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Common domains of nurses’ competencies in public health emergencies: a scoping review



A public health emergency can cause large numbers of deaths in a short period, with devastating social, economic and health consequences. Nurses are the main healthcare providers during such emergencies, and their competencies affect the control and outcomes of the situation. Studies on nurses’ competencies in public health emergencies vary between countries and healthcare systems. Therefore, we conducted a scoping review to identify the common domains of nurses’ competencies in public health emergencies worldwide.


We searched the PubMed, CINHAL, Scopus, Web of Science, Science Direct, Embase, Cochrane Library, WanFang and ECRI databases from their inception to 2023. All published articles on nurses’ competencies in public health emergencies that were published in English and Chinese were included. We mainly analyzed and synthesized nurses’ competencies, assessment instruments and the training described in the included studies.


A total of 27 competency domains were identified following an analysis and summary. The most frequently cited domains were communication skills, self-protection skills, basic knowledge of a public health emergency, laws and ethics and the capacity for organizational collaboration. The Disaster Preparedness Evaluation Tool and the Emergency Preparedness Information Questionnaire were the most commonly used tools for assessing competencies. Most training was conducted online and the content that was covered varied by country.


Given the significant roles and responsibilities of nurses in public health emergencies, knowing the domains of their competencies is essential to evaluating, developing, and conducting clinical training.

Peer Review reports


A public health emergency is defined as the occurrence or imminent threat of a disease or health condition (e.g., an infectious disease or bioterrorist attack) that poses a significant risk of death, injury or long-term or permanent disability in a large number of people [1]. A public health emergency has the potential to cause large numbers of deaths in a short period of time, with devastating social, economic and health consequences [2]. It challenges the preparedness and capacity for responses by governments, hospitals, clinics, public health institutions and academic researchers [3]. How to respond to a public health emergency has become a vital issue for governments and international organizations worldwide [4].

Once a public health emergency occurs, the health department must initiate a medical rescue quickly and efficiently to minimize casualties and health hazards. Nurses have multiple roles and responsibilities in public health emergencies; they work with limited resources in fast-paced environments and perform critical tasks, such as triage and first aid [5, 6]. It is challenging for inexperienced nurses to be involved in rescues without training.

Competency is defined as a combination of the knowledge, skills and abilities required to perform a specific task [7]. Determining nurses’ competencies would be helpful for making preparations to provide training and to conduct research [8]. Several countries have formulated competency sets in accordance with the characteristics of their healthcare system and the types of public health emergencies or disasters. In the United States (US), hurricanes, terrorist attacks and bioterrorism have increased attention to disasters; hence, studies have focused on the competencies associated with disasters. In China, most studies have focused on infectious diseases because of the outbreak of major infectious diseases.

Two reviews have outlined nurses’ competencies in disasters [9, 10], but both of them only described the competencies of each of the included studies, and did not group. These competency domains might not have been sufficient or specific to encounters with infectious disease outbreaks. The outbreak of COVID-19 highlighted the importance of enhancing nurses’ competencies [11,12,13], many studies have been conducted to identify competencies that should be required [14,15,16]. Thus, it was vital to conduct a scoping review to analyze and synthesize the existing research to identify the most common domains of nurses’ competencies during public health emergencies with the intent of improving formal education and training programs for nurses.



A scoping review method was used, incorporating explanations, interpretations, and summaries of quantitative and qualitative literature to address research questions. This approach allows for review to extract different data and develop them in a meaningful, transparent, and systematic way [17]. The iceberg model was used as a theoretical basis, guiding the competency domain identification process [18]. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) checklist was used to guide the writing of this review [19].

Search method

We searched the PubMed, CINHAL, Scopus, Web of Science, Science Direct, Embase, Cochrane Library, WanFang and ECRI databases. The search for grey literature included the BASE and Opengrey dababases. The search terms and Boolean strings used in PubMed are presented in Table 1.

Table 1 The search terms and Boolean strings used in the PubMed database

Articles that met the criteria for inclusion in the scoping review: (1) were published from the inception of the database to 2023, (2) were written in English or Chinese, (3) consisted of qualitative and quantitative studies, policy documents and grey literature and (4) focused on nurses’ competencies that were developed or described in response to public health emergencies. Articles with the following characteristics were excluded from the scoping review: (1) the full text was unavailable, (2) the study did not focus on nurses (i.e., doctors, laboratory engineers, pharmacist) or (3) the study did not address competencies.

Search outcomes

Figure 1 depicts the process of selecting the articles for this scoping review. A total of 3153 titles were identified through a database search and other sources. After we screened the titles and abstracts, 84 studies were retained for a full-text review, of which 30 were included in the scoping review. All of the studies were read and screened independently by two of the study’s authors, in accordance with the inclusion and exclusion criteria, and disagreements were resolved by consensus or by a third author.

Fig. 1
figure 1

PRISMA flow chart of the selection of articles

Quality appraisal

The Joanna Briggs Institute Critical Appraisal Checklist for text and opinions [15], reporting prevalence data [20], quasi-experimental studies [21], cohort studies [22] and qualitative research [23] were used to conduct a quality assessment of the scoping review. Two reviewers independently assessed each included study, and any discrepancies in scores were resolved by a third reviewer. All of the articles were included in the scoping review after a quality appraisal was conducted. The results are presented in Additional file 1: Appendix I Table A I-V.

Data extraction

The extracted data consisted of information about the studies, including the country where the research was conducted, competencies, models and methods of competencies, instruments and training, etc. Data were analyzed using Microsoft Excel and we used the following procedure to identify competency domains. First, we developed an initial set of competency domains. All of the reviewers listed competency domains independently after reading all of the included studies. We retained the identical domains, discussed different domains and eventually developed an initial set of competency domains. Second, two of the reviewers independently listed all of the competencies mentioned in all of the included studies; any disagreement was resolved through consensus or by a third reviewer. Third, two reviewers coded studies and competencies to identify them. We encoded the selected studies using the letter "S" followed by three numbers, with "S001" as the code to identify the first study. We encoded the agreed upon competencies as the letter “C” followed by three numbers, with “C001” as the code to identify the first competency (e.g., "C123 S010" could be identified as competency 123 belonging to study 10). After a group discussion, we assigned all competencies to the specific domain with which they most closely aligned and considered whether we needed to make changes to the initial set of competency domains. The frequency of each competency domain was counted to identify the domain with the most competencies.


The 30 papers that were examined in this scoping review were conducted in 12 countries: China, the US, India, Korea, Syria, South Africa, England, Turkey, Kenya, Canada, Slovenia and Israel. The characteristics of the included studies are presented in Tables 2, 3 and 4

Table 2 Summary of the identified competencies in the included studies
Table 3 Summary of the included studies on training
Table 4 Summary of the cross-sectional included studies

Identified competencies

We identified 590 competency indicators by analyzing and summarizing the competencies mentioned in the included studies, and we sorted them into 27 competency domains. Based on the iceberg model, the competency domains were divided into three major dimensions: knowledge, skills, and personal characteristics (Table 5).

Table 5 Competency domains

After counting the frequency of the competency domains mentioned in the studies, the five most-cited competency domains were found to be communication skills, self-protection skills, basic knowledge of public health emergencies, laws and ethics and capacity for organizational collaboration. Self-protection skills mainly included the proper use of personal protective equipment (PPE), hand hygiene, infection control principles and medical waste disposal skills. Effective communication with physicians, patients and their families were expected of nurses, in addition to a basic knowledge of public health emergencies, mainly including definitions, categories, etiology, epidemiology, prevention and control. Issues related to laws and ethics were attended to within the legal and ethical framework of public health emergencies. The capacity for organizational collaboration included coordination, teamwork, collaboration and organization.

Literature reviews, in-depth interviews, key informant interviews, questionnaire surveys and the Delphi approach were used to identify competencies, of which the Delphi technique was used most often. Related theories included the iceberg theory, the onion theory, the Miller hierarchy, the Prevention, Preparedness, Response and Recovery Model (PPRR Model), the Three-phase Emergency Response Theory and the World Health Organization framework for taking action on infectious disease outbreaks. The PPRR Model was used most often.

Assessment instruments

The instruments used to assess nurses’ competencies during public health emergencies were as follows:

  1. (1)

    the Nurses’ Perceptions of Disaster Core Competencies Scale (NPDCC);

  2. (2)

    the Korean version of the Nurse Disaster Preparedness Evaluation Tool (DPET-K), which was adapted from the DPET [51, 52];

  3. (3)

    the Disaster Nursing Preparedness-Response Competency (DNPRC) score, which was based on the International Council of Nurses’ Core Competencies in Disaster Nursing, version 1.0 (ICN CCDN V1.0) [53];.

  4. (4)

    the Slovenian version of the Disaster Nursing Core Competencies Scale (SL-DNCC-Scale). The original DNCC was designed by Abdulellah Al Thobaity [54, 55];

  5. (5)

    the Core Emergency Response Competency Questionnaire developed by Kan Ting [32]; and.

  6. (6)

    the EPIQ, which was designed by the Wisconsin Nurses’ Association [56].

The DPET and EPIQ were the most commonly used assessment tools; they were widely used in different countries. The NPDCC was used in Turkey, Iran and China and the DNPRC was used in Korea though less often. The DNCC was used in the Kingdom of Saudi Arabia and Slovenia, and the Core Emergency rResponse Competency Questionnaire was widely used in China.


Training can prepare nurses for future public health emergencies by helping them improve their competencies and acquire new ones. The focus of training is different in each country due to differences in their healthcare systems and cultures. The basic training curricula for public health emergencies in the US focused on emergency preparedness for public health nurses and was introduced in 2002. However, training in China mostly began during the COVID-19 outbreak and focused on nurses' professional and technical skills, especially critical care skills and knowledge of PPE. Most of the training, which was conducted online used relevant training methods, including virtual reality simulation and mobile-video online learning. Just-in-time education was also a common training strategy. It is an educational method based on work, in which a person is trained at a time that is close to the actual clinical event [57]. Rapid cycle deliberate practice includes immediate directional feedback, which allows brief corrective instructions to be given to the learner and is followed by a repeated attempt of the learner to master the learning task [58].


Until now, no unified standards have been formulated for nursing competencies in public health emergencies. However, this scoping review focused on identifying nurses’ competencies regarding public health emergencies and summarizing relevant evaluation instruments and training practices to improve formal education and training programs for nurses.

Identification of common domains of competencies

The most-cited competency domains in this scoping review were communication skills, self-protection skills, basic knowledge of public health emergencies, laws and ethics, and the capacity for organizational collaboration. Hospitals often exhibit poor communication as well as a lack of planning, empowerment, motivation, a common language, and emergency-trained nurses [59]. Effective communication is crucial for supporting nurses through extended periods of crisis, and relevant communication strategies should be developed [60,61,62]. To prevent the spread of infectious diseases in pandemics, it is vital for nurses to implement protective measures in order to reduce infection risk [63]. During SARS-Cov-2, training and demonstrations for donning and doffing PPE safely was the best way for nurses to prevent infection [64]. Therefore, there is a need to strengthen the training of healthcare workers to prepare them for the next outbreak. The basic knowledge of public health emergencies mainly include disease-related epidemiology: etiology of disease, origin, incubation period and transmission; quarantine, contacts and contact tracing principles; related diagnostic tests; signs and symptoms of disease; infection control and prevention strategies; and evidence-based drug use. Nurses are required to know and abide by the laws regarding professional responsibility, licensure, and volunteering for public health emergencies. Ethics and value as a concept was the core element in the resilience framework for public health emergency preparedness [65]. It was essential for a country to respond effectively to public health emergency [66,67,68]. According to the American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements, nurses are expected to practice with compassion and respect for patients and to commit to them [69]. A public health emergency rescue usually relies on an interdisciplinary team and multisectoral collaboration, with the capacity for good organizational collaboration that can improve rescue efficiency [70, 71].

Researchers often use methods and theoretical frameworks to develop a competency set. The Delphi method, which has been widely used in nursing practice, was a useful tool for identifying competencies because it promotes ownership and increasing acceptance of the consensus generated by the process [72,73,74]. The Delphi method, which was used in many of the included studies established a panel of experts, and conducted anonymous surveys on specific topics using structured questionnaires in successive rounds. And researchers analyzed and amended the content based on expert recommendations until consensus was reached [75]. A comprehensive approach to the identification of competencies was often used, based on the previous literature, which combined Delphi methods with interviews to ensure the integrity and scientific accuracy of the information. The research areas of experts should include public health, infectious diseases, critical care, medicine, emergency nursing and nursing management. The experts who participated in public health emergencies are preferred. Interviews may involve specialists, nurses or patients. The steps for identifying competencies in China were to: choose a theoretical framework, analyze and summarize the literature and qualitative interviews; refine the entries and formulate the initial competency set; make revisions using Delphi expert consultation and reach a consensus to finalize the competency set. The process in the US involved using the Delphi method to identify competencies, and then conducting a focus group to assess the identified competencies. Competencies were primarily determined by researchers or clinicians in China, and by associates in the US. The competency model was often based on a theoretical framework, and the PPRR Model was the most cited framework [76]. The PPRR model was used in disaster risk reduction and emergency management, outlining various stages of the disaster cycle [77]. In this review, we used the iceberg model to synthesize identified competency because the personal characteristics were not included in the PPRR model. The iceberg model is also widely used to develop nurse competency model [78, 79].

Nurses’ training programs based on emergency competencies

Current training is mainly competency-based and focuses on nurses’ knowledge and skills in public health emergencies. Since the outbreak of COVID-19, recent studies have shown that an increasing amount of attention has been paid to the cultivation of culture and personal characteristics competencies, which is consistent with the iceberg model of competency. Increasing cultural training will help promote nurses’ initiative and willingness to provide nursing care during public health events. Personal characteristics, social roles and values, which play key roles in distinguishing individual behavior and performance, have often been ignored. Incorporating personal characteristics into assessments and training may help select nurses who are more suitable for front-line rescues and for practicing scientific competency-based human resource management. China has a collectivist culture, which emphasizes cohesion, duty and the achievement of group goals. Therefore, Chinese nurses have a high level of willingness to respond to public health emergencies and some Chinese nurses even believe they lived out their calling during COVID-19 [80].

Some of the assessment instruments investigated in this review can be used to evaluate nurses' competencies and to develop relevant training. The DPET and EPIQ were the two most commonly used evaluation tools. The items of the DPET were used to assess the competencies of the nurses in at three disaster stages: the pre-disaster, mitigation and response and evaluation stages. The DPET has been translated and used in many countries, including Korea, Japan, Indonesia, China, Iran, Jordan, Thailand and Saudi Arabia [46, 81,82,83,84,85,86,87,88]. Some of the studies verified the validity and reliability of these instruments in their respective countries [81, 83, 86]. The EPIQ consists of two parts: the dimensions of personal information and disaster preparedness competencies. This instrument has also been used in other countries. (e.g., the United Kingdom, Malaysia, Saudi Arabia, Iran and Korea [89,90,91,92,93].

Implications for nursing management

Nursing managers should emphasize improvements in nurses’ competencies in public health emergencies, strengthen relevant training and prepare for the next epidemic. Our identification of competency domains in this scoping review will foster the development of an education curriculum or clinical training program. Training methods and strategies that were synthesized in this scoping review can be used in clinical training to help nurses quickly master relevant skills, and the instruments for evaluating competencies can help nurse managers select competent nurses, ensure a high quality of care, provide feedback on training results and adjust relevant training programs.


Conceptual limitations: this scoping review focused on nurse competency in infectious disease outbreaks, with relatively few studies on other disasters. Language biases: the languages of the included studies were limited to English and Chinese; hence, it is also necessary to determine the competencies reported in studies published in different languages. Implicit biases: the cultural backgrounds of the researchers may have influenced their perspectives.


This scoping review outlined the common domains of nurses’ competencies in public health emergencies. Three dimensions with 27 competency domains were identified after they were analyzed and synthesized, and the most-cited competency domains were self-protection skills, communication skills, basic knowledge of public health emergencies, laws and ethics and capacity for organizational collaboration. The identified competencies may be helpful for developing an education curriculum and for conducting clinical training. The competency assessment instruments, training methods, and strategies synthesized in this scoping review will be useful for nursing management and future research.

Availability of data and materials

All data generated or analysed during this study are included in this published article.



Coronavirus disease


Disaster Nursing Preparedness-Response Competency score


Nurse Disaster Preparedness Evaluation Tool


Korean version of the Nurse Disaster Preparedness Evaluation Tool


Emergency Preparedness Information Questionnaire


International Council of Nurses Core Competencies in Disaster Nursing, version 1.0


Nurses’ Perceptions of Disaster Core Competencies Scale


Personal protective equipment

PPRR Model:

Prevention, Preparedness, Response and Recovery Model


Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews


Severe Acute Respiratory Syndrome Coronavirus-2


The Slovenian version of the Disaster Nursing Core Competencies Scale


United States


  1. World Health Organisation. Framework for a public health emergency operations centre. Published 2015. Assessed 16 Sep 2023.

  2. Allen T, Spencer R. Barriers and enablers to using an emergency operations Center in Public Health Emergency Management: a scoping review. Disaster Med Public Health Prep. 2023;17:407.

    Article  Google Scholar 

  3. Lurie N, Manolio T, Patterson AP, Collins F, Frieden T. Research as a part of public health emergency response. N Engl J Med. 2013;368(13):1251–5.

    Article  CAS  PubMed  Google Scholar 

  4. Brencic DJ, Pinto M, Gill A, Kinzer MH, Hernandez L, Pasi OG. CDC support for global public health emergency management. Emerg Infect Dis. 2017;23(13):S183–9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. International Council of Nursing (ICN). Core competencies in Disaster Nursing Version 2.0. Geneva: International Council of Nursing. 2019.

  6. Guilamo-Ramos V, Thimm-Kaiser M, Benzekri A, Hidalgo A, Lanier Y, Tlou S, de Lourdes Rosas López M, Soletti AB, Hagan H. Nurses at the frontline of public health emergency preparedness and response: lessons learned from the HIV/AIDS pandemic and emerging infectious disease outbreaks. Lancet Infect Dis. 2021;21(10):e326–33.

    Article  PubMed  PubMed Central  Google Scholar 

  7. US Department of Education. National Center for Education Statistics: Defining and Assessing Learning: Exploring Competency-Based Initiatives. Washington DC: US Department of Education, National Center for Education Statistics. 2001.

  8. Ling KWK, Daily EK. Linking competency with training needs: session summary on disaster studies and evaluation, session BO-17. Prehosp Disaster Med. 2016;31(1):117–8.

    Article  PubMed  Google Scholar 

  9. Horrocks P, Hobbs L, Tippett V, Aitken P. Paramedic disaster health management competencies: a scoping review. Prehosp Disaster Med. 2019;34(3):322–9.

    Article  PubMed  Google Scholar 

  10. Al Thobaity A, Plummer V, Williams B. What are the most common domains of the core competencies of disaster nursing? A scoping review. Int Emerg Nurs. 2017;31:64–71.

    Article  PubMed  Google Scholar 

  11. Labrague LJ, De Los Santos JAA. COVID-19 anxiety among front-line nurses: predictive role of organisational support, personal resilience and social support. J Nurs Manag. 2020;28(7):1653–61.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ye Q, Yang J, Cheng Y, Weiguo D. How to strengthen the training on hospital infection control during the COVID-19 pandemic. Chin J Med Educ. 2020;40(7):490–4.

    Article  Google Scholar 

  13. Department of health. Updates on novel coronavirus disease (COVID-19). 2020.

  14. Wu C, Wu P, Li P, Cheng F, Du Y, He S, Lang H: Construction of an index system of core competence assessment for infectious disease specialist nurse in China: a Delphi study. BMC Infect Dis 2021;21(1).

  15. McGarity T, Acker K, Baldwin S. COVID-19 and nurse competency and readiness: The value of just-in-time education. J Nurses Prof Dev. 2022;38(2):88–91.

  16. Dashash M, Almasri B, Takaleh E, Halawah AA, Sahyouni A. Educational perspective for the identification of essential competencies required for approaching patients with COVID-19. East Mediterr Health J. 2020;26(9):1011–7.

    Article  PubMed  Google Scholar 

  17. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91–108.

    Article  PubMed  Google Scholar 

  18. Spencer LM, Spencer SM. Competence at work: Models for superior performance. 1st ed. New York: Wiley; 1993.

    Google Scholar 

  19. Tricco AC, Lillie E, Zarin W, O’Brien KK, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.

    Article  PubMed  Google Scholar 

  20. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. JBI Manual for Evidence Synthesis. In: Chapter 5: Systematic reviews of prevalence and incidence. Edited by Aromataris E, Munn Z: JBI; 2020.

  21. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. JBI Manual for Evidence Synthesis. In: Chapter 3: Systematic reviews of effectiveness. Edited by Aromataris E, Munn Z: JBI; 2020.

  22. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Lisy K, Qureshi R, Mattis P et al. JBI Manual for evidence synthesis. In: Chapter 7: Systematic reviews of etiology and risk. Edited by Aromataris E, Munn Z: JBI; 2020.

  23. Lockwood C, Munn Z, Porritt K. Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. Int J Evid Based Healthc. 2015;13(3):179–87.

    Article  PubMed  Google Scholar 

  24. Bai X, Gan X, Yang R, Zhang C, Luo X, Luo C, Chen S. Construction of a competency evaluation index system for front-line nurses during the outbreak of major infectious diseases: a Delphi study. PLoS One. 2022;17(7).

  25. Cui L, He A, Wang X, Wang Y, Huang X, Ni Z. Development and validation of a competency evaluation model for hospital infection prevention and control practitioners in the post-pandemic era: a mixed methods study. J Hosp Infect. 2022;119:132–40.

    Article  CAS  PubMed  Google Scholar 

  26. Mao X, Yang Q, Li X, Chen X, Guo C, Wen X, Loke AY. An illumination of the ICN’s core competencies in disaster nursing version 2.0: advanced nursing response to COVID-19 outbreak in China. J Nurs Manag. 2021;29(3):412–20.

    Article  PubMed  Google Scholar 

  27. Papadopoulos I. The covid -19 pandemic and cultural competence: global implications for managers, nurses and healthcare workers during major health disasters and emergencies. J Nurs Manag. 2022.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhao Y, Wang Y, Zhang T, Wang M, Ye X, Wang X, Sun H. Development and preliminary validation of a public health emergency competency model for medical staffs of national health emergency teams in China. BMC Health Services Research. 2022;22(1).

  29. Qiao W, Yang W. The construction of evaluation system of response capacity to public health emergencies for emergency specialized nurses. Chin Nurs Manage. 2014;7:696-698,699.

    Article  Google Scholar 

  30. Bian H, Yu P, Liu H, Bai M. Construction of competency index of nurses in public health emergencies based on iceberg model. Chin J Prac Nurs. 2021;37(27):2122–7.

    Article  Google Scholar 

  31. Lin Y, Zhu X, Chen Y. Construction of an emergency rescue competence index system for public health emergency among community nurses. Chin J Nurs. 2021;56(8):1158–64.

    Article  Google Scholar 

  32. Kan T, Chen C, Huang Y, Liu J, Wang Y, Gui L. Construction of core response competence index system for infectious disease emergencies among medical staff. Chin J Nurs. 2018;53(4):461–6.

    Article  Google Scholar 

  33. Huang X, Zhou L, Ma R. Core competency system for emergency rescue of sudden infectious diseases among military advance nurses. Chin J Prac Nurs. 2021;37(12):887–93.

    Article  Google Scholar 

  34. Chan WF, Adamson B, Chung JWY, Chow MCM. Validity and reliability of the proposed core competency for infection control nurses of hospitals in Hong Kong. Am J Infect Control. 2011;39(3):e11-13.

    Article  PubMed  Google Scholar 

  35. Jorgensen AM, Mendoza GJ, Henderson JL. Emergency preparedness and disaster response Core competency set for perinatal and neonatal nurses. JOGNN – J Obstetr Gynecol Neonatal Nurs. 2010;39(4):450–67.

    Article  Google Scholar 

  36. Polivka BJ, Stanley SAR, Gordon D, Taulbee K, Kieffer G, McCorkle SM. Public health nursing competencies for public health surge events. Public Health Nurs. 2008;25(2):159–65.

    Article  PubMed  Google Scholar 

  37. Slobodin O, Kula Y, Clempert N, Cohen O. Building capacity in times of crisis: Increasing cultural competence of healthcare professionals in the context of the COVID-19. J Clin Nurs. 2021:1–10.

  38. Zhang D, Liao H, Jia Y, Yang W, He P, Wang D, Chen Y, Yang W, Zhang YP. Effect of virtual reality simulation training on the response capability of public health emergency reserve nurses in China: a quasiexperimental study. BMJ Open. 2021;11(9):e048611.

    Article  PubMed  Google Scholar 

  39. Qureshi KA, Merrill JA, Gershon RR, Calero-Breckheimer A. Emergency preparedness training for public health nurses: a pilot study. J Urban Health. 2002;79(3):413–6.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Qureshi KA, Gershon RR, Merrill JA, Calero-Breckheimer A, Murrman M, Gebbie KM, Moskin LC, May L, Morse SS, Sherman M. Effectiveness of an emergency preparedness training program for public health nurses in New York City. Fam Community Health. 2004;27(3):242–9.

    Article  PubMed  Google Scholar 

  41. Jen HJ, Chou KR, Chang CY. Fostering nursing staff competence in personal protective equipment education during COVID-19: a Mobile-video online learning approach. Int J Environ Res Public Health. 2022;19(15):9238.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Dhal S, Mohapatra S. Training need identification of nursing professional’s competencies during pandemic and scale development. In: Rajagopal, Behl, R, editors. Palgrave Studies in Democracy, Innovation and Entrepreneurship for Growth. 2022. p. 365–90.

  43. Lavin RP, Veenema TG, Langan JC, Charney RL, Zimmerman RS, Bender A. Zika and Flint water public health emergencies: disaster training tool kits relevant to pregnant women and children. Journal of Perinatal and Neonatal Nursing. 2019;33(3):229–37.

    Article  PubMed  Google Scholar 

  44. Lauck SB, Bains VK, Nordby D, Iacoe E, Forman J, Polderman J, Farina L. Responding to the COVID-19 pandemic: development of a critical care nursing surge model to meet patient needs and maximise competencies. Aust Crit Care. 2022;35(1):13–21.

    Article  PubMed  Google Scholar 

  45. Alan H, Eskici GT, Sen HT, Bacaksiz FE. Nurses’ disaster core competencies and resilience during the COVID-19 pandemic: a cross-sectional study from Turkey. J Nurs Manag. 2022;30(3):622–32.

    Article  PubMed  Google Scholar 

  46. Hong E, Jung A, Woo K. A cross-sectional study on public health nurses’ disaster competencies and influencing factors during the COVID-19 pandemic in Korea. BMC Public Health. 2022;22(1):731.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Jang SJ, Kim H, Lee H. Mental health nurses’ disaster nursing competencies: a cross-sectional study. Int J Ment Health Nurs. 2022;31(1):142–52.

    Article  PubMed  Google Scholar 

  48. Karnjuš I, Prosen M, Ličen S. Nurses’ core disaster-response competencies for combating COVID-19 a cross-sectional study. PLoS ONE. 2021;16(6):e0252934.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Li H, Dong S, He L, Wang R, Long S, He F, Tang H, Feng L. Nurses’ core emergency competencies for COVID-19 in China: a cross-sectional study. Int Nurs Rev. 2021;68(4):524–32.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Song S, Li X, Bell SA, Yang X, Zhang W. Emergency response: a cross-sectional study of Core competencies for nurses regarding major infectious disease outbreaks. J Emerg Nurs. 2021;47(6):902–13.

    Article  PubMed  Google Scholar 

  51. Tichy M, Bond AE. NPs’ perceptions of disaster preparedness education: quanititative survey research. Am J Nurs Pract. 2009;13(1):10–22 (

    Google Scholar 

  52. Han SJ, Chun J. Validation of the disaster preparedness evaluation tool for nurses-the Korean version. Int J Environ Res Public Health. 2021;18(3):1348.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Ahn O-H, Jang E-H, Kim S-H. Development of the Disaster Nursing Preparedness·Response Competency (DNPRC) scale in terms of convergence. J Korea Converg Soc. 2017;8(7):101–11.

    Article  Google Scholar 

  54. Al Thobaity A, Williams B, Plummer V. A new scale for disaster nursing core competencies: development and psychometric testing. Austral Emerg Nurs J: AENJ. 2016;19(1):11–9.

    Article  Google Scholar 

  55. Prosen M, Ličen S, Karnjuš I. Adaptation and psychometric validation of the Disaster Nursing Core Competencies Scale during the time of the SARS-CoV-2 (COVID-19) epidemic in Slovenia. Slovenian Nurs Rev. 2020;54:113–21.

    Article  Google Scholar 

  56. Wisniewski R, Dennik-Champion G, Peltier JW. Emergency preparedness competencies: assessing nurses’ educational needs. J Nurs Adm. 2004;34(10):475–80.

    Article  PubMed  Google Scholar 

  57. Niles D, Sutton RM, Donoghue A, Kalsi MS, Roberts K, Boyle L, Nishisaki A, Arbogast KB, Helfaer M, Nadkarni V. “Rolling refreshers”: a novel approach to maintain CPR psychomotor skill competence. Resuscitation. 2009;80(8):909–12.

    Article  PubMed  Google Scholar 

  58. Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, Bradshaw JH, Diener-West M, Perretta JS, Shilkofski NA. Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation. 2014;85(7):945–51.

    Article  PubMed  Google Scholar 

  59. Yarmohammadian MH, Atighechian G, Shams L, Haghshenas A. Are hospitals ready to respond to disasters? challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS). J Res Med Sci. 2011;16(8):1070–7.

    PubMed  PubMed Central  Google Scholar 

  60. Lord H, Loveday C, Moxham L, Fernandez R. Effective communication is key to intensive care nurses’ willingness to provide nursing care amidst the COVID-19 pandemic. Intensive Crit Care Nurs. 2021;62:102946.

    Article  PubMed  Google Scholar 

  61. Simonovich SD, Spurlark RS, Badowski D, et al. Examining effective communication in nursing practice during COVID-19: a large-scale qualitative study. Int Nurs Rev. 2021;68(4):512–23.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Shin S, Yoo HJ. Frontline nurses’ caring experiences in COVID-19 units: a qualitative study. J Nurs Manag. 2022;30(5):1087–95.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Patil U, Kostareva U, Hadley M, Manganello JA, Okan O, Dadaczynski K, Massey PM, Agner J, Sentell T. Health literacy, digital health literacy, and COVID-19 pandemic attitudes and behaviors in U.S. college students: implications for interventions. Int J Environ Res Public Health. 2021;18(6).

  64. Ortega R, Gonzalez M, Nozari A, Canelli R. Personal protective equipment and covid-19. N Engl J Med. 2020;382(26):e105.

    Article  CAS  PubMed  Google Scholar 

  65. Lee JM, Jansen R, Sanderson KE, et al. Public health emergency preparedness for infectious disease emergencies: a scoping review of recent evidence. BMC Public Health. 2023;23(1):420.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Alfandre D, Sharpe VA, Geppert C, Foglia MB, Berkowitz K, Chanko B, Schonfeld T: Between usual and crisis phases of a public health emergency: the mediating role of contingency measures. Am J Bioeth 2021;21(8).

  67. Maketa V, Luzolo F, Muhindo Mavoko H, et al. Boosting ethics review capacity in public health emergency situations: co-creation of a training model for French-speaking research ethics committees. Trop Med Int Health. 2022;27(10):934–40.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Yeh M-J, Lee P-H. Ethical preparedness for health policymaking and implementation during public health emergencies: the role of rapid ethical assessment. Health Secur. 2023;21(5):371–8.

    Article  PubMed  Google Scholar 

  69. American Nurses Association. Code of ethics for nurses with interpretative statements. 2001.

  70. Tambo E, Al-Nazawi AM. Combating the global spread of poverty-related Monkeypox outbreaks and beyond. Infect Dis Poverty. 2022;11(1):80.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Wang H, Sun J, Shi Y, Shen T. Driving the effectiveness of public health emergency management strategies through cross-departmental collaboration: configuration analysis based on 15 cities in China. Front Public Health. 2022;10:1032576.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Serra-Barril MA, Benito-Aracil L, Pla-Consuegra M, Ferro-García T. Delphi survey on the application of advanced practice nursing competencies: strong points and unfinished business in cancer care. J Nurs Manag. 2022;30(8):4339–53.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Wielenga JM, Tume LN, Latour JM, van den Hoogen A. European neonatal intensive care nursing research priorities: an e-Delphi study. Arch Dis Child Fetal Neonatal Ed. 2015;100(1):F66–71.

    Article  PubMed  Google Scholar 

  74. Wu Q, Jiang H-J, Chen H-Q. Establishment of infection prevention and control strategy in nursing managements during surgical operations in COVID-19 patients based on Delphi method. Nurs Open. 2023;10(6):3906–13.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Savic LC, Smith AF. How to conduct a Delphi consensus process. Anaesthesia. 2023;78(2):247–50.

    Article  CAS  PubMed  Google Scholar 

  76. McLoughlin D. A framework for integrated emergency management. Public Adm Rev. 1985;45:165–72.

    Article  Google Scholar 

  77. Management D. Prevention preparedness, response and recovery disaster management guideline. 2018.

  78. Liu J, Qiu HF, Zhang XH, Zhang CL, He F, Yan P. Development of billing post competency evaluation index system for nurses in China: a Delphi study. BMC Nurs. 2023;22(1):136.

  79. Michibayashi C, Omote S, Nakamura M, Okamoto R, Nakada AI. Competency model for public health nurses working on tobacco control in local governments in Japan: A qualitative study. Jpn J Nurs Sci. 2020;17(1):e12288.

  80. Galehdar N, Kamran A, Toulabi T, Heydari H. Exploring nurses’ experiences of psychological distress during care of patients with COVID-19: a qualitative study. BMC Psychiatry. 2020;20(1):489.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Chen T-F, Chou K-R, Liao Y-M, Ho C-H, Chung M-H. Construct validity and reliability of the Chinese version of the disaster preparedness evaluation tool in Taiwan. J Clin Nurs. 2015;24(7–8):1132–43.

    Article  PubMed  Google Scholar 

  82. Usher K, Mills J, West C, Casella E, Dorji P, Guo A, Koy V, Pego G, Phanpaseuth S, Phouthavong O, et al. Cross-sectional survey of the disaster preparedness of nurses across the Asia-Pacific region. Nurs Health Sci. 2015;17(4):434–43.

    Article  PubMed  Google Scholar 

  83. Fung OWM, Loke AY, Lai CKY. Disaster preparedness among Hong Kong nurses. J Adv Nurs. 2008;62(6):698–703.

    Article  PubMed  Google Scholar 

  84. Martono M, Satino S, Nursalam N, Efendi F, Bushy A. Indonesian nurses’ perception of disaster management preparedness. Chin J Traumatol. 2019;22(1):41–6.

    Article  PubMed  Google Scholar 

  85. Öztekin SD, Larson EE, Akahoshi M, Öztekin İ. Japanese nurses’ perception of their preparedness for disasters: quantitative survey research on one prefecture in Japan. Jpn J Nurs Sci. 2016;13(3):391–401.

    Article  PubMed  Google Scholar 

  86. Al Khalaileh MA, Bond E, Alasad JA. Jordanian nurses’ perceptions of their preparedness for disaster management. Int Emerg Nurs. 2012;20(1):14–23.

    Article  PubMed  Google Scholar 

  87. Tabiee S, Nakhaei M. Nurses' preparedness for disaster in South Khorasan Province, Iran. Health Emerg Disasters Q. 2016;2(1):13–8.

  88. Al Thobaity A, Plummer V, Innes K, Copnell B. Perceptions of knowledge of disaster management among military and civilian nurses in Saudi Arabia. Australas Emerg Nurs J. 2015;18(3):156–64.

    Article  PubMed  Google Scholar 

  89. Worrall J. Are emergency care staff prepared for disaster? Emerg Nurse. 2012;19(9):31–7.

    Article  PubMed  Google Scholar 

  90. Azizpour I, Mehri S, Soola AH. Disaster preparedness knowledge and its relationship with triage decision-making among hospital and pre-hospital emergency nurses - Ardabil. Iran BMC Health Serv Res. 2022;22(1):934.

    Article  PubMed  Google Scholar 

  91. Chua BS, Cosmas G, Arsat N, Wider W. Do contextual and demographic factors help malaysian nurses prepare in dealing with the COVID-19 Pandemic? Int J Environ Res Public Health. 2022;19(9).

  92. Solbakken R, Bergdahl E, Rudolfsson G, Bondas T. International nursing: caring in nursing leadership-a meta-ethnography from the nurse leader's perspective. Nurs Adm Q. 2018;42(4).

  93. Ghazi BO. Preparedness assessment for managing disasters among nurses in an international setting: implications for nurses. Int Emerg Nurs. 2021;56:100993.

    Article  Google Scholar 

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This work was supported by the Medical Science and Technology Project of Zhejiang Province, China [grant number 2021421245].

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XEG searched database, summarized competencies, and drafted the initial manuscript. LFB summarized competencies and revised the manuscript. YL, CYL and YL evaluated literature quality and summarized competencies. All authors read and approved the final manuscript.

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Correspondence to Li-Fang Bian.

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Supplementary Information

Additional file 1: Table A 1.

JBI critical appraisal checklist for text and opinion papers. Table A 2. Quality assessment of opinion papers. Table A 3. JBI critical appraisal checklist for studies reporting prevalence data. Table A 4. Quality assessment of descriptive studies. Table A 5. JBI critical appraisal checklist for quasi-experimental studies. Table A 6. Quality assessment of quasi-experimental studies. Table A 7. JBI critical appraisal checklist for cohort studies. Table A 8. Quality assessment of cohort study. Table A 9. JBI critical appraisal checklist for qualitative research. Table A 10. Quality assessment of qualitative studies.

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Guo, XE., Bian, LF., Li, Y. et al. Common domains of nurses’ competencies in public health emergencies: a scoping review. BMC Nurs 22, 490 (2023).

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