1. Course portfolio
Family & Community as a Client
Tiia Salminen
March 2015
Degree Programme in Nursing
Social and Health Care

2. 1
Sisältö
1 Community Health Profile.......................................................................................2
1.1 Community table: Kuokkala ............................................................................3
1.2 Health profile of the community.....................................................................4
2 Articles ....................................................................................................................7
2.1 The health-promoting school: what role for nursing?....................................7
2.2 Child in hospital: family experiences and expectations of how nurses can
promote family health ...............................................................................................8
3 Family health care nursing – book..........................................................................9
4 Own learning.........................................................................................................10
References....................................................................................................................11

3. 2
1 Community Health Profile
A community is a group of people who share some common interests, values
or geographical background. For example they can have same religion,
political view, cultural background or residential area.
If defined geographically I belong to Finland-, Savonlinna - and Jyväskylä-
communities, and more specific, I belong to Kuokkala- community as I live
there. Savonlinna- community brings along Savo- community, the eastern part
of Finland and its speaking style, traditional foods and way of being.
As cultural aspect my communities are Finnish people and also Nordic people
I guess. In addition of cultural point of view, the language connects us as
Swedish as our second mother tongue. Of course I’m also an European but it
doesn’t define me as much that I’m a Finnish.
As a nursing student, JAMK University of Applied Sciences is quite important
community at the moment. I also studied chemistry at University of Jyväskylä
before and have friends there so include it as one of my communities although
I’m not attending there anymore.
I play flute in Wind band Puhkupillit of the University of Jyväskylä so the
orchestra and also other people that have music as their hobby belong to one
community. I’m also starting a new hobby, capoeira, so I guess it will also
create new community to me.
I’m a Christian and I share some values included that religion but otherwise
I’m not very active member of that community. I have some kind of political

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orientation but not very clear as I’m not very interested in politics. But there
are clearly political groups having values that I’m not sharing.
I am in cohabitation with my boyfriend but this community doesn’t feel very
clear or close to me. I guess there is more when you are married and
especially when you have children.
1.1 Community table: Kuokkala
Positive
resources
Negative
resources
Examples of positive/negative
resources
Environment x x Lots of entrepreneurships. One of the
most violent suburbs in Jyväskylä.
Housing x Different types of houses, both private
and student apartments. Bit lower rents
than in centrum. Low rate of homeless.
Demography x There lives ca. 16 500 inhabitants,
Kuokkala being biggest suburb near to
centrum.
Social class x Not any specific, both higher and lower
educated.
Transport x Lots of people have own car. Good
parking place at Kuokkala centrum.
Good connections with buses.
Shops x Two markets on Kuokkala centrum,
otherwise there are Siwas which are
more expensive. Shopping malls are in
city centrum, about 1,5 km distance. IT
services, photography shops,
construction services, real estate
services, accounting services etc.
available in Kuokkala.
Religious groups x There is Evangelical Lutheran church
with own activities and couple of other
congregations.
Leisure facilities x Couple of bars at centrum, many
cafeterias and pizzerias. Popular sport
hall Graniitti near of centrum, couple
of beaches, lake, litted boardwalk

5. 4
around lake, summer theatre. Few
playgrounds.
Education x Day care centers and schools for under
15. Art school for dance and music, not
near centrum.
Health care x Health-care centre and dental care in
centrum with good parking lot.
Alongside is couple of nursing homes.
There are also physiotherapy and
massage services, pharmacy and
veterinarian.
Voluntary groups x Some church groups.
Character x The construction in Kuokkala started
mainly in 80’s so settlement in quite
new. There are couple of historical
buildings. New buildings are mainly
builded near to lake. There are lots of
immigrants and students near the
centrum, families live more distant.
There are resident unions for different
areas in Kuokkala to improve the living
in here.
Family structures x There are many kinds of family
structures in Kuokkala as the area is so
large. No statics about it.
Economics x There are lower rents compared to
other suburbs near the city centre but
also new buildings with high rents so I
guess there are lots of people with
different economic status, also
unemployed.
1.2 Health profile of the community
The area I chose for this analysis is my hometown Savonlinna which is located
in eastern part of Finland, in the region of Etelä-Savo or Southern Savonia as
translated in English. Savonlinna ranges 3 597,71 km² area as third of it as
water systems such Lake Saimaa. There are 36 048 inhabitants and the
population density is 16,10/km². (Yleistietoa Savonlinnasta 2015)

6. 5
The centrum of Savonlinna is partially builded on islands which separate Lake
Saimaa in two parts, to Haapavesi and Pihjalavesi (Savonlinna 2014). It’s not
very exaggerated to say that where ever you are in Savonlinna you can see
water or at least there is water near you. There are also lots of forests nearby.
After the construction of passing road traffic have become more flowing in the
centrum area. This is because Savonlinna has only one main road and now all
the big trucks can pass it by without blocking all the traffic.
The main industries in Savonlinna are travel industry, metal technology, ICT,
industry electronics, electrical engineering and regenerating lumber industry
(Savonlinna tarjoaa yrittämiseen monimuotoisen toimintaympäristön 2015).
The summer cottage culture, Savonlinna’s Opera Festival and other summer
activities draw lots of tourists in summertime. Also the lakes and unique
national landscape in Punkaharju are popular. In wintertime there are mainly
Russian tourists spending their holidays.
There are lots of different kind of leisure time possibilities in Savonlinna area.
For example different kind of museums, historical sights, theatres and concert
hall offer experiences of culture. It is possible to be into different kind of
sports and other activities as Savonlinna has several sport teams and services
to offer them. The music academy, the art school and the secondary school of
art and music organizes concerts and exhibitions around the year.
(Savonlinna, Kulttuuri 2015.)
The community I chose is elderly people (65 years and older) and as a number
they were 26,1 % of whole population of Savonlinna in 2013 as in whole
Finland there are 19,4 % (Savonlinna, Alueluokitus 2014). There were no
information about sex and ethnicity in every age group but there were
foreigners 2,3 % of the whole population and my strong guess is they are

7. 6
mainly adults. I also think that the gender distribution within elderly people
is that there are more women than men as there usually is (Väestö iän mukaan
2013.) As we are talking about over 65 years and older people they are mainly
retired, 32 % being retired of whole population (Savonlinna, Alueluokitus
2014).
In Savonlinna there are lot of services for elderly people. In addition of home
nursing, nursing homes, institutional care, day cares for elderly, social
workers and rehabilitation services for veterans, there are also council of
elderly and commission of veterans. Savonlinna is also offering financial
support to caregivers and there are support groups for them. (Huttunen &
Makkonen 2015.) In recent years there is also constructed buildings to the
centrum designed for elderly people.
For leisure time there are renewed main library in the centrum but also branch
offices in the suburbs. Exercise services are for example swimming hall, spa
and services produced by senior centrum and adult education center. Adult
education center and senior center arranges also other kinds of courses and
education for elderly. Finnish Red Cross and congregations offer voluntary
friend services. (Huttunen et al. 2015.)
Mainly the services and accommodation is in good state. However, primarily
all the leisure services and also health services are in centrum area and there
are lot of elderly people still living in distant way and usually in detached
houses alone. Also, Savonlinna is “aging” city as there were in 2012 25,3 %
over 65 years old (Wikipedia: Savonlinna 2013) and in 2013 the percentage
was 26,1 % (Yleistietoa Savonlinnasta 2014) so the need of services and
accommodation near the city centrum grow in future. The city has invested a
lot to new housing services but there should happen investments in social and
health care. There’s going on “a care park district” development project where

8. 7
the aim is to investigate the possibilities to improve the central hospital and
the central health-care center area as a care park. In other words it is examined
what could be done to improve the services and also the infrastructure by
considering also the development of population by age. (Hoivapuistoalueen
kehittämishanke 2015.)
2 Articles
2.1 The health-promoting school: what role for nursing?
This article reviews some articles about health-promoting schools and
ponders what should be done in the future. Main problem is that function of
school nursing has stayed to basic health education though it should also do
health-promoting like in community nursing as school being a community.
Traditionally school nursing focuses on individual consultations and health
education with young people neither that it would provide strategies to have
supportive, healthy school environment via health-promoting. The reasons
behind this might be lack of training, preparation, research evidence and
evaluated health programmes but also unclear role and discipline of the
school nurse. (Whitehead 2005, 264, 267.)
The article suggests two possible solutions to this situation. First one is to shut
down the school nursing services and align them back to public
family/community health services. Second solution is that the school nursing
would align in some health schools programme where school nurses could
collaborate with other health-promoting professionals. (Whitehead 2005, 268.)

9. 8
I’m not very aware what‘s the situation now in Finnish school nursing but if
the case is same as in the article I agree that the schools should consider more
health promotion as basic thing in curriculum. I remember from my
childhood that there were some education days about smoking, drugs and
alcohol and also some projects where the aim was to make kids move more
and do sports. And of course we had health education lessons as normal
school subject which works quite well as itself in my opinion but maybe it
could do more collaboration with school nurses?
2.2 Child in hospital: family experiences and expectations of how
nurses can promote family health
The aim of the article was to explore what could be done better during the
time when child is hospitalized from parents’ point of view. The time when
child is chronically ill and has to spend a lot of time in hospital is usually very
stressful to parent(s). In this study one author interviewed parent(s) from 29
families. There came up 5 main points: reinforcing parenthood, looking after
child’s welfare, sharing the emotional burden, supporting everyday coping
and creating a confidential care relationship. (Hopia, Paavilainen, Tomlinson
& Åstedt-Kurki 2005, 212-214.) The common thing that connects these five is
that parents are in new environment and don’t know how to act as a parent
there.
All five domains feel like obvious things when you read them but obviously
they are not for everyone. Of course the lack of time of the nurses affect
sometimes that they can’t always pay attention to parents as much they might
want but as said in the article even little attention is important. But I also think
that in a child ward there should be enough nurses that they can offer their
time and help to the whole family when needed.

10. 9
All these emerged things should be brought to practice because it’s no need to
make big changes in nurse’s behavior or normal policy to promote whole
family’s health and comfort.
3 Family health care nursing – book
At this point of my studies I’m quite interested on two difficult subjects: how
to interact with patients who are going to die and patients with mental illness
and their families. I find these subjects somehow a bit scary because I don’t
know how to act as a good nurse but luckily there are lots of literature to read
and prepare.
Families in Palliative and End-of-Life Care- chapter was very instructive
although many things in different sections were in common in my opinion.
There are lot of characteristics that a nurse should be: respectful,
nonjudgmental, reflecting, supportive, open, collaborative, willing to listen,
reliable, inquisitive, accessible and compassionate. It’s difficult to think that
you could express all these although many of them come quite natural. But it
is true that with these characteristics you can do many things as for example
creating connection between family, patient and professionals, empowering
family, relieving the patients suffering (in addition of medical and other
treatments) and preparing family and patient to death and time after it. It is
also important find and introduce other resources to family and patient such
as social workers and hospice services and to help them to managing negative
feelings. (Coehlo, Harmon Hanson, Gedaly-Duff & Rowe Kaakinen 2010, 281-
291.)
Because of all these tasks it feels challenging and interesting at same time. I
don’t have many experiences about death in my inner circle so I’m quite

11. 10
unsure how I can be supportive as I’m quite sensitive to other’s grief. I know
it’s not wrong to cry with patient or his/her family as long as you don’t fall to
hole with them without the ladders.
Family Mental Health Nursing introduces quite different point of view how
the illness of family member affects to rest of the family. As in palliative care
the impact is mainly involved with fear of the death and how to cope with it
the impact in mental illness issues is more to do with shame and “stigma”.
(Coehlo et al. 2010, 451-452.) In this case also scary part is not people with
mental illness or his/her family but the way how to create connection with
them.
Familiar from mental health studies was psychoeducation but from the
chapter there came up few more interesting ways to help families to cope:
mobilizing the resources, search for spiritual support, reframing, passivity,
social support and internal and external patterns. Social support is usually the
most effective help to families to cope as there might also be people that don’t
understand the impact of mental illness of family member same way as if the
patient had e.g. cancer or dementia. There is also mentioned in the text that
many caregiver felt lack of information about services for them, lack of
encouragement to recognize the effect of caregiving and lack of identifying the
resources for themselves. So it would be critical to improve the family-
centered health care in mental health services as there is evidence to support
that it is the most successful treatment at least when a child has a mental
illness. (Coehlo et al. 2010, 453-454.)
4 Own learning
Family and Community module has given me good knowledge about
different kind of resources and strain factors that can affect to family and

12. 11
community and vice versa: what family and community can give to single
member of them. It is a challenge as a nurse to find out resources of the
patient and his/her family by listening and asking the suitable questions even
then when patient him-/herself can’t see them.
Community nursing was quite new and strange concept although now
afterwards it feels quite reasonable to consider. Still it is difficult to imagine
that kind of situation where you should fill up that kind of table that was in
the course assignment. I found it quite hard and difficult to understand. The
assignment was quite challenging and the first part was somehow frustrating
but I guess it also deepened my learning little. The literature was very
interesting and there came up lot of things that I should write down and use
in practice e.g. the methods how to promote family health while a child is
hospitalized.
References
Coehlo Padgett, D., Harmon Hanson, S. M., Gedaly-Duff, V. & Rowe
Kaakinen, J. 2010. Family Health Care Nursing. Philadelphia, F.A. Davis
Company
Hopia, H., Paavilainen, E., Tomlinson, P. & Åstedt-Kurki, P. 2005. Child in
hospital: family experiences and expectations of how nurses can promote
family health. Journal of Clinical Nursing 14, 2, 212-222. Accessed 6.3.2015.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2004.01041.x/epdf

13. 12
Huttunen, C. & Makkonen T. 2015. Ikäihmisten palveluopas Savonlinna.
Accessed 8.3.2015. http://www.savonlinna.fi/filebank/6105-
Ikaihmisten_palveluopas.pdf
Savonlinna. N.d. Savonlinnan kotisivut. Accessed 8.3.2015.
http://www.savonlinna.fi/
Savonlinna. N.d. Wikipedian sivut Savonlinnasta. Accessed 6.3.2015.
http://fi.wikipedia.org/wiki/Savonlinna
Savonlinna- Nyslott. 2014. Tilastokeskuksen kuntien avainluvut. Accessed
6.3.2015. http://tilastokeskus.fi/tup/kunnat/kuntatiedot/740.html
Väestö. 2014. Tilastokeskuksen väestötilastot. Accessed 6.3.2015.
http://tilastokeskus.fi/tup/suoluk/suoluk_vaesto.html
Whitehead, D. 2005. The health-promoting school: what role for nursing?
Journal of Clinical Nursing 15, 264–271.