Original Research
Disaster Nursing & Emergency Preparedness

Disaster Management: Identifying Knowledge of Emergency Nurses and Community Health Nurses and Its Predictors in Malaysia

Background and Significance

Disasters, whether natural or human-made, are unpredictable events that can cause widespread destruction to lives, property, and the environment. In Malaysia, the geographic positioning of the country — while sparing it from the most severe seismic activity — still exposes it to flooding, landslides, and occasional exposure to regional disasters such as the 2004 Indian Ocean tsunami. When such events occur, healthcare professionals, and especially nurses, serve as frontline responders critical to managing the immediate health consequences for affected communities.

This study, published in the Malaysian Journal of Public Health Medicine, represents an important contribution to understanding how prepared Malaysian nurses are for disaster scenarios. The researchers focused specifically on two cadres: emergency nurses, who work in hospital emergency departments where disaster victims typically first present, and community health nurses, who serve populations in primary care settings where ongoing health needs persist in the aftermath of disaster events.

Disaster preparedness within the healthcare workforce has gained increased attention globally, particularly following major catastrophic events. Malaysia’s National Security Council Directive No. 20 outlines the policy and mechanisms for national disaster relief and management, yet questions remain about whether frontline health workers possess the knowledge, attitudes, and practical skills necessary to execute their roles effectively during emergencies.

Study Design and Methodology

The researchers employed a cross-sectional study design, distributing questionnaire forms to 468 nurses working in emergency departments and health clinics across Selangor state, one of the most densely populated states in Peninsular Malaysia. The survey was conducted from October to November 2011 and achieved a response rate of 84.6%, indicating strong participation.

The questionnaire instrument elicited information across three domains: knowledge of disaster management protocols and procedures, attitudes towards disaster preparedness and response, and self-reported practices in disaster-related activities. Sociodemographic variables including gender, education level, years of working experience, involvement in previous disaster responses, and history of attending disaster-related training were collected to identify potential predictors of knowledge, attitude, and practice levels.

Statistical analyses included descriptive statistics, chi-square tests for associations between categorical variables, and multivariate logistic regression to identify independent predictors while adjusting for potential confounders.

Findings on Knowledge, Attitude, and Practice

The study produced several noteworthy findings. Both groups of nurses — emergency and community health — demonstrated similarly inadequate levels of disaster management knowledge. This finding is significant because it challenges assumptions that emergency department nurses, by virtue of their clinical environment, would possess superior disaster preparedness knowledge compared to their community-based colleagues.

Despite these knowledge gaps, both groups of nurses maintained positive attitudes towards disaster management. This is an encouraging finding because it suggests a foundation of professional motivation upon which educational interventions could build. Positive attitudes indicate receptivity to training, a willingness to engage with disaster preparedness protocols, and an understanding that disaster response is within the professional scope of nursing practice.

When the researchers examined practice scores, meaningful differences emerged. Multivariate analysis revealed that attending disaster-related education or training was the strongest predictor of adequate knowledge and practice. Among community health nurses specifically, those who had received training were approximately 3.5 times more likely to demonstrate adequate knowledge and approximately 4 times more likely to demonstrate adequate practice compared to untrained counterparts.

The workplace setting, which effectively distinguished between emergency and community health nurses, was also an independent predictor for practice adequacy. This suggests that the clinical environment and the types of cases encountered do contribute to practical preparedness, even when formal knowledge may be equivalent.

Comparison with Regional and International Findings

These findings align with a broader body of international evidence indicating that nurses, despite being central to disaster response, often exhibit knowledge and preparedness gaps. Research from Jordan, Saudi Arabia, Bangladesh, and other settings has similarly documented that disaster management knowledge among nurses tends to be suboptimal, and that formal training is consistently the strongest predictor of improved preparedness.

A subsequent study by the same lead author, examining emergency nursing and medical personnel in the East Coast region hospitals of Malaysia, reinforced these findings. That study found that while the majority of 194 personnel demonstrated adequate knowledge and practices and portrayed positive attitudes, gender, education level, working experience, and prior involvement in disaster response were significant predictors of practice scores.

Systematic reviews of disaster preparedness among nurses in disaster-prone countries have further confirmed that previous disaster relief experience and disaster-related education are the two most consistent predictors of adequate preparedness globally. These findings position the current study within a robust international evidence base.

The Malaysian Context

Malaysia’s disaster management framework has evolved considerably since the Highland Towers collapse in 1993, which served as a catalyst for systematic disaster preparedness policy. The establishment of the National Security Council Directive No. 20 provided a structured framework for inter-agency coordination during disasters. However, the translation of policy frameworks into operational readiness at the individual healthcare worker level remains an ongoing challenge.

Selangor, where this study was conducted, is Malaysia’s most economically developed state and hosts the country’s largest concentration of healthcare facilities. If knowledge gaps exist among nurses in this relatively well-resourced state, the situation in more rural or underserved states may be even more concerning. This consideration is particularly relevant for states in East Malaysia (Sabah and Sarawak) and the east coast of Peninsular Malaysia, which face higher risks from flooding and other natural hazards.

Recommendations for Practice and Policy

The study’s findings carry several actionable implications. First, the strong association between training attendance and improved knowledge and practice underscores the need for systematic, mandatory disaster management training for all nurses, regardless of their clinical setting. Current continuing professional development frameworks should incorporate disaster preparedness modules as required components rather than optional electives.

Second, the finding that community health nurses benefit substantially from training suggests that disaster preparedness education should not be confined to hospital-based emergency personnel. Community health nurses are often the first point of contact for populations affected by disasters, particularly in rural and semi-urban settings where hospital access may be disrupted.

Third, simulation-based training and disaster drills should be conducted regularly across healthcare facilities. Evidence from international studies consistently demonstrates that practical, hands-on training improves both confidence and competence more effectively than didactic instruction alone.

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