INTRODUCTION:

Adolescence is believed to be a period of great stress as rapid physical and mental changes occur during this period. Typically, it is divided into three early 12-15 years, middle 15-18years, and late adolescent upto 18 years. Adolescents account for about 1/5^th of India^'s population (Anon, 2004)¹. Adolescents in disadvantaged communities are at elevated risk for exposure to multiple stressors, indicating high rates of crime and victimization, family poverty, family conflicts, increased prevalence of deviant peers and school with inadequate The use of hazardous drugs (in particular, antineoplastic drugs used in oncology) is increasing for a number of reasons. On the one hand, there has been an increase in the number of cancer cases, which account for almost 30% of deaths in Quebec annually (Boothroyd, 2004). The National Cancer Institute of Canada estimates the number of new cases of cancer in Quebec in 2006 at 38,300. According to the data from British Columbia, the number of individuals receiving chemotherapy increased by 43% from 1996-1997 to 2001-2002. There is every reason to believe that the situation is similar in Quebec (MSSS, 2003). On the other, the hazardous drugs used are more potent and are more often used in combination and at higher doses. They are also used to treat conditions other than cancer. For example, the immunosuppressive properties of methotrexate also make it useful for treating arthritis and other conditions².

The Oncology Nursing Society recommends that in order to provide quality care and maintain safety standards, nurses must be competent in oncology nursing practice and have an awareness of risks amid their workplace. A major facet of this competency is that nurses must be remain educated and regularly engage in mandatory updates (Crannell, 2012)³.

Polovich and Clark (2012) pose that several barriers may be influencing the practice problem of unintended exposure to chemotherapy and indicate that political factors regarding mandatory national safety guidelines need to encourage employers to acknowledge this safety issue. However, existing studies suggest that despite the existence of policies and procedures, contamination is likely still occurring (Polovich and Clark, 2012).

BACKGROUND:

Oncology nurses working in ambulatory settings pride themselves in their ability to protect their clients from unnecessary exposure to chemotherapy. However, many health care professionals have misconceptions of the extent of their own risk in this environment (Fuller, Bain, and Sperrazza, 2007). According to Fuller and colleagues, only 54% of surveyed nurses were aware of safe handling programs available in their workplace and only 30% of them actually read the information that was offered. This suggests a potential knowledge deficit and possible lack of compliance with the National Institute for Occupational Safety and Health (NIOSH) recommendations (Fuller et al., 2007) identifying a significant safety concern for employees of oncology centers who administer chemotherapy and the general public⁴.

A lack of education and the inconvenience of safety equipment may prevent many nurses from taking appropriate precautions for themselves (Polovich and Eisenberg, 2009). In a study of inpatient and outpatient nurses, researchers found that only 31% wore protective gowns during the administration of chemotherapy despite the availability of personal protective equipment

(Martin and Larson, 2003). This study also suggests the enforcement of protective equipment use through means of medical surveillance is not occurring in a manner consistent with national recommendations⁵.

In fact, recent studies suggest that although hazardous drug policies are in place in many workplaces, existing practices may not reflect current recommendations for safe chemotherapy handling and are not enforced or monitored by managerial staff (Polovich and Clark, 2012). The major issue of concern is that although these policies are in place and personal protective equipment (PPE) is available, nurses are not consistently taking appropriate action for their protection.

OBJECTIVES:

· To assess the practice regarding safety measures used by nurses while handling chemotherapy drugs.

· To find out the association between the practice regarding safety measures used by nurses while handling chemotherapy drugs with selected demographic variables

METHODOLOGY:

Research design- This study include the descriptive research design.

Sample – This study include the staff Nurses who are working in the oncology hospital/cancer hospital.

Sample size - This study include the staff Nurses who are working in the oncology hospital/cancer hospital. Sample size was 100 staff nurses.

Setting of the study – The study was undertaken in Saint Tukdoji Maharaj Cancer Hospital, Nagpur.

Sampling technique - –Non probability purposive sampling technique is used for this study.

VARIABLES:

Independent variable

· The independent variable in this study is nurses working in the hospital.

Dependent variable

· The dependent variables in this study is practice regarding safety measures while handling chemotherapy drugs

CRITERIA FOR SAMPLE SELECTION

· Inclusion criteria:-

- Staff Nurses who are working in oncology department

- Those who knows hindi, marathi and english language.

· Exclusion criteria:-

- Those who are experience not more than 3years.

METHOD OF DATA COLLECTION:

Method of data collection:

The data shall be collected from all the nursing staff who is working in oncology department. The participant shall be explained about the purpose of the study. Written consent shall be taken before recruiting the subjects for the study .Check list shall be given to the participants to collect the data.

ANALYSIS

Collected data were organized in tabular form for analysis. The collected data was analyzed by using descriptive statistics and inferential statistics. Association is made with the help of T- test, one way ANOVA test. The data is presented in the form of tables and graphs.

RESULTS:

The data are based on the objectives of the study. Data presented under the following headings.

SECTION 1- Demographic Variables

Distribution of nurses according to their age in years shows that 64% of the nurses belonging to 21-30 years,33% of nurses belonging to 31-40 years, 1% belonging to 41-50 years and 2% nurses belonging to above 51 years respectively.

Distribution of nurses according to their gender shows that 15% were belonging to male gender and 85 % were belonging to female gender respectively.

Distribution of nurses according to their marital status shows that 34% of nurses were single, 66% of nurses were married and no widowed respectively.

Distribution of nurses according to their number of living children shows that 24% of nurse were one living child,31% of nurses were two living children, 6% of nurses were more than two children and 39% of nurses were no child respectively.

Distribution of nurses according to their number of abortion shows that 21% of nurses were one abortion, 4% of nurses were two abortions, 1% of nurses were more than two abortion and 74% of nurses were no abortion respectively.

Distribution of nurses according to their previous training shows that 8% of nurses were having previous training and 92% of nurses were having no previous training respectively.

Distribution of nurses according to their education qualification shows that 66% of nurses were belonging to RGNM, 28% of nurses were belonging to Basic. B.Sc/Post Basic. BSc nursing, 2% of nurses belonging to M.Sc nursing respectively.

Distribution of nurses according to their working experience shows that 70% of nurses were belonging to 1-5 years experience, 28% of nurses were belonging to 6-10 years experience, 2% of nurses belonging to above 16 years working experience respectively.

Distribution of nurses according to their regular medical checkup shows that 31% of nurses were belonging to no regular checkup, 68% of nurses were belonging to every 2-5 years regular checkup and 1% of nurses belonging to more than 5 years regular checkup respectively.

Section II

Table no 1- Assessment of the practice regarding safety measures used by nurses while handling chemotherapy drugs. n= 100

Assessment of practice while handling chemotherapy drugs	Percentage score	Assessment of practice while handling chemotherapy drugs
		Frequency	%
Poor	1-3(0-40%)	56	56%
Good	4-6 (41-80%)	44	44%
Minimum score	1
Maximum score	6
Mean score	2.69±1.82

The above table no. 1 shows the assessment of nurses practice while handling chemotherapy drug. Majority of samples 56 (56%) were having poor practice while handling chemotherapy drugs and 44% of nurses were having good practice while handling chemotherapy drugs, Maximum score was 6 and minimum score was 1.

Figure No 1- Assessment of practice while handling chemotherapy drugs.

Association of the practice regarding safety measures used by nurses while handling chemotherapy drugs in relation to demographic variable.

Table 2: Association of practice regarding safety measures used by nurses while handling chemotherapy drugs in relation to age n=100

Age(years)	Number of Nurses	Mean Practice while handling	F-value	p-value
21-30 yrs.	64	2.56±1.69	3.56	0.05 S,p<0.05
31-40 yrs.	33	2.79±2.02
41-50 yrs.	1	5.00±0
51 Above yrs.	2	5.00±0

This table shows the association of practice score regarding safety measures used by nurses while handling chemotherapy drugs in relation to age The tabulated ‘F’ values was 4.13 (df=2,57) which is higher than the calculated ‘F’ i.e. 3.56 at 5% level of significance. Also the calculated ‘p’=0.05 which was much less than the acceptable level of significance i.e. ‘p’=0.05. Hence it is interpreted that age in years of nurses is associated with their practice while handling chemotherapy drugs scores.

Table 3: Association of practice regarding safety measures used by nurses while handling chemotherapy drugs in relation to gender n =100

Gender

Number of Nurses

Mean Practice while handling

t-value

p-value

Male

3.07±1.71

4.54

0.00

S,p<0.05

Female

2.65±1.85

This table shows the association of practice score regarding safety measures used by nurses while handling chemotherapy drugs in relation to gender. The tabulated‘t’ values was 4.54 (df=2,57) which is less than the calculated ‘t’ i.e. 0.63 at 5% level of significance. Also the calculated ‘p’=0.00 which was much less than the acceptable level of significance i.e. ‘p’=0.05. Hence it is interpreted that gender of nurses is associated with their practice while handling chemotherapy drugs scores.

Table 4: Association of practice regarding safety measures used by nurses while handling chemotherapy drugs in relation to Previous training n=100

Previous training

Number of Nurses

Mean Practice while handling

F-value

p-value

Yes

4.25±2.05

2.24

0.05

S,p<0.05

2.58±1.75

This table shows the association of practice score regarding safety measures used by nurses while handling chemotherapy drugs in relation to previous training. The tabulated ‘F’ values was 3.56 (df=2,57) which is higher than the calculated ‘F’ i.e. 2.24 at 5% level of significance. Also the calculated ‘p’=0.05 which was much less than the acceptable level of significance i.e. ‘p’=0.05. Hence it is interpreted that previous training of nurses is associated with their practice while handling chemotherapy drugs scores.

Table 5 : Association of practice regarding safety measures used by nurses while handling chemotherapy drugs in relation to Working Experience n=100

Working Experience	Number of Nurses	Mean Practice while handling	F- value	p- value
1-5 years	70	2.50±1.67	2.64	0.02 S, p<0.05
6-10 years	28	3.07±2.10
11-15 years	0	0
Above 16 years	2	5.00±0.00

This table shows the association of practice score regarding safety measures used by nurses while handling chemotherapy drugs in relation to working experience. The tabulated ‘F’ values was 3.56 (df=2,57) which is higher than the calculated ‘F’ i.e. 2.64 at 5% level of significance. Also the calculated ‘p’=0.02 which was much less than the acceptable level of significance i.e. ‘p’=0.05. Hence it is interpreted that working experience of nurses is associated with their practice while handling chemotherapy drugs scores.

Table 6: Association of practice regarding safety measures used by nurses while handling chemotherapy drugs in relation to Regular medical checkup n=100

Regular medical checkup	Number of Nurses	Mean Practice while handling	F-value	p- value
No	31	1.10±0.30	14.39	0.00 S,p>0.05
Every 2-5 years	68	3.41±1.76
More than 5 years	1	5.00±0.00

This table shows the association of practice score regarding safety measures used by nurses while handling chemotherapy drugs in relation to regular medical checkup. The tabulated ‘F’ values was 3.56 (df=2,57) which is higher than the calculated ‘F’ i.e. 14.39 at 5% level of significance. Also the calculated ‘p’=0.00 which was much less than the acceptable level of significance i.e. ‘p’=0.05. Hence it is interpreted that regular medical checkup of nurses is associated with their practice while handling chemotherapy drugs scores.

DISCUSSION:

In our study there was poor use of gloves, gowns and personal protective equipment among study nurses, when handling patient and cleaning up spills. When handling Chemotherapy drugs there was no use of gloves and surgical mask by study nurses but a very small number of them used all of the recommended protective equipment. According to standards set by the OSHA directives, it is routinely that nurses used protective gloves, protective masks, eye glasses and apron during the preparation and administration of Chemotherapy drugs. The results about using safety materials during Chemotherapy drugs preparation are parallel to other studies carried out in our country. These results showed that there is a lack of suitable Chemotherapy drugs management in our country. Gloves and Aprons protect staff from direct skin contact .It has been proposed that unpowered thick latex gloves during administration. As glove permeability increases by time, they should be changed at the end of every 30 minute for surgical latex but for nitryl at the end of every 60 minute. If gloves torn or contaminated it must be changed immediately regardless of type^6,7 while In our study, all nurses study did not used any protective materials as gown, mask, and eye glasses due to lack of knowledge and according to their practical experience they think that this measures as gloves did not permit the nurse to palpate the vein of the patient and also due to think that the chemotherapeutic drugs are not infected material and also not harmful^8,9. In my opinion the idea behind the nurses answers regard not use of protective measures as gloves due to inability to palpate the vain and look for it in appropriate site while regards wearing of eye glasses ,it is the first time to know the using of it in Chemotherapy drugs room and related to gown, the nurses wear only the lab coat and when it was contaminated with Chemotherapy drugs wash it in their home in dish washer with family clothes and the nurse cannot put mask and work with it and did not used soap and water except the Chemotherapy drugs enter nurses eye and when the hand contaminated by Chemotherapy drugs the nurse dry it with tissue paper on in their coat^10,11.

Our results about the nurses’ safety behavior showed that eating food in handling area with Chemotherapy drugs was the most common risky behavior among exposed nurses in study group. Followed by drinking beverages, in improper place for preparing and handling Chemotherapy drugs as well as expelling air from syringes filled with Chemotherapy drugs were common risky activities. Others included needle stick injuries, contamination of hands, poor hand washing, collection of blood, urine and stool samples, cleaning spills and handling body fluids or contaminated materials these findings showed that the working place was not a safe environment for those nurses. An analytical cross sectional study carried out in Ege University Teaching Hospital by Meral et al 2004 reported that approximately half of the nurses were drinking beverages.

Exposure of health care providers to antineoplastic drugs and the routes of exposure are typically inhalation, dermal or oral. Workers may be exposed by inhalation via droplets, particulates and vapors when they create aerosols and clean up spills. Dermal exposure may occur when workers touch contaminated surfaces during the preparation, administration or disposal of hazardous drugs and oral exposure may occur from hand to mouth contact. Accidental infection with an antineoplastic drugs, although rare has been documented. In handling chemotherapeutic area half of the nurses in study group have at least one risky behavior in the working environment. Only 32.5 % of the nurses declared that they prepare the Chemotherapy drugs in proper preparation cabins. Only 45% of the nurses reported that their working environment had proper aspiration system. In a previous study it was reported that 94% of nurses drink and eat in the preparation area for Chemotherapy drugs. Although some of the previous studies report similar finding and some studies especially in the more developed countries report that the majority were prepared Chemotherapy drugs in a laminar air flow hood¹².

CONCLUSIONS:

After the detailed analysis, this study leads to the following conclusion. Assessment of nurse’s practice while handling chemotherapy drug. Majority of samples were having poor practice while handling chemotherapy drugs. There is therefore, a need to improve the safety of the work environment; make available protective equipment develop standard practice guidelines for oncology nurses. Association of practice regarding safety measures used by nurses while handling chemotherapy drugs in relation to Regular medical checkup

RECOMMENDATION:

On the basis of the findings of the study, it is recommended that the following studies can be conducted.

1. A similar study may be conducted on a larger population for generalization of findings.

2. Mass and individual education in regional languages to enlighten the nurses can be organized at all the level of health facilities.

3. A study can be carried out to evaluate the efficiency of various teaching strategies like SIM, pamphlets, leaflets and computer-assisted instruction on behavioural problems of children.

4. A study can be carried out to assess the effectiveness of structured teaching progemme on handling chemotherapy drugs in hospital setting.

5. Mannuals, information booklets and self-instruction module may be developed on handling chemotherapy drugs.

6. An experimental study can be undertaken with control group for effective comparison of result.

REFERENCES:

1. Prevention guide safe handling of hazardous drugs by Assts as, page. No 4-10.

2. American Society of Health System Pharmacists (2006). ASHP guidelines on handling hazardous drugs. American Journal of Health System Pharmacists, 63, 1172-1193.

3. Hansen, J., and Olsen, J. H. (1994). Cancer morbidity among Danish female pharmacy technicians. [Study]. Scandinavian Journal of Work and Environmental Health, 20, 22-26.

4. Ben-Ami S, Shaham J, Rabin S, et al (2001). The influence of nurses’ knowledge, attitudes, and health beliefs on their safe behaviour with cytotoxic drugs in Israel. Cancer Nursing, 24, 192-200.

5. Oxford Journal, mutagenesis, P.V. Rekhadevi, N. Sailaja, and Paramjit Grover. July18,2007.

6. Bouraoui S, Brahem A, Tabka F, et al (2011). Assessment of chromosomal aberrations, micronuclei and proliferation rate index in peripheral lymphocytes from Tunisian nurses handling cytotoxic drugs. Environ Toxicol Pharmacol, 31, 250-7.

7. Valanis B, Vollmer WM, Labuhn K, Glass A, and Corelle C. Antineoplastic drug handling protection after OSHA guidelines: Comparison by profession, handling activity and work site. Journal of Occupational Medicine; 34: 149– 155, 1999

8. Kosgeroglou N., Ayranci U., Ozerdogan N. and Demirustu C. Turkish nurses' information about and administration of chemotherapy drugs. Journal of clinical nursing; 15 [1]:1179-8725),2006.

9. Tiffany R. Oncology for Nurses and Healthcare Professionals: Pathology, Diagnosis and Treatment I, 2nd edn. London: Harper and Row, 37–45,2007

10. Creedon S., Slevin B., Quinn G., Boyle L., Doyle A., O'brien B., O' Connell N. and Ryan L. Hand hygiene compliance: Exploring variating in practice between hospitals. Available at nursing times. 7, (2): 20-24,2008

11. Sessink, B. C, Wittenhorst, R. B, Anzion, R. P. and Bor, P.s, “Exposure of Pharmacy Technicians to Antineoplastic Agents; Reevaluation after Additional Protective Measures,” Archives of Environmental Health, Vol. 52, No. 3, pp. 240-244,1999.

12. Nygren E and. Lundgren C, “Determination of Platinum in Workroom Air and in Blood and Urine from Nursing Staff Attending Patients Receiving Cisplatin Chemotherapy,” International Archives of Occupational Environmental Health, Vol. 70, No. 3, , pp. 209-214, 2006.

Received on 15.07.2016 Modified on 22.08.2016

Int. J. Adv. Nur. Management. 2016; 4(4): 349-354.

DOI: 10.5958/2454-2652.2016.00078.0