Knowledge in Handling Psychosocial Problems among Nurses on

Disaster Response in Banda Aceh Hospitals: A Comparative Study

Cut Husna

1,2

, Abdurrahman

, Hajjul Kamil

, Mustanir

, Isna Maulida Roza

and Teuku Tahlil

Post Graduate of Mathematic and Applied Science, Universitas Syiah Kuala, Banda Aceh, Indonesia

Department of Medical and Surgical Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia

Nursing Department, Ministry of Health Republic of Indonesia, Banda Aceh, Indonesia

Department of Nursing Administration and Management, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh,

Indonesia

Professor at Department of Chemistry, Faculty of Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia

Nursing Student Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia

Department of Community Health Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia

Keywords: Disaster, Knowledge, Nurse, Psychosocial, Response, Hospital.

Abstract: Aceh is vulnerable and high risk area of disasters such as floods, fires, earthquakes, tsunamis, landslides and

tornadoes. Disasters have a significant impact on physical, psychological and psychosocial of the victims.

Some behavioural related psychosocial problems such as suspicion, irritability, withdrawal, smoking, and

drug abuse are affected to patients. Nurses who serve an important role in caring for the patients in the

event of a disaster are required to have extensive knowledge in handling psychosocial problems that have

worse impact on the patients. The aimed of this study was to identify the knowledge differences in handling

the patient’ psychosocial problems in disaster response between Maternal and Child and Meuraxa Regional

Hospitals of Banda Aceh. The research was comparative study with cross sectional approach. The total

sampling technique was used to select 295 respondents both of hospitals. The questionnaires developed by

the researchers consist of 34 items in dichotomous scales. The questionnaire has passed the validity and

reliability testing with a value of 0.811 and 0.958 respectively. Data were analyzed using independent t-test.

The result of the study showed that mean value at Maternal and Child Hospital was 91.84 with SD = 8.538

and in Meuraxa General Hospital was 94.84, SD = 7.436 with p-value 0.003 (p<0.05). There is a significant

difference between knowledge in handling psychosocial problem in disaster response among nurses in both

hospitals. It is recommended for the hospital policy makers to develop the disaster training and disaster

simulation to increase nurses’ knowledge on psychosocial problems in disaster response.

1 INTRODUCTION

Disaster is a series of events that threaten human life

caused by natural, non-natural and human factors

which result in the emergence of casualties,

environmental damage, loss of property and family

and psychological impacts. Disasters can be natural

or man-made, ranging from local to large-scale

events. Disasters usually occur in stages, namely the

pre-event phase, during the event, and after the

event. Disasters are unpredictable and can result in

chaos, loss of life and loss of property (Achora &

Kamanyire, 2016), National Disaster Management

Agency, 2008; Houston, Pfefferbaum, and

Rosenholtz, 2012).

Indonesia is one of most high risk and vulnerable

countries on the world prone to disasters, both

natural disasters and man-made disasters. There are

several factors that can cause disasters, such as

geographical conditions, climate, geology, socio-

cultural and political diversity (Ministry of Health,

2007).

Disasters in the 5 years period between 2010 -

2014 reached 1,907 disasters, consisting of 1,124

natural disasters, 626 non-natural disasters and 157

social disasters, while in 2014 the number of

disasters was 456 disasters, consisting of 227 natural

disasters, 197 non-natural disasters and 32 social

disasters. In 2014 the number of disasters reached

1,567 which resulted in 568 deaths and missing,

2,680,133 people suffered and displaced, and

Husna, C., Abdurrahman, ., Kamil, H., Mustanir, ., Roza, I. and Tahlil, T.

Knowledge in Handling Psychosocial Problems among Nurses on Disaster Response in Banda Aceh Hospitals: A Comparative Study.

DOI: 10.5220/0008200800420048

In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 42-48

ISBN: 978-989-758-406-0

residential damaged 51,577 units (National Disaster

Management Agency, 2014).

Disaster impacts on psychosocial well-being

such as loss of family members, parents, siblings,

work, place of residence and other property. This

impact might trigger a mental health disorder, so it is

important to be anticipated. Disaster resulting of

various psychological problems such as loss of self-

confidence, worries, phobias, decreased physical and

mental abilities, and reduced adaptive ability (Smith

& Grant, 2016). The psychosocial is as the

comprehension of behaviours, attitudes, emotions

and thoughts of individuals or groups, that involved

historical, social and ideological environment and

background in order to explain and solve the

problems (Hofmeister & Navarro, 2017).

The most vulnerable groups to psychosocial

disorders are children, adolescents, women and the

elderly. In children and adolescents who experience

traumatic events will lead to lack interest in social

and school activities, children become rebels, eating

disorders, sleep disorders, lack of concentration,

posttraumatic stress disorder (PTSD) and alcohol

abuse or prostitution. Psychosocial conditions for

women resulting in a variety of psychological

shocks such as loss of self-esteem, worries and even

phobia symptoms that are excessive fear. While, the

elderly decrease in physical and mental abilities.

Several studies report that the involvement of nurses

in handling psychosocial issues in disasters is still

lacking, ignorance of roles, insufficient knowledge,

lack of prior disaster experience and education and

training related to handling the issue (Ranse,

Lenson, & Nursprac, 2012).

Psychosocial is a dynamic relationship in the

interaction between humans, behaviour, thoughts

and emotions of individuals will be influenced by

other people or social experiences. Psychosocial

problems are social problems that have a negative

impact to patients’ well-being and influence to the

emergence of mental disorders, such as post-

traumatic stress disorder (PTSD). The Psychosocial

problems may cause withdrawal, dependence,

hostility and self-destruction (Forbes et al., 2011;

ICN and WHO, 2009, Laluyan & Nurrachman,

2007; Schultz, Koenig, Whiteside, & Murray, 2012).

Disasters can cause some emotional reactions

that can be influenced by biological factors (stress

response), psychology (fear, anger, shock, sadness,

etc.), and sociocultural (support and assistance for

victims). Some behavioural and appearance

responses related to psychosocial problems due to

disasters can be manifested by suspicion, irritability,

withdrawal, silence, loss/increase in appetite,

smoking, drug abuse, and others. Feelings and

emotions are manifested by anxiety, feelings of

guilt, grieving, denial, panic, fear, feelings of failure,

blaming others, etc. Whereas thoughts, beliefs and

perceptions are manifested by confusion,

nightmares, disorientation, impaired concentration,

memory disorders, difficulty making decisions, etc.

(Gorman & Sultan, 2008).

Psychosocial problems are often occurred in

disasters. Many countries have focused on physical

services and financial problems rather than handling

the psychosocial impacts of victims (Zokaeefar,

Mirbeigi, Eskash, & Dousti, 2015). The results of

the study by Witteveen et al. (2012) state that the

psychosocial problem results of screening there are

42-65% of adults at risk of post-disaster trauma, and

those diagnosed with trauma by 50-62%, while the

results of screening are 9-31% of children who are at

risk of trauma, and 13-21% are diagnosed with post-

disaster trauma.

Nurses are the largest population and frontline in

hospitals that have roles and responsibilities in

helping disaster victims. Nurses are required to have

adequate competencies including knowledge, skills,

and attitudes in responding to disasters through

education and training programs and research related

to hospital preparedness and disaster response

(Thobaity et al., 2017). During and after disasters,

the role of nurses is to provide psychological care,

first aid mental health, and psychosocial care (Ranse

et al., 2012). Nurses are not only limited to

providing nursing care at the hospital but also must

be able to work in disaster response so that they

must be able to act according to competence in

caring for disaster victims (Hammad, Arbon,

Gebbie, & Hutton, 2017).

According to The European Network for

Traumatic Stress/TENTS (2008) for psychosocial

care following disasters and major incidents,

described that the competencies of nurse classified:

1) Management of preparation and planning, 2)

Immediate response (<1 week), 3) Response in the

week first post disaster, 4) Response at 1 month after

the disaster, 5) Response at 1-3 months after the

disaster, 6) Response >3 months after the disaster.

Nichols (2003) interventions in caring

psychosocial problems for injury/trauma patients

including disaster victims consisted: 1)

informational or educational care) 2) emotional care,

3) counselling care, and 4) provide support,

advocacy, and referrals. Furthermore, the skills that

must be possessed in monitoring patients'

psychological conditions: 1) patient centered

communication, 2) open versus closed questions,

Knowledge in Handling Psychosocial Problems among Nurses on Disaster Response in Banda Aceh Hospitals: A Comparative Study

and 3) good listening skills. Caring for disaster

victims more be focused on physical problems and

illnesses of patients, but psychosocial problems are

often overlooked when a major problem when a

disaster occurred. Several study report that many

nurses have inadequate knowledge in recognizing

psychosocial problems and less ability to respond to

disasters properly (Suserud & Haljamäe, 2003).

The hospital is a public health service center that

is most urgent when a disaster occurred. Readiness

of services in hospitals to provide health care to the

victims is an important indicator of the success of

disaster response (Kaji, Langford, & Lewis, 2008).

Meuraxa General Hospital (MGH). The MGH is a

type B hospital owned by the Banda Aceh City

Government which has 210 nursing staff. While, the

Mother and Child Hospital is a special type B

hospital owned by the Aceh Government, with 95

nursing staff. The MCH is in charge of providing

health services to the community, especially mothers

and child as well as other health services. The types

of medical services include emergency services,

outpatient services, inpatient services, surgical

services and intensive care. Both of these hospitals

located near the coastal area of Banda Aceh were

totally damaged by the 2004 tsunami disaster and

rebuilt by foreign aid or NGOs as part of the

reconstruction phase of Aceh at that time. Recently,

both hospitals receive referral patients from various

districts and cities in Aceh province with various

cases including victims of disasters and mass

casualty incidents (BLUD RSIA, 2015; Public

Relations RSUDM, 2016; Kemenkes RI, 2016). This

research can be recommended for policy makers at

both hospitals in preparing nurses' knowledge

through education and training in handling patients

with psychosocial problems due to disasters.

2 METHOD

The descriptive comparative is used in the study.

This research was conducted with respect to the

ethical principles in nursing research. It was

approved after consideration by the Faculty of

Nursing Ethics Committee of Universitas Syiah

Kuala Banda Aceh. The respondents were all given

all the required information about the research

without any form of coercing and were asked to

willingly sign the informed consent before

commencing the study.The study was aimed to

examine differences in nurses' knowledge in caring

psychosocial problems in the disaster response at the

Maternal and Child Hospital (MCH) the Meuraxa

General Hospital (MGH) of Banda Aceh. A cross-

sectional design with a total sampling method of 315

respondents was used in the study. The exclusion

criteria for the sample are nurses who did not

undergoing annual leave/birth leave. Then, the

sample met the inclusion criteria was 295

respondents. The exclusion criterion was the nurses

who have been undergoing annually leave, or

training and education. The respondents who did not

meet the inclusion criteria were not included in the

study.

The collection tool is a questionnaire consisting

of 2 parts, namely: a) demographic data, including:

age, gender, last education, length of work and

training that has been attended, b) psychosocial care

questionnaire consists of 26 items in a positive

statement and 8 items in a negative statement with a

total of 34 items using the dichotomous scales. The

Instrument passed validity and reliability testing was

carried out on 31 nurses at the Regional General

Hospital dr. Zainoel Abidin Banda Aceh. The

questionnaires passed the validity and reliability

testing with a value of 0.811 and 0.958 respectively.

The reliability testing used the Kuder Richardson

(KR-20) method and Pearson Product Moment for

correlation technique. The data was analyzed using

independent t-test which tests the significance of the

mean difference. A hypothesis testing of the study is

accepted with p-value ≤0.05.

2.1 Study Selection

The study was conducted in May-June, 2018 in both

of the hospitals. The hospitals are a referral hospital

in Banda Aceh located at high risk area of the

disaster prone. During the tsunami 2004, both

hospitals collapsed and many of nursing staff injured

and died by its impact. As a referral hospital

particularly in disaster response, the readiness of

nurses in handling the psychosocial problems in

patients must be the main priority to reduce the long

term effect due to disasters.

2.2 Description of Study

The study is focused on the nurses’ knowledge in

handling the psychological problems as the main

problem during disaster response such as lost

properties, families’ members, livelihoods, and self-

esteem that influence on patients’ mental disorders.

The nurses’ knowledge may influent to skill and

performance in caring the patients. The study was

conducted at the regional hospitals of Banda Aceh as

a high risk prone area of disaster such as earthquake

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

and tsunami. Limited studies have reported the

knowledge of nurses in caring the psychosocial

problems in disaster response in hospital setting.

3 RESULTS

3.1 Characteristics of Respondents

The respondents from the Mother and Child Hospital

(MCH) and the Meuraxa General Hospital (MGH)

were 95 and 200 respondents respectively. The

demographic data consist of age, gender, educational

level, working experience, attending disaster

management training, and kind of disaster training

attended. The population in this study is all nurses in

MGH and MCH who worked in inpatient ward:

aediatric ward, Medical ward, Surgical ward,

Intensive Care Unit, and Emergency Department

(EDs).

Table 1: Demographic Data at MCH and MGH Hospitals

of Banda Aceh (n = 295).

Demographic data

MCH MGH

(f) (%) (f) (%)

1. Age (year)

20-35 56 58.9 162 81.0

36-50 36 37.9 38 19.0

51-65 3 3. 2 - -

2. Gende

Male 13 13.7 50 25.0

Female 82 86.3 150 75.0

3. Education

Diploma III 78 82.2 140 70.0

Diploma IV 6 6.3 10 5.0

Nurse profession 11 11.5 50 25.0

4. Working experience

(year)

< 5 23 24.2 64 32.0

6-10 52 54.7 117 58.5

> 10 20 21.1 19 9.5

5.Attending disaster

training

Yes 51 53.7 62 31.0

No 44 46.3 138 69.0

6. Disaster training

attended:

Neve

44 46.3 138 69.0

BTCLS 43 45.3 - -

Fire managemen

6 6.3 13 6.5

Disaster

eme

gency

- - 3 1.5

Disaster drill - - 40 20.0

Youth alert disaste

- - 1 0.5

DASIPENA - - 1 0.5

Emergency - - 1 0.5

BTCLS - - 1 0.5

Fire and disaster dril

- - 2 1.0

Triage 2 2.1 - -

Table 1 indicates that both hospitals indicated the

age range of respondents between 20-35 years,

majority gender was female, diploma for education

level, 6-10 years for working experience, and

attended in disaster training (MCH = 53.7%; MGH

31%).

Table 2: Nurses’ Knowledge in Handling Psychosocial

Problems in Disaster Response (n=295).

Hospital Mean SD SE p-value N

MCH 91.84 8.53

.87

0.003

MGH 94.84 7.43 0.52 200

Table 2, it shows there is a difference in nurses'

knowledge of MCH with a mean ± SD (91.8 ± 0.87)

and MGH Hospitals (94.84 ± 0.52) at p-value 0.003.

4 DISCUSSIONS

Disasters are associated with a substantial

psychosocial burden for affected individuals,

families and communities. Nurses’ knowledge about

how to address these risks and problems is valuable

for the nurses in the hospital. Psychosocial care aims

to address mental health problems and patients’

needs. It covers all the support and care directed at

the psychological well-being and health of people

affected during and after disaster (Gouweloos,

Dückers, te Brake, Kleber, & Drogendijk, 2014).

The psychosocial problems that occur in a

disaster event, such as loss of residence, loss of

family, loss of livelihood until losing self-esteem as

an individual have influence on patients’ mental

disorders. Hence, social support is needed in the

disaster response to reduce the long-term impact on

these psychological problems (Gorman & Sultan,

2008). Psychosocial support is defined as processes

of accompaniment on an individual, family,

community and social level, aimed at preventing,

addressing and confronting the consequences of the

impact of a specific event such as a disaster. These

processes promote well-being, social and emotional

support for the disaster victims and contribute to re-

establishing integrity, strengthening dignity and

stimulating the victim in actions in the search of

truth, justice and integral reparation. Psychosocial

support considers the reconstruction of those social

support networks to restoring the dignity of the

victims and their families in society life (Hofmeister

& Navarro, 2017).

According to Sundram et al., (2008) stated that

there are some general principles of psychosocial

disaster intervention that must provide by the nurses

Knowledge in Handling Psychosocial Problems among Nurses on Disaster Response in Banda Aceh Hospitals: A Comparative Study

such as (1) Assessment of disaster, extant service

systems and incoming resources, (2) Assessment of

help-seeking pathways and cultural models of

illness, (3) Facilitation and support for family

reunion, identification of the dead and cultural and

religious practices to address death and grief, (4)

Foster and bolster community group activities where

possible, (5) Psychosocial training of community,

(6) Promote general community psychoeducation,

(7)Train medical and health staff in basic psychiatric

and psychological assessment and intervention for

post-traumatic stress, mood and anxiety disorders,

(8) Minimize risk factors for psychiatric morbidity

such as displacement and loss of gainful activity and

(9) Reshape mental health systems recognizing the

long-term psychiatric sequelae of disaster.

The results of the study reveal that there were

differences in demographic data of the respondents

of both hospitals. It is an important role in handling

the psychological problems in disaster response such

as age, educational level, working experience, and

attending disaster training. The data showed that

most of respondents in MGH have 20-35 year old is

81%, and in MCH is 58.9%. At 20-35 year old the

respondent has more opportunity to seek and obtain

knowledge related to psychosocial problems of

disaster victims. The knowledge might obtain

through various reading materials such as books,

journals, newspaper, and electronic, so that it can

have positive impact on the level of knowledge

gained in caring disaster victims with psychosocial

problems. While, educational level also play an

important role in the results of the study that showed

that 25.0% of nurses at MGH had nurse profession

levels compared to MCH only 11.5% and most of

them still diploma level (61.1%). The level of

education has an important role in increasing

knowledge of nurses to manage the psychosocial

problems among patient.

Moreover, the working experience in providing

services at the hospital may also has a positive

impact on the ability of nurses to determine what

kind of knowledge needed in caring for patients with

psychosocial problems. In this study, nurses who

have 6-10 years of work experience at MGH was

58.5% compared to MCH of 54.7%. Working

experience is very important in providing services to

patients including knowledge in caring for disaster

victims. The 6-10 years working experience

provides direct exposure to the nurses to understand

the various psychosocial problems experienced by

the patients and provide interventions to handle

these problems. According to Nichols (2003), the

intervention for the treatment of psychological and

psychosocial problems in patients with illness and

injury/trauma consist of information support,

emotional support, counselling care and support,

advocacy, and referrals.

Attending in disaster training is also very crucial

to influence nurses' knowledge in disaster response.

The results of the study showed that 31% of nurses

in MGH had participated in emergency and disaster

training program such as basic trauma and cardiac

life support (BTCLS), fire management, emergency

and disaster drill, youth alert disaster, and triage.

These trainings are certainly very helpful in

increasing nurses' knowledge in providing health

and nursing services to patients regarding

emergency and disaster management particularly in

handling psychosocial problems. Because through

disaster training, especially disaster drills, nurses are

taught knowledge and skills in dealing with various

psychosocial problems of patients. The results of the

study supported by study of Elangovan and Kasi

(2014) mentioned that teachers who were provided

training on psychosocial disaster preparedness had

better knowledge than the control group. The

teachers who have good knowledge of disaster

preparedness about psychosocial problems, revealed

that better children's knowledge after being given the

same training compared to children in the control

group.

Psychosocial support is needed to reduce

anxiety, depression, stress, and PTSD post-disaster.

According to Thordardottir, Gudmundsdottir,

Petursdottir, Valdimarsdottir, and Hauksdottir

(2018), psychosocial support have a high level on

patient’ and family’ satisfaction (16-37%) in the

affected population in the year 1995-2010.

Psychosocial support might be conducted with

collaboration with various cross-sectors in caring

disaster victims. The study also reported that PTSD

symptoms negatively associated with utilization of

psychosocial support to the disaster victims.

In the study of Hughes, Grigg, Fritsch, and

Calder (2007) mentioned that the nurses as the

largest component of the emergency response team

must be able to ascertain how the patient reacts

normally or not and can contribute to the recovery of

psychosocial problems in patients. Nurses also

provide effective social interventions to minimize

the potential for serious mental illness. Ranse,

Hutton, Wilson, and Usher (2015) stated that the

recovery of psychosocial problems not only be

focused on patients, but also on nurses who help to

psychosocial problems as a result of disasters.

Psychosocial problems are not only about the

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

support given but also the physical condition of the

victim may affect to patients’ mental status.

One thing to support the psychological problem

among patient in disaster response is provide

cultural, belief and spiritual approaches in handling

the problems. The results of the study supported by

answered of the respondents for the statement

"Nurses support patients in conducting religious

activities" was 100% the nurses in MGH and 96.8%

of nurses in MCH answering did it. In addition, in

the statement "Nurses respect the cultural practices

believed by patients", nurses answered correctly in

MGH and MCH were 97,5% and 88.4%

respectively. Based on the results of the study, there

is a difference in nurses' knowledge in handling

psychosocial problems in disaster response between

MCH and MGH hospitals.

In addition to considering spiritual and belief, the

nurse's experience in handling trauma will have an

impact on the strength of the knowledge and

experienced gained. This is in line with the opinion

by Bugge et al., (2019) mentioned that traumatic

experiences was mostly perceived as positive and

linked to various helpful outcomes. To engaging in

the trauma narrative, the nurses needed to

comprehend and address how the traumatic

experiences and the hospitalization resulted in the

survivors’ extended fear and changed appraisals

about themselves. The nurses are needed available a

lot of time to stay physically and mentally close to

the patients as a part of nursing intervention in the

handling psychosocial problems. The nurses played

a significant role in strengthening the survivors’

confidence in own capabilities and trust in others.

The results of the study supported by Ranse,

Hutton, Jeeawody, and Wilson (2014) indicated that

psychosocial aspects in disaster nursing were ranked

highest and main issues to be handled. This result

indicates that in the future disaster nursing research

should focus on psychosocial aspects to minimize

problems of the victims.

According to The European Network for

Traumatic Stress/TENTS (2008) mentioned that

every area should have guidelines and competencies

on the provision of psychosocial care in emergencies

including knowledge to address psychosocial

problems. In term of response, the nurses should

promote a sense of safety, self and community

efficacy/empowerment, connectedness, calm and

hope. Responses should provide general support,

access to social support, physical support and

psychological support to the victims. Regular

training for nurses related to handling psychosocial

problems is needed to improve the competencies in

respond to disaster. Recent study by Zokaeefar et al.,

(2015) found that hold regular educational programs

are needed in order to create and maintain readiness

and response to disasters.

5 CONCLUSIONS

The conclusion of the study is there was a significant

difference mean score of knowledge among nurses

in handling psychosocial problems in disaster at

MCH and MGH in Banda Aceh (p-value = 0.003).

The result of the study recommended to the hospital

policy makers to arrange the disaster training and

disaster simulation regularly in increasing nurses’

knowledge in handling psychosocial problems in

hospital setting.

ACKNOWLEGEMENTS

The authors would like to thank all nurses who

worked in both hospitals, for their fully participation

in the research. The authors also appreciate to the

Chairman of Research and Training of MCH and

MGH hospitals of Banda Aceh for their kind

assistance in this study.

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ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association