Obstacles and Strategies in Nursing Care for Migrant,Asylum-Seeking,and Refugee Children: A Scoping Review

Obstacles to Nursing Care for Migrant, Asylum Seekers, and Refugee Children

The obstacles experienced by nurses and families in the provision of nursing care to migrant children, asylum seekers, and refugee children included cultural and linguistic barriers, increased nursing workload, limited knowledge among nurses regarding migrants’ rights, racism and discrimination, and bureaucratic constraints. Families also faced difficulties related to limited knowledge of the health care system, financial difficulties, low educational levels, lack of translated information, and the insufficient number of interpreters. These barriers are summarized in Table 3.

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Table 3.

Obstacles in Nursing Care.

Authors	Cultural barrier	Linguistic barrier	Increase in nurses’ workload	Nurses lacking knowledge of rights	Racism/ discrimination	Bureaucracy	Lack of knowledge of the healthcare system	Financial difficulties	Level of education	Lack of information translated	Insufficient number of interpreters
Riggs et al. (2012)	X	X	X	X			X		X	X
Tavallali et al. (2017)	X	X
Tulli et al. (2020)	X	X			X	X	X	X	X
Kaufmann et al. (2020)	X	X	X					X
Barghadouch et al. (2020)						X
Tek et al. (2021)	X	X	X					X			X
Kvamme & Voldner (2022)				X
Öner et al. (2023)	X	X	X
Top (2023)	X	X	X						X		X
Inkeroinen et al. (2023)	X	X	X	X

Linguistic and cultural barriers were identified as significant challenges in most of the studies included. Difficulties related to language differences and cultural misunderstandings were reported by both nurses and parents, hindering effective communication and the development of therapeutic relationships. These barriers were reported to increase nurses` workload, as additional time is required to negotiate care plans, obtain informed consent, and understand the cultural context of each family (Inkeroinen et al., 2023; Kaufmann et al., 2020; Öner et al., 2023; Riggs et al., 2012; Tek et al., 2021; Top, 2023).

Another major obstacle identified in several studies was the lack of accessible health histories for migrant, asylum-seeking, and refugee children (Barghadouch et al., 2020; Inkeroinen et al., 2023; Kaufmann et al., 2020; Riggs et al., 2012). This issue is often compounded by language barriers and the loss of medical documentation during migration or displacement. As a result, health care professionals frequently lack essential information regarding vaccination status, chronic conditions, and previous treatments when these children arrive in host countries.

Limited knowledge among nurses regarding the human rights and health rights of migrant and refugee children was also identified as a barrier to the delivery of appropriate care (Inkeroinen et al., 2023; Kvamme & Voldner, 2022; Riggs et al., 2012). This lack of knowledge may hinder nurses’ ability to advocate effectively for this vulnerable population within health care systems.

Considered from parents’ perspective, several studies reported feelings of insufficient support upon arrival in the host country (Riggs et al., 2012; Tulli et al., 2020). These experiences were largely associated with unfamiliarity with the organization and functioning of the host country’s health care system, including available services and access procedures.

Furthermore, legislative, structural, and bureaucratic barriers were identified as additional challenges that may delay access to child health services (Barghadouch et al., 2020; Tulli et al., 2020). Some parents also reported experiences of discrimination from health care professionals, which negatively influenced their willingness to seek health care for their children.

Socioeconomic factors were also reported as relevant obstacles. Financial hardship among migrant, asylum-seeking, and refugee families limits the ability to obtain necessary health care resources (Kaufmann et al., 2020; Tek et al., 2021; Tulli et al., 2020). In addition, low educational attainment among many parents was associated with reduced health literacy, which may affect their understanding of health information and adherence to treatment recommendations (Riggs et al., 2012; Top, 2023; Tulli et al., 2020).

Finally, the lack of communication tools tailored to this population was identified as a significant barrier to effective care. These challenges include the lack of informational materials in the families’ native languages, a shortage of qualified interpreters, and limited expertise in translating complex scientific or medical terminology (Riggs et al., 2012; Tek et al., 2021; Top, 2023). These factors may undermine communication and hinder the establishment of trust between nurses, children, and their families.

Strategies in Nursing Care for Migrant, Asylum Seekers, and Refugee Children

A range of strategies to facilitate nursing care for migrant, asylum-seeking, and refugee children was identified across the selected studies. These included the presence of a school nurse, training nurses and other health care professionals in cultural competence, the use of interpreters, and training on health services and access pathways. Other relevant strategies included establishing a relationship of trust with children and families, respecting beliefs and traditions, allocating extra time for care, and promoting cultural sensitivity and nurses’ neutrality in nursing practice. Furthermore, the provision of translated information in families’ native languages was identified as an important measure to improve communication and health literacy. These strategies are summarized in Table 4.

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Table 4.

Facilitating Strategies in Nursing Care.

Authors	School Nurse	Training nurses in cultural competences	Interpreters	Training on health services	Relationship of trust	Respect beliefs/traditions	Extra time for care	Translated Information	Neutrality of the nurse	Cultural sensitivity
Riggs et al. (2012)		X	X		X
Tavallali et al. (2017)		X			X	X				X
Tulli et al. (2020)	X	X	X	X						X
Kaufmann et al. (2020)		X	X		X	X				X
Barghadouch et al. (2020)					X	X			X	X
Tek et al. (2021)		X	X							X
Kvamme & Voldner (2022)					X		X		X
Öner et al. (2023)		X	X					X
Top (2023)		X	X					X
Inkeroinen et al. (2023)	X	X	X	X			X

Several studies highlighted the importance of establishing a strong partnership between nurses, children, and their families as a foundation for effective care (Barghadouch et al., 2020; Kaufmann et al., 2020; Kvamme & Voldner, 2022; Riggs et al., 2012; Tavallali et al., 2017). Building trust was identified as a key element in this process.

To foster such partnerships, nurses must develop cultural competence and demonstrate respect for the beliefs, values, and traditions of migrant and refugee populations (Barghadouch et al., 2020; Inkeroinen et al., 2023; Kaufmann et al., 2020; Öner et al., 2023; Riggs et al., 2012; Tavallali et al., 2017; Tek et al., 2021; Top, 2023; Tulli et al., 2020). Cultural sensitivity in communication and care practices was also emphasized as an essential component of high-quality nursing care (Barghadouch et al., 2020; Riggs et al., 2012; Tavallali et al., 2017; Tek et al., 2021; Tulli et al., 2020).

In the case of undocumented migrants, it is particularly important for nurses to clarify the separation between health care services and immigration or political authorities. This reassurance may help reduce fear among families and promote greater engagement with health care services, reinforcing the ethical commitment of nurses to human rights and professional neutrality (Barghadouch et al., 2020; Kvamme & Voldner, 2022). In addition, dedicating more time to interactions with migrant families was identified as a strategy that fosters the development of trust and enables nurses to better understand the specific needs of each family (Inkeroinen et al., 2023; Kvamme & Voldner, 2022).

School nurses were also identified as important facilitators of health care access. By maintaining close relationships with children and their families within the school environment, they can support families’ adaptation to the host country and help connect them with relevant health care services (Inkeroinen et al., 2023; Tulli et al., 2020).

Communication strategies were widely emphasized across the included studies. The use of trained interpreters was considered essential for bridging communication gaps between health care professionals and migrant families (Inkeroinen et al., 2023; Kaufmann et al., 2020; Öner et al., 2023; Riggs et al., 2012; Tek et al., 2021; Top, 2023; Tulli et al., 2020). However, interpreters must possess adequate proficiency in scientific terminology to ensure accurate and effective communication.

Finally, the development and dissemination of educational materials in the native languages of migrant children and their families were identified as additional strategies to enhance understanding and promote health literacy (Öner et al., 2023; Top, 2023). These resources helped reduce communication barriers, improve families’ understanding of health information, and facilitate access to and navigation of the health care system.

Structural Barriers Within the Host-Country Health System

The findings of this review suggest that migrant and refugee families frequently encounter structural and organizational barriers when attempting to access health care services. Difficulties navigating administrative procedures, legal restrictions, and limited knowledge of the health care system organization were identified as important obstacles to care (Barghadouch et al., 2020; Riggs et al., 2012; Tulli et al., 2020). These challenges may delay access to health care and contribute to inequalities in health outcomes among migrant children.

These findings are consistent with previous research indicating that health care systems are often insufficiently prepared to meet the needs of increasingly diverse populations (Durbeej et al., 2021; Pereira Ramos, 2021). Migration processes frequently involve disruptions in access to health care and difficulties in continuity of care, particularly when medical documentation is unavailable or incomplete, as identified in some of the studies included in this review (Barghadouch et al., 2020; Inkeroinen et al., 2023; Kaufmann et al., 2020; Riggs et al., 2012). Strengthening health system responses through inclusive policies and improved coordination between health and social services may therefore be essential to ensuring equitable access to care for migrant children.

These issues are closely aligned with the United Nations Sustainable Development Goal 3, which emphasizes the importance of ensuring healthy lives and promoting well-being for all individuals, regardless of their social or legal status (Organização das Nações Unidas, 2024). In this context, health care systems must develop policies and organizational frameworks that promote equitable and culturally responsive health care delivery (Willey et al., 2022).

Communication and Culturally Responsive Care

Communication challenges emerged as one of the most significant barriers in the provision of nursing care for migrant children and their families. Language differences and cultural misunderstandings may limit effective communication between nurses and families, hinder the development of therapeutic relationships, and increase the risk of misinterpretation of health information. Several studies included in this review highlighted language barriers as a major challenge in nursing practice (Inkeroinen et al., 2023; Kaufmann et al., 2020; Öner et al., 2023; Riggs et al., 2012; Tek et al., 2021; Top, 2023; Tulli et al., 2020). The use of trained interpreters was frequently identified as a key strategy for facilitating communication and ensuring that families are able to understand health information and participate in care decisions (Inkeroinen et al., 2023; Kaufmann et al., 2020; Öner et al., 2023; Riggs et al., 2012; Tek et al., 2021; Top, 2023; Tulli et al., 2020). However, some studies also reported limitations in the availability of qualified interpreters and in their ability to accurately translate complex medical terminology (Tek et al., 2021; Top, 2023). Previous research similarly emphasizes the importance of interpreter services as a fundamental component of safe and equitable health care for migrant populations (Willey et al., 2022).

In addition to interpreter services, providing health information in migrant families’ native languages may significantly improve understanding and promote informed decision-making. Some studies included in this review highlighted the lack of translated educational materials as a barrier to effective communication and individualized care planning (Öner et al., 2023; Riggs et al., 2012; Top, 2023). Developing culturally and linguistically appropriate communication strategies may therefore represent an important step toward improving health care access and treatment adherence among migrant families (Pereira Ramos, 2021; Willey et al., 2022).

Socioeconomic Vulnerability and Health Inequalities

This review also highlights the influence of socioeconomic vulnerability on health care access and experiences among migrant and refugee families. Forced migration is frequently associated with financial instability, precarious employment, and limited educational opportunities, factors that may reduce families’ capacity to access health care resources and navigate complex health systems (Pereira Ramos, 2021). Several studies included in this review reported that low levels of parental education and limited health literacy can hinder families’ understanding of health information and complicate the implementation of nursing interventions (Riggs et al., 2012; Top, 2023; Tulli et al., 2020).

Financial difficulties may also affect families’ ability to acquire essential resources needed for their children’s care, even when health care services are available (Kaufmann et al., 2020; Tek et al., 2021; Tulli et al., 2020). These structural determinants of health contribute to persistent health inequalities among migrant populations and highlight the need for integrated responses that address both health care and social support needs.

In addition, experiences of discrimination within health care settings were reported in some studies (Tulli et al., 2020), suggesting that migrant families may encounter barriers not only at structural levels but also within interpersonal interactions. Health care professionals, therefore, have a critical responsibility to ensure equitable and respectful care. According to the International Council of Nurses, nurses must protect and advocate for the health rights of all individuals, acting as agents of change to promote inclusion and reduce inequalities in health care access (International Council of Nurses, 2011; Truong et al., 2021).

The Role of Culturally Competent Nursing Care

Culturally competent nursing care emerged as a key strategy for improving health care experiences among migrant children and their families. Cultural competence involves recognizing and respecting diverse values, beliefs, and health practices while adapting care to meet the specific needs of culturally diverse populations. Several studies included in this review highlighted the importance of cultural sensitivity in nursing interactions and its role in establishing trust between nurses and families (Barghadouch et al., 2020; Riggs et al., 2012; Tavallali et al., 2017; Tek et al., 2021; Tulli et al., 2020).

Leininger’s theory of transcultural nursing emphasizes the importance of culturally congruent care in promoting health and well-being among diverse populations (Leininger, 1988). In multicultural health care environments, nurses must develop cultural awareness and avoid ethnocentric assumptions to deliver respectful and individualized care (George, 2014).

Trust-building was also identified as a fundamental element of effective nursing care. Studies included in this review reported that when nurses demonstrate respect for cultural beliefs and provide empathetic communication, families are more likely to trust health care professionals and engage with health care services (Barghadouch et al., 2020; Kaufmann et al., 2020; Kvamme & Voldner, 2022; Riggs et al., 2012; Tavallali et al., 2017). This aspect is particularly relevant for undocumented migrants, who may fear contact with institutions due to concerns about immigration enforcement. In such cases, clearly distinguishing health care services from immigration authorities may help foster trust and encourage families to seek care when needed (Barghadouch et al., 2020; Kvamme & Voldner, 2022).

Trust-building was also identified as a fundamental element of effective nursing care. Studies included in this review reported that when nurses demonstrate respect for cultural beliefs and provide empathetic communication, families are more likely to trust health care professionals and engage with health care services (Barghadouch et al., 2020; Kaufmann et al., 2020; Kvamme & Voldner, 2022; Riggs et al., 2012; Tavallali et al., 2017). This aspect is particularly relevant for undocumented migrants, who may fear contact with institutions due to concerns about immigration enforcement. In such cases, clearly distinguishing health care services from immigration authorities may help foster trust and encourage families to seek care when needed (Barghadouch et al., 2020; Kvamme & Voldner, 2022).

School Nurses as Facilitators of Health Care Access

Schools may represent important settings for promoting health and supporting the integration of migrant children and their families. The school environment provides opportunities for continuous contact between health care professionals, children, and families, allowing early identification of health needs and facilitating access to health care services. Some studies included in this review highlighted the role of school nurses in supporting migrant children’s adaptation to new environments and improving families’ access to health care services (Inkeroinen et al., 2023; Tulli et al., 2020).

Previous research similarly identifies schools as key community settings where social networks can be strengthened, and health information can be disseminated in a supportive and non-stigmatizing environment Durbeej et al. (2021). Strengthening collaboration between health care and educational institutions may therefore represent an effective strategy to improve health access and outcomes for migrant children.