Nurses' bioterrorism preparedness: an evolutionary concept analysis

Bioterrorism, involving the deliberate use or release of microorganisms or biologically derived toxins to cause illness or death, poses a distinct threat to public health and healthcare systems. Its intentional nature distinguishes it from naturally occurring infectious disease outbreaks and accidental biological releases. Nurses are essential frontline responders to bioterrorism, yet nurses' bioterrorism preparedness remains inconsistently defined, limiting the development of targeted education, competency assessment, and response planning. This study aimed to clarify nurses' bioterrorism preparedness using Rodgers' evolutionary concept analysis.

A systematic search of PubMed, Web of Science, CINAHL, MEDLINE, Embase, and ProQuest was conducted from database inception to 8 November 2025. The search identified 537 records, of which 35 sources were included in the concept analysis.

Matrix and thematic analyses identified six defining attributes: knowledge, practical skills, response intention and decision-making, interdepartmental collaboration, operational coordination of equipment and supplies, and continuous learning and iteration. Five antecedent domains were identified: education and training, organisational systems and policies, resource support, prior emergency experience and lessons learned, and threat perception and professional responsibility. The reviewed literature associated preparedness with timely recognition and reporting, protective practices, and coordinated response; descriptions of inadequate preparedness included delays, exposure risks, communication difficulties, and service strain. These associations do not establish causal effects.

Nurses' bioterrorism preparedness is therefore conceptualised as a dynamic, context-sensitive, multidimensional professional competency linking individual capabilities with coordinated organisational response. This conceptualisation may inform subsequent education, assessment, and preparedness research in the context of deliberate biological threats.