"Chiiki no Engawa" (Community Verandas) and Nursing Education | Satoko Nagata, Assistant Dean, Faculty of Nursing and Medical Care
2022.02.01
My name is Satoko Nagata, and I am the Assistant Dean of the Faculty of Nursing and Medical Care. This is my first time posting on the "Okashira Nikki" blog. It's a pleasure to be here.
In my field of expertise, Home Care Nursing, we aim to enable people with illnesses or disabilities to live as they wish in the place of their choosing. To this end, we examine methodologies for nursing practice from various perspectives, including providing nursing care to individuals and families, building care systems, and designing institutional frameworks. My specific research theme focuses on support measures in the gap between medical institutions and home care, such as during hospital admission and discharge or in outpatient settings. I typically work with staff from home-visit nursing stations and hospital discharge support departments.
Recently, a nurse from the Social Welfare Council has been guiding me on visits to the various "Chiiki no Engawa" (Community Verandas) located throughout Fujisawa City. According to the Fujisawa City website, a "Chiiki no Engawa" is "a place where diverse local residents can casually drop by, with the aim of creating a town where everyone can live a vibrant and healthy life by fostering connections and mutual support among residents and expanding social harmony." There are currently over 30 registered locations. Many of you may know that SFC faculty and students are involved in activities at several of these locations. I have been visiting "Mon no Ki no Ie," one of the Chiiki no Engawa within walking distance of SFC, for some time. Since activities like karaoke were suspended due to the COVID-19 pandemic, I have also been helping with activities such as health workshops.
The direct reason for my recent visits to other "Chiiki no Engawa" is a change in the nursing curriculum. According to the "Regulations for Designation of Training Schools for Public Health Nurses, Midwives, and Nurses," which define the curriculum for national nursing licensure, the subject "Home Care Nursing Theory" will be renamed "Community and Home Care Nursing Theory" starting this spring. This change reflects the growing need for students to deepen their understanding of the lives of diverse community members early in their basic nursing education, as medical institutions increasingly specialize and home-based care becomes more prevalent.
At our university, we offer licensure programs for public health nurses and midwives in addition to nurses at the undergraduate level. While all students are required to take courses like "Community Health Nursing Theory" as part of the public health nurse curriculum, which already covers some of this content, this revision to the designation regulations prompted us to create a new compulsory first-year seminar, "Introduction to Integrated Community Care." This course will provide experiential learning related to "Community and Home Care Nursing Theory." I am currently developing the specifics with faculty from Community Health Nursing and Gerontological Nursing. Our aim is for first-year students to spend a day at the beginning of the fall semester visiting various sites in and around Fujisawa. By participating in activities and interacting directly with local residents of different ages and health statuses, they will deepen their learning about health, daily life, and nursing. While potential sites include various gatherings for seniors and day-care facilities for people with disabilities (I will refrain from naming them as arrangements are ongoing), the "Chiiki no Engawa" are also being coordinated as candidate locations.
As of the end of January, I have only visited nine locations, including "Mon no Ki." However, through conversations with city officials, I have been struck by the diversity of the "Chiiki no Engawa," sensing both their potential and their challenges. These "Chiiki no Engawa" operate in various settings—private homes and annexes, community halls in housing complexes, and corners of shops in shopping districts—and their frequency varies from one to five times a week. While many primarily cater to the elderly, some also serve as gathering places for people with disabilities or for children. Operations are managed by staff from the Social Welfare Council and local resident volunteers. I was told that the city provides funding based on performance and participant numbers and offers advice to help them fulfill their public roles. However, I also heard that their position as "mutual aid organizations with a public function," so to speak, creates various internal conflicts.
Balancing the "comfort" of those who gather with the "public benefit" for the wider community seems to be a constant challenge for these spaces. Furthermore, the COVID-19 pandemic forced them to close during states of emergency and to revise their programs at other times, as activities like communal meals and karaoke were prohibited. Many people have stayed away due to infection concerns. Reports from across the country indicate that reduced opportunities for outings during the pandemic have led to increased frailty among the elderly, and it is likely that a similar situation is affecting participants in the Engawa projects. I also heard from some operators who felt that the pandemic had negated their work, causing them to question the meaning of their activities after having believed so strongly in the importance of creating local spaces and fostering connections. Although the sixth wave is now beginning to have an impact, I was told that many Engawa are striving to continue their operations by fully utilizing the wisdom they have gained, knowing that suspending activities is deeply damaging for both operators and participants. I believe that nursing has a necessary role to play in balancing infection control with community activities.
Despite these challenges, the unique nature of the Engawa concept—a space on the boundary between the outside (soto) and inside (uchi) that serves as both an "open" and a "personal" place—and the "connections" (en) forged there are truly a community asset. In considering the role of nursing in creating a livable society for all residents, regardless of age or health status, the "Chiiki no Engawa" provide an ideal learning environment. I am also hopeful that something new may emerge from a deeper engagement of the "university," "faculty," and "students" with these spaces. As a first step, we will continue to explore how to develop the "Introduction to Integrated Community Care" course, including the "Chiiki no Engawa," as a form of nursing education unique to SFC. I would be grateful for any advice or suggestions you may have.