FACTORS RELATED TO DISASTER PREPAREDNESS AMONG NURSES: A SYTEMATIC REVIEW

Dewa Gede Sanjaya Putra*, Kuswantoro Rusca Putra, Noorhamdani AS
Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia

*Corresponding Author’s Email: sanjayaputradewagede@gmail.com

ABSTRACT

Introduction: One-decade disasters that occur globally are the phenomena that will not stop but increase. This results in a high rate of injury, death, large numbers of infrastructure damages, and also enormous economic and personal loss to society. Nurses are in the frontline and have a very important role in all phases of disaster management. The purpose of writing this article is to review the factors of preparedness of nurses in disaster management.

Methods: This is a literature review of scientific articles conducted from 2009 to 2019 on nurses’ preparedness for disasters. The review was proceeded through several stages; making questions, identification, eligibility, article inclu- sion selection, screening, and appraisal. The selection process was listed in the review systematic framework and 8 article articles were obtained. The articles were then summarized and assessed by JBI in each article.

Results: The review shows that nurse preparedness is related to several factors, namely; education level, years of work, previous disaster response experience, attendance in disaster simulation training, family preparedness, and self-regula- tion.

Conclusion: Providing a sustainable education and training on disaster simulation that involves nurses in disaster map- ping will increase nurses' confidence and preparedness in facing future disasters.

Keyword: Disaster, Preparedness, Nurses

INTRODUCTION

Disasters that occur globally are the phenomena that will not stop and increase, this will result in high rates of deaths and injuries, large numbers damages to infrastructure and enormous economic and personal losses for the community (Kayano et al., 2019). The number of deaths and injuries varies and depend on factors related to the nature of the disasters and the regional infrastructure where the disaster has occurred (Guha-Sapir et al., 2016).

Nurses are the largest sector of the workforce in health care and will be at the forefront. They are the first health profes- sional to visit the victims for every disaster emergency response (Veenerma, 2015). Nurses have a very important role in disaster preparedness, especially nurses who work in emergency units or installations (Grochtdreis et al., 2016). Nurses have played an important part in disasters in all phases, including preparedness, mitigation, response and recov- ery/rehabilitation (Miller & Farra, 2012). Among those phases, disaster nursing requires a special attention on its plan- ning and preparation (International Council of Nurse, 2009). The important role of nurses in disaster management must be considered to minimize the increasing global threats. In case of disaster it is very important for nurses to improve their competence in disaster preparedness (Achora & Kamanyire, 2016).

Within the Sendai Framework it was found that there are four priorities in disaster risk management, namely 1). Under- stand disaster risk; 2). Strengthening disaster risk management to manage disaster risk; 3). Invest in disaster risk reduc- tion for resilience and 4). Improve disaster preparedness for effective response and to rebuild better in terms of recovery, rehabilitation and reconstruction (Surianto et al., 2019). A recent study found that nurses' preparedness in disaster man- agement is still at the moderate to lower level (Labrague et al., 2018). Nurses also do not understand their exact role in disaster management (Duong, 2009).

Figure 1: Flow chart of the selection process

Considering the increasing risk of global disasters and the large role of health workers, especially nurses in disaster management in all phases of disaster management, the author would like to make a review on the factors that contributes to the preparedness of nurses in disaster management.

METHODOLOGY

This study is a systematic review on factors that contribute to nurses' preparedness for disasters, through several elec- tronic medical databases namely, ProQuest, Science Direct, and NCBI. The search keywords included: Nurses Role, Disaster Preparedness, and Disaster Response. Those keywords are applied in a combination using conjunction "AND", i.e., ‘Nurses Role and Disaster Preparedness and Disaster Response’. The author identifies the article by selecting set- tings on each database search page, namely: articles published between 2009-2019. Besides, the criteria for the articles included in this review are original research articles with a quantitative approach written in English. While theses, sys- tematic reviews, qualitative studies, and articles that are not written in English are excluded.

The search was done by combining the three keywords with the combination "AND" resulted in 894 articles in Science Direct, 330 articles in NCBI and 990 articles in ProQuest. This number was reduced to 129 after the title and abstract review. It was found that 2085 articles are not relevant to the purpose of the review. The full text reading of the remaining articles produced 8 articles that were deemed suitable for review. The process followed to identify articles that are relevant for review is shown in the attached figure. After the authors determine the articles to be reviewed, all articles are summarized and assessed using the Joanna Briggs Institute check list (Joanna Briggs Institute, 2019). The summary of the results of each article is explained in the attached table below:

Table 1: Summary of Results of Each Article

RESULTS

From the results of the review conducted by the author it can be concluded that there are six factors that contribute to the preparedness of nurses in disaster management.

Level of Education

Nurses who have a degree of undergraduate education have a positive correlation with the high level of nurses' knowledge and skills in disaster management (Ahayalimudin & Osman, 2016).

Year of Work

Length of work shows a significant and positive correlation on increasing nurse preparedness in management and re- sponding to disasters (Ahayalimudin & Osman, 2016). In other studies it was also found that nurses who worked more than 5 years in health institutions will have more knowledge and skills in disaster management (Nofal et al., 2018). The work period is also stated to have a strong and positive relationship to the perception of emergency nurse preparedness in Indonesia in preparing themselves for future disasters (Rizqillah & Suna, 2018). The clinical experience (years of work) of nurses was also conveyed to be an important factor that had a positive correlation in increasing knowledge and skills in providing nurse care to patients in Post-Tsunami Aceh (Husna, Hatthakit & Chaowalit, 2011).

Experience in Previous Disaster Response

The selected articles in this review also expose the relationship between nurses’ experience in disaster response and their

preparedness. Nurses involved in responding to disasters have a positive and significant correlation with the improve- ment of their knowledge and skills in future disaster management (Ahayalimudin & Osman, 2016), while those who have never been exposed to disasters in their area have less knowledge about the dangers of other disasters (Rizqillah & Suna, 2018). Besides, nurses’ experience in responding to major disasters give a positive impact on the perception of competency they have (Baack &Alfred, 2013). Other study also found that previous disaster-related experiences were important findings and had the strongest influence on the main competencies of emergency room nurses in South Korea in terms of future disaster management (Park & Kim, 2017). Conclusively, previously reported studies found that dis- aster experiences will be able to positively enhance nurses' knowledge and competency in disaster preparedness.

Disaster Simulation Training

A study revealed that nurses who attended previous disaster simulation training had a positive correlation with their knowledge and skills in caring for patients after the Aceh Tsunami. The findings of this study could serve as evidence for stakeholders in the hospital to prepare nursing staff for nurses' knowledge and skills for tsunami care by providing regular disaster and emergency training to respond to future disasters (Husna, Hatthakit & Chaowalit, 2011). It was also found in another study that nurses who worked in emergency departments, and those who previously attended disaster management training had high self-confidence when facing an impending disaster (Rizqillah & Suna, 2018). The pro- vision of disaster simulations and ongoing training by hospitals provides a positive contribution to improving the main competencies of emergency room nurses in responding when a disasters occur (Park & Kim, 2017). Giving a short simulation through computer media also has a positive correlation to the increase the confidence of the head nurse in responding to disaster occurances (Jonson et al., 2017). The presence of officers in every training and disaster simulation is very important in improving their knowledge and skills in dealing with future disasters (Lim, Lim & Vasu, 2013).

Family Readiness and Support

Nurses whose families that have adequate readiness and could plan for disaster, are given a support to be able to give a good response when a disaster occurs. Sharing information about the scope of work of health workers with their family members will be beneficial. This will enable family members to understand and support their work, especially in the event of a disaster (Lim, Lim & Vasu, 2013).

Self-Regulation

Self-regulation in this case is an effort made by nurses to regulate themselves. So that, they are able to survive and can provide the best response when a disaster occurs. Self-Regulation, which relates to motivation, has a positive and strong correlation to the increase in nurse preparedness for disaster management (Baack & Alfred, 2013).

DISCUSSION

From the articles reviewed, it was found that there are six predominant factors that contribute to the nurses’ preparedness in disaster management, namely; the level of education, years of work, experience in previous disaster response, disaster simulation training, family readiness and support, Self-Regulation. In terms of nurses level of education, effective dis- aster response is influenced by a high level of education, a long duration of education, good learning, and an abundance of disaster knowledge and skills from nurses (Xu & Zeng, 2016). As the frontline of health services during disasters, nurses must be equipped with knowledge and readiness in responding to disasters in all phases (Hutton, Veenema & Gebbie, 2016).

The availability of knowledge resources in the form of difficult to find appropriate libraries and internet networks were also obstacle for nurses to increase their capacity to obtain the latest knowledge in disaster preparedness (Sangkala & Gerdtz, 2018). The availability of information and literature is a key factor in supporting clinical staff to keep their knowledge updated and follow current practices. Limited access to published literature will reduce nurses' abilities in clinical practice (Melnyk & Ellen, 2014). As a result, nurses who lack knowledge and readiness will have difficulty in providing adequate care and support for disaster victims and their families (Arbon et al., 2013).

Nurses' knowledge and skills in nurse preparedness are reported to have a significant relationship with experience of dealing with previous disasters and the frequency of their attendance in disaster simulation training (Labrague et al., 2018). The involvement of nurses in mapping potential disasters that will occur, providing education through disaster simulations to nurses will be able to increase their confidence in dealing with future disasters (Al Khalailah, Bond & Alasad, 2012). Another study reported a significant and positive correlation between the frequency of training for nurses and their confidence (Duong, 2009). In other words, with more training on disaster management they have higher con- fidence in their abilities with disaster management (Naser & Saleem, 2018).

Disaster management training must be provided for all nurses, especially those who work in non-government hospitals, who have not received training on disaster management, to increase their knowledge in responding to any possible disasters. The more nurses attending disaster simulation exercises will increase nurses' confidence in dealing with actual disasters in the future (Vincent, Berg & Ikegami, 2009; Morrison & Catanzaro, 2010; Alim, Kawabata & Nakazawa, 2015; Jonson et al., 2017). However, it is still found in some countries a lack of nurse awareness and awareness to attend training related to increasing the capacity of nurses in disaster preparedness (Usher et al., 2015). Disaster-related training must be included in nursing education programs and continuing education courses to help hospital nurses recognize and improve their own preparedness for disaster response (Tzeng et al., 2016).

The preparedness of health workers, especially nurses, is not only related to how they receive training and continue education, but family support in the form of family preparedness also has an important role for nurses to be able to provide their best response in disaster management (Lim, Lim & Vasu, 2013). Nurses’ who are involved in family planning and preparedness in facing disasters are eight times more willing to attend their workplaces in disasters (Arbon et al., 2013). Other research also shows nurses who have higher personal preparedness, such as disaster plans at their homes, have a higher level of willingness to attend their workplaces in disasters (Goodhue et al., 2012).

Besides that nurses in responding to disasters require motivation and strength to organize themselves so that they are truly prepared to face the conditions they experience (Baack & Alfred, 2013). The first phase when they are confronted with an actual disaster is a feeling of being unprepared because they are taken aback by seeing the catastrophic disaster and the impact of the damage resulting from the disaster that occurred (Li. et al., 2017). After being hit by reality, the process of adapting to these circumstances requires extensive professional experience (Li et al., 2015).

CONCLUSION

This literature review aims to identify the factors that contribute to the nurses’ preparedness in disaster management. The studies reviewed has elucidated that there are six main factors which are proven to promote nurses’ preparedness, namely; the level of education, year of work, experience in previous disaster response, disaster simulation training, family readiness and support, Self-Regulation. Those six factors are concluded to be beneficial for the nurses’ compe- tency both in the aspects of knowledge and skill. Therefore, this article would suggest the importance of continuous professional development for nurses, especially in disaster management. Thus, providing training and education may not only be about knowledge that increases their skills in helping victims but must also include how they should be encouraged to have a strong self-regulation of a risk-filled challenge that would enforce their readiness when an actual disaster occurs.

Conflict of Interests

The authors declare that they have no conflict of interest.

ACKNOWLEDGEMENT

The authors are thankful to the institutional authority for completion of the work.

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