How Japanese Public Health Nurses Perform Community Diagnosis?: Towards a Health Geography in Japan

We investigated the extent to which public health nurses in Japan are performing community diagnosis in terms of health geography, an area whose focus is on the relationship between health and place. From October 2006 to February 2007, we carried out semi-structured interviews to public health nurses of area "A" in central Japan. The interviews lasted from 1 to 3 hours and were conducted in two prefectural public health centers and ten municipal health centers. Our questions targeted four fundamental areas: daily duties, activity areas, extent of community diagnosis and future goals regarding community health. As a result, we found that few of the public health nurses systematically perform community diagnosis. Three reasons for this were identified: 1) their normal duties (particularly desk work) occupy most of their time, 2) they are generally poor at doing community diagnosis because of a lack of training, and 3) there is little exchange of local information among the nurses (primarily due to the frequent resignation of more knowledgeable nurses). Despite these problems, the public health nurses do have a tacit knowledge of community diagnosis acquired through community awareness and relationships outside their workplaces. This knowledge can potentially be used in forming local relationships and thus for strengthening people's confidence in community. Regarding health geography, we indicated that public health nurses have the potential to contribute to the improvement of social relationship. To realize this potential, public health nurses should practice community diagnosis and incorporate a spatial dimension (point (household) - line (relationship) - surface (area)). They should also reevaluate qualitative local information, which has been regarded as subjective and corporeal. Improvement of labor conditions for public health nurses is also needed in order to create an incentive for sharing local knowledge among them.