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Nurses’ Compliance with Safe-Handling Practices


Oncology nurses often handle medications and devices that can be harmful to one’s health. Thus, they should adhere to specific guidelines in order to protect themselves. Colvin, Karius, and Albert (2016) analyze nurses’ compliance with the safe-handling practices outlined by the NIOSH (National Institute for Occupational Safety and Health). The researchers use a mixed-method approach to compare the rates of adherence documented through observation and self-assessment.

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They find that only some practices were followed by the majority of nurses, while others were neglected for unobserved reasons. The study by Colvin et al. (2016) utilizes a small sample but shows that an educational program for quality improvement may promote the use of safety equipment among oncology nurses.

Research Questions

The main question of the article considers the use of personal protective equipment (PPE) by oncology nurses during the administration of chemotherapy. Moreover, the authors aim to determine the differences between the results of nurses’ self-assessment and professional observation. The comparison of these two information-gathering approaches reveals multiple possible issues with nurses’ adherence levels. First of all, it allows researchers to appraise the nurses’ experience with chemotherapy administration. Second, it also grants them an opportunity to learn more about nurses’ knowledge regarding safety guidelines.

The scholars note that, in the United States’ hospitals, standardized implementation procedures for NIOSH recommendations do not exist (Colvin et al., 2016). It is possible that they pose this question because of the lack of previous studies in this sphere.

Research Design

The scholars choose an approach that considers both qualitative and quantitative information. They employ a “prospective and comparative mixed methods design” for this study (Colvin et al., 2016, p. 618). Thus, they collect data through surveys of nurses where the healthcare providers assess their own adherence to PPE safety guidelines. Furthermore, Colvin et al. (2016) instruct a number of highly experienced nurses to observe their coworkers and appraise their completion of safety procedures. The authors do not collect any demographic data apart from nurses’ professional experience and job satisfaction. The utilized mixed methods design may have been chosen due to its ability to compare the results of different assessment viewpoints.


The study was based on the evaluation of one medical center’s oncology nurses. Instructed participants observed 22 nurse operations related to chemotherapy administration, including medication handling, disconnecting, and discarding. 12 nurses also completed the self-assessment questionnaire – it was not recorded whether some of these specialists also contributed to the observation. Overall, 33 nurses were chosen to participate in the study.

The size of the sample is small to provide the researchers with results that will be easy to generalize. The study’s mixed design implies that some quantitative tools are used, which usually require a much a large sample size (Singh & Masuku, 2014). The authors confirm that this is a pilot study that needs improvement and a larger sample to provide conclusive results and the current observation is an initial test of the concept.

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Data Collection Method

The mixed-methods utilized by the scholars include two main ways of information gathering. The first approach was the questionnaire that has 15 questions with “yes/no” answers (Colvin et al., 2016). It was administered to the nurses by mail and delivered back in unmarked pre-addressed envelopes to ensure full anonymity. The second was a number of micro-ethnicity observations initiated by three highly-skilled nurses with experience in oncology and trained by the investigator (Colvin et al., 2016). The nurses used a special checklist that contained information about the necessary nursing skills mentioned by the NIOSH. The authors acknowledged the ethical consideration of confidentiality and insured the full anonymity of all participants.


The main limitation of the study is its small sample that is limited to one hospital. It is possible that the hospital’s individual implementation of guidelines affected the outcomes of the study. If the researchers had a large sample that included multiple facilities, the results could have been significantly different. Moreover, the use of a small sample does not allow researchers to make some conclusions regarding the study’s usability. Finally, the nurses who completed the survey could also have been observed, making the results of the study unclear. The authors recognize these limitations and propose a multicenter study with a uniform assessment structure for future research opportunities.


The scholars found that three procedures recommended by the NIOSH were followed in all described instances. These included the proper disposal of gloves into “a chemotherapy-approved container” after the start of the procedure as well as bags and secondary tubing after chemotherapy and hand-washing after administration (Colvin et al., 2016, p. 620). Other procedures did not have the same level of adherence, showing less than 50% compliance.

The authors also note that self-assessment adherence results were generally higher than observation rates. Both data collection methods led the authors to believe that the adherence level in the hospital needs improvement. These findings fully support the posed research question. They can be considered credible due to their transparency and a clear, logical structure.


In the article by Colvin et al. (2016), the authors explore the adherence rates of oncology nurses to the self-protection guidelines proposed by NIOSH. The scholars aimed to answer whether the nurses were knowledgeable about and consistent in using PPE safety measures during chemotherapy administration. They also posed a question of differences between nurses’ observation and self-assessment efficacy.

The study has multiple limitations, but its mixed-method can be used in future research to yield a reliable and practical conclusion for practice change. The discussed article is a pilot study in which the authors propose an interesting research method, exploring both the guidelines’ adherence and nurses’ reporting capabilities.


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. Web.

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Singh, A. S., & Masuku, M. B. (2014). Sampling techniques & determination of sample size in applied statistics research: An overview. International Journal of Economics, Commerce and Management, 2(11), 1-22.

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