Digital Repository Masters Theses Spring 2026 Home Health Nurses' Emergency Response Chad Chambers Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Chambers, C. 2026.Home Health Nurses' Emergency Response. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Home Health Nurses' Emergency Response Project Title by Chad Chambers Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 19, 2026 Date Chad Chambers 4/19/26 Student Name, Credentials (electronic signature) Date 5/28/26 MSN Project Faculty (electronic signature) Date 6/9/26 Anne Kendrick (electronic signature) DNP, RN, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Home Health Nurses’ Emergency Response Chad Chambers Annie Taylor Dee School of Nursing Weber State University Amber Fowler MSN Project 04/19/2026 2 Abstract Purposes/Aims: The purpose of this project is to implement a standardized disaster preparedness toolkit and a structured nurse education program to improve emergency preparedness among rural home health patients receiving skilled nursing services. Rationale/Background: Rural homebound patients face increased vulnerability during disasters due to limited mobility, geographic isolation, reduced hospital access, and lack of formal emergency preparedness planning within home health agencies. Research shows that disaster nursing competencies, structured education, and patient self-sufficiency tools improve preparedness and resilience during disasters. However, standardized processes to support home health patients during emergencies remain limited. Methods: Using the Advancing Research and Clinical Practice through Close Collaboration (ARCC) model, this project will implement a nurse-led emergency preparedness toolkit with a structured staff education session. Organizational readiness will be assessed, nurses will be trained to use the toolkit, and pre- and post-surveys will measure changes in knowledge, confidence, and preparedness. Results: The implementation of the toolkit and standardized education will increase nurses’ knowledge, confidence, and perceived preparedness to provide disaster preparedness education to home health patients. Conclusions: Standardizing emergency preparedness education in home health may improve disaster resilience, reduce strain on rural healthcare systems, and enhance nursing leadership in community emergency response. Keywords: disaster preparedness, home health nursing, rural health, emergency toolkit, evidencebased practice. 3 Home Health Nurses’ Emergency Response During natural or man-made disasters, hospitals can be overwhelmed, and at full capacity, and rural patients who are homebound and require medical attention may not receive adequate care (Franzosa et al., 2022). Many patients live alone, face mobility limitations, or have complex medical diagnoses. When disaster strikes, the inability to evacuate or seek medical assistance can lead to severe health complications (Lessinnes et al., 2023). The rural home health patient’s ability to access medical care is complicated. “Improving disaster nursing locally and worldwide requires a multifaceted approach, starting with enhancing nurses’ understanding of core competency domains. Integrating these domains into training and disaster drills helps reinforce practical skills, ensuring efficient and effective responses in real-life disaster situations” (Al Thobaity, 2024). In home health services, healthcare professionals can see patients in rural communities during disasters. This project aims to promote emergency preparedness among home care patients through a nurse-led emergency toolkit. Statement of Problem Patients in rural communities may not have access to hospitals during disasters. Inability to access the hospital, the hospital reaching capacity, and a lack of coordination or knowledge of emergency response all impact a patient’s emergency access to healthcare (Al Thobaity, 2024). Depending on the type of disaster, homebound patients in rural areas will not be able to get the medical attention they need. However, when nurses working for home health agencies are prepared to respond, they can increase patients' access to healthcare (Zhu et al., 2025). A toolkit for patients to utilize during emergencies will be crucial in emergency response (Lessinnes et al., 2023). 4 Understanding what home health agencies are doing to prepare for such emergencies will be essential. Certain patients may require skilled care, while others may need supplies (Shang et al., 2020). When disasters disrupt patient care, home health nurses can provide access to treatments in rural areas. The goal of this project is to modify existing strategies within home health agencies to prepare for emergencies, including the development of a patient toolkit. The better prepared the community is for emergencies, the more equipped the response will be to support recovery and protect lives. Significance of the Project Home health nurses can help their patients prepare for disasters. Home health agencies help bridge the gap between patients and healthcare systems during disasters, although many lack emergency preparedness procedures (Zhu et al., 2025). Home health agencies are disconnected from hospital networks and require distinct emergency preparedness resources (Franzosa et al., 2022). Providing training for home health nurses to implement a patient toolkit on emergency preparedness will empower home health patients during disasters (U.S. Department of Veterans Affairs, 2025). During disasters, hospitals can be overwhelmed with patients. Home health nurses can help prepare patients to remain in their homes, thereby reducing hospital demand (Franzosa et al., 2022). Patients in rural communities often face challenges accessing hospitals due to long distances and limited transportation options, as well as the closure of hospitals (Al Thobaity, 2024). When patients have the necessary resources, supplies, and preparedness plans during disasters, they can manage their care at home without overwhelming nearby hospitals. Patients requiring home health care are more exposed to disasters because they are immobile and 5 homebound (Lessinnes et al., 2023). Home health patients' inability to evacuate creates complications and delays for care, including serious health problems that can occur during disasters (Lessinnes et al., 2023). Creating a toolkit will prepare these homebound patients to remain at home and away from hospitalization. Homebound patients face higher risks during disasters due to limited hospital access, mobility issues, and complex diagnoses, which can lead to increased complications with delayed care. By strengthening home health care with toolkits, patients can be more prepared for disasters, improving their health outcomes and reducing the strain on hospitals. Review of the Literature This literature review aims to examine current evidence on emergency preparedness strategies for patients receiving home health care in rural communities. Patients in rural communities may not have access to hospitals during disasters. Inability to access the hospital, reaching capacity, and a lack of coordination or knowledge of emergency response all affect a patient’s access to emergency healthcare (Al Thobaity, 2024). Depending on the type of disaster, homebound patients in rural areas may not receive the medical attention they need. Themes found in the literature review include barriers to emergency access in rural areas, the role of home health organizations in disaster readiness, and practical patient education/self-sufficiency and preparedness tools, such as implementing a toolkit. The PICOT question is: With home health patients receiving skilled nursing, how does providing a standardized disaster preparedness toolkit, compared with the current practice, improve disaster preparedness within 3 months? 6 Framework The Advancing Research and Clinical Practice through Close Collaboration (ARCC) change model is an appropriate framework to guide this project. According to Dusin et al. (2023), the steps of the ARCC model are: assessing the healthcare organization's readiness for change; identifying potential and actual barriers and facilitators; identifying evidence-based practice champions; implementing evidence-based practice in the clinical setting; and evaluating EBP outcomes. This model emphasizes organizational readiness, which is essential for successfully initiating and sustaining change (Dusin et al., 2023). In applying the ARCC model to this project, the first step would be to assess whether the home health organization is prepared to make the necessary changes. Evaluating readiness ensures that resources, leadership support, and staff engagement are in place before implementation starts. Evaluating readiness can be done through an assessment survey. After recognizing an organization's readiness, the next step would be to identify potential and actual barriers and facilitators that could help the project succeed. Barriers might include resistance to the change or limited training. Facilitators could provide strong leadership roles to support the project. The next step would be to identify EBP champions within the organization, which is crucial for promoting and supporting the change. These EBP champions can be clinical leaders, nurses, or educators. They will be able to motivate staff and promote collaboration while helping the organization to overcome resistance. The next step is to implement evidence into practice by introducing a toolkit. This toolkit will include evidence-based interventions designed to improve patient emergency preparedness during disasters. 7 The last step is to evaluate the EBP outcomes, which is essential to determine the effectiveness of the interventions. The EBP outcomes can be evaluated by analyzing survey data collected after implementing the toolkit. The post-implementation surveys will assess whether staff members have increased confidence in emergency response and if patients utilized the toolkit. Strengths and Limitations The ARCC model helps organizations implement practice change in the most effective way (Melnyk & Fineout-Overholt, 2023, p. 486). An organization's readiness for change will determine the strength of this change model and EBP champions (Melnyk & Fineout-Overholt, 2023, p. 487). Some limitations include the ARCC model's resource intensity, requiring time and training (Dusin et al., 2023). To mitigate this limitation, the project could be implemented in phases, each with a specific goal to improve efficiency in time and training. This change model will be applied to the proposed project, utilizing evidence-based interventions and the toolkit. The emphasis on mentorship and evaluation directly applies to the project proposed. Search Strategies A literature search was conducted using PubMed, CINAHL, and Weber State University’s Stewart Library’s OneSearch and Advanced Search functions to identify peerreviewed articles related to the PICOT question on disaster preparedness among home health nurses and their patients. The articles searched were limited to peer-reviewed articles published between 2018 and 2025 to ensure that the information was up-to-date and relevant. Search terms came from the PICOT question, which included the keywords: (“home health” OR “home healthcare” OR “home care”) AND (“patients” OR “recipients of skilled nursing”) AND 8 (“disaster preparedness” OR “disaster planning”) AND (“toolkit” OR “preparedness toolkit”). The articles chosen were limited to those written in English and available in full text. Synthesis of the Literature Three themes emerged from the literature review regarding patients receiving skilled nursing at home for emergency preparedness. The themes are: 1) barriers to emergency access in rural areas, 2) the role of home health organizations in disaster readiness, and 3) practical patient education/self-sufficiency and preparedness tools. Barriers to Emergency Access in Rural Areas Patients living in rural communities face barriers that hinder emergency response during disasters. Patients enrolled in home health care are typically homebound, meaning they are unable to leave their homes. During disasters such as floods, storms, power outages, and epidemics, homebound patients face additional risks (Lessinnes et al., 2023). Rural communities will have fewer health care providers and fewer facilities, such as emergency rooms and hospitals (Shang et al., 2020). Rural areas often have inadequate transportation options for patients and face challenges in retaining healthcare workers (Franzosa et al., 2022). Home health agencies in rural areas face challenges in maintaining an adequate supply of resources during emergencies (Franzosa et al., 2022; Xue et al., 2020). The distribution of resources raises ethical concerns regarding rural communities, as urban areas often require more Personal Protective Equipment (PPE) due to their higher population density (Al Thobaity, 2024; Shang et al., 2020). In rural communities, patients often rely on home health services for convenience and because they are homebound. This creates a challenge during disasters. Lessinnes et al. (2023) 9 report that home health agencies often lack formalized disaster plans and staff training in protocols. Patients who are unprepared for emergencies will experience negative health impacts compared to those who overcome barriers (Lessinnes et al., 2023). Home health services should prioritize emergency preparedness to be more effective in rural communities for future disasters (Lessinnes et al., 2023). Rural home health agencies will face less competition for PPE, but this is due to fewer health care facilities, which also reduces the initial PPE available (Franzosa et al., 2022; Shang et al., 2020). Along with fewer facilities, the opportunity to travel is more difficult because patients are homebound and geographically isolated. Because leaving home can be a considerable and taxing effort, homebound patients benefit from receiving home-based care through home health agencies, thereby avoiding hospitalizations, emergency department visits, and long-term care placements (Franzosa et al., 2022). Xue et al (2020) report that having a shortage of supplies will greatly reduce the efficiency of emergency response. Home health agencies can become disconnected from the public health emergency response due to their decentralized nature and limited integration into the broader healthcare system (Franzosa et al., 2022). This will result in limited access to PPE. Rural communities must overcome logistical issues related to supplies and resources to enhance their preparedness (Al Thobaity, 2024). Partnering with health departments and hospitals for rural communities can help establish a supply of PPE equipment and other resources (Shang et al., 2020). The Role of Home Health Organizations in Disaster Readiness Home health organizations work in the community to identify needs in disaster readiness, such as developing plans, providing information, and recognizing individuals vulnerable to 10 complications in care or evacuation challenges (Lessinnes et al., 2023). The recent COVID-19 pandemic highlighted the crucial role of home health organizations in supporting patients at home during emergencies (Franzosa et al., 2022). Nurses are a vital workforce in response to emergencies for vulnerable patients, such as the elderly and children (Al Thobaity, 2024). Triage training should be included as a fundamental competency in nursing education to improve readiness (Wolf et al., 2025). Home health organizations can help raise public awareness, create an emergency readiness plan, initiate training, and provide access to resources (Abu Hasheesh, 2023). Home health organizations are largely independent of large healthcare systems and therefore play a significant role in the community (Lessinnes et al., 2023). Patients rely on home health services, thus requiring home health organizations to play a central role in creating disaster preparedness plans, responding to disasters, educating patients, and assisting vulnerable individuals (Lessinnes et al., 2023). Patients prefer to stay in their homes rather than a hospital or long-term care facility. To allow patients to remain at home, home health organizations must always be prepared and ready to deliver safe, timely, and effective care (Lessinnes et al., 2023). The recent COVID-19 pandemic highlighted the crucial role of home health organizations in supporting patients at home during emergencies (Franzosa et al., 2022). The separation of some home health organizations from larger healthcare facilities has resulted in difficulties sustaining sufficient resources, including supplies and personnel (Franzosa et al., 2022). Home health organizations should be seen as valuable partners in helping the community during emergencies. Given that nurses comprise a significant portion of the emergency response workforce, home health organizations can use nurses to educate patients on disaster preparedness (Al 11 Thobaity, 2024). Nurses, therefore, require proper education and training to acquire the necessary skills to educate their patients (Baker, 2021). Another role nurses have, especially in home health, is to be advocates for patients who require their support, and raising public awareness for vulnerable populations during emergencies will be vital in creating disaster plans (Abu Hasheesh, 2023; Al Thobaity, 2024). Home health organizations can help educate and foster a community of resilient patients in the event of a disaster (Al Thobaity, 2024). Practical Patient Education, Self-Sufficiency, and Preparedness Tools Educating homebound patients to be more self-sufficient and providing preparedness tools are essential for promoting resilience and supporting hospitals’ capacity during emergencies (Al Thobaity, 2024). By educating patients on emergency preparedness, the patients can help improve the outcome of disaster treatment (Feng et al., 2025). Being self-sufficient is crucial for emergency preparedness (U.S. Department of Veterans Affairs, 2025). Education can enhance psychological resilience during disasters (Xue et al., 2020). Emergency Departments are vital components of the community, though many people abuse them by using them for nonurgent concerns (Shi & Singh, 2022, p. 316). Nurses can help patients stay informed about emergency preparedness and develop skills that reduce disaster-related risks (Li et al., 2024). Educating patients to be self-sufficient will create a more resilient healthcare system by allowing patients to avoid hospitalization during emergencies (Al Thobaity, 2024). By being educated in preparedness, patients will be better equipped to respond to disasters, fostering a community that can support one another (Feng et al., 2025). One challenge in educating oneself and striving for self-reliance is determining the necessary resources and supplies for disaster preparedness (Al Thobaity, 2024). 12 Patient education should include guidance on preparing for community-level disasters that emphasizes emergency preparedness, self-reliance, and personal safety planning (U.S. Department of Veterans Affairs, 2025). The U.S. Department of Veterans Affairs (2025) website offers a toolkit with an emergency preparedness supply list. Having emergency kits available will help patients be self-reliant. Being prepared will help patients and communities avoid being overwhelmed during the disaster response (Xue et al., 2020). During disasters, psychological pressure increases, and any way to mitigate this pressure is critical for effective response (Xue et al., 2020). By encouraging self-sufficiency and being prepared, patients can help mitigate the abuse and overuse of emergency departments (Shi & Singh, 2022, p. 316). When emergency departments are overused, they can be closed, a trend increasingly common in the United States, particularly in rural communities (Shi & Singh, 2022, p. 317). Nurses are responsible for being educated in emergency preparedness, and by teaching patients about it, patients can protect themselves from disaster situations and the consequences of being unprepared (Li et al., 2024). Strengthening disaster response skills through targeted training will improve nurses' ability to effectively educate patients (Baker, 2021; Zhu et al., 2025). Increasing awareness of necessary supplies will improve emergency preparedness in both patients and home health nurses (Li et al., 2024). Summary of Literature Review Findings and Application to the Project The literature review identified three themes related to the challenges and opportunities faced by home health patients and emergency preparedness. The themes are: 1) barriers to emergency access in rural areas, 2) the role of home health organizations in disaster readiness, and 3) practical patient education/self-sufficiency and preparedness tools. 13 The literature review findings support the idea that implementing a standardized disaster preparedness toolkit for home health patients will improve outcomes during emergencies. By educating patients, they will be better equipped to be more resilient and prepared during emergencies by following a toolkit provided by home health agencies. A toolkit will have educational materials, checklists, and supply guides to help patients become self-sufficient. This will reduce the strain on other healthcare facilities during emergencies. Project Plan and Implementation This section outlines the plan of change and describes how it will be implemented. Guided by the literature review above and using the ARCC evidence-based practice model, the project will focus on enhancing patients’ emergency preparedness through nurse-provided education and resources (Dusin et al., 2023). The implementation plan outlines the steps required to prepare staff, engage stakeholders, and implement the toolkit into home health practices. Plan and Implementation Process The proposed project will be implemented in collaboration with rural home health agencies that provide skilled nursing services to homebound patients requiring complex medical care. The intended recipients of the project are the home health nurses and patients receiving home health care. Nurses will be responsible for delivering education and distributing disaster preparedness literature, pamphlets, and toolkits. Home health patients will be the primary beneficiaries of this intervention. The implementation process will begin with assessing the home health organization's readiness using the ARCC model. Leadership support will be encouraged to ensure the agencies’ goals align with the new process. Leadership will also identify potential champions of evidencebased practice. Once readiness is achieved, staff education will be initiated to help nurses 14 understand disaster preparedness principles, the toolkit, and standardized teaching approaches. The nurses will then incorporate the toolkit into routine patient visits during the three-month implementation period. The patient education will focus on individual emergency planning, supply preparation, and strategies to maintain safety and continuity of care during disasters that may affect their ability to receive necessary care. Surveys and other forms of communication will be conducted on an ongoing basis to analyze staff engagement and identify any barriers that may arise during the implementation process. Interdisciplinary Team The practical implementation of this project for disaster preparedness will require collaboration between multiple members of the healthcare team and home health. Each member of the team will contribute to achieving patient safety, education, and preparedness outcomes. Home Health Nurses. Home health nurses will serve as the primary drivers of this project. Their role will include completing project-related education, delivering patient education materials, conducting teaching sessions, and distributing the disaster preparedness toolkit during home visits. Nurses will need to assess patients’ individual risks, tailor education to patients’ cognitive and physical abilities, and reinforce preparation strategies. With consistent education and follow-up, nurses will help improve patient confidence and self-sufficiency during emergencies. Nurse Leadership/Administrators. Nurse managers and administrators will provide oversight during the project. Their responsibilities will include approving the plan, allocating time for staff education, and supporting the evidence-based practice champions. Leadership involvement will help promote accountability among staff who are resistant to change. 15 Primary Care Providers. Primary care providers will be the doctors and NPs/PAs responsible for signing orders and approving any additional medication needed to keep patients prepared. A request will be made to allow patients to have additional medication backup for at least a month in case supplies are delayed. Patients will be able to refill prescriptions before they run out, allowing them to maintain a stockpile during emergencies, if permitted by their insurance companies. Certified Nurse Assistants. Certified Nursing Assistants (CNAs) will play a vital role in this project. CNAs will be educated to report any additional changes or safety concerns they notice, such as loss of electricity, heat, air conditioning, or running water. They can also report equipment failures and whether the patient is out of food, water, medication, or emergency supplies. CNAs will report any changes to the nursing staff. They will not be allowed to provide education but can observe patient readiness and report any unmet needs or concerns to the nursing team. Community and Emergency Partners. Maintaining communication with local emergency management agencies, public health departments, and other community organizations will strengthen this project’s aims. These community partnerships will establish resources to ensure patient safety and preparation consistent with emergency strategies already in place at the community and county levels. The project lead will be responsible for collaborating with local emergency management, EMS, public health departments, and other community associations. The lead will establish a quarterly meeting with these agencies to review local disaster risk assessments and collaborate by sharing educational materials. Once a year, there will be a disaster simulation that first responders in the community can include home health nurses in to improve response protocols. 16 Description and Development of Project Deliverables The proposed project will include evidence-based deliverables designed to improve emergency preparedness for home health patients by supporting home health nurses’ education. Each deliverable aims to increase preparedness for disasters among home health patients and supports the implementation of a standardized emergency preparedness toolkit. The toolkit (see Appendix A) provides space for emergency plans and a checklist. The staff lesson plan (see Appendix B) will be used to educate home health nurses on disaster preparedness principles and the effective use of the patient emergency preparedness toolkit. The lesson plan will include learning objectives, content outlines, nursing roles, and educational strategies. The goal for the lesson plan is to strengthen nurses’ disaster preparedness knowledge and improve their confidence. The survey (see Appendix C) is designed to evaluate the effectiveness of the staff lesson plan. It will be measured using the Likert scale. Nurses will answer the question to determine their knowledge and confidence in using the toolkit. The survey will be administered before and after the lesson plan and the toolkit being implemented. The flyer (see Appendix D) was developed as part of the handouts to provide clear, easy-to-understand information to the nurses and patients. Timeline The proposed timeline for this change implementation will be as follows. The home health emergency preparedness project will run over three months. The first month will be spent determining the organization’s readiness and planning. The organization will need to find evidence-based practice champions, and leadership will need final approval before the 17 champions are trained. Staff preparation would begin with the pre-survey and continue with the staff lesson plan. The second month would include completing staff training and implementing the toolkit with patients. Nurses would introduce the emergency preparedness toolkit to patients deemed appropriate. Patients would be deemed appropriate based on criteria set by nurse leadership during the project's planning phase. The parameters would align with organizational policy and clinical judgment, such as cognitive ability, caregiver support, and vulnerability during emergencies. Nurses would educate patients and their caregivers about emergency planning and the use of the toolkit. The third and final month would be to evaluate the nurses using the post-survey to provide data for comparison with the pre-survey and show changes. Changes in knowledge, confidence, and perceived preparedness will be evaluated. The data will be analyzed to assess the project’s outcomes and identify opportunities for improvement. The timeline will be provided in Appendix E to show each phase of the project. Overall, this project is designed to be implemented over three months, allowing the organization to assess staff education and patient engagement readiness and evaluate outcomes. Using the ARCC model, the project will support the implementation of emergency preparedness education into home health practices. Project Evaluation Formative and summative evaluation methods will be used to determine the effectiveness of the emergency preparedness toolkit project. This evaluation will examine whether implementing a standardized disaster preparedness toolkit will improve home health nurses’ knowledge, confidence, and ability to educate patients. Evaluation of evidence-based practice 18 projects is essential to determine whether the intervention improves knowledge, confidence, and practice outcomes (Melnyk & Fineout-Overholt, 2023, p. 405). The evaluations will determine how well the project is being implemented, how well it improves nurses’ knowledge and confidence, and how often emergency preparedness education is integrated into home health practice. The formative evaluation will occur during the first two months of the project. Formative evaluation includes the pre-survey, ongoing nurse feedback, monitoring the distribution of the toolkit, and identifying workflow barriers. The primary focus will be on assessing whether the intervention is being implemented as planned and identifying any early barriers. The ARCC model emphasizes assessing organizational readiness, identifying early barriers, and using EBP champions for implementation (Dusin et al., 2023). Early barriers will be identified through informal feedback during staff meetings and communication with evidence-based practice champions. If nurses report time constraints or difficulty incorporating the toolkit into routine visits, the nurse will report it to the champion for escalation to leadership to make any necessary adjustments. The pre-survey (see Appendix C) will be given to home health nurses prior to the education and toolkit rollout. The purpose of the pre-survey is to establish a baseline measure of nurses’ knowledge, confidence, and perceived preparedness to educate patients and implement the emergency preparedness toolkit in home health practice. Previous research has shown that nurses’ disaster preparedness knowledge and confidence vary and are influenced by training and organizational support (Baker, 2021; Feng et al., 2025). The survey uses Likert-scale questions for self-reported levels of readiness and competency to implement the toolkit. Baseline data collected from the pre-survey will be compared to post-survey results obtained at the end of the 19 three-month implementation period to evaluate changes in knowledge, confidence, and perceived readiness. This comparison will allow for an assessment of the educational effectiveness of its impact on nurses’ readiness to implement the toolkit into practice. The summative evaluation will take place in the third month and assess the overall success of this project. Near the end of the implementation period, the nurses will be given access to the post-survey (see Appendix C) to measure the same aspects as in the pre-survey: knowledge, confidence, and perceived preparedness in emergency preparedness and patient education, to compare with baseline. Pre- and post-surveys results will be analyzed to determine what improvements were made. Additional summative evaluation aspects to be measured include the percentage of eligible patients who received the toolkit. The summative evaluation is important because it determines if the project has achieved its goal of increasing nurses’ knowledge and confidence in educating patients with emergency preparedness. Increasing nurses’ disaster preparedness has been shown to improve response time and patient outcomes (Al Thobaity, 2024; Zhu et al., 2025). Ethical Considerations The ethical considerations will be addressed in accordance with principles of social responsibility, respect for persons, non-discrimination, and confidentiality. Social responsibility will be addressed by identifying the needs of vulnerable populations, particularly homebound patients who face risks during disasters (Lessinnes et al., 2023). All patients will be offered education and access to the emergency preparedness toolkit based on clinical appropriateness, not on age, gender, race, disability, or socioeconomic status. Nurses will use clinical judgement to determine whether the patient is clinically appropriate. The policy created will also help determine clinical appropriateness. Parameters will include aspects 20 from OASIS data, including cognitive ability, caregiver support, physical ability, and vulnerability during emergencies. Identifying high-risk patients to tailor preparedness efforts will improve disaster planning (Lessinnes et al., 2023). The educational materials will be written in clear, plain language that is understandable to patients. The participation will be voluntary, and those who choose not to will not face any penalties or negative performance evaluations. Patients who do not wish to participate will also be able to continue home health care without affecting the quality of care. Nurses will protect privacy and confidentiality during and after the project. The surveys will be confidential, with no identifying information linked to the results by removing the nurses’ names. All project data will be reviewed exclusively by leadership, and only authorized leaders will have access to the survey results through secure data storage. Awareness of potential personal bias is essential for quality improvement programs addressing emergency preparedness. Research indicates that disaster preparedness competency assessments rely on self-reported measures, which can be influenced by bias (Li et al., 2024). If there is any bias in the results, the data and credibility are weakened, making it difficult to determine whether the intervention is best practice. To reduce the potential risk, the surveys will be standardized and administered anonymously to promote honest responses and minimize bias. Leadership oversight will support objective interpretation of the project's outcomes by ensuring accurate and transparent reporting to reduce the influence of the project leads’ potential bias. Discussion Rural home health patients face various barriers during disasters, including limited hospital access, supply shortages, and lack of formal preparedness planning (Franzosa et al., 2022; Lessinnes et al., 2023). Home health agencies lack standardized processes to support 21 patients during emergencies. This project will implement a standardized disaster preparedness education module for nurses, along with a toolkit to help patients be more self-sufficient during disasters. The following discussion will address dissemination of the project, its significance to the nursing practice, implications and limitations, recommendations for future improvement, and overall conclusion. Evidence-Based Solutions for Dissemination The project findings will be disseminated in a professional poster format, viewed by peers and faculty in the final semester of NRSG 6802. Posters are an effective way to disseminate information about the emergency preparedness project in the home health setting. Poster presentations will allow peer and faculty feedback, and other discussions can arise. Significance to the Advancement of Nursing Practice The project can enhance nursing knowledge and the nursing profession by strengthening disaster nursing competencies and expanding home health nurses' roles in emergency preparedness. Al Thobaity (2024) and Feng et al. (2025) show that disaster preparedness competencies with nurses positively influence emergency response outcomes. Home health agencies are often overlooked in formal disaster preparedness planning (Franzosa et al., 2022). The project attempts to address the strained, limited resources in rural communities' emergency response (Shi & Singh, 2022). To support rural healthcare facilities, the project seeks to educate nurses to empower patients to be more self-sufficient during disasters. This will help relieve the burden on community responders and other public health organizations. This project aims to implement a standardized toolkit and structured education for nurses to maximize their disaster preparedness competencies. The toolkit and education will reinforce nurses’ roles as disaster preparedness educators for their patients, who will be vulnerable during 22 disasters (Abu Hasheesh, 2023). To improve nurses’ competency through training, their confidence, knowledge, and response will improve (Baker, 2021). This will be measured by preand post-surveys (see Appendix C). This project will advance nursing practice in home health by strengthening nurses' roles as community leaders, patient educators, and disaster preparedness advocates. Implications The project's prospective strength is the use of the ARCC model for implementation (Dusin et al., 2023). The ARCC model framework encourages leadership engagement, the identification of EBP champions, and the evaluation of outcomes. Another strength is the focus on education, which Al Thobaity (2024) shows that, when structured, education will improve resilience and reduce disaster-related risks. Limitations of this project are time constraints, competing staff priorities, and resistance to change. Home health agencies often operate with limited staff and already have a high focus on patient education (Franzosa et al., 2022). Implementing the toolkit may not be the highest priority during certain home health visits. There are also implementation limitations due to patients’ cognitive abilities, caregiver support, and socioeconomic status. To overcome these limitations, the implementation phases will be supported by the leadership and reinforced by the EBP champions (Melnyk & Fineout-Overholt, 2023, p. 406). Additionally, communication with community responders can help overcome limitations by improving resource coordination and ensuring consistent messaging for patient preparedness. Recommendations Recommendations to improve the project include extending the timeline. Extension of the timeline would allow for a more extensive evaluation of the patient outcome in addition to 23 nurses’ surveys. Additional recommendations include focusing future research on patient outcomes, including hospitalization rates during disasters. A gap that may require further research is the provision of triage competencies for nurses to improve their triage assessments (Wolf et al., 2025). Conclusions Rural patients who are homebound face higher risks during disasters due to limited mobility, geographic isolation, and limited access to hospitals (Lessinnes et al., 2023). Home health nurses are available to provide patient education when given structured emergency preparedness education and toolkits. Improving nurses' competency will increase patients' disaster resilience (Baker, 2021; Feng et al., 2025; Zhu et al., 2025). The project aims to strengthen nurses’ ability to educate patients about emergency preparedness, thereby promoting a prepared community. Strengthening disaster preparedness within home health agencies not only protects the vulnerable rural population but also reinforces nursing leadership with community emergency response. 24 References Abu Hasheesh M. O. (2023). Jordanian nurses' perceived disaster preparedness: factors influencing successful planning. The Scientific World Journal, 2023, 5473777. https://doi.org/10.1155/2023/5473777 Al Thobaity, A. (2024). Overcoming challenges in nursing disaster preparedness and response: An umbrella review. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-02226-y Baker, O. (2021). Preparedness assessment for managing disasters among nurses in an international setting: Implications for nurses. Journal of Nursing Management, 29(8), 2301–2312. https://doi.org/10.1016/j.ienj.2021.100993 Dusin, J., Melanson, A., & Mische-Lawson, L. (2023). Evidence-based practice models and frameworks in the healthcare setting: A scoping review. BMJ Open, 13(5), e071188. https://doi.org/10.1136/bmjopen-2022-071188 Feng, J., et al. (2025). Influencing factors of nurses' disaster preparedness: A meta-analysis. BMC Public Health, 25(1), 1–12. https://doi.org/10.1186/s12889-025-23981-w Franzosa, E., Wyte-Lake, T., Tsui, E. K., Reckrey, J. M., & Sterling, M. R. (2022). Essential but excluded: Building disaster preparedness capacity for home health care workers and home care agencies. Journal of the American Medical Directors Association, 23(12), 1990–1996. https://doi.org/10.1016/j.jamda.2022.09.012 Lessinnes, S., Köhler, M., & Ewers, M. (2023). Evidence of disaster planning by home care providers: An integrative literature review. International Journal of Environmental Research and Public Health, 20(9), 5658. https://doi.org/10.3390/ijerph20095658 Li, T., Zhao, C., Zhang, Y., Bai, S., Zhou, Z., Li, N., Yao, L., Ren, S., & Zhong, R. (2024). 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Establishing triage competencies and verification processes: A survey study. Journal of Emergency Nursing, 51(1), 59–78. https://doi.org/10.1016/j.jen.2024.09.005 Xue, C.-L., Shu, Y.-S., Hayter, M., & Lee, A. (2020). Experiences of nurses involved in natural disaster relief: a meta-synthesis of qualitative literature. Journal of Clinical Nursing, 29(23-24), 4514-4531. https://doi.org/10.1111/jocn.15476 Zhu, D., Li, Y., Chen, Q., Ke, J., Fan, Y., Sheng, X., Yuan, L., & Chen, Y. (2025). Status and influencing factors of clinical nurses’ disaster nursing competency: A Multicenter crosssectional study. BMC Nursing, 24(1). https://doi.org/10.1186/s12912-025-03026-8 26 Appendix A Toolkit Emergency Plan What disasters impact my area the most? ____________________________________ Where and how will I get Emergency Notifications ______________________________ Household Member’s Contact Information/Emergency Contact Information Pets in the Home? Emergency Escape Routes and Meeting Locations/Evacuation Plan Kit Checklist o Cash o 3 Days of non-perishable food o Duct Tape o Water (one gallon per person per o Garbage Bags day) o Gloves o Manual Can opener o Rope o Matches o Sleeping bag/blanket o Flashlight o Change of Clothes o Weather Radio o Medication o Batteries o First Aid kit o Camping knife o Personal Hygiene items o Whistle/glowsticks o Documents U.S. Department of Veterans Affairs, VA Caregiver Support Program. (2025, June 23). Disaster & emergency preparedness. https://www.caregiver.va.gov/Emergency_Preparedness.asp#Prepare 2 Appendix B Presentation for Employee Education 3 4 5 6 7 8 9 Appendix C Pre-Survey https://docs.google.com/forms/d/e/1FAIpQLScUVhlvc_oq6MQ0aqdbcD9m5k1w4Ds5ZtnfJPejR 3hnPkjxzw/viewform?usp=dialog Post-Survey https://docs.google.com/forms/d/e/1FAIpQLScsK27uBTVBK1yIGYHgWBlVLsp7GeirWz4JvA br6UetQNKLyQ/viewform?usp=publish-editor 10 Appendix D Flyer 11 Appendix E Timeline