Nurses Taking On Readiness Measures - Mercer County, New Jersey
Phase: NA
Conditions: Disaster, Vulnerable Populations
Sponsor: Hunter College of City University of New York

N-TORM INTERVENTION 
 
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Official Title: Nurses Taking on Readiness Measures – Mercer County, NJ 
NCT Number: 05455580 
Document Date: May 19, 2022 
 
 
 
 
 
 
 
 
Research Protocol: 
Nurses Taking On Readiness Measures – Mercer County, New Jersey  
 
 
Tara Heagele, PhD, RN 
Hunter College School of Nursing 
Hunter College, The City University of New York 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Abstract 
 
Nurses Taking On Readiness Measures (N-TORM) is an innovative nurse-driven 
household emergency preparedness (HEP) intervention modeled after an existing 
community intervention provided by emergency management personnel. The proposed 
pilot study will describe the implementation and effectiveness of N-TORM in the 
community setting, but provided by nurses. The aims of this implementation study are 
to: (a) increase the reach of N-TORM to vulnerable populations; (b) evaluate the 
effectiveness of N-TORM for increasing HEP knowledge and behavior; (c) implement N-
TORM in a community located in an area at increased risk for disasters, measuring 
consistency of delivery, time, and cost of N-TORM; (d) describe the factors necessary to 
maintain and expand N-TORM, and; (e) pilot test a new HEP instrument in order to 
perform psychometric testing on the instrument and generate reliability and validity data. 
 
Keywords: disasters, disaster planning, hazard, emergency, preparedness, 
planning, readiness, kit, vulnerable populations  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Personnel 
 
Tara Heagele, PhD, RN 
Principal Investigator (PI) 
Hunter-College School of Nursing, Hunter College, The City University of New York 
• Heagele curriculum vitae 
• Heagele Collaborative Institutional Training Initiative (CITI) Human Subjects 
Research for Social & Behavioral Faculty, Graduate Students & Postdoctoral 
Scholars  
 
 
Research Sites 
 
Name 
Mercer County, New Jersey 
 
Site Principal Investigator  
Tara Heagele, PhD, RN 
 
Role of the Site in Research 
Recruitment, screening, obtaining consent, interacting with subjects, performing the 
intervention, data collection, data analysis 
 
Has IRB 
Yes 
 
Permission Granted 
Yes 
 
CUNY Site 
Hunter College 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Funding 
 
Grant Title 
Cycle 51 PSC-CUNY Research Award 
 
Grant Number 
63040-00 51 
 
Funding Status 
$3,330.00 
 
Grant PI 
Tara Heagele, PhD, RN, EMT 
 
Funding Category 
Research 
 
Funding Source 
PSC-CUNY Research Award Program through the New York State budget 
 
Do the protocol and funding proposal match?  
Yes 
 
Is CUNY PI the lead PI? 
Yes 
 
The PI Heagele will maintain the following records for this study: 
• 
Documentation of current IRB approval, signed consent forms, completed 
household emergency preparedness instruments, participant demographic data 
forms, participant experience surveys, disaster kit distribution list (per PSC-
CUNY mandate), participant list (participant identification number and first and 
last name initials only) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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Research Design 
 
Purpose and Hypothesis 
 
As more chronically ill people are living in the community and disasters are 
occurring frequently, the elderly and the medically frail vulnerable populations are 
experiencing significantly more disaster-related morbidity and mortality than the rest of 
the population. Lack of knowledge on how best to prepare for disasters and lack of 
means to purchase supplies are significant barriers to adequate household emergency 
preparedness (HEP). Community-based HEP interventions present a unique 
opportunity to address these barriers and disaster-related morbidity and mortality 
disparities in vulnerable populations. Modeled after a community intervention targeting 
healthy seniors (Golden, 2013) and residents (New York State, n.d. ), Nurses Taking On 
Readiness Measures (N-TORM) is a nurse-driven HEP intervention that will be offered 
in the community to older adults, individuals with chronic illnesses, pregnant women, 
and caregivers of medically frail individuals. The Federal Emergency Management 
Agency (FEMA) Emergency Management Institute (2014) states that these individuals 
have access or functional needs during disasters and are considered vulnerable 
populations. The proposed study develops, tests, and evaluates the N-TORM 
intervention for the purpose of contributing to generalizable knowledge about the 
nurses’ role in the HEP of vulnerable community members. The proposed pilot study will 
specifically target independently living community members with access and functional 
needs. The N-TORM intervention will enable the household to meet the FEMA 
recommendations for HEP, to safely shelter in place, and evacuate quickly with their 
supplies if needed. Measurable outcomes of the proposed study include the nurse’s 
impact on the participants’ level of HEP post-intervention and participant satisfaction 
with the intervention. Multi-disciplinary collaboration with engagement of community and 
government organizations will be demonstrated by the proposed study. Community 
resources provided by the New Jersey Office of Emergency Management will be 
incorporated into N-TORM. Local utility companies will be queried about priority 
restoration registries, and the police and fire departments about evacuation assistance 
and shelters. It is plausible that the long-term impact of the N-TORM intervention would 
be lives saved and resources conserved. Because the N-TORM intervention uses an 
all-hazards approach, it is possible to replicate nationally and with different vulnerable 
populations. The investigator will disseminate the findings via a peer-reviewed scholarly 
research journal article and at a nursing conference so that other institutions, clinicians, 
and community members may learn from this pilot study.  
 
• RQ 1: What is the baseline level of HEP of the participants? 
• RQ 2: How much of the variance in HEP is explained by the Household 
Emergency Preparedness Instrument (HEPI)? 
• RQ 3: Is there a significant difference in HEP level after receiving the N-
TORM intervention? 
• RQ 4: What are the facilitators and barriers of nurses delivering and 
participants receiving the N-TORM intervention? 
 

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Finally, the proposed study will also pilot test a new household emergency 
preparedness instrument (Heagele et al., 2020) in order to perform 
psychometric testing on the instrument and generate reliability and validity data. 
There is support for face, content, and criterion validity of this instrument.  
 
Design and Methodology 
 
This is a non-randomized, non-blinded, quasi-experimental, pre- and post-test 
design pilot study.  
 
Only approved research personnel will be involved in the research procedures. 
Principal Investigator Dr. Tara Heagele is employed at Hunter College (Assistant 
Professor) and her duties in this study will be conducted under her role as an employee 
of Hunter College.  
 
The study start date is dependent on IRB approval. Recruitment and data 
collection are projected to start in March of 2022 and conclude by the end of March 
2023. Data analysis is projected to conclude within two months after data collection is 
concluded. 
 
The N-TORM intervention is not being offered in any other in-patient, out-patient, 
or community setting at this time. However, the N-TORM intervention was pilot tested 
with new parents in the neonatal intensive care unit and newborn nursery of 
Maimonides Medical Center in New York in 2020 (Heagele & Nurse-Clarke, 2022).  
 
One participant per household will be eligible to participate. Inclusion criteria for 
the participants in the proposed study will: 
• be aged 18 years or older 
• be English-speaking 
• have access and functional needs during disasters or are caregivers of 
individuals with access and functional needs 
• live independently within Mercer County, New Jersey (i.e., not in a rehabilitation 
facility, long-term care facility, halfway house, or prison) 
• consent to participate  
 
Participants with cognitive impairments will be excluded because they are not 
responsible for their household emergency preparedness activities. However, their 
primary caregivers will be eligible to participate. Participants less than 18 years of age 
will also be excluded because children are generally not responsible for their household 
emergency preparedness activities. Non-English speaking and non-English reading 
families will be excluded from the study because the principal investigator does not 
speak a language other than English. 
 
No more than 70 participants will be invited to participate in this study, with 
recruitment ceasing at 31 successful completions of the N-TORM intervention.  
 

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Potential Participants will be recruited from a private Facebook group called 
“Hamilton Twp. Mercer County NJ.” The principal investigator will also utilize the 
Snowball Sampling technique where participants suggest other potential participants. 
The principal investigator will provide flyers to the participants with the hope that they 
will share them with other potential participants.  
 
Per the administrator guidelines of the private Facebook group “Hamilton Twp. 
Mercer County NJ,” the principal investigator will post the recruitment message once 
per week until 31 successful completions of the N-TORM intervention are completed. 
The administrators must approve the post for it to display to the members. Interested 
group members will be instructed to contact the principal investigator via private 
message on Facebook or via the principal investigator’s work e-mail at 
th1591@hunter.cuny.edu. If any questions are asked in the comments section of the 
recruitment post, the principal investigator will answer via private message to the 
potential participant and delete the comment. 
 
 The principal investigator will then perform the online screening. The participant 
will be informed of this screening immediately before they receive it. This will only occur 
once per potential participant. Participants will be screened in a private message on 
Facebook. The principal investigator will determine if the participant is eligible to 
participate by determining 
 
a. the participant’s self-reported age is 18 years or older.  
 
b. the participant’s self-reported lack of preparedness for disasters. 
 
c. the participant’s ability to speak and read the English language.  
 
d. if the participant lives independently in Mercer County, New Jersey.  
 
e. if the participant has access or functional needs during disasters according to 
the Federal Emergency Management Association’s definition.  
 
f. if the participant is alert and oriented (the participant can correctly identify 
him/herself, the year, and the current president of the United States).  
 
The principal investigator will deliver the recruitment script to eligible participants 
(see attachment).  
 
Participants will be consented only once when they enroll in the study. The 
consent form will be provided during the online screening/recruitment for the potential 
participant to read. The consent form will be signed at the in-person meeting at a public 
place of the participant’s choice within Mercer County, New Jersey, after the principal 
investigator has answered any questions that the participant has. 
 
Once a potential participant is either screened out or completes the intervention, 

N-TORM INTERVENTION 
 
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the private message in Facebook or the e-mail will be deleted.  
 
After informed consent is obtained, the principal investigator will perform the N-
TORM intervention with the participant. 
 
The principal investigator’s role in the N-TORM intervention is to:  
 
a. screen participants for eligibility. 
 
b. deliver the recruitment script to the participants. 
 
c. obtain informed consent from the participants. 
 
d. administer the demographic data form to the participants (gender, age, 
race/ethnicity, relationship status, employment status, education, income, daily 
prescription medication use, special medical equipment use, disability status, 
military experience, English as a first language, zip code, home ownership, years 
lived in home, years lived in the community, type of home, children in the home). 
Demographic variables were chosen on the basis of previous HEP literature. 
 
e. administer the Household Emergency Preparedness Instrument (HEPI) to the 
participants before and after the intervention. The participant’s baseline HEP 
level will be assessed with the HEPI. The HEPI is two standard letter-size 
papers, double-sided and will be completed with a pen or pencil. The participant 
will be asked to check off which preparedness actions they have completed and 
what disaster supply kit items they have in their home. It will take approximately 5 
minutes to complete this questionnaire. Feedback will not be given to the 
participants based on their questionnaire results. The pre- and post-survey data 
will be linked by a number, but the number will not be linked to the consent form. 
 
f. perform the N-TORM intervention, which consists of educating the participants 
about HEP via the Family Disaster Plan booklet, and checking for completion of 
the Family Disaster Plan booklet. The intervention will begin with instructing the 
participant to complete the Family Disaster Plan booklet. The principal 
investigator will talk about the different sections of the booklet and instruct the 
participants how to fill out their emergency plans in the booklet. Participants will 
write their medical history, medications, physician, next of kin, pharmacy contact 
information, evacuation plan information, family communication plan, and 
insurance policy numbers and contact information. The booklet includes 
household emergency preparedness recommendations, evacuation zone 
information, a disaster supply kit contents list, local utility company contact 
information, shelter locations, and special needs and priority utility restoration 
registry information.  
 
g. The education portion of the intervention will take place at a public place of the 
participant’s choice within Mercer County, New Jersey. The participant's portion 

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of the intervention will take place immediately after the education portion of the 
intervention, also at the public place of the participant’s choice. 
 
h. administer the participant experience survey. The participant experience survey 
will be administered after the second HEPI is completed. The participant 
experience survey is one standard letter-size paper, single-sided, and will be 
completed with a pen or pencil. 
 
i. securely store research documents during and after data collection.  
 
j. analyze the data. 
 
k. disseminate the results. 
 
The completed Family Disaster Plan booklets will not be copied, collected, 
stored, or used for research purposes. The booklets are for the participants to keep; 
they are the participants’ household emergency preparedness plans and they will also 
serve as a community disaster resources information source. The participants will be 
provided with a disaster supply kit after successful completion of the booklet. The 
disaster supply kit, valued at $111.60 on September 18, 2020, is part of the intervention 
and is not considered compensation.  
 
As this is a pilot study, it is unknown how long the N-TORM intervention will take 
to complete. It is estimated that the education portion will take approximately 5 minutes. 
It is estimated that the completion of the booklet by the participant will take 
approximately 25 minutes.  
 
There is no need for follow-up with the participants after they have completed the 
intervention.  
 
There is no more than minimal risk for participation in this study. Little to no 
feelings of discomfort are expected. When completing the HEPI and the Family Disaster 
Plan booklet, participants may experience unpleasant memories, anxiety, or respondent 
burden. To mitigate this risk, participants will be able to skip HEPI questions or stop the 
HEPI at any time if they become uncomfortable. Participants will also be able to stop 
filling out the Family Disaster Plan booklet at any time. In addition, the informed consent 
includes an assurance of the participant’s right to choose not to participate or to 
terminate participation at any time during the intervention and states that, should the 
participant decide not to participate in this research study, his or her relationship with 
the study team will not change and he or she will not lose any benefits to which he or 
she is otherwise entitled. 
 
All efforts will be made to keep participants’ personal information in their research 
record confidential, but total confidentiality cannot be guaranteed. To mitigate this risk, 
no personal identifying information will be asked on the HEPI or the demographic data 
form. Each participant will be given a number by the principal investigator, which will be 

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on both the HEPI and the demographic data form. The participants will be instructed to 
record this number. They will need it if they would like their data removed from the 
study. Only the principal investigator will know which numeric identifier is linked to which 
participant. Signed consents will not be numbered. The consents will be kept in a locked 
file in the principal investigator’s office at Hunter College.  
 
To comply with the funding agency’s auditing requirements, the principal 
investigator will keep a Disaster Kit Distribution List that includes the following 
information: participant identification number, date the kit was distributed, and person 
who distributed the kit. The principal investigator is the only person who will have 
access to this list. The list will be stored in the principal investigator’s locked office at 
Hunter College.  
 
There are no direct benefits to participating in this study. This research does not 
claim to present a therapeutic benefit to the participants. Participants who successfully 
complete the intervention may be self-sufficient for up to 72-hours post-disaster, but the 
association between disaster preparedness level and disaster resilience has not been 
empirically tested. It is anticipated that this study will benefit society. The study data can 
build evidence for a promising individual and community HEP intervention. This HEP 
intervention can also be used in longitudinal studies to determine whether there is an 
association between being prepared for a disaster and surviving the disaster without the 
need for rescue or outside assistance. For medically frail community members, it can be 
determined whether there is an association between being prepared for a disaster and 
surviving the disaster without an acute exacerbation of a chronic illness and with no 
change in baseline functional status. 
 
The participants will not incur any research-related costs. The participants will not 
be compensated for their participation.  
 
After the participant data collection is completed, the participant will complete a 
1-page, paper and pencil, anonymous survey about their experience with the 
implementation of the N-TORM intervention.  
 
The data from the HEPIs, demographic data forms, and surveys will be 
transcribed by the principal investigator into electronic documents. This deidentified 
data will be stored on a password-protected, encrypted server (The City University of 
New York Dropbox), which complies with the City University of New York’s Computer 
Use and Internet-Based Research Policy. The data will be stored in one password-
protected, shared Dropbox folder that only the investigator has access to. Study data 
will not be downloaded or stored on personal or work desktop or laptop computers. The 
data will be stored in the password-protected Dropbox folder for three years after the 
study is completed and closed out with the IRB. After the three years are completed, the 
study data will be deleted from the Dropbox folder. The paper copies of the HEPIs, 
demographic data forms, and surveys will be shredded after they are transcribed. The 
principal investigator will store the consent documents in a locked filing cabinet in her 
office at Hunter College for three years after the study is completed and closed out with 

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the IRB. After the three years are completed, the documents will be destroyed. The data 
will not be stored or distributed for future research studies. 
 
The principal investigator will analyze the quantitative and qualitative data. The 
principal investigator may utilize a statistician to assist with analyzing deidentified 
quantitative data. 
 
Descriptive statistics of the sample will be analyzed. Regression analyses will be 
conducted to examine the associations between the study variables. The change in 
level of HEP will be evaluated with the pre- and post-intervention scores on the HEPI. 
The improvement from pretest to posttest will be computed by subtracting each 
participant’s pretest score from his or her posttest score. If the gain score is positive, it 
will indicate that the level of household emergency preparedness is greater after the N-
TORM intervention. In addition, the change in score will be evaluated with a matched 
pairs t-test. Finally, the mean household emergency preparedness pretest score for all 
of the participants will be compared to the mean posttest score with a percentage 
change calculation. Qualitative data obtained from the participants’ surveys will be 
analyzed via content analysis methods.  
 
The reliability of the HEPI will be measured by looking at the internal consistency 
of the items. Polychoric correlations will be used to examine the factor structure of the 
HEPI. Known-group validity of the HEPI will be assessed by comparing the scores of 
the participants who self-reported that they were unprepared for a disaster before and 
after the N-TORM intervention.  
 
This pilot study has been awarded grant funding via Cycle 51 PSC-CUNY 
Research Award grant in the amount of $3,330.00. The grant will fund the intervention 
materials (disaster supply kits and the Family Disaster Plan booklets).  
 
References  
 
FEMA Emergency Management Institute. (2014). IS-368: Including people with 
disabilities and others with access and functional needs in disaster operations. 
Retrieved from https://training.fema.gov/is/courseoverview.aspx?code=is-368 
 
Golden, S. (2013). STORM Seniors Taking on Readiness Measures: Family disaster 
plan. Freehold, NJ Monmouth County Sheriff’s Office. 
 
Heagele, T. N., McNeill, C. C., Adams, L. M., & Alfred, D. M. (2020). Household  
emergency preparedness instrument development: A Delphi study. Disaster 
Medicine and Public Health Preparedness. https://doi.org/10.1017/dmp.2020.292 
 
Heagele, T. N. & Nurse-Clarke, N. J. (2022). A nurse-led home disaster preparedness  
intervention for new parents. Neonatal Network: The Journal of Neonatal 
Nursing, 41(1), 5-10. http://doi.org/10.1891/11-T-714 
 

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New York State. (n.d. ). New York State Citizen Preparedness Corps. Retrieved from 
http://www.dhses.ny.gov/aware-prepare/nysprepare/