State of Nursing Science in Finland
6.4 Development of Nursing Research
science departments. Furthermore, they recommended to strengthen the group iden- tity of PhD students as well as emphasizing the need for post-doctoral training fel- lowships. Based on these recommendations, many outcomes can be identified. At the University of Turku, a professorship in clinical nursing science was established in 2008, and the Finnish national doctoral network was strengthened. However, set- ting up a post-doctoral training programme, as recommended, took a while and was established in Turku in 2013. Other universities have since followed suit. In conclu- sion, the international evaluation conducted in 2003 by the Academy of Finland was extremely useful for the discipline of nursing science in Finland.
After that, evaluations have been performed at the universities as part of their general evaluation [22, 23]. Generally, the level of nursing research has been valued as high. In 2016 the nursing science department at the University of Turku, for example, scored very high or “excellent” in all 14 areas of the evaluation.
Furthermore, nursing research at the University of Turku has ranked high in the International QS ranking [24] and the Shanghai ranking [25]. Also, the University of Eastern Finland ranked high, coming in the second position in Finland. Units of nursing/caring science in all Finnish universities, however, have been very success- ful and productive.
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universities. The development and progress of nursing research in Finland is evi- dent; however, there is no systematic description or national-level database where to collect central information about nursing research. Different level degrees accom- plished in nursing science are compiled in a national archive/database (Vipunen—
Education Statistics Finland) [27], whereas the number of scientific publications is registered solely in university-level registries. Leadership in Finnish nursing science has not been a very common topic. Based on the analysis of all doctoral disserta- tions in nursing science, only a small proportion (4%, n = 16) of studies focused on leadership. The studies were conducted predominantly between the years 2010 and 2015. Their main focus has been on leadership styles, nurse staffing and workplace culture. Although research on dissertation level in nursing science is limited, there are several researchers and research projects studying leadership in Finnish health care, and there are educational units at the universities purely for this purpose. The research focus, for example, on leaders’ wellbeing [28], management competencies [29] and leadership in general [30]. These studies naturally have relevance for nurs- ing leadership as well.
6.4.1 Finnish Nursing Science: A Strong and Versatile Discipline Nursing science in the five Finnish universities is realized with research programmes.
Since the 1990s, most of the universities have their own research programmes and areas of expertise in the field of nursing science. Currently, based on the most recent research programmes, in the University of Eastern Finland, the focus of nursing research is on basic and applied research on health promotion and its impact on patient care [31]. In the University of Oulu, nursing research focuses on adherence to self-care, counselling and health coaching, the wellbeing of older people and the competence of health professionals, students and teachers [32]. The University of Tampere has a strong focus on family nursing science with investigations on health and care of families [33]. The University of Turku aims to empower populations, patients and professionals in health care with research focusing on ethics in health care, digital nursing, mental health, older individuals, children and families at early life, patient and nursing education and clinical quality [34]. Åbo Akademi conducts basic research in caring science with a humanistic and hermeneutic approach [6].
Some analyses of nursing research in Finland have been made through the years.
The first comprehensive review, analysing Finnish nursing research from 1958 to 1995, was published in 1998 [35]. In the early years, the research designs and meth- ods were mainly descriptive, with data collected using interviews and questionnaires.
The key conclusions at that time were that nursing research is mainly descriptive, lacking methodological articles and concept analyses. Moreover, national centred- ness in data collection was evident [35]. A review analysing Finnish nursing research during the years 1984–2015 shows a clear trend towards more complex and multi- method type of studies [26]. In addition, there are reviews and synopses in special nursing research areas. Research in nursing education, accounting for about 12% of all Finnish doctoral dissertations published, focuses strongly on structural factors in
H. Leino-Kilpi and M. Stolt
nursing education, nurse teacherhood, teaching activities and learning outcomes, stu- dents being the predominant group of informants, followed by nurse mentors and educators [36]. One example of successful national collaboration in nursing educa- tion research is a research project focusing on the competence of health-care educa- tors. All five Finnish universities offering nursing science take part in this project (University of Turku, competence of health-care educators) [37]. The collaboration has resulted in the main professional textbook [38] in the field and brought up many relevant ideas for nursing education at universities of applied sciences and for clini- cal practice in health-care organizations. Among important research areas in nursing science is older people nursing science with about 10% of doctoral dissertations published in Finland [39]. Research in older people nursing science focuses on clini- cal nursing settings [39]. A typical characteristic of this research is the emphasis on the individualization of the care and the ethical basis of the care of older people [40].
At the moment and in the coming years, person- centred care will be the main prin- ciple in the new health and social care reform in Finland.
Interest in historical studies on nursing science has been rather limited in Finland, accounting for only 2% of the doctoral studies published and concentrating mainly on health-care professionals [41]. The value basis and ethics of nursing and health care has been a topic of research since the beginning of the discipline. Over the years, the focus of ethics research has evolved from descriptive studies towards complex cross-sectional and intervention studies. Nevertheless, the informants have remained the same, namely, patients, professionals, educators and health-care orga- nizations. Moreover, today the content of ethics research covers caring ethics, clini- cal ethics, empirical ethics and organizational ethics [42]. This research has important connections, for example, with the development of collegiality issues in the country and analysis of the realization of patients’ rights. The largest research field in nursing science is clinical nursing research, investigating persons’ real and potential health problems, decision-making procedures and nursing interventions.
Clinical nursing research aims to prevent, care and control these health problems. At the same time, individuals, their families and significant others and the population are encouraged and supported to take part in the care of their own health, decision- making and activities. Clinical nursing research is basic research or applied research by its nature, and it is the prevailing area of research in all units of nursing science in Finland. However, in the University of Turku, the Department of Nursing Science holds a specific professorship in clinical nursing science, having a strong research focus on digitalization of nursing and producing innovations in the field of nursing practice. Mental health nursing research is conducted in multidisciplinary teams with strong focus on cross-sectional and intervention studies [43]. All in all, nursing research is Finland seems to be strong and stable. Each university has its own research programmes and focuses clearly on its own topics so that overlapping in research between universities is minimal. Despite the distinct research areas, all universities work together in many academic activities, for example, in doctoral education, and have strong networks to support each other in society. In most of the research, nurse researchers collaborate with other disciplines, mainly medicine, social and educational sciences, information technology and ethics.
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6.4.2 Research Funding: A Prerequisite for Research
National research funding sources for nursing research is limited. In Finland, two foundations or associations target their grants to nursing science, namely, the Foundation of Nursing Education and the Finnish Association of Nursing Research.
In addition, nursing research is supported by state research funding coordinated by the Ministry of Social Affairs and Health. The state research funding is allocated on general level to research promoting health and wellbeing conducted within the health service system [44], and the areas of funding are published by the Ministry.
Nurse researchers in many health districts have been successful in receiving funding from the State Research Funding, indicating the relevance of nursing research for the development of the organization of health care. Currently, the Academy of Finland funds several research projects led by senior or post-doc nursing science researchers. The number of grants and the amount of funding awarded by the Academy of Finland for nursing science have increased notably compared to the evaluation conducted in 2003 [21]. Moreover, nursing researchers have been suc- cessful in obtaining grants from several national foundations which provide finan- cial support for nursing research, such as the Finnish Cultural Foundation, the Finnish Work Environment Fund and the Foundation for Municipal Development sr.
International research funding comes predominantly from the European Union.
The Horizon 2020 research and innovation programme has provided funding for Finnish nursing research. Moreover, interdisciplinary research networks and mobil- ity grants have been obtained from other funding instruments of the European Commission, like Erasmus Plus. However, despite these funding opportunities, nurse researchers need to take part in strong competition with other more traditional disciplines often making it challenging for them to receive funding. The fact remains that nursing research needs more funding to support the further development of nursing science in Finland.