Nurses play a central role in administering hazardous medications such as chemotherapy. According to Stockwell (2015), such interventional measures expose caregivers to occupational exposure risks. Aapro, Clemons, Schwartzberg and Warr (2018) explain that physicians that avail chemotherapy as a remedy among their patients are more likely to reveal cancer occurrences compared to their counterparts who are not exposed to such remedies. On the other hand, nurses working in these environments end to reveal chromosomal destructions, infertility, allergic reactions, dermatitis and miscarriages (Colvin, Karius, Albert, 2016). To date stakeholders working in these settings are met with controversies in balancing between fostering a working relationship that instills higher levels of safety and availing high quality patient care that prevents them from the procedural dangers associated with exposure to the risks associated with chemotherapy.
While administrative organs such as the U.S. Department of Labor Occupational Safety and Health Administration (OSHA) have come up with effective measures of limiting such dangers through advancement of policy guidelines aimed at helping caregivers administering chemotherapy and handling patients in need of this remedy, issues such as poor regulation in the processes of implementing and reduced levels of adherence to the guidelines set by OSHA act as key impediments to effective adoption of safe working environments. While the National Institute for Occupational Safety and Health (NIOSH) makes it a requirement that physicians offering this remedy must uphold personal protective equipment (PPE) through adoption of a safe dressing code, multiple concerns have been raised on the efficacy of these strategies. As a consequence, the current study seeks to present a critical article review of pilot quality advancements and the extents to which the proposed guidelines have been adopted in medical settings by analyzing nurses’ adherence to PPE and OSHA guidelines.
Research question
The article under review seeks to establish the extents to which caregivers offering chemotherapy have adhered to the regulatory and safety frameworks set by PPE, OSHA and NIOSH in actual clinical settings. The pilot study audits the effectiveness of the institutionally set screens in fostering the adoption of the recommended frameworks in reducing the caregivers’ risks of exposure to hazards. Based on the observations made, caregivers are still faced with multiple gaps in their efforts of adopting the guidelines and policy frameworks set by OSHA, PPE and NIOSH to offer guidance on the most effective ways of avoiding the dangers associated with the administration of chemotherapy. I would attribute such a position to issues such as complacency on the side of caregivers, shrinking population of caregivers, an increase in workload and lack of institutional support aimed at creating a suitable environment for the implementation of the set policy frameworks.
Research design
The study adopts prospective and comparative mixed methods design to foster the analysis of the levels of inception of the standards and safety measures put in place by OSHA NIOSH and PPE. Creswell and Creswell (2015) describe a research design as a framework applied with the aim of guiding how a study is planned, analyzed and implemented. According to McCusker and Gunaydin (2015), prospective and comparative mixed methods design is highly influential in fostering the examination of the effectiveness of institutions in implementing policies. On the other hand, Gorter et al. (2015) explain that prospective designs seek to evaluate the comparative value of the policies adopted in healthcare settings with the aim of initiating the advancement of evidences.
One of the greatest advantages of the prospective and comparative mixed methods design adopted for his study emanates from its inherent ability to foster clarity of temporal sequences. According to Edmonds and Kennedy (2016), prospective research designs form a reasonable basis of analyzing and ascertaining past exposures and therefore the efficacy of the control frameworks adopted in institutional settings. On the other hand, Patel et al. (2016) explain that the prospective and comparative mixed methods design allows the researcher to establish accurate calculation of incidence such as the absolute risks, risk differences, attributable risks and relative risks associated with the effects of the inception of the policy under consideration. However, the prospective and comparative mixed methods design fails based on its inability to alienate recall bias as the subjects considered may face difficulties in remembering past exposures. The fact that the biases associated with the prospective and comparative mixed methods design are slim explains why the researcher adopted it for this study.
Description of the Sample
The study adopted a sample size of 33 oncology ambulatory nurses working at the Cleveland Clinic. For inclusion, the researchers made it a requirement for the caregivers to have a minimum experience of two years of practice in oncology. In my analysis, I uphold he viewpoint that the sample space (n= 33) adopted for this study was not adequate. According to McNeish and Stapleton (2016), a small sample size does not only reduce the generalization power of the study under consideration but also intensifies the scope of errors; an aspect that limits its reliability. The fact that the number of participants adopted for the study coupled with the use of one institution (Cleveland Clinic) limits the power of the results obtained in fostering generalizations for the entire population of caregivers working as oncology nurses in the United States.
Tools
The researcher adopted a questionnaire of adherence to PPE requirements as a tool of recruiting a cohort of caregivers to reveal the levels of inception of the OSHA, NIOSH and PPE at the Cleveland Clinic. On the other hand, a nurse checklist comprising of 15 yes/no items was adopted to evaluate the abilities of the participants in adhering to the set policy and regulatory frameworks. Further, a nine-item questionnaire and a fill-in the blank questionnaire were adopted to foster the nurses’ self-analysis to the conventionally set guidelines of handling patients seeking chemotherapy.
To minimize recall biases associated with the research design adopted by the study, the scholars adopted independent observers to assess crucial procedures such as administration, handling and disposure of materials used in chemotherapy procedures. Mulvey (2015) considers privacy and confidentiality as primary ethical measures that must be upheld when dealing with participants in a study. As a consequence, the scholars adopted anonymous questionnaires to ensure privacy.
Strengths and weaknesses of the study
The ability of the study to uphold higher levels of ethics reveals its strength. Issues of privacy and confidentiality of the participants were effectively adhered to. for instance, self-sealing envelops were adopted to conceal the identity of the respondents. Further, adoption of multiple instruments of measuring the issues under investigation such as adherence to PPE recommendations enhanced the levels of reliability of the results obtained. However, the weakness of the study emanates from the narrow sample space adopted. Further, the fact that the study was only based in a single institution weakens the efficacy of applying the recommendations made to multiple organizational settings.
Limitations of the Study
The study depicts for major limitations. First, the researchers’ decision to adopt a single healthcare institution limited its effectiveness in fostering generalizations. Second, the sample size (n=33) was very small. According to McNeish and Stapleton (2016), adoption of a diminutive population in research hinders he efficacy of generalizing the findings established. Third, there are tendencies that some of the caregivers who undertook the self-assessment were new in the area of oncology despite the fact that their working experience was adequate for inclusion. Fourth, there are possibilities that issues of uniformity in the assessment forms adopted may have led to variations in the caregivers’ comprehension and therefore, adherence to the set PPE recommendations. Lastly, the researchers lacked a proper framework of initiating comparisons between the participants’ traits.
To overcome the aforementioned limitations, future studies need to increase the population of oncology nurses chosen as participants. Further, multiple institutions need to be adopted to ensure that the results established are not limited by the challenges and inadequacies of a single organization. On the other hand, future scholarly works could limit the challenges associated with generalization through inclusion of a framework aimed at comparing actual and perceived behaviors depicted by the participants.
Ethical Considerations
Privacy and confidentiality are the key ethical issues put into consideration by the researchers. For instance, confidentiality was ensured by avoiding he processes that require concerning nurse characteristics. On the other hand, privacy was enhanced by the use of anonymous questionnaires.
Findings
The study reveals that oncology nurses do not adhere to the recommended policy frameworks aimed at regulating the use, administration and disposal of chemotherapy agents. However, post-operative measures such as disconnection and disposal of chemotherapy bags into the institutionally recognized bins was adequately adhered to among the participants included for the research. Further, wearing of gloves and institutional gowns was reported as a practice with the highest levels of non-adherence. An analysis of the results reveals that the study question was adequately addressed. However, the credibility of these findings is limited by the narrow sample size. Despite the limitations, the current review makes a conclusive recommendation that oncology nurses must come up with proper measures of fostering adherence to OSHA, PPE and NIOSH guidelines on chemotherapy to enhance their levels of operational safety.
References
Aapro, M., Clemons, M., Schwartzberg, L., & Warr, D. (2018). Searching for perfection: further progress in management of chemotherapy-induced nausea and vomiting—CME information. Supportive Care in Cancer, 26(1), 1-2.
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
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Edmonds, W. A., & Kennedy, T. D. (2016). An applied guide to research designs: Quantitative, qualitative, and mixed methods. Sage Publications.
Gorter, J. W., Stewart, D., Cohen, E., Hlyva, O., Morrison, A., Galuppi, B., … & Punthakee, Z. (2015). Are two youth-focused interventions sufficient to empower youth with chronic health conditions in their transition to adult healthcare: a mixed-methods longitudinal prospective cohort study. BMJ open, 5(5), e007553.
McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed methods and choice based on the research. Perfusion, 30(7), 537-542.
McNeish, D. M., & Stapleton, L. M. (2016). The effect of small sample size on two-level model estimates: A review and illustration. Educational Psychology Review, 28(2), 295-314.
Mulvey, G. J. (2015). Ethics in research. Bulletin of the American Meteorological Society, 96(3), 477-479.
Patel, H. D., Riffon, M. F., Joice, G. A., Johnson, M. H., Chang, P., Wagner, A. A., … & Pierorazio, P. M. (2016). A prospective, comparative study of quality of life among patients with small renal masses choosing active surveillance and primary intervention. The Journal of urology, 196(5), 1356-1362.
Stockwell, S. (2015). Online First: Warning at NCCN conference about combination of chemotherapy plus afatinib for head and neck cancer; small study closed after dangers became evident. Oncology Times.
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