**5. Discussions**

In this paper, we assessed the readiness of emergency nurses in the southern region of the KSA in the managemen<sup>t</sup> of public health emergencies, major incidents, and disasters. The reasons for such evaluation were the continuous exposure of the region to both man-made and natural disasters and the advanced educational backgrounds of the nursing staff.

The results of this study indicate a good preparedness in all theoretical dimensions of MID management, including emergency preparedness terms and activities, Incident Command Systems and their role in MID management, ethical issues in triage, epidemiology and surveillance, isolation and quarantine, decontamination, communication issues, psychological issues, managemen<sup>t</sup> of special/vulnerable populations, and assessment of critical resources. However, the nurses appeared to be uncertain about their skills and practical performance and the evaluation of their own abilities. These results are opposite to what was reported earlier from the KSA [16] and thus confirm a good theoretical knowledge and a need for practical opportunities. Bearing in mind that 93.5% of nurses had a BSN, 6% had an MSN, and 0.5% had a PhD in nursing and that most of the practicing nurses (66%) had more than five years of experience, these results might be indicative of a need for further educational initiatives to improve the skills and practical performance of all nurses working in the managemen<sup>t</sup> of MIDs [6–9].

The quantitative nature of this study and the collected data provide an understanding of the preparedness of nurses working at MOH hospitals in the southern region of the KSA and reveal both strengths and weaknesses that can be implementable and relevant in other regions and countries. The current COVID-19 pandemic has demonstrated di fficulties in MID management, such as resource scarcity and medical decision-making, which seem to be more complicated in practice than in theory [22]. The EPIQ questionnaire enabled the researchers to capture various dimensions of disaster preparedness and response in nursing environments [23]. However, the nurses' lack of confidence in their own skills and performance should be considered a critical shortcoming. Several studies have shown that healthcare workers who are confident in their own level of competence are more likely to react effectively in real crises than those who are not [24–28]. Nurses' theoretical knowledge, such as their ability to identify the signs and symptoms associated with highly infectious biological and chemical agents, is essential for enhancing disaster preparedness; however, this theoretical knowledge should be incorporated in practical performance to yield a robust preparedness. Proper education and training in an environment where nurses can act without hesitation, make mistakes with no harm to patients, and establish contact with necessary agencies without getting rejected will enable them to attain the required knowledge and skills to identify and report signs and symptoms that are unclear and to treat and intervene with necessary and evaluable measures [4,29–32]. Such performance and collaborative action will ensure their confidence in their response activities as key players in an MID.

Nurses' emergency preparedness is determined by their familiarity with their organisation's emergency operations plan (EOP), which allows them to follow the recommended procedures for crisis intervention from a healthcare perspective [33]. Nurses' knowledge of the ethical, legal, cultural, psychological, and safety dimensions of emergency response is critical for e ffective intervention and recovery [23,34]. Planning to address the needs of special populations is a strategic dimension of emergency response and recovery initiatives [17]. E ffective communication during an emergency is essential for ensuring nurses' collaboration with other stakeholders involved in a crisis event. The epidemiology and surveillance aspects of disaster managemen<sup>t</sup> require streamlined communication among various departments and agencies [17].

Most of the nurses in this study reported knowledge of and familiarity with all aforementioned dimensions. However, since MIDs are rare events, they have no chance to evaluate their theoretical and practical abilities in a real situation. Simulation exercises may o ffer a chance to examine these abilities in a safe environment with no harm to patients [4,35,36]. These exercises may also o ffer an opportunity to raise their awareness about pandemics, quarantine, isolation, the use of PPE, and other critical resources to foster recovery and minimise the spread of highly infectious diseases. A majority of nurses in this study understood the methods for isolation but lacked adequate knowledge concerning the community quarantine process and the impact it may have on the mental health of both a ffected people and workers. This finding supports earlier findings by McCarthy [23,37], which as part of building modern contemporary emergency nurses, argued the need for nurses to increase their understating of procedures performed and competency in practice. This shortcoming would be addressed in collaborative simulation exercises [4].

In this study, there was a significant correlation between qualification and the dimensions of emergency preparedness, epidemiology and surveillance, isolation and quarantine, and critical resources. These findings are in accordance with Gladston, who reported a significant correlation between nurses' perceptions and qualifications [38], and similar to studies showing statistically significant associations between the dimensions of psychological issues and age, qualification and experience [38–41].
