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Identification of the preparedness level of nurses for disasters in Turkey: A university hospital example
International Journal of Disaster Risk Reduction 44 (2020) 101441
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International Journal of Disaster Risk Reduction journal homepage: http://www.elsevier.com/locate/ijdrr
Identification of the preparedness level of nurses for disasters in Turkey: A university hospital example Filiz Tas a, *, Mehmet Cakir b, Sahin Kadioglu c a
_ Kahramanmaras¸ Sütçü Imam University Faculty of Health Sciences, Public Health Nursing, Turkey _ _ Postgraduate School of Health Management Department, Kahramanmaras¸ Sütçü Imam University, I_ IBF, Health Administration Department, Turkey c _ Kahramanmaras¸ Sütçü Imam University Health Application and Research Hospital, Nurse, Turkey b
A R T I C L E I N F O
A B S T R A C T
Keywords: Nurses Disasters Preparedness for disasters
Introduction: Disasters cause difficulties for people in meeting their basic needs by creating loss of life and property. In such cases, a great number of injured people which can exceed the capacity of hospitals can be in question. The disruption of the meeting of needs for any reason can cause vital activities to stop. Purpose: This study as a definition aimed at identifying the awareness level of nurses who work in a state institution of disasters. Method: This study of descriptive design was carried out with 230 volunteering nurses who are working at the Faculty of Medicine Hospital located in the eastern Mediterranean region in Turkey. The data were collected through an interview form and consisting of 20 questions and ‘Preparation for Disasters for Nurses Perception Scale’ and the numbers, percentage rate and standard deviation were analyzed with the Pearson Correlation Analysis, Independent-Samples T Test and One-Way ANOVA. Findings: As a result of the analyses, it was determined that there is no significant difference between the Preparation for Disaster Perception of the nurses and gender, work experience in years and disaster experience (p > 0.05) and a significant difference was found between education, training in cases of disasters, disaster training type and having read the disaster plan of the hospital (p < 0.05). Conclusion: The responsibility of health institutions in cases of disasters consists of meeting the increasing medical and treatment needs during and after disasters.
1. Introduction Disaster are events which disrupt the order of a society, cause eco nomic and social loss and deeply impact societies [1] by either halting or suspending people’s daily lives and activities [2]. Disasters can be nat ural or man-made [3] of small scale [4] and impact only a certain area or of big scale [5], and impact more than one area and negatively affect public health [6,7]. The disasters which take place every day all around the world leave behind significant worries in the national and interna tional level [8], and have dramatic effects on individuals, families and societies [9,10]. According to the World Disasters Report, 771,911 people have lost their lives throughout the world in 2015 due to disasters [11]. In addi tion, disasters have affected 108 million people in the world in 2015. In the last decade, 1.9 billion people have been affected from disasters [12].
Health services are one of the services which are demanded the most during disasters and expected to be provided with quality [13]. It is highly important that nurses [14,15], who constitute the largest group of health services and are members of health teams which need to work systematically under all conditions, are ready at times of disasters, have an efficient role [15] in participating in disaster management, work in a coordinated manner in their teams for the health and well-being of the society with the care they provide [16,17]. Today, nurses in many countries are expected to be ready for possible disasters and acquire the knowledge and skills needed for such situations [11]. According to this view, nurses need to know about disaster man agement regardless of their area of expertise and it should be made possible for them to work in all phases of disasters [14]. The Interna tional Council of Nurses underlines that, clinicians, educators, re searchers, administrators and all nurses should acquire the disaster care, planning and management skills [18] in the best manner and should
_ * Corresponding author. Kahramanmaras¸ Sütçü Imam University Faculty of Health Sciences, Bahçelievler Campus, 46100, Kahramanmaras¸, Turkey. E-mail addresses: [email protected] (F. Tas), [email protected] (M. Cakir), [email protected] (S. Kadioglu). https://doi.org/10.1016/j.ijdrr.2019.101441 Received 19 June 2019; Received in revised form 19 September 2019; Accepted 7 December 2019 Available online 14 December 2019 2212-4209/© 2019 Elsevier Ltd. All rights reserved.
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International Journal of Disaster Risk Reduction 44 (2020) 101441
Table 1 Characteristics of the Knowledge and Experience of the Nurses about Disasters (n ¼ 230). Sub-variables
n
(%)
83 22
31.9 8.5
13 5 137 260
5.0 1.9 52.7 100.0
54 176 230
23.5 76.5 100.0
22 208 230
9.6 90.4 100.0
138 40 52 230
60.0 17.4 22.6 100.0
95 135 230
41.3 58.7 100.0
180 128 167 102 104 2 683
26.4 18.7 24.5 14.9 15.2 0.3 100.0
Table 3 The nurses’ state of receiving training on disasters (n ¼ 230). Sub-variables State of Receiving Training Yes, Those who received training in their institution Yes, Those who received training outside of their institution No Total The Type of Disaster Training Theoretical Theoretical þ Applied No training Total The Duration of Received Training 2-4 Hours 1–2 Days 1 Week More than 1 Week No Total a Subjects which are Needed for Training First aid Triage in the field Basic Life-Support Infection Control Cardiovascular Life-Support Intervention to Multiple Traumas Psychological Approach to Individuals in Post-Traumatic Situations None of these are necessary Total
a
Definition of Disasters Disasters such as earthquakes, Floods and Hurricanes Terrorist acts carried out through biological, chemical or explosive agents Accidents which may take place in electrical or nuclear plants Highly epidemic diseases such as the bird flu All Total Experience on disasters Yes No Total Caregiving for disasters victims Yes No Total Having a disaster plan at the hospital Yes No Not sure Total Having read the disasters plan Yes No Total a Roles of nurses during disasters Caregiver Consultant Coordinator Administrator Educator Other Total a
a
100 68 62 230
43.4 29.6 27.0 100.0
61 107 62 230
26.5 46.5 27.0 100.0
125 20 19 4 62 230
54.3 8.7 8.3 1.7 27.0 100.0
159 114 141 44 114 146 93 7 818
19.4 13.9 17.2 5.4 13.9 17.8 11.4 0.9 100.0
More than one choice has been selected.
This study of descriptive design was carried out with 230 volun teering nurses who are working at a Public Hospital located in the city of Kahramanmaras¸, in Turkey. The data of the study were collected be tween in a three month period from October to December 2018. The nurses who were on vacation leave and did not wish to participate in the study were excluded.
have the knowledge and skills related to preparation for and interven tion to disasters [19]. This study aims at identifying the preparedness level of nurses who work at a state university hospital for disasters. 2. Materials and method
2.3. Data collection tool
2.1. Study questions
The data collection tool used in the study consists of two parts. In the first part, the interview form and in the second part, the Preparedness Perception Scale of Disaster in Nurses (PPSDN) was used.
1 What is the preparedness level of nurses for disasters? 2 Do the demographic characteristics, educational status and working years of nurses affect the preparedness level of nurses for disasters?
2.3.1. Interview form An interview form with the purpose of determining the personal and professional characteristics of the nurses (age, education level, working year, disaster training, hospital disaster protocol, etc.) which consists of 20 questions was used.
Table 2 Preparedness state of the institution and the nurses for disasters (n ¼ 230). Priority of nurses during disasters To escape in the shortest time possible To evacuate as many patients as possible To carry out the directions of the person in charge at the unit being worked in To follow the Disaster Plan Protocol prepared for disaster management Total The nurses’ state of being prepared for disasters I am not prepared at all I am partially prepared I am completely prepared Total The institution’s state of being prepared for disasters Not prepared at all Partially prepared Completely prepared Total
(%)
2.2. The study sample
More than one choice has been selected.
Sub-variables
n
n
(%)
22 53 26
9.5 23.0 11.3
129
56.2
230
100.0
25 154 51 230
10.8 67.0 22.2 100.0
30 163 37 230
13.0 70.9 16.1 100.0
2.3.2. Preparedness Perception Scale of Disaster in Nurses (PPSDN) The validity and reliability studies of the scale used in the study were € carried out by Ozcan [20] on 200 nurses who work in two faculty of medicine hospitals in Turkey. The 20 question Likert type scale con sisted of three headings: The preparation Stage (questions 1–6); The Intervention Stage (questions 7–15) and After the Disaster Stage (questions 16–20). In line with the literature, the items of the scale are 5 point Likert type (1-I totally don’t agree, 2-I don’t agree, 3-I partially agree, 4-I agree, 5-I totally agree). The Cronbach’s Alpha coefficient of the scale has been determined as 0.90. As the score obtained from the scale increases, the preparedness for disasters perception increases as well. The lowest score which can be received from the scale is 20 and the highest score is 100. The Cronbach’s Alpha coefficient for this study was determined as 0.89. 2
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International Journal of Disaster Risk Reduction 44 (2020) 101441
Table 4 Distribution of the score averages of the PDNPS sub-dimension according to some demographic characteristics of the nurses. Factors (Gender)
n
Preparation for disasters stage Female 158 Male 72 Intervention in disasters stage Female 158 Male 72 After disasters stage Female 158 Male 72 Educational degree
n
Preparation for disasters stage Bachelor’s degree 65 Master’s/doctorate degree 35 Professional experience 130 Total 230 Intervention in disasters stage Bachelor’s degree 65 Master’s/doctorate degree 35 Professional experience 130 Total 230 After disasters stage Bachelor’s degree 65 Master’s/doctorate degree 35 Professional experience 130 Total 230 Factors (Working years)
n
Preparation for disasters stage 0–5 year 122 6–10 year 75 11–15 year 23 15 and over 10 Total 230 Intervention in disasters stage 0–5 year 122 6–10 year 75 11–15 year 23 15 and over 10 Total 230 After disasters stage 0–5 year 122 6–10 year 75 11–15 year 23 15 and over 10 Total 230
Average
Sd
t
3.350 3.561
0.737 0.854
1.914
0.057
3.987 4.151
0.875 1.185
1.175
0.241
3.704 3.802
0.731 0.838
0.900
0.369
Average
Sd
f
p
3.390 3.216 3.482 3.416
0.762 0.805 0.778 0.780
1.655
0.193
4.032 3.547 4.173 4.038
0.859 1.052 0.987 0.983
5.826
3.670 3.640 3.793 3.735
0.812 0.805 0.730 0.765
0.876
0.418
Average
Sd
f
p
3.380 3.507 3.315 3.400 3.416
0.805 0.758 0.820 0.506 0.780
0.555
0.645
3.936 4.188 4.036 4.150 4.038
0.084 1.065 1.051 0.677 0.983
1.046
3.724 3.767 3.643 3.840 3.735
0.803 0.742 0.738 0.571 0.765
0.222
Table 5 Distribution of the Score Averages of the PDNPS Sub-dimension according to the experience of the nurses on disasters and their state of having received training or not.
p
Factors Experience on Disasters Preparation for disasters stage Yes I’ve had experience No experience Intervention to disasters stage Yes I’ve had experience No experince After disasters stage Yes I’ve had experince No experince Factors Training on Disasters Preparation for disasters stage Yes I’ve got training No training Intervention to disasters stage Yes I’ve got training No training After disasters stage Yes I’ve got training No training
0.003
Factors Type of Disaster Training Preparation for disasters stage Theoretical Theoretical þ Applied Intervention to disasters stage Theoretical Theoretical þ Applied After disasters stage Theoretical Theoretical þ Applied
0.373
Factors Having Read the Disaster Plan
0.881
Preparation for disasters stage Yes I have read No I didn’t read Intervention to disasters stage Yes I have read No I didn’t read After disasters stage Yes I have read No I didn’t read
2.4. The ethical dimension of the study
n
Average
Sd
t
p
54 76
3.345 3.437
0.916 0.734
54 76
4.069 4.029
0.741 1.048
54 76
3.684 3.751
0.757 0.769
n
Average
Sd
t
p
168 62
3.483 3.232
0.796 0.708
2.183
0.030
168 62
4.085 3.911
1.000 0.932
1.188
0.236
168 62
3.809 3.535
0.754 0.766
2.432
0.016
n
Average
Sd
f
p
61 107
3.271 3.604
0.718 0.816
2.651
0.009
61 107
3.911 4.184
1.260 0.806
1.710
0.089
61 107
3.579 3.940
0.751 0.727
3.053
0.003
n
Average
Sd
t
p
86 135
3.549 3.334
0.768 0.778
2.013
0.045
86 135
4.122 3.953
1.099 0.913
1.237
0.217
86 135
3.843 3.662
0.745 0.772
1.724
0.086
0.758 0.261 0.561
0.449 0.795 0.576
determined variance levels being high showed that the scale has a strong factor structure. The 8 items in the first factor constituted the prepara tion for disasters stage; the Cronbach’s Alpha was determined as 0.89 and the obtained variance value was determined as 38.922%. The reli ability of the 6 items which constitute the disaster intervention stage in the second factor was determined as alpha ¼ 0.732 and the obtained variance value was determined as 34.722%. Lastly, the reliability of the 5 items which constitute the after the disaster stage in the third factor were determined as alpha ¼ 0.875 and the obtained variance value was determined as 14.615%.
In order to carry out the study, the committee approval was taken from Sutcu Imam University’s Social Sciences Ethics Committee (2018/ 13) and the administration of the hospital. The nurses who participated in the study were informed about the purpose of the study, the form were filled out through the face to face interview method and verbal permissions were taken from the nurses before the interviews. 2.5. The statistical analysis of the data The data of the study were analyzed with the SPSS 24.0 software program. The analysis carried out showed that the data displayed normal distribution. Descriptive statistics such as frequencies, averages, percentages and standard deviation were used to test the answers. In the analysis of the data, the student t-test was used in the comparison of the binary data and the One Way ANOVA test in the multiple comparisons. For the 3 dimensions obtained from the 19 items on which factor analysis was done, the same parametric tests were performed and ana lyses were done according to the participants’ gender, educational status and working years. p < 0.05 was accepted as significant in the analyses. The reliability coefficients which make up the scale and the
3. Findings 68.3% of the nurses who participated in the study are female and 31.3% are male. 41.3% of the nurses are in the 25–31 age group and it was determined that 56.5% of the nurses have professional experience. It was determined that 57.0% of the nurses are married and 53.0% have been working for 0–5 years. The knowledge level of the nurses is shown in Table 1. 52.7% of the nurses stated that, they gave service in events defined as disasters such as disasters like earthquakes, floods and hurricanes (31.9%); biological, 3
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International Journal of Disaster Risk Reduction 44 (2020) 101441
chemical or explosive terrorist acts (8.5%); accidents which may take place in electrical or nuclear plants (5.0%); highly epidemic diseases such as bird flu (1.9%). In addition, 76.5% of the nurses stated that they have not experienced any disasters; 90.4% stated that they have not taken care of disaster victims; 60.0% stated that their hospital has a disaster plan and 58.7% stated that they have never read the hospital disaster plan. It was determined that the nurses defined their roles during disasters as caregivers (26.4%), coordinators (24.5%) and con sultants (18.7%). 67.4% of the participants stated that a hospital disaster plan drill was carried out in their institution, 56.2% of the nurses stated that they would prefer to watch the hospital disaster plan protocol in disaster management, whereas 9.5% stated that they would prefer to escape in the soonest time possible. While 67.0% of the nurses defined themselves as ‘partially ready’ for disasters, 70.9% defined their institution as ‘partially ready.’ (Table 2). It was determined that 73.0% of the nurses have received training on disasters, whereas 46.5% have received the training in a theoretical þ applied manner. It was seen that in trainings about disasters, the subjects nurses most need are first aid (19.4%), intervention for multiple traumas (17.8%) and basic life support (17.2%). (Table 3). No statistically significant difference was found between the gender and preparation stage for disasters of the nurses (t: 1.914; p ¼ 0.057 > 0.05), their intervention stage (t: 1.175; p ¼ 0.241 > 0.05) and stage after disasters (t: 0.900; p ¼ 0.369 > 0.05) (Table 4). A statistically significant difference was found between the score averages of the educational levels of the nurses and their disaster intervention stage (f:5.826; p ¼ 0.003 < 0.05). It was determined that this significant difference was between undergraduate nurses and graduate/post-graduate nurses. A statistically significant difference was not found between the score averages of the nurses’ educational level and disaster intervention stage and after disasters stage (p > 0.05). A statistically significant difference was not found between the scores of working years of the nurses and the preparation stage (f:1.046; p ¼ 0.373 > 0.05), intervention stage (f:0.555; p ¼ 0.645 > 0.05) and after disasters stage (f: 0.222; p ¼ 0.881 > 0.05). It was determined that there was no statistically significant difference between the score averages of disaster experience of the nurses who partici pated in the study and the preparation stage (t: 0.758; p ¼ 0.449), inter vention stage (t: 0.261; p ¼ 0.795) and after disasters stage (t: 0.561; p ¼ 0.576 > 0.05). In the study, the difference between the score averages of disasters and training and preparation stage (t: 2.183; p ¼ 0.030 < 0.05) and after disaster stage (t:2.432; p ¼ 0.016 < 0.05) was found statistically signifi cant. It was determined that there is not significant difference between the score averages of intervention stage (t: 1.188; p ¼ 0.236 > 0.05). The score averages of preparation and intervention of nurses were found to be higher than those nurses who did not receive disaster training. In the study, the score averages of type of disaster training and prepa ration stage (t: 2.651; p ¼ 0.009 < 0.05) and the after disaster stage (t: 3.053; p ¼ 0.003 < 0.05) were determined to be statistically significant. A statistically significant difference was not found between the score averages of the intervention stage (t: 1.710; p ¼ 0.089 > 0.05). The score averages of nurses who received theoretical and applied training were found to be higher than those who only received theoretical training. It was determined that the score averages between having read hospital disaster plan and the preparation for disasters stage (t:2.013; p ¼ 0.045 < 0.05) are statistically significant. In addition, it was found that the averages of nurses who read their institution’s disaster plan have a higher perception compared to nurses who did not.
conditions were identified. Nurses who are the most important members of health teams assume many important roles such as caregivers, edu cators and rehabilitators in disasters [18,19]. These roles are important in terms of having less losses in disaster, speedily returning to a normal life and preventing losses. In the study, when the views of the nurses on the concept of disasters was analyzed, it was seen that 52.7% of them regard disasters, terrorist acts, electrical or nuclear plant accidents and epidemics as disasters, 31.9% of them regard natural events such as earthquakes, floods and € tornadoes as disasters (Table 1). In Ozcan’s study [20], it was seen that 74.4% of the nurses regarded terrorist acts, electrical or nuclear plant accidents and epidemics as disasters as well. Al Thobaity et al. [21] in their study on nurses determined that nurses have medium level knowledge on being prepared for disasters. The findings of our study and the findings of their study are partly display parallelism. Nurses lack knowledge in terms of defining what disasters are and it is considered that they need to be trained about it. It was determined that nurses rather see their roles in disasters as caregivers (26.4%), coordinators (24.5%) and consultants (18.7%) € (Table 1). It was determined in Ozcan’s [20], study as well that the nurses see their roles in disasters as caregivers (92.4%), coordinators (75.8%) and educators (67.4%). In Labrague et al.’s study [22], it was determined that the nurses primarily see their roles as educators (62.9%); secondly as caregivers (61.1%) and lastly as consultants (48.2%). In Taskiran and Baykal’s [11], study on 406 nurses, it was determined that nurses had a high level of knowledge in technical skills but that they were not at a sufficient level in terms of critical thinking levels. When the studies are analyzed, it can be stated that nurses can support individuals more with their caregiver roles in disasters and that their awareness about their other roles is low. In the study, it was determined that 67.0% of the nurses felt ‘partly ready’ for disasters, whereas as 10.8% did not feel ready at all (Table 2). Fung et al. [4] in their study reported that a majority of the nurses (97%) stated that they did not feel ready for disasters. Labrague et al. [22], reported in their study on identifying the preparedness level of Filipino nurses for disasters that 80% of the nurses were not completely prepared for disasters. Labrague et al. [18], stated that the nurses were not completely prepared for disaster intervention and that they were hesi tant about intervening disasters in an efficient manner. In addition, when studies on disasters were analyzed, it was seen that nurses and nursing students do not feel that they are prepared for disasters [6,9,23]. Our study displays parallelisms with other studies. Taking these studies into consideration, it is suggested that activities need to be organized for nurses to prepare them for disasters in Turkey and other countries. These activities should be designed in a manner to include training programs in nursing curricula, increase the number of training programs for nurses and develop policies in this respect. In our study, the nurses stated that they needed training about di sasters the most in the areas of first-aid (19.4%), intervention for mul tiple trauma (17.8%) and basic life support (17.2%) (Table 3). In the other studies, the nurses have stated that they needed training programs on disasters and that they wanted to receive disaster training on educational subjects such as trauma intervention and in the field triage, besides first-aid, basic life support and advanced cardiovascular life support [5,17,24]. Labrague et al. [22] reported in their study that the nurses stated that training programs on first-aid (46.4%), in the field triage (25.2%) and basic cardiovascular life support (33.5%) are important in terms of being prepared for disasters. Maleki et al. [7], determined in their study on 384 nurses that there is a positive rela tionship between the nurses’ knowledge and attitudes and that as their knowledge level increases, their attitudes change. In general, a majority of the nurses stated that they needed various trainings. This can be interpreted as the nurses’ wish to develop themselves and being open to training programs. In order to be able to keep the nurses’ perception of being prepared for disasters at a high level, they need to be supported with updated theoretical and applied training and increase their
4. Discussion In this study, the factors which impact the preparedness level of nurses who work at the Faculty of Medicine Hospital for disasters prior to, during and after disasters and the factors which influence these 4
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International Journal of Disaster Risk Reduction 44 (2020) 101441
communication skills. In the study, it was determined that in the preparation for disasters (4.151), intervention to disasters (3.561) and after disasters (3.802) stages, the male nurses’ perception was higher compared to the female nurses (Table 4). When other studies on the same subject are analyzed, it can be seen that gender difference between nurses has not been an issue. In Turkey, which is in an earthquake zone, in particular earthquakes are frequently experienced disasters. Frequent disasters taking place in Turkey in which mostly a patriarchal family structure exists can be stated to influence in particular male nurses’ perception of disasters and their preparedness for disasters. It was determined in the study in terms of the nurses’ educational level that, in the preparation for disasters (4.173), intervention to di sasters (3.482) and after disasters (3.793) levels, their educational level is effective; in particular nurses who have received postgraduate/ doctorate level education have a higher perception of being prepared for disasters compared to nurses who are high-school graduates and that there is a statistically significant difference in the preparation for di sasters stage (p < 0.05) (Table 4). In Hoffmann and Muttarak’s study [10], it was shown that trainings given to individuals on disasters positively affect their attitudes towards disasters. As the educational level of nurses increases, their preparedness for disasters perception also increases and this can be explained with the training programs and the content of the curricula. In Turkey, disaster nursing training is not a part of graduate education for nurses. This causes nurses to remain insuffi cient in terms of being prepared for disasters [19]. In Turkey, in which a majority of the nurses have received undergraduate education, giving place to training on disaster nursing in the curricula is important in terms of initial intervention and achieving positive results. When the nurses’ score average distribution was analyzed in terms of their working years, it was seen that the preparedness for disaster perception of nurses who have 6–10 years of experience was higher in the intervention to disasters (3.507) and being prepared for disasters (4.188) stages, whereas the perception of nurses who have 15 years and more experience were higher in the after disasters stage (3.840) but that there was no significance (Table 4; p > 0.05). Labrague et al. [18], determined in their systematic review study that, disaster intervention experience and training on disasters were among the factors which influenced being prepared for disaster intervention In Vatan and Salur’s [25] study involving 39 hospitals and 71 administrative nurses, it was reported that administrative nurses were not very prepared for disasters and that they were not sure about the hospital’s disasters plans. This finding is also in parallel to the findings of our study. It can be stated that working years and experience are important in being prepared for di sasters. According to these data, it can be seen that the nurses have just begun to get to know the hospital they work in as a young group and that gender, educational level and working years are important for being prepared for disasters. When the nurses’ reading the hospital disaster plan was analyzed, it was seen that those who have read the hospital disaster plan in the intervention to disasters (3.549), being prepared for disasters (4.422) and after disasters (3.843) stages have a higher perception of being prepared for disasters compared to those who have not read the plan and that there is a significant difference between them (Table 5 p < 0.05). Labrague et al. [22] determined in their study that more than half of the nurses who participated in their study (57.7%) were not aware of their hospital’s disaster management protocol. Al Thobaity et al. [21] deter mined that a majority of the nurses acquired most of their knowledge and skills from the disaster drills. Alim et al. [23] showed in their study on increasing the preparedness for disasters level of nursing students that disaster training programs and drills increased their knowledge on preparedness for. When these findings are taken into consideration with our study, having knowledge about and reading the disaster plans of the hospitals and carrying out disaster drills are important in terms of raising awareness of disasters and being prepared when disasters take place.
5. Conclusion As a result, it was determined in our study that more than half of the nurses who work at a University Hospital regarded themselves as partly sufficient in being prepared for disasters, intervention and after disasters categories and that factors such as socio-demographic characteristics, experience, reading the hospital disaster plan and participating in disaster training programs affect being prepared for disasters, inter vention and after disaster situations. Since it is not possible to prevent disasters, it is highly important that institutions and individuals who are providing service to use time prior to disasters in the best manner possible and get prepared for disasters. Therefore, it is suggested for health institutions to organize updated trainings on disaster nursing to nurses, carry out regular drills and have their health teams work in a systematic manner. Scientific Responsibility Statement The authors declare that they are responsible for the article’s sci entific content including study design, data collection, analysis and interpretation, writing, some of the main line, or all of the preparation and scientific review of the contents and approval of the final version of the article. Animal and human rights statement All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research commit tee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animal or human studies were carried out by the authors for this article. The limitations of the study This study was conducted at a public hospital in the East Mediter ranean Region of Turkey. It cannot be generalized to the nurses in other regions and institutions. The answers given by the nurses to the surveys are their own statements. Contributions of the writers FT, MC, SK; study concept and design, MC, SK; collection of data, analysis of data FT, MC, SK; interpretation of data, FT MC, SK; prepa ration of the article, FT; study supervision Funding This study was not funded. Declaration of competing interest Authors declare no conflict of interest. Acknowledgments We would like to thank the nurses who participated in the study and contributed to science and the hospital administrators who gave their approval for this study. References [1] F.A. Abdelghany Ibrahim, “Nurses knowledge, attitudes, practices and familiarity regarding disaster and emergency preparedness – Saudi Arabia, Am. J. Nurs. Sci. 3 (2) (2014) 18. [2] W.C. Tzeng, et al., Readiness of hospital nurses for disaster responses in Taiwan: a cross-sectional study, Nurse Educ. Today 47 (2016) 37–42.
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[3] S. Baack, D. Alfred, Nurses’ preparedness and perceived competence in managing disasters, J. Nurs. Scholarsh. 45 (3) (2013) 281–287. [4] O.W.M. Fung, A.Y. Loke, C.K.Y. Lai, Disaster preparedness among Hong Kong nurses, J. Adv. Nurs. 62 (6) (2008) 698–703. [5] G.M. Holdo, L. Miles, H. Hartwell, Disaster nursing: looking to the future in Norway, Int. J. Saf. Secur. Eng. 7 (3) (2017) 431–442. [6] S. Achora, J.K. Kamanyire, Disaster preparedness: need for inclusion in undergraduate nursing education, Sultan Qaboos Univ. Med. J. 16 (1) (2016) e15–e19. [7] L. Maleki, M.T. Moghadamnia, M. Porshikhian, E. Kazemnejad, Evaluation of the factors predicting nurses’ attitude to phase of preparedness to respond to disasters, Rev. Latinoam. Hipertens. 13 (6) (2018) 538–543. [8] F. Ozpulat, E. Kabasakal, Knowledge levels of nursing students on disaster nursing and their state of disaster preparedness, Int. J. Med. Res. Health Sci. 7 (8) (2018) 165–174. [9] M. Top, O. Gider, Y. Tas, An investigation of hospital disaster preparedness in Turkey, J. Homel. Secur. Emerg. Manag. 7 (1) (2011). [10] R. Hoffmann, R. Muttarak, Learn from the past, prepare for the future: impacts of education and experience on disaster preparedness in the Philippines and Thailand, World Dev. 96 (2017) 32–51. [11] G. Taskiran, U. Baykal, Nurses’ disaster preparedness and core competencies in Turkey: a descriptive correlational design, Int. Nurs. Rev. 66 (2) (2019) 165–175. [12] G. Taskiran, U. Baykal, Nurses’ opınıons experıences and preparedness perceptıons related to dısasters, Int. Refereed J. Nurs. Res. (10) (2017) 36–58, 0. [13] W.M.M. Sattar, Sahar Abdel Latif Abdel, Nehad Ahmed Ibrahim Zahra, The effect of an educational intervention about disaster preparedness on knowledge and attitudes of technical nursing institute intern-nurse students, Am. J. Nurs. Sci. 7 (6) (2018) 287–295. [14] O. Erdogan, Disaster nursing education, Turkey Clin. (2018) 115–120, no. October.
6
Contents lists available at ScienceDirect
International Journal of Disaster Risk Reduction journal homepage: http://www.elsevier.com/locate/ijdrr
Identification of the preparedness level of nurses for disasters in Turkey: A university hospital example Filiz Tas a, *, Mehmet Cakir b, Sahin Kadioglu c a
_ Kahramanmaras¸ Sütçü Imam University Faculty of Health Sciences, Public Health Nursing, Turkey _ _ Postgraduate School of Health Management Department, Kahramanmaras¸ Sütçü Imam University, I_ IBF, Health Administration Department, Turkey c _ Kahramanmaras¸ Sütçü Imam University Health Application and Research Hospital, Nurse, Turkey b
A R T I C L E I N F O
A B S T R A C T
Keywords: Nurses Disasters Preparedness for disasters
Introduction: Disasters cause difficulties for people in meeting their basic needs by creating loss of life and property. In such cases, a great number of injured people which can exceed the capacity of hospitals can be in question. The disruption of the meeting of needs for any reason can cause vital activities to stop. Purpose: This study as a definition aimed at identifying the awareness level of nurses who work in a state institution of disasters. Method: This study of descriptive design was carried out with 230 volunteering nurses who are working at the Faculty of Medicine Hospital located in the eastern Mediterranean region in Turkey. The data were collected through an interview form and consisting of 20 questions and ‘Preparation for Disasters for Nurses Perception Scale’ and the numbers, percentage rate and standard deviation were analyzed with the Pearson Correlation Analysis, Independent-Samples T Test and One-Way ANOVA. Findings: As a result of the analyses, it was determined that there is no significant difference between the Preparation for Disaster Perception of the nurses and gender, work experience in years and disaster experience (p > 0.05) and a significant difference was found between education, training in cases of disasters, disaster training type and having read the disaster plan of the hospital (p < 0.05). Conclusion: The responsibility of health institutions in cases of disasters consists of meeting the increasing medical and treatment needs during and after disasters.
1. Introduction Disaster are events which disrupt the order of a society, cause eco nomic and social loss and deeply impact societies [1] by either halting or suspending people’s daily lives and activities [2]. Disasters can be nat ural or man-made [3] of small scale [4] and impact only a certain area or of big scale [5], and impact more than one area and negatively affect public health [6,7]. The disasters which take place every day all around the world leave behind significant worries in the national and interna tional level [8], and have dramatic effects on individuals, families and societies [9,10]. According to the World Disasters Report, 771,911 people have lost their lives throughout the world in 2015 due to disasters [11]. In addi tion, disasters have affected 108 million people in the world in 2015. In the last decade, 1.9 billion people have been affected from disasters [12].
Health services are one of the services which are demanded the most during disasters and expected to be provided with quality [13]. It is highly important that nurses [14,15], who constitute the largest group of health services and are members of health teams which need to work systematically under all conditions, are ready at times of disasters, have an efficient role [15] in participating in disaster management, work in a coordinated manner in their teams for the health and well-being of the society with the care they provide [16,17]. Today, nurses in many countries are expected to be ready for possible disasters and acquire the knowledge and skills needed for such situations [11]. According to this view, nurses need to know about disaster man agement regardless of their area of expertise and it should be made possible for them to work in all phases of disasters [14]. The Interna tional Council of Nurses underlines that, clinicians, educators, re searchers, administrators and all nurses should acquire the disaster care, planning and management skills [18] in the best manner and should
_ * Corresponding author. Kahramanmaras¸ Sütçü Imam University Faculty of Health Sciences, Bahçelievler Campus, 46100, Kahramanmaras¸, Turkey. E-mail addresses: [email protected] (F. Tas), [email protected] (M. Cakir), [email protected] (S. Kadioglu). https://doi.org/10.1016/j.ijdrr.2019.101441 Received 19 June 2019; Received in revised form 19 September 2019; Accepted 7 December 2019 Available online 14 December 2019 2212-4209/© 2019 Elsevier Ltd. All rights reserved.
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Table 1 Characteristics of the Knowledge and Experience of the Nurses about Disasters (n ¼ 230). Sub-variables
n
(%)
83 22
31.9 8.5
13 5 137 260
5.0 1.9 52.7 100.0
54 176 230
23.5 76.5 100.0
22 208 230
9.6 90.4 100.0
138 40 52 230
60.0 17.4 22.6 100.0
95 135 230
41.3 58.7 100.0
180 128 167 102 104 2 683
26.4 18.7 24.5 14.9 15.2 0.3 100.0
Table 3 The nurses’ state of receiving training on disasters (n ¼ 230). Sub-variables State of Receiving Training Yes, Those who received training in their institution Yes, Those who received training outside of their institution No Total The Type of Disaster Training Theoretical Theoretical þ Applied No training Total The Duration of Received Training 2-4 Hours 1–2 Days 1 Week More than 1 Week No Total a Subjects which are Needed for Training First aid Triage in the field Basic Life-Support Infection Control Cardiovascular Life-Support Intervention to Multiple Traumas Psychological Approach to Individuals in Post-Traumatic Situations None of these are necessary Total
a
Definition of Disasters Disasters such as earthquakes, Floods and Hurricanes Terrorist acts carried out through biological, chemical or explosive agents Accidents which may take place in electrical or nuclear plants Highly epidemic diseases such as the bird flu All Total Experience on disasters Yes No Total Caregiving for disasters victims Yes No Total Having a disaster plan at the hospital Yes No Not sure Total Having read the disasters plan Yes No Total a Roles of nurses during disasters Caregiver Consultant Coordinator Administrator Educator Other Total a
a
100 68 62 230
43.4 29.6 27.0 100.0
61 107 62 230
26.5 46.5 27.0 100.0
125 20 19 4 62 230
54.3 8.7 8.3 1.7 27.0 100.0
159 114 141 44 114 146 93 7 818
19.4 13.9 17.2 5.4 13.9 17.8 11.4 0.9 100.0
More than one choice has been selected.
This study of descriptive design was carried out with 230 volun teering nurses who are working at a Public Hospital located in the city of Kahramanmaras¸, in Turkey. The data of the study were collected be tween in a three month period from October to December 2018. The nurses who were on vacation leave and did not wish to participate in the study were excluded.
have the knowledge and skills related to preparation for and interven tion to disasters [19]. This study aims at identifying the preparedness level of nurses who work at a state university hospital for disasters. 2. Materials and method
2.3. Data collection tool
2.1. Study questions
The data collection tool used in the study consists of two parts. In the first part, the interview form and in the second part, the Preparedness Perception Scale of Disaster in Nurses (PPSDN) was used.
1 What is the preparedness level of nurses for disasters? 2 Do the demographic characteristics, educational status and working years of nurses affect the preparedness level of nurses for disasters?
2.3.1. Interview form An interview form with the purpose of determining the personal and professional characteristics of the nurses (age, education level, working year, disaster training, hospital disaster protocol, etc.) which consists of 20 questions was used.
Table 2 Preparedness state of the institution and the nurses for disasters (n ¼ 230). Priority of nurses during disasters To escape in the shortest time possible To evacuate as many patients as possible To carry out the directions of the person in charge at the unit being worked in To follow the Disaster Plan Protocol prepared for disaster management Total The nurses’ state of being prepared for disasters I am not prepared at all I am partially prepared I am completely prepared Total The institution’s state of being prepared for disasters Not prepared at all Partially prepared Completely prepared Total
(%)
2.2. The study sample
More than one choice has been selected.
Sub-variables
n
n
(%)
22 53 26
9.5 23.0 11.3
129
56.2
230
100.0
25 154 51 230
10.8 67.0 22.2 100.0
30 163 37 230
13.0 70.9 16.1 100.0
2.3.2. Preparedness Perception Scale of Disaster in Nurses (PPSDN) The validity and reliability studies of the scale used in the study were € carried out by Ozcan [20] on 200 nurses who work in two faculty of medicine hospitals in Turkey. The 20 question Likert type scale con sisted of three headings: The preparation Stage (questions 1–6); The Intervention Stage (questions 7–15) and After the Disaster Stage (questions 16–20). In line with the literature, the items of the scale are 5 point Likert type (1-I totally don’t agree, 2-I don’t agree, 3-I partially agree, 4-I agree, 5-I totally agree). The Cronbach’s Alpha coefficient of the scale has been determined as 0.90. As the score obtained from the scale increases, the preparedness for disasters perception increases as well. The lowest score which can be received from the scale is 20 and the highest score is 100. The Cronbach’s Alpha coefficient for this study was determined as 0.89. 2
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International Journal of Disaster Risk Reduction 44 (2020) 101441
Table 4 Distribution of the score averages of the PDNPS sub-dimension according to some demographic characteristics of the nurses. Factors (Gender)
n
Preparation for disasters stage Female 158 Male 72 Intervention in disasters stage Female 158 Male 72 After disasters stage Female 158 Male 72 Educational degree
n
Preparation for disasters stage Bachelor’s degree 65 Master’s/doctorate degree 35 Professional experience 130 Total 230 Intervention in disasters stage Bachelor’s degree 65 Master’s/doctorate degree 35 Professional experience 130 Total 230 After disasters stage Bachelor’s degree 65 Master’s/doctorate degree 35 Professional experience 130 Total 230 Factors (Working years)
n
Preparation for disasters stage 0–5 year 122 6–10 year 75 11–15 year 23 15 and over 10 Total 230 Intervention in disasters stage 0–5 year 122 6–10 year 75 11–15 year 23 15 and over 10 Total 230 After disasters stage 0–5 year 122 6–10 year 75 11–15 year 23 15 and over 10 Total 230
Average
Sd
t
3.350 3.561
0.737 0.854
1.914
0.057
3.987 4.151
0.875 1.185
1.175
0.241
3.704 3.802
0.731 0.838
0.900
0.369
Average
Sd
f
p
3.390 3.216 3.482 3.416
0.762 0.805 0.778 0.780
1.655
0.193
4.032 3.547 4.173 4.038
0.859 1.052 0.987 0.983
5.826
3.670 3.640 3.793 3.735
0.812 0.805 0.730 0.765
0.876
0.418
Average
Sd
f
p
3.380 3.507 3.315 3.400 3.416
0.805 0.758 0.820 0.506 0.780
0.555
0.645
3.936 4.188 4.036 4.150 4.038
0.084 1.065 1.051 0.677 0.983
1.046
3.724 3.767 3.643 3.840 3.735
0.803 0.742 0.738 0.571 0.765
0.222
Table 5 Distribution of the Score Averages of the PDNPS Sub-dimension according to the experience of the nurses on disasters and their state of having received training or not.
p
Factors Experience on Disasters Preparation for disasters stage Yes I’ve had experience No experience Intervention to disasters stage Yes I’ve had experience No experince After disasters stage Yes I’ve had experince No experince Factors Training on Disasters Preparation for disasters stage Yes I’ve got training No training Intervention to disasters stage Yes I’ve got training No training After disasters stage Yes I’ve got training No training
0.003
Factors Type of Disaster Training Preparation for disasters stage Theoretical Theoretical þ Applied Intervention to disasters stage Theoretical Theoretical þ Applied After disasters stage Theoretical Theoretical þ Applied
0.373
Factors Having Read the Disaster Plan
0.881
Preparation for disasters stage Yes I have read No I didn’t read Intervention to disasters stage Yes I have read No I didn’t read After disasters stage Yes I have read No I didn’t read
2.4. The ethical dimension of the study
n
Average
Sd
t
p
54 76
3.345 3.437
0.916 0.734
54 76
4.069 4.029
0.741 1.048
54 76
3.684 3.751
0.757 0.769
n
Average
Sd
t
p
168 62
3.483 3.232
0.796 0.708
2.183
0.030
168 62
4.085 3.911
1.000 0.932
1.188
0.236
168 62
3.809 3.535
0.754 0.766
2.432
0.016
n
Average
Sd
f
p
61 107
3.271 3.604
0.718 0.816
2.651
0.009
61 107
3.911 4.184
1.260 0.806
1.710
0.089
61 107
3.579 3.940
0.751 0.727
3.053
0.003
n
Average
Sd
t
p
86 135
3.549 3.334
0.768 0.778
2.013
0.045
86 135
4.122 3.953
1.099 0.913
1.237
0.217
86 135
3.843 3.662
0.745 0.772
1.724
0.086
0.758 0.261 0.561
0.449 0.795 0.576
determined variance levels being high showed that the scale has a strong factor structure. The 8 items in the first factor constituted the prepara tion for disasters stage; the Cronbach’s Alpha was determined as 0.89 and the obtained variance value was determined as 38.922%. The reli ability of the 6 items which constitute the disaster intervention stage in the second factor was determined as alpha ¼ 0.732 and the obtained variance value was determined as 34.722%. Lastly, the reliability of the 5 items which constitute the after the disaster stage in the third factor were determined as alpha ¼ 0.875 and the obtained variance value was determined as 14.615%.
In order to carry out the study, the committee approval was taken from Sutcu Imam University’s Social Sciences Ethics Committee (2018/ 13) and the administration of the hospital. The nurses who participated in the study were informed about the purpose of the study, the form were filled out through the face to face interview method and verbal permissions were taken from the nurses before the interviews. 2.5. The statistical analysis of the data The data of the study were analyzed with the SPSS 24.0 software program. The analysis carried out showed that the data displayed normal distribution. Descriptive statistics such as frequencies, averages, percentages and standard deviation were used to test the answers. In the analysis of the data, the student t-test was used in the comparison of the binary data and the One Way ANOVA test in the multiple comparisons. For the 3 dimensions obtained from the 19 items on which factor analysis was done, the same parametric tests were performed and ana lyses were done according to the participants’ gender, educational status and working years. p < 0.05 was accepted as significant in the analyses. The reliability coefficients which make up the scale and the
3. Findings 68.3% of the nurses who participated in the study are female and 31.3% are male. 41.3% of the nurses are in the 25–31 age group and it was determined that 56.5% of the nurses have professional experience. It was determined that 57.0% of the nurses are married and 53.0% have been working for 0–5 years. The knowledge level of the nurses is shown in Table 1. 52.7% of the nurses stated that, they gave service in events defined as disasters such as disasters like earthquakes, floods and hurricanes (31.9%); biological, 3
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International Journal of Disaster Risk Reduction 44 (2020) 101441
chemical or explosive terrorist acts (8.5%); accidents which may take place in electrical or nuclear plants (5.0%); highly epidemic diseases such as bird flu (1.9%). In addition, 76.5% of the nurses stated that they have not experienced any disasters; 90.4% stated that they have not taken care of disaster victims; 60.0% stated that their hospital has a disaster plan and 58.7% stated that they have never read the hospital disaster plan. It was determined that the nurses defined their roles during disasters as caregivers (26.4%), coordinators (24.5%) and con sultants (18.7%). 67.4% of the participants stated that a hospital disaster plan drill was carried out in their institution, 56.2% of the nurses stated that they would prefer to watch the hospital disaster plan protocol in disaster management, whereas 9.5% stated that they would prefer to escape in the soonest time possible. While 67.0% of the nurses defined themselves as ‘partially ready’ for disasters, 70.9% defined their institution as ‘partially ready.’ (Table 2). It was determined that 73.0% of the nurses have received training on disasters, whereas 46.5% have received the training in a theoretical þ applied manner. It was seen that in trainings about disasters, the subjects nurses most need are first aid (19.4%), intervention for multiple traumas (17.8%) and basic life support (17.2%). (Table 3). No statistically significant difference was found between the gender and preparation stage for disasters of the nurses (t: 1.914; p ¼ 0.057 > 0.05), their intervention stage (t: 1.175; p ¼ 0.241 > 0.05) and stage after disasters (t: 0.900; p ¼ 0.369 > 0.05) (Table 4). A statistically significant difference was found between the score averages of the educational levels of the nurses and their disaster intervention stage (f:5.826; p ¼ 0.003 < 0.05). It was determined that this significant difference was between undergraduate nurses and graduate/post-graduate nurses. A statistically significant difference was not found between the score averages of the nurses’ educational level and disaster intervention stage and after disasters stage (p > 0.05). A statistically significant difference was not found between the scores of working years of the nurses and the preparation stage (f:1.046; p ¼ 0.373 > 0.05), intervention stage (f:0.555; p ¼ 0.645 > 0.05) and after disasters stage (f: 0.222; p ¼ 0.881 > 0.05). It was determined that there was no statistically significant difference between the score averages of disaster experience of the nurses who partici pated in the study and the preparation stage (t: 0.758; p ¼ 0.449), inter vention stage (t: 0.261; p ¼ 0.795) and after disasters stage (t: 0.561; p ¼ 0.576 > 0.05). In the study, the difference between the score averages of disasters and training and preparation stage (t: 2.183; p ¼ 0.030 < 0.05) and after disaster stage (t:2.432; p ¼ 0.016 < 0.05) was found statistically signifi cant. It was determined that there is not significant difference between the score averages of intervention stage (t: 1.188; p ¼ 0.236 > 0.05). The score averages of preparation and intervention of nurses were found to be higher than those nurses who did not receive disaster training. In the study, the score averages of type of disaster training and prepa ration stage (t: 2.651; p ¼ 0.009 < 0.05) and the after disaster stage (t: 3.053; p ¼ 0.003 < 0.05) were determined to be statistically significant. A statistically significant difference was not found between the score averages of the intervention stage (t: 1.710; p ¼ 0.089 > 0.05). The score averages of nurses who received theoretical and applied training were found to be higher than those who only received theoretical training. It was determined that the score averages between having read hospital disaster plan and the preparation for disasters stage (t:2.013; p ¼ 0.045 < 0.05) are statistically significant. In addition, it was found that the averages of nurses who read their institution’s disaster plan have a higher perception compared to nurses who did not.
conditions were identified. Nurses who are the most important members of health teams assume many important roles such as caregivers, edu cators and rehabilitators in disasters [18,19]. These roles are important in terms of having less losses in disaster, speedily returning to a normal life and preventing losses. In the study, when the views of the nurses on the concept of disasters was analyzed, it was seen that 52.7% of them regard disasters, terrorist acts, electrical or nuclear plant accidents and epidemics as disasters, 31.9% of them regard natural events such as earthquakes, floods and € tornadoes as disasters (Table 1). In Ozcan’s study [20], it was seen that 74.4% of the nurses regarded terrorist acts, electrical or nuclear plant accidents and epidemics as disasters as well. Al Thobaity et al. [21] in their study on nurses determined that nurses have medium level knowledge on being prepared for disasters. The findings of our study and the findings of their study are partly display parallelism. Nurses lack knowledge in terms of defining what disasters are and it is considered that they need to be trained about it. It was determined that nurses rather see their roles in disasters as caregivers (26.4%), coordinators (24.5%) and consultants (18.7%) € (Table 1). It was determined in Ozcan’s [20], study as well that the nurses see their roles in disasters as caregivers (92.4%), coordinators (75.8%) and educators (67.4%). In Labrague et al.’s study [22], it was determined that the nurses primarily see their roles as educators (62.9%); secondly as caregivers (61.1%) and lastly as consultants (48.2%). In Taskiran and Baykal’s [11], study on 406 nurses, it was determined that nurses had a high level of knowledge in technical skills but that they were not at a sufficient level in terms of critical thinking levels. When the studies are analyzed, it can be stated that nurses can support individuals more with their caregiver roles in disasters and that their awareness about their other roles is low. In the study, it was determined that 67.0% of the nurses felt ‘partly ready’ for disasters, whereas as 10.8% did not feel ready at all (Table 2). Fung et al. [4] in their study reported that a majority of the nurses (97%) stated that they did not feel ready for disasters. Labrague et al. [22], reported in their study on identifying the preparedness level of Filipino nurses for disasters that 80% of the nurses were not completely prepared for disasters. Labrague et al. [18], stated that the nurses were not completely prepared for disaster intervention and that they were hesi tant about intervening disasters in an efficient manner. In addition, when studies on disasters were analyzed, it was seen that nurses and nursing students do not feel that they are prepared for disasters [6,9,23]. Our study displays parallelisms with other studies. Taking these studies into consideration, it is suggested that activities need to be organized for nurses to prepare them for disasters in Turkey and other countries. These activities should be designed in a manner to include training programs in nursing curricula, increase the number of training programs for nurses and develop policies in this respect. In our study, the nurses stated that they needed training about di sasters the most in the areas of first-aid (19.4%), intervention for mul tiple trauma (17.8%) and basic life support (17.2%) (Table 3). In the other studies, the nurses have stated that they needed training programs on disasters and that they wanted to receive disaster training on educational subjects such as trauma intervention and in the field triage, besides first-aid, basic life support and advanced cardiovascular life support [5,17,24]. Labrague et al. [22] reported in their study that the nurses stated that training programs on first-aid (46.4%), in the field triage (25.2%) and basic cardiovascular life support (33.5%) are important in terms of being prepared for disasters. Maleki et al. [7], determined in their study on 384 nurses that there is a positive rela tionship between the nurses’ knowledge and attitudes and that as their knowledge level increases, their attitudes change. In general, a majority of the nurses stated that they needed various trainings. This can be interpreted as the nurses’ wish to develop themselves and being open to training programs. In order to be able to keep the nurses’ perception of being prepared for disasters at a high level, they need to be supported with updated theoretical and applied training and increase their
4. Discussion In this study, the factors which impact the preparedness level of nurses who work at the Faculty of Medicine Hospital for disasters prior to, during and after disasters and the factors which influence these 4
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communication skills. In the study, it was determined that in the preparation for disasters (4.151), intervention to disasters (3.561) and after disasters (3.802) stages, the male nurses’ perception was higher compared to the female nurses (Table 4). When other studies on the same subject are analyzed, it can be seen that gender difference between nurses has not been an issue. In Turkey, which is in an earthquake zone, in particular earthquakes are frequently experienced disasters. Frequent disasters taking place in Turkey in which mostly a patriarchal family structure exists can be stated to influence in particular male nurses’ perception of disasters and their preparedness for disasters. It was determined in the study in terms of the nurses’ educational level that, in the preparation for disasters (4.173), intervention to di sasters (3.482) and after disasters (3.793) levels, their educational level is effective; in particular nurses who have received postgraduate/ doctorate level education have a higher perception of being prepared for disasters compared to nurses who are high-school graduates and that there is a statistically significant difference in the preparation for di sasters stage (p < 0.05) (Table 4). In Hoffmann and Muttarak’s study [10], it was shown that trainings given to individuals on disasters positively affect their attitudes towards disasters. As the educational level of nurses increases, their preparedness for disasters perception also increases and this can be explained with the training programs and the content of the curricula. In Turkey, disaster nursing training is not a part of graduate education for nurses. This causes nurses to remain insuffi cient in terms of being prepared for disasters [19]. In Turkey, in which a majority of the nurses have received undergraduate education, giving place to training on disaster nursing in the curricula is important in terms of initial intervention and achieving positive results. When the nurses’ score average distribution was analyzed in terms of their working years, it was seen that the preparedness for disaster perception of nurses who have 6–10 years of experience was higher in the intervention to disasters (3.507) and being prepared for disasters (4.188) stages, whereas the perception of nurses who have 15 years and more experience were higher in the after disasters stage (3.840) but that there was no significance (Table 4; p > 0.05). Labrague et al. [18], determined in their systematic review study that, disaster intervention experience and training on disasters were among the factors which influenced being prepared for disaster intervention In Vatan and Salur’s [25] study involving 39 hospitals and 71 administrative nurses, it was reported that administrative nurses were not very prepared for disasters and that they were not sure about the hospital’s disasters plans. This finding is also in parallel to the findings of our study. It can be stated that working years and experience are important in being prepared for di sasters. According to these data, it can be seen that the nurses have just begun to get to know the hospital they work in as a young group and that gender, educational level and working years are important for being prepared for disasters. When the nurses’ reading the hospital disaster plan was analyzed, it was seen that those who have read the hospital disaster plan in the intervention to disasters (3.549), being prepared for disasters (4.422) and after disasters (3.843) stages have a higher perception of being prepared for disasters compared to those who have not read the plan and that there is a significant difference between them (Table 5 p < 0.05). Labrague et al. [22] determined in their study that more than half of the nurses who participated in their study (57.7%) were not aware of their hospital’s disaster management protocol. Al Thobaity et al. [21] deter mined that a majority of the nurses acquired most of their knowledge and skills from the disaster drills. Alim et al. [23] showed in their study on increasing the preparedness for disasters level of nursing students that disaster training programs and drills increased their knowledge on preparedness for. When these findings are taken into consideration with our study, having knowledge about and reading the disaster plans of the hospitals and carrying out disaster drills are important in terms of raising awareness of disasters and being prepared when disasters take place.
5. Conclusion As a result, it was determined in our study that more than half of the nurses who work at a University Hospital regarded themselves as partly sufficient in being prepared for disasters, intervention and after disasters categories and that factors such as socio-demographic characteristics, experience, reading the hospital disaster plan and participating in disaster training programs affect being prepared for disasters, inter vention and after disaster situations. Since it is not possible to prevent disasters, it is highly important that institutions and individuals who are providing service to use time prior to disasters in the best manner possible and get prepared for disasters. Therefore, it is suggested for health institutions to organize updated trainings on disaster nursing to nurses, carry out regular drills and have their health teams work in a systematic manner. Scientific Responsibility Statement The authors declare that they are responsible for the article’s sci entific content including study design, data collection, analysis and interpretation, writing, some of the main line, or all of the preparation and scientific review of the contents and approval of the final version of the article. Animal and human rights statement All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research commit tee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animal or human studies were carried out by the authors for this article. The limitations of the study This study was conducted at a public hospital in the East Mediter ranean Region of Turkey. It cannot be generalized to the nurses in other regions and institutions. The answers given by the nurses to the surveys are their own statements. Contributions of the writers FT, MC, SK; study concept and design, MC, SK; collection of data, analysis of data FT, MC, SK; interpretation of data, FT MC, SK; prepa ration of the article, FT; study supervision Funding This study was not funded. Declaration of competing interest Authors declare no conflict of interest. Acknowledgments We would like to thank the nurses who participated in the study and contributed to science and the hospital administrators who gave their approval for this study. References [1] F.A. Abdelghany Ibrahim, “Nurses knowledge, attitudes, practices and familiarity regarding disaster and emergency preparedness – Saudi Arabia, Am. J. Nurs. Sci. 3 (2) (2014) 18. [2] W.C. Tzeng, et al., Readiness of hospital nurses for disaster responses in Taiwan: a cross-sectional study, Nurse Educ. Today 47 (2016) 37–42.
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