Malaysian Journal of Public Health Medicine 2016, Vol.

16 (3): 66-74

DISASTER MANAGEMENT: IDENTIFYING KNOWLEDGE OF EMERGENCY

NURSES AND COMMUNITY HEALTH NURSES AND ITS PREDICTORS IN
MALAYSIA
Aniza Ismail1, Hasanain Faisal Ghazi2, Ismail M.S 3 & Nurul’Ain A.4
1 Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre. Kuala
Lumpur, Malaysia.
2 Community Medicine Unit, International Medical School, Management and Science University, Selangor, Malaysia.
3Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre. Kuala

Lumpur, Malaysia.
4 Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia.

ABSTRACT

As a front-liner in healthcare services, nurses play an important role in managing disaster victims. Thus, it is crucial
for nurses to be prepared when facing disaster. The aim of this paper is to determine the knowledge of emergency
nurses (EN) and community health nurses (CHN) with respect to disaster management, as well as identify predictor
factors. This comparative cross-sectional study was conducted between October and November 2011. The 17-items of
the self-developed questionnaire in assessing knowledge towards disaster management were distributed to randomly
selected nurses from 10 emergency and trauma departments (132 respondents) and 8 health clinics (264 respondents)
in one of the state in Malaysia. The results showed that both groups had a comparable median score on knowledge,
58.82 with interquartile range (IQR) =52.94–70.58 for EN and IQR=48.53–69.12 for CHN. No significant difference in
knowledge was identified within these groups, with approximately 59.1% having inadequate knowledge of disaster
management. Attending disaster-related education/training was identified as a predictor factor for adequacy of
knowledge among EN with significant value of p<0.01, (AOR) of 3.807, 95% (CI) of 1.584-9.153) and CHN (p<0.001,
AOR=3.511, 95% CI=2.097-5.881). As conclusion, emergency and community health nurses have inadequate knowledge
with regard to disaster management, and it has been demonstrated statistically that adequacy of knowledge is driven
by attending disaster-related education/training, which predicts knowledge level. Therefore, it is paramount for
organizations to conduct disaster-related education/training to improve nurses’ knowledge.

Keywords: Disaster Management; Knowledge; Emergency Nurse; Community Health Nurse; Predictor Factors; Malaysia.

INTRODUCTION receive little training. Moreover, nurses feel

The world has witnessed a series of disasters such
as war, terrorism, earthquakes, tsunamis,
hurricanes, floods and many more events around
the world. It seems increasing in trend on the
occurrence of disaster worldwide, predominantly
in natural disaster. Year 2004 and 2005 are seen
as catastrophic years for Asia as a result of
earthquakes, wind storms and floods1.
Malaysia is habitually facing floods, which are the
most common natural disaster experience and
fortunate to be free from earthquakes and
typhoons. However, during Sumatera-Andaman
Earthquake and tsunami strike in 2004, Malaysia
had been affected as well although the centre of
the earthquake is about hundreds kilometres
away.
United Nation International Strategy for Disaster
Reduction2 defined disaster as “a serious
disruption of the functioning of a community or a
society causing widespread human, material,
economic or environmental losses that exceed the
ability of the affected community or society to
cope using its own resources”.
As a fraction of healthcare providers, nurses are
in a greater number in providing healthcare
services. They have been involved in disaster care
since long ago; yet, it has not been accounted in
the literature. Nurses play a crucial role and also
experience a strong role during a disaster but they
inadequately prepared to function effectively in
these types of situation and feels lack of
confidence.
In managing disaster, effective planning of
disaster preparedness should integrate the types
of relief and assistance efforts that will be needed
for communities not merely to survive but to
recover3. It justified the necessity of collaborative
care among emergency and public health
personnel in order to give best practices to the
residential in managing disaster beginning from
the mitigation until recovery phase. This duty
shall encompass public health and medical
personnel in taking care of victims.
With the escalating number of disaster events, it
is important for nurses to execute their
responsibilities towards population by gaining
adequate knowledge. Inadequate disaster training
among nurses may result in negative upshot for
population involved in disaster. Preparation of
nurses are closely linked to the level of training
perceived, either in acute setting or public health
setting, as well as experience through
participation in a disaster response4. Therefore,
the objective of this study was to determine
nurses’ knowledge towards disaster management,
thus identifying the predictor factors which lead
to adequacy of knowledge.
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74
METHODS
A comparative cross-sectional has been carried
out to determine the adequacy of knowledge of
emergency nurse (EN) and community health
nurse (CHN). The quantitative research approach
based where the self-developed questionnaire
distributed to the participants.
Procedure
The approval to conduct this study was given by
the gatekeeper of each study location; head of
department, sisters and matrons. The
questionnaire then filled up by those who fulfil
the inclusion criteria to be selected in this study.
In total, the number of nursing staff involved was
about n=396.
Setting and sample
Multistage sampling method were used. About 132
ENs and 264 CHNs were recruited from Emergency
and Trauma Departments (ETDs) and health clinics
(HCs) of Ministry of Health hospital in Selangor
state. There were unequal distributions among
ENs and CHNs, with ratio of 1:2. The samples were
chosen through simple random sampling method
as name list was obtained from the person in-
charge. Nurses who met the inclusion criteria and
agreed to participate were chosen while those
who were on leave, or part time were excluded.
Data collection and instrument
A thorough search has not identified any existing
tools, perhaps it remains unpublished. Therefore,
self-developed questionnaire has been utilized for
collecting data and the period was between
October and November 2011.
Self-developed questionnaire has been utilized in
this study to determine adequacy of knowledge
towards disaster management among nurses. It
consists of socio-demographic section as well as
knowledge section. There are about 17 items for
respondents to answer which consists of
definition, classification, disaster phases and
activities in each phase, and impact of disaster to
the community. This questionnaire has gone
through reliability test with Cronbach’s alpha is
0.923.
Malaysia is known as a developing country and it
is believed that it has paucity in the disaster-
related education/training predominantly related
to health disaster. Therefore, the cut-off point of
the result identified as 60% after taking into
consideration the level of ‘pass’ for score of
knowledge from study by Bartley et al (2006)5.
Data analysis
Raw data entered into Microsoft Office Excel 2007
then converted into PASW (formerly known as
SPSS) version 18. The analyses include descriptive
statistics; frequency and percentage, median and
inter-quartile range (IQR) as data was not
normally distributed. Chi-square test utilized for
categorical data as well as Fisher’s exact test and
Chi-square with Yates correction used to identify
association between independents variables with
knowledge and reveal the difference between two
groups of nurses. Multiple logistic regressions
applied to identify predictor factors among the
knowledge domain and socio-demographic profile
as well as to eliminate bias after data collected.
Ethical considerations
Ethical approval granted by Ethical and Research
Committee of Universiti Kebangsaan Malaysia
Medical Centre (UKMMC) and MOH Research and
Ethical Committee (MREC). The participants were
reinforced on the anonymity and confidentiality
of their respond. They are also being informed of
their right to withdraw from this study.
RESULTS
Sociodemographic profile
A total of 470 questionnaires were circulated,
with response rate of 84.6% (n= 396) for each
groups. Table 1 showed the summary of
respondent’s socio-demographic profile. The age
of respondents was ranged between ages of 21 to
60 years where majority ENs were younger
(med=28.00) as compared to CHNs (med=37.00).
The data showed majority of ENs and CHNs were
in a group of 40 years and above (n=119, 90.2%;
n= 179, 67.8% respectively). Unfortunately, there
were no male nurses who participated and
responded to this study due to fewer numbers of
them who work in ETD and none of them work in
HC.
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74

Table 1: Analysis of socio-demographic data of respondents

Variable Emergency nurse Community health

(n=132) nurse (n=264)
n % n %
Age 28.00 (IQR=25.25 – 32.00) 37.00 (IQR=31.25 – 43.00)

≤ 40 years 119 90.2 179 67.8

>40 years 13 9.8 85 32.2
Gender
Male 0 0.0 0 0.0
Female 132 100 264 100.0
Education level
Certificate 18 13.7 41 15.5
Diploma 112 84.8 222 84.1
Bachelor degree 2 1.5 1 0.4
Graduation year
< year 2000 20 15.2 132 50.0
≥ year 2000 112 84.8 132 50.0
Working experience 3.00 (IQR=1.25 – 5.00) 7.00 (IQR=3.00 – 12.00)
< 5 years 87 65.9 96 36.4
≥ 5 years 45 34.1 168 63.6
Involved in disaster response
No 82 62.1 188 71.2
Yes 50 37.9 76 28.8
Attended disaster education
No 45 34.1 143 54.2
Yes 87 65.9 121 45.8

Majority of nurses working in ETD or HC are Knowledge

diploma holders with n=112 (85.0%) of ENs,
whereby n=222 (84.1%) of nurse works in HC and
only three (3) respondents have a bachelor
degree. Others are those who have a nursing
certificate. Most of the ENs (84.8%) and CHNs
(50.0%) are graduated from nursing school from
year 2000 onwards, whereby the others are
graduated before year 2000.
Working experiences of the respondents were
ranged between 2 months to 34 years with median
of ENs are 3 years (IQR=1.25 – 5.00) and CHNs are
7 years (IQR=3.00 – 12.00). About 63.6% (n=168) of
CHNs have working experience of more than 5
years in current disciplines, and ENs are
about34.1% (n=45). There were about n=87
(65.9%) of ENs and n=96 (36.4%) of CHNs who have
worked in the current discipline 4 years and less.
Majority of nurses were never involved in disaster
response with about n=82 (62.1%) of ENs and
n=188 (71.2%) of CHNs, whereby about n=50
(37.9%) and n=76 (28.8%) of ENs and CHNs
respectively, have the opportunity to be involved
in disaster response. Of 396 respondents, there
were about n=87 (65.9%) of ENs and n=121 (45.8%)
of CHNs have attended disaster-related education
provided by their institution.
Items of knowledge on disaster management
consisted of general knowledge, definition of
disaster, type of disaster, phases in disaster
management, activities on each phases in disaster
management and impact of disaster to
population. There were total of 17 items have
been constructed to assess the knowledge of
respondents towards disaster management.
An analysis (Table 2) from the question of
knowledge towards disaster management showed
that majority of ENs and CHNs heard about
disaster management prior to the distribution of
questionnaire and well identified the definition of
disaster. As floods were frequently struck some
part of Malaysia, therefore more than 90.0% of
both groups of nurses distinguish it very well that
flood are categorized as natural disaster, whereby
less than half of both groups of nurses answered
correctly that famine is not classified as man-
made disaster as it is very rare famine occurred in
Malaysia. Unfortunately, majority of nurses (>
than 60.0%) were uncertain that phases in disaster
as according to Malaysia National Security Council
guidelines are consisted of 4 phases. It showed
that nurses are lack of knowledge on the
fundamental of disaster and knowledge in relation
to the policy.
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74

Table 2: Analysis of 17-items on knowledge related to disaster management between 2 groups

Knowledge domain

Item Emergency nurse (n=132) Community health nurse (n=264)

Yes No Uncertain Yes No Uncertain
n (%) n (%) n (%) n (%) n (%) n (%)
Have you heard about disaster management before? 109 11 12 166 70 28
(82.6) (8.3) (9.1) (62.9) (26.5) (10.6)
Disaster is defined as situations that overwhelm the health 107* 16 9 239* 16 9
care system when it occurs. (81.1) (12.1) (6.8) (90.5) (6.1) (3.4)
Disaster management involves all measures taken to reduce 106* 12 14 235* 14 15
the likelihood of damage that will occur. (80.3) (9.1) (10.6) (89.0) (5.3) (5.7)
Floods can be classified as a natural disaster. 121* 5 6 249* 13 2
(91.7) (3.8) (4.5) (94.3) (4.9) (0.8)
Famine is a type of man-made disaster. 52 42* 38 175 58* 31
(39.4) (31.8) (28.8) (66.3) (22.0) (11.7)
Based on Malaysia guideline, disaster management phase 32 13* 87 67 9* 188
can be divided into 5 phases. (24.3) (9.8) (65.9) (25.4) (3.4) (71.2)
Mitigation activities takes place before disaster happen. 49* 12 71 96* 20 148
(37.1) (9.1) (53.8) (36.4) (7.6) (56.1)
Water level monitoring is an activity in the mitigation 46 11* 75 121 15* 128
phase. (34.8) (8.4) (56.8) (45.8) (5.7) (48.5)
Preparedness activities take place during disaster event. 60 16* 56 131 45* 88
(45.5) (12.1) (42.4) (49.6) (17.0) (33.3)
Field simulation of disaster management plan is an activity 86* 4 42 160* 11 93
in the preparedness. (65.2) (3.0) (31.8) (60.6) (4.2) (35.2)
Response is to put your preparedness plans into action. 101* 4 27 172* 12 80
(76.5) (3.0) (20.5) (65.2) (4.5) (30.3)
Disaster response involved the Ministry of Health without 29 75* 28 67 152* 45
involvement of other private healthcare system. (22.0) (56.8) (21.2) (25.4) (57.6) (17.0)
Activities in recovery phase takes place during disaster 63 30* 39 154 49* 61
event. (47.7) (22.7) (29.6) (58.3) (18.6) (23.1)
Recovery includes actions taken to return to a normal or an 119* 3 10 238* 6 20
even safer situation. (90.2) (2.3) (7.5) (90.2) (2.3) (7.5)
Water supply and sanitation can give impact to health that 115* 7 10 253* 6 5
result from disaster. (87.1) (5.3) (7.6) (95.8) (2.3) (1.9)
Disaster will not increase risk of developing communicable 17 104* 11 25 229* 10
disease. (12.9) (78.8) (8.3) (9.5) (86.7) (3.8)
Population displacements can cause social burden to 105* 12 15 238* 15 11
inhabitants. (79.5) (9.1) (11.4) (90.2) (5.7) (4.2)
* indicate the correct answer
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74

Table 3: Association between socio-demographic profile and knowledge

Knowledge
Emergency Nurse (n=132) Community Health Nurse (n=264)
Inadequate Adequate χ2 value p value Inadequate Adequate χ2 value p value
n (%) n (%) n (%) n (%)

Age 0.998 0.318 3.749 0.053

≤ 40 years 72 (60.5) 47 (39.5) 113 (63.1) 66 (36.9)
>40 years 6 (46.2) 7 (53.8) 43 (50.6) 42 (49.4)

Education level 0.788# 0.809 1.607# 0.477

Certificate 12 (66.7) 6 (33.3) 23 (56.1) 18 (43.9)
Diploma & Bachelor degree 66 (58.0) 48 (42.0) 133 (59.9) 89 (40.1)

Graduation year 3.554 0.059 3.071 0.080

< year 2000 8 (40.0) 12 (60.0) 71 (53.8) 61 (46.2)
≥ year 2000 70 (62.5) 42 (37.5) 85 (64.4) 47 (35.6)

Working experience 2.940 0.086 1.883 0.170

(current disciplines)
< 5 years 56 (64.4) 31 (35.6) 62 (64.6) 34 (35.4)
≥ 5 years 22 (48.9) 23 (51.1) 94 (56.0) 74 (44.0)

Involved in disaster response 4.096 0.043** 0.647 0.421

No 54 (65.9) 28 (34.1) 114 (60.6) 74 (39.4)
Yes 24 (48.0) 26 (52.0) 42 (55.3) 34 (44.7)

Attended disaster education 12.348 0.000* 24.000 0.000*

No 36 (80.0) 9 (20.0) 104 (72.7) 39 (27.3)
Yes 42 (48.3) 45 (51.7) 52 (43.0) 69 (57.0)
* ** #
significant at p< 0.001, significant at p<0.05 Fisher’s Exact Test
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74

Table 4: Identification of predictors for knowledge adequacy on disaster management among respondents

Knowledge Emergency nurse Community Health Nurse

B SE Wald p value AOR 95% CI B SE Wald p value AOR 95% CI
Lower Upper Lower Upper

Involved in disaster
response
Yes (1) 0.367 0.393 0.870 0.351 1.443 0.668 3.120 0.139 0.288 0.234 0.629 1.150 0.653 2.024
[No] (0)

Attended disaster-
related
education/training
Yes (1) 1.337 0.448 8.923 0.003** 3.807 1.584 9.153 1.256 0.263 22.788 0.000* 3.511 2.097 5.881
[No] (0)
* ** significant
significant at p<0.001 at p<0.01 [ ] reference

With regards to activities in each of phases in disaster, there are necessities of
any relevant authorities to render significant knowledge to all nurses as majority
of them earn less relevant information. Meanwhile, in relation to the impact of
the disaster, majority of nurses able to identified that disaster increase the risk
of developing communicable disease and population displacements can cause
social burden to inhabitants.
Generally, both groups showed an equivalent median of 58.82 in score of
knowledge. However, there is a difference in inter-quartile range results,
whereby knowledge of ENs (52.94 – 70.59) where it was slightly higher compared
to CHNs (48.53 – 69.12). Both groups have equal percentage of nurses with an
adequate knowledge (40.9%). It can be interpreted that both groups have more
than 50%nurses with inadequate knowledge on disaster management.
From the result (Table 3), it showed that there is an association between
involvements of ENs in disaster response and attended disaster-related
education/training with their knowledge. Whereby, CHNs who attended disaster-
related education/training is showing a significant association but not to those
who were involved in disaster response. It can be described that regardless of
working place of respondent, their knowledge on disaster management may not
be influenced. It can be seen clearly from the similarity on percentage of both
groups. However, those who involved in disaster response and attended disaster-
related education/training have significant association with their knowledge,
predominantly for ENs.
Predictor factors
From multiple logistic regressions analysis, it had been identified that attending
disaster-related education/training is the factor that predicts the adequacy of
knowledge among respondents as it shows to be statistically significant. Results
from Table 4 shows that ENs who had attended disaster-related
education/training is four times more likely to have adequate knowledge as
compared to those who did not attend, whereby for CHNs, it is about 3.5 times.
Evidence shows that having adequate knowledge is determined by their
attendance on disaster-related education/training.
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74
DISCUSSION
To know foundation of disaster management is
crucial for nurses, predominantly activities in
each of the disaster phases. Nurses believed an
essential knowledge base for disaster response
was essential4. In a study conducted by O’Sullivan
et al. (2008)6 indicates that nurses feel
unprepared to respond to large-scale
disasters/attacks. Majority of respondents in this
study believed that the nurses shall be educated
on the long-term impact of disaster in order to
avoid mental health problem arise subsequent of
responding to disaster events.
Disasters occur unpredictably and at no specific
time, therefore nurses should have maximum
standards, knowledge and ability to plan and
respond to disaster appropriately. Thus, Malaysian
nurses should have knowledge on disaster
management phases; “obtain basic core
knowledge of what to respond and anticipate the
challenges of working in extreme conditions 7.
The organization should establish guidelines for
disaster planning, disaster exercise and capacities
so that hospitals are aware of patient loads they
could handle in a mass casualty event8,9. Nurses
showed an overall low level of self-reported
knowledge of emergency preparedness 10, hence
nurses should possess a simple understanding and
skill set to provide care in the event of a mass
casualty11.
During disaster events, all health care providers
are subjected to the challenges in providing care
for casualties. Therefore, nurses have a critical
role in providing nursing care during a disaster and
during the recovery phase. Furthermore, Al-
Khaleilah et. al. (2011)12 stated that nurses must
have adequate knowledge and skills to perform
these roles effectively.
It is critical for nurses to know on phases in
disaster management, particularly what is being
practiced in Malaysia as it will guide nurses in
performing their roles and providing care to
affected population. Through frequent disaster-
related education/training conducted, perhaps it
increases knowledge as well as cultivates
awareness among nurses towards disaster
management.
Disaster cannot be managed solitarily, where it
requires multi-approach methods from other
agencies, not merely Ministry of Health per se.
Respondents do agree that managing disaster
should involve private healthcare providers as
well. “By working together, 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”13. Besides, 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 14. Emergency
personnel are well known as being devoted to
their duties in disaster response particularly in
emergency response. Nonetheless, involvement of
public health personnel in managing disaster
should not be denied.
Respondents feel that this is important for them
to read and understand their institutions’ disaster
plan. This is for the purpose of preparing
themselves before the occurrence of disasters,
thus may reduce fright and anxiety. It is
imperative that nurses receive information on the
potential psychosocial responses and the
differences between normal and abnormal
responses to disaster as they can minimize the
potential long-term psychological effects 15.
Nurses are the greater population of healthcare
providers, however merely 28.8% of CHNs and
37.6% have been involved in disaster response. In
community setting, community health nurses are
accustomed to handling outbreaks of
communicable disease and routinely collaborate
with other health care workers in primary care
and hospital 13. CHNs must be an integral part of
a multidisciplinary response team while managing
for disaster.
Organization should have their own plans for
disaster as to ensure the staffs know about the
standard operating procedure. “Joint Commission
on Accreditation of Healthcare Organizations
(JCAHO) requires hospitals to have disaster plans,
however there is no promise whether the plan will
be followed or not”16. There was about 45.3% of
respondents know location of their organization
disaster plans. There was a huge difference the
study by Duong (2009)17 where she revealed 87%
of South Australian emergency nurse stated that
they know where their disaster plan was located.
It differs between those who know and read with
those who know but did not read the plan. About
48.2% (n=191) read their own institution disaster
plans and the findings contrary to study by Duong
(2009)17 where42% stated that they had not read
their departmental disaster plans. In this study,
about 51.8% of respondents stated that their
institutions’ disaster plan is located in a place
that was easily accessible. Despite having a good
disaster plan, it is not sufficient without trained
nurses to execute it. Approximately 40% of
respondents were unaware if their hospital had an
emergency plan for a large-scale outbreak 6.
In managing disasters, preparedness of the health
care personnel is crucial. Effective general
preparation will enable nurses to respond
appropriately, regardless of the type 18. About
68.4% (n=271) of nurses are prepared to be
involved in any disaster response. Study by Duong
demonstrates that South Australian emergency
nurses perceived themselves to have a decreased
level of disaster preparedness, perhaps due to
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74

limited education opportunities and previous Competing interests

disaster response experience 17; lack of The authors declare that they have no competing
knowledge and skills19; and unprepared to respond interests.
adequately to a large-scale emergency 7.
Therefore, nurses must have adequate knowledge REFERENCES
in managing disaster and its victims11. It has been
identified that 72.7% (n=96) of ENs and 60.2% 1. Asian Disaster Reduction Centre.
(n=159) of CHNs stated that their institution did Malaysia: Country report. The
conduct training involving emergency and Malaysian experience and future
community health personnel. About 78.0% (n=103) direction on disaster management.
of ENs and 77.3% (n=204) declared that their 2003.
institution collaborated training with other http://www.adrc.asia/countryreport/
agencies such as fire and rescue brigade. From the mys/2003/index.html [November 27,
study conducted by Gomez et al.20 44% of medical 2015].
directors of trauma centres reported that their
centres had been involved in a live mass casualty 2. United Nation International Strategy
exercise with other hospital, first responders for Disaster Reduction (UNISDR).
and/or other relevant stakeholders. Terminology 2007.
http://www.unisdr.org/we/inform/
In relations to disaster training and/or education, terminology [September 27, 2015]
about 60.2% (n=80) of ENs and 41.7% (n=110) of
CHNs stated that their institution had conducted 3. Kent R. Disaster Preparedness 2nd ed.,
regularly. This finding contradicts to study by Disaster Management Training
Gomez et al. (2011)20. Some countries participate Programme. 1994.
in regular exercise or drills that focus on mass http://www.undmtp.org [September
casualty management, which are found to be 25, 2015]
effective in training hospital staff in disaster
response21,22. A study by Bartley et al. (2006)5 4. Chapman K. &Arbon P., Are nurses
compared perceived personal and departmental ready? Disaster preparedness in the
preparedness for disaster and importance of acute setting. Australasian Emergency
disaster preparedness in the department and the Nursing Journal 2008, 11: 135-144.
results showed that there is no difference
between pre- and post-intervention with regards 5. Bartley BH, Stella JB & Walsh LD. What
to department preparation (44%). a disaster?! Assessing utility of
simulated disaster exercise and
There are few limitations can be identified in this educational process for improving
study; involvement of male is ‘0’ due to minimal hospital preparedness. Prehospital
number of them work in ETD where the Disaster Medicine 2006; 21(4):249-255.
respondents have been chosen randomly and none
of them works at health clinics, therefore 6. O'Sullivan TL, Dow D, Turner
researcher could not make a comparison and MC, Lemyre L, Corneil W, Krewski
obtain the association with the gender. Also, short D, Phillips KP & Amaratunga CA.
working experience of 2 months is too short and Disaster and emergency management:
at least a 1-year experience should be included in Canadian nurses' perceptions of
future researches. preparedness on hospital front lines.
Prehospital Disaster Medicine 2008;
CONCLUSION AND RECOMMENDATIONS 23(3): 11-18.

The results showed that ENs and CHNs have equal 7. Tillman P. Disaster preparedness for
percentage of knowledge, however, majority of nurses: A teaching guide. The Journal
ENs have inadequate knowledge as well as CHNs. of Continuing Education in Nursing
Therefore, the type of nurses does not predict 2011; 42 (9): 404-408.
their adequacy of knowledge. Regarding
associated factors, only attended disaster-related 8. Bergin A. &Khosa B. Are we ready?
education is significantly associated with ENs Healthcare preparedness for
knowledge and CHNs. Generally, ENs and CHNs catastrophic terrorism. Australian
have inadequate knowledge on disaster Strategic Policy Institute 2007; 4:1-19.
management. http://www.aspi.org.au/publications/
publication_details.aspx?ContentID=12
List of abbreviations used (if any) 1 [December 13, 2015]
Emergency nurses (EN); Community health nurses
(CHN); Emergency and Trauma Departments 9. Hsu EB, Thomas TL, Bass EB, Whyne D.
(ETDs) ; health clinics (HCs); inter-quartile range Kelen GD, & Green GB. Healthcare
(IQR) worker competencies for disaster
Malaysian Journal of Public Health Medicine 2016, Vol. 16 (3): 66-74

training. Biomed Central 2006; 6(19): Disaster Preparedness in Rural

1-19.
10. McKibbin AE, Sekula K, Colbert
AM, Peltier JW. Assessing the Learning
Needs of South Carolina Nurses by
Exploring Their Perceived Knowledge of
Emergency Preparedness: Evaluation of
a Tool. Journal of Continuing Education
in Nursing 2011; 10:1-12.
11. Stanley, J. Disaster competency
development and integration in nursing
education. Nursing Clinics of North
America 2005; 40: 453-467
12. Al Khalaileh MA, Bond E &Alasad JA.
Jordanian nurses’ perceptions of their
preparedness for disaster management.
International Emergency Nursing 2011;
20 (1): 14-23.
13. Rowney R. & Barton G. The Role of
Public Health Nursing in Emergency
Preparedness and Response. Nursing
Clinics of North America 2005; 40: 499-
509.
14. Nasrabadi AN, Naji H, Mirzabeigi G
&Dadbakhs M. Earthquake relief:
Iranian nurses’ responses in Bam, 2003,
and lessons learned. International
Nursing Review 2007; 54: 13-18.
Hospitals, Disaster Management &
Response 2006; 4 (3): 80-87.
17. Duong K. Disaster education and
training of emergency nurses in South
Australia. Australasian Emergency
Nursing Journal 2009; 12 (3): 86-92.
18. Shaluf I. Disaster types. Disaster
Prevention and Management 2007; 16
(5): 704-717.
19. Littleton-Kearney MT &Slepski LA.
Directions for disaster nursing
education in the United States. Critical
Care Nursing Clinics of North America
2008; 20: 103-109.
20. Gomez D, Haas B, Ahmed N, Tien H
&Nathens A. Disaster preparedness of
Canadian trauma centres: the
perspective of medical directors of
trauma. Canadian Journal of Surgery
2011; 54(1): 9-16.
21. Hsu EB, Jenckes MW, Cateltt CL,
Robinson KA, Feuerstein C, Cosgrove SE
& et al. Effectiveness of hospital staff
mass-casualty incident training
methods: a systematic literature
review. Prehospital Disaster Medicine
2004; 19 (3): 191-199.

15. Hughes F, Grigg D, Fritsch K. & Calder 22. Rosenfeld JV, Fitzgerald M, Kossmann
S. Psychosocial response in emergency T, Pearce A, Joseph A, Tan G & et al. Is
situations: The nurses’ role. the Australian hospital system
International Nursing Review 2007; 54: adequately prepared for terrorism?
19-27. Medical Journal of Australia 2005;
183(11-12): 567-569.
16. Manley WG, FurbeePM, Coben JH,
Smyth SK &Helmkamp JC. Realities of