Abstract
BackgroundProvision 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.MethodsA 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.ResultsData 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.ConclusionEmerged 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.
Highlights
Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering
These findings align with our academic partnership experiences pursued through two Pan-American Health Organization(PAHO)/World Health Organization (WHO) Collaborating Centers (WHOCCs); one based at the University of Alabama at Birmingham (UAB) in the United States of America (USA), and another at the University of West Indies (UWI) in Jamaica. This academic partnership between WHOCCs has led to research immersion, simulation training, visiting scholar exchanges, and development of distanceaccessible courses [42, 43]. The purpose of this critical review was to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Caribbean countries with a special focus on Jamaica, and to formulate hypotheses about potential mitigating strategies
Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from Caribbean Community and Common Marketplace (CARICOM) by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation reduction strategies
Summary
Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Outmigration 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. Palliative care is a team-based holistic approach that focuses on improving quality of life and reducing suffering in those with serious illnesses [1, 2]. Understanding the phenomenon of nurse migration and ensuring that adequately skilled nurses are retained is of utmost importance in palliative care integration efforts, especially in light of the ongoing COVID-19 pandemic
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