Effectiveness of structured education on safe handling and disposal of chemotherapeutic drugs among nursing students

Angel R G et al / Int. J. of Pharmacology and Clin. Res. Vol-1(1) 2017 [15-18]
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IJPCR |Volume 1 | Issue 1 | Jan – Jun- 2017
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Research Article Clinical Research
Effectiveness of structured education on safe handling and disposal of
chemotherapeutic drugs among nursing students
*Angel Rajakumari.G1
, Soli.T.K2
1
Professor, Department of obstetrics and Gynecology, Annai Dora College of Nursing, Aundipatty, Tamilnadu,
India.
2
Staff Nurse, King Saud Hospital, KSA
*Correspondence Author: Angel Rajakumari. G
E-mail: angu318@gmail.com
ABSTRACT
Aim
To evaluate the effectiveness of structured education on safe handling and disposal of chemotherapeutic drugs among nursing
students
Participants and setting
A pre-experimental one group pre-test – post-test design was adopted for this study. The study was conducted in Vandhana
school of Nursing, Kodhad, telugana, India. The investigator selected 40 nursing students who fulfilled the inclusion criteria
were selected by using simple random sampling technique.
Intervention
Data was collected regarding demographic variable, knowledge and attitude of the diploma in nursing students on safe
handling and disposal of chemotherapeutic drugs.The investigator assessed the level of knowledge and attitude of the
diploma in nursing students by using structured questionnaire and modified three point Likert Scale and by using checklist
through one to one teaching by lecture, demonstration, video clippings and verbalization. Structured teaching programme was
conducted on the same day on group wise each group consists of 17members. Data collection was done in English the
questionnaire was distributed to each nursing students. At the end of the teaching the doubts were cleared. Then 10 minutes
was allotted for discussion.
Measurement and findings
The analysis finding indicates clearly that 36% of students had inadequate knowledge and 46% of them had negative attitude
regarding safe handling and disposal of chemotherapeutic drugs. A well planned structured teaching programme given to the
same group. The effectiveness of programme showed high level of significant at p<0.001 level. It showed that structured
teaching programme was an effective method to improve the knowledge and attitude.
Conclusion
The pharmacist-based interventions improved the knowledge of nursing students in cytotoxic drug handling. Further
assessment may help to confirm the sustainability of the improved practices.
Keywords: Knowledge, Attitude, Effectiveness, Chemotherapeutic Drugs, Nursing students
ISSN:2521-2206
International Journal of Pharmacology and
Clinical Research (IJPCR)

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INTRODUCTION
Cancer therapy is broadly based upon the use
chemotherapeutic drugs with strong anti-cancer
cytotoxic effects. Their widespread use has led to
concerns about the hazards that they can cause among
hospital personnel involved in their use, as besides
cancer cells these agents can also affect normal cells
causing them important damages. In order to minimize
occupational exposure to chemotherapeutic cytotoxic
drugs, special department design and equipment are
necessary as well as personal protective measures and
safety practices during all procedures involving the use of
these agents, such as transportation and storage,
preparation and reconstitution, administration and care of
patients and finally disposal. [1] The toxic effects of
anticancer chemotherapy are well known to oncology
specialists and to primary care clinicians. Awareness of
these effects typically influences treatment plans for
patients undergoing cancer therapy to prevent or mitigate
adverse outcomes. However, beyond the patient safety
concerns arising from the necessary therapeutic use of
these drugs, occupational risks to health care workers
handling these drugs in the course of their duties still need
to be fully addressed. [2] Worldwide, more than 11
million new cases of cancer are diagnosed each year, and
that number is expected to rise to 16 million by 2020.In
the United States, the American Cancer Society (ACS)
predicts that almost 1.4 million new cancer cases will be
diagnosed in 2006. The National Cancer Institute predicts
that this figure will double by the year 2050 because the
US population is growing and aging. This increased
patient load, along with the use of high-dose
chemotherapy, combinations of several drugs, and the use
of antineoplastic drugs for diseases other than cancer, will
increase the potential for exposure of the health care
worker to these drugs. [3] For the past 3 decades,
treatment for many of these cancer cases has relied
principally on anticancer chemotherapy. The first such
agent, sulphur mustard gas, was observed to cause
changes in bone marrow of World War I veterans who
were hospitalized many years later. This led to its
evaluation as an anticancer agent, and the related, but less
toxic, nitrogen mustards were later demonstrated to
produce tumour regression in lymphoma patients. With
approximately 100 different antineoplastic drugs now in
use and many more under development, drugs used to
treat cancer have opened new avenues, from improving
the quality of life of patients with cancer to a complete
cure. Addressing these drugs' formidable toxicity profile,
however, has been an ongoing campaign for clinicians
and, more recently, for the occupational health
community. [4] Nurses must be aware of the safe handling
of the chemotherapeutics, its classification, its action on
cells and the safe handling and disposal to prevent the
hazards. They must be conscious about their on health. [5]
In response to reports of measurable air levels of
antineoplastic agents in hospitals and preliminary
evidence of exposure to personnel handling these agents,
a survey was designed and conducted to document the
current handling practices of injectable antineoplastic
drugs by hospital and health care workers at two major
teaching hospitals and three affiliated community
hospitals. The survey included assessment of drug
preparation, administration, and disposal. A sample of
nurses, pharmacists, physicians, and other staff who
routinely come in contact with these drugs was
interviewed for validation of the observed results. Drug
preparation facilities and methods were not uniform even
within a single institution, including local preparation in
the pharmacy under controlled or uncontrolled conditions,
as well as individual drug preparation and administration
on the hospital floors. Handling practices for drug
preparation were not consistent from practitioner to
practitioner. In some cases, where laboratory coats and
disposable gloves were provided, it was not a routine
practice to wear them. Based on such analysis of risk
factors, recommendations for improved practices are
given.7
MATERIALS AND METHODS
The study investigated 40 adolescent nursing
students in the City of kodhad, Telugana. Their
understanding of the English language used in the
questionnaire. A twenty-five statements questionnaire
on their knowledge of safe handling and disposal of
chemotherapeutic drugs was administered for their
responses. Permission to administer the questionnaire
was sought from the Senior Management of the
institution. Following their consent, the questionnaire
was administered after briefing participants that the
questionnaire was to find out how much they knew
about safe handling and disposal of chemotherapeutic
drugs and their participation was subject to their
agreeing to participate. Frequency and percentage
distribution was used to analyze the demographic data
of school students. Mean and standard deviation was
used to complete the knowledge and attitude of safe
handling and disposal of chemotherapeutic drugs of
school students. Paired’ test was used to analyze the
effectiveness between the pre and posttest. Chi-square

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test was used to associate the demographic variables
with knowledge and attitude of safe handling and
disposal of chemotherapeutic drugs among nursing
students. Correlation co-efficient was to analyze the
correlation between knowledge and attitude of safe
handling and disposal of chemotherapeutic drugs
among nursing students.
Description of research tool
It consists of three sections.
Section A
It consists of demographic variables which include
age of the individual, religion, education, type of
family, previous exposure to knowledge.
Section B
Multiple choice questions to assess the knowledge
of safe handling and disposal of chemotherapeutic
drugs
Part I: Questions related to safe handling and disposal
of chemotherapeutic drugs.
Section C
Modified three point Likert scale to assess the
attitude regarding safe handling and disposal of
chemotherapeutic drugs. This section includes 10 items
with choices as agree, uncertain and disagree.
RESULTS
Table 1: Mean and standard deviation of knowledge and attitude on of safe handling and disposal of
chemotherapeutic drugs nursing students
N=40
Domain Pre test Post test ‘t’ value
Mean S.D Mean S.D
Knowledge 6.78 1.241 19.11 1.23 44.63*** (S)
Attitude 11.48 1.29 11.48 1.29 3.523*** (S)
*p<0.05, **p<0.01, ***p<0.001, S – Significant
Table 1 denotes the mean and standard deviation of
knowledge and attitude of nursing students on safe
handling and disposal of chemotherapeutic drugs.
Observing the pre-test level of mean knowledge score
was 6.78 with S.D 1.241 and post-test level of mean
knowledge score was 19.11 with S.D 1.23 and the ‘t’
value of 44.63 showed high level of significance. With
respect to the pre-test mean attitude score was 11.48
with S.D 1.29 and post-test mean attitude score was
11.48 with S.D 1.29 and the ‘t’ value of 3.523 showed
high level of significance.
0
10
20
Pretest Posttest
7.68
20.21
10.48 15.38
Percentage
Fig 1: Mean score of pre and post test level of
knowledge and attitude of nursing students
Knowledge
Attitude

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Table 2: Correlation of pre and post-test level of knowledge and attitude on safe handling and disposal of
chemotherapeutic drugs of nursing students
N=40
Domain Knowledge Attitude ‘r’ value
Mean S.D Mean S.D
Pre test 6.78 1.241 11.48 1.29 0.66*
Post test 19.11 1.23 11.48 1.29 0.57***
*p<0.05, ***p<0.001
Table 2 shows the correlation of pre and post-test
level of knowledge and attitude on safe handling and
disposal of chemotherapeutic drugs of nursing students
mean score was 6.78 with S.D 1.241, the attitude mean
11.48 with S.D 1.29 and overall ‘r’ value was 0.66
which significant The analysis reveals that the pre-test
level of knowledge at p<0.05 level. The post-test level
of knowledge mean score was 19.11 with S.D 1.23 the
attitude mean 11.48 with S.D 1.29 clearly indicates a
positive correlation between knowledge and attitude (r
= 0.57) which is significant at p<0.001 level.
DISSCUSION
Table 1 denotes the mean and standard deviation of
knowledge and attitude of nursing students on safe
handling and disposal of chemotherapeutic drugs.
Observing the pre-test level of mean knowledge score
was 6.78 with S.D 1.241 and post-test level of mean
knowledge score was 19.11 with S.D 1.23 and the ‘t’
value of 44.63 showed high level of significance. With
respect to the pre-test mean attitude score was 11.48
with S.D 1.29 and post-test mean attitude score was
11.48 with S.D 1.29 and the ‘t’ value of 3.523 showed
high level of significance. 2 shows the correlation of
pre and post-test level of knowledge and attitude on
safe handling and disposal of chemotherapeutic drugs
of nursing students mean score was 6.78 with S.D
1.241, the attitude mean 11.48 with S.D 1.29 and
overall ‘r’ value was 0.66 which significant The
analysis reveals that the pre-test level of knowledge at
p<0.05 level. The post-test level of knowledge mean
score was 19.11 with S.D 1.23 the attitude mean 11.48
with S.D 1.29 clearly indicates a positive correlation
between knowledge and attitude (r = 0.57) which is
significant at p<0.001 level.
CONCLUSION
The results of this study indicate a significant
improvement of knowledge among nursing students
handling cytotoxic anticancer drugs after a series of
interventions. Pharmacists, with the knowledge on the
nature and potential hazards of cytotoxic drugs, play an
important role to improve the nurses’ capability to
handle these drugs safely. The centralization of
cytotoxic drug reconstitution (CDR) activities is a
crucial strategy to minimize the improper drug
handling in wards. On top of that, sufficient education
and training as well as hospital policy are effective
tools to improve the safety climate in a hospital
catering chemotherapy actively.
REFERENCES
[1]. Constantinidis T, Vagka, Pullidow, et al. Occupation health and safety of person handling chemotherapeutic agents.
European jnl of cancer care 20(1), 2001, 123-31.
[2]. Conoor T H, Melissa A. Safe handling of antineoplastic agents. Cancer j clncs 56(6), 2006, 54-365.
[3]. Cabner B, Allegra C J, Curt G, et al. Anteneoplastic agents, the pharmacological basis of therapeutics. New York: Mc
Graw Hill:: p. 9, 1996, 1233-87.
[4]. Womer RB, Tracy E, Soo-Hoo W, Bickert B, DiTaranto S, Barnsteiner JH. Multidisciplinary systems approach to
chemotherapy safety: rebuilding processes and holding the gains. J Clin Oncol 20, 2002, 4705–12.
[5]. Mike Parker. What is the role of oncology nurse? [online] available from: 2010
[6]. Villarini M, Dominici L, Piccininni R. Assessment of primary oxidative and excision repaired DNA damage in hospital
personnel handling antineoplastic drugs.Mmutagenesis 26(3), 2011, 359-69.
[7]. Jeanne M, Barbara M, Robert M. Assessment of potential exposure to antineoplastic agents in health care settings.
Amrcn society of prvntve oncl 20(3), 2004, 143-50.

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Effectiveness of structured education on safe handling and disposal of chemotherapeutic drugs among nursing students