The article under study is on the occupation risks posed by handling, administration, and disposal of chemotherapy medication by oncologist nurses. The study was conducted by Christina Colvin, Diana Karius, and Nancy Albert, who are experts in this field and have years of experience as oncology nurses. The paper intends to look into questions posed by the authors, methods and design used to investigate those questions, procedures and data collection methods used to achieve their goals, as well as their discussions and recommendations with an aim of critiquing, identifying short-comings, and appraising good work in their research as it relates to evidence based nursing practices.
The researchers focused their study on Personal Protective Equipment (PPE) used by oncologist nurses and adherence to their use. They posed three questions that upon answering would shed light on current trends on the use of PPE. The first question was whether nurses adhered to PPE recommendations and hospital policies for safe handling when administering and disposing of IV chemotherapy based on direct observation. Secondly, the researchers posed whether PPE recommendations and hospital policies for safe handling were followed based on nurse self-assessment. Finally, the researchers wanted to known if there were any deviations and differences from the two study methods their questions were conducted with. The questions were well thought out and are consistent with industry practices since nursing is a practical profession the need to corroborate self-assessments and observations is paramount.
A comparative mixed method design was used by the team (Colvin et al, 2016). The design methods were meant to compare observable data against data obtained through questionnaires from same or different respondents. The design method enables the team to obtain quantitative as well as qualitative data on the use of PPE by practitioners. Additionally, the methods help give the participant’s point of vie which is essential in advancing and increasing the use of PPE to combat risks that may arise due to exposure. The limitations for the mixed design methods include increased complexity of procedures and how to differentiate the data.
Moreover, mixed design methods are expensive as they require multidisciplinary teams to carry out the different mixes of the design so achieve desired quality in results (Tashakkori & Teddlie, 1998). The authors likely preferred the prospective mixed method of design as it gives a feel of what is happening on the ground as indicated by the observations. This is in addition to giving insight from industry practitioners of where focus is meant to be channeled in terms of policy implementation towards the proper and full use of PPE in administering Chemotherapy.
The sample was picked from Cleveland Clinic, Ohio with 33 oncology nurses eligible to participate in the study. The sample would be divided into two cohorts, one of highly experienced nurses that would undertake the observation test while the other cohort that might have included nurses from the first cohort was to take part in a questionnaire. A minimum of two years working experience as oncologist nurses was a requirement for nurses partaking in the study for both cohorts (Colvin et al, 2016).
The sample size was not adequate as it only involved participants from only one hospital. The sample is thus biased as it only experiences one policy which is that of the Cleveland Clinic which is not representative of any demographic that is sufficient enough for a National study. Twenty-two cases of chemotherapy administration were observed and 12 oncology nurses of the possible 33 took part in the questionnaire. The goal of the study to have at least 40% respondents of the total sample to take part in the questionnaire was therefore not reached (Colvin et al, 2016). The number was not sufficient as well as it was not comparable to the number of observations made (Saris & Gallhofer, 2014). Although the numbers by this study are above previous and similar studies, they are still below thresholds that would be able to ascertain sentiments from the questionnaires.
Collection of data was done through invigilators for the observation who also conducted the questionnaires. The invigilators used a skill test check off list that was marked during the 22 observed cases with Yes or No type of questions. Questionnaires were prepared with questions having five choices to choose from with 0 being never and 4 being always. An extra option of not applicable was also available (Colvin et al, 2016).
Ethical considerations addressed by the research team included anonymity of invigilators and restriction of subject characteristics to the invigilators, also the subjects and their patients were required to give consent for the study to proceed. Limitations for the study include the small sample size and the one center approach. A much larger sample would give definitive result of the adherence to PPE. Discussion of limitations within as study are important as they give other prospective researchers a leaf to borrow and improve on (Browner, 2006) This helps over time attain results that reflect true sentiments from a particular topic due to gradual improvements through elimination of impairments of such studies.
The study found out that of the 15 questions in the checklist only 2 observed cases had complete adherence to PPE guidelines and policies. In the questionnaires, of the nine items the oncologist nurses were asked only two had 100% adherence to prevailing policies. When comparison was done to answer the third question intended by the study, there was a mismatch of sentiments with observable conduct. Only one comparable behavior, that of wearing double gloves during Chemotherapy administration matched out of six. The findings answer the questions posed by the team and are credible to the extent of the size sample and limited by limitations such as unknowledgeable invigilators of nurse characteristics.
In conclusion, the paper informs practitioners of the health hazards involved in chemotherapy application as well the risk of infertility and pregnancy complications to subjects. Moreover, the paper makes it clear that there exists no safe level of exposure to chemotherapy. Finally, the paper recommends that programs to improve nurses’ ability to safely handle chemotherapy treatments would aid improve the figures and help hospital be safer for both patients and practicing oncologist nurses.
- Browner, W. S. (2006). Publishing and presenting clinical research. Philadelphia: Lippincott Williams & Wilkins.
- Colvin, C., Karius, D., & Albert, N. (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
- Saris, W. E., & Gallhofer, I. N. (2014). Design, evaluation, and analysis of questionnaires for survey research. Hoboken, NJ: Wiley.
- Tashakkori, A., & Teddlie, C. (1998). Mixed methodology: Combining qualitative and quantitative approaches. Thousand Oaks, California: SAGE