Nurses ’ Training and Medical Care Management at Juntendo University Hospital : Perspective of a South Korean Nurse Team

Here I report my observations and assessments following two weeks of training at Juntendo University, including stints at the main hospital, the Tokyo Koto Geriatric Medical Center, and Shizuoka Hospital with its associated Faculty of Health Science and Nursing. I focus on three facets: work division and specification of duties, coordination both multidisciplinary and multi-facility to achieve state-of-the-art treatment, and finally, exemplary nurse training programs. All three facets combine to ensure that patients receive the highest level of care from thoroughly trained and motivated health care professionals who are dedicated to serving patientsʼ medical needs while deeply respecting individual dignity.


First week: Juntendo University Hospital
Juntendo University Hospital lies in Ochanomizu at the center of Tokyo.On the first day, the head of Nursing, Noriko Terunuma, carefully explained our training program schedule and its purpose: to experience special nursing and other activities at the hospital .
She went on to explain the philosophy guiding the nurses, the education system and human resources management.Most impressive to me was the use of their"Penguin system"for training new nurses.A preceptor, senior nurses, colleagues, trainers and department heads are all part of the system, which helps new nurses adapt to working in the hospital system and managing their responsibilities with greater ease.While Konyang University also uses a preceptor system, it is not as elaborate and comprehensive as the Penguin system.
Within the hospital, several measures are in place to curb the spread of infections.Upon patient discharge, the patientʼs mattress must be replaced with one that has been washed.Patient rooms are equipped with radiant air flow ventilation systems (RAFV) and an infection control kit that includes a mask, apron, gloves, and hand sanitizer, etc.This kit is provided both at the room entrance and by each bed, and is available to anyone at any time.
The Stoma Clinic provides outpatient care and systematic education to those who live with colonoscopies, ileostomies or urostomies.The care provided there proceeded very smoothly.
The operating rooms we visited were very tidy and neat.Furthermore, their management was very sensible and effective.
Other aspects were also as one would expect from a modern well-run hospital.As viewed from the emergency room entrances, the structure and workspaces were very efficient, allowing patients to be cared for more effectively.In every aspect I observed, patient safety was given priority.The hospital wards were highly conducive to learning basic nursing, and all equipment was well-pre-pared.Lastly, all vital facilities were well-equipped and maintained, and such items as UDS (unit dose system) and PDAs (personal digital assistants) were in use.The only difference from Konyang University Hospital was that anesthesiology nursing staff were not organizationally separate from other nursing staff.

Second week: Juntendo Tokyo Koto Geriatric Medical Center
After concluding my week at Juntendo Univer-sityʼs main hospital at Tokyoʼs Ochanomizu, I spent the next four days at the universityʼ s Geriatric Medical Center in Koto Ward, which is on the eastern edge of Tokyo, near Chiba Prefecture.The purpose of this training was to experience actual medical elderly care, special nursing and other activities (Table -2).
At this center, I was able to observe the general ward, the dementia ward, the high-care ward, the outpatient ward, and the facility complex.Here, the bright smiles of the nurses taking care of the dementia patients and their families remains my most vivid memory.Moreover, the programs for dementia were quite impressive.The visiting care and dementia centers provide critical support for the local community, and are jointly administered with local government.I was able to observe these in operation, and was impressed that the hospital seemed actively engaged in resolving the problems of the elderly.On the final day of training, I visited Juntendo University School of Medicineʼs Shizuoka Hospital and the Faculty of Health Science and Nursing.Shizuoka Prefecture lies between the Tokyo-Yokohama metropolitan region and Nagoya, Japanʼ s fourth most populous urban area.The prefecture itself is largely mountainous with many small remote towns and villages as one moves inland from the coast.Thus providing rapid access to emergency hospital care to such residents is a major challenge.
Appropriately, emergency care is a major focus of the hospital, with a helicopter (doctor-heli) ferrying doctors out to patients and then bringing them back to the hospital 3 to 9 times a day.There is also an exclusive intensive care unit and a hospital ward for emergencies.These wellequipped systems allow the hospitalization process to proceed as quickly as possible.
The NICU has a robust medical team and provides emergency care only for newborn babies.It serves the needs of the local population by successfully treating newborns that require special care and monitoring.
We also toured a laboratory and lecture rooms in the Faculty of Health Science and Nursing.The laboratory was arranged neatly, and I was much impressed that the equipment and facilities were so well-maintained as to look new.In fact, we were informed that the students and professors clean and manage everything together, a detail that illus-trates how well-organized the Juntendo education systems are.

Conclusion
My take-home lessons from two weeks of training and observation at Juntendo University affiliated hospitals and medical centers can be divided into three areas: (i) division and specialization of responsibilities, (ii) facilities management, teamwork and professional morale, and (iii) the unsurpassed level of nursesʼ training at Juntendo.Juntendo University Hospital is very clear in defining the duties of its employees, and work is subdivided and specialized.Stated more concretely, medical doctors focus on treating their patients, nurses focus on taking care of their patients, pharmacists focus on managing medicines in the hospital using the UDS system, all medical equipment is managed by the medical engineering team, clinical engineers handle machines in the dialysis center and Central Supply Room (CSR) instruments used in surgery, and the sterilization of instruments used in the hospital is handled by an external company.The nurses in each department focus only on patient care, because they have administrative assistants who manage visitor paperwork.Moreover, even when a patient is admitted late at night, the staff members do not hesitate or complain, but rather treat their patients with professionalism.Juntendo University Hospitals are well-managed and well-equipped.Six affiliated hospitals including the main hospital in central Tokyo collaborate and share information as well as the latest medical technology and expertise with each other.At the same time, the healthcare system has been set up very professionally so as to deny outside access and safeguard patient confidentiality.
In addition, the specialization of duties mentioned above was complemented by excellent communication.I observed many examples of successful multidisciplinary care, including palliative care.I was deeply impressed with how happy the team of doctors, nurses, pharmacists and psychological staff were to take care of their patients.Furthermore, visitors can gain access only through a strict security system, providing a safe and pleasant environment for both patients and staff.Finally, Juntendo is unsurpassed as a training hospital.With a 119-year history in nursing, the Juntendo education system nurtures and trains nurses while emphasizing the human aspects of their profession.The key concepts in this training are "Fudan Zenshin" (continuously moving forward) and the spirit of"Jin"(benevolence). Programs include Certified Nurse, the Penguins System, and Nurse Empowerment programs for management of new nurses.Juntendoʼ s healthcare professionals take special pride in their history, and constantly strive for professionalism, humility and sincerity.I think that their love, commitment, and sense of responsibility toward the patients have made Juntendo University Hospital a success.One can see the medical staff and doctors kneeling down on the floor just to maintain eye contact and pay attention to the patients while they are talking.If I were a patient, this preservation of dignity and respect would draw me to this hospital.
In the future, I hope for more opportunities to return to the quiet and cleanliness of Japan, especially Juntendo Hospital.

Table - 1
Training schedule in Juntendo University Hospita

Table - 2
Training schedule in Juntendo Tokyo Koto Geriatric Medical Center, Shizuoka Hospital and Faculty of Health Science and Nursing