GET THE APP

Level of Disaster Preparedness among Emergency Nurses in Aseer Region, KSA

Journal of Research in Medical and Dental Science
eISSN No. 2347-2367 pISSN No. 2347-2545

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.

Research - (2022) Volume 10, Issue 3

Level of Disaster Preparedness among Emergency Nurses in Aseer Region, KSA

Mousa ibrahim Ali Asiri1*, Suheir AM Sayed2, Mohammed Almalki2, Mysara Alfaki2 and Ahmed Nasser Ahmed Assiri2

*Correspondence: Mousa ibrahim Ali Asiri, Nursing Specialist, Khamis Mushayt General Hospital, Ministry of Health, KSA, Email:

Author info »

Abstract

Background: Nowadays, the possibility of disaster that occurs around the world increased, and the need to adapted people and organizations to be ready is a vital part of disaster management. As a part of the healthcare organization, the preparedness of nursing staff for disaster leads to an increased level of awareness of the organization. Furthermore, nursing staff in hospitals dealing with different situations daily in the emergency department but all worlds there is no daily disaster that occurs, so preparedness if the disaster is an integral part of disaster management. Aim: To evaluate the level of disaster preparedness among emergency nurses in the Aseer region. Methods: Descriptive facility-based study. Data were collected by standardized, close-ended Questionnaire through direct interview and was analyzed by computer (SPSS program), Data was presented in the form of simple frequency, tables, and graphs. Statistical significance analysis will be performed Results: The ages of the participants ranged from 20 to 50 Years old, 56% of them are females. A two-tailed samples t-test was used to compare the mean difference in Disaster knowledge between standard Disaster knowledge=3 and Disaster knowledge. The Type I error rate was set at alpha=0.05. The results suggest that the average Disaster knowledge is less than for Disaster knowledge standard, t(150)=-6.429, p=0.000. There is a significant difference between gender in variable familiar with Emergency Preparedness Terms & Activities p.value=0.019 Conclusion: Level of the disaster preparedness among nurses in Aseer region was less than the standard. Recommendation: giving all emergency nurses courses on how to prepare and deal with disasters. These courses are continuous, and their attendance is required before working in the emergency department and adds a course on how to deal with emergencies and disasters in all health college curriculums.

Keywords

Disaster preparedness, Emergency nurses, Continuous education

Introduction

It has been widely reported that nurses worldwide play a significant role in the response to disasters and have done so since the earliest days of the profession [1]. All communities across the world could potentially be threatened by a disaster. In 2015 alone, 99 countries were hit by natural disasters resulting in the displacement of millions of people, more than 22 000 deaths, and 70.3 billion USD (United States Dollar) worth of damage. Furthermore, these figures represent an upward trend in disasters. Given the frequency with which disasters occur and the effect they have, nurses’ preparedness to respond to these events is of critical importance in reducing the negative consequences to the health of the affected population.

Despite growing initiatives to prepare nurses for any disasters, evidence suggests they are underprepared for disaster response. A disaster is unpredictable and can strike at any time and place, causing severe damage to the function and structure of local communities as well as the natural environment. The increasing frequency of disasters worldwide necessitates nurses to adequately prepare to respond to disasters to mitigate the negative consequences of the event on the affected population. Despite growing initiatives to prepare nurses for any disasters, evidence suggests they are underprepared for disaster response. According to The International Federation of Red Cross and Red Crescent (IFRC) disaster is a sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its resources. Though often caused by nature, disasters can have humans.

In any disaster, the health sector is mandated to act and be ready to help in causality and manage the situations everywhere, preparedness for the disaster is a complicated process regarding multifactor restraining it. The health sector in preparation of disaster requires commitment and follow up to be ready if a disaster happens, nurses as a big part and influenced part in hospitals must be ready and well prepared for disaster management, Because nurses make up the majority of the health care workforce worldwide, they will most assuredly play a pivotal role in future Disasters [2]. However, nursing staff in hospitals dealing with different situations daily in the emergency department but all worlds there is no daily disaster that occurs, so preparedness if the disaster is an integral part of disaster management. Furthermore, if nurses do not have basic core readiness, for themselves and their families, they face the quandary of whether to report for or stay at work to care for others [3].

Here in Saudi Arabia, like any country of the world need to have qualified nurses in all hospitals is vital due to the presence of the two holy mosques and the Geopolitical location of unstable parts of the world. Besides, the climate changes that might be causing natural disasters; additionally, there is a few studies or research conduct in disaster preparedness in Saudi Arabia. The level of disaster preparedness among nurses in Saudi Arabia was revealed to be moderate. This finding indicated that Saudi Arabia nurses are inadequately prepared for disaster management [4].

Notably, there is an increased risk of significant disaster that might happen either epidemic like coronavirus or missile attack, even Terrorist attacks like the attack on the security canter in Abha 2015. The nurses play a vital role in the preparedness process in part of setting the policy and raising the awareness regarding the disaster and their role, and I am quoting from [2] this description of the nursing role in properness “It is of utmost importance that nurses during this phase are involved in the discussion of surge capacity and patient care aspects of the developing disaster plan”.

The research will help and improve the database of disaster management in the health sector of the Aseer region, especially. It will assist in filling the areas of problem-prone preparedness for disaster. Moreover, the result of the research will facilitate to figure of the knowledge of nurses and their reasonable level regarding the disaster preparedness plan in the region. It will contribute to the development of the policy regarding the disaster in the hospital after publishing the result and training methods in the hospital.

Methodology

Study design

The research design for this study was a descriptive -facility-based study to evaluate the level of disaster preparedness among emergency department nurses in the Aseer region.

Study area and population

This research was conducted in the ministry of health hospitals in the Aseer region, which is twenty hospitals randomly select the following hospital according to the geographical location which including the following hospital:

Aseer central hospital.
Khamis Mushayt general hospital.
Sarat Abeidah general hospital.
Muhayl general hospital.
Ballesmer general hospital.
The research targeted the nurses in the emergency department.

Inclusion criteria

Nurses work in an emergency department.

Exclusion criteria

Nurses work in another department.

Sampling procedure

The hospital selected randomly from the list according to interval total hospitals were 12, randomly selected 5 from it and a total coverage was taken, the number of nurses in the emergency department in this hospital was 200 registered nurses.

Study period

Data was collected from Jun to September 2021.

Study variables

Disaster preparedness, emergency nurses, continuous education.

Data collection

Data were collected by standardized, closeended Questionnaire through direct interview.

Data analysis and presentations

The data were analyzed by computer (SPSS program). Data were compared by using Chi– test, T-Test for equality of means was used and Data were be presented in the form of simple frequency, tables, and graphs. Statistical significance analysis will be performed to test the impact of the intervention.

Pre-test

The tools were being tested and modified accordingly.

Ethical considerations

An official letter will be taken from Taif University to approach the directors of the research administration in the Aseer region health director for permission to conduct the study and approval was taken from directors of the health in Aseer region NO: 822021.

Informed and verbal consent was taken individually from each member.

Results

Distribution of the sample according to age It is noticed that the distribution of ages around the different groups is appropriate, as the highest percentage of ages from 31 to 35 amounted to 28%, then the group from 26 to 30 amounted to 23%, while the group over 50 years amounted to only 2% (Table 1).

Item Measures Frequency Percentage
Age 20-25years 22 14.50%
26-30years 35 23%
31-35years 43 28.30%
36-40years 21 13.80%
41-45years 16 10.50%
46-50years 12 7.90%
More than50years 3 2%
Gender Male 66 43.40%
Female 86 56.60%
Year of Experience less than one year 26 17.10%
1-5Years 42 27.60%
6-10Years 33 21.70%
11-15Years 24 15.80%
16-20Years 18 11.80%
More than20Years 9 5.90%
Degree Diploma Degree in Nursing 48 30.60%
Bachelor Degree in Nursing 90 59.20%
Master Degree in Nursing 12 7.90%
PHD Degree in Nursing 2 1.30%
Hospital Aseer central hospital 54 35.50%
khmis mushayt General hospital 41 27%
Sarat Abidah General hospital 17 11.20%
Muhayl general hospital 25 16.40%
Ballasmer General hospital 15 9.90%
Nationality Saudi Arabia 96 63.20%
Philippine 32 21.10%
Indian 22 14.50%
Egyptian 2 1.30%

Gender

It is noted from the gender distribution of the sample that 56% of them are females.

Experience

Years of experience, more than two groups take high distribution rates, which are the category from one year to five years at a rate of 27.6%, then the next category from 6 to 10 years 21%.

Degree

The highest distribution of degrees Bachelor Degree in Nursing 59%.

Hospital

The highest distribution of hospital is Aseer central hospital 35.5%.

Nationality

The highest distribution of nationality Saudi Arabia 63.2% and Philippine 21.1%.

It is noticed from the distribution of statistics for the familiar with Emergency Preparedness Terms & Activities in Table 2 that most of the distributions are between the neutral Very familiar with the emergency preparedness. 62.5% are receiving ongoing training regarding disaster and 63% of them from 1 to 4 times per year (Table 3). 50% of method of disaster drills is Operational or mock drills (Table 4).

Very familiar Somewhat familiar Familiar neutral Somewhat not familiar Not familiar
N % N % N % N % N %
Are you familiar with Emergency Preparedness Terms & Activities? 47 30.90% 40 26.30% 35 23% 13 8.60% 17 11.20%
How familiar Are you with Incident Command System (ICS) and your role within it? 22 14.50% 36 23.70% 41 27% 23 15.10% 30 19.70%
Are you familiar with Epidemiology and Surveillance of disaster? 21 13.80% 34 22.40% 51 33.60% 20 13.20% 26 17.10%
How familiar Are you with the Decontamination process? 19 12.50% 56 36.80% 32 21.10% 26 17.10% 19 12.50%
Are you familiar with the Communication Connectivity channel? 25 16.40% 50 32.90% 30 19.70% 17 11.20% 30 19.70%
Are you familiar with Psychological Issues related to disaster? 27 17.80% 33 21.70% 41 27% 26 17.10% 25 16.40%
Are you familiar with Special Populations? 22 14.50% 43 28.30% 39 25.70% 18 11.80% 30 19.70%
Are you familiar with Accessing Critical Resources? 25 16.40% 45 29.60% 36 23.70% 21 13.80% 25 16.40%

Table 2: Emergency preparedness terms & activities among nurses in Aseer region.

  If yes, how often?
Are you receiving ongoing training regarding disaster?   Value   N %
yes N 95 1-4 Times per year 60 63%
% 62.50% 5-9 Times per year 22 23%
  10 or More than 10 13 14%
No N 57  
% 37.50%
  Yes   No   Don 't Know  
N % N % N %
Are disaster drills done at your hospital? 87 57.20% 27 17.80% 38 25%
Is the disaster plan periodically updated? 75 49.30% 25 16.40% 52 34.20%

Table 3: Disaster preparedness training among nurses in Aseer region.

Which method of disaster drills is done? you can choose more than one option Responses
N Percent
Methods Computer simulations 46 25.30%
Tabletop drills 45 24.70%
Operational or mock drills 91 50.00%
Total 182 100.00%
Yes No
N % N %
Do you work for a disaster preparedness team before? 73 48% 79 52%
Do you participate in any disaster? 91 59.90% 61 40.10%

Table 4: Multiple response regarding previous participate and drills among nurses in Aseer region.

Table 5 shows the ranking of the items of the variable of Disaster knowledge according to the mean statistic, so it is noted that the highest level of knowledge is represented in the (triage system during a disaster is the same as the daily triage system) statement and the lower was (Hazard identification and analysis are methods by which planners identify which events are most likely to affect a community and serve as the foundation for decision making).

Descriptive Statistics ranking for Disaster knowledge items among nurses in Aseer region
N Minimum Maximum Mean Std. Deviation
The triage system during a disaster is the same as the daily triage system 152 1 5 2.9803 1.13622
All type of disaster can use one triage method 152 1 5 2.8289 1.12041
As an emergency nursing staff, I read the disaster plan of my hospital. 152 1 5 2.7566 1.11579
I receive an educational program in the disaster plan of my hospital during my orientation period 152 1 5 2.6645 1.13315
The hospital has an emergency operation center familiar to the staff 152 1 5 2.6382 1.13084
The hospital disaster plan includes a clear communication channel during the disaster. 152 1 5 2.5921 1.06327
Hospital disaster plan indicate the chain of command 152 1 5 2.5263 1.08541
Triage methodologies are focused on the proper sorting and distribution of patients, either in the prehospital (field or community) or hospital (emergency department)settings. 152 1 5 2.5197 1.16784
Disaster plans clarify the role of nursing in the emergency department during disaster management 152 1 5 2.4868 1.0357
Hazard identification and analysis are methods by which planners identify which events are most likely to affect a community and serve as the foundation for decision making 152 1 5 2.3355 0.99631

Table 5: Disaster knowledge analysis for reliability and validly among nurses in Aseer region.

The Cronbach's alpha=0.84 which is very high and it reflect good reliability of Disaster knowledge indictor. The validity statistic is high and it is equal 0.92 (Table 6).

Variables Reliability Validity No of Items
Disaster knowledge 0.84 0.92 10

Table 6: This variable described through 10.

According to the p.value of Shapiro-Wilk and normality tests which is greater than 0.05 , the distribution of variable, was normally distributed, in this case the researcher will conduct the parametric statistics t-test instead of non- parametric tests to examine the Disaster knowledge (Table 7).

Shapiro-Wilk normality test for disaster knowledge
Statistic Df Sig.
0.984 152 0.069

Table 7: Normality test for disaster knowledge statistically.

In Table 8 A two-tailed one samples t-test was used to compare the mean difference in Disaster knowledge between standard Disaster knowledge=3 and Disaster knowledge. The Type I error rate was set at alpha=0.05. The results suggest that the average Disaster knowledge is less than for Disaster knowledge standard, t(150)=-6.429, p=0.000. There is significant difference between gender in Disaster knowledge p.value=0.019 (Table 9).

One-Sample Statistics
N Mean Std. Deviation Std. Error Mean
Disaster knowledge 152 2.6329 0.70399 0.0571
t Df Sig. (2-tailed) Mean Difference
Disaster knowledge -6.429 151 0 -0.36711

Table 8: T-test to compare the mean difference in disaster knowledge.

Gender N Mean Std. Deviation Std. Error Mean
Disaster Male 66 2.7848 0.65286 0.08036
Female 86 2.5163 0.72304 0.07797
Independent Samples Test
Levene's Test for Equality of Variances t-test for Equality of Means
F Sig. T Df
Disaster Equal variances assumed 1.649 0.201 2.367 150
Equal variances not assumed 2.399 146.023

Table 9: T-Test difference between gender in disaster knowledge.

There is significant difference between gender in variable familiar with Emergency Preparedness Terms & Activities p.value=0.019 (Table 10).

Independent Samples Test
  Levene's Test for Equality of Variances t-test for Equality of Means
F Sig. T Df
Familiar with Equal variances assumed 0.211 0.647 2.001 150
Equal variances not assumed 2.023 145.19
Sig. (2-tailed) Mean Difference
familiar with Equal variances assumed 0.047 0.30237
Equal variances not assumed 0.045 0.30237
familiar with Gender N Mean Std. Deviation Std. Error Mean
Male 66 3.0189 0.87849 0.10814
Female 86 2.7166 0.95668 0.10316

Table 10: T-test of difference between gender in variable familiar with emergency preparedness terms and activities.

All the points do not coincide with an evidence line that the variable is normally distributed (Figure 1).

Medical-Dental-points

Figure 1: Noticed that all the points do not coincide with an evidence line that the variable is normally distributed.

Discussion

In the beginning, I would like to clarify that by reviewing the points of agreement and differences between previous studies, we point out that the current study agrees with previous studies in its main subject and general objective, but it differs from it in several aspects that represent the contemporary variables that this study addresses.

In our study that was prepared Evaluate the level of disaster preparedness among emergency nurses in Aseer region , it became clear with regard to ages and according to the sample, it was noted that the ages around the different groups are appropriate, as the highest percentage of ages from 31 to 35 reached 28%, then the group from 26 to 30 amounted to 23%, while the group over 50 years amounted to 2% Jus ,and in one of the studies entitled Nurses Knowledge, attitude, practices and familiarity regarding disaster and emergency preparedness-Saudi Arabia which was in 2014 by Fatma Abdelalim, it became clear regarding age in other study show regarding the age that almost two third 67.1%at the study participate were aged between >25:30 year old with mean score of 26:36 ± 1.82 so It is clear here in my study that I fully expanded the distribution of the study to different age groups until the demographic variables are known and the study prepared clearly in order to know the age groups that need training for disaster preparedness at their different ages 25 and 36, and there are different age groups for nurses that must be prepared within the study. The findings also reveal a significant difference between the selfregulation scores in terms of age.

It is noted from the gender distribution of the sample among emergency nurses in Aseer region that 56% of them are females and 44% are males comparison in the previous study entitled Emergency Nurses Readiness for Disaster Response-An Explorative Study among Najran region which was in 2017 by Mohammed Ali Salem there were more female nurses 66% than the male nurses belong to 34% It is evident in gender here a clear convergence in the number of females in this study and the previous study,

In this study among Aseer region Years of experience, more than two groups take high distribution rates, which are the category from 1 to 5 years at a rate of 27.6%, then the next category from 6 to 10 years 21% in the previous study that I mention above among Najran region shows the work experience majority of them had 1 to 5 years of experience at a rate 49% and 6 to 10 year experience at a rate 33%, In both studies, there is a similarity in the number of years of experience, which was from one to five years, but a difference in the sampling rate in the two studies, as the current study, the average experience rate indicates 27%, and the average number of years of high experience refers to 21%, while the previous study, the average experience rate Refers to 49%, and the average number of years of experience refers to 33%, and it is clear that the rates differ, but the average experience is statistically the most in both region, This indicates the continuity of new employment, and therefore we have to target training with recent categories of experience. This is corroborated by the present study which noted that with young age the competence of the disaster management, as well as preparedness, improves given the increased exposure to disaster training and education and prior involvement in the disaster.

The findings among Aseer region have indicated that the highest educational level degrees were Bachelor Degree in Nursing 59% Compared with the findings in another study in 2019 titled A descriptive study to analyze the disaster preparedness among Saudi nurses through self-regulation survey have indicated that both Saudi and non-Saudi nurses with a diploma were more self-regulated as compared to the present study with BSN (Bachelor of Science in Nursing) so in the present study, the bachelor degree in nursing more than this previous study that Saudi and non-Saudi nurses with a diploma were may be due to a different structure which is followed for arranging their lectures or courses in terms of the parallel years.

Among Aseer region the study was distributed in five hospitals as are Ballasmer General Hospital 9.9%, Aseer Central Hospital 35.5%, Khamis Mushyate General Hospital 27%, Sarat Abidah General Hospital 11.2%, and Muhyal General Hospital 16.4% so the highest distribution of hospitals is Aseer central hospital 35.5%.

It is noticed from the distribution of statistics for the familiar with Emergency Preparedness Terms & Activities that most of the distributions are between the neutral Very familiar with the emergency preparedness. 62.5% are receiving ongoing training regarding disaster and 63% of them from 1 to 4 times per year. 50% of a method of disaster drills is Operational or mock drills.

Major of responses did not work for a disaster preparedness team before 52%. But major of them participate in any disaster 60%. Disaster knowledge analysis for reliability and validity: This variable is described through 10 items. the Cronbach's alpha=0.84 which is very high and it reflects good reliability of the Disaster knowledge indictor. the validity statistic is high and it is equal 0.92.

Also is noted that the highest level of knowledge is represented in the ( triage system during a disaster is the same as the daily triage system) statement and the lower was (Hazard identification and analysis are methods by which planners identify which events are most likely to affect a community and serve as the foundation for decision making). And in another study Readiness of hospital nurses for disaster responses in Taiwan: A cross-sectional study was in 2016 by Wen-Chil Tzeng [5] their results showed that from 311 hospital nurses in Taiwan showed that they had the greatest readiness to respond to a disaster outside the hospital in terms of clinical management and the least readiness in self-protection. Overall. the majority of these hospital nurses reported poor readiness for disaster responses consistent with previous findings For 140 hospitals nurses in Australia [6]. 620 hospitals nurses in the US and 164 nurses in Hong Kong participant in our study with disaster-related training or experience in disaster response were more likely to perceive readiness for future disaster events as previously reported from Singapore. In addition, our participant's readiness for disaster responses was associated with having a bachelor's degree emergency/intensive care experience,> 10 years of nursing experience, and military background. These findings help nurse educators evaluate hospital nurses' readiness to respond to a disaster and recognize significant factors that require further training during undergraduate or continuing education.

Our participants reported the highest disasterreadiness scores in clinical management including physical assessment and equipment operation in an austere environment.

This result is likely due to the nurses in this study performing these skills during their daily practice and clinical management being traditionally included in continuing nursing education programmers. as previously reported. However, the clinical experience of hospital nurses might not guarantee their effective performance in disaster conditions. Thus multiple evaluation methods should be considered when assessing nurses' clinical knowledge and skills for disaster response [7-10].

It was clear from the current study and the previous study in Taiwan the difference in the readiness of hospital nurses to respond to disasters in that the two studies showed different rates of results, but they are similar in that they have the utmost preparedness for disaster response and clinical management. A difference in readiness rates.

It was also found that participants in the current study with disaster-related training or experience in disaster response were more likely to perceive preparedness for future disaster events as was the case in the previous study. and we can say that from the two studies, and I'm talking here about my current study and the previous study, that participants have the highest levels of disaster preparedness in clinical management, this result is likely because the nurses in this study perform these skills during their daily practice and clinical management that are traditionally included in education Continuous nursing. We emphasize that the clinical experience of hospital nurses may not guarantee their effective performance in disaster situations and therefore multiple assessment methods should be considered when assessing nurses' clinical knowledge and skills for disaster response.

Acknowledgement

The authors would like to acknowledge Taif University for supporting this study through the University Research Supporting Project number (TURSP-2020/317).

References

  1. Veenema TG, Woolsey C. Essentials of disaster planning. Disaster nursing and emergency preparedness for chemical, biological, and radiological terrorism and other hazards. 2003; 18:3-29.
  2. Google Scholar

  3. Ciottone GR, Biddinger PD, Darling RG, et al. Ciottone's disaster medicine. Elsevier Health Sciences 2015.
  4. Google Scholar

  5. Corrigan E, Samrasinghe I. Disaster preparedness in an Australian urban trauma center: Staff knowledge and perceptions. Prehosp Disaster Med 2012; 27:432-438.
  6. Indexed at, Google Scholar, Cross Ref

  7. Al Thobaity A, Plummer V, Innes K, et al. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J 2015; 18:156-164.
  8. Indexed at, Google Scholar, Cross Ref

  9. Tzeng WC, Feng HP, Cheng WT, et al. Readiness of hospital nurses for disaster responses in Taiwan: A cross-sectional study. Nurse Educ Today 2016; 47:37-42.
  10. Indexed at, Google Scholar, Cross Ref

  11. Reineck C, Finstuen K, Connelly LM, et al. Army nurse readiness instrument: psychometric evaluation and field administration. Military Med 2001; 166:931-9.
  12. Indexed at, Google Scholar, Cross Ref

  13. Evans CA, Baumberger-Henry M. Readiness: How prepared are you?. J Emerg Nurs 2014; 40:448-452.
  14. Indexed at, Google Scholar, Cross Ref

  15. Labrague LJ, Hammad K, Gloe DS, et al. Disaster preparedness among nurses: a systematic review of literature. Int Nurs Rev 2018; 65:41-53.
  16. Indexed at, Google Scholar, Cross Ref

  17. Ibrahim FA. Nurses knowledge, attitudes, practices and familiarity regarding disaster and emergency preparedness–Saudi Arabia. Am J Nurs Sci 2014; 3:18-25.
  18. Indexed at, Google Scholar, Cross Ref

  19. Sultan M, Mary E, Al Grad M. Emergency nurses readiness for disaster response-An explorative study. Am Res J Nurs 2017; 4:1.
  20. Indexed at, Google Scholar, Cross Ref

Author Info

Mousa ibrahim Ali Asiri1*, Suheir AM Sayed2, Mohammed Almalki2, Mysara Alfaki2 and Ahmed Nasser Ahmed Assiri2

1Nursing Specialist, Khamis Mushayt General Hospital, Ministry of Health, KSA
2Department of Nursing, Collage of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
 

Citation: Mousa ibrahim Ali Asiri, Suheir AM Sayed, Mohammed Almalki, Mysara Alfaki, Ahmed Nasser Ahmed Assiri, Level of Disaster Preparedness among Emergency Nurses in Aseer Region, KSA, J Res Med Dent Sci, 2022, 10 (3):01-09.

Received: 06-Mar-2022, Manuscript No. JRMDS-22- 51302; , Pre QC No. JRMDS-22-51302 (PQ); Editor assigned: 08-Mar-2022, Pre QC No. JRMDS-22-51302 (PQ); Reviewed: 21-Mar-2022, QC No. JRMDS-22-51302; Revised: 26-Mar-2022, Manuscript No. JRMDS-22-51302 (R); Published: 31-Mar-2022

cappadocia tours
cappadocia hotels
cappadocia balloon flights

paper.io

agar io

wormax io