily or permanently.

Barriers to Healthcare Access:
- Limited access to health care and services post-migration.
- Health may decline post-migration due to lack of initial coverage and other logistical barriers.
- The waiting period for healthcare services might affect their health status.
- Language barriers complicate navigation of the healthcare system.

Nurses are required to understand the diversity of health perceptions among immigrant populations within social and economic contexts.
Importance of advocating for social justice in healthcare delivery.
Social determinants of health (SDOH) assessment is critical and should include factors like:
- Employment conditions
- Recruitment fees applicable to temporary workers
- Employer practices affecting worker safety and rights.

Findings from Focus Groups:
- Many migrant workers lack awareness of their rights regarding labor and face significant challenges in achieving permanent residency.
- Concerns include separation from family, low wages, and employer discrimination.
- Access to vaccinations during COVID-19 was observed, yet proper safety measures were inadequate in many cases.

Importance of recognizing personal bias and filtering processes during assessments.
Engage in holistic assessments that value individual patient narratives around their migration experience:
- Suggested Assessment Questions:
  - Experience of migration to Canada.
  - Current life challenges and supports.
  - Views on health and healthcare.
Language and cultural barriers should be mitigated through the use of interpreters and culturally informed approaches.

The nurse’s responsibility to cultivate cultural knowledge and understand patient backgrounds to inform care practices.
Emphasis on therapeutic communication through varied modes and fostering cultural connection.

Culture is dynamic, contextually influenced, and involves selective responses from individuals.
The relational process of culture should not be conflated with singular identities—recognize intersections with race, ethnicity, and power.
Reflective practices should include mapping personal cultural identities and recognizing their impacts.