Critique Study on Nurse Adherence to Safe-handling Practices
Over a long time, studies have shown a connection between occupational exposure and adverse health effects. For instance, evidence exists showing oncology nurses being placed at occupational exposure risk while administering chemotherapy medication. With no literature on the adherence of nurses to the guidelines on safe-handling practices, Colvin Christina, Karius Diana, and Albert Nancy decided to conduct a study on the topic. The purpose of this paper is to critique the article. The study used a mixed method research design which is associated with a deeper and extensiveness understanding of the research problem. It found that the adherence rate was below the expectations. Use of proper research design, data collection methods and tools, and having an adequate response rate improves the credibility of the study findings. However, every study has its limitations that this is no exception with a smaller sample size.
The research question of the article was, “are the current NIOSH PPE and hospital policy chemotherapy exposure controls adhered to in an actual clinical practice based on nurses’ assessment and on observation?” (Colvin et al., 2016). The article states that there is strong evidence on possible adverse effects on oncology nurses who administer hazardous medications. This is associated with concerns in the safety in handling chemotherapy drugs. The concerns made NIOSH to update the guidelines in handling the medications in a safe manner. NIOSH also aimed at alerting nurses on the importance of adhering in the prevention of occupational exposures to the hazardous medication. However, even with these guidelines, the authors find limited evidence on real adherence to the guidelines. This trend influenced the authors to design the research question with the focus on finding out whether the guidelines are adhere to the real world (Rahi, 2017). The research question has several qualities that make it good. First, it builds on available research on the safety of oncology nurses but it also seeks to offer new information. Second the question is addressing a real problem. Third, the question is simple and clearly states the variables that the study will examine (Rahi, 2017). Additionally, the question states clearly that the answer will be derived through self-assessment and observation.
The study used mixed methods as the research design. A prospective and comparative mixed method approach was used in the comparison of subjective and objective behaviors. Questionnaires and micro-ethnography were used. Mixed research design involves the use of quantitative and qualitative research elements (Almalki, 2016). Researchers use the research design in the collection, analysis, and integration of qualitative and quantitative research. The purpose of the design is gaining a deeper understanding of the target topic. The design is used when a researcher seeks to validate results found from through other designs, to explore similar variables in different methods, to utilize one technique to inform another, and when one seeks to generalize qualitative research findings. The design is advantageous in that; it addresses the weaknesses of using one approach (Rahi, 2017). For instance, it is easier to understand how people behave through a qualitative research than through a quantitative research design. However, qualitative research faces bias issues. Therefore, it is better if the two are used together to make up for their weaknesses.
Second, provides a deeper understanding. Third, the design helps in explaining the findings. The design however has disadvantages. First, it is complex. Second, it is difficult to implement it. The authors must have considered the mixed methods research design to strengthen the conclusion of the study (Almalki, 2016). Mostly, the research design is preferred when it has potential in giving a clear understanding of a problem compared to results of either qualitative or quantitative deigns. By using questionnaires and micro-ethnography in the study, the authors sought to compare the results and eventually give valid conclusions. The design would enable the authors to explore their topic extensively through the two methods (Rahi, 2017). Additionally, the authors could have used the design to improve the credibility of the research.
Sample and sample size
Sampling a number of participants from the target population. The results from the sample are then generalized to the whole population. For the conclusion to be valid, the sample must be a representative of the target population. Colvin et al aimed at observing at least 15 encounters (Colvin et al., 2016). For the ethnography, 33 nurses were eligible for participation. The authors aimed at having approximately 40% of the nurses participate in questionnaires study component. Based on the research question and its purpose, the number of participants in this study was inadequate (Rahi, 2017). It is clear that the authors wished to generalize their findings to oncology nurses in the US in regard to adhering to chemotherapy exposure controls. However, only 20 participants were included for observation criteria out of which only 12 were involved. Again, of the 33 participants chosen for self-assessment component only 12 participated (Colvin et al., 2016). This number is low compared to a number of working oncology nurses and therefore it can be difficult to generalize the findings.
Data collection methods
Collection of data involves gathering certain information that helps in answering the research question. There are various methods of collecting data including focus groups, ethnographies, interviews, case studies, and questionnaires. Colvin et al collected data in two phases. First is through micro-ethnicity observation. This took place between 2012 and 2013. Under this component observers, were unknown to participants, were working in the oncology sector, and principal investigator if the researcher had trained them on behaviour observation (Colvin et al., 2016). The observers used a nurse skill checklist to observe how the participants handled, administered, and disposed of hazardous medications. On the self-assessment component, questionnaires were used as data collection tools. One clear ethical consideration is made during data collection. Questionnaires were to be returned anonymously. One of the principles of research ethics is the protection of confidentiality and anonymity (Rahi, 2017). However, there are other principles that the study should have considered such as informed consent. This is one of the major ethical principles in studies that involve human participants.
Study limitations are aspects that can hinder a study of the findings. According to the authors, the study has several limitations. First the study was limited to a single center. The reader is however left to imagine the reason why this is a limitation. The reason could be the need to generalize the findings to oncology nurses in the country. Second, the sample size is inadequate considering the population size (Colvin et al., 2016). Third, the characteristics of the participants were not collected. A sample size of those observed was also small. Group findings guided the analysis with no correlations noted between self-assessment and observations (Colvin et al., 2016). It is commendable that the authors have listed the limitations. First, all studies have limitations. Second, clarifying study limitations gives a reader a better understanding of how best to interpret the findings. Third, explaining study limitations is an indicator that the researcher is knowledgeable, a source of validity (Ioannidis, 2007). These limitations affect the aspect of generalizing the results. To improve them, representative sample sizes should be selected. Additionally, several study settings should be involved in the study. With a higher quality research, quality results can be generated.
Findings are the results found after data has been collected and analyzed. On observation, the study found nurses’ score was a hundred percent in washing hands after administering chemotherapy, appropriate disposal of gloves, and proper discard of chemotherapy bag. However 12 items were not always completed with seven going below 45% in adherence (Colvin et al., 2016). On self-assessment study component, the study found nurses’ score being 100% in proper disposal of contaminated tools, and proper use of gowns that are approved for chemotherapy during drug administration. Based on self-assessment on adherence component nurses scored 92% in washing hands during chemotherapy administration and 17% in double gloving as per the guidelines. Upon comparison of subjective and objective behaviour on adherence, observation showed three behaviors carried out at a greater frequency (Colvin et al., 2016). These are proper discarding, double gloving, and proper gown upon disconnection of chemotherapy. On the other hand, observation showed two behaviors occurring at a lower frequency. These are protecting of the work surface, and double gloving. In short, the found that the adherence rate was lower compared to the expectations.
The research question was whether nurses adhere to the current NIOSH PPE and hospital policy chemotherapy exposure controls in a real clinical practice. The findings have attempted to answer this question by indicating that the adherence rate is lower that the set expectations. The answer is however not a precise yes or no. They reader is left in between with yes they adhere to the guidelines but more need to be done. The credibility of research findings refers to confidence in the findings (Anney, 2014). Several factors show that the findings are credible. First, the study was conducted by trained people. Second, a proper research design that is associated with better results. Third, appropriate data collection methods as well as tools were used. Fourth, the response rate was adequate. However, a lower sample size leads to questions whether the findings can be generalised (Anney, 2014). However, as already stated all studies have limitations and these should not be used to dismiss the findings.
It is clear that chemotherapy medications can affect the health of oncology nurses. It is thus important, that the nurses adhere to the provided safety guidelines. The clear research question, proper research design, data collection methods and tools, and adequate response rate improves the credibility of the study findings. However, the sample size as well as the setting of the study raises concerns on whether the findings can be generalized. Study limitations are nonetheless part of every study. The limitations should serve as a guide to other studies that would help bring clearer findings. They should not be used to dismiss study findings. Higher quality studies should however be conducted with larger samples and more target settings. This will ensure that the findings can be generalized to the target population across the nation. Colvin, Karius, and Albert have offered some new information on adherence to safe handling practices. With more research on the topic, nurses will be safe from all risks that are associated with chemotherapy or related medications.
Almalki, S. (2016). Integrating Quantitative and Qualitative Data in Mixed Methods Research—Challenges and Benefits. Journal of Education and Learning, Vol. 5, No. 3, pp.288-296.
Anney, V. (2014). Ensuring the Quality of the Findings of Qualitative Research: Looking at Trustworthiness Criteria. Journal of Emerging Trends in Educational Research and Policy Studies (JETERAPS), Vol. 5, No. 2, pp.272-281.
Colvin, C. M., Karius, D., & Albert, N. M. (2016). Nurse adherence to safe-handling practices: Observation versus self-assessment. Clinical Journal of Oncology Nursing, Vol. 20, No. 6, pp. 617-622.
Ioannidis, J. (2007). Limitations are not properly acknowledged in the scientific literature. Journal of Clinical Epidemiology, Vol.60, pp. 324-329.
Rahi, S. (2017). Research Design and Methods: A Systematic Review of Research Paradigms, Sampling Issues and Instruments Development. International Journal of Economics & Management Sciences, Vol.6, No.2, pp. 1-5.