Current Nursing Values and Theory
Global Health Nursing:A New Discipline in Japan
Junko Tashiro, RN. PhDWHO 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
Korea Sigma Thea Tau International Conference
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 in Japan and Asia
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 Africa 183 145 60Southern Asia 122 77 40Oceania 85 59 28CIS, Asia 78 42 26Northern Africa 83 35 27Developed Regions 11 6 3
Current Global Health Issues:Maternal Mortality Rate
1990 2005 2015
Sub-Saharan Africa 920 900 230
Southern Asia 620 490 155
Oceania 550 430 138
South-Eastern Asia 450 300 113
Western Asia 190 160 48
Developed Regions 11 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 Source: WHO People at the Centre of Care Initiative
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.
Source: WHO People at the Centre of Care Initiative
Four Domains of PCHC
Domain 1: For individuals, patients and their families, and community
Domain 2: For health practitionersDomain 3: In health care
organizationsDomain 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 self-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
Developing community leaders
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, families, and communities
Time Periods
BeforeWorld War II
1935-45
AfterWorld War II1946-54
Economic Development 1955-74
AgingTrend
1975-88
Preparationfor AgingSociety1989-99
Aging Society
2000-
Main
Health
Issues
・ Tuber- culosis・ AcuteInfections
・ Tuber- culosis・ Malnu- trition
・ Chronic Diseases: Hypertension C.V. Cancer
・ Chronic Diseases: Cancer・EmergingInfections: 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)
0%10%20%30%40%50%60%70%80%90%
100%
1950 1970 1990 2008
65-15-640-14
“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 implementersLong-term Care Insurance System started in 2000The health promotion law was enforced on May, 2003
Health Promotion Movement
Changes of Nursing Practice Model in Chuo-ku, Tokyo Health Transition: Phase I Phase II Phase III
Top-downTop-down Service Providing
Participating
Coordinating
Networking & Collaboration
Health Counseling
Nurse
Community People
NurseCommunity
People
Community People
SupporterSupporter
Community People
Nurse
Community People
SupporterResource
SocialWelfare
Health Medicine
Nurse
PolicyMaker
CommunityPeople
Nurse
TriangleTriangle
Supporter Nurse
Social WelfareHomes for Elderly
Health Centers for Elderly
Medical CareClinics Long-term care
Hospitals Visiting Nursing Stations
Health CareCommunity 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 Care2.Health Promotion Service & Strategy
Development and Evaluation・ Program Development for Healthy Families・ Nursing Practice Development for International
Collaboration・ Know Your Body Program for Preschoolers & Families3.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 PHCNursing Development Collaboration Center
Application and assessment of nursing service
Nursing practice research and development
studies
Schematic Diagram of People-centered Care
PeoplePolicy makers
Healthcare specialists
Nursing service assessment & development
Nursing service provision strategy development and
research
Health 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 community
CommunitiesPeople-
centered Care SystemA 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
Health Promotion
Kango-net
Research Center for Development of Nursing Practice
Graduate School of Nursing Doctoral
Course
WHO PHCNursing 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 people)
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 to global health for health equity
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-centeredin Local Community
Japan
Global communities
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 Nursing Consortium was formed
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 PHCSt. Luke’s College of Nursing, Tokyo, JapanJunko 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 (2002~2004)
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 Global Health or International Nursing.
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.
Fig. Competencies of International Nursing Collaborator and Educational ProgramsFactors inf lue ncin g Col lab oration Factors inf lue ncin g Col lab oration
Host country
Social Status & Situation of Nursing
Cultural/ Economical/Social Situation
Both Organization
Relationship with Other Agencies and Projects
Activiti es of Coll ab oration Ta sk
Activ ities
Japan
Cultural/ Economical/Social Situation
Collecting InformationAssessment NetworkingPlanningImplementingProblem AnalysisProblem Solving SpecialtyKnowledge ofGlobal Health and NursingPersonal competenciesCultural Understanding &
AdaptationApplicability
Language & Communication
Compete ncies Educational Programs
Social Status & Situation of Nursing
NursingArea & Levels
Governmental
Organizational
Team
Individual
Policy making
Administration
Clinical
Nursing education
Community
Professionalorganization
From preparation To planning
Implementation
Evaluation
A Model of Competencies of International Nursing Collaborators (Experts )
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 educator
d) 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) Comparative nursing research (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
collaboration (2)
.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
Major fields (12)
Basic S
ubjects (12)
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 Indonesia.
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