The school setting as a key arena for health promotion and early prevention action

I am currently finalizing my PhD thesis with a focus on gambling as a health problem at the Department of Caring Science at Åbo Akademi University. In one of the sub-studies of my thesis, mapping the field of Nordic gambling research, the need for an increased focus on early prevention efforts targeting problematic aspects of gambling were highlighted. Considering this finding, I am very happy to currently be taking part in a regional project where we as representatives for Health Sciences at Åbo Akademi University are evaluating an early prevention program primarily taking place in the school context. In the project, Evaluering av den österbottniska drogförebyggande modellen (EDGAR), a new Ostrobothnian model targeting substance use and abuse, Pohjanmaan ehkäisevän päihdetyön malli (PEPP), is systematically evaluated. In addition to focusing on traditional themes highlighted in substance use prevention such as alcohol, topics such as energy drinks, gambling and gaming are also included in the project scope. The PEPP project is owned by Nykterhetsförbundet Hälsa och Trafik rf. The EDGAR project is led by Anna K. Forsman who is also responsible for the Study Programme in Health Sciences, specialization in Health Education (teacher education programme) at the Department of Caring Science.

The PEPP project targets children and adolescents in primary and secondary schools in Ostrobothnia, applying an early prevention and health promotion approach. The structured model is based on a sustainable whole school approach where PEPP project resources and activities are integrated in the school curriculum and overall school activities. Focal points include supporting and promoting mental health, social skills and media literacy. While the material is primarily aimed at representatives for the school arena, resources are also available for parents as well as representatives for non-governmental organizations and other stakeholders with activities aimed at children and young people. In the first phase of the EDGAR evaluation project, the team has performed 28 focus group interviews with representatives for school personnel (representing both teaching and student health) and parents. The aim was to explore participants´ views on challenges and possibilities regarding early prevention work. In the winter of 2020-2021, the plan is to perform follow-up interviews focusing on participants’ experiences regarding the use of the PEPP resources.

On February 13th 2020 the EDGAR and PEPP projects hosted a knowledge sharing seminar in Vaasa, with 140 participants representing the school context and regional municipalities, non-governmental organizations and other interested parties. At the event, PEPP project leader Sanna Tuomela presented the resources of the PEPP project, freely available online in both Finnish and Swedish. EDGAR project leader Anna K Forsman elaborated on schools as an important arena for health promotion work and the importance of evidence-based practice in health promotion and early prevention work in this setting. I myself held a brief presentation based on preliminary research findings stemming from the focus group interviews conducted in the first phase of the EDGAR project. I focused on the participants views on roles and responsibilities among different stakeholders with regard to early prevention work. Overall, the interviewees expressed thoughts and opinions in line with the WHO healthy settings approach, highlighting a need for shared responsibility and collaboration between key societal arenas as well as the importance of multi-professional collaboration within the school setting.

Pictured from left to right: Panel discussion participants and moderators at a knowledge sharing seminar at Academill in Vaasa 13.2.2020. The panelists included Nina Herrgård, (substance use prevention coordinator, Mustasaari municipality) Anna K. Forsman (Associate Professor in Health Sciences at Åbo Akademi, EDGAR project leader), Isak Westerlund (Teacher, Gerby skola), Anne Salovaara-Kero (Director, Pohjanmaan kriisikeskus Valo), Pia Blomqvist (Assistant principal, Korsholms högstadium). Moderators: Johanna Nordmyr (Åbo Akademi, EDGAR project coordinator) and Sanna Tuomela (PEPP project leader).

I thoroughly enjoy research activities where we have the opportunity to work side by side with valuable partners in the field in further developing evidence-based initiatives and services to support health and well-being in our region.

Johanna Nordmyr
Project coordinator (MSocSc, PhD candidate)


Nursing scientist on the tip of an iceberg

“When I travel, I see the beautiful ice and the beautiful mountains, and I see nice people who greet me.“ These lyrics of an old Inuit song describe perfectly my adventure to colorful Nuuk, the capital of Greenland in October 2019. Taking an opportunity to apply and receive a travel grant from the Nordic Society of Circumpolar Health (NSCH) as well as receiving financial support from the Research Unit of Nursing Science and Management in the University of Oulu made it possible for me to participate a PhD course and the NunamedX Conference.

A group photo of the PhD course participants taken in front of the Greenland Centre of Health Research, University of Greenland.

My home university of Oulu has nurtured me with a slogan of “science with arctic attitude”. A PhD course in Nuuk took it to the next cooler and harder lever, shaping it towards a metaphor of an iceberg. As well known, only a tip of an iceberg is visible and 90% of it is hidden underwater and takes effort to explore. The tip might be beautiful, just the shape of an answer I have been looking for my research questions, but there might be something else much more meaningful and relevant underneath the surface.

As we went around the icebergs on our boat trip excursion, I as a health researcher have to go around and around my data but also have to dip in the icy water and dive a little deeper to see the whole shape of the iceberg. The idea of an iceberg fits well also the state of research done on visual impairment in Finland. The tip of the iceberg consist of beautiful and unique data gathered on the Finnish Register of Visual impairment, but the majority of issues relating to the lives of visually impaired people remain unexplored. For example, well-being, functional capacity and individual experiences related to disability in later life are things that need consideration.

My research involves health-related quality of life among elderly people with visual impairments. It can take many colours, like ice that has formed over decades. The more turquoise the ice of an iceberg is, the older it is. In my research, I want to bring out the voice of elderly people with visual impairment and expand the stereotypic picture of visual impairment in Western societies.

The focus of the PhD course, community based health research, got me thinking about the term indigenous in relation to community of visually impaired people. Elderly visually impaired people represent a majority in number, but a minority in cultures of visually impaired people. Elderly VI people may not be recognized and strongly included into VI communities for various reasons. Visual impairment in later life may not lead to a feeling of impairment to the same extent than for a younger person and therefore, elderly people might themselves stand outside the visual impairment communities. Therefore, elderly people might have something to add to the existing VI communities and the general perception of visual impairment in society. The sound of a slowly melting old ice is worth listening, it has a story to tell that has an enormous value today.

An iceberg floating in Nuuk Bay

NunamedX conference introduced multidisciplinary aspects to health research in the arctic. Aspects of rehabilitation in the arctic regions could be further reinforced with a nursing science perspective and it´s paradigm. Human, environment, health and care are core elements in nursing science research, but also holistic rehabilitation. Rehabilitation is about maintaining and recovery but also discovery in terms of empowerment. As we have to protect the arctic climate, way of life and the vulnerable nature from climate change, we have to find ways to empower the elderly population with disabilities in modern society with it´s rapid and ongoing change with digitalization.

Heidi Siira 
yliopisto-opettaja, TtT-opiskelija 
Hoitotieteen ja terveyshallintotieteen tutkimusyksikkö, 
Oulun yliopisto


Hoitotiede sairaanhoitajan ja kätilön vuonna 2020

Maailman terveysjärjestö on nimennyt tämän vuoden sairaanhoitajan ja kätilön vuodeksi. Aivan aiheesta. Sairaanhoitajat ja kätilöt ovat maailmanlaajuisesti korvaamattomia terveyden edistämisessä, sairauksien hoidossa ja terveyspalvelujen laadun kehittämisessä. He ovat monissa maissa ensimmäinen tai ainoa hoidon ja tuen tarjoaja sairastuneille ja tukea tarvitseville. Sairaanhoitajia ja kätilöitä arvioidaan tarvittavan 9 miljoona lisää vuoteen 2030 mennessä. Samaan aikaan monissa maissa alan houkuttelevuus on laskenut, valmiit hoitajat vaihtavat alaa muutaman vuoden työskenneltyään ja monet kokevat, että eivät pysty tekemään hoitotyötä niin kuin eettisesti oikeaksi kokevat. Hankala yhtälö.

Miten tämä liittyy hoitotieteeseen? Hoitotiede on tuottanut ainutlaatuista selittävää ja kuvaavaa tietoa sairaanhoitajien ja kätilöiden työstä, esimerkiksi teoreettisista perusteista, työoloista, osaamistarpeista, työn eettisistä kipukohdista ja palkitsemisesta. Hoitotieteen tutkijat ovat kehittäneet ja arvioineet vähintään satoja innovatiivisia hoitomenetelmiä, joita sairaanhoitajat ja kätilöt käyttävät työssään potilaiden ja heidän läheistensä hoitamiseksi ja tukemiseksi. Hoitotiede on siis osaltaan tehnyt näkyväksi sitä arvokasta ja laadukasta työtä mitä sairaanhoitajat ja kätilöt tekevät.

Toinen kysymys on, onko hoitotiede pystynyt kommunikoimaan tekemäänsä työtä kuplansa ulkopuolelle. Paine julkaista tutkimustuloksia vain kansainvälisissä tiedelehdissä on vääjäämättä vaikuttanut siihen, että hoitotieteen merkitys ei näy riittävästi ulospäin. Valitettavan usein omien tutkimustuloksien popularisointi ja tiivistäminen kaikille alan toimijoille sopivaan muotoon unohtuu tieteellisen artikkelin julkaisemisen jälkeen. Arvokkaiden löydöksien ja ison työn tulokset jäävät näin puolitiehen ja potentiaaliset tiedon hyödyntäjät tavoittamatta. Samalla jää sanomatta se tosiasia, että sairaanhoitajat ja kätilöt tekevät myös kovatasoista ja vaikuttavaa tiedettä ja ovat oleellinen osa akateemista maailmaa.

Haastan kaikki vuonna 2020 pro gradu -tutkielman, ylemmän amk -tutkinnon, tieteellisen artikkelin tai väitöskirjan tehneet hoitotieteilijät julkaisemaan tutkimustuloksiaan tiiviissä ja ymmärrettävässä muodossa sosiaalisen median eri kanavilla samalla tuoden esille oman ammatillisen taustansa hoitajana. Näin teemme osaltamme näkyväksi sitä mikä valtava merkitys sairaanhoitajilla ja kätilöillä on sosiaali- ja terveydenhuollolle ja miten monialaisia osaajia sairaanhoitajat ja kätilöt ovat.


Lauri Kuosmanen
Sairaanhoitaja, professori (ma)
Itä-Suomen yliopisto
Hoitotieteen laitos