Home In Iceland Research Articles

The Power of Women: A Conversation with the Honorable Vigdís Finnbogadóttir


 
 
 Riane Eisler interviews Vigdís Finnbogadóttir, president of Iceland from 1980 to 1996, at her home in Iceland, about equality and partnership. The nation of Iceland got its independence from the kingdom of Denmark in 1944; in its infancy as a democracy, Icelanders elected a single divorced mother as their head of state, which gained world attention. She was the world‘s first democratically elected woman president, and the longest-serving. Since then she has been a leader in Iceland and internationally, with the Council of Women World Leaders, UNESCO, The Club of Madrid, and The Vigdís International Centre for Multilingualism and Intercultural Understanding at the University of Iceland.

Communication is more than just a conversation: family members' satisfaction with end-of-life care.

The main aim of this study was to investigate family member's experiences of communicating with health professionals (HP) during end-of-life care in acute medical wards and a nursing home. A qualitative approach using 19 semi-structured interviews to collect data was used. The text was analysed using a content analysis methodology, extracting content that reflected family member's experiences of end-of-life care in acute medical wards, and a nursing home in Iceland. Four themes were identified as contributing to favourable communication with HPs in end-of-life care: establishing a relationship; flow of information; environment; acceptance at the time of death. Findings suggested that the context of communication in end-of-life care is more than just a conversation. It includes health professional's appearances, decision-making and respect. Satisfactory communication is a necessary factor of quality of care and the fundamental aspect of the establishment of a positive interpersonal relationship.

Use of complementary therapies in nursing homes: Descriptive study

IntroductionComplementary therapies may have positive effect on residents in nursing homes. The aim of this research was to investigate what kind of complementary therapies are provided in Icelandic nursing homes and who are the providers. Also whether the nursing homes need assistance to support the use of such therapies. MethodA questionnaire was mailed to all the nursing homes in Iceland (N = 59). Total of forty-five nursing homes replied or 76% response rate. ResultsRegistered nurses and licenced practical did most of the planning and provision of complementary therapies. The most common therapies were: heat packs, physical exercise and massage. Managers would like to have more knowledge and support in providing complementary therapies. ConclusionThe use of some complementary therapies is common in Icelandic nursing homes. More knowledge is needed to support the use of CT in Icelandic nursing homes.

Challenges in maintaining satisfactory documentation routines and evidence-based diabetes management in nursing homes

Introduction: The increasing prevalence of diabetes worldwide entails an expected rise in the number of older individuals with diabetes needing nursing home placement. Internationally, a consistent lack of adherence to clinical guidelines has been identified in the care of older people. In this study, we therefore investigated whether diabetes management in a sample of nursing homes in Norway and Iceland was in accordance with clinical guideline recommendations.Methods: We used a descriptive cross-sectional study design to assess diabetes management in 12 nursing homes: eight in Norway and four in Iceland.Results: We identified 162 residents with diabetes. The diagnosis of diabetes was available for 100% of the residents in the nursing homes in Iceland and respectively for 81 and 51% of the residents in southwestern and northern Norway. Totally, 3% of the residents with diabetes had a treatment goal for blood glucose regulation (HbA1c) documented in their medical record, 48% had agreed individualized rout...

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.

Lyfjanotkun á hjúkrunarheimilum á Íslandi árin 2002-2004

To describe medication use in nursing homes in Iceland during the years 2002-2004. In nursing homes using automated medication delivery, the number of medications used were calculated, from the beginning of 2002 to the end of 2004. Information was obtained from 10 nursing homes; a total of 1409 individuals or approximately 60% of the inhabitants of all nursing homes in Iceland. 65% of the population were women, mean age was 83 years and 43% died during the study periond. The total number of prescribed medications was collected as well as their use for common chronic conditions and symptoms was analysed. There were on average 8.9 (±4,0) medications used at the beginning of the study period, increasing to 9.9 (±4,3) by its end. On average, women got one more medication than men (p<0,001). 56.2% of women and 47% of men received >10 kinds of medication by the end of the study. Women got more psychiatric medications than men, but men got more medications for cardiovascular diseases. 82% of the population used psychiatric medications regularly, 65% used sedatives/hypnotics, 50% antidepressants and 20 % antipsychotics. Approximately additional 15% used psychiatric medication temporarily over the study period. The majority of medications were used constantly during the study period, especially cardiovascular medications. Medication for urinary incontinence, non steroidal antiinflammatory medications, medications for osteoporosis and medications against Alzheimers disease were used more often temporarily than constantly. Medications that were in constant use by >40% of the population were sedative/hypnotics, antidepressants, paracetamol, diuretics and vitamin D. There is a high number of medications used in nursing homes in Iceland. Most medications were already in use at the start of the study and continued throughout the study period indicating that medication review might be lacking. There are no indications of under-treated of pain or depression. Vitamin D is frequently used but should be used more often not least among men.

A New Approach to Spatial–Temporal Development of Second Homes: Case Study from Iceland

In northern Europe, the interest in rural tourism is widely connected with the phenomenon of second homes as a private place to relax and spend holidays. This paper describes second home development in Iceland with the aim of assessing and analysing changes in spatial patterns. Furthermore, based on the data analysis, a new model of second home distribution development, describing the emergence of existing patterns with regard to both mobility and urbanization processes is being proposed. The results reveal that despite the relatively late start of the second home development in comparison with the Scandinavian countries, second home tourism in Iceland has grown to a significant size. The spatial distribution of second homes in Iceland reflects the country's specific physical, demographic and historical conditions. Common factors generating the need for second homes such as pollution, noise and high levels of stress seem not to be the major catalyst for second home development in Iceland, since a high occurrence of second home ownership can be observed in both smaller towns and rural areas. However, similar to other countries, the largest second home areas have developed a relatively short distance from the country's major cities.

Needs and care of older people living at home in Iceland

The Icelandic old-age care system is universal and the official goal is to support older people live independently for as long as possible. The aim of this study is to analyse living conditions and use of formal and informal care of older people in Iceland. The results are based on the new study ICEOLD, a telephone survey which included questions on social network, health, activities of daily living, and received support from the community and/or from relatives, neighbours, and friends. Almost half of the sample (47%) receives some kind of care, with 27% of them receiving only informal care, which is understood to mean that informal care is of great importance and families are the main providers of help. For hypothetical future long-term care, older people wish to be cared for in their homes, but those already in need of assistance prefer to be cared for in institutions. Caring relatives are the main providers of support to older people in their homes and it is important to provide them with suitable formal support when the care responsibility increases. As the care system in Iceland is now under reconstruction, the important contribution of informal carers must be recognised and taken into account when planning the care of older people.

End of life in an Icelandic nursing home: an ethnographic study

To examine care of the dying elderly in a nursing home in Iceland. An ethnographic study design was adopted. The study sample comprised all of the nursing home residents, their relatives, and all of the staff working in the nursing home, but with a particular focus on the 11 registered nurses (RNs) on the site. Data was collected through participant observation, semi-structured group interviews with the RNs, and an examination of the nursing home's official records. Underlying themes were discovered using interpretative phenomenology. Two main themes emerged: that palliative care is the most important element of care in the home, and that RNs are the pillars of caring for the dying elderly in the nursing home. The findings suggest that RNs' professional knowledge can greatly contribute to the care of dying elderly residents in nursing homes. There seem to be many parallels between the condition and wellbeing of very frail nursing home residents and patients in specialized palliative care units for the elderly. Public awareness of palliative care of the elderly in Icelandic nursing homes should be encouraged.

Predicting mortality of residents at admission to nursing home: A longitudinal cohort study

BackgroundAn increasing numbers of deaths occur in nursing homes. Knowledge of the course of development over the years in death rates and predictors of mortality is important for officials responsible for organizing care to be able to ensure that staff is knowledgeable in the areas of care needed. The aim of this study was to investigate the time from residents' admission to Icelandic nursing homes to death and the predictive power of demographic variables, health status (health stability, pain, depression and cognitive performance) and functional profile (ADL and social engagement) for 3-year mortality in yearly cohorts from 1996-2006.MethodsThe samples consisted of residents (N = 2206) admitted to nursing homes in Iceland in 1996-2006, who were assessed once at baseline with a Minimum Data Set (MDS) within 90 days of their admittance to the nursing home. The follow-up time for survival of each cohort was 36 months from admission. Based on Kaplan-Meier analysis (log rank test) and non-parametric correlation analyses (Spearman's rho), variables associated with survival time with a p-value < 0.05 were entered into a multivariate Cox regression model.ResultsThe median survival time was 31 months, and no significant difference was detected in the mortality rate between cohorts. Age, gender (HR 1.52), place admitted from (HR 1.27), ADL functioning (HR 1.33-1.80), health stability (HR 1.61-16.12) and ability to engage in social activities (HR 1.51-1.65) were significant predictors of mortality. A total of 28.8% of residents died within a year, 43.4% within two years and 53.1% of the residents died within 3 years.ConclusionIt is noteworthy that despite financial constraints, the mortality rate did not change over the study period. Health stability was a strong predictor of mortality, in addition to ADL performance. Considering these variables is thus valuable when deciding on the type of service an elderly person needs. The mortality rate showed that more than 50% died within 3 years, and almost a third of the residents may have needed palliative care within a year of admission. Considering the short survival time from admission, it seems relevant that staff is trained in providing palliative care as much as restorative care.

Quality of life in nursing homes: perception of physically frail elderly residents

The purpose of this research was to disclose the characteristics of quality of life as perceived by physically frail but lucid elderly people living in nursing homes to increase the understanding of the phenomenon of quality of life in this setting. Eight elderly residents living in two nursing homes in Iceland were interviewed on two occasions. The interviews were audio-taped and transcribed to generate text for hermeneutic phenomenological analysis. Observation was also undertaken at both nursing homes to enhance the understanding of the residents' narration. The participants' concern in relation to quality of life emerges in the following main themes: (i) Securing the insecure body; (ii) Seeking solace; (iii) Preparing for departure; and (iv) Affirmation of self. The findings indicate that the phenomenon quality of life is manifold and complex, having many dimensions. The most important aspects of quality of life were for the residents to feel secure in the nursing home, have a place of their own where they could be alone with their thoughts, set their affairs in order and be prepared for death. Furthermore, it mattered to be recognized as an individual with his or her roots in their own respective family and doing meaningful things. These aspects of life in a nursing home contribute to living in a meaningful world in which humanity is preserved. It is important in caring for this particular group of residents in the nursing home to know what matters most in relation to their quality of life.

Patterns of Pain and Analgesic Use in 3- to 7-Year-Old Children After Tonsillectomy

Tonsillectomy is a common surgical procedure usually associated with moderate to severe pain. Although self-report is the gold standard for pain assessment, researchers have not studied young children at home with self-report measures. The purpose of this study was to describe the patterns of self-reported pain intensity and analgesic administration in 3- to 7-year-old children undergoing tonsillectomy during the operative day in the hospital and the first 2 postoperative days at home in Iceland. As part of a larger study, 68 children undergoing tonsillectomy were taught to use the Wong-Baker FACES Pain Rating Scale. Pain intensity scores and data about administration of analgesics were collected from children, the medical record, and the parents over a 3-day period. Children received primarily acetaminophen or acetaminophen with codeine in the hospital. At home, 99% of doses administered were acetaminophen only. Most doses were administered rectally. Forty percent of children received 24-hour therapeutic doses in the hospital. Only 10% received a 24-hour therapeutic dose at home despite significant pain scores of 4 or 5 persisting through the second postoperative day. Younger children were less likely to receive acetaminophen with codeine. In the hospital, children with pain intensity scores of 4 or 5 received prescribed morphine only 13% of the time. Children experienced clinically significant pain through the second postoperative day and will probably require a change in protocol to provide more aggressive pain management earlier. This study extends to younger children the research evidence that current pain protocols are inadequate.

From the state to the family: reconfiguring the responsibility for long-term nursing care at home.

This paper discusses the implications of the shift in the location of the provision of healthcare services from healthcare institutions to the home, which has occurred or is projected to occur in coming years. It is argued that the responsibility for the provision of care and assistance needed by the elderly living at home and people with long-term conditions living at home has shifted from public services to the family. Studies of care-givers have shown that in many situations they experience tremendous burdens, financial difficulties and health problems. Their social lives have been confined to the home, and contacts with friends and neighbors have been significantly reduced. This situation needs to be addressed by nurses, who in many cases serve as the bridge between the home and the official healthcare system. Using Foucault's exploration of power, particularly his idea of governmentality, a genealogy of care-giving in the home in Iceland's health-care has been constructed. The main findings were that, although this is occurring somewhat later than in many other countries, the state is withdrawing from its previously defined responsibility for the health and well-being of the nation. At the same time the citizen's responsibility for maintaining health is emphasized. Based on these findings, the argument is made that nurses in Iceland can have a profound influence on policy-making in relation to the organization of services provided in those homes. Suggestions are made as to how this can be done, which may be of interest to nurses in other countries.