38 Nurse-Deaconess Education in the Sami Region

Lea Rättyä and Tiina Ervellius

Aim: To enable cultural themes as a part of professional academic studies in nurse-deaconess education.  

Methods: Developing the nurse-deaconess curriculum in cooperation with the Sámi Education Institute. Adding to the curriculum Sámi cultural and Sámi language studies and organizing education in the Sámi region in a project funded by the EU. This also includes developing a model of a culturally sensitive nurse-deaconess education within the Sámi culture. 

Results: Culture has an important role in people’s health. Through adding culturally sensitive knowledge of Sámi culture into the curriculum, the graduating nurse-deaconesses have better competence in culturally sensitive, individual, holistic and client-centred care of patients with a Sámi background. 

Conclusions: After this project the model of culturally sensitive nurse-deaconess education can also be used and tested in other cultures.

Key Terms: culturally sensitive, Sami, registered nurse, deaconess, curriculum

Nurse-deaconess Education in Finland

Deaconesses were the first educated registered nurses in Finland. In 1867, deaconess education began in the Helsinki Deaconess Institution and more Deaconess Institutions were founded in different cities in Finland soon after. In the early days, deaconesses took care of the sick and dying people at their homes; they helped the poor and gave spiritual support to those who needed it (Rättyä, 2014). In the early days, deaconesses were women, but nowadays there are also male deaconesses.

Diaconia University of Applied Sciences (Diak) is the only University in Finland where students can study to become a registered nurse-deaconess. According to students, studying at Diak gives them opportunities to make the world a better place and helps them find their calling and place in the world of work (Diaconia University of Applied Sciences 2017a). Graduates of the Bachelor of Health Care, Diaconal Nursing program qualify both as a registered nurse and as a deaconess of the Evangelical-Lutheran Church of Finland, consisting of 240 credit points (ECTS) (Diaconia University of Applied Sciences, 2017b).

Deaconesses are health care professionals whose work involves holistic health promotion, helping people gain personal resources, and supporting hopefulness, independence, and inclusion. In nursing practice, a holistic view of the human condition and people’s well-being is a particular strength of deaconesses (Diaconia University of Applied Sciences, 2017c). In holistic care, the whole person and the whole life situation of the patient or client is taken into account. That can mean mental, emotional, social, spiritual, and practical help like nursing intervention, guidance, or financial support to the client (Rättyä, 2009). Holistic care is easier if there is understanding of the context where people live (e.g. northern environment, nature, attitudes, values, communality, traditions), which includes a respect and knowledge of Sámi culture and lifestyle.

The program provides comprehensive theoretical knowledge and clinical skills for nursing practice, as well as religious studies. A deaconess carries out preventative and outreach work by assisting and supporting individuals, families, groups, and communities in various life circumstances. The health care competencies of deaconesses are valuable in church community work, for example, when working with seniors, children or people with disabilities. As a parish worker, a deaconess works in close cooperation with health and social services and various organizations (Diaconia University of Applied Sciences, 2017d). Diaconal nursing shares many similarities with Faith Community Nursing (Balint & George, 2015; Ziebarth, 2016).

Developing Culturally Sensitive Knowledge of Sami Culture into the Nurse-deaconess Curriculum

Culture has an important meaning to one’s health, especially in the circumpolar countries (Tervo & Nikkonen, 2010). Towards this theme, there has been growing research interest in the past few years (see for example Catwood et al., 2017). The Sami are Indigenous people and their homeland is situated in the northern Arctic areas of Finland, Norway, Sweden, and Russia.  The amount of Sami living in Finland is estimated to be about 10,000. There are challenges for the provision of education, services, and communications in the Sami language (Sami Parliament, 2018). This is why we started the co-operative project Nursing-Deaconess education at the Sami region together with the Sami Education Institute at Ivalo (2015-2018). The main aim of this co-operative project is to increase the amount of professionals, both in healthcare and in churches’ diaconal work, with a good command of Sami culture and culturally sensitive working methods towards the Sami.

Developing the Nurse-Deaconess Curriculum

The need for this project and curriculum development came from the Sami people. They have been in co-operation with curriculum development from the beginning. Content planning to the courses, teaching, presentations in seminars, guiding the practical training and evaluation have been a part of the curriculum development and project.

This project is generating a model of culturally sensitive teaching method suitable for both nursing and deaconess teaching and studying in the context of Sami culture. This includes developing the curriculum towards Sami cultural issues.

The basic Sami cultural course (5 credits) includes knowledge about Sami history and modern times. It includes knowledge about traditional professions (reindeer herding, artisan, berry-picking, fishing and hunting), traditional food (about reindeer meet, fish and hunted animals, berries), traditional way of living in northern natural environment, and meaning of family and social interaction to well-being (Tervo & Nikkonen, 2010).

Three Sami languages are spoken in Finland: North Sami, Inari Sami and Skolt Sami. Students could choose one of these to study. First, there is a language course (6 credits) to learn all the basics, then a course about Sami language in nursing (4 credits), and a third course on Sami language in deaconess’s work (1 credit.)

Several tasks in studying academic themes were included to take into account Sami cultural themes. This way, students could deepen their knowledge about the Sami culture. Examples of themes included nursing for children, adults, and elderly people in the Sami context. For example, students observed the reindeer herders at the reindeer round-up to understand the challenge of first aid there (Ervelius, Nuottila & Vilminko, 2016). Furthermore, at least one of the practice placements of each student is located in a Sami area to learn and practice how to meet and help Sami people in a culturally sensitive way. All of the students have completed their thesis, including developing nursing or/and deaconess working methods at the Sami context.

The Co-operational Project Nurse-Deaconess Education at the Sami Region

The project helped nurse-deaconess education through its contacts and partnerships. It was possible to have all the professionals and local authorities involved in this education, and students made several visits to different organizations who are working in co-operation with Sami. Both Diak and the the Sami Education Institute have a lot of experience in online teaching. This co-operative project provided a good opportunity to develop together online teaching methods and test new ideas.

The results of this project and education are being analysed.  Already now we have reached positive feedback from local professionals both in nursing and parish environments (Ervelius & Blomster, 2016). Evaluation is conducted by analysing curriculum and interviewing nursing students, Sami people, and local social, health care, and parish workers. The main results will be in working methods in the context of the Sami culture and also Sami language speaking skills. Local health care organizations and parishes seem to be satisfied with this curriculum because some of the students have already graduated and offered several working opportunities in the Sami homeland.

As a result of this project, a model for culturally sensitive teaching methods has been developed that is suitable for both nursing and deaconess teaching, and studying within the context of Sami culture. This model can be adapted into curriculum development work in other cultures too.

Additional Resources

EU-project: Nurse-deaconess education in the Sámi region. Retrieved from https://www.eura2014.fi/rrtiepa/projekti.php?projektikoodi=S20056.

Gävert T. 2016. Diaconia barometer 2016: findings in brief E-Book. Retrieved from https://finna.fi/Record/diana.111710.


Balint K. A., & George N. M. (2015). Faith Community Nursing Scope of Practice. Extending Access to Healthcare. Journal Christian Nursing, 32(1), 34-40. Retrieved from https://www.nursingcenter.com/cearticle?an=00005217-201503000-00013.

Chatwood, Susan, et al. (2017). Indigenous Values and Health Systems Stewardship in Circumpolar Countries. International Journal of Environmental Research and Public Health, 14(12), 1462-1482.

Diaconia University of Applied Sciences 2017a. Retrieved from https://www.diak.fi/en/.

Diaconia University of Applied Sciences 2017b. Retrieved from www.diak.fi/en/admissions/degree-programmes/ba-programmes/ba-of-health-care-diaconal-nursing/.

Diaconia University of Applied Sciences 2017c. Retrieved from www.diak.fi/en/admissions/degree-programmes/ba-programmes/ba-of-health-care-diaconal-nursing/.

Diaconia University of Applied Sciences 2017d. Retrieved from www.diak.fi/en/admissions/degree-programmes/ba-programmes/ba-of-health-care-diaconal-nursing/.

Ervelius, T., & Blomster, M-L. (2016). Opintojen ohjaus osana saamelaisalueen sairaanhoitaja-diakonissakoulutusta. In Gothóni, R., Karjalainen, A. L., Koistinen, P. & Marjo Kolkka (Eds.) Osallistavaa oppimista ja kehittämistä. Helsinki: Diakonia-ammattikorkeakoulu. Retrieved from https://www.theseus.fi/bitstream/handle/10024/121673/DIAK_opetus_3_9789524932806.pdf?sequence=1&isAllowed=y.

Ervelius, T., Nuottila, K., & Vilminko, S. (2016). Koulutus tasa-arvon ja yhdenvertaisuuden tuottajana. In Gothóni, R., Hyväri, S., Kolkka, M., & Vuokila-Oikkonen, P. Osallisuus yhteiskunnallisena haasteena – Diakonia-ammattikorkeakoulun  & TKI-toiminnan vuosikirja 2. Retrieved from https://www.theseus.fi/bitstream/handle/10024/117560/Ty%C3%B6el%C3%A4m%C3%A4_7_9789524932752.pdf?sequence=6&isAllowed=y

Rättyä, L. (2009). Diakoniatyö yksilöllisenä ja yhteisöllisenä auttamisena  yhteiskunnallisessa muutoksessa (Doctoral dissertation). Kuopio University, Kuopio, Finland.

Rättyä, L. (2014). Finland´s Long History of Parish Nursing. Perspectives. A Newsletter for  Faith Community Nursing, 13(1).

The Sámi Parlament. Historia – taustat. Retrieved from http://www.samediggi.fi/historia-taustat/.

Tervo, H., & Nikkonen, M. (2010). “In the mountains one feels like a dog off the leash” –

Sámi perceptions of welfare and its influencing factors. Nordic Journal of Nursing Research, 30(4), 9-14. Retrieved from  http://journals.sagepub.com/doi/abs/10.1177/010740831003000403.

Ziebarth, D. J. (2016). Wholistic Health Care: Evolutionary conceptual analysis. Journal of Religion and Health, 55(5), 1800–1823.


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