The public health nurse--the linchpin of primary health care
Siivola, U.; Martikainen, T.
World Health Forum 11(1): 102-107
1990
ISSN/ISBN: 0251-2432 PMID: 2206229 Document Number: 371686
Public health nursing (PHN) in Finland goes back to the start of the 20th century. Then, the country was poor, agrarian, and had a high birth rate; infant mortality was high. The frontline worker in an economical model of health care delivery to local communities was a nurse who had special training in preventive medicine. In developing the public health nursing service, Finland's people studies education methods and practice in use elsewhere. A family-centered service was seen as the most useful and economic form for Finland. The local "communes" organized the basic services, financed by communal taxes and state aid. The public health nurse was to try to change habits harmful to health. The state took over education of nurses in 1931. In 1944, a network of maternal-child health (MCH) centers, and public health nurses and communal midwives was started with 1 public health nurse for every 4000 inhabitants. The community health team was made up of a physician, midwife, and public health nurse. MCH centers were located in small quarters called "health houses." Also, care was given in village-level subcenters. Home visits by the public health nurse and midwife were important. Their services were free and available to everyone. A unique feature of MCH in Finland is that practically all mothers use it and do to this day, although it is not compulsory. The public health nurse worked for the local health board. Her supervisor was a local medical officer. The service emphasizes health promotion, primary prevention and health maintenance, and also acute and tertiary care. These duties require much education. At least once every 10 years, public health nurses were required to take an additional course to help them maintain their skills. From 1950 on, much work went into creating a network of central hospitals. Nurses had to be responsible for smaller districts. Services were reorganized in 1972 with the new Public Health Act. Home visits were reduced. The public health nurse is still a key person in primary health care. PHN education has been expanded to 4 1/2 years, including 3 years of general nursing education.