الفهرس 
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Abstract
Emergency preparedness explained as pre-impact activities that establish a state of readiness to respond to extreme events that affects the community. Large scale emergencies consider extreme event and it defined as event which had result with severe impacts on large concentrations of people, activity and wealth and last for a longer time. Nurses play a major role during responding to disasters in order to save many lives and for best outcomes. They usually
have a desire to help, but they do not always have knowledge that qualifies them to provide effective help. If they inadequately prepared, a nurse can be more of a hindrance than a help during disaster response. Empowering nurses with knowledge and continuing education can improve their role and their ability for help and supporting victims those in need of care.
Everyday renovation of disaster types need nurses’ knowledge to keep up with this new types and new technologies.
The study aims to assess nurses’ knowledge about large scale emergency
preparedness in emergency units and compare between staff nurses’ knowledge in governmental and private hospitals.
Setting of the study:
This study was conducted in Emergency Units and General Critical Care Units at two healthcare setting; University Hospital (non-profit hospital) namely: Alexandria Main University Hospital and Private Hospital for profit namely: Mabert El Asafra Hospital East and West. The study hospitals selected based on their bed capacity were 50 beds. Alexandria Main University Hospital includes 7 units: Emergency Rooms (n=2) namely:
Emergency Room and Triage Unit. General Critical Care Units (n=5) namely: Critical Care Unit I, II, III, Post-Operative Care Unit and Emergency Anesthesia ICU with 147 bed capacity.
Mabert El Asafra East Hospital includes 4 units: Emergency Room (n=1). General Critical Care Units (n=3) namely: Critical Care Unit a, b and c. Mabert El Asafra West Hospital includes 3 units: Emergency Room (n=1) and Critical Care Units (n=2) namely: Critical Care Unit a and b.
Subjects of the study:
A Convenient sampling includes nurses who were working in the previously
mentioned units and were available at the time of data collection (n=230) who were working in the previously selected setting with experience more than 6 month and were available during time of data collection and distributed as follow 154 nurses at Main University Hospital, 38 nurses at Mabert El Asafra East and 38 nurses at Mabert El Asafra West.
Tool:
The data for this study were obtained by using one tool:
Nurses’ knowledge about emergency preparedness questionnaire
It was developed by the researcher based on review of related current literature
Adelman & Gray, (2009); Haddad et al., (2016); Herrera, Selim, Youssef & Zaki, (2010); Khorram, (2017b); Ministry of Health & Medical Services, (2013); MOHP, WHO & Mediterranean, (2016); Nied, (2009); REACH International, (2015); Schwartz, (2017); Silvestri, (2017); Singhal, Bhatnagar, Lal & Paliwal, (2016a); United Nation, (2017); WHO, (2011b), AWHONN;s Position Statement, (2012); Xu & Zeng, 2016) to assess nurses’ knowledge about emergency preparedness. The tool was classified into two parts:
Part (1): This part was developed to assess general knowledge about emergency preparedness. This part based on (KAP) surveys and focused on knowledge regarding disaster team, drill and plan and calling system during disaster. It was developed in English then translated into Arabic. It was consisted from 7 main questions and each question had sub-questions which developed in structured and open ended manner that represented the study concern. The response was measured on a 3-point likert scale ranging from (2) yes, (1) I do not know and (0) no. Also, there were open ended questions and its responses was measured (1) true answer and (0) false answer. As, question number 1,2,3.
Part (2): This part was developed to assess specific knowledge about large scale emergency preparedness. This part based on ten dimensions of Emergency Preparedness Information Questionnaire (EPIQ). EPIQ was created by Wisniewiski, Dennick-Champion and Peltier (2004), for assessing the basic educational needs for nurses regarding their familiarity with emergency preparedness. This part consisted of 45 questions in the form of case studies (n=19) and multiple choice questions (n=26) which classified under ten dimensions namely:
Detection and response to an event (5 questions), Incident Command System (ICS) and nurses’ role within it (4 questions), Knowledge about activities in Triage (9 questions), Epidemiology and Surveillance (3 questions), Isolation/Quarantine (5 questions), Decontamination (6 questions), Communication and Connectivity (3 questions), Psychological Issues (2 questions), Ethical issues and Special Populations (4 questions), and Accessing Critical Resources (4 questions). It was developed in English then translated into Arabic. The responses was measured (1) for true answer and (0) for false answer.
In addition, Nurses socio-demographic data sheet
It was developed by the researcher include questions about; age, gender, marital status, educational qualification, working unit, years of experience since graduation, years of experience in current unit, type of training received and type of large scale emergency situations attended.
Method:
1. An official letter from the Faculty of Nursing was delivered to the hospital
authority personnel in the private and governmental hospitals and the approval was obtained after providing explanation for the aim of the study.
2. Tool development:
- The tool was developed by the researcher based on:
▪ Interview with thirteen experts and they were asked about:
❖ The most needed area of nurses’ knowledge regarding emergency preparedness in large scale emergency that must be covered.
❖ The ten dimensions in which tool based on and how much those relevant to nurses practice during large scale emergency events.
▪ Review Ministry of Health and Population handbook regarding disaster management and first aid.
▪ Review current literature to determine the basic knowledge, main dimensions and how other authors address the topic.
Review current NCLEX PN & RN exams and Prometric exams.
- EPIQ is considering more centered on specific knowledge about emergency
preparedness. For that issue, questions which assessed nurses’ general knowledge about emergency preparedness was added which adapted from Habbir et al., (2017)
- Tool was developed in English then translated into Arabic based on review of the related literature.
3. Tool validation:
- Face and Content validity, the tool was tested for its face validity by eleven experts; eight experts from academic departments at the Faculty of Nursing, Alexandra University: four from Nursing Administration Department and four from Emergency and Critical Care Nursing Department. In addition, three Medical Physician in Critical Care Units to give their recommendations and suggestions regarding the tool content, nature of questions and clarity of items. Their recommendations and suggestions were taken into consideration. The tool tested for content validity by eight experts; four from Nursing Administration Department and four from Emergency and Critical Care Nursing Department.
- Content Validity Index (CVI), result of CVI for initial version of the tool (part I & II)
shows that both parts Scale- Content Validity Index/ Average (S-CVI/Ave) were less than 0.83, modifications done for initial version and the result of CVI for final version of the tool was S-CVI/Ave for part I equal 0.988 and part II equal 0.861.
4. A pilot study was carried out on 10 % of nurses (n=23) rather than the study subjects in order to check and ensure clarity of the tool, its applicability, feasibility, identify obstacles and problems that may be encountered during data collection.
- Many obstacles were raised during the pilot study such as the response rate low, more missed items, some questions were vague and the tool was too long.
- The previous obstacles were overcome by modification for the tool first version and changing method of data collection from self-administered questionnaire to structured interview.
5. Tool reliability:
- The study tool was tested for its reliability using Cronbach’s Alpha Coefficient. Both, part I and part II were strongly reliable, where Cronbach’s Alpha Coefficient = 0.797, 0.778, respectively.
6. Ethical considerations:
- Ethical aspects were taken into consideration.
- A written informed consent from the study subjects was obtained. Right to refuse to participate in the research and to withdrawal from the study at any time was assured.
- Confidentiality of the data, privacy, and anonymity of the study subjects were
maintained.
7. Data collection:
- Data collection was conducted by researcher through structured interview for 20 minutes before or after nurse’ shift according their preference.
- Data collected mainly in evening, night shifts and before morning shift with half an
hour as avoidance of workload times.
- Data collected in a period more than 5 months from 10/2018 to 2/2019.
8. After completion of data collection, Cronbach’s Alpha Coefficient repeated and the test shows that both parts were strongly reliable. where the result of Cronbach’s Alpha
Coefficient part I and part II = 0.715 – 0.768, respectively.
- The appropriate statistical analysis was used to determine nurses’ knowledge about the emergency preparedness in governmental and private hospitals. Data was computerized using the SPSS version 21 to perform the tabulation and statistical analysis.
The following were the main results of the present study:
The present study revealed that there was no significant difference between
governmental and private hospitals in relation to general knowledge, specific knowledge and overall knowledge where p value were (0.091 – 0.584 – 0.274) respectively. Moreover,there were significant differences between nurses’ knowledge about emergency preparedness in large scale emergency in both governmental and private hospitals in somedimensions as p value for ”Knowledge about activities in triage” (0.008*), ”Epidemiology and surveillance” (0.009*), ”Isolation and quarantine” (0.005*), ”Ethical issues and special population” (<0.001*), and ”Accessing critical resources” (0.025*).
Recommendations were given based on the results of the present study to add well structured courses about large scale emergency preparedness to undergraduate nursing study.
1. Involve nurses when developing and updating policies regarding to emergency preparedness.
2. Enforce on applying the nursing staff license renewal law.
3. Continue update nurses’ knowledge through continuous workshops, training and frequent disaster drill.
4. Develop a handbook in Arabic to facilitate acquiring knowledge regarding large scale emergencies for all healthcare providers