Population aging has been a global concern for a few decades, and Japan is one of the leading nations, in which nearly 28% of citizens are aged 65 or over in 2017; it is estimated that the percentage of the elders in Japan will increase to 35% by 2040. Along with its aging society, Japan has faced various challenges in health care systems, and there are considerable and various demands of nursing care in order to meet the needs of the elderly. For example, nursing and health care policy in Japan have focused more on enhancing the capacity of providing comprehensive health care services including promotion, prevention, and rehabilitation to maximize health of the elderly. Moreover, the situation of population aging in rural and remote areas is worse than that in urban areas in Japan, especially in the remote islands in which the elderly experience great difficulties in accessing quality health care due to the lack of health resources.
In order to meet growing demands of various health care needs, a first graduate program for nurse practitioner was established in 2008 in Japan. Since then, 359 nurse practitioners have been produced nationwide in Japan. Japanese nurse practitioners are expected to contribute to providing comprehensive and quality nursing care to the elders. Nevertheless, the policy regarding Japanese nurse practitioners are rather ambiguous. In fact, there is no national qualification and license for nurse practitioners even though the law allows nurse practitioners to perform 38 kinds of specific medical procedures. Compared to their counterparts in other countries, Japanese nurse practitioners have a very limited scope of practice and autonomy; they have to be under supervision of medical doctors. The extent of procedures nurse practitioners could perform are determined solely at the discretion of the policy of each facility or each supervised doctor, and their performed-procedures are merely regarded as a substitute of medical doctors. Therefore, it can be said that the nature and characteristics of work activities of Japanese nurse practitioners remains unclear.
There are a few research studies investigating activities of nurse practitioners in home health care services or comparing assessment skills between nurses and nurse practitioners in Japan; however, no study focuses on their clinical thinking process. It is said that a nurse’s judgment is at the heart of care delivery, and clinical judgment and decision making are considered as key attributes for professional and evidence-based nursing practice. They guide actions of nurses, promoting not only safe, effective, and ethical care to patients but also an efficient leadership in health care team.
In order to build a solid theoretical base for nurse practitioner education, it would be necessary to clarify actual characteristics of work activities as well as to delineate a thinking process of clinical judgment and decision making of Japanese nurse practitioners. This study attempts to illustrate a conceptual model of the thinking process when nurse practitioners uses on a day to day clinical practice.
Methods：
A qualitative descriptive research design was employed in this study. Five nurse practitioners were recruited to participate in this study. Selection criteria of the participants include (1)currently working as a nurse practitioner who has passed the NP qualification exam offered by the Japanese Organization Nurse Practitioner Faculties (JONPF) and holds a master’s degree, (2)having at least one-year clinical experience as a nurse practitioner, and (3)living as well as practicing nursing care at a medical facility in rural remote islands. It is expected that nurse practitioners who reside in remote islands tend to provide health care from a more comprehensive perspective and possess a more authority in organizations due to the shortage of primary care physicians in those areas.
Data were collected through systematic observations of the participants, in which a researcher accompanied with each participant in his or her medical facility for at least three full workdays and recorded his or her behaviors, communication patterns, assessment methods, and characteristics of thinking process using semi-structured field notes. The field notes were analyzed using qualitative content analysis methods. To ensure the accuracy of the data recorded and clarify the participants’ thoughts, a short interview was further conducted.
Prior to conducting this research, a necessary IRB approval was obtained.
Results:
Analyses of the data in this study is currently in process and will be completed during spring 2019.
Implications:
The results of this study will serve as a basis for improving quality of nurse practitioner education in Japan. It is expected to be an effective guideline to help graduate nurse practitioner students to assess, judge, make a decision, and provide sound nursing care for patients. This study will help facilitate development of solid and sound foundations for academic program of nurse practitioners in Japan.
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