SEMINAR

PHENOMENA

NURSES PREPAREDNESS FOR DISASTER MANAGEMENT IN MT. ANAK

KRAKATAU BANDAR LAMPUNG AREA, INDONESIA

279891 Seminar In Advanced Nursing Practice And Research

Presented to :
Associate Professor Dr. Earmporn Thongkrajai
Dr. Nichapatr Phuttikkamin

Presented by :
TIARA 5850600298

Master of Nursing Science Program

Faculty of Nursing, Khon Kaen University Academic

Year 2016
 CHAPTER I
INTRODUCTION
1. Background and significance of the problem.

A disaster is an occurrence disrupting the normal conditions of existence and causing

a level of suffering that exceeds the capacity of adjustment of the affected community (world

health organization, 2004). 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/society to cope using its own resources. One of the natural disaster

coused by this geographical condition is vulcano disaster, natural disasters include strorms,

such as hurricanes and cyclones, floods, eartquakes, extreme heat and cold emergencies,

tsunams, vulcanic, eruptions, pendemics and famine (U.N. ISDR 2002).

According to the data from World disaster report 2007 reported a 60 % increase in

disasters in the last decade (1997-2007) over the previous decade (1987-1996). Additionally, the

number of reported death grew from 600.000 to over 1.2 million. At the some time the number

of people affected from 230 million to 270 million, a 17 % increase( Kylman, Kouppart &

Mukheir,2007).

Based on the data from the United Nation’s Bureau of crisis prevention and recovery,

some 75 % of the world’s population live in areas that have been affected at least once by either

an earthqueke, a tropical cyclone, flooding or drought between 1980 and 2000 (IRIN,2007).

The data on active vulcanoes Around 62 % in the world are located around the margin

of the pacific ocean, the east pacific island, for example includes 45 % of the worlds active

vulcanoes while the central and south america segments countain only 17% of the vulcanoes,

about 14 % vulcanoes are located in the indonesia island swhile, of the remaining 24%, 3%

are located in the mid pacific ocean, 1 % in mid Indian ocean island, 13% on mid atlantic
ocean island, and the last 7 % scattered trought the mediteranean sea and central asia (

Turkey, iraq. etc).

Therefore Natural disasters have been increasing over the last years, with the greatest

increase in the last decade (Birnbaum, 2002). And on average during 2000-2006 there is 116.3

countries were hit by disaster each years (Scheuren et al, 2008). As in 2006, Asia was most

affected by disasters by disasters both the number of deaths and the number of disasters in 2007

(Hoyois, Schauren, Below & Guha sapir, 2007).

Indonesia is a country with more than thousands island which located in the ring of

fire. Moreover, indonesia located in three active faults , they are the Pacific, Indo-Australia

and Eurasian faults. The movement of these three faults impact to the natural disaster event in

indonesia (Kusumastuti, 2014).

Based on BNPB (National Agency for Disaster Management) the The number of

disaster in indonesia in 2012 (1.790 events), in 2013 (1.707 events), in 2014 (1.559) in 2015

(781 events) and on januari 2016 (174 events). Including flood, drought, whirlwind, flood,

landslide, and vulcano eruption. The data of natural disaster in lampung from 2011 until

2015 there were 243 events, including flood, drought, whirlwind, flood, landslide and

vulcano eruption (BNBP, 2016).

It is possible to divide the vulcanoes of the world into seven region as follow : (1)

Vulcanoes of the pacific ocean island ares and alaska continental rim, (2) vulcanoes of the

east pacific continental rim, (3) vulcanoes of alpine indonesia mountain belt, (4) vulcanous of

east african-arabian, (5) vulcanoes of the rift and mountain of eurasia, (6) vulcanoes of the

west indies and (7) vulcanoes of the ocena floor (Kirianov, 2001) Goverment of indonesia set

four levels of vulcano activities based on seismic activities, they are normal (level 1), Alert

(Level 2), standby (Level 3) and beware ( Level 4). Since on september 30th 2011 Mt. Anak

krakatau is be increased from level II ( Alert) to be level III ( Standby) but the earthquake
of Mt Krakatau to be decrease since December 2011 untill the status of anak derived from

level III tobe level II until now. The up and down level determination in Mt. Anak Krakatau

were measured based on seismic activities. And it is very changeable.

Since its appearance in 1929, Anak Krakatau Volcano has been growing fastly. The

elevation of Anak Krakatau Volcano from 1930 to 2005, within 75 years, has reached 315 m

high. The growth rate is approximated to be four meters per year in average. Based on

calculation, the volume of the body from the sea floor since 1927 until 1981 was 2.35 km3,

and then in 1983 was 2.87 km3 and then in 1990 it reached 3.25 km3. The latest volume

measurement in 2000, was 5.52 km3 and since 1992 up to 2001, within nine years, the

eruption of Anak Krakatau took place almost every day and the interval time were not

unexpected. the elevation of anak krakatau increase more than 100 m, and its area extent to

become 378,527 m2. If the increase in height and the increase in volume are consistent, it is

expected that in 2020, the volume of Anak Krakatau’s edifi ce will proceed the volume of

Rakata Volcano, Danan Volcano, and Perbuwatan Volcano (11.01 km3) shortly before

catastrophic eruption in 1883. the eruption of Krakatoa on 27 August 1883 has been in follow

by the tsunami that has destroyed 260 towns and villages as well as the about 36,000 people

death.

Anak krakatau located in The Sunda Strait region has been an important location even

so today, it serves as a gate for sailing activities and a passage way to cross from the island of

Sumatra to Java, Its status and its role has become even more important following the huge

development leap in the end of 20th century, with an improvement of the quality of access to

the surrounding area and the emergence of many economic activities such as industrial

activities (chemical, metallurgy, energy, etc), transportation (Merak, Bakauheni, Panjang,

Tarahan, etc), fishery (Padang Cermin, etc) and a military base (Teluk Ratai). The

geographical location of the area is very strategic as it stands as the gate of sailing from the
Indian Ocean and its close proximity to the center of government of the country (Jakarta) and

province (Tanjung Karang) (Hantoro 2003).

Most of the houshold rely on their living to the Mt. Anak Krakatau through

agriculture and tourism activities. many tourism interested to see the Mt. Anak Krakatau.

The number of people live in anak krakatau area are 195.271 people consist of 4 sub districts

are : panjang district 52.475 people, teluk betung utara 84.299 people, teluk betung barat

51.972 and gunung mas 6.525 (Dinas Kesehatan Kota Bandar Lampung, 2006). The distance

the city of bandar lampung with the anak krakatau mountain is 64.36 Km. Very potential

risk to incur the larva and tsunami if the anak krakatau euruption and many impact that

inflicted . The impact of disaster in health setting such us Illness, disability & death due to

hospital acquired infections, injuries & Violence Displacement as a result of insecurity or

destruction of living quarters Psychological trauma due to illness, death & disability of

colleagues & displacement.

Based on the large number the impact of disaster so the importance to nurse

preparednes for reduce the impact of disaster. Nurse as the centre of the front in a health

services have a responsibility and role of that is great in handling patients emergency daily or

when the of disasters. Competence nurse in phase preparedness is education in nursing

disaster, training for the calamity tackling, observe services in terms of equipment and

resources, and do confirmation and make network support nursing (Ohara, 2007). Based on

the impact of disaster that the responsibility from goverment or other sector is very

importance to reduce the impact in each area.

Bandar Lampung area is the one of the high level of risk. And thr government set the

range of disaster prone area in differently for each vulcano. In example Mt. Krakatau set the

range area for each disaster area is 2 Km. In other case Mt. Merapi where located in between

yogyakarta and Central Java Province set the disaster prone rage in each of 4 Km.
 The importance of determining the impact and the affected agents in natural disasters.

First, that information is useful for policy makers, as they can know the need for external

assistance and which may be more effective; second, specific segments of affected can be

identified, e.g. how low income household are affected, etc); and third, it may be also useful

for planning assistance for natural disasters and the potential consequences .(Lindell and

Prater, 2003).

Disaster preparedness including risk assesment and multi-diciplinary management

startegies at all system management strategies at all system levels, is critical to the delivery of

effective responses to the short , medium, and long term needs of a disaster-stricken

population. Nurses with their technical skill and knowledge of epidemiology, physicology,

pharmacology, cultural-familial structures and psycological issues can assist in disaster

preparedness programes as well as during disaster (ICN, 2006).

The nurses play a key role in disaster preparedness, but they must accomplish the

critical elements of personal and professional preparedness first. Disaster management

includes four stages: prevention (or mitigation ), preparedness, response, and recovery.

Nurses have unique skills for all aspects of disaster to include assessment, priority setting,

collaboration, and addressing of both preventive and acute care needs. Nurses must work

collaboratively with other health professionals, disaster responders, non governmental

organizations and government. Nurses must be capable of shifting focus of care from one

patient to large numbers of patients. nurses also must understand their own competence and

be able to adapt their competencies for disaster context and situation. Nurses will have roles

in disasters in a range of settings.These include in policy development, or in-hospital, pre-

hospital, community, retrieval, transport and deploymentto the scene as first responders

(Littleton, 2008)
 Preparedness is The state of being ready to be used or to act for something that will

happen in the future (oxford dictionary, 2008) and George W Bush, 2003 said that

“preparedness is A series of activities conducted through organizing and taking the correct

and useful steps.

Almost 70 % of the school nurses in a three country area of north-eastern ohio, united

states they needed additional education related to emergency responses in order to respon

affectivelly (Mosca, Sweeney and Brenner, 2005).

Some previous disaster studies of found the all most of the nurses less disaster

preparedness, including leodoro, J 2015 his research showed 80% the nurses were not fully

prepared to respond disaster and only 20 % the nurses were adequately prepared, another

research from Khalaileh, 2011 his research showed 65% respondents described their current

disaster preparedness as weak and only 5 % felt preparedness was very good. Lisnawati Nur

Farida In 2010 her research showed that most of the participants were not implement their

role in disaster preparedness, since there was no institutional preparation facing disasters

event.Another studies from Agus Khoirul Anam in 2013, his research showed that the level

of preparedness of nurses is lack and there is relationship between knowledge and attitudes

of nurses with disaster preparedness eruption of Mount Kelud in Blitar.

The preparation based on the goverment is socializing to the disaster, and conduct the

picket of staff to the observe the Mt. Anak Krakatau activities. disaster prone area is

determined by government and be devided in three (3) level which is based on the risk

level(Regulation of minister of energy and mineral resources of republic indonesia. Disaster

prone area with the highest level of risk is named in disaster prone level 3 and mostly the

government set the range of disaster prone area in differently for each od vulcano.
 Indonesia goverment is aware to the gheographical situation of indonesia which

impact to the potential of vulcano disaster. National Agency for Disaster Management or

called as Badan Nasional Penanggulangan Bencana (BNPB) established in 2004 to

implement disaster management concept to reduce hazard coused of natural disaster. It was

established after big earhquake and tsunami hit banda aceh and impact to international matter

because of tsunami range. Learn from this study, the goverment of indonesia built BNBP and

formulated guidline for disaster management and merged into national development planning

of 2005-2025( Bappenas, 2005). However the implementation , BNBP is helped by BPBD or

stans for badan penanggulangan bencana daerah (in english : local agency for disaster

management) which located in each of districs.

Indonesia goverment is aware to the gheographical situation of indoneia which impact

to the potential vulcano disaster. National agency for disaster management or called as Badan

Nasional Penanggulangan Bencana (BNBP) established in 2004 to implement disaster.

Responsible in disaster management in Indonesia

Name / organisation Level of place
National Disaster Management Provincial
Coordinating Board (BAKORNAS) And District Units
SATKORLAK District Level
SATLAK District And Sub-District Level

The role of the nurse for disaster is Nurse as the centre of the front in a health services have a

responsibility and role of that is great in handling patients emergency daily or when the of

disasters.Competence nurse in phase preparedness is education in nursing disaster, training

for the calamity tackling, observe services in terms of equipment and resources, and do

confirmation and make network support nursing, and nurses preparedness is very important

(Ohara, 2007)

The goals of disaster preparedness are knowing what to do when disaster occur,

knowing how to do it being well-equipped with the right tool to do effetively. Preparedness
minimize hazard adverse effect trough effective percautionary measures that ensure a timely.

This action has different recipient they area goverment, individuals,businesses and health.

This study related to theory social cognitive theory from bandura, this study utilizes

the social cognitive perspective that posits that a person’s behavior can be explained in terms

of individual and environmental factors rather than just being controlled by external stimuly

or inner forces. A study that used SCT in the context of disaster preparedness showed that

people’s motivation to prepare for disaster is a function of the cognitive and effective

reactions to a disaster.

During practicing and observing, the researcher interviewed 10 nurses working in the

hospital with the resulth that the hospital dont have guide line to prepared disaster

management. Seven Nurses said that they don’t know how to prepare and how to response

the disaster, and three nurses said that they know how to preparedness of disaster

management. The observation also found that lack of education in disaster preparedness.

Nurses need more education in all areas of disaster management, most importantly in their

roles during response to disasters. Nurses perceive themselves as not well-prepared but they

are willing to improve their skills in disaster preparedness if educational opportunities are

provided. Almost the nurses agreed training and knowladge about the management disaster

very important.