title: Primary Child Health Care Nurses' assessment of health risks in children of foreign origin and their parents--a theoretical model.
abstract: BACKGROUND
  According to recent studies, intercultural interaction in health care between clients and care-givers seems to be problematic. A recent Swedish study revealed that a majority of Primary Child Health Care Nurses (PCHNurses) experienced difficulties in their interaction with children and parents of foreign origin. As every third child in the Primary Child Heath Care (PCHC) services is of foreign origin it seem to be of utmost importance to examine in depth how these difficulties could be understood and explained.
  
  
  OBJECTIVE
  The present study aimed at a theoretical explanation of the core problem concerning PCHNurses' interaction with children and parents of foreign origin, as experienced by the PCHNurses.
  
  
  METHODS
  Fifteen PCHNurses working in the PCHC services were interviewed. Grounded Theory was used as research methodology because focus is on social interactions and the aim is to theoretically explain unarticulated social processes.
  
  
  RESULTS
  Anxiety about missing children, exposed to risks of ill-health, due to various conditions in the child's home environment, turned out to be the PCHNurses' main concern. An assessment of health risks was initiated, when PCHNurses thought that psychosocial conditions in the child's environment might cause ill health. Some of the psychosocial conditions were difficult to assess, as they were unfamiliar and not understood by the PCHNurses. In such difficult-to-assess cases, when the PCHNurses considered the possibility of undefined risk to the child's health they held on to the assessment of the cases and worked out strategies to learn and understand more about the child and the child's home environment. A theoretical model grounded in data was created accounting for the variation in the assessment process and the different strategies used. Implications are discussed and recommendations for improvements are given.
authors.affiliation: Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden. anita.berlin@sll.se
authors.forename: Anita
authors.initials: A
authors.lastname: Berlin
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hylander
authors.forename: Lena
authors.initials: L
authors.lastname: Törnkvist
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence; D054521:Cultural Competency; D004641:Emigration and Immigration; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000208:ethnology / Q000451:nursing; D016294:Models, Nursing; D020380:Needs Assessment; D009723:Nurse-Patient Relations; D009730:Nursing Assessment / Q000458:organization & administration*; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000458:organization & administration / Q000523:psychology*; D010290:Parents / Q000193:education / Q000523:psychology; D010371:Pediatric Nursing / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011368:Professional-Family Relations; D012111:Residence Characteristics; D018570:Risk Assessment / Q000458:organization & administration; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013548:Sweden; D035501:Uncertainty