Current Nursing Values and Theory Global Health Nursing: A New Discipline in Japan

1. Korea Sigma Thea Tau International Conference Current Nursing Values and TheoryGlobal Health Nursing:A New Discipline in Japan Junko Tashiro, RN. PhD WHO 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

2. 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

3. 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

4. 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.

5. Current Global Health Issues: Child (under-five) Mortality Rate • per 1000 live births • Source: The Millennium Development Goals Reports

6. Current Global Health Issues:Maternal Mortality Rate per 100,000 live births Source: The Millennium Development Goals Reports2009

7. “ 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

8. 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

9. Four Domains of PCHC Domain 1: For individuals, patients and their families, and community Domain 2: For health practitioners Domain 3: In health care organizations Domain 4: In health systems

10. 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

11. 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

12. Health Trends and Phases in Japan: Health of the People

13. Current Health Issues:The Aging Society of Japan (Health and Welfare Statistic Association, 2007)

14. Health Promotion Movement “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 implementers Long-term Care Insurance System started in 2000 The health promotion law was enforced on May, 2003

15. Changes of Nursing Practice Model in Chuo-ku, Tokyo Health Transition:Phase IPhase IIPhase III Top-downService Providing Triangle Policy Maker Nurse Community People Community People Nurse Health Counseling Community People Nurse Participating Community People Supporter Supporter Nurse Networking & Collaboration Coordinating Community People Community People Supporter Supporter Nurse Resource Social Welfare Health Medicine Nurse

16. Networking & Collaboration Model Medical Care Clinics Long-term care Hospitals Visiting Nursing Stations SocialWelfare Homes for Elderly Health Centers for Elderly Clients, Families, Community, Nurses Health Care Community health centers

17. 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,

18. Community-based Participatory Research 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 Care 2.Health Promotion Service & Strategy Development and Evaluation ・Program Development for Healthy Families ・Nursing Practice Development for International Collaboration ・Know Your Body Program for Preschoolers & Families 3.Health information system：”Kango-net”http://www.kango-net.jp

19. Schematic Diagram of People-centered Care People Healthcare specialists Policy makers Application and assessment of nursing service Collection, dissemination, exchange of health information Nursing service assessment & development Nursing service provision strategy development and research Nursing practice research and development studies Research Center for Development of Nursing Practice Graduate School of Nursing Doctoral Course WHO PHC Nursing Development Collaboration Center

20. 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

21. Conceptual Framework of People-centered Care A society based on a sense of security and good health People-centered Care System Individuals/Families Communities A system of collaborative solutions based on partnerships （Collaborative Solutions） active participation in the decision making process resourceful community health-promoting community wise use of health information

22. 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

23. Overview of People-centered Care Initiatives Knowledge Skills Decision making Trust Sharing Partnership Mutual-leadership Collaboration Partners Formation, Network formation; System formation Health Promotion Problems with advanced medicine and nursing Coping with illness and nursing Social problems and nursing

24. Schematic Diagram of People-centered Care Networking lay experts of health Care Shaping public opinion on health Health-promoting community Kango-net Promotion of community- based participatory research “Community Health Station” (the base of collaborative practice in partnership with people) Production of useful health information Research Center for Development of Nursing Practice Graduate School of Nursing Doctoral Course WHO PHC Nursing Development Collaboration Center

25. 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

26. 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 Global communities Japan People-centered in Local Community

27. 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

28. 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 PHC St. Luke’s College of Nursing, Tokyo, Japan Junko 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)

29. 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.

30. 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.

31. 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.

32. 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 basicknowledge 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.

33. A Model of Competencies of International Nursing Collaborators (Experts )

34. Competencies and Educational Content for Undergraduates Personal & Basic Knowledge Educational Content &Competencies

35. Data-Driven Competencies for International Nursing Collaborator • Information gathering • Problem Analysis • Planning • Problem Solving • Management • Networking • Evaluation

36. 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.

37. 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.

38. 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

39. Core Courses (6 Credit hours) • Introduction to international nursing (2) • International nursing collaboration (2) • Comparative nursing research (2)

40. 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)

41. . Thesis Research (8) Major fields (12) 2nd Year Practicum (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) 1st Year Basic Subjects (12) 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), Fig. Global Health Nursing Curriculum Diagram

42. 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.

43. 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

44. 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