Japanese Public Health Nurses Research Articles

A concept of "cultural competence" among public health nurses in Japan.

To clarify the conceptual structure of "cultural competence (CC)" among Japanese public health nurses (PHNs), to enhance culturally appropriate support. A modified grounded theory approach (M-GTA) was used. A total of 11 municipal PHNs participated in this study. Data were collected through semistructured interviews. Interviews were audiotaped and transcribed. A comparative analysis was performed using M-GTA. Five categories were identified. Japanese PHNs supported foreign residents while (1) maintaining a sincere attitude with curiosity and humility toward others regarding CC; (2) deepening their realization of issues arising from awareness of one's own and other cultures; (3) developing their knowledge about clients' cultures and the surrounding environments; and (4) mastering the skills of building a relationship with clients while creating supportive systems surrounding them. As they gained more experience in supporting foreign residents, as indicated in the above categories, their cultural competence grew, allowing them to (5) gain experience while encountering individuals without holding stereotypes and prejudice. The concepts of CC that emerged are based on cultural humility and are cultivated through supportive activities. The concepts identified in this study can serve as educational guidelines for health nurses and other care providers in Japan.

Japanese public health nurses classified based on empathy and secondary traumatic stress: variable-centered and person-centered approaches

BackgroundHealthcare providers frequently help traumatized people and are regularly exposed to indirect trauma from their work, resulting in negative psychological responses, such as secondary traumatic stress. Empathy has been associated with patient’s quality of care and secondary traumatic stress among healthcare providers. However, the relationship between dispositional empathy and secondary traumatic stress has not been fully elucidated. This study used person- and variable-centered approaches to explore the nature of this relationship.MethodsA total of 1,006 Japanese public health nurses working in the Tohoku region and Saitama prefecture completed questionnaires that included scales assessing dispositional empathy, secondary traumatic stress, and burnout. First, we examined predictors of secondary traumatic stress using multiple linear regression analysis. Then, we conducted a latent profile analysis to classify participants into unique groups based on four subscales of dispositional empathy (i.e., empathic concern, perspective taking, personal distress, fantasy) and secondary traumatic stress. Finally, we compared the mean values of the study variables across these groups.ResultsThe multiple regression indicated that in those working in Saitama prefecture, lifetime traumatic experiences, work-related distress, and personal distress were positively related to secondary traumatic stress, but perceived support was negatively related to secondary traumatic stress. Latent profile analysis extracted four unique subgroups. Group 1 displayed the highest secondary traumatic stress levels. Group 2 was characterized by the highest level of empathic concern, personal distress, and fantasy and the lowest perspective taking. Group 3 had a moderate secondary traumatic stress level. Group 4 had the lowest secondary traumatic stress and personal distress scores. In these four groups, the burnout scale (exhaustion, cynicism, and professional efficacy) showed a pattern similar to the secondary traumatic stress scale.ConclusionsOur person-centered approach showed that this sample of public health nurses could be classified into four unique groups based on their empathy and secondary traumatic stress scores. Although this group of public health nurses was not large, one group displayed high personal distress levels and high secondary traumatic stress levels. Further research is needed to determine effective interventions for this group.

Experience and Resilience of Japanese Public Health Nurses during the COVID-19 Pandemic and Their Impact on Burnout.

Japanese public health nurses (PHNs) at public health centers (PHCs) have played critical roles in infection prevention and control during the COVID-19 pandemic. This study aimed to examine the actual pandemic-related experiences of PHNs and the relation between their experiences, individual resilience, two components of organizational resilience (system and human resilience), and burnout. An analysis of the responses of 351 PHNs revealed that mid-level PHNs scored higher in experience and lower in organizational resilience compared with those in other positions. More than 80% of respondents experienced inappropriate staff allocation. Multiple regression revealed that burnout was positively associated with the components of the experience of PHNs and negatively with individual and human resilience. In hierarchical multiple regression with depersonalization as the dependent variable, the sign of system resilience reversed from negative to positive when human resilience was added. The results highlight the need to prepare for future health crises including establishing a system with enough personnel, promoting human resilience such as collaboration among staff members, and burnout prevention measures, especially among mid-level PHNs. The study also described alternative approaches to comprehend system resilience-namely, a suppression variable of human resilience, promotion of depersonalization, and multicollinearity-and the need for further research on organizational resilience.

Developing a scale for Japanese public health nurses supporting resident groups toward community-building.

This study developed a scale for public health nurses supporting resident groups toward community-building and verified its reliability and validity. In this cross-sectional investigation, self-administered questionnaires were distributed to 1,924 public health nurses in Japanese municipalities. The questionnaire included items on the public health nurses' demographic attributes, the developmental stage of the resident groups they supported, a draft scale, and an external criterion. Reliability was verified by calculating the alpha coefficient and test-retest reliability. To clarify construct validity, we conducted exploratory and confirmatory factor analyses. We analyzed 570 questionnaires. The scale was structured using 30 items covering four factors: "Creating opportunities to connect with community residents, other groups, and governments," "Stimulating activities by improving organizational capacity," "Promoting stable organizational management," and "Providing opportunities to review community health issues and activities." The Cronbach's alpha coefficient for this scale was 0.944. The intraclass correlation coefficient was 0.923 using test-retest relativity. Correlations were noted for criterion-related validity (r=0.388, p<.01). Confirmatory factor analysis with structural equation modeling revealed a reasonable fit to the data. The scale for public health nurses supporting resident groups toward community-building was confirmed to be reliable and valid.

Difficulties and distress experienced by Japanese public health nurses specializing in quarantine services when dealing with COVID-19: A qualitative study in peri-urban municipality.

Public health nurses (PHNs) are among the few municipal civil servants who lead community infection control and prevention initiatives in Japanese public health centers (PHCs). This study aims to investigate the distress faced by PHNs and clarify their difficulties and working environment relative to infection prevention control activities during the COVID-19 pandemic. We adopted a qualitative description methodology in this study of 12 PHNs who were involved in COVID-19 prevention and control in PHCs in Prefecture A. The distress during the early phase of the pandemic was due to the uncertainty of the SARS-CoV-2 related disease, which caused panic in medical institutions and among residents. PHNs were overwhelmed, distressed and exhausted by their inability to control the 'pandemic', lack of patient cooperation for prevention control and the unsustainable organizational environment. They were also distressed because they were one of the specialized personnel responsible for saving residents' lives with limited medical resources and while having identity crises due to an inability to carry out the PHN's role of controlling infection in the community. For future crises, rapid, drastic innovation defying conventional organizational systems is critical to reform sustainable organizations so that they play an effective role in the community. Innovation in crisis communication and strengthening the medical system will help achieve a resilient community in a health crisis.

Difficulties in providing genetic consultations by public health nurses in Japan.

The objectives of this study were to identify the topics that Japanese public health nurses (PHNs) find difficult during genetic consultations and to identify the relationships between these difficulties and PHNs' genetic education. We conducted a mail survey delivered to PHNs employed by local Japanese governmental agencies in the Tokyo metropolitan area, between July and October 2015. The self-administered questionnaire queried the (1) experience with genetic consultation, (2) perceived difficulties in genetic consultation, (3) genetics education background, and (4) demographics. The association between the perceived difficulties in genetic consultations and the genetics education opportunities was examined using logistic regression. Of the 907 mailed surveys, 536 PHNs responded (59.1% response rate). Most of the respondents (89.7%) had previously conducted genetic consultations. The majority of respondents (72.7%) had partaken in consultations regarding a possible hereditary disorder in the client or their families, and of those, 76.6% perceived difficulties during the genetic consultation. Respondents who had previously studied decision-making support for genetic testing were significantly less likely to perceive difficulties in genetic consultations on prenatal diagnosis (OR = 0.04, 95% CI [0.00-0.73]). Our results suggest that PHNs receive training in genetic consultation, which can be integrated into everyday practice.

Impact of COVID-19 on Japanese municipal public health nurses and public health practices related to communication with community residents

Objective This study analyzed the impact of COVID-19 on municipal public health nurses and public health practices related to communication with community residents.Method A self-administered questionnaire survey targeted 474 public health nurses working in 40 municipalities in Japan's Aomori Prefecture. Participants were asked about the following basic attributes: whether they provided care for people who were COVID-19 positive or were in close contact with infected people; physical or mental impacts; how each work area was impacted; how mask-wearing affected their communication with community residents; positive and negative aspects of current infection-control measures; how they communicated and shared information with residents as they provided care; challenges and initiatives; and creative work efforts. We conducted the survey from September 23 to October 7, 2020, and analyzed the data using SPSS and KH Coder.Results We received 228 responses (48.1% valid responses); 11.4% reported that they provided care or were in close contact with people who were COVID-19 positive. At least 60% of respondents had been impacted mentally. Mask-wearing hindered communication with community residents, however, it did not significantly impact trust-building. COVID-19 measures had a positive impact on respondents' public health work as infection-prevention awareness increased and infection-control measures advanced. Meetings, including online conferences, became more efficient, and nurses had opportunities to reexamine their work performance. Negative consequences included weakened communication with residents, slander against infected people, increased stress among residents, repercussions from not going out, and difficulty implementing necessary public health services. Most of the interaction, information sharing, and support for residents were carried out over the phone. Responses regarding new challenges and initiatives were classified into six categories: public health services that consider infection-control measures; various preventive measures; efforts to establish new lifestyles; review of methods for conducting group-health check-ups; review of operations and implementation of creative efforts in providing health guidance; and review of meetings, training sessions, and online conferences.Conclusion The survey revealed that COVID-19 affected most public health nurses mentally. Challenges in providing in-person care were reported. Nurses faced significant obstacles communicating with residents; however, they reported that services incorporating infection-control measures were progressively gaining traction. Nurses are exploring new communication methods based on established community trust. Furthermore, it is necessary to explore public health services that fulfill both the current and future community requirements.

Perceptual changes among public health nurses brought on through a newly adopted system for providing continuous support in the municipality: Modelled at its core on Finnish practice for maternity and child health clinics (Neuvola)

Objectives This study targeted public health nurses in a Japanese municipality that had newly adopted the core components of the Finnish system to provide continuous support to families with children until preschool. It sought to analyze changes in their perceptions for activities in maternal and child health care before and after the adoption.Methods Relevant data were collected through semi-structured focus group interviews, following an interview guide, conducted from September to October 2020. The study protocol was approved by the Ethics Committee of Osaka City University in Japan.Results A total of 12 public health nurses participated. Prior to the adoption of the system modelled on Finnish practice, these nurses were dedicated to addressing the risks regarding families with children (especially those at high risk) through continuous engagement. However, they were hesitant to proactively engage with families at lower risk as non-continuous, one-off engagements resulted in a patchwork response. After the system was adopted, the nurses became aware of the trust cultivated with families under their care, which included those at lower risk, that enabled them to respond to the changing needs flexibly. The nurses recognized that they had acquired the capability to notice the subtle signs of changes, engage more proactively with the families under their care, and deliver the necessary preventive interventions at an early stage. They also demonstrated joy and satisfaction derived from the growth of children and mothers under their care, as well as keen awareness of the need to improve their professional skills, even though they were busy.Conclusion These findings indicate that the continuous support system modelled on the core components from Finland enables public health nurses to proactively engage with families at lower risk and deliver preventive interventions at an early stage. The system also motivated Japanese public health nurses who found greater pleasure in their work.

Development of a prenatal smoking cessation counseling scale for public health nurses in Japan.

INTRODUCTIONThis study aimed to develop a scale to measure prenatal smoking cessation counseling for Japanese public health nurses (PHNs).METHODSA cross-sectional study was conducted via an anonymous, self-administered questionnaire. The sample included 1933 PHNs working in 424 municipal health centers nationwide, which were randomly selected. We created the draft scale based on semi-structured interviews, previous studies, and preliminary survey. Additionally, we conducted back translation for English version of the draft scale to be applicable in English countries. The analytic strategy consisted of item analysis, exploratory factor analysis, and differentiation by ‘known groups’.RESULTSA total of 550 responses (28.5%) were included in the analysis. Most of the respondents were female (98.2%) and the mean age was 37.5±9.37 years. In the exploratory factor analysis, two factors were extracted and the factor loadings for all items were greater than 0.40. The first factor with eleven items was named as ‘basic counseling’ and the second factor with seven items was named as ‘advanced counseling’. The Cronbach’s alpha of the scale was 0.918, and the cumulative contribution was 44.908%. Multiple comparisons by experience years working as a PHN revealed significant differences in the scale and two factors.CONCLUSIONSIn this study, we initially developed the prenatal smoking cessation counseling scale for Japanese PHNs, and the reliability and validity of the scale were considered to be acceptable.

Factors Associated with Prenatal Smoking Cessation Interventions among Public Health Nurses in Japan.

This study aimed to identify the factors associated with prenatal smoking cessation interventions based on the 5As model among public health nurses (PHNs) in Japan. A nationwide cross-sectional study was conducted from December 2019 to February 2020 via a self-administered questionnaire. The study subjects were 1988 PHNs working in 431 health centers of municipalities and special wards across the country. Of the 1988 questionnaires mailed, 521 responses (26.2%) were included in the analysis. Of the 521 responses, most of the respondents were female (98.1%) and the mean age was 37.5 years. There were statistically significant differences on age, work regions, experience years working as a PHN and smoking cessation training after becoming a PHN in implementing the 5As. Self-efficacy, professional development competency, research utilization competency, age and experience years working as a PHN were positively associated with the 5As. Social nicotine dependence was negatively associated with the 5As. Furthermore, self-efficacy mediated the relationship between the 5As and professional development competency, research utilization competency, social nicotine dependence, age and experience years working as a PHN. In the future, smoking cessation intervention training should be widely implemented to improve self-efficacy and prenatal smoking cessation interventions among Japanese PHNs.

保健医療福祉計画策定における日本の保健師の用いている方策に関する文献レビュー ―2013〜2018年に発表された論文に焦点を当てて―

保健医療福祉計画策定における日本の保健師の用いている方策に関する文献レビュー ―2013〜2018年に発表された論文に焦点を当てて―

Factors associated with professional confidence in Japanese public health nurses: A cross-sectional survey.

ObjectivesTo clarify factors associated with professional confidence in Japanese public health nurses (PHNs) and to examine the relationship between professional confidence and professional competency.DesignA cross‐sectional study.SamplePublic health nurses (N = 1,512) working in local government agencies.MeasurementsAn anonymous, self‐administered questionnaire with questions on demographic characteristics (sex, age, experience as a PHN, educational background, affiliation, and position) and 34 items on professional confidence developed by the researchers based on a literature review was administered. Factors associated with the professional confidence were extracted through an exploratory factor analysis, and construct validity of the confidence was verified through a confirmatory factor analysis.ResultsIn total, 883 responses (response rate, 58.4%) were received; only 467 (30.9%) of them were valid. On the basis of the exploratory factor analysis results, professional confidence included 17 items, with the following four factors: “technical practice,” “effortful learning,” “exploring the evidence,” and “educators in workplace.” The goodness‐of‐fit model in the confirmatory factor analysis proved the construct validity of professional confidence.ConclusionsProfessional confidence was gained by self‐improvement that reflects on public health practice. Professional confidence underpinned the generalist level of professional competency among PHNs.

Japanese public health nurses’ culturally sensitive disaster nursing for small island communities

Objective: To clarify the tacit knowledge of Japanese public-health nurses who administer culturally sensitive disaster nursing for small island communities. Design: Qualitative and inductive study. Sample: Eleven public-health nurses who provided disaster aid on one of six affected islands. Measurements: Semi-structured interviews, with qualitative analysis of data. Nursing actions that were based on consideration for islanders’ culture were categorized in terms of similarity. Results: Categories of culturally sensitive disaster nursing were identified for each disaster phase of the recovery process. These included confirming islanders’ safety and using existing interpersonal bonds to notify others (acute phase); assisting shelter management by facilitating the application of local rules and bonds (semi-acute phase); compensating for weakened neighbour-based relationships through public services (mid-term phase); and supporting the completion of necessary procedures by utilizing/adjusting islanders’ existing relationships with local government personnel (long-term phase). Cultural elements included interpersonal bonds and relationship, which emerged across phases. Conclusion: Public-health nurses should utilize culture not only to comfort islanders, but also to strengthen their sense of coherence and resilience as islander. They should also remember the nursing principle of compensating for a lack of self-care. To provide effective aid, the changes in cultural influences with recovery phases should be considered.

Influence of a community-based approach to improve risk factors of lifestyle diseases by Japanese public health nurses: A case-control study.

It is important to examine the roles of specific health check-up and specific health guidance in individuals at high riskof common lifestyle diseases, but evaluation based on a stratified analysis of people undergoing a health check-up has not been adequately performed. In this study, we examined the effects of providing specific health guidance to individuals considered at high risk for alifestyle disease after specific health check-ups. Subjects who underwent a specific health check-up in 2012 were assigned to either a group that received health guidance from public health nurses over three years (n = 393) or a control group (n = 109). Clinical findings of both groups were analysed to evaluate the correlation between their changes and health guidance. A significant decrease was observed in blood pressure, and lipid and glucose levels only in the health guidance group. Multiple regression analysis revealed that health guidance was the explanatory variable of serum lipid improvement. Continued support by Japanese public health nurses through health guidance closely related to the subject's lifestyle over three years may lead to a comprehensive reduction in the risk of lifestyle diseases.

Culturally Sensitive Disaster Nursing Focusing on Pacific Rim Island Countries: First Report on Japanese Public Health Nurses

Introduction:Providing culturally sensitive disaster nursing is essential to enhance survivors’ resilience, especially in Pacific Rim island countries, which are home to 80% of the disaster victims of the world. Until now, most studies have focused on immigrant culture or language, and few have explored the idea of disaster nursing adjusted to the affected area’s culture.Aim:The study explores public health nurses’ (PHNs) tacit knowledge regarding culturally sensitive disaster nursing focusing on the Pacific Rim island countries. This first report is the result of the study that clarified how Japanese PHNs, as relief nurses, considered the local culture to provide care to survivors in Japan.Methods:Study participants were nine PHNs from seven prefectures, who provided care to survivors of natural disasters that occurred in 2011–2017 in Japan. Semi-structured interviews were conducted with questions such as, “Which culture did you consider while providing care to survivors in each disaster phase?” Data were analyzed qualitatively and inductively and were sorted according to the four disaster phases. The study was approved by the ethical committee at the National Institution of Public Health.Results:In the acute phase, PHNs utilized close relationships between local residents and health care providers to collect information. They balanced local habits and the prevention of secondary health damage in the subacute phase; for example, balancing sanitation habits and prevention of contaminations. Additionally, they, as strangers to the community, played a role in alleviating tensions between residents under stress. During the recovery phase, they strengthened survivors’ attachment to the area.Discussion:PHNs dispatched from the outside of the affected areas must be culturally malleable to adjust their practice to the local context. Being strangers in an affected area can be advantageous if they utilize their position effectively.

Effectiveness of an educational program for mid‐level Japanese public health nurses to improve program planning competencies: A preliminary randomized control trial

To evaluate the effectiveness of an education program for mid-level Japanese public health nurses (PHNs) to improve their competencies in program planning, which will fulfill community health needs. Randomized control trial. During 2017, 103 PHNs with 5-20years of PHN work experience in Japan were enrolled and randomly allocated to the intervention (n=51) or control group (n=52). The primary outcome measured competency in program planning based on Competency Measurement of Creativity for PHNs (CMC), knowledge, and skills regarding program planning. Six web-based learning modules followed by two face-to-face group sessions. The PHN participants averaged about 12years of experience. In the intervention group, 25 PHNs completed all modules (49.0%). Post intervention, there were no statistically significant differences among any between-group CMC scores. However, the intervention group's CMC 3 score was significantly higher than that of the control group of ≥12years of experience. Total knowledge and skill scores also improved significantly in the intervention group compared with the control group. The results suggest that PHNs with ≥12years of experience are a suitable target of this educational program, and should play a key role in program planning.

Quality of Work Life among Public Health Nurses: A Survey Comparison between Thailand and Japan

Researchers from Thailand and Japan have initiated a collaborative project to compare the Quality of Work Life (QWL) among public health nurses. Thus, the QWL of registered nurses working in a community in Thailand was identified and compared with the Public Health Nurses (PHNs) in Japan. The purpose of which was to determine the similarities and differences between the two countries regarding their nurses’ quality of work life. The 42-item of Brooks’ survey of Quality of Nursing Work Life (QNWL) was translated and evaluated in Thailand and Japan. There were 102 Thai and 209 Japanese public health nurses completed the questionnaire.&#x0D; Findings showed that the QNWL level of both Thai and Japanese PHNs were at moderate level. Thai nurses scored higher than Japanese nurses in overall scores. Thai reported significantly higher on work design dimensions (t = 9.12, p &lt; 0.05). For both groups, three out of four dimensions were ranked in the same pattern in which home life/work life was recorded as the lowest. This was followed by work design and work context. However, Thai scored lowest on work world dimension, while Japanese scored highest on that dimension. Findings also showed significant association between country and age groups (χ2 = 20.01, p = 0.00, marital status (χ2 = 6.50, p = 0.01), education (χ2 = 70.05, p = 0.00), and dependent family members (χ2 = 128.16, p = 0.00). No significant association was noted between country and gender (χ2 = 0.37, p = 0.54), and between country and work experience (χ2 = 2.88, p = 0.23).The findings extended our understanding of the Public Health Nurse’s quality of work life that contributes to nursing in different cultural contexts through a rare direct comparison of Public Health Nurses between Thailand and Japan.

Supporting Children with Developmental Disorders: Difficulties and Future Strategies as Perceived by Japanese Public Health Nurses

In Japan, according to the “Law to Support Persons with Developmental Disabilities” and the project “Healthy Parents and Children 21 (Second Phase),” every prefecture, city, and town needs to identify children affected by developmental disorders and provide support to these children and their parents as early as possible. Public health nurses (PHNs) are responsible for the early detection of cases and complete a diverse range of tasks relating to screening and supporting procedures. The number of children who are waiting to receive specialized medical care in institutions is increasing. Furthermore, the demands for expert personnel such as child psychiatrists, child psychologists, occupational therapists, as well as the establishment of more specialized institutions, are escalating. Various professionals encounter many challenges in identifying children affected by developmental disabilities and in providing effective treatments. Rehabilitative care for children with developmental disorders may be applied to developmental support as for other normal children. It is necessary to promote the skills of professionals relating to maternal and child care. Hence, this study aimed to identify the difficulties experienced by PHNs in providing early care to children with developmental disorders, and to examine ways to improve their performance in the future

The structure of the perceived professional identity of Japanese public health nurses

As health problems become more diverse and complicated, the way public health nurses (PHNs) work is changing. Research at the conceptual level of professional identity of PHNs is lacking. This study aimed to explore the structure of the perceived professional identity of Japanese PHNs. Grounded theory method was used. Twenty-five PHNs in Japanese municipalities were participated in the study. Data were collected through semistructured interviews and analyzed using open, axial, and selective coding. Three categories emerged: (1) providing support to the consulter directly, (2) working as a member of the administrative organization, and (3) working for all residents to improve community development. The modality of perceived professional identity showed interindividual and intraindividual differences and was either stable or unstable. The perceived professional identities coexisted, but there was a conflict between (1) and (2). PHNs should be made aware of the three identities revealed in our study and the possibility of a conflict between identities. Moreover, to ensure working for all residents to improve community development, a population-based approach to education is needed with cooperation of universities and clinical practice.

Interdepartmental support for individual care by Japanese public health nurses and future challenges

Interdepartmental support for individual care by Japanese public health nurses and future challenges