神戸大学 大学教育推進機構 大学教育研究
第 18 号（2009 年度） 2009 年 9 月 30 日発行：29−55

Developing a disaster nursing educational program based on theexperiential learning theory

米谷 淳・畑 吉節未・畑 正夫

Developing a disaster nursing educational program based on
the experiential learning theory
Kiyoshi Maiya (Kobe University)
Kiyomi Hata (Kobe Tokiwa University)
Masao Hata (Hyogo Prefecture)
Introduction
A certain nursing school was requested to assist in routine disaster drills by adisaster core hospital in Hyogo Prefecture. Determining that this would be an
excellent opportunity for disaster nursing education, the nursing school experimented
with an experiential learning theory-based educational program, in which
educational intervention would be made both before and after the disaster drills. This
paper provides records of the experiment and the results of a questionnaire survey
and group sessions, and then examines the effectiveness of this educational program.
1. Background
1) The present state of disaster nursing education as a part of basic nursing education
In order to respond appropriately to the kinds of unprecedented disasters thathave frequently occurred in recent years and mitigate any resultant damage, it isessential to make provisions during normal times.1 With the introduction of disasternursing education to all basic nursing education curricula imminent in 2009, it has
become urgent to develop an adequate and effective disaster nursing program into
these curricula. In relation to this, the necessity of an experience-based learning
program on the occasion of routine disaster drills, in particular, has been pointed out.2
Even in 2004, nearly a decade after the Great Hanshin-Awaji Earthquake, only five
percent of the curricula in basic nursing education had a course in “disaster nursing,”
and barely more than twenty percent offered such a course as a part of some othercourse. The course is seldom included in general curricula outside of those designedby the Japanese Red Cross Society.3 Reports have been made on studies aimed atdeveloping a curriculum for disaster nursing 4, 5 and on practical examples in which
triage training is incorporated into an educational program; 6-20 in those cases,

students are given the experience of playing the roles of patients and their families,
7-15

as well as nurses and members of a rescue crew or medical team. 9, 13, 14Students who participated in these programs gave positive feedback overall, sayingthat they “gained a better idea of the state of disaster and how patients would behave
at such a time”; 8, 19 the program “provided motivation to study and a strong desire tolearn, completely changing the atmosphere of the class”; 11, 14-6 and the program helped
students to “learn efficiently.” 8, 15 On the other hand, some pointed out that“experiential learning requires a well thought out plan,” 5 and “students may learn
different things depending on what role they played.” 8 Still others suggested that
improvements be made by “having students acquire fundamental knowledge on
disaster nursing and prepare for the drills beforehand so as to enhance the effects ofthe drills”; 7, 10 “having them participate from their first year”; 15 and “ensuring ex post
facto approaches by instructors and offering opportunities for the students to sharewhat they learned with their peers.” 12, 14, 16
2) Experiential learning and the jigsaw classroom
Experiential learning is often used for adult education in the United States 21 andhigher education in the United Kingdom.22 In nursing education as well, thesignificance and effects of educational programs based on the experiential learningtheory have been widely recognized.23 According to the experiential learning theory,22,24experiences help learners to grow and develop as they learn while following thefour-stage cycle of “concrete experiences -> group reflection -> theorization andconceptualization based on literary documents -> concrete experiments (-> concrete
experiences ->…).” Following this theory, a disaster nursing educational program inwhich disaster drills are incorporated should preferably include these four stages.
This approach provides the basis for the authors’ on-going attempt to develop an
effective educational program for nursing students.
Students are given opportunities to play the roles of patients and their families in a
triage drill given at a hospital. The authors wished to discover whether suchopportunities could be used to enhance students’ interest in disaster nursing and if
what they have learned and noticed through their experiences could be fed back to
subsequent basic education in nursing more generally and, if such a process ispossible, how it can be conducted effectively. In order to give these issues properconsideration, the authors have developed and duly implemented a disaster nursing
educational program which incorporates triage drills at a disaster core hospital.
Through experiential learning,22 learners may broaden and deepen their experiencein a group session for reflection, by comparing their own experiences with others’ andthen seeing them in a new light in response to questions from instructors. It would
not be enough for learners to simply put their own experiences in writing or report
them. The most important element here is having discussions with others who haveshared the same experiences, with the instructor serving as a facilitator.
Unfortunately, there is a risk that playing the role of a patient and his or her family
can have adverse effects on students.8 In order to prevent this from happening, and toensure that students will not form a one-sided view of disaster nursing from any
fragmentary information that they have acquired from a drill that is both
extraordinary and difficult to organize frequently, it would be necessary to have thembe exposed to many different perspectives, share their experiences with all of theother students, and take action that will assist them in their subsequent learning anddevelopment. In more concrete terms, during group reflection of their experiencesfrom a disaster drill, having students who have played the same role conduct a
discussion can deepen their experiences, but at the same time create the risk of
having their views become one-sided. The concept of a jigsaw classroom, 25 which isadopted in primary and secondary education, is considered one such action to prevent
this. 26 Introducing the jigsaw classroom into the reflection stage could help students
broaden, deepen, integrate, and synthesize their understanding of the various
experiences that they underwent during a disaster drill. Based on this assumption, it
was decided to introduce the jigsaw classroom method into the ex post facto learningof a disaster nursing educational program for nursing students, out of considerationof the psychological impact that the disaster drill might have on participating
students.
2. Development of educational / training programs
1) Status of the disaster nursing educational program
For nurses to be able to act appropriately in the time of a disaster, postgraduate
education alone is insufficient, and so something must be done from the early stagesof basic nursing education. It would be effective for students to learn about disasternursing from classroom lectures and literary documents and then participate in a
drill, playing the roles of patients and their families, or medical staff. Such experience
will help them to better understand those whom they nurse (the state of mind thatpatients and their family members are in, changes in patients’ symptoms and healthconditions) and also the role that the nursing profession is expected to play (the role ofnurses, patient-nurse relationships, the function of nurses in a medical team).
For these reasons, it has been deemed essential to develop and put forward an
educational program based on the experiential learning theory, so that students’experiences will be of better use in basic nursing education.
2) Development of a program based on the experiential learning theory
Gibbs (1988) cited the following seven requirements for successful experiential
learning: 22(1) Learner’s “initiative” to learn actively based on his or her own ideas andassumptions (guaranteeing spontaneity)(2) Learner’s selective reflection on his or her experience “from a criticalperspective”(3) Learner’s “commitment” to the process of exploring his or her experience andlearning(4) Securing of a margin for the learner to exercise some “independence” bydevising appropriate experiences for the learner(5) Guarantee of “methodicalness” that takes into account the structure whereinlearning takes place(6) Development of conditions for the learner to feel a “sense of fulfillment”(7) “Selection of teaching methods” for each stage of the cyclical sequence ofexperiential learning
In Figure 1, the educational program that the authors have developed is correlated
to the learning cycle of the experiential learning theory. If this educational program
were to be explained according to the four stages of experiential learning describedearlier, it would be comprised of the following:(1) “Preparatory learning,” consisting of the acquisition of knowledge and concepts
through books and lectures, and drill orientation

(2) “Preparation” for the drill(3) Actual “drill”(4) “Reflection” following the drill

Fig.1 Educational program cycle throughout the entire disaster drill process
Preparatory learning
Students are given lectures on topics such as the definitions and types ofdisasters, the basics and methodology of triage, and the roles of nursing in the timeof a disaster, and also watch videos of triage drills, thus encouraging them todevelop a picture of what such a drill would be like. At this time, students will havealready been assigned the roles of patients in mild, moderate, or serious condition,

or their family members. In order to ensure that students may actively learn about
the medical condition of the patient and the state of mind of the family member
whose role they have been assigned, and that the students will not receive the drill
with only the partial view on disaster nursing that they have formed from books
and lectures, they are taught a carefully-selected set of specific knowledge, allowed
a margin for self-learning, and guaranteed the opportunity for independent
learning. Students are also briefed on the drill planning so that they can develop
an overall picture of the drill program.
Preparation for the drill
Students are encouraged to attempt to conceive beforehand the state of mind
that a patient would be in and the emotions that would arise in the patient. They
are also encouraged to develop a plan concerning how they will play the role of apatient or family member and what kind of action they will take if assigned therole of a nurse, so that they are able to actively participate in the drill. The
students are then grouped by role, and they present their plans to the groupmembers for discussion. Meanwhile, the instructors concentrate on their role asfacilitator so that the students can feel a sense of fulfillment through voluntary
participation, ensuring that interaction within a group is fully taken advantage of.
Drill
At the beginning, instructors tell students to “concentrate and role-play as they
have thought out beforehand,” so as to ease their tension and relax them before thedrill. Instructors will keep their involvement to a minimum in order to draw out
students’ initiative and independence, but still closely observe student behavior
with attention being paid to students’ state of mind throughout the session.
Reflection
Students are requested to answer questions concerning their impressions of thedrill. They are then asked to develop a process record which describes the
behaviors of the members of a medical team, their own behaviors, and theemotions that have been aroused within them, so that their experiences in various
situations of the drill will not escape their memory. They are also requested to take

notes on such issues as how they have come to understand the state of mind of apatient and a nurse through their own experience, what they felt was important
about a nurse’s involvement in the time of a disaster, and what types of nurse
behaviors made them comfortable or made them uneasy.
Between one and two months after the drill is completed, a group discussion isorganized for reflection by referring to the process record and notes that the students
made immediately following the drill. The jigsaw classroom method is used here toprevent students from forming a biased view.
Throughout each of the stages, an overall plan is presented to students so as toinvite their active and spontaneous participation. In every stage after the beginningof the program, instructors ensure students’ commitment by continuously motivating
students with comments such as, “Treasure your experience,” “Value the emotions
that arise within you,” “Attach meaning to your experience,” and “Simply write down
whatever you see, hear, and feel.”3) Ex post facto learning using the jigsaw classroom method
Jigsaw learning is a method for group learning developed by Aronson, et al. in theearly 1970s. Split into small groups, students work on an assignment individuallyassigned to them, and then present the knowledge and experience they have gained toa group of students to whom different assignments were given and to another group
who played the same role as theirs. By relativizing what students are expected tolearn, this group learning method ensures that every student understands thelearning targets. Because each piece of knowledge and experience that students
contribute all come together like the pieces of a puzzle, this method is referred to as
the jigsaw classroom. 25 In nursing education as well, this is one of the methods ofgroup learning which has been designed to provide students with opportunities tomake use of such critical skills as analysis, reflection, integration, and reconstruction.
26

Reports have been made on its application at an intramural nursing practicum andits effectiveness. 27, 28
According to Aronson, the effects of the jigsaw classroom are two-fold: teachingmaterials may be learned by making use of effective techniques, and individual
students play an important role in each learning process. Aronson stated that

common learning is achieved as students mutually rely on others who play a roledifferent from their own and feel empathy with them as they listen to their reports,
while at the same time he mentions that due attention must be paid to the fact thatlearning may not reach the desired depth depending upon how the groups are
structured and the competence of individual members.
What follows is an account of the actual application of a reflection program to which
the jigsaw classroom has been incorporated with this view in mind. The program
consists of an introduction, two group sessions, and a summary (Table 1). In the
introduction, after the basic structure of the program is presented, an archive video ofa disaster drill is shown in order to give the students an overview of the entire drill.
Watching videos is believed to be effective in reflective practice, since it allows viewers
to speak about whatever comes to their mind spontaneously. 23
Next there is “tension relaxation,” which is designed to stimulate student
discussions. In the two group sessions, a jigsaw classroom approach is taken. In
Group Session #1, the students are grouped by role, namely, patients in mild,moderate, or serious condition or their family members, while in Group Session #2
students who played different roles are placed into the same group.

Table 1 Program Structure

Prior to Group Session #1, students are encouraged to explore through discussion
what they all felt empathically, what they hoped to share with others, and what
they would like to ask from those who played other roles. In order to facilitate theirreflection, the notes and questionnaire responses which the students made in the
preparatory stage and immediately after the drill are returned to them. The
results of the discussions are then summarized for each group. In Group Session #2,
students are encouraged to discuss four different aspects, namely, what they havelearned, what they can do as a nursing student in the time of a disaster, the roles
nurses are expected to play in the time of a disaster, and what they need to learn tobecome a nurse who is capable of fulfilling those roles. Between the two groupsessions, the instructors briefly explain the purpose and significance of the drill, aswell as its overall flow, as they quote the results of a preliminary questionnaire.
The entire program is 180 minutes long, with a ten-minute break.
3. Trial implementation and evaluation
1) Methodology(1) Subjects
Thirty-two first-year students of a nurse training school (three-year course) (averageage: 19.5, SD: 3.1)
(2) Duration
From November 2005 through February 2006
(3) Outline of the drillThis was the first triage drill given at a public hospital which is designated by the
Hyogo Prefectural Government as a disaster core hospital (beds: 303, doctors: 32,
nurses: 242). The drill was conducted on the assumption that a large number of sickand wounded was generated by a major accident on the expressway and transported
to a disaster core hospital. At the request of the public hospital, the nurse training
school asked its students to play the roles of patients and their family members.
Twenty-two students played the roles of patients (3 patients in serious condition, 5 inmoderate condition, and 14 in mild condition), and ten students played the roles of
their family members.
(4) Data gathering①

A questionnaire survey was conducted regarding six items concerning thesignificance of the drill (the necessity of disaster drills, whether the drill will be
useful in future learning, satisfaction with the drill and reasons why, whether
they have taken an interest in disaster nursing, whether they wish toparticipate in the next drill). Aside from the questions where the students wereasked to give reasons, the item concerning whether they wish to participate in
the next drill was assessed in two-grades, with “1” being positive (would liketo) and “2” being negative (would not like to), while the other items wereassessed in three-grades, with “1” being the most positive (very much), “2”being generally positive (reasonably), and “3” being negative (not at all).

②

Evaluation of the program that has been developed: The program wasconducted two months after the drill. In order to verify the effects of thereflections made in a jigsaw classroom environment, discussions were held inGroup Sessions #1 and #2, at the end of which students were asked to itemize
on paper the things that came to their attention. In Group Session #1, students
were divided into four groups by role (3, 5, 14, and 10 students), and in Group
Session #2, three groups were formed in which at least one student waspresent for each role (10, 11, and 11 students).

(5) Analysis method
For each group session, the list of what came to students’ attention was classified
into the four categories of “patients and their families,” “nurses and members of the
medical team,” “situation of the hospital,” and “general.” Then the things that came tothe students’ attention and what they learned were classified into the four
sub-categories of “knowledge,” “skills,” “attitudes and emotions,” and “action.” Theabove categories and sub-categories were established based on those used by Ohara. 29(6) Ethical considerations
Students were informed that the drill would be a part of extracurricular activities,
and were briefed on the entire scope of the program which included what would
happen both before and after the drill. Then the purpose and significance of this study
was explained so as to seek cooperation from the students. Students were also
informed that it would be left to their discretion whether or not they would
participate in the drill or cooperate with the study; that they could quit anytime; that
non-participation would not negatively affect their grades; and that, even if theychose not to participate, they could still share learning with other participants in a
post-drill portion of the program. Finally, it was explained that the privacy of thegathered data would be protected and that the data would not be used for any
purposes other than this study. All thirty-two of the first-year students agreed toparticipate.

2) Findings(1) Evaluation of the disaster drill
In the questionnaire conducted immediately following the drill, the majority of thestudents gave a positive response to their experiences in the drill, with 16 (50.0%)
stating they were “very much satisfied” and 14 (43.8%) “reasonably satisfied.” When
asked about the necessity of the drill, 28 (87.5%) students said that they “felt thenecessity more strongly than [they] did before the drill” and 22 (68.8%) answered that“the drill would be of great use for future learning.” Some of the reasons for theirsatisfaction included: “by acting a patient, my emotions welled up inside of me, and I
was able to better understand how they might feel” and “the nursing experience in avery realistic setting was highly educational.” Among those who were not satisfied,
one student felt “displeasure and pain because no one took notice of what state [he orshe] was in.” Being asked whether their attitudes toward nursing have changed, as
many as 26 (81.3%) students said “yes,” but six (18.7%) students said “no.”Twenty-three (71.9%) students “had very much interest” in disaster nursing.
Concerning whether or not they hoped to participate in the next drill, 27 (84.4%)
students were affirmative, but four (12.5%) – three of whom played the role ofpatients in serious condition and one of a family member – were negative.
Those who played roles other than that of a patient in serious condition gave alargely positive response to the disaster drill. Four out of 10, eight out of 14, and oneout of five students who played the roles of a family member, patient in mild condition,and patient in moderate condition, respectively, gave the most positive response,
marking “1” for all items in the questionnaire conducted immediately after the drill.
Likewise, all of the three students who played the role of a patient in serious
condition gave a largely positive evaluation, but their response to the question
concerning their intention to participate in future drills is clearly different than thatof other students. In more concrete terms, with the exception of one student, all 29
students condition who played roles other than that of a patient in serious answeredthat they “would like to participate again,” but all three students who played the roleof a patient in serious condition answered negative.
(2) Group session results
When totalizing the lists of things that came to the students’ attention, which themembers of each group were asked to itemize at the end of each session, a total of 40

matters were reported in Group Session #1 (five from “patients in serious condition,”nine from “patients in moderate condition,” 15 from “patients in mild condition” and11 from “family members”). In Group Session #2, a total of 74 matters were reported,with Groups 1, 2, and 3 each contributing 28, 23, and 23, respectively. When the
responses gathered in Group Session #1 were categorized (Table 2), those categorized
into “patients and their family members” were the most numerous with 16 (40.0%)
responses, 14 (35.0%) being classified into “nurses and members of the medical team,”nine (22.5%) into the “situation of the hospital,” and one (2.5%) into “general.” ForGroup Session #2, three (4.1%) were categorized into “patients and their family
members,” 39 (52.7%) into “nurses and members of the medical team,” 11 (14.9%) into
the “situation of the hospital,” and 21 (28.4%) into “general.”Table 2 Responses in each Category for Group Sessions #1 & #2

In every group, feelings of “anxiety and relief” from the perspective of patients andtheir family members were commonly observed, some of the comments describing
how they “became uneasy, feeling always unattended”； “felt anxious, not knowingwhere [they] would be taken”； and “felt relieved to see [their] family.” Divided by role,
the things that came to the attention of students who played the role of a patient in aserious condition were categorized either into “knowledge” about patients and theirfamilies (“because members of the medical team did not explain what was going on toa patient in serious condition who was losing consciousness”), or “attitudes” which
include their anxieties and irritation about what was going on at the hospital (“wasn’t
aware that there were many medical staff members around me”).
Groups of students who played roles other than that of a patient in serious
condition shared comments concerning “waiting time” (“being left alone for long
periods, I felt unattended”). Groups of students who played the roles of patients inmoderate or mild condition said that they felt feelings of “friendship and closeness”
with nurses and members of the medical team (“The very existence of a nurse who
was always by my side and concerned about me made me feel so secure”; “Nurses
approached me kindly and were always with me.”). Groups of students who played
the roles of a patient in moderate condition and family member said that they becameaware of care from nurses and members of the medical team. The groups of students
who played the roles of a patient in a mild condition and family members also asked
how others felt (“What experience made you feel unpleasant?” and “How did you findthe medical professionals’ treatment of family members?”). Such awareness indicatinginterest and concern for other groups (roles) was observed throughout all of thegroups of students with different roles.
Furthermore, they said that something needed to be done with “information
management” (“Asked the same question by several members of the medical team”;“Felt they should share the medical records”; “Hard to identify a patient with names
only. Patients’ characteristics should be made use of as well.”).
(3) Group Session #2
A close look at the categories assigned to output from each group shows that, fromthe perspective of patients and their family members, all groups produced output that
could be categorized into “needs for nursing” under the “knowledge” segment(“Patients and their family members feel lonely by themselves, and so they wantsomeone to be by their side”; “If you’re completely conscious, such as when you playthe role of a patient in mild condition, you feel a lot of anxiety and stress”; etc.).
From this point of view, nothing came to students’ attention concerning “skills,”“attitudes and emotions,” or “action.” (Table 3)
Table 3 What Students Became Aware of and Learned in Group Session #2

From the viewpoint of nurses and members of the medical team, students fromevery group said that, under the “knowledge” segment, they became aware of “careskills” (“relaxing patients by touching them”); under the “skills” segment, they took
notice of “psychological care” (“providing psychological care by staying close, speaking,and touching”), “specific care” (“being close to the family members of a patient tolisten to what they have to say” and “dealing with people with a warm attitude”) and“information management” (for “facilitating communications so as not to keep
patients waiting for testing when there is so much conflicting information” and“guiding and leading the way for patients and their family members”); and under the“action” segment, they became aware of a “calm manner” (“not overwhelmed bypatients, always being able to act with composure”) and “calm and prompt judgment”(“ability to keep everything under control,” “dealing with patients calmly,” etc.).
Students from two of the three groups said that they became aware of a “nursingplan” (knowledge); “physical care” and “observation, monitoring” (skills); “attitudes ofthe medical staff” (attitudes); and “teamwork” and “quality of care” (action).
Concerning the “situation of the hospital,” students from two of the three groups
said that they were made aware of matters concerning “information management(e.g., “appropriate response to mass media”)” and “general action (e.g., “things would
be much more terrible in a real situation”; “obviously this is not an everyday
happening, and the surrounding atmosphere was clearly different”).
From the “general” viewpoint, students from all three groups said that they becameaware of the “tasks and goals for learning” (knowledge) (“necessary to acquire
knowledge on illness”; “important to understand everything about our own physicaland psychological aspects and become capable of dealing with them”; “necessary tohave an observer’s perspective”) and “willingness to learn” (attitude) (“necessary to
make a habit of communicating information to patients appropriately so that [one]can do so even at busy times,” and “always be conscious of what to do in the time of adisaster”). Students from two of the three groups said that they learned about“attitudes toward the drill” (knowledge), “general skills” and “care skills” (skills), andthe “tasks and goals for learning” (action).
3) Consideration(1) Student participation
According to the nursing instructors who provided supervision and guidance during
the disaster drill and ex post facto learning, all of the students actively participated inboth preparatory and ex post facto learning sessions with good concentration, andplayed their roles seriously during the disaster drill. While listing what came to theirattention during the ex post facto learning, and then itemizing the same in individual
group sessions, every student worked together until the time had elapsed completely.
A student who played the role of a patient in a serious condition, who answered in aquestionnaire that she would not like to participate in the next drill, said in the expost facto learning, “I didn’t realize there were so many people around me at thattime” as she watched a video of the drill, and, when she heard a phone ring, said toherself, “That’s the sound I heard then,” apparently trying to connect her experiences.
(2) Significance and effects of disaster drill experience
Although it has been indicated that a disaster drill can evoke negative emotions insome participants, 8 it may be inferred that the majority of the participants in thisdisaster drill did not react to their experience in any emotionally problematic manner.
Rather, they gave largely positive ratings to the questions regarding necessity,
usefulness, satisfaction, effects, and willingness to participate. On the other hand,
students who played the role of a patient in serious condition responded negatively tothe question regarding their willingness to participate in future drills, unlike those
who played other roles. Obviously, their impression of experiencing triage was suchthat for some time after the disaster drill was over they became reluctant to undergo
any similar experience again, the drill being still fresh in their memory.
(3) Significance of Group Session #1
It has been reported that students participating in a disaster drill may becomeaware of and learn different things depending on their role (patient, etc.). 15 The
results of Group Session #1 support this statement. In other words, the things thatwere noticed and learned by students who played the roles of patients in serious,
moderate, and mild conditions were unique to each respective role group. Meanwhile,
students from all groups showed a high interest in the experiences of students ofgroups that played roles different from their own. This testifies the significance oforganizing group sessions with students who played different roles, as well as among
students who played the same role.
Research into the social comparison theory has revealed that people who haveshared the same experiences and circumstances develop a desire for amicability. 30

Those who experience the stressful role of a patient in serious condition during adisaster drill can become uneasy, running the risk of them being unable to continue
subsequent disaster studies in a positive manner. Should this be the case, it would bemeaningful to organize group sessions among people who shared a similar experience,and encourage them to express and compare each other’s emotions and thoughts.
According to the experiential learning theory, it is important to guide students toward
relativizing their experiences in a group session with those who shared the same
experience so that these experiences can be deepened further. 22
According to Garcia and Lindsay, when students study disaster nursing it would be
useful to do so in a controlled environment, since organizing opportunities to learn at
an actual site of nursing, like other types of practical training, can cause excessive
learning or, under some circumstances, can even be dangerous. 31 It is safe to say thatGroup Session #1, which was conducted as a part of this research program, is anattempt to provide students with a “controlled” learning environment byincorporating two elements into the program, namely, support for students who have
had a negative experience, and experiential learning among students who played thesame role. In this sense, the importance of having students who played the same role
discuss with each other and summarize what came to their attention at Group
Session #1 is certainly not insignificant.
(4) Significance of Group Session #2
When the results of the two group sessions were compared, both the number ofmatters that came to students’ attention and the variety of sub-categories were shownto increase from 40 to 74 and from eight to 11 for Group Session #1 and Group Session#2, respectively. It does not seem that the instructions before each session
significantly affected the number of items that came to students’ attention, as the
instructors only told them to “listen to what others experienced while telling them
about your own experiences.” Rather, it is inferred that the structure of the groups
had a significant impact on the results.
The number of items that came to students’ attention in the “patients and theirfamily members” category decreased from 16 to three, but that in the “nurses andmembers of the medical team” increased from 14 to 39 between the two groupsessions, evidence that Group Session #2 encouraged the focus of students’ awarenessto shift from the perspective of patients and their family members to that of nurses
and members of the medical team.
In the subcategories of “patients and their family members,” 12 responses under“attitudes and emotions” were yielded in Group Session #1, but none in Group Session#2. On the other hand, while only the group of students who played the role of apatient in serious condition produced responses in the “knowledge” subcategory inGroup Session #1, all of the groups did so in Group Session #2. For the “nurses andmembers of the medical team” category, Group Session #1 did not produce any
responses that could be categorized into “Knowledge,” but all of the groups produced
such responses in Group Session #2. From this, it may be gathered that Group
Session #2 brought about a change in the nature of students’ responses fromsubjective, personal ones based on individual experiences and perspectives according
to the roles assigned to them, to more objective, specialized ones based on a common
awareness of issues.
In the “general” category, only one response was produced in Group Session #1,
whereas a total of 21 responses were given in Group Session #2 (eight, six, and sevenfrom Groups 1, 2, and 3, respectively). This suggests that Group Session #2 madestudents of all the groups become aware of matters that are necessary to make themost of their experiences during the disaster drill in their lives and studies in the
future.
4. Discussions
1) Experiential learning and reflection
In experiential learning, reflection should be made among groups of students who
have shared the same experience. 22 In this educational program, students wereorganized into small groups and encouraged to share their experiences with otherparticipants while reflecting on those experiences, so that they can recognize common
and individual features of what came to their attention during the disaster drill andreach more profound awareness. How efficiently group dynamics can be tapped into isessential to the success of experiential learning, which is also the case for thiseducational program. As the results suggest, the students rated highly andstrengthened the things that came to their attention during the disaster drill. Fromthese findings, it is safe to say that this educational program has successfully made

use of group dynamics.
2) Effects of the jigsaw classroom
It is assumed that the jigsaw classroom, which was used in conjunction with group
discussions, helped to enhance such group dynamics. It is believed that the jigsaw
classroom will enhance students’ capability to acquire the role assigned to them andmake it possible for them to think from the logical and emotional perspectives ofothers, while at the same time having positive effects on their behavior and emotions
by having them learn in a small group environment while cooperating with othermembers. 25
Group Session #2 increased the width and depth of student responses that had notbeen achieved in Group Session #1. This might suggest that there is good reason forhaving students who played different roles reflect on their experiences, as well asorganizing group sessions with students who played the same role.
3) Follow-up
Continuous follow-up is being conducted for students who played therole of a patient in serious condition and gave negative responses to somequestions in the questionnaire survey following the drill. The significanceof disaster drills and ex post facto learning that includes follow-up needs
to be investigated over the long term and, as such, will be reported on as
the opportunity arises.
This paper discussed a triage drill conducted immediately after the occurrence ofdisaster. Whether or not the educational program introduced here can be applied toother types of disasters requires further verification.
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Developing a disaster nursing educational program
based on the experiential learning theory
Kiyoshi Maiya(Kobe University)
Kiyomi Hata (Kobe Tokiwa University)
Masao Hata(Hyogo Prefecture)
The purpose of this study was to develop an educational program of disaster nursing
on the basis of Kolb’s experiential learning theory. The jigsaw learning method was
adopted in the discussion session in order to make students’ views comprehensive,
integrated and unified. 32 students of a nurse’s school participated in this action
study program. After they learned basic conceptions about triage in disaster situation,
they participated in a TT in a hospital, role-playing patients and their families. Twomonth later, they wrote about their experience and discussed these experiences in two
group session. In the first group session, the students of the same role made groups todiscuss together, and in the second group session, the students of the different role
made groups to discuss together. As the results, it was found that the participants
were not only satisfied with the program, but also motivated into learning to become
good nurses, broadened and deepened their understanding of triage in disaster byreflecting their experiences through the group process. The group session was also
effective in consoling the stress of the participants who had had negative experiences
through role- playing patients of serious illness as they were abandoned in the TT.