Disaster Preparedness Education Program for Nursing Staff

Received 21 June 2021 Accepted 21 August 2021 Published 25 September 2021 Preparedness in the face of a disaster is one of the important elements of activities in reducing the risk and impact of a disaster, this is very much needed during a disaster, therefore a disaster education program is needed to prepare nurses' preparedness so that they can provide fast, accurate service and save victims from physical disability and death. The aim of the literature study is to identify a disaster education program to prepare the preparedness of nursing personnel in both institutional and acute settings. The method used is narrative review. Search for data using electronic data sources, such as PubMed, ScienceDirect, and Garuda Portal. The articles found will be selected based on the full paper with the publication year 2011-2021, open access, publications in English and Indonesian, while articles that are not relevant to the research topic and duplicated will be issued. Increasing disaster preparedness for nurses, namely by providing education coupled with special training, while nursing students by providing modules, peer group discussions, and evaluating materials included in the curriculum. Keyword:

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INTRODUCTION
The Unitary State of the Republic of Indonesia is located in a disaster-prone area. Astronomically, Indonesia is located between 60LU -110LS and 950BT -1410BT. Seen from a geographical side, Indonesia is located between two continents and two oceans, namely the continents of Asia and Australia and the Indian and Pacific oceans. In addition, Indonesia is the meeting place of three active plates between Indo-Australia, Eurasia and the Pacific. Indonesia is also traversed by two circums, namely the Pacific circum and the Mediterranean circum where there are three movements from the meeting point of the earth which can cause the activation of volcanism and frequent earthquakes so, Indonesia is included in the "Ring of Fire" area (Henley & Schulte Nordholt, 2015).
Disasters not only significantly affect health care institutions and providers, they also affect people's lives and economies around the world. The report of BNPB (National Board for Disaster Management), Indonesia has experienced various disasters as many as 3,397 times, and claimed 3,874 lives, both dead and missing in 2018. The impact of a disaster varies widely, ranging from damage, loss, to causing casualties. There are three important things to know about how disasters relate to health First, according to the World Health Organization (WHO), a disaster is any incidence that can end human life or cause a health-related hazard and requires an immediate response with adequate personnel and resources, preparedness, planning, response and recovery by many agencies, including health care institutions (Hammad et al., 2011) Second, hospitals must increase their capacity to respond effectively to disasters; Large-scale disasters have a very negative impact on hospitals. Third, as the largest group of health care providers, nurses play an important role in treating the injured and their families holistically throughout the four stages of disaster management (Al Harthi et al., 2020).
Emergency services are part of an effort that must be carried out quickly and precisely in the incidence of a disaster. Emergency actions are carried out in an effort to save the victims and the implementation of emergency services is one of the priority factors to prevent and or reduce the occurrence of death, disability and the spread of an infectious disease. Individual awareness of disaster preparedness can affect their actions in protecting and saving themselves from various kinds of hazards caused by disasters (Istiqomah, 2015).
Preparedness is a series of activities carried out by a person in anticipating a disaster which is organized through appropriate and efficient steps (UU RI No. 24 of 2007). Meanwhile, preparedness according to IDEP (2007) is an effort and effort in conducting a need assessment to deal with emergency situations and identifying the required resources. Preparedness in the health sector according to the Ministry of Health of the Republic of Indonesia (2006) aims to: (1) Minimize casualties/life (2) Reduce the suffering felt by victims (3) Prevent the emergence of possible postdisaster health problems and (4) Facilitate and expedite emergency response efforts quickly in the recovery process.
In disaster preparedness, nothing more important than the readiness of health workers. Each disaster can strike at any time and preparation for this incidence is health care. Nurses as one of the largest groups of health care providers play an important role in all aspects of providing health care for patients and their families, especially during disasters (Al Harthi et al., 2020). In holistic disaster preparedness, nurses must be involved in preparing, activating plans, and educated with disaster management (Goodwin Veenema, 2018). Some literature has discussed the role of nurses in the preparedness stage but needs to be reviewed further based on its implementation, both in the student and clinical sphere (Wand et al., 2015;Goodwin Veenema, 2018).
The purpose of this review is to identify the disaster education programs to prepare nursing staff for preparedness in both institutional and acute settings.

METHOD
The literature review methodology that is suitable to be used in this literature study was a narrative review because of the general research question, and the research objective was to get an overview. This review used narrative review guidelines according to (Green et al., 2006). Narrative review included a summary, and didn't have a specific analytical method (Goodman, 2016). Therefore, the articles included in this review were only summarized and analyzed due to time efficiency. Although narrative reviews have shortcomings, the materials used must be trusted, and only taken from reliable sources because narrative reviews are based on other research so, the articles produced must be reliable and honest.
The data searching used electronic data sources, such as PubMed, ScienceDirect, and Garuda Portal. The PICO technique was used to make it easier for getting the appropriate literature in conducting a literature search. The population (P) in this literature study were nurses, both nursing students and nurses, intervention (I) was in the form of a disaster education program, comparison (C) was not used, and the outcome (O) determined was nurse preparedness.
Based on the technique ofliterature search, the keywords used in the English database (PubMed, ScienceDirect) were, "nursing education" and "disaster preparedness" while the keywords used in the Indonesian database (Portal Garuda) were nurse education, and pre-disaster. . Keywords are combined with boolean operators. The data obtained will be selected based on the inclusion criteria, namely full paper with publication year 2011-2021, open access, publication in English and Indonesian, while articles that are not relevant to the research topic and duplicated will be excluded.

RESULTS AND DISCUSSION
The articles obtained are sorted to get appropriate articlebased on literature study carried out. The sorting of articles is done by adjusting the inclusion and exclusion criteria that have been set.
The inclusion criteria set are articles that discuss disaster education programs to prepare nursing staff preparedness both in institutional and acute settings, the year of publication of the article (2010-2020), the sample used is nursing staff, articles in Indonesian or English, full text availability , published in a sinta accredited journal or indexed by Scopus.
The exclusion criteria in this literature study were articles that did not include the volume, number, and publisher of the article.
The data found collected will be extracted into a table and then the data will be analyzed using an inductive method of content analysis where the publications obtained will be grouped into several sub-groups, and critical analysis on the publications content which then has a pattern of associations with the discussion. From the content analysis, there were 2 main sub categories, namely disaster education programs for nursing students, and disaster education programs for clinical nurses.
The following is a flow chart for sorting articles obtained according to topic of the literature study carried out:

Chart 1. Flowchart of Article Selection Process
The data found collected will be extracted into a table and then the data will be analyzed using an inductive method of content analysis where the publications obtained will be grouped into several sub-groups, and critical analysis on the content of the publications which then has a pattern of associations with the topic of discussion. From the content analysis, there were 2 main subcategories, namely disaster education programs for nursing students, and disaster education programs for clinical nurses.
According to WHO, any occurence that can end human life or cause a health-related hazard and requires an immediate response with adequate personnel and resources, preparedness, planning, response and recovery by many agencies, including health care institutions (Hammad et al., 2011) In disaster preparedness, nothing is more important than the readiness of health workers. Any disaster can strike at any time and preparation for this event is health care. Nurses as one of the largest groups of health care providers play an important role in all aspects of providing health care for patients and their families, especially during disasters (Al Harthi et al., 2020). Nurses need to prepare themselves starting from being a student to being a nurse.  (Kalanlar, 2018).

Disaster Education Program for Nurses
When a disaster occurs, members of the nursing profession are often the first to respond to the situation. Thus, disaster preparedness training of all health care professionals is essential for maintaining an efficient health care system in the midst of a disaster, especially given the potentially widespread nature and complex environment of these types of events (Kalanlar, 2018).
According to Wiyadi & Rahman, (2020), stated that nurses in the emergency room had a moderate level of alertness based on the results of the 8 readiness dimensions assessed. These include incident instruction systems, victim triage, epidemiological systems, surveillance, prevention efforts, communication, psychological conditions, population and access to resources.
From the 8 dimensions assessed, there is one dimension that is still lacking, even though training has been carried out, namely on the special population dimension, because certain populations in an emergency are a priority that requires attention. However, in reality there is still a delay and lack of preparedness in fulfiling the needs for special populations so, the handling of special populations during disasters can fail and have an impact on disability, illness and even death. So it is necessary to increase a more detailed understanding of special populations, for example by providing training for nurses on handling certain populations during disaster.
This showed that nurses in applying the implementation of nursing are less than optimal, reinforced by research by Anam et al., (2015) which states that nurses do not have the right readiness for disaster management with a result of 97%.
In addition, based on the research of Simbolon & Situmorang, (2017), it was found that there are three most important domains owned by nurses in providing services in emergency conditions, namely the domains of knowledge, attitudes, and skills. From the study result, it was found that most nurses had knowledge in the good category and the category of positive attitude, but there were still some nurses who were not skilled in carrying out emergency actions. Therefore, it is needed a training in improving the competence of an emergency nurse, such as training in the Integrated Emergency Management System (IEMS), Basic Life Support (BLS) training and Basic Trauma/heart training in life support (BTCLS).
According to research conducted by Sonneborn et al (2018), disaster training in surveyed hospitals is included in the mandatory online annual 'Emergency Training', which includes responses to quiz questions for internal incidence such as fires, information technology malfunctions, bomb threats, or patient aggression. Code Brown activation training is also conducted through exercise simulations by individual departments or by specialist disaster training courses, such as the Major Incident Medical Management & Support (MIMMS) course, sought after by relevant and interested staff, but not available to all nursing staff.
The quality of disaster education provided to nurses is a determinant of nurses' willingness to participate, feel confident in conducting their roles and performance in responding to disasters. Disaster preparedness education for acute care departments such as emergency rooms, intensive care and operating rooms. The purpose of developing such a framework for each acute care department is to reduce the burden of developing and establishing disaster education programs in individual departments and organizations and to strengthen the disaster preparedness resources available for dissemination to acute care settings across institutions and countries.
According to research conducted by Samosir, RV, Suroto, S., & Kurniawan, (2015), it was found that the provision of material on the patient evacuation system for inpatient nurses was carried out at least once a year and at least participated in the training material for three times within a period of time work. The material purpose is expected to provide an initial understanding to new nurses and at the same time to old nurses in reminding the importance of life safety and disaster management. Knowledge has a significant relationship with the level of preparedness for disaster management due to fire, because one's knowledge is the result of a sensing process, one of which is influenced by education.

Disaster Education Program for Nursing Students
Disaster preparedness is an important element of educational institutions owned by a health professional graduate. Thus, the main competence of disaster preparedness as a professional requirement must be established and can be functioned effectively through an adequate educational process in accordance with the certainty In 2015 the Association of Indonesian Nurse Education Center (AINEC) established a curriculum for the Bachelor of Nursing program. This curriculum contained about disaster nursing. The International Council of Nursing (ICN) module on disaster nursing competencies was also used in Turkey with a good success rate (Kalanlar, 2018). In East Java, the content of the disaster nursing module was implemented in the seventh semester of the undergraduate nursing program. However, the experiences of nursing students in middleincome countries, such as Indonesia, were underrepresented in the disaster literature for undergraduate students compared to master's programs, which get more exploration from training, seminars, and workshops (Hindriyastuti et al., 2019).
The learning model by using the tutorial group education model is ideal and effective in developing students for critical thinking, clinical reasoning and decision-making skills in accordance with the desired competencies. Educational arrangements with tutorial groups begin with reviewing the educational program before moving on to an internship. This group tutorial process gradually creates a more conducive environment for exchanging ideas and assessments and identifying areas for improvement (Arrigoni et al., 2017). This is also in line with the research of Constantia et al., (2017) which stated that the use of the tutorial group education model produces a number of results that should be expected from nursing graduates which can be measured and determined by the knowledge, skills and talents of nursing students.
According to research conducted by Kalanlar, (2018), it was revealed that nursing students have limited knowledge about disasters and have different views about what will be covered in the nursing study program for the post-disaster process, the fact that disaster management is a distinct, multi-dimensional and disciplinary field of study is ignored, legislation related to disasters does not have a general framework containing activities from all phases of disaster management and lastly disaster nursing should be included in the study program from all nursing faculties in Indonesia.

CONCLUSIOAN AND SUGGESTION
Improving nurse preparedness in the field is by providing education and training for IEMS, BLS and BTCLS on how to deal with a disaster and then implementing it directly, while nurse preparedness in the nursing student sphere is by using ways to improve education both with learning modules, evaluations, and peer groups discussion that is included in the curriculum and later on, the student will be able to improve the skills that have been learned when the student has become a nurse by participating in disaster preparedness training.