Predictors of parenting difficulties at the 18-month health checkups: A retrospective study using administrative data from infant health checkups

OBJECTIVE

This study aimed to identify predictors of parenting difficulties at 18 months from the results of the 4-, 6-7-, and 9-10-month infant health checkups among caregivers who had not experienced difficulties at 4 months.

DESIGN AND SAMPLES

This retrospective study used data from infant health checkups conducted in a city in Tokyo from November 2019 to October 2021. The participants were caregiver-child dyads of children who had undergone four checkups. Low birthweight, preterm, and multiple birth infants, and caregivers who experienced difficulties at 4 months were excluded.

MEASUREMENTS

Data included caregiver, child-rearing environment, and child factors at the 4-, 6-7-, and 9-10-month checkups and caregivers' self-reported parenting difficulties at the 18-month checkup.

RESULTS

Of the 555 caregivers, 48 (8.6%) experienced parenting difficulties at 18 months. Logistic regression analyses showed that mothers' physical condition (4 months), children being male, abnormal child growth (4 months), less than 10th percentile for children's height (6-7 and 9-10 months), and abnormal examination results (6-7 months) were significantly associated with parenting difficulties at 18 months.

CONCLUSIONS

To prevent child abuse, public health nurses should consider the identified factors to detect and support caregivers with emerging parenting difficulties.

Developing an Educational Program for Ultrasound Hip Screening during Newborn and Infant Home Visits: A Protocol Paper

Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).

Community-Based Hip Screening for Up to Four-Month-Old Infants and Health Guidance for Their Caregivers in Japan: A Nation-Wide Survey

Early detection of developmental dysplasia of the hip (DDH) in children is crucial. Due to COVID-19, maternal and child health services have been suspended temporarily, increasing the risk of late detection of DDH. This study aimed to reveal Japan's current situation regarding community hip screening for newborns and infants and to provide health guidance for caregivers regarding DDH. A web-based, nationwide cross-sectional survey was conducted between February and March 2023 (n = 1737). One public health nurse overseeing maternal and child health per municipality responded to the 2022 municipality hip screening system. Among the 436 municipalities that responded (response rate: 25.1%), 97.5% implemented hip screening within 4 months, and approximately 60% performed it during newborn home visits, while only 2.3% conducted hip ultrasound screening. Perfect checking of the risk factors for DDH during newborn home visits and training opportunities for home visitors must be improved. Educational programs regarding DDH for home visitors and caregivers are needed to prevent the late diagnosis of DDH. Furthermore, collaboration between pediatric orthopedic surgeons and nurses is crucial for developing effective community-based hip-screening systems by bridging the evidence and practice gap in the early detection of DDH.

Effectiveness of a web-based learning program for promoting local healthcare planning competencies

OBJECTIVE

To determine the effectiveness of a web-based educational program regarding local healthcare planning by public health nurses (PHNs) in Japan.

DESIGN

A single-blind randomized controlled trial.

SAMPLE

Full-time PHNs working for local governments across Japan.

MEASUREMENTS

The primary outcome was nurses' self-perception of competencies in public health policy. The secondary outcome was self-perception of knowledge, skills, and perspectives regarding local healthcare planning. We analyzed intergroup differences using the intention-to-treat principle and the Mann-Whitney U-test.

INTERVENTION

The intervention group received six web-based learning modules including substantial knowledge and skills regarding local healthcare planning based on the analysis, design, development, implementation, and evaluation model and adult learning theory.

RESULTS

Totally, 273 PHNs registered, and 38 were excluded without completing the baseline survey; 235 were randomly allocated to either the intervention (n = 118) or control (n = 117) groups. Sixty-four participants in the intervention group completed the program. Over 70% of the participants lacked opportunities to learn about local healthcare planning. The intervention group showed significant improvement in self-perception of competencies, knowledge, and skills regarding local healthcare planning, except for items related to evaluation.

CONCLUSIONS

The web-based learning program effectively improved participants' self-perception of competencies in local healthcare planning.

New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design

BACKGROUND

Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients' and nursing interventions' classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan's lagging digitalization, supervisory PHNs face difficulties in monitoring each department's activities and staff members' performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices.

OBJECTIVE

We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices.

METHODS

We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system's architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments.

RESULTS

This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones.

CONCLUSIONS

This study will reveal PHNs' tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management.

TRIAL REGISTRATION

UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45342.

Developing a Virtual Reality Simulation Program for Improving Nursing Students' Clinical Reasoning Skills in Home Settings: A Protocol Paper

Most nursing simulation programs focus on persons' healthcare needs in hospital settings, and little is known about how to identify them in home settings. This study aims to develop and validate a virtual reality (VR) simulation program for nursing students to improve their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings. We developed a VR simulation program based on a literature review and expert discussion. In Phase 1, home visit nurses or public health nurses will validate the program through their interviews in 2022. In Phase 2, we will conduct a pilot and main single-blinded randomized trial for nursing students to confirm the effectiveness from 2022 and 2023. Participants will be randomly allocated into an intervention group using VR simulations and a control group receiving videos regarding three kinds of community residents' lives [1:1]. After obtaining informed consent, the students will submit their anonymous data to the researchers to prevent associating their grade evaluation. The primary outcome will be their clinical reasoning skills. The second outcome will include their satisfaction and self-confidence. This study will examine the effectiveness of improving their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings.

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.

Evaluation of Infant Injury Prevention Education Provided during Antenatal Classes after Two Years: A Pilot Prospective Cohort Study

This study examined the long-term effects of an infant injury prevention program implemented during an antenatal class of 131 mothers. Questionnaires were completed 2 years postpartum to assess the incidence of injury (medically attended or home-care), mothers’ perception of injury prevention, implementation of safety practices, and active attitudes toward injury prevention. Responses were obtained from 68 (51.9%) mothers (intervention group, 40; control group, 28), including 24 who reported medically attended injuries and 55 who reported home-care injuries. The incidence of medically attended injuries did not differ between groups. The incidence of home-care injuries was also not significantly different, but was lower in the intervention group (72.5% vs. 92.9%, p = 0.050). Significantly fewer children in the intervention group experienced “injury due to being caught between objects” (12.5% vs. 39.3%, p = 0.014). Mothers in the intervention group were significantly more aware of injury prevention than those in the control group (p = 0.033). The risk of home-care injuries was inversely related to mothers’ injury-prevention perception (odds ratio [OR]: 0.55, p = 0.035). This study suggests that group education during pregnancy regarding injury prevention increases mothers’ perception of injury prevention. These findings support implementing injury prevention education during antenatal classes.

Feasibility of an educational program for public health nurses to promote local healthcare planning: protocol for a pilot randomized controlled trial

BACKGROUND

Promoting of local healthcare planning is crucial for assisting public health nurses in improving community health inequities. However, there is no effective educational program for developing relevant skills and knowledge among these nurses. Therefore, this study aims to assess the feasibility of a newly developed web-based self-learning program to promote the involvement of public health nurses in the local healthcare planning process.

METHODS

A pilot randomized control trial randomly allocated eligible public health nurses to intervention and control wait-list groups [1:1]. The former will be exposed to six web-based learning modules from July to October 2021. After collecting post-test data, the wait-list group will be exposed to the same modules to ensure learning equity. The primary outcome will be evaluated by implementing a validated and standardized scale designed to measure public health policy competencies at the baseline and post-intervention, while secondary outcome will be measured on an action scale to demonstrate the necessity of healthcare activities. The third outcome will be the knowledge and skills related to local healthcare planning by public health nurses. The participants will provide feedback through free descriptions on the trial feasibility and a web-based self-learning program to identify improvement points for continual refinement.

DISCUSSION

The results will provide suggestions in preparation for a future definitive randomized controlled trial. This will provide preliminary data for an intervention aimed at improving relevant competencies among public health nurses who are tasked with resolving health inequities in their respective communities through local health planning.

TRIAL REGISTRATION

The protocol for this study was registered with the University Hospital Medical Information Network Clinical Trials Registry and approved by the International Committee of Medical Journal Editors (No. UMIN000043628 , March 23, 2021).

Content Analysis of the Free COVID-19 Telephone Consultations Available during the First Wave of the Pandemic in Japan

This cross-sectional study aimed to (1) describe the unclassified contents of telephone consultation services provided by a public health center during the first wave of COVID-19 in Japan and (2) examine whether the contents required assistance from public health nurses (PHNs). We analyzed a total of 207 calls in which the purpose of the call was unclassified into pre-set categories. PHNs transcribed the exact text of the consultation conversations recorded from 25 March to 20 April 2020 in City A. Approximately half of the calls were from residents. Seven categories were extracted through a qualitative content analysis. The most common topic was infection control measures, where the presence of COVID-19 infection was assumed (n = 62); the second most common was extreme anxiety and fear of infection (n = 50). Questions about the COVID-19 response system (n = 30), discrimination and misunderstandings about COVID-19 (n = 24), and response measures for COVID-19 outbreaks within organizations (n = 18) were also included. The unclassified consultations included various topics, several of which required the expertise of a PHN. Each local government should consider sharing and task-shifting telephone consultation services among PHNs and other staff to reduce their burden and allow them to concentrate on conducting infection control more effectively.

Confusions and responses of managerial public health nurses during the COVID-19 pandemic in Japan

Objective

This study aimed to elucidate the experiences of public health nurses (PHNs) in Japan during the first wave of COVID‐19.

Design and sample

Twelve PHNs in charge of responding to COVID‐19 in X‐city within Tokyo metropolis in Japan participated in this case study.

Measurements

Data were collected through self‐administered questionnaires and semi‐structured interviews on PHNs’ experiences from January 2020 to May 2020.

Results

Initially, only infectious disease control division (IDCD) PHNs experienced confusion due to the rapidly increased workload. Managerial PHNs attempted to explain the need for a dispatch system for the IDCD, using available statistical data from other managerial members, within one's maximum understanding of this unprecedented situation. Without having a clear and forward‐looking understanding regarding the purpose and reasons for dispatching, some dispatched PHNs had concerns and frustrations; they did not view the COVID‐19 pandemic as a disaster. In the never‐ending, exhausting work, PHNs managed to modify the provision of conventional services to residents.

Conclusions

Despite experiencing confusion, PHNs worked to continuously provide community services, re‐considering the meaning of public health nursing. Prioritizing the work and shifting tasks to other professionals at an early stage of the pandemic may prevent organizational dysfunction.

Mothers susceptible to child maltreatment and requiring public health nurses' continuous support

OBJECTIVE

This study aimed to identify the characteristics of mothers who are at a high risk for future child maltreatment and therefore, require continuous support from public health nurses (PHNs) to prevent child maltreatment and those who do not require it.

DESIGN AND SAMPLES

This retrospective cross-sectional study included women who were registered in 2018 for being at risk for future child maltreatment and required help with childrearing in City A within the Tokyo metropolis.

MEASUREMENTS

Public health nurses registered data pertaining to each mother, including demographic data, family-related variables, assessment by PHNs, use of maternal and child healthcare services, and continuity of support from PHNs.

RESULTS

Of the 206 cases, the discontinued group-comprising those who no longer needed PHNs' support-included 83 cases (40.3%) and the continuing group-comprising those needed continuing support-included 123 cases (59.7%). Logistic regression analysis showed that those with marital conflicts, maternal mental instability, lack of parenting skills, and not moving out of the city were more likely to require continuous PHNs' support.

CONCLUSIONS

By identifying these factors, PHNs can identify new mothers who need continuous support and provide more concentrated care for them. Thus, support from PHNs can help prevent child maltreatment.

[Factors associated with community collaboration in the implementation phase of the local health-care, medical, and welfare plan]

Objective　The aim of this study was to elucidate the status of health-care, medical, and welfare planning (hereafter, "planning")-in which public health nurses (PHNs) had participated-and the factors associated with community collaboration in the implementation phase. Additionally, suggestions regarding health activities that would contribute to improving the entire community's health level were obtained.Methods　The Plan-Do-Check-Act (PDCA) cycle was the conceptual framework for this study, and the focus was the implementation phase of the plan (i.e., corresponding to the "Do" phase). Survey items were part of the "Plan" phase and identified the extent to which PHNs collaborated with community-dwellers in implementation, their demographics, their participation in the planning process, organizational factors, and the strategies used in the planning phase. The participants were full-time PHNs working in local governments who had participated in the planning process since 2013 (when the guidelines for PHNs' practices were published). A nationwide, cross-sectional survey was conducted in Japan with 2,185 PHNs from 220 regions (36 prefectures, 41 cities with public health centers, and 153 municipalities) who expressed the willingness to participate in this study. A binomial logistic regression analysis was conducted to examine the association between community collaboration and the independent variables.Results　A total of 1,281 answers (a 58.6% response rate) were received. Ultimately, 1,028 (a 47.0% valid response rate) were analyzed; exclusions were 203 for no experience in health care planning since 2013 and 50 with missing values. There were 125 (12.2%) PHNs who answered that they "did not collaborate with the community-dwellers at all," 293 (28.5%) who answered that they "did not collaborate with them much," 482 (46.9%) who replied that they "collaborated with them a little," and 128 (12.4%) who responded that they "collaborated with them a lot." The binomial logistic regression analysis showed that the following were associated with PHNs' collaboration with the community: being in a managerial position, having experience developing a health promotion plan, conducting a questionnaire survey or group work, as well as participating in municipal health planning committees with community-dwellers, utilizing research evidence, identifying target groups, and managing the plan's progress.Conclusion　From the planning phase, PHNs must collaborate with community residents and reflect their voices so that the formulated plan will help resolve medium to long-term issues in the community related to health and life.

Factors associated with the utilization of community assessment models among Japanese nurses

OBJECTIVES

This study aimed to identify factors related to the practical utilization of community health needs assessment (CHNA) models that public health nurses (PHNs) learned in their fundamental education.

DESIGN

A nationwide questionnaire survey was conducted via postal mail.

SAMPLE

We randomly selected 630 public health institutes in Japan. The participants were 3397 full-time novice and mid-level PHNs.

MEASUREMENTS

The questionnaire included the participants' basic personal information, six items regarding the perception of CHNA with a 4-point Likert scale, learned models in their undergraduate education, their utilization in practical settings, and the reasons for their answer in narrative form.

RESULTS

There were 951 valid responses. The results of logistic regression showed that the significant positively factors with model utilization were perception of CHNA as "not troublesome" or "not impossible as they learned," continuing education with 5 years of experience, and identification of the learned model in continuing education. Furthermore, the results of text mining showed the reasons for non-utilization of the model included being "busy" and having a lack of "opportunity."

CONCLUSIONS

This study showed the associated factors with rare utilization of a learned model for PHNs. These findings may suggest improvement of continuing education and development of an appropriate assessment model.

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.

Factors related to complex care needs of older adults in community-based integrated care centers in Japan: A cross-sectional study

AIM

This study aimed to identify the factors related to complex care needs of older adults in community-based integrated care centers.

METHODS

We sent 936 self-reported questionnaires to community-based integrated care center directors in the Kinki region of Japan. These questionnaires included questions not only about the directors' demographic data, but also regarding the sociodemographic, psychosocial, and family-related dimensions of the older adults in the community centers. The directors divided their cases into two categories: "Complex cases" and "Straightforward cases." We compared the intergroup differences and examined the factors related to complex care needs in older adults.

RESULTS

A total of 232 directors responded. Complex cases were significantly associated with younger age, poor health conditions, and having a family member who needs care, as compared to straightforward cases where these associations were not present. Logistic regression showed that in older adults, factors of refusing support or social services, social isolation, and trouble with neighbors were associated with their complexities. Additionally, family members with a high likelihood of refusing social services, older adults without a key family member, and difficulties in forming their consensus regarding care were associated with older adults' complexities.

CONCLUSION

Older adults with complex care needs could have the risk of self-neglect, and their families faced difficulties in supporting them as family members. Healthcare professions should carefully assess these factors and develop needs-oriented services for them without their family support as an upstream intervention.

Characteristics of Departments That Provided Primary Support for Households with Complex Care Needs in the Community: A Preliminary Cross-Sectional Study

To prevent emergency admissions and save medical costs, support should be provided to households that include people with complex care needs to allow them to continue living in their own homes. This community-based, cross-sectional study was conducted to (1) identify which departments that public health nurses (PHNs) worked have been the primary providers of support for households with complex care needs and (2) clarify the length of time required by each department to resolve primary health problems. We analyzed 148 households with complex care needs that were registered in City A from April 2018 to July 2019. Four types of departments were the primary support providers for complex care households: the department supporting persons with disabilities (n = 54, 36.5%), public/community health centers (n = 47, 31.8%), department of older adults (n = 29, 19.6%), and welfare offices (n = 18, 12.2%). The Mantel–Cox test showed that welfare offices mainly supported households in economic distress and needed significantly less time to resolve their primary health issues than other departments. For early detection and resolution of primary health problems for households with complex care needs, PHNs and healthcare professionals should focus on their economic distress and enhanced multidisciplinary approaches.

Effectiveness of Health Guidance Simulation in Community Settings for Public Health Nursing Students: A Preliminary Study

Introduction

Simulation-based learning is a relatively new concept in public health nursing education, and little is known about the efficacy of this approach for teaching of health guidance. Objective: The aim of this study was to evaluate the effectiveness of health guidance simulation in community settings for public health nursing students.

Methods

Using a pre/post-test design, 29 public health nursing students in their third year participated in a high-fidelity simulation program with standardized patients. We developed six scenarios on health guidance for three themes (mother and child, tuberculosis, and adult occupational health) and practice guidelines for the standardized patients to act and assist in understanding of the purpose of the course. Data were collected at baseline and after the simulation sessions through evaluation sheets that the students placed in a designated box on campus. Changes in the level of self-confidence of the students were evaluated based on the “practical skills required for public health nurses and achievement level at graduation” of the Ministry of Health, Labor and Welfare, and the skills in the minimum requirements for public health nurse education defined by the Japan Association of Public Health Nurse Educational Institutions.

Results

The total score for self-confidence and the mean self-confidence scores for health guidance skills for mother and child, tuberculosis, and adult occupational health nursing were significantly higher post-test compared to pre-test (p < 0.001).

Conclusion

These results indicate that high-fidelity simulation focused on health guidance in community settings can bridge the gap between theoretical knowledge and practice of students.

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

AIM

To identify self-reported competencies of public health nurses for reflecting community healthcare needs in local healthcare plans.

DESIGN

We conducted a nationwide cross-sectional survey in Japan from October 7-November 30, 2019.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

IMPACT

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.

Developing sustainable public health care systems for responding to COVID-19 in Japan

OBJECTIVE

Despite having prevented public health center (PHC) dysfunction in response to COVID-19 during the first wave, public health nurses (PHNs) who play a central role in preventing COVID-19 and supporting community people were unable to share practical knowledge with other PHNs immediately. This report aims to introduce the development of novel sustainable public health care systems with regard to COVID-19 in Japan: task sharing, securing staff, and task shifting.

METHODS

A descriptive study. The Japan Ministry of Health, Labour, and Welfare enlisted good practices regarding resource allocation and developing full readiness for sustainable public health care systems in September 2020.

RESULTS

Public health center developed systems for office support, infection control, hospital coordination, and outsourced inventory control. To reduce the workload of PHNs, a support team of three to four office workers developed a response manual for residents and a format for telephone consultations regarding COVID-19. Developing an infection control team and web-based system for hospital coordination decreased the workload of PHCs in each community to prepare for the pandemic.

CONCLUSION

Public health center should consider managing limited human resources and focus on providing specialized care for COVID-19 patients. Task sharing, securing staff, and task shifting are crucial strategies for developing sustainable public health care systems.

COVID-19-Related Free Telephone Consultations by Public Health Nurses

Public health centers are located in each municipality in Japan and are responsible for infectious disease control including COVID-19. Public health nurses (PHNs) are stationed at the centers and work at the forefront, covering a variety of services from individual consultations to hospital escort for those tested positive. Starting January, PHNs at A city (population approx. 210,000) established a free telephone consultation hotline for COVID-19. This study aims to review the PHNs’ telephone consultations during the first wave of COVID-19. The number of calls were aggregated weekly and their time-trend was examined. The study was approved by the University of Tokyo Ethics Review Board. During the first wave between January and May, there were 3,242 calls, with the highest number of calls (n=491/week) in the second week of April. At this point the regular PHNs were not enough to meet the hightened needs of consultations and PHNs from other departments were temporalily transferred for support. The number of consultation calls fluctuated weekly. The increase of calls seemed to preceed the increase of positive cases by one week. We consider that the call may be an initial action of those who suspected possible infection, and the consultation by the PHN might have led them to proper clinic visits and PCR testing. Telephone consultation is an easy tool to use for general public, especially older persons. Having health professionals respond directly to calls may have had the advantage of providing appropriate guidance for infection control and PCR testing and mental support.

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

OBJECTIVE

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.

DESIGN

Randomized control trial.

SAMPLE

During 2017, 103 PHNs with 5-20 years of PHN work experience in Japan were enrolled and randomly allocated to the intervention (n = 51) or control group (n = 52).

MEASUREMENTS

The primary outcome measured competency in program planning based on Competency Measurement of Creativity for PHNs (CMC), knowledge, and skills regarding program planning.

INTERVENTION

Six web-based learning modules followed by two face-to-face group sessions.

RESULTS

The PHN participants averaged about 12 years 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 ≥12 years of experience. Total knowledge and skill scores also improved significantly in the intervention group compared with the control group.

CONCLUSIONS

The results suggest that PHNs with ≥12 years of experience are a suitable target of this educational program, and should play a key role in program planning.

[Preparations made and considered by parents of children with mental illness for their children's lives in the community after their own death]

Objectives　To examine how parents of children with mental illness prepare for their children's lives in the community after their own death.Methods　Twenty-two parents living in the Kanto region, who have children with mental illness, were interviewed from December 2016 to February 2017. Through qualitative inductive analysis, codes were identified from the narrative data that showed the preparation of parents and compared their similarities and differences. Similar codes were collected and subcategories and categories were created with increasing abstraction levels. Each category was considered with respect to the purpose and the reason why each preparation was done.Results　Participants were 9 fathers (40.9%) and 13 mothers (59.1%). Their ages were as follows: in their sixties (n=9; 40.9%), seventies (n=10; 45.5%), and eighties (n=3; 13.6%).　Ten categories emerged regarding parental preparation for their children's life after their death: 1) Forecasting their own death and recognizing the limitations of support; 2) Trying to share with their children about their own death; 3) With consideration of after their own death, organizing the necessary information for their children and their own belongings; 4) Consulting with their relatives about the lives of their children and inheritance, and considering the use of the social resources; 5) Trying to secure a residence and living expenses for their children; 6) Connecting with social resources, searching for recovery methods for their children, and their own health maintenance; 7) Stabilizing and recovering disease conditions of their children, supporting to take medication and outpatient visits; 8) Assessing the ability of their children to live considering their independent life; 9) Developing their abilities to live and sociality, and making reliable supporters other than parents; 10) Encouraging to have fun in their children's lives and considering their employment. Parents were preparing to hope their child would cope with difficulties in their lives after their own death, and maintain a stable life in the community by him/herself.Conclusions　The results suggested that parents should recognize the need of an independent life for their children in the community, to promote concrete preparations toward their children living in the community after their own death.

Educational program for middle-level public health nurses to develop new health services regarding community health needs: protocol for a randomized controlled trial

Background

Developing health services is a key strategy for improving the community health provided by public health nurses. However, an effective educational program for improving their skills in planning such services has not been developed. To describe our program and its evaluation protocol for the education of middle-level public health nurses to improve their skills in developing new health services to fulfil community health needs in Japan.

Methods

In this randomized control trial, eligible participants in Japan will be randomly allocated to an intervention group and a control wait-list group. We will provide 8 modules of web-based learning for public health nurses from July to October 2018. To ensure fairness of educational opportunity, the wait-list group will participate in the same program as the intervention group after collection of follow-up data of the intervention group. The primary outcomes will be evaluated using the scale of competency measurement of creativity for public health nurses at baseline, immediately after the intervention. Secondary outcomes will be knowledge and performance regarding program development of public health nurses.

Discussion

This study will enable the analysis of the effects of the educational program on public health nurses for improving their competency to develop new health services for fulfilling community health needs and enriching health care systems.

Trial registration

We registered our study protocol to the University hospital Medical Information Network- Clinical Trials Registry approved by International Committee of Medical Journal Editors (No. UMIN000032176, April, 2018).

Characteristics and related factors of Japanese mothers who have faced difficulties with childrearing

OBJECTIVE

To identify characteristics of mothers who face difficulties with childrearing.

DESIGN AND SAMPLE

Cross-sectional study. During 2014, 221 mothers and 248 children living in City A within the Tokyo metropolis were registered as requiring help with childrearing. Nursing records of 205 mothers (92.8%) and their 227 children (91.5%) were available. We excluded 29 mothers and children owing to incomplete data for a final sample of 176 mothers (79.6%) and 198 children (79.8%).

MEASURES

Difficulties with childrearing were assessed by self-reported questionnaires at the newborn child's 4-month health checkups. Data on maternal and child variables were collected from nursing records.

RESULTS

The "Difficulties group" included 59 mothers (35.4%) and their 70 children. Logistic regression analysis showed that mothers who were aged 40 years or older, who had a total score on the Edinburgh Postnatal Depression Scale of 9 or greater, who used more child-care support services, and who were monitored more frequently by public health nurses had a high risk of facing difficulties with childrearing.

CONCLUSIONS

Periodic monitoring by PHNs is a key strategy to improve the impact of the difficulties of childrearing for mothers of yoshien jido and their children.

Caesarean section by maternal age group among singleton deliveries and primiparous Japanese women: a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health

Background

The rising caesarean section rate is an important public health concern that in turn increases maternal and perinatal risks of adverse effects, unnecessary medical consumption, and inequities in worldwide access. The aim of this study was to investigate caesarean section indications by maternal age group and examine the association between age and caesarean section in primiparous Japanese women with singleton births.

Methods

We analyzed the Japanese data of primiparous women with singleton births from the WHO Global Survey on Maternal and Perinatal Health to compare maternal and neonatal characteristics and outcomes between groups with and without caesarean section. Women were divided into 3 maternal age groups (≤29, 30 to 34 and ≥35 years). We performed multivariable logistic-regression analysis to identify characteristics associated with caesarean section.

Results

Of the 3245 women with singleton births were included in the Japanese data, 610 women (18.8 %) delivered by caesarean section, half of whom (n = 305) were nulliparous. We included singleton nulliparous women (1747 deliveries) in our analysis. The maternal age 35 years old was associated with higher risks for all caesarean section (adjusted odds ratio [AOR] 1.89, 95 % CI 1.28–2.78) and emergency antepartum caesarean section (AOR 2.26, 95 % CI 1.49–3.40). Intrapartum caesarean section, which is mainly performed for obstetric indications, was not higher among the older maternal age group.

Conclusion

In Japan, advanced maternal age significantly increased the risk for caesarean section; however, intrapartum caesarean section was not higher risk among the older age group. Management of maternal complications would help to reduce the rate of caesarean sections and associated unnecessary medical consumption.

[Characteristics and related factors of individuals who refuse the support of health and welfare professionals]

OBJECTIVES

Health and welfare professionals experience difficulties during their casework on individuals in the community. The purpose of this study was to identify the characteristics and related factors of those in the community who refuse the support of health and welfare professionals.

METHODS

Since 2006, based on a signed research agreement between researchers and local government office A, the series of psychiatric consultation services was initiated for healthcare professionals who experienced difficulties in carrying out their casework on individuals in the community. Data were acquired from local government office A and included the patient's basic attributes, family-related factors, psychiatric factors, and problematic behaviors. Additionally, information on whether individuals refused support was obtained. The data did not include private information. To investigate risk factors for refusing healthcare professional support, 372 profiles of patients who underwent consultation services from 2006 to 2012, were analyzed by logistic regression analysis.

RESULTS

Among 309 persons, only 102 (33.0%) accepted support from health and welfare professionals, and 207 (67.0%) persons refused support. Logistic regression analysis revealed that individuals in the community who received welfare benefits (odds ratio [OR]=1.86, 95% confidence interval [CI]=1.02-3.39), refused medication (OR=2.07, 95%CI=1.10-3.90), or used abusive language towards healthcare professionals (OR=1.97, 95%CI=1.09-3.55) were more likely to refuse support from health and welfare professionals.

CONCLUSION

The results indicate that individuals in the community who refused support of health and welfare professionals tend to have a worsening condition and a greater need for crisis intervention than those who did not refuse support.

[Difficulties and solutions related to the experience of developing a new project by Japanese municipal public health nurses according to their seniority]

OBJECTIVES

Public health nurses (PHNs) have to regularly develop new projects that actively solve community health problems. The purpose of this study was to clarify the difficulties encountered by PHNs while developing a new project and their solutions for them. We also aimed to examine the effect of experience of Japanese PHNs in developing new projects, according to their seniority.

METHODS

Using random sampling, we chose 374 of 1871 municipalities that could not be consolidated with neighbouring municipalities in 2005, and 305 municipalities responded to questionnaires. The self-administered questionnaires were mailed to 2306 Japanese PHNs working within the municipalities. The questionnaire included items on the following: (1) PHN-related variables; (2) whether the PHN had experience in project development; (3) open-ended description of the difficulties and solutions related to the development of new projects by the PHN; (4) the reasons why the PHN could not create new services. We used content analysis to categorize the descriptions based on commonalities. We divided PHNs into 4 groups according to their seniority: Novice, Lower middle-level, Upper middle-level, and Expert. We performed the chi2 test (Fisher's exact test) to examine the relationship between experience and parameters such as "the difficulties" and "the solutions" in each group.

RESULTS

Among the 1270 respondents, 340 PHNs were in the Novice group, 347 in the Lower middle-level group, 329 in the Upper middle-level group, and 254 in the Expert group. The chi2 test (Fisher's exact test) revealed that there was a significant difference between difficulties and having experience in all 4 groups: 'Facing a busy schedule.' In these 4 groups, the following 7 solutions were statistically related with experience: 'Deepening the understanding of the PHNs' work of supervisors and colleagues,' 'Explaining the need for creating a new system with evidence,' 'Sharing information for creating a new service on a daily basis, 'Organizing the evidence to demonstrate the need for developing a new project,' 'Making a practical project plan,' 'Cooperating with persons concerned and facilitating consensus-building among them,' 'Coping with the cost of a new program.

CONCLUSION

In order to overcome difficulties encountered by PNHs while developing new projects, our findings suggest that the work done by PHNs' should be better understood by supervisors and colleagues. Further, evidence should be used to explain the need for creating a new system, and a consensus should be built at carefully. Moreover, the budget of the new program should be carefully managed.

[Factors related to experience of project development processes by municipal public health nurses in Japan]

PURPOSE

Public health nurses (PHNs) need to develop new projects to solve community health problems as an active strategy. The purpose of this study was to clarify how many Japanese PHNs actually have experience of project development process, and to examine related factors.

METHOD

By using random-sampling, we chose 374 municipalities from a total of 1,871 that would not consolidate with their neighbours in 2005, and obtained cooperation from 305. In collaboration with the Association of Japanese Public Health Nurses, questionnaires mailed to 2306 Japanese PHNs working in the municipalities in 2005. The self-administered questionnaire included items on; 1) municipal and organizational variables; 2) PHN-related factors; 3) whether the PHNs had experience of project-development processes. We performed logistic regression analysis to examine the relationship between experience and these parameters.

RESULTS

Among the 1,270 respondents, PHNs who did not recognize the necessity of creating a new project accounted for 481 (37.9%); those who recognized the need to create a new project but did not propose any practical means numbered 324 (25.5%); those who proposed a new project but did not implement it were 66 (5.2%); and those who provided a new project for their residents were 399 (31.4%). The logistic regression analysis revealed that PHNs who had experience of developing new services by themselves and read health, medical and welfare journals were significantly more likely to provide new projects for their residents.

CONCLUSION

PHNs have the capability to create new projects and individuals in all municipalities and organizations need to acquire active experience of developing projects.

Function and practice of public health nursing in Japan: a trial to develop the Japanese Purpose-Focused Public Health Nursing Model

AIM

To clarify the significance of public health nurses' practice, we introduced the activities of Japanese public health nurses and tried to develop a model based on the purpose of their work.

BACKGROUND

Despite international efforts toward clarifying public health nurses' practice, earlier models based on the purpose of their activities were underdeveloped.

METHOD

Japanese terms describing public health nurses' activities were gathered from the literature, nine researchers analysed and brainstormed the activities to develop a model. Seven municipality public health nurses and three researchers in both Japan and the USA validated the model.

RESULTS

The model includes three categories: creating the basis for support; working with individuals, families to enhance their health; and enhancing the health of individuals, families, groups, communities/regions by working with the community.

CONCLUSION

The Japanese Purpose-Focused Public Health Nursing Model was based on the purpose of public health nurses' practice which was considered significant for assisting public health nurses to explain the meaning of their work.

Tacit knowledge of public health nurses in identifying community health problems and need for new services: a case study

BACKGROUND

The purpose of this study was to explore the tacit knowledge of public health nurses in identifying community health problems and developing relevant new projects. Previous research only roughly showed those skills for creating new community health services, such as lobbying.

METHOD

Nine Japanese public health nurses who had created new projects in their municipalities were selected by theoretical sampling and interviewed in 2002-2003. Yin's Case Study Method, especially the multiple-case study design, was used.

RESULTS

All 9 public health nurses used similar approaches in identifying community health problems and the need for creating new services, even though their experiences differed and the kinds of projects varied. They identified the difficulties of clients, recognized clients who had the same problems, elucidated the limitations of existing services, and forecasted outcomes from the neglect of the clients' problems. Then they succeeded in creating a new project by examining individual health problems in the context of their community's characteristics, societal factors, and using existing policies to support their clients.

CONCLUSION

This is the first study to explore the skills of public health nurses and their intention to use such skills in creating new projects as well as the exact process. They could identify community health problems that will be the basis for developing new services to provide care for individual clients. This is different from the traditional community assessment approach that requires the collection of a huge amount of information to clarify community health problems. The tacit knowledge of public health nurses will help to create needs-oriented new services more smoothly.