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Nursing in Japan (2016)

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Nursing in Japan (2016) Table of Content 1. Japanese Society 2 Socioeconomic situation Transition of population Health situation and trend 2. Japanese Healthcare System 4 Health insurance system and medical fee Healthcare provision system Long-term care insurance system Reforms in health and long-term care services 3. Overview of Japanese Nursing System 7 History and system Public health nurses Midwives Nurses 4. Nursing Education in Japan 10 Basic nursing education Contents of education Development of university nursing education Clinical training for newly-graduated nursing personnel Continuing education Credentialing system Training system for nurses to perform specific medical interventions 5. Working Conditions in Nursing in Japan 14 Employment status of nursing personnel Improvement of work environment References 16 Nursing in Japan 2016 01 1. Japanese Society Socioeconomic situation Japan is an advanced developed country, as with the issues of unstable employment and low shown by its G7/G20 membership. However, Japan’s wages. In 2013, non-regular employment workers economy has been stagnant since the economic accounted for 37.4% of all the employed workers bubble burst in the beginning of 1990’s. In recent excluding executives1). The increased number of years, the population decrease and population aging elderly household and unemployment caused by is progressing simultaneously. The employment socio-economic situation resulted in the upward pattern in Japan has been changed. This raises trend of public assistant recipients and the challenge the proportion of non-regular employment workers of poverty2). Transition of population Japan’s population is 127.01 million as of January (as of January 2, 2015) 3) 4) 1, 2015 , accounting for approximately 1.75% of the Men (Age) Women world’s population. over 100 95～99 After the birthrate declined around the end of World 90～94 War II, Japan’s population showed an increase, 85～89 80～84 experiencing two baby booms in 1947-49 and 1971- 75～79 74. However, the population decrease was seen 70～74 65～69 in 2005 for the first time after WW II and it showed 60～64 increase and decrease thereafter. Since 2010, the 55～59 50～54 population is on the declining trend. 45～49 Since around 1970, the elderly population has 40～44 been increasing dramatically. The proportion of 35～39 30～34 the population aged 65-year or over to the total 25～29 population was 26.5% in 20153) and will reach 39.9% 20～24 5) 15～19 in 2060 . In contrast, the proportion of the population 10～14 under 15 will decline from 12.7% in 20153) to 9.1% 5～9 5) 0～4 in 2060 . This means one in 2.5 people will be an 600 500 400 300 200 100 0 0 100200 300 400 500 600 elderly person. (10,000 persons) Figure 1: Population pyramid3) Health situation and trend Japan’s health situation has continuously improved (2013) in all health-related indicators, such as the average Live births Deaths Infant deaths Fetal deaths life expectancy of men is 80.21-year and that of (included in Deaths) women 86.61-year6), while the infant mortality rate is 2.17) as of 2013. The healthy life expectancy of men is 71.19-year and that of women 74.21-year as of 2013, which 1,029,816 1,268,436 2,185 24,102 indicates the length of life without activity limitation 1 in every 31 1 in every 25 1 in every 4hrs. 1 in every caused by health problems. Although the healthy life seconds seconds 33 seconds 21 min. 48 seconds Figure 2: Vital statistics overview9) (population per 1,000) 30.0 28.1 Fertility rate (per 1,000 births) 25.0 80.0 4.00 Mortality rate 3.65 70.0 3.50 Total fertility rate 20.0 18.6 18.8 19.4 17.2 17.1 60.0 3.00 60.1 2.37 50.0 2.50 15.0 2.14 2.00 11.9 40.0 1.75 1.76 2.00 13.6 10.0 10.1 2.13 10.9 9.6 9.5 9.5 39.8 1.54 1.91 1.42 1.36 1.39 10.0 8.6 30.0 1.26 1.50 30.7 Infant mortality rate 1.43 8.4 8.5 8.2 20.0 1.00 7.8 7.6 7.4 7.7 5.0 7.1 6.9 6.7 10.0 6.3 6.2 6.3 18.5 7.5 10.0 5.5 4.6 4.3 0.50 13.1 3.2 2.8 2.3 2.1 0 0.00 0.0 1950 55 60 65 70 75 80 85 90 95 2000 1005 13 1950 55 60 65 70 75 80 85 90 95 2000 05 10 13 (Year) (Year) Figure 4: Transition of infant mortality rates and total Figure 3: Transition of fertility and mortality rates7) fertility rates7) 02 Nursing in Japan 2016 expectancy is extending, the gap between healthy 2.3 million to have type C11). It has become an issue life expectancy and life expectancy are approximately since the time of infection can hardly be identified 9-year for men and 12-year for women8). As aging and the infection is often asymptomatic, patients progresses, the measures “to prolong the healthy who have not received treatment at an appropriate life expectancy” are taken which will lead the time can easily develop cirrhosis or liver cancer. In advancement of quality of people’s life and reduction addition, the number of people with mental problems of the burden of social security expenses. has also been increasing due to the stress of severe Concerning the birth trend in Japan, the birthrate work environments, including overwork, in modern (per 1,000 population) hovered in the 30s from the Japanese society. Meiji period (1868) through the beginning of the Among the in- and outpatient rates (per 100,000 Showa period (1920s). Immediately after World War population), the survey in 2011 showed that persons II, an increase in marriages triggered the first baby aged 65 or older accounted for over 68% of boom with high birthrates. However, after its peak inpatients and 46% of outpatients12). in 1950, the birthrate declined rapidly. Those who were born during the first baby boom reached their TB Malignant tumor childrearing age, showing a temporary increase in Heart disease Cerebra-vascular disease Pneumonia the birthrate during the second baby boom in 1971- 300 74. Since then, however, the birthrate has remained at a low level with some fluctuations.7) 250 The total fertility rate was 3.65 in the 1950s, but 200 declined to 1.43 in 2013. This has many possible causes. In addition to lower neonatal and infant 150 mortality rates due to advancement in health care, the decline in the 80s can be attributed to the trend 100 toward delayed marriage and increase in unmarried 50 people and in the 90s can be attributed to a change in the number of children per couple. The average 0 age of mothers giving birth to their first child was 195055 60 65 70 75 80 85 90 95 2000 05 10 13 25.7-year in 1965 and 1975, and risen to 30.4-year in Figure 5: Transition of mortality rates by the primary cause of death7) 2013.7) Although the mortality rate (crude deaths per 1,000 population) in Japan had hovered at the 20s (1,000 people) (inpatient) around the Meiji period (1868-1912), it declined to 16 age 0-14 age 15-34 age 35-64 age over 65 in 1941. After the War, the rate showed a continuous 1,000 downward trend, reaching the lowest point of 6.0 900 in 1982. However, this rate has been showing an 800 upward trend with the aging population and was 10.1 700 in 2013.7) 600 The primary cause of death was pneumonia 500 througuout the Meiji period, then it changed to 400 tuberculosis (TB). From the latter 1950s deaths 300 from TB greatly decreased and the causes of death 200 in Japan shifted significantly from communicable 100 diseases to non-communicable diseases. Since 0 1958, malignant neoplasms, heart disease and cerebral vascular disease have formed the three 1960 1965 1970 1975 1980 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 major causes of death, and currently account for approximately 60% of all deaths. Under (1,000 people) (outpatient) these circumstances, measures to prevent non- age 0-14 age 15-34 age 35-64 age over 65 communicable diseases are stressed. Amid the 3,500 ongoing population aging, efforts are taken “to 3,000 prolong the healthy life expectancy” so that people can live their life longer without activity limitation. 2,500 Although the number of deaths due to communicable 2,000 diseases has been reduced, there are still some issues like HIV/AIDS, TB and hepatitis. 1,500 The prevalence rate of TB (per 100,000 population) 1,000 reached below the 20s level in 2007 for the first time, and was 16.1 in 2013.10) Although it shows a 500 continuous downward trend, Japan is a country 0 with a medium tuberculosis epidemic in the world. Among the patients with persistent viral hepatitis, 1960 1965 1970 1975 1980 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 1.1-1.4 million are estimated to have type B and 1.9- Figure 6: Annual transition of patient estimates by age group12) Nursing in Japan 2016 03 2. Japanese Healthcare System Health insurance system and medical fee Japan’s social security system are roughly divided so that anyone can obtain appropriate healthcare into four component pillars: social insurance, social anywhere at any time.
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