The development and psychometric testing of a Disaster Response Self-
Efficacy Scale Among Undergraduate Nursing Students

Hong-Yan Li, Rui-Xue Bi, Qing-Ling Zhong

PII: S0260-6917(17)30170-3
DOI: doi:10.1016/j.nedt.2017.07.009
Reference: YNEDT 3584

To appear in: Nurse Education Today

Received date: 23 August 2016

Revised date: 19 June 2017
Accepted date: 12 July 2017

Please cite this article as: Li, Hong-Yan, Bi, Rui-Xue, Zhong, Qing-Ling, The develop-
ment and psychometric testing of a Disaster Response Self-Efficacy Scale Among Under-
graduate Nursing Students, Nurse Education Today (2017), doi:10.1016/j.nedt.2017.07.009

This is a PDF file of an unedited manuscript that has been accepted for publication.
As a service to our customers we are providing this early version of the manuscript.
The manuscript will undergo copyediting, typesetting, and review of the resulting proof
before it is published in its final form. Please note that during the production process
errors may be discovered which could affect the content, and all legal disclaimers that
apply to the journal pertain.
 ACCEPTED MANUSCRIPT

THE DEVELOPMENT AND PSYCHOMETRIC TESTING OF A DISASTER

RESPONSE SELF-EFFICACY SCALE AMONG UNDERGRADUATE
NURSING STUDENTS

Word Count:4224

T
Hong-Yan Li1, Rui-Xue Bi1, Qing-Ling Zhong*

IP
School of Nursing, Nanchang University, Jiangxi Province, People’s Republic of China

R
SC
*Corresponding author address: Emergency Nursing Department, School of Nursing,
Nanchang University. BaYi Road 461, Nanchang city, Jiangxi Province, People’s Republic of
China

NU
Tel: +86 079186361291; Fax: +86 079186360530
E-mail addresses: Janet_lhy@163.com(Hong-Yan Li), snowbi2000@163.com(Rui-Xue
Bi),qingling5218@163.com (Qing-Ling Zhong)
MA
1
The first two authors have contributed equally.
1
Tel.: +86 079186360530; Fax: +86 079186360530
D
TE

Acknowledgements
Authors thank all nursing students who participated in this study. This work was supported
by Jiangxi Provincial Education Department (grant numbers: JXJG-13-1-6).
P
CE
AC
 ACCEPTED MANUSCRIPT

Abstract
Background: Disaster nurse education has received increasing importance in China.

Knowing the abilities of disaster response in undergraduate nursing students is

T
beneficial to promote teaching and learning. However, there are few valid and reliable

IP
tools that measure the abilities of disaster response in undergraduate nursing students.

R
Objectives: To develop a self-report scale of self-efficacy in disaster response for

SC
Chinese undergraduate nursing students and test its psychometric properties.

NU
Participants and Settings: Nursing students (N = 318) from two medical colleges were

chosen by purposive sampling.

MA
Methods: The Disaster Response Self-Efficacy Scale (DRSES) was developed and
D

psychometrically tested. Reliability and content validity were studied.Construct

TE

validity was tested by exploratory and confirmatory factor analysis. Reliability was

tested by internal consistency and testretest reliability.

P
CE

Results: The DRSES consisted of 3 factors and 19 items with a 5-point rating.The

content validity was 0.91, Cronbach's alpha coefficient was 0.912, and the intraclass
AC

correlation coefficient for test-retest reliability was 0.953. The construct validity was

good (χ2/df = 2.440, RMSEA = 0.068, NFI = 0.907, CFI = 0.942, IFI = 0.430,

P<0.001). Conclusions:The newly developed DRSES has proven good reliability and

validity. It could therefore be used as an assessment tool to evaluate self-efficacy in

disaster response for Chinese undergraduate nursing students.

Keywords
Disasters response, Measure, Self-efficacy, Nurse student, Competency
 ACCEPTED MANUSCRIPT

INTRODUCTION

Natural and man-made disasters happen frequently throughout the whole world and pose

severe threats to public health. As a part of medical rescue activities, disaster nurses takes on

T
IP
an important role in saving lives, reducing casualties, disabilities, and abating complications

R
and mortality during the whole process of disaster rescue (Kako et al., 2004).

SC
Realizing the importance of disaster nursing, education has been developing rapidly. In

Japan, disaster nursing has been included in basic and continuing nurse education since the end

NU
of the 1990s (Yamamoto, 2009). Courses in disaster nursing have also been added to
MA
undergraduate, postgraduate, and continuing education in the United States, Britain, Australia,

and some European countries (Chaffee, 2005; Veenema, 2006; World Health Organization
D

[WHO] and International Council of Nurses [ICN], 2009). In China, an international

TE

collaborating training program, related to first aid and disaster response competency, was
P

pioneered by the nursing school of Yanbian University and Johns Hopkins University (Li and
CE

Robinson, 2009). After the Wenchuan earthquake in 2008, some medical colleges set up
AC

disaster nursing courses, and some hospitals developed disaster nurse training programs (Shi et

al., 2014; Wang et al., 2010).

In 2008, the WHO proposed to integrate emergency preparedness in undergraduate nurse

education and suggested a curriculum based on disaster nursing abilities (WHO, 2008). In 2009,

the WHO collaborated with the ICN and established the Framework of Disaster Nursing

Competencies (WHO and ICN, 2009). Afterwards, localized research based on the framework

emerged (Chan et al., 2010). The different research institutes have now built their own disaster

nursing competencies or emergency preparedness competency standards for different

 ACCEPTED MANUSCRIPT

professional groups, districts, and disaster types. For instance, some research institutes carried

out studies on emergency preparedness or disaster nursing competency research in general and

specialized nurses (Gebbien and Qureshi, 2002; Jorgensen et al., 2010), community nurses

T
IP
(Yang and Luo, 2010), and public health staff (Polivka et al., 2008). Others investigated disaster

R
nursing core competencies for nurses from disaster-prone areas (Han et al., 2012) or nuclear

SC
emergency preparedness (Liu, 2014). Most of these studies focused on building indicators or

content framework of disaster nursing competency and contributed to establishing a disaster

NU
nursing curriculum and evaluating their teaching effects. However, a measuring tool needs to
MA
be developed to quantitatively evaluate level of disaster nursing competency in nursing students.
D

BACKGROUND
TE

At present, there are few evaluation tools that measure nursing students level of
P

competency in disaster management. Tichy et al. (2009) developed a disaster preparedness

CE

evaluation tool to assess the preparedness of nurse practitioners for disasters. The scale consists
AC

of 3 factors and 68 items; 25 items relate to pre-disaster preparedness, 16 to mitigation, 6 to the

debriefing stage of a disaster response, and 21 items are open-ended questions regarding

demographic data. Participants rated the first 47 items on a 6-point Likert scale in the range 1–

6, with a higher score indicating greater disaster preparedness. The scale has good reliability

and validity, has been translated into Arabic (Al Khalaileh et al., 2010), and has been studied in

Taiwan (Chen et al., 2014). A new scale for disaster nursing core competencies has recently

been developed by Al Thobaity et al. (2015). The development of this scale was based on the

ICN disaster nursing framework. Three factors were extracted by principal component analysis:
 ACCEPTED MANUSCRIPT

core competencies of disaster nursing (29 items), barriers to developing disaster nursing (8

items), and nurse roles in disaster management (5 items). Items were rated on a Likert scale

from 1 to 10. Although this scale had very good reliability, with high internal and external

T
IP
consistency, a confirmatory factor analysis (CFA) was not performed. Furthermore, the two

R
scales were designed to assess nurses working in hospitals or public health nurses.

SC
According to the ICN competency framework, Chan et al. (2010) developed a disaster

nursing competencies self-report questionnaire to assess the effect of a disaster nurse training

NU
course. This questionnaire is composed of 10 domains and 125 items. Participants were senior
MA
undergraduates and graduates in China. Each item was rated on a 5-point Likert scale, which

ranged from 1 (No knowledge) to 5 (Effective application of knowledge, skill, and judgment).
D

The reliability of the questionnaire was high, but no statement of validity was provided.
TE

An investigation showed that most of the nurses were not confident to attend disaster
P

rescue and had low disaster rescue skills (Huang and Liu, 2011). The confidence in, and
CE

willingness for, disaster response was influenced by disaster response competency (Liu et al.,
AC

2012; Mitani et al., 2003). According to the cognition theory proposed by Bandura, self-efficacy

is an individual’s confidence in the ability to realize certain behavioral goals, which is positively

related with personal behavioral ability and behavior outcome (Bandura, 1977, 1989).

Therefore, disaster nursing self-efficacy could represent an indicator for disaster nursing

competency.

Disaster nursing competencies involve four phases consisting of prevention/mitigation,

preparedness, response, and recovery/rehabilitation (WHO and ICN, 2009). The most required

competencies relate to disaster response (Loke and Fung, 2014). During the disaster response
 ACCEPTED MANUSCRIPT

phase, nurses strive to save lives, meet victim needs, and reduce the long-term impact on health

induced by the disaster (WHO and ICN, 2009). The nursing competency of disaster response

should be the emphasis of disaster nurse education for undergraduates. However, most of the

T
IP
scales on disaster nursing are related to disaster preparedness or disaster core competencies,

R
and only a few address the issue of disaster response (Al Thobaity et al., 2015; Baack and Alfred,

SC
2013; Chen, et al., 2014; Luo et al., 2013; Tichy et al., 2009). Scales for nursing students on

disaster response rarely exist.

NU
This study aimed to develop a scale of self-efficacy in disaster response for undergraduate
MA
nursing students and to test the validity and reliability of the scale.
D
TE

METHODS

Participants
P
CE

Two undergraduate nursing schools were selected by purposive sampling. Schools were

chosen because of nationwide enrollment, and the offering of courses related to disaster nursing.
AC

Using purposive sampling, 318 junior and senior undergraduate nursing students were recruited

to participate in this study. In each school, all students of each grade were informed about the

study, and those that consented to participate were told of a meeting place to respond to the

questionnaires. Questionnaires were handed out to all participants by teachers of the courses

related to disaster nursing, who were all researchers of the current study. In total, 318 students

participated by responding to the scale, resulting in a response rate of 100%. The duration of

the study was three months, from January to March 2015. All 318 questionnaires were returned,

of which 314 were valid (98.7%). Among the participants, 21 were male and 293 were female;
 ACCEPTED MANUSCRIPT

ages ranged from 18 to 23 years, with a mean age of 20.50 ± 1.15; 205 were juniors and 113

were seniors. Two weeks after distribution of each individual questionnaire, 40 students (20

students in each grade) were chosen with multistage random sampling to repeat the

T
IP
questionnaire for the test-retest reliability assessment.

R
The recruited criteria included students who were full-time undergraduate nursing students

SC
in Jiangxi province, who had taken the course in disaster nursing, and who were willing to

participate. The students who had work experience in the disaster field were excluded.

NU
MA
Research design

Item creation
D

Disaster response competencies consisted of four areas: care of the community, care of
TE

individuals and families, psychological care, and care of vulnerable populations according to
P

the ICN framework (WHO and ICN, 2009). Yin et al. (2011) suggested the following core
CE

nursing skills for disaster response: transportation, emergency management (e.g., hemostasis,
AC

bandaging, fixation, manual handling), observation and monitoring, triage, controlling specific

infection, psychological crisis intervention, cardiopulmonary resuscitation, patient care

recording, etc. Luo et al. (2013) stated that Chinese community nurses should possess

competencies in six domains of disaster response and management, which are disaster

knowledge, risk assessment, emergency responses, coping with psychological stress,

communicable disease control, and personal qualifications.

Based on a literature review, and using the ICN framework as a guideline, the research

team discussed the domains and items of the scale. Five domains and 37 items were created to
 ACCEPTED MANUSCRIPT

form the original scale. It consisted of disaster assessment (7 items), emergency rescue (13

items), psychological nursing (5 items), communication and cooperation (5 items), and role

quality and adaptation (7 items).

T
IP
According to the methods of self-efficacy evaluation, and based on the general self-

R
efficacy scale (Luszczynska et al., 2005), the rating standard was identified. All the items were

SC
rated on a scale from 1 to 5 (1 = No confidence at all, 2 = Basically no confidence, 3 = Little

confidence, 4 = Basically confident, 5 = Complete confidence). A higher rating was

NU
representative of a higher self-efficacy score in disaster response.
MA

Expert consultation
D

Five experts who were either nurse specialists in emergency and disaster nursing, or had
TE

participated in disaster rescue, were invited to assess content validity. According to the advice
P

provided by these experts, the scale was formed with 4 domains and 22 items. It consisted of
CE

disaster assessment competency (5 items), disaster emergency rescue competency (9 items),

AC

disaster psychological nursing competency (4 items), and disaster role quality and adaptation

competency (4 items). The original scale was finalized, and presented in Table 1.

Pilot testing

In the pilot test, 30 undergraduate nursing students (15 for each grade) were chosen

randomly. Researchers recorded the time for finishing the scale and asked students about their

impressions about completing the scale. The purpose was to test the feasibility of the scale,

further remedy issues according to the feedback provided, measure the time needed for
 ACCEPTED MANUSCRIPT

completing the scale, and gain experience for the formal investigation. Subsequently, the first-

edition scale was finalized.

T
IP
Psychometric testing of the Disaster Response Self-Efficacy Scale

R
The methods for psychometric testing of the Disaster Response Self-Efficacy Scale

SC
(DRSES) included exploratory factor analysis (EFA) for extracting potential factors, CFA for

testing construct validity, and Cronbach’s coefficient alpha for indicating reliability.

NU
MA
Data analysis

Data were analyzed using IBM SPSS 17.0 for Windows and AMOS 17.0. The internal
D

consistency reliability of the scale was measured by Cronbach’s alpha, and the stability of the
TE

scale was measured by its test-retest reliability. Content validity was assessed by calculating
P

the item content validity index (I-CVI) and scale validity index (S-CVI). Construct validity was
CE

tested by using EFA. The Kaiser-Meyer-Olkin (KMO) test and Bartlett’s test were used to check
AC

whether the items were suitable for factor analysis. Then, principal component analysis (PCA)

was used to count factor loadings. The number of factors was identified by their eigenvalues

over 1 and scree test. Finally, the construct of the scale was confirmed by CFA.

Ethical Considerations

Ethical approval was granted by the Ethics Committee of School of Nursing in Nanchang

University. Participants were assured that their participation would be completely voluntary

and the data collected would be kept confidential. The participants gave their informed consent
 ACCEPTED MANUSCRIPT

prior to the data collection process.

RESULTS

T
IP
Content validity

R
After a two-round e-mail expert consultation, the items of the scale were modified,

SC
adjusted, or deleted. Finally, each I-CVI was above 0.80 and S-CVI was 0.91.

Construct validity: EFA

NU
MA
The initial EFA was applied for the first-edition scale. Item Q14 was deleted because of

the appearance of dual factors. Then, the second-edition was formed. The second EFA was
D

applied to the second-edition scale. Item Q5 was deleted because of a mismatch with a related
TE

factor, and Q6 was deleted because its loading value on the common factor was below 0.40.
P

Finally, the third-edition scale was formed with 3 domains and 19 items.
CE

The third EFA was performed for the third-edition scale. According to Bartlett’s test of
AC

sphericity, the KMO was 0.876 and χ2 was 3521.77 (p < 0.01), confirming the suitability of the

factor analysis. The PCA was applied to extract common factors. The factors whose eigenvalue

was above 1.0 were extracted. Three factors were extracted: the first eigenvalue was 7.491, the

second was 2.375, and the third was 1.384, which together explained 59.21% of the total

variance. After research team discussion, the domains of the scale were reconfirmed. Disaster

assessment and disaster emergency rescue were joined together as disaster on-site rescue

competency, while the other two factors remained the same, namely, disaster psychological

nursing competency and disaster role quality and adaptation competency.

 ACCEPTED MANUSCRIPT

Construct validity: CFA

AMOS 17.0 was applied to analyze the factors in the model. The chi square of the factorial

T
IP
model was significant: χ2/df = 2.440, RMSEA = 0.068, NFI = 0.907, CFI = 0.942, IFI = 0.430,

R
p < 0.001. These values present the goodness of fit-statistics for the tested factorial model.

SC
The correlation coefficient between F1 and F2 was 0.50, between F1 and F3 it was 0.34,

and between F2 and F3 it was 0.54 (Figure 1). This indicated that the three factors could be

NU
used to measure self-efficacy in disaster nursing response for undergraduate nursing students.
MA
The factor loading of each item was above 0.43 (Table 2, Figure 1).
D

Reliability
TE

The total Cronbach’s alpha of the scale was 0.912, and the Cronbach’s alphas for the three
P

dimensions were 0.893, 0.862, and 0.832. The questionnaires were retested two weeks after the
CE

first round, and the test-retest reliabilities of the three dimensions were 0.910, 0.950, and 0.930.
AC

The total test-retest reliability of the scale was 0.953 (p < 0.01).

DISCUSSION

At present, disaster nursing is gradually being emphasized in undergraduate nurse

education. The disaster education for undergraduate nursing students is different from the

education for specialized disaster nurses, because not all nursing students will become

specialized nurses; however, all of them must have competencies to respond to disasters

(Adams et al., 2015). Measuring disaster nurse competencies of undergraduate nursing students,
 ACCEPTED MANUSCRIPT

especially disaster response competencies, is one of the main aspects in disaster nurse education

evaluation. Therefore, exploring a systematic, scientific, and feasible evaluating tool is the key

for effective evaluation.

T
IP
Self-efficacy is defined as “People’s judgments of their capabilities to organize and

R
execute courses of action required to attain designated types of performances” (Bandura, 1986).

SC
It is often described as task-specific self-confidence. The self-efficacy of students, and their

actual medical skills (or competence), is reciprocal, that is, competence likely helps to grow

NU
self-efficacy and self-efficacy helps to develop competence (Bandura, 1986; Artino et al., 2012).
MA
Some scholars have suggested that the self-efficacy of medical students has a significantly

positive correlation with their current and future clinical competency (Plant, 2011; Artino,
D

2010). This is also the case among nursing undergraduates (Xue et al., 2012; Park et al.,
TE

2012). Academic self-efficacy has been considered an important predictor of academic

P

achievement (Artino, 2012; Artino et al., 2012). Therefore, in the realm of medical education,
CE

educators pay more and more attention to the evaluation of academic self-efficacy. Based on
AC

the ICN Framework of Disaster Nursing Competencies and self-efficacy theory, this study

developed a scale of self-efficacy in disaster response for undergraduate nursing students.

According to the ratings by experts, the CVI of each item was above 0.80, and the CVI of

the whole scale was 0.91, which indicated appropriate content validity of the scale. Through

EFA and CFA, the resulting scale consisted of three domains, which were disaster on-site rescue

competency, disaster psychological nursing competency, and disaster role quality and

adaptation competency. The Cronbach’s alpha for the total scale was 0.912, and the Cronbach’s

alphas for the three domains were all above 0.80, indicating that the internal consistency
 ACCEPTED MANUSCRIPT

reliability of the scale was good. The factor loadings of the three factors were all above 0.43,

indicating that the items had homogeneity with its related factor. The test-retest reliability of

the total scale and each dimension were above 0.90 indicating good stability of the scale.

T
IP
The ICN proposed that the main role of nurses in a disaster response was to assess physical

R
and mental health condition, provide care for vulnerable groups, communicate and cooperate

SC
with other rescue organizations, monitor the disaster situation, and report an epidemic situation

in a timely fashion (WHO and ICN, 2009). In addition to on-site rescue and emergency care,

NU
identifying individuals with chronic disease or disability is a critical responsibility. Nurses must
MA
be able to identify mental health issues and provide care (WHO and ICN, 2009). The content

of this scale was mainly in accordance with the description in the ICN framework. A recent
D

study mentioned the 10 most common core competencies disaster nurses should have whether
TE

in disaster preparedness or response phase, such as detection of an event, emergency care, triage,
P

epidemiology and surveillance, psychological care, communication, ethics, etc. (Al Thobaity
CE

et al., 2016). These core competencies also were mostly confirmed in our study. Except three
AC

items representing “assess essential risk factors,” “survey, record, and report epidemic situation,”

and “procedures of disaster rescue” were deleted in our study, because the nurse students had

no disaster response experiences and lacked training in disaster response management.

Good psychological competency is necessary for rescue nurses while being on-site during

disasters (Zhang and Qian, 2004). The psychological stress level of rescue nurses in disasters

was found to be higher than normal (Liu and Li, 2009). A qualitative study further found that

rescue nurses in disasters suffered from post-traumatic stress disorder to a varying extent (Li et

al., 2015). Rescue nurses in disasters should equip themselves with sound psychological
 ACCEPTED MANUSCRIPT

resilience and suitable self-adjustment competency (Zhang, 2011). Thus, it is reasonable to

measure role adaptation of nurses in the disaster response phase.

The developed scale aimed to measure coping confidence for disaster response among

T
IP
nursing students, that is, self-efficacy toward a disaster response. Individuals who had higher

R
self-efficacy tended to have a more positive attitude, display stronger willingness to overcome

SC
difficulties, and adapt better to a new environment (Yahaya et al., 2010). Hence, it is crucial to

establish confidence and strengthen self-efficacy for disaster response. After a disaster, the

NU
residents and rescue staff in the disaster area tend to experience a variety of emotional reactions
MA
and psychological problems (Au et al., 2013; Benedek et al., 2007; Tang, et al., 2014). Nurses

should face disaster difficulties with a positive attitude and pass on their positive energy. Studies
D

found that readiness of disaster knowledge and skills and education affected the confidence or
TE

willingness of nurses during a disaster response (Arbon et al., 2013; Li and Sheng, 2014). Thus,
P

the scale could also be used to evaluate the effect of disaster nurse training or education
CE

programs.
AC

LIMITATIONS

There are some limitations in this study. The correlation coefficients for each dimension

were in the range of 0.3 to 0.5, which indicates that items of the scale need to be further

optimized. Considering that the predominant evaluation of nursing competencies related to

disaster prevention, preparedness, and recovery is more suited to registered nurses who have

some disaster experiences, this study mainly focused on self-efficacy of undergraduate nursing

students in disaster response. The scale could be further used to evaluate disaster education for
 ACCEPTED MANUSCRIPT

nurses working in hospitals and communities, which is planned for future research.

CONCLUSION

T
IP
The developed scale has good reliability and validity and can be applied to evaluate self-

R
efficacy of disaster response among undergraduate nursing students. Thus, the scale is practical

SC
for undergraduate students and applicable for teaching evaluation.

NU
MA
D
P TE
CE
AC
 ACCEPTED MANUSCRIPT

REFERENCES

Adams, L.M., Canclini, S.B., Frable, P.J., 2015. “Skip the infection, get the injection”: A case

study in emergency preparedness education. Nurse Education in Practice 15, 58-62.

T
IP
Al Khalaileh, M.A., Bond, A.E., Beckstrand, R.L., Al Talafha, A., 2010. The disaster

R
preparedness evaluation tool: Psychometric testing of the classical Arabic version. Journal

SC
of Advanced Nursing 66 (3), 664-672.

Al Thobaity, A., Plummer, V., Innes, K., Copnell, B., 2015. Perceptions of knowledge of

NU
disaster management among military and civilian nurses in Saudi Arabia. Australasian
MA
Emergency Nursing Journal 18 (3), 156-164.

Al Thobaity, A., Williams, B., Plummer, V., 2016. A new scale for disaster nursing core
D

competencies: Development and psychometric testing. Australasian Emergency Nursing

TE

Journal 19 (1), 11-19.

P

Arbon, P., Ranse, J., Cusack, L., Considine, J., Shaban, R.Z., Woodman, R.J., Bahnisch, L.,
CE

Kako, M., Hammad, K., Mitchell, B., 2013. Australasian emergency nurses’ willingness
AC

to attend work in a disaster: a survey. Australasian Emergency Nursing Journal 16 (2), 52-

57.

Artino, A. R., 2012. Academic self-efficacy: from educational theory to instructional practice.

Perspectives Medicine Education 1(2), 76-85.

Artino, A. R., Dong, T., DeZee, K. J., Gilliland, W. R., Waechter, D. M., Cruess, D. F., Durning,

S. J., 2012. Development and initial validation of a survey to assess students' self-efficacy

in medical school. Military Medicine 177(9), 31-37.

Artino, A. R., La Rochelle, J. S., Durning, S. J., 2010. Second-year medical students'
 ACCEPTED MANUSCRIPT

motivational beliefs, emotions, and achievement. Medicine Education 44(12), 1203-1212.

Au, T. M., Dickstein, B. D., Comer, J. S., Salters-Pednault, K., Litz, B. T., 2013. Co-occurring

posttraumatic stress and depression symptoms after sexual assault: a latent profile analysis.

T
IP
Journal of Affective Disorders 149(1-3), 209-216.

R
Baack, S., Alfred, D., 2013. Nurses’ preparedness and perceived competence in managing

SC
disasters. Journal of Nursing Scholarship 45(3), 281-287.

Bandura, A., 1977. Self-efficacy: Toward a unifying theory of behavior change. Psychological

Review 84, 191-215.

NU
MA
Bandura, A., 1986. Social foundations of thought and action: a social cognitive theory.

Prentice Hall, Englewood Cliffs.

D

Bandura, A., 1989. Human agency in social cognition theory. American Psychologist 44, 1175-
TE

1184.
P

Bandura A., 1997. Self-Efficacy: The Exercise of Control. W. H. Freeman and Company, New
CE

York.
AC

Benedek, D. M., Fullerton, C., Ursano, R. J., 2007. First responders: mental health

consequences of natural and human-made disasters for public health and public safety

workers. Annual Review of Public Health 28, 55-68.

Chaffee, M. W., 2005. Hospital response to acute-onset disasters: the state of the science in

2005. Nursing Clinics of North America 40, 565-577.

Chan, S. S. S., Chan, W. S., Cheng, Y. J., Fung, O. W. M., Lai, T. K. H., Leung, A. W. K., Leung,

K. L. K., Li, S. J., Yip, A. L. K., Pang, S. M. C., 2010. Development and evaluation of an

undergraduate training course for developing international council of nurses disaster

 ACCEPTED MANUSCRIPT

nursing competencies in China. Journal of Nursing Scholarship 42 (4), 405-413.

Chen, T. F., Chou, K. R., Liao, Y. M., Ho, C. H., Chung, M. H., 2014. Construct validity and

reliability of the Chinese version of the Disaster Preparedness Evaluation Tool in Taiwan.

T
IP
Journal of Clinical Nursing 24, 1132-1143.

R
Gebbien, K. M., Qureshi, K., 2002. Emergency and disaster preparedness: core competencies

SC
for nurses: What every nurse should but may not know. American Journal of Nursing

102(1), 46-51.

NU
Han, R. J., Lu, H., Li, J., Zhang, H., Zhu, X. H., Hu, J., 2012. The construction of nurses’ core
MA
competency system for disastrous events in plateau regions. Chinese Journal of Nursing

47(7), 585-587.
D

Huang, L. H., Liu, Y. B., 2011. Investigation of the medical staff’s professional skill of disaster
TE

rescue. Chinese Hospitals 15(4), 24-26.

P

Jorgensen, A. M., Mendoza, G. J., Henderson, J. L., 2010. Emergency preparedness and disaster
CE

response core competency set for perinatal and neonatal nurses. Journal of Obstetric,
AC

Gynecologic & Neonatal Nursing 6(39), 450-467.

Kako, M., Ranse, J., Yamamoto, A., Arbon, P., 2004. What was the role of nurses during the

2011 Great East Earthquake of Japan? An integrative review of the Japanese literature.

Prehospital and Disaster Medicine 29(3), 275-279.

Li, C.Y., Robinson, C., 2009. The research of disaster response training system for nurses.

Chinese Nursing Management 9(5), 11-13.

Li, Y., Turale, S., Stone, T. E., Petrini, M., 2015. A grounded theory study of ‘turning into a

strong nurse’: Earthquake experiences and perspectives on disaster nursing education.

 ACCEPTED MANUSCRIPT

Nurse Education Today 35(9), 43-49.

Li, Z., Sheng, Y., 2014. An investigation of emergency nurses’ preparedness for disasters in

China. Chinese Journal of Nursing 49(6), 699-672.

T
IP
Liu, D. C., Li, Z., 2009. Qualitative research of the posttraumatic stress disorder and coping of

R
the rescue nurse. Chinese Nurses Continuing Education 24(6), 495-498.

SC
Liu, X. W., Fung, O., Loke, A. Y., 2012. Experience of nursing after earthquake relief. Chinese

Nursing Research 26(7C), 1935-1938.

NU
Liu, Y., 2014. Development and application of the scale for nurses’ capability assessment in
MA
nuclear emergency rescue. University of South China. Master’s thesis.

Loke, A. Y., Fung, O. W. M., 2014. Nurses’ competencies in disaster nursing: implications for
D

curriculum development and public health. International Journal of Environmental

TE

Research and Public Health 11(3), 3289-3303.

P

Luo, Y., Liu, L., Huang, W. Q., Yang, Y. N., Deng, J., Yin, C. H., Ren, H., Wang, X. Y., 2013.
CE

A disaster response and management competency mapping of community nurses in China

AC

Iranian Journal of Public Health 42(9), 941-949.

Luszczynska, A., Scholz, U., Schwarzer, R., 2005. The general self-efficacy scale: multicultural

validation studies. Journal of Psychology 139, 439-457

Mitani, S., Kuboyama, K., Shirakawa, T., 2003. Nursing in sudden-onset disasters: factors and

information that affect participation. Prehospital and Disaster Medicine 18(4), 359-364.

Park, J. W., Kim, C. J., Kim, Y. S., Yoo, M. S., Yoo, H., Chae, S. M., Ahn, J. A., 2012. Impact

of critical thinking disposition, general self-efficacy, and leadership on clinical

competence in nursing students. Korean Journal of Medical Education 24(3), 223-231.

 ACCEPTED MANUSCRIPT

Plant, J. L., van Schaik, S. M., Sliwka, D. C., Boscardin, C. K., O'Sullivan, P. S., 2011.

Validation of a self-efficacy instrument and its relationship to performance of crisis

resource management skills. Advances in Health Science Education: Theory and Practice

T
IP
16(5), 579-590.

R
Polivka, B. J., Stanley, S. A. R., Gordon, D., Taulbee, K., Kieffer, G., McCorkle, S. M., 2008.

SC
Public health nursing competencies for public health surge events. Public Health Nursing

25(2), 159-165.

NU
Shi, X. F., Zhao, Q. X., Sha, G. S., Dong, X. W., 2014. Action learning applied to disaster
MA
training for emergency nurses. Chinese General Practice Nursing 12(26), 2473-2474.

Tang, B., Liu, X., Liu, Y., Xue, C., Zhang, L., 2014. A meta-analysis of risk factors for
D

depression in adults and children after natural disasters. BMC Public Health 14(1), 623.
TE

Tichy, M., Bond, A. E., Beckstrand, R. L., Heise, B., 2009. Nurse practitioners perception of
P

disaster preparedness education. American Journal of Nurse Practitioners 13(1), 10-22.

CE

Veenema, T.G., 2006. Expanding educational opportunities in disaster response and emergency
AC

preparedness for nurses. Nursing Education Perspectives 27(2), 93-99.

Wang, L., Cheng, Y. J., Cheng, S. S., Peng, M. C., Cheng, H., Zhang, F. Y., 2010. Design and

practice for disasters nursing curriculum. Chinese Journal of Nursing 45(5), 456-457.

World Health Organization, 2008. Integrating Emergency Preparedness and Response into

Undergraduate Nursing Curricula. WHO Press, Geneva, Switzerland.

World Health Organization and International Council of Nurses, 2009. ICN Framework of

Disaster Nursing Competencies. International Council of Nurses, Geneva, Switzerland.

Xue, J. J., Sun, J. P., Wu, W. C., 2012. Correlation of general self-efficacy and clinical
 ACCEPTED MANUSCRIPT

competence among undergraduate nursing students. Chinese Journal of Nurse Education

9(3), 126-128.

Yahaya, A., Ramli, J., Yahaya, N., Yen, G. S., 2010. Correlation between self-esteem, coping

T
IP
difficulties, self-efficacy, and illness symptoms towards supported education for students

R
with psychiatric disabilities. Procedia Social and Behavioral Sciences 7(C), 642-651.

SC
Yamamoto, A., 2009. Disaster nurse education in Japan. Chinese Nursing Management 9(5),

19-20.

NU
Yang, Y. N., Luo, Y., 2010. Study on construction of evaluation index system for disaster
MA
preparedness and coping capacity of community nurses. Chinese Nursing Research

24(4A), 855-858.
D

Yin, H., He, H., Arbon, P., Zhu, J., 2011. A survey of the practice of nurses’ skills in Wenchuan
TE

earthquake disaster sites: implications for disaster training. Journal of Advanced Nursing
P

67(10), 2231-2238.
CE

Zhang, J., 2011. A theoretical study to develop a competence based disaster nursing curriculum.
AC

The Second Military University, China. Doctoral thesis.

Zhang, L. L., Qian, M. Y., 2004. National mental health services for disaster and crisis in the

United States. Chinese Mental Health Journal 18(6), 395-397.

 ACCEPTED MANUSCRIPT

T
R IP
SC
NU
MA
D
TE

Figure 1.Confirmatory factor analysis of the Disaster Response Self-Efficacy Scale (DRSES)
P
CE
AC
 ACCEPTED MANUSCRIPT

Table 1
Items of the Disaster Response Self-Efficacy Scale (DRSES) for undergraduate nursing students
Dimension Items
1. Detect the relative harm from the disaster
2. Assess injuries accurately and swiftly
disaster

T
3. Assess the epidemic situation after the disaster, such as infectious
assessment
diseases or acute poisoning

IP
competency
4. Recognize vulnerable groups, such as chronic patients or disabled people

R
5. Assess essential risk factors after the disaster, such as personal security
6. Acquaintance with common procedures of disaster rescue

SC
7. Triage technique
8. Debridement, hemostasis, bandaging, and splinting
disaster
9. Lifting

NU
emergency
10. Transfer
rescue
11. Emergency rescue techniques
competency
12. Intensive care and nursing of critically ill patients
MA
13. Prevention and control of infectious diseases in disaster area
14.Survey, record, and report epidemic situation in disaster area
15. Initial psychological assessment of disaster victims
disaster 16. Recognize common psychiatric and psychological problems after
D

psychological disaster, such as PTSD, depression, and anxiety

TE

nursing 17. Provide basic psychological treatment for disaster victims

competency 18. Referral of victims who need psychiatric and psychological treatment in
the disaster area
P

19. Adjust one’s own psychological state and adapt to the working
CE

environment quickly
disaster role 20. Communicate with other team professionals and establish good
quality and cooperation relationship
AC

adaptation 21. Actively communicate with victims and relatives and establish good
competency nurse-patient relationship
22. Obey professional ethics with humanitarian and full of empathy and
love
 ACCEPTED MANUSCRIPT

Table 2
Factor loading of the Disaster Response Self-Efficacy Scale (DRSES) for undergraduate nursing
students
Role quality and adaptation
On-site rescue (F1) Psychological nursing (F2)
(F3)

T
Factor
Item Item Factor loading Item Factor loading
loading

IP
Q1 0.43 Q15 0.72 Q19 0.93
Q2 0.62 Q16 0.75 Q20 0.67

R
Q3 0.50 Q17 0.86 Q21 0.67

SC
Q4 0.44 Q18 0.80 Q22 0.71
Q7 0.66
Q8 0.43

NU
Q9 0.60
Q10 0.97
Q11 0.50
MA
Q12 0.59
Q13 0.94
D
P TE
CE
AC
 ACCEPTED MANUSCRIPT

Highlights
• Self-efficacy in disaster response is important for aspiring nurses.
• No instruments exist that measure this self-efficacy in undergraduate nursing students.
• A tool to measure self-efficacy in disaster response among students was developed.
• Content and construct validity as well as reliability of the scale were good.
• The scale could evaluate the effect of disaster response education among nursing students.

T
R IP
SC
NU
MA
D
P TE
CE
AC