Resea ch A icle
Iden i ying and In e ening in Child Mal ea men and
Implemen ing Rela ed Na ional Guidelines by Public Heal h
Nu ses in Finland and Japan
Kayoko Suzuki,1Eija Paa ilainen,2Mika Helminen,3Aune Flinck,4Na suko Hi oyama,5
Taiko Hi ose,5No iko Okubo,5and Mo oko Okami su5
1School o Nu sing, Tokyo A iake Uni e si y o Medical and Heal h Sciences, Tokyo, Japan
2School o Heal h Sciences, Uni e si y o Tampe e, E el¨
a-Pohjanmaa Hospi al Dis ic , Tampe e, Finland
3School o Heal h Sciences, Uni e si y o Tampe e and Science Cen e , Pi kanmaa Hospi al Dis ic , Tampe e, Finland
4School o Heal h Sciences, Uni e si y o Tampe e, Na ional Ins i u e o Heal h and Wel a e, Depa men o Go e nmen Se ices,
Tampe e, Finland
5G adua e School o Heal h Ca e Sciences, Tokyo Medical and Den al Uni e si y, Tokyo, Japan
Co espondence should be add essed o Kayoko Suzuki; suzukik@ au.ac.jp
Recei ed 6 Oc obe 2016; Accep ed 28 Decembe 2016; Published 6 Feb ua y 2017
Academic Edi o : Lesley Wilkes
Copy igh © 2017 Kayoko Suzuki e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License,
which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
Aim. This s udy aimed o in es iga e how public heal h nu ses iden i y, in e ene in, and implemen he guidelines on child
mal ea men in Finland and Japan and o compa e he da a be ween he wo coun ies. Me hod. This s udy employed a c oss-
sec ional design. Public heal h nu ses’ knowledge and skills wi h espec o child mal ea men p e en ion we e assessed using a
ques ionnai e consis ing o h ee ca ego ies: iden i ica ion, in e en ion, and implemen a ion o guidelines. Public heal h nu ses
wo king in he a ea o ma e nal and child heal h ca e in Finland (𝑛 = 193)andJapan(𝑛 = 440) we e he pa icipan s. Resul s.A
signi ican ly highe pe cen age o Japanese public heal h nu ses iden i ied child mal ea men compa ed o Finnish public heal h
nu ses, while Finnish nu ses in e ened in child mal ea men be e han hei Japanese coun e pa s. In bo h coun ies, public
heal h nu ses who had ead and used he guidelines deal wi h child mal ea men be e han hose who did no . Conclusion. The
esul s sugges ha e ec i e aining on child mal ea men and he use o guidelines a e impo an o inc ease public heal h nu ses’
knowledge and skills o iden i ying and in e ening in child mal ea men .
1. In oduc ion
The si ua ion wi h espec o child well-being has apidly
imp o ed in mos de eloped coun ies including Finland and
Japan du ing he las ew decades. Finland and Japan a e op
anked coun ies in he in e na ional compa ison su ey on
child well-being in aspec s such as heal h, sa e y, educa ion,
and en i onmen [1]. Awa eness o child mal ea men and i s
consequences on he u u e well-being and de elopmen o
child en has also inc eased du ing las decades. Conside able
esou cesha ebeendeployed o ackle hep oblembu no
always o he maximum e ec [2]. The numbe o child
mal ea men cases has con inued o inc ease in Japan. In
2013, 73,802 cases we e epo ed o he Child P o ec ion
Se ice in Japan. The numbe was 2.8 imes as many as
ha epo ed in 2003 (26,569) [3]. The con ex is simila
in Finland, whe e he numbe o child en in eme gency
placemen has been g owing o e he las decade. A o al
o 4,192 o child en we e aken in o eme gency placemen
in 2013 in Finland. The numbe inc eased 3.3 imes in 10
yea s as compa ed o ha epo ed in 2003 (1,267) [4]. Child
mal ea men is he e o e a social issue in bo h coun ies.
Pa en s o mal ea ed child en a e o en known o a ange o
p o essionals, and i is c ucial o p o essionals o be ale o
signals o mal ea men , because child en who a e abused a e
unlikely o exp ess he need o o seek help di ec ly om
Hindawi Publishing Co po a ion
Nu sing Resea ch and P ac ice
Volume 2017, A icle ID 5936781, 7 pages
h ps://doi.o g/10.1155/2017/5936781
2Nu sing Resea ch and P ac ice
s a u o y agencies; u he mo e, hei pa en s a e likely o
be ill-equipped o seek and make use o in o mal suppo
se ices [5].
Childhood mal ea men is associa ed wi h a a i-
e y o changes in b ain s uc u e and unc ion and in
s ess- esponsi e neu obiological sys ems [6–8]. In addi-
ion, ad e se expe iences in ea ly childhood can ha e long-
e m heal h consequences, bo h physical and psychological
[8]. Consequences o child mal ea men include impai ed
li elong physical and men al heal h such as pos auma ic
s ess diso de o dep ession, and he social and occupa ional
ou comes can ul ima ely slow he economic and social de el-
opmen o he coun y [9, 10]. The e o e, ea ly childhood is
a c i ical ime o he p omo ion o heal hy de elopmen and
he p e en ion o men al diso de s in adul li e.
The e a e public heal h ca e sys ems in place o suppo
child en and hei amilies in Finland and Japan. Public
heal hnu ses(PHNs)wo kingwi hchild enand hei
amilies p o ide p e en i e heal h ca e se ices and play an
impo an ole as on wo ke s in iden i ying, in e ening
in, and p e en ing child mal ea men . I is impo an o
nu ses o de ec signs o child en and amilies being a a
isk o mal ea men . P e en i e in e en ion in child mal-
ea men is p ac iced based on guidelines in bo h coun ies.
In Finland, he Na ional Nu sing Guideline o iden i ying
and in e ening in child mal ea men based on sys ema ic
e iew was published by he Nu sing Resea ch Founda ion in
2008.Themainpu poseo heguidelinewas o indme hods
wi h which i is possible o iden i y child mal ea men cases
and, ollowing ha , con inue o help child en and amilies
by inding ways ou o hei si ua ion [11, 12]. In Japan, he
guideline o child mal ea men p e en ion was designed
by Minis y o Heal h, Labou and Wel a e in 1999 and
e ised se e al imes [13]. The con en s o he guideline
a e mainly he de ini ion o child mal ea men , p e en ion,
and in e en ion in child mal ea men and child p o ec ion.
The na ional guideline was a anged by each heal h ca e
cen e and u ilized. Howe e , iden i ying and in e ening in
child mal ea men is ex emely di icul and complex. Child
mal ea men is mos ly iden i ied when child en al eady ha e
se ious consequences and he sensi i i ies and speci ici y o
ools a e inadequa e. Failu e o conside he possibili y o
mal ea men will mean ha app op ia e diagnosis is no
made and he child is e u ned o an abusi e en i onmen
[14]. The e o e, esea ch o imp o e he assessmen o child
mal ea men is needed o p e en i e nu sing in e en ion.
The aims o his s udy we e o in es iga e how PHNs
iden i y, in e ene in, and implemen guidelines on child
mal ea men in Finland and Japan and o compa e he
esul s be ween he wo coun ies. The indings will be help ul
o inc ease PHNs’ knowledge and skills o p e en child
mal ea men .
2. Me hods
2.1. Design and Pa icipan s. This s udy employed a c oss-
sec ional design o in es iga e how PHNs iden i y, in e ene
in, and implemen guidelines on child mal ea men in
Finland and Japan. The knowledge and skills o PHNs wi h
espec o child mal ea men we e assessed using a sel -
assessmen ques ionnai e. Pa icipan s in his s udy we e
PHNs wo king in he a ea o ma e nal and child heal h ca e
in bo h coun ies.
Finland. Pa icipan s we e ec ui ed om he egis e o
he Finnish Union o Public Heal h Nu ses. An elec onic
ques ionnai e was sen o PHNs who had an e-mail add ess
andwo kedinchild- ela edclinics(𝑛 = 800)inFeb ua y
2012, among whom 367 nu ses comple ed he ques ionnai e,
esul ing in a esponse a e o 46%. The su ey was app o ed
by he boa d o he Public Heal h Nu se Union. A le e
s a ing he aim and de ails o his s udy was a ached o he
ques ionnai e and emphasized ha he esponden s would
emain anonymous. Replying o he elec onic ques ionnai e
indica ed in o med consen .
Japan. The su ey was conduc ed om Sep embe o Oc obe
in2012.TheJapanesepublicheal hca esys emwasclas-
si ied in o 5 ypes acco ding o he popula ion size o he
municipali y. A o al o 700 heal h ca e cen e s we e selec ed
using a s a i ied sampling me hod acco ding o he numbe
o PHNs wo king in 5 ypes o heal h ca e cen e s in 2011.
Simila ly, 486 heal h ca e cen e s in small municipali ies
we e selec ed by s a i ied sampling based on he numbe o
PHNs wo king in he municipali ies o he 47 p e ec u es.
Resea ch andomize was used o he s a i ied sampling.
Two se s o ques ionnai es we e sen by mail o he PHNs who
wo ked wi h p egnan women, child en, and hei amilies in
a o al o 700 heal h ca e cen e s (𝑛=1,400), o which 453
nu ses comple ed he ques ionnai e ( esponse a e: 32.4%).
A co e le e was a ached o he ques ionnai e o explain
he aim and de ails o he s udy. I was emphasized ha
pa icipa ion in he s udy was olun a y and pa icipan s
would emain anonymous. Replying o he ques ionnai e
indica ed in o med consen . This s udy was conduc ed wi h
he app o al o he E hics Commi ee o Tokyo Medical and
Den al Uni e si y.
2.2. Measu es. A ques ionnai e o assess PHNs’ knowledge
and skills wi h espec o child mal ea men was de eloped
basedon he esea cho Paa ilainene al.[15]basedon
he Finnish Na ional Guideline. The con ex o he Finnish
Guideline was sui able also o he Japanese con ex . The
ques ionnai e consis ed o 3 ca ego ies: iden i ica ion (8 s a e-
men s), in e en ion (31 s a emen s), and implemen a ion o
guidelines (8 s a emen s) on child mal ea men . Pa icipan s
we e asked o a e, on a 6-poin Like scale anging om
1 ( o ally disag ee) o 6 ( o ally ag ee), he ex en o which
hey ag eed wi h he s a emen s. The ques ionnai e included
demog aphic ques ions (age, gende , wo k expe ience as a
PHN, and cu en job) and ques ions conce ning whe he
PHNs knew abou he exis ence o guidelines on child
mal ea men and had ead hem. Be o e conduc ing his
su ey, 10 Finnish PHNs pa icipa ed in a pilo es o he
elec onic e sion o he ques ionnai e, and subsequen ly a
pa was modi ied.
Nu sing Resea ch and P ac ice 3
Table 1: Backg ound o he pa icipan s.
Va iables Finland (𝑛 = 193)Japan(𝑛 = 440)
Mean (SD)
Age 42.1 (11.2) 37.3 (9.1)
Wo king yea s as a nu se 12.5 (10.3) 12.1 (9.1)
𝑛(pe cen ages)
Gende (male/ emale) 1 (0.5%)/192 (99.5%) 5 (1%)/434 (99.0%)
PHNs knowing he exis ence o he guidelines 156 (80.8%) 417 (95.4%)
PHNs who had ead he guidelines 104 (53.9%) 383 (88.0%)
Table 2: Iden i ica ion o child mal ea men .
Va iables Finland (𝑛 = 193)Japan(𝑛 = 440)𝜒2(1) Φ
Disag ee Ag ee Disag ee Ag ee
PHNs mee mal ea ed child en o en 164 (85%) 29 (15%) 290 (67%) 145 (33%) 22.37∗∗∗ .19
PHNs ecognize child mal ea men based on
Child- ela ed isk ac o s 88 (46%) 105 (54%) 25 (6%) 413 (94%) 114.99∗∗∗ .48
Pa en s- ela ed isk ac o s 58 (30%) 135 (70%) 21 (5%) 418 (95%) 78.26∗∗∗ .35
Family- ela ed isk ac o s 62 (32%) 131 (68%) 28 (6%) 411 (94%) 72.77∗∗∗ .34
The child’s beha io 117 (61%) 76 (39%) 140 (32%) 299 (68%) 45.87∗∗∗ .27
The pa en s’ beha io 130 (67%) 63 (33%) 131 (30%) 308 (70%) 77.84∗∗∗ .35
PHNs ecognize physical signs su icien ly well 88 (46%) 105 (54%) 73 (17%) 366 (83%) 59.25∗∗∗ .31
PHNs ecognize men al signs su icien ly well 120 (62%) 73 (38%) 111 (25%) 327 (75%) 78.32∗∗∗ .35
Es ima e signi icance: ∗∗∗𝑃< 0.001.
In Japan, he same ques ionnai e ansla ed in o Japanese
wasusedin hesu ey.Japanesepa icipan swe easked
o a e hei ag eemen wi h he s a emen s using a 4-
poin Like scale anging om 1 ( o ally disag ee) o 4
( o ally ag ee). A ques ionnai e using 4-poin Like scale
is widely used in Japan. A scale which had wide ange o
choices was di icul o answe and unsui able o Japanese
pa icipan s. The e o e 4-poin Like scale was adap ed o
he Japanese ques ionnai e ins ead o 6-poin scale. One i em
abou in e en ion in child mal ea men was excluded om
heJapaneseques ionnai ebecausei wasdi icul oanswe
in Japanese.
2.3. Da a Analysis. To make he g oups as compa able as
possible, da a om PHNs wo king in ma e ni y, amily
planning, o child clinics in Finland (𝑛 = 193)andda a om
Japanese pa icipan s who wo ked wi h p egnan women,
child en, and hei amilies (𝑛 = 440)we eused o he
analysis.
The answe s o each i em on he ques ionnai e we e
classed as ei he “disag ee” (answe s o 1–3 poin s in Finland
and 1-2 poin s in Japan) o “ag ee” (answe s o 4–6 poin s in
Finland and 3-4 poin in Japan). Using chi-squa e es s, we
examined whe he he e we e signi ican di e ences be ween
Finnish and Japanese pa icipan s. S a is ical analyses we e
conduc ed using SPSS.
3. Resul s
3.1. Demog aphic Cha ac e is ics. The demog aphic cha ac-
e is ics o he pa icipan s a e shown in Table 1. Mos pa ic-
ipan s we e emale in Finland and Japan. App oxima ely 80%
o Finnish pa icipan s knew abou he guidelines; howe e ,
only 53.9% o hem had ead hem. On he o he hand,
abou 95% o Japanese pa icipan s knew abou he guidelines
and 88% o hem had ead hem. The e we e signi ican
di e ences be ween hese answe s om Finnish and Japanese
PHNs (𝑃 < 0.001).
3.2. Iden i ica ion o Child Mal ea men . On all o he
i ems ega ding he iden i ica ion o child mal ea men ,
he pe cen age o Japanese PHNs wi h “ag ee” answe s was
signi ican ly highe han Finnish PHNs (Table 2). Mo e
han 90% o Japanese pa icipan s esponded ha hey
ecognized isk ac o s o child mal ea men ela ed o
child en, pa en s, and amilies. Finnish esponden s ag eed
ha hey ecognized child mal ea men based on pa en s-
ela ed isk ac o s and amily- ela ed isk ac o s mode a ely
well, al hough mo e han 60% o esponden s p o ided
“disag ee” answe s on h ee i ems; PHNs ecognized child
mal ea men basedon hechild’sbeha io and hepa -
en s’ beha io , and hey ecognized men al signs su icien ly
well.
4Nu sing Resea ch and P ac ice
Table 3: In e en ion o suppo child en and hei amilies.
Va iables Finland (𝑛 = 193)Japan(𝑛 = 440)𝜒2(1) Φ
Disag ee Ag ee Disag ee Ag ee
PHNs discuss su icien ly well wi h amilies
Risk ac o s in amilies 54 (28%) 139 (72%) 203 (47%) 233 (53%) 19.13∗∗∗ −.17
The child’s ca e 35 (18%) 158 (82%) 140 (32%) 297 (68%) 12.90∗∗∗ −.14
P oblems in he couple's ela ionship 70 (36%) 123 (64%) 258 (59%) 179 (41%) 27.81∗∗∗ −.21
P oblems in hei daily li e 17 (9%) 176 (91%) 132 (30%) 304 (70%) 34.10∗∗∗ −.23
The child’s de elopmen 21 (11%) 172 (89%) 92 (21%) 345 (79%) 9.41∗∗ −.12
P oblems in he child’s de elopmen 22 (11%) 171 (89%) 93 (21%) 343 (79%) 8.83∗∗ −.12
PHNs ad ise pa en s su icien ly well o
Seek help when needed 9 (5%) 184 (95%) 117 (27%) 319 (73%) 41.05∗∗∗ −.26
Deal well wi h he child’s an ums 22 (11%) 171 (89%) 112 (26%) 324 (74%) 16.29∗∗∗ −.16
Ac well when he child does no mee pa en s’ expec a ions 31 (16%) 162 (84%) 148 (34%) 289 (66%) 20.55∗∗∗ −.18
Ac well when he child has special needs o illness 52 (27%) 141 (73%) 143 (33%) 293 (67%) 2.14NS −.06
Ac well when he child c ies 26 (13%) 167 (87%) 112 (26%) 323 (74%) 11.75∗∗ −.14
Discuss hei consis en nu u e 35 (18%) 158 (82%) 135 (31%) 300 (69%) 11.27∗∗ −.13
Es ima e signi icance: NS = no signi ican ; ∗∗𝑃<0.01;∗∗∗𝑃< 0.001.
Table 4: In e en ion when suspec ing child mal ea men .
Va iables Finland (𝑛 = 193)Japan(𝑛 = 440)𝜒2(1) Φ
Disag ee Ag ee Disag ee Ag ee
When suspec ing child mal ea men PHNs
Ask abou i di ec ly 48 (25%) 145 (75%) 247 (57%) 189 (57%) 54.26∗∗∗ −.29
Always make a child wel a e no i ica ion 16 (8%) 177 (92%) 133 (31%) 303 (69%) 36.52∗∗∗ −.24
Help he mal ea ed child su icien ly well 86 (45%) 107 (55%) 265 (61%) 170 (39%) 14.51∗∗∗ −.15
Help he amily su icien ly well 88 (46%) 105 (54%) 282 (65%) 154 (35%) 20.11∗∗∗ −.18
Documen he mal ea ed child 17 (9%) 176 (91%) 41 ( 9%) 396 (91%) 0.05NS −.01
Guide o ollow-up ea men 17 (9%) 176 (91%) 176 (40%) 259 (60%) 62.91∗∗∗ −.32
Lis en o he amily unde suspicion 14 (7%) 179 (93%) 96 (22%) 341 (78%) 20.11∗∗∗ −.18
Es ima e signi icance: NS = no signi ican ; ∗∗∗𝑃< 0.001.
3.3. In e en ion in Child Mal ea men . Conce ning he
in e en ion o suppo child en and hei amilies, he pe -
cen age o Finnish pa icipan s who esponded wi h “ag ee”
was highe han Japanese pa icipan s o all i ems. The e
we e signi ican di e ences be ween answe s o Finnish and
Japanese PHNs in all he i ems excep one i em ega ding
suppo when he child has special needs o illness (Table 3).
Fo mos i emsabou in e en ionwhensuspec ingchild
mal ea men , he a e o pa icipan s who esponded wi h
“ag ee” was signi ican ly highe o Finland han Japan. Mo e
han 90% o Finnish PHNs esponded ha hey always
made a child wel a e no i ica ion, documen ed he mal ea ed
child, guided o ollow-up ea men , and lis ened o he
amily unde suspicion. Mo e han 90% o Japanese PHNs
esponded wi h “ag ee” o an i em abou documen a ion.
The pe cen age o PHNs epo ing ha hey helped he
mal ea ed child and he amily su icien ly well was less han
40% in Japan (Table 4).
Rega ding he i ems on in e en ion, collabo a ion, and
suppo om o he p o essionals, he pe cen age o Finnish
PHNs who esponded wi h “ag ee” was signi ican ly highe
han Japanese PHNs in 5 i ems: collabo a ion wi h o he
p o essionals, suppo om pee s, suppo om physicians,
clea ins uc ions on how o make a child wel a e no i ica ion,
and wo king acco ding o he child mal ea men guidelines.
The a e o Finnish PHNs who esponded wi h “ag ee” was
signi ican lylowe hanJapanesePHNs o 2i emsabou
suppo omsupe io sandins uc ions ohandlechild
mal ea men cases. O e 90% o PHNs in bo h coun ies
epo ed ha hey knew who o con ac when suspec ing
child mal ea men , and he e we e no signi ican di e ences
be ween he wo coun ies o his i em (Table 5). In addi ion,
mo e han 80% o PHNs in Finland and Japan epo ed
ge ing enough suppo om pee s when child mal ea men
was suspec ed, and he a es we e he highes o suppo
om o he p o essionals in bo h coun ies. Al hough 78%
o Finnish PHNs epo ed ecei ing enough suppo om
physicians, his a e was only 29% o Japanese PHNs.
3.4. Implemen a ion o Guidelines. Answe s ega ding he
implemen a ion o guidelines a e shown in Table 6. The
pe cen age o Finnish pa icipan s who esponded wi h
Nu sing Resea ch and P ac ice 5
Table 5: In e en ion, collabo a ion, and suppo om o he p o essionals.
Va iables Finland (𝑛 = 193)Japan(𝑛 = 440)𝜒2(1) Φ
Disag ee Ag ee Disag ee Ag ee
When suspec ing child mal ea men PHNs
Collabo a e su icien ly well wi h o he p o essionals 9 (5%) 184 (95%) 103 (24%) 331 (76%) 33.11∗∗∗ −.23
Think mul i-p o essional collabo a ion wo ks well in he municipali y 73 (38%) 120 (62%) 151 (35%) 285 (65%) 0.59NS .03
Think mul i-p o essional collabo a ion wo ks well in hei o ganiza ion 46 (24%) 147 (76%) 131 (30%) 305 (70%) 2.55NS −.06
Know who o con ac 17 (9%) 176 (91%) 22 (5%) 415 (95%) 3.28NS .07
When suspec ing child mal ea men PHNs ge enough suppo om
Supe io s 85 (44%) 108 (56%) 92 (21%) 345 (79%) 35.02∗∗∗ .24
Pee s 17 (9%) 176 (91%) 70 (16%) 366 (84%) 5.90∗−.10
Physicians 43 (22%) 150 (78%) 307 (71%) 128 (29%) 126.39∗∗∗ −.45
Child p o ec ion 52 (27%) 141 (73%) 139 (32%) 298 (68%) 1.50NS −.05
In he o ice/clinic
PHNs ha e join ins uc ions o deal wi h child mal ea men 75 (39%) 118 (61%) 128 (29%) 309 (71%) 5.61∗.09
PHNs ha e clea ins uc ions how o make a child wel a e no i ica ion 45 (23%) 148 (77%) 179 (41%) 257 (59%) 18.36∗∗∗ −.17
I is possible o wo k acco ding o he guidelines 58 (30%) 135 (70%) 181 (42%) 250 (58%) 8.05∗∗ −.11
Es ima e signi icance: NS = no signi ican ; ∗𝑃<0.05;∗∗𝑃<0.01;∗∗∗𝑃< 0.001.
Table 6: Implemen a ion o guidelines on child mal ea men .
Va iables Finland (𝑛 = 193)Japan(𝑛 = 440)𝜒2(1) Φ
Disag ee Ag ee Disag ee Ag ee
The guidelines a e an impo an
ool 20 (10%) 173 (90%) 196 (45%) 237 (55%) 71.96∗∗∗ −.34
The guidelines lead my wo k 65 (34%) 128 (66%) 223 (52%) 210 (48%) 17.07∗∗∗ −.17
The guidelines change my wo k
ou ines o comply wi h he
ecommenda ions
13 (7%) 180 (93%) 372 (87%) 56 (13%) 362.97∗∗∗ −.77
PHNs ha e had enough aining
on he con en s o he guidelines 147 (76%) 46 (24%) 376 (87%) 57 (13%) 11.06∗∗ −.13
PHNs ha e amilia ized
hemsel es wi h he con en s o
he guidelines
96 (50%) 97 (50%) 355 (82%) 78 (18%) 68.92∗∗∗ −.33
PHNs discuss he con en s o he
guidelines in he o ice 144 (75%) 49 (25%) 373 (86%) 60 (14%) 12.35∗∗∗ −.14
PHNs suppo each o he o ac
in acco dance wi h he guidelines
in he o ice
90 (47%) 103 (53%) 321 (74%) 112 (26%) 44.78∗∗∗ −.27
The e a e su icien esou ces o
implemen he guidelines in he
o ice
110 (57%) 83 (43%) 394 (91%) 38 (9%) 100.00∗∗∗ −.40
Es ima e signi icance: ∗∗𝑃<0.01;∗∗∗𝑃< 0.001.
“ag ee” was signi ican ly highe han Japanese pa icipan s
o all i ems ega ding he implemen a ion o guidelines.
Al hough mo e han 40% o Finnish PHNs had no ead he
guidelines, 90% o hem epo ed ha he guidelines we e
an impo an ool. Al hough 90% o PHNs had ead he
guidelines in Japan, only 55% o hem ecognized hem as an
impo an ool. The pe cen age o Japanese esponden s who
epo ed ha ing amilia ized hemsel es wi h he con en s
o he guidelines (18%) was signi ican ly lowe han Finnish
esponden s (50%).
Da a om he PHNs in each coun y we e di ided in o
wo g oups acco ding o he answe gi en o he i em on
ha ing amilia ized hemsel es wi h he con en s o he
guidelines. PHNs’ answe s o he 8 i ems in he iden i ica ion
sec ion and he 31 i ems in he in e en ion sec ion we e
analyzed using a chi-squa e es o explo e he di e ences
be ween he answe s om PHNs in he wo g oups. The
esul so hecompa ison,o heJapanese esponden swho
we e amilia wi h he con en s o he guideline wi h hose
who we e no , showed signi ican di e ences in he esponses

6Nu sing Resea ch and P ac ice
o7o heiden i ica ioni emsand27o hein e en ioni ems
( he o me g oup had a highe pe cen age o PHNs who
esponded wi h “ag ee”). Likewise, signi ican di e ences
we e obse ed in he Finnish esponden s’ answe s o 4 o he
iden i ica ion i ems and 12 o he in e en ion i ems, when
compa ing hose who we e amilia wi h he con en s o he
guideline wi h hose who we e no . Thus, he pe cen age o
pa icipan s who esponded wi h “ag ee” was signi ican ly
highe in he g oup o PHNs who we e amilia wi h he
con en s o he guideline, compa ed wi h he g oup o PHNs
who we e no .
4. Discussion
4.1. Iden i ica ion and In e en ion in Child Mal ea men .
The cu en su ey was conduc ed o in es iga e PHNs’
knowledge and skills ega ding child mal ea men p e-
en ion and da a om Finnish and Japanese PHNs we e
compa ed. The esul s indica e ha Japanese PHNs iden i y
child mal ea men be e han hei Finnish coun e pa s,
whileFinnishPHNsin e eneinchildmal ea men be e
han Japanese PHNs. This may be due o he di e ences in he
public heal h ca e sys ems o he wo coun ies. In Finland, as
a No dic coun y, child heal h ca e se ices a e p o ided o
all child en and hei amilies, who can access hese se ices
16 imes be o e en e ing school. The se ices a e ee o cha ge
and hei a e o use is ex emely high [16]. The e o e, PHNs
in Finland can suppo all child en and hei amilies based
on hei needs. In Japan he e is a public heal h ca e sys em,
bu he equencyo useo heuni e salchildheal hca e
se ices is ex emely lowe han in Finland. I is he e o e
an impo an ole o Japanese PHNs o iden i y mal ea ed
child en and o connec hem wi h addi ional heal h ca e
and wel a e se ices, as he oppo uni ies o PHNs o mee
child en and hei amilies a e limi ed [17]. I seems ha his
sys em migh p omo e Japanese PHNs skills o iden i y child
mal ea men .
Japanese PHNs e alua ed hei knowledge and skills
o iden i ying child mal ea men mo e posi i ely han o
in e ening in child mal ea men . This esul is simila o
ha o an ea lie s udy conduc ed on pedia ic hospi al s a
[18].Theknowledgeandskillso FinnishPHNs oin e ene
in child mal ea men we e highe han hose epo ed in ha
esea ch [18]. I has al eady been epo ed ha Finnish PHNs
who had pa icipa ed in aining on child mal ea men
in e ened well in child mal ea men [15]. In Finland, PHNs’
aining was p omo ed in he con ex o he Ea ly Eu opean
P omo ion P ojec (EEPP). The EEPP was conduc ed in i e
Eu opean coun ies including Finland du ing he i s hal
o he 2000s, wi h he aim o p omo ing pa en -in an ela-
ionships and hence in an men al heal h and o p e en ing
emo ional and beha io al p oblems by p o iding a uni e sal
se ice a ailable o all amilies wi h small child en. T aining
in he EEPP was in ended o p omo e PHNs p e en i e wo k
o young child en and hei amilies [19–21]. I seems ha
his aining migh ha e inc eased Finnish PHNs’ knowledge
andskills oin e eneinchildmal ea men .The e o e,
i is sugges ed ha e ec i e PHNs’ aining, such as he
EEPP aining, is also needed o Japanese PHNs o inc ease
hei knowledge and skills ega ding child mal ea men
in e en ion.
4.2. Implemen a ion o Guidelines on Child Mal ea men .
Al hough mos Japanese PHNs had ead he guidelines on
child mal ea men , mos o hem did no ag ee wi h he
ques ionnai e s a emen s ega ding he implemen a ion o
he guidelines. This inding shows ha , ega dless o he
guidelines, he e a e some issues in he p ocess o hei
in oduc ion and implemen a ion. In addi ion, he Japanese
PHNs who we e amilia wi h he con en s o he guidelines
iden i ied and in e ened in child mal ea men be e han
he PHNs who did no . These esul s sugges ha de eloping
s a egies o u ilizing he guidelines a e equi ed in o de
o inc ease PHNs’ knowledge and skills o iden i ying and
in e ening in child mal ea men in Japan.
In his s udy, Finnish PHNs who amilia ized hemsel es
wi h he con en s o he guidelines deal wi h child mal-
ea men be e han PHNs who did no . The impo ance
o guidelines has been shown in ea lie esea ch ega d-
ing child mal ea men [22]. The e o e, i is sugges ed ha
unde s anding he con en s o guidelines is also impo an
in o de o inc ease he knowledge and skills o iden i ying
and in e ening in child mal ea men in Finland as well as
in Japan.
4.3. Limi a ions o This S udy. The knowledge and skills o
PHNs o iden i y and in e ene in child mal ea men we e
assessed using a sel - epo ques ionnai e in his s udy. I
is conside ed ha e alua ing PHNs’ knowledge and skills
accu a ely o p e en child mal ea men in his way is
di icul and his is a limi a ion o his s udy.
The su ey was conduc ed using ques ionnai es, in he
o m o a web-based su ey in Finland and a mail su ey in
Japan. The di e ence in he su ey me hods may ha e con-
ibu ed o he di e ences in he answe s o he esponden s
be ween he wo coun ies.
Da a om Finnish and Japanese PNHs we e compa ed
and discussed in his s udy. Howe e , he ac o s associa ed
wi h e ec i e nu sing in e en ions we e no conside ed
in de ail. Fu he discussion abou hese ac o s is needed
in o de o p omo e PHNs’ skills wi h espec o child
mal ea men in e en ion.
5. Conclusion
The cu en s udy ound ha Japanese PHNs iden i ied child
mal ea men be e han Finnish PHNs, and Finnish PHNs
in e ened in child mal ea men be e han hei Japanese
coun e pa s. I was shown ha e ec i e aining on child
mal ea men is needed o inc ease PHNs’ knowledge and
skills o iden i ying and in e ening in child mal ea men .
In addi ion, u ilizing guidelines is also equi ed in o de o
e ec i ely in e ene in child mal ea men in Finland and
Japan.
Nu sing Resea ch and P ac ice 7
Compe ing In e es s
The au ho s ha e no con lic o in e es s di ec ly ele an o
he con en o his a icle.
Acknowledgmen s
The au ho s wish o acknowledge he con ibu ion o Finnish
andJapanesePHNswhopa icipa edin hiss udy, heboa d
o he Public Heal h Nu se Union in Finland, he heal h ca e
cen e s ha ex ended hei coope a ion o his s udy in Japan,
and he s a is ical assis ance o D . Takahide Omo i.
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