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Japan Journal of Nursing Science (2014)

doi:10.1111/jjns.12054

ORIGINAL ARTICLE

Nursing educators perceptions about disaster preparedness and

response in Istanbul and Miyazaki
RAS,3 Serpil YKSEL4
Seher Deniz ZTEKIN,1 Eric Edwin LARSON,2 Glay ALTUN UG
5
and Sevim SAVASER
1

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.

functioning of a community or a society causing widespread human, material, economic or environmental

losses which exceed the ability of the affected community or society to cope using its own resources (The
United Nations Office for Disaster Risk Reductions:
UNISDR, 2004, p. 9). The authors will also define mass
casualty incidents (MCI) as . . . an incident that has
produced more casualties than a customary response
assignment can handle (Thomas, p. 2). Therefore,
nursing educators should be aware of the high possibility of unforeseeable disaster or MCI and be ready
to take part in disaster management situations. The

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S. D. ztekin et al.

Japan Journal of Nursing Science (2014)

purpose of this preliminary joint research is to clarify

current perceptions of nursing educators knowledge
about disaster preparedness and their willingness to
respond to possible disasters.

Disaster situation internationally

Natural disasters and its victims are increasing worldwide. With many of those affected living in Asia, countries like Japan and Turkey need to increase their
exchange of information about disaster education and
research (Ohara et al., 2012).

Disaster education internationally

In most countries, disaster-nursing education is rarely
provided at basic nursing education levels (Yamamoto,
2008). The World Health Organization (WHO) and
International Council for Nurses (ICN) (2009) indicated
that the lack of knowledge in disaster response and
management creates confusion among the responders
and delays effective humanitarian responses. Nursing
students are not the only ones lacking in the mastery of
emergency preparedness content. Nursing faculties were
found to be inadequately prepared in the field of disaster
preparedness as well (Chapman & Arbon, 2008;
Weiner, Irwin, Trangenstein, & Gordon, 2005; WHO &
ICN, 2009). Most faculty members felt they were poorly
or not at all prepared to teach disaster preparedness
content (Weiner, Irwin, Trangenstein, & Gordon, 2005).
Similar findings have been presented by researchers in
Japan in relation to faculty learning needs (Weiner,
2006; Weiner et al., 2005; Yamamoto, 2004).
Nurses are expected to demonstrate basic competency
in responding to emergencies that also include emergency preparedness and disaster response (Culley,
2010). In particular, nursing educators need to develop
strategies to prepare their students for disasters (Ranse,
et al., 2013; Schmidt et al., 2011). In addition, given the
current overall nursing shortage and to meet the increase
nursing workforce demand for disaster response, it will
likely be necessary to identify and educate a supplemental workforce, like nursing students and other healthcare
professionals, who can be cross-trained to provide
nursing care during surge emergencies (National
Advisory Council on Nurse Education and Practice
(NACNEP), 2009).
All nurses should possess minimum knowledge about
disasters and emergency preparedness, and have fundamental skills that are refined enough to incorporate that
knowledge into everyday practice when the need presents itself (Rains, 2013). Nursing faculties find it challenging to provide learning experiences that enable

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.

Disaster situation in Japan and Turkey

While Japan is known for its earthquakes, it also has
frequent flooding like Turkey (Center for Research on
the Epidemiology of Disasters [CRED], 2009; Nozawa,

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Watanabe, Katada, Minami, & Yamamoto, 2008). Since

the earthquakes of 23 October 2011 in eastern Turkey,
and 11 March 2011 in northern Japan, there is a critical
need for increased awareness in all nurses in Turkey and
Japan about MCI and natural disasters (Elgin, 2006;
Fuse et al., 2011; International Affairs Division, Miyagi
Prefectural Government, 2011; Modaressi et al., 2011;
nl, Kapucu, & Sahin, 2010; Yamamoto, 2008). The
development of knowledge and expertise related to mass
casualty (MC) education (Hilton & Allison, 2004;
Veenema, 2006; Yamamoto, 2008) is also in crucial
need.

Disaster education in Japan and Turkey

The disaster-nursing subject is basically an elective
course in Japan (Ohara et al., 2012) and nursing educators have yet to show any substantial course changes
(Gebbie, Hutton, & Plummer, 2012; WHO & ICN,
2009). Some schools of nursing in Japan have begun
courses dealing with disaster nursing. One university in
Miyazaki teaches seven classes about disaster nursing .
Istanbul University is an example of a school that has
incorporated an elective course called disaster culture
in its general curricula 2 h/week for all faculties by distance learning (e-learning) for one semester:
With the increased demands on curriculum . . . disaster
nursing education has not been a priority. There is also a
lack of confidence among faculty who feel unprepared to
teach disaster nursing. (WHO & ICN, 2009; p. 30).

Perron et al. (2010) indicated to Whittys (2006)

comments about expectations of a knowledgeable
nursing response. Unfortunately, most nursing educators have not received MC preparation and therefore
hesitate to incorporate disaster preparedness into their
nursing curricula. Less is known about postgraduate
education and the influence this has on nurses preparedness to participate in disaster relief (Ranse et al.,
2013). There is no research that demonstrates the perceptions or basic and personal knowledge levels about
disaster preparedness and their willingness to respond
to possible disasters in Miyazaki, Japan, and Istanbul,
Turkey.

METHODS
Aim
This research aims to determine the perceptions of
nursing educators on their knowledge status about
disaster preparedness and response (DP&R).

Nursing educators perceptions

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

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research team, and minor amendments were made to the

questionnaire in response to comments from the pilot
study.

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

Nursing Universitys Ethics Board in Miyazaki

approved the study. Ethical and humans rights were
approved. Permission to use the questionnaire was
granted from the directors of the affiliated nursing
schools. The researchers asked written permission from
all participants. They were then informed that the
researchers would store all information on the questionnaire confidentially and that it would only be used
for scientific purposes. Members were then assured
that their participation was voluntary and that they
could withdraw from the study at any time with no
risk of penalties. Return of the completed questionnaire was considered as implied consent. The research
was conducted in accordance with the approved protocol and there were no withdrawals or complaints
received.

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).

Roles of nurses, conflicts, and concerns in

cases of disaster events
The majority of respondents (78.5%) perceived the
caregiver role as one of nursing they could undertake.
The possibility of the existence of major concerns
about conflicts between family commitments and
nursing school obligations only averaged 44.4%, but
showed significantly higher levels in Miyazaki (72.3%;
Istanbul, 30.9%). The top ranked concern in this area
was the existence of a conflict between family and job
responsibilities (33.6%) in both cities (Table 2).

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Japan Journal of Nursing Science 2014 Japan Academy of Nursing Science

Japan Journal of Nursing Science (2014)

Nursing educators perceptions

Table 1 Nursing educators demographics

Istanbul
(n = 97)

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

SD, standard deviation.

Comparison of nursing educators

considerations and characteristics with basic
knowledge about disaster preparedness
and response
In general, age and academic levels were shown to
be statistically significant concerning basic DP&R

knowledge (P < 0.05, Table 3). Research assistants

and young nursing educators showed higher levels of
basic DP&R knowledge. Nursing educators from
Miyazaki who attended special courses on DP&R
outside of university (52.9%) had more knowledge on
DP&R rather than the others who did not attend these
courses (47.1%) (P < 0.05, Table 3). Having basic

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Table 2 Roles of nurses, conflicts, and concerns in cases of disaster events

Istanbul (n = 97)

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

Perceived roles of nurses

Caregiver
Triage
Managerial
Existence of possible major concerns and conflicts in disaster response
Exists
1. Conflicts between family and nursing school obligations
2. Family safety (information about family members location,
lack of information about family)
3. Psychological and physical effects (worrying about family vs
taking care, meeting basic needs, treatment of health problems)
Does not exist

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).

Describing the characteristics of disasters,

likelihood of natural or man-made disaster
types occurring in region currently living in,
and most serious impact of possible disasters
for nursing educators and/or families in
Istanbul and Miyazaki
Most nursing educators in both cities described characteristics of disasters as unpredictable/sudden/disorganized (77.8%). In Istanbul, responses related to
structural (50.5%) and human damage (60.8%) were
high, yet approximately one-third of the participants
had no knowledge about disaster characteristics
(27.1%) (Fig. 1).
For likelihood of disaster types occurring in both
cities, earthquake (90.7%) and flood (52.6%) were
chosen by most participants in Istanbul whereas volcanic eruption (63.8%) and typhoon (66%) were
ranked first and second in Miyazaki (Fig. 2). Death,
injury, disability, and psychological effects was ranked
as the top serious impact of a possible disaster for
nursing educators and/or family in Istanbul (70.1%;
55.6%, overall). In Miyazaki, lack of communication
with family members was ranked as the top serious
impact of a possible disaster (42.6%; 38.2% overall).
(Fig. 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

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Nursing educators perceptions

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.

undergraduate and postgraduate nursing curriculum

content on DP&R in the future.
Every nurse should be considered as a disaster nurse
because the skills required in disasters are similar to
those required on regular shifts, although the settings
are different and the resources are stretched or absent
(Gebbie, 2010). All nurses should be trained to give
support to peers and team members who may be
responding with them in MCI (Speraw & Persell, 2013).
Acute care skills are also needed to provide care specific
to the acuity level of disaster victims (Jakeway, LaRosa,
Cary, & Schoenfisch; Association of State and
Territorial Directors of Nursing, 2008; Morrison &
Catanzaro, 2010). Taking an active role in disaster man-

agement should come natural to nurses as they are in

good positions to be able to detect changes in normal
health (Chapman & Arbon, 2008; Gebbie & Qureshi,
2002). However, as this research and supporting published work suggests, this may not be entirely true. One
can only speculate that normal nursing managerial skills
can be dealt with by nurses, but these same nurses feel
reluctant to deal with disaster management.

Roles of nurse, conflicts, and concerns

In this study, the caregiver role one that participants
could undertake (Table 2). This finding was seen as
normal since the majority of nursing educators were

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Japan Journal of Nursing Science (2014)

Figure 1 Characteristics of disasters according to nursing educators in Istanbul and Miyazaki.

Figure 2 Likelihood of natural or man-made disaster types occurring in the region of current residence.

working in the division fundamentals of nursing

(Table 1). A study by Caudill (2011) shows nursing educators seem to be trusted by community members, are
viewed as caregivers, and spend much of their working
hours with patients in many different settings. If nursing
educators were feeling competent about their roles of
nursing they can perform during disasters (Ireland, Ea,
Kontzamanis, & Michael, 2006), and if basic DP&R
content was included in the nursing curriculum before
2001 (Littleton-Kearney & Slepski, 2008), more nursing
educators in this study may have also cited being able to
carry out the roles of nursing in management and triage
(Caudill, 2011; Gebbie et al., 2012; Ireland, Ea,
Kontzamanis, & Michael, 2006; Romig, 2013; Smith,
2007).
Knowledge required to adequately give disaster triage
and care for victims is generally not included in most
nursing curricula (James & Duarte, 2006). Incorporat-

ing disaster-nursing content into nursing curricula is

crucial in nursing education (Jennings-Sanders, 2004).
Therefore, research needs to aim at the content of
DP&R education and training, which also may have a
positive effect on nurses attitudes and skills in disaster
response (Arbon et al., 2006; Chapman & Arbon, 2008;
Gebbie et al., 2012; Gebbie & Qureshi, 2002; Wetter,
Daniell, & Tesser, 2001).
Nursing educators from Miyazaki felt a deeper sense
of conflict between family commitments and nursing
school obligations than their counterparts from Istanbul (Table 2). Similar findings by Yamamoto (2008) in
other parts of Japan show faculty members struggling
with professional versus family commitments. This
conflict potentially influences nursing educators
response to a disaster incident as reported earlier
(French, Sole, & Byers, 2002). In Miyazaki, nursing
educators may feel a deep sense of family commitment,

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Nursing educators perceptions

Figure 3 Most serious impact of possible disasters for nursing educators and/or families in Istanbul and Miyazaki.

empowerment, and a need to respond to the event,

regardless of what they were doing and what complexities may arise in making preparations for their
families. One suggested area of disaster education for
faculties already includes how to deal with relatives
following an MCI (Bergin & Khosa, 2007; Chapman
& Arbon, 2008; Edwards, Caldicott, Eliseo, & Pearce,
2006; Hsu et al., 2004; Nasrabadi, Naji, Mirzabeigi,
& Dadbakhs, 2007).
Caudill (2011) has demonstrated the significant deficits in nursing textbooks, both in the absence of essential
emergency preparedness content and in the presence of
outdated information. One strategy to improve emergency preparedness knowledge of faculty members is to
ensure the content included in all nursing textbooks is
accurate, evidence-based, and updated in a timely
manner. Improved texts with standardized content
would be a big educational step towards decreasing
deficits listed above.

Associations between considerations and

characteristics with basic knowledge about
disaster preparedness and response
Before 2001, few nurses received any formal education
in the areas of emergency preparedness or disaster
response (Littleton-Kearney & Slepski, 2008). Similarly,
in this study, research assistants and participants who
were 2540 years of age showed higher levels of basic
knowledge about DP&R than those who were older
than 40 years (Table 3). Clearly, DP&R content was
poor in the past. This study also showed nursing edu-

cators not responding effectively to MCI because they

lacked knowledge on personal preparedness for possible
disaster and would not consider volunteering for possible disaster response (Table 3). It is clear that nursing
universities need to collaborate with community agencies that can demonstrate how to reach out to the community and forge new relationships with nursing
educators, individuals, and groups (Wise, 2007).
Educational programs on DP&R must address existing knowledge deficits of nurses, including nursing educators (Erickson, 2001; Fitzgerald, Aitken, Davis, &
Daily, 2010; James & Duarte, 2006; Urbano, 2002;
Wisniewski, Dennik-Champion, & Peltier, 2004) and
undergraduate nursing students (Gebbie et al., 2012;
Usher & Mayner, 2011). It is estimated that if half of the
nursing population does not receive disaster content in
an undergraduate setting, they will need to receive it in
postgraduate settings through employer- and privateprovided educational packages (Gebbie et al., 2012;
Slepski & Littleton-Kearney, 2010). Disaster-nursing
content is now being included in the curricula of a few
institutions, such as at Istanbul University, but overall
they are far too few. For example, despite being a
country with a history of major earthquakes, 60% of
the nursing programs in Japan have no disaster-nursing
courses and no intention of adding a DP&R course
in the future (Gebbie et al., 2012; WHO & ICN,
2009).
In this study, nursing educators from Miyazaki who
attended special courses on DP&R outside of university had more knowledge on DP&R compared to those
who did not attend these courses. This points to the

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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

Arbon et al. (2013b) indicated in their recent findings

the willingness of 451 Australian emergency nurses to
attend their workplace during a conventional disaster. If
these nurses worked full time, had received formal education pertaining to disaster, had a family disaster plan,
and had no children, they were more willing to come to
work during hazardous times. Working in an environment in which these nurses perceived their colleagues,
managers, and organizations to be well prepared would
make their decision to work in conventional disasters a
much easier one. The authors believe that such a number
of complex factors can change nursing educators
thoughts on being a volunteer in Istanbul and Miyazaki
as well.

Characteristics, likelihood of disasters, and

serious impact of possible disasters
Nursing educators in both cities described characteristics of disasters as unpredictable/sudden/disorganized
(Fig. 1) as stated in the earlier study by Fung, Lai, and
Loke (2009). Other descriptions of disaster characteristics in Istanbul were injuries, deaths and loss of families and loss of properties. The top characteristic
of a disaster worldwide is unpredictable/sudden/
disorganized. According to the responses of the nursing
educators in this study, loss of lives/injuries and loss
of personal properties were cited as the number one
characteristic which is consistent and expected outcomes for both regions (CRED, 2009). A disturbing
finding in this study was that approximately one-third of
participants did not know the characteristics of disasters
in their area (Fig. 1). It can be only hoped that a broader
range of opinions on disaster characteristics may be
obtained by a larger scale of nursing educators who have
attended special courses on DP&R at/outside of universities in both cities.
Disaster awareness has increased among healthcare
professionals, yet the concept is relatively new to many
nursing educators in Istanbul because encounters of
major disasters seldom occur there compared to
Miyazaki. In the past 10 years, a number of unfortunate
events in Turkey and Japan have been reported in published work (CRED, 2009). The top seven disastrous
events in the past 13 years in Turkey (20002012) were
earthquakes, severe flooding, extreme temperature/
storm, mass movement, wildfires, volcanoes, and epidemics, whereas the top seven events in Japan were
typhoons, earthquakes, severe flooding, extreme temperature, epidemics, volcanoes, and wildfires. Although
there is no specific data for either city, this study showed
the top three unfortunate events being similar with the

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Japan Journal of Nursing Science (2014)

published work (CRED, 2009) (Fig. 2). These results

show that nursing educators in Istanbul and Miyazaki
are aware of the likelihood of certain disaster types in
their areas but, as stated before, lack an overall understanding of what disasters are out there.
Results further showed nursing educators in Istanbul
indicating deaths, injuries, disabilities, and physiological effects of disasters and/or damage to environment/
buildings as serious possible disaster impacts for
themselves and/or family. Results from Miyazaki show
the inability to communicate with their families as the
number one response (Fig. 3). Nozawa et al. (2008)
uncovered aspects of similar awareness and behavioral
patterns of residents in disaster areas in Japan giving
insight into what is needed for future disaster preparedness, equipment, and the potential for nursing education.
Disasters can be unpredictable, destructive, and
mostly unanticipated. Even though Istanbul seldom
experiences disasters like Miyazaki, it is by no means
immune from them. Given the geographical proximity
of both cities, nursing educators need to be prepared and
be aware of the roles of nurses during a disaster, the
importance of basic knowledge about DP&R for being a
volunteer, and characteristics of, and vulnerability, to
unpredictable disasters. Therefore, during the predisaster phase, nursing educators from Istanbul and
Miyazaki should take the opportunity to gain similar
knowledge and skills for future disaster care.

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.

Nursing educators perceptions

AUTHOR CONTRIBUTION
All authors have contributed significantly and all
authors are in agreement with the content of the manuscript.

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