Climate-Resilient Disaster Preparedness Education to Strengthen Undergraduate Nurses' Critical Care-Relevant Skills: A Quasi-Experimental Study From Saudi Arabia.

BACKGROUND: Climate-related disasters are increasingly associated with mass-casualty incidents, infectious surges and infrastructure disruption, creating rapid escalation to critical illness and sudden increases in demand for emergency and critical care nursing. Undergraduate nursing programmes often provide limited structured preparation for disaster triage, resuscitation, safe evacuation and team-based coordination under resource constraints. AIM: This study aimed to evaluate the impact of a climate-resilient disaster preparedness education programme on undergraduate nursing students' knowledge and critical care-relevant clinical skills to strengthen workforce readiness for climate-amplified emergencies. STUDY DESIGN: A quasi-experimental pre-test/post-test control group design was adopted among undergraduate nursing students to examine change following a structured educational intervention. The intervention comprised eight sessions integrating brief didactic content, case-based discussions, skills-laboratory practice, and simulation focused on disaster cycle management and climate resilience. Knowledge was measured using an adapted disaster preparedness evaluation instrument, and skills were assessed through objective structured clinical examinations (OSCEs) targeting triage, immediate life support, evacuation and transport of deteriorating patients, infection prevention and control, interprofessional communication and psychosocial first aid. RESULTS: In total, data from 157 participants were included in the final analysis (intervention n = 78; control n = 79). Groups were comparable at baseline. The findings demonstrated significant post-intervention gains in the intervention group compared with controls in both knowledge and skills. Knowledge scores increased to 34.7 ± 2.8 versus 23.1 ± 3.0 out of 40 (p < 0.001), and OSCE performance improved to 77.2 ± 6.1 versus 44.3 ± 5.5 out of 100 (p < 0.001). Improvements were most pronounced in rapid prioritisation/triage, resuscitation actions under surge conditions, and safe transport and infection control-competencies closely aligned with emergency and critical care surge response. Gains were largely maintained at 4-week follow-up, suggesting short-term retention of both cognitive and performance outcomes. CONCLUSIONS: A structured climate-resilient disaster preparedness programme can meaningfully strengthen nursing students' knowledge and practical competencies directly transferable to emergency and critical care contexts. Embedding climate resilience within simulation-based disaster education may support scalable workforce preparation for climate-related events that precipitate critical illness surges. RELEVANCE TO CLINICAL PRACTICE: The findings highlight the need to integrate climate-informed disaster preparedness into nursing curricula using simulation and competency-based assessment. This approach can improve triage accuracy, resuscitation readiness, infection control and coordinated team communication-skills essential for critical care nurses managing surge capacity and deteriorating patients during climate-amplified emergencies.