Knowledge, Attitude and Practice of Nurses Regarding Disaster Management: A Study from Peshawar KPK

Background: Disasters are unforeseeable events that destroy lives and affect people, ruins possessions and disturb environment. Nurses play a vital role in dealing with the victims of such events and it is essential for nurses to be prepared in facing the consequences of disasters. Objective: The purpose of this study was to determine the knowledge, attitude and practices of nurses in different department like emergency, trauma care intensive cares (cardio vascular, cardiothoracic and neurosurgery departments) regarding disaster preparedness. Methods: Quantitative (descriptive study) among staff and student nurses of tertiary care hospitals (LRH, KTH and HMC) in Peshawar. Sample size was 90 through questionnaires. And collecting in 3 months from 15th Sep (2014) to 30th Dec (2014). Results: The main points developed during the presentations and discussions included: (1) the need for evidencebased assessments and planning, (2) the need for a shift in focus to health-sector readiness, (3) empowerment of survivors, (4) provision of relief for the caregivers, (5) address the incentives and disincentives to attain readiness, (6) engage in joint preparation, response, and training, (7) focus on prevention and mitigation of the damage from events, and (8) improve media relations. There exists a need for institutionalization of processes for learning from experiences obtained from disasters. Conclusion: There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.


Introduction
Disasters happens daily at someplace in the world with intense effect on life of individuals, families and communities and it endangered the quality of life on Whether it is a family house on fire or on destroying communities like tsunami. (Ibrahim, F. 2014). The World Health Organization defines a disaster as "a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources".
Disasters are unforeseeable events that destroy lives and affect people, ruins possessions and disturb environment. (Ahayalimudin, Ismail, & Saiboon, 2012). For some natural disasters like floods, volcanoes and hurricanes health care institutions receive advance warning to be able to faster their activities for before the disaster event but some natural disasters like earthquakes , tsunami, there is no prediction and warning in advance. Furthermore Several man-made disasters also gives no advance warning including acts of terrorisms, chemical plant explosions, building collapse and industrial accidents. Therefor each type of event requires and must be consider uniquely (Mehta S, 2006).Health care professionals should be involved at all levels of disaster planning especially those who are in immediate response these events (Carlos Primero Gundran, 2013).
Developed nations usually are able to restore effected economy and infrastructure but developing nation are more vulnerable because low funding for disaster preparedness and effect of disasters on the health care, social system, economy of region and disaster can wipe out years of development in seconds of developing country. Disaster preparedness and management strategies at all system levels, is crucial to the delivery of active responses to the health needs of a disaster-traumatized people (Ibrahim, F. 2014).
Pakistan is most vulnerable to disaster due to its climate and environmental features according to record Pakistan experienced 138 events of natural disaster from 1980 to 2010 in which 87,053 people died and 58,098,719 are affected. After the 9/11 the disaster of bomb blasts mostly targeted Khyber pukhtoonkhwa, and attached tribal areas. Like other preventive and disaster management measures, the Emergency department of hospital should be prepared to deal with increased demands of services during such events. Nurses play a vital role in dealing with the victims of such events .Therefore it is essential for nurses to be prepared in facing the consequences of disasters (Ahayalimudin, Ismail, & Saiboon, 2012). Assessment of the nursing staff, skills and knowledge with attitude to be made periodically to know the preparedness and lacks to deal with. This study was conducted to determine the knowledge, attitude and practices of nurses in different department like emergency, trauma care intensive cares (cardio vascular, cardiothoracic and neurosurgery departments) regarding disaster preparedness.

Methodology
A cross sectional study was carried out in the emergency and intensive care departments of the three tertiary care hospitals Lady Reading Hospital, Hayatabad Medical Complex, and Khyber teaching hospitals, Peshawar, completed in two weeks duration, starting from Nov 2014. Ninety staff members will be included in this study. Data was collected through pre designed and pre tested questionnaire after informed consent. Data was analyzed through SPSS version 16. Descriptive characteristics were studied. Written inform consent were given to the respondents for their voluntary participation, informing about purpose of the study.

Results
We have found in our study that there is no any training program in those three tertiary hospitals, and also their views were that disaster management is not only for doctors and nurses. And almost all of the participants have not got any training for disaster management. But they can provide help in disaster and emergency situation.

Figure 1. Work experience of participants
27.8% of participants were known about disaster management, 72.2% of participants were did not. There were 57.8% of participants known about the finding of plan for disaster and 42.2% did not. 90% of participants were agreed that the management should be adequately prepared for disaster occurrence but 10% were did not agreed with it. "Few people should be specialized in the disaster management" it was the statement of 73.3% of participants of the study but a small amount of participants was not agreed with this statement. 88.9% of participants have faced problem during disaster management and a little number of participants were did not. Our study have found that 94.4% participants mentioned that training is necessary for all health management, and only 5.6% of participants mentioned that it is not necessary. We found answered from 1.1% study participants that they got training for disaster management and 98.9% of them answered that they have never got training for management. 78.9% of participants were mentioned that there is no ongoing training in their hospital, but 21.1% of participants were did not know about it. 94.4% of participants verbalized that if there is disaster or emergency happened they can provide help to the best of their ability and 5.6% verbalized they did not. There were 72.2% of participants in our study said that they have responded or provided help in a disaster or emergency situation and 27.8% of participants were did not. "Disaster plan need to be regularly update" it is stated by 94.4% of participants and a small amount of participants were did not agreed with it.

Discussion
Our study has found that there were 73.3% of participants did not know about disaster. And there was defined by Veenema, a disaster is "any event where the demand exceeds the available resources. This means that nurses need to be prepared to deal with all hazards. Our study has found that 94.4% participants of this study can provide help in a disaster or emergency situation which are dissimilar to the findings study conducted by Al Khalaileh, Bond & Alasad (2012) as they concluded that only 12 % of nurse's student showed good and 5% showed very good preparedness for disaster management. This study also found that 94.4% of the participants have identified that an updated disaster preparedness training is required for them in their hospital, whereas in the study of Gundran (2013) carried out in Philippine he identify that most of the participants(81.3%) disaster simulation should be performed for their training in hospitals.73.3% of our study participants have responded that few people should be specialized in disaster management, whereas Al Thobaity, Plummer, Innes and Copnell (2015) concluded on the basis of their quantitative study that Nurses must have sufficient knowledge in all extents of disaster management especially in responding to disasters. Nurses do not consider themselves well-equipped but if training opportunities are provided they will be definitely willing to advance their knowledge and skills in disaster preparedness and management. And Using data from epidemiologic studies of disasters, nurses are better prepared to address the challenges of providing care in different types of disasters and under different conditions. Preparedness and mitigation activities have become a worldwide priority (Prevention Web, 2008).

Conclusion
The disaster management programs in Pakistan especially in KPK, despite the lack of resources, should continue and work towards its enhancement The Formulation of more responsive disaster management programs should be given prime importance. The slow transcendence from relieforiented to preparedness and mitigation-focused disaster management approach will require the development of a communication strategy that would strongly influence the thinking of administrators towards a paradigm shift. The Change in the public's attitude of complacency to a safer preventionconscious one should be other object of disaster manager's efforts. It is true that we cannot avert or prevent the occurrence of many of the disasters. But by taking appropriate steps, we can definitely reduce their effects. The focus should be on all areas including connectivity in form of road, telecommunication and air connectivity. It is here that the role of a proper mechanism to guide and coordinate a comprehensive disaster preparedness program becomes relevant. Some of the initiatives have been taken in the right direction but still there is a long way to go.

Conflict of Interest
There is no conflict of interest among study authors