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KawasakiJourna

lofMedica

IWel

reVo

.20

, No

,1

, 201431‐41

1or

na

ーPaper三

Health SupportProvided

by Public Health

Nurses

for

卦4iddle‐aged

Recipien」ts

ofPubl

Assistance

Living

at

Ho]mーe

sanae

TOM[

IT‐A

and Kazuko

M【

ITOKU**

催c

c勿r

edル〃e20

,2似の

Key

words:

heal

th

problems,

hea

thsupport

,mi

dd

age

,publ

assistance

rec

ent

,pub

chea

th

nurse                                                 Abstract

Th

study

wa

conducted to examine

there

onsh

between

hea

th problemsin middle‐aged

recipients

fpubl

assistance

ng

at

home and

awareness

these problems

by publ

c hea

th

nurses   Surveyitems

nc

udedthebas

attributes

35

pub

c hea

th

nurses

andthe

awareness

heal

th

problems

n midd

aged

recipients

fpubl

assistance

ng

at

home

.The

nurses were

dedintotwo

groups according to

theleve

loftheir

awareness,andlogistic regression analysis

wa

sconduc

ed wi

ththetwolevel

so

f(

ghandl

ow)awarenessasdependentvar

ab

es

Va

responses

wereco

ec

edf

rom

06

nur

ses(

va

dresponserate

:63

2%)

.Thef

owi

ng

nurses recognized

that middle

aged

recipients

ofpubl

assistance have a number

fheal

th

problems: those

who

work

government‐ordinance‐designated and majorurban citiesandtowns;collaborate

wi

th soc

workers; and consider

thatthe heal

th

needs

fthe

recipients

fpubl

assistance

shou

dbe

understood

Publ

chea

th

nurses’awareness

wa

notcorrelated

wi

ththe

age,years

experience,and

whether

or not

theyhad

experience

fproviding

public assistancerecipients

wi

th

support.

ti

necessary to

implement

education

wi

th

an emphasis on

the

weak

and

improvethe

sk

sof

pub

chea

th

nurses working

n mun

pa

esbyprovidingthem wi

th

support

1.lntroduction

The Wor

d Heal

th

organization

(WHO

and UN Human

Settlements

Programme(UN‐HAB工TAT)joint

presented a report

wi

ththe globaltheme:”Hidden

images

fc

es

: Wi

th the a

im

of reducing

hea

th

spar

es

. Accord

ng

to

thi

reportillnesses

and

other

hea

th

problems are more serious among

the

poor

ngi

urban areas

andhea

th d

spar

es

are

buted

to

soc

status

andthel

ng

environment

suggests

thatloca

governments are responsible

or

reducing

erencesi

nthel

eve

lofheal

th among

commun

tyres

dents[

Art

e25o

fthe

Constitution ofJapan guarantees allpeopletherightto maintainthe minimum standard   *DepartmentofNursing,FacultyofHealthandwrelfare,KawasakiUniversityofM[edicalw了elfare,   Kurashiki,okayama701‐0193,Japan     E‐M【ail:tomita@mw.kawasaki−m.ac.〕p ** UniversityofHumanEnvironments,okazaki,Aichi444‐3505,Japan                                                 31

(2)

Sanae

Tomi

aand

Kazuko

oku

32 anae   o

fl

ng

,i

nc

ud

ngthe publ

assistance system for people

poverty. Under

th

system,a survey ls conducted to examine

thel

ng

conditions

an applicant

or

assistance,including savings

and whe

ther

theappl

canti

si

juredorabl

et

o work

,andtheperson w

lbeprovided wi

thpubl

assistance

fh

s/her

income

lowerthan

the

amountrequiredto maintain

the minimum standardofl

ng

asstipulated

nthe

constitution.

Publ

assistance

sc

edi

nt

oe

ghtt

ypes

,i

nc

ud

ng

assistanceforliving,education,housing,

and hea

th and

nursing care,

and

standards have been

es

tabl

shedf

or

each

fthem [

.For

example,as

orthe mi

imum standardfor

monthly

pub

assistance

or

one set

ff

ami

es wi

th twochi

dren,itis

235

040

yen

orl

ve

hood

assistance,education assistance

and

housing assistance

class

ace[

According

to a

2004

survey conducted

bythe∼l

ryofHea

th

,Labouran

d下

ve

re

,theamounto

fpubl

assistance

nJapani

sre

ve

large compared to

the

income support

n Br

ta

n and publ

assistance・n other

devel

opedcountr

es[

.However

,th

sdoesno

t meanthatthequa

tyofl

e(QOL

)o

fpubl

cas

tance

recipients

PARS

)i

s h

igh.Sincethe

position

fthepubl

assistance system

a country depends on

re

onsh

p wi

ththe

socialsecurity system

fthat

country,there

no point

so

comparing the

pub

assistancesystems

fd

erent

countries

wi

thoutdi

scus

ngthemin

relation to

thesoc

security systems‐

工n

fact,recipients

fpubl

assistance

njapan

arerequiredto undergo a meanstest,and some of

them

are

gma

zed

,accor

ngtoareport[

  工n recent years,there have been

gn

cant

changes

japanese society

and

economy,including ag・ng

fthe

population,subsequent decrease

nthe

workforce,and changes

nthe

system of employment,such as an increase

n the

number

contract

empl

oyees[

.ln

response to these

soc

changes,there

has

been a steady increase

nthe

number

recipients

fpubl

assistance. There were approxilnLately

95

mi

onPARsi

n2011

,wh

ch wa

sl

52% oroneinapproximately66japanesepeople[

.Thera

eo

fi

ncrea

se

nthe

number

recipients

fpubl

assistance

dur

ngtheper

od

between

200

and 2010f

orthe

“other

household

group

was

approximately

,the h

ghes

recorded,due to the continuing recession

The

largest

propor

on

,or26

5%,ofPARscited

nessori

jurytotheheadofthehouseho

lぜ

asthereason

or

he

need

oras

tance(September2010

)[

.Accord

ngtoasurvey(

2007Surveyon Medi

ca

IAss

tance

the

largest proportion

fPARS

received

med

ca

assistance

or menta

/behaviora

ld

sorder

,f

owed by

thatf

orcard

ova

scu

rd

sorder

s{

工njapan,

there are

pub

chea

thnurses(PHNS

)whosupportthehea

thofcommuni

tyres

dentsincluding

peop1e

poverty. The

PH 寸

,de

nedi

nthe Ac

on

p日Ns

, 1

dwives

,and

Nurses asthe governing

aw,is

heal

th

professional.People,basically nurses, who have completed courses

re

ed

to

publ

c hea

th

nursing

and

passed

the

nationalexamination are

cer

ed

as

PHNs

.The Quad Counc

lofPubl

c Hea

th

Nursing organizations

fthe Amer

can Pub

c Hea

Association

def

nespubl

c hea

th

nursing as,“An activity to   promote

the hea

th of

groups

people

andthe

protection,based on a

knowledgein

nursing,sociology,

andpubl

chea

tげ [

.PHNs

are alsorequiredto be

ab

et

oi

dent

yhea

thproblemsinthecommuni

tyand

develop

measuresfor

heal

th

promotion. As

admi

ra

ve

servlce

prov

ders

,PHNs

can respond to

hea

th

orsocial,problems

acedbyPARS1

ngi

nthecommun

tyandprovidethem wi

thhea

th

support.

As middle‐aged

recipients

fpubl

assistanceoften have

五cul

ty

gainingemployment,few of

them

have opportunitiesto undergo regular

hea

th

check‐ups

n workpl

aces

.Wr

hen

they become

,they areprov

ded

wi

th med

ca

assistance under

thepubl

assistance system.People

wi

th psychol

ogi

ca

or other problems

may

receive support

rom

PHNS. However, when

the hea

th ofPARsi

s d

scussed

from the viewpoint

preventive care,problems can

remain

nthef

ldsofhea

th

promotion (primary

prevent

on

)and

supportfortheprevention/earlyidentification ofdisorders(secondary prevention).

A summaryof

previous

tudi

es

on

thehea

th

support

prov

dedforPARsi

asfollows: A previousstudy using

SF‐

10

suggested

thatthe hea

th

re

ted(HR)(

phys

ca

land psychological

) QOL of midd

leaged

recipients

fpubl

assistance

ss

gn

cant

lower

thantha

tofthe

general

pub

,andtha

ti

is necessary to

prov

ide

appropriate

hea

th

information

ava

ab

ei

nthecommun

ty and

support

re

ed

to nutrition

and

resttoincrease

the

HRQOL{

11

.A

previous study on

the hea

th behavi

orso

f middleaged

recipients

pub

assistance

vi

ng

at

homef

oundtha

tthe

smoking rate

wa

s h

gh

;there

were

ew

normal‐weight

(3)

33

Supportfor

Publ

c As

tance

Recipients

sub

ject

sand mos

were obese or

th

;and

they,even those with hypertension orother

sorder

,had

not

deve

opedhea

thybehavior[12]

.Fur

thermore

,al

argernumberofPARssu茸eredf

rom a

coho

sm and

other

add

ons

comparedto generalcom munity residents【13],and they required carefulsupport because

mos

fthem

were

ng

eandhadl

imi

edsoc

lnetworks[

14

.Accord

ngtotheresul

so

fthesepreviousstudies

thehea

thcondi

onso

fPARs

are worsethan those

other people,and

thei

problems,such as

add

on

are

mored

cu

toresolve.

No

studies have been conductedto examine

the

status

support

prov

ded

for

PARsby municipaIPHNS

as

we

as

the

awareness

fthi

issue

though

there have been

some

related studies:a

qua

tat

ves

tudy

onthefunction

fpubl

health nursing was

scussedba

sedon

examples

fthe

activities

fPHNSass

gned

as

pub

assistance counselors

15

and

tudyontheski

so

fPHNS workingin wel

areo茸

ces

to suPport

peop

ei

npoverty[

16

Thef

owi

ngf

nd

ngs

were

obta

ned

there has been anincrease

nt

he

number

fPARS

− particularly

househo

ldsincluding middleaged

recipients

ass

edi

ntothe

“othe

  group;the

HRQOL

and hea

th

conditions

fPARs

are poorer

than

those

other people,and measures

or

lifestyle‐related diseases

shou

ld

be

implemented;there are problems

relation to

hea

th

measures

or PARS

;andf

ew s

tudi

es

have been conducted on

the act

eso

fPHNs

for

PARS

.The

present study,involving

muni

pa

IPHNS

,a

imed

to examine

there

onsh

between

heal

th

problems

aced by middl

aged

recipients

fpubl

assistance

ng

at

homeandPHNS

awareness

and

to

helpdevelop

measurestoimprove

hea

thsupportforPARS

2.Methods

       

Thesubjects

were

512 PHNS

working

a prefecture as

f May l,2011. Mayorsfrom 2l ofthe27

mun

pa

esi

nth

prefecture consented to participate

nthe

study,and survey forms were

buted

to

them.Thesubjects

were

IPHNsinthe21 munic

pa

es

,exc

ud

ng

those

who had

taken aleave

absencesuch as

ch

dcareleave

               

An

anonymous se1f−comp1eted questionna.re survey

wa

conducted between February

and M[

rch 2012

The municipal

es

were

asked

to

bute

survey forms to

the PHNS

,andthey

sent back

the

forms

rec

yto

the

university by mail          Surveyitems

nc

udedtheba

attributes

fPHNS(

sca

eo

fthe municipal

tyin whichthey worked

,age

years

experience as

PHNs

,and h

ghes

tl

eve

lof

academic

backgroundinthei

rspec

ty)

,spec

chea

th

support

prov

dedforPARS

,PHNS

awareness

fhea

th

problems

aced by PARsand hea

th

support

or

them,

andd

cu

typrovidingsupport

Ci

esand

towns

n wh

chthePHNs

work were

ed

intothree groups accordingtothescale

fthe

mun

pa

ty

1) government‐ordinance‐designated

es wi

th

a population of morethan

500

oooand

urban

es wi

th

a population of more

than 300

000

,(

)c

estha

have not been

des

gna

ed

,and(

)t

ownsand

ages wi

th

sma

population.

Academic

backgrounds

nursing were

ss

edi

nt

graduate schools unlversity,specialties

juniorcolleges,andtechnicalcolleges.

PHNs

were

sked whe

ther

or notthey

had

experience

fprovidingPARswi

thhea

th

support,regardless

fthe

rage

.PHNs whohadprov

dedhea

th

support were

thenasked whether

or not

theyhad

experience

ofvi

ngthe

homes

of

patients

wi

th

psychiatric

sorders

,co

laborat

ng wi

th other

professionals to

implement

case studies

and

conducting

ta

lhea

th

management

or PARS

,i

nc

ud

ngthe

development

approachesto

he

pthem

consult physicians

and

understand

the

rhea

th cond

ons

.The

presentstudy

imed

toexamine

PHNS

awareness

fhea

thproblemsfacedby middle‐agedrec

ent

so

fpubl

assistance

ng

at home

based

on previous studies

12

survey

nc

ud

ngthef

owi

ng

tenitems

wa

conducted:

(4)

Sanae

Tomi

taand Kazukoルl

oku

34                                           anae   omltaan     azu   o   lto   u

QOL

scores

re

ed

to

phys

ca

landpsychological

health,smoking,drinking,obesity,excessivethinness,

the

ab

ty

to

obta

n hea

th

information

and

understand

mun

pa

lheal

th

information,frequency ofundergoing regular

heal

th/cancer

examinations,and awareness

fthe

activities

fPHNS

.PHNs

were

sked

to choose

rom f

ve

answers

or

each

ques

on

:(A pub1

assistance recipient has)”many””a

ew

一げ,

”no problems“,and”nostated problem”.   Another survey

was

also conducted to examine

the

awareness

fhea

th

support

prov

dedfor middle‐

aged

recipients

fpubl

assistance

ng

at

home

.PHNS

chosefrom four

opt

ons

,i

nc

ud

ng“Definitely

yes

and

”Definitely

no”,to answer eac

ques

on

.PHNs were

also

asked whether

or notthey

had di茸icul

ty

cop・ng

wi

th midd

aged

recipients

fpubl

assistance

ng

at home,as

we

as

the

reasons.PHNs

who

had di

cu

ty

were

then asked whether

or not

they

experienced

thefo

owi

ng

seven problems: having

i茸

cu

y co

abora

ng wi

th

case workers;noinformation on

hea

th

problems

aced by PARsi

s ava

ab

no

budgeti

sa

oca

eddespi

ei

necessity;there

no

ime

because

PHNs

are busy;othertasks

shou

dbe

pr

or

zed

persons

charge

fpubl

assistance have been appointed;and there are no opportunities to

scusstheprobl

ems(mu

eanswer

sa

owed

.4.石覆おc〆 co刀魂d{erαすめれs

vvr

en

requests,including

the

purpose

fthe

survey

and

an explanation

that

participants

nthe

study are

owed

to

wi

thdrawf

romi

atanytime,weresentto

muni

pa

est

oobta

their written consent・

v▽e

skedthe

persons

charge

f municipal

es

to

butethe

survey

orms

to

nd

dua

IPHNS

,andPHNs

who had

consented to

the

study sent

them back

to

the

university. The survey was conducted

wi

th the

approval

ftheethicscommi

eeo

fKawasakiUnivers

tyofMedica

I We

re(Approva

lnumber

:312

.D所ααmかs

PHNs

were

ided

into

two

groups according to

thelevelof

awareness

fhea

th

problems

aced by

midd

aged

recipients

fpubl

assistance

ng

at

home

.PHNs who

viewed   ” all”and   ”three orless

fthe loi

tems

as

heal

th

problems were

as

ed

into“high‐awareness” and “low‐awareness   groups, respectively.Logisticregression analysis

was

conducted to examine

there

onsh

ps

between the

eve

lof

awareness as a dependent

va

ab

eand

survey items. Logistic regression analysis

us

ngthef

orced

entry

me

thod was

also

conduct

ed

,wi

thre

ed

dependentvariables

andPHNS

workpl

aces

as

ad

jus

edva

abl

es

odds

ratios betweenfactorsinauencing

the

awareness

fhea

th

problems

andthe95% conf

dence

interval were calculated

Thesigni

cancel

eve

lofthetests waso

05

.Fors

tat

ca

lana

ys

,IBM SPSS Ver

21

Jf

or

Wi

ndows

wasused

3.Results

A tota

lof353 PHNsin 21 munic

pa

esi

nthe

prefecture consented to participate

the study,

and

survey forms were

buted

to

326

them,excludingthose

whohad

taken aleave of absence such as

ch

dcare

leave.

Thenumberofco

ec

edf

orms wa

s215(

66

0%)

.A t

ta

lof206(63

2%)PHNS

,whose

answers to

questions were appropriateandrelevant,were analyzed.

.斑煽ろ冴e

s げpの 危 座α耽 れ“r

Tablel

shows

the

attributes

fthe muni

pa

IPHNS

.The mean

age

was40

± 10

years

.The mean

pe

odo

expehence

fwor

ng

as a

P主

1 was16

± 10

ye削ぐs.Regm

ngthe 粒ghes

tl

eve

lofthe

academic background,

63

30

6%)

PHNshad

graduated

rom

graduate

schoo

or

un

ver

es

,23(

11

2%)f

rom

special programs

njuni

or co

eges

,and 120(

58

3%)f

rom techni

ca

lcol

eges

, wh

ch

accounted

orthe

largest proportion

fthe

total

.E叩e“e

〃α げpm“粛〃g 庇〆効s叩pα『ルr

pの 稔 α那加伽c

zec中詑〃な

survey

was

conducted to examine whether

the PHNshad provided hea

th

supportfor

midd

aged

(5)

SupportforPubl

cAss

tance

Recipients                                     35 TableI   Attributes

publichealthnursesandtheirexperienceofprovidingsupportforrecipients(n=206) 工te]ms

n(%)

Citiesandtownsas workplaces   Designatedand

ma

urbancities                                                             56(272)   Citiesthathavenotbeen designatedorarenoturbancities                               126(612)   Townsandvillages withasmallpopulation                                                 24(117)

40

3±10

Age(mean ±

SD)

Bxperienceaspublichealth nurses(mean ± SD)(years)                                   168±102 Highestacademicbackgroundinspecialty   GraduateschooI   University Specialtyinjuniorcollege   Technicalcollege

7 (

56(

27

23(

11

120(

58

Experienceofprovidinghealthsupportforpublicassistancerecipients   Yes   No

179(

869

27(

13

Typesofhealthsupportprovidedforpublicassistancerecipientsa   Experienceofhonqevisits   People with mentaldisorders                                                           146(816)   E1derl                                                                                   97(542)   People withintellectualdisorders                                                         63(352)   People withphysicaldisorders                                                           46(257)   Tuberculosis                                                                                 27(151)   Experienceofcollaboration   , Examplesofpublicassistancerecipients                                                     84(469)     Collaboration

wi

case workersinchargeofpublicassistance                             154(860)   Collaboration withsocialworkers                                                       l03(575)   System forthetotalhealth managementofpublicassistancerecipients   Experienceofprovidingsupport                                                         43(240)     ゑ:There Were

179

publicheaーthnurses Whohadexperienceofprovidinghea1thsupportforpub1icassistance       recipients

and

other

PARS

.A

total

f179(

86

9%)PHNshad

experience

fproviding heal

th

support

○nthe

other

hand

,35

9% ofPHNsinthe

r20s

,11

7% i

nthe

r30s

,5

3% i

nthe

r40s

,and 6

0% i

nthe

r50s

or older

had

no experience. Table ・ shows

the

results

a survey

nvo

ng PHNs wi

th

experience

fproviding heal

th

support

The homesof

patients

wi

th

psychiatric

sorders

were

vi

ted by 146(81.6%)

,or

the largest percentage

fPHNs

,andthe e

lder

were

ted by 97(54.2%)PHNS.Regardingthe

experience

co

abora

ng wi

th

other

hea

thprofess

ona

,86

oand57

5% ofPH r

shadco

abora

ed wi

th

case

andsoc

workers,respectively.

Thetota

lhea

th

management

fPARS

,i

nc

ud

ngthe

developmentofapproachesto

helpthem

consult

phys

ansand

understand

the

rhea

thcond

ons

,hadbeen

experienced

by24

0% ofthe

pH

rs

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