The nature of nursing practice in rural and remote areas of Greenland.

BACKGROUND: The Greenlandic Healthcare Reform (2010) required improved quality of services for health promotion, prevention of infectious and lifestyle diseases, family nursing and evidence-based clinical nursing. AIM: To investigate current nursing practice in Greenland and to identify whether it meets the requirements of healthcare reform. DESIGN: This ethnographic study utilised documentary analysis, participant observation and qualitative interviewing carried out in remote areas of Greenland during 2011-2012. Eight registered nurses, four women and four men, aged between 35 and 55, participated in this study. Four were working at healthcare centres in towns and four were working at nursing stations in villages. The nurses were educated in Greenland or a Nordic country and had been practicing nursing for at least 2 years in an Arctic region. They were observed for 1-5 days, and subsequently interviewed. Interviews included in-depth questioning, based on emerging outcomes from observation. Interviews were recorded and transcribed; they were analysed within a phenomenological-hermeneutic approach. RESULTS: Nurses in rural and remote areas navigate their health promotion and preventive work with conflict between health strategies and everyday realities, where unpredictable tasks often lead to prioritisation of urgent, acute work. There is interaction between personal and professional skills. Everyday life is characterised by opportunities and challenges in the grey areas, namely nursing, medical and social work. CONCLUSION: The nature of nursing practice in rural and remote Greenland is characterised by a high degree of variability and complexity, with a requirement for a wide range of knowledge and skills. Nurses need to be better prepared with regard to acute medical care, preventive care, social work, humanistic approaches and information technology to implement the ideology of health strategies.

Violence- and alcohol-related acute healthcare visits in Greenland.

AIMS: The aim of this study was to describe emergency admissions in Greenland's healthcare system, and the extent to which admissions were associated with alcohol abuse or violence. Furthermore, we aimed to test whether data on emergencies in Greenland could be registered in a reliable way by simple means. METHODS: Registration of all emergencies presented in 15 out of 17 of Greenland's health districts in the period 21 May to 7 June 2010. RESULTS: In the 17-day registration period, 2403 emergencies were registered. In 10% of cases the patients were clinically alcohol intoxicated. When reason for presentation were mental or social problems, attempted suicide, accidents, or violence, 24, 50, 15, and 59% respectively were intoxicated. Alcohol intoxication was statistically significantly more often associated with advanced treatment (e.g. evacuation, hospitalisation, or follow up by doctor or nurse). CONCLUSIONS: This study confirms that violence- and alcohol-related emergencies put a considerable strain on Greenland's healthcare system. Due to the short observation period, we have not been able to describe the actual extent of the problem in detail, nor was it possible to estimate whether this problem is more pronounced in Greenland than in other countries, for example Denmark.