Journal of Public Health Research 2022; volume 11:2732

Review

Factors affecting nurses’ ability to provide effective care in a disaster

response: A review
Amelia Kimin,1 Elly Nurachmah,2 Fatma Lestari,3 Dewi Gayatri4
1Facultyof Nursing; 2Department of Medical-Surgical Nursing; 3Department of Occupational Health and
Safety; 4Department
of Basic Science and Fundamentals of Nursing, Faculty of Nursing, Universitas Indonesia,
Depok, Jawa Barat, Indonesia

disasters’ survivor; however, it was found that nurses’ prepared-

Abstract ness level in dealing with disasters is still low.3-7 Research on
Disasters cause death, trauma, and psychological distress. emergency nurses in hospitals in New York,3 and in Mecca Saudi
Comprising the largest number of healthcare workers, nurses play Arabia4 are indicating that nurses not fully prepared to handle dis-
a crucial role in reducing the impact of a disaster. The objective of aster. It was also found that Indonesian nurses’ preparedness level
this review is to identify the factors that influence nurses’ ability is still low.5,6 This low level of preparedness causes a lack of abil-
during a disaster emergency response to provide adequate care. ity and confidence when nurses must act during disasters.7 It is
This research was conducted by doing a literature search from the necessary to identify the factors that influence nurses’ services
during a disaster emergency response in relation to providing ade-
Pro-Quest and Science-Direct databases using the PRISMA-ScR
quate services so that a program to improve the ability of nurses
to screen the articles. The final results included 13 articles. An
can be developed by considering the factors identified. Therefore,
analysis was performed to identify themes in line with the purpose
a literature review was conducted to find studies related to the fac-
of the review. All factors affecting nurses’ ability to respond to a
tors affecting nurses’ performance in responding to a disaster
disaster situation were classified into three themes: 1) factors
emergency.
increasing nurses’ ability, 2) barriers to delivering effective nurs-
The aim of this study was to review information through a lit-
ing care, and 3) support needed to maintain the nurses’ ability.
erature review to identify the factors that influence nurses’ ability
During an emergency situation due to a disaster, adequate knowl-
during a disaster emergency response to provide adequate care
edge and skill to save lives, treat injuries, manage stress and coor-
after a disaster occurs.
dinate between teams are the basic competencies needed for opti-
mal care. Nurses’ clinical experience or previous disaster experi-
ence and training could increase nurses’ adaptability in disaster
conditions. Support from nurses’ workplace and proper implemen-
Design and Methods
tation of disaster management policy enhance nurses’ services and
prevent barrier under disaster condition. The results emphasize A literature review was conducted to analyze previous
that future training should aim for improving nurses’ knowledge research publications. The search was carried out using the
and skills, including the knowledge of nurses’ family to protect ProQuest and Science-Direct databases with the following key-
themselves and deal with disasters. Such knowledge increased words: nurse OR nurses AND preparedness AND disaster
family preparedness, which is an important factor to enhance nurs- response AND emergency response. This search process was con-
es’ willingness to work following a disaster. ducted by the first author, and then the third author re-checked the
information found during the screening process.
The inclusion criteria were full-text, peer-reviewed studies in
the English language, including studies with various designs, such
as quantitative, qualitative, and mixed-method studies. The arti-
Introduction cles were published from January 2010 to March 2020. Full access
In addition to causing death, trauma, and damage, disasters to the file was provided, and the keywords are mentioned in the
can lead to psychological, social, and spiritual distress, which can titles or abstracts. The exclusion criteria were articles that do not
have long-term effects, potentially leading to post-traumatic stress discuss nurses and articles that are not accessible. To enhance the
disorder (PTSD).1,2 Nurses need to be prepared to overcome the quality of this literature review manuscript, the Preferred
complexity of health problems caused by a disaster. They are Reporting Items for Systematic Reviews and Meta-Analyses
required to possess the proper competences to reduce trauma due Extension for Scoping Reviews (PRISMA-ScR) checklist was
to the physical, psychological, and social distress suffered by the used as the reporting guideline.8 The search using the keywords

Significance for public health

This review provides an overview of the factors affecting nurses’ performance in responding to a disaster. This information is important to related parties in
making necessary plans and actions so that nurses, who comprise the majority of the healthcare workforce, can deliver safe, effective, and efficient health serv-
ices to the public during disasters.

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produced 132 articles. All articles were then checked for duplica- the literature that may be analyzed. The final articles were ana-
tion, which resulted in 34 articles. The search continued by check- lyzed to identify the major findings from each article, which were
ing the abstracts, and 68 articles were excluded. All articles found the factors affecting nurses’ ability to respond to a disaster. All
(n=18) were then checked by the relevancy of the content, and the findings then were classified into themes in accordance with the
final result of the search produced 13 articles (Figure 1). factors increasing nurses’ ability, the barriers, and the support
The data from the articles were charted manually using Excel, needed to deliver optimal services during the response to a disaster.
including their general characteristics: author/year/country, aims,
research design, sample/type/size, major findings, and the implica-
tions of the relevant studies, such as factors supporting a disaster
response and potential barriers. The extraction was carried out
using the Mixed Methods Appraisal Tool (MMAT).9 The aim of
Results
the screening using the MMAT was to determine whether the liter- This study includes four articles using quantitative methods,
ature obtained in the previous stage was adequate to be included in five articles using qualitative methods, one article using mixed-

Figure 1. PRISMA flow diagram for included articles.

Table 1. Characteristics of the included articles.

Quantitative Qualitative Mix methods
4 articles 5 articles 1 article
Sample Countries Samples Countries Samples Countries
132 hospital nurses KSA 10 hospital nurses Southeastern US 16 hospital nurses New York
384 hospital nurses Iran 12 hospital nurses Chine 528 hospital nurses
852 healthcare workers Israeli 11 hospital nurses New Zealand
311 hospital nurses Taiwan 11 hospital nurses and Bantul Indonesia
11 midwives
13 hospital nurses Australia,
Indonesian, Israel, Kapan,
Kenya, Palestine,
Saudi Arabia, and US

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Table 2. Factors supporting nurses’ ability in disaster responses and potential barriers.

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Table 2. Factors supporting nurses’ ability in disaster responses and potential barriers.

[Journal of Public Health Research 2022; 11:2732] [page 39]

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Table 2. Factors supporting nurses’ ability in disaster responses and potential barriers.

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Table 2. Factors supporting nurses’ ability in disaster responses and potential barriers.

[Journal of Public Health Research 2022; 11:2732] [page 41]

Review

methods, and three articles using a literature review. The respon- Nurses’ self-preparedness
dents were from several countries, including China, Taiwan,
Nurses’ self-preparedness includes the ability to prepare them-
Australia, Indonesia, Israel, Iran, Kapan, Kenya, Palestine, Saudi
selves and their families for self-rescue and managing limitations
Arabia, and the US. The quantitative and mixed-methods studies
in disasters. Nurses’ self-preparedness is crucial because it
had 2,171 respondents, while the qualitative studies had 73 partic-
ipants. From these articles, three articles used a literature review, strengthens nurses’ self-confidence and commitment. These
including a total of 84 articles. In the quantitative and qualitative aspects induce a willingness to respond in a disaster.12–15 Another
articles, all samples met the criteria: 1) nurses involved in a disas- factor was nurses’ personal traits.16–18 Certain traits, such as adapt-
ter emergency response or disaster response from an earthquake, ability and flexibility, are important because these traits increase
storm and flood, forest fire, or mass riots, and 2) nurses working in nurses’ adaptability in chaotic situations and when experiencing a
a hospital or in community services. There were only two articles high level of stress.
that involved other healthcare professionals (doctor and midwife)
as their respondents. Table 1 presents the characteristics of the Nurses’ experience
included articles. Nurses’ experience in clinical aspects is considered a factor
Most of the articles (n=5) identify nurses’ competencies in that can improve the effectiveness of the response to
both knowledge and skills during a disaster response. Three arti-
disasters.16One article mentioned that nursing experience of ≥10
cles that identify nurses’ readiness and willingness to response a
years, emergency/intensive nursing care experience, ability to
disaster, four articles that discuss the effects of disasters on nurses,
function in the clinical management domain, and disaster response
and one article focusing on the factors predicting nurses’ attitudes
during a disaster response. The instrument used in the quantitative experience improve nurses’ ability to respond to a disaster.19
research articles was generally a questionnaire that had been mod-
ified by the researcher, while the qualitative studies involved in-
Barriers in providing nursing care
depth interviews. Barriers make it difficult to provide effective nursing care. It
All 13 articles analyze the factors affecting nurses’ abilities, was reported that concerns about their own and their family’s safe-
the supporting factors, and the barriers involved when responding ty, stress and anxiety, and limited equipment and human resources
to disaster situations (Table 2). are considered factors that decrease the effectiveness of the health-
All articles identified the importance of knowledge and skills care system in responding to a disaster.14,18,20
for nurses to provide optimal services when disasters occur. Hence,
knowledge level is a strong predictor of nurses’ ability to work Supports to maintain the nurses’ ability
effectively in disaster responses.10 The required knowledge and
Support from nurses’ working institutions and governments
skills for disaster-trauma treatment consist of post-disaster trauma
were identified as important external influencing factors. The
treatment, post-disaster psychological treatment, and disaster man-
agement and leadership (Table 3). Nurses’ knowledge should be implementation of a disaster policy, the provision of tools,
increased by implementing continuing training in hospitals resources, and funds, and inter-collaborative practice training help
because their experience in clinical aspects would improve the nurses provide good health services during a disaster.10,21 Other
effectiveness of their response to disasters. It is identified that par- support needed includes psychological health services for nurses
ticipating in disaster’s training and drilling is a very strong positive after working in a disaster situation to help them recover from trau-
correlation that would increase nurses’ ability.11 ma.15-22

Table 3. List of knowledge and skills of earthquake emergency response.

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Discussion Correspondence: Elly Nurachmah, Department of Medical-Surgical

During a disaster, priority actions are emergency assessments, Nursing, Universitas Indonesia, Jl. Prof. Dr. Bahder Djohan, Kampus
UI Depok, West Java 16424, Indonesia.
saving lives, and caring victims, which is comprised of disaster
Tel.: +62.21.78849120 - Fax. +62.21.7864124.
triage, emergency first aid, evacuation, transportation for victims, E-mail: [email protected]
and treatment of mental and psychosocial disorders for those
affected, also. Other actions needed is coordination to manage a Key words: Nurse, Preparedness, Disaster, Emergency response,
healthcare post as the center of prehospital health crisis manage- Nurse’s ability.
ment.23,24 Communication skills and the ability to make rapid deci-
sions concerning the disaster situation is important to act as a lead- Contributions: AK: data extraction. EN and FL: checking and criti-
er in a crisis.25 Training is a significant aspect in preparing nurses. cally reviewing the data. DG: re-checking the information found dur-
Duration of work does not influence nurses’ preparedness levels; ing the screening process
however, if it is combined with disaster training and drilling, it
Conflict of interest: The authors declare no potential conflict of interest.
could significantly correlate with disaster preparedness. Therefore,
regular training and drilling with a method similar to disaster con-
Funding: This work is supported by PUTI Doktor 2020 funded by
ditions should be practiced more frequently.13,26 Directorate of Research and Development Universitas Indonesia No.
Self-preparedness is critical for nurses. Previous studies show NKB-3209/UN2.RST/HKP.05.00/2020.
that a better preparedness score can be obtained by nurses who
have previous training and disaster response experience, have good Ethical approval: Not applicable.
self-confidence, and are supported by their working institutions.27
It was also mentioned that good self and family preparedness, such Availability of data and materials: All data are included in this pub-
as planning to manage children, families, and pets when disasters lished article.
occur, increases the willingness to work in disaster.3,12,28,29
Patient consent for publication: Not applicable.
Another study showed that more than half of respondents reported
not having personal planning for dealing with disasters, and this
Informed consent: Not applicable.
group showed a low willingness to work during disasters.30
Factors affecting health services in earthquake areas include Conference presentation: This final manuscript has been presented
support from workplace institutions, opportunities for training, at 7th Virtual Biennial International Nursing Conference, Faculty of
provision of logistics, infrastructure for disasters, and financial Nursing, Universitas Indonesia on September 24thh, October 30th,
support as external factors, while nurses’ competencies and self- November 16th 2020.
preparedness are internal factors that affect nurses’ ability to man-
age a disaster.31 The identification of these two factors helped to Received for publication: 1 August 2021.
develop strategies to support nurses during a disaster. There is spe- Accepted for publication: 28 October 2021.
cial emphasis on future training to enhance the employees’ sense ©Copyright: the Author(s), 2021
of efficacy and professional commitment and to address the Licensee PAGEPress, Italy
increasing concern regarding family preparation and well-being Journal of Public Health Research 2022;11:2732
following an earthquake. Hence, organizations should also provide doi:10.4081/jphr.2021.2732
disaster standards of care and psychology support programs that This work is licensed under a Creative Commons Attribution
influence nurses’ willingness to respond. NonCommercial 4.0 License (CC BY-NC 4.0).

Conclusions
References
Although a careful approach has been used, the search only
1 Hammad KS, Arbon P, Gebbie K, Hutton A. Why a disaster is
included electronic scientific databases accessible to the authors’
not just normal business ramped up: disaster response among
institution, and only articles published in English were included.
ED nurses. Australas Emerg Care 2018;21:36–41.
The populations, contexts, and concepts of the literature are fea-
tures of their methodologies rather than their quality. The review 2 Park HY, Kim JS. Factors influencing disaster nursing core
may not be fully comprehensive as it only covers studies between competencies of emergency nurses. Appl Nurs Res 2017;37:1–
2010 and 2020 and does not cover policy papers or guidelines. 5.
The competencies of disaster response include not only the 3 Baack S, Alfred D. Nurses’ preparedness and perceived com-
ability to care for patients during a disaster, which can induce petence in managing disasters. J Nurs Scholarsh 2013;45:281–
physical and psychological trauma, but also to coordinate and 7.
manage health posts during a disaster. Concerns regarding nurses’ 4 Alzahrani F, Kyratsis Y. Emergency nurse disaster prepared-
personal safety and the safety of their families are also factors that ness during mass gatherings: a cross-sectional survey of emer-
affect nurses’ readiness. It is emphasized that future education and gency nurses’ perceptions in hospitals in Mecca, Saudi Arabia.
training must include methods that can simulate disaster conditions BMJ Open 2017;7:e013563.
and increase family self-rescue. Support from nurses’ workplaces 5 Martono M, Satino S, Nursalam N, et al. Indonesian nurses’
in their clinical and disaster continuing education as well as a psy- perception of disaster management preparedness. Chin J
chological support program would enhance the effectiveness of Traumatol 2019;22:41–6.
nursing care. 6 Rizqillah AF, Suna J. Indonesian emergency nurses’ prepared-
ness to respond to disaster: a descriptive survey. Australas

[Journal of Public Health Research 2022; 11:2732] [page 43]

Review

Emerg Care 2018;21:64–8. Zealand. Prehosp Disaster Med 2016;31:10–6.

7 Nash TJ. Unveiling the truth about nurses’ personal prepared- 19 Tzeng WC, Feng HP, Cheng WT, et al. Readiness of hospital
ness for disaster response: a pilot study. Medsurg Nurs nurses for disaster responses in Taiwan: a cross-sectional
2015;24:425–31. study. Nurse Educ Today 2016;47:37–42.
8 Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for 20 Veenema TG, Lavin RP, Bender A, et al. National nurse readi-
scoping reviews (PRISMA-ScR): checklist and explanation. ness for radiation emergencies and nuclear events: a systematic
Ann Intern Med 2018;169:467–73. review of the literature. Nurs Outlook 2019;67:54–88.
9 Hong Q, Pluye P, Fàbregues S, et al. Mixed methods appraisal 21 Hammad KS, Arbon P, Gebbie K, Hutton A. Moments of dis-
tool (MMAT) version 2018: user guide. Montreal: McGill aster response in the emergency department (ED). Australas
University; 2018. Available from: http://mixedmethodsap- Emerg Nurs J 2017;20:181–5.
praisaltoolpublic.pbworks.com/w/file/fetch/127916259/MMA 22 Said NB, Chiang VCL. The knowledge, skill competencies,
T_2018_criteria-manual_2018-08-01_ENG.pdf and psychological preparedness of nurses for disasters: a sys-
10 Maleki L, Moghadamnia MT, Porshikhian M, Kazemnejad E. tematic review. Int Emerg Nurs 2020;48:100806.
Evaluation of the factors predicting nurses’ attitude to phase of 23 Bahrami M, Aliakbari F, Aein F. Iranian nurses’ perception of
preparedness to respond to disasters. Rev Latinoama Hipertens essential competences in disaster response: a qualitative study.
2018;13:538–43. J Educ Health Promot 2014;3:81.
11. Al Thobaity A, Williams B, Plummer V. A new scale for disas- 24 Wynd C, Lee C-L, Chiang L-C, et al. What was the role of
ter nursing core competencies: development and psychometric nurses during the 2011 great east earthquake of Japan? An inte-
testing. Australas Emerg Nurs J 2016;19:11-9. grative review of the Japanese literature. Prehosp Disaster Med
12 Shapira S, Friger M, Bar-Dayan Y, Aharonson-Daniel L. 2014;29:275–9.
Healthcare workers’ willingness to respond following a disas- 25 Ayuba SB, Danjuma A, Nassa YG, et al. Role of the nurse in
ter: a novel statistical approach toward data analysis. BMC emergency preparedness: a survey of secondary health facili-
Med Educ 2019;19:130. ties in Northern, Nigeria. World J Prev Med. 2015;3:54–60.
13 Al Thobaity A, Plummer V, Williams B. What are the most 26 Ahayalimudin NA, Osman NNS. Disaster management: emer-
common domains of the core competencies of disaster nurs- gency nursing and medical personnel’s knowledge, attitude
ing? A scoping review. Int Emerg Nurs 2017;31:64–71. and practices of the East Coast region hospitals of Malaysia.
14 Sugino M, Hapsari ED, Madyaningrum E, et al. Issues raised Australas Emerg Nurs J 2016;19:203–9.
by nurses and midwives in a post-disaster Bantul community. 27 Lim GH, Lim BL, Vasu A. Survey of factors affecting health
Disaster Prev Manag 2014;23:420–36. care workers’ perception towards institutional and individual
15 Raveis VH, VanDevanter N, Kovner CT, Gershon R. Enabling disaster preparedness. Prehosp Disaster Med 2013;28:353–8.
a disaster-resilient workforce: attending to individual stress 28 Nakayama Y, Kato I, Ohkawa T. Sustaining power of nurses in
and collective trauma. J Nurs Scholarsh 2017;49:653–60. a damaged hospital during the great East Japan earthquake. J
16 Shipman SJ, Stanton MP, Tomlinson S, et al. Qualitative anal- Nurs Scholarsh 2019;51:271–80.
ysis of the lived experience of first-time nurse responders in 29 Melnikov S, Itzhaki M, Kagan I. Israeli nurses’ intention to
disaster. J Contin Educ Nurs 2016;47:61–71. report for work in an emergency or disaster. J Nurs Scholarsh
17 Wenji Z, Turale S, Stone TE, Petrini MA. Chinese nurses’ 2014;46:134–42.
relief experiences following two earthquakes: implications for 30 Al Khalaileh MA, Bond E, Alasad JA. Jordanian nurses’ per-
disaster education and policy development. Nurse Educ Prac. ceptions of their preparedness for disaster management. Int
2015;15:75–81. Emerg Nurs 2012;20:14–23.
18 Johal SS, Mounsey Z, Brannelly P, Johnston DM. Nurse per- 31 Veenema TG, Griffin A, Gable AR, et al. Nurses as leaders in
spectives on the practical, emotional, and professional impacts disaster preparedness and response-a call to action. J Nurs
of living and working in post-earthquake Canterbury, New Scholarsh 2016;48:187–200

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