| Objective:(1)Through the combined method of quantitative and qualitative research,a disaster literacy model of clinical nurses is developed and verified,and an evaluation tool is established for the popularization and high-quality development of disaster literacy of clinical nurses in China.(2)The disaster literacy model and related scales of clinical nurses were used to conduct a questionnaire survey among clinical nurses in China to explore the influencing factors affecting the disaster literacy of clinical nurses,integrate the psychosocial factors,and construct the influencing factor model to further clarify the path and effect of these factors on the disaster literacy of clinical nurses.(3)Based on the analysis of influencing factors and on the intervention mapping theory,combined with the best evidence summary,semi-structured interview and focus group interview,this paper puts forward the intervention strategy of clinical nurses’ disaster literacy,so as to provide evidence support and reference suggestions for improving the level of clinical nurses’ disaster literacy in China.Methods:(1)Based on Nutbeam’s health literacy theory and Lisa M’s disaster literacy concept,this study determined the concept of disaster literacy of clinical nurses,analyzed the content of 21 literatures at home and abroad in view of SMART theory,and extracted the primary and secondary indicators of disaster literacy of clinical nurses.According to the division method of seven geographical regions in China,31 clinical nurses in China were interviewed on key events,42 excellent cases of disaster nursing in China were analyzed,and the disaster literacy index system of clinical nurses was preliminarily determined.Seven members from sectors including disaster emergency response,nursing management,nursing education and clinical nurses,etc.were invited nationwide to conduct thematic discussions on the established index system for preliminary optimization;32 experts from all over the country were invited to conduct two rounds of Delphi expert letters to optimize the index system again.Through analytic hierarchy process,the weight of indicators at all levels of disaster literacy of clinical nurses was determined.(2)Based on the index system,a pre-investigation was carried out among the 2135 clinical nurses nationwide.The potential reliability and validity of the questionnaire system were identified by exploratory factor analysis,content validity analysis and reliability analysis.On this basis,a confirmatory survey was conducted among 2161 clinical nurses in China.The overall fitness of the index system was verified through aggregation validity,discrimination validity and model fitting indicators,and finally a disaster literacy model of clinical nurses was formed.(3)A formal survey was conducted among 5503 clinical nurses in seven geographical regions of China using the disaster literacy model,and the predictive factors affecting their disaster literacy were analyzed from four aspects: demographic factors,occupational / disaster factors,organizational factors and psychosocial factors.On this basis,the structural equation model method was used to construct the influencing factor model of disaster literacy of clinical nurses,which included five psychosocial factors:professional identity,organizational support,social support,self-efficacy and resilience.(4)Based on the intervention mapping theory,the needs of disaster literacy intervention research of clinical nurses were analyzed through literature research and preliminary questionnaire survey results;based on the analysis of influencing factors,the best evidence of 34 studies at home and abroad was summarized to clarify the intervention objectives of disaster literacy of clinical nurses;semi structured interviews were conducted with 30 clinical nurses nationwide to determine the intervention practice strategy;through the focus group interview composed of 12 expert members,the disaster literacy intervention strategy of clinical nurses was finally determined.Results:(1)Three primary indexes and nine secondary indexes were extracted through literature research;3 primary indicators,9 secondary indicators and 44 tertiary indicators were extracted through key event interviews,and the index system was initially established.Further,through the case study of disaster nursing situation,3 primary indicators,9 secondary indicators and 43 tertiary indicators were extracted to preliminarily determine the index system.Through panel discussion,the index system is preliminarily optimized consisting of 3 primary indicators,9 secondary indicators and 35 tertiary indicators;through two rounds of Delphi expert letters from the same group of experts,the index system of disaster literacy of clinical nurses was optimized again consisting of 3 primary indicators,9 secondary indicators and 37 tertiary indicators.The weights of indicators at all levels of disaster literacy of clinical nurses were determined by analytic hierarchy process.(2)Item analysis showed that the differences between the high and low groups of37 items were statistically significant(P < 0.01),and all items were retained.The KMO statistic result of exploratory factor analysis is 0.983,and Bartlett sphericity test P< 0.001,indicating that factor analysis is suitable.The principal component maximum variance rotation method was used to determine the number of factors with the eigenvalue greater than 1 and the factor loading greater than 0.5 as the conditions for the entry of factors.The indicators with similar load coefficients but no specificity in two or more factors were deleted and a total of three common factors were obtained,and the cumulative variance contribution rate was 79.98%.In the pre survey,the item content validity(I-CVI)is concentrated in 0.8 ～ 1.0,and the proportion of items with full score is 0.823,indicating that the content validity is good.Reliability analysis showed that Cronbach’s αand Guttman Split-half coefficient were greater than 0.9,and each secondary index Cronbach’s α and Guttman Split-half coefficient were greater than 0.8,indicating that the index system had high internal consistency and high reliability.(3)The confirmatory investigation showed that the absolute value of standardized loading coefficient of each measurement relationship was greater than 0.60,which showed significance,indicating that the items corresponding to each latent variable were highly representative.In addition,the AVE of each latent variable was greater than 0.50,and Cronbach’s α was greater than 0.90,showing the sample data had good reliability,and the combined reliability CR was greater than 0.90,indicating that the aggregation validity was ideal.There was a significant correlation between the primary indicators(P< 0.001),and the absolute values of the correlation coefficients were less than 0.5 and less than the square root of the corresponding AVE,indicating that there was a certain correlation between the latent variables and a certain degree of discrimination between them,demonstrating that the discriminant validity of the disaster literacy model of clinical nurses was ideal.The similarity index of the disaster literacy model of clinical nurses was acceptable,but the dissimilarity index RMSEA was not in the range of standard value.After moderate correction,all indexes were basically acceptable.According to the performance evaluation results,the final model containing 3 dimensions of 34 items was finally obtained.(4)The formal investigation showed that the average age of the investigated nurses was(32.31 ± 7.39)years;there were 183 males(3.3%)and 5322 females(96.7%).The Cronbach’s α of each scale was greater than 0.70.The disaster literacy of clinical nurses was at the medium level,in which the score of interactive literacy was the highest and the score of functional literacy was the lowest.The univariate analysis showed that: age,gender,working years,region,highest academic qualifications / degree,marital status,monthly income,hospital level,professional technical title,current occupation,whether having engaged in the COVID-19 work,whether having received disaster nursing training at work,whether having received disaster nursing education during school,whether the employer unit has established a perfect emergency plan,whether the employer unit has established a disaster rescue team,self-efficacy,resilience,professional identity,organizational support and social support were related to the disaster literacy of clinical nurses(P < 0.05).Multiple linear regression analysis showed that: Multiple linear regression analysis showed that: gender,whether having received disaster nursing training at work,whether having received disaster nursing education during school,whether having engaged in the COVID-19 work,highest academic qualifications/degree,geographical area,professional titles,self-efficacy,resilience,professional identity,social support,organizational support were the main influencing factor of disaster literacy of clinical nurses(P < 0.05).(5)The influencing factor model showed that professional identity,social support,self-efficacy and resilience had direct effects on disaster literacy,while organizational support had only indirect effects.In influencing factor model 1,the relationship between the direct effect size is self-efficacy(0.443)> social support(0.112)> professional identity(0.087);in influencing factor model 2,the relationship between the direct effect size is resilience(0.377)> social support(0.158)> professional identity(0.112),and both are positive effects.Professional identity,organizational support and social support all had indirect effects on disaster literacy,and social support had the largest indirect effect,which was 0.196 and 0.170,respectively.Self-efficacy and resilience,as non-trait attributes,were directly influenced by trait related cues in social support,organizational support and professional identity,among which social support had the greatest direct influence,with values of 0.443 and 0.451,respectively.(6)Literature research showed that the existing research on disaster literacy intervention of clinical nurses was mostly a traditional experience transmission model,which was in need of theoretical guidance and support of scientific framework.Through the best evidence summary,this study found that the existing evidence of disaster literacy of clinical nurses has less high-quality support,especially the lack of guidelines,expert consensus and high-quality systematic evaluation.Based on the summary and analysis of the existing evidence,13 evidence categories and 70 evidence items were extracted.Based on the best evidence summary,the practice strategies of 6 themes and 11 sub themes were extracted through semi-structured interview research;through focus group interviews,the six aspects of disaster literacy intervention strategies of clinical nurses and the relevant key points of the multi-level intervention strategies corresponding to individual level,group level and organizational system level were finally determined.Conclusions:(1)Through scientific and improved model development and performance evaluation,34 items of clinical nurses’ disaster literacy model including three dimensions of functional literacy,interactive literacy and critical literacy were finally selected.The model will become an effective evaluation tool for the measurement of clinical nurses’ disaster literacy in China.(2)In the evaluation the disaster literacy level of clinical nurses and formulation of the corresponding intervention strategies,attention should be paid to the male clinical nurses,clinical nurses with previous disaster relief experience,having participated in school education or continuing training,clinical nurses with high academic and senior professional titles,so as to give full play to their advantages.(3)When evaluating the disaster literacy level of clinical nurses and formulating corresponding intervention strategies,we should pay attention to the influence of psychosocial factors of clinical nurses.The effects of self-efficacy,resilience and social support on disaster literacy of clinical nurses should be emphasized,followed by professional identity and organizational support.It is suggested to improve the level of self-efficacy and resilience of clinical nurses by improving their social support,professional identity and organizational support,so as to improve the disaster literacy of clinical nurses.(4)Strengthening disaster education and training,disaster simulation exercises,providing psychosocial support,strengthening the construction of disaster nursing team,disaster response preparation and knowledge transformation are important intervention strategies to improve the disaster literacy of clinical nurses.The multi-level disaster literacy intervention strategy of clinical nurses which is based on intervention mapping theory can provide evidence support for promoting the overall improvement of clinical nurses’ disaster literacy. |
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