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Masataru Takahashi

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What is learned through practical exercises in nursing care?

Masataru Takahashi
Professor of Sports Medicine, Social Welfare for the Elderly, and Sports for the Disabled, Faculty of Economics, Chuo University

1. Introduction

Perhaps due to global warming, summer has been extremely hot for the past few years. A large number of elderly people suffering from heatstroke have been transported to hospitals by ambulance. On August 9th, 2013, the Fire and Disaster Management Agency announced that 23,699 people suffering from heatstroke had been transported to hospitals throughout all of Japan in July. This was the highest number of patients ever in July since the survey was started in 2008. The previous high was 21,082 patients in 2012. Persons aged 65 and older accounted for 11,420, or about half of all patients. 27 people died from heatstroke. On the evening of August 13th, the bodies of an elderly couple believed to have died from heatstroke were found at an apartment in Edogawa City, Tokyo (quoted from the August 14th, 2013 edition of the Mainichi Newspapers). As human beings age, our skin becomes less sensitive to temperature. It takes longer for us to sweat and heat tends to become trapped in the body. Additionally, in the case of weakened cognitive ability, it becomes difficult to operate air conditioning. For such reasons, families consisting of only elderly people tend to be slow in preparing appropriate cooler clothing or using air conditioning. This makes elderly people prone to serious cases of heatstroke. Additionally, serious cases involving the elderly are reported every day, such as nursing care for elderly individuals with dementia.

As of 2010, the average lifespan for a Japanese person was 79.59 years for a man and 86.44 years for a woman. Japanese society is aging rapidly. Moreover, there is a pronounced shift towards nuclear families, resulting in a changing relationship between the elderly and their families, as well as the community. In the past, many elderly people in Japan lived together with their children and grandchildren. Today, however, the number of elderly people living alone is increasing rapidly. There is a particularly notable increase in the number of late elderly (aged 75 and older) living alone. Although the majority of early elderly (aged 65 to 74) are still relatively healthy and are capable of leading an independent lifestyle, this vitality dwindles dramatically upon entering the stage of late elderly. In addition to reduced physical strength, an increasing ratio of late elderly suffer from some degree of dementia. It is estimated that the number of elderly people requiring nursing care will increase to approximately 4.21 million (men: 1.41 million, women: 2.8 million) in 2030. These statistics indicate that the rapidly increasing number of elderly people requiring nursing care will be a serious social problem in the near future.

Together with the issues of pensions and medical care, the problem of nursing care for the elderly is a serious national issue. Although the enhancement of nursing care systems is obviously important, it is even more vital that we recognize nursing care as an issue that affects each one of us. All Japanese citizens must embrace the spirit of mutual care and support. In this article, I will report on the form of practical exercises in nursing care conducted in the Faculty of Economics, Chuo University. I will also offer some observations on social welfare education.

2. Introduction of practical exercises in nursing care

The Faculty of Economics at Chuo University offers a course entitled Practical Exercises in Nursing Care. This course is unique to the Faculty of Economics and does not exist in the curriculum of any other faculty at Chuo University. I opened the course in 1996 when I began working at our university. Since then, many students have taken Practical Exercises in Nursing Care before graduating. In addition to female students, a large number of male students have also taken the course. Practical Exercises in Nursing Care is an elective course included in the curriculum of Practical Exercises in Health and Sport. The course is a program with two parts. During the first term, students spend one period a week learning the basics of nursing care. Then, during summer vacation, students acquire actual experience in nursing care. Students spend a total of 5 days engaging in practical exercises at a special nursing home in Hino City. During the practical exercises, students talk with elderly people staying in the home and help nursing care workers. Students are not involved in full-scale care activities such as feeding and toilet support. The main work performed by students is to help with the serving and clearing of meals, room cleaning, neatening of residents after they take a bath, arrangement of washed clothes and changing sheets. There is also a day on which students give a small performance in front of elderly residents.

Students also help with events to show respect for the elderly. Furthermore, on one of the 5 days, students participate in recreation together with elderly people living nearby as part of a day-service program. If a large number of students are enrolled in the course, students are divided into two groups. The first group conducts practical exercises during the summer festival period in August, and the second group conducts exercises at the time of event to show respect for the elderly in September, helping to prepare for the events and, on the day of events, assisting with the movement of the many elderly residents in wheelchairs. Every day, students write a journal on what they learned through that day’s practical exercises and include any questions that they may have. Nursing care staff reads these journals and provides advice and instruction. Students are also required to write a report on the 5 days of practical exercises. In the report, students discuss whether they were able to achieve learning goals such as assignments or themes which were set before starting the exercises, reflect on what they could have done better and set new goals for themselves in the future.

This program is significant in two respects. The first is studying normalization, a concept which seeks to realize a coexisting society. Coexistence refers to a relationship of mutual aid, similar to the relationship between an ant and aphid. Every human being grows old. We gradually become unable to walk and our movements become slow. In some cases, we may not be able to eat or use the toilet by ourselves. In response to such conditions, young people must play a leading role in supporting all of society. By actually experiencing the lifestyle of elderly people living in nursing facilities, students get a clearer idea regarding the realities of an aging population.

The second goal of the course is to study basic knowledge related to nursing care for the elderly. In particular, students deepen their understanding of recent knowledge related to dementia. Dementia is caused by a variety of factors, resulting in decreased memory and decision-making ability. Different forms of dementia include mild cognitive impairment, Alzheimer's disease, cerebral vascular dementia, Lewy body dementia, and frontotemporal lobar degeneration. Symptoms and treatments differ depending on the illness which causes dementia. Some forms of dementia can be healed through appropriate treatment. Therefore, it is imperative to be examined at a hospital as soon as there is any sign of dementia. Nonetheless, generally speaking, a number of misconceptions regarding dementia are often seen. Additionally, in terms of health management, it is necessary for the elderly to broadly study the fundamentals of medical knowledge. Signs of illness in the elderly often differ from those in young people. For example, in general, a heart attack victim will feel severe chest pain and crouch to the ground while pressing against their chest. However, this is not always true for the elderly. There are cases in which an elderly visits a hospital while complaining of vague stomach irritation and a stiff left shoulder, only to be diagnosed as having had a heart attack.

I hope that all students will become interested in medical treatment and social welfare for the elderly. In a modern society where there is little interaction among different generations, this program creates opportunities for students to interact with the elderly. Opinions such as the following have been given by students who participated in practical nursing care exercises: “It was a precious experience which will be useful throughout my entire life. If I have the opportunity, I would like to have the same experience again.”

3. Observations on social welfare education

Some people oppose recognizing such activities as an accredited university course. When addressing this question, it is necessary to consider two main issues. The first issue is whether it is appropriate to give university credits for volunteer activities. The opposition states that cultivating volunteers is not the objective of universities and that there are more important things to be learned. This opinion against accreditation is given by more than a few people. However, such people either do not understand the severity of financial problems associated with a rapidly super-aging society, or they are optimists who believe that someone will find a method for increasing Japan’s national income. Indeed, raising consumption tax is unavoidable in order to respond to the vast budget deficit which will continue to increase in the future. However, implementing social welfare education and spreading volunteer activities is also an important policy. Social welfare facilities in Japan are operated under the nursing-care insurance system. Unfortunately, it is difficult to find nursing care staff because the pay is low despite the hard work. Even if facility management gives their best effort, the financial situation is quite severe. As such, facilities currently rely on donations and volunteer manpower. Even Holland, the first country to implement nursing-care insurance, is struggling with a budget deficit. Consequently, Holland is working to spread a national policy of unofficial care activities in which relatives, friends and neighbors care for the elderly. The importance of volunteer studies has finally started to receive broad recognition in Japan. As a result of deregulation enacted in 1991 for standards of establishing universities, university education is now based completely on the autonomy of universities. This has led to volunteer studies being implemented at universities. According to a report issued by the MEXT (Ministry of Education, Culture, Sports, Science and Technology), at universities which had established courses related to volunteer activities as of 2008, social welfare activities (nursing care, personal care, provision of meals, childcare, etc. for the elderly or disabled) were conducted at a total of 203 schools (28.1%). By category, there were 31 national universities (37.8%), 11 public universities (15.1%) and 161 private universities (28.3%). This survey included 82 national universities, 73 public universities and 568 private universities, for a total of 723 schools. The Open University of Japan was included in the category of private universities. Originally, Japan possessed the culture of mutual support for elderly people within the community. In the future, it is expected that volunteer studies will expand even further as a national policy.

The second issue is to understand the difference between social welfare education and volunteer studies, and to examine the theoretical basis for social welfare education.

In September 1983, the Social Welfare Education Research Committee of the Japan National Council of Social Welfare defined the concept of social welfare education as follows: Social welfare education is the study of social welfare that has been historically and socially excluded as a method for realizing a peaceful and democratic society as based on human rights as defined in Article 13 and Article 25 of the Japanese Constitution. Social welfare education consists of activities which, through the subject matter described above, promote interest and understanding toward social welfare systems and activities, and instill the ability to lead a fulfilling lifestyle through cooperation and to implement solutions for social welfare issues, without excluding people who receive social welfare services, while also developing own human character from the society and community. In other words, social welfare education seeks to embody the philosophy of normalization, deepen understanding and interest toward social welfare problems among Japanese citizens, and instill students with practical ability for solving problems (excerpt from Theory and Practical Application of Social Welfare Education-Searching for New Developments, written and edited by Mitsugu Sakano, Aikawa Books, 2000). Conversely, volunteers studies were defined as follows in the Guide to Volunteer Studies (1996) by the Shizuoka Prefectural Education Committee: In volunteer studies, students learn how to live as a human being through volunteer activities. Volunteer studies are an experience in activities which realize a bright, comfortable living environment and an affluent community. At the same time, volunteer studies fulfill three important roles required by modern society. The first role is to form the human character of learners, the second are volunteer activities which address lifestyle issues, and the third is realizing an affluent and comfortable community. Until now, volunteer activities have been implemented for elementary school, junior high school and high school students. Through volunteer experience activities, the focus has been placed on cultivating people who are interested in a variety of social issues. Volunteer studies encompass a variety of fields including social welfare issues, cultural/sports activities, nature conservation and environmental protection. However, the subject of social welfare education has been minorities such as the elderly, the disabled and other people in weak social positions, as well as creation of social welfare systems and awareness toward social welfare in the community. Based on the points raised above, social welfare education can be described as an important academic subject that seeks to embody the philosophy of normalization and to instill students with knowledge and practical ability for solving social welfare problems. As Japan turns into a super-aging society, how will we address the enormous debt shouldered by Japan and the cost of social security for the rapidly increasing number of elderly people?—This is a question facing all Japanese citizens. As such, social welfare education which includes volunteer studies must be guaranteed as part of fundamental liberal arts education at institutions of higher learning.

4. Conclusion

This article described Practical Exercises in Nursing Care which is offered in the Faculty of Economics, Chuo University. It also examined the status of social welfare education. Although the nursing-care insurance system has already been established in Japan, payments will continue to increase as society ages. As a result, a budget deficit is predicted. Amidst such circumstances, I hope that Practical Exercises in Nursing Care will produce many young people who conduct volunteer activities such as mantelzorgers that supplement official care.

Masataru Takahashi
Professor of Sports Medicine, Social Welfare for the Elderly, and Sports for the Disabled, Faculty of Economics, Chuo University
Born in Gunma Prefecture in 1946. Graduated from the School of Medicine, Gunma University in 1970.
In 1970, entered the Department of Orthopedics in the Faculty of Medicine, the University of Tokyo. Holds a PhD in medicine from the University of Tokyo.
Served as Director of orthopedics at Sempos Tokyo Takanawa Hospital before assuming his current position in 1996.
In 2007, served as a visiting researcher at the Psychology Department of California State University.
Accredited as a sports physician for the disabled by the Japan Sports Association for the Disabled. His current research theme is organizing sports for the disabled by classes. His major written works include Q&A for Orthopedic and Plastic Surgery Examinations (co-written; Roppo Publishing, 1989) and Comprehensive Textbook of Orthopedic Operations (co-written; Kanehara & Co., Ltd., 1991), etc.