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On-line version ISSN 1695-6141
Enferm. glob. vol.11 n.27 Jul. 2012
Prejudices of the Nurses towards the immigrant population: An outlook from the South of Spain
Prejuicios de las enfermeras hacia la población inmigrante: una mirada desde el Sur de España
Plaza del Pino, F.J.*
*Complejo Hospitalario Torrecárdenas de Almería. Facultad de Ciencias de la Salud de la Universidad de Almería. E-mail: firstname.lastname@example.org
In the last decades Spain has turned into a receiver country of immigrants. This increase entails a rise in the cultural diversity in the society which is reflected in the change of the cultural profile of the users of the health public system.
The aim of this study has been to approach the prejudices of the nurses towards the immigrant population.
Methodology: Transversal quantitative study. Participants: Nursing professionals from the three public hospitals of Almería. Data collection: Anonymous questionnaire.
Results: More than 68% of the sample thinks that "we take advantage of the immigrants in order to offer themthe most precarious jobs", and they do not consider that there are some Spanish people unemployed becauseof the immigrants.Half of the sample agrees with the statement "the ethnic minorities constitute a source of social conflicts" and more than 80% relate immigration to delinquency.
Conclusions: The social prejudices mark mostly the Nurses opinions. It's necessary to develop some trainingand sensitization programs aimed to these professionals as a key to achieve a change towards these negative opinions.
Key words: Attitude; Immigration; Nursing; Prejudices.
En las últimas décadas España se ha convertido en un país receptor de inmigrantes, este aumento con lleva una creciente diversidad cultural en la sociedad que se refleja en el cambio del perfil cultural de los usuarios del sistema sanitario público.
En este trabajo se ha marcado como objetivo tener una primera aproximación a los prejuicios que tiene el personal de Enfermería acerca de la población inmigrante.
Metodología. Estudio cuantitativo transversal. Participantes: Personal de Enfermería de hospitales públicos de Almería. Recogida de datos: Cuestionario anónimo.
Resultados. Más de un 68% de la muestra opina que "nos aprovechamos de los inmigrantes para ofrecerles los trabajos más precarios", no considerando que los inmigrantes dejen a españoles en el paro. Más de la mitad de la muestra está de acuerdo con la afirmación de que las minorías étnicas constituyen una fuente de conflictividad social y más del 80% relacionan inmigración y delincuencia.
Conclusiones. Los prejuicios sociales marcan mayoritariamente las opiniones de las enfermeras. Vemos necesario el desarrollo de programas de formación y sensibilización dirigido a estos profesionales como clave para conseguir cambiar estas opiniones negativas.
Palabras clave: actitud; inmigración; enfermería; prejuicios.
We live in a globalised world, the last 30 years have transformed the economic model which regulated various countries and cities. These transformations are bringing about important changes and adaptations which require new ways of management to resolve the conflicts. Inside these big changes is globalisation, understood to be the economic model allowing the freedom of movement to the international capital in order to find the maximum economic benefit whilst the movement of people becomes even more limited. Globalization is a process which transcends groups, classes and nations, a process which makes an impact on alllevels; economic, social, cultural and family.
Things are like that, migratory movements produce a tremendously unfair distribution of global wealth as a result. The migrants are forced to leave their homes due to the need to improve their lives because of the conditions in which they are living; poverty, repression, wars and zero job opportunities...it makes them spend their lives looking for a country that welcomes them with the opportunity to live with dignity.
In the last decades Spain has stopped being a country from which people emigrate, to a country to which people emigrate. Since the 90's immigration has made our country a phenomenon of great demographic and economic importance. According to the 2010 report done by the Spanish National Institution of Statistics (INEE)(1), in January of 2010 there were 5.7 million people living in Spain that had been born outside of the country. This represents 14% of the 47 million people in the registered population.
This rise of the foreign population in Spain leads a growth in cultural diversity in society. This diversity has come into healthcare, where we are starting to see new patients with new visions, customs, values and up-bringings, plus different views of the world, of life, of death and the process of good and ill health. These new patients also have different views on how people become ill, get better and who can help them get better (2). Living in the province of Almeria in southern Spain, according to the data of the NIS(1), there are 200,000 foreigners, of which it is estimated 50,000 are living illegally.
A wide bibliographical research on immigration, prejudices and nursing in different languages from research databases such as MEDLINE, CINAHL, CUIDEN, CUIDATGE, IME, BDIE, Biblioteca Cochrane y Google Scholar shows us that investigation in this field is an area of interest which is growing in tune with the rise in the foreign population in our country both in public and private institutions even though studies on the attitudes and prejudices of healthcare professionals towards the immigrant population are scarce. We understand social prejudice as "the negative predisposition that a person develops of a group of individuals, due to the acceptance of a stereotype of the group without any evidence, a stereotype is a stable set of beliefs and preconceived ideas that members of a particular group share about characteristics of other groups" (3).
In this project we will concentrate on the prejudices that the nursing staff have of the immigrant population in our country, stressing the importance of the Moroccans as they are the largest group in this area of study, the province of Almeria. These results form part of a larger investigation developed during 2008/9 financed by the Andalucían Board of Health titled "Intercultural and communicative competence of healthcare professionals towards immigrant Muslim patients" PI 424-2007 (4)
To understand the prejudices of nursing staff towards immigrants
Material and method
For the explorative project which we are presenting a cross sectional survey which is descriptive and observational, as it is the best way to approach the samples and opinions.
The scope of the project
The project has developed between the healthcare professionals on the wards of three hospitals in Almeria; Hospital Torrecárdenas de la capital, Hospital de Poniente de El Ejido and Hospital La Inmaculada de Huercal Overa.
It was decided to perform the investigation with the staff on the hospital wards and to assess how close the relationship is between the nurses, the foreign patients and their families
The project is taken from around 1400 professionals. The calculations of the model have been made using the computer program Epidat version 3.1. With the results obtained in a pilot poll of 20 people: the expected standard deviation was 24,043, with a confidence level of 95%, a maximum error of 3% and a population size of 1400. The minimum model size needed is 210 people, considering losses of 10% the final model size needed would be 241 people. A probabilistic selection of the model had not been performed but 560 questionnaires have been distributed with the intention of recovering, at least, 210 which have been completed. In the end 243 of the questionaires were recovered, of which 226 were considered valid. The characteristics of the model are described in the following table.
The age range with the most individuals is between 31 and 40 with a total of 92 out of 226, representing just over 40% of all who took part with the group between 41 and 50 also being very numerous.
Regarding the distribution of the model by gender, the feminisation of the nursing profession is reflected in the group studied as less than a quarter of the group are males, 53 men vs.173 women. Also, given the fact that the study was only carried out on staff who work in hospitalization it is more often that male professionals are found in special called services or in operating theatres, special cares, emergencies etc.
The ethics and research committees are requesting each one of the three hospitals permission to develop the study by declaring the results of the research will be fully confidential. Permission to carry out the study was brought through in two meetings of the committees.
An anonymous questionnaire was used to collect the data called the "The attitude scale towards Immigration for Nursing" or EAIE(5), after gaining the permission of the authors it was modified in some aspects in order to achieve the objective of centralising the study more on the attitudes of Moroccan immigrants. The people who took part were also asked for personal details such as their profession, age and gender. The reliability of the modified form was estimated using Cronbach's internal consistency index (Cronbach's Alpha) getting a result of 0.924, the validity of which has also been shown by the analyses carried out by their authors.
Implementation of the Surveys
The data was collected during the months of October and November in 2008, the surveys collectively administered in every ward, Guaranteeing anonymity and confidentiality of the answers of the survey. Leaving them in visible places so that each professional could complete one when possible. The completed surveys were deposited in mailboxes placed there for them.
Analysis of Data
Once the surveys were collected, the data was put into the computer programme SPSS for Windows, version 15.0. For the qualitative variables frequency tables were used.
We will present the results of the parts of the EAIE which show the aspects of prejudices towards the immigrant population in the following tables below. They address the issues related to the preconceived ideas and the topics on immigrants in day to day life: the high birth rate in immigrant families, the loss of job opportunities for Spanish people, the differences between Europeans and foreigners from outside Europe, immigration as a sourceof social problems, the relationship between immigration and crime plus whether or not the Spanish are ready to share public space with immigrants etc. The results also specifically analyse various items central to prejudices with respect to Moroccans.
In the presentation of the results we will differentiate between those items which present negative attitudes and those which present positive attitudes towards immigration.
• Items which present positive attitudes:
The rise in the birth rate due to immigration is valued by professionals as positive by 71.3% while more that 68% think that we make the most of them by offering them the more dangerous jobs.
• Items which present negative attitudes:
Three out of every four individuals of the survey do not consider that immigrants leave the Spanish unemployed. 68.6% do not agree with the claim that a European citizen settled in Spain provides more benefits for our society than an African, Asian or South-American immigrant. This is what a nurse from the Hospital la Inmaculada had to say about this; "you have to take into account the immigration of English and German citizens etc. because their group is growing and they also raise spending on health and education". Regarding the statement that ethnic minorities are a source of social conflict more than half the survey agreed.
• Relation between immigration and crime:
A large majority of the survey are of the opinion that the immigrants who commit crimes should be deported from the country and practically the same percentage relates the arrival of immigrants to the rise in crime. This direct relation between immigration and crime is worrying and the causes of these opinions should be analysed.
• Attitudes towards Moroccans
Regarding the preference to not sit next to a Moroccan on public transport a remarkable 61.5% of the survey disagreed. The result of the second claim is not positive for the Moroccans with 58.8% of the survey in clear agreement with the statement that, in general, Moroccans do not care for their personal hygiene. However, it draws attention that aproportion that only just reaches a third of the survey, 34.5%, either fully or partly agree withthe statement "in general, I cannot stand Moroccans". The percentages are similarly proportioned for those who are scared for their safety when they see a group of Moroccans as the percentage of people who fully agreed with this statement was 31.4%.
The surveyed professionals mostly think that we make the most of the immigrants by giving them the more dangerous jobs. failing to compete for the same jobs as the natives and by offering them the more dangerous jobs, the professionals do not blame the immigrants for unemployment. The percentages were similar with the other statement, that ethnic minorities are not a source of social conflict.
The rise in crime levels relates to the arrival of immigrants and it is believed that the immigrants that commit these crimes should be deported from the country, similar to what was presented in the Social Survey of the Andalucian Studies Centre Foundation in 2003, in which it is said that a large group of Andalucians associate the arrival of the immigrant population with the worsening of the region, putting this matter on intermediate levels, being a positive positional anecdote. At this point the role played by the media should be highlighted, in most cases the news coverage of immigration tends to cause social alarm feeding the idea that it is a source of public danger. There are often headlines in the press linking crimes to certain nationalities, such as "a Moroccan raped..." or "a Lithuanian stole..." etc. The entry of immigrants is cited almost the same as the arrival of criminals; "the Civil Guard arrested 30 illegal immigrants" another headline which without doubt does not help the coexistence.
The bad valuation that the Moroccan contingent has gained in this study is in line with other investigations which show that in Spain the least valued immigrants are the North Africans, with Gypsies coming second and Sub Saharans third (7). By nationality, Moroccans are the immigrants with the most different culture to the native people in Spain due to their Muslim religion. There is an intense un-acceptance of Islam in Spain as it is thought to affect both daily life and the integration of Muslims into Spanish society, "the religion also appears to be a principle factor in the subordination of women, the relationships are often so uneven that Spanish neighbours get offended" (8).
This particularly negative view of Moroccans is a bias which negatively influences the relationships established between the nurses and patients (9). It is necessary to create awareness that these negative opinions exist among professionals and that work is done to change them.
Limitations of study
• The subject of the project
We assume that an investigation aimed at studying prejudices is always complicated, addingin the fact that we have focused on prejudices towards the immigrant population and that immigration is a very "sensitive" topic in society, we believe that these circumstances have made it difficult to achieve genuine results from the professionals which has limited the study.
For this project on prejudices we have only used one type of methodology, quantitative methodology, which limits the possibility of getting to know the motivations of the prejudices. It would be recommended to complement and enrich the results with those obtained through quantitative methodology.
• The population of the study
The study has been based around the nursing staff on the wards of public hospitals in the province of Almería, this implies that the conclusions only reflect their approach and their opinions. The development is not ruled as a similar study to those in other fields of nursing, like community nursing, where the circumstances of the development of the nurse-patient relationships are distant and, therefore, the conclusions can be postponed.
We also believe that it would be of great interest to the completion of the study to deepen the understanding of the nurse-Muslim patient relationships from the point of view of our own Muslim public healthcare staff as a precursor to a valuation with both sides of the story.
In Spain working with foreign patients is a fact which has surprised nurses and health institutions, something for which they have not received any specific training. The rising levels of foreigners entering Europe will continue according to the data of The Spanish National Institution of Statistics (INEE) (1) and as a result the cultural profile of public healthcare staff will be increasingly diverse and will be maintained over time. The intercultural meetings in hospitals have gone from being exceptional at first to habitual and day to day, similarly the migratory tendencies of Moroccans continue and their presence in Spain will remain and will progressively increase.
The specific training and intercultural sensitization is absolutely vital for health care professionals in order to deal with the guaranteed success of the administration of health careto foreign patients. Nurses need to be prepared and able to offer culturally competent healthcare to foreign patients (10, 11, 12), even more in the case of the professionals who workin any of the National Healthcare sectors, the public healthcare system has to ensure the universal right to healthcare for all foreign citizens living in Spain as is demanded by the current Spanish legislation.
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3. Iglesias, I. Comunicación intercultural y enseñanza de lenguas extranjeras: hacia la superación del etnocentrismo, Boletín de ASELE. 1999; 21. [ Links ]
4. Plaza del Pino, FJ. Cuidando a pacientes musulmanes. Las fronteras de la Enfermería en la comunicación intercultural. Almería; Universidad de Almería. 2010. [ Links ]
5. Antonín, M. y Tomás, J. La escala de actitud ante la inmigración para enfermería: validación preliminar. Enfermería Científica. 2004; 262-263. En-Fr. [ Links ]
6. Fundación Centro de Estudios Andaluces. Encuesta Social Andaluza. Sevilla; Consejería de Relaciones Institucionales. 2003. [ Links ]
7. Navas MS, Pumares P, Sánchez J, García MC, Rojas A, Cuadrado I. et al. Estrategias y actitudes de aculturación: la perspectiva de los inmigrantes y de los autóctonos en Almería. Sevilla; Consejería de Gobernación. Junta de Andalucía. 2004. [ Links ]
8. Cea D'Ancona, MaA. La medición de las actitudes ante la inmigración: evaluación de los indicadores tradicionales de racismo. Revista Española de Investigaciones Sociológicas. 2002; 99: 87-111. [ Links ]
9. Kessar, Z. Eviter les stereotypes de l'approche culturalliste des soins. Soins. 2010 747: 33-35. [ Links ]
10. Raheem A. Health beliefs, practice and priorities for health care of Arab Muslims in the United States. Journal of Transcultural Nursing. 2008; 19 (3): 284-291. [ Links ]
11. Tuohy D, McCarthy J, Cassidy I. and Graham MM. Educational needs of nurses when nursing people of a different culture in Ireland. International Nursing Review. 2008; 55:164-170. [ Links ]
12. Leininger, M. Transcultural nursing and globalization of health care: importance, focus and historical aspects. In Transcultural Nursing; Concepts, Theories, Research and Practice, 3rd edn (Leininger, M & McFarland, M.R., eds). McGraw-Hill, New York; 2002. p. 3-44. [ Links ]