This study focused on the changes in the activity of public health nurses, while they are affected by transitions in local government, due to small municipal governments becoming merged with larger ones. An interview survey obtained data that was analyzed through activity theory. Results indicated the following. First, before the merger, the activities of the public health nurses were distinguished into categories of "activity within the central city" (which was specified by law), and "activity within surrounding areas" (which they visit local community and provide services). Second, during municipal mergers, policies toward providing services equally to all areas were laid out, but this posed a double bind with existing policies. Third, after the merger, there was a period of confusion arising from the induction of new policies, while nurses explored ways to escape the double bind while providing services to the citizens, and consequently, they realized the need for a new vision of community service based on their professional capacities. These results suggest that such an environmental transition induces an extensive learning process leading to creative activity planning which takes into account the capacities of public health nurses, who must deal flexibly with organizational, and demographic constituency expansion.
View full abstract