Factors related to interest in foreign perinatal culture and confidence in the care for foreign people among nurses and midwives working in Maternal Care Units: A pilot study
2025 年 9 巻 2 号 p. 11-19
詳細
2025 年 9 巻 2 号 p. 11-19
Purpose
This pilot study aimed to explore the levels and related factors of nurses' and midwives’ interest in “culture concerning pregnancy, childbirth, and childcare for foreign people,” and their confidence in “perinatal care for foreign parents.”
Methods
A paper-based self-administered questionnaire was used to conduct this cross-sectional study. It included 19 items on demographic data, interest and confidence levels, values, and needs when providing care. The levels ranged from 1 (not at all) to 7 (very much). Association between the two levels: interest and confidence, and related factors were analyzed using Spearman’s correlation coefficients (ρ) and the Mann-Whitney U-test. Free descriptions were coded and categorized using content analysis.
Results
One nurse and eight midwives completed the survey (response rate: 30.0%). The mean value of the interest level was 5.89 and the major related factors (effect size > 0.5) were years of nursing experience at maternal care units (ρ = 0.650, P = 0.058), length of stay abroad (ρ = 0.662, P = 0.052), opportunities to interact with foreign people outside work (r = 0.730, P = 0.028), and learning experiences of cross-cultural studies (r = 0.730, P = 0.028). The mean value of confidence level was 2.33 and the major related factors were highest educational degree (ρ = 0.637, P = 0.065), opportunities to interact with foreign people outside work (r = 0.606, P = 0.069), learning experience of cross-cultural studies (r = 0.606, P = 0.069), learning experience of perinatal care for foreign people (r = 0.535, P = 0.109), have overseas experiences (r = 0.507, P = 0.128). All the participants experienced difficulties in care, and all participants reported the language barrier. They considered language skills to be required to provide care with more confidence.
Conclusion
While nurses and midwives in this study have a strong interest in foreign perinatal culture, they have low confidence in providing care, which may affect their way of providing care. This study suggests a potential need for developing learning environments for care providers to provide appropriate perinatal care to foreign people in Japan.
In recent years, the number of foreign residents in Japan has increased (Immigration Service Agency, 2022). Although the number decreased from 2019 to 2021 due to the COVID-19 pandemic, it became the highest ever in June 2022 (Immigration Service Agency, 2021; Immigration Service Agency, 2022). According to National Institute of Population and Social Security Research (2023), the number of births in which both parents and/or one parent is a foreign national has remained approximately at around 35,000 since 2000. The percentage of newborns and children with foreign roots was about 1.3% in 1987 but has gradually increased to 4.4% in 2021 (National Institute of Population and Social Security Research, 2023). The number of foreign women experiencing pregnancy, childbirth, and childcare in Japan is on the increase.
Previous studies have identified anxiety about language barriers and cultural differences (Saito et al., 2018), financial problems, difficulties in understanding Japanese-style healthcare (Nishimura et al., 2021), the need to improve communication (Yoshimoto et al., 2021), cultural (Hara & Yanagisawa, 2020; Kawakami et al., 2020) and social (Suzuki, 2021) support, and understanding foreign people who experience pregnancy, childbirth, and childcare in Japan. When foreign pregnant women and postpartum mothers living in Japan have difficulties regarding pregnancy, childbirth, and childcare, many choose to consult with their family, friends, and communities formed by people from their country rather than Japanese medical professionals (Nishimura et al., 2021; Toda, 2019). Support from people close to them is essential; however, it is also necessary for foreign people in Japan to receive professional support to safely give birth and raise their children. The quality of perinatal care for foreign people can be improved if Japanese healthcare providers understand the culture of pregnancy, childbirth, and childcare of the care receiver’s country of origin and have confidence in care. The International Federation of Midwives (2018) states in its position statement that midwives should consider individual women’s cultural and social needs, even if they are not common in their countries.
However, no study has focused on the degree of interest and confidence in perinatal care for foreign people among nurses and midwives working in Japanese maternal care units. Additionally, factors related to the interest and confidence of such individuals remains unclear. Furthermore, what nurses and midwives value when providing care, what they find difficult during care for foreign individuals, and what they think is important for improving their confidence in care remain unknown.
This is a pilot study that aimed to explore the levels of nurses and midwives’ interest in “the culture concerning pregnancy, childbirth, and childcare for foreign people,” their confidence in “perinatal care for foreign parents,” and the related factors. Moreover, this study aimed to reveal the potential factors and situations related to difficulties in caring for foreign expectant and nursing parents (hereafter, clients) and what the care providers believe is necessary for ensuring confidence in care.
1. Design and participants
A paper-based self-administered questionnaire was used to conduct this cross-sectional study. Data were collected from a university hospital with 800 beds in Tokyo, Japan, which has a critical medical center and an International Medical Department, between August 2nd and 27th 2023. The inclusion criteria were nurses and midwives working in the maternal care units, with experience in providing perinatal care.
2. Data collection
Questionnaires and envelopes were distributed to the participants by a head nurse in the maternal care units involved. The collection bags were then placed at a nursing station. Participants were asked to fill out the paper, seal it in an envelope, and place it in the bag.
The questionnaire included the following 19 items: demographic data (age, position, highest educational degree, license, years of nursing experience and experience in maternal care units), number of experiences with clients, national origin of clients, experience of feeling difficulties in caring for clients, overseas experience, opportunities to interact with foreign people outside work, fluency in foreign languages, learning experience of cross-cultural studies, learning experience of perinatal care for clients, level of interest in foreign perinatal culture, level of confidence in perinatal care for clients, and what they think is important to improve their confidence in caring for clients. These items are based on two previous studies (Sugiura, 2003; Sakamoto & Iriyama, 2020). Free descriptions of nurses’ and midwives’ values and what they found difficult when providing care were also included. The two levels of interest and confidence were scaled from 1 (not at all) to 7 (very much).
3. Analysis
This was a pilot study, and the sample size was small. Therefore, in addition to the p-value, the effect size was considered. Missing values were considered as missing data. Spearman’s correlation coefficients (ρ) were used to analyze the association between the two ordinal scale variables: interest and confidence level, and ordinal and ratio scale variables. The Mann-Whitney U-test was used to analyze differences between the two independent groups. Items for which all participants had the same answers or only one participant gave a different response were excluded from the analysis. The effect size r was calculated using Z/√n. Z is calculated from the test statistics, and U from the mean and variance (Tomczak & Tomczak, 2014). Effect size ρ and r were regarded as small at .10, medium at .30, and large at .50 (Mizumoto & Takeuchi, 2010).
Content analysis was used to analyze free descriptions for the two questions, which were coded and categorized by their similarities. The numbers of answers by participants were counted.
4. Ethical considerations
This study was approved by the Ethics Committee of the Integrated Education Organization of the Institute of Science Tokyo (former Tokyo Medical and Dental University) (No.C2023-014). Research consent forms were distributed with the questionnaires. In the informed consent form, we described the significance and purpose of the research, methods, voluntary participation and freedom to withdraw, protection of personal information, and that since this was an anonymous survey, participants could not cancel after submitting the completed survey. We also explained that their answer would not be used for work evaluation, but would be used just for this study. No reward was provided for participation. If the participant decided to participate in the study, they checked the box “Agree” at the beginning of the questionnaire.
1. Characteristics of participants
One nurse and eight midwives completed the survey (response rate: 30.0%). None of them were excluded owing to high missing values. Average years of nursing experience were 7.46 ± 6.77 years, and eight participants had a bachelor’s or master’s degree (Table 1). All the participants had nursing experience with one or more clients. Five participants (55.6%) had overseas experiences. Two participants had opportunities to interact with foreign people outside work, and only one participant thought that she was good at some foreign languages. Six (66.7%) participants had learning experiences of perinatal care for foreign people, and 50% had studied by themselves.
Table 1 Participants’ characteristics
| Table 1 Participants’ characteristics N=9 | ||
|---|---|---|
|
Age (years old), n (%)
|
20~29 | 5 (55.6) |
| 30~39 | 2 (22.2) | |
| 40~49 | 2 (22.2) | |
| Position, n (%) | Head nurse, Vice head nurse, Chief nurse | 3 (33.3) |
| Member nurse | 6 (66.7) | |
|
Highest educational degree, n (%)
|
Master’s | 3 (33.3) |
| Bachelor’s | 5 (55.6) | |
| Diploma | 1 (11.1) | |
|
license※1, n (%)
|
Registered nurse | 9 (100) |
| Midwife | 8 (88.9) | |
| Public health nurse | 5 (55.6) | |
| Years of nursing experience | Average years ± SD | 7.46±6.77 |
| Range | 0.3-16.3 | |
| Years of nursing experience at maternal care units | Average years ± SD | 4.47 ± 4.15 |
| Range | 0.3-12.3 | |
| Nursing experiences for foreign patients or expectant and nursing parents, n (%) | 0~5 | 3 (42.9) n=7※2 |
| 6~10 | 2 (28.6) | |
| 11~ | 2 (28.6) | |
| National origin of foreign patients or expectant and nursing parents for which the participants have provided care※1, n (%) | China | 9 (100) |
| Korea | 7 (77.8) | |
| France | 5 (55.6) | |
| Vietnam | 5 (55.6) | |
| Philippines | 3 (33.3) | |
| Taiwan | 2 (22.2) | |
| India | 2 (22.2) | |
| Russia | 2 (22.2) | |
| Brazil | 2 (22.2) | |
| Afghanistan, United Kingdom, Mongolia, Chile, Italy, Nepal, Indonesia, Turkey, European※3, African※3 | 1 (11.1) each | |
| Have overseas experiences, n (%) | Yes | 5 (55.6) |
| No | 4 (44.4) | |
|
Purpose of the overseas travel※1, n (%)
|
Sightseeing | 5 (100) n=5※2 |
| Training | 2 (40.0) | |
| Oversea Support | 1 (20.0) | |
|
Length of stay abroad, n (%)
|
Less than a week | 2 (40.0) n=5※2 |
| More than a week, less than a month | 2 (40.0) | |
| More than a month, less than six months | 1 (20.0) | |
| Have opportunities to interact with foreign people outside work, n (%) | Yes | 2 (22.2) |
| No | 7 (77.8) | |
| Ways to interact with foreign people outside work※1, n (%) | e-mail/SNS | 2 (100) n=2※2 |
| Face-to-face | 1 (50.0) | |
| Online (Video call) | 1 (50.0) | |
| Have foreign language they are good at, n (%) | Yes | 1 (11.1) |
| No | 8 (88.9) | |
| The foreign language good at※1, n (%) | English | 1 (100) n=1※2 |
| Korean | 1 (100) | |
| Have learning experience of cross-cultural studies, n (%) | Yes | 2 (22.2) |
| No | 7 (77.8) | |
| Have learning experience of perinatal care for foreign people, n (%) | Yes | 6 (66.7) |
| No | 3 (33.3) | |
|
How they learned about perinatal care for foreign people※1, n (%)
|
Self-study | 3 (50.0) n=6※2 |
| Lectures and exercises for basic nursing education course | 1 (16.7) | |
| Teaching, lectures and workshops at the institution | 1 (16.7) | |
| Lectures for midwifery licensure program | 1 (16.7) | |
|
※1Multiple answers allowed. ※2There are missing values. ※3 They did not report specific countries but just reported broad areas. |
||
2. Level of interest and confidence
Table 2 shows the levels of interest and confidence and the correlation with each ordinal and ratio-level variable. The mean interest level of the nurses and midwives in this study was 5.89 and mean confidence level was 2.33. For interest, “years of nursing experience at maternal care units” (ρ = 0.650, P = 0.058) and “length of stay abroad” (ρ = 0.662, P = 0.052) had large effect sizes (> .50). For confidence, “highest educational degree” (ρ = 0.637, P = 0.065) had a large effect size.
Table 2 Level of interest in foreign perinatal culture and confidence in the care for foreign people and related factors
| Table 2 Level of interest in foreign perinatal culture and confidence in the care for foreign people and related factors (N=9) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| mean | median | Age | Position | Degree | Years of nursing experience | Years of nursing experience at maternal care units | Number of foreign patients provided care for n=7※ | Length of stay abroad | ||
| Level of interest in foreign pregnancy, childbirth, and childcare culture | 5.89 | 6 | ρ | 0.123 | -0.098 | 0.289 | 0.228 | 0.650 | 0.231 | 0.662 |
| P | 0.752 | 0.803 | 0.451 | 0.555 | 0.058 | 0.618 | 0.052 | |||
| Level of confidence in perinatal care for foreign people | 2.33 | 2 | ρ | 0.210 | 0.472 | 0.637 | 0.312 | 0.086 | -0.231 | 0.491 |
| P | 0.588 | 0.199 | 0.065 | 0.414 | 0.825 | 0.618 | 0.180 | |||
|
ρ:Spearman's correlation coefficients. All P values were larger than 0.05. ※There are missing values [Interest level] Do you have interest in foreign pregnancy, childbirth and childcare culture? [Confidence level] Do you have confidence in perinatal care for foreign people? |
||||||||||
| 1: Not at all 2: No 3: Not much 4: None of the other options 5: A little 6: Yes 7: Very much | ||||||||||
Table 3 presents the relationship between the two levels and each nominal variable. For interest, “have opportunities to interact with foreign people outside work” (r = 0.730, P = 0.028) and “have learning experience of cross-cultural studies” (r = 0.730, P = 0.028) had large effect sizes. For confidence, “have opportunities to interact with foreign people outside work” (r = 0.606, P = 0.069), “have learning experience of cross-cultural studies” (r = 0.606, P = 0.069), “have learning experience of perinatal care for foreign people” (r = 0.535, P = 0.109), and “have overseas experiences” (r = 0.507, P = 0.128) had large effect sizes.
Table3 Level of interest in foreign perinatal culture and confidence in the care for foreign people and related factors
| Table3 Level of interest in foreign perinatal culture and confidence in the care for foreign people and related factors (N=9) | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Level of interest | Level of confidence | ||||||||||
| n | Mean | SD | r | P | Mean | SD | r | P | |||
|
Public health nurse license
|
Yes | 5 | 5.60 | 0.490 | -0.393 | 0.239 | 2.00 | 1.095 | -0.254 | 0.447 | |
| No | 4 | 6.25 | 0.829 | 2.75 | 1.479 | ||||||
|
Have overseas experiences
|
Yes | 5 | 6.20 | 0.748 | 0.436 | 0.190 | 3.00 | 1.414 | 0.507 | 0.128 | |
| No | 4 | 5.50 | 0.500 | 1.50 | 0.500 | ||||||
| Have opportunities to interact with foreign people outside work | Yes | 2 | 7.00 | 0.000 | 0.730 | 0.028 | 4.00 | 1.000 | 0.606 | 0.069 | |
| No | 7 | 5.57 | 0.495 | 1.86 | 0.990 | ||||||
| Have learning experience of cross-cultural studies | Yes | 2 | 7.00 | 0.000 | 0.730 | 0.028 | 4.00 | 1.000 | 0.606 | 0.069 | |
| No | 7 | 5.57 | 0.495 | 1.86 | 0.990 | ||||||
| Have learning experience of perinatal care for foreign people | Yes | 6 | 6.00 | 0.816 | 0.184 | 0.581 | 2.83 | 1.344 | 0.535 | 0.109 | |
| No | 3 | 5.67 | 0.471 | 1.33 | 0.471 | ||||||
| Mann-Whiteny U test | |||||||||||
3. Difficulties in caring for clients
According to the answers to the questions regarding difficulties in caring for clients, all participants experienced some difficulties, and all participants (100%) selected the language barrier between clients. Six participants (66.7%) selected considering cultural and customary differences as difficult part in caring. Seven participants (77.6 %) selected teaching parenting skills in situations in which they experienced difficulties. Descriptions of medical procedures, care for anxiety reduction, common problems with mothers and newborn babies, breastfeeding care, and care during labor were selected by six participants (66.7%). Additionally, all participants (100%) believed that language skills were required to improve their confidence in care. Six participants (66.7%) answered that knowledge of pregnancy among foreigners, childbirth, and childcare culture was also important.
4. Nurses and midwives’ values and needs
What care providers think is important to keep in mind and try to actualize when dealing with clients are summarized in Table 4. 【】, “”, and [ ] represent categories, codes, and answers of the respondents, respectively. For nurses and midwives’ values, seven codes were retrieved and classified into three categories. The three codes were represented as 【Communication methods and attitude】. Respondents valued the “Attitude to convey essential information,” such as [Explaining the benefits of Japanese methods for a mother and a child] and [Providing information so that both mother and baby can have a safe delivery]. “Improving communication methods” by [using translation devices, easy Japanese and simple words] contributed to improving the quality of communication. “Attitude of listening to complaints,” in concrete, [An Attitude of trying to listen to complaints even if I cannot understand the language] was also valued. 【Consideration for cultural and personal values】, including “Consideration of cultural differences” and “Consideration of personal values” when dealing with clients were highlighted.【Careful support】, whereby “Providing proactive support” such as [Try to talk actively] and in an “Attitude of being close to the person” and ensuring that clients feel a sense of security were also considered as important.
The problems faced or likely to be faced in the future when dealing with clients are summarized in Table 5. Five codes were retrieved and classified into three categories. There were several codes regarding communication. Six participants “Experienced difficulty in communicating owing to the language barrier” and [Experienced difficulty communicating necessary information owing to language incomprehension] and [concerned about whether what they wanted to explain was being conveyed]. Moreover, they experienced difficulty in communicating, especially [when the patient was confused, such as during childbirth]. Additionally, four participants experienced “Decline in quality of care owing to communication difficulties.” For example, when a sudden change occurs, it is difficult to explain the situation instantly, and a pregnant woman might be left behind. Furthermore, there are “Limits of resource use for communication.” Respondents had difficulty understanding clients’ complaints [when the AI translator did not understand the message]. Although various efforts had been made to ensure effective communication, several problems remained unsolved.
Table 4 Things to keep in mind and try to do when dealing with foreign expectant and nursing parents
| Table 4 Things to keep in mind and try to do when dealing with foreign expectant and nursing parents | ||
|---|---|---|
| Category | Code | Individual answers |
| Communication methods and attitude |
Attitude to convey essential information
|
An attitude of trying to communicate even if I cannot understand the language |
| Whether essential information is being conveyed | ||
| Explain the benefits of Japanese methods for a mother and a child | ||
| Provide information so that both mother and baby can have a safe delivery | ||
| Improving communication methods | Use translation device | |
| Use easy Japanese | ||
| Use simple words | ||
| Attitude of listening to complaints | An attitude of trying to listen to complaints even if I cannot understand the language | |
| Consideration for cultural and personal values | Consideration of cultural differences | Whether special cultural considerations are required |
| Explain Japanese methods after understanding the differences in perinatal care depending on national culture | ||
| Respect the cultural differences | ||
| Consideration for personal values | Listen to what the person thinks is important | |
| Understand the culture and background of the person and provide care that respects the person's will and feelings as much as possible | ||
| Careful support | Providing proactive support | Try to talk actively |
| Empathize with the fact that pregnancy and childcare in a foreign country is an environment where there is little support, and it is difficult to seek support and let them know that they can rely on medical professionals without hesitation. | ||
| Attitude of being close to the person | Try to be considerate of the person’s feelings | |
| Try to be close to the person | ||
Table 5 Problems faced or likely to be faced in the future when dealing with foreign expectant and nursing parents
| Table 5 Problems faced or likely to be faced in the future when dealing with foreign expectant and nursing parents | ||
|---|---|---|
| Category | Code | Individual answers |
| Communication problems | Experienced difficulty communicating owing to language barrier | Experienced difficulty communicating the necessary information owing to language incomprehension |
| Concerned about whether what I wanted to explain was being conveyed | ||
| Thick language barrier | ||
| Language barrier (sometimes I don't know how much information is being communicated to the patient) | ||
| Dealing with the expectant and nursing mothers who don't understand both English and Japanese | ||
| Communication when the patient was confused, such as during childbirth | ||
| Decline in quality of care owing to communication difficulties | Mental care when the patient is confused, such as during childbirth | |
| Concerned about whether the way I speak is not rude | ||
| When a sudden change occurs, it is not possible to explain the situation instantly, and the pregnant woman is left behind | ||
| If neither our staff nor the pregnant women themselves understand technical terms, explanations, and care implementation will become inefficient | ||
| Limits of resource use for communication | When an AI translator doesn't understand a message | |
| Difficult to ask the International Medical Department for help on weekends and public holidays | ||
| Cultural concern | Dealing with cultural differences | Cultural differences (it tends to be Japanese-style childcare guidance) |
| Post-discharge support | Follow-up after discharge | Follow-up after discharge |
To the best of our knowledge, this is the first study to focus on levels of interest and confidence in foreign perinatal care, and related factors. While nurses and midwives in this study have strong interest in foreign perinatal culture, they have low confidence in providing care. The major influencing factors for both interest and confidence level were opportunities for international exchange and learning experiences in cross-cultural studies. It was also suggested that learning experiences about perinatal care for clients and overseas experiences could be related to confidence level. Language barrier may be a major cause of these difficulties for nurses as previous studies reported (Kondo et al., 2020; Kambayashi et al., 2020); however, the outcome cannot be generalized, which is a limitation in this study. The participants experienced difficulties in providing care in various situations from pregnancy to the postpartum period and sought to improve their language skills to provide care with more confidence.
Having strong interest in foreign perinatal culture but low confidence in providing care was similar to Kuwano et al.’s (2016) study that reported lower professional autonomy when nurses care for non-Japanese patients. Additionally, Meng & Hayashi (2021) reported that employee’s self-efficacy, which is described as an individual’s self-belief in accomplishing a task and the perception of the possibility that an individual can perform the required behavior in a given situation in a thoughtful way, is moderately correlated with an individual’s job performance. This can suggest that, while the nurses and midwives were eager to provide high-quality care to clients, they may not be able to provide the care they think is necessary to support clients due to their lack of confidence. Furthermore, there is a relatively strong positive correlation between the interest level and “years of nursing experience at maternal care units.” This suggests that experiencing actual care for clients at work may increase their interest in foreign perinatal culture. On the other hand, correlation between the confidence level and “years of nursing experience at maternal care units” was not indicated. The nursing experience for clients may decrease the participants’ confidence level, as Nonaka & Higuchi (2010) reported that Japanese nurses hesitate to provide care for foreign patients because of their past negative nursing experiences with foreign patients and their limited vocabulary, which made them lose confidence. Additionally, most of the participants in our study received education at universities or graduate schools, and “highest educational degree” had a relatively strong positive correlation with confidence levels. Moreover, some respondents thought that knowledge of foreign pregnancy, childbirth, and childcare cultures helped improve their confidence in care. The result was similar to Ishikawa’s (2018) study that reported professional knowledge and skills affect mid-career midwives’ confidence. However, in our study, only two participants received education about perinatal care for clients at educational institutions in basic nursing education and training course for midwives, whereas others supplemented their studies with postgraduate studies, such as self-study or training at their workplaces. Furthermore, international exchange, such as the experience of staying abroad or daily interaction with foreign people, was related to confidence levels. However, most of the stays were for a short period and sightseeing, which may not provide an opportunity to learn specific care for clients.
Communication is the greatest cause of anxiety for nurses caring for foreign people in Japan (Hasegawa et al., 2002). It has been found that language barriers have a variety of negative effects on patients (Oshimi, 2010). This study’s results show a tendency consistent with those of a previous study that mentioned “language and communication” as well as “culture and customs” as issues requiring improvement for Japanese nurses (Saito et al., 2018). Challenges related to providing information to prepare for emergencies and deliveries have also been reported (Yoshikawa et al., 2020). Nurses and midwives struggle to communicate important information in a respectful manner and stay safe. Communication difficulties become an obstacle to offering the highest-quality care, and language barriers may prevent Japanese nurses and midwives from exercising their skills. Therefore, having enough learning environments regarding foreign perinatal culture, caring for clients, and communicating in foreign languages when offering care, may help improve self-confidence among such healthcare providers.
Limitations
This pilot study cannot be generalized. To obtain meaningful results in future studies, it will be necessary to increase the sample size. For example, to examine the relationship between the learning experience of perinatal care for foreign people and confidence level, at least 134 participants are needed to obtain significant results by using the Wilcoxon-Mann-Whitney test for two groups with an effect size of 0.5, alpha error of 0.05, and power of 0.8. Since this study asked participants to respond about their confidence in their care, we believe that a social desirability bias may have occurred. Although we tried to decrease the bias by ensuring the anonymity of participants' responses and explaining this to them as well, it would be difficult to completely eliminate the bias.
Although nurses and midwives had a high level of interest in the culture concerning pregnancy, childbirth, and childcare for foreign people, their confidence in perinatal care for clients was low. The major influencing factors for both the interest and confidence levels were opportunities for international exchange and learning experiences in cross-cultural studies. Learning experiences about perinatal care for clients and overseas experiences could also be related to confidence level. Communication is the greatest challenge faced by a nurse and midwives in this study. The participants experienced difficulties in providing care in various situations from pregnancy to the postpartum period and sought to improve their language skills to provide care with more confidence. This study suggests a potential need for developing learning environments to improve self-confidence, which may improve the quality of care. Their confidence will help foreign residents become pregnant, give birth, and raise their children comfortably in Japan.
This study was conducted as a graduation thesis in Nursing Science, School of Health Care Science at Tokyo Medical and Dental University in 2023. This study was conducted using International Nursing Development’s field cost of the university.
The authors declare no conflicts of interest associated with this study.
Akiko Kondo and Nozomi Kagenishi equally contributed for conceptualization and design; data curation, formal analysis, and interpretation of data; drafting the work, revising the work, critically reviewed and approved the final manuscript. Natsuko Hiroyama helped conceptualization and design, critically reviewed and approved the final manuscript.
All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors, and all authors are in agreement with the manuscript.
