RESUMEN
BACKGROUND: Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. METHODS: A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. RESULTS: Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. CONCLUSION: Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.
Asunto(s)
Enfermería de Cuidados Paliativos al Final de la Vida , Cuidados Paliativos , Emigración e Inmigración , Femenino , Humanos , Jamaica , MotivaciónRESUMEN
This paper documents an exploratory meeting organized by the Pan American Health Organization, that gathered nurses from countries of Latin America, who identified the shortage and migration tendencies as an emerging area in need of investigation. The exploratory meeting was conducted under the direction of the Regional Advisor on Nursing and Allied Health Personnel at the Pan American Health Organization in collaboration with the nursing leadership of Latin America. Fifteen of the 19 Latin American Countries participated in the meeting including: Argentina, Bolivia, Brazil, Chile, Colombia, Dominican Republic, El Salvador, Ecuador, Guatemala, Honduras, Mexico, Panama, Peru, Uruguay, and Venezuela. All agreed that documentation was needed concerning the shortage and migration of nurses including its causes and effects, the distribution of professional nurses, and available public policies to support the needs of professional nurses in Latin America (AU).