Discussion

Natural disasters are common worldwide and have long-term impacts on individuals, families, communities, and the environment. ^{Reference Bayrak Aykan, Eren Fidancı and Yıldız13} Due to rapid population growth, deterioration of natural balance with urbanization, global warming, and climate change, disasters are increasing and affecting various countries. ^{Reference Oral and Cengiz1,Reference Bayrak Aykan, Eren Fidancı and Yıldız13} All around the world (2020), 500 natural and human-induced disasters have occurred, affecting 998,647,04 people and causing 17,664 deaths and 19,444 injuries. In Turkey, 15 disasters have been recorded in 2020, where 76,995 people were affected, 3022 people were injured, and 349 people died. ^{Reference Şimşek and Gündüz14} It is a well-known fact that extraordinary situations caused by disasters cannot be prevented or controlled. Therefore, it is vital that various groups, including health-care professionals and community organizations, are prepared for disasters in an effective fight against disasters. ^{Reference Bayrak Aykan, Eren Fidancı and Yıldız13} Nurses, who constitute the largest group among the health-care personnel in Turkey, as in the whole world, usually work in difficult situations with limited resources and assume vital roles whenever disasters ocur. ¹⁵ According to the data from Turkey (2020), there are 733,888 health-care professionals, 227,292 of which are nurses. ^{Reference Birinci and Ülgü16} Nurses assume a critical role in the disaster process. ^{Reference Unver, Basak and Tastan17} In this study, which is conducted to determine nurses’ perceptions of disaster preparedness, the preparation phase sub-dimension of nurses is determined as 4.40 ± 0.62, the intervention phase sub-dimension is determined as 3.45 ± 0.74, the postdisaster phase sub-dimension is determined as 3.76 ± 0.72, and the total score of NPDPS is determined as 3.81 ± 0.54. In the study by Tercan and Şahinöz, the NPDPS total scale score was determined as 3.68 ± 0.53, the preparation stage score was determined as 4.19 ± 0.75, the intervention stage score was determined as 3.40 ± 0.68, and postdisaster stage score was determined as 3.58 ± 0.72. ^{Reference Tercan and Şahinöz18} Different scales have been used in different studies to measure the disaster preparedness of nurses, and the common finding is that nurses are not prepared enough for disasters. All studies reported that nurses were prepared at low and moderate. ^{Reference Al Khalaileh, Bond and Alasad19–Reference Labrague, Hammad and Gloe32} Wang et al. (2021) argued that nurses’ perception of disaster preparedness was moderate. ^{Reference Wang, Sun and Lu33} In this study, the disaster preparedness scores of the nurses are determined as moderate.

This situation increases their awareness, self-confidence, and skills in disaster intervention and reduces their vulnerability to unforeseen phenomena. ^{Reference Taşkıran and Baykal9} In this study, it was determined that nurses who experienced disasters had higher NPDPS preparation stage sub-dimension scores and NPDPS total scores. Studies have attributed previous disaster intervention experiences to a higher perceived level of disaster preparedness. ^{Reference Al Thobaity, Plummer and Innes20,Reference Baack and Alfred21,Reference Nilsson, Johansson and Carlsson26,Reference Tzeng, Feng and Cheng29,Reference Usher, Mills and West30} Baack and Alfred (2013) reported that nurses’ previous experiences with major disasters affected their perceived competence in disaster preparedness. ^{Reference Baack and Alfred21} It is consistent with the findings of O’Sullivan et al. (2008). ^{Reference O’Sullivan, Dow and Turner34} They found that nurses who had previously been exposed to infectious disease outbreaks, including severe acute respiratory syndrome (SARS) in 2009, had higher levels of disaster preparedness perception. ^{Reference Labrague, Hammad and Gloe32}

Nurses assume important and critical roles in their care for disaster preparedness, their active role in the disaster, and maintaining the health and welfare of society. ^{Reference Unver, Basak and Tastan17,Reference Tercan and Şahinöz18} Nurses need to know their roles to fully fulfill their duties and responsibilities in disasters. Nurses should follow up-to-date education and technology to provide individuals, families, and communities with high-quality health care during and after disasters. It was predicted that nurses who were prepared for disasters and received training on disasters could play an essential role in the event of disasters and cope better with disasters. ^{Reference Veenema35} The nurses who participated in the disaster drills had a higher NPDPS intervention and postdisaster stage sub-dimension score and the NPDPS total score, the nurses who perused the unit disaster plan had a higher NPDPS intervention stage sub-dimension score and the NPDPS total score, and the nurses who stated to assume a role before the disaster had a higher NPDPS score. It was determined that the intervention stage sub-dimension mean score was higher and the total score of NPDPS was higher for the nurses who stated to assume roles following the disaster (P < 0.05). Bayrak Aykan et al. (2022) determined that the disaster preparedness of nurses who received disaster preparedness training was 3571 times higher than those who did not, ^{Reference Bayrak Aykan, Eren Fidancı and Yıldız13} and nurses who participated in disaster drills had higher preparedness perceptions. ^{Reference Tercan and Şahinöz18} Tzeng et al. (2016) found that nurses with previous disaster training reported higher personal preparedness for disaster intervention. ^{Reference Tzeng, Feng and Cheng29} Similarly, Al Thobaity et al. (2015) asserted that the majority of respondents reported that most of their disaster management knowledge and skills were acquired from real-time drills and disaster training. ^{Reference Al Thobaity, Plummer and Innes20} It is expected that nurses who participate in disaster education are more likely to have sufficient knowledge and practice. Some studies in the literature, which support our research results, indicated that health-care staff who have acquired disaster experience by receiving training on disaster or participating in drills have a high perception of disaster preparedness. ^{Reference Tercan and Şahinöz18,Reference Baack and Alfred21,Reference Rizqillah and Suna36} In the study of Wang et al. (2021), 2 of the main factors associated with disaster preparedness were expressed as disaster education and disaster drill experience. ^{Reference Wang, Sun and Lu33} Sattar et al. (2018) found that a positive change occurred in the knowledge and attitudes of nursing students following disaster education. ^{Reference Sattar, Zahra and Mohamed37} In this study, it was seen that education and disaster drills positively affected nurses’ perceptions of disaster preparedness.

If nurses and other health professionals have sufficient knowledge and equipment to prepare for disasters; they can provide faster planning and service. ^{Reference Tercan and Şahinöz18} In this study, a statistically significant relationship is found between the last school from which the nurses graduated and the NPDPS intervention and postdisaster stage sub-dimension mean scores and the NPDPS total scale score (P < 0.05). High school graduate nurses’ NPDPS intervention and postdisaster stage sub-dimension mean scores and NPDPS total scale mean score are higher than other education groups. This may have been due to the fact that high school graduate nurses had been nurses for a long time. During this period, the nurse’s participation in information regarding disasters with more courses and training programs may have affected the preparedness perception score.

It is quite important for the health-care professionals working in hospitals to intervene and care for the injured during and after the disaster. Therefore, planning should be done before disasters occur. In this study, it is determined that more than half of the nurses are aware of the unit disaster plan, and this group has better perceptions of disaster preparedness. In the literature, nurses’ awareness of workplace disaster protocols or plans has been addressed as a factor in disaster preparedness. ^{Reference Al Khalaileh, Bond and Alasad19,Reference Duong22,Reference Fung, Loke and Lai23,Reference Labrague, Yboa and McEnroe-Petitte25,Reference Öztekin, Larson and Akahoshi27,Reference Whetzel, Walker-Cillo and Chan31} In 4 studies, the majority of nurses reported that they were aware of the existence of a disaster management protocol in their workplace. ^{Reference Duong22,Reference Fung, Loke and Lai23,Reference Öztekin, Larson and Akahoshi27,Reference Whetzel, Walker-Cillo and Chan31} In 3 different studies conducted in Turkey, it was stated that 76.1%, 68.4%, and 83.4% of nurses were aware of the hospital’s disaster plan, and more than half of those who have knowledge perused that plan. ^{Reference Çakmak and Er Aydın Rahmiye11,Reference Tercan and Şahinöz18,Reference Vatan and Salur38} In the study by Fung et al., it was determined that 61% of the nurses perused the hospital disaster plan. ^{Reference Fung, Loke and Lai23} The perusal of the disaster plan and awareness of what to do in the presence of a disaster enables nurses to effectively manage this process. In this process, being familiar with the disaster plan may have eliminated the uncertainty and positively affected the perception of disaster preparedness.

Institutions should provide training opportunities for nurses in terms of disaster preparedness. If nurses are well aware of the planning and execution processes of disaster management at the top levels of the country, they can more easily ensure that the disaster plans they prepare at the personal/institutional level are compatible with the national disaster plans of the country prepared for the general public. In this study, disaster preparedness as a nurse and hospital affected the NPDPS total scale and sub-dimension scores. It is imperative that nurses become a part of their local or national disaster management programs. All nurses should improve their professional skills in providing adequate health-care services before, during, and after disasters by participating in prevention, mitigation, preparedness, and assistance activities. Participation of nurses in disaster prevention, mitigation, preparedness, and recovery activities is recommended because they are ecpected to enhance their professional skills to provide adequate health services before, during, and after disasters. ^{Reference Taşkıran and Baykal9}

Health systems and health-care delivery in disaster situations would be only successful when nurses have basic disaster competencies or the skills to intervene quickly and effectively. ¹⁵ In this study, a statistically significant relationship is found between the ability to perform basic first aid practices, the ability to initiate appropriate isolation and decontamination procedures in case of CBRN exposure, the ability to evaluate the transport status of the injured individual, the ability to evaluate the psychological reactions of the affected individuals and disaster response officers during or after the disaster, and the NPDPS total scale score, and those who stated that they could have these competencies and teach them to others has a higher NPDPS total mean score. Nurses provide assistance and care throughout the disaster process to minimize the health-related hazards and life-threatening damages that may occur during and after the disaster. For disaster nurses to provide the expected service, they should have knowledge of various issues in the field of disaster nursing. ^{Reference Akpınar and Ceran39} For disaster intervention; real-time exercises, desk exercises, drills, drills, and scenarios are determined as necessary to prepare nurses for disasters. ^{Reference Duong22,Reference Labrague, Yboa and McEnroe-Petitte25} Nurses assume roles such as being prepared for disasters, participating in disaster management in terms of intervention, effective management, performing postdisaster care functions, and making efforts for the health and welfare of society. ^{Reference Taşkıran and Baykal9,Reference Fung, Loke and Lai23} Studies have indicated that most nurses do not consider themselves ready to intervene in disasters, and their education and skills are not at a sufficient level to make disaster-based interventions. ^{Reference Al Khalaileh, Bond and Alasad19,Reference Fung, Loke and Lai23,Reference Labrague, Yboa and McEnroe-Petitte25,Reference Fothergill, Palumbo and Rambur40,Reference Seyedin, Abbasi Dolatabadi and Rajabifard41} In this study, it is crucial for nurses to consider themselves sufficient in terms of physical and psychological intervention in the event of a disaster.

Disasters can cause a great deal of harm to society. It is clear that nurses need more training on various aspects of emergency preparedness. Disaster preparedness, which is an emergency for a nurse, requires technical competencies such as basic scientific knowledge, disaster experience, and disaster drills. ^{Reference Bayrak Aykan, Eren Fidancı and Yıldız13} In this study, the NPDPS total scale scores of the nurses who have attended or continue to attend disaster management training, first aid training, field triage training, basic life support training, have previously participated in advanced cardiovascular life support training, trauma advanced life support training, adult advanced life support training, advanced life support training in children, posttraumatic mental care training, infection control training, communication training in disaster and crisis situations, and training for all courses, are determined as higher. Although Özdemir and Sarıkamış (2006) stated that quite a high ratio of 83% of the health-care staff working in the emergency departments of university hospitals in Ankara was not familiar with triage; in a study conducted on 823 nurses in Japan, it was stated that 31% of nurses were not familiar with triage. ^{Reference Özdemir and Sarıkamış42,Reference Demirbaş, Sezer and Ergun43} In separate studies conducted in the Philippines ^{Reference Labrague, Yboa and McEnroe-Petitte25} and Hong Kong, ^{Reference Fung, Loke and Lai23} nurses identified first aid training, field triage, advanced basic life support, and infection control as necessary training needs to prepare nurses. ^{Reference Duong22,Reference Labrague, Yboa and McEnroe-Petitte25} Labrague et al. (2016) and Baack and Alfred (2013) suggested that nurses should have been offered opportunities to participate in disaster education and real-time drills to develop their confidence and familiarity with intervening in disasters. ^{Reference Baack and Alfred21,Reference Labrague, Yboa and McEnroe-Petitte25} Nurses work actively in tasks such as determining priorities in disasters, triage, and acute care. ^{Reference Demirbaş, Sezer and Ergun43} Therefore, nurses should have the knowledge and competence to intervene effectively in providing physical and psychological care in the field or in hospitals during disasters. Although effective education and training are believed to be crucial to prepare to provide disaster care and maintain a confident nurse workforce, current evidence has not proven to be successful in education and training. ^{Reference Tas and Cakir44} Considering the dynamic process of education, it is essential to update nurses’ knowledge with continuing education programs.

Upon examining natural disasters all around the world, it is seen that 28 of 31 natural disasters are meteorological disasters. According to 2020 AFAD data, 321 earthquakes, 270 storms, hail, extreme winter conditions, 177 floods, and 107 landslides occurred in Turkey. ^{Reference Bayrak Aykan, Eren Fidancı and Yıldız13} In this study, a statistically significant relationship is found between the situation of encountering a terrorist attack and experiencing an earthquake and the NPDPS total scale score (P < 0.05). Earthquake ranks first among the natural disasters frequently experienced in Turkey. In this study, 94.6% of the nurses define disasters as natural disasters such as earthquakes, landslides, and avalanches. A total of 85.4% of the nurses stated to assume a caregiver role during the disaster. In this study, 94.6% of the nurses defined disasters as natural disasters such as earthquakes, landslides, and avalanches. Tercan and Şahinöz (2021) defined a disaster as a natural disaster. ^{Reference Tercan and Şahinöz18} The type of disasters encountered by nurses may also have affected their perceptions of disaster preparedness.