Introduction
In recent years, the National Institute for Safety and Health (NIOSH) developed a range of measures to reduce the level of chemotherapy exposure among oncology nurses. Unsafe contact with antineoplastic drugs can lead to adverse health outcomes. For example, oncology department staff experiences a higher risk of negative effects on reproductive function (Connor, Lawson, Polovich, & McDiarmid, 2014).
However, the adherence to self-handling requirements in chemotherapy administration is generally low (Boiano, Steege, & Sweeney, 2014). The article by Colvin, Karius, and Albert (2016) demonstrates that oncology nurses tend to overestimate their level of compliance with safety standards. The current paper aims to examine the conducted research and evaluate its conclusion and implications. Despite the pilot nature of the study and a relatively small sample, it contains valuable information highlighting possible ways of safety adherence improvement.
The Purpose of the Study
Nursing practice imposes various risks on medical workers. In the oncology department, daily activities involve interaction with toxic antineoplastic drugs. The NIOSH guidelines were explicitly designed to resolve safety concerns. However, the state of compliance with different personal protective equipment (PPE) recommendations and policies among oncology nurses was not investigated sufficiently. Therefore, the aim of this study was to assess the existing adherence through direct observations of healthcare activities during chemotherapy administration and operation with antineoplastic drugs. Furthermore, nurses’ perception of their compliance was also investigated through the use of a questionnaire.
Based on my experience, there could be a difference between official recommendations and professional activity in real practice. Understandable desire to help a patient often leads to unnecessary and even dangerous disregard for safety measures. Moreover, dealing with toxic substances on a daily basis, nurses may underestimate the level of exposure. Therefore, the research of ongoing medical activities within the chemotherapy unit can facilitate the improvement of the adherence to NIOSH guidelines.
Study Design and Setting
The research was conducted in the Cleveland Clinic, which had 76 ambulatory oncology infusion treatment chairs for chemotherapy administration. It was a pilot study with a prospective and comparative design involving mixed methods (Colvin et al., 2016). Such design allowed observing the existing nursing practice and collecting real operational data. However, one of the study weaknesses relates to a consequential difficulty in performing a comparison: due to confidentiality concerns, the collected data did not indicate individual views and working habits of each nurse. Therefore, existing practices could be analyzed only as a whole for a given sample without any particular associations derived between two sets of data. Also, almost half of the observed nurses did not complete the questionnaire.
Sample Characteristics
The sample included 22 experienced oncology nurses from the clinic with two or more years of experience. The median number of years working as a registered nurse was 10, with 3.9 years of chemotherapy medical experience in this hospital (Colvin et al., 2016, p. 619). The exclusion criteria were not developed due to the specificity of the sample and setting. The goal was to involve and observe as many nurses as possible; despite these efforts, the size of the sample was small. A multicentered approach is needed to expand the research beyond one hospital setting. Therefore, the sample can be considered adequate only if the pilot nature of the study is taken into account.
Data Collection Methods
The study’s mixed-methods included direct observation and a questionnaire administration. They were applied to acquire both information on daily self-handling practices and the nurses’ perception of those practices. The data was collected by three trained professionals utilizing the nurse skill checklist. Not all activities from the checklist were registered. The ethical considerations mostly included confidentiality concerns, which allowed the participants to be honest in their replies to the questionnaire. However, the low number of collected responses could be explained by the nurses’ unwillingness to state their inadequate level of compliance.
Study Limitations
Few limitations should be recognized when interpreting the study’s outcomes and designing future investigations of this subject. As mentioned earlier, the data analysis does not involve an individual dimension; therefore, there are no correlations calculated between nurses’ work habits and their responses. Also, the sample size and its characteristics do not allow a broad generalization of the research findings. These limitations could be overcome with a bigger sample from multiple medical facilities. A more efficient study design could provide a more practical insight into the relationship between nurses’ beliefs and their self-handling practices.
General Findings of the Study
Only a few items from the checklist were completed accordingly to recommendations 100% of the time, such as washing hands after the procedure. 12 items were not performed in compliance all of the observed time; 7 items had less than 45% level of compliance (Colvin et al., p. 620). The questionnaire responses revealed two items with 100% adherence; however, only one, the disposal of contaminated equipment, was confirmed during observations.
The rest of the activities had the same or a higher level of self-reported adherence, and no item displayed adherence higher by observation than self-assessment. The overall level of compliance with NIOSH guidelines among the Cleveland Clinic oncology nurses was low. Therefore, the study findings provided valuable outcomes to the research question; they are credible and could be used in future research.
Study Value and Implications for Nursing Practice
The study by Colvin et al. (2016) is a useful source of practical information regarding safety compliance among oncology nurses. The research question involved the examination of self-handling practices during chemotherapy administration and nurses’ beliefs about those practices. Despite a few limitations, the findings highlighted an existing gap between observed and self-assessed adherence to PPE recommendations, which should be addressed to decrease occupational risk in nursing practice. The main implication relates to the conclusion that an annual competency assessment might not be sufficient for the required compliance maintenance. Proper measures should be developed to improve the adherence level among medical staff administering chemotherapy treatment, including educational programs and more thorough controlling procedures.
References
Boiano, J. M., Steege, A. L., & Sweeney, M. H. (2014). Adherence to safe handling guidelines by health care workers who administer antineoplastic drugs. Journal of Occupational and Environmental Hygiene, 11(11), 728-740.
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.
Connor, T. H., Lawson, C. C., Polovich, M., & McDiarmid, M. A. (2014). Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: A review of the evidence. Journal of Occupational and Environmental Medicine, 56(9), 901-910. Web.