Developing an Educational Program for Ultrasound Hip Screening during Newborn and Infant Home Visits: A Protocol Paper.

Ultrasound hip screening is suitable for the early identification of developmental dysplasia of the hip (DDH). Newborn and infant home visits are good opportunities for hip screening in the community, but studies focusing on nurse-led screenings are lacking. Based on a pre-post design, this study aims to develop and evaluate an ultrasound training program to improve nurses' assessment skills in detecting DDH cases during newborn and infant home visits. Said educational program will include e-learning, hands-on seminars, and clinical training. The primary outcome will be the success rate of imaging standard planes (standardized images for hip assessment) in clinical training. The secondary outcomes will include knowledge test results, objective structured clinical examination scores, time required for imaging, and inter-rater reliability between nurses and physicians. The educational program will address the issue of missed and late detection of DDH cases in resource-limited communities. This study will demonstrate the feasibility of procedures and the effectiveness of the educational program in 2024. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry before starting the study (no. UMIN000051929, 16 August 2023).

Predictors of parenting difficulties at the 18-month health checkups: A retrospective study using administrative data from infant health checkups.

OBJECTIVE: This study aimed to identify predictors of parenting difficulties at 18 months from the results of the 4-, 6-7-, and 9-10-month infant health checkups among caregivers who had not experienced difficulties at 4 months. DESIGN AND SAMPLES: This retrospective study used data from infant health checkups conducted in a city in Tokyo from November 2019 to October 2021. The participants were caregiver-child dyads of children who had undergone four checkups. Low birthweight, preterm, and multiple birth infants, and caregivers who experienced difficulties at 4 months were excluded. MEASUREMENTS: Data included caregiver, child-rearing environment, and child factors at the 4-, 6-7-, and 9-10-month checkups and caregivers' self-reported parenting difficulties at the 18-month checkup. RESULTS: Of the 555 caregivers, 48 (8.6%) experienced parenting difficulties at 18 months. Logistic regression analyses showed that mothers' physical condition (4 months), children being male, abnormal child growth (4 months), less than 10th percentile for children's height (6-7 and 9-10 months), and abnormal examination results (6-7 months) were significantly associated with parenting difficulties at 18 months. CONCLUSIONS: To prevent child abuse, public health nurses should consider the identified factors to detect and support caregivers with emerging parenting difficulties.

Community-Based Hip Screening for Up to Four-Month-Old Infants and Health Guidance for Their Caregivers in Japan: A Nation-Wide Survey.

Early detection of developmental dysplasia of the hip (DDH) in children is crucial. Due to COVID-19, maternal and child health services have been suspended temporarily, increasing the risk of late detection of DDH. This study aimed to reveal Japan's current situation regarding community hip screening for newborns and infants and to provide health guidance for caregivers regarding DDH. A web-based, nationwide cross-sectional survey was conducted between February and March 2023 (n = 1737). One public health nurse overseeing maternal and child health per municipality responded to the 2022 municipality hip screening system. Among the 436 municipalities that responded (response rate: 25.1%), 97.5% implemented hip screening within 4 months, and approximately 60% performed it during newborn home visits, while only 2.3% conducted hip ultrasound screening. Perfect checking of the risk factors for DDH during newborn home visits and training opportunities for home visitors must be improved. Educational programs regarding DDH for home visitors and caregivers are needed to prevent the late diagnosis of DDH. Furthermore, collaboration between pediatric orthopedic surgeons and nurses is crucial for developing effective community-based hip-screening systems by bridging the evidence and practice gap in the early detection of DDH.

Effectiveness of a web-based learning program for promoting local healthcare planning competencies.

OBJECTIVE: To determine the effectiveness of a web-based educational program regarding local healthcare planning by public health nurses (PHNs) in Japan. DESIGN: A single-blind randomized controlled trial. SAMPLE: Full-time PHNs working for local governments across Japan. MEASUREMENTS: The primary outcome was nurses' self-perception of competencies in public health policy. The secondary outcome was self-perception of knowledge, skills, and perspectives regarding local healthcare planning. We analyzed intergroup differences using the intention-to-treat principle and the Mann-Whitney U-test. INTERVENTION: The intervention group received six web-based learning modules including substantial knowledge and skills regarding local healthcare planning based on the analysis, design, development, implementation, and evaluation model and adult learning theory. RESULTS: Totally, 273 PHNs registered, and 38 were excluded without completing the baseline survey; 235 were randomly allocated to either the intervention (n = 118) or control (n = 117) groups. Sixty-four participants in the intervention group completed the program. Over 70% of the participants lacked opportunities to learn about local healthcare planning. The intervention group showed significant improvement in self-perception of competencies, knowledge, and skills regarding local healthcare planning, except for items related to evaluation. CONCLUSIONS: The web-based learning program effectively improved participants' self-perception of competencies in local healthcare planning.

New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design.

BACKGROUND: Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients' and nursing interventions' classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan's lagging digitalization, supervisory PHNs face difficulties in monitoring each department's activities and staff members' performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices. OBJECTIVE: We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices. METHODS: We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system's architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments. RESULTS: This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones. CONCLUSIONS: This study will reveal PHNs' tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management. TRIAL REGISTRATION: UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45342.

Effect of the third dose of BNT162b2 COVID-19 mRNA vaccine on anti-SARS-CoV-2 antibody levels in healthcare workers.

PURPOSE: Administration of three doses of Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine was completed in Japan in the spring of 2022. This study aimed to evaluate the antibody responses, and kinetics of three doses of vaccine in healthcare workers (HCWs). PATIENTS AND METHODS: We conducted a longitudinal cohort study with HCWs, who had no history of COVID-19 or serologic evidence of SARS-CoV-2 infection, from a single hospital. Immunoglobulin G (IgG) titers of anti-SARS-CoV-2 spike protein (SP) and nucleocapsid protein (NP) titers were measured using an automated chemiluminescent enzyme immunoassay system. RESULTS: A total of 636 HCWs participated in the study. The anti-SP IgG titers decreased slowly after the second dose of the BNT162b2 vaccine in all participants, and robust antibody response was observed after the third dose of the vaccine. The peak anti-SP IgG titer after the third dose was approximately 4.1-fold higher than that after the first and second doses, and the rate of decrease in the anti-SP IgG titer after the third dose was significantly more gradual, than that after the second dose. After the second dose of vaccine, the antibody response was weaker in older participants than in younger participants, and in males than in females respectively, whereas the response to the third dose of vaccine did not differ significantly by sex or age. Adverse events following immunization were generally mild to moderate. CONCLUSION: The third dose of the BNT162b2 vaccine induced a significant and sustained increase in anti-SP IgG titers, and was generally safe and well-tolerated.

Association between public health nurses' involvement in local healthcare planning and the corresponding off-the-job training.

OBJECTIVE: This study investigated the association between receiving off-the-job training and the involvement of public health nurses in local healthcare planning. DESIGN: A nationwide, cross-sectional study design. METHODS: We sent self-report questionnaires to 2,185 public health nurses with experience in developing local healthcare plans in Japan since 2013 and collected information related to three main categories: demographic data, involvement in local healthcare planning and strategies for healthcare planning. RESULTS: We received 1,281 responses (return rate of 58.6%), of which 231 did not meet the inclusion criteria. Thus, we analysed 1,050 valid responses. Among the 1,050 respondents, 496 (47.2%) had received off-the-job training in healthcare planning. A subsequent logistic regression analysis revealed that the following factors were associated with this achievement: holding a managerial position, receiving healthcare planning education at the undergraduate level, having mentors regarding the promotion of it, partially conducting cross-sectional coordination and conducting groupwork with community-dwelling residents.

Factors of Parental Preparation of Children with Mental Illnesses for Their Independent Living after Their Own Death.

Families of children with mental illnesses are often concerned about living in the community after their parents' death. The cross-sectional study aimed to examine the association between how parents prepare adult children with mental illnesses to live independently after the death of the parent(s). The participants were 1112 members of 46 family support groups for mental illnesses in Tokyo, Japan. The age of the people with mental illness was 40s, and that of their parents was 70s. Logistic regression analysis showed that mothers' support in daily living, no income or pension for disabled people, staying at home during free time, and parental livelihood being the same as the person with mental illness were factors that were negatively associated with the independent living of people with mental illness. In contrast, parental participation in the family group and creating a system for securing regular living expenses of the person with mental illness were positively associated with independent living. The results suggest that parents need to promote their children's recovery and prepare them financially by forecasting their independent living after their own death.

Developing a Virtual Reality Simulation Program for Improving Nursing Students' Clinical Reasoning Skills in Home Settings: A Protocol Paper.

Most nursing simulation programs focus on persons' healthcare needs in hospital settings, and little is known about how to identify them in home settings. This study aims to develop and validate a virtual reality (VR) simulation program for nursing students to improve their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings. We developed a VR simulation program based on a literature review and expert discussion. In Phase 1, home visit nurses or public health nurses will validate the program through their interviews in 2022. In Phase 2, we will conduct a pilot and main single-blinded randomized trial for nursing students to confirm the effectiveness from 2022 and 2023. Participants will be randomly allocated into an intervention group using VR simulations and a control group receiving videos regarding three kinds of community residents' lives [1:1]. After obtaining informed consent, the students will submit their anonymous data to the researchers to prevent associating their grade evaluation. The primary outcome will be their clinical reasoning skills. The second outcome will include their satisfaction and self-confidence. This study will examine the effectiveness of improving their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings.

Evaluation of Infant Injury Prevention Education Provided during Antenatal Classes after Two Years: A Pilot Prospective Cohort Study.

This study examined the long-term effects of an infant injury prevention program implemented during an antenatal class of 131 mothers. Questionnaires were completed 2 years postpartum to assess the incidence of injury (medically attended or home-care), mothers' perception of injury prevention, implementation of safety practices, and active attitudes toward injury prevention. Responses were obtained from 68 (51.9%) mothers (intervention group, 40; control group, 28), including 24 who reported medically attended injuries and 55 who reported home-care injuries. The incidence of medically attended injuries did not differ between groups. The incidence of home-care injuries was also not significantly different, but was lower in the intervention group (72.5% vs. 92.9%, p = 0.050). Significantly fewer children in the intervention group experienced "injury due to being caught between objects" (12.5% vs. 39.3%, p = 0.014). Mothers in the intervention group were significantly more aware of injury prevention than those in the control group (p = 0.033). The risk of home-care injuries was inversely related to mothers' injury-prevention perception (odds ratio [OR]: 0.55, p = 0.035). This study suggests that group education during pregnancy regarding injury prevention increases mothers' perception of injury prevention. These findings support implementing injury prevention education during antenatal classes.

Can Outpatient Rehabilitation Be Continued During the COVID-19 Pandemic? A Report from a Japanese Regional Medical University Hospital.

Objective: To describe the operation of an outpatient rehabilitation practice at a Japanese hospital severely affected by the coronavirus disease 2019 (COVID-19) pandemic. Design: Analytical observational study. Setting: Outpatient rehabilitation department in Saitama, Japan. Participants: Number (N=953) of outpatients from January 2019 to July 2021. Interventions: Not applicable. Main Outcome Measures: This paper begins with a review of the infection control measures that were initiated after declaration of a state of emergency in April 2020. The effects of the pandemic were then examined by comparing the daily average number of outpatients from January 2020 to July 2021 with that noted for the same duration during 2019. Results: In April 2020, the average daily number of patients decreased by 77.1% compared with the number in 2019 and was further decreased by 65.7% and 63.7% in May and June 2020, respectively. The time limitations on rehabilitation were lifted in June, and the number of patients increased by 82.3% in July 2020. Thereafter, it remained at approximately 80% throughout the rest of the year compared with that noted in 2019. From January 2021 to July 2021, the number of patients approached the number noted during normal practice or was even higher. Conclusions: The implementation of infection control measures, adjustments to procedures, and widespread vaccination permitted the continuation of our outpatient practice.

Feasibility of an educational program for public health nurses to promote local healthcare planning: protocol for a pilot randomized controlled trial.

BACKGROUND: Promoting of local healthcare planning is crucial for assisting public health nurses in improving community health inequities. However, there is no effective educational program for developing relevant skills and knowledge among these nurses. Therefore, this study aims to assess the feasibility of a newly developed web-based self-learning program to promote the involvement of public health nurses in the local healthcare planning process. METHODS: A pilot randomized control trial randomly allocated eligible public health nurses to intervention and control wait-list groups [1:1]. The former will be exposed to six web-based learning modules from July to October 2021. After collecting post-test data, the wait-list group will be exposed to the same modules to ensure learning equity. The primary outcome will be evaluated by implementing a validated and standardized scale designed to measure public health policy competencies at the baseline and post-intervention, while secondary outcome will be measured on an action scale to demonstrate the necessity of healthcare activities. The third outcome will be the knowledge and skills related to local healthcare planning by public health nurses. The participants will provide feedback through free descriptions on the trial feasibility and a web-based self-learning program to identify improvement points for continual refinement. DISCUSSION: The results will provide suggestions in preparation for a future definitive randomized controlled trial. This will provide preliminary data for an intervention aimed at improving relevant competencies among public health nurses who are tasked with resolving health inequities in their respective communities through local health planning. TRIAL REGISTRATION: The protocol for this study was registered with the University Hospital Medical Information Network Clinical Trials Registry and approved by the International Committee of Medical Journal Editors (No. UMIN000043628 , March 23, 2021).

Prefectural public health nurses' support in human resource development of municipal public health nurses in Japan.

Objective　This study aimed to explore the support extended by prefectural public health nurses (PHNs) toward the human resource development (HRD) of municipal PHNs in Japan.Methods　We performed a qualitative descriptive study involving nine prefectural PHNs from April 2019 to May 2020. The data were collected through semi-structured interviews using an interview guide, described qualitatively, coded, and then categorized.Results　Five categories were extracted. "Clarifying the needs and problems related to HRD and daily PHN activities in the municipalities," "Creating an environment where all municipal PHNs have equal opportunities for off-the-job training," and "Helping municipal PHNs recognize the meaning of practice and develop an evaluation perspective" were extracted from the prefectural government PHNs and prefectural health center (HC) PHNs. "Clarifying problems and future prospects to encourage the growth of PHNs" and "Creating an environment where the significance and value of the activities of PHNs are recognized within the organization and HRD can easily take place" were extracted from the HC PHNs.Conclusion　Much of the HRD support provided by the prefectural PHNs to the municipal PHNs was analogous to the PHN activities provided to the community and residents. To promote HRD effectively, prefectural PHNs should apply their individual care skills to the HRD of municipal PHNs.

Factors associated with the utilization of community assessment models among Japanese nurses.

OBJECTIVES: This study aimed to identify factors related to the practical utilization of community health needs assessment (CHNA) models that public health nurses (PHNs) learned in their fundamental education. DESIGN: A nationwide questionnaire survey was conducted via postal mail. SAMPLE: We randomly selected 630 public health institutes in Japan. The participants were 3397 full-time novice and mid-level PHNs. MEASUREMENTS: The questionnaire included the participants' basic personal information, six items regarding the perception of CHNA with a 4-point Likert scale, learned models in their undergraduate education, their utilization in practical settings, and the reasons for their answer in narrative form. RESULTS: There were 951 valid responses. The results of logistic regression showed that the significant positively factors with model utilization were perception of CHNA as "not troublesome" or "not impossible as they learned," continuing education with 5 years of experience, and identification of the learned model in continuing education. Furthermore, the results of text mining showed the reasons for non-utilization of the model included being "busy" and having a lack of "opportunity." CONCLUSIONS: This study showed the associated factors with rare utilization of a learned model for PHNs. These findings may suggest improvement of continuing education and development of an appropriate assessment model.

Mothers susceptible to child maltreatment and requiring public health nurses' continuous support.

OBJECTIVE: This study aimed to identify the characteristics of mothers who are at a high risk for future child maltreatment and therefore, require continuous support from public health nurses (PHNs) to prevent child maltreatment and those who do not require it. DESIGN AND SAMPLES: This retrospective cross-sectional study included women who were registered in 2018 for being at risk for future child maltreatment and required help with childrearing in City A within the Tokyo metropolis. MEASUREMENTS: Public health nurses registered data pertaining to each mother, including demographic data, family-related variables, assessment by PHNs, use of maternal and child healthcare services, and continuity of support from PHNs. RESULTS: Of the 206 cases, the discontinued group-comprising those who no longer needed PHNs' support-included 83 cases (40.3%) and the continuing group-comprising those needed continuing support-included 123 cases (59.7%). Logistic regression analysis showed that those with marital conflicts, maternal mental instability, lack of parenting skills, and not moving out of the city were more likely to require continuous PHNs' support. CONCLUSIONS: By identifying these factors, PHNs can identify new mothers who need continuous support and provide more concentrated care for them. Thus, support from PHNs can help prevent child maltreatment.

Confusions and responses of managerial public health nurses during the COVID-19 pandemic in Japan.

OBJECTIVE: This study aimed to elucidate the experiences of public health nurses (PHNs) in Japan during the first wave of COVID-19. DESIGN AND SAMPLE: Twelve PHNs in charge of responding to COVID-19 in X-city within Tokyo metropolis in Japan participated in this case study. MEASUREMENTS: Data were collected through self-administered questionnaires and semi-structured interviews on PHNs' experiences from January 2020 to May 2020. RESULTS: Initially, only infectious disease control division (IDCD) PHNs experienced confusion due to the rapidly increased workload. Managerial PHNs attempted to explain the need for a dispatch system for the IDCD, using available statistical data from other managerial members, within one's maximum understanding of this unprecedented situation. Without having a clear and forward-looking understanding regarding the purpose and reasons for dispatching, some dispatched PHNs had concerns and frustrations; they did not view the COVID-19 pandemic as a disaster. In the never-ending, exhausting work, PHNs managed to modify the provision of conventional services to residents. CONCLUSIONS: Despite experiencing confusion, PHNs worked to continuously provide community services, re-considering the meaning of public health nursing. Prioritizing the work and shifting tasks to other professionals at an early stage of the pandemic may prevent organizational dysfunction.

Content Analysis of the Free COVID-19 Telephone Consultations Available during the First Wave of the Pandemic in Japan.

This cross-sectional study aimed to (1) describe the unclassified contents of telephone consultation services provided by a public health center during the first wave of COVID-19 in Japan and (2) examine whether the contents required assistance from public health nurses (PHNs). We analyzed a total of 207 calls in which the purpose of the call was unclassified into pre-set categories. PHNs transcribed the exact text of the consultation conversations recorded from 25 March to 20 April 2020 in City A. Approximately half of the calls were from residents. Seven categories were extracted through a qualitative content analysis. The most common topic was infection control measures, where the presence of COVID-19 infection was assumed (n = 62); the second most common was extreme anxiety and fear of infection (n = 50). Questions about the COVID-19 response system (n = 30), discrimination and misunderstandings about COVID-19 (n = 24), and response measures for COVID-19 outbreaks within organizations (n = 18) were also included. The unclassified consultations included various topics, several of which required the expertise of a PHN. Each local government should consider sharing and task-shifting telephone consultation services among PHNs and other staff to reduce their burden and allow them to concentrate on conducting infection control more effectively.