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Improving collaboration skills among nursing students through disaster preparedness simulation
Arief Andriyantoa,
Corresponding author
ners.arif91@gmail.com

Corresponding author.
, Rina Nur Hidayatib
a Department of Nursing, Bina Sehat PPNI Mojokerto College of Health Sciences, Indonesia
b Postgraduate Program Department of Nursing, Bina Sehat PPNI Mojokerto College of Health Sciences, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Most of the nurses in the world will never be deployed to disaster areas&#44; even though disasters can strike anywhere without prior notice&#44; so all nurses must have a basic understanding of disaster nursing&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Accidents occur throughout the world and cause an enormous amount of human suffering and disturbance to society&#46; The number of people affected by disasters has increased&#44; and in 2016&#44; more than 569&#46;4 million people were affected&#44; mostly by natural disasters&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a> The World Health Organization &#40;WHO&#41; recommends health care professionals in all countries to be trained in how to deal with disasters&#44; regardless of the frequency of these accidents in the countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The phenomenon that occurs in nursing students regarding teaching methods related to disaster nursing is only in the form of demonstrations given in class without any simulation methods that illustrate the relationship between theory and practice&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a> To provide optimal quality of service to patients&#44; providers must be competent in providing team-based care by understanding the forms of collaboration among health care professionals&#44; such as communication&#44; collaboration&#44; roles and responsibilities&#44; patient&#47;client-family collaboration approaches&#44; team functions&#44; and conflict management&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The significant effort of nursing practice is to provide care to the injured or sick and to help individuals and families deal with physical and emotional problems and work to improve the health and well-being of the community&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> The Interprofessional Education Collaborative Expert Panel &#40;IPEC&#41; reports that the care provided by the collaborative team results in better patient care&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> Interprofessional collaboration is essential to build a team-based workforce with an understanding of the various roles and responsibilities that can communicate in an effective way to provide patient-centered care effectively&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> Therefore&#44; during their undergraduate studies&#44; nursing students must receive training for their role in the disaster&#46; Nursing undergraduate programs must provide training methods on disaster preparedness in the form of simulations&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Simulations and exercises also play an essential role in disaster preparedness&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">4&#44;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Simulation is a learning and teaching strategy that is commonly used in health-related education&#46; High-fidelity simulations provide nursing students with opportunities to practice&#44; develop&#44; and apply knowledge and skills in realistic clinical situations while staying in a safe environment&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> Simulation is known for its ability to standardize a patient&#39;s condition and implement it consistently&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> The use of simulation training for disaster preparedness combines theoretical knowledge and clinical skills that provide invaluable experience for nursing students&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> Additionally&#44; simulations allow nursing students to improve their clinical skills without risking patient safety&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the case of disaster training&#44; participants learn how to manage care services for injured people&#44; to triage patients&#44; to examine facts more effectively&#44; make related decisions&#44; and develop procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> These skills are the reason why simulations are usually used in disaster training&#44; and it is widely stated that simulations improve the knowledge&#44; skills&#44; and performance of trainees&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> This study aims to analyze the improvement of collaboration skills among nursing students through disaster preparedness simulations at Bina Sehat PPNI Mojokerto College of Health Sciences&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This study used a quasi-experimental pre-post-test with a control group design for three months&#44; totaling 10 sessions &#40;September&#8211;November&#44; 2019&#41;&#46; The study was conducted at the Bina Sehat PPNI Mojokerto College of Health Sciences&#46; The estimates were made at the 5&#37; significance level and 80&#37; strength test&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a> The sample using the effect design was multiplied by two previous studies&#44; so the minimum number of samples needed is 69 respondents for each group&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The instrument used in this study was the Interprofessional Collaborator Assessment Rubric &#40;ICAR&#41;&#46; ICAR was designed to assess the competencies expressed by the collaboration of the Intraprofessional Executive Committee&#46; The validity test showed that both internal consistency and intra-class correlation were good with r count values&#44; ranges starting from the lowest 0&#46;311 to the highest of 0&#46;830&#46; The reliability test showed the results of Cronbach&#39;s Alpha 0&#46;754&#46; Respondents were assigned randomly to the intervention and control group&#44; where the intervention group was given a ten-session disaster preparedness simulation&#44; while for the control group&#44; disaster preparedness was delivered using the usual method without simulation&#46; The stages of the activity for the intervention group can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">A pre-test &#40;questionnaire B&#41; was given for both groups prior to the simulation program began&#46; A post-test was then given after the intervention group completed the program for both groups&#46; Data analysis was conducted to see differences between pre and post-test&#46; The normality test used was the Kolmogorov&#8211;Smirnov test to examine the normality distribution of the data&#46; The homogeneity test was performed using a one-way ANOVA test to determines if the two have the same distribution of a single categorical variable&#46; The result obtained for the intervention group was 0&#46;451&#44; and the control group was 0&#46;541 means that both groups had equal variance &#40;&#62;0&#46;05&#41;&#46; The statistical tests using IBM-21 with paired <span class="elsevierStyleItalic">t</span>-test and pooled <span class="elsevierStyleItalic">t</span>-test&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> Prior to the study&#44; informed consent and explanation of the study were given to all respondents to get the approval&#46; This study also has been received permission and the ethical clearance from the Indonesian National Nurse Association Mojokerto &#40;No&#46;RK&#46;08&#47;KEPK&#47;STIKes-BS&#47;III&#47;2019&#41;&#46; The application of ethical principles during the research process based on respect for human dignity&#44; beneficence&#44; and justice&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The results of respondents&#8217; characteristics in both groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; show that the majority of respondents were female in both the intervention group &#40;73&#46;9&#37;&#41; and the control group &#40;66&#46;7&#37;&#41;&#46; The mean age of respondents in the intervention group was 21&#46;23 years&#44; and in the control group was 19&#46;75 years&#46; The majority of information obtained by the intervention group was from health workers&#47;lecturers &#40;44&#46;9&#37;&#41; and the control group &#40;46&#46;3&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">This study aimed to examine the effect of using the simulation method in disaster preparedness subject on nursing student&#39;s collaboration skills&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows that there is an improvement of collaboration skills among nursing students after receiving a simulation method in the intervention but not found in the control group that only received the usual method of teaching&#46; This study shows that there were significant differences in the collaboration abilities of nursing students before and after a disaster preparedness simulation &#40;<span class="elsevierStyleItalic">p</span>-value 0&#46;001<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; in the intervention group compared to those in the control group &#40;<span class="elsevierStyleItalic">p</span>-value 0&#46;162<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Preparing nurses for facing disasters is crucial for the ability and capacity to respond to emergencies and provide effective disaster response&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> This preparation should be started at the university stage&#46; Interactive methods and real experience are proven to be more effective in improving the skills of nursing students in learning about disaster preparedness&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> This current study shows that the simulation method is proven to have more impact on students&#8217; ability to perform collaboration with others&#46; In this study&#44; disaster-related perceptions from the participants were analyzed using the &#8220;disaster management&#8221; method&#46; The disaster management continuum is generally accepted as a method for dealing with all aspects related to the disaster&#46; Many models have been used to provide a continuum for disaster management&#46; The approach adopted in this study is consistent with the Velineema Disaster Nursing Timeline model&#44; where the disaster phases are classified into three components&#58; pre-incident&#44; which includes prevention&#47;mitigation and preparedness&#44; incident &#40;response&#41;&#44; and post-incidents&#44; which involve reconstruction&#47;rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Disaster management programs have been introduced and taught in many nursing schools in Indonesia because it is included in the national curriculum for the nursing institution&#46; However&#44; to make this learning more permanent&#44; this course must be delivered using appropriate methods&#46; Disaster drills or simulations provide opportunities for health care personnel to practice and assess their readiness to treat patients&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a> Many studies claim that nursing students who participate in disaster simulations learn to prioritize patient care during a disaster and know what to do and decided the most appropriate treatment for patients and community&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> Simulation-based training programs have a positive impact on the acquisition of skills&#44; performance&#44; and patient outcomes&#46; Simulation-based training also offers unique opportunities to overcome high risks and elaborate events in challenging environments where the operations team or students must be prepared to act quickly and effectively&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> This current study shows that nursing students who learn disaster preparedness using a simulation method can improve their collaborative skills among them&#44; where almost all participants expressed positive views about disaster simulation and training activities&#46; After the simulation&#44; the majority of students indicated that they agree that the simulation increased their knowledge and confidence in managing emergency preparedness events and in working in teams&#46; This result in line with a study in Tehran&#44; Iran&#44; that using a virtual social network can improve the knowledge and attitude of emergency nurses toward disaster preparedness&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Disaster preparedness can be achieved in two primary ways&#58; personal preparation and professional preparedness&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> Personal preparedness refers to the recognition of issues&#44; including family disaster plans and emergency cases&#44; emergency bags&#44; emergency communication cards&#44; and how to act correctly in cases of emergencies and evacuations&#46; There are various opinions about nurses&#8217; professional readiness of nurses during disasters&#46; During disasters&#44; nurses are expected to fulfill the role of medical practitioners in several respects&#46; This role is not the primary role in the scope of nursing practice in terms of their knowledge and abilities&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> However&#44; nurses need to be trained in disaster medicine to be assigned to medical tasks during an emergency response&#44; including triage and on-site intervention for victims with trauma&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> In this current study&#44; in the simulation and training activities&#44; participants were trained skills including triage&#44; interventions for victims with some trauma on-site&#44; interventions for injured patients&#44; teamwork&#44; and time management&#46; During the training&#44; participants had the opportunity to triage patients on location and to provide the first aid&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> To improve interpersonal collaboration skills for disaster preparedness&#44; education related to disasters must involve multidisciplinary health professionals team&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a> Although this study was conducted to nursing students&#44; the involvement of the local government disaster team &#40;BPBD team&#41; seems to contribute to the interprofessional collaborative skills and professional readiness of participants&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">One of the best ways to prepare nursing students for disasters is to involve them in collaboration exercises or simulation exercises&#46; Nursing schools need to incorporate this exercise into learning to improve student disaster preparedness&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a> The nursing faculty can collaborate with the local emergency coordinator and participate in area training&#46; In this study&#44; the local emergency planner&#44; BPBD&#44; is a partner in simulation and training activities&#46; This collaboration seems to have a positive effect on simulation activities and exercises&#46; Simulation activities carried out a variety of media and teaching aids&#46; In this research&#44; the researchers used a learning module to guide the implementation of interventions&#44; and the final results of this study obtained a simulation video played by all respondents in the intervention group that is used as a learning medium for other students and as a reference for further research&#46; The limitation of this research is in making the most in-depth simulation video in a place that follows the conditions of the disaster less supportive and no control group also become limitation of this study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">The results show that interactive methods such as simulation methods for disaster preparedness are more effective in improving the collaborative skill among nursing students&#46; Disaster preparedness simulation activities are activities that prepare nursing students to be able to know their role in disaster management and to practice skills in communicating&#44; collaborating&#44; understanding characters&#44; being responsible&#44; and skilled in conflict management&#46; This method can be recommended for nursing institutions as one of the learning methods combining with theoretical and practical fact-based fieldwork&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The Authors declare no conflict of interest&#46;</p></span></span>"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1459207"
          "palabras" => array:4 [
            0 => "Collaborative skills"
            1 => "Disaster nursing"
            2 => "Disaster preparedness"
            3 => "Simulation"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aims to analyze the improvement of collaboration skills among nursing students through disaster preparedness simulations&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study used a quasi-experimental pre-post-test with a control group design&#46; The intervention was conducted for three months&#44; and it had ten sessions with a sample of 69 respondents in each group&#46; The instrument in the research used The Interprofessional Collaborator Assessment Rubric &#40;ICAR&#41;&#46; Statistical tests applied paired <span class="elsevierStyleItalic">t</span>-test and pooled <span class="elsevierStyleItalic">t</span>-test&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results of the study obtain a <span class="elsevierStyleItalic">p</span>-value of 0&#46;001<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; which means that there is a significant effect of disaster preparedness simulations on collaboration skills among nursing students&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Collaboration skills among nursing students improved after being given a disaster preparedness simulation&#46; As a recommendation&#44; nurses can develop competencies related to disaster care and the role of health workers in the stages of a disaster&#44; which includes pre-disaster&#44; during the disaster&#44; and post-disaster&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Peer-review process of the 3rd International Nursing &#38; Health Sciences Students &#38; Health Care Professionals Conference &#40;INHSP&#41; 2019 is under the responsibility of the scientific committee of the 3rd International Nursing &#38; Health Sciences Students &#38; Health Care Professionals Conference &#40;INHSP&#41;&#46;</p>"
      ]
    ]
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Date&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Stages of implementation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Session&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">September 16 and 24&#44; 2019October 8 and 15&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preparation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Pre-test2&#46; Identification and mapping of infrastructure and facilities3&#46; Arrange clustering areas4&#46; Team formation5&#46; Develop a technical simulation proposal6&#46; Develop a simulation scenario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Each course<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 22&#8211;24&#44; 2019 point a-cOctober 29&#8211;31&#44; 2019 point d-fNovember 5&#8211;8&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Implementation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Team training<span class="elsevierStyleHsp" style=""></span>a&#46; Communication technique<span class="elsevierStyleHsp" style=""></span>b&#46; Collaboration<span class="elsevierStyleHsp" style=""></span>c&#46; Roles and responsibilities&#44;<span class="elsevierStyleHsp" style=""></span>d&#46; Patient&#47;client-family collaboration approach&#44;<span class="elsevierStyleHsp" style=""></span>e&#46; Team function<span class="elsevierStyleHsp" style=""></span>f&#46; Conflict management2&#46; Disaster simulation and supervision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2345678&#8211;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Team training each course<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>45<span class="elsevierStyleHsp" style=""></span>minDisaster simulation<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>180<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">November 19 and 26&#44; 2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evaluation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Preparation2&#46; Evaluation3&#46; Post-test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#177;45<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intervention schedule simulation&#46;</p>"
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        "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Respondent characteristics&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>SD<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Mean&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#46;23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;789</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">19&#46;75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;143</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Source of information about Disaster Nursing</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Health workers&#47;lecturers&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">46&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Family&#47;friends&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Media &#40;TV&#47;newspaper&#44; internet&#44; posters&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Did not get information from anyone&nbsp;\t\t\t\t\t\t\n
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Original language: English
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