ABSTRACT
One of the characteristics of nursing in Southeast Asia is the ASEAN Mutual Recognition Arrangements on Nursing Services, which strengthens professional capabilities through four objectives include facilitating mobility of nursing professionals within ASEAN. The Japanese government supports human resources for health in the ASEAN region, as a member country of ASEAN+3. A meeting was held at the Annual Meeting of the Japan Association for International Health 2017. The meeting objectives were as follows: (1) to share three nursing research findings regarding nursing migration, regulatory framework, and in-service training that may affect quality of nursing and (2) to discuss Japan’s role in improving the quality of nursing in the ASEAN region. This report aims to summarize the presentations and points of that meeting. The academic level of nursing education and nursing regulations have improved in ASEAN member countries. All member countries have university nursing education, and some have master’s and doctoral degree nursing programs. In lower middle income ASEAN countries, such as Cambodia, Laos, and Vietnam, the nursing education system is in the process of transition, from the technical to professional level of nursing. The next step for these countries is to strengthen the capabilities of nursing teachers who are responsible for professional nursing education at universities. The ASEAN University Network and universities in neighboring Thailand could also contribute to this end. In-service training is also needed because the guidance of more experienced nurses is crucial in nursing service as well as nursing practicums. Japan’s experience of developing an in-service training system could be useful for some ASEAN countries. The objective of mobility among nursing professionals within the ASEAN has yet to be accomplished. However, there are pull and push factors of nurse migration due to economic conditions within the ASEAN. It is predicted that nurse migration will occur with mixed-skill caregivers to high income countries out of the ASEAN countries, because of the lack of caregivers for the aging population. In order to ensure quality nursing in the ASEAN region, it is not only necessary to share country-level experiences to improve nursing education and regulations but also crucial to develop systems that promote the circulation of nursing professionals through wide regional cooperation.
ABSTRACT
Yuri Kumiai General Hospital is a community-based core hospital that treated approximately 14,000 patients in the emergency outpatient clinic in 2014, with approximately 7,800 walk-in patients on Saturdays, Sundays, and holidays. In April 2014, we incorporated an inhospital triage system for walk-in patients on weekends and holidays to quickly diagnose the conditions of patients in a crowded waiting room and promptly treat those requiring urgent care. Furthermore, in April 2015, we introduced the Japanese Triage and Acuity Scale (JTAS) to standardize the quality of triage care. Evaluation and analysis of 7,454 triage forms to identify future challenges revealed that the triage rate was 88% immediately after the incorporation of the JTAS, with 93 incomplete triage forms, 13 undertriage cases, and 18 overtriage cases. This showed that the severity of emergency was determined based only on subjective symptoms and complaints, with no application of objective physical assessment. We presented a list of analysis results to triage staff, further assessed undertriage cases, and provided feedback in monthly workshops. At 1 year after introduction, the rate of triage increased to 95%, with 12 incomplete forms, 9 undertriage cases, and 21 overtriage cases, and the number of cases increased where the severity of emergency was determined accurately from the entire clinical picture including vital signs and the cause of injury. These findings suggest that use of the JTAS enabled a standardized triage system to be established and that the assessment of undertriage cases and organization of continuous workshops improved the quality of triage and the skill of triage nurses.