日本地域看護学会誌

No. 20Japan Academy of Community Health Nursing
Established October 15, 1997

Vol.24 No.1, 2021

APRIL 2021

homes3). Additionally, expanding the polymerase

Topics of Japanese Community
Health Nursing

chain reaction test (PCR) and securing the healthand medical care delivery system is a crucial
measure for early detection and keeping sustainable

1. COVID-19 and Community HealthNursing in Japan

service provision to community people3).
Securing staff is an urgent issue for each local
government. The World Health Organization (WHO)1) Overview of COVID-19 in Community Healthhighlighted the necessity of considering task

Nursing Practice in Japanese Ministry of

sharing, securing staff, and task shifting4). With

Health, Labor and Welfare

regard to securing staff, the MHLW and the Ministryof Internal Affairs and Communications developed a

Kyoko Yoshioka-Maeda

scheme to supporting the dispatch of public health

Chief senior researcher, Department of Healthnurses (PHNs) and other professionals among local

Promotion, National Institute of Public Health,

governments and from related academic societies

Saitama, Japanand organizations to enable emergency response
across prefectures5). In cases of particular urgency

With the outbreak of COVID-19 in China, thethe WHLW would coordinate the dispatch of theWorld Health Organization (WHO) declared a public

PHNs without waiting for notification from thehealth emergency of international concern inprefectural government. Additionally, each

January 2020 . Maintaining the healthcare system in

prefectural government would prepare to establish aeach community is a crucial issue. After facing

human resource bank to register potential PHNs inseveral waves of the epidemic in 2020 (1), the2021. With regard to task sharing and shifting, theJapan Ministry of Health, Labor and Welfare

MHLW emphasized reducing the workload of PHCs

(MHLW) has asked each health center to estimate

and reexamining the tasks that can be reduced or

the number of personnel and hospital beds needed

postponed, and outsourcing work. The MHLW

to respond to the maximum demand for COVID-19

showed good practice regarding developing

patients in June 2020 . For balancing infection

sustainable health service systems and resource

prevention and socioeconomic activities, the MHLW

allocation5). Furthermore, due to the increasing

annovnced future initiatives on 28 August 20203). To

number of people entering Japan with the easing offurther reduce the burden on public health centersentry restrictions from some countries and(PHC) and hospitals, COVID-19 patients with minor

consulting with foreign residents in Japan, theor asymptomatic conditions are treated at their

MHLW started telephone interpretation services to

1)

2)

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public health centers in December 2020. This

Hokensho ni okeru shingata corona irus kansenshou ni

service covered six languages, including English,

shisuru denwa tuuyaku service nit suite. https://www.

Chinese (Mandarin), Korean, Spanish, Portuguese6).
Managing limited human resources andproviding specialized care for COVID-19 patients ineach community, and developing sustainable healthand medical care systems is crucial (YoshiokaMaeda et al., 2020; WHO, 2020b). The MHLW has

mhlw.go.jp/content/000710395.pdf (4 January 2020).
7) Yoshioka-Maeda K , Iwasaki-Motegi R, Honda C:
Preventing the dysfunction of public health centers
responding to COVID-19 by focusing on public healthnurses in Japan. Journal of Advanced Nursing, May 4:
1–2, 2020, doi: 10.1111/jan.14409.

provided technical support for local government for2) Voluntary Consultation in COVID-19 fromcombating COVID-19 and saving community-

Japan Academy of Community Healthdwelling people’s lives.

Nursing【References】
1) World Health Organization: Statement on the second
meeting of the International Health Regulations (2005)
Emergency Committee regarding the outbreak of novel

Sanae Haruyama
Chair of Committee for Improvement of Disaster
Reliefcoronavirus (2019-nCoV). https://www.who.int/news/
item/30-01-2020-statement-on-the-second-meeting-of-

The Japan Academy of Community Healththe-international-health-regulations-(2005)-emergency-

Nursing (JACHN) began its COVID-19-related

committee-regarding-the-outbreak-of-novel-

support activities in March 2020 by supporting acoronavirus-(2019-ncov) (4 January 2020).

Hokkaido COVID-19 countermeasures team in2) Japan Ministry of Health, Labor and Welfare: Kongo wo

response to a request from the Ministry of Health,misueta hokenshi no soku ou taisei no seibi ni tsuite.

Labour and Welfare (MHLW). I set out to Hokkaido

https://www.mhlw.go.jp/content/000641920.pdf (4January 2020).
3) Japan Ministry of Health, Labor and Welfare: Shingata
corona virus kansenshou ni kansuru kongo no torikumi.

with another member of the JACHN to sort out
issues in public health activities and advise leadpublic health nurses. In addition, roughly 20 JACHN

https://www.mhlw.go.jp/content/10900000/000664804.

members with experience in public health center

pdf. (4 January 2020)

activities and home care support gathered and4) World Health Organization: Operational considerations
for case management of COVID-19 in health facility

organized information on severely ill patients to
support the MHLW surveillance team.

and community. Interim guidance 19 March 2020.

In the second wave of COVID-19, which

Retrieved:https://apps.who.int/iris/bitstream/occurred from June to August, about 10 JACHN

handle/10665/331492/W HO - 2019- nCoV-H C F_

members supported public health centers in Tokyo

operations-2020.1-eng.pdf?sequence=1&isAllowed=y.
5) Japan Ministry of Health: Labor and Welfare andMinistry of Internal Affairs and Communications.
Hokensho ni kakaru ‘shingata corona virus

and other regions where infections were prevalent.
This support included consultations by phone,observing the health of patients recuperating at

kansenshou ni kansuru kongo no torikumi’ ni tsuite.

home and people who had close contact withhttps://www.mhlw.go.jp/content/000680239.pdf (4COVID-19 patients, proactive epidemiological

January 2020).

surveys, and preparing checklists to prevent

6) Japan Ministry of Health: Labor and Welfare.

infections at facilities such as elderly care facilities.

日本地域看護学会誌

These JACHN members also advised lead public

Vol.24 No.1, 2021

nursing findings related to COVID-19 countermeasures.

health nurses on matters such as securing support
staff and constructing a system for accepting3) Collaboration among Public Health Nurses
Belonging to Municipalities or Public Healthsupport.
In Japan, the spread of COVID-19 has forced
public health centers to take on more duties. As a

Centers Toward Countermeasures Against
the Novel Coronavirus

result, the maintenance and enhancement of publichealth centers’ functions have become major issues.

Hatsumi Yamazaki

The MHLW has created a personnel bank to support

Director of Public Health Planning, Kobe City Healthpublic health centers in dealing with COVID-19 andBureauhas asked the JACHN for its cooperation. The third
wave, in which COVID-19 spread widely from

Kobe is a designated city with a population of

December to February, required networks of all

around 1.52 million people. There are 224 public

government offices in infected regions throughout

health nurses working in 39 departments across 32

the country and securing personnel from outside

divisions at city government and 9 ward offices.

municipalities dealing with infections and elsewheretosupportpublichealthcenters.

Under normal circumstances, a total of 5

Thesemanagers and staff members (public health nurses

requirements in turn called for a reexamination ofand administrative staff) led by the public healthorganizational structures and management for

director (a physician) are responsible for policy

accepting large numbers of personnel. Constructing

planning and coordination related to communicablea system for accepting support is not easy when

disease. In addition, area-based public healthdealing with ever-growing numbers of COVID-19

nurses, who are responsible for maternal and childpatients. The JACHN, which has registered with thehealth, adult and elderly health, and comprehensive

MHLW’s personnel bank, has not only supported thecommunity care support, handle matters related to

implementation of epidemiological surveys andinfectious diseases in the community.

health observation but has also used its previous

The outbreak of COVID-19 is recognized as asupport experience to support the management ofpublic health crisis, and all of Kobe’s public healthincoming personnel; this management involves thenurses are involved in the fight against the virus

placement and duties of personnel, orientation inwhile continuing to carry out their regular duties. A

those duties, and the provision of materials. Even as

system allowing flexible support to be provided was

we speak, JACHN members are providing support

implemented jointly by the administrative staff of theto local public health centers and other facilities ashuman resources division and the heads of eachthe spread of infection demands.

department.

Our experience in the ongoing pandemic has

Since the first case of COVID-19 was reported

brought the roles of the JACHN into focus. Thesein Japan, public health nurses at city government

roles include operational support, support for leadand each ward office worked together to share

public health nurses in regard to COVID-19

information and ensure the smooth handling ofcountermeasures and management for accepting

matters at each phase of the project.

support, and learning and transmitting public healthA consultation center was set up in city

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government early on, and relevant information wasshared with the public to raise awareness and2. Best Research Awards of JapaneseCommunity Health Nursing

prevent panic in the community. In addition, staff
worked to improve the system by participating in the1) Mothers’ Process of Avoiding Radiation

establishment and operation of treatment facilities.

Exposure by Fukushima Daiichi Nuclear

With respect to the care of COVID-19 patients,

Power Stations Accident

ward-based public health nurses assessed patients
at home or at medical facilities and advised thempatient interviews were conducted to collectHitomi Matsunaga
Atomic Bomb Disease InstituteNagasaki University, Department
of Global Health, Medicine andWelfareinformation about symptoms, behavior history, andBackground: On 11 March 2011, the Great East

workplace contacts and patients were instructed onJapan Earthquake caused extensive damage toproper disinfection techniques. The role of publicTokyo Electric Power Company’s Fukushima Daiichi

health nurses is to obtain accurate information,

Nuclear Power Station (FDNPS), which resulted inprevent patients from becoming seriously ill, andthe release of various radionuclides into theminimize cluster outbreaks by collaborating withatmosphere. Due to the accident, many guardians of

medical institutions and social welfare facilities.

children evacuated to their hometowns because of

Public health nurses also raise awareness aboutanxiety about exposure to radiation and healthenvironments and behaviors associated with higheffects for their children, even if their area was notrisk of infection.

under an evacuation order. However, theregarding whether they should stay home from workor be hospitalized. To determine the source of
infection and prevent the spread of further infection,

The individual responsibilities of public healthpsychological and behavioral processes of thesenurses vary widely in terms of quantity and quality.

guardians have not been clarified.

Accordingly, they may be actively involved in

Objective: The purpose of the study is to clarify theplanning and manualization, with the goal ofvoluntary evacuation process of mothers of children

preventing the spread of infection throughunder 6 years of age for the purpose of avoiding

cooperation with administrative staff, support fromradiation exposure at the time of the FDNPS

university faculty, outsourcing, and otheraccident.

multidisciplinary efforts.

Method: A semi-structured interview was conducted

Lastly, public health nurses have neverwith the 21 mothers and the data were analyzed

experienced a situation similar to the current

following the trajectory equifinality approach (TEA).

COVID-19 pandemic and it can be difficult to obtain

Results: Immediately after the accident, mothers

information useful for public health guidance. We

became aware of the serious damage caused by thesincerely hope that this experience will lead to theaccident via TV and radio, and then they began toestablishment of a network that enabling public

collect more detailed information on social

health nurses to share such information on a global

networking services (SNS) including Twitter, LINElevel.

and Facebook. There, mothers saw negative
information about the accident. Moreover, they

日本地域看護学会誌

Vol.24 No.1, 2021

encountered information from SNS stating that if

knowledge about the accident and radiation healththey were to continue to live in their residential area,

effects, we should understand their desire to protect

their children would begin to suffer various healththeir children from the accident.

consequences due to the accident from theradionuclides. At that same time, the Government of【Reference】

Japan said there were no immediate health effects

1) Nuclear Emergency Response Headquarters offrom the accident. However, mothers did not trust

Japanese Government. Report of Japanese

the information from the government because they

government to the IAEA ministerial conference on

perceived general health symptoms such as cough,fever, and nosebleeds in their children as potential
negative health effects from the accident based on
information from SNS. From their experience, they

nuclear safety. The Accident at TEPCO’s Fukushima
nuclear power stations. Available at http://www.iaea.
org/newscenter/focus/fukushima/japan-report/.
Accessed 2020 January 21.

began to distrust the information from the Japanese

2) Psychological Process of Starting andGovernment which said there would be no harmful

Continuing to Quit Smoking among

health effects from the radiation caused by the

Outpatients in a Stop-smoking Clinic

accident. The mothers thought that if they continued
to live in their residential area instead of evacuating,their children may experience more and more healthissues that were attributable to their radiationconsider taking their children and evacuating the

Akiko Yoda
Saku University, School of
Nursingdisaster area. In addition to considering whether toPurpose: The purpose of this study is to identify theevacuate the disaster area with their children, thepsychological process of stopping smoking andmothers also had to think deeply about how thiscontinuing to be smoke free by outpatients of achoice would affect their family members, especially

Stop-Smoking Clinic.

their husbands. However, while negotiating whether

Method: Six outpatients of a stop-smoking clinic

to evacuate the disaster area with their husbands,

were interviewed after visiting the clinic for three

the mothers decided to give priority to their role asmonths, (from the initial visit until the last visit).

mother. As a result, they decided to evacuate theResults were analyzed using a modified groundeddisaster area to provide a good life for their children.

theory approach.

Discussion: There is scientifically evidence that

Results: Various stages were observed within thehealth effects on children living in affected area ofprocess :from “developing the desire to quit

the FDNPS accident did not occur . However, thesmoking” and “preparing to organize one’s feelings”

mothers recognized the possibility of future healthat the initial visit, “seeing the light at the end of theeffects children due to the FDNPS accident. Whentunnel, and relaxing a little” after starting to stop

working as a regional nurse and providing support tosmoking by “consciously working to change one’s

the mothers, it is important to understand that theymind to quit,” and “definitely deciding to stop” by the

had to endure suffering and conflict prior to theirend of the visits. Self-anxiety which decided

evacuation. Even if mothers have incorrect

smoking cessation at the initial visit changed to

exposure. Because of this, the mothers began to

1)

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feelings of confidence through the above-describedstable life in the future.

process. It was observed that “self-anxieties

The purpose of this study is to clarify public

decreased but could not be completely eliminated”

health nurses’ (PHNs’) support in terms of theeven to the end, and these two processes mutually

viability of residents with schizophrenia in the local

existed. However, psychological support by family

community who were untreated or had interrupted

and clinic staff encouraged the stopping of smoking.

treatment. In this study, semi-structured interviews

Discussion: While anxiety regarding being able towere conducted with 10 PHNs experienced incontinue to stop smoking were concurrently present,

mental health and welfare counseling at municipal

a psychological process where feelings ofpublic health centers. Transcripts of the interviews

achievement in overcoming difficulties and gaining awere analyzed qualitatively.

feeling of self-efficacy were found to connect to thecontinuation of efforts to stop smoking.

Their average years of experience were 23.2
years as a PHN and 3.4 years as a mental healthand welfare counselor. There were four untreated

3) Public Health Nurses’ Support Based on the
Perspective of the Viability among Residents
with Schizophrenia Who Are Untreated orwith Interrupted Treatment

cases and nine cases of interrupted treatment. Nine
categories and 42 subcategories were extracted as
PHNs’ support in terms of viability. For many of thecases they dealt with, it was difficult to provide
continuous support.
The PHNs found the viability of patients fromthe context of relationships by continuously

Keiko Matsumoto
Osaka City Health Centerengaging with residents, and from their living
environment, and they led patients to treatment.

In mental health, medical, and welfare measures,

Viability is partially reduced when the patients’a “comprehensive community care system forconditions worsen due to lack of treatment or

people with mental disorders” has been established,treatment that is interrupted. However, patients wereand legal development is underway with the aim ofable to live at home even if their viability declined,“enhancement of early support for those who haveand the PHNs found that they had the ability to

been untreated or with interrupted treatment”. Under

supplement patients’ viability. Therefore, the PHNs

such circumstances, further enhancement of theregarded patients’ power as viability, focused on it

support system for people with schizophrenia is

as giving the ability to continue living in therequired.

community, and PHNs provided support.

The ultimate goal of treating schizophrenia is to

In this study, while PHNs were carefully involved

reduce patients’ mental symptoms, help them regainin the lives of people with schizophrenia, theviability and hope for life, which are often lost due toprocess of grasping the ingenuity and adaptability

various dysfunctions caused by schizophrenia, andacquired by patients and the support skills of PHNs

enable them to live their own lives. Therefore, theaccording to patients’ viability were clarified.

viability of schizophrenic patients needs to be

We believe that this information can be widely

correctly grasped because it is not only important forused in various types of difficult cases in the field oftreatment, but is also an important index related to amental health in the future.

日本地域看護学会誌

Vol.24 No.1, 2021

We aim to convey the support skills revealed incompetency could be enhanced to provide nursing

this study to PHNs and improve the quality ofcare for individuals living in various public health/assistance for people with schizophrenia and theirclinical/welfare care settings with multidisciplinefamilies from now on.

collaboration in the present revision.

Finally, we would like to express our sincere

One of the major revisions in our expertise ofgratitude to everyone who cooperated with thiscommunity health nursing is that the subject “Home

research.

Health Nursing” is revised to “Community and Home

3. “Community & Home Health Nursing”
of the renew curriculum in nursing
education in 2020
Ayumi Kono
Osaka City University, Department of Home HealthNursing
Japan is facing a declining birth rate andprogressively aging population, and a well-designed

Health Nursing.” Furthermore, academic credits fornursing lectures are going to increase from four tosix credits to enhance nursing provided incommunity care settings. On achievement of therevised subject, nursing students could understandthe characteristics and care needs of communitydwelling individuals and their families and acquire
fundamental knowledge and skills and appropriate
attitudes for providing nursing care in various
community health and welfare care settings.

health care system should be established in

To date, “Home Health Nursing” was consideredaccordance with the Community-based Integrated

a subject in integrated nursing subject group, which

Care System and Regional Health Care Plan, which

generally should be provided to senior grade nursing

were promoted by the government. Information andstudents after nursing clinical curriculum focused oncommunication technology (ICT), including artificial

nursing in hospital. However, in the present revision,

intelligence (AI) or Internet of Things (IoT), is rapidly“Community and Home Health Nursing” wasintroduced to the field of clinical or long-term careregarded as a major nursing subject, which should

and in many other industries. Workplaces of nurses

be provided to junior grade nursing students

who provide direct care to patients are extending to

immediately after they learned basic nursing

a wide variety of homes or facilities, not limited totheories or methods. This revision intends for

traditional clinical settings including hospitals,

nursing students to study community and home

outpatient clinics, or nursing homes. Nurses whohealth nursing throughout the course in the school ofbear health care of the next generation are expectednursing, as all patients or clients come from theirto acquire competency in interdisciplinary collaboration

communities and go back to their communities, evenand creativity to provide care to patients or clientsthough they have diseases or receive medicalwith diverse and complex care needs.

treatment in hospitals.

Following these kinds of changes in the

The amended rule will be applied in the nursing

situation of our society, the fifth amendment of thecurriculum, including vocational nursing schools or

Designation Rule for Certifying School of Nursing,nursing colleges nationwide from April 2022.

which was previously in 2008, was conducted in

Therefore, there is a challenge to clarify and introduce2020 according to the Health Policy Bureau, Ministrynovel or significant aspects of community and homeof Health, Labour and Welfare. Particularly, basic

health nursing in nursing education programs.

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The 24th Annual Research Conference of JACHN
Theme : New Challenges for Community Health Nursing in Inclusive society
Date : August 27- September 12, 2021 (On-demand streaming) , September 11-12, 2021 (Live streaming)
Chair : Emiko Kishi (Graduate School of Nursing, Toho University)
Program :◆Chairperson’s speech : Emiko Kishi
Community Health Nursing Toward Inclusive Society◆Educational lecture ◆Symposium ◆Appointed workshop ◆Poster session ◆Workshop ◆Open lecture
Website : https://confit.atlas.jp/guide/event/jachn24/top

Conference Advertising
The 7th Conference on International Collaboration for Community HealthNursing Research: ICCHNR
Date：June 21-22, 2022
Venue：Linnaenus University in Vaxjo, Sweden
Greeting：At Linnaeus University we are very proud to be hosting the upcoming 2022 ICCHNR-conference. We aim toturn this conference an opportunity for researchers from both near and far to attend and to present their mostrecent research findings in the field of "Community nursing towards sustainable health". We hope to attract
specialists from various disciplines of community nursing, professional, education, research andmanagement to the conference.
Website：https://lnu.se/en/communitynursing2022

The 6th International Conference on Global Network of Public HealthNursing: GNPHN
Date：January 7-9, 2022
Venue：Grand Cube Osaka (Osaka City)
Chair：Reiko Okamoto, PhD (NS), (Professor, Graduate School of Medicine, Osaka University)
Vice Chair：Tamami Matsumoto, (Executive Director of Public Health Nursing, Osaka City Government)
Website：https://www.gnphn.com/gnphn-6th-international-conference-japan-2022/
Publisher: International Exchange Promotion Committee
Ayumi Kono (Osaka City University), Kaoru Konishi (Osaka University),
Reiko Okamoto (Osaka University), Miho Hamayoshi (Bukkyo University),
Kyoko Yoshioka (National Institute of Public Health)

Secretariat of JACHN:
162-0825 2F Ozawa-building, 4-1-1, Kagurazaka, Shinjuku-ku,
Tokyo
TEL: +81-(0)3-5206-7431 FAX: +81-(0)3-5206-7757
MAIL: office@ jachn.net