Like the United States, Japan has a highly skilled nursing force and the rich industrial resources that are indicative of a strong economy. This summer St. Luke’s International University in Tokyo sought assistance from faculty from the School of Nursing as they launched Japan’s first Doctor of Nursing Practice program to help them better leverage those resources for the benefit of the entire country.
SeonAe Yeo, PhD, professor, and Mark Toles, PhD, assistant professor, traveled to Tokyo in mid-June to visit the new DNP program, now instructing its second cohort of 10 students, to teach them the research approaches and implementation science they can use to improve their own hospitals and clinics. In that time, they taught three DNP courses, presented a faculty-developed seminar and consulted at a faculty meeting, and they met with 32 groups of faculty and students for one-on-one conferences.
“Last year, in 2017, I went to Japan to help start the first cohort, and these were the very first DPN students in Japan,” says Yeo.
Yeo’s collaboration with St. Luke’s began more than five years ago as Yeo wanted to find a unique way to impact her beloved home country of Japan and Carolina, where she has been on faculty for 11 years, and see if they could have an impact on one another. 2016 brought a more formal collaboration as St. Luke’s asked Yeo to develop a formal curriculum for a new DNP program. School of Nursing Professor Emerita Donna Havens, PhD, and Jennifer D’Auria, PhD, an associate professor and assistant dean in the MSN/DNP division, shared the curriculum from the school’s own DNP program as guide.
St. Luke’s is the premier nursing school in Japan, established in 1920 by an American missionary, Dr. Rudolf Bolling Teusler, who appointed Alice C. St. John, an American nurse, to produce skilled nurses.
“St. Luke’s has been collaborative from the very beginning, so I wanted to make this a very real collaboration on the school level instead of one I did on my own,” says Yeo.
For this summer’s trip, where Yeo planned to evaluate the progress of the first cohort and welcome the second, Yeo asked her colleague, Mark Toles, to join her. He brought to St. Luke’s program a course on research approaches and methods of implementation science, which is the science of strategically applying solutions to solve problems in health care, particularly to improve the health of a particular population of a hospital, clinic or other demographics.
“I wanted to bring them much more than information. Mark has had unique experiences implementing change in diverse healthcare settings and knows what will work. With the two of us in Tokyo, Mark could lead the second cohort as I evaluated the success of those who had entered the previous year, and we could work on really teaching research approaches,” says Yeo. “The lessons we learn as we do this will help us refine what we teach. It’s more than guiding them – this isn’t a mutual partnership if we can’t learn from them.”
Japan is highly technologically advanced, rich with new ideas, and incredibly inventive in multiple domains. Thus, it was no surprise that faculty leaders at St Luke’s sought new ways to prepare nurses for translating innovations into clinical practice. Many American ideas about quality improvement processes originated in Japan – the Japanese word kaizen being the origin for our term “continuous quality improvement.” In Japan, Yeo and Toles taught a new synthesis of kaizen and implementation science, with the goal of preparing new DNP trainees to become health care leaders in their communities.
Toles says the DNP program is specifically focused on how to move innovation into practice, into their hospitals and community-based settings. “A doctorly trained work force will give them the capacity for change; for example, to increase assessments of depression in senior centers, to retain new nurses and reduce staff turnover in hospitals, and to support patients as they undergo courses of chemotherapy.” The students weren’t the only ones who wanted to learn the evidence based intervention and implementation methods necessary for an impactful DNP program – many of the faculty advisors weren’t familiar with the DNP degree or with implementation science, but they were enthusiastic about learning. Toles and Yeo met with all the DNP students individually and again with their advisors. In order to master the concepts, faculty members were encouraged to audit courses with their students.
“All students in the program are working nurses with at least three years of master’s-level clinical experience. Maintaining full-time employment is a requirement of the program, because clinical problems at students’ work sites dictate the learning process in their courses,” says Yeo. “They are serious about using this program to make a difference in population health.” Toles had never been to Japan, and he says he had to give Yeo’s invitation a bit of thought. With Yeo’s guidance in Japan, and the positive experiences he had working with St. Luke’s faculty, he was committed. The experience was so professionally and personally inspiring that he can’t wait to go back. “At St. Luke’s, they were ready for this program,” he says.
The first cohort of 10 students were defending their research proposals in Fall 2018 for the projects they will execute in the spring and summer, using the DNP project guidelines prepared by Toles and translated by Yeo.
“This is the first milestone, to see these 10 students defend their proposals. We are excited to work with them on their plans so far away, in another part of the world. By the time we go back next year, the projects of the first cohort will be nearing completion, the faculty will have a lot of feedback, and the new proposals will already be coming up,” Toles says.
Dr. Shigeko Horiuchi, the incoming dean at St. Luke’s wrote School of Nursing Dean Nilda Peragallo Montano to communicate her university’s gratitude for sharing the future of research and clinical practice in the field of nursing. She wrote that the collaboration was essential to developing a unique and effective DNP program in Japan, and that she hoped the relationship would continue and grow.
“Not only our DNP students, but also all the faculty in our school, were very inspired,” she wrote.
Yeo says she can see something extraordinary coming together as they work on establishing this program and refining the curriculum. Her vision of having a collaborative partnership, where faculty and staff across schools will be able to explore new opportunities for conducting research and solving big problems in health care, can be realized.
“I’m really excited to see this grow at St. Luke’s and see how the faculty here can engage with and learn from them, so we can share information back and forth.”
Toles says participating in a global project is much more than just a visit to another country, but also a wonderful opportunity to start seeing the people in far-away places as mutual partners. “
I am heavily invested in the students as they begin to implement these models and do the work. There’s such an openness as they talk to us about it,” he says. “And, I think we are learning – that will help us refine our own program. This is really a learning lab for all of us.”