06

Role of the Fertility Nurse in Japan: 

Role of the Fertility Nurse in Japan Japanese Society of Infertility Nursing President St. Luke’s College of Nursing Akiko Mori, RN,NM,MN Associate Professor

Slide2: 

St. Luke’s College of Nursing and St. Luke’s International Hospital

Slide3: 

St. Luke’s International Hospital , Tokyo in Spring Obstetrics and Gynecology Center for Advanced Reproduction

St. Luke’s College of Nursing 21st Century COE Program: 

St. Luke’s College of Nursing 21st Century COE Program Fertility care project

Aims: 

Aims To give an overview of reproductive medical care and how it affects fertility nursing in Japan To explain the role of fertility nursing in Japan

What issues are there in Japanese reproductive medicine?: 

What issues are there in Japanese reproductive medicine? No legal rules for medical care Insufficient quality assurance Patients’ stressful situation

Insufficient Quality Assurance: ◆There are many small-scale facilities. : 

Insufficient Quality Assurance: ◆There are many small-scale facilities. Number of registered facilities IVF-ET : 640 Frozen ET : 518 (80.9%) ICSI : 363 (56.7%) DI : 23 (JSOG: As of October 31, 2004) Distribution of number of facilities according to number of IVF cycles (As of 2002) ８４％

Insufficient Quality Assurance:◆Most facilities don't disclose treatment results.◆It is difficult to gauge the result according to the age.: 

Insufficient Quality Assurance: ◆Most facilities don't disclose treatment results. ◆It is difficult to gauge the result according to the age. All ages: Results of IVF-ET( Fresh) (As of 2002) The source: Japan Society of Obstetrics and Gynecology http://www.jsog.or.jp

Patients’ Stressful Situation :: 

Patients’ Stressful Situation : A survey by self help group, Finrrage, January, 1999, N=857 Treatment years: 4.3 years (The longest:18) No. of hospitals they consulted: 2.7 facilities (Maximum:15) A Japanese woman complained in her book published in 2004 “Before I became the “Patient”, I needed to ask myself what do I want to do and what can I do in the situation "Infertility“ , so I needed to form by directing the mind as a person.” “In our society, there is the fantasy everyone can get pregnant if they go to a hospital.”

Nurses Also Struggle to Care:: 

Nurses Also Struggle to Care: ＊No consideration ＊Do not understand the feelings of patients with fertility problems ＊Obvious mistakes ＊Biased manner of 　 speaking ＊No time, no space, no manpower ＊worry that infertile patients use the same waiting room as pregnant women. ＊painful to know patient's suffering ＊difficult to care for patient with long term infertility and patients whose pregnancy has failed ＊lack of fertility nursing skills ＊difficult to care for patients who have 　 different values from theirs ＊Patient and doctor's bonds are too 　 strong for the nurse to take part Patients Nurses (Finnrage, 2001) (Mori, Arimori, Muramoto, 2002)

Measures of Government: 

Measures of Government Sukoyaka Family 21（2001～2010） 　　＊Arrangement of consultation centers 　 　　　 specializing in infertility　 　　　　　　　　　　47 Prefectures & 4 Cities ( in 2004) 　　＊Assuring counseling before and during treatment 　　＊Preparation of medical guideline The specific fertility treatment expense aid system （2004～）

Development of Fertility Nursing in Japan: 

Development of Fertility Nursing in Japan In 1983, The first IVF baby was born in Japan In 1998, Certification of IVF coordinator was started In 1999, Japan Infertility Nursing Network (JINN) was established In 2002, Certified Expert Nurse (CEN) in the fertility field In 2003, Japanese Society of Infertility Nursing (JSIN) was established (shift from JINN to JSIN)

Current Fertility Nursing in Japan: 

Current Fertility Nursing in Japan Settings: Private / Public / University Hospitals , Private Clinics, Consultation centers Certification: ・Certified expert nurse (26:RN or MW) (Japanese Nursing Association, as of 2004) ・Fertility counselor (317:not only nurses) ・IVF coordinator (227:not only nurses) (Japan society for infertility counseling, as of 2004)

Certified Expert Nurse: Infertility FieldEducation and Accreditation: 

Certified Expert Nurse: Infertility Field Education and Accreditation ・General nurse (RN) ・Public health nurse　 ・Midwife Either of these licenses Experiences: 3 years or more OBGYN clinical practice, and care of infertile patient at fertility unit Complete curriculum of Certified Expert Nurse ( 6 months ・more than 600 hours ) Documents examination and written test Grant certificate and Registration ★update examination every five years Tokyo Kobe JNA Kobe Continuing Education Center

Current Role of Fertility Nurse in Japan: 

Current Role of Fertility Nurse in Japan 250 facilities N=78(nurses) The source: Japanese Nursing Association, 2002

Fertility Nurse for the Future in Japan:To Provide Patient-centered Care: 

Fertility Nurse for the Future in Japan: To Provide Patient-centered Care Need to structure the framework of fertility nursing Need to exhibit the specialty in health care system Need to advocate patients’ needs Therefore, Actively enhance education and research Promote to collaborate with other medical team members, self-help groups, and other social resources