Nagata Satoko, Murashima Sachiyo, Haruna Megumi, Kitagawa Sadayoshi, Kuramochi Kazue, Furuya Akie, Horii Toyomi, Yuzawa Masami, Tagami Yutaka
Department of Community Health Nursing, Graduate School of Medicine, University of Tokyo.
Nihon Koshu Eisei Zasshi. 2003 Aug;50(8):713-23.
We conducted a nationwide questionnaire survey to elucidate the present status of public health nurses (PHNs) after initiation of the Long-Term Care Insurance (LTCI) system, in order to study the influence of the allocation of PHNs upon the performance of the system.
In March 2001, a questionnaire was mailed to 1,344 municipalities throughout Japan (all cities and 23 wards in Tokyo; one quarter of towns/villages).
Responses to the questionnaire were received from 569 (42.3%). The largest percentage (36.4%) of PHNs was assigned to Elderly Health, 29.8% was assigned to Maternal and Child Health, and 10.2% assigned to the LTCI. Among LTCI operations, follow-up of individuals not certified as requiring care, guidance for the family caregiver, and counseling/grievance procedures were performed with participation of PHNs in more than 80% of municipalities. In urban areas, PHNs participated in training/guidance/advice for care certification investigators/care managers, guidance for service providers, and preparation/coordination for the Certification Committee for Long-Term Care Need in 60-80% municipalities, while those who participated in these activities were only 30-60% in towns/villages. The participation ratios were highest in municipalities where PHNs were allocated to the LTCI department for almost all of the activities except individual counseling. More PHNs from LTCI departments participated in certificating of care need and improving quality of care plans/services than from other departments in offices of municipalities. On the other hand, more PHNs in Welfare or Public Health-Welfare sections than in the LTCI were involved in individual counseling, guidance for both clients and caregivers, or in case management. Training or guidance for service providers was conducted in nearly 50% of municipalities and the performance rates were lower in towns/villages. In open-ended items of the questionnaire, the following problems were mentioned: difficulties in collaboration between sections; large workloads for certification of care need/care management, and difficulties in capturing information about clients.
The allocation of PHN influences the activities of the LTCI system, especially in relation to quality assurance. Recently, the sections to which PHNs are posted have expanded to include LTCI and Welfare. While improvement in the quality of LTCI services is anticipated, efforts are needed to strengthen collaboration among different departments. In towns/villages, performance rates of activities such as guidance for service providers of LTCI are low, suggesting the support from prefectural health centers in necessary.
我们开展了一项全国性问卷调查，以阐明长期护理保险（LTCI）系统启动后公共卫生护士（PHN）的现状，从而研究PHN的分配对该系统运行的影响。
2001年3月，向日本全国1344个自治市（所有城市及东京的23个区；四分之一的城镇/乡村）邮寄了调查问卷。
共收到569份（42.3%）问卷回复。分配到老年健康领域的PHN比例最高（36.4%），分配到母婴健康领域的占29.8%，分配到LTCI的占10.2%。在LTCI业务中，超过80%的自治市在对未被认证为需要护理的个人进行随访、对家庭护理员进行指导以及咨询/投诉程序时都有PHN参与。在城市地区，60 - 80%的自治市中，PHN参与了护理认证调查员/护理经理的培训/指导/建议、对服务提供者的指导以及长期护理需求认证委员会的筹备/协调工作，而在城镇/乡村，参与这些活动的比例仅为30 - 60%。除个别咨询外，在几乎所有活动中，PHN被分配到LTCI部门的自治市参与比例最高。与自治市办公室其他部门相比，LTCI部门的更多PHN参与了护理需求认证和提高护理计划/服务质量的工作。另一方面，福利或公共卫生 - 福利部门参与个别咨询、对客户和护理员的指导或病例管理的PHN比LTCI部门的更多。近50%的自治市开展了对服务提供者的培训或指导，城镇/乡村的执行率较低。在问卷的开放式问题中，提到了以下问题：各部门之间协作困难；护理需求认证/护理管理工作量大，以及获取客户信息困难。
PHN的分配影响LTCI系统的活动，尤其是在质量保证方面。最近，PHN所属部门已扩大到包括LTCI和福利部门。虽然预计LTCI服务质量会有所提高，但仍需要加强不同部门之间的协作。在城镇/乡村，LTCI服务提供者指导等活动的执行率较低，这表明需要县级卫生中心的支持。
