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The international language of caring

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Japan's nursing services is structured differently Japan's nursing services is structured differently to the UK's

I was honoured to be invited to speak in Tokyo, Japan, recently. The invitation was from the professor of social policy at Yokahama University who has visited the Queen’s Nursing Institute (QNI) on three occasions in recent years and earlier this year attended the QNI annual conference in London.

There is a pressing need in Japan to invest in the development of a system that promotes primary and community care rather than attendance at hospital A&E departments for minor illnesses and injuries. This sounds familiar – but in Japan, the primary care services are under-developed and there are no practice nurses. Most people choose to visit the hospital for any illness, rather than a local ‘family doctor’. This puts considerable pressure on the already overstretched hospital doctors.

I saw for myself the lines of patients waiting to be seen for minor ailments at a city hospital and spoke with the nurses about what they would like to see change. While nurses in Japan do not prescribe, there is a culture of specialism for which the education and training is rigorously applied. Nurses must undertake a two-year master’s programme in their specialist area of practice, of which half the learning must be in practice as a student.

The nurses are exceptionally well prepared to undertake assessments and provide interventions for their specialist area of practice, and they work closely with medical colleagues in the delivery of comprehensive care for their patients. However, district nursing as a specialist area of practice is yet to reach the nurses working in the community, requiring that nurses highly experienced in hospital based care move to work in the community in autonomous roles.

It was a privilege to see care being delivered in the home and I was welcomed enthusiastically by patients – as if I was one of the regular community nursing team. The easily recognisable approach of nursing in the home was a joy to witness – creativity in nursing skills where there is very little physical space, warm relationships with carers and family members, deep respect for the patient, around whom all activity was centred.

I learned much about the smooth operation of integrated services, the challenges of market forces in a system that is based on a mixture of national and personal medical insurance, and the cultural expectations of Japanese people receiving care in their homes. Comparing and contrasting nursing in our two countries was a great learning experience that will stay with me for many years to come.

The nurses I shadowed spoke just a few words of English but the international language of providing nursing care in the home required no translation – and the joy the nurses had in their work was clear for all to see.

Crystal Oldman, chief executive, Queen’s Nursing Institute

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The Article shows what can be achieved with investment in people skills to allow for the knowledge caring and nuturing skill development of individuals in the Nursing and Caring profession, and the benefits that can be achieved by devoted staff well equipped to deliver the very best to those for whom it is required
It was a pleasure to read and my hope is that in the near future personal care will be top of the health care agenda in the UK
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