Dr. Sigríður Sía Jónsdóttir is an assistant professor at the School of Health Science at the University of Akureyri, Iceland, where she manages a postgraduate diploma program on primary health care in the community. The program offers advanced education to primary health care nurses. The skillset they attain is especially relevant in remote regions where they might be one of few healthcare workers within an hour’s drive – or two. We asked Dr. Jónsdóttir about how accessible healthcare is in small Icelandic communities, the program specifically and how it has prepared nurses across the country to deal with the current pandemic.
The whole population of Iceland is close to 360,000 people; about one third is scattered around the country and two thirds live in the capital area of Reykjavik. Outside of the capital city area, Akureyri is the largest town with around 20,000 people. In each region around the country, we have a town with up to 4000 inhabitants, which accommodates the local healthcare system. Since 2015, the country is divided into special healthcare institutions. We have seven of them across Iceland. In addition, we have the main hospital in Akureyri, which serves around 35,000 people and the national hospital in Reykjavik. The seven institutions around the country offer the regional healthcare services and are relatively easily accessible to the majority of people in rural areas – of course dependent on the road conditions. But my estimate is that most people live at most a two-hour drive away from their nearest healthcare center.
It is a special one-year program for nurses that are employed at one of the healthcare institutions. They are hired into an eighty per cent position, so the equivalent to four full days per week, and their salary mainly comes from the Ministry of Health. The University of Akureyri and the Healthcare center of the Capital area started the educational program in 2015 with in agreement with Ministry of Health. That’s how it started; and a year later the other healthcare institutions slowly began to come on board. Now six offer their nurses this education.
We require that the nurses have worked at the healthcare institution for at least a year or longer. So, we want them to have clinical experience in this area before they begin the program. This year we educate ten nurses, but next fall – if everything goes well in the system and the world – we expect to take in twelve.
Our aim is to give nurses tools and education to become stronger in clinical practice, more independent and capable of taking on more difficult cases. The program is therefore divided into two parts: clinical expertise and theory.
The clinical expertise includes courses on topics such as primary prevention, pharmacology, supportive interviewing, cognitive behavior therapy, as well as physical and mental assessments. They are taught by specialists from different areas of expertise. In addition, each nurse has a mentor, who works at the same institution, who has a master´s degree and a minimum of five years’ experience.
Early in the program, that year, one of the Institution did not have a master’s preparade nurse but wanted to be a part of the program. Our solution was to team up a very experienced local nurse and a mentor who was station in Reykjavik. This went very well.
The theoretical part in turn prepares the nurses to launch prevention programs, to develop research projects and to, for example, look at a community as a whole from an epidemiology point of view. So far, 38 nurses have graduated from the program and many of them have since taken lead positions in healthcare institutions – thus, they are well prepared to work independently and be in the forefront of health care service.
They are very well equipped. Interestingly, one of the courses especially addresses the link and cooperation between the healthcare service and the civil protection. That has always been an emphasis of the program in order to get the nurses equipped to deal with special situations like the current corona virus outbreak. When you are in rural areas and there are few to support you, you need to know how to work in the system.
Definitely. The current pandemic is very much a learning experience, to see how it spreads around the country.