Public Health Nurses In Japan Research Articles

Public health nurses leaving remote islands: An investigation into the turnover rate of remote island PHNs in Japan.

This study investigated the number of public health nurses (PHNs) and the turnover rates of PHNs working in small municipal administrations on remote islands throughout Japan. A questionnaire survey was administered on 359 remote islands, each with a population of less than 5000, including islands connected to the Japanese mainland by a bridge or road. The survey questionnaire asked about the number of PHNs stationed on the remote islands, their length of service, the number of retirees, and the ages of those who had retired. Of the 353 islands which responded, 30 islands had a total of 77 PHNs. Of those 30 islands, 29 were isolated islands that were not connected to the mainland by a bridge or road. The turnover rate of PHNs on the 29 islands was 13.3%. The turnover rate of 13.3% for PHNs on remote islands (with no bridge or road) with a population of less than 5000 was higher than the 7.9% turnover rate for PHNs in municipalities of equal size. To maintain the quality of life of island residents, preventingPHNs from leaving their jobs is an important challenge.

Best practice transfer by public health nurses in Japan: actual conditions and related factors

BackgroundThe workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors.MethodsAn anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis.ResultsOne hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice.ConclusionsThrough a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research.

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.

Prefectural public health nurses' support in human resource development of municipal public health nurses in Japan.

Objective This study aimed to explore the support extended by prefectural public health nurses (PHNs) toward the human resource development (HRD) of municipal PHNs in Japan.Methods We performed a qualitative descriptive study involving nine prefectural PHNs from April 2019 to May 2020. The data were collected through semi-structured interviews using an interview guide, described qualitatively, coded, and then categorized.Results Five categories were extracted. "Clarifying the needs and problems related to HRD and daily PHN activities in the municipalities," "Creating an environment where all municipal PHNs have equal opportunities for off-the-job training," and "Helping municipal PHNs recognize the meaning of practice and develop an evaluation perspective" were extracted from the prefectural government PHNs and prefectural health center (HC) PHNs. "Clarifying problems and future prospects to encourage the growth of PHNs" and "Creating an environment where the significance and value of the activities of PHNs are recognized within the organization and HRD can easily take place" were extracted from the HC PHNs.Conclusion Much of the HRD support provided by the prefectural PHNs to the municipal PHNs was analogous to the PHN activities provided to the community and residents. To promote HRD effectively, prefectural PHNs should apply their individual care skills to the HRD of municipal PHNs.

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.

Implementation Degree Assessment Sheet for Health Program in Japan by Customizing CFIR: Development and Validation

PurposeMore than 70% of public health nurses in Japan belong to government agencies, and there is a need for further evidence-based capacity development for program implementation. The purpose of this research was to develop an Implementation Degree Assessment Sheet (IDAS) by customizing the Consolidated Framework for Implementation Research (CFIR) to health programs in Japan.MethodsThe draft IDAS (five domains, 31 constructs) created by customizing the CFIR was refined by the researchers and modified through pre-testing. The survey covered full-time public health nurses (PHNs) affiliated to all prefectures and the cities with health centers of Japan. The survey was conducted as an anonymous, self-administered questionnaire survey by mail.ResultsOne hundred eighty-five of the 334 institutions (55.4%) agreed to participate in our survey. Of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. No item required consideration of deletion based on the results of item analysis, and our confirmatory factor analysis on model fitness between the five IDAS domains and CFIR showed sufficient fit indices after modification. With regard to reliability, Cronbach’s coefficient alpha, a measure of internal consistency, stayed above 0.8 overall. Our verification of stability with the split-half (odd/even) method resulted in a Spearman–Brown reliability coefficient of 0.95. The correlation coefficient between the IDAS scores and the research utilization competency score, used as an external criterion, was 0.51 (p<0.001), supporting the coexistence validity of the criterion-related validity of the IDAS. The significant differences were observed between known-groups, supporting the known-group validity of the IDAS.ConclusionThis study developed the IDAS and confirmed constant reliability and validity. Hereafter, it is necessary to promote the required capacity development based on the actual degree of implementation in order to use the IDAS for the competency development of public health nurses and related professions to deliver health programs.

Cases of intervention refusal encountered by public health nurses in Japan and characteristics of their support\u2013 qualitative analysis of described mother-child and elderly cases

BackgroundThe purpose of this study is to clarify the actual situation of the cases and the characteristics of support, focusing on mothers and their children, and elderly persons among the cases of intervention refusal encountered by public health nurses (PHNs) in Japan.MethodsThe data were descriptions of intervention refusal cases that were freely described by PHNs working for prefectural and municipal governments in questionnaire surveys nationwide. The characteristics of the cases and the support were categorized according to the situation of the case, and the number of descriptions was summarized and interpreted.ResultsThe results revealed that interventions involving mothers and children were refused in most of by mother or parents. The refusals were related to child abuse, parental mental illness, obsessiveness, and complex backgrounds. The actual status of intervention refusal in elderly persons, interventions are frequently refused by elderly persons themselves in the case of self-neglect and by family members living with the elderly in the case of abuse. The refusals were related to mental disorders or dementia and living alone. In both cases, PHNs provided support in collaboration with multi-disciplinary and multi-agencies, and attempts were made to alleviate the situation of refusal to intervene, from detecting cases through contact during home visits and in other settings, and by coordinating with appropriate team members as required.ConclusionsIt is suggested that PHNs need to acquire practical skills depending on the characteristics of the case to cope with critical situations throughout the process of engagement.

The roles and education system of public health nurses in Japan

The roles and education system of public health nurses in Japan

Characteristics of COVID-19-Related Free Telephone Consultations by Public Health Nurses in Japan: A Retrospective Study.

This study aimed to (1) describe the characteristics of community residents who used coronavirus disease 2019 (COVID-19)-related telephone consultation systems by public health nurses (PHNs) and (2) analyze the concerns they had during the first wave of COVID-19 in Japan. Among 1126 telephone consultations, PHNs recorded telephone consultations between 25 March, and 30 April, 2020, in City A, Japan. We analyzed 1017 consultations involving 799 (79%) community residents (resident group) and 218 (21%) organizational representatives (organization group) located in City A. Half of the consultations were made during midmorning, and most of the consultations were regarding COVID-19 symptoms. Among the resident group, visiting a primary care doctor was the most common recommendation by the PHNs; there was no difference in provision of consultation by sex. Health- and welfare-related organizations mainly consulted PHNs about “having COVID-19-related symptoms” and “undergoing PCR testing,” and PHNs’ recommended them to visit a primary care doctor and coordinate PCR testing. The results suggest that public health centers should provide more helpful information on COVID-19 that accurately reflects the concerns of the population.

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.

Culturally sensitive disaster nursing by Public health nurses in Japan

To clarify culturally sensitive disaster nursing by public health nurses (PHNs) in Japan, an island nation located on the Pacific Rim, with regard to PHNs' intentions and comforting supports for affected people. Qualitative descriptive study. Participants were 17 local PHNs and 13 affected people in nine disaster-affected municipalities throughout Japan. Semi-structured interviews were conducted between October 2018 and July 2019. Two types of categories were qualitatively created: categories for PHNs' culturally sensitive disaster nursing actions, including their intentions; and categories for comforting supports that PHNs provided for affected people through the four phases of disaster. The relationship between these two types of categories was determined. Cultural factors were extracted from the culturally sensitive disaster nursing actions of PHNs and categorized. Regarding intentions, in the acute phase, PHNs utilized culture. In the sub-acute phase, they utilized, acted based on, followed, thought of, and balanced cultural knowledge. In the mid-term-phase, they utilized, thought of, followed, and balanced with local culture. In the long-term phase, they merged, thought of, balanced, utilized, and followed local cultural practices. The actions associated with these intentions corresponded to comforting supports for affected people. Cultural factors, such as transportation style, were obtained in each phase. To enhance the resilience of a community affected by disaster, PHNs should focus on maximizing, preserving, and accommodating culture to maintain familiar life patterns when people's circumstances are totally disrupted by powerful forces of nature.

Self-reported competences of public health nurses for developing needs-oriented local healthcare plans: A nationwide cross-sectional survey.

To identify self-reported competencies of public health nurses for reflecting community healthcare needs in local healthcare plans. We conducted a nationwide cross-sectional survey in Japan from October 7-November 30, 2019. We sent 2,185 self-reported questionnaires to public health nurses in Japan who had developed a local healthcare plan since 2013. Self-reported questionnaires included questions regarding demographic data and the reflection of community healthcare needs in local healthcare plans, and the involvement in local healthcare planning. We analysed 1,042 questionnaires: 651 (62.5%) were from public health nurses who reported that they elicited and shared community views to be reflected for purposes of local healthcare planning (the reflecting group), and 391 (37.5%) of the remaining public health nurses who reported that they did not do so (the non-reflecting group). The logistic regression analysis revealed that public health nurses in the reflecting group were more likely to be in a managerial position, have colleagues who played an active role in healthcare planning, conduct a questionnaire survey, engage in group work, participate in a municipal healthcare planning committee with community-dwelling people, and identify the opinions of the professional organizations. Identifying community healthcare needs through collaboration with community-dwelling people and professional organizations should be essential competencies for public health nurses (the reflecting group) in developing needs-oriented local healthcare plans. Identification of their related competencies for developing a needs-oriented local healthcare plan as an upstream strategy to mitigate the prevalence of health inequities in each community.

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.

Preparing for Complex Emergencies While Combating COVID-19: The Role of Public Health Nurses in Japan.

A combination of natural calamities and coronavirus disease 2019 (COVID-19) would cause a complex emergency. Modifying a disaster prevention plan to combat COVID-19, by developing an evacuation and monitoring system for the COVID-19 cases and their contacts who stay at their homes, is urgently needed in the public sector. This short communication presents a preparation for the complex disaster by public health nurses who could contribute to preventing risks and death of community-dwelling people.

Validation of the PHNs precepting experiential learning causal model for preceptors of novice public health nurses in Japan.

AimsThe purpose of this study was to analyse the relationship among public health nurse (PHN) precepting experiential learning (PHN‐PEL) and the outcomes.BackgroundThe government supported PHNs' systematic career development and precepting learners.DesignA nationwide questionnaire survey was conducted for PHNs who precepted novice PHNs in governmental units from 2012 to 2015.Methods“PHN Precepting Experiential Learning Scale,” “Professional Development for Public Health Nurses” and “Awareness of Responsibility for Organization” were examined through structural equation modelling.ResultsUsable responses were 378 (43.5%). Significant relationships were as follows: “Role Performance of Fostering Novice PHN” related to “Self‐development as a PHN” (β = 0.72, p < .001); “Role Performance of Fostering Novice PHN” related to “Sharing to Foster Novice PHN” (β = 0.52, p < .001) and “Sharing to Foster Novice PHN” related to “Improving Career Development Environment” (β = 0.69, p < .001). “Role Performance of Fostering Novice PHN” and “Self‐development as a PHN” related to “Professional Development for Public Health Nurse” (β = 0.31, p < .001; β = 0.29, p < .001). Moreover, “Improving Career Development Environment” related to “Awareness of Responsibility for Organization” (β = 0.33, p < .001).

Developing a comprehensive career development scale for public health nurses in Japan.

This study aims to develop a scale that can comprehensively measure public health nurses'(PHNs) career development and to verify the validity and reliability of that scale. This study is a cross-sectional investigation. The participants were 1,009 PHNs working in a government facility in Japan. A total of 586 participants who had been working for more than 3years as PHNs were analyzed. Anonymous self-response questionnaires included items on professional awareness, practical competency, and job satisfaction. We conducted exploratory factor analysis and confirmatory factor analysis to clarify the construct validity of the scale. The reliability was examined by the Cronbach's α coefficient. The validity was examined by an external reference relevant validity and the known-group method. The scale was structured with 32 items covering three factors: "community activities, policy, and management," "PHN identity," and "foundations as a PHN." The Cronbach's α coefficients were all greater than 0.9. In confirmatory factor analysis, the scale showed acceptable goodness of fit. The comprehensive career development scale for PHNs proved its reliability and validity. This scale may be useful to promote PHN identity and competency comprehensively in basic education and in-charge education.

Care during Breastfeeding: Perceptions of Mothers and Health Professionals.

Purpose. To know the perceptions of mothers and health professionals in relation to the care provided and received during breastfeeding at primary health care level.Methods. A qualitative exploratory study was conducted with breastfeeding mothers (10) and primary health care professionals (24). Data was gathered through in-depth interviews and focus groups. Data analysis was performed through thematic content analysis. The rigor of the study was ensured by the Guba and Lincoln criteria for qualitative research. Ethical aspects were addressed through the informed consent process, confidentiality, and methodological rigor.Results. The experience of providing/receiving breastfeeding support was revealed as a dynamic, multidimensional care and support process, through three central themes: 1. Influence of previous care and support experiences during the breastfeeding process; 2. Importance of the context within which care is framed; and 3. Addressing emotions to establish trust between professionals and mothers.Conclusion. The study findings contribute to further understanding a complex phenomenon, such as breastfeeding support and care for mothers/families, from the experience of the actors involved, deepening the experiences of both in integrated manner. In addition, the relational, organizational, and contextual dimensions that influence support, and that should guide care, are also highlighted.

Education systems for occupational health nursing in the basic education course for public health nurses in Japan

This study aimed to clarify the education systems for occupational health nursing (OHN) in the basic education course for public health nurses (PHNs) in Japanese nursing universities. An anonymous self-administered questionnaire survey was conducted among 234 nursing universities with PHN courses. We surveyed the outline of PHN/OHN curricula, clinical practicum in OHN, and the skill achievement levels of students in OHN clinical practicum according to the "Minimum Requirements in PHNs Education 2004" (MR2004) developed by the Japan Association of PHN Educational Institutions. The data were analyzed using a t-test and Mann-Whitney U test. All statistical analyses were carried out using IBM SPSS ver. 21.0. In the analysis, we used data from the 80 respondent schools (response rate 34.2%). In 39 schools (48.1%), lectures related to a clinical practicum in OHN were offered as independent subjects in the school curriculum; of these 39, two schools (2.5%) offered OHN as multiple independent subjects. In 49 schools (60.5%), clinical practicum in OHN was designated as a part of PHN training. In colleges that had a clinical practicum in OHN, the number of lecture hours related to OHN was 9.7 ± 11.6 hours, which was more than that in colleges without such a practicum, although the difference was not significant. We compared the skill achievement levels between the groups where the number of days in the OHN clinical practicum was up to two and up to three or more. There was a tendency for the skill achievement level to be higher in the group with the greater number of days, with a significant difference in 16 of 19 items. We clarified that the PHN curriculum is offered with many variations in colleges, and that the lectures and clinical practicum in OHN are developed according to each college's policy. We observed the following tendency: the more days in the OHN clinical practicum, the higher the student's skill achievement level. These findings suggest that guaranteeing a certain number of days in a clinical practicum in OHN is important for realizing high-quality PHN training.

Community-based lymphedema risk reduction programs for cancer survivors: An Internet survey of public health nurses.

Currently, there is no provision for continuous care to monitor lymphedema risk-reduction behavior for survivors of cancer. The aim was to explore the possibility of community-based lymphedema education programs by investigating the knowledge, training needs, and intention to organize such programs and barriers among government-employed public health nurses. A cross-sectional Internet survey was conducted among government-employed public health nurses in Japan. The participants were recruited from 2841 health center and community health centers. The final sample included 641 government-employed public health nurses. The participants' knowledge about lymphedema risk-reduction strategies was relatively good, especially on the importance of observation, detection of early signs, and referral to lymphedema clinics. A small proportion of participants indicated an intention to organize community-based lymphedema education programs. Three determinants for this intention were identified: a general interest in lymphedema education, past experience of undertaking training in lymphedema risk-reduction strategies, and the perceived difficulty in organizing community-based lymphedema education programs. The participants' perceptions of difficulty included not knowing the needs for lymphedema education in their community with survivors of cancer. The results suggest that working collaboratively with government-employed public health nurses to organize community-based lymphedema education programs is possible. Achieving this requires further investigation of the needs of survivors of cancer in the community, communicating these needs to governmental agencies, and organizing and delivering comprehensive training programs about lymphedema risk-reduction strategies for government-employed public health nurses.

Actual Status of Healthy Lifestyle Habits of Public Health Nurses in Japan

Background: The public health nurse should make efforts to keep his/her own mental and physical health good, which is the professional responsibility. However, a variety of challenging issues have been pointed out with regard to well-being of healthcare professionals. Public health nurses are likely to face some difficulties in their habits of leading healthy lifestyles. The purpose of this study was to identify how Japanese public health nurses actually live their healthy lives. Methods: This study covered 1725 public health nurses in the Chugoku/Shikoku Region. We conducted an anonymous self-completed questionnaire survey. As basic attributes, the following 6 categories were set. The health practice indices used in this research consisted of the 7 practices of Breslow’s Health Practice Index (B-HPI), the Morimoto’s 8 practices, and 6 practices related to lifestyle habits that have been developed independently by the authors of this research (Health Lifestyle Index (HLI)), that is, 16 practices in total. The study plan was approved by the Ethics Committee of Okayama University. Results: We analyzed the 960 (55.7%) valid responses. This survey has demonstrated that the healthy life-style practices of public health nurses are generally good. However, there were some practices such as eating between meals, having little physical activity, and not having a good rest/sleep, that need to be improved. None of the assessment tools correlated with the length of experience. Conclusions: This survey has clarified that the healthy lifestyle practices of public health nurses did not correlated with their length of experience, indicating that the healthy lifestyle practices are not intensified by the accumulated career experience as public health nurses.