Department Chair’s Greeting (For graduate course)
The Department of Nursing Sciences underwent a series of transformations before moving to its current location at the Faculty of Health Sciences at Tokyo Metropolitan University (TMU). First affiliated with the Tokyo Metropolitan College of Allied Medical Sciences, a junior college established in 1986, the department later joined the Faculty of Health Sciences of the Tokyo Metropolitan University of Health Sciences, following the university’s reorganization. Eventually, the department found a new home at TMU, a new public university born from the merger of several extant universities in 2005.
Today, most of our graduates go on to work in medical facilities, educational institutions, local and prefectural governments, and the corporate world, where they handle pressing health issues across a variety of nursing occupations. Everywhere they are deployed, from far-flung corners of Japan to foreign countries, these professionals are highly respected by employers and patients alike for their ability to help people through life’s struggles.
Our department’s curriculum has been carefully designed to train healthcare workers capable of operating in diverse environments, imparting students with fundamental concepts, attitudes, and skills across the wide spectrum of the nursing sciences. With these attainments, our graduates are well equipped to provide care for patients in need, helping them to live authentically, comfortably, and independently. In practice, nursing is the net product of nurses’ interactions with the people who need them. We have structured the program to reflect this quality, incorporating exercises and training so that you, your peers, and your instructors can try new things and inspire each other, rather than rely only on the top-down transmission of knowledge.
Department Chair’s Greeting (For postgraduate course)
Our curriculum will help you to not only establish a foothold in nursing research but also move the profession forward, giving you ample opportunities to acquire a wide variety of specialized knowledge and learn diverse research methods in the nursing sciences. Students are advised by faculty members with wide-ranging expertise in an environment where they can engage in research using a variety of approaches. In addition to a nursing research course, our master’s curriculum includes a course on certified nurse specialist of child health nursing. Our students carry out research activities that are wide in scope, covering topics on health in modern society and the future of nursing. They find inspiration through discussions with their peers and teachers in daily seminars.
We welcome all who would join us in pursuing our mission to foster the next generation of nursing science professionals.
Advantages of the Department of Nursing Sciences
Three Unique Characteristics
Three unique qualities characterize the Department of Nursing Sciences at TMU, as seen in the results of a 2017 survey of enrolled nursing students:
Dynamic learning and collaborative study with your friends
- Eighty-seven percent of students were satisfied with campus life (as indicated by responses of “satisfied” or “very satisfied”).
- Ninety percent of fourth-year students felt they had achieved personal growth. Over 50% of students said they had at least seven friends, from TMU schools and departments in earlier or later academic years, they could chat and have fun with.
Real, practical skills in the nursing sciences
- Seventy percent of students felt confident about their nursing skills. The percentages of students who were confident regarding their professional ethics as well as their abilities to communicate with and respect both care recipients and providers were particularly high.
- Students also reported high satisfaction with items related to the learning environment, including faculty expertise, talks by clinical professionals and outside lecturers, and instructors’ guidance during clinical training.
International experience: Study abroad, overseas training, and intramural exchange
- Every year, about 10 of our students go abroad to study or participate in intensive training (past locations include the UK, Sweden, Taiwan, and Spain). Students at TMU can also mingle with peers from Sweden’s Karolinska Institute, which sends students here every year.
During Year 1, TMU students primarily take introductory-level courses and fulfill general education requirements at the Minami-Osawa campus, taking advantage of the wide range of liberal arts courses expected of a large liberal arts university. Other features of our curriculum include practical instruction in English by foreign lecturers, computer training (information science), and basic seminars where students can learn and experience basic scientific principles for themselves. Such a high-quality liberal arts education is indispensable to students of nursing, which is a human-centric profession.
During Years 2 and 3, activities shift to the Arakawa campus, with the material’s degree of specialization gradually increasing. Students are taught everything from the basic medical knowledge all clinical professionals must possess to nursing-specific knowledge, attitudes, and ethical issues. Students’ practical skills are honed through on-campus labs and on-site clinical training. In Year 4, nursing research and graduation projects give students an opportunity to put scientific and critical thinking in action, and to integrate what they have learned over the previous three years.
TMU has over 1.6 million holdings in its libraries, split between the Minami-Osawa, Hino, and Arakawa campuses. These resources include countless academic journals and professional books in fields other than nursing, serving to enrich the university learning experience. The Arakawa library, in particular, holds essential materials for nursing occupations requiring advanced expertise, such as registered nursing, public health nursing, midwifery, physiotherapy, occupational therapy, and diagnostic radiation. Here, students can access both Japanese and international medical databases and receive the most current literature.
On-Site Clinical Training
After spending Year 1 at the Minami-Osawa campus, your studies will revolve around the Arakawa campus for Years 2 through 4. Various resources have been put in place to ensure the professional character of your nursing education.
Every year at the beginning of August, the campus holds an open house for prospective students to gain exposure to some of the wide-ranging activities in the nursing field.
- 1) Main Training Facilities
On-site clinical training proceeds smoothly thanks to the cooperation of municipal and other hospitals in Tokyo, chosen based on their suitability for certain skills and subject matter. Courses with training components at these institutions include the following:
- FuAndamental Nursing (Year 2) and Adult Nursing I (Year 1): The Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital
- Adult Nursing II (Year 3): Tokyo Metropolitan Bokutoh Hospital
- Maternal Nursing: Tokyo Metropolitan Ohtsuka Hospital
- Pediatric Nursing: Tokyo Metropolitan Children’s Medical Center
- Gerontological Nursing: National Center for Global Health and Medicine, and local long-term care health facilities
- Mental Health Nursing: Tokyo Metropolitan Matsuzawa Hospital
- Home Care Nursing: Visiting nurse stations—primarily in Tokyo’s Arakawa city (near campus) and the nearby Kita and Adachi cities—and hospital discharge support units
- 2) Faculty Advisors to Support You and Your Peers
“I want to be a nurse.…” This desire burns deep in the heart of every student who comes through our doors. Over the four years of your student life, you will experience wonderful things you’ll remember forever. However, difficulties may arise as well: you may struggle with academics, health issues, or even in your friendships.
The Department of Nursing Sciences assigns each incoming class a dedicated faculty advisor to help them flourish in their nursing careers. They schedule regular face-to-face meetings with students and are available for personal consultations.
TMU also employs non-teaching staff such as student counselors (clinical psychologists), academic counselors, and career counselors as part of a support system to help you cope with the wide variety of worries that can arise in student life.
Available Certifications and National Examinations
1) Available Certifications
Students who have graduated from the Department of Nursing Sciences, or are anticipated to, are eligible to sit for the national licensing exam for registered nurses (RNs).
RNs often work in hospitals, medical clinics, and visiting nurse stations; their duties involve watching over patients during their treatment and recovery, and assisting with medical care. In May of each year, the Japan Nursing Association sponsors community “meet-and-greet” events so the public can better understand the position’s responsibilities.
Public Health Nurse (selected through an examination)
Students who have graduated from the Department of Nursing Sciences, or are anticipated to, can sit for the national licensing exam for public health nurses (PHNs) if they have taken and passed certain designated courses, including Clinical Practicum in Public Health Nursing (11 units). Students who pass the national exam and become licensed PHNs can go on to apply for certification as school nurses (2nd grade) or 1st grade health supervisors.
PHNs often work in health centers; public administration, including in municipalities, cities, or villages; as well as in industry, schools, or hospitals, where they observe people’s health and lifestyle and give professional advice for disease prevention and the promotion of healthy living. If the number of eligible applicants exceeds the fixed number of exam slots, a selection examination will decide the matter.
Your Postgraduate Career
In a typical year, the majority of our graduates go on to work as RNs at over 30 hospitals. The vast majority work in medical institutions in Tokyo, including metropolitan hospitals, private hospitals (e.g., Tokyo Hoken Iryo Corporation), national specialist institutions (e.g., National Center for Global Health and Medicine, National Center for Child Health and Development), and university hospitals (e.g., The University of Tokyo Hospital, Tokyo Medical and Dental University, Medical Hospital), while others seek to practice in regional core hospitals. Most students independently initiate employment searches based on their career plans.
In addition, many others pass the highly competitive national exam to become certified PHNs. In this role, they serve communities in prefectures, cities, and districts all over Japan, endeavoring to “raise the bar” for residents’ health.Other graduates advance to a master’s program at TMU or to our graduate program of midwifery.
Generally, many new nursing graduates choose to work at a hospital for a few years, where they can become accustomed to applying basic nursing skills and techniques. (This phenomenon isn’t limited to TMU graduates, of course.)
Thereafter, career paths start to diverge as our graduates seek to acquire more specialized skills. Some go on to graduate school, where they engage in education and research; diligent students among them can further specialize as certified nurses or clinical nurse specialists. Some become managerial staff in hospital wards; others set out on a new course of study to become school nurses or midwives. Still others prefer a community-based career as a visiting nurse or care manager.
Seeing any of these paths through to the end requires effort and resolve. We are confident, however, that your desire for a career in the nursing sciences will present you with a multitude of possibilities as diverse as the field is broad.
Short Lectures on Introduction to Nursing Sciences
1. Fundamental Nursing: NOMURA Ayumi, Associate Professor
1) Medical Anthropology and Cross-Cultural Understanding: Two Requirements for Future Nurses
- (1) Medical anthropology
Researchers in the discipline of cultural anthropology engage with people from other cultures to answer questions about how culture and society shape people’s core beliefs about life. The related field of medical anthropology builds upon this foundation to explore disease- and medicine-related topics in terms of their cultural and social aspects. While medical anthropology is a relatively new area of study, first coming to Japan from North America in the 1970s, there will surely be an increased demand in medicine and nursing for people familiar with its tenets and concepts.
- (2) Cultural differences in healthcare and views on life and death
People in less developed areas where modern scientific technology has yet to take hold sometimes treat disease using folk or traditional remedies, witchcraft, or sorcery. How do people strike compromises with disease or illness as they go about their lives? How is this process governed by faith and culture? Investigating such questions is of primary interest in medical anthropology.
Human ideas about illness and death vary widely across cultures. In Sri Lanka, for example, inpatients stay in hospital a mere four days on average, much shorter than the average of 16 days in Japan. This could be explained by Sri Lankans leaving (or transferring) hospitals soon after admission. Moreover, they might only visit the hospital when they are close to death, with most preferring to pass away in the comfort of their own homes. Sri Lankan cultural beliefs about life-prolonging treatment differ from those in Japan, with few doctors pursuing intensive treatment in the name of survival (as is sometimes seen here). This isn’t to say that one way is “better” or “worse” than the other. Thinking about human mortality involves finding a personal answer to the question, “What makes you happy?”
- (3) What are the aims of nursing?
What is happiness? Ruminating on this question raises yet another: What are the ideals of nursing and medical care? Global perspectives are important in thinking about these ideals, as is a multidimensional view of the nursing sciences. Exposure to cultural and human diversity forces us to re-examine our own culture’s approaches to healthcare, as well as our own beliefs. This means that when providing care, you will constantly ask yourself about what it means to be human as well as the true meaning of health. Cross-cultural understanding amounts to cross-cultural understanding is a cornerstone of nursing practice—a cornerstone of nursing practice.
2) Why Is It That Senior Citizens with Dementia in Sri Lanka Can Live in Their Communities?
- (1) Aging and the elderly in Sri Lanka
Sri Lanka was devastated by the tsunami caused by the 2004 Indian Ocean earthquake. Suspecting that psychological trauma wrought by the disaster could increase residents’ risk of subsequently developing dementia, investigators conducted a study to test this hypothesis starting in 2006.
Two things were clear from the results: elderly adults affected by the disaster were indeed experiencing psychological trauma, and the nationwide prevalence of suspected dementia was comparable to Japan’s rate in the same period. However, these are purely population-level statistics—epidemiological trends—which tell quite a different story from the actual lives of the subjects. In fact, the researchers hardly encountered anyone in Sri Lanka with telltale signs of dementia during the investigation period.
- (2) How people live outside of Japan
So, how are Sri Lanka’s elderly with dementia living in their communities? Just because researchers didn’t spot any clear cases of the condition doesn’t mean it doesn’t exist there. Sri Lanka is a highly religious country, where respecting the elderly and communal responsibility for taking care of them are taken for granted. While dedicated care facilities such as nursing homes exist, they house only a small fraction of the elderly population, suggesting the existence of social mechanisms enabling the majority to continue living in their communities without becoming isolated. It is believed that this kind of lifestyle delays the onset of dementia and helps elderly adults to continue leading worry-free lives if and when they do develop it.
- (3) Medical anthropology: Exploring differences in culture and medicine
There is still a need for more detailed research on the association between environment and disease, the findings of which could prompt healthcare and nursing reforms in Japan. That said, the Sri Lankan approach to elder care cannot be applied in Japan indiscriminately, given the differences in lifestyles, customs, and family structures between the two countries. Successful approaches must take these discrepancies into account.
For this reason, we need to properly identify and appreciate differences in culture between the two countries, as well as in their conventional ideas about medicine. The field of medical anthropology is devoted to exploring these matters.
3) Message to High School and Prospective Studentsa
High school students often ask me what they should be studying. I recommend developing two crucial abilities: critical thinking and survival skills. Critical thinking gives you the power to doubt received truths—to not be swayed by conventional wisdom and popular belief. By survival skills, I mean a kind of social intelligence: in times of trouble, if you don’t know something, do you know who you can ask to find out? These abilities normally take time to cultivate; in the meantime, please explore and pursue topics that make you scratch your head. This is the proactive attitude demanded of university students and a precursor to a cornerstone of nursing: human understanding.
2. Adult Health Nursing 1: NISHIMURA Yumi, Professor
1) Revisiting Things That Happen in Nursing Practice through the Lens of Philosophy
- (1) Seeing care settings for what they really are
Nurses always work as part of a team in healthcare settings, orchestrating a complex suite of duties to coordinate patient care. This behavior has a technical term: collaborative practice. The question of how such collaboration is realized and manifested among hospital nurses has been taken up by field research in the nursing sciences.
One anecdote that stands out involves using the bathroom, an activity for which many hospitalized patients require assistance. Normally, patients would use a nurse call button to hail their primary nurse, who would head to their room once they heard the buzzer. In this study, one of the nurse participants called on one of her patients, unprompted by a buzzer, to check if anything was wrong. Peeking into the room on her way somewhere else, she sensed her patient moving about behind the curtain and thought it was odd that he hadn’t called anyone. Put another way, anyone can respond to the ringing of a bell, but it takes a special sensitivity to respond to it not ringing.
- (2) “We work,” not “I work”
What was especially intriguing in this case was that the nurse in question was not the patient’s primary (attending) nurse but rather the lead nurse on her team. Attending nurses not only exchange information with each other but also send it up the chain to the lead nurse in minute detail, granting him or her an especially clear view of goings-on across the ward. Such information exchanges and handovers also provide an opportunity to take note of any minor changes in a patient’s condition. This organizational culture of information sharing across the entire ward inculcates a kind of mindfulness in nurses, encouraging them to make mental notes of their patient interactions and observations to later communicate with other members of the nursing team.
- (3) Philosophy can change your beliefs about nursing practice
Attempts to investigate and reconceptualize what nurses actually experience in clinical practice in this fashion accords with a branch of philosophical inquiry called phenomenology. Once you see your duties in a new light, your workplace will start to look different as well. Philosophical perspectives can further deepen nurses’ understanding of healthcare settings and trigger improvements in how they provide care.
2) Connecting Philosophy to Nursing Will Change Your View of Care Provision
- (1) View everything without preconceived notions
As a discipline, philosophy certainly seems far removed from the nursing sciences. Nonetheless, it can provide valuable insight into how nurses carry out their duties in healthcare settings, helping them to more closely align their understanding with the real world.
You’ve probably heard the argument that one person’s pain is “unknowable” to others since it is a highly personal, subjective sensation intrinsic to that person’s body. But is that really the case? Philosophy helps us set aside preconceived notions and frameworks and reevaluate what is happening before our very eyes.
- (2) Nurses who can “see” patients’ pain
Consider the hypothetical example of a patient asked by his primary nurse to rate his pain on a scale of 1 to 10. Even if he claims it’s only 3 or so, she might insist, “Are you sure it isn’t higher? Let’s get you some medicine.” Since nurses care for patients every day, it’s easier for them to “see” a patient’s pain by comparing their behavior with previous interactions: in our example, the nurse wasn’t reacting to the number coming from his mouth but rather the pain clearly visible in his face. This intuition, sometimes called practical wisdom, guides nurses’ actions according to real circumstances encountered in clinical practice.
Dialogue with nurses can encourage patients to reevaluate their pain and assent to treatment. Of course, some might insist that they don’t hurt at all. Such discrepancies do arise—pain, after all, is subjective—but you should only consider this possibility if several lines of questioning lead to the same conclusion.
- (3) Reconceptualizing nursing practice from a phenomenological standpoint
People perceive and describe the composition of the world they live in in terms of preconceived frameworks. This is a basic tenet of phenomenology, a core philosophical approach. Reporting “just the facts,” exactly as they happen, to other nurses on your team and using such accounts to provide feedback will help them reframe their own responsibilities and invigorate their clinical practice and workplace environment. Your understanding of nursing will deepen when you revisit what you have done unawares, and philosophy plays an important role in catalyzing this process.
3) Message to High School and Prospective Students
I study how collaboration is realized in the field of nursing among groups of people as they work together. You might think you’re all alone when you’re studying or picturing your future in your mind’s eye. Probe deeper, though, and you’ll see how many others who are in the picture—family, teachers, friends, and rivals—are guiding your actions. Fully internalize this, and how you live—how you choose to live—will start to change. Seize every opportunity to take another look at yourself.
3. Adult Health Nursing 2: FUKUI Satomi, Associate Professor
1) Mental Healthcare for Patients with Cancer
- (1) A cancer diagnosis can trigger psychological issues
You have cancer. This news shocks its recipients, who may react in a variety of ways. Most associate cancer with death and are overwhelmed with fear and anxiety at the prospect of dying. That’s not all: the need to consider changes to one’s life plans, the long and arduous chemotherapy regimens, and the potential of recurrence after remission can all trigger worry, anxiety, and a host of other psychological issues.
- (2) What are the benefits of support groups?
Cancer patients are particularly vulnerable to feelings of isolation and alienation, and are prone to believing no one will understand how they feel. Support groups—where patients in similar situations gather and talk about their personal and shared experiences—can provide great mental health benefits to this end. Participants gain a sense of relief and belonging, knowing that they are not the only ones who feel the way they do. Support groups can also engender feelings of confidence and fulfillment (e.g., being useful to others) since attendees not only relate their own stories but also listen to the accounts of others.
- (3) The importance of peer support
Enacted in 2007, Japan’s Cancer Control Act was intended to not only help people with the disease overcome it but also reduce suffering and improve quality of life (QOL) among them and their families. The law aimed to make this level of care available to all Japanese citizens, regardless of their place of residence. Since the Act’s passage, hospitals and healthcare organizations have improved the standard of already existing support groups and other measures for the psychosocial benefit of cancer patients. Once limited to greater Tokyo, support groups are today available even in rural Japan, and their low barriers to entry give patients more options to explore.
Support groups fall under a type of intervention called peer support, which is characterized by patients helping each other. The idea of a supportive environment—being surrounded by allies in similar situations, dedicated to a common cause—is intrinsic to such interventions’ effectiveness. When combined with professional support from medical staff, peer support can enhance the provision of mental healthcare and improve participants’ QOL.
2) How Should We Provide “Spiritual” Comfort to Patients with Chronic Diseases?
- (1) Psychological issues of patients with chronic disease
Patients with chronic disease, meaning any illness that requires long-term treatment and care, can experience unique mental health issues. Mental healthcare, as provided by nurses or other healthcare professionals, is, of course, essential to assuaging or eliminating the anxieties such patients feel regarding their health or their lives. However, they also need support from their families and others in their lives, not only during hospitalization but also during the long process of therapy. Professionals today have started to emphasize how important it is for patients to discuss their worries and fears with one another in a candid and vulnerable manner.
- (2) Support groups: Helping one another
Patients have long sought to take charge of their own care by meeting and communicating with like-minded individuals in similar, informal gatherings called patient groups. One advantage of these groups is that they provide a way to exchange information about hospitals and doctors. However, such groups also carry the risk of spreading misinformation since no medical professional is required to attend.
Ever since the Cancer Control Act was enacted in 2007, hospitals have actively encouraged support groups to improve the mental health of patients with cancer and other chronic diseases. Hospital support groups are favored because a medical professional, who can facilitate and guide patient discussions and aims to make mental health intervention run more smoothly and effectively, also attends. The role of facilitator—often fulfilled by RNs, clinical psychologists, or social workers—requires a wide range of competencies and techniques to assuage participants’ fears and make them more optimistic.
- (3) Emotional support must be personalized
However, support groups are not effective for all chronic diseases. While some patients find it therapeutic to collect a lot of information, or cathartic to divulge their innermost emotions, others find spiritual peace in shutting out excess “noise” and contemplating their situation in solitude. The decision to recommend a support group should be based on a full understanding of the personality of the patient in question. In other words, you shouldn’t assume that everyone needs a support group; the goal should be to create an environment where everyone who does need help can access it.
3) Message to High School and Prospective Students
In junior high and high school, I was on the basketball team, and I can recall many times where I hit my physical and mental limit during practices and games. These painful experiences have proven useful in my nursing career, helping develop my endurance as I try to fully understand and support patients in my care. Here, I would call on you to put your full effort into whatever you are doing. Even if you don’t get the results you expected, the struggle itself—and the process of coming to terms with what you did achieve—will help you understand people better. I hope that all of you who wish to become nurses come to appreciate the connectedness of body and mind, and develop a rich sense of empathy to approach issues from your patients’ points of view.
4. Child Health Nursing: YAMAMOTO Michiyo, Professor
1) Siblings of Children with Disabilities
- (1) Nursing that keeps in mind the families of people with disabilities
Disability is a heavy burden that some children start carrying during infancy while others are born with it. In the last decade or so, child health nursing has broadened its scope to include the families of children with disabilities, with researchers particularly interested in the “healthy siblings” who grow up alongside them. Here, let’s look at what we’ve learned about this population from interviews and other research.
- (2) When siblings are “too good”
Parents of children with disabilities are often surprised at the selflessness of healthy siblings as they help with chores or look after their disabled brother or sister. To all appearances, these siblings are beyond reproach: they play the roles of the “good boys” and “good girls” their parents need, without showing their own feelings on the matter. Many, however, are merely putting on a tough face, intuiting their parents’ hardships and hiding their own feelings to avoid adding to their parents’ troubles.
For these children to develop into their authentic selves, they need parental attention and guidance just as much as their disabled brothers and sisters. It’s crucial that parents spend “quality time” with their healthy children (e.g., going shopping or to a movie) without the disabled children’s care needs competing for their attention. For this to happen, parents need facilities where they can place their handicapped children in temporary care; unfortunately, such facilities are still rare in Japan. Society must do its part to help these siblings as well.
- (3) Siblings’ emotions: A complex, winding journey
While children might typically regard a sibling’s disability as nothing out of the ordinary in early childhood, as they approach the end of elementary school, even the kindest among them might feel embarrassed to speak about their situation with their friends. Keenly sensitive to society’s gaze, in an attempt to conform, they might seek to conceal their sibling’s handicap, lie about the sibling, or stop being seen in public with the sibling altogether.
Yet, after becoming more integrated into society and deepening their knowledge of disability, siblings typically start to mention their disabled brothers or sisters again in high school and into adulthood. In other words, it is important that parents be patient and wait for their child to come to naturally accept their disabled sibling. You will learn more about this and other things as you study how nurses care for the families of children with disabilities.
2) How to Avoid Crisis Situations in Families with Children with Disabilities
- (1) Home care: A growing burden for many families
Today, about 70% of children with severe disabilities in Japan live at home, not in hospitals or care facilities, which increases the care burden on families.
Children with severe disabilities often require sophisticated medical care (e.g., respirators or some type of suction device to remove phlegm so they don’t choke). This is as true at home as it is in hospitals, but in this case, the responsibility may fall completely on the child’s primary caregiver (in Japan, often the mother).
- (2) Home care in critical condition
The need for continual care places a heavy burden on the child’s primary caregiver, who may lose the ability to think rationally about the situation if it continues too long. Beyond the burden of medical care as such, these individuals experience a persistent lack of sleep and mounting fatigue, making them more prone to mental distress. Their friends and acquaintances might fail to appreciate or even notice their dire situation. Fortunately, there are observant nurses who will try to infer any budding “crisis” based on the words and behaviors of these parents during their regular hospital visits.
- (3) Nurses need to be able to detect the unusual
Years of experience have given these nurses the ability to pick up on unusual changes in a parent from just a little small talk. Their observations aren’t empirical—these changes can’t be measured with scientific equipment or expressed as data; rather, they are subjective and may rely on prior impressions of the parent. Parents’ actions also provide a glimpse into potential crisis situations: for example, a mother taking her child’s shirt off roughly likely reflects underlying frustration. Keen powers of observation, backed by a wealth of experience, are key to heading off disaster and improving conditions in the home.
The mind of a parent tasked with home care is like a black box: not only is it difficult for you to inquire about and uncover their inner thoughts but you risk being shut out if you probe too forcibly. For this reason, communications skills—the ability to decipher someone’s inner thoughts based on well-timed questions and listening in casual conversation—are also demanded of nurses.
3) Message to High School and Prospective Students
As you aspire to a career in nursing, what I would like you to keep in mind is seeking face-to-face communication. For example, I think most people today contact friends by phone or social networking services if they need something. But if your friend lives close by, why not go directly to his or her home? When you visit friends at home, you might get a chance to talk to people from different generations—such as their parents or grandparents—letting you catch a glimpse of their relationships with their families. I advise going to their homes because your thoughts and beliefs will become more flexible with more face-to-face communication.
5. Home Care Nursing: SHIMADA Megumi, Associate Professor
1) Nursing Care to Support Self-Management Among HIV/AIDS Patients
- (1) HIV medicine originated from a court settlement
Japan’s HIV healthcare system was established in the wake of a court settlement involving HIV-tainted blood products, adjudicated in 1996, with patients starting to receive treatment the following year. Today, HIV-positive patients can lead relatively normal, independent lives if medication can keep their viral load under control. Unfortunately, these patients must visit the hospital regularly and continue taking these drugs their entire lives. It is plausible that at some point they will face emotional, psychological, or financial difficulties that might hinder them from continuing to take their medication or go to the hospital. These externalities drove a new demand for nursing professionals who could provide wide-ranging support in outpatient settings, giving rise to a new occupation: the HIV/AIDS coordinator nurse.
- (2) HIV/AIDS nursing: An opportunity to think about nursing
Even veteran nurses might occasionally hesitate when dealing with HIV-positive patients. Since HIV is often sexually transmitted, intake interviews cover patients’ sexual orientation. Reluctance to ask such personal questions, or oversensitivity to privacy, can lead nurses to fail to collect critical information. Once you internalize the importance of such questions, you should be able to treat them like regular queries in the medical interview. It is fair to say that such fresh realizations, and the prompted revisions to one’s own practice, are a key characteristic of HIV/AIDS nursing.
- (3) Supporting patients’ self-management
People with HIV live in the shadow of major stress. The disease affects their relationships with important people in their lives and gives rise to a secrecy born of fear that their status will become widely known. This is why healthcare professionals must endeavor to be these patients’ first line of support. I hope that HIV-positive individuals, even those who are struggling, can strike a balance between treatment and lifestyle, and find cause for optimism in their daily lives. Wouldn’t it be wonderful if everyone could? This requires us, on the care-provision side, to conscientiously support self-management so that HIV patients can take charge of their lives.
2) Outpatient Nursing: A Field of Growing Importance As We Transition to Home Healthcare
- (1) “Outpatient management”? Why not “outpatient nursing”?
Ward nursing and outpatient nursing are two nursing subfields in hospitals. Outpatient nursing (also known as ambulatory nursing) is used to emphasize outpatient management—generally, logistical concerns such as ensuring that a visiting patient’s exams and tests go smoothly. Little attention was given to “lifestyle.” Japan’s healthcare system wasn’t really equipped to provide certain services, such as care consultations and essential information provision, in ambulatory settings. However, various trends have started to shift the medical industry toward home healthcare in recent years. These trends include rapid population aging, increased numbers of patients with chronic diseases, reduced hospital stays, bed shortages, and progress in outpatient medicine (including day surgery and outpatient chemotherapy). Along with this, there is a growing appreciation of the importance of balancing outpatient care with patient lifestyle.
- (2) Building long-term relationships and caring for outpatients
Primary nurses in charge of a patient’s home care need to consider how to minimize the potential for hospitalization, counseling the patient about his or her medical care and providing information in an outpatient setting. Healthcare programs and policies that can achieve this in a systematic and planned fashion are extremely important in this regard. Symptoms that were once stable can change over weeks, months, or even years of successive visits. No doubt, patients’ lives and feelings must evolve as well. To predict the various changes that may occur over the long course of ambulatory treatment, and to recommend preventative care to ensure that patients can continue to balance their care with their lifestyle, nurses must be conscientious in planning their care, endeavoring not to miss the need for intervention or consultation.
- (3) Outpatient nursing: New yet “old-fashioned”
Some outpatient nurses might think their true job is outpatient management; conversely, some are too busy to do it, even though they would like to. Outpatient nursing is fundamentally a very rewarding job. Interviewing patients and assessing their status in ambulatory settings gives us insight into changes in condition; looking at their medical records and laboratory data tells us about their test results and disease/treatment status. We must shed the “old” image of outpatient nursing, with its focus on outpatient management, and work to reconceptualize it in its modern form. Or, given its patient-centric nature and the key role of communication, should we be calling this style “old-fashioned”?
3) Message to High School and Prospective Students
There are two things I would recommend to students with an interest in nursing. The first is to master three essential skills: reading, writing, and speaking. The future will require nurses who have the power to communicate, who can relay what they are thinking through speech and writing to patients, families, and colleagues alike. This makes these skills, which can be acquired through diligent study, very important. The other is to cherish your relationships with those around you. This is because the more attention you pay to your interactions with important people in your life—family, friends, teachers, and others—the better equipped you are to accommodate the feelings of patients and their families in your professional role.
6. Public Health Nursing: SAITO Emiko, Professor
1) Community Health Nursing Diagnosis Process: Building a Healthy Community
- (1) Community health nursing diagnosis: Assessing people’s health
Health is an important component of living a happy life. Public health nursing includes methods for assessing the health status of people living in communities and their actual living conditions, as well as analyzing and determining what kinds of activities are needed to promote their health. This process, called community health nursing diagnosis or community assessment, provides the foundation for healthcare activities led by PHNs working at the prefectural, municipal, and neighborhood levels throughout Japan.
- (2) Need-based strategies to get communities healthy
In community health nursing diagnosis, PHNs utilize basic data—such as birth rates, mortality, and the relative sizes of age groups in the population—in addition to collecting information about people’s living environments, including not only natural environments but also public transportation, hospitals, and other facilities. Similarly, they meet with neighborhood residents as part of house calls or health promotion initiatives, listening carefully to firsthand accounts of residents’ health and lifestyles. In this process, nurses must remember to assess their subjects in an integrated way, taking a multidimensional approach to information gathering, ranging from individual complaints to pervasive, community-level issues.
PHNs design health promotion initiatives according to community health needs. In cities, however, it is not unusual to encounter difficulties when trying to address all community residents’ needs fairly and impartially, given their sheer numbers. In response, these nursing professionals fully utilize their expert knowledge and skills to reach out to pregnant women, infants and their parents, the elderly, and other demographics who especially need health or life-related assistance, as well as those who struggle to survive because of disease or disability.
- (3) Building communities that support people’s health
In recent years, many cities and towns have worked to create shared environments in support of residents’ health. Others have sought to understand the specific characteristics of their communities with respect to health maintenance, soliciting residents’ opinions and concerns and reflecting these in regional government policies.
Some academic disciplines function by expanding the literature or researching unexplored aspects of some basic theme while others prioritize certain topics or subjects according to people’s needs and social conditions. Public health nursing should be regarded as belonging to the latter. Ongoing work in this discipline will serve as a cornerstone of efforts to maintain people’s health.
2) Why Is It That Senior Citizens with Dementia in Sri Lanka Can Live in Their Communities?
- (1) Public health nursing: Fundamental knowledge for PHNs
As an academic discipline, public health nursing aims to promote health, prevent illness, and improve the QOL of all people, from infants to the elderly. Public health nursing is also related to the educational curriculum used to train PHNs, who are distinct from RNs, assistant nurses, and midwives.
While as many as 1,200,000 people work as RNs in Japan, PHNs number a mere 60,000. The average person might not have many opportunities to encounter PHNs in their daily lives. PHNs typically work at public centers (primarily in prefectures and government-designated cities), health and welfare centers in cities and towns, and in companies, hospitals, and schools.
- (2) Making healthy people healthier
PHNs working at the prefectural and municipal levels tend to engage with and provide guidance to already healthy community residents so that they remain in good health. Someone who feels sick, experiencing symptoms like pain or fever, would tend to head to the hospital independently to seek treatment. However, even in the absence of noticeable symptoms today, someone might go on to develop a lifestyle-related disease if, for example, they continued to eat poorly for many years. One of the roles of PHNs is to promote health to keep these diseases from changing from potential threats into real ones. To achieve this, they go into the communities they serve and listen to what residents say to determine the current availability and distribution of social resources there. Moreover, their scope of activities is broader than mere disease prevention: they also develop projects and programs for the purpose of community health promotion.
- (3) Healthcare during epidemics and disasters
PHNs may also work under specific circumstances, such as during a mass outbreak of disease or after a natural disaster. After the Great East Japan Earthquake and Tsunami, PHNs employed at the prefectural and municipal levels from all over the country were dispatched to affected areas, where their activities continue to this day. Tailoring their professional activities to the demands of society is yet another characteristic of their work. Working in close proximity with community residents to support their health is a highly significant job.
3) Message to High School and Prospective Students
Students with an interest in the nursing sciences would surely benefit from participating in a “nurse-for-a-day” type of event at a hospital while in high school or volunteering at a public health center. This would give you the opportunity to interact with a variety of people, which I think would help focus your motivation for study. During high school, it is very important to study language, the basis of communication; this means not just Japanese but also English and other foreign languages. Moreover, since the discipline is fundamentally concerned with humans, as well as the environment and society that surround them, you should prioritize civics-related subjects, such as social studies and ethics, in addition to physical sciences like biology and chemistry.