The purpose of this literature review research proposal is to estimate the efficacy of AOP, and close supervision which is provided by nursing schools and hospitals on the Needle Sticks Injuries [NSI’s] prevention among the nursing student population. Research has shown that the educational programme for prevention of NSI’s is crucial for the healthcare workers but it is rarely conducted and evaluated among vocational school nursing students. Bearing in mind the previous points, the review will be complemented by using methodology of a wide-ranging review of the related literature. That is to say, the effective appliance of the educational programme and close supervision might lead to prevent the NSI’s among the nursing student population.
To review critically and analyse literature on the effect of close supervision and academic orientation programme that are provided by schools and hospitals on the needle stick injuries among the nursing student population.
To evaluate the needlestick injuries among nursing students. Factors related to exposure, departments in which they work and high risk procedures causing most of these injuries.
To develop recommendations for practice based on the findings of this proposal review.
Framework for Proposal: Punch’s (2006) framework for developing research proposal was used as a structure for this proposal. Besides, punch stated that the proposal is a central and essential component to performing any research.
In recent years, there has been an increasing interest in strategies which might reduce the risk of exposure to blood-borne pathogens, including hepatitis B vaccination, clinical training, educational programmes, universal precautions and, most recently, needle-protective devices as stated by the Centers for Disease Control and Prevention [CDC] (2011). According to World Health Organisation [WHO] (2006), needle sticks injuries play a crucial role of blood born serious pathogens transmission among Healthcare Workers (HCW’s). ‘One single accident could is sufficient to produce a serious infection’ as stated by the CDC (2003). Furthermore, the main hazards of sharp injuries are viruses such as Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human immunodeficiency virus (HIV) (Yao et al., 2012). Remembered that, the first case of HIV transmission from patient to an HCW was reported in 1986 (Stricof & Morse, 1986, cited in Petrucci et al., 2009).
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According to RCN (2012) sharps injuries are preventable and learning following incidents should be put in place to avoid repeating accidents. Further analysis showed that, the majority of these, such as exposures sustained whilst handling needles or clearing clinical waste are preventable with adherence to procedures for the safe handling of sharps and the disposal of clinical waste (HPA, 2008). Yao et al (2010) reported that there are insufficient clinical experience and occupational safety training provided by nursing schools and hospitals, hence nursing students are at high-risk of needle stick injuries. However there are other studies shows that a combination of education, introducing a universal precautions to different hospital departments, especially emphasizing on the importance of needle recapping prohibition, and the use of sharp containers disposal containers have reduced NSIs by 80 % (Wilburn et al., 2004).
Another important finding report that the common clinical areas in which NSIs and sharps injuries occur include surgical departments and medical settings (Yao et al., 2010). Research has shown that, the majority of NSI’s (40%) occurs in the medical wards, intensive care units and operating rooms (Petrucci et al., 2009). In addition, the needlestick injuries were most commonly reported as occurring on wards and in patients’ rooms (Talas et al., 2009). It is clear from the above that, when injuries stratified by departments, the highest rate of needle stick injuries was seen in the surgery department. It might be said that the occurrence of needle stick injuries is significantly related to clinical practice behaviours.
Limited work experience with handling NSIs and insufficient awareness of occupational safety measures are reported in Chinese nursing students (Yao et al., 2010). That is to say, the probability of accidental exposure is reduced significantly with the increase of clinical skills during the clinical training period and the effective presence of tutors in clinical training education as stated by Petrucci (2009). Aslam et al (2010) stated that recapping the needle after use has been considered as the most frequent factors responsible for NSIs among health care workers. It must also be noted that, 42.5% of NSIs occurred when nursing students was working alone (Petrucci et al., 2009). A possible explanation for this is suggested by Talas et al (2009), that inadequate supervision in clinical practice areas causing NSIs.
It has been found that the NSI’s as high as 100,000 per year between 1997 and 2007 (Godfrey, 2001 cited in RCN, 2012). However, there were just fewer than 4,000 significant occupational exposure incidents reported to the Health Protection Agency (HPA, 2008). Nurses account for the highest percentage of percutaneous injuries (CDC, 2004, cited in Petrucci et al., 2009). According to NHS (2011) at least four UK healthcare workers are known to have died following occupationally-acquired HIV infection. This project will investigate the available literature with the aim of summarising, and evaluating current knowledge according to Machi and Mcevoy (2012). Incidentally, to explore the question with reference to different sample groups who are geographically spread. In general what this means, the study will have an international focus to help meet the diversity consideration.
Current/Preliminary literature review:
To recognise how this study fits with the existing body of knowledge on the subject, a literature search was carried out using a number of databases including PubMed were searched. In addition, CDC website was hand searched as it is a key website related to the evaluation topic.
Although most of NSI’s research focused on HCW’s students, nursing students in hospital clinical practice are also at high risk of exposure. Also, most of investigation that examined NSI’s in students populations generally studied medical and dental students rather that nursing students (Aslam et al., 2010; Zafar et al., 2009; Valls et al., 2007 and Sharma et al., 2010).
As a result, the information related to nursing students’ NSI’s is relatively lacking worldwide. However, plentiful studies have been carried out in recent years all aimed at understanding the factors which are related the needlestick injuries among nursing students in order to produce an effective preventable measure which should be implemented early in nursing students’ education (Talas et al., 2009; Yang et al., 2007; Yao et al., 2010; Hambridge et al., 2011; Yao et al., 2012 and Petrucci et al., 2009). Consequently, the most crucial point made so far is how are the Academic Orientation Programme (AOP), and close supervision of needle stick injury prevention among the nursing student population?
According to Aveyard (2010) a literature review is a comprehensive study and interpretation of current literature in relation to an exact topic. It involves the identification of a research question and aims to answer said question via searching and analysing relevant literature in a systematic approach. Aveyard (2010) also argues that a literature has even more validity if reviewed in relation to other literature available on the same topic. The researcher deems the use of a literature review for the purpose of this study appropriately as the study aims to examine various current literatures, interpret and summarize them, infer new ideas and present gotten ideas in a methodical and well-established manner.
In order to address the research question ‘how effective are the Academic Orientation Programme (AOP), and close supervision of needle stick injuries prevention among the nursing student population?’. This study review will be from both qualitative and quantitative traditions. The reason for selecting a qualitative approach was that it was felt that more detailed explanation by nursing students would provide more depth to the investigation. This investigation was based on secondary research due to the fact that a rich body of data already existed and further analysis could offer insight. On the other hand, using of quantitative tradition could highlight some statistical analysis.
A number of research studies have been undertaken to discuss the needlestick injuries among the nursing student population. Yao et al., (2012) reported that the appliance of safety training and educational programmes consider a need for nursing students before they start clinical practice. Research has shown that, the adequate presence of tutors in the clinical training education and simulation laboratories for nursing practice that could enable nursing students to gain a remarkable experience by doing procedures and then observing their impact without compromising the health and safety of human patients (Petrucci et al., 2009). However, few studies have included nursing students; some studies survey the attitude of nursing students towards needle sticks and sharp injuries in different workplace. Data into the reasons why nursing students are vulnerable to needle stick injuries was collected from three main sources. Sources were found via an electronic database and were articles which focused on different primary studies undertaken in 2010, 2009 and 2008. The first stage of the investigation involved analysing the three sources and comparing them to see if there were clear themes common to all three.
According to Punch (2006) the method section is the specific data collection and analysis procedure that defines how the data will be collected and processed to answer the research question. This refers to that the proposal should demonstrate an internal validity. Here, this means that the chosen methods should match the written question (Punch, 2006). Furthermore, a review must be carried out, systematically, thoroughly and comprehensively to enable the production of valid results which in turn relates to conclusions (Aveyard, 2010). Method section is significant to evade collection of data unrelated to the study as stated by Hart (1998). To ensure this, a systemic search strategy would be developed involving the use of electronic searches, hand searches and reference list searches as suggested by Aveyard (2010).
Sample and data collection method:
According to Aveyard (2010) using of inclusion and exclusion criteria will frame and narrowing of literature and certain significance of data to the study. In addition the using of inclusion and exclusion criteria enable the researcher to demonstrate the scope of detail of the review that would not demonstrated in the review question itself (Aveyard, 2010). Unpublished
Example of inclusion criteria:
Primary research relating to needlestick injuries among the nursing student population.
Literature focused on the needlestick injuries among nursing students during their clinical practice in hospitals.
English language literature only.
Published literature only.
Example of exclusion criteria:
Literature discussed the needlestick injuries among health care workers or medical, dentist students only rather than nursing students.
None ethically approved and conducted studies, to ensure validity of the study.
The PICO framework, as set out below, was used to define the search strategy:
Population – Nursing students from different area of practice.
Intervention – Academic Orientation Programmes and close supervision which provided by nursing schools and hospitals.
Comparison – Nursing students have been received or have not been received effective academic orientation programme and close supervision, and their perception toward needle sticks injuries preventive methods.
Outcome – Prevention or avoiding the NSI’s by insuring that nursing students have received the necessary preventive measures without fail.
For effective data collection method, the identification of key terms and using a Boolean logical operators such as (OR, NOT and AND), Wildcards (?) And Truncations (*) are essential for obtaining the maximum number of relevant data on the research topic (MACHI and McEVOY 2012). The restriction was put on the year of publication, studies have been done after 2007 and only English language articles were included. Appendix 1 and 2 in the appendices gives an illustration of search terms using BOOLEEN operators, wildcards and truncations to connect the keywords.
Access to data/sample:
According to Aveyard (2010) the using of academic search engines could be more specific than a general search engine electronic searching, they allow the researcher to do advance searching using different combination of words and have direct access to academic journals and e-books. In addition,
To effectively carry out this study, data collection will be from different sources. Data will be accessed mainly via the Oxford Brookes University available databases. These databases are;
PUBMED: An extensive medical, biomedical and nursing database.
CINAHL (Cumulative Index to Nursing and Allied Health literature)
MEDLINE (Connecting through Ebsco, Web of knowledge or PubMed)
In addition, academic literature references throughout Google Scholar, E-journals and books from the university library as well as the John Radcliffe hospital library would be searched for the purpose of this study. This is to ensure a level of credibility in the data being used for the study.
Data analysis method:
This stage involves the critical appraisal and analysis of the data has been collected. One set of tools has been produced by the Critical Appraisal Skills Programme (CASP, 2011). Also, CASP has published critical appraisal tools for review articles, quantitative studies, RCTs, cohort and case control studies (Aveyard, 2010). The benefit of using a critical appraisal tool rather than using an unstructured approach in relation to the research question deems the use of a CASP tool appropriate. This is due to the fact that all of the appraisal tools listed, the CASP tool is the most diverse. According to the University of South Australia division of Health Sciences (2011) it could be used in critically analysing different kinds of studies (RCT, Case Control Study, Systemic Review, and Qualitative Study). Furthermore, it provides a checklist for the researcher in relation to the type of study being conducted which enables checking for biases and confounding variables so that it has no effect on the analysed result (,). The CASP tool for systematic reviews would thus be utilised in the critical analysis of data for the study.
According to Aveyard (2010) to determine the relevance of each selected paper, researcher could use 3 fundamental questions:
Is this literature relevant to my review?
Have I identified literature at the top of my hierarchy of evidence?
Is this literature of high enough quality to include in my review?
Whilst this helps the novice researcher the data will require testing with a validated critical appraisal tool. This will be the Critical Appraisal Skill Programme tools (CASP) a recognised framework for critical assessment, developed by the Public Health Research Unit at Oxford University. This department is now under the direction of Solutions for Public Health (SPH, 2011).
To advance credibility to my research I will explore the concept of triangulation (Holtzhausen, 2001) in my analysis. Furthermore, by following triangulation as a multi-method research approach, the literature review sits well with the triangulation concept of using more than one method or source of data to study social phenomena. This idea supports the process of cross checking findings that is derived from both qualitative and quantitative research and exploring any comparisons that appear adding rigour to the findings. According to Aveyard (2010) looking for similarities and disparity is important in the synthesis of the research. Also, comparing and contrasting outcomes that encompass negative and positive results will be discussed to illustrate the depth and variety of data reviewed.
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Given that the proposed methodology for this research is a literature review, ethical approval is not a prerequisite as stated by Aveyard (2010). According to Houghton et al (2010) the ethical issues are present in any kind of research; have to be considered when undertaking qualitative research. This is due to the fact that literature reviews are grounded solely on critically analysing and estimating primary research carried out by other researchers, hence there is no direct contact between the researcher and participants. In addition there are no primary data to be collected. Though, it is significant to recognise the mechanisms for granting such approvals as the outcome may lead to further research.
As a reviewer of research and a qualified nurse I am accountable to ensure that any research reviewed had been handled ethically. Guiding ethical principles to consider in health care are; Non-malfeasance, Beneficence, respect for autonomy, informed consent, honesty and integrity, and the need to maintain confidentiality and anonymity. Awareness of all others research I am responsible for portraying other work fairly and objectively whilst acknowledgment by referencing, all materials discussed.
According to Vickers (1995) literature reviews should be subject to the same standards of scientific rigour as primary research. In other words, the process of extracting information from the published scientific data should it be scientific. In addition, Vikers (1995) further explains that two major characteristics of a well conducted study are transparency; meaning that the reasons for any conclusions written by the researcher are made explicit, and replicability; which implies that the research if carried out by the reader produces the same results. Therefore, in carrying out this study the researcher will ensure transparency and replicability by ensuring the collection, appraisal and analysis of data as well as representation of findings are comprehensive, thorough and systematic.
Resources will be limited with no financial support. Additional finance might have enabled you to employ the assistance of other researchers who would have aided you in the search, critique and bringing together of the literature (Aveyard, 2010). Seeking out grey literature will be time consuming. In contrast, Aveyard (2010) stated that the using of only published data could bias the result of the review. However, the amount of data available could be overwhelming for the novice and must be planned with care to avoid this happening. Punch (2006) stated that the delimitation means defining the limits of our drawing the boundaries around a study, and showing clearly what is and is not included. This is sometimes useful in avoiding misunderstanding by the reader. As a novice researcher the approach to the identification, critique and bringing together of the literature may not have been as thorough as that of a more experienced researcher (Aveyard, 2010).
In any research, limitations should be expected. Thus, it is essential for a researcher to acknowledge anticipated limitations of a study (Punch, 2006).
Some of the potential limitations of this study include;
Inability to access data: As some databases are only accessible by members of a particular group or association. This may result in finding a limited amount of data that suit the purpose of the study which could in turn lead to bias. The researcher will endeavour to avoid this by going an extra length to access such databases including signing up to such groups or associations where possible.
The inexperience of the researcher: This may result in discrepancies in the collection and critical analysis of data.
The project time scale: This study is set to take place within a 12 month period and this may serve as a constraint.
This table outlines the project management plan (Time frame). It’s anticipated that the study will take over 12 months, table below show how I will carry out the project over the coming months.
Recommendations for practice:
As a result of the present study, the following are recommended:
Design more intensive education program directed at all nursing student populations to increase their awareness of and compliance with universal precautions and in instituting polices.
Ensure that all nursing students are fully immunised against hepatitis B before they begin clinical practice.
Eliminate “unnecessary needles” from the hospital environment wherever possible and replace with safer products through implementation of industrial research for the development of new technologies that could improve working conditions and reduce the risk of occupational diseases in health care settings.
Activate the tutor’s role in providing a high quality of monitoring and presence during clinical training education.
The purpose of this study is to identify the effectiveness of the Academic Orientation Programme (AOP), and close supervision on needle stick injuries prevention among the nursing student population. Dissemination of the results is what makes the project valuable, dependent on the findings it is anticipated that the outcomes will support improvements in practice. As the outcome is intended as a resource for my department it is anticipated that the dissertation be communicated as a presentation. Therefore, for the findings of this study to have an effective impact, widespread distribution is important. The researcher proposes dissemination would be done via peer reviewed journals, seminar presentation to colleagues and members of staff of the Oxford Brookes University and via the internet for further education of the general public. Also, copies would be made available in the Oxford Brookes University library for students and other prospective researchers.
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