key: cord-1028471-2qpup1lf
authors: Yoshioka‐Maeda, Kyoko; Iwasaki‐Motegi, Riho; Honda, Chikako
title: Preventing the dysfunction of public health centres responding to COVID‐19 by focusing on public health nurses in Japan
date: 2020-05-18
journal: J Adv Nurs
DOI: 10.1111/jan.14409
sha: a5f85e48885594a96cbfd0552f274e5fbc4ba0ad
doc_id: 1028471
cord_uid: 2qpup1lf

With the outbreak of COVID-19, maintaining the healthcare system is a crucial issue. In Japan, the number of COVID-19 cases is increasing rapidly day by day with a risk of overshooting initial estimations (WHO, 2020a). Public health nurses (PHNs) working in public health centers in prefectures and designated centers in cities or core cities, play a critical role in controlling COVID-19 (Yoshioka-Maeda, Honda, Iwasaki-Motegi, 2020). Providing care for COVID-19 patients, their families, and the community, the workload of PHNs has been reaching the maximum limit.

With the outbreak of COVID-19, maintaining the healthcare system is a crucial issue. In Japan, the number of COVID-19 cases is increasing rapidly day by day with a risk of overshooting initial estimations (WHO, 2020a) . Public health nurses (PHNs) working in public health centres in prefectures and designated centres in cities or core cities, play a critical role in controlling COVID-19 (Yoshioka-Maeda, Honda, & Iwasaki-Motegi, 2020) . Providing care for COVID-19 patients, their families, and the community, the workload of PHNs has been reaching the maximum limit. The World Health Organization (WHO) released an interim guide "Operational considerations for case management of COVID-19 in a health facility and community" on 19 March 2020 (WHO, 2020b) . This study aims to focus on resolutions to prevent the dysfunction of public health centres developed by PHNs regarding COVID-19 in Japan, as well as task sharing and securing staff, and task shifting.

When clusters of COVID-19 cases emerge, task sharing and securing staff are among the first strategies to ensure the sustainable provision of health services. By identifying core health services, service delivery systems and staff allocations can be modified (WHO, 2020b) . There are two ways of securing staff: getting support from outside the organization, and from within the organization. In an earthquake, the national government coordinates and sends PHNs to the earthquake-stricken area. However, COVID-19 is spreading nationwide. Local governments cannot send PHNs to another area. To source support from outside the organization, hiring part-time PHNs, nurses, re-employment, and securing volunteers from faculty members and graduate students in the community are popular strategies to secure additional staff.

In the case of getting support from within the organization, chief 

At first, a telephone consultation system was set up in each public health centre to answer people's questions regarding COVID-19 (Japan Ministry of Health, Labour, & Welfare, 2020) . However, individual public health centres faced difficulties responding to the vast number of questions. Outsourcing is an example of task shifting (Henderson, Willis, Toffoli, Hamilton, & Blackman, 2016) . To reduce the total number of telephone consultations, PHNs tried to outsource the telephone consultation system to local medical and nursing associations.

Additionally, each public health centre assessed the need for polymerize chain reaction (PCR) testing based on these telephone consultations. As consultations regarding the PCR testing increased, they could not respond fast enough and those suspected of being infected with COVID-19 were kept waiting. PHNs repeatedly called on hospitals to conduct PCR testing of suspected cases. To delay the spread, slow down and stop the transmission of COVID-19, the PCR testing system had to be refined quickly. Collaborating with local medical associations, the PCR testing shifted to local hospitals as a vital hub.

Please note that editorials have not been externally peer reviewed

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