The Impact Of Nurses Knowledge On Chemotherapy Administration Nursing Essay

This chapter deals with the related literature review which aids to generate a picture of what is known and not known about a particular situation.

According to Geri LoBiondo-Wood et al (2006)13, Review of literature is an organized critique of important scholarly literature which supports a study and a key step in research process.

An extensive review of literature was done by the investigator to gain an insight into the problem, collect maximum information from systematic and critical review of scholarly publications and unpublished scholarly print materials. The logical sequence of the chapter is organized in the following sections:


SECTION –A : Reviews related to the Chemotherapy administration safety standard protocol and practices.

SECTION–B : Reviews related to the impact of nurses knowledge on chemotherapy administration.

SECTION–C : Reviews related to Chemotherapy administration errors.

SECTION–D : Reviews related to the awareness programme towards handling of chemotherapy.


Jacobson, J.O., et al., (2012) 45 conducted a prospective study on revision to the chemotherapy administration safety standards, given in 2009, by the American Society of Clinical Oncology (ASCO) / Oncology Nursing Society (ONS), by expanding the scope to include the safety standard component in in-patients settings. The ASCO and ONS members reviewed the standards in inpatient and outpatient setting with adult cancer patients. In January 2011, ASCO and ONS members were convened to review feedback received since publication of the standards. This change reflects the conviction that the same standard for chemotherapy administration safety should apply in all settings.

Ashley, L., et al., (2011)36 conducted a prospective study on systems-focused clinical risk assessment among 8 nurse lead multi-disciplinary teams for improving the standard of chemotherapy administration in large urban hospitals in United Kingdom. It aims to identify and generate remedial structure to counteract errors occurring during chemotherapy administration. The process outcome revealed that nurses collectively improved the procedure of chemotherapy administration.

Nirenberg, A., et al., (2010)58 conducted a descriptive survey to describe oncology nurses use of National Comprehensive Cancer Network Clinical Practice Guidelines for chemotherapy induced neutropenia and febrile neutropenia among 309 Oncology Nursing Society members. The findings gave an insight into workplace barriers to evidence based practices in various settings.

Mahon, S. M., et al., (2009)51 conducted a descriptive study in St. Louis University Hospital to describe how 103 nurses from a local Oncology Nursing Society implemented Occupational Safety and Health Administration Guidelines for handling cytotoxic drugs in their individual practices and to identity barriers to implementing these guidelines. In sum, barriers must be overcome and better safe handling practices incorporated to ensure the safety of nurses.

Opfer, K. B., et al., (2008)59 conducted a descriptive study for developing implementing and documenting chemotherapy orders for patients in the acute-care setting in selected hospitals at Chicago. The result showed that standardized approach dramatically improved ordering, dispensing, and administration chemotherapy. Along with that multidisciplinary verification and documentation of dose and schedule, helped to reduce chemotherapy-related errors.

Manias, E., et al., (2007)52 conducted a prospective study to determine how graduate nurses use protocols in their medication management activities. Twelve graduate nurses involved in direct patient care from a metropolitan teaching hospital are participated in the study. The result of the study showed that graduate nurses adhere to protocols if they felt encouraged to make their own decision and if there was a decreased likelihood that disciplinary actions would be involved.

Bru, G. (2004)39 conducted a prospective study on revised standards set by the Association Of Pediatric Nurses (APON) ; the standards of practice were revised in the process outcome. Six standards referred to direct care of patient than family, direct care of child and family and a final standard referred to the nurse’s professional responsibility to maintain expertise as a specialist or competency as a generalist.


Gibson, F., et al., (2012)44 conducted a descriptive study to explore the knowledge, attitude and beliefs of nurses who administer chemotherapy to children and young people, 286 nurses were the samples of study. The study showed that nurses new to chemotherapy administration were initially anxious about their role and due to their anxious state makes drug error. Education and support from colleagues appears to have had a positive effect on reducing worry and increasing competence.

Polovich, M., & Clark, P. C., (2012)61 conducted a cross-sectional study, among 165 nurses who were reported handling chemotherapy in oncology centers across the United States using mailed survey method, to examine relationship among factors affecting nurses use of hazardous drugs, safe-handling precautions, identify the factors that promote over interfere with the hazardous drug precaution use and determine managers perspective on the use of hazardous drug safe handling precaution. The result showed that circumstances in the work place interfere with the nurses to use precaution during drug preparation.

Brown, C. G., et al., (2010)38 conducted a prospective study to assess the value of oncology nursing certification. A total of 940 Oncology nurses participated and completed a demographic survey and the perceived value of certification tool. Most were Caucasian women. 36% were staff nurses.19% were nurse managers and 10% were advance practice nurses. A high value of certification was reported. Both certified and non-certified nurse’s valued certification. Increasing institutional reorganization and financial support could improve nurses’ certification rates and ultimately result in improved patient care.

Creaton, E. M., et al., (2009)40 conducted a descriptive study among the inpatient oncology staff of St Elisabeth’s hospital in Boston. The programme consist of theoretical and practical component in which in-patient oncology nursing staffs were highly motivated to expand their knowledge base for cancer patient care and expressed interest in chemotherapy administration.

Verity, R., et al., (2008)72 conducted a descriptive study to explore the work of nurses who administer chemotherapy. The study was conducted across 26 London hospitals providing cancer services.244 nurses were the study participants, the findings highlighted the value of formal educational preparation in chemotherapy prior to undertaking the aspect of nursing. The result reinforced that co ordinated education and training strategy for chemotherapy practice is warranted to underpin safe and effective practice in this area.

Kosgeroglu, N., et al., (2008)50 conducted a descriptive study among 121 Turkish nurses, to determine both the level of information that nurses possessed and the method of administration nurses used during chemotherapeutic drug preparation and administration. Nurses showed that their actual administration method was insufficient according to their level of information. The ratio for nurse’s usage of the safety cabinet during the preparation of chemotherapeutic drugs was very low at 14.2%. Only 7.4% of nurses had received in-service education about chemotherapeutics. The study revealed that the hospital should be required to provide sufficient equipment and to give this precedence in hospital policies.

Mc Ilfatrick, S., et al., (2007)56 descriptive study tried to explore the nurse’s experience on chemotherapy service in an acute general hospital in North Ireland. Face to Face focused in-depth interviews were concluded among 10 nurses. Data analysis involved a two stage approach. The study concluded that the nurses viewed their experience of the chemotherapy day hospital as having both positive and negative dimensions. The positive dimensions include an increased sense of autonomy and the challenge of developing new skills, while the negative dimension included a perceived decrease in their caring role. Role changes leads to a perceived dichotomy between their actual and aspired role and their caring and clinical role.

Jezewski, M. A., et al., (2006)46 conducted a descriptive co relational study in New York to determine Oncology nurses knowledge, attitude and experience regarding advance directives, among 3840 oncology nurses of which 794 responded. The mean total knowledge score based on the 3 subscales was 17.4 of the possible 30. The result showed that nurse’s knowledge scores were low, nurses in this study were not highly confident in their ability to assess patient with advance directives. More education related to advance directives is needed and could be administered through in service classes or continuing education.

McCaughan, E., & Parahoo, K., (2009)55 conducted a descriptive study among 106 nurses working in medical surgical department in the selected hospital at Ireland, regarding perceptions of their level of competence and educational need in caring for patients with cancer. Results showed that these nurses who cared for people with a varied range of cancer had above moderate level of competence, and they also rated that their level of competence is higher in physical care than in psycho-social care.


Kim, K. S., et al., (2011)49 conducted a descriptive study among 220 Korean nurses from seven selected hospitals by using convenient snow ball sampling technique to assess nurses’ perception of medication error. The study revealed that developing strategies for drug administration and non punitive reporting system reduces the medication error.

Schwappach, DL., et al., (2011)67 conducted a descriptive study in Switzerland to explore oncology nurses perceptions about involving patients in prevention of chemotherapy administration errors. A total of 479 patients shared affirmative attitudes and overwhelmingly reported positive experiences with engaging safety behavior. In this study, nurses acknowledged the diverse need of patient and deliberately used different strategies to involve patients in safety of chemotherapy administration. To successfully involve patients in medication error prevention, clinicians need to address their patients’ beliefs and reduce barriers through education.

Dickinson, A., et al., (2010)41 conducted a descriptive study to understand Pediatric nurse’s practice regarding double checking medication and identify facilitators and barriers to the process of independent double checking. Seven pediatric nurses participated in the homogenous group based on their level of practice. The barriers identified are workload, distractions and environmental factors.

Jones, J., Treiber, L., (2010)47 conducted a descriptive study among 158 nurses in Georgia, to describes nurses perception about how and why medication errors occur and their personal experiences with medication errors. A survey was mailed to a random sample of registered nurses.202 nurses responded, of which 158 nurses admitted making medication errors. This study provided the perspective of front line nurses, contributed to the body of knowledge on medication errors.

Scalzone, M., et al., (2010)64 performed a descriptive study in the division of pediatric oncology in Rome, to identify the errors involving patients receiving intrathecal chemotherapy. Despite the improvement in the management of antineoplastic agents, unintentional intrathecal administration of chemotherapeutic drugs that were indicated only for systemic administration, continue to cause severe neurotoxicity, which is usually fatal in outcome. The study proposed diverse rescue therapy but the effective mean is only by preventing error during administration.

Mc Niff, K.K., et al., (2009)77 conducted a descriptive study to review the standards set by oncology nursing society for chemotherapy administration. The investigator also invited broad range of stakeholders to set standards for chemotherapy administration, mainly to standardize care because standardization of care reduces the risk of errors, increase efficiency, and provide a framework for best practice.

Schulmeister, L., (2008)85 conducted a prospective study by suggesting 10 simple strategies to prevent chemotherapy errors. The strategies were computerized prescriber order entry, automated medication dispensing machines, bar coding; verify patient identity, metric measurements, work place illumination and organization. Other strategies suggested were eliminations of abbreviations and acronyms.


Rizalar, S., et al., (2012)63 conducted a study in Turkey, to determine the safety measures on personal and environmental protection taken by nurses during chemotherapy preparation and administration. 73 nurses were included in the study group. Data were obtained via questionnaire form. The finding showed that nurses notwithstanding the rules and regulation pertaining to chemotherapeutics. The result clearly pointed out the importance of need for regular education programme and this study also revealed the necessity for improvement of the working environment.

Gan, et al., (2010)43 conducted a study in Japan regarding safety issues of chemo drug administration handling by nurses from an occupational exposure view point and through visualization with contrast media for ophthalmic vasculature. The result showed spills all over in the procedure by nurses in the study, specifically splash to environment around the drug preparation area, contamination of needles which were used for drug preparation, contamination of environment as a result of priming with chemo agent. So it is considered that strict conformity to chemo drug administration procedure based on authorization guidelines is very important in addition to the standard of administration procedure in each facility.

Martin, S., Larson, E., (2008)53 conducted a descriptive co relational study among 500 randomly selected members of the oncology nursing society who identified their work settings as office, clinic, or outpatient private practice. The aim of the study was to determine the current patterns of use of personal protective equipments among oncology nurses while handling anti-neoplastic chemotherapeutic agents in outpatient and office based settings. Findings revealed that use and availability of personal protective equipment when handling chemotherapy have increased, but medical monitoring of exposed employees are still neither widely practiced nor consistent with occupational safety and health administration guidelines.