Hospital A, nestled among hills, plays a central role in providing health services in the region with a population of about 150,000. Designated as a secondary emergency care hospital, it has no independent emergency care team, but has made every arrangement to provide emergency medical services around the clock: In the daytime on weekdays, clinical department physicians and nurses, and in the night time and on holidays, one doctor and two nurses on duty are in charge. Nurses on night duty and on holidays vary in clinical experience and ability to cope with emergencies. Apparently, they are struggling to maintain their presence of mind when they are receiving patients requiring immediate attention or when they are answering to emergency telephone calls. In May 2012, the hospital moved to the place within easy access of the main road and a heliport was built. It was expected that the number ofpatients rushed to the hospital in ambulances would increase. Against this background, there arouse an urgent need for every paramedic and nurse to make an right assessment of the conditions of the patients promptly and sort them rightly according to the emergency of their need for care. To meet this need, we started to work on standards of triage categorization and practice according symptoms, and classification of severity. Moreover, to develop the ability of the staff to deal with the emergencies, study meetings were held and case reviews took place.

Introduction   Recently, the number of foreign residents residing in Japan has increased. The purpose of this study was to describe the backgrounds of public health nurses (PHNs) who encounter the cultural differences and their resultant difficulties while providing maternal and child health (MCH) services to foreign residents in a metropolitan area of Japan.Methods   Questionnaires were administered to PHNs working at local health centers in a metropolitan area. Information about the backgrounds and working areas of the PHNs were extracted from descriptive statistics. The χ2- test, Fisher’s exact test, and the Mann-Whitney U test were conducted to analyze their experiences of and difficulties caused by cultural differences.Results   A total of 265 PHNs completed the survey (response rate: 17.7%), among whom, 246 (92.8%) responded that they had encountered difficulties due to cultural differences while providing MCH services to foreign residents, and 212 (80.0%) responded that they had faced difficulties caused by cultural differences in general. Significant differences were found in experiences of cultural differences, the length of each PHN’s professional career and his or her MCH activities, the presence of continual concerns from foreign residents, and the list of MCH activities that required English or another language, as well as the accurate interpretation of these languages. The size of the foreign residents population was a significant cause of difficulties resulting from different cultural experiences. Few PHNs were able to interpret languages effectively at any time (10.6%), and only 3.0% were able to implement the training provided by their center.Conclusions  PHNs who work in areas with a high proportion of foreign residents face significant difficulties. However, it is possible that all PHNs face difficulties irrespective of their language ability and overseas experiences.