Introduction
Disasters, whether natural or human-induced, disrupt societal functioning and often necessitate large-scale emergency responses, including the establishment of shelters. These shelters provide physical protection and serve as critical hubs for addressing the immediate health, hygiene, and psychological needs of affected populations [1, 2]. Natural disasters such as earthquakes, floods, hurricanes, tsunamis, and man-made disasters such as wars, terrorist attacks, industrial accidents, and nuclear spills disrupt the functioning of societies and require emergency response and long-term recovery efforts [3‐6].
The increasing frequency and severity of disasters, driven by factors such as climate change and urbanization, underscore the urgent need for effective disaster management strategies. Reports from the United Nations Office for Disaster Risk Reduction [7] show a dramatic rise in global disasters, increasing from 3,656 events between 1980 and 1999 to 7,348 events between 2000 and 2019. Similarly, the World Meteorological Organization [8] highlights a fivefold increase in recorded disasters over the past 50 years due to human-induced climate change. Despite these alarming trends, only 50% of countries currently have operational early-warning systems, revealing significant gaps in disaster preparedness and response frameworks [9]. These statistics emphasize the critical need for specialized healthcare services in disaster shelters to mitigate health risks and support recovery efforts [10].
Anzeige
Shelters play a crucial role in survival and recovery during disasters. Beyond providing temporary housing, they address affected populations’ psychological support and social integration needs [11‐13]. However, crowded and unhygienic conditions in shelters can lead to significant health risks, including the spread of infectious diseases, malnutrition, and mental health problems [14, 15]. A well-designed shelter meets basic needs while promoting a safe living environment by considering environmental, economic, technical, and socio-cultural factors. This contributes to both immediate relief and long-term recovery [16‐18].
Shelter nursing is a specialized field of nursing practiced within temporary disaster shelters. It encompasses the provision of basic healthcare, infection control, chronic disease management, mental health support, and hygiene promotion in resource-constrained environments [19]. Beyond physical care, shelter nursing also focuses on psychological and social support to foster resilience among disaster-affected populations [20, 21]. Shelter nurses collaborate with disaster management teams to assess health risks, improve shelter conditions, and implement preventive measures [22]. Their role extends beyond treating physical injuries to protecting mental health and enhancing social resilience during recovery [23, 24].
Despite their critical role, shelter nurses face various challenges, including limited resources, infrastructure issues, cultural and linguistic barriers, overcrowding, and long working hours [25, 26]. These challenges can increase their workload and impact the quality of care they provide [27, 28]. Therefore, shelter nurses must possess adequate knowledge, skills, and psychological preparedness to respond effectively to disaster situations [29‐31].
Although disaster nursing and disaster management are well-represented in the nursing literature, the unique dynamics and challenges of shelter nursing remain underexplored. Studies have identified shelter nursing as a priority area within disaster nursing research. For instance, Ranse et al. [22] highlighted research priorities in this field, emphasizing the importance of shelter nursing. Loke and Fung [32] underlined the need to incorporate shelter nursing competencies into nursing curricula. Similarly, Pourvakhshoori et al. [33] revealed nurses’ uncertainties and challenges in disaster situations. These findings demonstrate the critical need for further research on shelter nursing.
Anzeige
There is a notable lack of data on nursing students’ knowledge, attitudes, and competencies regarding shelter nursing [34, 35]. This study seeks to address this gap by evaluating nursing students’ understanding of shelter nursing and identifying areas for curriculum improvement.
This research aims to comprehensively assess nursing students’ (future health professionals) knowledge and attitudes about shelter nursing. By identifying current educational gaps, the study aims to propose curriculum enhancements and highlight the importance of shelter nursing to academic and policy-making audiences. Furthermore, this study explores potential demographic variations in shelter nursing knowledge and awareness through descriptive and inferential statistical analyses. By identifying subgroup-specific trends, such as gender or marital status, the research provides a nuanced understanding of educational disparities and opportunities for targeted interventions. These findings aim to guide the development of inclusive and effective nursing education programs, ensuring that future health professionals are better equipped to address disaster management challenges in shelter settings.
This research aims to contribute to disaster healthcare by expanding knowledge in shelter nursing. Its findings will support improvements in nursing education, enhance shelter nursing practices, and ultimately improve the health outcomes of disaster victims. The study can potentially contribute valuable to shelter nursing literature, guide future research, and inform the development of effective practices in disaster situations.
Method
Study design
This study utilized a descriptive cross-sectional design to evaluate nursing students’ knowledge, attitudes, and awareness regarding shelter nursing during a specific time frame. A cross-sectional approach was chosen for its efficiency in collecting quantitative data from a large sample, providing a snapshot of the current educational needs in this area [36]. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [37] to ensure methodological transparency and rigor.
To enhance the depth of analysis, statistical tests, including chi-square analyses, were conducted to identify significant differences in knowledge and awareness across demographic subgroups, such as gender and marital status. A p-value of < 0.05 was considered statistically significant.
While this design provides valuable insights into the educational needs of nursing students, it is limited by its single-time-point data collection, which may not account for changes in attitudes or awareness over time. Additionally, the generalizability of the findings may be restricted by the study’s focus on two universities, which may not fully represent the broader nursing student population.
Sample and participants
The study was conducted at Fırat University, Faculty of Health Sciences, Department of Nursing, and Sakarya University, Faculty of Health Sciences, Department of Nursing, between August and November 2024. The population of the study consisted of 1,450 nursing students actively enrolled in these departments during the data collection period (Fırat University, n = 650; Sakarya University, n = 800). These universities were selected to capture geographical diversity and variations in nursing education practices, ensuring a broader representation of nursing students.
The sample size was calculated using OpenEpi Version-3 software based on an anticipated effect size of 0.8, consistent with similar studies in the literature [38‐40]. A power of 80% (1-β = 0.80) and a significance level of 5% (α = 0.05) were chosen. To account for an expected dropout rate of 10%, the final sample size was adjusted to 304 participants.
Anzeige
Inclusion and exclusion criteria
Inclusion criteria required participants to be actively enrolled in nursing students, without any communication barriers, and willing to participate voluntarily. Exclusion criteria included students currently receiving psychological therapy or treatment, those not enrolled in nursing programs, or those who declined to participate. These criteria were established to minimize potential biases and ensure that the study accurately represents the target population of nursing students.
Specific measures were implemented to ensure adherence to these criteria and enhance the study’s validity. For example, participants were required to confirm their enrollment status and willingness to participate through an initial screening question in the survey. These steps aimed to maintain methodological rigor and consistency throughout the data collection process.
Data collection tools
The original questionnaire, titled “A Field Study on Determination of Disaster Awareness and Awareness Levels of Public Employees,” was developed by Vefa Özcan under the supervision of Assoc. Prof. Dr. Metin Işık [41]. This tool was initially designed to assess public employees’ disaster awareness, attitudes, and preparedness levels. The adaptation process involved expert reviews and a pilot test with 30 nursing students, ensuring content validity. The pilot test ensured that the questions were comprehensible and relevant to the target population, leading to minor adjustments for clarity and precision. Reliability analysis was performed using Cronbach’s Alpha for scale-based variables: knowledge (α = 0.82), attitudes (α = 0.80), and practices (α = 0.78). Socio-demographic variables were analyzed using descriptive statistics (frequencies and percentages).
The adapted questionnaire consisted of a total of 35 items, categorized as follows: 5 items for socio-demographics, 10 items for knowledge, 10 items for attitudes, and 10 items for practices. A sample item from the knowledge category is: “What is the primary purpose of shelter nursing during a disaster?” Items were rated on a 5-point Likert scale ranging from “Strongly Disagree” (1) to “Strongly Agree” (5). This categorization and a Likert scale were designed to evaluate the study objectives and facilitate statistical analysis comprehensively.
Anzeige
Data collection process
The survey was distributed through Google Forms, a reliable online data collection platform. To prevent duplicate submissions, participants were required to provide their email addresses, and the system restricted multiple responses from the same email address. A total of 1,450 students were invited, and 304 valid responses were received, yielding a response rate of 20.96%. The response rate of 20.96% (304 out of 1,450 students) is acknowledged as a limitation. However, the sample size was calculated using OpenEpi software with a 95% confidence interval and 80% power, ensuring statistical validity despite the low response rate. The response rate is consistent with challenges faced by online surveys, such as voluntary participation and survey fatigue. This limitation has been acknowledged, and the findings are interpreted with caution. Cases with more than 10% missing responses were excluded, and mean imputation was applied for minor missing data. This approach is supported by Jakobsen et al. [42], ensuring data integrity and reliability. While the impact of missing data on results is minimal due to the low extent of missing data, advanced imputation methods are recommended for future studies. To ensure data integrity, IP address checks and email-based identification were employed, and the survey platform was regularly monitored to address any technical issues promptly. The questionnaire was designed to take approximately 8–10 min to complete, balancing thoroughness with user convenience. Collected data were securely backed up by the researchers for confidentiality and integrity.
Data analysis
Data analysis was conducted using SPSS for Windows version 26 (IBM Corp., Armonk, NY, USA). Descriptive statistics were calculated to summarize the data, including frequencies, percentages, means, and standard deviations. The Shapiro-Wilk test was used to evaluate the normality of the data distribution, and a p-value of < 0.05 was considered statistically significant. Chi-square tests and Fisher’s Exact Tests were employed to examine differences between categorical variables, such as gender and marital status. The significance level of p < 0.05 was used to determine statistical significance. These analyses were performed to identify potential variations in knowledge, attitudes, and awareness of shelter nursing across different demographic groups.
Ethical considerations
The study adhered strictly to the ethical principles of the Declaration of Helsinki. Ethics committee approval (Approval No: E-61923333-050.99-380566, Date: 18.07.2024) and institutional permissions were obtained. Through a detailed informed consent process, participants were informed about their rights, including confidentiality, anonymity, and the ability to withdraw without penalty. Permission to use and adapt the questionnaire was obtained from correspondence with the original author, Vefa Özcan, and the supervising professor, Assoc. Prof. Dr. Metin Işık.
Findings
This section presents the findings regarding the socio-demographic characteristics of the nursing students (N = 304) who participated in the study and their knowledge, attitudes, and practices related to shelter nursing.
Anzeige
Socio-demographic characteristics
The socio-demographic data summarized in Table 1 indicate that the sample consisted of young adult nursing students. The average age of the participants was 20.92 years (SD = 2.66). Most participants were female (83.2%, n = 253), which reflects the traditional gender distribution within the nursing profession. Nearly all participants were single (98.7%, n = 300), consistent with the sample’s student status and age group.
Students from all academic years were represented in the study, with first-year students comprising the largest group (35.5%, n = 108). Including students from various educational levels provides an opportunity to compare shelter nursing knowledge and attitudes across different stages of nursing education.
Table 1
Distribution of nursing students’ Socio-Demographic characteristics
Demographic Information | N | % | Mean ± SD |
|---|---|---|---|
Age | 304 | 20.92 ± 2.66 | |
Gender | |||
Female | 253 | 83.2 | |
Male | 51 | 16.8 | |
Marital status | |||
Married | 4 | 1.3 | |
Single | 300 | 98.7 | |
Class | |||
1st | 108 | 35.5 | |
2nd | 76 | 25 | |
3rd | 54 | 17.8 | |
4th | 66 | 21.7 |
Knowledge and attitudes toward shelter nursing
The findings presented in Table 2 indicate that nursing students’ awareness and knowledge levels about shelter nursing are notably low. Only 5.9% (n = 18) of participants had heard of refuge nursing before, and 6.6% (n = 20) knew its definition. This limited awareness reflects a significant gap in nursing education regarding disaster preparedness. Additionally, 25.3% (n = 77) of participants found the current curriculum inadequate, specifically citing a lack of practical training, simulation-based education, and comprehensive theoretical content on shelter nursing practices.
The finding that 76.6% of the students (n = 233) felt inadequate in shelter nursing clearly indicates a serious need for education in this field. This need is further supported by the students’ preferences for training topics in refuge nursing, highlighting areas such as crisis management, psychological first aid, and practical shelter nursing skills. The most requested training subject was crisis management, with 73.7% (n = 224). This emphasizes the need to improve student’s decision-making and management skills in emergencies. This was followed by basic first aid with 72.4% (n = 220), indicating the students’ desire to improve their practical intervention skills. Psychosocial support ranked third with 60.5% (n = 184), with participants highlighting the importance of psychological first aid, fostering emotional resilience, and effective communication skills to address the psychological and social needs of disaster victims. This rate reflects the importance given by the students to the mental health of disaster victims and their desire to improve themselves in this field. Finally, infection control ranked fourth with 53.9% (n = 164), indicating an understanding of the importance of health risk management. These data suggest that students understand the multifaceted nature of shelter nursing and want to develop themselves in the different dimensions of this field. However, the finding that only 1.3% (n = 4) of the students had received training on the subject indicates that shelter nursing is not sufficiently included in current education programs and highlights the urgent need for a curriculum update in this field.
The study results show that nursing students are aware of the health problems encountered in shelter nursing, but they have serious deficiencies in intervention to these problems. 50.7% of the students (n = 154) identified traumas and psychological problems as the most common health problems. This shows that students recognize the importance of both physical and mental health problems in disaster situations. At the same time, infections (47.7%, n = 145) were also perceived as a common problem, reflectingstudents’ awareness of health risks. This awareness indicates that they have a basic understanding of the potential health risks of shelter environments.
However, the finding that 91.1% (n = 277) of the students stated they did not know essential medical interventions reveals a significant gap between theoretical knowledge and practical application. This situation shows that students can identify health problems but feel inadequate in intervening in them.
Table 2
Distribution of nursing students’ knowledge and attitudes toward shelter nursing
Variables | N | % |
|---|---|---|
Never heard of shelter nursing before | ||
Yes | 18 | 5.9 |
No | 286 | 94.1 |
Where did she hear about shelter nursing? | ||
Social media/TV | 10 | 3.3 |
Article/Magazine | 2 | 0.7 |
School | 4 | 1.3 |
Friends/Social environment | 2 | 0.7 |
To know the definition of shelter nursing | ||
Yes | 20 | 6.6 |
No | 284 | 93.4 |
Thinking that shelter nursing is important | ||
Yes | 48 | 15.8 |
No | 5 | 1.6 |
No opinion | 251 | 82.6 |
Finding oneself competent in shelter nursing | ||
Yes | 3 | 1 |
No | 233 | 76.6 |
Partially | 68 | 22.4 |
Participation in information or awareness-raising activities related to shelter nursing | ||
Yes | 3 | 1 |
No | 301 | 99 |
Sources used to obtain information on shelter nursing* | ||
Internet | 78 | 25.7 |
Books | 10 | 3.3 |
Academic journals | 13 | 4.3 |
Education programs | 11 | 3.6 |
I did not use any source | 213 | 70.1 |
Opportunity to practice shelter nursing | ||
Yes | 2 | 0.7 |
No | 302 | 99.3 |
To know how shelter nursing changes according to different types of disasters | ||
Yes | 18 | 5.9 |
No | 286 | 94.1 |
Thinking that the current curriculum on shelter nursing is sufficient | ||
Yes | 6 | 2 |
No | 77 | 25.3 |
No opinion | 221 | 72.7 |
Thinking about how often shelter nursing training should be repeated | ||
Every year | 91 | 29.9 |
Every two years | 26 | 8.6 |
Every five years | 6 | 2 |
When necessary | 26 | 8.6 |
No Opinion | 155 | 51 |
Receiving a training on shelter nursing | ||
Yes | 4 | 1.3 |
No | 300 | 98.7 |
Subjects she wants to be trained in shelter nursing* | ||
Basic first aid | 220 | 72.4 |
Crisis management | 224 | 73.7 |
Psychosocial support | 184 | 60.5 |
Infection control | 164 | 53.9 |
Other | 3 | 1 |
The most common health problem encountered during shelter nursing* | ||
Traumas | 154 | 50.7 |
Infections | 145 | 47.7 |
Psychological problems | 154 | 50.7 |
Chronic diseases | 75 | 24.7 |
No opinion | 6 | 2 |
To know infection control in shelter nursing | ||
Yes | 22 | 7.2 |
No | 282 | 92.8 |
To know the basic medical interventions used during shelter nursing | ||
Yes | 27 | 8.9 |
No | 277 | 91.1 |
Skills and priorities in shelter nursing
Table 3 highlights the nursing students’ perceptions of the most critical skills required in shelter nursing. The top three skills identified were quick decision-making (69.7%), providing psychological support (60.9%), and effective communication (57.6%). These rankings emphasize the essential need for rapid and accurate decision-making during emergencies, addressing the psychological needs of disaster victims, and maintaining effective communication in challenging environments. Additionally, 51.6% of students identified technical knowledge as necessary, further underscoring the multifaceted nature of skills required in shelter nursing.
Regarding training methods, most students (72.4%) consider simulations and field experiences the most effective learning method. This preference emphasizes the importance of practical experience as well as theoretical knowledge. 74% of the students believed such experiences would improve their practical skills, and 64.1% thought that simulation training would give them confidence. These findings suggest that shelter nursing education should emphasize practical learning methods.
Table 3
Distribution of nursing students’ thoughts on skills and priorities in shelter nursing
Variables | N | % | Mean ± SD |
|---|---|---|---|
Skills considered important in shelter nursing* | |||
Fast decision making | 212 | 69.7 | |
Communication skills | 175 | 57.6 | |
Technical information | 157 | 51.6 | |
Psychological support | 185 | 60.9 | |
No Opinion | 9 | 3 | |
The priority considered to be the most important in shelter nursing | |||
Saving lives | 178 | 58.6 | |
Psychosocial support | 73 | 24 | |
Infection control | 45 | 14.8 | |
The method that is considered to be effective for developing practical skills in shelter nursing training* | |||
Simulations and field experiences | 220 | 72.4 | |
Interactive workshops and training exercises | 45 | 14.8 | |
Mentoring and shadowing programs | 15 | 4.9 | |
Online training modules | 21 | 6.9 | |
Other | 3 | 1 | |
Benefits of using field experience or simulations in the field of shelter nursing* | |||
Practical skills development | 225 | 74 | |
Gaining a sense of trust | 109 | 35.9 | |
Learning emergency responses | 191 | 62.8 | |
Developing teamwork skills | 144 | 47.4 | |
No Opinion | 3 | 1 | |
Thinking that training with simulations will provide a sense of confidence in shelter nursing | |||
Yes | 195 | 64.1 | |
No | 14 | 4.6 | |
No Opinion | 95 | 31.3 | |
Caring about taking an active role in shelter nursing practices | 3.77 ± 1.04 | ||
The existence of a particular interest in shelter nursing | |||
Yes | 40 | 13.2 | |
No | 264 | 86.8 | |
What she did to improve herself in the field of shelter nursing | |||
Receiving additional training | 27 | 8.9 | |
To make readings on the subject | 30 | 9.9 | |
Participating in drills | 27 | 8.9 | |
I am not engaged in any activity | 215 | 70.7 | |
Other | 5 | 1.6 |
The results show that nursing students generally find it important to actively participate in shelter nursing practice (3.77 ± 1.04). However, only 13.2% had a particular interest in this field, and 70.7% did not engage in any activities to improve themselves, indicating a gap in motivation and proactive learning.
Challenges and ethical issues
Table 4 shows nursing students’ views on the difficulties encountered during shelter nursing, ethical issues, and teamwork.
Half of the students (50.3%) stated that lack of education is the most significant difficulty encountered in shelter nursing. This was followed by psychological pressure (25.3%) and lack of resources (21.7%). This result clearly shows the need for more comprehensive educational programs in shelter nursing.
The student’s perception of the importance of teamwork was relatively high (4.28 ± 1.03). This shows that the students understand the multidisciplinary nature of shelter nursing and the critical importance of cooperation.
Regarding critical equipment, most students (60.5%) consider the first aid kit the most important. This is followed by communication tools, protective clothing (44.7%), and medical devices (42.4%). This ranking shows that students realize the importance of essential medical interventions, communication, and personal protection.
As for ethical issues, it is noteworthy that most students (92.1%) stated that they did not know about the ethical problems they might encounter in shelter nursing. Regarding dealing with ethical issues, 39.5% of the students prefer to receive training, 35.9% prefer to consult experienced colleagues, and 27% prefer to read the literature. However, 38.8% of the students stated that they had no opinion on this issue, emphasizing the need for more awareness and education on ethical issues.
Table 4
Distribution of nursing students’ various opinions about the difficulties encountered during shelter nursing and ethical issues
Variables | N | % | Mean ± SD |
|---|---|---|---|
The biggest challenge encountered during shelter nursing | |||
Lack of resources | 66 | 21.7 | |
Lack of training | 153 | 50.3 | |
Psychological pressure | 77 | 25.3 | |
No opinion | 8 | 2.6 | |
Thinking that teamwork is important in shelter nursing | 4.28 ± 1.03 | ||
Equipment considered critical in shelter nursing* | |||
First aid kit | 184 | 60.5 | |
Medical devices | 129 | 42.4 | |
Communication tools | 136 | 44.7 | |
Protective clothing | 136 | 44.7 | |
No opinion | 4 | 1.3 | |
To have knowledge about ethical problems that may be encountered in shelter nursing | |||
Yes | 24 | 7.9 | |
No | 280 | 92.1 | |
The method to be used in dealing with ethical problems in shelter nursing* | |||
Receive training | 120 | 39.5 | |
Consulting experienced colleagues | 109 | 35.9 | |
Reading literature | 82 | 27 | |
No opinion | 118 | 38.8 |
Psychosocial support, communication, and use of technology
Table 5 reveals nursing students’ views on psychosocial support, communication, and the use of technology in shelter nursing practices.
Students rated the importance of psychological support in shelter nursing quite high (4.25 ± 0.99). The most preferred method for psychosocial support was psychological first aid (47.7%), followed by individual counseling (35.9%) and group therapy (27.6%). However, it is noteworthy that 42.1% of the students stated they did not know this subject. Regarding patient confidentiality, 70.4% of the students stated they had no knowledge. Similarly, the rate of those who said they did not have information about health and safety protocols was at a very high level of 95.4%. These findings indicate a severe lack of education on ethics and safety issues.
The perception of students about the importance of communication skills is relatively high (4.28 ± 0.95). However, the rate of those who do not have information about the communication tools used in shelter nursing is at a very high level of 95.4%. Students think that face-to-face communication (83.6%) should be used the most in shelter nursing, followed by telephone (61.8%) and internet (54.3%). Regarding technology integration, 53% of the students consider integrating emergency notification systems the most crucial method. This is followed by mobile applications for health monitoring and communication (18.4%). Regarding the contribution of technology in emergency communication, the students mainly emphasized that it provides rapid health assessment and counseling (30.3%) and facilitates the coordination and management of emergencies through communication networks (27.6%). Regarding the role of technology in disaster management and health services, students mainly emphasized that it improves coordination of health services by accelerating information sharing (28%) and provides rapid access to emergency health services through mobile applications and remote health services (25.3%).
Table 5
Distribution of nursing students’ opinions on psychosocial support, communication, and use of technology in shelter nursing practices
Variables | N | % | Mean ± SD |
|---|---|---|---|
Evaluating the importance of psychological support during shelter nursing | 4.25 ± 0.99 | ||
The method that should be used to provide psychosocial support in shelter nursing* | |||
Individual counseling | 109 | 35.9 | |
Group therapy | 84 | 27.6 | |
Psychological first aid | 145 | 47.7 | |
No information | 128 | 42.1 | |
To know about protecting patient privacy during shelter nursing | |||
Yes | 90 | 29.6 | |
No | 214 | 70.4 | |
To know health and safety protocols in shelter nursing | |||
Yes | 14 | 4.6 | |
No | 290 | 95.4 | |
Evaluating the importance of communication skills during shelter nursing | 4.28 ± 0.95 | ||
To know communication tools used during shelter nursing | |||
Yes | 14 | 4.6 | |
No | 290 | 95.4 | |
Communication tools that should be used in shelter nursing* | |||
Telephone | 188 | 61.8 | |
Radio | 105 | 34.5 | |
Internet | 165 | 54.3 | |
Face-to-face communication | 254 | 83.6 | |
Other | 1 | 0.3 | |
The method that she thinks technology should be integrated in shelter nursing practices | |||
Use of remote health services | 21 | 6.9 | |
Use of mobile applications for health monitoring and communication | 56 | 18.4 | |
Integration of emergency notification systems | 161 | 53 | |
Digital management of health record systems | 33 | 10.9 | |
Communication tools and video conferencing technologies | 33 | 10.9 | |
The area where technology in emergency communication (e.g., mobile applications or telehealth services) could contribute to refuge nursing practice | |||
Provides rapid health assessment and counselling | 92 | 30.3 | |
Provides information sharing and training opportunities for disaster victims | 38 | 12.5 | |
Increases the accessibility of health records in digital environment | 41 | 13.5 | |
Expert support in the disaster area can be provided through remote management and counselling services | 49 | 16.1 | |
Facilitates the coordination and management of emergencies through communication networks | 84 | 27.6 | |
Evaluating the role of effective use of technology in shelter nursing practices, disaster management and health services | |||
Mobile applications and remote health services provide quick access to emergency health services. | 77 | 25.3 | |
Telemedical support and remote counselling improve communication between health professionals. | 38 | 12.5 | |
Improves coordination of health services by accelerating information sharing. | 85 | 28 | |
Ensures the provision of effective and coordinated health services to disaster victims. | 69 | 22.7 | |
Strengthens public health. | 35 | 11.5 |
Comparative analysis of demographic variables
A chi-square analysis was performed to explore differences in knowledge, attitudes, and awareness of shelter nursing based on gender and marital status. The results indicated a statistically significant difference in awareness of shelter nursing by gender (p = 0.018). Among female participants, 95.7% reported having never heard of shelter nursing, compared to 86.3% of male participants. However, no statistically significant differences were observed between genders in terms of knowing the definition of shelter nursing (p = 0.349), perceiving shelter nursing as important (p = 0.738), feeling competent in shelter nursing (p = 0.738), participating in awareness-raising activities (p = 0.575), or having opportunities to practice shelter nursing (p = 0.692) (Table 6).
Table 6
Examination of the distribution of certain variables related to shelter nursing by gender
Gender | |||
|---|---|---|---|
Female | Male | Statistical testing and significance | |
Never heard of shelter nursing before | |||
Yes | 11 (4.3) | 7 (13.7) | X2*=6.701 |
No | 242 (95.7) | 44 (86.3) | p = 0.018 |
To know the definition of shelter nursing | |||
Yes | 15 (5.9) | 5 (9.8) | X2**=1.037 |
No | 238 (94.1) | 46 (90.2) | P = 0.349 |
Thinking that shelter nursing is important | |||
Yes | 33 (13) | 15 (29.4) | |
No | 2 (0.8) | 3 (5.9) | X2*=0.607 |
No opinion | 218 (86.2) | 33 (64.7) | p = 0.738 |
Finding oneself competent in shelter nursing | |||
Yes | 2 (0.8) | 1 (2) | |
No | 194 (76.7) | 39(76.5) | X2*=0.607 |
Partially | 57 (22.5) | 11 (21.6) | P = 0.738 |
Participation in information or awareness-raising activities related to shelter nursing | |||
Yes | 3(1.2) | - | X2*=0.611 |
No | 250(98.8) | 51 (100) | p = 0.575 |
Opportunity to practice shelter nursing | |||
Yes | 2 (0.8) | - | X2**=0.406 |
No | 251 (99.2) | 51 (100) | P = 0.692 |
Similarly, marital status was analyzed to determine its impact on shelter nursing awareness. All married participants (100%) and 94% of single participants stated that they had never heard of shelter nursing (p = 0.782). No statistically significant differences were observed in other variables, including knowing the definition of shelter nursing (p = 0.239), perceiving its importance (p = 0.855), feeling competent (p = 0.539), participating in awareness-raising activities (p = 0.961), or having opportunities to practice shelter nursing (p = 0.974) (Table 7).
Table 7
Examination of the distribution of certain variables related to shelter nursing by marital status
Marital status | |||
|---|---|---|---|
Married | Single | Statistical testing and significance | |
Never heard of shelter nursing before | |||
Yes | - | 18 (6) | X2**=0.255 |
No | 4 (100) | 282 (94) | P = 0.782 |
To know the definition of shelter nursing | |||
Yes | 1 (25) | 19 (6.3) | X2**=2.238 |
No | 3 (75) | 281 (93.7) | p = 0.239 |
Thinking that shelter nursing is important | |||
Yes | 1 (25) | 47 (15.7) | |
No | - | 5 (1.7) | X2 = 0.313 |
No opinion | 3 (75) | 248 (82.7) | p = 0.855 |
Finding oneself competent in shelter nursing | |||
Yes | - | 3 (1) | |
No | 4 (100) | 229 (76.3) | X2 = 1.235 |
Partially | - | 68 (22.7) | p = 0.539 |
Participation in information or awareness-raising activities related to shelter nursing | |||
Yes | - | 3 (1) | X2**=0.4 |
No | 4 (100) | 297 (99) | p = 0.961 |
Opportunity to practice shelter nursing | |||
Yes | - | 2 (0.7) | X2**=0.027 |
No | 4 (100) | 298 (99.3) | p = 0.974 |
These findings suggest that while gender has a significant impact on awareness of shelter nursing, other variables, such as attitudes and participation, do not show significant differences based on gender or marital status. Marital status appears to have no notable influence on shelter nursing awareness or related attitudes.
Discussion
This study provides critical insights into nursing students’ knowledge, attitudes, and awareness regarding shelter nursing, revealing both challenges and opportunities for educational interventions. One of the key contributions of this research is the identification of specific gaps, such as students’ emphasis on psychosocial support and technology integration, which are often underrepresented in existing literature. These findings enhance our understanding of shelter nursing education and its critical role in disaster preparedness.
The study highlights that nursing students’ awareness and knowledge of shelter nursing are generally low, with the majority (94.1%) unfamiliar with the concept and its definition (93.4%). Moreover, the chi-square analysis revealed that gender had a statistically significant impact on awareness of shelter nursing, with 95.7% of female participants and 86.3% of male participants reporting that they had not heard of the concept before (p = 0.018). However, no statistically significant differences were found between genders for other variables, such as knowing the definition of shelter nursing, perceived importance, or self-assessed competence (p > 0.05). Similarly, marital status did not show statistically significant differences across the analyzed variables (p > 0.05). This is consistent with findings from studies by Jennings-Sanders et al. [43] and Pesiridis et al. [44], emphasizing the limited knowledge of disaster-related nursing among students in various educational settings.
The response rate of 20.96% is acknowledged as a limitation, as lower participation rates may impact the generalizability of the findings. This challenge is common in online surveys due to factors such as survey fatigue, voluntary participation, and survey length. Literature indicates that online survey response rates vary widely, with averages ranging from 29 to 33%, depending on the survey type and distribution method. Furthermore, response rates tend to decline significantly for surveys exceeding 12 questions or five minutes in length, with a 17% drop in participation observed in such cases [45]. Despite this limitation, the sample size was determined using robust statistical criteria to ensure validity and reliability. Additionally, the diverse geographical backgrounds of participants provide valuable insights into the state of nursing education across different regions. Notably, Wu et al. [46] reported that merely increasing the number of survey invitations does not necessarily improve participation, whereas targeted recruitment and engagement strategies are more effective in enhancing response rates. Future studies may consider personalized invitations, follow-up reminders, and survey length optimization as strategies to improve response rates and enhance the representativeness of findings.
One of the novel findings of this study is the significant value nursing students placed on psychosocial support as a critical component of shelter nursing. This aligns with the work of Hugelius and Adolfsson [47], who highlighted the need to address both the psychological and social needs of disaster victims, alongside their physical health. Nursing students in this study placed significant value on psychological first aid and mental health interventions, emphasizing the need to integrate these elements into nursing curricula. These findings suggest that disaster nursing education should prioritize both technical and psychosocial competencies to prepare future nurses for comprehensive disaster management.
Another key finding is the emphasis students placed on technology integration, with 53% identifying emergency notification systems as a critical component of shelter nursing. This reflects an evolving understanding of the role of technology in disaster management and healthcare delivery, as noted by Veenema et al. [11]. The recognition of telehealth, electronic health records, and social media as essential tools underscores the need for disaster nursing curricula to incorporate technology-driven training modules.
The preference for practical training methods, such as simulations and field experiences, expressed by 72.4% of students, offers valuable insights for curriculum development. Simulation-based training has been shown to enhance disaster preparedness, as emphasized in the studies by Kalanlar and Kubilay [48] and Hasan et al. [49]. These findings underscore the importance of experiential learning in developing decision-making and technical skills necessary for effective shelter nursing. Additionally, the students’ interest in crisis management (73.7%) and basic first aid (72.4%) highlights the need for structured, scenario-based training that prepares them for post-disaster caregiving roles. This indicates a growing emphasis on hands-on and practical approaches.
This study also identifies barriers to shelter nursing education, including a lack of awareness (82.6%) and low self-reported competence (1%). These findings align with previous research highlighting the intermediate knowledge levels (M = 2.99, SD = 0.66) of nursing students regarding disaster management [49]. Addressing these gaps through targeted educational programs, regular training updates, and interdisciplinary collaborations is critical for fostering confidence and competence in future nurses.
These findings hold significant implications for disaster nursing education and policy-making. Educational programs must integrate simulation-based learning, technology-driven tools, and psychosocial components to enhance preparedness. Policymakers should also consider these findings when designing national and institutional guidelines for disaster nursing curricula. Additionally, ongoing education programs are necessary to reinforce learning and ensure long-term preparedness.
Further studies should systematically evaluate the effectiveness of integrating technology, such as telehealth and electronic health records, into disaster nursing education. Comparative studies across diverse cultural and institutional settings can provide insights into global best practices. Longitudinal studies that track the long-term impact of shelter nursing education on professional competencies and disaster response outcomes would further strengthen the evidence base.
Conclusions and recommendations
This study evaluated nursing students’ knowledge, attitudes, and awareness regarding shelter nursing, revealing significant gaps and areas for improvement. The findings demonstrated that students’ awareness and knowledge about shelter nursing are notably low, with the majority acknowledging the need for additional training in this field. Crisis management and basic first aid emerged as the most desired training topics, while simulations and field experiences were identified as the most effective methods for skill development. Rapid decision-making and psychological support were highlighted as critical competencies, and the lack of dedicated training in shelter nursing was identified as a key challenge.
The findings also highlight the importance of addressing gender differences in awareness through targeted educational campaigns. Programs specifically designed to engage male nursing students may help bridge the awareness gap observed in this study. Additionally, although marital status did not significantly affect shelter nursing awareness or attitudes, training modules should be designed to be inclusive and accessible to diverse demographic groups.
To address these gaps, it is recommended that nursing education programs integrate comprehensive content on shelter nursing and disaster management, encompassing both theoretical and practical components. Increasing the use of simulation-based training and field experiences will help bridge the gap between theoretical knowledge and practical application. Training should also emphasize psychosocial support, ethics, and technology integration, such as virtual simulations and telehealth platforms, to enhance learning and disaster response capabilities. Additionally, continuing education programs, awareness campaigns, and international collaborations should be promoted to improve nursing students’ and professionals’ competencies in shelter nursing. These measures will strengthen future nurses’ preparedness and contribute to more effective healthcare delivery during emergencies.
Future research should explore the effectiveness of these interventions in improving nursing students’ preparedness. Comparative studies across different cultural and educational contexts could provide insights into global best practices. Additionally, longitudinal studies tracking the impact of shelter nursing education on professional competencies and disaster response outcomes would be valuable. Monitoring advancements in the field and integrating innovative approaches into training programs will be essential for the continued development of shelter nursing as a vital component of disaster management.
Limitations
This study has several limitations. The sample was selected from two universities, which may limit the generalizability of the findings to other educational systems or cultural contexts. Additionally, the use of an online survey, while practical, may have led to the exclusion of participants with limited internet access or technical proficiency, potentially compromising the representativeness of the sample. Self-reported data may have introduced response biases, as participants might have overestimated or underestimated their knowledge and attitudes. The voluntary nature of participation might have also introduced selection bias, as students with a stronger interest in shelter nursing might have been more likely to respond.
Furthermore, non-response bias remains a potential limitation, as students who participated may have been more interested in disaster preparedness than non-respondents, which could result in an overestimation of awareness and attitudes. Future research should explore strategies such as multi-modal survey distribution, personalized invitations, and follow-up reminders to improve response rates and enhance sample representativeness.
Cases with more than 10% missing data were excluded, and mean imputation was applied for minor missing data. This approach, as supported by Jakobsen et al. [42], helps ensure data integrity and reliability. However, using more advanced imputation methods in future research could further enhance the reliability and validity of results. Additionally, mean imputation may lead to an underestimation of variability in the data and potential biases in parameter estimates. Future research should consider sensitivity analyses or alternative imputation techniques to assess the robustness of results.
To address these limitations, future studies should include a more extensive and diverse sample from multiple institutions and cultural contexts, employ mixed methods to provide a more comprehensive analysis, and implement strategies to achieve higher response rates. These measures will contribute to more robust and generalizable findings that better inform educational policies and practices in shelter nursing.
Declarations
Ethics approval and consent to participate
This study was conducted following the Declaration of Helsinki and approved by the Ethics Committee of the Faculty of Health Sciences at Sakarya University (Approval No: E-61923333-050.99-380566, Date: 18.07.2024). All participants were thoroughly informed about the study’s purpose, procedures, and their rights before providing written informed consent. Participation was entirely voluntary, and participants were informed of their right to withdraw from the study at any time without consequence. Confidentiality and anonymity of all participants were strictly maintained throughout the research process.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
