|ORIGINAL RESEARCH REPORT
|Year : 2016 | Volume
| Issue : 1 | Page : 23-28
Knowledge, attitude, and practices of emergency health workers toward emergency preparedness and management in two hospitals in Lagos
Babajide A Adenekan, Mobolanle R Balogun, Victor Inem
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
|Date of Web Publication||2-Feb-2016|
Babajide A Adenekan
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi.Araba, PMB - 12003, Lagos
Source of Support: None, Conflict of Interest: None
Background and Objective: The Emergency Department is of significance and is the vital entry points of patients into the healthcare facility of the hospital all around the world. This study aims to assess the knowledge, attitude and practices of emergency personnel at two tertiary hospitals in Lagos as regards emergency management and preparedness. Aims: This study aims to assess the knowledge, attitude, and practices of emergency personnel at two tertiary hospitals in Lagos with regard to emergency management and preparedness. Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: A convenient recruitment was made of eligible and consenting individuals at both hospitals until the required sample size was reached. Statistical Analysis Used: The data obtained were analyzed using Epi Info statistical software version 3.5.1. Results: The majority (93.2%) of the participants were clinicians. It was discovered that less than half or 98 (47.8%) of the participants had good knowledge of emergency preparedness and planning, 76 (37.1%) had a fair knowledge, while 31 (15.1%) had poor knowledge. The respondents' attitude toward emergency preparedness was generally positive, as most of them, that is, 191 (93.2%) believed that they needed to know about emergency planning. Only a minority, that is, 72 (35.1%) of the respondents knew that emergency drills are done in their respective hospitals. Conclusions: There was an overall deficiency in the respondents' knowledge of emergency preparedness. Their attitude was good and acceptable, but their practices in terms of the frequency of emergency drills and the frequency of regularly updating the emergency plans were grossly inadequate.
Keywords: Attitude, emergency department, emergency preparedness, knowledge
|How to cite this article:|
Adenekan BA, Balogun MR, Inem V. Knowledge, attitude, and practices of emergency health workers toward emergency preparedness and management in two hospitals in Lagos. J Clin Sci 2016;13:23-8
|How to cite this URL:|
Adenekan BA, Balogun MR, Inem V. Knowledge, attitude, and practices of emergency health workers toward emergency preparedness and management in two hospitals in Lagos. J Clin Sci [serial online] 2016 [cited 2019 Mar 20];13:23-8. Available from: http://www.jcsjournal.org/text.asp?2016/13/1/23/175483
| Introduction|| |
The Accident and Emergency (A and E) Department, which is also referred to as the Emergency Room (ER), Emergency Ward (EW), or Casualty Department is a medical treatment facility that specializes in the acute care of patients who present without prior appointment. Emergency care is one delivered in the first few hours after the onset of an acute medical condition, e.g., a childbirth complication, heart attack, injury, or any health problem that reaches an acute stage and poses a threat to life.
The Emergency ward responds to and manages a variety of cases in all the clinical areas and it provides insight into the quality of care available in the institution. The quality of care in the ER is an indirect indicator of the standard of health-care delivery that is provided in a health institution; therefore, the ability of a hospital to respond to an emergency depends on having staff who know what to do and have the skills needed to do so.
In Nigeria, reports from various centers and studies show a high mortality rate for cases that present to the A and E Department. Therefore, the need for a realistic hospital and emergency service response program designed on the principle of equitable distribution of appropriate equipment and supplies and well-trained emergency medical personnel, cannot be overemphasized. In 2010, a study carried out at Imo State University Teaching Hospital located in the suburban town of Orlu in Imo State, Nigeria recorded that there was a total of 281 deaths out of 5754 cases treated at the A and E, showing a crude mortality rate of 4.88%. A similar study done in Port Harcourt, Nigeria in an urban teaching hospital over a 3-year period reported a crude mortality of 2%. About 23.13% of all these deaths were caused by injuries and trauma sustained from road traffic accidents.
The outcome of a patient and the speed of recovery of emergencies presenting to a hospital are largely dependent on the initial response by emergency health workers and the quality of care delivered at presentation. This means that the knowledge and attitude of these emergency workers toward the management of the emergency cases presenting to their hospitals, and their preparedness, add up to a major factor that determines the outcome and recovery of such patients. In addition to working toward the patients' survival, preparedness encompasses planning, training, equipment, and exercises.
The high mortality rates at the emergency centers in tertiary hospitals (government-owned) in the country have been of major concern. A study at the University of Benin Teaching Hospital showed that 288 patients died over a 3-year period. At the University College Hospital, Ibadan, a study showed that 168 patients died within 1 year. These high mortality rates are a result of the imbalance between emergency physicians available and patients who present to the emergency centers as suggested by recent studies, which is currently considered a threat to health-care delivery and outcome for patients worldwide. Judging by these reports, the available staff in our emergency centers need to be trained so that medical and emergency professionals who understand emergency preparedness are better equipped to respond adequately to hospital emergencies.
Aims and objective
With the high rate of deaths recorded in our emergency centers in Nigeria and worldwide, there is a need for us to assess the responsiveness of emergency health workers to emergency cases, which is a function of their knowledge and their preparedness. The World Health Organization (WHO) recommends periodic assessment of the capabiliity of health facilities to respond to emergencies. Hospital preparedness assessment is a means for a hospital to test and evaluate its capabilities and/or recovering from an event that placed a significant strain on its patient care and operating systems. This study aimed to assess the knowledge, attitude, and practices of emergency personnel at two tertiary hospitals in Lagos with regard to emergency management and preparedness, and the objectives were to determine the following: The level of knowledge of emergency workers in emergency preparedness; the attitudes of emergency workers toward emergency cases presenting to these hospitals; the current practices of emergency workers regarding emergency preparedness; and whether there are hospital-specific plans regarding emergency preparedness and management.
| Materials and Methods|| |
The study location was the adult A and E department of the Lagos University Teaching Hospital (LUTH), the foremost referral hospital in Lagos located in Idi-Araba, Mushin Local Government Area, Lagos State, southwestern Nigeria. The A and E Department of LUTH delivers a 24-h intensive emergency service in all clinical areas (medicine, surgery, trauma, and obstetrics and gynecology), and the casualty center of the National Orthopaedic Hospital, Igbobi, Lagos (NOHIL), a premiere orthopedic hospital in Nigeria, which is an outstanding, popular tertiary hospital for the management of accident and emergency victims. This hospital has about 450 bed spaces and houses mainly casualties from accidents, burns, and spine injuries.
This descriptive, cross-sectional study was carried out during the period March-May 2013 among physicians, surgeons, nurses, clerical officers, security, porters, and other support service personnel who work in the ER or do rotations in the ER, who are involved in emergency case management and who would be called upon should there be an emergency upsurge or disaster within or outside the hospital.
A convenient recruitment was made of eligible and consenting individuals at both hospitals until the required sample size was reached: Out of the total of 431 health workers who rotate on the emergency departments of these hospitals during the period of study, 103 individuals from LUTH and 100 from NOHIL were recruited, which in sum equaled the calculated sample size of 203.
After approval by the Ethics and Research Committees of the two hospitals, informed consent was obtained from each respondent before involvement in the study.
A self-administered questionnaire (adapted from a similar study in South Africa) was used for collection of information, and 11 core questions about basic knowledge of emergency preparedness were used to assess respondents' knowledge. A correct response scored 1, while an incorrect response or no response scored 0. All the scores were summed up to get the overall scores for each respondent. Respondents with aggregate correct scores of 9 or higher were graded “good,” those with scores between 5 and 8 were graded as having “fair” knowledge, and respondents with scores of 4 or less were graded “poor.” The totals for each grade were then obtained and reported. For attitude, 10 core questions about expected attitude toward emergency preparedness were used in determining the respondents' attitudes. Each correct answer was awarded 3 marks and an incorrect or non-response scored 0, with the maximum score obtainable being 30; a respondent's attitude was said to be positive if he/she had a score ≥15, and negative when a participants scored <15. The data obtained were analyzed using Epi Info statistical software version 3.5.1 (Centre for Disease Control in the U.S.A). The results were presented in tabular and graphical form using Microsoft Word. Association between variables was tested at 0.05 level of statistical significance.
| Results|| |
The mean age of the respondents was 35.2 ± 9.0 years. A majority, that is, 108 (52.7%) of the participants were nurses. The doctors numbered 83 (40.5%) and included resident doctors and house officers working in the emergency departments and those who did rotations in the emergency or trauma centers of these two hospitals. Other respondents were from allied medical (3, or 1.5%) and support services (11, or 5.5%). It was discovered from this study that only 98 (47.8%) of the participants had “good” knowledge of emergency preparedness and planning, 76 (37.1%) had “fair” knowledge, and 31 (15.1%) had “poor” knowledge [Table 1]; this indicated an overall deficiency in knowledge of emergency preparedness among the health workers. The respondents' attitude toward emergency preparedness was generally positive, as most of them (191, or 93.2%) believed that they needed to know about emergency plans [Table 1]. They felt: That these plans should be regularly updated; that emergency simulations should be performed frequently in the hospital; and that the staff should be adequately trained, as emergency preparedness and management is necessary for all health workers in the hospital. The participants also agreed that emergency drills should be conducted in the hospital [Table 2]. Ninety-eight (98, or 47.8%) of all the respondents had good knowledge of emergency preparedness, 76 (37.1%) had fair knowledge, and 31 (15.1%) had poor knowledge [Figure 1]. The attitude toward emergency preparedness was generally positive [Figure 2]. Only a minority, that is, 72 (35.1%) of the respondents knew that emergency drills were done in their respective hospitals. Out of those who knew, 55 (76.4%) knew when they were done and were aware of the importance of emergency drills but were not sure of the frequency of the drills [Table 3]. There was a statistically significant association (P = 0.021) between the staff category and the knowledge of emergency preparedness, as staff in the medical and surgical categories showed better knowledge (63.4% and 53.5% respectively) than those in any other staff category, for example nursing services (43.5%) [Table 4].
|Table 2: Attitude of respondents towards emergency preparedness and management (N=205)|
Click here to view
|Figure 1: The overall knowledge of the respondents on emergency preparedness|
Click here to view
|Figure 2: The overall attitude of the respondents toward emergency preparedness|
Click here to view
|Table 4: Association between the category of staff and the knowledge of the respondents|
Click here to view
| Discussion|| |
The findings from this study revealed that only 98 (47.8%) of the participants had good knowledge of emergency preparedness and planning, 76 (37.1%) had fair knowledge, and 31 (15.1%) had poor knowledge. An overall the deficiency in the knowledge of emergency preparedness was found in this study unlike in the Johannesburg study where 70% of the participants had good knowledge about emergency preparedness and 90% of the participants had above-average knowledge about an emergency plan being a logistic structure to ensure the optimal use of resources., This shows that the emergency health workers in those hospitals had a basic and underlying knowledge of emergency preparedness and what should constitute standard emergency medical practice. The respondents' attitude toward emergency preparedness was generally positive, as most of them, that is, 191 (93.2%) believed: That they needed to know about emergency plans; that these plans should be regularly updated; that emergency simulations should be performed frequently in the hospital; and that staff should be adequately trained, as emergency preparedness and management is necessary for all health workers in the hospital. They also believed that management should be adequately prepared should an upsurge in emergency occur in the hospital, that every member of staff should be involved with active participation of all cadres of staff, and that it was not for nurses and doctors alone. They also agreed that emergency drills should be conducted in the hospital; these findings in this study were similar to those of a study in a Johannesburg hospital in South Africa.
This is encouraging because emergency staff having a positive attitude will promote quick response to emergencies, and when there is a heavy strain on available resources in times of surges or disaster, this can be adequately contained and managed without putting the whole hospital system in disarray.
The respondents also disagreed that an emergency upsurge or disaster was unlikely to happen in their respective hospitals. In the final analysis, only a small percentage of the participants (3, or 1.5%) had a negative attitude toward emergency preparedness. This is good, as the staff clearly know the importance and relevance of preparedness for emergency and disaster, as such knowledge is vital in their individual medical practices. In the present study, most of the respondents did not know when emergency drills were done in their respective hospitals; this is similar to the findings from a study done at a Johannesburg hospital in South Africa about the knowledge, attitude, and practices of health care workers regarding disaster preparedness, where the participants were aware of the importance of the drills but were not sure of when they were done, but where the majority of the respondents knew that disaster drills (in their own case) were done at the hospital, even though 40% did not know the type of drills done. In contrast, a study done in Israel showed that drills were performed adequately for emergency physicians, and a strong to very strong relationship was found between training and drills and the total preparedness score for emergency scenarios among health workers in the hospital. A majority, or 104 (50.7%) of the respondents in our study did not know and had no idea if the emergency plans were periodically updated or not. This indicates a big gap and deficiency in the practices of these hospitals regarding emergency preparedness and management, and thus work still needs to be done in these hospitals regarding preparedness for emergency and upsurge or disaster and the practices of the hospital management.
It was also discovered that there was a significant association between the staff category and the knowledge of emergency preparedness. Findings from the present study revealed that emergency staff in the medical and surgical categories exhibited better knowledge than staff in other categories.
In this study there was no significant association between working years of respondents and their emergency preparedness and management as P > 0.05 [Table 5].
|Table 5: Association between the working years of respondents in their respective hospitals and their knowledge of emergency preparedness and management|
Click here to view
| Conclusion|| |
There was an overall deficiency in respondents' knowledge of emergency preparedness: Their attitude was good and acceptable, but from the findings, their practices in terms of frequency of emergency drills and the frequency of regularly updating the emergency plans, were grossly inadequate. There is a need for improvement in our emergency response so as to match the existing demands of emergency care in the country and worldwide. To improve the knowledge, attitudes, and practices of emergency health workers at the hospitals studied and in other hospitals, the following recommendations are made. Basic knowledge of emergency preparedness should be obtained by all new and existing staff members of the hospitals, especially those involved in the management of emergencies. Emergency plans and drills should be made and held on a regular basis, hence instilling emergency preparedness. This being done, the hospital is adequately prepared should an emergency upsurge or disaster occur.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Uzoechina NS Jr, Abiola AO, Akodu BA, Mbakwem A, Arogundade AR, Tijani H, et al
. Pattern and outcomes of cases seen at the Adult Accidents and Emergency Department of the Lagos University Teaching Hospital, Idi-araba, Lagos. Nig Q J Hosp Med 2012;22:209-15.
Ekere EU, Yellowe BE, Umune S. Mortality patterns in the accident and emergency department of an Urban hospital in Nigeria. Niger J Clin Pract 2005:8:14-8.
Centre for Public Health Preparedness Columbia University. MAUMAN School of Public Healthcare for Health Policy. Columbia University. School of Nursing in Collaboration with Greater New York Hospital Association (GNYHA). Emergency Preparedness and Response Competencies for Hospital Workers.
Christian MD, Kollek D, Schwartz B. Emergency preparedness: What every health care workers need to know. CJEM 2005;7:330-7.
Lee T, Karajie M. Impact of pollen on asthma emergency room visit in NYC. J Allergy Clin Immunol 2008;121:92.
Stoon-Verslut MN, Ubbink DT, Chin a Choi V, Luitse JS. Observe agreement of the Manchester Triage System and the Emergency Severity Index: A simulation study. Emerg Med J 2009;26:556-60.
de Souza D. Evidence-based approach to decision making: The inclusion of this as part of Ghana's Health Information System. Ghana Med J 2009;43:1-6.
Bruria A, Goldberg A, Cohen R, Laor D, Bar-Dayan Y. Evidence-based support for the all-hazards approach to emergency preparedness. Ann Emerg Med 2006;48:194-9.
Hui Z, Jian-Shi H, Xiong H, Peng L, Da-Long Q. An analysis of the current status of hospital emergency preparedness for infectious disease outbreaks in Beijing, China. Am J Infect Control 2007;35:62-7.
Moabi RM. Knowledge, Attitudes and Practices of Health Care Workers Regarding Disaster Preparedness at Johannesburg Hospital in Gauteng Province, South-Africa: 2009.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]