Novice nurses’ preparedness for psychological first aid in conflict-affected Middle Eastern Countries: a cross-sectional survey

Abstract

Frontline healthcare professionals, especially nurses, are often the main providers of psychological first aid in conflict settings, offering supportive communication, grief support, and trauma-informed care. However, despite its recognized importance in emergency response, PFA capacity remains limited in many conflict-affected countries. This study aimed to assess PFA knowledge and self-perceived competence among novice nurses in delivering PFA during armed conflict across multiple Middle Eastern countries. A multi-country analytical cross-sectional survey was conducted using convenience sampling. The participants were 465 novice nurses, comprising nursing interns and early-career nurses with less than one year of clinical experience, from six Middle Eastern countries: Iraq, Syria, Yemen, Palestine, Saudi Arabia, and Lebanon. Data was collected using a PFA knowledge and competency questionnaire adapted from the WHO Psychological First Aid: Facilitator’s Manual for Orienting Field Workers. Possible scores ranged from 0 to 15 for PFA knowledge and from 1 to 5 for self-perceived PFA competence. Independent sample t-tests, one-way ANOVA, and Chi-square were used to analyze the data. The overall mean self-perceived PFA competence score was 3.52 ± 0.70 out of 5, while the overall mean PFA knowledge score was 7.61 ± 1.75 out of 15. Self-perceived PFA competence differed significantly across countries (F = 7.083, p < .001, η² = 0.072). Participants from Palestine (M = 3.83, SD = 0.64) and Syria (M = 3.76, SD = 0.69) reported the highest competence scores, whereas those from Lebanon (M = 3.26, SD = 0.56) and Saudi Arabia (M = 3.18, SD = 0.66) reported the lowest. PFA knowledge scores differed across countries in the omnibus analysis (F = 2.850, p = .018, η² = 0.037), with the highest mean observed in Palestine (M = 8.25, SD = 1.68) and the lowest in Saudi Arabia (M = 7.00, SD = 2.14). However, no Bonferroni-adjusted pairwise country comparison remained statistically significant in the adjusted model. The mean PFA knowledge score among novice nurses was 7.61 out of 15, and self-perceived PFA competence varied across the participating countries. Due to the low KR-20 value, knowledge findings were interpreted primarily at the item level. The identified item-level knowledge gaps and country-level variation in self-perceived competence support the further development and evaluation of PFA education for novice nurses in conflict-affected settings.