Tabletop Simulation Boosts Disaster Nursing Skills in Undergraduates, Study Finds

When disasters strike, nurses are often the first and most sustained line of medical defense, working in chaotic environments where triage decisions, resource allocation, and patient transport logistics can mean the difference between life and death. Yet nursing educators worldwide have long struggled with a persistent problem: how to prepare students for the realities of disaster response without access to expensive, high-fidelity simulation centers. A new quasi-experimental study from South Korea offers a compelling answer in the form of an unexpectedly simple tool—the humble tabletop exercise.

Researchers Myongsun Cho of Kangwon National University, Miyoung Kwon of Kangwon National University, and Hyosung Cha of Eulji University developed and tested a community-based tabletop simulation program designed to strengthen four critical dimensions of disaster readiness among undergraduate nursing students: disaster nursing competency, disaster preparedness, transfer motivation, and learning self-efficacy. Their findings, published in BMC Nursing, show that the low-cost intervention produced significant and sustained improvements across all four outcomes, suggesting that scalable educational strategies could play a meaningful role in building a disaster-ready nursing workforce.

The study employed a non-equivalent control group design involving 93 undergraduate nursing students, with 43 assigned to an experimental group and 50 to a control group. While both groups received standard disaster nursing instruction, only the experimental group participated in the structured tabletop simulation program. The researchers deliberately anchored the simulation in community-based scenarios, requiring students to make patient transport decisions based on realistic assessments of hospital capacity and available resources—an element often missing from classroom-based disaster education.

At the heart of the program was what the researchers call the 3T disaster response process: triage, treatment, and transport. Students worked through the START protocol, or Simple Triage and Rapid Treatment, a widely used field triage system that categorizes casualties by the severity of their condition. The tabletop format allowed participants to visualize disaster scenes on a map or table surface, move patient tokens through the response chain, and confront the logistical bottlenecks that emerge when the number of casualties exceeds local medical capacity. By embedding the exercise in community contexts, the simulation pushed students beyond individual clinical skills toward systems-level thinking about how hospitals, emergency services, and public health infrastructure interact during a crisis.

The program itself was built using the ADDIE framework—Analysis, Design, Development, Implementation, and Evaluation—a systematic instructional design model that ensured the simulation content was validated before delivery. The researchers assessed content validity using item-level and scale-level content validity indices, involving expert review to confirm that the scenarios reflected realistic disaster conditions and appropriate nursing responses. This methodological rigor matters because simulation-based education has often been criticized for variable quality, and the study’s structured approach offers a replicable template for other institutions.

Outcome measures were collected at three time points: baseline, immediately after the intervention, and at follow-up. Using repeated measures analysis of variance, the researchers examined group-by-time interaction effects to determine whether the two groups diverged over the course of the study. The results were striking. The experimental group showed significantly greater improvements than the control group in disaster nursing competency, with a test statistic of F = 23.13 and p < .001. Disaster preparedness followed a similar pattern, with F = 24.53 and p < .001. Transfer motivation—the students’ willingness and intention to apply what they learned in future practice—also improved significantly, with F = 4.83 and p = .011, as did learning self-efficacy, with F = 5.14 and p = .009.

What makes these findings particularly noteworthy is their durability. The improvements in the experimental group were sustained across all three measurement points, while changes in the control group remained modest. Educational interventions often produce short-lived gains that fade within weeks, so the persistence of the tabletop simulation’s effects at follow-up suggests that the experiential, decision-driven nature of the exercise helped consolidate learning in a way that lectures alone cannot. The findings also speak to the psychological dimension of disaster readiness: by walking students through high-pressure scenarios in a safe environment, the program appears to have strengthened both their confidence and their motivation to carry these skills into real clinical settings.

The study was approved by the Institutional Review Board of Eulji University (IRB No. EU25-017), and all participants provided written informed consent in accordance with the Declaration of Helsinki. The research was supported by Eulji University in 2025 under grant EJRG-25-06, with the funder playing no role in the conceptualization, design, data collection, analysis, or publication decisions. All three authors contributed equally to the work, and the researchers declared no competing interests.

The broader implications extend well beyond a single nursing school in South Korea. As climate change intensifies the frequency and severity of earthquakes, floods, wildfires, and pandemics, health systems in disaster-prone regions face mounting pressure to prepare frontline workers. High-fidelity simulation labs and full-scale disaster drills remain gold standards, but their cost and logistical demands put them out of reach for many institutions, particularly in low-resource settings. Tabletop simulation, by contrast, requires little more than trained facilitators, scenario materials, and classroom space, making it an attractive and scalable option for integrating disaster education into standard nursing curricula.

The authors caution that further multicenter studies with long-term follow-up are needed to confirm their findings and to test whether the gains translate into actual performance during real disaster responses. Still, the study adds to a growing body of evidence that experiential, community-grounded education can close the persistent gap between what nursing students learn about disasters and what they feel ready to do when one occurs. If the results hold across larger and more diverse populations, tabletop simulation could become a cornerstone of disaster preparedness training—proof that in the race to ready the next generation of nurses, sometimes the simplest tools are the most powerful.

Subject of Research: The effect of community-based tabletop simulation on disaster nursing competency, preparedness, transfer motivation, and self-efficacy in undergraduate nursing students.

Article Title: Effect of community-based tabletop simulation on disaster nursing competency, preparedness, transfer motivation, and self-efficacy: a quasi-experimental study

Article References: Effect of community-based tabletop simulation on disaster nursing competency, preparedness, transfer motivation, and self-efficacy: a quasi-experimental study. (n.d.). https://doi.org/10.1186/s12912-026-05386-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05386-1

Keywords: disaster nursing, tabletop simulation, nursing education, disaster preparedness, nursing competency, transfer motivation, self-efficacy, quasi-experimental study, triage, simulation-based education, nursing students, community health