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Australasian Emergency Nursing Journal (2015) xxx, xxx—xxx

Available online at www.sciencedirect.com

ScienceDirect journal homepage: www.elsevier.com/locate/aenj

RESEARCH PAPER

Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia Abdulellah Al Thobaity, RN, MN a,b Virginia Plummer, RN, PhD a,c,∗ Kelli Innes, RN, MN (Emergency) a,c Beverley Copnell, RN, PhD a a

Monash University, Australia Taif University, Saudi Arabia c Member CENA, Australia b

Received 2 October 2014; received in revised form 1 February 2015; accepted 13 March 2015

KEYWORDS Disaster; Nursing; Management; Saudi Arabia; Military; Knowledge



Summary Background: It is generally accepted that nurses have insufficient knowledge about disaster preparedness due to a lack of acceptance of core competencies and the absence of disaster preparedness in nursing curricula.1 This study explored nurses’ knowledge and sources of knowledge, and skills as they relate to disaster management in Saudi Arabia, where more than 4660 people have died, 32,000 people have been affected, and US$4.65 billion in damage has been caused by disaster since 1980.2 Methods: A quantitative, non-experimental, descriptive research design. Results: Nurses in Saudi Arabia have moderate knowledge concerning disaster preparedness. However, nurses in military hospitals possess more knowledge than those who work in government hospitals. The majority of nurses gained their knowledge and skills from disaster drills. Conclusions: Nurses need more education in all areas of disaster management, most importantly in their roles during response to disasters. Nurses perceive themselves as not well-prepared but they are willing to improve their skills in disaster preparedness if educational opportunities are provided. © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Corresponding author at: Monash University, PO Box 527, Frankston 3199, Australia. Tel.: +61 03 99044064; fax: +61 03 99044655. E-mail address: [email protected] (V. Plummer).

http://dx.doi.org/10.1016/j.aenj.2015.03.001 1574-6267/© 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

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What this paper adds? • This study is the first study of the perceptions of preparedness for disaster management (as opposed to disaster clinical skills) for nurses in Saudi Arabia. The level of preparedness was found to be moderate, with a high interest by nurses in furthering their education in this area. • In cities which are vulnerable for disaster in Saudi Arabia, the perception of preparedness by nurses working in military hospitals is higher than for those working in government hospitals. • The disaster management nursing educational needs and preferences have been identified for the first time.

What is known about the topic? • Nurses have insufficient knowledge about disaster preparedness. • There is an absence of disaster preparedness content in nursing curricula. • Nurses are not equipped with essential knowledge and skills for disaster management due to a lack of opportunity for education and training. • Nurses are interested in improving their disaster — preparedness knowledge.

Introduction The increase in the number of disasters of all types over the last 15 years has been accompanied by an increased focus on the work of responding health workers, both within countries and in international response.3 Awareness of, and preparedness for, disasters by both communities and healthcare workers are essential for the management of associated injury, death and loss of health service infrastructure. The field of disaster nursing is in an early stage of development. There is insufficient evidence on disaster upon which to base practice, together with a lack of qualified educators and a lack of formal education and training at the level of health organisations.12 In addition, it is not fully incorporated into nursing curricula.7 Consequently, it is important to develop disaster nursing, particularly disaster nursing management, to ensure that nurses practice with a high level of competence and clearly understand their roles and the roles of others in disaster. Due to differences in experience and qualifications, nurses hold disparate knowledge and skills in terms of disaster preparedness.13,14 However, these issues can be resolved through the identification of gaps in their expertise and the subsequent provision of further education and training to mitigate those deficits. To extend effective help to communities before, during and after the occurrence of a disaster, all nurses, including students, novice practitioners and experienced nurses, must possess high-level knowledge and proficiency in disaster nursing.15 Nurses play a critical role in managing disasters, as they account for the largest

professional group in the healthcare sector. Slepski and Littleton-Kearney16 argued that adequately prepared nurses were critical to confidently respond to and provide effective healthcare for victims of disaster. Nurses also play important roles in the planning, strategy, evaluation and policy development of disaster management. However, several studies have found that in many countries nurses are not fully prepared for their role in disasters.4—9 There is a growing awareness by governments, communities and healthcare agencies of the need to evaluate nurses’ roles in an organised response, especially the role of nurses in response to humanitarian disasters where populations need long-term on-going health support.2 In 2005, the World Health Organization (WHO)10 called on all countries to establish a clear plan to reduce the risks associated with disasters. In the same year, WHO identified strategies for disaster preparedness, including continuous assessment and monitoring, coordination, planning, implementation and building resilience. In particular, healthcare workers in hospitals and other medical organisations were required to possess sufficient information and skills regarding disaster management so they could assist in the event of mass casualties or damage to the facility itself. Areas that required particular attention with respect to creating guidelines were communication, response processes, chain of command, resource management, patient safety, transportation, triage and contamination.11 Disaster nursing in the Middle East is not reported often in the literature. Only a small number of studies were found that aimed to evaluate disaster management information, skills and preparedness. After the Bam earthquake in Iran, which killed more than 43,000 people, researchers investigated nurses’ experiences and skills in disaster management through semi-structured interviews of 13 Registered Nurses (RN).17 The findings were a lack of practical protocols, lack of effective teamwork at disaster sites and lack of education in disaster relief. Furthermore, there was a need to develop strategies for staff to manage catastrophic events. Recently, an integrative literature review was conducted to explore the issues of disaster nursing in Iran. This review revealed that: there is a lack of coordination between organisations that participate in disaster response; nurses are not equipped with the essential knowledge and skills for disaster management due to a lack of opportunity for education and training; finally, like many other countries, the education system of disaster nursing in Iran is not fully developed.18 Among Jordanian nurses, who share the same language, culture and religion, and a border with Saudi Arabia, a sample of 471 practitioners from five hospitals participated in a study to evaluate preparedness for disaster management.4 The study was conducted using the Disaster Preparedness Evaluation Tool (DPET) created by Tichy and Bond in 2007.4,8 The authors found variations in disaster preparedness ranging from moderate to low. The nurses had low knowledge and skills in terms of disaster planning and a low understanding of preparations for bioterrorism. However, the nurses recognised their limitations and were aware of the disaster risks in their communities. The authors found that more nurses acquired their skills from disaster drills than from any other situation. Nearly all of the participants wanted to increase their skills and knowledge in this area.

Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

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Perceptions of knowledge of disaster management In Saudi Arabia, more than 4660 people have died, 32,000 people have been affected, and US$4.65 billion in damage has been caused by disaster in the 35 years since 1980.2 The disasters of recent years have been more costly in both human and fiscal terms.19 For example, ‘‘Black Wednesday’’ was a tragic day for the city of Jeddah. On November 25, 2009, a heavy rainstorm struck affecting more than 25,000 people, and resulting in 125 deaths. The storm caused around US$3 billion damage. Flooding affected over 11,000 houses and damaged hospital laboratories and databases.21 Mental disorders among vulnerable populations, mainly in the elderly and children emerged20 as issue. Momani and Fadil20 concluded that due to poor emergency management and failure to identify risks and hazards prior to flooding events, the recovery period to search for missing bodies was too long. Taif is located between two major roads that connect Riyadh and the southern cities with Makah. Various disasters have occurred in this city, including major transport accidents and flooding. However, municipal officials in Taif have been criticised for their ill-preparedness and poor mitigation strategies and planning, including allowing construction of houses close to valleys that are at a high risk of flooding during heavy rains.22 In 2013 flooding resulted in property damage and the loss of over 20 lives.23 Approximately 640 people were rescued, and shelter was provided to more than 800 people.23 The regions around Tabuk, Jizan and Yemen experience the most seismic activity in Saudi Arabia. Tabuk was affected by a destructive quake in 1995. (Al-Amri, reported by Khan).24 Despite this, no precise data are available on the number of people who have died or been injured. In this type of disaster, environmental and earthquake researchers expect loss of life and property due to a predicted increase in the onset, scope and effect of earthquakes in this region.25 Nurses will have roles in disasters in a range of settings. These include in policy development, or in-hospital, prehospital, community, retrieval, transport and deployment to the scene as first responders.26,27 Nurses are on the frontline within the full breadth of health services and are critical to the health and wellbeing of the community.5,28,29 Since nurses’ are required to respond in a variety of ways to any type of disaster, a firm foundation of disaster preparedness is imperative. Such preparedness entails adequate information and awareness of the disaster plans of government, essential services and individual health organisations, as well as an understanding of international evidence-based practices. This raises the question of whether nurses in Saudi Arabia perceive themselves as being prepared to manage disasters in their region. Therefore, the aim of the study was to evaluate disaster knowledge among nurses in Saudi Arabia and to identify the sources of their knowledge and skills regarding disaster management.

Method Study design A quantitative, non-experimental, descriptive research design was selected for this study.

3

Setting The setting was six hospitals located in Jeddah, Taif and Tabuk.22—24 Three of the hospitals were operated by the military and the other three were government hospitals.

Sample and population The sample were RNs from emergency departments, critical care and surgical units holding a three-year diploma/degree in nursing. Inclusion criteria were a minimum one year of work experience (thus ensuring at least 12 months exposure to disaster drills and hospital based education programmes if offered), ability to read and write English and be aged at least 18 years of age. There was no upper age limit. The total population of nurses in Saudi Arabia is unknown; thus the sample size was calculated to be at least 384 participants with a 5% precision level, where the confidence level is 95%, and p = 0.05 will be at least 384 nurses.30

Data collection Data were collected from June 20, 2012 through September 1, 2012. Questionnaires (n = 600) were distributed to the nurses in English, the main language used in all Saudi Arabian hospitals. Nurses were invited to participate in this study as volunteers through announcements posted on bulletin boards throughout the hospitals. Participants were asked to return the completed anonymous questionnaires to dropboxes located near the sign-in areas in government hospitals or via the quality management departments in military hospitals. One hundred questionnaires were distributed at each of six hospitals to attain the identified sample size.

Instrument Data were collected using the Disaster Preparedness Evaluation Tool (DPET) with permission from its authors. Bond and Tichy developed the DPET in 2007 to evaluate the knowledge and skills of nursing practitioners in relation to disaster management preparedness.4,8 The DPET contains 56 items that measure the perceptions of nursing practitioners regarding preparedness for disaster management and eight demographic questions. A total of 45 items were rated on a Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Of these, 13 items relate to knowledge of disaster preparedness. An additional 11 items were closed- and open-ended questions relating to disaster preparedness and the sources of participants’ disaster management knowledge (e.g., undergraduate courses, in-service training and master’s degree courses). No modifications were made to the DPET for this investigation other than to add in an option for participants to check their hospital type. The language and terminology of the survey used by the original authors referred to a regular ‘RN’ or Registered Nurse and was not specifically framed for a Nurse Practitioner and therefore this instrument was easily transferrable for use in the settings in Saudi Arabia in its original form. In terms of reliability, the Cronbach’s alpha coefficient of knowledge items in the original tool in 2007 was 0.90. Additionally, the validity and

Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

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reliability of this tool was tested again in the Middle East by using a psychometric test; the result of Cronbach’s was 0.90.4

Data analysis Data were analysed using SPSS version 20. The mean and the standard deviation (SD) were calculated for each of the Likert scale questions. Perceived weak knowledge was defined as a mean between 1.00 and 2.99, perceived moderate knowledge was defined as a mean between 3.00 and 4.99, and perceived strong knowledge was defined as a mean between 5.00 and 6.00. This was applied for both individual items and overall score. Frequencies were calculated for demographic variables.

Ethical considerations Prior to collecting the survey data, a Human Ethics Certificate of Approval was obtained from Monash University’s Human Research Ethics Committee (Approval CF12/09442012000431). Before the study began, approval was also obtained from the all participating military (12532/24/9) and government hospitals (01-1-183507-77-2) in Saudi Arabia.

Results Demographics The sample in this study included 429 nurses from six Saudi hospitals (71.5% response rate). After a review 33 incomplete questionnaires were excluded, resulting in 396 (66%) completed questionnaires considered suitable for the study. Hospital group, gender, age, level of education and experiences of participants are presented in Table 1 by frequencies and percentages.

Table 1

Demographic data.

Group Military Government Total Gender Female Male Total Age 20—25 years 26—30 years 31—36 years More than 36 years Total Level of education Diploma Bachelor’s Master’s Total Experience 1—3 years 4—6 years 7—10 years 11—13 years More than 13 years Total

n

% of total n

180 216 396

45.45 54.55 100.0

364 32 396

91.92 8.08 100.0

91 144 57 104 396

22.8 36.4 14.5 26.3 100.0

126 261 9 396

31.8 65.9 2.3 100.0

118 99 54 50 75 396

29.8 25.0 13.6 12.6 18.9 100.0

relevant research and reading journal articles related to disaster preparedness (Table 2).

Disaster knowledge of participants

Differences in the knowledge of nurses in military and government hospitals

The frequency distributions and descriptive statistics for the responses to 13 items concerning the participants’ knowledge of disaster preparedness are presented in Table 2. The mean scores for each item were sorted in order of high to low. The overall mean score based on the 13 items was 4.16 as shown in Table 3, which tends towards the high end (i.e., towards ‘‘agree’’) of the six-point scale and implies that the level of knowledge is, on average, moderate, indicating that nurses need more preparation. Despite the fact that nurses in Saudi Arabia are moderately prepared for disasters, it is clear that they are willing to actively engage in educational activities such as drills, classes and seminars (Table 2). The findings of this study show that nurses in Saudi Arabia are willing to learn and to obtain more education in disaster preparedness. Items relating to disaster preparedness, planning and research, and finding resources for gaining disaster knowledge had the lowest ratings by participants. The highest levels of disagreement, implying the lowest levels of knowledge were for participating in disaster planning, finding

The military nurses clearly perceived themselves as more disaster-prepared than the government nurses (Table 3). On average, knowledge of military nurses appeared to be better. The results of an independent-sample t-test conducted to compare the knowledge scores for military nurses and government nurses are shown in Table 4. The magnitude of the differences in the means (mean difference = 0.50, 95% CI: 0.31—0.71) was moderate (Eta-squared = 0.06). The scores obtained by nurses at military hospitals for the 13 items were consistently greater than those nurses at government hospitals, which indicated positive mean differences. The highest differences, which were greater than 0.7, were for the five items shown in Table 6. These items include participating in an emergency plan, finding relevant research about disaster preparedness, having a contact list in their health community and knowing referral contacts in case of a disaster situation, reading journal articles related to disaster preparedness and participating in disaster drills. The statistical significance of these differences was examined by independent t-test as shown in Table 5.

Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

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Perceptions of knowledge of disaster management Table 2

5

Level of knowledge of disaster management.

13 items related to disaster knowledge

n

Mean

SD

I would be interested in educational classes on disaster preparedness that relate specifically to my community situation. I participate in disaster drills or exercises at my workplace (clinic, hospital, etc.) on a regular basis. I participate in one of the following educational activities on a regular basis: continuing education classes, seminars, or conferences dealing with disaster preparedness. In case of a disaster situation, I think that there is sufficient support from local officials at the county, region, or governance level. I know whom to contact (chain of command) in disaster situations in my community. I am aware of classes about disaster preparedness and management that are offered (for example, at my workplace, the university, or the community). I find that the research literature on disaster preparedness is understandable. Finding relevant information about disaster preparedness related to my community needs is an obstacle to my level of preparedness. 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. I find that the research literature on disaster preparedness and management is easily accessible. I read journal articles related to disaster preparedness. I know where to find relevant research or information related to disaster preparedness and management to fill in gaps in my knowledge. I have participated in emergency plan drafting and emergency planning for disaster situations in my community.

395

5.10

1.091

395

4.41

1.635

394

4.40

1.530

396

4.38

1.440

388 395

4.37 4.27

1.549 1.451

390 391

4.14 4.00

1.595 1.445

395

3.92

1.566

392

3.87

1.556

395 394

3.86 3.84

1.487 1.436

393

3.60

1.695

Sources of knowledge and skills

slight increase in knowledge was clear in those who acquired their knowledge and skills from continuing education.

Table 6 presents the most common sources through which participants acquired their knowledge and skills for disaster preparedness. The majority of participants (n = 280; 71%) perceived that they had acquired their knowledge and skills for disasters in drill situations. The second most important source for disaster management knowledge and skills acquisition (n = 148; 37.47%) was participation in continuing education courses. Nurses reported slightly more knowledge and skills in disaster management gained from their graduate courses than from their undergraduate courses. Of the participants, 115 (29%) indicated that they acquired their knowledge and skills from graduate courses, whereas only 108 (27%) indicated receiving their knowledge and skills in undergraduate courses. Finally, 113 participants (26%) indicated that their source of disaster knowledge and skills came from being involved in actual disasters. It is noteworthy that although most of the participants reported that their knowledge and skills were acquired through disaster drills, in comparing the mean of knowledge according to the identified sources, a

Table 3

Differences in level of disaster knowledge.

Group

Mean

n

SD

Minimum

Maximum

Military Government

4.44 3.94

163 205

0.96887 0.94574

1.00 1.00

6.00 6.00

Total

4.16

368

0.98723

1.00

6.00

Discussion The level of disaster preparedness among nurses in Saudi Arabia was revealed to be moderate. This finding indicated that Saudi Arabia nurses are inadequately prepared for disaster management. This is reflected in the literature, where multiple studies have found that nurses internationally are underprepared for dealing with disasters.4—9 This study clearly demonstrated that nurses in Saudi Arabia are interested in improving their knowledge regarding disaster preparedness. Their lack of preparedness may be a consequence of their low knowledge in this area and the lack of formal and/or informal education in curricula and hospitals. This finding is similar to those of other studies, in that the participants in other studies were also interested in improving their disaster-preparedness knowledge.31—33 Moreover, studies in Jordan4 and Indonesia34 have found similar results. These knowledge deficits may be due to limitations in education for disaster preparedness. Hammad et al.31 maintained that nurses in southern Australia are unprepared due to a lack of education, training and experience in disaster preparedness. This study also indicates that providing ongoing education helps strengthen nursing practitioners’ preparedness. Therefore, it is recommended that disaster management be included in formal educational programmes and continuing education programmes for nurses, including undergraduate and post-graduate tertiary courses. Disaster education

Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

Group

I read journal articles related to disaster preparedness. I am aware of classes about disaster preparedness and management that are offered for example at either my workplace, the university, or community. I would be interested in educational classes on disaster preparedness that relate specifically to my community situation. I would be interested in educational classes on disaster preparedness that relate specifically to my community situation. I find that the research literature on disaster preparedness and management is easily accessible. I find that the research literature on disaster preparedness is understandable. I know where to find relevant research or information related to disaster preparedness and management to fill in gaps in my knowledge. 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.). In case of a disaster situation I think that there is sufficient support from local officials on the county, region or governance level.

Military Government Military Government Military Government Military Government Military Government Military Government Military Government Military Government Military Government Military Government Military Government Military Government Military Government

Mean

SD

180 215 177 215 172 216 178 216 179 216 180 215 179 216 178 214 178 212 176 215 179 215 180 215 180 216

4.79 4.08 4.30 3.04 4.72 4.09 4.75 4.11 4.26 3.52 4.51 4.07 5.06 5.13 4.15 3.64 4.29 4.01 4.00 4.00 4.29 3.47 4.33 3.58 4.52 4.26

1.254 1.836 1.456 1.668 1.216 1.723 1.234 1.686 1.246 1.588 1.198 1.608 1.090 1.094 1.485 1.580 1.541 1.632 1.406 1.479 1.187 1.519 1.328 1.669 1.271 1.561

Mean differences .715 1.262

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I participate in disaster drills or exercises at my workplace (clinic, hospital, etc.) on a regular basis. I have participated in emergency plan drafting and emergency planning for disaster situations in my community. 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.

n

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.623 .636 .734 .440 −.078 .511 .277 .000 .825 .746 .253

A. Al Thobaity et al.

Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

Table 4

Q2 Q3 Q4 Q5 Q1: Q2: Q3: Q4: Q5:

I I I I I

variances variances variances variances variances variances variances variances variances variances

assumed not assumed assumed not assumed assumed not assumed assumed not assumed assumed not assumed

Sig.

15.76

.000

26.94

.000

30.22

.000

30.89

.000

67.90

.000

7.89 7.99 5.92 6.05 4.85 4.95 5.03 5.15 4.43 4.58

df

390 388.66 39 390.51 393 392.014 393 391.87 393 378.41

Sig. (two-tailed)

.000 .000 .000 .000 .000 .000 .000 .000 .000 .000

Mean difference

1.262 1.262 .825 .825 .746 .746 .734 .734 .715 .715

Std. error difference

.160 .158 .139 .136 .154 .151 .146 .143 .161 .156

95% confidence interval of confidence Lower

Upper

.95 .95 .55 .56 .44 .45 .43 .45 .40 .41

1.58 1.57 1.10 1.09 1.05 1.04 1.02 1.09 1.03 1.02

have participated in emergency plan drafting and emergency planning for disaster situations in my community. know where to find relevant research or information related to disaster preparedness and management to fill in gaps in my knowledge. 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.). read journal articles related to disaster preparedness. participate in disaster drills or exercises at my workplace (clinic, hospital, etc.) on a regular basis.

Table 6

Sources of knowledge and skills acquisition.

Undergraduate Sum % of total sum

Undergraduate course

Graduate course

Drills

Continuing education

Real disaster experience

396 108

396 115

396 280

396 148

396 103

27.27%

29.04%

70.71%

37.37%

26.01%

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Equal Equal Equal Equal Equal Equal Equal Equal Equal Equal

Q1

F

t

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Independent samples test for the highest differences.

Perceptions of knowledge of disaster management

Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

Table 5

7

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improves self-confidence, ability to plan for disasters, coordination of patient flow, cost-effectiveness and risk identification.1 Accessing appropriate resources, such as relevant research, is essential to improving the knowledge gap in disaster preparedness. Overall, nurses in Saudi Arabia reported difficulty finding relevant research articles and information. Whitehead and Arbon35 viewed this issue as an international concern. Additionally, protocols and guidelines are frequently not available, the information in journals varies extensively, and new articles and textbooks about disaster nursing are often outdated.35 Furthermore, Al Khalaileh et al.4 suggested that the gap in information and knowledge is related to the decrease in the number of international journals available in many developing countries. An interesting finding from this research is that military nurses read more articles, have more access to research studies and have greater access to information than nurses in government hospitals. This may be related to advancements in technology, the availability of databases, and access to qualified researchers and educators in military hospitals. However, it can be recommended that nurses in government hospitals must have the same opportunities to access the research literature to enhance their preparation. Successful disaster response commonly depends on plans that are well-established, organised, updated and understandable by response-team members. Understanding the plans, however, requires continuous evaluation, education, training and drills.36 Similar to nurses in other Middle Eastern countries, government nurses in Saudi Arabia had the lowest scores in disaster planning. For example, Jordanian nurses4 and Iranian nurses17 perceived their knowledge about participating in disaster planning as very low. The nurses in these studies perceived a lack of preparedness in guidelines and protocols, which made the situation more complex. Participants need planning and coordination before a disaster.4,28,37—39 Nurses in many countries are not permitted to be involved in developing plans and guidelines for several reasons, including gender issues.14,17 However, the nurses in Saudi Arabian military hospitals showed that they participate in drafting disaster plans, and that nurses can plan and prepare for disaster. It is recommended that nurses are involved in planning for disasters to better understand preparedness, where culturally appropriate. Achieving a solid understanding of the nurse’s role in disaster preparations may be resolved through education and training in disaster response; such measures include conducting regular drills.28,31 Fung et al.32 found that nurses in Hong Kong felt that disaster drills were very important and useful tools for building disaster competencies. Hammad et al.31 concluded that regular disaster drills allow nurses to understand their roles in real disasters. Thus, regular disaster drills are useful in training nurses to respond confidently and competently when disasters strike. While it might be reasonable to assume that nurses in military hospitals participate in disaster drills more frequently than nurses in government hospitals, international studies have found that nearly half the participants had no experience either in handling actual disasters or in mock drills.5 It is recommended that participation by nurses in real or mock drill experience is a useful adjunct for understanding their role and building disaster nursing management competencies.

Limitations This study has a number of limitations that should be considered when interpreting the results. The first limitation is self-reporting. Perception of knowledge does not necessarily translate into the participants’ actual level of knowledge. Secondly, the results are not generalisable, as they are specific to the hospitals participating in the study. Finally, the perceptions of employers, nursing educators and the public were not explored in this study and their perceptions of the level of knowledge of the participants may differ. There may be a heightened level of preparedness among military nurses compared to civilians by the nature of their employment in the military and the characteristics of those who are recruited to military operations, for example higher levels of confidence, though this is outside the scope of the study.

Conclusion Despite acknowledging knowledge gaps, overall the participants in this study had a perceived moderate level of knowledge in disaster management. Findings indicated that participants were interested in learning and were willing to do so, but a lack of resources affected their ability to address their knowledge gaps. There are several key implications arising from this study. The first is the importance of disaster management being incorporated into educational programmes, including both formal and ongoing education. The second implication is that nurses need to better understand the role they play in response to disasters in order to effectively contribute to the team response. Nurses’ perceptions of preparedness correlate with self-recognition of their own level of competence and ability to provide highquality care in disaster situations. The concern for nurses is that every drill is virtually the same but every disaster is different, and in the latter, their competence will be tested very differently. Future research is required in this important area of nursing, particularly as disasters are increasing in frequency and impact, around the globe.

Authors’ contributions AA was responsible for conceiving the study, literature review, study design, acquiring the data, data analysis and drafting the manuscript. VP, KI and BC were responsible for supervision of the study, the ethical aspects of the project, input into instrument design, data analysis, and critical review of the manuscript.

Provenance and conflict of interest There were no financial or personal matters of conflict. This paper was not commissioned.

Funding The project was unfunded.

Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

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Perceptions of knowledge of disaster management

Acknowledgements We would like to extend our appreciation, gratitude and thanks to Monash University and Taif University for their help and support. We also thank Dr. Kais Hamza for his statistical advice.

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Please cite this article in press as: Al Thobaity A, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J (2015), http://dx.doi.org/10.1016/j.aenj.2015.03.001

Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia.

It is generally accepted that nurses have insufficient knowledge about disaster preparedness due to a lack of acceptance of core competencies and the ...
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