International Nurses Day 2020: Case study of the week

Nurse Practitioners and Refugee Care, New Zealand

Contributor: Marie-Lyne Bournival

World Refugee Day was celebrated on 20 June. To mark this day, we bring you an IND case study on the role of nurse practitioners in refugee care and humanitarian relief.

Humanitarian relief, whether in a refugee or aid context, is typically supported by registered nurses, doctors and other health organisations. This means that the majority of mainstream non-governmental organisations (NGOs) are rather well resourced and catered for. However, only a few NGOs accept nurse practitioners (NPs) working within their scope of practice, and most NPs taking part in humanitarian relief will have to work in a senior nurse role. Now, as the world responds to the increasing demand from humanitarian crises globally, smaller NGOs are emerging that provide more opportunities for NPs to offer their services within their scope of practice.

On 22 February 2011, Christchurch, New Zealand was hit by a destructive 6.2 earthquake. Marie-Lyne Bournival, a Canadian NP working in primary health care in Christchurch, had completed the Primary Response in Medical Emergencies (PRIME) training, and so was asked by the New Zealand Ministry of Health to take part in the primary health care response team.

During the response to the earthquake, Ms Bournival set up and opened the isolation quarter when an outbreak of diarrhea and vomiting occurred in one the five welfare centres. She was later selected to be trained by the NZ Medical Assistance Team.

This experience and her background as an NP have enabled her to support smaller NGOs, where she works as a volunteer NP. Every year, Ms Bournival has packed her backpack, grabbed her stethoscope and gone to where the greatest needs in the world are, including travelling to the Pacific Islands, to the Rohingya refugee camps in Bangladesh and to the Middle-East refugee camps in Greece. Small NGOs have welcomed her with open arms, and she has been able to work with them within the full extent of her scope of practice as an NP.

As an NP working with these NGOs in primary healthcare, Ms Bournival conducts clinics and sees people of all ages with an array of health conditions. Post-traumatic stress disorder and other mental health conditions that result from intense trauma and displacement are part of the daily presentations she sees, and they are a challenge to treat. The complexities are numerous and the solutions are usually scarce, and it is virtually impossible to separate political and social issues from health.

In most cases, treatments and services are limited, and frontline teams must think creatively to offer the best possible care to ensure positive outcomes. Refugees who live outside the camps become very quickly disenfranchised and desperate to meet their basic needs as homelessness, IV-drug use, prostitution and violence are prevalent, especially in urban areas.

One of the many challenges in refugee care is to ensure continuity of care, especially when volunteers usually stay with the NGOs for only limited periods of time. Nevertheless, NPs can be an invaluable resource and bring unprecedented expertise to address the immediate unmet needs of refugee populations around the world.

Marie-Lyne Bournival is the Secretary of the ICN Nurse Practitioner- Advanced Practice Nurse Network Core Steering Group and the liaison person for its communication sub-group. She is also on the Nurse Practitioner New Zealand Executive Committee and the Nursing Council of New Zealand NP Assessment Panel.