abstract: 'Background Provision of palliative care to individuals with late-stage

  serious illnesses is critical to reduce suffering. Palliative care is

  slowly gaining momentum in Jamaica but requires a highly skilled

  workforce, including nurses. Out-migration of nurses to wealthier

  countries negatively impacts the delivery of health care services and

  may impede palliative care capacity-building. This critical review aimed

  to explore the evidence pertaining to the nurse migration effect on the

  integration of palliative care services in Jamaica and to formulate

  hypotheses about potential mitigating strategies. Methods A

  comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases

  aimed to identify articles pertinent to nurse migration in the Caribbean

  context. Grant and Booth''s methodologic framework for critical reviews

  was used to evaluate the literature. This methodology uses a narrative,

  chronologic synthesis and was guided by the World Health Organization

  (WHO) Public Health Model and the Model of Sustainability in Global

  Nursing. Results Data from 14 articles were extracted and mapped. Poorer

  patient outcomes were in part attributed to the out-migration of the

  most skilled nurses. `Push-factors'' such as aggressive recruitment by

  wealthier countries, lack of continuing educational opportunities,

  disparate wages, and a lack of professional autonomy and respect were

  clear contributors. Gender inequalities negatively impacted females and

  children left behind. Poor working conditions were not necessarily a

  primary reason for nurse migration. Four main themes were identified

  across articles: (a) globalization creating opportunities for migration,

  (b) recruitment of skilled professionals from CARICOM by high income

  countries, (c) imbalance and inequities resulting from migration, and

  (d) mitigation strategies. Thirteen articles suggested education,

  partnerships, policy, and incentives as mitigation strategies. Those

  strategies directly align with the WHO Public Health Model drivers to

  palliative care integration. Conclusion Emerged evidence supports that

  nurse migration is an ongoing phenomenon that strains health systems in

  Caribbean Community and Common Market (CARICOM) countries, with Jamaica

  being deeply impacted. This critical review demonstrates the importance

  of strategically addressing nurse migration as part of palliative care

  integration efforts in Jamaica. Future studies should include targeted

  migration mitigation interventions and should be guided by the three

  working hypotheses derived from this review.'
affiliation: 'Edwards, RL (Corresponding Author), Univ Alabama Birmingham, Sch Nursing,
  Dept Acute Chron \& Continuing Care, 1720 2nd Ave South, Birmingham, AL 35294 USA.

  Edwards, Rebecca L., Univ Alabama Birmingham, Sch Nursing, Dept Acute Chron \& Continuing
  Care, 1720 2nd Ave South, Birmingham, AL 35294 USA.

  Patrician, Patricia A., Univ Alabama Birmingham, Sch Nursing, Family Community \&
  Hlth Syst Dept, 1720 2nd Ave South, Birmingham, AL 35294 USA.

  Bakitas, Marie, Univ Alabama Birmingham, Sch Nursing, Ctr Palliat \& Support Care,
  1720 2nd Ave South, Birmingham, AL 35294 USA.

  Markaki, Adelais, Univ Alabama Birmingham, Sch Nursing, PAHO WHOCC Int Nursing Family
  Community \& Hlth Sy, 1720 2nd Ave South, Birmingham, AL 35294 USA.'
article-number: '155'
author: Edwards, Rebecca L. and Patrician, Patricia A. and Bakitas, Marie and Markaki,
  Adelais
author-email: rledwards@uab.edu
author_list:
- family: Edwards
  given: Rebecca L.
- family: Patrician
  given: Patricia A.
- family: Bakitas
  given: Marie
- family: Markaki
  given: Adelais
da: '2023-09-28'
doi: 10.1186/s12904-021-00863-7
files: []
issn: 1472-684X
journal: BMC PALLIATIVE CARE
keywords: 'Palliative care; Integration; Nurse migration; Jamaica; CARICOM;

  Caribbean; Critical review'
keywords-plus: CANCER CARE; GUIDELINES; INCOME; PAIN
language: English
month: OCT 13
number: '1'
number-of-cited-references: '68'
orcid-numbers: 'Edwards, Rebecca Lynn/0000-0002-1468-6790

  Markaki, Adelais/0000-0002-2038-3139

  Patrician, Patricia/0000-0002-9608-1866

  Bakitas, Marie/0000-0002-2913-2053'
papis_id: 3df4941b0168e584f4aafcba0ab65022
ref: Edwards2021palliativecare
researcherid-numbers: 'Edwards, Rebecca Lynn/HTN-7649-2023

  Markaki, Adelais/N-7747-2017

  '
tags:
- review
times-cited: '3'
title: 'Palliative care integration: a critical review of nurse migration effect in
  Jamaica'
type: article
unique-id: WOS:000706736400001
usage-count-last-180-days: '1'
usage-count-since-2013: '3'
volume: '20'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2021'