Preparedness and Nurse-Associated Factors of Forensic Nursing Care among Nurses at Kenyatta National Hospital’s Accident and Emergency Department

Abstract

The approach to the fight against violence, a global menace with both health and legal consequences, is multipronged. The discipline of nursing can effectively contribute through forensic nursing. This sub-speciality focuses on bridging the gap between legal and health systems for potential forensic patients. Establishing the level of preparedness of nurses to provide forensic nursing care and identifying nurse-related factors, particularly in Accident and Emergency (A&E) departments, in the face of high incidences of violence in our neighbourhoods should be prioritised. The A&E department, as the port of entry for victims/survivors of violence at Kenyatta National Hospital (KNH), was purposely selected for the study. A convergent mixed-method research design was employed for the study, whereby a sample of (n=81) respondents selected by a consecutive sampling technique completed filling a modified Knowledge Questionnaire over Forensic Nursing Practice (KQFNP), over eight weeks for quantitative data. Key informant interviews were conducted and data were captured manually among seven (n=7) purposely selected sections in charge of collecting complementary qualitative data. The Chi-square test of significance p<.05 was used in hypothesis testing, while logistic regression analysis was used to predict determinants of preparedness, with findings presented using tables and figures. Qualitative data were transcribed, thematically analysed, and presented in verbatim and narrations. A majority (81.5%, n=66) of study respondents had a low level of preparedness to provide forensic nursing care, a finding reinforced by key informants (KI-1)… “Assessment and identification of forensic patients are limited to sexual assault clients. Our focus is basically on clinical care.”  The years of experience post-licensure (Fisher exact value= 9.838; p value= 0.006), training in forensic evidence collection and preservation (Fisher exact value= 9.933; p value= 0.002), and training in expert witnessing in the courts of law (Fisher exact value= 6.488; p value= 0.019) were statistically significantly associated with preparedness. Those trained in evidence collection and preservation, and expert witnessing were 6.8 times and 16.3 times more likely to be prepared compared to untrained (COR= 6.750; 95% CI =2.018-22.582; P=0.002) and (COR= 16.250; 95% CI =1.557-169.618; P=0.020) respectively. The majority of nurses in the A&E department at KNH have low levels of preparedness to provide forensic nursing care. The years of experience post licensure, training in forensic evidence collection, and expert witnessing were statistically significantly associated with preparedness. Develop and implement targeted in-service educational initiatives to address gaps in formal training in forensic nursing. Tailor training interventions leveraging on identified demographic factors.