A study to assess the Effectiveness of Planned Teaching on Knowledge Regarding safe Handling of Chemotherapeutic Drugs among the Student Nurses in selected Nursing Colleges of  Vidarbha Region.

 

Ms. Rupali P. Pethe1 , Ms. Alphy Rose2 , Mrs. Seema Singh3

1Clinical Instructor, Sadhu Vaswani College of Nursing, 10-10/1, Koregaon Park, Pune, Maharashtra, 411001.

2Smt. Radhikabai Meghe Memorial College of Nursing, Sawangi (M), Wardha.

3Research Guide and Professor, Smt. Radhikabai Meghe Memorial College of Nursing, Sawangi (M), Wardha.

*Corresponding Author Email: petherupali@gmail.com

 

ABSTRACT:

Background: Acute and repeated exposure to chemotherapeutic agents is especially dangerous. Chemotherapy drugs are carcinogenic, mutagenic, and/or teratogenic. They can cause organ toxicity, including damage to a woman's reproductive system. The adverse reproductive effects associated with occupational exposure to these drugs—such as temporary and permanent infertility, birth defects, menstrual dysfunction, ectopic pregnancies, and spontaneous abortions. Objectives: To assess the knowledge of student nurses regarding safe handling of chemotherapeutic drugs. To assess the post test knowledge of student nurses regarding safe handling of chemotherapeutic drugs. To associate the knowledge score of the student nurses with their selected demographic variables. Material: Tool used for the study is structured knowledge questionnaire.   Method: Non experimental Descriptive study on 60 subjects which includes student nurses of selected nursing colleges of Vidarbha region by Non probability convenience sampling. Results: In pre-test, 1.67% had very poor knowledge, 26.67% of subjects had poor knowledge, 58.83% had average knowledge, 13.33% had good knowledge and none of them had excellent knowledge. The minimum score was 4, maximum score was 15 and mean score was 9.95 ± 2.281. Whereas in post-test 45% had good and excellent knowledge, 8.33% had average knowledge, 1.67% had poor knowledge and none were there in the group of very poor. The minimum score was 5 and maximum score was 20, the mean score was 16.05 ± 2.620. It is statistically interpreted that posttest knowledge score was higher than the pretest knowledge score. There was no significant association between age, gender etc. There is significant increase in knowledge of student nurses regarding safe handling of chemotherapeutic drugs. So Research Hypothesis H1 is accepted. Conclusion: The study was conducted among student nurses in order to assess their knowledge regarding safe handling of chemotherapeutic drugs. After the completion of the study it is revealed that before the planned teaching knowledge of student nurses was not adequate but after the planned teaching knowledge of student nurses improved tremendously.

 

KEYWORDS: planned teaching, knowledge, chemotherapeutic drugs, and student nurses.


 


 

INTRODUCTION:

The word chemotherapy means the use of any drug (such as aspirin or penicillin) to treat any disease, but to most people chemotherapy refers to drugs used for cancer treatment. It’s often shortened to “chemo.” Two other medical terms used to describe cancer chemotherapy are antineoplastic (meaning anti-cancer) therapy and cytotoxic (cellkilling) therapy. Treatments like radiation and surgery are considered local treatments. They act only in one area of the body such as the breast, lung, or prostate and usually target the cancer directly. Chemotherapy differs from surgery or radiation in that it’s almost always used as a systemic treatment. This means the drugs travel throughout the body to reach cancer cells wherever they are. Chemotherapy is used to treat many cancers. More than 100 chemotherapy drugs are used today — either alone or in combination with other drugs or treatments. As research continues, more drugs are expected to become available. These drugs vary widely in their chemical composition, how they are taken, their usefulness in treating specific forms of cancer, and their side effects.1

 

There are 3 Possible Goals for Chemotherapy Treatment:

Cure: If possible, chemotherapy is used to cure the cancer, meaning that the cancer disappears and does not return. However, most doctors do not use the word “cure” except as a possibility or intention. When giving treatment that has a chance of curing a person’s cancer, the doctor may describe it as treatment with curative intent. But there are no guarantees, and though cure may be the goal, it doesn’t always work out that way. It often takes many years to know if a person’s cancer is actually cured.

 

Control:

If cure is not possible, the goal may be to control the disease — to shrink any cancerous tumors and/or stop the cancer from growing and spreading. This can help someone with cancer feel better and possibly live longer. In many cases, the cancer does not completely go away but is controlled and managed as a chronic disease, much like heart disease or diabetes. In other cases, the cancer may even seem to have gone away for a while, but it’s expected to come back.

 

Palliation:

When the cancer is at an advanced stage, chemotherapy drugs may be used to relieve symptoms caused by the cancer. When the only goal of a certain treatment is to improve the quality of life but not treat the disease itself, it’s called palliative treatment or palliation.2 sometimes, chemotherapy is the only treatment used. In other cases, chemotherapy may be given along with other treatments. It may be used as adjuvant therapy or neoadjuvant therapy.

 

Adjuvant Chemotherapy:

After surgery to remove the cancer, there may still be some cancer cells left behind that cannot be seen. When drugs are used to kill those unseen cancer cells, it’s called adjuvant chemotherapy. Adjuvant treatment can also be given after radiation. An example of this would be adjuvant hormone therapy after radiation for prostate cancer.

 

Neoadjuvant Chemotherapy:

Chemotherapy can be given before the main cancer treatment (such as surgery or radiation). Giving chemotherapy first can shrink a large cancerous tumor, making it easier to remove with surgery. Shrinking the tumor may also allow it to be treated more easily with radiation. Neoadjuvant chemotherapy also can kill small deposits of cancer cells that cannot be seen on scans or x-rays.3 Drugs used for systemic (total body) chemotherapy can be given in these ways: Oral (PO) — taken by mouth (usually as pills), Intravenous (IV) — infused through a vein, Intramuscular (IM) — injected into a muscle, Subcutaneous (SQ) — injected under the skin4 Nurses may have an exposure without realizing it. In a study of 83 nurses and pharmacists who handled or administered chemotherapy drugs, a specialized scanning device revealed that 13% of the group had one or more spots of drug contamination on their gloved or ungloved hands, gowns, or shoes.5 Acute exposure generally causes transient symptoms such as headache, nausea, dizziness, rash, skin and mucous membrane irritation, and eye or throat irritation. However, repeated exposure to chemotherapeutic agents is especially dangerous. Chemotherapy drugs are carcinogenic, mutagenic (induces or increases genetic mutations), and/or teratogenic (causes malformations in developing embryos). They can cause organ toxicity, including damage to a woman's reproductive system. The adverse reproductive effects associated with occupational exposure to these drugs—such as temporary and permanent infertility, birth defects, menstrual dysfunction, ectopic pregnancies, and spontaneous abortions—have been documented in a number of studies were non-oncology nurses, and the other third weren't nurses at all. The percentage of birth defects was 3.1% for oncology nurses, 1.5% for the non-oncology nurses, and 0.3% for the non-nurses.5 It's more difficult to connect long-term exposure in healthcare workers to an increased risk of developing malignancies because of the time interval between exposure and the onset of malignancy. It's also difficult to differentiate the influence of individual risk factors for cancer from occupational ones. Some studies have found increased chromosomal aberrations and evidence of mutagenicity in the urine of nurses who handle cytotoxic drugs, while other studies have failed to find a relationship between exposure and these measures. These disparate results may be due to differences in levels of exposure between studies, differences in the use of personal protective equipment (PPE) and work techniques, and differences in urine collection timing.5 While the long-term effects on nurses who are occupationally exposed to these drugs require further study, much research has already been done on the long-term effects on patients receiving chemotherapy. The development of secondary malignancies such as leukemia, bladder cancer, and lymphoma is well documented.5 A recent major study has found the rate of spontaneous abortion in nurses who handle chemotherapy drugs to be twice that of nurses who did not handle the drugs. Past studies have reported similar results, but this study, a partnership between the National Institute for Occupations Safety and Health (NIOSH) and the Nurses’ Health Study, looked at pregnancy outcome and occupational exposures retrospectively from 8,461 participants in the Nurses’ Health Study. Participants reported 6,707 live births and 775 (10%) spontaneous abortions (less than 20 weeks).6 Many chemotherapy drugs are considered hazardous to healthy people. That’s why the nurses and doctors who give chemotherapy will take precautions to avoid direct contact with the drugs while giving them to you. Chemotherapy drugs can be dangerous to others in these ways:

·         They can cause abnormal changes in DNA. (They are mutagenic.)

·         They may be able to alter development of a fetus or embryo, leading to birth defects. (They are teratogenic.)

·         They may be able to cause another type of cancer. (They are carcinogenic.)

·         Some may cause skin irritation or damage.

 

Nurses may wear special gloves, goggles, and gowns when preparing and giving you chemotherapy. Pharmacists or nurses prepare the drugs in areas with special ventilation systems to avoid spattering and/or inhaling the droplets that can form while mixing.1 Although chemotherapy is given to kill cancer cells, it also damages normal cells. The normal cells most likely to be damaged are those that divide rapidly, for instance:

·         Bone marrow/blood cells

·         Cells of hair follicles

·         Cells lining the digestive tract

·         Cells lining the reproductive tract

 

Damage to these cells accounts for many of the side effects of chemotherapy drugs. Side effects are different for each chemotherapy drug. They also differ based on the dose, the way the drug is given, and how the drug affects you individually.2 If patient is in the hospital, the health care professionals caring for him may use special precautions when they handle urine and stool for a few days after treatment. This is because patient’s body waste may contain the drugs. If patient get chemotherapy at home, patient and family members will be given special instructions by the nurse and precautions to ensure the safety of caregivers and those living with patient. Special procedures are used to dispose of materials that were used to mix and give the drugs. There are separate plastic containers to dispose of sharp items, syringes, IV tubing, and medicine bags. Gowns and gloves are disposed of in special bags. If there are any visible leaks or spills, special precautions are used to clean up the drugs.7 Many antineoplastic agents are known to be teratogenic and mutagenic to humans. Nurses are the main groups that are exposed to these drugs in hospital setting. Generally, the occupational activities that pose to greatest risk of exposure are the preparation and administration of antineoplastic agents, cleaning of chemotherapy spills, and handling of patient excreta. Objective: The objectives of this study were to evaluate the knowledge of nurse regarding the way of exposure of Cytotoxic Drugs (CDs) and to determine the current patterns of use of personal protective equipments while handling antineoplastic chemotherapeutic agents.8 The chemotherapy drugs nurses are most likely to administer are paclitaxel (Taxol); doxorubicin HCl (Adriamycin, Doxil); cyclophosphamide (Cytoxan); cisplatin (Platinol); docetaxel (Taxotere); etoposide, which is commonly known as VP-16 (VePesid); methotrexate; fluorouracil, which is commonly known as 5-FU (Adrucil); and carboplatin (Paraplatin).  Accidental exposure to such agents can occur in several ways: by direct absorption of a drug through the skin; by ingestion while eating or drinking after hand contact with a drug; and by inhalation of airborne droplets.9 Today cancer patients are diagnosed earlier than in the past, and many receive multiple courses of chemotherapy for a longer period of time . Many antineoplastic drugs are known to be carcinogenic, teratogenic and mutagenic to humans . Recent studies show the increase in the potential risks due to occupational exposure to Cytotoxic Drugs (CDs). Occupational exposure is important be-cause physical, economic and socio cultural factors are major determinants of behaviour relevant to cancer. Exposure and absorption occur during the preparation and administration in health care practice. Nurses and pharmacists are the main groups that are exposed to these drugs in the ambulatory care and hospital settings10 During the clinical experience, investigators found that so many student nurses are carelessly handling the chemotherapeutic drugs. Also investigators have observed that staff nurses don’t have adequate knowledge regarding the chemotherapeutic drugs and its effects on cancerous and normal cells. Most of the student nurses are not aware of the fact that it has negative effects on the caregivers. Hence they found this study as relevant.

 

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of planned teaching on knowledge regarding safe handling of  chemotherapeutic drugs among the student nurses in selected nursing colleges of  Vidarbha region.

 

OBJECTIVES OF THE STUDY:

1.        To assess the knowledge of student nurses regarding safe handling of chemotherapeutic drugs.

2.        To assess the post test knowledge of student nurses regarding safe handling of chemotherapeutic drugs.

3.        To associate the knowledge score of the student nurses with their selected demographic variables.

 

ASSUMPTIONS:

1.        Student nurses may have some knowledge regarding handling of chemotherapeutic drugs.

2.        Knowledge level of student nurses will vary from individual to individual.

 

HYPOTHESES:

H0:

There is no significant association of knowledge score with their demographic variables.

 

H1:

There is a significant association of knowledge score with their demographic variables.

 

DELIMITATIONS:

·         The study was conducted in selected hospitals of Vidarbha region.

 

MATERIALS AND METHODS:

Research Approach:

The interventional approach would help the investigator to evaluate the effect of the intervention that is “planned teaching” on the variable that is knowledge of the student nurses. 

 

Research Design:

In the present study Quasi experimental one group pre-test post-test research design was used. A pre-test was administered by means of structured questionnaire then planned teaching was given to the student nurses regarding the safe handling of chemotherapeutic drugs. A post test was conducted using the same structured questionnaire.

 

Variables:

Independent Variable:

planned teaching on safe handling of chemotherapeutic drugs.

 

Dependent Variable:

knowledge of student nurses.

 

Research Setting:

The study was conducted in selected Nursing colleges of Vidarbha region. The investigators found the setting appropriate to conduct the study because adequate numbers of student nurses were available who could be taken for the study and also college authorities were co-operative and gave permission to conduct the study. Name of Nursing college is:

1.                    Shri. Radhikabai Meghe memorial college of Nursing, Sawangi (Meghe), Wardha.

 

Population:

Target population: In this study the target population was the student nurses from selected Nursing colleges of Vidarbha region. Accessible population: The accessible population for this study was the student nurses from the selected Nursing colleges of Wardha Districts.

 

Sample:

In this study the samples consisted of 60 student nurses who were fulfilling the inclusion and exclusion criteria.

 

Sampling Technique:

The sampling technique used in the study was non probability convenient sampling.

 

Criteria for Sample Selection:

Inclusion criteria:

Student nurses, those who were

·         Present at the time of data collection.

·         Willing to participate in the study.

·         Able to understand English.

 

Exclusion criteria:

·         Student nurses who have participated in similar type of studies.

 

Development of the tool:

The investigators developed the tool after updating their theoretical knowledge regarding safe handling of chemotherapeutic drugs, the investigator’s own experience, theoretical knowledge and guidance from the experts along with the review of literature.

 

Description of the tool:

Structured questionnaire consists of two sections

Section I:

Consists of demographic variables of the student nurses to be participated in the study (age, gender, and experience in hospital area and attainment in any similar educational programme).

 

Section II:

consists of 20 questions on knowledge regarding safe handling of chemotherapeutic drugs.

 

Scoring:

·         Score 1 was given for correct answer

·         Score 0 was given for wrong answer

·         Knowledge was graded from poor knowledge to excellent knowledge based on scores

Method of data collection:

The investigators visited to selected Nursing colleges of Vidarbha region in advance and obtained the necessary permission from the concerned authorities. The investigator approached the student nurses studying in selected nursing colleges of Vidarbha region and explained the purposes of the study and explained how it will be beneficial for them. They enquired their willingness to participate in the study and obtain consent from them, the investigators personally visit each student nurses and then made them comfortable and oriented to the study and administered questionnaire to them. Once the questionnaire completed, investigator collected them back, each sample required mean time of 30 min. to complete the structured questionnaire. After the pretest planned teaching is given. Post test was administered with the same questionnaire on the 7th day. The collection of data was performed within the stipulated time.

 

Plan for data analysis:

The data were analyzed by using descriptive and inferential statistics.

 

RESULT:

Section I :

Most 86.67% student nurses were in age group of 18-20 years , majorities 96.67% of the subjects were females, maximum 88.33% of subjects had no history of working in the hospital setup, and none of them had attended educational programs in the past.

 

Section II :

This section shows level of knowledge of student nurses in pretest and posttest regarding safe handling of chemotherapeutic drugs.


 

 

Fig 1 : Distribution of student nurses with regards to level of knowledge

 

Section –III : The table no. 1  shows the comparison of knowledge scores in pre-test and post-test.

 

Table 1: Comparison of knowledge in pretest and post test n = 60

Level of knowledge score

Score range

Percentage Range (%)

Pretest score

Post test score

Frequency

Percentage (%)

Frequency

Percentage (%)

Very poor

0-4

0-19

1

1.67%

0

0%

Poor

5-8

20-39

16

26.67%

1

1.67%

Average

9-12

40-59

35

58.83%

5

8.33%

Good

13-16

60-79

8

13.33%

27

45%

Excellent

17-20

80-100

0

0%

27

45%

Minimum scores

4

5

Maximum scores

15

20

Mean scores

9.95 ± 2.281

16.05 ± 2.620

Mean percentage

49.75 ± 11.40

80.25 ± 13.13

 

Table2: Significance of difference between knowledge score in pre and post-test of staff nurses regarding safe handling of chemotherapeutic drugs.n = 60

Overall

Mean knowledge score

SD

Mean percentage

t value

P value

Pretest

9.95

2.281

49.75

2.678

0.00

S, p < 0.05

Posttest

16.05

2.620

80.25

 


The table no. 2 shows the area-wise comparison of pre-test and post-test knowledge scores of all areas of the knowledge regarding safe handling of chemotherapeutic drugs. The tabulated t value for n-1 (60-1) i.e. 59 degrees of freedom was 2.00. The calculated‘t’ value is 2.678. The calculated‘t’ value was higher than the tabulated value at 5% level of significance which is statistically acceptable level of significance. In addition the calculated ‘p’ value for all the areas of knowledge was 0.00 which is ideal for any population. Hence it is statistically interpreted that the planned teaching regarding safe handling of chemotherapeutic drugs was effective. Thus the H1 is accepted.

 

Section IV:

This section shows association of post-test knowledge score with selected demographic variables. There was no significant association between age, gender, experience of working in hospital set up etc and post test knowledge scores of student nurses. There is significant increase in knowledge of student nurses regarding safe handling of chemotherapeutic drugs.

 

DISCUSSION:

A detailed review of literature indicated that most of the studies indicating that education had significant effect in improving the knowledge regarding safe handling of chemotherapeutic drugs. This study was the modest effort to increase the knowledge of student nurses regarding safe handling of chemotherapeutic drugs. Student nurses need more knowledge in safe handling of chemotherapeutic drugs because they are having a crucial role in caring for the patient on chemotherapy. Chemotherapeutic drugs are more dangerous for the patients, health professionals, patient’s relatives and for the environment also. In the present study knowledge of student nurse regarding safe handling of chemotherapeutic drugs are assessed. An evaluative study was conducted in Madhya Pradesh on the effectiveness regarding cancer chemotherapy and its side effects management on knowledge, attitude and practice. Sample size was 30 nursing personnel working in a cancer hospital. The tool used for data collection were knowledge questionnaire, attitude scale and observation checklist. The study revealed that mean post – test knowledge score (39.46) of nursing personnel was found to be significantly higher than their mean pre –test knowledge score (32.93) as accident from the‘t’ value (t=10.9,  (29), P<0.05).11 In the present study, the student nurses are the study subjects and the finding shows that the student nurses were having insufficient knowledge before administering planned teaching. Education is needed for the student nurses to enlighten their knowledge. A study was conducted to identify the effect of antineplastic drugs on nurses handling chemotherapeutic agents. Sample size was 59 nurses who handled antineplastic drugs and 64 community health nurses (unexposed group). A cross – sectional design was used in which interview data and urine sample analysis were compared from exposed and unexposed nurses. Thirty – six to fifty – nine of exposed nurses had positive urine mutagenecity.  Abdominal pain, headache and skin rashes were reported more frequently in the exposed group.12

 

The findings of the present study also show the improvement of knowledge scores after intervention i.e. planned teaching. The result shows that in pre-test scores, 1.67% has very poor knowledge, 26.67% have poor knowledge, 13.33% of samples had good knowledge, 58.83%  had average knowledge and 15% had very good knowledge, whether in post-test scores 45% the study participants have good and excellent knowledge, 8.33% have average knowledge and only 1.67% has poor knowledge. A study was conducted on “Risk of handling injectable neoplastic agents” in America.  Health care personals, described physical complaints like skin, mucus membrane and eye irritation, light headness, facial flushing, hair loss, nausea experienced following the preparation of antineoplastic drugs. Some studies demonstrated that chemotherapy drugs attack reproducing cells, they cannot differentiate between normal tissues that are replacing worn-out cells and targeted cancer cells. The normal cells will be damaged by chemotherapy along with cancer cells which results in side effects.13

 

The finding of the present study shows that there is no significant association between age, gender, hospital working experience and participation in similar educational programmes in past. After the detailed analysis, this study leads to the following conclusion: The student nurses do not have 100% knowledge regarding safe handling of chemotherapeutic drugs. There was a significant increase in the knowledge of subjects after the administration of planned teaching. To find the effectiveness of planned teaching student‘t’ test was applied and t value was calculated, post-test knowledge score was significantly higher at 0.05 level than that of pre-test score. Thus it was concluded that planned teaching on safe handling of chemotherapeutic drugs was found effective as a teaching strategy. Demographic variables did not show a major role in influencing knowledge score among student nurses. Hence based on the above cited findings, it was concluded undoubtedly that the written prepared material by the investigators in the form of planned teaching helped the student nurses to improve their knowledge on safe handling of chemotherapeutic drugs.

 

RECOMMENDATIONS:

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

·         A similar study on a large scale including nursing colleges across the country can be carried out in order to estimate the level of knowledge regarding safe handling of chemotherapeutic drugs for generalization of findings.

·         Study can be conducted to evaluate the effectiveness of planned teaching programme versus other methods of teaching on safe handling of chemotherapeutic drugs.

·         A study can be undertaken with large sample size to assess the level of knowledge and for generalization of findings.

·         An experimental study could be undertaken with control group.

·         A similar study can be conducted by using SIM for educating Student nurses.

 

REFERENCES:

1.        Armstrong DK, Bundy B, Wenzel L, et al; Gynecologic Oncology Group. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006 Jan 5; 354(1):34-43.

2.        Freter CE, Perry MC, Abeloff MD, et al; Abeloff’s Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008: 449-483.

3.        Gullatte MM, Gaddis J.,et al; A Cancer Source Book for Nurses. 8th ed. Sudbury, Mass: Jones and Bartlett; 2004:103-130.

4.        Itano JK, Taoka KN, eds. Core Curriculum for Oncology Nursing. 4th ed. Philadelphia, Pa: Elsevier Saunders; 2005.

5.        http://www.modernmedicine.com/modern-medicine/news/handling-chemo-safely-your-concern-too

6.        Oncology Nursing Society. Chemotherapy and Biotherapy Course. Available at: http://chemovc.ons.wego. net/. Accessed Nov. 17, 2003.

7.        Kirby JS, Miller CJ. Intralesional chemotherapy for nonmelanoma skin cancer: A practical review. J Am Acad Dermatol. 2010 May 31. [Epub ahead of print]

8.        http://www.scirp.org/journal/PaperInformation.aspx?paperID=17232

9.        Martin S, Larson E. Chemotherapy-handling practices of outpatient and office-based oncology nurses. Oncol Nurs Forum. 2003; 30:575-581.

10.     American Society of Health-System Pharmacists (ASHP). Medication Misadventures—Guidelines. Available at: www.ashp.org. Accessed Nov. 17, 2003.

11.     Labulin K et al. Cancer Nursing 1998 April; 21(2):277-285.

12.     Journal of Occupational Environmental Medicine 1997 June; 39(6):574-580.

13.     Jerrold B., Marvtin S. Complete Medical enzyclopedia. First edition. Random house. Refence Newyork. 2003; P-347.

 

 

 

 

Received on 30.05.2016          Modified on 15.06.2016

Accepted on 29.06.2016          © A&V Publications all right reserved

Asian J. Nur. Edu. and Research.2017; 7(2): 191-197.

DOI: 10.5958/2349-2996.2017.00039.8