Objectives: The aim of this review was to analyze the concepts of the generalist in public health nursing and discuss the role of the National Institute of Public Health (NIPH).
Methods: We reviewed descriptions in the literature on definitions, roles, and features of public health nursing, including public health nursing textbooks, nursing journal articles, and statements of nursing academic societies and nursing professional associations. The extracted descriptions related to generalists (e.g., uncategorical care and a wide range of clients) were categorized according to similarities.
Results: A total of 19 manuscripts were selected: 11 public health nursing textbooks, 3 journal articles, 2 statements of nursing academic societies, and 3 statements of professional associations. We did not find any Japanese journal articles on public health nursing that discussed the concept of the generalist. The extracted descriptions were divided into 5 categories: (1) care at all ages and in all health statuses, (2) linking multi-level systems from the individual level to the national level, (3) promoting social justice by weaving various methods from individual care to policy making, (4) providing nursing care from the long-term perspectives, and (5) providing care based on a wide range of fields.
Conclusions: The reason why no Japanese articles about generalists were found may be that the generalist role is considered one that is obvious for public health nurses (PHNs) and scholars. Two categories appear to be the primary foci for public health nursing generalists: (1) providing nursing care from the long-term perspective and (2) providing care that is based on a wide range of fields. In addition to these 2 foci, public health nursing generalists should also focus on preventing health problems across multiple fields.
The National Institute of Public Health has recently created and implemented training programs to enhance PHNs' capability to develop human resources. However, NIPH needs to improve these training programs to strengthen the generalist role of PHNs. It must be required to clarify the tacit knowledges of PHNs as generalists and make use of explicit knowledges for the generalists training programs. To attain its goals, NIPH needs to establish a new section focusing on public health nursing.
Since its inception, public health nursing has focused significantly on individual care. This activity, which seeks to contribute to maintaining and improving the health level of individuals and families, is the cornerstone of improving the health level of the entire community. Public health nurses have always responded to changes in social needs and health issues while being influenced by changes in the times. In recent years, the need for care for difficult cases with complicated health and life problems has increased in the communities. Many factors, which are complicatedly interlinked with one another, have brought about the emergence of these cases. We focused on 6 factors: (1) the increasing severity of poverty, (2) the division of residential areas by social stratification and its impact on health, (3) the changes in roles and values of families, (4) the diversification of health and life issues, (5) the changes in interactions among community residents, and (6) the increasing numbers of foreign residents.
The health and life problems of difficult cases are a microcosm of society, and it is imperative that public health nurses collaborate with members of various relevant organizations inside and outside the local government to solve these cases. In general, in many departments of the public administration, we adopt “vertical administrative structures” that focus on defined affairs only. In contrast, public health nurses have collaborated with various related organizations to address inter-department health and life issues. This “interdepartmental support” style is emphasized in the concept of the community symbiosis society, which has been adopted by the Ministry of Health, Labour and Welfare. To realize a community symbiosis society, the public health nurse should promote individual care and community development in cooperation with related organizations and members of the community, while utilizing practical knowledge. Considering accelerating depopulation and the decreasing numbers of public servants, public health nurses should develop efficient and effective health policies and community health care systems for solving the health and life problems identified in individual care and for preventing future problems.
Today, public health nurses handle cases with multiple problems, and many related organizations are involved. Furthermore, it is becoming more important to collaborate with relevant organizations in policy planning. We analyzed cases where public health nurses have worked with many related organizations to resolve problems. We also analyzed cases of policy planning involving public health nurses. From the case analysis, we examined the roles and abilities required of public health nurses. Our results indicate that the skills necessary for public health nurses to demonstrate expertise as generalists include the following: (1) communication skills, (2) coordination abilities, and (3) management abilities.
Appropriate data collection, assessment, and use with population-based approaches are essential for addressing health problems in communities. The collecting and assessment of various health data promote evidence-based practice. Collaboration of local governments with different academic fields has merits for focusing and assessing the essential causes of health problems in the communities because professionals from these fields have the expertise to conduct follow-up studies on disease incidences and processes. Health data sorted by academic fields should effectively be used to service communities. Using the strengths of the local government and communities in the introduction of their data may promote cross-sectional health, addressing and improving health in the communities.
This article shows a population-based health practice and some steps of the cohort study, and explains the importance of cross-sectional collaboration between local governments and academic fields in collecting data in communities. Some examples for using health data that are common for local governments are also shown. Good relationships among government staff, professionals from different academic fields, and community members are essential for cross-sectional collaboration. The examples in this article are based on the author's experiences in Goto city, Japan, in collaboration with Nagasaki University. The importance of strong relationships, shared objectives and future visions for communities, and mutual support was demonstrated in the examples.
A decreasing population and a “super-aged” society have created new challenges in communities. To meet these challenges, community development efforts have been carried out in many fields. This research aims to clarify the meaning of “community development” in different fields. Additionally, I identified the following points of view: social determinants of health and social inclusion, and abilities; management and developing partnerships for public health nurses who engage in collaborative community development with people in communities; and multidisciplinary groups of professionals across various fields, departments, and institutions.
Objective: The aim of this study was to determine the characteristics of involvement by public health nurses (PHNs) at public health centers in the development of community medical care systems (CMCSs) by comparing the involvement of PHNs with the involvement of members of other occupations.
Methods: A questionnaire survey (to be filled out anonymously) was mailed to public health nurses and others, mainly in charge of duties involving collaboration in community medical care at 372 prefectural public health centers in Japan, to compare involvement by public health nurses with involvement by members of occupations other than public health nursing. The survey consisted of the following: (1) basic information on subjects, (2) overview of the organization in charge, and (3) 32 items related to regional CARE system construction.
Results: Subjects were 148 public health nurses (group A) and 163 non-public health nurses (group B) who had responded to the survey. There were no major differences between the 2 groups with regard to age and administrative experience. With regard to the development stage of CMCSs, both groups had the “development stage (intermediate stage)” at the highest proportion and group A had the “founding stage (early stage)” at the next highest proportion. With regard to conferences by affiliated institutions, both groups had “collaboration promotion associations” the most, and “hospitals” were the most affiliated institutions in collaborations. Group A had more “municipalities,” “health clinics,” “home-visit nursing stations,” etc., than group B. With regard to involvement, 12 items including “to plan seminars on collaboration in community medical care by affiliated parties” were significantly higher for group A than group B (P < .001). As a result of examining these 12 items by dividing them into the “group of strong involvement,” “group of intermediate involvement,” and “group of weak involvement,” it was found that the “group of strong involvement” presented a function to educate professionals in the community, the “group of intermediate involvement” presented a function to manage development of CMCS, and the “group of weak involvement” presented a function to collect and dispatch information.
Conclusions: This study found that PHNs contributed to the development of CMCSs by providing support to small organizations and conferences and serving as advocates for members of other occupations in weaker positions and as coordinators to connect various institutions. They also carried out management functions, such as business/task management, at the early and middle stages of the development of CMCSs. This role serves as an example of how public health nurses function as generalists.
In the period immediately following a natural disaster, there are rapid increases in needs related to medical treatment and the preservation of health and welfare. After a natural disaster, there is an imbalance in supply and demand. In addition, during the reconstruction period, various factors related to education, housing, labor, and traffic impact residents. Recently, serious disasters have been occurring frequently in Japan. For this reason, more effort is being made to meet the needs of victims at earlier stages.
Working with professionals from other fields is important in the development of an effective activity system and in gaining support. I discuss the generalist skills of public health nurses that are required after natural disasters, and I describe methods of working with professionals from other fields to promote effective activity.
The integrated community care system is aimed at establishing a regional system that can provide services such as housing, health care, medical care, nursing care, and welfare for the community. Public health nurses have been actively engaged in the work related to local health, welfare, medical care, etc. Therefore, there is high expectation with regard to the contribution of public health nurses to the new community-based care system.
Firstly, I assess the current situation of public health nurses by examining prior research, survey reports, and administrative materials. Secondly, from the viewpoint of public policy studies, I clarify the role of public health nurses in the integrated community care system. For this purpose, I focus particularly on public health nurses of municipalities (cities, towns and villages).
In municipalities, public health nurses belong to various organizations and are engaged in the duties of various fields. Today, a major responsibility of a public health nurse is the management of cross-sectoral public activities. As street-level bureaucrats, they are responsible for implementing policies related to daily life of citizens. It is also clear that the contribution of public health nurses to policy making is increasing.
In conclusion, the role of public health nurses in the integrated community care system is 3-fold: (1) to coordinate experts in the fields of health, welfare, medical care, and nursing care who are working in a community; (2) to link various departments and organizations of municipalities involved in care; and (3) to get involved in the policy making of all fields in their municipality in addition to making policies and projects related to care. In other words, it is the role of making policies based on the actual condition of the community and citizens' needs. In order for public health nurses to play all 3 roles, they must function not only as specialists but also as generalists. It is also required to develop the capacity of policy making as well as policy implementation.
Public health nurses are the driving force behind health administration activities. In the super-aging society Japan finds itself in however, the roles of these public health nurses are currently changing and expanding even further, in order to cover the various health-related needs of the people. As a result, the number of public health nurses in local municipalities are increasing, and a re-examination of the placement and role distribution of public health nurses is believed to be needed.
Also, in health administration activities, promoting the support of social capital utilization for self-help and mutual assistance in addition to furthering existing health practices is very important. Health administration activities must be implemented to create a sustainable health promotion plan appropriate to the regional characteristics, and ensure a secure health emergency management structure. Public health nurses must further support these activities, in accordance with the “Guidelines for Public Health Nurses' Activities.”
It is therefore extremely important for public health nurses to be trained not only to have specialized knowledge and skills but also have capable abilities in cooperation, coordination, and administrative management and evaluation, in order to handle the Abstract wide variety of health activities. However, the education curriculum for public health nurses has diversified in recent years, thus the amount of experience and wisdom one may have is not always uniform with one's years of experience as a public health nurse. Therefore, there is a need to assess and evaluate public health nurses' individual abilities using the career ladder system, and develop a systematic approach to training public health nurses. In order to establish a systematic human resource development approach, it is preferable to collaborate with the human resources department and educational institutes and create a cooperative structure body.
The importance in the roles of supervising public health nurses is also increasing, in order to carry out health activities effectively, as well as promote human resource development. The cross-organizational duties of supervising public health nurses also play a key role in organization during natural disasters, which have become increasingly prominent the past few years. Local municipalities must reassess their health activities thus far, and formulate a new plan with supervising public health nurses. It is anticipated that promoting the roles of these municipal public health nurses will lead to further reassurance and comfort for local residents.
To calculate the quality-adjusted life years (QALY), it is necessary to use quality of life (QOL) scores measured on a preference-based measure. In recent years, it has become a frequent practice to employ ”mapping“ to utilize scores measured on a non-preference-based QOL measure for economic evaluation of healthcare technologies. Mapping is a procedure for predicting the QOL scores measured on a preference-based measure from those measured on a non-preference-based measure. As for study reports on mapping, there has been a MApping onto Preference-based measures reporting Standards (MAPS) statement drawn up comprising 23 sections. We translated MAPS statement into Japanese and it is shown in the appendix of this article, including a detailed account of the statement. The current status of research on mapping is indeed a mixture of wheat and chaff. However, MAPS statement may improve the quality of reporting on mapping research.