As Florence Nightingale stated, nursing plays a critical role in environmental management for people in sick, injured, and even good conditions. In current practice, affected people are forced to reside in the evacuation shelters for a prolonged period in Japan. Unfavorable living conditions lead to adverse physical and psychological outcomes including cardiovascular events, depression, and more. However, environment management cannot be achieved without involving the community.

To initiate community into shelter environment management a multi-cluster drill was coordinated by the Department of Psychiatric and Mental Health Nursing, University of Miyazaki, which appointed a director of Shelter Management for the annual nation-wide disaster drill hosted by the Cabinet Office of Japan.

With the Department of Health and Pharmaceuticals, Miyazaki Prefecture, the director invited local communities and held an exhibition type disaster drill on August 4, 2018.

36 organizations, including prefectural and municipal crisis management departments, health care organizations, a social welfare council, Red Cross, a telecommunication company, WASH cluster organizations, and the Japan Ground Self-Defense Force participated. The director requested to develop a plan filled with tactics and techniques protecting the health of people living in the shelter. Through meetings, the organizations recognized similarities and differences in roles, responsibilities, and capacities leading to an organized inter-cluster network. Participants created and prosecuted the plan independently and the director only orchestrated and negotiated with other supporting entities. The organizations exhibited and demonstrated how residents can protect their own physical and psychological health by setting up a proper shelter environment. Direct feedback from residents to organizations resulted in an expanded local network and the organizations improving their capacities.

Shelter environment cannot be managed by nursing solely but coordination by nurses may consolidate multi-cluster aid organizations so that shelter environment management would be done by residents and local organizations.