Australasian Emergency Care 21 (2018) 23–30

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Australasian Emergency Care

journal homepage: www.elsevier.com/locate/auec

Research paper

Disaster preparedness and learning needs among community health

nurse coordinators in South Sulawesi Indonesia
Moh. Syafar Sangkala a,∗ , Marie Frances Gerdtz b
a
Emergency Nursing Department, Faculty of Nursing, Hasanuddin University, South Sulawesi, Indonesia
b
University of Melbourne and Melbourne Health, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Background: The number of natural disasters occurring worldwide has increased, including Indonesia, a
Received 7 November 2016 country that continues to experience natural disasters of varying level of severity. Despite this evidence,
Received in revised form limited information is available about nurses’ disaster preparedness in Indonesia particularly in commu-
21 November 2017
nity settings. This study aims to identify the current level of disaster preparedness and learning needs
Accepted 21 November 2017
for managing natural disasters as perceived by community health nurse (CHN) coordinators who are
working in community health settings in South Sulawesi, Indonesia.
Keywords:
Methods: This study used a descriptive study design. A self-administered survey, the Disaster Prepared-
Disaster preparedness ®
Community health nurse coordinator ness Evaluation Tools (DPET ) was utilized to determine the current levels of disaster preparedness and
Learning needs management of the CHN coordinators. In addition, structured questions were used to identify learn-
ing needs. It was distributed to 254 CHN coordinators working in community health settings in South
Sulawesi Province, Indonesia.
Results: In total 214 CHN coordinators completed the survey. There were around 6.5% respondents
perceived their current disaster preparedness as weak; 84.6% moderate; and 8.9% rated their prepared-
ness as strong. Around one-third of the participants considered frequent disaster drills as the best learning
method to achieve effective disaster preparedness.
Conclusion: Although overall disaster preparedness levels of the CHN coordinators in South Sulawesi
province Indonesia were moderate, continuing disaster training that integrates CHN coordinators specific
learning needs is still required to achieve effective disaster preparedness and management in community
levels.
© 2017 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia.

Introduction
Disaster is a worldwide issue with unpredictable impact espe-
cially for those communities affected. According to the World
Disasters Report from the International Federation of Red Cross
and Red Crescent Societies [1], within the period 1997–2006, disas-
ter incidences increased around 60% and the number of reported
deaths due to the hazards doubled to over 1.2 million when com-
pared to the previous decade. During the same period, it was
reported that the average number of people affected by disasters
was close to 270 million, an annual increase of around 17%. The
economic impact of natural disasters is estimated to be around US$
∗ Corresponding author at: Fakultas Keperawatan, Universitas Hasanuddin, Jl. Per-
intis Kemerdekaan Km.10, Kampus Tamalanrea, Unhas, Makassar 90245, Sulawesi
Selatan, Indonesia.
E-mail addresses: moh.syafar@unhas.ac.id, mohsyafar@gmail.com
(Moh.S. Sangkala).
41.5 billion, and in 2009 that contributed more than 73% of the total
reported damages caused by all disasters [2]. Indeed, natural disas-
ters account for the majority of the impacts of disasters of any types
[1].
Indonesia is a country that is prone to natural disasters and has
experienced numerous events of differing levels of severity over the
last decade. The Asia Pacific Disaster Report 2010 ranked Indonesia
by the number of disasters as being fourth highest among Asia
Pacific countries [3]. Indonesia is also ranked second highest by
number of deaths (191,164) from disasters and it is estimated that
approximately 18 million people have been negatively affected by
disasters for the period 1980–2009 [2–4].
South Sulawesi Province is situated in the middle region of
Indonesia. It has experienced disasters such as flood, landslide,
storm and fire [5]. Although those were not considerably large
scale disasters compared to the incidences that have occurred
in Java and Sumatera islands, the Indonesian National Board for
Disaster Management [6] has categorized half of the districts in
South Sulawesi Province as high prone level areas to disaster inci-

https://doi.org/10.1016/j.auec.2017.11.002
2588-994X/© 2017 Published by Elsevier Ltd on behalf of College of Emergency Nursing Australasia.
24 Moh.S. Sangkala, M.F. Gerdtz / Australasian Emergency Care 21 (2018) 23–30
dence. Therefore comprehensive multi-hazard and risk reduction
strategies are imperative and should involve all parties including
nurses who directly engage with community [7–10].
Community Health Nurses (CHNs) are one of the largest
specialist groups working in community health centers who are
positioned to provide primary health care including in response
to disasters [11]. A review by Putra, Petpichetchian and Maneewat
[12] found that CHNs hold major roles in providing health care for
communities during all stages of disaster including preparedness,
mitigation, response and recovery. In addition, this review also
suggested that CHNs need to assure that they are ready for disaster
occurrences by understanding the scope of their responsibilities
and the competencies required. In Indonesia, Community Health
Nurse (CHN) Coordinator is a nurse who is responsible for man-
aging and coordinating community health nursing programs in
community settings [13].
Effective disaster preparedness is important in determining
successful disaster management [14]. All potentially participating
disaster teams including CHNs are expected to be well-prepared
and fully understand their role before participating in a real disas-
ter [11]. Al Khalaileh et al. [15], conducted a cross-sectional survey
of 512 nurses in Jordan to assess the RNs’ perceptions about their
levels of disaster preparedness found that more than half of the par-
ticipants (65%) rated their current level of disaster preparedness as
weak. Similar results were also found by Fung et al. [16], who con-
ducted a survey of 164 RNs studying in the master degree program
in Hong Kong. A qualitative study by Yang et al. [17], of ten RNs who
had participated in an earthquake response in China also indicates
that nurses are not adequately prepared for disaster and need con-
tinuing effective disaster preparedness and management programs
to improve their preparedness level. Those findings highlight the
importance of determining nurses’ current level of preparedness
to facilitate the development of the suitable educational program
based of their learning needs [15].
Aims
This study aimed to identify the current levels of knowledge,
skills and preparedness for managing natural disasters as perceived
by CHN coordinators working in community health settings in
South Sulawesi. Further, the research aimed to define learning
needs to knowledge development and clinical decision making
skills in disaster preparedness and management.
Methods
Study design
This study used a cross-sectional survey design to measure the
perceived current levels of knowledge, skill and preparedness for
disaster among CHN coordinators and to define their learning needs
for effective disaster preparedness and management.
Study setting and period
This study was conducted in South Sulawesi Province Indonesia.
It included community health centers [18] situated in 24
cities/districts in South Sulawesi Province where CHN coordi-
nators practice. Data collection was conducted by lead author from
September to October 2011.
Population and sampling method
There are 425 CHN coordinators in South Sulawesi, 24 are
district coordinators and 401 are community health center coor-
dinators that are distributed across 24 cities/districts in South
Sulawesi Province [19]. Based upon a precision-based sample size
calculation of 5% significance and 3% precision, a total of 254 CHN
coordinators were invited to participate by way of consecutive
sampling. The precision-based sampling approach allowed for a
margin of 20% incomplete or unreturned surveys [20].
The inclusion criteria for this study were:
i) At least 2 years’ experience as a Registered Nurse.
ii) Working as a CHN coordinator.
iii) Hold an educational background of at least a three year diploma
in nursing.
The exclusion criteria were:
i) Incomplete survey
ii) Refuse to participate in this study
Recruitment
The identification, selection and recruitment of participants
were carried out by the research team in two ways: via inter-
national seminar and workshop of community health nursing
organized by Nursing Study Program of Hasanuddin University,
Provincial Health Office of South Sulawesi and University of Hyogo
Japan on 13–14 September 2011; and direct approach achieved by
visiting the health centers where the CHN coordinators practice.
An invitation to participate in this study along with the survey was
distributed before the seminar/workshop. Participants competed
the survey in their own time and were given options for how they
would return the survey: either directly to the research team or via
mail with a stamped, returning envelope provided.
The direct approach method was used after the seminar to
achieve the desired sample size. The research team visited commu-
nity health centers where the CHN coordinators work to invite them
to participate in this study. Similarly, participants could complete
the survey in their own time and were given options for how they
will return the survey: either directly to the research team or via
mail with a stamped, returning envelope provided. This approach
was based on a preliminary study carried out by the lead author. In
the preliminary work, it was found that the direct approach elicited
a positive response from the CHN coordinators who were keen to
offer their advice on how programs might be improved.
Instrumentation
Description
Data were collected through a cross-sectional survey. The
survey was translated from English to Bahasa Indonesia. The trans-
lations were carried out by the lead author whose the first language
is Bahasa Indonesia. The content had been analyzed, modified and
validated by three independent translators from Hasanuddin Uni-
versity, Indonesia. These translators are nurses who obtained their
post-graduate degrees from English speaking countries.
The survey was divided into two sections. Section “introduction”
®
consisted of the Disaster Preparedness Evaluation Tool (DPET )
which was developed by Bond and Tichy [21,22]. It measures
the current levels of knowledge, skills and personal preparedness
®
related to disaster. The DPET instrument contains 47 Likert-type
questions with six response options ranging from strongly dis-
agree to strongly agree. Since this study will focus on natural
disaster preparedness among CHN coordinators, nine questions
that focused on manmade disaster and biological hazards were
excluded. In addition, adjustments and clarifications were made
to several questions (after being translated into Bahasa Indonesia)
without changing the meaning of the statements to ensure the
 Moh.S. Sangkala, M.F. Gerdtz / Australasian Emergency Care 21 (2018) 23–30 25

relevancy of the tool with the research theme and the popula-
tion studied. The final survey contained of 38 Likert-type questions
measured using a 6-point Likert-scale and consisted of: 13 items
focused on knowledge, 8 questions related to skill and 17 items
rated personal preparation for disaster management (PDM). Sec-
tion “methods” sought demographic information and included two
structured questions to define learning needs related to disaster
preparedness of the CHN coordinators and were drawn from a
variety of studies [15–17,23,24].
In order to measure the CHN coordinators perception of their
disaster preparedness levels in general and specific domains
(knowledge, skills and PDM), medians and Inter-Quartile Ranges
®
(IQRs) of the collected data have been calculated from the DPET
questionnaires. If the value of the median is 1–2.99, the CHN coor-
dinators’ perception of their disaster preparedness level is weak; if
the value of the median is 3–4.99, the CHN coordinators’ perception
of their disaster preparedness level is moderate; if the value of the
median is 5–6, the CHN coordinators’ perception of their disaster
preparedness level is strong [15].
Validity and reliability
This study reproduced a survey from a previous study that had
been tested and cited several times [15,21,22]. The validity pro-
cess comprised two stages, screening the content and excluding
the items that did not focus on the research question (i.e., natural
disaster). The reliability test was presented based on the total par-
ticipants of this study to show the consistency level of the survey
experience as RN less than two years and 7 respondents did not
complete the survey). Finally, only 214 questionnaires (84.25%)
were included for data analysis.
Demographic characteristics
Table 1 shows the CHN coordinators’ demographic characteris-
tics including age, experience as RN and CHN coordinator that are
presented in continuous data (central tendency). The CHN coordi-
nators participating in this study were aged between 22 and 48
years with a median age of 31 years. The experience as RN ranged
from 2 to 26 years with a median of 10 years. The experience as CHN
coordinator ranged from 1 to 16 years with a median of 2 years.
These data indicate that although respondents’ experience as RN
is varied, it can be seen that majority of the respondents were less
experience as CHN coordinators in their workplaces.
Table 2 indicates the CHN coordinators’ characteristics includ-
ing district disaster prone level, gender, age, highest educational
level attained, experience as RN and CHN coordinator. The findings
show the majority of the CHN coordinators were female (66.8%,
n = 143), came from high disaster prone level areas (54.2%, n = 116)
and had attained diploma in nursing as their highest educational
Table 1
Respondents’ baseline data related to age, experience as RN and CHNC in year.
Variables n Median IQR Mode Min Max

after being translated into Bahasa Indonesia. Q1 Q3

Cronbach’s alphas internal consistency for the original instru- Age (year) 214 31 27.75 37 29 22 48
ment were ranging from 0.91 to 0.93 from three domain level of Experience as RN (year) 214 10 5 14 6 2 26
preparedness (disaster preparedness, response and recovery) [21]. Experience as CHNC (year) 214 2 1 3 1 1 16
This tool also have been translated into the Classical Arabic version
where the overall reliability of the survey as measured by Cron-
Table 2
bach’s alpha was 0.93 [22]. In this study, it was found that the Respondents’ characteristics related to workplace, district prone levels, gender, age
Cronbach’s alpha for the complete instrument was 0.95, which indi- groups, educational levels, experience as RN and CHNC, previous participation in
cates an excellent internal consistency and supports the reliability any disaster courses and in a real disaster (N = 214).
of the original tool [21,22]. Internal consistency was also calculated Variables n %
for the three domains measured. Cronbach’s alpha for the knowl-
District disaster-prone level
edge subscale was 0.83, for the skills subscale was 0.83 and 0.94
Low 12 5.6
for the PDM subscale. All of those values indicated strong internal Moderate 86 40.2
consistency [25–27]. High 116 54.2
Gender
Data analysis Male 71 33.2
Female 143 66.8
Age group
The data were presented with descriptive statistics such as fre- 22–29 years old 82 38.3
quencies, percentages and measures of central tendency. Median 30–39 years old 94 43.9
and Inter-Quartile Range/IQR measures were preferred because the 40–48 years old 38 17.8
Highest educational level attained
data were not normally distributed [27,28].
Postgraduate 7 3.3
Undergraduate 82 38.3
Ethical consideration Diploma in nursing 125 58.4
Experience as RN
This study has gained ethical approval from The University of 2–10 years 119 55.6
11–19 years 72 33.7
Melbourne Human Research Ethics Committee (HREC). Research ≥20 years 23 10.7
permits were also obtained from the South Sulawesi Government Experience as CHNC
and Provincial Health Office before commencing this study. ≤3 years 164 76.6
>3 years 50 23.4
Participation in any disaster courses
Results
Yes 71 33.2
No 143 66.8
Questionnaire response The course meet the need for preparedness (n = 71)
Yes 60 84.5
During the study period, 254 questionnaires were distributed to No 11 15.5
Participation in real disaster
CHN coordinators in South Sulawesi, Indonesia. 238 were returned, Yes 54 25.2
representing a 93.7% response rate. After data cleaning, 24 ques- No 160 74.8
tionnaires were excluded (4 respondents had nursing educational If yes, did you feel prepared? (n = 54)
background lower than three year nursing diploma, 6 respondents Yes 47 87.0
No 7 13.0
did not have nursing educational background, 7 respondents had
26 Moh.S. Sangkala, M.F. Gerdtz / Australasian Emergency Care 21 (2018) 23–30
level (58.4%, n = 125). About 43.9% (n = 94) CHN coordinators had
age range between 30 and 39 years. More than half CHN coordi-
nators (55.6%, n = 119) had experience as RN less or equal than 10
years and more than three quarters of them (76.6%, n = 164) have
been coordinators less than or equal to 3 years.
Disaster training and participation in a real disaster are valuable
experiences to improve disaster preparedness and management.
Among the CHN coordinators, there were only 33.2% (n = 71) who
had participated in disaster courses/trainings. About 84.5% (n = 60)
of them felt that the course met the need for disaster preparedness.
In reference to participation in a real disaster, there were only 25.2%
(n = 54) CHN coordinators that had participated in a real disaster
since they have been coordinators and the majority of them (87%,
n = 47) felt prepared when participating in the disasters.
Disaster preparedness levels
Study findings related to the CHN coordinators disaster pre-
paredness levels are presented in Tables 3 and 4. Table 3 highlights
the median scores for each question in three domains of disaster
preparedness measured (perceived knowledge, skills and PDM).
Overall levels of disaster preparedness for all CHN coordinator
respondents are presented in Table 4.
Knowledge
®
The first domain measured on the DPET was related to knowl-
edge. It included 13 items with answers ranging from 1 to 6
(strongly disagree to strongly agree). Respondents considered
themselves weakly prepared because they perceived that it was
difficult to find relevant information about disaster prepared-
ness related to their community needs (Median = 2, IQR = 2–3).
For all other areas of the knowledge domain, the CHN coordi-
nators perceived themselves moderately and strongly prepared
(see Table 3).
Skills
® the perceived clinical skills levels for disaster management partic-
There were eight DPET items related to skills, with answers
ranging from 1 to 6 (Strongly Disagree to Strongly Agree). Respon-
dents perceived themselves moderately prepared for participating
in creating new guidelines, emergency plans, or lobbying for
improvement at the local or national level (Median = 4, IQR = 2–5);
for being considered as a key leadership figure in their commu-
nity in a disaster situation (Median = 4, IQR = 2–5); and for having
an agreement with loved one and family members on how to exe-
cute their personal/family emergency plans (Median = 4, IQR = 3–5).
For all other areas of the skills domain, the CHN coordinators
perceived themselves strongly prepared and possessed these skills
(see Table 3).
Preparation for disaster management (PDM)
®
There were 17 DPET items related to PDM domain, with
answers ranging from 1 to 6 (Strongly Disagree to Strongly
Agree). Respondents perceived themselves moderately prepared
for majority of areas measured such as PTSD identification and psy-
chological intervention (Median = 4, IQR = 3–5). For all other areas
of the PDM domain, the CHN coordinators considered themselves
strongly prepared (see Table 3).
Finally, the results indicate that the majority of the CHN coor-
dinators perceived themselves moderately prepared for disaster
management in the three domains measured (knowledge, skills,
PDM) and total domain scores. It was found that 6.5% (n = 14) of the
CHN coordinators described their current disaster preparedness as
weak; 84.6% (n = 181) as moderate; and 8.9% (n = 19) as strong (see
Table 4).
Learning needs
Study findings related to the CHN coordinators learning needs
are presented in Table 5. It highlights the CHN coordinators’ main
source of knowledge and skills regarding disaster preparedness and
preferable effective learning methods for disaster preparedness.
It was found that around one third of all CHN coordinators
(32.2%, n = 69) considered undergraduate/graduate nursing pro-
gram as their main source of disaster knowledge and skills. While,
more than forty percent of CHN coordinators indicated continu-
ing disaster class/training and facility drills as their main sources
of disaster knowledge and skills. Furthermore, the CHN coordi-
nators were asked to identify their perception of effective learning
methods for disaster preparedness. The findings show that fre-
quent disaster drills/training (32.9%, f = 200), participating in a
real disaster (23.9%, f = 145) and including disaster programs in an
academic curriculum (20.1%, f = 122) as the most preferable meth-
ods to achieve effective disaster preparedness and management
perceived by the CHN coordinators.
Discussion
This study sought to identify current levels of disaster pre-
paredness and learning needs for effective disaster preparedness
and management among CHN coordinators in South Sulawesi,
Indonesia. The results of this study have highlighted several areas
for future research and implications for CHN coordinators practice
relating to disaster preparedness, learning needs and management.
Overall, the perceived levels of disaster preparedness of CHN
coordinators in South Sulawesi Province Indonesia were found to
be at a moderate level. These findings are slightly different to a
previous study by Al Khalaileh et al. [15], using the same sur-
vey instrument. These researchers found low levels of perceived
disaster preparedness among nurses working in hospital settings.
However, the results of the current research are consistent with
a study by Husna et al. [29] who conducted a survey to measure
ularly in relation to tsunami care (which is also one of the domains
measured by the researchers in this study although not specific
to tsunamis) for 78 nurses in a provincial hospital in Banda Aceh
Indonesia. These researchers found that the majority of the respon-
dents rated their perceived clinical skills at a moderate level.
There is an increase in the awareness of the need for disas-
ter preparedness and management in Indonesia in the last decade
especially after tsunami in Aceh Province in 2004 and recurrent
natural disaster in Sumatera and Java Islands in 2008. This can be
seen from the disaster risk reduction efforts started at community
level such as the amend of health centers as part of the national
emergency management system and community-based rehabili-
tation center [7,10,30,31]. Specifically in South Sulawesi Province,
there has been ongoing research collaboration among provincial
health office of South Sulawesi, Nursing Study Program of Hasanud-
din University Indonesia and College of Nursing Art and Science
and Research Institute of Nursing Care for People and Commu-
nity the University of Hyogo Japan [32] that focus on community
health nursing in South Sulawesi province in which disaster nurs-
ing is incorporated within the CHN program [33]. These factors may
contribute to the slightly higher perceived level of current disaster
preparedness of the CHN coordinators in South Sulawesi Indonesia.
In respect to the domains of the survey which measured CHN
coordinators’ perceived knowledge regarding disaster prepared-
ness, the participants in this study reported moderate to strong
levels of perceived knowledge. Interestingly, the lowest response
item in this domain reported difficulties in finding relevant infor-
mation or literature about disaster preparedness and management.
 Moh.S. Sangkala, M.F. Gerdtz / Australasian Emergency Care 21 (2018) 23–30 27

Table 3
CHNCs’ level of knowledge, skills & preparedness for disaster management.

No. Item statistics (knowledge) Median IQR n

1 Q1 I participate in disaster drills or exercises at my workplace regularly at least every two 5 4–5 214
years.
2 Q2 I have participated in emergency plan drafting and emergency planning for disaster 5 3–5 214
situations in my community.
3 Q3 I know who to contact in disaster situations in my community. 5 5–5 214
4 Q4 I participate in one of the following educational activities regularly: continuing education 5 3–5 214
classes, seminars, or conferences dealing with disaster preparedness.
5 Q5 I read journal articles, books and literatures related to disaster preparedness and 5 4–5 214
management.
6 Q6 I aware of classes about disaster preparedness and management that are offered for 5 4–5 214
example at either my workplace, the university, or community.
7 Q7 I would be interested in educational classes on disaster preparedness that relate 5 5–6 214
specifically to my community situation.
8 Q8 I find that literatures (journal article, books, etc.) related to disaster preparedness and 4 2–5 214
management is easily accessible.
9 Q9 I find that the research literature on disaster preparedness is understandable. 4 3–5 214
10 Q11 Finding relevant information about disaster preparedness related to my community needs 2 2–3 214
is an obstacle to my level of preparedness.
11 Q12 I know where to find relevant research or information related to disaster preparedness 4 2–5 214
and management to fill in gaps in my knowledge.
12 Q13 I have a list of contacts in the medical or health community in which I practice and I know 5 4–5 214
referral contacts in case of a disaster situation (health department, e.g.).
13 Q14 In case of a disaster situation, I think that there is sufficient support from local officials on 5 4–5 214
the country, region or governance level.

No. Item statistics (skills) Median IQR n

1 Q10 I consider myself prepared for the management of disasters. 5 4–5 214
2 Q15 I participate/have participated in creating new guidelines, emergency plans, or lobbying 4 2–5 214
for improvements on the local or national level.
3 Q16 I would be considered a key leadership figure in my community in a disaster situation. 4 2–5 214
4 Q17 I aware of what the potential risks in my community are (e.g. earthquake, floods, terror, 5 4–5 214
etc.).
5 Q19 I am familiar with the local emergency response system for disasters. 5 4–5 214
6 Q20 I am familiar with accepted triage principles used in disaster situations. 5 4–5 214
7 Q21 I have personal/family emergency plans in place for disaster situations. 5 4–5 214
8 Q22 I have an agreement with loved ones and family members on how to execute our 4 3–5 214
personal/family emergency plans.

No. Item statistics (preparation for disaster management) Median IQR n

1 Q18 I know the limits of my knowledge, skills, and authority as an RN to act in disaster 5 5–5 214
situations and I would know when I exceed them.
2 Q23 I can identify possible indicators of mass exposure evidenced by a clustering of patients 5 4–5 214
with similar symptoms.
3 Q24 I can manage the common symptoms and reactions of disaster survivors that are of 5 4–5 214
affective, behavioral, cognitive, and physical nature.
4 Q25 I am familiar with psychological interventions, behavioral therapy, cognitive strategies, 4 3–5 214
support groups and incident debriefing for patients who experience emotional or physical
trauma.
5 Q26 I am able to describe my role in the response phase of a disaster in the context of my 4 3–5 214
workplace, the general public, media, and personal contacts.
6 Q27 As an RN, I would feel confident in my abilities as a direct care provider and first responder 5 4–5 214
in disaster situations.
7 Q28 As an RN, I would feel confident as a manager or coordinator of a shelter. 5 4–5 214
8 Q29 I feel reasonably confident I can care for patients independently without supervision of a 4 3–5 214
physician in a disaster situation.
9 Q30 I am familiar with the organizational logistics and roles among local and national agencies 4 3–5 214
in disaster response situations.
10 Q31 I would feel confident implementing emergency plans, evacuation procedures, and similar 4 3–5 214
functions.
11 Q32 I would feel confident providing patient education on stress and abnormal functioning 5 4–5 214
related to trauma.
12 Q33 I would feel confident providing education on coping skills and training for patients who 5 4–5 214
experience traumatic situations so they are able to manage themselves.
13 Q34 I am able to differentiate the signs and symptoms of Acute Stress disorder and Post 4 3–5 214
Traumatic Stress Disorders (PTSD).
14 Q35 I am familiar with what the scope of my role as a registered nurse in a post-disaster 5 4–5 214
situation would be.
15 Q36 I participate in peer evaluation of skills on disaster preparedness and response. 4 3–5 214
16 Q37 I am familiar with how to perform focused health assessment for PTSD. 4 3–5 214
17 Q38 I feel confident managing (caring, evaluating) emotional outcomes for Acute Stress 4 3–5 214
Disorder or PTSD following disaster or trauma in a multi-disciplinary way such as
referrals, and follow-ups and I know what to expect in ensuing months.
28 Moh.S. Sangkala, M.F. Gerdtz / Australasian Emergency Care 21 (2018) 23–30

Table 4
The CHNCs’ current levels of disaster preparedness (n = 214).

Domain Level of preparedness Median of average scorea IQR

Weak Moderate Strong

n % n % n %

Knowledge 15 7.0 182 85.1 17 7.9 4.31 3.62–4.69

Skills 17 7.9 170 79.5 27 12.6 4.25 3.63–4.75
PDMb 15 7.0 168 78.5 31 14.5 4.29 3.71–4.82
Total fields 14 6.5 181 84.6 19 8.9 4.26 3.73–4.69
a
Responses ranging from 1 = strongly disagree to 6 = strongly agree.
b
Preparation for disaster management.

Table 5 sufficient knowledge and skills to deliver effective psychological

Main sources of disaster knowledge and skills (n = 214), and effective learning meth-
ods for disaster preparedness.
Main sources of disaster knowledge and skills n %
Undergraduate/graduate nursing program 69
Continuing disaster class/training 57
Facility drills 34
Participate in real disaster 26
Others (Self-study: books, media/news, internet) 28
Effective learning methods for disaster preparedness fa
Frequent disaster drill/training 200
Participate in real disaster 145
Include this course in academic curriculum 122
Online web-based learning 49
Videotapes/CD/DVD 32
Self-instruction 21
Videoconferencing 20
Newsletter/Pamphlets 16
Involve in disaster planning 2 0.3
Total 607
a for disaster preparedness (see Table 5).
Responses are not based on the number of participants.
This response was relevant with the lead author observation when
visiting the Community Health Centres, where majority of the cen-
ters did not have libraries. It was also worsened by difficult access
of either transportation or communication and information such
as internet for some remote areas. The availability of information
and literature is the key factor in supporting clinical staff to keep
their knowledge up to date and practice current [34]. Limited access
to published research literature may significantly impact effective
disaster preparedness and management [35].
The results of this study also found that the perceived skills
domain of the CHN coordinators was slightly better that their
perceived knowledge where all responses ranged from moderate to
strong levels. The lowest responses related to participation in creat-
ing new guidelines, emergency plans or lobbying for improvements
on the local and national level, and consideration as a key leadership
figure in a disaster situation. Powers and Daily [11] identified that
nurses sometimes are not involved in the development of disaster
plans in many countries due to a lack of professional recognition
and/or gender. This lack of involvement may affect the implementa-
tion of the plan because the nurses may do not fully understand the
disaster response plan that subsequently cause ineffective delivery
in healthcare during and after disaster impact.
The perceived PDM domain showed responses that ranged
between moderate to strong levels. The lowest responses of the
CHN coordinators showed that the CHN coordinators felt less con-
fident on skills related to the psychological interventions and PTSD
management. These findings indicate the need to improve the CHN
coordinators preparedness in relation to mental health nursing
after disaster because mental health problems are one of the great
burdens especially after disaster [36]. This issue also has been inte-
grated into disaster nursing competencies to ensure nurses have
intervention to reduce the incidence of the problems [11,14,23].
Identification of learning needs and the preferred style of deliv-
ery is an important step in optimizing disaster preparedness and
32.2 management including in Indonesia [17,37]. In reference to the
26.6 previous discussion above related to disaster preparedness level,
15.9
particularly on the preparedness for disaster management domain,
12.2
13.1 the finding stressed the need to improve the CHN coordinators’
preparedness related to post-disaster management, specifically
% psychological intervention and PTSD management.
32.9
Another noteworthy finding of this research related to the CHN
23.9 coordinators learning needs identified to achieve effective disas-
20.1 ter preparedness and management in community level. It was
8.1 found that the majority of the CHN coordinators consider frequent
5.3
disaster drills/training, Participating in real disasters and including
3.5
3.3 disaster nursing in the academic curriculum as effective mecha-
2.6 nism for optimizing disaster preparedness. These findings relevant
with the participants’ responses to the main sources of their disas-
100 ter knowledge and skills and effective learning method preference
From the literature, several approaches have been highlighted
to assist in improving the efficacy of disaster management [37–39].
Wang et al., [39] conducted a pre- and post-test and semi-structure
interviews to evaluate an emergency preparedness training pro-
gram among 76 public health staff in China. These researchers
found that the emergency preparedness training improved partic-
ipants’ knowledge level and increased attitudinal and behavioral
intention scores for emergency preparedness. In another study,
Vincent et al. [40] conducted research with 182 healthcare
providers from eight Asia-Pacific countries that participated in four
simulation seminars and found that simulation/drills-based train-
ings were considered effective methods for managing emergency
and disaster situations and were able to overcome language and
cultural barriers. These findings are consistent with a study by Mor-
rison and Catanzaro [38] and Simpson [41] that also found similar
results and supported that the disaster drills/training as one of
the best methods to achieve effective disaster preparedness and
management.
In reference to the participation in a real disaster, Mitani et al.
[42] emphasized the importance of integrating disaster dispatch as
a part of nursing duties especially for those who work in commu-
nity settings. Participation in a real disaster situation will involve
learning, experiencing and reflecting process that is considerably
effective to increase the retention of information (knowledge and
skills) in relation to disaster preparedness and management [37].
Finally, including a disaster nursing course in academic nursing
curriculum in Indonesia was preferred by the CHN coordinators in
this study. Fung et al. [16] and Chapman and Arbon [43] emphasized
the imperative to integrate and standardize the disaster nursing
management into the basic education for nurses. Despite the evi-
dence that Indonesia is a country that is prone to natural disaster,
unfortunately, disaster nursing subject has just been incorporated
in national nursing curricula in the late 2015 [44]. Anecdotally,
 Moh.S. Sangkala, M.F. Gerdtz / Australasian Emergency Care 21 (2018) 23–30
some universities/colleges in Indonesia have included the topic as
their additional subject before nationally standardized; there were
possibility differences in the level of knowledge and competence
obtained by the nurse students.
Implications of the findings for practice
The study findings have significant implications for disaster
preparedness and management of CHN coordinators in Indonesia
particularly in South Sulawesi Province. This is the first large scale
study in Indonesia that focuses on disaster preparedness and man-
agement in community health settings. This study revealed areas
for improvement and learning needs for effective disaster pre-
paredness and management in community level.
The study results support recommendations in disaster pre-
paredness and management area. Firstly, it is imperative to provide
effective and continuous disaster programs for nurses particularly
those working in community settings that are designed based on
their learning needs to achieve the optimal level of disaster pre-
paredness and management.
Finally, Indonesia is a disaster prone area country, thus incorpo-
rates disaster nursing competence into national nursing curriculum
is imperative to ensure Indonesian nurses acquire standardized
knowledge and skills required to participate in any disaster inci-
dence.
Recommendations for future research
Future research can involve interviews with nurses, disaster
team, nursing educator, disaster manager and policy maker to iden-
tify their perception about the effectiveness of current disaster
management and to explore learning needs for disaster man-
agement generally. Furthermore, action research or experimental
studies may necessary to evaluate educational programs developed
based on these study findings.
Strengths of the study
There are many strengths of this study. Firstly, this research was
relatively new in Indonesia especially in the eastern region of the
country that focused on community health level and answering
previously unanswered questions related to disaster preparedness
and management which is important given context. Secondly, it
was a large-scale study that covered one province in Indonesia
(South Sulawesi) and invited participation of more than a half of the
CHN coordinator population in the province. Thirdly, although this
study used a validated instrument that was translated into Bahasa
Indonesia; the researcher of this study had performed the content
validity and the reliability test for the total participants that show
a high consistency level as the original survey. Finally, the results
indicate the perceived current level of disaster preparedness and
learning needs of the CHN coordinators for effective disaster pre-
paredness in community level that can be a baseline data to develop
suitable educational programs to improve the nurses’ disaster pre-
paredness and management.
Limitations of the study
There are also some limitations in this study. This study used
a consecutive sampling method for data collection that conducted
during international seminar and workshop of community health
nursing organized by Nursing Study Program of Hasanuddin Uni-
versity, Provincial Health Office of South Sulawesi and University of
Hyogo Japan on 13–14 September 2011, thus it is possible that there
were over-representative of CHN coordinators that came from cer-
tain districts in the province. In addition, this study was conducted
29
in the South Sulawesi province that has experienced low disaster
incidences and those did not considered as large scale disasters,
thus this result may not be applicable for the provinces/areas that
have high/frequent disaster incidence areas like in Java and Sumat-
era islands. However, It is important to be noted that half districts in
this province are categorized in high disaster prone level areas [6],
therefore it is critical to ensure all potentially participated groups
in disaster such as community nurse hold necessary competences
before participating in real disaster when it strikes.
Conclusion
This study was conducted to identify the current level of disas-
ter preparedness as perceived by CHN coordinators working in
community health settings in South Sulawesi Indonesia and to
define learning needs for effective disaster preparedness and man-
agement in their workplace. The results indicate that majority of
the CHN coordinators perceived themselves moderately prepared
for disaster management. In reference to the learning needs, the
CHN coordinators perceived frequent disaster drills/training, par-
ticipating in real disaster and including disaster nursing course in
academic curriculum as the most effective methods for successful
disaster preparedness and management.
This study provides information regarding the current disaster
preparedness level of the CHN coordinators to achieve effective
disaster preparedness and management in community settings
in Indonesia particularly in South Sulawesi province. The study
also identifies area for improvement that can be used to develop
effective educational program and disaster nursing curriculum to
improve nurse disaster preparedness and management.
Acknowledgment
The authors would like to gratitude to Prof. Elaine Bond, Prof.
Murad A. Al Khalaileh and colleagues for permitting me to adopt
the DPET instrument in to Indonesia version. I also thank to all my
colleagues in the School of Nursing of Hasanuddin University for all
supports during this study.
Provenance and conflict of interest
The authors declared no conflicts of interest. This article was not
commissioned.
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