Arctic nurses in Greenland: Triage and treatment 2007 Dorte Gilså Hansen MD, PhD, Senior researcher Senior Researcher, MD, PhD Audit Project Odense Research Unit of General Practice University of Southern Denmark

Background Primary care has a central role in health care in Greenland Arctic nurses have to work on their own independently doing triage, diagnosis and treatment Shortage of health care professionals, especially physicians Coming organizational changes of the primary health care sector Political and professional demand for a descriptive study covering the nurses’ actual tasks and qualifications

Objective To describe the daily tasks among nurses working in the districts To analyse associations between competences and educational organizational and structural factors

Data 44 nurses from 14 of the 16 districts 10 days’ registration of all consultations – 1861 contacts A short questionnaire – Conditions of appointment – Education and professional experience from Greenland – Accommodations – Personal clinical competences – Guidelines available

Distrikt: Deltagernr: Navn: Audit: Sygeplejerskernes opgaver med diagnostik og behandling i distrikterne, Grønland 2007 Dato M K Dag Måned År Fødselsdag Køn Feber uden fokus Øre-,næse-, halssymptomer Åndenød/opspyt UVI/graviditets- og underlivsproblemer Hovedpine, muskel- og ledsmerter Mave- og tarmklager Psykiske eller sociale problemer ØjenklagerHudgener Urinstix Strep-A podning Samtale (psyk/social/ råd /vejl.) Skader inkl. følger af vold Stetoskopi Otoskopi Temp. BT+puls Suturering Ingen af førnævnte Urin HCG EKG Peak-flow måling Øjentrykmåling Ingen af førnævnte Ingen andre rådspurgt Rådspurgt læge Andet Kliniske procedurer: Analysearbejde: Involvering Henvendelsesårsag: Kun 1 X Mindst 1 X 1x ®Copyright: Audit Projekt Odense, J.B. Winsløws Vej 9A, Odense C Blodprøve: Hgb/BS/leucocyt Brystsmerter 35 >15 min. Læge tilkaldt Rådspurgt andre sundhedspersoner Tids- for- brug: 1x 0–15 min. Klokke- time Følte mig kompetent Utilstrækkelig egen viden/erfaring Kom- peten- ce 1x Mindst 1 X Registeringsskema Reason for encounter Clinical procedures Analytical tests Time consumption Competence Involvement of other health care providers

Reason for encounter Ear, nose and throat15.5% Others13.9% Dermal problems11.7% Headache & musculoskeletal problems 11.3% Violence and accidents9.8% UTI, pregnancy/ gynecological9.5% Eye problems5.3% Stomach5.3% Psycosocial4.2% Dyspnoea/expectoration4.2% Chest pain2.0% n=1871

Main results Triage, diagnosis and treatment of all kind of clinical problems No involvement of other health care professionals in more than 60% Physicians are involved in 29%, present in only 12% Clinical competences are perceived as inadequate in every 5th Experience from Greenland did not influence perceived competences Clinical guidelines and flowcharts are not widely used Continuing medical education and supervision by telemedicine has to be optimised during the organisational changes

Strengths and weaknesses This method for activity registration is applicable to healthcare systems like the one in Greenland Dependent on the postal services Limited number of items This activity registration may be selective (biased) No information about quality of care Small number of contacts for analytical purposes

Other topics analysed Contraception Respiratory tract infections X-ray Preventive medicine

Dorte Gilså Hansen, APO, Research Unit for General Practice, University of Southern Denmark Jens Otto Veje, Kystledelsen, Nuuk, Grønland Ella Skifte, Kystledelsen, Nuuk, Grønland Ann B Kjeldsen, Center for Sundhedsuddannelser, Nuuk, Grønland Anders Munck, APO, Research Unit for General Practice, University of Southern Denmark