The JNA Effort toward
Restoration Assistancefollowing the Great East
Japan Earthquake
2. JNA’s effort for policy proposals,
information collection/sharing/provision,and support to afflicted facilities/nurses

Japanese Nursing Association

1.

2.

The Great East Japan Earthquake and JNA’s
provision of in-person support – disaster relief
nurses
JNA’s effort for policy proposals, informationcollection/sharing/provision, and support toafflicted facilities/nurses

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The material for the second volume presents policy proposals,
information collection/sharing/provision, and support to afflictedfacilities/nurses among the activities conducted by the Japan Nursing
Association (JNA). It also describes JNA’s future actions.

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Overview of JNA Initiatives
Mar - May
2011

Provision of
in-person
support
Policyproposals
andinformationcollection/
sharing/provisionJun 2011 Mar 2012

FY2012FY2013

FY2014FY20152016 andafter

Crisis management
structure
Task force for
Establishment of a department dedicated to assistance for reconstruction
disaster
response
Dispatch of
Disaster Relief
Revision of Agreement with prefectural
Training to develop trainers
Dispatch
Nurse and its
nursing associations based on
dispatchrelated activities
guidelines the dispatch guidelines
Policy proposals
and initiative
reports

Presentation atacademic conferences

Policy proposals to the government and parties

Status surveys
Status survey of nursing
professionals in afflicted areas

Status survey of afflicted members
Participation inmeetings andinformationcollection/provisionOpinion exchange at theParticipation in the liaison council to support thenursing associations ofhealth of afflicted people
Implementation report afflicted prefectures

Public relations
Holding reconstruction forums

Support toafflicted
facilities andnursesFinancial support
to theTransportation Raising
Allocation of raised relief funds
establishment ofof relief goods relief funds
infrastructure, etc.
Support to holding
seminars, etc.

Support to nursing
qualityenhancement
Support tostrengthening thepractical
capabilities ofpublic healthnursesSupport toparticipation inacademic
conferences andto refreshing
eventsSupport to holding meetingsof administrators in afflicted
areas

Support to seminars inafflicted prefectures

Nursing quality
enhancement project

Support to strengthening thepractical capabilities of publichealth nurses in afflicted areas

Support to participationin exchange meetingsfor each nursing
professionals

Support to promoting theallocation of supervising publichealth nurses to afflicted areas

Support to participation in academic
conferences of the Japan Society of
Nursing, and holding exchange
meetings

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Policy Proposals andInformation
Collection/Sharing/
Provision

Japanese Nursing Association

5Overview of efforts for policy
proposals and for informationcollection/sharing/provision
To respond to changing situations in the afflicted regions, JNA
conducted activities to learn about the circumstances and called forassistance with recovery and reconstruction. JNA also carried out
activities to raise awareness of and interest in healthcare and nursing
in these areas among the general public and nurses.
• Sharing of information and collaboration with national and local
governments• Making policy proposals for related ministries and agencies, rulingparties and opposition parties• Communication and coordination with prefectural nursing
associations, the governmental sectors and related organizations tounderstand the actual state of the afflicted regions• Fact-finding surveys on members and member facilities to grasp
the state of damage• Participation in related meetings to share information and provide
statements• Placement of opinion ads in national newspapers and organizationof forums and other events to increase publicity

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Policy proposals and requests
JNA made policy proposals for assistance with recovery andreconstruction to the government and political parties on various
occasions. The main works were as follows.

From immediately after the earthquake to around one year later
On different occasions, JNA gave presentations about the disaster
relief nurses, made emergency proposals and submitted requests incoordination with other requesting activities.
• Proposal for reconstruction of healthcare institutions, home
based care, and healthcare activities• Proposal for support for re-employment of nurses who lost jobs
due to the disaster
Request concerning exceptional measures following the earthquake
disaster (September 19, 2012)
In view of the seriousness of the damage, exceptional measures wereintroduced with respect to healthcare covered by the national healthinsurance, the heart of Japan’s healthcare system. The measures
were intended to ease some standards so that healthcare might becontinuously provided in the afflicted areas. For nursing, somerequirements were relaxed, such as those concerning monthly
average night shift working hours and nurse staffing. It meant that asmaller number of nurses would serve more hospitalized patients
than regulated and that they would be allowed to work for morenight shift hours than regulated, suggesting that nurses in afflicted
regions could bear heavier burdens.
JNA requested that exceptional measures should not be exercised
permanently. JNA made a point that assistance was needed tomaintain positive working environment of nurses. Because thefindings of the survey conducted with JNA and the nursing
associations in the afflicted prefectures indicated nurses were
fatigued and it was difficult to secure nursing personnel despite
various efforts to provide a positive working environment.
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Policy proposals and requests(continued)
Report on JNA’s efforts for restoration assistance and proposals to
address issues in the afflicted regions (March 6, 2015)
At the ruling parties’ committees on nursing, JNA reported on its
efforts for restoration assistance and made the following proposal toaddress issues in the afflicted regions.
•

Assistance with securing, retaining, and developing nursing
personnel•

Enrichment and enhancement of support for health of
populations in the afflicted regions

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Overview of the status survey ofafflicted members
In May 2011, JNA carried out a survey of the conditions of afflicted
members in the coastal areas of the three afflicted prefectures incollaboration with the Iwate, Miyagi and Fukushima Nursing Associations.
It was accompanied by a follow-up survey in June 2014.
Background of the 2011 survey(1) Particularly just after the disaster, it was difficult to confirm if
members were safe.
(2) There were information that some members were obliged to move
due to evacuation instructions following the nuclear power station
accident and their whereabouts could not be confirmed, and othermembers faced loss of jobs or deteriorated working conditions.
Purpose of the 2011 survey(1) Checking safety and damage for members in the coastal areas of thethree afflicted prefectures that suffered multiple damage caused by theearthquake, tsunami and nuclear disaster in the Great East Japan
Earthquake(2) Obtaining information, background materials and data for offering
disaster relief money in accordance with JNA regulations(3) Obtaining information, background materials and data for considering
a way of supporting afflicted members
Background of the 2014 survey
Three years after the disaster, it remained difficult to secure and retain
nursing personnel in the afflicted regions. The survey was conducted as afollow-up to the 2011 survey.
Purpose of the 2014 survey(1) Understanding problems to be solved to secure and retain personnel
by conducting survey of actual situation of nursing personnel in the
afflicted regions(2) Obtaining basic information and data for exploring future assistanceJapanese Nursing Association

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Summary of findings of the 2011
surveyThe survey unveiled (1) damage to the buildings of facilities, (2)damage to members, (3) members’ health conditions, and (4)members’ state of working and employment.
• In 38 coastal municipalities in the three afflicted prefectures, 57.7%of the buildings of facilities were reported damaged.
• A comparison in the number of nurses including non-members in thethree afflicted prefectures before and after the Great East Japan
Earthquake (namely, March 1, 2011 and May 1, 2011) confirmed adecrease by 197 people. There were 41 nurses whose safety could
not be confirmed and 1,394 suffered damage to their houses.
• With respect to members’ health conditions, the report referred tomental symptoms, such as sleep disorders, mental strain, anxiety anddepression, as well as physical symptoms, including feelings of fatigue
and weariness, high blood pressure, pain, inflammatory symptoms
and repeated cold symptoms.

• Four hundred sixty-six (466) members left or changed their jobs, and366 were on a leave of absence.
The survey results confirmed the need for assistance as follows.
(1) Recovery of nursing functions for healthcare institutions in the
coastal areas of the three afflicted prefectures(2) Assistance for nurses: Helping healthcare institutions to secure
personnel and ensuring that nurses can continue to work(3) Assistance with employment(4) Reissuance of nursing licenses, etc.

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Summary of findings of the 2014
surveyThe follow-up survey discovered that nurses had decreased at nearly
30% of the facilities and that it was necessary to secure more nurses
at more than 50% of the facilities.
It also revealed the reality of nurses in the afflicted regions. Many
faced difficulty continuing to provide nursing to affected people withhealth problems which became complicated through disaster, as they
themselves were afflicted and suffered mental and physical damages.
It confirmed the following as issues to be addressed in the future.
(1) It is necessary to prioritize the development and support forhuman resource for nursing .
(2) The efforts to securing nurses requires involvement of thegovernmental sectors.
(3) It is necessary to offer assistance appropriate to local
circumstances.
The findings of the follow-up survey were published in the Reports
on Actual Situation of Nursing Staff at the Afflicted Areas. The main
findings are presented in some of the following pages.

Source: Japanese Nursing Association(2015) Reports on actual situation of nursing staff at the afflicted areas. (in Japanese)
http://www.nurse.or.jp/nursing/practice/reconstruction/support/research/pdf/jittaichosa_2014.pdf (accessed on January 16,2018)

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Damage to facilities(by prefecture)(incl. multiple answers)
The
nuclearpower
stationaccident

OthersNoresponse

045(17.9%)

4(1.6%)

19(7.5%)

8(21.1%)

00(0.0%)

1(2.6%)

8(21.1%)

98(90.7%)

16(14.8%)

02(1.9%)

1(0.9%)

7(6.5%)

97(91.5%)

8(7.5%)

043(40.6%)

2(1.9%)

4(3.8%)

Total
numberoffacilities

Earthquake

TsunamiTotal

252(100%)

223(88.5%)

32(12.7%)

Iwate

38(100%)

28(73.7%)

Miyagi108(100%)

Fukushima

106(100%)

Fire

According to the follow-up survey in 2014, as of March 2011, 88.5% offacilities were damaged by the earthquake, 17.9% by the nuclear power
station accident and 12.7% by the tsunami.

Source: Japanese Nursing Association(2015) Reports on actual situation of nursing staff at the afflicted areas.
http://www.nurse.or.jp/nursing/practice/reconstruction/support/research/pdf/jittaichosa_2014.pdf (accessed on January 16,2018)(in Japanese)

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Change in state of operation offacilities(unit: no. of facilities)

2011 Survey(May 1st, 2011)2014 Survey(June 1st, 2014)

Total no.
of
facilities

Normaloperation

Partly inoperation

Temporarilyclosed

374

284

45

15

9

24

100%

75.9%

12.0%

4.0%

2.4%

6.4%

252

233

14

1

2

2

100%

92.5%

5.6%

0.4%

0.8%

0.8%

Noresponse

ClosedThe 2014 survey showed that 92.5% of the facilities were operating
normally.

Source:Japanese Nursing Association (2012) Efforts of Japanese Nursing Association at the time of the Great East Japan Earthquake.
http://www.nurse.or.jp/nursing/practice/reconstruction/support/research/index.html (accessed on January 16, 2018) (in Japanese)
Japanese Nursing Association(2015) Reports on actual situation of nursing staff at the afflicted areas.
http://www.nurse.or.jp/nursing/practice/reconstruction/support/research/pdf/jittaichosa_2014.pdf (accessed on January 16,2018)(in Japanese)

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Number of facilities by change in number ofnurses on duty and change in number ofnurses(by prefecture and by district)

Overall

Iwate

Miyagi

Fukushima

Total No.
offacilities

Decreased

No change

IncreasedThechange ofnursesnumber

250

74

64

112

349

100%

29.6%

25.6%

44.8%

38

13

10

15

100%

34.2%

26.3%

39.5%

106

30

29

47

100%

28.3%

27.4%

44.3%

106

31

25

50

100%

29.2%

23.6%

47.2%

▲54

152

251

*the data used were limited to facilities which provided valid response for no. of nurses both as ofMarch 2011 and June 2014 .
*▲ indicates decrease

According to the findings by district in Fukushima Prefecture, 11
facilities in the Iwaki district saw a decrease in nurses, and five of the
12 facilities in the Soso district were severely affected by the accident
at the Fukushima Daiichi Nuclear Power Station and saw a decreasein nurses.
Source: Japanese Nursing Association(2015) Reports on actual situation of nursing staff at the afflicted areas.
http://www.nurse.or.jp/nursing/practice/reconstruction/support/research/pdf/jittaichosa_2014.pdf (accessed on January 16,2018)(in Japanese)

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Collection of information forrecovery and reconstruction
through nursing associations inafflicted prefectures
The nursing associations in the afflicted prefectures, namely Iwate,
Miyagi and Fukushima, organized meetings of nursing
administrators in afflicted healthcare facilities. They mutuallyshared issues faced by their respective facilities and continually
discussed activities for recovery of nursing functions. JNA collected
information and understood the needs through these meetings
held in 2011 and planned an assistance initiative towards recovery
and reconstruction for fiscal 2012.
These meetings paved the way for monitoring how subjects andopinions changed over time. The first meeting discussed actions
taken by facilities and the feelings of nursing administrators during
their efforts. Half a year later, they began discussing the difficultyof securing nursing personnel, desirable assistance for nurses withmental disorders and afflicted people, and future disaster control
measures.

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Liaison Council to Support the
Health of Afflicted People
JNA made necessary policy proposals in collaboration with relatedorganizations.
In April 2011, the Liaison Council to Support the Health of Afflicted
People* made up of organizations related to healthcare and nursing
was set up in response to a request from the Headquarters forSpecial Measures to Assist the Lives of Disaster Victims in theJapanese government.
The purposes of the Council were, firstly, to respond to healthcare
needs in afflicted places and to ensure the long-term dispatch of thehealthcare team, and secondly, to grasp the needs for ensuring
health in evacuation centers and elsewhere in afflicted areas and to
take required actions to ensure the health of afflicted people, such as
infectious disease prevention.
JNA took part in this Council to regularly share and exchange
information, which led to the policy proposals.
*At the time of 2016 Kumamoto Earthquake, the Council was also
held as an opportunity of information sharing among healthcare andnursing organizations providing response action and assistance.

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Creation of educational materials
on nursing to address radioactive
hazards
Titles of Materials• Nuclear Disasters and Roles of Nurses: Correctly Understanding
Health Hazard of Radioactivity• Nuclear Disasters and Roles of Nurses: The Way to Estimate
Exposed Dose - Exposed Dose is Significant to Health Hazard• Nuclear Disasters and Roles of Nurses: Health Counseling for
Expecting Mothers

The accident at the Fukushima Daiichi Nuclear Power Station had
such a large social impact that it caused health concerns for locals
and reputational damage.
JNA created educational materials on nursing to address radioactive
hazards on the fifth day following the occurrence of a disaster inorder to provide nurses with accurate knowledge the impact ofradiation on health and about what action to take to address them.
The materials created were sent to the prefectural nursing
associations and the Ministry of Health, Labour and Welfare. These
videos were also posted on our website.

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Public relations

The Daily Yomiuri March 11, 2012

After the Great East Japan Earthquake, JNA provided information about
its efforts and those of nurses in afflicted regions through “JNA News”
provided to its members.
On March 11, 2012, just one year after the earthquake, JNA placed anadvertisement in a newspaper to make widely publicize for society andits members its disaster relief activities and those of nurses that had
supported healthcare in the afflicted regions.
The advertisement was designed to encourage readers to think again
about healthcare and nursing after the disaster based on nurses’
activities for supporting health care in the afflicted areas, such as how
they felt, what actions they took and how they should learn from thisexperience for future nursing. JNA also placed ads reporting nurses’
activities in a national newspaper on the occasion of the third (featuring
the restoration forum; see the following page for its details) and fifth
anniversaries.
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Public relations:
The Great East Japan Earthquake
Restoration Forum
Three years after the Great East Japan Earthquake, JNA organized
Restoration Forum 2014: Current Nursing in Afflicted Areas. It aims
were to share information on nursing practice in the wake of a disasterin order to explore the capabilities and new potential of nursing; toempower nurses and those who provide assistance in afflicted areas;
to inform young people who will play active roles in future generations
and many members of the public about the appeal of nursing; and tohelp secure and develop nursing personnel. It attracted 831
participants, including general public, nurses, those engaged inassistance to afflicted people and reconstruction assistance, andnursing students. The forum served as an opportunity to share theroles of nurses and new possibilities.

Forum participants looking at the exhibits.
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JNA’s Efforts:
Support to Afflicted
Facilities and Nurses

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Overview• As an initial response immediately after the disaster, JNA began toprocure, transport and distribute relief goods.
• JNA raised relief funds for financial assistance for afflicted people,
purchase of relief goods and dispatch of Disaster Relief Nurses.

• To ensure that the funds would be used fairly for the public good,
JNA established a committee for consideration of the allocation offunds. The committee discussed the policy and method of
allocation and distributed the funds.

Japanese Nursing Association21

Procurement, transport anddistribution of relief goods

As an initial action immediately after the disaster, JNA began to procure,transport and distribute relief goods.
The procurement of supplies commenced on March 14, 2011. JNA
received a good deal of supplies from about 38 organizations. To avoid
concentration of large quantities of the same materials in certain places,
JNA transported and distributed sorted goods to destination by buses
which transported disaster relief nurses.
Relief goods were so wide-ranging that they included hygiene materials to
be used by nurses in afflicted areas for prevention of infectious diseases
as well as toilet paper, diapers, toothbrushes and other daily necessities.
Gloves, masks, and other hygiene materials were in high demand toaddress dust from the huge volume of rubble caused by tsunami, in
addition to act as preventive measures against influenza, norovirus andother infectious diseases.
One month after the evacuation, there was a sudden increase in bed
sores among those requiring long-term care. Appeals made mainly by
Certified Nurses in Wound, Ostomy and Continence Nursing led to theprovision of bed sore products.
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Relief funds
JNA raised relief funds from March 14 to July 15, 2011 forfinancial assistance for afflicted people, purchase of relief
goods and dispatch of Disaster Relief Nurses. Contributions
came broadly from members, non-member nurses,
businesses, organizations and individuals as well as fromoverseas nursing organizations and individuals.

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Allocation of relief funds
Relief funds phased allocation plan (Fiscal 2011)
Phase 1
(1) Dispatch of Disaster Relief Nurses(2) Support for initial activities of nursing associations in the afflicted
prefectures(3) Support for dispatch activities from neighboring prefectures(4) Support for activities by prefectural nursing associations accepting
evacuees from inside and outside their respective prefectures
Phase 2
Restoration of nursing departments in hospitals, visiting nursing stations,and healthcare sections in public health centers, municipal governments
and health and welfare centers
Phase 3
Restoration of nursing education institutions and nursing functions ofcare and welfare facilities
Phase 4
Restoration of home based care (visiting nursing stations without
members)
Relief funds covered expenses related to dispatch of Disaster Relief Nurses,
recovery of nursing functions of healthcare institutions in coastal areas in
Iwate, Miyagi and Fukushima Prefectures suffering particularly serious
damage and support for restoration of home based care.
To ensure that the funds raised would be used fairly for the public good,
JNA established a committee for consideration of allocation of funds
including outside experts. The committee organized a basic policy anddiscussed a phased allocation plan, areas and facilities for allocation,
beneficiaries, and methods of calculation and they were finally approved
by JNA’s Board Meeting.
For the restoration of healthcare institutions, relief funds were distributedon a facility-by-facility basis. Eligible facilities were asked to reallocate
funds provided to (1) restoration of their nursing functions and to (2)afflicted nurses, irrespective of member or non-member status.
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Activities on allocated relief funds
Funds allocated to:Funds spent on:

13 visiting nursing stations

Reconstruction of visiting nursing
stations

Five general incorporated
associations

Support for expectant mothers andmothers and children

Four medical corporations

Health assistance for afflicted people
and others

Three individuals

Exhibition of photos of activities forsupporting afflicted people, etc.

11 others, such asuniversities and businesses

Relaxation, volunteer performances,etc.

JNA implemented activities on allocated relief funds in fiscal years
2012 and 2013. The committee for consideration of allocation offunds discussed which entities the funds should be allocated fromamong those corporations, organizations and others engaging in
supporting afflicted people and in activation of home-visit nursing,which applied in answer to open invitation. Consequently, funds wereallocated to a total of 36 organizations, specifically to 10
organizations in Iwate Prefecture, 13 in Miyagi Prefecture, and 13 inFukushima Prefecture. They were spent on event-type andcommunity-based support for afflicted people and restoration ofvisiting nursing stations.
Amid various difficulties, individual entities were encouraged by thefunds to carry out activities that matched local circumstances.

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JNA’s Efforts:
Support for Securing,
Retaining andDeveloping Personnel

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Overview
JNA worked to provide assistance in securing, retaining anddeveloping nursing personnel.
After the Great East Japan Earthquake, it continued to be difficult tosecure and retain nursing personnel, which was a serious problem. It
was also necessary to support afflicted nurses who were on leave or
had left their jobs for returning to nursing. JNA endeavored to secureand retain nursing personnel.
Even one year after the quake, those who spent a life as evacuees
and those unable to regain ordinary life needed help. Due toprolonged life in temporary housing and elsewhere, secondary healthproblems of afflicted people became severe, such as social
withdrawal, depression, and alcohol-related problems. JNA worked todevelop personnel to improve the quality of nursing, discouragenurses from quitting their jobs, and encourage measures to retain
nurses.
Three years after the disaster, regional gaps in the level of recovery
began to emerge among different afflicted areas. To provide
comprehensive and continuous care that matched the needs of theafflicted people, nurses were required to provide high quality nursing
practice. However, they were not given opportunities to be fully
trained due to shortage of human and financial resources. JNA
continued to support nurses to participate in academic conferences
and hold workshops aiming to provide educational opportunity andimprove nursing skills.

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Assistance in securing and retaining
nursesNurse Center supports restoration through securing nurses.
Job listing in Iwate >Job listing in Miyagi >Job listing in Fukushima >Website of E-Nurse Center (at present) https://www.nurse-center.net/nccs/ (accessed on December 12, 2017)

Since 2011, the year of the Great East Japan Earthquake, JNA has been
providing assistance in securing nurses at job-seeking facilities in the
afflicted prefectures in conjunction and collaboration with the Nurse
Centers* of prefectural nursing associations (as of February 2018).
Continued difficulty in securing nurses in the afflicted prefectures after thedisaster developed into a serious issue. In Iwate, Miyagi and Fukushima
Prefectures, which suffered particularly severe damages, job opportunities
at healthcare institutions with a shortage of nurses are published on eNurse Center** as special information in a bid to advertise nursing jobs tojob seekers across the country to secure nurses in the afflicted regions.
JNA provided assistance in organizing the nursing job fair and the Fukushima
Prefecture hospital tour held in 2012 by the Fukushima Prefectural
Government.
* Nurse Centers refer to a free job placement service offered by prefectural nursing associations.
** e-Nurse Center is a website with the functions of Nurse Centers.
Japanese Nursing Association28

Project to support improvementof nursing quality
The project aiming to ensure nursing quality and secure and retain
nurses was conducted in fiscal 2012.
Background: In hospitals based in Soso district of Fukushima Prefecture,
their healthcare service system experienced difficulties immediately
after the district was afflicted, because the inhabitants and healthcare
professionals evacuated due to radioactive contamination.
JNA interviewed hospitals in Soso district and learned that Onoda
Hospital faced difficulties keeping nursing provisional system andhospital management. Recognizing the necessity to provide support
that leads to nursing quality improvement instead of mere support for
securing nurses with a view towards future enrichment of local
healthcare services, JNA held discussions with Onoda Hospital andcarried out a project to assist the area in infection control.
Overview of Onoda Hospital:
Approximately 25 km from Tokyo Electric Power Company’s Fukushima
Daiichi Nuclear Power Station, its location was designated as an
emergency evacuation preparation zone. After the evacuation ofhealthcare workers due to radioactive contamination, the number ofnurses decreased from 78 before the disaster to 62 and the number ofbeds in operation also fell from 199 to 93.
Purpose: Establishment of a model of assistance for securing andretaining nurses aimed at boosting job motivation and helping them tostay at their current jobs.
Targets:(1) Enhance practical nursing skills of nurses in infection control(2) Increase self-efficacy of nurses(3) Boost job motivation of nurses and help them stay at nursing jobs
through (1) and (2)Japanese Nursing Association

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Project to support improvementof nursing quality
Period: From mid-September 2012 to March 2013
Method: Dispatching a Certified Nurse in infection control once aweek (19 times total) to Onoda Hospital to support nursing
Main Points of Nursing support:(1) Organization of in-hospital committee on infection control
measures(2) 30-minute lecture held at lunchtime for all personnel(3) Guidance and practice on a tour of the hospital ward
Results:
The Certified Nurses gave assistance in infection control activities
that brought about positive changes, such as regaining responsibility
for nursing and motivation for learning.
This project was highly regarded and the Fukushima Prefectural
Government earmarked a budget for implementation of operations
using this scheme within the prefecture. The Fukushima Nursing
Association is commissioned to implement the project for nursing
capacity building support in healthcare institutions.

Japanese Nursing Association30

Support for enhancement of practicing
capabilities of public health nurses
In Fukushima Prefecture, support was provided for four years, from fiscal
year 2012 to 2015, to enhance the practicing capabilities of public healthnurses.
In Japan, nursing professionals with a national license, called public healthnurses, are in charge of preventive and health promotion activities in thelocal communities. They can intervene before a problem arises.
Background: In afflicted areas, especially in coastal areas, unemployment
was a big problem. Some families were forced to live separately. For
example, fathers were unable to leave the areas for work while the rest of
the family left to avoid the impact of radioactivity coming from thecrippled nuclear power plant. Under these circumstances, a variety ofhealth problems were latent and observed, such as stress, post traumaticstress disorder (PTSD), abuse, depression, alcohol-induced disorders andobesity. Public health nurses working in the communities were urged toaddress these new health problems, and assistance was needed for thereconstruction of local care systems.
JNA carried out interviews in fiscal year 2011 to clarify the current statusof public health nurses in evacuated areas due to the nuclear plant
accident and what assistance was required. Providing support for afflictedpeople, public health nurses were afflicted themselves and had toaddress successive health problems that arose. It was necessary toprovide them with opportunities to increase self-efficacy and mutual
support.
Purpose: Enhancing practical capabilities and increasing self-efficacy of
public health nurses
Details: JNA provided support for the organization of case study meetings.
(A psychiatrist and a public health nurse who excelled in consideration ofcases meetings were dispatched to provide support.)
Japanese Nursing Association31

Support for refreshing event
In June 2012, JNA invited afflicted nurses to the exchange meetings
by areas of nursing profession (Public Health Nurses, Midwives andNurses) that followed the JNA Annual General Convention andsubsequently organized a social gathering to allow them to refreshthemselves physically and mentally.
One year after the Great East Japan Earthquake, nurses in the
afflicted regions engaged in nursing under harsh circumstances while
they themselves were afflicted. JNA repeatedly explored what
support could be provided and planned the refreshing event for
afflicted nurses. In association with the 1995 Great Hanshin-Awaji
Earthquake, there was evidence that leaving the affected areas once
would lead to reinvigoration. Therefore, the event was aimed at
prompting them to leave their afflicted areas to join JNA meeting andothers as an exchange with other nurses.
The participants attended the exchange meeting by areas of nursing
profession about the current states and problems in their interest
areas of nursing profession. At the social gathering, information on
damage and the current conditions in each afflicted prefecture wereshared and the necessity to continuously provide mutual support
among nurses was reconfirmed.

Then-President of JNA listening attentively to the story of nurses at the social gathering.
Japanese Nursing Association32

Support for participation inacademic conferences
For supporting education of the afflicted nurses, JNA provided
support for their participation in the Conference of the Japan
Society of Nursing which we organized, from 2013 to 2015.
Background: The nurses were so busy with everyday duties thatthey were unable to acquire new information or techniques on
nursing and to review their own nursing work. It was also difficult
for them to take part in learning opportunities.
Purpose: Providing nurses working in afflicted with opportunities tolearn the latest nursing trends and to reflect on their own nursing
which may lead to increased learning motivation and improved
everyday nursing practice.

Eligibility: Nurses in Iwate, Miyagi and Fukushima Prefectures
Details: JNA offered financial support that covered the expenses forparticipation and others. At the venue, a booth featuring restorationfrom the Great East Japan Earthquake was set up to give them an
opportunity to present their own experience in suffering and their
nursing activities. They reported the actual state of the afflicted
regions and exchanged with other participants.

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Guidelines for the Developmentof Disaster Preparedness
Manuals for Delivery Facilities
JNA published the “Guidelines for the Development of Disaster
Preparedness Manuals for Delivery Facilities” (hereinaftertheGuidelines) in 2013.
Given that support for pregnant and puerperal women and newborns
was not necessarily sufficient under conditions with extensive andserious damage, JNA carried out a survey for learning facts and sortingout issues about post-disaster assistance and disaster control measuresat delivery facilities. The survey revealed that a limited number had
manuals on action taken at delivery in the event of a disaster, although
the healthcare facilities had a disaster response manuals. Regarding thematter as an urgent issue, JNA developed the Guidelines.
One lesson learned from the disasters suggests that action should bedone at ordinary times, in daily work and on a routine basis. Preparationof a manual and everyday drills will be helpful for quick decision andaction in the wake of a disaster.
The Guidelines covers actions to be taken for about three months fromoccurrence of a disaster. It consists of three chapters: (1) a manual foreveryday preparations, (2) a manual for action immediately after adisaster, and (3) a manual for medium- and long-term support.
JNA created the Guidelines instead of a manual itself because wethought that the approach for preparation of manual would varydepending on the roles and functions of delivery facilities.

Source：Japanese Nursing Association(2013) Guidelines for the Development of Disaster Preparedness Manuals for Delivery Facilities , Tokyo.
http://www.nurse.or.jp/nursing/josan/oyakudachi/kanren/sasshi/pdf/saigaitaio-ing.pdf (accessed on January 16, 2018)

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Towards the Future

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Future issues in restoration
assistance for the Great East
Japan Earthquake
JNA has conducted various activities for restoration assistance andgenerated some positive outcomes. Meanwhile, we have learned
valuable information and suggestions from these activities. The following
describes three issues in future restoration assistance.
1. Issue on securing personnel
Efforts made by individual facilities for securing nurses has limitations. It
will continue to be an issue that needs to be addressed in collaboration
with local governments and prefectural nursing associations.
The coastal areas in Iwate, Miyagi, and Fukushima Prefectures were
devastated by the Great East Japan Earthquake. In these areas, it was
already difficult to secure nurses before the disaster, and the disastermade this issues even more apparent. A regional gap is beginning tooccur on the path and the pace of recovery. The afflicted prefectures areworking to somehow secure and retain nurses. JNA distributes
information on the efforts concerning securing and retaining personnel
and its free job opportunity website continues to offer support.
2. Issue on prolongation of evacuation life
Long-term evacuation life increases the risk of onset of noncommunicable diseases. Continuously suffering from stress about life
and the economy, PTSD, feelings of isolation and frustration followingchanges in lifestyle, alcoholism, abuse and others, afflict people thatremain in these situations and are far from being resolved.
For future health support for afflicted people, it is necessary to form a
network among community health and healthcare and welfare services
to disseminate information and raise awareness about the prevention of
non-communicable diseases, mental health and opportunities for healthcheckups among afflicted people, and to have highly individualizedinteractions with them. While the recovery work continues, it is essential
to build new communities in an effort to restore the viewpoint of watch
over by all generations as cultivated in conventional communities.
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Future issues in restoration
assistance for the Great East
Japan Earthquake (continued)
3. Support for afflicted facilities and nurses
It is vital to ensure opportunities that allow nurses who experienced
an unprecedented disaster to discuss it for future generations, as
appropriate.
Sharing the experience of nursing at the time of disaster and thereality of ongoing situation of nursing continuously is not only
passing on the mission of nursing but also preventing people fromforgetting the experience and raising awareness of disaster
preparedness. JNA received many comments from afflicted nurses
who participated academic conferences through JNA’s support aspart of its restoration assistance. The comments mentioned that it
was good opportunity for them to talk about their experiences andnursing practice under threat which made nurses without such
experience to draw on afflicted nurses’ experience and raised
awareness of their disaster preparedness. Many of the nurses maderemarks that the opportunity to talk about helped them to organize
their thoughts and to realize the importance of communicating theexperience.

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JNA’s preparations for future
large-scale disasters 1
1. Incorporation of lessons learned into enhancement of the disaster
relief assistance structure with safety and effectiveness
It is necessary to continue efforts to improve the efficacy of assistancein accurate risk evaluation and high quality disaster relief assistance
while building collaborative relations with local governments and with
the national government and experts. It is challenging to streamline acrisis management system in the event of a disaster while fully
understanding the limit of preparations under normal conditions.
A good deal of highly reliable information is essential for theconsideration of assistance and measures in the wake of a disaster.
Sharing information on needs for nursing in afflicted areas is significant.
It is required to establish the solid collaboration among the government,
related organization and prefectural nursing associations within disaster
control head quarters launched in an afflicted prefecture in the event ofdisaster in order to share and provide information. Therefore, it isuseful to build relations under normal circumstances.
With regard to Disaster Relief Nurses, prefectural nursing associations
have various underlying conditions, such as their roles in the event ofdisasters and the number of registered Disaster Relief Nurses. JNA
needs to keep these diverse context in mind and always share favorable
way to dispatch Disaster Relief Nurses with the top priority on ensuring
their safety with prefectural nursing associations across the country as
JNA dispatches Disaster Relief Nurses in the case of a large-scaledisaster.
JNA will work with prefectural nursing associations in close relation
with local governments to develop a system in the event of a disasterand to help nursing associations in afflicted prefectures to act at thetime of a disaster.
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JNA’s preparations for future
large-scale disasters 2
2. Development of personnel who practice disaster nursing
In preparation for any large-scale disaster, it is necessary to develop
personnel concerned with disaster drills and disaster relief activities
and to otherwise enhance the operational aspect.
The level of satisfaction with JNA’s existing training on disaster nursing
is high. However, a wider scope of training content is requested, suchas specific examples of collaborations among different professions that
could take place in afflicted areas and skills to treat afflicted people inevacuation centers in which the circumstances continuously change.
JNA will consider changing the training for the better to ensure thatthe activities of Disaster Relief Nurses will be conducted safely andeffectively.
Nurse administrators at hospitals and other facilities will cooperate indispatching Disaster Relief Nurses in the event of a disaster. If theirregions are afflicted, they will direct the assistance from outsiders. JNA
will consider future management of nursing at the time of disaster byreferring to the actions of prefectural nursing associations alreadyconducting training and more. JNA will also explore enhancing
capabilities of management in disaster nursing.

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JNA’s preparations for future
large-scale disasters 3
3. Policy proposals and collection and provision of information
In the wake of a large-scale disaster, it is necessary to swiftly
understand the needs in afflicted areas, to share information withthose concerned, and to make policy proposals and requests.
JNA will push ahead with its study on measures to quickly andefficiently learn the needs in collaboration with nursing associationsin afflicted prefectures. While it is significant to swiftly grasp theneeds of the afflicted members and to consider and implement
necessary assistance, it is often the case that the consideration isconducted after direct assistance in afflicted regions. During theGreat East Japan Earthquake, the survey was conducted two months
after the occurrence. JNA will consider presenting core items andformats of gathered information to nursing associations in afflicted
prefectures as well as what assistance it should provide.
After the Great East Japan Earthquake, systems are being developed
to distribute information on healthcare and welfare needs of afflicted
local governments and to share assistance activities of different
organizations. JNA will continue to disseminate the disaster relief
activities by JNA and prefectural nursing associations to relatedorganizations and society. JNA will also discuss with relatedorganizations the issues of supporting, securing, and retaining nurses,
continuous assistance in health management in afflicted regions, andthe establishment of a collaborative assistance system.

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Conclusion
JNA has closed down the department dedicated to disaster relief
actions in association with the Great East Japan Earthquake, but JNA
will continue to engage in activities that lead to assistance inrecovery and restoration.
JNA’s disaster relief focuses on support for afflicted nurses by nurses.
In the long process of recovery and restoration, necessary nursing
provided by nurses in afflicted regions will help to revitalize theafflicted areas. In Japan, more large-scale earthquakes andsubsequent tsunamis are expected to occur. JNA will learn from theexperience and lessons on the recent occasion and move forwardwith preparations for future disasters.

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Resources• Japanese Nursing Association (2012) Efforts of Japanese Nursing Association at the timeof the Great East Japan Earthquake.
http://www.nurse.or.jp/nursing/practice/reconstruction/support/research/index.html(accessed on January 16, 2018) (in Japanese)• Japanese Nursing Association (2017) Report on JNA activity of reconstruction assistancefor the Great East Japan Earthquake – moving side by side toward future.
http://www.nurse.or.jp/home/publication/pdf/2017/reconstruction_report.pdf (accessedon January 16, 2018) (in Japanese)• Japanese Nursing Association. Dispatch guidelines for disaster relief nurses.
http://www.nurse.or.jp/nursing/practice/saigai/pdf/hakenyoryo.pdf (accessed on
January 16, 2018) (in Japanese )• Japanese Nursing Association(2015) Reports on actual situation of nursing staff at theafflicted areas.
http://www.nurse.or.jp/nursing/practice/reconstruction/support/research/pdf/jittaichosa_2014.pdf (accessed on January 16, 2018) (in Japanese )• Japanese Nursing Association (2013) FY 2012 activity of reconstruction assistance for theGreat East Japan Earth quake- Report on “ Project to improve of nursing quality” at thehealth care facilities located in Soso area of Fukushima prefecture. ( in Japanese)• Japanese Nursing Association(2013) Guidelines for the Development of Disaster
Preparedness Manuals for Delivery Facilities , Tokyo.
http://www.nurse.or.jp/nursing/josan/oyakudachi/kanren/sasshi/pdf/saigaitaio-ing.pdf(accessed on January 16, 2018)• Japanese Nursing Association; Actual situations of affected JNA members in Iwate, Miyagi
and Fukushima(Interim Report), 2011.
http://www.nurse.or.jp/jna/English/pdf/interim.pdf (accessed on January 16, 2018)

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