Japanese nurse practitioners' legal liability ambiguity regarding their medical practice: a qualitative study

Applying Advanced Practice Nurses in Rural Japan: A Mixed-Methods Perspective

Introduction Rural hospitals, particularly those in geographically isolated regions like Shimane Prefecture, Japan, face significant healthcare delivery challenges. These include limited resources, an aging population, and a scarcity of healthcare professionals. Advanced practice nurses (APNs) have emerged as pivotal in addressing these gaps, offering specialized patient assessment, diagnosis, and management skills. This study aimed to evaluate the demand for APNs in rural community hospitals, focusing on the specific educational needs and clinical competencies required to improve healthcare outcomes in these settings. Method Employing a mixed-methods approach, this research combined qualitative insights from stakeholder interviews with quantitative data analysis of electronic health records (EHRs) at Unnan City Hospital. This sequential exploratory design aimed to capture comprehensive educational needs and outcomes, integrating the depth of qualitative data with the breadth of quantitative evidence to tailor a curriculum for APNs in rural healthcare contexts. Results The study revealed a critical demand for APNs skilled in managing common medical issues in rural settings, such as infections, circulatory failures, and respiratory problems. Stakeholder interviews highlighted the necessity for a curriculum that enhances clinical competencies and emphasizes soft skills like communication and leadership. An analysis of EHRs identified 21 specific diseases across six categories, underlining the importance of targeted education on these prevalent conditions. Conclusion The findings underscore the urgent need for specialized education programs for APNs in rural hospitals to address these communities' unique healthcare challenges. Developing a curriculum that focuses on clinical and soft skills essential for rural healthcare delivery can significantly enhance the quality of care. This study advocates for implementing such tailored educational programs to empower APNs, thereby contributing to healthcare equity and improving patient outcomes in rural settings.

Effectiveness of point of care ultrasound (POCUS) simulation course and skills retention for Japanese nurse practitioners

BACKGROUND

In Japan, the nurse practitioner (NP) system has only been in place for a short time, and there is no ultrasound (US) simulation course for NPs. Therefore, NPs may have to attend US simulation courses for physicians. We evaluated whether US simulation course for physicians lead to improved image acquisition and interpretation amongst NPs and, if so, if these changes would be maintained over time.

METHODS

A 2-day point-of-care ultrasound (POCUS) course designed for physicians in cardiac US, lung US, lower extremity deep vein thrombosis (DVT) US, and abdominal US was held for Japanese nurse practitioners (JNP) and JNP trainees in 2018 and 2019. Participants kept a record of the number of US examinations they performed for 3 months before and 3 months after the course. The number of US exams performed was grouped into six categories. All participants underwent pre-course, immediate post-course, and 4-month post-course testing to assess image interpretation skills, image acquisition skills, and confidence.

RESULTS

Thirty-three participants from 21 facilities completed the program. Before and immediately after the course, test scores of the image interpretation test, image acquisition test, and confidence increased significantly (37.1, 72.6: P < 0.001), (13.7, 53.6: P < 0.001), and (15.8, 35.7: P < 0.001), respectively. Comparing the follow-up tests immediately after the course and 4 months later, there was no decrease in scores on the image interpretation test, the image acquisition test, or confidence (72.6, 71.8: P = 1.00) (53.6, 52.9: p = 1.00) (35.7, 33.0: P = 0.34). There was a statistically significant increase (P < 0.001) in both the total number of ultrasound examinations and in the number of ultrasound examinations by category (cardiac, lung, lower extremity DVT, and abdominal) in the 3 months before and 3 months after the course.

CONCLUSIONS

The POCUS simulation course for physicians is useful for JNPs to acquire US examination skills even if it is not arranged for JNPs. Image interpretation skill, image acquisition skill, and confidence improved significantly and were maintained even after 4 months of the course. It leads to behavioral changes such as increasing the number of US examinations in daily practice after the course.