Background data
Seven hospitals were invited to participate; one declined. The study population according to ED management was comprised of a total of 372 registered nurses employed at the six participating emergency departments. A total of 140 nurses answered the questionnaire resulting in a response rate of 38% (n=140/372). The majority of the nurses (70.4%) were between the ages of 26-44. 65% percent of nurses had more than five years of nursing experience. 40% percent of the participants reported having prior major incident experience. 30% of the registered nurses had advanced degrees within a variety of specialties. In addition, 54.6% of registered nurses had disaster medicine as a part of their bachelor’s curriculum (Table 1).
Table 1 Demographic data n=140
|
n
|
%
|
Gender
|
Female
|
109
|
77.9
|
Male
|
31
|
22.1
|
Total
|
140
|
100
|
Age
|
20-25
|
12
|
8.6
|
26-34
|
51
|
36.4
|
35-44
|
48
|
34.3
|
45-54
|
19
|
13.6
|
55-65
|
10
|
7.1
|
Total
|
140
|
100
|
|
|
|
|
Degree
|
Registered Nurse
|
98
|
70
|
|
Specialist Nurse
|
42
|
30
|
Clinical experience
|
|
|
|
|
<1
|
7
|
5
|
|
1-3
|
24
|
17.1
|
|
3-5
|
18
|
12.9
|
|
5-10
|
33
|
23.6
|
|
10->20
|
58
|
41.4
|
Disaster medicine in bachelor’s degree
|
|
|
|
|
Yes
|
79
|
54.6
|
|
No
|
40
|
15
|
|
Uncertain
|
21
|
28.6*
|
Clinical experience during major incident?
|
|
|
|
|
Yes
|
56
|
40
|
|
No
|
72
|
50.7
|
|
Uncertain
|
13
|
9.3*
|
Frequency of disaster training at place of work
|
|
|
|
|
<1 year
|
45
|
32.1
|
|
Once a year
|
34
|
24.3
|
|
2 or more/ year
|
19
|
13.6
|
|
Uncertain
|
22
|
15.7*
|
|
Never
|
20
|
14.3
|
Instructor
|
|
|
|
|
Yes
|
35
|
25
|
|
No
|
105
|
75
|
*Recoded as user missing data for analysis
Exploratory factor analysis
The exploratory factor analysis resulted in three sub-dimensions and one main dimension. The first subdimension consisted of 28 items related to “Staff, Stuff, Structure, System”, (α= 0.98). The second consisted of 10 items related to Chemical, Biological, Radiological, and Nuclear (CBRN) competencies (α= 0.97), and the third consisted of 8 items relating to specific patient groups (α= 0.95) (see additional file1). These three subdimensions together create the main dimension, Total Disaster Competency.
Internal reliability for the questionnaire as expressed by Cronbach’s alpha was α=0.989 (see additional file 2).
ED RNs’ knowledge
56% (n=75/135) correctly answered that their ED had alternative systems for triage. 42 %(n=58/139) of the nurses correctly answered that level of care for patients was not automatically lowered when the HICG declared “state of disaster”.
Nurses’ disaster competency
The mean for Total Disaster Competency was 2.34. Means for the three subdimensions were 2.89 (Staff, Stuff, Structure, System), 2.00 (CBRN), and 2.17 (Specific patient groups) (Table 4). The final item assessed nurses’ perception of their overall disaster preparedness. Nurses rated their competency statistically significantly higher (M=2.74) than the Total Disaster Competency (M=2.34, ρ=.000) (Table 2).
Table 2
Means per dimension
|
|
Mean
|
Std. Deviation
|
Stuff, staff, structure, system
|
2.89
|
1.03
|
CBRNE
|
2.00
|
0.93
|
Specific patient groups
|
2.17
|
1.00
|
Total Disaster Competency
|
2.34
|
0.92
|
Self-perceived overall disaster competency
|
2.74
|
1.14
|
There were significant differences in means for all dimensions based on several factors as exemplified by the means for Total Disaster Competency; Means for level of education (bachelor’s degree M=2.03 advanced degree M=3.07 ρ=.000), clinical experience, (1-3 years M= 1.67, over 10 years M= 2.99 ρ=.000), being an instructor (M=2.98 vs 2.13 ρ=.000) having prior MI experience (M=2.68 vs M=2.08) , and having formal disaster medicine education (M= 2.10 vs 2.61 ρ=.000). There were no significant differences based on gender. (Table 3).
Table 3 Means and standard deviations for dimensions and factors
|
Surge
|
CBRNE
|
Specific Patient groups
|
Total Disaster Competency Score
|
Perceived disaster competency
|
|
Mean SD
|
Mean SD
|
Mean SD
|
Mean SD
|
Mean SD
|
Gender
|
|
|
|
|
|
Female
|
2.95 ± 1.03
|
2.02 ± 0.92
|
2.19 ± 0.97
|
2.38 ± 0.9
|
2.77 ± 1.14
|
Male
|
2.67 ± 1.03
|
1.91 ± 0.94
|
2.12 ± 1.09
|
2.23 ± 0.99
|
2.61 ± 1.17
|
Test and significance
|
U=1194
ρ=0.21
|
U=1461.5 ρ=.063
|
U= 1429.5 ρ=0.53
|
U=1510.5 ρ=0.36
|
U=1539
ρ=0.43
|
|
|
|
|
|
|
|
|
|
|
|
|
Registered Nurse
|
2.55 ± 0.91
|
1.72 ± 0.74
|
1.84 ± .082
|
2.03 ± 0.77
|
2.38 ± 1
|
Specialist
|
3.61 ± 0.9
|
2.65 ± 1.01
|
2.96 ± 0.94
|
3.07 ± 0.77
|
3.57 ± 1.03
|
Test and significance
|
U=681
ρ=0.000
|
U=857
ρ=0.000
|
U=728
ρ=0.000
|
U=739
ρ=0.000
|
U=876
ρ=0.000
|
|
|
|
|
|
|
Professional experience
|
|
|
|
|
|
<1
|
1.22 ± 0.14
|
1.05 ± 0.07
|
1.08 ± 0.18
|
1.12 ± 0.11
|
1.14 ±.0.37
|
1-3
|
2.07 ± 0.82
|
1.47 ± 0.58
|
1.64 ± 0.82
|
1.67 ± 0.67
|
2.00 ± 0.98
|
3-5
|
2.43 ± 0.94
|
1.67 ± 0.66
|
1.67 ± 0.71
|
1.9 ± 0.74
|
2.28 ± 1.17
|
5-10
|
2.82 ± 0.74
|
1.17 ± 0.79
|
1.98 ± 0.84
|
2.2 ± 0.71
|
2.45 ± 0.79
|
10 and over
|
3.61 ± 0.74
|
2.65 ±0.87
|
2.81 ± 0.9
|
2.99 ± 0.76
|
3.53 ± 0.86
|
Test and significance
|
KW 57,7
ρ=0.000
|
52,452
ρ=0.000
|
44,67
ρ=0.000
|
KW 62,712 ρ=0.000
|
KW 56,646 ρ=0.000
|
|
|
|
|
|
|
Disaster medicine course
|
|
|
|
|
|
Yes
|
2.58 ± 1.05
|
1.82 ± 0.93
|
1.88 ± 0.99
|
2.10 ± 0.95
|
2.41 ± 1.14
|
No
|
3.19 ± 0.88
|
2.17 ± 0.8
|
2.50 ± 0.89
|
2.61 ± 0.78
|
2.63 ± 0.78
|
|
|
|
|
|
|
Test and significance
|
U= 837 ρ=0.002
|
U=969
ρ=0.007
|
U=845
ρ=0.000
|
U=982
ρ=0.001
|
U= 1031 ρ=<0.001
|
Instructor
|
|
|
|
|
|
Yes
|
3.53 ± 0.99
|
2.66 ± 0.78
|
2.79 ± 0.98
|
2.98 ± 0.89
|
3.43 ± 1.06
|
No
|
2.67 ± 0.99
|
1.78 ± 0.78
|
1.98 ±0.93
|
2.13 ± .083
|
2.50 ± 1.08
|
Test and significance
|
U=769.5 ρ=0.000
|
U=808.5 ρ=0.000
|
U=872= ρ=0.000
|
U=879
ρ=0.000
|
U=1006
ρ=0.000
|
|
|
|
|
|
|
Prior major incident experience
|
|
|
|
|
|
Yes
|
3.29 ± 1.00
|
2.40 ± 0.98
|
2.44 ± 1.04
|
2.68 ± 0.95
|
3.20 ± 1.11
|
No
|
2.61 ± 0.98
|
1.70 ± 0.78
|
1.92 ± 0.93
|
2.08 ± 0.84
|
2.35 ± 1.03
|
Test and significance
|
U=1004.5 ρ=0.001
|
U=994.0 ρ=0.000
|
U=1247.5 ρ=0.003
|
1253.0
ρ=0.000
|
1152
ρ=0.000
|
|
|
|
|
|
|
Frequency of training
|
|
|
|
|
|
None
|
2.43 ± 0.66
|
1.72 ± 0.67
|
1.90 ± 1.02
|
2.04 ± 0.75
|
2.35 ± 0.98
|
< 1 x year
|
3.02 ± 0.86
|
1.94 ± 0.80
|
2.20 ± 0.93
|
2.36 ± 0.82
|
2.69 ± 1.01
|
1 x year
|
3.27 ± 0.97
|
2.20 ± 0.91
|
2.40 ± 0.88
|
2.58 ± 0.88
|
3.09 ± 1.11
|
≥2 x year
|
3.48 ± 1.20
|
2.64 ± 1.29
|
2.40 ± 1.27
|
2.86 ± 1.19
|
3.21 ± 1.39
|
Test and significance
|
KW 12.09
ρ=.007
|
KW 5.86
ρ=0.118
|
KW 4.03
ρ=0.258
|
KW 8.21
ρ=<0.042
|
KW 8.18
ρ=<0.042
|
Factors correlated to Total Disaster Competency
Professional clinical experience (r=.688), followed by higher education (r=.488), being an instructor (r=.391) prior MI experience (r=.318), and formal disaster medicine education (r=.-310) were in decreasing order correlated with Total Disaster Competency (Table 4).
These same factors were significantly correlated with RNs' perception of their overall disaster preparedness. The mean score of their perceived preparedness tended to increase with professional clinical experience (r= .623), level of education (r=.470), and prior MI experience (r=.373), except for formal disaster medicine education which decreased (r=-.293). RNs without formal disaster medicine education assessed their preparedness significantly higher than RNs with formal disaster medicine education (M= 3.08 vs 2.41 ρ =.004).
Table 4
Correlation of demographic factors and disaster competencies
Spearman's rho
|
|
|
Surge
|
CBRN
|
Specific patient groups
|
Total disaster competency score
|
Perceived overall disaster preparedness
|
Gender
|
-.110ns
|
-.042ns
|
-.054ns
|
-0.76 ns
|
-0.06ns
|
Education level
|
.479**
|
.415**
|
.478**
|
.488 **
|
.470**
|
Professional experience
|
.669**
|
.614**
|
.572**
|
.668 **
|
.623**
|
Disaster medicine course
|
-.298**
|
-.256**
|
-.337**
|
-.310**
|
-.293**
|
Instructor
|
.368**
|
.366**
|
.330**
|
.391**
|
.350**
|
Prior major incident experience
|
.321**
|
.375**
|
.269**
|
.318**
|
.373**
|
Frequency of training
|
-.081ns
|
.018ns
|
-.066ns
|
-.041ns
|
-.015ns
|
|
|
|
|
|
|
*Correlation is significant at the 0.05 level (2-tailed).**Correlation is significant at the 0.01 level (2-tailed).
A correct answer in relation to alternative triages systems was positively correlated with education (ρ=.007). 73.3% of the RNs with advanced degrees answered correctly as compared to 47.9% with bachelor’s degrees answering correctly. In addition, frequency of training was also positively correlated (ρ=.000) to a correct answer concerning alternative triage systems (Table 5). There was no correlation between underlying factors such as education and correctly answering the question concerning how hospital response (state of disaster) affects level of care (table 6).
Table 5. Correlation of nurses’ knowledge of their hospital’s alternative triage. χ2
|
Correct (%)
|
Incorrect (%)
|
Chi square test
|
Level of education
|
|
|
|
Bachelor’s degree
|
45(47.9)
|
49 (52.1)
|
χ2 (1) =7.4
ρ= .007
φ = 0.234
n= 135
|
Advanced
|
30 (73.2)
|
11 (26.8)
|
Frequency of training at workplace
|
|
|
|
<1/ year
|
24 (36.9)
|
20 (41.7)
|
χ2 (4) = 19.12
ρ = .000
φ= 0.402
n= 113
|
1 x / year
|
23 (35.4)
|
8 (16.7)
|
2 or more / year
|
14 (21.5)
|
4 (8.3)
|
Never
|
4 (6.2)
|
16 (33.3)
|
Table 6. Comparisons of demographic data participant’s knowledge of how level of standard of care is affected by hospitals state of response
|
Correct (%)
|
Incorrect (%)
|
Chi square test
|
Level of education
|
|
|
|
Bachelor’s degree
|
38 (39.2)
|
59 (60.8)
|
χ2 (1) =0.858
ρ= .354
φ = 0.07
n= 139
|
Specialist
|
20 (47.6)
|
22 (52.4)
|
Frequency of training at workplace
|
|
|
|
<1/ year
|
20 (44.4)
|
25 (55.6)
|
χ2 (4) = 7.71
ρ = .103
φ= 0.236
n= 139
|