Today, the use of X-rays in medical science has led to major advances in the diagnosis and treatment of many diseases [1, 2]. Studies show that more than ten million radiographic tests and hundreds of thousands of nuclear medicine tests are performed worldwide every day. The greatest amount of radiation from human-generated radiation sources is due to X-ray diagnostic tests [4, 5].
Serious protection of staff and patients is essential due to the presence of X-rays and other dangerous factors in the hospital [7]. Adherence to the principles of protection against ionizing radiation can reduce the risk of complications from these diagnostic methods [6]. Today, radiation protection programs are defined based on maintaining the radiation exposure of patients, radiation workers, and all members of society based on the principle As Low As Reasonably Achievable (ALARA) [7, 8].
Today, the advancement of communication science and information science has provided new fields for education. Virtual education is a dynamic, new and rich way to create educational opportunities that can be relied on to convey the most up-to-date educational materials and tips to people by saving time and money, regardless of location and time [10-12] .
Considering the advantages of virtual education and the significant expansion of virtual social networks in Iran and the leading problems in nursing education, it seems that the use of this flexible teaching method can be more effective [10, 17]. Due to the experience of researchers in the field of nursing education in class, the problems of holding and participating in these courses, the research group decided to examine the impact of virtual education of nurses on compliance with the principles of protection against X-rays.

 

This research is a two-group clinical trial with pre- and post-test design on 90 nurses working in Beheshti and Besat hospitals, affiliated with Hamadan University of Medical Sciences, which have the largest number of mobile (portable) radiographies done, since the beginning of winter 2017 until the end of the summer of 2018. This research was registered with the code of ethics of IR.UMSHA.REC.1396.412 in the Iranian clinical trial system with the code IRCT20160110025929N10. Criteria for entering the research included: having at least a bachelor's degree, working in the areas affected by mobile radiographies and X-rays (orthopedics and intensive care units), history of clinical work for more than six months in the relevant department and having a desire to participate in research. Also, in the intervention group, in addition to the mentioned cases, familiarity with the social network and active participation in it was considered as a criterion for entering the research. Based on similar studies [19, 18] with a test strength of 90%, a confidence level of 95% and a 20% probability of sample loss in each group, the sample size was estimated at 50 people. An estimated 50 people in each group participated in the study.
Data were collected through population-based questionnaires (age, gender, education, marital status, clinical history, shift status, and place of employment), knowledge, and performance list. The collected data were analyzed using SPSS 24 (SPSS Inc., Chicago, Ill., USA) and statistical methods of paired, independent, and double-decay t-test and the level of significance was considered to be less than 0.05. Also, the two groups were homogeneous and the data were normal.

The mean and standard deviation of the level of protection against x-rays in the intervention group before and after the intervention were 15.84±3.64, 30.2±26.3 and in the control group before and after the intervention was 14.08±4.45, 48.14±4.27, respectively. Mean and standard deviation of nurses' performance score before and after intervention in the intervention group were 2.8±1.03, 5.62±0.96 and 3.82±1.07, 3.93±1.03 in the control group before and after the intervention, respectively. The results of paired and independent t-test showed that the mean of performance and the mean score of nurses' knowledge about the application of the principles of X-ray protection before and after the intervention in the intervention group were significantly different; the mean score of nurses' performance and knowledge after intervention was increased (P=0.000). The results are presented in Tables 1, 2 and 3.

Table 1. Comparison of mean and standard deviation of nurses' knowledge and performance scores before and after intervention in two intervention and control groups 

* Adjusted for performance score before intervention and age and marriage; ** Modified for protective knowledge score before intervention and age and marital status


Table 2. Qualitative comparison of knowledge levels and performance before and after the intervention in the two groups of intervention and control

Research by Luntsi et al. [8] showed the appropriate and desirable knowledge of nurses regarding radiation protection principles. In this study, most of the nurses were in the radiology department. Because nurses in the radiology department are more involved with X-rays and work in a department that specializes in radiology and radiation, creates more incentive for nurses to better access educational resources called radiation protection principles, which consequently will lead to increase in their protective knowledge. The mediocre and poor knowledge of nurses can be due to limited pre-graduate education and lack of continuing post-graduate education. Also, the lack of nurses 'access to approved educational resources from international organizations and institutions, can be an influential factor for nurses' inadequate knowledge of the nature of X-rays and adherence to protective principles. 

 Learning based on cyberspace increases the level of protection knowledge and the performance of nurses against X-rays.
 

This article is taken from the dissertation of Master of Nursing, Internal Medicine, Department of Surgery, approved by the Research Council of Hamadan University of Medical Sciences with the code of ethics IR.UMSHA.REC.1396.412. Also, this research has been registered in Iran Clinical Examination Center with IRCT code: IRCT2016011002592N10. In this way, the authors thank the esteemed Vice Chancellor for Research of Hamadan University of Medical Sciences, the officials of the Faculty of Nursing and Midwifery, and the staff of Shahid Beheshti and Besat Hospitals of Hamadan.
 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.