Association between physical fitness and core emergency competencies among emergency nurses in China

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Aims The aims of this study were to describe the levels of physical fitness of emergency nurses and to explore the influence of physical fitness on their core emergency competencies. Study Design: A cross-sectional study involving emergency nurses was conducted in China between April and May 2024. The data were collected using a self-report questionnaire (sociodemographic characteristics and core emergency competencies) and physical fitness tests. Multiple linear regression analysis was used to identify the factors associated with the core emergency competencies of emergency nurses. Results The study included 146 emergency nurses. The mean score for core emergency competencies was 137.73 ± 18.96. Among the nurses, 3.5% had good physical fitness, 47.3% had general physical fitness, and 49.3% had poor physical fitness. Furthermore, 88.4% agreed that their health-related physical fitness (HRPF) had an impact on their core emergency competencies. A multivariate analysis indicated that core emergency competencies were associated with self-reported HRPF (β = 0.251, p < 0.001), body mass index (β = 0.195, p = 0.004), work tenure (β = 0.195, p = 0.006), choice reaction time (β = −0.179, p = 0.011), and professional qualifications (β = 0.229, p = 0.049). Conclusion Nearly half the emergency nurses had poor physical fitness. Work tenure, professional qualifications, self-reported HRPF, body mass index, and choice reaction time were all found to be related to the core emergency competencies.Nurse managers should prioritize the development of programs aimed at enhancing the aspects of emergency nurses’ physical fitness that may impact their core emergency competencies. core emergency competencies physical fitness emergency nurses Introduction In today’s world, as population aging accelerates, the prevalence of chronic diseases rises, acute illnesses induced by unhealthy lifestyles increase, and public health emergencies and disaster accidents become more frequent, the emergency medical service system is facing greater challenges.The emergency department (ED) plays a crucial role in the emergency medical service system, delivering acute care for a variety of urgent health issues [ 2 ] . The number of ED visits tripled from 51.9 million to 166.5 million over the 2005–2017 period in China [ 3 ] .Yet for the ED to rise to these challenges and deliver such critical acute care, the expertise of its nursing team in navigating urgent scenarios is indispensable, and this expertise hinges on their core emergency competencies.Core emergency competencies refer to the ability of nurses to provide a comprehensive and rapid response to unexpected diseases with their knowledge, skills and experiences [ 4 ] . According to Trisyani et al’s qualitative study, emergency nurse core competencies include shifting the nursing practice, caring for acute critical patients, communicating and coordinating, covering disaster nursing roles, reflecting on the ethical and legal standards, researching competency, teaching competencies and leadership competencies [ 5 ] .Studies have discovered that core emergency competencies directly determine the quality and outcome of patients’ rescue [ 6 ] . Thus, developing the core emergency competencies are a priority in the training of emergency nurses. Identifying the influencing factors of core emergency competencies among emergency nurses is a necessary step in the process of designing training programs, particularly modifiable influencing factors. Several traditional influencing factors of core emergency competencies among emergency nurses have been identified, including age, sex,education level, nursing experience, professional qualifications. In recent years, there has been a growing realization that the physical fitness of nurses has implications for both nurses’ occupational health and the quality of healthcare services [ 9 ] . Emergency nurses work in high-stress, fast-paced environments that demand exceptional professionalism and physical fitness. Physical fitness is recognized as an integrated measure of nearly all the bodily functions that are needed to perform physical activity in everyday situations and in sports; it is also an important health marker [ 10 ] . The physical fitness components that are related to health are referred to as the health-related physical fitness (HRPF) components, which is the ability of the cardiovascular, lungs and muscles to perform at optimal efficiency. HRPF includes body composition(including metrics such as body fat percentage, muscle mass), cardiorespiratory fitness(cardiovascular, pulmonary and muscular efficiency to support prolonged aerobic activity), muscular strength and muscular endurance(the ability of a muscle to burst in a short period of time or work continuously for a long period of time), flexibility(joint range of motion and body extensibility) [ 11 ] . Physical fitness has been shown to be positively associated with cognition [ 12 ] , bone health [ 13 ] , psychological health [ 14 ] , and occupational task performance [ 15 ] . Previous studies have predominantly examined the relationship between physical fitness and cardiopulmonary resuscitation.Cardiopulmonary resuscitation (CPR) is one of the core competency skills that emergency nurses must master, as the precision of its operation is directly linked to the survival prognosis of patients in cardiac arrest. CPR imposes rigorous physical demands on emergency nurses, requiring sustained stamina and muscular endurance to maintain effective chest compressions. It has been consistently shown that higher levels of physical fitness enhance a rescuer’s capacity to deliver high-quality chest compressions over extended periods, irrespective of their medical training or experience [ 15 ] . Moreover, physical fitness (measured using upper-body anaerobic power and bench press scores) was found to robustly predict high-quality CPR performance [ 19 ] .While these findings underscore the critical role of physical fitness in optimizing CPR performance, there is limited knowledge about the impact of physical fitness on the core emergency competencies among emergency nurses. Therefore, the aims of this study were to determine the physical fitness of emergency nurses and to explore the influence of physical fitness on their core emergency competencies. Methods Study design and participants In this study, a cross-sectional design was utilized. Potential participants were deemed eligible for this study if they were ED nurses, had signed an informed consent form, and had volunteered to participate. The exclusion criteria were as follows: (1) practice student or study nurse, (2) currently pregnant, (3) on sick leave or maternity leave, or (4) had a basic cardiopulmonary disease (e.g., arrhythmia). The Kendall method was used to estimate the sample size. First, the initial size was set as 5–10 times more than the survey variables, then we took into account that 10–15% of the questionnaires would likely be invalid, and the final sample size was 146. Ethical consideration This study was reviewed and approved by the Medical Ethics Committee of Zhongda Hospital Southeast University (2023ZDSYLL398-P01). Participants’ information is completely confidential, questionnaires are recorded anonymously, and survey contents are used only for scientific research. Measurements A questionnaire was designed using information gained from a literature review, group discussion, and expert panel discussion. The questionnaire items were designed to collect data on the participants’ sex, age, marital status, education level, working tenure, professional qualifications, critical care specialization, work tenure and emergency experience (years). Core emergency competencies were measured using the self-reported Chinese version of the evaluation tool for core emergency ability [ 19 ] . Developed by Zhao in 2015, the instrument consists of eight dimensions (theoretical knowledge, technical skill, emergency response capability, communication and coordination skills, emergency management capacity, emergency research capacity, personal traits, and work attitude) and includes 32 items that are answered using the Likert five-point scale (1 = absolutely matched to 5 = not matched). The total score ranges from 32 to 160 points. The higher the score, the greater the ability to deliver emergency care. The value of Cronbach’s α for the instrument was 0.851, a test-retest reliability was 0.893. Cronbach'α for each dimension of the subscales ranged from 0.827–0.971. The assessment of physical fitness was based on the 2023 version of the Chinese National Physical Fitness Measurement Standards [ 21 ] ,which includes 11 fitness indicators across three areas: physical form (body mass index [BMI] and body fat percentage), physical function (vital capacity and two-stage workload cycle ergometer tests), and physical quality (grip strength, vertical jump, sit-and-reach, push-ups/knee press-ups, 1-min sit-up, stand on one foot with eyes closed, and choice reaction time tests). The assessment results reflected the participants’ cardiorespiratory endurance, muscle strength and endurance, body flexibility, and ability to balance. BMI was calculated as weight in kilograms divided by the square of the height in meters (kg/m 2 ). The BMI measurements were divided into four categories: underweight (< 18.5 kg/m 2 ), normal weight (18.5 to < 24 kg/m 2 ), overweight (24 to < 28 kg/m 2 ), and obese (≥ 28 kg/m 2 ). Each participant’s body fat percentage was measured via bioelectrical impedance analysis (BIA; 2000-M). Vital capacity is defined as the maximum volume (mL) of air that can be exhaled after maximal inspiration. The participants exhaled into the test instrument with maximum force after maximum inhalation. A two-stage workload cycle ergometer was used to determine cardiorespiratory fitness. Each participant pedaled a power bike at 60 rpm under a set load for 7 min. The first 30 s were for warm-up, the last 30 s were for recovery, and the middle 6 min constituted the official test. Grip strength is an indicator of the strength of the upper limbs. Participants were instructed to grasp the grip strength device for a few seconds. Vertical jump height was used to determine lower limb strength. Each participant bent their knees to a half-squat position and then jumped straight up, as high as possible. The sit-and-reach test is used to assess joint flexibility, as well as ligament and muscle extensibility and elasticity. Each participant sat on a cushion, straightened their legs and knees, and placed their feet flat against the test board. They then stretched their hands and body forward to push the cursor as far as possible. The ability to perform push-ups/knee press-ups is used as an indicator of overall upper body strength. The male participants performed the push-up test. Each participant maintained a straight torso and legs, with arms and forefeet on the mat. They bent their arms to lower their body until their shoulders and elbows were aligned, then pushed back up to the starting position. This was repeated continuously until the participant could no longer continue. The female participants performed the knee press-ups test. Each participant kept her arms straight, supported her knees on the mat, maintained a straight torso, and crossed her feet off the ground. The rest of the procedure followed the push-up form. Abdominal muscle strength was measured using the 1-min sit-up test. The participants were placed in a supine position, with their knees flexed, feet flat on a floor mat, and hands placed behind their head with fingers interlaced. A sit-up was deemed complete when both elbows made contact with or surpassed both knees. The number of sit-ups completed in 1 min was recorded. Choice reaction time is the time taken between a stimulus and an action that requires a choice. The participants were instructed to press the “start key” and await the initiation signal. Upon receiving a signal from any “signal key” (indicated by a light), participants were required to press the corresponding key as swiftly as possible and then return to the “start key” to await the subsequent signal. Each test consisted of five signal responses, and the response times were recorded in seconds. To test their muscle strength and balance, the participants were asked to stand on one foot with their eyes closed. The participants stood on the test mat on one leg with their eyes closed, and the duration until their raised foot touched the mat was recorded. Each fitness indicator score was weighted by an age- and sex-specific percentage. The composite rating score was based on the sum of the participants’ individual scores multiplied by their respective weights, and a 100-mark system was used. The scores were divided into four categories: excellent (≥ 83), good (75 to < 83), pass (60 to < 75), and fail (< 60). Self-reported HRPF was assessed using a specifically designed item (“What do you think of your health-related physical fitness?”). The item was answered using a five-point scale (1 = “very good,” 2 = “good,” 3 = “fair,” 4 = “poor,” or 5 = “very poor”). The impact of each participant’s self-reported HRPF on their core emergency competencies, mental fitness, and attention was assessed using three specifically designed items (“Do you think health-related physical fitness has an impact on your core emergency competencies/mental fitness/attention?”). Data collection Data were collected between April 2024 and May 2024 at the research site. The questionnaire was administered using Wenjuanxing ( https://www.wjx.cn/ ), an online data collection platform. Trained research assistants were available to answer questions. The participants could only submit the questionnaires when all the questions had been answered. Only one completed questionnaire could be submitted from one IP address. The physical fitness tests were conducted (and the results recorded) by trained examiners, who were recruited from provincial sports centers and capable of conducting different types of physical fitness tests. All participants gave written informed consent to be involved in the study after being notified of its purpose, benefits, and risks. Measures were taken to protect the participants’ identities. Data analysis Data were exported from the Wenjuanxing platform, and SPSS 26.0 was used to perform the statistical analysis. Frequencies and percentages were calculated for categorical variables, and means and standard deviations or medians were calculated for continuous variables. Potential associations between the dependent variable (core emergency competencies) and the independent variables (sociodemographic variables and physical fitness indicators) were determined with one-way ANOVAs and T-tests. A multivariate linear regression analysis was conducted to explore the influence of various factors on the core emergency competencies. All sociodemographic variables and physical fitness indicators were initially included in the model. The coefficient of determination (R 2 ),the proportion of variance explained, and so on were used to detect the effect size. A P -value < 0.05 was considered statistically significant. Results Participants’ characteristics The total number of nurses asked to participate was 188, of which 146 accepted to participate and completed physical fitness tests.The response rate was 78%. Among them, 97 (66.4%) were female, 76 (52.1%) were no more than 30 years old, 133 (91.1%) had an undergraduate or higher level of education, 86 (58.9%) were senior nurses, 25 (17.1%) were critical care specialized nurses, 67 (45.9%) had more than 10 years of professional experience, and 56 (38.3%) had more than 10 years’ experience in the emergency care field. There were significant differences within the cohort in terms of age, marital status, professional qualifications, critical care specialization, work tenure, and emergency experience ( p < 0.01). The sociodemographic characteristics of the participants are shown in Table 1 . Table 1 Sociodemographic characteristics of the study participants (N = 146) Variable N % Core emergency competencies t/F P Sex Male 49 33.6 136.04 ± 19.39 -0.762 0.447 Female 97 66.4 138.58 ± 18.78 Age (years) ≤ 30 76 52.1 132.28 ± 21.08 9.299 0.000 31–40 58 39.7 141.69 ± 14.43 > 40 12 8.2 153.08 ± 9.18 Marital status No 62 42.5 131.47 ± 21.24 6.306 0.002 Married 82 56.2 142.38 ± 15.77 Divorced 2 1.4 141.00 ± 15.56 Education level Below undergraduate 13 8.9 132.38 ± 30.07 -0.692 0.502 Undergraduate or higher 133 91.1 138.25 ± 17.60 Professional qualifications Junior nurse 36 24.7 123.17 ± 21.08 21.105 0.000 Senior nurse 86 58.9 140.38 ± 16.01 Supervisor nurse and above 24 16.4 150.04 ± 11.25 Critical care specialization Yes 25 17.1 146.48 ± 12.24 -3.486 0.001 No 121 82.9 135.92 ± 19.62 Work tenure (years) < 5 41 28.1 124.46 ± 20.46 13.873 0.000 5–10 38 26.0 138.84 ± 17.89 10–15 46 31.5 142.87 ± 13.80 ≥ 15 21 14.4 150.33 ± 12.56 Emergency experience (years) ≤ 5 42 28.8 125.07 ± 20.59 12.692 0.000 5–10 48 32.9 139.40 ± 17.11 10–15 37 25.3 143.59 ± 13.78 ≥ 15 19 13.0 150.05 ± 13.19 Self-reported HRPF Very good 12 8.2 152.08 ± 9.38 4.001 0.009 Good 46 31.5 140.20 ± 17.43 General 71 48.6 135.49 ± 19.70 Poor 17 11.6 130.24 ± 19.79 Core emergency competencies of emergency nurses The mean score for the core emergency competencies was 137.73 ± 18.96. The scores for each dimension of this measure are shown in Table 2 . Table 2 Scores for the core emergency competencies of the study participants (N = 146) Dimension Item Mean SD Max Min Theoretical knowledge 5 21.22 3.557 9 25 Technical skill 2 8.82 1.38 4 10 Emergency response capability 12 52.48 7.74 24 60 Communication and coordination skills 2 8.75 1.369 4 10 Emergency management capacity 3 13.26 1.94 6 15 Emergency research capacity 2 8.50 1.30 4 10 Personal traits 3 13.18 1.92 6 15 Work attitude 3 11.51 1.85 8 15 Total 32 137.73 18.96 66 100 Physical fitness of emergency nurses Among the participants, 3.5% had good physical fitness, 47.3% had general physical fitness, and 49.3% had poor physical fitness.The overall level of physical fitness was not significantly correlated with the core emergency competencies among the participants ( p >0.05) (Table 1 ). The mean BMI value of the emergency nurses was 24.47 ± 4.43 kg/m 2 , 5.5% (n = 8) of the nurses were underweight, 31.5% (n = 46) were overweight, and 16.4% (n = 24) were obese. The details of physical fitness indicators are shown in Table 3 . Table 3 Physical fitness of the study participants (N = 146) Dimension Variable Mean ± SD/IQR Physical form BMI (kg/m 2 ) 24.47 ± 4.43 Body fat percentage (%) 29.38 ± 8.92 Physical function Vital capacity (mL) 2642.84 ± 994.06 Two-stage workload cycle ergometer (mL/kg/min) 31.18 ± 8.23 Physical quality Grip strength (kg) 25.85(20.80–36.56) Vertical jump (cm) 23.90(19.0–30.30) Sit-and-reach (cm) 9.28 ± 7.89 Push-ups/Knee press-ups (n) 21.66 ± 11.95 1-min sit-up (n/min) 17.60 ± 10.16 Standing on one leg with eyes closed (s) 20.50(11.0–40.0) Choice reaction time (s) 0.66 ± 0.097 Less than half (39.7%) of the participants thought that their HRPF was very good or good.Self-reported HRPF was significantly correlated with the core emergency competencies among the participants (P < 0.05) (Table 1 ). The majority of the participants agreed that their HRPF had an impact on their core emergency competencies (88.4%), their mental fitness (84.2%), and their attention (92.5%) (Table 4 ). Table 4 Participants’ perceptions of impact of HRPF on core emergency competencies, mental fitness and attention (N = 146) Dimension N % Do you think HRPF has an impact on your core emergency competencies༟ Yes 129 88.4 No 17 11.6 Do you think HRPF has an impact on your mental fitness༟ Yes 123 84.2 No 23 15.8 Do you think HRPF has an impact on your attention༟ Yes 135 92.5 No 11 7.5 Influencing factors associated with the core emergency competencies among emergency nurses A multiple linear regression analysis was performed to assess the factors that influence the core emergency competencies, and the results are shown in Table 5 . The regression tolerance was > 0.1, and the models were statistically significant (F = 17.311, R 2 = 36.5%, p < 0.001). The score for the core emergency competencies correlated with self-reported HRPF (β = 0.251, p < 0.001), BMI (β = 0.195, p = 0.004), work tenure (β = 0.195, p = 0.006), choice reaction time (β = -0.179, p = 0.011), and professional qualifications (β = 0.229, p = 0.049). Table 5 Multiple linear regression analysis of the factors that influence the core emergency competencies (N = 146) Variable Non-standardized Standardized t p R 2 β SE β Constant 138.363 10.313 13.417 0.000 0.365 Self-reported HRPF(ref: very bad) 6.038 1.651 0.251 3.657 0.000 BMI(ref: underweight) 4.461 1.532 0.195 2.912 0.004 Work tenure(ref: < 5 years) 5.959 2.120 0.326 2.811 0.006 Choice reaction time -34.682 13.463 -0.179 -2.576 0.011 Professional qualifications(ref: junior nurse) 6.771 3.416 0.229 1.982 0.049 Discussion To our knowledge, this was the first study to explore the effects of physical fitness on the core emergency competencies among emergency nurses. This cross-sectional study had several important findings. First, nearly half of the emergency nurses who participated in the study had poor physical fitness. Second, the total score for the core emergency competencies among the participants was 137.73 ± 18.96. Third, physical fitness-related factors (i.e., self-reported HRPF, BMI, and choice reaction time) were associated with the core emergency competencies of emergency nurses. The proportion of participants who were physically fit (50.7%) was lower than that reported in the Fifth National Physical Fitness Monitoring Bulletin of residents aged 20–59 years in China (87.2% of people aged 20–39 years and 90.6% of people aged 40–59 years) [ 22 ] . This inconsistency could be explained by the musculoskeletal disorders that are common in nurses. The most affected body parts are the neck, waist, shoulders, and back [ 23 ] . Such disorders could have affected their performance in the physical fitness tests, especially those designed to assess physical quality (i.e., the sit-and-reach, push-ups/knee press-ups, and 1-min sit-up tests). The total score for the core emergency competencies recorded in this study (137.73 ± 18.96) was slightly higher than that recorded in a survey conducted among nurses from different clinical departments in China (135.05 ± 12.96), as were the scores for the theoretical knowledge, technical skill, emergency response capability, communication and coordination skills, and emergency management capacity dimensions [ 24 ] . This may be because the nurses included in this study were selected from ED. In previous studies, it was found that among departments where core emergency competencies are frequently applied, staff tended to be more competent in this ability [ 6 , 25 ] . In this study, longer work tenure and higher professional qualifications of emergency nurses were significantly associated with higher core emergency competencies.This was consistent with the findings of a cross-sectional study that included 14,527 medical staff from 12 Chinese provinces [ 6 ] . As nurses accumulate more work experience in their roles over time, their core emergency competencies are expected to increase correspondingly [ 7 ] . Nurse with higher professional qualifications were more likely to have more comprehensive core competencies and perform complex emergency nursing work [ 26 ] . In addition to demographic factors, this study also revealed that physical fitness-related factors (i.e., self-reported HRPF, BMI, and choice reaction time) were associated with the core emergency competencies.Nurses with higher levels of self-reported HRPF were more likely to have greater proficiency in core emergency competencies.This conclusion is in line with the findings of a previous study that showed that higher levels of physical fitness were related to better occupational-specific task performance in firefighters [ 27 ] . Emergency care nursing is intensive and urgent in nature, and nurses are required to stand for long periods, carry and transfer patients, and perform first aid procedures (e.g., CPR), all of which place considerable demands on their physical abilities. Thus, nurses who have good levels of HRPF can perform their daily tasks better and operate in a highly functional state. The influence that a higher BMI value has on the ability to perform adequate external chest compressions has been demonstrated [ 17 , 28 , 29 ] . Angel et al. confirmed that heavier people perform CPR better than lighter people. These findings imply that there is an association between the mass of the person performing the CPR and the effectiveness of the procedure, with heavier people enhancing the impact of gravity during the procedure. Nurses with shorter choice reaction times tended to exhibit higher levels of core emergency competencies. An individual’s reaction time is dependent on the coordination between, and the rapid response capacity of, their nervous and muscular systems [ 31 ] . The reaction time reflects the rapid response capacity in core emergency competencies,which plays a crucial role in patient care and survival [ 32 ] . In clinical settings, emergency nurses must quickly identify critical patients at potential risk by observing their abnormal vital signs and symptomatic changes, make the correct nursing decisions, activate the emergency response system, and cooperate with physicians to deliver life-saving treatment. Limitations The study has several limitations. First, this was a cross-sectional study. Hence, it is not possible to identify any causal links, and further longitudinal studies are needed. Second, all of the participants were recruited from one hospital. This may limit the generalizability of the results to nurses in China. Implications The findings of this study provide insight into the role that physical fitness plays in the core emergency competencies of emergency nurses. The finding that the overall level of physical fitness among the participants was not high guides nurse managers to pay attention to developing programs for emergency care nurses to enhance the aspects of their physical fitness that impact their core emergency competencies. In addition, the findings indicate that nurse managers should pay attention to the factors that substantially influence emergency nurses’ core emergency competencies, including work tenure and professional qualifications. Future studies should also be conducted to investigate the biological and physiological mechanisms involved in physical fitness having an effect on the core emergency competencies. Studies with larger sample sizes and longitudinal designs are also needed to rigorously assess the effects of physical fitness on the core emergency competencies. Conclusion In this study, the overall physical fitness level of the emergency nurses was not ideal. Work tenure, professional qualifications, self-reported HRPF, BMI, and choice reaction time were all found to be related to the improvement of core emergency competencies. It is recommended that more intervention programs targeting the identified modifiable influencing factors be implemented to improve the core emergency competencies of emergency nurses in China. Declarations Acknowledgment We acknowledged all the nurses who participated in the study. Special thanks to the sports staff at Wutaishan Gymnasium in Jiangsu Province in China. Authors’ contributions Shan Jiang was responsible for conceptualisation, investigation, formal analysis and writing-original draft preparation.Rucui Xia was responsible for study coordination and implementation, investigation, writing-reviewing and editing.Xue Cai and Zeyan Xia were responsible for conceptualisation, methodology,writing- reviewing and supervision. Xiaoqing Li and Lu Tao were responsible for investigation and data curation. Availability of data and materials Data are available from the corresponding authors upon reasonable request. Funding This study was supported by Nursing Research Fund of Southeast University Affiliated Zhongda Hospital(KJZC-HL-202202). Ethics approval and participation consent This study was reviewed and approved by the Medical Ethics Committee of Zhongda Hospital Southeast University (2023ZDSYLL398-P01). The participants provided written informed consent and were assured of confident. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee with the Helsinki declaration. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Chan T C. Specialty grand challenge: emergency health services[J]. Frontiers in Disaster and Emergency Medicine,2023:1-1310474. Lurie N, Margolis G S, Rising K L. 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Lopez-Gonzalez A, Sanchez-Lopez M, Garcia-Hermoso A, et al. Muscular fitness as a mediator of quality cardiopulmonary resuscitation[J]. Am J Emerg Med,2016,34(9):1845-1849. Adleman N E, Chen G, Reynolds R C, et al. Age-related differences in the neural correlates of trial-to-trial variations of reaction time[J]. Dev Cogn Neurosci,2016,19:248-257. Wu Y, Wang J, Luo F, et al. Construct and clinical verification of a nurse-led rapid response systems and activation criteria[J]. BMC Nurs,2022,21(1):311. Additional Declarations No competing interests reported. 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population aging accelerates, the prevalence of chronic diseases rises, acute illnesses induced by unhealthy lifestyles increase, and public health emergencies and disaster accidents become more frequent, the emergency medical service system is facing greater challenges.The emergency department (ED) plays a crucial role in the emergency medical service system, delivering acute care for a variety of urgent health issues\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. The number of ED visits tripled from 51.9\u0026nbsp;million to 166.5\u0026nbsp;million over the 2005\u0026ndash;2017 period in China\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.Yet for the ED to rise to these challenges and deliver such critical acute care, the expertise of its nursing team in navigating urgent scenarios is indispensable, and this expertise hinges on their core emergency competencies.Core emergency competencies refer to the ability of nurses to provide a comprehensive and rapid response to unexpected diseases with their knowledge, skills and experiences\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. According to Trisyani et al\u0026rsquo;s qualitative study, emergency nurse core competencies include shifting the nursing practice, caring for acute critical patients, communicating and coordinating, covering disaster nursing roles, reflecting on the ethical and legal standards, researching competency, teaching competencies and leadership competencies\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.Studies have discovered that core emergency competencies directly determine the quality and outcome of patients\u0026rsquo; rescue\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Thus, developing the core emergency competencies are a priority in the training of emergency nurses.\u003c/p\u003e\u003cp\u003eIdentifying the influencing factors of core emergency competencies among emergency nurses is a necessary step in the process of designing training programs, particularly modifiable influencing factors. Several traditional influencing factors of core emergency competencies among emergency nurses have been identified, including age, sex,education level, nursing experience, professional qualifications. In recent years, there has been a growing realization that the physical fitness of nurses has implications for both nurses\u0026rsquo; occupational health and the quality of healthcare services\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Emergency nurses work in high-stress, fast-paced environments that demand exceptional professionalism and physical fitness. Physical fitness is recognized as an integrated measure of nearly all the bodily functions that are needed to perform physical activity in everyday situations and in sports; it is also an important health marker\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The physical fitness components that are related to health are referred to as the health-related physical fitness (HRPF) components, which is the ability of the cardiovascular, lungs and muscles to perform at optimal efficiency. HRPF includes body composition(including metrics such as body fat percentage, muscle mass), cardiorespiratory fitness(cardiovascular, pulmonary and muscular efficiency to support prolonged aerobic activity), muscular strength and muscular endurance(the ability of a muscle to burst in a short period of time or work continuously for a long period of time), flexibility(joint range of motion and body extensibility) \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Physical fitness has been shown to be positively associated with cognition\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, bone health\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, psychological health\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, and occupational task performance\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePrevious studies have predominantly examined the relationship between physical fitness and cardiopulmonary resuscitation.Cardiopulmonary resuscitation (CPR) is one of the core competency skills that emergency nurses must master, as the precision of its operation is directly linked to the survival prognosis of patients in cardiac arrest. CPR imposes rigorous physical demands on emergency nurses, requiring sustained stamina and muscular endurance to maintain effective chest compressions. It has been consistently shown that higher levels of physical fitness enhance a rescuer\u0026rsquo;s capacity to deliver high-quality chest compressions over extended periods, irrespective of their medical training or experience\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Moreover, physical fitness (measured using upper-body anaerobic power and bench press scores) was found to robustly predict high-quality CPR performance\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.While these findings underscore the critical role of physical fitness in optimizing CPR performance, there is limited knowledge about the impact of physical fitness on the core emergency competencies among emergency nurses.\u003c/p\u003e\u003cp\u003eTherefore, the aims of this study were to determine the physical fitness of emergency nurses and to explore the influence of physical fitness on their core emergency competencies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eIn this study, a cross-sectional design was utilized. Potential participants were deemed eligible for this study if they were ED nurses, had signed an informed consent form, and had volunteered to participate. The exclusion criteria were as follows: (1) practice student or study nurse, (2) currently pregnant, (3) on sick leave or maternity leave, or (4) had a basic cardiopulmonary disease (e.g., arrhythmia). The Kendall method was used to estimate the sample size. First, the initial size was set as 5\u0026ndash;10 times more than the survey variables, then we took into account that 10\u0026ndash;15% of the questionnaires would likely be invalid, and the final sample size was 146.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003e This study was reviewed and approved by the Medical Ethics Committee of Zhongda Hospital Southeast University (2023ZDSYLL398-P01). Participants\u0026rsquo; information is completely confidential, questionnaires are recorded anonymously, and survey contents are used only for scientific research.\u003c/p\u003e\n\u003ch3\u003eMeasurements\u003c/h3\u003e\n\u003cp\u003eA questionnaire was designed using information gained from a literature review, group discussion, and expert panel discussion. The questionnaire items were designed to collect data on the participants\u0026rsquo; sex, age, marital status, education level, working tenure, professional qualifications, critical care specialization, work tenure and emergency experience (years).\u003c/p\u003e\u003cp\u003eCore emergency competencies were measured using the self-reported Chinese version of the evaluation tool for core emergency ability\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Developed by Zhao in 2015, the instrument consists of eight dimensions (theoretical knowledge, technical skill, emergency response capability, communication and coordination skills, emergency management capacity, emergency research capacity, personal traits, and work attitude) and includes 32 items that are answered using the Likert five-point scale (1\u0026thinsp;=\u0026thinsp;absolutely matched to 5\u0026thinsp;=\u0026thinsp;not matched). The total score ranges from 32 to 160 points. The higher the score, the greater the ability to deliver emergency care. The value of Cronbach\u0026rsquo;s α for the instrument was 0.851, a test-retest reliability was 0.893. Cronbach'α for each dimension of the subscales ranged from 0.827\u0026ndash;0.971.\u003c/p\u003e\u003cp\u003eThe assessment of physical fitness was based on the 2023 version of the Chinese National Physical Fitness Measurement Standards\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e,which includes 11 fitness indicators across three areas: physical form (body mass index [BMI] and body fat percentage), physical function (vital capacity and two-stage workload cycle ergometer tests), and physical quality (grip strength, vertical jump, sit-and-reach, push-ups/knee press-ups, 1-min sit-up, stand on one foot with eyes closed, and choice reaction time tests). The assessment results reflected the participants\u0026rsquo; cardiorespiratory endurance, muscle strength and endurance, body flexibility, and ability to balance.\u003c/p\u003e\u003cp\u003eBMI was calculated as weight in kilograms divided by the square of the height in meters (kg/m\u003csup\u003e2\u003c/sup\u003e). The BMI measurements were divided into four categories: underweight (\u0026lt;\u0026thinsp;18.5 kg/m\u003csup\u003e2\u003c/sup\u003e), normal weight (18.5 to \u0026lt;\u0026thinsp;24 kg/m\u003csup\u003e2\u003c/sup\u003e), overweight (24 to \u0026lt;\u0026thinsp;28 kg/m\u003csup\u003e2\u003c/sup\u003e), and obese (\u0026ge;\u0026thinsp;28 kg/m\u003csup\u003e2\u003c/sup\u003e). Each participant\u0026rsquo;s body fat percentage was measured via bioelectrical impedance analysis (BIA; 2000-M).\u003c/p\u003e\u003cp\u003eVital capacity is defined as the maximum volume (mL) of air that can be exhaled after maximal inspiration. The participants exhaled into the test instrument with maximum force after maximum inhalation.\u003c/p\u003e\u003cp\u003eA two-stage workload cycle ergometer was used to determine cardiorespiratory fitness. Each participant pedaled a power bike at 60 rpm under a set load for 7 min. The first 30 s were for warm-up, the last 30 s were for recovery, and the middle 6 min constituted the official test.\u003c/p\u003e\u003cp\u003eGrip strength is an indicator of the strength of the upper limbs. Participants were instructed to grasp the grip strength device for a few seconds.\u003c/p\u003e\u003cp\u003eVertical jump height was used to determine lower limb strength. Each participant bent their knees to a half-squat position and then jumped straight up, as high as possible.\u003c/p\u003e\u003cp\u003eThe sit-and-reach test is used to assess joint flexibility, as well as ligament and muscle extensibility and elasticity. Each participant sat on a cushion, straightened their legs and knees, and placed their feet flat against the test board. They then stretched their hands and body forward to push the cursor as far as possible.\u003c/p\u003e\u003cp\u003eThe ability to perform push-ups/knee press-ups is used as an indicator of overall upper body strength. The male participants performed the push-up test. Each participant maintained a straight torso and legs, with arms and forefeet on the mat. They bent their arms to lower their body until their shoulders and elbows were aligned, then pushed back up to the starting position. This was repeated continuously until the participant could no longer continue. The female participants performed the knee press-ups test. Each participant kept her arms straight, supported her knees on the mat, maintained a straight torso, and crossed her feet off the ground. The rest of the procedure followed the push-up form.\u003c/p\u003e\u003cp\u003eAbdominal muscle strength was measured using the 1-min sit-up test. The participants were placed in a supine position, with their knees flexed, feet flat on a floor mat, and hands placed behind their head with fingers interlaced. A sit-up was deemed complete when both elbows made contact with or surpassed both knees. The number of sit-ups completed in 1 min was recorded.\u003c/p\u003e\u003cp\u003eChoice reaction time is the time taken between a stimulus and an action that requires a choice. The participants were instructed to press the \u0026ldquo;start key\u0026rdquo; and await the initiation signal. Upon receiving a signal from any \u0026ldquo;signal key\u0026rdquo; (indicated by a light), participants were required to press the corresponding key as swiftly as possible and then return to the \u0026ldquo;start key\u0026rdquo; to await the subsequent signal. Each test consisted of five signal responses, and the response times were recorded in seconds.\u003c/p\u003e\u003cp\u003eTo test their muscle strength and balance, the participants were asked to stand on one foot with their eyes closed. The participants stood on the test mat on one leg with their eyes closed, and the duration until their raised foot touched the mat was recorded.\u003c/p\u003e\u003cp\u003eEach fitness indicator score was weighted by an age- and sex-specific percentage. The composite rating score was based on the sum of the participants\u0026rsquo; individual scores multiplied by their respective weights, and a 100-mark system was used. The scores were divided into four categories: excellent (\u0026ge;\u0026thinsp;83), good (75 to \u0026lt;\u0026thinsp;83), pass (60 to \u0026lt;\u0026thinsp;75), and fail (\u0026lt;\u0026thinsp;60).\u003c/p\u003e\u003cp\u003eSelf-reported HRPF was assessed using a specifically designed item (\u0026ldquo;What do you think of your health-related physical fitness?\u0026rdquo;). The item was answered using a five-point scale (1 = \u0026ldquo;very good,\u0026rdquo; 2 = \u0026ldquo;good,\u0026rdquo; 3 = \u0026ldquo;fair,\u0026rdquo; 4 = \u0026ldquo;poor,\u0026rdquo; or 5 = \u0026ldquo;very poor\u0026rdquo;). The impact of each participant\u0026rsquo;s self-reported HRPF on their core emergency competencies, mental fitness, and attention was assessed using three specifically designed items (\u0026ldquo;Do you think health-related physical fitness has an impact on your core emergency competencies/mental fitness/attention?\u0026rdquo;).\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected between April 2024 and May 2024 at the research site. The questionnaire was administered using Wenjuanxing (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wjx.cn/\u003c/span\u003e\u003cspan address=\"https://www.wjx.cn/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), an online data collection platform. Trained research assistants were available to answer questions. The participants could only submit the questionnaires when all the questions had been answered. Only one completed questionnaire could be submitted from one IP address. The physical fitness tests were conducted (and the results recorded) by trained examiners, who were recruited from provincial sports centers and capable of conducting different types of physical fitness tests. All participants gave written informed consent to be involved in the study after being notified of its purpose, benefits, and risks. Measures were taken to protect the participants\u0026rsquo; identities.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData were exported from the Wenjuanxing platform, and SPSS 26.0 was used to perform the statistical analysis. Frequencies and percentages were calculated for categorical variables, and means and standard deviations or medians were calculated for continuous variables. Potential associations between the dependent variable (core emergency competencies) and the independent variables (sociodemographic variables and physical fitness indicators) were determined with one-way ANOVAs and T-tests. A multivariate linear regression analysis was conducted to explore the influence of various factors on the core emergency competencies. All sociodemographic variables and physical fitness indicators were initially included in the model. The coefficient of determination (R\u003csup\u003e2\u003c/sup\u003e),the proportion of variance explained, and so on were used to detect the effect size. A \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u0026rsquo; characteristics\u003c/h2\u003e\u003cp\u003eThe total number of nurses asked to participate was 188, of which 146 accepted to participate and completed physical fitness tests.The response rate was 78%. Among them, 97 (66.4%) were female, 76 (52.1%) were no more than 30 years old, 133 (91.1%) had an undergraduate or higher level of education, 86 (58.9%) were senior nurses, 25 (17.1%) were critical care specialized nurses, 67 (45.9%) had more than 10 years of professional experience, and 56 (38.3%) had more than 10 years\u0026rsquo; experience in the emergency care field. There were significant differences within the cohort in terms of age, marital status, professional qualifications, critical care specialization, work tenure, and emergency experience (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The sociodemographic characteristics of the participants are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of the study participants (N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCore emergency competencies\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003et/F\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e136.04\u0026thinsp;\u0026plusmn;\u0026thinsp;19.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-0.762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.447\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e138.58\u0026thinsp;\u0026plusmn;\u0026thinsp;18.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e132.28\u0026thinsp;\u0026plusmn;\u0026thinsp;21.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e9.299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e141.69\u0026thinsp;\u0026plusmn;\u0026thinsp;14.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e153.08\u0026thinsp;\u0026plusmn;\u0026thinsp;9.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e131.47\u0026thinsp;\u0026plusmn;\u0026thinsp;21.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e142.38\u0026thinsp;\u0026plusmn;\u0026thinsp;15.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e141.00\u0026thinsp;\u0026plusmn;\u0026thinsp;15.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEducation level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBelow undergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e132.38\u0026thinsp;\u0026plusmn;\u0026thinsp;30.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-0.692\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.502\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUndergraduate or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e91.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e138.25\u0026thinsp;\u0026plusmn;\u0026thinsp;17.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eProfessional qualifications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJunior nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e123.17\u0026thinsp;\u0026plusmn;\u0026thinsp;21.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e21.105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenior nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e140.38\u0026thinsp;\u0026plusmn;\u0026thinsp;16.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupervisor nurse and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e150.04\u0026thinsp;\u0026plusmn;\u0026thinsp;11.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCritical care specialization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e146.48\u0026thinsp;\u0026plusmn;\u0026thinsp;12.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-3.486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e82.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e135.92\u0026thinsp;\u0026plusmn;\u0026thinsp;19.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eWork tenure\u003c/p\u003e\u003cp\u003e(years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e124.46\u0026thinsp;\u0026plusmn;\u0026thinsp;20.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13.873\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e138.84\u0026thinsp;\u0026plusmn;\u0026thinsp;17.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e142.87\u0026thinsp;\u0026plusmn;\u0026thinsp;13.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e150.33\u0026thinsp;\u0026plusmn;\u0026thinsp;12.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEmergency experience\u003c/p\u003e\u003cp\u003e(years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e125.07\u0026thinsp;\u0026plusmn;\u0026thinsp;20.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12.692\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u0026ndash;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e139.40\u0026thinsp;\u0026plusmn;\u0026thinsp;17.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e143.59\u0026thinsp;\u0026plusmn;\u0026thinsp;13.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e150.05\u0026thinsp;\u0026plusmn;\u0026thinsp;13.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eSelf-reported HRPF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e152.08\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e140.20\u0026thinsp;\u0026plusmn;\u0026thinsp;17.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e135.49\u0026thinsp;\u0026plusmn;\u0026thinsp;19.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e\u003cp\u003e130.24\u0026thinsp;\u0026plusmn;\u0026thinsp;19.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCore emergency competencies of emergency nurses\u003c/h3\u003e\n\u003cp\u003eThe mean score for the core emergency competencies was 137.73\u0026thinsp;\u0026plusmn;\u0026thinsp;18.96. The scores for each dimension of this measure are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eScores for the core emergency competencies of the study participants (N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMax\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMin\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheoretical knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.557\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTechnical skill\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency response capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunication and coordination skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency management capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmergency research capacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal traits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork attitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003cdiv class=\"Heading\"\u003ePhysical fitness of emergency nurses\u003c/div\u003e\u003cp\u003eAmong the participants, 3.5% had good physical fitness, 47.3% had general physical fitness, and 49.3% had poor physical fitness.The overall level of physical fitness was not significantly correlated with the core emergency competencies among the participants (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean BMI value of the emergency nurses was 24.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43 kg/m\u003csup\u003e2\u003c/sup\u003e, 5.5% (n\u0026thinsp;=\u0026thinsp;8) of the nurses were underweight, 31.5% (n\u0026thinsp;=\u0026thinsp;46) were overweight, and 16.4% (n\u0026thinsp;=\u0026thinsp;24) were obese. The details of physical fitness indicators are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePhysical fitness of the study participants (N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD/IQR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePhysical form\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.47\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBody fat percentage (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.38\u0026thinsp;\u0026plusmn;\u0026thinsp;8.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePhysical function\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVital capacity (mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2642.84\u0026thinsp;\u0026plusmn;\u0026thinsp;994.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo-stage workload cycle ergometer (mL/kg/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.18\u0026thinsp;\u0026plusmn;\u0026thinsp;8.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003ePhysical quality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrip strength (kg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.85(20.80\u0026ndash;36.56)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVertical jump (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.90(19.0\u0026ndash;30.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSit-and-reach (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePush-ups/Knee press-ups (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.66\u0026thinsp;\u0026plusmn;\u0026thinsp;11.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1-min sit-up (n/min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.60\u0026thinsp;\u0026plusmn;\u0026thinsp;10.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStanding on one leg with eyes closed (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.50(11.0\u0026ndash;40.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChoice reaction time (s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.097\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLess than half (39.7%) of the participants thought that their HRPF was very good or good.Self-reported HRPF was significantly correlated with the core emergency competencies among the participants (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of the participants agreed that their HRPF had an impact on their core emergency competencies (88.4%), their mental fitness (84.2%), and their attention (92.5%) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants\u0026rsquo; perceptions of impact of HRPF on core emergency competencies, mental fitness and attention (N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDimension\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDo you think HRPF has an impact on your core emergency competencies༟\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e88.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDo you think HRPF has an impact on your mental fitness༟\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e84.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDo you think HRPF has an impact on your attention༟\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e92.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eInfluencing factors associated with the core emergency competencies among emergency nurses\u003c/h2\u003e\u003cp\u003eA multiple linear regression analysis was performed to assess the factors that influence the core emergency competencies, and the results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The regression tolerance was \u0026gt;\u0026thinsp;0.1, and the models were statistically significant (F\u0026thinsp;=\u0026thinsp;17.311, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;36.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The score for the core emergency competencies correlated with self-reported HRPF (β\u0026thinsp;=\u0026thinsp;0.251, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), BMI (β\u0026thinsp;=\u0026thinsp;0.195, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), work tenure (β\u0026thinsp;=\u0026thinsp;0.195, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), choice reaction time (β = -0.179, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011), and professional qualifications (β\u0026thinsp;=\u0026thinsp;0.229, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultiple linear regression analysis of the factors that influence the core emergency competencies (N\u0026thinsp;=\u0026thinsp;146)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNon-standardized\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardized\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138.363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.313\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.365\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-reported HRPF(ref: very bad)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.651\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.251\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.657\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI(ref: underweight)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWork tenure(ref: \u0026lt; 5 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.326\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChoice reaction time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-34.682\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.463\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-2.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional qualifications(ref: junior nurse)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.771\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.982\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this was the first study to explore the effects of physical fitness on the core emergency competencies among emergency nurses. This cross-sectional study had several important findings. First, nearly half of the emergency nurses who participated in the study had poor physical fitness. Second, the total score for the core emergency competencies among the participants was 137.73\u0026thinsp;\u0026plusmn;\u0026thinsp;18.96. Third, physical fitness-related factors (i.e., self-reported HRPF, BMI, and choice reaction time) were associated with the core emergency competencies of emergency nurses.\u003c/p\u003e\u003cp\u003eThe proportion of participants who were physically fit (50.7%) was lower than that reported in the Fifth National Physical Fitness Monitoring Bulletin of residents aged 20\u0026ndash;59 years in China (87.2% of people aged 20\u0026ndash;39 years and 90.6% of people aged 40\u0026ndash;59 years)\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. This inconsistency could be explained by the musculoskeletal disorders that are common in nurses. The most affected body parts are the neck, waist, shoulders, and back\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Such disorders could have affected their performance in the physical fitness tests, especially those designed to assess physical quality (i.e., the sit-and-reach, push-ups/knee press-ups, and 1-min sit-up tests).\u003c/p\u003e\u003cp\u003eThe total score for the core emergency competencies recorded in this study (137.73\u0026thinsp;\u0026plusmn;\u0026thinsp;18.96) was slightly higher than that recorded in a survey conducted among nurses from different clinical departments in China (135.05\u0026thinsp;\u0026plusmn;\u0026thinsp;12.96), as were the scores for the theoretical knowledge, technical skill, emergency response capability, communication and coordination skills, and emergency management capacity dimensions\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. This may be because the nurses included in this study were selected from ED. In previous studies, it was found that among departments where core emergency competencies are frequently applied, staff tended to be more competent in this ability\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn this study, longer work tenure and higher professional qualifications of emergency nurses were significantly associated with higher core emergency competencies.This was consistent with the findings of a cross-sectional study that included 14,527 medical staff from 12 Chinese provinces\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. As nurses accumulate more work experience in their roles over time, their core emergency competencies are expected to increase correspondingly\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Nurse with higher professional qualifications were more likely to have more comprehensive core competencies and perform complex emergency nursing work\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn addition to demographic factors, this study also revealed that physical fitness-related factors (i.e., self-reported HRPF, BMI, and choice reaction time) were associated with the core emergency competencies.Nurses with higher levels of self-reported HRPF were more likely to have greater proficiency in core emergency competencies.This conclusion is in line with the findings of a previous study that showed that higher levels of physical fitness were related to better occupational-specific task performance in firefighters\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Emergency care nursing is intensive and urgent in nature, and nurses are required to stand for long periods, carry and transfer patients, and perform first aid procedures (e.g., CPR), all of which place considerable demands on their physical abilities. Thus, nurses who have good levels of HRPF can perform their daily tasks better and operate in a highly functional state.\u003c/p\u003e\u003cp\u003eThe influence that a higher BMI value has on the ability to perform adequate external chest compressions has been demonstrated\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Angel et al. confirmed that heavier people perform CPR better than lighter people. These findings imply that there is an association between the mass of the person performing the CPR and the effectiveness of the procedure, with heavier people enhancing the impact of gravity during the procedure.\u003c/p\u003e\u003cp\u003eNurses with shorter choice reaction times tended to exhibit higher levels of core emergency competencies. An individual\u0026rsquo;s reaction time is dependent on the coordination between, and the rapid response capacity of, their nervous and muscular systems\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. The reaction time reflects the rapid response capacity in core emergency competencies,which plays a crucial role in patient care and survival\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. In clinical settings, emergency nurses must quickly identify critical patients at potential risk by observing their abnormal vital signs and symptomatic changes, make the correct nursing decisions, activate the emergency response system, and cooperate with physicians to deliver life-saving treatment.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe study has several limitations. First, this was a cross-sectional study. Hence, it is not possible to identify any causal links, and further longitudinal studies are needed. Second, all of the participants were recruited from one hospital. This may limit the generalizability of the results to nurses in China.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eImplications\u003c/h2\u003e\u003cp\u003eThe findings of this study provide insight into the role that physical fitness plays in the core emergency competencies of emergency nurses. The finding that the overall level of physical fitness among the participants was not high guides nurse managers to pay attention to developing programs for emergency care nurses to enhance the aspects of their physical fitness that impact their core emergency competencies. In addition, the findings indicate that nurse managers should pay attention to the factors that substantially influence emergency nurses\u0026rsquo; core emergency competencies, including work tenure and professional qualifications.\u003c/p\u003e\u003cp\u003eFuture studies should also be conducted to investigate the biological and physiological mechanisms involved in physical fitness having an effect on the core emergency competencies. Studies with larger sample sizes and longitudinal designs are also needed to rigorously assess the effects of physical fitness on the core emergency competencies.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, the overall physical fitness level of the emergency nurses was not ideal. Work tenure, professional qualifications, self-reported HRPF, BMI, and choice reaction time were all found to be related to the improvement of core emergency competencies. It is recommended that more intervention programs targeting the identified modifiable influencing factors be implemented to improve the core emergency competencies of emergency nurses in China.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledged all the nurses who participated in the study. Special thanks to the sports staff at Wutaishan Gymnasium in Jiangsu Province in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShan Jiang was responsible for conceptualisation, investigation, formal analysis and writing-original draft preparation.Rucui Xia was responsible for study coordination and implementation, investigation, writing-reviewing and editing.Xue Cai and Zeyan Xia were responsible for conceptualisation, methodology,writing- reviewing and supervision. Xiaoqing Li and Lu Tao were responsible for investigation and data curation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Nursing Research Fund of Southeast University Affiliated Zhongda Hospital(KJZC-HL-202202).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and participation consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Medical Ethics Committee of Zhongda Hospital Southeast University (2023ZDSYLL398-P01). The participants provided written informed consent and were assured of confident. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee with the Helsinki declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eChan T C. Specialty grand challenge: emergency health services[J]. Frontiers in Disaster and Emergency Medicine,2023:1-1310474.\u003c/li\u003e\n \u003cli\u003eLurie N, Margolis G S, Rising K L. The US emergency care system: meeting everyday acute care needs while being ready for disasters[J]. Health Aff (Millwood),2013,32(12):2166-2171.\u003c/li\u003e\n \u003cli\u003ePan C, Pang J, Cheng K, et al. Trends and challenges of emergency and acute care in Chinese mainland: 2005-2017[J]. World J Emerg Med,2021,12(1):5-11.\u003c/li\u003e\n \u003cli\u003eLi H, Dong S, He L, et al. Nurses\u0026apos; core emergency competencies for COVID-19 in China: A cross-sectional study[J]. Int Nurs Rev,2021,68(4):524-532.\u003c/li\u003e\n \u003cli\u003eTrisyani Y, Emaliyawati E, Prawesti A, et al. Emergency Nurses\u0026apos; Competency in the Emergency Department Context: A Qualitative Study[J]. Open Access Emerg Med,2023,15:165-175.\u003c/li\u003e\n \u003cli\u003eWang J, Lv C, Song X, et al. Current situation and needs analysis of medical staff first aid ability in China: a cross-sectional study[J]. BMC Emerg Med,2023,23(1):128.\u003c/li\u003e\n \u003cli\u003eSalameh B, Amarneh D, Abdallah J, et al. Evaluation of Clinical Competence and Job Satisfaction and Their Related Factors Among Emergency Nurses in Palestinian Hospitals[J]. SAGE Open Nurs,2023,9:2105861765.\u003c/li\u003e\n \u003cli\u003eLi X, Zhou M, Wang H, et al. Factors associated with core competencies of emergency-room nurses in tertiary hospitals in China[J]. Jpn J Nurs Sci,2020,17(3):e12337.\u003c/li\u003e\n \u003cli\u003eChappel S E, Verswijveren S, Aisbett B, et al. Nurses\u0026apos; occupational physical activity levels: A systematic review[J]. Int J Nurs Stud,2017,73:52-62.\u003c/li\u003e\n \u003cli\u003eOrtega F B, Ruiz J R, Castillo M J, et al. Physical fitness in childhood and adolescence: a powerful marker of health[J]. Int J Obes (Lond),2008,32(1):1-11.\u003c/li\u003e\n \u003cli\u003eQi F, Soh K G, Nasiruddin N, et al. Effect of Taichi Chuan on health-related physical fitness in adults: A systematic review with meta-analysis[J]. Complement Ther Med,2023,77:102971.\u003c/li\u003e\n \u003cli\u003eDonnelly J E, Hillman C H, Castelli D, et al. Physical Activity, Fitness, Cognitive Function, and Academic Achievement in Children: A Systematic Review[J]. Med Sci Sports Exerc,2016,48 (6):1197-1222.\u003c/li\u003e\n \u003cli\u003eHenriques-Neto D, Magalhaes J P, Hetherington-Rauth M, et al. Physical Fitness and Bone Health in Young Athletes and Nonathletes[J]. Sports Health,2020,12(5):441-448.\u003c/li\u003e\n \u003cli\u003eMa S, Xu Y, Xu S, et al. The effect of physical fitness on psychological health: evidence from Chinese university students[J]. BMC Public Health,2024,24(1):1365.\u003c/li\u003e\n \u003cli\u003eSkinner T L, Kelly V G, Boytar A N, et al. Aviation Rescue Firefighters physical fitness and predictors of task performance[J]. J Sci Med Sport,2020,23(12):1228-1233.\u003c/li\u003e\n \u003cli\u003eOck S M, Kim Y M, Chung J, et al. Influence of physical fitness on the performance of 5-minute continuous chest compression[J]. 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Chin J Mod Nurs\u003cem\u003e.\u003c/em\u003e2015;(12):1368-1371.\u003c/li\u003e\n \u003cli\u003eNational Physical Fitness Surveillance Center. The Chinese National Physical Fitness Measurement Standards (2023 version).2023.Accessed June 10, 2024. https://www.sport.gov.cn/n 315/n20001395/c25880704/part/25880716.pdf.\u003c/li\u003e\n \u003cli\u003eNational Physical Fitness Surveillance Center.National Physical Fitness Monitoring Bulletin [Z]. 2023.Accessed July 18, 2024.https://www.gov.cn/guoqing/2023-03/12/content_5745851.htm.\u003c/li\u003e\n \u003cli\u003eWang K, Zeng X, Li J, et al. The prevalence and risk factors of work-related musculoskeletal disorders among nurses in China: A systematic review and meta-analysis[J]. Int J Nurs Stud,2024, 157:104826.\u003c/li\u003e\n \u003cli\u003eZhao LT.The Study On The evaluation tool for core emergency ability of clinical nursing staff.Shanxi Medical University\u003cem\u003e.\u003c/em\u003e2015.\u003c/li\u003e\n \u003cli\u003ePoveda-Moral S, de la Casa P J, Sanchez-Valero P, et al. Association between knowledge and attitudes towards advance directives in emergency services[J]. BMC Med Ethics,2021,22(1):75.\u003c/li\u003e\n \u003cli\u003eLu Y, Wang L, Hu SL.A literature review of nurses\u0026apos; first aid ability. Journal of Nursing Science. 2019;34(12):107-110.\u003c/li\u003e\n \u003cli\u003eHarbison S, Melton B F, Hunt N, et al. The Relationship Between Physical Mobility and Firefighter Occupational Task Performance[J]. Int J Exerc Sci,2023,16(3):1216-1227.\u003c/li\u003e\n \u003cli\u003eKrikscionaitiene A, Stasaitis K, Dambrauskiene M, et al. Can lightweight rescuers adequately perform CPR according to 2010 resuscitation guideline requirements?[J]. Emerg Med J,2013,30 (2):159-160.\u003c/li\u003e\n \u003cli\u003eSayee N, Mccluskey D. Factors influencing performance of cardiopulmonary resuscitation (CPR) by Foundation Year 1 hospital doctors[J]. Ulster Med J,2012,81(1):14-18.\u003c/li\u003e\n \u003cli\u003eLopez-Gonzalez A, Sanchez-Lopez M, Garcia-Hermoso A, et al. Muscular fitness as a mediator of quality cardiopulmonary resuscitation[J]. Am J Emerg Med,2016,34(9):1845-1849.\u003c/li\u003e\n \u003cli\u003eAdleman N E, Chen G, Reynolds R C, et al. Age-related differences in the neural correlates of trial-to-trial variations of reaction time[J]. Dev Cogn Neurosci,2016,19:248-257.\u003c/li\u003e\n \u003cli\u003eWu Y, Wang J, Luo F, et al. Construct and clinical verification of a nurse-led rapid response systems and activation criteria[J]. BMC Nurs,2022,21(1):311.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"core emergency competencies, physical fitness, emergency, nurses","lastPublishedDoi":"10.21203/rs.3.rs-7487242/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7487242/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEmergency nurses require exceptional levels of clinical professionalism and physical fitness.However, little is known about the impact of physical fitness on the core emergency competencies of emergency nurses.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e\u003cp\u003eThe aims of this study were to describe the levels of physical fitness of emergency nurses and to explore the influence of physical fitness on their core emergency competencies.\u003c/p\u003e\u003ch2\u003eStudy Design:\u003c/h2\u003e\u003cp\u003eA cross-sectional study involving emergency nurses was conducted in China between April and May 2024. The data were collected using a self-report questionnaire (sociodemographic characteristics and core emergency competencies) and physical fitness tests. Multiple linear regression analysis was used to identify the factors associated with the core emergency competencies of emergency nurses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe study included 146 emergency nurses. The mean score for core emergency competencies was 137.73\u0026thinsp;\u0026plusmn;\u0026thinsp;18.96. Among the nurses, 3.5% had good physical fitness, 47.3% had general physical fitness, and 49.3% had poor physical fitness. Furthermore, 88.4% agreed that their health-related physical fitness (HRPF) had an impact on their core emergency competencies. A multivariate analysis indicated that core emergency competencies were associated with self-reported HRPF (β\u0026thinsp;=\u0026thinsp;0.251, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), body mass index (β\u0026thinsp;=\u0026thinsp;0.195, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), work tenure (β\u0026thinsp;=\u0026thinsp;0.195, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), choice reaction time (β = \u0026minus;0.179, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011), and professional qualifications (β\u0026thinsp;=\u0026thinsp;0.229, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.049).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eNearly half the emergency nurses had poor physical fitness. Work tenure, professional qualifications, self-reported HRPF, body mass index, and choice reaction time were all found to be related to the core emergency competencies.Nurse managers should prioritize the development of programs aimed at enhancing the aspects of emergency nurses\u0026rsquo; physical fitness that may impact their core emergency competencies.\u003c/p\u003e","manuscriptTitle":"Association between physical fitness and core emergency competencies among emergency nurses in China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 11:26:06","doi":"10.21203/rs.3.rs-7487242/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T16:36:16+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-27T11:20:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-26T21:00:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-24T08:07:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163400249649770317783263149645839615489","date":"2025-10-24T07:38:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210367541812996756741872091048673796299","date":"2025-10-20T15:49:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"99717680030732879588426573151125312817","date":"2025-10-18T20:59:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T16:10:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49117410063312124338197969062722450937","date":"2025-10-09T14:35:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84134438541706637684878699242713484398","date":"2025-10-09T12:07:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T11:10:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-19T09:40:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T08:46:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-03T01:55:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-09-03T01:52:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e6a5d913-c67d-4d61-b544-0521d098088e","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:40:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 11:26:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7487242","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7487242","identity":"rs-7487242","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}