Yonago Acta medica 2008;51:89–94

Guided Discussion and Activities in Englishfor Future Health Professionals: Relationships between
Nursing and Community Design
Timothy L. Wiltshire, Tamiko Mogami*, Kevin M. Leyden† and Michio Maeta‡
Department of Fundamental Nursing and *Department of Clinical Psychology, School of HealthScience, Tottori University Faculty of Medicine, Yonago 683-8053 Japan, †Department of PoliticalScience, West Virginia University, Morgantown, WV 26505-6317 United States and ‡Director, Tottori
Prefecture Public Hospital, Kurayoshi 682-0804 Japan

Recent interest in community design has become evident in medical circles. Relationships
between a community’s design, its function, and citizens’ health are an increasing concern
for people who care about the quality of human life. Among these people, an influential
group is health professionals. They can play a great part in how a community can be constructed or (re)designed to afford better living conditions in society. To develop a sense of
the importance of involvement in community planning and clarify the health needs of citizens, and to rethink ideas about responsibilities of health professionals, medical education
should provide classes, seminars, lectures and activities to give students chances to explore possibilities of direct involvement for creating a healthy community. At the Tottori
University Faculty of Medicine, a seminar was held for 3rd-year nursing students andfaculty members on community development and design as related to health. The main
lecturer explained how trends in various diseases and increases in obesity in the UnitedStates are directly related to how communities are designed. Although the lecture was inEnglish, translation into Japanese was provided with a question-and-answer period at theend. In preparation for the lecture, students were given two questions on the relationshipbetween nursing and community design. As this lecture occurred at the end of the year,
further study could not be done. This paper presents ideas for giving future health professionals opportunities to explore a new direction. Class activities are outlined with anemphasis on English language teaching and learning techniques.
Key words: community, educational techniques, group discussion, neighborhood, teaching
methods, training activities

For a long while in the United States, health officials have become increasingly concerned about
the health problems of Americans. These problems take on many forms but one of the greatest
concerns facing Americans now is obesity. The
fact that obesity is the cause of other severe healthproblems is common knowledge. Recently, theratio of overweight people has grown dramatically revealing that people are in greater dangerof various health problems such as heart disease
and hypertension. Of course, weight problems
can partly be attributed to food. There are various theories as to why people become overweight,
i.e. from bad eating habits, but it is clear that fatty

Abbreviations: EFL, English as a Foreign Language; ESP-M, English for Special Purposes – Medicine

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foods, overeating and lack of nutrients play a largepart in this trend. It’s also evident that obesity is
not an isolated problem, not one which is unrelated to other sources of trouble, but pervasive andconnected to so many other factors which contribute to lifestyle. Lack of proper physical activity is
one of these factors. It’s true that anyone can run
down to the gym once or twice a week to workout. But if communities were organized in sucha way as to allow people natural opportunities toget enough exercise (walking, for example) would
going to the gym be necessary at all? Some researchers have suggested that the very organization of society plays a big part in why people do
not exercise. They claim that because society has
spread out into urban areas, and has basically become a “car” culture, that people have less need
to walk and must depend on their own transport.
Not only have people become less active, but theirrelationships to their neighbors, the closeness ofthe neighborhood when people knew each otherwell and supported each other in need is becoming a thing of the past. This isolation can also
contribute to feelings of loneliness, separation anddepression. Along with a lack of responsibility
toward the community comes the impersonalityof dealing with each other as “objects”, and in thisway we may suffer even further.
Of course, all citizens share some responsibility for how their community will be shaped
and how it will function. In the various areas ofsociety, education, business, agriculture, government, etc., people can take a part in creating anice environment for themselves, their neighbors
and their children. As health plays a major partin the proper functioning of any community, theresponsibility of how healthy a community is lies
partly in the hands of health professionals. So, it
is important to educate future health professionals
and provide them with the skills to tackle healthproblems not only on an individual scale (with patients) but on a wider scale (for the community).
In Japan, where many of the problems theUnited States and other countries face have notyet become fully developed, offering students
the opportunity to discuss health problems on acommunity level may be just in time. Asian communities, and specifically those in Japan, havedeveloped differently than those in America, sourbanization as it occurs in Japan, while creating
similar problems to the United States, may cause
the development of other as yet unseen dangers.
These need to be thought out and discussed forpossible solutions and one of the best places tostart doing this is in the schools.

Participants and Teaching Methods
Ninety-three 3rd-year nursing students and 7
instructors from the School of Health Science,
Faculty of Medicine at Tottori University attended
a lecture on community design and development
by an American professor. Dr. Kevin M. Leyden
spoke for an hour using a PowerPoint presentationand translation assistance by Dr. Tamiko Mogami.
The lecture focused on urbanization in the
United States and Dr. Leyden explained how thishas been a large part of the reason for current
common health problems: high blood pressure,heart disease, diabetes, obesity, various mental
disturbances and so on. But on a positive notehe has said that “[a] growing number of researchers agree that social networks and community
involvement have positive health consequences.
Persons who are socially engaged with others andactively involved in their communities tend to live
longer and be healthier physically and mentally”(Leyden, 2003). The problem is that if communities are allowed to urbanize and expand intolarger impersonal living arrangements, the needfor more automobiles and thus the slow decline ofphysical activity in terms of walking, riding bicycles and so on will occur (Leyden, 2003). Also,a wider, spread-out community where the housing
is pre-fabricated and built quickly to accommodate those who are basically long-distance commuters and their families, thus creating so-called“bedroom communities”, will greatly increase thechances of neighbors being strangers to each otherand this can lead to a decline in basic community
values and family-oriented life in general (Leyden,90

Discussion for nurses on community design2001). This sort of arrangement can lead to alienation and isolation which can thus lead to mental
instability. Dr. Leyden then showed possible solutions to the problems of urbanization by offering a
new look at what a healthy community should be– more neighborhood oriented facilities, smaller
shops and stores within walking range, more trees
and parks in local areas, bike and walking paths,
long term community arrangements where families will want to stay for a number of years andpossibly even pass the house on to future generations, etc. This should not be seen as an blind
regression into the past but a rethinking of pastvalues, accepting the good parts and applying
them to newly designed areas where people canlead healthy lives.
Previous to the lecture, the students weregiven two questions to answer about community
design and health. The main goal of offering thestudents these questions was to help them become
familiar with the term “community design” as a
new concept in relation to health. Through somediscussion in class, it was fairly clear that few ofthe students had any experience in the field, manyof them unfamiliar with the term “community design” even in Japanese (machi-zukuri). It was also
clear that most of them had no idea how to answer
the questions posed to them: i) What do you
think the relationship of nursing to community development is? and ii) What role does nursing playin the planning of a community? Most answers
for both questions were short and to the point.
And although no great answers were expected outof the students, all of them answered positively– they all saw the relationship as something interesting and necessary. But some answers showedthat a portion of the students misunderstood thequestion. A few students said that they would liketo be community nurses in the future but gave noreal explanation. Some said that nurses played
a great part in the community but gave no details. On the other hand, many of them generally
stated that because nurses know about the healthof patients intimately, they know the factors thatwould create a good life for citizens and that theyshould play a large part in planning. Incidentally,

although the nursing course is considered a special course under English for Special Purposes –Medicine (ESP-M) the techniques described hereand used in the class follow basic EFL (English asa Foreign Language) theory.
Unfortunately, as this lecture was held on thefinal class of the year, further study on the issuesof community design could not be realized. Butfor future reference, we would like to offer someideas for class discussion through group work in
English classes. These ideas can be applied to
any course in nursing or other medical fields but
we felt that because English can be taught througha variety of contexts, the freedom to experiment
without harm to the education of future healthprofessionals (nurses) could be done more easily.
Medical English courses focusing on conversation
often use group work and guided discussion ascommon techniques for teaching intermediate toadvanced level English. With group work, someindividual activity in the form of preparation may
be necessary through the internet in English and/or Japanese (although the attempted output will
be in English).
Initially, students need to be prepped on
the goals of their discussions. One good way to
do this is to have them observe, think about andbrainstorm the good and bad effects of community on health. Questions like, “What do you seein the community that may be good or bad for
citizens’ health?” “Is there anything that is notreadily apparent which may affect the health ofpeople in a community?” Students should makea list as they recognize or imagine these factors.
This can be done individually or in groups.
Then, in group meetings, students can present their ideas and compare them with each other,adding, modifying and strengthening their pointsof view. Once this is done, students can then select some of the most important health problems
that exist in communities related either to poor
design or activities such as pollution from factories or noise pollution from airports and traffic
which can have a real direct affect on people.
From here, a number of group activities can be
imagined: role plays, presentations using Power91

T. L. Wiltshire et al.

Point, debates, etc. Of course, the output of these
activities will be in English although the moredifficult parts of discussion, preparation and writing may be in Japanese. Also, the focus of every
activity will involve the students’ viewpoints as
nurses. Generally, questions like “How would anurse think about this?”, “What would a nurse door how would a nurse act in this situation?” should
be kept in mind the entire time the discussion oractivity is occurring.
Following are two outlines of possible roleplays that students can perform. One involves theparticipation of nurses in a town council session
where the discussion will focus on health in thecommunity and the effect of heavy traffic on citizens. In a role play like this, long range and shortrange ideas should be considered. Another roleplay centers around a family sitting around thedinner table, the father complaining about driving
20 km to work and the mother worrying about thechildren walking to school on heavily trafficked
roads where there are no sidewalks.
It’s obvious that the possibilities for considering nursing influence in community design are
open ended. The problem for the teacher is tomake sure students keep the project on track as
this is a short term project (2 or 3 classes). Students should be encouraged to use English for
speaking as much as possible but if struggling
to speak in English causes the discussion to bog
down Japanese can be used. Above all, students
should enjoy learning about a new field and new
possibilities in nursing and have fun pushingthemselves to speak a few useful English phrases
whenever possible.

course of teaching medical vocabulary, grammar
for writing, reading, listening and speaking alongwith some cultural information, students canparticipate in some specially designed projects
which can help them to realize goals set up by theteacher. In cases like these, the teacher will nothave a strict agenda and will allow the students tofind their own answers to the problems set beforethem and encourage them toward a rather flexiblegoal. Goal setting and realization can even become part of the lesson plan. In the case of community design, students should learn what goals
are important to consider and work out the details
to achieve those goals. Of course, the main goalof nursing is to assist in creating a healthy community and a healthy society. So, basically thestudents will have to ask what makes a healthysociety and what is “unhealthy”. From this, theyshould be encouraged to continue asking questions which lead them to discover for themselves
how they can help their communities at large.
One of the focuses on considering the community
at large will be to look at how medical professionals (nurses) can get involved in community design
while keeping health concerns of citizens in mind.

Acknowledgments: As the main author, I would liketo thank co-authors Dr. Michio Maeta and Dr. Kevin
Leyden for making this paper possible. Also and mostimportantly, I would like to thank Dr. Tamiko Mogami
for doing an excellent translation during the lecture.
Without her expertise, the students and those not sofamiliar with English would have been completely lost.
Finally, to the graduating nursing class of 2008–09:“Thanks and good luck in the future.”Discussion

References

As most medical education courses are specialized, it is difficult to include lessons on community design unless the course is specificallytailored for it. For this reason, English courses
can be used part of the time to present content inEnglish on social (that is, health) problems alongwith usual language skill development. In the1 Leyden KM, Michelbach P. Democracy and neighborly communities: some theoretical considerations
on the built environment. In: Hass T, ed. New urbanism and beyond. New York and London: Rizzoli
Publishers; 2008.
2 Leyden KM. Social capital and the built environment: the importance of walkable neighborhoods.
Am J Pub Health 2003;93:1546–1551.
3 Leyden KM. The health consequences of Irish

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4sprawl and car dependency. In: The Irish Times(newspaper). May 3, 2003.
Leyden KM. Urban sprawl not the social way. In:The Irish Times (newspaper). May 8, 2001.

Received July 3, 2008; accepted August 5, 2008
Corresponding author: T. L. Wiltshire[Appendix]
Discussion Guide for Nursing Students Interested inCommunity Design
Make groups of 4 or 5 people. One person can be the representative of the group and consolidate all ideas of the group into a summarized text.
When discussing, you need some words and phrases to help you speak in English.
General words and phrases
What do you think?
I think so (too). I agree.
I don’t think so (either). I don’t agree. I disagree.
Why do you think so? Please explain.
Why don’t you think so? Please explain.
That’s interesting.
Wow.
Really?
That’s hard to believe.
I don’t believe that.
Thank you.
You’re welcome.
Vocabulary and information
Do you have a (new/another) vocabulary word? What (new) vocabulary word do you
have/did you find?
What’s your vocabulary word? How do you spell it?
What does it mean? (Can you translate it to Japanese? Can you explain it in English?)
What did you find on the internet?
Can you share (some of) your ideas with us/me?

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Specific questions
What is community development? What is community design?
What should life in a community be like? What is the best (healthiest) way to live?
Why have so many people grown overweight? Why are so many people getting overweight?
Is this a big problem in Japan? What is a big health problem in Japan?
Why are people not more active socially?
Why don’t people get more exercise?
Is there such a thing as a community development nurse? What would be the qualities
of such a person?
What other considerations on a social-wide scale would be important concerning health?
(Not only community design but Police relationship, types of food available,
Write your own questions, either more specific or general, and phrases on the back ofthis paper.

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