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• W4283824596 abstract "The International Organization on Migration (IOM)—the international organization representing people who migrate from their birth countries for a variety of reasons—defines displaced persons as “The movement of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters” (IOM, 2019). During wars, displaced persons seek freedom and safety, fleeing from conflict zones and violence; while others are looking for better economic opportunities (Becker & Ferrara, 2019; Lipson et al., 2003; Zimmerman & Beam, 2020). On February 24, 2022, Russia's invasion of Ukraine which was a former republic of the Union of Soviet Socialist Republics (USSR), has prompted a new wave of displaced persons from Ukraine. According to the United Nations High Commissioner for Refugees (2022), as of April 11, 2022, about 4,615,830 refugees had left Ukraine. Some data indicate most Ukrainian refugees are temporarily settling in neighboring countries, such as Poland, Romania, and Hungary. The United States (US) will accept 100,000 Ukrainian refugees over the next year (United States Department of Homeland Security, 2022). They will join one of the largest groups of immigrants in the US: Russian speakers. The Migration Policy Institute's calculations indicate there are approximately 941,000 Russian speakers currently living in the US (Esterline & Batalova, 2022). Nurses and midwives globally should be cognizant of the deeper socio-cultural issues impacting Russian-speaking immigrants who are currently being displaced as well as their immigration history. As we continue our series on learning the language of health equity, in this editorial we seek to advance our understanding of strategies to provide culturally sensitive person-centered care to Russian-speaking immigrants. Russian speakers come not only from Russia, but also from countries comprised of the Former Soviet Union—now sometimes designated as FSU countries for their common political and economic histories(American Immigration Council, 2021). Established in 1922, the USSR included nearly 60 cultural groups and consisted of 15 republics: Russia, Ukraine, Belorussia (Belarus), Moldavia (Moldova), Georgia, Armenia, Azerbaijan, Tadzhikistan, Turkmenistan, Kirgizia, Uzbekistan, Kazakhstan, Latvia, Lithuania, and Estonia (see Figure 1; Bazilevich et al., 1947). Historically, the population of the Soviet Union spoke Russian as their primary and common language in addition to their country's language (Duncan & Simmons, 1996; Resick, 2008). Russian, however, was not their first language. When immigrating to other countries, people from these countries tend to indicate they speak Russian as it is a more common language. Russian-speaking immigrants living in the US are a complex group and comprise individuals from different historic periods and geopolitical areas in the FSU. The population of Russian-speaking individuals has been described as a highly educated, mostly urbanized multi-ethnic group with many immigrants being trained professionals, including but not limited to scientists (Ganguli, 2015), physicians, nurses, teachers, musicians, and engineers (Evanikoff del Puerto & Sigal, 2005; Tulchinsky & Varavikova, 1996). Since the establishment of the USSR on December 30, 1922, several waves of migration from this region occurred (Evanikoff del Puerto & Sigal, 2005). The first waves of immigrants from the Soviet Union in the early 20th century consisted mostly of political and religious refugees who were fleeing wars. As time progressed, the next wave of immigrants from the late 1960s to early 1970s consisted mostly of individuals who self-identified as Jews and were escaping political and religious persecution (Cohen & Haberfeld, 2007; Evanikoff del Puerto & Sigal, 2005). After the collapse of the USSR in 1991, the most recent wave of immigrants from this region emerged. This wave of immigrants from the USSR was associated with Mikhail Gorbachev's Proclamation of Glasnost (openness) and Perestroika (restructuring) movements in the 1980s, which led to the dissolution of the USSR (Evanikoff del Puerto & Sigal, 2005). After the Proclamation of Glasnost and Perestroika, the population of immigrants from the Soviet region shifted from individuals seeking religious freedom to immigrants looking for better economic and occupational opportunities in the US and other countries. The latter wave included both individuals from multiple religious groups and economic immigrants (Hoffman et al., 2006). The waves of immigrants from the USSR to the US from the late 1960s to early 1990s were mainly born and raised during the Soviet Era (Amburg, 2019). However, there are differences between those immigrants who left the USSR and individuals who migrated after the USSR's dissolution. Immigrants from the Soviet Era were fleeing the totalitarian state and many of these individuals could not have any form of communication with their families and friends in the USSR because those who were left behind were more likely to be arrested by the government or expelled from universities and different places of employment (Amburg, 2019; Benifand, 1991; Heitman, 1991; Lazin, 2005). With Perestroika and the restructuring of the country, the government's totalitarian control over the lives of its Soviet citizens diminished and the newer wave of Russian-speaking immigrants had no restrictions on contacting their countries of origin (Amburg, 2019; Heitman, 1991; Lazin, 2005). The earlier immigrants have tended to be more assimilated and associate themselves more with the culture and citizenship in the US or other destination countries compared to individuals who immigrated after the USSR's dissolution. The later immigrants had more freedom to connect to the “old country” without the interference or encumbrance of the Soviet government (Amburg & Lindgren, 2013; Evanikoff del Puerto & Sigal, 2005). Despite the influx of immigrants from the countries of the former USSR, very few empirical studies have addressed this population in the US and elsewhere (Amburg et al., 2022; Eckemoff et al., 2018; Kostareva et al., 2020). With increasing numbers of immigrants from the countries of the FSU (U.S. Census Bureau, 2019), the health needs of this group will require the attention of registered nurses and midwives, and other groups of health professionals within receiving countries. Despite a paucity of current data on Russian-speaking immigrants, there are reports of unhealthy lifestyles, negative health indicators, and poor engagement in health promotion and screening behaviors among these individuals (Amburg, 2019; Ivanov et al., 2010). Individuals born in the FSU have a high prevalence of cardiovascular illnesses, breast cancer, diabetes mellitus, and dental problems, while tuberculosis is still prevalent. These individuals are also at high risk of various cancers—especially those associated with substance use, as well as obesity, depression, and sexually-transmitted infections (Evanikoff del Puerto & Sigal, 2005; Kemp & Rasbridge, 2004). There is also evidence that immigrants from the FSU have poor engagement with primary care health systems in the US (Aroian & Vander Val, 2007; Ivanov et al., 2010; Tselmin et al., 2007). These health risks come with them when they migrate. To understand the health profiles of Russian-speaking immigrants, it is important to have some background on the structure of FSU health systems and how the legacies of those structures may influence health-seeking behaviors. Historically, the countries of the former Soviet Union provided universal healthcare services at no cost to the public (Barr & Field, 1996; Lipson et al., 2003; Tulchinsky & Varavikova, 1996; Yarova et al., 2013). Established in 1920, the socialized healthcare system was centralized, organized, standardized, and bureaucratized (Barr & Field, 1996). Soviet citizens were assigned district physicians based on their geographical area (Sheiman, 2013). Although convenient, this system did not allow individuals seeking healthcare services to have a choice of which healthcare providers would manage their care (Amburg, 2019). Health promotion and disease prevention were not common practices in the FSU. The healthcare system in the FSU was based on an “illness model,” had poor primary and rehabilitative care services, and clients would experience very prolonged hospital stays (Sheiman, 2013). More contemporary literature suggests that individuals who self-identified as Russian-speaking immigrants report that hospital services they experienced included extremely crowded hospitals that had outdated technology in the FSU countries (Amburg, 2019). The lack of material and human resources in these health systems put healthcare professionals at an economic disadvantage. Despite being free to the public, it was not unusual for patients to bribe healthcare providers for services (Amburg, 2019). Giving gifts and money to thank for care or in the hope of getting extra care and attention was a custom in FSU countries. In some instances, healthcare professionals demanded to be additionally compensated by patients for the provision of their services (Barr & Field, 1996; Tulchinsky & Varavikova, 1996). The government of the FSU territories had total control of the statistical and epidemiologic data, which they did not make accessible to the public (Duncan & Simmons, 1996; Tulchinsky & Varavikova, 1996). Many citizens of the FSU were unaware of occupational and environmental exposure to hazards due to unregulated air pollution and poor enforcement of workplace safety (Duncan & Simmons, 1996; Lukjanova & Popova, 2011). For example, in 1986, a nuclear reactor in the city of Chernobyl (located in Ukraine) exploded, spreading radioactive material into the environment and exposing many FSU citizens to radiation (Evangeliou et al., 2014). This was recorded as one of the worst nuclear disasters in human history as the radiation was also carried by the wind through regions of Europe. Radionuclides were absorbed by ecosystems and the impact on human health has been documented (Bourguignon & Scholz, 2016). Many have criticized the Soviet Union government's inadequate response to the Chernobyl disaster, which left many people without proper healthcare services and significant exposure to radiation (Remennick, 2002). Before the current war, Ukraine had assumed responsibility for nuclear cleanup after its independence from the USSR. Many people born in FSU countries also have negative perceptions of psychiatric care. There is a stigma associated with psychiatry and distrust of mental health professionals, and with good reason. Government officials often referred individuals to psychiatric services in the Soviet Union to control people who were labeled as rebels and protestors against the Soviet regime (Hundley & Lambie, 2007). As such, previous interactions with healthcare services of the immigrants from the FSU cannot be underestimated. These experiences affected the immigrants' perceptions and expectations of healthcare providers outside of the countries of the FSU (Amburg, 2019). Nurses' and midwives' first step toward working with Russian-speaking immigrants should be to familiarize themselves with the history of this group. The second step would be to confirm if Russian is the preferred language of communication or another one as most of these individuals will be multi-lingual. All health care providers will then need to be mindful of the mental and physical health of these immigrants related to the timing of their migration experiences—especially those who will migrate from Ukraine during and after the year 2022 as they may be negatively impacted by the trauma of war, losing family members and friends, and experience a loss of their citizenship and sense of belonging. As the first point of contact with the health care system, nurses and midwives will likely provide the most direct care and should first form trusting relationships to provide person-centered care. Providing person-centered care requires consideration of the values and preferences of clients to ensure the care being provided is both evidence-based and culturally humble. When providing care to immigrants from the FSU countries, nurses and midwives should be cognizant and considerate of the historical events which have shaped the lived experiences of individuals from these countries. Importantly, nurses and midwives must be mindful of their biases and bracket their feelings when providing care for Russian-speaking immigrants they may encounter from FSU countries. Russia is considered the antagonist in the current war with Ukraine; therefore, nurses and midwives may associate Russian-speaking immigrants with provocations of war. Yet a Russian-speaking immigrant may not have been born in Russia because a large segment of the Ukrainian people is also fluent in this language due to the history, migration patterns, and geographical proximity between Russia and Ukraine. Some of these immigrants have also experienced the collapse of the Soviet Union, the destruction of the healthcare system, economic instability, and the eruption of violence. Additionally, other immigrants left this region under a totalitarian regime, which oftentimes severed connections with their families, social networks, and wider communities. Regardless of the period of their departure from the FSU, this group of immigrants experienced social, economic, cultural, and political upheaval that has had unaccounted tolls on their health. Nurses and midwives also need to be cognizant that immigrants from the FSU represent a complex and diverse group. Oftentimes these immigrants are referred to as Russians, even though some individuals were not born or raised in Russia. Therefore, as our teams have advocated for in our two previous editorials about Hispanic/Latinx populations (Nava et al., 2022) and persons of Asian heritage (Niles et al., 2022), accurate documentation of the person's preferred language—which may not be Russian—is critical for meeting communication needs and making this population of immigrants more visible in research data. Additionally, avoiding cultural grouping by language is also an important step. Recent geopolitical changes and economic instability in countries of the FSU will contribute to continuous waves of migration from this region. Language barriers and cultural differences could lead to health inequities in this group. For example, a study by Squires et al. (2022) found that Russian speakers had the second-highest readmission rate to hospitals from home health care services after Spanish speakers. It is through an understanding of socio-cultural, political, linguistic, and historical context of the FSU countries that nurses and midwives will truly begin to comprehend the lived experience of immigrants from this region. This deeper appreciation of the FSU people's lived experience will strengthen the cultural humility and competence of nurses and midwives to assess and implement the appropriate interventions to ensure positive health outcomes. All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. All authors (Dr. Polina Amburg, Dr. Roy Thompson, Dr. Cedonnie Curtis, and Dr. Allison Squires) contributed to: editorial concept and design, drafting of the editorial, and critical revision of the editorial for important intellectual content. The authors declare no conflicts of interest. No data available for this manuscript." @default.
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• W4283824596 title "Different countries and cultures, same language: How registered nurses and midwives can provide culturally humble care to Russian‐speaking immigrants" @default.
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