[Role and function of public health nurses in Taiwan: review of current status and future perspectives]

Public health nursing is a core practice of primary health care. Public health nurses (PHNs) in Taiwan act both as individual/family-based primary care providers and as population-based community care providers. Previous studies in Western countries have shown the role preference of PHNs to be highly influenced by the structure of the healthcare system, policies and major programs, and health insurance reimbursement mechanisms. Thus, the impact of the health transition and related changes in the abovementioned systems should be taken into consideration when adjusting the roles and functions of PHNs. The rising prevalence of chronic diseases and the multiple burdens caused by diseases is making healthcare delivery increasingly complicated. With PHNs no longer able to provide "catch-all" services due to manpower shortages, several potential specialty areas have opened up to participation and development by community nursing. These include psychiatric care, long-term care and palliative care, school/workplace health promotion, and disease management in hospitals. It will be essential that community nurses bridge the gap in service left by PHNs so that PHNs may refocus their job role on the health needs of the community as a whole. PHNs should continue to build partnerships with primary care settings and perform the key functions of demonstration, support, collaboration, service, and surveillance in the community.

[Development of a scale measuring the competences of public health nurses in public health policy in Japanese administrative agencies]

OBJECTIVES

There is an urgent need to build healthy communities and increase the public health nursing capacity to solve the complex and diverse health problems in modern society. The purpose of this study was to develop a scale called the Competences of Public health nurses in Public health policy (hereinafter referred to as the CPP scale), and to test the reliability and validity of the scale.

METHODS

A literature review, individual qualitative interviews with five expert public health nurses, and surveys of all public health nurses in the local governments in one ordinance-designated city in Japan (n=460) were conducted.

RESULTS

A factor analysis of the results showed that the CPP scale contained two factors and 16 items: the first factor was "Community Partnership," and the second factor was "Community Nursing Diagnosis Cycle." Confirmatory factor analysis for the CPP scale demonstrated high fit indices (GFI=.889, AGFI=.847, CFI=.956, RMSEA=.068). The Cronbach's α coefficient of the scale was 0.93, and the scale scores were significantly correlated with the standardized scale, the Competency Measurement of Creativity (r=0.52, P<0.01).

CONCLUSION

It was concluded that the CPP scale had sufficient reliability and validity to assess the competency of public health nurses in forging public health policy.

A randomized controlled trial of a public health nurse-delivered asthma program to elementary schools

BACKGROUND

Childhood asthma is a serious and common chronic disease that requires the attention of nurses and other school personnel. Schools are often the first setting that children take the lead in managing their asthma. Often, children are ill prepared for this role. Our study evaluated a school-based, multifaceted asthma program that targeted students with asthma and the broader school community.

METHODS

A randomized trial involving 130 schools with grades 1-5 and 1316 children with asthma and their families was conducted. Outcomes of interest for the child, at 1 year, were urgent care use and school absenteeism for asthma, inhaler technique, and quality of life, and for the school, at 14 months, were indicators of a supportive school environment.

RESULTS

Improvements were observed at the child and school level for the intervention group. Fewer children in the intervention group had a school absence (50% vs 60%; p < .01), required urgent care for asthma (41% vs 51%; p < .0001), or reported a day of interrupted activity (51% vs 63%; p < .01), and had improved quality of life (5.8 ± 1.2 vs 5.4 ± 1.4; p < .0001). Schools in the intervention group were more likely to have practices supporting an asthma-friendly environment.

CONCLUSIONS

Implementation of a multifaceted school-based asthma program can lead to asthma-friendly schools that support children with asthma to be successful managers of their asthma and experience improved quality of life and decreased disease associated burden.

[Public health nurse support at initial community DOTS meetings with non-hospitalized tuberculosis patients--comparison of patients who did and did not complete treatment]

PURPOSE

This study focused on the initial meeting between public health nurses and TB patients to investigate the detection of patients' needs and the support provided by public health nurses during the meeting, with the aim of successfully implementing a directly observed treatment short course (DOTS) strategy for the community.

METHODS

A self-administered questionnaire was sent to nurses responsible for community DOTS strategy for TB in Aichi, Gifu, Mie, and Shizuoka prefectures in the Tokai region in order to collect the following information concerning the initial meeting between public health nurses and TB patients: nurses' characteristics, patient characteristics, information collected by the nurses, concerns expressed by patients, and specific support provided by the nurses. Data collected were compared between patients who completed TB treatment (complete treatment group) and those who did not (incomplete treatment group).

RESULTS AND DISCUSSION

Valid responses were obtained from 42 public health nurses regarding 158 TB patients. The incomplete treatment group had a high proportion of patients who received no support from their families, had irregular lifestyles, or had financial problems. There were discrepancies between the information collected by public health nurses and patients' concerns. It was also revealed that public health nurses provided more specific support and a wider range of support to the incomplete treatment group, suggesting that public health nurses give specific support in the initial meeting to patients who were likely to discontinue TB treatment, thereby motivating them to complete the treatment.

CONCLUSIONS

It is essential to arrange initial public health nurse-patient meetings at an early stage to build patients awareness of the disease and the importance of treatment adherence. Continuous support is crucial until the patients complete treatment.

[Development of the role scale for municipal supervising public health nurses]

OBJECTIVES

As public health nurses are becoming increasingly decentralized in municipalities, recommendations for allocating supervising public health nurses are being made. This study aimed to develop a scale for measuring the implementation of role of municipal supervising public health nurses and to test its reliability and validity.

METHODS

Scale items were developed using results of a qualitative inductive analysis of interview data, and the items were then revised following an examination of content validity by experts, resulting in a provisional scale of 17 items. A self-administered, written questionnaire was then completed by supervising public health nurses or public health nurses holding the most senior positions in all municipalities nationwide, with the exception of three prefectures in the Tohoku region (total 1,621 locations).

RESULTS

In total, 1,036 responses were received, and 931 were used for analysis (valid response rate = 57.4%). Of these, 406 were completed by supervising public health nurses. After deleting one item as a result of item analysis and conducting principal component analysis, factor analysis was conducted using the major factor method and Promax rotation. One item with high loading on multiple factors was deleted, resulting in a scale comprising 15 items and 3 factors. The cumulative contribution ratio was 56.10%. The three factors were labeled "Promotion of health activities across the whole locality," "Coordination as a PHN role leader," and "Development of the skills of public health nurses". The reliability coefficient of the RMSP (Role Scale for Municipal Supervising Public Health Nurses) as a whole was 0.84 using the split-half method (Spearman-Brown formula) and 0.91 using Cronbach's alpha, confirming internal consistency. In terms of validity, an examination was conducted of the correlation of two RMSP scale scores (strength of awareness of role as a supervising public health nurse and confidence as a supervising public health nurse) and scores on existing scales assessing management abilities, and a significant correlation (P < 0.01) was obtained. Additionally, a comparison of the RMSP scores of decentralized local public health nurses according to rank and years of service in areas where there were no supervising public health nurses with the RMSP scores of supervising public health nurses showed that the scores of supervising public health nurses were higher.

CONCLUSION

The developed scale was found to be reliable and valid for measuring the implementation of supervising public health nurses' role.