When is the home the best choice? Issues and emphases in home care nursing

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThis paper tries to answer the question: When is the home a good place to provide health care services? To answer this question an extensive literature search was conducted focusing on the home as a place of health care, the organization of health and social services and the participation of relatives in care giving. In addition to the Icelandic and international studies used, the paper was also based on unpublished findings from a study designed and conducted in Reykjavik by the author. The main findings show that people’s relationship to their homes is complex and sometimes contradictory, laden with an array of different feelings and understandings, which nurses need to know how to respond to. Similarly, the studies reviewed show that the views of relatives towards their roles and responsiblities are ambiguous. Most of them express a need for more assistance form the authorities than they receive. Many countries have developed community based services aimed at supporting people to live at home in spite of debilitating long term conditions. However, studies show that theses services suffer from rationing. Therefore, the final part of the paper attempts to clarify the complex ethical and political issues with which home care nurses are confronted in their practice.Í þessari grein er leitað svara við spurningunni: Hvenær er heimilið ákjósanlegur staður til að veita heilbrigðisþjónustu? Til að svara henni var gerð ítarleg leit að efni um aðstæður á heimilum, skipulag heilbrigðis- og stuðningsþjónustu á heimilum og um þátttöku aðstandenda í umönnun á heimilum. Auk þeirra íslensku og alþjóðlegu rannsókna, sem stuðst var við, byggir umfjöllunin einnig á óbirtum niðurstöðum rannsókna höfundar á heimahjúkrun á höfuðborgarsvæðinu sem nefnist Hjúkrað heima. Fram kemur að samband fólks við heimili sín er í mörgum tilvikum flókið og tvíbent, hlaðið ólíkum tilfinningum og skilningi sem mikilvægt er að hjúkrunarfræðingar þekki og geti brugðist við. Á svipaðan hátt er afstaða aðstandenda til aðstæðna sinna margræð en flestir þeirra óska eftir meiri stuðningi frá hinu opinbera en þeim er veittur. Víða í heiminum hefur verið byggð upp umfangsmikil heimaþjónusta sem miðar að því að styðja fólk til að búa áfram heima. Rannsóknir sýna þó að oft er slíkri þjónustu sniðinn ansi þröngur fjárhagslegur rammi. Því er leitast við að varpa ljósi á hin flóknu siðfræðilegu og pólitísku álitamál sem hjúkrunarfræðingar í heimahjúkrun standa frammi fyrir í kjölfar þess að heimilið verður vettvangur heilbrigðisþjónustu

Sérfræðingar í hjúkrun : skilgreining, viðurkenning og nám

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenThis paper describes the roles of specialists in nursing, ways in which their services are certified and regulated and it also discusses the characteristics of the knowledge and education that specialists in nursing require. A comprehensive literature search led to a variety of sources from a number of European countries such as the United Kingdom, Germany, Sweden, Switzerland and the Netherlands in addition to literature from North America. Important work on the clarification of specialists in nursing has also been done by International Counsil of Nurses and European Federation of Nurses Associations (EFN). Results showed that there is no current consensus on definitions, regulations, roles, education nor practice of nurse specialists between countries, neither in Europe nor in the Anglo-Saxon world. There are even large differences between regions and states of the same country. In comparison to the education of specialists in other practice oriented disciplines in Iceland, e.g. psychologists or physicians, more emphasis is placed on theoretical knowledge than on clinical experience in the education of nurse specialists in Iceland. Differences in traditions and positions with regard to preparing specialist nurses for practice are described and discussed. A number of suggestions are made regarding the development of specialist education in Iceland.Tilgangur þessarar greinar er að skýra hlutverk, starfssvið og þekkingu sérfræðinga í hjúkrun svo hægt sé að skipuleggja framhaldsnám í hjúkrunarfræði sem endurspeglar þær væntingar sem gerðar eru til þeirra. Gögnum um störf, viðurkenningu og menntun sérfræðinga í hjúkrun var safnað frá ýmsum löndum, auk upplýsinga um sérfræðinga í öðrum starfsgreinum hér á landi. Í þeim kemur fram að gerðar eru ólíkar kröfur um menntun og starfsreynslu sérfræðinga í hjúkrun eftir löndum og jafnvel svæðum innan landa og að ábyrgð og sjálfstæði sérfræðinga er mismikið. Borið saman við aðrar starfsstéttir er lögð mikil áhersla á fræðilega þekkingu í sérfræðinámi í hjúkrun en minni á klíníska starfsreynslu. Í greininni eru hinar ólíku hefðir og stefnur um störf og menntun sérfræðinga kynntar og ræddar og bent á atriði sem huga þarf að samfara fjölgun sérfræðinga og frekari menntun þeirra á Íslandi á komandi árum

Growing old at home: the experience

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textAll projections indicate that the number of elderly individuals will rise sharply in the near future. It is the policy of the Icelandic government to help elderly people to live in their own homes for as long as possible. This is also the preference of elderly individuals themselves. Therefore, it is important to develop knowledge in relation to the experience of the elderly of living in their own homes. The purpose of this study was to describe how the frail elderly experience living in their own home and what kind of assistance and living environment they consider necessary to continue independent living. This was an interpretative­phenomenological study and was conducted in collaboration with the primary health care in the greater Reykjavík area. Eight elderly individuals, four men and four women who were waiting for nursing home placement and lived in their own homes, were interviewed. The interviews were analyzed and interpreted to meet the purpose of the study. The findings revealed that most participants enjoyed living in their own homes and planned to continue living there for as long as possible. They lived for each day and were content with life at home. However, they evinced a clear sense of insecurity owing to deteriorating health which was the main reason for considering moving to a nursing home. Many of them had experienced prolonged hospital stays and dreaded another downturn in health. The assistance from the public care system and families, in addition to good accommodation, were considered necessary to continue residence at home. Those living in so­called “service flats” for the elderly were particularly satisfied with their situation and experienced security. Nurses must assess the health and wellbeing of the frail elderly and organize appropriate services in participation with them. In addition, the family must be supported in its care giving and consulted when services are organized.Allar spár benda til þess að eldri borgurum muni fjölga á komandi árum. Stefna íslenskra stjórnvalda er að aldraðir geti búið á heimilum sínum sem lengst og það er einnig vilji eldri borgara sjálfra. Því er mikilvægt að efla þekkingu á reynslu aldraðra af því að búa heima. Tilgangur þessarar rannsóknar var að lýsa reynslu eldri borgara, sem hafa átt við veikindi að stríða og búa við dvínandi færni til sjálfsumönnunar, af því að búa á eigin heimili. Jafnframt að lýsa þeirri aðstoð og aðstæðum sem eldri borgarar telja að þörf sé á til að þeir geti haldið áfram að búa heima. Um er að ræða túlkandi fyrirbærafræðilega rannsókn sem unnin var í samstarfi við Heilsugæslu höfuðborgarsvæðisins. Tekin voru viðtöl við átta aldraða einstaklinga, fjórar konur og fjóra karla, sem biðu eftir hjúkrunarrými en bjuggu á eigin heimili. Viðtölin voru greind og túlkuð í þeim tilgangi að varpa ljósi á reynslu þátttakenda og þá aðstoð sem þeir nutu og aðstæður sem þeir bjuggu við. Niðurstöður leiddu í ljós að flestum þátttakendum leið vel á heimili sínu og vildu reyna til þrautar að búa áfram heima. Þeir létu hverjum degi nægja sína þjáningu og undu hag sínum vel. Þó fundu þeir einnig fyrir öryggisleysi vegna versnandi heilsufars og það var helsta ástæða þess að flutningur á hjúkrunarheimili var hugleiddur. Margir þeirra höfðu dvalið á sjúkrahúsi í lengri eða skemmri tíma og óttuðust að verða aftur fyrir því. Aðstoð hins opinbera og fjölskyldu ásamt góðum aðstæðum á heimilinu voru forsenda fyrir áframhaldandi búsetu heima. Margir þátttakenda höfðu flust í þjónustuíbúð og lýstu ánægju sinni með það. Þeir töldu meira öryggi fylgja því að búa í slíkum íbúðum. Mikilvægt er að hjúkrunarfræðingar meti heilsufar aldraðra, sem búa heima, og skipuleggi viðeigandi aðstoð í samráði við þá. Einnig þarf að veita fjölskyldum þeirra stuðning og hafa þær með í ráðum.Félag íslenskra hjúkrunarfræðinga, Minningarsjóður Margrétar Björgólfsdóttu

Patient safety in the operating room: Work environment and operating room nursing

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenMarkmið rannsóknarinnar var að afla þekkingar á því hvernig stuðlað er að öryggi sjúklinga sem fara í skurðaðgerðir og hvað hjúkrunarfræðingar á skurðstofum álíta að ógni öryggi. Rannsóknin var eigindleg og gagna var aflað með viðtölum við skurðhjúkrunarfræðinga og með umræðum í rýnihópum. Þátttakendur voru hjúkrunarfræðingar á tveimur skurðstofum Landspítala – háskólasjúkrahúss. Gögn voru greind með túlkandi innihaldsgreiningu. Niðurstöður lýsa þáttum sem styrkja öryggi sjúklinga, svo sem áherslu á fyrirbyggingu í skurðhjúkrun, skipulagi starfa skurðhjúkrunarfræðinga í sérhæfð teymi og áhrifum góðs samstarfs á skurðstofum. Þáttum, sem geta ógnað öryggi sjúklinga, var einnig lýst. Það eru fyrst og fremst þættir sem lúta að skipulagi og vinnuumhverfi, svo sem miklum hraða, auknum kröfum um afköst, vinnuálagi, ójafnvægi í mönnun og því að hafa ekki stjórn á aðstæðum. Atvik, sem upp hafa komið, voru rædd í rýnihópunum. Gildi rannsóknarinnar felst í því að þáttum í starfsemi skurðstofa, sem hjúkrunarfræðingar telja að styrki öryggi sjúklinga og ástæða er til að hlúa að, er lýst sem og þáttum sem ógna öryggi.The aim of this study was to gain knowledge of what enhances the safety of patients undergoing operations and what OR nurses perceive as threats to their safety. This was a qualitative study based on interviews with OR nurses and focus group discussions among them. Participants were nurses on two of the OR units at Landspitali University Hospital. Data were analysed using an interpretive content analysis. They reflect factors in OR nursing that enhance patient safety such as the emphasis placed on prevention of mistakes, the organization of the work into specialized teams and good collaboration in the teams. Factors that threaten patient safety were mainly related to the organization of the work and the conditions under which the work took place. The speed at which the work is performed, demands increased efficiency and output, instability in staffing and lack of control over the conditions of work were all mentioned. Insidents that have occured were discussed in the focus groups. This study has added to current knowledge and understanding by outlining factors in the OR work environment that OR nurses consider strengthening for patient safety and should therefore be enhanced as well as describing factors that threaten patient safety

Guerrilla art and the quest for equality: the contribution of men with intellectual disabilities to equality work.

Á undanförnum misserum hafa orðið breytingar í umræðunni um jafnrétti þar sem áhersla er lögð á jafnrétti allra í stað þess að beina sjónum fyrst og fremst að jafnrétti kynjanna. Þrátt fyrir þessar breytingar hefur fatlað fólk, og þá sérstaklega fólk með þroskahömlun, áfram verið jaðarsett í íslenskri jafnréttis- og hagsmunabaráttu. Þar sem konur með þroskahömlun hafa verið meira áberandi í hagsmunabaráttu fatlaðs fólks er mikilvægt að beina sjónum að því hvernig hægt er að virkja karla með þroskahömlun til vitundar um jafnréttismál og þátttöku í jafnréttisstarfi. Í greininni verður fjallað um aðgerðir tveggja karla með þroskahömlun í þágu jafnréttis sem fóru fram í miðbæ Reykjavíkur sumarið 2016. Aðgerðirnar voru liður í verkefninu Jafnrétti fyrir alla sem styrkt var af Jafnréttissjóði og Rannsóknasjóði HÍ og hafði það að markmiði að skoða viðhorf karla með þroskahömlun til jafnréttismála og leita leiða til að virkja þá til þátttöku í jafnréttisstarfi. Aðgerðirnar voru í anda skærulistar (e. guerrilla art) sem sköpuð er í leyfisleysi þegar enginn sér til og felur í sér ádeilu á ríkjandi menningu og samfélagsskipan. Tilgangurinn er að vekja almenning til vitundar um samfélagsleg málefni. Í greininni er aðgerðunum lýst og hvernig þátttakendur sköpuðu sér rými í miðbænum þar sem þeir höfðu skilgreiningarvaldið og trufluðu gangandi vegfarendur sem stöldruðu við til að skoða veggspjöld, lásu falin skilaboð eða skrifuðu í ferðadagbækur. Aðgerðirnar voru liður í samvinnurannsókn þar sem karlar með þroskahömlun og ófatlaður háskólakennari unnu náið saman og allir aðilar voru virkir þátttakendur í rannsóknarferlinu. Samvinnurannsóknum er ætlað að vera valdeflandi og gefa fólki með þroskahömlun tækifæri til að hafa áhrif á það hvernig fjallað er um líf þess og reynslu. Það takmarkar hins vegar valdið að hafa ekki raunverulegan aðgang að fræðasamfélaginu. Ráðstefnur eru gjarnan haldnar í óaðgengilegu húsnæði, ráðstefnugjöldin eru há og fyrirlesarar nota óþarflega mörg og flókin orð, og hið sama á við um nefndarstörf. Það er því mikilvægt að leita annarra og óhefðbundinna leiða til að gera sig gildandi innan fræðasamfélagsins og jafnréttisbaráttunnar, en skærulistin var einmitt liður í því.People with intellectual disabilities have been marginalized within the disability movement and not had access to ideas on gender equality or equality work (Björnsdóttir and Traustadóttir, 2010). This has led to an overemphasis on traditional gender roles within the special education and support systems where gender/sexuality has been normalized in the lives of people with intellectual disabilities (Björnsdóttir, Stefánsdóttir and Stefánsdóttir, 2017). It has been recognized that disabled women are subject to multiple discrimination and are at greater risk of violence and abuse than non-disabled women or men (Snæfríðar- and Gunnarsdóttir, and Traustadóttir, 2015). Consequently, there has been more focus on the lived experiences of disabled women within the academic fields of disability studies and gender studies than on the lives of disabled men. However, research suggests that men with intellectual disabilities are denied opportunities equal to others to develop their gender and sexual identities and are often considered to be asexual eternal children or sexual predators who need to be managed and controlled (Björnsdóttir, Stefánsdóttir and Stefánsdóttir, 2017). In January 2016, two men with intellectual disabilities were hired by the University of Iceland’s School of Education to work on a research project which aims to explore the access of men with intellectual disabilities to ideas on gender equality and equality work. This article discusses the actions of two men with intellectual disabilities who performed guerrilla art, in downtown Reykjavík, in the summer of 2016, in their quest for equality. Guerrilla art is created anonymously, performed without permission and critiques the dominant culture and social order. The purpose is to raise public awareness about various social issues. The article describes the actions and explains how the men are both contributing to equality work and disability activism. In recent years equality work in Iceland has expanded from a strict focus on gender equality to broader notions of diversity and human rights (Þorvaldsdóttir, 2014). The guerrilla project was initially focused on gender equality but developed into a broader notion of equality where disability, gender, and other categories of oppression intersect. The men are, therefore, not in the role of self-advocates per se, but rather as activists demanding equality for all. The article describes how the men carved out space in Reykjavík’s city centre for their activism where they had the power to define intellectual disabilities in relation to equality. Their presence and their actions in the city centre were disrupting; pedestrians stopped and looked at their posters, read hidden messages in library books, wrote their thoughts in travel journals and shared their experience on social media. The French philosopher Michel De Certeau (1984) distinguishes between place and space. The dominant social groups strategically organize places of order and stability. An example of a place is the University of Iceland, the campus with buildings, offices, classrooms and laboratories, departments and programs managed by the staff, laws and regulations. Strict rules state who have access to university life, academics and activities. Another example of a place is downtown Reykjavik where the guerrilla art was performed. There are buildings, streets, sidewalks and walkways and we are supposed to walk along the sidewalks and cross streets on walkways. De Certeau (1984) called it “tactic” when people would use the place wrongly, for example by walking on the street. The guerrilla art was their tactic and the men used it to carve out space where they had the power to disrupt the existing social order. They are disrupting by asking pedestrians to stop and reflect on their society. Who are welcome? Who have access? What is equality? The disruption transformed the place into a space for equality work. The guerrilla art project is part of an ongoing inclusive research where men labelled as having intellectual disabilities collaborate on research with a non-disabled university teacher. In inclusive research, people with intellectual disabilities are not viewed as passive research subjects and they have opportunities to participate in the research process and often take on valued social roles as co-researchers. Inclusive research is supposed to be empowering for people with intellectual disabilities since they get an opportunity to contribute on the discussion of disability and acquire control over how people with intellectual disabilities are presented in research (Walmsley and Johnson (2003). However, barriers to full inclusion to academia, the place of research, are oppressive. Conferences are often held in inaccessible buildings, conference fees are expensive and speakers commonly use an excessive number of complex words and the same applies to committee meetings. It is, therefore, important to look for other non-traditional ways to make their presence felt within academia, and the guerrilla art event was part of that. By collaborating on this academic article we are also carving space within academia where people with intellectual disabilities are recognized for their contribution to the generation of knowledge about equality and disability. However, we also fear that this article has reduced the empowering experience of creating guerrilla art to something different, a traditional academic construction which is consequently inaccessible to most people with intellectual disabilities. We have been funded by research funds and are obligated to produce our research outcomes and hopefully we are also disrupting academia by sharing this collaborative knowledge production.Peer Reviewe

Integration of health and social services: An Integrative review

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnÁ Íslandi sem og í hinum vestræna heimi mun öldruðum fjölga hlutfallslega á komandi áratugum. Stefna stjórnvalda er að aldraðir geti búið sem lengst á heimilum sínum með viðeigandi aðstoð. Hér hefur ábyrgðin á opinberri þjónustu við þá skipst milli félagsþjónustu, sem er starfrækt af sveitarfélögunum, og heilbrigðisþjónustu, meðal annars heimahjúkrunar, sem er á vegum ríkisins. Það er yfirlýst stefna stjórnvalda að samþætta þessa þjónustu undir sameiginlegri stjórn sveitarfélaganna. Tilgangur þessarar greinar er að varpa ljósi á það hvernig samþættingu heilbrigðis og félagsþjónustu fyrir aldraða er best fyrir komið. Gerð var ítarleg leit að umfjöllun um skilgreiningar á samþættingu, markmiðum hennar og rannsóknum á árangri samþættingarverkefna í gagnasöfnunum PubMed, Scopus, Cinahl og Gegni. Leitin afmarkaðist við greinar frá löndum Evrópu og Norður Ameríku skrifaðar á ensku frá árunum 2000 til 2010. Lýsingar á samþættingu þjónustueininga innan heilbrigðiskerfisins voru útilokaðar. Stuðst var við aðgreiningu Leutz á stigum samþættingar við flokkun greina. Tekið var mið af 49 ritverkum við greiningu á skilgreiningum og markmiðum samþættingar. Umfjöllun um árangur samþættingar byggðist á greiningu á 7 stórum verkefnum sem höfðu öll verið metin í rannsóknum. Fram kom að skilningur á samþættingu er breytilegur eftir löndum en lýsingar á markmiðum þessara verkefna voru samhljóða, þ.e. að aldraðir séu betur komnir heima en á stofnunum. Þeir séu misleitur hópur með fjölþættar þjónustuþarfir sem sinnt er af mörgum faghópum sem nauðsynlegt er að samhæfa svo ekki verði tvíverknaður eða göt í þjónustunni. Það sem einkennir árangursrík samþættingarverkefni er þjónustustjórnun og þjónustustjóri, ein þjónustugátt, gerð er áætlun um þjónustu sem allir sameinast um, matstæki og upplýsingaforrit eða skráning eru sameigin leg, teymisvinna er ástunduð og húsnæði er sameiginlegt. Hér á landi er vinna við samþættingu heilbrigðis og félagsþjónustu komin einna lengst í Reykjavík þar sem hluti hennar er á þriðja stigi samkvæmt skilgreiningu Leutz. Niðurstöður samantektarinnar eru hjálplegar við mat á styrk og veikleikum samþættingarverkefna.------------------------------------------------------------It is forecasted that the number of elderly in Iceland, as in other western societies, will increase proportionally in the coming years. Icelandic policy reflects the authorities’ commitment to help older people remain living in their own homes for as long as possible, with the appropriate services. Responsibility for providing such services has been divided between the municipalities, providing social services, and the state taking care of health services, but current policy reflects the aim to integrate these services at the municipal level. The purpose of this paper was to explore how such integration has been developed. A literature search was undertaken in PubMed, Scopus, Chinal and Gegnir, focusing on the way in which integration is defined, its aims and studies of results of integration projects. The search was limited to studies written in English, focusing on the situation in Europe and North America from 2000 to 2010. Studies addressing integration between services within the health care system were excluded. Categorization of studies was based on Leutz’s levels of integration. Analysis of definitions and aims of integration was based on 49 documents, but analysis of successful integration was based on 7 projects that have been evaluated through research. Considerable variation was observed in how integration was defined between countries, but the aims were universally identified as supporting the elderly to live at home rather than moving to an institution. They are described as a heterogeneous group with diverse needs which demands services from different professional groups which calls for coordination to prevent duplication and gaps in services. Successful integration projects use service management and case management, single entry point, individualized service plans, collective assessment instruments, teamwork and united documentation system and all services are located in the same place. In Iceland integration has been initiated in a number of municipalities and in Reykjavik part of the services are already at Leutz’s third level. This study provides helpful guidance in evaluating the barriers and facilitators of integratio

Líkamleg færni og stuðningur frá formlegum og óformlegum stuðningsaðilum hjá 90 ára og eldri á Íslandi

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenVorið 2003 lauk greinarhöfundur meistararannsókn við hjúkrunarfræðideild Háskóla Íslands. Tilgangurinn með þessu rannsóknarverkefni var að kanna sjálfsbjargargetu langlífra Íslendinga sem búa á eigin heimilum, hvaða stuðning þeir fá frá aðstandendum og hinu opinbera og hvaða þættir hafa áhrif á þann stuðning sem veittur er. Í þessari grein verða kynntar helstu lýsandi niðurstöður rannsóknarinnar. Gögnin í þessari rannsókn voru unnin upp úr gagnasafni um heilsufar og hjúkrunarþarfir 90 ára og eldri á Íslandi, sem safnað var í tengslum við rannsókn á erfðum langlífis í samstarfi Íslenskrar erfðagreiningar (ÍE)og Rannsóknarstofu Háskóla Íslands og Landspítala-háskólasjúkrahúss í öldrunarfræðum (RHLÖ). Rannsóknin fór fram á tímabilinu frá mars árið 2000 til september árið 2002. Í rannsóknarhópnum voru ásamt greinarhöfundi Pálmi V. Jónsson, Helga Sæunn Sveinbjörnsdóttir, Hulda Jóhannesdóttir, Hjalti Guðmundsson og Kristleifur Kristleifsson. Leiðbeinendur í meistaranámi voru Kristín Björnsdóttir og Ragnar Friðrik Ólafsson

Nordic perspectives on disability studies in education : A review of research in Finland and Iceland

Disability studies in education (DSE) is an interdisciplinary field derived from the need to re-conceptualise special education dominated by a medical perspective on disability. In this article we identify what characterises DSE research and consider whether there is a case for arguing for a specific field of DSE in Finland and Iceland. Our analysis is based on a review of 59 studies published by Finnish and Icelandic scholars during the time period of ratification process of the UN Convention on the Rights of People with Disabilities from 2007 to 2016 in Finland and Iceland. We suggest that DSE has emerged as a dynamic area of research in both countries. It has provoked researchers to analyse disability in social contexts and turn the gaze from individual person with disabilities to the social structures and educational policies and practices. The fields of DSE in Finland and Iceland have not developed in identical ways and both have fluid crossovers to related fields such as disability studies and inclusive education. We argue for the potential of DSE to contribute to the discussion on educational equality and social justice. However, this requires opportunities to bring together scholars across disciplinary borders.Peer reviewe

Autonomy and People with Intellectual Disabilities Who Require More Intensive Support

In this article we explore the personal autonomy of people with intellectual disabilities who require more intensive support. The authors draw on qualitative research in Iceland carried out in the homes of 24 individuals. It is demonstrated how their personal autonomy can be defined, evaluated and enhanced in their daily lives. The conclusions show that to be able to respect personal autonomy of the participants those who support them need to view them as socially embedded, where personal autonomy is formed in relation to other people. To do that we refer to the idea of relational autonomy with support, advocacy and enablement being regarded as key elements for personal autonomy to flourish. By using this approach it is possible to note a positive change regarding respect for the personal autonomy of people with intellectual disabilities who require more intensive support. Considerable advances can still be made, however, in enhancing personal autonomy in their daily lives.Peer Reviewe

Risky Obliviousness Within Fragmented Services: Experiences of Families With Disabled Children During the Covid‐19 Pandemic

Living on an island in a pandemic has its obvious advantages. However, in a globalised economy, border restrictions cannot keep the COVID‐19 virus completely at bay. Despite coordinated efforts at infection control and extensive vaccination, Iceland, a sparsely populated island in the north, was placed among the countries in the highest risk category by the ECDC. In this article, wereport a qualitative study carried out at the peak of the fourth COVID‐19 wave in 2021, when the pandemic had severely hit the Icelandic social and healthcare system, with a record‐breaking number of infections. Semi‐structured interviews were conducted with parents with seven disabled children. Guided by feminist standpoint theory and critical disability studies, we focused on how service structures affected and shaped parents’ and children’s experiences during the first waves of the pandemic. The findings suggest that the pandemic intensified the already precarious position of the families. During the pandemic, the gaps in the already fragmented services widened, and the families were left to navigate this new reality on their own. Preventive measures enforced by municipalities and healthcare services centred on non‐disabled people’s experiences and needs. Unprepared service systems distanced themselves from the families while maintaining governance and supervision over defining their need for support