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Working papers are preliminary documents circulated to stimulate discussion and obtain comments iii Preface International migration has become an important feature of globalized labour markets in health care. The impact of international migration is very complex both for health workers and for the countries involved. There has been concern about international migration in health services for some years now, but recently the situation has become more acute for a number of reasons, mostly reflected in severe staff and skill shortages in the health systems of many countries. While industrialized countries, in addressing the problem of staff shortages, become " recipient " countries and actively recruit health personnel abroad, the emigration of qualified health workers in a number of " donor " countries may undermine the functioning of their health systems. raised the migration of health workers as one major concern and requested the International Labour Office to take further action. The Sectoral Activities Department commissioned this study as a direct follow-up to the recommendations of the Joint Meeting. The study provides an overview of existing information on migration of health workers with an emphasis on related labour and social issues; it considers migration policies and practices, working conditions and the role of international standards and trade agreements. As a Sectoral Working Paper, the study is meant as a preliminary document; it is circulated to stimulate discussion and to obtain comments. We hope that it will contribute to a discussion on policies and practices for socially acceptable management of health worker migration, allowing for decent working conditions for migrant health workers as well as for health workers remaining in their countries, with the aim of ensuring the equal access to quality health services for all.

International Migration of Health Workers: Labour and Social Issues.

Nurses from Asian countries make up the majority of immigrant nurses globally. Although there are a limited number of studies on the lived experiences of Asian nurses working in Western countries, the development of nursing science will be impeded if the rich understanding gleaned from these studies is not synthesized. Using Noblit and Hare's (Meta-ethnography: Synthesizing Qualitative Studies. Newbury Park, Calif: Sage; 1988) procedures, a metasynthesis was conducted on 14 studies that met preset selection criteria. Four overarching themes emerged: (a) communication as a daunting challenge; (b) differences in nursing practice; (c) marginalization, discrimination, and exploitation; and (d) cultural differences. Based on the metasynthesis, a large narrative and expanded interpretation was constructed and implications for nursing knowledge development, clinical practice, and policy making are elaborated.

Strangers in strange lands: a metasynthesis of lived experiences of immigrant asian nurses working in Western countries.

This critical cultural discourse analysis explores the internal logic of Transcultural Nursing Theory and interrogates the underlying assumptions, goals, and strategies of this approach to race and other human and social differences. Drawing on examples from nursing textbooks and policy documents, I assert that Transcultural Nursing Theory operates from a liberal standpoint that focuses attention on a broadly defined, but narrowly applied, concept of culture. The goal of providing culturally competent care and the processes used to achieve that outcome reinforce, rather than transform, the social practices and relations that institutionalize the dominant approach to social and human differences.

Transcultural nursing theory from a critical cultural perspective.

The purpose of this article is to describe the experience of a group of immigrant women nurses regarding their life and work in a culture other than their own. Semistructured, in-depth interviews were conducted with nurses who were born in Kerala, India, educated in India, and are actively employed as nurses in the United States. The participants told stories that were about (a) the challenges of living between two cultures and countries, (b) the racism they experience, and (c) their marginalization as female nurses of color. This study underscores the continuing inequities of our health care system. Our challenge is to establish a more just and effective environment for those who provide care as well as those who receive it.

The racial and gendered experiences of immigrant nurses from Kerala, India.

Purpose: To document and describe the experiences of immigrant nurses of colour who have filed grievances concerning their employers' discriminatory practices; and to solicit their views of existing policies and recommendations for equity in professional life.

Design and Methods: In this descriptive, exploratory study nine immigrant nurses of colour in Ontario, Canada, were interviewed between 1997 and 1998. Data were collected through face-to-face interviews and in focus groups. The discourse theory and methods of van Dijk and Essed were used to analyse the qualitative data.

Findings: Recurring themes were: (a) being marginalized and acknowledging and naming the racist experiences; (b) experiencing physical stress and emotional pain; (c) strategizing to cope and survive; (d) recommending policy changes.

Conclusions: All nurses interviewed had experienced reprisals as a result of complaining or filing grievances and unfairness was encountered in the redress process itself. Participants recommended policy initiatives to ensure equity and fair practices in the nursing profession.

Enid Collins

Papers

Immigrant nurses' experience of racism.

The experiences of professional nurses who have migrated to Canada: cosmopolitan citizenship or democratic racism?