Disaster Management: Identifying Knowledge of Community Health

Disaster Management: Identifying Knowledge of Community Health Nurses and Its Predictive Factor

NURUL’AIN AHAYALIMUDIN

LECTURER,

DEPARTMENT OF CRITICAL CARE NURSING

KULLIYYAH OF NURSING

INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA Commonwealth Nurses Conference, 8th-9th March 2014 London 1

Malaysia habitually facing natural disasters

Floods

Landslides

Fortunate to be free from earthquakes and tsunamis.

2004 – Sumatera-Andaman earthquakes proven that Malaysia is also vulnerable to devastating disasters occurs in neighbouring countries.

BACKGROUND

Commonwealth Nurses Conference, 8th-9th March 2014 London 2

PURPOSES

• To determine nurses’ knowledge towards disaster management.

Objective 1

• To identify socio-demographic factors that predict nurses’ knowledge towards disaster management.

Objective 2


Study setting: 8 Health Clinics

Study design: Cross-sectional

Sampling: Multistage (stratified and simple random)

Tools: Self-developed questionnaire 17 items

Cronbach’s alpha: 0.923

Ethical consideration:

MOH Research Ethics Committee (MREC)

UKMMC Ethical Committee

METHODOLOGY


Descriptive analysis of sociodemographic data

Frequency & percentage

Median & IQR

Bivariate analysis – chi square, yates correction and Fisher exact test

Multiple logistic regression

DATA ANALYSIS


Variable Community health nurse

(n=264)

n %

Age 37.00 (IQR=31.25 – 43.00)

≤ 40 years 179 67.8

≥ 41 years 85 32.2

Gender

Male 0 0.0

Female 264 100.0

Education level

Certificate 41 15.5

Diploma 222 84.1

Bachelor degree 1 0.4

Graduation year

≤ year 1999 132 50.0

≥ year 2000 132 50.0


RESULTS

Variable Community health nurse

(n=264)

n %

Working experience 7.00 (IQR=3.00 – 12.00)

≤ 4 years 96 36.4

≥ 5 years 168 63.6

Involved in disaster response

No 188 71.2

Yes 76 28.8

Attended disaster education

No 143 54.2

Yes 121 45.8


RESULTS

Knowledge

Community Health Nurse (n=264)

Inadequate Adequate χ2 value p value

n (%) n (%)

Age 3.749 0.053

≤ 40 years 113 (63.1) 66 (36.9)

≥ 41 years 43 (50.6) 42 (49.4)

Education level 1.607# 0.477

Certificate 23 (56.1) 18 (43.9)

Diploma 133 (59.9) 89 (40.1)

Bachelor degree 0 (0.0) 1 (100.0)

Graduation year 3.071 0.080

≤ year 1999 71 (53.8) 61 (46.2)

≥ year 2000 85 (64.4) 47 (35.6)


RESULTS

Knowledge

Community Health Nurse (n=264)

Inadequate Adequate χ2 value p value

n (%) n (%)

Working experience 1.883 0.170

≤ 4 years 62 (64.6) 34 (35.4)

≥ 5 years 94 (56.0) 74 (44.0)

Involved in disaster

response

0.647 0.421

No 114 (60.6) 74 (39.4)

Yes 42 (55.3) 34 (44.7)

Attended disaster education 24.000 0.000*

No 104 (72.7) 39 (27.3)

Yes 52 (43.0) 69 (57.0)


RESULTS

Knowledge Community Health Nurse (n=264)

B SE Wald p value AOR 95% CI

Lower Upper

Involved in disaster

response

Yes (1) 0.139 0.288 0.234 0.629 1.150 0.653 2.024

[No] (0)

Attended disaster-related

education/ training

Yes (1) 1.256 0.263 22.788 0.000* 3.511 2.097 5.881

[No] (0)

[ ] reference

** significant at p<0.01

* significant at p<0.001

10

RESULTS...cont’

Adequacy of knowledge among CHNs less than 60%.

CHNs (med = 58.82, IQR = 48.53 – 69.12).

There was an association between attended disaster-related education/training with adequacy of knowledge for nurses.

CHNs = p<0.001, χ2= 24.000.


DISCUSSION

It has been statistically identified that attending disaster-related education is the factor that predicts the adequacy of knowledge among the nurses.

It can be concluded that adequacy of knowledge among nurses determined by their attendance on disaster-related education/training.


DISCUSSION

Attended disaster-related education

There is an association between attended disaster-related education and knowledge for both groups of nurses.

Opportunities to be educated do exist for nurses.

Limited and difficult to access, particularly within organization that rarely involved in disaster response.


DISCUSSION

About 47.5% never attended disaster-related education/training.

39.0% (Duong 2009)

18% in study by Hammad et al (2010) with 42% have not received any disaster training for 12 months or more.

60% (Rebmann & Mohr 2010) in Missouri.

10.5% had previously participated in disaster training in Philadelphia (Greenberg et al 2002).


DISCUSSION

PERKARA / ITEM

1 Adakah anda pernah mendengar berkenaan pengurusan bencana sebelum ini? Sekiranya jawapan anda YA, sila nyatakan sumber tersebut:

Have you heard about disaster management before? If YES, Please state the source of information:

2 Bencana boleh didefinisikan sebagai satu situasi yang mengganggu sistem jagaan kesihatan apabila ianya berlaku.

Disaster is defines as a situation that overwhelm the health care system when it occurs.

3 Pengurusan bencana melibatkan semua tindakan yang diambil bagi mengurangkan kerosakan yang berkemungkinan akan berlaku.

Disaster management involves all measures taken to reduce the likelihood of damage that will occur.

4 Banjir boleh diklasifikasikan sebagai bencana alam semulajadi.

Floods can be classified as a natural disaster.

5 Kebuluran adalah salah satu jenis bencana akibat dari perbuatan manusia.*

Famine is a type of man-made disaster.*

6 Berdasarkan garispanduan pengurusan bencana di Malaysia, pengurusan bencana dibahagikan kepada lima (5) fasa.*

Based on Malaysia guideline, disaster management phase can be divided into five (5) phase.*

7 Aktiviti mitigasiberlaku sebelum terjadinya sesuatu bencana.

Mitigation activities takes place before disaster happen.

8 Pemantauan paras air adalah antara aktiviti yang berlaku dalam fasa mitigasi.*

Water level monitoring is an activity in the mitigation phase*

9 Aktiviti kesiapsiagaan berlaku di sepanjang waktu bencana.

Preparedness activities takes place during disaster event*

10 Simulasi lapangan dalam pelan pengurusan bencana adalah aktiviti yang dijalankan dalam fasa kesiapsiagaan.

Field simulation of disaster management plan is an activity in the preparedness.

11 Respon adalah dengan menukarkan pelan kesiapsiagaan menjadi suatu bentuk tindakan.

Response is to put your preparedness plans into action.

12 Respon untuk bencana perlu melibatkan Kementerian Kesihatan Malaysia tanpa campurtangan dari sistem jagaan kesihatan swasta*.

Disaster response shall involve the Ministry of Health without involvement of other private healthcare system*.

13 Aktiviti dalam fasa pemulihan (recovery) berlaku sepanjang terjadinya kejadian bencana*.

Activities in recovery phase takes place during disaster event*.

14 Fasa pemulihan termasuklah tindakan yang diambil untuk mengembalikan keadaan menjadi normal atau lebih baik.

Recovery includes actions taken to return to a normal or an even safer situation.

15 Bekalan air dan sanitasi boleh memberikan kesan terhadap kesihatan akibat dari bencana yang berlaku.

Water supply and sanitation can give impact to health that result from disaster.

16 Kejadian bencana tidak akan meningkatkan risiko wujudnya kejadian penyakit berjangkit*.

Disaster will not increase risk of developing communicable disease*.

17 Perpindahan populasi penduduk boleh menyebabkan beban sosial ke atas penduduk yang terlibat.

Population displacements can cause social burden to inhabitants.

15

Item

Knowledge domain

Community health nurse (n=264)

Yes

n (%)

No

n (%)

Uncertain

n (%)

Have you heard about disaster management before? 166

(62.9)

70

(26.5)

28

(10.6)

Disaster is defined as situations that overwhelm the health care system when it

occurs.

239

(90.5)

16

(6.1)

9

(3.4)

Disaster management involves all measures taken to reduce the likelihood of damage

that will occur.

235

(89.0)

14

(5.3)

15

(5.7)

Floods can be classified as a natural disaster. 249

(94.3)

13

(4.9)

2

(0.8)

Mitigation activities takes place before disaster happen. 96

(36.4)

20

(7.6)

148

(56.1)

Field simulation of disaster management plan is an activity in the preparedness. 160

(60.6)

11

(4.2)

93

(35.2)

Response is to put your preparedness plans into action. 172

(65.2)

12

(4.5)

80

(30.3)

Recovery includes actions taken to return to a normal or an even safer situation. 238

(90.2)

6

(2.3)

20

(7.5)

Water supply and sanitation can give impact to health that result from disaster. 253

(95.8)

6

(2.3)

5

(1.9)

Population displacements can cause social burden to inhabitants. 238

(90.2)

15

(5.7)

11

(4.2)

16

Item

Knowledge domain

Community health nurse (n=264)

Yes

n (%)

No

n (%)

Uncertain

n (%)

Famine is a type of man-made disaster.* 175

(66.3)

58

(22.0)

31

(11.7)

Based on Malaysia guideline, disaster management phase can be divided into 5

phase.*

67

(25.4)

9

(3.4)

188

(71.2)

Water level monitoring is an activity in the mitigation phase.* 121

(45.8)

15

(5.7)

128

(48.5)

Preparedness activities take place during disaster event.* 131

(49.6)

45

(17.0)

88

(33.3)

Disaster response involved the Ministry of Health without involvement of other

private healthcare system.*

67

(25.4)

152

(57.6)

45

(17.0)

Activities in recovery phase takes place during disaster event.* 154

(58.3)

49

(18.6)

61

(23.1)

Disaster will not increase risk of developing communicable disease.* 25

(9.5)

229

(86.7)

10

(3.8) 17

1. Education

Nurses believed that they were unprepared to respond to disaster (O’Sullivan 2008).

To know foundation of disaster management is crucial for nurses.

Respond & anticipate the challenges of working in extreme conditions (Tillman 2011), perform roles effectively (Al-Khaleilah et al 2011) and enable nurses to respond appropriately (Shaluf 2007).

18

1. Education...cont’

Frequent disaster-related education/training conducted.

Increases knowledge as well as cultivate awareness among nurses towards disaster management.

Guide nurses in performing their roles and providing care to affected population.

Ministry of Health shall conduct training involving emergency and community health personnel.

19

1. Education...cont’

It is important for nurses to read and understand their institutions’ disaster plans.

Preparing themselves before the occurrence of disasters, thus may reduce fright and anxiety.

Minimize the potential long-term psychological effects (Hughes et al 2007).

20

2. Practice

Managing disaster should involve hospital and community settings, together with private healthcare institutions.

The agencies create plans, conduct exercises, and practice drills to build the trust and relationships that will be needed in the first hours and over the long term (Rowney & Barton 2005).

Ensure the smooth running of an entire organization in a disaster response incident through multi-approach (Nasrabadi et al 2007).

21

2. Practice...cont’

The roles of ENs and CHNs are required to be integrated with each other.

The role of public health nurse (PHN) in an all-hazards event must be recognized and understood by all partners within a multidisciplinary emergency response team (Veenema 2007).

Therefore, involvement of CHNs in disaster response and involvement of ENs in recovery phase shall be acknowledged. 22

2. Practice...cont’

Participate in regular exercise or drills that focus on mass casualty management, which are found to be effective in training hospital staff in disaster response (Hsu et al. 2004; Rosenfeld et al. 2005).

23

3. Research

Expand the study across Malaysia.

More studies should be conducted in Malaysia setting.

The result can be used to evaluate the need for incorporating disaster management in nursing curricula in Malaysia.

Focused to other factors such as organizational factors, environmental factors and so forth.

24

4. Policy Making

Organization should have their own plans for disaster so as to ensure the staff know about the standard operating procedure.

45.3% of respondents know the location of their organization disaster plans.

There is a necessity for planning and preparedness to ensure the smooth running of an entire organization in a disaster response incident through multi-approach (Nasrabadi et al 2007).

25

4. Policy Making...cont’

Nurses should have maximum standards, knowledge and ability to plan and respond to disaster appropriately.

Emergency personnel are well known as being devoted to their duties in disaster response particularly in emergency response, however, involvement of public health personnel in managing disaster should not be denied.

26

LIMITATION

Homogeneous (female).

Utilizing of self-administered questionnaire may lead to information bias.

27

CONCLUSION

Less than half of nurses who had an adequate knowledge and majority having inadequate knowledge.

It had been identified in this study that only involvement in disaster response and attended disaster-related education/training was significant.

Involvement in disaster response and having adequate knowledge shows significant association. However, involvement in disaster response was a not a predictor to the adequacy of knowledge among CHNs. 28

Al Khalaileh, M.A., Bond, E. &Alasad, J.A., 2011. Jordanian nurses’ perceptions of their preparedness for disaster management. International Emergency Nursing (2011), doi: 10.1016/j.ienj.2011.01.001

Duong, K. 2009. Disaster education and training of emergency nurses in South Australia. Australasian Emergency Nursing Journal 12 (3): 86-92

Greenberg, M. I., Jurgens, S.M. &Gracely, E.J., 2002. Emergency department preparedness for the evaluation and treatment of victims of biological or chemical terrorist attack. J Emerg Med, 22 (3): 273-278

Hammad, K.S., Arbon, P. and Gebbie, K.M., 2010. Emergency nurses and disaster response: An exploration of South Australian emergency nurses’ knowledge and perceptions of their roles in disaster response. AustralasEmergNurs J (2010), doi: 10.1016/j.aenj.2010.10.002

Hsu, E.B. Jenckes, M.W, Cateltt, C.L., Robinson, K.A., Feuerstein C. Cosgrove SE., et al., 2004. Effectiveness of hospital staff mass-casualty incident training methods: a systematic literature review. PrehospDisast Med, 19 (3): 191-199

Hughes, F., Grigg, D., Fritsch, K. & Calder, S., 2007. Psychosocial response in emergency situations: The nurses’ role. International Nursing Review, 54: 19-27

Nasrabadi, A.N., Naji, H., Mirzabeigi, G. &Dadbakhs, M. 2007. Earthquake relief: Iranian nurses’ responses in Bam, 2003, and lessons learned. IntNurs Rev 54: 13-18

O'Sullivan, T.L, Dow, D., Turner, M.C., Lemyre, L., Corneil, W., Krewski, D., Phillips, K.P., Amaratunga, C.A. 2008.Disaster and emergency management: Canadian nurses' perceptions of preparedness on hospital front lines. Prehosp Disaster Med, 23(3):11-18

Rebmann, T. & Mohr, L.B., 2010. Bioterrorism knowledge and educational participation of nurses in Missouri. The Journal of Continuing Education in Nursing, 41(2): 67-76

Rosenfeld, J.V., Fitzgerald, M., Kossmann, T., Pearce, A., Joseph, A., Tan, G., et al., 2005. Is the Australian hospital system adequately prepared for terrorism? Med J Aust, 183(11-12): 567-569

Rowney, R. & Barton, G. 2005. The Role of Public Health Nursing in Emergency Preparedness and Response. Nursing Clinics of North America 40: 499-509.

Shaluf, I., 2007. Disaster types. Disaster Prevention and Management, 16 (5): 704-717

Tillman, P., 2011. Disaster preparedness for nurses: A teaching guide. The Journal of Continuing Education in Nursing, 42 (9): 404-408

Veenema, T.G. 2007. Disaster Nursing and Emergency Preparedness for Chemical, Biological and Radiological Terrorism and Other Hazards, 2nded. New York: Springer Publishing Company


REFERENCES

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Disaster Management: Identifying Knowledge of Community Health