A different perspective on Finnish nursing

Mantta-Vippula Hospital

It's beautiful lakeside setting

My hosts Anne-Mirjami and Sirpa

This morning I caught the 6.05am bus from Tampere and travelled 84 km to Mantta-Vippula primary and secondary care hospital in the Upper Pirkanmaa district. The original idea of the hospital came from the paper mill factory owner Gösta Serlachius, who donated the land for the hospital to be built on. The Upper Pirkanmaa district includes the municipalties of Mantta- Vippula and Ruovesi. It is very different to the other health care areas that I have visited so far. It has succeeded in integrating primary and secondary healthcare over the past 10 years. There is both a primary care and secondary care ward with many other specialists. What is particularly distinctive here is that the nurses generally have a much greater degree of responsibility and therefore autonomy. This is partly due to the fact that the hospital does not have as many doctors as the large university hospital at TAYS but also the nurses here were extremely motivated to extend their traditional roles and take on some of the care that has previously been only done by doctors. The doctors have also encouraged and supported them to do this.

The general medical ward has 15 beds and the primary health care unit has 25 beds. There are specialist nurses in diabetes, sleep apnoea, radiology, chiropody, laboratory work, audiometry, memory, asthma and social care, particularly facilitating discharges. It was very unusual for me to meet the people working in the radiology unit, for example, and find out that they were both nurses who had then specialised in radiology. They had digital imaging and so were able to send results directly to the specialists at TAYS. The paramedics were working in the emergency department in between calls. For many of the nurses they could work in almost all of the departments and so were multi-skilled and very competent in many areas of care. It was sad that the operating department had been completely refurbished given them 3 operating rooms for it to then be closed apart from minor operations.

Treatment area in the emergency department

The co-operation between primary and secondary care had been difficult to introduce 10 years ago and they have had many challenges such as maintaining separate budgets. However, it now works very well and staff are very supportive. Unfortunately though the plan is to separate the two again with the changes that have been introduced. The balance to this though is that health and social care will be integrated. It would have been a truly radical system if they could have kept the former integration too.

Sirpa's office

Wood carving on her wall - more later

Patients often come from TAYS to the primary care beds before they either go home or to residential care. Some of the acute patients from the secondary care beds move into the primary care beds for ongoing rehabilitation.

They also run a telephone support service for the patients. This started in August. Unlike the service I visited yesterday, it is only from 8-4 Monday to Friday. All patients had to start using it 10 months ago unless it is an emergency. They are triaged by the nurse manning the phone. Generally within a week they will answer about 300-600 calls. The difference with this service is that the patient calls in and if the nurse cannot answer the call they input their telephone number and the nurse then calls them back. This was they do not have the number of missed calls that they had at Tampere. The call centre then offer advice where appropriate but generally make appointments for the patients to be assessed or treated. They can offer appointments with the practical nurses who will remove sutures, give injections, take blood pressures, give basic wound care, make plaster casts. They may offer an appointment with the patient's own nurse or doctor.

I was very interested to learn about Anne-Mirjami's work with sleep apnoea patients. In Finland they have been leading the discovery that there is a really strong link between diabetes and sleep apnoea. This is something I shall have to find out more about.

Anne-Mirjami's room

Diabetes and sleep apnoea

I had spent a really interesting time with Anne-Mirjami and Sirpa. They had then arranged for us to visit some of the sights of Mantta.We firstly stopped at a complex which has an elderly residential care home and day care centre.

Many elderly people attend for rehabilitation, exercise, social activities including coffee, meals or a sauna. The centre also houses dental and children's services, mental health and substance misuse and their home care services. Here again there were many striking differences to the service I visited yesterday in Tampere. The personal care is carried out by social care and the home carers are registered nurses who only do nursing tasks. They were quite unsure about the introduction of the new integration next year with social care but I suggested to my hosts that they hopefully will find it is of great benefit to them and their patients once they have embraced this new way of working, as happened with their own joining of primary and secondary care.

Our next stop was the Gosta Serlachius Museum of Fine Arts. It houses mainly Finnish works dating from the 18th Century to some very modern pieces. It is set in the Joenniemi manor park and is a very beautiful setting. 

The lakeside setting

The manor house

It was here that I was to meet an elk! Although maybe not quite what I had hoped for!

An elk at last!

We walked around the grounds and saw some more of the amazing wood carvings that I had seen in Sirpa's office. These were done by Hannes Autere and depict the lives of ordinary Finnish people. I had also hoped to see a bear but I think this carving he did will be the closest I get to bear in Finland too.

The main door

"The bear's tour"

They had arranged to us to have a personal guided tour of the art works and so we were told about most of the art works and sculpures in the museum. It was really interesting. There were works by some very famous Finnish artists - Akseli Gallen-Kallela, Helene Schjerfbeck Magnus Enckell, and the sculptor Waino Aaltonen.

On the way back to the bus station we stopped at the shopping village of Myllyranta, but, probably, fortunately, we did not have much time there, so I managed not to spend any money! I then caught a bus to Orisevi, managed to change and find the bus going back to Tampere and came back after a long but very enjoyable and interesting day.