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Australasian Emergency Nursing Journal xxx (2016) xxxxxx
Contents lists available at ScienceDirect
Australasian Emergency Nursing Journal

journal homepage: www.elsevier.com/locate/aenj
Research paper
Disaster management: Emergency nursing and medical personnels

knowledge, attitude and practices of the East Coast region hospitals of
Malaysia
NurulAin Ahayalimudin (RN, MCHSc.) a, , Nor Naimah Saidah Osman (RN, BN) b,
a
b
Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, 25100 Kuantan, Pahang, Malaysia
Kulliyyah of Nursing, International Islamic University Malaysia, 25100 Kuantan, Pahang, Malaysia
a r t i c l e
i n f o
Article history:
Received 10 February 2016
Received in revised form 28 July 2016
Accepted 3 August 2016
Available online xxx
Keywords:
Disaster management
Emergency nursing
Emergency medical personnel
Knowledge
Attitude and practices
East Coast region hospitals
Malaysia
a b s t r a c t
Background: Disaster management is critical, as its insight could diminish the impact of a disaster, and participation of emergency medical personnel is crucial. This study explores emergency medical personnels
knowledge, attitude and practice towards disaster management.
Methodology: This study utilised a cross-sectional study design, and the data collected from 194 emergency nursing and medical personnel (staff nurses, doctors and assistant medical ofcers), using a
questionnaire.
Results: Majority of the personnel had an adequate knowledge and practices, and portrayed a positive attitude towards disaster management. Amongst the sociodemographic factors studied, gender and
education level were signicantly associated with increased knowledge and practice scores. Working
experience, involvement in disaster response and attended disaster training had a signicant association with higher practice scores. None of the sociodemographic factors studied had an effect on attitude
scores.
Conclusion: Despite the diversity of their backgrounds, respondents exhibited their adequate knowledge
and practice, and had positive attitudes towards disaster management. It is substantial for emergency
nursing and medical personnel, to inhibit the severity of the impacts of the disasters. Their knowledge,
attitude and practice studies could assist in the implementation of programmes relevant to disaster
management to ensure their preparedness to assist the affected communities.
2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
Introduction
In recent years, the world has been affected by the increasing incidence of major disasters, such as earthquakes, hurricanes,
oods and tsunamis. These events involve an enormous number
of deaths, damaged properties, and affect the economy of the
countries concerned. The number of people affected by disasters
worldwide has increased by 17 percent over the past few decades
[1]. Indeed, a disaster does not only refer to catastrophic natural
disasters, but it also includes technological disasters [2,3,4].
Disaster is dened as a serious disruption of the functioning
of the 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
Corresponding authors.
E-mail addresses: ainyanun@iium.edu.my, ainyanun98@gmail.com
(N. Ahayalimudin), naimahosman@gmail.com (N.N.S. Osman).
[5]. Unlike neighbouring countries, Malaysia has not been struck

by large-scale disasters, such as volcanoes and typhoons, thanks to
its geographical topography. Rather, Malaysia often faces localised
disasters, such as oods, hazes, landslides and pandemics. However, since the millennium years, tsunami and earthquakes have
begun appearing. When this happens, the health care personnel, in
particular, those who work in hospitals play active roles in assisting
the community affected.
Disaster management came to the attention of Malaysian government after the event of building collapsed in 1997 [6,7]. Ever
since, the government began to improve the planning of disaster management, establishing National Security Council Directive
No.20; on the Policy and Mechanism on National Disaster Relief
and Management. The Directive No.20, the main policy for disaster
management in Malaysia, guides agencies across the nation managing disaster and its aftermath [8]. Emergency nursing and medical
personnel play vital roles in situations involving human lives dur-
http://dx.doi.org/10.1016/j.aenj.2016.08.001
1574-6267/ 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Ahayalimudin N, Osman NNS. Disaster management: Emergency nursing and medical personnels knowledge, attitude and practices of the East Coast region hospitals of Malaysia. Australas Emerg Nurs J (2016),
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N. Ahayalimudin, N.N.S. Osman / Australasian Emergency Nursing Journal xxx (2016) xxxxxx
ing a disaster, yet they receive little training to the disaster that
then result in low levels of awareness due to the less exposure.
In Malaysia, the study of disaster management amongst health
care providers, primarily those who work in Emergency and
Trauma Department, is limited, despite the growing number of
disaster events [9]. The United Nation International Strategy for
Disaster Reduction (UNISDR) emphasises that hospitals and other
health care facilities are important assets to communities on a dayto-day basis, as well as during the occurrence of a disaster [10].
Since disaster is unpredictable, the failure of hospitals and emergency services to manage a disaster severely affects the community.
Due to that reason, the demand for improvement of disaster
planning and preparation with the aim of equipping the needs of
health care workers in providing care to victims is greater than
ever. Hammad and associates argue that a review of the literature
demonstrates a small volume of studies directly related to emergency nurses or emergency medical personnel with disaster [11].
Indeed, Hammad et al. [12] also reveal that emergency nurses with
disaster exposure results in better preparedness and an increase in
determination to handle the situation.
Several authors report that education and training prior to disaster response is a crucial element to prepare emergency medical
personnel beforehand [13,14], and proved to be a key feature to
handling any disasters [15]. The Ministry of Health Malaysia is yet
to mandate disaster training among the health care professionals.
However, Grey claims emergency nursing and medical personnel
must be trained and be prepared to assist the community because
of the risk of emerging disease and facing the dynamic of health
care system [16].
In order to establish the need for disaster training amongst
emergency nursing and medical personnel, it is vital to ascertain their knowledge, attitude and practices towards disaster
management. Furthermore, this study also explores which sociodemographic prole inuence knowledge, attitude and practices of
emergency nursing and medical personnel about disaster management.
Material and methods

This study was a quantitative, cross-sectional, study, which targeted all emergency nursing and medical personnel who work in
the general hospitals of three states of East Coast region of Malaysia.
Using Raosoft online calculator, the total sample of 196 required
to be representative of the entire population of 329 emergency
nursing and medical personnel (doctors, staff nurses and assistant
medical ofcers). Stratied random sampling was used to ensure
distribution across hospitals and professional groups. Houseman
ofcer, any health care students and those on leave, i.e. maternity
leave, sick leave and annual leave were excluded. A total of 196
personnel were randomly selected.
For this study, a questionnaire developed by Ahayalimudin [17]
was utilised to collect the study data. This questionnaire had three
domains: knowledge, attitude and practice. The questionnaire distribution involved a 17-item of knowledge, an 11-item of attitude
and a 14-item of practices. The questionnaire of yes-no-uncertain
choice covers the aspect ranging from the denition, classication, phases and its activities to the impacts of the disaster. A
5-Likert scale (agree-disagree-uncertain) was utilised to determine
their attitude on the involvement, phases and its activities and the
impacts of the disaster. The items for practice section comprised
of the yes-no-uncertain answer. The scores of all domains were
set to 60% cut-off point to distinguish the adequate, inadequate for
knowledge and practice, and positive, negative for attitude.
The questionnaire underwent validity and reliability testing and
was scrutinised by experts from disaster medicine, community
health medicine and nursing. Face validity was established by a

pilot study of a similar population of nurses. For the reliability test,
the questionnaire was assessed by using internal consistency after
a pilot study was carried out. A Cronbachs alpha of knowledge and
practice appears above 0.7, and 0.660 for attitude. The questionnaire was prepared with a combination of positive and negative
response to avoid leading the respondents answering merely yes
answer. The questionnaire was distributed to all personnel, and 194
responded (99.0%). This study had ethical approval from the Ministry of Health Malaysia (MOH) and International Islamic University
Malaysia (IIUM) and was carried out between March and June 2013.
Indeed, this study was awarded a research grant by IIUM.
SPSS version 19.0 was used to analyse the data. From the test
of Kolmogorov-Smirnov, skewness and kurtosis, the data demonstrated normal distribution, so means (M) and standard deviations
(SD) were presented. In addition, Chi-square and Fisher exact test
for the inferential (bivariate) were used to examine associations
between variables and for comparing the knowledge, attitude and
practices of respondents between different hospitals.
Results
Of Table 1, the majority of respondents were aged 40 years or
less (83.5%, n = 162) and this was comparable to all three hospitals. Only 16.5% (n = 32) of respondents were aged over 40 years.
In relation to gender, 46.9% (n = 91) were males and 53.1% (n = 103)
were females. There was a variation in the levels of education of the
respondents for all three hospitals. Most of the Bachelor and Masters degree holders were doctors, whereas certicate and diploma
holders were mostly nurses and assistant medical ofcers. Year of
graduation indicates those who graduated before the year 2000 had
less exposure to disaster training during their basic or undergraduate training.
Most of the respondents had four or fewer years of experience (55.15%, n = 107) and 44.8% (n = 87) had ve or more years of
experience. Respondents year of graduation was similar between
the three hospitals. In relation to the respondents involvement in
disaster response, there was a comparable distribution amongst
three hospitals. Of 194 respondents, the vast majority had attended
disaster training/education with 77.84% (n = 151), with a similar
distribution between the three hospitals.
Referring to the questionnaire, more than 80% of the respondents answered correctly of two of the items on knowledge domain
asked the denition of disaster and disaster management. More
than 60% of respondents answered yes despite no for item Based
on Malaysia guideline, disaster management phase can be divided
into ve (5) phase. The respondents replied most of the negative
response items that have been asked on disaster activities differently from the actual answer. Majority of the respondents know
that disaster will increase the risk of developing communicable
disease among the community affected as well as to the responder.
For items of attitude, more than 93% respondents agreed that
it is important for them to read and understand their institutions
disaster management plan. The majority of them were willingly
involved during disaster response. However, half of them felt that
assisting disaster victims regarding their basic needs is not their
responsibilities. The questionnaire also asked about their opinion
on the incorporation of disaster nursing management into nursing
curriculum and more than 85% agreed the authorities do so.
More than half knew the location of their disaster plan and
agreed that it could be easily accessed, with more than 60% have
read the plan and some taken initiative to read other institutions
disaster plan. In addition, more than three quarter prepared to be
involved in any disaster response and majority willing to partic-
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Table 1
Analysis of sociodemographic prole.
Variables
HC (n = 66)
HA (n = 63)
HB (n = 65)
Age
40
41
5214
78.821.2
55 8
87.312.7
5510
84.615.4
Gender
Male
Female
4521
68.231.8
1746
27.073.0
2936
44.655.4
Level of education
Certicate & Diploma
Degree & Master
47
19
71.2
28.8
55
8
87.3
12.7
52
13
80.0
20.0
Year of graduation
1999
2000
18
48
27.3
72.7
13
50
20.6
79.4
20
45
30.8
69.2
Working experience
4 Years
5 Years
38
28
57.6
42.4
35
28
55.6
44.4
34
31
52.3
47.7
Involved in disaster response

Yes
No
32
34
48.5
51.5
31
32
49.2
50.8
33
32
50.8
49.2
Attended disaster education/training

Yes
No
49
17
74.2
25.8
52
11
82.5
17.5
50
15
76.9
23.1
Table 2
Classication of knowledge by group of hospital.
Table 3
Classication of attitude by group of hospital.
Knowledge
Attitude
Adequate
n
Mean = 63.90
(SD = 11.392
HC
Mean = 66.60
(SD = 17.299)
HA
Mean = 66.60
(SD = 16.102)
HB
36
36
41
Inadequate
%
57.6
59.0
63.1
28
25
24
Positive
%
Negative
42.4
Mean = 81.61
(SD = 14.947)
HC
60
90.9
9.1
41.0
Mean = 77.27
(SD = 16.409)
HA
52
82.5
11
17.5
36.9
Mean = 86.64
(SD = 10.128)
HB
64
98.5
1.5
ipate in disaster training. Nonetheless, most of them stated that

their institutions do not regularly conduct the training for disaster.
Investigation of knowledge, attitude and practice amongst
respondents from the different hospitals showed minor distinctions from one another (Table 2). Respondents from hospital A (HA)
and Hospital B (HB) share similar results of mean, unlike Hospital
C (HC). Although the means were similar, the discrepancy of the
standard deviations suggests that adequacy of knowledge of the
emergency nursing and medical personnel of HA was slightly more
varied than HB. The HB personnel had the highest positive attitude
when compared to HA and HC (Table 3). HB had a higher mean score
for practices than HA and HC presents a higher mean of practices
than HA and HC (Table 4).
The results that of comparing between three hospitals demonstrated HA was outweighed HB and HC for knowledge scores,
whereby HB led the scores for attitude and practice domain as compared to HA and HC. This study merely comparing the scores of all
domains between those hospitals and it does not attempt to investigate the reason. Therefore, a future study could explore upon this
matter.
The majority of respondents from each hospital demonstrate
an adequate knowledge of disaster and disaster management,
and adequate practices, and a positive attitude towards disaster
Table 4
Classication of practice by group of hospital.
Practice
Adequate
Inadequate
Mean = 64.57
(SD = 24.802)
HC
48
72.7
18
27.3
Mean = 64.47
(SD = 27.018)
HA
37
58.7
26
41.3
Mean = 66.86
(SD = 23.628)
HB
43
67.2
21
32.8
management. Gender and level of education were signicantly

associated with increased knowledge and practice scores (Table 5).
None of the sociodemographic proles had an inuence on the
attitude of emergency nursing and medical personnel (Table 6).
Working experience, involvement in disaster response and attendance of disaster-related education/training were all associated
with increased practice scores (Table 7).
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Table 5
Association between socio-demographic data and knowledge.
Item
Knowledge
Adequate
Inadequate
2 value
p value
Age
40
41
10015
62.546.9
6017
37.553.1
2.710
0.100
Gender
Male
Female
62 53
67.751.5
2750
30.348.5
6.589
0.010*
Level of education
Certicate & Diploma
Degree & Master
83 32
54.282.1
70 7
45.817.9
10.001
0.002*
Year of graduation
1999
2000
31 84
60.859.6
2057
39.240.4
0.23
0.880
Working experience
4 Years
5 Years
65 50
60.758.8
4235
39.341.2
0.073
0.787

Yes
No
60 55
63.856.1
3443
36.243.9
1.187
0.276

Yes
No
93 22
62.451.2
5621
37.648.8
1.759
0.185
2 value
p value
Signicant at p < 0.05.
Table 6
Association between sociodemographic data and attitude.
Item
Attitude
Positive
Negative
Age
40
41
14729
90.790.6
153
9.3 9.4
0.000f
1.000
Gender
Male
Female
81 95
89.092.2
108
11.07.8
0.569
0.440
Level of education
Certicate & Diploma
Degree & Master
13937
90.392.5
153
9.7 7.5
0.189f
1.000
Year of graduation
1999
2000
47129
92.290.2
414
7.8 9.8
0.169f
0.786
Working experience
4 Years
5 Years
95 81
88.893.1
126
11.26.9
1.063
0.303

Yes
No
90 86
93.887.8
612
6.212.2
2.071
0.150

Yes
No
13739
90.790.7
144
9.3 9.3
0.000f
1.000
Fisher Exact Test.
Discussion
This study shows that most of the emergency nursing and medical personnel in East Coast region of Malaysia have adequate
knowledge, more than cut-off point level, 60%. Ahayalimudin, on
her previous study, set the cut-off point of 60% scores for all
domains and this study followed to hers since it was conducted
in Malaysia as well. The knowledge results in this study are com-
parable to a study by Hermawati, who showed the level of nurses

preparedness knowledge was at a moderate level [18]. Moabi also
showed in her study that participants were knowledgeable about
the hospitals disaster preparedness [19]. In contrast, the previous
study by Ahayalimudin indicates about only 40.9% of nurses had an
adequate knowledge of disaster management [20] and Hammad
et al. concluded that the respondents had a score of knowledge less
than 50% [21].
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Table 7
Association between sociodemographic data and practice.
Item
Practice
Adequate
Inadequate
2 value
p value
Age
40
41
10523
65.271.9
56 9
34.828.1
0.530
0.467
Gender
Male
Female
72 56
79.154.9
1946
20.945.1
12.629
0.000*
Level of education
Certicate & Diploma
Degree & Master
10721
69.952.5
4619
30.147.5
4.315
0.038*
Year of graduation
1999
2000
37 91
72.564.1
1451
27.535.9
1.204
0.273
Working experience
4 Years
5 Years
61 67
57.077.9
4619
43.022.1
9.322
0.002*

Yes
No
81 47
84.448.5
1550
15.651.5
27.873
0.000*

Yes
No
11018
73.341.9
4025
26.758.1
14.821
0.000*
The positive attitude of respondents in our study is similar to

previous studies by Ahayalimudin that found more than 80% of
nurses had a positive attitude to disaster management [22]. Likewise, another study demonstrates that the participants attitude
towards disaster preparedness was good and that the respondent
believed in the need to have insight into disaster management
[23]. However, Roosli showed that respondents had a negative
attitude towards the implementation of MNSC Directive 20 [24]
and Mohamed Diab and Mabrouk reports that only 37.5% of the
respondents in the study had a positive attitude towards disaster
management [25].
Most of the emergency nursing and medical personnel demonstrate an adequate practice towards disaster management, with a
mean percentage of 65.3. Our results were different to those of
Ahayalimudin where less than half of the respondents exhibited
an adequate practice [26] and Moabi, who showed that the participants practice was probably inadequate [27]. Practice is among the
vital components in any domain to study about one routine. In this
study, practice is referred to the use of idea and belief rather than
performance towards disaster management.
The outcomes of this study indicate that disaster-related education/training is signicant and benecial to improve knowledge,
attitude and practice of emergency medical personnel, specically
those of nurses. In relations of education, we recommend that the
authorities should include the syllabus of disaster management
into the existing curriculum, specically for the advanced educational programme. This topic could be included in continuous
nursing or medical education (CNE/CME) and regarded as an important topic for all medical personnel, mainly those who work in
emergency and trauma departments. Therefore, emergency nursing and medical personnel would be enabled to care for disaster
victims successfully.
This study showed that training is important to ensure that
personnel is ready and prepared to face disaster when it strikes,
as there is a signicant relationship between the attendance
of disaster-related education/training and practice. Personnel
attended disaster education or training and were involved in disaster response had more condence and improved awareness of
the importance of disaster management [28]. Training creates a

readiness for managing the impacts of the disaster. It requires
augmentation of the training facilities and the provision of opportunities by the health care authorities to enable emergency nursing
and medical personnel to fully participate.
As a result, health care authorities, for instance, hospitals and
state health department, as well as universities, should increase
their practice of disaster management by providing sufcient training to their health care personnel, which ranging from didactic
lectures until disaster drills. The training could enhance their
knowledge and practices, thus improving their attitude and bringing them to the light in disaster management.
Limitation
In relation to the study design, this study utilises a crosssectional design that limits the result, as it merely reects on the
current situation. Thus, it is not possible to determine cause and
effect of the factors tested. The results analysed extend to the
bivariate statistical tests. Therefore, future studies could progress
to multivariate analyses to conrm the prediction of sociodemographic factors and disaster management domains. Our results may
not truly represent Malaysia as a whole since it was merely conducted in the East Coast of Malaysia. Likewise other states across
the country, these states regularly struck by a ood, which is among
natural disaster that happens almost every year during the monsoon season, yet they still require ood disaster preparedness.
Conclusion
Disaster management is a relatively new eld of nursing, medical and health services in Malaysia. Consequently, there is little
research conducted in Malaysia on the topic. Thus, it receives less
attention compared to other elds of nursing, medicine and health.
In Malaysia, the rapid movement of disaster training occurred after
the occurrence of the 2004 tsunami. Since then, the government
of Malaysia has been exerting a twofold effort and focusing on the
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programme to train and educate relevant personnel in managing

the disaster [29].
The emergency department is recognised as a front line of
any hospital, in particular, during a disaster. Hence, it is signicant for emergency nursing and medical personnel to demonstrate
adequate knowledge and practice and have a positive attitude
towards disaster management to inhibit the severity of the impacts.
Knowledge, attitude and practice studies could assist in the implementation of programmes relevant to disaster management to
ensure emergency nursing and medical personnel are more prepared to assist the affected communities and population [30].
As a whole, this study showed that almost half of the personnel studied took part in disaster response at any time during
their services. About three-quarter of the respondents attended
some disaster training/education provided by their authorities.
Other than involvement in disaster response and attending disaster education, working experience, gender and level of education
inuenced any of the domains of knowledge, attitude and practice
towards disaster management.
Despite the diversity of their backgrounds, respondents exhibited their adequate knowledge and practice and had positive
attitudes towards disaster management. However, further investigation of multivariate analysis is required to conrm the
contribution of these factors to disaster management knowledge,
attitude and practice. This result then assists in the enhancement of
disaster preparedness among emergency nursing and medical personnel across the country, not merely to serve the country but could
contribute their knowledge and competencies to other countries
that need assistance.
Authorship
The authors equally contributed to producing this manuscript.
NAA and NNSO designed this study, NAA secured the funding,
developed the study protocol and designed the study instrument,
NNSO collected and analysed the data with NAA supervision, NNSO
drafted the manuscript, which was then rened by NAA, and both
approved the manuscript.
Provenance and conict of interest

This paper has been awarded an educational institution grant;
however, no conict of interest exists since ethical approval for conducting study and publication were agreed among all organization
involved.
Funding
This study received funding from International Islamic University Malaysia (EDW B 13-074-0959).
Ethical approval
This study was approved by and adhered to Ministry of Health,
Malaysia Research and Ethical Committee (MREC) with registration
number of NMRR-13-154-14981 entitled Disaster Management: A
Study on Knowledge, Attitude and Practice of Emergency Personnel
in 3 Hospitals of East Coast Region dated on 30th April 2013. This
study also approved by International Islamic University Malaysia
Research Committee (Kulliyyah of Medicine, Research and Ethical
Committee).
Acknowledgements
The authors wish to acknowledge the International Islamic University Malaysia for awarding the grant to funding this study and
Ministry of Health, Malaysia for the approval to conduct this study
in their facilities.
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G Model

AENJ-360; No. of Pages 7

Contents lists available at ScienceDirect

Australasian Emergency Nursing Journal

Disaster management: Emergency nursing and medical personnels

[5]. Unlike neighbouring countries, Malaysia has not been struck

Material and methods

health medicine and nursing. Face validity was established by a

AENJ-360; No. of Pages 7

Involved in disaster response

Attended disaster education/training

ipate in disaster training. Nonetheless, most of them stated that

management. Gender and level of education were signicantly

AENJ-360; No. of Pages 7

Involved in disaster response

Attended disaster education/training

Signicant at p < 0.05.

Involved in disaster response

Attended disaster education/training

Fisher Exact Test.

parable to a study by Hermawati, who showed the level of nurses

AENJ-360; No. of Pages 7

Involved in disaster response

Attended disaster education/training

The positive attitude of respondents in our study is similar to

the importance of disaster management [28]. Training creates a

AENJ-360; No. of Pages 7

programme to train and educate relevant personnel in managing

Provenance and conict of interest

[28] Ahayalimudin N, Ismail A, Mohd Saiboon I. Disaster management: a study on

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