Results from participants
Among 870 nurses, 513 (59%) returned the questionnaire. The 513 nurses were employed at 350 hospitals in eight prefectures in Japan: Hiroshima (152), Hyogo (117), Hokkaido (106), Chiba (37), Nagano (35), Kyoto (27), Aichi (26) and Osaka (13). All nurses were of Japanese ethnicity, and none had taken a course on international culture or global health as part of their education. Table 1 shows the mode of nurse age was 40 to 49 years (range 20–59). Most the nurses were female (91.6%, 470). Their profession was mainly Registered Nurse (99.8%, 477), with the lone exception being one Licensed Practical Nurse. For educational background, most had a three-year nursing school diploma (93.1%, 450). The average duration of work experience was 20.4 years (SD 5.6), and the majority of the nurses served as either a unit chief or deputy chief (82.3%, 413).
Of the respondents, many (92.3%, 469) had experience taking care of overseas visitors, mainly at inpatient units (83.2%, 427). They responded to whether their hospitals are prepared to take care of overseas visitors: Yes (32.8%, 167), No (42.6%, 217) and Do not know (24.6%, 125).
Results from open-ended questions
Question 1: The response rate was 513 (100%), comprising a total of 7420 words and 1651 sentences. Question 2: The response rate was 513 (100%), comprising a total of 2551 words and 760 sentences.
Question 1: Responsibility for taking care of overseas visitors
Word frequency analysis (Figure 1)
The four words the nurses mentioned most frequently concerning the care of overseas visitors at their hospitals were: languages (kotoba) mentioned 252 times, worry (sinpai) 170 times, understanding (rikai) 142 times, and differencechigai) 135 times.
Other words mentioned by the nurses, as assessed with word frequency analysis (Figure 3)
The nurses also mentioned the following words: bring word (tutaeru)14 times, relate (kankeisuru) 12 times, contactfureai)12 times, understanding (rikai) 7 times, and not charge (motomenai) 2 times. These five words emerged from the 7420 total words as having importance when caring for overseas visitors.
Positive/negative viewpoints from the reputation analysis (Figure 4)
The nurses mentioned only three words having a negative connotation, namely emotion (kanjo),, pain (itami),, and feeling, compared with eight words having a positive connotation.
Word relationship network and through co-occurrence (Figure 5)
The nurses’ concerns were analyzed using word relationship networks and through co-occurrence. The size of each circle or oval in Figure 5 indicates words mentioned at greater frequency pertaining to language (kotoba) and communication (komyunikasion).. The thickness of each line indicates the strength of the relationship with the words and each other.
The concerns could be classified into six groups that were denoted by letters: (A) language (kotoba),, (B) communication (komyunikasion),, (C) people (hitobito),, (D) Japanese (nihongo),, (E) anxious (sinpai),, and (F) difference (chigai).. In Group A, language was related to several other words (very thick lines in Figure 5) and had a large frequency for the words “not understand” (rikaidekinai),, “important” (taisetu),, “inpatient” (nyuin-kanjya),, and “good” (yoi).. Many other words also were classified in Group A. For Group B, communication was related to “cannot do” (dekinai),, “can do” (dekiru), “proficiency” (umai),, “language” (kotoba),, “conversation” (kaiwa) and “self” (honnin).. In Group C, the concept people, was related to “exist” (iru) and “interpreting” (tuyaku).. In Group D, the word Japanese was related to “can speak” (hanasu-dekiru).. In Group E, anxious was related to “transmitted” (tutawaru).. In Group F, difference was related to “culture” (bunka) and “trouble” (toraburu)..
Correspondence analysis by preparation (Figure 6)
The largest circle shown in Figure 6 was language (kotoba),, whichwas almost the same distance from “prepare-yes“, “prepare-no”, and “prepare-unknown”. The words “communication” (komunikesion) and “problem” (mondai) were at almost similar distances from prepare-yes, and prepare-no in two squares. The response “prepare-yes” was closely related to “difference”chigai),, “culture”bunka),, “life style”lifu-stail) and “explain” (hyogen). The word “Japanese” (nihongo) was closely related to “prepare-no” as well as to “interpreting”tuyaku),, “anxiety” (sinpai),, “no understanding (wakaranai)”"and “need (youkyu)”.“. The nurses who answered that they did not know if their hospitals were prepared for non-Japanese patients were close in distance from the word “concern” (sinpai)..
Question 2: Preparations for taking care of overseas visitors
Word frequency analysis for preparedness (Figure 2)
Accordingly, “speak-staff” (hanasu-sutafu) was, for both “prepare-yes” and “prepare-no”, a strong key element. The top five words from nurses whose hospitals had prepared for overseas visitors were: “speak staff” (hanasu-sutafu),, “English” (eigo),, “interpreting” (tuyaku),, “foreign language” (gaikokugo),, and “language” (kotoba)..
Results from closed-ended questions
Descriptive statistics analysis
The results for each item of Mari Meter are presented in terms of a percentage in a bar graph with descriptive statistics in all nurses (Figure 7). On average, 80% of nurses responded as very concerned or somewhat concerned. Of the 15 items for concerned, the top 5 terms were: language communication, informed consent, payment of medical expenses, lifestyle difference, and dealing with medical staff. The reliability of the 15 multi-item questions of Mari Meter was confirmed by calculating Cronbach’s alpha, which was 0.82.
Results from our Text Mining analyses found that those nurses from hospitals that had preparations for foreign patients were more concerned about the patients’ cultural background. On the other hand, nurses whose hospitals had no preparation for foreign patients were concerned about language. In categorical logistic regression, we aim for the analysis to predict the nurses in the “yes” or “no” for preparation at their hospitals to take care of foreigners, as a concerning factor of Mari Meter questionnaire. The following hypotheses were set.
H0: There is no relationship between having or not having preparation to take care of foreigners and Mari Meter.
H1: There is relationship between having or not having preparation to take care of foreigners and Mari Meter.
Results showed a relationship between “yes” and “no” to take care of foreign patients with all 15 items of significance; lifestyle difference, emergency care and protection of privacy (p < 0.001) which were more concern the nurses who had preparation to take care of foreigners at their hospitals (Table 2). The nurses whose hospital made preparations were more concerned about the patients’ backgrounds. By contrast, the nurses who did not make preparation to take care of foreign patients had a greater concern about other 12 items significantly (p < 0.001). The nurses who did not make preparations to take care of foreign patients most two concerns were language communication and informed consent.