- PH..r Nursing 2 ■ 
Nursing Affairs 
Public Health and Welfare Technical Bulletin 
PH&W GHQ SCAP APO 500 
December 194-8 
1 • General 
. j 
a»' Situation in Japan 
As nursing and midwifery play an important role in every community 
it is important that the Military Government Public Health Nurse give consider- 
ation to the supervision of the training of the students* The schools of 
nursing are under the various Ministries, all of which have different standards. 
It must be realized that the type of training the students have had 
in previous yeais is not sufficient to carry on a modern program of nursing 
today. With this mass of untrained personnel we are faced with a tremendous 
and urgent need for a good nursing service that will supply the present needs. 
b* Current legislation and Plans 
A Nursing and Midwifery Law (Lav/ No. 203) was enacted July 30, 194-8. 
The enforcement of the law will begin in 1950. This law provides official 
registration, as well as improved standards, for schools of nursing and mid- 
wifery. 
2. Schools of Nursing 
aa General 
If we are to have, good Clinical Nurses, Public Health Nurses and 
Midwives the foundation must be laid in the basic school of nursing. This 
must be a well-rounded,all-inclusive course of three years. The student in 
the school of nursing must have a broad and varied experience. The curriculum 
must included classroom instruction, study and clinical practice in the hos- 
pital. The clinical practice, done under supervision, gives the student an 
opportunity to observe and apply the principles and methods she has learned 
in classroom, 
b. Supervision of Schools 
It is important to give considerable time, guidance and supervision 
to these schools of nursing. This will be necessary if we are to build a lasting, effective nursing service that will reach into Post Graduate * 
work in the fields of Public Health and Midwifery, Leaders will have 
to be trained to teach in the schools cf nursing, doctors and admin- 
istrators will need to understand'the function and aims of the school 
of nursing and well qualified students must be recruited, 
The modern hospital’s first objective is to restore the 
mental and uhysical health of the patient. The second objective 
should be the education of ‘nurses, doctors and other personnel, 
patients, and the public. The third objective should be to encour- 
age-and-promote scientific.research, 
c9 Class A & B Schools 
Class A & B schools are to fulfill the requirements as set 
forth in the revised ordinance #28, The curriculum for Class ”A”schools 
has been arranged in credit hours in order to provide for accredita- 
tion in the college program in the event the nurse desires to pursue 
her studies. The goal is one class ”A” school of nursing in every pref- 
ecture. 
The Proposed Plan of the Curriculum of the "AM Class Nurses’ Training 
School is as follows: The Goal is one class !,A” school in every prefecture. 
Total 
1st 
2nd 
3rd 
Subjects of Study 
Hours 
Class 
Class 
Class 
Remarks 
Anatomy & Physiology 
90 
90 
Microbiology 
45 
45 .■ 
Chemistry 
45 
45 
'Community Hygiene & 
Sanitation 
30 • 
30 
Nutrition & Diet Therapy 
45 
Nutrition 
30 
Diet Therapy 
15 
Materia Medica 
30 
Materia Medica 
20 
Physican 
Drugs & Solution 
10 
Pharmacist 
Science of Nursing Arts 
485 
175 
200 
110 
Sociology 
15 
15 
Psychology 
30 
30 
, 'TOTAL 
800 
435 
255 
110 
Besides the above' subjects, the study of foreign languages, music, 
gymnastic and something about culture may be studied. 
2 The Items of the Science of radical Nursing Arts 
Subject of Study 
Total 
Hours 
1st 
Class 
2nd 
C la s s 
3rd 
Class 
Remarks 
History & ethics of 
bursing Art 
30 
30 
Principles & Prac- 
tices of Nursing 
Arts 
35 
35 
Internal ledicine & 
its Nursing Arts 
(include Pathclogy) 
60 
60 
M.D. - AO hours 
Nurse - 20 hours 
Surgery & its Nursing 105 
Arts (Include Ortho- 
pedics & OF, Technique) 
Physiotherapy 15 
Infectious Diseases 
& its Nursing Arts 
Including TB, VD & 
parisitology 75 
50 
55 
55 
15 
20 
Gen, Surgery 
M ,D . - AO hours 
Nurse - 35 hours 
Gen. £5, OH 10 
Orthopedics 
MD - 15 hours 
Nurse - 15 hours 
Gen, - MD - 15 hr. 
Nurse 15 hours 
TB-15 MD, 10 Mur. 
Pari.- 10 
VD - 10 
75 hours 
Pediatrics & its 
Nursing Arts 
A5 
A5 
MD - 25 
Nurse - 20 
Obstetrics & Gyn- 
ecol ogy 
& their Nursing Arts 
A5 
15 
30 
M.D« - 25 
Nurse - 20 
Dermatology 
EoE.N.T, & their 
Nursing Arts 
15 
30 
\ 
30 
15 
. . . 
Psychiatry & Mental 
Hygiene 
3° 
30 
-■ 
TOTAL 
4S5 
175 
200, 
no • 
Note: Nurses shculd 
teach 
nursing 
subject. 
■ The Proportion of the Weeks of Clinical Practice 
Experience on Fard 
0< Pa D, 
Internal Medicine 
16-20 
Internal Medicine 
3 
Surgery 
16-20 
Surgery 
2 
Pediatrics - 
15 
Pediatrics. 
3 
Obstetrics & Gynecology 
16 
Obstetrics & Gyn, 
2 
Obs. - 12 
Gyn. - U 
Othology ENT 
2 
Infectious Diseases 
10 
Op ht ha 1 ora o lo gy 
2 
(Including TB) 
Dermatology & 
Operating P oora 
10 
Genitology 
2 
Diet Kitchen 
8 
TOTAL 
91-99 
TOTAL 
16 
Others 
8 
• '• . TOTAL- 
-107*-115 weeks 
''The Proposed Plan of the Curriculum of the "S’ Class Nurses* 
Training School 
Subject's of Study Total Hrs• 
1st Class 
2nd Class 
Remarks 
Anatomy &• Physiology 
A5 
A5 
Microbiology & Disin- 
fection"& Sterilization 30 
30 
Hygiene Personnel & 
30 
30 
Hospital Pieties (incl. 
Theory - 20 
methods of cooking) 
30 
30 
Lab - 10 
Materia-Medina (simple) 20 
20 
Nurse Dosage 
• - 
adm. to Patient 
General Nursing 
3A0 
2A0 
100 
Social & economic 
aspects of*illness 
15 
15' 
Legal Health' Fegula- 
tions 
10 
10 
House Keeping 
A0 
20 
20 
Care & Development of 
Well Child 
30 
30 
TOTAL 
590 
395 
195 
Note; Besides the above subjects, 
the study of languages, music, 
gymnastics, and 
culture may 
be taught. The Froporti.cn of the ~eeks of Clinical Practice 
Hospital Practice 
O.P.E. 
Internal Medicine including TB 
16 
Inter na1 Medi ci ne 
2 
Surgery 
12 
Surgery 
2 
Pediatry 
8 
Pediatry 
2 
Obstetrics & 
Gynecol ogy 
6 
Obstetrics & Gyn. 
2 
Operating Room duty 
4 
Skin-g-u, Disease 
2 
Cooking Room 
4 
Ophthalmology & 
2 
Otolaryngopharynology 
Dentistry 
2 
TOTAL 
' 
50 
TOTAL 14 
Freliminary 
16 wks e 
Vacation 
6 wks. 
Sick Leave 
4 wks. 
OPD 
14 wksa 
H. Practice 
50 wks. 
90 wks. 
The items of the General Nursing 
Total 
1st 
2nd 
Subjects of Study 
Hours 
Class 
Class 
Remarks 
History & Ethics of 
Nursing 
20 
20 
Principle & Practice 
of Nursing Procedures 
100 
100 
Disease of Internal 
Medicine & Nursing 
30 
SO 
Including infectious ones 
M.D, - 30, Nurse 50 
Diseases of Surgery 
& nursing 
AO 
4.0 
M.D, -15, Nurse 25 Incl. 
Orthopedics, bandaging, 
and first aid. 
Pediatrics & Nursing 
30 
30 
M.D. - 15 hrs, Nurse - 15. 
Diseases of Obstetrics 
& Gynecology & Nursing 
&• Newborn Baby 
30 
30 
M.D.-15, Nurse 15 
Dermatological Nursing 
10 
10 
E.E.N.T. & Nursing 
15- 
15 
Physiotherapy 
15 
15 
' 
TOTAL 
34.0 
24-0 
100 
The foundation of computation (the same 
as "A11 
class) 
5 In the first term of the first class students have not practice 
(16 wks)i 
Total Hours 
1st Class 
2nd Class 
U,22U ' 
• 2,112 
2,112 
d. Pecruitment Program 
It will be necessary to begin the recruitment pro- 
gram in the high schools in all prefectures as early as December. 
194'i in order to build up the schools of nursing. This program 
can be carried on by radio broadcasts, newspaper and magazine 
articles, posters, short talks in high schools and pamphlets 
giving information concerning nursings 
3. The National Association 
a• Organization 
The Military Government Public Health Nurse should take 
an active part in interesting nurses and midwives in their pro- 
fessional association. The Japanese Midwives, Clinical Nurses 
and Public Health Nurses’ Association was formed in November 194-6, 
In April 194-7 they changed their constitution to permit the forma- 
tion of Branch Associations in each prefecture. All prefectures have 
now organized such branch associations. At the present time many of 
the branch associations are very weak and poorly organized. The 
National Association will only be as strong and as stable as the 
weakest branch association, 
b, .Responsibility of Military Government Public Health Nurse 
The Military Government Public Health, Nurse.should give 
guidance and advice to the officers and members,, of this Association, 
In performance,of-this duty she should: 
(1) Interpret to them the principles of leadership and 
democratic organization, - -■• 
(2) Guide the officers in the details of business admin- 
istration of an association, (Guiding them to obtain adequate office 
space, efficient; methods for■collecting dues etc,) 
(3) Interpret to the officers the responsibilities, privileges 
and duties of each office. She should help them to find the ways and 
means whereby they can carry out these duties. 
6 (A) Interpret tc the corairitt.ee members the duties and 
responsibilities of the committee. 
A. Midwifery 
a. Present Situation in Jaoan 
Approximately 96$ of the babies in Japan are delivered by 
midwives, the majority of whom have had little or no formal training. 
The immediate need for this group is instruction and supervision'in 
the basic principles of midwifery, with special emphasis on prenatal 
careP In the past there has been a total lack of prenatal supervision 
with toxemia being the highest cause of maternal deaths. 
b. National Gods for Midwives 
The national goals which have been set up for midwives 
should be interpreted for the ones who are practicing at the present 
time. These are as follows; 
(l) Two complete physical examinations by a doctor during 
each pregnancy. 
(a) The first examination should be done as earny in 
pregnancy as possible. Much can be done in the 
early months to make the prenatal period a safer 
and more comfortable one. 
(b) The second examination will come two or three weeks 
before the baby is expected. This is to make sure 
everything has gone well throughout pregnancy and 
that the mother is in good condition to go through 
the labor, delivery and recovery period. 
(2) Every normal patient should be seen by the midwife once 
each month during the first eight months and every two weeks after 
that time. 
(3) The midwife will have detailed discussions with each one 
of her patients .when she sees her for.the monthly supervisory visit. 
She will explain to the patient the physical and emotional changes 
that take place during pregnancy, and tell her about the things that 
she can do to make the time a safer and a happier time. There are two 
things that the midwife should always keep in mind when talking to her 
patients, they ares 
(a) Always give the patient a reason for doing the 
things you ask.her to do. (b) Never ask a patient to do something unless you know 
that it is possible for her to do it. Frequently the midwife will 
be able to suggest ways or means whereby the patient can do the 
things that she is asking her to, 
(h) The midwife will make each patient responsible for supply- 
ing the following information, and specimen, at each supervisory 
visit; 
(a) Her weight, taken the day previous to visit. 
’ , ; ■ (b) The exact amount, in figures,-, of urine passed in a 
2J+ hour period' the day before visit and also a small amount of urine 
from, the 2U hour specimen for the midwife to examine. 
(5) One or more conferences should be held with the husband 
of each patient, at which time definite suggestions will be made as 
to what he may do toward making the maternity period a safer and 
happier experience for his wife. The following suggestions may be 
made.to the patient as to where she may get her complete physical 
examinations: 
(a) Her own private physician 
(b) The Health Center nearest her, home- 
’(o) The out-patient department of a hospital 
(d) The local physician in smaller villages, 
(A committee of midwives may request this physician to cooperate 
in the program for improving maternity care by making special rates 
for all patients referred by them - using standard referral form), 
(6) A'special effort will be made to get'all patients 
to report for a postpartum examination,: 
c• assistance by Military Government Public Health Nurse 
(1) An educational program for the preparation of midwife 
supervisors and instructors in the new schools is very urgently 
needed, ,1 
(2.) ' The new: laws, rple and . regulations pertaining to 
midwifery, should be explained to all individuals concerned, pre-g 
fecture off icials, hospital educational personnel, midwive5,' .etc,, 
in order that they may plan their.programs to meet the hew requirements. (3) Advisory service should be given to hospitals which are 
interested in the establishment of a school of midwifery under the new 
regulations„ 
(4) The aspects of public health nursing should be inculcated 
into the program for midwives. The midwife is too prone to think in 
terms of only the pregnant woman in the home, not recognizing that every 
health problem in the home may affect the maternity patient, 
5. Public Health Nursing 
ac According to a census of nurses taken in March 1948, Japan has 
15,859 active Public Health Nurses, Many of these nurses have had poor 
professional preparation and as a result have a very limited understand- 
ing of their functions as Public Health Nurses. In view of this mass of 
poorly trained personnel the Military Government Nurse must concentrate 
upon two definite programs in regard to the public health nursing fieldi 
(l) Supervision and guidance of Public Health Nurses now em- 
ployed by an agency or community., These nurses will have to be trained 
for their work through refresher courses in public health nursing, 
through staff education programs and constant in-service supervision 
as outlined below, 
(a) In April 1947 a four-months' refresher course for 
Public Health Nurses was set up at the Public Health Institute in Tokyo, 
This course will continue until 730 Public Health Nurses from all pre- 
fectures throughout Japan have received this special training. Each 
time the course is given one nurse is to be sent from each prefecture 
and one from each of the following cities; Kyoto, Kobe, Nagoya,_ Osaka, 
Tokyo £ nd Yokohama, Personal expenses for this course are to be borne 
by the prefecture and the agency from which she is sent and she is paid 
her usual salary plus traveling expenses. It is the responsibility of 
the Military Government Nurse to see that potential leaders are selected 
for this training. 
(b) In November 1947, a five-months' course in Tubercu- 
losis was started for Public Health Nurses in Tokyo. The puroose of this 
course is to train Public Health Nurses to more ably care for the tuber- 
culosis patient in the home. Each prefecture is permitted to send one 
nurse to this course expenses for which are borne by the prefecture, the 
agency from which she is sent and the Anti-Tuberculosis Association. The 
prefecture assumes the responsibility of assuring payment of her usual 
salary and traveling expense to and from the course, The Military 
Government Nurse should lend assistance to the prefectural Health Depart- 
ment officials in the selection of a nurse to be sent to the course each 
time it is offered. 
9 v (c) Lac' veer the Ministry of V'elfa.re has advanced a 
budget - tor short refresher courses for Public Pealth Nurses* The 
money is earmarked to be used in the following nays: 
1; To train'nursing leaders. The Leaders Course 
Is planned on the national level and proposes to bring Public health 
Nurse leaders together for an instructional and informational meeting. 
2, To train Public health Nurses in general. The 
Course for'the-Public health Nurses in general is given either on a 
regional or :prefectural level. The budget' for this Course is divided 
equally between the 1,6 prefectures, who have the responsibility of plan- 
ning or giving a short course at least once each, year. Pertinent 
information regarding this course is sent to the local area from the 
national level but it is the responsibility of the Military 'Government 
Nurse to give guidance to the Japanese nurses in the planning and carry- 
ing out of this Course. ■ ; , , 
, , (d)- 'Other refresher courses are to be offered whenever 
the Military Government recognizes a need for such a course, 
(2) '■ Supervision and'guidance to public health nursing., schools 
(a) At present there are 4-5 public health nursing schools 
operating in Japan. Many of these schools will not be able to meet the 
requirements of the Nursing Law, . ....«•. 
' 1 (b) After 19:51 it will be,, necessary that public health 
nursing schools meet the requirements as set up by Ministerial Ordinance 
No, 28 .(revised edition) which outlines, the.regulations for public ’health 
midwifery and nurse training schools. 
(c) The' curriculum to be offered must fulfill the 
minimum requirements as set up under revised Ministerial Ordinance No, 28. 
(d) One good public health nursing; school in each region 
will be considered a goal towards which to work. 
This goal may not be realized for many years to come. 
Should the prefecture, city, hospital or individual be desirous of setting 
up a school above this quota the need and possibilities of such a school 
should be carefully considered. In setting up these public health nurs- 
ing schools the aim shall be for quality rather than quantity, remembering 
that in the future- only "A" class nurses will be eligible for these 
schools, also that qualified Public Health Nurses will be needed' to teach 
these courses* (e) Among, the public health nursing schools of Japan 
there should bo those attached to universities or accredited by the 
Department of Education so that the nurse might bo able to apply her 
public health nursing work towards college credit if she should so 
desire* (ouch schools must be considered in the long term plan of 
public health nursing institutions,) 
b , In Japan Public health Nurses are employed in many different 
fields of public health0 It is the responsibility of the Military 
Government Nurse to set up a nursing program vihick envisions the utili- 
zation of all Public health Nurses in the prefecture. In order to 
properly utilize all of these Public uealth Nurses, the functions and 
responsibilities of nurses uorking under each of these programs must be 
carefully studied and defined according to the following outline; 
(1) Nurses uorking in prefecture! and city offices; these may 
be assigned to the Department of Health, Department of Education or the 
Federation of National Health Insurance. 
(2) Nurses working in town and village offices; these may be 
employed by the town or village, by the Agricultural Cooperative or by 
the National Health Insurance Section, 
(3) Nurses working in school health programs. 
(4) Nurses working as industrial nurses with industrial 
firms, mining companies, shipping companies, etc, 
(3) Nurses working in miscellaneous programs; o.g, - in 
reclamation districts. 
The Military Government Nurse should work out a plan whe: eby all oj 
those Public Health Nurses will be employed without a duplication of 
service or lack of nursing service in any part of her prefecture, 
6, Japanese Guido for Public Health Nurses 
A guide for the Japanese Public Health Nurses has been prepared by 
the Nursing Affairs Section of the Ministry of Welfare and sent to the 
Prefectures, An English translation is inclosed with this Bulletin, 
1 Inclosure a/s 
11 GUIDE FOR Japanese public health nurses 
Object: The Object of Supervision in P H N Service 
'The object in view is to make the public health nurses understand their 
mission in their various posts, to promote re-education for improving their 
qualities, to put them on better terms so that they can pursue their origi- 
nal work with undivided attention, to expedite the activities of individual 
public health nurse, and to see that they uphold the various laws concerned 
as well as to see that they contribute to the public health of the people. 
Means: 
I. System of leadership 
Ministry of Welfare (Nursing Section) shall keep close contact 
with the organs concerned with public health nurses, shall plan a uniform 
leadership program by considering the purpose for which public health nurses 
were employed in each organ, and shall give directions to To, Do, Fu or Ken 
(Nursing Section or Nursing Sub-division). 
Following the above mentioned leadership program, the To, Do, Fu 
or Ken (Nursing- Section or Nursing Sub-division) shall contact the organs 
concerned in To, Do, Fu, or Ken and discuss with them about items that seem 
necessary, and give directions to the Health Center Chiefs. 
The Health Center Chiefs shall make the above mentioned directions 
clear to each of the public health nurses within their jurisdiction and make 
them observe the directions strictly. Moreover, in this case, the Health 
Center Chiefs without fail shall contacthe persons who are going to enpby 
these public health nurses and make them understand. 
Looking at the present condition of the public health nursing ser- 
vice it seems especially important that (the Nursing Section) keep close 
contact with the various organs concerned. The Nursing Section therefore 
shall plan to meet with these various organs occasionally according to the 
following chart and shall plan for the practical policy by taking into 
consideration the peculiarities of each organ. 
In do sure fi 1 National Insurance 
Organization 
/ Health Center 
Section 
~ Tims try of 
1 welfare 
(Nursing Section) 
Agricultural Coopera- 
tive Organization 
National Insur- 
ance, S ection 
Ltc. 
i reclamation, 
Guidance Section 
League of National 
Insurance Organization \ 
Public Health 
Section 
Concerned, uith -.gn- 
cultural Cooperative 
To, no, Tu, i.en 
’ (Nursing Section) 
or 
Nursing Sub-division 
National■Insurance 
- Sub-division 
htc. 
Section concerned 
with Reclamation 
National Insurance 
association 
provincial Office 
Agricultural Coopera- 
tive association 
Health Center 
City, Town 
~rL Village 
[ Reclamation Division 
xatC. 
Other P H N . 
— —— 
I r H N in declamation 
Districts 
, .gricultural Cooperativej 
i' H N j 
J National Insurance 
I' II N 
j I H K-’in/City, Town 
, or Village 
i - 
j r H N in Health Center 
l_ — —I 
2 II, Hatters to be carried out by. To, Do, Fu, or Ken. 
(Nursing Section or Nursing Sub-division), 
(1) The To, Do, Fu, or Ken (Nursing Section or Nursing Sub-division) shall 
ask the Health Centers to perform the following items in general regarding the 
guidance of the public health nurses within their jurisdiction. 
a. Reporting the change of duties of public health Nurses, 
bhenever there is a change in the duties of the public health nurse, the health 
center is to request a report from that nurse each time and is to enter that 
into the already furnished public health nurses* register (the form to be 
notified separately)a This should be reported to To, Do, Fu, or Ken once every 
throe months, (June, September, December and March), 
b. Observing the activities. 
The health center must request a Public Health Nurses1 Duty Report 
(the form to be notified separately) from every public health nurse by the tenth 
of the following month in order to raiderstand the activities of the public 
health nurses within its .jurisdiction, „nd then report that to the To, Do, Fu 
or Ken by the 20th. However, for the time being the public health ( arses of 
the National Health Insurance will not have to go through the Health Center but 
will be controlled by the Competent Section of the National Insurance as before, 
c• Guiding the study group of nursing service. 
It shall have the public health nurses within its jurisdiction 
meet once every month or once every other month, and it shall guide them in 
their study of general as well as special nursing service. 
d. Guiding in field service. 
The chief .of the Health Center and the chief public health nurse 
should visit the field as much as possible and give guidance to the various pro- 
blems of public health nursing activities to meet the actual conditions, 
(2) The To, Do, Fu, or Ken (nursing Section or Nursing Sub-division)shall 
gather the reports of the 'bN' and "Dn of the previous item and report to the 
Ministry of ..elfare (Nursing Section) by the end of following month, 
(3) The To, Do, Fu, or Ken (Nursing Section or Nursing Sub-division)shall 
strive to attend the meeting mentioned in 11 cn of the previous item and shall 
give heed to giving guidance voluntarily at any time regards to nd". 
III, Items regarding re-education, 
(1) The public health nurses* organization of each To, Do, Fu or Ken shall 
sponsor a refresher course for the general public health nurses more than once 
a year and part of its expense shall be paid by the national subsidy, 
(2) The refresher course for the leading public health nurses shall be 
sponsored bp the Ministry of ..elfaro more than once a jrear. 
3 (2) The refresher course for the leading- public health nurses shall 
be sponsored by the 1. Inis try of Welfare more than once a .year. 
(3) The educational content of the program for the refresher course 
given by the various organizations concerned vdth the public health nurses 
shall be made uniform by the Ministry of welfare (to be notified sepalately), 
IV. Supervision 
Supervision of 
To see that no one is'in actual service in public health nursing 
without a license. 
For the above purpose, a public health nurses' register should be 
provided for and,arranged in order. 
' Every time there is a change concerning the license, the To, Do, Fu, 
or Ken shall notify the- Health Center. 
4