NURSES' PERCEPTIONS REGARDING RISK OF OCCUPATIONAL EXPOSURE TO CYTOTOXIC DRUGS IN A TERTIARY HOSPITAL IN SAUDI ARABIA: A GROUNDED THEORY STUDY

Abstract

Introduction/Background: Nurses are the predominant occupational healthcare group accountable for safe cytotoxic drug (CD) administration to patients. Nurses are at higher occupational risk of exposure to cytotoxic drugs, through direct and indirect contact. To date, there is no evidence of a safe level for CD exposure nor are there reliable methods for estimation of the occupational risk. Nevertheless, evidence suggests that safe handling guidelines and exposure control procedures are not regularly followed by nurses in clinical practice. There is a paucity of data on nurses’ experiences, attitudes and beliefs towards the use of health-protective measures, risk behaviour, and their perceptions of training and hospital support, especially in Saudi healthcare organisations. Aim: To explore nurses’ perceptions of occupational risk during CD administration in two hospitals in Saudi Arabia. Method: The exploratory study used Charmaz’s constructivist grounded theory. Thirteen nurses handling CDs were recruited initially through purposive sampling from two Saudi healthcare institutions. Purposive sampling was followed by a theoretical sampling of six nurses and five key stakeholders as well as a sampling of key policy documents. Key stakeholders included middle managers (safety, policy and clinical) and educators, Data was collected using in-depth face-to-face individual semi-structured interviews and also included policy document review. Data was analysed concurrently using a constant comparative analytical process. Findings: Four interrelated categories emerged that explained the nurses’ perceptions of occupational risk during CD handling and administration: 'Nurses’ preparation for practice', 'Experiences, perceptions and concerns of nurses caring for cancer patients', `Protection practice and exposure to CD' and 'Organisational factors perceived as influencing nurses’ occupational exposure to CD and personal protective equipment practice'. The study’s key finding was that most nurses lacked awareness, preparation and training for the CD handling role. They perceived cancer care as difficult and complex and were emotionally stressed by caring for cancer patients and by the CD handling responsibilities. These concerns led nurses to experience psychological and physical symptoms. Nurses in this study reported inadequate compliance with safe CD handling policies, mainly involving inadequate PPE use. Prolonged nursing shortages, shortages of safety equipment including PPE, and inadequate safety and occupational health systems, were core organisational factors that contributed to nurses’ poor PPE compliance and occupational exposure to CDs. Conclusion: Sufficient nursing workforce and protective resources are critical for safer working environments in the Saudi cultural context. A comprehensive safety system is essential for limiting nurses' occupational exposure to CD risks. A conceptual description of the socially constructed processes associated with nurses’ managing occupational risk in CD administration presented four main concept categories; i) individual/ personal factors, ii) organisational factors, iii) managing/ coping strategies and iv) consequences/ impact (psychological and physical), and define the relationship and context impact on the nurses' perceptions. These study findings may be relevant to nurses handling CDs in other Gulf countries and similar parts of the world.

Date of Award	1 Aug 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Moira Attree (Supervisor) & Hannah Cooke (Supervisor)