THE EFFECT OF DISASTER NURSING SIMULATION

ON NURSES BEHAVIOR IN MEDAN

Johansen Hutajulu1, Hafizah Che Hassan2, Santhna Letchmi Panduragan3, Henny Syapitri4,
Tanti Yosepha Ompusunggu5, Jagentar Parlindungan Pane 6, Sandeep Poddar7

1,4,5
Faculty of Pharmacy & Health Science Sari Mutiara Indonesia University
Jalan Kapten Muslim No. 79 Medan, North Sumatra, Indonesia
2,3,7
Lincoln University Collage, Jl. Stadium SS 7/15, Petaling Jaya, Selangor, Malaysia
6
Stikes Santa Elisabeth Medan North Sumatra, Indonesia
*Coresponding Author’s Email : jojo3boy@yahoo.com

ABSTRACT

Various efforts continue to develop human resources in the face of disaster, but the
high number of victims of disaster events can not be avoided. Nurses as one part of the
first responder in disaster management need to be better prepared in the care of mass
victims including starting when finding victims, stabilising to do reference. The ICN
Core Competencies in Disaster Nursing are organised within eight domains which have
been updated from those used in ICN Core Competencies 3.0 based on research and
experiences over the intervening years. A nurse needs to have knowledge and skills
regarding disaster and disaster management. The purpose of this study is to determine
the effect of disaster nursing simulation on nurses behavior in Medan. Methods the
research uses quantitative methods, Quasy Experimental research design was used in
this research. The population in this research were nurses in the city of Medan is 94
nurses and The targeted sample size was 76 respondents. This research focused on
the emergency Nurse in Hospital Type B Medan City. Majority of the age 20 – 30 Years
(40,8%), majority of the gender female (57.9%) majority of the length of working > 4
Years (47,4%), and majority of the job status non goverment (86,8%). There is a
significant effect of attitude toward behavior on behavior with a P value of 0.028 and a
value of t = 2.193 > 1.96; There is a significant effect of attitude toward behavioral
towards Intention with a P value of 0.000 and a value of t = 3.493 > 1.96; There is a
significant effect of Subjective Norm on Intention with P Values of 0.000 and t value =
6.650 > 1.96; There is a significant effect of Perceived Behavioral Control on Intention
with a P Value of 0.035 and a value of t = 2.106 > 1.96; There is a significant effect of
Perceived Behavioral Control on behavior (Behavior) with a P value of 0.017 and a
value of t = 2.386 > 1.96; There is no significant effect of intention on behavior
(Behavior) with a P value of 0.889 and a value of t = 0.139 > 1.96. Continuous
improvement is needed using the Disaster response action skills. Important to conduct
emergency training or disaster response training and then carrying out
joint/coordinating activities with cross-sectors in order to prepare human resources for
disaster response.
Keywords: effect, disaster, nursing, simulation, theory planned behavior

Introduction North Sumatera is one of the regions in

Indonesia with a potential disaster that
has the worst impact. The death toll,
injuries, economic losses and
environmental damage could not be said
to be slight. Various efforts continue to
develop human resources in the face of
disaster, but the high number of victims
of disaster events can not be avoided.
Nurses as one part of the first responder
in disaster management need to be
better prepared in the care of mass
victims including starting when finding
victims, stabilising to do reference. But
the field is still in the situation that the
victims found immediately carried out
without any optimal stabilization process
(Wenji et al., 2014).
The competencies of Level I and Level II
nurses were outlined in the ICN Core
Competencies in Disaster Nursing 2.0
released in 2019. These Competencies
for Nurses involved in Emergency
Medical Teams supplement those
expected of the practicing nurse as
defined by ICN. The domains include :
Domain 1 : Preparation and Planning
actions taken apart from any specific
emergency situation to increase
readiness and confidence in actions to
be taken during an event; Domain 2 :
Communication approaches to
conveying and updating essential
information within one’s place of work or
emergency assignment and
documenting actions taken, and
decisions made; Domain 3 : Incident
Management the structure of disaster/
emergency responses required by
countries/ organisations/ institutions and
actions to make them effective and
efficient; Domain 4 : Safety and Security
assuring that nurses, their colleagues,
and patients do not add to the burden of
response by unsafe practices; Domain 5
: Assessment gathering data about
assigned patients/ families/ communities
on which to base subsequent nursing
actions; Domain 6 : Intervention - clinical
or other actions taken in response to
assessment of patients/ families/
communities within the incident
management of the disaster event;
Domain 7 : Recovery steps taken to
facilitate resumption of pre-event
individual/ family/ community/
organisation functioning or moving it to a
higher level; Domain 8 : Law and Ethics
the legal and ethical framework for
disaster/emergency nursing (Loke et al.,
2014).
Simulation has been used widely in the
clinical training of health-care students
and professionals. A tabletop exercise
usually lasts from 1 to 4 hours, but can
vary depending on the incident.
Simulation method Table Top Disaster
Nursing Simulationis a method of
simulation using the media in the form of
a map image catastrophic incident on a
flat board or table (tabletop) along with
disaster scenarios and comes to the
implementation of role play all
participants to resolve problems related
to the management of victims in disaster
response in accordance with scenario.
Thus, application of Table Top Disaster
Nursing Simulation is very effective
when applied to the emergency
conditions of disaster management in
providing disaster victims effectively and
efficiently (Xia & Yang, 2016).
Methods
This section will describe the
quantitative research design, methods of
data analysis used in quasi-
experimental designs. This research
focused on the emergency Nurse in
Hospital Type B Medan City. Names of
the participant were obtained in the data
from INNA Medan. The targeted sample
size was 76 respondents in the current
research; a simple random sampling
technique was used in collecting the
data from the population. The survey
instrument used in current study is
divided in few sections as discussed.
After the data was collected, this study
utilized PLS path modelling.
Results
A total of 76 respondents completed and Figure 1. Measurement Model (Inner
replied the questionnaire. Table 4.1 Model)
summaries the data pertaining to
respondent’s background information.
The data shows respondent’s age, Table 2. Matrix Patch Coefficient
gender, Length of working and job
status.

Table 1. Socio - Demographics of

Respondents
Based on the description of table 1. an
Demographics Frequency % overview of the structural model is
n=76 obtained as follows:
Age 1. There is a positive effect of attitude
<20 Years 21 27.6 toward behavioral towards Intention
20 – 30 Years 31 40.8 with a parameter coefficient value of
>40 Years 24 31.6 0.494.
2. There is an effect of Subjective
Gender Norm on Intention with a parameter
Male 32 42.1 coefficient value of 0.728.
Female 44 57.9 3. There is no positive effect of
Perceived Behavioral Control on
Length of Working Respondents Intention with a parameter
<2 Years 13 17.1 coefficient value of -0.230.
2 – 4 Years 27 35.5 4. There is a positive influence of
>4 Years 36 47.4 Perceived Behavioral Control on
behavior (Behavior) with a
Job Status parameter coefficient value of
Goverment 10 13.2 0.469.
Non Goverment 66 86.8 5. There is a positive influence of
Intention on behavior (Behavior)
with a parameter coefficient value of
0.031.

The next stage is to test the structural

model. At this stage the goal is to
determine the influence of variables.
This test uses a comparison t test (t-
test), if the calculated t value is greater
than t table, t-value> 1.96 means the
test is significant.

Table 3. Patch Coefficient – Mean,

STDEV, T Values, P Values
1. There is a significant effect of
attitude toward behavior on behavior
with a P value of 0.028 and a value
of t = 2.193 > 1.96.
2. There is a significant effect of
attitude toward behavioral towards
Intention with a P value of 0.000 and
a value of t = 3.493 > 1.96.
3. There is a significant effect of
Subjective Norm on Intention with P
Values of 0.000 and t value = 6.650
> 1.96.
4. There is a significant effect of
Perceived Behavioral Control on
Intention with a P Value of 0.035
and a value of t = 2.106 > 1.96.
5. There is a significant effect of
Perceived Behavioral Control on
behavior (Behavior) with a P value
of 0.017 and a value of t = 2.386 >
1.96.
6. There is no significant effect of
intention on behavior (Behavior)
with a P value of 0.889 and a value
of t = 0.139 > 1.96.
Table 4. Goodness of fit on Model Fit
To validate the overall structural model,
Goodness of Fit (GOF) is used. The
GOF index is a single measure to
validate the combined performance of
the measurement model and the
structural model. The goodness of fit in
this research model is seen from the
SRMR value where the value is 0.031
<0.1, so the fit model has been fulfilled
and the model is suitable.
The Goodness Of Fit (GOF) value
ranges from 0 to 1 with the interpretation
of values: 0.1 (small GOF), 0.25
(moderate GOF), and 0.36 (good GOF).
The GOF value in this research model is
0.826 > 0.36, meaning that the Theory
Planned Behavior-Based Disaster
Response Improvement Model in the
context of local cultural wisdom in
Pacitan Regency can be applied.
Discussions
1. The Effect Of Attitude Toward
Behavior On Intention In Responsive
Behavior Disaster
There is an influence between
attitude toward behavioral towards
Intention . Fishbein and Azjen, (2010)
explain intention as a cognitive and
conative representation of an
individual's readiness to perform a
behavior. Intention is the determinant
and disposition of behavior, so that
the individual has the opportunity and
the right time to show a behavior
concretely.
2. Effect Of Subjective Norm On
Intention In Responsive Behavior
Disaster
An influence of Subjective Norm on
Intention . According to Fishbein
and Azjen (2010) subjective norm is
defined as a social factor that
indicates social pressure that is felt
to do or not to do an act, this social
factor is influenced by perceptions
or beliefs about other people's
expectations of him (Normative
beliefs) and motivation in meet
expectations (Motivation to comply).
3. Effect Of Perceived Behavioral
Control On Intention In Disaster
Response Behavior
There is an influence of Perceived
Behavioral Control on Intention. As
stated by Conner et al., (2014),
intention (intention) is based more
on a feeling about going to perform
a behavior (affective attitude), which
 in previous thoughts there are all
possibilities or consequences of an
action that will performed (cognitive
attitudes), and was also associated
with better behavior prediction. So
that with a good and strong attitude
will bring positive intentions.
Meanwhile , perceived behavior
control is more likely to perceive
obstacles that are easy or difficult
for a behavior to be implemented.
This variable is assumed to reflect
past experience, and anticipate
obstacles that may occur.
4. The Effect Of Intention On
Responsive Behavior Disaster
There is no influence of Intention on
behavior. According to research
conducted in Martinez and Lewis,
(2016), Attitude is the first predictor
and is a function of a very strong
desire and the likelihood of the
expected outcome and what has
been proven will be a strong
predictor of some behavior.
Knowledge is the most important
factor related to behavior. With the
value of knowledge possessed,
there is a desire to prove what has
been learned. The next factors that
support the formation of behavior
are followed by subjective norms,
practice control, and attitudes. All of
these studies are in accordance
with the original theory of TPB.
However, an intention does not
always turn into a behavior. Many
things can affect a person's
intention so that he does not take
an action. So there appears a gap
(distance) between intention and
behavior.
Conflict Of Interest
The authors declare no conflict of
interest on this research.
Acknowledgements
First of all, I thank Allah for inspiring me
with the ability, strength and patience to
perform this modest study. My deepest
gratitude and appreciation to my
supervisor I am most grateful to my
supervisor Prof Datin Hafizah Che
Hassan. I am most grateful to my Co
supervisor Prof Santhna Letchmi
Panduragan for her bright ideas. I wish
to express my most sincere appreciation
to Rector of Sari Mutiara Indonesia
University Dr. Dra. Ivan Elisabeth Purba,
SH, M.Kes. Finally, my
acknowledgement would not be
completed without recognizing the role
of my beloved wife Tanti Yosepha
Ompusunggu, my beloved children
Fortune Libby Hutajulu and Jeofrey
Tangwin Hutajulu.
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