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433
DOI: 10.2174/1874434602115010433, 2021, 15, 433-443
The Open Nursing Journal
Content list available at: https://opennursingjournal.com
RESEARCH ARTICLE
The Impact of Islamic-Based Disaster Response Competencies Program on
Nurses: A Computer-based Training Randomized Controlled Trial
Cut Husna1,2, Mustanir Yahya3, Hajjul Kamil4 and Teuku Tahlil5,*
1Graduate School of Mathematics and Applied Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
2Department of Medical and Surgical Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
3Department of Chemistry, Faculty of Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
4Department of Management Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia
5Department of Community Health Nursing, Faculty of Nursing, Universitas Syiah Kuala Banda Aceh, Indonesia
Abstract:
Introduction:
Disasters have a significant impact on physical, psychological, psychosocial, and spiritual conditions. Indonesia, a predominately Muslim country,
is a country of high vulnerability and risk for disasters. The nurses are frontliners and care providers need sufficient competencies in handling the
survivors in health service centers. Local government regulations in the Aceh Province required Islamic-based health services.
Objective:
The study aims to identify the effectiveness of the Islamic-based disaster response competencies on nurses at the Banda Aceh Hospitals.
Methods:
A randomized controlled trial with a pre- and post-tests with a control group design was used in this study. The population was all nurses at three
hospitals in four wards: emergency department, intensive care, medical, and surgical wards. The samples were selected using cluster random
sampling and assigned into three groups: evidence = 50, Islamic = 49, and control = 48. Data were analyzed using parametric and non-parametric
tests.
Results:
The results showed a significant increase in nurses’ knowledge, skills, and attitudes of disaster response in the evidence and Islamic groups with
the mean and SD of the Islamic group in post-test 1 and 2 (knowledge = 15.9±2.9 and 15.8±2.9, skills = 19.0±1.4 and 18.9±1.4, attitude =
108.1±6.9 and 108.2±6.9) were higher than the evidence group (knowledge = 15.6±2.7 and 15.5±2.7, skills = 18.7±1.5 and 18.8±1.5, attitudes =
107.5±7.4 and 107.4±7.3) and the control group (knowledge=13.8±4.0 and 13.9±4.0, skills = 17.9±1.9 and 17.9±1.9, attitude = 104.5±8.8 and
104.6±8.8), respectively.
Conclusion:
The results indicate the Islamic group is more effective in increasing the disaster response competencies of nurses. This finding suggests the
importance of developing regulations including policies, guidelines, emergency and disaster training, and public health services to support the
implementation of an appropriate Islamic-based disaster nursing responses for hospitals in the Aceh Province and other regions with the
implementation of Islamic law. Request number ANZCTR 378930
Keywords: Nurses, Competencies, Disaster, Response, Islamic-based, Hospital.
Article History Received: April 20, 2021 Revised: September 29, 2021 Accepted: November 08, 2021
1. INTRODUCTION
Indonesia is one of the high-risk countries for natural
disasters because of its location at the confluence of the three
major plates of the world; the Indo-Australia, Eurasia, and the
Pacific [1]. Disasters, led by natural, non-natural, and human
factors, threaten the population in the region by causing
casualty, environmental damage, property loss, and
psychological impact [2]. Although the incidence and
frequency of disasters have increased in the last few decades
434 The Open Nursing Journal, 2021, Volume 15 Husna et al.
and resulted in many casualties, therefore, disaster
management is not well managed [3 - 5]. The adequacy of
disaster preparedness and response should be the main priority,
especially in high-risk areas of disasters, by increasing the
responsiveness of health workers, including nurses in hospitals
and community settings.
As a public health services center, hospitals play an urgent
role when a disaster occurs. Disaster response in hospitals to
manage the survivors is an important indicator in disaster
management. Hospitals must prepare the necessary resources,
especially equipment, ward/department, medical personnel, and
nurses, through adequate emergency preparedness and hospital
disaster plans. In case the hospital is destroyed by the disaster;
a field hospital is required to handle the survivors [6]. Nurses
are the frontline workers who have the main role in the disaster
response. Thus, adequate disaster response competencies are
needed, including knowledge, skills, and attitudes regarding
services for disaster survivors through education and training
programs [3]. The competencies and roles of nurses in both the
preparedness and disaster response phases are inadequate in
caring for disaster survivors. The previous study reported that
88% of the population affected was still dissatisfied with the
skills shown by nurses and physicians in caring for disaster
survivors [7, 8].
Disasters negatively impact the exposed communities, such
as physical, psychological, psychosocial, and spiritual
problems. Nurses’ competencies in handling these problems
have been described in some literature [9, 10]. However,
Islamic-based interventions to address these problems have not
been reported. The implementation of Islamic law is based on
the holy book of the Quran and hadith, which are used as
guidelines in Islamic-based health service interventions. Efforts
to support Islamic-based nurses’ competencies are strongly
supported by implementing Islamic law in public services,
including hospitals. Aceh is a province in Indonesia where
98.19% of the population is Muslim. The implementation of
Islamic law in Aceh has been carried out since 2000 [11].
This study adopts a conceptual framework about
emergency preparedness competency dimensions and disaster
nursing competencies, and all-hazard disaster core
competencies for acute care medical professionals consist of
handling physical, psychological, and psychosocial problems
[10, 12]. Also, spiritual competencies contained in spiritual
care and nursing; a nurse contribution and practice must
consider human diversity (culture, belief, and values) [9], and
the conceptual framework for Islamic-based competencies
about the standard of service for sharia hospitals [13], based on
Islamic law (the Holy Quran and hadith) and need asssement to
care for the survivors, that found four themes: (1) the percep-
* Address correspondence to this author at the Department of Community Health
Nursing, Faculty of Nursing, Universitas Syiah Kuala, Banda Aceh, Indonesia,
23111; E-mail: ttahlil@unsyiah.ac.id
tion of disaster in an Islamic perspective consisted of: disaster
as a destiny from God, a test of faith, and a warning from God,
(2) the skills and attitudes of nurses in disaster response are
sincerity, caring, empathy, and patience, (3) the role of nurses
in disaster response is by integrating Islamic values in patient
care: prayer, dzikir (remembrance), shalawat, (salutation to
Prophet Mohammad PBUH (Peace Be Upon Him), reciting Al-
Quran, and endeavors, and motivating patient through surah
Nabawiyah (the story of the prophets), and (4) nurses’
competencies barriers in disaster response.
The religiosity, Islamic values, beliefs, and also the
regulation of local government to implement Islamic-based
health care services are reinforcement to support for this study.
This research was conducted to assess the impact of an Islamic-
based disaster intervention program on nurses’ competencies of
disaster response in dealing with survivors’ psychological,
psychosocial, and spiritual problems.
2. METHODS
2.1. Study Design
A quantitative study with a randomized controlled trial
(RCT) with a pre-test and post-test control group design was
conducted in this study consisted of three groups; evidence,
Islamic, and control groups. Evidence group was an
intervention group using disaster response competencies based
on the International Council of Nurses and other studies.
Islamic group was an intervention group according to the
standard of service for sharia hospitals (Islamic law) and
needed asssement by focus group discussion; meanwhile, the
control group did not provide intervention, but only routine
care. The RCT intervention program of this study is as follow
(Figs. 1a and 1b).
2.2. Participants
The population in this study were nurses working in four
wards; (1) emergency department (ED), (2) intensive care (IC),
(3) medical ward, and (4) surgical ward. This study applied a
medium effect size with a power of 0.08, a confidence level of
95% (α=0.05), and a value of d Cohen = 0.60, so the sample
size was 45 respondents [14, 15]. To avoid the attrition rate, the
sample size was increased by 10%, generating the total number
of respondents were 150 people (50 respondents in each
group). The sample selection used random cluster sampling
with the following inclusion criteria: a) nurses in the
emergency department, intensive care ward, medical ward, and
surgical ward, b) working period ≥ two years, c) minimum
educational background of Diploma in Nursing, and d) not
currently on leave annual/study assignments. The number of
final samples in the training program for each group was as
follows: the evidence group = 50, Islamic = 49, and control =
48 respondents.
The Impact of Islamic-Based Disaster Response Competencies The Open Nursing Journal, 2021, Volume 15 435
Fig. (1a). RCT intervention program using CONSORT models.
Fig. (1b). CONSORT flow diagram representing study model.
436 The Open Nursing Journal, 2021, Volume 15 Husna et al.
Fig. (2). Respondent of the study through the intervention program.
2.3. Randomization
Samples were selected by random cluster sampling in four
wards at three hospitals in Banda Aceh. The samples consisted
of three groups; Evidence-based intervention/EBI (hospital A),
Islamic-based intervention/IBI (hospital B) and control
group/CG (hospital C). The sample selection was in
accordance with the inclusion criteria by making clusters for
each designated ward (Fig. 2).
2.4. Program Development
The program development began with three focus groups
with 24 nurses and nine disaster survivors, and three series of
face-to-face in-depth interviews with eight policymakers at the
hospital and nine members of the Aceh Ulama Consultative
Council, Indonesia. Focus group discussions (FGDs) and in-
depth interviews aimed to identify and explore the need for
nurses’ disaster response competencies in handling
psychological, psychosocial, and spiritual problems due to
disasters. This development program is useful to support
intervention and implementation programs at the nurse training
stage.
2.5. Program Intervention and Implementation
2.5.1. The Evidence-based Intervention (Evidence group)
In this group, the intervention focused on the evidence-
based intervention for nurses in hospitals using standardized
nurses’ competencies in disaster response adopted from
International Council of Nurses (ICN) than other literatures,
consisting of six sessions with a duration of 60-90
minutes/session. The intervention material consists of
knowledge of disaster overview, causes and impacts of
disasters, and nurses' competencies in handling psychological,
psychosocial, and spiritual problems. Nurses' skills in handling
psychological, psychosocial, and spiritual problems in disasters
include educational care, emotional care, counseling care,
support, advocacy, and referrals. Finally, attitudes in caring for
disaster survivors include patient-centered care, open vs. closed
questions, and good listening skills. The method of intervention
comprised lectures, discussions, demonstrations, active
learning through role-play, and storytelling.
2.5.2. The Islamic-based Intervention (Islamic group)
In this group using nurses’ competencies in disaster
response adopted from the standard of service for sharia
hospitals (Islamic law) and need assesments from FGDs.The
intervention focused on the Islamic-Based Disaster Response
Competencies for Nurses in Hospital, consisting of six sessions
with a duration of 60-90 minutes/session. The intervention
materials consisted of 1) the concept of disasters from an
Islamic perspective, 2) the impact of disasters and disaster
management laws in Indonesia, symptoms of psychological,
psychosocial, and spiritual problems related to disasters, 3)
Islamic-based disaster response knowledge, skills, and attitudes
to nurses in handling psychological, psychosocial, and spiritual
problems, 4) the concept of self-consciousness, 5) Islamic-
based emotional freedom technique (EFT), 6) ikhtiar
(endeavor), doa (prayers), and tawakkal (trusting in God’s
plan) in response disaster, and termination and follow-up plans.
The intervention method included lectures, discussions,
demonstrations, active learning through role-play, and
storytelling.
2.5.3. The Control Group
No intervention was conducted in this group. It only
focused on routine care in the hospital following the standard
operating procedures (SOPs).
2.6. Program Providers
According to their respective competencies and expertise,
four experts were selected: disaster nursing nurse, psychiatric
nurse, psychologist, and Islamic scholar. For the evidence-
based intervention group, the program providers were a
disaster nursing nurse, a psychiatric nurse, and a psychologist.
For the Islamic-based intervention group, apart from three
other providers, an Islamic scholar was added with an intensive
training program on Islamic-based disaster response
competencies for nurses to handle psychological, psychosocial,
and spiritual problems.
A one-day training of providers was conducted to optimize
the implementation of the intervention program and uniform
perceptions, goals, achievements, and the expected results on
each of these training materials. The training activities
Evidence-based
intervention
(EBI)
Islamic-based
intervention
(IBI)
Control
group (CG)
Hospital A
Four wards: ED, IC,
medical, surgical
Hospital B
Four wards: ED, IC,
medical, surgical
Hospital C
Four wards: ED, IC,
medical, surgical
The Impact of Islamic-Based Disaster Response Competencies The Open Nursing Journal, 2021, Volume 15 437
consisted of the introduction of the training objectives and
programs, materials, methods, media, and evaluation used for
the six sessions of the intervention program. All experts and
researchers discussed and shared their expertise and experience
to be developed as resources used in this training program.
2.7. Ethical Considerations
This study pays attention to ethical principles in nursing
research. The respondents involved in this study signed written
informed consent to indicate their willingness. This study was
approved for ethical considerations by the Ethics Committee of
Dr. Zainoel Abidin Banda Aceh Hospital, with number
1171012P dated January 25, 2019.
2.8. Primary Outcomes
The primary outcomes of this study were the nurses’
competencies, including knowledge, skills, and attitude of
disaster response to deal with psychological, psychosocial, and
spiritual problems, which were measured by a questionnaire. It
was adopted from the literature [9, 12, 13, 16] and used for the
development of training materials and modules the intervention
program.
2.9. Development and Testing of the Instrument
The questionnaire was developed based on the literature
review and consisted of four parts: demographic data,
knowledge of nurses, skills of nurses, and attitudes of nurses in
disaster response. The questionnaire was tested for content
validity using the content validity index by three experts in
their fields related to research topics: a) an expert nurse in
disaster nursing, b) a psychologist, and c) an Islamic scholar
from Aceh. The reliability of the instrument was assessed by
the Cronbach alpha, which was carried out on 38 nurses at
regional hospital Banda Aceh. The results of the reliability test
for the nurses’ were knowledge = 0.80, attitude = 0.86, and
skills = 0.70.
2.9.1. Demographic Information
Demographic data included age (years), gender, highest
educational level, ward, working experience (years),
attendance in disaster/emergency training (yes/no, if “yes” the
type of training and the year).
2.9.2. Nurses’ Knowledge about Disaster
The nurses’ knowledge of disaster response was measured
using 22 multiple-choice items. Each question consisted of five
answers, scored “1” for the correct answer and “0” for the
wrong answer. The total scores ranged from 0-22, with the high
scores describing the high nurses’ knowledge of disaster
response.
2.9.3. Nurses’ Skills about Disaster
Nurses' skills of disaster response were measured using 20
dichotomous items. Each statement was scored “1” for the
correct answer and “0” for the wrong answer. The total scores
ranged from 0-20, with the high scores describing the high
nurses’ disaster response skills.
2.9.4. Nurses’ Attitude about Disaster
Nurses’ attitudes of disaster response were measured using
24 items a-5 points Likert scale (1=strongly disagree,
2=disagree, 3=doubtful, 4=agree, and 5=strongly agree). The
total value was from 1 to 120, with the high scores describing
the high nurses’ attitudes in disaster response.
2.10. Study Procedure
The training program in the intervention group was carried
out in six sessions in six weeks with 60-90 minutes/session. It
was computer-based training due to the COVID-19 pandemic.
The evaluation began with a pre-test, followed by materials
provided by the program providers. The post-test was carried
out twice. Post-test 1 was carried out two weeks, and post-test
2 four weeks after the completion program. The evaluation was
carried out using google form assisted by three research
assistants who had no affiliation with the hospitals.
2.11. Statistical Analysis
Descriptive statistics were used for frequency, percentage,
mean, and standard deviation. Inferential statistics using for
parametric and non-parametric tests. This study used a type 1
error of p<0.05 as the criterion for statistical tests used to
determine the effects and interactions of each analysis. Data
analysis was conducted using SPSS version 12.0.
3. RESULTS
3.1. Subject Characteristic
Demographic characteristics of respondents consisted of
age, gender, highest educational level, religion, working
experience, disaster training attendance, and the type of
training attended are shown in Table 1.
Table 1. The characteristics of the respondents.
Characteristics Evidence
(n = 50)
Islamic
(n = 49)
Control
(n = 48)
P-value
n (%) n (%) n (%)
Age (Year);
(M±SD)
33.9±5.6) 32.5±3.4 29.0±3.9 0.406
Gender:
Male
Female
7 (14)
43 (86)
16 (32.7)
33 (67.3)
11 (23)
37 (77)
0.000
Highest Educational Level
Diploma
Bachelor
33 (66)
17 (34)
29 (59.2)
20 (40.8)
34 (70.8)
14 (29.2)
0.077
438 The Open Nursing Journal, 2021, Volume 15 Husna et al.
Characteristics Evidence
(n = 50)
Islamic
(n = 49)
Control
(n = 48)
P-value
n (%) n (%) n (%)
Working Experience (Year)
(M±SD)
2.4 ±2.8 7.4±3.4 2.7±1.5 0.770
Disaster Training Attendance:
Yes
No
11 (22)
39 (78)
14 (28.6)
35 (71.4)
13 (27.1)
35 (72.9)
0.278
Types of Disaster Training Attended:
Basic Life Support
Basic Trauma Cardiac Life Support
Light Fire Extinguisher (LFE)
Disaster Management (drill)
8 (16)
10 (20)
11 (24)
6 (12)
10 (20.4)
11 (22.4)
9 (18.3)
4 (8.1)
8 (16.6)
12 (25)
12 (25)
4 (8.3)
0.592
Table 2. The impact of the evidence-based intervention, Islamic-based intervention, and control groups on nurses’
competencies of disaster response.
Outcomes
Evidence
(n = 50)
Control
(n = 48) P-value Islamic
(n = 49)
Control
(n = 48) P-value Evidence
(n = 50)
Islamic
(n = 49)
P-
value
MR SR MR SR -MR SR MR SR -MR SR MR SR -
Knowledge
Pre-test
Post-test 1
Post-test 2
49.98
56.45
55.80
2499.0
2822.5
2790.0
49.00
42.26
42.94
2352.0
2028.5
2061.0
0.864
0.013
0.024
49.96
56.16
55.93
2448.0
2752.0
2740.5
48.02
41.69
41.93
2305.0
2001.0
2012.5
0.733
0.011
0.013
49.08
49.00
48.47
2454
2450
2423
49.94
49.00
48.47
2397
2401
2427.5
0.881
0.857
0.711
Skills
Pre-test
Post-test 1
Post-test 2
50.08
58.48
57.84
2504.0
2924.0
2892.0
48.90
40.15
40.81
2347.0
1927.0
1959.0
0.833
0.001
0.002
50.20
58.39
57.21
2460.0
2861.0
2803.5
47.77
39.43
40.61
2293.0
1892.0
1949.5
0.663
0.001
0.003
48.65
48.66
49.64
2432.5
2433
2468.5
50.39
50.38
49.64
2418.5
2418
23.82
0.757
0.741
0.960
Attitude
Pre-test
Post-test 1
Post-test 2
49.97
55.60
55.25
2498.5
2780.0
2762.5
49.01
43.15
43.51
2352.5
2071.0
2088.5
0.867
0.030
0.041
49.58
55.16
55.01
2429.5
2703.0
2695.5
48.41
42.71
42.86
2323.5
2050.0
2057.0
0.837
0.029
0.033
49.61
49.12
49.05
2480.5
2456
2452.5
49.39
49.90
49.64
2370.5
2395
2398.5
0.969
0.892
0.873
*p<0.05 MR: Mean Rank, SR: Sum of Rank.
Table 1 shows the mean of age and standard deviation
(SD) in the evidence-based group = 33.9 ± 5.6, Islamic-based =
32.5 ± 3.4, and the control = 29.0 ± 3.9. The respondents in
three groups were mainly females (evidence= 86%, Islamic=
67.3%, control = 77%). Concerning the respondents' religion,
100% is Islam, while the educational level in the three groups
was dominated by Diploma (evidence = 66%, Islami = 59.2%,
and control = 70.8%). For the working experience, the highest
mean and SD = 7.4 ± 3.4 was found in the Islamic group, and
the lowest was in the evidence group, with the mean and SD =
2.4 ± 2.8. Disaster training attendance was dominated by the
Islamic group (28.6%), and the disaster training attended was
mainly control group, namely basic trauma cardiac life support
and LFE, by 25%, respectively. There were no differences
between the three groups based on their demographic
characteristics.
3.2. Effect of the Interventions on Knowledge
The analysis results of three mean scores in the evidence,
Islamic, and control groups were conducted using the Kruskal-
Wallis test in the pre-test, post-test 1, post-test 2 to assess the
difference of disaster response knowledge are shown in Table
3. The results of the study showed significant differences of
knowledge in post-test 1 (p-value = 0.014) and post-test 2 (p-
value = 0.023) between the evidence, Islamic, and control
groups. The statistical results indicate a significant effect on
knowledge of disaster response in the post-test 1 and post-test 2
in the evidence and Islamic groups.
Effects of the intervention programs on nurses’ knowledge
of disaster response are shown in Table 2. For the nurses’
knowledge, there was no significant difference in the pre-test
between the evidence and control groups (p-value = 0.864) and
between the Islamic and control groups (p-value = 0.733).
However, after the intervention program, significant
differences in post-test 1 were indicated in the knowledge of
disaster response between the evidence and control groups (p-
value = 0.013) and between Islamic and control groups at post-
test 1 (p-value = 0.011). The results indicated the difference in
nurses’ knowledge of the disaster response in both the evidence
and Islamic groups compared to the control group in pre-test
and post-test 1.
3.3. Effect of the Interventions on Skills
In the analysis, results of three mean scores in the pre-test,
post-test 1, post-test 2 in the evidence, Islamic, and control
groups using the Kruskal-Wallis test are shown in Table 3. It
shows significant differences in the mean rank of skills in the
evidence, Islamic, and control groups in the post-test 1 (p-value
= 0.001) and post-test 2 (p-value = 0.002). These results
concluded a significant effect of disaster response skills on
nurses in the post-test 1 and post-test 2 in the evidence,
Islamic, and control groups.
Effects of the intervention programs on disaster response
(Table 1) contd .....
The Impact of Islamic-Based Disaster Response Competencies The Open Nursing Journal, 2021, Volume 15 439
skills among nurses are presented in Table 2. For the nurses’
skills, there was no significant difference of pre-test between
the evidence and control groups (p-value = 0.833) and between
the Islamic group and control (p-value = 0.66). After the
intervention program, a significant difference was found in
effect on disaster response skills between the evidence and
control groups (p-value = 0.001) and between the Islamic and
control groups (p-value = 0.001). The results indicate a
significant difference in disaster response skills among nurses
in both the evidence and Islamic groups compared to the
control group in post-test 1.
3.4. Effect of the Interventions on Attitude
The results of the mean score in the pre-test, post-test 1,
post-test 2 in the evidence, Islamic, and control groups are
shown in Table 3. There were significant differences in disaster
response attitudes in the evidence, Islamic and control groups
on the post-test 1 (p-value = 0.042) and post-test 2 (p-value =
0.050) at α = 0.05. These results indicate a significant effect on
nurses’ attitude of disaster response in the post-test 1 and post-
test 2 in the evidence, Islamic, and control groups.
Effects of the interventions on disaster response attitude
among nurses are shown in Table 2. Concerning the nurses’
attitudes for disaster response, there was no significant
difference in the pre-test between the evidence and control
groups (p-value = 0.867) and between the Islamic group with
control (p-value = 0.837). After the intervention program, it
showed a significant difference in the effect of disaster
response attitudes between the evidence and control groups (p-
value = 0.001) and between Islamic and control groups (p=
0.001). The results concluded a significant difference in
disaster response attitudes among nurses in both the evidence
and Islamic groups compared to the control group in post-test
1.
Table 3 shows a significant difference in the nurses’
knowledge of disaster response on post-test 1, with M ± SD
(15.6 ± 2.7), and post-test 2 (15.5 ± 2.7), higher than the pre-
test (13.9 ± 3.9). The skills of nurses in the disaster response in
the post-test 1 (18.9 ± 1.5) and post-test 2 (18.8 ± 1.5) were
higher than the pre-test (17.9 ± 1.9), and the nurses’ attitude in
disasters response on the post-test 1 (107.5 ± 7.4) and post-test
2 (107.4 ± 7.3) were also higher than the pre-test (104.7 ± 8.6).
The comparison is shown in Table 4 below.
Table 3. The Comparison of the mean and standard deviation of knowledge, skills, and attitudes of disaster response among
nurses on the pre-test, post-test 1, and post-test 2.
Outcomes Evidence (n = 50) Islamic (n = 49) Control (n = 48)
M±SD M± SD M± SD
Knowledge - - -
Pre-test 13.9±3.9 13.9±4.0 13.7±4.0
Posttest 1 15.6±2.7 15.9±2.9 13.8±4.0
Posttest 2 15.5±2.7 15.8±2.9 13.8±4.0
Skills - - -
Pre-test 17.9±1.9 17.9±1.9 17.7±1.9
Posttest 1 18.7±1.5 19.0±1.4 17.8±2.0
Posttest 2 18.8±1.5 18.9±1.4 17.9±1.9
Attitude - - -
Pre-test 104.7±8.6 104.7±8.7 103.8±8.8
Posttest 1 107.5±7.4 108.1±7.0 104.5±8.8
Posttest 2 107.4±7.3 108.2±6.9 104.6±8.8
M = Mean; SD = Standard Deviation.
Table 4. The Comparison of the mean rank of knowledge, skills, and attitude of disaster response among nurses in the pre-
test, post-test 1 and post-test 2.
Variables Outcomes Groups MR X2P-value
Knowledge
Pre-test Evidence 73.96 0.12 0.94
Islamic 75.49
Control 72.52
Post-test 1 Evidence 80.55 8.49 0.01
Islamic 81.57
Control 59.45
Post-test 2 Evidence 79.35 7.54 0.02
Islamic 81.90
Control 60.36
440 The Open Nursing Journal, 2021, Volume 15 Husna et al.
Variables Outcomes Groups MR X2P-value
Skills
Pre-test Evidence 73.90 0.20 0.91
Islamic 75.90
Control 72.17
Post-test 1 Evidence 82.40 15.61 0.001
Islamic 83.98
Control 55.06
Post-test 2 Evidence 82.45 12.60 0.002
Islamic 82.10
Control 56.93
Attitude
Pre-test Evidence 74.32 0.05 0.98
Islamic 74.73
Control 72.92
Post-test 1 Evidence 79.65 6.32 0.04
Islamic 80.62
Control 61.35
Post-test 2 Evidence 79.19 5.83 0.05
Islamic 80.58
Control 61.88
p<0.05; MR: Mean Rank, X2: Chi-square Test.
4. DISCUSSION
Disasters have a significant impact on physical,
psychological, psychosocial and spiritual conditions. Sufficient
competencies of nurses, as the frontliner workers in disaster
response are needed in caring for survivors [17]. This
intervention program was carried out for six sessions [18 - 20]
in both intervention groups (Islamic and evidence) for 60-90
minutes/session for every week period and a control group.
There were two follow-ups: post-test 1, carried out two weeks
after the intervention program, and post-test 2, conducted one
month after completion program [21].
Disaster response knowledge is obtained from formal, non-
formal, informal education through education and training
programs [22]. The study results showed the knowledge of
disaster response significantly increased between the pre-test
and post-test 1 and pre-test and post-test 2 in the evidence
group. This program showed a significant impact on increasing
nurses' knowledge in disaster response in handling
psychological, psychosocial, and spiritual problems. To
achieve the learning objectives in each session, the evidence
group prepared several learning media such as 2 modules for
nurses, power points, case scenarios, videos for each session,
and quizzes at the end of each session. The preparation of
learning materials was very helpful for respondents in
mastering the training ourcomes. This is supported by the
opinion mentioned that hardcopy and softcopy attachments of
training materials could be provided to increase understanding
and achieve learning outcomes [23]. On the other hand,
recorded video and audio links for participants' Whatapps
group were also provided. This provides an opportunity for
respondents experiencing technical problems, such as internet
signals and environmental factors.
The existence of this recorded material could help achieve
the learning outcomes for the session. The computer-based
training (CBT) could provide a significant benefit in pandemic
conditions. Various methods could be used through CBT, and
internet-based training (IBT), such as teaching, simulation
exercises, role-play, skills practice, watching videos, and case
discussions can be combined [24]. This is also supported by
web-based training, which is part of the health
education/promotion program and is reported to be effective in
modifying health behavior, increasing knowledge and self-
confidence [25, 26].
The study results reported no significant difference of
knowledge between post-test 1 and post-test 2 (p-value =
0.102, α = 0.05) in the evidence group. This indicates that the
information provided from this training has a constant impact
on the evidence group. Furthermore, knowledge, attitudes, and
skills are important elements in disaster management to ensure
communities’ disasters preparedness [27]. The results of this
study also supported the fact that the training program is
feasible and effective in increasing the knowledge of nurses
related to disaster response [19].
In this study, the statistical tests for nurses’ knowledge of
disaster response in the Islamic group indicated a significant
difference between the pre-test and post-test 1 (p-value =
0.000), pre-test and post-test 2 (p-value = 0.000) (p<0.05).
However, there was no a significant difference between post-
test 1 and post-test 2 (p-value = 0.157) (p<0.05). The statistical
test reported that nurses’ knowledge of disaster response in the
Islamic group with a mean rank pre-test = 75.49, post-test 1 =
81.57, and post-test 2 = 81.90 were higher than the evidence
group with the mean rank pre-test = 73.96, post-test 1 = 80.55,
and post-test 2 = 79.35, respectively. This interpreted that the
Islamic group was significantly more effective in increasing
nurses’ knowledge in disaster response than the evidence
group.
The training program materials for the Islamic group
consisted of disaster perceptions in an Islamic perspective, the
roles and functions of Islamic-based nurses, knowledge of
disaster response through Islamic-based values, Islamic
attitudes in facing disaster, the principles of Islamic-based
(Table 4) contd .....
The Impact of Islamic-Based Disaster Response Competencies The Open Nursing Journal, 2021, Volume 15 441
communication skills, Islamic-based method to overcome
psycho-socio-spiritual problems due to disasters, actions that
are blessed by Allah in serving patients, and perspective of sick
from Islamic views. The training material has increased the
respondents' knowledge because it is relevant and applicable to
the values, religiosity, norms, and beliefs (100% Muslim).
Besides, the results of this study are supported by socio-
demographic of respondents, such as age with mean ± SD
(32.49 ± 3.38), bachelor education (40.8%), working
experience with mean ± SD (7.44 ± 3.37), and disaster training
attended (28.6%). Relevant training program materials also
support it with the competencies needed in caring for patients
with psychological, psychosocial, and spiritual problems due to
disasters or other health problems.
Disaster response skills are critical competencies for nurses
as the frontline workers in disaster response [28]. In the
intervention program to increase the skills of nurses in disaster
response in the evidence group, the interventions used disaster
response skills adopted from several literature [9, 10, 29].
Disaster response skills include communication skills, such as
patient center communication, open versus closed questions,
and good listening skills, educational care skills, emotional
care, counseling care and skills to provide support as well as
the ability to involve families engagement to the deal with
patient problems. In the evidence group, it was found that there
were significant differences in disaster response skills among
nurses in the pre-test, post-test 1 and post-test 2.
Although it has not been supported by the Islamic-based
standard operating procedures (SOPs) documents in these
hospitals, the IBT-based training method is considered
effective in improving the nurses’ skills due to the interesting
materials and techniques provided, effective learning media,
attractive and communicative videos, and case scenarios that
increase the nurse's critical thinking and practical skills in
analyzing cases related to the skills required by nurses.
Therefore, this training has had a significant impact on
improving the skills of nurses in disaster response. This is also
supported by the simulation method training, which helps
trainees understand the actual situation at hand. While, the skill
materials in the evidence group consist of the assessment of
psychological responses, fulfillment of emotional needs,
communication techniques with patients, listening techniques,
maladaptive responses, psychosocial care, family engagement,
and handling of spiritual problems due to disasters [30].
Respondents were also provided with videos and case scenarios
to achieve skills in dealing with patient problems. This case
scenario guides respondents in analyzing, internalizing, and
demonstrating the skills of nurses in overcoming the problems.
This is supported by nurses’ skills needed in dealing with
psychological problems such as patient center communication,
open versus closed questions, and good listening skills [31]. At
the end of each session, a quiz was also provided to ask for
feedback on the mastery of the materials training delivered.
This is in line with a study that explained that evaluation of
computer-assisted resilience training is carried out through
role-play, demonstrations and quizzes to provide feedback
relevant to the individual context [24]. Furthermore, several
training methods, such as case studies, workshops, tutorials,
group discussions, role-plays, demonstrations, and lectures, are
used in training programs [19].
Furthermore, intervention for Islamic group was adopted
from the Holy Book of the Quran and the hadith of the prophet
Mohammad PBUH (Peace Be Upon Him) as a way of life for
Moslem society. The Qur'an is a way of life, as a revelation
from God to deliver relationships with God and humans. While
the hadith is all the words, deeds, provisions, and approvals of
the Prophet Mohammad PBUH as the basis of Islamic law. The
implementation of Islamic-based nurses’ competencies in
response to the disaster was developed from both the Qur'an
and the hadith.
In the Islamic group, relevant training materials for nurses’
skills consisted of an assessment of disaster victims' behavioral
responses, emotional needs, Islamic-based effective
communication techniques (qaulan sadida, qaulan baligha,
qaulan ma'rufa, qaulan karima, qaulan layina, and qaulan
maysura), Islamic-based adaptive behavior, application of
Islamic values in dealing with patients' problems (prayers,
dzikir (remember of God), and reciting Quran), assessment of
psychosocial problems, Islamic-based emotional freedom
technique, the prohibition of despair in Islam, and the principle
of endeavor, prayers, and tawakkal (resignation) in Islam as an
obligation for every Moslim. These materials were adopted
from several previous studies and the results of the need
assessment in the previous supporting qualitative studies.
The results of this training support the hospital policies for
Islamic-based services in accordance with the Republic of
Indonesia Law No.11, 2006 concerning the implementation of
Islamic law. However, the SOPs for nursing intervention,
especially for handling Islamic-based psychological,
psychosocial, and spiritual problems are not available. The
results of this study in the Islamic group indicate that the
intervention program improves the disaster response skills of
nurses in the hospitals. These results are supported by the
materials that are applicable to Islamic values, relevant to
nursing practices, feasible and achievable in overcoming the
patients’ problems. Family engagement in patients care and
effective communication techniques (qaulan baligha), and
listening skills are recommended in Islam as part of noble
deeds blessed by Allah.
The results of this study related to nurses’ disaster response
attitudes consisted of assessment behavior, acceptance, and
support for several positive attitudes shown in dealing with
disaster survivors. In the evidence group, the increase in the
disaster response attitude is supported by several factors,
including the age of the respondents (mean = 33.9 years) with
high learning motivation, training media, methods of delivering
the materials with a two-way and attractive approach, and an
underlying attitude in caring for the patients (caring and
empathy).This study results are supported that caring is the
center of nursing practice based on the values of kindness, care,
compassion for oneself and others, and respect for the client's
spiritual beliefs [32].
This study showed that the training program activities had
changed nurses' positive attitudes in disaster response. This is
supported that the positive attitude of nurses in disaster
response includes listening skills to patient responses, asking
442 The Open Nursing Journal, 2021, Volume 15 Husna et al.
closed and open questions, showing acceptance and being
ready to serve patients, being a good listener on adaptive and
maladaptive responses, and involving patients and families in
intervention or dealing with the problems [10]. Nurses are
required to have caring behavior and empathy for patients.
However, the emphasis on training in the Islamic group is
sincerity and calm, most importantly to create caring and
empathy’ attitudes.
There were several attitudes in accordance with Islamic
values in caring for disaster survivors, namely: sincerity, caring
(ri'ayah), empathy (al 'adhifi), and calm (ithmi'naanun). Of
these four attitudes, sincerity is the main positive attitude
necessary for forming a caring attitude and empathy for
patients’ care. The important points from the aspect of an
Islamic-based attitude are listening, involving, accompanying,
appreciating, accepting, convincing, and agreeing to the
opinion of patients and their families in showing sincerity and
caring [33]. This is in line with the teachings of Islam where
there are several manners of hearing and speaking that regulate
a person to interact with others [34].
The results of the study in the Islamic group, the existence
of Islamic values and religiosity of the respondents could be a
suggestion in this intervention. Several studies reported that
religion and religiosity give meaning and purpose to human life
[35], and religion has an element of positive suggestion to
affect physiology and psychology well-being [36], reduce
anxiety and pain, and improve well-being and recovery [37],
the spirit is meaningful in health practice and has an impact on
the healing process [38].
CONCLUSION
This study found a significant difference in knowledge,
skills, and attitudes of disaster response among nurses between
the pre-test and post-test 1. However, there was no significant
difference between post-test 1 and 2 in the three groups,
indicating that this intervention program showed constant
results at the two measurements. The pre-test and post-test of
nurses' knowledge, skills, and attitudes were significantly
different, with the Islamic group being higher than both the
evidence and control groups.The results of this study benefit to
support the implementation of an appropriate Islamic-based
disaster nursing responses for hospitals in the Aceh Province
and other regions with the implementation of Islamic law. The
study findings help the hospital policymakers establish an
Islamic-based hospital disaster plan, including the policies,
guidelines, training for emergencies and disaster plans,
developing Islamic-based SOPs in handling psycho-social-
spiritual problems due to disasters.
LIMITATIONS
This study was conducted at the peak of the COVID-19
pandemic. Several respondents had contact with COVID-19
patients and were infected. The nurses’ skills slightly decreased
in post-test 2, however, remained above the baseline. In
addition, all the respondents are Moslim and thus, supporting
factors such as religiosity, beliefs and Islamic values of
respondents may affect the results of the study. Hence, the
findings could not be generalized to other areas with non-
Muslim populations.
ETHICS APPROVAL AND CONSENT TO PARTI-
CIPATE
This study was approved for ethical considerations by the
Ethics Committee of Dr. Zainoel Abidin Banda Aceh Hospital,
with number 1171012P dated January 25, 2019.
HUMAN AND ANIMAL RIGHTS
No animals were used in this research. All human research
procedures were followed in accordance with the ethical
standards of the committee responsible for human
experimentation (institutional and national), and with the
Helsinki Declaration of 1975, as revised in 2013.
CONSENT FOR PUBLICATION
The respondents involved in this study signed written
informed consent to indicate their willingness.
STANDARDS OF REPORTING
CONSORT guidelines and methodologies were followed
for this study.
AVAILABILITY OF DATA AND MATERIALS
Not applicable.
FUNDING
None.
CONFLICT OF INTEREST
The authors declare no conflict of interest, financial or
otherwise.
ACKNOWLEDGEMENTS
Researchers would like to thank all the participants for
their willingness to be involved in this study. We also extend
our gratitude to all hospital leaders, especially in education and
training at the three hospitals in Banda Aceh, for their support.
Also, we thank all research assistants for their valuable
assistance in completing this study.
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