<![CDATA[Emergency nurses in protracted conflict zones require updated competencies to manage high-acuity presentations under severe resource constraints. This study evaluated the impact of a structured training program on clinical knowledge and procedural performance. A one-group pretest–posttest design was used with 82 emergency nurses at Al Aqsa Martyrs Hospital in the Gaza Strip. The intervention combined didactic instruction with manikin-based simulations across 14 core emergency modules. Knowledge was measured via a validated 30-item multiple-choice examination, while practical competence was assessed using a standardized observational checklist. Paired t-tests analyzed score differentials. Post-intervention data revealed statistically significant improvements across all domains (p < 0.001). Mean knowledge scores increased by 40.1%, and practical performance improved by 43.8%. The most substantial gains occurred in basic/advanced life support, trauma assessment, airway management, and shock resuscitation. Subgroup analyses indicated that nurses aged ≤30 years and those without prior formal emergency training achieved the greatest relative improvement. Simulation-enhanced training substantially elevates emergency nursing competencies in resource-limited, high-stress environments. Integrating standardized simulation into continuous professional development is essential to sustain clinical readiness and optimize acute care delivery in conflict-affected healthcare systems.]]>
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