In Japan, in order to promote a comprehensive regional health care system and differentiate, strengthen and make health care functions more collaborative new medical fees have been introduced to provide comprehensive urinary care to restore lower urinary tract function through the intervention of an interdisciplinary care team (urinary care team) for patients with lower urinary tract symptoms（LUTS）.For this reason, there has been an increase in the number of training workshops for nursing personnel by continence societies and associations and there is a growing interest in urinary care.Correctly analyzing LUTS determines the quality of urinary care provided. Is it right for technical training for urinary care to only be held in hospitals receiving medical treatment fees? In order to resolve the problems faced by patients health care workers from a variety of disciplines need to be able to evaluation lower urinary tract functions, know how to formulate a plan to provide comprehensive urinary tract care, understand issues including how to intervene and also improve their practical skills. In this study, after conducting technical training for interdisciplinary care team for patients with LUTS, our aim is to clarify the effect of the training and obtain suggestions on how to build a high-quality technical training system.

The targets of this study are the participants of the technical training held in prefecture A; 61 participants (nurses, care workers, physiotherapists, occupational therapists) from 20 facilities.Technical training dates:  9:00-12:00, 2/12/2017．Configuration: A lecturer and 6 groups (a facilitator and approximately 10 members from a variety of occupations).The flow of the technical training was as follows: a lecture on the evaluation of lower urinary tract function and how to formulate a comprehensive urinary care plan → group work → ( case studies of patients with LUTS → organizing patient information using the independent urination instruction sheet →assessment based on a urination journal → proposing a comprehensive urinary care plan) → summary．Technical training refers to the measurement of residual urine using assessment and the proposing of a care plan LUTS and the practice of urinary care  lifestyle coaching and and behavioral therapy (induced urination, bladder training and pelvic floor muscle training).The survey methods and research design are of the category of action research.After the training the participants were asked to fill in an anonymous self-administered questionnaire of their own free will and it was considered that consent was given for those collected.6 months after the technical training we explained the purpose of the research to 8 randomly chosen facilities that participated in the training (participant group) and 2 facilities that did not participate in the training (control group). A semi-structured interview was held with the facility representative and we asked about the state of urinary care at their facility. We analyzed qualitatively and inductively the content their free comments and the content of the interviews.We used Donald Kirkpatrick’s Four-Level Training Evaluation Model to evaluate the technical training. 1)

54 questionnaires were collected after the technical training (88.5% of recovery).Of these, 30 (56%) were nurses, eight (15%) were occupational therapists, eight (15%) were physical therapists, five (9%) were care-workers and the remaining 3 (5%) were doctors, pharmacists and so on.Of the participants who participated in the technical training, 32 (56%) participated voluntarily, 13 (24%) were sent from hospitals in order to receive medical payments and 9 (20%) were invited by friends to participate. The level 1 “Reaction” results from the questionnaire conducted immediately after the technical training was that 16 (30%) said they really understood the content; 34 (63%) said they understood the content a little; 4 (7%) said they could not understand the content very well and no participants said they could not understand the content at all.  Level 2, “Learning”the free comment section comments of the questionnaire were categorized into, “understanding of basic knowledge”, “understanding of assessment and evaluation” and “understanding of the care plan”. For level 3, “Behavior” 53 participants (98%) said they are able to utilize what they learned in the future; showing a significantly high effectiveness after the technical training (P < 0.001).Level 4, “Results” were investigated 6 months after the technical training and of the eight participant facilities six (75%) reported that they were able to utilize the training and were conducting urinary care.In level 1 of Donald Kirkpatrick’s Four-Level Training Evaluation Model you evaluate the participants’ “Reaction”.  This was done by asking participants to fill out a questionnaire immediately after training and this evaluates the degree of satisfaction.Level 2, “Learning” evaluates the level of participants’ understanding by looking at how much they understood and mastered the content of the training provided.Level 3, “Behavior” measures changes in the behavior of the participants.Level 4, “Results” measures the degree that changes in the participant lead to the achievement of results in the facility.

It became clear that over half of the participants participated voluntarily in a quest to improve urinary care regardless of remuneration. It seems that urinary assessment skill increased while receiving guidance from both the instructor and the facilitator. However, while participants felt that they understood the content of the lecture at the time, it seems that it is difficult to change behavior and keep what was learned in mind on a day to day basis. Execution of participants understood the general rate is approximately 20-30% said.In this research the rate that interdisciplinary team care was conducted on patients with lower urinary tract symptoms after the technical training was 75%. The reason for this may be because we created an environment where it is always possible to consult with nearby participants about unclear points, even after technical training.We believe that there is a need to continue encouraging participation in technical training and the conducting of workshops which explore the issues facing facilities which cannot provide care and use case studies of a variety of occupations facing difficulties and achieving successes continuing caring for patients with lower urinary tract symptoms.

Training desirable of “Training satisfaction (level 1)” was conducted.The results of participation in technical training to individual participants with regards to achievement of learning (level 2) and behavior modification (level 3) were high (learning attainment or behavior changes).Individual behavior did have an impact on the participant’s organization under “outcomes achievement (level 4)” .In the future we need to evaluate how these results impacted the “patient satisfaction” of patients (users) and to provide even higher level technical training.

Kirkpatrick,D.L. "Techniques for Evaluating Training Programs,"in Evaluating Training Programs. Alexandria, VA: American Society for Training and Development, 1975,pp.1-17.