This study aimed to explore the incidence and type of sharps injuries among pre-registration nursing students. Although sharps usage is an imperative and essential clinical skill for all nursing students, how many such injuries occur and what impact they have on the individual remain underexplored in the UK. Many studies have been conducted investigating sharps injuries among registered nurses and other healthcare workers in the UK, but research focusing on nursing students in the UK remains elusive.
Sharps injuries can be defined as ‘…skin penetrating stab wounds caused by a sharp instrument and accidents in a medical setting’ (Centers for Disease Control and Prevention, 2008). Definitions of sharps within health care vary widely (Hersey and Martin, 1994). Box 1 provides a list, which is not intended to be exhaustive, of items defined as ‘sharps’ that have been reported to have caused injuries to healthcare workers:
Box 1.Examples of items defined as ‘sharps’
- Blood collection needles
- Bone fragments or teeth
- Broken glass
- Emergency services' cutting equipment
- Instruments used in invasive operations, surgery, dentistry and acupuncture
- Intravenous (IV) cannulas, or needles used to connect parts of IV delivery systems
- Jagged metal
- Lancets
- Needles such as hypodermic and hollow bore
- Razors
- Scalpels
- Scissors
- Winged steel needles, known as butterfly needles
- Other medical instruments that are necessary for carrying out healthcare work
Sources: Hersey and Martin, 1994; Health and Safety Executive (HSE), 1998; World Health Organization, 2003; Muralidhar et al, 2010; Royal College of Nursing, 2013; Riddell et al, 2015; HSE, 2016
Sharps injuries can transmit up to 60 types of pathogen to the injured party (Tarantola et al, 2006). Although up to 100% of some nursing student populations sustain sharps injuries (Trivedi et al, 2013), there is a dearth of research studies investigating the topic worldwide.
Background
The reported incidence of sharps injuries involving nursing students worldwide is wide ranging. A study by Cheung et al (2012) reported an incidence rate of 5.9% (n=52), while Trivedi et al (2013) reported a rate of 100% (n=100). In numerous studies reporting incidence worldwide, the time frame for reporting ranged from the previous week (Kermode et al, 2005) to an entire academic training period (3–4 years) (Small et al, 2011). Findings from studies investigating the most common stage of nursing student training when sharps injuries occur suggest that the second year is the stage at which incidence is highest (Albertoni et al, 1992; Smith and Leggat, 2005; Petrucci et al, 2009; Talas, 2009; Mitra et al, 2010; Small et al, 2011; Ozer and Bektas 2012; Unver et al, 2012).
The type of device associated with the highest incidence was an intravenous (IV) needle, with an incidence of 86% (n=86) (Trivedi et al, 2013). This was followed by other needle types (eg insulin, hypodermic, hollow bore), with an incidence of 80.8% (n=55) (Hussain et al, 2012). Glass items (bottle of patient secretion, blood collection tube, broken ampoule) were also reported to have a high incidence (66%; n=33) (Karadağ, 2010).
A study carried out in India (Muralidhar et al, 2010), found the most frequent occurrence of a sharps injury was likely to be when administering an injection. The highest incidence occurred ‘when re-capping the needle’ (62.5%; n=40) (Muralidhar et al, 2010), with the next highest likelihood of injury ‘after administration but before disposal of the needle’ (61%; n=39) (Muralidhar et al, 2010). However, in India stringent industrial legislation has not been fully implemented or regulated (Agnihotram, 2005) due to resources issues (Gramling and Nachreiner, 2013), so the incidence is likely to be higher than in many other countries.
Although some international studies have collected data on the incidence of sharps injuries, the studies have been primarily conducted in hospital settings. There is a lack of evidence regarding sharps injuries within nursing populations in the UK, relating to the incidence, type and location of injuries. The purpose of this study was to focus on sharps injuries sustained by UK nursing students.
Aims
The study explored the incidence and type of sharps injuries among nursing students in the UK.
Methods
Design
A survey was designed and administered locally and nationally to nursing students using convenience and snowball sampling (Polit and Beck, 2010). The STROBE checklist for reporting cross-sectional studies was adhered to.
Participants and data collection
For the local survey, a convenience sample of pre-registration adult nursing students at a university in the UK were accessed (with permission) from a database. Survey Monkey (www.surveymonkey.com) was used to construct the questionnaire, which was distributed to students via email.
For the national survey, social media was used to distribute the survey. This included convenience sampling of participants within nursing student interest groups on Facebook and snowball sampling via Twitter. The questionnaire link was distributed to the students between July 2015 to November 2015, at the end of their academic year. The demographic data collected included gender, age, university, previous experience in health care and current academic year of study.
Measurement
The questionnaire was based on a systematic review and a review of available previous questionnaires exploring the same topic area. It initially consisted of 18 questions (Box 2).
Box 2.Questionnare details
- Have you had a sharps injury in this current academic year?
- How many sharps injuries have you had in this current academic year?
- Did you report the sharps injury (injuries)?
- Please state what device(s) were involved when you had the sharps injury (injuries)
- Please indicate what procedure was happening when the sharps injury (injuries) occurred
- If the sharps injury (injuries) happened during an injection procedure, please state at what stage of the process the injury (injuries) occurred
- Please state what time of day or night the sharps injury (injuries) happened
- Please state which shift you were working at the time of the injury (injuries)
- Please state what you consider were the potential ‘causes’ or ‘contributing factors’ of the sharps injury (injuries)
- Were you being directly observed by your mentor, or a trained nurse, or a health professional, or a university lecturer at the time of the sharps injury (injuries)?
- Please state if the sharp involved in the injury (injuries) was ‘used’ (contaminated) or ‘unused’ (sterile)
- Please state the exact location where the sharps injury (injuries) occurred
- Please state the ‘specialty’ of the placement where you had the sharps injury (injuries)
- Please state if you reported the sharps injury (injuries)
- Did you record the injury (injuries) on an accident form, or an incident form, or an electronic reporting system?
- If you did not report the sharps injury (injuries), please state the main reason why you did not report the sharps injury (injuries)
- Please state which part of your body was injured when the sharps injury (injuries) occurred
- Are you right handed or left handed?
Additional questions
- 19. In the month following the sharps injury (injuries) did you have nightmares about it or thought about it when you did not want to?
- 20. In the month following the sharps injury (injuries) did you try hard not to think about it or went out of your way to avoid situations that reminded you of it?
- 21. In the month following the sharps injury (injuries) were you constantly on guard, watchful or easily startled?
- 22. In the month following the sharps injury (injuries) did you feel numb or detached from others, activities or your surroundings?
To determine the impact of a sharps injury, including post-traumatic stress disorder (PTSD), four questions were created and added to the questionnaire (Box 2). The Primary Care PTSD Screen (PC-PTSD Screen) (US Department of Veteran Affairs, 2013) was slightly adapted for this purpose. Current research suggests that the results of the PC-PTSD should be considered ‘positive’ if a person answers ‘Yes’ to any three items.
For the national survey, two of the questions gathering demographic data were altered slightly. There was an additional question on which branch of nursing was being studied: adult, child, mental health and learning disability. Additionally, the question relating to the student's university did not offer alternative options other than the name of a university.
To explore face validity the questionnaire was distributed to a professor and lecturers in nursing on nine occasions, requiring only minor changes to be made. Content validity within the study was assessed using a content validity index (Martuza, 1977). A content validity score of 100% was achieved after 10 pertinent nurse professionals reviewed the questionnaire, and a test-retest showed that it had a 94.4% level of accuracy. Internal consistency reliability was high and assessed with the repetition of a question within the questionnaire. Following a small pilot study (n=22) minor grammatical corrections were required.
Data analysis
Completed questionnaires were obtained via Survey Monkey. The data were converted and analysed using the SPSSv22 software package. For each questionnaire, descriptive statistics were performed to summarise the data, including frequency, mean and standard deviation. Chi-square and Fischer's exact test (FET) were then employed to determine a significant difference between the expected frequencies and the observed frequencies in various categories. This choice of statistical test depended on sample size, sampling method and level of measurement. This aided the generalisation of findings to equivalent populations (Parahoo, 2014).
Ethical considerations
Prior to agreeing to participate in survey one (local), nursing students at one university in the UK received an email with information explaining the purpose of the study and requesting their participation. Information explaining the study was also provided in the first part of the Survey Monkey questionnaire to encompass participants in survey two (national).
Potential participants were provided with information to enable them make an informed choice (Taylor, 2014). To aid openness and honesty, the contact details of the researcher were given in case potential participants had questions at any stage of the study. It was also explained that completion of the survey would imply consent to be part of the study, that participation was voluntary and that they had the right to withdraw at any time before the survey was completed. Students from the local university were informed that participation, or refusal to take part, would have no bearing on their studies.
The information given to potential respondents locally and nationally stated that, due to the delicate nature of the study, they should seek counselling or support from university services or their GP if they felt they had been psychologically harmed by a sharps injury. Because of the anonymous nature of surveys, it was not possible to ensure this had happened. Before and following the interviews, this support was reiterated to participants.
Potential participants were informed that their responses were confidential and anonymous, and that the survey was not a test of knowledge—it was solely seeking to obtain the honest views of participants. Students were informed that the study had been approved by the ethics committee at the local university. Finally, they were informed that, if they had any questions or concerns about the project, they could contact the researcher.
Results
Sample characteristics
Survey one (local)was distributed to 954 nursing students, with 544 responses, or a response rate of 57.02%. After incomplete questionnaires were removed, 537 remained for analysis. Survey two (national) received 471 responses and, once incomplete questionnaires were removed, the total remaining for analysis was 274. Because the questionnaire was distributed via social media, it was impossible to determine the response rate.
Survey one (local) had similar numbers of respondents from each of the three years of academic study; the mean age was 28.44 years old, with a range of 18 to 54 years. The majority of respondents were female (92.4%; n=496) and had previous experience of working in health care before embarking on the programme (63.7%; n=342). The most common previous occupation was healthcare assistant (HCA) or equivalent (84.9%; n=288).
Survey two (national) had proportionately more respondents in the second year of study (40.5%; n=111); the mean age was 27.88 years old, with a range of 19 to 51 years. Most of the respondents were female (89.1%; n=244) and had previous experience of working within health care before embarking on their studies (59.1%; n=162). The most common previous occupation was healthcare assistant (HCA) or equivalent (87.6%; n=151).
Initially, the aim was to compare local and national data, but due to the homogenous nature of respondents across both groups the data were amalgamated for analysis.
Incidence rate
The incidence rate of a sharps injury in the final academic year was 14.7% (n=119).
Academic year when injury was sustained
The most frequent academic year when a sharps injury occurred was in the second year of study (44.54%; n=53), followed by the third year (36.1%; n=43), and then the first year (19.3%; n=23).
Number of injuries sustained in current academic year
Most of the respondents who had sustained a sharps injury had had one incident within their current academic year (89.66%; 104/116), 8.62% (10/116) had sustained two, 0.9% (1/116) had sustained three, and 0.9% (n=1) sustained more than five. There was no statistically significant association between the number of injuries sustained and gender (P=0.227, FET), academic year (P=0.711, FET); previous experience (P=0.847, FET) or being right or left handed (P=0.545, FET).
Time and shift when injuries occurred
Analysis of individual injuries (n=135) revealed that the most common time period when sharps injuries occurred was 12.00–14.59 (31.5%; n=35), followed by 09.00-11.59 (27%; n=30) and 15.00-17.59 (20.7%; n=23). There was no statistically significant association between the time zone when sharps injuries occurred and gender (P=0.457, FET), academic year (P=0.564, FET); previous healthcare experience (P=0.786, FET) or being right or left handed (P=0.589, FET).
Analysis of injuries also showed that the most common shift when sharps injuries occurred was on a long day (65%, 76/117), followed by an early shift (25.6%, 30/117). There was a statistically significant association between the type of shift and academic year (P=0.017, FET). There was no statistically significant association between type of shift when the incident occurred and gender (P=0.650, FET), previous experience (P=0.279, FET) or being right or left handed (P=0.266, FET).
Exact geographical location of injuries
The most common location for a sharps injury to occur was in the ‘treatment room’ (44.4%; 52/117), followed by the ‘patient's bedside’ (29.1%; 34/117), and the ‘patient's own home’ (8.5%; 10/117). In total, there were 10 different locations where sharps injuries were reported (Table 1). There was no statistically significant association between and injury location and gender (P=0.059, FET), academic year (P=0.787, FET), previous experience (P=0.276, FET) or being right or left handed (P=0.995).
Table 1. Exact geographical location of sharps injury
| Location | Frequency (n=117) | Percentage |
|---|---|---|
| Treatment room | 52 | 44.4% |
| Patient's bedside | 34 | 29.1% |
| Patient's own home | 10 | 8.5% |
| Operating theatre | 9 | 7.7% |
| Clinical skills simulation ward | 6 | 5.1% |
| Office | 2 | 1.7% |
| Sluice | 1 | 0.9% |
| Ward pharmacy room | 1 | 0.9% |
| Drug room | 1 | 0.9% |
| Care home | 1 | 0.9% |
Specialty where injuries occurred
The most common specialities where sharps injuries occurred were ‘medical’ environment (26.3%; 30/114), ‘surgical’ (18.4%; 21/114) and ‘district nursing’ (15.8%; 18/114). In total, sharps injuries were reported across 15 specialties (Table 2). There was no statistically significant association between a specialty where the injury occurred and gender (P=0.966, FET); academic year (P=0.639, FET), previous experience (P=0.392, FET), and being right or left handed (P=0.520, FET).
Table 2. Specialties where sharps injuries occurred
| Specialty | Frequency (n=114) | Percentage |
|---|---|---|
| Medical | 30 | 26.3% |
| Surgical | 21 | 18.4% |
| District nursing | 18 | 15.8% |
| University clinical skills ward | 6 | 5.3% |
| Theatres (including recovery) | 6 | 5.3% |
| GP surgery | 5 | 4.4% |
| Nursing home | 5 | 4.4% |
| Oncology | 4 | 3.5% |
| Intensive care unit | 4 | 3.5% |
| Out patients department (including genitourinary clinic) | 4 | 3.5% |
| Community hospital | 3 | 2.6% |
| Palliative care unit and hospice | 3 | 2.6% |
| Emergency department | 2 | 1.8% |
| Gynaecology | 2 | 1.8% |
| Endoscopy unit | 1 | 0.9% |
Was student under observation when injury occurred
In total, 78.6% (n=92/117) of sharps injuries occurred when the student was being observed by their mentor. There was a statistically significant association between gender and whether the nursing student was being observed (χ2(2)=10.381, P=0.006). There was no statistically significant association between whether the nursing student was being observed and academic year (χ2(4)=2.230, P=0.694), previous experience (χ2(2)=1.541, P=0.463) or being right or left handed (χ2(4)=0.987, P=0.912).
The potential causes of the sharps injury
A total of 116 of 135 responses reported the potential cause of an individual sharps injury. The most commonly mentioned possible cause was ‘inexperience’, followed by ‘lack of familiarity’ and ‘the equipment’. A total of 16 potential causes were reported (Table 3).
Table 3. Potential causes of sharps injuries
| Cause | Frequency of reporting |
|---|---|
| Inexperience | 54 |
| Lack of familiarity | 35 |
| Equipment | 35 |
| Stress | 18 |
| Haste | 15 |
| Lack of sleep | 11 |
| Lack of protective devices | 11 |
| Inattention | 11 |
| Carelessness | 11 |
| Supervision | 5 |
| Heavy workload | 5 |
| Carelessness of a colleague | 2 |
| Faulty equipment | 1 |
| Patient movement | 1 |
| Patient's skin integrity | 1 |
| Lack of light | 1 |
NB Students could select more than one options
Part of the body affected by the injury
Most of the sharps injuries occurred to the hand (98.2%; 109/111). One injury occurred to the arm (0.9%) and one to the thigh (0.9%).
Was the sharps injury reported by the student?
Analysis of the data showed that 56.1% (74/135) of incidents were reported. There was a statistically significant association between reporting the sharps injury and being right or left handed (χ2(2)=8.936, P=0.011), and also academic year (χ2(2)=10.821, P=0.004). There was no statistically significant association between reporting the sharps injury and gender (χ2(1)= 3.222, P=0.073), and previous experience (χ2(1)=1.960, P=0.161).
Reasons why student did not report injury
Respondents (n=80/135) provided information regarding why sharps injuries were not reported. They were able to give more than one response. The most common reason was because the sharp was ‘unused or clean’, followed by it being a ‘minor injury’, being ‘embarrassed’ and because the ‘patient was not infected’. In total, there were 11 reasons given for non-reporting. This data is presented in Table 4.
Table 4. Why nursing students did not report the sharps injury
| Reason | Frequency |
|---|---|
| Unused or clean | 61 |
| Minor injury | 44 |
| Embarrassed | 25 |
| Patient not infected | 11 |
| Did not know how to report | 9 |
| Afraid | 6 |
| Too shy | 5 |
| Worried it would affect assessment | 5 |
| Lack of time | 3 |
| Mentor/other advised not to report | 2 |
| Too complicated | 1 |
NB Students could select more than one options
Devices involved in individual sharps injuries
Analysis of individual injuries found that the most common devices involved with sharps injuries were items or equipment made of glass (34.9%; n=44), subcutaneous injection needles (29.4%; n=37) and intramuscular injection needles (13.5%; n=17). In total, 12 types of sharps devices were reported (Table 5).
Table 5. Device involved in individual sharps injuries
| Device | Frequency (n=126) | Percentage |
|---|---|---|
| Glass | 44 | 34.9% |
| Subcutaneous injection needle | 37 | 29.4% |
| Intramuscular injection needle | 17 | 13.5% |
| Blood glucose lancet | 7 | 5.6% |
| Intravenous injection needle | 6 | 4.8% |
| Scalpel or stitch cutter | 4 | 3.2% |
| Scissors | 3 | 2.4% |
| Filter needle | 3 | 2.4% |
| Tablet cutter | 2 | 1.6% |
| Intradermal injection needle | 1 | 0.8% |
| Cap of urine bottle | 1 | 0.8% |
| Sewing needle | 1 | 0.8% |
There was no statistically significant association between the type of device involved in the injury and gender (P=0.486, FET), academic year (P=0.172, FET), previous experience (P=0.456, FET) or being right or left handed (P=0.846, FET).
Procedure involved when individual injuries occurred
Analysis of the individual injuries revealed that the most common procedure being performed when sharps injuries occurred was ‘preparation of an injection’ (65%; n=80), followed by ‘administration of an injection’ with 12.2% (n=15), and ‘when cleaning or clearing’ (8.9%; n=11). Respondents reported performing 11 procedures when the injuries occurred (Table 6).
Table 6. Procedure involved when individual sharps injuries occurred
| The procedure | Frequency (n=123) | Percentage |
|---|---|---|
| Preparation of an injection | 80 | 65% |
| Administration of an injection | 15 | 12.2% |
| When cleaning or clearing | 11 | 8.9% |
| When assisting a surgical procedure | 3 | 2.4% |
| Accidently injured by a colleague | 3 | 2.4% |
| Taking a blood glucose sample | 3 | 2.4% |
| Removing a suture | 2 | 1.6% |
| Performing an aseptic technique | 2 | 1.6% |
| Handling or transferring a sample | 2 | 1.6% |
| Processing or cleaning equipment | 1 | 0.8% |
| Washing a patient | 1 | 0.8% |
There was no statistically significant association between the procedure involved when the individual sharps injury occurred and gender (P=0.842, FET), academic year (P=0.129, FET), previous experience (P=0.675, FET) or being right or left handed (P=0.751, FET).
Stage of injection process when injury occurred
Analysis of the individual injuries that occurred during the injection process found that the most common stages were ‘when drawing up the drug’ (27.7%; n=26); ‘when assembling the syringe and needle’ (23.4%; n=22), and ‘when opening the ampoule’ (18.1%; n=17). There was no statistically significant association between the stage of injection process when the injury occurred and gender (P=0.484, FET), academic year (P=0.997, FET), previous experience (P=0.911, FET) or being right or left handed (P=0.701, FET).
Whether the sharp was used or clean
In total, 82.5% (n=94) of sharps injuries occurred with unused (clean) sharps. There was a statistically significant association between whether the sharp was used or clean and gender (χ2(2)=9.592, P=0.008). There was no statistically significant association between whether the sharp was used or clean and academic year (χ2(4)=1.194, P=0.879), previous experience (χ2(2)=0.881, P=0.644) or being right or left handed (χ2(4)=1.314, P=0.859).
Post-traumatic stress disorder incidence
The survey asked four questions that tested for incidence of PTSD following a sharps injury. In total, 5.9% (n=6) of respondents who had sustained a sharps injury answered three or more of the four PTSD questions positively. This suggests that these respondents showed signs of PTSD. In total, 37.3% (n=38) respondents answered ‘yes’ to at least one PTSD question. There was no statistically significant association between sustaining PTSD and gender (P=0.434, FET), academic year (P=0.183, FET), previous experience (P=0.681, FET) or being right or left handed (P=0.598, FET).
Discussion
This appears to be the first survey exploring the incidence and type of sharps injuries among a nursing student population in the UK. The study findings identified the incidence rate of sharps injuries to be 14.7% within nursing students in the UK. A search of the literature found that worldwide the findings on sharps injuries varied greatly, with some international studies reporting an incidence of between 9.4% and 100% (Blackwell et al, 2007; Trivedi et al, 2013), and similarly wide-ranging prevalence rates of between 5.9% and 94.2% (Sharma et al, 2010; Cheung et al, 2012). The low incidence rate reported in our study is comparable with similar figures reported in Italy (Petrucci et al, 2009); Belgium (Vandijck et al, 2008); Australia (Smith and Leggat, 2005); Canada (McCarthy and Britton, 2000); South Africa (Zungu et al, 2008); India (Kermode et al, 2005) and Turkey (Irmak and Baybuga, 2011), with a range of 10.3% to 19.4%.
This study revealed that sharps injuries occurred mostly in the second year of a nursing programme, with the incidence rate found to be 44.5%. This echoes the findings of studies that identified the second year as the academic year with the most occurrences of such injuries (Petrucci et al, 2009; Mitra et al, 2010). The reason for this could be greater sharps usage by students at this stage of their programme and possibly more opportunities to give injections than in the previous year (Smith and Leggat, 2005; Ozer and Bektas, 2012).
Various environments where sharps injuries occurred were identified, with the treatment room (44.4%) and the patient's bedside (29.1%) shown to be the prime locations. Similar findings were identified in the literature: Talas (2009), 74% on wards; Karadağ (2010), 90% treatment room and 10% patient room; and Lukianskyte et al (2011), 59% treatment room and 15% patient room. Within this study, medical (26.3%; n=30) and surgical (18.4%; n=21) environments were reported as the most common specialties, which echoes the findings from the review of the literature: Yang et al (2004), 36.3% medical and 34% surgical; Yao et al (2010), 20.1% medical and 20.5% surgical; Yao et al (2013), 0.955 events/student medical, 0.935 events/student surgical (no percentages); Irmak and Baybuga (2011), 43.3% medical and 56.7% surgical; and Cheung et al (2012), 53.2% medical and 29.8% surgical.
This study identified a range of devices involved in sharps injuries, with items made of glass (34.9%; n=44) being the most common. Devices made of glass have been reported as the main types of equipment involved in sharps injuries in other studies (Karadağ, 2010; Ozer and Bektas, 2012).
Most of the sharps involved were clean and unused, but it is a concern that 17.5% of respondents in this study reported that the device was used. A similar figure of 15.8% was identified by Smith and Leggat (2005), but this is about half the number reported by Zhang et al (2018), whose study found that 36.3% of injuries to nursing students were caused by used sharps.
This study also explored the experience of nursing students who had sustained a sharps injury. It was identified that 21.4% (n=25) of students were not being observed by their mentor at the time of the incident. This is about half the rate of 55% (n=27) reported by Small et al (2011) and 50% reported by Petrucci et al (2009), and far lower than the ideal of mentors observing students' use of sharps devices in 100% of cases.
A number of contributing factors were identified as resulting in the sharps injury, with inexperience (n=54) being considered as the most common cause. A small body of knowledge relating to this issue supports this finding (Shiao et al, 2002; Smith and Leggat, 2005; Khoshnood et al, 2015; Suliman et al, 2018).
Of nursing students who had sustained a sharps injury, more than a third (37.3%, 18/119) responded affirmatively to at least one of the questions relating to PTSD, with 5.9% (6/119) giving affirmative answers to three or four of these questions, showing that they had characteristics of PTSD as a consequence of the injury. There is a dearth of data regarding sharps injuries and nursing students within the literature with which to compare these finding. The only research that considered the psychological consequences suffered by health professionals following a sharps injury was conducted by Hussain et al (2012), who investigated sharps injuries among dental, medical and nursing students and discovered that 15% had suffered mental distress as a consequence.
Additionally, Naidoo (2010) documented that nursing students suffer many psychological effects that could be indicators of PTSD, but they did not definitively identify the condition in study participants. Because there are no direct comparisons with other research studies investigating nursing students and PTSD following a sharps injury, the only available comparison are with the effects of sharps injuries on medical students. PTSD was identified in 12% of medical students who had experienced at least one sharps injury during training in the UK (Naghavi et al, 2013).
Strengths and limitations
The online survey questionnaire was developed with attention to detail solely for the purpose of this study, and went through a rigorous process of validity and reliability testing. This aided the generation of pertinent data for analysis in order to answer the research questions that had been set (Moule and Goodman, 2014).
The use of social media to distribute the survey nationally proved to be a cheap and effective method of targeting 274 nursing students across the UK (O'Connor et al, 2014). Survey results can always be questioned due to sample size and whether ‘true responses’ were actually obtained. This is due to an individual's memory (ie people's ability to recollect past events accurately), participants' motivation to complete the survey, their desire to present themselves in a favourable light and the participants not wanting to appear incompetent (Moule and Goodman, 2014).
The use of convenience and snowball sampling within a quantitative framework also risks potential sampling bias affecting the research process (Taylor, 2014).
Due to the nature and purpose of the study, the researcher devised the data collection instruments, and collected and analysed all the data. Although there was triangulation with other researchers playing a role in verifying the instruments, bias could have been introduced within data collection and at analysis stage (Parahoo, 2014).
Conclusion
The study identified that sharps injuries occurred most commonly in the afternoon on a long day shift, and the main environments were the treatment room and the patient's bedside. Medical and surgical environments were also specialties where sharps injuries occurred, with the district setting being a common location because of its unfamiliarity to some students.
The contributing factors to an incident occurring were numerous, with inexperience considered to be a major factor. The hand was by far the most common site of the body affected, accounting for just over half the reported sharps injuries. A major psychological factor was identified and, although the number of those affected was small, some students showed signs and symptoms of PTSD following a sharps injury. A larger research study needs to be carried out to investigate the associations between sharps injuries and PTSD.
Relevance to clinical practice and education
The study has identified an incidence rate of sharps injuries in a UK nursing student population of 14.7%. Although there are data on the incidence of sharps injuries in other countries, there has been a dearth of data for the UK. In addition, it has been identified that the second year of the nursing programme is most commonly when sharps injuries occur in the UK. There is now an indication of how many nursing students per year may sustain a sharps injury in the UK. Sharps injuries can occur in most placement areas within hospitals and within community areas, so it is essential to ensure that mentors in practice settings are made aware of this.
Glass devices have been established as most commonly involved with sharps injuries among nursing students, often caused by the use of an incorrect technique when opening a glass ampoule. It is imperative that the correct technique is taught and demonstrated to nursing students in practice settings, with the employment of protective devices that should be made freely available. It is also vital that mentors and managers work within safety legislation, directives and guidelines.
The study found that some sharps injuries occur when a nursing student is not being observed by their mentor. Students should not be performing procedures that could lead to sharps injures unobserved until they are deemed competent in a procedure and the mentor is satisfied that they can comply with the legislation on safe practice. However, mentors should be aware that being observed can lead to anxiety and can therefore contribute to the incidence of sharps injuries.
Nursing students from all field reported sharps injuries. Nurses, mentors and healthcare workers in practice should be aware that students on adult, child, mental health and learning disability programmes are at risk of sharps injuries from the various sharps-related procedures students will.
Healthcare workers should be aware that some nursing students who sustain sharps injuries could show signs and symptoms of PTSD or other anxiety-related issues—and these could continue for up to 2 years. It is vital to make this issue known to enable the required follow-up services and help to be instigated.
KEY POINTS
- Nursing students in the UK sustain sharps injuries in many different placement areas involving a wide range of sharp devices, with equipment containing glass being the most common
- A small percentage of nursing students suffer from post-traumatic stress disorder as a consequence of a sharps injury, with many others suffering psychological effects
- Further research is required into this area within the UK to highlight the issue of sharps injuries among nursing students
- Improvements need to be made with regards to sharps' usage and management and prevention of sharps injuries in nursing
CPD reflective questions
- Reflect on your practice of using sharps and consider how your clinical practice could be enhanced
- What steps could you take to decrease the risk of sharps injuries to yourself and others?
- Reflect on the psychological support that is accessible to nursing students (and other healthcare workers) following a sharps injury