ONS Connect - August 2008 - (Page 7)

EDITOR’SNOTE Why Do Nurses Resist Safe-Handling Behaviors? [By Debra M. Wujcik, RN, PhD, AOCN®, Editor] S Debra M. Wujcik, RN, PhD, AOCN ®, Editor Perhaps it is time to adopt the same approaches we use to change patient behaviors to change our own. afe handling of antineoplastic drugs has been a concern for oncology nurses for more than three decades. Guidelines for safe mixing and administration have been established, yet exposure and threshold limits have yet to be defined. Nurses resist wearing personal protective equipment (PPE), and safe practice behaviors remain inconsistent (Gabrell & Moore, 2006). Perhaps it is time to adopt the same approaches we use to change patient behaviors to change our own. The Health Belief Model (HBM) attempts to explain and predict health behaviors by focusing on the attitudes and beliefs of individuals (Glanz, Rimer, & Lewis, 2002). The HBM is based on the understanding that people will take health-related action if they feel that a negative health condition can be avoided and if they have a positive expectation that they can successfully take a recommended action to avoid the negative condition. The original model included four constructs—perceived susceptibility, severity, benefits, and barriers—which combine to determine a readiness to act. Another construct, self efficacy, was added later to describe a person’s confidence in the ability to successfully perform the action. The HBM may give insight to the issue of nurses’ compliance with safe handling of antineoplastic drugs. To demonstrate the desired behavior, nurses must believe that adverse reproductive outcomes resulting from exposure to chemotherapy drugs (i.e., the negative health condition) can be avoided by wearing PPE (i.e., taking a recommended action) and that PPE are easily accessible and do not interfere with care delivery (i.e., nurses can successfully take the recommended action). If adverse reproductive outcomes are the documented outcomes, do nurses perceive susceptibility or risk of the outcome and is the severity serious enough to cause a behavioral change? Do the barriers of inconvenience, expense, and accessibility outweigh the benefits of minimizing personal and environmental exposure? This month’s feature article by Contributing Editor Hanan SacaHazboun, RN, MSN, describes two institutions with effective guidelines to minimize exposure. We also heard from many nurses who had concerns about the lack of PPE and guidelines in their work settings and had questions regarding safe handling. I suggest that we apply theoretical models to the problem of safe handling. We must empower nurses with knowledge of the risk associated with chemotherapy exposure and the actions to decrease or eliminate the negative outcome. Our challenge is to identify and diminish the barriers to safe handling and ensure that personal and environmental benefits are well documented. ✱ Gabrell, J., & Moore, S. (2006). Assessing workplace compliance with handling of antineoplastic agents. Clinical Journal of Oncology Nursing, 10(4), 473–476. Glanz, K., Rimer, B.K., & Lewis, F.M. (2002). Health behavior and health education. Theory, research and practice. San Francisco: Wiley and Sons. August 2008 ONS CONNECT 7

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ONS Connect - August 2008 Contents Editor's Note Just In Safe Handling of Chemotherapy A Year in the Life—Month Eight Put Evidence Into Practice to Manage Dyspnea Web Connect Capitol Connection Notice Nursing Now Caregiver Care KRAS Status Predicts Response to Cetuximab for Metastatic Colorectal Cancer Calendar of Events Working for You Staying on Top

ONS Connect - August 2008

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