Caring For Refugees In Emergency Departments In New Zealand 

Abstract
Refugees and asylum seekers represent a significant proportion of attendees in emergency departments in Auckland Hospitals. Culture and ethnicity are a major factor to be considered in addressing the health care needs of this population. Other factors such as the physical and psychological sequelae of the refugee experience, health care experience prior to arrival in New Zealand, poverty, language, and the trauma of resettlement also have a major impact on health care seeking behaviours. This paper outlines some of the special health needs of people from refugee backgrounds who present in the emergency department, and the role of emergency department nurses in improving care for refugee and migrant peoples.  

Keywords
Emergency department nurses, refugees, asylum seekers, migrants   

Introduction
The increasing utilisation by refugee and refugee-like migrant groups (those from refugee-producing countries) of emergency departments in Auckland reflects the shifting ethnic composition of the Auckland region (Ngai, Latimer, & Cheung, 2001; North & Lovell, 2002). Refugees and migrants present at emergency departments with both urgent and non-urgent complaints at a disproportionately higher rate than other populations (Mortensen & Young, 2002). Refugees differ from migrants and other low-income families in New Zealand in ways that negatively impact on their health and responses to illness. Even when previously intact, refugee families rarely migrate together. Refugee families have experienced severe trauma and disruption to their lives, and have often been unexpectedly and violently torn apart, leading to the multiple loss of friends, family and community members, and uncertain reunification. The experience of exile fragments and disrupts the patterns of family interactions, roles, boundaries and the codes of what is expected of family members during crises and ill health (Hamilton, Anderson, Frater-Mathieson, Loewen, & Moore, 2001). On resettlement in New Zealand, refugees live with greater adversity than other communities, including more illness, unemployment, and isolation from support networks (Hamilton et al.).