# Negative Capability-Related Dimensions Among Local Government Public Health Nurses in Japan and Their Associated Factors

## TL;DR

This study explores how Japanese public health nurses handle uncertainty in their work and what factors influence their ability to tolerate ambiguity.

## Contribution

The study identifies specific factors, such as resilience and career development, associated with ambiguity tolerance and attitudes among public health nurses in Japan.

## Key findings

- Resilience and organizational support are positively linked to enjoying ambiguity among public health nurses.
- Resilience and policy competence are negatively associated with anxiety about ambiguity.
- Years of public health nursing experience reduce anxiety about ambiguity.

## Abstract

Objective

Local government public health nurses (PHNs) in Japan deliver community-based public health services and often make practice decisions under uncertainty, incomplete information, and competing priorities. This study examined negative capability (NC)-related dimensions among PHNs in Japan - operationalized as ambiguity intolerance (MAT) and attitudes toward ambiguity - and explored factors associated with these dimensions.

Methods

We conducted an anonymous web-based survey of local government PHNs in Japan from July 16 to August 25, 2024. Ambiguity intolerance (indexed by higher MAT scores) was assessed using the Japanese 24-item Measure of Ambiguity Tolerance (MAT), and attitudes toward ambiguity were measured using a 26-item scale with five subscales (enjoyment, anxiety, reception, control, exclusion). Self-rated understanding of NC was assessed using a visual analogue scale (VAS, 0-100), resilience was measured using the 14-item Resilience Scale (RS14), and career development was measured using a 26-item career development scale for local government PHNs. Multiple linear regression (forced entry) was conducted for MAT and each attitude subscale, including sex, municipality type, years of PHN, RN, and other work experience, resilience, NC understanding, and career development subscales as explanatory variables. The primary outcome was ambiguity intolerance (MAT total score). The five attitude subscales (enjoyment, anxiety, reception, control, and exclusion) were treated as secondary exploratory outcomes.

Results

Data from 380 PHNs were analyzed (94.7% female; mean age 41.2 years, SD 11.9). The model for ambiguity enjoyment was significant (F(12,367)=9.03, p<0.001; adjusted R²=0.203) and showed positive associations with resilience (β=0.257, t=4.00, p<0.001), organizational mission/interpersonal support (β=0.168, t=2.27, p=0.024), professional identity as a PHN (β=0.147, t=2.29, p=0.023), and years of other work experience (β=0.103, t=2.20, p=0.029); years of PHN experience was not significantly associated (β=-0.122, t=-1.94, p=0.053). The model for ambiguity anxiety was significant (F(12,367)=9.82, p<0.001; adjusted R²=0.218) and showed negative associations with resilience (β=-0.357, t=-5.61, p<0.001), policy/organizational management competence (β=-0.270, t=-3.40, p<0.001), and years of PHN experience (β=-0.174, t=-2.79, p=0.006). Other attitude subscales (reception, control, and exclusion) also showed significant associations with several predictors, although effect sizes were modest. Of 532 submitted responses, 152 were excluded due to incomplete key variables. Adjusted R² ranged from 0.076 to 0.218 across outcomes, indicating modest explanatory power.

Conclusion

NC-related dimensions among local government PHNs were associated with both individual resources (resilience) and career development. Because the design was cross-sectional and outcomes captured NC-adjacent dimensions rather than NC itself, causal interpretation should be avoided; longitudinal, intervention, and qualitative studies are warranted. Because multiple outcomes and subscales were examined, there is an increased risk of chance findings; results should be interpreted cautiously and as hypothesis-generating.