Postcards from Japan

Developing important collaborative ties with nurses overseas can help Australia improve its nursing system here. Linda Belardi reports.

Stepping into the hospital ward for the first time as a student nurse can be daunting, but do they immediately feel a sense of belonging to the profession and how might the experience differ for students from various cultural backgrounds?

These critical questions will form the basis of a research project to be undertaken by University of Newcastle bachelor of nursing honours student, Kazuma Honda.

Honda, who was awarded a prestigious 2012 Prime Minister’s Australia Asia Outgoing Endeavour Award (the only nurse to receive the prize), will use the scholarship to investigate the clinical placement experiences of nursing students in Japan.

Over the next 12 months, Honda will study a cohort of third- and fourth-year Japanese nursing students at Yamaguchi University Hospital in Ube, which has been a sister city of Newcastle since 1980. There, he will explore questions of professional identity and students’ experiences of belongingness during their clinical placements.

“A key factor in the retention of nursing students is the experience of ‘belonging’, particularly in clinical settings,” says Honda. “Research in the social sciences and psychology suggests that the need to belong exerts a powerful influence on cognitive processes, emotional patterns, behavioural responses, health and wellbeing,” says Honda.

Research shows that people who are deprived of belongingness are more likely to experience diminished self-esteem, increased stress and anxiety, higher rates of depression, impaired cognition, and a decrease in general wellbeing.

“Empirical studies on nursing cohorts indicate that diminished belongingness may affect motivation for learning, and influence the degree to which they are willing to adopt a questioning approach to practice,” says Honda.

Replicating identical studies previously conducted in Australia and the UK, Honda will ask Japanese nursing students to complete the Belongingness Scale – Clinical Placement Experience survey, an online self-report survey developed in 2009 by Professor Tracy Levett-Jones from the University of Newcastle.

To gather qualitative data, Honda will also invite a sub-group of students to take part in semi-structured interviews to explore factors that influence Japanese nursing students’ sense of belonging in clinical placements.

Honda says there are important lessons to be learned from his research for Australia’s international nursing students. “It is important for policy makers and educational institutions to know how to teach and how to interact with Asian students because our concept of studying is very different,” he told Nursing Review from Yamaguchi.

“For example, in Japan, group harmony is much more important than individual harmony and I want to find out how this might influence students’ sense of belonging in the clinical environment.

Hopefully, my study can contribute to the way nursing academics and clinicians in Australia teach Japanese students in the future,” he says.

Because a sense of belonging is extremely important for Japanese culture, he suggests that it will be even more prominent for nurses with a Japanese background working in Japanese and Australian hospital settings. “In my professional experience I see a link between the lack of a sense of belonging in novice nurses, which can lead to attrition.

“If nursing students don’t experience a sense of belonging during their clinical placements evidence suggests that this has a negative effect on rates of attrition, clinical performance and long-term success. This in turn can have personal costs for nursing students and public costs for government and the community,” he says.

Having completed his undergraduate training and practiced in Australia as a nurse, Honda is also eager to compare his learning experience with his international colleagues. To complement his research, he also hopes to conduct an internship later in the year with the Japanese Ministry of Health to develop his understanding of the nursing policy environment.

Honda is also working as a part-time tutor at Yamaguchi University teaching basic medical English conversation to nursing and laboratory science students.

In Australia, his advocacy for international students has resulted in the University of Newcastle introducing initiatives to ensure these students were better prepared for living and nursing in Australia. He was awarded a Peer Support Award for his mentoring work.

Honda says he is passionate about supporting international students and wants to make nursing a more inclusive career for all.

In the course of his studies he has received the University of Newcastle’s Dean’s Merit Award and has twice been awarded the Enrolled Nurse to Registered Nurse scholarship from the NSW Nursing and Midwifery Scholarship Fund.

Last year, in response to the tsunami disaster in Japan, Honda also initiated a charity drive at his workplace, the Royal North Shore Hospital, which raised $2000 to support victims.

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