Vol.11

FALL 2001

NEWS FROM JANS
National Long-term Care Insurance System in Japan
Katsuko Kanagawa, R.N., Ph.D(President, Ishikawa Prefectural Nursing University)
The average life expectancy inJapan is 77 yeas old for men and 84years old for women. The ratio of
those who are aged 65 or older is 17%of the total population. Japan is thecountry which enjoys the highest
longevity in the world. We can be
happy about this, but we cannot ignore
various problems accompanying thistrend. There has been increasingawareness among the Japanese on
the issues of population aging. Of particularly serious concern is theincrease of medical cost for the elderly
and how to provide care for them.
Japan has been discussing various
policies of health, medicine, and social
welfare for the elderly population. April
in 2000, the national long-term careinsurance system was started which
had been a focus of Japanesepeople's attention.The bill for this system passed the National Diet on
December 9th in 1997, and was issued
on the December 17th of the sameyear. It began April 1st, 2000.
The purposes of this care insurance
are: To enable society to support thecaregiving load, to eliminate hospitalization of the elderly who need a place
to stay rather than medical care byseparating them from a medical insurance category, to provide diverse services, and to collect money from citizens through social insurance
approach.
Specific policies include (1) creatinga publicly supported system for taking
care of the elderly, (2) enabling theelderly to make choices of their own,
(3) emphasizing in-home care, (4)emphasizing prevention and rehabilitation, (5) providing comprehensive andefficient services, (6) participation by
citizens and active utilization of privatesectors, (7) mutual support throughsocial insurance approach, (8) safeand efficient management and emphasis on regionally-based operations.

In the national long-term care insurance system, the insures are local governments such as cities, wards, villages. The insured is either Type 1
recipient who is from 40 to 64 years
old or Type 2 recipient who is aged 65
years or older. The premium depends
on the income, the amount of pension,or the type of medical insurance, but iscollected individually or deducted frompension from the elderly aged 65 years
or older. In case of those aged 40-64,
it is collected as a part of nationalized
medical insurance. When the insured
receives services, he/she pays ten percent of service cost as a co-payment.
The amount of premium varies in different cities and villages. But they
have estimated the average amount ofservices needed for those aged 65 orover, and set the standard premium forthem as 2,500 yen a month.
In order to receive care insurance
services, one has to apply to his/her
local government. After one s applying to the city, ward, or village, theinvestigation is conducted by the committee to evaluate the application.
Then whether to provide a service ornot, with what level, and the amount ofservice cost are determined.
The national long-term care insurance system provides services tothose who are currently needing careor who may need it very soon. The
level of care ranges from Level 1:
where only partial
care needed,assistance is needed for daily life, toLevel 5: care needed, where themost intense care is required. For
those who can eat and go to the toilet
by themselves but still may be in thestate of needing care very soon, thecategory is Support needed.
The services can be chosen andreceived based on the determined
level and within the limit of the national
long-term care insurance system. For
Level 1: care needed
example,starts from 170,000 yen a month, andcan increase to a maximum of Level
368,000 yen a
5: care needed,
Support needed provides
month.
services at 64,000 yen a month. The
insurance pays ten percent of thisamount. The types of services include
sending home-helpers, day service,rehabilitation service, nurse visit, andinstitutionalization.
Since the national long-term careinsurance system has made caregiving
for the elderly the society s responsibility by partially relieving the family of theburden, it is a step forward. But there
are still many unresolved problems, forexample, some elderly people are notable to pay the premium. The evaluation procedure of determining the levelof care is not considered fair. The contents of services are also considered tolack uniformity across regions andproviders. It is important that no matter where one lives, the elderly canreceive quality services, which help
them to have an independent life
according to their abilities. All of us in
the nursing profession have a responsibility and an important role to make it
happen.
It will take a number of years for a
newly introduced system to work effectively. Based on the reality, constantefforts are being made to improve thesituation.

NEWS FROM JANSThe Fourth International Nursing Research Conference in Mie

The 4th International Nursing
Research Conference of JANS was
held in Mie Center for the Arts on
August 29, 30 and 31, 2001. TheA Holistic Approach: Atheme wasBetter Quality of Life for All―In Searchof Core Principles for Nursing in theThe importance of
21st Century.
this theme was described by Dr.
Sumiko Maehara, chairperson of theconference, in her opening remarks:
As we stand on the threshold of the
21st century, we felt the necessity tostop and take stock of the idea role ofnursing science that would contributeto the health and welfare of people.

This is why we came to hold this academic conference, with holistic
approach as its lead phase. What isthe holistic approach that brings a better quality of life for all in terms of individuals, families, regions and ultimately
the globe? We hope to hold discussions on this theme, re-examining withyou all what the core principles of nursing are.
There were four keynote speeches:□ Chairperson s Address: A HolisticApproach to Nursing
Dr. Sumiko Maehara, President, Mie
Prefectural College of Nursing, Japan,
spoke about holistic approach in nursing and nursing education in Japan,
basing her discussion on science, culture and nursing care systems for the21st century.
□ Keynote Address ø: Holistic Nursing and Caring
Dr. Jean Watson, Distinguished Professor, University of Colorado Health
Sciences Center, U.S.A., provided anoverview of Holistic Nursing, and Caring and Healing, as an expanded
model for nursing and health sciences
for a new era.
□ Keynote Address¿ : A Holistic
Approach: A Better Quality of life for All(The Meaning of the Group or Region)
Dr. Barbara Bowers, Professor, University of Wisconsin-Madison, U.S.A.,
addressed the meaning of social con-text, described strategies that could be
used to create a more sociologicalunderstanding of our patients and ourwork, and suggested consequences ofbeing more sociological.
□ Keynote Address ¡ : A Holistic
Approach: A Better Quality of Life forAll, on a Global Scale
Dr. Darunee Rujkorakarn, Professor,Mie Prefectural College of Nursing,Japan, focused on three aspects, global health problems in the 21st century,models of holistic approach, and core
principles and challenges in holistic
approach on a global scale.
521 participants attended to Ekiden
Symposiums, panel discussions, oralpresentations, poster presentations,workshops and information exchanges.
JANS describes an ekiden symposium as a discussion held over time, inJapanese ekiden means from station to station and conveys the idea ofa relay race in which the baton is pastfrom one runner to the next. Twoissues were discussed by eight presenters in the Ekiden Symposiums:
Human and Human Relationship:Partnership with Dignity and Nurses Collaboration for Health Promotion in Cities and Rural Communities.
The program also featured an open
seminar for the general public. The
speaker, Mr. Hiroshi Ikushima, was theauthor of What has happened to myHe spoke about 21 cengrandma?
tury home care service for the elderly
in Japan based on his own experience.
The JANS International Nursing
Research Conference is held every
three years. The next conference will
be held in 2004.

Conference Highlight
A HOLISTIC APPROACH TO NURSING
Sumiko Maehara R.N., C.N.M., Ph.D
Mie Prefectural College of Nursing, Japan
Based on what was learned during
the 20th century, which saw wars andtechnological innovations, people
expect to achieve a better quality of lifein the 21st century.
In the field of medical care, the 21stcentury is being referred to as theage of nursing, or age of care,
and as such will demand majorchanges in the basic concept of what
nursing should entail.
In such an era, we should seek a
new concept of ideal nursing to reaf-firm thecore principle of nursing.
Adopting a holistic approach asthat core principle, I hope to examine
what is actually meant by holistic,
the keyword of this conference, interms of nursing practice, education,research, and administration.
Practice : Under the relationship ofmutual trust between nurses andclients, nurses have taken, or madeefforts to take, a holistic approach tocare to ease their clients pain andsuffering. At the foundation of nursing,
there should be sincere affection forthe patient. This can enable nurses tojudge what is best for their clients
particular needs. For such affection to
be complete, practical nursing techniques are necessary.
These techniques should be supported by a holistic approach unique inthe field of nursing. The approach will
be different from those of other professions.

Education : Through education, I
hope to develop students sensitivity
toward the suffering of others. To thisend, teachers should also take a holistic approach to education.
Research : It is required to develop
as swiftly as possible the various holistic techniques availble, to alleviate
people s physical and mental pain andto help patients become independent.
It is expected that further researches
will realize these techniques in thefuture.
Management : The scope of nursing
services will expand throughout theworld. We have to consider the kind ofservices that should be included in thescope of nursing. As well, we will needa political support to ensure such services will be appreciated at their proper
economic value. This is because
ensuring proper economic value is an
important requirement to realize aholistic approach to nursing.

The Anniversary Conference of the Japan Academy of Nursing Science
The 20th Anniversary Conference ofJANS was held in Tokyo on December
15 and 16, 2000. Located in the heartof the city, the Tokyo International
Forum was the perfect place for thisacademic conference and over 2500
people attended. The theme wasNursing Research: Challenges for
Health Care Reform and People s
The chairperson ofQuality of Life.
this conference, Dr. Sawako Kawamura, Dean of the School of Nursing atTokyo Metropolitan University of
Health Sciences, presented thekeynote address Changes in Society
The conferand Nursing Research.
ence featured 12 facilitated informationexchange sessions and two symposia:

Constructing Nursing Policy to Anticipate Society s needs and Developing Systems for Nursing Practice inTimes of Change: From Acute Care toIn addition.
Home Care Nursing.
over 300 research projects were presented.
The 21st Anniversary Conference ofJANS will be held in Kobe on December 1 and 2, 2001. The theme is
Examining Ethical Perspective onDr.
Nursing in the 21st Century.
Noriko Katada, Professor of College ofNursing Art and Science, Hyogo, ischairperson of this year s conference.
We look forward to seeing all our colleagues in Kobe.

NEWS FROM JANS
Education for Nursing Ethics in Baccalaureate Program
Steering Committee for Nursing Ethics
Since 1990, the committee has presented ethical issues which nurses facein clinical settings, ethics in relation tonursing research and the system of ethical inquiry. To train nurses who areable to judge and act based upon an
ethical viewpoint, it is necessary to
improve programs on nursing ethics.
However, educational programs on
ethics have not been surveyed. The
purpose of this study was to investigate
the education of nursing ethics carriedout by the faculties of 67 colleges
established before 1998.
Fifty-two colleges(77.6%) responded.

Twenty-two colleges(32.8%) offer thesubjects of Bioethics and/or Nursing
Ethics, and 24 colleges(35.8%) do notoffer Nursing Ethics as an independent
subject but the content of it is includedin their educational programs. Most colleges introduce and utilize the Japanese Nursing Association Code of Ethics
for Nurses and the ICN Code of Ethics
for Nurses, and relatively many colleges
utilize patients rights, ethical principles, the concept of the ethics of care.
In terms of the clinical practice of student nurses, ethical perspectives aregiven careful consideration in the actual
process of the practice. However, aclear statement of purpose and the goal
relevant to ethics was not indicated.
Educational issues related to nursing
ethics are the following: 1) through dailycare of the patients, the knowledge isrelated to practice; and 2) the collaborative relationship between educationalsettings and clinical settings has to beestablished.
The committee has proposed statements regarding the ethics of humangenome/gene encoding research, thetechnology of cloning human beingsand organ transplantation.

Editor s Note
The advent of technology and otheradvances in modern science have supported a cure orientation rather than ahealth promotion and disease prevention. Western and biomedical treatments which derived from a mechanistic view of the body may alleviate signs
and symptoms of disease but often failto heal the whole person. During thelast three decades, there has been an
increased interest in a more holisticand humanistic approach for controllingvarious health problems. Sometimes,
this change referred to a paradigm
shift. This paradigm shift offers opportunities for increasing the use of holistic
types of care in practice to the benefit
of both patient and caregiver. Contributions on this change are emphasis
on self-control through various techniques, enhancement of the individualÕs
role in maintaining personal health, thesearch for natural health, and a greater
anti-medical climate.
More than a century ago, FlorenceNightingale defined nursing as seeking
to put the body in the best possible
state for nature to take its course.
NightingaleÕs philosophy of nursing isconsistent with that of current holistic
health and healing therapies. Nightingale described about the whole person
and the environment. The discipline ofnursing has been incorporating manyof the concepts of a holistic paradigm
into nursing as a means of integrating
the professionÕs conceptual frameworks for theory, research, and practice.
Traditionally, Eastern philosophy
views the human being as a unity or awhole. Therefore, mind-body connection is considered as an important partof health services. In addition to Werstern and biomedical therapies, many
Japanese people have been using avariety of holistic type of therapies.
These therapies not only help to relieve
symptoms of disease and improvemental status or feeling, but alsoenhance a patientÕs sense of control
over his or her own life.
These therapies are called folk, Eastern, alternative, complementary, andintegrative healing modalities. Examples of such therapies include meditation, progressive relaxation, guided
imagery, hypnosis, therapeutic touch,JANS Information
Welcome to JANS Home Page!
http://plaza.umin.ac.jp/~jans/
http://plaza.umin.ac.jp/~jans/index.htm

acupuncture, massage, music, humor,art, nutritional therapies and so on. A
holistic perspective of health has traditionally been incorporated in nursing
curricula of nursing schools. TheJapanese national health insurance
has covered some therapies such as
herbal medicine, acupuncture, andmassage.
However, these alternative and complementary therapies are not acceptedor utilized by all Japanese nurses asuseful treatment modalities. Some ofalternative and complementary therapies may prove to be effective and others may be shown to be ineffective orharmful. Nurses sometimes feel difficulties in dealing with various questions ofalternative and complementary therapies asked by patients and their families. Recently, nursing literature aboutalternative and complementary therapies has increased in Japan. Nurses
have responsibilities for their patientsand families and for their professions tovalidate the safety and effectiveness oftheir practice.
(Shoko Arakawa)

JAPAN ACADEMY OF NURSING SCIENCE
Promoting Committee of International Affairs
c/o Business Center for Academic Societies 5-16-9,
Honkomagome, Bunkyo-ku, Tokyo 113-0021, Japan