Kristín Björnsdóttir

Nursing and patient safety in the operating room

AIM This paper is a report of a study to identify what operating room nurses believe influences patient safety and how they see their role in enhancing patient safety. BACKGROUND Research in health care shows that work experience, communication and the organization of work are key factors in patient safety. This study draws on Reasons definitions of active and latent errors to conceptualize the complex issues that affect patient safety in the operating room. METHOD The study reported here is part of an action research project at a university hospital in Iceland. Semi-structured interviews were conducted in 2004 with eight nurses, followed by two focus groups of four nurses each in 2005. Data were analysed using interpretive content analysis. FINDINGS Securing patient safety and preventing mistakes were described as key elements in operating room nursing by all survey participants. In the interviews, the nurses identified the existing culture of prevention and protection that characterizes operating room nursing as crucial in enhancing safety. The organization of work into specialty teams was considered essential. Increased speed of work in an environment where enhanced productivity is imperative, as well as imbalance in staffing, was identified as the main threats to safety. CONCLUSION Operating room nurses have a common understanding of the core of their work, which is to ensure patient safety during operations. The work environment is increasingly characterized by latent error, i.e. system-based threats to patient safety that can materialize at any time. Interventions to enhance patient safety in operating room nursing are needed.

Stuck in the land of disability? The intersection of learning difficulties, class, gender and religion

This article discusses the discrepancy between formal rights to full social inclusion and the lived experiences of young adults with learning difficulties. It draws on inclusive life history research in Iceland and employs intersectional theory to study the social participation of young adults with learning difficulties. In an attempt to understand the complex political, economic and ideological forces that hinder the actualisation of their formal rights the intersection of disability, class, gender and religion in the production and reproduction of existing social hierarchies is examined. The article demonstrates how the research collaborators resisted their devalued social construction and attempted to create and affirm themselves as competent social actors.

How do prospective parents who decline prenatal screening account for their decision? A qualitative study.

Despite the aim of nuchal translucency screening to enhance reproductive choices among prospective parents, research on the experience of those who choose to decline this screening has been fairly limited. The objective of this study is to gain an understanding of how parents who decline screening account for their decision in a setting where screening for Downs syndrome in early pregnancy is the norm. The majority of research on prenatal screening choices has been conducted retrospectively; there has been very little research that has explored decision making on a prospective basis and that has included both parents. In order to study this question, a purposive sample of ten couples who had decided to decline screening was recruited from four health care centres in Iceland. Data were gathered in semi-structured interviews conducted with each participant twice during the pregnancy (at 7-12 weeks pregnant and at 12-24 weeks pregnant), for a total of 40 interviews. We find that the decision to decline screening is largely determined by what prospective parents bring with them to the pregnancy, i.e., their personal philosophy of Downs syndrome and the high value they place on maintaining the complexity of life. The test is also considered unreliable by some of the participants. These findings have implications for those who are involved in formulating and providing antenatal screening policies and practices.

The ethics and politics of home care

BACKGROUND In the dominant health-care policy, commonly referred to as New Public Management, primary emphasis is placed on the reduction of costs in health care. This development threatens to increase inequality in society based on levels of health or impairment and on gender. AIM The aim of this paper is therefore to raise awareness among nurses about the impact of New Public Management and explore how they might develop services that meet the diverse needs and wishes of those being served. THEORETICAL APPROACH AND METHOD: Although this policy has been criticised by nurses, it has also been observed that they are key players in its realisation. This discussion paper explores the impact of different discourses upon the practice of home-nursing care. It was developed within the post-structural tradition, where discourses are considered of key importance in shaping practice. Discourses represent different viewpoints and interests, and determine what can be considered meaningful and possible. The empirical studies which form the base for many of the main arguments presented were identified through an extensive review of published ethnographic research of home care in the years 2000-2008. RESULTS A review of studies conducted in a number of countries both in North America and Europe showed that home-care services have in many ways been diminished. Clients and their caregivers experience insecurity and wish for more assistance. With New Public Management the focus has shifted from an ethical discourse to an economic one, although this shift has not been clearly articulated and critiqued. By understanding the impact of New Public Management, nurses can better focus their practice to meet the diverse needs of patients and their caregivers. CONCLUSION In order to be able to respond to retrenchment in health services, nurses need to understand the complex ethical and political issues of New Public Management. A number of practices can be developed for working with patients and their families in such a way that their needs and wishes are respected.

‘It’s my life’ Autonomy and people with intellectual disabilities

This article discusses autonomy in the lives of adults with intellectual disabilities. The article draws on inclusive research in Iceland with 25 women and 16 men and employs ideas of relational autonomy from the perspectives of the Nordic relational approach to disability. In this article, we examine autonomy in relation to private life, that is, homes and daily activities. The article demonstrates how practices have improved with time and seem less paternalistic. However, the article also demonstrates that the assistance people with intellectual disabilities receive in their homes often has institutional qualities, and they are often met with belittling perspectives from staff and family members. Furthermore, many did not have access to important information needed to develop individual autonomy and independence, including making their own choices. The research findings suggest that people with intellectual disabilities can with appropriate support develop individual autonomy and make their own choices.

People With Intellectual Disabilities in Iceland: A Bourdieuean Interpretation of Self-Advocacy

There are many barriers to social participation in Iceland for people with intellectual disabilities. This article builds on qualitative research with young adults with intellectual disabilities. The purpose of this article is to develop an approach where the struggles over the meaning of social participation of people with intellectual disabilities are seen as social strategies. In the article, the authors suggest that people with intellectual disabilities are carving out a space where intellectual disability is gaining higher social status. They also posit that people with intellectual disabilities use several social strategies in the emerging field of self-advocacy for the purpose of improving their social position. Thus, the article contributes to a new social understanding of disability and how people with disabilities gain authority over their lives and experiences.

‘I am a college student’ postsecondary education for students with intellectual disabilities

ABSTRACTPostsecondary education for students with intellectual disabilities is almost unheard of in the Nordic countries, but several colleges in America, Australia and Europe offer such programmes. These colleges seldom offer inclusive education services; since 2007, however, the University of Iceland has offered a Vocational Diploma in inclusive settings for students with intellectual disabilities. In this article we report on qualitative research carried out in 2009–2013 among 39 graduated students with intellectual disabilities from the University of Iceland and 14 lecturers who have taught inclusive college courses. The findings suggest that, despite some reservations, there seems to be a common agreement that this initiative is an important part of improving the access of disabled people both to education and society. The courses are inclusive, that is, offered to disabled and non-disabled students at the School of Education studying at the undergraduate level. The graduated students described incre...

Theorizing accommodation in supportive home care for older people

This paper examines the issue of what thinking is necessary in order to advance a notion of accommodation in the organization and provision of supportive home care for older people. Accommodation in this context is understood as responsiveness to the singularity of older adults, and we consider how this idea might be used to support opportunities for (independent) living for elders as they age and become frailer. To elaborate the question we draw on examples from our empirical work - ethnographic studies of home care practice undertaken in Canada and Iceland - and consider these examples in light of critical philosophical and social theory, particularly Agambens (1993) work, The Coming Community. This is a relevant frame through which to consider the potential for the accommodation of the unique needs of older adults in home care because it helps us to problematize the systems through which care is accomplished and the current, dominant terms of relations between individuals and collectives. We argue that giving substance to a notion of accommodation contributes an important dimension to aligned ideas, such as patient-centeredness in care, by working to shift the intentionality of these practices. That is, accommodation, as an orientation to care practices, contests the organizational impulse to carry on in the usual way.

'Have you had the test?' A discourse analysis of media presentation of prenatal screening in Iceland.

Nuchal translucency (NT) screening has come to be widely used in antenatal care in many countries. In the capital area of Iceland, which is the focus of this study, 84% of pregnant women underwent screening in 2005. At the time no official policy had been formulated regarding the use of this screening, and very limited public discussion had taken place on the ethical issues related to its use. Although screening has been widely welcomed as a scientific and technological improvement, it may also have unintended consequences, both for practitioners and prospective parents, and for particular groups such as the disabled, which have not been fully explored. The purpose of this study was to examine how NT screening was introduced as a new practice and came to be adopted in prenatal care in Iceland. Using a genealogical approach, we explored the way in which the value and potential drawbacks of NT screening were presented to the public. The data used in the analysis comprised material published from the beginning of 2000 until the end of 2005, such as television programmes, newspaper and magazine articles and booklets written for prospective parents. The findings reveal that the screening was mainly promoted by staff at the specialized clinic where the test was offered, and that soon after its initiation screening became widespread. In interviews, both practitioners and parents of children with Downs syndrome questioned the eugenic implications of screening and its impact on the lives of the disabled and their relatives. However, the societal response was fairly muted and a critical debate regarding the routine use of NT screening can hardly be said to have taken place. These findings alert us to the importance of promoting critical discussion of new knowledge and technology in health care, particularly when serious ethical issues are involved.Scand J Caring Sci; 2010; 24; 414–421 ‘Have you had the test?’ A discourse analysis of media presentation of prenatal screening in Iceland Nuchal translucency (NT) screening has come to be widely used in antenatal care in many countries. In the capital area of Iceland, which is the focus of this study, 84% of pregnant women underwent screening in 2005. At the time no official policy had been formulated regarding the use of this screening, and very limited public discussion had taken place on the ethical issues related to its use. Although screening has been widely welcomed as a scientific and technological improvement, it may also have unintended consequences, both for practitioners and prospective parents, and for particular groups such as the disabled, which have not been fully explored. The purpose of this study was to examine how NT screening was introduced as a new practice and came to be adopted in prenatal care in Iceland. Using a genealogical approach, we explored the way in which the value and potential drawbacks of NT screening were presented to the public. The data used in the analysis comprised material published from the beginning of 2000 until the end of 2005, such as television programmes, newspaper and magazine articles and booklets written for prospective parents. The findings reveal that the screening was mainly promoted by staff at the specialized clinic where the test was offered, and that soon after its initiation screening became widespread. In interviews, both practitioners and parents of children with Down’s syndrome questioned the eugenic implications of screening and its impact on the lives of the disabled and their relatives. However, the societal response was fairly muted and a critical debate regarding the routine use of NT screening can hardly be said to have taken place. These findings alert us to the importance of promoting critical discussion of new knowledge and technology in health care, particularly when serious ethical issues are involved.

Development of Hermes, a new person-centered assessment tool in nursing rehabilitation, through action research

In this article, an action-research project has been outlined, aimed at exploring ways for developing an assessment tool, underpinned by phenomenology, which would enhance a person-centered approach to the participation of patients in nursing assessment and care planning in rehabilitation. Participants were nurses in physical rehabilitation and a consultant. Data were collected by interviews and observation of the documentation on the tool. The tool, Hermes, was adopted in practice. Through its use, important person-centered assessment practices were enhanced and several aspects of its phenomenological grounding were supported. Hermes has potential for facilitating the transfusion of phenomenology into nursing practice.