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ORIGINAL RESEARCH

Determinants of Nurse Preparedness in Disaster

Management: A Cross-Sectional Study Among the
Community Health Nurses in Coastal Areas

Etika Emaliyawati 1,2 Purpose: Because Indonesia has a high risk of natural disasters, nurse preparedness is
Kusman Ibrahim 3 necessary to reduce and prevent deaths in the aftermath of such disasters. The aim of this
Yanny Trisyani 1 study was to determine the factors associated with nurse preparedness in disaster manage­
Ristina Mirwanti 1 ment among a sample of community health nurses in coastal areas.
Patients and Methods: A cross-sectional study was undertaken from May to August 2020.
Fitri Muthiara Ilhami 4
The sample consisted of 142 nurses who worked at six Public Health Centers in
Hidayat Arifin 3
Pangandaran, West Java, Indonesia. Participants were recruited using the total sampling
1
Department of Critical Care and technique. The data were collected using the Emergency Preparedness Information
Emergency Nursing, Faculty of Nursing,
Universitas Padjadjaran, Bandung, Questionnaire and analyzed using Chi-Square and binary logistic regression.
Indonesia; 2Doctoral Study Program, Results: Of the 142 respondents, 54.24% had a high level of preparedness. Multivariate
Faculty of Medicine, Universitas analysis showed that nurses with higher levels of preparedness had worked between 6 and 10
Padjadjaran, Bandung, Indonesia;
3
Department of Medical-Surgical Nursing, years (adjusted odds ratio (AOR): 12.755, 95% confidence interval (CI): 2.653–61.314).
Faculty of Nursing, Universitas Respondents who lacked disaster training were less likely to have a high level of disaster
Padjadjaran, Bandung, Indonesia; 4Under-
preparedness (AOR: 4.631, 95% CI: 1.604–13.367). Respondents who had never served as
Graduate Program, Faculty of Nursing,
Universitas Padjadjaran, Bandung, disaster volunteers were also less likely to have disaster preparedness (AOR: 0.18, 95% CI:
Indonesia 0.053–0.616).
Conclusion: With nearly half of the respondents (45.77%) having a low level of disaster
preparedness, this topic needs more attention from the government and healthcare workers.
Several actions are needed to improve community nurses’ disaster preparedness: providing
them with routine disaster-related training, encouraging them to serve as volunteers in
various disaster conditions, and offering them useful disaster-related information.
Keywords: nurses, disaster, disaster management, coastal area, preparedness

Introduction
The trend of disaster events in Indonesia continues. The National Agency for
Disaster Management Indonesia recorded an increase in the incidence of disasters
from August 2018 to August 2019 of around 7.3%. From January to August 2019,
the average number of people affected by a disaster was 2.5% of the population.1 In
the West Java province of Indonesia, the Pangandaran Regency ranks sixth in
Correspondence: Etika Emaliyawati
Department of Critical Care and
earthquake and tsunamis risk. These types of disasters result in injuries, missing
Emergency Nursing, Faculty of Nursing, people, deaths, displaced families, and economic problems.2 Frequent disasters
Universitas Padjadjaran, Bandung, 45363,
Indonesia require disaster management efforts that involve all possible parties, including
Tel +62 817-222-086 nurses. Because nurses are the largest and most important group of healthcare
Fax +62 22 7795596
Email [email protected] providers in disaster management, their competencies need to be continually

Open Access Emergency Medicine 2021:13 373–379 373

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 Emaliyawati et al Dovepress

assessed and improved.3–5 Given these facts, disaster man­ preparedness among community health nurses in coastal
agement preparedness remains a strong area of concern for areas.
nurses in disaster-prone areas.
Disaster management preparedness is a very important Patients and Methods
professional skill for nurses, as nurses with a strong sense
Study Design
of readiness can provide assistance to disaster victims.6
A cross-sectional design was used for this study.
Furthermore, nurses can perform comprehensive relief
management services, such as mapping the disaster loca­
tion, providing disaster mitigation, triaging patients, and Setting and Sample
organizing first aid involving cross-sector collaboration The study was conducted from May to August 2020 in six
and interdisciplinary professional teams.7–9 Nurse prepa­ PHCs in the coastal areas of Pangandaran, West Java,
redness can be measured using the following eight dimen­ Indonesia. The sample consisted of 142 community health
sions: triage and basic first aid; detection; accessing nurses who were recruited using the total sampling tech­
critical resources and reporting; the incident command nique. The inclusion criteria were community health
system (ICS); isolation, quarantine, and decontamination; nurses with a minimum of a diploma in nursing education
psychological issues; epidemiology and clinical decision- who were employed at one of the PHCs in the coastal
making; and communication and connectivity.10 Another areas and had worked for a minimum of three months. The
recent study reported that nurses with emergency prepa­ exclusion criteria were community health nurses who were
redness competencies are more likely to have profes­ on leave, too busy with their duties to participate in the
sional competence in disaster responses, maintain study, or were not able to complete the study. The data
personal disaster preparedness, and report to work after were collected using questionnaires.
a disaster.11
One of the roles of community public health centers Variables
(PHCs) is to minimize the effects of disasters on the The independent variables were age, education level, gen­
population. Despite nurses being primarily responsible der, number of years working as a nurse (referred to as
for most (72.97%) PHC disaster programs, previous work history), disaster training, disaster preparedness
study results indicated that 50% of PHC nurses had low knowledge sources, disaster volunteering, and disaster
disaster preparedness.12 Furthermore, nurses’ service cap­ management experience. The age variable was divided
abilities for treating disaster victims at PHCs were limited into four categories: 21–25 years, 26–35 years, 36–45
to caring for victims flagged as green during triage years, and >45 years. Nursing education level was divided
(84.21%).13 into three categories: diploma, Bachelor’s degree, and
Another study showed that high levels of readiness in professional nursing education. Respondent gender was
nurses serving in disasters are related to nurse age, classified as either male or female. Work history was
experience,14 knowledge,15 responsibilities,16 support divided into four categories: ≤1 year, 2–5 years, 6–10
from the government,17 and training.18 In addition, the years, and >10 years. Responses about disaster training
average level of nurse preparation to respond to disaster were divided into one of two categories: yes (having any
conditions was low. Results from several other studies level of training) or no (having no training). Preparedness
indicated that many nurses did not know the tasks required knowledge sources were classified into the following cate­
during disaster or post-disaster conditions.19–22 Providing gories: lectures, seminars, training, simulations, participa­
nurses with disaster management training will increase tion, and other methods. Disaster volunteering history was
their ability to handle disaster conditions. Other factors classified as either yes (have served as a volunteer) or no
that can affect nurse preparedness include work experi­ (have never served as a volunteer). Finally, disaster man­
ence, length of time spent preparing to face disasters, agement was classified into ever (having provided disaster
disaster volunteer experience, and access to information management services) or never (having provided these
sources. Unfortunately, there is a lack of studies about the services).
disaster preparedness of nurses working in disaster-prone The Emergency Preparedness Information
coastal areas of Indonesia. Therefore, this study aimed to Questionnaire (EPIQ) was used in this study to determine
determine the factors associated with disaster management the dependent variable, preparedness level.23 The EPIQ

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 Dovepress Emaliyawati et al

assesses eight dimensions of preparedness: triage and (X2: 5.459; p < 0.05) all had a significant correlation with
basic first aid; detection; accessing critical resources and nurse preparedness. In contrast, age, education level, and
reporting; the ICS; isolation, quarantine, and decontamina­ gender were not correlated with preparedness (Table 1).
tion; psychological issues; epidemiology and clinical deci­ Multivariate analysis using binary logistic regression
sion-making; and communication and connectivity. The showed that nurses with a work history spanning 6–10
nurse preparedness variable was divided into two cate­ years were 12.755 times more likely to have a high level
gories: Low (if the value was less than the mean) or of preparedness than those with a work history of ≤1 year
High (if the value was greater than the mean). Each (AOR: 12.755; 95% CI: 2.653–61.314). Interestingly,
category was coded as Low = 0 and High = 1. The nurses with no disaster training history were 4.631 times
Cronbach’s alpha result was 0.951. more likely to have a high level of preparedness than were
those with such training (AOR: 4.631; 95% CI: 1.604–
Data Analysis 13.367). Finally, respondents who had never served as dis­
To manage and analyze the data, we used STATA/MP aster volunteers were 0.18 times less likely to have a high
version 16.1 (Mac). Chi-Square and Binary Logistic level of preparedness than were those who had served as
Regression were used to analyze the factors associated volunteers (AOR: 0.18; 95% CI: 0.053–0.616; Table 2).
with nurse disaster management preparedness among the
sample of community health nurses from the coastal areas. Discussion
The significance value was p < 0.05, and the adjusted odds It is important to consider the disaster preparedness of
ratio (AOR) had a 95% confidence interval (CI). nurses working in coastal areas that face disasters more
frequently than non-coastal areas. The results of this study
Ethical Considerations indicated that almost half of the nurses surveyed had a low
We received approval from the Health Ethics Commission level of disaster preparedness. This finding is consistent
of Universitas Padjadjaran (439/UN6.KEP/EC/2020) on with study results showing low to moderate readiness
April 30, 2020. Respondents were informed about the among nurses in Cambodia, China, Laos, Nepal, and the
study objectives and provided informed consent and this Solomon Islands.24 Likewise, in the Philippines, three-
study was conducted in accordance with the Declaration of quarters of nurses (80%) stated that they were not fully
Helsinki. Participation was voluntary, and the study did prepared to work during a disaster.25
not have the potential to harm the participants physically In this study, we found that three factors were signifi­
or mentally. cantly correlated with preparedness among the nurses:
work history, disaster training history, and service as
Results a disaster volunteer. Disaster nurses are defined as nurses
The demographic data showed that more than half the who have the expertise to help victims by minimizing life-
participants (54.23%) had a high level of disaster prepa­ threatening health risks.26 Given this definition, we can
redness and 45.77% had a low level of preparedness. One- surmise that nurses are expected to be able to adapt to their
third of the respondents were 26–35 years of age. environment and disaster conditions.23
Regarding education, 50% had either a diploma or profes­ The results of this study showed that work history had
sional nursing education and most had worked for more a significant relationship with disaster preparedness. This
than 10 years. A majority of respondents had attended finding is likely due to the fact that these nurses gained
disaster training, served as a disaster volunteer, and gained a great deal of disaster management information and
knowledge about disasters while attending lectures. Apart knowledge from working and living in a coastal area.
from that, many respondents had never provided disaster The ideal work history is in the range of 6–10 years,
management services. a period when nurses are still active and enthusiastic at
The bivariate analysis conducted using Chi-Square work and have good cognitive abilities. This finding is in
showed that the variables of work history (X2: 13.784; line with that of a previous study showing that nurses with
p < 0.01), disaster training (X2: 16.986; p < 0.01), knowl­ the ideal length of work history can have increased pro­
edge sources (X2: 13.972; p < 0.05), disaster volunteering ductivity, performance, and ability in providing care.27–30
(X2: 9.574; p < 0.01), and disaster management experience However, it should be noted that nurses who have worked

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Table 1 Respondents’ Characteristics and Bivariate Analysis of Nurse Preparedness in Disaster Management Among the Community
Health Nurses in the Coastal Areas (n=142)
Variable n % Nurse Preparedness X2 p

Low High

n % n %

Age
21–25 years old 31 21.83 14 9.86 17 11.97 0.962 0.810
26–35 years old 53 37.32 25 17.61 28 19.72
36–45 years old 41 28.87 20 14.08 21 14.79
>45 years old 17 11.97 6 4.23 11 7.75

Education level
Diploma in nursing 65 45.77 27 19.01 38 26.76 2.148 0.342
Bachelor’s in nursing 14 9.86 5 3.52 9 6.34
Professional nursing 63 44.37 33 23.24 30 21.13

Gender
Male 51 35.92 21 14.79 30 21.13 0.677 0.410
Female 91 64.08 44 30.99 47 33.10

Length of working
≤ 1 year 19 13.38 16 11.27 3 2.11 13.784*** 0.003
2–5 years 40 28.17 15 10.56 25 17.61
6–10 years 31 21.83 11 7.75 20 14.08
>10 years 52 36.62 23 16.20 29 20.42

Disaster training
Yes 95 66.90 55 38.73 40 28.17 16.986*** 0.000
No 47 33.10 10 7.04 37 26.06

Source of knowledge
Lectures 54 38.03 25 17.61 29 20.42 13.972** 0.016
Seminars 35 24.65 14 9.86 21 14.79
Training 4 2.82 3 2.11 1 0.70
Simulations 32 22.54 17 11.97 15 10.56
Participation 9 6.34 6 4.23 3 2.11
Other 8 5.63 0 0 8 5.63

Disaster volunteering
Yes 105 73.94 40 28.17 65 45.77 9.574*** 0.002
No 37 26.06 25 17.61 12 8.45

Ever done disaster management

Ever 51 35.92 30 21.13 21 14.79 5.459** 0.019
Never 91 64.08 35 24.65 56 39.44

Notes: ***p<0.001; **p<0.05.

Abbreviation: X2, Chi-Square.

for a long time with a heavy workload can experience effective enough to improve nurses’ disaster preparedness.
decreased productivity due to boredom and burnout when This finding is consistent with previous studies indicating
working as a disaster nurse.31,32 that a training approach that uses easy-to-understand meth­
One surprising finding of this study was that nurses ods is likely to be more effective.33,34 Based on this find­
who had not participated in disaster training had a greater ing, it is important that future research be conducted to
likelihood of having a higher level of disaster preparedness evaluate common disaster training methods. Our respon­
than those who had engaged in such training. This result dents indicated that most of their knowledge came from
may be due to the fact that the provided training was not lectures, seminars, and simulations.

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 Dovepress Emaliyawati et al

Table 2 Multivariate Analysis of Nurse Preparedness in Disaster levels—efforts that address the salient factors are needed to
Management Among the Community Health Nurses in Coastal increase the disaster preparedness among nurses in coastal
Areas (n=142)
areas. For example, nurses’ history of work experience, disas­
Variable AOR p 95% CI ter training, and volunteering can serve as the basis for further
Lower Upper policy formation to address this crucial issue. However,
because this research was limited to specific areas in the
Length of working
Pangandaran Regency, future research covering more areas is
≤ 1 year Ref.
2–5 years 9.313*** 0.003 2.144 40.452 needed to further explicate the factors that affect nurses’ dis­
6–10 years 12.755*** 0.001 2.653 61.314 aster preparedness in coastal areas.
>10 years 9.403*** 0.006 1.888 46.836

Disaster training Conclusion

Yes Ref. Almost half of the study participants had low levels of
No 4.631*** 0.005 1.604 13.367 disaster preparedness. This finding requires serious atten­
Sources of knowledge tion, as the research was conducted in a disaster-prone
Lectures Ref. location. Strengthening the cooperation from the govern­
Seminars 2.328 0.151 0.735 7.376 ment and PHCs to increase nurses’ capacity to work dur­
Training 0.273 0.349 0.018 4.137
ing disasters—through training and opportunities to
Simulations 1.229 0.714 0.408 3.696
volunteer in disaster conditions—are necessary to improve
Participation 2.028 0.455 0.318 12.947
Other 1 – – – the ability of nurses to work during disasters. We suggest
two specific methods for addressing this issue: offering
Disaster volunteering
nurses routine disaster-related training that involves them
Yes Ref.
No 0.18*** 0.006 0.053 0.616 working as volunteers in various disaster conditions, and
providing effective disaster-related information through
Ever done disaster
seminars, flyers, and other media.
management
Ever Ref.
Never 0.965 0.953 0.291 3.198 Funding
Note: ***p<0.001. The study was funded by Universitas Padjadjaran with the
Abbreviation: CI, confidence Interval.
Doctoral Dissertation Research Program scheme number
1427/UN6.3.1/LT/2020.
From these findings, we learned that nurses who have
never volunteered during disaster conditions have a lower Disclosure
level of disaster preparedness. Conversely, nurses with The authors report no conflicts of interest in this work.
volunteer experience have a higher level of self-confidence
in dealing with disasters. These results are similar to those of References
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