Factors associated with the intention of health care personnel to respond to a disaster

An assessment of nurses' perceived and actual household emergency preparedness

Nurses' household preparedness is critical if they are to avoid role conflict and report for duty during an emergency. To date, the alignment between nurses' perceived and actual household preparedness remains under examined. Investigating one of these variables in isolation fails to consider that perceived and actual household preparedness must be high and aligned. If misaligned, vulnerabilities could surface during emergencies, like concerns about family safety, potentially impacting a nurse's commitment to duty during a crisis, or nurses may lack the actual preparedness to continue working long hours during an emergency. An online questionnaire was distributed to registered nurses in Ireland. The questionnaire was informed by a review of the literature and captured nurses' perceived and actual household preparedness, attitudes towards and exposure to a range of emergencies, and pertinent demographic characteristics. The results showed a relationship between how nurses view their household preparedness and their actual preparedness. Regression analyses indicate that while there is an overlap, the factors associated with how prepared nurses think they are and how prepared they are can differ. This means that strategies to boost actual preparedness may differ from those needed to boost perceived preparedness. This finding underscores the importance of psychosocial preparedness. Feeling prepared is crucial as it can influence how one responds in an emergency. Considering both the perceived and actual aspects of household preparedness can lead to a more effective response during emergencies.

Meta-analyses of motivational factors of response to natural disaster

Response behavior of individuals is of critical importance to decrease chances of injury and death as well as ameliorate costs in property and infrastructure damage in natural disasters. Plenty of studies have examined which factors motivate individuals to respond to natural disasters. However, a systematic overview of the key motivating factors of various response behaviors is lacking. This study conducts a series of meta-analyses using data of 53,713 samples from 87 studies (77 papers) conducted in 27 different countries and regions to examine how 17 motivational factors were associated with individuals' response to natural disasters. The results indicate self-efficacy, outcome efficacy, attitudes, subjective norms, and information acquisition show the strongest effects on response behavior. Contrarily, the impact of negative affects like fear, depression, and anxiety on victims is minimal, despite the common assumption that they are significant related to response behaviour. In addition, current studies have disproportionally focused on studying risk perception, experience and information acquisition, earthquake and hurricane, and evacuation and preparation, while attention given to other types of motivational factors, disasters and response behaviors is lacking.

Willingness to Work during Public Health Emergencies: A Systematic Literature Review

The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies.

Behavioral Intentions and Factors Influencing Nurses' Care of COVID-19 Patients: A Cross-Sectional Study

Objective

Behavioral intentions to care for patients with infectious diseases are crucial for improving quality of care. However, there have been few studies of the behavioral intentions and factors influencing patient care by clinical nurses during the COVID-19 pandemic. This study aims to explore cognition, attitudes, subjective norms, self-efficacy, and behavioral intentions of clinical nurses while caring for COVID-19 patients and to explore any influencing factors.

Method

A cross-sectional survey was conducted of nurses through convenience sampling in southeast China from February 2020 to March 2020. The questionnaire was developed based on the theory of planned behavior and self-efficacy.

Results

A total of 774 nurses completed the survey. Of these, 69.12% (535/774) reported positive behavioral intentions, 75.58% (585/774) reported a positive attitude, and 63.82% (494/774) reported having the confidence to care for patients. However, the lack of support from family and friends and special allowance affected their self-confidence. Attitude, self-efficacy, subjective norms, and ethical cognition were significantly positively correlated with behavioral intentions (r = 0.719, 0.690, 0.603, and 0.546, respectively, all P < 0.001). Structural equation model showed that self-efficacy, attitude, ethical cognition, and subjective norms had positive effects on behavioral intentions (β = 0.402, 0.382, 0.091, and 0.066, respectively, P < 0.01). The total effect of behavioral intentions was influenced by attitude, ethical cognition, self-efficacy, and subjective norms (β = 0.656, 0.630, 0.402, and 0.157, respectively, P < 0.01). In addition, ethical cognition had a positive mediating effect on behavioral intentions (β = 0.539, P < 0.001).

Conclusion

The study results indicated that attitude, ethical cognition, and self-efficacy were the main factors influencing nurses' behavioral intention. Efforts should be made to improve nurses' attitude and self-efficacy through ethical education and training to increase behavioral intentions to care for patients with infectious diseases, which will improve the quality of nursing care.

Perceived Stress and Intention to Work during the COVID-19 Pandemic among Nurses in West Sumatra Indonesia

BACKGROUND: Nurses are at high risk of experiencing stress when treating patients with COVID-19. The presence of an outbreak could also result in burnout among nurses due to job stress, poor hospital resources for the treatment, and inadequate support from family and friends. All of these related obstacles might be interfered with the intention of nurses to work during a pandemic. AIM: The objective of the study was to identify perceived stress and intention to work during the COVID-19 pandemic among nurses. METHODS: An online-based cross-sectional study was conducted among nurses in Indonesia. There were 238 responses received. Multiple regression analysis was used to examine for data analysis. RESULTS: There was a significant correlation between perceived stress and intention to work (p < 0.001). The regression model showed the variance in the perceived stress with other main predictors. CONCLUSIONS: To maintain an adequate workforce during the pandemic, hospital management should ensure adequate hospital goods supply and deploy retention strategies to retain clinically experienced nurses.

Intention to Care for COVID-19 Patients Among Nurses Working at Health Care Institutions of Debre Tabor Town, North Central Ethiopia

Background

Coronavirus disease 2019 (COVID-19) has caused many challenges for health care providers. Nurses meet patients with coronavirus disease and offer care for newly communicable diseases. Despite global and national efforts to prevent the spread, the outbreak is still on a rise, and studies on the health care behaviors of nurses were scarce in the study setting. Therefore, this study was intended in addressing nurses’ intention to care for coronavirus disease 19 patients and its determinants among nurses working at Debre Tabor town Health Care Institutions, 2020.

Methodology

An institutional-based cross-sectional study was conducted among 163 nurses working at health care institutions of Debre Tabor Town, from June 01 to 15/2020. The data were collected using tools with a self-administration questionnaire adapted from the theory of planned behavior and different kinds of literatures. All nurses working at Debre Tabor health care institutions were included. Data were entered using Epi-data 4.2.0.0 statistical software, and analysis was done by Stata version 14 statistical software. Binary logistic regression model was used for analysis. Strength of association was measured using the odds ratio with 95% CI, and the level of significance was estimated at P-value ≤0.05.

Results

Nurses’ intention to care for COVID-19 patient was 59.5% (95% CI; 58.7:60.3). Having better working experience (adjusted odds ratio (AOR) =2.3:95% CI; 1.120, 4.910), caring experience for infectious disease (AOR=2.5; 95% CI: 1.10, 5.50), good perceived behavioral control (AOR=2.33; 95% CI: 1.13, 4.8), and subjective norms (AOR= 2.14; 95% CI: 1.05, 4.36) were significantly associated with intention of caring behavior.

Conclusion

Nurses’ intention to care for COVID-19 patients was low. Working experience, the experience of caring for infectious disease, self-efficacy, and subjective norm were independently related with nurses’ caring intention. The government should work on improving nurse’s confidence in disaster management, design disaster management nursing education, and frequent support of nurses.

Nurses’ Intention to Work during the COVID-19 Outbreak in West Sumatra, Indonesia

Background: Nurses who work on the front-line and are involved in caring for COVID-19 patients have a high risk of transmission. The increase in the number of confirmed and suspected cases, followed by an increase in workload, a limitation of personal protection equipment, a lack of effective treatment, and inadequate emotional support may contribute to the work intention during a pandemic.Purpose: This study aimed to describe nurses’ intention to work and provide care when people may be at risk of the COVID-19 and examine its relating factors. Methods: This was a cross-sectional and survey-based study that collected the respondents' characteristics and the intention to work measurements from 238 nurses in 36 hospitals in West Sumatera, Indonesia. Data analysis was performed using descriptive statistics, T-tests, and ANOVA.Results: The mean and standard deviation scores of nurses’ intention to work during the COVID-19 outbreak were 42.49±5.92. The isolation experience, the presence of authorized beds for COVID-19, and sufficient protection equipment supply, were correlated to the intention to work (p=0.016, p=0.035, p=0.000). Nurse respondents expected that hospital managers should provide more attention to nurses who agreed to attend to work during the COVID-19 outbreak. Conclusion: Nurses showed preserved intention to work during the COVID-19 outbreak. The factors correlated with intention to work were isolation experience, the presence of authorized beds for COVID-19, and protection equipment supply. The government and hospital management should ensure strategies and regulations to provide adequate hospital protective equipment supplies. They should also support compensations to nurses who actively care for patients during the COVID-19 outbreak.

Interventions to Improve the Willingness to Work Among Health care Professionals in Times of Disaster: A Scoping Review

The critical role of the health workforce in the function of the health care system is undeniable. In times of disaster and public health emergency, the importance of this valuable resource for the organization multiplies. This scoping review was conducted to identify, analyze, and categorize interventions to improve willingness to work in times of disaster as well as the existing knowledge gaps in the topic. For this purpose, four databases were searched. These included Scopus, PubMed, WOS, and World Health Organization observatory, and they were searched for papers published from July 2000 to September 2020. Studies of the English language that described strategies to improve human resources for health willingness to work during times of disaster/public health emergency were included. Full-text papers were screened by authors and data extraction was done according to self-designed form. Framework analysis identified key interventions based on human resources for health action framework. From 6246 search results, 52 articles were included, a great portion of which was published in 2020 probably due to the COVID-19 pandemic. Northern America was the region with most studies. From 52 included studies, 21 papers have reported the interventions to improve willingness to work and 31 papers have explored factors that affected a willingness to work. The interventions used in the studies were categorized into five themes as Leadership, Partnership, Financing, Education, and Organizational policies. The most and least interventions were financial and partnership respectively. The review identified a wide range of feasible strategies and interventions to improve human resources for health's willingness to work at times of disaster that are expected to be effective. Organizations should let the staff know these decisions and as a necessary step in every organizational intervention remember to evaluate the impacts.

Intention to response, emergency preparedness and intention to leave among nurses during COVID-19

AIM

To comprehensively assess the current level and identify associated factors of intention to response and emergency preparedness of clinical nurses during COVID-19 outbreak.

DESIGN

A cross-sectional study was designed.

METHODS

Demographic and characteristic questionnaire, intention to response scale, emergency preparedness scale and a self-designed questionnaire related to effects of events and intention to leave were used in this study.

RESULTS

The mean scores of intention to response and emergency preparedness were 82.00 (SD = 18.17) and 64.99 (SD = 12.94), respectively. Moral consideration, engaged in COVID-19 protection training, had working experience in SARS, and the other eight factors were explained 34.6% of the total model variance in intention to response model (F = 80.05, p < .001). While, the level of IR, whether the pace of work was affected and above three same factors were explained 21.5% of the total model variance (F = 91.05, p < .001). Pathway analysis revealed that moral consideration, intention to leave and impacts on work and life mediate the relationship between EP and IR.

Survey of Hospital Employees' Personal Preparedness and Willingness to Work Following a Disaster

OBJECTIVES

Little is known about the personal readiness of hospital staff for disasters. As many as 30% of hospital staff say that they plan not to report for work during a large-scale disaster. We sought to understand the personal disaster preparedness for hospital staff.

METHODS

Surveys were distributed to the staff of a large academic tertiary-care hospital by either a paper-based version distributed through the departmental safety coordinators or a Web-based version distributed through employee e-mail services, depending on employee familiarity with and access to computer services. Surveys assessed the demographic variables and characteristics of personal readiness for disaster.

RESULTS

Of the individuals who accessed the survey, 1334 (95.9%) enrolled in it. Women made up 75% of the respondents, with a mean age of 43 years. Respondents had worked at the hospital an average of 9 years, with the majority (90%) being full-time employees. Most households (93%) reported ≤4 members, 6% supported a person with special medical needs, and 17% were headed by a single parent. A small number (24%) of respondents reported an established meeting place for reuniting households during a disaster. Many reported stockpiling a 3-day supply of food (86%) and a 3-day supply of water (51%). Eighteen percent of respondents were not aware of workplace evacuation plans. Most respondents were willing to report to work for natural disasters (eg, tornado, snowstorm; all categories >65%), but fewer respondents were willing to report during events such as an influenza epidemic (54%), a biological outbreak (41%), a chemical exposure, (40%), or a radiation exposure (39%). Multivariate analysis revealed being female, having a child in the household younger than 6 years old, and having a child in school lowered the likelihood of being willing to report to work in two or more event types, whereas pet ownership, being a clinical healthcare worker, and being familiar with the work emergency plan increased the likelihood.

CONCLUSIONS

Despite being employed at the same facility for a prolonged period, employees reported being willing to report for work at a low rate in a variety of disasters. Subjects reported suboptimal personal preparedness for disaster, which may further limit the number of staff who will report for work. Hospitals should promote personal disaster preparedness for staff and explore staffing models with an understanding of reduced staff availability during disasters.

All the Resources was Gone: The Environmental Context of Disaster Nursing

US nurses are not prepared for the altered conditions of the disaster environment, nor has the context of providing disaster nursing care been a focus of disaster research. Using an existential phenomenologic approach, US nurses described the "not normal" conditions of the disaster environment they experienced as physically and emotionally challenging, because of the reduced infrastructural capabilities, unfamiliar patient populations, and reliance on low-technology nursing with insufficient staff and supplies. Preparation for the reduced resources of the disaster environment should be integrated into current nursing education, clinical practice, and disaster preparedness policy.

Development and Validation of a Questionnaire to Measure Iranian Nurses' Knowledge, Attitude and Practice Regarding Disaster Preparedness

INTRODUCTION

Despite the key role of Iranian nurses throughout disaster management, there is no instrument available to examine nurses' current disaster preparation levels.

AIM

The aim of this study was to develop and analyse the reliability and validity of a questionnaire on the nurses' knowledge, attitude and practice of disaster preparedness.

MATERIALS AND METHODS

The scale was developed based on a comprehensive literature review and applied to 112 nurses in three public educational center affiliated to Ilam University of Medical Sciences, Ilam, Iran. Relibility was obtained using the test-retest method. Cronbach's alpha was used to verify internal consistency. Exploratory factor analysis was used to assess the validity of the questionnaire.

RESULTS

Explanatory factor analysis using varimax rotation revealed seven main factors associated with the nurses' knowledge, attitude and practice regarding disaster preparedness. The questionnaire overall internal consistency using Cronbach's alpha was 0.785, showing acceptable internal consistency. The intraclass correlation coefficient using Test-retest method was 0.82. Total variance was 67.57%.

CONCLUSION

The instrument has satisfactory reliability and validity indices and can be used to measure nurses' knowledge, attitude and practice regarding disaster preparedness.

Professionalism under fire: Conflict, war and epidemics

Today's medical students (tomorrow's doctors) will be entering a world of conflict, war and regular outbreaks of infectious diseases. Despite numerous international declarations and treaties protecting human rights, the last few decades has been fraught with reports of "lapses" in medical professionalism involving torture and force-feeding of detainees (e.g. captured during the War on Terror) and health care professionals refusing to treat infected patients (e.g. HIV and Ebola). This paper provides some historical background to the changing status of a physician's duty to treat and how medical practitioners came to be involved in the inhumane treatment of detainees during the War on Terror, culminating in reports of "lapses" in professionalism. The Theory of Planned Behavior, which takes into account the individual, the environment and the social context, is used to explain the factors that might influence an individual's behavior in challenging situations. The paper concludes with some recommendations for medical and health professions education. The recommendations include selecting students who, as a minimum, can provide evidence of "basic" professionalism, engaging them in exploring the history of the medical profession, exposing them to contexts of uncertainty and moral dilemmas and challenging them to reflect on their responses.