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Collegian (2010) 17, 161—173
avai lab le at www.sc iencedi rec t .com
A literature review of disaster nursing competenciesin Japanese nursing journals
Mayumi Kako, RN, PhD, MRCNa,∗, Satoko Mitani, RN, MSc, PhDb
a Flinders University, School of Nursing & Midwifery, Australiab Graduate School of Medicine and Faculty of Medicine, Kyoto University, Australia
Received 24 June 2010; received in revised form 8 September 2010; accepted 22 September 2010
KEYWORDSCompetencies;Literature review;Disaster nursing;Japanese;Concept
Summary Introduction: Competencies is an important concept used for assessing healthprofessionals’ capability to perform their role. By means of a literature review of Japaneseprofessional journals this paper will investigate the competencies concept, particularly withrelation to disaster nursing. Methods: The literature research was conducted using the databaseichu-shi (ver. 4). All literature is written and published in Japanese and was published between2001 and 2008. Due to an unfamiliarity of the term ‘competencies’ in Japanese, the key wordswere sought while deconstructing the meaning and concepts of ‘competencies’ into termsmore recognisable in the Japanese context. Twelve key words: disaster, capability, education,practice, licensure, ability, function, prevention, response, planning, emergency, and disasternursing were chosen as being most likely to find literature relevant to the English languageconcept of competencies. The searched articles were then written into the disaster nursingcompetencies review worksheet for analysis. Result: One hundred and twenty articles werefound by searching a combination of these key words. Of these articles, those that were not inthe context of disaster nursing were eliminated. As a result, 43 articles were chosen as beingsuitable for analysis of the context. These articles are classified into four themes. Conclusion:These theme groups indicated a foundation for competencies in disaster nursing. The definition
of competencies in Japanese nursing journals was quite varied and cannot be easily defined ascommon disaster nursing competencies. Given the variety of areas and the distinct phases indisaster nursing, as well as the ‘what for’ and ‘who governs’, disaster nursing competencieswill need its own discussion in order to establish the common competencies internationally.rsingia Pt
© 2010 Royal College of NuInternational Books Austral
∗ Corresponding author at: GPO box 2100, Flinders University,School of Nursing & Midwifery, 5001 SA, Australia.Tel.: +61 8 82017637.
E-mail address: [email protected] (M. Kako).
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Atnct
1322-7696/$ — see front matter © 2010 Royal College of Nursing, Australia. Published by Elsevie
doi:10.1016/j.colegn.2010.09.003
, Australia. Published by Elsevier Australia (a division of Reedy Ltd). All rights reserved.
ntroduction
competency is an important concept used for assessinghe health professionals’ capability to perform their desig-ated role. The International Council of Nurses (ICN) definesompetence as ‘. . . a level of performance demonstratinghe effective application of knowledge, skill and judgement’
r Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
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International Council of Nurses, 1997). Gonczi et al. (1990)lso states that competence ‘. . . is focused on performancef a role or set of tasks’.
Global market expansion in the 21st century promptedrofessionals around the world to seek international recogni-ion, and the setting of competencies is an essential task forhose seeking professional recognition in the internationalrena. A disaster situation represents a similar situationo health professionals wherever they reside, in that allealth professionals are required to draw together and co-rdinate their efforts for disaster relief activities on a globalevel. Under these circumstances, competencies will aidealth professionals to be equipped with standardised skillsnd knowledge for a more effective disaster relief (Dorsey,n press). Although there are discussions of disaster nurs-ng competencies available in English journals, discussionsn the other languages, such as in the Japanese nursingrofessional journals, are tremendously under-investigated.he language difference also prevents those languages fromommunicating and exchanging information in this area oftudy. The authors expect that this literature review willeveal the differences in interpretation of competencies inapanese from English so that this discussion could con-ribute to construct deeper knowledge in competencies inisaster nursing area. Therefore this study will aim to searchow the term competencies in Japanese nursing profes-ional journals are explained and understood. Unfamiliarityith the term competencies and the term is rarely used
n the Japanese language, while the literature search caneveal what kind of capabilities are expected of healthrofessionals, especially of nurses in disaster situations.larifying capabilities such as skills, knowledge and pro-essional attitudes in the Japanese disaster nursing areaan imply disaster nursing competencies in English. Dueo these differences in language use, the authors soughthe meaning of competencies by looking up to find whicherms are most frequently used in journals. Disaster nurs-ng includes all areas/phases of nursing, such as acute,hronic and rehabilitation, as well as at each age-stage ofhe population. Competencies in disaster nursing could alsoe varied, depending on which phase of the disaster is underiscussion. It is hoped that this literature review study willeveal an understanding of the competencies concept inisaster nursing in Japanese nursing journals and seekingnowledge gap in interpretation of competencies in differ-nt languages. The authors also hope that this result canontribute to international discussions on disaster nursingompetencies.
ethods
he literature research was conducted with the databasechu-shi (ver. 4). This database is most commonly usedor health-science related literature in Japan, with alliterature being written and published in Japanese. Thehosen period of published literature was between 2001 and
008 in order to capture that period in which there werencreased numbers of disasters nationally and internation-lly (International Federation of Red Cross and Red Crescentocieties, 2009; The Statistics Bureau and the Director-eneral for Policy Planning, 2010 retrieved 15 August, 2010Kaai
M. Kako, S. Mitani
rom http://www.stat.go.jp/data/nenkan/pdf/yhyou26.df). The key words were sought while deconstructing theeaning and concepts of competencies into the common
se in the Japanese context due to their unfamiliarity withhe term competencies. Although this term is commonlysed in the human resource management area to describecapability’ of personnel, it is rarely used in nursing due tots unfamiliarity and the unspecified meaning in Japanese.he authors discussed terms, including synonyms, whileonstructing a concept of competencies in Japanese. As aesult, 12 key words, ‘disaster’, ‘capability’, ‘education’,practice’, ‘licensure’, ‘ability’, ‘function’, ‘prevention’,response’, ‘planning’, ‘emergency’ and ‘disaster nursing’ere chosen. These key words were combined to seekppropriate articles focusing on the competencies inisaster nursing.
Inclusion of article criteria was peer reviewed and pri-ary research based articles in disaster nursing area.rey literature such as government reports and non-peer
eviewed articles were excluded. The articles retrievedrom searches were tabulated for the purpose of over-iewing the result. Summarised articles were carefullyead through by investigators to synthesise the themesrom selected articles in order to identify emerging topicalesearch issues concerning competencies in disaster nursinghile focusing on the commonality in the purpose of studynd outcomes.
esults
ne hundred and twenty articles were found by a combina-ion of the key words (Table 1). Table 1 shows the variousombinations of key words for searches and the numberf articles found in each search category. The bracketedumber shows the number of articles duplicated in otherearches. Although the total number of analysed articlesndicated 58 were suitable for inlcusion, 15 were duplicateshich meant that only 43 were chosen as being appropriate
o analyse. After the synthesising process, 4 themes wereenerated from the literature review. These were:
1) questioning the practice capability (n = 3).2) measurement of health professionals’ preparedness
(n = 20).3) evaluating preparedness in the community, and (n = 11).4) disaster nursing and curriculum (n = 9).
Table 2 shows the summary of articles categorised intohemes. The retrieved articles show that the study topicsnclude not only nurses (as human resources) and nursing,ut also the research methods and medical institutions in theommunities. These articles imply the multiplicity and com-lexity of disaster nursing competencies, and consequentlynvolving the many and varied elements in disaster nursing.
uestioning the practice capability
ubo et al. (2006) investigates the capacity for nurses tossess patients at the relief shelters. This is the only articleddressing the competence, or required capability of nursesn a disaster situation. The capabilities that they came up
Disaster nursing competencies in Japanese nursing journals 163
Table 1 Search results.
Combination of key words The number ofarticles found
The number of articlesanalysed
1. Practice, capability, disaster 1 12. Disaster nursing, education 50 15 (3)3. Disaster, response, planning 25 14 (6)4. Emergency, response, planning 10 5 (2)5. Practice, disaster nursing 10 9 (4)6. Licensure, disaster nursing 1 17. Ability, disaster nursing 5 5 (3)8. Function, disaster nursing 3 29. Disaster, prevention, disaster nursing 15 6 (5)
Total 120 58 (15 articles are
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with are similar to those required in almost any category ofnursing; such as observation, collection of information andapplication of the techniques and interventions availableto them in the disaster situation (Schmieding, 2002). Theability to cope in a non-institutional environment with verylimited resources is an essential requirement in disaster sit-uations. Fujii and Hashimoto (2007) surveyed Public HealthNurses (PHN) on their role in disasters. The result shows that29.6% of responses cite tasks such as health checks of evac-uees as a core role of the PHN. PHN in Japan hold a differentlicence to that of the Registered Nurses, with their primaryrole being public health work in the community. Despite thisrole differentiation between professionals, the provision ofsafety and care for evacuees and casualties is one respon-sibility and role they do share. Under such circumstanceshealth professionals are required to make decisions on thespur of the moment, assess the situation and then ascertainwhat is needed to address it according to this assessment.
Measurement of health professionals’preparedness
Most articles (n = 20) retrieved were in this category of pri-oritisation and preparedness. The degree of preparedness ismeasured by the attitude to, and knowledge of a disaster sit-uation by means of undertaking comparison studies betweenpre and post workshop for nurses. The intention of this isto gain an indication of the understanding of procedures inthe event of a disaster (Iwata et al., 2006; Tominaga et al.,2006; Ohima et al., 2007). The participants of the studieswere health professionals and patients/clients at commu-nity and medical institutions. The workshops were providedat work unit level, such as in the ICU, the HD unit, the oper-ation theatre, and in orthopaedic and gynaecology wards.These studies were aimed at raising the awareness of nursesregarding the knowledge they will need in the event of dis-asters such as a highly developed level of communication
in emergency situations, and the safety of both patientsand nurses at the ward level and in evacuation procedures.Tateno et al. (2007) surveyed 2040 practising nurses on theirexperience of CPR. Of these, 815 nurses affirmed that theyhave experience of CPR. Aizawa et al. (2007) also surveyedcctlc
identified in more thantwo categories)
urses’ competency of triage in a hospital, and found thaturses’ triage interest is low, and half the participants dis-layed difficulty in even understanding the principles ofriage. They concluded that there is a real need for regu-ar triage training for health professionals. The Niwa andamaguchi (2005) study also discovered that ‘triage tag’sed in the drill was not at all familiar to those surveyed.heir survey was conducted at a hospital and included healthrofessionals, fire and paramedical officers, and adminis-rative officers. This result showed that the layout andnstruction needed to administrate a triage tag should beuch clearer. In the case of a drill involving the entireersonnel in an organisation, careful attention needs to beiven to each of the personnel and their role/responsibilityn the event of a disaster situation. Their study also rec-mmended strengthening communication strategies. Theorishita et al. (2002) study also pointed out the importancef communication. In addition, they surveyed the disasterreparedness of nursing professionals. The result indicated aow score in coordination of volunteers, as well as in commu-ication and networking with nearby medical institutions.hus, the measuring of preparedness in health profession-ls must include an assessment of the health professionals’ndividual capability in disaster cases, as well as their levelf organisational capability in the valuable skills of network-ng and communicating with any other institutions that maye involved.
valuating preparedness in the community
rticles falling into this category generally covered a broadrea in disaster nursing, especially those focused on theore vulnerable members of the population, such as older
itizens, children with chronic illnesses and people in homeare. For example, Ohta et al. (2002) surveyed parents car-ng for children with chronic illness for preparedness in anmergency situation. The result shows that 23% of parent
oncerns involve the establishment of communication pro-edures in case of emergency, while 14% indicated thathey hoped to have some kind of emergency network estab-ished. Communication establishment is a key element inase of an emergency. The Goto et al. (2004) article also
164 M. Kako, S. Mitani
Table 2 Summary of articles.
Themes Authors, year Methods Findings
1. Questioning thepractice capability (3)
Kubo et al. (2006) Semi-structured interviewof 4 nurses who attendedrelief activities in a volcanodisaster.
Investigated the ability toassess during the reliefactivities. Three categories arepointed out: (1) gatheringinformation, (2) aidingtechnique, (3) self-recognition.
Fujii and Hashimoto (2007) Questionnaire given toPublic Health Nurses.
79 PHN replied (29.6%). PHNregarded their roles to behealth check of evacuees,home visiting.
Ishikawa et al. (2003) Semi-structured interviewof a Public Health Nurse.
The interview summarises therole of the public health nurse.
2. Measurement ofhealth professionals’preparedness (20)
Tateno et al. (2007) Survey given to 2040 nursingprofessionals who work inpractices over Japan.
1008 returned.
815 answered that they hadexperience in CPR, with 57claiming to have experience indisaster emergencies. Theauthors pointed to the need fora course in first aid for nursingprofessionals.
Ohata et al. (2006) Questionnaire given to 295nurses who are either activeas a E nurses (or haveresponsibility in the area).
Awareness of nurses at Ahospital: the role of E nurseand activities. The study foundthat many nurses areconcerned about leadership ina disaster situation. The Enurses were keen toparticipate in the workshopsand training; however,practicing and motivating theunits and wards to which theywere attached was not highlyprioritised.
Aizawa et al. (2007) Questionnaire given to 28nurses at a hospital.
The result shows that theinterest in triage is low. Halfthe participants had difficultyin under-standing the conceptof triage in a disaster situation.Regular workshops will beneeded to promote disasterawareness.
Mizushima and Hayashi(2006)
Questionnaire to nurses whoparticipated in the reliefduring the earthquake inNiigata
Attracted a 71.1% reply rate.The aim was to improve carefor patients with chronichealth issues, as well toimprove the context of bothhealth consulting andpsychological assistance.
Makino et al. (2008) Interviews withdisaster-planning officers inmedical institutions.
Questions were aimed atdisaster planning, especially incontinuity of treatment forcancer patients. Educatingpatients to raise their self-care capability was also raisedas an issue.
Disaster nursing competencies in Japanese nursing journals 165
Table 2 (Continued )
Themes Authors, year Methods Findings
Numata et al. (2008) Data collection through website, with 33 participants toagreeing to discuss thecontent of a leaflet forcancer patients.
An improvement of the Carepackage for cancer patientsduring disasters was basedaround the Web search. Theresearchers found that 58% ofthe participants thought thatit was now appropriate forthese patients.
Hitachi, Tanaka, Yamamoto,Kimura, and Ohta (2002)
Reviewing the manual atthe primary treatment roomat a hospital.
Human resources, goods, andcommunication with familywas reviewed, and the systemconsequently restructured.
Nagata et al. (2007) Questionnaire given to 56health professionals at anICU unit.
18% of the correspondentsshowed no preparedness inthe event of an earthquakebefore the workshop. Thischanged to 80% feelingprepared after the workshop.Only 38% of participants knewof the disaster manual beforethe workshop. There wereother questions that werealso answered correctly . . .
after the workshop.Ohta et al. (2006) Questionnaire given to 39
theatre nurses regardingthe ‘no lifeline’ disastersituation.
After the presentation of thedisaster response manual atan operating theatre, thequestionnaire was distributedto nurses. 80% of nurses withless than 3-years’ clinicalexperience replied that theyfelt that they could notmanage casualties and 55% ofnurses with more than4-years experience repliedthat they would find itdifficult.
Koiwai and Watanabe (2007) Questionnaire given to 13theatre nurses.
The survey result indicatedthat the awareness of staffrose after the meeting toevaluate the content of thecare package for theatrepersonnel in a disastersituation. A comparison wasmade before and after themeeting.
Iwata et al. (2006) Questionnaire given to 20HD nurses
A questionnaire at theworkshop to assess disasterresponse at an HD unit wasconducted both before andafter the workshop. Theworkshop included personnelfrom an emergencydetachment from HD, fire andcommunication personnel.
166 M. Kako, S. Mitani
Table 2 (Continued )
Themes Authors, year Methods Findings
Aoki, Suzuki, Matsumoto,and Inoue (2007)
Questionnaire given to 27orthopaediatric nurses
26 nurses replied with 100%expressing concern over thepreparation for response todisaster situations. 56% ofnurses did not have theknowledge to evacuatethose needing specialorthopaedic care.Post-questionnaire scenariosimulation was useful inimproving nurses’preparedness forevacuation.
Futada et al. (2007) Questionnaire to 14gynaecology nurses atdisaster workshop.
Staff studied their role andresponsibility, includingemergency evacuationroutes and undertakingdisaster drills. The workshopseemed to be generalisedand was not aimedspecifically at those workingin a gynaecology ward.
Hayashi et al. (2005) Questionnaire given tonursing managers inIshikawa prefecture.
85 people replied, making a76.6% response. There donot seem to be manymedical institutions withpast disaster experience.Most are now committed todisaster drills.Although there are fewinstitutions practicingdisaster education,evacuations in case of fireand other disasters are nowincluded. However, themajority of managersanswered ‘not sure’ and ‘notuseful’ when asked whetherthey found the manualuseful.
Niwa and Yamaguchi (2005) Evaluation of the drills, 435participants including firepersonnel, paramedicofficers, nurses, doctors andadministrators.
Among the participants, 63%were nurses, about 15% wereadministrative officers, and6% were doctors. The resultsproposed fourrecommendations. Firstly,that the layout of the triageneeded to be clearly shown.Secondly, introducing‘arm-chair’ training,including documentation forthe triage tag. Thirdly,rehearsing with mockpatients at the ward, andlastly, communication withother institutions.
Disaster nursing competencies in Japanese nursing journals 167
Table 2 (Continued )
Themes Authors, year Methods Findings
Tominaga et al. (2006) Evaluation of simulationtraining for 11 theatrenurses.
The comparison before andafter the simulation trainingdid not show any differencein the clinical experience.
Mizuno et al. (2006) Questionnaire to 590nurses. 79.1% response rate.
The result pointed out thathuman resources can beready during a potentialnight-time disaster. It alsoindicated a need to increaseeducation, workshops,training, and insurance forthe relief personnel.
Oshima et al. (2007) Evaluation of knowledge indisaster nursing before andafter seminar.
A questionnaire wasdistributed to 24 nursesbefore, and 25 after. Only 20%of nurses answered that theyattended the lecture ondisaster nursing, althoughthey claimed to haveparticipated in reliefactivities in the past.
Morishita et al. (2002) Questionnaire given to 688health professionals.
Evaluation of disaster nursingpreparedness in A prefecture.The result showed a low scorein volunteer coordination andin communication andnetworking with othermedical institutions. Theauthors also pointed out theneed for drills and buildingthe capacity for networking.
Ganaha and Anri (2002) Report of the incident. Staff at a hospital discoveredan unidentified white powder,which was thought to beanthrax. The reportconcerned what they learnedand how they coped with theincident.
3. Evaluatingpreparedness in thecommunity (11)
Ohta (2003) Analysis of disastermitigation system.
Analysing disaster planningbetween in 1923 and 1992.The result shows a closeassociation betweengovernance and disastermitigation.
Nemoto et al. (2007) Patients’ awareness ofdisasters. Questionnairewas given to 40 HD patientsbefore and after they hadwatched disaster videomaterial.
The researcher compared theawareness of patients bothbefore and after the video.
Kanzaki et al. (2006) Developing a Websitedatabase catalogue.
The authors developed acatalogue system for disasternursing. The database can beused for specialised searchesby health professionals, but isalso of use to civilians.
168 M. Kako, S. Mitani
Table 2 (Continued )
Themes Authors, year Methods Findings
Gotoh et al. (2004) Preparedness in the case ofolder people and disaster.
Questionnaire given to olderpeople in Yamagata to studythe response andpreparedness in the case ofdisasters. 2524 replies out of2841 cases. The questionsrequired answers on healthstatus, activities, lifestyleand comments to the citygovernment. 15.9% of olderpeople do not seem to haveanyone taking responsibilityfor their health.
Nishimura et al. (2005) Report from the No. 23typhoon and floods.
Reviewing the water disasterof No. 23 typhoon. Raisingpreparedness was shown asthings like storing moreemergency devices, such asportable suctions, rechargesystems etc
Ohta et al. (2002) Questionnaire to 100parents who have chronicillness in Iwate prefecture
The questionnaire addressedthe preparedness for disasterof parents who have childrenwith chronic illness. 23.1% ofparents asked how tocommunicate with medicalpersonnel. 13.8% of parentshoped to have an emergencynetwork established.
Okuno et al. (2006) Questionnaire to 21participants who attendedthe seminar.
4 males and 17 femalesparticipated in the seminar.They had a strong interest indisaster prevention andpreparedness; however therecognition degree of theseare influenced by personalviews and situations as wellas experience, so the contextneeds to include promotionfor preparedness in disastersituations.
Kawahara et al. (2006) Interview with 61 familieswho have a family memberusing a community nursingservice.
After the interview thenursing manual was launched.Interviews with families weresuccessful in raising theirpreparedness for a disastersituation.
Hirano et al. (2007) Questionnaire given to 96nursing students
56.3% of students replied tothe questionnaire. Theypointed out obstructionsrelating to the ceiling andwalls, and that there was notenough warning tosuccessfully evacuate.
Watanabe et al. (2005) Questionnaire given tohealth professionals at theworkshop.
The result showed the 8th
element to be volunteering.
Disaster nursing competencies in Japanese nursing journals 169
Table 2 (Continued )
Themes Authors, year Methods Findings
Kumagaya and Ebina (2007) Questionnaire to 31,second-year students
The survey was conductedwith nursing students. Thefindings indicate the role ofnurses and the experience ofthe patients.
4. Disaster nursing andcurriculum (9)
Motoyama and Sakaguchi(2003)
113 third year studentsquestionnaire about therecognition of disaster
Survey given to 113 nursingstudents to investigaterecognition of disasterhazards. The recognition ofrisk hazard is higher innatural disaster thanman-made disaster. Theretends to be less recognitionof disaster hazard bystudents as well as a lowpreparedness towardsdisaster.
Ishikawa et al. (2006) Questionnaire/evaluation ofthe topic by the students(the number of students isnot mentioned).
The content of the topic wassurveyed by the students,with 32 elements beingretrieved and 5 elementswhereby students learntabout the health needs inthe community. The topicinvolved activities such asfield-work and drills.
Bouta et al. (2007) Questionnaire given to 280final year students after thetriage training
Final year nursing students(total 280 students)conducted a rally triage. Theaim was to bring aboutreflective learning from theexperience.
Tozawa et al. (2007) Questionnaire to 70third-year students tocompare the groupsbetween not having theseminar and having theseminar (that is, a campingexperience)
Surveyed nursing studentswho experienced camping.
Katahono et al. (2007) Questionnaires given to 62final year (fourth year)nursing students askingthem to evaluate of theobjectives of disastermanagement practice.
The result shows that overallthe objectives wereachieved. It is also pointedout that some topics, such asinternational cooperationand man-made disasterneeds to be included into thetopics.
Oyama et al. (2006) Questionnaire. Responserate 46.7%.
The questionnaires weredistributed to theparticipants of the session onmental health in disaster.The findings show that theparticipants learned tobetter understand thevictims in disasters, as wellas initiating self-exploration.
170 M. Kako, S. Mitani
Table 2 (Continued )
Themes Authors, year Methods Findings
Nimi et al. (2006) Report analysis of 40first-year students after thedrill.
Analysis of the students’reports after participatingthe drill.
Matsumoto et al. (2007) Questionnaire to 84 inJapanese universities (in2004)
Surveyed the availability ofthe disaster-nursing coursein Japan. 15 schools of the61 surveyed offered disasternursing courses.
Yamamoto and Kishitani(2007)
Literature review and groupdiscussion (kind of focusgroup, as the authors didnot name this)
Survey given to 39 Red Crossschools in Japan. Based onthe philosophy of Red Crossschools, which all offer thetopic of disaster nursing, asthere are slight differencesand other schools tend tooffer the topic by combiningit with other topics, such asacute nursing. The authorspointed out that continuingeducation in practice willbe needed to bridge thesituation of disaster nursingin undergraduate courses sothat a consistency and
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xpressed this concern. They distributed questionnaires tolder people in a prefecture where the area is not only quiteemote, but also some of the areas within it experienceeavy snow in winter. The survey showed that 16% of oldereople answered that they do not have anyone responsibleor their health other than themselves. This result indicateshat these older people are likely to be living by themselvesnd may have an inadequate social network to support themn case of an emergency. For the purpose of raising aware-ess in disaster preparation, Kawahara, Hasegawa, Hanajiri,himizu, and Kawaguchi (2006) interviewed 61 families whoad a family member using community nursing services. Theethod of their study involved the more educational aspects
f raising the preparedness of various residents in the com-unity.
isaster nursing and curriculum
ine articles were chosen from this category. Seven of theine (Bouta et al., 2007; Ishikawa et al., 2006; Katahono,oshida, Matsumoto, Takahira, & Uniumi, 2007; Motoyama
Sakaguchi, 2003; Nimi et al., 2006; Oyama et al.,006; Tozawa, Takagi, Hosaka, & Yoshioka, 2007) focusedn course/topic evaluation by means of administrating a
uestionnaire to students. These questions were asked oftudents who had experienced medical intervention andursing care via means of disaster drills, although the eval-ations vary due to discrepancies in the purpose of thetudies. The result of the studies indicated positive out-musaf
continuity of education canbe maintained.
omes as a consequence of conducting drills for nursingtudents. The effectiveness of drills is discussed, with manytudies finding that drills are effective in raising the aware-ess of the drill participants, especially when comparedo those who do not undertake the drills, although biasesere observable which were closely related to who providednd who participated in the training (Williams, Nocere, &asteel, 2008). Therefore, the dispute on whether or notrills were effective may not be pertinent for discussion.nstead, the discussion needs to focus on the most effectiveethod by which to deliver training/drills, rather than on
he general effectiveness of the training/drills.Motoyama and Sakaguchi (2003) found that the students
ith the least awareness of disaster hazards correspondedery closely to a low preparedness for action in the eventf a disaster. Matsumoto et al. (2007) found that 15 out of1 schools that replied to the questionnaire distributed to4 universities offer disaster nursing topics at tertiary edu-ation level. Although 18% of the schools contacted offerisaster nursing, the authors should note that Matsumoto etl. (2007) study found the classification of disasters in Japanomewhat different to Motoyama and Sakaguchi (2003)’s,ith a strong awareness of natural hazards but less aware-ess of the man-made hazards.
Another interesting point Motoyama and Sakaguchi (2003)
ake is that the disaster nursing topics are all offered atndergraduate level. There is no information on whetherpecific, specialised disaster nursing courses are providedt post graduate level, although there are training coursesor clinical and community nurses available provided by pro-
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Disaster nursing competencies in Japanese nursing journals
fessional associations and organisations such as the NursingAssociation, the Society of Disaster Nursing, and others.
Discussion
Complexity of disaster nursing competencies
As the participants as well as the objectives of researchvaries, the authors found it anything but straightforward tooverview competencies of disaster nursing, due to the broadmeaning of competencies and how it is defined. For exam-ple, 7 searches out of 9 uncovered duplicated articles. Insome of the searches more than half the articles were dupli-cates. Co-sharing of key words implies that some article’scontexts are quite similar to other’s. Although this particu-lar literature review did not aim to review the associationbetween duplicated articles and key words, this closenessof concepts will become a further research objective.
The authors also found that lack of familiarity with termsused in practice needs more attention. As a result, theoutcome of the literature review produced three articlesdiscussing the abilities required by nurses to assess clientsat relief shelters (Fujii & Hashimoto, 2007; Ishikawa, Ushio,Mutou, Yamada, & Miyazaki, 2003; Kubo et al., 2006), withtwo articles pointing to the role of the PHN during a disastersituation (Fujii & Hashimoto, 2007; Ishikawa et al., 2003).Including these two articles, a total of three articles dis-cussed the competencies in disaster nursing as two of thearticles relate specifically to the PHN. It also reveals thatthe nature of disaster nursing covers a very broad area.
For example, the various phases from acute to chronic,whether in regard to individuals or organisations, wereall observed in this literature review. Watanabe et al.(2006) includes the various health stages and ages ofnursing, which only serves to make disaster nursingcompetencies appear even more complex (http://www.coe-cnas.jp/english/group education/core competencies.html).Garfield, Al Ward, and Nada (2008) mentioned that a com-mon set of emergency competencies could be establishedthrough consultation and discussion with WHO and itscommittee members. This particular competencies focusis centred on emergency situations; or in other words,is focused on the acute phase of the disaster cycle. Thisperspective could change if other phases of disaster, suchas recovery and development were to be included, sinceeach disaster cycle demands very different resources fromthe people and the community.
Too many competencies
Furthermore, disasters involve various agencies such ashealth professionals, personnel from NPO, NGO, local,national and international governments, as well as the mil-itary to support affected people recover and rebuild theircommunities. With the added complexity of the variousagencies’ involvement, not to mention going through all the
different phases of disaster, it is little wonder that Daily(2009) described this as a complexity of competencies indisaster nursing. She claims that problems in disaster nurs-ing competencies were due to this ‘multiple level of disasternursing involvement’, and to ‘no standardized education’,r
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s well as ‘no standards’ and the too ‘numerous compe-encies’. The issue of numerous competencies suggests thatingle organisations, medical institutions, educational insti-utions and professional associations and so forth, createheir own competencies. When the authors consider theuestions, ‘whose competencies are for what?’ and ‘whoets the competencies?’, it is obvious that there are stillome questions that remain unanswered.
As Daily’s description (2009) shows the varieties of com-etencies, the aim of these competencies expects thearious members, students and practitioners; in fact whom-oever belongs to these organisations and professionalroups to possess the abilities they describe. In other words,his is also a reflection on the public of the credibility ofhese organisations and professional groups. In the earlytage disaster situations, individual ability/capability ratherhan organisational ability/capability is often being priori-ised as it would be the case in the acute phase. Of course,t is an equally important aspect of the organisational abil-ty/capability to manage and assess situations in order torovide better support and care for those who are in needs part of the organisational mission. To achieve theserganisational missions, each individual as a member of theeam/organisation needs to be competent.
The competencies in a disaster situation could just asasily be influenced by the situation a health professionals in, not merely by the organisation in which a professionalorks. In this situation a health professional should beble to respond to the needs in any situation and provideupport/care as and when it is needed. For this reasonisaster nursing competencies need to have in place coreompetencies that will be applicable to all nurses whottend a disaster situation. Gebbie and Qureshi (2002) alsouggested the ideal of core competencies in their paper,nd emphasised the importance of identification of roleesponsibilities in case of emergency, by asking us whethere know who of us will take which role, and how we will actn various issues. In the international level of discussion,ingma (2008) reported that the ICN is in the process ofeveloping disaster nurse competencies. This movementill support to identify knowledge and skills gaps in disasterursing. Basic competencies need to be developed andhared within the nursing education curriculum, becausehe basic core competency is also a foundation from whicho develop into a registered nurse and a health professional.here were only few articles which clearly identified theompetencies in the Japanese nursing professional and istill room o investigate the competencies based on thearious disaster experiences to develop skills and knowledgeequired in these situations to contribute internationaliscussion on competencies in disaster nursing. Based onhis basic core competency, advanced competencies, whichlso could include the various areas of disaster nursing,ould also be developed in the future.
eed for more method/study, including
etrospective study in practicehe result of small number of the study on the competenciesas due to the language difference in terms of describing theapacity of nurses’ practice. Using the term ‘competencies’
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irectly in a Japanese context may not be suitable for situa-ions such as nursing management and education. To clarifyhe meaning of competencies in Japanese context, utilisingich nurses’ experience of disasters in Japan may help toease out elements of competencies required in disaster sit-ations. This process will also have a possibility to utilise asn evidence of disaster nursing competencies developmenthile the national curriculum policy has just been reviewednd there is a change of implementation of disaster nurs-ng topic required at the tertiary level of nursing educationince 2009 in Japan.
On the other hand, there are many studies on evaluat-ng the preparedness of health professionals. Preparednesss an essential element if the practitioner is able to actffectively in a disaster situation, although it offers vari-us perspectives and reflections in daily practice as well. Its also relatively accessible to conduct a study on prepared-ess.
To ascertain various competencies in disaster nursing,dditional in-depth investigations from broader perspec-ives will be required. Moreover, controlling and knowinghe boundary between the daily and the extreme situations important. In other words, nurses need to recognise, notnly investigate competencies for particular situations, butlso appreciate that these particular situations are linear tohe daily practice. If this is to be achieved, each health pro-essional should be able to self-govern any disaster situationith their acquired competency and skills.
onclusion
his paper reviewed disaster nursing competencies inapanese nursing professional journals. The findings fromhis study show the great complexity of competencies inisaster nursing, as there is not only involvement from var-ous agencies, but there are also various phases of theisaster cycle to be considered. Competencies in Japanesere not familiar term, however elements of term compe-encies such as capability, ability and preparedness ando forth were discussed in literature. There are vari-us skills and knowledge involved in disaster situationso support these complexities and developing basic coreompetencies would be extremely beneficial for nursing pro-essionals, and consequently for nursing students. Basedn various disaster experience, nurses and nursing aca-emics in Japan has further possibilities to investigatend contribute to disaster nursing area of study inter-ationally. With the clear purpose of cultivating disasterursing competencies, along with other in-depth studies,he disaster nursing competencies would gradually, by expo-ure to them on a regular basis, become more clearlyefined.
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