Indonesian emergency nurses’ preparedness to respond to disaster: A descriptive survey

Disaster preparedness among nurses in disaster-prone countries: A systematic review

BACKGROUND

Disaster preparedness is crucial for mitigating the impact of disasters and saving lives. Ensuring preparedness for disaster response and management, particularly among nurses in disaster-prone countries, is essential due to the serious threats disasters pose to affected populations. This study was conducted to appraise and synthesize the literature examining preparedness for disaster management and response among nurses in countries with the highest disaster risks.

METHODS

A systematic review of the literature published from 2000 onwards was conducted using five databases: SCOPUS, PubMed, MEDLINE, PsychINFO, and CINAHL. Twenty-one relevant articles were identified for this review.

RESULTS

The findings revealed that nurses in countries at high risk of disasters had inadequate disaster knowledge and skills, leaving them ill-prepared to respond to such situations. Previous experience in disaster relief, disaster-related education and training, and higher academic qualifications were associated with increased readiness for disaster response and management.

CONCLUSION

The review's findings provide insight into the current state of disaster preparedness among nurses in disaster-prone nations. The review identified evidence highlighting the value of disaster-related education and training, as well as disaster response experience, in fostering preparedness among nurses. These results can inform policymakers, hospital administrators, and nurse administrators in developing strategies for promoting disaster preparedness in nurses through evidence-based training programs and interventions.

Experiences of Nurses Providing Care to Individuals in Earthquake-Affected Areas of Eastern Turkey: A Phenomenological Study

PURPOSE

The aim of this study is to examine the experiences of nurses who provide care to individuals in earthquake-affected areas of eastern Turkey.

DESIGN

A phenomenological design from qualitative research methods was utilized in this study.

METHODS

The study was conducted between May 29, 2023, and August 15, 2023, with 11 nurses working in the western region of Turkey's provinces through one-on-one semi-structured interviews. The interviews were conducted online and recorded on video. Content analysis was performed using the MAXQDA software package.

FINDINGS

Themes and sub-themes were identified from the expressions of nurses in line with research findings. Accordingly, 5 themes were determined for nurses providing care to individuals in the earthquake. zone: "challenges they face,""emotions they felt,""coping methods,""knowledge and skills"and "effects of earthquake".

CONCLUSION

The results obtained from this study demonstrated that nurses experienced difficulties due to environmental (hygiene, cold weather, shelter) and work-related (lack of coordination, psychosocial issues) conditions during the earthquake event. While providing care to individuals in earthquake-affected areas of eastern Turkey, nurses reported feelings of sadness, inadequacy, anxiety, and fear. They employed coping methods such as talking to family/friends, attempting not to dwell on thoughts, and turning to religious practices to manage these negative emotions. Nurses emphasized the necessity of having professional knowledge and crisis management skills to care for individuals during the earthquake period. In accordance with the findings of the research, it is recommended that nurses are provided with realistic training through simulations and drills in disaster management, as well as psychological support interventions.

Nurse Perceptions of Knowledge and Preparedness for Disasters

OBJECTIVE

The study aimed to determine the level of knowledge and perceptions of preparedness for disasters among nurses working in a tertiary university hospital.

METHOD

The population of this cross-sectional study consisted of nurses working in a university hospital in the Eastern Black Sea Region of Turkey (n = 340). The sample included 183 nurses who were determined using the OpenEpi program and the universal sampling method. The data were collected using the Sociodemographic Information Form and the Disaster Preparedness Perception Scale in Nurses (DPPSN) and analyzed using SPSS 22 software.

RESULTS

The mean age of the participants was 34.31 + 8.52 years; 83.1% were female, 66.1% had at least a bachelor's degree and worked in a surgical ward, 49.7% had been working for at least 11 years, and 58.5% had received training on disasters. Those who received disaster-related training received it mostly face to face (70.1%) from their institutions (91.6%) and in the form of 2-4 hours of training (75.7%); 52.5% had previously participated in a disaster-related drill, and 83.1% took on the role of caregiver during a disaster. The DPPSN mean score of the nurses involved in the study was found to be 3.53 ± 0.58 out of 5 points for the total scale.

CONCLUSION

The results of the study showed that nurses considered themselves partially adequate for disaster preparedness, in general.

Iranian nurses' perceptions of core competencies required for disaster risk management

BACKGROUND

With an increase in the incidence and severity of disasters, disaster risk management receives an important priority in the health system. Nurses at all levels of healthcare play an important role in disaster risk management and they must have core preparation and competencies to respond to disasters. This study aimed to evaluate Iranian nurses' core competencies required for disaster risk management.

METHODS

This cross-sectional study was conducted on 277 nurses working in three hospitals affiliated to Kerman University of Medical Sciences in 2022. The demographic information questionnaire and the nurses' perceptions of disaster core competencies scale (NPDCC) were used to collect data, and SPSS21 was used to analyze data.

RESULTS

Nurses' competencies in disaster risk management were favorable (3.67 ± 0.77), with the subscales of technical skills and special diagnostic skills receiving the highest (3.91 ± 0.65) and the lowest mean scores, respectively (3.46 ± 0.87). The results found a significant difference between the scores of nurses' competencies in disaster risk management in terms of education level, age, work experience, employment status, participation in training courses related to disaster risk management, work experience in incidents and disasters.

CONCLUSION

The study results suggested nurses' high level of competency in disaster risk management, but indicated gaps in their core competencies. The study results recommend authorities provide various training courses related to disaster risk management for all nurses.

Disaster Training for Nurses in Indonesia: Balancing Physical, Psychological, and Managerial Competencies

BACKGROUND

Indonesian nurses receive training for disasters when they take an undergraduate nursing program at the university, but there have been variations in the curriculum. Moreover, there is still limited informal training available specifically for disaster nursing. Therefore, needs assessments are necessary to identify the gap between Indonesian disaster nurses' existing and expected competencies. This study was conducted to identify competencies needed by disaster nurses.

METHOD

A descriptive qualitative approach was used in this study. Data were collected from August to September 2019 from three areas in Indonesia: Yogyakarta, Lombok, and Jakarta. These areas frequently experience natural disasters, such as volcanic eruptions, earthquakes, and floods. Thirty-two nurses were interviewed. Data were analyzed with a descriptive qualitative approach.

RESULTS

The study highlighted three main competencies needed by Indonesian nurses, which are physical, psychological, and managerial.

CONCLUSION

Training for disaster nurses needs to balance the achievement of competencies related to physical, psychological, and managerial needs. [J Contin Educ Nurs. 2023;54(8):378-384.].

Are Nurses Ready for a Disaster in Turkey? A Hospital Case

OBJECTIVE

In Turkey, which is a land of disasters, it is vital for nurses to be prepared before a disaster, and to exhibit an effective attitude and behavior during it. Having a large number of casualties during a disaster may cause inadequacies in receiving basic health care in the hospital.

METHODS

This study was conducted in a descriptive and cross-sectional style to determine the disaster preparedness and preparedness perceptions of nurses. Data were collected with the Personal Information Form and Nurses' Perception of Disaster Preparedness Scale (NPDPS).

RESULTS

Nurses' disaster experience, drill experience, and perusal of the disaster plan positively affected the perception of disaster. The disaster preparedness of the institution positively affected the perception of disaster preparation. A significant difference was determined between the requests for information regarding disaster education and NPDPS. A statistically significant relationship was found between terrorist attacks, earthquake exposure, and the total scale score of NPDPS.

CONCLUSIONS

Consequently, nurses and health institutions, whose responsibilities become graver in disasters, have duties such as providing treatment and medical support. Therefore, it was suggested that disaster nursing and disaster management should have been included in the in-service training of nurses.

Disaster preparedness knowledge and its relationship with triage decision-making among hospital and pre-hospital emergency nurses - Ardabil, Iran

Background

Hospital and pre-hospital emergency nurses are at the forefront of disaster response. Disaster incidents continue to pose a threat to healthcare systems by exposing them to an overwhelming surge of patients.

Methods

This descriptive cross-sectional study was performed on 472 hospital and pre-hospital emergency nurses in Ardabil province, in the northwest Iran, from March to April 2021, were recruited by convenience sampling method. Data were collected using valid and reliable self-reported questionnaires, including the Emergency Preparedness Information questionnaire (EPIQ) and Triage Decision-making Inventory (TDMI). Data were analyzed using SPSS (Version 22) software using descriptive statistics, Pearson correlation coefficient test, t-test, ANOVA test, and multiple linear regression analysis.

Results

Emergency nurses’ disaster preparedness knowledge was low according to the mean score of total disaster preparedness knowledge. Furthermore, multiple linear regression analysis showed triage decision-making, age, residence, disaster preparedness training, working on duty during a disaster, and training organization variables were predictors of disaster preparedness knowledge in hospital and pre-hospital emergency nurses (p < 0.05).

Conclusion

Emergency nurses who have higher disaster preparedness knowledge have higher triage decision-making skills. It is suggested that the managers of educational and medical centres and professional organizations provide favourable conditions for training and increasing disaster preparedness of emergency nurses according to their age and residence.

Familiarity with emergency preparedness and its predictors among nurses and physicians working at public hospitals in east Gojjam zone, northwest Ethiopia

Objective:

Emergency preparedness and response operations for all types of catastrophes rely heavily on healthcare facilities and their staff. On the other hand, hospital employees suffer significant gaps in emergency preparedness knowledge and skills when it comes to treating mass casualties. The objective of this study was to assess the nurses’ and physicians’ familiarity with emergency preparedness and identify the associated factors.

Methods:

A facility-based cross-sectional survey was conducted by census utilizing a self-administered questionnaire among all nurses and physicians working in emergency departments in East Gojjam zone public hospitals. The collected data were entered into Epi-data version 4.2 and exported to SPSS 25.0 for further analysis. Frequency, mean, and standard deviation were computed to describe individual and other characteristics of the sample. A simple and multiple linear regression model was fitted to identify factors associated with familiarity with emergency preparedness. An unstandardized adjusted beta (β) coefficient with a 95 % confidence level was used to report the result of the association at a p-value of 0.05 statistical significance.

Results:

In this study, a total of 237 individuals completed the questionnaire, yielding a response rate of 94 %. The mean score of familiarity with emergency preparedness was 106.1 ± 31.8 (95% CI: 102, 110.1), with approximately 52.3 % scoring higher than the mean score. Self-regulation (B = 3.8, 95% CI: 2.6, 5), health care climate (B = 1.4, 95% CI: 0.4, 2.43) and participation in actual major disaster event (B = 15.5, 95% CI: 7.8, 23.2) were significant predictors of familiarity.

Conclusion:

According to the findings of this study, nurses’ and physicians’ expertise in emergency and disaster preparedness is inadequate. Previous engagement in actual disaster events, self-regulation, and the healthcare climate were significant predictors of familiarity. As a result, the responsible stakeholders should develop strategy to enhance self-regulation (motivation), job satisfaction of emergency department employees, and drills and hands-on training in mass casualty management.

Do Contextual and Demographic Factors Help Malaysian Nurses Prepare in Dealing with the COVID-19 Pandemic?

As of 11 October 2020, Sabah comprised a quarter of all COVID19 cases reported in Malaysia since the start of the pandemic last January 2020. In this pandemic, nurses serve in vital roles to mitigate the effects of COVID-19. This study aims to explore the nurses’ preparedness in managing the COVID-19 outbreak situation in Sabah, Malaysia, examining the contextual (e.g., participated in an actual major disaster event) and demographic factors (e.g., age and working experience that may influence nurses’ preparedness for managing the COVID-19 pandemic). A total of 317 nurses in Sabah, Malaysia were involved in this study. The Emergency Preparedness Information Questionnaire (EPIQ) contained 41 items and was used to assess civilian nurses’ perceived familiarity with 9 competency dimensions of preparedness. The mean scores of nurses’ preparedness indicated a moderate level of nurses’ preparedness in managing the COVID-19 pandemic (mean ranging from 2.89 to 3.79). The results indicated that there was a significant difference between the nurses who actively participate in an actual major disaster event and who were not active in a total of preparedness and all dimensions (t = 2.79, df = 285, p = 0.006) (except in familiarity with decontamination and familiarity with special populations), across working experience (F(2,291) = 5.09, p = 0.007) (except familiarity with Incident Command System and role), and age among nurses ((F(3,290) = 2.68, p = 0.047)) (total of preparedness, familiarity with ethical issues in triage, epidemiology, and surveillance, and psychological issues). Overall, this study has made a significant theoretical contribution, as well as in clinical implications in the field of nursing practice, by addressing the impact of contextual and demographic factors on nurses’ preparedness in managing the COVID-19 outbreak situation. This study will help nurses to understand the skills, abilities, knowledge, and actions needed to respond, mitigate, and prepare for emergencies during pandemics and disasters.

Mental health nurses' disaster nursing competencies: A cross-sectional study

The unprecedented and prolonged coronavirus disease 2019 (COVID-19) pandemic has escalated the gravity of disasters in the field of mental health. Nurses are health care providers who play a pivotal role in all phases of disaster management and psychiatric nurses are required to be prepared and equipped with competencies to respond to such disasters. This cross-sectional study aimed to investigate the effects of mental health nurses' professional quality of life on disaster nursing competencies. This study adhered to the STROBE checklist for observational research. Data were collected from 196 mental health nurses working in various settings, including hospitals and communities in South Korea. Compassion satisfaction and compassion fatigue were measured using the Korean version of the Professional Quality of Life Scale. Disaster nursing competencies were measured using the Disaster Nursing Preparedness-Response Competencies Scale. Multiple regression analysis showed that compassion satisfaction (β = 0.36, P < 0.001) was the most potent predictor of disaster nursing competencies of mental health nurses, followed by participation in disaster nursing (β = 0.15, P = 0.023) and disaster nursing-related education (β = 0.15, P = 0.026); these factors explained 30.1% of the variance. Education programmes ensuring that mental health nurses are adequately prepared for disaster management should include theoretical content as well as simulation training using virtual situations that resemble actual disasters. Further, supportive leadership and work environments that encourage cohesive teamwork are needed to increase compassion satisfaction of nurses.

Nurses' disaster core competencies and resilience during the COVID-19 pandemic: A cross-sectional study from Turkey

AIM

Determining nurses' disaster core competency levels, comparing them based on characteristics, and examining the relationships with psychological resilience.

BACKGROUND

Since nurses constitute a critical part in the healthcare services, it is important to understand the competencies and effective factors in their disaster preparedness.

METHOD

The data were collected from 489 nurses between January and February 2021 with an introductory information form, Nurses' Perceptions of Disaster Core Competencies Scale, and Connor-Davidson Resilience Scale.

RESULTS

Nurses' level of disaster core competencies was above the average, and it is positively correlated with their psychological resilience. Nurses' disaster experiences made higher significant differences on their disaster core competencies rather than their personal and professional characteristics.

CONCLUSIONS

It is important to provide disaster training and drills to all nurses on a regular basis. However, under disaster conditions, resilience should also be taken into account and included in the preparation plans for nurses to apply their professional competencies and qualifications. Implications for nursing management Nurse managers should play a leadership role in planning disaster preparedness training for nurses, and these trainings should be addressed to cover both professional competencies and resilience for nurses to respond effectively to disasters.

Disaster preparedness and core competencies among emergency nurses: A cross-sectional study

Aim

With the rise in frequency and severity of disasters in recent decades, it is essentially important that nurses must be adequately prepared to handle them. This study was aimed to evaluate the levels of disaster core competencies and preparedness of nurses in the emergency department.

Design

A cross‐sectional survey design was used.

Methods

This cross‐sectional research was conducted from August 2020 to December 2020 among 271 nurses in the emergency departments of six hospitals in Qazvin, Iran. The participants completed the “Nurses Perceptions of Disaster Core Competencies Scale” (NPDCC) (45 items) and the disaster preparedness (a single‐item visual scale). Data were analysed by one‐way analysis of variance, independent t‐tests and multiple linear regression analysis.

Results

The mean scores of disaster preparedness and core competencies of nurses were 6.75 out of 10 (SD = 1.63) and 2.88 out of 5 (SD = 0.80), respectively. "Technical skills" (mean = 3.24, SD = 0.91) were the highest and "communication skills" (mean = 2.57, SD = 0.95) were the lowest across the subscales of the scale. A significant association was found between disaster core competencies and preparedness of nurses (p < .001). Regression analysis results indicated that nursing disaster core competencies were perceived betted by older nurses (B = −0.405) who had experience in the disaster stage (B = 0.228) and nurses with disaster response experience (B = 0.223) and lower professional experience (B = 0.309). Nurses with a postdiploma degree (B = −0.480) and bachelor's degree (B = −0.416) were perceived to have lower disaster core competency than nurses with a master's or PhD degree.

Conclusion

There are still gaps in disaster preparedness and core competencies for emergency nurses that need to be addressed. Nursing managers must support an improvement in nursing disaster core competencies. This may be done by conducting sessions for routine disaster scenarios and providing formal disaster preparedness training.

Factors affecting nurses' ability to provide effective care in a disaster response: a review

Disasters cause death, trauma, and psychological distress. Comprising the largest number of healthcare workers, nurses play a crucial role in reducing the impact of a disaster. The objective of this review is to identify the factors that influence nurses’ ability during a disaster emergency response to provide adequate care. This research was conducted by doing a literature search from the Pro-Quest and Science-Direct databases using the PRISMA-ScR to screen the articles. The final results included 13 articles. An analysis was performed to identify themes in line with the purpose of the review. All factors affecting nurses’ ability to respond to a disaster situation were classified into three themes: 1) factors increasing nurses’ ability, 2) barriers to delivering effective nursing care, and 3) support needed to maintain the nurses’ ability. During an emergency situation due to a disaster, adequate knowledge and skill to save lives, treat injuries, manage stress and coordinate between teams are the basic competencies needed for optimal care. Nurses’ clinical experience or previous disaster experience and training could increase nurses’ adaptability in disaster conditions. Support from nurses’ workplace and proper implementation of disaster management policy enhance nurses’ services and prevent barrier under disaster condition. The results emphasize that future training should aim for improving nurses’ knowledge and skills, including the knowledge of nurses’ family to protect themselves and deal with disasters. Such knowledge increased family preparedness, which is an important factor to enhance nurses’ willingness to work following a disaster.

Nurses' knowledge, skills and preparedness for disaster management of a Megapolis: Implications for nursing disaster education

As frontline health caregivers, nurses must be adequately prepared to respond effectively to disasters. Therefore, it is necessary to assess nurses' disaster management capacity to know their preparedness levels, especially for a densely populated Megapolis like Dhaka, which is at high risk of disasters. Thus, the study aimed to examine Dhaka city nurses' knowledge, skills, preparedness (KSP) for disasters and explore the factors influencing the KSP levels. A self-explanatory descriptive survey questionnaire was developed adopting the Disaster Preparedness Evaluation Tool (DPET) in Bangla language for quantitative data collection. Following multistage sampling, 410 nurses' data were collected from eight hospitals in Dhaka city. The nurses in Dhaka city had moderate levels of knowledge, skills, and preparedness for disaster management, reflecting that they need more development to deal with disasters effectively. Moreover, multiple linear regression analyses indicate that nurses' disaster knowledge, skills, and preparedness scores were significantly positively associated with training on disaster management (p < 0.001) and disaster response experience (p < 0.001). In addition, one-half of the respondents demanded more drills and exercises on disaster management in their workplaces to enhance their disaster skills and preparedness. Furthermore, disaster education should be incorporated into the nursing curriculum, which would play a seminal role in preparing them for future disaster management.

Emergency healthcare workers' preparedness for disaster management: An integrative review

BACKGROUND

Around 2 billion people globally were affected by natural disasters between 2008-2018. The World Health Organization requires countries and governments to have disaster plans and emergency health workers ready and prepared at all times.

OBJECTIVES

To conduct an integrative review of literature of emergency healthcare workers' perceived preparedness for disaster management.

METHODOLOGY

An integrative literature review using the PRISMA checklist guidelines was conducted to explore physicians, nurses, emergency medical services and allied medical professionals' preparedness for disasters. Literature was searched from 2005, published in the English language and from MEDLINE (PubMed), Google Scholar, EMBASE, PsycINFO, SCOPUS, ProQuest and CINAHL databases. Reviews, case reports, clinical audits, editorials and short communications were excluded. Studies were critically appraised using the Mixed Methods Appraisal Tool.

RESULTS

The initial search yielded 9589 articles. Twenty-seven articles were included following application of the eligibility criteria. Included studies were geographically diverse including North America, the Middle East and the Asia Pacific. Most studies (n = 24) assessed the knowledge of healthcare workers in general disasters. Studies using the Disaster Preparedness Evaluation Tool reported moderate disaster preparedness and knowledge, while studies using other instruments largely reported inadequate disaster preparedness and knowledge. Regional variations were recorded, with high-income countries' reporting a higher perceived preparedness for disasters than low-income countries.

CONCLUSION

The majority of the emergency healthcare workers appear to have inadequate disaster preparedness. Previous disaster experience and training improved disaster preparedness. Future research should focus on interventions to improve emergency healthcare workers preparedness for disasters.

Educational needs and disaster response readiness: A cross-sectional study of clinical nurses

AIM

To analyse clinical nurses' educational needs and disaster response readiness and the factors influencing their disaster response readiness.

DESIGN

This was a cross-sectional study.

METHODS

A convenience sample comprising 260 nurses with more than a year of working experience at a hospital in Korea was selected from 1-31 August 2019. Data on nurses' educational needs and disaster response readiness were collected from participants. A multiple regression model was used to examine the factors influencing disaster response readiness among nurses.

RESULTS

Factors influencing personal readiness were number of years of clinical experience, being female, working in a medical ward, and educational needs for disaster response. Factors influencing self-protection were working in a medical ward and working in the emergency room. Factors influencing the emergency response were working in a medical ward and working in the emergency room. Factors influencing clinical management were a graduate-level education or higher, working in a medical ward, working in the emergency room, working in the paediatric ward, experience receiving disaster-related education, and educational needs for disaster response.

CONCLUSION

It is essential to be aware of the educational needs and disaster readiness of hospital clinical nurses, to develop their capacity to respond such situations. In addition, to improve the disaster competency of nurses, it is necessary to develop an education programme that considers the factors influencing disaster response readiness in this study.

IMPACT

Nurses must have the knowledge and skills to respond to a disaster. Nurse educators should help nurses strengthen their disaster-related knowledge, skills, and judgment. Hospital administrators should encourage nurse educators to provide disaster-related training and simulation-based education to increase nurses' disaster competency to act during disasters.

Expectations of survivors towards disaster nurses in Indonesia: A qualitative study

Objective

This study aims to explore the expectations of survivors towards disaster nurses.

Methods

The study used qualitative content analysis. Data were collected in 2017 through three focus group discussions with 21 survivors and in-depth interviews with three community leaders; the respondents had experienced one of the following events: a) an earthquake in Padang 2009, b) a volcanic eruption in Yogyakarta 2010, and c) flooding in Jakarta 2014.

Results

Four themes represented survivors' expectations of what nurses can do in responding to a disaster, including: a) provision of direct nursing care, b) provision of information of health service access, c) provision of resources through cross-sector coordination, and d) disaster preparedness activities for the community.

Conclusions

This study suggests the importance of disaster nurses having the competency to update information regarding healthcare access, particularly the utilization of health insurance and providing culturally competent care to the survivors. Disaster nurses are also expected to be able to train the community and families about preparedness-related activities. Besides, these disaster nurses should improve their competency in disaster risk reduction. More broadly, such nurses should have the ability to advocate and coordinate with the local government and other stakeholders regarding access to healthcare services and continuous rapid assessment, so that survivors receive immediate and appropriate treatment.

Nurses' disaster preparedness and core competencies in Turkey: a descriptive correlational design

AIM

This descriptive correlational study aimed to identify nurses' perceptions of their own disaster preparedness and core competencies.

BACKGROUND

As disasters have increased in number and severity in recent years, it is crucial that nurses should be appropriately prepared. There is still limited research on this issue in Turkey.

INTRODUCTION

With changes in disaster policies in the last decade, the need to improve the disaster core competencies of nurses has also increased.

METHODS

A sample of 406 nurses selected with convenience sampling and working in an 1816-bed capacity university hospital was included in this descriptive correlational study. A single-item visual scale and the 45-item Nurses Perceptions of Disaster Core Competencies Scale were used.

RESULTS

'Technical Skills' scored highest across the subscales of the scale, and 'Critical Thinking Skills' scored lowest. When the total and subscale scores were compared by age group, professional experience, working position and prior disaster experience, there were statistically significant differences.

CONCLUSIONS

The Turkish nurses had different levels of disaster core competencies and considered themselves more competent in some areas of disaster preparedness than in others. There are clearly gaps to be filled in disaster preparedness and core competencies in Turkish nurses.

IMPLICATIONS FOR NURSING AND POLICY

Nurse managers should advocate for increasing disaster preparedness for all nurses. This could be accomplished by offering formal training in disaster preparedness and/or by scheduling regular disaster drills, perhaps using a mix of tabletop exercises with occasional hospital-wide disaster scenarios. In addition, managers should regularly evaluate nurses' disaster core competencies to achieve effective preparation plans and training.