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.

Subject Teacher Training and Teaching in English

The purpose of this Master s thesis is on one hand to find out how CLIL (Content and Language Integrated Learning) teachers and English teachers perceive English and its use in teaching, and on the other hand, what they consider important in subject teacher education in English that is being planned and piloted in STEP Project at the University of Helsinki Department of Teacher Education. One research question is also what kind of language requirements teachers think CLIL teachers should have. The research results are viewed in light of previous research and literature on CLIL education. Six teachers participate in this study. Two of them are English teachers in the comprehensive school, two are class teachers in bilingual elementary education, and two are subject teachers in bilingual education, one of whom teaches in a lower secondary school and the other in an upper secondary school. One English teacher and one bilingual class teacher have graduated from a pilot class teacher program in English that started at the University of Helsinki in the middle of the 1990 s. The bilingual subject teachers are not trained in English but they have learned English elsewhere, which is a particular focus of interest in this study because it is expected that a great number of CLIL teachers in Finland do not have actual studies in English philology. The research method is interview and this is a qualitative case study. The interviews are recorded and transcribed for the ease of analysis. The English teachers do not always use English in their lessons and they would not feel confident in teaching another subject completely in English. All of the CLIL teachers trust their English skills in teaching, but the bilingual class teachers also use Finnish during lessons either because some teaching material is in Finnish, or they feel that rules and instructions are understood better in mother tongue or students English skills are not strong enough. One of the bilingual subject teachers is the only one who consciously uses only English in teaching and in discussions with students. Although teachers good English skills are generally considered important, only the teachers who have graduated from the class teacher education in English consider it important that CLIL teachers would have studies in English philology. Regarding the subject teacher education program in English, the respondents hope that its teachers will have strong enough English skills and that it will deliver what it promises. Having student teachers of different subjects studying together is considered beneficial. The results of the study show that acquiring teaching material in English continues to be the teachers own responsibility and a huge burden for the teachers, and there has, in fact, not been much progress in the matter since the beginning of CLIL education. The bilingual subject teachers think, however, that using one s own material can give new inspiration to teaching and enable the use of various pedagogical methods. Although it is questionable if the language competence requirements set for CLIL teachers by the Finnish Ministry of Education are not adhered to, it becomes apparent in the study that studies in English philology do not necessarily guarantee strong enough language skills for CLIL teaching, but teachers own personality and self-confidence have significance. Keywords: CLIL, bilingual education, English, subject teacher training, subject teacher education in English, STEP

Whose ETSIP? National and local ownership of Namibia's education and training sector improvement programme

Tämä työ tarkastelee kansallista ja paikallista omistajuutta Namibian opetussektorin kehittämisohjelmassa. Opetussektorin kehittämisohjelma ETSIP on 15-vuotinen sektoriohjelma vuosille 2005-2015 ja sen tavoitteena on edesauttaa Namibian kehittymistä tietoyhteiskunnaksi. Tutkimuksen tarkoituksena on selvittää miten kansallinen ja paikallinen omistajuus on toteutunut ETSIP prosessin aikana. Erityisesti pyritään selvittämään paikallistason opetussektorin virkamiesten näkemyksiä ETSIP prosessista, heidän roolistaan siinä ja siitä millaisia vaikuttamisen ja hallinnan mahdollisuuksia heillä on ollut prosessin aikana. Tutkimuksen lähtökohta on laadullinen ja lähestymistapa konstruktionistinen: tutkimus tarkastelee todellisuutta ihmisten kokemusten, näkemysten ja toiminnan kautta. Tutkimusaineisto koostuu haastatteluista, epävirallisista keskusteluista, lehtiartikkeleista ja ETSIP dokumenteista. Tutkimus osoittaa että kansallinen omistajuus on epämääräinen käsite sillä kansallisia toimijoita ja näkemyksiä on useita. Tutkimus vahvistaa Castel-Brancon huomion siitä, että omistajuutta on tarkasteltava kontekstissaan: muuttuvana ja kilpailtuna. ETSIPin rinnalle ollaan valmistelemassa uutta strategista ohjelmaa opetusministeriölle mikä saattaa muuttaa omistajuutta ETSIPiin. ETSIP dokumenttien omistajuusretoriikka myötäilee kansainvälisiä sitoumuksia avun vaikuttavuuden parantamiseksi mutta niistä puuttuu syvällisempi analyysi siitä, miten kansallinen ja paikallinen omistajuus toteutuisi käytännössä. Avunantajien näkemys omistajuudesta on suppea: omistajuus nähdään lähinnä sitoutumisena ennalta määrättyyn politiikkaohjelmaan. Haastatteluaineistosta nousee esiin Whitfieldin ja Frazerin jaottelu suppeista ja laajoista omistajuuskäsityksistä. Sitoutumista ETSIP ohjelmaan pidetään tärkeänä mutta riittämättömänä määritteenä omistajuudelle. Paikallisella tasolla sitoutuminen ETSIP ohjelman periaatteisiin ja tavoitteisiin on toteutunut melko hyvin mutta jos omistajuutta tarkastellaan laajemmin vaikutusvallan ja hallinnan käsitteiden kautta voidaan todeta että omistajuus on ollut heikkoa. Paikallisella tasolla ei ole ollut juurikaan vaikutusvaltaa ETSIP ohjelman sisältöön eikä mahdollisuutta hallita ohjelman toteutusta ja päättää siitä mitä hankkeita ohjelman kautta rahoitetaan. Tujanin demokraattisen omistajuuden käsite kuvaa tarvetta muuttaa ja laajentaa omistajuusajattelua huomioiden paikallisen tason paremmin. Tämä tutkimus viittaa siihen että omistajuuden toteutuminen paikallisella tasolla edellyttäisi institutionaalisen kulttuurin muutosta ja institutionaalisen legitimiteetin vahvistamista. Omistajuuden mahdollistamiseksi paikallisella tasolla tarvittaisiin poliittista johtajuutta, luottamusta, vastuullisuuden kulttuurin kehittämistä, tehokkaampaa tiedonjakoa, laajaa osallistumista, vuoropuhelua ja yhteistyötä. Ennen kaikkea tarvittaisiin paikallisen tason vaikutusvaltaa päätöksenteossa ja kontrollia resurssien käytöstä. Tälle muutokselle on selvä tarve ja tilaus.