Formulation, Implementation, and Evaluation of Health, Medical, and Welfare Plans: The #1 Skill Required of Public Health Nurses (Part 1)

This is the first part of the lecture on the formulation, implementation, and evaluation of health, medical, and welfare plans, which I gave at the Miyazaki Prefectural Nursing University graduate school.

The minutes are based on those created by the AI voice recorder Plaud.

1. Medical issues facing Miyazaki Prefecture

1.1 Demographic changes: Intensifying population decline and aging

Miyazaki Prefecture's population is decreasing at a rate of approximately 7,000 people per year (a scale equivalent to two towns disappearing), and it is projected to fall to 890,000 by 2040.

The population tends to concentrate in Miyazaki City or migrate out of the prefecture, and there is a particular challenge with a shortage of doctors in their 40s, who are in their prime working years.

At the same time, the population is aging; in about 20 years, the largest demographic group for men will be those aged 65-69, and there will be a significant increase in late-stage elderly people (women) aged 75 and over.

1.2 Changes in medical needs: Changes in disease structure due to aging and the necessity of nursing care coordination

Due to the aging population, medical needs are changing significantly.

- Characteristics of late-stage elderly patients: They face issues such as hearing loss, mild dementia, multiple concurrent diseases, and polypharmacy, and many use long-term care insurance services.

- Impact on medical care: A new flow of "nursing care facilities ⇔ acute care hospitals" is becoming mainstream, where admissions and discharges (due to pneumonia, urinary tract infections, fractures, etc.) are repeated between nursing care facilities and acute care hospitals.

- Changes in disease structure: Demand for cerebrovascular diseases, heart diseases, neurological diseases (especially dementia), and fractures is expected to increase, while cancer and diabetes are expected to remain flat, and childbirth-related cases are expected to decrease.

1.3 Issues in the medical provision system: Doctor shortages and regional disparities

Miyazaki Prefecture is the only "doctor-shortage prefecture" in Kyushu, and although the number of doctors is on an upward trend, the disparity within the prefecture is serious. While doctors are concentrated in Miyazaki City, there is a significant shortage in regions such as Hyuga/Iryu, Saito/Koyu, and Nishimoro.

The background to this is the current situation where medical students from the University of Miyazaki leave the prefecture (especially for Tokyo) after graduation.

2. The 8th Miyazaki Prefecture Medical Plan and related national plans

2.1 The direction aimed for by the 8th Miyazaki Prefecture Medical Plan

- Basic philosophy: Realization of a sustainable medical provision system where residents can receive safe, high-quality medical care without interruption.

- Priority policies:

- Utilization of digital technology: Used as a "trump card" in medical care.

- Enhancement of home medical care and nursing care systems.

- Construction of a medical system that supports the region and the training and securing of medical personnel.

- Prevention and health promotion, and the stable supply of pharmaceuticals.

- Regional Medical Vision: As a higher-level concept of the medical plan, it evaluates the functions of each hospital (such as highly acute care, acute care, etc.) and promotes the division of roles.

The current seven secondary medical areas will be maintained for the time being, but a future review has been suggested.

2.2 Prefectural Initiatives for Securing Physicians

To ensure physician retention within the prefecture and correct regional disparities, the following measures are being strongly promoted:

- Establishment of regional quotas: A regional quota of 40 students has been set for medical schools, with a requirement to work in physician-shortage areas for a certain period after graduation.

- Joint declaration by the 'Big Four': The Prefectural Superintendent of Education, the President of the University of Miyazaki, the Prefectural Governor, and the Prefectural Medical Association President have collaborated to declare support for young physicians' career development and the improvement of working environments.

- Approach to medical students: Encouraging retention within the prefecture through seminars and student loan programs starting from their time as students.

- Activities of the Regional Medical Support Organization: Supporting physicians training in Miyazaki through newspaper advertisements and public relations activities, aiming for their long-term retention in the region.

2.3 Coordination with Major National Related Plans

Medical plans can achieve higher-quality initiatives by coordinating with plans formulated by ministries other than the Ministry of Health, Labour and Welfare.

- Industrial Accident Prevention Plan: Can be utilized for fall prevention among the elderly and women, and for lower back pain countermeasures in welfare facilities (such as support for introducing lifts).

- School Health and Safety Plan: A plan formulated by each school.

- Basic Environment Plan: Includes the philosophy of the SDGs and can be coordinated with health promotion utilizing the natural environment (Health Japan 21).

- Basic Plan for Shokuiku (Food Education): Promotes local production for local consumption and allows for the development of unique food education that leverages Miyazaki Prefecture's rich food culture.

3. Plan Promotion and the Role of Public Health Nurses

3.1 Management Methods for Plan Promotion: Utilization of the PDCA Cycle and Challenges

To effectively promote a plan, the PDCA cycle—Plan, Do, Check, and Action—is effective.

However, because it focuses on improvements based on past performance, it is difficult to respond to rapid environmental changes, and there is a risk of hindering innovation.

It is important to break out of ruts and maintain an attitude of constantly incorporating new things.

Weekly Shonen Jump achieved great success by upholding three key elements to capture readers' hearts: (1) Friendship, (2) Effort, and (3) Victory.

However, it eventually led to a collection of similar manga, resulting in stagnation and reader fatigue.

It is necessary to understand the weaknesses of the PDCA cycle, such as over-application, and to run the cycle with that awareness.

3.2 The Role and Skills of Public Health Nurses Supporting the Community

Public health nurses are essential for implementing national policies (especially in the field of prevention), and the foundation of their activities lies in targeting the 'community'.

- The Desired Physician Profile and Collaboration with Public Health Nurses: In an aging society, 'general practitioners' who treat patients holistically rather than focusing on specific organs are becoming important.

Public health nurses are expected to collaborate by conveying care situations and other information to physicians to propose better treatment plans.

- 'Love for the Community' and Administrative Skills: True community medicine requires 'love for the community' to understand its history and culture, as well as 'administrative skills (PDCA)' to formulate, execute, and evaluate plans.

- Social Determinants of Health (SDH) and the Life Course Approach: Health is significantly influenced not only by individual lifestyle habits but also by social factors (SDH) such as social inequality, education, and economic status.

Furthermore, the perspective of the 'life course approach,' which posits that the accumulation of experiences from pregnancy throughout one's life (health capital) determines health status, is important.

- Principles of Disaster Medicine 'CSCATTT': In the event of a disaster, knowing the management functions of Command, Safety, Communication, and Assessment, as well as the field activity principles of Triage, Treatment, and Transport, leads to organized and calm responses.

4. Future Prospects and Actions

4.1 Utilization of DX and Technology

Digital transformation (DX) will be a powerful weapon in future public health nursing activities.

By utilizing smartphone pedometers, meal recording apps, and subscription-based health information delivery, new forms of health guidance become possible.

4.2 Practice of New Health Guidance

Advances in technology also change the content of health guidance.

For example, regarding Anisakis countermeasures, in addition to the conventional knowledge that 'wasabi and vinegar are ineffective,' conveying specific preventive methods such as 'freezing at -20°C or lower for 24 hours or more' and using 'Anisakis lights' can reduce outbreaks in the community.

4.3 What is Required of Future Medical and Health Professionals

It is important for future public health nurses and medical professionals to have their own unique strengths.

By having at least one area of expertise that can be called a 'special move,' such as being an 'online support professional' or an 'expert in health manga,' you can increase your own value and respond to the complex and diversifying needs of the public.

No matter how much the work of public health nurses expands, there is no doubt that it will continue to be developed with the 'community' as the target.