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[A qualitative study on perceived changes and improvement in the current state of public health activities of public health nurses in Hokkaido, Japan].

OBJECTIVES
This study aimed to clarify perceived changes in the current state of public health activities by Japanese public health nurses, and further to gather their ideas and proposals for coping with changes from a public health point of view considering the community as a whole.


METHODS
Three separate focus group discussions (FGD) were conducted among public health nurses who had at least five years work experience at prefectural public health centers or municipalities in Hokkaido, Japan. Dialogs were analyzed using the qualitative research method developed by Berelson.


RESULTS
Changes in the current work situation that twenty four public health nurses perceived through the FGD were categorized into the following five categories, along with their opinions on how to cope with them. First, both the system and curriculum at nursing schools in Japan have recently changed and issues remain on postgraduate education for newly graduated public health nurses as well as those with more experience. Second, job content has been transformed because of public health reform, which resulted in a growing burden on public health nurses due to an increase in workload, collaboration with clerical staff, and allocation of designated tasks. Increased liaison with office staff and regional personnel was suggested as a solution for coping with the work burden. Third, psychological changes in public health nurses were emphasized, especially worry and anxiety arising from changes in their social role, motivation and community health activities. To overcome such a distressed mental state, they believed they needed to improve awareness of their capability as public health specialists, with better real communication among themselves. Finally, focus group members identified how prefectural and municipal health systems as well as the sense of community had gradually changed. Strengthening interactions both between and within systems as well as acting locally were acknowledged as means of mitigating the disadvantages of change.


CONCLUSION
This study indicated that to deal with the drastically changing situation in the current community health system, postgraduate education promotion for public health nurses, a redefinition of their mission with more emphasis on self-motivation, sharing worries among colleagues, reinforcing communication with clerical staff as well as the institutions and people concerned, and a reconstruction of the relationship between municipalities and provincial public health centers may be necessary.