Screaming body and silent healthcare providers: A case study with a childhood sexual abuse survivor

Publisher's version (útgefin grein)Stressful early life experiences cause immune dysregulation across the lifespan. Despite the fact that studies have identified childhood sexual abuse (CSA) survivors as a particularly vulnerable group, only a few attempts have been made to study their lived-experience of the physical health consequences of CSA. The aim of this study was to explore a female CSA survivor’s lived-experience of the physical health consequences of CSA and how she experienced the reactions of healthcare providers. Seven interviews were conducted with this 40-year-old woman, Anne, using a phenomenological research approach. Anne was still a young child (two to three years old) when her father started to rape her. Since her childhood, she has experienced complex and widespread physical health consequences such as repeated vaginal and abdominal infections, widespread and chronic pain, sleeping problems, digestive problems, chronic back problems, fibromyalgia, musculoskeletal problems, repeated urinary tract infections, cervical dysplasia, inflammation of the Fallopian tubes, menorrhagia, endometrial hyperplasia, chlamydia, ovarian cysts, ectopic pregnancies, uterus problems, severe adhesions, and ovarian cancer. Anne disclosed her CSA experience to several healthcare providers but they were silent and failed to provide trauma-informed care. Anne’s situation, albeit unique, might reflect similar problems in other female CSA survivors.Peer reviewe

Correlation between stressful factors in the working environment, sleep, and musculoskeletal pain among middle managers

Millistjórnendur eru í krefjandi hlutverki og upplifa sig oft eins og milli steins og sleggju. Þeir gegna þungavigtarhlutverki en störf þeirra einkennast af miklu vinnuálagi og streitu. Þó hafa þeir fengið fremur litla athygli í stjórnendafræðum, einkum innan heilbrigðisþjónustunnar. Við vitum til dæmis lítið um áhrif þessa krefjandi starfs á heilsu þeirra, til dæmis hvort streituvaldandi þættir í starfsumhverfinu tengjast stoðkerfisverkjum og svefni. Tilgangur þessarar rannsóknar var að skoða þessi tengsl. Um er að ræða lýsandi þversniðsrannsókn þar sem gögnum var safnað með forprófuðum spurningalista sem sendur var rafrænt á 137 hjúkrunardeildarstjóra í gegnum Outcome-kannanakerfið. Svarhlutfall var 80,9%. Lýsandi tölfræði og ályktunartölfræði var notuð við úrvinnslu gagna. Niðurstöður sýndu skýr tengsl streituvaldandi þátta í starfsumhverfi, stoðkerfisverkja og ófullnægjandi svefns eftir að stjórnað var fyrir áhrifum af aldri, hjúskaparstöðu og fjölda stöðugilda í hjúkrun á deild. Streituvaldandi þættir í starfsumhverfinu og svefn höfðu tengsl við styrkleika stoðkerfisverkja á hálssvæði og herðum og svefn hafði tengsl við styrkleika verkja í neðri hluta baks. Meiri streita þýddi meiri stoðkerfisverki á hálssvæði og í herðum að teknu tilliti til svefns. Ófullnægjandi svefn þýddi aftur meiri stoðkerfisverki frá öllum þremur líkamssvæðunum að teknu tilliti til streituvaldandi þátta. Saman skýrðu streituvaldandi þættir í starfsumhverfinu og ófullnægjandi svefn, að teknu tilliti til aldurs, hjúskaparstöðu og fjölda stöðugilda við hjúkrun á deild, 17% af heildarbreytileika í styrkleika stoðkerfisverkja á hálssvæði, 21% í herðum og 14% í neðri hluta baks. Fram kom marktæk samvirkni milli streituvaldandi þátta í starfsumhverfinu og svefns varðandi styrkleika stoðkerfisverkja á hálssvæði. Niðurstöður þessarar rannsóknar verða vonandi til þess að hugað verði betur að streituvaldandi þáttum í starfsumhverfi millistjórnenda svefni og stoðkerfisverkjum þeirra.Middle managers have demanding roles and often experience themselves between a rock and a hard place, and their jobs are characterized by a heavy workload and stress. They have not received adequate attention in management science, in particular within healthcare. We know, for example, little about how stressful factors in the work environment are related to musculoskeletal pain and sleep. The purpose of this study was to examine this relationship. This is a descriptive cross-sectional study in which data was collected by a questionnaire which was sent electronically to 137 nursing managers through the Outcome-survey system. The response rate was 80.9%. Descriptive statistics and inferential statistics were used for statistical analysis. The results showed a clear link between stressful factors in the work environment and insufficient sleep, after controlling for the effects of age, marital status and the number of staff in the nursing unit. Stressful factors in the work environment and sleep affected the intensity of pain in the neck and shoulder area, and sleep correlated with the intensity of pain in the lower back. Taking sleep into account, more stress meant more pain in the neck and shoulder area. Taking into account stressful factors, insufficient sleep meant more pain in all three body regions. Together, stressful factors in the work environment and insufficient sleep explained 17% of the total variation in the intensity of pain in the neck area, 21% in the shoulder area, and 14% in the lower back, taking into account age, marital status and the number of staff in the nursing unit. There was a statistically significant interaction between stressful factors in the work environment and sleep regarding the intensity of musculoskeletal pain in the neck area. The results of this study will hopefully lead to better consideration of stressful factors in the work environment, sleep and musculoskeletal pain of middle managers.Peer ReviewedRitrýnt tímari

Stressful factors in the working environment, lack of adequate sleep, and musculoskeletal pain among nursing unit managers

Background: Middle managers have not received enough attention within the healthcare field, and little is known how stressful factors in their work environment coupled with a lack of adequate sleep are related to musculoskeletal pain. The aim of this study was to examine the correlation between stressful factors in the work environment, lack of adequate sleep, and pain/discomfort in three body areas. Methods: Questionnaire was sent electronically to all female nursing unit managers (NUM) in Iceland through the outcome-survey system. The response rate was 80.9%. Results: NUM who had high pain/discomfort in the neck area also had very high pain/discomfort in the shoulder area and pain in the lower back. The results also revealed positive a medium-strong correlation between mental and physical exhaustion at the end of the workday and musculoskeletal pain. Stress in daily work, mental strain at work, and being under time-pressures had hardly any correlation with pain/discomfort in the three body parts. Adequate sleep had a significant negative correlation with all stressful factors in the work environment and all three body parts under review. Conclusion: The results will hopefully lead to a better consideration of stressful factors in the work environment, sleep, and musculoskeletal pain in middle managers.Funding: This study was funded partly by The Icelandic Nurses’ Association—Science Fund.Peer Reviewe

Public or private primary health care: A comparison of efficiency and patient satisfaction

Skipulag heilbrigðisþjónustu er meðal erfiðustu viðfangsefna stjórnvalda. Líkt og aðrar þjóðir sem reka félagslegt heilbrigðiskerfi standa Íslendingar frammi fyrir spurningunni um hvert eigi að vera hlutverk einkarekstrar innan heilsugæslunnar. Markmið rannsóknarinnar var tvíþætt: að bera saman einkarekstur og ríkisrekstur 17 heilsugæslustöðva á höfuðborgarsvæðinu og greina ánægjukannanir þeim tengdar. Við upphaf Íslandsbyggðar verður til lögbundin samhjálp þar sem kveðið er á um skyldur samfélagsins við þá sem þarfnast hjálpar og með lögum um heilbrigðisþjónustu árið 1973 féll íslenska heilbrigðiskerfið undir norræna velferðarsamfélagið með jöfnu aðgengi og þéttu öryggisneti. Rannsóknin sýnir að einkareknu heilsugæslustöðvarnar voru með lágan kostnað á hverja verkeiningu en þó ekki þann lægsta. Fjórar til sjö ríkisreknar stöðvar voru með lægri kostnað á hvern skráðan einstakling en þær einkareknu. Kostnaður á hverja stöðu læknis var hæstur hjá annarri einkareknu stöðinni. Þjónustukannanir sýndu að enginn munur var á ánægju með gæði þjónustu milli þessara tveggja ólíku rekstrarforma. Þá ályktun má draga af þessari rannsókn að ekki sé hægt að fullyrða að einkarekstur í heilsugæslu bæti meðferð opinbers fjár eða auki gæði þjónustunnar.The organization of health care is one of the most complex present day challenges. Like other countries that run socialized health care systems, Icelanders face the question of the role of private enterprise in health care. The objective of this study was two-fold: to compare the cost of 17 private and state-run health care centers in the metropolitan area, and to compare consumer satisfaction related to these. At the beginning of Icelandic settlement, there were statutory laws decreeing that community services should be provided for those in need. By the Health Care Act in 1973, the Icelandic health care system fell under the Nordic welfare society with equal access and a tight safety net. The results show that the private health care centers had a low cost per work unit, but not the lowest. Four to seven state run health care centers had less expenditure per patient than the private centers. The cost of each doctor’s position was highest in one of the private clinics. Patient satisfaction surveys showed that there is no difference in the quality of services between these two different operating modes. A conclusion can be drawn from this study that it is not clear whether private health care improves the use of public funds or increases the quality of services.Félag íslenskra heimilislækna fær þakkir fyrir að styrkja verkefnið úr vísindasjóði.Peer Reviewe

Heilbrigðisþjónusta Fjallabyggðar: Viðhorf íbúa í kjölfar mikilla samfélagsbreytinga

The aim of this paper is to present a study on attitudes of the population in Fjallabyggð towards access to healthcare service and its diversity and quality, in an age of austerity, which the restructuring after the economic collapse of 2008 demanded, and the tunnel in Héðinsfjörður made possible. We used a mixed method with a transformational design. First, data were collected by questionnaires (response rate of 53% in 2009 and 30% in 2012), followed by ten interviews (2009 and 2014). The results were integrated and interpreted within the ecological model of Bronfenbrenner relating to the interactions between the individual and the environment. Findings show significantly less satisfaction with the availability and diversity of healthcare service in 2012, after the merger and downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. The results indicate that improved transportation infrastructure contributed positively to the development of healthcare service and enhanced equality and human rights. The financial cutbacks to health institutes, had however, a negative impact on attitudes.Markmið greinarinnar er að kynna niðurstöður rannsóknar á viðhorfum íbúa Fjallabyggðar til aðgengis að heilbrigðisþjónustu, fjölbreytileika hennar og gæða, í kjölfar niðurskurðar og hagræðingar sem efnahagshrun ársins 2008 krafðist og Héðinsfjarðargöngin gerðu mögulega. Notuð var blönduð aðferð með umbreytingarsniði. Fyrst var gögnum safnað með spurningalistum (svarhlutfall 53% árið 2009 og 30% árið 2012), sem fylgt var eftir með tíu viðtölum (2009 og 2014). Niðurstöðurnar voru samþættar og túlkaðar innan vistfræðilíkans Bronfenbrenner sem snýr að gagnkvæmum áhrifum einstaklings og umhverfis. Marktækt minni ánægja var með aðgengi og fjölbreytileika heilbrigðisþjónustunnar árið 2012 eftir sameiningu og niðurskurð í heilbrigðisþjónustunni. Grundvallaratriði fyrir líf á dreifbýlu svæði töldu íbúar vera góða heilsugæslu, góða umönnun aldraðra innan sveitafélagsins, eitthvert frelsi í vali á heilbrigðisþjónustu og áreiðanlega þjónustu í neyðartilvikum. Niðurstöðurnar gefa vísbendingar um að bættar samgöngur hafi átt þátt í jákvæðri þróun í heilbrigðisþjónustu Fjallabyggðar og aukið jöfnuð og mannréttindi íbúanna en að niðurskurður ríkisins til heilbrigðismála hafi haft neikvæð áhrif á viðhorf þeirra.Peer reviewe

Social justice, access and quality of healthcare in an age of austerity: Users’ perspective from rural Iceland

Publisher's version (útgefin grein)Iceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users’ perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014). The results were integrated and interpreted within Bronfenbrenner’s Ecological Model. There was significantly less satisfaction with accessibility and variety of healthcare services in 2012 after services downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. Equal access to healthcare is part of a fundamental human right. In times of economic downturn, people in rural areas, who are already vulnerable, may become even more vulnerable and disadvantaged, seriously threatening social justice and equity. With severe cutbacks in vitally important healthcare services people may eventually choose to self-migrate.Road Administration Research FundPeer reviewe

The essential structure of a caring and an uncaring encounter with a nurse -- from the client's perspective

This phenomenological study was designed to explore the essential structure of caring and uncaring encounters, as perceived by recipients of nursing care in their interactions with nurses, with the aim of adding to the knowledge and understanding of these phenomena. Data were collected through 18 in-depth interviews with nine former recipients of nursing care. The interviews were tape-recorded and transcribed verbatim for each participant. The researcher saw the participants in the study as coresearchers and through inter-subjective interaction, or dialogue, the essential description of a caring and an uncaring encounter was constructed. The essential structures of both caring and uncaring encounters are composed of three basic components: the approach by the nurse, the presence or absence of relationship formation, and finally, the patient responses to the encounter. The first component in the essential structure of a caring encounter with a nurse — from the client's perspective, is the professional caring nurse approach. The nurse is perceived to be competent, administering her care with genuine concern for the patient as a person, giving him full attention when with him, and constituting a cheerful presence for the patient. The coresearchers reported that these characteristics, which were perceived by them as evidence of caring, had promoted in them a feeling of trust, which had facilitated a development of a nurse-patient relationship. The development of a nurse-patient relationship, or professional attachment, comprises the second essential component of a caring encounter. Developing a nurse-patient relationship was conceptualized in this study as a process involving five phases: initiating attachment, consisting of reaching out and responding by both nurse and patient; mutual acknowledgement of personhood, where nurse and patient recognize each others as persons; acknowledgement of attachment, involving confirmation of attachment; professional intimacy, when the patient feels safe enough in the relationship to reveal to the nurse particulars about his present condition and how he feels about them; and finally negotiation of care, when the nurse works collaboratively with the patient and truely takes his perspective into account when giving nursing care. Throughout the attachment development the professional nurse keeps a distance, an important dimension of professional attachment which the coresearchers clearly articulated had to be present in order to keep the nurse-patient relationship within the professional domain. This combination of intimacy and distance is referred to as nurse-patient attachment with professional distance. The professional caring nurse approach and the resulting nurse-patient attachment with professional distance form the essential structure of professional caring. The patient responses to professional caring comprise the last component in the structure of a caring encounter with a nurse. Five themes were identified in the coresearchers' accounts: sense of acceptance and self-worth; sense of encouragement and support; sense of confidence and control; sense of well-being and healing; and finally sense of gratitude and liking. The essential structure of an uncaring encounter with a nurse — from the client's perspective is also comprised of three basic components: the nurse's approach to the patient, which is perceived by the patient as indifference to him as a person; the resulting nurse-patient detachment with total distance between the nurse and the patient; and finally patient responses to uncaring. Four dimensions of an uncaring nurse approach were identified in the data, characterized by increased indifference, inattentiveness, and insensitivity to the patient and his needs: apathetic inattention, unconcerned insensitivity unkind coldness, and harsh inhumanity. Perceived nurse indifference to the patient as a person makes the patient distrustful of the nurse. The patient often perceives the nurse as an authoritarian person with a need to control, and the patient's encounter with her is characterized by a lack of professional attachment, limited verbal communication, negative nonverbal communication by the nurse, and a lack of collaboration and negotiation of care. This is referred to as nurse-patient detachment with total distance. It was the core searchers' unanimous perception that uncaring encounters with nurses were very discouraging and distressing experiences for them as patients. The coresearchers responses to the uncaring encounters were many-sided. Seven major themes were identified in their accounts: puzzlement and disbelief; anger and resentment; despair and helplessness; feelings of alienation and identity-loss; feelings of vulnerability; perceived effects on healing; and finally long-term effects of uncaring encounters. It was the coresearchers' unanimous perception that the uncaring encounters made an indelible impression on them, had a longer lasting effect than caring encounters, and tended to be both acid edged and memorable unresolved experiences.Applied Science, Faculty ofNursing, School ofGraduat

Silent, invisible and unacknowledged: experiences of young caregivers of single parents diagnosed with multiple sclerosis.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageMost people diagnosed with multiple sclerosis (MS) choose to live at home without known consequences for their children.To study the personal experience of being a young caregiver of a chronically ill parent diagnosed with MS.Phenomenology was the methodological approach of the study since it gives an inside information of the lived experience.The study was approved by the National Bioethics Committee and reported to the Data Protection Authority.We explored in 21 interviews the lived experience of 11 young caregivers who had cared for single chronically ill parents, diagnosed with MS.The participants felt silent, invisible and unacknowledged as caregivers and received limited professional assistance. They were left to provide their parents with intimate physical and emotional care and support that was demanding, embarrassing and quite difficult while feeling unsupported, excluded and abandoned. Their caring responsibilities lead to severe restrictions in life as their parents' disease progressed and they lived without a true childhood; left to manage far too many responsibilities completely on their own and at a young age. At the time of the interviews, most of the participants had left their post as primary caregivers. They were learning to let go of the emotional pain, some of them with a welcomed partner. Most of them were experiencing a healthy transition and personal growth, existentially moving from feeling abandoned towards feeling independent. However, some of them were still hurting.In choosing participants for the study a sampling bias may have occurred.Health professionals are urged to provide information, support and guidance for young carers in a culturally sensitive way and to take on the leading role of helping and empowering children and adolescents in similar situations

The challenge of caring for patients in pain: from the nurse's perspective

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldAIM: To increase understanding of what it is like for nurses to care for patients in pain. BACKGROUND: Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses' relations with patients and doctors, it may be fruitful to study nurses' experience of caring for patients in pain to increase understanding of the above problem. DESIGN: A phenomenological study involved 20 dialogues with 10 experienced nurses. RESULTS: The findings indicate that caring for a patient in pain is a 'challenging journey' for the nurse. The nurse seems to have a 'strong motivation to ease the pain' through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are 'reading the patient', 'dealing with inner conflict of moral dilemmas', 'dealing with gatekeepers' (physicians) and 'organisational hindrances'. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse. CONCLUSIONS: Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses' knowledge in this respect may hitherto have been too narrowly defined. RELEVANCE TO CLINICAL PRACTICE: The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses' clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge