Yasuko Kume*, Rie Tomizawa, Harumi Yamaguchi
Graduate School of Nursing, School of Nursing, Mukogawa Womesn’s University, Nishinomiya-city, Hyogo, 663-8558, Japan
Corresponding Author Details: Yasuko Kume, Graduate School of Nursing, School of Nursing, Mukogawa Womesn’s University, Nishinomiya-city, Hyogo, 663-8558, Japan. E-mail: kume@mukogawa-u.ac.jp
Received date: 20th September, 2017
Accepted date: 29th November, 2017
Published date: 12th December, 2017
Citation: Kume, Y., Tomizawa, R., & Yamaguchi, H. (2017). The Future State of Nursing Education in Japan with Respect to the Nursing Process and Nursing Records: Understanding the Current Needs and Suggestions for the Future. J Comp Nurs Res Care 2(2): 116.
Copyright: ©2017, This is an open-access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
The nursing process is a flexible and holistic approach, whereby nurses may use critical thinking in responding to the changing health conditions of patients, and is unique as a problem-oriented and ubiquitous process [1]. In Japan, the nursing process is a method of thinking that applies scientific problem-solving to achieve the objective of nursing [2] and plays a vital role within basic nursing education and continuing education in guiding and expanding nursing practice. Emphasis is also placed on education concerning nursing records in terms of using it for recording the sequence of steps of nursing practice and demonstrating the thought process and conduct of the nursing profession [3].
Japan continues to see a rapidly declining birth rate and an aging society, and a proposal by the Ministry of Health, Labour and Welfare has suggested building a system (Community-based Integrated Care System) that comprehensively and continually provides medical care, nursing, and living assistance under the objective of preserving the dignity of the elderly and aiding an independent lifestyle for them so that they may live their lives to the very end in the regions in which they are accustomed to living. The admittance periods in medical care facilities in particular are shortening and there is an increasing need for home-visit nursing. Considering the present circumstances, we have reached a turning point where we must review the conventional state of the nursing process and nursing records. This paper looks at the issues and future conditions of education regarding the nursing process and nursing records in Japan
1. Current condition and concerns of nursing education regarding the nursing process “Nursing diagnosis” is one method of the nursing process. There has been skepticism regarding “nursing diagnoses” in Japan [4]. A prior study reported that among respondents, approximately 70% of the teaching staff at educational institutions incorporated a nursing diagnosis into the basic nursing education curriculum for a portion of the courses [5]. However, there are differences in the nursing education contents for nursing process and diagnoses at each educational institution [6], which suggests that each institution is incorporating these into the curriculum through trial and error. Therefore, there are numerous training records to expand the nursing process according to the way each educational institution thinks, and in many cases the type of training records differ even within the same institution. This difference in recording formats can sometimes be confusing depending on the study conditions of nursing students.
It is said, “A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability” [7] (p. 464), and nursing diagnosis is emphasized as a basis for nursing intervention. Although a nursing diagnosis being the center of the nursing process is stated to be important even in education for the training to maintain nursing records, it is also reported to be insufficiently utilized [8]. Meanwhile, it has also been reported that there was no clear difference in clinical nursing education between nursing interventions selected using nursing diagnosis with and without the NANDA (North American Nursing Diagnosis Association) classification text book [9]. It is surmised that while learning the nursing process and diagnosis in an actual nursing setting, the care developed within the setting of nursing training acts as an influence and tends to lead to the development of the nursing process accordingly. In particular, in Japan, the usage conditions and results of nursing diagnosis and the state of linkage with nursing intervention differs for each facility; even supposing that someone used a nursing diagnosis in school, in clinical training there are some facilities that record the usage of a critical path and unique nursing issues. Although the necessity of basic education for the nursing process in undergraduate courses is discussed [10], the linkage between learning within school education and in an educational setting of clinical training is inadequate.
Meanwhile, the need for a training method that is not conventional in terms of merely injecting knowledge has been previously pointed out as a strategy for teaching the nursing process and diagnoses, and there have been reports on the educational effects of critical thinking training [11], problem-based learning (PBL) [12], and methods using written case studies [13]. On the other hand, there are issues with the nursing process training regarding the leadership abilities of nursing instructors using the active learning method, which depends on the problem-solving skills of students. In addition, there are difficulties in terms of insufficient lecture time to teach the nursing process, selecting effective methods that meet the preparation conditions of students, and assessing the educational effect of the nursing process.
2. Present condition and issues of nursing education regarding nursing records Nursing records that show the sequence of steps of the nursing practice, including the nursing process, are connected with teaching the nursing process. Nursing records are important for the students to be able to check the details of thought and reflect on them. Instructions linked with the state of nursing records are easier to process as realistic details that can be understood easily.
The linking of the quality of nursing records with improving care quality and the time needed to complete electronic nursing records is said to be connected to the degree of application of information technology (IT) [14]. In addition, much like a nurse’s attitude towards IT, the ease of use and ability to use IT, as well as equipment availability and technical functionality, influence the use of IT. In short, the environment and function of nursing records and IT application as well as the attitude and ability of nurses towards IT are becoming important factors internationally.
Although there are many facilities in Japan using electronic clinical records, according to the Japanese Asso- ciation of Healthcare Information Systems Industry (2017), the overall spread rate of electronic clinical records is 30.2%, and although facilities with around 500 beds have a spread rate of 76.0%, those with 50 to 99 beds have a spread rate of only 16.6% [15], showing a huge difference in scale according to the number of beds per facility. Interview studies on nurses have shown that there is a need for the application of an electronic health record sys- tem [16]. From the perspective of lessening the burden of local health care providers, it has also been suggested that there be a nationwide unification of specifications for electronic clinical records systems and compensation claim systems [17]. However, since the recording media and contents still differ depending on the facility, nursing education is also focusing on the ability to deal with paper record formats in addition to its needs regarding training for IT application skills. In other words, while considering numerous conditions, nursing training involving a basic way of thinking by focusing on expressing a series of nursing and thought processes without being constrained by the recording form or style is needed. Conversely, if we were able to share the recording media used in actual medical care locations with educational institutions, it could help mitigate the anxiety and distress that accompany its actual employment.
3. Important points for teaching the nursing process and improving nursing records to improve nursing records, it is important that nurses understand the meaning of the concept of nursing [18]. It is also important to first understand not the format of nursing records, but rather the basic thought process of nurses and the nursing process, and then train them in a variety of nursing process developments that can be applied in definite training settings. Using a consistent education policy related to a nursing process that complies with the curriculum policy within the same educational institution is important for this purpose. Such consistent use would have a positive effect on identifying the appropriate lecture time required, due to the shortening of preparation hours, and effective time allotment, made possible due to the build-up approach to education.
One can surmise that there is a bias regarding medical facilities in Japan that use nursing diagnoses and it is often believed that the concern regarding the use of diagnosis terminology is perceived as a major crossroad in education. However, regardless of the type of terminology used, there is no difference in accurately understanding a patient’s condition by giving it a name and thinking about the condition of patients in nursing care. We would like to teach the basic meaning of the nursing process and emphasize that although there is no difference in the fundamental objective and process, there is a difference in the tools and format for expressing these thinking processes.
Having the opportunity to use electronic clinical records in a practical setting while collecting information and conducting analyses is important for basic nursing education. First, the student studying examples of the nursing process based on learning concepts and specific cases and then expanding on the nursing process based on actual cases is the general method. When expanding on the nursing process through cases, the patient’s condi- tion is interpreted and analyzed by putting related fields of study into action, such as anatomy, physiology, phar- macology, pathology, and disease treatment, as well as knowledge of basic nursing and specialized subjects such as adult nursing. For the students, this interpretation and analysis is a huge challenge, and many find it difficult to utilize the knowledge that they have gained until now to understand a patient’s condition.
Being trained to repeatedly reflect on several cases is important. This training is important not only with regard to thinking about how to interpret information, but also on the specific behavioral level of what to look for in order to interpret the information and what needs to be examined. Nursing students are used to being able to easily obtain information from the internet although they are often not quite as skilled in searching for references and books. They must be supplemented with training in skills for searching and collecting information. By the same accord, we can say that utilizing a PBL system for the education of the nursing process is effective. For this, it is necessary that nursing instructors are sufficiently proficient in effective applications such as PBL and case-based learning (CBL) and in instruction methods.
Ultimately, a place for developing the nursing process in clinical practice is important. It is necessary to determine how to collect information and understand the patient’s condition during its quick development while providing continual care during the training period despite the difficulties and limited opportunities due to the shortening of the hospital admittance period. For this purpose, it would be effective to share various nursing record media with educational institutions, use them in prior school exercises, and ensure that difficulties in op- eration and insufficient understanding of the structure does not impede the development of the nursing process or nursing training. In addition, it is important to include activities of coordination between other fields, such as a facility and the home or medical care and nursing, to maintain field-specific records. During nursing edu- cation and even in training settings, information coordination where record formats and contents can be easily exchanged across fields and regions is essential. Expanding the nursing process within a dynamic training en- vironment as a result of coordinating with a training instructor, accurately understanding a patient’s condition, experiencing a nursing assistance setting, and acquiring a series of opportunities for undergoing assessments are major turning points determining whether nursing students can understand the actual significance and impor- tance of the nursing process.
The author meets the criteria of the International Committee of Medical Journal Editors (ICMJE) for authorship credit (www.icmje. org/ethi-cal_1author.html), as follows: (1) substantial contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.
The author declares that there are no conflicts of interest.
Kuyrukluyildiz, U., Binici, O., Kupeli, I., Erturk, N., & Gulhan, B., et al. (2016) What is the best pulmonary physiotherapy method in ICU? Canadian Resp J.View
Esguerra-Gonzalez, A., Ilagan-Honorio, M., & Fraschilla, S. (2013). Pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy. Am J Critical Care 22: 115-124.View
Braverman, J. (2007). A practical intervention for secretion retention in the ICU. Respiratory Ther 2: 26-29.
Mutalithas, K., Watkin, G., Willing, B., Wardlaw, A., & Pavord, I.D., et al. (2008). Improvement in health status following bronchopulmonary hygiene physical therapy in patients with bronchiectasis. Respirat Med 102: 1140–1144.View
Patterson, J.E., Bradley, J.M., & Elborn, J.S. (2004). Airways clearance in bronchiectasis a randomized crossover trial of active cycle of breathing techniques (incorporating Postural drainage and vibration) versus test of incremental respiratory endurance. Chron Respirat Disease 1: 127–130.View
Oermann, C.M., Swank, P.R., & Sockrider, M.M. (2000). Validation of an instrument measuring patient satisfaction with chest physiotherapy techniques in cystic fibrosis. Chest 118: 92-97.View
Paneroni, M., Clini, E., Simonelli, C., Bianchi, L., Degli Antoni, F., et al. (2011). Safety and efficacy of short-term intrapulmonary percussive ventilation in patients with bronchiectasis. Respiratory Care 56: 984-988.View
Morrison, L., & Innes, S. (2017). Oscillating devices for airway clearance in people with cystic fibrosis. Cochrane Database Systematic Review.View
Lee, D.S., Park, S.W., Yeom, S.R., Han, S.K., & Lee, S.H. et al. (2011). Highfrequency chest wall oscillation therapy: Clinical effectiveness in the patients with pulmonary contusion. Korean J Critical Care Med 26: 25-260.
Chakravorty, I., Chahal, K., & Austin, G. (2011). A pilot study of the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion. Int J Chronic Obstruct Pulmon Disease 6: 693- 699.View
Warwick, W.J., Wielinski, C.L., & Hansen, L.G. (2004). Comparison of expectorated sputum after manual chest physical therapy and high-frequency chest compression. Biomed Instrument Tech 38: 470-475.View
Wilson, L.M., Agnew, J., Morrison, L., Akinyede, O., & Robinson, K. A. (2014). Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews (Protocol). Cochrane Database Systematic Reviews 8: 1-6.View
Hristara – Papadopoulou, A., Tsanakas, J., Diomou, G., & Papadopoulou, O. (2008). Current devices of respiratory physiotherapy. Hippokratia 12: 211-220.View
Fainardi, V., Longo, F., Faverzani, S., Tripodi, M.C., Chetta, et al. (2011). Short-term effects of high- Frequency chest compression and positive expiratory pressure in patients with cystic fibrosis. J Clin Med Res 3: 279-284.View
Bradley, J.M. (2010). High frequency chest wall oscillation in cystic fibrosis. Thorax 65: 189-190.View
Kempainen, R.R., Milla, C., Dunitz, J., Savik, K., & Hazelwood, A., et al. (2010). Comparison of settings used for high-frequency chest wall compression in cystic fibrosis. Respirat Care 55: 695-701.View
Morrison, L., & Agnew, J. (2009). Oscillating devices for airway clearance in people with cystic fibrosis. Cochrane Library.View
Mahajan, A.K., Diette, G.B., Hatipoğlu, U., Bilderback, A., & Ridge, A. et al. (2011). High frequency chest wall oscillation for asthma and chronic obstructive pulmonary disease exacerbations: a randomized sham-controlled clinical trial. Respiratory Res 12: 120.View
Braveman, J., & Nozzarella, M. (2007). High-frequency chest compression advanced therapy for obstructive lung disease. Respirat Ther 2: 48–51.
Anderson, C.A., Palmer, C.A., Ney, A.L., Becker, B., & Schaffel, S.D., et al. (2008). Evaluation of the safety of high-frequency chest wall oscillation (HFCWO) therapy in blunt thoracic trauma patients. J Trauma Manag Outcomes 2: 8.View
Antonello, N., Federica, C., Norma, L., Sergio, L., & Maura, F., et al. (2013). Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis. BioMed Central Pulmonary Med 13: 13-21.View
Nicolini, A., Cardini, F., Landucci, N., Lanata, S., & Ferrari-Bravo, M., et al. (2013). Effectiveness of treatment with high-frequency chest wall oscillation in patients with bronchiectasis. BMC Pulmonary Med 13: 21.View
Brierley, S., Adams, C., Suelter, J., Gooch, T., & Becker, B. (2003). Safety and tolerance of high frequency chest wall oscillation in hospitalized critical care patients. Respiratory Care 48: 1112.
Chao, L. M. (2014). The effectiveness of patient sputum clearance with high frequency chest wall oscillation therapy. Central Taiwan University of Science and Technology.
Clinkscale, D., Spihlman, K., Watts, P., Rosenbluth, D,, Kollef, M.H. (2012). A randomized trial of conventional chestphysical therapy versus high frequency chest wall compressions in intubated and non-intubated adults. Respiratory Care, 57(2): 221-228.View
Huang, W-C., Wu, P-C., Chen, C-J., Cheng, Y-H., & Shih, S-J., et al. (2016). High-frequency chest wall oscillation in prolonged mechanical ventilation patients: a randomized controlled trial. Clinical Respirat J 10: 272-281.View
Chen, Y.C., Wu, L.F., Mu, P.F., Lin, L.H., & Chou, S.S., et al. (2009). Using chest vibration nursing intervention to improve expectoration of airway secretions and prevent lung collapse in ventilated ICU patients: A randomized controlled trial. J Chinese Medical Asso 72: 316-322.View