The structure of Japan's population is continually changing. Japan's Health System must cater for the increase in foreign born and raised Japanese nationals, as well as foreign residents. At the same time, the nursing profession in Japan is becoming more professional and international in its stance. From August 1999 through to March 2000, we did an extensive study to investigate the situation in hospitals, as well as educational institutions all over Japan. We also made inquiries overseas (Australia and the U.S.) in order to investigate the linguistic support given to non-native language speakers, and the type of cultural and linguistic education given to prospective care-givers in each country.
Questionnaires were prepared and sent to 200 hospitals and 200 nursing schools and nursing departments at universities nation-wide. The survey done overseas was predominately done in the form of interviews for it was initially hard to know if the Japanese system (which we were very familiar with) was typical.
Larger hospitals, usually with more than 400 beds, in larger cities were chosen for this survey, in the belief that non-Japanese-speaking residents would naturally gravitate to cities, and make use of hospitals with multiple, rather than one, specialist areas. An average of 4 hospitals per prefecture were chosen, with the exception of the metropolises of Tokyo and Osaka (14 and 13 respectively). Of the 200 surveys sent out, we received 106 replies. Each prefecture was represented.
The Hospital Questionnaire focused on:
a) whether English was considered necessary or not,
b) if so, which skill (reading, writing, listening speaking) was regarded as more important,
c) in which ward was English thought to be most used, and
d) the availability of language support (handbook, or volunteer group).
Results: An overwhelming, but not surprising, 92.4% of the hospitals who replied said that English was necessary, with 92.8% of them indicating a great need for speaking with the patients and their families. 64.2% also noted the need to read patient's records, as, in Japan, doctors now often write out the patient's symptoms, diagnosis, and treatment, in English. When asked in which ward was English most needed, more than half considered English to be necessary in all wards. In response to the question concerning language support, just over half replied that they had access to bi- or multi-lingual handbooks, but only 7 hospitals had access to volunteer or in-house interpreters.
Of the 200 surveys sent out, there were replies from 134 institutions; 22 Universities (with 4-year degree courses), 41 'Tandai' Colleges (with 3-year certificate courses), and 71 "Senmon" Colleges (with 3-year completion certificate courses). This breakdown reflects the distribution of nursing institutions within Japan. The total return rate of 67% is also close to the return rate for each institute category.
The School Questionnaire focused on:
a) whether or not English was a mandatory entrance exam subject,
b) the weight English tuition carries within the curriculum,
c) which skill was given more attention, and
d) what textbooks were used, and if medical magazines, etc. were accessible to students to enhance their knowledge of foreign nursing situations.
Results: A very high percentage (92.5%) of the schools include English in the entrance exams, with 90% saying that it is a mandatory subject. On the other hand, of an average of 105 total credits to graduate, English amounts only to an average of 4 credits. When asked about the focus of the English course, replies indicated that everyone was working hard on Speaking and Listening skills, and many focused on ESP-Nursing. Unfortunately, contrary to these high results, a look at the textbooks in use showed that of the 187 titles used at 115 schools, less than a third had any connection with health topics. Further more, a look at the most frequently used book titles showed that it was the Senmon Colleges (rather than the prestigious universities) that focused on specific Nursing English. About a third of the schools said that foreign magazines were available in the library, but less than a tenth of the schools made any use of them in class.
As the American sample was so small, I will discuss only the process and the results of the Australian survey. Interviews were conducted at three Hospitals, three Community Council Offices, and two Schools of Nursing.
The interviews focused on:
a) whether or not hospitals had in-house language support systems, and
b) the weight foreign language tuition carries with the nursing curriculum.
Results: In the hospital situation, doctors can avail themselves of an interpreting service, provided by the government. This service is available in 24 languages. For doctors in outlying areas, pamphlets in the foreign language most needed in their particular area can be requested from the Department of Health, and/or the Department of Ethnic Affairs. It was also revealed that most hospitals have set up a data base of which languages each staff member speaks, while a number of small mono-lingual nursing home have sprung up catering for, for example, Polish, Russian, or Vietnamese patients.
Furthermore, we were very surprised to find that, to spite its multi-lingual / multi-cultural society, nursing schools in Australia do not provide foreign language subjects, or provide them as one amongst many elective subjects. However, a special emphasis is put on multi-cultural education. Two important points made were that 1) even native English speakers come from various cultures and religious beliefs, and 2) important life events such as birth and death are handled very differently in different religions; a concept beyond language.
Considering the fact that not only patients, but also many doctors, use English, it was found that on-the-job practical (medical) English for Nurses is in great need here in Japan. However, English education at present does not effectively fill that requirement. Furthermore, the importance of culture and religious value education has yet to be fully recognized. It is hoped that in the future, these inadequacies in the system can be realized and rectified.