By LCDR Kathleen Charters
Kenko Shimbun, November 1984, p. 9
On November 1, 1984 I had the unique opportunity to share my thoughts on how American nurses train for and practice nursing. What made the occasion special was that it came about through the request of Japanese ICU and CCU nurses from the Second National Hospital of Tokyo.
Dr. Fukuhara, staff physician at the hospital, had served as an intern at the old U.S. Naval Hospital Yokosuka, and had gone to the University of California, San Francisco to train for his board specialty in Internal Medicine. He had returned to Japan to share his knowledge and wanted to help the Japanese nurses learn about how nurses in the United States functioned.
During my visit Dr. Fukuhara explained what the Japanese nurses wanted to know, and put my comments into phrases they could understand. He also graciously relayed their comments and questions to me, along with an explanation of the differences between Japanese and American nursing practices.
It was a fascinating exchange of ideas. Dr. Shibano, one of USNH’s interns, was extremely helpful in bridging the communication gap. She translated my notes into kanji, so that the Japanese nurses could follow my outline.
I gave a brief explanation of the different levels of nursing care providers (Nursing Assistants, LVN’s, and RN’s) and the educational preparation required at each level. Then I spoke about the additional educational preparation necessary to work in Critical Care areas, and about ways in which the advanced skills could be mastered.
When I spoke of skills requiring certification, and of the certification (and recertification) process, they became very excited. Dr. Fukuhara explained that they did not have this process, and we spent quite some time going over the IV Push Certification Program, and the CPR training done at USNH Yokosuka.
Another area of keen interest was the concept of standing orders. In essence, they wanted to know: why bother with special training if a physician had to be present for the skills to be used? We discussed the ACLS protocol and Yokosuka ‘s ICU standing orders covering the protocol. This also was a new concept, and one which they thought could be very useful.
One interesting question came up, which got right to the heart of the issue of integrating high technology into the hands-on practice of nursing. The nurses wanted to know whether an American CCU nurse would give a bedbath. Stressing that American nurses realize high technology does not replace the patient’s need for human touch, I assured them that giving a bedbath was an excellent way to assess how a patient was doing, and provided an opportunity to do patient teaching.
It was in the realm of patient teaching that I found the greatest cultural differences. The Japanese nurses were surprised at the MI Discharges Teaching care plan. They indicated that anxiety about a heart attack was rare for their patients. Japanese MI patients usually have no idea of what a heart attack is, and rarely consider it serious, they said.
Once admitted to the hospital, patients no longer worry about their illness, because it will now be taken care of by the physicians and nurses. Refusing to take medicines or carry out requests by physicians or nurses is unthinkable – after all, they are the professional health care providers.
It was a fun and interesting discussion. I hope the Japanese nurses were pleased with the exchange of ideas. I know I had a good time.