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AN EVALUATION OF THE MANAGEMENT OF HAZARDOUS MEDICATIONS BY NURSING AND MIDWIFERY PERSONNEL IN THE NIGERIAN HEALTHCARE SECTOR
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CHAPTER ONE
INTRODUCTION
1.1 Background of the study
In the realm of healthcare delivery, the oversight of hazardous medications poses considerable risks for both healthcare professionals and patients alike. Hazardous medications are characterised by their potential to inflict harm owing to their toxic properties or elevated risk profile, necessitating meticulous handling and administration to reduce health risks (NIOSH, 2023). The substances in question encompass antineoplastic agents, antiviral medications, hormones, and specific antibiotics recognised for their potential to induce organ damage, reproductive toxicity, or cancer in individuals exposed to them without adequate precautions (Connor et al., 2016; Victorian Therapeutics Advisory Group, 2021; Cancer Institute NSW, 2024). The administration of these medications falls predominantly to nurses and midwives, who serve as the frontline healthcare providers. Their handling practices are essential for ensuring safety in this critical aspect of care.
Nurses and midwives manage medications that are cytotoxic, non-cytotoxic, and pose reproductive hazards across various healthcare environments. Exposure to hazardous medications may arise through dermal or mucosal absorption, inhalation, or ingestion via hand-to-mouth contact (Celano et al., 2019; Nixon and Schulmeister, 2016). Healthcare environments that are contaminated may serve as a source of exposure for healthcare professionals, nonclinical personnel in healthcare settings, patients, as well as their carers and families (Power and Coyne, 2018; Griffin, 2003). Even with the adoption of safe handling practices, it is acknowledged that contamination within the healthcare environment continues to be a concern (Delafoy et al., 2022; Muller-Ramirez et al., 2017).
The effective management of hazardous medications is essential in nursing and midwifery practice, as it has a direct influence on patient safety, the well-being of healthcare workers, and the overall outcomes of healthcare delivery. In numerous healthcare environments around the world, protocols and standards have been implemented to reduce the dangers linked to the management of hazardous medications. The guidelines encompass the utilisation of personal protective equipment (PPE), closed system drug transfer devices (CSTDs), and environmental controls, including adequate ventilation in areas designated for medication preparation (National Institute for Occupational Safety and Health (NIOSH, 2023). Nevertheless, in Nigeria, the commitment to these safety measures is frequently hindered by systemic challenges, including resource limitations, inadequate infrastructure, and insufficient regulatory enforcement. This presents a significant concern not only for healthcare professionals who frequently encounter hazardous materials but also for patients who could experience negative outcomes stemming from inadequate medication management and administration techniques.
Research indicates that healthcare professionals, especially nurses and midwives, who are exposed to hazardous medications face a heightened risk of experiencing a range of health complications. Exposure to these pharmaceuticals in occupational settings, even at minimal concentrations, has been associated with reproductive health complications including miscarriages, infertility, and congenital anomalies, alongside an elevated risk of cancer among healthcare professionals (Boiano et al., 2018). Healthcare professionals in Nigeria frequently encounter inadequate working environments, and the absence of appropriate protective measures exacerbates these dangers. Studies have indicated that numerous healthcare facilities in Nigeria face significant resource challenges, characterised by insufficient provision of personal protective equipment, restricted access to closed system transfer devices, and a lack of comprehensive training on the safe management of hazardous medications (Ogundele et al., 2020). The challenges present in this context lead to a precarious working environment, increasing the likelihood of unintentional exposure to hazardous substances for both nurses and midwives.
The insufficient training provided to nurses and midwives regarding the management of hazardous medications represents a critical concern within Nigeria’s healthcare system. Although nursing and midwifery programs encompass general pharmacology and medication administration, there is frequently a lack of adequate training regarding the management of hazardous drugs, which may be completely overlooked. The deficiency in training indicates that numerous healthcare professionals might lack awareness regarding the potential risks linked to these medications or the optimal strategies for reducing exposure. A research conducted by Ojo et al. (2018) revealed that more than 60% of nurses in Nigeria lacked formal training in the management of hazardous drugs, resulting in unsafe practices such as preparing medications in poorly ventilated spaces or inconsistent use of personal protective equipment. The deficiency in training is compounded by the lack of institutional policies and guidelines that specifically address the management of hazardous medications in numerous healthcare facilities. This situation results in nurses and midwives lacking clear direction on the safe handling of these substances (Erce, 2015).
The ramifications of inadequate oversight of hazardous medications reach far beyond healthcare professionals, impacting patients as well. The inadequate management and application of hazardous drugs may lead to medication errors, contamination, and adverse drug reactions, all of which detrimentally affect patient care (Zhang et al., 2018; Woerdenbag et al., 2022). Chemotherapy drugs, categorised as hazardous, necessitate meticulous handling to prevent accidental exposure or improper dosage administration (Cancer Institute NSW, 2024). In Nigeria, the healthcare system frequently faces significant strain, leading to an increased likelihood of medication errors involving hazardous drugs, which presents substantial risks to patient safety (Ezeife et al., 2018). The absence of adequate safety protocols jeopardises patient well-being and diminishes the overall standard of healthcare provision, thereby exacerbating the elevated morbidity and mortality rates linked to avoidable medical errors within the nation.
Considering the significant responsibilities that nurses and midwives hold in the administration of hazardous medications, it is imperative to assess their management practices and recognise the obstacles they encounter in maintaining safe medication handling. The assessment of existing methodologies will yield valuable understanding regarding the deficiencies in knowledge, training, and resources that impede the secure handling of hazardous substances. The main objective of this research is to assess how nursing and midwifery staff handle hazardous medications within the Nigerian healthcare system.
1.2 Statement of the Problem
The administration of hazardous medications within healthcare environments represents a vital component of nursing and midwifery practice, especially in resource-constrained nations such as Nigeria. Hazardous medications, encompassing cytotoxic drugs, hormone therapies, and specific anti-infective agents, present considerable risks to healthcare workers, patients, and the environment when not managed appropriately (Hernandez et al., 2019). In Nigeria, the challenges faced by healthcare systems, including resource limitations, inadequate training, and insufficient regulatory oversight, highlight the critical importance of ensuring the safe management of these medications.
The roles of nursing and midwifery personnel are essential in the administration and management of medications within healthcare environments. Nonetheless, research has shown that a significant number of healthcare practitioners in Nigeria are insufficiently trained and informed about the dangers posed by hazardous medications and the optimal strategies for their management (Umar et al., 2020). The deficiency in understanding may result in improper handling techniques, thereby heightening the risk of exposure and negative health outcomes for both healthcare professionals and patients. Moreover, the absence of uniform protocols and guidelines for managing hazardous medications intensifies the problem. A significant number of healthcare facilities in Nigeria function without thorough policies for the safe management of these substances, resulting in varying practices across different environments (Adeyemo et al., 2021). The lack of efficient waste disposal techniques, appropriate labelling, and secure storage conditions heightens the potential for contamination and accidents, thereby posing greater risks to healthcare professionals and the environment.
The emotional and psychological impact of overseeing hazardous medications warrants careful consideration. Healthcare professionals frequently encounter stress and anxiety stemming from concerns about exposure and the possible health consequences of managing these substances. This issue can influence job satisfaction and overall mental well-being, resulting in elevated turnover rates among nursing and midwifery staff (Afolabi et al., 2022). Neglecting these psychological factors may lead to a significant loss of essential personnel in the healthcare sector, ultimately compromising the standard of care delivered to patients.
Furthermore, the wider consequences of inadequate oversight of hazardous medications reach far beyond the confines of the healthcare environment. Insufficient practices may result in environmental pollution, threatening the health and safety of nearby communities (Ogunbanjo et al., 2023). The inappropriate disposal of hazardous waste poses a significant threat to water sources and soil integrity, leading to a cycle of health risks that impacts both healthcare professionals and the broader community. It is crucial to tackle these challenges to enhance safety protocols in healthcare settings, safeguard healthcare workers, and achieve improved health results for patients. Therefore, this study is essential.
1.3 Objectives of the study
The primary objective of this study is to critically evaluate the management of hazardous medications by nursing and midwifery personnel in the Nigerian healthcare sector. Specific objectives of this study are to:
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To assess the level of awareness and knowledge of nursing and midwifery personnel regarding hazardous medications and their associated risks in Nigeria
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To evaluate the existing practices followed by nurses and midwives in the management of hazardous medications in healthcare settings in Nigeria
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To identify the challenges faced by nursing and midwifery personnel in ensuring the safe handling of hazardous medications in Nigeria
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To explore the emotional and psychological impacts of managing hazardous medications on nursing and midwifery personnel in Nigeria
1.4 Research Questions
The following research questions which are in line with the objectives of this study will be answered in this study:
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What is the level of awareness and knowledge of nursing and midwifery personnel regarding hazardous medications and their associated risks in Nigeria?
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What are existing practices followed by nurses and midwives in the management of hazardous medications in healthcare settings in Nigeria?
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What are the challenges faced by nursing and midwifery personnel in ensuring the safe handling of hazardous medications in Nigeria?
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What are the emotional and psychological impacts of managing hazardous medications on nursing and midwifery personnel in Nigeria?
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1.5 Research Hypotheses
To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:
Ho: The level of awareness and knowledge of nursing and midwifery personnel regarding hazardous medications and their associated risks in Nigeria is low
Ha: The level of awareness and knowledge of nursing and midwifery personnel regarding hazardous medications and their associated risks in Nigeria is high
1.6 Significance of the study
The importance of this study is far-reaching, influencing numerous stakeholders such as healthcare providers, patients, policymakers, educational institutions, and the wider community.
This study will provide substantial advantages to healthcare providers, especially nurses and midwives. Gaining insight into the existing practices and obstacles related to hazardous medication management can deepen their comprehension and awareness of safe handling protocols. Enhanced training and education derived from the study's findings can enable these professionals to adopt safer practices, ultimately safeguarding their health and the welfare of their patients.
The outcomes of this research will have a direct influence on patients. The proficient administration of hazardous medications is essential for reducing the risks linked to exposure and potential adverse effects. When nursing and midwifery personnel possess a comprehensive understanding of knowledge and protocols for safe handling, the quality of care provided to patients is significantly enhanced. This enhances health outcomes and cultivates confidence in the healthcare system.
The study presents important insights that will be of great relevance to those in positions of authority, emphasising key areas that require targeted action within the healthcare sector. The findings derived from the assessment can guide the formulation of policies and protocols designed to enhance the oversight of hazardous medications. This may result in greater financial support for educational initiatives, the creation of uniform guidelines, and improved regulatory supervision, ultimately fostering an environment of safety within healthcare institutions.
Educational institutions will gain valuable insights from the findings, enhancing their comprehension of the training requirements for nursing and midwifery personnel. The research can inform the creation of educational programs that target particular deficiencies in understanding hazardous medication management. By incorporating these insights into nursing and midwifery education, institutions can enhance the preparedness of future healthcare professionals to manage hazardous medications with safety and efficacy.
The wider community will undoubtedly recognise the importance of this research. The prudent management of hazardous medications serves to protect both healthcare professionals and patients, while also ensuring the preservation of our environment. The examination of waste disposal practices serves to illuminate the environmental consequences associated with the management of hazardous medications, potentially inspiring community efforts to advocate for responsible disposal methods and mitigate contamination risks.
The study will be of significant importance to students, offering essential insights into a vital domain of nursing and midwifery practice. The results may provide a foundation for scholarly endeavours, investigative pursuits, and practical implementations within clinical environments. Grasping the intricacies of hazardous medication management can enrich their learning journey and equip them for practical challenges in the healthcare field. This study will provide valuable insights for those engaged in research, enhancing the current understanding of medication safety and management practices.
1.7 Scope of the study
Broadly, this study focus is to critically evaluate the management of hazardous medications by nursing and midwifery personnel in the Nigerian healthcare sector. Empirically the study will explore the level of awareness and knowledge of nursing and midwifery personnel regarding hazardous medications and their associated risks in Nigeria, the existing practices followed by nurses and midwives in the management of hazardous medications in healthcare settings in Nigeria, the challenges faced by nursing and midwifery personnel in ensuring the safe handling of hazardous medications in Nigeria and the emotional and psychological impacts of managing hazardous medications on nursing and midwifery personnel in Nigeria.
Geographically, the study will be carried out in General Hospital, Kubwa, FCT, Abuja.
1.8 Limitations of the study
Throughout the investigation, the researchers meticulously examined the fundamental limitations inherent in all human behaviours. A significant obstacle encountered was the insufficient examination in the scholarly investigation of the topic. A crucial element that influenced the circumstances was the restricted access to data concerning evaluating the management of hazardous medications by nursing and midwifery personnel in the Nigerian healthcare sector. In light of the undertaking, it proved to be quite challenging to locate the necessary materials, texts, or information, as well as to systematically arrange the data, necessitating a considerable allocation of time and effort.
Furthermore, the results of the study may be limited by the small sample size and the particular focus of the research, which is predominantly centred on General Hospital, Kubwa, FCT, Abuja. The findings of the study possess restricted practical significance, underscoring the necessity for additional investigation.
Furthermore, the individual faced considerable restrictions stemming from financial limitations. As an individual pursuing academic excellence amidst financial limitations, they had to thoughtfully maneuver through these obstacles along their educational journey. The increased transportation costs at the research site presented a considerable obstacle in fulfilling the financial responsibilities associated with travel expenses.
Furthermore, the individual adhered to a demanding timetable due to their academic responsibilities, which included attending lectures and engaging in various educational activities.
1.9 Definition of terms
Hazardous: Hazardous refers to involving or exposing one to risk (as of loss or harm) a hazardous occupation. disposing of hazardous waste.
Midwifery: Midwifery is defined as “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from prepregnancy, pregnancy, birth, postpartum and the early weeks of life.
This material content is developed to serve as a GUIDE for students to conduct academic research
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