Research
Research
1 | September 2022
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       Abstract – Multitudinous disasters have crippled the country, leaving severe casualties and abundant
   challenges among many citizens, especially among the vulnerable groups of elderly, who pose increasingly
   physiological and immunological deficiencies in dealing with disasters, particularly amidst the pandemic. As
   healthcare professionals, nurses carry crucial responsibilities in providing assistance and management among
   them to help alleviate their suffering and distress from these circumstances. This quantitative, descriptive-
   correlational study aims to determine the nurses’ roles among elderly during pandemic, the nurses’ disaster
   preparedness among elderly during pandemic, the nurses’ disaster management among elderly during
   pandemic, the challenges among nurses in taking care of elderly during pandemic, and the significant
   relationship between nurses’ disaster preparedness, nurses’ disaster management and challenges among nurses
   in taking care of elderly during pandemic. 170 public health nurses working on municipalities within the 30-km
   radius around Taal volcano were purposively selected and surveyed via Google forms. Gathered findings
   revealed that during pandemic, nurses always fulfill their roles in rendering essential health care among the
   elderly; however, they often experience challenges in taking care of them. Furthermore, they often perform
   measures for boosting their disaster preparedness and management among this group without being correlated
   by the challenges they encounter. This study concludes that nurses still require continuous enhancement of their
   disaster preparedness and management among elderly during pandemic thus, further provision of high standard
   training programs directing to this is recommended for the supplementary sustainment of the elderly’s
   significant health care needs fundamental in upholding their well-being.
       Keywords – Disaster management, disaster preparedness, elderly, nurses’ roles, pandemic
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                                          Indicators                                          WM             VI          R
 1. I use the basic and continuing education to improve understanding of the need for
                                                                                              3.52        Always         1
 competency in disaster response for elderly.
 2. My institution organizes programs and trainings to promote a better preparation for
 emergency response to vulnerable groups like elderly in times of disasters in the midst 3.34              Often         5
 of pandemic.
 3. I equip myself in acquiring practical experiences in providing care during disaster and               Always         2
                                                                                              3.51
 use this experience to facilitate proper interventions to elderly patients.
 4. I attend in seminars about the appropriate ways of equipping the elderly groups and                    Often         10
                                                                                              3.02
 their families for household emergency preparedness during COVID-19 pandemic.
 5. I participate in emergency evacuation training for older adults that can be employed in                Often         9
                                                                                              3.06
 both natural and manmade disasters in the midst of pandemic.
 6. I join in the infection prevention and control seminars that is particularly applicable                Often         6
                                                                                              3.19
 among elderly during disasters in the period of COVID-19 pandemic.
 7. I participate in disaster drills at my workplace on a regular basis.                      3.38         Often         4
 8. I join in assemblies that address enhancement of skills in providing psychosocial
 counselling and support for elderly people who may undergo traumatic experiences 3.18                     Often         7
 brought about by disasters during pandemic.
 9. I attend in trainings that improve skills in providing first aid service specifically for
                                                                                              3.15         Often         8
 older adults.
 10. I develop mechanisms to increase rush capability, while maintaining expertise and
 competence in handling emergency situations for elderly during disasters in the midst of 3.44             Often         3
 pandemic.
                                       Composite Mean                                              3.28       Often
Legend: 3.50 – 4.00 = Always; 2.50 – 3.49 = Often; 1.50 – 2.49 = Sometimes; 1.00 – 1.49 = Never
          Nurses continue to seek for personal and   There might be numerous seminars and training for
professional development by the enrichment of        nurses to further enhance their knowledge and skills yet,
technical or customized knowledge and skills as health
                                                     it lacks assemblies mainly focused on equipping them
care professionals who assist in the resolution of issues
                                                     about the proper measures for household emergency
for service in their specialized area of discipline. As a
                                                     preparedness for the elderly and their families. People
result of this, nurses who are more prepared tend to can be equipped in a disaster if they are aware of and
provide better care to the elderly groups needing    plan for the sorts of catastrophes to which they are most
support and management.                              vulnerable, establish a social interaction and evacuation
   Disaster preparedness has been incorporated into the
                                                     plan in the event of a crisis, and organize a necessary
                                                     disaster supply pack [12].
nursing curriculum, emphasizing principles and patient
management in the event of a disaster [10]. Several      Table 3 shows that nurses often perform the disaster
studies have highlighted the importance of disaster   management among elderly during pandemic. with a
nursing education in enhancing disaster knowledge and composite mean of 3.43.
skills in preparation for their response. Nurses who haveThis relates to the results gathered from the table 2
                                                     in which due to the nurses’ curtailed attendance on
previously completed disaster nursing education have a
higher level of personal preparedness for disaster   seminars and assemblies that can boost their disaster
response [11].                                       preparedness in responding to the vulnerable groups of
   However, attending in seminars about the          the elderly during disasters, they also often work on the
appropriate ways of equipping the elderly groups and principal measures for the efficient disaster
their families for household emergency preparedness  management in assisting the elderlies during disasters
during COVID-19 pandemic, got the lowest mean value  amidst the pandemic. Premise on this that being
(3.02).                                              prepared leads to adequate management of a situation
                                                     even in times of crises.
                  Table 3. Nurses’ Disaster Management among Elderly During Pandemic
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                                                                                            WM     VI                 R
 1. I work with emergency planners and local government authorities in organizing
 courses of actions for elderly for incoming disasters, evacuation and provision of care 3.28     Often                9
 to elderly patients during emergencies in the period of COVID-19 pandemic.
 2. I integrate the physiological, psychological, social, and family-oriented aspects of
                                                                                            3.37  Often                8
 care during disasters while considering the special health needs of elderly.
 3. I can educate the older adults and their families about emergency preparedness that
                                                                                            3.45  Often                6
 is essential in the arrival of disasters in the midst of pandemic.
 4. I inform and require the elderly people about the practice of infection prevention and
 control measures in all phases of disaster especially within the period of COVID-19 3.51 Always                       4
 pandemic.
 5. When disaster strikes, I work systematically to ensure that no one is abandoned, even
                                                                                            3.49  Often                5
 the bed-ridden and physically disabled elderlies particularly in access of isolated areas.
 6. I assist in seeking and providing a safe site for evacuation where equitable
                                                                                            3.54 Always                3
 distribution of necessary supplies and services will be accessible.
 7. I monitor the well-being and identify the signs and symptoms of injury or incident to
                                                                                            3.57 Always                2
 older adults when responding to disasters.
 8. I provide the advanced first aid to older adults when required to support the
                                                                                            3.44  Often                7
 emergency services in the rescue efforts for disasters.
 9. I deliver counseling and one-to-one support when required for elderly people who
 have lost family members, homes and livelihood brought about by disasters within the 3.05        Often               10
 period of pandemic.
 10. I am able to work under pressure and remain calm, even the situation is difficult to
                                                                                            3.62 Always                1
 handle.
                                       Composite Mean                                       3.43 Often
Legend: 3.50 – 4.00 = Always; 2.50 – 3.49 = Often; 1.50 – 2.49 = Sometimes; 1.00 – 1.49 = Never
         Among the items cited, working under            environment to disaster victims while they perform
pressure and remaining calm, even if the situation is    their interventions to the people affected by these
difficult to handle (3.62), monitoring the well-being of events, allowing them to focus on the demands of the
patients and identifying the signs and symptoms of       situation [14].
injury or incident to older adults when responding to             Nonetheless, delivering counsel and one-to-
disasters (3.57), and assisting in seeking and providing one  support when required for elderly people who have
a safe site for evacuation where equitable distribution  lost family members, homes and livelihood brought
of necessary supplies and services will be accessible    about by disasters within the period of pandemic
(3.54) got the highest ratings.                          (3.05). Disasters are agonizing for those affected
         Nurses are fortified with calmness and          people. With that, psychological counseling is required
composure even when working under pressure in            as they rehabilitate from these circumstances.
handling emergencies [13]. They may be troubled by       COVID-19 has harmed the lives and health of over
the unsettling events happening within disaster          millions of individuals throughout the world and
scenarios, but they manage to be unruffled to properly   overwhelmed the healthcare system. Nurses
strategize about their subsequent management for the     experienced significant challenges caused by the
elderlies and other community members in these           pandemic, including a critical shortage of nurses and
situations. This is a fundamental characteristic,        medical supplies, and the risk of infection, resulting
especially during these circumstances, as it may help    them to be hesitant in providing one-on-one care to
alleviate the apprehensive feelings of the elderly       clients. Aiding and addressing the needs of nurses will
patients brought about by the emergency and disasters.   help them respond more confidently and appropriately
Nurses still manage to provide a comforting nursing      to the needs of their clients amidst crises [15].
                Table 4. Challenges Among Nurses in Taking Care of Elderly During Pandemic
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                                                                                                                                        WM       VI      R
  1. I am hindered by the limited face-to-face interaction in providing home care visit to
                                                                                                                                        3.11    Often    2
  elderly people needing health assistance and surveillance.
  2. I experience a shortage of nurses in my institution that impedes to meet the increased
                                                                                                                                        3.09    Often    3
  health care needs of the elderly in the community.
  3. I encounter having insufficient personal protective equipment and medical supplies that
                                                                                                                                        2.85    Often    8
  help to reduce the spread of infection.
  4. I fear of having increased risk of contracting the virus for myself and my family due to
                                                                                                                                        3.46    Often    1
  my exposure to different kinds of people in fulfilling my nursing roles.
  5. I experience discrimination by the society as a health worker which affects my self-
  esteem in interacting and providing care with the people especially the vulnerable elderly                                            2.88    Often    7
  in the community.
  6. I feel pressured in intervening with elderly patients as they require more complex and
                                                                                                                                        2.92    Often    6
  time-consuming care that may result to poorer health outcomes.
  7. I have inadequate training in taking care of elderly people affected by the COVID 19
                                                                                                                                        2.75    Often    10
  due to lack of programs and facilities in my institution that supports it.
  8. I experience an unfavorable atmosphere for elderly care brought about by stressful and
                                                                                                                                        2.76    Often    9
  emotional environment especially in times of disasters.
  9. I encounter an inadequate allocation of medication, and health supplies provided by the
  government for the elderly needing intensive care especially during disasters in the midst                                            2.95    Often    5
  of pandemic.
  10. I experience physical and emotional exhaustions caused by overloaded tasks that
                                                                                                                                        3.04    Often    4
  reduces my abilities to competently provide care for elderly.
                                        Composite Mean                                                                                  2.98    Often
Legend: 3.50 – 4.00 = Always; 2.50 – 3.49 = Often; 1.50 – 2.49 = Sometimes; 1.00 – 1.49 = Never
    Table 4 presents that nurses often experience                                                      It affects their mindset while working as health care
challenges in taking care of elderly during pandemic.                                              professionals, knowing how life-threatening the
with a composite mean of 2.98. It reflects that as health                                          COVID-19 disease could be. Galehdar et al. [16] found
care professionals concern for the safety of the people                                            out that nurses experience death anxiety due to
in the community, especially of the elderly,                                                       excessive exposure to the nature of the disease, fear of
encountering challenges in serving them amidst the                                                 unknowingly passing the virus to others, and emotional
pandemic has been inevitable because of the dangerous                                              stress. However, the implementation and compliance of
circumstances the pandemic poses. Among the items                                                  proper protocols could mitigate the effects of anxiety on
cited, fear of having increased risk of contracting the                                            the nurse's mental health. Job responsibilities and
virus for themselves and their family due to their                                                 attendance at COVID-19-related training were also
exposure to different kinds of people in fulfilling their                                          discovered to predict anxiety of contracting COVID-19
nursing roles (3.46), being hindered by the limited                                                among their nurse respondents [17]. Furthermore, a
face-to-face interaction in providing home care visit to                                           greater fear of COVID-19 was connected to lower work
elderly people needing health assistance and                                                       satisfaction, increased psychological discomfort, and
surveillance (3.11), and there is a nursing shortage,                                              organizational and professional turnover intentions in
which makes it difficult to address the rising health                                              the workplace in the Philippine setting [18]. On the other
care needs of the elderly in the community (3.09) got                                              hand, having inadequate training in taking care of
the highest rating. Nurses risk their lives to carry out                                           elderly people affected by the COVID19 due to lack of
their nursing duties in promoting health wellness and                                              programs and facilities in the institution with a weighted
preventing illness among their clients. However, as                                                mean of 2.75 obtained the lowest rating. Nurses are
high-risk individuals, they are still concerned about                                              given a variety of trainings to help them develop their
becoming infected or unintentionally infecting their                                               psychological traits and firstaid skills. They can make
elderly patients and relatives.                                                                    quick assessments and judgments in an emergency, take
                                                                                                   appropriate measures, closely monitor disease states,
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and accurately and timely follow doctor's advice [19].         afraid of contracting the disease than their fellow
Furthermore, nurses who had worked previously                  employees who had not, demonstrating that experience
through pandemic reported a higher level of competence         can reduce fears.
to deal with such events in the future [20] and were less
     Table 5. Relationship Between Nurses’ Disaster Preparedness, Nurses’ Disaster Management, and
                   Challenges among Nurses in Taking Care of Elderly during Pandemic
                                                     r-value                 p-value                 Interpretation
    Table 5 depicts the association between nurses’               elderly during pandemic as they sustain their basic
disaster preparedness, nurses’ disaster management, and           health needs; yet, uplifting their mental health status was
challenges among nurses in taking care of the elderly             being disregarded despite experiencing traumatic events
during pandemic. It was observed that the obtained r-             brought about by the disasters. During the pandemic,
values indicate an almost negligible correlation, and the         nurses often experience challenges in taking care of the
computed p-values were greater than the 0.05 alpha                elderly, wherein the fear of having increased risk of
levels. This means that no significant relationship exists        contracting the virus for themselves and their family due
between the indicators and implies that the nurses’               to exposure to different kinds of people as they fulfil
disaster preparedness and management were not                     their nursing roles was mostly suffered by nurses.
affected by the challenges experienced.                           Nurses implement measures to develop their disaster
    Cayaban et al. [21] reported that the past experiences        preparedness and management among elderly without
of nurses and having disaster-related training helps them         being affected by the challenges they encounter in
to increase preparedness response but sometimes shows             taking care of this group of individuals during
a lack of confidence in doing so. With that, the findings         pandemic.
of their study provide evidence that with proper training,             Based on the accumulated findings, this study
sufficient disaster education, and adequate involvement           sought to provide the following recommendations:
in assemblies and programs about disaster preparedness,           Hospital          administrators and        Local
nurses will effectively manage and handle emergency               Government Units, in coordination with the City Health
and disaster situations despite the shortcomings that may         Office or Provincial Health Office and Red Cross
arise.                                                            Organization, must deliver high-standard training
                                                                  programs to improve nurse's knowledge and skills in
CONCLUSION AND RECOMMENDATION                                     responding to disasters, taking note of the exclusive
    After the results were analyzed, the following are            measures to perform among the elderly while
therefore concluded: Nurses always fulfill their roles as         considering their special health care needs during a
health care professionals in rendering care and service           pandemic. Nurses must also be encouraged to engage in
to the elderly in the community, who are considered               and seek out training opportunities in mock disaster
highly susceptible individuals during pandemic. Nurses            drills and actual disaster events. Promote the
exploit their educational attainment, develop practical           involvement of nurses in the meetings and assemblies
experiences, and join in different seminars and training          with the local government authorities and other
to equip and prepare them in responding to disasters,             emergency responders in organizing courses of action
especially amidst pandemic; however, institutions and             for the incoming disasters, evacuation, and provision of
organizations have insufficient programs and activities           care to the elderly groups to highlight the consideration
that particularly target and prioritize the needs of the          for their essential health care needs and further engage
elderly groups during these situations. Nurses perform            nurses in responding to disaster events. Boost utilization
the integral measures for disaster management among               of telemedicine among nurses to maximize
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