Effect of Tabletop Exercises on Nurses’ Chemical, Biological, Radiological, and Nuclear Preparedness: A Quasi-Experimental Study

Background Chemical, biological, radiological, and nuclear (CBRN) emergencies pose major global health threats, especially in geopolitically sensitive and disaster-prone regions. Nurses, as key frontline responders, must possess sufficient knowledge, a positive attitude, and operational readiness to effectively manage such high-risk events. Simulation-based education—particularly tabletop exercises (TTEs)—is increasingly recognized as an effective method to enhance disaster preparedness in healthcare settings. Objective This study evaluated the effectiveness of a CBRN-focused TTE in improving nurses’ knowledge, attitude, and preparedness in a hospital environment. Methods A quasi-experimental one-group pretest-posttest design was employed involving 60 hospital nurses in Iran. Participants completed validated tools measuring CBRN-related knowledge (26 items), attitude (11 Likert-scale items), and preparedness (modified 45-item Emergency Preparedness Information Questionnaire). A structured tabletop scenario was conducted, followed by re-assessment 1 week later. Paired t-tests and Pearson correlation analyses were performed. Results post-intervention analysis revealed statistically significant improvements across all domains: knowledge (mean difference = + 8.13, 18.5% improvement, P < .001), attitude (+2.35, 10.0% improvement, P = .039), and preparedness (+30.04, 32.4% improvement, P < .001). Conclusion TTEs effectively improve nursing competencies related to CBRN response. Findings indicate that preparedness showed the greatest relative improvement, supporting the integration of TTEs into regular professional development programs to build readiness capacities.