Impact of the Great East Japan Earthquake followed by the nuclear power plant accident on the nursing students’ academic progress in Soma, Fukushima, Japan: a retrospective cohort study with questionnaire survey

Abstract

Background

The Great East Japan Earthquake and the subsequent Fukushima nuclear power plant accident in 2011 posed significant challenges to the educational sector, particularly affecting nursing students in the disaster area. However, to the best of our knowledge, there are no reports on the effects of the natural disaster coupled with the nuclear accident on the nursing students. Therefore, this study aimed to determine the impact of the Fukushima disasters on rate of academic failure events in nursing education.

Methods

A retrospective cohort approach was conducted, focusing on 677 students from Soma Nursing School admitted between 2001 and 2017. Four failure events—failure to pass the national examination, student retention, suspension, and withdrawal from school—were compared between three time periods: pre-disaster, early peri-disaster, and later peri-disaster. This analysis was followed by a questionnaire survey among the students and an interview with faculty members to gain further insights.

Results

Of the student cohort, 17% had at least one failure event. Students in the later peri-disaster phase faced an elevated failure rate at 29%. Variables such as being male, admission during later peri-disaster period, and local pre-admission residence played a significant role in these failure events in multivariate logistic regression analysis (adjusted odds ratio [95% confidence interval, p value]; 2.63 [1.49–4.64, < 0.001], 3.207 [2.00–5.15, < 0.001], and 1.84 [1.12–3.02, 0.02], respectively).

Conclusions

This study highlights the impact of the Great East Japan Earthquake and the following nuclear accident on nursing education. The elevated failure rates in the later peri-disaster period emphasize the challenges posed by continuing disaster phases. Thus, there is a need for intensified and tailored strategies in nursing education in disaster-affected regions.

Introduction

The impact of disasters on educational activities, encompassing both natural and human-related events, has been well-documented. Natural disasters, such as earthquakes and tsunamis, disrupt educational pursuits in academic institutions by necessitating temporary closures of schools and creating physical and psychological distress among students [1,2,3,4]. When New Zealand was hit by the 2010 Canterbury Earthquake, nursing students reported experiencing psychological effects due to conflicting pressures and societal expectations regarding disaster relief efforts [5]. A Polish study also found that human-related disasters, not limited to natural disasters, affect nursing students [6]. The psychological impact of technological disasters, exemplified by the long-lasting repercussions of the 1989 oil spill in Alaska, underscores the persistent effects of such events [7].

On March 11, 2011, a 9.0 magnitude earthquake and subsequent tsunami struck eastern Japan [8]. This event triggered a radiation accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP). Despite advancing reconstruction, the Fukushima disaster persists [9, 10]. In fact, seven municipalities still have areas designated as difficult to return to. In the midst of emergency and long-term evacuations necessitated by radioactive contamination, decontamination efforts have been ongoing. In November 2023, evacuation orders for all the Specific Reconstruction and Revitalization Base Areas, which were previously restricted for residency, were lifted in six municipalities within Fukushima Prefecture [11]. Several studies, including a five to nine-year follow-up, have illustrated that heightened risk perceptions of radiation exposure led to post-traumatic stress symptoms in Fukushima residents [12,13,14,15]. Nurses played a crucial role in responding to the surge in healthcare needs during this disaster [16, 17]. Considering the critical role of nurses in disaster response, educating nursing students in maintaining healthcare services amidst disasters is a fundamental aspect of preparedness [18, 19]. Nevertheless, there remains a notable gap in the literature concerning the educational impact of cascading disasters, which integrate both natural and human-related elements, on nursing students.

Influence of the Fukushima disaster on local nurses and nursing students

Local nurses that provided care were also victims of the disaster. In fact, the number of nursing staff, including nurses and assistant nurses at medical facilities in the vicinity of the FDNPP, decreased by 47.7% from 2010 to 2013 due to evacuation and concerns about radiation exposure [20]. Mental health concerns were another significant issue for nurses, while a study revealed that anxiety about radiation exposure tended to be lower among nurses with greater knowledge about radiation than among those less knowledgeable [21]. Japanese nursing students were reported to have poor knowledge and a high fear of radiation [21]. These observations suggest that nursing students in the disaster-affected area likely faced obstacles in continuing their education based on personal concerns. However, there appears to be a lack of comprehensive studies determining the combined impact of the natural disaster and subsequent nuclear accident on nursing education.

A nursing school near the FDNPP

Soma Nursing School, located 44.4 km from the FDNPP in Soma, Fukushima Prefecture, Japan, faced significant challenges after the combined disaster in 2011 (Fig. 1). Following the earthquake and the following tsunami, which reached heights of over 9.3 m, Soma was among the cities that experienced direct destruction, including damage to 5,234 residential buildings, leading to the evacuation of 4,545 residents [22, 23]. The hospitals in Soma faced critical conditions, including power shortages, medication scarcities, and a lack of dialysate, to provide care for both outpatients and inpatients [24].

Fig. 1

Location of the Soma Nursing School. The Soma Nursing School, situated on the Pacific coast of Fukushima Prefecture in Japan, is approximately 44.4 km distant from the Fukushima Daiichi Nuclear Power Plant. The figure was prepared for this study using a public map by Geospatial Information Authority of Japan

Annually, approximately 40 new students enter the Soma Nursing School’s three-year program. These students come from both Soma City and surrounding regions, regardless of their proximity to the FDNPP. Despite facing no direct human casualties from the 2011 disaster, the school infrastructure sustained considerable damage, including the collapse of the gymnasium’s outer wall, cracks in the main building’s walls, crashed lighting fixtures, and a compromised parking lot. In the face of these adversities, the collective efforts of the school staff and the collaborative support from teaching hospitals facilitated the resumption of classes in April 2011, merely a month following the disaster. This swift recovery was further strengthened by alternative medical training institutions, which welcomed the displaced nursing students, thus ensuring the uninterrupted progression of their education and practical training. Such collaborative endeavors not only showed the resilience of the educational institution amid a disaster but also highlighted the critical role of community and institutional support in sustaining the continuity of nursing education during the crisis. Thus, we stratified nursing students in Soma into three groups based on enrollment periods: a pre-disaster group (April 2001-April 2008), an early peri-disaster group experiencing class disruptions (April 2009-April 2011), and a later peri-disaster group (April 2012-April 2017) to examine the effects of the ongoing Fukushima disaster on nursing education.

This study investigated the impact of the great earthquake, tsunami, and subsequent FDNPP accident on nursing education in the affected region. Given the critical role of Soma Nursing School in supplying healthcare professionals to the disaster-struck community, understanding the multifaceted effects of this event is crucial. Specifically, the following research questions were addressed:

• a) Did the Fukushima disaster—consisting of the great earthquake, tsunami, and nuclear accident—affect the characteristics of nursing students in the disaster area? This was investigated through a retrospective analysis of the student database.

• b) Was the occurrence of obstacles in nursing education different for pre-, early peri-, and later peri-disaster student cohorts? We evaluated the obstacles as failure events—defined as drop-out rates, suspensions, and failure to pass the national examination. We hypothesized that the disaster could negatively affect early peri-group students due to disruptions in classes and other educational activities. Therefore, we conducted a stratified analysis based on the year of enrollment.

• c) What contributed to the failure events? We discussed the cause of events in interviews with faculty members. Research here aimed to understand the underlying reasons for the observed outcomes and gather both nursing students’ and educators’ perspectives on our findings.

Methods

Study design and participants

This study consisted of three components: a retrospective observational analysis of failure events at Soma Nursing School before and after the Fukushima disaster, a questionnaire survey administered to the school graduates to gather their insights on the causes of these failure events, and interviews with faculty staff to collect their perspectives on the study findings for validation. The retrospective analysis was performed with existing data on student admissions, progression, graduation rates, and results from national examinations for nursing licensure. Students admitted to Soma Nursing School between April 2001 and April 2017 were included in the analysis. Graduates who were members of the alumni association between March 2003 and March 2020 were invited to participate in the questionnaire survey.

Data collection

The retrospective observational study examined the following variables: sex, age at admission, year of enrollment, district of residence during admission, year of graduation, scholarship status, school promotion, and outcome of national examination of nursing licensure. Address information was categorized based on whether it was within or outside the Soma area, which encompasses Soma City, Minamisoma City, Shinchi Town, and Iitate Village (Fig. 1).

Measures of retrospective study

In this study, an event is defined as any of the following occurrences: suspension, retention, dropping out of school, or graduation within three years without passing the national examination. The occurrence of events was assessed after classifying pre-disaster, early peri-disaster, and late peri-disaster periods.

Definitions of the other terms were given as follows. “Suspension” refers to students requesting a long-term hiatus from their studies. “Retention” means that the student failed to progress to the next academic year, indicating a failure to advance to the second year or to graduate. Nursing students were categorized based on their enrollment period relative to the disaster, presented as pre-disaster, early peri-disaster, and late peri-disaster periods. Specifically, “pre-disaster enrollees” include students who enrolled from April 2001 to April 2008. “Early peri-disaster enrollees” enrolled between April 2009 and April 2011, and “late peri-disaster enrollees” enrolled between April 2012 and April 2017. According to this framework, students enrolled in the early peri-disaster period experienced class disruptions between March and April 2011 while attending school.

Questionnaire survey

The questionnaire, specifically designed for this study, asked about several key areas: the occurrence of events of suspension, retention, dropping out, or failure to pass the national examination, the reasons behind these events if experienced, and the participants’ employment status following graduation from nursing school. Additionally, it collected demographic information, categorizing participants by age in 10-year increments at response and sex (Supplementary Appendix 1). We also put an open question on lessons learned from the disaster during school days.

Among all of the 677 graduates of Soma Nursing School who graduated between March 2003 and March 2020, 457 with identifiable addresses were invited to participate in a questionnaire survey distributed by postal mail between November 30, 2020 and January 12, 2021. The participants provided their responses anonymously, following their consent to participate in the survey. Thus, we did not individually link the retrospective data and the survey responses.

Validation of study results with faculty members

We conducted interviews with faculty members at Soma Nursing School after presenting results from the retrospective analyses and questionnaire surveys. A structured guide was specifically prepared for the interview (Supplemental Appendix 2). The qualitative assessment of the interview data was made through the review and categorization of responses by two authors. This step was employed to identify inconsistencies between the findings from the retrospective analysis and questionnaire survey with graduates, and the insights provided by faculty members. This was done to ensure a comprehensive understanding of the research context, particularly regarding the cause of failure events.

Data analysis

Descriptive statistics were performed to summarize the characteristics of the nursing students. The three-group comparison was made with the Fisher exact test followed by a post-hoc analysis of the Holm method. Univariate and multivariate logistic regression analyses were then performed to determine whether the overall failure events were associated with the explanatory variables of male sex, age at admission, admission period groups, and address at admission examination. A two-sided p-value < 0.05 was considered statistically significant for all evaluations. The analysis was performed with IBM SPSS Statistics version 28 (Armonk, NY, USA) except for a three-group comparison with the R package (Version 4.2.2) of RVAideMemoire (Version 0.9-81-2) [25].

Results

Students’ characteristics

The retrospective analysis included 677 students, 606 (89.5%) of whom were women (Table 1). Among those women, 598 (88.3%) were admitted at the age of 18 just after graduation from high school, and 439 (64.8%) were from the Soma area. We compared their characteristics across the three periods of the disaster. No significant differences were found in sex and age groups. Significant higher percentages of students from the Soma area were observed at the early and later peri-disaster periods than pre-disaster (71.1%, 74.7%, and 55.2%, respectively. p values for early peri- versus pre-disaster and later peri- versus pre-disaster periods: <0.001 and < 0.001, respectively). The percentage of students receiving scholarships was significantly higher in the later peri-disaster group (43.9%) compared to the early peri-disaster enrollees (19.8%, p < 0.001) and the pre-disaster group (0%, p < 0.001). The changes in admission conditions and event occurrences are shown by year in Supplemental Table 1. The table shows that 10–50% of enrollees were prioritized by candidates from Fukushima Prefecture, with recommendations from their high school since the school opening. The candidates who failed admission in former years were eligible after 2011.

Table 1 Characteristics of nursing students for the retrospective observational study and classification of disaster periods

Occurrence of events

We compared the occurrence of failure in national examination, retention, suspension, and withdrawal between three groups of pre-, early peri-, and later peri-disaster periods (Table 2). Statistical significances were observed in the overall event, retention, suspension, and withdrawal rates between the three disaster-period groups (p with Fisher’s exact tests < 0.001). Subsequent post-hoc analysis revealed no significant differences between the pre- and early peri-disaster groups for these events.

However, a significant increase was observed in the later peri-disaster period, which showed significantly higher rates of overall event, retention, suspension, and withdrawal when compared to the pre-disaster period, with respective percentages of 28.7% vs. 10.0%, 14.3% vs. 2.8%, 12.2% vs. 2.5%, and 12.2% vs. 2.8% (p < 0.001 for all comparisons). Additionally, the later peri-disaster group exhibited significantly elevated rates of these events compared to the early peri-disaster group, with p-values of 0.001, 0.01, 0.03, and 0.002, respectively. Detailed yearly summaries of these events are provided in Supplementary Table 1.

Table 2 Event occurrence classified by the disaster period groups

Students’ characteristics associated with events

We performed the univariate, followed by multivariate logistic analysis to explore the students’ characteristics associated with events (Table 3). The univariate analysis revealed that male, later peri-disaster admission and residence before admission in the Soma area showed statistical significance for event occurrence (p < 0.001, < 0.001, and = 0.001, respectively). We then performed the multivariate logistic analysis, which identified male, later peri-disaster admission, and residence before admission in the Soma area as the significant predictors (adjusted odds ratio [95% confidence interval, p value]: 2.63 [1.49–4.64, p < 0.001], 3.21 [2.00–5.15, p < 0.001], and 1.84 [1.12–3.02, p = 0.02], respectively).

Table 3 Univariate analysis followed by multivariate logistic regression analysis for the predictors of event occurrence

Questionnaire survey to the graduates

A total of 112 graduates responded to the questionnaire (response rate: 24.5%). Their distribution across the disaster periods was as follows: 52 from the pre-disaster group, 20 from the early peri-disaster group, and 40 from the later peri-disaster group. Of these, eight (7.1%) reported experiencing a failure event, such as failure of a national examination, retention, suspension, or withdrawal.

Four of these eight graduates were from the early peri-disaster group, and four from the later peri-disaster group. Six respondents indicated that the disaster had prompted changes in their daily lives or work environments, including long-term evacuation (n = 4) and worsening health conditions (n = 2). Furthermore, in the open-ended responses, two individuals highlighted that their events were influenced by fears related to tsunamis and radiation.

Interview with faculty members of the Soma Nursing School

The study results of the retrospective analysis and the questionnaire survey of the graduates were shared with four faculty members at the Soma Nursing School to determine potential discrepancies between their observations and our research outcomes. These faculty members served as nurses in hospitals during the disaster before transitioning to educational roles at the Soma Nursing School for five to eight years. The faculty comments, summarized into four key areas (Table 4), are presented as follows.

Changes in the prevalence of failure events

Faculty members suggested a possible indirect connection to the consequences of the disaster. However, a faculty member believes that failing events are solely determined by individual student characteristics, and not influenced by the disaster.

The results on the events might have been indirectly influenced by the disaster. However, this is a retrospective reflection, and I don’t necessarily associate the event prevalence with the earthquake on a daily basis. This is purely a hunch in response to your question.

Being honest and good-natured doesn’t necessarily translate to academic performance. In my experience, I haven’t observed a connection between these traits and the event prevalence. Ultimately, when considering factors influencing the events, the characteristics of individual students seems closest to what I’ve observed, despite the vagueness of the term.

Motivation of nursing students immediately after the disaster

Students in the early peri-disaster group exhibited a profound motivation to pursue careers in nursing.

Students who enrolled immediately following the earthquake were high school students at the time of the 2011 earthquake. This direct experience with the earthquake appears to have induced a strong sense of purpose in many of these students. They described being helped by nurses during the evacuation, witnessing the dedication of nurses, and even losing loved ones. These experiences seem to have motivated them to aspire to become nurses, with a desire to work hard as a nurse in the Soma region and contribute to their local community.

Changes in student motivation over time

The faculty members also noted a gradual decline in the motivation of students to pursue a nursing career during the later peri-disaster phase.

Over time since the earthquake, it has become evident that some students may not be driven by a strong desire to become nurses. Examples of motivations mentioned include being encouraged by parents, wanting a short commute from home, or finding the program easier to enter due to lower competition.

While this falls outside the scope of our study period, it’s worth noting that even recently, some students have been motivated by the disaster to pursue nursing or enroll in our program. For example, a graduate from a prefecture outside of Fukushima who joined us recently chose our school because she wanted to study nursing in a disaster-affected area and contribute to the recovery efforts in Soma.

Academic performance of nursing students and the educational environment

Some faculty members thought that the lack of learning opportunities in the Soma area might be related to the academic performance of nursing students.

Following the earthquake, over time, the perception that there has been an increase in the number of students who might require additional academic support cannot be ignored.

Following the earthquake, a significant number of residents evacuated from the Soma area. This resulted in a population decline, a decrease in the number of children, and potentially lower academic performance in the area.

The academic performance of students from Miyagi Prefecture, especially those from the Sendai area, is better than that of students from the local Soma region. But, it might be more accurate to say there are disparities in study skills and educational resources between the two regions.

Table 4 Classification of interview comments from faculty members of the Soma Nursing School

Discussion

This study demonstrated that the Great East Japan Earthquake and the subsequent FDNPP accident could have significantly impacted nursing education. We hypothesized that failure events in nursing school education would be more frequent in the students in the early peri-disaster group than in pre- and later peri-disaster groups due to disruptions in classes and other educational activities. Contradicting our initial hypothesis, we observed an increased incidence of combined events of failure in the national examination, academic retention, suspension, or withdrawal in the later peri-disaster group, compared to their pre- and early peri-disaster counterparts. This suggests that the disaster is ongoing and that the challenges to students may become greater during a later phase of the continuing disaster. As such, continuous efforts and initiatives are essential to enhance nursing education in disaster-affected areas.

Gender difference

The multivariate logistic regression model followed by the univariate analysis identified men, the later peri-disaster admission group, and local residence prior to admission as variables associated with failure events (Table 3).

Male students might encounter unfavorable conditions in nursing education. Even though there is no gender requirement for admission policy in the Soma Nursing School, male students were found to be associated with the failure events in this study. Historically, the modern nursing profession, often associated with the image of its founder, Florence Nightingale [26], has been perceived as a feminine profession, although this perception must be understood in the social context [27]. In fact, approximately 90% of the global nursing workforce is women [28]. In Japan, the percentage of male nurses remains low, accounting for 8% of all nurses by 2020 [29] when compared to the United States at 13% in 2023 [30] and the United Kingdom at 11% in 2022 [31]. To our knowledge, there are no publications showing significant differences in learning performance in nursing education between genders. A study on nursing students revealed that gender is a variable associated with teamwork ability [32]. The minority status and isolated perception of male students might serve as impediments in the context of nursing education. There is a need to continue research on the educational environment surrounding male nursing students.

Influence of the Fukushima disaster on nursing education

There were several hurdles to continuing nursing education during the disaster period; for example, some students and their families were forced to evacuate due to health issues. There were restrictions in teaching hospitals during the earthquake period. Rumors about the effects of the nuclear power plant accident might have influenced the motivation of nursing students. Despite these circumstances, the failure events did not significantly increase in the early peri-disaster group compared to the pre-disaster group. Tremendous efforts were made by the school faculties, teaching hospitals, and facilities to ensure learning opportunities for nursing students. For instance, the opening of the Soma Nursing School was delayed for only two weeks after the great earthquake on March 11, 2011. The hospital internship for nursing students was arranged at medical institutions in non-evacuation areas.

Surprisingly, the failure events significantly increased in the later peri-disaster phase compared to the pre- and early peri-disaster groups. This increase in educational failures in the later peri-disaster period might be related to a series of indirect factors associated with the ongoing effects, such as long-term evacuation, uncertainty, as well as characteristics specific to the Soma region. The faculty members largely supported the possibility of an indirect causal relationship; however, one faculty member believed that there was no causal connection between the event prevalence and the disaster. This topic will be further discussed in the following sections.

A decline in student motivation towards a nursing career could be a contributing factor to educational failures. The following two issues can be considered in this regard. One is a decrease in the desire to contribute to disaster relief, and the other is that nursing education in Japan is transitioning from nursing schools to nursing universities. Many students had a strong willingness to serve disaster relief operations as nurses immediately after the great earthquake. This motivation was deeply anchored in their experiences during the disaster, including receiving assistance from nurses, observing the disaster relief efforts by nurses, and experiencing personal loss. Collectively, these factors fostered a strong determination among the students to serve as healthcare professionals in the Soma area. However, as time passed, fewer students have retained such willingness. Only a fraction of them have continued to display a strong resolve to learn and serve in disaster-stricken areas in recent years, as per the faculty’s observation. We believe that it is important to share the experience of nursing care in the ongoing disaster relief efforts with the current nursing students. The recovery efforts for the ongoing disaster, such as providing care to elderly residents in Soma Nagaya housing, may offer opportunities for nursing students to gain valuable experience and increase their motivation. These residents, aged 60 and over and living alone, continue to receive medical and care services [33].

Moreover, training systems have been transitioning from nursing schools to nursing universities. The Japan Nursing Association has promoted a four-year nursing education program in the university [34]. The nursing student population has been shifting from three-year nursing schools to four-year universities. In 2013, there were 19,376 students in nursing universities and 28,612 in nursing schools. However, by 2022, the numbers have almost leveled out, with 26,517 students in nursing universities and 26,475 in nursing schools, respectively. Even though the nursing certifications are identical, holding a university degree might confer an employment advantage.

Regional characteristics

Residence in the Soma area prior to admission was identified as a variable associated with failure events. This might be related to the declining number of children in Soma City and the priority given to local students in entrance examinations through the recommendation mechanism. The number (proportion) of the young population aged between 0 and 14 years old in Soma City was 6,161 (15.9%) in 2000, falling to 4,893 (12.7%) in 2015 [35]. Furthermore, the increase in the regional recommendation slots in the entrance examination might be involved in the decrease in competitiveness, which in turn might be linked to the decreased motivation to become a nurse among students: 17% and 54% of acceptance rates in 2001 and 2017, respectively. (Supplemental Table 1). In fact, some of the learning support provided to high school students immediately after the disaster disappeared over time. Enhancing learning opportunities for the young population in Soma area and maintaining competitiveness for admission to nursing schools might be a solution to prevent failure events. Thus, a scholarship system might be beneficial to maintain competitiveness.

Scholarship

In this study, event failures increased in the later peri-disaster group, where the number of scholarship recipients increased. An example of scholarship assistance is 45,000 to 56,000 yen per month [36, 37], accounting for 540,000 to 672,000 per year, which is about half or over half of education and living expenses. In general, scholarships are intended to support excellent students and eliminate the economic gap. The scholarship system was expected to reduce the number of failure events, but the results of this study are contrary to expectations. The fact that the number of applicants decreased during the later peri-disaster phase might explain this contradiction (Supplemental Table 1). The decrease in the number of applicants might negate the benefits of the scholarship. As no students received scholarships before the disaster, the presence or absence of a scholarship was excluded from the multivariate logistic analysis. The ongoing disaster may be exacerbating the decline in the number of applicants, possibly due to a decrease in the youth population and a perception among prospective students that the area is less attractive. Future studies need to verify the efficacy of scholarships.

Categorization of the school faculty interview

Our analysis of the interview data yielded four key categories, presented in Table 4. These categories are based on the three research questions listed at the end of the Introduction section. To explore the primary outcome of the disaster’s influence on nursing education, we initially focused on the category labeled “changes in the prevalence of failure events.” Faculty opinions appeared to support our study’s findings; however, we acknowledge the possibility of unidentified factors contributing to the failure events. Subsequently, we identified categories related to student motivation and academic performance, which were the faculties’ main concerns. The potential link between failure events and the disaster might be mediated by a combination of individual student characteristics, such as resilience and prior academic achievement. Overall, the interview results suggest that the disaster’s indirect effects may continue to influence student engagement and academic success.

Strengths and limitations

To our knowledge, this is the first study to investigate the long-term effect of a major and ongoing disaster consisting of natural and nuclear accidents on nursing education. Moreover, this study is based on complete and reliable data on the number of enrollees and event occurrence, with no information being missing. However, several limitations need to be kept in mind with regard to the generalization of the study findings. First, this study is a single-site, retrospective, and observational investigation, which causes unknown biases. A comparison of event occurrence between nursing schools in the evacuation and non-evacuation areas might correct this. Second, the scholarships and recommendation entrance exams were enhanced after the disaster, which might be a confounding variable in a multivariate logistic analysis. Third, only a small percentage of graduates with failure events responded to the questionnaire survey. This made it difficult to identify real reasons for event occurrences. Furthermore, the COVID-19 pandemic resulted in a suspension of hospital training for nursing students for over two years, potentially causing similar or even greater disruption to nursing education. A limitation of the faculty interview data is the inability to link specific comments to individual faculty members due to recording issues during the group discussion. This hinders our ability to correlate faculty characteristics with their perspectives and reduces the depth of qualitative analysis. Future research is necessary to understand the full impact of the COVID-19 pandemic-induced interruption on nursing education.

Conclusions

The results of this study suggest that continuing disasters create significantly greater challenges for students. Failure events, such as national examination failures, retentions, suspensions, and withdrawals from nursing school, were more frequently observed in the later peri-disaster period compared to the pre-disaster and early peri-disaster phases at the Soma Nursing School, which is located close to the FDNPP. The failures were associated with being male, admission during the later peri-disaster period, and local residency prior to admission. A questionnaire survey of graduates experiencing these failure events revealed significant changes in their daily lives due to the disaster, including prolonged displacement and deteriorating health conditions. Faculty members perceived a decline in students’ intentions to pursue a career in nursing over time, which may be linked to the increase in unsuccessful outcomes in the later peri-disaster phase. The findings of this study have important implications for the training and recruitment of an adequate nursing workforce to serve a disaster-prone area. The findings could be used by nursing schools as a basis to provide greater support to students whose progress is hampered by prolonged displacement and radiation fears. Given the potential for long-term impacts of this ongoing disaster on nursing education, further research should investigate the causes of failure events in nursing education in depth and identify the preventive measures.