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