CONCEPT ANALYSIS

PREPAREDNESS

Presented to:

Assoc. Prof. Pattama Surit, Phd., RN

TIARA (585060029-8)

Master of Nursing Science Program

Faculty of Nursing Khon Kaen University
First Semester, Academic Year 2015
PHENOMENA

NURSES PREPAREDNESS FOR DISASTER MANAGEMENT IN MT. ANAK

KRAKATAU BANDAR LAMPUNG AREA, INDONESIA.

BACKGROUND

A disaster is an occurrence disrupting the normal conditions of existence and causing

a level of suffering that exceeds the capacity of adjustment of the affected community (world

health organization, 2004). A serious disruption of the functioning of a community or a society

causing widespread human, material, economic or environmental losses which exceed the ability

of the affected community/society to cope using its own resources. (U.N. ISDR 2002,)

Natural disasters include strorms, such as hurricanes and cyclones, floods, eartquakes,

extreme heat and cold emergencies, tsunams, vulcanic, eruptions, pendemics and famine (food

and Agriculture organization of the united Nations, 1999).

World disaster report 2007 reported a 60 % increase in disasters in the last decade (1997-

2007) over the previous decade (1987-1996). Adiditionally, the number of reported death grew

from 600.000 to over 1.2 million. At the some time the number of people affected rose from 230

million to 270 million, a 17 % increase( Kylman, Kouppart & Mukheir,2007)

According to the United Nations Bureau Of crisis prevention and recovery, some 75 %

of the worlds population live in areas that have been affected at least once by either an

earthqueke, a tropical cyclone, flooding or drought between 1980 and 2000 (IRIN,2007).

Natural disasters have been increasing over the last years, withthe greatest increase in the

last decade (Birnbaum, 2002). And on average during 2000-2006 there is 116.3 countries were

hit by disaster each years (Scheuren et al, 2008). As in 2006, Asia was most affected by disasters

by disasters both the number of deaths and the number of disasters in 2007 (Hoyois, Schauren,

Below & Guha sapir, 2007).

 Around 62 % of all active vulcanoes in the world are located around the margin of the

pacific ocean, the east pacific island, for example includes 45 % of the worlds active

vulcanoes while the central and south amerika segments countain only 17% of the fulcanoes,

about 14 % vulcanoes are located in the indonesia island swhile, of the remaining 24%, 3%

are located in the mid pacific ocean, 1 % in mid indian ocean island, 13% on mid atlantic

ocean island, and the last 7 % scattered trought the mediteranean sea and central ASIA (

Turkey, iraq. Ect). It is possible to divide the vulcanoes of the world into seven region as

follow : 1. Vulcanoes of the pacific ocean island ares and alaska continental rim, 2 vulcanoes

of the east pacific continental rim, 3 vulcanoes of alpine indonesia mountain belt, 4 vulcanous

of east african-arabian, 5 vulcanoes of the rift and mountain of eurasia, 6 vulcanoes of the

west indies and 7 vulcanoes of the ocena floor (Kirianov, 2001)

The Major volcanic eruptions of the past 250 years are Grimsvotn (Laki or

Lakagigar), Iceland 1783, Tambora, Sumbawa, Indonesia 1815 ,Cosiguina, Nicaragua 1835,

Askja, Iceland 1875, Krakatau, Indonesia 1883, Okataina (Tarawera), North Island, New

Zealand 1886, Santa Maria, Guatemala 1902 Ksudach, Kamchatka, Russia 1907, Novarupta

(Katmai), Alaska, US 1912, Agung, Bali, Indonesia 1963, Mt. St. Helens, Washington, US

1980, El Chicho n, Chiapas, Mexico 1982, Mt. Pinatubo, Luzon, Philippines (Robock, A ,

2000)

The vulcanoes eruption are 1783 Laki, Iceland death 9,340 (mostly starvation), 1815

Tambora, Indonesia death 92,000 (mostly starvation) 1883 Krakatao, Indonesia death 36,000

(mostly tsunami), 1902 Mt. Pelee, Martinique death 29,000 (ash flows) 1985 Nevada del

Ruiz, Colombia death 22,000 (mud flows) Vulcano in indonesia could divide into 4 type

vulcanos shape, which are stratavulcano or strobolian, shield, cinder cone and caldera.

Indonesia is a country with more than thousands island which located in the ring of

fire. Moreover, indonesia located in three active faulth , they are pacific, indo-australia and
eurasia faults,. The movement of these three faults inpact to the natural disaster event in

indonesia. One of the natural disaster caoused by this geographical condition is vulvano

disaster ( Kusumastuti et oal, 2014). More than 130 active vulcanoes apread to all island in

indonesia (center for reseach on epidemology of disaster, 2006). Vulcano in indonesia could

devide into 4 type of vulcanos shape, which are strata vulcano or strombolian, shield, cinder

cone and caldera. One of mountain in sumatera island which had fluctuation seismic

activities for this year is mountain anak krakatau.

Since its appearance in 1929, Anak Krakatau Volcano has been growing fastly. The

elevation of Anak Krakatau Volcano from 1930 to 2005, within 75 years, has reached 315 m

high. The growth rate is approximated to be four meters per year in average. Based on

calculation, the volume of the body from the sea floor since 1927 until 1981 was 2.35 km3,

and then in 1983 was 2.87 km3 and then in 1990 it reached 3.25 km3. The latest volume

measurement in 2000, was 5.52 km3.

Between 1992 up to 2001, within nine years, the eruption of Anak Krakatau took

place almost every day, and it had caused its elevation to increase more than 100 m, and its

area extent to become 378,527 m2. If the increase in height and the increase in volume are

consistent, it is expected that in 2020, the volume of Anak Krakataus edifi ce will proceed

the volume of Rakata Volcano, Danan Volcano, and Perbuwatan Volcano (11.01 km3)

shortly before catastrophic eruption in 1883. the eruption of Krakatoa on 27 August 1883 has

been in follow by the tsunami that has destroyed 260 towns and villages as well as the about

36,000 people death.

Anak krakatau located in The Sunda Strait region has been an important location even

so today, it serves as a gate for sailing activities and a passage way to cross from the island of

Sumatra to Java, Its status and its role has become even more important following the huge

development leap in the end of 20th century, with an improvement of the quality of access to
the surrounding area and the emergence of many economic activities such as industrial

activities (chemical, metallurgy, energy, etc), transportation (Merak, Bakauheni, Panjang,

Tarahan, etc), fishery (Padang Cermin, etc) and a military base (Teluk Ratai). The

geographical location of the area is very strategic as it stands as the gate of sailing from the

Indian Ocean and its close proximity to the center of government of the country (Jakarta) and

province (Tanjung Karang) (Hantoro 2003).

Most of the houshold rely on their living to the Mt. Anak Krakatau through

agriculture and tourism activities. many tourism interested to see the Mt. Anak Krakatau.

The number of people live in anak krakatau area are 195.271 people consist of 4 sub distric (

panjang 52.475 people, teluk betung utara 84.299 people, teluk betung barat 51.972 and

gunung mas 6.525 (Dinas Kesehatan Kota Bandar Lampung, 2006). The distance the city of

bandar lampung with the anak krakatau mountain is 64.36 Km. Very potential risk to incur

the larva and tsunami if the anak krakatau euruption .

Goverment of indonesia set four levels of vulcano activities based on seismic

activities, they are normal (level 1), Alert (Level 2), standby (Level 3) and beware ( Level 4).

Since on september 30th 2011 , Mt. Anak krakatau is be increased from level II ( Alert)

tobe level III ( Standby) but the earthquake of Mt Krakatau to be decreaise since december

2011 untill the status of anak derived from level III tobe level II until now. The up and down

level determination in Mt. Anak Krakatau were measured based on seismic activities.

Based on the large number the impact of disaster so the importance to nurse

preparednes for reduce the impact of disaster. Bandar Lampung area is the one of the high

level of risk. And thr goverment set the range of disaster prone area in differently for each

vulcano. In example Mt. Krakatau set the range area for each disaster area is 2 Km. In other

case Mt. Merapi where located in between yogyakarta and Central Java Province set the

disaster prone rage in each of 4 Km.

 Lindell and Prater (2003) outline the importance of determining the impact and the

affected agents in natural disasters. First, that information is useful for policy makers, as they

can know the need for external assistance and which may be more effective; second, specific

segments of affected can be identified, e.g. how low income household are affected, etc); and

third, it may be also useful for planning assistance for natural disasters and the potential

consequences..

One of the main questions regarding the impact of natural disaster on households or

localities is how random they may be. Lindell and Prater (2003) also outline how the impact

of natural disasters should take into account other mechanisms, such as mitigation practices

emergency preparedness, assistance, etc, to determine the real impact. Some hospitals in

Lampung have been training about the disaster but almost the training is about fire not

vulcanous.

Preparedness is The state of being ready to be used or to act for something that will

happen in the future (oxford dictionary, 2008) and George W Bush, 2003, preparedness is A

series of activities conducted through organizing and taking the correct and useful steps.

Disaster preparedness including risk assesment and multi-diciplinary management

startegies at all system management strategies at all system levels, is critical to the delivery of

effective responses to the short , medium, and long term needs of a disaster-stricken

population. Nurses with their technical skill and knowledge of epidemiology, physicology,

pharmacology, cultural-familial structures and psycological issues can assist in disaster

preparedness programes as well as during disaster (ICN, 2006).

Almost 70 % of the school nurses in a three country area of north-eastern ohio, united

states they needed additional education related to emergency responses in order to respon

affectivelly (Mosca, Sweeney and Brenner, 2005).

 The ISDR defines preparedness as activities and measures taken in advance to ensure

effective response to the impact of hazards, including the issuance of timely and affective

early warnings adn the temporary evacuation of people and property from thretened location

(ISDR, 2004). Element of preparedness include : recruiting volunteers. Planning, training,

equipping, public education, exercising and evaluation.

The number of disaster in indonesia since 1907 to 2004 is cyclone number o events

10 (1.992 death ), Drought number of events 11 (9.329 death), Earquake number of event 78

(21.856 detah), Flood number of event 93 (4.298 death) and vulcano the number of event

(17.945 death) (The Earth Institute, 2004).

The preparation based on the goverment is socializing to the disaster, and conduct the

picket of staff to the observe the Mt. Anak Krakatau activities. disaster prone area is

determined by govrnment and be devided in three (3) level which is based on the risk

level(Regulation of minister of energy and mineral resources of republic indonesia. Disaster

prone area with the highest level of risk is named in disaster prone level 3 and mostly the

government set the range of disaster prone area in differently for each od vulcano.

Indonesia goverment is aware to the gheographical situation of indonesia which

impact to the potential of vulcano disaster. National Agency for Disaster Management or

called as Badan Nasional Penanggulangan Bencana (BNPB) established in 2004 to

implement disaster management concept to reduce hazard coused of natural disaster. It was

established after big earhquake and tsunami hit banda aceh and impact to international matter

because of tsunami range. Learn from this study, the goverment of indonesia built BNBP and

formulated guidline for disaster management and merged into national development planning

of 2005-2025( Bappenas, 2005). However the implementation , BNBP is helped by BPBD or

stans for badan penanggulangan bencana daerah (in english : local agency for disaster

management) which located in each of districs.

The disaster management at the pre disaster so far many forgotten , but even at the pre

disaster is very important because what had already been prepared at the it is a financier in

the face of disaster and post disaster .A little the government along the public and private

thinking about langkah-langkah or kegiatan-kegiatan what is needed in face disasters or how

reduce the impact of disasters Rachmat, 2008).

Responsible for health in disaster management at the center is health minister assisted by the

echelon 1 under coordination of coordination the head of the national disaster ( BAKORNAS

PB ) the vice of president , and implementation in the department of health coordinated by un

secretary general in this case is chairman of the central.

Responsible for health in disaster management in the provincial level is head of the provincial

health office if necessary will call for aid to ministry of finance under coordination of a unit

of coordinate the operation of the disaster management ( satkorlak pb ) headed by gubernur

At the district level responsible for health in disaster management is head of district health

offices if necessary can asked for help to the province under coordination of the executing

unit disaster management ( satlak pb ) headed by Bupati (KepMenKes RI, 2007).

Nurse as the centre of the front in a health services have a responsibility and role of that is

great in handling patients emergency daily or when the of disasters.Competence nurse in

phase preparedness is education in nursing disaster, training for the calamity tackling,

observe services in terms of equipment and resources, and do confirmation and make network

support nursing (Ohara, 2007)

There is no percentage is certain about the number of nurses who are involved in disaster

management in the community. Until this time the nurse workforce needs to handle the

disaster victims in the community as much as 33% of all health care personnel involved.

The goals of disaster preparedness are knowing what to do when disaster occur,

knowing how to do it being well-equipped with the right tool to do effetively. Preparedness

minimize hazard adverse effect trough effective percautionary measures that ensure a timely.

This action has different recipient they area goverment, individuals,businesses and health.

The nurses play a key role in disaster preparedness, but they must accomplish the

critical elements of personal and professional preparedness first. Disaster management

includes four stages: prevention (or mitigation ), preparedness, response, and recovery.

Nurses have unique skills for all aspects of disaster to include assessment, priority setting,

collaboration, and addressing of both preventive and acute care needs. In addition, public

health nurses have a skill set that serves their community well in disaster to include health

education and disease screening, mass clinic expertise, an ability to provide essential public

health services, community resource referral and liaison work, population advocacy,

psychological fi rsaid, public health triage, and rapid needs assessment.

The role of nurse during a disaster depends a great deal on the nurses experience,

professional role in a community disaster plan, and prior disaster knowledge to include

personal readiness. Public health nurses bring leadership, policy, planning, and practice

expertise to disaster preparedness and response ( ASTDN, 2008 ). Based on this

phenomenona im interested to do this research .

1. SELECT CONCEPT

Preparedness

2. DITERMINE THE AIM OR PURPOSE OF ANALYSIS

A concept is a building block for scientific research and theory development in a

dicipline. This paper explores the meaning of preparedness. A concept analysis uses the

method described by Walker and Avant (2005) undertaken to examine the atributes,

characteristics and use of the concept. The goal of this undertaking is to identify and

clarify the meaning of preparedness.

.
3. USES OF THE CONCEPT OF PREPAREDNESS

Experts in concept analysis agree that inquiry begins by reviewing relevant literature.

Pearson (2004) suggestd that reviewing multiple sources from many disciplined may

support the development of understandings of the research, therefore, in this present

analysis information is retrieved from journal and theory of dictionaries and other

diciplines. The refrences will explain in the different way about complience that will

make us more understand about the definition of preparedness.

a. Definition of preparedness from dictionaries

Dictionaries describe a concept in term of its widely accepted and universal use.

Oxford learners pocket dictionary (2008) describe meaning of preparedness

is a state of readiness especilally for war : the country maintened a high level of

military preparednees (oxford, 2008)

Thasaurus dictionary defines that preparedness is: 1. The state of being

prepared, rediness. 2 possesion of adequate armed forces, industrial resourches and

potential etc :especialy of ditterent to enemy attact. The synonim of preparedness is

readiness, prepartion, alertness, mobility, willingness and zeal. (Thausaurus, 2014)

 British dictionary define of preparedness is The state of being or ready especially

militarily ready for war

Combridge dictionary define of preparedness is to expect that something or

someone ready for something that will happen in the future ( combridge, 2014)

The Comprehensive Bahasa Indonesia Dictionary defines preparedness as a

prepared condition. It came from the basic word prepared, meaning ready to be

used or to act. While the definition provided by Law Number 24 Year 2007 for

Disaster Prevention is a series of activities conducted to anticipate disaster through

organising as well as taking the correct and useful steps.

b. Preparedness from the perspective of theories

Preparedness has a many of definitions. The different perspective of different

diciplines further preparedness a unified of the term.

Preparedness is the degree to which an organization, agency, or discipline is

capable of preventing, responding to, or recovering from a threat, crisis, disaster,

incident, or event of mass destruction, mass exposure, or mass disruption. An official

definition is: The term preparedness refers to the existence of plans, procedures,

policies, training, and equipment necessary at the Federal, State, and local level to

maximize the ability to prevent, respond to, and recover from major events. The term

readiness is used interchangeably with preparedness Preparedness is a process, or

as is proposed in these papers, a cycle (George W. Bush, 2003).

Today, however the concept of preparedness has been transformed from community

survival pattern into the rhetoric of formalized bureaucratic organizations ( Tierney

1989; smith and Dowell 2000).

Preparedness Are the measures that ensure the organized mobilization of personnel,

funds, equipments, and supplies within a safe environment for effective relief
(Transitional Government of Ethiopia (TGE) 1993). Preparedness is the degree to

which an organization, agency, or discipline is capable of preventing, responding to,

or recovering from a threat, crisis, disaster, incident, or event of mass destruction,

mass exposure, or mass disruption. An official definition is: The term preparedness

refers to the existence of plans, procedures, policies, training, and equipment

necessary at the Federal, State, and local level to maximize the ability to prevent,

respond to, and recover from major events. The term readiness is used

interchangeably with preparedness (George W Bush, 2003)

FEMA (Federal Emergency Management Agency) defines preparedness as: the

leadership, training, readiness and exercise support, and technical and financial

assistance to strengthen citizens, communities, state, local, and tribal governments,

and professional emergency workers as they prepare for disasters, mitigate the effects

of disasters, respond to community needs after a disaster, and launch effective

recovery efforts (www.fema.gov).

 Conclusion of preparedness definitions
Dictionaries
1. A state of readiness especilally for war
2. The state of being prepared, rediness.
3. possesion of adequate armed forces, industrial
resourches and potential etc :especialy of ditterent to
enemy attact
4. The state of being or ready especially militarily ready for
war
5. to expect that something or someone ready for
something that will happen in the future
6. prepared condition

Preparedness
the existence of plans, procedures,
policies, training, and equipment
George W Bush, necessary at the Federal, State, and local
2003 level to maximize the ability to prevent,
respond to, and recover from major events

Other literature is the degree to which an organization,

agency, or discipline is capable of
Transitional preventing, responding to, or recovering
Government of from a threat, crisis, disaster, incident, or
Ethio event of mass destruction, mass exposure,
or mass disruption

the leadership, training, readiness and

FEMA exercise support, and technical and
financial assistance to strengthen
citizens, communities, state, local, and
tribal governments, and professional
emergency workers as they prepare for
disasters, mitigate the effects of
disasters, respond to community needs
after a disaster, and launch effective
recovery efforts
4. Defining attributes

According to Walker and Avant (1995), defining attributes are those characteristics

of a concept that are most frequantly associated with the concept, and appear

repeatedly in references to the concept.

Preparedness attributes

1. The state of being ready to be used or to act for something that will happen in the

future.

2. A series of activities conducted through organizing and taking the correct and useful

steps.

3. A process of plans, procedures, policies, trainings, and equipment necessary to

maximize the ability to prevent, respond to, and recover from major events.

4. The state of leadership in strengthening people and communities to prepare for

disaster or respond to the effects of disaster with effective recovery efforts

5. Model Case

A Model case is a real life example of the use of the concept that includes all the

critical attributes of the concept. Model case should be a purse case of the concept, a

paradigmatic example (Walker and Avant, 1995). The example of model case as

follows :

A group of nurses working in health care center in Bandar Lampung near Mt.

Anak Krakatau vulcanous this area is a potential threat to themselves, their

familiesand their community. The status of Mt. Krakatau is level III (Standby) and the

nurse evaluate whether becoming better prepared is important to them at this time.

The nurses want to act in a response to the vulcanous eruption that would happen in

the future. The nurses decided to develop a disaster management program which
 consisted at five steps : 1. Planing for action which involved healtcare provider

community and agency responsibility and also get a financial and material suport

from the goverment and private sector. 2. Exercise to carry out their duties but also

help to find problems in the plan in emergency situation.3. Equipmet that need to

maximize the ability to prevent, respond to, and recover from major events.

4.Training, The community nurses do the training make a team work and the training

based on the prosedur and guidline from the policies, and the nurse took

responsibility to help the peoples in this area because nurses became a leader 5.

Evaluation for all the activities.

Table 1.1 Summary of Attribute

Attribute Sentences

The state of being ready to be used The nurses want to act in a response to the
or to act for something that will vulcanous eruption that would happen in the
happen in the future future

A series of activities conducted The nurses decided to develop a disaster

through organizing and taking management program which consisted at five step
the correct and useful steps

A process of plans, procedures, Equipmet that need to maximize the ability to

policies, trainings, and
equipment necessary to
maximize the ability to prevent,
respond to, and recover from
major events
prevent, respond to, and recover from major
events. 4 training The community ners took
responsibility to help the peoples in this area
because they became a leader.

The state of leadership in Training The community ners took responsibility

strengthening people and to help the peoples in this area because they
communities to prepare for became a leader
disaster or respond to the
effects of disaster with effective
recovery efforts
 6. contruct additional cases

6.1 Boderline Case

Borderline cases are those example or instances that contain some of the concept being

examined but not all of them (Walker & Avant, 1995).

The folowing example presents a boderline case for the concept of preparedness :

The nurses were working in a health care center in lampung, near Mt. Merapi in Central

Java. This area is very dangerous to all peoples, the status of Mt. Merapi is level

III(standby). And the nurses need evaluated whether bocoming better prepared is very

importan to them in this time and . The group of nurses agree to action in a reponse to the

vulcanous eruption that would happent in the future and in the beggining. The nurses dont

have a training and knowladge about the disaster preparedness. They cannot set up the

programe to preparation for vulcanous damages. The community nurses have a

responsibility to help the peoples because the nurses become a leader.

In this borderline case some, but not all of the defining attribut are present. The grup

of nurses wanr to act to prepare to the vulcanous eruption but the nurses dont have a

training and they cannot set up the programe to preparation for vulcanous demages.

6.2 Contrary case

Contrary cases are those that are clear examples of Not the concept. (walker

&Avant,1995).

A group of nurses working in health care center in Bandar Lampung near Mt. Anak

Krakatau vulcanous this area is a potential threat to themselves, their familiesand their

community. The status of Mt. Krakatau is level III (Standby) and the nurse evaluate
 whether becoming better prepared is important to them at this time. And preparedness is

priority to take a action.

The group of nurses didnt to action in a response to the vulcanous eruption that would

happent in the future . they dont have a knowladge and cannot set a program and dont

know how to star to work in preparation for vulcaous damages. The nurses dont have

planning or traning about the disaster.

6.3 Related case

Related case are instances of concept that related to the concept being studies but that do

not contain the critical atributtes (Walker & Avant, 1995). A related concept to to

preparedness is readiness. State of preparedness of persons, systems, or organizations to

meet a situation and carry out a planned sequence of actions. Readiness is based on

thoroughness of the planning, adequacy and training of the personnel, and supply and

reserve of support services or systems (bussines.dictionarry).

Definition Readiness from oxford pocket dictionary is state as the result of a process of

preparation, willingness as an attitude, promptness as a capacity for immediate action.

Readiness, WHO Definition 1997 is Final definition resulting from combining all the

above. Keywords: Preparedness, Willingness, Promptness for Action (underline Action).

The concept implies material resources, procedures, human skill ands good will.

Differences between preparedness and readiness : The DHS Lexicon (2007) defined

preparedness as activities necessary to build, sustain, and improve readiness capabilities

to prevent, protect against, respond to, and recover from natural or man-made incidents.

Note that this definition mentions readiness. Theres a lot of confusion regarding

preparedness and readiness. In fact, the now defunct Homeland Security Presidential

Directive (HSPD)-8, explains that The term preparedness refers to the existence of
 plans, procedures, policies, training, and equipment necessary at the Federal, State, and

local level to maximize the ability to prevent, respond to, and recover from major events.

The term readiness is used interchangeably with preparedness.

But In my opinion, preparedness is the sum of plans, policy, procedures, protocols,

risk/hazard/threat/vulnerability identification/analysis, and development of

training curriculum for incident response/recovery. readiness is somewhat different.

Readiness is the capability of successfully responding or conducting recovery operations

(in other words, the ability to implement processes, procedures, etc included in

preparedness).

The case example of relate case that uses the concepts but do not contain contrary: The

nurses were working in a health care center in lampung, near Mt. Merapi in Central Java.

This area is very dangerous to all peoples, the status of Mt. Merapi is level III(standby).

And the nurses need evaluated whether bocoming better prepared is very importan to them

in this time. The nurse have a planning in a response to the vulcanous eruption that would

happen in the future and the begining. The group of nurses do training to help the peoples

and the nurse give a support system to the peoples.

7.1 Antecedents

According to Rodgers (2000), antecedents are the factors that must exist for phenomenon

to occur. Walker and Avant (2005) suggest that antecedent are helpful to the theorist in

identifying the underlying assumption regarding the concept under study. Antecedent may

be defined as events or incidents that must happen before the occurrence of the concept.

Acceptance

Acceptance is the first antecedent of nursing preparedness. According to the Concise

Oxford Dictionary,acceptance means to believe or receive as valid or correct (Soanes

2001). In relation to nursing preparedness, acceptance means that nurses believe that

vulcanous euruption is a feasible threat or risk. Nurses who are in denial about the

possibility of a vulcanous euruption r or its relevance to their lives have not achieved

acceptance. Without acceptance, nurses will not engage in both components of the

vulcanous euruption. This supports acceptance as an antecedent in nursing preparedness. If

nurses do not believe that vulcanous euruption is a risk (i.e. acceptance), they cannot or

will not engage in the preparedness process (Rebmann 2005b). Acceptance alone is not

enough to elicit a change in nurses behaviour. Researchers have indicated that, although

many infection control and public health nurses believe that a vulcanous euruption is

likely to occur somewhere in world, most nurses have not pursued preparedness education

or participated in exercises (Shadel et al. 2003, 2004). This indicates that more than

acceptance is required to result in a behaviour change. Nurses must also be ready to

change before preparedness can occur

Readiness to change

Accepting the threat of vulcanous may not be sufficient to prompt nurses to engage in the

disaster preparedness process. They must be ready to change before they engage in

preparedness activities, making readiness to change an antecedent to preparedness. The

concept of readiness to change has never been explicitly delineated in bioterrorism

preparedness literature. Rather than addressing nurses readiness to change, authors simply

give information on how to become better prepared for a bioterrorism attack. This assumes

that nurses reading the article are ready to change (i.e. become better prepared) or they

would not be reading the article. Readiness to change is both a process of becoming ready

and a state of being ready to change (Dalton & Gottlieb 2003). It consists of three steps

when viewed as a process: (a) realizing something needs to change; (b) weighing the
 cost/benefit; and (c) planning for action (Dalton & Gottlieb 2003, p. 111). As a state,

readiness to change refers to the variations in clients desire and/or intent to

take action (Dalton & Gottlieb 2003, p. 115). When applied to nursing preparedness,

readiness to change means that nurses realize that they need to become better prepared for

disaster, perceive the benefits of preparedness as outweighing the potential negative effect

of not being better prepared, have the desire and intent to become better prepared and

decide to take action. If all components are not present, readiness to change has not

occurred.

7.2 Consequences

Walker and Avant (2005: 73) suggest that consequences are those events or incidents that

occur as a result of the concept. Therefore, consequences must transpire after the concept

occurs. In the case of nursing preparedness, consequences are the actions that occur as a

result of engaging in the process of vulcanoues preparedness. Nurses who engage in the

disaster preparedness process are likely to have greater knowledge and more

comprehensive response plans than nurses who are no engaged in the process. Greater

knowledge and more complete response plans make it more likely that a nurse will be able

to recognize a potential event and implement response behaviours than nurses who are not

engaged in the process or those who participate in fewer preparedness initiatives.

8. Empirical Refrences

The final step of Walker and Avant's method of concept analysis is empirical references.

Empirical references present how the concept is to be measured or what the observation

of a phenomenon should be in reality . It is the event that demonstrates the existence of the

concept. Determining is the final step in concept analysis. From the analysis of

preparedness : 1) some distinctions that should be made between theories that can be

helpful to emergency managers in the practice of their profession and general theories of
disaster or hazards, disaster or hazards responses, emergency management, and homeland

security; 2) there are numerous normative theories that are relevant to all of the above

listed areas that can be useful to emergency managers; 3) there are numerous broad

perspectives within the social sciences that can help emergency managers make more

informed decisions; 4) there are several specific micro theories that have been empirically

verified that can provide guidance to emergency managers; 5) there are a few embryonic

theories of disaster responses to natural disasters that offer promise and potential for the

future; and 6) some personal assessments.

 References

1. oxford, 2008.

2. Thausaurus, 2014

3. combridge, 2014

4. fema

5. George W Bush, 2003