CONCEPT ANALYSIS
PREPAREDNESS
Presented to:
Assoc. Prof. Pattama Surit, Phd., RN
TIARA (585060029-8)
Master of Nursing Science Program
Faculty of Nursing Khon Kaen University
First Semester, Academic Year 2015
PHENOMENA
NURSES PREPAREDNESS FOR DISASTER MANAGEMENT IN MT. ANAK
KRAKATAU BANDAR LAMPUNG AREA, INDONESIA.
BACKGROUND
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. (U.N. ISDR 2002,)
Natural disasters include strorms, such as hurricanes and cyclones, floods, eartquakes,
extreme heat and cold emergencies, tsunams, vulcanic, eruptions, pendemics and famine (food
and Agriculture organization of the united Nations, 1999).
World disaster report 2007 reported a 60 % increase in disasters in the last decade (1997-
2007) over the previous decade (1987-1996). Adiditionally, the number of reported death grew
from 600.000 to over 1.2 million. At the some time the number of people affected rose from 230
million to 270 million, a 17 % increase( Kylman, Kouppart & Mukheir,2007)
According to the United Nations Bureau Of crisis prevention and recovery, some 75 %
of the worlds 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).
Natural disasters have been increasing over the last years, withthe 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).
Around 62 % of all active vulcanoes 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 amerika segments countain only 17% of the fulcanoes,
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. Ect). 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)
The Major volcanic eruptions of the past 250 years are Grimsvotn (Laki or
Lakagigar), Iceland 1783, Tambora, Sumbawa, Indonesia 1815 ,Cosiguina, Nicaragua 1835,
Askja, Iceland 1875, Krakatau, Indonesia 1883, Okataina (Tarawera), North Island, New
Zealand 1886, Santa Maria, Guatemala 1902 Ksudach, Kamchatka, Russia 1907, Novarupta
(Katmai), Alaska, US 1912, Agung, Bali, Indonesia 1963, Mt. St. Helens, Washington, US
1980, El Chicho n, Chiapas, Mexico 1982, Mt. Pinatubo, Luzon, Philippines (Robock, A ,
2000)
The vulcanoes eruption are 1783 Laki, Iceland death 9,340 (mostly starvation), 1815
Tambora, Indonesia death 92,000 (mostly starvation) 1883 Krakatao, Indonesia death 36,000
(mostly tsunami), 1902 Mt. Pelee, Martinique death 29,000 (ash flows) 1985 Nevada del
Ruiz, Colombia death 22,000 (mud flows) Vulcano in indonesia could divide into 4 type
vulcanos shape, which are stratavulcano or strobolian, shield, cinder cone and caldera.
Indonesia is a country with more than thousands island which located in the ring of
fire. Moreover, indonesia located in three active faulth , they are pacific, indo-australia and
eurasia faults,. The movement of these three faults inpact to the natural disaster event in
indonesia. One of the natural disaster caoused by this geographical condition is vulvano
disaster ( Kusumastuti et oal, 2014). More than 130 active vulcanoes apread to all island in
indonesia (center for reseach on epidemology of disaster, 2006). Vulcano in indonesia could
devide into 4 type of vulcanos shape, which are strata vulcano or strombolian, shield, cinder
cone and caldera. One of mountain in sumatera island which had fluctuation seismic
activities for this year is mountain anak krakatau.
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.
Between 1992 up to 2001, within nine years, the eruption of Anak Krakatau took
place almost every day, and it had caused its elevation to 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 Krakataus 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 distric (
panjang 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 .
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)
tobe level III ( Standby) but the earthquake of Mt Krakatau to be decreaise 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.
Based on the large number the impact of disaster so the importance to nurse
preparednes for reduce the impact of disaster. Bandar Lampung area is the one of the high
level of risk. And thr goverment 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.
Lindell and Prater (2003) outline 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..
One of the main questions regarding the impact of natural disaster on households or
localities is how random they may be. Lindell and Prater (2003) also outline how the impact
of natural disasters should take into account other mechanisms, such as mitigation practices
emergency preparedness, assistance, etc, to determine the real impact. Some hospitals in
Lampung have been training about the disaster but almost the training is about fire not
vulcanous.
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, preparedness is A
series of activities conducted through organizing and taking the correct and useful steps.
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).
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).
The ISDR defines preparedness as activities and measures taken in advance to ensure
effective response to the impact of hazards, including the issuance of timely and affective
early warnings adn the temporary evacuation of people and property from thretened location
(ISDR, 2004). Element of preparedness include : recruiting volunteers. Planning, training,
equipping, public education, exercising and evaluation.
The number of disaster in indonesia since 1907 to 2004 is cyclone number o events
10 (1.992 death ), Drought number of events 11 (9.329 death), Earquake number of event 78
(21.856 detah), Flood number of event 93 (4.298 death) and vulcano the number of event
(17.945 death) (The Earth Institute, 2004).
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 govrnment 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.
The disaster management at the pre disaster so far many forgotten , but even at the pre
disaster is very important because what had already been prepared at the it is a financier in
the face of disaster and post disaster .A little the government along the public and private
thinking about langkah-langkah or kegiatan-kegiatan what is needed in face disasters or how
reduce the impact of disasters Rachmat, 2008).
Responsible for health in disaster management at the center is health minister assisted by the
echelon 1 under coordination of coordination the head of the national disaster ( BAKORNAS
PB ) the vice of president , and implementation in the department of health coordinated by un
secretary general in this case is chairman of the central.
Responsible for health in disaster management in the provincial level is head of the provincial
health office if necessary will call for aid to ministry of finance under coordination of a unit
of coordinate the operation of the disaster management ( satkorlak pb ) headed by gubernur
At the district level responsible for health in disaster management is head of district health
offices if necessary can asked for help to the province under coordination of the executing
unit disaster management ( satlak pb ) headed by Bupati (KepMenKes RI, 2007).
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)
There is no percentage is certain about the number of nurses who are involved in disaster
management in the community. Until this time the nurse workforce needs to handle the
disaster victims in the community as much as 33% of all health care personnel involved.
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.
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. In addition, public
health nurses have a skill set that serves their community well in disaster to include health
education and disease screening, mass clinic expertise, an ability to provide essential public
health services, community resource referral and liaison work, population advocacy,
psychological fi rsaid, public health triage, and rapid needs assessment.
The role of nurse during a disaster depends a great deal on the nurses experience,
professional role in a community disaster plan, and prior disaster knowledge to include
personal readiness. Public health nurses bring leadership, policy, planning, and practice
expertise to disaster preparedness and response ( ASTDN, 2008 ). Based on this
phenomenona im interested to do this research .
1. SELECT CONCEPT
Preparedness
2. DITERMINE THE AIM OR PURPOSE OF ANALYSIS
A concept is a building block for scientific research and theory development in a
dicipline. This paper explores the meaning of preparedness. A concept analysis uses the
method described by Walker and Avant (2005) undertaken to examine the atributes,
characteristics and use of the concept. The goal of this undertaking is to identify and
clarify the meaning of preparedness.
.
3. USES OF THE CONCEPT OF PREPAREDNESS
Experts in concept analysis agree that inquiry begins by reviewing relevant literature.
Pearson (2004) suggestd that reviewing multiple sources from many disciplined may
support the development of understandings of the research, therefore, in this present
analysis information is retrieved from journal and theory of dictionaries and other
diciplines. The refrences will explain in the different way about complience that will
make us more understand about the definition of preparedness.
a. Definition of preparedness from dictionaries
Dictionaries describe a concept in term of its widely accepted and universal use.
Oxford learners pocket dictionary (2008) describe meaning of preparedness
is a state of readiness especilally for war : the country maintened a high level of
military preparednees (oxford, 2008)
Thasaurus dictionary defines that preparedness is: 1. The state of being
prepared, rediness. 2 possesion of adequate armed forces, industrial resourches and
potential etc :especialy of ditterent to enemy attact. The synonim of preparedness is
readiness, prepartion, alertness, mobility, willingness and zeal. (Thausaurus, 2014)
British dictionary define of preparedness is The state of being or ready especially
militarily ready for war
Combridge dictionary define of preparedness is to expect that something or
someone ready for something that will happen in the future ( combridge, 2014)
The Comprehensive Bahasa Indonesia Dictionary defines preparedness as a
prepared condition. It came from the basic word prepared, meaning ready to be
used or to act. While the definition provided by Law Number 24 Year 2007 for
Disaster Prevention is a series of activities conducted to anticipate disaster through
organising as well as taking the correct and useful steps.
b. Preparedness from the perspective of theories
Preparedness has a many of definitions. The different perspective of different
diciplines further preparedness a unified of the term.
Preparedness is the degree to which an organization, agency, or discipline is
capable of preventing, responding to, or recovering from a threat, crisis, disaster,
incident, or event of mass destruction, mass exposure, or mass disruption. An official
definition is: The term preparedness refers to the existence of plans, procedures,
policies, training, and equipment necessary at the Federal, State, and local level to
maximize the ability to prevent, respond to, and recover from major events. The term
readiness is used interchangeably with preparedness Preparedness is a process, or
as is proposed in these papers, a cycle (George W. Bush, 2003).
Today, however the concept of preparedness has been transformed from community
survival pattern into the rhetoric of formalized bureaucratic organizations ( Tierney
1989; smith and Dowell 2000).
Preparedness Are the measures that ensure the organized mobilization of personnel,
funds, equipments, and supplies within a safe environment for effective relief
(Transitional Government of Ethiopia (TGE) 1993). Preparedness is the degree to
which an organization, agency, or discipline is capable of preventing, responding to,
or recovering from a threat, crisis, disaster, incident, or event of mass destruction,
mass exposure, or mass disruption. An official definition is: The term preparedness
refers to the existence of plans, procedures, policies, training, and equipment
necessary at the Federal, State, and local level to maximize the ability to prevent,
respond to, and recover from major events. The term readiness is used
interchangeably with preparedness (George W Bush, 2003)
FEMA (Federal Emergency Management Agency) defines preparedness as: the
leadership, training, readiness and exercise support, and technical and financial
assistance to strengthen citizens, communities, state, local, and tribal governments,
and professional emergency workers as they prepare for disasters, mitigate the effects
of disasters, respond to community needs after a disaster, and launch effective
recovery efforts (www.fema.gov).
Conclusion of preparedness definitions
1. A state of readiness especilally for war
2. The state of being prepared, rediness.
3. possesion of adequate armed forces, industrial
resourches and potential etc :especialy of ditterent to
enemy attact
Dictionaries 4. The state of being or ready especially militarily ready for
war
5. to expect that something or someone ready for
something that will happen in the future
6. prepared condition
Preparedness
the existence of plans, procedures,
policies, training, and equipment
George W Bush, necessary at the Federal, State, and local
2003 level to maximize the ability to prevent,
respond to, and recover from major events
Other literature is the degree to which an organization,
agency, or discipline is capable of
Transitional preventing, responding to, or recovering
Government of from a threat, crisis, disaster, incident, or
Ethio event of mass destruction, mass exposure,
or mass disruption
the leadership, training, readiness and
FEMA exercise support, and technical and
financial assistance to strengthen
citizens, communities, state, local, and
tribal governments, and professional
emergency workers as they prepare for
disasters, mitigate the effects of
disasters, respond to community needs
after a disaster, and launch effective
recovery efforts
4. Defining attributes
According to Walker and Avant (1995), defining attributes are those characteristics
of a concept that are most frequantly associated with the concept, and appear
repeatedly in references to the concept.
Preparedness attributes
1. The state of being ready to be used or to act for something that will happen in the
future.
2. A series of activities conducted through organizing and taking the correct and useful
steps.
3. A process of plans, procedures, policies, trainings, and equipment necessary to
maximize the ability to prevent, respond to, and recover from major events.
4. The state of leadership in strengthening people and communities to prepare for
disaster or respond to the effects of disaster with effective recovery efforts
5. Model Case
A Model case is a real life example of the use of the concept that includes all the
critical attributes of the concept. Model case should be a purse case of the concept, a
paradigmatic example (Walker and Avant, 1995). The example of model case as
follows :
A group of nurses working in health care center in Bandar Lampung near Mt.
Anak Krakatau vulcanous this area is a potential threat to themselves, their
familiesand their community. The status of Mt. Krakatau is level III (Standby) and the
nurse evaluate whether becoming better prepared is important to them at this time.
The nurses want to act in a response to the vulcanous eruption that would happen in
the future. The nurses decided to develop a disaster management program which
consisted at five steps : 1. Planing for action which involved healtcare provider
community and agency responsibility and also get a financial and material suport
from the goverment and private sector. 2. Exercise to carry out their duties but also
help to find problems in the plan in emergency situation.3. Equipmet that need to
maximize the ability to prevent, respond to, and recover from major events.
4.Training, The community nurses do the training make a team work and the training
based on the prosedur and guidline from the policies, and the nurse took
responsibility to help the peoples in this area because nurses became a leader 5.
Evaluation for all the activities.
Table 1.1 Summary of Attribute
Attribute Sentences
The state of being ready to be used The nurses want to act in a response to the
or to act for something that will vulcanous eruption that would happen in the
happen in the future future
A series of activities conducted The nurses decided to develop a disaster
through organizing and taking management program which consisted at five step
the correct and useful steps
A process of plans, procedures, Equipmet that need to maximize the ability to
policies, trainings, and prevent, respond to, and recover from major
equipment necessary to events. 4 training The community ners took
maximize the ability to prevent, responsibility to help the peoples in this area
respond to, and recover from because they became a leader.
major events
The state of leadership in Training The community ners took responsibility
strengthening people and to help the peoples in this area because they
communities to prepare for became a leader
disaster or respond to the
effects of disaster with effective
recovery efforts
6. contruct additional cases
6.1 Boderline Case
Borderline cases are those example or instances that contain some of the concept being
examined but not all of them (Walker & Avant, 1995).
The folowing example presents a boderline case for the concept of preparedness :
The nurses were working in a health care center in lampung, near Mt. Merapi in Central
Java. This area is very dangerous to all peoples, the status of Mt. Merapi is level
III(standby). And the nurses need evaluated whether bocoming better prepared is very
importan to them in this time and . The group of nurses agree to action in a reponse to the
vulcanous eruption that would happent in the future and in the beggining. The nurses dont
have a training and knowladge about the disaster preparedness. They cannot set up the
programe to preparation for vulcanous damages. The community nurses have a
responsibility to help the peoples because the nurses become a leader.
In this borderline case some, but not all of the defining attribut are present. The grup
of nurses wanr to act to prepare to the vulcanous eruption but the nurses dont have a
training and they cannot set up the programe to preparation for vulcanous demages.
6.2 Contrary case
Contrary cases are those that are clear examples of Not the concept. (walker
&Avant,1995).
A group of nurses working in health care center in Bandar Lampung near Mt. Anak
Krakatau vulcanous this area is a potential threat to themselves, their familiesand their
community. The status of Mt. Krakatau is level III (Standby) and the nurse evaluate
whether becoming better prepared is important to them at this time. And preparedness is
priority to take a action.
The group of nurses didnt to action in a response to the vulcanous eruption that would
happent in the future . they dont have a knowladge and cannot set a program and dont
know how to star to work in preparation for vulcaous damages. The nurses dont have
planning or traning about the disaster.
6.3 Related case
Related case are instances of concept that related to the concept being studies but that do
not contain the critical atributtes (Walker & Avant, 1995). A related concept to to
preparedness is readiness. State of preparedness of persons, systems, or organizations to
meet a situation and carry out a planned sequence of actions. Readiness is based on
thoroughness of the planning, adequacy and training of the personnel, and supply and
reserve of support services or systems (bussines.dictionarry).
Definition Readiness from oxford pocket dictionary is state as the result of a process of
preparation, willingness as an attitude, promptness as a capacity for immediate action.
Readiness, WHO Definition 1997 is Final definition resulting from combining all the
above. Keywords: Preparedness, Willingness, Promptness for Action (underline Action).
The concept implies material resources, procedures, human skill ands good will.
Differences between preparedness and readiness : The DHS Lexicon (2007) defined
preparedness as activities necessary to build, sustain, and improve readiness capabilities
to prevent, protect against, respond to, and recover from natural or man-made incidents.
Note that this definition mentions readiness. Theres a lot of confusion regarding
preparedness and readiness. In fact, the now defunct Homeland Security Presidential
Directive (HSPD)-8, explains that The term preparedness refers to the existence of
plans, procedures, policies, training, and equipment necessary at the Federal, State, and
local level to maximize the ability to prevent, respond to, and recover from major events.
The term readiness is used interchangeably with preparedness.
But In my opinion, preparedness is the sum of plans, policy, procedures, protocols,
risk/hazard/threat/vulnerability identification/analysis, and development of
training curriculum for incident response/recovery. readiness is somewhat different.
Readiness is the capability of successfully responding or conducting recovery operations
(in other words, the ability to implement processes, procedures, etc included in
preparedness).
The case example of relate case that uses the concepts but do not contain contrary: The
nurses were working in a health care center in lampung, near Mt. Merapi in Central Java.
This area is very dangerous to all peoples, the status of Mt. Merapi is level III(standby).
And the nurses need evaluated whether bocoming better prepared is very importan to them
in this time. The nurse have a planning in a response to the vulcanous eruption that would
happen in the future and the begining. The group of nurses do training to help the peoples
and the nurse give a support system to the peoples.
7.1 Antecedents
According to Rodgers (2000), antecedents are the factors that must exist for phenomenon
to occur. Walker and Avant (2005) suggest that antecedent are helpful to the theorist in
identifying the underlying assumption regarding the concept under study. Antecedent may
be defined as events or incidents that must happen before the occurrence of the concept.
Acceptance
Acceptance is the first antecedent of nursing preparedness. According to the Concise
Oxford Dictionary,acceptance means to believe or receive as valid or correct (Soanes
2001). In relation to nursing preparedness, acceptance means that nurses believe that
vulcanous euruption is a feasible threat or risk. Nurses who are in denial about the
possibility of a vulcanous euruption r or its relevance to their lives have not achieved
acceptance. Without acceptance, nurses will not engage in both components of the
vulcanous euruption. This supports acceptance as an antecedent in nursing preparedness. If
nurses do not believe that vulcanous euruption is a risk (i.e. acceptance), they cannot or
will not engage in the preparedness process (Rebmann 2005b). Acceptance alone is not
enough to elicit a change in nurses behaviour. Researchers have indicated that, although
many infection control and public health nurses believe that a vulcanous euruption is
likely to occur somewhere in world, most nurses have not pursued preparedness education
or participated in exercises (Shadel et al. 2003, 2004). This indicates that more than
acceptance is required to result in a behaviour change. Nurses must also be ready to
change before preparedness can occur
Readiness to change
Accepting the threat of vulcanous may not be sufficient to prompt nurses to engage in the
disaster preparedness process. They must be ready to change before they engage in
preparedness activities, making readiness to change an antecedent to preparedness. The
concept of readiness to change has never been explicitly delineated in bioterrorism
preparedness literature. Rather than addressing nurses readiness to change, authors simply
give information on how to become better prepared for a bioterrorism attack. This assumes
that nurses reading the article are ready to change (i.e. become better prepared) or they
would not be reading the article. Readiness to change is both a process of becoming ready
and a state of being ready to change (Dalton & Gottlieb 2003). It consists of three steps
when viewed as a process: (a) realizing something needs to change; (b) weighing the
cost/benefit; and (c) planning for action (Dalton & Gottlieb 2003, p. 111). As a state,
readiness to change refers to the variations in clients desire and/or intent to
take action (Dalton & Gottlieb 2003, p. 115). When applied to nursing preparedness,
readiness to change means that nurses realize that they need to become better prepared for
disaster, perceive the benefits of preparedness as outweighing the potential negative effect
of not being better prepared, have the desire and intent to become better prepared and
decide to take action. If all components are not present, readiness to change has not
occurred.
7.2 Consequences
Walker and Avant (2005: 73) suggest that consequences are those events or incidents that
occur as a result of the concept. Therefore, consequences must transpire after the concept
occurs. In the case of nursing preparedness, consequences are the actions that occur as a
result of engaging in the process of vulcanoues preparedness. Nurses who engage in the
disaster preparedness process are likely to have greater knowledge and more
comprehensive response plans than nurses who are no engaged in the process. Greater
knowledge and more complete response plans make it more likely that a nurse will be able
to recognize a potential event and implement response behaviours than nurses who are not
engaged in the process or those who participate in fewer preparedness initiatives.
8. Empirical Refrences
The final step of Walker and Avant's method of concept analysis is empirical references.
Empirical references present how the concept is to be measured or what the observation
of a phenomenon should be in reality . It is the event that demonstrates the existence of the
concept. Determining is the final step in concept analysis. From the analysis of
preparedness : 1) some distinctions that should be made between theories that can be
helpful to emergency managers in the practice of their profession and general theories of
disaster or hazards, disaster or hazards responses, emergency management, and homeland
security; 2) there are numerous normative theories that are relevant to all of the above
listed areas that can be useful to emergency managers; 3) there are numerous broad
perspectives within the social sciences that can help emergency managers make more
informed decisions; 4) there are several specific micro theories that have been empirically
verified that can provide guidance to emergency managers; 5) there are a few embryonic
theories of disaster responses to natural disasters that offer promise and potential for the
future; and 6) some personal assessments.
References
1. oxford, 2008.
2. Thausaurus, 2014
3. combridge, 2014
4. fema
5. George W Bush, 2003
