Professional Documents
Culture Documents
doi:10.1111/jjns.12054
ORIGINAL ARTICLE
Division of Surgical Nursing, Florence Nightingale Faculty of Nursing, University of Istanbul, Istanbul, 3Division of Surgical
Nursing, School of Health, University of Mersin, Mersin, 4Division of Surgical Nursing, Bolu Health School, University of
Abant Izzet Baysal, Bolu, 5Health, Family, Labor and Social Affairs Commission, Istanbul Senate, Ankara, Turkey and
2
Miyazaki Prefectural Nursing University, Miyazaki, Japan
Abstract
Aim: As healthcare professionals, nursing educators need to be prepared to manage and deliver care in what
are often dangerous conditions. This research aims to determine and compare nursing educators perceptions
of disaster preparedness and response (DP&R) in Istanbul and Miyazaki.
Methods: An 18 question descriptive questionnaire was used.
Results: One hundred and forty-four nursing educators representing two state university nursing schools in
Istanbul, Turkey, and one state and two private universities in Miyazaki, Japan were enrolled. Educators had
an average age of 40 years and had been educators for 115 years. Just over half of the participants had basic
knowledge regarding DP&R with most of them considering taking special courses in the future. The
majority considered caregiver as a role they could undertake in a disaster situation. The existence of major
concerns and conflicts in disaster responses were low. The top ranked item was in the area of conflict
between family and job responsibilities. Age and academic levels showed significant differences in basic
knowledge on DP&R. Regardless of knowledge in this subject area, no statistical significance on personal
preparedness or being a volunteer to disaster events was found.
Conclusion: Nursing educators were not thinking about what kinds of disasters occur in the areas where
they currently teach and were underprepared to deal with disaster situations. To improve the perceptions of
the nursing educators on DP&R, mass casualty care and disaster management skills need to be incorporated
into formal education and training on disaster preparedness and workplace preparedness.
Key words: disasters, emergency preparedness, nursing faculty, perception, response.
INTRODUCTION
General introduction: defining key terms
For the purpose of this paper, the authors employed a
definition of a disaster as a serious disruption of the
Correspondence: Seher Deniz ztekin, Istanbul niversitesi,
Florence Nightingale Hemsirelik Fakltesi, Cerrahi
Hastalklar Hemsireligi Anabilim Dal gretim yesi,
Abide-i Hrriyet cd. Sisli Istanbul, Turkey 34381.
Email: doztekin@istanbul.edu.tr; oztekin.deniz@gmail.com
Received 17 June 2013; accepted 12 March 2014.
S. D. ztekin et al.
students to use appropriate assessment, clinical judgment, and decision-making skills during disasters, MCI,
and other emergency situations (Culley, 2010). Perhaps
the greatest reason why nursing educators find it difficult to provide learning experiences for their students is
their own lack of information in this area.
Nursing educators are accountable for their students,
communities, and society at large to prepare graduates
who can work in an environment where the potential for
disasters is no longer a probable event (Whitty &
Burnett, 2009). However, many nurses lack the confidence in preparedness to respond to emergency management situations (Mosca, Sweeney, Hazy, & Brenner,
2005; WHO & ICN, 2009).
Review of previous disaster response efforts reveals
that patients are frequently transferred without
adequate triage and patient distribution to existing
healthcare facilities is often grossly unequal and not
coordinated (Auf der Heide, 2002; Auf der Heide, 2006;
Romig, 2013; Veenema & Woolsey, 2013). Thus, all
nurses should have sufficient knowledge and skills to
recognize trauma, injury, or illnesses that are disasterrelated, intervene appropriately, and conduct basic
assessment and triage in emergency situations (Rains,
2013; Romig, 2013).
Nurses, in particular, are ideally positioned to assume
new roles related to disaster response with nursing
curricula as a key area where the teaching of these new
skills should operate. Disaster-related roles of nurses
may involve responding to emergencies, detecting
threats, providing direct patient care, managing healthcare teams and facilities, reducing or eliminating injuries
and deaths, developing health policies, conducting
research, and working in collaboration with other organizations including the military (Perron, Rudge, Blais, &
Holmes, 2010).
Ohara et al. (2012) conducted research in 205 universities from 11 countries in Asia to study how disaster
nursing is introduced at nursing schools. Results from
the survey show many respondents wishing to share
lessons learned from Japan. With similar types of disasters in Turkey and Japan, nursing educators in Istanbul
and Miyazaki should be aware of the high possibility of
unforeseeable disasters and be ready to take part in
disaster management situations.
METHODS
Aim
This research aims to determine the perceptions of
nursing educators on their knowledge status about
disaster preparedness and response (DP&R).
Research design
A descriptive design was used for the study (Polit &
Beck, 2008).
Settings
Five universities; two state universities in Istanbul,
Turkey, and one state university and two private universities in Miyazaki, Japan, participated in the study.
Sample
A convenience sample targeting Turkish and Japanese
nursing educators consisted of 171 participants (Istanbul, 120; Miyazaki, 51). One hundred and forty-four
nursing educators (Istanbul, 97; Miyazaki, 47) participated in the study with a return rate of 84% (Istanbul,
80.8%; Miyazaki, 92.2%).
Instrument
No existing published and validated tool was available
to measure DP&R knowledge status for nursing educators for this study. As such, the questionnaire was based
on the professional expertise of the research team and
themes from the existing published work (Chapman &
Arbon, 2008; Corrigan & Samrasinghe, 2012; Fung,
Loke, & Lai, 2008; Gebbie & Qureshi, 2002; Hilton &
Allison, 2004; Jennings-Sanders, 2004; ONeill, 2005;
Weiner et al., 2005; WHO & ICN, 2009; Yamamoto,
2008).
The questionnaire domains focused on prior education specific to disasters, basic knowledge about DP&R,
types and impacts of disasters according to nursing educators, likelihood of disasters occurring in the two cities,
perceived personal preparedness, and a willingness
to respond to possible disasters as volunteer nursing
educators.
The questionnaire was formulated in English. It was
then translated into Japanese and Turkish. Language
validity was established following a review of the questionnaire in English by a panel of two experts in emergency health care and disaster response. Two different
language expert translators ensured validity across two
different languages (Turkish and Japanese) and confirmed that the questionnaire was understandable for
participants. Slight modifications for clarity in Turkish
and in Japanese were made and then pretested in a pilot
study group of nursing educators from Japan and
Turkey (n = 20, 10 from each country). They were asked
whether or not the questions were understandable and
appropriate for the purpose of the study. The results of
the pilot study were summarized, discussed by the
S. D. ztekin et al.
Data collection
Questionnaires were hand delivered to the deans of
the participating universities nursing schools. Deans
planned to distribute the questionnaires to 171
nursing educators by using staff notice boards. One
hundred and forty-four questionnaires were completed
anonymously.
Data from nursing educators were collected through a
questionnaire between May and July 2012 in Istanbul
and Miyazaki. Paper-based questionnaires are readily
distributed, easy to complete, and obviate researcher
bias (Jirojwong, Johnson, & Welch, 2011). The questionnaire used in this research was designed to be brief,
taking less than 10 min to complete. The paper-based
questionnaire was completed by participants and
returned to a secure locked box within the participants
workplace. The questionnaires in both cities were collected roughly a week later by the researchers due to
the different workloads of the participating nursing
educators.
Data analysis
The characteristics of the participants, roles of nurses,
conflicts, and concerns in cases of disaster events, characteristics of disasters, likelihood of natural or manmade disaster types occurring in the region of current
residence, and most serious impact of possible disasters
for nursing educators and/or families were determined
using descriptive statistics, including frequency of categorical values, numerical values, and mean and standard deviation. Associations between the basic
knowledge status about DP&R with characteristics of
participants (age, years worked as nurse, and academic
level), attending a special course about DP&R, knowledge about personnel preparedness for a disaster event,
and being a volunteer in disaster response were assessed
using 2-tests (Pearsons, continuity correction, Fishers
exact test). Data obtained in the study were evaluated
using IBM SPSS software for Windows 10.0 (SPSS,
Chicago, IL, USA) and MS Excel 2003 (Microsoft,
Redmond, WA, USA) and were evaluated at a 95%
confidence interval. P < 0.05 was considered statistically
significant.
Ethical perspective
Istanbul University Cerrahpasa School of Medicines
Ethics Board in Istanbul and Miyazaki Prefectural
RESULTS
Nursing educators demographics
Most participants were women (96.5%), aged 2540
years (56.9%). They had an average age of
40.01 10.04 years and had been working for up to
15 years. In Istanbul, most of the participants (n = 60;
61.9%) were research assistants, had Ph.D. qualifications, and were working in either medicalsurgical
nursing or obstetric and gynecologic nursing (20.6%);
in Miyazaki, however, most participants were working
in fundamentals of nursing (53.2%). Of the nursing
educators in Miyazaki, 57.4% were lecturers and 30
(63.8%) had licenses and bachelor degrees and had no
basic knowledge about DP&R (63.8%), while 60.8%
of participants in Istanbul showed knowledge in
DP&R. In general, most nursing educators considered
taking special courses on DP&R in the future
(Miyazaki, 83%; Istanbul, 69.1%; total, 73.6%)
(Table 1).
Miyazaki
(n = 47)
Total
(n = 144)
Characteristics
Mean
SD
Mean
SD
Mean
SD
Age (years)
37.27
8.67
45.68
10.38
40.01
10.04
N
Age groups (years)
2540
4155
56
Sex
Female
Male
Years worked as nurse educator
15
610
1115
>15
Academic position
Research assistant
Assistant professor
Associate professor
Professor
Lecturer
Educational degree
License and bachelor
Masters
PhD
Division currently working in
Medical surgical nursing
Obstetric and gynecologic nursing
Public health nursing
Fundamentals of nursing
Psychiatric nursing
Pediatric nursing
Administration in nursing
Nursing education
Geriatric or adult nursing
Basic knowledge about disaster preparedness and response
Yes
No
Willingness to take special courses on disaster preparedness and response
Yes
No
65
29
3
67.0
29.9
3.1
17
18
12
36.2
38.3
25.5
82
47
15
56.9
32.6
10.4
97
100.0
42
5
89.4
10.6
139
5
96.5
3.5
9
22
14
52
9.3
22.7
14.4
53.6
17
11
11
8
36.2
23.4
23.4
17.0
26
23
25
60
18.1
22.9
17.4
41.7
60
19
9
5
4
61.9
19.6
9.3
5.2
4.1
11
1
2
6
27
23.4
2.1
4.3
12.8
57.4
71
20
11
11
31
49.3
13.9
7.6
7.6
21.5
37
60
38.1
61.9
30
4
13
63.8
8.5
27.7
19
41
67
13.2
28.5
46.5
20
20
18
11
9
7
6
6
20.6
20.6
18.6
11.3
9.3
7.2
6.2
6.2
5
7
25
3
1
10.6
14.9
53.2
6.4
2.1
12.8
20
25
25
36
12
8
6
6
6
13.9
17.4
17.4
25.0
8.3
5.6
4.2
4.2
4.2
59
38
60.8
39.2
17
30
36.2
63.8
76
68
52.8
47.2
67
30
69.1
30.9
39
8
83.0
17.0
106
38
73.6
26.4
S. D. ztekin et al.
Miyazaki (n = 47)
Total (n = 144)
79
47
42
81.4
48.5
43.3
34
13
6
72.3
27.7
12.8
113
60
48
78.5
41.7
33.3
30
30
18
30.9
34.9
20.9
34
20
14
72.3
31.7
22.2
64
50
32
44.4
33.6
21.5
20
23.3
12.7
28
18.8
67
69.1
13
27.7
80
55.6
Multiple choices were marked. Multiple replies (Istanbul, 68; Miyazaki, 42; total, 110) were given.
knowledge about disaster preparedness showed no statistical significance on the knowledge about personal
disaster preparedness (P = 0.56) and considerations
about volunteering for possible disasters (P > 0.05,
Table 3).
DISCUSSION
Demographic factors
Younger ages, having doctorate degrees, more years in
the educational nursing field, and working in the fundamentals of nursing division were important factors for
basic knowledge about DP&R. However, the current
basic knowledge level in this study may be less than
hoped for because most participants did not have such
basic knowledge but were considering taking courses on
DP&R in the future (Table 1). Reasons for this outcome
may be due to the majority of the respondents graduating before 2001. Littleton-Kearney and Slepski (2008)
indicated that most nurses graduating from schools
before 2001 have wide gaps in their knowledge of disaster care. Before 2001, few nurses received any formal
education in the areas of emergency preparedness or
disaster response.
The American Association of Colleges of Nursing (as
cited in Stanley et al., 2008) stated that all nurses
should be trained to respond to chemical, biological,
radiological, nuclear, and explosive events as part of
their beginning education. Also, the International
Nursing Coalition for Mass Casualty Education
(INCMCE) (2003) (as cited in Weiner et al., 2005) surveyed 2013 deans or directors of 348 nursing schools
in regards to their curricula for emergency preparedness prior to 11 September 2001. Of the participants,
75% thought their nursing faculty was inadequately
prepared for disaster management. Based on the published work review, these findings indicate the importance of developing continuing education, and
Table 3 Comparison of nursing educators considerations and characteristics with basic knowledge about disaster preparedness
and response
Basic knowledge about disaster preparedness and response
Istanbul
Yes
Characteristics, basic knowledge, and considerations
Miyazaki
No
Yes
N
Total
No
Yes
N
No
N
Characteristics
Age (years)
2540
43 72.9 22 57.9
7
41.2 10 33.3 50 65.8 32 47.1
41
16 27.1 16 42.1 10
58.8 20 66.7 26 34.2 36 52
2, P, d.f.
1.719, 0.190, 1
0.049, 0.824, 1
5.136, 0.023, 1
Years worked as nurse
110 years
23 39.0
8 21.1 11
64.7 17 56.7 34 44.7 25 36.8
educator
>10 years
36 61.0 30 78.9
6
35.3 13 43.3 42 55.3 43 63.2
2, P, d.f.
2.642, 0.104, 1
0.053, 0.818, 1
0.642, 0.423, 1
Academic level
Research assistant
40 67.8 20 52.6
4
23.5
7 23.3 44 57.9 27 39.7
Assistant professor
12 20.3
7 18.4
1
5.9
13 17.1
7 10.3
Associate professor
2
3.4
7 18.4
1
5.9
1
3.3
3
3.9
8 11.8
Professor
2
3.4
3
7.9
4
23.5
2
6.7
6
7.9
5
7.4
Lecturer
3
5.1
1
2.6
7
41.2 20 66.7 10 13.2 21 30.9
2, P, d.f.
7.778, 0.100, 4
5.575, 0.233, 4
11.729, 0.019, 4
Attended special courses at/outside of university about disaster preparedness and response
At the university
Attended
14 23.7 12 31.6
8
47.1
8 26.7 22 28.9 20 29.4
Not attended
45 76.3 26 68.4
9
52.9 22 73.3 54 71.1 48 70.6
2, P, d.f.
0.381, 0.537, 1
1.204, 0.273, 1
0.000, 1.000, 1
Outside the university
Attended
6 10.2
6 15.8
9
52.9
3 10.0 15 19.7
9 13.2
Not attended
53 89.8 32 84.2
8
47.1 27 90.0 61 80.3 59 86.8
2, P, d.f.
0.255, 0.614, 1
8.386, 0.004, 1
0.674, 0.412, 1
Having basic knowledge about personal preparedness for a possible disaster event
Knowledge
Having
30 50.8 23 60.5 14
82.4 21 70.0 44 57.9 44 64.7
Not having
29 49.2 15 39.5
3
17.6
9 30.0 32 42.1 24 35.3
2, P, d.f.
0.527, 0.468, 1
0.342, 0.558, 1
0.443, 0.506, 1
Considerations about being a volunteer fellow in community disaster response efforts in a possible disaster event
Being a volunteer
Considering
55 93.2 34 89.5 17 100
28 93.3 72 94.7 62 91.2
Not considering
4
6.8
4 10.5
0
0.0
2
6.7
4
5.3
6
8.8
P
0.384
0.402
0.304
Continuity correction. Pearson 2-test. Fishers exact test. d.f.: degrees of freedom.
S. D. ztekin et al.
Figure 2 Likelihood of natural or man-made disaster types occurring in the region of current residence.
Figure 3 Most serious impact of possible disasters for nursing educators and/or families in Istanbul and Miyazaki.
S. D. ztekin et al.
fact that special courses taught outside of the universities in Japan are effective in gaining knowledge for
nursing educators. An educational and research
program supported by the Japanese Government,
entitled Disaster Nursing in a Ubiquitous Society in
Japan, has been conducted throughout Japan from
2003 to 2007. This program has facilitated the development of various networks for disaster nursing,
disaster-nursing care strategies, and disaster-nursing
education (Yamamoto, 2008). Replication of these
activities related to disaster nursing should be organized globally to meet nursing educators educational
needs (Yamamoto, 2008) and to identify how expected
learning outcomes can be properly assessed (Chan
et al., 2010; Gebbie et al., 2012).
There is a reasonable public perception that schools of
nursing have a responsibility to adequately prepare their
students (Veenema, 2006; Veenema & Woolsey, 2013).
In this study, having basic knowledge about disaster
preparedness showed no statistical significance on personal disaster preparedness about DP&R and considerations about being a volunteer for possible disasters
(Table 3). The decision to attend work or not during a
disaster includes a number of complex personal, workrelated, and professional factors that can change,
depending on the type of disaster, preparedness of the
work environment, and the emergency nurses personal
responsibilities (Arbon et al., 2013a). Arbon et al.
(2013a) indicated three major themes that influenced a
willingness to work during a disaster. Theme one
reflected on the uncertainty of the situation, such as the
type of disaster. The second theme surrounded the preparedness of the workplace, emergency nurse, and colleagues. The third theme considered personal and
professional choice based on home and work circumstances and responsibilities. In fact, positive outcomes
on becoming a volunteer and thoughts on personal preparedness may improve nursing educators confidence
and their understandings of the importance of their roles
of nursing during a disaster event (Hsu et al., 2004;
Jennings-Sanders, 2004).
Similarly, it was reported that motivation for attending
training sessions on disaster preparedness was of a personal and professional matter where nurses felt that they
had a responsibility to be trained and prepared for disaster events (Chapman & Arbon, 2008; Wetta-Hall,
Fredrickson, Ablah, Cook, & Molgaard, 2006). Arbon
et al. (2006) found that 80% of the nurses who volunteered in the SumatraAndaman earthquake and tsunami
did so for the first time and were inexperienced and
educationally unprepared for such a large-scale disaster.
10
CONCLUSION
Disasters can be unpredictable, destructive, and mostly
unanticipated. Given the geographical proximity of both
cities, nursing educators need to know what types of
disasters are prevalent in the areas where they work, be
prepared to deal with these disasters, and be aware of
the roles of nurses during a disaster. Nursing educators
therefore have an obligation to become educated about
disasters in order to teach them to their students. Therefore, during the pre-disaster phase, nursing educators
from Istanbul and Miyazaki should take the opportunity
to gain knowledge and skills for future disasters.
CONFLICT OF INTEREST
The content has not been published or submitted for
publication elsewhere. The authors declare that they
have no financial or personal relationship with people or
organizations that could inappropriately influence this
work. No conflicting interests exist for any authors.
AUTHOR CONTRIBUTION
All authors have contributed significantly and all
authors are in agreement with the content of the manuscript.
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