It was perhaps a breakthrough in 1988 when NIVA (The Nordic Institute for Advanced Training in Occupational Health) and Kitta Rossi from the Institute of Occupational Health in Finland arranged an International Workshop at the Finnish town of Hanasaari. Under the unique skills of Ruth Alston, U.K., a dynamic conceptual model emerged. Another workshop arranged by the same group took place in Aspenäs, Sweden in 1992 and included delegates from the then newly independent Baltic States, Iceland, Switzerland and Africa.
How the Model Was Developed
The workshop brought together occupational health nurses to explore the links between their practical experience and the underlying theories of the profession. Rather than starting from abstract theory, the group worked step-by-step: first identifying nursing concepts relevant to occupational health practice, then considering the developing role of the occupational health nurse in order to establish priority areas, and finally examining how specific concepts of occupational health nursing related to broader occupational health approaches. The concepts arising from this process were then grouped according to their similarities, relationships and actions, resulting in the conceptual model presented below. Some concepts that emerged reflected broad, abstract ideas, while others were closely tied to the practical role and function of the occupational health nurse.
The Hanasaari Conceptual Model
The Total Environment Concept
The general environment system, which incorporates health and safety aspects, is represented by the large outer circle — a global concept. Within the outer circle, the influences which have global effects, and which in turn may affect health, are represented by economic, political, social, ecological and organisational factors. These are interesting areas for practice and education innovation in occupational health nursing.
Man Work and Health Concept
This is represented by the man, work and health triangle and operates within the total environment, aspects of the total environment having a significant (although indirect) effect on workplace health. Political and social policies, for example, will either expand or contract the development of occupational health. Organisational cultures and strategies may exert a stronger, more direct influence on the man, work and health triangle.
Occupational Health Nursing Interaction — the Centre of the Model
Occupational Health Nursing is presented at the centre of the model, built around several supporting concepts:
- Team — an important concept, since nurses are required to work with managers and other occupational and community health disciplines. The team concept in occupational health nursing differs considerably from traditional team concepts in nursing more broadly; good interpersonal relationships may be the key to successful occupational health practice.
- Care — the therapeutic and preventive measures which are significant for practice.
- Prevention — an emphasis on preventive measures relating to workplace hazards and environmental health.
- Value and quality — the value of occupational health approaches has to be considered in relation to individuals, groups, organisations and the total environment. Quality measures are concerned with the physical, mental and social wellbeing of individuals and groups at work, and help justify and quantify the quality of the services occupational health provides.
- Promotion — supporting the wider development and visibility of occupational health within organisations and communities.
Flexibility was interpreted as being proactive rather than reactive, and is represented by a curving circle of arrows which exerts influence on, and develops, the concepts identified — ultimately improving the health of people at work and affecting the health of communities outside the workplace, in the total environment. Being flexible was deliberately understood as a dynamic rather than a static idea. The outward, proactive approach may influence politically, socially, economically and ecologically, particularly if occupational health nurses raise the level of awareness of their real contribution to health issues in a wider environment.
The Micro-Environment: Interaction
"Interaction" is the key word used in the model to describe the role of the occupational health nurse, reflecting the two-way communication between nurse and client that underpins occupational health practice in a holistic way. It encompasses many of the skills that occupational health nurses learn or acquire through practice, which enable them to perform roles such as information givers, counsellors, educators and trainers, advisers, mentors and supervisors. The relationship that an occupational health nurse has with clients and organisations is the key to success or failure. Negativity in this area of interaction may result in reactive occupational health services, while a positive approach to interaction tends to support innovation and development in professional practice. Interpretation of interaction as a concept therefore shows a strong correlation between what an organisation wants and what an occupational health nurse can, and is enabled to, provide within the professional framework.
The Macro-Environment: Ecology, Politics and Social Organisation
The model's link between the micro-environment of the individual practitioner and the wider work–health concept places occupational health practice firmly within an international context. Several strands of the total environment concept deserve particular attention:
- Ecology has emerged as a particularly significant area in recent years, reflecting the relationship between humans and the environment in which they live. Cultural practices are part of this human–environment interface, and understanding some of these wider environmental and cultural issues is worth considering as areas for practice and educational development in occupational health nursing.
- Politics organises and structures social affairs in relation to the allocation of resources and the means by which people or groups acquire and maintain control over situations. Political activity, though not always recognised as directly relevant to occupational health, shapes the rules, resources and structures within which occupational health is delivered — so some understanding of politics is useful background knowledge for occupational health practitioners.
- Social organisation operates at international, national and organisational levels, involving bodies such as the World Health Organization, the International Labour Office and the European Community, alongside national governments, professional societies and employing organisations. These structures and cultures significantly influence how health care is delivered in the workplace.
- Social policy, concerned with income, health, education and housing standards, cannot be separated from occupational health, since social and economic factors such as unemployment, poverty and illness are closely interconnected with wider policy questions.
A Pan-European Legacy
Although developed nearly four decades ago in the Nordic countries, the concepts underpinning the Hanasaari model continue to shape occupational health nursing practice across Europe. The model's early expansion — from a Finnish–Swedish initiative to a workshop involving delegates from the Baltic States, Iceland, Switzerland and Africa — reflected exactly the kind of cross-border professional exchange that led, in 1993, to the founding of FOHNEU itself. As the European single market developed through the late 1980s and early 1990s, occupational health professionals across member states increasingly recognised the need for shared standards, education and practice frameworks — a need that FOHNEU was created to meet, bringing together national occupational health nursing associations from across the European Union.
Ruth Alston, who shaped the original model at Hanasaari, remains recognised across the profession for this contribution; her contribution is still marked by an annual memorial lecture in the UK. Her work continues to underpin FOHNEU's understanding of occupational health nursing as a discipline that operates within — and helps shape — a wider social, political and ecological environment. Practitioners are still encouraged to reflect on whether occupational health services are genuinely proactive, shaping healthier workplaces, or merely reactive to problems as they arise.
Sources:
- Alston RM. A model for international understanding in occupational health nursing. In: Alston R. Occupational health nurses' changing roles: An international perspective. UNE New England Press. 1994: 28-34.
- iOH (2026). Ruth Alston and the Hanasaari Conceptual Model: Still relevant today. https://ioh.org.uk/2026/03/ruth-alston-and-the-hanasaari-conceptual-model-still-relevant-today/
- iOH. Ruth Alston Memorial Lecture. https://ioh.org.uk/ruth-alston-memorial-lecture-and-gala-dinner-2026/
- Carty, S. Occupational health models: Ruth Alston's legacy and influence. Personnel Today. https://www.personneltoday.com/hr/roccupational-health-models-ruth-alstons-legacy-and-influence
