A modeling analysis of nurses’ use of hazardous drug safe handling precautions

• Main Authors: Ying-Siou Lin, 林盈秀
• Other Authors: 羅美芳
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/m8bt8b

博士 === 國立臺灣大學 === 護理學研究所 === 107 === Background. Research demonstrates that the nurses’ perceptions regarding workplace safety climate and perception to personal protective equipment use are common factors affecting their compliance with safety precautions. However, to date, no study has empirically examined a structural model to identify the factors related to nurses’ compliance with hazardous drug (HD) safe handling precautions. In this study, we aim to verify whether the ability of predict variables to explain and predict nurses’ compliance with HD safe handling precautions by using partial least squares structural equation modeling (PLS-SEM); the results provide recommendations for nursing clinical practice, education, research, and policy. Aims. This study aims to explore the relationship among nurses’ perception of the workplace safety climate, personal factors, the workplace background, and nurses’ behavior in complying with HD safe handling precautions during the intravenous administration and disconnection of HDs by PLS-SEM. Methods. This study included a cross-sectional survey of nurses recruited in the northern, northwestern, and south-central branches of a university medical system in Taiwan, in which 484 (of 506) self-administrated questionnaires were returned by respondents (response rate, 95.7%). Each participant was asked to complete the structured questionnaire developed by the author. It comprises the following four main parts: nurses’ perception of the workplace safety climate, personal factors, the workplace background, and nurses’ behavior regarding their compliance with HD safe handling precautions during the intravenous administration and disconnection of HDs. The data (N = 484) were randomly split into two groups, one group (N = 237) for exploratory factor analysis, and the other (N = 247) for confirmatory factor analysis. The exploratory factor analysis resulted in seven factors related to the workplace safety climate, and the result of the confirmatory factor analysis verified the acceptability of the model. The seven factors, with 31 items of the workplace safety climate, were “Clinical Care Situation,” “Colleagues Remind Each Other,” “Creation of a Safe Working Environment by the Head Nurse.,” “Creation of a Safe Working Environment by the Organization Manager,” “Ease of Use of Personal Protective Equipment,” “Perception of Comfortable Level of the Workplace,”and “Perception of Comfortable Level of Use of Personal Protective Equipment.” We used the samples (N = 247) for confirmatory factor analysis to verify the model by PLS-SEM 3.2.8. Result. The descriptive statistical results showed that nurses recorded the highest score for the “Creation of a Safe Working Environment by the Organization Manager” (Mean ± SD: 4.58 ± 0.52) of workplace safety climate and lowest for “Perception of Comfortable Level of Use of Personal Protective Equipment” (Mean ± SD: 3.24 ± 1.03). The mean frequency of the nurses’ compliance with HD safe handling precautions during intravenous administration (Mean ± SD: 4.25 ± 0.84) was higher than that during the disconnection of HDs (Mean ± SD: 2.92 ± 1.22). The PLS-SEM analyses revealed that workplace safety climate can explain 29.3% of the variance in nurses’ behavior regarding their compliance with HD safe handling precautions during intravenous administration and 30.5% of the variance during the disconnection of HDs. In addition, workplace safety climate can predict the outcome variable, and the results showed an acceptable model fit. Among the aforementioned variables, the “Clinical Care Situation,” “Colleagues Remind Each Other,” “Ease of Use of Personal Protective Equipment,” and “Perception of Comfortable Level of Use of Personal Protective Equipment” of workplace safety climate were significantly associated with nurses’ behavior regarding their compliance with HD safe handling precautions. We added nurses’ personal factors and the workplace background in the model; the result showed that nurses’ years of experience in administering chemotherapy, familiarity with the policy and procedure for the safe handling of HDs, and chemotherapy workload may significantly affect nurses’ behavior regarding their compliance with HD safe handling precautions during intravenous administration. Suggestions. We suggest that managers of hospitals and researchers should design interventions according to the “Clinical Care Situation,” “Colleagues Remind Each Other,” “Ease of Use of Personal Protective Equipment,” and “Perception of Comfortable Level of Use of Personal Protective Equipment” of workplace safety climate, such as enhancing nurses’ awareness of the importance of personal protective equipment use, creating opportunities for nurses to share with peers their opinions regarding the safe handling of HDs, and purchasing personal protective equipments that are easy to use and comfortable to wear and placing them at optimal locations for easy access. To increase nurses’ frequency of adherence to the HD safe handling precautions, we suggest that hospital managers should provide multifaceted learning resources, update the skills checklist, and invite nurses who are highly experienced in HD handling to conduct regular audits.