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International Challenges in Community Nursing Research

Posted on: Wednesday, 30 November 2005, 06:00 CST

By Adams, Cheryll

COMMUNITY HEALTH NURSING CONFERENCE

The Third International Conference on Community Health Nursing Research was hosted in Tokyo, Japan by the Japan Academy of Community Health Nursing Research and convened by CPHVA members Rosamund Bryar and Sally Kendall. CHERYLL ADAMS reports on what proved to be an invaluable insight into alternative ways of working, and the challenges faced by our community nursing colleagues across the globe

Tokyo, Japan was the venue for the recent International Conference on Community Health Nursing Research (ICCHNR). Hosted by the Japan Academy of Community Health Nursing, the conference was convened by CPHVA members Professors Rosamund Bryar and Sally Kendall with the support of an international organising committee.

The conference took place over three days and included keynote speeches, oral presentations, workshops, research design sessions, poster presentations and networking sessions. Many members of the CPHVA research community read papers. In all 573 delegates attended from 21 countries spanning the globe. The conference was followed by a study tour providing an opportunity to see at first hand the delivery of public health and community nursing in Japan.

A cultural experience

The Japanese culture is certainly very different from our own and it was exciting to have the opportunity to embrace and learn about it. Perhaps the most challenging aspect was the food and lack of access to English translations when making choices!

Of importance for conference delegates was understanding the protocol required for the exchange of business cards. Cards are usually exchanged immediately following initial introductions. They are held in both hands when given and the Japanese would insist on keeping their hands lower than those of their foreign visitors as a mark of respect. It is considered rude to write on visiting cards, unlike in the UK.

The Japanese are very hospitable and UK delegates really admired the fact that so many Japanese presenters made the effort to present in English despite often having little command of the language. Professor Sally Kendall's opening remarks in Japanese to launch the conference were greeted by rapturous applause by both the Japanese and her British supporters. It was an impressive performance. She paid tribute to Lisbeth Hockey, one of the UK's most respected nurse researchers who founded the ICCHNR in 1993 to promote the development of community nursing internationally. Lisbeth died last year at the age of 86.

Addressing the challenges of old age

Thought-provoking keynotes speeches were delivered by Professor Karen Luker from Manchester, England, Jeanne Bisner from Calgary, Canada and Professor Setsu Shimanouchi from Japan, the conference chairperson. All looked at issues around the development and delivery of quality services.

The 128 oral presentations spanned the whole age range for healthcare delivery providing much of interest to every delegate, but there was a significant focus on research into the community nurse and public health needs of the elderly, which are prioritised in Japan.

It was important for the UK health visiting delegates to remember just how much can be achieved from public health approaches addressing the challenges of old age. These have been largely lost in health visiting by the focus on childhood over the past 10 years. District nursing delegates also found these papers interesting, admitting that while trained in public health approaches their clinical demands rarely allow them time to undertake preventive strategies. While old age still commands enormous respect in the East, it was obvious that with most young couples now both working, Japan faces similar challenges to the UK in maintaining elderly relatives in their own homes.

The Japanese are tackling this by developing strategies for keeping the elderly healthy such as through exercise and mental stimulation. Traditionally it has been the norm for the frail elderly to be encouraged to stay in bed where they will be looked after by their relatives. Enormous public health nursing efforts are now focused on overturning this tradition and encouraging the frail elderly to lead fit and independent lives. Faced with similar financial challenges to ourselves in supporting an ageing population the Japanese have implemented a long-term care insurance system to help reduce the burden of care.

Saved by the bell

There are many memorable moments from the conference, such as the Japanese Hat Dance delivered by public health students during the welcome reception. This dance is used as a means of exercise, the hats representing dumbbells. The dancers were accompanied by their tutors who provided traditional music and sang.

Delegates had been warned that they must keep their presentations to time and allow five minutes for questions. I don't think any of us, however, had anticipated how strictly this would be enforced! One helper was assigned to each presentation session with a stopwatch and loud bell. This was rung two minutes before the end of the allotted speaking time, at time, and again at the end of questions. It was certainly an efficient system for stopping papers from over-running and reducing the time for subsequent speakers. We may consider a similar system for the CPHVA conferences.

Key conference themes

Themes come out of most conferences. For me in Japan these were:

* how much can be learnt from other methods of Healthcare delivery;

* reinforcement of the need for health visitors to keep their main activities 'upstream' focusing on primary prevention;

* a reminder that being very old doesn't have to equate with a loss of fitness, a social life and independence. In particular, the role of primary prevention in older people, which can make a real difference to reducing health expenditure, was highlighted;

* the real contribution health visitors and nurses can, and do, make to developing evidence to underpin practice;

* that it's not enough to have the evidence, we must get much better at implementing it;

* the need for more research focused on areas identified by healthcare users;

* the challenges all western nations are facing from changing demography with falling birth rates and increasing longevity and the need to research more effective ways to respond.

Presentation highlights

Some research papers had a particular impact on me and may be of interest.

Sharon De Goeas and Kay Aranda from Brighton University have involved consumers in every stage of specialist practice training, which has proved a very challenging piece of work. The doctoral work of Carol Taylor, from Manchester Metropolitan University, demonstrated that, rather than relying on robust research findings, nurses favour using their colleagues and information from pharmaceutical companies when developing their practice.

Amy and Richard McCutcheon from Canada demonstrated that, however effective the leadership style, there is an optimum size for span of control for delivering effective management in healthcare organisations. This is particularly significant in the light of current changes in the NHS with a reduction in the number of managers and increase in their span of control.

CPHVA members Christine Bidmead and Sarah Cowley's paper on evaluating the family partnership model of health visiting training was also thought provoking.

There were also a large number of pieces of interesting Japanese research into community practice. I particularly enjoyed Kijomi Ashara's paper which made a good case when describing the similarities between community health nursing and ethnography.

It was also very interesting to participate in a workshop attempting to develop and clarify terminology for public health nursing activity in Japan. What came out as a priority from this and other presentations across the span of community nursing was the absolute necessity for the nurse to develop a relationship with the client in order to deliver quality, client-focused care.

Supporting nursing research

The CPHVA hosted a workshop looking at the support professional bodies can offer the development of community nursing research. I presented papers on the D-SCOVOR research project (supported by CPHVA), led by King's College, London, which looked at what health visitors are doing in practice, and an analysis of the education and training needs of health visitors in relation to primary mental health promotion. The findings of both projects will be published over the next few months.

It is intended that keynote papers from the ICCHNR conference will be published in the journal Primary Care, Research and Development next year.

The conference was followed by a study tour for interested delegates. It started with a presentation from the President of the Japanese Nursing Association, who described the health challenges Japan is facing and how the public health and community nursing services are seeking to address them. My group then visited the suburb of Setagaya in Tokyo. We observed two different types of exercise group for the elderly, promoting the maintenance of independent living. The day finished with a lengthy question-and- answer session with public health nurses and group facilitators. During this we learnt that new mothers in Japan spend five days in hospital post-delivery and all expect to breastfeed.

Health challenges in Japan

The main public health challenges in Japan are a rapidly increasing elderly popul\ation, increasing rates of cancer and cardiovascular disease, infections such as SARS, natural disasters such as earthquakes and a terrorist threat. Japan seems very proactive in learning to manage the health demands of an increasingly elderly population; life expectancy for women there is 85.3 years. There are currently 22 million elderly people in Japan and this is expected to increase by a further 10 million over the next 10 years. They are also about to confront how to manage the falling birth rate which has dropped from an average of 4.3 babies per family after the second World War to 1.29 babies today.

Public health nursing in Japan

There are many overlaps between health visiting in the UK and public health nursing in Japan. Public health nurses provide a family-focused public health service that is targeted at all parts of the population. They seem much more closely aligned with local authority departments and have a high degree of autonomy, assessing needs, involving all stakeholders (including the public) in planning strategies and then lead on implementation of these strategies. This seems to include planning for the public health consequences of natural disasters.

They also support families in the home, arrange developmental screening, meet the needs of mothers with postnatal depression and manage families where there are child protection or domestic violence issues. Work with other parts of the population may involve individual contact at the level of needs assessment. More time is focused on developing population level health strategies and assuring their implementation by a wide range of professionals. Certainly, according to a presentation by senior members of the government and Japanese Nursing Association, public health nurses are very highly respected in Japan.

All public health nurses have a nursing qualification at graduate level and then do at least one year's additional training in public health. They must obtain a public health licence before they are able to practice.

There are many positive outcomes for the professional and their work through attending international conferences. Future ICCHNR conferences include a symposium in Spain in 2007 and the Fourth International Conference, to be held in Adelaide, Australia in 2009. I do hope this report will encourage others to try to attend these events

Enormous public health nursing efforts are now focused on overturning this tradition and encouraging the frail elderly to lead fit and independent lives

Public health nurses [in Japan] provide a family-focused service that is targeted at all parts of the population. They seem much more closely aligned with local authority departments and have a high degree of autonomy

Cheryll Adams is CPHVA professional officer for research and practice development

Copyright TG Scott & Son Ltd. Nov 2005

Source: Community Practitioner

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