"It feels like a healing process..." : the maintenance of traditional values among the Mohawk of Akwesasne

This thesis contains case studies from two Mohawk communities in present-day United States and Canada; specifically a language immersion school at the Akwesanse reservation, and an off-reservation settlement in the Mohawk Valley, which both focus on the preservation of language and culture for the future generations. Based on these studies and their political and historical contexts, I have looked at the traditionalist way of life as a part of long-term strategies for cultural preservation, and connected this to concepts of ‘healing’ and ‘decolonization’. ‘Healing’ is a concept with long and deep roots in Native American cultures, and thus makes a good metaphor for the work that is done to preserve and revitalize culture and language in a ‘post-colonial’ context. I further challenge theories that see traditions as political constructions and inventions, and argue that to acknowledge the importance of tradition in peoples lives, one should not see it as opposed to ‘modernity’, and as an idea of the past; but rather as modern expressions of a contemporary connection with the past while looking towards the future. Tradition is not just political constructions and strategies to reach a goal, but in some contexts and for some people a goal in itself

Virological treatment outcome under HAART : does sex matter?

Background: In Germany, 17% of 59,000 persons living with HIV/AIDS are female. Accordingly, the research focus in clinical studies as well as in cohort analyses has been almost exclusively on HIV-positive men. As a consequence, there is an urgent need to characterize and evaluate the outcome of HAART in HIV-positive women and to identify special requirements of this particular patient population. Methods: Cross-sectional multicentre (n = 31 centres) evaluation to observe characteristics of 1,557 HIV-positive women receiving medical care in Germany between June 2007 and March 2008. Data acquisition was performed using standardized questionnaires. Summary of results: Of 1,557 HIV-positive women studied, 1,191 (77%) received HAART. Mean age was 40 years and average time of known HIV-infection was 9 years. Risk of HIV transmission was: 40% heterosexual intercourse in Germany, 36% heterosexual intercourse in a high prevalence country; 17% IDU; 7% other reasons for transmission. 46% of the women had a migration background. Mean time on antiretroviral treatment was 7 years. 53% of the female participants had been treated with >2 HAART-regimens. 47% of the study subjects received a PI-based regimen, 33% a NNRTI-based regimen; 20% were on other combinations. The most commonly used PI and NNRTI were lopinavir/r and nevirapine, respectively. Only 48% of all women under HAART achieved a viral load <40 copies/ml. There was a significant difference between the PI-treated group with 44% patients <40 copies/ml and the NNRTI-treated group with 56% <40 copies/ml (p = 0.003). Conclusion: We found that HIV-positive women depicted an inferior virological response to HAART compared to those previously published in German cohort analyses dominated by men (response rates >75%). Possible differences in adherence or drug resistance may have impacted these results and are currently being evaluated in ongoing sub-analyses. Of note, the lack of a study arm with male patients is a limitation of this investigation. However, this is partly off-set by the fact that there are good comparative data in the male population found in other cohorts. We conclude that our results are in discordance to the popular assumption that there are no gender specific differences in virological treatment outcome of HAART

Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios

Background: The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Methods: Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n¼18, response rate 90%) as a testeretest assessment. Results: Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Conclusion: Correct classification of acute and nonurgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage

Understanding of and adherence to advice after telephone counselling by nurse: a survey among callers to a primary emergency out-of-hours service in Norway

<p>Abstract</p> <p>Background</p> <p>To investigate how callers understand the information given by telephone by registered nurses in a casualty clinic, to what degree the advice was followed, and the final outcome of the condition for the patients.</p> <p>Methods</p> <p>The study was conducted at a large out-of-hours inter-municipality casualty clinic in Norway during April and May 2010. Telephone interviews were performed with 100 callers/patients who had received information and advice by a nurse as a sole response. Six topics from the interview guide were compared with the telephone record files to check whether the caller had understood the advice. In addition, questions were asked about how the caller followed the advice provided and the patient's outcome.</p> <p>Results</p> <p>99 out of 100 interviewed callers stated that they had understood the nurse's advice, but interpreted from the telephone records, the total agreement for all six topics was 82.6%. 93 callers/patients stated that they followed the advice and 11 re-contacted the casualty clinic. 22 contacted their GP for the same complaints the same week, of whom five patients received medical treatment and one was hospitalised. There were significant difference between the native-Norwegian and the non-native Norwegian regarding whether they trusted the nurse (p = 0.017), and if they got relevant answers to their questions (p = 0.005).</p> <p>Conclusion</p> <p>Callers to the out-of-hours service seem to understand the advice given by the registered nurses, and a large majority of the patients did not contact their GP or other health services again with the same complaints.</p> <p>Practice Implication</p> <p>Medical and communicative training must be an important part of the continuous improvement strategy within the out-of-hour services.</p

A Systematic Review of Intuition – A way of knowing in clinical nursing?

-The aim of this systematic review was to illuminate intuition in clinical nursing. Frequently described as a defining characteristic of professional expertise, intuition is gaining acceptance as a legitimate form of knowledge in clinical nursing. A total of 352 abstracts were read and eight quantitative studies included. A thematic analysis was performed to one main theme, two themes, and four sub-themes emerged. The main theme was: Sensing an unconscious and conscious state of mind, and the two themes were: A sudden emotional awareness and reflection, and arousal of conscious thought processes. The first theme included two sub-themes: Sensing spiritual connections with patients and experiencing physical sensations; worrying and reassuring feelings. The second theme comprised two sub-themes: Willingness to act on personal, interpersonal, and Clinical experiences; the influence of maturity and social support in clinical decision-making. An implication for clinical nursing was the need to develop sensitivity as a key to understanding the patient’s illness. In conclusion, leadership and management could facilitate discussions about intuition as a legitimate method of processing information and making decisions about patient care

“Employers could use us, but they don’t”. Voices from blue-collar workplaces in a northern periphery

This article analyses labour market experiences of migrants of non-Nordic origin who have settled in the Faroe Islands, a small North Atlantic archipelago with a population of about 51,000 people. By examining the experiences of educated migrant workers who are employed in three different blue-collar workplaces: a cleaning company and two fish-processing plants, evidence is drawn from a cross-disciplinary study on language and migration in the Faroe Islands. This study explores the experiences of migrants in acquiring, using and becoming “new speakers” of Faroese and the challenges they face regarding labour market access and participation. In this article, framed within an ethnography of language policy, we highlight the institutional language policies which may be shaping migrants’ experiences, and how migrants enact their own language policy decisions and practices on the ground. We focus in particular on internal communication and language management in the three blue-collar worksites, comprising views and voices of both employers and employees, on the language policies and practices observed in these workplaces, and on workers’ views on language learning opportunities in blue-collar workplaces. Added to this, attention is drawn to implications of limited language learning opportunities in blue-collar jobs (which become the main barrier to accessing skilled jobs), to underutilisation of professional skills, and to long term implications of present macro- and micro-level language policies and practices affecting lived realities of workers of migrant origin

Incidence of emergency contacts (red responses) to Norwegian emergency primary healthcare services in 2007 – a prospective observational study

<p>Abstract</p> <p>Background</p> <p>The municipalities are responsible for the emergency primary health care services in Norway. These services include casualty clinics, primary doctors on-call and local emergency medical communication centres (LEMC). The National centre for emergency primary health care has initiated an enterprise called "The Watchtowers", comprising emergency primary health care districts, to provide routine information (patients' way of contact, level of urgency and first action taken by the out-of-hours services) over several years based on a minimal dataset. This will enable monitoring, evaluation and comparison of the respective activities in the emergency primary health care services. The aim of this study was to assess incidence of emergency contacts (potential life-threatening situations, red responses) to the emergency primary health care service.</p> <p>Methods</p> <p>A representative sample of Norwegian emergency primary health care districts, "The Watchtowers" recorded all contacts and first action taken during the year of 2007. All the variables were continuously registered in a data program by the attending nurses and sent by email to the National Centre for Emergency Primary Health Care at a monthly basis.</p> <p>Results</p> <p>During 2007 the Watchtowers registered 85 288 contacts, of which 1 946 (2.3%) were defined as emergency contacts (red responses), corresponding to a rate of 9 per 1 000 inhabitants per year. 65% of the instances were initiated by patient, next of kin or health personnel by calling local emergency medical communication centres or meeting directly at the casualty clinics. In 48% of the red responses, the first action taken was a call-out of doctor and ambulance. On a national basis we can estimate approximately 42 500 red responses per year in the EPH in Norway.</p> <p>Conclusion</p> <p>The emergency primary health care services constitute an important part of the emergency system in Norway. Patients call the LEMC or meet directly at casualty clinics with medical problems that initially are classified as a potentially life-threatening situation, a red response.</p