Background: Nurses play a crucial role in health emergencies, such as pandemics, bioterrorism, and natural disasters, but many gaps exist in the biosecurity and emergency preparedness training for nurses around the world - especially for vulnerable communities in low-resourced settings. Aim: This integrative review evaluates the efficacy of nurse education on biosecurity and health emergency preparedness, examining their nature in nurse education, what they measure, what they assess, what issues exist, and how the findings can be used to make evidence-based, relevant changes. Methods: 27 studies from 2015-2025 were synthesized from PubMed, CINAHL, Scopus, Web of Science, and EMBASE with a focus on education modalities, competency domains, and evaluation. Data were analyzed thematically and descriptively using descriptive and inferential statistics, and quality was appraised using the Mixed Methods Appraisal Tool. Results: Simulation-based education improved knowledge (10% to 30% improvement), skills (p=0.027), and confidence (70% reported a higher perceived preparedness). Simulation training was a better educational modality than a lecture. Low baseline levels of knowledge were noted (78% with no familiarity with any protocols), which were particularly low for bioterrorism-specific education (15% described potential agents correctly pre-education). The DPET and EPIQ measures were both valid and reliable measures of competencies but did not measure the competence specific to bioterrorism. The missing themes in the findings included an absence of exposure to training, standardization for standards of practice, or competency, with no discussion of mental readiness for emergencies that require equivalent faculty support. Conclusion: Simulation-based education and standardization improve nurse preparedness and readiness, although education relating to bioterrorism scenarios and equipping mental health capacity for nurses is essential prior to a public health emergency.
Alzahrani et al. (Wed,) studied this question.