When Every Moment Matters | DUQ Nursing Magazine 2026

When Assessment Goes Beyond Symptoms

The emergency department was busy that Tuesday afternoon when the 7-year-old arrived with her grandmother complaining of stomach pain. To most observers, it looked routine. Another child with a common complaint. But imagine a nurse trained to notice what others might miss: the child flinches when adults move too quickly, her story feels rehearsed, her grandmother’s energy is tense.

This scenario captures why Karakachian and Colbert are determined to equip nurses to recognize, respond to and report child maltreatment through trauma-informed, simulation-based education. Their work has already led to real-world success stories — including a student who later emailed to say the training helped her navigate a suspected case of abuse.

From Uncertainty to Action

Karakachian has seen firsthand how the warning signs of abuse can be missed — not because of negligence, but due to a lack of preparation.

“Most nurses understand their responsibility as mandated reporters,” Karakachian explains. “But they often feel uncertain about what to say or do in the moment — and that uncertainty can delay or prevent action. This training works to change that.”

Together with Colbert, she developed a trauma-informed curriculum to transform how nursing students are prepared for these situations.

“Throughout our careers, we recognized a gap in how nursing students were trained to identify and respond to child maltreatment,” Colbert says. “Angela’s work has taken that concern and transformed it into a rigorous, evidence-based intervention.”

Their research revealed the same pattern repeatedly: nurses eager to help but unsure how. “That’s what this project is all about,” says Karakachian. “Giving nurses the knowledge, language and lived practice they need to respond when something feels wrong.”

Simulation That Feels Real - Because It Is

At the heart of the project is a simulation-based learning experience. Traditional classroom education wasn’t enough. Karakachian recognized that detecting child maltreatment requires more than knowledge — it demands the ability to navigate emotionally charged conversations in real time.

Her solution: live actors in realistic scenarios where students can safely practice these crucial moments.

The simulation process is carefully orchestrated. Students first watch an hour-long educational video developed with forensic nurses and child advocacy physicians. Then, paired in teams, participants have just 10 minutes to navigate challenging conversations with trained actors portraying children and parents, and then must decide how to proceed. The scenarios, drawn from real cases with modified details for confidentiality, mirror what nurses might encounter.

“Using live actors brings emotional realism,” Karakachian explains. “It’s not just about spotting bruises or behaviors — it’s about allowing them to feel the discomfort, uncertainty and urgency that come with real patient encounters.”

This helps to improve students’ empathy and prepare them to respond when they encounter potential cases of child maltreatment. Students not only practice with trained actors but also serve as actors themselves, learning how abuse often presents. In spring 2024, they launched a pilot program that reached over 120 nurses and students. “We saw increased confidence in identifying maltreatment and communicating with victims and families,” Karakachian says. “That’s exactly what we hoped for.”

Research Takes Shape

Funding from Sigma Theta Tau International’s Joan K. Stout Research Grant and Duquesne’s Henry Leach Grant supported the project with both nursing students and emergency room nurses at a local hospital. Over a year, the professors collaborated with forensic nurses, child advocacy physicians and trained actors to create authentic scenarios.

“We are preparing nurses to care for the most vulnerable. That’s the heart of what we do, and who we are. By preparing nurses to act with skill, empathy and confidence, we’re not just shaping clinical practice. We are giving children a better chance at safety, healing and hope.”

Through eight simulations, they trained 64 nursing students and 65 emergency nurses from Jefferson Hospital in Pittsburgh. “The feedback was overwhelmingly positive,” Karakachian says. “Students said this should be part of their education and reported increased confidence in detecting and reporting maltreatment.”

Colbert adds that even experienced emergency nurses saw value in rehearsing these challenging situations.

The Ripple Effect: From Classroom to Community

What makes this work especially powerful is its spirit of collaboration across disciplines. The team partnered with Rachel Berger, MD, MPH, of UPMC Children’s Hospital of Pittsburgh’s Child Protection Team and director of child abuse research at the Safar Center for Resuscitation Research at the University of Pittsburgh; Tammy Bimber, DNP, MSN, RN, SANE-A, SANE-P, CEN, a forensic nurse at The Wellness and Forensic Center and consultant for the International Association of Forensic Nurses; Debbie Nugent, MS, RN, SANE project coordinator at the Network of Victim Assistance (NOVA); and Duquesne University School of Nursing Professor and Associate Dean for Research Melissa Kalarchian, PhD. Together, they ensured the project’s accuracy and authenticity. “Responding to child maltreatment requires a multidisciplinary team approach,” Karakachian explains. “It’s critical that students understand holistic, patient-centered care — including the emotional, social and cultural dynamics at play.”

Confronting Difficult Questions

The professors do not shy away from complex issues, including addressing concerns about systematic bias and over-reporting in marginalized communities.

“These are complex and difficult issues,” Karakachian acknowledges. “We are seeking funding for our next educational intervention to build an unbiased nursing workforce with the skills and confidence to identify victims accurately.”

Their vision reaches beyond detection alone: a truly equitable response means addressing social, structural and economic disparities to prevent abuse altogether.

Caring for the Caregivers

Working with emotionally charged material takes a toll, so self-care is built into the program. “During simulations, both students and actors could say ‘stop’ if anything was triggering,” Karakachian explains. “Immediately afterward, we debriefed. Many visibly expressed relief during those conversations.”

For Colbert, the reward is watching transformation unfold: “Seeing students’ satisfaction and improved confidence after the simulation experience is worth it. Every time I feel overwhelmed, I try to think of those moments when students express gratitude.” Karakachian adds: “Preparation itself is self-care. Having the skills to handle

Looking Ahead: A National Vision

While the simulation is not yet part of Duquesne’s formal nursing curriculum, Karakachian is working to change that with strong support from Colbert and others across the University.

“We want every Duquesne nursing graduate — undergraduate and graduate alike — to feel confident and competent in recognizing and reporting suspected maltreatment,” Karakachian says.

And their ambitions extend far beyond Duquesne’s campus. “This is not just for our students,” she continues. “We hope to create a nationally recognized, evidence-based model that schools and hospitals can adopt.”

They’re currently validating their approach and exploring expansion across nursing programs and other health care disciplines within Duquesne’s School of Health Sciences. We want to educate every student nurse, every nurse nationwide!” Karakachian declares.

Colbert notes, “Angela’s vision has the potential to reshape how child maltreatment is taught across health care disciplines. I am proud to support that work.”

A Simple But Profound Goal

For both researchers, this work is deeply personal and firmly rooted in Duquesne’s mission.

“We are preparing nurses to care for the most vulnerable,” Karakachian says. “That’s the heart of what we do, and who we are. By preparing nurses to act with skill, empathy and confidence, we’re not just shaping clinical practice. We are giving children a better chance at safety, healing and hope.”

Their hope is simple but powerful: that every nurse who completes the training leaves with the confidence to recognize and act on signs of child maltreatment.

By adopting a holistic approach to nursing education, Karakachian and Colbert are creating ripple effects that extend far beyond the simulation room — potentially changing the trajectory of vulnerable children’s lives.

As Karakachian reflects: “We are empowering future nurses to make a lasting difference — ultimately giving children a healthier, brighter future.”

In a world where children’s safety often depends on adults’ ability to recognize danger and act decisively, Karakachian and Colbert’s work ensures that the next generation of nurses will be ready when those critical moments arise.