Building on advanced practice of community nurses to improve access and continuity of care for refugees: Pilot study in Sherbrooke, Canada

In response to the lack of access and continuity of care for refugees, a community nursing intervention has been implemented since 209, following joint reflection between users, caregivers, clinicians, decision-makers, and researchers. This intervention is based on advanced nursing practice and an existing intersectoral network in Sherbrooke, Canada.The aim of this project was to improve the accessibility and continuity of care and health services for vulnerable populations, in a perspective of integrated care. The aim was to offer both a population-based and specific intervention for refugees and asylum seekers.The community nurse (CN) responds to the needs of users (to the extent of her scope of practice) and acts as a pivot actor, referring users to the refugee clinic (specialized nurses and physicians), hospital centers, or community organizations, depending on the needs identified, and receiving clients referred by these same actors.This intervention results from a research-action project in which all actors involved (refugees themselves, social workers, managers, deciders) identified the best intervention model: a community nursing intervention integrated in an intersectoral network.The present study relies on a developmental evaluation of the implementation of this intervention. A mixed design was used, based on interviews with managers, professionals, and users of the intervention (n=6) and on data collection forms filled in by the CN and other actors of the pathway (specialized nurses and physicians). These forms were adapted to monitor their scope of practice. A total of 474 forms were filled out: 397 consultations (with 248 unique users) and 77 other activities in the absence of users.The objectives of this presentation are ) to present an assessment of the factors that facilitate and hinder the implementation of the intervention, based on Damschroder's CFIR model (2009); 2) to show the results of this initiative in terms of meeting the needs of refugees and asylum seekers (quantitative and qualitative data).Our results show that the implementation of the initiative was facilitated by the characteristics of the intervention, in particular its origin (action research with the actors concerned) and the characteristics of the actors involved (a community nurse and a manager's assistant). However, implementation was hampered by communication problems between stakeholders and between systems for access to patient records. CN interventions reach vulnerable populations: majority of users are refugees and asylum seekers (58,3%) (compared to citizens and permanent residents), women (67,5%), unemployed (75.8%), and without a family doctor (90%).The main reasons for consulting the CN are minor health problems (32%), gyneco-obstetric reasons (4.6%), need in navigating the health care system (4.2%) and mental health (7.3%). The CN was able to resolve 35,4% of the consultations herself, i.e. she did not need to refer to the specialized nurses or physicians. Collaboration between social workers and CN also facilitated the identification and appropriate follow-up of mental health issues. These evidence-based learnings support the need for and feasibility of interventions based on advanced nursing practice integrated into intersectoral networks. This initiative has a reach that can extend beyond the targeted neighborhoods and inspire other areas if appropriately adapted to other contexts. The aim is also to reflect on the current challenges of sustaining the initiative, which faces structural obstacles within the healthcare organization.

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