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Background: Remote area nursing has been studied globally, highlighting daily challenges, yet there is limited research in the Nordic countries, especially in the island communities, such as the archipelago. Studying and addressing the challenges that nurses face is of importance from an organizational and occupational health perspective, as attracting and retaining nurses in remote areas is a global challenge. Despite previous research on these challenges, it appears that healthcare professionals and managers still lack full understanding of the meaning of working in this context. Deeper insight into the role of nurses in remote areas can support healthcare professional and organizational efforts. Illuminating the meaning of being a nurse in these areas can contribute to a deeper understanding. It is also important to conduct longitudinal studies on what nurses do as the scope of practice evolves.

Aim: This licentiate thesis aimed to explore nursing practice in the archipelago setting.

Methods: Study I was a quantitative survey study based on registered nurses and primary healthcare nurses’ patient record documentation, and self-reporting of nurse activities. In total, 1,062 documented nursing encounters were analyzed using descriptive and analytical statistics to describe and analyze the characteristics of nursing encounters in primary healthcare in remote areas. Study II was a qualitative study to illuminate the meaning of being a nurse in the archipelago. Eleven individual interviews were performed with registered nurses and/or primary health nurses. The interviews were analyzed using a phenomenological hermeneutical method.

Results: In Study I, a great variety of the characteristics of nursing encounters was shown, as well as common features. Nurses were caring for newborns, to patients aged 100 years old. However, patients aged 65 years and older were the most common. The reasons, assessments and clinical interventions varied in total, and between age groups, and reflected a diversity in the material. In Study II, the results concluded with one main theme, Standing alone on the frontline, and three themes: Combating sea, weather and the clock, Standing firm but wavering, and Being a lifeline throughout the entire lifespan.

Conclusions: Nursing practice in the archipelago does not significantly differ from other remote areas, except for the reliance on the sea. The results support previous research that there is considerable variation in ivthe characteristics of nursing encounters. A wide range of competencies to provide high-quality healthcare to islanders are needed. Nurses need to be prepared for independent and solitary work. It may be relevant to note that there is a practical focus on medical care rather than health promotion. To improve occupational health and foster professional growth, nurses need time for reflection, resources to address daily challenges, opportunities to learn new skills and build potential, and a sense of belonging − not only with the islanders but also with colleagues, management team, and the healthcare organization.Keywords archipelago, phenomenological hermeneutical, primary care nursing, primary healthcare, registered nurse, remote area, survey