Disaster Training Research Articles

Opportunities for Implementation of Disaster Risk Management Strategies among Public Housing Authorities

Renters living in subsidized housing managed by Public Housing Authorities (PHAs) are vulnerable to disasters. This study aims to describe barriers, facilitators, and opportunities for the implementation of disaster risk management (DRM) strategies at PHAs. Fifteen semi-structured key informant (KI) interviews with federal and state housing officials, PHA leaders, and housing non-profit staff were conducted and thematically analyzed. Interviewees mentioned financial and administrative hindrances, lack of policy, and lack of disaster training among PHA staff as notable barriers to engaging in DRM. Past disaster experience, interagency partnerships, and designated DRM roles at PHAs were introduced as facilitators for implementing DRM strategies.

Experiences of Turkish nurses volunteering in the disaster zone following the 2023 Türkiye-Syria earthquake.

The study aimed to determine the experiences of Turkish nurses who volunteered in the disaster zone following the 2023 Türkiye-Syria earthquake. The earthquake devastated 11 cities in Türkiye, which required a comprehensive humanitarian response. Despite the crucial role of nurses in crisis management, limited research exists on their experiences in earthquake zones. Nurses experience difficulties in disaster areas, such as physical conditions, lack of disaster plans, and inadequate disaster training before being deployed to earthquake areas. This study used a qualitative research model and case study design. Data were collected through in-depth qualitative interviews. Nine participants who had worked in earthquake zones for at least 5 days were included in the study. The discussions were recorded, transcribed verbatim, and analyzed thematically. The purposive sampling method was used, and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. As a result, 4 themes, namely physical conditions, psychosocial conditions, professional conditions, and organization, and their 14 subthemes were determined. This study revealed that nurses encountered difficulties related to physical conditions in earthquake zones. Moreover, the emotional burden expressed by the nurses highlighted the profound psychological impact of disaster response. This study determines that disaster preparedness and support for nurses should be enhanced to improve the arrangement of health services in future calamities. The results of this study can be used by nurse managers and healthcare policymakers to create nursing training programs that focus on disaster-related competencies.

Relationship Between Determinant Factors of Nurse Competency in Disaster Mitigation in 5 Community Health Centers in Ende

This research aims to determine factors related to nurse competency in disaster mitigation. This research is a descriptive analytical study with a cross sectional approach. The population in this study were all nurses in 5 Community Health Centers in Ende City. Sampling used a purposive sampling technique with an instrument in the form of a questionnaire. Data were processed using SPSS software with a multiple regression test. The research results showed that there was no relationship between age, gender, education level, length of service and participation in disaster training with nurses' competency in carrying out disaster mitigation. Meanwhile, the level of education and knowledge, length of service and attitudes and competence of nurses in disaster mitigation have a significant relationship

Determinants in disaster preparedness of nurses in the Azores

Abstract Background Disasters are situations of complexity and unpredictability, increasingly frequent and more destructive. They require rapid and effective action from different teams from different contexts, with preparation and qualifications for an adequate response to victims, recovering the environment, and restoring living conditions, and nurses play a significant role in these events. Understanding the level of preparedness of nurses for disasters is fundamental for defining the competency framework in the disaster management cycle. Objectives To analyze the preparation of nurses in the Azores for a catastrophe. Methods A cross-sectional study was performed with 160 nurses from the Azores. The questionnaire validated for the Portuguese population “Disaster Preparedness Evaluation Tool (DPET ®): Preparation of nurses in the face of a catastrophe” was applied. It was approved by the Ethics Committee. Results More than half of respondents (n = 137, 71%) indicated that they were not fully prepared to respond to disasters, while 29% (n = 46) acknowledged that they felt adequately prepared. Of the 160 respondents, only 20% (n = 30) participated in the development of emergency plans and only 14% (n = 22) participated in the creation of emergency plans that contribute to improvements at the local level. Training through simulation training was cited as important in disaster preparedness (n = 129, 78%). Discussion The present study identified little involvement of RAA nurses in preparing emergency plans and less than half feel poorly prepared in responding to a catastrophe. This finding is consistent with studies by Baker, Alamri, & Aboshaiqah (2019) and Emaliyawati et al. (2021). Conclusions This study was conducted in a region prone to natural disasters. It is vital to invest in the training of these professionals throughout the disaster cycle so that they can contribute to reducing the impact that the catastrophe will have on the individual/family and community. Key messages • Strengthening capabilities through regular disaster training based on effective information. • Low participation in the development of emergency plans that contribute to improvements at the local level.

Tohoku resilient schools and youth engagement in memory after 2011 tsunami

PurposeIn 2011, a disaster devastated the Tohoku region in Japan and left more than 15,000 victims. However, there could have been more. School buildings became a center of response and evacuation during the emergency, playing a central role in each disaster phase. How did the schools manage the situation in small Japanese communities and what lessons can be drawn? Disaster prevention education and training, rapid evacuation, survival in shelters and transmission of experiences to future generations are the key to disaster management in Japan. In the Tohoku area, these lessons are also connected with the history and memory of previous tsunamis.Design/methodology/approachFrom a local approach and socio-historical methodology, research is based on ethnographic fieldwork in disaster-affected communities, archival data collection and oral testimonies. Between November 2020 and March 2023, in-depth interviews were conducted with tsunami survivors, children and community leaders involved in disaster response during the months and years following the tsunami. The analysis focuses on disaster response in schools, survival and building capacities of youth during reconstruction through six case studies.FindingsThis research determines the importance of local history in tsunami management in Tohoku. It offers practical examples from each disaster phase for individuals and communities to face disasters and foster resilience. It reveals, on the other hand, how during the reconstruction process, a young generation embraced memory to reinforce disaster prevention for the future of the region.Originality/valueHighlighting the importance of including children and youth in disaster response, reconstruction and memory through applicable cases, this study provides a guide of school experiences in Japan that can become global lessons for disaster risk reduction (DRR).

Improve disaster literacy in nurses: a qualitative descriptive study.

The enhancement of nurses' disaster literacy is crucial for effective disaster emergency management, especially for clinical nurses with no prior experience in disaster rescue. This study aims to explore the perspectives of nurses who have been involved in disaster rescue operations on strategies to advance nurses' disaster literacy. A qualitative descriptive study, which follows unified qualitative study reporting guidelines. Thirty disaster rescue nurses were recruited to participate in this study, who came from 30 third-class hospitals in China. From October to December 2021, information was acquired by conducting semi-structured telephone interviews with participants. Qualitative content analysis was used to examine the data. Six categories and eleven subcategories were created. Strengthening disaster education and training was the main focus, and its subcategories included continuing education, nursing curriculum development, and disaster rescue experience guide. The second focus, which included scene simulation, actual combat/military simulation, and virtual reality simulation, was strengthening disaster simulation and drill. The third focus was on providing psychosocial support, which included improving self-psychological adjustment, developing resilience, and engaging in active coping. The fourth category was to strengthen nurse/hospital managers roles and leadership, which included enhancing professional identity and policies/leadership support. The fifth category was disaster preparedness, and the sixth was enhancing knowledge transformation. Government agencies or healthcare organizations should actively promote the formation of nurses' disaster literacy from multiple viewpoints. Disaster education and training, simulation exercises, and psychosocial support should be prioritized.

Disaster Risk Perception and Sustainable Earthquake Awareness Among Public and Private University Nursing Students.

This research was conducted in descriptive type to determine the disaster risk perception and sustainable earthquake awareness of nursing students studying at public and private universities. The study sample consisted of 400 nursing students studying at one public and one private university. The research was conducted between April and May 2023. The data were collected using a Sociodemographic Form, University Students Disaster Risk Perception Scale (USDRPS), and Sustainable Earthquake Awareness Scale (SEAS). Data were collected online using a questionnaire created on Google Forms. Analyses included frequency, percentage, mean, standard deviation values, independent groups t-test, post-hoc Tukey test, LSD, and ANOVA test. Of the students, 61.8% had a disaster experience, 17.4% had lost a relative in the disaster, and 76.8% did not consider themselves prepared for a possible disaster. In the study, the exposure sub-dimension score of the disaster risk perception scale was found to be higher in students who had disaster experience than in those who did not (p=0.032). Nursing students from the private university had higher sustainable earthquake awareness scores than those studying at the state university (p=0.001). The mean scores of female students on the earthquake preparedness and preparation application sub-dimensions showed a significant difference compared to the scores of male students (p=0.016). In the study, sustainable earthquake awareness total and earthquake preparedness sub-dimension scores were higher in second-year nursing students than in students of other years (p=0.042; 0.015). Those who had received disaster training had low scores on the uncontrollable sub-dimension of the disaster risk perception scale, and high scores on the total SEAS and earthquake-structure relationship, earthquake preparedness, and earthquake preparation application sub-dimensions (p<0.05). In the study, three out of four students did not find themselves prepared for disasters. Those who had disaster experience had higher disaster risk perceptions. Students who had received disaster-related training had more positive earthquake preparedness, earthquake-structure relationship, and earthquake preparation applications than those who had not. Students who were female and were in the second year had higher earthquake awareness. Studies can be carried out to inform people about the pre-disaster and preparation stages to raise awareness about disasters at universities. Education on disaster management can be integrated into courses from the first years of university.

Pelatihan Manajemen Bencana Dengan Table Top Disaster Simulation: Perintisan Desa Siaga Bencana di Kabupaten Musi Rawas Sumatera Selatan

Minimizing the impact that occurs due to disasters, and preparing for the possibility of a disaster occurring is the most important thing that must be done, including preparing human resources to be ready to face the disaster itself. One form of preparing society to be able to respond well to disasters is by providing good education and training on how to respond to disasters. Table Top Disaster Simulation is an effective education and training method for preparing human resources. This activity aims to increase community knowledge about disaster management as part of the Disaster Preparedness Village pilot in Air Satan Village, Musi Rawas Regency, South Sumatra. This activity is community service using education and training methods with a total of 33 participants. Participants' disaster management knowledge was measured before and after attending education and training using a questionnaire. The evaluation results showed that there was an increase in knowledge before being given the training with the average knowledge score of participants being 44.71, while after being given the training the average knowledge score was 78.32. After conducting education and training using tabletop disaster simulation, public knowledge about disaster management increased. It is hoped that after this pioneering disaster preparedness village activity, education and training will continue to be carried out on other factors in responding to disasters such as training on handling injuries for lay people, training on handling drowning victims for lay people, and so on.

Factors related to evacuation intention when a Level 4 evacuation order was issued among people with mental health illnesses using group homes in Japan: A cross-sectional study.

This study aimed to identify factors related to the intention to evacuate in a disaster following a Level 4 evacuation order among people with mental health illnesses living in group homes in Japan. The participants were people with mental health conditions living in group homes in Ishikawa Prefecture, Japan. We created an original self-administered questionnaire and conducted a survey among this group. Of the 625 people with mental health conditions using group homes, 152 (24.3%) responded. Of these, 110 (5.9%) who provided valid data were included in the analysis. A total of 85 (77.3%) people said that they intended to evacuate in the event of a Level 4 evacuation order. We controlled for gender, age group, type of disability, experience of participating in disaster training, fear of contracting COVID-19 during evacuation, and earthquake and flood disaster experience as confounders. After controlling for these variables, the factors associated with intention to evacuate under a Level 4 evacuation order included not having emergency food prepared (odds ratio [OR] 3.81, 95% confidence interval [CI]: 1.03-14.08); believing that group home users would help them during disasters (OR 3.08, 95% CI: 1.04-9.12); and planning to ask the local government for help (OR 2.84, 95% CI: 1.01-8.01). Group home managers should be aware that people who do not believe that other group home residents would help them, and those not wishing to seek help from local government, may decide not to evacuate. Longitudinal studies across diverse regions are needed to identify factors that affect evacuation intention.

Development and testing of the spiritual first aid curriculum for training disaster care providers: An initial pilot effectiveness study.

Development and testing of the spiritual first aid curriculum for training disaster care providers: An initial pilot effectiveness study.

Factors Associated with Nurse Preparedness in Handling Disaster Victims in Central Sulawesi

Several factors influence nurses' preparedness in handling disaster victims. This study aims to identify the factors associated with nurses' preparedness to manage Central Sulawesi disaster victims. Conducted between April and July 2023, this cross-sectional quantitative study involved 124 nurses from Undata Hospital, Anutapura Hospital, Madani Hospital, Bhayangkara Hospital, and Dr. Sindhu Trisno Hospital, selected through total sampling. Preparedness was measured using the Disaster Preparedness Evaluation Tool (DPET). At the same time, knowledge, attitudes, and experiences in disaster management were assessed with the Knowledge, Attitude, and Practices of Disaster Management (KAP DM) questionnaire. Data were analyzed using chi-square and linear regression tests. The chi-square results indicated significant relationships between preparedness and knowledge (p=0.004), attitude (p=0.045), length of service (p=0.037), participation in disaster training (p=0.004), and experience in disaster management (p=0.028). At the same time, education level showed no significant relationship (p = 0.075). Linear regression revealed that knowledge had the strongest influence on preparedness. The study concludes that knowledge, attitudes, length of service, disaster training, and disaster management experience are key factors affecting nurses' preparedness. It is recommended that emergency nurses regularly participate in disaster-related training to enhance their ability to provide timely medical assistance, thereby reducing disaster-related mortality.

Disaster Protection Education and Training Concepts and Policies

In the context of natural human rights, the foundation of the modern state, as well as the systems approach, relevant basic concepts and state policies have been generated to increase the effectiveness of disaster and crisis protection education and training. Their goals for increasing the effectiveness of officials training in the state and local administration, as well as the population for disaster and crisis response, are substantiated. An organizational-cultural approach to the formation of an appropriate, citizen engaging, cultural model for more effective achievement of these goals has been considered. As an important system-forming element, a key regulatory framework for disaster protection, which must be known and applied by the state and local administration, as well as the population, is analyzed. On this basis, necessary and relevant concepts and policies to increase the effectiveness of disaster and crisis protection education and training are derived and substantiated.

Determination of individual disaster resilience levels of hospital staff: A case study of Kartal Dr. Lütfi Kirdar City Hospital

Istanbul is one of Turkey's most important financial and industrial centers, and it is located in a region with a high potential for seismicity. Due to its historical architecture and high level of urbanization, the city has a large population and is particularly vulnerable due to the building stock that will be affected by earthquakes. In the event of a possible earthquake in Istanbul, it is crucial that the hospital staff have high levels of disaster resilience/resilience. This is particularly important given the seismically isolated and earthquake-resistant structure of Istanbul Kartal Dr. Lütfi Kırdar City Hospital and its capacity to serve those injured by the earthquake. This study examines the resilience levels of hospital staff at Kartal Dr. Lütfi Kırdar City Hospital in the face of earthquake disasters and the various factors that affect these resilience levels. The data for this study were collected using a 13-question personal information form and the ‘Individual Disaster Resilience Assessment (IDRA)’ scale developed by DiTirro (2018). Descriptive statistics, Pearson Chi-square tests, Independent Samples T-tests, and One-Way ANOVA were used to analyze the data. The research found that the hospital staff's IDRA scores averaged 3.27. It was concluded that the mean resilience score of the participants was above the medium level. The research findings show that receiving disaster training or being prepared for disasters in advance significantly influences individual resistance/resilience. In this context, it is essential to determine the earthquake resistance levels of all healthcare workers in Istanbul, especially those at the city hospital where the study was conducted. Necessary training should be provided, and simulation-based disaster drills should be planned and integrated into in-service training programs. Additionally, projects should be developed to ensure that healthcare workers can reach their hospitals safely during disaster situations.

Strengthening Community Disaster Education for Disaster Mitigation

Indonesia, particularly Java Island, is highly vulnerable to natural disasters, which have frequently resulted in significant loss of life, property damage, and fatalities. Given this high level of risk, it is crucial to enhance community preparedness to mitigate the impacts of such disasters. This paper highlights the critical role of disaster education in effective disaster mitigation efforts. Utilizing a library research methodology, this study involved a comprehensive review of literature, including books, journals, and secondary data related to disaster education. The findings indicate that there is currently no standardized method for delivering disaster education. Instead, various approaches are employed, including disaster training programs, awareness campaigns, seminars, simulations, and exhibitions. These alternative methods aim to improve public knowledge and preparedness, although a unified and systematic approach is still lacking.

Effects of Immersive Technology-Based Education for Undergraduate Nursing Students: Systematic Review and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach.

The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs. This systematic review aimed to identify the contents of immersive technology-based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods. A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latest search was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Quality assessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool for Nonrandomized Studies. The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevant literature. A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home health care; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on the NWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in the selected studies. Results of the subgroup analysis showed that immersive technology-based nursing education is more effective than traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70, 95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%). These findings support the effectiveness of immersive technology-based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluate the effects of immersive technology-based nursing education on NWKM level 4.

Design of Online Digital Disaster Training Program for Pre-Service Teachers

At the basic education level, content related to disasters is included in the scope of courses such as Life Sciences, Science, and Social Studies. Studies reveal that teachers and pre-service teachers who conduct these courses are not equipped with the necessary technological and pedagogical skills. It is predicted that integrating disasters and disaster education, which have an interdisciplinary structure, with Web 2.0 technologies, one of today's digital learning tools, will make significant contributions to making disaster education effective. In this framework, the study aimed to design a "Digital Disaster Education Program" in an online learning environment for pre-service primary school, science and social sciences teachers. The study consists of three main parts: designing, implementing, and evaluating the Digital Disaster Education Program. Taba (Grassroots Rationale) model was used in the design of the program. The program, which had a five-day implementation period in the online environment, was repeated three times on different dates and with different participants within a year. In each implementation, 24 pre-service social studies, 24 pre-service science, and 24 pre-service primary school teachers (72 pre-service teachers in total) from across Turkey participated voluntarily. The digital disaster education materials developed by the participants during the program were evaluated with an analytical rubric. As a result, an example of Web 2.0 supported online disaster education programme based on Taba Model has emerged. After the evaluation process, some of the participant products were entitled to receive support by being projected toThe Scientific and Technological Research Council of Türkiye (TÜBİTAK), which is one of the reflections of the positive results of the process. At the end of the study, suggestions were presented for the acquisition of disaster education and digital teaching skills in the pre-service process.

A Systematic Review of the Efficacy of Full-Scale Simulation Exercises in Enhancing Hospital Disaster Preparedness

Introduction: A full-scale simulation exercise is a comprehensive drill designed to replicate a real-world emergency scenario, thereby identifying the strengths and weaknesses in current practices. The overarching goal is to enhance healthcare system resilience through improved protocols, as highlighted in this systematic review tailored for researchers. The study aims specifically to assess the impact of full-scale simulations on enhancing hospital disaster plans. Methodology: Following PRISMA guidelines, this systematic review investigates the impact of full-scale simulation exercises on hospital disaster preparedness. The focus was on hospital staff involved in disaster and emergency preparedness training. The primary intervention was the execution of full-scale simulation exercises, and our research included various study designs, including randomised controlled trials and observational study designs. A comprehensive electronic database search was conducted, spanning PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials, from inception until October 9, 2023. The risk of bias was assessed using NIH tools. Results: The literature search yielded 2398 results, with 28 publications finally included in the systematic review. Summarising a broad range of disaster preparedness simulation exercises with a specific focus on full-scale simulation (FSS), the studies consistently demonstrated a positive impact on participants' skills, as well as identifying safety issues in hospital settings. Moreover, they revealed that simulations effectively addressed crucial areas for improvement in disaster response, including communication breakdowns, equipment deficiencies, and flaws in emergency plans. The studies utilised a multidimensional approach to evaluation metrics, encompassing non-technical skills, communication, teamwork, decision-making, and operational readiness. The exercises varied in duration from 30 minutes to multi-day simulations, covering a diverse range of disaster scenarios, such as mass casualties, viral epidemics, large aviation accidents, and terrorist attacks. Conclusion: Full-scale simulation exercises are a preparatory learning tool to test facility and staff readiness for complex emergencies. This systematic review focused on the different exercise scenarios used to address critical aspects of disaster response such as communication breakdowns, equipment deficiencies, and flaws in emergency plans. The scenarios and their duration were varied, and involved a multidimensional approach to evaluation. Such exercises enhance critical thinking and problem-solving skills, increase familiarity with potential emergencies, and build confidence in making judgments in real-world situations. In our opinion, there is a need for further programs that align simulation exercises with community resources for better preparedness in the face of public health disasters.

Metaverse: A New Opportunity in Emergency and Disaster Training

Metaverse: A New Opportunity in Emergency and Disaster Training

Evaluation of an On-Site Disaster Medical Management Course in Nepal.

The great 2015 Nepal earthquake of magnitude 7.6 killed about 9000 people. To better ensure a more coordinated disaster response, a Basic On-Site Disaster Medical Support (BOS-DMS) course was designed in 2017. This study evaluates the effectiveness of the BOS-DM course. The course was conducted twice and attended by 135 participants, of whom 113 (83.7%) answered pre-test and post-test based multiple-choice questions. Qualitative and quantitative feedback was provided by 94 participants (69.6%). Mean test scores for the participants increased from 4.24 ± 1.42 to 6.55 ± 2.16 (p-value < 0.0001; paired t-test). More than 92.0% of participants felt that the course prepared healthcare workers to manage acute medical situations at a disaster site. Subject knowledge scores increased from 34.8% to 90.2%. A three-day BOS_DMS course has the potential to improve on-site disaster management knowledge. Our study noted that precise scheduling, making attendance compulsory, translating course materials into the local language, inclusion of disaster exercises and training local master trainers can enhance course effectiveness.

Jordanian nurses’ competencies in providing community care during disaster: a cross-sectional survey

Purpose The purpose of this paper is to assess the perceived level of Jordanian nurses’ competencies in offering care to the community during a disaster. Design/methodology/approach A correlational descriptive design was used to assess nurses’ competencies in offering care for the community during a disaster. Findings A total of 370 nurses (55 % males) aged 25−55 agreed to participate. The mean score of competencies of nurses who offer care to the community during the disaster was 2.11 (SD = 0.59) points. The results of correlation coefficient tests revealed a significant positive correlation between stated competencies level and nurses’ sex, receiving disaster education and training with rpb (371) = 0.13, p &lt; 0.01; rpb (598) = 0.15, p = 0.004; rpb (598) = 0.21, p &lt; 0.001, respectively. Furthermore, the “care of communities” subscale had a weak positive correlation with the. Originality/value Nurses play a critical role in disaster response. However, there was a gap in nurses’ competencies for disaster, which shows there is a crucial need to include disaster management courses in the nursing curriculum and update disaster management courses in hospitals based on nurses’ needs to improve their competencies during disasters.