ABSTRACT
BACKGROUND: This paper presents a study that explored the lived experience of foreign nurses working at hospitals in Iceland. AIM: The aim was to generate an understanding of this experience both for local and international purposes. METHOD: The methodology that guided the study was the Vancouver school of doing phenomenology. Sampling was purposeful and consisted of 11 registered nurse from seven countries. The data were collected in dialogues; the analyses were thematic. FINDINGS: The findings are presented in five main themes that describe the essence of the experience with the overall theme of 'Growing through experiencing strangeness and communication barriers'. The first theme portrays how the nurses met and tackled the multiple initial challenges. One of the challenges, described in the second theme, was becoming outsiders and needing to be let in. The third theme explores the language barrier the nurses encountered and the fourth theme the different work culture. The fifth then illuminates how the nurses finally overcame these challenges and won through. CONCLUSION: The findings and their international context suggest the importance of language for personal and professional well-being and how language and culture are inseparable entities.
Subject(s)
Acculturation , Adaptation, Psychological , Attitude of Health Personnel/ethnology , Foreign Professional Personnel/psychology , Nursing Staff, Hospital/psychology , Adult , Burnout, Professional/etiology , Burnout, Professional/prevention & control , Burnout, Professional/psychology , Communication Barriers , Female , Foreign Professional Personnel/education , Friends/psychology , Health Facility Environment , Humans , Iceland , Interprofessional Relations , Middle Aged , Nursing Methodology Research , Nursing Staff, Hospital/education , Organizational Culture , Psychological Distance , Self Concept , Semantics , Social Isolation , Social Support , Surveys and Questionnaires , Workplace/organization & administration , Workplace/psychologyABSTRACT
BACKGROUND: Sympathetic nerve activity was recorded in the leg during high thoracic epidural anesthesia with a segmental sensory blockade of the upper thoracic dermatomes to test the hypothesis that the sympathetic blockade accompanying thoracic epidural anesthesia includes caudal parts of the sympathetic nervous system. METHODS: Experiments were performed on 10 patients scheduled for thoracotomy. An epidural catheter was inserted at the T3-T4 or T4-T5 interspace. In the main protocol (seven patients), blood pressure, heart rate, and skin temperature (big toe, thumb) were continuously monitored, and multiunit postganglionic sympathetic nerve activity was recorded with a tungsten microelectrode in a muscle-innervating fascicle of the peroneal nerve. After baseline data collection, muscle sympathetic nerve activity was recorded for an additional 45-min period after epidural injection of 4-6 ml bupivacaine, 5 mg/ml. In an additional three patients, the effects of thoracic epidural anesthesia on skin-innervating sympathetic nerve activity were qualitatively assessed. RESULTS: Activation of thoracic epidural anesthesia caused no significant changes in peroneal muscle sympathetic nerve activity (n = 7), blood pressure, or heart rate. Skin temperature increased significantly in the hand 15 min after activation of the blockade, from 32.7 +/- 2.4 degrees C to 34.4 +/- 1.5 degrees C (mean +/- SD), whereas no changes were observed in foot temperature. The sensory blockade extended from T1 (C4-T2) to T8 (T6-T11). CONCLUSIONS: A high thoracic epidural anesthesia with adequate sensory blockade of upper thoracic dermatomes may be achieved without blockade of caudal parts of the sympathetic nervous system. This finding differs from that of earlier studies that used indirect methods to evaluate changes in sympathetic nerve activity.
Subject(s)
Anesthesia, Epidural , Leg/innervation , Sympathetic Nervous System/drug effects , Blood Pressure/drug effects , Electrophysiology , Foot/innervation , Galvanic Skin Response/drug effects , Hand/innervation , Heart Rate/drug effects , Humans , Muscle, Skeletal/drug effects , Muscle, Skeletal/innervation , Peroneal Nerve/drug effects , Regional Blood Flow/drug effects , Skin/blood supply , Skin/drug effects , Skin/innervation , Skin Temperature/drug effects , Sympathetic Fibers, Postganglionic/drug effects , ThoracotomyABSTRACT
BACKGROUND: Cardiac sympathetic blockade by thoracic epidural anesthesia (TEA) dilates stenotic coronary arteries and has been used to control pain in patients with unstable angina. The aim of the present study was to evaluate the potential anti-ischemic effects of cardiac sympathetic blockade by TEA in severe, refractory, unstable angina. METHODS AND RESULTS: Forty patients with unstable angina refractory to standard anti-anginal therapy were randomized to receive either continuous epidural infusion of bupivacaine (TEA, Th1 to Th5) or to standard anti-anginal therapy including beta-blockers, calcium antagonists, aspirin, heparin, and nitroglycerin infusion (control group). The primary end points were number of anginal attacks and severity of myocardial ischemia assessed by 48-hour ambulatory Holter monitoring. The incidence of myocardial ischemia was lower in the TEA group (22% versus 61%; P<.05). The number of ischemic episodes per patient was 1.0+/-0.6 in the TEA group and 3.6+/-0.9 in the control group (P<.05). The episode duration per patient was 4.1+/-2.5 minutes and 19.7+/-6.2 minutes in the TEA and the control groups, respectively (P<.05). The mean area-under-the-ST-time-curve was 6.8+/-4.3 and 32.2+/-14.3 (mm-min) in the TEA and the control groups, respectively (P<.05). Fifteen anginal attacks were recorded in the control group and one attack in the TEA group (0.83+/-0.21 versus 0.06+/-0.06/patient, respectively, P<.01). CONCLUSIONS: The anti-ischemic and anti-anginal effects of continuous TEA are superior to those of conventional therapy in the treatment of refractory unstable angina.
