Effect of a forensic nursing virtual education course on knowledge and clinical decision-making of master’s nursing students in Iran: a non-equivalent control group pre- and post-test study

Purpose: Forensic nursing is a specialty in the nursing profession based on legal procedures. This study aimed to assess the effect of a forensic nursing virtual education course on knowledge and clinical decision-making among master’s nursing students. Methods: In a quasi-experimental study with a pre- and post-test, 106 master’s nursing students at Guilan (n=65) and Mazandaran (n=41) Universities of Medical Sciences, Iran were enrolled. Data were collected using census sampling from March to April 2021. Participants in the intervention group received a forensic nursing virtual education course in three 90-minute sessions for 2 days. Results: A total of 88 out of 106 master’s nursing students were enrolled in this study. The mean post-education score for knowledge in the intervention group was significantly higher than in the control group (12.52 vs. 7.67, P<0.001). The mean post-education score for clinical decision-making in the intervention group was significantly higher than in the control group (16.96 vs. 13.64, P<0.001). Conclusion: The level of knowledge and clinical decision-making of master’s nursing students regarding forensic evidence improved after the forensic nursing virtual education course in the intervention group compared to the control group. Nursing managers and policymakers can develop appropriate strategies to improve the knowledge and clinical decision-making of nursing students by using forensic nursing education courses in the curricula of nursing programs, especially in postgraduate education as an elective or mandatory course.


Introduction Background
Forensic nursing is a specialty in the nursing profession based on legal procedures. In fact, forensic nursing is defined as a nursing specialty with subspecialties that focus on nursing practice related to clinical legal issues of living or deceased victims and offenders [1]. Nurses are the first people who are in contact Values are presented as mean± standard deviation or number (%). a) P-value was obtained with the independent t-test. b) P-value was obtained with the chi-square test. c) P-value was obtained with the Fisher exact test. Values are presented as mean± standard deviation or number (%).
CDM, clinical decision-making. a) P-value was obtained with the independent t-test. b) P-value was obtained with the Fisher exact test. c) Pvalue was obtained with the chi-square test.  The testimony of a forensic nurse is reliable in all legal cases in court.

2
The presence of multiple knife wounds on the hands and feet can indicate a person's self-defense against violence.
3 Sexual assault refers only to injuries caused in the sexual area. 4 The presence of bruises and redness around the genital area in children can indicate sexual abuse.

5
In patients considered to be the victims of poisoning, collecting body secretions (sweat or eye fluids, etc.) has legal value.

6
In order to protect a sample of semen obtained from the vagina, a wet swab is sent to the laboratory in a plastic bag.

7
In rape victims, even in the case of taking a bath, semen can be sampled by taking a swab from inside the vagina.

8
In rapes, semen spilled on clothes has legal value without a time limit. 9 In order to document the exact size of an active stab wound, a forensic nurse is required to photograph it while placing a ruler next to the wound.
10 If active nonbleeding wounds are suspected, a nurse should photograph the wound to document the exact size of the wound by placing a ruler next to the wound. 11 A contusion caused by the pressure of a car wheel in a driving accident presents as a bruise on the spine area when entering the emergency room.
12 The best environment for protecting DNA in the collected samples is formalin.
13 DNA can be extracted from the hair separated from the body of the aggressor only up to 72 hours.
14 A nurse should pack the bloody clothes of a shooting victim into a plastic bag as evidence. 15 All patients referred to the emergency room are considered legal patients unless proven otherwise.
16 In the care of forensic patients, help can also be obtained from the patient's companion.
17 The first step for a nurse when dealing with the victims of driving accidents is to make a detailed chart of the location of the injuries on the body chart.

Statement Answers
Scenario 1 Neda is a 10-year-old girl who lives with her parents in Rasht. She goes to school at 7:30 AM every day and returns at 2:00 PM. On Sunday, Neda asked her mother for permission to go to her friend Fatima's birthday and return home by 5:00 PM, but she did not return until 6:00 PM and her mother was very worried. She called Fatemeh's house and a young boy who introduced himself as Fatemeh's brother replied that the party was over and there was no news of Neda. Finally, at 8:00 PM, Neda entered the house with slow and limping steps while her clothes were dirty and soiled and some of the buttons on her clothes were loose. The mother asked what happened to her and why she was late. The mother asked her a question, but she replied while her voice was shaking that: she fell on the way back home. And she quickly went to her room. While she was changing her clothes, her mother entered the room and noticed redness and bruises around her neck and back, which she mentioned. When her mother asked why she was confused, she said that she hit something. Neda's mother was very worried. Neda's mother insistently brings her to the hospital's emergency room while Neda cries and resists. Neda's mother will explain the story to you. By building trust in Neda and by telling her not to worry about anything and that you intend to help her, you get her to agree to the examination, and you also obtain permission from Neda's mother for the examination. You notice that Neda's face is scrunched up while walking and she walks slowly and limply. You ask Neda to take off her clothes while you make Neda's surroundings quiet and communicate with Neda with your communication skills. Meanwhile, you notice bruises on her arms and redbrown spots on her neck and shoulders, as well as numerous bruises on her inner thighs. As a nurse, answer the following questions: a. You ask the mother to bring the patient's old clothes.
b. Pay attention to the location of the bruises, their intensity, extent, and color, and record the information.
c. Check the clothes for the presence of liquid and send them to the laboratory. Hashemi's hands and face. In further investigations, the nurse notices that the patient is barefoot and had multiple wounds on the toes of both feet. At this moment, the patient states that her toes have been hurting for some time for no reason and also that she has run out of insulin for 3 days and has not been able to get insulin again. By paying closer attention to the patient's symptoms, the nurse smells the smell of acetone on her breath. As a nurse, answer the following questions: During the visit of a car driver to the emergency department of the hospital, a pregnant young woman is admitted to the emergency department. This lady had an accident with a moving car and the assailant's car fled from the scene of the accident the injured person was taken to the hospital by the people present on the scene while his clothes were wet with blood. In the initial examination conducted by the emergency nurse, the patient was fully conscious at first and had placed her hands on her stomach and was writhing in pain, and said that her baby was not moving. She desperately begged the nurse to save her child. After a few minutes, she loses consciousness and passes out. According to the above scenario, answer the following questions: 16 In such a situation, what is the first decision you make as a nurse?
a. I will immediately inform the emergency doctor.
b. I ask my colleagues for help.
c. I will announce a code.
d. I will inform the legal authorities immediately. Scenario 5 A 25-year-old woman was taken to the hospital and finally to the operating room, after asking for help from her neighbors, while several wounds were seen on the backs of her hands, arms, neck, and chest, and her clothes were soaked with blood. Due to the urgency of the patient's condition, the nurses took off the patient's clothes without using gloves and cut parts of the clothes for easy changing and threw them on the floor on the infected nylon in a corner, and prepared the patient for the operation. After that, they folded the clothes and put them in a nylon bag. According to the above scenario, answer the following questions:

21
In the above situation, what do you do with the patient's clothes?
a. I put all her clothes in a nylon bag after changing.
b. I throw away the patient's clothes.
c. I leave the clothes to the service to deliver to the patient's caregivers.
d. I put the clothes separately in paper boxes.

22
Due to the urgency of the patient's condition, what do you do to change the patient's clothes?
a. The tears in the clothes are expanded by hand to make them easier to change.
b. I cut the middle of the dress with a scalpel or scissors.
c. I open the dress from the seams.
d. I undress the patient according to her comfort level.

23
In such a situation, which of the following actions would you take?
a. I do the work related to the patient and finally, register my name on the items collected from the patient.
b. I request my colleagues to help me expedite patient care.
c. I only prepare the patient for the operating room quickly and do not waste time talking to the patient.
d. I leave the evidence collected from the patient in the same room where I prepared the patient.

24
What do you do if you encounter this patient?
a. In the nursing report, I mention the presence of a wound due to a knife and explain the rest of the details verbally.
b. I write down the wounds and the type of cuts, their location, size, depth, and other features of the cut.
c. It is not necessary to report to the supervisor about the presence of this patient immediately.
d. I do all of the above.

25
Which of the following options is incorrect?
a. The forensic nurse should document the exact size of the wound by placing a ruler next to it.
b. In caring for a legal patient, one should not always ask for help from the patient's caregivers.
c. Multiple stab wounds on the backs of hands and arms can indicate a person's self-defense against violence.
d. The testimony of a forensic nurse is reliable in court.