Nursing is a wonderful and fulfilling career that one can ever have. According to Lori Wilt, ‘There is a tangible satisfaction in helping others achieve goals, whether it be in health promotion or nursing education. Having an influence on patients, students, and the community is the greatest reward in nursing,’ (Wojciechowski, 2016). This article is based on a study on the risks that oncology nurses are exposed to during their practice.
Oncology nurses administer medications that are considered to be hazardous. Such medications include chemotherapy, which places these nurses at a risk of exposure. The effects of exposure range from simple to severe ones. The authors mentioned some of the risks of exposing healthcare workers to the risks involved which include an increase in cancer cases, infertility among women, miscarriages, damage to the chromosomes of the unborn fetus, as well as other symptoms including nausea, contact dermatitis, and reactions or allergies.
According to the National Institute of Occupational Safety and Health (NIOSH), hazardous drugs are those that have characteristics like carcinogenicity, reproductive toxicity, genotoxicity and teratogenicity among others.
The purpose of these researchers was to determine if nurses adhered to personal protective equipment (PPE) recommendations and hospital policies for safe handling during the administration and disposing of IV Chemotherapy as seen through observation. Secondly, to determine if PPE recommendations as well as hospital policies were adhered in reference to nurse assessments and lastly, to determine if there were any differences that were noted in the observations and nurse assessments in adherence to the recommendations and policies of the hospital under study.
This paper also seeks to describe the research question, research design, discuss the study sample, methods of data collection, limitations of the paper, findings of the paper, and lastly summarize the article.
As nurses, we play a critical role in the care and wellbeing of patients suffering from various diseases and conditions. This research article is meant to provide information on whether nurses adhere to safe handling practices based on observation and nurse assessments. This research study was carried out at Cleveland Clinic, a hospital with a total of 1400 beds and 76 nurses who deal with ambulatory oncology infusion treatment to patients.
The study involved the use of two methodologies, observation and a group of nurses who were administered with questionnaires to determine the level of adherence to PPE recommendations and the policies of the hospital. These two methodologies will help to determine the most appropriate way of determining nurse adherence and also determine whether indeed nurses follow the laid down policies and PPE recommendations while doing chemotherapy to their patients.
Despite the fact that policies are in existence and many other organizations, such as NIOSH, U.S. Department of Labor and Occupational Safety and Health Organization (OSHA) and the American Society of Health-System Pharmacists (ASHP) have recommended measures to help in protecting nurses from the risks posed by Chemotherapy, this study unearths that many nurses do not follow these guidelines.
This information will be helpful to the nurses because they will be reminded about the risks involved in nursing ontology and thus know the need to follow the laid down recommendations and policies. Some of the events that could have affected the research question are the fact that nurse characteristic was not taken into account while doing the research (Colvin, Karius, Nancy & Albert, 2016).
The research design used in this study article is the perspective and comparative mixed methods design. The researcher used the perspective, comparative mixed methods study to compare nurse behaviors while dealing with chemotherapy. The comparative design employed in this research can be described as a comparative qualitative because it involved observing nurses activities in relation to chemotherapy safe handling recommendations and guidelines (Richardson, 2018). In this research, the researchers observed the actions of nurses and their work environment. The behaviors of nurses in relation to the study were recorded.
The study took place in Cleveland clinic, a hospital that has a bed capacity of 1400. The hospital facility had a total of 76 oncology infusion centers that help in the treatment of chemotherapy. A total of 15 nurses were observed on how they encountered IV chemotherapy and how they disposed of them. With the questionnaire method, a total of 33 nurses were involved. The researchers wanted a sample of at least 40% and with 33 out of 76 oncology nurses, it represents a total of 43% of the nurses.
Based on the total number of oncology nurses in the facility, a total of 33 who were used during the administration of questionnaires is a good number. On the other hand, only 15 nurses were observed which represents a very small number. This number of 15 cannot be used to generate generalized results about the safe handling of chemotherapy equipment (Colvin, Karius, & Albert, 2016). The observational sample had a team of experienced oncologist nurses who filled a questionnaire to determine their adherence levels to the laid down guidelines. The researchers also used nurses with a two-year experience.
Based on the intention of the study, the general numbers are very low. It could have been wise to use a bigger sample, from different hospitals, to help answer the study question better. The study should also have involved unexperienced oncology nurses so as to determine the differences between them and the experienced ones in dealing with the research question.
Data Collection Methods
The observation data involved three observers, the principal investigator and two others who were working on the oncology unit of the hospital. The observers were people with a vast knowledge in oncology nursing care. The principal investigator also trained the other observers on how to observe behaviors. On the other hand, the self-assessment of the oncology nurses was done by delivering questionnaires to oncology nurses in envelopes and they were asked to return them when dully filled.
The study was conducted in two different phases. The researchers started with an observation which started in 2012 January to 2013 March. The questionnaire took just one month, March of 2013. In micro-ethnography observation, the nurses to be examined had to have knowledge of the recommendations needed for chemotherapy guidelines. The principal observer also evaluated the quality of the data collected by the other observers every day. For that duration of the study.
Some of the tools that were used in the micro-ethnography phase included medications which had been spiked, primed and double checked with a compatible carrier fluid. The observers then evaluated the handling, administration and disposing of chemotherapy equipment by applying the nurse skill checklist (Colvin, Karius, Nancy & Albert, 2016). The observers are expected to observe confidentiality and integrity during the observation time.
If one of them informed the nurses that study was being conducted, they will definitely change their ways of operation. Employing a mixed data collection technique is important as it helps the researcher to get a deeper understanding of the topic under study. It also provides a better understanding and also helps in explaining the findings of the research findings (Creswell, 2013).
Limitations of the Study
There are a few limitations which are evident in the study. First, the research was done in one center, that is, Cleveland clinic. Despite the fact that the administration of questionnaires was successful because the sample size was more than 40%, the total sample size was scanty. Secondly, the project researchers had to maintain the confidentiality of the research and thus had to avoid collecting nurse characteristics. Third, the sample sizes used were very small because such data needs to be generalized against thousands of oncology nurses. Fourth, a single nurse is likely to be observed on numerous occasions by different observers and thus affecting the sample size.
In subsequent studies, the researchers ought to overcome this limitation. For the first limitation, the researchers should conduct the research in various centers. For instance, they can do research in a whole state, city or a good number of centers. This also applies to the third limitation. They can also collect nurse characteristics by doing it in advance before the research commences or after the research.
The last limitation is about the repeated evaluation of a single nurse. They can obtain the names or pictures of the nurses so that the observer on duty can be informed about the nurses to observe. Limitations help in placing the research findings in context, deciding the credibility of the study and in interpreting the scientific work (Martinez, 2017).
A total of 22 private observations were made on 12 nurses out of the 20 who were eligible. The observation took 13 days. Also, 12 nurses, out of the 33 were involved in filling the questionnaires. The nurses were asked on their feeling while at the hospital and their answers were expected to be in form of being very uncomfortable, comfortable and very comfortable (Colvin, Karius, Nancy & Albert, 2016).
Based on the results, 5 were very uncomfortable, 4 were comfortable while 3 were very comfortable. The results were not 100% in almost all cases. On three occasions, the nurses three behaviors. They include disposing gloves I chemotherapy approved containers, washing hands after administering chemotherapy and disposing of the chemotherapy bag and tubing after disconnecting chemotherapy infusions. These findings answer the question of the study because it addresses the behaviors that nurses practiced in relation to chemotherapy treatment.
The research article was based on nurse adherence to safe-handling practices and the researchers employed observation and self-assessment. Oncology nurses interact with patients in hazardous environments like chemotherapy. Therefore, such nurses are at a risk of developing complications at some time in their life.
The researchers used a mixed research design and the research was based in a single center, Cleveland Clinic. They assessed ambulatory Oncology nurses by use of questionnaires and observation (Colvin, Karius, Nancy & Albert, 2016). The research wanted to establish whether the nurses adhered to the recommendations put in place by NIOSH and other bodies in the way they handle, administer, and dispose of chemotherapy equipment.
The data were collected in two phases, with the first one starting from 2012, January to 2013, March and the second one took place on March 2013. Data collection by three observers, the principal investigator, and two other experienced oncology nurses. After the data had been collected, it was analyzed by describing the nurse skill checklist frequencies by using quartiles and medians of all variables.
Means were also collected by the researchers. The research got the needed findings by using the nurse skill checklist. They made 22 observations on 13 days which involved 12 out of the 20 nurses. During the comparison, it was established that nurse’s self-assessment had two items which achieved 100% but when the observation was carried out, only one achieved 100%.
There is a need for a practice change to ensure that nurses adhere100% to the laid down recommendations. The evidence suggests strong enough that there is a need for change. Nurses were not using 2 gloves 100%, and generally, the behaviors that were tested need a total overhaul (Colvin, Karius, Nancy & Albert, et al., n.d).
- Colvin, C. M., Karius, D., & Albert, N. M. (2016). Nurse adherence to safe-handling practices: Observation versus self-assessment. Clinical Journal of Oncology Nursing, 20(6), 617-622. doi:10.1188/16.CJON.617-622 https://chamberlainuniversity.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=c9h&AN=119605781&site=eds-live&scope=site (Links to an external site.)Links to an external site.
- Creswell, J. W. (2013). Research design: Qualitative, quantitative, and mixed methods approaches. Sage Publications, Incorporated.
- Martinez, R.A. (2017). Importance of expressing study limitations. Retrieved from https://schoolofauthors.wordpress.com/2017/03/02/importance-of-expressing-study-limitations/
- Richardson, H. (2018). Characteristics of a comparative research design. Retrieved from https://classroom.synonym.com/characteristics-comparative-research-design-8274567.html
- Wojciechowski, M. (2016). Why I love being a nurse. Retrieved from https://dailynurse.com/why-i-love-being-a-nurse/