Comparison of global nursing education and necessary supports for nurse educators between Japan and four English-speaking countries: An international cross-sectional study

AIM

This study aimed to compare characteristics of nurse educators, factors related to teaching global nursing, contents of global education and support and the level of burden of global education and factors related to the burden between nurse educators among top nursing universities in Japan and four English-speaking countries.

BACKGROUND

Intercultural sensitivity is the active desire to motivate oneself to understand, appreciate and accept different cultures. Nurse educators need to be culturally sensitive to teach cultural care to nursing students.

DESIGN

This is a cross-sectional exploratory international comparative study using an online survey.

METHODS

Participants were nurse educators with a nurse license in the top 20 in Japan and the top 10 universitiesin the United States, Canada, United Kingdom and Australia (hereafter "English-speaking countries"), respectively. The questions in Google form selected participants by the inclusion criteria. Intercultural sensitivity was measured by the Intercultural Sensitivity Scale. Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and Spearman's correlation coefficients were used for the analyses. Data were collected from October 2023 to January 2024.

RESULTS

A total of 144 in Japan (response rate=29.0 %) and 106 educators in English-speaking countries (response rate=2.4 %) were included in the analysis. Nurse educators in Japan had less work experience in foreign countries, had fewer opportunities to take part in cross-cultural interactions and had significantly lower intercultural sensitivity. In both groups, those who had more experience in foreign countries with higher intercultural sensitivity taught global nursing. While in Japan nurse educators who had higher proficiency in non-native languages and those who had more frequently taken part in cross-cultural interactions taught global nursing, in English-speaking countries full-time workers who had attended international academic conferences taught. In Japan, global nursing was a more optional course and the number of contents taught was lower. While participants in Japan had international seminars at universities as support for global nursing education, those in English-speaking countries had faculty members with different cultural backgrounds. Participants in Japan felt more burden for global nursing education. In Japan, more proficient non-native language, more frequent cross-cultural interaction and higher intercultural sensitivities were associated with a lower burden, while teaching other than in their native language, contents taught and performance evaluation were associated with a higher burden in English-speaking countries.

CONCLUSIONS

Higher intercultural sensitivity, performance evaluation and proficiency in non-native language may be important for nurse educators to teach global nursing and support is necessary to enhance them.

Barriers encountered by nurses in the care of walk-in international patients in an emergency department in Japan

BACKGROUND

An increasing number of international patients continue to visit emergency departments (EDs) in Japanese hospitals. However, nurses in Japan perceive challenges when caring for patients from other countries. This study explored ED nurses' perceptions of barriers when caring for walk-in international patients.

METHODS

Five semi-structured online focus group interviews involving 15 registered nurses with experience in caring for patients in an ED at a university referral hospital located in the center of Tokyo were conducted. Thematic analysis was used to identify patterns from the interviews.

RESULTS

The themes that emerged were as follows: (1) hesitation to engage with patients due to ambiguity, (2) loss of harmony in the ED, (3) difficulty with mutual goal settings, and (4) decreased professional self-efficacy.

CONCLUSION

The findings provide an understanding of the challenges faced when caring for walk-in international patients. Educational interventions for ED nurses and other strategies, such as the use of interpreters, can enhance nurses' abilities to improve patient safety and maintain equality.

Enhancing intercultural sensitivity in Japanese nursing students through international online nursing courses: A quasi-experimental study

BACKGROUND

Globalization has highlighted the importance of being competent in communicating with people of various cultural backgrounds.

PURPOSE

To evaluate the effect of international courses for nursing students through online education in terms of intercultural sensitivity and perceived English proficiency.

DESIGN

A one-group pretest-posttest quasi-experimental design with an online self-reported questionnaire was conducted.

PARTICIPANTS AND SETTINGS

Participants were second-, third-, and fourth-year nursing students at a medical university in Tokyo in the spring term of 2021.

METHOD

Measurements were performed before and after the international nursing courses, which consisted of 1) nursing communication English, taught by native English instructors to second- and third-year students; and 2) international health nursing, taught by overseas-experienced faculty members to fourth-year students. Furthermore, there is an elective Collaborative Online International Learning course, where students discuss, collaborate, and complete common assignments with students from a university in the United States. Intercultural sensitivity was measured using the Japanese version of the Intercultural Sensitivity Scale. The pre- and post-test intercultural sensitivity were compared using a paired t-test. Content analysis was employed to analyze the open-ended questions.

RESULTS

A total of 104 students' data were analyzed. Students' intercultural sensitivity mean improved significantly from 79.88 ± 8.47 (pre) to 83.04 ± 8.63 (post). Participants in the elective course (n = 7) showed significantly higher intercultural sensitivity levels than non-participants. The self-evaluated English proficiency of second- and third-year students who took English courses significantly improved after the courses. Themes extracted by elective course participants revealed students' perceptions toward learning about diverse cultures, resilience, and intercultural communication skills, which they can utilize for nursing practice in the future.

CONCLUSION

Taking international nursing courses can increase nursing students' intercultural sensitivity. Universities are encouraged to provide international nursing courses to help enhance their cultural sensitivity and competency for their future nursing careers.

The Impact of Collaborative Online International Learning on Intercultural Sensitivity Among Nursing Students in the United States and Japan

ABSTRACT

Collaborative online international learning (COIL) is a curricular approach that allows students to collaborate across cultures using various communication technologies. Little is known about the influence of COIL on intercultural sensitivity, a key competency for nursing students to better serve increasingly diverse patient populations. We implemented COIL in undergraduate nursing courses in the United States and Japan and examined its impact on intercultural sensitivity using the Intercultural Sensitivity Scale (ISS) as a pretest and posttest. The results of a paired t -test indicated ISS total scores significantly increased after COIL, supporting its use in nursing education courses.

Narratives on the Current Medical Situation in Japan According to Highly Specialized Foreign Professionals

In order to understand the difficulties faced by highly skilled foreign professionals when dealing with the Japanese healthcare system and to identify the support they require therein, university health center staff members of the Okinawa Institute of Science and Technology Graduate University conducted semi-structured interviews with faculty, staff, and students from the Institute. Data from the interviews were analyzed by subject matter analysis using a narrative-oriented approach. In total, 13 participants were interviewed, and five themes and 15 subthemes were generated from the 40 codes extracted. Although participants considered themselves to be accepting of other cultures and made little mention of the need for cultural and religious considerations that previous studies have identified as important, they reported that their experiences receiving healthcare in Japan were fraught with many difficulties. They felt that the capacity to communicate in Japanese was a prerequisite for receiving appropriate healthcare and that hospitals should assume the responsibility of providing language support. While they reported satisfaction with the easy and inexpensive access to advanced medical equipment and specialists in Japan, they also noted challenges in selecting medical institutions and departments, the flow and procedures in the hospital, and building open and direct relationships with doctors. In addition, based on the present study, people with chronic illnesses felt isolated from the community, worried about a lack of privacy, and wanted a primary care physician they could trust. In order to provide appropriate healthcare to foreigners, we require an accurate understanding of their needs, how to address these comprehensively and in a multifaceted manner, and how the communication responsibilities should be shared among the involved parties (i.e., foreign care recipients and Japanese medical professionals).

Comparison of Disease Patterns and Outcomes Between Non-Japanese and Japanese Patients at a Single Tertiary Emergency Care Center in Japan

BACKGROUND

Japan's historically low immigration rate and monolingual culture makes it a particularly interesting setting for clarifying non-national medical care. Our study objective was to examine disease patterns and outcome differences between Japanese and non-Japanese patients in a rapidly globalizing nation.

METHODS

A secondary data analysis of 325 non-Japanese and 13,370 Japanese patients requiring tertiary care or intensive-care unit or high-care unit admission to the emergency department at the Tokyo Medical and Dental University medical hospital from 2010 through 2019 was conducted. Multivariable linear and logistic regressions models were applied to examine differences in percentage of diagnosis, mortality rates, and length of stay, stratified by Glasgow Coma Scale (GCS) scores to consider the impact of language barriers. Sex and age were adjusted.

RESULTS

Non-Japanese patients had more anaphylaxis, burns, and infectious disease, but less cardiovascular diagnoses prior to adjustment. After adjustment, there were significantly more anaphylaxis (adjusted odds ratio [aOR] 2.7; 95% confidence interval [CI], 1.7-4.4) and infectious disease diagnoses (aOR 2.2; 95% CI, 1.3-3.7), and marginally more burn diagnoses (aOR 2.3; 95% CI, 0.96-5.3) than Japanese patients. Regardless of GCS scores, there were no significant differences between non-Japanese and Japanese patient length of stay for anaphylaxis, burn, and infectious disease after covariate adjustment.

CONCLUSION

There were more non-Japanese patients diagnosed with anaphylaxis, burns, and infectious disease, but no notable patient care differences for length of stay. Further prevention efforts are needed against anaphylaxis, burns, and infectious disease for non-Japanese tourists or residents.

Demographic Data Differences in Perceived Control over Nursing Practice among Nurses Caring for Nursing Home Residents

Introduction

Control over nursing practice is crucial for improved quality of life for nursing home (NH) residents. Nevertheless, little is known about the association of nurses' demographic data with their perceived control over nursing practice in Jordan and beyond. Therefore, this study aimed at examining the differences in nurses' levels of perceived control over nursing practice based on their demographic characteristics.

Methods

This descriptive-correlational study was conducted on a convenience sample of 163 nurses caring for NH residents. Nurses' perceived control over nursing practice was measured by the Control Over Nursing Practice (CONP) scale.

Results

The participating nurses were found to have low levels of perceived control over nursing practice which varied between the nurse groups according to gender, level of experience, and type of NHs.

Discussion/Conclusion

This study is the first quantitative study to examine association between nurses' demographic characteristics, such as age or years of nursing experience, and their perceived control over nursing practice. Despite the preliminary findings of this study, the findings of this study provide a better understanding of the impact of nurses' sociodemographic and professional characteristics on their levels of perceived control over nursing practice.

Preserving nurses' professional dignity: Six evidence-based strategies

AIM

This study aimed to develop and refine strategies for preserving nurses' professional dignity.

BACKGROUND

Professional dignity is a non-negotiable nursing professional value. It should at all times be respected because of the worthiness of nurses as professional human beings. They are at the centre of healthcare societies. Their worth and contributions to the health of others should be acknowledged and preserved.

METHODS

Descriptive qualitative research was conducted during the development of the strategies while applying the principles of strategic navigation. The process was guided by the findings of the initial phase of the study and contextualised literature. Focus group discussions were held with healthcare professionals for the refinement of the strategies in two private hospitals in South Africa.

FINDINGS

The strategies unfolded multiple possibilities to value nurses' professional dignity. These were pathways for respecting, appreciating and supporting nurses; honouring nurses' desire to hold the well-being of patients in the highest regard; supporting nurses in fulfilling their professional roles; enabling nurses to take pride in themselves and the nursing profession; supporting nurses in demanding and complex circumstances and supporting nurses in coping with humiliating workplace experiences.

CONCLUSION

Strategies to ensure successful outcomes in preserving nurses' professional dignity were developed and refined. The professional dignity experiences that mattered most were presented.

IMPLICATIONS FOR NURSING/HEALTH POLICY

Valuing nurses' professional dignity promotes respect and support for nurses and their desire to prioritise patient-centred care, contributing to improved nursing practice and nurses' confidence to assert their professional dignity. Preserving nurses' professional dignity is a necessity in healthcare. It should be affirmed in equal standing in nursing codes of conduct, nursing curriculums and healthcare policies.

The experiences of foreign-educated nurses in Japan: a systematic review

AIM

To conduct a systematic review to understand the experiences of foreign-educated nurses in Japan.

BACKGROUND

The experiences of foreign nurses in host countries, and the challenges they face, have been widely investigated around the world. However, no systematic review has focused on the experience of foreign-educated nurses in Japan.

METHODS

A systematic literature review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. Japan Medical Abstract Society, Citation Information by National Institute of Informatics, Cumulative Index to Nursing and Allied Health Literature, and PubMed databases were used for the literature search. Inclusion criteria were research articles published between 2013 and 2020 written in Japanese or English. A quality assessment was performed using Version 2018 of the Mixed Methods Appraisal Tool. Selected articles were read repeatedly, and relevant contents were extracted and summarized thematically.

RESULTS

Twenty-five studies were selected for the review. The themes generated included (1) reasons for nurses to come to Japan, (2) experiences and current situations among the Economic Partnership Agreement nurses/nurse candidates living in Japan, and (3) experiences and current situation of nurses who had returned to their home countries. The second theme was classified into four categories: language and communication barriers, low pass rates for the national qualification exam, adaptation to workplaces and social environments, and psychological distress.

CONCLUSION

Foreign nurses in Japan face various challenges and difficulties, even after they return to their home countries. Solving these problems may improve the wellbeing of foreign-educated nurses in Japan.

IMPLICATIONS FOR NURSING POLICY

The results from the current review highlight the necessity for immediate intervention by policymakers to improve the current support system for Economic Partnership Agreement nurses/nurse candidates. A thorough pre-arrival orientation should be provided for the nurse candidates to able them to make a well-informed choice.

The Ethical Dilemma of Truth-Telling in Healthcare in China

Truth-telling is often regarded as a challenge in Chinese medical practices given the amount of clinical and ethical controversies it may raise. This study sets to collect and synthesize relevant ethical evidence of the current situation in mainland China, thereby providing corresponding guidance for medical practices. This study looks into the ethical issues on the basis of the philosophy of deontology and utilitarianism and the ethical principles of veracity, autonomy, beneficence, and nonmaleficence. Chinese philosophy, context and culture are also discussed to provide some suggestions for decision-making about disclosure in a medical setting. This study holds that, in order to respect the basic rights to which critically ill patients are entitled, decisions regarding truth-telling and their implementation should be carried out with thorough consideration, which can be achieved by critical thinking, well-developed and effective communication skills, the consideration of cultural context, an understanding of individual differences, and compliance with relevant laws and regulations.

Professional Autonomy of Nurses: A Qualitative Meta-Synthesis Study

Background:

Autonomy is the main element of professional practice in nursing. However, despite the many studies conducted on nursing autonomy, this concept is not fully understood and a comprehensive explanation of this concept in nursing is necessary. Meta-synthesis offers a way to increase the understanding of this concept using existing research findings. Thus, the present study aimed to explain the concept of professional nursing autonomy.

Materials and Methods:

This qualitative meta-synthesis was conducted based on a modified version of Noblit and Hare's meta-ethnography approach and qualitative studies on the concept of nursing autonomy published in databases such as PubMed, Scopus, Web of Science, Cochrane, SID, IranMedex, Magiran, and ScienceDirect in the past 15 years (2003–2018).

Results:

Thirteen articles that reported the experiences of nurses regarding professional autonomy were included in the research. Based on the meta-synthesis of findings, the final interpretation of the professional autonomy of clinical nurses was presented in the three themes of professional competence, professional decision making, and professional interactions.

Conclusions:

According to the results, the concept of professional autonomy is a developmental achievement based on patient-based professional competence along with self-reliance to provide the best care plan for the promotion of patients' health through the professional decision making and professional interactions with other professional team members.

Testing the psychometric properties of the Finnish version of the cross-cultural competence instrument of healthcare professionals (CCCHP)

Background

To test the validity of the Finnish version of the Bernhard et al.’s Cross-Cultural Competence instrument of Healthcare Professionals (CCCHP).

Methods

The study sample comprised registered nurses (N = 810) from the Finnish “Competent workforce for the future” -project (COPE). Exploratory factor analyses and structural equation modelling were applied to test structural validity of the CCCHP. Internal consistency of the sub-scales was evaluated using the Cronbach’s alphas. Criterion validity was explored in terms of received education for multicultural work, perceived difficulty of patients, and job satisfaction variables.

Results

The revised version of the instrument including four (motivation/curiosity, attitudes, skills and emotions/empathy) of the five original dimensions provided satisfactory psychometric properties (internal consistency, a good model fit of the data). Of the four remaining competence sub-scales, motivation/curiosity, attitudes and emotions/empathy were associated with the amount of received education for multicultural work, and all with perceived difficulty of patients, and all but attitudes with job satisfaction.

Conclusion

This revised Finnish version of the CCCHP provides a useful tool for studies focusing on the healthcare personnel’s cross-cultural competence in delivering effective and culturally sensitive healthcare services for patients from different cultures.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4105-2) contains supplementary material, which is available to authorized users.