Nursing Students’ Occupational Health and Safety Problems in Surgical Clinical Practice:

Semra Eyi; İbrahim Eyi

doi:10.1177/2158244020901801

Nursing Students’ Occupational Health and Safety Problems in Surgical Clinical Practice:

Eyi, Semra; Eyi, İbrahim 2020-01-30 00:00:00 Student nurses are exposed to hazards in terms of occupational health and safety (OHS) problems in Turkey. Researching these problems in the clinical setting, improving the health and safety of student nurses is an issue that needs to be investigated. The aim of this study is to present OHS-related impressions and OHS experiences of nursing students in relation to the risk assessment process and from an educational perspective. A descriptive and cross-sectional study was conducted with 140 students at a nursing school. The study indicated that almost all of the students’ OHS knowledge and awareness level were low, were exposed to contact with blood and body fluids as most dangerous situations, have difficulties in the provision of personnel protective equipment (PPE), were subjected to verbal assault, and experienced anxiety and irritability. They encountered dangerous situations applying treatment in the clinic, preparing drugs, following vital signs, giving general care, and during the intervention in the emergency room, and experienced back pain, headache, increased tendency to sleep, fatigue, and forearm, wrist, hand, and finger injuries. Because of contact with hand antiseptic/latex, skin irritation, and burning eyes, nose, and throat, allergy symptoms were detected. Carelessness and intensive work tempo were the most common causes of workplace accidents. The clinical practice areas are limited in terms of OHS; students are exposed to physical, psychological, and chemical risks with respect to OHS, and they are most psychologically affected by experiencing anxiety and irritability, as well as physiologically, and have symptoms similar to burnout syndrome; they are at risk of getting burnout syndrome. Keywords nursing, behavioral sciences, student nurse, occupational health and safety accidents, protective equipment usage, clinical practice and urgent interventions are intensive (Erdağı & Özer, 2015). Introduction Nurses, who are the most important members of the health As the health sector is one of the most risky groups in terms care team, who provide direct care to the patient in surgical of occupational accidents and diseases, the World Health units, are exposed to numerous occupational hazards, such as Organization emphasizes that hospitals are the primary pri- drugs, chemicals, infectious agents, lack of materials and ority in preventing workplace hazards (Cheah et al., 2012; ergonomic conditions, heavy working, and excessive work- Elewa & Sahar Banan, 2016). To draw attention to the impor- load, and also they have physical (needle stinging, penetrat- tance of the occupational safety in hospitals, the International ing stab injuries, musculoskeletal disorders and pain, cancer Council of Nurses published themes of the week for nurses resulting from night work, hearing loss, and varicose veins), as “Positive Work Environments, Quality Workplaces = chemical (skin problems, latex allergies), biological (infec- Quality Patient Care” (International Council of Nurses, tious diseases), and psychological (stress, burnout syndrome, 2016). Clinical environments in hospitals consist of intense mental health problems, sleep disorders) problems (Anandh work hazards and risky environments, complex business pro- cesses, and the intensive use of technology (Cebeci, 2013; Trakya University, Edirne, Turkey Ulutaşdemir et al., 2015). The unit and characteristics of the 2 Istanbul Aydın University, Turkey clinic also affect the possibility of encountering hazards Corresponding Author: (Parlar, 2008). Surgical clinics are environments with high- Semra Eyi, Assistant Professor, Department of Nursing, Keşan Hakkı risk closed units such as operating rooms and intensive care Yörük School of Health, Trakya University, Edirne 22880, Turkey. units (ICUs), where critical thinking, quick decision making, Email: semra_il@yahoo.com Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open et al., 2015; Attar, 2014; Attarchi et al., 2014; Bernal et al., being exposed to occupational hazards in clinical practice 2015; Broadwater & Brueck, 2017; Elewa & Sahar Banan, due to lack of instructors (Council of Higher Education, 2016; Hamnerius et al., 2018; Rathore et al., 2017; Samulin 2018). Student nurses are at risk because of diseases and Erdem et al., 2017; Xiong et al., 2017). injuries resulting from clinical applications especially in Literature shows that nursing students face numerous surgical clinics such as operating rooms and ICUs, where occupational health hazards as qualified nurses face during critical thinking, quick decision making, and emergency their work (Boucaut & Cusack, 2016). In particular, nursing interventions are intensive. Besides, some nursing students students may be experiencing stress and anxiety (Taşdelen & who do not have a good economic situation face financial Zaybak, 2013; N. Yıldırım et al., 2017) and exposed to occu- pressures to work in paid work during the time they have pational hazards due to their underdeveloped abilities, lack of left their classes and this causes them to experience fatigue. knowledge, and other professional health professionals in the In the literature, it is stated that this fatigue affects the aca- clinical setting (Cheung et al., 2015). Like qualified nurses, demic achievement of students, and they are not prepared nursing students are exposed to violence from verbal/nonver- enough for the nursing profession (Rella et al., 2009); it is bal to physical violence by fellow students, faculty or hospital also reported in the literature that nursing students are prone staff, patients, and patients’ relatives in surgical clinical set- to experience stress in their clinical training and theoretical tings (Seibel, 2014). It is also reported in the literature that training (Pulido-Martos et al., 2012). The fatigue and stress nursing students are exposed to patient infections as a result of the students cause accidents to increase, and the safety of of stab wounds and needle stinging (Scaggiante et al., 2013). the patients remains under threat. The occupational health Dermatitis, often caused by washing hands and wearing and safety (OHS) issue is an important component of clini- gloves, is another occupational situation experienced by nurs- cal practice skills, which reflects what student nurses have ing students (Akan et al., 2012; Visser et al., 2014). Nursing learned in theoretical practice and theoretical knowledge. students, like qualified nurses, face difficulties with transport, Therefore, it is vital that student nurses work safely during carry of patient and equipment and musculoskeletal disor- clinical practice. Besides, academicians and educators have ders. Researchers in the United Kingdom and Australia sug- responsibilities for students, including the OHS risks that gest that students face difficulties in safe handling practices in their students may face in clinical practice. clinical situations; some nursing students have experienced As a result of the reviewed literature, in summary, the fact severe low back pain due to lifting and bending characteris- that nursing students are more weighted in surgical clinical tics (Cornish & Jones, 2010; Kneafsey et al., 2012; Mitchell applications and take a more active role in clinical applica- et al., 2008). Nursing education in universities in Turkey tions especially in their second and third years of education requires 4 years of full-time university study and 4,600 hr; period clearly shows OHS is a matter of importance and seri- 50% includes theoretical training, and 50% includes clinical ous concern. practice training. Clinical practice, which covers an important In this study, it is aimed to present the views and experi- part of education, is an intensive part of the contemporary ences of the student nurses about the OHS and OHS experi- nursing curriculum and is an essential element of nursing ences in surgical units in relation to the risk assessment and education. This training is conducted in a variety of clinical to evaluate them from an educational perspective. settings that provide the basis for the continuous development of students’ critical thinking and decision-making skills; it Study Aim also improves professional practice competence (Ören & Zengin, 2019). In Turkey, during the first year of university The aim of this study is to gather information about occupa- programs (consisting of a year of two semesters), students tional accidents, occupational diseases, and problems related take lessons in basic science courses (anatomy, including to OHS during clinical practices in the second and third years physiology and biochemistry) and “Basic Principles and of the education in which the surgical clinical applications Practices of Nursing Courses.” are more weighted and the students have more active role in In the second and third years, there are 8 hr of theoretical the clinical practices; to provide information about nursing courses and 14 hr of clinical practice for Surgical Nursing, students’ level of knowledge and awareness about OHS, to Internal Medicine Nursing, Obstetrics and Gynecology, determine the status of compliance with OHS measures in and Pediatric Nursing. For these clinical courses, students relation to the risk assessment; and to evaluate them from an attend formal clinical practice in surgical clinics/areas of educational perspective. The research questions are as hospitals 2 or 3 days a week (16–24 hr). For this reason, in follows: the second and third years of their education, students are actively involved in clinical practice in surgical units. Research Question 1: What occupational threats and Students can participate in clinical practice under the risks are experienced by nursing students in clinical prac- supervision of academicians. The number of nursing tice? (identifying threats) schools studying in Turkey has increased in recent years. Research Question 2: What level of awareness and Unfortunately, the number of academicians has not knowledge do nursing students have in relation to OHS? increased at the same level. This raises the risk of students (detection of OHS situation in nursing students) Eyi and Eyi 3 Research Question 3: What is nursing students’ level of and extend students’ patient care to self-care. The first stage compliance with OHS measures and personnel protective of the Nursing Process involves collecting, organizing, veri- equipment (PPE) usage? (evaluation of risk control) fying, and documenting data; this stage is similar to the haz- Research Question 4: What are nursing students’ ard identification of the risk assessment process. The thoughts about hazard sources and preventive measures? “Planning” and “Implementation of Interventions” stages of (assessment) the Nursing Process include both the risk assessment and control stages of Risk Management to prevent or reduce harm to both itself and staff. The final stage of both models Method is “Assessment.” Comparing the similarities between the Nursing Process model and the risk assessment process can Survey Design facilitate nursing students to consider their safety, particu- This was a descriptive design that used a self-administered larly by encouraging students to consider self-care and questionnaire, developed specifically for this study. patient care as part of their clinical logic processes (Boucaut & Cusack, 2016). Then, 10 students who did not participate in the study Sample Group were given a questionnaire, and questions that were not Students enrolled in a health college consisted of the popula- understood in this pilot test were rewritten. The question- tion of the study. A questionnaire was applied with a sample naires were given to the students on the first day of their visit of nursing students performing hospital clinical rotations. to the hospital between February and June 2018, and col- The population of the study consisted of 140 students study- lected on the last day of clinical rotations (clinical rotations ing in the second and third years of the nursing department. are totally 11 weeks). As the whole population was taken as a sample group, no The questionnaires were distributed by academicians who sampling method was used. The first-grade students who were not part of the research, and explained the purpose of take university basic science courses (including anatomy, the study and how to complete the form. physiology, and biochemistry) and “Basic Principles and Practices of Nursing” and fourth-grade students who take Data Analysis Public Health Nursing and Mental Health Nursing courses were excluded from the study because they did not attend The data were analyzed using the SPSS 21 computer soft- clinical practice in surgical units. ware package (SPSS, Chicago, IL, USA). Percentages and the chi-square test were used in the evaluation. The p value of <.05 was considered to be statistically significant. Data Collection and Measurement Tool The researchers developed a questionnaire based on the Ethical Considerations research knowledge in the literature and the experience of the researchers (in consultation with the nursing teacher, aca- The required written permission was received from the facil- demician, hospital nurse, and OHS specialist). There are 29 ities for conducting the study (October 12, 2017, No. questions in the questionnaire: four questions to determine 33505391-044-E.167490). All participants provided students’ demographic characteristics and 25 questions to informed written consent after the research aim had been measure their attitudes and awareness about OHS in which explained to them. Before starting the survey, the students they explain the problems they face in the clinical practice were informed about the research topic and given instruc- environment, and the answers given are classified under four tions about form. The students were informed that participa- subheadings (identifying threats, detection of OHS situation tion in the research was voluntary, that they were free to in nursing students, evaluation of risk control, and assess- complete the form without any limitations, that they would ment) (Table 1). not be rewarded or punished for participating in the study, Expert opinion was obtained to determine whether the and that this research would have no impact on their grade. It questions were appropriate for the study and whether the was also said that data obtained from the questionnaire would information requested was sufficient. All questions were not be used anywhere else from research and would remain analyzed and coded in such a way that each author indepen- confidential. dently identified the risk within the scope of risk assessment, categorizing them under identifying threats, detection of Results OHS situation in nursing students, evaluation of risk control, and assessment subheadings. Risk assessment, as Boucaut The findings were handled within the framework of risk and Cusack (2016) point out, allows students to link the assessment, identifying threats, detection of OHS situation Nursing Process and the risk assessment process, help them nursing students, risk control assessment, and evaluation incorporate OHS risk management into their clinical logic, subheadings. 4 Table 1. Questionnaire With Research Subheadings. Risk management framework Questionnaire Research questions 1. Identifying threats What kind of dangerous situations related to OHS did you encounter in clinical practice? What are the occupational threats and risks □ Contact with blood and body fluids □ Supervisor nurse/doctor physical/verbal assault regarding OHS faced by nursing students in □ Taking blood sample/IM, IV, SC needle stick after injection □ Falling, slipping, strain, material drop clinical practice? □ Academicians’ physical/verbal assault □ Contact with chemical additives or liquid material □ Colleagues’ physical/verbal assault □ Sharp-driller tool injury (scalpel, scissors, etc.) □ Patient/patient’s relatives’ physical/verbal assault □ Other . . . What kind of PPE usage problems did you have in clinical practice? □ Handle with single glove due to insufficient gloves □ Rebuked for changing gloves due to insufficient gloves □ Providing care to multiple patients with the same single glove □ Entering rooms of patients with respiratory contagious diseases without mask due to nonexistence of masks □ Not wearing gown or goggles due to nonexistence/insufficient number of gowns, goggles during body care □ Other . . . What kind of symptoms did you experience in clinical practice? □ Headache □ Early fatigue □ Exhaustion □ Increased tendency to sleep □ Hair loss □ Burning eyes and throat □ Nose bleeding □ Irritation on skin □ Allergy □ Breathing difficulty □ Crying □ Backache □ Anxiety, Anger If you were injured, what are the common areas of the body injured in clinical practice? □ Head (head, eye, face, etc.) □ Forearm, wrist, palm, finger □ Patella, calf, foot □ Mental damage □ Other Which chemicals did you have to contact in clinical practice? □ Hand antiseptic □ Formaldehyde, Glutaraldehyde, Ethylene oxide, Antineoplastic cancer drugs □ Latex □ Other 2. Detection of OHS Do you think OHS is related to your profession and affects it? □ No □ Yes What is the knowledge and perception of situation of nursing Do you have any knowledge about OHS regarding your profession? □ No □ Yes nursing students regarding OHS? students What are the information sources for OHS? □ In the lesson □ Academicians □ OHS course □ Meetings of subject matter experts □ Media □ Friends Do you know the definition of occupational disease? □ No □ Yes: It is . . . Do you want if there is an OHS class in the curriculum? □ No □ Yes Do you know the national regulation of OHS? □ 2547 (Law Nu) □ 657 (Law Nu) □ 926 (Law Nu) □ 6,331 (Law Nu) Do you know the OHS hazard classification of hospital service? □ Less Dangerous □ Dangerous □ Very Dangerous Do you know OHS commitments and rights of patients and health workers in case of a hazardous situation? □ No □ Yes Do you have knowledge of OHS regulation novelties? □ No □ Yes 3. Evaluation of risk control Do you give the required sensitivity to OHS rules in clinical practice? □ No □ Yes What is the status of nursing students to Do you think OHS measures taken are sufficient? □ No □ Yes comply with OHS measures and PPE use in As a student, do you give required sensitivity to PPE usage in clinical practice? □ No □ Yes clinical practice? Do you think that your profession requires PPE usage? □ No □ Yes What kind of equipment do you use in clinical practice? □ Glove □ Mask □ Gowns/Goggles □ Bone 4. Assessment What were you doing when you faced dangerous situations related to OHS in clinical practice? What are nursing students’ thoughts about the □ Giving regular care to patient □ Preparing drugs for treatment origin of risks, threat sources, and actions □ During intervention in emergency service □ Applying treatments in clinic □ Tracking vital signs in clinic during the OHS issue? □ Recapping needles □ During taking patient story □ Delivering laboratory samples (blood, urine, stools) of patient □ Taking patient to bed or transferring to another place □ During clinic medical visit/academician visit □Other Did you get any rest leave when you experienced clinical hazards? □ No □ Yes Whom did you notify in case of a hazardous incident? □ I didn’t tell to anyone □ I informed the supervisor nurse and he or she interested □ I told my responsible academician and he or she took an immediate interest Is it documented when you encounter a dangerous situation? □ No □ Yes What is the reason for occupational accidents, according to you? □ Intensive work tempo □ Lacking in attention □ Not using PPE □ Long working hours □ Inexperience What is your priority when you face a dangerous situation? □ I comply if our institution takes every precaution □ My own health is my top priority □ My priority is my job Note. OHS = occupational health and safety; IM = intramuscular; IV = intravenous; SC = subcutaneous; PPE = personnel protective equipment. Eyi and Eyi 5 Table 2. Students Identifying Characteristics and Vaccine Status. Character n % Sex Female 96 68.6 Male 44 31.4 Class 2 80 57.1 3 60 42.9 Working in a job after school for extra money Yes 20 14.3 No 120 85.7 Vaccines received before clinical practice Hepatitis B 79 56.4 DaBT 75 53.5 Measles, epidemic parotitis, German measles 13 9.3 Influenza 6 4.3 Varicella 5 3.6 Note. DaBT = diphtheria, pertussis, tetanus; DTaP = diphtheria, tetanus, and acellular pertussis. significant difference was found for these problems based on Characteristics of the Participants sex (p > .05), the difference between classes was statistically Of the participants, 68.9% were female and 31.4% male; significant (p < .05). 14.3% of students stated that they work in another job. Some Proportionate with the problems they faced, students students had been vaccinated in the hospital before begin- mostly experienced anxiety, anger (77.8%), headache ning clinical practice (Table 2). (71.4%), increased tendency to sleep (70.7%), exhaustion (68.5%), backache (61.4%), and early fatigue (57.8%) dur- Identifying threats. To identify threats, the students were ing clinical practice. The most commonly injured body areas asked the questions shown in Table 1. Students were exposed were forearms, palms, wrists, and fingers (52.8%). Most stu- to hazards related to OHS in clinical practice such as contact- dents who experienced these symptoms were in the second ing blood and body fluids (90.7%), physical/verbal assault class and female (Table 3); no statistically significant differ- by patients/patients’ relatives (60%), nurses and doctors ence for injuries was found based on sex (p >.05), but the (40.7%), sharp injuries (scalpel, scissors; 30.7%), and needle difference based on class was significant (p < .05). stick injuries (27.8%). Students who contacted blood, body Hand sanitizer (89.2%) and latex (60.7%) were the chem- fluids, chemicals, or other fluids and who experienced slip- icals most used by students. Most students who reported ping, falling, strain, and material fall were female and in the using these chemicals were female and in the second class, second class, whereas students who experienced physical/ and a statistically significant difference was found between verbal assault by patients/patients’ relatives/nurses/doctors, both sexes and classes (p < .05). sharp injuries (scalpel, scissor), and needle stick injuries were female but in the third class. The difference in problems Detection of OHS situation in nursing students. To measure encountered based on sex was not statistically significant nursing students’ OHS knowledge and awareness, subtitled (p > .05), while the difference between classes was statisti- “Detection of OHS situation in nursing students,” all stu- cally significant (p < .05). dents provided positive responses to the fact that OHS They identified the following problems with PPE usage: relates to and affects their profession. Regarding sociode- Students did not wear protective gowns or use goggles dur- mographic characteristics, most were female and in the sec- ing body care of patients (44.2%), either because gowns/ ond class, but this was not statistically significant (p > .05). goggles were unavailable or their availability was limited. Almost all students (95.7%) reported having some knowl- They had to use a single glove due to insufficient supply of edge of OHS, from sources such as OHS courses (52.8%), gloves (42.1%) or because they were reprimanded for chang- experts’ information meetings (48.5%), classes (37.1%), ing gloves (37.1%), they had to care for more than one academicians (37.1%), media (20.7%), and friends (15%). patient with a single glove (36.4%), and they had to enter the The difference between OHS information sources between rooms of patients with respiratory contagious diseases with- sex and classes was statistically significant (p < .05). Stu- out masks, due to the nonexistence of masks (22.1%). As dents knew the definition of occupational diseases (90.7%), shown in Table 3, most students who faced these problems the national OHS regulations/laws (43.5%), the hazard clas- were females in their third year. While no statistically sification of hospital services in OHS (32.1%), and rights 6 SAGE Open Table 3. Nursing Students’ Experiences of Occupational Hazards and Risks of OHS in Clinical Practices. Sex Class Female Male 2 3 Total Identifying threats n % n % n % n % n % Dangerous situations related to OHS encountered in clinical practice Contact with blood and body fluids 89 70.0 38 29.9 67 52.7 60 47.2 127 90.7 Patient/patient’s relatives’ physical/verbal assault 66 78.5 18 21.4 40 47.6 44 52.3 84 60.0 Supervisor nurse/doctor physical/verbal assault 44 77.1 13 22.8 20 35.0 37 64.9 57 40.7 Sharp-driller tool injure (scalpel, scissors, etc.) 33 76.7 10 23.2 18 41.8 25 58.1 43 30.7 Take blood sample/IM, IV, SC needle stick after 29 74.3 10 25.6 20 51.2 19 48.7 39 27.8 injection Falling, slipping, strain, material drop 25 59.5 17 40.4 24 57.1 18 42.8 42 30.0 Contact with chemical additives or liquid material 25 71.4 10 28.5 23 65.7 12 34.2 35 25.0 Colleagues’ physical/verbal assault 12 66.6 6 33.3 2 11.1 16 88.8 18 12.8 Academicians’ physical/verbal assault 5 50.0 5 50.0 4 40.0 6 60.0 10 7.1 χ /p value 32.534/p = .090 70.668/p = .000 PPE usage problems in clinical practice Not wearing a shirt or goggles due to nonexistence/ 48 77.4 14 22.5 30 48.3 32 51.6 62 44.2 insufficient number of shirts and goggles during body care Handle with single glove due to insufficient gloves 46 77.9 13 22.0 24 40.6 35 59.3 59 42.1 Rebuked for changing gloves due to insufficient gloves 41 78.8 11 21.1 20 38.4 32 61.5 52 37.1 Providing care to multiple patients with the same 35 68.6 16 31.3 21 41.1 30 58.8 51 36.4 single glove Entering rooms of patients with respiratory 24 77.4 7 22.5 17 54.8 14 45.1 31 22.1 contagious diseases without masks, due to nonexistence of masks χ /p value 7.432/p = .385 42.717/p = .000 Findings and symptoms in clinical practice Anxiety, anger 80 73.3 29 26.6 63 57.8 46 42.2 109 77.8 Headache 70 70.0 30 30.0 58 58.0 42 42.0 100 71.4 Increased tendency to sleep 65 65.6 34 34.3 51 51.5 48 48.4 99 70.7 Exhaustion 65 67.7 31 32.2 56 58.3 40 41.6 96 68.5 Backache 60 69.7 26 30.2 48 55.8 38 44.1 86 61.4 Early fatigue 58 71.6 23 28.4 51 62.9 30 37.0 81 57.8 Crying 17 85.0 3 15.0 15 75.0 5 25.0 20 14.2 Irritation on skin 17 85.0 3 15.0 7 35.0 13 65.0 20 14.2 Burning eyes and throat, nose bleeding 13 76.4 4 23.5 5 29.4 12 70.5 17 12.1 Allergy 14 82.3 3 17.6 12 70.5 5 29.4 17 12.1 Hair loss 11 68.7 5 31.2 9 56.2 7 43.7 16 11.4 Breathing difficulty 10 76.9 3 23.0 4 30.7 9 69.2 13 9.2 χ /p value 23.256/p = .107 37.038/p = .002 Common areas of the body injured in clinical practice Forearm, wrist, palm, finger 54 72.9 20 27.0 43 58.1 31 41.8 74 52.8 Anger 10 83.3 2 16.6 4 33.3 8 66.6 12 8.5 Patella, calf, foot 7 70.0 3 30.0 2 20.0 8 80.0 10 7.1 Head (head, eye, face, etc.) 4 66.6 2 33.3 2 33.33 4 66.6 6 4.2 χ /p value 5.986/p = .649 17.774/p = .023 Chemicals contacted in clinical practice Hand antiseptic 90 72.0 35 28.0 68 54.4 57 45.6 125 89.2 Latex 69 81.1 16 18.8 53 62.3 32 37.6 85 60.7 Formaldehyde, glutaraldehyde, ethylene oxide, 22 57.8 16 42.1 12 31.5 26 68.4 38 27.1 antineoplastic cancer drugs χ /p value 23.437/p = .003 24.363/p = .002 Note. OHS = occupational health and safety; IM = intramuscular; IV = intravenous; SC = subcutaneous; PPE = personnel protective equipment. Bold value significance that p < .05 and statistically significant difference was found. Eyi and Eyi 7 Table 4. Nursing Students’ OHS Knowledge and Awareness. Sex Class Female Male 2 3 Total Detection of OHS situation in nursing students n % n % n % n % n % Thinking of OHS is related to their profession and effects it Yes 96 68.5 44 31.4 80 57.1 60 42.8 140 100 Having knowledge of OHS True 93 69.4 41 30.6 76 56.7 58 43.2 134 95.7 χ /p value 1.926/p = .165 1.070/p = .301 Information sources of students for OHS OHS course 54 72.9 20 27.0 45 60.8 29 39.1 74 52.8 Meetings of subject matter experts 48 70.5 20 29.4 33 48.5 35 51.4 68 48.5 In the lesson 37 71.1 15 28.8 27 51.9 25 48.0 52 37.1 Academicians 33 63.4 19 36.5 34 65.3 18 34.6 52 37.1 Media 15 51.7 14 48.2 11 37.9 18 62.0 29 20.7 Friends 7 33.3 14 66.6 11 52.3 10 47.6 21 15.0 χ /p value 21.791/p = .001 13.593/p = .035 Knowing definition of occupational disease True 92 72.4 35 27.5 72 56.6 32 25.2 127 90.7 χ /p value 9.502/p = .002 0.113/p = .737 Wanting an OHS class in curriculum Yes 78 70.2 33 29.7 62 55.8 49 44.1 111 79.2 χ /p value 0.718/p = .397 0.362/p = .547 Knowing national OHS regulation/law True 47 77.0 14 22.9 37 60.6 24 39.3 61 43.5 χ /p value 3.605/p = .058 0.545/p = .460 Knowing OHS hazard classification of hospital service True 35 77.7 10 22.2 22 48.8 23 51.1 45 32.1 χ /p value 2.127/p = .145 1.583/p = .208 Knowing OHS commitments and rights of patients and health workers that might be result from hazardous situations Yes 26 60.4 17 39.5 19 44.1 24 55.8 43 30.7 χ /p value 1.684/p = .194 3.868/p = .049 Having knowledge of OHS regulation novelties Yes 3 30.0 7 70.0 5 50.0 5 50.0 10 7.1 χ /p value 7.434/p = .006 0.224/p = .636 Note. OHS = occupational health and safety. Bold value significance that p < .05 and statistically significant difference was found. and legal commitments (30.7%) that might result from Evaluation of risk control. Table 5 shows to evaluate risk con- workers and patients encountering dangerous OHS inci- trol measures. In total, 92.1% of students stated that they gave dents. A total of 79.2% of students wanted separate classes the required sensitivity to OHS rules. Most students thought regarding OHS as part of the curriculum. Although students that their profession required PPE usage (97.1%) and that reported having knowledge of OHS and thought that it they were sensitive enough to use PPE (97.8%). The differ- relates to their profession, only 7.1% were aware of new ence between sex and classes in this respect was not signifi- OHS regulations/laws. The difference between sexes and cant (p > .05). When asked what kind of PPE they used in classes with regard to knowledge of OHS and regulations, clinical practice, most reported using gloves (100%), masks desiring an OHS class as part of the curriculum and know- (90%), and bone (36.4%). As seen in Table 4, a significant ing the hazard classification of hospital services, was not difference was found between classes and sex with regard to significant (p > .05). A statistical difference was found for the scope of PPE that was used (p < .005). The percentage sex in resources of OHS knowledge, new OHS regulations, (11.4%) of students who felt that OHS precautions were suf- and knowing the definition of occupational illness, while a ficient for the problems they faced was very low. No signifi- significant difference was found for classes in terms of legal cant difference was found between classes in terms of commitments and rights resulting from dangerous incidents considering “OHS precautions sufficient” (p > .005), but a in OHS (p < .05; Table 4). significant difference was found between sexes (p < .005). 8 SAGE Open Table 5. Nursing Students’ Compliance With OHS Measures and PPE Usage. Sex Class Female Male 2 3 Total Evaluation of risk control n % n % n % n % n % Giving required sensitivity to OHS rules in clinical practice Yes 89 68.9 40 31.0 72 55.8 57 44.1 129 92.1 χ /p value 0.135/p = .713 1.184/p = .277 Thinking that OHS measures taken are sufficient Yes 5 31.2 11 68.7 10 62.5 6 37.5 16 11.4 χ /p value 11.675/p = .001 0.212/p = .645 Giving required sensitivity to PPE usage in clinical practice Yes 94 68.6 43 31.3 77 56.2 60 43.8 137 97.8 χ /p value 0.005/p = .943 2.299/p = .129 Thinking that nursing profession requires PPE usage Yes 94 69.1 42 30.8 76 55.8 60 44.1 136 97.1 χ /p value 1.737/p = .187 2.329/p = .127 PPE equipment used in clinical practice Glove 96 68.5 44 31.4 80 57.1 60 42.8 140 100.0 Mask 90 71.4 36 28.5 69 54.7 57 45.2 126 90.0 Bone 29 56.8 22 43.1 6 11.7 45 88.2 51 36.4 Gowns/goggles 30 85.7 5 14.2 8 22.8 27 77.1 35 25.0 χ /p value 15.788/p = .007 90.835/p = .000 Note. OHS = occupational health and safety; PPE = personnel protective equipment. Bold value significance that p < .05 and statistically significant difference was found. Assessment. The students mostly encountered occupational Conclusion hazards while executing treatment in clinics (54.2%), pre- This study has demonstrated that the conditions of OHS in paring drugs for treatment (41.4%), tracking fire-pulse- clinical practice areas are very limited for students. Students blood pressure (25%), maintaining general care (22.1%), in this study were exposed to physical, chemical, and physi- during intervention in emergency services (22.1%), and ological risks, and were mainly affected psychologically, fol- recapping needles (20.7%). No significant difference was lowed by physically. It was concluded that the students were found between sexes for work during dangerous situations at risk of getting burnout syndrome before they start the (p > .005), but the difference for classes was significant nursing profession by experiencing similar symptoms to (p < .005). Most students reported incidents related to burnout syndrome (anxiety and irritability, low back and occupational hazards to supervisor nurses (54.3%), and back pain, headache, increased tendency to sleep, exhaus- supervisor nurses showed instant interest. Students stated tion, early fatigue). Although nearly all students reported that occupational accidents were caused by lack of atten- having knowledge of OHS at the end of their study, their tion (84.2%) and intensive work tempo (81.4%). They knowledge and awareness of OHS were revealed to be very reported that when they face hazardous situations, they give low. Moreover, in terms of OHS-related hazardous incidents, priority to their health first (65%). No significant difference students were mostly exposed to contact with blood and was found for sex or classes in taking rest leave, the person body fluids and had serious problems accessing PPE, which to whom incidents were reported, documentation of inci- comprises a protective measure against exposure to physical/ dent, or practice type in which they were exposed to hazards verbal assault. They experienced anxiety and irritability in (p > .05; Table 6). clinical practice. Most students also reported symptoms of backache, headache, increasing tendency to sleep, exhaus- Discussion tion, and fatigue. The chemicals with which students had The discussion is handled within the framework of the risk most contact were latex and hand antiseptic, which they assessment process based on the findings, within the frame- reported to have caused skin irritation, burning eyes and work of the identifying threats, detection of OHS situation in throat, nose bleeds, and allergy. Students faced hazardous nursing students, evaluation of risk control, and assessment incidents when applying treatments in clinics, preparing subheadings, and presented in Table 7 in comparison with drugs, tracking fire-pulse-blood pressure, recapping needles, the relevant literature. and making interventions in emergency services. Most such Eyi and Eyi 9 Table 6. Nursing Students’ Thoughts on Hazard Sources and Compliance With OHS Precautions. Sex Class Female Male 2 3 Total Evaluation n % n % n % n % n % Practice made and hazardous situation exposed in clinic Applying treatments in clinic 52 68.4 24 31.5 36 47.3 40 52.6 76 54.2 Preparing drugs for treatment 43 74.1 15 25.8 31 53.4 27 46.5 58 41.4 Tracking vital signs in clinic 27 77.1 8 22.8 19 54.2 16 45.7 35 25.0 Giving regular care to patient 18 58.0 13 41.9 13 41.9 18 58.0 31 22.1 During intervention in emergency service 19 61.2 12 38.7 15 48.3 16 51.6 31 22.1 Recapping needles 19 65.5 10 34.4 15 51.7 14 48.2 29 20.7 During taking patient story 16 66.6 8 33.3 5 20.8 19 79.1 24 17.1 Delivering laboratory samples (blood, urine, stools) of 17 70.8 7 29.1 17 70.8 7 29.1 24 17.1 patient Taking patient to bed or transferring to another place 12 80.0 3 20.0 7 46.6 8 53.3 15 10.7 During clinic medical visit/academician visit 4 40.0 6 60.0 5 50.0 5 50.0 10 7.1 χ /p value 16.427/p = .288 32.127/p = .004 Taking rest leave for incidents in clinic Yes 2 33.3 4 66.6 2 33.3 4 66.6 6 4.2 χ /p value 3.326/p = .068 1.413/p = .235 Notified person in case of hazardous incident I informed the supervisor nurse and he or she was 50 65.7 26 34.2 48 63.1 28 36.8 76 54.2 interested I did not tell anyone 20 80.0 5 20.0 14 56.0 11 44.0 25 17.8 I told my responsible academician and he or she took 9 81.8 2 18.1 4 36.3 7 63.6 11 7.8 immediate interest χ /p value 4.484/p = .344 7.481/p = .113 Documentation in case of dangerous situation Yes 23 71.8 9 28.1 20 62.5 12 37.5 32 22.8 χ /p value 0.431/p = .512 0.566/p = 452 Reasons for occupational accidents Lacking in attention 77 65.2 41 34.7 64 54.2 54 45.7 118 84.2 Intensive work tempo 82 71.9 32 28.0 60 52.6 54 47.3 114 81.4 Not using PPE 64 66.6 32 33.3 46 47.9 50 52.0 96 68.5 Long working hours 61 67.7 29 32.2 43 47.7 47 52.2 90 64.2 Inexperience 50 64.1 28 35.9 47 60.2 31 39.7 78 55.7 χ /p value 9.267/p = .099 28.029/p = .000 Facing with dangerous situation My own health is my top priority 57 62.6 34 37.3 50 54.9 41 45.0 91 65.0 I comply if our institution takes every precaution 31 81.5 7 18.4 28 73.6 18 47.3 38 27.1 My priority is my job 4 57.1 3 42.8 6 85.7 1 14.2 7 5.00 χ /p value 4.926/p = .177 3.657/p = .301 Note. OHS = occupational health and safety; PPE = personnel protective equipment. Bold value significance that p < .05 and statistically significant difference was found. injuries occurred to their forearms, wrists, palms, and fin- workers face common occupational risks, it may be possible gers. The most frequently cited reasons for occupational to apply these recommendations to other medical students accidents were lack of attention and heavy/intensive work as well. To prevent occupational exposure and its effects on tempo. This study is limited as the study sample came from a nursing students, burning out syndrome, and other occupa- single center; thus, the results cannot be compared with other tional harms before entering the nursing profession, it is rec- centers and the findings cannot be generalized to all nursing ommended that all students take OHS training. This study schools. and relevant literature reveals that nursing students have two main platform working area and learning area, that is, the college and hospital setting. To protect students from Recommendations occupational hazards and to acquire an occupational safety Despite these limitations, we have provided several recom- culture in students, students have to be trained in both col- mendations below. Because nurses and other medical lege and hospital settings. In college, nursing students 10 Table 7. Discussion. Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments 1. Identifying threats Vaccination status Çelikalp et al. (2017) In literature, it is stated that the students had In our study, 56.4% of the students had the In the second paragraph of Article 15 of the Togan et al. (2015) health examination tests done before clinical Hepatitis B vaccine and 53.5% had DaBT “Occupational Health and Safety Law No. Kömerik et al. (2005) practice within the scope of OHS, and hepatitis vaccines before clinical practice 6331” in Turkey, it is stated that employees Altıok et al. (2009) markers (Hepatitis B, Hepatitis C), ELISA test, cannot be started to work without health www.mevzuat.gov.tr/ chest radiography, and blood count are among reports. In this case, a health report MevzuatMetin/1.5.6331.pdf the first of these tests. Hepatitis B vaccination indicating health status is requested from rate was found to be 83.6% in Togan et al. and the students who will start the internship 71% in the study conducted by Kömerik et al. by the institutions. It is assessed that almost Çelikalp et al. found that the rate of vaccination half of the students had to have vaccination against hepatitis B was 95.2%, and Altıok et al. done before clinical practice, as a result of found that the hepatitis B vaccination rate was the obligation imposed by law 79.5% for health workers In this study, 90.7% of the students came into Contact with blood and body fluids carries Contact with blood and Doig (2000) In the study of Doig, students’ contact with body fluids Tarantola et al. (2003) blood and body fluids was reported as 32%. contact with blood and body fluids risks for health care workers, and it is a common characteristic of health care Hsieh et al. (2006) Tarantola et al. stated that blood and body Adesunkanmi et al. (2003) fluid exposure was 60% in nurses and nursing services. Giving that health care workers are under risk in terms of OHS, the risk is students in the study with 7,649 health care workers in 61 hospitals. Hsieh et al., higher for unexperienced nursing students. investigating the exposure of health care Therefore, OHS training is more important workers to blood and body fluids, reported for nursing students than actual health care that the exposure to health care workers was workers 60.6%. Adesunkanmi et al., investigating the prevalence of accidental injuries and exposure to body fluids among staff during general surgery, reported 10.5% of surgical personnel were exposed to severe injuries and body fluids Physical/verbal assault Samadzadeh and International reports indicate that student In this study, 60% of the students were Our results are consistent with the studies in (from patient/ Aghamohammadi (2018) nurses, such as nurses working in many physically/verbally attacked by patient/ the literature, but it is not compatible with patient’s relatives– Budden et al. (2017) countries, are often exposed to unpleasant patient’s relatives and 40.7% by clinical nurses Tee et al.’s study at some point. Although supervisor nurse/ Tee et al. (2016) violence in the clinical setting. These and doctors. Although it was not statistically Tee et al. found that nursing students were doctor–colleagues– Koç and Batkın (2016) experiences range from dissatisfaction, significant in terms of gender, females who exposed to physical/verbal attack more academicians) Eljedi (2015) witnessing, or experiencing verbal or nonverbal were subjected to physical/verbal assault by frequently by nurses, hospital staff, and Timm (2014) assault to physical violence. In the literature, the patient/patient’s relatives/clinical nurses/ administrators (31.1%) and less frequently Seibel (2014) the frequency of violence experienced by doctors were the most ones and the third (4.9% to 1.2%, respectively) by patients Ünal et al. (2012) nursing students is high. The clinical exposure grade was found to be statistically significant and their relatives, in our study, they were Clarke et al. (2012) of nursing students to violence was at a ratio between the grades more frequently experienced from physical/ Magnavita and Heponiemi of 34% in Italy, 35.3% in Iran, 42.2% in the verbal attack by patients/relatives and less (2011) United Kingdom, and 50.3% in Turkey. They frequently by physical nurses and doctors. are exposed to violence by the patient and The results of the study, relatively higher his family, faculty or hospital staff, nurses, and from other studies, may be partly explained instructors. It is also stated in the literature by differences in definitions of clinical that there is violence due to other nursing violence due to socioeconomic cultural students diversity of populations in other studies. Students may not be familiar with the definition of violence. (continued) ü ü Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Aghajanloo et al. (2011) Also, due to cultural values and norms in Turkey, especially in hospitals and/or clinics, Jackson et al. (2011) Çelebioğlu et al. (2010) universities have lower rates of violence Ferns and Meerabeau (2009) by staff; it may be explained because they are more obedient and respectful to senior elders. Although the nurse is a caregiver, the violence caused by hospital staff is a major concern. However, the causes of such violence are not well understood. Future research is needed to explain the factors contributing to such clinical violence and to identify intervention approaches to reduce violence in clinics. Research-based information on the causes and increasing nature of violent incidents will facilitate the planning of interventions Sharp instrument injures Zhang et al. (2018) The incidence of sharp instrument injuries In this study, 30.7% of the students Exposure to blood-borne pathogens, which (scalpel, scissor, etc.) Suliman et al. (2018) during the clinical applications of the students experienced sharp instrument injuries result in serious occupational diseases due and needle stick injury Budden et al. (2017) ranged from 18.1% to 84.0% in the literature. (scalpel, scissors, etc.), and 27.8% to needle stick injuries, is a potential risk Nawafleh et al. (2017) Smith and Leggat reported that the incidence experienced needle stick injuries after factor for nursing students. In this study, Quynh and Einhellig (2017) of sharp instrument injuries was 15.0% in taking blood samples/IM, IV, SC injection sharp instrument injury and needle stick Byk et al. (2016) Taiwanese students and 18.0% in Italian nursing injury’s results are higher than studies in Yıldırım and Özpulat (2015) students, and these rates ranged from 22.0% other countries but are close to similar Prasuna et al. (2015) to 72.0%. The prevalence of sharp instrument studies in Turkey. The injuries rate is high Ünver et al. (2012) injuries among nursing students was 35.0% in because students are at the risk of exposure Irmak and Baybuga (2011) Singapore, 30.0% to 33.0% in the United States, to occupational hazards in clinical practice Karadag (2010) 29.0% in Australia, 24.0% in France, and 12% in due to lack of trainers and an increasing Smith and Leggat (2005) the United Kingdom. Students are particularly number of students working in many active susceptible to needle stick injuries due to lack areas. Increasing the number of simulation of awareness of workplace safety and having laboratories, increasing laboratory hours limited clinical experience. The frequency of in nursing curricula, and decreasing clinical needle stick injury studies conducted in Turkey practice hours may decrease the students’ ranges between 19.4% and 52.5%, and in other exposure to clinical risks countries ranged from 13.9% to 59.9% PPE usage problems in Duminy (2010) In the studies conducted, it was stated that When the problems experienced by the Our findings are consistent with the clinical practice Ganczak and Szych (2007) the compliance of surgical nurses to the use students about the use of PPE in clinical literature. In our study, as in the literature, of PPE varies according to PPE, that there is applications were investigated, students gloves are the most commonly used PPE, not enough PPE in the study areas, and that if managed with a single glove because they while difficulties in the procurement of there is a deficiency in protective equipment, were scarce (42.1%) or rebuked (37.1%) with PPE are the main factors. A comprehensive compliance with standard measures may be each glove replacement, and had to treat/ understanding of infection prevention and affected. In a study by Ganczak and Szych, care for more than one patient during the control is important for nurses who want gloves were shown to be the most commonly internship with one glove (36.4%); because to protect themselves, patients, colleagues, used protective equipment that reflects the there was no mask, they had to enter the and the general public from infection. PPE, long-term tradition of wearing. However, room of the patients with respiratory disease such as gloves, gowns, and/or gowns and regular glove use was reported to be 17% in without mask (22.1%). eye protection, is an important aspect of the survey participants. In the study of Ganczak infection prevention and control for all and Szych, 9% of the nurses reported health care personnel, including nurses. (continued) 12 Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments that they wear protective goggles regularly and In addition, they did not wear any gowns Occupational safety regulations require showed the lack of supplies as a reason for not and did not wear any goggles (44.2%) during employers to provide employees with using PPE body care because of the lack of gowns and adequate protection against harmful goggles substances, including microorganisms, and this issue needs to be addressed with institutional support. Supplying adequate equipment can result in high costs, but the resulting cost will be much lower than all costs associated with the treatment of health care workers Findings and symptoms in Abou-Elwafa et al. (2017) In the literature, it was determined that nursing Students reported that they experienced Our results are consistent with the study of clinical practice Huang et al. (2016) students had musculoskeletal complaints, symptoms of most anxiety and irritability Abou-Elwafa et al. The higher incidence of Eljedi (2015) mostly leg/foot (55.8%) and back pain (46.7%). during their clinical practice (77.9%), symptoms in women may be that women In the study of Abou-Elwafa et al., it was headache (71.4%), increased tendency to are more vulnerable to the health impact of stated that musculoskeletal complaints and sleep (70.7%), exhaustion (68.5%), low back certain demands and constraints that they occupational injuries differed significantly and upper back pain (61.4%), and early fatigue face with patient care during clinical practice between female students (75.4%, 71.7%) (57.8%). It was found that the majority of the compared with male students (24.6%, 28.3%, students who experienced these symptoms respectively). In the study of Abou-Elwafa and injuries were females and second grade et al., 74% of the students reported that musculoskeletal complaints were more frequent in the legs/feet (55.8%) and back (46.7%) and that the musculoskeletal morbidity of women is higher than men Common areas of the Yıldırım and In the study of Omaç et al., the injury area in the As a result of these dangerous situations, Our results are consistent with the literature. the most injured body area of the students The high incidence of needle stick and sharp body injured in clinical Özpulat (2015) body of nurses was questioned and reported as practice Önder et al. (2011) the right hand (41.3%), the left hand (40.0%), the was found to be the forearm, wrist, hand, instrument injuries, which can be prevented and finger (52.8%). Students encountered by safe tool use, is thought due to the lack Omaç et al. (2010) arm (5.9%), and then the other regions (12%, 8—trunk, feet, legs). In the study of dangerous situations and were injured while of information on safe tool use applying the treatments in the clinic (54.3%), Önder et al., 18.6% of the nurses stated that they had hand–finger cuts, 6.4% of them had preparing drugs for treatment (41.4%), following vital signs (25%), giving general pinch–bruise wounds, and 13.8% of them had an accident in the form of needle prick. In the study care to the patient (22.1%), during the intervention in the emergency department of A. Yıldırım and Özpulat, the injury sites were questioned according to the frequency of injury: (22.1%), and closing the needle tip (20.7%) 65.0% (67 people) of the right hand, 32.0% (25 people) of the left hand, 2.1% of the arm, and 0.9% of other parts (trunk, leg, foot). They also reported that they were injured due to drug preparation for injector, lancet–scalpel use, injector, and ampoule fractures Chemical contacted in Abou-Elwafa et al. (2017) Worldwide, latex sensitivity is reported to be Hand antiseptic (89.2%) and latex (60.7%) Our results are consistent with the literature. clinical practice Elewa and Sahar Banan 1% in the general population and 5% to 12% were found to be the most commonly In this study, it was shown that female (2016) for occupational latex sensitivity. In a study contacted chemicals by students in clinical students were at high risk in terms of latex Kartal et al. (2015) conducted with students, the frequency of skin practice. In this study, students experienced allergy as it conforms with similar studies/ Lamberti et al. (2015) problems related to the use of latex gloves symptoms of skin irritation (14.2%); burning literature. Katrancha and Harshberger was reported to be 4%, which was lower in in the eyes, nose, and throat; bleeding from (2012) students than in health care workers. the nose (12.1%); and allergies (12.1%). (continued) 13 Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Çelik et al. (2013) Elewa stated that most nursing students had It was found statistically significant that the It has been reported in the studies about the Yalçın et al. (2011) irritation in their eyes, nose, and throat majority of the students who experienced continuation of latex contact, and the lack Eliakimu et al. (2008) due to natural latex gloves and other latex- these symptoms and injuries were female and of treatment increases the risk of systemic Diéguez et al. (2007) containing medical devices. Similarly, the second grade allergic reactions to skin irritations due Leggat and Smith (2007) students were exposed to chemical hazards to the use of latex gloves. It is important and experienced allergic reactions ranging to identify individuals who are at risk for from skin rash, asthma, dermatitis, to severe susceptible or latex allergy during school itching and irritation. Eliakimu et al. reported years and to take preventive measures in that the use of chemicals such as antiseptics these individuals to prevent life-threatening and disinfectants used in hospitals for cleaning reactions such as anaphylaxis in the future contributes to the burning of the skin. In the study by Kartal et al., dermatitis-like skin lesions were the most common clinical complaints developed after contact with medical latex products. Allergic complaints due to latex like dermatitis and urticaria in health school students are also in the foreground in similar studies in the literature. The study of Kartal et al. reported that nursing students had complaints of swelling around the eyes, mouth, and throat, and had complaints of severe respiratory system problems 2. Detection of OHS situation in nursing students In this study, almost all of the students In Turkey, with the second article of the Having knowledge Elewa and Sahar Banan (2016) In the literature, it was observed that the of OHS and Boucaut and Cusack (2016) students had a wide awareness of OHS despite (95.7%) stated that they have knowledge of Occupational Health and Safety Law OHS, and they showed as information source No. 6331, Occupational Health and Safety information sources Burdurlu (2014) the lack of clinical experience in the first years. Al-Dabbas and Abu-Rmeileh In the third year, it was found out that they of the OHS course (52.8%) Trainings are compulsory for the students had knowledge and experience on OHS issues with the inclusion of the students accepted (2012) Baniyousef et al. (2015) besides awareness. It was also revealed that to do internships in the workplaces within nursing students gained their knowledge about the scope of employee safety. It can be Aluko et al. (2016) www.mevzuat.gov.tr/ occupational safety in their courses. In the assessed that is because of that law the study conducted in Palestine, it was reported students got training before clinical practice MevzuatMetin/1.5.6331.pdf Tavolacci et al. (2008) that the majority of the participants obtained information about blood-borne infectious disease mainly from official lectures and then books. In the study conducted in Saudi Arabia, it was stated that the source of information was the education curriculum. It was seen that in Burdurlu’s (2014) study, 33.1% of the participants had good knowledge of OHS and 36.5% received OHS training. Aluko et al.’s study found 57.6% had high knowledge of occupational hazards, 42.6% low knowledge of occupational hazards, 58% acquired through professional training, 67% aware of job aids, and 93% aware of PPE (continued) 14 Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Knowing the definition Çelikalp et al. (2017) To prepare the students for work–life during In this study, 90.7% of the students knew the This ratio (90.7%), which is high in our study, of occupational disease the education process and to predict the definition of occupational disease is important in terms of showing that the dangers they may face in their professional life, training given to students on workplace risk the students should have knowledge about factors is effective. However, low results in occupational diseases and preventive practices. the literature reveal the necessity of training In the study conducted by Çelikalp et al. programs on the subjects (2017), it was determined that the knowledge level of the students about the definition of occupational accidents and occupational diseases before education was very insufficient. The same study found that 12.9% of the health workers were fully aware of their occupational risks and needed serious consideration Wanting an OHS class Aksoy et al. (2013) Aksoy et al. (2013) evaluated the OHS training In our study, 79.3% of the students wanted As is seen in the studies, OHS training should to have courses in the curriculum related to be compulsory in terms of providing OHS, in curriculum Al-Momani et al. (2013) given to students studying in some associate Yang et al. (2007) degree programs, and the students agreed that worker health and safety and the willingness of the students in this regard can be considered as a reflection of OHS courses they took during the associate degree programs increased their occupational their lack of knowledge about OHS safety awareness. Al-Momani et al. described training as an important factor in reducing the risk of needle stick and sharp instrument injuries. Yang et al. found that the rate of needle stick and sharp instrument injuries in nursing school students decreased to 25.2% after education from 50.5% Knowledge of OHS’ Burdurlu (2014) Burdurlu (2014) reported that almost half In this study, 43.6% of the students stated they Even if there is somehow knowledge of OHS regulations/OHS’ (48.1%) of the health workers receiving OHS knew about the OHS law in our country regulations, it is not effective to protect commitments, novelties, training knew their rights in the event of an and 30.7% about the legal obligations and nursing students without the proper rights of patients, and occupational accident; it is stated that those rights that may arise as a result of dangerous acquisition of OHS culture. Informative health workers who have knowledge about the regulations do situations that both employees and patients approach, practice, and monitoring in not know much about innovations may experience. Although the students OHS training may have a positive effect on know and say that OHS is related to their behavioral acquisition and OHS culture professions, the percentage of students who have knowledge of the innovations introduced by the OHS regulations is 7.1% 3. Evaluation of risk control Giving required Duminy (2010) In the studies conducted in the literature, it was In this study, 97.8% of the students stated The main role of PPE is to decrease the risk sensitivity to PPE usage Ganczak and Szych (2007) stated that the compliance of surgical nurses to that they showed sensitivity to use PPE in of microorganism transmission between in clinical practice and the use of PPE varies according to PPE types, clinical applications, and most of them health care workers and patients. Even so, thinking of the nursing that there is not enough PPE in the study areas, (97.1%) stated that their profession there is a high score of students’ sensitivity profession requires PPE and that if there is a deficiency in the protective requires PPE to use PPE; their PPE usage scores (in the usage equipment, compliance with standard measures “Identifying Threats” section) show that PPE may be affected may not be effectively used as intended (continued) ü ü Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments In the study of Burdurlu (2014), the majority of 100% of the students stated that they wear It can be said that women are careful to take PPE equipment used in Burdurlu (2014) clinical practice Timm (2014) the employees (71%) were using protectives gloves as PPE equipment and 90% of the precautions against job risks compared with Magnavita and Heponiemi such as wearing gloves, masks, and so on, students wear masks as PPE equipment. men, that the sense of protection is more (2011) during their work. The study conducted by Consistent with the study of the Çalışkan, intense because of the role of women and Altıok et al. (2009) Çalışkan and Akdur was seen as individual in our study, female students used PPE at mother and they give importance to using Gngör Özdemir and Şengöz measures taken by the nurses against the risks higher levels compared with men, which is PPE (2012) they face in their working environments; the statistically significant Çalışkan (2017) use of gloves and masks was 62.8%, infection prevention 33.4%, compliance with personal hygiene rules 30.4%, and vaccination 13.1%. Önder, Ağırbaş , Yaşar, and Aksoy stated that those who regularly use PPE against occupational risks are 13.4% among physicians and 32.3% among nurses. In their study, Altıok et al. found that the rate of use of protective materials among health workers, in general, was quite high (72%). In their study, Gngör Özdemir and Şengöz determined the usage of protective materials as gloves 45%, mask 19%, gown 17%, and glasses 4%, respectively. In Çalışkan’s study, the behaviors of the personnel to use PPE according to their gender; women’s behaviors of using PPE were higher than men. 4. Assessment Hazardous situation Yeshitila et al. (2015) In the literature, needle stick and sharp Students encountered dangerous situations Numerous obstacles may arise during clinical exposed in clinic A. Yıldırım and Özpulat (2015) instrument injuries occur during injection, and were injured while applying the treatment. It has to be proper procedures Amini et al. (2016) when the patient moves suddenly; during treatments in clinical practice (54.3%), to follow treatments in the clinical Kepenek and Şahin-Eker intravenous administration; and during the preparing drugs for treatment (41.4%), environment. The nursing students should (2017) transportation or disposal of waste. It has following vital signs (25%), giving general also be trained to follow procedures Kurşun and Arslan (2014) been found in the literature that needle stick care to the patient (22.1%), during emergency Nawafleh et al. (2017) injuries often occur when preparing treatment room intervention (22.1), and closing the Abou-Elwafa et al. (2017) and closing the injector cap needle tip (20.7%) Documentation in case Suliman et al. (2018) Similarly, the frequency of noninjury reporting Nevertheless, the ratio of students who The necessity of keeping records and of dangerous situation Nawafleh et al. (2017) among nursing students ranged from 43.0% to documented a dangerous situation in clinical inspections related to OHS systems, in clinic/taking rest/ Prasuna et al. (2015) 86.3%. The low rate of reporting of accidents practice was as low as 22.9%. The students occupational accidents, occupational notified person Azadi et al. (2010) and injuries of students is important in terms (54.3%) explained the dangerous situation diseases, and dangerous situations in Altıok et al. (2009) of making it difficult to determine the risks that mostly to the clinical nurse and stated that enterprises is considered as a subject Talas (2009) students face in clinics. In a study conducted in the clinical nurse was immediately interested accepted by both national and international Taiwan, it was stated that only 39.0% of nursing experts. The rules regarding the content students reported after injury. In the study of of the data to be collected regarding Azadi et al. on the incidence of needle stick occupational accidents are stated in the and sharp instrument injuries that were not “Recording and Notification of Occupational reported among Iranian nurses, it was found Accidents and Diseases” published by ILO in that approximately 1996 (Uçak, 2009). (continued) ü ü ü ü Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Byk et al. (2016) 45% of the students were injured with needle It is stated that if accidents occur in stick and sharp instrument injuries at least the workplace where the student is an Yang et al. (2004) www.mevzuat.gov.tr/ once during their clinical experience and about apprentice or trainee, the Social Security MevzuatMetin/1.5.6331.pdf 36% of these injuries were reported. Injury Institution should be notified within three Uçak (2009) reporting rates were 12.7% in the study of working days by the second paragraph of Altıok et al., 43.9% in the study of Talas, and Article 14 of the Occupational Health and 14.8% in the study of Byk et al. Safety Law No. 6331 in Turkey. Although notification of accidents is mandatory by law in Turkey, the notification rates were low. It is considered that it is because of ineffective OHS training received by the students involved in occupational accidents and the ignorance of supervisors who guide students Reasons for occupational Burdurlu (2014) In the literature, the reasons for occupational In this study, the students stated that the The results of this study confirm previous accidents Souza-Borges et al. (2014) accidents and occupational diseases include most common causes of occupational studies. That reason comes from the Yeshitila et al. (2015) inexperience; not using protective, carelessness, accidents were inattention (84.3%) and characteristics of the working environment. Huang et al. (2016) long working hours; and intensive work intensive work tempo (81.4%), while they Hospitals are intense working areas, tempo. In the study of Burdurlu (2014), health stated that their priority was their health and therefore there are lots of things workers stated that occupational accidents (65%) when faced with a dangerous job happening at the same time and also require and occupational diseases were preventable monitoring activities for 24 hr. It is highly and for occupational accidents stated reasons possible for an instant change in the working as intensive work tempo, long working area. Intensive work tempo is indispensable hours, lack of protective use, carelessness, and could bring inattention with time. and inexperience. Lack of supervision of the Organizational measures and enough academician, technical mistakes made by the health workers could decrease risks for student, crowded working environment, occupational accidents and lack of skills are also mentioned for occupational accidents Note. OHS = occupational health and safety; ELISA = enzyme-linked immunosorbent assay; DaBT = diphtheria, pertussis, tetanus; IM = intramuscular; IV = intravenous; SC = subcutaneous; PPE = personnel protective equipment. ILO = International Labour Organization. Eyi and Eyi 17 should take an extra class for OHS especially for health care References workers, and after clinical practice, students could discuss Abou-Elwafa, H. S., Khashaba, E. O., El-Gilany, A.-H., & the work environment in the class and increase their aware- El-Raouf, S. A. (2017). Work profile and associated health ness. In hospital settings and in clinical practice, it should hazards among nursing students at Mansoura University, be given OHS pretraining before starting any clinical prac- Egypt [Profil professionnel et risques sanitaires associés parmi les étudiants en soins infirmiers de l’Université de Mansoura, tice by a responsible OHS person, and nursing students Égypte]. EMHJ-Eastern Mediterranean Health Journal, 23(2), should be monitored and checked. It is recommended that 100–109. https://apps.who.int/iris/handle/10665/260376 all students take OHS training, including the wide con- Adesunkanmi, A. K., Badmus, T. A., & Ogunlusi, J. O. (2003). cepts of the recommended OHS education before and after Accidental injuries and cutaneous contaminations during clinical practice. Both the previous literature and our study general surgical operations in a Nigerian teaching hospital. reveal that there is a lack of common understanding of East African Medical Journal, 80(5), 227–234. http://dx.doi. OHS for health students, regarding how to educate stu- org/10.4314/eamj.v80i5.8691 dents in OHS and how to apply a professional approach to Aghajanloo, A., Nirumand-Zandi, K., Safavi-Bayat, Z., & Alavi- OHS in medical areas. It is also recommended that amend- Majd, H. (2011). Clinical violence in nursing students. Iranian ments be added to the required legal regulations in schools Journal of Nursing and Midwifery Research, 16, 284–287. and clinical practice areas and that students’ OHS situa- https://europepmc.org/article/pmc/pmc3583097 Akan, A., Toyran, M., Erkocoglu, M., Kaya, A., & Kocabas, C. tions be tracked. N. (2012). The prevalence of allergic contact sensitization of practicing and student nurses. The International Journal of Limitations of the Study Occupational and Environmental Medicine, 3, 10–18. https:// www.theijoem.com/ijoem/index.php/ijoem/article/view/121 The present study is a pilot study with small focus group Aksoy, S., Çevik, B., & Çakicier, N. (2013). Gümüşova Meslek numbers. However, the participating students provided valu- Yüksekokulu’nda İş Güvenliği Bilincinin Belirlenmesi able information about their impressions and experiences on [Determination of occupational safety awareness in Gümüşova various OHS issues. We recognize that the views presented Vocational School]. Düzce Üniversitesi Bilim ve Teknoloji in small numbers may not represent the views of the wider Dergisi, 1(1), 69–76. https://dergipark.org.tr/tr/pub/dubited/ issue/4806/66180 student population. Although the results are not generalized Al-Dabbas, M., & Abu-Rmeileh, N. M. (2012). Needlestick injury to other nursing students, the findings provide useful materi- among interns and medical students in the Occupied Palestinian als for consideration by other nursing schools and health sci- Territory. Eastern Mediterranean Health Journal, 18(7), 700– ences faculty who have students in clinical placement. 706. http://hdl.handle.net/20.500.11889/3239 Findings and related literature support the need for further Al-Momani, S. M., Hdaib, M., & Najjar, Y. W. (2013). Sustained studies in this field. reduction in needlestick and sharp injuries among nursing stu- dents: An initiative educational program. Educational Research, Authors’ Note 4(9), 654–658. http://dx.doi.org/10.14303/er.2013.214 Altıok, M., Kuyurtar, F., Karaçorlu, S., Ersöz, G., & Erdoğan, S. (2009). This study was submitted as oral presentation in the Union of Sağlık çalışanlarının delici kesici aletlerle yaralanma deneyimleri Thrace Universities 2nd International Health Sciences Congress in ve yaralanmaya yönelik alınan önlemler [Healthcare workers Tekirdağ/Turkey on November 15–17, 2018. experiences with sharps and needlestick injuries and precau- tions they took when injuring]. Maltepe Üniversitesi Hemşirelik Acknowledgments Bilim ve Sanatı Dergisi, 2(3), 70–79. https://www.researchgate. We would like to thank the students for participating in this study. net/profile/Erdogan_Semra/publication/239601046_Saglik_ We would like to thank Editage (www.editage.com) for English Ca lisa nla rin in_D el ici _Ke sic i_A let ler le_ Yar ala nma _ language editing. Deneyimleri_ve_Yaralanmaya_Yonelik_Alinan_Onlemler/ links/54d90bb10cf24647581d5493.pdf Aluko, O. O., Adebayo, A. E., Adebisi, T. F., Ewegbemi, M. K., Declaration of Conflicting Interests Abidoye, A. T., & Popoola, B. F. (2016). Knowledge, attitudes The author(s) declared no potential conflicts of interest with respect and perceptions of occupational hazards and safety practices in to the research, authorship, and/or publication of this article. Nigerian healthcare workers. BMC Research Notes, 9, Article 71. https://doi.org/10.1186/s13104-016-1880-2 Funding Amini, R., Soltanian, A. R., Ebrahimkhani, A., & Beigyan, M. (2016). Investigating the use of safe injection guidelines The author(s) received no financial support for the research, author- after needle stick and sharp instruments injuries in Nursing & ship, and/or publication of this article. Midwifery students of Hamadan University of Iran. 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Needlestick and sharps injuries among nurs- Dermatitis, 70, 44–55. https://doi.org/10.1111/cod.12131 ing students in Nanjing, China. Workplace Health & Safety, Xiong, X., Li, M., Jiang, Y., Tong, X., & Peng, Y. (2017). Study 66(6), 276–284. https://doi.org/10.1177/2165079917732799 of blood exposure-related mental health illness among clini- cal nurses. Frontiers of Medicine, 11(1), 147–151. https://doi. Author Biographies org/10.1007/s11684-016-0481-8 Semra Eyi is an assistant professor at Trakya University, Keşan Yalçın, A. D., Cakin, O., Polat, H. H., & Terzioglu, E. (2011). Hakkı Yörük School of Health. Her research interests include surgi- Occupational disease of healthcare workers: Latex allergy. cal nursing and care, and nursing education. Erciyes Tip Dergisi/Erciyes Medical Journal, 33(2), 103– 110. https://www.researchgate.net/publication/230554088_ İbrahim Eyi is a doctoral student at Istanbul Aydın University, Occupational_Disease_of_Healthcare_Workers_Latex_Allergy Institute of Science and Technology, Department of Occupational Yang, Y. H., Liou, S. H., Chen, C. J., Yang, C. H., Wang, C. L., Health and Safety. His research interests include occupational Chen, C. Y., & Wu, T. N. (2007). The effectiveness of a training safety matters on all subjects, including medical areas. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png SAGE Open SAGE http://www.deepdyve.com/lp/sage/nursing-students-occupational-health-and-safety-problems-in-surgical-1BCA06wJyt

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DOI: 10.1177/2158244020901801
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Abstract

Student nurses are exposed to hazards in terms of occupational health and safety (OHS) problems in Turkey. Researching these problems in the clinical setting, improving the health and safety of student nurses is an issue that needs to be investigated. The aim of this study is to present OHS-related impressions and OHS experiences of nursing students in relation to the risk assessment process and from an educational perspective. A descriptive and cross-sectional study was conducted with 140 students at a nursing school. The study indicated that almost all of the students’ OHS knowledge and awareness level were low, were exposed to contact with blood and body fluids as most dangerous situations, have difficulties in the provision of personnel protective equipment (PPE), were subjected to verbal assault, and experienced anxiety and irritability. They encountered dangerous situations applying treatment in the clinic, preparing drugs, following vital signs, giving general care, and during the intervention in the emergency room, and experienced back pain, headache, increased tendency to sleep, fatigue, and forearm, wrist, hand, and finger injuries. Because of contact with hand antiseptic/latex, skin irritation, and burning eyes, nose, and throat, allergy symptoms were detected. Carelessness and intensive work tempo were the most common causes of workplace accidents. The clinical practice areas are limited in terms of OHS; students are exposed to physical, psychological, and chemical risks with respect to OHS, and they are most psychologically affected by experiencing anxiety and irritability, as well as physiologically, and have symptoms similar to burnout syndrome; they are at risk of getting burnout syndrome. Keywords nursing, behavioral sciences, student nurse, occupational health and safety accidents, protective equipment usage, clinical practice and urgent interventions are intensive (Erdağı & Özer, 2015). Introduction Nurses, who are the most important members of the health As the health sector is one of the most risky groups in terms care team, who provide direct care to the patient in surgical of occupational accidents and diseases, the World Health units, are exposed to numerous occupational hazards, such as Organization emphasizes that hospitals are the primary pri- drugs, chemicals, infectious agents, lack of materials and ority in preventing workplace hazards (Cheah et al., 2012; ergonomic conditions, heavy working, and excessive work- Elewa & Sahar Banan, 2016). To draw attention to the impor- load, and also they have physical (needle stinging, penetrat- tance of the occupational safety in hospitals, the International ing stab injuries, musculoskeletal disorders and pain, cancer Council of Nurses published themes of the week for nurses resulting from night work, hearing loss, and varicose veins), as “Positive Work Environments, Quality Workplaces = chemical (skin problems, latex allergies), biological (infec- Quality Patient Care” (International Council of Nurses, tious diseases), and psychological (stress, burnout syndrome, 2016). Clinical environments in hospitals consist of intense mental health problems, sleep disorders) problems (Anandh work hazards and risky environments, complex business pro- cesses, and the intensive use of technology (Cebeci, 2013; Trakya University, Edirne, Turkey Ulutaşdemir et al., 2015). The unit and characteristics of the 2 Istanbul Aydın University, Turkey clinic also affect the possibility of encountering hazards Corresponding Author: (Parlar, 2008). Surgical clinics are environments with high- Semra Eyi, Assistant Professor, Department of Nursing, Keşan Hakkı risk closed units such as operating rooms and intensive care Yörük School of Health, Trakya University, Edirne 22880, Turkey. units (ICUs), where critical thinking, quick decision making, Email: semra_il@yahoo.com Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open et al., 2015; Attar, 2014; Attarchi et al., 2014; Bernal et al., being exposed to occupational hazards in clinical practice 2015; Broadwater & Brueck, 2017; Elewa & Sahar Banan, due to lack of instructors (Council of Higher Education, 2016; Hamnerius et al., 2018; Rathore et al., 2017; Samulin 2018). Student nurses are at risk because of diseases and Erdem et al., 2017; Xiong et al., 2017). injuries resulting from clinical applications especially in Literature shows that nursing students face numerous surgical clinics such as operating rooms and ICUs, where occupational health hazards as qualified nurses face during critical thinking, quick decision making, and emergency their work (Boucaut & Cusack, 2016). In particular, nursing interventions are intensive. Besides, some nursing students students may be experiencing stress and anxiety (Taşdelen & who do not have a good economic situation face financial Zaybak, 2013; N. Yıldırım et al., 2017) and exposed to occu- pressures to work in paid work during the time they have pational hazards due to their underdeveloped abilities, lack of left their classes and this causes them to experience fatigue. knowledge, and other professional health professionals in the In the literature, it is stated that this fatigue affects the aca- clinical setting (Cheung et al., 2015). Like qualified nurses, demic achievement of students, and they are not prepared nursing students are exposed to violence from verbal/nonver- enough for the nursing profession (Rella et al., 2009); it is bal to physical violence by fellow students, faculty or hospital also reported in the literature that nursing students are prone staff, patients, and patients’ relatives in surgical clinical set- to experience stress in their clinical training and theoretical tings (Seibel, 2014). It is also reported in the literature that training (Pulido-Martos et al., 2012). The fatigue and stress nursing students are exposed to patient infections as a result of the students cause accidents to increase, and the safety of of stab wounds and needle stinging (Scaggiante et al., 2013). the patients remains under threat. The occupational health Dermatitis, often caused by washing hands and wearing and safety (OHS) issue is an important component of clini- gloves, is another occupational situation experienced by nurs- cal practice skills, which reflects what student nurses have ing students (Akan et al., 2012; Visser et al., 2014). Nursing learned in theoretical practice and theoretical knowledge. students, like qualified nurses, face difficulties with transport, Therefore, it is vital that student nurses work safely during carry of patient and equipment and musculoskeletal disor- clinical practice. Besides, academicians and educators have ders. Researchers in the United Kingdom and Australia sug- responsibilities for students, including the OHS risks that gest that students face difficulties in safe handling practices in their students may face in clinical practice. clinical situations; some nursing students have experienced As a result of the reviewed literature, in summary, the fact severe low back pain due to lifting and bending characteris- that nursing students are more weighted in surgical clinical tics (Cornish & Jones, 2010; Kneafsey et al., 2012; Mitchell applications and take a more active role in clinical applica- et al., 2008). Nursing education in universities in Turkey tions especially in their second and third years of education requires 4 years of full-time university study and 4,600 hr; period clearly shows OHS is a matter of importance and seri- 50% includes theoretical training, and 50% includes clinical ous concern. practice training. Clinical practice, which covers an important In this study, it is aimed to present the views and experi- part of education, is an intensive part of the contemporary ences of the student nurses about the OHS and OHS experi- nursing curriculum and is an essential element of nursing ences in surgical units in relation to the risk assessment and education. This training is conducted in a variety of clinical to evaluate them from an educational perspective. settings that provide the basis for the continuous development of students’ critical thinking and decision-making skills; it Study Aim also improves professional practice competence (Ören & Zengin, 2019). In Turkey, during the first year of university The aim of this study is to gather information about occupa- programs (consisting of a year of two semesters), students tional accidents, occupational diseases, and problems related take lessons in basic science courses (anatomy, including to OHS during clinical practices in the second and third years physiology and biochemistry) and “Basic Principles and of the education in which the surgical clinical applications Practices of Nursing Courses.” are more weighted and the students have more active role in In the second and third years, there are 8 hr of theoretical the clinical practices; to provide information about nursing courses and 14 hr of clinical practice for Surgical Nursing, students’ level of knowledge and awareness about OHS, to Internal Medicine Nursing, Obstetrics and Gynecology, determine the status of compliance with OHS measures in and Pediatric Nursing. For these clinical courses, students relation to the risk assessment; and to evaluate them from an attend formal clinical practice in surgical clinics/areas of educational perspective. The research questions are as hospitals 2 or 3 days a week (16–24 hr). For this reason, in follows: the second and third years of their education, students are actively involved in clinical practice in surgical units. Research Question 1: What occupational threats and Students can participate in clinical practice under the risks are experienced by nursing students in clinical prac- supervision of academicians. The number of nursing tice? (identifying threats) schools studying in Turkey has increased in recent years. Research Question 2: What level of awareness and Unfortunately, the number of academicians has not knowledge do nursing students have in relation to OHS? increased at the same level. This raises the risk of students (detection of OHS situation in nursing students) Eyi and Eyi 3 Research Question 3: What is nursing students’ level of and extend students’ patient care to self-care. The first stage compliance with OHS measures and personnel protective of the Nursing Process involves collecting, organizing, veri- equipment (PPE) usage? (evaluation of risk control) fying, and documenting data; this stage is similar to the haz- Research Question 4: What are nursing students’ ard identification of the risk assessment process. The thoughts about hazard sources and preventive measures? “Planning” and “Implementation of Interventions” stages of (assessment) the Nursing Process include both the risk assessment and control stages of Risk Management to prevent or reduce harm to both itself and staff. The final stage of both models Method is “Assessment.” Comparing the similarities between the Nursing Process model and the risk assessment process can Survey Design facilitate nursing students to consider their safety, particu- This was a descriptive design that used a self-administered larly by encouraging students to consider self-care and questionnaire, developed specifically for this study. patient care as part of their clinical logic processes (Boucaut & Cusack, 2016). Then, 10 students who did not participate in the study Sample Group were given a questionnaire, and questions that were not Students enrolled in a health college consisted of the popula- understood in this pilot test were rewritten. The question- tion of the study. A questionnaire was applied with a sample naires were given to the students on the first day of their visit of nursing students performing hospital clinical rotations. to the hospital between February and June 2018, and col- The population of the study consisted of 140 students study- lected on the last day of clinical rotations (clinical rotations ing in the second and third years of the nursing department. are totally 11 weeks). As the whole population was taken as a sample group, no The questionnaires were distributed by academicians who sampling method was used. The first-grade students who were not part of the research, and explained the purpose of take university basic science courses (including anatomy, the study and how to complete the form. physiology, and biochemistry) and “Basic Principles and Practices of Nursing” and fourth-grade students who take Data Analysis Public Health Nursing and Mental Health Nursing courses were excluded from the study because they did not attend The data were analyzed using the SPSS 21 computer soft- clinical practice in surgical units. ware package (SPSS, Chicago, IL, USA). Percentages and the chi-square test were used in the evaluation. The p value of <.05 was considered to be statistically significant. Data Collection and Measurement Tool The researchers developed a questionnaire based on the Ethical Considerations research knowledge in the literature and the experience of the researchers (in consultation with the nursing teacher, aca- The required written permission was received from the facil- demician, hospital nurse, and OHS specialist). There are 29 ities for conducting the study (October 12, 2017, No. questions in the questionnaire: four questions to determine 33505391-044-E.167490). All participants provided students’ demographic characteristics and 25 questions to informed written consent after the research aim had been measure their attitudes and awareness about OHS in which explained to them. Before starting the survey, the students they explain the problems they face in the clinical practice were informed about the research topic and given instruc- environment, and the answers given are classified under four tions about form. The students were informed that participa- subheadings (identifying threats, detection of OHS situation tion in the research was voluntary, that they were free to in nursing students, evaluation of risk control, and assess- complete the form without any limitations, that they would ment) (Table 1). not be rewarded or punished for participating in the study, Expert opinion was obtained to determine whether the and that this research would have no impact on their grade. It questions were appropriate for the study and whether the was also said that data obtained from the questionnaire would information requested was sufficient. All questions were not be used anywhere else from research and would remain analyzed and coded in such a way that each author indepen- confidential. dently identified the risk within the scope of risk assessment, categorizing them under identifying threats, detection of Results OHS situation in nursing students, evaluation of risk control, and assessment subheadings. Risk assessment, as Boucaut The findings were handled within the framework of risk and Cusack (2016) point out, allows students to link the assessment, identifying threats, detection of OHS situation Nursing Process and the risk assessment process, help them nursing students, risk control assessment, and evaluation incorporate OHS risk management into their clinical logic, subheadings. 4 Table 1. Questionnaire With Research Subheadings. Risk management framework Questionnaire Research questions 1. Identifying threats What kind of dangerous situations related to OHS did you encounter in clinical practice? What are the occupational threats and risks □ Contact with blood and body fluids □ Supervisor nurse/doctor physical/verbal assault regarding OHS faced by nursing students in □ Taking blood sample/IM, IV, SC needle stick after injection □ Falling, slipping, strain, material drop clinical practice? □ Academicians’ physical/verbal assault □ Contact with chemical additives or liquid material □ Colleagues’ physical/verbal assault □ Sharp-driller tool injury (scalpel, scissors, etc.) □ Patient/patient’s relatives’ physical/verbal assault □ Other . . . What kind of PPE usage problems did you have in clinical practice? □ Handle with single glove due to insufficient gloves □ Rebuked for changing gloves due to insufficient gloves □ Providing care to multiple patients with the same single glove □ Entering rooms of patients with respiratory contagious diseases without mask due to nonexistence of masks □ Not wearing gown or goggles due to nonexistence/insufficient number of gowns, goggles during body care □ Other . . . What kind of symptoms did you experience in clinical practice? □ Headache □ Early fatigue □ Exhaustion □ Increased tendency to sleep □ Hair loss □ Burning eyes and throat □ Nose bleeding □ Irritation on skin □ Allergy □ Breathing difficulty □ Crying □ Backache □ Anxiety, Anger If you were injured, what are the common areas of the body injured in clinical practice? □ Head (head, eye, face, etc.) □ Forearm, wrist, palm, finger □ Patella, calf, foot □ Mental damage □ Other Which chemicals did you have to contact in clinical practice? □ Hand antiseptic □ Formaldehyde, Glutaraldehyde, Ethylene oxide, Antineoplastic cancer drugs □ Latex □ Other 2. Detection of OHS Do you think OHS is related to your profession and affects it? □ No □ Yes What is the knowledge and perception of situation of nursing Do you have any knowledge about OHS regarding your profession? □ No □ Yes nursing students regarding OHS? students What are the information sources for OHS? □ In the lesson □ Academicians □ OHS course □ Meetings of subject matter experts □ Media □ Friends Do you know the definition of occupational disease? □ No □ Yes: It is . . . Do you want if there is an OHS class in the curriculum? □ No □ Yes Do you know the national regulation of OHS? □ 2547 (Law Nu) □ 657 (Law Nu) □ 926 (Law Nu) □ 6,331 (Law Nu) Do you know the OHS hazard classification of hospital service? □ Less Dangerous □ Dangerous □ Very Dangerous Do you know OHS commitments and rights of patients and health workers in case of a hazardous situation? □ No □ Yes Do you have knowledge of OHS regulation novelties? □ No □ Yes 3. Evaluation of risk control Do you give the required sensitivity to OHS rules in clinical practice? □ No □ Yes What is the status of nursing students to Do you think OHS measures taken are sufficient? □ No □ Yes comply with OHS measures and PPE use in As a student, do you give required sensitivity to PPE usage in clinical practice? □ No □ Yes clinical practice? Do you think that your profession requires PPE usage? □ No □ Yes What kind of equipment do you use in clinical practice? □ Glove □ Mask □ Gowns/Goggles □ Bone 4. Assessment What were you doing when you faced dangerous situations related to OHS in clinical practice? What are nursing students’ thoughts about the □ Giving regular care to patient □ Preparing drugs for treatment origin of risks, threat sources, and actions □ During intervention in emergency service □ Applying treatments in clinic □ Tracking vital signs in clinic during the OHS issue? □ Recapping needles □ During taking patient story □ Delivering laboratory samples (blood, urine, stools) of patient □ Taking patient to bed or transferring to another place □ During clinic medical visit/academician visit □Other Did you get any rest leave when you experienced clinical hazards? □ No □ Yes Whom did you notify in case of a hazardous incident? □ I didn’t tell to anyone □ I informed the supervisor nurse and he or she interested □ I told my responsible academician and he or she took an immediate interest Is it documented when you encounter a dangerous situation? □ No □ Yes What is the reason for occupational accidents, according to you? □ Intensive work tempo □ Lacking in attention □ Not using PPE □ Long working hours □ Inexperience What is your priority when you face a dangerous situation? □ I comply if our institution takes every precaution □ My own health is my top priority □ My priority is my job Note. OHS = occupational health and safety; IM = intramuscular; IV = intravenous; SC = subcutaneous; PPE = personnel protective equipment. Eyi and Eyi 5 Table 2. Students Identifying Characteristics and Vaccine Status. Character n % Sex Female 96 68.6 Male 44 31.4 Class 2 80 57.1 3 60 42.9 Working in a job after school for extra money Yes 20 14.3 No 120 85.7 Vaccines received before clinical practice Hepatitis B 79 56.4 DaBT 75 53.5 Measles, epidemic parotitis, German measles 13 9.3 Influenza 6 4.3 Varicella 5 3.6 Note. DaBT = diphtheria, pertussis, tetanus; DTaP = diphtheria, tetanus, and acellular pertussis. significant difference was found for these problems based on Characteristics of the Participants sex (p > .05), the difference between classes was statistically Of the participants, 68.9% were female and 31.4% male; significant (p < .05). 14.3% of students stated that they work in another job. Some Proportionate with the problems they faced, students students had been vaccinated in the hospital before begin- mostly experienced anxiety, anger (77.8%), headache ning clinical practice (Table 2). (71.4%), increased tendency to sleep (70.7%), exhaustion (68.5%), backache (61.4%), and early fatigue (57.8%) dur- Identifying threats. To identify threats, the students were ing clinical practice. The most commonly injured body areas asked the questions shown in Table 1. Students were exposed were forearms, palms, wrists, and fingers (52.8%). Most stu- to hazards related to OHS in clinical practice such as contact- dents who experienced these symptoms were in the second ing blood and body fluids (90.7%), physical/verbal assault class and female (Table 3); no statistically significant differ- by patients/patients’ relatives (60%), nurses and doctors ence for injuries was found based on sex (p >.05), but the (40.7%), sharp injuries (scalpel, scissors; 30.7%), and needle difference based on class was significant (p < .05). stick injuries (27.8%). Students who contacted blood, body Hand sanitizer (89.2%) and latex (60.7%) were the chem- fluids, chemicals, or other fluids and who experienced slip- icals most used by students. Most students who reported ping, falling, strain, and material fall were female and in the using these chemicals were female and in the second class, second class, whereas students who experienced physical/ and a statistically significant difference was found between verbal assault by patients/patients’ relatives/nurses/doctors, both sexes and classes (p < .05). sharp injuries (scalpel, scissor), and needle stick injuries were female but in the third class. The difference in problems Detection of OHS situation in nursing students. To measure encountered based on sex was not statistically significant nursing students’ OHS knowledge and awareness, subtitled (p > .05), while the difference between classes was statisti- “Detection of OHS situation in nursing students,” all stu- cally significant (p < .05). dents provided positive responses to the fact that OHS They identified the following problems with PPE usage: relates to and affects their profession. Regarding sociode- Students did not wear protective gowns or use goggles dur- mographic characteristics, most were female and in the sec- ing body care of patients (44.2%), either because gowns/ ond class, but this was not statistically significant (p > .05). goggles were unavailable or their availability was limited. Almost all students (95.7%) reported having some knowl- They had to use a single glove due to insufficient supply of edge of OHS, from sources such as OHS courses (52.8%), gloves (42.1%) or because they were reprimanded for chang- experts’ information meetings (48.5%), classes (37.1%), ing gloves (37.1%), they had to care for more than one academicians (37.1%), media (20.7%), and friends (15%). patient with a single glove (36.4%), and they had to enter the The difference between OHS information sources between rooms of patients with respiratory contagious diseases with- sex and classes was statistically significant (p < .05). Stu- out masks, due to the nonexistence of masks (22.1%). As dents knew the definition of occupational diseases (90.7%), shown in Table 3, most students who faced these problems the national OHS regulations/laws (43.5%), the hazard clas- were females in their third year. While no statistically sification of hospital services in OHS (32.1%), and rights 6 SAGE Open Table 3. Nursing Students’ Experiences of Occupational Hazards and Risks of OHS in Clinical Practices. Sex Class Female Male 2 3 Total Identifying threats n % n % n % n % n % Dangerous situations related to OHS encountered in clinical practice Contact with blood and body fluids 89 70.0 38 29.9 67 52.7 60 47.2 127 90.7 Patient/patient’s relatives’ physical/verbal assault 66 78.5 18 21.4 40 47.6 44 52.3 84 60.0 Supervisor nurse/doctor physical/verbal assault 44 77.1 13 22.8 20 35.0 37 64.9 57 40.7 Sharp-driller tool injure (scalpel, scissors, etc.) 33 76.7 10 23.2 18 41.8 25 58.1 43 30.7 Take blood sample/IM, IV, SC needle stick after 29 74.3 10 25.6 20 51.2 19 48.7 39 27.8 injection Falling, slipping, strain, material drop 25 59.5 17 40.4 24 57.1 18 42.8 42 30.0 Contact with chemical additives or liquid material 25 71.4 10 28.5 23 65.7 12 34.2 35 25.0 Colleagues’ physical/verbal assault 12 66.6 6 33.3 2 11.1 16 88.8 18 12.8 Academicians’ physical/verbal assault 5 50.0 5 50.0 4 40.0 6 60.0 10 7.1 χ /p value 32.534/p = .090 70.668/p = .000 PPE usage problems in clinical practice Not wearing a shirt or goggles due to nonexistence/ 48 77.4 14 22.5 30 48.3 32 51.6 62 44.2 insufficient number of shirts and goggles during body care Handle with single glove due to insufficient gloves 46 77.9 13 22.0 24 40.6 35 59.3 59 42.1 Rebuked for changing gloves due to insufficient gloves 41 78.8 11 21.1 20 38.4 32 61.5 52 37.1 Providing care to multiple patients with the same 35 68.6 16 31.3 21 41.1 30 58.8 51 36.4 single glove Entering rooms of patients with respiratory 24 77.4 7 22.5 17 54.8 14 45.1 31 22.1 contagious diseases without masks, due to nonexistence of masks χ /p value 7.432/p = .385 42.717/p = .000 Findings and symptoms in clinical practice Anxiety, anger 80 73.3 29 26.6 63 57.8 46 42.2 109 77.8 Headache 70 70.0 30 30.0 58 58.0 42 42.0 100 71.4 Increased tendency to sleep 65 65.6 34 34.3 51 51.5 48 48.4 99 70.7 Exhaustion 65 67.7 31 32.2 56 58.3 40 41.6 96 68.5 Backache 60 69.7 26 30.2 48 55.8 38 44.1 86 61.4 Early fatigue 58 71.6 23 28.4 51 62.9 30 37.0 81 57.8 Crying 17 85.0 3 15.0 15 75.0 5 25.0 20 14.2 Irritation on skin 17 85.0 3 15.0 7 35.0 13 65.0 20 14.2 Burning eyes and throat, nose bleeding 13 76.4 4 23.5 5 29.4 12 70.5 17 12.1 Allergy 14 82.3 3 17.6 12 70.5 5 29.4 17 12.1 Hair loss 11 68.7 5 31.2 9 56.2 7 43.7 16 11.4 Breathing difficulty 10 76.9 3 23.0 4 30.7 9 69.2 13 9.2 χ /p value 23.256/p = .107 37.038/p = .002 Common areas of the body injured in clinical practice Forearm, wrist, palm, finger 54 72.9 20 27.0 43 58.1 31 41.8 74 52.8 Anger 10 83.3 2 16.6 4 33.3 8 66.6 12 8.5 Patella, calf, foot 7 70.0 3 30.0 2 20.0 8 80.0 10 7.1 Head (head, eye, face, etc.) 4 66.6 2 33.3 2 33.33 4 66.6 6 4.2 χ /p value 5.986/p = .649 17.774/p = .023 Chemicals contacted in clinical practice Hand antiseptic 90 72.0 35 28.0 68 54.4 57 45.6 125 89.2 Latex 69 81.1 16 18.8 53 62.3 32 37.6 85 60.7 Formaldehyde, glutaraldehyde, ethylene oxide, 22 57.8 16 42.1 12 31.5 26 68.4 38 27.1 antineoplastic cancer drugs χ /p value 23.437/p = .003 24.363/p = .002 Note. OHS = occupational health and safety; IM = intramuscular; IV = intravenous; SC = subcutaneous; PPE = personnel protective equipment. Bold value significance that p < .05 and statistically significant difference was found. Eyi and Eyi 7 Table 4. Nursing Students’ OHS Knowledge and Awareness. Sex Class Female Male 2 3 Total Detection of OHS situation in nursing students n % n % n % n % n % Thinking of OHS is related to their profession and effects it Yes 96 68.5 44 31.4 80 57.1 60 42.8 140 100 Having knowledge of OHS True 93 69.4 41 30.6 76 56.7 58 43.2 134 95.7 χ /p value 1.926/p = .165 1.070/p = .301 Information sources of students for OHS OHS course 54 72.9 20 27.0 45 60.8 29 39.1 74 52.8 Meetings of subject matter experts 48 70.5 20 29.4 33 48.5 35 51.4 68 48.5 In the lesson 37 71.1 15 28.8 27 51.9 25 48.0 52 37.1 Academicians 33 63.4 19 36.5 34 65.3 18 34.6 52 37.1 Media 15 51.7 14 48.2 11 37.9 18 62.0 29 20.7 Friends 7 33.3 14 66.6 11 52.3 10 47.6 21 15.0 χ /p value 21.791/p = .001 13.593/p = .035 Knowing definition of occupational disease True 92 72.4 35 27.5 72 56.6 32 25.2 127 90.7 χ /p value 9.502/p = .002 0.113/p = .737 Wanting an OHS class in curriculum Yes 78 70.2 33 29.7 62 55.8 49 44.1 111 79.2 χ /p value 0.718/p = .397 0.362/p = .547 Knowing national OHS regulation/law True 47 77.0 14 22.9 37 60.6 24 39.3 61 43.5 χ /p value 3.605/p = .058 0.545/p = .460 Knowing OHS hazard classification of hospital service True 35 77.7 10 22.2 22 48.8 23 51.1 45 32.1 χ /p value 2.127/p = .145 1.583/p = .208 Knowing OHS commitments and rights of patients and health workers that might be result from hazardous situations Yes 26 60.4 17 39.5 19 44.1 24 55.8 43 30.7 χ /p value 1.684/p = .194 3.868/p = .049 Having knowledge of OHS regulation novelties Yes 3 30.0 7 70.0 5 50.0 5 50.0 10 7.1 χ /p value 7.434/p = .006 0.224/p = .636 Note. OHS = occupational health and safety. Bold value significance that p < .05 and statistically significant difference was found. and legal commitments (30.7%) that might result from Evaluation of risk control. Table 5 shows to evaluate risk con- workers and patients encountering dangerous OHS inci- trol measures. In total, 92.1% of students stated that they gave dents. A total of 79.2% of students wanted separate classes the required sensitivity to OHS rules. Most students thought regarding OHS as part of the curriculum. Although students that their profession required PPE usage (97.1%) and that reported having knowledge of OHS and thought that it they were sensitive enough to use PPE (97.8%). The differ- relates to their profession, only 7.1% were aware of new ence between sex and classes in this respect was not signifi- OHS regulations/laws. The difference between sexes and cant (p > .05). When asked what kind of PPE they used in classes with regard to knowledge of OHS and regulations, clinical practice, most reported using gloves (100%), masks desiring an OHS class as part of the curriculum and know- (90%), and bone (36.4%). As seen in Table 4, a significant ing the hazard classification of hospital services, was not difference was found between classes and sex with regard to significant (p > .05). A statistical difference was found for the scope of PPE that was used (p < .005). The percentage sex in resources of OHS knowledge, new OHS regulations, (11.4%) of students who felt that OHS precautions were suf- and knowing the definition of occupational illness, while a ficient for the problems they faced was very low. No signifi- significant difference was found for classes in terms of legal cant difference was found between classes in terms of commitments and rights resulting from dangerous incidents considering “OHS precautions sufficient” (p > .005), but a in OHS (p < .05; Table 4). significant difference was found between sexes (p < .005). 8 SAGE Open Table 5. Nursing Students’ Compliance With OHS Measures and PPE Usage. Sex Class Female Male 2 3 Total Evaluation of risk control n % n % n % n % n % Giving required sensitivity to OHS rules in clinical practice Yes 89 68.9 40 31.0 72 55.8 57 44.1 129 92.1 χ /p value 0.135/p = .713 1.184/p = .277 Thinking that OHS measures taken are sufficient Yes 5 31.2 11 68.7 10 62.5 6 37.5 16 11.4 χ /p value 11.675/p = .001 0.212/p = .645 Giving required sensitivity to PPE usage in clinical practice Yes 94 68.6 43 31.3 77 56.2 60 43.8 137 97.8 χ /p value 0.005/p = .943 2.299/p = .129 Thinking that nursing profession requires PPE usage Yes 94 69.1 42 30.8 76 55.8 60 44.1 136 97.1 χ /p value 1.737/p = .187 2.329/p = .127 PPE equipment used in clinical practice Glove 96 68.5 44 31.4 80 57.1 60 42.8 140 100.0 Mask 90 71.4 36 28.5 69 54.7 57 45.2 126 90.0 Bone 29 56.8 22 43.1 6 11.7 45 88.2 51 36.4 Gowns/goggles 30 85.7 5 14.2 8 22.8 27 77.1 35 25.0 χ /p value 15.788/p = .007 90.835/p = .000 Note. OHS = occupational health and safety; PPE = personnel protective equipment. Bold value significance that p < .05 and statistically significant difference was found. Assessment. The students mostly encountered occupational Conclusion hazards while executing treatment in clinics (54.2%), pre- This study has demonstrated that the conditions of OHS in paring drugs for treatment (41.4%), tracking fire-pulse- clinical practice areas are very limited for students. Students blood pressure (25%), maintaining general care (22.1%), in this study were exposed to physical, chemical, and physi- during intervention in emergency services (22.1%), and ological risks, and were mainly affected psychologically, fol- recapping needles (20.7%). No significant difference was lowed by physically. It was concluded that the students were found between sexes for work during dangerous situations at risk of getting burnout syndrome before they start the (p > .005), but the difference for classes was significant nursing profession by experiencing similar symptoms to (p < .005). Most students reported incidents related to burnout syndrome (anxiety and irritability, low back and occupational hazards to supervisor nurses (54.3%), and back pain, headache, increased tendency to sleep, exhaus- supervisor nurses showed instant interest. Students stated tion, early fatigue). Although nearly all students reported that occupational accidents were caused by lack of atten- having knowledge of OHS at the end of their study, their tion (84.2%) and intensive work tempo (81.4%). They knowledge and awareness of OHS were revealed to be very reported that when they face hazardous situations, they give low. Moreover, in terms of OHS-related hazardous incidents, priority to their health first (65%). No significant difference students were mostly exposed to contact with blood and was found for sex or classes in taking rest leave, the person body fluids and had serious problems accessing PPE, which to whom incidents were reported, documentation of inci- comprises a protective measure against exposure to physical/ dent, or practice type in which they were exposed to hazards verbal assault. They experienced anxiety and irritability in (p > .05; Table 6). clinical practice. Most students also reported symptoms of backache, headache, increasing tendency to sleep, exhaus- Discussion tion, and fatigue. The chemicals with which students had The discussion is handled within the framework of the risk most contact were latex and hand antiseptic, which they assessment process based on the findings, within the frame- reported to have caused skin irritation, burning eyes and work of the identifying threats, detection of OHS situation in throat, nose bleeds, and allergy. Students faced hazardous nursing students, evaluation of risk control, and assessment incidents when applying treatments in clinics, preparing subheadings, and presented in Table 7 in comparison with drugs, tracking fire-pulse-blood pressure, recapping needles, the relevant literature. and making interventions in emergency services. Most such Eyi and Eyi 9 Table 6. Nursing Students’ Thoughts on Hazard Sources and Compliance With OHS Precautions. Sex Class Female Male 2 3 Total Evaluation n % n % n % n % n % Practice made and hazardous situation exposed in clinic Applying treatments in clinic 52 68.4 24 31.5 36 47.3 40 52.6 76 54.2 Preparing drugs for treatment 43 74.1 15 25.8 31 53.4 27 46.5 58 41.4 Tracking vital signs in clinic 27 77.1 8 22.8 19 54.2 16 45.7 35 25.0 Giving regular care to patient 18 58.0 13 41.9 13 41.9 18 58.0 31 22.1 During intervention in emergency service 19 61.2 12 38.7 15 48.3 16 51.6 31 22.1 Recapping needles 19 65.5 10 34.4 15 51.7 14 48.2 29 20.7 During taking patient story 16 66.6 8 33.3 5 20.8 19 79.1 24 17.1 Delivering laboratory samples (blood, urine, stools) of 17 70.8 7 29.1 17 70.8 7 29.1 24 17.1 patient Taking patient to bed or transferring to another place 12 80.0 3 20.0 7 46.6 8 53.3 15 10.7 During clinic medical visit/academician visit 4 40.0 6 60.0 5 50.0 5 50.0 10 7.1 χ /p value 16.427/p = .288 32.127/p = .004 Taking rest leave for incidents in clinic Yes 2 33.3 4 66.6 2 33.3 4 66.6 6 4.2 χ /p value 3.326/p = .068 1.413/p = .235 Notified person in case of hazardous incident I informed the supervisor nurse and he or she was 50 65.7 26 34.2 48 63.1 28 36.8 76 54.2 interested I did not tell anyone 20 80.0 5 20.0 14 56.0 11 44.0 25 17.8 I told my responsible academician and he or she took 9 81.8 2 18.1 4 36.3 7 63.6 11 7.8 immediate interest χ /p value 4.484/p = .344 7.481/p = .113 Documentation in case of dangerous situation Yes 23 71.8 9 28.1 20 62.5 12 37.5 32 22.8 χ /p value 0.431/p = .512 0.566/p = 452 Reasons for occupational accidents Lacking in attention 77 65.2 41 34.7 64 54.2 54 45.7 118 84.2 Intensive work tempo 82 71.9 32 28.0 60 52.6 54 47.3 114 81.4 Not using PPE 64 66.6 32 33.3 46 47.9 50 52.0 96 68.5 Long working hours 61 67.7 29 32.2 43 47.7 47 52.2 90 64.2 Inexperience 50 64.1 28 35.9 47 60.2 31 39.7 78 55.7 χ /p value 9.267/p = .099 28.029/p = .000 Facing with dangerous situation My own health is my top priority 57 62.6 34 37.3 50 54.9 41 45.0 91 65.0 I comply if our institution takes every precaution 31 81.5 7 18.4 28 73.6 18 47.3 38 27.1 My priority is my job 4 57.1 3 42.8 6 85.7 1 14.2 7 5.00 χ /p value 4.926/p = .177 3.657/p = .301 Note. OHS = occupational health and safety; PPE = personnel protective equipment. Bold value significance that p < .05 and statistically significant difference was found. injuries occurred to their forearms, wrists, palms, and fin- workers face common occupational risks, it may be possible gers. The most frequently cited reasons for occupational to apply these recommendations to other medical students accidents were lack of attention and heavy/intensive work as well. To prevent occupational exposure and its effects on tempo. This study is limited as the study sample came from a nursing students, burning out syndrome, and other occupa- single center; thus, the results cannot be compared with other tional harms before entering the nursing profession, it is rec- centers and the findings cannot be generalized to all nursing ommended that all students take OHS training. This study schools. and relevant literature reveals that nursing students have two main platform working area and learning area, that is, the college and hospital setting. To protect students from Recommendations occupational hazards and to acquire an occupational safety Despite these limitations, we have provided several recom- culture in students, students have to be trained in both col- mendations below. Because nurses and other medical lege and hospital settings. In college, nursing students 10 Table 7. Discussion. Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments 1. Identifying threats Vaccination status Çelikalp et al. (2017) In literature, it is stated that the students had In our study, 56.4% of the students had the In the second paragraph of Article 15 of the Togan et al. (2015) health examination tests done before clinical Hepatitis B vaccine and 53.5% had DaBT “Occupational Health and Safety Law No. Kömerik et al. (2005) practice within the scope of OHS, and hepatitis vaccines before clinical practice 6331” in Turkey, it is stated that employees Altıok et al. (2009) markers (Hepatitis B, Hepatitis C), ELISA test, cannot be started to work without health www.mevzuat.gov.tr/ chest radiography, and blood count are among reports. In this case, a health report MevzuatMetin/1.5.6331.pdf the first of these tests. Hepatitis B vaccination indicating health status is requested from rate was found to be 83.6% in Togan et al. and the students who will start the internship 71% in the study conducted by Kömerik et al. by the institutions. It is assessed that almost Çelikalp et al. found that the rate of vaccination half of the students had to have vaccination against hepatitis B was 95.2%, and Altıok et al. done before clinical practice, as a result of found that the hepatitis B vaccination rate was the obligation imposed by law 79.5% for health workers In this study, 90.7% of the students came into Contact with blood and body fluids carries Contact with blood and Doig (2000) In the study of Doig, students’ contact with body fluids Tarantola et al. (2003) blood and body fluids was reported as 32%. contact with blood and body fluids risks for health care workers, and it is a common characteristic of health care Hsieh et al. (2006) Tarantola et al. stated that blood and body Adesunkanmi et al. (2003) fluid exposure was 60% in nurses and nursing services. Giving that health care workers are under risk in terms of OHS, the risk is students in the study with 7,649 health care workers in 61 hospitals. Hsieh et al., higher for unexperienced nursing students. investigating the exposure of health care Therefore, OHS training is more important workers to blood and body fluids, reported for nursing students than actual health care that the exposure to health care workers was workers 60.6%. Adesunkanmi et al., investigating the prevalence of accidental injuries and exposure to body fluids among staff during general surgery, reported 10.5% of surgical personnel were exposed to severe injuries and body fluids Physical/verbal assault Samadzadeh and International reports indicate that student In this study, 60% of the students were Our results are consistent with the studies in (from patient/ Aghamohammadi (2018) nurses, such as nurses working in many physically/verbally attacked by patient/ the literature, but it is not compatible with patient’s relatives– Budden et al. (2017) countries, are often exposed to unpleasant patient’s relatives and 40.7% by clinical nurses Tee et al.’s study at some point. Although supervisor nurse/ Tee et al. (2016) violence in the clinical setting. These and doctors. Although it was not statistically Tee et al. found that nursing students were doctor–colleagues– Koç and Batkın (2016) experiences range from dissatisfaction, significant in terms of gender, females who exposed to physical/verbal attack more academicians) Eljedi (2015) witnessing, or experiencing verbal or nonverbal were subjected to physical/verbal assault by frequently by nurses, hospital staff, and Timm (2014) assault to physical violence. In the literature, the patient/patient’s relatives/clinical nurses/ administrators (31.1%) and less frequently Seibel (2014) the frequency of violence experienced by doctors were the most ones and the third (4.9% to 1.2%, respectively) by patients Ünal et al. (2012) nursing students is high. The clinical exposure grade was found to be statistically significant and their relatives, in our study, they were Clarke et al. (2012) of nursing students to violence was at a ratio between the grades more frequently experienced from physical/ Magnavita and Heponiemi of 34% in Italy, 35.3% in Iran, 42.2% in the verbal attack by patients/relatives and less (2011) United Kingdom, and 50.3% in Turkey. They frequently by physical nurses and doctors. are exposed to violence by the patient and The results of the study, relatively higher his family, faculty or hospital staff, nurses, and from other studies, may be partly explained instructors. It is also stated in the literature by differences in definitions of clinical that there is violence due to other nursing violence due to socioeconomic cultural students diversity of populations in other studies. Students may not be familiar with the definition of violence. (continued) ü ü Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Aghajanloo et al. (2011) Also, due to cultural values and norms in Turkey, especially in hospitals and/or clinics, Jackson et al. (2011) Çelebioğlu et al. (2010) universities have lower rates of violence Ferns and Meerabeau (2009) by staff; it may be explained because they are more obedient and respectful to senior elders. Although the nurse is a caregiver, the violence caused by hospital staff is a major concern. However, the causes of such violence are not well understood. Future research is needed to explain the factors contributing to such clinical violence and to identify intervention approaches to reduce violence in clinics. Research-based information on the causes and increasing nature of violent incidents will facilitate the planning of interventions Sharp instrument injures Zhang et al. (2018) The incidence of sharp instrument injuries In this study, 30.7% of the students Exposure to blood-borne pathogens, which (scalpel, scissor, etc.) Suliman et al. (2018) during the clinical applications of the students experienced sharp instrument injuries result in serious occupational diseases due and needle stick injury Budden et al. (2017) ranged from 18.1% to 84.0% in the literature. (scalpel, scissors, etc.), and 27.8% to needle stick injuries, is a potential risk Nawafleh et al. (2017) Smith and Leggat reported that the incidence experienced needle stick injuries after factor for nursing students. In this study, Quynh and Einhellig (2017) of sharp instrument injuries was 15.0% in taking blood samples/IM, IV, SC injection sharp instrument injury and needle stick Byk et al. (2016) Taiwanese students and 18.0% in Italian nursing injury’s results are higher than studies in Yıldırım and Özpulat (2015) students, and these rates ranged from 22.0% other countries but are close to similar Prasuna et al. (2015) to 72.0%. The prevalence of sharp instrument studies in Turkey. The injuries rate is high Ünver et al. (2012) injuries among nursing students was 35.0% in because students are at the risk of exposure Irmak and Baybuga (2011) Singapore, 30.0% to 33.0% in the United States, to occupational hazards in clinical practice Karadag (2010) 29.0% in Australia, 24.0% in France, and 12% in due to lack of trainers and an increasing Smith and Leggat (2005) the United Kingdom. Students are particularly number of students working in many active susceptible to needle stick injuries due to lack areas. Increasing the number of simulation of awareness of workplace safety and having laboratories, increasing laboratory hours limited clinical experience. The frequency of in nursing curricula, and decreasing clinical needle stick injury studies conducted in Turkey practice hours may decrease the students’ ranges between 19.4% and 52.5%, and in other exposure to clinical risks countries ranged from 13.9% to 59.9% PPE usage problems in Duminy (2010) In the studies conducted, it was stated that When the problems experienced by the Our findings are consistent with the clinical practice Ganczak and Szych (2007) the compliance of surgical nurses to the use students about the use of PPE in clinical literature. In our study, as in the literature, of PPE varies according to PPE, that there is applications were investigated, students gloves are the most commonly used PPE, not enough PPE in the study areas, and that if managed with a single glove because they while difficulties in the procurement of there is a deficiency in protective equipment, were scarce (42.1%) or rebuked (37.1%) with PPE are the main factors. A comprehensive compliance with standard measures may be each glove replacement, and had to treat/ understanding of infection prevention and affected. In a study by Ganczak and Szych, care for more than one patient during the control is important for nurses who want gloves were shown to be the most commonly internship with one glove (36.4%); because to protect themselves, patients, colleagues, used protective equipment that reflects the there was no mask, they had to enter the and the general public from infection. PPE, long-term tradition of wearing. However, room of the patients with respiratory disease such as gloves, gowns, and/or gowns and regular glove use was reported to be 17% in without mask (22.1%). eye protection, is an important aspect of the survey participants. In the study of Ganczak infection prevention and control for all and Szych, 9% of the nurses reported health care personnel, including nurses. (continued) 12 Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments that they wear protective goggles regularly and In addition, they did not wear any gowns Occupational safety regulations require showed the lack of supplies as a reason for not and did not wear any goggles (44.2%) during employers to provide employees with using PPE body care because of the lack of gowns and adequate protection against harmful goggles substances, including microorganisms, and this issue needs to be addressed with institutional support. Supplying adequate equipment can result in high costs, but the resulting cost will be much lower than all costs associated with the treatment of health care workers Findings and symptoms in Abou-Elwafa et al. (2017) In the literature, it was determined that nursing Students reported that they experienced Our results are consistent with the study of clinical practice Huang et al. (2016) students had musculoskeletal complaints, symptoms of most anxiety and irritability Abou-Elwafa et al. The higher incidence of Eljedi (2015) mostly leg/foot (55.8%) and back pain (46.7%). during their clinical practice (77.9%), symptoms in women may be that women In the study of Abou-Elwafa et al., it was headache (71.4%), increased tendency to are more vulnerable to the health impact of stated that musculoskeletal complaints and sleep (70.7%), exhaustion (68.5%), low back certain demands and constraints that they occupational injuries differed significantly and upper back pain (61.4%), and early fatigue face with patient care during clinical practice between female students (75.4%, 71.7%) (57.8%). It was found that the majority of the compared with male students (24.6%, 28.3%, students who experienced these symptoms respectively). In the study of Abou-Elwafa and injuries were females and second grade et al., 74% of the students reported that musculoskeletal complaints were more frequent in the legs/feet (55.8%) and back (46.7%) and that the musculoskeletal morbidity of women is higher than men Common areas of the Yıldırım and In the study of Omaç et al., the injury area in the As a result of these dangerous situations, Our results are consistent with the literature. the most injured body area of the students The high incidence of needle stick and sharp body injured in clinical Özpulat (2015) body of nurses was questioned and reported as practice Önder et al. (2011) the right hand (41.3%), the left hand (40.0%), the was found to be the forearm, wrist, hand, instrument injuries, which can be prevented and finger (52.8%). Students encountered by safe tool use, is thought due to the lack Omaç et al. (2010) arm (5.9%), and then the other regions (12%, 8—trunk, feet, legs). In the study of dangerous situations and were injured while of information on safe tool use applying the treatments in the clinic (54.3%), Önder et al., 18.6% of the nurses stated that they had hand–finger cuts, 6.4% of them had preparing drugs for treatment (41.4%), following vital signs (25%), giving general pinch–bruise wounds, and 13.8% of them had an accident in the form of needle prick. In the study care to the patient (22.1%), during the intervention in the emergency department of A. Yıldırım and Özpulat, the injury sites were questioned according to the frequency of injury: (22.1%), and closing the needle tip (20.7%) 65.0% (67 people) of the right hand, 32.0% (25 people) of the left hand, 2.1% of the arm, and 0.9% of other parts (trunk, leg, foot). They also reported that they were injured due to drug preparation for injector, lancet–scalpel use, injector, and ampoule fractures Chemical contacted in Abou-Elwafa et al. (2017) Worldwide, latex sensitivity is reported to be Hand antiseptic (89.2%) and latex (60.7%) Our results are consistent with the literature. clinical practice Elewa and Sahar Banan 1% in the general population and 5% to 12% were found to be the most commonly In this study, it was shown that female (2016) for occupational latex sensitivity. In a study contacted chemicals by students in clinical students were at high risk in terms of latex Kartal et al. (2015) conducted with students, the frequency of skin practice. In this study, students experienced allergy as it conforms with similar studies/ Lamberti et al. (2015) problems related to the use of latex gloves symptoms of skin irritation (14.2%); burning literature. Katrancha and Harshberger was reported to be 4%, which was lower in in the eyes, nose, and throat; bleeding from (2012) students than in health care workers. the nose (12.1%); and allergies (12.1%). (continued) 13 Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Çelik et al. (2013) Elewa stated that most nursing students had It was found statistically significant that the It has been reported in the studies about the Yalçın et al. (2011) irritation in their eyes, nose, and throat majority of the students who experienced continuation of latex contact, and the lack Eliakimu et al. (2008) due to natural latex gloves and other latex- these symptoms and injuries were female and of treatment increases the risk of systemic Diéguez et al. (2007) containing medical devices. Similarly, the second grade allergic reactions to skin irritations due Leggat and Smith (2007) students were exposed to chemical hazards to the use of latex gloves. It is important and experienced allergic reactions ranging to identify individuals who are at risk for from skin rash, asthma, dermatitis, to severe susceptible or latex allergy during school itching and irritation. Eliakimu et al. reported years and to take preventive measures in that the use of chemicals such as antiseptics these individuals to prevent life-threatening and disinfectants used in hospitals for cleaning reactions such as anaphylaxis in the future contributes to the burning of the skin. In the study by Kartal et al., dermatitis-like skin lesions were the most common clinical complaints developed after contact with medical latex products. Allergic complaints due to latex like dermatitis and urticaria in health school students are also in the foreground in similar studies in the literature. The study of Kartal et al. reported that nursing students had complaints of swelling around the eyes, mouth, and throat, and had complaints of severe respiratory system problems 2. Detection of OHS situation in nursing students In this study, almost all of the students In Turkey, with the second article of the Having knowledge Elewa and Sahar Banan (2016) In the literature, it was observed that the of OHS and Boucaut and Cusack (2016) students had a wide awareness of OHS despite (95.7%) stated that they have knowledge of Occupational Health and Safety Law OHS, and they showed as information source No. 6331, Occupational Health and Safety information sources Burdurlu (2014) the lack of clinical experience in the first years. Al-Dabbas and Abu-Rmeileh In the third year, it was found out that they of the OHS course (52.8%) Trainings are compulsory for the students had knowledge and experience on OHS issues with the inclusion of the students accepted (2012) Baniyousef et al. (2015) besides awareness. It was also revealed that to do internships in the workplaces within nursing students gained their knowledge about the scope of employee safety. It can be Aluko et al. (2016) www.mevzuat.gov.tr/ occupational safety in their courses. In the assessed that is because of that law the study conducted in Palestine, it was reported students got training before clinical practice MevzuatMetin/1.5.6331.pdf Tavolacci et al. (2008) that the majority of the participants obtained information about blood-borne infectious disease mainly from official lectures and then books. In the study conducted in Saudi Arabia, it was stated that the source of information was the education curriculum. It was seen that in Burdurlu’s (2014) study, 33.1% of the participants had good knowledge of OHS and 36.5% received OHS training. Aluko et al.’s study found 57.6% had high knowledge of occupational hazards, 42.6% low knowledge of occupational hazards, 58% acquired through professional training, 67% aware of job aids, and 93% aware of PPE (continued) 14 Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Knowing the definition Çelikalp et al. (2017) To prepare the students for work–life during In this study, 90.7% of the students knew the This ratio (90.7%), which is high in our study, of occupational disease the education process and to predict the definition of occupational disease is important in terms of showing that the dangers they may face in their professional life, training given to students on workplace risk the students should have knowledge about factors is effective. However, low results in occupational diseases and preventive practices. the literature reveal the necessity of training In the study conducted by Çelikalp et al. programs on the subjects (2017), it was determined that the knowledge level of the students about the definition of occupational accidents and occupational diseases before education was very insufficient. The same study found that 12.9% of the health workers were fully aware of their occupational risks and needed serious consideration Wanting an OHS class Aksoy et al. (2013) Aksoy et al. (2013) evaluated the OHS training In our study, 79.3% of the students wanted As is seen in the studies, OHS training should to have courses in the curriculum related to be compulsory in terms of providing OHS, in curriculum Al-Momani et al. (2013) given to students studying in some associate Yang et al. (2007) degree programs, and the students agreed that worker health and safety and the willingness of the students in this regard can be considered as a reflection of OHS courses they took during the associate degree programs increased their occupational their lack of knowledge about OHS safety awareness. Al-Momani et al. described training as an important factor in reducing the risk of needle stick and sharp instrument injuries. Yang et al. found that the rate of needle stick and sharp instrument injuries in nursing school students decreased to 25.2% after education from 50.5% Knowledge of OHS’ Burdurlu (2014) Burdurlu (2014) reported that almost half In this study, 43.6% of the students stated they Even if there is somehow knowledge of OHS regulations/OHS’ (48.1%) of the health workers receiving OHS knew about the OHS law in our country regulations, it is not effective to protect commitments, novelties, training knew their rights in the event of an and 30.7% about the legal obligations and nursing students without the proper rights of patients, and occupational accident; it is stated that those rights that may arise as a result of dangerous acquisition of OHS culture. Informative health workers who have knowledge about the regulations do situations that both employees and patients approach, practice, and monitoring in not know much about innovations may experience. Although the students OHS training may have a positive effect on know and say that OHS is related to their behavioral acquisition and OHS culture professions, the percentage of students who have knowledge of the innovations introduced by the OHS regulations is 7.1% 3. Evaluation of risk control Giving required Duminy (2010) In the studies conducted in the literature, it was In this study, 97.8% of the students stated The main role of PPE is to decrease the risk sensitivity to PPE usage Ganczak and Szych (2007) stated that the compliance of surgical nurses to that they showed sensitivity to use PPE in of microorganism transmission between in clinical practice and the use of PPE varies according to PPE types, clinical applications, and most of them health care workers and patients. Even so, thinking of the nursing that there is not enough PPE in the study areas, (97.1%) stated that their profession there is a high score of students’ sensitivity profession requires PPE and that if there is a deficiency in the protective requires PPE to use PPE; their PPE usage scores (in the usage equipment, compliance with standard measures “Identifying Threats” section) show that PPE may be affected may not be effectively used as intended (continued) ü ü Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments In the study of Burdurlu (2014), the majority of 100% of the students stated that they wear It can be said that women are careful to take PPE equipment used in Burdurlu (2014) clinical practice Timm (2014) the employees (71%) were using protectives gloves as PPE equipment and 90% of the precautions against job risks compared with Magnavita and Heponiemi such as wearing gloves, masks, and so on, students wear masks as PPE equipment. men, that the sense of protection is more (2011) during their work. The study conducted by Consistent with the study of the Çalışkan, intense because of the role of women and Altıok et al. (2009) Çalışkan and Akdur was seen as individual in our study, female students used PPE at mother and they give importance to using Gngör Özdemir and Şengöz measures taken by the nurses against the risks higher levels compared with men, which is PPE (2012) they face in their working environments; the statistically significant Çalışkan (2017) use of gloves and masks was 62.8%, infection prevention 33.4%, compliance with personal hygiene rules 30.4%, and vaccination 13.1%. Önder, Ağırbaş , Yaşar, and Aksoy stated that those who regularly use PPE against occupational risks are 13.4% among physicians and 32.3% among nurses. In their study, Altıok et al. found that the rate of use of protective materials among health workers, in general, was quite high (72%). In their study, Gngör Özdemir and Şengöz determined the usage of protective materials as gloves 45%, mask 19%, gown 17%, and glasses 4%, respectively. In Çalışkan’s study, the behaviors of the personnel to use PPE according to their gender; women’s behaviors of using PPE were higher than men. 4. Assessment Hazardous situation Yeshitila et al. (2015) In the literature, needle stick and sharp Students encountered dangerous situations Numerous obstacles may arise during clinical exposed in clinic A. Yıldırım and Özpulat (2015) instrument injuries occur during injection, and were injured while applying the treatment. It has to be proper procedures Amini et al. (2016) when the patient moves suddenly; during treatments in clinical practice (54.3%), to follow treatments in the clinical Kepenek and Şahin-Eker intravenous administration; and during the preparing drugs for treatment (41.4%), environment. The nursing students should (2017) transportation or disposal of waste. It has following vital signs (25%), giving general also be trained to follow procedures Kurşun and Arslan (2014) been found in the literature that needle stick care to the patient (22.1%), during emergency Nawafleh et al. (2017) injuries often occur when preparing treatment room intervention (22.1), and closing the Abou-Elwafa et al. (2017) and closing the injector cap needle tip (20.7%) Documentation in case Suliman et al. (2018) Similarly, the frequency of noninjury reporting Nevertheless, the ratio of students who The necessity of keeping records and of dangerous situation Nawafleh et al. (2017) among nursing students ranged from 43.0% to documented a dangerous situation in clinical inspections related to OHS systems, in clinic/taking rest/ Prasuna et al. (2015) 86.3%. The low rate of reporting of accidents practice was as low as 22.9%. The students occupational accidents, occupational notified person Azadi et al. (2010) and injuries of students is important in terms (54.3%) explained the dangerous situation diseases, and dangerous situations in Altıok et al. (2009) of making it difficult to determine the risks that mostly to the clinical nurse and stated that enterprises is considered as a subject Talas (2009) students face in clinics. In a study conducted in the clinical nurse was immediately interested accepted by both national and international Taiwan, it was stated that only 39.0% of nursing experts. The rules regarding the content students reported after injury. In the study of of the data to be collected regarding Azadi et al. on the incidence of needle stick occupational accidents are stated in the and sharp instrument injuries that were not “Recording and Notification of Occupational reported among Iranian nurses, it was found Accidents and Diseases” published by ILO in that approximately 1996 (Uçak, 2009). (continued) ü ü ü ü Table 7. (continued) Related literature Problem prevalence (%) and explanation in Problem prevalence (%) and explanation in Problem Author, Year related literature current study Comments Byk et al. (2016) 45% of the students were injured with needle It is stated that if accidents occur in stick and sharp instrument injuries at least the workplace where the student is an Yang et al. (2004) www.mevzuat.gov.tr/ once during their clinical experience and about apprentice or trainee, the Social Security MevzuatMetin/1.5.6331.pdf 36% of these injuries were reported. Injury Institution should be notified within three Uçak (2009) reporting rates were 12.7% in the study of working days by the second paragraph of Altıok et al., 43.9% in the study of Talas, and Article 14 of the Occupational Health and 14.8% in the study of Byk et al. Safety Law No. 6331 in Turkey. Although notification of accidents is mandatory by law in Turkey, the notification rates were low. It is considered that it is because of ineffective OHS training received by the students involved in occupational accidents and the ignorance of supervisors who guide students Reasons for occupational Burdurlu (2014) In the literature, the reasons for occupational In this study, the students stated that the The results of this study confirm previous accidents Souza-Borges et al. (2014) accidents and occupational diseases include most common causes of occupational studies. That reason comes from the Yeshitila et al. (2015) inexperience; not using protective, carelessness, accidents were inattention (84.3%) and characteristics of the working environment. Huang et al. (2016) long working hours; and intensive work intensive work tempo (81.4%), while they Hospitals are intense working areas, tempo. In the study of Burdurlu (2014), health stated that their priority was their health and therefore there are lots of things workers stated that occupational accidents (65%) when faced with a dangerous job happening at the same time and also require and occupational diseases were preventable monitoring activities for 24 hr. It is highly and for occupational accidents stated reasons possible for an instant change in the working as intensive work tempo, long working area. Intensive work tempo is indispensable hours, lack of protective use, carelessness, and could bring inattention with time. and inexperience. Lack of supervision of the Organizational measures and enough academician, technical mistakes made by the health workers could decrease risks for student, crowded working environment, occupational accidents and lack of skills are also mentioned for occupational accidents Note. OHS = occupational health and safety; ELISA = enzyme-linked immunosorbent assay; DaBT = diphtheria, pertussis, tetanus; IM = intramuscular; IV = intravenous; SC = subcutaneous; PPE = personnel protective equipment. ILO = International Labour Organization. Eyi and Eyi 17 should take an extra class for OHS especially for health care References workers, and after clinical practice, students could discuss Abou-Elwafa, H. S., Khashaba, E. O., El-Gilany, A.-H., & the work environment in the class and increase their aware- El-Raouf, S. A. (2017). Work profile and associated health ness. In hospital settings and in clinical practice, it should hazards among nursing students at Mansoura University, be given OHS pretraining before starting any clinical prac- Egypt [Profil professionnel et risques sanitaires associés parmi les étudiants en soins infirmiers de l’Université de Mansoura, tice by a responsible OHS person, and nursing students Égypte]. EMHJ-Eastern Mediterranean Health Journal, 23(2), should be monitored and checked. It is recommended that 100–109. https://apps.who.int/iris/handle/10665/260376 all students take OHS training, including the wide con- Adesunkanmi, A. K., Badmus, T. A., & Ogunlusi, J. O. (2003). cepts of the recommended OHS education before and after Accidental injuries and cutaneous contaminations during clinical practice. Both the previous literature and our study general surgical operations in a Nigerian teaching hospital. reveal that there is a lack of common understanding of East African Medical Journal, 80(5), 227–234. http://dx.doi. OHS for health students, regarding how to educate stu- org/10.4314/eamj.v80i5.8691 dents in OHS and how to apply a professional approach to Aghajanloo, A., Nirumand-Zandi, K., Safavi-Bayat, Z., & Alavi- OHS in medical areas. It is also recommended that amend- Majd, H. (2011). Clinical violence in nursing students. Iranian ments be added to the required legal regulations in schools Journal of Nursing and Midwifery Research, 16, 284–287. and clinical practice areas and that students’ OHS situa- https://europepmc.org/article/pmc/pmc3583097 Akan, A., Toyran, M., Erkocoglu, M., Kaya, A., & Kocabas, C. tions be tracked. N. (2012). The prevalence of allergic contact sensitization of practicing and student nurses. The International Journal of Limitations of the Study Occupational and Environmental Medicine, 3, 10–18. https:// www.theijoem.com/ijoem/index.php/ijoem/article/view/121 The present study is a pilot study with small focus group Aksoy, S., Çevik, B., & Çakicier, N. (2013). Gümüşova Meslek numbers. However, the participating students provided valu- Yüksekokulu’nda İş Güvenliği Bilincinin Belirlenmesi able information about their impressions and experiences on [Determination of occupational safety awareness in Gümüşova various OHS issues. We recognize that the views presented Vocational School]. Düzce Üniversitesi Bilim ve Teknoloji in small numbers may not represent the views of the wider Dergisi, 1(1), 69–76. https://dergipark.org.tr/tr/pub/dubited/ issue/4806/66180 student population. Although the results are not generalized Al-Dabbas, M., & Abu-Rmeileh, N. M. (2012). Needlestick injury to other nursing students, the findings provide useful materi- among interns and medical students in the Occupied Palestinian als for consideration by other nursing schools and health sci- Territory. Eastern Mediterranean Health Journal, 18(7), 700– ences faculty who have students in clinical placement. 706. http://hdl.handle.net/20.500.11889/3239 Findings and related literature support the need for further Al-Momani, S. M., Hdaib, M., & Najjar, Y. W. (2013). Sustained studies in this field. reduction in needlestick and sharp injuries among nursing stu- dents: An initiative educational program. Educational Research, Authors’ Note 4(9), 654–658. http://dx.doi.org/10.14303/er.2013.214 Altıok, M., Kuyurtar, F., Karaçorlu, S., Ersöz, G., & Erdoğan, S. (2009). This study was submitted as oral presentation in the Union of Sağlık çalışanlarının delici kesici aletlerle yaralanma deneyimleri Thrace Universities 2nd International Health Sciences Congress in ve yaralanmaya yönelik alınan önlemler [Healthcare workers Tekirdağ/Turkey on November 15–17, 2018. experiences with sharps and needlestick injuries and precau- tions they took when injuring]. Maltepe Üniversitesi Hemşirelik Acknowledgments Bilim ve Sanatı Dergisi, 2(3), 70–79. https://www.researchgate. We would like to thank the students for participating in this study. net/profile/Erdogan_Semra/publication/239601046_Saglik_ We would like to thank Editage (www.editage.com) for English Ca lisa nla rin in_D el ici _Ke sic i_A let ler le_ Yar ala nma _ language editing. Deneyimleri_ve_Yaralanmaya_Yonelik_Alinan_Onlemler/ links/54d90bb10cf24647581d5493.pdf Aluko, O. O., Adebayo, A. E., Adebisi, T. F., Ewegbemi, M. K., Declaration of Conflicting Interests Abidoye, A. T., & Popoola, B. F. (2016). Knowledge, attitudes The author(s) declared no potential conflicts of interest with respect and perceptions of occupational hazards and safety practices in to the research, authorship, and/or publication of this article. Nigerian healthcare workers. BMC Research Notes, 9, Article 71. https://doi.org/10.1186/s13104-016-1880-2 Funding Amini, R., Soltanian, A. R., Ebrahimkhani, A., & Beigyan, M. (2016). Investigating the use of safe injection guidelines The author(s) received no financial support for the research, author- after needle stick and sharp instruments injuries in Nursing & ship, and/or publication of this article. Midwifery students of Hamadan University of Iran. 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Erciyes Tip Dergisi/Erciyes Medical Journal, 33(2), 103– 110. https://www.researchgate.net/publication/230554088_ İbrahim Eyi is a doctoral student at Istanbul Aydın University, Occupational_Disease_of_Healthcare_Workers_Latex_Allergy Institute of Science and Technology, Department of Occupational Yang, Y. H., Liou, S. H., Chen, C. J., Yang, C. H., Wang, C. L., Health and Safety. His research interests include occupational Chen, C. Y., & Wu, T. N. (2007). The effectiveness of a training safety matters on all subjects, including medical areas.

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Published: Jan 30, 2020

Keywords: nursing; behavioral sciences; student nurse; occupational health and safety accidents; protective equipment usage; clinical practice

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Nursing Students’ Occupational Health and Safety Problems in Surgical Clinical Practice:

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