Article review 1

Research article

Are nursing students ready to respond to disasters? A study on self-efficacy of nursing students to apply psychological first aid

Nurhayat Kılıç Bayageldi a,*, Dilek Kaloğlu Binici b

a Artvin Çoruh University, Faculty of Health Sciences, Department of Psychiatric Nursing, Artvin, Turkey b Artvin Çoruh University Faculty of Health Science, Department of Obstetrics and Gynecology Nursing, Artvin, Turkey

A R T I C L E I N F O

Keywords: Disasters Nursing students Psychological first aid Psychosocial intervention Self-efficacy

A B S T R A C T

Background: Psychological first aid (PFA) is an effective initial response to disasters. Nursing students are an important human resource for supporting health services during and after disasters. Improving nursing students’ PFA application competencies is necessary for both themselves and aid providers. Aim: This study aimed to determine sernior nursing students’ self-efficacy in psychological first aid application in disaster situations. Design: This was a descriptive cross-sectional study. Setting and participants: A total of 536 senior nursing students who had received undergraduate nursing education in Turkey participated in this study. Methods: Data were collected between March and June 2022, using an online questionnaire comprising a “Personal Information Form” and “PFA Application Self-Efficacy Scale.” The data obtained were analyzed using descriptive statistics, independent samples t-test, Mann–Whitney U test, one-way analysis of variance, Krus- kal–Wallis test, multiple comparison tests, and linear regression analysis. Results: The average age of the senior nursing students was 21.82 ± 2.23 years. Overall, 89.6 % of the students had not received PFA service from any institution. Furthermore, 91.4 % had not received PFA training at any institution. The students’ mean score on the PFA application self-efficacy scale was 123.37 ± 22.92. Students who received PFA training had high average scores. Conclusions: It is necessary to develop senior nursing students’ self-efficacy in PFA application. In this context, it is recommended that systematic training, including training on the application of PFA, be conducted regularly along with applied studies on disaster response situations.

1. Introduction

In recent years, the number of disasters worldwide has increased. Disasters cause collective stress in society and disrupt community life, resulting in high mortality and morbidity. Individuals affected by di- sasters experience both physical and psychological trauma (Abolhadi et al., 2022; Agyapong et al., 2022; Erdur Baker, 2014; Leppold et al., 2022; Sever et al., 2020). Depending on the disaster severity, affected individuals may experience various symptoms related to posttraumatic stress disorder, depression, anxiety, substance abuse, sleep disorders, avoidance behaviors, suicide attempts, and social isolation (Abolhadi et al., 2022; Kar et al., 2014; Mensi et al., 2022).

Nurses play an important role in disaster preparation, response, and post-disaster recovery (Fletcher et al., 2022; Jang et al., 2021; Said et al.,

2022). However, disaster response can challenge nurses’ capabilities. Additional human resources are required to maintain and restore health services during and after a disaster (Ranse et al., 2022; Shujuan et al., 2022). In addition to qualified nurses, nursing students are an important human resource for supporting health services in disaster situations (Iserson, 2020; Ranse et al., 2022; Shujuan et al., 2022). The most recent example is the Corona Virus Disease-19 (COVID-19) pandemic, during which a large number of nursing students in their last year of university education provided assistance to ensure an adequate response from healthcare teams to manage COVID-19 patients (Iserson, 2020). Previ- ous studies have indicated that nursing students can provide various types of assistance and are willing to do so, both during and after a disaster. However, lack of knowledge regarding the appropriate steps to be taken during and/or after a disaster is a concern for these students

* Corresponding author. E-mail addresses: [email protected] (N.K. Bayageldi), [email protected] (D. Kaloğlu Binici).

Contents lists available at ScienceDirect

Nurse Education Today

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https://doi.org/10.1016/j.nedt.2024.106367 Received 20 January 2024; Received in revised form 13 June 2024; Accepted 18 August 2024

Nurse Education Today 143 (2024) 106367

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(Grimes et al., 2020; Satoh et al., 2018). To better prepare nurses for managing disaster situations and

improve the quality of response, nurses should be provided PFA training during and after their undergraduate education (Kılıç and Şimşek, 2019; Said et al., 2022). PFA training should be integrated into the under- graduate nursing curriculum (Kılıç and Şimşek, 2019; Kılıç Bayageldi and Kaloğlu Binici, 2024). However, it has been reported that PFA training is insufficient and not integrated into the courses on nursing (Zhang et al., 2022). According to previous research, knowledge of PFA positively affects nursing students’ perception of disaster preparedness and response (Kılıç and Şimşek, 2019). The application of PFA in disaster situations can reduce the psychological effects of the traumatic event, thereby contributing to the development of general self-efficacy and increasing individual and social resilience (Kılıç and Şimşek, 2019; Said et al., 2022). Therefore, is important to determine and develop PFA application competencies for nursing students. However, it is difficult to directly measure the quality of response and actual per- formance of individuals providing assistance in disaster situations (Kılıç and Şimşek, 2019; Kılıç Bayageldi and Şimşek, 2022). Therefore, self- efficacy may be an alternative determinant of competence. Previous studies have demonstrated a positive relationship between high self- efficacy perception, effective interventions, and performance (Marceron and Rohrbeck, 2019; Sawyer et al., 2013). In this context, determining the PFA application self-efficacy of nursing students who intervene in disaster situations is important for improving the quality of future interventions. However, to date, no study has investigated nursing students’ self-efficacy in applying PFA in disaster situations using a direct measurement tool.

According to previous studies, nursing students act as supportive structures for nurses, who constitute an important part of the healthcare team (Ranse et al., 2022; Shujuan et al., 2022). This indicates that nursing students play an active role in managing disaster situations (Kılıç and Şimşek, 2019). Globally, there is a consensus that the appli- cation of PFA in disaster situations should be the first-line approach (Sijbrandij et al., 2020). In this context, it is important to directly assess nursing students’ readiness to apply PFA and estimate the quality of the intervention. The present study aimed to determine the PFA application self-efficacy of senior (final year) nursing students who will shortly begin their professional lives and participate in every stage of disaster response.

2. Bacground

Disasters occur frequently and unpredictably and impact extensive areas. They are categorized into natural disasters, such as earthquakes, tsunamis, droughts, hurricanes, and epidemics, and human-induced disasters, including armed conflicts, famines, and chemical or radio- logical events. The sudden onset of these events, coupled with multiple losses, and their occurrence beyond human control across vast geographical regions, renders them highly impactful and destructive (Erdur Baker, 2014; Farokhzadian et al., 2024; Fletcher et al., 2022). Nurses play a critical role in addressing the individual and social effects of disasters (Farokhzadian et al., 2024; Fletcher et al., 2022). It has been noted that nursing students also engage in various roles in caring for individuals affected by disasters (Bülbül, 2021). Nursing students represent a potential workforce capable of enhancing the capacity of the health system and improving health outcomes during a crisis (Erkin et al., 2023). However, numerous studies have highlighted that nursing students’ education, preparedness, and awareness of their roles and skills in disaster scenarios are often inadequate (Bülbül, 2021; Abou Hashish and Banoona, 2023; Kaviani et al., 2022; Kim and Ahn, 2013; Mohamed et al., 2023). Schmidt et al. (2011) found that nursing stu- dents were not well-prepared to manage disasters. Kaviani et al. (2022) showed that nursing students’ competency in disaster situations was low, and emphasized the need for training to handle disasters. In a study by Hasan et al. (2022), nursing students demonstrated moderate levels

of disaster preparedness and response skills. In their study on nursing students in Turkey, Keskin and Alan (2023) reported a moderate level of self-efficacy in responding to disasters. Studies have found that while nursing students were willing to volunteer in disaster situations, they felt unprepared and possessed limited knowledge of their roles during such events (Kamanyire et al., 2021; Grimes et al., 2020). It is essential that nursing students receive comprehensive education to effectively fulfill their roles in disaster management (Keskin and Alan, 2023). The literature suggests that nursing students should receive psychological first aid training during undergraduate education to enhance their disaster management capabilities and improve response quality (Kılıç Bayageldi and Kaloğlu Binici, 2024; Kılıç and Şimşek, 2019). Although studies have indicated that PFA knowledge positively affects nursing students’ perception of disaster preparedness and intervention, comprehensive research remains limited (Kılıç and Şimşek, 2019; Zhang et al., 2022). Zhang et al. (2022) reported that PFA knowledge enhanced nursing students’ knowledge, competence, general self-efficacy, and resilience. Schafer et al. (2010) observed that PFA training increased students’ confidence in their ability to assist distressed individuals during disasters. Said et al. (2022) noted that PFA training enhanced nurses’ capacity to address psychological issues during and after emer- gencies and disasters. Thus, PFA training and practice is effective in preparing individuals for disaster response (Cho, 2015).

PFA knowledge is deemed essential not only for aiding the survivors but also for supporting aid workers, including nurses, in stressful envi- ronments (Kılıç and Şimşek, 2018; Said et al., 2022). Nursing students who directly participated in recent disaster events experienced signifi- cant stress, anxiety, and fear induced by traumatic experiences (Eweida et al., 2023). Possessing PFA knowledge can help reduce anxiety and stress levels, while enhancing resilience. Eweida et al. (2020) advocated the provision of psychological first aid interventions to vulnerable pre- licensure nursing students to mitigate the negative psychological impact of disasters. Such interventions are crucial during this vulnerable professional phase (Eweida et al., 2023). Recent studies have under- scored the need for robust support for nursing students in anticipation of future disasters, highlighting that PFA knowledge can improve their resilience (Carolan et al., 2020; Zhang et al., 2022). Resilience signifi- cantly influences nursing students’ psychological health and the quality of nursing care provided to patients (Eweida et al., 2023). Maintaining the mental health of nursing students is critical for preparing a new generation of competent nurses capable of advancing their profession (Carolan et al., 2020).

Both globally and in Turkey, PFA training for nursing students is notably scarce (Kılıç and Şimşek, 2019; Zhang et al., 2022). Currently, there is only one documented study on PFA training for nursing students in Turkey (Kılıç and Şimşek, 2019). Typically, undergraduate nursing programs in Turkey span four years; however, PFA training has not been fully incorporated into these programs’ curricula. Consequently, there is no standardized educational model for PFA training for nursing students in Turkey.

Nursing students serve as a reserve workforce for community mental health support (Zhang et al., 2022). To improve this support, it is essential to prepare nursing students to effectively manage disaster re- sponses (Chegini et al., 2022; Shujuan et al., 2022). Given the unpre- dictability of major disasters in terms of time and location, maintaining a constant state of readiness is crucial for rapid and effective response. Consequently, self-efficacy in PFA application is vital to ensure that nursing students possess the necessary knowledge and skills to handle disaster situations. Considering the future role of nursing students as service providers, accurately assessing their self-efficacy in applying PFA in disaster contexts is critical to the quality of the intervention. Although the literature comprises studies on emergencies and disasters, significant gaps exist regarding the PFA application competencies of nursing students. This study is the first to assess the PFA application self- efficacy of fourth-year nursing students who are nearing the commencement of their careers, using a direct measurement tool. The

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findings of this study are expected to contribute to the development of PFA training programs for nursing students and the enhancement of their PFA application skills.

3. Methods

3.1. Study design

This was a descriptive cross-section study that aimed to determine senior nursing students’ self-efficacy in psychological first aid applica- tion in disaster situations.

3.2. Setting and sample

This study was conducted between March and June 2022 in Turkey. The inclusion criteria were: senior undergraduate nursing students in Turkey who had Internet access, agreed to participate in the study by providing informed consent, used WhatsApp and social media applica- tions, and submitted fully completed questionnaires. As the study was conducted online, only students with Internet access participated. The exclusion criteria were: students (associate degree, bachelor’s degree, master’s degree, and doctoral degree) other than senior undergraduate nursing students in Turkey and individuals who returned incomplete questionnaires. Fifty-six individuals were excluded from the study because they were not senior nursing students or they returned incom- plete questionnaires. The sample size was calculated using G Power V. 3.1.9.6. A sample size universe was created using a known sample calculation formula. With an acceptable error of 5 % and confidence level of 95 % (t = 1.96), at least 225 participants were required. A total of 536 senior nursing students participated in the study.

3.3. Ethical approval

This study was approved by the Ethical Review Committee of a university in Turkey (Approval No 02.02.2022-38128). As participation was voluntary, online consent was obtained from all participants.

3.4. Pilot study

A pilot study was conducted with 40 senior nursing students who exhibited characteristics similar to those of the target population, to assess the reliability and validity of the scale. Following the pilot study, the scale’s Cronbach’s alpha was determined to be 0.956.

3.5. Data collection instruments

The “Personal Information Form” and “Psychological First Aid Application Self-Efficacy Scale” were used to collect data. The Personal Information Form included 8 items: age, gender, previous PFA training, institute where PFA training was obtained, previous PFA service status, nstitute where PFA service received, disaster response self-efficacy, and disaster preparedness self-efficacy (Kılıç and Şimşek, 2019).

The Psychological First Aid Application Self-Efficacy Scale was developed by Kılıç Bayageldi and Şimşek (2022) to effectively commu- nicate with individuals affected by traumatic events, provide appro- priate services to individuals with different needs, ensure the physical and emotional safety of individuals affected by trauma, identify urgent individual needs and problems, provide practical assistance tailored to individual needs and problems, approach people who have lost relatives without hurting them emotionally, reduce the stress of individuals who have lost the ability to manage their emotions, collect necessary infor- mation, and connect individuals with social support resources and collaborative services (aid services). The scale measures skills such as self-care maintenance. It consists of 35 items and a single subdimension. The items are arranged on a 5-point Likert scale (1 = not at all suitable, 2 = not suitable, 3 = moderately suitable, 4 = appropriate, and 5 =

completely appropriate). The score range of the scale items is from 1 to 5; the lowest total score is 35, and the highest is 175. The total score is obtained by summing the scores obtained from a single factor on the scale. A high score indicates high self-efficacy in applying PFA, whereas a low score indicates low self-efficacy. The Cronbach’s alpha internal consistency coefficient of the scale was 0.951, and the test-retest cor- relation coefficient was 0.932 (Kılıç Bayageldi and Şimşek, 2022).

3.6. Data collection

This study aimed to reach as many senior nursing students as possible, without sample selection. Social media platforms (WhatsApp, Facebook, and Instagram) and the snowball sampling technique were used to collect data, using Google Forms. The researchers received doctoral education from the nursing departments of different univer- sities and worked as academic staff in the nursing department of a university. Therefore, many universities have direct or indirect con- nections with their nursing departments. The researchers asked for support from the academic staff of the nursing department at the uni- versity to share the survey. A link was sent to the academic staff who agreed to share the survey. The link to the data collection form was sent to the students through e-mail and various social media platforms. The students were asked to distribute the data collection form to as many people as possible.

The study was disseminated through the researchers’ social media and various platforms and associations frequented by nursing students to broaden participant outreach. The research link was shared multiple times on these platforms to increase student participation. This study complied with the principles of the Declaration of Helsinki for Human Research. The participants were provided with a cover letter detailing the study, and it was clarified that withdrawal was possible at any time. Prior written informed consent was obtained, with students indicating consent by selecting “yes” or “no” before beginning the questionnaire. Those who selected “no” were redirected away from the questionnaire without further requirements. The study link guided the students directly to the study information and informed consent pages. After meeting the inclusion criteria and deciding to participate in the study, students were provided with a personal information form and the Psy- chological First Aid Application Self-Efficacy Scale. To prevent multiple submissions, the option allowing students to provide multiple answers in the Google Forms section was disabled, and the option allowing only one answer was enabled. This ensured data security by recording only one response from each student. The data collection link remained accessible throughout the study period.

3.7. Data analysis

The data were analyzed using IBM SPSS (Statistical Package for So- cial Sciences) Statistics for Windows, Version 23.0. software (IBM Corp., Armonk, NY, USA). Normal distribution compliance was assessed with skewness-kurtosis coefficients (±2). Descriptive statistics (number, percentage, mean, and standard deviation) were used for data analysis. The independent samples t-test was used for normally distributed scale scores between the two groups, while the Mann–Whitney U test was applied for scores that did not follow a normal distribution. One-way analysis of variance (ANOVA) was used to compare the scale scores among groups consisting of three or more, assuming a normal distri- bution. Subsequently, multiple comparisons were conducted using Duncan’s test. For scale scores not adhering to a normal distribution within groups of three or more, the Kruskal–Wallis test was used, fol- lowed by multiple comparisons with the Dunn test. Independent vari- ables influencing the Psychological First Aid Application Self-Efficacy Scale were assessed using linear regression analysis, employing the enter method to incorporate the independent variables into the model. Anal- ysis outcomes were presented as mean ± standard deviation and median (percentile 25–percentile 75). The level of significance was set at p <

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0.05. In the present study, the scale’s reliability was 0.965.

4. Results

Table 1 shows the demographic characteristics of the participating nursing students. The participants’ average age was 21.82 ± 2.23 years (minimum: 21; maximum: 34), and 66 % of them were women. Overall, 89.6 % of the students had not received PFA training from any institute. Of the 56 students who had received training, 51.8 % had received it from associations. Moreover, 91.4 % of the students had not undergone any PFA training; of the 46 students who received training, 54.3 % received it during their educational program. While 27.6 % of the stu- dents reported a medium level of self-efficacy in disaster preparedness, 25.9 % stated that they had a medium level of self-efficacy in disaster response.

Table 2. shows the average score of the nursing students on the PFA application self-efficacy scale. The total PFA Application Self-Efficacy Scale score was 123.37 ± 22.92 (min = 39–max = 175).

Table 3 presents a comparison of the self-efficacy scale scores of nursing students across various demographic variables. The PFA appli- cation self-efficacy scores differed according to PFA training status (p < 0.001). An independent samples t-test determined that the PFA appli- cation self-efficacy scores were significantly higher among nursing stu- dents who had previously received PFA training (132.84 ± 19.62) compared with those who had not received any training (122.55 ± 23.03). There was a notable difference in the PFA application self- efficacy scale scores based on disaster response self-efficacy level (p < 0.001). The results of the Kruskal–Wallis showed that individuals who rated their disaster response self-efficacy as completely adequate (126.79 ± 21.67), partially adequate (123.26 ± 17.35), and adequate (121.62 ± 22.76) had significantly higher mean PFA scale scores than those who rated their disaster response self-efficacy as completely inadequate (119.86 ± 23.59), partially inadequate (119.88 ± 23.40), and inadequate (119.54 ± 22.45). The PFA application self-efficacy scores varied significantly with disaster preparedness self-efficacy levels (p < 0.001). According to the results of the ANOVA, individuals who perceived their disaster preparedness self-efficacy as completely adequate (135.57 ± 22.19), partially adequate (127.7 ± 21.33), and adequate (127.54 ± 23.18) scored higher on average than those who considered their preparedness as completely inadequate (118.57 ± 18.63), partially inadequate (122.79 ± 23.01), and inadequate (122.83

± 22.17). Additionally, individuals who rated their disaster response self-efficacy as completely adequate (126.79 ± 21.67) had significantly higher PFA scale mean scores than those who rated their self-efficacy as partially adequate (123.26 ± 17.35) and adequate (121.62 ± 22.76). However, the PFA application self-efficacy scale mean scores did not differ according to gender (p = 0.347) and did not vary based on the location where PFA training was obtained (p = 0.292) or the reception of PFA service (p = 0.164). Similarly, the PFA application self-efficacy mean scores did not differ based on the place where PFA service was received (p = 0.719).

The linear regression model developed to evaluate the independent variables affecting the PFA score was statistically significant (F = 5.490; p < 0.001) (Table 4). The model explained 13.1 % of the variance in PFA scores. The PFA score of individuals who stated that their disaster response self-efficacy was completely adequate was 4.72 points higher than the score of individuals who stated that their self-efficacy was completely inadequate (p < 0.001). Similarly, the score of individuals with adequate disaster response self-efficacy wasre 4.12 points higher than those with completely inadequate self-efficacy (p < 0.001). Furthermore, individuals with partially adequate disaster response self- efficacy scored 3.50 points higher than those with completely inade- quate self-efficacy (p < 0.001). The PFA score of individuals with completely adequate disaster preparedness self-efficacy was 18.72 points higher than that of individuals with completely inadequate disaster preparedness self-efficacy (p < 0.001). Moreover, those who deemed their preparedness sufficient scored 27.08 points higher compared to individuals who deemed it completely inadequate (p < 0.001). Finally, the score was 20.02 points higher for those who considered their preparedness to be partially adequate than for those who viewed it as completely inadequate (p < 0.001). No significant effects of the other variables were observed (p > 0.050).

5. Discussion

PFA can alleviate psychological distress among individuals affected by disasters and enhance nurses’ preparedness to respond to psycho- logical issues during and after emergencies and disasters (Said et al., 2022; Shah et al., 2020). To mitigate the psychological impact of di- sasters, it is crucial for all relief effort participants to be proficient in PFA (Allen et al., 2010; Kılıç and Şimşek, 2019). This study is the first to employ a direct measurement method to assess self-efficacy in PFA ap- plications among senior nursing students poised to start their profes- sional careers and manage disaster situations.

In this study, nursing students who received PFA training exhibited significantly higher scores on the PFA application self-efficacy scale than those who did not. Similarly, Kılıç Bayageldi and Kaloğlu Binici (2024) reported that the mean scores on the PFA application self-efficacy scale were significantly higher among nurses who received PFA training than among those who did not receive such training. Additionally, Ediz and Yanık (2024) found a significant correlation between nursing students’ PFA self-efficacy and their participation in PFA training. Zhang et al. (2022) found a significant increase in the knowledge and proficiency scores of nursing students who received PFA training. Park and Choi (2020) reported that the participants’ PFA performance competencies improved after PFA training. Following the incorporation of PFA edu- cation into nursing courses, nurses were able to provide a better response to disaster preparedness in the future (Said and Chiang, 2020).

Table 1 Sociodemographic characteristics of the students.

Age (Mean ± SD) 21.82 ± 2.23 (Min- Max:21–34)

Number percentage (n) (%)

Gender Women 354 66.0 Men 182 34.0

Have you receive PFA service before? Yes 56 10.4 No 480 89.6

Institution that receives psychological first aid services

Hospital Associations

27 29

48.2 51.8

Have you receive PFA training before? Yes 46 8.6 No 490 91.4

Institution that receives psychological first aid training

During Education 25 54.3 Associations 21 45.7

How do you evaluate Disaster Preparedness self-efficacy?

I’m so inadequate I’m partially inadequate I’m ınadequate I’m enough I’m partially enough I’m so enough

31 90 96 148 100 71

5.8 16.8 18.0 27.6 18.6 13.2

How do you evaluate Disaster Response self-efficacy?

I’m so inadequate I’m partially inadequate I’m ınadequate I’m enough I’m partially enough I’m so enough

46 74 89 139 103 85

8.58 13.8 16.6 25.9 19.2 15.8

Table 2 Average score on the psychological first aid application self-efficacy scale.

n Min Max X SD

Psychological First Aid Application Self- Efficacy Scale

536 39 175 123.37 22.92

Min: Minimum, Max: Maximum, X: Mean, SD: Standard Deviation.

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Thus, the participants’ knowledge of the subject was found to improve their perception of PFA application self-efficacy.

The average PFA application self-efficacy scale score of the senior nursing students was 123.37 ± 22.92. Considering that the total score of the scale was 175, this finding implies an urgent need to develop PFA self-efficacy in senior nursing students. Similarly, Ediz and Yanık (2024) reported that senior nursing students (n = 57) scored 130.45 ± 20.27 on the scale. Kılıç Bayageldi and Kaloğlu Binici (2024) reported that nurses’ average score on the PFA application self-efficacy scale was 131.61 ± 19.41. Zhang et al. (2022) demonstrated that nursing students’ knowl- edge and competencies improved after PFA training. Kim and Choi (2022) found that PFA training improved nurses’ PFA performance competencies. Lee et al. (2017) reported that students who received PFA training showed significantly improved perceived competencies in PFA knowledge and skills. PFA training, varying from a few hours to several days, delivered by professionals from diverse backgrounds, can be adapted for the general public and students globally using simulation technology, case scenarios, videos, study notes, guides, lectures, and PFA models. Such training enhances students’ knowledge, skills, atti- tudes, and self-efficacy (Asaoka et al., 2021; Kim and Choi, 2022; Lee et al., 2017; Park and Choi, 2020; Said and Chiang, 2020; Zafar et al., 2021).

As it was found that very few nursing students received PFA training, it may be misleading to make generalizations about PFA application self- efficacy. The average scores of the nursing students in this study are noteworthy. In Turkey, direct PFA training has not yet been fully inte- grated into undergraduate nursing education. Undergraduate nursing students receive training in disaster nursing, intervention for individuals experiencing trauma, crisis intervention, approach to individuals in the loss and mourning processes, communication and intervention ap- proaches in special situations, communication skills, problem-solving, and coping with stress. It is assumed that the knowledge and skills they acquired as a result of this training positively affected their PFA application scale scores.

The average score on the PFA application self-efficacy scale of nursing students who described their disaster response self-efficacy as moderately adequate, sufficient, and completely sufficient was signifi- cantly higher than that of students who assessed their self-efficacy as inadequate, partially inadequate, and completely inadequate. Kılıç and Şimşek (2019) reported that PFA knowledge enhanced the disaster response competency of senior nursing students. Hambrick et al. (2014) highlighted that PFA practices equipped aid providers with skills to respond effectively and pragmatically to urgent psychological needs during disasters. In a study conducted in Japan, Semlitz et al. (2013) observed that PFA knowledge led to improvements in students’ abilities to provide appropriate interventions to individuals affected by disasters and other stressful events. Research indicates that PFA knowledge fa- cilitates proper intervention in disaster scenarios (Cheung, 2014; Chandra et al., 2014). PFA includes knowledge of psychological support, psychological stress, triage, emergency needs, social support, connec- tions with aid services, and coping strategies, representing a compre- hensive disaster response approach (Brymer et al., 2006; Cho, 2015; Hambrick et al., 2014). Thus, PFA knowledge positively influences disaster response competence.

The disaster preparedness self-efficacy levels of individuals who re- ported being moderately competent, adequate, and completely suffi- cient were significantly higher than those who considered themselves completely inadequate, partially inadequate, or inadequate. Kılıç and Şimşek (2019) found that PFA knowledge positively impacted nursing students’ perceptions of disaster preparedness. Similarly, Cheung (2014) noted that PFA knowledge, which includes basic interventions suitable for disaster scenarios, equipped aid workers with essential skills for disaster response.

Table 3 Comparison of nursing students’ psychological first aid application self-efficacy scale and sociodemographic variables (n = 536).

Sociodemographic variables

Psychological first aid application self-efficacy scale

Mean ± SD

Median (Q1- Q3)

Test statistics

p

Gender Women 124.04

± 23.18 125.5 (108–139)

t = 0.942 0.347

Men 122.07 ± 22.43

120.5 (109–136)

Institution that receives psychological first aid training During education 126.43

± 18.95 125 (113.5–139)

t = 1.751 0.292

Associations 125.71 ± 22.83

126 (109–138)

Have you receive PFA training before? Yes I did 132.84

± 19.62 134 (121–142) t = 2.841 0.002

No I did’nt 122.55 ± 23.03

123 (108–137)

Have you receive PFA service before? Yes I did 127.41

± 23.61 125.5 (113.5–141.5)

t = 1.394 0.164

No I did’nt 122.9 ± 22.82

123.5 (108–138)

Institution that receives psychological first aid services Hospital 127.81

± 19.04 125 (115–142) U = 427.5 0.719

Associations 129.47 ± 26.1

133 (111–141)

Did you take part in disasters? Yes 122.74

± 23.43 124 (109–138) t = − 0.550 0.583

No 123.84 ± 22.57

124 (108–139)

How do you evaluate disaster response self- efficacy? I’m so inadequate 119.86

± 23.59

119 (103–137.5)a

χ2=17.618 ab>a

0.003

I’m partially inadequate

119.88 ± 23.40

119 (105–136)a

I’m ınadequate 119.54 ± 22.45

119 (104-135a

I’m adequate 121.62 ± 22.76

125 (108–134)ab

I’m partially adequate 123.26 ± 17.35

125 (112–139)ab

I’m completely adequate

126.79 ± 21.67

126.5 (113.5–139)ab

How do you evaluate your disaster preparedness self- efficacy? I’m so inadequate 118.57

± 18.63a 117 (106–123) F = 9.027

c > a c > b b > a

<0.001

I’m partially inadequate

122.79 ± 23.01a

119.5 (109–136)

I’m ınadequate 122.83 ± 22.17a

124 (109–137)

I’m adequate 127.54 ± 23.18b

128 (111–141)

I’m partially adequate 127.7 ± 21.33b

138 (125–147)

I’m completely adequate

135.57 ± 22.19c

130 (115–140)

t: Independent Samples t-Test; U: Mann Whitney U Test; F: One-Way Analysis of Variance; χ^2: Kruskal Wallis Test; Q1: Percentile 25; Q3: Percentile 75; a-c: There

is no difference between groups with the same letter Note: Bold values indicates statistical significance.

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6. Limitations

This study had limitations in terms of online data collection and the fact that it comprised senior nursing students in Turkey. Subsequent studies should use larger sample sizes and include diverse regions to improve the reliability.

7. Conclusion

The present study concluded that nursing students’ self-efficacy in applying PFA in disaster situations should be improved. Nursing stu- dents are an important workforce that supports health services during and after disasters. Therefore, nursing students should be provided with sufficient knowledge and skills to deal with emergencies and disasters. It is important to develop training programs for PFA to comprehensively strengthen nursing students’ abilities to manage disasters effectively. Studies should be conducted to enhance the self-efficacy of nursing students in applying PFA during disasters. Furthermore, as suggested in previous studies, PFA training should be systematically implemented during the nursing education period. Considering that the current nursing students will be responsible for future healthcare service de- livery, it is important to determine and develop PFA self-efficacy.

Ethical approval statement

Ethical approval was obtained from the relevant Ethical Review Committee (Approval No: 02.02.2022-38128). Because participation was voluntary, online consent was obtained from all participants.

Financial support

None.

CRediT authorship contribution statement

Nurhayat Kılıç Bayageldi: Writing – review & editing, Writing – original draft, Visualization, Validation, Supervision, Software, Re- sources, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Data curation, Conceptualization. Dilek Kaloğlu Binici: Writing – review & editing, Supervision, Software,

Investigation, Data curation.

Declaration of competing interest

None.

Acknowledgement

Thank you to all participants who participated in the study.

References

Abolhadi, E., Divsalar, P., Mosleh-Shirazi, M.A., Dehesh, T., 2022. Latent classes of posttraumatic stress disorder among survivors of the bam earthquake after 17 years. BMC Psychiatry 22 (1), 1–10. https://doi.org/10.1186/s12888-022-04216-3.

Abou Hashish, E., Banoona, R., 2023. Disaster nursing and disaster preparedness: an investigation of nursing students’ knowledge, competence and attitudes. Nurs. Manage. 30 (1), 25–31. https://doi.org/10.7748/nm.2022.e2058.

Agyapong, B., Shalaby, R., Eboreime, E., Obuobi-Donkor, G., Owusu, E., Adu, M.K., Oluwasina, F., Agyapong, V.I., 2022. Cumulative trauma from multiple natural disasters increases mental health burden on residents of Fort McMurray. Eur. J. Psychotraumatol. 13 (1), 2059999 https://doi.org/10.1080/ 20008198.2022.2059999.

Allen, B., Brymer, M.J., Steinberg, A.M., Vernberg, E.M., Jacobs, A., Speier, A.H., Pynoos, R.S., 2010. Perceptions of psychological first aid among providers responding to hurricanes Gustav and Ike. J. Trauma. Stress 23 (4), 509–513. https:// doi.org/10.1002/jts.20539.

Asaoka, H., Koido, Y., Kawashima, Y., Ikeda, M., Miyamoto, Y., Nishi, D., 2021. Longitudinal change of psychological distress among healthcare professionals with and without psychological first aid training experience during the COVID-19 pandemic. Int. J. Environ. Res. Public Health 18 (23), 12474 (2-12). https://doi. org/10.3390/ijerph182312474.

Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, R., Steinberg, A., Vernberg, E., Watson, j hbbb c b P, 2006. Psychological First Aid: Field Operations Guide, 2nd ed. National Child Traumatic Stress Network and National Center for PTSD.

Bülbül, E., 2021. Assessment of nursıng students’ self-effıcıency ın dısaster response. Emergency Aid Disaster Sci. 1 (2), 45–49.

Carolan, C., Davies, C.L., Crookes, P., McGhee, S., Roxburgh, M., 2020. COVID 19: disruptive impacts and transformative opportunities in undergraduate nurse education. Nurse Educ. Pract. 46, 102807 https://doi.org/10.1016/j. nepr.2020.102807.

Chandra, A., Kim, J., Pieters, H.C., Tang, J., McCreary, M., Schreiber, M., Wells, K., 2014. Implementing psychological first-aid training for medical reserve corps volunteers. Disaster Med. Public Health Prep. 8 (1), 95–100. https://doi.org/10.1017/ dmp.2013.112.

Chegini, Z., Arab-Zozani, M., Kakemam, E., Lotfi, M., Nobakht, A., Aziz Karkan, H., 2022. Disaster preparedness and core competencies among emergency nurses: a cross- sectional study. Nurs. Open 9 (2), 1294–1302. https://doi.org/10.1002/nop2.1172 (Epub 2022).

Table 4 Analysis of the independent variables affecting the nursing students’ PFA application self-efficacy scale scores using linear regression analysis.

β0 (%95 CI) S. Hata β1 t p r1 r2 VIF

Constant 150.399 (126.677–174.121) 12.075 12.456 <0.001 Age − 2.029 (− 3.057 - -1.001) 0.523 − 0.197 − 3.879 0.891 − 0.175 − 0.168 1.592 Gender (Reference: Women)

Men − 2.85 (− 6.718–1.018) 1.969 − 0.059 − 1.447 0.148 − 0.043 − 0.064 1.022 Have you receive PFA training before? (Reference: No I dıd’not)

Yes I did 10.058 (3–17.117) 3.593 0.12 2.8 0.005 0.121 0.122 1.121 Have you receive PFA service before? (Reference: No I dıd’not)

Yes I did − 0.118 (− 6.52–6.284) 3.259 − 0.002 − 0.036 0.971 0.059 − 0.002 1.169 How do you evaluate disaster response self-efficacy?

(Reference:= I’m completely inadequate) Referans I’m partially inadequate − 2.84 (− 12.002–6.322) 4.664 − 0.042 0.609 0.302 − 0.031 − 0.027 2.941 I’m ınadequate 0.976 (− 8.415–10.366) 4.78 0.016 0.204 0.838 0.076 0.009 3.92 I’m adequate 3.606 (− 12.506–5.295) 4.531 0.061 0.796 <0.001 0.075 0.035 3.664 I’m partially adequate 4.122 (− 12.662–4.417) 4.347 0.081 0.948 <0.001 0.097 0.042 4.441 I’m completely adequate 4.729 (− 4.265–13.722) 4.578 0.077 1.033 <0.001 0.145 0.045 3.444

How do you evaluate your disaster preparedness self-efficacy? (Reference:= I’m completely inadequate) I’m partially inadequate 15.446 (8.556–22.336) 3.507 0.257 4.404 0.101 − 0.013 0.19 2.093 I’m ınadequate 15.326 (9.045–21.608) 3.197 0.316 4.793 0.213 − 0.019 0.206 2.674 I’m adequate 20.026 (13.194–26.858) 3.478 0.358 5.759 <0.001 0.093 0.246 2.382 I’m partially adequate 20.086 (18.002–36.17) 4.624 0.293 5.858 <0.001 0.14 0.25 1.536 I’m completely adequate 21.729 (10.662–26.797) 4.106 0.238 4.561 <0.001 0.06 0.197 1.678

F = 5.490. p < 0.001. R2 = %16.1. Adjusted R2 = %13.1. β0: Non-standardized beta coefficient. β1: Standardized beta coefficient. r1: Zero-order correlation coefficient. r2: Partial correlation coefficient.

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6

Cheung, Y.L., 2014. Psychological First Aid as a Public Health Disaster Response Preparedness Strategy for Responders in Critical ıncidents and Disasters, Doctor of Philosophy İn Public Health (PhD thesis). The Chinese University of Hong Kong, Hong Kong, p. 346.

Cho, J.H.Y., 2015. Disaster relief and psychological first aid (Electronic Theses & Dissertations). https://scholarsrepository.llu.edu/etd/189/.

Ediz, Ç., Yanık, D., 2024. Determination of nursing students’ psychological first aid practice self-efficacy level and mental WellBeing: a multicenter descriptive study. Gümüşhane Univ. J. Health Sci. 13 (1), 193–202.

Erdur Baker, Ö., 2014. Müdahalelere genel bakış. In: Afetler, Krizler, Travmalar ve Psikolojik Yardım, 2nd ed. Atalay Matbaacılık, Altındağ/Ankara, Türkiye.

Erkin, Ö., Konakçı, G., Arkan, G., 2023. The effect of disaster nursing course on nursing Students’ perceptions of disaster awareness, preparedness, response self-efficacy. J. Disaster Risk 6 (4), 1234–1246. https://doi.org/10.35341/afet.1240283.

Eweida, R.S., Rashwan, Z.I., Desoky, G.M., Khonji, L.M., 2020. Mental strain and changes in psychological health hub among intern-nursing students at pediatric and medical- surgical units amid ambience of COVID-19 pandemic: a comprehensive survey. Nurse Educ. Pract. 49, 102915 https://doi.org/10.1016/j.nepr.2020.102915.

Eweida, R.S., Rashwan, Z.I., Khonji, L.M., Shalhoub, A.A.B., Ibrahim, N., 2023. Psychological first aid intervention: rescue from psychological distress and improving the pre-licensure nursing students’ resilience amidst COVID-19 crisis and beyond. Sci. Afr. 19, e01472 https://doi.org/10.1016/j.sciaf.2022.e01472.

Farokhzadian, J., Mangolian Shahrbabaki, P., Farahmandnia, H., Taskiran Eskici, G., Soltani Goki, F., 2024. Nurses’ challenges for disaster response: a qualitative study. BMC Emerg. Med. 24 (1), 1–15. https://doi.org/10.1186/s12873-023-00921-8.

Fletcher, K.A., Reddin, K., Tait, D., 2022. The history of disaster nursing: from nightingale to nursing in the 21st century. J. Res. Nurs. 27 (3), 257–272. https://doi. org/10.1177/17449871211058854.

Grimes, A., Sparke, V., Rouen, C., West, C., 2020. Preparedness and resilience of student nurses in northern Queensland Australia for disasters. Int. J. Disaster Risk Reduct. 48, 101585 https://doi.org/10.1016/j.ijdrr.2020.101585.

Hambrick, E.P., Rubens, S.L., Vernberg, E.M., Jacobs, A.K., Kanine, R.M., 2014. Towards successful dissemination of psychological first aid: a study of provider training preferences. J. Behav. Health Serv. Res. 41 (2), 203–215. https://doi.org/10.1007/ s11414-013-9362-y.

Hasan, M.K., Uddin, H., Younos, T.B., 2022. Bangladeshi nursing students’ perceived preparedness and readiness for disaster management. Int. J. Disaster Risk Reduct. 81, 103303 https://doi.org/10.1016/j.ijdrr.2022.103303.

Iserson, K.V., 2020. Augmenting the disaster healthcare workforce. West. J. Emerg. Med. 21 (3), 490–496. https://doi.org/10.5811/westjem.2020.4.47553.

Jang, I., Kim, J.S., Lee, J., Seo, Y., 2021. Educational needs and disaster response readiness: a cross-sectional study of clinical nurses. J. Adv. Nurs. 77 (1), 189–197. https://doi.org/10.1111/jan.14570.

Kamanyire, J.K., Wesonga, R., Achora, S., Labrague, L.L., Malik, A., Alshaqsi, S., Alhabsi, J.A.S., 2021. Nursing Students’ Perceived Disaster Preparedness and Response: Pilot study in Oman. Sultan Qaboos Univ. Med. J. 21 (4), 621–625. https://doi.org/10.18295/squmj.5.2021.074.

Kar, N., Krishnaraaj, R., Rameshraj, K., 2014. Long-term mental health outcomes following the 2004 Asian tsunami disaster: a comparative study on direct and indirect exposure. Disaster Health 2 (1), 35–45. https://doi.org/10.4161/dh.24705.

Kaviani, F., Aliakbari, F., Sheikhbardsiri, H., Arbon, P., 2022. Nursing Students’ competency to attend disaster situations: a study in Western Iran. Disaster Med. Public Health Prep. 16 (5), 2044–2048. https://doi.org/10.1017/dmp.2021.263.

Keskin, A.Y., Alan, H., 2023. Assessment of undergraduate nursing students’ self- efficiency in disaster response. J. Nurs. Effect 16 (3), 329–339. https://doi.org/ 10.46483/jnef.1327474.

Kiliç Bayageldi, N., Kaloğlu Binici, D., 2024. Psychological first aid practice self-efficacy of nurses in disasters. Nurs. Health Sci. 26 (1), 1–10. https://doi.org/10.1111/ nhs.13093.

Kılıç Bayageldi, N., Şimşek, N., 2022. Development study of psychological first aid application self-efficacy scale. Perspect. Psychiatr. Care 58 (4), 1665–1679. https:// doi.org/10.1111/ppc.12975.

Kılıç, N., Şimşek, N., 2018. Psychological first aid and nursing. J. Psychiatr. Nurs. 9 (3), 212–218. https://doi.org/10.14744/phd.2017.76376.

Kılıç, N., Şimşek, N., 2019. The effects of psychological first aid training on disaster preparedness perception and self-efficacy. Nurse Educ. Today 83, 104203. https:// doi.org/10.1016/j.nedt.2019.104203.

Kim, S.K., Ahn, E.K., 2013. Disaster experience, perception and core competencies on disaster nursing of nursing students. J. Digit Converg. 11 (6), 257–267.

Kim, H.W., Choi, Y.J., 2022. A simulation-based nursing education of psychological first aid for adolescents exposed to hazardous chemical disasters. BMC Med. Educ. 22 (1), 93. https://doi.org/10.1186/s12909-022-03164-6.

Lee, J.S., You, S., Choi, Y.K., Youn, H.Y., Shin, H.S., 2017. A preliminary evaluation of the training effects of a didactic and simulation-based psychological first aid program in students and school counselors in South Korea. PloS One 12 (7), e0181271. https://doi.org/10.1371/journal.pone.0181271.

Leppold, C., Gibbs, L., Block, K., Reifels, L., Quinn, P., 2022. Public health implications of multiple disaster exposures. Lancet Public Health 7, 274–286. https://doi.org/ 10.1016/S2468-2667(21)00255-3.

Marceron, J.E., Rohrbeck, C.A., 2019. Disability and disasters: the role of self-efficacy in emergency preparedness. Psychol. Health Med. 24 (1), 83–93. https://doi.org/ 10.1080/13548506.2018.1492730.

Mensi, M.M., Iacopelli, M., Orlandi, M., Capone, L., Rogantini, C., Vecchio, A., Casini, E., Borgatti, R., 2022. Psychiatric symptoms and emotional impact of the COVID-19 pandemic on Italian adolescents during the third lockdown: a cross-sectional cohort study. Sci. Rep. 12 (1), 20901 https://doi.org/10.1038/s41598-022-25358-0.

Mohamed, N.A., Abdel-Aziz, H.R., Elsehrawy, M.G., 2023. Nursing students’ knowledge, attitude, and practice regarding disaster preparedness: a cross-sectional study. Risk Manag. Healthc. Policy 2427–2437.

Park, J.S., Choi, Y.J., 2020. The effect of a simulated fire disaster psychological first aid training program on the self-efficacy, competence, and knowl-edge of mental health practitioners. Disaster Med. Public Health Prep. 14, 1–7. https://doi.org/10.1017/ dmp.2020.184.

Ranse, J., Ituma, O.W., Bail, K., Hutton, A., 2022. Disaster education in undergraduate nursing curriculum: a Delphi study to prioritise content for nursing students. Collegian 29 (5), 590–597. https://doi.org/10.1016/j.colegn.2022.02.001.

Said, N.B., Chiang, V.C., 2020. The knowledge, skill competencies, and psychological preparedness of nurses for disasters: a systematic review. Int. Emerg. Nurs. 48, 100806 https://doi.org/10.1016/j.ienj.2019.100806.

Said, N.B., Molassiotis, A., Chiang, V.C., 2022. Psychological first aid training in disaster preparedness for nurses working with emergencies and traumas. Int. Nurs. Rev. 69 (4), 548–558. https://doi.org/10.1111/inr.12749.

Satoh, M., Iwamitsu, H., Yamada, E., Kuribayashi, Y., Yamagami-Matsuyama, T., Yamada, Y., 2018. Disaster nursing knowledge and competencies among nursing university students participated in relief activities following the 2016 Kumamoto earthquakes. SAGE Open Nurs. 4, 1–9. https://doi.org/10.1177/ 2377960818804918.

Sawyer, C., Peters, M.L., Willis, J., 2013. Self-efficacy of beginning counselors to counsel clients in crisis. J. Counselor Preparation Super. 5 (2), 30–42.

Schafer, A., Snider, L., Ommeren, M.V., 2010. Psychological first aid pilot: Haiti emergency response. Intervention 8 (3), 245–254.

Schmidt, C.K., Davis, J.M., Sanders, J.L., Chapman, L.A., Cisco, M.C., Hady, A.R., 2011. Exploring nursing students’ level of preparedness for disaster response. Nurs. Educ. Perspect. 32 (6), 380–383. https://doi.org/10.5480/1536-5026-32.6.380.

Semlitz, L., Ogiwara, K., Weissbecker, I., Gilbert, E., Sato, M., Taniguchi, M., Ishii, C., Sawa, C., 2013. Psychological first aid training after Japan’s triple disaster: changes in perceived self competency. Int. J. Emerg. Ment. Health 15 (3), 181–196.

Sever, M.S., Vanholder, R., Lameire, N., 2020. Acute kidney injury in active wars and other man-made disasters. Semin. Nephrol. 40 (4), 341–353. https://doi.org/ 10.1016/j.semnephrol.2020.06.001.

Shah, K., Bedi, S., Onyeaka, H., Singh, R., Chaudhari, G., 2020. The role of psychological first aid to support public mental health in the COVID-19 pandemic. Cureus 12 (6). https://doi.org/10.7759/cureus.8821.

Shujuan, L., Mawpin, T., Meichan, C., Weijun, X., Jing, W., Biru, L., 2022. The use of virtual reality to improve disaster preparedness among nursing students: a randomized study. J. Nurs. Educ. 61 (2), 93–96. https://doi.org/10.3928/ 01484834-20211213-05.

Sijbrandij, M., Horn, R., Esliker, R., O’may, F., Reiffers, R., Ruttenberg, L., Stam, K., de Jong, J., Ager, A., 2020. The effect of psychological first aid training on knowledge and understanding about psychosocial support principles: a cluster-randomized controlled trial. Int. J. Environ. Res. Public Health 17 (2), 484. https://doi.org/ 10.3390/ijerph17020484.

Zafar, N., Naeem, M., Zehra, A., Ashiq, U., Zohaib, N., Moaz, M., Imran, M., 2021. Efficacy of psychological first aid training on the perceived competence of frontline workers during COVID-19 pandemic. Asia Pac J. Paediatr. Child Health 4, 27–32.

Zhang, J., Cao, M., Ma, D., Zhang, G., Shi, Y., Chen, B., 2022. Exploring effect of psychological first aid education on vocational nursing students: a quasi- experimental study. Nurse Educ. Today 119 (105576), 548–558. https://doi.org/ 10.1016/j.nedt.2022.105576 (Epub 2022).

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