Historical and Current
Perspectives on Public
Health Nursing in Japan
Junko Tashiro, RN, PhD
Junko Tashiro, RN, PhD
St. Luke’s College of Nursing, Tokyo, Japan
St. Luke’s College of Nursing, Tokyo, Japan
Oct. 15, 2009 Oct. 15, 2009
Challenges and Opportunities for Public Health Nurses at College of Nursing, Taipei Medical University
2 2
St. Luke's College of Nursing, Main Building in Tokyo Japan
Greetings from
Greetings from
St. Luke’s College of Nursing
St. Luke’s College of Nursing
St. Luke's College of Nursing, Main Building in Tokyo Japan
Ｇｒｅｅｔｉｎｇｓ from
Contents
Contents
Introduction of health status, health care
Introduction of health status, health care
system and community nursing practice
system and community nursing practice
and education.
and education.
Current issues of health care in Japan
Current issues of health care in Japan
Transition of health status and nursing
Transition of health status and nursing
practice models
practice models
Challenges and opportunities for Public
Challenges and opportunities for Public
Health Nurses
Introduction
Introduction
Country Profile of Japan
Country Profile of Japan
(1)
(1)
Location
Location Eastern coast of the Asian continentEastern coast of the Asian continent Land
Land Four main islands and small islandsFour main islands and small islands Land area
Land area 377,899 sq.km377,899 sq.km Climate
Climate Four well-defined seasonsFour well-defined seasons Ethnic group
Ethnic group Japanese (99%)Japanese (99%)
Religion
Religion Shintoism, BuddhismShintoism, Buddhism Population
Population 127,692,000 (ranked 10127,692,000 (ranked 10thth in the world) in the world)
Population
Population
density
Introduction
Introduction
Country Profile of Japan (2)
Country Profile of Japan (2)
Govern Govern -ments -ments National National Prefectural (47) Prefectural (47) Municipalities Municipalities
(1,821 and 18(1,821 and 18 ordinance-designed cities)ordinance-designed cities)
Educational Educational System System A 6-3-3 system A 6-3-3 system
Compulsory: through the first 9 yearsCompulsory: through the first 9 years
97.7% proceeded to the upper secondary 97.7% proceeded to the upper secondary
51.2% of graduates went on to 51.2% of graduates went on to
higher educational institutionshigher educational institutions
GDP
GDP US$ 4,923,760 millionUS$ 4,923,760 million （ （ IMFIMF 2008)
2008)
GNI/person
Health Status of Japanese
Health Status of Japanese
：：
Life expectancy
Life expectancy 86.05 (female) (’08)86.05 (female) (’08)
79.29 (male)
79.29 (male)
Infant mortality
Infant mortality 2.6 per 1000 (’08)2.6 per 1000 (’08) Leading causes
Leading causes
of death
of death 1. Malignant neoplasms,2. Heart disease,1. Malignant neoplasms,2. Heart disease,
3. Cerebrovascular disease
3. Cerebrovascular disease
4. Pneumonia & Bronchitis
4. Pneumonia & Bronchitis
5. Accidents 5. Accidents 6. Suicide 6. Suicide
Current Health Issues for Japan:
Current Health Issues for Japan:
An Aging Society with Fewer Children
An Aging Society with Fewer Children
Community Health Law started in 1994 Community Health Law started in 1994
Reinforcement of 510 (prefectural) health centers, Reinforcement of 510 (prefectural) health centers, and 2,726 municipal health centers (2008).
and 2,726 municipal health centers (2008).
Long-term Care Insurance System started in 2000 Long-term Care Insurance System started in 2000
Aims of the System were to:Aims of the System were to:
1) make everyone aware of long-term care,1) make everyone aware of long-term care,
2) obtain the understanding of the people,2) obtain the understanding of the people,
3) enable users to have comprehensive health,3) enable users to have comprehensive health,
medical , and welfare services andmedical , and welfare services and
4) provide social security structure reform.4) provide social security structure reform. After five years, reform of the system has started After five years, reform of the system has started
Current Health Care System (1) :
Current Health Care System (1) :
Long-term Care Insurance
“
“Healthy Japan 21” started in 2000Healthy Japan 21” started in 2000
Basic directions:Basic directions:
1) Focusing on primary prevention.1) Focusing on primary prevention.
2) Developing the environment to support health2) Developing the environment to support health
promotion.promotion.
3) Setting objectives and evaluating performance3) Setting objectives and evaluating performance
4) Effectively moving programs forward with 4) Effectively moving programs forward with diversified yet coordinated implementers.
diversified yet coordinated implementers.
The health promotion law was enforced on May, 2003
The health promotion law was enforced on May, 2003
Current Health Care System (2):
Current Health Care System (2):
Health Promotion Movement
The Health Promotion Law was enforced in 2003
The Health Promotion Law was enforced in 2003
The law provides guidelines for:
The law provides guidelines for:
1)The national government formulated the basic 1)The national government formulated the basic
policy for the national objectives policy for the national objectives
and basic directions for health enhancementand basic directions for health enhancement
2)Local public organizations formulate health 2)Local public organizations formulate health
promotion plans to implement health promotion plans to implement health
enhancement to meet the local requirements, and
enhancement to meet the local requirements, and
common guidelines for health screening.
common guidelines for health screening.
(Ministry of Health and Labour and Welfare, 2005)(Ministry of Health and Labour and Welfare, 2005)
Current Health Care System (3):
Current Health Care System (3):
Ｔｈｅ
Ｔｈｅ
Health Promotion
Health Promotion
Ｌ
Ｌ
ａｗ
Brief History of Modern
Brief History of Modern
Nursing & Education in
Nursing & Education in
Japan
Japan
1876 Midwifery Training School
1876 Midwifery Training School
1885
1885 A Two Year Nursing Training SchoolA Two Year Nursing Training School 1920 A Three Year Nursing School
1920 A Three Year Nursing School
1927 Public Health Nursing Started
1927 Public Health Nursing Started
1930 One year Public Health Nurse Training
1930 One year Public Health Nurse Training
1935
1935 Community Health Center Community Health Center
1946 Demonstration School of Nursing
1946 Demonstration School of Nursing
1952 Four Year Nursing Program
1952 Four Year Nursing Program
1980 Master’s Program in Nursing
1980 Master’s Program in Nursing
1988 Doctoral Program in Nursing Science
Brief History of Public
Brief History of Public
Health
Health
in Japan
in Japan
1872 Department of Medicine Started 1872 Department of Medicine Started
1874
1874 Law of Medicine proclaimedLaw of Medicine proclaimed
(Public health was included to control infectious (Public health was included to control infectious
diseases) diseases)
1925 St. Luke’s Hospital started School Health Center 1925 St. Luke’s Hospital started School Health Center
1927
1927 St. Luke’s Hospital started Public Health Nursing St. Luke’s Hospital started Public Health Nursing
activitiesactivities
1935 First Urban Public Health Center 1935 First Urban Public Health Center
Development of a Nursing Practice
Development of a Nursing Practice
Model Using Primary Health Care
Model Using Primary Health Care
Concepts in Japan
Concepts in Japan
Funded by the Japanese Ministry of Health & Labor
Funded by the Japanese Ministry of Health & Labor
(1999-2001)
(1999-2001)
Hishinuma, M.; Tashiro, J.; Mori, A; Oshikawa, Y,; Sakai, K;
Hishinuma, M.; Tashiro, J.; Mori, A; Oshikawa, Y,; Sakai, K;
Naruse, K.
Naruse, K.
St. Luke’s College of Nursing, Tokyo, Japan
Purpose
Purpose
Identify nursing practice models used by Identify nursing practice models used by
Japanese nurses, and develop an appropriate
Japanese nurses, and develop an appropriate
nursing practice model for an aging society
nursing practice model for an aging society
facing nurses today.
facing nurses today.
Method
Method
Historical Study Approach & TrendingHistorical Study Approach & Trending
Review of historical documents and textsReview of historical documents and texts Conceptual Framework
Conceptual Framework
Health Transition Health Transition (Braiant, 1991)(Hirai, 1997) (Braiant, 1991)(Hirai, 1997)
Development of a Nursing Practice Model
Development of a Nursing Practice Model
Using Primary Health Care Concepts in
Using Primary Health Care Concepts in
Japan
Sample-Community in
Sample-Community in
Tokyo
Tokyo
Time Time Periods Periods Before Before World War World War II II 1935-45 1935-45 After After WW II WW II 1946-54 1946-54 Economic Economic Develop Develop -ment -ment 1955-74 1955-74 Aging Aging Trend Trend 1975-88 1975-88 Preparation Preparation for Aging for Aging Society Society 1989-99 1989-99 Aging Aging Society Society 2000-Main Main Health Health Issues Issues ・ ・ Tuber- Tuber-culosis culosis ・ ・ AcuteAcute Infections Infections ・ ・ Tuber- Tuber-culosis culosis ・ ・ Malnu- Malnu-trition trition ・ ・ ChronicChronic Disease: Disease: Hypertension Hypertension C.V.C.V. CancerCancer ・ ・ Chronic Chronic Disease:Disease: CancerCancer ・ ・ Emerging Emerging Infections : Infections : HIV/AIDS HIV/AIDS Hepatitis Hepatitis B B ・ ・ ChronicChronic Disease: Disease: Lifestyle Lifestyle related related disease disease ・ ・ Mental Mental Health Health Infant Infant Mortality Mortality 90.5/1,00090.5/1,000 (1935) (1935) 31.9 31.9 (1952) (1952) 20.6 20.6 (1961) (1961) 13.0 13.0 (1976) (1976) 4.4 4.4 (1989) (1989) 3.0 3.0 (2003) (2003) Life Life Expectancy Expectancy M/F M/F 47/5047/50 56/6056/60 66/7166/71 72/7772/77 77/8377/83 79/8679/86 Health Health Transition
Transition Phase1Phase1 Phase2Phase2 Phase3Phase3
Changes of Nursing Practice Model in Chuo-ku, Tokyo
Transition: Phase I Phase II
Phase III Top-down Top-down Service Providing Participating Coordinating Networking & Collaboration Health Counseling Nurse Community People
Nurse CommunityPeople
Community People Supporter Supporter Community People Nurse Community People Supporter Resource Social
Welfare Health Medicine
Nurse Policy Maker Community People Nurse TriangleTriangle Supporter Nurse
Elderly Family
Care Manager CommunityVolunteers
Current Care System for
the Elderly
Medicine Prevention Promotion Health Care Social Welfare Living care Nursing Cure Physical nursing CareSocial Welfare Homes for Elderly
Health Centers for Elderly
Medical Care Clinics Long-term Care
Hospitals Visiting Nursing Stations
Health Care
Community Health Centers
Nurses
Comprehensive Care System for
Nursing for People-centered
Nursing for People-centered
Initiatives in Health Care and Health
Initiatives in Health Care and Health
Promotion: People-centered Care
Promotion: People-centered Care
St. Luke’s College of Nursing 21st Century Center of Excellence
Program (FY2003 - 2007)
Komatsu, H; Ibe, T; Horiuchi, S; Hishinuma, M; Kawagoe, H; Tashiro, J; Oikawa, I; Nakayama, K;
Collection, dissemination, exchange of health information
Research Center for Development of Nursing Practice Graduate School of Nursing Doctoral Course WHO PHC Nursing Development Collaboration Center Application and assessment of nursing service Nursing practice
research and development
Schematic Diagram of People-centered Care People Decision makers Healthcare specialists Nursing service development and assessment Nursing service provisioning strategy development and research
Organization
President
International Evaluation Committee:
•Dr. Holzemer (UCSF, U.S.A.) •Dr. White (OHSU, U.S.A.) •Dr. Kim (Univ.of Yonsei, Korea) •WHO Global Network ： Dr. Carty (George Mason Univ. U.S.A.)
2.Health-information System Development
4.Research Support Team
1.Research and Development
National Evaluation Committee: Community leaders (patients/business/ government/media/ nursing association) COE Leader
3.Nursing Service Application and Assessment
Steering Committe
Conceptual Framework of
People-centered Care
A society based on a sense of security and good health
active participation in the decision making process wise use of health information Individuals/families resourceful community health-promoting community Communities People-centered Care System A system of collaborative solution based on partnership （ Collaborative Solutions ）
1.Nursing Care Service Development & Evaluation
1.Nursing Care Service Development & Evaluation
・
・ Children and Family Centered CareChildren and Family Centered Care ・
・ Women-centered CareWomen-centered Care ・
・ Japanese Genetic NursingJapanese Genetic Nursing
・
・ Japanese Cancer NursingJapanese Cancer Nursing ・
・ Japanese Geriatric NursingJapanese Geriatric Nursing ・
・ Community-based Palliative CareCommunity-based Palliative Care
2.Health Promotion Service & Strategy
2.Health Promotion Service & Strategy
Development and EvaluationDevelopment and Evaluation
・
・ Program Development for Healthy FamiliesProgram Development for Healthy Families ・
・ Nursing Practice Development for International CollaborationNursing Practice Development for International Collaboration ・
・ Know Your Body Know Your Body Program for Preschoolers & FamiliesProgram for Preschoolers & Families
3.Health information system
3.Health information system ：：”” Kango-net”Kango-net” http://www.kango-net.jp http://www.kango-net.jp
Community-based Participatory
Community-based Participatory
Research
Research
Community-based
Community-based
Participatory Research
Participatory Research
Governme nt Hospice Hospit al Community-based participatory palliative care peopl e Dispensing pharmacy Visiting care service provider Visiting care center Clinic people famil y the dyin g Lobbying ・ Public meeting
・ Development of training programs
for volunteers Community-based Palliative Care:
“building a community to provide a better care of the dying ” -an example of “Community Health
Station”-A model for Station”-Asian communities
・ Developing a community-based palliative care program ・ Developing a community-based care standard
⑪ Health information system: Kango-net Dissemination of health Dissemination of health information information
News and eventsNews and events Research resultsResearch results Useful linksUseful links
About nursing:About nursing:
““What is nursing?”, “How to find What is nursing?”, “How to find reliable health information on the
reliable health information on the
net?
net?” ”
MedWave (the latest medical news)MedWave (the latest medical news)
Communication space “Kango Communication space “Kango
community” community”
Nurse of the monthNurse of the month
One-click questionnaireOne-click questionnaire
On-line health consultationOn-line health consultation Discussion groups with blogDiscussion groups with blog
Program aim: Children aged five to six should learn correct knowledge according to the body-systems used in
medical organizations, with parents, in order to be aware of the importance of the body’s function and life itself. Educational tools:
(1) Picture books of seven organ systems (digestive, circulatory, respiratory, urinary, bone and muscle, nervous, reproductive)
(2) Picture-card show (3) Body-organ t-shirt
Know Our Body
Know Our Body
:
:
Child Learning Program
Health information system
Health information system ：：””Kango-net”Kango-net” http://www.kango-net.jp/
http://www.kango-net.jp/
Decision making
Sharing Trust PartnershipMutual-leadership
Problems with advanced medicine and nursing Coping with illness and nursing Social problems and nursing Collaboration
Partners Formation, Network formation; System formation
Knowledge Skills
Health Promotion
Overview of People-centered Care Initiatives
Outcomes:
Outcomes:
Institutional Benefits in PCC
Institutional Benefits in PCC
Increased variety of care projects & Increased variety of care projects &
partners
partners
Web-site of Health and Nursing Web-site of Health and Nursing
Information is accessed by the community
Information is accessed by the community Active study - activities of People-Active study - activities of
People-centered care
centered care
Expansion and innovation of education for Expansion and innovation of education for
undergraduate and graduate students
undergraduate and graduate students
Increase motivation to further contribute Increase motivation to further contribute
to global health for health equity
Kango-net Research Center for Development of Nursing Practice Graduate School of Nursing Doctoral Course WHO PHC Nursing Development Collaboration Center
Schematic Diagram of People-centered Care - Future Outlook Shaping public opinion on health Networking lay experts of health care Production of useful health information Promotion of community- based participatory research Health-promoting community “Community Health Station”
(the base of collaborative practice in partnership
Challenges and Opportunities
for Public Health Nurses
Public Health Nurses should be good
Public Health Nurses should be good
health communicators for vulnerable
health communicators for vulnerable
People
People
Public Health Nurses should be
Public Health Nurses should be
collaborators for “Health Equity”
collaborators for “Health Equity”
Public Health Nurses should be health
Public Health Nurses should be health
advocators and evidence-based policy
advocators and evidence-based policy
makers for People-centered Health Care.
makers for People-centered Health Care.
Community Nursing (12 Credit Hours) Community Nursing (12 Credit Hours)
* Introduction (2)* Introduction (2)
* Life support of individuals, families,* Life support of individuals, families,
and aggregates or communities and aggregates or communities
* Community nursing process* Community nursing process
* Community nursing administration
* Community nursing administration
(10)(10)
Epidemiology (2)Epidemiology (2) Health Statistics (2)Health Statistics (2)
Health & Welfare Policy (3)Health & Welfare Policy (3)
Practicum (Total of 4 credit hours)Practicum (Total of 4 credit hours)
* Community Nursing process and administration at health * Community Nursing process and administration at health
centers (2)
centers (2)
* Home Visiting Care for Individual/Family/aggregates (2)* Home Visiting Care for Individual/Family/aggregates (2)
Revised regulation of
Revised regulation of
education of PHNs in
education of PHNs in
Japan
Japan
Providing competent PHNs after the current competent PHNs retire.
How to educate PHN students competent in a team approach and EBP?
How do we revise the curriculum of PHN training within the BSN program.
How do we ask Health Care Centers to accept PHN students ?
How do we develop career radar for PHN from the entry level to advanced level in Master’s and Doctoral program?
