Current Nursing Values and Theory
Global Health Nursing:
A New Discipline in Japan
Junko Tashiro, RN. PhD
WHO Collaborating Centre for Nursing and Midwifery in PHC St. Luke’s College of Nursing, Tokyo, Japan
September 22, 2009
Ewha Women’s University, Seoul, Korea
Introduction
Health” or “Well-being - a shared value or
philosophy as well as ultimate goal of the people
Current issues: health gaps among people and
nations
The UN MDGs were adopted by the international
community in 2000
Japanese nurses have worked for “Health Equity”
or “Health for All” since 1960s
In 2009, Global Health Nursing became
recognized under the Regulation for Basic Nursing Education
Contents
Current nursing issue: Global health
New global health philosophy and policy
in WPRO & SEARO: “ People-centered
Health Care (PCHC)”
Nursing care for individual, family, and
community base on “PCHC”
Current nursing education: forming new
discipline; “Global or International Health
Nursing” in Japan
Further challenges; forming a Consortium
Health as universal philosophy, value, and goal CONSTITUTION OF THE WORLD HEALTH ORGANIZATION
THE STATES Parties to this Constitution declare, in conformity with the Charter of
the United Nations, that the following principles are basic to the happiness, harmonious relations and security of all peoples:
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States.
The achievement of any State in the promotion and protection of health is of value to all.
Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger.
Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development.
The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures.
Source: Basic Documents, Forty-fifth edition, Supplement, October 2006
This text replaces that on pages 1-18 of the Forty-fifth edition of Basic documents, following the coming into force of amendments adopted by the Fifty-first World Health Assembly.
Current Global Health Issues:
Child (under-five) Mortality Rate
per 1000 live births
Source: The Millennium Development Goals Reports
1990
2007
2015
Sub-Saharan Africa183
145
60
Southern Asia122
77
40
Oceania85
59
28
CIS, Asia78
42
26
Northern Africa83
35
27
Developed Regions11
6
3
Current Global Health Issues:
Maternal Mortality Rate
1990
2005
2015
Sub-Saharan Africa920
900
230
Southern Asia620
490
155
Oceania550
430
138
South-Eastern Asia450
300
113
Western Asia190
160
48
Developed Regions11
6
3
per 100,000 live births
Source: The Millennium Development Goals Reports 2009
“ People-centered Health Care”
New Global Health Philosophy and
Policy in WPRO & SEARO
“People-centered Health Care” is an umbrella term
1948: WHO constitution Universal Declaration of Human Rights
1978: Alma Ata Declaration
1994: Cairo Declaration of Population and Development 1995: Beijing Declaration and Platform for Action,
Forth World Conference on Women Yanuca ‘Healthy Island’ Declaration
1997: Declaration for Health Development in the SEARO in 21st century
1999: Copenhagen Declaration on Social Development 2000: United Nations Millennium Declaration
The Core Values of PCHC
Empowerment Participation
The central role of the family and community in
any process of development
An end to gender and all other forms of
discrimination
The right and duty of people to participate individually and collectively in all aspects of their lives has been emphasized in relation to health and development.
Four Domains of PCHC
Domain 1: For individuals, patients and
their families, and community
Domain 2: For health practitioners
Domain 3: In health care organizations
Domain 4: In health systems
PCHC-Domain 1:
Informed and Empowered Individual,
Families, and Communities, and Approaches
Increasing health literacy
Providing communication and negotiation skills
that lead to meaningful participation in decision-making
Improving capacity for management and
self-care
Increasing capacity of the voluntary sector,
community-based organizations and professional organizations to extend mutual assistance
Promoting social infrastructure that supports
community participation in health services planning and facilitates greater collaboration between local governments and communities
Domestic Context in Japan
Transition of health status, and policy
change
Transition of nursing practice model
Current nursing practice model:
People-centered Care for individuals,
Time Periods Before World War II 1935-45 After World War II 1946-54 Economic Development 1955-74 Aging Trend 1975-88 Preparation for Aging Society 1989-99 Aging Society 2000-Main Health Issues ・ culosis ・ Acute Infections ・ culosis ・ trition ・ Chronic Diseases: Hypertension C.V. Cancer ・ Chronic Diseases: Cancer ・ Emerging Infections: HIV/AIDS Hepatitis B ・ Chronic Diseases: Lifestyle related Disease ・ Mental Health ・ Chronic Disease: Lifestyle related Disease ・ Mental Health ・ Elderly care Infant Mortality 90.5/1,000 (1935) 31.9 (1952) 20.6 (1961) 13.0 (1976) 4.4 (1989) 2.6 (2006) Life Expectancy M/F 47/50 56/60 66/71 72/77 77/83 79/86 Health
transition
Phase1
Phase2
Phase3
Health Trends and Phases in Japan:
Health of the People
Current Health Issues:
The Aging Society of Japan
(Health and Welfare Statistic Association, 2007)
“Healthy Japan 21” started in 2000
Basic directions
1) Focus is on the primary prevention
2) Developing the environment to support health promotion
3) Setting objects and evaluating performance
4) Propelling effective movements with diversified but coordinated implementers
Long-term Care Insurance System started in 2000
The health promotion law was enforced on May, 2003
Changes of Nursing Practice Model in Chuo-ku, Tokyo
Health Transition: Phase I Phase II Phase III Top-down Top-down Service Providing Participating Coordinating Networking & Collaboration Health Counseling Nurse Community People
Nurse Community People
Community People Supporter Supporter Community People Nurse Community People Supporter Resource Social
Welfare Health Medicine Nurse Policy Maker Community People Nurse TriangleTriangle Supporter Nurse
Social
Welfare
Homes for Elderly Health Centers
for Elderly
Medical Care
Clinics Long-term care Hospitals Visiting
Nursing Stations
Health Care
Community health centers
Nurses
Networking & Collaboration Model
Clients,
Families,
Community,
Nursing for People-centered
Initiatives in Health Care and Health
Promotion: People-centered Care
St. Luke’s College of Nursing, 21st Century COE Program
(FY2003 - 2007)
Komatsu, H; Ibe, T; Horiuchi, S; Hishinuma, M; Kawagoe, H; Tashiro, J; Oikawa, I; Nakayama, K; Ito, K; Kamei, T; Mori, A; Tonosaki, A; Kikuta, F ； Arimori, N; Hayashi, N,
1.Nursing Care Service Development & Evaluation
・ Children and Family Centered Care ・ Women-centered Care
・ Japanese Genetic Nursing ・ Japanese Cancer Nursing
・ Japanese Geriatric Nursing
・ Community-based Palliative Care
2.Health Promotion Service & Strategy
Development and Evaluation
・ Program Development for Healthy Families
・ Nursing Practice Development for International Collaboration ・ Know Your Body Program for Preschoolers & Families
3.Health information system ：” Kango-net” http://www.kango-net.jp
Community-based Participatory
Research
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 studies
Schematic Diagram of People-centered Care
People
Policy makers Healthcare specialists Nursing service assessment & development Nursing service provision strategy development and researchHealth Information System: Kango (Nursing) - net
Dissemination of health information
News and events Research results Useful links
About nursing:
“What is nursing?”, “How to find reliable health information on the net?”
MedWave (the latest medical news)
Communication space “Kango community”
Nurse of the month
One-click questionnaire
On-line health consultation Discussion groups with blog
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 communityCommunities
People-centered Care
System
A system of collaborative solutions based on partnerships （ Collaborative Solutions ）Know Our Body
: Child Learning Program
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
Health information system ：” Kango-net”
http://www.kango-net.jp/
Decision making
Sharing Trust PartnershipMutual-leadership
Overview of People-centered Care Initiatives
Problems with advanced medicine and nursing Coping with illness and nursing Social problems and nursing Collaboration
Partners Formation, Network formation; System formation
Knowledge Skills
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
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 with
Outcomes:
Institutional Benefits in PCC
Increased variety of care projects &
partners
Web-site of Health and Nursing
Information is accessed by community
people
Active study activities on People-centered
care
Expansion and innovation of educational
for undergraduate as well as graduate
Increase motivation to further contribute
Current Challenges for
Actualizing Values in Health
Forming a new discipline & network for strengthen People-centered Care in Japan and a global community for health equity
People-centered in Local Community
Japan
Current Trends of Higher Education in
International Nursing and Midwifery
Based on Web-based survey
(Tashiro et al, 2008)Various types of “Global Health or International
Nursing” are provided
67(40%) out of the 168 baccalaureate nursing
programs
16(15%) out of the 104 master’s programs
3 out of the 4 midwifery master programs 13 out of the 47 nursing programs
2008: International or Global Health Midwifery and
Designing a Curriculum for
an International Nursing Master’s of Science
in Japan:
Capacity Building for International Collaborators to Strengthen Nursing and Midwifery
WHO Collaborating Center for Nursing in PHC St. Luke’s College of Nursing, Tokyo, Japan
Junko Tashiro,RN PhD; Naoko Hayashi, RN, PhD; Fumiko Kajii, RN, PhD; Yoshimi Yamazaki, RN, MNS; Akiko Hayashi, RN, MS; Hiromi Eto, RN, CNM, DNSc; Yumi Sakyo, RN, MNS; Shigeko Horiuchi, RN, CNM, DNSc.
Funded by a Grant for International Medical Cooperation Study, International Medical Center in Japan
Background
Japanese nurses have cooperated with
their counter-parts in developing countries
since 1960.
Today number of Japanese nurses &
nurse-midwives are working in order to strengthen
nursing & Midwifery in developing countries
Limited opportunities existed for advanced
education as a specialist collaborator in
Purpose
To design a specialty of International
Nursing in a master’s program in
Japan, based on “competencies of
international nursing collaborators”
for nurses who are interested in
working for and in developing
countries.
Method
First Phase: Study the existing competencies of
Nurse International Collaborators
Data collection: Interview survey
Participants:
Japanese nurses who worked or are working for more than one year in
developing countries to strengthening
that country’s nursing and midwifery capacities.
Analysis: Content analysis
Second Phase: Curriculum Development
A conceptual framework of “International Nursing Collaboration” was derived from the data.
Findings
Snow-ball sampling technique located twenty-six
(26) nurses who were then interviewed.
39 categories of competences were derived from
interview data.
2 major types of categories: personal and basic
knowledge and competencies and international collaborating competences.
They were organized into 4 levels of education:
undergraduate, continuing-ed., graduate-masters, and graduate-doctoral level of education.
A Model of Competencies of
Competencies and Educational
Content for Undergraduates
Personal & Basic Knowledge Educational
Content &Competencies Cultural Adaptability Applicability Language & Communication Skill Basic knowledge of International Nursing Cultural Experience Language and Communication Introduction of International Nursing
Data-Driven Competencies for
International Nursing Collaborator
Information gathering
Problem Analysis
Planning
Problem Solving
Management
Networking
Evaluation
Curriculum for Global Health Nursing
in Master’s Program
Educational Aim :
To provide students with the basic
skills to serve as leaders in the
nursing field in “Global Health”,
adding knowledge and skills in
international public health medical
services to their own specialist
nursing abilities.
Learning Objectives of Master
in Global Health Nursing
• Increase specialized knowledge of international
nursing, based on fundamental skills ( e.g. Language ability, cultural adaptability)
•Strengthen ability:
a) to make an accurate assessment of nursing issues in the specialized field of international cooperation, covering different cultural,
socioeconomic, and public health systems.
b) to plan cooperative and assistance projects,
responding to the nursing needs of the counterpart nation.
Continued - Learning Objectives
c)
to build collaborative relationships with local counterparts, forming a practical model, and serving as a consultant and educatord) to use human and material resources to set
directions in development and problem solving to achieve goals
e) to evaluate the results of international nursing collaborative projects
f) to assist in nursing development using methods unique to the counterpart nation
Core Courses (6 Credit hours)
Introduction to international nursing (2)
International nursing collaboration (2)
Elective Courses (6 credits)
Comparative nursing policy making (2)
Comparative community health &
nursing (2)
Comparative nursing education (2)
Comparative nursing administration (2)
Comparative clinical nursing (2)
Comparative nursing research
.
2nd Year
Thesis Research (8) Practicum (2)
1st Year
Nursing management & administration (2) Nursing education (2) Community nursing (2) Clinical nursing (2) Nursing research (2), Nursing theory (2), Statistics (2) Nursing ethics (2),
Anatomy & Physiology(2), Pathology(2),
Nursing Sociology(2) ， Nursing psychology (2),
Elective Minor Courses (6)
Comparative nursing policy making (2) Comparative community health and nursing (2)
Comparative nursing education (2) Comparative nursing administration (2) Comparative clinical nursing (2)
Comparative nursing research collaboration (2)
Core Courses (6)
Introduction to international nursing (2) International nursing collaboration (2) Comparative nursing research (2)
Fig. Global Health Nursing Curriculum Diagram
M ajo r fie ld s (1 2) B as ic S ub je cts (1 2)
Progress of Master’s Program
in Global Health Nursing
Our Master’s program in Global
Health Nursing started in 2005, and
two students were enrolled.
Last three years, total of four
graduates completed the program,
and two are working as International
Collaborators in Tanzania and
Further Challenges
Standardizing core curriculum of
“international nursing” is needed in order
to provide common competencies and
educational needs of nurses and midwives
working for Improvement of Global Health
Forming network among institutions and
health workers seeking health for all and
equity
Acknowledgements
We wish acknowledge advisors: Dr. William
Holzemer, Dr. Caroline White, Dr. Beverly
McElmurry; and our English editor, Dr. Sarah Porter
We also acknowledge our research team members
of the WHO Collaborating Center
These series of studies were funded by a Grant for
International Medical Cooperation, National
International Medical Center in Japan, Ministry of Health and Labor in Japan, as well as the 21st
Century Center of Excellent in Ministry of Education, Science, and Sports
