Introduction of a Foreign Lecturer
in an International Nursing Curriculum in Japan
Yasunori Oka1,2), Oyunsuren Munkhjargal1,3), Norimi Takata2)
1) Center for Sleep Medicine, Ehime University Hospital2) Matsuyama School of Nursing, University of Human Environments3) Graduate School of Medicine, Ehime University

Abstract

nursing students (Miles, 2019; Cuellar, 2008), including
having a permanent foreign lecturer. Previously in ourA core goal of international nursing (IN) curricula isuniversity in Japan, all IN lectures were taught in Englishto help students gain an understanding of healthcareby a British nurse with the assistance of a Japanesesituations in foreign countries. Lectures by a local (e.g.,interpreter. However, it can be difficult to hire a native-a Japanese lecturer in Japan) may not be sufficient toEnglish-speaking lecturer for IN curriculum, and theimpart cultural diversity understanding, even with thestudents' ability to understand the contents of suchaid of audio-visual materials. To address this goal withlectures may be impeded by a language barrier. Someour IN students, we conducted a trial of bringing in aIN programs in Japan have pursued exchange programs

foreign lecturer to supplement our IN curriculum. Ourwith foreign institutions or visitation to facilities outside

aim was to employ a practical strategy to create a moreof Japan. In 2019, selected IN program students in ourinternational atmosphere. Nursing student participants

program visited Thailand with the aim of broadening

provided favorable responses to the trial and felt that thetheir perspective of IN. Although this activity was aforeign lecturer's contributions provider an enhancement

fruitful experience for the students (Minami, 2019),

that could not be met with textbook-based lectures. Given

subsequent trips have not been possible due to thepandemic-related travel uncertainty, it is unknown when

COVID-19 pandemic.

students will be able to travel abroad to communicate

Since April 2020, the IN curriculum in our programwith foreign nurses or when it will be feasible for guest

has been taught by two Japanese lecturers. To bringlecturers to commit to international plans. During thisreal-world international affairs into the lectures, current

period, the inclusion of accessible educational activities,

topics related to COVID-19 were included in our 2020

such as short lectures by foreigner residents andIN curriculum. The introduction of topical issues proved

connecting via video-chat software with healthcare

to be an effective way of attracting the attention of theprofessionals located in other countries may be used tonursing students (Oka, 2021). To further enhance INenhance IN education.

instruction and, hopefully, create a more international
atmosphere, we employed the practical strategy ofIntroduction

conducting a trial with an invited foreign lecturer who
supplemented the IN curriculum.

An important element of international nursing(IN) instruction is understanding how healthcare
circumstances vary across regions and countries.

Curriculum

However, it is usually difficult to teach this information

In most nursing degree programs in Japan, IN is taught

effectively through lectures alone, even with the aid of

by way of a series of about 15 lectures administeredaudio-visual materials. Efforts have been made to improveto students over one or two program years, though

global health experience and cultural competence amongsome programs have a specialized international nursing

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85

Yasunori Oka, Oyunsuren Munkhjargal, Norimi Takata

department. The Matsuyama School of Nursing at theTable 2. Topics covered by the foreign lecturer

University of Human Environments in Japan has an

Multicultural co-existence, foreign residents in Japan(Lecture 6)
Mental health in urban and nomadic people (Lecture 7)
Infectious disorders: COVID-19 (Lecture 8)
Non-communicable diseases in Mongolia (Lecture 9)
International cooperation between Mongolia and Japan(Lecture 12)

IN curriculum integrated within its four-year degree
program. During the first two program years, all students
attend fifteen 90-minute lectures. Selected students go
on to attend fifteen IN lectures in year three and eight
more lectures in year four. Currently, the IN lectures atMatsuyama School of Nursing are provided entirely by
the authors of this paper (NT and YO).
In the first term of 2021, fourteen third-year students
attended IN lectures. The contents of the IN curriculum
lectures for program year three are summarized in Table
1. The continued IN instruction for third-year students
included lectures combined with small group discussionsof the lecture topics.
Table 1. International nursing curriculum
Program year three
1. Practical issues in global nursing
2. Background in world health problems 1: Poverty andpeace keeping activity
3. Background in world health problems 2: Gender andfemale health problems
4. Background in world health problems 3: Population andaging
5. Background in world health problems 4: Child health andeducation
6. Background in world health problems 5: Cultural issues
and immigrants
7. World health problems 1: Mental health in developing
countries
8. World health problems 2: Infectious diseases
9. World health problems 3: Non-communicable diseases(NCDs)

Figure 1. Example lecture slides.
Example slides from lecture 7 (mental health, left) and lecture
9 (non-communicable diseases).

tongue, her English fluency was sufficient for lecturing
in English to nursing students. We asked the invited

10. International health activities 1: Environments

foreign lecturer to join the following five lectures (Table

11. International health activities 2: Foreign residents inJapan2), previously given solely by a local physician instructor

12. Human resources in international nursing 1: JICA andJOCV

Cultural issues and immigrants; lecture 7, World health13. Human resources in international nursing 2: Carrier
design8, World health problems 2: Infectious diseases; lecture(YO): lecture 6, Background in world health problems:problems 1: Mental health in developing countries; lecture

14. International collaboration 1: Maternity health andnursing education

9, World health problems 3: Non-communicable diseases

15. International collaboration 2: Working outside of Japannursing 1: Japan International Cooperation Agency (JICA)

JICA: Japan International Cooperation Agency
JOCV: Japan Overseas Cooperation Volunteers

Lectures by a foreign lecturer(NCDs); and lecture 12, Human resources in international
and Japan Overseas Cooperation Volunteers (JOCV).
Each of these co-administered lectures included twoparts. The first part covered background knowledge forthe topic based on the textbook and was given by theWe invited a Mongolian medical doctor who wasJapanese instructor. The foreign lecturer gave the second

working at a university in Ehime for her clinical training

part of each of these lectures, which consisted of aand doctoral research (OM) to serve as a foreign lecturer

10-minute talk in English that was related to the lecture

in our program. Although English was not her mothertopic (Figure 1). A PowerPoint® presentation consisting

86

大学教育実践ジャーナル 第21号 2022

Introduction of a Foreign Lecturer in an International Nursing Curriculum in JapanThe students' response sheet comments highlighted
the need to avoid prejudice against foreign patientswith psychiatric disorders and their hopes for a moresophisticated system that is adaptive to foreign patients.
In lecture 8 (Infectious diseases), the Japanese
instructor talked about three major infectious diseases
that remain a major problem in developing countries(AIDS, tuberculosis, and malaria) and provided a brief
update on COVID-19. The Mongolian lecturer talked
Figure 2. Lecture by an invited Mongolian doctor.

about COVID-19 transmission in Mongolia, which wasvery well controlled initially with a lockdown but thenworsened later in the pandemic, as had also occurred inof ten or so slides written in English was prepared formany other countries. Six students commented on theeach lecture. The content included explanations of theresponse sheet that they were impressed with the quick

experiences of the lecturer in Japan and in Mongolia

decision by the Mongolian government to lockdown at ain some cases, or medical information about Mongolia

very early stage of the pandemic.

germane to the lecture topic. She was instructed toIn lecture 9 (NCDs), the Japanese instructor told thetalk slowly in a simple English to facilitate the students'

students about the emerging problem of NCDs suchcomprehension. For each slide, the Japanese instructor

as obesity, diabetes, and hypertension in Japan. The

summarized the foreign lecturer's talk in Japanese toMongolian lecturer shared information regarding howfurther enhance the students' understanding (Figure

Mongolian people have started to develop more NCDs in2). After the lectures, the students were given therecent years. In their response sheet comments, students

opportunity to ask questions or make comments, andexpressed interest in the situation of traditionally nomadic

the Japanese lecturer was available for translation of thepeople who have been considered to be generally healthy

discussion as necessary.

developing NCDs due to lifestyle changes.

In lecture 6 (Cultural issues and immigrants), theFinally, in lecture 12 (International cooperation),Japanese instructor talked about immigrants to Japan,

the Japanese instructor showed several videos about

focusing on the burden of becoming ill in a foreign

JICA and JOCV activities in developing countries. Thecountry. The Mongolian lecturer talked about her

Mongolian lecturer talked about a Mongolian-Japaneseexperiences as a foreign resident in Japan, sharing hercooperative program focused on sleep education thatperspective on differences in lifestyle, food, weather,

was initiated by a Japanese lecture five years ago andand medical care between Mongolia and Japan. Nursing

led to a Mongolian lecturer's presentation in Japan on

students were quite interested in learning about thesleep medicine training and research. She told stories

Mongolian climate and were intrigued to learn thatabout the ongoing cooperation related to these lectures

winter temperatures in Mongolia can reach as low

and thus gave the nursing students a strong impression

as -40℃. On their post-lecture response sheets, thestudents made comments regarding gaining a better
understanding of the burden that foreign residents living
in Japan face and the difficulties people face consulting
hospitals in a place with another culture.
In lecture 7 (Mental health in developing countries),
the Japanese instructor presented the case of a patientwith a psychiatric disorder in a developing country
and discussed the burden of taking care of psychiatricdisorders in developing countries. Then the Mongolian
lecturer talked about emerging mental healthcare
problems, particularly with respect to the mental health

Figure 3. Online discussion connecting students withneeds of nomadic people moving into urban cities.

a Mongolian healthcare provider.

大学教育実践ジャーナル 第21号 202287Yasunori Oka, Oyunsuren Munkhjargal, Norimi Takata

differences, health issues remain a particularly serious
problem. She remarked that having professionals withknowledge of these issues would be very helpful toforeigners and that foreigners would benefit from moreinternationally informed health care service providers.

Discussion
Cultural diversity should be considered seriously in
IN curricula. Although integrated cultural competence
Figure 4. Group photo of the lecturers and students.

curricula have been introduced in Western countries,

Mongolian lecturer in a Mongolian traditional costume (backrow, 3rd person from left), Japanese lecturer (back row, 2nd
person from left), and the organizer of the lecture series (frontrow, 1st person on the right).

levels of achievement differ greatly from beginner
to expert and theoretical formulations about culture,
health, and nursing have yet to be addressed sufficiently(Brennan, 2008). Compared to Western countries withmulti-cultural societies, it may be more difficult forof the feasibility of international cooperation. In addition,

Japanese nursing students to feel and understand cultural

the Mongolian lecturer connected with a colleague indiversity while living in a Japanese community.

Mongolia via Zoom (Figure 3), and students were given

Exposure to foreign environments and people canthe opportunity to ask questions about Mongolia online

improve cultural understanding in nursing students. Forwith the assistance of the presenters for inter-translation

example, nursing students in ethnically diverse areas

among Mongolian, Japanese, and English. After lecture

tend to show greater interest in healthcare for foreign

12, a group photo of the students with the Japanese

residents, indicating the importance of contact experience

instructor and the Mongolian lecturer was taken (Figurein understanding ethnic diversity (Tanaka, 2018). Online4). Ten students commented on their response sheetstranscultural nursing courses meet the learning objectivethat they were pleased with the opportunity of havingof providing opportunities for a variety of students; andlectures from the Mongolian physician. Additionally, theysuccessful online learning experiences can contributecommented that they enjoyed having live communication

to the provision of culturally competent nursing carewith the lecturer's Mongolian colleague via Zoom.

(Adam, 2008). Learning from real world experiences mayThe Mongolian lecturer (OM) shared that she wasprovide a unique educational opportunity, especially in

impressed with the lecture series. Firstly, she felt thatrelation to international issues. Our aim in introducing a

the curriculum content was very educational for students

foreign lecturer into the teaching of IN curriculum was toin terms of addressing social problems, healthcare issues,produce as much opportunity as possible for the students

and possible solutions on an international level. She

to attend talks by a foreign resident who has herself

commented that she felt it would help the students toexperienced cultural disconnections.

see a broader perspective of IN, the field the students

Although we did not obtain statistical data inare preparing to practice in. Secondly, she indicated that

this educational trial, our IN students provided

she hoped that the introduction to her country and thefavorable responses to the trial. Despite most not fully

differences between Mongolia and Japan from her point

understanding the lectures in English, they were ableof view were interesting for the students, particularly

to feel the tone of the discussion without translation.

with respect to real-life experiences and the discussions

A majority of students used their free-responsethat were had about cultural differences. Thirdly, shecomment cards to express their being impressed withconsidered notable highlights of the curriculum to be

the supplemented lectures. Some students lauded thatthe consideration of foreign residents' experiences living

listening to the Mongolian lecturer's talk live provided

in Japan and the preparation provided for students toan experience that could not be matched by a textbook-interact with and help foreigners in their future jobs.

based lecture alone. Although there were some internet

While living in a foreign country can be associated withconnection glitches during the online discussion with themany challenges, such as language barriers and cultural

Mongolian colleague, the students seemed to enjoy the88

大学教育実践ジャーナル 第21号 2022

Introduction of a Foreign Lecturer in an International Nursing Curriculum in Japansession fully. The Mongolian lecturer was impressed byinternational nursing curriculum”, Journal of Faculty andthe lecture series and appreciated that communication

Staff Development in Higher Education 19:29-33

with nursing students enhanced her own understanding

Tanaka, J. (2018)“Interest in medical health care for foreignof differences in healthcare related issues between

residents among Japanese nursing students in areas ofMongolia and Japan.

varying ethnic diversity”, Nurse Education Today 65:41-45

Given the uncertainty regarding future COVID-19
travel protocols, it is unclear when students will be able
to travel abroad to communicate with foreign nurses
or welcome foreign lecturers to Japan. We welcomeda Mongolian doctor residing in Japan for this trial andfound that these efforts were a great augmentation to thelecture series. Although it may not always be possible
to invite medical professionals from abroad, foreign
residents may have some share-worthy experiences
and they may have endured some healthcare related
challenges. Communication with foreign people about
culture, nutrition, healthcare, and diseases may also
serve to enhance healthcare providers' understanding of
cultural diversity in health and medicine.

Conclusion
Inclusion of a foreign lecturer within an IN curriculum
had positive outcomes for the students as well as
the invited lecturer. Although a systematic approachto enhancing communication with foreign medical
professionals may be difficult to establish due to humanresource and funding limitations, international healthcare
education can be improved in small steps.

References
Adam, J. (2008)“Transcultural nursing courses online:
implications for culturally competent care”, Nursing Clinics
of North America 43(4):567-574
Brennan, A. (2008)“Student perceptions of cultural competence
content in the curriculum”, Journal of Professional Nursing
24(3):155-160
Cuellar N. (2008)“Cultural competence in the undergraduate
nursing curriculum”, Journal of Professional Nursing24(3):143-149
Miles, L. (2019)“The World Is Our Campus: Student
Satisfaction With an International Nursing Education
Partnership”, Nursing Education Perspectives 40(5):300-302
Minami, M. (2019) “Report on completing student's visit in
Thailand, country of smiles”, Journal of Nursing Science in
Human Life 2:40-45
Oka, Y. (2021)“Introduction of lectures on COVID-19 in

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