Introduction
Japan has a long history of developing disaster planning systems due to both its geographical characteristics and the frequent occurrence of disasters in Southeast Asia. There were 2,909 reported disasters between 1999 and 2008 with 1,023,081 people reported killed during this period.1 The Asian region has a high number of disasters, 38% of which occurred between 1975 and 2000, affecting as much as 88% of the population of the region.2 This frequent occurrence of disasters becomes a serious socio-financial burden to the countries involved.
The frequency of earthquakes experienced in recent years has had a significant influence on disaster health research in Japan. Sakai and Kikuchi surveyed the trend of disaster nursing research and found that disaster nursing research articles have appeared in the literature since 1991.Reference Sakai and Kikuchi3 Their review demonstrated that disaster nursing research has become more diversified, reflecting the occurrences of various other types of disasters, such as the Sarin Gas underground incident in Tokyo, the Great Hanshin-Awaji earthquake of 1995, and the Great East Japan earthquake in 2011.
Disaster health research now has a broad area of focus, including areas such as disaster planning, disaster management, and community capacity building. Disaster health is a practice that also calls for multidisciplinary research, as emphasized by Kuroda and Sakai.Reference Kuroda and Sakai4
Although the number of disaster health research articles has increased and the focus has expanded, the studies have not yet been systematically reviewed, particularly in Japanese nursing journals.
It is also not known if unique language usage exists that prevents the comparison of Japanese disaster nursing research findings with those of other countries. In order to determine the extent and focus of disaster health research literature, in particular disaster nursing research in the Japanese language, the authors reviewed the literature to investigate tendencies and characteristics in current disaster health research. This report focused on the review of Japanese disaster nursing education literature.
Methods
Article Selection Process and Inclusion Criteria
A literature search was conducted using the Japanese database Ichushi (version 4.0). This database is the sole Japanese database of health professionals’ research articles. The keywords or combinations of keywords used for this search were: (1) disaster nursing, education; (2) function, disaster nursing; (3) practice, disaster nursing; (4) capability, disaster nursing; (5) disaster response, planning; (6) emergency, response, planning; (7) disaster prevention, disaster nursing; (8) licensure, disaster nursing; (9) ability, disaster nursing; and (10) research, disaster nursing. Relevant literature published from 2001 through 2007 was chosen for review to capture that period in which there were increased numbers of disasters nationally and internationally. Translation from Japanese into English was performed by checking that the term and context used in the Japanese article were the same as those used in an English-language context. If this was not the case, the authors tried to search using the most comparable term. Only peer-reviewed, research-based articles on disaster nursing were included. “Grey literature,” such as government reports and non-peer reviewed articles, was excluded.
Six of 10 searches resulted in duplicate articles. For example, the search using the keywords function and disaster nursing resulted in one duplicate article. Duplicate articles were used for analysis only at the first appearance in searches.
The information retrieved from each search was tabulated for data synthesis. Information from each reviewed article was synthesized according to themes to identify the issues and trends in disaster nursing articles in Japan. The results were also analyzed by year of publication to investigate trends. The articles were sorted into the following four themes: (1) learning outcome/experience; (2) drills and training in nursing education; (3) discipline/curriculum development; and (4) attributes of disaster relief nurses.
Results
A total of 222 articles were retrieved. Among the keyword search categories, the search: disaster nursing and research yielded the largest number of articles (n = 106, 48%). This search also yielded articles published every year from 2001 through 2007 (Table 1). The smallest number of retrievals resulted from the search using the keywords practice, capability, disaster nursing, and from the search using the keywords licensure and disaster nursing (n = 1 in both categories). With the exception of the year 2003 and 2004, the number of research articles published in the area of disaster nursing increased gradually each year with the greatest number of articles published in 2007. After 2003, the number continued to increase, peaking in 2007.
Table 1 Overview of literature search results
Article search results are shown in Table 2. The 222 retrieved articles were sorted for data analysis. The articles that did not focus on a disaster context or a nursing context were excluded from analysis.
Table 2 Summary of keywords and number of articles retrieved and analyzed
aNumbers in parentheses indicate articles that overlapped with other categories.
All retrieved articles from the search using the keywords disaster nursing and research were excluded from analysis; most of these articles (n = 82) overlapped with other search category results, with the 24 remaining articles not focused on nursing. The searches using the keywords disaster nursing, education; practice, capability, disaster nursing; disaster response, planning and licensure, disaster nursing did not yield articles that were duplicated in other searches.
The search using disaster nursing and education yielded the highest number of articles for analysis (n = 16). The content of these articles varied to include case study reports of evaluation of disaster educational courses,Reference Nimi and Horii5-Reference Ishikawa, Yamada, Muto, Sato, Miyazaki and Ushio8, Reference Yamamoto and Kishi23 disaster drills,Reference Bouta, Yokouchi and Okada9-Reference Kumatani and Ebina14 and discussion of disaster nursing as a discipline.Reference Yamamoto17-Reference Yamamoto, Masuno, Tuda, Nakanishi, Ando and Yamada19, Reference Matumoto, Takahira, Katahono, Yoshida and Utumi22 As this is the main interest of this study, the authors concentrated on the results and analysis of this search.
Learning Outcome and Experience Articles
A summary of articles that were categorized as focusing on students’ learning outcomes and experiences are shown in Table 3. With the exception of one article by Nimi and Horii, the articles focused on teaching styles.Reference Nimi and Horii5 Ohara introduced triage education and training in nursing students’ final year of clinical work.Reference Ohara6 The self-evaluated results following the education showed that the triage decision-making of the final year nursing students was more accurate in some scenarios than that of registered nurses working in the clinical setting. Tozawa et al surveyed nursing students’ abilities during a survival camping experience and compared the findings for nursing students with camping experience to the findings for those not experienced in camping.Reference Tozawa, Takagi, Hozaka and Yoshioka7 This descriptive report was a unique study illustrating students’ experiences during challenging circumstances, and showed that life experiences may influence students’ motivation to study disaster nursing. Ishikawa et al used a survey of nursing students to evaluate the topic “disaster nursing and the community.”Reference Ishikawa, Yamada, Muto, Sato, Miyazaki and Ushio8 She reported that the use of group case studies was a valuable way to teach disaster nursing content. The inclusion of fieldwork as well as drills was important for students in obtaining practical knowledge.
Table 3 Summary of articles with the theme “learning outcome and experience”
Drills and Training in Nursing Education
Six articles were retrieved that focused on the issue of drills and training in nursing education (Table 4). The methods used for studies varied and included report analysis, semi-structured interviews, and questionnaires. Four of six articles in this category were on course evaluation. The studies included students’ reflections on learning from participation in disaster drills,Reference Bouta, Yokouchi and Okada9-Reference Imaeda, Mokuan, Nishitani and Tobinaga12 as well as their role in the simulated disaster situations.Reference Hatayoshi, Maeda and Yonetani13, Reference Kumatani and Ebina14 All six of the articles in this category reported on the student involvement in drills (some studies with the health professional working in both hospitals and community) and the effectiveness of participating in these drills.
Table 4 Summary of articles with the theme “drills and trainings in nursing education”
Discipline and Curriculum Development
Four articles were retrieved that focused on discipline and curriculum development (Table 5) with two of these articles reporting on the availability of a disaster nursing topic in Japanese university curricula. Yoshida reported that 13% of the nursing undergraduate programs provided disaster nursing topics.Reference Yoshida15 Matsumoto et al also surveyed the availability of disaster nursing topics in nursing undergraduate programs with 15 of 61 schools replying that they provided these courses.Reference Matumoto, Takahira, Katahono, Yoshida and Utumi22 Yamatomo et al also surveyed 39 Red Cross nursing schools in Japan to explore the disaster nursing course context.Reference Yamamoto, Masuno, Tuda, Nakanishi, Ando and Yamada19 They summarized seven areas in the context of disaster nursing education: (1) disaster theory; (2) preparedness for disaster; (3) nursing in disaster situations; (4) protection of healthcare workers in disaster situations; (5) volunteerism and nursing; (6) ethical issues in disaster nursing; and (7) international cooperation.
Table 5 Summary of articles with the theme “discipline and curriculum development”
Only one article focused on the development of the discipline of disaster nursing.Reference Miura, Ohara and Ito18 All other articles focused on the availability of disaster nursing in Japan, and did not address the context of discipline development.
Attributes of Disaster Relief Nurses
Only one article directly addressed the attributes of the disaster relief nurse (Table 6). Hirano surveyed 62 nursing students to investigate their attributes and made comparisons between those who were not interested in being relief nurses and those who were.Reference Hirano20 The results showed that there is a significant difference between these two groups, with the attributes of disaster relief nurses being those of commitment, devotion, and willingness to participate in disaster relief activities.
Table 6 Summary of articles with the theme “attitudes of disaster relief nurses”
Discussion
Developing Research Methodology in Disaster Nursing Education
Yamamoto et al pointed out that there was an urgent need for a theoretical framework development for disaster nursing; however, no article discussing a methodology or theoretical framework of disaster nursing was found in this review.Reference Yamamoto, Masuno, Tuda, Nakanishi, Ando and Yamada19 This could be due to the nature of disaster in that it cannot be predicted when a disaster will happen, and health professionals need to concentrate on relief activities during a disaster without taking time to conduct research.Reference Kuroda and Sakai4 Therefore, there has been an emphasis on increasing preparedness in the case of disaster situations. If a theoretical framework is well-developed, researchers can explore further this area of study depending on the stage of disaster cycles and the needs of patients. It is necessary to develop a theoretical framework in disaster nursing; however, it is also important to focus on the stories of victims of disasters and those of responders, because these stories could also point out needs in disaster nursing research.Reference Kuroda and Sakai4 Hence, a focus on both the individual and the organization is essential.
In this review, the majority of studies at institutional settings focused on pre- and post-training changes when assessing the present status of preparedness. This was due to the focus of this review on disaster nursing education, and to the fact that the qualitative method was employed more frequently to evaluate the effectiveness of the programs, sessions, and training. Disaster nursing involves various life stages (pediatric, adult, and geriatric) and areas of study (including mental health). Expertise in these areas is required to further investigate the disaster nursing context. If the disaster nursing theoretical framework is defined, the deficient areas of disaster nursing research can be further highlighted. Due to the various life stages and areas of study, the disciplinary area of disaster nursing seems to be scattered, and needs to be categorized into areas of study. This categorization would make disaster nursing research more comprehensive.
Measuring preparedness in disaster nursing is an important concept, and requires continuity in training and awareness. However, none of the studies reviewed undertook a longitudinal perspective. Preparedness is an index that can indicate deficiencies in terms of resources, knowledge, and education. This area needs further investigation during the development of a disaster nursing theoretical framework, with various situations and scenarios applied to the framework. Research methodology in disaster nursing can also be developed by sharing the experiences of nurses and the communities from past disasters to enhance the effectiveness of programs and sessions. This allows for drawing upon what was learned from being involved in actual experiences. While the theoretical framework for disaster nursing is clarified, a methodological approach also needs development.
Disaster Nursing Topics in Curricula
Drills and training were considered to be an important part of the curriculum in nursing education. Due to curriculum revision in 2009, nursing schools in Japan are required to implement disaster nursing topics. Disaster nursing content is also included the national nursing registration examination that is required to sit for the exam to be qualified as a registered nurse in Japan. This revision will influence the disaster nursing content in nursing schools in the future. Investigating and documenting changes after the 2009 nursing curriculum revision is a potential topic for future research.
The Red Cross has a long history of contributing to disaster relief in Japan, and any school funded by the organization is expected to adopt the Red Cross philosophy that promotes first aid in communities. Therefore, implementation of topics relevant to disaster nursing is occurring naturally. The content of the topics vary, and it is assumed that this is related to the particular school's geographical location. For example, one school includes snow as a natural disaster hazard because it often has heavy snow fall around the school. As schools and universities embed the Red Cross philosophy into their curricula, the continuity of education through professional development is essential.Reference Miura, Ohara and Ito18 Exposure to disaster training and education in earlier stages of professional education is beneficial. For example, one study found that nursing student participation in drills at a hospital worked in a positive way for both nurses and nursing students.1 This finding dispelled the notion that nursing students are not yet ready to work in an emergency triage system that requires quick decision-making within both clinical and ethical aspects. The study gave an indication of the effectiveness of triage training for nursing students, and is a potential topic for future research. Achieving positive outcomes and a communal understanding of the drills between health professionals and nursing students is necessary.
There are three venues where buffering capacity can be developed: in the work environment, in the educational setting, and in the community. The articles involving communities (Table 5) focus on how nurses should be involved in communities to protect them from disaster. This may be influenced by the professional roles of nurses and public health nurses in Japan. Mizushima et al reported that the role of the public health nurse during flooding of a regional area was significant, providing long term and community-based health support.Reference Mizushima and Hayashi16 Although the differences in the focus on nursing are pointed out, a greater focus on community involvement is needed. This paper focused on nursing education articles. A further focus on maintaining continuing education is essential, since health professionals need to utilize their ongoing knowledge and skills in practice.Reference Yamamoto17
Characteristics of Japanese Disaster Nursing Education Studies
Japan experiences frequent disasters, and it could be said that the Japanese disaster health area of study has developed with need. Yamamoto developed a project to establish a network in disaster nursing to encourage the establishment of disaster nursing research, as well as education.1 Demand for disaster nursing education is high, not only within Japanese nursing educational institutions, but throughout Asia. A survey study by Miura et al showed that 44 out of 51 schools in the Asian region offer disaster education.Reference Miura, Ohara and Ito18
An increase in the number of articles published also reinforces the importance of disaster nursing education. This may be related to the influence of the Red Cross, as some of the authors for papers found in this review have educational backgrounds with Red Cross nursing schools and universities. However, health professionals including nurses in the hospital setting, long-term institutional settings, and communities are also part of disaster nursing. Therefore, focusing on the various aspects for preparing for disasters requires inclusive development.
Conclusion
This study summarizes current research trends and issues for disaster nursing in Japan. Evaluation was frequently the primary objective of studies. This literature search showed that a wide variety of disaster nursing studies came to the conclusion that research influences practice. Disasters affect not only the institutional setting within an acute hospital locale but also affects people in communities, with the nurses roles expected to expand to the area of disaster nursing. The Japanese nursing curriculum revision in 2009 will influence disaster nursing education, and it is expected that there will be a variety of future studies. Education in disaster nursing is an important hub to build up the capacity in the community. Further development in this area of study is expected to explore evidence-based methodology including the theoretical framework for disaster nursing.
Abbreviations
- none
