Disaster nursing involves systematic and professional care provided to communities affected by natural or man-made disasters. With limited resources in global disaster settings, nurses play a crucial role in disaster management. The aim of this study is to investigate the impact of integrating 'Disaster Nursing' into nursing curricula on nursing students' perceptions of disaster literacy and preparedness.
Methods
This quasi-experimental one-group pretest–posttest study was conducted at a public university in Izmir, Turkey. The pre-test took place on September 27, 2021, and the post-test on January 7, 2022. The study population comprised 66 nursing students enrolled in the elective "Disaster Nursing" course, with 62 volunteering for participation. Data collection tools included an individual introduction form, the Disaster Literacy Scale, and the Perception of Disaster Preparedness in Nurses Scale. The 14-week "Disaster Nursing" course served as the intervention. Data were collected online and analyzed using descriptive statistics, paired sample t-tests, and Pearson correlation.
Results
Of the students, 51.6% were aged 22–23, and 62.9% were female. Additionally, 54.8% reported previous disaster experience. The mean pre-test score on the Disaster Literacy Scale was 32.97 ± 6.47, which increased significantly to 40.58 ± 5.95 post-test (p < 0.05). The mean pre-test score on the Perception of Disaster Preparedness in Nurses Scale was 81.66 ± 4.61, rising significantly to 90.64 ± 6.25 post-test (p < 0.05). A statistically significant positive correlation was found between the total scores of the Disaster Literacy and Disaster Preparedness in Nurses scales (r = 0.79).
Conclusions
The integration of "Disaster Nursing" into nursing curricula positively enhanced the disaster literacy and preparedness perceptions of nursing students. The results demonstrated that higher levels of disaster literacy were associated with increased disaster preparedness among nurses. These findings can inform the development of educational policies for disaster nursing education in Turkey.
Hinweise
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Introduction
The number of disasters that seriously affect public health is increasing worldwide. In 2022, the Emergency Event Database EM-DAT documented 387 natural hazards, resulting in 30.704 fatalities and affecting 185 million people [1]. Turkey, situated in a seismic hotspot with numerous active faults, faces earthquake risks [2]. Turkey ranks 53rd among 119 countries with a score of 5 in the "Global Risk Management Index" 2020 report and is in the high-risk group [3]. The Turkey-Syria earthquake on February 6, 2023, impacted 11 provinces, requiring extensive emergency medical assistance. This event affected 9.1 million individuals, leading to 44.000 fatalities and 108.000 injuries [4].
Disaster nursing is systematic and professional nursing care for communities affected by natural and/or man-made disasters [5]. Since Florence Nightingale, nurses have assumed many roles in disaster management [6]. Working with limited resources in disasters occurring worldwide, nurses play a vital role in disaster management [7, 8]. Nurses are obliged to take part not only in the intervention phase of disasters, but also in every phase, including preparation, to save the lives of disaster victims, and to protect their physical and psychological health [9]. According to the 2020 statistical data of the Ministry of Health of the Republic of Turkey, 156.205 nurses are employed within the Ministry of Health, 35.014 in university hospitals and 36.073 in private hospitals [10]. According to the 2023 vision of Human Resources in Health, the need for nurses in 2023 has been determined as approximately 315.017 [11]. In this case, the number of nurses per 1.000 people in 2023 is 3.7. In a study conducted in Turkey, it was reported that 13.005 students were registered in 2020 and the current number of students was 54.397 [12]. Providing quality and timely health services is of great importance. Nurses, who interact with patients and provide services at many stages to provide quality service, have great responsibilities. A good level of service satisfaction and the existence of quality service depend on nursing services in many ways. Undergraduate education has a great impact on providing quality nursing services [13].
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Care in a disaster environment is different from daily nursing care and nurses have special needs during a disaster. In a study conducted with university students in China, 88.64% of the participants obtained disaster information from TV or the Internet and only 12.89% stated that relevant courses were given in their departments [14]. In one Turkish study, 68.9% of the participants reported that they followed news about disasters. The source of disaster information for nursing students should be evidence-based and curriculum-integrated courses [15, 16].
Disaster nursing has become a specialized area of nursing in many countries with high disaster risk, such as Japan, the United States, China, the United Kingdom, and Italy [17]. The level of educational preparedness of undergraduate nursing students varies across countries and even among universities within the same country. In most cases, disaster-related content is not a mandatory component of undergraduate nursing curricula [18]. However, disaster nursing education is rarely provided in universities at undergraduate level and there is a lack of curriculum in many countries [19‐22]. While the importance of educating nurses in the basics of disaster care is acknowledged and significant progress has been made, nursing curricula in the United States largely remain insufficient [23]. In Turkey, a study conducted with 206 universities affiliated with the Higher Education Council (2020) found that 58.7% offer a nursing program, but only 32.2% of these institutions include a course on disaster education. Among the reviewed curricula, 38.5% of the courses are titled "Nursing and First Aid in Disasters," while 53.8% offer it as an elective course consisting of two hours of theoretical instruction per week. Additionally, it was possible to access course content for 53.8% of the examined programs [24]. These findings align with a survey of Australian undergraduate nursing curricula, which revealed significant variation in the amount and type of disaster-related content across universities [25]. Of the 19 Australian nursing schools surveyed, only seven included disaster-related content, with most embedding it within existing courses rather than offering it as a standalone unit [26]. Inclusion of disaster nursing in the nursing curriculum will be an important gain [19]. It appears that there is no global standard for the practice of disaster nursing. In a Turkish study, it was observed that approximately one-third of nursing undergraduate programs included a disaster-related course, typically structured as a 2-h per week, 2-ECTS, theoretical elective [24]. In contrast, Iranian nursing programs currently offer disaster, emergency, and related units as part of a curriculum that includes 1.5 credits of combined theoretical and practical instruction, along with a 2-credit internship component [27].
Despite the existence of national nursing education program standards for undergraduate nursing curricula in Turkey since 2014 (HUCEP, 2014), which set minimum requirements for accreditation and educational programs, the disaster nursing course provided in universities is often insufficient [28]. The disaster nursing workshops offered post-university typically cover only basic intervention topics [5, 29]. If nurses are unable to effectively fulfill their role in providing care to those affected by disasters, it can result in unmet care needs and poorer health outcomes for victims [30, 31]. In a study conducted with Turkish and Japanese nursing students, it was reported that nursing students in both countries felt inadequate about disasters [20]. Studies conducted in Turkey draw attention to the need for knowledge/accumulation and training in disaster nursing for both nursing students and graduate nurses [20, 32, 33]. On the other hand, universities have some flexibility in determining the design of their curricula, including the order and form of content delivery [28]. Similarly, in Australia, national accreditation standards for undergraduate nursing curricula have existed since 2009, setting minimum requirements while allowing for flexibility in incorporating additional content, including disaster-related topics [34, 35]. Nurse educators should address the need for disaster nursing education for undergraduate, graduate, and advanced practice nursing groups by organizing the curriculum accordingly [36].
Disaster literacy is the ability to understand and use information about disasters to make informed decisions about disaster preparedness, response, and recovery [37]. In other words, the scope of disaster literacy is to make society resilient to disasters [38]. Improving disaster literacy is an essential need to reduce the humanitarian consequences and economic costs of disasters [39]. Disaster education designed to help individuals recognize and prepare for disasters in their environment is an important resource for improving disaster literacy and resilience at the societal or personal level [40]. For these reasons, all stakeholders are called upon to develop and implement disaster literacy programs for all ages, make disaster information accessible in multiple languages, work with communities to address cultural barriers to disaster preparedness and response, and promote disaster literacy as an essential component of emergency management [39]. Different studies have reported that disaster literacy can be improved through education and awareness-raising programs [41‐43].
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In countries with high disaster risk, preparedness is an important factor in reducing disasters [44‐46]. Being prepared for disasters generally means taking measures to reduce the severity of disasters or to eliminate them completely by creating emergency plans before an event occurs, implementing these plans quickly and effectively, and making the community or individuals aware of the dangers and risks [47]. A comprehensive review of nurses' preparedness for disasters is essential for improving preparedness for disaster events. In recent years, there has been an increasing focus on the disaster preparedness of nurses in the literature [48‐51]. Several recommendations have been put forward in the literature to increase the preparedness of nurses for disasters [49‐52]. For example, it is suggested that nurses should be offered opportunities to participate in disaster nursing course and drills to increase their confidence and familiarity in responding to disasters [50, 52]. There are also examples where disaster preparedness is integrated into the nursing curriculum [50, 51]. Nurses, regardless of their specialty, need to be prepared for disasters at a level that can take part in all stages of the disaster and are responsible for gaining relevant experience and knowledge [33, 53, 54]. The aim of this study is to investigate the impact of integrating 'Disaster Nursing' into nursing curricula on nursing students' perceptions of disaster literacy and preparedness. This study was conducted based on the question "How Does Integrating 'Disaster Nursing' into Nursing Curricula Impact Nursing Students' Perception of Disaster Literacy and Preparedness?".
Hypothesis of this research are as follows:
H11: There is a difference between the pre-test and post-test scores of nursing students from the disaster literacy scale.
H12: There is a difference between the pre-test and post-test scores of the students on the scale of disaster preparedness perception in nurses.
Methods
Study design
One-group quasi-experimental study design with a pre-test post-test design.
Place of the study/year
It was conducted in the fall semester of the 2021–2022 academic year in the Department of Nursing, Faculty of Health Sciences, X University in İzmir which is located western part of Turkey. The data was collected on September 27, 2021 (Pre-test), and the post-test was applied on January 7, 2022.
Study population
The sample for this study consisted of 66 fourth-year nursing students enrolled in the elective course 'Disaster Nursing' at X University, Faculty of Health Sciences, Department of Nursing. No specific sampling method was employed, as all students who met the inclusion criteria and consented to participate were invited to take part. Among these, 62 students completed both the pre-test and post-test, and were therefore included in the final analysis. The criteria for inclusion were enrollment in the disaster nursing course, regular attendance at meetings, and voluntary participation in the study. The study excluded participants with any form of cognitive, mental, or physical disability that interfered with communication, as well as individuals with employment history, a diploma, or a certificate in the subject of disaster. The power of the study was calculated on the "G-Power-3.1.9.2" software. As a result of the analysis (n: 62), the effect size was found to be 1.60, at the α = 0.05 level. It was also calculated to be 1.00 as post-hoc. The minimum acceptable power value that should be obtained in post- hoc analysis is 0.67. Therefore, the power of the study was at an acceptable level. The flow chart of the research is presented in Fig. 1.
Fig. 1
Research flow chart
×
Data collection
The questionnaires of this one group quasi-experimental study in pretest–posttest design were collected via Google form during the online education process on the grounds of COVID-19 in the fall semester of 2021–2022. There was informed consent at the beginning of the form, and individuals completed the survey online if they gave consent. Informed consent to participate was obtained from all of the participants. Students enrolled in the "disaster nursing" elective course were informed about the research at the beginning of the first course and it was explained that no grade would be given. It was explained that the same questionnaire would be applied in the pre-test and post-test and that the questionnaires belonging to the same person would be matched and the students were asked to write a Nicknames. Participants were informed that they had the right to leave the study at any time. It took an average of 15–20 min to answer the forms.
Data collection tools
The data were collected using "Personal data form (13 questions)", "Disaster Literacy Scale (61 items)", "Nurses' Perception of Disaster Preparedness Scale (20 items)".
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Personal data form
The form prepared by the researchers in line with the literature [55‐57] includes 13 questions. The form includes questions about age, gender, experiencing a disaster, caring for a disaster victim, knowing the existence of disaster plans in the environment, reading these disaster plans, needing training on disaster management, participating in disaster risk reduction activities/drills, volunteering to help prepare for or respond to disasters, accessing information to prepare for a disaster, and information source.
Disaster literacy scale (DLS)
The Turkish scale developed by Çalışkan and Üner (2020, 2021) is a self-report tool designed to assess disaster literacy in individuals aged 18–60 [16, 58]. The scale’s conceptual framework is based on four key disaster-related dimensions: Mitigation/Prevention, Preparedness, Response, and Recovery/Rehabilitation. Additionally, it assesses the processes individuals use to acquire disaster-specific information, including access, understanding, decision-making, and implementation [16]. The 61-item scale comprises 16 domains that cover these four dimensions [16]. Items are distributed across subdimensions: 17 items for Mitigation/Prevention, 16 items for Preparedness, 13 items for Response, and 15 items for Recovery/Rehabilitation. Each item is scored on a 5-point Likert scale, ranging from 1 (very difficult) to 5 (very easy). Higher scores indicate greater disaster literacy. For ease of interpretation, the total score is standardized on a 0–50 scale, using the formula: Index = (arithmetic mean—1) x [50/4]. Based on this, disaster literacy is categorized as inadequate (0- < 30), limited (30- < 36), adequate (36- < 42), or excellent (42–50). As scores increase, so does the participant’s level of disaster literacy. The overall Cronbach Alpha value of the scale, which indicates its reliability, was originally reported as 0.95 [16, 59]. In this study, the overall Cronbach Alpha value of the scale was found to be 0.96.
Nurses' perception of disaster preparedness scale (NPDPS)
This scale, which was developed by Özcan [60] in Turkish, was created to determine the level of nurses' readiness for disaster. This scale, which contains 20 items in total, consists of three sub-dimensions: "Preparedness phase" (questions 1–6), "Response phase" (questions 7–15) and "Post-disaster phase" (questions 16–20). The five-point Likert type scale includes the options "1-Strongly disagree, 2-Disagree, 3-Somewhat agree, 4-Agree, 5-Strongly agree" for rating. The higher the score obtained from the scale, the higher the perception of disaster preparedness. In the reliability and validity study, the "Cronbach's alpha coefficient was found to be 0.90 and the test–retest reliability coefficient was found to be 0.98". In addition, the overall content validity index was calculated as 92.57%. Factor analysis revealed a three-factor structure explaining 60.76% of the total variance [60]. In this study, the overall "Cronbach's Alpha value" of the scale was found to be 0.91.
Intervention
"The 'Disaster Nursing' course in this study is an elective course integrated into the nursing curriculum at X University. It was specifically developed to meet the needs of nursing students and has been part of the curriculum since the 2021–2022 academic year. While the course draws on established disaster nursing principles and competencies, it was tailored to align with the nursing program's educational goals. The elective course is delivered in Turkish, as this is the language of instruction at the university, and is conducted for two hours per week, covering both theoretical aspects. It is assigned an ECTS credit value of 2. The course content included identification of risks and resources for disasters at the primary protection level, nurse's caregiver (triage and holistic care) and case manager role at the secondary protection level, reassessment of individuals’ care needs at the tertiary level, and review of education and the current disaster plan at the protection level. The disaster nursing course was intended to develop students’ perception of disaster awareness, preparedness, and response self-efficacy by providing them with primary, secondary, and tertiary level protection roles (Fig. 2). The disaster nursing course, which serves as an intervention in this study, offers similar content and credit to that provided by 32.2% of undergraduate nursing programs in Turkey [24].
Fig. 2
The content of the disaster nursing course
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As part of the 'Disaster Nursing' course, several pedagogical methods were employed to enhance students' understanding and practical skills in disaster preparedness and response. Lectures and Presentations were delivered weekly, providing a solid theoretical foundation on disaster nursing concepts, principles, and the role of nurses in disaster management. Case Studies were incorporated to bridge theory with practice, enabling students to analyze real-world disaster scenarios and apply their theoretical knowledge to these complex situations. In addition, Group Discussions were conducted regularly, fostering collaborative learning and encouraging students to critically examine diverse perspectives and problem-solving approaches in disaster management. To further develop practical skills, Simulations and Role-Playing exercises were included, with a specific focus on disaster triage. These hands-on sessions allowed students to engage in real-time decision-making and teamwork in high-pressure disaster settings. Furthermore, Guest Speakers—including emergency response personnel from Turkish Republic Ministry of Interior/Disaster and Emergency Management Presidency (AFAD) and healthcare professionals with direct disaster experience—were invited to share invaluable insights, thereby enriching the learning experience with real-world expertise. Students were also assigned Projects and Assignments that required them to develop disaster preparedness plans and conduct in-depth case analyses, promoting critical thinking and the application of course content to real-life disaster planning and response strategies.
Ethics approval and consent to participate
Written permission was obtained from the institution where the study was conducted and the non-interventional research ethics committee of İzmir Democracy University (Decision no: 2021/10–01, date: 16.07.2021). Permission for the scale was obtained from the author via e-mail. The research was conducted in accordance with the Declaration of Helsinki Principles. Before the research, the purpose of the study was explained to the students and that they could leave the study at any time. At the beginning of the questionnaire, it was informed that participation in the study was voluntary and that no grade would be given. Necessary precautions were taken to protect the confidentiality of the data, the identity information of the participants was not included in the data collection tools and all personal information in the questionnaire form was kept confidential. Participants were ensured to provide their consent voluntarily and without coercion. Written informed consent to participate was obtained from all of the participants in this study.
Statistical analysis
The data obtained at the end of the study were analyzed using SPSS 25.0 statistical program. Shapiro–Wilk and Skewness and Kurtosis were used for the normality test of the data. For the evaluation of the data, numerical values (number, percentage, mean, standard deviation) were obtained using descriptive statistical methods. Since the data were normally distributed, paired sample t-test was used for comparisons between two dependent groups and Pearson correlation was used for numerical variables. In all tests, p < 0.05 was taken into account to determine whether there was a statistically significant difference [61].
Results
While 51.6% of the students were 22–23 years old, 62.9% were female. While 54.8% of the students reported that they had a disaster experience, 98.4% stated that they did not provide care to a disaster victim. Of the students, 67.8% stated that they did not know the existence of a disaster plan such as school/housing, etc. in their neighborhood, and 88.7% stated that they had not read it (Table 1). Of the students 85.5% reported that they paid attention to the information within the scope of disaster management in their environment and 66.1% reported that they had participated in disaster drills before. Eighty-eight-point seven percent of the students stated that they needed training on disasters (Table 1). The information sources of the students before/during or after disasters were internet for 56.5%, social media for 22.5%, television/radio for 21.0%, respectively. It was determined that 91.9% of the students did not volunteer to prepare for or respond to disasters (Table 2).
Table 1
Comparison of students' scores on nurses' disaster preparedness perception scale and dimensions
Subdimensions
PRETEST
POST TEST
±SS
Test value
p
Preparedness phase
PRE
25.80
1.73
-8.488**
0.000*
POST
27.80
1.89
Response phase
PRE
34.38
2.76
-12.517**
0.000*
POST
39.74
3.18
Post-disaster phase
PRE
21.46
1.84
-6.687**
0.000*
POST
23.09
1.84
Nurses' Perception of Disaster Preparedness Scale
PRE
81.66
4.61
-12.586**
0.000*
POST
90.64
6.25
*p<0.05, **Dependent t test; PRE Pretest, POST Post test.
Table 2
Distribution of students participating in the research according to their descriptive characteristics
Variables
n
%
Age (±SD, 21.54±0.76)
20-21
30
48.4
22-23
32
51.6
Gender
Female
39
62.9
Male
23
37.1
Status of experiencing a disaster
Yes
34
54.8
No
28
45.2
Status of having to care for a disaster victim
Yes
1
1.6
No
61
98.4
Knowledge of the existence of a disaster plan in the neighborhood, school, or dormitory
Yes
17
27.4
No
3
4.8
No idea
42
67.8
Status of reading the disaster plan of the environment
Yes
7
11.3
No
55
88.7
Status of paying attention to the information within the scope of disaster management in the environment
Yes
53
85.5
No
9
14.5
Status of participating in disaster drills before
Yes
41
66.1
No
21
33.9
Status of thinking that there is a need for education on disasters
Yes
55
88.7
No
7
11.3
Status of participating in disaster risk reduction activities and exercises
Yes
28
45.2
No
34
54.8
Status of knowing how to access information to prepare for a disaster
Yes
44
71.0
No
18
29.0
Source of information before, during, and after a disaster
Social media
22
22.5
The Internet
35
56.5
Television/radio
13
21.0
Status of being prepared or willing to respond to disasters
Yes
5
8.1
No
57
91.9
Total
62
100.0
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The mean pretest score of the disaster literacy scale was 32.97 ± 6.47 and the mean posttest score was 40.58 ± 5.95. It is seen that there is a statistically significant difference between the pre-test and post-test scores of the disaster literacy scale (p < 0.05), mitigation sub-dimension (p < 0.05), preparation sub-dimension (p < 0.05), response sub-dimension (p < 0.05), recovery sub-dimension (p < 0.05). It is seen that the post-test scores of the disaster literacy scale and its dimensions are higher than the pre-test scores (Table 3).
Table 3
Comparison of students' disaster literacy scale and sub-dimensions scores
Subdimensions
PRETEST
POST TEST
±SD
Test value
p
Mitigation/Prevention
PRET
32.94
6.05
-9.381**
0.000*
POSTT
40.95
5.85
Preparedness
PRET
33.10
6.71
-8.118**
0.000*
POSTT
40.94
6.01
Response
PRET
34.75
7.28
-6.485**
0.000*
POSTT
40.71
6.65
Recovery/Rehabilitation
PRET
31.33
8.25
-7.132**
0.000*
POSTT
39.67
7.17
Disaster Literacy Scale
PRET
32.97
6.47
-8.650**
0.000*
POSTT
40.58
5.95
*p<0.05, **Dependent t test; PRE Pretest, POST Post test.
The mean pre-test score of the students in the "Perception of disaster preparedness in nurses scale" was 81.66 ± 4.61 and the mean post-test score was 90.64 ± 6.25. It is seen that there is a statistically significant difference between the pre-test and post-test scores of the disaster preparedness perception scale in nurses (p < 0.05), preparation phase sub-dimension (p < 0.05), intervention phase sub-dimension (p < 0.05), post-disaster phase sub-dimension (p < 0.05). It is seen that the post-test scores of the disaster preparedness perception scale and its dimensions are higher than the pre-test scores (Table 1).
A statistically positive relationship was found between the total scale scores of both scales (r = 0.79). As the total score of "Disaster Literacy" scale increased, the total score of "Disaster Preparedness in Nurses" also increased (Table 4).
Table 4
The correlation between the scores of the students from the DLS and NPDPS Nurses' Perception of Disaster Preparedness Scale scores (N = 62)
Scale/Subdimensions
1
2
3
4
5
6
7
8
9
1- Mitigation/Prevention
r
1.000
0.840
0.847
0.772
0.934
0.026
0.041
0.058
0.011
p
-
0.000*
0.000*
0.000*
0.000*
0.841
0.753
0.656
0.931
2-Preparedness
r
1.000
0.784
0.757
0.916
0.030
0.060
0.108
0.019
p
-
0.000*
0.000*
0.000*
0.815
0.643
0.402
0.885
3-Response
r
1.000
0.800
0.924
0.011
0.016
0.112
0.050
p
-
0.000*
0.000*
0.933
0.902
0.387
0.885
4-Recovery/Rehabilitation
r
1.000
0.912
0.096
0.022
0.096
0.061
p
-
0.000*
0.457
0.866
0.457
0.635
5- Disaster Literacy Scale
r
1.000
0.029
0.030
0.101
0.796
p
-
0.823
0.817
0.433
0.033*
6-Preparedness phase
r
1.000
0.180
0.316
0.610
p
-
0.162
0.012*
0.000*
7-Response phase
r
1.000
0.340
0.803
p
-
0.007*
0.000*
8-Post-disaster phase
r
1.000
0.722
p
-
0.000*
9- Nurses' Perception of Disaster Preparedness Scale
r
1.000
p
-
* Statistically significant (p<0.05) values are given. Note: r = Pearson product–moment correlation
Discussion
Today, disasters and extraordinary situations require trained healthcare professionals who can take part in each step of the disaster process and intervene [17]. Considering the frequency and effects of disasters worldwide, the readiness of nurses to respond to these events is critical in reducing the negative consequences on the health of the affected population [7, 8]. However, disaster nursing education is rarely provided in universities at undergraduate level and there is a lack of curriculum in many countries [19‐22]. Studies conducted in Turkey draw attention to the need of both nursing students and nurses for knowledge/ accumulation and training on disaster nursing [32, 33]. This study was conducted based on the question "Does the disaster nursing course affect the disaster literacy and preparedness perceptions of nursing students?". More than half of the participants were 22–23 years old and female. While more than half of the participants reported that they had experienced a disaster, almost all of them stated that they did not care for a disaster victim. An Iranian study revealed that when asked about the “disaster training course,” 64.3% of participants indicated that they had not received any disaster-related training. Additionally, in response to the question about “maneuver training experience,” 88.6% reported that they had not participated in any drills, while 71.4% stated that they had no prior involvement in disaster situations concerning their “history of disaster participation.” [27]. In a descriptive study conducted with nursing students in Turkey, 29.2% of the participants reported having been exposed to any disaster [62]. In Çalışkan's [16] study, it was determined that 37.7% of the participants experienced a disaster, and the vast majority (90% and above) did not experience any loss (loss of property, loss of a relative or injury) in the disaster [16]. The earthquake that occurred in Turkey on February 6, 2023 affected 9.1 million people in 11 cities [4]. While the profile of the participants in this study is similar to previous studies conducted in Turkey, it is seen that the number of people who have experienced disasters has increased over the years [16, 62].
More than half of the participants (67.8%) stated that they did not know that their neighborhood had a disaster plan such as school/home etc., while more than three-quarters reported that they had not read the disaster plan of their neighborhood. In another study conducted in Turkey, 87.6% of the participants did not have a family disaster plan[16]. In the preparation phase for disasters, it is life-saving for individuals, especially nurses who provide health care to the community, to know the disaster plans and to be prepared by reading them [15, 16]. However, similar to the literature, in the current study, it was shown that the participants did not know disaster plans before the disaster nursing course and did not read them even if they knew. If nurses are unable to effectively fulfill their role in providing care to those affected by disasters, it can result in unmet care needs and poorer health outcomes for victims [30, 31]. For these reasons, it is important to inform nursing students before graduation that the hospitals where they do clinical practice have disaster plans and that these plans should be read to be ready for disaster. In addition, it is seen that there is a need for a training program for learning the location and use of the necessary equipment to be used in disaster intervention. The information sources of nursing students participating in this study before/during or after disasters were distributed as internet, television/radio, and social media, respectively. In a study conducted with university students in China, 88.64% of the participants obtained disaster information from TV or internet and only 12.89% stated that relevant courses were given in their departments [14]. Genc et al. [15] reported that 90.3% of the participants in their study conducted with 18–60 individuals and 68.9% of the participants in Çalışkan's [16] study followed news about disasters. The study findings are similar to the existing literature, and it is thought that the source of information for nursing students should be evidence-based and curriculum-integrated courses[15, 16]. In a Japanish study, nursing students who participated in relief efforts during and following the 2016 Kumamoto earthquakes were questioned regarding their experiences. The findings indicated that those students who had undergone a disaster nursing program as part of their undergraduate training exhibited greater competency in four specified areas compared to their peers who had not received similar instruction [63].
Disasters definitely have an impact such as causing damage, injury and loss of life. Disaster literacy education is important to improve people's knowledge and understanding of disasters and to increase their ability to prepare for and respond to disasters [42]. Minimizing this impact is possible by increasing disaster literacy skills and ensuring community preparedness [64]. In this study, with the effect of the disaster nursing course, the disaster literacy of nursing students increased in the last week of the course (40.58 ± 5.95) compared to the first week of the course (32.97 ± 6.47). It was revealed that the disaster nursing course was effective in increasing the disaster literacy of the students. Similarly, it has been shown in the literature that disaster literacy can be improved through education and awareness-raising programs [41‐43]. In the literature, it has been shown that training programs to improve the disaster literacy of educators and administrators positively improve the disaster literacy of participants [65, 66]. Kesumaningtyas et al. [42] suggested that disaster literacy education should be integrated into school curricula, community programs and government policies, thus strengthening disaster resilience in the region [42]. In this context, the integration of disaster-related content into the undergraduate nursing curriculum can be effectively achieved through embedding it throughout the program. This study demonstrates that the incorporation of the "disaster nursing" course into the curriculum positively affects disaster literacy. The approach of embedding specific focus areas within nursing curricula is not new and has been successfully implemented in various subjects in the past, such as evidence-based practice [67], palliative care [68], and nursing informatics [69]. This study demonstrates that the “disaster nursing” course effectively increased students' disaster literacy, as indicated by a notable improvement in their scores from the beginning to the end of the course. These results support the acceptance of the first hypothesis of this study.
Disaster preparedness is crucial to minimize the impact of disasters on individuals and communities. Society's perception of disaster risks plays an important role in disaster preparedness [46]. To increase nurses' willingness to assist in a disaster, it is important to improve disaster knowledge and skills, create a family disaster plan, and improve the perception of workplace preparedness [70]. In this study, it was observed that nursing students' scores increased from 81.66 ± 4.61 at the beginning of the disaster nursing course to 90.64 ± 6.25 at the end of the course (p < 0.05). These values are important in terms of showing that the disaster preparedness perception scale scores of the students after the disaster nursing course were higher than the pre-test scores. With these results, the second hypothesis "There is a difference between the pre-test and post-test scores of the students on the scale of disaster preparedness perception in nurses" was accepted. In similar studies conducted in Korea and Turkey, it was reported that the competencies of nursing students in the intervention group regarding disaster preparedness increased with the training program [9, 71]. In a study conducted in Korea, it was found that the level of disaster preparedness of nursing students was low and it was stated that it should be supported with education [72]. The educational needs of nursing students in Japan and Turkey regarding disaster preparedness and intervention have been compared, revealing that Japanese students have a higher demand for training than their Turkish counterparts [20]. Tzeng et al. [73] found that Taiwanese nurses who had previously received disaster training reported higher personal preparedness for disaster response [73]. In the literature review of Labrague et al. (2018), it was reported that Filipino nurses' perception of disaster preparedness was also high or low according to the type of disaster [57]. A national nurse survey conducted in Canada revealed that nurses felt more prepared for infectious disease outbreaks and natural hazards than for chemical, biological, radiological or nuclear disasters [74]. Usher et al. [25] reported that nurses in Cambodia and Solomon Islands felt unprepared to conduct assessments of biological and chemical agents [25]. Al Khalaileh et al. [75] found that nurses in Jordan rated themselves as inadequately prepared in areas of disaster response such as conducting comprehensive health assessments of chemical and biological agents and undertaking organizational logistics and roles [75]. A cross-sectional study among community health nurses in six coastal areas in Indonesia showed that 50% of nurses providing primary health care services had a low level of disaster preparedness [76]. In the study of Taskiran and Baykal (2019), it is suggested that inexperienced and young nurses should be properly trained to improve disaster preparedness [77]. Due to the recent global increase in disasters, the World Health Organization recommends that all countries, no matter how often they face disasters, should consider health professionals as a national and local priority to adapt to disasters [18]. "Disaster nursing" integrated into nursing curricula, positively improved the disaster preparedness of nursing students.
Limitations
This study has some limitations. Since the study data were collected using an online questionnaire, there may have been response errors associated with internet technology. Additionally, health records could not be accessed, and the analysis relied solely on participants' self-reports provided in the survey form, which can be subject to bias such as social desirability or recall bias. The data obtained are limited to the statements on the scales used in the research and the self-reports of the students. Moreover, the outcomes of the research are based on data collected from students at a single state university, making it difficult to generalize the findings to all nursing students in the country. The lack of a control group in this study also limits the ability to compare the effectiveness of the disaster nursing course to those who did not receive the same education. Another significant limitation is that post-disaster nursing follow-up was not performed (e.g., at 1 month, 3 months, or 6 months), preventing the assessment of whether the improvements in disaster literacy and preparedness were sustained over time. Additionally, the relatively short duration of the study may have impacted the depth of insights into long-term retention and application of the course material.
Conclusion
Based on the results of this study, it is seen that the 14-week disaster nursing course integrated into the nursing curriculum can be used as an approach that contributes to nursing students' disaster literacy and preparedness perceptions. It was revealed that as the level of disaster literacy of students increased, the level of disaster preparedness of nurses also increased. Since nursing students' perceptions of disaster literacy and preparedness increased, periodic mandatory practice and training programs in this field are beneficial in increasing the students' disaster literacy. To reduce educational disparities among universities, nurses should receive a standardized number of training hours, and a mandatory disaster nursing course should be introduced in all nursing curricula. The findings from this research can offer support for formulating educational policies in disaster nursing education in Turkey. Simulation-based disaster drills can be offered in disaster nursing course content to improve nursing students' skills, especially for the intervention phase before disaster events and to allow to act out what needs to be done. Taking the nursing department as an example, providing disaster literacy and disaster preparedness training to all undergraduate students by emphasizing the relevance of their professional fields (such as engineering, medicine, environment, and urban planning) may be a solution to increase social resilience. Based on the results of this study, it is recommended to conduct qualitative, randomized controlled studies with different sample groups in different geographical regions of the country.
Acknowledgements
The authors extend their sincere gratitude to the nursing students who willingly took part in this study. Their participation is greatly valued and appreciated.
Declarations
Ethics approval and consent to participate
This study was approved by the ethics committee at the İzmir Democracy University Turkey (Decision no: 2021/10–01, date: 16.07.2021). We adhered to the principles of the Declaration of Helsinki and relevant guidelines. Participation was based on voluntariness and willingness, and students were informed about sensitive points related to the teacher-student relationship (such as participation or non-participation in the research not affecting their performance evaluations, etc.). Written informed consent to participate was obtained from all of the participants in this study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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