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RESEARCH

region is one of the worst affected, resulting in high num- bers of deaths and injuries and a great deal of personal suffering, economic loss, and environmental damage ( Usher & Mayner, 2010 ).

Japan is located in the Circum-Pacific Mobile Belt, where seismic and volcanic activities constantly occur. Al- though the country covers only 0.25% of the land area on the planet, the number of earthquakes and active volca- noes is quite high; nearly 20% of the world’s earthquakes of magnitude 6 or greater have occurred in or around Japan ( Cabinet Office, Government of Japan, 2015 ). Throughout its history, Japan has experienced extensive devastation caused by a multitude of natural disasters, including earthquakes, tsunamis, volcanic eruptions, ty- phoons, rainstorms, flooding, landslides, and snowstorms ( Early Warning Sub-Committee of the Inter-Ministerial Committee on International Cooperation for Disaster Re- duction, 2006 ). The number of deaths and missing per- sons resulting from natural disasters between 1994 and 2013 was 27,368. In 1995, more than 6,400 people died in the Great Hanshin-Awaji Earthquake, and in March 2011, more than 21,000 people lost their lives in the Great East Japan Earthquake and the subsequent tsunami ( Cabinet Office, Government of Japan, 2015 ). In Japan, these kinds of natural disasters occur on a larger scale than man-made

A disaster is an extreme disruption of the function- ing of a society that causes widespread human, material, or environmental losses that exceed the ability of the affected society to cope using only its own resources ( International Federation of Red

Cross and Red Crescent Societies, 2000 ). A disaster is defined as an acute, collectively experienced traumatic event with a sudden onset; it can be natural or man- made. ( Dominici, Levy, & Louis, 2005 ). Disasters affect more people, destroy more property, and disrupt more of the environment in which people live than ever before ( Ahayalimudin, Ismail, & Saiboon, 2012) . Worldwide dis- asters are occurring more frequently, and the Asia-Pacific

ABSTRACT The purpose of this study was to identify differences in

motivation for joining disaster relief activities as a nurse in the

future between Japanese and Korean nursing students.

A descriptive 2-group comparative study design was used.

The participants were 721 first- to fourth-year nursing

students (Japanese, n = 324; Korean, n = 397). From

June to September 2014, data were collected through a

researcher-administered questionnaire and self-reported

answers. The collected data were analyzed by descriptive

statistics, the χ 2 test, and the t test. No significant difference

was found between Japanese and Korean students in

motivation to join domestic relief activities should a disaster

occur in the area in which they lived. Compared with

Korean students, Japanese students strongly agreed that

it is necessary to carry out relief work across borders when

disasters occur in foreign countries ( p = .001). Meanwhile,

Japanese students showed less motivation than Korean

students to join relief activities in other domestic areas

and foreign countries ( p = .020). The results of this study

suggest that the motivation of Japanese students to join

disaster relief activities as nurses in the future should

a disaster occur in other domestic areas and foreign

countries needs to be increased. The results also suggest

that undergraduate students should be well prepared for

disasters through disaster nursing education, including

practical training, disaster drills, and simulation.

Key Words Disaster , Motivation , Nursing , Student

Author Affiliations: College of Nursing, The Research Institute of Nursing

Science, Seoul National University, Seoul, Republic of Korea (Dr Bang);

Oita University of Nursing and Health Sciences, Megusuno, Oita, Japan

(Drs Kuwano and Choe); College of Nursing, Eulji University, Seongnam-si,

Republic of Korea (Dr Cho); School of Health Sciences, Faculty of

Medicine, Kagoshima University, Kagoshima, Japan (Dr Yatsushiro); and

Toranomon Hospital, Tokyo, Japan (Ms Kawata).

The authors declare no conflicts of interest.

Correspondence: Myoung-Ae Choe, PhD, RN, FAAN, Oita University of

Nursing and Health Sciences, 2944-9 Megusuno, Oita, Japan, 870-1201

( [email protected]; [email protected] ).

Japanese and Korean Nursing Students’ Motivation for Joining Disaster Relief Activities as Nurses in the Future

Myoung-Ae Choe , PhD, RN, FAAN ■ Noriko Kuwano , PhD, RN, MW, PHN ■ Kyung-Sook Bang , PhD, RN ■ Mi-Kyoung Cho , PhD, RN ■ Rika Yatsushiro , PhD, RN ■ Yuki Kawata , RN

DOI: 10.1097/JTN.0000000000000291

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disasters ( Japan Statistics Bureau, Ministry of Internal Af- fairs and Communications, 2016 ).

In Korea, from 2000 to 2009, 115 disasters and 3,079 mass causality incidents (MCIs) occurred. Technical disasters/MCIs occurred more frequently than natural disasters/MCIs. The crude mortality rates for disasters and MCIs were 2.36 and 6.78 deaths per 100,000 persons, re- spectively, and the crude injury incidence rates were 25.47 and 152 injuries per 100,000 persons, respectively. The leading causes for disasters in Korea were man-made, such as road accidents, general floods, fires, and incidents at mass gatherings. Statistics show that the incidence and mortality rates of disasters/MCIs in Korea seem to be lower than those of trends around the world ( Kim et al., 2013 ).

When disasters occur, nurses and nursing students can play a significant role in caring for those who are affected ( Jennings-Sanders, Frisch, & Wing, 2005 ). In this regard, nurses and nursing students have to be better prepared for natural and/or man-made disasters. Earlier studies have indicated that nursing students are ill-prepared for disasters ( Schmidt et al., 2011 ). Nursing students have lim- itations in finding information related to disasters, and this leads to inadequate gains of knowledge associated with disaster nursing ( Jennings-Sanders et al., 2005 ). Oztekin, Larson, Yukisel, and Altun (2015) reported that under- graduate nursing students in earthquake-prone cities in Istanbul, Turkey, and Miyazaki, located in active earth- quake zone in Japan were generally ill-prepared for dis- aster events or had insufficient knowledge about disaster preparedness and response.

One way to help areas become better prepared for natural and/or man-made disasters is to educate under- graduate nursing students about disaster preparedness and response ( Oztekin et al., 2015 ). In recent years, many academic institutions have introduced disaster topics for students in disaster- or emergency-related training programs. In addition, nursing education in- stitutions have started to incorporate disaster-related subjects into their curriculums ( Alim, Kawabata, & Na- kazawa, 2015 ).

According to a previous study, self-regulation of be- havior (motivation) was found to be a significant predic- tor of perceived nurse competence to manage disasters in terms of the nurse’s willingness to assume the risk of involvement in a disaster situation ( Baack & Alfred, 2013 ). In addition to education, motivation is important because it causes a person to act. Motivation can be defined as one’s behavioral direction, namely, what causes a person to want to repeat a behavior ( Elliot & Covington, 2001 ). The motivation of nursing students to join disaster relief activities could help students to be better prepared for fu- ture disasters as nurses. However, very little research has been conducted on the motivation of nursing students to join disaster relief activities.

Today’s undergraduate nursing students will become future health care providers who play an important role in the response to disaster events. Owing to the increased incidence of natural and man-made disasters in recent years, addressing the topic of motivation in undergradu- ate nursing education has become essential.

Therefore, the aim of the present study was to explore and compare the motivation of undergraduate Japanese and Korean nursing students to join disaster relief ac- tivities as nurses in the future. Furthermore, the current study aimed to compare reasons for joining disaster relief activities between Japanese and Korean nursing students as well as to compare countermeasures against disasters used by them.

The results of this study are expected to provide infor- mation to help address both domestic and international issues regarding the development of disaster nursing cur- riculum as well as strategies to improve disaster prepared-

ness among nursing students.

PURPOSE The purpose of this study of Japanese and Korean nurs- ing students was to identify differences in motivation to join disaster relief activities as a nurse in the future.

METHODS

Study Design and Setting A descriptive two-group comparative study design was used. A cross-sectional study of 1st- through 4th-year students was conducted at four universities, two each in Japan and Korea.

Sample The total study population was 1,094 nursing students (Japanese, n = 464; Korean, n = 630). All participants consented and responded to a questionnaire survey, re- sulting in a final return rate of 74.8% ( n = 347) in Japan and 67.3% ( n = 424) in Korea. After excluding incom- plete responses and missing data, the number of partici- pants included in the final analysis was 324 (93.4%) in Japan and 397 (93.6%) in Korea.

Questionnaire Development A questionnaire was conceived and developed on the ba- sis of a review of published work ( Baack & Alfred, 2013 ; Lee, 2005 ; Matsukiyo, 2012 ). In developing the question- naire, a “nurse in the future” was defined as postgraduate registered nurse after completion of his or her nursing program. The questionnaire items were designed and developed for current undergraduate nursing students in regard to their future as postgraduate registered nurses.

The questionnaire was composed of items regarding the students’ demographics, their motivation for joining

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disaster relief activities as nurses in the future in the area where they lived and in domestic areas and foreign countries outside where they lived, the reasons why they wanted/did not want to join disaster relief activities, and countermeasures against disasters. Each item of motiva- tion for joining disaster relief activities was rated on a 4-point Likert-type scale ranging from strongly disagree (scored as 1) to strongly agree (scored as 4).

To confirm the validity of the questionnaire, we con- sulted with professors who had extensive expertise in disaster nursing. The questionnaire was translated from Japanese to Korean by a Korean graduate student who had studied in Japan and was proficient in Japanese. The Korean version of the questionnaire was back-translated by a Japanese graduate student who had studied in Korea and was proficient in Korean. Comparing the back-trans- lation with the Japanese version, all items were found to match. The Japanese version of the questionnaire was finalized after validating its comprehensibility and clarity in a pilot test with 10 students.

Ethical Considerations The study was approved by our university institutional review board before the start of data collection. The par- ticipants were informed that the survey was voluntary, that they were free to withdraw at any point without pen- alty, and that the anonymity and confidentiality of the collected data would be guaranteed.

Data Collection Convenience sampling was used to collect data between June and September 2014. The data were collected through researcher-administered questionnaires and self- reported answers. The questionnaires were administered at the end of normal classes and were collected immedi- ately after completion by the researchers.

Data Analysis The data were statistically analyzed using SPSS for Windows (version 17.0; SPSS Inc., Chicago, IL) and Microsoft Excel (EXCEL Co., Ltd., Tokyo, Japan, 2013). Descriptive statistics, the χ 2 test, and the t test were used to compare differences between Japanese and Korean students in regard to their characteristics and motivation for joining future disaster relief activities. Statistical signifi- cance was accepted as a p value less than .05.

RESULTS

Participants’ Characteristics Table 1 shows the characteristics of the Japanese and Korean nursing students who participated in the pre- sent study. The majority of the participants were female (93.2% in Japan, 88.7% in Korea), with a high propor-

tion of 3rd-year students in Japan (39.5%) and 1st-year students in Korea (26.7%). About 34.9% of the Japanese students had taken a disaster nursing course, compared with only 2.8% of the Korean students. The majority of the participants (89.2% in Japan, 90.7% in Korea) had no disaster experience. In addition, 38.6% and 64.2% of the Japanese and Korean students, respectively, had visited a foreign country. Among those who had, 86.4% of the 125 Japanese students and 51.8% of the 255 Korean students did not know which disasters occurred most frequently in the countries they had visited.

Students’ motivation for joining domestic disaster re- lief activities in the area where they lived is shown in Table 2 . Almost all students (92.6% in Japan and 92.4% in Korea) responded strongly agree or agree in regard to the need to join disaster relief activities as a nurse in the future should a disaster occur in the area where they live. Regarding the reason to join disaster relief activities, 62% of 300 Japanese students and 49.9% of 367 Korean students responded, “I want to help many people by myself.” Concerning the question, “How would you like to join disaster relief activities?,” 46.7% and 62.9% of the Japanese and Korean students, respectively, responded, “I want to be part of the rescue team as a nurse at disaster sites,” and 36.0% and 22.1% of the Japanese and Korean students, respectively, responded, “I want to care for in- jured people at the hospital where I work.” Regarding the question, “Why don’t you want to join disaster relief activities?,” 50.0% of 24 Japanese students and 30.0% of 30 Korean students responded, “Because I have no idea what I can do.”

Table 3 shows the students’ motivation for joining dis- aster relief activities in domestic areas outside the areas where they lived. Most of the students (75.0% of 324 Japa- nese students and 82.4% of 397 Korean students) respond- ed that they strongly agreed or agreed that they wanted to join disaster relief activities as a nurse in domestic areas outside where they lived. Regarding the reason to join disaster relief activities, 63% of 243 Japanese students and 41.9% of 327 Korean students responded, “I want to help many people by myself.” Concerning the question, “How would you like to join disaster relief activities?,” 60.9% and 68.2% of the Japanese and Korean students, respec- tively, responded, “I want to be part of the rescue team as a nurse at a disaster site,” whereas 15.6% and 19.3% of the Japanese and Korean students, respectively, responded, “I want to care for injured people at the hospital where I work.” Regarding the question, “Why don’t you want to join disaster relief activities?,” 40.7% of 81 Japanese stu- dents and 17.1% of 70 Korean students responded, “Be- cause I have no idea what I can do.”

The motivation for joining future international disaster relief activities as a nurse in foreign countries is depicted in Table 4 . Regarding the question, “Do you think that it

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is necessary to carry out relief work across borders should a disaster occur in a foreign country?,” 26.9% and 14.1% of the Japanese and Korean students, respectively, re- sponded that they strongly agreed, and 60.5% and 71.0%, respectively, responded that they agreed.

Concerning the question, “Would you like to join dis- aster relief activities as a nurse in the future?,” 40.4% and 60.6% of the Japanese and Korean students, respectively, responded that they agreed, whereas 47.3% and 27.5%, respectively, responded that they disagreed.

Table 5 shows differences between Japanese and Ko- rean nursing students in motivation for joining disaster relief activities. Regarding the question, “Would you like to join disaster relief activities as a nurse in the future should a disaster occur in the area where you live?,” no difference in motivation was observed between Japanese

and Korean students (mean ± standard deviation: Japa- nese students, 3.19 ± 0.57; Korean students, 3.17 ± 0.57). However, Korean students (2.98 ± 0.63) were signifi- cantly more motivated ( p = .020) than Japanese students (2.87 ± 0.66) to join disaster relief activities in domestic areas outside where they lived. Korean students (2.78 ± 0.64) were also significantly more motivated ( p < .001) than Japanese students (2.52 ± 0.71) to join disaster re- lief activities should a disaster occur in a foreign country. Compared with Korean students (2.98 ± 0.59), Japanese students (3.13 ± 0.65) significantly agreed that it is neces- sary to carry out relief work across borders when a disas- ter occurs in a foreign country ( p = .001).

A comparison of countermeasures against disasters be- tween Japanese and Korean nursing students was shown as multiple responses ( Table 6 ). More than 60% of the

TABLE 1 Characteristics of the Japanese and Korean Nursing Students in the Present Study ( N = 721)

Items Japan (n = 324),

n (%) Korea (n = 397),

n (%) χ2 p

Gender

Female 302 (93.2) 352 (88.7) 4.372 .037

Male 22 (6.8) 45 (11.3)

Grade

Freshman 54 (16.7) 106 (26.7) 44.852 <.001

Sophomore 104 (32.1) 102 (25.7)

Junior 128 (39.5) 89 (22.4)

Senior 38 (11.7) 100 (25.2)

Disaster nursing course

I am taking the course 47 (14.5) 10 (2.5) 222.815 <.001

I had taken the course 113 (34.9) 11 (2.8)

I will take the course 34 (10.5) 19 (4.8)

I have no plan to take the course 14 (4.3) 113 (28.5)

I have no idea 116 (35.8) 244 (61.4)

Disaster experiences

Yes 35 (10.8) 37 (9.3) 0.436 .509

No 289 (89.2) 360 (90.7)

Have you ever visited foreign countries?

Yes 125 (38.6) 255 (64.2) 47.093 <.001

No 199 (61.4) 142 (35.8)

Do you know which disasters occur mostly in the foreign countries where you had visited? (Japan [n = 125]a, Korea [n = 255]a)

Yes 17 (13.6) 123 (48.2) 43.796 <.001

No 108 (86.4) 132 (51.8)

aThe number of students who answered “yes.”

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Japanese students participated in school disaster drills as countermeasures against disasters. However, Korean students demonstrated a higher percentage of participa- tion than Japanese students in all other countermeasures except school disaster drills. More than 60% of Korean students confirmed that there were refugee shelters in the area where they lived and that they had methods for con- tacting their families in the event of a disaster.

DISCUSSION This study compared the motivation of Japanese and Ko- rean nursing students to join domestic relief activities as a

nurse in the future should a disaster occur in the area where they live, in other domestic area, and in a foreign country. Although no significant difference was observed between Japanese and Korean students in motivation to join relief activities as a nurse in the future should a disaster occur in the area where they live, Korean students showed signifi- cantly more motivation than Japanese students to join relief activities in other domestic areas and foreign countries.

Other studies in Japan have reported similar findings showing more motivation among Korean than among Japanese nursing students to perform volunteer disaster relief activities ( Lee & Nishikawa, 2011 ). This finding may

TABLE 2 Motivation to Join Disaster Relief Activities in the Area Where the Nursing Students Live ( N = 721)

Items Japan (n = 324),

n (%) Korea (n = 397),

n (%) χ2 p

Would you like to join disaster relief activities as a nurse in the future should a disaster occur in the area where you live?

Strongly agree 86 (26.5) 101 (25.4) 0.157 .984

Agree 214 (66.1) 266 (67.0)

Disagree 22 (6.8) 27 (6.8)

Strongly disagree 2 (0.6) 3 (0.8)

Why do you want to join disaster relief activities? (Japan [n = 300]a, Korea [n = 367]a)

Because I want to apply disaster nursing knowledge I have learned.

59 (19.7) 53 (14.4) 25.618 <.001

Because I want to help many people by myself. 186 (62.0) 183 (49.9)

Because I was damaged by the disaster in the past. 1 (0.3) 6 (1.6)

Because I think that manpower for the relief activities is deficient at a disaster site.

45 (15.0) 105 (28.6)

Others 9 (3.0) 20 (5.5)

How would you like to join disaster relief activities?

I want to care for the injured people at the hospital where I work.

108 (36.0) 81 (22.1) 20.067 <.001

I want to be part of the rescue team as a nurse at a disaster site.

140 (46.7) 231 (62.9)

I want to be part of the rescue team as a volunteer at a disaster site.

23 (7.7) 25 (6.8)

I want to be part of the psychological care team. 28 (9.3) 28 (7.6)

Others 1 (0.3) 2 (0.6)

Why don’t you want to join disaster relief activities? (Japan [n = 24]b, Korea [n = 30]b)

Because I am personally busy. 5 (20.8) 4 (13.3) 9.526 .049

Because I want to stay with my families 6 (25.0) 5 (16.7)

Because I have no idea what I can do 12 (50.0) 9 (30.0)

Because I am afraid of the second disaster 1 (4.2) 8 (26.7)

Others 0 (0.0) 4 (13.3) aThe number of students who responded “strongly agree or agree”. bThe number of students who responded “strongly disagree or disagree”.

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be due to Japanese students’ fear and hesitation result- ing from their recollection of the destruction and mass casualties that have been caused by recent earthquakes in Japan. Lee and Nishikawa (2011) indicated that the lower motivation of Japanese nursing students to perform volunteer disaster relief activities could be attributed to some extent to a vivid recollection of the Great East Japan Earthquake and subsequent tsunami.

Japan has had large-scale natural than man-made dis- asters, whereas this is opposite for Korea. Natural disas- ters include droughts, epidemics, extreme temperatures,

earthquakes, floods, tsunamis, hurricanes, volcanic erup- tions, ice storms, wind storms, landslides, and wildfires. According to the International Disaster Database (EM-DAT, 2007), man-made disasters are regarded as technologi- cal disasters resulting from emergencies such as those in industry and transportation. Man-made disasters may include complex emergencies, transport or industrial ac- cidents, material shortages, contamination of food and wa- ter, terrorist attacks, nuclear explosions/radiation, or wars.

It is unclear whether such differences in terms of dis- asters could have led to the differences in motivation

TABLE 3 Motivation to Join Disaster Relief Activities in Domestic Areas Outside From Where Nursing Students Live ( N = 721)

Items Japan ( n = 324),

n (%) Korea ( n = 397),

n (%) χ 2 p

Would you like to join disaster relief activities as a nurse in the future should a disaster occur in other domestic areas?

Strongly agree 45 (13.9) 69 (17.4) 6.493 .090

Agree 198 (61.1) 258 (65.0)

Disagree 75 (23.1) 64 (16.1)

Strongly disagree 6 (1.9) 6 (1.5)

Why do you want to join disaster relief activities? (Japan [ n = 243] a , Korea [ n = 327] a )

Because I want to apply disaster nursing knowledge I have learned.

39 (16.0) 59 (18.0) 28.728 < .001

Because I want to help many people by myself. 153 (63.0) 137 (41.9)

Because I was damaged by the disaster in the past. 3 (1.2) 5 (1.5)

Because I think that manpower for the relief activities is deficient at a disaster site.

42 (17.3) 112 (34.3)

Others 6 (2.5) 14 (4.3)

How would you like to join disaster relief activities?

I want to care for the injured people at the hospital where I work.

38 (15.6) 63 (19.3)

I want to be part of the rescue team as a nurse at a disaster site.

148 (60.9) 223 (68.2)

I want to be part of the rescue team as a volunteer at a disaster site.

34 (14.0) 19 (5.8)

I want to be part of the psychological care team 22 (9.1) 20 (6.1)

Others 1 (0.4) 2 (0.6)

Why don’t you want to join disaster (Japan [ n = 81] b , Korea [ n = 70] b ) relief activities?

Because I intentionally do not want to go to the dangerous area

16 (19.8) 18 (25.7) 11.668 .020

Because I have no idea what I can do 33 (40.7) 12 (17.1)

Because I am afraid of the second disaster 3 (3.7) 4 (5.7)

Because I think that my everyday task is a priority 26 (32.1) 28 (40.0)

Others 3 (3.7) 8 (11.5)

a The number of students who responded “strongly agree or agree.”

b The number of students who responded “strongly disagree or disagree.”

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between the two countries. In the questionnaire, disasters included both natural and man-made disasters ( Cabinet Office, Government of Japan, 2000 ). Korean students may have perceived natural disasters as vague and indirect events, which might have influenced their motivation to join relief activities in foreign countries. The lower moti- vation seen among Japanese students may have derived from their perceived incompetence regarding disaster re- lief activities and their anxiety over causing the victims more trouble ( Sachishima, Hatayoshi, Kawabata, & Michi- hiro, 2014 ).

The present study showed that compared with Korean students, Japanese students strongly agree that it is neces- sary to carry out disaster relief activities across borders when disasters occur in foreign countries. Meanwhile, in this study, Japanese nursing students showed less motiva- tion than Korean students to join disaster relief activities in foreign countries. These findings may be due to a lower motivation among students in Japan to participate in in-

ternational nursing activities. Yatsushiro, Lee, and Kadota (2008) reported that the ratio of Japanese nursing students who “wanted to work” in areas related to international nursing activities was lower than the ratio of students who had an “interest” in international nursing activities.

According to a survey conducted on new employees in Japan ( Sanno Institute of Management, 2015 ; http://www .sanno.ac.jp/research/global2015.html ), the ratio of the new employees who “do not want to work abroad” was 63.7%, the highest since 2001; this result was interpreted as being mainly due to a lack of confidence in language ability and anxiety over daily life in foreign countries, as well as a perceived incapacity for working abroad.

In the present study, Japanese students were found to have less experience visiting foreign countries than Ko- rean students. Furthermore, less than 15% of Japanese students, but about 50% of Korean students, knew which disasters most frequently occurred in the foreign coun- tries they had visited.

TABLE 4 Motivation to Join Disaster Relief Activities in a Foreign Country ( N = 721)

Items Japan (n = 324),

n (%) Korea (n = 397),

n (%) χ2 p

Do you think that it is necessary to carry out disaster relief activities across borders should a disaster occur in a foreign country?

Strongly agree 87 (26.9) 56 (14.1) 18.328 <.001

Agree 196 (60.5) 282 (71.0)

Disagree 36 (11.1) 53 (13.4)

Strongly disagree 5 (1.5) 6 (1.5)

Would you like to join disaster relief activities as a nurse in the future should a disaster occur in a foreign country?

Strongly agree 26 (8.0) 38 (9.6) 36.233 <.001

Agree 131 (40.4) 241 (60.6)

Disagree 153 (47.3) 109 (27.5)

Strongly disagree 14 (4.3) 9 (2.3)

TABLE 5 Differences Between Japanese and Korean Nursing Students in Motivation to Join Disaster Relief Activities ( N = 721)

Items Japan ( n = 324),

M ± SD Korea ( n = 397),

M ± SD t p

Would you like to join disaster relief activities as a nurse in the future?

Should a disaster occur in the area where you live 3.19 ± 0.57 3.17 ± 0.57 − 0.326 .754

Should a disaster occur in other domestic area 2.87 ± 0.66 2.98 ± 0.63 2.324 .020

Should a disaster occur in a foreign country, do you think that it is necessary to carry out disaster relief activities across borders?

3.13 ± 0.65 2.98 ± 0.58 − 3.209 .001

Would you like to participate in disaster relief activities as a nurse in the future?

2.52 ± 0.71 2.78 ± 0.64 5.011 < .001

http://www.sanno.ac.jp/research/global2015.html

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These results suggest that Japanese students have more motivation to assist in activities for domestic than international disasters. To improve their motivation to as- sist in activities for global disasters, nursing programs in Japan should work to foster students with a more inter- national outlook. Through more active participation in in- ternational activities and increased interrelationships with culturally diverse and linguistically different people, stu- dents in Japan could increase their confidence in their for- eign language ability and reduce their anxiety about work- ing abroad, ultimately developing a more global mind.

The present study also investigated the reason why students do not want to join disaster relief activities af- ter a disaster occurs; half of the Japanese and one-third of the Korean students responded that they had no idea what they could do to help. Japanese and Korean stu- dents both felt that they were not adequately prepared for a disaster. In addition, one-third and one-sixth of the Japanese students had taken or were taking a disaster nursing course, respectively, whereas only 2.8% and 2.5% of the Korean students had taken or were taking such a course, respectively.

These results indicate that compared with Japanese students, Korean students have fewer opportunities to learn disaster nursing. According to Lee (2005) , disaster nursing was introduced in Korea in the early 1990s, but people did not pay attention until around 2005. Disaster nursing is a relatively new field in Korea.

Specialized courses for disaster nursing are still very limited in the undergraduate nursing curriculum in Korea. Generally, only emergency care is offered. Few nursing students have experienced a disaster, and only 10.3% of Korean students have taken a disaster nursing course ( Hur & Park, 2015 ). In another previous study in Korea, the average disaster awareness score was 3.71 out of

5 points, and the average preparedness for disaster score was only 0.54 out of 4 points ( Woo, Yoo, & Park, 2015 ).

Moreover, the average level of core competencies for disaster nursing was 2.76 out of 5 points, and that for dis- aster preparedness was 2.14 out of 5 points, suggesting that Korean students are generally ill-prepared for a disas- ter ( Woo et al., 2015 ). In the study by Kim (2015) , 85.8% of students in Korea responded that a disaster nursing course is necessary. The results of these previous studies suggest that Korea urgently needs to develop a disaster nursing curriculum.

In Japan, disaster nursing was formally incorporated into basic nursing education in 2009 following the Great Hanshin-Awaji Earthquake and the sarin gas attack in the Tokyo subway in 1995. After these two large-scale disas- ters, the Japan Society of Disaster Nursing was established in 1998, and it has exerted great effort to develop and incorporate disaster nursing education into the nursing curriculum. Since that time, practice and research in dis- aster nursing have been developing; however, a concrete content regarding disaster nursing education and compe- tencies has not been clearly defined ( Sato, 2014 ).

According to a study by Lee and Nishikawa (2011) , 97% of Japanese nursing students have experienced an earthquake, and 270 of 271 participants responded that disaster nursing education is necessary. In another study in Japan, nursing students were found to be lack of prep- aration for disasters although they knew the importance of preparation. In addition, most of them were interested only in the emergency period, although they were high- ly aware of disasters ( Nakamura, Fujii, Sugano, & Ono, 2013 ). In the study by Sachishima et al. (2014) , only 20% of nursing students in Japan were prepared for a future disaster. Sato (2014) reported that although interest in disaster nursing is on the rise, students feel difficulty in

TABLE 6 Countermeasures Against Disasters Used by Japanese and Korean Nursing Students ( N = 721)

Items Japan ( n = 324),

n (%) a Korea ( n = 397),

n (%) a

Which countermeasures do you use for disasters? (Multiple responses)

Participation in school disaster drills 202 (62.3) 193 (48.6)

Participation in disaster drills in the area where you live 6 (1.9) 211 (53.1)

Confirmation of refugee shelters in the area where you live 60 (18.5) 275 (69.3)

Confirmation of refugee shelters near your home 61 (18.8) 275 (69.3)

Confirmation of refugee shelters near the school 30 (9.3) 182 (45.8)

Preparation of emergency disaster kit at home (foods, drugs, and flash light) 62 (19.1) 197 (49.6)

Confirmation of methods on how to contact families in the event of a disaster 58 (17.9) 243 (61.2)

a Multiple responses.

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visualizing concrete disaster nursing activities, resulting in a lack of disaster nursing competencies.

Recent studies in Korea and Japan have confirmed the findings of previous studies reporting that nursing stu- dents in each country are generally ill-prepared for dis- asters ( Oztekin et al., 2015 ; Schmidt et al., 2011 ). These findings also confirm those of other studies in which nurses were shown to be unprepared for disaster work ( Baack & Alfred, 2013 ; Johnstone & Turale, 2014 ; Zhou, Turale, Stone, & Petrini, 2015 ).

Zhou et al. (2015) emphasized that nurses, as signifi- cant first responders, should be well prepared and edu- cated to care for the victims of mass disasters. Every nurse around the world should be well prepared by means of education, training, and awareness programs ( Fung, Lai, & Loke, 2009 ). Oztekin et al. (2015) suggested that one way to become better prepared for disasters is to educate undergraduate nursing students about disaster prepared- ness and response. Findings from previous studies have shown that disaster preparedness among nursing students should be increased through education.

According to Baack and Alfred (2013) , disaster nursing should be included in the undergraduate nursing curricu- lum. Courses on disaster nursing should be a part of all nursing curricula, whether it is a stand-alone course or integrated content ( World Health Organization Regional Offices for the Western Pacific and South-East Asia, 2012 ).

Nakamura et al. (2013) suggested several practical training courses, such as attending disaster simulation training to prepare for disasters, training for triage during an emergency, and training for using an automatic exter- nal defibrillator. Furthermore, it was suggested that stu- dents should attend lectures from experts in the field of emergency preparedness and participate in existing mock disaster drills in their community.

Jennings-Sanders et al. (2005) recommended mock disaster drills or tabletop exercises, Kaplan, Connor, Ferranti, Holmes, and Spencer (2012) recommended disaster simulations, and Alim et al. (2015) recommended disaster preparedness training and disaster drills be introduced and incorporated into disaster nursing education.

Faculty support and encouragement for nursing stu- dents is essential in disaster preparedness education. Sato (2014) indicated that nursing faculty should encourage students to learn and think about their role in a postdisas- ter period on their own initiative. Nursing faculties should support and encourage disaster preparedness in nursing education ( Baack & Alfred, 2013 ).

In the present study, the countermeasures used by Japanese students were found to be different from those used by Korean students, although most of the students in both countries had no disaster experience. More than half of the Japanese students participated in school disas- ter drills as a countermeasure against disasters, whereas

more than half of the Korean students confirmed that there were refugee shelters in the area where they lived and that they had methods for contacting their families in the event of a disaster.

These results suggest that Japanese students use group countermeasures against disasters, whereas Korean stu- dents use individual countermeasures. In Japan, it is com- pulsory for schools, hospitals, factories, workplaces, and many other facilities to conduct evacuation drills. From the time they are children, Japanese people start taking part in evacuation drills, so this is something they are already used to.

In summary, both Korean and Japanese nursing stu- dents had a high level of motivation and responsibility for taking care of people in the event of a disaster, al- though they did not feel confident about their prepared- ness for disaster nursing. Especially for Japanese students, more active participation in international activities would promote their motivation to join disaster relief activities around the world. In addition, disaster nursing education including practical training, disaster drills, and simulation should be provided to increase student preparedness for disasters. This study provides information to help address issues that could promote the development of disaster nursing curricula and strategies to improve disaster pre- paredness among nursing students around the world.

LIMITATIONS The majority of the participants in the present study were found to have no disaster experience. A larger sample size and a more expansive sampling region from both countries might have provided data yielding a broader understanding regarding student motivation to join future disaster relief activities.

CONCLUSIONS This study found that motivation to join future disaster relief activities as a nurse should a disaster occur in other domestic area or a foreign country needs to be increased among Japanese nursing students. The results of this study also suggest that undergraduate students should be better prepared for disasters through disaster nursing education that includes practical training, disaster drills, and simulation.

Implications for Education and Further Research To increase motivation to join relief activities as a nurse in the future should a disaster occur in a foreign coun- try, Japanese nursing students should develop an interna- tional outlook through more active participation in inter- national activities and an increased interrelationship with culturally diverse and linguistically different people.

In addition, to increase confidence regarding their preparedness for disaster nursing, undergraduate nursing

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students should receive adequate disaster nursing educa- tion. Nurse educators need to develop strategies such as disaster simulation to better prepare students for disasters, and disaster nursing needs to be taught as a specialty in a nursing program by nursing faculty.

Further research should explore how the motivation of Japanese students to join future disaster relief activities in foreign countries might be improved after participa- tion in international activities at the undergraduate level has been implemented. Investigating the effect of disaster nursing competencies on the motivation of undergradu- ate nursing students to join future disaster relief activities is an additional area for further research.

REFERENCES Ahayalimudin , N. , Ismail , A. , & Saiboon , I. M. ( 2012 ). Disaster

management: A study on knowledge, attitude and practice of emergency nurse and community health nurse , BioMed Central Public Health , 12 , A3 .

Alim , S. , Kawabata , M. , & Nakazawa , M. ( 2015 ). Evaluation of disaster preparedness training and disaster drill for nursing students , Nurse Education Today , 35 , 25 – 31.

Baack , S. , & Alfred , D. ( 2013 ). Nurses’ preparedness and perceived competence in managing disasters . Journal of Nursing Scholarship , 45 ( 3 ), 281 – 287 .

Cabinet Office, Government of Japan . ( 2000 ). Basic act on disaster control measures . Tokyo, Japan: Cabinet Office, Government of Japan .

Cabinet Office, Government of Japan . ( 2015 ). Disaster management in Japan (pp. 1–13) . Tokyo, Japan: Cabinet Office, Government of Japan .

Dominici , F. , Levy , J. I. , & Louis , T. A. ( 2005 ). Methodological challenges and contributions in disaster epidemiology . Epidemiologic Reviews , 27 , 9 – 12 . doi:10.1093/epirev/mxi009

Early Warning Sub-Committee of the Inter-Ministerial Committee on International Cooperation for Disaster Reduction . ( 2006 ). Japan’s natural disaster early warning systems and international cooperative efforts, 1 . Retrieved September 2016, from http:// www.bousai.go.jp/kokusai/kyoryoku/pdf/soukikeikai.pdf

Elliot , A. J. , & Covington , M. V. ( 2001 ). Approach and avoidance motivation . Educational Psychology Review , 13 ( 2 ), 73 – 92 . doi:10.1023/A:1009009018235

EM-DAT ( 2007 ). The international disasters database. Retrieved February 2017, from http://www.em-datemdat.netbe/

Fung , W. M. , Lai , K. Y. , & Loke , A. Y. ( 2009 ). Nurses’ perception of disaster: Implications for disaster nursing curriculum . Journal of Clinical Nursing , 18 , 3165 – 3171 . doi:10.1111/j.1365- 2702.2008.02777.x

Hur , J. , & Park , H. J. ( 2015 ). Nursing students’ perception, competency of disaster nursing and ego resilience . Journal of Learner-Centered Curriculum and Instruction , 15 ( 8 ), 121 – 138 .

International Federation of Red Cross and Red Crescent Societies (IFRC) . ( 2000 ). Introduction to disaster preparedness—disaster preparedness training program . Retrieved September 2016, from http://www.irfc.rog/what/dp/manual/introdp.pdf

Japan Statistics Bureau, Ministry of Internal Affairs and Commu- nications . ( 2016 ). Chapter 29. Disasters and accidents . Retrieved September 2016, from http://www.stat.go.jp/data/chouki/29.htm

Jennings-Sanders , A. , Frisch , N. , & Wing , S. ( 2005 ). Nursing students’ perception about disaster nursing . Disaster Management and Response , 3 , 80 – 85 .

Johnstone , M. J. , & Turale , S. ( 2014 ). Nurses’ experiences of ethical preparedness for public health emergencies and healthcare disasters: A systematic review of qualitative evidence . Nursing & Health Sciences , 16 , 67 – 77 .

Kaplan , B. G. , Connor , A. , Ferranti , E. P. , Holmes , L. , & Spencer , L. ( 2012 ). Use of an emergency preparedness disaster simulation with undergraduate nursing students . Public Health Nursing , 29 ( 1 ), 44 – 51 .

Kim , H. J. ( 2015 ). A study on disaster preparedness, core competencies and educational needs on disaster nursing of nursing students . Journal of Korea Academia-Industrial Cooperation Society , 16 ( 11 ), 7447 – 7455 . Retrieved from http://www.Koreatimes . co.kr/www/news/nation/2015/04/116- 77843

Kim , S. J. , Kim , C. H. , Shin , S. D. , Lee , S. C. , Park , J. O. , & Sung , J. ( 2013 ). Incidence and mortality rates of disasters and mass casualty incidents in Korea: A population-based cross-sectional study, 2000–2009 . Journal of Korean Medical Science , 28 ( 5 ), 658 – 666 . doi:10.3346/jkms.2013.28.5.658

Lee , O. ( 2005 ). Disaster nursing education of Korea . International Nursing Review , 28 ( 3 ), 132 – 133 .

Lee , S. , & Nishikawa , M. ( 2011 ). Kannichi Kangogakusei no saigai to sono kyouiku ni taisuru ishiki chousa—cross-sectional study—[Perception of Korean and Japanese nursing students about disaster and disaster nursing education—cross-sectional study—] . Mathematical Systems Incarnation , Retrieved from https:// www.msi.co.jp/tmstudio/stu11contents/stu11_03.pdf

Matsukiyo , Y. ( 2012 ). Disaster prevention awareness and disaster prevention action of a nursing student living in the different area of disaster properties . The Japanese Association of Medical and Nursing Education , 21 , 39 – 44 .

Nakamura , M. , Fujii , K. , Sugano , N. , & Ono , T. ( 2013 ). Kangogakusei no saigaikangogaku rishuubetu bousaiishiki to bousaikoudou no kentou [Discussion on the disaster awareness and the preventive action for disaster among nursing students who learned disaster nursing or not] . Japanese Academy of Human Care Science , 5 ( 1 ), 55 – 60 .

Oztekin , S. D. , Larson , E. E. , Yukisel , S. , & Altun , U. G. ( 2015 ). Undergraduate nursing students’ perceptions about disaster preparedness and response in Istanbul, Turkey, and Miyazaki, Japan: A cross-sectional study . Japan Journal of Nursing Science , 12 , 145 – 153 .

Sachishima , M. , Hatayoshi , S. , Kawabata , H. , & Michihiro , M. ( 2014 ). Kango gakusei no rediness wo ikasu saigaikango kyouiku houhou no kentou [Discussion about how we improve disaster nursing education by exploiting students’ readiness] . Transcription of the Japan Nursing Association , 44 , 26 – 29 .

Sanno Institute of Management . ( 2015 ). Dai roku kai shinnyuushain no global ishiki chousa [ The 6th new employees’ global attitude survey ] . Kanagawa, Japan: Sanno Institute of Management . Retrieved September 2016, from http://www.sanno.ac.jp/ research/global2015.html

KEY POINTS

• Most nursing students in Japan and Korea are highly

motivated to join domestic disaster relief activities, which is

derived from their mission to help others.

• Japanese nursing students need to develop a more global

mind in order to increase their motivation to join disaster

relief activities around the world through more active

participation in international activities.

• To increase disaster preparedness, adequate disaster

nursing education that includes practical training, disaster

drills, and simulation should be provided for nursing

students around the world.

http://www.bousai.go.jp/kokusai/kyoryoku/pdf/soukikeikai.pdf

http://www.Koreatimes.co.kr/www/news/nation/2015/04/116-77843

http://www.sanno.ac.jp/research/global2015.html

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Sato , S. ( 2014 ). Saigai no sukunai chiiki no gakusei ga shutaiteki ni torikumu saigaikango no gakushuuseika—Higashi Nihon Daishinsai kara Manama saigaikango—[Outcome of disaster nursing education of nursing students’ learning actively in the area of few disaster—disaster nursing learned from the East Japan Great Earthquake -] . Transcription of the Japan Nursing Association , 44 , 302 – 305 .

Schmidt , C. K. , Davis , J. M. , Sanders , J. L. , Chapman , L. A. , Cisco , M. C. , & Hardy , A. R. ( 2011 ). Exploring nursing students’ level of preparedness for disaster response . Nursing Education Perspective , 32 ( 6 ), 380 – 383 .

Usher , K. , & Mayner , L. ( 2010 ). Disaster nursing: A descriptive survey of Australian undergraduate nursing curricula . Australian Emergency Nursing Journal , 14 , 75 – 80 .

Woo , C. H. , Yoo , J. Y. , & Park , J. Y. ( 2015 ). Experience, awareness and preparedness of disaster among nursing college students . Korean Review of Crisis & Emergency Management , 11 ( 11 ), 19 – 35 .

World Health Organization [WHO] Regional Offices for the Western Pacific and South-East Asia . ( 2012, August). An all- hazards preparedness approach to disasters . In Asia Pacific Emergency and Disaster Nursing Network Meeting and the Third International Conference on disaster nursing, Seoul and Daejeon, Republic of Korea, 21–24 October 2011. Retrieved October 2016 from http://www.wpro.who.int/hrh/ documents/2011_meeting_report.pdf

Yatsushiro , R. , Lee , S. W. , & Kadota , M. ( 2008 ). Nursing students’ perceptions toward international health and nursing . In The 2008 International Conference on Health People for a Healthy World, Bangkok, Thailand.

Zhou , W. J. , Turale , S. , Stone , T. , & Petrini , M. ( 2015 ). Chinese nurses’ relief experiences following two earthquakes: Implications for disaster education and policy development . Nursing Education in Practice, 15(1), 75–81 . doi:10.1016/j.nepr. 2014.06.011

http://www.wpro.who.int/hrh/documents/2011_meeting_report.pdf

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