Sairaanhoitajaksi kasvattaminen : Sairaanhoitajakoulutus ja siinä käytetyt oppikirjat Suomessa vuoteen 1967 asti

The historical development of Finnish nursing textbooks from the late 1880s to 1967: the training of nurses in the Foucauldian perspective. This study aims, first, to analyse the historical development of Finnish nursing textbooks in the training of nurses and in nursing education: what Foucauldian power processes operate in the writing and publishing processes? What picture of nursing did early nursing books portray and who were the decision makers? Second, this study also aims to analyse the processes of power in nurse training processes. The time frame extends from the early stages of nurse training in the late 1880s to 1967. This present study is a part of textbook research and of the history of professional education in Finland. This study seeks to explain how, who or what contributed the power processes involved in the writing of nursing textbooks and through textbooks. Did someone use these books as a tool to influence nursing education? The third aim of this study is to define and analyse the purpose of nurse training. Michel Foucault´s concept of power served as an explanatory framework for this study. A very central part of power is the assembling of data, the supplying of information and messages, and the creation of discourses. When applied to the training of nurses, power dictates what information is taught in the training and contained in the books. Thus, the textbook holds an influential position as a power user in these processes. Other processes in which such power is exercised include school discipline and all other normalizing processes. One of most powerful ways of adapting is the hall of residence, where nursing pupils were required to live. Trained nurses desired to separate themselves from their untrained predecessors and from those with less training by wearing different uniforms and living in separate housing units. The state supported the registration of trained nurses by legislation. With this decision the state made it illegal to work as a nurse without an authorised education, and use these regulations to limit and confirm the professional knowledge and power of nurses. Nurses, physicians and government authorities used textbooks in nursing education as tools to achieve their own purposes and principles. With these books all three groups attempted to confirm their own professional power and knowledge while at the same time limit the power and expertise of others. Public authorities sought to unify the training of nurses and the basis of knowledge in all nursing schools in Finland with similar and obligatory textbooks. This standardisation started 20 years before the government unified nursing training in 1930. The textbooks also served as data assemblers in unifying nursing practices in Finnish hospitals, because the Medical Board required all training hospitals to attach the textbooks to units with nursing pupils. For the nurses, and especially for the associations of Finnish nurses, making and publishing their own textbooks for the training of nurses was a part of their professional projects. With these textbooks, the nursing elite and the teachers tended to prepare nursing pupils’ identities for nursing’s very special mission. From the 1960s, nursing was no longer understood as a mission, but as a normal vocation. Nurses and doctors disputed this view throughout the period studied, which was the optimal relationship between theory and practice in nursing textbooks and in nurse education. The discussion of medical knowledge in nursing textbooks took place in the 1930s and 1940s. Nurses were very confused about their own professional knowledge and expertise, which explains why they could not create a new nursing textbook despite the urgency. A brand new nursing textbook was published in 1967, about 30 years after the predecessor. Keyword: nurse, nurse training, nursing education, power, textbook, Michel Foucault

Nutrition and Nutritional Care of Elderly People in Finnish Nursing Homes and Hospitals

Background: Malnutrition is a common problem for residents of nursing homes and long-term care hospitals. It has a negative influence on elderly residents and patients health and quality of life. Nutritional care seems to have a positive effect on elderly individuals nutritional status and well-being. Studies of Finnish elderly people s nutrition and nutritional care in institutions are scarce. Objectives: The primary aim was to investigate the nutritional status and its associated factors of elderly nursing home residents and long-term care patients in Finland. In particular, to find out, if the nursing or nutritional care factors are associated with the nutritional status, and how do carers and nurses recognize malnutrition. A further aim was to assess the energy and nutrient intake of the residents of dementia wards. A final objective was to find out, if the nutrition training of professionals leads to changes in their knowledge and further translate into better nutrition for the aged residents of dementia wards. Subjects and methods: The residents (n=2114) and patients (n=1043) nutritional status was assessed in all studies using the Mini Nutritional Assessment test (MNA). Information was gathered in a questionnaire on residents and patients daily routines providing nutritional care. Residents energy and nutrient intake (n=23; n=21) in dementia wards were determined over three days by the precise weighing method. Constructive learning theory was the basis for educating the professionals (n=28). A half-structured questionnaire was used to assess professionals learning. Studies I-IV were cross-sectional studies whereas study V was an intervention study. Results: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. According to the MNA, 11% to 57% of the studied elderly people suffered from malnutrition, and 40-89% were at risk of malnutrition, whereas only 0-16% had a good nutritional status. Resident- and patient-related factors such as dementia, impaired ADL (Activities of Daily Living), swallowing difficulties and constipation mainly explained the malnutrition, but also some nutritional care related factors, such as eating less than half of the offered food portion and not receiving snacks were also related to malnutrition. The intake of energy and some nutrients by the residents of dementia wards were lower than those recommended, although the offered food contained enough energy and nutrients. The proportion of residents receiving vitamin D supplementation was low, although there is a recommendation and known benefits for the adequate intake of vitamin D. Nurses recognized malnutrition poorly, only one in four (26.7%) of the actual cases. Keeping and analysing food diaries and reflecting on nutritional issues in small group discussions were effective training methods for professionals. The nutrition education of professionals had a positive impact on the energy and protein intake, BMIs, and the MNA scores of some residents in dementia wards. Conclusions: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. Although residents- and patient related factors mainly explained malnutrition, nurses recognized malnutrition poorly and nutritional care possibilities were in minor use. Professionals nutrition education had a positive impact on the nutrition of elderly residents. Further studies describing successful nutritional care and nutrition education of professionals are needed.