Stress, burnout and coping among nurses working on acute medical wards and in the community: A quantitative study.

BACKGROUND: Psychological distress can cause burnout, which affects mental and physical well-being. It is important to identify factors associated with psychological distress and physical discomfort and how nurses deal with these problems. AIM: The aim was to investigate distress, burnout and coping among community nurses (CN) and hospital nurses (HN). APPROACH AND METHODS: In this cross-sectional study, 409 nurses completed three questionnaires: Perceived Stress Scale (PSS), Copenhagen Burnout Inventory (CBI) and Ways of Coping (WOC). FINDINGS: Participants younger than 40 demonstrated significantly more distress and burnout than those older than 40 years. Participants who had moderate and high distress on the PSS were significantly more at risk for experiencing personal, work-related and patient-related burnout. A significant positive correlation was found between distress and behavioural escape-avoidance, cognitive escape-avoidance and distancing. Significant positive correlations were also seen between all the subscales of the CBI and behavioural escape-avoidance, cognitive escape-avoidance and distancing. Positive significant correlation was also obtained between staff resources and distress and personal-related and work-related burnout. Negative correlation was demonstrated between staff resources and patient-related burnout. Participants with longer work experience were less likely to report moderate or high distress, and those who scored higher on personal burnout and behavioural escape-avoidance were more likely to have moderate or high distress. CONCLUSION: The results of this study call for increased attention to the younger generation in the nursing profession. The results also validate the need to investigate further the correlation between distress, burnout and coping and how these issues might influence each other among nurses working in the community and hospitals. Findings should be taken with precaution, they do not describe in detail what underlying factors contribute to distress and discomfort found in this study, they do, however, indicate certain coping strategies nurses use to deal with distress and burnout.

[Adult chronic pain in relation to psychological trauma in childhood].

INTRODUCTION: Chronic pain is a health problem that is one of leading cause of disability. Studies have shown that various aspects of a person's history, such as difficult experiences in early life, can affect lifestyle and health later. The aim of this study was to examine the relationship between chronic pain, adverse childhood experience (ACE) and violence in adulthood in the general population of Iceland.  MATERIAL AND METHODS: A retrospective cross-sectional study. The sample was 12.400 individuals, 18-80 years of age, randomly selected from respondents' group of the data collection company MASKINA (National Portal). Data on chronic pain, ACE and experience of violence in adulthood were examined. Statistical processing was carried out in IBM SPSS Statistics 28th edition.  RESULTS: Response rate was 44.8% (female 57.1%, M=56 years). Prevalence of chronic pain (≥3 months) was 40.1%. A total of 91.1% of participants answered questions about ACE, of which 16.1% ≥4 ACE-scores. There was a positive relationship between ACE and chronic pain (OR = 1.675, 95% CI: 1.420 - 1.977). Those who had ≥4 ACE-scores were more likely to have experienced violence in adulthood.  CSONCLUSION: The results of this study show that chronic pain and violence in adulthood can be associated with psychological childhood trauma. People who experience psychological childhood trauma and violence in adulthood are more likely to suffer from chronic pain. It is important to be aware of experiences of childhood psychological trauma and violence when people seek healthcare for chronic pain.

Pregnancy complications, sick leave and service needs of women who experience perinatal distress, weak social support and dissatisfaction in their partner relationships.

INTRODUCTION: Although perinatal distress is acknowledged as a burdening condition for pregnant women, its effects on pregnancy are not well known. This study was conducted to increase knowledge regarding the effects of distress on pregnancy-related problems. The study also assessed women's need for sick leave and increased prenatal care due to distress, and the effects of weak social support and dissatisfaction with their partner relationships. METHODS: In total, 2523 women were screened for perinatal distress three times during pregnancy in this quantitative cohort study. Structured psychiatric interviews were conducted following the screening, with 562 of the participants. Data from participants' pregnancy records were also analysed. The study was conducted in primary healthcare centres in Iceland after receiving approval from the Icelandic National Bioethical Committee. The main outcome measures were pregnancy problems, sick leave issued and prenatal service needs. RESULTS: Data from 503 women were analysed. The perinatal distress group (PDG) was significantly more likely than was the nondistressed group (NDG) to experience fatigue, vomiting and pelvic pain after controlling for background variables. Distressed women who reported weak family support experienced symptoms of nausea and heartburn. The PDG needed more frequent prenatal care than did the NDG and was issued sick leave for up to 42 days longer. Dissatisfaction in the partner relationship and with the division of household tasks and childcare was strongly associated with distress, the development of complications and the need for sick leave. DISCUSSION: Identification of perinatal distress by midwives and other healthcare professionals is important, since distress may be linked to women's complaints of fatigue, vomiting, pelvic pain and need for prolonged sick leave, and additional prenatal care services will be needed. Perceived dissatisfaction in the partner relationship and with the division of household tasks should also form part of clinical practice and assistance provided.

Psychometric properties of the client-centred rehabilitation questionnaire-is derived from a large and varied group of rehabilitation users.

PURPOSE: The purpose of this study was to inspect and establish the factor structure of the Icelandic Client-Centred Rehabilitation Questionnaire [CCRQ-is] and investigate the service experiences of a large and varied sample of rehabilitation users. MATERIALS AND METHODS: Altogether 499 rehabilitation users completed the questionnaire. Confirmatory and exploratory factor analysis was conducted for analysis of items. Mann-Whitney's U and Kruskal-Wallis test was used to compare subscale responses based on participants' characteristics. RESULTS: Four factors explained 53,2% of the variance: Respect and attentiveness, Interaction with significant others, Responsiveness to needs and preferences and Education and enablement. Subscales showed internal consistency from 0.72-0.91 and 0.92 for the whole instrument. The subscale Respect and attentiveness represented user centred rehabilitation the most and Interaction with significant others the least. Significant differences in relation to health conditions and age were obtained on all four subscales and differences by gender on one subscale. CONCLUSIONS: Our results suggest the CCRQ-is is a reliable tool that can be used with rehabilitation users with a broad range of characteristics within the Icelandic context. The extent to which the intersection of age, gender and health issues influence users' perception of services needs to be further scrutinized.

Increasingly users of rehabilitation have complex and composite health issues as physical and mental health conditions commonly co-exist.The four subscale Client-Centred Rehabilitation Questionnaire [CCRQ-is] demonstrated strong reliability for assessing the client-centredness of rehabilitation services for people with different health issues in Iceland.People receiving rehabilitation for mental health reasons seem to find the service to be less client-centred than other rehabilitation service users.The lowest scores on the CCRQ-is were consistently found on the dimension Interaction with significant others.The key role often played by families during and after the rehabilitation process should be recognized.

Waste management in Iceland: Challenges and costs related to achieving the EU municipal solid waste targets.

Waste management in Iceland has developed considerably in recent years. Before 1990, most of the waste was either burnt in open pits or landfilled. In the past, information about waste management in Iceland used to be almost exclusively published in reports and was primarily based on rough estimates. Currently, incinerators and landfilling sites are highly regulated and follow EU legislation. Additionally, reporting has gradually improved and is approaching EU standards, although improvement is still needed. In an international context, Iceland is far behind the other Nordic countries as well as the EU-27 countries in reducing landfill rates and enhancing energy recovery and recycling rates. According to the EU landfill directive, the total amount of municipal solid waste (MSW) landfilled must be below 10% by 2035; however, it is currently over 60%. Other targets are similarly far off, and it is unlikely that Iceland will meet those in time without immediate and significant changes in waste management. This article aims to evaluate MSW management in Iceland at the national and regional levels, its compliance with the EU's targets for waste management and the associated costs inflicted on municipalities. Hence, annual accounts data were used when comparing regions and municipalities. It was found that there are significant differences in per capita waste management expenditure between municipalities with less than 1,000 inhabitants (€379) and ones with more than 10,000 inhabitants (€106). Without changes in proposed future waste management strategies, this gap will inevitably increase in the upcoming years.

Family Caregivers' Satisfaction With Specialized End-of-Life Care Provided at Home: Assessment of the Psychometric Characteristics of the Icelandic Version of the Family Assessment of Treatment at the End of Life Questionnaire.

Several studies have highlighted the significant role of families in end-of-life care. Carers' well-being may depend on how they experience the care and support provided to their loved ones. This study was conducted to investigate family caregivers' assessment of specialized end-of-life care in a sample of 119 close family members in Iceland. The response rate was 58.8% (n = 70). Furthermore, the aim was to assess the psychometric characteristics of the Icelandic version of Family Assessment of Treatment at the End of Life (FATE). Descriptive statistics were used to describe the characteristics of the data. Results indicate that good communication and understanding of all parties concerned are the foundation for family caregivers' satisfaction with end-of-life care. Participants were generally satisfied with the care provided, whereas some important aspects of care were rated as excellent. Evaluation of management of symptoms reported in this study should be given specific attention in future studies considering its unsatisfactory outcomes. Nurses need to be aware of the impact that physical suffering of the patient might have on the family caregivers. The Icelandic version of the Family Assessment of Treatment at the End of Life instrument is a psychometrically sound instrument useful for measuring caregivers' satisfaction with service provided at the end of life, although modifications would improve the instrument for use on this population.

Pain management and medical interventions during childbirth among perinatal distressed women and women dissatisfied in their partner relationship: A prospective cohort study.

OBJECTIVE: The purpose of this study was to investigate possible associations between distress in pregnant women and their use of pain management and medical interventions. Furthermore, we assessed the effects of reported dissatisfaction in relationship with their partner, or weak social support. DESIGN: This was a prospective cohort study. SETTING: Women were invited to participate while attending prenatal care at participating Icelandic health care centres. Birth outcome data were obtained from the hospitals where these women gave birth. PARTICIPANTS: Women in this study participated in a research project where 2523 women were screened three times during pregnancy for anxiety and depression. Women who had positive results at screening were invited to a semi-structured interview during pregnancy as well as every fourth woman who had negative results. Five hundred and sixty-two women participated in the interviews and the final sample was 442 women. MEASUREMENTS: Distress was defined as symptoms of anxiety, stress and depression. The Edinburgh Postpartum Depression Scale (EPDS) and the Depression, Anxiety and Stress Scales (DASS) were used for screening purposes. During the interview, the women answered the Dyadic Adjustment Scale (DAS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Adverse Experienced Interview (AEI). The main outcome variables that were obtained from the women's childbirth records were: (1) use of pain management, categorized as: epidural analgesia, non-pharmacological pain management, nitrous oxide, pharmacological medication, or no pain management; (2) medical interventions categorized as: induction, stimulation, and episiotomy; and (3) mode of childbirth. A logistic regression analysis, adjusted for significant covariates, was conducted. FINDINGS: A significant association was found between perinatal distress at 16 weeks gestation and use of epidural as single pain management. Overall, distressed women were 2.6 times more likely than non-distressed women to use epidural as a single pain management. They were also less likely to go through childbirth without use of any pain management method. Women who were dissatisfied in their relationship were significantly more likely to undergo induction of childbirth, an episiotomy and/or a vacuum extraction than those who were satisfied in their relationship, regardless if they were distressed or not. No association was found between social support and the outcome variables. KEY CONCLUSIONS: Women with perinatal distress were more likely to use an epidural than non-distressed women. The use of an epidural might help them manage pain and uncertainties related to childbirth. Women who were dissatisfied in their partner relationship may be more likely to undergo induction of childbirth, episiotomy and/or vacuum extraction. IMPLICATION FOR PRACTICE: Midwives need to acknowledge the possible association of distress and use of an epidural during childbirth and screen for distress early in pregnancy. It is important to offer counselling and help during pregnancy for expectant parents who are distressed or dissatisfied in their relationship.