What was the role of nurses during the 2011 Great East Earthquake of Japan? An integrative review of the Japanese literature

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ABSTRACT

Background: An earthquake and tsunami hit the east coast of Japan on March 11, 2011. Nurses were actively involved in the health response to this disaster and, subsequently, many authors have reported on the role nurses played in these efforts in Japanese nursing professional journals.

Aim: To describe the role of nurses who assisted in the 2011 Great East Earthquake of Japan by reviewing Japanese literature and reporting the findings in English.

Method: This research used an integrative literature review methodology. Manuscripts were obtained from the Japanese database Ichushi Ver. 5 (Japan Medical Abstracts Society, Tokyo, Japan). A total of 44 manuscripts were identified and included in a thematic analysis.

Results: Three main themes were identified: (1) nursing roles, (2) specialized nursing roles, and (3) preparedness education. Nurses fulfilled different roles in the period after the disaster (ie, as a clinician, a communicator, a leader, and a provider of psychosocial support). Additionally, the specialized nurse role was identified, along with the need for preparedness education to support the nurse’s role in a disaster.

Conclusion: The understanding of the role of nurses in disasters is expanding. There is a need to further explore the roles of specialized nurses in disasters. Further disaster education opportunities should be available as a part of continuing education for all nurses. Radiation aspects of disaster assistance should be included in disaster education programs where there are radio-nuclear hazards present in the environment

Kako M, Ranse J, Yamamoto A, Arbon P. (2014). What was the role of nurses during the 2011 Great East Earthquake of Japan? An integrative review of the Japanese literature. Prehospital Disaster Medicine. 29(3):1-5.

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The role of Australian nurses in disasters: what ‘group’ of nurses should assist?

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OVERVIEW
This publication builds on the understanding of the Australian nurses role in a disaster. In particular it focuses on research conducted following the Black Saturday and Victorian Bushfires of 2009. It highlights the need for nurses from multiple disciplines to assist following a disaster.


Ranse J. (2013). The role of Australian nurses in disasters: what ‘group’ of nurses should assist? The Hive [Australian College of Nursing – newsletter publication]. (4):24-25

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Author response — Letter to the editor: Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009.

I was fortunate to have someone write a letter to the editor to my original article titled: Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009, which was coauthored with Shane Lenson. This letter to the editor was published in the journal Australasian Emergency Nursing Journal. The author make a number of observations regarding our work. 

In response to this letter to the editor, Shane Lenson and I wrote a response. This response was also published in the Australasian Emergency Nursing Journal .

The response is available here in full text

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Beyond a clinical role: nursing is disasters

This presentation highlighted the key findings of research that explored the role of nurses who participated in the Black Saturday and Victorian bushfires in February 2009. It was highlighted that the nurses’ role in providing health care during and/or following a disaster is more than a clinical care role. Nurses undertook roles including being a psychosocial supporter, a coordinator of care and resources, and problem solvers.

It was argued that this understanding regarding the role of nurses in disasters should be applied to the development of education programs, competencies and policies, with a particular focus on contextualising the education to the realities of possible disastrous scenarios that incorporates elements of coordination, problem solving and psychosocial care within a national framework. Additionally, this awareness education should be used to inform nurses about the realities of working in disaster environments.


Ranse J, Lenson S. (2012). Beyond a clinical role; paper presented at the 2nd Australian Capital Region Nursing and Midwifery Research Conference, Canberra, Australia, 11th October.

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Role of mental health nurses in disasters

This presentation provided an overview of the role of Australian nurses in disasters, both locally, nationally and internationally. In particular the focus of this presentation was on the mental health aspects of disasters - particularly from a population health perspective. Following the presentation, the group discussion focused on the role of mental health nurses in disasters.

Ranse J. (2012). Role of mental health nurses in disasters; presented to students of the University of Canberra – Postgraduate Mental Health Nursing, Canberra, ACT, 17th September.

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Role of critical care nurses in disasters

I presented to a group of students undertaking postgraduate studies in Critical Care Nursing at the University of Canberra. My presentation focused on both the in-hospital and out-of-hospital role of critical care nurses, in disasters. The presentation was a superficial overview of a number of issues associated with the health effects of a disaster, and the role of nurses in these circumstances

This presentation covered topics such as: the nurse role, willingness to assist during a disaster, disaster triage concepts, education for nurses in disaster health and other topics of consideration for emergency and intensive care nurses.


Ranse J. (2012). Role of critical care nurses in disasters; presented to students of the University of Canberra – Postgraduate Critical Care Nursing, Canberra, ACT, 11th September.

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Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009

Aim: This research explores the roles of nurses that participated in the Black Saturday and Victorian bushfires in February 2009, including aspects that influence nurses’ roles, such as prior education, training and availability of resources.

Background: It is acknowledged that nurses play an important role in disaster response and recovery. However, our understanding of nurses’ roles is superficial and commonly based on descriptions of events in which specifics relating to the nurses’ roles are embedded within other topics or issues. Similarly, aspects that support nurses in the disaster environment, including previous experience, education and the provision of resources, are not well understood.

Method: Single, semi-structured telephone interviews were conducted with 11 volunteer nursing members of St John Ambulance Australia. These interviews were electronically recorded, transcribed verbatim and thematically analysed using a well-recognised human science approach.

Findings: The thematic analysis identified two broad themes: being prepared and having an expansive role. Participants indicated that they were educationally prepared and had adequate clinical experience. They outlined that they took many resources with them; however, they were used very little, as their role consisted of minimal clinical care. Additionally, nurses performed roles including a psychosocial supporter, a coordinator of care and resources, and problem solvers.

Conclusions: The nurses’ role in providing health care during and/or following a disaster is more than a clinical care role. This understanding should be applied to the development of education programs, competencies and policies, with a particular focus on contextualising the education to the realities of possible disastrous scenarios that incorporates elements of coordination, problem solving and psychosocial care within a national framework. Additionally, this awareness education should be used to inform nurses about the realities of working in disaster environments.


Ranse J, Lenson S. 2012. Beyond a clinical role: Nurses were psychosocial supporters, coordinators and problem solvers in the Black Saturday and Victorian bushfires in 2009. Australasian Emergency Nursing Journal. 15(3):156-163. doi:10.1016/j.aenj.2012.05.001

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The role of new graduate nurses in disasters (workshop)

Shane Lenson assisted me in presenting this workshop to graduate nurses at Calvary Health Care ACT during a study day focusing on 'codes'. The workshop focused on 'code brown' or external disasters / emergencies. The workshop comprised of a short oral presentation (above) followed by a number of workshop activities. The activities focused on the role a graduate nurse may undertake during disasters. Broadly this included:
• Prioritisation of care
• Accommodating surge capacity
• Communication
• Business continuity (or continuing adequate patient care) during power, water and/or oxygen supply shortages.


Ranse J. (2011). The role of new graduate nurses in disasters; workshop presented to new graduate nurse at Calvary Health Care ACT, Canberra, ACT, 28th September.

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Exploring the role of nurses during the ‘Black Saturday’ and Victorian bushfires of 2009 in Australia

Shane Lenson presented on behalf of our research team, the key findings from our project that explored the role of nurses who assisted in the 2009 Black Saturday and Victorian Bushfires.

The Black Saturday bushfires were a series of bushfires that burned across the Australian state of Victoria. Extreme bushfire-weather conditions, resulted in Australia's highest ever loss of life and property from a bushfire. A total of 173 people died, 414 were injured, over 2030 houses, and 3500 structures were destroyed. Nurses provided clinical care, amongst other activities, in the pre-hospital environment during these fires. To date, there is a lack of literature regarding the experience of nurses in this environment. As such, this research explored the experience of nurses who assisted in the pre-hospital environment during the Victorian bushfires.

This research was descriptive and exploratory in nature using semi-structure interview as a means of data collection. Twelve nursing members of St John Ambulance Australia participated in the interviews which were electronic recorded and transcribed verbatim. Their narrative was them thematically analysed using a well-established human science approach. The findings identified two main themes and a number of sub-themes. The first theme: being prepared, included the subthemes of adequate clinical experience, appropriate level of training and enough resources. The second theme: expansive roles included the subthemes of minimal clinical care, emotional supporter, incident commander and administrator.

This research has provided valuable insight into the personal preparedness and nursing roles during the Black Saturday and Victorian bushfires of 2009. It has demonstrated that nurses are adaptable to their clinical environment and community needs, in a nursing role is that expansive beyond that of traditional images of nurses providing care in disasters.

Lenson S*, Ranse J. (2011). Exploring the role of nurses during the ‘Black Saturday’ and Victorian bushfires of 2009 in Australia; paper presented at the 9th International Conference for Emergency Nurses, Adelaide, South Australia, 29th September.

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Role of intensive care and emergency nurses in disasters

I presented to a group of students undertaking postgraduate studies in Critical Care Nursing at the University of Canberra. My presentation focused on both the in-hospital and out-of-hospital role of intensive care and emergency nurses, in disasters. The presentation emphasised that in-hospital, nurses will and should continue to practice in their normal roles. Additionally, in the out-of-hospital environment, nurses are more likely to undertake a primary health, emotional supporter and problem-solver role, than undertaking a trauma / surgical role.

This presentation also covered topics such as; willingness to assist during a disaster, education for nurses in disaster health and other topics of consideration for emergency and intensive care nurses.

Ranse J. (2011). Role of intensive care and emergency nurses in disasters; presented to students of the University of Canberra – Postgraduate Critical Care Nursing, Canberra, ACT, 30th August.

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Role, resources, and clinical and educational backgrounds of nurses who participated in the prehospital response to the 2009 bushfires in Victoria, Australia

This presentation provided an overview of research relating to the role of nurses in the pre-hospital setting of the 2009 Victorian bushfires. It highlighted that nurses undertake roles beyond that of a purely clinical nature, including: emotional support, coordination of care and problem solving. Additionally, this presentation illustrated the varied amount and type of resources taken to the disaster environment, and the usefulness of these resources.

Ranse J, Lenson S. (2011). Role, response and clinical and educational backgrounds of nurses who participated in the pre-hospital response to the 2009 Bushfires in Victoria, Australia; paper presented at the 17th World Congress on Disaster and Emergency Medicine, Beijing, China, 1st June.

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Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting

 

Background: In February 2009, bushfires devastated the state of Victoria, Australia, resulting in the loss of property and life — this event was named ‘Black Saturday’. Pre, during and post the impact of this event, health care professionals, such as nursing members of St John Ambulance Australia, provided clinical care in the pre-hospital environment. There is a paucity of literature regarding the clinical and disaster background, education and preparedness of those health care professionals who assist in similar emergencies, as such the characteristics of responders are not well understood.

Method: This research used a retrospective descriptive postal survey design, to survey nursing members of St John Ambulance Australia regarding their nursing experience; pre-hospital experience; disaster education, training and experience; and their role during the response to the 2009 Victorian bushfires.

Results: A total of 53 nurses were approached for inclusion in this research, of which 24 (45%) voluntarily participated. Males represented 46% and females represented 54% of participants. Participants had more combined years of nursing experience in the medical and surgical environments, then other areas of practice. Post-graduate critical care nursing was the primary area of completed post-graduate education. The previous disaster experience of participants was principally related to bushfire emergency response. Most participants had undertaken disaster related education, however this varied in type and duration. Similarly, most had participated in training or mock disasters; however this was commonly not related to bushfire emergencies. During the response to the Victorian bushfires, those nurses who undertook a clinical role did so at a staging area, caring for fire fighters and working with other members of their organisation. Half of the participants undertook an administrative role.

Conclusions: This research has provided insight into the characteristics and level of preparedness, of nurses who responded to the 2009 Victorian bushfires. Previously, such information has not been available in the literature. In this research, males were overrepresented when compared to the national average of nurses. The most amount of nursing experience was in the medical and surgical environment, this is consistent with national nursing workforce trends. Whilst most had clinical experience in bushfires, no training or mock scenarios focused specifically to bushfires. There is a need to explore further, the various roles undertaken by nurses during response, as this research has focused on one event — the 2009 Victorian bushfires.

Reference: Ranse J, Lenson S, Aimers B. (2010). Black Saturday and the Victorian Bushfires of February 2009: A descriptive survey of nurses who assisted in the pre-hospital setting. Collegian. 17(4):153-159

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What is the role of nursing students and faculties of nursing during disasters and emergencies? A discussion paper

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During times of disaster, the front-line nursing workforce and the health services in which they work may be overwhelmed by a surge in patient demand. As a result, assistance will be required to bolster the nursing workforce. Commonly, discussions regarding workforce supply and sustainability during disasters are isolated within particular health service institutions. The aims of this discussion paper are to; firstly, consider the potential contribution of nursing students and schools of nursing within Australian universities to increase the health workforce during a disaster, and secondly, to present a number of recommendations that universities and schools of nursing could consider in developing their own emergency and disaster plans.

Reference: Cusack L, Arbon P, Ranse J. (2010). What is the role of nursing students and faculties What is the role of nursing students and of nursing during disasters and emergencies? A discussion paper. Collegian. 17(4):193-197

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The pre-hospital role of nurses during the Victorian Bushfires

This presentation illustrated the preliminary findings from a research project that explored the role of nurses who assisted in the response and/or recovery during the 2009 Victorian Bushfires. Whilst the focus was on the role of nurses during this event, this research highlighted other interesting findings, such as; nurses often trained for disaster using mock scenarios such as, aviation accidents or CBR incidents, however, in the Australian context they are more likely to participant in a bushfire or flood event.

Ranse J, Aimers B, Lenson S. The pre-hospital role of nurses during the Victorian Bushfires; paper presented at the 7th International Conference for Emergency Nurses, Gold Coast, Australia, 8th October 2009.

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Public health care emergencies: the role of nurses volunteering

This paper provides discussion regarding the response of nurses to public health care emergencies and disasters in Australia.

Ranse J. Public health care emergencies: the role of nurses volunteering. Connections [Royal College of Nursing, Australia – newsletter publication]. 2008;11(2):15-16.

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