Nurses’ preparedness and hospital-associated factors of forensic nursing care at Kenyatta national hospital’s accident and emergency department

Abstract

A comprehensive response to violence, a global menace with consequences beyond medical interventions, is multipronged. The nursing profession has a duty to society through forensic nursing, a specialty that bridges the gap between the legal and health systems, in the fight against violence. In the face of increased incidences of victims/survivors of violence visiting hospitals primarily via Accident and Emergency (A&E) departments, forensic nursing preparedness, and associated hospital factors deserve scrutiny. This study sought to establish the level of preparedness to provide forensic nursing care among nurses working in the A&E department at Kenyatta National Hospital (KNH) and reveal hospital-related factors associated with it. The A&E department as the port of entry for victims/survivors of violence at KNH was purposively selected as the setting of the study. The department receives averagely 3000 patients a day, 24% of whom are potential forensic patients according to hospital patients’ attendance registers. A convergent mixed-method research design was adopted. A sample of (n=81) nurses working at the A&E department of KNH selected through census method completed filling self-administered webbased modified Knowledge Questionnaire over Forensic Nursing Practice (KQFNP), over eight weeks. Key informant interviews were conducted and captured manually among seven (n=7) purposively selected section in-charges. The observational checklists were used to carry out a structural audit of the hospital factors. The Chi-square and Fisher exact tests of significance p<.05 were used to test the null hypothesis of no association between hospital factors and the level of nurses’ preparedness to provide forensic nursing care at the A&E department of KNH. Binary logistic regression analysis was used to predict odds of preparedness, with findings presented using tables and a figure. Qualitative data were subjected to thematic analysis and presented in verbatim and narrations. Findings revealed that 18.5% (n=15) of study respondents had a high level of preparedness to provide forensic nursing care, this was reinforced by key informant (KI1)…“most nurses are ill-prepared to provide forensic nursing care, except for sexual assault cases...” A structural audit of the department revealed a dearth of material resources needed to provide quality forensic nursing care except for sexual assault cases. Bivariate analysis using the Chisquare/fisher exact test of association revealed that among the hospital-related factors: recognition of the nurses ‘contribution in forensic care by hospital administrators (fisher exact value =8.519; p value=0.012) and provision of forensic evidence collection kits (X2 value =8.637; df=2; p value=0.013) were significantly associated with preparedness. Binary logistic regression analysis revealed that those who were unsure of recognition by hospital administration of their contribution were 99.8% less likely to be prepared compared to those who were affirmative (COR= 0.150; 95% CI =0.035-0.638; P=0.010) while those who were unsure of the provision of forensic evidence collection kits were 99.8% less likely to be prepared compared to those who reported the kits were provided (COR= 0.117; 95% CI =0.023-0.584; P=0.009). The null hypothesis of no association between hospital factors and preparedness was rejected. The majority of study respondents had low levels of preparedness to provide forensic nursing care. Recognition of nurses’ contribution in caring for forensic patients and the availability of evidence collection kits are significantly associated with preparedness. KNH’s A&E department should adopt a system approach to preparedness by availing hospital resources supportive of preparedness to provide forensic nursing care.