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This article is part of a long term project "Promoting the Occupational Well-Being of School Staff-Action Research Project in Finland and Estonia, 2009-2014." The purpose of this article is to describe the significance of action plans in the promotion of the occupational well-being of primary and upper secondary school staff in Finland and Estonia from 2010 to the turn of the year 2011-2012. An electronic open questionnaire was sent to occupational well-being groups in Finland (N=18) and in Estonia (N=39). In Finland, the questionnaire was responded to by 16 (n=16) occupational well-being groups, and in Estonia, by 38 (n=38) groups. The qualitative data were analyzed using the inductive-deductive method and content analysis. The obtained results indicate that the schools had named goals for action plans in all aspects of the promotion of occupational well-being in schools (worker and work, working conditions, professional competence, working community) and that these goals were mainly realized in the schools in a systematic way. Schools felt that the action plan for occupational well-being helped them to set goals for occupational well-being and that the planned actions were realized in a more systematic way than before., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aims: The aim of this study was to compare the prevalence of smoking, smoking experimentation and future intention to smoke in the Pitkäranta district, the Republic of Karelia, Russia and Eastern Finland in the years 1995 and 2013., Methods: Cross-sectional studies were carried out among 15-year-old ninth grade adolescents in all schools in the Pitkäranta region (1995: n=385, response rate 95%; 2013: 182, response rate 98%) and a sample of schools in Eastern Finland (1995: n=2098, response rate 91%; 2013: 635 response rate 95%)., Results: The daily smoking prevalence among adolescents did not change either in Eastern Finland or in the Pitkäranta district from 1995 to 2013. However, smoking among Finnish adolescents was more common than among Russians (p<0.001) and boys, in general, smoke more commonly than girls (p<0.001). In Finland, early smoking experimentations declined by half among both genders but in Pitkäranta the girls' smoking experimentations tripled (relative risk 3.03, 95% confidence interval 1.76-5.20) from 1995 to 2013. The combined effect of country and gender was significant (p<0.001) for future intention to smoke. In Finland future intentions to smoke were very similar in boys and girls compared with obvious gender differences in Russia., Conclusions: These results suggest that more attention should be paid for programmes that consider better gender and culture-specific issues in preventing initiation of smoking and promoting an anti-smoking climate in societies., (© 2015 the Nordic Societies of Public Health.)

Aims and Objectives: The aims of this study were to identify and reach consensus among municipal primary health care participants on nurse practitioners' (NPs') required case management competencies in health promotion practices in eastern Finland., Background: The NP's role as a case manager of patients with chronic conditions has been found to have positive outcomes in health promotion, such as reduced hospital lengths of stay and readmission rates. However, the challenging work of health promotion requires NPs to have multidimensional competencies in health promotion, including communication, advocacy, assessment, planning, consultation and implementation., Design: A two-stage modified Delphi study., Methods: Round 1 semi-structured interviews were conducted among municipal primary health care participants (n = 42) in 11 health centres from April-July 2009, and the round 2 questionnaire survey was conducted in the same health centres in eastern Finland in January and March 2011. The questionnaire was answered by 64% of those surveyed (n = 56). Content analysis and descriptive statistics were used for data analysis., Results: We identified a total of 18 required case management competencies for NPs' health promotion practices in municipal primary health care. In 17 of these competencies (such as knowledge, skills and ability to work independently in health promotion), a consensus was reached (51% or over). However, the need to be interested in municipal decision-making (44·6%) did not reach consensus., Conclusion: Consensus was clearly achieved for 17 competencies that NPs were required to have, and these indicated the knowledge or abilities of health promotion. Nevertheless, there was no agreement on the NPs' need to be interested in municipal decision-making., Relevance to Clinical Practice: NPs need a variety of case management skills and abilities to realise health promotion in municipal primary health care and they need to be supported by primary health care leaders to develop health promotion activities., (© 2015 John Wiley & Sons Ltd.)

Background: Assessment received by students affects the way that they conduct their studies and shapes their interests in clinical placements. It is therefore important that mentors and teachers have high quality assessment strategies to ensure the competence of nursing students., Objectives: The objective of this study is to describe the views and experiences of nursing students, nursing teachers, and mentors on the final assessment of nursing students in clinical practice. The study also investigates respondents' views on using a standardized national or European scheme for clinical assessment in the future., Design: Descriptive survey design with a questionnaire., Settings: Implemented in five Finnish universities of applied sciences and in five partner hospitals., Participants: Nursing students (n=276), nursing teachers (n=108) and mentors (n=225)., Methods: A questionnaire was used to collect data. Survey data were analyzed by using SPSS version 19. Descriptive statistics and cross tabulations were used to characterize the data., Results: Nursing students felt that they had spent enough time with their mentors during their clinical practice period to ensure that the mentors could assess their behavior. Mentors also evaluated that they had spent enough time with the students. Students and mentors both indicated occasional difficulties with the language used in the competence assessment document. Most of the nursing students and mentors shared the view that it is always necessary for a teacher to be involved in the final assessment discussion., Conclusions: The study highlights the importance of assessment skills of mentors and the important role of the teachers. Findings from this study indicate that nursing students' clinical practice assessment already includes many good practices, but we still have some difficulties in ensuring effective measures of competence., (Copyright © 2014. Published by Elsevier Ltd.)

A variety of legislation, initiatives and organizations exist to support, encourage and even oblige schools to collaborate more effectively with parents or guardians. However, there is minimal understanding of the experiences and opinions of parents and school staff about their roles, especially in relation to children's health education. This study examined how parents of 10-11-year-old children perceive the roles of both home and school in educating children about health. A questionnaire, based partly on the Finnish national core curriculum for basic education, was administered to 348 parents; the response rate was 53%. Factor analysis was used to define sum variables, which were then used as dependent variables in an analysis of variance examining the effects of children's gender and health; parents' education, gender, work status and year of birth; and school location (urban/rural). The results suggested that parents considered that either health education was mainly their responsibility, or it was a mutual responsibility with the school. Parents living in rural areas and the youngest group of parents were more likely to consider that health education should be shared with schools than were parents living in cities, or older parents. To expand awareness about the role of home and school in children's health education and to develop further health promotion within the whole school community, it is important to gather parents' views regarding health issues. This study was conducted as part of a broader program in the health promotion network of the Schools for Health in Europe (SHE).

Aims and Objectives: To examine nursing staff's perceptions about how often they provide interventions of emotional support and the level of competence needed on neurosurgical wards to support traumatic brain injury patients' family members., Background: Traumatic brain injury in one individual affects the health of their whole family. Studying the emotional support provided by nursing staff is important because such support is crucial for the family members of a traumatic brain injury patient during the acute phase of treatment. Members of the nursing staff provide emotional support to family members by consoling them; this alleviates insecurity, anxiety, hopelessness and depression., Design: A structured self-reported questionnaire presented to 172 nurses working on neurosurgical wards. The response rate was 67% (n = 115)., Methods: Descriptive statistics were used to determine how often nurses provided emotional support to the traumatic brain injury patients family members and one-way anova to examine the relationships between the background variables and the respondents' evaluations of how often they gave emotional support to brain injury patients' family members., Results: Thirty-seven percentage of nurses stated that they always took account of family members' individuality and 65% that they were always respectful. All registered nurses and staff members with long work experience (21 years or more) on a neurosurgical ward reported that they took family members' feelings of anger and guilt into consideration slightly more often than other nursing staff did. Most nurses considered these skills to represent basic competencies., Conclusion: Further service training on dealing with difficult emotions of traumatic brain injury patients' family members could help nurses to face these situations. Both education and work experience affected the frequency at which nursing staff provided emotional support to traumatic brain injury patients' family members., Relevance to Clinical Practice: The results are relevant for example when planning specialised studies or in-service training for neuro-nurses, as well as when selecting the subjects to be addressed during the orientation of a new staff member. In addition, the results should help nursing staff to understand their role in the emotional support of family members., (© 2013 Blackwell Publishing Ltd.)

A 2-year, participatory action research school health study focused on developing components for home-school partnerships to support children's health learning process. Two intervention schools implemented strengthened health and collaboration-orientated activities; two control schools followed the national core curriculum without extracurricular activities. The parents of fourth-grade pupils (10-11 years at baseline) completed questionnaires before intervention in spring 2008 (N = 348) and after intervention in spring 2010 (N = 358). A two-way analysis of variance was conducted to determine whether time (2008/2010) and group (intervention/control) influenced parents' perceptions and experiences of parental involvement, health education and health support received from the school. Compared with controls, the intervention schools' parents experienced greater involvement ethos (Cohen's d = 0.57, P < 0.001), increased knowledge of health education (Cohen's d = 0.60, P = 0.02) and health support (Cohen's d = 0.35, P = 0.02). Health education participation among parents increased only partially during the intervention (Cohen's d = -0.12, P = 0.193). School health interventions based on schools' needs may have the potential to influence positively the relationship between home and school and increase the visibility of health education. The study was undertaken within the Schools for Health in Europe program.

Background: In Russia, tobacco and alcohol use by adolescents are serious problems. In Finland, as in many other European countries, alcohol use is a growing concern., Aims: This study aimed to find out whether similar environmental factors predict adolescents' alcohol use among 15-year old adolescents in two politically and economically different cultures: in the Pitkäranta district in Russian Karelia and in eastern Finland., Methods: Research data gathered by self-administered questionnaires from the second North Karelia Youth Study and the Pitkäranta Youth Study were analysed. Path models using the structural equation modelling (SEM) approach were constructed to test whether similar path structures fit for boys and girls in both countries, and to test whether regression coefficients are similar between the cultures and by gender., Results: The results showed that alcohol use by family members and best friend is positively related to adolescents' alcohol use both directly and indirectly. The best friend's alcohol use was the most important predictor of adolescents' own alcohol use in every sub-sample. When indirect influences were also identified, the significance of parents' and siblings' alcohol use, in addition to alcohol use by the best friends, was strongly supported., Conclusions: The results highlighted the importance of the process of peer selection for adolescents' choices, and the importance of offering support to the parents and to the health personnel working with children and adolescents.

Nurse teacherhood is usually examined from the perspectives of nurse teachers' tasks, roles, skills and managing. The purpose of this study was to discuss how nurse teachers themselves describe their teacherhood. The purpose was also to generate a substantive theory of nurse teacherhood, its development, changes and manifestation. Nurse teachers from different polytechnics (today called universities of applied sciences) in Finland (N=34) were interviewed using a semi-structured interview. The data were analysed by employing the grounded theory method. Nurse teacherhood was found to be a dynamic process influenced by processes of change in the organisation, the operating culture of the health care working community, nurse teachers' professional self-esteem, the focus of nurse teachers' competence, their relationship with students, the future of their profession and requirements for staying in the profession. Commitment emerged as the core feature of nurse teacherhood. It was possible to distinguish eight types of commitment: (1) searching for new content in one's position, (2) being adapted to one's position, (3) trying to advance in one's position, (4) having found one's position, (5) searching for one's position, (6) withdrawing from one's position, (7) being satisfied with one's position and (8) being uncertain about one's position.

Background: The concept of 'nurse teacherhood' is multidimensional. In this article, 'nurse teacherhood' includes nurse teachers' tasks and different multidimensional roles as well as their personal experiences of being a nurse teacher., Objectives: The article examines the topics of nursing research concerning nurse teacherhood, the changes in these topics and the results reported from January 1990 to April 2004., Design and Method: The material was obtained by conducting a systematic review, and it included nursing research papers and Finnish academic dissertations (N=207). The material was analysed by using content analysis., Results: The topics of the studies were divided into three thematic categories: the expansion of nurse teacherhood, the skills of nurse teacherhood and their development, nurse teacherhood and membership in working community. The number of studies on the first two themes had increased (1990-1994:43; 1995-1999:57; 2000-4/2004:65), while those on the third theme had decreased (1990-1994:18; 1995-1999:19; 2000-4/2004:5)., Conclusions: Nurse teacherhood has been studied actively during the past 15 years and approached from several perspectives. Most of the topics of the studies discussed the expansion of nurse teacherhood. The focus of the studies in different years varied depending on the kind of challenges posed to nurse teachers' work in each period of time.

The aim of this research was to analyze conversations between expectant families (N = 21) in Net Clinic, an Internet-based service designed for patients using public maternity care. The online conversations, shared opinions about experiences of pregnancy, and family life constituted the data for content analysis. The families developed a sense of virtual community, which gradually evolved into a real-life community, by discovering the similarity of their life situations and by giving parent-to-parent support for everyday life events. As a view of daily family life, Net Clinic offers maternity care professionals a deeper understanding of how to enhance safer pregnancy, birth, and growth of the family.

Objective: The aim of this study was to find out what aspects of their parenthood parents revealed, and how they expressed their thoughts concerning maternity care services on an online communication forum., Background: The 'Information Society' offers a growing variety of health services as part of public primary health care via the internet. Little is known about the contents produced online by pregnant families, and how they reflect on both family life and maternity care services., Methods: The data for this study were obtained from online discussions between families (n=21) in Net Clinic, an internet-based service designed for public maternity care. The data included experiences of family life during pregnancy, childbirth and parenting, and was analysed by inductive content analysis., Results: While maturing into parenthood, both women and men recognised the uniqueness of their new role and wanted to prepare for safe childbirth. Online communication in the home environment nourished new social networks among families who were expecting their first, second or third child. In addition, families reflected on maternity care services on the Net Clinic's communication forum. This provided realistic feedback to maternity care professionals., Conclusions: Today, the relationship between clients and professionals is inevitably changing. More online services and advocacy are needed if families are to have access to online health services. The role of professionals is diversifying from being authorities to supporting and facilitating clients' individual self-care. Based on direct client feedback, the quality of maternity care can be improved.

The purpose of this paper is to describe the views of health care and information technology professionals and patients about the future use and scenarios of information and communication technologies (ICT) in nursing practice. The perspective was set at the year 2010. The Delphi method was used, and the data were gathered during the years 2001 and 2002 with three Delphi rounds from a Finnish expert panel (N = 81). The experts consisted of clinical nurses, clinical nurse managers, nurse educators, professionals of development, research and information technology and patients. The data were gathered and analysed with qualitative and quantitative methods. The use of ICT was observed from the viewpoints of probability and desirability. The experts agreed more often about the desirability than the probability of the use of ICT. Three future nursing scenarios were outlined based on the results: nursing knowledge management and development, patient orientation and self-care, and technology vs. the human being. The scenarios will be take-off points for development in nursing practice and education.

This paper describes occupational health nurses' and school staff members' experiences of work ability maintenance carried out at schools and the development of ideas to promote the collaboration between occupational health care and school community and to enhance work ability maintenance. The data were collected in a baseline situation of an action research project to further plan and develop activities. The data were analysed by inductive content analysis. According to the results, school community staff members' work ability maintenance focused on the employee, the school community, school work and the working conditions as well as professional competence. The practical actions involved some individual and school-specific variation, focusing on actions to maintain individual and physical work ability. It seems that the collaboration between the school community and occupational health service for work ability maintenance took place at the individual level, but an obvious need for more structural collaboration emerged by several suggestions made by the participants (e.g. better information exchange between the school and occupational health care, improved collaboration between the school staff and the co-operative partners). The progress in collaboration may lead towards spontaneous collaboration, in which case both actors have the same target and work in a planned, continuous and natural way to ensure work ability maintenance in the school community.

The purpose of this study was to elicit critical incidents that illustrate the reality in which health promotion processes take place in the Finnish European Network of Health Promoting Schools (ENHPS). In this study, critical incidents were used as a data collection method. The data were collected by asking representatives (n = 30) of the schools to describe in writing both positive and negative critical incidents related to health promotion in their school community. Altogether 48 critical incidents were analysed using qualitative content analysis. The results show that collaboration in a network of participants from inside and outside the school community to plan and implement a special school health day was the most commonly described positive critical incident. In addition, the organizational culture of the schools seemed to improve in a positive way. The reorganization of resources for health promotion resulted in positive progress, whereas a lack of resources had a frustrating and negative effect. The most commonly described negative critical incident was a failure to discourage smoking by pupils.

The aim of nursing students' operating room (OR) clinical practice is to gain experience of the perioperative nursing process and to develop skills related to the practice within OR teams in a variety of situations. However, it has previously been problematic to get enough practical experience within OR teams because of the general urgency, e.g. rapid turnover and flow of emergency cases, and preceptors' multiple responsibilities related to their simultaneous need to work as team members. This study describes how Finnish, British and American nursing students (n = 30) experienced learning about teamwork during their OR placement period. The critical incident technique was used for data collection, and data were analysed using a descriptive phenomenological method. Three types of teamwork emerged based on the students' perceptions: functional manifestation of OR teamwork, gaining OR team membership and technical orientation of OR teamwork. The findings are discussed in relation to OR practice, education and research on ways to improve teamwork while maintaining a satisfactory OR learning context and stimulating interest in perioperative nursing.

The role of public health nursing in Europe is changing as an ageing population and increasing social exclusion make new demands on health and social services. The purpose of this study was to describe how Finnish public health nurses (PHNs) practise in their daily work in order to meet the needs of this changing society. The knowledge base of the PHNs' work strongly emphasised experiential knowledge. However, on a theoretical level, medical knowledge dominated their work. The target of the PHNs' work was most frequently an individual, and perspectives of population or community were less common. The methods used in interactions with clients were participatory and empowered individuals to enhance their own health, and multiprofessional collaboration focused on joint decision-making and working towards the shared health goals of the client. However, PHNs need to employ a more reflective approach to their daily practice and take a more active role as an influential person in community and policy level.

This study describes how ninth-grade adolescents' smoking behavior in the Pitkäranta district (Russia) differs from their eastern Finland counterparts. Cross-sectional data from the second North Karelia Youth Study and the Pitkäranta Youth Study were used. Subjects were all (n=385) ninth-grade students in 10 comprehensive schools in Pitkäranta and all (n=2098) students of the same age in 24 comprehensive schools in eastern Finland. Students were asked about their smoking status, intentions to smoke, smoking situations, acquisition of tobacco products, and opportunity to smoke in the school area. The results showed very large differences in the smoking prevalence between Pitkäranta and eastern Finland. For boys, the prevalence of daily smoking was 29% and 19% in Pitkäranta and eastern Finland, respectively. The differences in girls were adverse: 7% and 21% of girls in Pitkäranta and eastern Finland, respectively, were daily smokers. However, as many as one third of the nonsmoking girls in Pitkäranta stated that they may experiment or start smoking later. Boys in Pitkäranta had vaguer attitudes about remaining nonsmokers than boys in eastern Finland. This situation anticipates worsening of the smoking epidemic in Pitkäranta and requires an effective prevention policy and cooperation between different groups in society.

The European Network of Health Promoting School (ENHPS) program aims to foster healthy lifestyles for school populations by developing supportive teaching and learning environments conducive to promotion of health. Most European countries have joined the network since its organization in 1993. This paper describes how the European, national, and local aims of the ENHPS program have been realized in Finnish schools during the first year of the second triennium (1997-1999). Substantial development related to health promotion has occurred in the Finnish ENHPS schools. A safe school environment was emphasized, and networking with other schools was encouraged at the international and national levels. Attitudes toward the ENHPS program generally were positive. However, Finnish schools have emphasized developing "structures" for health promotion. In the future, efforts should concentrate on students' active participation in the activities of health promotion in everyday teaching and learning situations.

Two family-based and two community- and school-based studies have been done in the province of North Karelia in eastern Finland. In the two family-based studies it was possible to decrease serum cholesterol level among children by 15%, showing that to a great extent the extremely high blood cholesterol level among Finnish children can be explained mainly by the typical Finnish diet high in saturated fat. In the first North Karelia Youth Project it was possible to affect the onset of smoking among adolescents. Two years after the program, smoking was about 30% less common in the intervention school than in the reference schools. In the eighth-year follow up survey the effect of the teacher-delivered program was still seen. In the second North Karelia Youth Project it was possible to delay the onset of smoking during the seventh grade but no permanent effect was seen. Diet was changed more among the program school students than in the reference school. These studies, done during the last 10 years, show the cardiovascular risk factors can be reduced among children and adolescents. The next main question is how to use these findings in the normal school and health care system. We have started the National Healthy School Program in Finland to assess the extent to which these programs can be implemented on the national level.

Serum total cholesterol, HDL-cholesterol and blood pressure were studied among 15-year-old school children in Eastern Finland. The mean serum total cholesterol was 4.47 mmol/l in boys and 4.86 mmol/l in girls; mean HDL-cholesterol was 1.29 mmol/l and 1.46 mmol/l, respectively. The mean blood pressure was 135/65 mmHg in boys and 126/67 mmHg in girls. Obese children had higher blood pressure and lower HDL-cholesterol levels than others. Among boys sexual maturation decreased the HDL-cholesterol level. Children whose parents had histories of cardiovascular disease did not have higher cholesterol or higher blood pressure levels than other children. Children at high risk apparently cannot be screened on the basis of parents' history of cardiovascular diseases.