Discussion

This research aimed to evaluate the competencies in disaster preparedness and response among nurses, highlighting a critical aspect of health care in emergencies. The findings of our study provide valuable insights into the complex interplay between training, experience, and perceived preparedness. While nurses with disaster training—particularly those who received both theoretical and practical components and participated in drills—demonstrated higher DNPRC scores, an unexpected outcome emerged among nurses who were actively involved in the 2023 Kahramanmaraş earthquakes. Contrary to our hypothesis, these nurses exhibited lower DNPRC scores. This result suggests a deeper implication. The responses on the DNPRC Scale, which reflect perceived preparedness and competency, might be more indicative of preparedness for hypothetical scenarios rather than real-world readiness for large-scale disasters such as the Kahramanmaraş earthquake. Research indicates that nurses actively involved in disaster response often experience significant psychological stress and trauma, which can negatively influence their self-assessment of preparedness and competency.Reference Varghese, George and Kondaguli ^{18 ,} Reference Turner ¹⁹ Studies on health care workers in the Kahramanmaraş earthquake zone revealed prevalent mental health challenges, including post-traumatic stress disorder (PTSD), burnout, and depression, which may contribute to the observed discrepancy in DNPRC scores.Reference Altuntaş, Korkmaz and Efe ^{13 ,} Reference Çuhadar, Bahar and Bağlama ²⁰ The phenomenon of “perception-reality gap” in disaster response is well-documented, suggesting that direct exposure to traumatic events can diminish self-efficacy and lead to undervaluation of one’s professional skills.Reference Sehlikoğlu, Yilmaz Karaman and Yastıbaş Kaçar ^{21 ,} Reference Aytaç, Ovayolu and Serçe ²² The experience of being actively involved in such a large-scale disaster appears to have provided these nurses with a more realistic appraisal of their competencies, highlighting potential gaps in disaster preparedness that were previously unrecognized. This finding underscores a critical gap between perception and reality in disaster scenarios. Facing the harsh realities of a major disaster can significantly alter one’s self-assessment of preparedness and competency, emphasizing the need for continuous evaluation and enhancement of disaster nursing training and readiness programs. Moreover, psychological factors such as stress, trauma, and resilience should be integral components of these programs, as they play a crucial role in how nurses perceive and respond to their own capabilities during crises.

The findings of this study also bring attention to the evolving landscape of disaster nursing education in Turkey. Notably, the updated Nursing Core Education Program (HUÇEP-2022), implemented a year prior to the 2023 Kahramanmaraş earthquakes, includes critical competencies related to disaster preparedness. According to the program, nursing graduates are expected to “determine nursing care priorities in situations that massively affect public health, such as natural disasters and pandemics, and take an active role in crisis management” (https://www.yok.gov.tr/en). Under the curriculum topic “First Aid and Extraordinary Situations,” disaster nursing and crisis management are introduced; however, given the high seismic risk in Turkey, these components may not be sufficient to fully prepare nurses for large-scale disaster scenarios. Despite these foundational competencies in undergraduate education, the devastating impact of the 2023 earthquakes underscored the need for more advanced and practical disaster training. Encouragingly, in the aftermath of the disaster, Turkey has seen a substantial increase in disaster-related education and awareness initiatives, including inter-institutional collaborations, in-service training programs, and nationwide educational campaigns led by the Presidency of Turkey (https://uzaktanegitimkapisi.cbiko.gov.tr/). These programs aim to enhance disaster preparedness and response competencies not only among health care professionals but also within the broader community.Reference Şermet Kaya and Erdoğan ^{23 ,} Reference Arıcı, Bozkaya and Cengiz ²⁴ Integrating such comprehensive training modules into formal nursing education and ongoing professional development programs could bridge the gap between theoretical knowledge and practical application, fostering both clinical proficiency and psychological resilience among nurses.

The findings from this study also indicate that nurses who received disaster training scored significantly higher on the DNPRC Scale compared to those who did not receive such training. Furthermore, nurses who underwent both theoretical and practical training achieved notably higher scores than those who only received theoretical training. Additionally, nurses who participated in drills outperformed those who did not participate in terms of their DNPRC Scale scores. This underscores the crucial role of training and experiential learning in enhancing disaster preparedness and response competencies.Reference Loke, Guo and Molassiotis ^{8 ,} Reference Ergezen, Akcan and Kol ²⁵ In addition to practical training, incorporating resilience-building programs and stress management strategies into disaster preparedness curricula could help mitigate the adverse psychological effects of disaster response. Techniques such as peer support groups, debriefing sessions, and structured mental health interventions may enhance both perceived and actual preparedness among nurses.Reference Altuntaş, Korkmaz and Efe ^{13 ,} Reference Varghese, George and Kondaguli ¹⁸ The theoretical knowledge component of disaster training provides the foundational understanding necessary for nurses to conceptualize and recognize various aspects of disaster scenarios.Reference Küçük, Sari and Demirbağ ^{4 ,} Reference Ahn, Jang and Kim ¹⁶ However, it is the practical application of this knowledge through simulations and drills that truly fortifies their ability to respond effectively in real-life situations.Reference Altuntaş, Çiçek Korkmaz and Efe ^{15 ,} Reference Geng, Luo and Pei ^{26 ,} Reference Hasan, Younos and Farid ²⁷ Engaging in practical exercises allows nurses to translate theoretical knowledge into actionable skills, fostering critical thinking and decision-making capabilities under pressure.Reference Loke, Guo and Molassiotis ^{8 ,} Reference Shi and Zhang ²⁸ Moreover, participation in drills simulates the high-stress environment of actual disaster responses, thereby preparing nurses to manage and mitigate the psychological impacts they may encounter.Reference Digregorio, Graber and Saylor ^{29 ,} Reference Tussing, Chesnick and Jackson ³⁰ Ultimately, the findings of this study highlight a critical gap between perceived and actual disaster preparedness among nurses. To address this gap, it is crucial to implement continuous training programs that integrate psychological support mechanisms, thereby fostering both professional competency and mental resilience. Future research should focus on longitudinal assessments to better understand how real-world disaster experiences influence health care professionals’ self-assessment and readiness over time.

The present study delves into the multifaceted nature of preparedness and competencies required in large-scale disaster scenarios, as reflected in the sub-dimensions of the DNPRC Scale. Ethical and Legal Practices require nurses to make critical decisions that adhere to both professional ethics and legal standards, even in challenging disaster contexts.Reference Al Harthi, Al Thobaity and Al Ahmari ^{31 ,} Reference Moradi, Abdi and Valiee ³² The importance of Communication and Information Sharing cannot be overstated, as clear, efficient communication and accurate information management are pivotal in coordinating effective response efforts.Reference Ahn, Jang and Kim ^{16 ,} Reference Al Harthi, Al Thobaity and Al Ahmari ³¹ Education serves a dual purpose, continually equipping nurses with updated knowledge and skills, and educating the community to enhance overall preparedness.Reference Loke, Guo and Molassiotis ^{8 ,} Reference Tussing, Chesnick and Jackson ³⁰ Safe Care focuses on maintaining safety standards for both patients and health care providers in the midst of a crisis.Reference Veenema ^{33 ,} Reference Grochtdreis, de Jong and Harenberg ³⁴ Individual Care and Family Care highlight the need for personalized care approaches considering the diverse needs of affected individuals and their families.Reference Ahn, Jang and Kim ^{16 ,} Reference Grochtdreis, de Jong and Harenberg ³⁴ Collaborative Care emphasizes teamwork and interprofessional collaboration, which are vital in disaster response.Reference Bahadori, Khankeh and Zaboli ³⁵ Finally, Psychological Care and Vulnerable Population Care address the mental health aspects and the needs of those most at risk in disasters.Reference Veenema ^{33 ,} Reference Benevolenza and DeRigne ³⁶

The sub-dimensions of the DNPRC Scale collectively indicate that disaster nursing competencies extend beyond medical treatment, encompassing a holistic understanding of various aspects essential for managing complex disaster scenarios.Reference Ahn, Jang and Kim ¹⁶ Nevertheless, it’s important to note that this scale primarily measures nurses’ perceptions of potential disaster scenarios. Consequently, nurses’ expectations about the magnitude of potential disasters and their own competencies in such situations can be misleading. Considering the devastating impact of the Kahramanmaraş earthquake, it’s clear that anticipating such a large-scale disaster is challenging. ^{9 ,} Reference Kahraman ¹⁰ Being urgently called to duty in a disaster of this magnitude may have placed nurses in a difficult position. Furthermore, this situation might have complicated effective interventions by various units that required coordinated actions from more authoritative decision-making bodies. Therefore, those who actively witnessed the events in Kahramanmaraş might have realized their inadequacies in several aspects, should a similar large-scale disaster occur again.

On the other hand, nurses who received training and participated in drills might feel more prepared, but their perceptions can change when tested in a real scenario.Reference Reed, Rohrbeck and Wirtz ^{1 ,} Reference Ryan, Kako and Şimşek ^{6 ,} Reference Veenema ³³ A growing body of literature supports the discrepancy between perceived and actual preparedness in disaster scenarios, highlighting that health care professionals, including nurses, often overestimate their readiness until faced with real-world challenges.Reference Koçak and Serin ^{11 ,} Reference Al Khalaileh, Bond and Alasad ^{37 ,} Reference Brown, McMullan and Largey ³⁸ Brown et al. (2024) demonstrated that while nurses may feel confident in their preparedness, actual preparedness measures, such as emergency planning and resource allocation, are often insufficient during crises.Reference Brown, McMullan and Largey ³⁸ Similarly, Al Khalaileh et al. (2012) found that despite moderate perceived preparedness among Jordanian nurses, objective assessments revealed significant gaps in disaster knowledge and skills, particularly when responding to large-scale emergencies.Reference Al Khalaileh, Bond and Alasad ³⁷ These findings align with our study’s results, suggesting that deployed nurses’ lower DNPRC scores may reflect a more accurate self-assessment influenced by their real-world experiences in the 2023 Kahramanmaraş earthquakes. This gap between perceived and actual preparedness underlines the importance of incorporating not only theoretical and practical training but also resilience-building programs and real-life simulations to enhance both the perceived and objective competencies of disaster response personnel.

Despite this gap between perceived and actual preparedness, it is also important to consider that external factors unrelated to disaster training and competency may have influenced the observed differences. This is because, in many respects, there were similarities between those who were called to duty and those who were not. Factors such as pregnancy, having young children, holding a critical role in their institution, or needing to care for a dependent, which are not specific to disaster preparedness and competency, cannot explain the underlying reasons for this difference. However, the realization of inadequacies by a subset of a larger group with similar characteristics and perceptions, post their active involvement in these harrowing scenarios, is a matter that warrants considerable reflection. Nurses who were active in the earthquake response, instead of feeling better prepared for the next disaster due to their experiential learning, may have paradoxically become more aware of their deficiencies. The literature suggests that exposure to traumatic events can lead to secondary traumatic stress and vicarious traumatization, potentially causing health care workers to undervalue their own competencies.Reference Altuntaş, Korkmaz and Efe ^{13 ,} Reference Turner ^{19 ,} Reference Sehlikoğlu, Yilmaz Karaman and Yastıbaş Kaçar ²¹ This phenomenon may explain why deployed nurses, despite their direct experience, reported lower DNPRC scores. This realization suggests a significant shift from the anticipated preparedness to an understanding of their actual limitations in the face of such calamities. To bridge the gap between perceived and actual preparedness, not only should disaster training programs be revisited, but also psychological support initiatives such as resilience training, peer support groups, and stress management workshops should be integrated into disaster response frameworks. These initiatives could help nurses process their experiences constructively, promoting both psychological well-being and professional growth. By fostering an environment where mental health is prioritized alongside clinical training, health care institutions can build a more resilient and competent nursing workforce ready to face future disasters.