Tervetuloa Suomeen Welcome to Finland

AORN members visiting operating rooms in Helsinki next September “will be pretty much at home,” according to Irma Mustakallio, a nurse-educator from Helsinki, Finland.

The Finnish teacher of operating room nursing was in the United States from Sep- tember to February visiting baccalaureate schools of nursing and hospitals in San An- tonio, Austin, Houston, San Francisco, and Denver.

With regard to operating room procedures and behavior, she comments, “ I haven’t seen much difference.” AORN visitors will note, however, that there are no trained techni- cians in Finnish operating rooms. The only auxiliary help are aides who receive no for- mal training, says Ms Mustakallio. Visitors will see that infection control measures, such as keeping hair, mouth, and nose covered, are similar and that Finnish OR supervisors also have the problem of keeping traffic to a

where there are many students (medical, nursing, and radiology) in the OR. Super- visors will note there is less staff turnover in Finland, and a surgeon is in charge of scheduling cases.

Finland is one of the Scandinavian coun- tries to be visited on the eighth annual AORN international symposium, Sept 4 to 18. The two-week tour will begin in Oslo, Norway, and proceed to Helsinki; Stockholm, Linkop- ing, Jonkoping, and Kalmar (Sweden); and Lund and Copenhagen (Denmark). Depar- ture home on Sept 18 will be from Copenha- gen.

Ifma Mustakallio, RN, Helsinki, Finland, is a teacher in operating room nursing at the Helsinki College of Nursing. She spent six

and baccalaureate schools of nursing. months in the United States visiting hospitals minimum, particularly in university hospitals

AORN Journal, April 1976, Vol23, No 5 897

An outdoor marketplace in Helsinki, Finland.

The cost of the basic tour is $1,450 leaving from New York City. An optional presym- posium tour to Norway is being planned. It costs an additional $395 and will begin Aug 29. For itinerary, see the February issue of the AORN Journal, 248, or pre-Congress is- sue, 530. To register for the tour, complete the coupon following this article. A $200 de- posit is required.

Ms Mustakallio explains that in Finland, the training of health personnel is directed by the government’s National Board of Vocational Education, subordinate to the Ministry of Education. The Board has two units. The professional unit is concerned with the edu- cation of nurses, physiotherapists, laboratory technicians, radiographers, and occupational therapists. The basic program is 21/2 years with a postbasic specialization of one

academic year and an additional three academic terms for advanced education to prepare persons for administration or teach- ing.

The nurse educator notes it takes about 5% years to get a teacher’s degree. “But, no one can make it in 5112 years because you have to have at least two years experience before going into the advanced program.”

The Board’s second, or auxilliary unit, oversees training of auxiliary personnel such as practical nurses, children’s help nurses, psychiatric attendants, dental assistants, rehabilitation assistants, hospital and am- bulance attendants, chiropodists, medical re- ceptionists and ward assistants, audiological assistants, and laboratory attendants. Train- ing at the auxiliary level is one to two years.

In 1974, there were 8,808 students

898 AORN Journal, April 1976, Val 23, No 5

enrolled in the health training centers throughout Finland. Of these, 4,870 were professional nurses including 340 male stu- dents.

The health training centers are autono- mous, that is, they are not affiliated with either a hospital or university.

In line with other changes in its educational system, Finland is looking to lengthening the education of nurses from 21/2 to 3 or 4 years so they may be better qualified to serve as supervisors and nurse-specialists. In the new program, the nine-month specialization, now optional, will be included in the basic cur- riculum. Plans are to move advanced educa- tion to prepare nurses as administrators or teachers into a university setting as soon as the nursing science is accepted by the uni- versities.

As a nurse-educator, Ms Mustakallio is involved in the latter change. Her visit to the United States was to gain information about university-level nursing education. Her visit is under the auspices of the International Edu- cational Development Program sponsored by the United States Department of State and the United States Department of Health, Education, and Welfare. There were 12 teachers in the program; five from Iran, two from Turkey, four from Finland, and one from Guyana, South America. Ms Mustakallio was the only nurse-educator.

Upon arrival in the United States, the group spent one week of orientation in Washington, DC. Then Ms Mustakallio went to Texas, a state twice as large as Finland. There she spent a quarter at the University of Texas in Austin observing and auditing nursing classes; visited AORN’s past presi- dent Sylvia Doyle, and St Luke’dTexas Children’dTexas Heart Institute in Houston; and spent a week at the University of Texas School of Nursing in San Antonio.

From Texas, Ms Mustakallio went to San Francisco where she visited the University of California School of Nursing and Stanford University Hospital.

In Colorado, she spent about two days at AORN Headquarters, a day with associate degree faculty at Metropolitan State College, and the remainder of the two-week period at the University of Colorado School of Nursing.

Then she went to Atlanta, Ga, for a week’s

visit to the National Medical Audiovisual Center before returning to Washington, DC, for a week-long critique session.

Ms Mustakallio has been teaching operat- ing room nursing at the Helsinki College of Nursing since 1963. The school has a faculty of 55 to 60, and about 1,000 nursing stu- dents including undergraduates, graduates, and registered nurses in continuing educa- tion classes. There are about 300 students in the undergraduate program.

She says it is hard to compare US and Finnish educational systems because, as a whole, they are structured differently. For example, the high school curriculum in Fin- land is, in general, more academic, and no courses such as driver’s education are of- fered.

“Nursing schools are different, too,” she notes. “Finnish schools run a more traditional program, whereas baccalaureate schools I visited here have integrated curricula and more individualized programs. This gives more freedom to students but at the same time gives them more responsibility in de- signing their own program.”

There are about 31 schools of nursing in Finland and operating room nursing is a re- quired course in each. Ms Mustakallio ex- plains that her students spend about four days a week for three weeks in the operating room and preoperative holding and recovery areas. “It’s a very short time,” she says. “We try to emphasize to the student they can use skills they learn in the operating room wher- ever they go. If later they wish to specialize, they take a nine-month postbasic course.”

Ms Mustakallio explains that each student is assigned to a staff nurse. “I’m lucky the operating room supervisors I work with are interested in the teaching aspect. They’ve found if they don’t teach, they don’t get staff members later on. They see it‘s part of their job to teach student nurses.”

She says operating rooms, in general, ex- perience no difficulty in attracting registered nurses; however, Finland does have a short- age of nurses. “It‘s a big issue,” Ms Mus- takallio says, adding “the Finnish Federation of Nurses contends if nurses received better wages, there would be no shortage.” About 8,400 of the country’s 30,000 professional nurses are not employed. Ms Mustakallio

900 AORN Journal, April 1976, Vol23, No 5

reports the average monthly salary for nurses in Finland is 2,000 to 3,000 Finn marks ($523 to $784). “The salary of experi- enced staff nurses and supervisors doesn’t differ that much because staff nurses receive a differential for working Saturdays, Sun- days, holidays, and overtime, whereas, supervisors do not.” She notes there is no shortage of nurse-educators.

Queried regarding her impression of operating room education in the US, Ms Mus- takallio says, “It’s been a neglected area, but I have the feeling it’s coming back. A col- league who was here two years ago re- ported, ‘There is no operating room nursing in university programs in the US.’ Now I discover that in nearly every place I visited they are reevaluating the need for operating room nursing in the curriculum and including it at least as an elective or area of concentra- tion.”

Finland ranks second in the world in hos- pital beds per capita. Its national health

insurance system was initiated in 1964 with benefits for health care and disability com- pensation. In 1973, the ratio of physicians to population was 1:800, and the ratio of den- tists was 1 :1,530.

According to Ms Mustakallio, “Many people have raised the question, ‘Why do you have such a low infant mortality rate and such a high middle-age risk rate?”’ The av- erage life expectancy in Finland is 66 years for men, and 73.6 years for women. In the US, it is 67.6 years for men, and 75.3 years for women. The US has about three times more maternal deaths (one death in 200,000 deliveries) than Finland. The infant mortality rate is the number of deaths under age one per thousand live births. The rate in Finland is 10.1 compared with the US rate of 16.5. (Sweden has the lowest infant death rate in the world with a rate of 9.6.) “We have a low infant mortality rate because we have well- educated public health nurses and midwives and a good network of maternity clinics all

Scandinavia Eighth Annual AORN International Symposium

Program cost per persondouble occupancy is $1,450. Optional tour to Norway is $395. Enclosed is my deposit for $200 per person for - person(s), a total of $ Valid passport required.

Name

Address

Phone

Membership # or relationship

Basic tour (Sept 4-18) - Basic tour plus extension (Aug 29 to Sept 18) - ~ Twin accommodations rooming with

~ I prefer to room with a nonsmoker

~ Single accommodations basic tour, at a supplemental cost of $124; additional $35

~ I would like the land portion of the basic program only, $973.50 double occupancy

for extended tour

Make checks payable to: AORNdth Int’l Symp. Mail to: Josten’s Travel, Inc, 5501 Norman Center Rd, Minneapolis, MN 55437 (612 830-3300)

902 AORN Journal, April 1976, Vol23, No 5

over the country,” explains Ms Mustakallio. About 99.9% of infants in Finland are deliv- ered in hospitals with attendance by a physi- cian or midwife.

“Our health care system is good up through school age, and again for the elderly. Now the focus is on the middle-aged working man-our high-risk client. As directed by the Public Health Act of 1972, more resources are being allocated for prevention of disease, primary health care, and elimination of re- gional inequalities in health care delivery. Preventive health is being emphasized more in television, radio programs, and articles in magazines and newspapers,” Ms Mustakallio explains.

Health insurance is compulsory in Finland and contributions are graded according to salaries. There are few private hospitals, but there are private physicians. An individual may decide which of two types of health insurance he prefers. The more expensive system gives a choice of physicians. Ms Mustakallio doesn’t believe the layman has a

choice. “What is his criteria?” she asks. “He chooses a doctor on the recommendation of his family or neighbors. This has nothing to do with competence.”

She explains that the person with the pri- vate physician pays a little more for a hospi- tal bed. “The rate is under $10 but more than the $2.50 others pay.”

Ms Mustakallio found she packed well for her trip to the United States. However, she would have liked boots and a warmer coat in Denver the day or two in February when the mercury plunged to near zero. The home of her sponsor is about a mile from the Univer- sity of Colorado School of Nursing and Ms Mustakallio thought nothing of walking it. The thing she missed most was the sauna-so much a part of Finnish life.

Her message to AORN members plan- ning to attend the international symposium: Tervetuloa Suomeen: Welcome to Finland.

Rose Marie Lee, RN Nurse editor

INCREASE YOUR CHAPTER MEMBERSHIP

Encourage other nurses to join AORN, to share experiences and to promote growth and achievement of every operating room nurse. Complete and return to: Member- ship Dept, AORN Headquarters, 10170 E Mississippi Ave, Denver, Colo 80231.

The following nurses are qualified to join AORN and may be interested to know of the advantages of AORN membership.

Name Address City, State & Zip

904 AORN Journal, April 1976, Vol23, No 5