Meagan Astill and Dr. Erin Maughan, Nursing

The importance of health promotion and disease prevention, primary focuses for public health nurses, has been a source of debate between medical professionals, many of whom focus only on the biomedical aspects of health care rather than ‘holistic’ care (Mino, 2005). The public health nurse is at the center of this age old argument for directing efforts toward preventative care versus curative care (Brock, 1976), serving as a primary educator and encourager in patients’ lives to help them implement preventative care practices. While the public health nurse addresses the immediate needs of the individuals, the basic principles of public health demand a focus on preventative services. This creates confusion and conflict as to what are the priorities of a public health nurse.

In Taiwan, the Nationalized Health Insurance (NHI) was implemented in March of 1995. In this new system, “the Taiwanese have more equal access to health care, greater financial risk protection, and equity in health care financing”(Lu & Hsiao, 2003, p77). But this change to nationalized health insurance has also increased the number of people using both inpatient and outpatient health care facilities (Lu & Hsiao, 2003). With the implementation of NHI, the amount of home nursing services grew from 27 in 1993 to 85 in 1995, and then to 125 in 1997 (Shyu, Liao, Shao, & Yang, 1999). But the role and very existence of the public health nurse, focused on holistic care, is threatened by a ‘heavily medical model oriented’ health care system (Shyu, Liao, Shao, & Yang, 1999). Understanding the perceptions versus actual function of the public health nurse in a nationalized health insurance system can assist awareness of the public health nurse in the United States and lead to improvements in public health for both societies.

The purpose of this study was two-fold: 1) to discover the perceptions of public health nurses in Taiwan from the viewpoint of public health nurses, hospital nurses, and health care consumers, and 2) to relate Taiwanese-found perceptions to those found in the United States to gain understanding on how to improve both health care systems.

Methods

Participants were selected to participate in this qualitative, descriptive study using a nonrandom, purposive sampling method, first by convenience sampling followed by snowballing methods. Participants were interviewed, using a semi-structured interview guide, either person to person or over the telephone. The interviews were recorded for later translation and evaluation. There were three subgroups within the selected informants, namely health consumers, hospital nurses, and public health nurses.

Results

Preliminary results indicate that although there are still difficulties related to the healthcare system as a whole and public health system in particular in Taiwan, things have improved from where they were in the past. The public health nurse is perceived as helpful, but not altogether clear as to what their roles and responsibilities are.

Most health consumers agreed that they do not access public health services as much as hospital services. Several shared experiences with public health as school-age children, with immunizations and check-ups. Although most health consumers valued nurses, they were not well versed in the roles or responsibilities of public health nurses.

Hospital nurses agreed that problems with the public health system and issues faced by public health nurses were circumstances that the government needed to address. They also felt that the healthcare system in Taiwan had some major drawbacks, mostly relating to higher patient loads, smaller salaries, and lower status levels of nurses in Taiwan, with some debate as to whether public health nurses can alleviate these problems.

Limitations and Follow-up

We encountered several difficulties that created limitations for the research we were able to obtain thus far. The time difference between Taiwan and the United States produced a challenging situation to work out scheduling conflicts when setting up telephone appointments with people in Taiwan. Also, we have yet to find a sample of public health nurses who are willing to be interviewed. Despite using the snowballing method to try to contact public health nurses, sending letters explaining the research study to hospitals and clinics throughout Taiwan, and contacting these hospitals by phone, we have not been able to find a sample of public health nurses. However, we have recently been in contact with a nurse in Taiwan who is willing to find a sample of public health nurses for interviewing. Also, we are associated with the Sigma Theta Tau International Society of Nurses and are hoping to use this connection to find nurses for our sample through these channels. Through these newfound resources, we hope to obtain the sample necessary to complete our research.

References

• Brock, J. F. (1976). A medical paradox: Curative versus preventative medicine. South African Medical Journal, 50(34), 1327-33.
• Lu, J. F. & Hsiao W. C. (2003). Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Affairs, 22(3), 77-88.
• Mino, J. C. & Lert, F. (2005). Beyond the biomedical model: Palliative care and its holistic model. HEC Forum, 17(3), 227-236.
• Shyu, Y. L., Liao, M. N., Shao, J. H., & Yang, C. L. (1999). A survey of home nursing services in Taiwan. Public Health Nursing, 16(6), 432-440.