A Qualitative Study on Challenges Chinese Nurses Face while Working in Japanese Hospitals

Background: Considering the increased numbers of Chinese nurses in Japan, we hypothesized that Chinese nurses in Japan are confronted with many difficulties, although few studies have been performed. Therefore, in-depth analyses of their experience to explore significant factors and aspects are required. Objectives: To clarify the problems and difficulties faced by Chinese nurses during their work and life in Japan and to address their future challenges. Methods: We performed semi-structured interviews with 13 Chinese nurses working at 2 Japanese hospitals with Chinese and Japanese registered nurse licenses in 2017. We analyzed data using a qualitative inductive method. Results: We found that Chinese nurses were motivated to work at Japanese hospitals for several reasons. Many Chinese nurses working in Japan had difficulties with the language barrier, interpersonal relationships related to cultural differences, and loneliness in their daily life, and also experienced fewer opportunities for promotion than Japanese nurses and insufficient support from Japanese hospitals. Many Chinese nurses were anxious about their future in Japan. More than half did not have a clear future direction for their working life in Japan. Conclusion: This study clarified the circumstances and difficulties of Chinese nurses working in Japan. One novel finding was that the main reason for their difficulties is due to their unknown career path and future workplace setting. Therefore, support for overcoming the language barrier and improving cultural understanding from hospitals is necessary to help nurses make better decisions based on their future plans.

Occupational Stress, Psychological Distress, Physical Symptoms, and their Interrelationships among Frontline Nurses Treating Patients with COVID-19

Background: The COVID-19 pandemic has presented mental health challenges to healthcare workers. Because of the urgency of the situation, this study was done to determine the amount of COVID-19-related occupational stress, psychosomatic symptoms, psychological distress, and their correlations among frontline nurses during and after the peak of the outbreak in Japan. Methods: Sixteen frontline nurses, aged 25-52 years, working in a ward with COVID-19 patients participated. Two months after the peak of the first wave of the COVID-19 outbreak in Japan, the COVID-19-related occupational stress scale (COS, questionnaire items: fear of infection, increased workload) and physical symptom scale (PS, questionnaire items: gastrointestinal symptoms, pain, appetite loss, insomnia) were assessed. The degree of general psychological distress was evaluated using the 6-item Kessler Scale (K6). At the same time, the participants were asked to recall their condition during the peak period of the first wave and to rate it using the same scale. Results: The COS, PS, and K6 scores during the peak period were all significantly higher than those two months after the peak. There were positive correlations between K6 and COS scores and between K6 and PS scores during the peak period (rs=.574, P=.020 and rs=.587, P=.017, respectively). However, these correlations were not significant two months after the peak. The correlation analysis including COS and K6 or PS showed that increased workload was positively correlated with K6 and PS scores during the peak period (rs=.869, P<.001; rs=.519, P=.040, respectively). In the post-peak period, a positive correlation was found only between increased workload and K6 score (rs=.686, P=.005). Insomnia was positively correlated with the K6 score both in the peak and post-peak periods (rs=.656, P=.006 and rs=.565, P=. 028). Conclusions: Among these Japanese nurses working in COVID-19 wards, COVID-19-related occupational stress, psychological distress, and physical symptoms were all decreased after the peak period compared with the peak period. During the peak period, associations were found between COVID-19-related occupational stress and psychological distress and between psychological distress and physical symptoms. Increased workload and insomnia were associated with psychological distress in both the peak and post-peak periods, and increased workload was associated with physical symptoms during the peak period.

Characterising end-of-life decision-making of life-sustaining treatment among Japanese nurses

Background: Often, nurses are closer to end-of-life (EOL) patients than other medical professionals, due to the time they spend with them at their bedside, which leads them to understand patients' care goals. Aims: To investigate the importance of EOL preferences by examining nurses' EOL decision-making regarding life-sustaining treatment (LST). Methods: In this cross-sectional study, 559 self-reported questionnaires of Japanese nurses were examined. Marital status, age and decision-making regarding LST for themselves were investigated. Findings: Unmarried participants from all age groups had a higher percentage of ‘no preference for LST’ than married groups. Differences between the percentages were higher in the 20s age group. Married participants increasingly preferred to receive no LST as their age increased, unlike single participants. Conclusion: Marital status influences Japanese nurses' EOL decision-making regarding LST. Therefore, it is necessary to consider a patient's marital status to facilitate better decision-making.

Work Engagement and the Validity of Job Demands–Resources Model Among Nurses in Japan: A Literature Review

Background: Work engagement (WE) is defined as a positive, fulfilling, and work-related state of mind. Enhancing WE leads to positive outcomes in both individuals and organizations. Although cultural factors may influence the antecedents and outcomes of WE, no reviews summarized these factors among nurses, mainly in Asia. This review aimed to identify the antecedents and outcomes of WE among nurses in Japan. This may offer novel insights into the influencing factors on WE. Methods: A literature search was conducted using six data sources: PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycINFO, Business Source Premier, Ichushi-Web, and CiNii. A total of 38 studies met the inclusion criteria. Studies that included registered nurses and/or midwives at hospitals or facilities were included in this review. The antecedents and outcomes were classified into four themes based on the job demands–resources model (JD-R model). Findings: Many variables in three components of the JD-R model (i.e., job resources, personal resources, and favorable outcomes) exhibited positive relationships with WE as theorized. Many other variables in job demands demonstrated negative relationships with WE as hypothesized. Many factors that were identified in this review were consistent with the JD-R model. The model in turn was found to be applicable among nurses. The antecedents and outcomes in this review were similar to those in previous studies in Western countries, while this review also revealed teamwork nursing as a possible antecedent of WE, which has not previously been reported. Conclusion/Application to Practice: Improving job resources (e.g., teamwork nursing) and personal resources may effectively enhance WE among Japanese nurses.

Cross-cultural information for Japanese nurses at an international hospital: a controlled before-after intervention study

BackgroundOverseas visitors to Japan steadily increased for a decade until the pandemic of 2020. In 2019, 31.8 million people visited the country due to an easing of restrictions and an emphasis on tourism. Nurses are the forefront of the healthcare system when they interact with those overseas visitors at a clinic or hospital. The goal of this study is to evaluate the efficacy of providing health information, through an ordinary travel guidebook or a short digital cartoon by measuring the anxiety level of Japanese nurses who deal with foreign patients.MethodOur approach involves a controlled before-after intervention study from January to March in 2016 at a major international hospital in Japan. We surveyed nurses at three wards of the hospital who understood English and cared for foreign patients as the 1st intervention group. Following which, we collected data from the same 1st intervention group, but now considered as the 2nd intervention group. Nurses in the 1st intervention group read health information in a travel guidebook for Japan. Nurses in the 2nd intervention read health information in the guidebook and watched a four-minute digital cartoon in English on health services in Japan, titled Mari Info. After each intervention, the nurses answered a self-questionnaire, wherein we assessed their level of anxiety to care for foreign patients. We evaluated the results through statistical testing and the State-Trait Anxiety Inventory Form Y (STAI-Y).ResultsOf 111 nurses, 83 (74.8%) completed both interventions and a questionnaire. Reading the guidebook as well as watching a digital cartoon, as the 2nd intervention was more effective in reducing the level of anxiety to care for foreign patients compared to reading only the guidebook.ConclusionsJapanese nurses can lower their anxieties on dealing with foreign patients by knowing the various forms of healthcare information currently accessible to overseas visitors in both guidebooks and digital content. This helps them learn the ethical concerns and cultural norms of foreign patients they might care for.