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

## TL;DR

This study explores how nurse practitioners operate in a Japanese rehabilitation hospital, highlighting their diverse roles and autonomy.

## Contribution

The study provides new insights into the development of nurse practitioner roles in Japan's rehabilitation healthcare system.

## Key findings

- Most NP activities occurred in adult inpatient wards, with a focus on internal medicine and orthopedic departments.
- Over half of NP interventions were self-initiated, showing significant professional autonomy.
- NP roles included direct patient care, coordination, education, and administrative tasks.

## Abstract

Introduction

Nurse practitioners (NPs) in Japan are primarily concentrated in acute care settings, with limited integration into rehabilitation hospitals. As Japan’s healthcare system increasingly emphasizes chronic and community-based care, understanding NP roles in post-acute rehabilitation is essential. This study aimed to examine the initiation and development of NP practice in a Japanese rehabilitation hospital, focusing on the scope, processes, and patterns of clinical activities.

Methods

We conducted a mixed-methods descriptive study at Kanagawa Rehabilitation Hospital over 12 months (April 2023-March 2024). All NP-involved clinical activities were extracted from hospital records, including the date, care setting, department, initiation mode, and free-text intervention descriptions. Quantitative data were analyzed using descriptive statistics, while qualitative content analysis identified thematic domains of NP practice.

Results

A total of 738 NP activities were recorded, most occurring in adult inpatient wards (n = 623, 84.4%), followed by pediatrics (n = 87, 11.8%) and clerical/administrative contexts (n = 28, 3.8%). Activities were concentrated in internal medicine (30.5%) and orthopedic (29.7%) departments. Over half of all interventions were self-initiated (415, 56.2%), indicating substantial professional autonomy. Qualitative analysis revealed four primary domains: direct clinical management (e.g., medication adjustments, swallowing care), care coordination (e.g., multidisciplinary conferences, interdepartmental referrals), patient and family education (e.g., disease-specific counseling, self-management guidance), and administrative/quality improvement activities (e.g., order entry, safety initiatives).

Conclusion

This study indicates that NP practice in rehabilitation settings encompasses diverse clinical, coordination, educational, and administrative roles, reflecting a high level of professional autonomy and integration into multidisciplinary care. These results provide insight into the scope and characteristics of NP practice in post-acute rehabilitation settings in Japan. Future studies are needed to evaluate the impact of NP integration on measurable patient and system-level outcomes, including quality, efficiency, and continuity of care.