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WORLD HEALTH

Israeli Nurses Intention to Report for Work in an Emergency


or Disaster
Semyon Melnikov, RN, PhD1 , Michal Itzhaki, RN, PhD2 , & Ilya Kagan, RN, PhD3
1 Lecturer, Department of Nursing, Tel Aviv University, Israel
2 Lecturer, Department of Nursing, Tel Aviv University, Israel
3 Lecturer, Department of Nursing, Tel Aviv University; Senior Coordinator, Quality and Patient Safety in Nursing, Rabin Medical Center, Clalit Health
Services, Israel

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.

One of the important elements in coping successfully


with a major treatment-overload event is the ability to
plan the scope of human resources available to medical institutions, since this will heavily affect the healthcare systems ability to provide appropriate care to multiple casualties (Murphy et al., 2012). The number of staff
reporting for work when a mass casualty event occurs
is influenced by several factors and can vary widely in
real time. Reports from the United States, Canada, Asia,
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and Israel state that during disasters (such as hurricanes,


infectious disease outbreaks, war, or terrorist attacks),
emergency medicine department staff does not necessarily report for work. During the huge wildfires in San
Diego, California, in 2007 for instance, the rate of nonreport for work at hospitals near the fire on the first day
was 10.6%, compared with 0.6% on the same day the
previous year (Davidson et al., 2009). Similarly, Shapira
et al. (1991) found that 58% of Israeli medical staff asked

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Melnikov et al.

about their intention to report for work in the event of


a nonconventional missile attack said they would not do
so. Partial knowledge or nonknowledge about the rates of
staff reporting for work in an emergency at a moment of
truth is clearly a threat to the quality of care and victims
health.
Studies of the factors affecting the readiness of healthcare workers (HCWs) to report for work in an emergency are divided into the retroactiveconducted after actual disastersand the hypotheticalwhich ask for
interviewees prospective responses to future emergencies. Of the retroactive studies, Davidson et al. (2009)
identified the most prominent factor affecting readiness
to report for work as the safety of the HCWs families.
If any family member was at risk for injury, then the
staffer would not even consider reporting to work. When
the healthcare system addressed this concern appropriately, workers demonstrated greater readiness to report
for work. When French, Sole, and Byers (2002) questioned U.S. nurses who were victims of Hurricane Floyd
but who nevertheless gave treatment to other victims at
their workplace, they found a conflict of interest between
commitment to family and to work. The safety of family,
pets, and the nurses themselves were of greater importance. After the 2003 severe acute respiratory syndrome
(SARS) outbreak, HCWs reported concern for their own
and their families health, and some even refused to treat
patients for those reasons (Kagan, Ovadia, Gazit, & Silner,
2004; Ovadia, Gazit, Silner, & Kagan, 2005).
Among studies of hypothetical readiness to report for
work, based on a prospective disaster scenario, Irvin, Cindrich, Patterson, and Southall (2008) used the scenario of
an avian flu pandemic. Half the physician and nurse respondents said they would show up, 42% said maybe,
and 8% said no. For those responding maybe, the
main factor in their decision was their trust that the
hospital would be able to protect them from the disease. Seale, Leask, Po, and MacIntyre (2009) used the
same scenario and found that, although only a third of
respondents believed their institution was prepared for
a flu pandemic, the majority expressed a desire to report for work. Qureshi et al. (2005) found that the barriers to ability to report included transportation problems and obligations to the care of children, elders,
and pets. The barriers to willingness were the same as
those found by other studies cited here. Understanding
nurses perception of their workplaces preparedness and
of the availability of support services for the nurses is
critical to designing more effective preparedness strategies and training programs (OSullivan et al., 2008). Researchers have also suggested that willingness to report is
affected by staff self-efficacy regarding their functioning

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Intention to Report

in an emergency (Ben Natan, Nigel, Yevdayev, Qadan, &


Dudkiewicz, 2013; Qureshi et al., 2005). Hospital staff
with a high perceived self-efficacy had a 5.8 times higher
declared rate of willingness to respond to an influenza
pandemic (Balicer et al., 2010). One of the factors predicting nurses intention to care for SARS patients was
also self-efficacy (Hope et al., 2010; Ko et al., 2004).
A personal risk appraisal during treatment of emergency casualties can create an additional perceived threat
to care providers. The level of knowledge about the risk
and its prevention or reduction can also play an important role in staff recruitment. For example, an influenza
pandemic is expected to result in a dramatic increase in
the flow of critically ill patients to emergency rooms, a
situation that puts HCWs at high risk for infection. In a
self-report survey, intensive care unit staff reported minimal knowledge of the risk of nosocomial transmission to
HCWs and of the response to this in pandemic conditions
(Daugherty, Perl, Rubinson, Bilderback, & Rand, 2009).
In an Israeli context, Balicer, Omer, Barnett and Everly
(2006) also found that lack of knowledge about pandemic
flu and uncertainty about the tasks to be performed decreased readiness to report for work by 2 to 10 times.
Grimes and Mendias (2010) also found that nurses differentiate the risk associated with caring for patients with
different infectious diseases and may weigh this risk before reporting to work. This is reflected in the fact that
nurses reported a higher willingness to report for work
when the infectious disease was of known origin, was
preventable and treatable, and protective equipment was
available.
A previous study of whether nurses fear of harm to
self and family during an earthquake would affect their
willingness to report to work (Ben Natan et al., 2013)
found no correlation between fear of the threat from the
earthquake itself and the nurses willingness to report to
work. Our study differs from the Ben Natan et al. (2013)
study in that we focus on the appraisal of risks and potential harm to the HCWs as a result of treating the casualties. We have located no previous study of how perceived
treatment-related risks affect nurses willingness to report
during different types of emergencies.
Finally, previous experience can play a role in reporting to work in an emergency. Nurses with previous
experience of providing treatment during an emergency
indicated a greater probability to report for work in a future emergency. Also, more experienced nurses felt more
confident to both care for patients and protect themselves
(Ben Natan et al., 2013; Goodhue et al., 2012; Grimes &
Mendias, 2010)
In light of the previous information, the present study
aimed to examine the effect of personal characteristics

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Table 1. Demographic Data on Participants (N = 243)


Variable

Variance

Variable

Years of age: M (SD)


36.13 (9.18) Field of practice: n (%)
Years of seniority: M
11.81 (9.53)
Internal
(SD)
medicine
Gender: n (%)
Surgery
Male
31 (12.75)
Intensive care
Female
210 (86.42)
Clinics
Missing
2 (0.82)
Gynecology
Country of birth: n (%)
Emergency
Israel
119 (49.4)
medicine
Former Soviet Union
115 (47.7)
Pediatrics
Other
9 (2.9)
Operating room
Workplace: n (%)
Oncology
Hospital
198 (82.1)
Other
Community clinic
34 (14.1)
Other
11 (3.8)
Position: n (%)
Regular nurse
184 (76.3)
Nursing coordinator
22 (9.1)
Head nurse
22 (9.1)
Other
15 (5.5)
Full or part-time: n (%)
Full-time
149 (62.3)
Part-time
94 (37.7)

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)

(self-efficacy regarding functioning in an emergency, risk


appraisal of exposure to health hazards, knowledge of
nurses roles and duties in an emergency, and past reporting to work in an emergency) and organizational factors
(barriers preventing nurses from reporting to work, availability of institutional support services) on nurses intention to report for work in an emergency.

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.

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The required sample size was obtained by means


of the WINPEPI COMPARE2 program (http://www.
brixtonhealth.com/pepi4windows.html), which is used
to determine power and sample size for comparisons of
two groups in cross-sectional designs (Abramson, 2011).
Power calculations based on an analysis of the 30 questionnaires collected during a pilot study showed that the
mean risk appraisal score of exposure to health hazards
among nurses who appraised that there was high risk or
no protection was 0.5 points higher than among nurses
who appraised that there was low risk or high protection. In order to determine whether the difference of
0.5 between the two groups was significant at the 5%
significance level with a power of 80% (Cohen, 1988),
the WINPEPI COMPARE2 (http://www.brixtonhealth.
com/pepi4windows.html) computer program calculated
a required sample size of 120 participants in each group
(a minimum total sample of 240 participants).

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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asked to score statements on a scale from 1 (low) to 5


(high). The Cronbachs score for this tool was .93.
Previous reporting to work was tested by two yes or
no questions: Have you ever been asked to report to
your workplace in an emergency or disaster in the past?
and Did you actually respond to this requirement to
report?
Barriers to reporting to work were rated by a fiveitem instrument constructed by Adams and Berry (2012).
The instrument prompted respondents on reasons why a
nurse might be unable to report for work (e.g., child or
pet care). The original instrument was modified by excluding the item other job and adding a Likert scale.
Participants were asked to rank items on a scale from 1
(insignificant) to 5 (very significant). The Cronbachs for
this section was .69.
In constructing the tool self-efficacy on personal functioning in emergency, the researchers followed the instructions for constructing self-efficacy measuring tools
(Bandura, 2001), which claim that a specific measure of
the selected domain of functioning is needed in order to
improve the questionnaires explanatory and predictive
value. The tool constructed represented a nurses duties
in the context of an emergency multicasualty incident.
The scale consisted of seven statements about nurse selfefficacy, such as I believe I can effectively organize the
reception and treatment of casualties on admission, I
believe I can identify life-threatening injuries, or I believe I can fulfill all my duties in an emergency. Respondents were asked to score statements on a scale from 1
(cannot do at all) to 9 (very certain I can do). The mean of
all items represented the overall perceived self-efficacy
score. The Cronbachs score for this questionnaire
was .92.
Risk appraisal of exposure to health hazards during delivery of care to casualties was measured by an eight-item
questionnaire. This tool consisted of two kinds of questions: four items examined the degree of perceived risk
to the nurses health during treatment of the injured,
while the second four items asked about the degree of
perceived protection that specific protective equipment
provided the nurse (the second four items were recoded).
Respondents were asked to rank their answers on a scale
from 1 (high risk or low protection) to 5 (low risk or high protection). Specimen items were: What do you think is the
level of risk of harmful exposure to a nurse, when delivering care to persons injured by chemical weapons?
or To what extent, in your opinion, does the protective equipment provided actually protect the nurses
treating radiation casualties? The overall score was represented by the mean. Cronbachs for this section
was .70.

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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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the questionnaire to complete, which took about 20 min.


The response rate was 93%.

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-

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Figure 1. Barriers to reporting for work.

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.

Relationships Among Variables


The results of the correlational analysis of the study
variables are shown in Table 2. There was a significant correlation between perceived knowledge, risk appraisal, self-efficacy, and intention to reportnurses who
demonstrated higher levels of knowledge, lower levels
of health hazards risk appraisal, and higher self-efficacy
in emergency functioning reported a higher intention
to report for disaster work. The significant correlations
between perceived knowledge, risk appraisal, and selfefficacy and the negative correlation between perceived
knowledge and barriers to reporting for work mean that
nurses who knew more about their roles and duties
in an emergency appraised the risk to their health as

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Table 2. Correlational Analysis of Study Variables (N = 243)


Study variables

1. Perceived knowledge

2. Appraisal of risk
.24

3. Self-efcacy
.37 .29

4. Availability of resources .06


.08
.10

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

p < .05 (statistically signicant); p < .01 (statistically highly signicant).

lower, perceived barriers as less restrictive, and reported


higher self-efficacy in functioning during an emergency.
Analysis of the relationships between study variables
and sociodemographic characteristics revealed a significant correlation between age or seniority and barriers to
reportingthe higher the age and seniority, the less restrictive were the barriers perceived.

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.

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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
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to report in an emergency, this study adds a significant


contribution.
An interesting finding of this study is the low level
of perceived knowledge as to the demands on, and duties of, nurses in a large-scale emergency. The concept of
perceived knowledge is widely used and seems to reliably represent actual knowledge (El-Deirawi & Zuraikat,
2001; Hsiao, Lee, Chen, & Lin, 2012; Kagan, Ovadia, &
Kaneti, 2009; Melnyk et al., 2004). Although the importance of Israeli nurses preparedness for emergencies has
been growing in recent years, few Israeli nurse training
programs cover this topic, and the field is not considered
an attractive one to nurses. The finding that Israeli nurses
feel they know little about their roles in an emergency is
a surprising one, given Israels stressful environment of
continuous alert and the obvious need for communitywide preparation for rapid response to bombings and
other terrorist acts. We believe that a psycho-educational
approach is needed, one that addresses attitudes, beliefs,
and the personality traits that influence professional behavior. The cognitive, information-providing approach
is inadequate to deal with affective issues (Epstein &
Hundert, 2002); indeed, it can actually strengthen existing stereotypes. Staff awareness and personal views need
to be addressed as they were in the drive to improve
infection prevention in hospitals by persuading staff to
wash their hands more and take standard precautions
(Pittet et al., 2004) and to stop doctors smoking (Cabana
et al., 1999). It is important to combine formal guidelines
with attention to the staffs personal views and with emphasis on the professional commitment to treating emergency casualties, even if this comes at some cost to the
family and some calculated risk to staff.
The significant positive correlation between perceived
knowledge of nurses duties and roles in a national emergency and their intention to report for work, which this
study found, adds to the importance of expanding this
knowledge. Not only would nurse preparedness improve,
but so would the ability of healthcare organizations to
plan for crises (Wynd, 2006). This recommendation also
echoes the theoretical model and interventions developed by Bandura (1997) and his successors discussed.
The positive correlations between knowledge of emergency functioning and self-efficacy, and between selfefficacy and intention to report for work, which the
present study found, are predicted by Banduras Social
Cognitive Theory (Bandura, 1997, 2001). According to
this model, knowledge acquired from direct and indirect
learning serves self-efficacy, which in turn helps explain
behavior in general and professional behavior in particular. That nurses who displayed higher levels of selfefficacy also stated a higher intention to report for work
is consistent with the basic premises of Banduras Model
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(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

r
r
r

American Nurses Association Disaster Preparedness Response: http://www.nursingworld.org/


MainMenuCategories/WorkplaceSafety/DPR
Centers for Disease Control and Prevention. Emergency Response Resources: http://www.cdc.gov/
niosh/topics/emres/
World Health Organization. Health Disaster
Risk
Management:
http://www.who.int/hac/
techguidance/preparedness/en/

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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

Journal of Nursing Scholarship, 2014; 46:2, 134142.



C 2013 Sigma Theta Tau International

Copyright of Journal of Nursing Scholarship is the property of Wiley-Blackwell and its


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Copyright of Journal of Nursing Scholarship is the property of Wiley-Blackwell and its


content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.