International Emergency Nursing (2012) 20, 14– 23
available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/aaen
Jordanian nurses’ perceptions of their
preparedness for disaster management
Murad A. Al Khalaileh RN, PhD (Assistant Professor, Chairman) a,
Elaine Bond DNSc, APRN, CCRN (Professor Emeritus) b,
Jafar A. Alasad PhD (Associate Professor) c,*
a
b
c
Adult Health Nursing Department, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
BYU College of Nursing, Emeritus, salt lake city, United States
University of Jordan, Amman, Jordan
Received 29 September 2010; received in revised form 30 December 2010; accepted 2 January 2011
KEYWORDS
Disaster nursing;
Disaster preparedness;
Jordanian nurses;
Disaster knowledge
Abstract
Aim: To assess Jordanian RNs’ perceptions regarding their knowledge, skills, and preparedness
for disaster management.
Background: Current disaster knowledge, skills, and preparedness levels need to be evaluated
to guide plans for effective educational programs. There is also a need to know where RNs
received their knowledge, skills, and preparation, to enhance or improve future educational
opportunities.
Methods: Cross-sectional survey where the Disaster Preparedness Evaluation Tool (DPET) was
distributed to Jordanian RNs who work in three randomly selected Ministry of Health hospitals
and two university hospitals.
Results: Four hundred and seventy-four participants completed the survey. Sixty-five per cent
of respondents described their current disaster preparedness as weak: 18% medium: 12% good;
and 5% felt their preparation was very good. Thirty-one per cent received disaster education in
undergraduate programs; 8% in graduate nursing programs; 31% in facility drills, and 22% in
continuing education courses. Eleven per cent had participated in a real disaster. Four hundred
and thirty RNs wanted to learn more about RNs role in disasters, including knowledge and skills.
Conclusion: Knowledge, skills, and disaster preparedness need continual reinforcement to
improve self efficacy for disaster management.
* Corresponding author. Tel.: +962 6 5355000.
E-mail addresses: m_khalailah@aabu.edu.jo (M.A. Al Khalaileh),
Elaine_Bond@BYU.edu, Elaine.Bond@ldschurch.org (E. Bond),
jalasad@ju.edu.jo, jalasad@hotmail.com (J.A. Alasad).
1755-599X/$ - see front matter ª 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ienj.2011.01.001
Jordanian nurses’ perceptions of their preparedness for disaster management
15
Recommendations: There is a need for a consistent national nursing curriculum for disaster
preparedness and nationwide drills to increase disaster knowledge, skills, preparedness, and
confidence.
ª 2011 Elsevier Ltd. All rights reserved.
Introduction
The worldwide number of natural and man-made disasters
has increased significantly in recent years. Approximately
75,000 people die every year because of unanticipated
disasters, with an additional 210 million who are directly
impacted in some way from such events (Deeny and
McFetridge, 2005). Disasters lead not only to the loss of life
and the destruction of public infrastructures, but also result
in an ensuing interruption in normal healthcare delivery,
and the ability to respond appropriately to disaster victims
(Tichy et al., 2009).
Though Jordan has been relatively stable for over a
decade, there was a terrorist attack on three major
hotels, in the fall of 2005. This disaster resulted in 57
deaths, 115 injuries, and untold suffering on the part of
those present and their families and associates throughout
the world (Al Rai News Paper, 2005). The resulting chaos
overwhelmed local hospitals’ ability to provide organized
care, as they were overrun with multiple patients with
multiple injuries. Another catastrophic event occurred in
January of 2008. Following a heavy snowstorm, a bus accident on the Amman–Irbid road resulted in 23 deaths and
33 injuries, with victims transferred to four hospitals (Al
Rai News Paper, 2008). Each of these events overwhelmed
the available resources, and made it difficult to provide
appropriate care.
The Asian Disaster Reduction Center (2003) defined disasters as ‘‘a serious disruption of the functioning of society,
causing widespread human, material, or environmental
losses, which exceed the ability of the affected society to
cope, using only its own resources’’ (p. 2). Therefore, an
important decision which must be made for health care providers to recognize how to provide adequate care, and when
they cannot provide effective care for the multiple victims
who are arriving in their facility.
A successful disaster response by health care providers
can be enhanced by disaster management preparedness.
This preparation can be achieved through different methods, such as continuing education courses in disaster
management, disaster management drills, and integrating
disaster management courses into nursing curricula (Jennings-Sanders, 2004). Although all health care providers
are involved whenever a disaster occurs, Registered Nurses
(RNs) have a critical role in providing nursing care during a
disaster and during the recovery phase of the disaster. Since
disaster strikes without warning, preparation and disaster
management abilities must be in place before a disaster occurs (Laye, 2002).
All RNs, along with other health care providers, need to
be familiar with disaster management procedures. Even
though disasters are usually classified into three types; (1)
natural, (2) man-made, and (3) hybrid – a combination of
natural and man-made – effective general preparation will
enable RNs to respond more appropriately, regardless of the
type (Shaluf, 2007). To perform these roles effectively, RNs
must have adequate knowledge and skills. As of this date,
there is no documented study in Jordan that has explored
the knowledge, skills, and preparedness of Jordanian RNs
regarding disaster management.
Jordan, like all other countries, is threatened by natural
and man-made disasters. After the 2005 terrorist attacks on
the three hotels, followed by the record snowfall in 2008,
there has been an increased concern regarding disaster
management and establishing a viable disaster management
plan. Such a plan needs to involve all health care professionals. The Ministry of Health (MOH) (2007) has developed a
Jordanian national plan for disaster management. The main
goal is to manage disasters that may occur in different parts
of Jordan. Furthermore, a large number of Jordanian RNs
participate in United Nation (UN) missions and humanitarian
activities in different places in the world where disasters
occur frequently. These RNs are in special need of high levels of disaster management preparedness to fulfill their duties. There may not be a mechanism in place specifically to
prepare them, before they leave for afflicted areas.
Although Jordanian RNs must fulfill major roles at home
and internationally, no information is available about Jordanian RNs disaster knowledge, skills and preparedness.
Determining the actual level of RNs’ preparedness can be
used to evaluate the need for incorporating disaster management in nursing curricula in Jordanian undergraduate
nursing programs and will help in planning for continuing
education courses, disaster drills, and mock disasters to
meet nurses needs.
Methods
Purpose
The primary purpose of this study was to assess Jordanian
RNs perceptions regarding their knowledge, skills, and
preparedness for disaster management. For that purpose
the study attempted to answer the following research
questions: (1) What knowledge do Jordanian RNs have about
disaster management? (2) What skills do Jordanian RNs have
for disaster management? (3) If they have knowledge and
skills, where did Jordanian RNs acquire the knowledge
and skills regarding disaster preparedness? (4) How do
Jordanian RNs perceive their preparedness for disaster
management?
Design
A descriptive cross-sectional survey was used to explore the
perception of Jordanian RNs about their preparedness for
disaster management.
16
M.A. Al Khalaileh et al.
Settings and sample
Data analysis
Participants were selected from a randomized sample of
hospitals from each of the three regions in Jordan (North,
Middle, and South) and the two main University hospitals
in Jordan. One hospital from each region was randomly selected in addition to the two university hospitals which
are located in the capital Amman and the Northern region.
A total of five Jordanian hospitals were included in the
study. RNs working in these hospitals were asked to participate in this study. Inclusion criteria included; RNs who had
at least a 3 year diploma degree in general nursing, had at
least 1 year experience, were currently working as an RN
in a hospital setting, and agreed to participate. All nurses
who met the inclusion criteria in the selected hospitals were
invited to participate.
Raw data were entered into SPSS 15. The analyses included
descriptive statistics to determine sample characteristics
and distribution of responses regarding each research question. Frequencies, measures of central tendency and dispersion were calculated. Cronbach’s Alpha Coefficients was
calculated for the scale and subscales. t-Tests and OneWay ANOVA were instituted to test for differences between
variables and groups.
Data collection and instrument
Data were collected through self-administered questionnaires using the Disaster Preparedness Evaluation Tool
(DPETª) (Tichy et al., 2009) between June and October
2008. The instrument was designed to measure Nurse Practitioner’s specific knowledge and skills regarding disaster/
post-disaster response and management. The DPETª has 68
items to measure Nurse Practitioner’s perception of their
preparedness for disaster management. It has two main sections; ‘Introduction’ contains 47 Likert type questions; with
the first 25 items discuss pre-disaster preparedness. The
scale of answers ranges from 1 to 6 (Strongly Disagree to
Strongly Agree) and the items were grouped into three categories: knowledge, disaster skills, and personal preparedness. The next 16 items discuss Response. The scale of
answers also ranges from 1 to 6 (Strongly Disagree to Strongly
Agree) and the items were grouped into two categories:
knowledge and patient management. The last six items in
the first section discusses the Recovery stage of disaster.
The scale of items also ranges from 1 to 6 and grouped in
two categories: knowledge, and management. Section 2
includes demographic data and one open question.
Cronbach’s alpha internal consistency reliability for the
original instrument was 0.91 (Tichy et al., 2009). In this
study Cronbach’s alpha for the DPETª instrument was
0.90. Cronbach’s alpha internal consistency reliability was
also calculated for the three groups of items which were
0.91 for the knowledge subscale, 0.90 for the skills subscale, and 0.91 for the post-disaster management subscale.
Ethical considerations
The study was approved by the Research and Ethics Committees at the University of Jordan’s Faculty of Nursing; The
University Research Committee at the University of Jordan;
the Research Committee in the Ministry of Health and research committees at all involved hospitals. Anonymity
and confidentiality of the respondents was ensured throughout the study. Participation on the study was voluntary and
based on informed consent. Respondents were advised they
were not obligated to participate in the study, and they
could withdraw from the study without any consequences
or penalties.
Results
The purpose of this study was to assess Jordanian RNs’ preparedness for disaster management. Of the 600 distributed
DPET questionnaires, 512 were returned, resulting in an
85.3% response rate. Empty and incomplete questionnaires
were eliminated from the study sample, and were not included in the data analysis (n = 38). Four hundred seventyfour were deemed complete and usable for the study.
Sixty-four per cent of the 474 RN respondents worked in
governmental hospitals and 36% worked in university hospitals. A t-test (independent sample t-test) showed there are
statistically significant differences in the perception of RNs
of their level of preparedness due to the type of hospital:
those who worked at University Hospitals rated their preparedness for disaster management better than those who
worked in Governmental Hospitals (p = 0.001) (see Table 1).
Years working as an RN ranged from 1 to 35 years. OneWay ANOVAs showed significant differences in the perception of nurses to their level of preparation for disaster response in terms of skills (p = 0.028) and overall score
(p = 0.045 according to experience (see Table 2). The post
hoc test revealed that RNs with more experience reported
higher levels of knowledge, skills, and preparedness than
less experienced RNs.
RNs aged from 21 to 53 years: 61.4% were female and
38.6% were male; their mean hours of work were 47 h per
week. Fourteen per cent had diploma degrees, 79% had
bachelor’s degrees, and 7% had Master’s degrees. There
were no significant differences in RNs preparedness for
disaster management based on age, gender, or educational
level (p > 0.05).
In order to measure RNs perception of their preparedness
toward disasters in general, and towards knowledge, skills,
and preparedness, means and standard deviations of the
collected data have been used for the DPET questionnaires. If the value of the mean is 1–2.99, the RNs’ perception of their preparation is weak; if the mean is 3–4.99; the
RNs’ perception of their preparation is moderate: if the value of mean is 5–6, the RNs’ perception of their preparation
is strong.
Knowledge
The first research question asked, ‘‘What knowledge do
Jordanian RNs have about disaster management?’’ Thirteen
items on the DPET were related to knowledge, with answers ranging from 1 to 6 (Strongly Disagree to Strongly
Agree). Cronbach’s Alpha for the knowledge section items
Jordanian nurses’ perceptions of their preparedness for disaster management
Table 1
t-Test (independent sample t-test) differences in RNs perception of their preparedness according to the experience.
Fields
Mean
Knowledge
Skills
Post-disaster management dimension
Total fields
*
**
Governmental hospital
University hospital
Governmental hospital
University hospital
Governmental hospital
University hospital
Governmental hospital
University hospital
3.14
3.50
2.99
3.12
3.23
3.51
3.14
3.44
SD
0.86
0.78
1.15
0.94
1.06
0.85
0.97
0.77
df
t-Calculated
**
t-Tabulated
Significant
1.96
0.001
472
4.60
472
2.24*
1.96
0.026
472
3.06**
1.96
0.002
472
3.45**
1.96
0.001
Significant at 0.05.
Significant at 0.01.
Table 2
One-Way ANOVA differences in RNs’ perception of their preparedness according to their experience.
Field
Knowledge
Skills
Post crises management
dimension
Total fields
*
17
Sum of squares
df
Mean squares
f-Calculated
f-Tabulated
Significant
Between groups
Within groups
Total
Between groups
Within groups
Total
Between groups
6.30
334.32
340.63
12.50
535.56
548.06
7.40
4
469
473
4
469
473
4
1.58
0.71
2.21
4.28
0.067
3.13
1.14
2.74*
4.28
0.028
1.85
1.88
4.28
0.113
Within groups
Total
Between groups
Within groups
Total
461.11
468.51
8.02
383.33
391.34
469
473
4
469
473
0.98
2.45*
4.28
0.045
2.00
0.82
Significant at 0.05.
was 0.86. Respondents considered themselves weakly prepared for participating in emergency plan drafting and
emergency planning for disaster situations in their community (M = 2.98) and for having a list of contacts in the medical or health communities in which they practice. For all
other areas of knowledge, the RNs’ perceived themselves
moderately prepared (see Table 3).
Skills
The second research question asked ‘‘What skills do Jordanian RNs have about disaster management?’’ There were 11
DPET items related to skills, with answers ranging from 1
to 6 (Strongly Disagree to Strongly Agree). Chronbach’s
Alpha was 0.90. Respondents considered themselves weakly
prepared for participating in creating new guidelines, emergency plans, or lobbying for improvements on the local or
national level (M = 2.99). In all other skill items, the RNs
considered themselves moderately prepared (see Table 1).
Around half of RNs had emergency family plans in place
for disasters (n = 235), even fewer had an agreement with
family members on how to execute family emergency plans
(n = 215) (see Table 4).
Preparedness
The third research question asked, ‘‘If they have knowledge
and skills, how did Jordanian RNs acquire the knowledge and
skills regarding disaster preparedness?’’ Approximately one
third of all respondents indicated they received disaster
education in their undergraduate or graduate nursing programs. Half received knowledge and skills in facility drills
or continuing education classes; 11% had participated in a
real disaster (see Table 5).
Perception of disaster preparation
The fourth research question asked, ‘‘How do Jordanian RNs
perceive their preparedness for disaster management?’’
There were 21 DPET items related to preparation for disaster management, with answers ranging from 1 to 6 (Strongly
Disagree to Strongly Agree). Chronbach’s Alpha was 0.88.
RNs considered themselves weakly prepared in health
assessments related to biological or chemical agents; organizational logistics and roles; and addressing Groups A–C of
biological weapons (Anthrax, Plague, Botulism, Smallpox,)
In all other areas, the RNs felt moderately prepared (see
Table 6).
18
Table 3
M.A. Al Khalaileh et al.
RNs’ level of knowledge for disaster management.
Items
M
SD
n
Finding relevant information about disaster preparedness related to
my community needs is an obstacle to my level of preparedness
I would be interested in educational classes on disaster
preparedness that relate specifically to my community situation
I am aware of classes about disaster preparedness and management
that are offered for example at either my workplace, the university,
or community
I read journal articles related to disaster preparedness
I find that the research literature on disaster preparedness is
understandable
In case of a disaster situation I think that there is sufficient support
from local officials on the county, region or governance level
I know who to contact (chain of command) in disaster situations in
my community
I participate in one of the following educational activities on a
regular basis: continuing education classes, seminars, or
conferences dealing with disaster preparedness
I find that the research literature on disaster preparedness and
management is easily accessible
I know where to find relevant research or information related to
disaster preparedness and management to fill in gaps in my
knowledge
I participate in disaster drills or exercises at my workplace (clinic,
hospital, etc.) on a regular basis
I have a list of contacts in the medical or health community in which
I practice. I know referral contacts in case of a disaster situation
(health department, e.g.)
I have participated in emergency plan drafting and emergency
planning for disaster situations in my community
3.57
1.532
472
3.41
1.555
471
3.41
1.543
470
3.36
3.32
1.594
1.498
473
473
3.27
1.595
474
3.25
1.736
473
3.14
1.334
471
3.13
1.326
473
3.04
1.627
471
3.03
1.396
474
2.99
1.419
471
2.98
1.434
470
Only 42.0%, (n = 199) of respondents were aware that
their workplace had established a disaster plan, while 58%
were not familiar with that workplace plan. Of those who
were aware of disaster plans in their workplace, 80%
(n = 379) were not confident about execution of the plan
in their workplace. The majority (72%, n = 342) of the
respondents were unaware of the level of preparation for
disasters of the system of health care in their community.
Discussion
Since there is a paucity of information on Jordanian RNs’
disaster preparedness, this descriptive cross-sectional current study was performed to assess RNs’ perception of their
preparedness for disaster, and to assess how they acquired
disaster knowledge and skills. This comes at a time of urgency, highlighted not only by the terror attacks of 2005
and the snowstorm of 2008, but also by the increasing
worldwide concerns regarding disaster and disaster
consequences.
In general, the respondents in the current study reported
moderate to low levels of disaster preparedness with large
gaps in the information RNs need to function effectively in
disasters, which is not possible without the necessary
knowledge and skills. These results are consistent with the
results of Rassin et al. (2007) who also found low preparedness levels for disaster management. Furthermore, Rassin
et al. (2007) found that early preparation on the part of
the health care system significantly affects its ability to respond effectively to a disaster.
It is not surprising to find RNs have low levels of preparedness for disaster management: this is a relatively
new, international concern. Many authors have reported
the same outcomes (Shih et al., 2002; Baldwin et al.,
2005; Bjerneld et al., 2005; Connelly, 2006; Slepski, 2007;
Felice et al., 2008). Similar to other countries, there are
no documented Jordanian national actions taken to prepare
nurses for disaster found in the literature. The Jordanian
Nursing Council has begun holding workshops, and several
universities have begun incorporating disaster preparedness
into their curricula. However, without understanding what
RNs already know, and where they learned that information,
new programs may duplicate current efforts, or miss important content.
In the first part of the DPETª questionnaire, which assesses RNs’ knowledge regarding disaster preparedness,
the top ranked answer respondents gave was ‘‘I would be
interested in educational classes on disaster preparedness
that relate specifically to my community situation.’’ This
presents a serious indication of RNs’ awareness of the
importance of disaster preparedness. However, the least
ranked answer respondents gave was ‘‘I have participated
in emergency plan drafting and emergency planning for
disaster situations in my community.’’ This reflects a
Jordanian nurses’ perceptions of their preparedness for disaster management
Table 4
19
RNs’ level of skills for disaster management.
Items
M
SD
n
I am aware of what the potential risks in my community are (e.g.
earthquake, floods, terror, etc.)
In case of a bioterrorism/biological or chemical attacks, I know how
to use personal protective equipment
I am familiar with accepted triage principles used in disaster
situations
I have personal/family emergency plans in place for disaster
situations
In a case of bioterrorism/biological or chemical attacks I know how
to perform isolation procedures so that I minimize the risks of
community exposure
I am familiar with the local emergency response system for disasters
In case of a bioterrorism/biological or chemical attacks I know how
to execute decontamination procedures
I have an agreement with loved ones and family members on how to
execute our personal/family emergency plans
I would be considered a key leadership figure in my community in a
disaster situation
I consider myself prepared for the management of disasters
I participate/have participated in creating new guidelines,
emergency plans, or lobbying for improvements on the local or
national level
3.41
1.555
474
3.41
1.543
472
3.36
1.594
474
3.32
1.498
474
3.27
1.595
473
3.25
3.14
1.736
1.334
471
474
3.13
1.326
474
3.04
1.627
473
3.03
2.99
1.396
1.419
474
474
Table 5
Where RNs received disaster knowledge and skills.
Place
n
%*
Undergraduate education
Graduate education
Continuing education courses
Facility drills
Participated in a real disaster
147
36
105
145
52
31
8
22
31
11
*
Percents do not add up to 100% – respondents could select
more than one answer.
serious lack of RNs inclusion in the planning process. These
findings are similar to previous findings by Elgie et al. (2005)
who found that RNs were willing to know about disaster
management and threats to their community, but were
not included in any community collaborative planning. However, in contrast, Cox (2008) indicated that RNs play an
important role in disaster planning and response, at both
the individual and community level. Moreover, Rogers and
Lawhorn (2007) found that RNs play a crucial role in
planning for disaster management, and strongly stated RNs
need to participate on disaster management and planning
boards.
Jordanian RNs identified a serious obstacle to finding
relevant literature regarding disaster preparedness; these
results may be related to the shortage of access to international journals in Jordanian hospitals, especially in governmental hospitals. However, it may be a common challenge
in many developing countries.
Around half of respondents were aware of contacts in
their communities in case of a disaster, knowing whom to
contact, or the chain of command in their community. Half
of respondents were familiar with the local response
systems. These findings are slightly better than findings by
Tichy et al. (2009), who found that few respondents have
referral contacts in case of a disaster, and fewer knew
whom to contact, or knew the chain of command in their
community. Not all RNs were familiar with the local response systems. Earlier reports (Gebbie and Qureshi, 2002;
Connelly, 2006) stressed that knowing the chain of command is a critical component of competency for providers.
Connelly (2006) recommend that all health care providers
should be familiar with the incident command system,
which is widely used by law enforcement, firefighters, and
the military, in emergency preparedness and response.
Moreover, Weiner and Irwin (2003) indicated that, RNs must
be able to reach the appropriate contacts with whom to
communicate quickly and effectively, to prevent worsening
of situations in mass casualty incidents.
In the second part of the questionnaire, RNs indicated
they have relatively better skills than knowledge, but even
at that, the level of preparedness regarding disaster preparedness skills appeared low. This finding is similar to
Fothergill et al.’s (2005) findings that respondents showed
lack of skills and training for disaster management. Hughes
et al. (2007) indicated that it is essential to ensure that RNs
have the skills and knowledge to respond effectively in
disaster situations. On the other hand the International
Nursing Coalition for Mass Casualty Education (INCMCE)
(2003) stressed that all RNs in all specialties should possess
basic knowledge and skills needed to appropriately respond
to disaster.
Family preparedness plays a crucial role in allowing RNs
to respond or participate in a disaster. Below half of respondents reported family emergency plans in place for
20
Table 6
M.A. Al Khalaileh et al.
RNs’ level of preparation for disaster management.
Items
M
SD
n
I know the limits of my knowledge, skills, and authority as an RN to act in disaster
situations, and I would know when I exceed them
I would feel confident providing patient education on stress and abnormal functioning
related to trauma
I am able to differentiate the signs and symptoms of acute stress disorder and post
traumatic stress disorders (PTSD)
I am familiar with what the scope of my role as a registered nurse in a post-disaster
situation would be
As an RN, I would feel reasonably confident in my abilities to be a member of a
decontamination team
I would feel confident providing education on coping skills and training for patients who
experience traumatic situations so they are able to manage themselves
As an RN, I would feel confident in my abilities as a direct care provider and first responder
in disaster situations
I feel reasonably confident I can care for patients independently without supervision of a
physician in a disaster situation
I can manage the common symptoms and reactions of disaster survivors that are of
affective, behavioural, cognitive, and physical nature
I would feel confident implementing emergency plans, evacuation procedures, and similar
functions
I can identify possible indicators of mass exposure evidenced by a clustering of patients
with similar symptoms
I am familiar with psychological interventions, behavioural therapy, cognitive strategies,
support groups and incident debriefing for patients who experience emotional or physical
trauma
As an RN, I would feel confident as a manager or coordinator of a shelter
I am able to describe my role in the response phase of a disaster in the context of my
workplace, the general public, media, and personal contacts
I participate in peer evaluation of skills on disaster preparedness and response
I feel confident managing (caring, evaluating) emotional outcomes for acute stress
disorder or PTSD following disaster or trauma in a multi-disciplinary way such as referrals,
and follow-ups and I know what to expect in ensuing months
In case of a bioterrorism/biological or chemical attacks, I know how to perform focused
health history and assessment, specific to the biological or chemical agents that are used
I am familiar with how to perform focused health assessment for PTSD
I feel confident recognizing differences in health assessments indicating potential
exposure to biological or chemical agents
I am familiar with the organizational logistics and roles among local and national agencies
in disaster response situations
I am familiar with the main Groups (A–C) of biological weapons (Anthrax, Plague,
Botulism, Smallpox, etc.), their signs and symptoms, and effective treatments
3.78
1.370
473
3.67
1.383
474
3.58
1.334
473
3.56
1.441
473
3.55
1.311
472
3.49
1.469
474
3.48
1.402
474
3.42
1.367
471
3.39
1.499
473
3.38
1.373
474
3.38
1.409
474
3.36
1.285
474
3.34
3.29
1.381
1.362
474
474
3.21
3.17
1.387
1.390
474
474
3.13
1.428
474
3.07
2.97
1.403
1.397
473
471
2.95
1.422
472
2.89
1.477
473
disasters, or agreements on how to execute family plans. If
RNs do not feel their families are safe or cared for, their focus and abilities to fully engage in disaster response will be
affected (Tichy et al., 2009). This statement is supported by
Syrett et al.’s (2007) findings that RNs were willing to work
in disaster situations when they felt their families were
safe, and the family could access effective treatment options, either at workplace or at home. Mitani et al. (2003)
reported many RNs did not participate in a recent earthquake disaster in Japan, because they could not provide
alternative care for their families.
In the third part of questionnaire which assessed RNs perceptions of their disaster management preparedness, the
RNs showed low levels of preparedness in relation to response to biological and chemical attacks. These findings
may be related to inadequate training for biological and
chemical attacks. Rebmann (2006) indicated that bioterrorism knowledge is obtained through participation in multidisciplinary educational initiatives and bioterrorism exercises. These results are similar to previous findings by
Baldwin et al. (2005) who found that RNs had limited knowledge of potential bioterrorism agents, as well as incomplete
understanding of emergency preparedness. In other studies
(Chaput et al., 2007; Hsu et al., 2005; Jacobson et al., 2010)
found that health care providers (including RNs) felt unprepared for biological, chemical and radiological attacks.
However, Manley et al. (2006) stated RN disaster preparedness should focus on natural disasters, or large scale accidents, rather than focus on biological disasters, which
have been extremely rare.
Jordanian nurses’ perceptions of their preparedness for disaster management
An interesting finding was that around two thirds of
respondents (n = 296) considered that integration of disaster preparedness in national curricula should be a first priority. This reflects Jordanian RNs’ concern and recognition
about the importance of disaster preparedness. These finding are consistent with the results of Hsu et al. (2005) who
found that emergency preparedness is a public health priority for all health care providers.
Another interesting finding is that the RNs reported they
were willing to learn about disasters to be prepared for
disaster management. This finding is similar to a previous
study conducted by Bond and Beaton (2005); they found that
both practicing RNs and nursing students indicated a strong
need for disaster nursing content.
This study shows that the majority of RNs preferred new
education to be delivered via courses and training. This
came in response to the question ‘‘Please describe one
thing that would make you personally better prepared for
the management of disasters’’. However, the literature
has shown that drilling – holding mock disasters – is considered one of the best methods of training and the preferred
method among RNs (Chaput et al., 2007). The question remains whether preferences exist because of an actual bias
for various formats or a lack of experience with other formats, and whether a broad spectrum of formats is the
answer.
Many RNs who participated in this study were willing to
receive additional information or materials in disaster preparedness. Significantly high numbers (91%) of RNs were
interested in learning about their role in a disaster situation and about biological and chemical agents and ways
to identify their signs and symptoms. This illustrates that
RNs really feel the importance of disaster preparedness
and the need to be prepared. These findings are congruent
with findings by Tichy et al. (2009) who found that 76% of
their respondents stated they needed more information
about biological and chemical agents, and ways to identify
their signs and symptoms; 73% (n = 122) wanted further
clarification of the RNs’ role (scope of practice, skills) in
a disaster.
Experienced RNs are better prepared than RNs with little
experience in term of skills. Experience is considered as the
basis of preparedness for core competencies (Stanley,
2005). Ireland et al. (2006) indicated that experiences in
the clinical field help in preparing nurses to respond in disaster situations. Moreover, Suserud and Haljamae (1997)
found experienced RNs had more ability to provide care in
emergency situations than less experienced RNs. Furthermore, clinical experiences enhance the ability to response
adequately in disaster situation (Bjerneld et al., 2005).
Despite the fact that RNs reported low levels of knowledge and skills, it is not well documented how and to what
extent nursing faculties are teaching this content in the
nursing curricula. Moreover, it is also not documented to
what extent RNs learned about disaster plans in their workplace. These findings are congruent with findings by Hsu
et al. (2005), who found that the majority (72.4%) of their
respondents reported that they had not participated in
disaster preparedness and response training. In addition,
knowing in advance exactly what is expected of RNs will
provide RNs with an opportunity to acquire the pertinent
knowledge and to practice necessary skills beforehand.
21
Not only in Jordan, but also in many countries all over
the world, disaster education is not uniformly incorporated
into the requirements for undergraduate nursing education.
This necessitates the need for postgraduate continuing education courses, and training programs in disaster preparedness and response. Since large scale emergency events are
unpredictable and RNs, as well as other health care providers, should be able to provide essential and suitable care as
part of first-response health teams, adequate education is
essential.
Though the RN respondents for this study reported low
levels of disaster preparedness, Jordanian programs to support preparedness are underway, or in place. Currently,
there is a significant concern in Jordan regarding disaster
management and in establishing viable disaster management plans. These plans need to involve all health care professionals. The Ministry of Health is developing a Jordanian
National Plan for disaster management, with the main goal
being to manage disasters that may occur in different parts
of Jordan. Recently the Jordanian Ministry of Health developed the National Strategy for Emergency Preparedness and
Humanitarian Action for the Health Care Sector (Ministry of
Health 2007).
Conclusion and recommendations
In conclusion, RNs consider themselves weakly to moderately prepared for disaster management. They think additional training through courses and facility drills would be
beneficial in increasing their level of preparedness. Overwhelming numbers would like additional information about
the RN role, the risks and resources in their communities,
biological and chemical agents and ways to address mental
health issues, post-disaster.
The results of this study can assist in identifying the
core competencies and role developments needed for
RNs to successfully assist patients in time of disaster situations. Furthermore, determining the actual level of RNs’
knowledge and skills can help in planning for continuing
education program courses to meet their needs. The results from this study can be used to evaluate the need of
incorporating disaster management in nursing curricula in
Jordanian nursing programs. Increased emphasis on disaster management knowledge and skills practiced and evaluation by drills and mock disasters will increase student
nurses and practicing RNs’ confidence in their ability to
manage future disasters.
This study identified gaps in nursing education in disaster
preparedness, disaster plans, disaster training, and education. Uniform integration of disaster management courses
into undergraduate nursing curricula is recommended to
prepare the next generation of RNs. Furthermore, development of graduate disaster management courses and programs will help in preparing RNs. Disaster drills and
exercises are the best ways to prepare RNs for a disaster.
Consequently, it is very important that health care institutions incorporate drills into their in-service education to increase RNs readiness and preparedness for disaster.
Development of national and international research networks for disaster nursing, with the purpose of dissemination of information at the national level, will help in
22
keeping RNs up to date with disaster management. Developing a national committee of disaster nursing will help define
the discipline of disaster nursing, building disaster curricula,
and setting disaster competencies. Ongoing training, including participation in drills is recommended, to increase RNs
disaster preparedness and decrease Jordan’s vulnerability.
RNs need to be active in disaster management plans, which
will enable RNs to be familiar with their responsibilities in
disaster situations. Moreover, RNs should participate in
disaster preparedness planning to help examine and create
policies and procedures for disaster response.
Given that this was the first study of Jordanian RNs disaster preparedness, more research needs to be done to validate these results as accurate reflections of perceived
preparedness or if they reflect unawareness, lack of training, or misconceptions. Moreover, further research is
needed to better understand the barriers faced by RNs in
preparing for potential disasters. This study could also be
replicated with RNs working in military hospitals. Intervention studies will improve Jordanian RNs’ preparedness for
disaster management.
Acknowledgment
This research project was funded by the University of
Jordan. The authors would like to thank all Registered
Nurses who participated in the study, and directors of
Hospitals in which the study was conducted, for facilitating
data collection. Gratitude also is extended to Prof. Madi
Jaghabir, Dr. Muayyad Ahmad, Dr. Majd Murayan, and
Dr. Kawkab Shishani for there valuable comments on an
earlier draft of the study.
References
Al Rai News Paper, Amman, No. 12890, 10 November, 2005.
Al Rai News Paper, Amman, No. 13695, 27 February, 2008.
Asian Disaster Reduction Center, 2003. Glossary on Natural Disasters. <http://www.adrc.asia/publications/terminology/top.
htm> (retrieved December 2010).
Baldwin, K., LaMantia, J., Proziack, L., 2005. Emergency preparedness and bioterrorism response: development of an educational
program for public health personnel. Public Health Nursing 22
(3), 248–253.
Bjerneld, M., Lindmark, G., Diskett, P., Garrett, M.J., 2005.
Perceptions of work in humanitarian assistance. Interviews with
returning Swedish health professionals. Disaster Manage
Response 2, 101–108.
Bond, E., Beaton, R., 2005. Disaster nursing curriculum development based on vulnerability assessment in the Pacific Northwest. Nursing Clinics of North America 40, 441–451.
Chaput, C.J., Deluhery, M.R., Stake, C.E., Martens, K.A., Cichon,
M.E., 2007. Disaster training for prehospital providers. Prehospital Emergency Care 11 (4), 458–465.
Connelly, M., 2006. IMERT deployment to Baton Rouge, Louisiana in
response to Hurricane Katrina, September 2005. Disaster Manage
Response 4, 4–11.
Cox, C.W., 2008. Manmade disasters: a historical review of
terrorism and implications for the future. The Online Journal
of Issues in Nursing 13 (1), <http://www.nursingworld.org/
MainMenuCategories/> (retrieved October 2008).
M.A. Al Khalaileh et al.
Deeny, P., McFetridge, B., 2005. The impact of disaster on culture,
self, identity: increased awareness by health care professionals
is needed. Nursing Clinics of North America 40, 431–440.
Elgie, R., Sapien, R.E., Fullerton-Gleason, L., 2005. The New Mexico
school nurse and emergency medical services emergency preparedness course: program description and evaluation. The
Journal of School Nursing 21 (4), 218–223.
Felice, M.D., Giuliani, A.R., Alfonsi, G., Mosca, G., Fabiani, L.,
2008. Survey of nursing knowledge on bioterrorism. International
Emergency Nursing 16, 101–108.
Fothergill, A., Val Palumbo, M., Rambur, B., Reinier, K., McIntosh,
B., 2005. The volunteer potential of inactive nurses for disaster
preparedness. Public Health Nursing 22 (5), 414–421.
Gebbie, K.M., Qureshi, K., 2002. Emergency and disaster preparedness. AJN 102 (1), 46–51.
Hsu, C., Mas, F.S., Jacobson, H., Papenfuss, R., Nkhoma, E.T.,
Zoretic, J., 2005. Assessing the readiness and training needs of
non-urban physicians in public health emergency and response.
Disaster Manage Response 3, 106–111.
Hughes, F., Grigg, D.M., Fritsch, K., Calder, S., 2007. Psychosocial
response in emergency situations – the nurse’s role. Journal
Compilation ª 2007 International Council of Nurses.
International Nursing Coalition for Mass Casualty Education, 2003.
Educational Competencies for Registered Nurses Responding to
Mass Casualty Incidents. <http://www.incmce.org/competenciespage> (retrieved December 2008).
Ireland, M., Ea, E., Kontzamanis, E., Michel, C., 2006. Integrating
disaster preparedness into a community health nursing course:
one school’s experience. Disaster Manage Response 4, 72–76.
Jacobson, H., Mas, F.S., Hsu, C., Turley, J., Miller, J., Kim, M.,
2010. Self-assessed emergency readiness and training needs of
nurses in rural Texas. Public Health Nursing 27 (1), 41–48.
Jennings-Sanders, A., 2004. Teaching disaster nursing by utilizing
the Jennings disaster nursing management model. Nurse Education in Practice 4, 69–76.
Laye, A., 2002. Avoiding Disaster How to Keep Your Business Going
When Catastrophe Strikes. Peter Yanev Orinda, California.
Manley, W., Furbee, P., Coben, J., Smyth, S., Summers, D.,
Althouse, R., Kimble, R., Kocsis, A., Helmkamp, J.D., 2006.
Realities of disaster preparedness in rural hospitals. Disaster
Manage Response 4 (3), 80–87.
Ministry of Health, 2007. National Strategy for Emergency Preparedness and Humanitarian Action for the Health Sector,
Amman, Jordan.
Mitani, S., Kuboyama, K., Shirakawa, T., 2003. Nursing in suddenonset disasters: factors and information that affect participation. Prehospital and Disaster Medicine 18 (4), 359–366.
Rassin, M., Avraham, M., Nasi-Bashari, Idelman, S., Peretz, Y.,
Morag, S., Silner, D., Weiss, G., 2007. Emergency department
staff preparedness for mass casualty events involving children.
Disaster Management and Response 5 (1), 36–44.
Rebmann, T., 2006. Defining bioterrorism preparedness for nurses:
concept analysis. Journal of Advanced Nursing 54 (5), 623–632.
Rogers, B., Lawhorn, E., 2007. Disaster preparedness. Occupational
and environmental health professionals’ response to hurricanes
Katrina and Rita. American Association of Occupational Health
Journal 55 (5), 197–207.
Shaluf, I., 2007. Disaster types. Disaster Prevention and Management 16 (5), 704–717.
Shih, F., Liao, Y., Chan, S., Gau, M., 2002. Taiwanese nurses’ most
unforgettable rescue experiences in the disaster area after the
9–21 earthquake in Taiwan. International Journal of Nursing
Studies 39, 195–206.
Slepski, L.A., 2007. Emergency preparedness and professional
competency among health care providers during hurricanes
Katrina and Rita: pilot study results. Disaster Manage Response
5, 99–110.
Jordanian nurses’ perceptions of their preparedness for disaster management
Suserud, B., Haljamae, H., 1997. Acting at a disaster site:
experiences expressed by Swedish nurses. Journal of Advanced
Nursing 25, 155–162.
Stanley, J., 2005. Disaster competency development and integration in nursing education. Nursing Clinics of North America 40,
453–467.
Syrett, J., Benitez, J., Livingston, W., Davis, E., 2007. Will
emergency health care providers respond to mass casualty
incidents? Prehospital Emergency Care 11 (1), 49–54.
23
Tichy, M., Bond, A.E., Beckstrand, R.L., Heise, B., 2009. Nurse
practitioners’ perception of disaster preparedness education.
American Journal of Nurse Practitioners 13 (1), 10–22.
Weiner, B., Irwin, M., 2003. Current initiatives for emergency
preparedness response: commentary on ‘‘new challenges for
public health care: biological and chemical weapons awareness,
surveillance, and response’’. Biological Research for Nursing 4
(4), 254–257.