Initiation and Development of Nurse Practitioner Practice in a Japanese Rehabilitation Hospital: A Mixed-Methods...

Area of Science:

• Healthcare Management
• Nursing Practice
• Rehabilitation Medicine

Background:

• Nurse practitioners (NPs) are underrepresented in Japanese rehabilitation settings, despite a national shift towards chronic and community care.
• Understanding NP roles is crucial for integrating them into post-acute rehabilitation to meet evolving healthcare demands.

Purpose of the Study:

• To examine the initiation, development, scope, processes, and patterns of clinical activities undertaken by nurse practitioners in a Japanese rehabilitation hospital.
• To provide insights into the diverse roles and professional autonomy of NPs in post-acute rehabilitation care within Japan.

Main Methods:

• A 12-month mixed-methods descriptive study at Kanagawa Rehabilitation Hospital.
• Analysis of 738 NP-involved clinical activities, including setting, department, initiation mode, and intervention details.
• Quantitative descriptive statistics and qualitative content analysis of NP practice domains.

Main Results:

• Most NP activities occurred in adult inpatient wards (84.4%) within internal medicine (30.5%) and orthopedic (29.7%) departments.
• Over half of NP interventions were self-initiated (56.2%), demonstrating significant professional autonomy.
• Identified domains included direct clinical management, care coordination, patient/family education, and administrative/quality improvement activities.

Conclusions:

• NP practice in Japanese rehabilitation settings is multifaceted, encompassing clinical, coordination, educational, and administrative functions.
• NPs exhibit substantial professional autonomy and are well-integrated into multidisciplinary rehabilitation teams.
• Further research is needed to assess the impact of NP integration on patient and system-level outcomes in rehabilitation care.