Effectiveness of disaster-chain scenario simulation in disaster nursing education: A three-arm randomized controlled...

Disaster nursing education requires strategies that integrate theory and practice and foster systems thinking, yet single-scenario simulations seldom reflect the cascading nature of real disasters.

To compare disaster-chain scenario simulation, single-scenario simulation and traditional lectures on nursing students' disaster competency.

Three-arm randomized controlled trial complemented by thematic analysis of students' post-intervention reflective journals. A total of 136 s-year nursing students were randomized to disaster-chain (n = 45), single-scenario (n = 46), or lecture groups (n = 45) in a 16-week disaster nursing course (2 h/week). All groups received identical lectures in weeks 1-8, followed by group-specific practical in weeks 9-16. The disaster-chain group completed two multi-stage scenarios ("Typhoon→Flood→Epidemic"; "Earthquake→Building collapse→Fire") using task-driven team planning, drills, and debriefing; the single-scenario group simulated the response process for a single type of disaster; and the lecture group received traditional lectures with case-based discussion. Outcomes include disaster-response self-efficacy (Disaster Response Self-Efficacy Scale; total and subscale scores) and a theoretical test score, measured at baseline and post-intervention. Generalized estimating equations and Kruskal-Wallis tests examined group, time, and group×time interaction effects and to calculate T1/T0 and ΔΔ ratios. Reflective journals underwent thematic analysis.

The disaster-chain group showed greater improvements in DRSES total, on-site rescue, role adaptation and theoretical test scores compared with the other groups (T1/T0 = 1.24-1.33 vs 1.01-1.07; ΔΔ = 1.19-1.26; all p < 0.001), with no between-group difference in psychological nursing competency (p > 0.05). Codes related to immersive learning, systems thinking and critical reflection were most frequent in the disaster-chain group (281 vs 163 and 52 in the single-scenario and lecture groups), indicating greater engagement and disaster-response reflection.

Disaster-chain simulation more effectively integrates theory and practice and improves core disaster-response competencies compared with single-scenario simulation or lectures, supporting its incorporation into disaster nursing curricula. However, the single-center design and short follow-up limit generalizability; Longer-term multicenter studies including psychosocial outcomes are needed.