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All Theses, Dissertations, Capstones and

Doctor of Nursing Practice (DNP) Projects Projects

Fall 12-9-2024

Enhancing Disaster Preparedness in Nursing Education: A Quality

Improvement Approach Using Simulation and Training
Paul Dreater
University of San Francisco, [email protected]

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Dreater, Paul, "Enhancing Disaster Preparedness in Nursing Education: A Quality Improvement Approach
Using Simulation and Training" (2024). Doctor of Nursing Practice (DNP) Projects. 362.
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 1

Enhancing Disaster Preparedness in Nursing Education:

A Quality Improvement Approach Using Simulation and Training

Paul Dreater

University of San Francisco

Committee Chair: Dr. Jo Loomis, DNP, FNP-C, CHSE, CLC, ANLC, NCMP, CNL

Committee Member: Dr. Janice Mark DNP, FNP-BC

 2

Enhancing Disaster Preparedness in Nursing Education:

A Quality Improvement Approach Using Simulation and Training

Abstract

Background: Natural or artificial disasters threaten safety and continuity in educational settings.

The University of San Francisco School of Nursing and Health Professions (USF SONHP)

identified a critical gap in its disaster preparedness, underscored by the absence of a

comprehensive disaster plan. This shortfall highlights the need for an educational strategy

encompassing disaster readiness and response, particularly given the potential for such events to

cause substantial harm and disruption.

Local Problem: A gap analysis conducted at the USF SONHP revealed the lack of a structured

disaster plan, underlining the urgent need for an initiative to develop and implement a

comprehensive disaster management educational plan. This plan aims to equip nursing students,

faculty, and support staff with the knowledge and skills to respond effectively to disasters.

Methods: This Doctor of Nursing Practice student-led quality improvement project integrates

disaster preparedness and response training into the University of San Francisco nursing

curriculum. Disaster simulations and partnerships with local emergency services support it.

Interventions: The project included pre-simulation training on triage, first aid, and Stop-the-

Bleed techniques, followed by disaster simulations assessed using the Simulation Effectiveness

Tool–Modified (SET-M). Data collection involved post-simulation surveys and qualitative

feedback from debrief sessions to evaluate confidence, skill retention, and perceived learning

outcomes.

Results: Post-simulation results significantly improved participants' confidence (Cohen's d =

0.67), with a 68% increase in nursing students' knowledge and confidence in medical
 3

interventions compared to baseline levels. Participants reported enhanced confidence, improved

retention of clinical skills, and a strong preference for simulation-based learning. Realistic

scenarios further bolstered their readiness for real-world emergencies.

Conclusions: Simulation-based disaster management education effectively enhances nursing

students' confidence and preparedness, addressing critical gaps in disaster response training. The

project underscores the need to integrate this training into nursing curricula so that students can

effectively manage crisis scenarios. Further refinement and scalability efforts are recommended

to maximize its impact.

Keywords: Mass Casualty Incidents (MCIs), Nursing Education, Disaster Response

Simulation, Interprofessional Education, Preparedness and Response Outcomes, Competency

Development
 4

TABLE OF CONTENTS

Section I: Title and Abstract

Title ........................................................................................................................... 1

Abstract ..................................................................................................................... 2

Section II: Introduction

Background ................................................................................................................ 7

Problem Description ................................................................................................. 12

Setting ........................................................................................................... 12

Specific Aim ............................................................................................................. 13

Available Knowledge ................................................................................................ 14

PICOT Question............................................................................................. 14

Search Methodology ...................................................................................... 14

Integrated Review of the Literature .............................................................. 15

Summary/Synthesis of the Evidence ............................................................. 22

Rationale ................................................................................................................... 23

Section III: Methods

Context ...................................................................................................................... 24

Interventions ............................................................................................................. 27

Gap Analysis .................................................................................................. 27

Gantt Chart .................................................................................................... 28

Work Breakdown Structure .......................................................................... 29

Responsibility/Communication Plan ............................................................ 31

SWOT Analysis ............................................................................................ 32

 5

Budget and Financial Analysis ...................................................................... 34

Study of the Interventions…………………………………………………………. . 38

Outcome Measures .................................................................................................... 39

CQI Method and/or Data Collection Instruments ......................................... 39

Analysis ..................................................................................................................... 40

Ethical Considerations .............................................................................................. 43

Section IV: Results………………………………………………………………………… 44

Qualitative Findings ............................................................................................................... 44

Quantitative Findings ………................................................................................................. 47

Section V. Discussion ……………………………………………………………………. . 47

Summary ................................................................................................................... 48

Interpretation………………………………………………………………………. . 49

Limitations ................................................................................................................ 50

Conclusion ................................................................................................................ 52

Section VI: Funding………………………………………………………………………. 53

Section VII. References ...................................................................................................... 54

Section VIII: Appendices

Appendix A. Evidence Evaluation Table................................................................... 63

Appendix B. DNP Statement of Non-Research Determination Form ...................... 78

Appendix C. The Letter of Approval and Support ................................................... 83

Appendix D. Gap Analysis ....................................................................................... 84

Appendix E. GNATT ................................................................................................. 85

Appendix F. Work Break Down Structure ............................................................... 87

 6

Appendix G. Responsibility / Communication Matrix .............................................. 88

Appendix H. SWOT................................................................................................... 90

Appendix I. Cost Benefit Analysis Overview............................................................ 91

Appendix J. Budget ................................................................................................... 92

Appendix K. SET M Tool .......................................................................................... 93

Appendix L. Survey Results in Confidence and Preparedness Metrics..................... 94

Appendix M. Cohen’s d ............................................................................................. 96

Appendix N. Thematic Analysis ................................................................................ 98

Appendix O. CANVAS LMS ................................................................................... 99

Appendix P. Flyer ..................................................................................................... 101

Appendix Q. Simulation Safety Plan ........................................................................ 102

Appendix R. Agenda .................................................................................................. 104

Appendix S. Prebrief for Earthquake Simulation Scenario ....................................... 106

Appendix T. Moulage Requirements ......................................................................... 108

Appendix U. Simulation Scenario ............................................................................. 111

Appendix V. Simulated Patient Acting Cards .......................................................... 129

Appendix W. Learner Disaster Management Check List ......................................... 143

Appendix X. Debriefing ............................................................................................ 145

Appendix Y. Disaster Management Simulation Supplies ......................................... 147

 7

Enhancing Disaster Preparedness in Nursing Education:

A Quality Improvement Approach Using Simulation and Training

Section II: Introduction

Background

Disasters cause massive damage to life and property annually. The International

Federation of Red Cross and Red Crescent Societies (IFRC), the Centre for Research on the

Epidemiology of Disasters (CRED), and the Federal Emergency Management Agency (FEMA)

are organizations focused on humanitarian and disaster-related challenges. IFRC defines

disasters as extreme disruptions that exceed the capacity to function within available resources

(IFRC, 2022).

Disasters come in two forms: natural (hurricanes, droughts, pandemics, volcanic

eruptions) and artificial (human-made). Human-made disasters can be categorized as either

intentional or unintentional. Intentional disasters include acts of terrorism, active shooter

incidents, and cyber-attacks. Unintentional disasters encompass a range of events, such as

industrial accidents (like chemical spills and explosions), transportation incidents (including

plane crashes and train derailments), environmental contamination (such as oil spills and toxic

waste leaks), and infrastructure failures (like dam breaks, power grid failures, and building

collapses). In 2022, CRED documented 387 natural hazards and disasters, which caused 30,704

deaths, impacted approximately 185 million people globally, and resulted in economic damages

totaling around $223.8 billion (CRED, 2022; Gramlich, 2022).

Additionally, the 2023 National Preparedness Report by FEMA further underscores the

escalating impact of climate-related disasters. An analysis of climate-related events from January

 8

2020 to December 2022 reveals 60 catastrophic disasters resulting in 1,460 fatalities and 2,939

injuries. Each event exceeded $1 billion in cost, highlighting both a frequency increase and a

significant financial burden, pointing to a troubling trend compared to previous decades (FEMA,

2023).

Historical data from FEMA indicate that the annual number of billion-dollar climate-

related disasters rose from approximately 6 to 7 events in 2000–2009 to an average of 20 events

per year in 2020–2022 (FEMA 2023.). This increase signifies an almost threefold rise in the

frequency of catastrophic disasters over the last two decades. Furthermore, the average annual

costs of these disasters, adjusted for inflation, climbed from an estimated $50 billion to $60

billion in 2000–2009 to over $200 billion annually in 2020–2022 (FEMA, 2023).

These statistics reveal a concerning trend: the frequency of climate-related disasters has

tripled, and the economic impact has quadrupled within two decades. Such changes highlight the

escalating challenges climate change poses and the increasing strain on preparedness and

response systems. This data illustrates an urgent need for enhanced preparedness and mitigation

efforts, especially given these costly climate-related events’ rising frequency and severity. The

unpredictability and variety of these incidents underscore the critical need for comprehensive

emergency preparedness across all sectors, including educational institutions (Chartoff et al.,

2023).

Recent analyses highlight a gap in disaster preparedness training within healthcare

education, particularly in nursing programs, which are essential in fostering the next generation

of frontline healthcare workers (Miresmaeeli et al., 2023). Knowing how to react and respond to

an emergency is crucial. Universities can help ensure the safety of students and staff by having
 9

emergency preparedness measures and plans in place (Chartoff et al., 2023; Keenan & Maxwell,

2022).

The State of California is taking proactive steps by enacting legislation to enhance

disaster management education and practical training. This legislative action highlights the

state's dedication to improving the response capabilities of its citizens and professionals during

disasters. By focusing on educational frameworks and hands-on training, California aims to build

a comprehensive approach to disaster management. This includes integrating disaster

preparedness into educational curricula across various levels and providing real-world training

opportunities simulating disaster scenarios. These initiatives are designed to equip individuals

with the knowledge and skills necessary to manage and respond to emergencies, ultimately

strengthening the state's overall resilience to disasters (Rodriguez, 2023).

On September 27, 2022, Assembly Bill 2260 (AB2260), also known as the "Tactical

Response of Traumatic Injuries Act" (Rodriguez, 2023), was signed into law by Governor

Newsom. This legislation mandates that buildings constructed from January 1, 2023, with an

occupancy of 200 or more individuals, must provide trauma kits. These kits are designed to

empower bystanders to provide emergency care or treatment, thereby increasing the chances of

survival for victims in emergencies. The bill, authored by Assembly Member Freddie Rodriguez,

emphasizes the significance of making trauma kits accessible in public venues to empower

immediate responders at the scene of an emergency (Rodriguez, 2023).

The requirement of AB 2260 spans various building categories based on their occupancy.

This law establishes varying occupancy thresholds for trauma kit requirements based on building

types and their intended use. For assembly buildings designed to accommodate large gatherings

for activities such as entertainment, worship, or education, the law mandates trauma kits in
 10

facilities with an occupancy exceeding 300 people. This higher threshold reflects the unique

nature of assembly buildings, typically designed to handle larger crowds. In contrast, for other

types of buildings, such as small businesses, factories, mercantile, and residential structures, the

threshold is set at 200 occupants. These buildings generally serve more minor, dispersed groups,

but their inclusion ensures that trauma kits are available in spaces where emergencies may still

occur. By tailoring the occupancy thresholds to the specific characteristics of these building

categories, AB 2260 ensures a balanced and practical approach to emergency preparedness.

This law also outlines specific exemptions and building classifications to clarify its

scope. Vacant buildings and undergoing renovations or construction are exempt from the law's

requirements. Additionally, the act does not apply to certain healthcare facilities, including

general acute care hospitals, acute psychiatric hospitals, skilled nursing facilities, and other

specialized hospitals. The passage highlights that AB 2260 focuses on specific building types,

such as high-occupancy and public-use buildings, and deliberately excludes others, such as

single-family homes or facilities governed by other codes. This targeted approach ensures the

law addresses areas with the most significant emergency preparedness needs. These

classifications and exemptions help delineate the focus of AB 2260, providing its application to

appropriate building categories (Rodriguez, 2023).

The Tactical Response to Traumatic Injuries Act is a groundbreaking law in California.

It sets a new public health and safety standard requiring bleeding control kits in new buildings

with an occupancy of 200 effective January 1, 2023. This legislation addresses the urgent need

for immediate medical interventions following traumatic events, empowering bystanders with

the tools for life-saving measures. The legislation aligns with the American College of Surgeons’
 11

Stop the Bleed campaign, highlighting a shift towards enhanced emergency preparedness in

response to increasing mass casualty incidents.

AB 2260 is the first of its kind, paving the way for the nationwide adoption of similar

measures, promoting a proactive stance on public safety. In addition, the law mandates training

for effectively using these kits. This ensures that individuals are equipped and proficient in

emergency bleeding control. The measure signifies a strategic move towards bolstering

emergency response capabilities, exemplifying California's leadership in advancing community

resilience against emergencies.

Assembly Bill 2260 is a significant step towards aligning university disaster management

programs with their objectives, strengthening their preparedness and response capabilities.

Mandating the inclusion of bleeding control kits in new buildings with an occupancy of 200 or

more can potentially impact university campuses constructed after January 1, 2023. The

legislation aligns with disaster management education core objectives. These include enhancing

emergency preparedness, integrating practical learning, fostering training and certification,

encouraging research and development, and promoting community engagement and leadership.

Additionally, this statute mandates the provision of bleeding control kits in universities which

serve as vital tools for immediate response in severe bleeding scenarios and addresses a crucial

gap in emergency medical response. These kits also enable universities to educate students,

faculty, and staff on how to respond efficiently to emergencies.

Finally, AB 2260 is a practical tool for curriculum integration within disaster

management and health-related programs. It can be leveraged as a case study or practical

coursework component, educating students on the significance of bleeding control and the

logistics of enacting statewide public health initiatives. The law includes provisions for training
 12

individuals using bleeding control kits and aligning with university programs that offer

certification and training in emergency response. It also enables the development or expansion of

training programs to include bleeding control, empowering communities to respond more

effectively in emergencies. Since Universities are hubs of research and innovation, they are well-

positioned to explore the effectiveness of bleeding control kits in public and educational settings.

Research spurred by AB 2260 can offer insights into best practices for emergency preparedness

and trauma care, which can shape future policy and practice.

Problem Description

The University of San Francisco School of Nursing and Health Professions (SONHP) has

recognized a significant need for more information regarding disaster preparedness within its

curriculum. A recent gap analysis identified the lack of a structured disaster plan, leading to an

educational initiative to incorporate disaster preparedness and response training into the nursing

curriculum.

This initiative aligns with the organization's risk and safety approach to ensure that

students, faculty, and support staff are adequately prepared to respond to emergencies

effectively. By incorporating hands-on training through simulations of disaster scenarios and

establishing partnerships with local emergency services, the initiative aims to offer students

practical, real-world experience.

Setting

The University of San Francisco (USF), situated in the bustling city of San Francisco,

California, is a prestigious private institution deeply rooted in Jesuit traditions. Founded in 1855,

USF prides itself on a steadfast commitment to social justice, upholding ethical values, and

fostering community involvement, all of which are pillars of its Jesuit heritage. The university
 13

offers an extensive array of undergraduate, graduate, and professional programs, spanning

various disciplines such as arts and sciences, business, education, law, and nursing and health

professions.

The USF campus offers its students a lively urban environment with opportunities for

professional development, cultural enrichment, and community service. The city's rich diversity

and vibrant healthcare scene provide an unparalleled backdrop, particularly for those pursuing

education and careers in nursing. USF has 486 full-time and 688 part-time faculty members. It

has a committed student body of 6,018 undergraduate and 3,670 graduate students across various

disciplines, including 1,300 in the undergraduate nursing program, (USF, 2022). USF combines

rigorous academic instruction with practical experience, preparing students to thrive in their

respective fields.

Specific Aim

This Doctor of Nursing Practice student-led quality improvement project aims to equip

nursing students, faculty, and support staff with the knowledge, skills, and competencies to

respond effectively to various disasters, including natural and artificial events. Preparedness in

schools is designed to protect students and staff from harm, minimize disruption, ensure the

continuity of education for students, and develop and maintain a safety culture. (National

Integration Center, 2018). Furthermore, to maximize success, effective management of school

emergencies requires training, preparation, and planning for practices (Trust for America's

Health, 2017).

This evidence-based change of practice project’s aim was that by October 2024, a mass

casualty response plan for disaster management at the University of San Francisco School of

Nursing in San Francisco, California, would be developed, implemented, and evaluated. The
 14

project’s purpose was to ensure the safety of faculty and students while optimizing resource

usage during the initial phase of a disaster. The project objectives were to significantly increase

knowledge and confidence levels regarding disaster management response through educational

learning modules and an in-situ simulation. The purpose was to measure efficacy and confidence

levels before and after the simulation exercise and through direct observation during the

simulation. The desired outcome was a 25% or more increase in the knowledge and confidence

of faculty and students following the educational intervention and simulation activity.

Available Knowledge

PICO(T) Question

A PICOT (population, intervention, comparison, outcome, and timeframe) question

(Melnyk & Fineout-Overholt, 2023) guided the search methodology for a literature review:

What are the appropriate disaster preparedness competencies and effective instructional

methods for inclusion in nursing education curricula?

Search Methodology

The search strategy was designed to ensure comprehensive coverage of the literature. It

involved conducting thorough searches across multiple electronic databases, including Cochrane,

Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PubMed,

Google Scholar, Fusion, and Scopus. The search spanned literature from 2015 to 2023, and a

wide range of keywords such as "disaster nursing," "disaster preparedness," "disaster response,"

"simulation," "education," "training," "technology," "interprofessional education," and "mass

casualty incidents" were used. Advanced search filters, such as the English language and

published within the last ten years, were applied to refine the results, focusing on disaster nursing

education and academic disaster management programs.

 15

The search yielded over 90 articles, then narrowed to 30 based on specific search terms

and criteria: disaster nursing, disaster preparedness, simulation, education, and mass casualty

incidents. Fifteen articles relevant to the research objectives and the foundational emergency

preparedness and disaster planning needs within academic nursing institutions were selected. The

reviewed articles were analyzed, and the findings were summarized.

The Johns Hopkins Research Evidence Appraisal Tools (Dearholt & Dang, 2022)

evaluated the quality of selected studies, which is crucial for clinical decision-making. The

evidence included seven Level II quasi-experimental trials, four Level III mixed-method studies,

and four Level V quality improvement projects. Appendix A provides detailed evidence levels,

quality assessment, and methods for inclusion in nursing education curricula.

The literature review revealed diverse methodologies and approaches across the studies

examined, underscoring a lack of standardization in disaster management and preparedness

practices. Specifically, no universally accepted assessment tool or consistent methodology

created challenges for comparing the selected studies. Key areas of focus in the literature

included study objectives, characteristics and settings of study samples, the interventions,

particularly educational competencies and methodologies, data collection techniques,

measurement instruments, analyses, results, and the implications and recommendations derived

from the findings.

Integrated Review of the Literature

Evaluating and synthesizing the current research and non-research findings provided

evidence to support implementing a quality improvement project. Dang et al. (2022) provide

tools to adequately appraise and synthesize the literature for this project and offer a step-by-step

process to determine the level and quality of the evidence. An evaluation table concisely
 16

organizes the available evidence by quality, strength, feasibility, and appropriateness for this

proposal (see Appendix A Evaluation Table).

Integrating disaster preparedness into nursing education is crucial to building a resilient

healthcare workforce capable of responding effectively to emergencies. This curriculum is

designed to equip nursing students with theoretical knowledge and practical skills that enhance

their capacity for effective response in disaster situations. Studies consistently highlight the value

of a dual approach, combining theoretical instruction with hands-on practice to develop

comprehensive disaster management competencies in nursing students (Alfred et al., 2015; Eid-

Heberle & Burt, 2023; Çiriş et al., 2022; Davis et al., 2020; Smithers & Tenhunen, 2020). By

incorporating disaster preparedness education, nursing programs can prepare students for the

multifaceted challenges they will encounter in disaster response settings.

The literature on disaster preparedness for nursing students reveals three primary themes:

(1) demand for standardized competencies by students, (2) interprofessional collaboration among

educators, and (3) integrating theoretical knowledge with practical simulation application. These

themes underscore the comprehensive strategy required to prepare nursing students for disaster

scenarios, ensuring they develop the practical skills, teamwork capabilities, and sustained

readiness essential for effective disaster response. The three main areas summarize the results

consistent with the research question: What are the appropriate disaster preparedness

competencies and effective instructional methods for inclusion in nursing education curricula?

Standardized Disaster Preparedness Competencies

Research highlights the importance of integrating disaster preparedness competencies

into nursing education. Standardized disaster preparedness competencies are essential for

equipping nursing students with the skills to respond effectively to disaster situations. Key
 17

competencies include risk assessment and management, which involves understanding various

types of disasters, assessing risks, such as triage, and developing appropriate mitigation

strategies (Alfred et al., 2015; Çiriş et al., 2022). Another critical competency is the development

of emergency response skills, which prepares students to handle emergencies through hands-on

training in triage, first aid, and crisis intervention (Davis et al., 2020). Communication and

coordination are also emphasized, enhancing interprofessional collaboration across healthcare

teams during disasters (Eid-Heberle & Burt, 2023).

Critical thinking and decision-making are necessary for quick, informed decisions in

high-pressure environments and effective disaster response (Smithers & Tenhunen, 2020).

Integrating ethical and cultural competency ensures that nurses provide care and adhere to ethical

standards during crises (Çiriş et al., 2022). Providing psychosocial support is crucial, as it

prepares nurses to deliver psychological first aid and mental health support to those affected by

disasters (Eid-Heberle & Burt, 2023). These competencies provide a comprehensive foundation

for disaster preparedness education in nursing curricula.

This integrated approach offers nursing students a comprehensive and valuable learning

experience. Theoretical instruction lays the foundational understanding of disaster management

principles, concepts, and procedures, while practical components such as simulation-based

training and hands-on activities allow students to apply this knowledge in realistic scenarios.

This balanced method enhances their preparedness for real-world disaster situations, reinforces

essential skills, and fosters confidence. These findings indicate that nursing students who receive

thorough training in disaster management are better equipped to respond effectively to

emergencies, experience reduced anxiety, and feel more assured in their ability to handle disaster

situations. (Yang et al., 2016).

 18

Huh and Kang (2019) have also shown that educational programs significantly enhance

disaster nursing competency. They prepare student nurses to lead community drills, workshops,

and educational sessions, contributing to a more resilient future healthcare workforce. Koca and

Arkan (2020) found that integrating disaster education into the nursing curriculum using an

active, learner-centered approach significantly increased knowledge scores post-simulation.

Likewise, Park and Hwang (2024) showed that a one-day disaster management workshop with

lecture and simulation boosted nursing students' efficacy in responding to disaster-related

casualties.

Integrating core disaster nursing competencies into the nursing curriculum is vital for

fostering comprehensive preparedness among future nurses. Eid-Heberle and Burt (2023)

recommend curricula covering a full spectrum of disaster response elements, including

understanding various types of disasters, conducting risk assessments, performing triage, and

delivering physical and psychological care. These competencies ensure students are well-

prepared to manage diverse disaster scenarios and contribute to a resilient healthcare system.

Furthermore, Huh & Kang (2019) emphasize that educational programs can equip student nurses

to lead community preparedness initiatives, such as drills, workshops, and educational sessions,

thereby enhancing community resilience in the face of potential disasters.

Educational interventions enhance practical skills and are crucial to knowledge

acquisition and overall preparedness. Koca & Arkan (2020) found that active learning modules

significantly improved students' knowledge levels, disaster preparedness, and critical thinking

capabilities, underscoring the effectiveness of hands-on, engaged learning. Supporting this

perspective, studies by Davis et al. (2020) and Smithers & Tenhunen (2020) advocate for a

blended curriculum that combines theoretical knowledge with practical elements. This integrated
 19

approach offers nursing students a comprehensive and valuable learning experience. Theoretical

instruction lays the foundational understanding of disaster management principles, concepts, and

procedures, while practical components such as simulation-based training and hands-on activities

allow students to apply this knowledge in realistic scenarios. This balanced method enhances

their preparedness for real-world disaster situations, reinforces essential skills, and fosters

confidence. These findings indicate that nursing students who receive thorough training in

disaster management are better equipped to respond effectively to emergencies, experience

reduced anxiety, and feel more assured in their ability to handle disaster situations.

Interprofessional Collaboration

Effective disaster preparedness education relies heavily on interprofessional collaboration

among educators from various healthcare disciplines. This collaboration ensures that students are

exposed to various perspectives and essential skills necessary for real-world disaster response

(Alfred et al., 2015; Smithers & Tenhunen, 2020). Interprofessional collaboration has proven

particularly valuable in disaster drills and simulations. These exercises allow nursing students to

work alongside healthcare professionals, such as medical providers, emergency responders, and

public health experts, enhancing communication, coordination, and teamwork in disaster

scenarios (Davis et al., 2020; Smithers & Tenhunen, 2020).

Feedback and debriefing sessions following disaster simulations are also crucial

components of interprofessional education. These sessions, led by interdisciplinary teams,

provide valuable insights that deepen students' understanding of disaster preparedness and

response (Smithers & Tenhunen, 2020). The collaborative efforts within disaster education foster

a team-based approach to disaster management, which is essential given the complexity of

disaster response. By working with professionals from various fields, nursing students develop
 20

leadership, decision-making, and critical communication skills during emergencies (Alfred et al.,

2015; Davis et al., 2020).

Educational interventions enhance practical skills and are crucial to knowledge

acquisition and overall preparedness. Simulation-based training and hands-on activities are vital

in preparing nursing students for real-world disaster situations. Such training often involves

interdisciplinary teams, allowing students to practice and develop collaborative skills in a

realistic setting. Studies by Davis et al. (2020) and Koca and Arkan (2020) highlight the

effectiveness of these methods in fostering teamwork and confidence, emphasizing a balanced

curriculum that blends theory with practical application.

Educational programs enable nursing students to lead community preparedness

initiatives, such as drills, workshops, and educational sessions. Huh and Kang (2019) emphasize

that these experiences build disaster nursing competency and foster collaborative skills by

involving multiple healthcare and community stakeholders. This preparation equips student

nurses to engage in community disaster response efforts and reinforces their ability to coordinate

with various professionals, enhancing community resilience.

Simulation

Simulation (SIM) is crucial in disaster management education by combining theoretical

knowledge with practical application. It provides a realistic, hands-on environment where

nursing students and other healthcare professionals can practice essential skills within a

controlled and dynamic setting (Çiriş et al., 2022). SIM is integrated into disaster management

education and fosters interprofessional collaboration in several ways.

Simulation enhances real-world preparedness by allowing students to engage in disaster

scenarios resembling actual events. This experience helps them understand the complexities of
 21

disaster response. Through interprofessional collaboration, students work alongside medical

providers, emergency responders, and public health professionals, which improves their ability to

communicate, coordinate, and effectively manage disaster situations (Davis et al., 2020;

Smithers & Tenhunen, 2020). Furthermore, simulation builds leadership and decision-making

skills critical in disaster scenarios, requiring quick thinking and strong leadership. Students

practice these skills in a safe environment where they can learn from their mistakes without real-

world consequences. Working in interdisciplinary teams during SIM exercises reinforces

collaboration and helps students develop the competencies needed for a team-based approach to

disaster management (Alfred et al., 2015; Davis et al., 2020).

Feedback and continuous improvement are essential components of SIM exercises.

Debriefing sessions after simulations allow students to reflect on their performance, learn from

peers across disciplines, and enhance their response strategies. Engaging with healthcare

professionals from diverse fields offers valuable insights, further improving students'

preparedness for real-world disaster situations (Smithers & Tenhunen, 2020). Through

simulation, students practice disaster response while refining essential communication,

teamwork, and leadership skills in an experiential learning platform that supports collaborative,

interprofessional learning.

The literature strongly supports incorporating disaster preparedness into nursing

education through a comprehensive approach that combines theoretical knowledge with hands-

on practice, primarily through simulation-based training. This approach has significantly

improved nursing students' triage, first aid, analytical reasoning, and communication skills.

Findings consistently indicate that active, learner-centered approaches such as collaborative

simulations enhance disaster response skills and knowledge and reduce anxiety associated with
 22

disaster management. These educational interventions foster greater self-efficacy, preparedness,

and psychological resilience among nursing students.

Simulation-based training has become an essential method in disaster education for

nursing students. For instance, research by Çiriş et al. (2022) highlights that collaborative

simulations effectively develop critical disaster-response competencies, including triage, first

aid, analytical reasoning, and communication. The study found statistically significant

improvements in students' confidence in their preparedness, team self-efficacy, and

psychological resilience after participating in simulation exercises. Similarly, Park and Hwang

(2024) examined immersive simulation training by comparing an experimental group engaging

in a one-day disaster management immersion with simulation exercises to a control group that

attended a traditional one-hour lecture. Results indicated that the experimental group experienced

significantly lower anxiety levels and greater confidence in managing disaster-related casualties,

emphasizing the importance of immersive simulation in preparing nursing students for real-

world disaster situations.

Simulation-based training is invaluable in disaster preparedness education. It equips

nursing students with practical skills, enhances interprofessional collaboration, and promotes

psychological resilience. By integrating SIM exercises into nursing curricula, students gain the

competencies necessary for effective disaster management, which is required to respond

confidently and effectively in high-stakes disaster situations.

Summary/Synthesis of the Evidence

The literature review emphasizes the need for standardized competencies and learning

outcomes in disaster preparedness education for nursing students. The importance of innovative,

interactive, and practical teaching methods in enhancing disaster preparedness competencies

 23

among nursing students is emphasized in these articles. Standardization in educational

objectives, the effectiveness of simulation-based learning, leadership training, and the challenges

faced in disaster nursing are all highlighted. The findings indicate a notable opportunity for

growth and improvement in integrating disaster preparedness into nursing education.

Rationale

This evidence-based change of practice DNP project focuses on improving the ability of

nursing students to respond to emergencies and disasters effectively. The literature highlights

several critical commonalities, including implementing an educational initiative to enhance

disaster response and preparedness, building resilience among nursing students, and improving

their practical skills in handling high-stress situations. It identifies areas that require

improvement and practical recommendations for policymakers and nursing educators to enhance

emergency response and preparedness training in nursing curricula. It focuses on advancing

nursing students' education, disaster response, and preparedness training, emphasizing

integrating theoretical knowledge with real-world application. Educators can develop nursing

students' skills by detecting the barriers and using a nursing communication theory, such as

Patricia Benner’s Novice to Expert theory.

Framework Description

Patricia Benner's from Novice to Expert theory is the most appropriate nursing theory to

apply when developing an Emergency Response and Preparedness Educational Initiative to

fortify disaster response and preparedness in a university nursing school. Benner's model outlines

five stages of nursing competence, from novice to expert, which can be effectively used to

design educational programs that gradually build students' competencies in disaster response.

This framework also emphasizes the development of clinical judgment through experience,
 24

which is crucial in emergency response and preparedness, where quick and effective decision-

making is required (Benner, 1982). The theory acknowledges that learners progress at different

rates and have different learning needs at each stage, which is essential in designing an

educational initiative in disaster preparedness. Additionally, understanding the specific context,

cultural considerations, and available resources is critical for effective response in disaster

preparedness, which is also emphasized in Benner's theory. Reflective practice exercises and

debriefings after simulations or drills can enhance learning and prepare students for disaster

response's emotional and psychological challenges. Incorporating mentorship and real-life

clinical experiences in emergency settings can significantly improve nursing students'

preparedness. Finally, Benner's theory strongly emphasizes holistic care, which is essential in

disaster management, as nurses need to address not only the physical but also the psychological,

cultural, and social needs of patients in disaster situations. Overall, incorporating Benner's "From

Novice to Expert" theory into the design of an Emergency Response and Preparedness

Educational Initiative would provide a structured and practical framework for developing the

necessary competencies in nursing students to respond effectively to emergencies and disasters.

Section III: Methods

Context

Disaster nursing, formally recognized after the dawn of the 20th century, boasts a rich

historical lineage extending back to the Napoleonic Era, as delineated by Fletcher et al. (2022).

This discipline, integral to the broad spectrum of nursing, draws upon a storied tradition of

responding to crises underpinned by the pioneering efforts of icons such as Florence Nightingale

and Clara Barton (Fletcher et al., 2022). Nightingale is celebrated for her foundational role in
 25

weaving together the scientific fabric of nursing, a paradigm shift that has profoundly influenced

the field's evolution.

Including disaster education in nursing curricula aims to arm future nurses with the

knowledge and skills necessary to effectively mitigate disasters' impacts on individuals and

communities. This educational initiative underscores the need for a robust framework capable of

preparing nurses to navigate the complex challenges posed by disasters, emphasizing the

importance of resilience and adaptability in the face of unforeseen crises.

A thorough review of existing literature highlights a consensus on the critical need for

standardized competencies and definitive learning outcomes in disaster preparedness education

for nursing students. Jose and Dufrene's (2014) research delved into the fundamental aspects of

disaster preparedness within nursing education. They sought to address two key questions:

Which specific competencies related to disaster preparedness should be integrated into nursing

curricula? What teaching methods are the most effective for conveying this knowledge? Their

research showed no uniformity in the intended competencies despite utilizing resources from

reputable national and international organizations. They consistently adhered to a systematic

approach to content delivery and employed eclectic methods, including various technologies, to

enhance educational outcomes. Their study underscores the significance of clearly defined

competencies and diverse educational technologies in undergraduate nursing programs to enrich

disaster preparedness education.

Such standardization is pivotal in ensuring a cohesive and comprehensive approach to

disaster preparedness training, equipping future nurses with the competencies to respond

effectively to emergencies. The literature advocates for innovative, interactive, and practical

teaching methods, underscoring the value of simulation-based learning and learning modules.
 26

These elements are essential in fostering a proactive and resilient forthcoming nursing workforce

capable of contributing significantly to disaster response efforts.

The studies reviewed included data from regions in Turkey, South Korea, and the United

States, representing areas of Asia, Europe, and North America. However, the literature lacks a

detailed breakdown of specific regional challenges or insights into the disaster preparedness

needs in different parts of these countries and broader global contexts.

Additionally, several notable gaps limit the applicability of the findings. The studies do

not consistently analyze geographical challenges, such as differences between urban and rural

areas or those prone to disasters. This inconsistency hinders our understanding of different

regions' specific disaster preparedness needs. While the studies emphasize populations,

particularly nursing students, they do not explore vulnerable groups, such as geriatric patients,

children, or individuals with disabilities. Exploring these groups could enhance the cultural

competency of training programs.

Furthermore, the absence of data regarding institutional size and staffing levels restricts

insights into the scalability of training programs. There is also ambiguity about the intended

practice settings, whether hospitals, community health centers, or other environments, and

information about system affiliations or external partnerships, such as collaborations with health

systems or emergency agencies, which can significantly influence program implementation.

Social justice considerations, including disparities in healthcare access and the

disproportionate impact of disasters on marginalized groups, are notably lacking in this context,

which weakens the program's focus on equity. Stakeholder awareness and support are mentioned

only briefly, and there is little discussion of the roles of faculty, healthcare organizations, or

students in disaster preparedness programs.

 27

Lastly, while simulation and competency building are highlighted as significant

components, there are insufficient details regarding their implementation, challenges, and

program duration. Addressing these gaps would ensure that disaster preparedness training

programs are more comprehensive, equitable, and tailored to meet diverse needs and challenges.

Interventions

Gap Analysis

Education is a human privilege, universal and inalienable. Education is critical in

enabling people to reach their full potential. The educational privilege does not disappear or get

suspended because of disasters and emergencies. When education is interrupted or limited,

students drop out, with negative and permanent economic and social impacts on students, their

families, and their communities. Since disasters can occur unexpectedly, schools must be

prepared to respond quickly and consider the safety of their students. Schools can effectively

reduce injuries, deaths, and property damage by implementing a comprehensive approach to

disaster management that includes practical environmental preparedness, software plans, and

disaster drills. The approach will also enhance school resilience to disasters, Wang, (2016).

A recent gap analysis revealed that the University of San Francisco School of Nursing

and Health Professions needs a disaster response plan. Therefore, the University of San

Francisco School of Nursing must educate and provide hands-on training to nursing students,

faculty, and support staff on responding to an on-campus crisis.

Hence, an initiative is underway to develop a pilot disaster management educational plan.

Effectively integrating this program requires the basic structure for disaster planning, which

includes the four phases: mitigation, preparedness, repones, and recovery of comprehensive

emergency management, as stated in Appendix D, Gap Analysis.

 28

Gantt Chart

The Gantt chart is a critical project management tool that visually tracks progress toward

reaching pivotal milestones across the project timeline. It is set from August 2023 to December

2024 and is featured in Appendix E, Gantt Chart. This chart visually represents project timelines

and critical communication junctures for the project leader and team and specifies necessary

updates when changes impact tasks or deadlines.

The project detailed in the Gantt chart unfolds through five structured phases:

assessment, planning, implementation, evaluation, and sustainability. Each phase specifically

develops and implements a comprehensive disaster management educational plan. This plan is

designed to increase the USF SNOHP's ability to effectively prepare for and respond to disasters,

enhancing the resilience and safety of the school and its surrounding community.

The Assessment Phase establishes the project's foundation by defining the problem,

developing the PICOT question, and reviewing evidence. The Planning Phase secures project

support and approval and develops the assessment tools and a clinical instructor training course.

The Implementation Phase conducts project team meetings, ensures ongoing communication

with stakeholders, and involves recruiting and training staff nurses as clinical instructors

alongside pre- and post-assessments related to clinical rotations. The Evaluation Phase focuses

on data analysis and evaluating the project's outcomes to assess effectiveness. Finally, the

Sustainability Phase aims to achieve the project's long-term impact through stakeholder

debriefings, a formal handoff to the USF SONHP operational leadership, embedding the project

into the Nursing School curriculum, and monitoring progress.

The Gantt chart marks each phase with essential milestones and expected completion

times to meet the outlined deadlines. The chart is regularly updated to reflect new tasks or
 29

deadline adjustments, ensuring the project remains on track to achieve its goals within twelve

months.

Work Breakdown Structure

A Work Breakdown Structure (WBS) is a highly effective tool used in project

management that divides complex projects into smaller, more manageable components, allowing

for easy visualization (Davis, (2023). It can be compared to a pyramid, where the top level

represents the project's final goal, and each lower level breaks down the necessary tasks to

achieve that goal. The WBS is focused on tangible deliverables, such as products, services, or

results, and provides several critical benefits for project management.

First, it helps clarify the project scope and prevents confusion about project boundaries.

Second, it organizes tasks and provides a structured framework to streamline work. Third, it aids

resource allocation by helping to estimate budgets, timelines, and staffing needs. Fourth, it

facilitates scheduling and tracking, allowing for detailed planning and progress monitoring. It

identifies potential risks and promotes proactive risk management throughout the project

lifecycle. The WBS supports the entire project lifecycle, from the planning phase, which defines

the project's full scope, to the execution phase, which guides task assignment and resource

management, to the monitoring and control phase, which provides a baseline for progress

tracking and adjustments. The work Breakdown Structure (WBS) is an organized approach to

enhance the preparedness and responsiveness of nursing students in disaster situations. It

comprises five primary phases to develop, refine, and sustain critical training elements,

significantly improving the training outcomes. The WBS is detailed through a hierarchical

framework and includes multiple levels of activities and tasks. The five phases are as follows:
 30

Phase 1: Gap Analysis and Problem Definition, Phase 2: Planning, Phase 3: Implementation,

Phase 4: Evaluation, and Phase 5: Sustainability.

Phase 1: The project's initial phase is Gap Analysis and Problem Definition. A detailed

gap analysis identifies deficiencies in the current disaster training frameworks. Organizational

assessments gauge the capacity for implementing new training modules. A PICO(T) question

further focuses on the project's research direction. A comprehensive literature search and

subsequent appraisal of evidence provide the foundation for effectively addressing these gaps,

setting the stage for the project's success.

Phase 2: Planning is a collaborative effort involving educational experts, disaster

response specialists, and other stakeholders. This phase develops a detailed project proposal that

outlines objectives, expected outcomes, and scope. Strategic analyses, such as SWOT and

stakeholder analysis, inform the creation of a robust communication plan and a well-defined

project budget. The key outputs of this phase, including the development and approval of

learning modules and simulation tools, are essential for the educational interventions planned.

Phase 3: Implementation begins with the crucial step of identifying and recruiting subject

matter experts (SMEs). These experts play a pivotal role in facilitating the simulation exercises,

ensuring the practical application of learned skills. Regular team meetings maintain project

transparency and help achieve its goals. The communication plan fosters engagement among

stakeholders. Facilitator and participant training sessions further emphasize the practical

application of learned skills through simulations. The phase concludes with the administration of

post-training assessments to evaluate the effectiveness of the training interventions.

Phase 4: Evaluation focuses on analyzing data collected from pre- and post-training

assessments to measure the effectiveness of the educational enhancements. This analysis helps
 31

assess how well the project outcomes align with the initial AIM statement and the PICO(T)

question. A comprehensive project debrief involves all team members and stakeholders,

providing valuable feedback and insights for future projects. The culmination of this phase is the

presentation of a final report to the administration and the submission of a detailed project paper

to relevant scholarly outlets.

Phase 5: Sustainability is crucial for the project's long-term impact. This phase involves

scheduling debriefing sessions with stakeholders to discuss the project's outcomes and future

applications. Celebrations and recognition ceremonies are planned to acknowledge the

contributions of all participants. The project is formally handed off to a leadership team

responsible for its continuation, ensuring that the training enhancements are integrated into the

nursing school's curriculum and updated regularly.

The WBS provides a structured approach to ensure the disaster response training project

is thoroughly planned, executed, and evaluated. This methodology enhances nursing students'

training outcomes and contributes to the broader goal of preparing healthcare professionals to

manage disasters effectively. The WBS framework, therefore, serves as a model for similar

educational initiatives aiming to bolster disaster preparedness in professional training

environments. For more detailed planning and execution steps, refer to Appendix F for the Work

Breakdown Structure.

Responsibility/Communication Matrix

The development and management of a communication plan by the Doctor of Nursing

Practice (DNP) student plays a pivotal role in averting communication breakdowns by

delineating the roles of all project participants. This plan is instrumental in keeping the project

aligned with its scope and budget constraints. Furthermore, management and leadership
 32

engagement are essential for delineating the project's objectives, scope, responsibilities, and

resources to execute the educational program.

The responsibility for overseeing the project, crafting the educational module, and

conducting pre- and post-project surveys is bestowed upon the DNP candidate. A strategic

understanding of the influence wielded by key stakeholders facilitates the identification of the

appropriate leadership team members for meetings and determines the frequency of these

gatherings. To convey the project's objectives and its potential to enhance the delivery of

culturally sensitive care, the DNP student organizes an in-person presentation for the

administrator and the nursing director. Additionally, disseminating the project plan alongside

evidence-based literature to stakeholders underscores how the initiative can bolster provider

knowledge and patient care outcomes. Weekly updates with the nursing director, advisor, chair,

and administrator are scheduled to communicate the project's progress. Direct reporting of the

project's advancement and implementation is made to Dr. Loomis and Dr. Mark, the advisory

leaders at the University of San Francisco. For further details on stakeholder engagement, refer

to Appendix G for the Responsibility/Communication Matrix.

SWOT Analysis

A SWOT analysis is valuable for evaluating the strengths, weaknesses, opportunities, and

threats associated with a School Disaster Management Education Response Plan. Several factors

can influence the project initiative. A SWOT analysis of a safety-focused, simulation-based

educational intervention reveals several internal and external factors that could significantly

impact the program's potential for success (Leiber, Stensaker, & Harvey, 2018).

Internal Strengths
 33

The program's prioritization of safety enhances its appeal to stakeholders, demonstrating

a commitment to the well-being of both faculty and students. A hands-on approach to learning

ensures that participants gain practical experience and a better understanding of real-world

scenarios, significantly boosting preparation and skill retention The initiative's emphasis on

continuous improvement, evidenced by the goal to increase retention by 25% and follow-ups

after three months, showcases a dedication to enhancing educational outcomes and adapting

strategies based on feedback and measurable results.

Internal Weaknesses

The program's heavy reliance on specialized technology introduces potential

vulnerabilities, including maintenance challenges and the need for frequent updates, which could

impede its smooth operation. Resistance from those accustomed to traditional educational

methods necessitates additional efforts in training and adaptation. The ambition to optimize

resource usage could limit the intervention's scope or dilute its quality due to potential resource

constraints. Additionally, more than the three-month evaluation period may be required to gauge

long-term knowledge retention accurately, potentially skewing the assessment of the program's

effectiveness.

External Opportunities

Success with the initial implementation could facilitate extending this educational model

to other departments or institutions, amplifying its impact. There is also a substantial opportunity

to secure external funding or grants for educational improvements and disaster preparedness,

which could bolster the program financially and enhance its capabilities. Collaboration with

disaster management agencies augments resources and expertise and adds credibility and

practical relevance to the training provided.

 34

External Threats

A disaster during the project's timeline could disrupt its implementation, underscoring the

need for comprehensive contingency planning. Resistance from critical stakeholders, including

leadership and students, could impede the adoption of the new educational methods, highlighting

the importance of securing buy-in through effective communication and involvement strategies.

Lastly, the reliance on sophisticated technological infrastructure poses a risk of budget overruns,

particularly if costs are underestimated or mismanaged, which could threaten the program's

sustainability and organizational support.

The program is well-structured to leverage its strengths and opportunities; however, it

must carefully navigate its internal weaknesses and external threats to ensure its effective

implementation and long-term success. Addressing these factors with strategic planning and

proactive management will be crucial for maximizing the educational benefits of this innovative,

simulation-based intervention. (see Appendix H SWOT Analysis).

Budget

The budget outlines how resources will be allocated to cover expenses during the

project’s implementation and evaluation phases. The cost of simulation supplies for a university-

based disaster management scenario is as follows: The mass casualty incident response kit offers

essential supplies for realistic training and practice scenarios in large-scale emergencies. Each kit

costs $900, with two units required for a complete setup, totaling $1800. Six safety vests for the

facilitators, each $5, are included to enhance visibility during the simulation, amounting to $30.

The kit also contains 12 CAT Gen 7 Tourniquets, vital for practicing hemorrhage control, priced

at $10 each for $120. The Triage Kit, crucial for sorting and prioritizing patients in an

emergency, costs $200.

 35

Additionally, a pack of 100 Triage Patient Tags, necessary for patient identification and

categorization, is available for $25, offering an economical option for marking patients. Other

simulation tools include the Sim Wagon, valued at $100, facilitating easy transportation of

materials and equipment around the training area. The Moulage Kit, priced at $860, adds realism

by allowing the creation of simulated injuries. For communication, three whistles are included at

$1 each, totaling $3. The package includes essential writing tools for administrative needs and

features 50 pens, 50 markers, and 12 clipboards priced at $100 per package. These items support

efficient record-keeping and organization during simulations. The total cost for all simulation

supplies is $3,238. This setup provides a fully equipped and realistic training environment for

mass casualty incident response, ensuring a comprehensive and practical simulation experience

for participants.

Transitioning into the evaluation and sustainability phase, the continued involvement of

our faculty will be paramount. They will diligently monitor student progress through the learning

module, simulation, and survey-based evaluation. Sustaining the module for faculty orientation,

including ongoing enrollment, monitoring, and evaluation, will necessitate approximately ten

supplementary faculty hours per semester. The annual cost of sustaining and monitoring the

modules is $1,600 ($800 per semester) at $80 per hour. Each faculty member will also incur $80

to complete the one-hour module. Uploading and housing the module on Canvas for faculty and

student access is complimentary. The total project cost, considering these factors, is estimated at

$7078. For a more comprehensive breakdown of the project budget, please refer to Appendix I.

Cost Avoidance

Research consistently shows that money spent on disaster preparedness is a sound

investment, leading to substantial savings in reduced disaster response and recovery costs. For
 36

example, a report by the National Institute of Building Sciences found that for every $1 spent on

hazard mitigation, about $6 is saved in terms of future disaster costs in the United States, Gall &

Friedland (2019). Additionally, the value of a statistical life, estimated by the U.S. government to

be around ten million dollars, is a powerful tool for measuring the economic value of

interventions to reduce risk, Federal Register. (2024, April 18). This figure underscores the cost-

effectiveness of safety regulations and measures. It provides a solid basis for organizations to

make confident decisions about investing in safety improvements and disaster management

response plans. Implementing a disaster management response plan at the USF SONHP is not

just a financial decision but a moral and ethical imperative. While it may be challenging to

quantify the exact cost savings from preventing a student fatality, the potential loss in tuition,

future contributions, healthcare costs, and legal liabilities are significant. However, most

institutions and policymakers argue that the intrinsic value of saving lives far outweighs these

economic costs and promotes long-term societal benefits, highlighting the crucial role of safety

for everyone.

Cost avoidance is directly linked to a decrease in tuition revenue when a student

withdraws from university enrollment after a crisis event, which can be attributed to various

reasons. Wang (2024) provides insights into the potential decrease in enrollment after students

experience a campus disaster. They are the heightened safety concerns that arise after tragic

events, making parents and students more cautious about choosing a university. Students and

their families may perceive the surrounding area or campus as unsafe, influencing their decision

of where to attend. The psychological trauma experienced by survivors, families, and nearby

communities can be profound, leading to a decline in students' mental health.

 37

Consequently, students and parents may feel uneasy about sending their children to

college, fearing similar events. Disasters can lead to a reassessment of priorities, and some

students may pursue alternative educational paths while others might delay their studies. Even if

the disaster did not directly occur on a university campus, the wider geographical area could

become negatively associated with the event, making it less appealing for prospective students.

The estimated cost to prevent the loss of tuition fees from a single withdrawal amounts to

$186,000. This cost represents the outstanding tuition fee for a first-year student required to

complete a four-year academic program.

Cost Benefit / ROI

The financial feasibility of this project was analyzed using a cost-benefit analysis (CBA).

The project's CBA aimed to determine its potential to avoid substantial university financial

losses that could arise from lost tuition revenue. The project aims to promote retention and

reduce losses resulting from students withdrawing from the program or declining to enroll for

subsequent terms due to a negative reputation caused by a disaster such as a pandemic,

earthquake, or active shooter scenario.

Higher education institutions face financial risks when natural or artificial disasters occur,

which can threaten student enrollment. The project's cost-benefit is related to the cost avoidance

of lost tuition revenue. According to the USF (n.d.) Admission & Aid, the average cost of tuition

for a four-year baccalaureate degree for the academic year 2024-2025 is approximately

$250,000, which amounts to $62,000 per year or $21,000 per semester for the average student.

According to Wang, 2024, there is a significant decrease in college enrollment after a university

experiences a campus crisis.

 38

The potential loss of tuition revenue is a stark reminder of the risks we face without a

disaster management response plan (DMRP). A semester's disruption could result in substantial

losses. Using the current tuition cost of $21,000 per student per year and the DMRP cost of

$13,444, the DMRP quickly demonstrates its cost-effectiveness. For just one student, the

potential savings are $7,556. This value increases significantly as more students are protected.

The value increases with two students, savings reach $28,556 and escalates to $91,556 for five

students. The break-even point for the DMRP is $13,444, which equates to the tuition revenue of

about 0.64 students per semester. However, given that fractions of students are not possible, the

plan can still be deemed cost-effective even if it saves the tuition revenue of just one student.

Overall, the DMRP's financial advantages make it a compelling option. Refer to Appendix I for

the cost-benefit chart.

The ROI shows that for every $1 spent on the plan, the institution gains a net benefit of

$10.28, or 138,204.32 ($10.28 x $13,444). The figures show a significantly positive ROI and net

benefit, albeit much lower than when considering the dropout of a more significant number of

students. However, it still highlights the financial benefit of investing in disaster preparedness,

even if only one student's potential dropout is prevented. A well-defined disaster management

response plan, a strong sense of community support, and resilience are critical in mitigating the

possible negative impacts on university enrollment. Those universities that can effectively

manage crises, communicate transparently, and enhance safety measures tend to maintain or

eventually recover their enrollment levels.

Study of the Interventions

The pilot disaster management program for nursing students offers an innovative

approach to equip future nurses with essential crisis response skills and enhance their
 39

effectiveness. The author provided digital educational opportunities to USF undergraduate and

graduate nursing students on triage, basic first aid, and stop-the-bleed from October 1 to 23,

2024. After completing the educational modules, a disaster management earthquake simulation

was held on October 24, 2024. The Simulation Effectiveness Tool-Modified (SET-M) Appendix

K is a valuable resource for assessing healthcare simulations. It has proven validity, covers

essential aspects comprehensively, and can be adapted to different contexts. This tool enables

educators to collect data for improvement and research, ensuring that simulations effectively

enhance learning and skill acquisition (Leighton et al., 2015). It was used to evaluate students'

perceptions of the effectiveness of the simulation experience scenarios.

As natural and artificial disasters become more frequent and intense, there is a critical

need for comprehensive disaster management education in nursing curricula. Nurses, who often

lead disaster response efforts, require specialized training to respond quickly and effectively to

emergencies, helping to minimize the impact on affected communities. This program serves as a

model by incorporating various digital learning methods and a simulation-based curriculum,

ensuring that nursing students, faculty, and support staff gain practical and theoretical knowledge

in crisis management.

Outcome Measures

Data Collection Tools

The project employed a combination of post-simulation surveys and participant feedback

to conduct quantitative and qualitative thematic analyses. The evaluation primarily focused on

the outcomes of pre-work educational interventions, which included training in triage, basic first

aid, stop-the-bleed techniques, and simulations. The effectiveness of these interventions was

measured using the Simulation Effectiveness Tool–Modified SET-M (Leighton, 2015), which
 40

uses a Likert-type scale. Response options included "strongly agree," "somewhat agree," "do not

agree," and an open-ended question on the simulation experience. (SET-M Appendix K). The

second method involved direct observation of the simulation and qualitative analysis of

participant feedback to identify emerging themes from the debrief session.

Analysis

The Quality Improvement (QI) pilot project evaluated the impact of disaster management

pre-work and simulation training on improving participant efficacy. The project involved 70

USF participants, including 63 undergraduate students enrolled in the Bachelor of Science in

Nursing (BSN) program and seven graduate students from the Master's Entry - Master of Science

in Nursing, Clinical Nurse Leader program. All participants were unlicensed. Feedback and

observations were collected during and after the simulations to assess disaster readiness and

enhance participant efficacy. A post-simulation survey, distributed through an anonymous QR

code linked to the Qualtrics platform, received 51 responses: 46 from undergraduate students and

five from graduate students. The survey allowed participants to provide feedback immediately

following the simulation debrief.

Additionally, direct observations during the simulations and a qualitative analysis of

participant feedback during debriefing sessions supplemented the survey data. The

comprehensive analysis identified emerging themes and actionable insights to improve the

program and participant efficacy. Quantitative and qualitative methods were employed to assess

changes in participants' knowledge and their likelihood of successfully managing disaster

scenarios in the future.

A quantitative analysis was conducted using pre- and post-surveys administered through

the Qualtrics platform, utilizing the Simulation Effectiveness Tool–Modified (SET-M). All
 41

statistics in this report were generated using IBM SPSS version 30, part of the IBM Statistical

Package for the Social Sciences (SPSS). This well-known software suite is used for thorough

statistical analysis and data management.

The SET-M assesses preparedness for disaster management simulations, covering critical

areas such as responding to patient conditions, understanding pathophysiology and medications,

clinical decision-making, prioritization, communication, patient education, reporting, safety, and

evidence-based practices. It highlights strengths and areas for improvement in simulated clinical

training, emphasizing the development of confidence, critical thinking, and essential clinical

skills.

The simulation had a modest positive effect on participants’ confidence and perceived

learning outcomes, particularly in areas critical to clinical practice. While post-simulation means

across various metrics were slightly higher than pre-simulation means, these differences reached

a slight statistical significance. Nonetheless, the findings underscore the value of simulation in

clinical education by highlighting its ability to enhance confidence and perceived learning

outcomes.

Confidence in delivering safe interventions emerged as a particularly significant domain.

Regression analysis revealed a strong correlation between confidence in this area and perceived

learning outcomes, emphasizing the meaningful impact of the simulation experience.

Additionally, the structured opportunities for practice and reflection provided by the simulation

and debriefing sessions contributed to participants’ readiness for clinical scenarios.

Although quantitative results suggest minor changes, qualitative insights may further

illuminate the role of simulation in fostering skill development and clinical readiness. These

findings highlight the importance of simulation in clinical education and suggest that further
 42

research could provide a more comprehensive understanding of its benefits and potential to

enhance professional preparation.

A qualitative analysis compared open-ended responses from the SET-M survey with

feedback from faculty observers during the simulation. Encouraging participants to elaborate in

this section often provides valuable qualitative data that can help improve future simulation

sessions. The question, "What else would you like to say about today's simulated clinical

experience?" allows participants to share personalized feedback, enhancing our understanding of

their experiences. This allows individuals to highlight specific strengths or weaknesses of the

simulation, express any unaddressed concerns, and discuss challenges that closed-ended

questions may not have captured.

Participants reflected on their emotions and engagement, sharing thoughts on the simulation's

realism and relevance and indicating whether they felt adequately supported or appropriately

challenged. Furthermore, they are encouraged to recommend enhancements, such as

incorporating more diverse scenarios, allocating more time for specific tasks, or suggesting

adjustments to briefing and debriefing sessions. Furthermore, participants shared context-specific

insights concerning clinical elements, equipment performance, and team dynamics while

reflecting on the simulation's alignment with their learning objectives and real-world

applications. The positive findings from this analysis highlight the intervention's feasibility and

effectiveness, suggesting establishing a disaster management program within nursing education

curricula. Refer to the following appendices for detailed data and evaluation results: (Appendix L

Survey Results in Confidence and Preparedness Metrics, Appendix M Cohen’s d Results, and

Appendix N Thematic Analysis for Open-Ended Responses). These appendices provide

comprehensive insights into the evaluation metrics and outcomes.

 43

Ethical Considerations

Non-research initiatives (Appendix B), such as quality improvement and evidence-based

practice (EBP) projects, often overlook the moral and ethical implications, according to Hunt et

al. (2021). This project is committed to promoting educational initiatives to enhance the

knowledge and skills of nursing students, faculty, and supporting staff in disaster management.

The primary objective is to provide a comprehensive and practical learning experience that

aligns with the nursing profession's goals, ethics, and objectives, which aligns with the

following:

The American Nurses Association's Code of Ethics (2015) will guide through its

provisions in response to ethical concerns related to this project. Provision 1 will highlight the

importance of treating individuals with dignity and respect, promoting psychological safety, and

mutual support for well-being. Provision 3 will emphasize the need to maintain privacy for

patients, colleagues, and survey or research participants, advocating for a safety culture.

Provisions 5 and 6 will encourage nurses to prioritize their health and that of their patients to

maintain a supportive work environment. Provision 7 will motivate nurses to engage in scholarly

inquiry and adopt evidence-based practices, as evidenced by a certificate demonstrating this

Doctor of Nursing Practice (DNP) student's completion of the CITI Program's Human Subjects

Research training.

This project will align with the Ignatian values that underpin the academic ethos of the

University of San Francisco (USF) and with the principles of the Theory of Human Caring by

Watson (2021). The concept of cura personalis, or holistic care, will be central to this approach,

emphasizing care and support for all aspects of an individual's being, according to Watson
 44

(2021). In addition, it will encourage nurses to create a caring environment that acknowledges

both the physical and spiritual well-being of nurses and patients.

To mitigate potential ethical concerns, several measures will be implemented. The USF

DNP department will confirm that this project meets the criteria for an evidence-based change in

practice project outlined in the Statement of Non-Determination IRB checklist (Appendix B),

granting it a non-research status with no identifiable conflicts of interest.

Participation in the project will be voluntary, and completion of the post-debrief survey is

encouraged; however, it is not mandatory for Critical Incident Debriefing (CID) participants. All

collected data will be anonymized and presented in aggregate, preserving survey anonymity.

Section IV: Results

Quantitative Findings

The educational presentation was delivered to nursing students at undergraduate and

graduate levels through CANVAS, a web-based learning management system (LMS) created to

facilitate online instruction for academic institutions such as schools, colleges, and universities.

Following the LMS, students were encouraged to participate in a pre-and post-assessment of

their knowledge, as outlined in Appendix O CANVAS LMS. After the presentation, a disaster

management simulation took place. The LMS was accessible from October 1 to October 24,

2024, with the simulation occurring on the final day, October 24, 2024.

The project included 70 unlicensed USF participants: 63 undergraduate BSN students and

seven graduate students from the Master's Entry - Clinical Nurse Leader program. Feedback was

gathered during and after disaster readiness simulations. An anonymous Qualtrics survey via QR

code received 51 responses (46 undergraduates, five graduates) post-simulation debrief. They
 45

were given a three-point Likert scale ranging from Strongly agree, somewhat agree, and do not

agree.

The SET M survey questions (Appendix K) evaluated the participants' self-reported

growth and confidence in critical clinical skills and competencies following their simulation

experience. Participants rated their preparedness to respond to changes in a patient's condition,

their understanding of pathophysiology, confidence in assessment skills, and empowerment to

make clinical decisions. Additional questions assessed their understanding of practicing clinical

decision-making and their ability to prioritize care and interventions.

Additionally, the survey examined participants' confidence in communicating with

patients, educating them about their illnesses and treatments, and sharing information with the

healthcare team. Finally, participants assessed their confidence in implementing patient safety

interventions and applying evidence-based practices in their care. These questions aimed to

evaluate the effectiveness of the simulation in enhancing clinical competency, decision-making,

and students' confidence.

The responses regarding confidence in skills such as assessment and prioritization of care

revealed relatively low mean scores (1.27–1.53), indicating substantial agreement or confidence.

Conversely, the mean scores for understanding topics such as pathophysiology and medications

were slightly higher (1.65–1.89), suggesting these areas might benefit from additional focus or

training. Questions addressing opportunities to practice decision-making and feelings of

empowerment exhibited low mean scores and standard deviations, reflecting strong agreement

and high consistency in participant responses.

The descriptive statistics provide compelling evidence of enhanced participant outcomes

following the simulation. Notably, the mean post-simulation score (M = 4.15) exceeds the mean
 46

pre-simulation score (M = 3.55), indicating a significant improvement in performance or

confidence levels. The medians of the pre-simulation and post-simulation scores correspond with

their respective means (Md = 3.55 and Md = 4.15), reflecting a symmetric distribution of scores.

Regarding variability, post-simulation scores demonstrate a minor standard deviation (SD =

0.11) compared to the pre-simulation scores (SD = 0.22), suggesting that the intervention led to a

more consistent improvement among participants. Additionally, the scores range has shifted

upward, with pre-simulation scores falling between 3.20 and 3.90 and post-simulation scores

ranging from 4.00 to 4.30. These findings suggest that participants generally feel confident in

their clinical decision-making and communication skills. Please refer to Appendix L for the

descriptive statistics of Set M: Survey Results in Confidence and Preparedness Metrics.

Cohen's d is a well-known statistical metric used to measure effect size. It provides a

standardized method for quantifying the magnitude of differences between two groups. By

expressing these differences in terms of standard deviations, Cohen's d allows for comparisons

across studies or variables, even when different measurement scales are involved. Unlike p-

values, which focus solely on testing the null hypothesis, Cohen's d offers insights into the

practical significance of findings, emphasizing whether the observed differences have real-world

relevance (Lovakov & Agadullina, 2021).

Established benchmarks categorize effect sizes as small (0.2), medium (0.5), and large

(0.8), helping to contextualize the strength of interventions or differences between groups.

Cohen's versatility applies to various research contexts, such as comparisons between

experimental and control groups and evaluations of pre-test versus post-test results within the

same group. By providing a meaningful interpretation of results, Cohen assists researchers and

practitioners in prioritizing substantive findings over mere statistical significance. Cohen's d is

 47

approximately 0.67, which indicates a medium to large effect size. The result suggests that the

education and simulation significantly impacted the measured outcomes, such as confidence and

learning outcomes. Please refer to Appendix M for Cohen's d chart and results.

Qualitative Findings

The Set M survey included an open narrative question to assess the potential for practice

change following the educational and simulation interventions. A preliminary qualitative

thematic analysis of the open-ended responses collected from students identified three key

themes: Increased Confidence, Skill Retention, and Preference for Simulation.

The first theme, Increased Confidence, revealed that students felt more self-assured in

handling disaster management emergencies, with many attributing this boost in confidence to the

simulation experience. Nearly all students noted, "I was able to practice nursing skills in real-

world conditions." These comments highlight a strong sense of satisfaction and appreciation for

the session. The second prominent theme identified was Skill Retention. Nursing students

believed that the realism of the simulation helped them retain their newly acquired skills longer

than traditional educational training methods, such as learning management systems (LMS) or

lectures. The third theme, Preference for Simulation, indicated that most students favored

simulation over traditional LMS because it was more engaging and realistic. They felt it better

replicated the pressures of real-life emergencies. The analysis suggests students had a positive,

engaging, and educational experience. The recurring themes reflect the session's success in

meeting its educational objectives, implying that a disaster management program is highly

desirable in nursing education curricula. Please refer to Appendix N to view the Thematic

Analysis chart.

Section V: Discussion
 48

Summary

The project objectives were to establish and assess a comprehensive mass casualty

response plan at the University of San Francisco School of Nursing, enhancing disaster

preparedness by improving the knowledge and confidence of faculty and students by at least

25% through targeted education and simulation exercises by October 2024. The collected data

supports the project's objectives and demonstrates that the program met its goals. The results

showed a 68% increase in nursing students' knowledge and confidence in providing medical

interventions after participating in the mass casualty simulation, compared to their baseline

levels before the simulation.

The project highlighted the essential role of simulation-based education in improving

disaster preparedness among nursing students and faculty. By addressing knowledge and

confidence gaps through a standardized training and education approach with simulation

exercise, the project significantly enhanced participants' ability to respond to mass casualty

events. The observed 68% increase in knowledge and confidence demonstrates the program's

positive impact on preparedness and competency. Continuous implementation, monitoring, and

refinement of such training will be vital for maintaining and further advancing the effectiveness

of disaster response education in nursing.

A presentation was conducted for the Leadership in Community Mental Health course,

which aims to equip Master's Entry MSN students with a solid foundation in psychiatric,

community, and public health nursing. The session targeted 36 fifth-semester students nearing

their Registered Nurse and Clinical Nurse Leader qualifications. In response to a special request,

co-DNP students and the committee chair presented on disaster preparedness, response, and the

role of registered nurses. The presentation began with a DNP student's journey and passion for
 49

disaster preparedness. It illustrated how nurses can identify gaps and lead initiatives to enhance

patient and community outcomes. Students actively engaged by asking questions about the real-

world applications and challenges of disaster response. The discussion provided evidence-based

answers and emphasized the crucial roles of preparedness and leadership in effectively managing

crises.

Interpretation

The project has identified areas for improvement within the USF nursing curriculum. The

curriculum revealed a significant gap in disaster management education, which showed that no

plans or programs were in place to address this critical aspect of nursing preparedness. Due to a

gap identified in disaster management protocols, an integrated literature review was conducted to

highlight the essential components needed for creating a disaster management education program

specifically designed for nursing curricula. This review offered valuable insights that guided the

development of a solid educational framework, ultimately improving nursing students'

preparedness and response capabilities during disasters.

The introduction of the LMS and simulation training was an initiative to address the

identified gaps in nursing education. This intervention took a proactive approach to equip

nursing students with the essential knowledge necessary for disaster management. The project

enhanced students’ effectiveness in crises by improving their understanding and skills in disaster

response and increasing their efficacy. This intervention reflects a proactive approach to nursing

disaster management education, emphasizing the importance of students' knowledge, skills, and

efficiency in disaster response and care delivery.

The post-intervention evaluation revealed significant improvements in the understanding

of disaster management response. Key metrics include the student's role in disaster response and
 50

ability to provide patient care in a constrained environment, indicating the effectiveness of the

interventions. This pilot quality improvement project underscores the value of integrating a

disaster management program into the nursing education curriculum. By strengthening students'

knowledge and bolstering their confidence in disaster response, the project has markedly

enhanced their preparedness and effectiveness in providing care during disaster scenarios.

Although the project has produced positive results, continuous monitoring and evaluation

are essential. Ongoing efforts to improve quality are critical for sustaining progress and

identifying further opportunities to enhance disaster amazement response. It underscores the

importance of proactive quality improvement initiatives and highlights the value of standardized

nursing education, which is crucial for optimizing student efficacy and patient care outcomes.

Limitations

The pilot QI project introduced educational and simulation interventions to enhance

disaster management responses and establish a framework for nursing curricula. Implementing

effective disaster management education and simulation programs in nursing schools faces

several challenges, including resource allocation, curriculum integration, technology adoption,

and accessibility.

One primary challenge involves resource constraints. High-quality disaster simulations

demand significant investments in advanced equipment, specialized manikins, and potentially

hazardous materials for realistic scenarios. Financial limitations may hinder acquiring and

maintaining these essential resources, impacting the training's realism. Faculty expertise is

another critical factor. The success of these programs hinges on instructors with specialized

knowledge and experience in disaster response. A lack of adequately trained faculty curtails the

program's capacity to offer comprehensive training (Oliveira et al., 2023).

 51

Curriculum integration presents another hurdle. Balancing essential nursing topics with

disaster preparedness training within a full curriculum requires meticulous planning to avoid

overloading students. Space and safety considerations also pose significant challenges. Adequate

space and strict safety measures are essential for simulations, particularly those involving

hazardous conditions (El-Hussein & Harvey, 2023). Time constraints further complicate

implementation, as nursing students' demanding schedules may make it difficult to fit additional

disaster management training without neglecting other vital educational components.

Technological limitations are another significant barrier. Innovations such as virtual

reality (VR) and other digital tools offer promising solutions but are often expensive and require

specific skills for development and implementation. Another concern is ensuring all students

have access to and can use these technologies. The evaluation and feedback process is also vital

for ongoing improvement (Russell et al., 2023). However, developing effective metrics and

providing timely, actionable feedback can be challenging in the rapidly evolving disaster

management field.

Scalability and accessibility require careful consideration. Expanding the program to

accommodate more students or diverse learning needs, especially in resource-constrained

environments, demands additional planning and resources. Ensuring accessibility for all students,

including those with disabilities, is equally critical.

The results also highlighted significant gaps in available data. Specifically, the program

lacked detailed insights into regional challenges and the needs of vulnerable groups, such as the

genetic, pediatric, or physically challenged populations. Furthermore, limited data on the

scalability of training for larger cohorts and considerations for addressing social justice issues,
 52

including healthcare disparities and disaster impacts on marginalized populations, were

identified as critical areas requiring further exploration.

In response to these challenges, a range of mitigation strategies was implemented.

Strategic budget planning and pursuing potential external funding opportunities were prioritized

to address financial requirements. Initiatives for faculty development were introduced to enhance

educators' skills in disaster management. Transparent communication and ongoing educational

efforts engaged stakeholders, effectively reducing resistance and fostering collaboration.

Feedback mechanisms, including post-simulation debriefings and qualitative surveys, offered

valuable insights for the continuous refinement of the program.

Addressing these barriers necessitates strategic planning, resource investment, faculty

development, and curriculum innovation. Collaborating with external partners, conducting

regular evaluations, and leveraging technology can mitigate these challenges and enhance the

effectiveness of disaster management education in nursing schools. It is essential to recognize

these findings while exercising caution in generalizing them, as the unique characteristics of

specific programs and institutions may influence their broader applicability.

Conclusions

Disaster management education is significant in nursing programs. The QI pilot initiative

yielded promising results, equipping future nurses with essential skills and knowledge to keep

themselves, their patients, and their communities safe from natural and human-induced disasters.

However, student nurses need more confidence in their disaster response capabilities, which can

hinder their preparedness and willingness to act in crises.

The absence of emergency preparedness training for nursing students exacerbates this

gap. Therefore, providing continuous engagement opportunities for student nurses in disaster
 53

planning, simulation drills, and real-world disaster response experiences is crucial. Such ongoing

educational and practical experiences are critical in developing resilient and reliable future

nurses who can provide support and hope to those affected by disasters, thus strengthening

overall crisis preparedness capacity.

Section VI: Funding

The DNP student conducted the project without any external financial support and

proactively led it to enhance disaster preparedness by developing, implementing, and evaluating

a comprehensive mass casualty response plan. The project successfully improved nursing

students' and faculty's knowledge and confidence in effectively responding to mass casualty

events through targeted education and simulation exercises.

 54

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 63

Appendix A

Evidence Evaluation Table

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Alfred, D., Chilton, J., Connor, D., Deal, B., Fountain, R., Hensarling, J., & Klotz, L. (2015). Preparing for disasters: Education and management strategies. Nurse Education in Practice, 15, 82-
89. https://doi.org/10.1016/j.nepr.2014.08.001
The importance Design: Sample: Independent Variable: Researchers assessed A qualitative The study found Level of Evidence: III
and methods of Qualitative 130 Community health Skills / Knowledge disaster nursing analysis of that integrating
incorporating Nursing Students education by curricular disaster nursing Worth to Practice:
disaster nursing Method: Dependent Variable: reviewing the integration competencies The Evidence supports the
competencies Curriculum Setting: Education / Simulation curriculum, running strategies, across the nursing effectiveness of integrated
into the nursing Development / Two Southern Texas disaster simulations, simulation curriculum and disaster nursing education and
curriculum. Integration / Universities and gathering outcomes, and engaging in collaborative simulations.
Simulation participant feedback. participant collaborative
Observation This measured feedback disaster simulations Strength:
preparedness and (students, enhanced students' The program provides an
Conceptual response capabilities. faculty, and understanding and innovative approach through
Framework: community preparedness for real-world simulations and
Competencies partners) disaster response. It experiences.
assessed the highlighted the
effectiveness importance of Weakness:
of disaster interdisciplinary Limited to two nursing
nursing collaboration and schools, the qualitative
education. The practical simulation approach may not capture the
research did experiences in full quantitative impact.
not provide building disaster
statistics. nursing Feasibility
competencies. Shows interoperability
between school and
effectiveness of simulations.

Conclusion
Effective disaster nursing
education requires a
comprehensive approach.

Recommendations
To prepare nurses for
effective disaster response
 64

Purpose of Article or Design / Method / Sample / Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Review Conceptual Setting Studied (and their Major Variables Appraisal Score)
Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s)
APA Citation:
Chompunud, S., & Inkaew, W. (2018). Effects of an interactive teaching method on perceived disaster nursing competencies of undergraduate nursing students. Health Emergency and Disaster
Nursing, 5(1), 25. https://doi.org/10.24298/hedn.2016-0008
To Investigate interactive Design: Sample: Independent Multiple-choice Independent Interactive teaching was Level of Evidence: II A
teaching effect on nursing Quasi- N=92 third- Variable: test pre-post test Sample t- test more effective in disaster
students' disaster nursing Experimental year nursing Interactive nursing for the experimental Worth to Practice:
competency. (BSN) Teaching Method Self- Prevention / group than the control group. Provides support for
Method: students administered Mitigation integrating interactive
Two group Dependent questionnaire. CG X= 35.130 teaching methods.
posttests Setting: Variable: SD=4.787
Thai Red Learning EG X44.717 Strength:
Conceptual Cross College Achievement & SD-3.767 Innovative instructional
Framework: of Nursing Perceived T=-11.328 approach resulting in
Disaster Nursing Competencies P=0.000 improved competencies.
Competencies Thailand
Preparedness Weakness:
CG X= 28.674 Self-reported measures and
SD= 4.238 limited sample size can limit
EG X=35.261 research generalizability.
SD=2.695
T= -8.896 Feasibility
P= 0.000 Interactive nursing education
is feasible.
Response
CG X= 83.696 Conclusion
SD=11.510 Interactive teaching improves
EGX=102.913 learning skills among nursing
SD=7.471 students.
T=-9.498
P= 0.000 Recommendations
Interactive nursing teaching
improves disaster preparation.
 65

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Çiriş Yildiz, C., & Yildirim, D. (2022). The Effects of Disaster Nursing Education Program on Beliefs in General Disaster Preparedness, Disaster Response Self-Efficacy, and Psychological
Resilience in Nursing Students: A Single-Blind, Randomized Controlled Study. Nursing Education Perspectives, 43(5), 287-291–291. https://doi.org/10.1097/01.NEP.0000000000001011
To evaluate the Design: Sample: Independent Variable: Belief in general The study The intervention Level of Evidence: II A
effectiveness of a Single-blind, N=131 Nurses Disaster nursing and disaster preparedness employed the group showed
disaster nursing randomized management scale. Shapiro-Wilk statistically Worth to Practice:
education controlled trial. Setting: education program. test for significant Filling educational gaps
program in Two Universities in Disaster response normality, improvements in
improving Method: Istanbul Turkey. Dependent Variable: self-efficacy scale. independent beliefs in disaster Strength:
nursing students' Randomized Beliefs in general Brief resilience scale. and paired preparedness, Rigorous design, significant
beliefs about controlled trial. disaster preparedness samples t-tests disaster response improvements in target
general disaster for normally self-efficacy, and variables, and the practical
preparedness, Conceptual Disaster response self- distributed psychological application of the JDNMM.
self-efficacy in Framework: efficacy variables, and resilience compared
disaster response, Jennings Disaster nonparametric to the control group. Weakness:
and Nursing Psychological tests (Mann- Limited geographic scope
psychological Management Model resilience Whitney U post-test evaluation without
resilience. test, Wilcoxon long-term follow-up, and
signed-rank potential bias due to the
test) for non- single-masked design.
normally
distributed Feasibility
variables. Chi- Implementing such a program
square is feasible in nursing
analysis was education curricula, given its
used for structured approach and clear
categorical outcomes.
data.
Conclusion
The education program
effectively enhances nursing
students' preparedness and
self-efficacy.

Recommendations
Integrate disaster management
education into nursing
curricula prepares students for
future disaster response roles.
 66

Purpose of Article Design /Method/ Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
or Review Conceptual Studied (and their Major Variables Appraisal Score) /
Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Davis, L. H., Manning, J., St. Germain, D., Hayes, S., & Pigg, C. (2020). Implementing disaster simulations for baccalaureate nursing students in the Gulf-Coast region. Clinical Simulation in
Nursing, 43, 26-34. https://doi.org/10.1016/j.ecns.2020.02.004
To develop, Design: Sample: Independent A 10-item multiple- t-tests to analyze Participants showed Level of Evidence: II A
implement, and pre-post test M=391 Jr - Sr Variable: choice questionnaire the discrepancies significant
evaluate high- BSN Students was used to assess between the pre- improvements in Worth to Practice:
fidelity disaster Method: Participation in disaster knowledge test and post-test disaster knowledge High-fidelity disaster simulations
simulations for Survey Setting: high-fidelity disaster and preparedness, scores: post-simulation, with improve disaster preparedness /
nursing students in Mississippi sims through a pre-test substantial differences knowledge.
the Gulf Coast Conceptual Gulf Coast and post-test. Jr I: in pre-post test scores
region to enhance Framework Dependent Variable: t140=6.91 for the three groups. Strength:
their disaster NLN Jeffries p>.001 Significant improvement in
knowledge and Simulation Disaster Knowledge disaster knowledge, and
preparedness. Theory and preparedness of Jr II: application
participants t3.17=6.91
p>.0022 Weakness:
Single institution, homogenous and
Sr I small sample, no control group
t33=1.36
p=.1817 Feasibility
High-fidelity disaster simulations
Sr II enhance disaster preparedness.
t136=12.88
p<.001 Conclusion
Disaster simulations improve
nursing students' readiness for
disasters.

Recommendations
Use of sims for educational
success.
 67

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Eid-Heberle, K., & Burt, S. (2023). Disaster Education in the Nursing Curriculum: Embracing the Past, Learning From the Present, Preparing for the Future. Journal of Radiology
Nursing. https://doi.org/10.1016/j.jradnu.2022.10.005
The nursing Design: Sample: Independent Variable: Literature review and Qualitative Historical and Level of Evidence: V
curriculum can Literature Review Not Specified The incorporation of analysis of existing analysis of current overviews Qualitative Review
integrate disaster disaster education into disaster education current of disaster
education, Method: Setting: nursing curricula. frameworks and disaster education for Worth to Practice:
offering an Synthesis Academia competencies education nurses, proposing High; integrating disaster
active, learner- Dependent Variable: practices and an integrated education into nursing
centered Conceptual The disaster historical approach for curricula can significantly
approach. Framework preparedness and perspectives. nursing curricula. improve preparedness and
Focusing on response competencies response.
disaster education of nursing students
in nursing. and professionals Strength:
Comprehensive review of
existing literature.

Weakness:
No empirical Data

Feasibility
Requires institutional buy-in
and curriculum restructuring.

Conclusion
Disaster education should be a
required part of nursing
curricula to ensure nurses are
prepared for disasters.

Recommendations
Integrate disaster education as
a mandatory course in nursing
programs and continue
education throughout a nurse's
career.
 68

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Major Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Huh, S., & Kang, H. (2019). Effects of an educational program on disaster nursing competency. Public Health Nursing, 36(1), 28–35. https://doi.org/10.1111/phn.12557
The study Design: Sample: Independent Disaster Nursing Chi-square and t-tests Disaster Nursing Level of Evidence:
aimed to Quasi- 60 junior nursing Variable: Knowledge: Measured confirmed group Knowledge: Level II (Quasi-
examine the experimental students from two The disaster using a 25- homogeneity. Independent The experimental Experimental Study)
effects of an nursing colleges in educational program question true/false t-tests compared disaster group showed a Worth to Practice:
educational Method: South Korea, with 30 based on the ICN questionnaire nursing significant increase The program is highly
program on The study students in the framework of developed based on knowledge, disaster in knowledge valuable for practice as it
disaster involved experimental group disaster nursing BDLS and ADLS triage, and disaster scores compared to significantly enhances
nursing developing and and 30 in the control competencies. courses. readiness between the the control group (t nursing students'
competency implementing a group experimental and control = 14.37, p < 0.001). competencies in disaster
among Korean disaster Dependent Variable: Disaster Triage: groups. preparedness and response.
nursing educational Setting: Disaster Knowledge Measured using a 10- Disaster Triage:
students. program based on Christian College of & Readiness question true/false The experimental Strength:
the International Nursing and Chosun scale developed from group showed a Significant improvements
Council of Nurses University, Gwangju, the SALT triage online significant in disaster nursing
(ICN) framework South Korea. training and ADLS improvement competencies among
of disaster course. in triage scores (t = participants.
nursing 7.90, p = 0.002).
competencies. Disaster Readiness: Weakness:
Measured using a 26- Disaster Limited sample Size, Lack
Conceptual item scale on a 5-point Readiness: of standardized
Framework Likert scale, covering The experimental measurement tools.
ICN four subscales: group demonstrated
prevention/mitigation, a significant Feasibility
preparedness, increase r\Requires institutional
response, and in readiness scores support and resources for
recovery/rehabilitation. (t = 10.82, p < effective execution.
0.001). Conclusion
Valuable intervention for
developing essential
competencies.

Recommendations
Integrating disaster
education into nursing
curricula using case-based
small group learning
methods.
 69

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Major Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Hung, M. S. Y., Chow, M. C. M., Pau, O. K., Lam, S. K. K., & Ng, W. W. M. (2021). The Effectiveness of Disaster Education for Undergraduate Nursing Students’ Knowledge, Willingness, and
Perceived Ability: An Evaluation Study. International Journal of Environmental Research and Public Health, 18(19). https://doi.org/10.3390/ijerph181910545
An Evaluation Design: Sample: Independent Variable: Disaster Knowledge: Paired t-tests Significant Level of Evidence: III
Study" aims to Mixed-method Undergraduate nursing Disaster Knowledge Assessed through a 15- were used to improvements in
evaluate the design students (N=157) who item true/false compare pre- disaster knowledge Worth to Practice:
effectiveness of voluntarily enrolled in Dependent Variable: questionnaire. and post- (t(156) = -8.12, p < Incorporating disaster training
a disaster Method: the disaster course Willingness intervention 0.01, d = -0.84) and into nursing curricula to
management Pre- and Post- Perceived Ability Willingness: scores perceived ability enhance preparedness.
training course Intervention Setting: Evaluated using a four- (t(156) = -7.95, p <
in improving Comparisons Hong Kong University point Likert scale for six 0.01, d = -0.72) were Strength:
Hong Kong selected disaster events. found. Mixed methods for robust
nursing students' Conceptual No substantial evaluation, and large sample
disaster Framework: Perceived Ability: change was size.
knowledge, Disaster Measured using a four- observed in
willingness, and preparedness and point Likert scale for willingness to Weakness:
perceived ability. response education confidence in respond to disasters. Single institutional setting,
within the context responding to the same Participants reliance on self-reported
of nursing six disaster events. expressed concerns measures which may
education. about willingness, introduce bias.
which included
personal risk Feasibility
perceptions, Programs feasible with
contextual factors, sufficient institutional support
and organizational and curriculum integration.
support.
Conclusion
Effectively improves nursing
students' knowledge and
perceived ability to respond to
disasters,

Recommendations
Incorporate disaster training
as a mandatory component of
nursing education.
 70

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Koca, B., & Arkan, G. (2020). The effect of the disaster management training program among nursing students. Public Health Nursing, 37, 769–777. https://doi.org/10.1111/phn.12760
To investigate Design: Sample: Independent Variable: The study used three 5‐point Likert‐ The training Level of Evidence: II A
the effect of a Randomized N=325, 3rd year Nursing Disaster Preparedness data collection type scale significantly
Jennings Disaster controlled trial. Students Perception instruments. consists of 20 increased disaster Worth to Practice:
Nursing items. preparedness Moderate-level evidence
Management Method: Setting: Dependent Variable: Socio‐demographic perceptions and supports the implementation
Model-based and A two-group University setting in Response Self- characteristics response self- of the training program in
Pretest
LMS-assisted comparison design Turkey Efficacy efficacy among the nursing education to enhance
questionnaires
six-module The Disaster experimental group disaster preparedness and
were
training program Conceptual Preparedness compared to the response self-efficacy.
distributed to
on nursing Framework: Perception Scale in control group,
the students,
students' disaster Jennings Disaster Nurses indicating a Strength:
and 3 months
preparedness Nursing moderate effect on Integrating such a program
later, posttests.
perceptions and Management Model The Disaster participants' into nursing curricula is high.
response self- Response Self‐ knowledge and self- Weakness:
efficacy. Efficacy Scale Descriptive efficacy. Only focused on one
statistics, t- university
tests, Mann-
The posttest values
Whitney U Feasibility
showed a statistically
tests, and Generalized due to outside
significant difference
regression USA.
in mean scores from
analysis, with
the response phase"
a significance Conclusion
and, post disaster"
level set at The model-based and LMS-
subscales of this
0.05. assisted training program
scale (p < .05).
enhances nursing students'
disaster preparedness and
response self-efficacy.

Recommendations
Continuous and recurrent
training programs are
recommended during and after
nursing education to develop
nurses' disaster preparedness
and response capabilities.
 71

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Major Data Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Variables Analysis Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Park, Y. M., & Hwang, W. J. (2024). Development and Effect of a Simulation-Based Disaster Nursing Education Program for Nursing Students Using Standardized Patients. The journal of nursing
research: JNR, 32(1), e314. https://doi.org/10.1097/jnr.0000000000000596
The purpose of Design: Sample: Independent DISASTER NURSING Data were Significant Level of Evidence: V
this study was Quasi- 140 senior nursing Variable: COMPETENCIES: Assessed analyzed differences were
to develop a experimental study students from two Simulation-based using a scale based on the using IBM found between the Worth to Practice:
simulation- using a universities in South disaster nursing ICN framework, with a 5- SPSS experimental and The simulation-based
based disaster nonequivalent, Korea. Participants education program point scale and a Cronbach's Statistics comparison/control program is valuable for
nursing control group, were divided into three using standardized alpha of .95. 23.0, groups in terms of enhancing disaster
education pretest-posttest groups: experimental patients. employing disaster nursing preparedness and nursing
program for design. group (70 students), DISASTER frequency, competencies, competencies among nursing
nursing students comparison group (35 Dependent Variable: PREPAREDNESS: Measured percentage, nursing triage, students, which is crucial for
using Method: students), and control Disaster nursing using a modified version of mean, disaster effective disaster response.
standardized Simulation-based group (35 students). competencies, Huh and Kang’s scale, with a standard preparedness,
patients and disaster nursing disaster triage CVI of .95 and a Cronbach's deviation, critical thinking Strength:
evaluate its education program Setting: competency, disaster alpha of .88. chi-square disposition, and Significant improvements in
effectiveness. with standardized University preparedness, critical TRIAGE SCORE: Evaluated test, t-test, confidence in disaster nursing
patients. thinking disposition, using a scenario and a scale Fisher's exact disaster nursing. competencies and
and confidence in with a CVI of .96. test, The experimental preparedness.
Conceptual disaster nursing. ANOVA, group showed the
Framework: CRITICAL and Scheffe most improvement Weakness:
Based on the THINKING: Measured using post hoc test. across all measured Limited sample size and
International Yoon's critical thinking scale, variables. geographical scope.
Council of Nurses' with a Cronbach's alpha of Reliance on self-reported
Framework of .87. data.
Disaster Nursing
Competencies and CONFIDENCE IN Feasibility
the Jeffries DISASTER Program is adaptable and
Simulation NURSING: Measured on a 0- feasible for nursing curricula.
Framework 10 scale, based on self-
assessment. Conclusion
Study confirms simulation-
based disaster nursing
education improves
competency in nursing
students.

Recommendations
Long-term follow-up studies
to assess the sustainability of
improvements.
 72

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Smith, S., Farra, S., Dempsey, A., & Arms, D. (2015). Preparing nursing students for leadership using a disaster-related simulation. Nurse Educator. https://doi.org/10.1097/NNE.0000000000000143
The article Design: Sample: Independent Variable: Leadership skills and A paired t-test The study Level of Evidence: II A
describes a Quasi-experimental N=76 Sr BSN students LEADERSHIP self-efficacy were was used to demonstrated a
learning design SKILLS IN evaluated using the assess changes significant Worth to Practice:
experience Setting: DISASTERS Emergency in EPIQ improvement in Combining lectures and
developed to Method: National Center for Preparedness scores from students' self- simulations improves nursing
facilitate the Simulation Medical Wright State Dependent Variable: Information pretest to efficacy related to students' disaster leadership
development of University, Dayton, SELF-EFFICACY IN Questionnaire posttest, disaster and confidence.
leadership skills Conceptual Ohio DISASTER (EPIQ), which indicating preparedness and
required of Framework: PREPAREDNESS comprises subscales changes in leadership skills, as Strength:
nurses in disaster Rolls and Efficacy reflecting nursing self-efficacy. evidenced by Innovative use of simulation,
situations leadership activities Analysis of decreased mean assessment of leadership
during a disaster. variance EPIQ scores from skills, and practical
Lower scores (ANOVA) the pretest to the application in a realistic
indicate higher self- was used to posttest. setting.
efficacy levels. explore Improvements were
differences significant across Weakness:
N=76 based on almost all subscales The simulation is time-
X=148.9 Pretest previous of the EPIQ. intensive and resource-
X=113.94 Post Test disaster intensive, and the sample is
Score Significance experience. limited to a single institution.
P<.001 No control groups.
ANOVA P<0.186
Feasibility
The complexity and resource
requirements of the simulation
experience may limit
widespread implementation.

Conclusion
Simulation-based learning can
enhance students' leadership
skills and self-efficacy in
disaster preparedness.

Recommendations
Improves disaster nurse
leadership training.
 73

Purpose of Design / Method / Sample / Setting Major Variables Studied Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual (and their Definitions) Major Variables Appraisal Score) /
Review Framework Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Smithers, B., & Tenhunen, M. L. (2020). Planning and Implementing Disaster Drills for Undergraduate Nursing Students. Nursing education perspectives, 41(2), 130–131.
https://doi.org/10.1097/01.NEP.0000000000000430
To understand Design: Sample: Independent Variable: CAE Simulation Student and Preparing students Level of Evidence: V
roles in Simulation Unknown DISASTER Effectiveness Tool faculty without giving
preparing for and PREPAREDNESS (SET-M) feedback away specific drill Worth to Practice:
responding to a Method: Setting: EDUCATION during details, balancing Contributes valuable insights
disaster. Observations Texas A&M University debriefing information into developing and
Dependent Variable: sessions provision with implementing disaster drills in
Conceptual INTERDISCIPLINARY avoiding over- nursing education.
Framework: DISASTER DRILL preparation.
Literature Review IMPLEMENTATION Strength:
This initiative to disaster
preparedness education,
fosters interdisciplinary
collaboration, feedback for
continuous improvement.

Weakness:
The field is limited by the
lack of clear, standardized
competencies for disaster
preparedness education.

Feasibility
The project shows how
disaster preparedness
simulations can be integrated
into nursing curricula.

Conclusion
All nurses should be educated
in disaster preparedness and
response with drills for best
outcomes.

Recommendations
Use this review for standards
development.
 74

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Stein, L. N. M. (2017). A strategy to enhance student experiences in public health emergency preparedness and response: Medical Reserve Corps nursing student summer externship. Nursing
Administration Quarterly, 41(2), 128-133. https://doi.org/10.1097/NAQ.0000000000000220
A program Design: Sample: Independent Variable: Researchers A knowledge, The article suggests Level of Evidence: V
designed to Pilot Program 12 Nursing Students NA measured variables attitudes, and the externship
enhance nursing by requiring student beliefs (KAB) program provided Worth to Practice:
students' Method: Setting: Dependent Variable: participation in survey was valuable experiences The externship program is a
knowledge and 10-week public Oklahoma Medical NA training, presentation administered for nursing students valuable strategy for
skills in disaster health emergency Reserve Corps development, student before and in public health enhancing nursing students'
response through preparedness and (OKMRC) Nursing interaction, and a after the emergency readiness for public health
The significant
a structured response externship Student Summer Volunteer Training externship to preparedness and emergencies.
variables include
summer pilot program Externship Workshop evaluate its response. However,
nursing students'
externship. impact. The specific outcomes Strength:
knowledge, skills, and
Conceptual focus was on from the post-survey Academic institutions and
preparedness for
Framework: knowledge data collection were public health organizations
public health
None improvement pending publication. expand partnerships to
emergencies, defined
and attitudinal strengthen community
through their
changes resources.
participation in
regarding
training, activities, and
public health Weakness:
the development of
emergency Small Sample, Pilot program.
leadership skills in
preparedness.
disaster response.
Feasibility
Generalized only one study.

Conclusion
Prepare nursing student for
disaster response.

Recommendations
The strategy prepares nursing
students for emergency roles
while creating a replicable
model to strengthen the
overall disaster response of
the nursing workforce.
 75

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Unver, V., Basak, T., Tastan, S., Kok, G., Guvenc, G., Demirtas, A., Ayhan, H., Köse, G., Iyigun, E., & Tosune, N. (2018). Analysis of the effects of high-fidelity simulation on nursing students’
perceptions of their preparedness for disasters. International Emergency Nursing, 38, 3–9. https://doi.org/10.1016/j.ienj.2018.03.002
The purpose of Design: Sample: Independent Variable: Sociodemographic Descriptive Preparedness Levels:
the study is to Quasi-experimental 87 senior nursing Preparedness for characteristics and statistics, Before the training, Level of Evidence: III
analyze the investigation. students Disasters: The level of views on disaster Wilcoxon 42.5% of students
effects of high- readiness expressed by preparedness. signed rank felt prepared for Worth to Practice:
fidelity Method: Setting: nursing students to test for disasters. After the Significant improvements in
simulation on the Pretest-posttest Turkey University handle disaster Scale of Perception comparing training, this disaster preparedness
perceptions of design School of Nursing situations, of Disaster pre- and post- increased to 89.7%. perceptions and skills through
senior nursing Preparedness among test scores. high-fidelity simulation
students Conceptual Nurses (SPDPN), SPDPN Scores:
regarding their Framework: Dependent Variable: which has three There was a Strength:
preparedness for The study was Perceptions of major components: statistically High-fidelity simulations
disasters. framed within the Disaster Preparedness: preparation stage, significant effectively enhance disaster
context of disaster Students' self-assessed intervention stage, improvement in the preparedness among nursing
preparedness perceptions measured and post-disaster SPDPN scores students and showed
training for nursing through a standardized stage. across all stages significant improvements in
students, utilizing scale (preparation, students' perceptions and
high-fidelity A survey intervention, post- skills.
simulations to questionnaire with disaster) post-
enhance their skills twelve items for training (p < 0.05). Weakness:
and perceptions. feedback on disaster The study involved only
simulation. Feedback: senior nursing students.
Most participants
recognized the Feasibility
significance of High-fidelity simulations is
education and practical and beneficial for
collaboration, were disaster preparedness training
pleased with the in nursing education.
program, and
reported an Conclusion
improvement in High-fidelity simulations and
knowledge and drills improve nursing
skills. students' perceived disaster
preparedness.

Recommendations
Integrate high-fidelity
simulation and drills into
nursing curricula to enhance
disaster preparedness.
 76

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Winarti, W., & Gracia, N. (2023). Exploring Nurses’ Perceptions of Disaster Preparedness Competencies. Nurse Media Journal of Nursing, 13(2), 236–245.
https://doi.org/10.14710/nmjn.v13i2.51936
Considering Design: Sample: Independent Variable: The NPDCC The data were The study found that Level of Evidence: III
Indonesia's Cross-sectional N=230 Nurses Education, disaster questionnaire, a analyzed using 51.7% of nurses
vulnerability to study simulation specialized Chi-square, perceived their Worth to Practice:
natural disasters, Setting: experience, and instrument for this Fisher's exact disaster preparedness Addresses a critical and
this study Method: Jakarta Province, awareness of hospital study, measures test, and competencies as underexplored area in disaster
explores how Quota sampling Indonesia disaster plans disaster preparedness Likelihood high, with an preparedness.
nurses perceive competencies. The ratio tests to average score of
their response Conceptual Dependent Variable: relationship between explore the 175.84 (SD=25.017). Strength:
readiness. Framework: Nurses' disaster nurses' characteristics relationship Factors significantly Addresses a crucial gap in
Competencies preparedness (education, disaster between influencing these disaster preparedness research,
competencies simulation nurses' perceptions included utilizing a comprehensive
experience, and characteristics education level, questionnaire and robust
awareness of hospital and their disaster simulation statistical analysis to produce
disaster plans) and disaster experience, and reliable findings.
their competencies preparedness awareness of the
perception is competencies hospital's disaster Weakness:
analyzed statistically. plans. Its cross-sectional design
prevents establishing
causality, focus on a single
hospital reduces
generalizability, and the
modest explained variance
indicates other factors may
influence nurses' perceptions.

Feasibility
Practical plan

Conclusion
Regular simulations and
education are required to
improve nurses' disaster
preparedness.

Recommendations
Ongoing nurse disaster
training is crucial.
 77

Purpose of Design / Method / Sample / Setting Major Variables Measurement of Data Analysis Study Findings Level of Evidence (Critical
Article or Conceptual Studied (and their Major Variables Appraisal Score) /
Review Framework Definitions) Worth to Practice /
Strengths and Weaknesses /
Feasibility /
Conclusion(s) /
Recommendation(s) /
APA Citation:
Zinan, N., Puia, D., & Kinsley, T. (2015). Results of a mass casualty incident simulation in an undergraduate nursing program. Journal of Nursing Education and Practice, 5(12), 71.
https://doi.org/10.5430/jnep.v5n12p71
To investigates Design: Sample: Independent Variable: Measurements were Data analysis There was a Level of Evidence: II A
the effects of Quasi-experimental 110 BSN Students Mass Casualty calculated using a was conducted statistically
mass casualty Incident Simulation survey instrument using SPSS significant Worth to Practice:
incident Method: Setting: designed by the software, improvement in Simulations are a valuable
simulation as an Pre-post-test design University of saint Dependent Variable: investigators, involving students’ self- educational tool.
educational tool Joseph, West Harford, Students’ self- reflecting the descriptive perceived
for Conceptual Connecticut perceived knowledge, educational statistics, knowledge, Strength:
undergraduate Framework: attitudes, and skills objectives, and based paired t-tests, attitudes, and skills A well-designed simulation
nursing students. Benner’s Novice to related to disaster on a 5-point Likert and a one-way related to disaster that effectively improves
Expert Model response. scale. The survey repeated- response. Notably, student competencies in
included questions on measures students reported disaster response.
familiarity with mass ANOVA. similar
casualty triage, improvements Weakness:
understanding team regardless of Limitations include a
roles, ability to whether they convenience sample and
respond and provide participated as reliance on self-reported data.
care, and ethical X= 23.14 and victims or providers
considerations during 23.9, t = -.85, in the simulation. Feasibility
a mass casualty df = 95.1, p = Provides a practical, hands-on
event. .39), learning experience.
indicating a
ASD students
relatively Conclusion
significantly differed
distribution Mass casualty incident
in prior healthcare
within these simulation is an effective
experience.
roles. method for teaching disaster
response to nursing students.

Recommendations
Incorporating such
simulations in nursing
education enhances students'
skills, knowledge, and
willingness to respond to
disasters.
 78

Appendix B

DNP Statement of Non-Research Determination Form

Student Name: Paul Dreater

Title of Project:

Enhancing Disaster Preparedness in Nursing Education:

A Quality Improvement Approach Using Simulation and Training

Brief Description of Project:

The main goal of the DNP PROJECT is to comprehensively prepare nursing students, faculty,
and support staff with the necessary knowledge, skills, and competencies to efficiently respond
to a broad spectrum of disasters, encompassing natural and artificial events. This initiative
underscores the importance of readiness within educational settings, aiming to safeguard students
and staff, reduce interruptions, ensure the seamless continuation of educational activities, and
cultivate a pervasive culture of safety and preparedness across the campus. Implementing
systematic training, preparation, and planning to manage emergencies effectively is essential to
achieving these objectives. By enhancing the USF SONHP community's disaster response
capabilities, the initiative seeks to protect and maintain the integrity and continuity of the
educational process in the face of potential disasters (AlOtaibi et al., 2024).

A) Aim Statement:

To increase the level of disaster response capabilities and preparedness among nursing
students, faculty, and support staff from current levels of unpreparedness and lack of
comprehensive disaster response training to a 25% improvement in knowledge and
confidence levels post-simulation by September 06, 2024, with a follow-up
reassessment three months later to evaluate knowledge retention in faculty, support
staff, and students at the University of San Francisco School of Nursing.

B) Description of Intervention:

The Doctor of Nursing Practice (DNP) project aims to enhance emergency preparedness
within the School of Nursing and Health Professions (SONHP) through three
SMART objectives. First, it seeks to develop a specialized emergency preparedness
educational plan by Summer 2024, leveraging a collaborative approach involving
simulation experts from the SONHP and external emergency response professionals.
This collaborative design ensures that the plan is both comprehensive and practically
applicable. Second, the project will execute a full-scale, 4-hour simulation exercise in
Fall 2024 to test the plan's effectiveness. This simulation will provide participants
valuable hands-on experience and generate insights into the plan's real-world
 79

applicability. Lastly, the project includes a rigorous assessment strategy to evaluate

the plan and simulation's success. This strategy encompasses pre- and post-test
evaluations to measure participants' knowledge gains and employs a detailed
checklist by simulation experts to assess the simulation's realism and impact. Through
these objectives, the project aims to significantly improve emergency preparedness,
knowledge, and response capabilities among the faculty, students, and support
personnel of the SONHP.

C) How will this intervention change practice?

Disaster management education in nursing schools introduces significant changes in nursing

practice by enhancing preparedness, fostering critical thinking, promoting
interprofessional collaboration, integrating evidence-based practices, strengthening
community engagement, and facilitating policy and leadership development. Nurses
with disaster management skills exhibit greater competence and confidence in
emergencies, showcasing improved clinical and psychological preparedness. Such
training ensures that nurses are adept at making informed decisions quickly,
managing resources efficiently, and working collaboratively with diverse healthcare
teams. Furthermore, it emphasizes the importance of clear communication,
continuous learning, and adaptability to emerging threats. By participating in disaster
management, nurses engage more actively in community education and volunteerism,
contributing to broader societal resilience. This specialized training empowers nurses
to take on leadership roles in disaster scenarios and influence health policy
development, elevating the nursing profession's role in disaster preparedness,
response, and recovery efforts.

D) Outcome measurements:

Defining Measures as Numerator/Denominator

Quantitative Metrics:
The project-defining measures will formulate a ratio or rate measurement. For instance, the
numerator will be the number of participants who complete the emergency preparedness training,
and the denominator could be the total number of participants enrolled in the training program.
This ratio can provide a precise percentage of successful completions.

Reliability and Validity of the Measure

Standardized Tools:

Utilize validated survey instruments and assessment tools to measure changes. Research peer-
reviewed literature documents the reliability and validity of these tools. Include these tools as
appendices in reports or presentations to substantiate the measurement approach.

Protecting Participant Confidentiality

Anonymity in Data Collection:

 80

Ensure that participant data does not include personal identifying information unless necessary.
Use participant codes instead of names.

Secure Data Storage:

Store all collected data securely using encrypted digital files or locked filing cabinets for paper
records, accessible only to authorized team members.

Ethical Considerations:

The project will obtain informed consent from participants, explain the purpose of data
collection, detail how the collected data will be used, and educate participants about their
confidentiality rights while adhering to ethical guidelines and fulfilling Institutional Review
Board (IRB) requirements for research involving human subjects. However, because the project
is an evidence-based activity that does not meet the definition of research, IRB review is not
required.

Sharing and Reporting:

When sharing or reporting data, use aggregated data instead of individual responses. Ensure that
no reports or publications reveal the identity of participants. By following these methodologies,
you can effectively measure outcomes, align them with your project's aims, ensure the reliability
and validity of your measures, and protect participants' confidentiality. This comprehensive
approach will help determine whether the changes led to genuine improvements.
 81

DNP Statement of Determination

Evidence-Based Change of Practice Project Checklist*
The SOD should be completed in NURS 7005 and NURS 791E/P or NURS 749/A/E

Project Title:
Enhancing Disaster Preparedness in Nursing Education:
A Quality Improvement Approach Using Simulation and Training

Mark an “X” under “Yes” or “No” for each of the following statements: Yes No
The aim of the project is to improve the process or delivery of care with established/ accepted X
standards, or to implement evidence-based change. There is no intention of using the data for
research purposes.
The specific aim is to improve performance on a specific service or program and is a part of usual X
care. All participants will receive standard of care.
The project is not designed to follow a research design, e.g., hypothesis testing or group X
comparison, randomization, control groups, prospective comparison groups, cross-sectional, case
control). The project does not follow a protocol that overrides clinical decision-making.
The project involves implementation of established and tested quality standards and/or systematic X
monitoring, assessment or evaluation of the organization to ensure that existing quality standards
are being met. The project does not develop paradigms or untested methods or new untested
standards.
The project involves implementation of care practices and interventions that are consensus-based or X
evidence-based. The project does not seek to test an intervention that is beyond current science
and experience.
The project is conducted by staff where the project will take place and involves staff who are working X
at an agency that has an agreement with USF SONHP.
The project has no funding from federal agencies or research-focused organizations and is not X
receiving funding for implementation research.
The agency or clinical practice unit agrees that this is a project that will be implemented to improve X
the process or delivery of care, i.e., not a personal research project that is dependent upon the
voluntary participation of colleagues, students and/ or patients.
If there is an intent to, or possibility of publishing your work, you and supervising faculty and the X
agency oversight committee are comfortable with the following statement in your methods section:
“This project was undertaken as an Evidence-based change of practice project at X hospital or
agency and as such was not formally supervised by the Institutional Review Board.”

Answer Key:
• If the answer to all of these items is “Yes”, the project can be considered an evidence-based activity
that does not meet the definition of research. IRB review is not required. Keep a copy of this checklist
in your files.
• If the answer to any of these questions is “No”, you must submit for IRB approval.

*Adapted with permission of Elizabeth L. Hohmann, MD, Director and Chair, Partners Human Research Committee,
Partners Health System, Boston, MA.
 82

DNP Statement of Determination

Evidence-Based Change of Practice Project Checklist Outcome
The SOD should be completed in NURS 7005 and NURS 791E/P or NURS 749/A/E

This project meets the guidelines for an Evidence-based Change in Practice Project as outlined in the
Project Checklist (attached). Student may proceed with implementation.

This project involves research with human subjects and must be submitted for IRB approval before
project activity can commence.

Comments: NONE

Student Student
Last Name: First
Dreater Name: Paul

08/01/2024
Student Signature: Paul Dreater Date:

Chairperson
Name: Dr. Jo Loomis

Chairperson
Signature: Signed Date: 08/01/2024

Second Reader
Name: Dr. Janice Mark Date: 10/01/2024
Second Reader
Signature: Signed

DNP SOD Review

Committee
Member Name: NA

DNP SOD Review

Committee
Member Signature: NA Date: NA
 83

Appendix C

The Letter of Approval and Support

 84

Appendix D

Gap Analysis

Area Under Consideration

Enhancing Disaster Preparedness in Nursing Education:
A Quality Improvement Approach Using Simulation and Training
Aim Statement

To enhance the safety of faculty and students at the USF SONHP while optimizing resource usage during
the initial phase of a disaster. The desired outcome is that USF SONHP faculty and student's knowledge
and confidence will be increased by 25% post-simulation educational intervention, followed up after three
months to measure knowledge retention.
Desired State Current State Action State
Safety Protocols: The faculty and Existing safety protocols may Develop disaster management
students of the USF SONHP are well- not be effective during a simulation modules
prepared and safe during the initial disaster's initial phase. specifically designed or
phase of any disaster. acquired to meet the needs of
the USF SONHP. (Mitigation)
Resource Optimization: RESOURCE USAGE: Conduct workshops to
The resources are used to their Resources are not used educate people on optimal
maximum potential, ensuring optimally during disaster resource usage during
effective disaster response without scenarios. disasters. (Preparedness)
any waste.
Knowledge Level: The faculty and KNOWLEDGE LEVEL: Create clear evaluation
students have increased their Faculty and students may need metrics and tools to measure
knowledge and confidence by at least more knowledge or confidence the increase in knowledge and
25% after the simulation-based regarding disaster its retention over time.
educational intervention. preparedness. (Response)
Knowledge Retention Metrics: A RETENTION METRICS: Launch awareness campaigns
precise mechanism is in place to There may not be an existing to inform and encourage
measure and ensure knowledge mechanism to measure faculty and students about the
retention three months post- knowledge retention over time. upcoming simulation-based
intervention. training, ensuring maximum
participation and buy-in.
(Recovery)
 85

Appendix E

Gantt Chart

GNATT Responsibility Matrix

Project Lead: Paul Dreater 2023 2024
Task Phases Responsibility Status Date

Mar
Aug

Aug
Nov

Nov
Apr

Jun
Feb
Dec

Dec
Jan
Oct

Oct
Sep

Sep
Ma

Jul
y
1.0 Phase: Assessment
1.1 Perform Gap Analysis. DNP Student X X Completed 09.01.23

1.2 Organizational Assessment. DNP Student X X Completed 10.01.23

1.3 Develop PICO(T) Question. DNP Student X X X Completed 11.01.23
1.4 Search Literature. DNP Student X X X X Completed 12.20.23
1.5 Appraise available evidence. DNP Student X X X X Completed 12.20.23
2.0 Phase: Planning
2.1 Develop project proposal. DNP Student X X X X Completed 01.24.24
2.2 Define project team. DNP Student X Completed
2.3 SWOT Analysis. DNP Student X Completed 11.15.23
2.4 Stakeholder Analysis. DNP Student X X Completed 11.25.23
2.5 Communication Plan. DNP Student X Completed
2.6 Develop Project Budget. DNP Student X X X X X X X X Completed 09.30.24
2.7 Secure project approval. DNP Student X X X X X Completed 09.27.24
2.8 Develop pre-assessment DNP Student X X X Completed 08.30.24
simulation tools.
2.9 Develop learning module and DNP Student X X X Completed 08.30.24
simulation.
3.0 Implementation Phase
3.1 Identify Simulation Subject DNP Student X X X X X X X X Completed 09.30.24
Matter Experts.
3.2 Schedule project team DNP Student X X X X X Completed 10.23.34
meetings.
3.3 Implement communication DNP Student X X X X X Completed 01.01.24
plan.
(continued next page)
 86

3.5 Administer pre-training DNP Student X X X X Completed 10.23.24

assessment to facilitators. and
participants.
3.6 Provide facilitator training. DNP Student X X X X X Completed 10.24.24
3.7 Monthly meetings with DNP Student X X X X X Completed 10.23.24
facilitators, stakeholders.
3.8 Administer post-assessment DNP Student X Completed 10.24.24
to facilitators.
4.0 Evaluation Phase
4.1 Analyze data from pre-and DNP Student X X Completed 11.01.24
post-assessments.
4.2 Evaluate project outcomes to DNP Student X X Completed 11.01.24
AIM statement and PICO(T).
4.3 Project Team DNP Student X Completed 10.24.24
Debrief/Evaluation.
4.4 Present Final Report to DNP Student X Completed 12.01.24
Administration.
4.5 Submit Final Project Paper. DNP Student X Completed 12.01.24
5.0 Sustainability Phase
5.1 Schedule stakeholder project DNP Student X Completed 10.28.24
debrief.
5.2 Celebration & recognition for DNP Student, X Completed 12.13.24
project participants.
5.3 Project Handoff to leader. DNP Student X Completed 12.01.24
Dean SONHP
5.4 Add updates to nursing DNP Student X Completed 12.01.24
school advisory board. SONHP
Advisory Board
 87

Appendix F

Work Breakdown Structure

Level 1 Level 2 Level 3

1.0 1.1 Gap Analysis and 1.1.1 Perform Gap Analysis.
Enhancing Problem Definition 1.1.2 Organizational Assessment.
Disaster 1.1.3 Develop PICO(T) Question.
Response: 1.1.4 Search Literature.
Education and 1.1.5 Appraise available evidence.
Simulation Pilot 1.2 Plan 1.2.1 Develop project proposal.
for Nursing 1.2.2 Define project team.
Schools 1.2.3 SWOT Analysis.
1.2.4 Stakeholder Analysis.
1.2.5 Communication Plan.
1.2.6 Develop Project Budget.
1.2.7 Secure project approval.
1.2.8 Develop pre-post test tools for simulation.
1.2.9 Develop an approved learning module and
simulation.
1.3 Implement 1.3.1 Identify Simulation Subject Matter Experts.
1.3.2 Schedule project team meetings.
1.3.3 Implement communication plan.
1.3.4 Recruit SME facilitator roles.
1.3.5 Administer pre-training assessment to facilitators
and participants.
1.3.6 Provide facilitator training.
1.3.7 Monthly meetings with facilitators, stakeholders.
1.3.8 Administer post-assessment to facilitators.
1.4 Evaluate 1.4.1 Analyze data from pre-and post-assessments.
1.4.2 Evaluate project outcomes to AIM statement and
PICO(T).
1.4.3 Project Team Debrief/Evaluation.
1.4.4 Present Final Report to Administration.
1.4.5 Submit Final Project Paper.
1.5 Sustainability 1.5.1 Schedule stakeholder project debrief.
1.5.2 Celebration & recognition for project participants.
1.5.3 Project Handoff to leader.
1.5.4 Add updates to nursing school advisory board.
 88

Appendix G

Responsibility/Communication Matrix

Level Keep Satisfied Manage Closely

of High Power, Low Interest High Power, High Interest
Power Local Government Emergency UNIVERSITY
Services
University Board of Trustees ADMINISTRATION

LEADERSHIP

EMERGENCY RESPONSE

TEAMS SAFETY OFFICERS

DISASTER MANAGEMENT

SIMULATION DESIGNERS’

COORDINATORS

Monitor Keep Informed

Lowe Power, Low Interest Low Power High Interest
Non-Participating University Participants
Departments Faculty \ Academic Staff
Local Community

Level of Interest

Adapted from: Power-interest matrix.png. (2020, September 16). Wikimedia Commons, the free media
repository. Retrieved 23:42, April 07 13, 2024, from https://commons.wikimedia.org/w/
index.php?title=File:Power-interest_matrix.png&oldid=460794454
 89

Information Stakeholders Method Frequency Responsibility

Project Proposal Executive Zoom Meetings / E- Monthly and as DNP student
Committee SONHP Mails needed
Dean, Chair
Project Scope & Executive Zoom Meetings / E- Monthly and as DNP student
Objectives Committee SONHP Mails needed
Dean, Chair,
Nursing Faculty
Standardized Chair, Nursing Zoom Meetings / E- Monthly and as DNP student
Workflow Faculty, Nursing Mails needed
Development Students
Detailed Project Chair Zoom Meetings / E- Monthly and as DNP student
Overview and Goals Mails needed
Project Overview Chair Zoom Meetings / E- Monthly and as DNP student
Review and Mails needed
Refinement
Initial Project Chair, Nursing Zoom Meetings / E- Weekly and as DNP student
Presentation and Faculty, Nursing Mails needed
Feedback Students
Presentation of Executive Zoom Meetings / E- Weekly and as DNP student
Project Outcomes Committee SONHP Mails needed
and Results Dean, Chair,
Nursing Faculty
Comprehensive First and Second Zoom Meetings / E- Weekly and as DNP student
Project Analysis Chair Mails needed
and Closure
Final Project First and Second Zoom Meetings / E- Weekly and as DNP student
Approval and Chair Mails needed
Documentation
 90

Appendix H

SWOT Analysis

Internal Factors

Strengths (+) Weakness (-)

• Prioritizing the safety of faculty and students • Dependence on Technology: If the simulation
indicates a strong emphasis on well-being, requires specialized technology, there may be issues
which stakeholders can positively receive. related to maintenance, access, and updates. Faculty
and students accustomed to traditional methods may
• A hands-on approach can help ensure more need to change their minds to a simulation-based
practical understanding and better preparation. approach.
• Continuous improvement and checks on long- • Optimizing resource usage implies that resources
term retention by aiming for a 25% increase may hinder the intervention's scale or quality.
and following up after three months.
• Three months may be needed to gauge knowledge
retention.

External Factors

Opportunities (+) Threats (-)

• If successful, the program and this simulation- • Ironically, an actual disaster during the project
based intervention can be expanded to other could disrupt its implementation.
departments or universities.
• Lack of buy in from leadership and students.
• The safety-centric approach may make the
project eligible for external funding or grants • If managed ineffectively, implementing such
focused on educational improvement and programs cannot stay within budget allocations,
disaster in which they are partnering. especially if technological infrastructure is involved.

• They are partnering and collaborating with

disaster management agencies on resources
and expertise for the initiative.
 91

Appendix I
 92

Appendix J

Proposed Budget

Category Description Cost per Unit Units Total Cost

Faculty Time Faculty hours for $80/hour 4 units/semester $320
(Evaluation& monitoring student
Monitoring) progress, surveys.
Faculty Time Faculty hours for $80/hour 10 units/semester $1,600
(Orientation) ongoing enrollment
& monitoring
Faculty One-time cost of $80/hour 4 units $320
Development faculty completing
the module
Module Hosting Uploading Learning $0 0 units $0
Module to Canvas
Sustainability Monitoring & $800/Semester 2 units $1,600
(Annual) faculty time for
sustained operation
(2 semesters)
Simulation Supplies Mass Casualty $900 2 units $1800
Incident Response
Kit for simulation.
Safety Vets $5 6 units $30
CAT Gen 7 $10 12 units $120
Tourniquets
Triage Kit $200 1 unit $200
Triage Patient Tags $25 100 units $25
Sim Wagon $100 1 unit $100
Moulage Kit $860 1 unit $860
Whistles $1 3 units $3
Admin Supplies Pens, Markers, Clip $100 50 Pens $100
Boards 50 markers
12 Clipboards
Sim + Admin ($3238)
Total Project Cost: $7078
 93

Appendix K

SET M

Simulation Effectiveness Tool - Modified (SET-M)

After completing a simulated clinical experience, please respond to the following statements by circling your response.
PREBRIEFING: Strongly Somewhat Do Not Agree
Agree Agree
Prebriefing increased my confidence 3 2 1
Prebriefing was beneficial to my learning. 3 2 1
SCENARIO:
I am better prepared to respond to changes in my patient’s condition. 3 2 1
I developed a better understanding of the pathophysiology. 3 2 1
I am more confident of my assessment skills. 3 2 1
I felt empowered to make clinical decisions. 3 2 1
I developed a better understanding of medications. (Leave blank if no medications in scenario) 3 2 1
I had the opportunity to practice my clinical decision making skills. 3 2 1
I am more confident in my ability to prioritize care and interventions 3 2 1
I am more confident in communicating with my patient. 3 2 1
I am more confident in my ability to teach patients about their illness and interventions. 3 2 1
I am more confident in my ability to report information to health care team. 3 2 1
I am more confident in providing interventions that foster patient safety. 3 2 1
I am more confident in using evidence-based practice to provide care. 3 2 1
DEBRIEFING:
Debriefing contributed to my learning. 3 2 1
Debriefing allowed me to communicate my feelings before focusing on the scenario.* 3 2 1
Debriefing was valuable in helping me improve my clinical judgment. 3 2 1
Debriefing provided opportunities to self-reflect on my performance during simulation. 3 2 1
Debriefing was a constructive evaluation of the simulation. 3 2 1
What else would you like to say about today’s simulated clinical experience?

*revised 4/3/20 for use in virtual debriefing

Leighton, K., Ravert, P., Mudra, V., & Macintosh, C. (2015). Update the Simulation Effectiveness Tool: Item modifications and reevaluation of psychometric
properties. Nursing Education Perspectives, 36(5), 317-323. Doi: 10.5480/1 5-1671.

Original Simulation Effectiveness Tool (SET) developed by Medical Education Technologies, Inc (METI, now CAE Healthcare) for Program for Nursing Curriculum
Integration (PNCI) (2005)
 94

Appendix L

Survey Results in Confidence and Preparedness Metrics

Questions Mean Standard

Deviation
I am better prepared to respond to changes in my patient’s condition. 1.39 .568

I developed a better understanding of the pathophysiology 1.65 .627

I am more confident of my assessment skills. 1.51 .579

I felt empowered to make clinical decisions. 1.37 .488
I developed a better understanding of medications 1.89 .727
I had the opportunity to practice my clinical decision-making skills. 1.27 .451
I am more confident in my ability to prioritize care and interventions 1.41 .497
I am more confident in communicating with my patients. 1.39 .493
I am more confident in my ability to teach patients about their illness and interventions. 1.53 .504
I am more confident in my ability to report information to health care team. 1.37 .528
I am more confident in providing interventions that foster patient safety. 1.31 .469
I am more confident in using evidence-based practice to provide care. 1.45 .541

Leighton, K., Ravert, P., Mudra, V., & Macintosh, C. (2015). Update the Simulation Effectiveness Tool:
Item modifications and reevaluation of psychometric properties. Nursing Education Perspectives, 36(5),
317-323. Doi: 10.5480/1 5-1671.
 95

The survey analysis reveals critical insights into student confidence and preparedness following
simulation interventions. Overall, mean scores ranged from 1.2 to 1.9, indicating that students felt
confident and prepared. The highest score, "Better understanding of medications" (1.89),
demonstrates strong confidence in their medication knowledge. On the other hand, the score for
"More confident in teaching patients about illness and interventions" (1.53) reflects adequate
preparation for patient education.

However, some areas need improvement. Scores for "Opportunity to practice clinical decision-
making skills" (1.27) and "More confident in providing patient safety interventions" (1.31) suggest
that further training in decision-making and patient safety is necessary.

Despite some variations in scores, the overall results indicate that the program has effectively
increased student confidence in several areas. The program should capitalize on its strengths while
enhancing training for clinical decision-making and patient safety to support positive learning
outcomes for students ultimately.
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Appendix M

Cohen’s d

Cohen’s d Results
Statistic Value
Pre-Simulation Mean 3.5
Post- Simulation Mean 4.0
Pre-Simulation Standard Deviation 0.8
Post-Simulation Standard Deviation 0.7
Pooled Standard Deviation 0.7516648189186450
Sample Size 51
Cohen’s d 0.6651901052377390
 97

The box plot displays the distribution of scores for both the pre-simulation and post-simulation
groups. The interquartile range (IQR), indicated by the height of each box, represents the range
between the 25th and 75th percentiles. The post-simulation group shows a higher IQR, suggesting
that scores improved overall after the simulation. The red lines, which represent the medians, also
indicate a noticeable increase from the pre-simulation to the post-simulation phase, reflecting an
upward shift in the central tendency of scores.

The whiskers illustrate the range of scores, excluding outliers. The post-simulation whisker
extends slightly higher, further supporting the improvement in scores. Additionally, one outlier in
the post-simulation group indicates a participant with a shallow score. The pre-simulation group
does not show any visible outliers, and the range of variability is similar across both groups.

Cohen’s d-effect size is 0.67, which indicates a moderate-to-large effect of the simulation on
participants’ scores, which suggests that the observed differences between pre-and post-simulation
scores are statistically significant and practically meaningful. Overall, the box plot visually
supports the conclusion that the simulation positively impacted participants’ performance.
 98

Appendix N

Thematic Analysis

The pie chart presents a thematic analysis of open-ended responses, identifying three key themes:
Increased Confidence, Skill Retention, and Preference for Simulation, each representing 33.3%
of the feedback. Increased Confidence highlights how Simulation boosts participants' self-
assurance in clinical skills. Skill Retention emphasizes the role of Simulation in maintaining
essential skills through practical learning. Preference for Simulation shows that participants find
this method more engaging and beneficial than traditional learning. The equal distribution of
these themes indicates a balanced recognition of Simulation's benefits, suggesting it effectively
enhances Confidence, promotes skill retention, and aligns with active learning preferences,
making it a valuable tool for educators.
 99

Appendix O

CANVAS Disaster Management Learning Modules First Aid / Basic Life Support / Stop
the Bleed Post Knowledge Questions and Answers

1. What is the first step in the Stop the Bleed protocol?

a) Apply a tourniquet
b) Call emergency services
c) Apply direct pressure to the wound
d) Elevate the injured limb
Answer: c) Apply direct pressure to the wound

2. When should a tourniquet be applied during a bleeding emergency?

a) When the wound is on the chest
b) When bleeding cannot be controlled by direct pressure or packing
c) For all types of bleeding, regardless of severity
d) Only if medical professionals are present
Answer: b) When bleeding cannot be controlled by direct pressure or packing

3. Which of the following is a common sign of shock?

a) Warm, dry skin
b) Rapid breathing and confusion
c) Strong and slow pulse
d) High fever
Answer: b) Rapid breathing and confusion

4. Where should a tourniquet be placed on a limb to stop severe bleeding?

a) Directly over the wound
b) 2-3 inches below the bleeding site
c) 2-3 inches above the bleeding site
d) On a joint like a knee or elbow
Answer: c) 2-3 inches above the bleeding site

5. How deep should chest compressions be when performing CPR on an adult?

a) 1 inch (2.5 cm)
b) 1.5 inches (3.8 cm)
c) 2 inches (5 cm)
d) 2.5 inches (6.4 cm)
Answer: c) 2 inches (5 cm)
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6. What is the correct ratio of chest compressions to rescue breaths during CPR for an
adult?
a) 15 compressions, 2 breaths
b) 20 compressions, 2 breaths
c) 30 compressions, 2 breaths
d) 40 compressions, 2 breaths
Answer: c) 30 compressions, 2 breaths

7. Which of the following is an appropriate first aid action if someone is experiencing

shock?
a) Give them water to drink) Elevate their legs and keep them warm
c) Make them walk to maintain circulation
d) Administer pain relief medication
Answer: b) Elevate their legs and keep them warm

8. How should you treat a deep wound before medical professionals arrive if bleeding
persists after applying direct pressure?
a) Apply ice directly to the wound
b) Clean the wound with alcohol and water
c) Pack the wound with clean gauze or cloth and continue applying pressure
d) Apply a bandage loosely and wait for help
Answer: c) Pack the wound with clean gauze or cloth and continue applying
pressure

9. Which of the following should you do when treating a person with a severe bleeding
wound on the leg?
a) Apply pressure above the wound, directly on the artery
b) Elevate the wound above the heart and apply direct pressure
c) Pour antiseptic into the wound immediately to prevent infection
d) Use a tourniquet as the first action
Answer: b) Elevate the wound above the heart and apply direct pressure

10. What is the correct action if you find an unconscious person who is not breathing?
a) Shake them gently and wait for a response
b) Call for emergency help and start chest compressions immediately
c) Place them in the recovery position and wait for medical assistance
d) Splash cold water on their face to try and revive them
Answer: b) Call for emergency help and start chest compressions immediately
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Appendix P
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Appendix Q

Simulation Safety Plan for Earthquake Disaster Scenario

1. Simulation Overview:
• Scenario Title: Enhancing Disaster Preparedness in Nursing Education: A Quality
Improvement Approach Using Simulation and Training.
• Location: University Campus, School of Education Parking Lot.
• Scenario Date: October 24, 2024.
• Duration: 120 minutes (simulation) + 60 minutes (debriefing).

2. Safety Objectives:
• Ensure the physical and psychological safety of participants, faculty, and observers
during the simulation.
• Maintain environmental safety by preventing accidents or injuries due to simulated
hazards.
• Monitor participants for stress or emotional reactions related to trauma simulations.
• Implement emergency response protocols for any actual incidents that occur during the
simulation.

3. Key Roles and Responsibilities:

• Simulation Coordinator: This person oversees the simulation, ensures all safety
protocols are in place, and monitors the environment for potential hazards.
• Faculty/Simulation Instructors: Guide participants, ensure they adhere to safety
protocols, and intervene in case of unsafe practices.
• Safety Officer: Observes for unsafe conditions and steps in to address actual or potential
hazards (e.g., falls, improper handling of equipment).
• Emergency Medical Personnel: On-site to respond to any actual medical emergencies.
• Simulation Participants: Responsible for following safety instructions and using
personal protective equipment (PPE).

4. Pre-Simulation Safety Briefing:

Before starting the simulation:
• Review safety procedures, including evacuation routes and nearest first aid stations.
• Discuss the boundaries of the simulation environment and potential hazard areas (e.g.,
uneven ground, simulated debris).
• Explain the use of all equipment, especially simulators, moulage supplies, and medical
props.
• Ensure participants are aware of psychological safety and provide them with information
on taking breaks or stepping out if the simulation becomes too intense.

5. Safety Protocols During Simulation:

• Personal Protective Equipment (PPE): Participants and faculty must wear gowns,
gloves, face masks, and eye protection, as specified.
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• Environmental Safety: Simulated debris should be lightweight and non-hazardous,

while obstacles should be marked to avoid falls or injuries.
• Patient Simulation: The manikins used should be placed securely to avoid accidents.
Any “injured” standard patients should be briefed on how to act without putting
themselves or others at risk.
• Communication: Radios or devices for communication between teams must be
functional to ensure coordinated responses.
• Debriefing Safety: Conduct an emotional check-in after the simulation and provide
resources for psychological support if needed.

6. Emergency Procedures:
• Medical Emergencies: Emergency medical personnel will be on-site. Simulation
activities must stop immediately in case of an actual injury or health emergency, and
authentic emergency response protocols must be followed.
• Fire or Building Hazard: In case of a fire or structural hazard (real, not simulated),
evacuate the simulation area immediately following the posted evacuation plan.
• Emotional Safety: If any participant becomes emotionally overwhelmed, they may
signal to step out of the simulation. Psychological support should be available for
debriefing.

7. Post-Simulation Safety Evaluation:

• Conduct a safety debrief to assess any safety issues encountered during the simulation.
• Collect feedback from participants about any environmental or psychological concerns.
• Document any incidents and revise safety protocols for future simulations.
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Appendix R

Agenda:
Disaster Strikes: Are You Ready? An Earthquake Simulation

Date:
Thursday, October 24, 2024
Time:
12:00 PM – 4:00 PM
Location:
University Campus, School of Education Parking Lot

TIME ACTIVITY KEY LEAD PARTICIPANTS ACTIONS

OBJECTIVES FACALITORS
0800 Simulation Arrange simulation Simulation Team Support Staff, Setup Scene Setting
- Area Set up stations, Volunteers
0930 equipment, and
props (manikins,
moulage kits, etc.).
0930 Moulage Apply moulage to Moulage Artists, Simulated Patients Moulage for
- Application & actors and brief Simulation Team (Actors) basic and
1130 Actor them on roles and advanced
Preparation key phrases. injuries
1130 Final Final check of Simulation Team All Participants Rehearsal
- Simulation moulage, station
1200 Checks setup, and actor
readiness.
1200 Welcome Brief introduction Dr. Loomis All Participants Simulation
- & Introduction to objectives and Jin Chin Refer Station to overview, goals,
1210 disaster Paul Dreater Assignment and roles, and
preparedness. (Simulation Team) Rotation logistics.
1210 Pre-Simulation Prepare Simulation Team All Participants Review of
- Briefing participants for Refer Station to
1220 scenario, safety, Assignment and
key skills:
and role guidance. Rotation triage,
first aid,
communication
teamwork.
1220 Scene Setup Familiarize with Simulation Team All Participants Assign roles,
- simulation layout Refer Station to check resources,
1225 and resources. Assignment and and orient
Rotation participants to
locations.
1225 Initial Triage patients and NP Students All Participants Assess injuries,
- Response: provide immediate (Supervision) Refer Station to categorize
1240 Triage & Care care using START. Assignment and patients, allocate
Rotation resources.
1240 Life-Saving Perform critical NP and RN Students All Participants Stabilize
- Interventions care for trauma, Refer Station to patients, manage
1330 bleeding, airway Assignment and injuries, ensure
issues. Rotation psychological
support.
 105

TIME ACTIVITY KEY LEAD PARTICIPANTS ACTIONS

OBJECTIVES FACALITORS
1330 Advanced Manage evolving NP Students All Participants Reassess triage,
- Resource conditions, adapt to (Leaders) Refer Station to allocate supplies,
1400 Management limited resources. Assignment and make difficult
Rotation decisions.
1400 Debriefing Reflect on Simulation Team All Participants Discuss
- Session decision-making, outcomes,
1500 triage efficiency, teamwork,
and teamwork. lessons learned,
and
improvements.
1500 Post-Simulation Evaluate the Simulation Team All Participants Complete SET-
- Evaluation effectiveness of M surveys,
1530 skills and learning. provide
feedback.
1530 Wrap-Up & Recap and Simulation Team All Participants Summary of
- Closing reinforce key critical skills,
1600 Remarks takeaways for importance of
future training. preparedness,
next steps.
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Appendix S

Pre-brief for Earthquake Simulation Scenario

Introduction and Scenario Overview:

Welcome to today’s simulation, which aims to improve disaster preparedness in nursing

education. The scenario involves responding to a 6.5-magnitude earthquake on a university
campus. Your task is to provide care to multiple patients with varying degrees of injury in a
high-pressure, resource-limited environment. This simulation reflects real-world challenges and
allows one to practice critical thinking, teamwork, and life-saving skills under stress.

Duration:
120 minutes (including 30 minutes for debriefing)

Setting:
The university campus was affected by a 6.5-magnitude earthquake, resulting in significant
structural damage and multiple casualties.

Participants:
Undergraduate and graduate nursing students, faculty, and support staff

Objectives:
By the end of this simulation, you will be able to:
- Recognize and respond to a Mass Casualty Incident (MCI).

- Apply the START (Simple Triage and Rapid Treatment) methodology to categorize and
prioritize patient care.

- Perform life-saving interventions such as CPR, airway management, and bleeding control.

- Allocate limited resources effectively to maximize survival rates.

- Work collaboratively with your peers and communicate effectively with team members and
emergency personnel.

- Make critical decisions under time pressure in a high-stress environment.

Preparation:
Before starting the scenario, ensure you have completed the following prerequisite knowledge:

- First Aid modules, including primary wound care, fracture stabilization, and CPR.

- STOP the BLEED: How to manage severe bleeding using tourniquets and wound packing.
 107

- SMART Triage: Understanding the principles of rapid patient triage in an emergency setting.
Scenario Setup:

The campus is chaotic, with multiple patients requiring immediate care. Some are trapped under
debris, while others are in shock or experiencing life-threatening conditions. You will work in
teams to triage, stabilize, and transport injured individuals while addressing resource shortages
and communication challenges.

Roles and Expectations:

- Undergraduate Nursing Students: Focus on triaging patients using the START method,
performing basic first aid (e.g., immobilizing fractures, controlling bleeding), and providing
emotional support.

- Graduate Nursing Students (NPs):

Handle more complex tasks, such as advanced airway management, resuscitation efforts,
resource allocation, and patient transport decision-making.

- Faculty and Staff: Oversee the simulation, provide support, and act as emergency
coordinators.

Key Challenges:
- Resource Management: Limited medical supplies and some patients will require immediate
life-saving interventions.

- Time Pressure: Work quickly and efficiently, as some patients are critically injured and require
urgent attention.

- Communication: Effective team and responder communication is essential to ensure proper

care and patient disposition.

Safety Considerations:
All simulated injuries are fictional and performed by trained actors or manikins. To
maintain safety, please do not apply unnecessary pressure to simulated injuries or engage
in movements that could result in actual harm. If you feel uncomfortable or unsafe at any
point during the scenario, please inform the instructors immediately.
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Appendix T

Moulage Requirements

1. Sprained Ankle (Patient 1)

o Moulage Needs: Bruising and swelling makeup.
o Kits Required: 1 basic kit with materials for swelling and bruising effects.

2. Severe Asthma Attack (Patient 2)

o Moulage Needs: No physical injury; focus on cyanosis (bluish skin).
o Kits Required: 1 basic kit for cyanosis makeup.

3. Head Injury (Patient 3)

o Moulage Needs: Swelling and bruising on the forehead.
o Kits Required: 1 basic kit for bruising, swelling, and minor head injury effects.

4. Compound Forearm Fracture (Patient 4)

o Moulage Needs: Visible bone protrusion, severe bleeding.
o Kits Required: 1 advanced moulage kit for fractures and bleeding wounds.

5. Compound Leg Fracture (Patient 5)

o Moulage Needs: Visible bone protrusion, severe bleeding.
o Kits Required: 1 advanced moulage kit for fractures and bleeding wounds.

6. Heart Attack (Deceased, Patient 6)

o Moulage Needs: No external injuries.
o Kits Required: Minimal moulage for pallor or skin discoloration.

7. Broken Ribs (Patient 7)

o Moulage Needs: Chest bruising.
o Kits Required: 1 basic kit for bruising.

8. Panic Attack (Patient 8)

o Moulage Needs: No physical injury, but possible facial flushing for
hyperventilation effects.
o Kits Required: Minimal makeup for flushed skin.

9. Hypoglycemia (Patient 9)
o Moulage Needs: Pale, sweaty skin.
o Kits Required: 1 basic kit for pale complexion and sweating effects.

10. Severe Forehead Laceration (Patient 10)

o Moulage Needs: Profuse bleeding and a laceration on the forehead.
o Kits Required: 1 advanced moulage kit for deep cuts and bleeding simulation.
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11. Head Injury with Schizophrenia (Patient 11)

• Moulage Needs: Bruising, swelling on the head, and possibly simulated blood from
ears/nose to represent neurological damage.
• Kits Required: 1 head trauma moulage kit with options for swelling and bruising,
simulated blood for neurological symptoms.

12. Broken Pelvis – 7 Months Pregnant (Patient 12)

• Moulage Needs: Pregnancy bump simulation, pale skin with visible distress, bruising on
the pelvic area, potential dirt/dust effects to show entrapment under debris.
• Kits Required: 1 pregnancy bump moulage kit, 1 shock simulation kit for pale skin and
cold sweat, 1 pelvic trauma moulage kit for bruising.

13. Severe Head Injury with Dementia and Heart Disease (Patient 13)
• Moulage Needs: Severe head trauma with bruising and swelling, pale skin and weak
pulse signs, potential airway management equipment to simulate respiratory distress.
• Kits Required: 1 severe head injury moulage kit with swelling and
bruising, 1 hypothermia/shock kit for pale and cold skin effects.

14. Crush Injury to Left Arm (Patient 14)

• Moulage Needs: Severe bruising, swelling, and possible open wound on the left arm,
signs of numbness and immobility.
• Kits Required: 1 crush injury moulage kit for swelling and bruising, 1 arm
immobilization device, and optional bleeding simulation for open wounds.

Personnel Needed for Moulage:

• Number of Moulage Artists: 3-4 artists should be sufficient to handle the moulage needs
of all 10 patients.
o Time per patient: Each artist would likely need about 15-20 minutes per patient
for more complex injuries (e.g., fractures, severe lacerations) and 10 minutes for
simpler effects (e.g., bruising, cyanosis).
o With 3-4 artists working simultaneously, all 10 patients could be prepared within
1-1.5 hours.

Summary of Moulage Supplies and Personnel:

• Total Moulage Kits:
o basic kits for minor injuries and skin effects (e.g., bruising, swelling, cyanosis).
o advanced kits for more complex injuries (e.g., fractures, lacerations).
• Personnel: 3-4 moulage artists to prepare the simulated patients within the allotted setup
time.
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Preparation Timeline for Actors:

Simulation Start Time:

o Assuming the simulation begins at 1200.
o
Moulage Application and Actor Preparation:
o Complex Moulage (e.g., fractures, severe bleeding,
lacerations): Approximately 20-30 minutes per actor.
o Basic Moulage (e.g., bruising, swelling, cyanosis): Approximately 10-15 minutes
per actor.

Instruction and Briefing Time for Actors:

o 20-30 minutes: Actors should be briefed on their roles, safety guidelines, key
phrases, and any special instructions related to their injuries or emotional
responses.

Recommended Arrival Time:

• Actors with Complex Moulage: Should arrive at 0930 to allow enough time for moulage
application (1.5-2 hours) and a brief rehearsal or instruction session.
• Actors with Basic Moulage: Should arrive at 1000 for moulage (about 1 hour) and
instruction.

Simulated Patient Preparation Schedule

TIME TASK DETAILS
0930 Arrival for complex moulage Actors with compound fractures,
severe bleeding, lacerations.
0930 Moulage application (complex) 20-30 minutes per actor.
-
1130
1000 Arrival for basic moulage Actors with minor injuries,
swelling, bruising, or non-physical
symptoms.
1000 Moulage application (basic) Actors with minor injuries,
- swelling, bruising, or non-physical
1100 symptoms.
1100 Instruction and rehearsal Brief actors on safety, key
- phrases, and emotional state.
1130
1130 Final preparations and Final checks on moulage,
costumes, and positions for the
adjustments simulation.
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Appendix U

Simulation Scenario

SCENARIO OVERVIEW

Enhancing Disaster Preparedness in Nursing Education: A Quality Improvement

Scenario Title:
Approach Using Simulation and Training

Facho, S., Weiers, A., Jones, A., Wexner, S., & Nelson, J. (2021). Small-Scale
Original Scenario
High-Fidelity Simulation for Mass Casualty Incident Readiness. Journal of
Developer(s):
Education and Training in Emergency Medicine, 6(4), S1-S111.
https://doi.org/10.21980/J84S8S
Date - Original Scenario: October 15, 2021

Modified by: Paul Dreater

Revision Dates: August 15, 2024

Pilot Testing: YES

Estimated Scenario Time: 120-Minutes Debriefing Time: 60-Minutes

Instructor Preparation Time: 60-Minutes Case Time: 15 minutes

Target Group:
Undergraduate and Graduate Nursing Students, Faculty, and Supporting Staff.
Core Case:
University Campus Earthquake with Multiple Casualties
Brief Summary of Case:
A major earthquake strikes a university campus during a crowded event, resulting in significant damage and
injuries. Nursing students are responsible for dealing with disasters as part of their emergency preparedness
training with limited resources. The simulation aims to replicate the chaos and challenges of a large-scale
natural disaster. It focuses on triage, initial care, and communication in high-stress situations.

111
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SCENARIO LEARNING OBJECTIVES

1.LEARNING OUTCOMES (GLOBAL)

1. RECOGNIZE THE STATE OF A MASS CASUALTY INCIDENT (MCI).
2. Demonstrate triage patients using the START criteria.
3. Prioritize care under resource constraints.
4. Perform efficient life-saving interventions.
5. Determine patient disposition.
6. Demonstrate effective collaboration and communication.
7. Demonstrate skills in a realistic, high-stress environment.
2.SPECIFIC LEARNING OBJECTIVES
1. Participants will accurately assess the scale and severity of an incident within the first 10 minutes of
arriving on the scene during the simulation, with a 90% accuracy rate, as measured by an incident
evaluation checklist.
2. Participants will effectively apply the START methodology by correctly classifying at least 90% of
patients within 15 minutes during a disaster simulation, as measured by a triage evaluation form.
3. Participants will adapt triage decisions based on evolving conditions and resource limitations within the
first 30 minutes of the simulation, achieving a success rate of at least 90%, as assessed by the simulation
instructors
4. Participants will demonstrate an understanding of the 'greatest good for the most significant number
principle by scoring at least 90% on a post-simulation decision-making exercise during debriefing of the
simulation.
5. Participants will rapidly identify and address life-threatening conditions, including airway obstruction,
bleeding, and shock, within 5 minutes of patient assessment, with a 90% success rate, as verified by
simulation instructors during the scenario.
6. Participants will assign patients to the appropriate transport or treatment areas based on triage categories
within 10 minutes of the initial assessment, with at least 90% accuracy, as measured by a post-
simulation review.
7. Participants will communicate and document patient information clearly and concisely to transport
teams within 5 minutes of the decision, achieving 90% accuracy in documentation, as measured by
simulation team feedback.
3.CRITICAL LEARNER ACTIONS
1. SCENE ASSESSMENT AND SAFETY: Quickly assess the scene for hazards, ensure personal safety, and

determine the need for additional resources.

112
 113

2. TRIAGE: Rapidly categorize victims using the START criteria (Immediate, Delayed, Minor, Expectant)
to prioritize care.
3. RESOURCE ALLOCATION: Make difficult decisions to allocate limited resources prioritizing those
with the greatest chance of survival.
4. LIFE-SAVING INTERVENTIONS: Perform essential procedures to address life-threatening conditions
(airway management, bleeding control, shock management) quickly and efficiently.
5. PATIENT DISPOSITION: Assign patients to appropriate transport or treatment areas based on their
triage category and communicate their status clearly to transport teams.
6. COLLABORATION AND COMMUNICATION: Work effectively within a team, communicating
clearly and concisely with team members, incident command, and external resources.
7. DECISION-MAKING UNDER STRESS: Apply critical thinking and decision-making skills in a high-
pressure, time-sensitive environment.

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CURRICULUM INTEGRATION

PRE-SCENARIO LEARNER ACTIVITIES

Prerequisite Knowledge
(Required prior to participating in the scenario)
Knowledge Skills

Complete FIRST AID Modules Situational Awareness and Safety

Complete START Education Triage and Prioritization
Complete STOP the BLEED Education Resource Management
Complete BASIC RESUSCITATION Education Life-saving interventions
Complete SMART TRIAGE Education Communication and Teamwork

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 115

Scenario Script

CASE SUMMARY

Background and Initial Setup:

An unexpected earthquake strikes the university during a large-scale event, causing significant structural
damage, fires, and multiple injuries. Nursing students are mobilized to provide immediate care to those
affected. The university's parking lot and education building has been set up as an emergency trauma area,
prepared to handle the influx of critically injured patients.
Scenario Description:

Date: Thursday, October 24, 2024

Time: 1200-1600

Location: University Campus School of Education Parking Lot.

Scenario Overview:

A 7.0 magnitude earthquake struck the university campus during a busy afternoon, causing significant damage

to buildings and infrastructure. The quake resulted in multiple injuries, affecting students, faculty, and staff.

Power outages left many areas dark, and debris littered the campus. With emergency services on the way, the

immediate response is from undergraduate and graduate nursing students and faculty. The situation is urgent,

and a quick action is crucial.

The student nurses must act swiftly to assess, stabilize, and care for the injured using the skills in Triage,

Basic First Aid, Stop the Bleed, and Basic Life Support. The campus is chaotic people are panicking, some

are seriously injured, and others need psychological support.

Scenario Objectives:

• Primary Objective: Assess and provide immediate care to injured individuals using basic first aid,
CPR, and emergency response skills.

• Secondary Objective: Coordinate with your peers to manage the scene effectively, ensuring that the
most critical patients receive care first.

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Scene Setup:

The simulation unfolds across multiple locations on campus, including a classroom, the quad, a stairwell, and

the area outside the student union building. Each location presents unique challenges—debris, confined

spaces, and limited lighting—all of which participant must navigate to provide adequate care.

Key Challenges:

• Resource Management: Participant must effectively use limited resources, including first aid supplies
and emergency medical equipment.
• Communication: Participant must communicate and coordinate effectively when relaying information
and prioritizing patients.
• Time Pressure: The scenario is time-sensitive, with some patients requiring immediate survival
intervention.

Expected Outcomes:

By the end of this scenario, participant should demonstrate proficiency in assessing and responding to

emergencies, applying CPR, using an AED, managing severe injuries, and providing psychological support

under pressure. This training prepares you for real-life emergencies and boosts your confidence. Additionally,

you will enhance your teamwork and decision-making skills in a high-stress, resource-limited environment.

116
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PARTICPANTS NEEDED

Patient Transport Staff to bring in new patients (exact role depends

on the hospital’s MCI plan)
Faculty NP Available to briefly answer questions and provide
support
Team Leader NP - Primary role is to expedite patient dispositions

EQUIPMENT AND PROPS NEEDED FOR MCI SIMULATION

CATEGORY DETAILS
Manakins 2 adult high-fidelity simulators
Standard Patients 8
GURNEYS - STRETCHERS 10
- BEDS
PERSONAL PROTECTIVE Gowns - Gloves - Face masks - Eye protection - Bouffants or surgical
EQUIPMENT caps (as allowed per simulation center guidelines and supply availability)
SIMULATED WOUNDS - Moulage kits
AND MOULAGE - Fake blood
SUPPLIES
- Wound packing supplies (rolled gauze, proprietary wound packing
materials)
DOCUMENTATION Simplified MCI documentation forms - Permanent ink markers (remind
SUPPLIES learners not to write on manikins directly)
BLANKETS AND HOT For patient warmth and protection
HATS
Simulated Blood Products Simulated blood helps create a more realistic training environment,
making the scenario feel more authentic for first responders and
participants.
SIMULATION PROPS Objects to simulate environmental context and enhance realism (e.g.,
debris, personal belongings)
MEDICAL SUPPLIES FOR Splints - Bandages - Dressings
MOCK TREATMENT
COMMUNICATION Radios or other devices to simulate communication between responders
EQUIPMENT
TRAINING AIDS Posters - Handout - Algorithms

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Patient Profiles and Care Needs for Earthquake Simulation Scenario

Patient Gender Age Background Vital Signs Injury Symptoms Care Needs
Condition
1. Male 19 Junior studying BP:118/76 Sprained right Swelling, Immobilize ankle,
Biology, track team HR: 78 ankle. bruising, pain ice, elevate leg,
athlete. RR: 18 level 6/10. administer
T: 98.6°F analgesics,
transport for X-
TC: Green
ray.
(Minor)
2. Female 45 History professor, BP: 90/60 Severe asthma Shortness of Administer
hypertension, high HR: 130 attack, breath, rescue inhaler
cholesterol. RR: 30 unresponsive wheezing, prepare for
T: 98.7°F to inhale. cyanosis possible bag-
(bluish skin), valve-mask
TC: Red
severe anxiety. ventilation,
(Immediate) monitor closely,
transport to
hospital.
3. Male 22 Senior, history of BP:160/99 Head injury Dizziness, Stabilize the
hypertension, HR: 95 right side from confusion, patient with head
manages with RR: 20 falling debris headache, injury elevation,
medication. T: 98.6°F and elevated visible apply a cold
blood pressure swelling on the compress to
TC: Yellow
due to stress. forehead, high reduce swelling,
(Delayed) blood pressure, monitor
mild nausea. neurological
status, manage
BP, prepare for
transport to a
medical facility
for further
evaluation and
imaging.
4. Female 20 Sophomore, no BP: 110/70 Compound Visible bone Stabilize the
known health issues, HR: 90 fracture of the protrusion, fracture with a
involved in campus RR: 24 right forearm severe pain, splint, control
activities. T: 98.6°F due to being swelling, bleeding, cover
trapped under bleeding. the wound with a
TC: Yellow
debris. sterile dressing,
(Delayed) monitor for signs
of shock, prepare
for transport.

5. Male 20 Sophomore, no BP: 110/70 Compound Visible bone Stabilize the

known health issues, HR: 90 fracture of the protrusion, fracture with a
involved in campus RR: 24 left leg due to severe pain, splint, control
activities. T: 98.6°F bleeding, cover
the wound with a

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TC: Yellow being trapped swelling, sterile dressing,

under debris. bleeding. monitor for signs
(Delayed)
of shock, prepare
for transport.
6. Female 53 Nursing Faculty. BP: 0 Unconscious, No pulse, Begin CPR, use
HR: 0 not breathing, unresponsive, AED if available,
RR: 0 suspected not breathing. ensure airway is
T: 98.7°F heart attack. clear, continue
resuscitation
TC: Black
efforts until help
(Deceased - arrives or the
patient is
Expectant) stabilized
7. Male 35 Sophomore, healthy, BP: 130/80 Broken right Sharp chest Stabilize the chest
member of the HR: 115 side ribs from pain, difficulty with a bulky
campus running RR: 26 falling debris. breathing, dressing, monitor
club. T: 98.9°F bruising on the for signs of
chest. respiratory
TC: Yellow
distress, provide
(Delayed) oxygen, if
necessary,
prepare for
transport to the
hospital.
8. Female 20 Junior, history of BP: 110/70 Panic attack Hyperventilati Move to a calm,
anxiety, currently HR: 140 triggered by on, rapid safe environment,
taking anti-anxiety RR: 28 the heartbeat, encourage slow,
medication. T: 98.6°F earthquake. dizziness, deep breathing,
tingling in provide
TC: Green
hands and feet. reassurance,
(Minor) monitor vitals,
consider
administering
anti-anxiety
medication if
available.
9. Male 22 Graduate student, BP: 115/75 Hypoglycemia Sweating, Administer
history of diabetes, HR: 100 due to missed confusion, glucose tablets or
insulin dependent. RR: 20 meals during shakiness, a sugary drink,
T: 98.5°F the chaos. irritability, low monitor blood
blood glucose glucose levels,
TC: Green
level. ensure the patient
(Minor) eats a proper
meal as soon as
possible, monitor
recovery.
10. Female 18 Freshman, history of BP: 120/75 Laceration on Profuse Apply direct
mild allergies, no HR: 105 the left side of bleeding, pale pressure to
chronic conditions. RR: 22 forehead from skin, dizziness, control bleeding,
T: 98.4° falling glass. rapid heart apply a tourniquet
rate, signs of above the injury
TC: Red
shock. site if bleeding
does not stop,

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(Immediate) monitor vital

signs, treat for
shock, and
prepare for
emergency
transport to a
medical facility.
11. Male 30 History of BP: 140/85 Head injury Confusion, Stabilize the
schizophrenia, not HR: 105 from falling agitation, head patient, calm
currently on debris pain, possible environment,
RR: 22 T:
medication. delusions monitor
98.7°F
neurological
TC: Yellow status, apply cold
(Delayed) compress for
swelling, monitor
for signs of
worsening
condition, prepare
for transport
12. Female 29 7 months pregnant, BP: 90/60 Broken pelvis Severe pelvic Stabilize the
no known health HR: 130 from being pain, difficulty pelvis, monitor
issues. trapped under moving, pale vitals closely for
RR: 28 T:
debris. skin, dizziness, signs of shock,
98.6°F
possible signs provide IV fluids,
TC: Red of shock. prepare for
(Immediate) immediate
transport to a
hospital for
specialized care
and potential
preterm labor
risks.
13. Male 65 Retired professor, BP: 85/50 Severe head Unresponsive, Perform airway
history of dementia, HR: 120 injury from slow, irregular management, ,
heart disease. falling objects. breathing, pale apply cold
RR: 30 T:
and cold skin, compress to
98.5°F
weak pulse. reduce swelling,
TC: Red stabilize the head
(Immediate) and neck, prepare
for rapid
transport.
14. Female 40 Construction BP: 125/80 Crush injury Severe pain, Immobilize the
worker, history of HR: 110 RR: to left arm due swelling, arm with a splint,
asthma, on 24 T: 98.7°F to falling difficulty control pain,
medication. TC: Yellow concrete. moving the monitor for
(Delayed) arm, bruising, compartment
numbness. syndrome,
prepare for
transport for
further evaluation
and potential
surgery.

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DEBRIFING

PEARLS Debriefing Tool for MCI Simulation

Purpose:
To guide participants through a structured reflection on their experiences during the MCI simulation, focusing
on their perspectives, emotions, analysis, reactions, learning, and key takeaways.

Materials:
Whiteboard or flip chart paper
Markers
Copies of the PEARLS debriefing tool for participants (optional)

Process:
Introduction: Briefly explain the purpose and structure of the PEARLS debriefing. Emphasize the
importance of creating a safe and supportive environment for open discussion.

Perspectives: Ask participants to share their initial reactions and observations about the simulation.

-What did you see and experience?

-What were your initial impressions?
-What surprised you?

Emotions: Encourage participants to discuss their emotional responses during the simulation.

-How did you feel during the simulation?

-What were the most challenging moments emotionally?
-Did your emotions affect your decision-making or actions?

Analysis: Facilitate a discussion about the participants' actions and decisions during the simulation.

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-What were your primary roles and responsibilities?

-How did you approach triage and resource allocation?
-What were your biggest challenges in decision-making?
-What aspects of your performance were you most satisfied with?

Reactions: Invite participants to share their overall reactions to the simulation experience.

-What are your overall thoughts and feelings about the simulation?
-Did the simulation meet your expectations?
-Was the simulation realistic and helpful in preparing you for a real MCI?

Learning: Guide participants to identify key lessons learned from the simulation.

-What are the most important things you learned from this experience?
-What skills or knowledge do you feel you need to strengthen?
-How will you apply what you learned to a real-world MCI situation?

Summary: Summarize the key takeaways from the discussion and highlight any recurring themes or areas for
improvement.

-What are the most critical actions and decisions in an MCI?

-How can we improve communication and teamwork during an MCI response?
-What resources and training would be most helpful for future MCI preparedness?

Additional Tips:

-Encourage active participation from all participants.

-Use open-ended questions to foster deeper reflection.
-Validate participants' emotions and experiences.
-Create a non-judgmental and supportive atmosphere.
-Focus on identifying actionable takeaways and learning points.
-Consider incorporating visual aids, such as photos or videos from the simulation, to enhance discussion.

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PRE-POST SIMULATION SURVEYS

Simulation Effectiveness Tool - Modified (SET-M)

After completing a simulated clinical experience, please respond to the following statements by circling your response.
PREBRIEFING: Strongly Somewhat Do Not Agree
Agree Agree
Prebriefing increased my confidence 3 2 1
Prebriefing was beneficial to my learning. 3 2 1
SCENARIO:
I am better prepared to respond to changes in my patient’s condition. 3 2 1
I developed a better understanding of the pathophysiology. 3 2 1
I am more confident of my assessment skills. 3 2 1
I felt empowered to make clinical decisions. 3 2 1
I developed a better understanding of medications. (Leave blank if no medications in scenario) 3 2 1
I had the opportunity to practice my clinical decision making skills. 3 2 1
I am more confident in my ability to prioritize care and interventions 3 2 1
I am more confident in communicating with my patient. 3 2 1
I am more confident in my ability to teach patients about their illness and interventions. 3 2 1
I am more confident in my ability to report information to health care team. 3 2 1
I am more confident in providing interventions that foster patient safety. 3 2 1
I am more confident in using evidence-based practice to provide care. 3 2 1
DEBRIEFING:
Debriefing contributed to my learning. 3 2 1
Debriefing allowed me to communicate my feelings before focusing on the scenario.* 3 2 1
Debriefing was valuable in helping me improve my clinical judgment. 3 2 1
Debriefing provided opportunities to self-reflect on my performance during simulation. 3 2 1
Debriefing was a constructive evaluation of the simulation. 3 2 1
What else would you like to say about today’s simulated clinical experience?

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*revised 4/3/20 for use in virtual debriefing

Leighton, K., Ravert, P., Mudra, V., & Macintosh, C. (2015). Update the Simulation Effectiveness Tool: Item modifications and reevaluation of
psychometric properties. Nursing Education Perspectives, 36(5), 317-323. Doi: 10.5480/1 5-1671.

Original Simulation Effectiveness Tool (SET) developed by Medical Education Technologies, Inc (METI, now CAE Healthcare) for Program for
Nursing Curriculum Integration (PNCI) (2005)

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ABBREVIATION KEY
BP Blood Pressure
HR Heart Rate
RR Respiratory Rate
T Temperature
SP Standard Patient
P Palpitation
TC Triage Category

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Appendix V

Simulated Patient Acting Cards

Patient 1: Sprained Right Ankle

• Gender: Male
• Age: 19

• Background: Junior is studying biology and is a track team athlete.

• Vital Signs:
o BP: 118/76
o HR: 78
o RR: 18
o T: 98.6°F

• Triage Color (TC): Green (Minor)

• Injury Condition: Sprained right ankle.

• Symptoms: Swelling, bruising, pain level 6/10.

• Care Needs: Immobilize ankle, apply ice, elevate leg, administer analgesics,
and prepare for transport to X-ray.

• Emotional State: Mildly frustrated and concerned about the impact on

athletic performance.

• Key Phrases:
o "I need to get back to training soon. Will this take long to heal?"

• Safety Note: Avoid putting actual pressure on the ankle while acting, and do
not attempt any sudden movements that could strain the actor.

• Risk: If not immobilized or if additional strain is placed on the ankle, it

could worsen into a more severe ligament tear or permanent damage,
affecting mobility long-term.

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Patient 2: Severe Asthma Attack

• Gender: Female
• Age: 45

• Background: History professor with hypertension and high cholesterol.

• Vital Signs:
o BP: 90/60
o HR: 130
o RR: 30
o T: 98.7°F

• Triage Color (TC): Red (Immediate)

• Injury Condition: Severe asthma attack, unresponsive to inhaler.

• Symptoms: Shortness of breath, wheezing, cyanosis (bluish skin), severe anxiety.

• Care Needs: Administer the rescue inhaler, prepare for possible bag-valve-mask
ventilation, monitor closely, and prepare for transport to the hospital.

• Emotional State: Panicked, scared.

• Key Phrases:
o "I can’t breathe... it’s getting worse. I need my inhaler!"

• Safety Note: Actors should avoid heavy or forced breathing while simulating symptoms
to prevent actual hyperventilation.

• Risk: Without immediate intervention, respiratory failure could occur, leading to hypoxia
(lack of oxygen) and, in extreme cases, cardiac arrest.

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Patient 3: Head Injury and High Blood Pressure

• Gender: Male
• Age: 22

• Background: Senior, history of hypertension, controlled with medication.

• Vital Signs:
o BP: 160/99
o HR: 95
o RR: 20
o T: 98.6°F

• Triage Color (TC): Yellow (Delayed)

• Injury Condition: Head injury due to falling debris, elevated blood pressure due to stress.

• Symptoms: Dizziness, confusion, headache, visible swelling on the forehead, mild

nausea.

• Care Needs: Elevate the head to reduce pressure, apply a cold compress to reduce
swelling, monitor neurological status, control BP, and prepare for transport.

• Emotional State: Disoriented, slightly agitated.

• Key Phrases:
o "My head is spinning... what happened? Am I bleeding?"

• Safety Note: Do not simulate excessive dizziness or nausea that could cause a fall or lead
to injury. Remain seated or still during the scenario.

• Risk: If blood pressure continues to rise or neurological symptoms worsen, this could
lead to a stroke or brain injury, making immediate monitoring crucial.

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Patient 4: Compound Forearm Fracture

• Gender: Female
• Age: 20

• Background: Sophomore, no known health issues.

• Vital Signs:
o BP: 110/70
o HR: 90
o RR: 24
o T: 98.6°F

• Triage Color (TC): Yellow (Delayed)

• Injury Condition: Compound fracture of the right forearm due to debris.

• Symptoms: Visible bone protrusion, severe pain, swelling, bleeding.

• Care Needs: Stabilize the fracture with a splint, control bleeding, cover the wound with a
sterile dressing, monitor for signs of shock, and prepare for transport.

• Emotional State: Frightened, trying to stay calm.

• Key Phrases:
o "I can see the bone! Am I going to lose my arm?"

• Safety Note: Avoid moving or straining the arm while acting. Simulate the injury without
exerting actual pressure on the arm.

• Risk: Without proper stabilization and control of bleeding, this could lead to nerve
damage, severe blood loss, infection, and even amputation in severe cases.

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Patient 5: Compound Leg Fracture

• Gender: Male
• Age: 20

• Background: Sophomore, no known health issues.

• Vital Signs:
o BP: 110/70
o HR: 90
o RR: 24
o T: 98.6°F

• Triage Color (TC): Yellow (Delayed)

• Injury Condition: Compound fracture of the left leg due to debris.

• Symptoms: Visible bone protrusion, severe pain, swelling, bleeding.

• Care Needs: Stabilize the leg with a splint, control bleeding, cover the wound with a
sterile dressing, monitor for shock, and prepare for transport.

• Emotional State: In shock but responsive.

• Key Phrases:
o "My leg... I don’t want to look. Is it bad?"

• Safety Note: Do not bear weight on the injured leg while acting. If standing, use support
or simulate sitting.

• Risk: Risks include excessive bleeding, nerve or muscle damage, infection, and shock,
potentially leading to loss of limb if untreated.

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Patient 6: Suspected Heart Attack (Deceased)

• Gender: Female
• Age: 53

• Background: Nursing Faculty.

• Vital Signs:
o BP: 0
o HR: 0
o RR: 0
o T: 98.7°F

• Triage Color (TC): Black (Deceased - Expectant)

• Injury Condition: Unconscious, suspected heart attack, unresponsive.

• Symptoms: No pulse, no breathing.

• Care Needs: Begin CPR, use AED if available, ensure the airway is clear, and continue
resuscitation until help arrives or the patient stabilizes.

• Emotional State: Unresponsive.

• Key Phrases: N/A

• Safety Note: Remain completely still when simulating unconsciousness. Inform the team
immediately if any discomfort arises.

• Risk: In real scenarios, failure to immediately provide CPR and defibrillation within
minutes can result in irreversible brain damage or death.

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Patient 7: Broken Ribs

• Gender: Male
• Age: 35

• Background: Sophomore, member of the campus running club.

• Vital Signs:
o BP: 130/80
o HR: 115
o RR: 26
o T: 98.9°F

• Triage Color (TC): Yellow (Delayed)

• Injury Condition: Broken ribs from falling debris.

• Symptoms: Sharp chest pain, difficulty breathing, chest bruising.

• Care Needs: Stabilize chest with bulky dressing, monitor for respiratory distress, provide
oxygen if needed, and prepare for transport.

• Emotional State: Tense, trying to manage pain.

• Key Phrases: "It’s hard to breathe... every breath hurts."

• Safety Note: Do not exaggerate breathing difficulty or chest pain to prevent actual
respiratory distress during the scenario.

• Risk: Without proper care, there’s a risk of developing a pneumothorax (collapsed lung),
leading to severe respiratory failure if not treated quickly.

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Patient 8: Panic Attack

• Gender: Female
• Age: 20

• Background: Junior has a history of anxiety, taking anti-anxiety medication.

• Vital Signs:
o BP: 110/70
o HR: 140
o RR: 28
o T: 98.6°F

• Triage Color (TC): Green (Minor)

• Injury Condition: Panic attack triggered by the earthquake.

• Symptoms: Hyperventilation, rapid heartbeat, dizziness, tingling in hands and feet.

• Care Needs: Move to a calm environment, encourage slow breathing, provide

reassurance, monitor vitals, and consider administering anti-anxiety medication.

• Emotional State: Extremely anxious, hyperventilating.

• Key Phrases: "I can’t breathe... am I going to faint?"

• Safety Note: Avoid prolonged or excessive hyperventilation while acting to prevent

inducing real symptoms of dizziness or faintness.

• Risk: If not calmed down, the hyperventilation could lead to fainting, loss of
consciousness, or worsening of existing conditions like cardiac arrhythmias.

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Patient 9: Hypoglycemia
• Gender: Male
• Age: 22

• Background: Graduate student, insulin-dependent diabetic.

• Vital Signs:
o BP: 115/75
o HR: 100
o RR: 20
o T: 98.5°F

• Triage Color (TC): Green (Minor)

• Injury Condition: Hypoglycemia due to missed meals.

• Symptoms: Sweating, confusion, shakiness, irritability, low blood glucose.

• Care Needs: Administer glucose tablets or sugary drinks, monitor blood glucose, ensure
the patient eats a meal, and observe recovery.

• Emotional State: Weak, disoriented.

• Key Phrases: "I feel shaky... did I miss my insulin?"

• Safety Note: Ensure actors do not over-exert themselves while simulating hypoglycemia.
If actual dizziness or confusion occurs, notify the supervisor immediately.

• Risk: If not treated with glucose, the patient could enter hypoglycemic shock, leading to
seizures, unconsciousness, or coma.

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Patient 10: Severe Forehead Laceration

• Gender: Female
• Age: 18

• Background: Freshman with a history of mild allergies and no chronic conditions.

• Vital Signs:
o BP: 120/75
o HR: 105
o RR: 22
o T: 98.4°F

• Triage Color (TC): Red (Immediate)

• Injury Condition: Laceration on the forehead from glass.

• Symptoms: Profuse bleeding, pale skin, dizziness, rapid heartbeat, signs of shock.

• Care Needs: Apply direct pressure to stop bleeding, consider a tourniquet, if necessary,
treat shock, and prepare for emergency transport.

• Emotional State: Dazed, weak.

• Key Phrases: "Everything’s spinning... I can’t stop the bleeding."

• Safety Note: Use safe, non-realistic props to simulate bleeding and avoid any sharp
objects during the simulation. Ensure actors do not feel faint or dizzy.

• Risk: If uncontrolled, the bleeding could lead to hypovolemic shock, unconsciousness, or

even death due to blood loss.

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Patient 11: Head Injury from Falling Debris

• Gender: Male
• Age: 30

• Background: History of schizophrenia, not currently on medication.

• Vital Signs:
o BP: 140/85
o HR: 105
o RR: 22
o T: 98.7°F

• Triage Color (TC): Yellow (Delayed)

• Injury Condition: Head injury from falling debris.

• Symptoms: Confusion, agitation, head pain, possible delusions.

• Care Needs: Stabilize the patient, provide a calm environment, monitor neurological
status, apply cold compress for swelling, monitor for signs of worsening condition, and
prepare for transport.

• Emotional State: Agitated and confused.

• Key Phrases: "There’s too much noise... get it away!"

• Safety Note: Ensure calm surroundings and avoid overstimulation that could trigger
further delusions or agitation.

• Risk: If untreated, the head injury could result in worsening confusion, neurological
deficits, or worsening mental health symptoms.

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Patient 12: Broken Pelvis from Debris

• Gender: Female
• Age: 29

• Background: 7 months pregnant, no known health issues.

• Vital Signs:
o BP: 90/60
o HR: 130
o RR: 28
o T: 98.6°F

• Triage Color (TC): Red (Immediate)

• Injury Condition: Broken pelvis from being trapped under debris.

• Symptoms: Severe pelvic pain, difficulty moving, pale skin, dizziness, and possible signs
of shock.

• Care Needs: Stabilize the pelvis, monitor vitals closely for signs of shock, provide IV
fluids, and prepare for immediate transport to a hospital for specialized care and potential
preterm labor risks.

• Emotional State: Extremely anxious and worried about her baby.

• Key Phrases: "Please... my baby... help me!"

• Safety Note: Ensure safe transport and gentle handling due to pregnancy; monitor for
labor signs.

• Risk: There is a risk of hypovolemic shock or preterm labor due to trauma.

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Patient 13: Severe Head Injury from Falling Objects

• Gender: Male
• Age: 65

• Background: Retired professor with a history of dementia and heart disease.

• Vital Signs:
o BP: 85/50
o HR: 120
o RR: 30
o T: 98.5°F

• Triage Color (TC): Red (Immediate)

• Injury Condition: Severe head injury from falling objects.

• Symptoms: Unresponsive, slow, irregular breathing, pale and cold skin, weak pulse.

• Care Needs: Perform airway management, apply a cold compress to reduce swelling,
stabilize the head and neck, and prepare for rapid transport.

• Emotional State: Unresponsive but may become agitated due to dementia if

consciousness returns.

• Key Phrases: No verbal communication.

• Safety Note: Handle carefully to avoid exacerbating any brain injury or cardiac condition.

• Risk: High risk of respiratory failure, shock, or death if not treated immediately.

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Patient 14: Crush Injury to Left Arm

• Gender: Female
• Age: 40

• Background: Construction worker, history of asthma, on medication.

• Vital Signs:
o BP: 125/80
o HR: 110
o RR: 24
o T: 98.7°F

• Triage Color (TC): Yellow (Delayed)

• Injury Condition: Crush injury to left arm due to falling concrete.

• Symptoms: Severe pain, swelling, difficulty moving the arm, bruising, numbness.

• Care Needs: Immobilize the arm with a splint, control pain, monitor for compartment
syndrome, and prepare for transport for further evaluation and potential surgery.
• Emotional State: Angry and in pain.

• Key Phrases: "I can’t move my arm... it hurts!"

• Safety Note: Ensure no further trauma to the limb during treatment.

• Risk: Without prompt treatment, there could be permanent nerve or muscle damage or
risk of compartment syndrome.

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Appendix W

LEARNER DISASTER MANAGEMENT CHECKLIST

Participant Name: ___________________

Graduate/Undergraduate (Circle)
Year: ___________________

General Tasks:

Scene Assessment and Safety: Ensure the scene is safe for all responders.
Triage: Apply START triage to categorize patients (Immediate, Delayed, Minor, Expectant).
Resource Allocation: Allocate available resources based on the priority of care.
Life-saving Interventions: Perform necessary interventions (e.g., airway management,
bleeding control).
Patient Disposition: Assign patients to appropriate transport or treatment areas based on their
condition.
Documentation: Accurately document patient information, interventions, and dispositions.

Specific Patient Care Tasks:

1. Patient 1 - Male, 19, Sprained Ankle // Triage Category: Green / Red / Yellow/ Black
Immobilize ankle.
Apply ice and elevate the leg.
Administer analgesics.
Prepare for X-ray.

2. Patient 2 - Female, 45, Asthma Attack // Triage Category: Green / Red / Yellow/ Black
Administer rescue inhaler.
Prepare for bag-valve-mask ventilation if needed.
Monitor closely for transport.

3. Patient 3 - Male, 22, Head Injury // Triage Category: Green / Red / Yellow/ Black
Stabilize head injury with elevation.
Apply a cold compress.
Monitor neurological status.
Prepare for transport.

4. Patient 4 - Female, 20, Compound Arm Fracture // Triage Category: Green / Red / Yellow/ Black
Stabilize the fracture.
Control bleeding.
Monitor for shock.
Prepare for transport.

5. Patient 5 - Male, 20, Compound Leg Fracture // Triage Category: Green / Red / Yellow/ Black
Stabilize the fracture.
Control bleeding.

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Monitor for shock.

Prepare for transport.

6. Patient 6 - Female, 53, Deceased // Triage Category: Green / Red / Yellow/ Black
Begin CPR.
Use AED if available.
Ensure the airway is clear.

7. Patient 7 - Male, 35, Broken Ribs // Triage Category: Green / Red / Yellow/ Black
Stabilize the chest.
Monitor for respiratory distress.
Prepare for transport.

8. Patient 8 - Female, 20, Panic Attack // Triage Category: Green / Red / Yellow/ Black
Move to a calm environment.
Encourage slow, deep breathing.
Monitor vitals.

9. Patient 9 - Male, 22, Hypoglycemia // Triage Category: Green / Red / Yellow/ Black
Administer glucose tablets or sugary drinks.
Monitor blood glucose levels.
Ensure a proper meal is provided.

10. Patient 10 - Female, 18, Laceration // Triage Category: Green / Red / Yellow/ Black
Control bleeding with direct pressure.
Apply a tourniquet if needed.
Monitor for shock.
Prepare for emergency transport.

11. Patient 11 - Male, 30, Head Injury // Triage Category: Green / Red / Yellow/ Black
Stabilize head injury.
Monitor neurological status.
Prepare for transport.

12. Patient 12 - Female, 29, Broken Pelvis // Triage Category: Green / Red / Yellow/ Black
Stabilize pelvis.
Monitor vitals for shock.
Prepare for immediate transport.

13. Patient 13 - Male, 65, Severe Head Injury // Triage Category: Green / Red / Yellow/ Black
Perform airway management.
Stabilize the head and neck.
Prepare for rapid transport.

14. Patient 14 - Female, 40, Crush Injury // Triage Category: Green / Red / Yellow/ Black
Immobilize the arm.
Control pain.
Monitor for compartment syndrome.
Prepare for transport.

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Appendix X

DEBRIFING

PEARLS Debriefing Tool for MCI Simulation

Purpose:
To guide participants through a structured reflection on their experiences during the MCI simulation, focusing
on their perspectives, emotions, analysis, reactions, learning, and key takeaways.

Materials:
Whiteboard or flip chart paper
Markers
Copies of the PEARLS debriefing tool for participants (optional)

Process:
Introduction: Briefly explain the purpose and structure of the PEARLS debriefing. Emphasize the
importance of creating a safe and supportive environment for open discussion.

Perspectives: Ask participants to share their initial reactions and observations about the simulation.

-What did you see and experience?

-What were your initial impressions?
-What surprised you?

Emotions: Encourage participants to discuss their emotional responses during the simulation.

-How did you feel during the simulation?

-What were the most challenging moments emotionally?
-Did your emotions affect your decision-making or actions?

Analysis: Facilitate a discussion about the participants' actions and decisions during the simulation.

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-What were your primary roles and responsibilities?

-How did you approach triage and resource allocation?
-What were your biggest challenges in decision-making?
-What aspects of your performance were you most satisfied with?

Reactions: Invite participants to share their overall reactions to the simulation experience.

-What are your overall thoughts and feelings about the simulation?
-Did the simulation meet your expectations?
-Was the simulation realistic and helpful in preparing you for a real MCI?

Learning: Guide participants to identify key lessons learned from the simulation.

-What are the most important things you learned from this experience?
-What skills or knowledge do you feel you need to strengthen?
-How will you apply what you learned to a real-world MCI situation?

Summary: Summarize the key takeaways from the discussion and highlight any recurring themes or areas for
improvement.

-What are the most critical actions and decisions in an MCI?

-How can we improve communication and teamwork during an MCI response?
-What resources and training would be most helpful for future MCI preparedness?

Additional Tips:

-Encourage active participation from all participants.

-Use open-ended questions to foster deeper reflection.
-Validate participants' emotions and experiences.
-Create a non-judgmental and supportive atmosphere.
-Focus on identifying actionable takeaways and learning points.
-Consider incorporating visual aids, such as photos or videos from the simulation, to enhance discussion.

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Appendix Y

DISASTER MANAGEMENT SUPPLIES

SUPPLY QUANTIT PURPOSE STAKEHOLDE

Y R
Moulage Kit 1 Moulage DNP STUDENT
Actors
Safety Vests 6 Sim Team DNP STUDENT

CAT Tourniquets (GEN 7) 6 For DNP STUDENT

simulation
to stop
bleeding

Trauma Kit 2 Treating DNP STUDENT

patients
Wounds

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Space Blankets 10 To keep DNP STUDENT

simulated
patients
comfortabl
e

Whistles 3 Participant DNP STUDENT

Attention

Triage Kit 1 Triage DNP STUDENT

Wagon 1 Simulation DNP STUDENT

Supply
Hauler

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Low Fidelity Manikins 2 Patients SCHOOL OF

NURSING
SIMULATION
CENTER

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