Consecuencias de la crisis

Marja Salo

Educational, developmental and research tasks in nursing in the Joint Municipality of Pääjärvi, Finland

Nurses in Finland

I´ll start by telling something about Finnish society and it´s history, because it is in connection with the situation of nurses in Finland. Then I’ll continue by telling about the education of nurses and end by telling something about todays issues and problems in nursing.

Finnish society and health care system

Finland is situated between Russia and Sweden. The main influence of society is from the west, but some of course from the east, too. Finland declared itself independent 1917. We have the policy of military unalliance and in developing the society we have followed the principles of Nordic welfare states. Finland is a democracy in the normal western sense of word, a parliamentary republic with a multiparty political system. The social structure in Finland is typical Nordic, resembling particularly that of Sweden. Important change in Finland´s position in Europe took place in 1995, when we joined the European Union. During year 2002 we joined to EMU so that our official currency is Euro.

Our population is 5,2 million. In our capital city Helsinki there is 560 000 inhabitants. Big part of the population in Finland lies in southern part.

Health care organization in Finland

After the second world war the main idea in health policy was, that improving the special care in hospitals it would also raise the national state of health. In 1950-1960 the hospitals were built up all over the country. However, it was not found out to have a good effect on the health situation. So in 1972 a political decision to put effort to preventive health services was made. The basic health care services all over the country were organized in Health Centres. Importance of preventive health care services was recognized and put to action in all age groups. Original idea was that the basic services are easy to access for everybody and free of charge. During the later years the preventive services are mainly free but the other services are charged to put note to self responsibility (for example 3 first visits to doctor during a year cost 11 € each )

Nowadays we have the primary or basic health care (both preventive and cure) in Health Centres and the special care in Hospitals throughout the country. The communes are supported by the state and they are put under an obligation to arrange services to the inhabitants. So the health care system in Finland lies strongly on public services. From our nurses 90 % are working in public area.

To some extend we have private services too; mainly in big towns and giving services of specialist-doctors, laboratory tests , X-ray tests and services in occupational health care. The customer, who uses private services is titled to get back some compensation from public sickness insurance.

Nursing and Nurse Education

The Nursing Education in Finland started in 1920´s . The Structure of nurse´s education based until 1980´s on medical specialities. The education took 2 ½ - 3 years and at least 2

years working experience afterwards allowed the nurse to go on with the studies of specialising (medical, surgical, anesthetic and theatre, childrens diseases, primary health visitor etc.)

Possibility to learn Nursing Science in University started in 1980 at the University of Kuopio. It was a very important phase for Nursing. Today we have six Universities, where it is possible to learn Nursing Science. There are different studying programs: administration and economics in health care, education, clinical expertise (elderly, preventive, occupational health, family health) and you are able to take candidate´s, master´s and doctor´s degree. International development and WHO´s project´s in Finland and own University education altered also nursing education. Nursing Education started to change mainly from the end of 1980´s so that it was based on it´s own Nursing theory and elements - both in structure and content.

Significant are also the changes that were made in upper secondary education in the later half of 1980`s. In health care we have had in Finland lower trained staff from 1960´s. Their vocational education of assisting nurses was shorter than that of nurses, about 2 years long. In 1980´s it seemed that there too many different lower vocational educations that made the system of using trained personality not very flexible. Even more important was that it disturbed to take care of the patients as holistic beings; there was a staff member, who took care of basic needs, one who did pedicure, one who took care of social aspects, one who took care of rehabilitation etc.

The upper Secondary Education was changed; lower trained social- and health care personal started to get wider basic knowledge about caring people, both in health and sick during the whole life span. After the basic modules, students choose the profound studies to specialised field of social- and health care.

The whole educational system was renewed to make possible to continue from upper secondary schools or vocational schools to Polytechnics and then to Universities.

The Nurse Education to Polytechnics

Challenges to think over nurse´s education was a topic again in later 1980`s and beginning of 1990´s. There were demands of economic, effective, affective and quality work in the fields of health care. There were demands for capability to use new information technology and to work in multicultural, international and in fast changing environment. Changes in surrounding world of work put pressure to have employees, who would be able to evaluate and develop their own practical work and who would have better capability to use increasing amount of new theoretical knowledge and for instance results of studies in nursing science. Clinical tasks themselves did not change much.

In educational system Polytechnics started mainly at the later part of 1990´s and this change made it possible to answer previous challenges better also in field of nursing.

Non-university higher education in Polytechnics is organised into degree programs, which are confirmed by the Ministry of Education. The curricula is independently decided by the Polytechnics. In that way the different Polytechnics create their own profile ( e.g. family, multicultural, community nursing). Degree program of Nursing typically consists of 140 credits in 3.5 years. In that program the basic studies consists of 20 credits, professional studies of 100 credits; which includes 50% practice, elective studies of 10 credits and theses

you can also have degree in Public health nursing, but it consists of 160 credits and degree in midwifery consists of 180 credits.

Hereby I add, as an example, information from nursing studies in Laurea Polytechnics. The key words in learning process are professional growth, value based ways of working, self- directness, problem solving, interaction and cooperative working methods. In programmes in nursing and in social services students concentrate on promoting and maintaining human wellbeing, taking care of the sick, and supporting people in need of help and rehabilitation. The objective of the program to get degree as Bachelor of Nursing is the student´s professional know-how constructed of evidence based knowledge, moral knowledge and knowledge found in skills and abilities. Also multicultural phenomena in nursing are examined. After getting the degree the student is able to work as a registered nurse or a public health nurse, as a health promoter and as a nursing expert in a multiprofessional team in order to develop and justify health care and social welfare services.

Discussion at this moment in nursing

The national aims and procedure of nursing in Finland was renewed just in January. This program is based to the national health policy: priorities are early intervention to health risks, health promotion in different fields of life, diminishing differencies in health and to renewing ways of functioning in health care.

To nursing this gives the first demand of improving and developing evidence based nursing. Possibility to gain proper care and promoting client-centered action - in generally - are also important aims. All actors in health care are challanged to develop regional network and cooperation . Important is that employers, educational field and trade unions are working together to gain previous mentioned aims.

We have specified our goal in nursing, but we have e.g. following challenges to solve:

* Lack of qualified labour especially in big towns (1992 depression and unemployment until 2000 –> nurses moved to England/ Norway/ Sweden)

How to get enough young who are interested about nursing studies

– long education and not so good salary and work in three shifts – how to combine work and family life

* Big challenges in work; quality, hurry, economical challenges, challenges in know-how -> threath that nurses are too stressed and lack of interest to the profession gets lower * Lack of doctors and discussion about transferring doctors´s tasks to nurses

* Nurses, who are at working life have different theoretical knowledge (education in 1960 and 2000 varies a lot ) –> need of supplementative education is big and in Finland it is duty of employers.

* In public sector middle age of nurses at working life is well over 40 years -> how to give the experienced knowledge to younger generation in future

Marja Salo RN, MNSc Educational, developmental and research tasks in nursing in the Joint Municipality of Pääjärvi Finland [email protected]

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