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People from a refugee or asylum seeking background are one of the most vulnerable population groups in Australia and frequently experience pre migration traumatic events such as physical and psychological trauma, torture, deprivation, prolonged poverty and poor access to healthcare.  On arrival people from refugee background frequently have multiple and complex physical and psychological health problems different to the wider community – including a high incidence of mental health problems, infectious diseases, disabilities, nutritional deficiencies and untreated chronic conditions (1).

Early access to primary care providers who are sensitive to the needs of refugee clients and skilled in managing complex health issues is critical. The provision of well organized, accessible and culturally sensitive health care – which responds to complex health issues and trauma related symptoms – is widely considered as fundamental to successful resettlement for people from refugee and asylum seeking back ground (2).

Refugee Health services and programs aim to:

• Increase access to primary health services for clients from a refugee or asylum seeker background
• Improve the capacity of mainstream  services to respond to clients from a refugee or asylum seeker background
• Provide coordinated  early intervention including  and comprehensive health screening  and case management
• Support individuals, families and refugee communities improve their health and well-being through better management and prevention (3).

In Australia and internationally, early intervention and comprehensive health screening is considered a vital aspect of competent health management. Each state and territory in Australia has a specific refugee health model of care depending on the geographic location, refugee intake and feasibility and funding. Refugee health specific services generally incorporate specialist multi-disciplinary refugee health services, Refugee Health Nurse (RHN) programs and community based primary care services (1).

In every State and Territory in Australia Refugee Health Nurses (RHNs) are integral to the delivery of comprehensive accessible services for clients from a refugee and asylum seeking back ground. RHNs play a pivotal role in increasing access to primary health services for refugee background clients, by providing early intervention and culturally appropriate services in a variety of health care settings including; community health centres, specialist and generalist refugee health services and in areas with high levels of refugee settlement.

RHN’s are frequently the initial point of contact with the health system for newly arrived refugee and asylum seekers. They provide ‘nurse – led’ on arrival comprehensive health screening , co-ordination of initial health care and facilitate  links between clients and mainstream GP’s, specialist and generalist health services (5).  

The RHN considers health within a holistic social context and recognises that health outcomes are determined by a range of pre and post migration social, environmental and economic factors.  RHNs acknowledge the incidence of pre migration trauma, including a history of gendered violence, amongst refugee populations and aim to provide care which is responsive, supportive and minimises long term complications.

RHNs practice within a Primary Health Care framework to promote early intervention, illness prevention, equity of health care access and self-determination as essential components of high quality care which support the immediate and long term health care of refugee families and individuals.

RHN’s acknowledge that health services for refugee and asylum seeker clients should:

• Be affordable, accessible, flexible and culturally sensitive
• Treat clients with dignity and respect
• Promote client rights to confidentiality and informed consent
• Ensure access to appropriate language services
• Enable individuals, families and refugee communities to improve their health and wellbeing (6, 7).

THE ROLE OF REFUGEE HEALTH NURSES:

The specific role of RHN’s in each State and Territory varies according to a range of factors including; refugee health funding models and strategic frameworks, clinical locations and scope of practice.

Broadly the RHN clinical role involves;

• Working closely with local settlement services to respond quickly to the needs of newly arrived clients.
• Undertaking initial health and social needs assessments.
• Providing on arrival health screening using standardised assessment tools and initiating diagnostic tests in preparation for comprehensive follow-up health checks.
• Facilitating and coordinating client’s health care including referral / liaison   with mainstream and specialist health and community service providers, advocacy and case management.
• Providing health education and health promotion intervention
• Working in partnership with key stakeholders to plan, implement and evaluate capacity building initiatives to improve client access to culturally appropriate health services.  
• Promote social connection and integration through referrals to established social support and orientation programs.

REFUGEE NURSES OF AUSTRALIA – (RNA)

Australia does not have a national Refugee Health policy or strategic framework. Although state funding and coordination of refugee health programs varies between states and territories, collaboration and networking between practitioners working with refugee background clients is successful on a variety of professional fronts.

The Refugee Health Network of Australia (RHeaNA) was formed in 2009 and is a network of health and community professionals who share expertise in refugee health.  RHeaNA has a multidisciplinary focus and draws members from every Australian State and Territory (8).

The Refugee Nurses Australia (RNA) network was formed in January 2016 by lead Refugee Health Nurses across Australia, many of whom are also members of RHeaNA. The RNA has a national focus and provides an opportunity for nurses working with people from a refugee background to share resources, be advocates, contribute to clinical guidelines and be involved in community of practice opportunities. The aim of RNA is to provide a forum for discussion of professional, strategic and contemporary issues for nurses who work with people with a refugee background.

RNA’s vision is that Australian nurses should have access to the support, networking and professional development opportunities they require in order to provide safe and high-quality care to refugee background clients – regardless of the clinical setting.