Disasters significantly impair a community’s ability to function and exceed its capacity for self-management. Disasters can arise from natural, artificial, and technical risks and might be influenced by various factors affecting the community.Reference Srinate 1 Hazardous occurrences have resulted in numerous fatalities, illnesses, disabilities, disruption of services, property destruction, and a negative impact on the economies of the communities and nations.Reference Mavrouli, Mavroulis and Lekkas 2
According to the World Health Organization (WHO), about 2.6 billion individuals have been impacted by disasters in the past 10 years. Mass casualties from disasters strained local medical services and prevented them from providing thorough and conclusive medical care.Reference Piltch-Loeb, Sahr and Nelson 3 Disasters can have a considerable negative impact on a community’s physical, emotional, and psychological well-being, as well as its social life.Reference Alfuqaha, Alosta and Khalifeh 4
Another example of a disaster that was related directly to the health sector is Corona the Disease-19 (COVID-19) pandemic were about 204.7 million cases diagnosed with COVID-19, and 3.5 million deaths were reported due to the COVID-19 pandemic in 2021; the number of affected people from other disasters was 121.3 million in 2021, while 14 577 deaths were reported.Reference Piltch-Loeb, Sahr and Nelson 3 The COVID-19 pandemic has jeopardized population health, economics, freedom, privacy, and quality of care while witnessing gaps in communication, leadership, preparedness, speed of research, and flexibility. It also provided health care organizations, managers, and researchers with an opportunity to learn from this experience.Reference Fahrudin, Hutahaean and Yusuf 5
Most nurses and midwives lack the necessary training for effective emergency and disaster response, particularly during mass casualty events.Reference Mavrouli, Mavroulis and Lekkas 2 A study from Jodan found that 65% of nurses rated their disaster preparedness as low or unsatisfactory.Reference Al Khalaileh, Bond and Alasad 6 Jordan faces numerous risks, especially those related to climate change, such as droughts, landslides, and flash floods, which are becoming more frequent and causing millions in economic losses, as well as loss of lives and properties.
On the other hand, skills for nurse managers in disaster situations and preparedness are poorly described in the literature, and little has been said about disaster response and recovery.Reference Veenema, Deruggiero and Losinski 7 The ability of management and personnel to protect patient safety is threatened if a hospital is not prepared for internal crises and disasters.Reference Barten, Klokman and Cleef 8 Failures to adequately respond to disasters can make people more vulnerable and harm property.Reference Al-Dahash, Kulatunga and Thayaparan 9 Nurse leaders’ levels of confidence, depending on their positions, level of expertise, and prior training in crisis management, play a crucial role in disaster management.Reference Reedy, Zedreck and Ren 10
Disaster preparedness consists of a set of measures undertaken in advance by governments, organizations, communities, or individuals to respond better and cope with the immediate aftermath of a disaster, whether it is human-induced or caused by natural hazards. The objective of this preparation is to reduce the loss of life and livelihoods.
Nurse managers should have access to a wide range of information, with an evidence-based approach, and resources to plan for, respond to, mitigate, and recover from such disasters because nurses are at the forefront of service for disaster situations.Reference Veenema, Deruggiero and Losinski 7 Nursing and hospital management at the service and unit level are ultimately responsible for implementing the emergency operations plan and incident command system protocols. These service/unit-based management decisions could potentially have a direct impact on patient outcomes, staff, and patients’ safety and care quality.Reference Veenema, Deruggiero and Losinski 7 The purpose of this study is to assess the level of disaster preparedness among first-line nurse managers in Jordan.
Theoretical Framework
The study incorporated Bandura’s Social-Cognitive Theory of Self-Efficacy, which posits that individuals’ beliefs in their capabilities and ability to manage challenges influence their performance. The theory defines perceived self-efficacy as an individual’s judgment of their ability to execute and organize actions necessary for achieving designated performance results. Self-efficacy mediates performance and knowledge.Reference Lauder, Holland and Roxburgh 11 On the other hand, skills and information are required for effective performance.Reference Bandura 12 Applying this framework, this study assumes that real-world disaster experiences and education in disaster preparedness enhance nurse managers’ capabilities to improve the quality of care they provide and their performance.
Research Question
What is the level of disaster preparedness among first-line nurse managers in Jordan, and how do factors such as education, training, leadership role, and hospital type influence their preparedness?
Methods
Research Design
The current study uses a descriptive cross-sectional survey design, which is well-suited for evaluating the level of disaster preparedness among first-line nurse managers at a specific point in time. This design allows for the determination of associations between disaster preparedness and key influencing factors, such as education, training, leadership roles, and hospital type.
However, a key limitation of cross-sectional studies is their inability to establish causality. While the study can identify relationships between variables, it does not determine whether specific factors directly cause variations in disaster preparedness. Additionally, because data were collected at a single time point, findings may be influenced by external factors present at the time of data collection, limiting generalizability. Future longitudinal studies are recommended to examine causal relationships and track changes in disaster.Reference Polit and Beck 13
Study setting and sampling method
The study was conducted in 3 different types of hospitals in Jordan: university-affiliated hospitals, private hospitals, and public hospitals. The rationale for choosing these hospitals was to ensure the inclusion of nurse managers working in different administrative and organizational structures, which may influence their level of disaster preparedness.
The target population included first-line nurse managers working in inpatient units and emergency departments, as they are more directly involved in disaster response and management. A non-probability convenience sampling method was used to recruit participants, ensuring accessibility to those available during the data collection period.
Eligibility criteria. For first-line nurse managers to be selected, they must meet the following criteria:
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1. Work as a first-line nurse manager in the in-patient units and emergency units at the targeted hospitals.
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2. Have at least 2 years of experience working as a nurse manager in in-patient and emergency units to demonstrate that they are familiar with and endorse the in-patient unit’s rules and protocols.
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3. Proficiency in English was required for participation, as the survey was administered in English (The English language serves as the foundation for nursing education and curriculum in Jordan).
Sample size calculation. The sample size was estimated using G power, using a medium to small effect size of 0.25, a power of 0.80 at 0.05, and a tailed significant using a t test. A total sample from 3 hospitals was 128 participants. A total of 106 participants responded and returned the survey, with a response rate of 75% among 141 participants who were invited to participate.
Data Collection
Data were collected through a self-administered questionnaire based on the International Council of Nurses (ICN) Disaster Preparedness Framework, a validated and reliable tool for assessing disaster preparedness among nurses. However, to ensure its cultural relevance to Jordan, the questionnaire was reviewed by a panel of nursing and disaster management experts. Minor modifications were made to ensure clarity and applicability to the local health care context. Despite this, no formal pilot testing was conducted, which may limit the instrument’s complete adaptation to the Jordanian setting. The data collection procedure followed these steps:
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1. Survey Distribution: The researcher coordinated with hospital administrators to distribute the questionnaires to eligible first-line nurse managers across selected hospitals.
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2. Participant Instructions: Each participant received a questionnaire along with detailed instructions on how to complete it. They were informed about the study’s objectives, the voluntary nature of participation, and confidentiality measures.
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3. Survey Completion: Participants were given sufficient time to complete the questionnaire during their shifts.
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4. Collection Process: Completed surveys were placed in sealed envelopes and submitted to a designated collection box at each hospital’s chief nursing office.
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5. Data Retrieval: The principal researcher made periodic visits to the hospitals to collect the completed questionnaires.
Ethical Considerations
Prior to data collection, this study received ethical approval from the Institutional Review Board (IRB) at Hospital (A) (IRB-JUH10/2023/5855) and from Hospitals (B+C) (MBA/Ethics/4027) to ensure the well-being and rights of participating nurse managers. All participants’ inquiries were addressed, and a research/equivalent coordinator at the target institution acted as a liaison to the study. Additionally, those participants who expressed interest in participating in the study were approached, the purpose of the study and its significance were explained, and the participants were informed that their participation was voluntary. They could withdraw from the study without any consequences or penalties. There was no personal identifier information to protect anonymity and confidentiality. Permission to use the ICN Framework’ Core Competencies in Disaster Nursing (tool) was obtained a prior. All documents related to the survey were saved and coded to ensure confidentiality, and no one other than the researchers had accessed or viewed the data.
Measurements
The data were collected using a self-reporting questionnaire. The tool used was developed based on the International Council of Nurses (ICN) Framework’ Core Competencies in Disaster Nursing: competencies for nurses involved in emergency medical teams (level III)’ to assess nurse manager preparation for disaster.Reference Dos Santos, Rabiais and Frade 14 The questionnaire included the 8 reliable and valid dimensions including: (1) preparation and planning, (2) communication, (3) incident management, (4) safety and security, (5) assessment, (6) intervention, (7) recovery, and (8) law and ethics. The questionnaire used a 5-point Likert scale: (1, not confident), (2, somewhat confident), (3, moderately confident), (4, very confident), and (5, expert).Reference Dos Santos, Rabiais and Frade 14
To explain and interpret the level of disaster preparedness based on the means of the estimates of the study, sample participants’ responses on each domain of the disaster preparedness questionnaire, as well as on the total of disaster preparedness, the tripartite statistical criterion was used: (From 1.00 to less than 2.34, low), (From 2.34 to less than 3.68, moderate), and (From 3.68 to 5.00, high). The overall reliability of the scale is adequate, with a Cronbach’s alpha of 0.974 for 8 subscales. This indicates that the scale is highly reliable and has excellent internal consistency. The value of α is considered excellent.Reference Mallery and George 15 A panel of experts assessed the tool’s validity and guaranteed its applicability, relevance, sufficiency, and clarity for the study.
Statistical Analysis
The Statistical Package for Social Science (SPSS version 25) was used for analysis. The significance level was set at 0.05; before examining the frequency distributions and descriptive statistics for each research variable, the data were cleaned and checked for outliers and missing data. The socio-demographic characteristics of the participants were defined, and the means, standard deviations, percentages, and frequencies of the variables that made up the study variables were computed. Descriptive statistics were also used to construct summaries. Finally, inferential statistics of independent t tests and analyses of variance (ANOVA) were used to compare results between groups and among various groups.
Missing values were checked and found on a random basis with no identified systematic patterns. Pairwise deletion was adopted during the statistical analysis of data. Missing scores on the continuous and ordinal variables were ignored, as they were inconsistent, had no identified patterns, and were less than 1%. The extreme outliers were managed initially by the initial verification of possible data entry errors, and then individualized management of outliers was done by excluding them from the analysis. The statistical test assumptions were verified and checked before running the statistical tests.
Results
A total of 141 questionnaires were distributed to the eligible participants. Among these, a total of 112 questionnaires were returned. Six questionnaires were incomplete, had missing data, and were not included in the process of data analysis. The final number of the completed questionnaires was 106, with a response rate of 75%. The participants in the current study were conveniently recruited from different settings.
Sample Characteristics
More than half of the study participants were female, with a percentage of 67.9% (n = 72), and most participants were young, with a mean age of (M = 37.1, SD = 6.9) years ranging from 26-59 years old. For the role in nursing, about 12.3% (n = 13) were managers, 24.5% (n = 26) were supervisors and head nurses, and 63.2% (n = 67) were in-charge nurses; regarding educational level variable, about 78.3% (n = 83) of the participants had their bachelor’s degrees in nursing and 17.9% (n = 19) of the participants had master’s degree (Table 1).
Descriptive statistics of the demographic characteristics of study participants (N = 106)
M: mean, SD: standard deviation
Regarding the experience of the participants in the nursing field, the mean was about 14.9, SD = 7.16 years, ranging from 2-38 years, while the experience in the current position was (M = 6.4, SD = 3.46), ranging from 2-16 years. The participants worked at different hospitals: public hospitals 41.5% (n = 44), university-affiliated hospitals 46.2%, (n = 49), and private hospitals 12.3% (n = 13). The participants worked at different units and departments, such as medical-surgical wards (31.1%) (n = 33), critical care units and cardiac care units (26.4%) (n = 28), pediatrics and gynecology units (19.8%) (n = 21), emergency departments (12.3%) (n = 13), and other departments (10. 4%) (n = 11). Around 66% (n = 70) of participants received disaster training during their job, and (49.1%) (n = 52) of participants received the type of disaster drill about internal disasters in hospitals. More than half of the participants in this study worked on A-shift, 51.9% (n = 55).
Levels of Disaster Preparedness
The current study showed a moderate level of disaster preparedness for first-line nurse managers in Jordan. The overall scale of confidence was recorded as (M = 3.52, SD = 0.84). The highest total score of domains was for domain 5 (assessment) (M = 3.65, SD = 0.92), domain 6 (intervention) (M = 3.58, SD = 0.98), domain 2 (communication) (M = 3.57, SD = 0.87), domain 4 (safety and security) (M = 3.55, SD = 0.91), domain 8 (law and ethics) (M = 3.54, SD = 1), domain 1 (preparation and planning) (M = 3.50, SD = 0.84), (incident management) (M = 3.44, SD = 0.98), and, finally, domain 7 (recovery) (M = 3.43, SD = 1).
Variations in First-Line Nurse Manager’s Response Based on Demographic Data
The t test analysis showed that the significance for education (P = 0.027) was higher than other degrees in bachelor’s degrees (M = 3.43, SD = 0.88). Type 2 disaster drills (pandemic disaster) and Type 6 disaster drills (supply chain interruption) scored significant results regarding the total score of disaster preparedness (P = 0.022 and P = 0.003, respectively). The independent sample t test showed that there is only 1 type of disaster training program that is statistically significant, which is training (during your job) (t = 3.553, P = 0.001) (Table 2).
Variation among first-line nurse managers based on demographic data (gender, training, type of disaster, shift) with the total score (N = 106) (independent sample t test)
M: mean, SD: standard deviation, *P < 0.05.
The ANOVA analysis showed a significant result for leadership roles (P = 0.009). The mean total score for the leadership role “Supervisor/head nurse” was higher than for other roles (M = 3.79, SD = 0.81), while the leadership role “nursing manager” scored the lowest mean (M = 2.92, SD = 1.10). Post hoc with Scheffe’s test revealed that nursing managers exhibited significantly lower mean scores compared to both supervisor/head nurses and in-charge nurses. This result means that the supervisor/head nurses and in-charge nurses are more prepared for disasters than managers.
The mean total score for the type of hospital for first-line managers, category “private hospital” (M = 4.09, SD = 0.22) scored higher than other hospitals, while working in a “university-affiliated hospital” had the lowest mean total score of (M = 3.40, SD = 0.87). One-way ANOVA test showed that there are statistically significant differences among first-line nurse managers based on the type of hospital in relation to the level of disaster preparedness (F = 3.721, P = 0.028) (Table 3).
Variation among first-line nurse managers depends on demographic data (N = 106) (one-way ANOVA test)
M: mean, SD: standard deviation, *P < 0.05.
Discussion
This study is the first to use this tool in a Jordanian health care setting and involves Jordanian first-line nurse managers. Other studies performed in Jordan examined the level of disaster preparedness among staff nurses only and not among first-line nurse managers. The mean age of participants was 37.1 years, with most between 35 and 45 years old. Over half were female, and most had 5-10 years in their current roles, with a total of 10-20 years in nursing. Notably, 87.3% held bachelor’s degrees, aligning with national trends. In contrast, a small proportion of first-line nurse managers held master’s or doctoral degrees. This finding is consistent with national data, indicating that most registered nurses, including nurse managers, hold baccalaureate degrees,Reference Suleiman, Hijazi and Al Kalaldeh 16 which may help explain the educational background of the participants.
Most first-line nurse managers in this study primarily worked in medical/surgical wards and ICUs, as these departments constitute the most significant areas in hospitals. Each ward is typically divided into sections, such as men’s and women’s surgery, where first-line nurse managers oversee operations, including head nurses and in-charge nurses across shifts. Most participants held leadership roles as “in-charge” nurses (67%), as each department typically includes 1 head nurse and 1 manager, along with several rotating “in-charge” nurses for all shifts. Most participants worked fixed day shifts (61%), as head nurses and senior “in-charge” nurses in the selected hospitals primarily operated on these shifts. Furthermore, a significant number of participants received disaster training during their employment (70%), with 52% participating in internal disaster drills and 47% in pandemic disaster drills.
The current study reported the highest scores for the assessment domain, which is in line with the findings. Another study noted a higher level of skills assessment and intervention among first-line nurse managers,Reference ahmed, sleem and El-Sayed 17 and there was indifference in another study.Reference Taskiran and Baykal 18 This discrepancy may be related to limited training courses offered by hospitals and educational institutions in disaster response, particularly in assessment and preparation. Moreover, there is a lack of correlation between disaster management education techniques and actual crisis scenarios.Reference Martono, Satino and Nursalam 19 In the recovery domain, the current study reported higher scores than those who focused on identifying and reporting events to health departments.Reference Reedy, Zedreck and Ren 10 Notably, no previous studies have specifically examined recovery competency for first-line nurse managers in disaster scenarios.
Several sociodemographic characteristics were found to be associated with first-line nurse managers’ preparedness for disaster. In the current study, educational preparation level is significantly related to disaster preparedness as measured by the overall score. Similar findings from Turkey reported a statistically significant increase in competency among those with postgraduate degrees compared to those with high school diplomas.Reference Taskiran and Baykal 18 In contrast, another study found no significant relationship between educational level and nurse leaders’ disaster preparedness.Reference Reedy, Zedreck and Ren 10 Nurses with advanced training, particularly at the doctoral level, perceived themselves as more prepared for disasters, reflecting a statistically significant difference in their disaster preparation stages. Postgraduate nurses also performed better on competency examinations, likely due to enhanced critical thinking skills gained during their graduate studies.
The current study revealed a significant difference between 2 types of disaster drills: pandemic disaster and supply chain management. This difference may stem from data collection occurring post-COVID-19 pandemic, when hospitals underwent both pandemic and supply chain disaster drills, particularly for nurses and nurse managers. Although no prior studies have addressed the impacts of these 2 types of disaster preparedness among first-line nurse managers, disaster training might have significant improvements in confidence regarding disaster preparedness.Reference Reedy, Zedreck and Ren 10
Results indicated that this type of training significantly improved preparedness, particularly for on-the-job training, with 70 participants reporting this type of training. Notably, 82% of participants in a study from the US reported similar results, which may reflect hospitals’ heightened focus on disaster preparedness post-COVID-19.Reference Reedy, Zedreck and Ren 10 However, few studies have discussed the relationship between on-the-job training and disaster preparedness, and eventually, implementation of disaster preparedness training programs significantly increased nurses’ knowledge and attitudes.Reference Mirzaei, Eftekhari and Sadeghian 20 , Reference Mohammadi, Sheikhasadi and Mahani 21 Positive correlations were noted between disaster preparedness and training.Reference Rizqillah and Suna 22
The current study found a significant relationship between leadership roles and disaster preparedness among first-line nurse managers. Similar results were reported in another study where a significant correlation was observed between overall confidence in disaster preparedness and nursing leadership roles.Reference Reedy, Zedreck and Ren 10 Nurse managers reported feeling more competent and prepared compared to other nurses, and this is likely due to their seniority and experience.Reference Yamashita and Kudo 23 In times of disaster, nurse managers are expected to take the lead, ensuring their staff attend to victims effectively, which likely enhances their sense of preparedness.Reference Yamashita and Kudo 23 , Reference Farokhzadian and Mangolian Shahrbabaki 24
The study reported significant findings regarding the type of hospital and disaster preparedness. Although no prior studies focused on variations based on hospital type and disaster preparedness among first-line nurse managers, a study in Jordan examined nurse competency during COVID-19 and found a significant positive correlation between reported competence and working area.Reference Alhamory, Khalaf and Alshraideh 25 To date, no studies have specifically addressed nurse managers’ competencies. One study examined registered nurses and their preparedness according to hospital type, indicating that those in government hospitals felt less equipped for crisis management compared to those in university-associated hospitals.Reference Al Khalaileh, Bond and Alasad 6 , Reference Farokhzadian and Mangolian Shahrbabaki 24 Differences in disaster preparedness may stem from variations in financial resources for staff training and disaster planning, as well as differing management styles across hospitals. No statistically significant relationships were found in the current study concerning gender, age, years of nursing experience, current position, working area, or shift type.
While this study’s findings align with prior research highlighting the impact of education, training, and leadership roles on disaster preparedness, some notable discrepancies emerged. Unlike previous studies that reported no significant differences in preparedness across hospital types, this study found that private hospital nurse managers exhibited higher preparedness levels compared to their counterparts in university-affiliated hospitals. This discrepancy may be attributed to differences in funding, institutional disaster planning, and frequency of training programs in private versus public settings.
Additionally, this study found lower preparedness scores in recovery and incident management compared to other domains, whereas some prior studies reported relatively balanced preparedness across domains. This suggests that Jordanian hospitals may have a stronger focus on immediate disaster response rather than long-term recovery planning. The lack of structured post-disaster training programs could be a contributing factor, highlighting the need for integrated recovery preparedness initiatives in nursing education and professional development.
The application of Bandura’s Social-Cognitive Theory also provides a nuanced interpretation of these discrepancies. Previous research has not extensively examined the role of self-efficacy in disaster preparedness. Yet, this study found that nurse managers with more training and education reported greater confidence and competence in disaster response. This supports Bandura’s assertion that higher self-efficacy leads to improved performance, suggesting that targeted training programs should not only impart technical skills but also enhance nurse managers’ confidence in executing disaster-related tasks.
Study Limitations
One significant limitation of this study is the exclusion of non-English-speaking participants. This choice may have introduced selection bias and limited the generalizability of the findings, as it potentially excluded a significant portion of the nursing workforce in Jordan. Future studies should consider offering the questionnaire in both Arabic and English to ensure broader representation and inclusivity.
Conclusion
No one can evade disaster, including first-line nurse managers; no one can stop disasters from happening. Learning from what happened during the COVID-19 pandemic is a basis. Adequate preparation around the world for any disasters may contribute to lessening their effects. Nursing management should focus on improving the level of disaster preparedness so that nurse managers can take the necessary steps to ensure well-preparedness through continuous training in disaster preparedness. First-line nurse managers must have the proper education and ongoing training in patient care, personal safety, and organizational response to deliver safe, high-quality care to patients and smoothly flow in these most urgent and challenging situations. Policies should be updated and modified (i.e., integrating disaster preparedness into bachelor’s degree programs for nursing students) to promote disaster preparedness and establish strong disaster plans, lowering the likelihood of fatalities and injuries in all kinds of future disasters.
Future Research Recommendations
To improve disaster preparedness, nurse managers should receive structured education that includes simulation-based training, case studies, and field exercises to enhance confidence and competency. Nursing curricula should integrate disaster preparedness modules with pre- and post-training evaluations to measure effectiveness. Standardized national training programs could be developed in collaboration with health care institutions, ensuring alignment with international best practices and regular updates. Certification programs should assess competency levels and reinforce preparedness. Hospitals should revise disaster policies, aligning them with WHO and ICN guidelines, mandating regular disaster drills, emergency resource allocation, and interprofessional collaboration. Leadership training in crisis management, decision-making, and communication is a priority.
Data availability statement
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
Acknowledgments
The authors wish to thank all first-line nurse managers who participated in this study.
Author contribution
Conceptualization: HSO, WMD. Methodology: HSO, WMD, MGD. Formal analysis: HSO, WMD. Data curation: HSO, MGD. Visualization: all authors. Project administration: HSO, WMD. Writing–original draft: all authors. Writing–review & editing: all authors.
Funding statement
The authors received no financial support for the research, authorship, and/or publication of this article.
Competing interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical standard
The Institutional Review Board (IRB) authorizations were obtained from participating organizations, and all participants have consented.
Open access
