REVIEW PROTOCOL

Forensic nursing competencies in disaster situations: a scoping review protocol

Thiago Augusto Soares Monteiro da Silva1, Débora Fernanda Haberland1, Thais da Silva Kneodler1, Alexandre Barbosa de Oliveira1

1Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brasil

ABSTRACT

Objective: to map the sources of technical-scientific information on forensic nursing competencies in disaster situations. Method: scoping review protocol, developed following the Joanna Briggs Institute (JBI) methodology. The search will be carried out in three stages, by two reviewers, independently, in selected databases and the grey literature, using keywords and descriptors. The selection, initially, will be conducted through the screening of titles, abstracts, and descriptors, observing the inclusion criteria. Subsequently, the texts will be filed in digital folders and read in full by two researchers with the support of an instrument. After extracting the data, the content analysis will be carried out. The summary of the results will be presented using graphs, diagrams, tables, and flow diagrams for the proper alignment with the review's objective and question.

Descriptors: Disasters; Forensic Nursing; Health.

INTRODUCTION

Disasters comprise complex phenomena that occur gradually or suddenly, resulting from threats from natural, technological and social sources, exposure, and vulnerabilities, exceeding the capacity for preparation and response(1-4). They constitute a serious public health problem, as they promote damage in the various dimensions of life for individuals, social groups, and the environment(1-4).

Since antiquity, humanity has experienced situations of different types of disasters of natural (landslides, floods, droughts, epidemics, and pandemics), technological (fires, breaches of tailings dams, chemical, radio, nuclear, rail, air, and road accidents) and social origin (violence, forced migrations and lack of assistance), triggering basic human needs to be assisted by nursing(1-4).

Regardless of typology, disaster situations have been increasing generating impacts for different societies, as identified in 2021 by the emergency events database (EM-DAT), which recorded 432 disasters that affected 101.8 million people, caused 10,492 deaths and led to a loss of approximately 252.1 billion dollars(5). Given the epidemiological situation, there is an urgent need to invest in governance, research, training of human resources in multiple areas, and developing skills and specific competencies to act during disasters(1,6,7).

In disaster situations, nursing professionals are the first responders, as they generally constitute the largest contingent of health professionals, assuming multiple roles in the pre-incident, incident, and post-incident stages(1,8-10).

Thus, the International Council of Nurses (ICN), together with the World Health Organization (WHO), pointed out certain challenges regarding the performance of nursing professionals in the health-disaster-care process, which leads to the need for research, discussion, and dissemination of information about essential nursing competencies to act in the different stages of disasters(8,9,11).

Among the subareas that can bring substantial contributions to support nursing competencies in disasters there is forensic nursing, as it is understood that, in the care process in such situations, problems inherent to forensic aspects emerge, such as cases of unidentified dead victims, presence of remains, abandonment of the elderly, neglect of care for children and people with special needs, injuries, the existence of multiple forensic traces, sexual violence against victims of wars and refugees, and interpersonal violence in temporary shelters and field hospitals, in addition to the need to provide care based on local, regional or national laws(12-16).

Forensic nursing comprises a new nursing specialty in Brazil, and its formal recognition occurred within the Federal Nursing Council (COFEN) through Resolution number 389, 2011. In turn, the areas of expertise and competencies of forensic nurses were recognized by Resolution number 0556 published by COFEN, in 2017(17-18). It should be noted that disasters, humanitarian missions, and catastrophes represent one of the eight areas of activity of forensic nurses in Brazil, and it is necessary to deepen scientific investigations on the competencies of forensic nurses in this context.

It is identified that the forensic nurse can act in the context of disasters by establishing preventive/mitigating actions, diagnosing the existence of risks and performing interventions, responding to installed situations, and promoting care to individuals(12).

Given the above, in order to support the development of a scoping review study, a preliminary search was carried out between November and December 2021 in PROSPERO, JBI Evidence Synthesis, MEDLINE (via PubMed), and Cochrane Database of Systematic Reviews, and no reviews of any nature were identified on forensic nursing competencies in disaster situations, which represents a novelty of this study. Therefore, we decided to carry out a scoping review due to the need to map concepts rigorously and systematically. Thus, it is understood that this synthesis will contribute to supporting further studies on forensic nursing, as well as amplify the discussion with educational institutions regarding the competencies of this field for nurses and nursing students, in addition to potentially aiding the instrumentalization of the training of forensic nurses.

Objective

To map the sources of technical-scientific information on forensic nursing competencies in disaster situations.

METHOD

The proposed scoping review will be conducted under the Joanna Briggs Institute (JBI)(19) methodology. The research protocol was registered in the Open Science Framework, under DOI 10.17605/OSF. IO/3WYSP.

Review question

What are the competencies of the forensic nurse in disaster situations?

Inclusion criteria

Population

The study population will be professional forensic nurses with knowledge or experience in disaster situations.

Concept

This review study will consider competencies as a concept. Competencies are the quality or state of being skilled to act in complex situations involving multiple problems that require articulation of knowledge for resolution in a critical-reflexive and creative way(20). In this sense, studies that point out the competencies and care performed by forensic nurses in disaster situations will be considered.

Context

The context considered is that of disasters, whether of any type: natural, technological, or social.

Based on these elements, search terms were mapped using controlled vocabularies: Health Sciences Descriptors (DECS), Medical Subject Headings (MESH), and Emtree (Embase subject headings). After a preliminary search, additional terms identified in titles, abstracts, and MESH descriptors of the articles were added (Figure 1).

Source types

This review will consider sources of technical-scientific information from existing literature, including primary studies, with a quantitative, qualitative, and mixed approach, experimental and quasi-experimental designs, case-control studies, literature reviews, before and after studies, time series, observational studies, cohort studies, and cross-sectional studies.

A search in the grey literature will also be conducted (theses and dissertations, websites, protocols, guidelines, books, legislations, letters, and opinion articles).

Search strategy

The search will be carried out in three stages by two researchers independently. It is noteworthy that the process of blinding between reviewers will be maintained and that this review will have the support of a librarian.

The first step will comprise a primary search in Medical Literature Analysis and Retrieval System Online (Medline) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, allowing the screening of titles, abstracts, and descriptors of the articles.

The second stage will involve a complete search in all databases selected for the study, using the Boolean operators “AND” and “OR”, together with the keywords and the following descriptors (Figure 1):

Source: Prepared by the authors, 2022.

Source: Prepared by the authors, 2022.

Figure 1– Language terms identified in the DECS, MESH, and ENTREE vocabularies. Rio de Janeiro, RJ, Brazil, 2021

The third stage will comprise the tertiary search by analyzing reference lists of all technical-scientific literature, which contemplates the established inclusion criteria. In addition, this review will include the additional search for information by contacting the authors of primary studies.

It should be noted that temporal and idiomatic restrictions or open-access definitions of sources will not be adopted, to expand the searches.

Databases

Searches will be performed through the Regional Portal of the Virtual Health Library (VHL) under the responsibility of the Latin American and Caribbean Center on Health Sciences Information(BIREME) in the main databases, Latin American and Caribbean Health Sciences Literature (Lilacs), Spanish Bibliographic Index on Health Sciences (IBECS), Nursing Databases (BDENF),Peruvian Network of Libraries in Health(LIPECS), PubMed of the National Library of Medicine (NLM), and Scientific Electronic Library Online (SciELO).

Through the Capes Portal of Journals, the following databases will be used: Elsevier: Embase and Scopus, Clarivate Analytics: Web of Science, Ebsco: Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Academic Search Premier (ASP). Moreover, searches will be conducted in CAB Direct, a platform that allows researchers to search for CAB Abstracts and Global Health.

The search will also include sites on forensic nursing, professional legislation, the International Council of Nurses, the International Association of Forensic Nurses (IAFN), digital libraries of theses and dissertations, and internet search engines. In order to operationalize the search for grey literature, the following integrators and grey literature portals will be accessed: Science.gov: USA.gov, Epistemonikos: Database of the best Evidence-Based Health Care, information technologies and a network of experts, and National Institute for Health and Care Excellence (NICE).

Sources selection

After searches, all identified citations will be imported into the Rayyan application (Qatar Computing Research Institute, Doha, Qatar). Initially, the sources will be analyzed by two reviewers, who will screen titles, abstracts, and descriptors, according to the inclusion criteria of the scoping review. Disagreements between the two reviewers will be resolved through consensus or decision of a third reviewer. Excluded studies will be registered and described as to the reasons for exclusion. It should be noted that the EndNote Web reference manager will be used to organize the references and identify duplicates, (Clarivate Analytics, PA, USA).

Two researchers will file the texts in digital folders and read them in full format. The selection results will be presented in a flowchart, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines(21).

Data extraction

The selected data will be extracted after full-text screening. For this, the instrument (Figures 2 and 3) will be used, following the Joanna Briggs Institute (JBI)(16) methodology. For the use of this instrument, a pilot test will be carried out on three sources, seeking familiarity with searching, selecting, and extracting data and identifying and making any necessary adjustments.

Source: Prepared by the authors, 2022.

Figure 2– Instrument for extracting data for the Scoping Review. Rio de Janeiro, RJ, Brazil, 2021

Source: Prepared by the authors, 2022.

Figure 3– Instrument for extracting data for the Scoping Review. Rio de Janeiro, RJ, Brazil, 2021

During the data extraction, the instrument may undergo adjustments as necessary. Disagreements will be resolved by discussion after consensus with a third reviewer. The extracted data will consider aspects such as population, concept, and context.

Data analysis and presentation

After extracting the data, a content analysis will be carried out with the support of the Iramuteq software. Data including study design and approach, origin and typology of the disaster situation, and forensic nursing competencies in disaster prevention/mitigation, disaster preparedness, disaster response, and disaster recovery/rehabilitation will be collected.

The synthesis of the results will be presented using graphs, diagrams, flow diagrams, and tables, aiming at the proper alignment with the review's objective and research question. Furthermore, a descriptive presentation will accompany the mapped results.

CONFLICT OF INTERESTS

The authors have declared that there is no conflict of interests.

REFERENCES

1. Chegini Z, Arab‐Zozani M, Kakemam E, Lotfi M, Nobakht A, Aziz Karkan H. Disaster preparedness and core competencies among emergency nurses: A cross‐sectional study. Nursing Open. 2022;9(2):1294-1302. https://doi.org/10.1002/nop2.1172

2. Park HY, Kim JS. Factors influencing disaster nursing core competencies of emergency nurses. Appl Nurs Res. 2017;37:1-5. https://doi.org/10.1016/j.apnr.2017.06.004

3. Freitas CM, Mazoto ML, Rocha V. Guia de preparação e respostas do setor de saúde aos desastres [Internet]. Rio de Janeiro (RJ): Fiocruz, Secretaria de Vigilância em Saúde; 2018 [cited 2021 Dec 20]. Available from: http://www.ensp.fiocruz.br/portal-ensp/informe/site/arquivos/anexos/adbdf1fb1bd20e237ab67233e3f0a4cfe67a267c.PDF  

4. Ministério da Saúde (BR). Guia de preparação e resposta à emergência em saúde pública por inundação. Secretaria de Vigilância em Saúde Ambiental e Saúde do Trabalhador [Internet]. Brasília (DF): Ministério da Saúde; 2017 [cited 2021 Jan 10]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/guia_preparacao_respostas_emergencia_saude_publica_inundacao.pdf

5. Centre for Research on the Epidemiology of Disasters (US). Disasters in Numbers [Internet]. Brussels: Centre for Research on the Epidemiology of Disasters; 2022 [cited 2022 Jul 26]. Available from: https://cred.be/sites/default/files/2021_EMDAT_report.pdf

6. Karnjuš I, Prosen M, Ličen S. Nurses’ core disaster-response competencies for combating COVID-19—A cross-sectional study. Plos One. 2021;16(6):e0252934. https://doi.org/10.1371/journal.pone.0252934

7. Al Harthi M, Al Thobaity A, Al Ahmari W, Almalki M. Challenges for nurses in disaster management: a scoping review. Risk Manag Healthc Policy. 2020;13:2627-2634. https://doi.org/10.2147/RMHP.S279513

8. International Council Of Nurses (ICN). Core Competencies in Disaster Nursing Version 2.0 [Internet]. Geneva: International Council of Nurses; 2019 [cited 2021 Dec 11]. Disponível em: https://www.icn.ch/sites/default/files/inline-files/ICN_Disaster-Comp-Report_WEB.pdf

9. International Council Of Nurses (ICN).  ICN Framework of Disaster Nursing Competencies [Internet]. Geneva (CH): International Council of Nurses; 2009 [cited 2021 Dec 12]. Available from: http://www.apednn.org/doc/resourcespublications/ICN%20Framework%20of%20Disaster%20Nursing%20Competenci

es%20ICN%202009.pdf

10. Kamanyire JK, Wesonga R, Achora S, Labrague LL, Malik A, Alshaqsi S, et al. Nursing Students' Perceived Disaster Preparedness and Response: Pilot study in Oman. Sultan Qaboos Univ Med J. 2021;21(4):621-625. https://doi.org/10.18295/squmj.5.2021.074

11. Al Thobaity A, Plummer V, Williams B. What are the most common domains of the core competencies of disaster nursing? A scoping review. Int Emerg Nurs. 2017;31:64-71. https://doi.org/10.1016/j.ienj.2016.10.003

12. Doyle L. Forensic Nursing: The key to Disaster preparedness strategy. Forensic Examiner [Internet]. 2013 [cited 2022 Feb 23];22(4):58-69. Available from: https://www.proquest.com/docview/1549251769

13. Lynch VA. Forensic nursing science: Global strategies in health and justice. Egyptian J Forensic Sci. 2011;1:69-76. https://doi.org/10.1016/j.ejfs.2011.04.001

14. Valentine JL, Sekula K, Lynch V. Evolution of Fofrensic Nursing Theory-Introduction of the Constructed Theory of Forensic Nursing Care: A middle-rande Theory. J Forensic Nurs. 2020;16(4):188-198. https://doi.org/10.1097/JFN.0000000000000287

15. Kelishami FG, Manoochehri H, Mohtashami J, Kiani M. Consequences of presence of forensic nurses in health care system: a qualitative study. Iran J Nurs Midwifery Res. 2020;25(3):195-201. https://doi.org/10.4103/ijnmr.IJNMR_119_19

16. Logie CH, Okumu M, Lukone SO, Loutet M, McAlpine A, Latif M, et al. Ngutulu Kagwero (agents of change): study design of a participatory comic pilot study on sexual violence prevention and post-rape clinical care with refugee youth in a humanitarian setting in Uganda. Glob Health Action. 2021;14(1):1940763. https://doi.org/10.1080/16549716.2021.1940763

17.Conselho Federal de Enfermagem (COFEN). Resolução nº 389, de 18 de outubro de 2011. Atualiza, no âmbito do Sistema Cofen/Conselhos Regionais de Enfermagem, os procedimentos para Registro de Títulos de Pós-Graduação Lato e Stricto Sensu concedido a Enfermeiros e lista as especialidades [Internet]. Brasília: COFEN; 2011 [cited 2022 Jul 26]. Available from: http://www.cofen.gov.br/resoluo-cofen-n-3892011_8036.html

18. Conselho Federal de Enfermagem (COFEN). Resolução COFEN nº 556/2017, de 23 agosto de 2017. Regulamenta a atividade do Enfermeiro Forense no Brasil, e dá outras providências [Internet]. Brasília: COFEN; 2017 [cited 2022 Jul 26]. Available from: http://www.cofen.gov.br/resolucao-cofen-no-05562017_54582.html  

19. Peters MDJ, Godfrey C, Mcinerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis [Internet]. Adelaide: JBI; 2020 [cited 2022 Jan 17]. Available from: https://jbi-global-wiki.refined.site/space/MANUAL/4687342/Chapter+11%3A+Scoping+reviews. https://doi.org/10.46658/JBIMES-20-12

20. Kuller JA, Rodrigo NF. Metodologia de Desenvolvimento de Competências. Rio de Janeiro: Senac Nacional; 2014.

21. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. https://doi.org/10.7326/M18-0850   

Submission: 05/01/2022

Approved: 11/18/2022