Disasters are circumstances or occurrences that are beyond the capabilities of the local community and necessitate asking for national or international aid. A catastrophe is an unforeseen, often unexpected occurrence that results in significant harm, devastation and suffering for people, according to data provided by the Center for Research on The Epidemiology of Disaster (CRED), it has been projected that a total of 396 natural disasters are expected to occur worldwide in the year 2019. 11,755 individuals have died, impacting more than 95 million people, at a cost to the GDP of $130 billion.

One of any nation's most important resources during a crisis are the health care professionals operating in different service areas [1].

Globally there is an increasing occurrence of both natural and man-made disasters, resulting in a growing magnitude of their detrimental impacts. The occurrence of infrastructure damage, many diseases, injuries and deaths may result in considerable suffering., health hazards and enormous economic costs on the front lines of disaster response, emergency nurses play an essential role. Low to moderate levels of current knowledge, Disasters are happening more often and these frontline personnel is reportedly less prepared, which is a problem that has to be addressed [2].

According to the World Health Organization's definition, a catastrophe refers to an event or situation that exceeds the magnitude of an emergency, resulting in the interruption of essential services such as shelter., transportation, communication, sanitation, water and healthcare. Furthermore, it necessitates the involvement of individuals beyond the affected community. The term "disaster" specifically denotes an occurrence that poses unanticipated, grave and immediate hazards to the well-being of the general public [3].

When triaging a trauma patient, it is crucial to consider many criteria including the patient's prehospital clinical history and vital signs, the cause of damage, the patient's age and any known or suspected comorbid disorders. Several findings, such as the variability in vital signs and the presence of several injuries, individuals at the extremes of age, indications of severe neurological damage and preexisting cardiac or pulmonary conditions, suggest the need for prompt investigation [4].

The process of triage holds significant value in the provision of care within emergency departments. The triage nurse plays a vital role as the first point of contact for emergency patients inside the emergency department, making them an essential member of the healthcare team. Therefore, it is crucial that the emergency nurse acquire the necessary expertise and experience. Furthermore, the triage procedure is initiated upon the patient's arrival at the emergency department and necessitates periodic reassessment as the patient progresses through the healthcare system, in order to guarantee the consistent and secure delivery of suitable care at an appropriate pace [5].

The Study's Importance

Nursing specialists in hospital and pre-hospital emergency care are essential to disaster response. Crisis situations force healthcare institutions to handle a patient rush that exceeds their capability, putting them at risk.

The use of triage in the Emergency Department (ED) has the potential to significantly cut mortality rates.

The triage nurse is often the initial healthcare professional that a patient encounter upon arrival at the Emergency Department seeking emergency care. The allocation of information among nurses, known as triage, is a crucial aspect of supervision and decision-making within the Emergency Department. When this process is not conducted at a standardized level, it can have detrimental effects on patient care outcomes and the overall efficiency of the Emergency Department. Triage nurses play a crucial role in the implementation of patient streaming in the Emergency Department, contributing to the reduction of patients' length of stay in this department. 

Cl in contrast, hospital emergency nurses play a crucial role as primary healthcare providers inside emergency rooms, offering prompt responses to various calamities. Individuals in this category constitute a significant portion of the population involved in the reception, evaluation and provision of care to individuals affected by catastrophic events. The results of a ten-year research investigation focused on assessing the degree of readiness within this specific demographic reveal a prevalent pattern characterized by a range of knowledge and perceived preparedness levels, mostly falling within the restricted to moderate spectrum, in the domain of disaster response.

An individual fulfilling the role of an emergency room nurse, sometimes referred to as an ER nurse, is a duly licensed nurse who has specialized expertise in providing healthcare services inside emergency department settings. The primary emphasis of medical therapy is directed towards patients who are experiencing traumatic or severe medical conditions that often pose a significant danger to their lives. The main responsibility of an emergency department nurse is the identification of medical conditions, evaluation of their severity and provision of immediate treatment to mitigate potential long-term consequences and, when required, save life. When a patient is brought into the emergency room, one of the first people who assists them is an emergency room nurse. 

Nurses are often the first medical professionals to examine a patient, even though doctors and specialists may do emergency procedures. Emergency room nurses are required to have the ability to analyze life-threatening circumstances and make decisions under pressure.

Objectives of the Study

• This study aimed to explore the level of nurse’s knowledge that nurses regarding disaster triage at Teaching Hospitals in Al-Nasiriyah city

• The study aims to: investigate correlation between level of nurse’s knowledge that nurses regarding disaster triage and some variables

Research Approach

The research employed a quantitative methodology. A quantitative methodology is employed to evaluate level of nurse’s knowledge who were working at emergency room toward disaster triage system and the correlation between nurse’s knowledge and some variables.

Design of the Study

To accomplish the above outlined aims, the present research used a concise quantitative design. A descriptive research methodology was used in the current study, covering the period from October 20, 2020, to April 1, 2021, at Teaching Hospitals located in Al-Nasiriyah city. The focus of the study was on in-hospital triage during emergency disasters.

Setting of the Study

The research was undertaken at two Teaching Hospitals in Al-Nasiriyah city:

• Al-Nasirayah teaching Hospital

• Al-Hussien teaching Hospital

Population

The research profiled male and female nurses at working in emergency room. The study included the participation of 100 nurses.

Sample

The present study employed a purposeful (non-probability) sampling technique and comprised a total of 100 nurse’s patients who were working in emergency room. The selection of the samples was based on the specified criteria:

• Those nurses working in emergency room

• Those who were have more than years of working at this place

• Nurses male and female

Administration Arrangement 

After receiving permission from the Training and Development Department of the Thi-qar Health Directorate would have the ultimate say on whether or not the research would be allowed to proceed. After that, presentations were given at AL-Hussein Teaching Hospital in Al-Nasiriyah city. As a direct consequence of the agreement take place.

Ethical Issues

The nurses provided their verbal agreement to participate in the study subsequent to the researcher's request. The collection of data was limited to only the information deemed essential for academic research purposes.

The Research Instruments

They were utilized during the period of the study. The investigation that was carried out by the researcher revealed that a questionnaire may be used to evaluate the level of knowledge that nursing staff members possess regarding catastrophe triage. The veracity of this assertion was substantiated by the discoveries made throughout the investigation. The objective of formulating the questionnaire was to conduct a comprehensive assessment of the prior research conducted on the topic of heart block awareness, as documented in scholarly publications. The purpose of this review was to enhance knowledge of heart block. The research instrument had two different components in its entirety. The connection between each subsequent component in the assembly was established.

Section I 

The demographics of nurses The demographic characteristics of individuals under consideration include age, gender, educational attainment and marital status. The duration of employment inside the hospital setting, the study examined the relationship between the duration of employment in the emergency department and the number of training courses completed by the participants.

Section II: Constructed Questionnaire for Assessment of Nurses' Knowledge about the Triage System of Study Sample

Which were consist from six domain (First Domain: The focus of assessing knowledge about the principles of triage, Second: The axis of knowledge assessment in the field of case triage , Third: the axis of knowledge assessment in the field of physical assessment during the triage system, Fourth: the axis of knowledge assessment in the field of nursing interventions, Fifth: the axis of knowledge assessment in the field of cardiopulmonary resuscitation and Sixth: the axis of evaluating knowledge related to the heart shock device) each domain have some items were deal with its goal of triage system.

Data Collection Procedure

As soon as it was established that the information was accurate, the researcher introduced himself to the subjects, gave them a brief rundown of the study and told them how crucial their participation would be. He walked the participants through the importance of the study and the next steps that must be taken to move forward. She explained to them that they could revoke their agreement at any time without any consequences and that they were under no duty to continue with the study. Also, He provided them with directions to the office that they were required to go to at that time. The participants in the study were given a brochure with information to read before they were asked for their consent to take part in the research. This was done so that the participants could be certain that they had an in-depth understanding of everything. The researchers provided the participants with time-breaking opportunities questionnaires, which they asked them to fill out in twenty to thirty minutes of their free time. There was a lower probability that the time or activities of the participants would be disrupted as a result of the situation.

Validity of the Questionnaire

The degree to which an instrument is able to reliably collect the kind of information for which it was developed is what is meant when it is referred to as having "validity." Evaluation of the clarity, relevance and suitability of the questionnaire in connection to the aims of the study is carried out by experts who have worked in their respective disciplines for a minimum of six years. As a consequence of this, there was a much reduced chance that the participants' schedules or activities would be interfered with.

Pilot Study was Conducted

A pilot study was done on a randomly selected sample of emergency nurses, representing 10% of the total population in the same environment. However, six nurses were removed from the study due to their refusal to participate. The objectives of the pilot project were to evaluate the clarity and applicability of the tool used to estimate the time required for questionnaire completion, as well as to identify any potential barriers that could impede data collection.

Reliability

On the basis of a key statistical parameter, the findings of the reliability analysis showed that the primary components of the questionnaire replies had a high degree of accuracy and internal consistency, as follows: The individual correlation coefficient was found to be 0.84 based on the findings of the Alpha Cronbach test.

Statistical Analysis

The data analyzed by applying statistical methods, using the SPSS version package (26).

Rating and Scoring

The item underwent evaluation and was assigned a score based on the following designs:

• The assessment of participants' knowledge on the catastrophe triage system in AL-Hussein Teaching Hospitals in Al-Nasiriyah city used a scoring system where each question was assigned a value of (2) for a correct response and (1) for an incorrect response 

• The questionnaire achieved a better score in the grading system (MS)

The data collected for this research were categorized into three levels of scale: High, Moderate and Low. 

These levels were assigned scores of 2, 1 and 1 correspondingly. The cutoff point was determined. The cutoff threshold, denoted as 0.33, was used to categorize the scores of the responses as follows:

• The value of high can be calculated by subtracting 2 from 1.68

• The range for the moderate category is defined as 1.34 to 1.67, while the range for the low category is defined as 1 to 1.33

• In relation to the practice of each, it is important to consider the mean score (M.S) together with its corresponding standard deviation (S.D) and frequency (f)

*Analysis of the statistical data using inferences: (Pearson correlation)

Limitations and Challenges

It is probable that the results that were given in this study are not generalizable to other hospitals in Iraq since the research was only conducted at Regarding Catastrophe Triage System in AL- Hussein Teaching Hospitals in Al- Nasiriyah city. This is a possibility because the research was carried out at AL- Hussein Teaching Hospitals. In addition, there is a paucity of research that is comparable to this both in the immediate geographic area and in the nations that are located in other regions.

Table 1 shows that 100 nurses, or 47% of the sample population, were in the age range of 26-30 years, with a mean age of 23.5 years. In terms of gender, 57 nurses, or 57.0% of the sample size, are male, making up the most of the research sample. Regarding educational level, the results showed that most of participants have Institute Nursing department, as shown by the 36 nurses (36.0%) among all study sample. Regarding the social Status of the nurses who were participants in this study were married accounted for (60.0%) all of them, regarding to the number of years of work in the hospital the most of study sample were have (1-5) years of services consist about (62.0%) of all sample, The number of years of work in emergency room the most of study sample were have (1-5) years of services consist about (72.0%) of all sample and finally relatively to the number of coarse of training participants were most of the answer with no.

Table 2, show summary statistical of sample regarding assessment of nurses' knowledge about the triage system of study Sample were revealed that most of response within moderate level of assessment, also that overall evaluation of nurse’s knowledge been moderate.

Findings exhibit there were no correlation between overall assessment of nurses' knowledge about the triage system and demographic characteristics, Except the were strong positive overall assessment of nurses' knowledge about the triage system and demographic characteristics and educational level at **. Correlation is significant at the 0.01 level (2-tailed) (Table 3).

Discussion of Sociodemographic Characteristics of Participants

According to Table 1 shows that 100 nurses, or 47% of the sample population, were in the age range of 26-30 years, with a mean age of 23.5 years. These results not come agree within age but agree with gender with study done by [4], in which mention that Men made up 56.8% of participants, with a mean age of 34.8 6.6 years. In terms of gender, 57 nurses, or 57.0% of the sample size, are male, making up the most of the research sample. Regarding educational level, the results showed that most of participants have Institute Nursing department, as shown by the 36 nurses (36.0%) among all study sample these results agree with study results done by [6], that mention that majority of (51%) were graduated from medical institutes.

Table 1: Shows The Distribution of the (100) Nurses

F: Frequency, %: Percent

Summary Statistical of Sample Regarding Assessment of Nurses' Knowledge about the Triage System of Study Sample

Table 2, show summary statistical of sample regarding assessment of nurses' knowledge about the triage system of study Sample were revealed that most of response within moderate level of assessment , Also that overall evaluation of nurses knowledge been moderate there is consistent come from study in Iran done by [7], in which mention that The nurses engaged in the emergency departments at Shahid Sadoughi University of Medical Sciences in Yazd possess a moderate level of understanding with regards to triage. Nevertheless, the performance of nurses employed in the emergency departments of the aforementioned healthcare facilities above the standard average. The present analysis suggests that there exists a pressing imperative to reassess the educational framework pertaining to nurses' triage training, with the aim of enhancing their knowledge and performance in the field of triage there is evidence of agreement within study done by [8], A moderate degree of triage competence was observed in slightly more than half of the individuals (52.9%).

Table 2: Summary Statistical of Sample Regarding Assessment of Nurses' Knowledge about the Triage System of study Sample

M.S.: Mean of score, S.D: Standard, Eval: Evaluation, No: Number of domain, Level of Evaluation: (1-1.33) = Low (L) ;( 1.34-1.67): Moderate (M); (1.68-2.00): High(H)

Discussion of Correlation between Overall Assessment of Nurses' Knowledge about the Triage System and Demographic Characteristics. (n = 100) Nurses

Findings exhibit there were no correlation between overall assessment of nurses' knowledge about the triage system and demographic characteristics, Except the were strong positive overall assessment of nurses' knowledge about the triage system and demographic characteristics and educational level at **. Correlation is significant at the 0.01 level (2-tailed), there is agreement come from study done by [8], that revealed that A significant and robust correlation was seen between the amount of triage knowledge and skill among nurses (r = 0.68, p .01). There exists a considerable correlation between one's knowledge pertaining to triage, educational attainment and prior training experience and their proficiency in doing triage, also that not agree from study done within [9], that said there were no statistically significant variations observed in the average total scores across different age groups, levels of education, years of nursing experience, or years of experience in the emergency department (Table 3).

Table 3: Correlation between Overall Assessment of Nurses' Knowledge about the Triage System and Demographic Characteristics. (n = 100) Nurses

**. Correlation is significant at the 0.01 level (2-tailed)

Conclusions from the research are as follows:

• The most of study sample at age 26-30 years’, with a mean age of 23.5 years a male

• The overall assessment of nurses’ knowledge toward triage system in emergency room were moderate

• There is no correlation between overall assessment of the nurses’ knowledge toward triage system at emergency room within demograpgics variables except found that were strong positive correlation between education level of nurse and overall assessment of the nurses’ knowledge toward triage system at emergency room at **. Correlation is significant at the 0.01 level (2-tailed)

Recommendations

The current study results analysis indicates a need to reevaluate the educational framework around nurses' triage training in order to improve their understanding and proficiency in the emergency room triage system., to enhance ED triage performance, adequate, timely in-service training is necessary to ensure new employees are informed and veteran staff have their knowledge and abilities reinforced.

1. Azizpour, I. et al. “Disaster preparedness knowledge and its relationship with triage decision-making among hospital and pre-hospital emergency nurses - Ardabil, Iran.” BMC Health Services Research, vol. 22, no. 1, 2022, pp. 1–10. https://doi.org/10.1186/s12913-022-08311-9

2. Amberson, T. et al. “Increasing disaster preparedness in emergency nurses: A quality improvement initiative.” Journal of Emergency Nursing, vol. 46, no. 5, 2020, pp. 654–665.e21. https://doi.org/10.1016/j.jen.2020.05.001

3. Brinjee, D. et al. “Identify the disaster nursing training and education needs for nurses in Taif City, Saudi Arabia.” Risk Management and Healthcare Policy, vol. 14, 2021, pp. 2301–2310. https://doi.org/10.2147/rmhp.s312940

4. Sherafat, A. et al. “Evaluation of emergency nurses’ knowledge and performance about hospital triage.” Journal of Pharmaceutical Research International, 2019, pp. 1–7. https://doi.org/10.9734/jpri/2019/v27i530182

5. Bahlibi, T.T. et al. “Effect of triage training on the knowledge application and practice improvement among the practicing nurses of the emergency departments of the national referral hospitals, 2018: A Pre-Post Study in Asmara, Eritrea.” BMC Emergency Medicine, vol. 22, no. 1, 2022, pp. 1–8. https://doi.org/10.1186/s12873-022-00755-w

6. Muhasin Naser, A. et al. “Determination knowledge of nurses’ concerning measurement of blood pressure in emergency department at Al-Hussein teaching hospital in Al-Nasiriya city.” Medico-Legal Update, vol. 20, no. 1, n.d.

7. Sherafat, A. et al. “Evaluation of emergency nurses’ knowledge and performance about hospital triage.” Journal of Pharmaceutical Research International, 2019, pp. 1–7. https://doi.org/10.9734/jpri/2019/v27i530182

8. Kerie, S. et al. “Triage skill and associated factors among emergency nurses in Addis Ababa, Ethiopia 2017: A cross-sectional study.” BMC Research Notes, vol. 11, no. 1, 2018. https://doi.org/10.1186/s13104-018-3769-8

9. Moceri, J.T. and D.J. Drevdahl. “Nurses’ knowledge and attitudes toward pain in the emergency department.” Journal of Emergency Nursing, vol. 40, no. 1, 2014, pp. 6–12. https://doi.org/10.1016/j.jen.2012.04.014