Key words
Intention to report for work, emergency events,
self-efcacy, risk appraisal
Correspondence
Dr. Semyon Melnikov, Nursing Department,
Tel Aviv University, Tel Aviv, Israel.
E-mail: melniko@post.tau.ac.il
Accepted: October 5, 2013
doi: 10.1111/jnu.12056
Abstract
Purpose: This study investigates the effect of personal characteristics and
organizational factors on nurses intention to report for work in a national
emergency.
Design: A convenience sample was drawn of 243 Israeli registered nurses.
A structured self-administered questionnaire collected data on (a) intention
to report for work, (b) barriers preventing nurses from reporting for work,
(c) perceived self-efficacy in emergency conditions, (d) risk appraisal of health
hazards, (e) knowledge of nurses roles in emergency work, (f) access to institutional support services, and (g) reporting to work in a past emergency.
Methods: Data were analyzed by descriptive statistics, Pearson correlation
coefficients, t tests, and multiple regression analysis.
Findings: Less than half of the nurses who said they had been asked to report for work in a past emergency had actually done so. The major barrier
to reporting for work was childcare demands. There was a significant correlation between perceived knowledge, risk appraisal, self-efficacy, and intention
to report. Self-efficacy, risk appraisal, working through an earlier emergency,
perceived knowledge, and full or part-time working altogether.
Conclusions: Personal factors, such as perceived knowledge, risk appraisal,
and self-efficacy, are more important to Israeli nurses than objective barriers
in preventing them from reporting for emergency work. The level of perceived
knowledge as to the demands on and duties of nurses in a large-scale emergency is low. Self-efficacy enhancing activities need to be introduced into nurse
training for emergency preparedness.
Clinical Relevance: This study makes an important contribution to research
on the importance of perceived self-efficacy in the context of disaster planning.
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Melnikov et al.
Variance
Variable
Variance
41 (17.1)
40 (16.7)
30 (12.5)
29 (12.1)
26 (10.8)
9 (3.8)
8 (3.3)
8 (3.3)
3 (1.3)
49 (19.2)
Methods
Sample
A convenience sample was drawn of 243 registered
nurses working in various hospitals and outpatient clinics (including general hospitals and specialized hospitals, such as trauma centers, rehabilitation, childrens,
geriatric, and psychiatric hospitals). Outpatient clinics refer to facilities providing general or specialized
types of community healthcare. Eighty-seven percent of
the sample were women; mean age was 36.13 years
(SD = 9.18); 49.4% were Israeli born, with the remainder
mostly immigrants from the former Soviet Union (FSU);
76.3% were regular ward nurses, with the remainder in
higher or managerial positions; mean work experience
was 11.81 years (SD = 9.53); 82% worked in 28 of the
total of 49 hospitals in Israel. Table 1 displays the participants demographic characteristics.
136
The Instrument
The structured self-administered questionnaire comprised eight sections: (a) intention to report for work; (b)
barriers to reporting for work; (c) self-efficacy as to functioning; (d) risk appraisal of exposure to health hazards;
(e) perceived knowledge of nurses roles and duties; (f)
availability of institutional support services; (g) reporting
to work in a previous emergency; and (h) demographic
data. All sections of the tool were developed by the authors (unless otherwise stated below), based on a thorough literature review, national policy, and work with
focus groups of medical staff taking training courses in
emergency and disaster preparedness. The guiding principles for constructing the tools drew on key elements
of the National Guidelines on Hospital Emergency Preparedness Planning, as formulated by the Israeli Ministry
of Health, Emergency Department (2013) and by the Israeli Parliament (Knesset; Koch Davidovich, 2011). Two
senior clinical nurses and three experts in disaster and
emergency management in hospitals (two nurses and one
physician) reviewed the questionnaire for face validity,
feasibility, and comprehensibility. All five judges had to
be in full agreement for any item to be included, and their
comments revised the final questionnaire.
Perceived knowledge of roles and duties in an emergency was tested by a six-item tool. The items measured respondents perceived degree of control over their
level of knowledge about their role in different kinds of
emergencies (conventional multicasualty accident, mass
chemical event, pandemic, attack by chemical or radiological weapon, and earthquake). Respondents were
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Melnikov et al.
Availability of institutional support services and resources was rated by an 11-item instrument that combined two tools constructed by OSullivan et al. (2008).
The first tool examined nurses perception of the adequacy of their supplies (e.g., gloves, gauze, masks, etc.),
and the second examined the perceived availability of a
variety of institutional supports (e.g., Internet access, psychological counseling, childcare facilities). Respondents
were asked to rate perceived availability on a scale from
1 (always available) to 5 (never available). The Cronbachs
for this section was .82.
Respondent demographic data included gender, age,
country of origin, job seniority, job position, full- or parttime working, and field of practice (see Table 1).
Intention to report for work was measured by a sevenitem scale. The tool was constructed on the basis of the
Qureshi et al. (2005) study, which found that employees
ability and willingness to report for duty varied by type of
event. In the present study, several possible scenarios in
an Israeli context were added, including an earthquake
or major terror attack with multiple casualties, an infectious disease pandemic, and an attack with conventional,
chemical, biological, or radiological weapons. A typical
item was: How firm is your intention to report for work
in a national emergency situation as a result of earthquake, pandemic, chemical weapons attack, etc.? Participants were asked to rank items on a scale from not firm at
all to very firm. The mean score for all items was taken
as indicating the level of intention to report for work. The
Cronbachs for this section was .91.
Procedure
Before beginning data collection, a pilot study was conducted (N = 30) to evaluate the data-collection procedure and respondents understanding of the questionnaire. Some items were altered in the light of comments
received. The final questionnaire was then distributed
to 260 working nurses enrolled in academic and other
training programs at Tel Aviv Universitys Nursing Department. At the beginning of a class, nurses were addressed by a senior researcher and asked to participate in
a study on intention to report in an emergency. The senior researcher explained the studys aim, the nature of
the nurses contribution to the research, and the manner
in which the information would be used. The researcher
also explained that their participation in the study was
entirely voluntary and could stop at any point. The nurses
were guaranteed that refusal to take part would cause
them no harm and that all information would remain
confidential. Nurses who agreed to participate in the
study signed an informed consent form and were given
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Melnikov et al.
Data Analysis
Descriptive statistics were used to analyze the nurses
sociodemographic data and to describe the study variables. Pearson correlation coefficients were used to test
relationships between variables, and t test analysis (for
independent samples and for paired samples) was used
to compare means between groups. Multiple regression
analysis measured the unique contribution of the independent variables to the dependent variables. The levels
of significance used throughout were .05 and .01. Data
were analyzed using SPSS 21.0 (SPSS Inc., Chicago, IL,
USA). Approval was obtained from the Ethics Board of
Tel Aviv University, Israel.
Results
Descriptive Statistics and Differences Among
Groups
The mean scores for the main study variables from the
whole sample were as follows (on a scale from 1 to 5):
for perceived knowledge of roles and duties, 2.67 (SD =
0.97); for risk appraisal of exposure to hazards, 2.58 (SD =
0.69); for perceived availability of support services, 3.60
(SD = 0.91); for perceived barriers preventing reporting
to work, 3.49 (SD = 0.88); and for intention to report for
work, 3.65 (SD = 0.96). The mean score for self-efficacy
was 6.62 (SD = 1.43) on a scale from 1 to 9.
Thirty-six percent of the nurses said they had been
asked to report for work in a past emergency, and 46.7%
of all nurses had done so (war, pandemic, etc., including as a volunteer). More than half (55.4%) estimated
that protective equipment (gowns, gloves, masks) were
always available at their workplace. The support services
cited as the most frequently available were phone access
(73.3%) and Internet access (60.8%). The support services least frequently available were a protected hostel
for elderly persons living with the nurse (6.6%) and protected accommodation for pets (2.9%). The most common barrier to reporting for work was childcare (71.1%).
Other barriers were the care of elderly parents (36.8%),
health problems (29.8%), transport access (27.2%), and
pet care (6.7%; Figure 1).
Comparing Israeli-born with FSU-born nurses, the former displayed higher levels of knowledge (M = 2.77 vs.
2.49, respectively; t = 2.2, p < .05), higher self-efficacy
(M = 6.9 vs. 6.3, respectively; t = 3.24, p < .01), and
higher intention to report for work (M = 3.75 vs. 3.49, re-
138
spectively; t = 2.09, p < .05). Perceived availability of resources and barriers and perceived risk exposure did not
differ by ethnicity. Significant differences were found between nurses by reporting for work in a past emergency.
Nurses who had been summoned to emergency work
in the past, or who had actually reported for work, displayed significantly higher levels of perceived knowledge,
self-efficacy, and intention to report for work. They also
perceived the barriers to getting to work as less restrictive. There were no gender-related differences on these
variables.
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Melnikov et al.
1. Perceived knowledge
2. Appraisal of risk
.24
3. Self-efcacy
.37 .29
5. Barriers
.25 .15 .13
.13
6. Intention to report
.42 .32 .42 .12 .17
M
2.63
2.60
6.63 3.60 3.49 3.65
SD
0.97
0.69
1.43 0.91 0.88 0.96
Regression Analysis
To measure the unique predictive contribution of selected variables to readiness to report for work, a multiple
stepwise regression analysis was performed. All sociodemographic and study variables were included as independent variables and readiness to report as the dependent
variable. This analysis demonstrated that the following
variables significantly predicted the dependent variable:
self-efficacy in emergency functioning (t = 3.70, B = .17,
= .26, p < .001), risk appraisal of exposure to hazards
(t = 3.63, B = .31, = .23, p < .001), reporting to work
in the past (t = 2.63, B = .32, = .17, p < .01), perceived knowledge of duties (t = 2.37, B = .17, = .18,
p < .05), and full- or part-time working (t = 2.35,
B = .19, = .15, p < .05). These together explain 33%
of the variance in nurses intention to report for work
in an emergency. In other words, the higher were selfefficacy, perceived knowledge, and actual past reporting
and the lower the number of hours worked per week and
the perceived risk of exposure, the higher was the intention to report for work.
Discussion
Planning for emergency preparedness depends, among
other things, on knowing how many staff will be available. The current study aimed to explore personal and organizational factors related to nurses intention to report
for work in emergency situations. Overall, the results of
this study showed that personal factors were more important to Israeli nurses than organizational factors. VariJournal of Nursing Scholarship, 2014; 46:2, 134142.
C 2013 Sigma Theta Tau International
ables such as reporting for work in previous emergencies, perceived knowledge of the nurses roles and duties in emergency conditions, appraisal of ones ability to
cope with these demands (self-efficacy), and of the risk
of potential harmful exposure were more important than
organizational aspects, such as the support provided by
the workplace and barriers to reporting for work. Should,
then, disaster preparedness planning focus on the personal and emotional preparation of personnel more than
on administrative issues? As usual, the present study provides a partial answer only.
Reporting for work in a past emergency was correlated
with higher levels of perceived knowledge, self-efficacy,
and intention to report for work. Similarly, Baack and
Alfred (2013) found that among 620 nurses from Texas,
those who had actual prior experience in disasters were
more confident in their ability to respond to major disaster events. The finding that personal factors outweigh
organizational factors contrasts with the OSullivan
et al. (2008) finding that nurses were concerned by institutional unpreparedness to the point that these factors would potentially prevent their reporting to work.
Further, whereas Qureshi et al. (2005) found that transportation difficulties (33.4%) and childcare (29.1%) were
the most common reasons for not reporting to work;
in the current study, childcare (71.1%) was by far the
mostly frequently cited. This finding can be explained
by the centrality of childcare and motherhood in Israels family-oriented society. This is reflected in the
strong commitment to the demands of childcare by
both employees and system managers (Bloomfield, 2009;
Remennick, 2000), to the extent that nurses, representing the working woman trying to combine motherhood
and profession, feel entitled to set up this factor as a key
barrier to their reporting for emergency duties.
However, variables such as perceived knowledge, risk
appraisal, and self-efficacy are more important to Israeli
nurses than the barriers preventing them from reporting for work. Israeli nurses who scored high on selfefficacy and knowledge of their roles and duties in an
emergency, and who rated as low the risk to their health
from patient care, demonstrated higher intention to report for work. The importance they ascribed to these personal variables could be explained both by the Jewish
value of sanctity of human life (Steinberg & Sprung,
2006) and the collective spirit and solidarity characteristic
of Israeli society during a national emergency (Ben-Dor
et al., 2008). These findings are also consistent with the
basic assumptions of Social Cognitive Theory (Bandura,
1977, 1997), which predicts a significant association between self-efficacy and professional performance. Since
little is known about the association between nurses
self-efficacy as regards their functioning and readiness
139
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Melnikov et al.
(1997), which emphasizes the predictive effect of selfefficacy on expectations and behaviors.
Conclusions
We propose introducing self-efficacy enhancing activities into staff education and training for emergency
preparedness. These activities would, following Bandura
(1997), focus on amplifying sources of self-efficacy (mastery experiences, social modeling, social persuasion,
psychological responses). Interventions would focus on
empowering staff through simulation training and learning from previous multicasualty events how other staff
has successfully met the challenges of a large-scale emergency. Staff in these training sessions should be encouraged to give their best efforts to meeting their
nursing duties, including discussion of the emotional
aspects of emergency functioning. Although the body
of self-efficacy research is huge, only a few reports refer to its contribution to predicting intention to report
for work in an emergency (Balicer et al., 2010; Ko
et al., 2004). Thus, the present study has made a further contribution to research on the importance of selfefficacy beliefs in the context of disaster and emergency
management.
Although the perceived barriers to reporting for work
were not significantly correlated with other study variables in the present study, nurse perceptions of these
barriers is worth a brief discussion. Older and more senior nurses perceived the barriers as less restrictive. One
obvious explanation for this is that childcare (the major
barrier) is more relevant to younger nurses. This finding leads us to recommend that in an emergency nurses
with children be given access to supervised kindergarten
and school facilities. Another explanation of this finding
may be that the collectivist ethos, rooted as it is in Israels
nation-building struggle, is stronger in the older generation of nurses than among new recruits to the profession
(Ben-Dor et al., 2008; Hanssen, 2004).
The limitations of our study include a possible sampling bias: the sample is drawn from nurses taking advanced academic training courses, who may well be
more committed to reporting for work in an emergency.
Another limitation is that all the variables are scored by
self-reporting and not by objective measurement. The
generalizability of the findings is limited by the use of
a convenience sample, which might not be representative of all Israeli nurses. However, since the nurses who
participated in the study work in a range of hospitals
and outpatient clinics, the study nonetheless provides
valuable information on the intentions of nurses to report for work in an emergency or disaster.
Journal of Nursing Scholarship, 2014; 46:2, 134142.
C 2013 Sigma Theta Tau International
Melnikov et al.
Acknowledgements
Dr. Melnikov and Dr. Itzhaki contributed equally to
this article.
Clinical Resources
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Supporting Information
Additional Supporting Information may be found in
the online version of this article at the publishers web
site:
Appendix 1. Self-efficacy in emergency functioning
questionnaire
Appendix 2. Items of risk appraisal of exposure to
health hazards tool