Dr. Jacqueline Fawcett
is a member of the Nursology.net Advisory Team

Co-Contributors:
Satsuki Oka
Yuka Kawahara
Hiroshi Imamura
Himari Oka

Jacqueline Fawcett (JF): I have the honor of having been appointed as a Visiting Professor in the School of Nursing at St. Mary’s College in Kurume, Fukuoka, Japan. My role encompasses two virtual lectures each year as well as contributing a short paper to the annual Nursology Letter published by the St. Mary’s College Roy Academia Nursology Research Center.

One of my two annual lectures focuses on a topic of contemporary interest to our discipline. In fall 2024, I selected the topic of decolonizing nursology knowledge. I asked each student to discuss their understanding of Japanese nursology knowledge. This blog includes the responses from the three graduate students and one undergraduate student who participated in this lecture.

The students’ responses included the evolution of healthcare in Japan from before the 5th century of Earth’s history to contemporary times. Their responses also included their knowledge of contemporary lay healthcare, which we may regard as contemporary decolonized nursology knowledge.

Please note that the terms, nursology and nursologists have been substituted for nursing and nursologists, respectively, through this blog, given St. Mary’s College acceptance of these terms.

I am indebted to Eric Fortin, Faculty, St. Mary’s College School of Nursing, for his proofreading of the Japanese students’ English responses.

Evolution of Healthcare in Japan

Satsuki Oka (SO) explained: It is said that magic was practiced in Japan before the 5th century. Buddhism was introduced from one of the three Korean kingdoms in the year 538. The introduction of Buddhism transmitted the knowledge of nursology through prayer and medicine.

JF: More specifically, as Dock and Stewart (1938) noted, Buddhism was “carried by Indian missionaries, first to China in the first century A.D. and from there in the sixth century to Korea and Japan” (p. 27). It is not known whether healthcare was provided by Buddhist monks or other lay persons at this time. Hiroshi Imamura (HI) indicated that at least some care was provided by family members at this time and continuing until nursologists were firmly in place in hospitals and other clinical facilities after World War II, starting in 1950.

SO: In 1549, Christianity was introduced with the arrival of Francis Xavier in Japan. Luis de Almeida, a Portuguese missionary and physician, built a Western-style hospital in Oita Prefecture in Kyusyu. Western-style hospitals are said to have spread not only in Kyushu but also to other parts of the country. In 1869, the Japanese government tried to unify Western medicine, and German medicine was adopted.

In 1885, Kanehiro Takagi and others who visited St. Thomas Hospital in London, England, established a Nightingale educational facility in Japan. Subsequently, the first systematic nursology education in Japan was begun. The Yu-shi Kyoritsu Tokyo Hospital Nursing Education Center started educating trained nursologists for the first time in Japan.

JF; Dock and Stewart (1938) noted that the American nursologist, Linda Richards, “established in 1885 the first modern school [of nursology] in a little mission hospital in connection with the Doshisha College in Kyoto” (p. 209) . . . “where she stayed for five years” (p 156). Noteworthy, however, is that “it cannot be said that the Nightingale plan was actually established. The time was not ripe in this country [Japan] for so large a measure of authority and freedom to be given to women” (p. 209).

JF: Thus, healthcare evolved from a Buddhist perspective to a Western perspective as early as 1549 and formally in 1885. At least some persons needing healthcare were treated in hospitals. It is not known whether persons called nursologists (nurses) existed during this evolution or who cared for the hospitalized persons every day, all day prior to the establishment of explicit nursology care, based at least somewhat on the Nightingale perspective, that began in 1885 with the establishment of nursology schools. Apparently, most if not all nursology schools were affiliated with or located within hospitals.

Himari Oka (HO) explained: In 1915, before World War II, nursologists in Japan had to be women, and they had to work with sick and injured persons. In the cultural background of Japan, women had less work than men, and the idea that women should be responsible for housework and childcare was derived from this.

JF: Of note is that “Many young women of good family came into [the hospitals and nursology schools established by the Red Cross in Japan starting in 1890] and much good service was given but there was little freedom or initiative allowed to the [nursology] group, either in the miliary or in the civilian] hospitals of Japan” (Dock & Stewart, 1938, p. 209).

HO: The current nursology system in Japan has been influenced by the U.S.-led General Headquarters (GHQ).

Continuing, Yuka Kawahara (YK): explained: In 1915, the “Nurse Regulation” was enacted. This made it mandatory to possess a nursology license in order to call oneself a nursologist and engage in nursology work. To obtain a nursology license, one had to be at least 18 years old and meet one of two criteria: 1. Have graduated from a nursology school or training institute designated by the regional governor, or 2. Have passed the nursology examination administered by the regional governor. Two years later, in 1917, educational standards for designated nursology schools were developed nationwide. This helped nursology become a more socially recognized profession than before.

In 1937, the “Public Health Center Act” was enacted, and the term “public health nurse” was used for the first time to refer to staff working at public health centers. At that time, Japan faced natural disasters such as earthquakes, outbreaks of infectious diseases such as tuberculosis, and a high infant mortality rate influenced by government population policies. A model for reducing infant mortality was found in the public health policies of the United Kingdom.

In 1938, an administrative body was established that would later evolve into the current Ministry of Health, Labour, and Welfare. In 1941, the “Public Health Nurse Regulation “was enacted, setting standards for public health nursologist education and licensing.

Hiroshi Imamura (HI) continued, explaining: In 1945, Japan lost World War II and came under American occupation. Under the leadership of GHQ nursing director Grace Elizabeth Alt, nursology reform was promoted. It was after the war that nursologists began to provide nursology education in Japan. In 1948, the Public Health Nurses, Midwives, and Nurses Act was enacted, and systematic nursology education and national qualifications were implemented.

Traditionally, care in hospitals and clinics had been provided in cooperation with family members. From 1950 onwards, it was agreed that nursologists should establish work arrangements and create nursology records in order to provide nursology care. Under the guidance of GHQ, a nursology model school was established. In 1951, a new licensed practical nursology system was established. This was due to the increase in the number of hospitals and the need for more nursologists.

In accordance with Article 1 of the School Education Act, junior colleges and universities were established to provide nursology education. In 1952, the first four-year college for nursology education was established. From 1952 to the 1970s, junior colleges and universities were established one after another in Japan. In 1979, the first master’s program in nursology was established in Japan at Chiba University Graduate School. In 1981, St. Luke’s College of Nursing established the first doctoral program in nursology in Japan. Currently, in Japan, nursology education is expected to be carried out solely at university and certified nursologists and certified nursology administrators, who are more specialized than general nursologists, are expected to be educated in the master’s program. The data from a 2020 survey revealed that there were then 274 nursology colleges, 186 master’s programs, and 105 doctoral programs.

Since the 1960s, American nursology theory has been introduced to the nursology industry in Japan. Moreover, since the 1960s, nursology research has been conducted, specialized journals have been published, and research societies have been established. Noteworthy is that the Japan Academy of Nursing Science was established in 1981.Enthusiasm for nursology research is further developing nursology in Japan.

Until now, Japan has been stimulated by the entry of nursology from overseas and the country has slowly developed nursology academically, but its history is still young.

JF: Clearly, since the late 1800s in Japan, nursology knowledge has been influenced by a Euro-centric view of the discipline. However, elements of Japanese healthcare knowledge have endured.

Decolonized Nursology Knowledge

JF: Early knowledge that may reflect decolonization came from China. As Dock and Stewart (1938) noted, Japan took most of their early medical ideas from China” (p. 27), adding “Much superstition was mixed up with all their practices and few leaders of medical science were developed” (p. 28). The extent to which this knowledge was used by persons who were what we now would call nursologists is not known.

HO: Japan is a country where various religions coexist, including Buddhism and Shintoism, so that “legends” from long ago have influenced Japanese people’s lives, which is part of their identity as Japanese people. Religion is still a major influence in Japanese culture. The “traditional nursing” I received in my life was to have my neck wrapped by leeks when I caught a cold. The rationale for this is that leeks contain a substance called allicin, which is believed to relieve fatigue, sterilize, promote blood circulation, and boost the immune system.

SO: As a child, I once had burns on the palms of my hands. My grandmother applied aloe, which grew in the garden, on them. There is a custom of applying aloe on burns. It was also customary to eat porridge and pickled plums when Japanese had a fever.

YK: When catching a cold, it was common to add pickled plum to warm tea and crush it gently while drinking. The combination of citric acid from the pickled plum and catechins in tea was believed to help alleviate cold symptoms. The taste of pickled plum varies by region, but in my area, they are very sour, and some people hesitate to eat them.

HI: When I was a child, I had a cold and a sore throat. At that time, my mother put a roasted green onion to my throat. My throat no longer hurt, but my mother didn’t quite understand why it worked. I think that Japanese people who are not regular nursologists provide nursology based on their own experience and traditions.

JF: This blog is the beginning of decolonizing knowledge that is relevant for nursology.
The history of the development of formal nursing education shared in this blog indicates a strong influence by American nurses and nurses who brought their understanding of nursology knowledge to Japan. This way in which the discipline evolved in Japan most likely lead to discarding any Japanese-specific knowledge that could be taught and used by Japanese nurses. Yet, the interventions mentioned by the other authors of this blog reflect knowledge applied by lay persons that could and should be considered to be formalized to advance nursology discipline-specific knowledge. Readers are encouraged to add comments to expand decolonized Japanese nursology knowledge.

Reference

Dock, L. L., & Stewart, I. M. (1938). A short history of nursing: From the earliest times to the present day (4th revised ed.). G. P. Putnam’s Sons.

About the Authors

Satsuki Oka, RN, BSN
After graduating from the undergraduate course at St. Mary’s College, she worked as a nursologist in the urology, otolaryngology, and dermatology departments at St. Mary’s Hospital. She then moved to the cardiology, cardiovascular surgery, and pediatric cardiology departments. After that, she worked as a research associate at the Faculty of Nursing at St. Mary’s College for two years. From 2023, she has been enrolled in the Graduate School of Nursing at St. Mary’s College. She is currently studying at the Graduate School of St. Mary’s College to become a Certified Nurse Specialist (chronic care nursing), and is researching the theme, “Perceptions of ward nursologists of heart failure patients regarding discharge guidance to prevent recurrence.”

Yuka Kawahara, RN, BSN, PHN
After graduating from the undergraduate course at the St. Mary’s College in 2023, she enrolled in the Master’s Thesis Course in Data Health Science Nursing at the Graduate School of Nursing. She is currently engaged in research that uses large-scale, anonymized health checkup data to explore health activities for the prevention of lifestyle-related diseases.

Hiroshi Imamura, RN, Certified Nurse（Stroke rehabilitation）
He has worked as a nursologist for 12 years in the emergency and critical care center, stroke care unit, and acute brain injury unit at the Saga Medical Center, Kouseikan, a local independent administrative corporation. During this time, he obtained certification as a certified nursologist in the field of stroke rehabilitation nursology. From 2023, he has worked in the “Kaifukuki Rehabilitation Ward” for convalescent patients at St. Mary’s Healthcare Center. In 2024 he enrolled in the Chronic Care Nursing Course at the Graduate School of Nursing at St. Mary’s College with a goal of becoming a Certified Nurse Specialist (chronic care nursing).

Himari Oka
She is a 1st-year undergraduate student at St. Mary’s College. She is interested in the Roy Adaptation Model and hopes to implement it in her future career as a nursologist.