Introduction
The frequency and intensity of disasters are on the rise globally, leading to adverse impacts on societies. Reference Baker, Alamri and Aboshaiqah1,Reference Bulut2 While developed countries can more swiftly restore infrastructure and economy, a disaster can erase years of progress in developing nations. Particularly, the COVID-19 pandemic has posed challenges for all countries, regardless of their development status. Reference Labrague, Hammad and Gloe3 In this context, the ability of nurses to respond to disasters is of vital importance, yet many nurses express a lack of preparedness in this area. Reference Baker, Alamri and Aboshaiqah1,Reference Taskiran and Baykal4,Reference Tercan5 In Turkey, there is a scarcity of research investigating nurses’ perception of preparedness for disasters. Reference Taskiran and Baykal4 The recent earthquake in 2023 underscores the urgency of this issue. The conflicting results of existing research make it challenging to formulate robust policies in this field. Reference Tercan5,Reference Yürekli6 This study aims to identify the factors related to the preparedness and response competency of nurses for disasters in Turkey through meta-analysis.
Methods
Overview
This study employed a meta-analytic approach to investigate nurses’ disaster preparedness in Turkey. The study encompassed articles published from January 1, 2000, to December 31, 2021, in both Turkish and English.
Data Sources and Search Strategy
A comprehensive search was executed across databases such as Dergipark, Turkey National Thesis Center, Web of Science, and PubMed, as well as Google Scholar. Keywords like “disaster,” “nurse,” “preparedness,” and “competency” were used in various combinations with Boolean operators “AND” and “OR.”
Study Selection and Data Extraction
Two independent researchers (FU and BA) assessed the relevance of the identified studies based on titles and abstracts. Any discrepancies were resolved through discussion with a third researcher (MA). Selected studies were systematically coded for parameters like title, author(s), publication year, and location, as well as sample size, and comparison statistics (Table 1).
Table 1. Characteristics of the studies included in the meta-analysis
Statistical Analysis
Data were analyzed using Comprehensive Meta-Analysis software, version 2 (BioStat, Englewood, NJ, USA). Heterogeneity was assessed using the I2 test, and publication bias was evaluated through Egger’s test (Table 2). Sensitivity analysis was also conducted to assess the influence of each study on the overall rate.
Table 2. Summary statistics related to the heterogeneity and publication bias
Q: Cochran Q statistic for homogeneity test; I2: proportion of observed variance that is real (%); Tau 2: between-study variance in random effect model; Egger: Egger’s regression test.
Results
Study Selection
Out of 1930 initially identified articles, 22 were selected for full-text review. Ultimately, 7 master’s theses and 2 articles met the inclusion criteria and were analyzed, encompassing a total of 3222 nurses. While master’s theses typically do not undergo peer review, the authors believe that the research information, data, and conclusions contained therein are pertinent to the scope of this study. Some of these theses may indeed undergo further review by peers, while others may not. It should be noted that the scientific examination of various aspects of disaster preparedness in Turkey is currently under-represented. Incorporating the data from these theses into our study will contribute to the ongoing efforts to enhance disaster preparedness in Turkey within the academic medical community.
Key Findings (Figure 1)
Figure 1. The Meta-Analysis Outcomes of the Impact of Related Factors on Nurses’ Disaster Preparedness.
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1) Gender and Preparedness: No significant effect of gender on nurses’ disaster preparedness was found (P = 0.851).
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2) Disaster Experience and Preparedness: No significant impact of disaster experience on preparedness was observed (P = 0.105). However, sensitivity analysis indicated near-significance when 1 study was excluded (P = 0.051).
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3) Disaster Education and Preparedness: A significant positive effect of disaster education on preparedness was noted (P < 0.001).
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4) Reading Disaster Plans and Preparedness: A significant positive effect was found (P = 0.021).
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5) Participation in Disaster Drills and Preparedness: A significant positive effect was observed (P < 0.001).
Heterogeneity and Publication Bias
Significant heterogeneity was detected for “disaster experience” and “reading disaster plans” variables. No evidence of publication bias was found across all variables, confirmed by Egger’s test (Table 2).
Discussion
A previous study underlined a critical gap in nurses’ disaster preparedness, emphasizing the need for better education. Reference Said, Molassiotis and Chiang7 In Turkey, this is a pressing issue as the educational system lacks specialized courses in disaster nursing. Current efforts like in-service training and occasional drills are insufficient given Turkey’s vulnerability to various disasters. This meta-analysis reveals mixed findings on whether prior disaster experience improves nurses’ preparedness. While some studies Reference Tercan5–Reference Yürekli6,Reference Kuğum8–Reference Zeren9 found no impact, others Reference Taskiran and Baykal4,Reference Durgut10–Reference Karakış11 reported a positive effect. The results are inconclusive, suggesting that experience alone may not be the key factor for policymaking.
Training, however, consistently shows a positive impact on preparedness. Several studies Reference Yürekli6,Reference Durgut10–Reference Özcan12 confirm that disaster training significantly elevates nurses’ readiness levels. This highlights the need for integrating comprehensive disaster education into both undergraduate and postgraduate curricula. In Turkey, while healthcare institutions have disaster plans, there’s no system to gauge nurses’ familiarity with them. Limited studies Reference Yürekli6,Reference Karakış11,Reference Özcan12 suggest that reading these plans can improve preparedness, indicating the importance of incorporating this into training programs. Lastly, participation in disaster drills was found to be effective in enhancing practical skills in disaster management. This calls for policies that prioritize such drills and allocate necessary resources. In summary, while individual experience in disasters may contribute to preparedness, it is not sufficient for policy-making. The focus should be on comprehensive education and practical training, supported by policies that ensure regular drills and familiarization with disaster plans.
Consequently, this study sheds light on the key factors affecting nurses’ disaster preparedness, notably the significance of comprehensive training, familiarity with disaster plans, and participation in drills. While the study has limitations, such as the exclusion of master’s theses and a focus on 1 country, it offers actionable insights. Gender was found to be inconsequential, but training and practical exercises stood out as pivotal. These findings underscore the need for national policies that prioritize disaster nursing education and continuous professional development. In clinical practice, nurses equipped with this specialized knowledge can enhance communication, contribute to effective disaster planning, and ultimately improve patient care and safety during emergencies. Therefore, a multi-faceted approach involving theoretical education, hands-on drills, and active engagement in disaster planning is crucial for preparing nurses for any disaster scenario.
Author contributions
Study design, data collection, and manuscript writing: FU, MA, BA; Data analysis: FU, BA; Study supervision and Critical revisions for important intellectual content: BA, MA
Funding disclosure
None.
Ethical Approval
Prior to commencing research, approval (2021/6.44) was obtained from the Non-Interventional Clinical Research Ethics Committee of Selcuk University, Faculty of Nursing, with the meeting held on June 16, 2021.
This study was also presented as an oral abstract at the 8th International Congress on Health Sciences and Management held in Trabzon from May 2 - 6, 2023.
