Skip to main content Accessibility help

Disaster and Emergency Management: Canadian Nurses' Perceptions of Preparedness on Hospital Front Lines

  • Tracey L. O'Sullivan (a1) (a2), Darcie Dow (a2), Michelle C. Turner (a3), Louise Lemyre (a4) (a5), Wayne Corneil (a2) (a4), Daniel Krewski (a3) (a6), Karen P. Phillips (a1) (a2) and Carol A. Amaratunga (a1) (a6) (a7)...



Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units.


The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness.


Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts and e-mail notices to complete a 30-minute online survey.


A total of 1,543 nurses completed the survey (90% female; 10% male). The results indicate that nurses feel unprepared to respond to large-scale disasters/attacks. The sense of preparedness varied according to the outbreak/disaster scenario with nurses feeling least prepared to respond to a CBRN event. A variety of socio-demographic factors, notably gender, previous outbreak experience (particularly with SARS), full-time vs. part-time job status, and region of employment also were related to perceptions of risk. Approximately 40% of respondents were unaware if their hospital had an emergency plan for a large-scale outbreak. Nurses reported inadequate access to resources to support disaster response capacity and expressed a low degree of confidence in the preparedness of Canadian healthcare institutions for future outbreaks.


Canadian nurses have indicated that considerably more training and information are needed to enhance preparedness for frontline healthcare workers as important members of the response community.


Corresponding author

Honours Bachelor of Health Sciences Program, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, K1N 6N5 Canada E-mail:


Hide All
1. DiGiovanni, C, Conley, J, Chiu, D, Zaborski, J: Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. Biosecur Bioterror 2004; 2:265272.
2. Maunder, R: The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned. Philos Trans R Soc Lond B Biol Sci 2004;359:11171125.
3. Nickell, LA, Crighton, EJ, Tracy, CS, et al. Psychosocial effects of SARS on hospital staff: Survey of a large tertiary care institution. CMAJ 2004;170(5):793798.
4. Public Health Agency of Canada. Canadian Pandemic Influenza Plan for the Health Sector. 2006. Available at: Accessed 03 October 2007.
5. O'Sullivan, TL, Amaratunga, CA, Hardt, J et al.,: Are we ready? Evidence of support mechanisms for Canadian health care workers in multi-jurisdictional emergency planning. Journal of Emergency Management 2007;5(4):2328.
6. Statistics Canada: Canadian Community Health Survey. Available at: Accessed 30 October 2006.
7. Corneil, W, Lemyre, L, Barette, J, et al: The health status of executives in the public service of Canada: Apex 2002 study, Association of Professional Executive of the Public Service of Canada. Available at 12 October 2007.
8. SAS Institute Inc. SAS/STAT Software. Available at Accessed 01 June 2007.
9. Rose, MA, Larrimore, KL: Knowledge and awareness concerning chemical and biological terrorism: Continuing education implications. J Contin Educ Nurs 2002;33:253258.
10. Karz, AR, Nekorchuk, DM, Holck, PS et al. ,: Hawaii physician and nurse bioterrorism preparedness survey. Prehospital Disast Med 2006:21(6):404411.
11. Mas, FS, Hsu, CE, Jacobson, H et al,: Physician assistants and bioterrorism preparedness. Biosecur Bioterror 2006;4(3):301306.
12. Hall, MJ, Norwood, AE, Ursano, RJ, Fullerton, CS: The psychological impacts of bioterrorism. Biosecur Bioterror 2003;1(2):139144.
13. RAND Corporation: Understanding how terrorists think, RAND Terrorism and Homeland Security Congressional Newsletter. May 2007. Available at Accessed 08 November 2007.
14. Lemyre, L, Turner, MC, Lee, JEC, Krewski, D: Differential perception of chemical, biological, radiological and nuclear terrorism in Canada. Int J Risk Assessment and Management 2007; in press.
15. Becker, BH: Emergency communication and information issues in terrorist events involving radioactive materials. Biosecur Bioterror 2004, 2:195207.
16. Krewski, D, Lemyre, L, Turner, MC et al,: Public perception of population health risks in Canada: Health hazards and sources of information. Human and Ecological Risk Assessment 2006;12:626644.
17. National Council on Radiation Protection and Measurements: Management of terrorist events year radioactive material. 2001(Report No.138). Available at: Accessed 24 May 2008.
18. Glik, D, Harrison, K, Davousi, M, Riopelle, D: Public perceptions and risk communications for botulism. Biosecur Bioterror 2004;2:216223.
19. Henderson, JN, Henderson, LC, Raskob, GE, Boatright, DT: Chemical (VX) terrorist threat: public knowledge, attitudes, and responses. Biosecur Bioterror 2004;2:224228.
20. Wray, R, Jupka, K: What does the public want to know in the event of a terrorist attack using plague? Biosecur Bioterror 2004;2:208215.
21. Drenkard, K, Rigotti, G, Hanfling, D: Healthcare systems disaster preparedness, part 1. JONA 2002;32:461469.
22. Mondy, C, Cardenas, D, Avila, M: The role of an advanced practice public health nurse in bioterrorism preparedness. Public Health Nurs 2003;20(6):422431.
23. Rendin, RW, Welch, NM, Kaplowitz, LG: Leveraging bioterrorism preparedness for nonbioterrorism events: A public health example. Biosecur Bioterror 2005;3:309315.
24. Bartley, BH, Stella, JB, Walsh, LD. What a disaster?! Assessing utility of simulated disaster exercise and educational process for improving hospital preparedness. Prehospital Disast Med 2006;21(4):249255.
25. Finucane, M, Slovic, P, Mertz, C: Gender, race, and perceived risk: The ‘white male’ effect. Health Risk Soc 2000;2:159172.
26. Dosman, D, Adamowicz, W, Hrudey, S: Socioeconomic determinants of health and food safety-related risk perception. Risk Anal 2001;21:307317.
27. Lemyre, L, Turner, MC, Lee, JC, Krewski, D: Public perception of terrorism threats and related information sources in Canada: Implications for the management of terrorism risks. Journal of Risk Research 2006;9(7):755774.
28. Lerner, J, Gonzalez, R, Small, D, Fischoff, B: Effects of fear and anger on perceived risks of terrorism: A national field experiment. Psychol Sci 2003;14:144150.
29. Sjoberg, L: The perceived risk of terrorism. SSE/EFI Working Paper Series in Business Administration 2002;11.
30. Lemyre, L, Lee, JEC, Turner, MC, Krewski, D: Terrorism preparedness in Canada: A public survey on perceived institutional and individual response to terrorism. Int J Emergency Management 2007;4(2):296315.
31. Fischoff, B, Slovic, P, Lichtenstein, S et al. ,: How safe is safe enough? A psychometric study of attitudes towards technological risks and benefits. Policy Science 1978;9:127152.
32. Slovic, P: Perception of risk. Science 1987;236:280285.
33. Nickell, LA, Crighton, EJ, Tracy, CS et al,: Psychosocial effects of SARS on hospital staff: survey of a large tertiary care institution. CAMJ 2004;170(5):793798.
34. Wynd, CA: A proposed model for military disaster nursing. OJIN 2006;11(3):5.
35. Campbell, A: The SARS Commission. Spring of Fear: Executive Summary. 2006:1-62. Available at Accessed 20 February 2007.
36. Amaratunga, CA, O'Sullivan, TL, Phillips, KP et al: If schools are closed, who will watch our kids? Family caregiving and other sources of role conflict among nurses during large-scale outbreaks. Accepted for publication in Prehospital Disast Med, 09 March, 2008.
37. Amaratunga, C, Carter, M, O'Sullivan, T et al: Caring for nurses in public health emergencies: Enhancing capacity for gender-based support mechanisms in emergency preparedness planning. Ottawa: Canadian Policy Research Networks, 2008.
38. Gebbie, KM, Qureshi, KA: A historical challenge: Nurses and emergencies. OJIN 2006;11(3):2.
39. Krewski, D, Lemyre, L, Dallaire, C et al: Public perception and acceptable levels of health risk among Canadians. Report prepared for Health Canada. 2005.
40. Gebbie, KM, Qureshi, KA: Emergency and disaster preparedness: Core competencies for nurses. Am J Nurs 2002;102(1):4651.
41. Lenaghan, PA, Smith, PW, Gangahar, D: Emergency preparedness and bioterrorism: A survey of the Nebraska Medical Center staff and physicians. J Emerg Nurs 2006;32:394397.
42. Weiner, E, Irwin, M, Trangenstein, P, Gordon, J: Emergency preparedness curriculum in nursing schools in the United States. Nurs Educ Perspect 2005;26:334339.
43. Rebmann, T: Defining bioterrorism preparedness for nurses: Concept analysis. J Adv Nurs 2006;54:623632.
44. ONA/OPSEU: Final Recommendations to Justice Campbell regarding: Occupational Health and Safety Matters Arising from SARS. 2004. Available at Accessed 13 December 2006.
45. Canadian Institute of Health Information (CIHI): Highlights from the Regulated Nursing Workforce in Canada, 2006. Available at Accessed 09 November 2007.
46. Canadian Institute of Health Information (CIHI): Health Care in Canada 2007. Available at Accessed 09 November 2007.
47. Fahlgren, TL, Drenkard, KN: Healthcare systems disaster preparedness, part 2. JONA 2002;32:531537.


Disaster and Emergency Management: Canadian Nurses' Perceptions of Preparedness on Hospital Front Lines

  • Tracey L. O'Sullivan (a1) (a2), Darcie Dow (a2), Michelle C. Turner (a3), Louise Lemyre (a4) (a5), Wayne Corneil (a2) (a4), Daniel Krewski (a3) (a6), Karen P. Phillips (a1) (a2) and Carol A. Amaratunga (a1) (a6) (a7)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed