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

Critical reflection is more than casual thinking about a difficult shift. Researchers define it as a structured, analytical learning process in which nurses systematically analyse clinical experiences, evaluate evidence-based practices, reconsider weaknesses in their own performance, and weigh ethical dimensions of care in complex situations. In the delirium context, this competency takes on particular urgency. Delirium is dynamic, unpredictable, and often distressing, requiring nurses to interpret biological, psychological, social, and ethical dimensions simultaneously while preserving patient dignity, minimising restrictive interventions, and staying within the bounds of clinical safety. Existing tools, such as the Critical Reflection Competency Scale developed by Shin and colleagues, the California Critical Thinking Disposition Inventory, and the Delirium Care Critical-Thinking Scale developed by Chang and colleagues in 2024, capture related but distinct constructs. None was designed to assess delirium-specific critical reflection, leaving a genuine measurement gap.

The research team, led by Fahimeh Magsoodi and Fatemeh Ghaffari of Babol University of Medical Sciences, conducted an exploratory mixed-methods study between June 2025 and March 2026, following the eight-step scale development framework of DeVellis and Thorpe. The construct was operationally defined as the ICU nurse’s ability to integrate scientific evidence, professional experience, ethical values, and theoretical knowledge through reflection-on-action and reflection-in-action, with the aim of sharpening clinical decision-making, improving care quality, and safeguarding the safety and dignity of patients with delirium. This definition deliberately spans cognitive, ethical, and anticipatory dimensions of practice rather than reducing reflection to a purely intellectual exercise.

Item generation combined deductive and inductive strategies. A systematic search of PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Google Scholar identified 130 records, of which 21 studies ultimately met inclusion criteria and yielded 10 preliminary items through content analysis. To ground the instrument in real clinical behaviour, the team also conducted semi-structured interviews with 15 ICU nurses, each with at least a year of intensive care experience and direct care of at least five delirious patients in the preceding six months. Interviews lasting roughly 35 to 40 minutes explored how nurses reassessed clinical decisions, recognised gaps between evidence and practice, evaluated patient dignity and privacy, communicated with families, and interpreted early warning signs. Conventional content analysis of the transcripts produced 20 items organised into seven subcategories and three principal categories: Analytical-Evaluative Clinical Reflection, Person-Centered Ethical Reflection, and Risk-Oriented Preventive Reflection.

The qualitative work was conducted with careful attention to trustworthiness, following the criteria of Guba and Lincoln. Credibility was supported by purposive sampling with maximum variation, member checking with eight participants, and independent review of portions of the coding process. Transferability, dependability, confirmability, and authenticity were each addressed through detailed documentation, transparent tracing of items back to raw data, and secure archiving of research files. One illustrative example shows how a participant’s description of covering a patient’s body during procedures, limiting unnecessary visitors, and documenting lapses in dignity was distilled into a final item asking nurses to evaluate the extent to which respect, privacy, and physical comfort of delirious patients were maintained.

Expert review then tightened the instrument. A panel of 10 nursing faculty members with critical care and instrument-development experience evaluated 30 initial items for relevance, clarity, and linguistic transparency. Content validity ratios ranged from 0.40 to 1.00, and nine items falling below the Lawshe threshold of 0.62 were removed. Item-level content validity indices for retained items ranged from 0.80 to 1.00, with scale-level averages of 0.93 and 0.86 by the averaging and universal-agreement methods respectively. Face validity testing with 10 ICU nurses using the impact score formula eliminated two further items whose abstract concepts invited inconsistent interpretations, leaving a preliminary version that was then administered to 700 ICU nurses employed at hospitals affiliated with Babol and Mazandaran Universities of Medical Sciences. Following the Nunnally and Bernstein rule of at least 10 participants per item, the sample was randomly split into equal halves of 350 for exploratory and confirmatory factor analysis.

The statistical results were striking. Sampling adequacy was excellent, with a Kaiser-Meyer-Olkin value of 0.912 and a highly significant Bartlett’s test. Exploratory factor analysis using principal axis factoring with Promax rotation confirmed a clean three-factor structure matching the qualitative categories, with all 19 items loading between 0.633 and 0.853 and no substantial cross-loadings. The three factors explained 20.38, 19.37, and 17.59 percent of variance respectively, for a cumulative 57.34 percent. Parallel analysis supported the three-factor solution. Confirmatory factor analysis on the independent subsample, using the WLSMV estimator appropriate for ordinal data, produced excellent fit: a chi-square to degrees-of-freedom ratio of 1.14, RMSEA of 0.029, CFI of 0.986, TLI of 0.984, and SRMR of 0.041. A second-order model loading the three dimensions onto a single overarching competency yielded identical fit indices, a mathematical necessity when exactly three first-order factors are specified, so the authors caution that this equivalence confirms correlated dimensions rather than proving a hierarchical structure.

Reliability and validity evidence was equally robust. Cronbach’s alpha for the total scale was 0.876 and McDonald’s omega 0.861, with dimension-level coefficients ranging from 0.845 to 0.878. Test-retest reliability over a two-week interval with 30 participants produced an intraclass correlation coefficient of 0.85 for the total score. Average variance extracted exceeded 0.50 for all three factors and composite reliability exceeded 0.70, while the Fornell-Larcker criterion confirmed that each dimension was empirically distinct, with square roots of AVE between 0.732 and 0.746 exceeding inter-factor correlations of 0.350 to 0.420. Standard errors of measurement were low, between 0.42 and 0.51, indicating precise scores. In a methodological departure from conventional validation studies, the team also applied exploratory graph analysis, whose network estimation with the graphical LASSO algorithm and Walktrap clustering reproduced exactly the three theoretical communities, and random forest regression, which identified analytical-evaluative reflection as the strongest contributor to the internal score structure, followed by person-centered ethical and risk-oriented preventive reflection.

The authors are careful about what these findings do and do not establish. Because predictors and outcome in the random forest analysis came from the same item set, the results describe internal score structure rather than external predictive validity, and the convergent validity evidence is model-based rather than criterion-related, since no external instrument was administered alongside the CRCDCS. Limitations include the cross-sectional design, a sample drawn exclusively from teaching hospitals of two Iranian universities, reliance on self-report vulnerable to social desirability bias, and the absence of measurement invariance testing across subgroups. The three-level score interpretation bands, spanning low, moderate, and high competency across the possible 19 to 95 range, are conventional equal-range divisions rather than clinically validated cut-offs.

Even with those caveats, the study represents a significant advance for critical care nursing. The CRCDCS is the first instrument designed specifically to measure, in a multidimensional way, how intensively care nurses reflect critically on delirium care, and its development blended theory, qualitative clinical experience, classical psychometrics, network science, and machine learning in a single coherent pipeline. Pending further validation against external criteria and longitudinal outcomes, the 19-item scale offers hospital managers, educators, and policymakers a practical tool for identifying performance gaps, benchmarking professional preparedness, and evaluating training programmes aimed at strengthening reflective thinking in delirium care. Given that delirium affects a large share of ICU patients and that early recognition depends heavily on nursing vigilance, a reliable measure of the reflective competency behind that recognition could ultimately translate into better outcomes for some of the most vulnerable patients in medicine.

Subject of Research: Development and psychometric validation of a scale assessing ICU nurses' critical reflection competency in delirium care

Article Title: Development and Psychometric Evaluation of the Critical Reflection Competency in Delirium Care Scale (CRCDCS) Among Iranian ICU Nurses

Article References: Magsoodi, F., & Ghaffari, F. (2026). Development and Psychometric Evaluation of the Critical Reflection Competency in Delirium Care Scale (CRCDCS) Among Iranian ICU Nurses. Nursing Open, 13(9), Article e70818. https://doi.org/10.1002/nop2.70818

Image Credits: AI Generated

DOI: 10.1002/nop2.70818

Keywords: delirium, ICU nursing, critical reflection, scale development, psychometric validation, factor analysis, nursing competency, patient safety, reflective practice, network analysis, Iran, critical care