Challenges in managing elderly people with diabetes in primary care settings in Norway

Objective
To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings.

Design
Focus-group interviews.

Subjects and setting
Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years.

Results
Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines.

Conclusion
Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.

Northern Lights: the positive policy example of Sweden, Finland, Denmark and Norway

The nations of Scandinavia and Finland, or Nordic Europe, continue to provide living proof that economic prosperity can be combined with social equality and environmental responsibility. This book, written from an Australian perspective, explores previous outside policy interest in the Nordic nations and outlines some lessons which the English-speaking world, in particular, can learn now from the achievements of the four main Nordic European nations. In terms of income distribution these countries are still much more equal than Australia, Britain, New Zealand and Canada – and nearly twice as equal as the United States. Workforce participation rates are high in the Nordic nations but working hours remain within reasonable limits, enabling genuine work–life balance. Sweden has played a leading role in improving wellbeing, and lowering poverty, among children. Finland has achieved stunning success in schools since the 1990s. Denmark invests in comprehensive skills training as part of providing security, as well as flexibility, in people’s employment lives. Norway’s taxation approach and other measures ensure that its natural resources are used sustainably for the entire nation’s long-term wealth. All of these achievements are relevant to the policy choices for the future which Australia, and other English-speaking countries, can now make.