RESEARCH TOPIC: KNOWLEDGE AND PRACTICE ON EMERGENCY

PREPAREDNESS AMONG HEALTH CARE PROVIDERS IN NAZARETH HOSPITAL.

NAME: ELICK KARIUKI ALBERT

REG.NO. RI 21

A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE

REQUIREMENT FOR THE AWARD OF KENYA REGISTERED COMMUNITY HEALTH

NURSE

NAZARETH HOSPITAL MEDICAL COLLEGE

YEAR: 2019

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 DECLARATION
I Elick Albert Kariuki registration number 94614k, hereby declare that this project is my own

original work and has not been submitted to any other learning institution for the awards of

Diploma. I further declare that all materials cited in this proposal which are not mine have been

duly acknowledged.

Name of student : Elick Kariuki Albert

Signature : …………………………….
Date : …………………………….

This research study was submitted for examination with the approval as the supervisor.

Supervisor’s Name: : Emily Wangari

Signature : …………………………….
Date : …………………………….

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 DEDICATIONS
I dedicate this research to my loving family, my dear friends my research supervisor Tutor
Emily, Nazareth hospital health care providers for their continued support throughout the whole
period of study.

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 ACKNOWLEDGEMENT
I would like to thank God for granting me the guidance and making all things possible
throughout the research study. I pass my gratitude to the following for their support and
coordination, which provided me an opportunity to develop this research project:
My supervisor tutor Emily and all nursing lecturers in the departments of nursing who gave me
their time to guide, correct and encourage me throughout the study.
The hospital administrator, Nazareth hospital Sr. Marietta Mary for granting authority to conduct
this study in Nazareth hospital.
MAY GOD BLESS YOU ALL

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 ABSTRACT
The study on knowledge and practice among health care providers was conducted in Nazareth
Hospital. The study population was health care providers who included Nurses, Doctors and
Clinical officers. The research utilized a descriptive cross-section study design to explore the
knowledge and practice among health care providers at Nazareth hospital. Data was collected
one point in time prospectively using closed and open ended questions. The study used a simple
random sampling technique to obtain a desired sample size.
The data was analyzed and presented in pie chart, bar graph and tables. The results showed that,
health care providers did not have adequate knowledge on emergency preparedness. 47%
indicated the percentage of the respondents who did not attend any emergency care training
which is almost half of the respondents who participated in the study. This show there is a gap
between emergency training and emergency care practice.
81% of the respondents their departments did not have a fully equipped emergency that it was
missing some of essential drugs which included adrenaline, salbutamol, post exposure
prophylaxis and equipment like ambubag, suction tubes and suction machine which showed
there is a gap in emergency preparedness practice.
The study revealed that 89% of respondents who were the majority said they do not conduct
emergency drills in the hospital which are essential exercises used to rehearse anticipated
emergency scenarios, they are designed to provide training, reduce confusion and verify the
adequacy of emergency response activities and equipment. Recommendations were as follows;
Nazareth hospital to start emergency care trainings once quarterly to equip health care providers
with knowledge to respond to emergencies promptly. This is supported by the fact that almost a
half of the respondent who participated in the study did not attend emergency care training i.e.
47% of the respondents
Emergency drills should be conducted in the hospital quarterly in order to equip health care
providers with experience on emergency responses skills. Emergency trolley in all departments
should always be updated having all essential drugs and equipment.

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vi
LIST OF ABBREVIATIONS
ED Emergency Department
AED Accident and Emergency Department
URTIS Upper Respiratory Tract Infection
ECN Enrolled Community Nurse
KRCHN Kenya Registered Community Health Nurse
BSN Bachelor of Science Nurse
ACLS Advance Cardiac Life Support
BLS Basic life support
ATLS Advanced Trauma Life support
UNISDR United Nations International Strategy for Disaster Reduction
CPR cardiopulmonary resuscitation

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DEFINITION OF KEY TERMS
Emergency An emergency is a sudden, unexpected or an impending situation that may cause
injury, loss of life, damage to the properties and or interference with the normal activities of a
person or firm and which therefore requires immediate attention and remedial action.
Emergency preparedness Refers to the steps taken to be ready to respond to and survive
during an emergency.
Emergency department The department of a hospital responsible for the provision of medical
and surgical care to patient arriving at the hospital in need of immediate care.
Emergency drills They are exercises used to rehearse anticipated emergency scenarios, they
are designed to provide training, reduce confusion and verify the adequacy of emergency
response activities and equipment.
Emergency trolley Is a set of trays/drawers/shelves on wheels used in hospital for
transportation and dispensing of emergency medication/equipment at site of medical/surgical
emergency for life support protocols potentially to save a patient’s life.
Casualty A person killed or injured in a war or accident
Glasgow coma scale Is a neurologic scale which aims to give a reliable and objective way of
recording the state of a person’s consciousness for initial as well as subsequent assessment.
Resuscitation The action or process of reviving someone from unconsciousness or apparent
death.
Cardiopulmonary resuscitation Is an emergency procedure that combines chest compressions
often with artificial ventilation in an effort to manually preserve intact brain function until
further measures are taken to restore spontaneous blood circulation and breathing in a person
who is in a cardiac arrest.

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 Contents
DECLARATION.............................................................................................................................ii
DEDICATIONS.............................................................................................................................iii
ACKNOWLEDGEMENT..............................................................................................................iv
ABSTRACT....................................................................................................................................v
LIST OF ABBREVIATIONS........................................................................................................vi
DEFINITION OF KEY TERMS...................................................................................................vii
LIST OF FIGURES.........................................................................................................................x
CHAPTER ONE: INTRODUCTION..............................................................................................1
1.1 Background information........................................................................................................1
1.2 Problem statement for study..................................................................................................3
1.3 objectives...............................................................................................................................3
1.3.1 Broad objective for the study..........................................................................................3
1.3.2 Specific objectives of the study.......................................................................................3
1.4 Research questions.................................................................................................................4
1.5 Hypothesis..............................................................................................................................4
1.6 Significance of the study........................................................................................................4
CHAPTER TWO.............................................................................................................................5
2.1 Literature review....................................................................................................................5
2.1.1 Knowledge on emergency preparedness.........................................................................5
2.1.3 Emergency plan...............................................................................................................8
CHAPTER THREE.........................................................................................................................9
RESEARCH METHODOLOGY.................................................................................................9
3.1 Research design..................................................................................................................9
3.2 Study Site...........................................................................................................................9
3.3 Study population.................................................................................................................9
3.4 Selection Criteria................................................................................................................9
3.5 Variables.............................................................................................................................9
3.6 Sampling.............................................................................................................................9
3.7 Data collection..................................................................................................................11
3.8 Data analysis.....................................................................................................................11

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 3.9 Ethical considerations.......................................................................................................11
CHAPTER FOUR:........................................................................................................................12
4.0 DATA ANALYSIS AND PRESENTATION.........................................................................12
4.1: Age of the respondents...........................................................................................................12
4.2: Sex of the respondents............................................................................................................12
4.3: Qualifications of the health care providers.........................................................................13
4.5 Emergency care training...................................................................................................14
5.3: Information on practice on emergency preparedness.........................................................19
5.8 Referral system in the hospital.............................................................................................22
CHAPTER FIVE: DISCUSSION CONCLUSION AND RECOMMENDATIONS...................23
5.1 DISCUSSION......................................................................................................................23
5.1.1 Health care provider’s knowledge on emergency preparedness................................23
5.1.2 Health care providers practice on emergency..............................................................23
5.2 CONCLUSION................................................................................................................24
5.1.4 RECOMMENDATIONS..............................................................................................25
References.....................................................................................................................................26
APPENDIX 1: QUESTIONNAIRES.....................................................................................27
APPENDIX 2: BUDGET.........................................................................................................31
APPENDIX 3: TIME PLAN...................................................................................................32

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LIST OF FIGURES
Figure 4.0 showing age distribution………………………………………………………….….12
Figure 4.3 showing distribution of qualifications of the health care providers………………….13
Figure 4.4.1 showing distribution of ideology on what is an emergency……………………….14
Figure 4.4.2 Distribution of ideas on meaning of emergency preparedness…………………….14
Figure 4.5 showing distribution of training attendance………………………………………….15
figure 4.6 showing distribution of training attended…………………………………………….15
Figure 4.7 showing distribution of familiarity of role in emergency……………………...…….16
Figure 4.8 showing distribution of necessity to have an emergency plan……………...……….17
Figure 4.9: showing percentages of respondents who had no reasons and who had reasons as to
why should have an emergency plan…………………………………………………….………17
Figure 5.0 showing distribution of familiarity with emergency committee in the
hospital……………………………………………………………………….………………….18
Figure 5.1 showing distribution of familiarity on function of emergency
committee……………………………………………………………………...…………………18
Figure 5.2 showing distribution of involvement in planning and preparation for emergency
drills…………………………………………….……………………………………………….19
Figure 5.4 showing distribution of conduction of emergency drills…………………………….20
Figure 5.5 showing distribution of frequency of conducting drills……………………….…….20
Figure 5.6 showing distribution of emergency trolley equipping………………………….…….21
Figure 5.7 showing distribution of availability of emergency standard operating
procedures…………………………………………………………………………………….….21
Figure 5.9 showing distribution of existence of referral system……………………….……….22

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 CHAPTER ONE: INTRODUCTION

1.1 Background information

An emergency is a sudden, unexpected or an impending situation that may cause injury, loss of
life, damage to the properties and or interference with the normal activities of a person or firm
and which therefore requires immediate attention and remedial action. These emergencies
include, fire outbreak, chemical poisoning, head injury, heart attack, hemorrhagic shock,
hypertension crisis, unconsciousness, severe respiratory distress, acute coronary syndrome,
severe, vomiting conditions associated with diabetes mellitus. On the other hand, an emergency
department{ED}also known as accident and emergency department{A&E}or casualty
department is a medical treatment facility specializing in emergency medicine, the acute care of
the patients who present without prior appointment, either by own means or by that of ambulance
(Mugendi, 2018)

A typical hospital has its emergency department in its own section of the ground floor of the
building, with its own dedicated entrance, as the patient can present at any time with an
emergency. A key part of operation of an emergency is prioritization of cases based on clinical
need, A process called triage. Triage is normally the first stage the patient passes through and
consists of brief assessment, including set of vital signs, and assignment of chief complains e.g.
Chest pain abdominal pain, difficulty breathing. Different types of emergencies require different
period and preparation for response, (Emergency Medicine Kenya Foundation, 2018)

Emergency cases are classified into five levels, which include:

(1) Immediate action level (resuscitation). This covers patients with conditions that are life
threatening or have eminent risk of deterioration needing immediate and aggressive intervention,
e.g. cardiac or respiratory arrest and severe head injury.

(2) Emergent triaging level which consists of patients with conditions that are potential threat to
life or function e.g. mild or moderate head injury with Glasgow score coma scale of 9-15/15 and
those with drugs and substance overdose and have stable vitals. This care has to be initiated
within 15 minutes (Mugendi, 2018).

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(3) Urgent triage level requires emergency care to be initiated within 30 minutes. Failure to this,
it could potentially progress to serious problem e.g. mild asthma, vomiting and diarrhea with
dehydration.

(4) Less urgent level, consist of condition that requires emergency care within 1 hour. Failure to
which could progress to serious problems, which are associated with discomfort, or inability to
perform activities of daily living e.g. minor trauma with soft tissue injury and URTIS with
fevers.

(5) Not urgent level, which includes conditions with or without signs of deterioration.
Emergency care required within 2 hours e.g. sore throat/URTIS without fevers and diarrhea with
vomiting without dehydration (Mugendi, 2018).

Annual assessment of emergency plan is required in order to ensure emergency preparedness.

Emergency preparedness assessment should include.

1. Element of disaster planning

2. Emergency coordination
3. Communication
4. Training
5. Expansion of hospital surge capacity
6. Personnel
7. Availability of equipment
8. Stockpiles of medical supplies
9. Expansion of laboratory capacities

The assessment program must be based on valid criteria that are measurable, reliable and enable
conclusion to be drawn (Adini, et al., 2006). Nazareth hospital is situated between Banana,
Limuru and kawaida towns where we also find government hospitals named Kiambu county
hospital, Karuri sub-county and Tigoni sub-county hospital these towns share road network and
circulating public transport that are at risk of road traffic accident. Nazareth is also surrounded
with tea and flower farms, which have several workers, and their children that are exposed to
chemical poisoning; it is therefore common to find emergency cases brought to Nazareth
hospital, which is a level 6b hospital.

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1.2 Problem statement for study
In emergencies, the health care providers are expected to save life, reduce permanent disabilities,
provide medical services to the injured and reduce the risk of disease and death due to illness or
other health risk. These responsibilities can only be carried out if the health facility and staff are
well equipped.

Nazareth being one of the major health facilities in Kiambu County is a critical health facility as
it receives many emergency victims from all corners of the county. The hospital has been faced
by emergencies in past which include, head injury, heart attack, hypertension, hemorrhagic shock
and tragic road accident victims.

The traffic road accident that occurred along limuru- Nairobi road 2017, led to congestion of
victims in the outpatient department, 20 casualties were in the outpatient, attended to in single
triaging room, which could not accommodate the large number of casualties that were brought
compared to other days during emergencies in the outpatient department.

The equipment used in emergency management were not enough and able to properly deal with
the emergency that occurred. Assuring emergency preparedness requires structured methodology
that will enable an objective assessment of the level of readiness (Levitin, 2006). In the past,
hospital has no evidence that displays that health care providers have been receiving emergency
care training, despite of occurrence of emergencies in the outpatient and casualty there are no
specialist on emergency care, there are no formal training on emergency care despite having to
deal with complex burden of diseases.

1.3 objectives

1.3.1 Broad objective for the study

To assess the level of emergency preparedness among health care providers in Nazareth.

1.3.2 Specific objectives of the study

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To assess the level knowledge on emergency preparedness among health care providers in
Nazareth hospital casualty/outpatient department

To assess the practice on emergencies among health care providers in Nazareth hospital
casualty/outpatient department.

1.4 Research questions

What is the level of knowledge of health care provider on emergency preparedness in Nazareth
hospital?

What is the practice of emergency care among health care providers in Nazareth hospital?

1.5 Hypothesis
Nazareth hospital may not be fully prepared for emergency care provision.

1.6 Significance of the study

The study will equip health care providers with knowledge based on emergency preparedness,
which will enhance proper and effective emergency services in Nazareth hospital. It will also
guide the hospital on equipping the various hospital department with necessary equipment
required for emergency handling. The findings will provide reference to the researchers
undertaking studies on areas of emergency preparedness.

The Hyogo framework for action 2005:2015 also recognizes the importance of health care
facilities during emergencies and it calls for the integration of emergency and disaster risk
reduction planning into the health sector, with promotion of the goal of the hospital safe from
disasters (UNISDR, 2005). Finally, the study will identify the gaps in the areas of emergency
preparedness among health care providers in Nazareth hospital and address them.

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 CHAPTER TWO

2.1 Literature review

2.1.1 Knowledge on emergency preparedness

A study conducted at the university hospital in Egypt in 2017 to evaluate the emergency
response of nurses towards Myocardial infarction patients. Knowledge was one of the key
aspects that was assessed. A sample size of 30 nurses working in coronary care unit using
random stratification. Thrombolytic therapy is an established treatment of acute myocardial
infarction, the benefits of which is time dependent and depends on the nurses known how.

Three tools were used, nurse’s background data, thrombolytic knowledge questionnaires and
thrombolytic management observation checklist. The analysis of data revealed that 86.7% of the
nurses have inadequate knowledge regarding selected thrombolytic therapy.

The study recommended offering education programs and upgrading courses with evidence-
based guidelines based on the nurses needs to improve their knowledge related to administration
of thrombolytic therapy and follow up of nurse’s performance in relation to administration of
thrombolytic therapy is recommended. (Ismail, Khalil, & Mohamed, 2017)

Triaging is the first stage in emergency response. It is an important stage as it identifies the
patient who needs immediate care and managed in time to preserve life. Triage nurse in the
emergency department is the first person that patient encounters and the nurses’ knowledge has
been cited as an influential factor in triage decision-making (Leshabari, Aloyce, & Brysiewicz,
2014)

A study done in Dar es Salaam in one national hospital and three district hospitals by Robert
Aloyce aimed at assessing knowledge and skills on triaging of patient using both descriptive
cross-sectional and observational study designs. A sample of 60 nurses were randomly selected
whom included enrolled and registered and data was collected using a structured questionnaire.

The results showed that 33% of the respondent were not knowledgeable about triage. The 13% of
the respondent reported that although they had attended workshops, they had a lack of
information on how to triage patient. The 52% of respondents were not able to allocate the
patient to the appropriate triage category. The 58% of the respondents had no knowledge on

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waiting time limits for the triaged categories. Among the four hospitals observed only one had
nurses specifically allocated for patient triage.

The respiratory rate was not assessed by 84% of the triage nurses observed. No pain assessment
was done by any of triage nurses observed. The study suggested that, to correct knowledge
deficit on triage, training/education workshops should be carried out, followed by continuous
professional development on regular basis, including refresher training, supportive supervision
and clinical skills sessions.

A traumatic brain injury is leading cause of death and disability worldwide before and after
arrival of patient involved in motor vehicles accident. Yearly about 1.5 million people die from
traumatic head injury and several million people that survive received emergency treatment
(Malaysia Medical University, 2016). In Malaysia, the statistic for the year 2009-2010 reveals
that the causes of death from motor vehicles accident are head injury.

The 56.5% followed by brain injury 38.1% both head and brain injury 34% and skull/cranial
facial fractures 27.9%. The common presentation to the emergency department is acutely altered
level of consciousness that requires quick assessment in the emergency department, which is
crucial action of all health care providers.

Glasgow coma scale is a tool requiring knowledge that is important in detecting early
deterioration in a patient’s level of consciousness with head injury in an emergency department.
A study aimed at exploring knowledge and competence in assessing the Glasgow coma scale
among nurses working in Malaysia tertiary medical Centre in emergency and outpatient
department was carried with a sample size of 135 nurses who randomly selected. A study used a
quantitative and descriptive cross-sectional study design.

In the outcomes of the study, 85.9% answered correctly to questions pertaining to the component
of the Glasgow coma scale. The 54.8 of the participants know that vital signs are not component
of Glasgow coma scale. Only 21.5% of nurses know how to test the best motor response. The
91.1% knows what the lowest score of the Glasgow coma scale is, however about a half know
the score, which defined comatose. Only 11.9% responded correctly to the questions on the
reduction of score to define deterioration. 63.7% said Glasgow coma scale can be assessed on an
intubated patient and 86.7% could answer the question pertaining to patient verbal response on

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assessing a patient verbal response with pain stimulus only 11.9% answered correctly. However,
to assess road traffic accident patient who has swollen eyes only 84.4% answered correctly.

The study revealed that the nurse’s knowledge on Glasgow coma scale is poor in detecting
deterioration of a patient. The study found that only 2.96% of the nurses have good knowledge in
Glasgow coma scale. This finding raises concern on the importance of knowledge and skills in
assessing Glasgow coma scale. The study recommended for continuing education and practice
on the use of the Glasgow coma scale as an important tool.

2.1.2 Practice on emergency

Anaphylaxis is life-threatening reaction where prompt and appropriate management can save
lives. Epinephrine is the treatment of choice, however, the recommended dose and route of
administration of epinephrine used in management of anaphylaxis is different from that used in
management of cardiac arrest. A study done in two-district hospital in England, one in north
wale and one in east England, it aimed at investigating how junior Doctors would administer
epinephrine in a case of anaphylactic shock in an adult. 95 hospital junior doctors were assessed
using short questionnaires.

The result showed that, 94% would administer epinephrine as the lifesaving drug of choice. Only
16.8% would administer it as recommend (Ismail, Khalil, & Mohamed, 2017) by UK
resuscitation council guidelines. Only 57.9% of the junior doctors would give epinephrine
intramuscularly. Of the 32.7% said would give 1mg ,1.8% would have given high dose and
30.9% did not know what dose to give .28.4% said they would give epinephrine intravenously,
of these 25.9% would have administered dose of 0.5-1mls of 1:10000 solutions ,29.6% would
administer high doses and 44% did not know what dose to give. Only 6.3% of the doctors
administer epinephrine subcutaneously;7.4% were not sure if they would administer it
intravenously, intramuscularly subcutaneously and would give incorrect doses.

Conclusion were, junior doctors may be called to make immediate management decisions in
patient with anaphylaxis, however, widespread confusion exist regarding the dose and the route
of administration of epinephrine. Strategies to improve education and access to appropriate drugs

7
are needed. A labeled anaphylaxis box on every resuscitation trolley containing the dose of
epinephrine with clear labelling for intramuscular use may be one of solution. (Ricardo Jose,
2007)

2.1.3 Emergency plan

An emergency management plan is a formal plan of action, which enables the hospital staff to
respond effectively and efficiently when confronted with an emergency. A study carried out at
university hospital in Egypt using cross-sectional design, it aimed at assessing the awareness of
health team regarding hospital internal emergency management plan at a university hospital.

It included six groups of subjects namely, medical leaders, head nurses, staff nurses, technicians,
employees, housekeepers, in addition to a jury group to test validity of the study tool. A self-
administered questionnaire form was used to assess staff awareness about the internal disaster
management plan in the hospital.

The results showed the absence of an emergency plan in the study setting and absence of a
hospital evacuation plan. In addition, the majority of various categories of the study subjects had
low awareness about all items of the disaster plan. It is concluded that there is a need for an
internal emergency plan for the hospital, and the awareness of study subjects about internal
disaster preparedness need to be raised.

Therefore, it is recommended that the hospital administration should develop policies for disaster
management and pay more attention to the problem of internal disasters and preparedness for
their management.

Training programs are essential for all categories of hospital staff in order to increase their
awareness about emergency management. (Elazeem1 & Hemat, 2011)

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 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Research design

The researcher will utilize a descriptive cross-section study design to explore the knowledge and
practice among health care providers at Nazareth hospital as data will be collected one point in
time prospectively.

3.2 Study Site

The study will be done at Nazareth Hospital. The Hospital was started in 1970s by Consolata
missionary sisters and is currently run by Franciscan Sister’s Immaculate Heart of Mary in
1970s. Nazareth hospital is located in Limuru on Riara Ridge road in Kiambu County, Kenya.
The hospital provides; preventive, curative, palliative, diagnostic, rehabilitative, medical, nursing
and emergency services.

3.3 Study population

The target population for the study will be eligible for health care providers who are offering
direct patient care at Nazareth Hospital during the study period.
The hospital has three cadres of nurses that are ECN, KRCHN and BSN nurses, Doctors, doctor
interns, clinical registered officers, clinical officer interns and laboratory officers who are
employed as full time employees of the hospital. The hospital has 82 health care providers.

3.4 Selection Criteria

3.4.1 Inclusion criteria for the study

Registered doctors, doctor’s interns, practicing nurses, clinical officers, clinical officer interns
and laboratory officers who will consent to take part in the study.

3.4.2 Exclusion criteria for the study

Registered doctors and interns, clinical officers and interns, practicing nurses and laboratory
officers who will not consent to take part in the study, supportive staffs, hospital cooks, nurses
on leave and nurses at Nazareth Hospital who are doing managerial and administrative duties.

3.5 Variables
The independent variable in this study is knowledge on emergency preparedness among health
care providers and dependent variable is practice on emergency among care providers in
Nazareth Hospital.

3.6 Sampling

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3.6.1 Sample size determinations
From the hospital staffs’ records, there are 82 health care providers employed on full time basis
at Nazareth hospital. To determine sample size, formula by Fisher et al., (1998);
N= z 2 pq /d 2
Where,
N=is desired sample size it targets population more than 10,000
Z=standard normal deviation at required confidence level (1.96)
P=proportion in target population estimated to have characteristics being measured since the
variability is unknown, the study will use maximum variability (0.5)
q=1-q
d=level of statistical significance test, the degree of accuracy desired usually set at 0.05level
(Mugenda and Mugenda, 2003)
nⱺ=the desired sample size when the population is less than 10,000.
N= [(1.96 ¿ ¿2(0.5) (0.5)]/ [(0.05 ¿ ¿2] =384
From the hospital records, there are 82 health care providers employed on full time basis at
Nazareth Hospital.
Since targeted population is less than 10,000 (82 health care providers,
The Yamane’s (1967) formula will be used to determine the sample size for the study as below:
nf=n/ (1+n/N)
nf=384/1+ (384/82)
=66 health care providers

3.6.2 Sampling technique

The study will utilize simple random sampling technique to sample subject for the study.
Nazareth hospital has department such as medical-surgical department, casualty department,
outpatient department, maternity department, high dependency unit and operating theatre. Simple
random sampling will be employed to pick subjects from the study population, picking of
subjects will be department based.
Simple random technique will be used to achieve by lottery where YES and NO papers will be
issued in each department, 67 health care providers who will pick YES participated in the study
and nurses who will pick NO did not participate in the study.

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3.7 Data collection

3.7.1 Data collection

The researcher will use self-administered questionnaires with closed and structured questions.
The questionnaires will have section with questions on demographic factors, knowledge and
practice on emergency preparedness at Nazareth Hospital.

3.7.2 Pretesting the tool

Pretesting the tool for validity and reliability will be done where by questionnaires will be given
to the respondents. Questionnaires will be administered by the researcher to the study subjects,
pretesting of the tool will be done one day and thereafter the necessary corrections will be made.

3.8 Data analysis

Data will be cleaned and coded and analysis will be done as per the SPSS (Statistical package for
social services) version 20 using descriptive statistics. The results will be presented in bar chart,
pie chart and tables, which are cross -tabulated with the independent variables derived from the
questionnaires. Qualitative data will be cleaned, coded and analyzed using thematic analysis and
presented in narrative texts.

3.9 Ethical considerations

The research will acquire approval from Nazareth medical college, nursing department through
the research supervisor from the college. A copy of the approval letter will also have sought from
the Nazareth hospital administration for approval to conduct the study at the Hospital.
The study purpose will be explained to the respondents in details and only respondent who will
be duly will sign an informed consent will be allowed to fill in the questionnaires.
Confidentiality will be maintained throughout the course of the research study, no form of
personal identification will be in cooperated onto the survey, therefore confidentiality and
anonymity is guaranteed.

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 CHAPTER FOUR:

4.0 DATA ANALYSIS AND PRESENTATION

The study was carried out in Nazareth hospital. A total of 64 respondents were interviewed for
study and 2 questionnaires were spoilt.

Section A: demographic data

4.1: Age of the respondents

AGE NUMBER PERCENTAGE

20-30 46 71.88%

31-40 15 23.44%

41-50 3 4.69%

AB 0 0%
OVE 50

Figure 4.0 showing age distribution

4.2: Sex of the respondents

Out of 64 respondents 58%(37) were females and 42%(27) were males who participated in the
study.

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 Sex of the respondents

Male
42%

Female
58%

4.3: Qualifications of the health care providers

Out of 64(100%) interviewed respondents 72%(46) were nurses, 16%(10) were clinical officers,
12%(10) were doctors and 0% other health care providers.

Qualifications
Clinical
officers
16%

Doctors
13%

Nurses
72%

Figure 4.3 showing distribution of qualifications of the health care providers

Section B: information on knowledge on emergency preparedness

4.4: Information on respondent on what is an emergency and emergency preparedness

Out of 64(100%) respondents 28%(18) knew what is an emergency, 56%(36) had idea what is an
emergency and 16%(10) had no idea what is an emergency.

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 Idea on what is an emergency
37.5
32.5
27.5
number of health care providers

22.5
17.5 56%
12.5
28%
7.5
16%
2.5
correct answer Had an idea No idea
IDEAS ON WHAT IS AN EMER- 18 36 10
GENCY

Figure 4.4.1 showing distribution of ideology on what is an emergency

Out of 64(100%) respondents 28%(18) of respondents had an idea on what is emergency
preparedness while 72%(46) of the respondents had completely no idea on what is emergency
preparedness.

Meaning of emergency preparedness

47.5
42.5
37.5
32.5
Number of health care providers

27.5
22.5 72%
17.5
12.5
7.5 28%
2.5
Had idea No idea
MEANING OF EMERGENCY PREPAREDNESS 18 46

Figure 4.4.2 Distribution of ideas on meaning of emergency preparedness

4.5 Emergency care training

Out of 64(100%) respondents,53%(34) had attended emergency training while 47% (30).

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 Emergency training attendance

YES
47% NO
53%

Figure 4.5 showing distribution of training attendance

Out of 34 respondents who said had attended emergency training, 58%(20) of respondents said
they attended basic life support training, while 21%(7) of respondents said had attended
advanced cardiac life support. The other 21%(7) said they had attended both basic life support
and advanced cardiac life support.
None of the respondents had attended advanced trauma support training among who said had
attended emergency training.

Types of emergency trainining attended

both ACLS & BLS
21%

BLS
ACLS 59%
21%

basic life support advanced cardiac life support

Both basic and advanced cardiac life support advanced trauma and life support
figure 4.6 showing distribution of training attended

Out of 64(100%) respondents 20%(13) did not know the role they play in an emergency while
80%(51) of the respondents knew the role they play in an emergency.

15
 Familiality of role in emergencies

20%

80%

YES NO

Figure 4.7 showing distribution of familiarity of role in emergency

Out of 51 respondents who knew their role in an emergency,2% played role of observer in an
emergency,14% played the role of Triger,37% played the role of rescuer 1-chest
compression,18% of the respondents said they played the role of rescue 2-maintaining airway
and oxygen delivery, 19% play the role of rescue 3-maintaining circulation, 2% play the role of
documentation and 8% play the role of team leader.
None of the respondents played any other role other than the ones stated.
Out of 64(100%) respondents 89%(57) said it was necessary to have emergency plan while
11%(7) said it was not necessary to have emergency plan in the hospital

16
 Necessity to have an emergency plan

11%
YES
NO

89%

Figure 4.8 showing distribution of necessity to have an emergency plan.

Out of 57 respondents who said it was necessary to have an emergency plan 67% of the
respondents had reason of having emergency plan in the hospital while 33% did not give reason
of having emergency plan.

Percentage of respondents on reasons to have an

emergency plan.

No reason
33%

Had reason
67%

Figure 4.9: showing percentages of respondents who had no reasons and who had reasons as to
why should have an emergency plan.

Out of 64 respondents 22%(14) were familiar with emergency committee while 78%(50) had no
idea on emergency committee in the hospital.

17
 Familiality with emergency committee in the hospital

YES NO

22%

78%

Figure 5.0 showing distribution of familiarity with emergency committee in the hospital.
Out of 14 respondents who ever heard of emergency committee in the hospital,29% knew the
role played by emergency committee, 71% of the respondents who were majority did not know
the role played by an emergency committee.

Familiality with the function of emergncy committee

familiar
29%

Not familiar
71%

familiar Not familiar

Figure 5.1 showing distribution of familiarity on function of emergency committee.

Out of 64 respondents who participated in the study, only 31% of the respondents have ever been
involved in the planning and preparation for emergency drills, while 69% have never been
involved in drills planning and preparation.

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 Involvement in plannig and preparation for emergency
drills

YES
31%

NO
69%

YES NO

Figure 5.2 showing distribution of involvement in planning and preparation for emergency drills.

5.3: Information on practice on emergency preparedness

5.3.1 conduction of emergency drills in the hospital

Out of 64 respondents who participated in the study 11% of the respondents said they conduct
emergency drills in the hospital while 89% who were the majority said they don’t conduct
emergency drills in the hospital.

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 Conduction of emergency drills

11%

YES
NO

89%

Figure 5.4 showing distribution of conduction of emergency drills

Out of 7 respondents who said they conduct emergency drills in the hospital 14% said were not
sure about frequency of conducting emergency drills in the hospital,43% of the respondents said
they conduct drills annually and the other 43% said they have no specific time for conducting
emergency drills in the hospital.

Frequency of conducting drills

14%

Unsure
43% Anually
NO specific time

43%

Figure 5.5 showing distribution of frequency of conducting drills.

Out of 64%respondents who participated in the study 19%(12) of the respondents said their
department had fully equipped emergency trolley and

20
 81%(52) of the respondents their departments did not have a fully equipped emergency
trolley.81% of the respondents who had their trolley not fully equipped said their emergency
trolleys in their departments were missing import drugs like adrenaline, salbutamol, post
exposure prophylaxis and equipment like ambubag, suction tubes and suction machine.

Emergency trolley equiping

19%

YES
NO

81%

Figure 5.6 showing distribution of emergency trolley equipping.

Out of 64(100%) respondents who participated in the study 42% of the respondents had standard
emergency operating procedure in their departments while 58% of the respondents did not have
standard emergency operating procedures their departments.

Availability of emergency standard operarating pro-

cedures

YES
42% NO

58%

21
Figure 5.7 showing distribution of availability of emergency standard operating procedures.

5.8 Referral system in the hospital

Out of 64(100%) respondents who participated in the study 78%(50) the majority said they had
referral system in the hospital and 22%(14) said they did not have referral system in the hospital.

Existence of referral system

22%

YES
NO

78%

Figure 5.9 showing distribution of existence of referral system

All the 78% of the respondents who said they had referral system in the hospital gave examples
of the emergences they refer.

22
 CHAPTER FIVE: DISCUSSION CONCLUSION AND RECOMMENDATIONS
This chapter aims to discuss findings of the study as analysed in chapter 4 and their
recommendations concerning knowledge and practice.

5.1 DISCUSSION

5.1.1 Health care provider’s knowledge on emergency preparedness

The study found that health care providers had inadequate knowledge on emergency prepared.
Out of 100%(64) of the respondents only 28%(18) knew the meaning of an emergency.
Comparing this study to the one done in university of Egypt there in agreement that 86.7% of the
nurses have inadequate knowledge regarding emergency preparedness.
This study is similar to the one that was carried in Malaysia medical university that was aiming
in assessing utilization of Glasgow coma scale in scoring of road traffic accident casualties the
study revealed that the nurse’s knowledge on Glasgow coma scale is poor in detecting
deterioration of a patient. The study found that only 2.96% of the nurses have good knowledge in
Glasgow coma scale.

5.1.2 Health care providers practice on emergency

The study found that health care providers do not have emergency practice skills, the study
clearly showed that out of 64 respondents who participated in the study 11% of the respondents
said they conduct emergency drills in the hospital while 89% who were the majority said they
don’t conduct emergency drills in the hospital.
This study is in agreement with the study that was done in in two district hospital in England
which aimed at investigating on administration of epinephrine management of anaphylactic
shock by doctors as part of emergency drills; the study revealed that only 16.8% would
administer it as recommend.
The study findings revealed an important aspects of the emergency trolley an essential item in
the department. Out of 64%respondents who participated in the study 19%(12) said their
department had fully equipped emergency trolley while 81%(52) of the respondents their
departments did not have a fully equipped emergency that it was missing some of essential drugs
like adrenaline, salbutamol, post exposure prophylaxis and equipment like ambubag, suction
tubes and suction machine.

23
5.2 CONCLUSION

In the emergency training out of 100%(64) only 53%(34) had attended emergency care training
and 47%(30) indicating the percentage of the respondent who did not attend any emergency care
training which is almost half of the respondents who participated in the study. This show there is
a gap between emergency training and emergency care practice.

In addition, majority of the care providers among who had attended emergency care training i.e.
58% of the respondents had basic life support training only while 21% of the respondents among
who attended emergency care training had advance cardiac life support training.

21% had attended both ACLS and BLS training, there is no doubt that none of the respondents
had attended at least both ACLS, BLS and ATLS training which is a disadvantage to trauma
casualties in the hospital. None of the health care provider had attended advanced trauma life
support(ATLS) training.

The study found that out of 100%(64) 80%(51) knew their role in an emergency. Suggestion of
11% of the respondents that it was not n necessary to have emergency plan shows the need to
have emergency care training in the hospital since it is a significant number. The study clearly
showed that 78% 0f the respondents were not familiar with emergency committee in the hospital
among those who were familiar with EC i.e.14 respondents, 71% the majority did not know the
role played by emergency committee(EC) in the hospital.

The study found that out 100% of the respondents who participated in the study 69% of the
respondents have never been involved in planning and preparation of the emergency drills.

5.2.1 Conduction of the emergency drills

The study found that out of 64 respondents who participated in the study 89% of respondents
who were the majority said they do not conduct emergency drills in the hospital.
The study revealed that majority of the hospital departments did not have a fully equipped
emergency trolley since 81% of the respondents the majority said their departments did not have
a fully equipped emergency. Drugs and the equipment’s included adrenaline, salbutamol, post
exposure prophylaxis and equipment like ambubags, suction tubes and suction machine.

24
As Standard operating procedures are used as a guide in every department on steps in responding
to emergencies, the study found that almost half 42% of the respondents said their departments
had no standard operating procedures (SOPS) in their department in the hospital.

5.1.4 RECOMMENDATIONS

I recommend that Nazareth hospital to start emergency care trasinings once quarterly to equip
health care providers with knowledge to respond to emergencies promptly. This is supported by
the fact that almost a half of the respondent who participated in the study did not attend
emergency care training i.e. 47% of the respondents
I also recommend health care providers who especially work in casualty department to undertake
training on ATLS since the study shows none of the respondents undergone such training which
could be an advantage to RTA casualties
Emergency drills should be conducted in the hospital quarterly in order to equip health care
providers with experience on emergency responses skills. All health care providers should
always be involved in the planning and preparation of emergency drills in order to gain
knowledge and skills on how to respond to an emergency.
Emergency trolley in all departments should always be updated having all essential drugs and
equipment.

25
 References
Adini, B., Goldberg, A., Laor, D., Cohen, R., Zadok, R., & Bar-Dayan, Y. (2006, November-
December 1). Assessing levels of hospital emergency preparedness. Prehosp Disaster
Med. , 451–457. Retrieved from PubMed: http:/www.ncbi.nlm.nih.gov/m/pubri
ALdridge m, J. p. (2014). cardia arrest to support circulation. Nursing times, 17-19.
Elazeem1, H. A., & Hemat, A. (2011). Awareness of Hospital Internal emergency Management
Plan among Health Team Members in A University Hospital. Life Science Journal, 0-8.
Emergency Medicine Kenya Foundation. (2018). Emergency care Algorithm. Nairobi:
Emergency medicine kenya foundation.
Ismail, M. S., Khalil, N. S., & Mohamed, A. S. (2017, 7 1). coronary care nurses practice on
management of thrombolytic therapy. (pp. 1-2). Cairo: Cairo University.
Kluwer, W. (2014). Journal of family medicine and primary care. Medknow publications, 305-
308.
Leshabari, S., Aloyce, R., & Brysiewicz, P. (2014). science direct. African journal of emergency
medicine, 14-18.
Levitin. (2006). assessing levels of hosital emergency preparedness. PubMED labs, 1.
Malaysia Medical University. (2016). Assessing nurses knowledge on glasgow coma in
emergency department. Nursing research and practice, 0-5.
Mugendi, F. (2018, 8 12). Standard operating procedures. Kiambu: Flavio Mugendi.
Naidoo, M. (2017). Emergency care training workshops. SciELO, 2071-2928.
Queensland Government. (2017). The triage system. Health alert , 1.
Rajeswaran, L. (2012). Audits of emergency trolleys’ contents in selected hospitals in Botswana.
Health SA Gesondheid, 1-2.
Ricardo Jose, G. J. (2007). Survey of the use of epinephrine for anahylaxis by junior doctors.
Postgraduate medical journal, 46.
UNISDR. (2005, January 18). Emergency and disaster preparedness. Retrieved from Hyogo
framework for action(HFA): http://www.unisdr.org
zucker, H. (2008, March 1). department of health Newyork. Retrieved from emergency
preparedness definition: htts:www.health.ny.gov

26
APPENDIX 1: QUESTIONNAIRES
I Am student nurse at Nazareth medical college, undertaking research on knowledge and practice
on emergency preparedness among health care providers in Nazareth hospital. Participation is
voluntary and you are assured of confidentiality. Your participation is highly valued.
Instructions:
Do not write your name.
Answer all questions.
Give a brief explanation where required.
Tick where applicable in the boxes.

PART 1
Section I: demographic data

1. What is your gender

a) Male
b) Female
2. What is your age
a) 20-30
b) 31-40
c) 41-50
d) Above 50 years
3. What is your qualification
a) Nurse
b) Doctor
c) Clinical officer
d) Others

Section II: information on knowledge on emergency preparedness

4.What is an emergency?
………………………………………………………………………………………………
…………………………………………………….
5.What is emergency preparedness?
………………………………………………………………………………………………
……………………………………………………

27
6.Have you attended any training on emergency cares?

I. Yes

II. No

If yes, which one?

a) Basic life support

b) Advanced cardiac life support

c) Advanced trauma and life support

d) Others. Specify
………………………………………………………………………………………
…………………………………………………

7.Do you know your role during an emergency?

I. Yes

II. No

If yes, what role do you play? [Tick appropriately inside the box
a) Observer
b) Triger
c) Rescuer 1-for chest compression
d) Rescuer 2-involved in airway and oxygen delivery.
e) Rescuer 3-maintain circulation i.e. cannulation and emergency drugs
administration
f) Team leader
g) Document event
Any other role specify…………………………………………………………………
8.Do you think it is necessary to have an emergency plan?
I. Yes

II. No

28
 If yes,why?.............................................................................................................................

9.Have you heard of an emergency committee in the hospital?

I. Yes

II. No

If yes, what role does the emergency committee play?

………………………………………………………………………………………………
…………………..
10.Have you been involved in the planning and preparation for emergency drills?
a. Yes
b. No

Section III: information on practice on emergency preparedness

11. Do you conduct emergency drills in the hospital

I. Yes

II. No

If yes, how often?

……………………………………………………………………………………………....
12. Have you been involved in planning and preparation of emergency drills?

I. Yes

II. No

13.Does Your Department Have a Fully Equipped Emergency Trolley/Tray?

I. Yes

II. No

29
14.Does your emergency trolley or department have following equipment? Tick against the box.

ITEM PRESENT MISSING F-faulty

E-expired
Adrenaline
Magnesium sulphate
Salbutamol
Diazepam
Post exposure
prophylaxis
Hydralazine
Ambubag
Suction tube
Oxygen mask/nasal
prong
Suction machine
Dextrose
Sodium
chloride/ringers
lactate fluids
Hydrocortisone
Aminophylline
Oxygen supply

15.What kind of emergencies do you get in your department?

…………………………………………………………………………………………….
16. Are there standard emergency operating procedures in your department?
a) Yes
b) No
17. Do You Have a Referral System in The Hospital?
a) Yes

30
 b) No

If yes, what types of emergencies do you refer? …………………………………………………

APPENDIX 2: BUDGET

Financial expenses that incurred during the research

ITEM AMOUNT

Stationery 400

Printing 800

Binding 500

Photocopy 250

Transport 300

Internet 1000

Questionnaire 250

Total 3500

31
 APPENDIX 3: TIME PLAN

ACTIVITIES DURATION IN MONTHS

JULY AUG SEP OCT NOV DEC JAN FEB MARCH APRIL
Identification of
research topic

Problem
statement

Literature
review

Research
methodology

Data analysis

Compiling of
the report

32