RESEARCH
DEVELOPMENT AND PSYCHOMETRIC TESTING OF A
TOOL MEASURING NURSES’ COMPETENCE FOR
DISASTER RESPONSE
Authors: Sandra Mara Marin, MSN, Alison Hutton, PhD, and Regina Rigatto Witt, PhD, Porto Alegre, Rio Grande do Sul, Brazil, and
Callaghan, New South Wales, Australia
Earn Up to 8.0 Hours. See page 722.
Contribution to Emergency Nursing Practice

The current literature on expected competencies and the
gaps in education have contributed to the difficulty in
recruiting nurses prepared to respond to a disaster
and provide assistance in an effective manner. Of the
existing disaster response competency self-evaluation
tools, only 1 includes questions regarding disaster pre-
paredness and response as part of a more comprehen-
sive competence evaluation tool.

This article contributes to development and initial vali-
dation of the Nurses’ Disaster Response Competencies
Assessment Questionnaire to evaluate nurses’ compe-
tence for disaster response.

Key implications for emergency nursing practice found
in this article focus on a novel tool for the assessment
of nurses’ competence for response in disasters. This in-
strument can be used in data-driven development of
educational policies and workforce preparation for
more effective disaster response.
Abstract
Introduction: There is a growing awareness among govern-
ments, communities, and health care agencies of the need to
evaluate roles and competencies in disaster nursing. A vali-
dated instrument was developed to evaluate nurses’ compe-
tencies for disaster response.
Sandra Mara Marin was a PhD candidate, School of Nursing, Universidade
Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil at
the time of the study; and is a professor, Centro de Educação Superior do
Oeste, Universidade do Estado de Santa Catarina, Chapecó, Santa Catarina,
Brazil.
Alison Hutton is a professor, University of Newcastle, Callaghan, New South
Wales, Australia. Twitter: @alison_hutton.
Regina Rigatto Witt is an associate professor, Department of Professional
Assistance and Guidance, School of Nursing, Universidade Federal do Rio
Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
September 2020 VOLUME 46
ISSUE 5
Methods: A psychometric evaluation study was developed in
2 stages: 1) content and face validity, and 2) verification of
feasibility and reliability with test-retest. Competencies were
extracted from the Framework of Disaster Nursing Compe-
tencies published by the International Council of Nurses. The
participants included 8 experts in emergencies and disasters
who were nurses with a PhD and had more than 2 years of expe-
rience with education or clinical practice in emergencies or di-
sasters, and 326 nurses from a mobile emergency care service
in southern Brazil. The data analysis used a content validity in-
dex and intraclass correlation coefficients. The psychometric
properties of the instrument included reliability assessed with
Cronbach alpha, feasibility and test-retest reliability assessed
with t tests and intraclass correlation coefficients, and factor
analysis.
Results: The overall evaluation of the instrument yielded an
intraclass correlation coefficient of 0.92 (SD ¼ 0.04), and the
mean content validity index was acceptable at 0.88
(SD ¼ 0.12). Out of 51 items, 41 were validated and organized
in 3 domains according to factor analysis: 1) care of the commu-
nity; 2) care of the individual and family; and 3) psychological
support and care of vulnerable populations. The instrument
demonstrated good internal consistency (Cronbach a ¼ 0.96)
and adequate test-retest reliability (intraclass correlation coef-
ficient >0.7).
Discussion: The Nurses’ Disaster Response Competencies
Assessment Questionnaire showed good internal consistency,
For correspondence, write: Sandra Mara Marin, MSN; E-mail: sandrapeju@
hotmail.com.
J Emerg Nurs 2020;46:623-32.
Available online 9 July 2020
0099-1767
Copyright Ó 2020 Emergency Nurses Association. Published by Elsevier Inc.
All rights reserved.
https://doi.org/10.1016/j.jen.2020.04.007
WWW.JENONLINE.ORG 623
RESEARCH/Marin et al
adequate reproducibility, and appropriate feasibility for use to
evaluate nurses’ competencies for disaster response.
Introduction
There is a growing awareness among governments, commu-
nities, and health care agencies of the need to evaluate
nurses’ roles in an organized response to humanitarian disas-
ters during which populations need long-term ongoing
health support.1 Despite growing initiatives to prepare
nurses for disasters, evidence suggests that in many coun-
tries, nurses are not fully prepared to respond to disasters.2,3
A systematic review of publications3 found that most of
the research that measures nurses’ disaster preparedness
originated from Asian countries. The need for research
originating from regions and nursing populations with less
experience with disaster response was emphasized.
A variety of tools are used to measure nurses’ education,
training, preparedness, knowledge, and awareness regarding
disasters: Emergency Preparedness Information Question-
naire,4 Personnel Preparation Survey,5 Modified Disaster
Preparedness Questionnaire,6 Disaster Preparedness Evalu-
ation Tool,7 Public Health Nurses’ Perceived Ability to
Practice Regarding Disaster Management Questionnaire,8
Nurses Assessment of Readiness,4 Nurse Professional
Competence Scale,9 and the Nash Duty to Care Scale for
Disaster Response.10 In an attempt to create a workforce
that is organized to respond effectively to disaster situations,
competency frameworks have also been developed,11 but
only recently a scale including questions to assess disaster
nursing competencies was developed.12
The Framework of Disaster Nursing Competencies,
published by the International Council of Nurses
(ICN),12 was developed for the generalist nurses to clarify
their role in disasters and assist in disaster training and edu-
cation. The initial framework consisted of 4 areas and 10 do-
mains. It has been used internationally for training,
education, and best practices,13 and its content can be modi-
fied to be culturally specific for different regions and to be
globally applicable. The purpose of this research was to
develop and validate the Nurses’ Disaster Response Compe-
tencies Assessment Questionnaire (NDRCAQ), intended to
measure self-reported competence for disaster response
among practicing nurses.
Methods
A methodological study, including construction of a new
scale and evaluation of its psychometric properties, was
developed.9 The study was designed to develop a disaster
624 JOURNAL OF EMERGENCY NURSING
Key words: Disaster; Nursing; Nursing evaluation research;
Professional competence; Validation study
nursing competence scale in 2 phases: 1) content and face
validity; and 2) verification of feasibility, reliability, and
test-retest. Content validity was indicated if the items in
the tool sample the complete range of the attribute under
study, whereas face validity meant that the instrument
looked, on the face of it, as if it measured the construct of
interest.14
SELECTION OF ITEMS
Competencies were extracted from the Framework of
Disaster Nursing Competencies published by the ICN.12
From the 10 competency domains (Table 1) outlined for
nurses responding to disasters, those corresponding to the
phase of response were chosen: 1) care of the community;
2) care of the individual and family; and 3) psychological
support and care of vulnerable populations.
PHASE 1: CONTENT VALIDITY
Selection of Judges
The content validity of the instrument was assessed by a
board of experts. The inclusion criteria for the board
included being a nurse with a PhD and having more than
2 years of experience with education or clinical practice in
emergencies or disasters. The participants were selected
from a platform (Lattes), a national curriculum system coor-
dinated by the Brazilian National Research Council, which
records the academic development of students and re-
searchers. Contact was made through their e-mail address
available on this platform.
Data Collection
The competencies of the ICN’s competence framework
were translated into Portuguese by one of the authors
(RRW) and sent to the experts via e-mail in 2 rounds.
The initial draft of the tool with 51 competencies was
used to determine the content validity index (CVI) and
the intraclass correlation coefficient (ICC). The compe-
tencies were evaluated in terms of their feasibility, objectiv-
ity, and implicitness: clarity, pertinence, and precision. The
tool was evaluated in terms of its presentation, clarity of the
statements, ease of reading, interpretation, and representa-
tiveness of the competencies in the dimensions. The evalu-
ation was based on a 4-point Likert scale (1 ¼ not relevant;
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TABLE 1
Framework of disaster nursing competencies according to areas and domains
Areas
Mitigation/prevention competencies
Preparedness competencies
Response competencies
Recovery/rehabilitation competencies
Data adapted from WHO/ICN, 2009.12
2 ¼ somewhat relevant; 3 ¼ quite relevant; and 4 ¼ very
relevant). The experts also answered open-ended questions
to recommend modifications to the competency items and
suggest additional items. Data were collected from January
2016 to June 2016.
PHASE 2: VERIFICATION OF FEASIBILITY, RELIABILITY,
AND TEST-RETEST
Participants and Sample Size
Nurses working at the mobile emergency care service in
Brazil’s southern states of Santa Catarina and Rio Grande do
Sul (n ¼ 608) were recruited to complete the instrument.
Their responses were used to evaluate the feasibility, internal
consistency reliability, and test-retest reliability of the tool.
The required sample size was calculated considering a
minimum size (7 3 number of items and >100) for factor
analysis.15 After the content validity procedure was complete,
the instrument contained 41 items. Thus, the required sample
size was calculated as 287 nurses, including 17 for test-retest.
The inclusion criteria included the nurses’ current practice at
the Brazilian mobile emergency care service. The participants
were contacted through their professional e-mail addresses.
Data Collection
In the second phase, the instrument was sent via e-mail to the
participating nurses. The demographics of the participants
were collected. To evaluate the degree of nurses’ proficiency
regarding the competencies described, a 5-point Likert scale
was used: 0 ¼ no experience and knowledge; 1 ¼ some
knowledge but no experience; 2 ¼ some knowledge and
experience; 3 ¼ knowledge and experience as required; and
September 2020 VOLUME 46
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Marin et al/RESEARCH
Domains
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 the individual and family
Psychological support
Care of vulnerable populations
Long-term recovery of individuals, families, and communities
4 ¼ extensive experience and knowledge. Data were collected
from July 2016 to December 2016. For the test-retest, the
first 45 nurses who completed the questionnaire were asked
to complete it again after approximately 2 weeks.
Data Analysis
In phase 1, the data analysis considered the extent to which
the domain of interest was comprehensively sampled by the
items in the questionnaire. For quantitative analysis, the
CVI and the ICC were calculated with analysis of variance
(ANOVA) 2-way mixed, average measure using SPSS
version 21.0 (IBM Corp, Armonk, NY). A minimum of
80% agreement was considered valid.
In phase 2, the quantitative variables of the scale were
described by mean and SD, or median and interquartile range.
To verify the psychometric properties of the instrument, we
used a Cronbach alpha coefficient for internal consistency, t
test for paired samples, and ICC to assess feasibility and test-
retest reliability. In addition, validity was determined using fac-
tor analysis with varimax rotation to maximize factor loads for
better definition of factors. The cutoff point for factor loads was
0.4 to find the minimum accepted level.16 When factors were
loaded on more than 1 scale, they were grouped together if one
of them exceeded 0.5, which denoted that 25% of variance was
accounted for.16 Alternately, the factors best suited in a combi-
nation of test items were believed to belong in one group.14
The associations between demographic variables with
the domains of the instrument and the construct validity as-
sociations were evaluated with t tests and 1-way ANOVA
with the Tukey test. Statistical analyses were performed us-
ing SPSS version 21.0 (IBM Corp, Armonk, NY), and the
level of significance was set at 0.05.
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ETHICAL CONSIDERATIONS
The authors obtained approval from the Institutional Ethics
Committee of the Federal University of Rio Grande do Sul
(number 51552515.0.0000.5347) in full accordance with
international ethical principles and Brazilian legal and
research ethics requirements for non-interventional studies.
Written informed consent was obtained from all partici-
pants.
Results
SAMPLE CHARACTERISTICS
For the board of experts for phase 1, 20 nurses were
approached. Of which 8 (40%) accepted the invitation to
participate. These 8 experts were aged between 34 years
and 55 years; more than half were female (n ¼ 5); and
they were all working either at the mobile emergency care
service (for 5 to 32 years) or as faculty (for 3 to 20 years).
Representation was obtained from most of the regions in
Brazil: Northeast (n ¼ 2), Center-East (n ¼ 2), Southeast
(n ¼ 3), and South (n ¼ 1). Six of the participants were
members of groups working in disaster preparation and
response.
Of the 608 nurses working at the mobile emergency
care service in Brazil’s southern states of Santa Catarina
and Rio Grande do Sul, 326 (53%) accepted the invitation
to evaluate the feasibility and reliability of the instrument.
Of the 32 invited for the test-retest, 21 (65%) completed
the instrument. Most of the nurses were female (n ¼ 206;
63%). Their professional experience was in emergency de-
partments (n ¼ 217) and teaching (n ¼ 109). The number
of years of working experience ranged from 6 years to 10
years. Most of the participants (n ¼ 252; 77%) were certi-
fied in emergency nursing by the Brazilian Education Min-
istry; 41 (12%) had a master’s degree; and 1 had a PhD.
Many had received disaster education (n ¼ 242; 74%).
Some of them reported experience in disaster response
(n ¼ 89; 27%) or as a member of a disaster preparation
and response organization (n ¼ 30; 9%).
CONTENT VALIDITY
The CVI was calculated for item evaluation; 11 items were
deleted because their relevance was below 0.75, indicating
redundancy with other items on the same scale.15 In
response to the experts’ suggestions, the authors also
performed wording revisions, and 1 additional competence
was included: “knowing the psychological and behavioral
626 JOURNAL OF EMERGENCY NURSING
reactions that are expected after disasters.” The mean CVI
was acceptable at 0.88 (SD ¼ 0.12). The overall evaluation
of the instrument yielded an ICC of 0.92 (SD ¼ 0.04).
Of the validated competencies, the experts suggested
that 9 should be modified. Those belonging to the domain
of “care of the individual and family” presented the greatest
number of suggestions and modifications. The experts indi-
cated that the items should be adapted to better suit the
nursing practices developed in Brazil. Both “psychological
support” and “care of vulnerable populations” received the
greatest number of recommendations for exclusion from
the instrument.
VERIFICATION OF FEASIBILITY, RELIABILITY, AND
TEST-RETEST
The factor analysis generated 3 domains (Table 2) instead of
the 4 previously proposed by the ICN 2009 reference frame-
work.13 The eigenvalues of the 3 domains were 16.7, 5.5,
and 2.3, respectively, and the percentages of variance
explained by the 3 factors were 19.6%, 36.9%, and
53.1%, respectively (Kaiser-Meyer-Olkin test value ¼
0.95; Bartlett’s test x2 ¼ 10,123; P < 0.001).
In this research, factor analysis was used to group the
competencies and originating dimensions, which were
analyzed together with those defined by the nurses, verifying
the correlations and symmetries. All competencies that
showed consistency were redistributed into 3 domains: 1)
care of the community (14 items); 2) care of the individual
and family (15 items); and 3) psychological support and care
of vulnerable populations (12 items).
The Cronbach alpha was satisfactory for the 3 domains
generated, indicating good internal consistency for the
whole instrument (0.96) and for the 3 factors (a >0.92)
because the values are considered acceptable if they are above
the threshold of 0.80. The response rate for the test-retest
was 50%. There was no significant difference between the
test and retest scores, and the ICC was higher than 0.7.
The 2-way ANOVA with Bonferroni’s test showed sig-
nificant differences in scores among the domains of the in-
strument. The post hoc test revealed that there was a
statistically significant difference among the 3 domains,
the scores being significantly higher in domain 2 than in do-
mains 1 and 3 (means of 2.86, 2.35, and 2.42, respectively;
P < 0.001 for both comparisons), followed by domain 3,
which had a significantly higher average than domain 1
(P ¼ 0.04). The highest mean score was found in the
domain of “care of the individual and family” (between
2.8 and 3.0) and the lowest in the domain of “care of the
community” (between 2.3 and 2.5).
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TABLE 2
Factor analysis with varimax rotation of the disaster response competence items
Domains/competencies Factor 1 Factor 2 Factor 3
Cuidado de Comunidades 0.74* 0.30 0.05
Care of Communities
Descreve as fases da resposta da comunidade ao desastre e as implicações para as
intervenções de enfermagem
Describes the phases of community response to disaster and the implications for nursing
interventions
Coleta dados sobre lesões e doenças, decorrentes de desastres conforme necessário 0.77* 0.21 0.07
Collects data regarding injuries and illnesses as required
Avalia as necessidades de saúde e os recursos disponíveis na área afetada pelo desastre 0.76* 0.23 0.11
para atender às necessidades básicas da população
Evaluates health needs and available resources in the disaster-affected area to meet basic
needs of the population
Colabora com a equipe de resposta a desastres para reduzir os perigos e riscos na área 0.72* 0.26 0.22
afetada pelo desastre
Collaborates with the disaster response team to reduce hazards and risks in the disaster-
affected area
Compreende como priorizar o cuidado e gerenciar múltiplas situações 0.58* 0.15 0.41*
Understands how to prioritize care and manage multiple situations
Participa de estratégias de prevenção, como em atividades de vacinação em massa 0.63* 0.22 0.06
Participates in preventive strategies such as mass immunization activities
Colabora com organizações de ajuda humanitária para atender às necessidades básicas da 0.60* 0.49* 0.03
comunidade (por exemplo, abrigo, comida, água, cuidados de saúde)
Collaborates with relief organizations to address basic needs of the community (eg, shelter,
food, water, health care)
Oferece serviços de educação na comunidade sobre implicações dos desastres na saúde 0.67* 0.46* 0.02
Provides community-based education regarding health implications of the disaster
Gerencia recursos e suprimentos necessários à prestação de cuidados na comunidade 0.72* 0.39 -0.02
Manages resources and supplies required to provide care in the community
Participa efetivamente de uma equipe multidisciplinar 0.48* 0.22 0.27
Effectively participates as part of a multidisciplinary team
Avaliação
Assessment
Executa rápida avaliação da situação de desastre e das necessidades de cuidados de 0.62* 0.35 0.21
enfermagem
Performs a rapid assessment of the disaster situation and nursing care needs
Descreve os sinais e sintomas de exposição a agentes químicos, biológicos, radiológicos, 0.67* 0.12 0.35
nucleares e explosivos
Describes the signs and symptoms of exposure to chemical, biological, radiological, and
nuclear and explosive agents.
Determina necessidade de descontaminação, isolamento ou quarentena em situações de 0.64* -0.03 0.46*
desastres biológicos
Determines need for decontamination, isolation, or quarantine and takes appropriate action
Reconhece necessidades de saúde e de saúde mental dos prestadores de cuidados e faz 0.62* 0.11 0.39
encaminhamentos adequados
Recognizes health and mental health needs of responders and makes appropriate referrals

continued

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TABLE 2
Continued
Domains/competencies Factor 1 Factor 2 Factor 3
Implementação
Implementation
Conhece os protocolos de atendimento de emergência em trauma 0.02 0.75* -0.02
Acknowledges emergency and trauma protocols of care
Aplica as ações baseadas em evidências para criar soluções na prestação de cuidados de 0.40* 0.41* 0.35
enfermagem que minimizem os efeitos dos desastres
Applies evidence-based practice to create solutions in providing nursing care to minimize the
effects of the disaster
Aplica princípios da classificação de risco ao estabelecer o cuidado baseado na situação 0.30 0.57* 0.33
de desastres e nos recursos disponíveis
Applies accepted triage principles when establishing care based on the disaster situation and
available resources
Adapta padrões de prática de enfermagem, promovendo a educação permanente, 0.34 0.61* 0.17
conforme necessário, com base em recursos disponíveis, para atender as necessidades
de cuidado do paciente
Adapts standards of nursing practice as required, promoting continuous education as needed,
based on resources available and patient care needs
Cria um ambiente seguro de assistência ao paciente 0.15 0.76* 0.17
Creates a safe patient care environment
Prepara os pacientes para o transporte e executa com segurança -0.04 0.79* 0.07
Prepares patients for transport and provides for patient safety during transport
Administra medicamentos, vacinas e imunizações com segurança 0.03 0.73* 0.05
Demonstrates safe administration of medication, vaccines and immunizations
Implementa princípios de controle de infecção e barreiras para evitar a propagação de 0.07 0.69* 0.13
doenças
Implements principles of infection control to prevent the spread of disease
Avalia os resultados das ações dos cuidados de enfermagem e revisa o cuidado, conforme 0.20 0.68* 0.09
necessário
Evaluates outcomes of nursing actions and revises care as required
Provê cuidados sem julgamentos morais 0.00 0.77* -0.05
Provides care in a non-judgmental manner
Mantém a segurança pessoal e a segurança de outras pessoas na cena de um desastre 0.01 0.56* 0.39
Maintains personal safety and the safety of others at the scene of a disaster
Documenta o cuidado de enfermagem de acordo com os procedimentos de desastre 0.17 0.43* 0.40*
Documents care in accordance with disaster procedures
Provê cuidados de uma forma que respeite a diversidade dos antecedentes culturais, 0.25 0.48* 0.16
sociais e espirituais dos indivíduos
Provides care in a manner that reflects cultural, social, spiritual and diverse background of
the individual
Gerencia os cuidados dos óbitos de uma maneira que respeite as crenças culturais, 0.17 0.58* 0.22
sociais e espirituais da população como a situação permite
Manages the care of the deceased in a manner that respects the cultural, social and spiritual
beliefs of the population as situation permits

continued

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TABLE 2
Continued
Domains/competencies Factor 1 Factor 2 Factor 3
Gerencia atividades de cuidados de saúde prestada por profissionais de saúde e/ou 0.14 0.50* 0.22
voluntários
Manages health care activities provided by others
Trabalha com indivíduos e agências adequadas para ajudar os sobreviventes a se 0.31 0.20 0.70*
reconectar com os membros da família e entes queridos
Works with appropriate individuals and agencies to assist survivors in reconnecting with
family members and loved ones
Defende a garantia do acesso aos cuidados para sobreviventes e socorristas 0.23 0.29 0.58*
Advocates for survivors and responders to assure access to care
Encaminha sobreviventes para outros serviços de atendimento conforme necessário 0.07 0.41 0.55*
Refers survivors to other groups or agencies as needed
Atendimento psicológico
Psychological care
Conhece as reações psicológica e comportamentais que são esperadas pós desastres 0.44* 0.16 0.55*
Describes the phases of psychological response to disaster and expected behavioral responses
Compreende o impacto psicológico de desastres em adultos, crianças, famílias, 0.44* 0.16 0.54*
populações vulneráveis e comunidades
Understands the psychological impact of disasters on adults, children, families, vulnerable
populations, and communities
Usa comunicação terapêutica de forma eficaz em uma situação de desastre 0.36 0.21 0.64*
Uses therapeutic relationships effectively in a disaster situation
Encaminha adequadamente as vítimas com reações psicológicas e comportamentais pós 0.37 0.12 0.75*
desastres para serviços conforme necessidades
Refers adequately victims with psychological and behavioral reactions to other services as
needed
Reconhece a diferença entre respostas de adaptação para o desastre e respostas 0.33 -0.04 0.77*
inadaptáveis pós desastres
Differentiates between adaptive responses to the disaster and maladaptive responses
Aplica intervenções de saúde mentais adequadas e inicia encaminhamentos necessário 0.31 0.04 0.75*
Applies appropriate mental health interventions and initiates referrals as required
Identifica sobreviventes e socorristas que requerem apoio de enfermagem em saúde 0.31 0.11 0.71*
mental adicional e encaminha a recursos apropriados
Identifies survivors and responders requiring additional mental health nursing support and
refers to appropriate resources
Cuidados de Populações Vulneráveis
Care of vulnerable populations (Special needs populations)
Descreve as populações vulneráveis em risco como resultado de um desastre e identifica 0.39 0.11 0.70*
implicações para a enfermagem, incluindo respostas físicas e psicológicas de
populações vulneráveis para o desastre; e necessidades únicas e riscos elevados de
populações vulneráveis associados aos desastres
Describes vulnerable populations at risk as a result of a disaster (eg, older persons, pregnant
women, children, and individuals with a disability or chronic conditions requiring
continued care) and identifies implications for nursing, including: physical and
psychological responses to the disaster of vulnerable populations; and unique needs high
risks of vulnerable populations associated with the disasters

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TABLE 2
Continued
Domains/competencies
Identifica recursos disponíveis, faz encaminhamentos adequados e colabora com
organizações, auxiliando populações vulneráveis a atender às necessidades de recursos
Identifies available resources, makes appropriate referrals and collaborates with
organizations serving vulnerable populations in meeting resource needs
Cronbach alpha (a)
Scale item’s original language is Portuguese. English version is in italics. Bold formatting indicates the largest value. An asterisk indicates a value >
Discussion
This study was designed to develop and psychometrically
evaluate a disaster nursing competency scale and to verify
its feasibility and reliability for nurses attending disasters.
The instrument was based on the ICN disaster compe-
tencies, with a particular focus on response, rather than miti-
gation, preparedness, and recovery.
The NDRCAQ is a valid and reliable instrument to
assess disaster nursing competency in emergency nurses in
Brazil. The use of this measurement instrument is a starting
point for assessing the level of training of professionals work-
ing in emergency services to deal with disasters, from the
perspective of their perceived competencies. In our study,
we modified the competency items in the domain of
“care of the individual and family” on the basis of the
recommendations of the board of experts as follows. In
Brazil, competencies for hospital nurses include casualty
triage and risk assessment according to the severity of each
patient, and the development of protocols for health care
in a disaster situation.17
We developed this instrument to meet the need to
review how nurses are using the ICN competencies
worldwide. A recent assessment conducted by the ICN
identified the need to include the psychosocial elements
involved in nurses caring for themselves and their col-
leagues.13 Knowledge related to caring for patients with
mental disorders is necessary when developing adequate
assistance for disaster victims and colleagues18 because
psychological crisis intervention at disaster sites is a
frequent nursing activity.19 However, in our study,
competence items from the domain of psychological sup-
port received recommendations for exclusion. A Japanese
study recently excluded mental health care for affected in-
dividuals from a study questionnaire because there are
few reports of mental health care for patients affected
by disasters.20 Psychological support is addressed in other
instruments that assess competencies in other phases of a
630 JOURNAL OF EMERGENCY NURSING
Factor 1 Factor 2 Factor 3
0.34 0.12 0.73*
0.94 0.93 0.94
_0.40.
disaster, such as the Public Health Nurses’ Perceived
Ability to Practice Regarding Disaster Management
Questionnaire.8
International guidelines on mental health and psycho-
logical support in emergency settings state that the mini-
mum responses under health services should include
specific psychological and social considerations in the provi-
sion of general health care.21 If nurses prioritize focusing
exclusively on physical care in the actual disaster response,
there is a risk of worsened long-term outcomes. Because
of this, the decision to exclude these competencies needs
to be reconsidered or augmented with other assessments
in the future.
In this report, the recognition that health workers have
a modest role to play in post-disaster social support owing to
the short-term focused response was the reason for
excluding competencies from the “care of vulnerable popu-
lations” dimension because they should be placed in the
reconstruction phase of disaster management.12 Alterna-
tively, it is important to note that disasters differ, and a
broader perspective of care should be adopted and devel-
oped in nursing education. These skills are needed to assist
victims, improve relationships between health professionals,
and develop adequate team compositions. In addition, more
autonomous managerial practices and patient-centered care
may contribute to a more positive experience in assisting
and caring for disaster victims.
Limitations
This is a self-report instrument, not an objective measure-
ment of the ability to carry out competencies. The develop-
ment and validation of this instrument was based on items
that, although chosen because of their comprehensiveness
and flexibility, had to be translated into Portuguese. It was
limited by its development in a specific region of Brazil
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and the fact that competencies from the phases of disaster
prevention, preparation, and recovery, in which nurses are
also expected to practice, were not included.
Implications for Emergency Nurses
This validated instrument will allow nurses to assess their
own competencies in disasters and identify areas of needed
education to fulfill their role in emergency preparedness and
response. The results obtained with its application will
consist of a valuable resource when participating in emer-
gency preparedness education and training. Further studies
on assessing the competency of other phases of disaster are
recommended to include the all-hazards approach. This
tool is a valid and reliable way to assess the need for
improved competency on a larger scale to plan educational
programs to meet nurses’ need of being fully prepared to
respond to disasters.
Conclusions
The NDRCAQ showed good internal consistency and
factorial validity, and presented adequate test-retest repro-
ducibility. The tool also showed appropriate feasibility to
evaluate the competencies of nurses in disaster response.
Although developed for emergency nurses, this instrument
would also be helpful with other populations of nurses
because many disasters require increased nursing workforce
capacity to respond to overwhelming clinical demands.
Future studies could examine the psychometric properties
of the scale with other nurse populations.
Author Disclosures
Conflicts of interest: none to report.
REFERENCES
1. Labrague LJ, Hammad K, Gloe DS, et al. Disaster preparedness among
nurses: a systematic review of literature. Int Nurs Rev. 2018;65(1):41-
53. https://doi.org/10.1111/inr.12369
2. Baack S, Alfred D. Nurses’ preparedness and perceived competence in
managing disasters. J Nurs Scholarsh. 2013;45(3):281-287. https://
doi.org/10.1111/jnu.12029
3. Yan YE, Turale S, Stone T, Petrini M. Disaster nursing skills, knowledge
and attitudes required in earthquake relief: implications for nursing edu-
cation. Int Nurs Rev. 2015;62(3):351-359. https://doi.org/10.1111/
inr.12175
September 2020 VOLUME 46
ISSUE 5
Marin et al/RESEARCH
4. Garbutt SJ, Peltier JW, Fitzpatrick JJ. Evaluation of an instrument to measure
nurses’ familiarity with emergency preparedness. Mil Med.
2008;173(11):1073-1077. https://doi.org/10.7205/MILMED.173.11.10
5. Chokshi NK, Behar S, Nager AL, Dorey F, Upperman JS. Disaster man-
agement among pediatric surgeons: preparedness, training and involve-
ment. Am J Disaster Med. 2008;3(1):5-14. https://doi.org/10.5055/
ajdm.2008.0001
6. Fung OW, Loke AY, Lai CK. Disaster preparedness among Hong Kong
nurses. J Adv Nurs. 2008;62(6):698-703. https://doi.org/10.1111/
j.1365-2648.2008.04655.x
7. Tichy M, Bond AE, Beckstrand RL, Heise B. NPs’ perceptions of disaster
preparedness education: quantitative survey research. Am J Nurse Pract.
2009;13:10-22.
8. Putra A, Wongchan P, Maneewat K. Perceived ability to practice in
disaster management among public health nurses in Aceh, Indonesia.
Nurse Media J Nurs. 2011;1(2):169-186. https://doi.org/10.14710/
nmjn.v1i2.971
9. Nilsson J, Johansson E, Egmar AC, et al. Development and validation of a
new tool measuring nurses self-reported professional competence - the
nurse professional competence (NPC) Scale. Nurse Educ Today.
2014;34(4):574-580. https://doi.org/10.1016/j.nedt.2013.07.016
10. Nash TJ. Development, testing, and psychometric qualities of the Nash
Duty to Care Scale for disaster response. J Nurs Meas. 2017;25(2):314-
331. https://doi.org/10.1891/1061-3749.25.2.314
11. Witt RR, Gebbie KM. Tailoring curricula to fit health professional’s needs
in a disaster: a proposal for Brazilian nurses. Rev Gaucha Enferm.
2016;37(1):e56229. https://doi.org/10.1590/1983-1447.2016.01.56229
12. World Health Organization, International Council of Nurses. ICN Frame-
work of Disaster Nursing Competencies. World Health Organization and In-
ternational Council of Nurses; 2009. http://www.cives-toscana.it/wp-content/
uploads/2017/12/disaster_nursing_competencies_liteicn-min.pdf. Accessed
March 15, 2015.
13. Hutton A, Veenema TG, Gebbie K. Review of the International Council
of Nurses (ICN) framework of disaster nursing competencies. Prehosp
Disaster Med. 2016;31(6):680-683. https://doi.org/10.1017/
S1049023X1600100X
14. DeVon HA, Block ME, Moyle-Wright P, et al. A psychometric toolbox
for testing validity and reliability. J Nurs Scholarsh. 2007;39(2):155-164.
https://doi.org/10.1111/j.1547-5069.2007.00161.X
15. Wilson RF, Pan W, Schumsky DA. Recalculation of the critical values for
Lawshe’s content validity ratio. Meas Eval Couns Dev. 2012;45(3):197-
210. https://doi.org/10.1177/0748175612440286
16. Hair JF, Babin BJ, Anderson RE, Black WC. Multivariate Data Analysis.
8th ed. United Kingdom: Cengage Learning EMEA; 2018
17. Marin SM, Witt RR. Hospital nurses’ competencies in disaster
situations: a qualitative study in the South of Brazil. Prehosp
Disaster Med. 2015;30(6):548-552. https://doi.org/10.1017/
S1049023X1500521X
18. Wenji Z, Turale S, Stone TE, Petrini MA. Chinese nurses’ relief experi-
ences following two earthquakes: implications for disaster education and
policy development. Nurse Educ Pract. 2015;15(1):75-81. https://
doi.org/10.1016/j.nepr.2014.06.011
WWW.JENONLINE.ORG 631
RESEARCH/Marin et al
19. Ranse J, Hutton A, Wilson R, Usher K. Leadership opportunities for
mental health nurses in the field of disaster preparation, response, and
recovery. Issues Ment Health Nurs. 2015;36(5):391-394. https://doi.org/
10.3109/01612840.2015.1017062
20. Noguchi N, Inoue S, Shimanoe C, Shibayama K, Shinchi K. Factors
associated with nursing activities in humanitarian aid and disaster relief.
632 JOURNAL OF EMERGENCY NURSING
PLoS One. 2016;11(3):e0151170. https://doi.org/10.1371/journal.-
pone.0151170
21. World Health Organization. Classification and minimum standards for
foreign medical teams in sudden onset disasters. Available at: http://
www.who.int/hac/global_health_cluster/fmt_guidelines_september2013.
pdf. Accessed June 25, 2017.
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ISSUE 5 September 2020