Practice, Training Need of Disaster Preparedness and Associated Factors in Nursing Staffs Working at Emergency Department, Amahra Regional State Referral Hospitals, Ethiopia, 2020G.C. A Hospital Based Cross Sectional Study

Background: Globally disasters are increasing at alarming rate that leads giving training and making preparing frontline emergency department nurses an important issue. Although disasters are manageable and preventable they are still considered as a major public health issues. Methods: Hospital based cross sectional study used to come up with the ndings. All emergency department working nurses from the region referral hospitals were assumed as study subjects. The disaster information on respondents was gathered with self-administered written questionnaires. Data entry and coding was made by using epidata software manager v4.6.0.2 and further exported to spss version 26 for further analysis. Result: In our study nding most participants were males 68(66.7%). In addition mean age of data respondents were 31.2±5.8. It is found that 25(24.5%) of participants have adequate practice on the contrary 75(75.5%) of respondents have inadequate practice. Also, 40(39.2%) respondents need training on rst aid and treatment principles, 37(36.3%) need training on disaster preparedness and 31(30.4%) need training on basic principles of disaster response. In multivariate analysis variables with practice of disaster preparedness are training performed in a hospital set up {P value= 0.047, OR: 0.282, 95%CI: (0.081-0.985)} and simulation done in hospital {P value= 0.002, OR: 0.071, 95%CI: (0.055-0.530)} were signicantly associated. Conclusions: Skill level of emergency department nurses with regard to disaster preparedness is inadequate so that training supported with drills & simulation and education are mandatory.

Conclusions: Skill level of emergency department nurses with regard to disaster preparedness is inadequate so that training supported with drills & simulation and education are mandatory.

Background
We can de ne disaster as an emergency situation that may endanger the life of the population (1-3).
Worldwide, disaster can occur every day that intern affect the community at large (2).World health organization/WHO gives a big consideration for this area and supports and advises states to build up their own disaster preparedness strategies (3). This emergency event my end up with disruption of properties in addition with human life. So that, the role of emergency department/ED nurses comes here which intern initiates the need of capacity building for these health professionals (4).
Globally disasters are increasing at alarming rate that leads giving training and making preparing frontline emergency department nurses an important issue (2,5). Especially this disruptive event puts a visible damage for less developed countries mainly due their economy to coup up with disaster impacts (2). Worldwide about 1.6 million people died because of disaster impacts. For underdeveloped states the impact becomes a double burden in addition to infectious diseases (6). Although disasters are manageable and preventable they are still considered as a major public health issues. In Ethiopia, currently traumatic injuries especially road tra c accidents are major issues (7).

Objectives
To describe practice of disaster preparedness among nurses working at emergency department , referral hospitals To identify the training need of disaster preparedness of nurses working at emergency department, referral hospitals To explore associated factors of disaster preparedness of nurses working at emergency department, referral hospitals Methods A hospital based cross-sectional study design was conducted at emergency department of Amahara regional state referral hospitals in March to April 2020G.C. All emergency department working nurses during the study period at Amhara regional state referral hospitals were assumed as study subjects.
All emergency department working nurses at Amhara regional state referral hospitals were eligible for the study. On the contrary those in study, annual and maternity leave were not eligible for this study.
All emergency department working nurses from the region referral hospitals were assumed as study subjects. The disaster information on respondents was gathered with self-administered written questionnaires. Five data collectors and two supervisors in a position to collect needed data from March to April, 2020G.C.
Data was collected from knowledge, attitude and practice questionnaire and emergency preparedness information questionnaire/EPIQ taken from (2) with some modi cation and that was applicable with many papers.
To keep the quality of the study, we conducted training for both data collectors and supervisors. In addition a tool of emergency preparedness information questionnaire was used. The Wiscon nurses association recommended to use the tool (2). Similarly, pretest was done on 5% of respondents at Boru meda hospital before the real data collection process commences. Filled questioners were reviewed by supervisor principal investigator before data entry initiates.
Data entry and coding was made by using epidata software manager v4.6.0.2 and further exported to spss version 26 for further analysis. Then ndings was presented by the help of tables and charts. The association of independent variables with that of dependent variables was assessed by using logistic regression.
We went forward only when got an ethical clearance from the research an ethical review o ce of Wollo University. After that permission was received from the respective hospital managements. Finally, an oral consent obtained from participants and the objective of the study cleared up to them and participation was only on volunteer bases.

Results
From the study a total of 115 emergency department working nurses were seen. Among them 106 were eligible for the study, from it 102 subjects were already participated in the study and data was collected with a response rate of 96.2% due to not returning certain tools.
In our study nding most participants were males 68(66.7%). In addition mean age of data respondents were 31.2±5. 8  The training need of respondents on disaster preparedness resulted with mean of 12.059±2.14( Table 3). showed as they need training on disaster readiness handling. Also in the same way in Johannesburg of other hospital nurses responded as 100% of disaster skill is needed(9, 11).
We have found that 40(39.2%) respondents need training on rst aid and treatment principles, 37(36.3%) need training on disaster preparedness and 31(30.4%) need training on basic principles of disaster response.
The paper reveals that through bivariate analysis, variables that were signi cantly associated with that of practice of disaster preparedness are having awareness on disaster, training performed in a hospital and simulation done at hospital setup. Further analysis through Multivariate analysis, variables that are signi cantly associated with practice of disaster preparedness are Training performed in a hospital set up and simulation done in hospital. This is supported with ndings at Tehran, disaster education and training increases skill level of professionals(5).

Conclusions
To conclude, we have got as 75.5% participants has inadequate practice in terms of disaster preparedness. But, only 24.5% respondents has adequate practice towards disaster preparedness at hospital emergency department level.
We can conclude also as disaster drills not done in hospital setup in 54.9%. We can say disaster drill not performed in hospital (only 18.6%) respondents received drills). As well, 80(78.4%) responded as there is no ongoing disaster training performed in their hospital. Only 14.7% participants responded as there is ongoing disaster training. As well 65.7% participants tells us the disaster plan is not periodically updated.
Also this paper revealed that, 39.2% need training on rst aid and treatment principles and 36.3% need training on disaster preparedness and 30.4% need training on basic principles of disaster response at referral hospital emergency departments.
Finally, in bivariate analysis, variables that were signi cantly associated with that of practice of disaster preparedness are having awareness on disaster, training performed in a hospital and simulation done at hospital setup. Further analysis through Multivariate analysis, variables that are signi cantly associated with practice of disaster preparedness are Training performed in a hospital set up and simulation done in hospital.

RECOMMENDATION
The nding resulted most respondents as having an inadequate skill with regard to disaster preparedness, the regional health o ce to facilitate a skill based training through dills or simulation to health professional nurses working at emergency and accident departments with regard to disaster preparedness.
As per the nding of this research, even though the attitude level of respondents towards accident and disaster handling preparedness is better, respondents' knowledge and familiarity level towards disaster is below expected. So, we recommend the regional health bureau of Amhara Region better if it gives attention on staff capacity building especially for those nurses working at emergency department that mainly helps to coup up with increasing disasters.
In addition the respective regional referral hospital is better to strengthen short term trainings and long term education for front line department working professionals on disaster preparedness in collaboration with health o ce and other concerned sectors. In similar manner emergency department working nurses are expected to share their part through further reading and in turn enhancing their skill of disaster preparedness. We went forward only when got an ethical clearance from the research an ethical review o ce of Wollo University. After that permission was received from the respective hospital managements. Finally, a written consent obtained from participants and the objective of the study cleared up to them and participation was only on volunteer bases. . Con dentiality of the information is kept by not mentioning respondents' name. For the written consent the ethical review o ce of Wollo University already approved and directed for future tasks.

Consent for Publication
Not applicable Availability for data and materials The data set used for analysis already found on the hands of the corresponding author on reasonable request.

Competing interests
Author declared as there is no con ict of interest.

Funding
The role of the budget provider for this study was it initiates for the development of an area of interest, then facilitates the proposal defense and evaluation and nally approves and fully covered the fund.

Authors Contribution
Author contributed from conception the research design to data collection, analysis, interpretation and total research write up also approval for publication and agreed to be accountable for all aspects of the work. That is LT, brought the original idea. LT, BD & MZ drafted and revised the work. LT, BD and MZ supervised data collection. LT, BD and MZ analyzed and interpreted the nding. MZ, LT, BD wrote the manuscript. Also all agreed for publication 10. Usher K, Mills J, West C, Casella E, Dorji P, Guo A, et al. Cross-sectional survey of the disaster preparedness of nurses across the A sia-P aci c region.  Figure 1 Practice level of participants with regard to disaster preparedness, Emergency Department, Amhara