Home In Finland Research Articles

Place of living at end-of-life according to cause of death: a comparative analysis of all decedents 70 years or older in 2009-2013 in Finland and Norway.

Time at home at end-of-life is perceived as valuable to individuals. Increasing home care is therefore often a political goal. Yet, little is known about where individuals live towards their end-of-life. Our aim was to describe where individuals reside their last 6 months of life in Finland and Norway, and how this differed by cause of death, sex, age, marital status, and income. We used individual-leveled national registry data on all decedents aged >70 years in 2009-2013 to describe the number of days individuals spent at home, in hospital, in long-term care (LTC) and short-term care (STC) facilities. We described the place of residence for all and by causes of death: cancer, diseases of the circulatory system, disease in the respiratory system, and mental and behavioral disorders (primarily dementia). We analyzed how age, marital status (indicating informal care), and income associated with place of residence. Analyses were stratified by sex and country. During the last 6 months of life, decedents in Finland (n=186,017) and Norway (n=159,756) spent similar amounts of days in hospital (8 and 11 days) and in STC facilities (15 and 13 days). Finnish decedents spent more days at home (96 vs. 84 days) and fewer days in LTC facilities (64 vs. 80 days). Living arrangement differed similarly by cause of death in the two countries, e.g., decedents from cancer and mental and behavioral disorders spent 123 [113] vs. 29 [21] days at home in Finland (Norway). In both countries, for all causes of death, lower age and marital status were associated with more days at home, for both males and females. While those with higher income spent more days at home in Norway, the opposite was found in Finland. Older individual's living arrangements in the last 6 months of life were similar in Finland and Norway but differed by cause of death. Younger individuals and those with access to informal care spent more days at home, compared to their counterparts. With aging populations, more individuals will likely need LTC at their end of life. Policies should align with these needs when developing future health care services.

Looking for integrated elderly care in practice

PurposeThe goal of integrated, multidisciplinary and person-centered care is on the welfare policy agenda in many countries, but how about integrated service delivery in action? This paper describes a three-year service journey of an elderly person from home to a nursing home through home care, specialized hospital and inpatient care. The aim of this viewpoint paper is to consider how customer orientation and integration are realized when an older lady living an active life becomes seriously ill and loses the ability to conduct daily functions.Design/methodology/approachThe service path will be described from the perspective of a relative.FindingsThe paper raises questions related to governance as well as multidisciplinary and customer orientation in integrated care.Originality/valueThe paper discusses a real-life experience of an elderly care journey from active senior life to a nursing home in Finland. When making visible an elderly care journey, this gives real-life information about the challenges and the needs for development. Better practical understanding helps to remove inter-organizational barriers toward more integrated and patient safe care.

Post-mortem oxycodone blood concentrations of hospitalized cancer and surgery patients compared with fatal poisonings

Oxycodone is a strong opioid drug commonly used to treat acute, cancer, and chronic non-malignant pain. In this study, all oxycodone-related medico-legal cases where death had occurred in a hospital or nursing home in Finland were investigated to determine the range of post-mortem (PM) oxycodone blood concentrations in a therapeutic setting. All toxicology cases in which oxycodone was detected in PM femoral blood during the 4-year period of 2016–2019 in Finland were retrieved from the national PM toxicology database. In this material, the 365 deceased hospital patient cases that met the study inclusion criteria were divided into four groups according to the cause and manner of death. The reference group of 121 fatal oxycodone poisoning cases comprised two groups: those with verified associated drug abuse and those without drug abuse. The median oxycodone concentration in PM blood was significantly higher in cancer patients (0.10 mg/L) than in patients with recent surgery (0.07 mg/L) or other disease (0.06 mg/L) (p < 0.05). In addition, the median oxycodone concentration was significantly lower in all hospital patient groups than in the poisoning groups, the latter displaying 0.38 mg/L (abuse) and 0.64 mg/L (no abuse) (p < 0.001). This study shows that half of the subjects in the cancer patient group had PM blood oxycodone concentrations above the typical clinical therapeutic plasma concentration range (0.005–0.10 mg/L). Appropriate medication of hospitalized surgery and cancer patients can result in concentrations of up to 0.2 and 0.6 mg/L, respectively, while higher concentrations are exceptional.

Global trends in the education system of high-ranking countries according to PISA-2018

Problem and aim. The modern education system is a complex of developed social institutions that form a system of connections and social norms that correspond to promising tasks focused on personal development and socialization. The PISA program evaluates the educational achievements of students and thereby identifies and interprets new global trends in the field of education. The aim of the article is to study the global trends in the education system of the high-ranking countries according to the PISA-2018. Materials and research methods. Empirical research has three stages. The first stage is the actualization of materials generated according to the Report PISA-2018 from three groups of ratings: TOP-10 OECD countries, TOP-10 OECD partner countries and an integral TOP-10 of all participating countries. The second stage is the study of the TOP-10 of all participating countries, where the focus is shifted to a specific group of indicators that identify global trends: globalization, practice-oriented learning, digitalization, individual educational track, sustainable development, social climate and emotional intelligence. At the third stage, a comparative analysis of global trend indicators was carried out. The empirical study included descriptive statistics (range of variation, standard deviation and coefficient of variation) to assess the homogeneity of the group of countries identified by the authors and the degree of difference between them. Research results. TOP-10 countries of the world with the best education systems according to PISA-2018 were selected, and those that maximally reveal the global trends in education systems in the high-ranking countries were identified. The highest indicators were found: practical orientation of education in Estonia – 100%; having digital devices at home in Finland – 82.6%; individual educational track (teacher's agreement with the student's opinion) in Chinese Taipei – 82.4%; emotional intelligence and a sense of belonging to school in Korea – 78.7%; social climate and parental participation in school activities in China (Beijing – Shanghai – Jiangsu – Guangdong) – 52.3%. Discussion and conclusion. The infiltration of global trends in the educational activities of a modern school makes it competitive in the context of global digitalization and strengthens the position of the entire country in the PISA ratings. All countries of the world recognizing the high role of education in the development of their country are introducing new digital technologies and improving existing ones. As a result, a picture emerges in which the leading countries of the world set global trends for digitalization and globalization of education, and other countries are implementing them.

The impact of COVID-19 on daily lives of transnational people based on smartphone data: Estonians in Finland

ABSTRACT Global crises such as the COVID-19 pandemic affect both the functioning of our societies and the daily lives of people. Yet the impact of the crisis and its mitigation measures have exerted disproportionate influence on different population groups. In March – May 2020, COVID-19 mitigation measures such as closures of national borders affected transnational people who cross borders frequently for work, shopping, services, family reasons and socialising. We have examined the influence of the COVID-19 pandemic on the daily lives of transnational Estonians residing in Finland, based on a unique longitudinal smartphone tracking survey. Findings show that besides a drastic but expected decrease in transnationals’ spatial mobility, the pandemic has especially affected their cross-border mobility patterns to and time spent in Estonia. Interestingly, during the lockdown, some transnationals decided to stay not in their primary home in Finland, but in Estonia. Mobile phone communication activity followed moderately the downward trend of spatial mobility, but the crisis changed the division of communication partners by country: Finnish contacts diminished, whereas Estonian partners remained active. We reflect on our findings for future research and discuss the applicability of the smartphone tracking approach for capturing the socio-spatial interactions of transnational people.

The problematic recruitment of migrant labor: A relational perspective on the agency of care work managers

Care organizations in northern Europe recruit increasing numbers of migrant workers, but mostly to low-end jobs and especially to old-age care. According to sociological research, employers and managers play a significant but under-examined role in such recruitment. This article examines the roles played by two care work managers who both have responsibilities in recruitment in a public nursing home in Finland. The article examines the managers’ work through the lens of their occupational agency. Drawing on Emirbayer’s distinction between substantialist and relational sociology, the article adopts a relational perspective on the managers’ agency. Opposite to substantialist studies that operate with analytically pre-given entities (such as agents and structures), the article portrays the managers’ agency as open to relationally changing interpretations. The analysis demonstrates how the managers’ agency in and around recruitment depends on how the recipients of care, migrant workers and their broader political environment are constructed and interpreted. These relationally changing interpretations, the article argues, can serve many functions, including care work managers’ impression management in different situations and, ultimately, the recruitment of migrant workers to (precarious) old-age care.

Patient involvement is essential in identifying drug-related problems.

The aim of this study is to evaluate how critical patient involvement is in pharmacist-led clinical medication reviews and in identifying the most significant clinical drug-related problems (DRPs). Pharmacist-led clinical medication reviews were conducted with 161 consenting patients aged ≥75years with at least seven prescribed medicines, living independently at home in Finland. A pharmacist, a nurse and a physician evaluated the clinical significance of the DRPs identified during the patient interview at an interprofessional case conference. It was evaluated whether the most significant clinical DRPs could also have been identified through reviewing the medication list only or the medication list and certain patient details. Altogether, the 111 most significant clinical DRPs were evaluated. Only 6% could have been identified through reviewing the medication list only, and 16% through reviewing the medication list and certain patient details. Hence, 84% of the most significant clinical DRPs could only have been identified with patient involvement. The most common DRPs were: poor therapy control (25%); nonoptimal drug (22%); intentional nonadherence (12%); and additional drug needed (11%). patient involvement was critical when identifying DRPs related to additional drug needed, unintentional nonadherence, use of over-the-counter medicines or dietary supplements, or contradictions in counselling. Patient involvement is essential when identifying clinical DRPs. Indeed, poor therapy control, nonoptimal drug use, intentional or unintentional nonadherence might otherwise be missed.

Perceived resident–facility fit and sense of control in assisted living

The concept of resident–facility fit has largely been used to illustrate whether a residential care facility and a resident are together able to meet requirements set by only the hampering functional abilities of the latter. The purpose of this paper is to study how assisted living residents perceive resident–facility fit. The data were gathered ethnographically from both observations and resident interviews in a sheltered home in Finland during 2013–2014. Perceived resident–facility fit is based on several relational factors that connect to both the residents as individuals and their surroundings. This fit seems also to be partly conditional and indeed depends on residents' trust in having their own potential to act. Good resident–facility fit results in feeling at home in a facility, whereas poor fit can even result in residents' feeling imprisoned. Care providers can thus utilize our results to affirm residents' quality of life in residential facilities.

Patient, resident, or person: Recognition and the continuity of self in long-term care for older people

Becoming a resident in a long-term care facility challenges older people's continuity of self in two major ways. Firstly, as they leave behind their previous home, neighborhood, and often their social surroundings, older people have to change their life-long lifestyles, causing fears of the loss of one's self. Secondly, modern-day care facilities have some features of ‘total’ institutions that produce patient-like role expectations and thus challenge older people's selves. Our ethnographic study in a geriatric hospital and a sheltered home in Finland aims to find out what features of daily life either support or challenge older people's continuity of self. A philosophical reading of the concept of recognition is used to explore how various daily practices and interactions support recognizing people as persons in long-term care. Categories of institution-centered and person-centered features are described to illustrate multiple ways in which people are recognized and misrecognized. The discussion highlights some ways in which long-term care providers could use the results of the study.

Second home mobility in Finland: Patterns, practices and relations of leisure oriented mobile lifestyle

The paper focuses on leisure oriented mobile lifestyle between urban home and rural second home in Finland which is one of the world’s leading countries in terms of second home ownership and tourism. Spatial patterns and social practices of physical mobility related to second home use are revealed by using triangulation of research methods and data. Analysis is based on GIS data, questionnaire survey results and national statistics. A relational approach is applied to conceptualise and contextualise second home mobility which is influenced by many bio-physical and socio-cultural processes and changes. Relational elements and processes interlinked to past, present and future of second home related physical mobility are identified. Natural amenities form the physical geographical basis for rural second home distribution which correlates with length of shoreline, distance to urban areas and local land use in second home environments. Second home related spatial mobility patterns differ and depend on size of the urban region of origin. Helsinki metropolitan dwellers have the longest trips to second homes which is explained not merely by environmental but by historical, societal and social reasons as well. Second home related social mobility practices are dependent on cottage owners’ and users’ life phase and standard of second homes. Retiring baby boom generation is the largest and most active cottager group and after retirement the use of second homes increases remarkably. The vast majority of second home owners and users travel the cottage trips by private cars and wish to spend at least as much time at rural second home as present. However, they do not intend to give up the urban home which leads to the conclusion that leisure related lifestyle mobility in between urban and rural living environments will continue to characterise second home owners’ and users’ way of life.

Letter-writing as a communicative practice - polyphony in Finnish emigrant letters in the 19th century

This paper discusses the correspondence between Finnish emigrants living in North America and their families and friends at home in Finland. This correspondence dates from the latter part of the nineteenth century, and concerns the first generation of emigrants. Sending and receiving letters in nineteenth-century Finland can be understood as a communicative practice of the local community, because letters were written collectively, and a literate person typically acted as a scribe in the community. Even reading and receiving a letter was a collective act of hearing. Linguistically, the collective nature of letter-writing is reflected in the different manifestations of polyphony in the texts. This article will focus on the polyphony of the immigrant correspondence, analysing who are allowed to have a voice of their own, and how the different voices are reconstructed in the letters. This analysis will focus particularly on conveying polyphony through the use of person marking in Finnish.

Circulating Communities Online: The Case of the Kauhajoki School Shooting

Circulating Communities Online: The Case of the Kauhajoki School Shooting

Modeling the Length of the Care Episode after Hip Fracture: Does the Type of Fracture Matter?

Hip fractures are common events that require intensive operative hospital care and a lengthy rehabilitation. The effect of hip fracture type on successful rehabilitation is not well known. The aim of this study is to model and compare the length of the care episodes between intra- and extracapsular hip fractures in Finland. 15544 hip fracture patients living at home in Finland 1998-2001 were followed using register-based data. Patient characteristics, outcomes, and length of stay (LOS) distributions were analyzed using a Bayesian nonparametric multilayer perceptron (MLP) network model. Mortality was similar in intra- and extracapsular hip fractures. Patients were more likely to need long-term care after extracapsular hip fracture. The average LOS at the surgical ward was similar for intra- and extracapsular fractures (1.7 weeks), but there was a considerable difference for the total inpatient LOS between the groups (5.2 weeks vs. 6.9 weeks). Intracapsular fractures had a simple unimodal LOS distribution, whereas the LOS distribution for the extracapsular fractures was multimodal with two clear peaks. Patients with more comorbidities required a longer LOS. The causes for differences in LOS between fracture types were most likely due to the different surgical methods and rehabilitation practices for the fracture types. As national guidelines suggest similar rehabilitation for all hip fracture patients, there is a need for early and aggressive rehabilitation of patients with extracapsular fractures, including full-weight bearing for all but selected patients.

What could explain the dramatic rise in out-of-home placement in Finland in the 1990s and early 2000s?

Objectives Despite exceptionally favourable economic conditions and school children's outstanding educational attainment the number of children placed outside their home in Finland has increased rapidly in the 1990s and early 2000s. This study identifies factors that are related to a child's risk of placement outside the home in Finland and tries to explore possible explanations for an increase in the share of children placed outside the home. Methods A regression analysis was applied to study the share of children placed outside the home and suggested risk factor indicators on sub-regional level. The use of sub-regional data from SOTKAnet indicator bank allowed us to test indicators for seven areas, namely family structure (single parenthood), receipt of social assistance, unemployment, parents' alcohol and substance abuse, parents' mental health, domestic violence and abortion. Educational level, number of social workers and domestic migration were included as background factors. Results Child placement outside home in Finland is most clearly associated with long-term economic hardships. However, the results indicate that the rate of change in the share of children placed outside the home is associated with alcohol and substance abuse. Conclusions The results suggest that the Finnish success story as a world leader in children's issues has a darker side. A change in the distribution of welfare in Finland seems to place the children in the margin of the society into a more disadvantaged position.

Staphylococcus aureus colonization among nursing home residents in a large Finnish nursing home

We studied colonization with methicillin-resistant and -sensitive Staphylococcus aureus (MRSA, MSSA) in the second largest nursing home in Finland, in which the residents volunteered had their nostrils, throats, perineums, skin lesions, and catheter exit sites swabbed, and catheter urines cultured. The specimens were cultured onto non-selective and selective agar, with or without enrichment in salt-containing trypticase soy broth (TSB). S. aureus was identified by routine methods, methicillin resistance was detected by oxacillin and cefoxitin disk diffusion and MIC E-tests, and GenoType MRSA -test was used for mecA gene confirmation. A total of 663 cultures were obtained from 213 residents. Of those, 165 specimens (25%) from 94 residents (44%) were positive for S. aureus, and 3 specimens (0.4%) from 2 (0.9%) residents were positive for MRSA. Of the 165 S. aureus isolates, 31 (19%) from 25 (27%) residents were found only from sites other than nostrils (30 MSSA and 1 MRSA). TSB enrichment detected additional 33 (5%) S. aureus isolates (32 MSSA and 1 MRSA), resulting in 8 (5%) additional residents. None of the MRSA strains would have been found if only nostrils and throat had been screened, and no enrichment broth had been used.

Do nurses exercise power in basic care situations?

Power is a matter of authority and control. It can be wielded either consciously or unconsciously, and it can be either overt or latent. Using a structured questionnaire, this study set out to describe nurses' opinions about the exercise of power in basic care situations in both acute and long-term care. The questionnaire was organized into four categories in which items concerned: power in obligatory daily activities; power in activities necessitated by obligatory activities; power in voluntary activities; and power in activities that take into account the patient's characteristics. The samples consisted of 228 nurses from five medical and surgical wards of district hospitals, and 233 nurses from five geriatric units of a community health centre and from one nursing home in Finland. The final response rate was 65% (acute care 76%; long-term care 55%). Data analysis was based on statistical methods. The results showed that, in the nurses' own opinion, negative power is exercised only in certain situations and in the patient's best interest, when for instance there are concerns that something may happen to the patient.

Changing to primary nursing in a nursing home in Finland: experiences of residents, their family members and nurses.

The aim of the study was to find out how nursing home residents, their families and nurses experienced the change to primary nursing in the nursing home. This study was carried out in a nursing home in Finland. Following years of functional nursing, the change to primary nursing had started 18 months prior to data collection. The transition was preceded by staff training, planning for the change to primary nursing and discussions with staff members. Meetings were also arranged with family members to inform them of what was happening and why. Staff implemented the changeover independently with the support of the institution's management. The data were gathered in focused interviews. There were five interview themes: change in the nursing home, the position of the resident in the nursing home, the relationship between the resident and nurse, the relationship between family member and nurse, and the role of the nurse as provider of nursing care. Residents reported no major changes in nursing care or in their relationship with nurses. However, family members had noticed changes in the behaviour of the nursing staff. Staff members had become friendlier, spent more time with the residents and showed a strong job motivation. Cooperation between nurses and family members had changed very little. Some nurses in the early stages of the change tended to show signs of resistance. Others said that there had been many changes during the past year, that they acted more independently and could use their own decision-making authority more freely than before. They treated residents as individuals and gave them a greater say in decision-making. They felt responsible for the development of the workplace as a collectivity. Primary nursing is one way in which nurses and family members can work more closely in the best interests of older residents. The findings of this study speak in favour of making the change from functional to primary nursing and at the same time highlight certain problems and possibilities in this process.

Medical charcoal for a child's poisoning at home: availability and success of administration in Finland.

In a prospective study, 174 families were interviewed over the telephone to find out whether the treatment of their child's poisoning with medical charcoal was successfully completed. The majority (103; 59.2%) of the families had no charcoal at home. The mean delay in administration for those who had to obtain charcoal was 41.6 min; significantly longer than the 24.5 min taken for those who had charcoal at home (P < 0.001). The treatment succeeded in all but five of the 102 patients given charcoal at home. Thus for mild poisoning in young children, the administration of activated charcoal at home, under the guidance of a Poison Information Centre, could be a rapid and safe first-aid treatment. Presently the widespread unavailability of charcoal in the home in Finland causes an unnecessary delay in treatment that could be of clinical importance.