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Early recognition of physical abuse in children is essential for ensuring child safety and preventing further harm. However, distinguishing abuse-related injuries from accidental findings can be challenging, especially for nursing students who have limited clinical experience. Simulation-based educational methods may provide safe and effective environments for developing these skills.
This study aims to evaluate the effectiveness of moulage-based simulation training in improving nursing students' ability to recognize signs of physical abuse in children. The study will use a randomized controlled design in which students will be assigned to either a moulage-based simulation group or a control group receiving standard theoretical education.
After a lecture on child physical abuse within the Child Health and Pediatric Nursing course, students will participate in laboratory practice sessions. The intervention group will assess a pediatric mannequin prepared with simulated abuse findings using moulage techniques. Students' knowledge and recognition of physical abuse indicators will be evaluated before and after the intervention.
The study seeks to determine whether moulage-based education improves nursing students' recognition of physical abuse findings and supports the development of clinical assessment skills.
Child abuse is a significant global public health problem and may occur in various forms, including physical, emotional, and sexual abuse as well as neglect. Physical abuse in children may manifest through a wide range of clinical findings such as bruises, burns, bite marks, cuts, fractures, and head injuries. Because these findings may sometimes be confused with other medical conditions or accidental injuries, it is critically important for healthcare professionals to accurately recognize signs of physical trauma in order to ensure the early protection of children.
Nurses frequently represent the first point of contact between abused children and the healthcare system and therefore play a key role in identifying trauma-related findings. For this reason, simulation-based educational strategies have gained increasing importance in nursing education to strengthen students' clinical observation and decision-making skills. Among these strategies, moulage is a makeup-based simulation technique that realistically replicates physical trauma findings such as bruises, burns, lacerations, and bite marks. By creating realistic clinical scenarios, moulage allows students to practice recognizing injury patterns and improves their ability to assess potential abuse cases.
Educational simulations using moulage can enhance students' engagement, facilitate experiential learning, and provide opportunities to practice clinical assessment skills in a safe learning environment. Such applications may contribute to improved recognition of trauma-related findings and support the development of professional competencies required for identifying possible child abuse cases.
The present study aims to evaluate the effectiveness of moulage-based simulation in improving nursing students' ability to recognize physical abuse findings in children. Within this framework, simulated physical abuse findings will be created on a pediatric mannequin using moulage techniques, and students will be asked to conduct a general physical assessment of the child. The effectiveness of this method will be compared with a traditional educational approach based on watching film scenes that include examples of physical abuse indicators.
The study will be conducted within the Child Health and Pediatric Nursing course at a university in Istanbul between December 2025 and February 2026. Students participating in the course will be randomly assigned to either a moulage-based simulation group or a film-based learning group. Following the educational interventions, students' knowledge, attitudes, communication skills, and learning experiences related to child abuse recognition will be evaluated using standardized assessment tools.
This research seeks to determine whether moulage-based simulation provides a more effective learning environment for recognizing signs of physical abuse in children. In addition, the study aims to explore how simulation-based training contributes to students' professional competencies in identifying potential abuse cases and to identify possible challenges encountered during the learning process.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group watching film clips showing physical abuse signs to support learning and discussion. | Active Comparator | A total of 30 minutes of selected clips from three films depicting physical abuse (Sleepers, Antwone Fisher, The Tale) will be shown. These clips include visual examples of physical abuse indicators, such as bruises, repeated injury marks (e.g., belt buckle marks, stick marks), and soft tissue injuries. The films will be shown only within the scope of the study and not as part of the course curriculum. During the intervention, students in both groups will be observed and guided by Assistant Professor Dr. Suna Uysal and Lecturer Nil Bruk, who have been invited from different universities. |
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| Moulage Technique Group | Experimental | Moulage applied to a child mannequin to assess students' attitudes and behavioral responses. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Moulage Technique Group | Other | Makeup (moulage) will be applied to a 3-5-year-old mannequin by an expert trained in moulage techniques. The application will be based on visual examples of physical abuse findings presented in the book "Physical Signs of Child Abuse" (Hobbs & Wynne, 2001), which serves as an atlas commonly used in healthcare studies for identifying physical signs and lesions associated with child abuse. Students will then be asked to perform a "general physical assessment of the child" on the mannequin with the applied moulage injuries. |
| Measure | Description | Time Frame |
|---|---|---|
| Healthcare Professionals' Attitudes Toward Reporting Child Abuse Scale | It is a 5-point Likert scale. Each item is scored as: Strongly disagree = 1 Disagree = 2 Neutral = 3 Agree = 4 Strongly agree = 5 Some items are reverse-scored; for these, 1↔5, 2↔4, 3 remains 3. Total score is the sum of all item scores. Higher scores indicate a more positive attitude toward reporting child abuse, while lower scores indicate reluctance or a negative attitude. | "pre-intervention" |
| Recognition of the signs and risk factors of child abuse and neglect measured using the Scale for Identifying the Signs and Risks of Child Abuse and Neglect. | The Attitudes of Healthcare Professionals Toward Reporting Child Abuse Scale, developed by Aynur Uysal in 1998, has 67 items and six subscales assessing knowledge of physical, behavioral, and neglect signs of abuse, as well as parent, child, and family risk factors. Items are rated on a 5-point Likert scale, with some reverse-scored, and higher subscale averages indicate greater knowledge in that area. | "immediately after the intervention" |
| Measure | Description | Time Frame |
|---|---|---|
| Student Satisfaction and Self-Confidence in Learning | The scale is a 12-item, 5-point Likert instrument with two subscales: "Satisfaction with Current Learning" (5 items) and "Self-Confidence in Learning" (7 items). Scores range from 1 to 5 per item, with higher scores indicating greater learning satisfaction and self-confidence, and the total score ranges from 12 to 60. The scale consists of 12 items and two subscales: Satisfaction with Current Learning (5 items) Self-Confidence in Learning (7 items) The instrument is a five-point Likert-type scale ranging from 1 to 5, and it contains no negatively worded items. Total scores range from 12 to 60, with higher scores indicating higher levels of satisfaction with learning and greater self-confidence. The internal consistency reliability of the scale was reported as Cronbach's alpha = 0.89. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| sermin dinç, Dr. | Contact | +905424033430 | sermin.dinc@atlas.edu.tr |
| Name | Affiliation | Role |
|---|---|---|
| sermin dinç, Dr. | Atlas University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Atlas University | Istanbul | Kağıthane | 34098 | Turkey (TĂ¼rkiye) |
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| Label | URL |
|---|---|
| Risk factors for child abuse: Quantitative correlational design | View source |
| Child abuse and neglect: Reporting by health professionals and their need for training | View source |
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| movie group | Other | Control group watches film clips showing physical abuse signs to support learning and discussion. A total of 30 minutes of selected clips from three films depicting physical abuse (Sleepers, Antwone Fisher, The Tale) will be shown. These clips include visual examples of physical abuse indicators, such as bruises, repeated injury marks (e.g., belt buckle marks, stick marks), and soft tissue injuries. The films will be shown only within the scope of the study and not as part of the course curriculum. |
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| "immediately after the intervention" |