Study design
This study used a descriptive-analytical study design with a convenience sample of 472 hospital and pre-hospital emergency nurses from March to April 2021 in Ardabil Province, north-western Iran. Ardabil Province has a cold mountainous climate and is famous for its hot springs. Sabalan Mountain is located at an altitude of 4811 meters in this province.
Participant and setting
The statistical population of this study consisted of hospital and pre-hospital emergency nurses, who were selected by convenience sampling method, from 12 educational-medical centers and 9 emergency medical services centers affiliated to Ardabil University of Medical Sciences. Emergency nurses in Iran are composed of hospital and pre-hospital emergency nurses. Pre-hospital emergency nurses have an associate or bachelor’s degree in emergency care. Also, nurses who have a bachelor’s or master’s degree may be, employed in pre-hospital emergencies. 31. Inclusion criteria for the study consisted of: (1) they had at least an associate degree in nursing education. (2)They had been working for a minimum of six months in the ED/EMS, and (3) they were active during the data collection stage. All those on break during the study time, non-nursing emergency staff, and incomplete questionnaires were excluded from the research. Finally, out of 821 nurses who met the inclusion criteria, 472 entered the study by completing a questionnaire.
Data collection
Data was collected through an emergency preparedness information questionnaire (EPIQ) and triage decision-making inventory (TDMI).
Emergency preparedness information questionnaire (EPIQ):
In this study, the emergency preparedness information questionnaire (EPIQ) was used. EPIQ is a 44-item instrument that was developed by Wisniewski et al in 2004 36 and was used in several studies 17,37–39. The questionnaire consisted of two parts: The first part was on 14 items, which aim were to collect participants’ personal and work-related characteristics such as; age, gender, level of education, place of work (Hospital and pre-hospital emergency), years of experience, years as an emergency nurse, marital status, shift type, training in disaster preparedness, caring during a disaster, Worked on during a disaster, triage, triage training, the organization in charge of training disaster preparation and city of residence. In the second part, EPIQ was selected as an instrument to assess the disaster preparedness knowledge of nurses with 8 competency dimensions (items) of emergency preparedness which included emergency nurses' familiarity with: The subcategories include incident command system (7 questions), triage (6 questions), communications (7 questions), psychological issues and vulnerable populations (6 questions), isolation, quarantine and decontamination (5 questions), epidemiology and clinical decision-making (4 questions), ability to access critical resources and reporting (4 questions), familiarity with biological agents (4 questions), and knowledge of understanding preparedness during critical situations (1 question). The questionnaire is scored based on a 5-point Likert scale (1 = Unfamiliar to 5 = Very familiar). Cronbach's alpha coefficient of the above 8 dimensions in the original study ranged from 0.83 to 0.94 36, and ranged from 0.86 to 0.90 in the present study. Cronbach's alpha coefficient for the whole questionnaire was reported to be 0.98 in a study conducted in Iran 39 and was obtained 0.97 in the present study.
Triage decision-making inventory (TDMI):
Triage decision-making inventory (TDMI) was developed by Cone in 2000 to quantitatively assess the level of self-confidence of emergency department nurses in triage decision-making 40. The original questionnaire consists of 37 questions and 4 subscales, which was reduced to 27 questions, with three subscales, in a subsequent study 41. In this study, a 27-item questionnaire was used, which included cognitive abilities (14 questions), experience (6 questions) and intuition (7 questions). The questionnaire is scored based on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree). The whole score of this questionnaire is 162 41. The whole score of this questionnaire and its subscales are obtained by dividing the sum of the scores given by the participants by the total number of questions 34. In the main study, Cronbach's alpha ranged from 0.85 to 0.92 for each subscale 41. In the current study, Cronbach's alpha for each subscale was 0.80 to 0.94 and 0.94 for the whole questionnaire.
After obtaining permission from the toolmaker, the questionnaire was translated into Persian by a translator. The validity of the instrument, in terms of content and form, was examined by a group of 12 university professors and their opinions were considered in the research. The reliability (internal consistency) of the instrument was calculated by calculating Cronbach's alpha (α = 0.97), and also test and retest methods were used to assess the reliability of the questionnaire. Twenty questionnaires were distributed among hospital and pre-hospital emergency nurses at the same time interval, then the agreement of the answers was evaluated, and a retest coefficient of r = 0.94 was defined, which indicates the compatibility of the questionnaire.
Data analysis
After collecting the questionnaires, the data were analysed using SPSS ver 22. At first, data related to demographic and occupational characteristics, disaster preparedness training, caring during a disaster, Working on duty during a disaster, and triage training were reported using percentages, means and standard deviations. Second, an independent t-test was used to investigate the relationship among emergency preparedness information with sex, marital status, work shift, workplace, disaster preparedness training, caring during a disaster, Working on during a disaster, and triage training. Also, an ANOVA test was used to investigate the relationship between disaster preparedness knowledge with work experience, years as an emergency nurse, level of education, and passing special disaster management and care courses. Pearson correlation analysis was used to investigate the relationship among disaster preparedness knowledge, triage decision-making, and triage decision-making inventory subscales. Factors affecting disaster preparedness knowledge, were identified, as predictors, via multiple linear regression analysis. Collinearity was controlled, with the VIF index.