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ORIGINAL ARTICLE |
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Year : 2016 | Volume
: 4
| Issue : 2 | Page : 63-66 |
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Are our hospitals prepared for disasters? Evaluation of health-care staff vis-à-vis disaster management at a public hospital in India
Sruti Sharma, Vipin Koushal, Navin Pandey
Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Date of Web Publication | 1-Jun-2016 |
Correspondence Address: Navin Pandey Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012 India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/2347-9019.183231
Background: Hospitals are the last line of defense against losses due to disasters. However, the prerequisite for hospitals to be able to measure up to the challenge is a sensitive, well-informed, and trained hospital staff. This study attempted to evaluate the knowledge, attitude, and practices of staff at a public hospital toward disaster management. Methods: This is a questionnaire-based cross-sectional study conducted at the Government Medical College and Hospital-32, a tertiary care public hospital in India. Questionnaire used for this study was prepared by the study team to evaluate the knowledge and attitude of hospital staff by modification of a questionnaire used for a similar study in South Africa. Results: Hospital staff, in general, was found to be sensitive toward disaster management, but their level of awareness regarding the same was low. Nurses were found to be significantly more informed than other staff whereas doctors were found to have the most positive attitude toward disaster management. Conclusion: Low knowledge regarding disaster management among hospital staff, as shown in this study, can have catastrophic consequences. Policy-makers and hospital management need to spend time and resources on training hospital staff in disaster management. Keywords: Awareness, disaster management, hospital staff
How to cite this article: Sharma S, Koushal V, Pandey N. Are our hospitals prepared for disasters? Evaluation of health-care staff vis-à-vis disaster management at a public hospital in India. Int J Health Syst Disaster Manage 2016;4:63-6 |
How to cite this URL: Sharma S, Koushal V, Pandey N. Are our hospitals prepared for disasters? Evaluation of health-care staff vis-à-vis disaster management at a public hospital in India. Int J Health Syst Disaster Manage [serial online] 2016 [cited 2024 Mar 29];4:63-6. Available from: https://www.ijhsdm.org/text.asp?2016/4/2/63/183231 |
Introduction | | |
The word disaster implies a sudden overwhelming and unforeseen event. [1] A disaster is a natural or man-made (or technological) hazard resulting in an event of substantial extent causing significant physical damage or destruction, loss of life, or drastic change to the environment. The WHO defines 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." [2] A disaster is any tragic event stemming from events such as earthquakes, floods, catastrophic accidents, fire, or explosions. Developing countries pay the greatest price - more than 95% of all deaths caused by disasters occur in developing countries, and losses due to natural disasters are 20 times greater (as a percentage of gross domestic product) in developing countries than in industrialized countries. [3] The loss in terms of private, community, and public assets due to disasters in India has been astronomical. [4],[5] At the global level, there has been considerable concern over natural disasters. Even as substantial scientific and material progress is made, the loss of lives and property due to disasters has not decreased. In fact, the human toll and economic losses have mounted. It was an effort by United Nations General Assembly to spread awareness about disaster awareness and preparedness, especially among developing countries. Another objective was sharing of data and expertise vis-a-vis disasters amongst different countries. [4]
Hospitals are the last line of defense against loss of human lives due to disasters. Hospitals need to be prepared to handle the overwhelmingly huge workload consequent to disasters. This necessitates a well-documented and tested disaster management plan (DMP) in every hospital. [6] More importantly, hospital staff working in any capacity need to be fully aware of the concepts of disaster management and well prepared to handle a disaster. This is one of the vital ways to mitigate the loss of human life due to disasters. This study was conducted with the aim of evaluating knowledge, attitude, and practices of healthcare workers vis'-a-vis' disaster management in a tertiary care public hospital in India.
Methods | | |
This is a cross-sectional questionnaire-based study conducted at the Government Medical College and Hospital-32, a multispecialty public hospital serving a population of around 11 lacs of North India. [7] The study population included all health-care staff working in the emergency area of the hospital. The study tool was a semi-structured questionnaire developed by the study by modifying the questionnaire used by Moabi in a similar study done at the University of Witwatersrand at Johannesburg, South Africa. [8] The first part of this questionnaire evaluated the awareness of study participants regarding disaster management through closed-ended questions. To analyze the results of this section, every positive response was given a score of 1 and every negative response a score of 0 with a maximum possible score of 8 and minimum of 0. The second part of this questionnaire evaluated the attitude of participants toward disaster management. The responses of the participants in this section were categorized into positive, negative, and unsure to analyze the results of this section. Each positive response was given a score of 1 whereas negative and unsure were given a score of 0 with a maximum of 10 and minimum of 0. The last part evaluated the practices followed by the hospital vis-à-vis training its staff in disaster management. One sample Kolmogorov-Smirnov test and Kruskal-Wallis test were used to check the normality of data and compare knowledge and attitude scores among different groups of study population, respectively. All statistical tests were two-sided and performed at a significance level of α = 0.05 using SPSS for Windows (version 16.0; SPSS Inc., Chicago, IL, USA).
Results | | |
One hundred and sixty-eight health-care workers out of a total staff of 200 workers were evaluated. The study sample comprised 38 (22.6%) doctors, 46 (27.6%) nurses, 48 (28.6%) technicians, and 36 (21.4%) administrative staff. Nearly, 54.8% (n = 92) of the study sample had been working in the hospital for <5 years, 17.3% (n = 29) for 10-15 years, 14.9% (n = 25) for 15-20 years, and 13.1% (n = 22) for a period 5-10 years.
Nearly, 40.5% (n = 68) of the study participants knew the concept of a disaster plan whereas 61.3% (n = 103) were aware of disaster drills. Eighty-four percent (n = 135) were aware of the location of disaster kit in the hospital, but only 56.5% (n = 95) knew about the concept of disaster kit [Table 1]. Analysis of scores obtained in the knowledge section of study tool by the four categories of evaluated health-care workers revealed nurses to have a significantly higher score [Table 2]. The nurses had the highest mean rank of 114.93 followed by doctors with a mean rank of 85.97, administrators with a mean rank of 74.71, and finally the technicians who managed a mean rank of 61.51. This difference was found to be statistically significant with χ2 (3) = 31.519, P < 0.001. | Table 2: Knowledge and attitude scores of health-care workers vis-à-vis disaster management
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The results showed that 140 (83.3%) out of 168 healthcare workers evaluated had a positive attitude vis'-a-vis', the fact that all health-care workers should be aware of the disaster plan, and 155 (90.5%) felt that training for disaster preparedness is essential for all staff. One hundred and thirty-nine (82.7%) agreed that management should be prepared for disaster [Table 3]. The comparison of the attitude scores showed that doctors with a mean rank of 104.08 had the highest positive attitude followed by nurses with a mean rank of 97.7 and least was seen in the technicians who managed a mean rank of 53.29 [Table 3]. This difference in attitude was found to be statistically significant with χ2 (3) = 26.747, P ≤ 0.001. Almost all health-care workers evaluated felt that disaster drills should be conducted regularly. Seventy percent of the participants were not aware of any such drills being conducted at the study institution whereas 93% of the participants were not aware if the study institution was conducting any training for disaster preparedness.
Discussion | | |
Disaster preparedness is the need of the hour to mitigate losses. Every hospital staff working in any capacity needs to be aware and trained vis'-a-vis' disaster management. This study revealed low awareness of concepts of disaster management among hospital staff. The administrative staff and technicians had a lesser awareness though they had been working at the hospital for a greater period. The study also clearly revealed that majority of the hospital staff evaluated had a positive attitude toward preparing for disaster. This is a sign for policy-makers to initiate capacity building programs vis'- a-vis' disaster preparedness in hospitals.
A study done by Moabi [8] at Johannesburg, South Africa, had also found that selected health-care workers were aware of disaster preparedness plans, and their attitudes to drills were largely positive. However, the practices were deficient, and work is needed to be done on training, performance of drills, and the frequency of updating of plans. These correspond with the findings of our study. Similar results were obtained by Onandjokwe in his study conducted at Lutheran Hospital in Namibia to evaluate the knowledge, attitude, and practices of health-care workers regarding disaster preparedness. [9]
This study revealed that among all health-care workers, nurses were the most aware of concepts of disaster management in contrast to a study conducted in Hong Kong, which found nurses to be inadequately prepared for disasters. [10] Another study conducted in China at four tertiary hospitals and two secondary hospitals showed that nurses managed average percentage scores of 66.33%, 68.87%, and 67.60% in the domains of knowledge, attitudes, and practice, respectively. [11] The nursing cadre is a huge and vital group in any hospital and this group needs to be completely aware and trained vis-à-vis concepts of disaster management. This group can then be utilized to train all other health-care workers. A study conducted on nurses working in emergency areas and community health nurses in Saudi Arabia revealed a greater positive attitude toward disaster preparedness among nurses attending disaster-related education. [12]
The demands on hospital resources are huge in current times. However, policy-makers and hospital management have to realize that continuous education and training of hospital staff is a vital requirement to prevent catastrophic losses due to a disaster. This study showed that almost 70% of the hospital staff was not aware of any disaster drills being conducted at the study institution. This corresponds with the findings of a study conducted by Lutheran where only 2% of staff was aware of any disaster drills conducted in their hospital. [9] Preparedness for disasters is a dynamic process. A well-documented DMP with regular training of hospital staff is absolutely essential for disaster preparedness. However, without regular drills on the lines of DMP, no institution can ever be sure of its disaster preparedness. The drills can be in the form of actual disaster drills, computer simulations, and tabletop or other exercises. [13] The Joint Commission on Accreditation of Healthcare Organizations actually requires hospitals to test their emergency plan twice a year, including at least one community-wide drill. [14]
Conclusion | | |
The quotation of Norman Schwarzkopf, "The more you sweat in peace, the less you bleed in war" holds absolutely true in the context of disaster preparedness. A study evaluating undergraduate students in Karachi found that students with formal training in first aid were better aware of the concepts of disaster management than other students. [15] There is no doubt regarding the absolute necessity of training hospital staff or for that matter staff at any institution for disaster management, but maybe incorporating training in first aid at school level itself should help in developing better prepared and aware workers of the future.
Acknowledgement
All the authors acknowledged have contributed significantly in the preparation of this manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]
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