Yonago Acta medica 1998;41:53–54

A Comparative Study on Medical Care for Children in Schools for theHandicapped in Japan and in the United States
Kahoru Kitagawa and Ikuko Miyabayashi
Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori
University, Yonago 683-0826, Japan
We conducted a survey to document the number of students who needed medical care
at schools for the handicapped in Osaka, Japan and in Dayton, Ohio, USA. The ratio ofstudents who needed medical care was similar in both cities (10–15%). In Dayton, allschools had school nurses who administered medical care to those who needed it. Incontrast, in Osaka, medical care was administered by people at various levels of medical
training and knowledge.
Key words: administered medical care; handicapped children; medical caretraining of personnel who administered themedical care. Then the analytical data obtainedin Japan and the United States were compared.
In Japan, 14 public schools for the handicapped were randomly selected in Osaka: of them,
11 schools had elementary, middle and highschool-age students, and 3 schools had elementary and middle school-age students. In theUnited States, 3 public schools for the handicapped were selected in Dayton, Ohio. The ages ofthe students ranged from 0 to 22 years.

A current law in Japan has prohibited the administration of medical care at schools for thehandicapped, but the number of students who
require it is increasing (Funahashi et al., 1990;
Kanai, 1994; Kuritani, 1996). Schools in Japanare not allowed to have qualified medical
personnel because of the law (Kitamura, 1995;
Kaneko et al., 1997). Schools for the handicapped in the United States are required to haveschool nurses (Anderson, 1994), and appear tohave minimal problems in providing medicalcare for handicapped children (Suzuki, 1993).
In the present study, we conducted surveys todocument the number of students who needed
medical care at schools for the handicapped inJapan and the United States, with the aim ofproviding a forum for discussion on the current
problems of school nurses at Japanese schools
for the handicapped.

Results and Discussion
In Osaka, 13 schools returned the survey: thetotal number of students was 1,325, and those
who needed medical care were 185 (14.0%).
The 3 schools in Dayton had 520 students, and54 (10.4%) needed medical care.
Among the 13 schools in Osaka, medicalcare was administered by class teachers andnurse-teachers (n = 4, 30.7%), by nurse-teachers(n = 2, 15.4%), by class teachers (n = 2, 15.4%),
by class teachers, nurse-teachers and guardians (n= 2, 15.4%), by class teachers and guardians (n =1, 7.7%), by guardians (n = 1, 7.7%) and by officepersonnel (n = 1, 7.7%). In contrast, school
nurses provided medical care in all 3 schools inDayton (100%). In Osaka, technical training tononmedical school staff members was given byphysicians in charge (n = 9, 69.2%), by guardi-Materials and Methods
Concerning medical care to be administered atschools for the handicapped, we defined suchtreatments as tube feeding, aspiration of sputum, urinary catheterization, oxygen administration and insulin injection. The items wesurveyed to outline the need of the administration were: i) how many students needed themedical care; ii) who administered the medicalcare; and iii) who was responsible for technical53

K. Kitagawa and I. Miyabayashi

ans (n = 9, 69.2%), by nurses (n = 4, 30.7%) andby school physicians (n = 2, 15.4%). One school
responded that technical training was given byguardians only.
The medical care information which wasrequested on the surveys involves specialized
nursing or medical knowledge for its administration. The ratio of students who needed themedical care was similar in both cities (10–15%). In Dayton, all schools had school nurses,
who had such specialized nursing knowledge:their medical knowledge and training levels are
similar to Japanese registered nurses. In contrast, in Osaka, medical care was provided bypeople who were at various levels of medical
training and knowledge.
The present data analysis has indicatedseveral problems: i) schools in Japan do nothave qualified medical personnel; ii) administration of medical care at schools is prohibitedin Japan under the current law; and iii) the concept of school health care has not yet been established in Japan. It is controversial that medical training of school personnel was given byguardians in Osaka. However, with the current
requirement of the training in Japan, this might
be a compromised solution.
The present study did not scrutinize howoften or what types of problems in medical careschools for the handicapped face; however, theobtained results at least raised questions about
the need for medical personnel who can safely
and professionally administer medical care forstudents at schools for the handicapped (Kondoet al., 1996).
The current law might warrant medicalcare at schools for the handicapped in Japan(Hayashi, 1993), and nursing professionals
might have a significant role in providing adequate medical care at the schools. Recommendations for the education program of school
nurses (American Nurses Association, 1995;Bachman, 1995) have emphasized: i) medical
aspects of physically handicapped children; ii)
developmental psychology; iii) education ofmentally retarded and physically handicappedchildren; iv) school nurse practice for mentally,physically handicapped children; and v) firstaid for the physically handicapped. Furthermore, the obtained facts offer some suggestions
for the school health system: that is, i) proposing a new law or system which allows school
nurses to perform medical care at schools; ii)
providing professional medical personnel toschools; iii) utilizing nurses as collaborators toprovide medical knowledge and techniques toguardians, school teachers and care givers; andiv) coordinating medical consultations andguidance.

References
1 American Nurses Association. 1995 Certification
catalog. Washington, DC: American Nurses
Credentialing Center. 1995:8–9.
2 Anderson JM. The changing role of school nurses:
one state’s experience. J Sch Nurs 1994; 10:22–26.
3 Bachman J. A university’s response to a need forschool nurse education. J Sch Nurs 1995;11:20–22, 24.
4 Funahashi M, Suzuki Y, Cho H, Kudo H, Ando H,Shikura K, et al. [A study on physically handicapped children needing routine medical care atschools.] No To Hattatsu 1990; 22:398–400 (inJapanese).
5 Hayashi H. [Nursing at home: some problems
concerning nursing in the aspect of labor laws.]
Jurisuto 1993;Suppl (Apr):134–145 (in Japanese).
6 Kanai K. The education of severely and profoundly multiply handicapped children: progressand problems in special school. Sogo Rihabiriteshon 1994;22:971–974 (in Japanese).
7 Kaneko M, Sato T, Suzuki E, Hirahara S, Muroi
C, Watanabe K, eds. Kyoiku Shoroppo. Tokyo:
Gakuyo Shobo, 1997:529–548.
8 Kitamura A. [On the education course of nurseteachers.] Kokoro No Kagaku 1995;64:59–66 (inJapanese).
9 Kondo N, Ogura A, Kawamura S, Tokuyama S,
Miyawaki I, Konishi N, et al. QOL and Nursing
care of a ventilator-assisted child at home. No To
Hattatsu 1996;28:225–230 (in Japanese with English Abstract).
10 Kuritani R. Medical care at schools for children
with physical handicaps. No To Hattatsu 1996;
28:220–224 (in Japanese with English Abstract).
11 Suzuki Y. [Medical care. I.] Minna No Negai
1993;303:62–67 (in Japanese).

(Received December 19, 1997, Accepted January 30, 1998)

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