Emergency Response: A Cross-sectional Study of Core Competencies for Nurses Regarding Major Infectious Disease Outbreaks

Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: Randomized Controlled Trial

BACKGROUND

During infectious disease outbreaks such as the COVID-19 pandemic, nurses are crucial in patient care and public health safety; however, they face challenges such as inadequate training and high stress in isolation wards. Virtual reality (VR) technology offers innovative training solutions to enhance nurses' clinical skills and preparedness. However, extensive studies on its effectiveness in isolation ward environments are still limited.

OBJECTIVE

This study aims to develop a nonimmersive VR (NIVR) simulation training program for isolation wards and further validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings.

METHODS

This study was a prospective, parallel, open-label, randomized controlled trial. A total of 90 nurses from 3 hospitals in China were randomly assigned to either the control or intervention group, with 45 (50%) individuals in each group. Both groups received training on isolation ward layout and nursing procedures. The control group underwent a 4-hour conventional training session consisting of 2 hours of face-to-face lectures and 2 hours of ward visits. The intervention group received a 4-hour NIVR simulation training session. Subsequently, both groups completed approximately 4 hours of emergency drills and assessments.

RESULTS

After the intervention, there were no significant differences in theoretical test or performance assessment scores between the 2 groups (t88=-0.30, P=.75; Cohen d=-0.06; z score=0.00, P>.99), using a 2-tailed t test. However, the intervention group completed 6 tasks faster than the control group (t88=5.10, P<.001; Cohen d=1.08), with an average reduction of about 3 minutes (control group: mean 43.91, SD 2.99 min; intervention group: mean 40.77, SD 2.85 min). Notably, they completed task 3 (patient reception inward) and task 6 (exiting the isolation area) significantly quicker (t88=3.22, P=.002; Cohen d=0.68; t88=3.03, P=.003; Cohen d=0.64, respectively), with no significant differences for the other tasks.

CONCLUSIONS

This study highlights the potential of NIVR simulation training for nurses working in isolation wards. Although NIVR simulation training does not significantly surpass traditional methods in imparting theoretical knowledge, it does reduce task completion time for specific activities. Its capacity for safe, repetitive practice and realistic scenario simulation makes NIVR a valuable tool in medical education. Further research and optimization of VR simulation training programs are recommended to enhance nurses' practical skills and pandemic preparedness.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR240083155; https://www.chictr.org.cn/hvshowproject.html?id=250356&v=1.0.

Construction of an Index System of the Biosafety Incident Response Capability for Nursing Staff: A Delphi Study

AIM

This study was to establish a scientific and sensitive index system of the biosafety incident response competence for clinical nursing staff to provide a reference for the evaluation of nurses' biosafety incident response competence.

DESIGN

A modified recommendation for the conducting and reporting of Delphi studies was used to guide this study.

METHODS

According to the literature review, preliminary biosafety incident response competence indicators for nursing staff were established, and an expert survey questionnaire was designed. The evaluation system for clinical nurses' biosafety incident response competence indicators was determined using the Delphi method.

RESULTS

After two-round Delphi survey, 28 nursing specialists from six provinces and cities around China, with expertise in three prevention research, epidemiology, military health service and biosafety incident rescue, established the index system of the biosafety incident response competence for nursing staff from April to May 2023. The final index system of the biosafety incident response competence was composed of four primary indicators, namely, biosafety incident preparedness, monitoring competence, protection ability and nursing disposal abilities; 10 secondary indicators and 49 tertiary indicators. The effective recovery rates of the two rounds of expert survey questionnaires were 93.33% and 100%, respectively. The authority coefficient, judgement coefficient and familiarity degree of Delphi experts were 0.877, 0.911 and 0.843, respectively. The Kendall's harmony coefficients of the two rounds of expert consultation were 0.301-0.384 and 0.401-0.424, respectively, with statistical significance (p < 0.05).

CONCLUSION

The index system of the biosafety incident response competence for nursing staff is scientific and reliable. The authors have provided a more reliable and comprehensive basis for evaluating nurses' biosafety incident response competence in the future.

CONCLUSION AND IMPLICATIONS FOR NURSING

It is helpful for nursing staff to perform better in biosafety incident by clarifying the specific items of biosafety response competence. Nursing staff can use the index system as the evaluation tool and training references to enhance their biosafety incident response competence.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Competence and Training Needs in Infectious Disease Emergency Response Among Chinese Nurses: Cross-Sectional Study

Background

In recent years, the frequent outbreaks of infectious diseases and insufficient emergency response capabilities, particularly issues exposed during the COVID-19 pandemic, have underscored the critical role of nurses in addressing public health crises. It is currently necessary to investigate the emergency preparedness of nursing personnel following the COVID-19 pandemic completely liberalized, aiming to identify weaknesses and optimize response strategies.

Objective

This study aimed to assess the emergency response competence of nurses, identify their specific training needs, and explore the various elements that impact their emergency response competence.

Methods

Using a multistage stratified sampling method, 5 provinces from different geographical locations nationwide were initially randomly selected using random number tables. Subsequently, within each province, 2 tertiary hospitals, 4 secondary hospitals, and 10 primary hospitals were randomly selected for the survey. The random selection and stratification of the hospitals took into account various aspects such as geographical locations, different levels, scale, and number of nurses. This study involved 80 hospitals (including 10 tertiary hospitals, 20 secondary hospitals, and 50 primary hospitals), where nurses from different departments, specialties, and age groups anonymously completed a questionnaire on infectious disease emergency response capabilities.

Results

This study involved 2055 participants representing various health care institutions. The nurses' mean score in infectious disease emergency response competence was 141.75 (SD 20.09), indicating a moderate to above-average level. Nearly one-fifth (n=397, 19.32%) of nurses have experience in responding to infectious disease emergencies; however, they acknowledge a lack of insufficient drills (n=615,29.93%) and training (n=502,24.43%). Notably, 1874 (91.19%) nurses expressed a willingness to undergo further training. Multiple linear regression analysis indicated that significant factors affecting infectious disease emergency response competence included the highest degree, frequency of drills and training, and the willingness to undertake further training (B=-11.455, 7.344, 11.639, 14.432, 10.255, 7.364, and -11.216; all P<.05). Notably, a higher frequency of participation in drills and training sessions correlated with better outcomes (P<.001 or P<.05). Nurses holding a master degree or higher demonstrated significantly lower competence scores in responding to infectious diseases compared with nurses with a diploma or associate degree (P=.001). Approximately 1644 (80%) of the nurses preferred training lasting from 3 days to 1 week, with scenario simulations and emergency drills considered the most popular training methods.

Conclusions

These findings highlight the potential and need for nurses with infectious disease emergency response competence. Frequent drills and training will significantly enhance response competence; however, a lack of practical experience in higher education may have a negative impact on emergency performance. The study emphasizes the critical need for personalized training to boost nurses' abilities, especially through short-term, intensive methods and simulation drills. Further training and tailored plans are essential to improve nurses' overall proficiency and ensure effective responses to infectious disease emergencies.

Knowledge, attitudes, and practices toward bioterrorism preparedness among nurses: a cross-sectional study

BACKGROUND

Bioterrorism is an important topic in the field of biosecurity. Nurses, the largest group of healthcare workers, play a critical role in addressing the threat of bioterrorism. This study aimed to examine the present level of bioterrorism knowledge, attitudes, and practices among nurses. It also explored the relationships among bioterrorism knowledge, attitudes, and practices, as well as demographic variables that influence the scores of each dimension.

METHODS

A descriptive correlational research design was conducted using a convenience sample of 429 nurses in five tertiary general hospitals in Tianjin. Registered nurses with six months or more of work experience, currently still working in hospitals, and volunteering to participate in the study are included; otherwise, they are excluded. A structured questionnaire with four components was used: sociodemographic characteristics, knowledge of bioterrorism, attitudes toward bioterrorism, and practices related to bioterrorism. The acquired data were analyzed using the Mann‒Whitney test, Kruskal‒Wallis test, Spearman correlation analysis, and multiple linear regression. This study followed the STROBE guidelines.

RESULTS

The study ultimately included 429 valid surveys. The mean score for bioterrorism knowledge was satisfactory (33.06 ± 4.87), the mean score for bioterrorism attitudes was good (23.83 ± 5.23), and the mean score for bioterrorism practices was poor (10.94 ± 6.51). There was a significant negative correlation between bioterrorism knowledge and attitudes (r=-0.38, p < 0.01), knowledge and practices (r=-0.42, p < 0.01). Bioterrorism practices were significantly positively correlated with attitudes (r = 0.21, p < 0.01). Educational level (β = 0.17, p < 0.001), years of experience (β = 0.26, p < 0.001), and previous bioterrorism education (β = 0.19, p < 0.001) influenced the bioterrorism knowledge score. Gender (β=-0.21, p < 0.001), educational level (β = 0.10, p < 0.05), and previous bioterrorism education (β = 0.22, p < 0.001) affected the bioterrorism attitude score. Years of experience (β=-0.28, p < 0.001) and previous bioterrorism education (β = 0.13, p < 0.01) had an impact on the practice score.

CONCLUSIONS

Knowledge of bioterrorism was significantly negatively correlated with attitudes and practices, which could be attributed to the specificity of bioterrorism itself. To improve nurses' bioterrorism preparedness, continuing medical education efforts must be strengthened, as well as regular delivery of bioterrorism-specific training and drills.

Assessing self-reported public health emergency competencies for civil aviation personnel in China: a pilot study

INTRODUCTION

COVID-19 has demonstrated the importance of competent staff with expertise in public health emergency preparedness and response in the civil aviation system. The civil aviation system is a critical sentinel and checkpoint to prevent imported cases and slow the spread of communicable diseases. Understanding the current competencies of staff to deal with public health emergencies will help government agencies develop targeted training and evidence-based policies to improve their public health preparedness and response capabilities.

METHODS

This cross-sectional pilot study was conducted from November 2022 to October 2023, involving 118 staff members from various positions within China's civil aviation system. A 59-item questionnaire was translated and developed according to a competency profile. Data were collected using the self-report questionnaire to measure the workforce's self-perceptions of knowledge and skills associated with public health emergency proficiency, categorized into (1) general competency, (2) preparedness competency, (3) response competency, and (4) recovery competency. KMO & Bartlett test and Cronbach's α reliability analysis were used to test the reliability and validity of the questionnaire. Descriptive statistics, independent sample T-test, ANOVA, and linear regression models were performed to analyze the competencies.

RESULTS

A total of 107 staff members from the aviation system were surveyed in this study. The KMO & Bartlett test, (KMO = 0.919, P < 0.001) and Cronbach's α coefficients (α = 0.985) for this questionnaire were acceptable. The results suggested that respondents scored a mean of 6.48 out of 9 for the single question. However, the staff needed to acquire more knowledge in investigating epidemic information (5.92) and case managing (5.91) in the response stage. Overall, males scored higher (409.05 ± 81.39) than females (367.99 ± 84.97), with scores in the medical department (445.67 ± 72.01) higher than management (387.00 ± 70.87) and general department (362.32 ± 86.93). Additionally, those with completely subjective evaluation (425.79 ± 88.10) scored higher than the general group (374.39 ± 79.91). To predict the total score, female medical workers were more likely to have lower scores (β = -34.5, P = 0.041). Compared with those in the medical department, the management workers (β = -65.54, P = 0.008) and general workers (β = -78.06, P < 0.001) were associated with a lower total score.

CONCLUSIONS

There was still a gap between the public health emergency competencies of the civil aviation system and the demand. Staff in China's civil aviation systems demonstrated overall competence in public health emergency preparedness and response. However, there was a need to enhance the accumulation of practical experience. Implementing effective training programs for public health emergencies was recommended to mitigate knowledge gaps. Meanwhile, regular training evaluations were also recommended to give comprehensive feedback on the value of the training programs.

Competency in responding to infectious disease outbreaks among nurses in primary healthcare institutions: a quantitative, cross-sectional multicentre study

Background

Nurses' competencies are crucial for infectious disease prevention and control. We aimed to investigate competencies in responding to infectious disease outbreaks of nurses in primary healthcare institutions and identify their training needs.

Methods

A cross-sectional study was conducted from June to September 2022, recruiting nurses from primary healthcare institutions across Sichuan Province. Their competencies and training needs were assessed using a modified Emergency Response Competency Scale for Infectious Diseases. Additionally, their sociodemographic characteristics and experience in infectious disease outbreak trainings were collected. Univariate analyses were used to compare competencies and training needs by participant characteristics. Multiple linear regression was conducted to identify determinants of their competencies.

Results

A total of 1,439 nurses from 44 primary healthcare institutions participated in this study. The overall competency and training needs had a median of 3.6 (IQR [3.1, 4.0]) and 4.0 (IQR [3.9, 4.7]), respectively. Age (β = -0.074, p = 0.005), experience in higher authority hospitals (β = 0.057, p = 0.035), infectious disease outbreak trainings attended within the last 5 years (β = 0.212, p < 0.001), and regions where the institutions located were determinants of the competencies.

Conclusion

The competencies in responding to infectious disease outbreaks among nurses in primary healthcare institutions were at a moderate level, influenced by varied factors.

Factors affecting nurses' emergency competencies in public health emergency: A cross-sectional study based on the stress-coping adaptation model

OBJECTIVES

To investigate the factors associated with stress, resilience, coping styles, and emergency competencies when nurses are faced with a public health emergency.

DESIGN

This study used a cross-sectional design.

SAMPLE

Study data came from a survey of 646 nurses who were from a tertiary hospital in Southern China in March-June 2022.

METHODS

Participants responded to self-report questionnaires through a web-based survey. Stress, resilience, emergency competencies, and response to public emergencies were assessed using the Perceived Stress Scale, Connor-Davidson Resilience Scale, the core competencies of nurses in public health emergencies, and a simplified coping style questionnaire.

RESULTS

A total of 646 nurses participated in this study. Slightly over half of the participants were ≤30 years old, and almost all were female. Resilience, positive coping, and negative coping were positively correlated with emergency competencies. Multiple linear regression analysis demonstrated that resilience, working years, and participation in the treatment of infectious diseases were significant predictors of emergency competencies.

CONCLUSION

The findings suggest that nurses require additional training in emergency management and clinical practice to enhance their emergency competencies. More interventions and social support should be provided to improve nurses' resilience and positive coping strategies when they encounter public health emergencies.

Current Status and Factors Influencing Emergency Response Capability of Shared Nurses in the Internet + Nursing Service Model: A Descriptive Cross-Sectional Study

Aim

To evaluate the existing level of emergency capabilities among shared nurses and analyze the factors influencing these capabilities.

Methods

An descriptive cross-sectional survey was conducted from September to October 2023, a purposive sampling method was employed to select 340 shared nurses as the subjects for investigation in Nanchang and Ganzhou cities of Jiangxi Province, as well as Wenzhou city in Zhejiang Province. A self - designed questionnaire on the emergency capabilities of shared nurses was utilized for data collection.

Results

This investigation encompassed the collection of 340 valid questionnaires, assessing the overall emergency response proficiency of shared nurses. The cumulative score amounted to (170.81±24.62), averaging (4.27±0.62). It is noteworthy that the dimension scoring the highest was preparedness (4.33±0.68), whereas the recovery capability dimension received the lowest score (4.17±0.75). Through multiple linear regression analysis, it was determined that marital status, participation in emergency capability training, and experience in home nursing services significantly influenced the emergency capabilities of shared nurses (P<0.05).

Conclusion

Shared nurses in China demonstrate a moderately high level of emergency response capability. The marital status, participation in emergency capacity training, and on-site nursing service experience are pivotal factors influencing the emergency capabilities of shared nurses. Nursing administrators should prioritize the development of emergency capacity training and team building for shared nurses, establishing a scientifically standardized mechanism for training, assessment, and management. The implementation of performance evaluation mechanisms for shared nurses is crucial to enhance professional awareness within the workforce.

Effects of a mobile-based bioterrorism response program among clinical nurses: A quasi-experimental study

BACKGROUND

To respond to unstable international security and the outbreak of new infectious diseases, clinical nurses should be equipped with bioterrorism response competencies.

OBJECTIVES

This study developed a mobile-based bioterrorism response program for clinical nurses and examined its effectiveness on their knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies.

DESIGN

A quasi-experimental study design was used.

SETTING

General or tertiary general hospitals in South Korea were considered.

PARTICIPANTS

Participants were 45 clinical nurses (23 in the experimental group and 22 in the control).

METHODS

The mobile-based bioterrorism response program was conducted over three weeks in 10 sessions (total of 300 min). The knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies were compared between two groups using paired t-test, and Wilcoxon signed ranks test. Satisfaction with the program was measured in the experimental group.

RESULTS

Upon completion of the mobile-based bioterrorism response program, the experimental group showed significant increases in knowledge of bioterrorism, attitude toward bioterrorism response, and bioterrorism response competencies.

CONCLUSIONS

The mobile-based bioterrorism response program is expected to contribute to better preparedness for bioterrorism response systems in clinical practice. In addition, this program is expected to be of valuable use in bioterrorism education for nursing students as well as other healthcare professionals involved in bioterrorism response.

Common domains of nurses' competencies in public health emergencies: a scoping review

BACKGROUND

A public health emergency can cause large numbers of deaths in a short period, with devastating social, economic and health consequences. Nurses are the main healthcare providers during such emergencies, and their competencies affect the control and outcomes of the situation. Studies on nurses' competencies in public health emergencies vary between countries and healthcare systems. Therefore, we conducted a scoping review to identify the common domains of nurses' competencies in public health emergencies worldwide.

METHODS

We searched the PubMed, CINHAL, Scopus, Web of Science, Science Direct, Embase, Cochrane Library, WanFang and ECRI databases from their inception to 2023. All published articles on nurses' competencies in public health emergencies that were published in English and Chinese were included. We mainly analyzed and synthesized nurses' competencies, assessment instruments and the training described in the included studies.

RESULTS

A total of 27 competency domains were identified following an analysis and summary. The most frequently cited domains were communication skills, self-protection skills, basic knowledge of a public health emergency, laws and ethics and the capacity for organizational collaboration. The Disaster Preparedness Evaluation Tool and the Emergency Preparedness Information Questionnaire were the most commonly used tools for assessing competencies. Most training was conducted online and the content that was covered varied by country.

CONCLUSIONS

Given the significant roles and responsibilities of nurses in public health emergencies, knowing the domains of their competencies is essential to evaluating, developing, and conducting clinical training.

Predictors of bioterrorism preparedness among clinical nurses: A cross-sectional study

BACKGROUND

Bioterrorism is terrorism that causes death, injury, or illness by the intentional release of viruses, bacteria, fungi, or toxins. Bioterrorism cannot be prevented; therefore, having the ability to recognize and respond to the consequences of infection caused by biological agents is imperative. This study aimed to examine the level of bioterrorism preparedness and identify the influencing factors of bioterrorism preparedness among nurses, who are early responders to bioterrorism.

METHODS

This study had a predictive correlational study design. It surveyed 245 clinical nurses currently working in general hospitals. We used a structured questionnaire consisting of items about general characteristics, knowledge about bioterrorism, awareness of bioterrorism risk, perception of institutional bioterrorism preparedness, attitude toward bioterrorism, and bioterrorism preparedness. The collected data were analyzed using descriptive statistics and by performing a t-test, chi-square test, analysis of variance, post-hoc test, correlational analysis, and regression analysis.

RESULTS

Bioterrorism preparedness was significantly positively correlated with the perception of institutional and frontline bioterrorism preparedness and attitude toward bioterrorism. It was also significantly influenced by sex, undergraduate bioterrorism education, employee bioterrorism education, perception of governmental bioterrorism preparedness, and attitude toward bioterrorism. The greatest predictors of bioterrorism preparedness were attitude toward bioterrorism, perception of institutional bioterrorism preparedness, and undergraduate bioterrorism education, which explained 39 % of the variance of bioterrorism preparedness.

CONCLUSION

This study found that clinical nurses' awareness and attitude toward bioterrorism are important factors in their bioterrorism preparedness and that attention to and education about bioterrorism are crucial to enhance clinical nurses' bioterrorism preparedness. Continued research is needed to establish a bioterrorism response system and relevant educational programs.

Association Between Clinical Competencies and Mental Health Symptoms Among Frontline Medical Staff During the COVID-19 Outbreak: A Cross-Sectional Study

Background

In China, mental health of frontline medical staff might be influenced by clinicians' ability to handle the outbreak of coronavirus disease 2019 (COVID-19). Few studies to-date have addressed the association between clinicians' competencies and mental health in this context. This cross-sectional study was to examine the prevalence of mental health symptoms among frontline medical staff that fought against the COVID-19 outbreak, and explore the associations between their competencies, and separate and concurrent depressive and anxiety symptoms.

Methods

A total of 623 frontline medical staff was included in this study. Competencies, depressive symptoms, and anxiety symptoms were assessed using a self-reported short form of the Chinese clinical physicians' competency model, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 questionnaire, respectively. Logistic regression models were used to evaluate the associations between one SD increase in competency scores and the prevalence of mental health problems.

Results

The prevalence of depressive, anxiety, and comorbid depressive and anxiety symptoms was 40.93, 31.78, and 26.00%, respectively. Among the medical staff with higher total competency scores, the prevalence of depressive [odds ratios (ORs) = 0.67, 95% confidence intervals (CIs): 0.55-0.81], anxiety (OR = 0.68, 95% CI: 0.56-0.83), and comorbid anxiety and depressive symptoms (OR = 0.69, 95% CI: 0.55-0.83) was lower than among their lower-scoring counterparts. Subgroup analyses stratified by core competency scores revealed similar associations as the main analyses.

Conclusion

The present findings highlight the association between high core competency scores and lower prevalence of depressive, anxiety, and comorbid anxiety and depressive symptoms.