Disaster preparedness knowledge and experiences among nurses during a competitive tabletop exercise program

Disasters are increasing globally, necessitating enhanced disaster response competencies among frontline nurses. Tabletop exercise (TTX), as a low-resource, immersive scenario-based training tool, offers significant potential for improving nurses' disaster preparedness. However, systematic evaluations of nurse-centered TTX programs remain scarce in China. This study aimed to comprehensively evaluate the effectiveness of a nurse-tailored competitive TTX program using the Kirkpatrick model.

A sequential explanatory mixed-methods design was adopted. A 270-min TTX competition program covering three disaster themes was implemented for 90 nurses from 30 healthcare institutions in Anhui Province. In accordance with the Kirkpatrick model, quantitative data from 85 participants were collected using the Student Satisfaction and Self-Confidence in Learning Scale (SCLS), Simulation Design Scale (SDS), Nursing Disaster Emergency Knowledge Scale (NDEKS), and Educational Practices Questionnaire (EPQ). Additionally, a survey on disaster-related activities in participants' institutions in 2025 was conducted. For the qualitative phase, maximum variation sampling was employed to purposely select 10 nurses for semi-structured interviews, and the qualitative data were analyzed using Colaizzi's methodological framework.

The TTX program achieved positive outcomes across all four Kirkpatrick levels. At the Reaction Level, SCLS scores (4.42 ± 0.54) and SDS scores (4.38 ± 0.52) reflected nurses' high satisfaction and recognition of program design. At the Learning Level, all six core domain scores of the NDEKS improved significantly post-TTX (all p < 0.001). At the Behavior Level, the EPQ total score reached 4.40 ± 0.55, indicating effective cultivation of positive behavioral tendencies. At the Results Level, the program drove remarkable regional disaster nursing development in Anhui Province in 2025, evidenced by over 220 science popularization activities, the establishment of new municipal committees, and diversified continuing education programs. Qualitative analysis identified four key themes, further supplementing and validating the quantitative findings of the TTX program's multi-dimensional effectiveness.

The nurse-tailored competitive TTX program, evaluated through the Kirkpatrick model, effectively enhances disaster knowledge, core competencies, and interdisciplinary collaboration while demonstrating tangible regional impact. This integrated evaluation framework provides robust evidence for optimizing disaster nursing training and strengthening healthcare system resilience.