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Obstacles' And Facilitators Facing Safe Administration Of Chemotherapy by Oncology Nurses

Nagwa Ragab, Maha Shokier

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Aim of the study : This study aimed to determine obstacles' and facilitators facing safe administration of chemotherapy by oncology nursing staff .  

Material and methods : Study design: descriptive study design (qualitative) was  used . Setting: the study was conducted at Tanta cancer center  affiliated to Ministry of Health at El Garbeia Governorate Egypt. Sample: All (55) nurses working in oncology medical department at Tanta cancer center and administer chemotherapy. Tools: five tools  was used to conduct this study . Tool one :  Structured interview questionnaire: It was developed by the research after review of related literature. It was consisted of two parts : First part: Socio-demographic characteristics of  oncology nurses and Second part: Level of knowledge needed  about cytotoxic chemotherapy) by nurses .The total responses was summed up and classified into three levels,  high ,moderate &Low .  Tool Two Obstacles'  facing nurses for  safe administration of  hazardous  drug. It was  developed by the researchers in Arabic & consisted of 13  open ended questions.

Tool Three: : Modified Nurses attitude toward  safe administration of  hazardous drug  for cancer patients (chemotherapy) questionnaire  . It was adapted and translated into Arabic by the researchers. It was consisted of 18 items & included both positive and negative item statements  Tool Four: Modified Nurses anxiety and fear to administer  hazardous drug for cancer  patient questionnaires.It was adapted  and translated into Arabic by the researchers. It consists of 18 items, the responses were 4 response Statements .Total anxiety scores: divided into three levels high ,  moderate and low according to scores ..Tool Five : Facilitators' of safe administration of hazardous drugs (cytotoxic chemotherapy  : It was  developed by the researchers in Arabic after review of related literature. It consisted of 13  open ended questions.

Method : 1. Permission was obtained from head of  oncology department at main Tanta University Hospital .2. Ten experts in the field of oncology, five oncology experts affiliated to Faculty of Medicine Tanta University and five nurses revised the tool for content validity. 3. Each nurses interviewed individually and participated to fulfill the questions in the five tools. 4. Ethical considerations: Consent was obtained from nurses after explanation of the research study aims and content. Confidentiality of data was ensured using code number instead of their names and withdrawal from the study was reserved. 5. Pilot study  was carried out on 10% of the study sample 10 nurses  working in outpatient clinics and administer chemotherapy and not included in the sample to test tool feasibility and applicability and the required modification was done.  

Results :Oncology nurses age was  from 21-55 and  have years of experiences from 0-30 year and more than two third of them married with deplume of secondary school level of education with no training courses about safe chemotherapy administration. Obstacles' for safe chemotherapy administration as perceived by nurses working in oncology department and administer chemotherapy according to priority ranking related to patient and as well as nurses  were the first priority  while the last priority was related to hospital system of care delivery. Nurses attitude affect their behaviors to administer chemotherapy safely  since slightly more than half 52%  of nurses  working in oncology had positive attitude toward safe administration of chemotherapy needed high level of knowledge and  more than two third  76.36 % had moderate level of anxiety respectively and the more oncology nurses had positive attitude and  more than two third 70.9% expressed they are in need to  increased knowledge to be  at high level the more they feel higher anxiety level to administer chemotherapy safely .Also facilitators for according to priority ranking, environmental factors especially  quite wide space  with sufficient illumination were the first priority followed by time of the shift and the last priority facilitors was hospital system .

Conclusion and Recommendation Recommendations : Strategies to improve medication safety also need to be targeted at  specific multiple points in addition to oncology nurses attitudes and feelings toward safe chemotherapy administration which in respect shaping their behavior of cancer patients' care.

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