W O R L D HE A L T H

Development and Evaluation of an Undergraduate Training

Course for Developing International Council of Nurses Disaster
Nursing Competencies in China
Sunshine S. S. Chan, RN, RM, MSc1 , Wai-shan Chan, RN, BSc, MSc2 , Yijuan Cheng, RN3 ,
Olivia W. M. Fung, RN, BSc, MPH4 , Timothy K. H. Lai, RN, BSc, MSc5 , Amanda W. K. Leung, BSSc, MSSc6 ,
Kevin L. K. Leung, SN, BNurs, MNurs7 , Sijian Li, RN, MPhil, PhD8 , Annie L. K. Yip, RN, BHSc, MSc9 ,
& Samantha M. C. Pang, RN, DN, BPHil, MSc, PhD10
1 Nurse Consultant, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
2 Clinical Associate, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
3 Professor and Director, West China School of Nursing, Sichuan University, Chengdu China
4 Clinical Associate, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
5 Advanced Practice Nurse, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
6 Communications Manager, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
7 Clinical Associate, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
8 Lecturer, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
9 Senior Clinical Associate, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
10 Professor and Head, School of Nursing, The Hong Kong Polytechnic University, Hong Kong

Key words
Curriculum development, course evaluation,
disaster nursing competencies, nursing
education
Correspondence
Prof. Samantha Pang, School of Nursing, The
Hong Kong Polytechnic University, Hung Hom,
Kowloon, Hong Kong SAR. E-mail:
hsspang@inet.polyu.edu.hk
Accepted: June 24, 2010
doi: 10.1111/j.1547-5069.2010.01363.x

Journal of Nursing Scholarship, 2010; 42:4, 405413.

c 2010 Sigma Theta Tau International


Abstract
Background: Nurses are often called upon to play the role of first responder
when disaster occurs. Yet the lack of accepted competencies and gaps in education make it difficult to recruit nurses prepared to respond to a disaster and
provide assistance in an effective manner.
Design: Based on the International Council of Nurses (ICN) Framework of
Disaster Nursing Competencies and Global Standards for the Initial Education
of Professional Nurses and Midwives, a training course titled Introduction to
Disaster Nursing was designed and implemented with 150 students. A prepost survey design was used to assess changes in participants self-rated disaster
nursing competencies. The impact of the training course on participants attitudes toward disaster nursing and their learning experience were also assessed.
Findings: All participants passed the assessments and examination with an
average score of 70%. Pre- and posttraining self-ratings of the disaster nursing
competencies increased from 2.09 to 3.71 (p < .001) on a Likert scale of 1 to
5, and the effect size was large, with Cohens d higher than 0.8. No significant
difference in both examination results (60% group assignments; 40% written
examination) and self-rated competencies was noted between the senior year
students and graduate nurse participants by Mann-Whitney U test (p value =
.90). The majority of participants indicated their willingness to participate
as a helper in disaster relief and saw themselves competent to work under
supervision.
Conclusions: The ICN Framework of Disaster Nursing Competencies was
instrumental to guide the training curriculum development. This introductory
training course could be incorporated into undergraduate nursing education
programs as well as serve as a continuing education program for graduate
nurses.
Clinical Relevance: The training program can be used for preparing generalist
nurses of their nursing competencies in disaster preparedness, response and
post-disaster recovery and rehabilitation.
405

Nurses Disaster Nursing Competencies

Nurses are often the first healthcare personnel who will

be called upon as first responders, direct care providers,
on-site coordinators of care, information providers or
educators, mental health counselors, and triage officers
when disasters occur (Priest, 2009; World Health Organization [WHO], 2009). At present, the lack of accepted
competencies and gaps in education make it difficult to
recruit nurses prepared to respond to a disaster and provide assistance in an effective manner (Weiner, Irwin,
Trangenstein, & Gordon, 2005; WHO & International
Council of Nurses [ICN], 2009). As nurses constitute the
largest group of healthcare providers, their readiness to
respond to disasters and to participate in preparedness
and recovery activities will be significant in making a
community more resilient against disaster.
There is a growing consensus in the international nursing community regarding the importance of equipping
all nurses with a knowledge base and the minimum set
of skills to enable them to meet the challenges they will
face in dealing with the complexities of disasters (ICN,
2006; WHO & ICN, 2009). To this end, the WHO and
ICN jointly formulated the ICN Framework of Disaster
Nursing Competencies. These competencies help clarify
the role of nurses in disasters, as well as guide the development of disaster training and education. It is envisaged
that such training and education can equip nurses with
similar competencies from around the world while giving
attention to local applications.
A disaster nursing task force composed of faculty members from both The Hong Kong Polytechnic University
and Sichuan University Schools of Nursing was formed
after the 2008 Wenchuan earthquake. The central tasks
were to develop community-based rehabilitation and
health promotion strategies for quake survivors and capacity building of health workers by using action research
as a change strategy. As disaster nursing has yet to be included as an integral part of the undergraduate nursing
curriculum, the task force saw the need to draw on the
international framework in developing a training course
that could equip nurses with the competencies expected
from generalist nurses globally, that is, those expected
from all nurses (Subbarao et al., 2008). This paper reports how this training course was developed by integrating an array of action learning activities with local relevance to engage students in acquiring the ICN disaster
nursing competencies, and the effects on developing students desired competencies.

Developing a Competency-Based
Disaster Nursing Curriculum
Introduction to Disaster Nursing was structured as
a 2-week intensive course targeting senior year nurs406

Chan et al.

ing students and graduate nurses. To achieve a global

perspective, two documents were used as a basis of the
curriculum design. They are the ICN Framework of Disaster Nursing Competencies (WHO & ICN, 2009) and
the Global Standards for the Initial Education of Professional Nurses and Midwives (WHO, 2009). According to the ICN (1997), competence is defined as a level
of performance demonstrating the effective application
of knowledge, skill, and judgment. Structured according to the disaster management continuum, the ICN
disaster nursing competencies were developed after an
analysis of existing competency frameworks in the areas of public health, mental health, emergency management and disaster nursing (WHO & ICN). They are articulated in four categories with 10 domains. The four
categories are Mitigation-prevention competencies, Preparedness competencies, Response competencies, and
Recovery-rehabilitation competencies. The 10 domains
include Risk reduction, disease prevention, and health
promotion; Policy development and planning; Ethical
practice, legal practice, and accountability; Communication and information sharing; Education and preparedness; Care of the community; Care of individuals and
families; Psychological care; Care of vulnerable populations; and Long-term recovery of individuals, families,
and communities (Table 1).
The three principles of curriculum design promulgated
in the Global Standards for the Initial Education of Professional Nurses and Midwives (WHO, 2009) were followed
in aligning the course contents, learning and teaching activities, and assessment methods with the expected disaster nursing competencies (WHO & ICN, 2009). The three
principles to be realized are: (a) the curriculum has to
build on established competencies, (b) the interaction between the nursing students and the client is the primary
focus of quality education and care, and (c) an interprofessional approach to education and practice is critical.
To this end, four clusters of teaching methods
were used to orchestrate a series of planned activities for helping students to acquire the knowledge and
skills necessary for developing the competencies in 10
domains across the disaster management continuum
(see Table 1). For instance, to help students acquire
prevention-mitigation competencies, a lecture was delivered to equip students with the concepts related to disaster and disaster relief. In the craft art action-learning
project, students were assigned in groups to draw on epidemiological data of different parts of China and identify
the risks and effects of specific disasters on the assigned
areas, and have them presented on a wall map using
handiwork. In the problem-based learning (PBL) project,
students were asked to produce a disaster plan to mitigate
the challenges and meet the healthcare needs of specific

Nurses Disaster Nursing Competencies

Chan et al.

Table 1. Alignment of Disaster Nursing Competencies With the Teaching and Learning Activities
ICN disaster
nursing competencies

Teaching and learning activities

Action learning

Prevention-mitigation competencies
Using craft art to illustrate the
(1) Risk reduction, disease
disasters that commonly
prevention, and health
happen in different parts of
promotion
China
(2) Policy development and
planning
Preparedness competencies
(3) Communication and
information sharing
(4) Education and
preparedness

Skill training

Communication skills
Healthcare response to
contain acute respiratory
disease transmission
Ethical decision
making in disasters

Ethical values underpinning

decision making in disaster
situations
Field visit to
earthquake-affected site,
temporary settlement
residence, tent hospital,
emergency care, intensive
care, trauma care, and
rehabilitation departments

Recovery-rehabilitation competencies
Visit of residents in
(10) Long-term recovery of
resettlement areas
individuals, families, and
communities

Lecture

Denition and types

of disaster

Developing disaster
preparedness plans for
different disaster scenarios

Community awareness
campaign, preparation of
personal/emergency kits for
vulnerable people

(5) Ethical practice, legal

practice, and accountability
Response competencies
(6) Care of the community
(7) Care of individuals and
families
(8) Psychological care
(9) Care of vulnerable
populations

Problem-based learning

Dealing with problems

encountered by different
client groups in re, ood,
and earthquake disaster
situations
Helping different vulnerable
groups to nd solutions in
dealing with emergent
problems

Prehospital transfer skills

Wound management
Interviewing skills
Psychological rst aid

Self resilience
Psychological
responses Dealing
with emotions

Community health needs

Role play: addressing
assessment
vulnerability and fostering
hope among residents living Health self-management
manuals for hypertension,
in temporary houses
arthritis, insomnia, and
mental health

vulnerable settings in different disasters. Skill training

workshops were organized for practicing psychomotor
skills. In order to provide timely feedback on students
learning and to track students learning progress, continuous assessments included skills tests (30%), PBL
seminars (30%), and written examination (40%). Only
the written examination assessed individual effort; all
other components assessed group performance within
a restrictive timeframe. This is purposely designed because disaster nursing demands competencies in teamwork, interprofessional collaboration, and planning for
the unplanned. The training course was implemented
at Sichuan University, Chengdu, between July 20 and
July 31, 2009. It was offered to 150 students from 44
member schools of the Chinese Consortium for Higher

Nursing Education (www.chinesenursing.org). A report

on this summer course has been published elsewhere
(Pang, Chan, & Cheng, 2009).

Evaluation Design
A pre-post survey design was used to assess changes
in participants self-rated disaster nursing competencies
expected of a first-level generalist nurse before and after the training course. The impact of the training course
on participants attitude toward disaster nursing and their
learning experience were assessed so as to determine
whether the course could help capacity building for disaster resilience and to elicit feedback on areas needing
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Nurses Disaster Nursing Competencies

Chan et al.

improvement. To this end, two self-administered questionnaires were designed.

ICN Disaster Nursing Competencies

Questionnaire
This questionnaire was structured according to the ICN
competency framework, which is composed of 125 items
in 10 domains (Table 2). The competencies were content
validated by an expert panel for their relevance to the role
requirements of generalist nurses in disasters (WHO &
ICN, 2009). These competencies were converted into selfassessment statements. Participants were asked to rate
their ability to perform each of the competencies based
on a 5-point Likert scale, which ranged from 1 (not knowing anything about it) to 5 (effective application of knowledge,
skill, and judgment). The questionnaire was administered
at two time points: on the day before the training course
commenced and at the last session of the training course.
The reliability of the ICN disaster nursing competencies
domains was high, with Cronbachs ranging from 0.92
to 0.96 (see Table 2).

Disaster Nursing Course Evaluation

Questionnaire
The questionnaire was composed of three sections. The
first section, with five items, evaluated participants attitude toward working in the field of disaster nursing.
These items were self-developed based on a review of dis-

aster training evaluation reports (Chaffee, 2009; Wang

et al., 2008), with a proposition that relevant training
and greater knowledge correlated with volunteering to
work. The second section assessed the training resources
in eight items, and the third section was composed of
two open-ended questions about the positive and negative aspects of participants learning experiences. These
items were drawn from the course evaluation question
bank of the Education Development Unit of The Hong
Kong Polytechnic University, whose validity and comprehensibility have been established for administering to undergraduate students. Participants were asked to rate the
items on a 5-point Likert scale, with higher scores indicating a higher level of agreement. It was administered
on the last day of the training course. Cronbachs values were 0.78 and 0.77, respectively, for the two sections
(Table 3).

Data Collection and Analysis

Approval to conduct the evaluation study was obtained
from Sichuan University West China School of Nursing.
Before the commencement of the training course, written consent was obtained from individual participants for
allowing the project team to use their course assignments
for anonymous analyses. All questionnaires were administered on a voluntary basis. They were coded so that
data were associated with a single participant. Analyses
were conducted using SPSS (version 15.0) for Windows
(SPSS Inc., 2006). Spearmans correlation was used to

Table 2. Self-ratings of Disaster Nursing Competencies Before and After the Training Course (N = 138)

ICN disaster
nursing competencies
Prevention-mitigation competencies
(1) Risk reduction, disease prevention, and health promotion
(2) Policy development and planning
Preparedness competencies
(3) Ethical practice, legal practice, and accountability
(4) Communication and information sharing
(5) Education and preparedness
Response competencies
(6) Care of the community
(7) Care of individuals and families
(8) Psychological care
(9) Care of vulnerable populations
Recovery-rehabilitation competencies
(10) Long-term recovery of individuals, families, and communities
Overall

Cronbachs

0.93
0.92
0.96
0.93
0.94
0.94
0.96
0.94
0.93
0.96

Pre-course
Mean (SD)

Post-course
Mean (SD)

Wilcoxons
signed ranks
test Z-value

p value

Effect size
Cohens d

1.99 (0.65)
2.13 (0.72)
1.86 (0.67)
2.14 (0.75)
2.17 (0.77)
2.20 (0.81)
2.04 (0.77)
2.15 (0.67)
2.15 (0.67)
2.34 (0.68)
2.11 (0.75)
2.12 (0.77)
2.05 (0.76)
2.05 (0.76)

3.76 (0.58)
3.71 (0.62)
3.80 (0.59)
3.69 (0.60)
3.48 (0.65)
3.70 (0.64)
3.90 (0.64)
3.71 (0.55)
3.79 (0.65)
3.81 (0.59)
3.89 (0.64)
3.38 (0.54)
3.69 (0.66)
3.69 (0.66)

9.74
9.85
9.97
9.89
9.86
9.90
10.03
9.89
9.91
9.86
9.84
9.84
10.04
10.04

<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001
<.001

2.88
2.37
2.56
2.29
1.84
2.07
2.62
2.53
2.28
2.31
2.55
1.88
2.32
2.32

2.07 (0.63)

3.71 (0.54)

9.02

<.001

2.79

Note. Competence level: 1, do not know anything about it; 2, have heard something about it; 3, have some knowledge but no skills; 4, have the relevant
knowledge and skills; 5, have learned the application of knowledge, skills, and judgment.

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Chan et al.

Table 3. Disaster Nursing Training Course Evaluation (N = 144)

Items
Attitude toward working in the eld of disaster nursing
(Cronbachs = 0.78)
I am willing to participate as a helper during a
disaster.
I have acquired basic competencies in my role as
helper in disaster care.
My supervisor/teacher would think that I am
competent to participate as a helper during a
disaster.
I am willing to spare my own time to learn more
about disaster nursing.
I am willing to participate in continuing education to
maintain up-to-date knowledge in areas relevant to
disaster nursing.
Training resource (Cronbachs = 0.77)
This course has usually been run in a well-organized
manner.
I have found the classes stimulating.
There were many opportunities for active
participation in this course.
The workload of this course is at an appropriate level.
The teaching and learning activities (e.g., lectures,
group discussions) have helped me to achieve the
courses learning outcomes.
The assessment has been fair and reasonable.
The teachers are willing to assist me when I
encounter learning difculties.
Generally speaking, I am satised with this course.

Mean (SD)a

4.59 (0.64)
3.65 (0.75)
3.64 (0.83)

the training course, and 144 completed the Course Evaluation Questionnaire. The response rates were 92% and
96%, respectively. Among these participants, 30 were
graduates and the rest were senior year nursing students.
They came from 44 universities across different parts of
the Chinese mainland, Taiwan, Macau, and Hong Kong.
Since no statistically significant differences were observed
in either examination results or questionnaire responses
between the graduate nurse and senior year student participants by Mann-Whitney U test (p = .90), the results
are presented below in one cohort.

4.42 (0.77)
4.52 (0.65)

4.53 (0.59)
4.60 (0.57)
4.83 (0.37)
4.03 (0.80)
4.27 (0.63)

4.26 (0.70)
4.73 (0.56)
4.67 (0.51)

Scores ranged from 1 to 5, higher scores indicating greater agreement

with the item.

assess the associations between participants examination

scores, willingness to help, and perceived post-course disaster nursing competencies. The Wilcoxon signed ranks
test was used to compare the self-ratings of the disaster nursing competencies before and after the training
course. A p value of <.05 was considered significant. The
effect size of each domain was calculated to determine the
effectiveness of the training course by Cohens d method.

Results
Participants
Of the 150 students who came from 44 member
schools of the Chinese Consortium for Higher Nursing
Education who had participated in the training course,
the majority of them were female (88.2%), senior year
nursing students (79.2%), and from the Chinese mainland (77.1%). A total of 138 completed the ICN Disaster Nursing Competencies Questionnaire before and after

Disaster Nursing Competencies

All participants passed the assessments and written
examination with an average scores of 70%, equivalent to grade B in Hong Kongs university grading system. Self-ratings of the disaster nursing competencies
before and after the training course showed significant
improvement. All post-course ratings (overall mean =
3.71) across the 10 domains of disaster nursing competencies were significantly higher than the pre-course
ratings (overall mean = 2.09; p < .001). According to
Cohens standard (d = 0.2, small; d = 0.5, medium; d =
0.8, large), the effect size of all domains was large, indicating that participants perceived disaster nursing competencies were markedly improved as a result of the
training course. A higher gain in self-perceived competence level was observed in the domains of policy development and planning, education and preparedness,
and psychological care. A relatively smaller gain in selfperceived competence level was observed in the domains
of ethical practice, legal practice and accountability, and
care of vulnerable populations. No statistically significant
correlation was observed between participants examination scores and self-perceived post-course competencies
(Spearmans rho: 0.040.13, p > .05).

Attitude Toward Working in the Field

of Disaster Nursing
A majority of the participants indicated their willingness to participate as a helper in disaster relief, and
saw themselves as competent to work under supervision. Most stated that they had developed an interest and
would continue to update their knowledge in the field
of disaster nursing. Spearmans correlation was used to
assess whether there was any interaction between students perceived disaster nursing competencies and their
attitudes toward working in the field of disaster nursing.
Results showed that there was moderate and fairly strong
correlation between the overall scores of self-perceived
competencies and both I am willing to participate as a
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Nurses Disaster Nursing Competencies

helper during a disaster (Spearmans rho = 0.19, p <

.05) and I have acquired basic competencies in my role
as helper in disaster care (Spearmans rho = 0.40, p <
.01).

Training Resources and Learning Experiences

The majority of participants rated the training course
favorably in the aspects of organization, stimulating and
participatory learning opportunities, assessment methods, and teacher quality (see Table 3). Content analysis of
the responses to the two open-ended questions revealed
the participants positive learning experiences. They considered PBL as a powerful strategy to motivate cooperative and interdependent learning. They appreciated that
the PBL triggers provided broad coverage of the kinds of
critical issues they would anticipate in disaster situations,
which they would not be able to comprehend in ordinary practice. Most participants found that the field visits
were meaningful experiential learning opportunities (see
Table 1). These learning activities impressed upon them
the kind of massive destruction disasters could cause and
how sufficient preparation and skilled management could
mitigate adversities.

Discussion
Based on the ICN Framework of Disaster Nursing Competencies and Global Standards for the Initial Education
of Professional Nurses and Midwives, a training course titled Introduction to Disaster Nursing was designed and
implemented with 150 students from 44 schools of nursing in China. The effectiveness of the training course was
demonstrated by the positive responses obtained from a
pre-post survey using the ICN Disaster Nursing Competencies Questionnaire (N = 138) and Disaster Nursing
Course Evaluation Questionnaire (N = 144). Self-ratings
of the disaster nursing competencies before and after
the training course showed significant improvement. The
majority of participants indicated their willingness to participate as helpers in disaster relief, and saw themselves
as competent to work under supervision. Many of them
expressed that they had developed an interest and would
continue to update their knowledge in the field of disaster nursing. The evaluation results demonstrated that
the course could be offered as part of the undergraduate nursing education program or a continuing education
course for registered nurses wanting to acquire the necessary competencies in disaster nursing. Based on the evaluation results, the following section will discuss to what
extent and in which aspects this training course could
help to build the capacity of generalist nurses in the field
of disaster nursing.
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Chan et al.

Building Capacity for Disaster Nursing

Competencies
The mean scores in the post-course self-ratings of disaster nursing competencies ranged from 3.69 to 3.76 across
the 10 domains that comprise the disaster management
continuum (see Table 2). Mean scores of less than 4 indicated that students saw themselves as having acquired
some knowledge and skills relevant to the competency
areas, yet they had not reached the competence level
in terms of ability to apply knowledge, skill, and judgment. This is further affirmed by the strong correlation
between their self-rated competence levels and their selfevaluation of basic competencies in performing the role
of helper in disaster care (Spearmans rho = 0.40, p <
.01; see Table 3). These results demonstrated that the
training course successfully delivered an overview and
comprehensive account of the knowledge base pertinent
to disaster nursing competencies. This course can therefore serve as a foundation for advanced disaster nursing
studies.
It is also worth mentioning that there was no significant difference in the perceived disaster nursing competencies between graduate and undergraduate students.
Nor was any significant difference noted between these
two groups of students in the examination scores. This
lack of score differential by the graduate nurses may be
explained by the fact that disaster nursing was as new a
subject to them as to the undergraduate students. Without prior educational input, both the graduate and undergraduate students behaved as novice learners.
We applied the ICN Framework for Disaster Nursing
Competencies to develop and assess the learning outcomes of this introductory course, and this framework
was found to be comprehensive and informative in guiding our future curriculum development by leveling the
expected competencies across the 10 disaster nursing
domains. Further, this ICN disaster nursing framework
takes nine basic skills in emergency and trauma care as
prerequisites (WHO & ICN, 2009). These skills, such as
cardiovascular assessment, burn assessment, mental status assessment, and management of crush injuries and
fractures, have not been included in some undergraduate
nursing programs in China. Further deliberations are required to determine what should be included in both the
general nursing curriculum and discipline-specific curricula in order to help learners to master all disaster nursing
competencies.

Applying the Three Principles Advocated

by the WHO on Curriculum Design
Other than applying the principle of building the
curriculum on the established ICN disaster nursing

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Chan et al.

competencies, this course endeavored to enact the other

two principles of curriculum design for professional nursing education (WHO, 2009) by blending an array of
learning and teaching strategies in simulated and reallife contexts (see Table 1). These included PBL, roleplay, lectures, action learning, group work, and disaster
site and hospital visits. The positive course evaluation results demonstrated students preference for such learning
methods (see Table 3). Based on this course, we have
illustrated how to apply the three principles to design a
nursing curriculum that meets the global standards for
nursing education at the course level (WHO). It is necessary to conduct further examination of the effective pedagogies in materializing these principles at the program
level to cultivate desirable attributes in graduate nurses.
Unlike the didactic approach, these teaching and learning strategies shifted the focus from teaching to student
learning and made full use of prior learning as the basis of new learning. These strategies have been particularly useful in this training course, as our students came
from different parts of the country, with different backgrounds of knowledge. Using this mode of teaching is not
without its shortcomings. Less classroom teaching and
more interactive teaching methods demand more coordination, experienced facilitators, and physical classroom
space. Students who were not familiar with this type of
learning-centered approach required intensive coaching.
This training course placed high value on interdependent and collaborative learning and hence the way
learning activities were organized. First, students were
motivated to work and learn in groups. Because disaster nursing demands collaborative rather than individual efforts, we arranged students in groups and they had
to work with students from other parts of the country.
Students were also given to understand that they had
to help each other learn because their academic results
were based more heavily on group rather than individual scores. Throughout the 2 weeks, students came to
know each other so well that most of them became more
friends than acquaintances. Second, students were given
materials for prereading, guided to plan for the learning before each session, and encouraged to actively participate in the course, and each day was concluded by
a debriefing session for students to both evaluate the
course and allow for personal reflection. Through these
arrangements, students came to realize the importance of
making information available to group members, careful
planning, communication and negotiation, coordinated
efforts in execution of the plan, exercising critical thinking in cases of unanticipated difficulty, and honest evaluation based on facts. Lastly, we attempted to expand
students knowledge base by integrating fundamental
patterns of knowing in nursing (Carper, 1978, p 13),

namely empirics, aesthetics, ethics, and personal knowledge, into our learning activities, such as craft art work
and role play (see Table 1). This integration allowed for
critical thinking as well as creative thinking; knowing
about the patient as well as about the personal self.

Willingness to Work in the Disaster Situation

On any disaster situation, the demand for a prepared
work force is great. The majority of our students indicated that they were willing to participate as helpers during a disaster after they had taken part in the training
course. As all students were self-selected and were highly
motivated to join the course, it was not clear whether
their willingness to work in a disaster situation voluntarily was already high before they took the course or
whether it was heightened by the training course. Most
research indicates that willingness to work in a disaster
situation would be improved after additional educational
input (Gullion, 2004). In this regard, we propose a longitudinal follow-up of the student cohort regarding their
participation in disaster-related activities over 12 months
after completion of the course.
In a systematic review of the literature, Chaffee (2009)
reported that the lack of willingness of healthcare professionals to work in disaster situations was associated
with concerns about personal safety and concerns about
their own families and man-made disasters. Qureshi et al.
(2005) similarly found that healthcare workers were
the least willing to report to work following a chemical event, smallpox epidemic, radiological event, SARS
outbreak, environmental disaster, mass casualty incident,
and snowstorm, in that order. In our training course, the
willingness of our students to work must be seen in the
light of natural disasters in terms of what this course had
emphasized.

Limitations
Teaching materials used in this course were based entirely on natural disasters and did not address man-made
disasters. This was not intended to underplay the threat of
man-made disasters. The decision to make natural disasters the priority was based on the fact that between 2000
and 2008, over 40% of all the natural disasters in the
world took place in Asia (Centre for Research on the Epidemiology of Disasters, 2009). Hence, it is more relevant
to this region to focus on natural disasters.
Scenarios used in this course were relatively benign
and straightforward. Students were not exposed to situations more devastating than they could imagine. It is
well noted that in real disaster situations, nurses may be
required to face multiple casualties, probably with body
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Nurses Disaster Nursing Competencies

mutilations. In hindsight, it would be helpful if simulated

disaster exercises or drills could be included so as to allow
students to gain first-hand experience, better understand
what rapid responses are called for in disaster situations,
and realize their own stress thresholds.
This training course involved participants from the
nursing discipline. Literature suggests that it is preferable
to involve different health disciplines in disaster training programs so as to prepare healthcare professionals
in collaborative practice in disaster situations (Kennedy,
Carson, & Garr, 2009). A post-course evaluation was conducted immediately after the course completion, though
whether the knowledge gained would be retained over
time is not known. Post-course assessment (612 months
after the course) could be considered to check the level of
knowledge retained in the future.
It is noteworthy that the two sets of evaluation
questionnaires were rated by students based on their
self-perceived competencies. There is limitation in the
methodology of using self-report questionnaires; the data
collected are subjective, with no validation undertaken.
Confident causal conclusions are difficult to draw based
on this methodology. However, it shows interactions
about how respondents perceive and feel (Spector, 1994).
It provides the insight of how competent the students
perceived themselves to be after the completion of the
course. Whether the students had acquired the expected
competencies could not be ascertained. One of the key
features in disaster nursing education is to prepare nurses
for meeting the challenges of the unprepared catastrophes. Since each disaster is unique and contextual (i.e.,
that one can be prepared for a disaster but not the disaster), how to assess the expected learning outcomes requires further deliberation.

Conclusions
This disaster nursing course at the introductory level
was guided by the ICN Framework of Disaster Nursing
Competencies (WHO & ICN, 2009) and integrated with
the Global Standards for the Initial Education of Professional Nurses and Midwives (WHO, 2009). Both of
these publications were found to be useful in ensuring
that quality education is provided to students in developing the desired nursing competencies. Well thoughtout teaching strategies in alignment with adult learning
principles were instrumental in achieving the anticipated
learning objectives and afforded a positive learning experience for the students. The contents and design of this
course can be integrated into the undergraduate nursing
program or offered as a stand-alone continuing educational program for registered nurses.
412

Chan et al.

Acknowledgments
We thank Dr. Richard Charles & the Esther Yewpick
Lee Charitable Foundation for sponsoring the disaster
nursing summer program in Sichuan 2009, and Kerry
Hsu, Lei Wang, Salome Ho, and Chi-ming Li for their contribution to data management.

Clinical Resources
r International Council of

r
r

Nurses: Disaster Nursing.

http://pdm.medicine.wisc.edu/Volume 23/issue 3/
kingma.pdf
Core competencies required for disaster nursing.
http://www.coe-cnas.jp/english/group education/
core competencies.html
Chinas actions for disaster prevention and reduction. http://www.gov.cn/english/official/200905/11/content 1310629.htm

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