TB - PF - NURSING 1 
PUBLIC HEALTH NURSING;.. 
PUBLIC HEALTH AND ./ELFARE TECHNICAL • BULLETIN 
HE & W GHQ, SCAP APO 500 
February 1947 
Introduction 
1. It is difficult:to prepare a. manual to guide in *he supervision 
of the nurses and midwives', work here in Japan because the standards thought 
of are guided by American standards and the difference is very severe. It 
is far better, therefore, not tc try to compare and expect the quality cf 
service and efficiency from these nurses to that found in the United States. 
First the system under which the Japanese nurse works makes her, 
as a woman, only a. servant. Second the educational background is low and; 
third the laws under which the nurse enters the medical urofession, works, 
studies and graduates are not only low but are net enforced and,hence there 
are all varieties cf standards. Courses are from reading books in the.home 
and taking the prefectural examination-, to three or six months in a privato 
clinic or surgical hospital or being "farmed” out by an Association, up to 
a two year formal course in a hospital with one exception, that exception 
is St. Luke’s and is the only hospital in Japan that compares to American 
standards, Hot only will all varieties .of schools and methods be found, 
but ea.ch one has different curricula and methods of teaching. There arc 
often found as much as 100 hours cf stretcher drill, 150 hours of Flower 
and Tea Ceremony compared to 10 hours of Anatomy and perhaps 5 hours of 
■Communicable Disease. No special time is given to see that the student gets 
practical work on various services. Hr practice r*oms, no laboratory and 
many times only cne lecture room go tc make up the complete teaching unit 
oven in the larger hospitals. The so-called Government credited schools do 
not require a prefectural examination, but all others do and all receive 
the same license and are called graduates, either clinical or public health 
nurses or midwives. Uith this introduction to the nursing situation here 
in Japan one can understand why it is difficult to tell what the nurse in 
each prefecture can or should.be capable, of doing. She may be a St. Luke’s 
graduate, if she is, she only needs a-little guidance and help and she will 
do a beautiful job. She may-be a. public health nurse who has no conception 
of Public Health Nursing, her lack of knowledge of prevention, sanitation 
and communicable disease may even.be startling. But wherever the Japanese 
nurse is found there will be found an eager personality who is anxious to 
learn and will do as she is- instructed to do with a vim that will also be 
startling, .This lack of training is not the nurse's fault — it is the 
custom of the race and the belief of the- system under which she lives and 
has no part in the making,. . • •• ■ An outline of the duties of a. Public Health nurse and the duties 
of a midwife are presented below. Extra,cts from the Imperial Ordinance 
• which governs the midwife are also included. Later as the legislation for 
nurses and midwives goes before the Diet copies will be published and may 
be used as an an*ex to this caper. 
All standards will be raised and there will be a National Examination* 
for nurses and midwives. Qualifications for entrance into the schools of 
nursing will be sufficiently high to attract the better students and in 
this way an attempt will be made to raise the so-called present day nurse 
to the standard of a. professional person. 
The Model Demonstration school in Tokyo is a three year course and 
from this school will come leaders in nursing but it will take time. 
PUBLIC HEALTH PUBSIPG 
2. What is Public Health Pursing? 
Public health nursing is health teaching and nursing care given 
by nurses in homes, in schools, in clinics, «nd in factories, for the 
purpose of improving and protecting the health of the general population. 
The aim of public health nursing is to teach people their part in the 
prevention of serious, costly illness and unnecessary dea.th through the 
use of correct health information. 
3. What is a. Public Health Purse? 
A public health nurse is a, graduate nurse, registered to practice 
nursing, who teaches public health practices to individuals, and demon- 
strates home nprsing ca.re. Besides having an interest in people and an 
ability to work; with them, she ha.s completed special courses in public 
health to prepare her to do this work, 
4. Who decides whether or not there shall be a, public health nursing 
servi ce? 
The Ministry of Welfare and the Prefectural Office will decide 
whether or not there shall be a public health nursing service in a certain 
district. 
5. Medical Guidance for Public Health Pursing. 
Public health nurses depend upon medical direction in the care 
and instruction they give to patients. All public health measures 
relating to communicable disease control are dependent unon medical 
guidance; therefore, public health nursing -programs must be in conformance 
with accepted modern medical practice. Public health nursing services 
look to. medical health officers for such guidance, 
6. Public Health pursing Beaches All Economic Levels. 
Public health problems are the concern of all Densons in the 
community. The public health nurse works with all economic groups and 
pla.ces emphasis unon those services which influence to greatest extent 
the general health conditions of the'community. 
o 
o 7. Functions of public health nurses:- 
a. ' Acute Communicable Disease Control; ■> 
•One 'of’the of public health nurses is to, 
assist with the control of acute communicable diseases through demon- 
stration of nursing care and isolation procedures. In the case of 
families receiving care from both agencies it is necessary for the public 
health nurse to work closely with the welfare workers in carrying out 
necessary isolation procedures. 
b. Tuberculosis: 
Public health nurses control tuberculosis by working closely 
with physicians and health officers to find newly infected persons. They 
instruct infected persons in the importance of continuous care and isolation 
and. assist persons who have recovered to become rehabilitated. 
Illustration I 
The value1of following positive reactors to the Mantoux 
test as a means of case finding. 'A school bus driver who wa.s 
being questioned on the possible source for his infection, 
suggested a man living in another part of the district. The 
loublic health nurse, assigned to work in that part of the 
district, called at the home of the man given as a source of 
infection and found he was sick, that he had lost considerable 
weight, that ’he had blood in his sputum, and that his sister 
had died of tuberculosis eight years previously. The nurse 
made arrangements for medical examinations for the man and 
his family, and within a, short time he was in the sanatorium. 
This man’s mother, being a resident of a. neighboring district 
wa.s referred to the district public health nursing service 
of that district so that she would be. encouraged to have a 
medical examination. 
Illustration IT 
The of continuous health supervision for persons 
who have had active tuberculosis. A’man who had received 
sanatorium treatment for several years, having had his chest 
x-rayed every year as a. part of the health supervision, 
this-year wa.s found to have the disease again. Fortunately 
for his family, however, no tubercle .bacilli were found in 
his sputum. Because the man did not make satisfactory prog- 
ress af home, he returned to the sanatorium. The members of 
this patient's family have been under close medical supervision 
all the time the patient was in the home. The district nurse 
made visits to teach the wife how to, prevent the spread of the 
infection and to encourage proper food and rest for all members 
of the family. _ 
When nursing supervision ip provided in, the home certain 
tuberculous patients may be discharged earlier from the san- 
atorium than otherwise, thus reducing costs.for sanatorium 
care of hospitalization. c. Venereal Diseases: 
Venereal disease problems, whether they occur singly or 
coincident with other health problems, are worked out cooperatively with 
the physician, the medical health authorities, and the district welfare 
board, 
d. Summary of Communicable Disease Control; 
(1) Public health nurses will participate with the 
welfare workers in the control of communicable 
diseases among the families in need: ■ 
(a) Fursing care of the sick is either provided 
or taught to responsible members of the family, 
(b) Isolation procedures are taught, 
(c) Living conditions and special needs due to 
health problems are discussed with the welfare 
worker. 
(d) Other special problems are solved cooperatively 
with welfare workers, physicians, and public 
health authorities. 
(2) Welfare workers may assist the public health nurse in 
the control of communicable diseases by: 
(a) Reporting suspected or diagnosed cases among the 
welfare clients to the district public health 
nurses as well as to the official health 
authorities. 
(b) Interpreting community health urograms to wolfare 
clients. 
(c) Assisting with dissemination of authentic public 
health information to welfare clients. 
e. Maternal Health; 
Medical and nursing supervision of all women during 
the antenatal, natal, ani postnatal periods are recognized as valuable 
means of promoting good health in the mother and the newborn. 
(1) In cooperating with the district welfare worker in 
maternity health supervision, the public health nurse 
will report to the welfare board all antenatal ca.ses 
which are in economic need so that medical care may 
be secured as oarly in pregnancy as possible. She 
will visit maternity cases that are reported to her 
by the Welfare worker to teach antenatal hygiene, to 
assist with preparations for deliveries, to demonstrate 
treatment ordered by the physicians, and to provide 
or supervise nursing care of the mothers and infants 
during and after deliveries. 
(2) Welfare workers may assist the public health nurse 
in the maternal health program by: (a) Referring to the nurse all expectant mothers 
of new babies, who .are registered with the 
welfare hoard. 
(b) Supplying the minimum ,of, sterile supplies which 
are essential to safe, nursing care when a client 
is to he delivered at home. 
0 •*, 
i(c) Encouraging women to .attend maternal and child ' 
health classes that are taught by the public 
health nurses. 
Illustration I 
■ A public health nurse convinced an expectant 
mother to place herself under .the care of a, physician 
without further delay. The mother had neglected 
to make the necessary arrangements with the district 
welfare and township beards for medical care, home 
delivery, or cloth** for the baby, until the nurse 
had helped her to understand the benefit this care 
would be to herself, to the new baby, and to her 
family. •. ... 
Illustration II 
Another mother in the same district was given 
help by the same nurse with for a home delivery 
and with recipes for cooking liver th»t her physician 
had advised, 
f. Infant and Pre-School Hygiene? 
(l} The public health nurse will assist with the program 
€or health supervision of Infants and preschool children as worked out 
cooperatively with the local medical and dental societies, the district 
welfare boards and the nursing commit ties. This service should include 
a plan for supervising and teaching nutrition, habit training, general 
hygiene and sanitation in the homes, and arranging for protection against 
diphtheria and smallpox. 
fe) The district welfare workers may extend the infant and 
pre-school health program to the children of families registered with that 
board by: ‘ 
' ) . t r _ , 
(a) ‘Sncouraging parents who have health problems among 
their young children to take advantage of the public health nursing 
service,’ , 
(b) Referring babies and pre-school children who have 
particular health'problems to the public.health-nurse. Examples: 
(1) Mothers who do not follow the ..physician1 s. instructions may need 
demonstration from the nurse, (2) families with a, communicable disease 
may need demonstrations on nursing and isolation nrocedurcs. (c) Interpreting the need for and the methods of 
protecting the infamts and pre-school childrcm against diphtheria, 
smallpox, whooping cough, measles, and the ’’common cold". 
Through their continuous teaching and demonstrating, public 
health nurses keep parents aware of the urgency and also keep them up to 
dale in the possibilities of protecting their very young children against 
infections brought into homes by older persons. Flans for intelligent 
feeding and habit training are more readily carried out when parents arc 
encouraged from time to time by the public health nurse. 
Illustration I 
A rublie health nurse reports that many young mothers 
ask her for government bulletins on- child care, and that a 
group of mothers in her part of the district have asked for 
a. cla.ss on the care of mothers and young children. 
Illustration II 
A public health htirse visited a. seventeen- day old 
ba„by being cared for in a foster home. Because the baby 
was having’a. serious discharge from both eyes, the district 
nurse got in touch immedis.tely with the doctor, and uuon 
his advice, she helped arrange hospital care for the baby, 
g. School Hygiene: 
One of the important functions in a school health service 
is the correction of physical defects among children whose families 
cannot provide private medical care. These nroblems should be reported 
to the district welfare board for individual investigation. When 
private agencies’ funds arc available for correction of defects, it is 
adivsablo that the rlan for using such funds be worked out jointly by 
the nursing committee and the welfare board in order to avoid duplicativns 
and tc extend the facilities of the local, agencies. 
(z) The welfare worker may augment the school health 
services by: 
(f ) Conferring with the school nurse on plans that 
have boon started from correction of physical defects. 
Acquainting the school nurse with social conditions 
in the homo that may have a bearing upon the physical and mental health 
of the child. 
Collaborating with the school administration on plans 
for supplemental food. 
(3$ The public health‘nurses cooperate with parents and 
teachers to i mo rove the health -'f children. Illustration I 
A school nurse reports that the school health service 
sort a letter to the parents of all children in a, grade, that 
had been exposed to scarlet fever. This letter toId parents 
what symptoms are character!stic of scarlet fever, and sug- 
gested that parents inspect their children every morning for 
signs of illness so that they would not send a sick child to 
school. The schorl nurse visited the home of the sick child 
to show the mother how to give nursing care and how to protect 
ether members of the family. 
Illustration II 
Another school nurse cites several types of school he a, 1th 
activities that she arranged for during one month: A total 
of 655 pupils from forty-two schools were given the tuberculin 
test. Of the 36 children who reacted positively, 29 of .them 
had chest x-rays before the end of the month. In one village 
community, a diphtheria immunization •program resulted in 91to 
of the pupils being protected. Three .rupiIs with very poor 
vision were found by the nurse during inspections; a child, 
whose physician recommended removal of tonsils, was referred 
to the Red Cross for financial aid, 
h. Adult Hygiene; 
The health of adults is another major concern of the public 
health nursing service. Through their visits in homo and schools, and 
through group teaching, public health nurses have many opportunities to 
encourage grown-ups to seek medical care before their "ailments'1 become 
serious. 
Illustration I 
A public health nurse reports that she found a, mother 
very despondent end worried since the death of her husband. 
After consulting the family physician and being told tha.t the 
mother had very high blood pressure, the nurse and a member 
of the nursing committee arranged for hplp in the home so that 
the mother could have the extra, rest she needed. 
Illustration II 
A school and city nurse states that she worked with the 
Red Cross Chapter to arrange for cream, milk, and oggs to be 
supplied to a person suffering from a peptic ulcer. 
i. Morbidity Service: 
When bedside nursing is iu.ded as a. part of the public health 
nursing service, the nursing needs of welfare clients will be discussed 
with the district welfare board. The nurse .works under the direction of the 
attending physician and when the nursing requirements in the family exceed 
the period of time, which the public health nursing agency can give, the 
public health nurse will confer with the. welfare board regarding other 
arrangements. (i) A public health nurse who is carrying cut nursing 
procedure's in the hemes on a visit basis should be responsible for teaching 
a member of the household or attendant how to carry out simple'nursing care 
during the nurse’s absence. When relief clients are discharged from the 
hospital, the public health nurse'will'make a home visit if'the physician 
indicates that the patient'requires seme nursing care, or instruction 
and supervision .in carrying out the attending physician’s recommendations. 
C3.) The district welfare worker may utilize the public health 
nursing service for giving nursing care' to the acutely ill client if 
bedside nursing is a part of the public health nursing program in that 
particular district. * • ■ 
Since the general policies of district'nursing services 
allow for-demonstration of nursing care, the welfare workers may refer 
families who require such services to the nursing service. 
Illustration I - • 
luring one day a public health nurse-had occasion to 
teach the ‘ others--in two homes h»w to give nursing care to 
children sick with scarlet fever, and how*to prevent the 
disease from spreading. 
I Hue t rat ion II 
A public health nurse, in answering-the calls given by 
a committee member, had occasion to convince a 93-year-old 
man to go to the. hospital for■treatment for his infected legs. 
j. Crippled Children's Service: 
o * 4 
The public health nurses work closely with the district 
welfare board to see that instructions ere carried out, especially with 
regard to keeping appliances in piece, the use of physiotherapy, and 
keeping ..hospital or clinic appointments, Transportation and other costs 
necessary to keep crippled children under medical c°re are referred to the 
district welfare board. 
Illustration I * 
A district nurse makes brief mention' of visiting in 
a home to urge the parents to keep appointments at the 
hospital for their child who was having treatments for a 
cleft palate. This visit stood Out in the mind of the 
nurse because she found the mother,complaining of cataracts 
in both: of‘her own eyes, .was to® frightened to go to a, 
physician for treatment. 
Illustration II 
A public health nurse'skates that at the suggestion cf 
a teacher,, ‘she made a, call in behalf of a-crippled child who 
was beginning, school. The. mother was- very sensitive about 
the child's condition and pointed cut the‘fact that her two 
younger- children had the sane rhyadc»l abnormalities as 
the school child. *• • Application papers for treatment at the hospital were 
explained to the parents by the nurse arjd the mother was 
encouraged by special books and pamphlets given tW her and 
to the teacher, 
k. nutritional Aspects: 
Since families in the lower economic levels with health 
problems require special help in planning for their nutritional 
needs, a close working relationship between the and 
nublie health agencies of the community is essential in order to 
safeguard and improve health conditions* For example; A family 
in which there is an expectant or nursing mother, an infant, or 
a case of tuberculosis, diabetes, or other debilitating illness 
may require increased budget allowance in order to secure the 
food that is required. 
l. Mental'Hygi e ne; 
Public health nurses recognize the for mental 
hygiene in their contacts with certain families. Families in 
financial need or having other social problems, frequently 
exhibit exaggerated emotional instabilities which require the 
combined efforts of the medical, nursing, and welfare agencies. 
Patients with a mental illness before admittance and after 
discharge from a hospital may require health supervision in the 
home by a public health nurse. 
m• Heme Environment: 
Instruction in home hygiene and sanitation as it 
influences the health cf the individual and the community, is 
emphasized by the public health nurses in all homes. Safety 
in the heme is an important phase of this instruction. When 
harmful conditions exist in the home environment that cannot 
be remedied by the families, the public health nurses will direct 
the families to the uroper sources for the necessary corrections. 
8. Conclusions 
Effective service to the community based upon sound preventive 
medicine and public health practice should be the factor guiding public 
health nurses and welfare workers in solving individual and community health 
problems. While these principles apply in general to all health problems, 
social and'economic conditions frequently necessitate individual consideration. 
The solution of problems involving the Joint administration cf welfare and 
nubile health programs required cooperation between these aencies. 
The public health nurse exerts a. contincus stimulation to 
community interests in knowing hew to recognize Pnd how to ccrreot conditions' 
that are real community health hazards. Midwives 
In Japan quite different from America the Midwives do not work in 
connection with health Department or under supervision of Doctors. They 
rate as individuals and independent of any agency. Their responsibility 
is therefore very different from the American midwife. 
The midwife makes the contact or initial visit by request of family. 
The midwife should: 
1. Do Urinalysis 
2. Blood Pressure 
, 3, Kahns are done if indicated, by the doctor. 
.4. Pelvic examination in order to determine the baby1 s relative size, 
position and .presentation before labor begins. 
5. rCrive constant care during labor tc_ comfort the mother, reassure 
her, and protect her from fatigue, fear, injury, infection, and 
unnecessary suffering. 
6. Examination and observation to leahn and'watch the condition of 
mother and baby after delivery. 
Extract taken from Imperial Ordinance; 
Art. VII. ‘ . . 
A midwife, shall, when she detects anything abnormal in a. pregnant 
women, a woman in labour or in childhood, a foetus, or a. living child, 
the person concerned to call in medical aid and shall not take 
any measures herself in the matter; .this rule, htwever, does not 
hold in case of first-aid measurer. 
Art. VIII. 
A midwife shall not, with respect tr a. pregnant woman, » woman in 
labour or in,childbed, a foetus, or a living child, perform any 
surgical operation, use cf obstetrical instruments, administer 
medicines, cr give directions therefore; this rule, however, dees 
not apply to such acts pg disinfection, excision of the umbilical 
cord, making rectal Injections, 
Art. IX (1) 
A midwife shall net put a person who is net inscribed in a midwives1 
register in complete charge of a pregnant woman, a woman in labour 
or in childbed,fsetus, tr a living child. 
Art. IX (2) 
A midwife shall net without personal examination'issue a certificate 
cf stillbirth or certificate of examination cf a dead foetus. 
Art. X . * ’ 
In the event cf a midwife being guilty cf abortion or any Tther 
offence connected with her profession or.of any offence for which 
t penalty %s not less than. imprisonment, the local governor may 
prohibit’her practice or suspend*it for a term not exceeding one 
year; the same rule holds in the case of-©n offence committed prior 
to the inscription in the midwives1 register. 
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