Authors: My Ngo, Bachelor of Healthcare, Nursing; Kavindi Dewanarayana, Bachelor of Healthcare, Nursing; Kaisa Tarkiainen, RN, MNSc, Senior Lecturer, Future Health Services, Lapland University of Applied Sciences & Anniina Tohmola, RN, PhD, Principal Lecturer, Future Health Services, Lapland University of Applied Sciences.

The population in Finland is getting older fast and at the same time Finland is hiring more nurses from abroad to fill the shortage of workers. When caregivers come from abroad, language proficiency requirements become more important. However, in clinical training placements of older people’s care are problems, which also have been highlighted in recent discussions and research – international students should be taught practical Finnish to be able to communicate properly with the people they are taking care of (Mikkonen et al 2017).

It is also an internationally recognized fact that patient safety can be compromised if a nurse or nursing student has poor language skills. Situations where nurses who cannot communicate and take care of older people in their own language led to misunderstandings, poor care, mistakes with medicine, and not being able to tell if someone is in pain (Al Shamsi et al 2020). New tools are needed for teaching Finnish to international nursing students (Mikkonen et al 2017). To address this shortcoming, the language training booklet was made that international nursing students can use on their internships in Finland healthcare system.

A booklet for everyday use in nursing

As a nursing thesis, a booklet was prepared to improve communication. It is a 21-page, A5-sized digital booklet titled ”Finnish communication in older people care – A practical guide for international nursing students” (Figure 1).

Figure 1. Cover page of booklet

The booklet was designed in Canva and PDF format, so it can be opened on any device such as phone, laptop, or computer during clinical placements. The final structure includes seven sections.

  • Communication tips
  • Quick survival vocabulary (equipment, dining, medication, pain and feeling)
  • Hygiene care communication
  • Mealtime communication
  • Pain and health assessment
  • Communication with person with cognitive disorder
  • Common commands and directions (added after pilot feedback)

To increase realism and usability, vocabulary and practical situations were built around four main characters (Figure 2). Merja, a 75-year-old person, has been recently diagnosed with Alzheimer’s disease and needs small assistance with daily activities. Veikko, an 86-year-old person, has lived with a memory disorder for six years and requires 24-hour care. Nea is a registered nurse working in the unit, and Kila is a nursing student doing her practical training. Following the same four people through different procedures: hygiene care, mealtimes, pain assessment and nighttime confusion was an intentional choice because research shows that scenario-based communication training improves nurse’s communication skills and their confidence (Hsu, Huang & Hsieh 2014).

Figure 2. Four characters of the booklet

Evidence-based learning

This booklet is based on facts from reliable sources and scientific knowledge, not random words – so it can be called evidence-based. The tips on how to communicate at the start were taken from a training program by the World Health Organization called Integrated Care for People (ICOPE). The main structure of the booklet follows the activities of daily living like hygiene care, mealtimes, taking medication, and helping with movement. These activities create situations where communication happens in elderly care (Edemekong et al 2025).

At the same time when learning Finnish, nursing students are learning important skills about interaction, like in section on hygiene care shows that how nurses communicate during care is directly linked to how residents cooperate. For example, asking permission to explain each step and using a tone can reduce resistance and anxiety (Belzil & Vézina 2015). When it comes to mealtimes, a type of communication that validates a person’s feelings has been shown to reduce agitation and increase food intake in residents, with dementia (Passos et al 2024). That is why one scenario shows Kila responding to Veikko with a validation method for understanding and empathy rather than correcting him (Söderlund et al 2016) (Figure 3).

Figure 3. Scenario-base in validation method

Most older people’s cognitive disorders are Alzheimer’s disease, or some other memory disorder (THL 2024), and nursing students will see a lot of these cases when they are in basic care placements. The way cases of Merja and Veikko were diagnosed is based on what is typical in Finland and for the pain and health assessment section, scenarios were built around non-verbal signs like facial expressions. These signs are important when the person cannot talk much. At the same time, a nurse should know the nursing interventions in non-pharmacological actions in many situations in older people nursing (Pruskowski et al 2019). The cognitive disorder section is based on using calm tone, short sentences, one instruction at a time, the resident’s name, validation of feeling, and no arguing with them (Bender et al 2022; Söderlund et al 2016). Because of this, nursing students learn how to communicate with people with cognitive disorders.

Finalizing the booklet after pilot testing

Before finishing the booklet, it was pilot tested with 29 nursing students. The comments were really supporting and positive, like ”this is really helpful,” ”easy to understand” and ”for elderly care, main things included.” After reviewing the pilot’s responses, like adding more visuals, more medical terminology, and informal everyday expressions, the booklet was finalized and got ready for nursing students’ use. These additions are supported by evidence and give booklet more validity, since based on previous research, simple verbal guidance during physical care improves resident safety and reduces injury risk (Kneafsey & Haigh 2007).

The pilot’s results confirm that the booklet works as intended. It is easy to use, directly relevant to clinical practice and make the confidence of international nursing students for placements in Finnish older people care. The booklet is freely available as a digital PDF and is accessible on any phone or laptop during placements – link to booklet.

The content of this guide is based not only on the students’ personal experiences but also on evidence-based knowledge. The students have demonstrated their competence excellently by combining theoretical knowledge, their own experiences and creativity, resulting in the creation of this guide. The guide is ready for use in Lapland UAS’s nursing education program when students need support in learning Finnish. This guide can be used in teaching basic nursing skills and communication in school, and it is particularly helpful in supporting new nursing students as they begin their clinical practice.

Finally

Working in this project really opened our eyes, as students and lecturers, to communicate in better Finnish older people’s nursing. It is very important for students to learn a language with real-life examples and vocabulary which is in use in practical training. This booklet is the new starting point for our nursing students to learn practical Finnish in older people care places. The guide effectively addresses the need to support international students in developing their Finnish language skills, an area where solutions are being sought also in several ongoing projects. The guide is also significant because it was created by international students who have firsthand experience studying Finnish and using the language in nursing.

The team behind this project has demonstrated exceptional initiative and creativity in carrying out the work. All the collaboration with the project has been extremely professional and smooth. We are very grateful for the work!

References

Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S. & Al Kalbani, T. 2020. Implica-tions of Language Barriers for Healthcare: A Systematic Review. Oman medical journal, 35(2), e122. Accessed on 12 December 2025. https://doi.org/10.5001/omj.2020.40.

Andreassen, L., Steindal, S. A., Sarin, J., & Strøm, B. S. 2025. Undergraduate nursing students’ experiences during international clinical placement: A scoping review. Nurse Education in Practice. Accessed on 08 April 2026. https://doi.org/10.1016/j.ijnsa.2025.100378.

Belzil, G. & Vézina, J. 2015. Impact of caregivers’ behaviors on resistiveness to care and collaboration in persons with dementia in the context of hygienic care: An interactional perspective. International Psychogeriatrics, 27(11), 1861–1873. Accessed on 10 April 2026. https://doi.org/10.1017/S1041610215000642.

Bender, E. N., Savundranayagam, M. Y., Murray, L. & Orange, J. B. 2022. Sup-portive strategies for nonverbal communication with persons living with dementia: A scoping review. International Journal of Nursing Studies, 136, 104365. Accessed on 16 December 2025. https://doi.org/10.1016/j.ijnurstu.2022.104365.

Edemekong, P. F., Bomgaars, D. L., Sukumaran, S. & Schoo, C. 2025. Activities of daily living. StatPearls. StatPearls Publishing. Accessed on 29 March 2026. https://www.ncbi.nlm.nih.gov/books/NBK470404/.

Hsu, L.-L., Huang, Y.-H. & Hsieh, S.-I. 2014. The effects of scenario-based communication training on nurses’ communication competence and self-efficacy and myocardial infarction knowledge. Patient Education and Counsel-ing, 95(3), 356–364. Accessed on 10 April 2026. https://doi.org/10.1016/j.pec.2014.03.010.

Kneafsey, R. & Haigh, C. 2007. Learning safe patient handling skills: student nurse experiences of university and practice based education. Nurse education today, 27(8), 832-839. Accessed on 10 April 2026. https://doi.org/10.1016/j.nedt.2006.11.005.

Mikkonen, K., Elo, S., Miettunen, J., Saarikoski, M., & Kääriäinen, M. 2017. Clinical learning environment and supervision of international nursing students: A cross-sectional study. Nurse Education Today, 52, 73-80. Accessed on 09 April 2026. https://doi.org/10.1016/j.nedt.2017.02.017.

Passos, L., Tavares, J., Batchelor, M. & Figueiredo, D. 2024. Interventions to address mealtime support needs in dementia: A scoping review. PloS one, 19(3), e0300987. Accessed on 22 December 2025. https://doi.org/10.1371/journal.pone.0300987.

Pruskowski, J., Wright, R. & Bhatnagar, M. 2018. Pain Management Considerations in Older Adults #356. Journal of palliative medicine, 21(8), 1185-1186. https://doi.org/10.1089/jpm.2018.0265.

Söderlund, M., Cronqvist, A., Norberg, A., Ternestedt, B. M. & Hansebo, G. 2016. Conversations between persons with dementia disease living in nursing homes and nurses-qualitative evaluation of an intervention with the valida-tion method. Scandinavian journal of caring sciences, 30(1), 37-47. Accessed on 23 March 2026. https://doi.org/10.1111/scs.12219.

THL. 2024. Memory disorders are more prevalent than previously estimated – in 2040, the number of people with a memory disorder will be 250,000. Finnish Institute for Health and Welfare. Accessed on 07 May 2026. https://valtioneuvosto.fi/en/-/155392151/memory-disorders-are-more-prevalent-than-previously-estimated-in-2040-nearly-250-000-will-fall-ill.

World Health Organization. 2024. Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care, 2nd ed. World Health Organization. https://iris.who.int/handle/10665/380175.