The Interplay of Ideals and Institutions in the Reform of Nursing Education in Postwar Japan —A Critical Examination of Ryoko Tsuboi et al.’s “The Formation Process of Nursing Education in Japan under the GHQ Occupation” and a Theoretical Perspective—
要約
The Tokyo Model Nursing School was not merely a model school; it was an institutional device for translating reform ideals into practice, testing them under Japanese conditions, and reproducing the resulting institutional system through human resources.
1. Introduction
The article “The Formation Process of Nursing Education in Japan under the GHQ Occupation: The Establishment and Development of the Tokyo Model Nursing School” by Ryoko Tsuboi, Akiko Okumiya, Machiko Hirao, and colleagues is an empirical study that carefully examines GHQ/SCAP Records and reconstructs, on the basis of primary sources, the formation process of postwar nursing education in Japan, focusing on the Tokyo Model Nursing School.
In particular, the study makes an important foundational contribution to the historiography of postwar nursing education by uncovering concrete historical facts that are difficult to grasp solely from Japanese sources. These include the proceedings of the Nursing Education Council, the curriculum structure of the Model School, and the students’ daily lives and clinical training as recorded in the Weekly Reports.
However, when these rich historical materials are reexamined from the perspective of institutional history, another issue emerges. Namely, there existed a substantial institutional, educational, and professional gap between the nursing reform ideals advocated by the GHQ and the prewar Japanese systems of nursing education and professional qualification.
This paper therefore takes the historical findings of Tsuboi and her colleagues as its point of departure and reinterprets the Tokyo Model Nursing School not merely as a “model school,” but as an institutional device designed to bridge the gap between the reform ideals of the GHQ and Japan’s preexisting institutional framework.
From this perspective, the Model School can be understood as a space possessing three interrelated functions:
(1) a standardization device, which embodied new educational contents and standards;
(2) an experimental device, which tested new educational systems in practice; and
(3) a reproduction device, which cultivated personnel capable of carrying forward the reforms and transmitting them to subsequent generations.
The purpose of this paper is not to challenge the empirical findings of Tsuboi et al. Rather, building upon the richness of their primary sources, it seeks to advance the discussion by posing the question: Why was an institutional space such as the Model School necessary? Through this inquiry, the paper aims to reconstruct the structural dynamics of postwar nursing education reform in Japan.
2. The Institutional Gap between the Prewar System and GHQ Reform Ideals
To understand the postwar reform of nursing education, it is first necessary to examine the institutional structure of the prewar system that became the target of reform.
The prewar nursing system was characterized by a number of structural problems, including, at least, (1) physician-led, apprenticeship-like training; (2) the coexistence of multiple qualifications and educational pathways; (3) institutional separation between nurses, midwives, and public health nurses; (4) the underdevelopment of nursing education within institutions of higher education; and (5) the subordinate character of nursing work, including the influence of military nursing.
In contrast, the GHQ/PHW sought to redefine nursing not merely as an auxiliary function of medicine, but as a profession requiring advanced knowledge, technical skills, and professional judgment.
For example, General Crawford F. Sams, Chief of the Public Health and Welfare Section (PHW), stated with regard to nurses that there should be no “second-class nurses” and that only “one class, first-class nurses” was needed. This position reflected a reform orientation toward overcoming the hierarchical structure of nursing qualifications and developing professional nurses who had received education at a certain minimum standard. The reform policy also placed particular emphasis on a minimum three-year program of basic nursing education.
What is important here is that the postwar reform should not simply be understood as a process in which “the GHQ introduced a new system.” Rather, it should be understood as a process of articulating different institutional principles.
In schematic form, the process can be represented as follows:
Prewar nursing education and professional system
↓
GHQ ideals of professionalization and advanced education
↓
Adjustment to Japan’s existing institutions, human resources, and educational environment
↓
Formation of a new postwar nursing education system
The central issue in the postwar reform of nursing education, therefore, lies not merely in the reform ideals themselves, but in how the gap between these different institutional principles was translated into a concrete educational system.
3. The Tokyo Model Nursing School as an Institutional Device for Bridging the Gap
From this perspective, the historical significance of the Tokyo Model Nursing School takes on a substantially different meaning.
The Model School was not established simply as an example of a “new type of nursing school.” Rather, it can be understood as a mediating institutional device designed to translate the GHQ’s new ideals of nursing education into the educational and medical environment of Japan, to test their feasibility in practice, and ultimately to transfer the resulting experience and knowledge into the broader institutional system.
Its functions can be understood from three interrelated perspectives.
3.1 The Standardization Device
The first function was to make the content and standards of the new nursing education concrete and visible through a structured curriculum.
Prewar nursing education was characterized by considerable variation in both educational content and standards. In contrast, the Model School established a curriculum comprising, among other components, 393 hours of general sciences and 504 hours of medical subjects and nursing techniques, for a total of 1,478 hours of instruction.
This curriculum should not be regarded merely as the educational plan of a single school. Rather, it can be understood as an institutional model that concretely defined what should be taught to nurses as professionals, to what extent, and in what manner.
Thus, the significance of the curriculum lies not simply in the number of instructional hours.
Its greater significance lies in the fact that nursing education, which had previously depended heavily on experience and apprenticeship-like training, was reorganized around a defined body of knowledge and a structured curriculum. The content of this new educational model was thereby made available for reference by other educational institutions.
In this sense, the Model School functioned as a standardization device for the emerging professional system of nursing.
3.2 The Experimental Device
The second function was to test the new educational system within the actual social conditions of postwar Japan.
Through the Weekly Reports, Tsuboi and her colleagues document various aspects of the Model School’s daily operation, including students’ living conditions, caloric intake, the number of students absent because of illness, and the number of patients at hospitals used for clinical training.
When these records are reread from the perspective of institutional history, they should not be regarded merely as records of routine school administration.
Rather, they can be interpreted as empirical evidence generated through the practical testing of institutional reform—evidence used to determine whether the new curriculum, clinical training, student life, and teacher education could actually function under the human and material conditions prevailing in Japan immediately after the war.
In this sense, the Model School was also an experimental site for translating ideals into institutions.
The reform ideals were not simply implemented unchanged. Through their encounter with practical constraints—including students’ living conditions, the availability of qualified instructors, the capacity of clinical training hospitals, and the availability of educational facilities—the ideals themselves may have been concretized, modified, and adjusted.
Accordingly, the Weekly Reports should be reevaluated not only as sources for understanding the everyday history of the school, but also as primary sources for tracing the process through which reform ideals were transformed into institutional practices.
3.3 The Reproduction Device
The third function was to cultivate the human resources necessary to sustain the reformed system.
At the opening ceremony of the Model School, General Sams characterized the students as the “nucleus” of a new type of school and expressed his expectation that similar schools would eventually be established throughout Japan.
Viewed from the perspective of institutional history, this statement suggests that the purpose of the Model School extended beyond the successful operation of a single educational institution.
Its underlying logic can be understood as a cycle:
Learning new educational ideals
↓
Developing as a new type of professional nurse
↓
Taking responsibility for the education of the next generation of nurses
↓
Reproducing the new institutional system from within Japanese society
For a reform introduced from outside to become established over the long term, it is not enough to create new institutional rules. It is also necessary to cultivate people who understand those rules, implement them, and transmit them to subsequent generations.
In this sense, the Model School can be positioned as a mediating device through which an externally initiated institutional reform was introduced into the Japanese nursing education system and, ultimately, through which the human resources capable of sustaining and reproducing that system were cultivated.
4. An Integrated Policy-Formation Model Based on the Three Devices
The three functions described above should not be regarded as independent of one another.
Rather, they can be understood as interconnected components of a cyclical process:
Concretization of reform ideals
↓
Standardization
↓
Practical experimentation and verification
↓
Revision and adjustment
↓
Human-resource development
↓
Institutional reproduction
According to this model, the Tokyo Model Nursing School was not simply a school for implementing an already completed institutional system. Rather, it was a site of policy formation where reform ideals were translated into institutional practices, those practices were tested and refined, and personnel capable of sustaining the emerging system were cultivated.
This provides an important basis for reevaluating the historical significance of the Model School.
At the same time, this model makes it possible to avoid understanding GHQ policy simply as a one-directional process of “imposition.”
The existence of GHQ reform ideals does not mean that those ideals were transferred directly and unchanged into the Japanese institutional system. Through negotiations within the GHQ, interactions with Japanese officials, constraints in educational practice, and shortages of human and material resources, the ideals were transformed as they were translated into concrete institutions.
What is therefore required in future research is not simply to describe ideals, policies, and institutions separately, but to trace, through primary sources, the process by which reform ideals were transformed into institutional arrangements and practices.
5. Conclusion: From Empirical Reconstruction to Institutional History
The study by Ryoko Tsuboi and her colleagues constitutes an important foundation for the historiography of postwar nursing education in Japan. By drawing extensively on the rich primary sources contained in the GHQ/SCAP Records, the study reconstructs in considerable detail the establishment and development of the Tokyo Model Nursing School.
Building upon this achievement, the present paper has sought to reinterpret the Model School not merely as a “model school,” but as an institutional device for bridging the gap between the prewar nursing education system and the new model of professional nursing education envisioned by the GHQ.
Acknowledgment
This paper was completed with the valuable guidance and encouragement of Professor Tomoko Yamamoto (Fukuoka School of Nursing). The author wishes to express his deepest gratitude for her insightful comments and generous support throughout the development of this study.
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