Disasters, either man-made or natural, are occurring more frequently around the world.^{Reference Wise1} No country is considered immune from them or any other catastrophic events.^{Reference Veenema2} Disasters can take place anywhere in the world, at any time, and cause extensive damage to resources and goods, especially homes, health care facilities, vehicles, transport, and communication networks.^{Reference Jose and Dufrene3} Approximately, there has been a 60% increase in disasters worldwide in the last 10 years. These disastrous events have left 2 million people dead, 4.2 million casualties, and 3.3 million people homeless.^{Reference Achora and Kamanyire4} Although disasters have had a harsh impact on peoples’ belongings and their surroundings, the ensuing morbidity and mortality rates require health care professionals to respond as effectively and as efficiently as possible.^{Reference Sloan5}

Disaster and mass casualties differ from ordinary emergency situations, necessitating extraordinary efforts to equip nurses with knowledge and skills that will prepare them to respond effectively.^{Reference Hubloue and Debacker6} Furthermore, for health care professionals, disaster management is a challenging situation in different settings^{Reference Conlon and Wiechula7} in which professionals, especially nurses, play an important role in all of the phases, such as planning, mitigation, and responding to medical consequences of a disaster or other community crisis, whether natural or man-made.^{Reference Conlon and Wiechula7}

Because nurses are expected to demonstrate basic competency in responding to disastrous events, they should be competent in their response to mass casualty incidents,^{Reference Yan, Turale, Stone and Petrini8} especially as nurses are often the first health care providers to respond in catastrophic situations.^{Reference Conlon and Wiechula7} Many studies have reported a low level of nursing preparedness in responding to and managing major disaster events.^{Reference Jose and Dufrene3,Reference Conlon and Wiechula7,Reference Austin, Hannafin and Nelson9-Reference Ranse, Shaban and Considine11}

An effective disaster response can be achieved by efficient preparedness, which can be accomplished through several methods, including mock drills, workshops, continuous education sessions, and the incorporation of disaster management contents into the nursing curriculum.^{Reference Baack and Alfred12} Preparing future nurses (current nursing students) to intervene appropriately in such situations is a dominant concern in nursing education.^{Reference Jose and Dufrene3} Nursing education plays a significant role in preparing nurses for a disaster because it helps in increasing their knowledge on disasters through research efforts and increasing the effectiveness of their response during a disaster.^{Reference Veneema, Losinski, Newton and Seal13} Integration of disaster preparedness content into undergraduate nursing curricula prepares the ensuing generation of nurses for disaster events in the future.^{Reference Al Thubaiti, Hamouda and El Seesy14} Other studies indicated that, through collaborative partnerships with hospital authorities and educational institutions, specific courses could be undertaken to assist professional nurses to be better prepared for disasters.^{Reference Halstead15,Reference Loke and Fung16} Furthermore, nurses emphasized the need to integrate disaster training in undergraduate curricula.^{Reference Al Khalaileh, Bond and Alasad17} One of the most important components of preparing nurses for a disaster is by integrating disaster preparedness contents in undergraduate nursing curriculum.^{Reference Al Khalaileh, Bond and Alasad17-Reference Öztekin, Larson and Altun Uğraş19}

Nursing educators should be equipped with knowledge and skills to employ an effective approach to responding to disasters.^{Reference El-Hosany and Ghonem20} They should also plan to prepare nursing students for disasters and emergency situations.^{Reference Ranse, Shaban and Considine11} Further research needs to focus on nursing educators to identify their perception toward the importance of disaster preparedness and the needs for disaster preparedness and management, in general.^{Reference Al Thubaiti, Hamouda and El Seesy14}

Nevertheless, a lack of undergraduate educators’ capacity to teach disaster management courses has been found,^{Reference Bajow, Djalali and Ingrassia21} despite their recognition of the importance of integrating such courses in nursing curricula.^{Reference Whitty and Burnett22} However, there is no evidence of the integration of disaster contents in nursing curricula in countries in the Africa and Middle East regions, except some nursing programs in Jordan, Turkey, and Iran.^{Reference Al Khalaileh, Bond and Alasad17,Reference Öztekin, Larson and Altun Uğraş19,Reference Zarea, Beiranvand and Sheini-Jaberi23}

Jordan, like all other countries, is vulnerable to all types of disasters. Despite the fact that Jordan has been relatively stable, nearby, an active Syrian civil war makes Jordan open to the threat of terrorist attacks. Coupled with this, Jordan is receiving huge numbers of refugees. Any potential event may overwhelm the available goods and supplies and consequently make Jordan unable to effectively manage a disaster.

Because education in disaster management is the cornerstone of preparedness, nursing educators can play a crucial role in preparing their students to respond effectively and efficiently to a catastrophe, if they perceive disaster preparedness as very important. As a response to the World Health Organization (WHO) and the International Council of Nurses’ (ICN) call for integration of disaster management, courses in basic nursing education came into existence in 2009. A 3-day workshop to develop nursing competencies held in cooperation with Jordanian Nurses Council was undertaken. To date, several Jordanian universities include different mandatory or elective disaster management courses as part of their basic nursing program (University of Jordan, Mutah University, Applied Sciences University, and Al al-Bayt University) in order to raise the awareness toward disaster management (Abu Safi, 2018, unpublished doctoral dissertation).

Determining the actual attitude and perception of nursing educators toward disaster preparedness can help in the integration of disaster management in nursing curricula. Thus, the main purpose of the current study was to explore the attitudes of nursing educators on baccalaureate degree nursing programs in Jordan toward the integration of mass casualty and disaster preparedness into nursing curricula.

RESULTS

Data were analyzed using the Statistical Package for Social Science (SPSS), version 22 (IBM Corp, Armonk, NY); according to the research questions, descriptive statistics were used to summarize central tendencies and frequencies. Correlation of nursing educators with some demographic data was also tested.

One hundred thirty-one (131) questionnaires distributed were returned with a response rate of 87%. Around two-thirds (62%) of participants were female, ages 25-26, and two-thirds (66%) currently worked in governmental universities with approximately two-thirds (68%) reporting more than 5 years of experience in clinical nursing. Seventy-three held a doctoral degree, and 58 held a master’s degree in nursing. Most of the participants (65%) had more than 5 years’ teaching experience. Nearly half (48%) teach adult health nursing, 23 (17.5%) teach women’s health, 21 (16%) teach community health, 14 (10.7%) teach mental health, and only 9 (6.8%) teach children’s health (Table 1).

TABLE 1

Nurse Educators Demographics Characteristics (N = 131)

To find out the training received by nursing educators related to disaster management, participants were asked to indicate their response to particular questions related to reading professional journal articles regarding disaster, undergoing continuing education regarding nursing disaster management, participating in emergency response mock disaster drills, and participating in real disasters. Seventy-two (55%) of participants had read no articles about disasters or disaster management, and 59 (45%) had read such articles. Only 30 (23%) participants had participated in continuous education programs regarding disaster management. The majority (81.7%) of participants had never participated in emergency response or mock disaster drills. Only 7 (5.3%) participants had participated in real disaster events (Table 2).

TABLE 2

Life Experiences Regarding Disaster Incidents as Reported by Nurse Educators (N = 131)

In order to find out Jordanian nursing educators’ perceptions regarding the importance of incorporating a disaster management course in the nursing curriculum, participants were asked to rate their responses to 51 items on a 5-point scale of the Likert scale with the following values: 1= not at all important, 2 = slightly important, 3 = fairly important, 4 = quite important, and 5 = very important. Responses indicated that the majority of participants perceived the integration of disaster courses in the nursing curriculum as quite important. According to their responses, the least important item was “Define terms relevant to disaster” (M = 3.68, SD = 0.978). The most important item was “Demonstrate basic first aid skills” (M = 4.46, SD = 0.787). Table 3 shows the mean of all items.

TABLE 3

Importance of Integrating Disaster Management in Nursing Curriculum (N = 131)

To examine the differences in the total mean in the primary teaching area, years of teaching experience, years of nursing experience, and age, it was intended to use analysis of variance (ANOVA). However, it was inappropriate because of the violation of the ANOVA assumption of “equal group and homogeneity of variance.” The Kruskal-Wallis test was used instead, which showed no significant differences among nursing educators in terms of their primary teaching area, years of teaching, years of nursing, and age (H [4] = 3.29, P = 5.11; H [3] = 4.37, P = 0.224; H [3] = 5.9, P = 0.117).

To examine the differences between males and females regarding the total mean score, a t-test was conducted; it showed significant differences (t = 2.29, P = 0.024) with females doing better than males. However, no significant differences were found regarding the type of university (private or public) or the level of education (masters or doctorate). Finally, no correlation was found between total mean and participants’ ages (r = 07, P = 4.08).