Disaster Preparedness of Nurses

A Research Presented to the

Faculty of Nursing Department

San Pedro College, Davao City

In Partial Fulfillment of the

Requirements in Nursing Research 1

By:

Cueto, Tryscia Mae

Magno, Deanne Kathleen

Pineda, Kimberly

Prudente, June Raye

Radam, Armida

Seo, Jihye

April 8, 2019
 CHAPTER I

INTRODUCTION

Disasters are unpredictable events which may cause altered health status

or worse the lives of many. The Philippines is ranked among the top five

countries who are most affected by natural disasters. The danger of man-made

disasters is also rising with the invention of high-technology biological,

biochemical and other warfare weapons and political tension among countries. In

these events, nurses are considered as the prime respondents which is why they

must have the knowledge and skills to be always prepared (Senate Economic

Planning Office, 2017).

According to Rabaya………… nurses are the front liners in the hospitals

during disasters. Having such big responsibility requires them to be prepared and

aware of what they should perform and prioritize in such events. The nurses are

usually one of the first responders during a disaster. They must fulfill many roles

which mainly revolves on caring for and giving medical assistance to casualties.

Nurse must be prepared in order to be aware of the potential dangers

accompanying disasters for them to be protected and function effectively even at

stressful situations. (Catalano, 2015)

The researchers had that the occurrence of disasters, both natural and

man-made seems to be increasing in today’s time. Yearly, the Philippines is hit by

typhoons, floods and earthquakes. There are also various reports of man-made
disasters especially terrorist attacks. A planned behavior is said to set an

expected outcome in relation with its nature. It is because of which that the

researches wanted to determine what the planned behaviors of nurses in

handling natural and man-made disasters are and whether it has a significant

effect on the disaster preparedness of nurses.

Review of Literature

Disaster

The United Nations International Strategy for Disaster Reduction defines

disaster as “a serious disruption of the functioning of a community or a society at

any scale due to hazardous events interacting with conditions of exposure,

vulnerability and capacity, leading to one or more of the following: material,

economic, and environmental losses and impacts”. For healthcare providers, a

disaster is characterized by an overwhelming number of casualties. Disasters

can be natural or man-made.

According to World Health Organization, “natural disaster is a result of an

ecological disruption or threat that exceeds the adjustment capacity of the

affected community”. Natural disasters include tornadoes, hurricanes, blizzards,

earthquakes, volcano eruptions, and floods. Man-made disasters on the other

hand include biological and biochemical terrorism, chemical spills, radiological

events, fires, explosions and acts of war. (Veenema, T.G., 2019)

Philippines was rank to be the 3rd most disaster prone country in the

world. Because of the archipelago location of the Philippines such as located

along the Pacific ring of fire, consisting 7,107 islands and 36,000 kilometer of
coastlines, Philippines is shown to be more likely to be affected by a natural

disaster. With an evidence of one of the disastrous typhoons like Yolanda (2013),

Pablo (2012) and Pepeng (2009); affected thousands of people with death and

leaving then homeless.

Although preparations were made for the typhoon Yolanda that ravaged

the Philippines last 2013, severity of the typhoon was underestimated which

crippled and limited the disaster response. During and after Yolanda, health care

staff were placed in both positions of care provider and at the same time the

victims. Although there were no in-depth analysis literatures reported on the

impact of typhoon Yolanda to the people and health care providers of the

Philippines (Cuesta, Loenhout, Banquesio, Isiderio, Aujoulat and Sapir, 2018).

Along the years, Philippines improved their disaster risk by taking different

approach along the years to improve the disaster preparedness in the

Philippines. Funds are also saved by the National Disaster Risk Reduction and

Management, for natural disaster. By 2016 the funds for the natural disaster

increased to an estimated 38.9 billion pesos for the rehabilitation recovery for the

people who were affected by the disaster. With the disaster risk reduction and

management improvement of this has contributed to the protection of the people

and the development of Philippines. Proper coordination will improve and allow a

well recognition of the effectiveness of disaster risk reduction and management

in the Philippines. (Senate Economic Planning Office, 2017)

Disaster Preparedness of Nurses

Due to the unpredictable events of disasters occurring all throughout the

world and the nurses’ primary role in providing care to the injured and ill, it is

imperative to ensure that nurses are ready to respond to any type of disaster

situations. According to Bautista and Maniago (2018), preparations through

disaster training acquired by education and skill through real-life simulation are

absolutely necessary in order to let the nurses understand their roles and

increase their readiness to respond to a disaster. It was stressed that nurses

should be involved in all the phases of planning in order to avoid

miscommunication and confusion in the event of actual disaster.

According to WHO, one disaster per week occurs around the world, with

Asia as the most affected region by natural disasters. During disastrous events,

nurses and other healthcare workers must be disaster ready to response to the

needs of casualties and to help maintain the communities’ stability. To determine

the perceived level of disaster preparedness of nurses in the Philippines, a

descriptive study using a cross-sectional approach was conducted. One hundred

seventy nurses (170) nurses participated by answering self-response

questionnaires consisting of demographic information and disaster preparedness

questionnaire. Eighty percent (80%) of the participants admitted that they were

not fully prepared while twenty percent (20%) deemed that they were adequately

prepared. (Evio and Bonito, 2017).

In 2016, a quantitative descriptive design authored by Rabaya, et al

(2016) on disaster preparedness of Filipino nurses was conducted. Using a

simple random technique, 291 nurses from Baguio and Benguet were chosen as

participants and were asked to answer the Emergency Preparedness Information

Questionnaire written by Garbutt, Peltier and Fitzpatrick. It has 10 aspects

including overall familiarity, decontamination, incident command system, ethical

issues in triage, disease outbreaks, epidemiology and surveillance, special

population, psychological issues, communication and connectivity and assessing

critical resources. An average mean of 3.27 was received by the nurses which is

interpreted as moderately familiar. Nurses have insufficient familiarity on disaster

preparedness management. Trainings on disaster preparedness should be given

priority by providing adequate funds and resources.

During a disaster nurses is considered to be the majority health care

provider. On 2018, Bautista, and Maniago conducted a descriptive study on

nurses persuade. This study was participated by 5 government hospital in

Zambales Philippines. The researcher used a survey questionnaire to evaluate

the responsiveness of the participants by categorizing them by age, sex, civil

status, highest educational attainment and years of working experience. In this

study it was shown that younger nurses are more aggressive in responds while

the older nurse was decisive. While nursing is said to be a female job, it is shown

that more men are leaving nursing, showing that 67% at female nurse are more

responsive than male nurses. Meanwhile in the civil status category, single

nurses are more responsive due to the less responsibility they have in their

family compare to married nurses. With the educational attainment, nurses are

more experience and hands on to emergency preparedness than any other

graduated course. While the working experience, more experience nurses are

more accurate and responsive rather than the novice one.

 Novice nurses were said to do the lighter task and our less confident in the

situation. To conclude, education, training and experience of a nurse will enhance

disaster risk reduction and management. Nurses should know what are their

roles and responsibility as a health care provider to respond disastrous event.

For this to happen it is encouraged that government hospital nurses should

attend a disaster risk reduction and management training, seminar in order to

plan in any disastrous event in the hospital.

Philippines was ranked to be the 3rd most disaster prone country in the

world. Because of the archipelago location of the Philippines such as located

along the Pacific ring of fire, consisting 7,107 islands and 36,000 kilometer of

coastlines, Philippines is shown to be more likely to be affected by a natural

disaster. With an evidence of one of the disastrous typhoons like Yolanda in

2013, Pablo in 2012 and Pepeng in 2009 affected thousands of people with

death and leaving then homeless. Along the years, Philippines improved their

disaster risk by taking different approach along the years to improve the disaster

preparedness in the Philippines. Funds are also saved by the National Disaster

Risk Reduction and Management, for natural disaster. By 2016 the funds for the

natural disaster increased to an estimated 38.9 billion pesos for the rehabilitation

recovery for the people who were affected by the disaster. With the disaster risk

reduction and management improvement of this has contributed to the protection

of the people and the development of Philippines. Proper coordination will

improve and allow a well recognition of the effectiveness of disaster risk

reduction and management in the Philippines

 An experimental study was conducted by Jacobs-Wingo, Schleyelmilch,

Berliner, Airall-Simon, and Lang (2019) in New York City on hospital nursing staff

emergency preparedness. Nurses are always prepared in the hospital setting,

but in the case of emergency preparedness nurses are not able to perform

emergency preparedness due to lack of confidence. The author of this study

conducted an experiment on 2012-2016 to develop nursing staff emergency

preparedness in the hospital. A curriculum was developed for nursing staff. In

phase I and II they surveyed 7177 staff nurses from 20 different hospitals in New

York City to participate and 20 focus groups to examine their familiarity and level

of confidence during emergency preparedness and to identify their roles in the

situation. While on phase III nurses were surveyed to identify unfamiliarity of

emergency preparedness and develop a curriculum of train the trainer to be

aware of Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE)

events. Finally, in phase IV emergency preparedness was implemented in the

participating hospitals by developing an online reference training and the reaction

of nurses in different situation. At the end of this study it was shown that there is

35% from 54% (range 45% - 75%) on pre-test to 89% (range 80 – 90%) on post-

test, of CBRNE nurse response during an emergency event.

A study was done on November 13, 2016 by Badryah Alsheri at Saudi

Arabia. He decided to use a survey tool after collecting data for his descriptive

study. In this tool, he had the permission to integrate similar questions used by

Duong and Hammad et al development in their previous study of Australian

emergency nurses’ knowledge to perceptions of their roles in a disaster

response. The survey consists of 23 items which are divided into three sections.

The demographic data, disaster preparedness and disaster education to training.

The tool was tested on nurses who could read and write English with one year

experience in ED at hospitals located in Riyadh. After going through the process,

it was revealed that the nurses understood their roles in disaster planning.

Though half of the respondents had completed training in the previous 12

months, 60% of them answered the item in relation of confidence post training.

26% of them answered the item related to confidence due to their involvement in

a real disaster. The significant difference was found between the confidence of

these who attended a real disaster than those who did not. The study concluded

that the nurses does not feel confident about being involved in real disaster

events because of their minimal disaster experiences. They still need more effort

in expanding disaster training which will ensure the nurses are properly prepared.

In 2016, Achora and Kamanyire of Sultan Qaboos University at Muscat,

Oman conducted a systematic review regarding the need of including a disaster

preparedness course for nursing education. They have gathered 29 literatures

related to this topic and found out that the number for disaster management is

still limited that resulted to the incompetence of professional nurses during

disasters. They recommended nurses must be knowledgeable in order to assess

their own limitations and skills and must be trained through Continuing

Professional Development (CPD) in order to cope up with the trends and prepare

them for disasters. This study concluded that there is a need for disaster

preparedness program in the undergraduate nursing curricula worldwide.

(Achora and Kamanyire, 2016)

Last 2017, Khan, Kausar, and Ghani of University of Health Sciences,

Lahore – Pakistan started a descriptive cross-sectional research study in

descriptive survey approach with 200 registered nurses as participants in various

areas of specialization which includes medical, surgical, critical care, emergency,

operation, obstetrics-gynecology and others. A total of 138 (69%) of the

participants had never participated in any disaster response while only 62 (31%)

of them previously experienced disasters. Out of the 200 participants, 176 (88%)

of them did not have proper disaster training programs meanwhile only 24 (12%)

conducted proper disaster-training program. Overall, this study found out that

nurses in Pakistan have inadequate knowledge about disaster preparedness and

recommended that disaster-preparedness should be included in Pakistan’s

nursing curricula both for Diploma and graduate nursing syllabus.

In 2017, Leider, DeBruin, Reynolds, Koch and Seaberg of American

Journal of Public Health, USA conducted a systematic review in the prevalence

and content for disaster response especially within the standards of critical crisis.

They have reviewed 580 articles which mentions ethics and disaster planning in

which a total 542 articles were excluded after thorough reviews in each of them.

This review showed that there is a significant evolution in disaster planning that

occurred in the last decade. Furthermore, ethical theories and frameworks have

been put to work by allowing it to be used disaster planning.

The study of Sultan, Mary and Al Grad last 2017 aims to determine the

level of knowledge of emergency nurses in terms of disaster readiness and their

role in terms of disaster response. Non-experimental explorative design was

used and was participated by 200 emergency nurses in all of the hospitals

connected to the Ministry of Health in Najran Saudi Arabia. Demographics

Information, Knowledge Questionnaire on Disaster Preparedness, Emergency

Preparedness Information Questionnaire (EPIQ) and Emergency Nurses Role on

Disaster Response were the tools used to collect data. Results showed that 66%

of the participants were female and 34% were male. 78% were in a Bachelor’s in

nursing education level, 21% in a diploma level and 1% in master’s level. 49% of

the participants have 1 to 5 years working experience and 56% are working in

the emergency department for 1 to 5 years. 44% were working in the hospital

during a disaster for 1 to 3 times, 33% for 4 to 6 times and 23% for 7 to 10 times.

55% of the emergency nurses have moderate knowledge about disaster

preparedness, 33% have adequate knowledge and 6% have inadequate

knowledge. Majority of the familiarity response of nurses for EPIQ was familiar

neutral (39%). Majority of the emergency nurses know their role in disaster

response and have adequate knowledge. In conclusion, the nurses have an

acceptable level of knowledge in terms of disaster readiness and are well aware

of their role in terms of disaster response even though only having a neutral

familiarity regarding emergency preparedness. Basing on the result, the article

concluded that in order to make the nurses more familiar with disaster

preparedness and response, training and drills are needed.

The study of Tracy Jeanne Nash last 2015 aims to determine the effect of

the disaster preparedness education intervention to nurses’ response to disaster.

Pilot study design was used and participated by 350 registered graduate nursing

students both in MSN and PhD level. Pre-intervention survey result shows that

many nurses do not have the preparedness items needed in disaster events and

are not prepared to respond to such disasters. After education intervention

survey was done, results showed that nurses value the importance of disaster

preparedness yet, still has not enough personal readiness to respond. Only

10.4% shows that they are prepared to respond to disasters while 9% feels that

they will be able to respond only within the 1st 72 hours of the catastrophic event.

In support with the result of the survey, the article emphasizes the need for

disaster education and training in order to make the nurses personally prepared

and be the frontline caregivers during disaster response especially since

personal preparedness affects disaster response. The study of Walczyszyn,

Patel, Oron and Mina last 2016 aims to determine the level of interest for training

in terms of disaster preparedness among hospital staff. A cross-sectional online

survey was used and was participated by 572 individuals in North Shore Long

Island Jewish hospitals, 79 of which are nurses, 25 physician assistants, 8

respiratory therapists and 460 attending physicians. Majority of the participants

said they had the experience of managing victims of both natural and man-made

disasters. 28% of them said they had no disaster management training, 33% said

they had 12 hours of training or less, 10% had a training of at least 24 hours, 5%

had a training up to 48 hours and 25% said they had more than 48 hours. 87% of

the participants stated that they would like to participate in a disaster

management training workshop although 68% of them are not comfortable

leading the disaster management response. Barriers identified to the possible

training workshop was the lack of time (80%), availability of resources (63%),

access to experts (45%), obtaining scenario exercises (36%) and lack of interest

(22%). The methods preferred by the participants for the disaster training were

live lectures with accompanied scenario exercises (66%), on-line courses (24%)

and live lectures only (3%) while the rest of the 6% do not want to participate in

any training workshops. In conclusion, although most of the staffs were not

comfortable in leading the disaster response initiative, vast majority of them were

still keen to participate in disaster management training workshops. Disasters are

very unpredictable and almost half of them have no disaster management

training making these frontline hospital staffs vulnerable, unable to protect

themselves as well as the victims. Thus this articles strongly emphasizes the

importance of disaster management training workshops as well as disaster

preparedness to be incorporated in undergraduate and graduate medical

education, making the future healthcare providers equipped with knowledge and

confidence to respond in disasters.

The study of Wilkinson and Matzo last 2015 aims to describe issues that

comes together when rendering nursing care to victims of catastrophic mass

casualty events (MCEs) and is bounded by scarce resources and knowledge that

will in turn affect their disaster response and management. First issue that was

defined is the shift of patient care from an individual to a whole population care,

second is MCE-specific care needs, and third is limitation in the triage system

and lastly, health care provider’s personal interests. Such factors can affect
health care providers’ willingness to assume emergency role and report to duty.

Lack of education for disaster preparedness was also a factor identified by the

study. In conclusion, the authors suggested having an integration of disaster

preparedness in nursing education, focusing on the type of MCE, management of

resources and emergency roles and proper response. With having this

recommendation, preparing for future natural and man-made disasters will be

efficiently done.

Planned Behavior

A study was published on September 6, 2017 by Najafi, Ardalan,

Akbansari, Noorbala, and Elmi at Iran. They used a cross-sectional study of

factors determining disaster preparedness behaviors in a representative sample

of 1233 Tehran inhabitants who were 18 years old and older. 1250 inhabitants

were selected in the study through a random multistage sampling method form

22 districts in Tehran. As a result, intentions to do DPB of a person could be

predicted from attitudes, subjective norms, and perceived behavioral control with

respect to DPB and actually doing DPB was strongly related to intentions and

perceptions of control assessed in the prepared people. It was concluded that the

more strongly they can be made to feel that they have control over DPB, the

more likely they carry out their intentions.

A study was conducted on July 1, 2015 by Luche Tadesse Ejeta, Ali

Ardalan, Douglas Paton at United States of America. Systematic literature review

was used to assess the application of behavioral theories to disaster and

emergency preparedness. The review was prepared to guide the development of

the study objectives, questions, inclusion and exclusion criteria and search

strategies were developed and pilot-tested at the beginning of the study.

Preparedness efforts focus on changing human behaviors in ways that reduce

people’s risk and increase their ability to cope with hazard consequences. From

the entire gathered database with a total of 2040 titles, 450 abstracts and 62 full

texts of articles were assessed for eligibility criteria, whilst five articles were

archived from Google Scholar and other sources. These 33 articles were

selected for using different behavioral theories and models to study the disaster

and emergency preparedness status for various hazards across the world. Using

the open code software, the 33 articles were categorized as: disease outbreak

preparedness (14 articles), flood disaster preparedness (6 articles), earthquake

preparedness (3 articles), preparedness for climate change including heat waves

(3 articles), tornado preparedness (2 article), terrorism preparedness (3 articles),

general emergency preparedness (2 articles), and one article deals with the

disaster preparedness for both flood and earthquake and one article was about

earthquake and tornado preparedness. This study concluded that the theories

and models applied to disasters and emergencies preparedness provided strong

evidence, which could guide public health professionals, disaster management

bodies and other actors in targeting interventions at preparedness phase of

disaster management and emergency.

The study has been published in November-December 2015 by Tracy Jeanne

Nash, BSN, RN, a Doctoral student, Graduate Research Assistant and Graduate

Teaching Assistant, The University of Texas at Tyler, College of Nursing, Tyler,

TX. It’s a pilot Study about Unveiling the Truth about Nurses' Personal

Preparedness for Disaster Response. This explains that professional

preparedness is not only about knowledge and skills but receiving education and

training in disaster prevention, management, mitigation, and recovery to asses,

prioritize, and function effectively in disaster situation, according to American

Nurses Association (ANA) 2015a. The study mentions that in the US, The Joint

Commissions (2015) requires health care facilities preparedness by sustaining

disaster drills and emergency plans, however, the study also uncovers some

problems on why nurses can’t report to the workplace during emergencies. Many

of the nurses are female and with many personal roles like childcare, elder-care

and others thus, they cannot easily respond to a sudden calamity. Also, many

facilities do not maintain preparedness and have substantial gaps in their

emergency response system. If this will happen, patient’s welfare might be at

risk.

In 2014, Ibrahim, F.A.A. in Saudi Arabia started a descriptive cross-

sectional study that has a target of 252 of two registered batches of bridging

nurses’ students. To collect information, the study uses, five tools; demographics,

knowledge, attitudes, practices, and emergency preparedness

questionnaire.Base on the result of the study, below average with acceptable

level of attitude when it comes to disaster preparedness and familiarity were

found for the level of knowledge and practice.

This study was conducted on 2018 by Labrague L.J., Hammad K., Gloe D.S.,

McEnroe-Petitte D.M., Fronda D.C., Obeidat A.A., Leocadio M.C., Cayaban A.R.,
and Mirafuentes E.C. in United States. They conducted a systematic review of

scientific articles conducted from 2006 to 2016 on nurses’ preparedness for

disasters. The result of this study is increase preparedness for disaster response

include previous disaster response experience and disaster-related training and

nurses are insufficiently prepared and do not feel confident responding effectively

to disasters.

Theoretical Framework/ Conceptual Framework

This study was anchored on the theory of Icek Ajzen’s Theory of Planned

Behavior (TPB). Icek Ajzen’s concept is geared towards investigating preceding

occurrences in making up a behavior. Behavior refers to an individual’s response

to a given situation. Preceding motivational factors are said to have a power to

influence an individual’s intention to perform a certain behavior (Najafi et al,

2017). First preceding motivational factor is attitude which refers to the

individual’s disposition towards the behavior, whether he/she gains something

from it or not. The second factor is subjective norm which refers to perceived

social pressures of the individual in doing or not doing that certain behavior. The

third factor is the perceived behavioral control which refers to the individual’s

perception of the level of difficulty in performing that certain behavior.

Figure 1. Schematic Presentation of Variables

 Disaster preparedness is a health behavior approach that encompasses

actions and response to the health needs of the population struck by a disaster.

In relation to the study, planned behaviors of nurses affect their disaster

preparedness and response. The conceptual paradigm (Figure 1) shows the

interaction between the independent and dependent variables. The disaster

preparedness of the nurses is the dependent variable which is the result of

planned behavior of nurses, the independent variable.

Statement of the Problem

This study aims to determine if planned behavior of nurses affect their

disaster preparedness. Specifically it aims to answer the following questions:

1. What are the planned behavior of nurses in terms of handling

a. natural disasters; and

b. man-made disasters?

2. What is the level of disaster preparedness of nurses?

3. Are the planned behaviors of nurses affecting their disaster preparedness?

Hypothesis

The planned behavior of nurses affect their disaster preparedness.

Significance of the Study

The researcher of this study aims to know what the planned behaviors of

nurses are in order to prepare for a disastrous event in the hospital. By knowing

what the planned behavior of nurses, nurses in different areas will benefit on what
are the behaviors they need to develop in order to be ready for disastrous events.

The hospital administrators and managers will be enlightened on the level

of preparedness of nurses and may be able to come up with interventions to

address it.

Nurses will be guided on what is the proper disaster management they have

to master in order to function in a disastrous event. They will also gain confidence

on different procedure that they are task to do in an undesirable setting and

prepare them physically and mentally in future events. This will also help gain

awareness on the preparations nurses have do in a disastrous even and will

encourage them to take part in trainings and seminars for disaster planning.

Nursing students will gain knowledge on emergency planning in the hospital

setting. They will also know what are the protocols and task nurses have to do in

order to continue their care to their patient.

This research will contribute to future research by serving as a reference on

what is the planned behavior of nurses during a disastrous event. This research

will also contribute on the preparation during a natural disaster or a man-made

disaster in the hospital. They may also modify and better technology and

techniques to achieve disaster readiness for nurses.