title: Tacit knowledge of public health nurses in identifying community health problems and need for new services: a case study.
abstract: BACKGROUND
  The purpose of this study was to explore the tacit knowledge of public health nurses in identifying community health problems and developing relevant new projects. Previous research only roughly showed those skills for creating new community health services, such as lobbying.
  
  
  METHODS
  Nine Japanese public health nurses who had created new projects in their municipalities were selected by theoretical sampling and interviewed in 2002-2003. Yin's Case Study Method, especially the multiple-case study design, was used.
  
  
  RESULTS
  All 9 public health nurses used similar approaches in identifying community health problems and the need for creating new services, even though their experiences differed and the kinds of projects varied. They identified the difficulties of clients, recognized clients who had the same problems, elucidated the limitations of existing services, and forecasted outcomes from the neglect of the clients' problems. Then they succeeded in creating a new project by examining individual health problems in the context of their community's characteristics, societal factors, and using existing policies to support their clients.
  
  
  CONCLUSIONS
  This is the first study to explore the skills of public health nurses and their intention to use such skills in creating new projects as well as the exact process. They could identify community health problems that will be the basis for developing new services to provide care for individual clients. This is different from the traditional community assessment approach that requires the collection of a huge amount of information to clarify community health problems. The tacit knowledge of public health nurses will help to create needs-oriented new services more smoothly.
authors.affiliation: Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Tokyo 113-0033, Japan. kyokoy-tky@umin.ac.jp
authors.forename: Kyoko
authors.initials: K
authors.lastname: Yoshioka-Maeda
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Murashima
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Asahara
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D018672:Community Health Planning / Q000458:organization & administration; D003625:Data Collection; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006801:Humans; D033182:Intention; D007564:Japan; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D020380:Needs Assessment / Q000458:organization & administration*; D024802:Nurse's Role / Q000523:psychology; D009730:Nursing Assessment / Q000458:organization & administration; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000523:psychology; D011637:Public Health Nursing / Q000458:organization & administration*; D012107:Research Design; D012944:Social Support; D011795:Surveys and Questionnaires