The experience and psychological impact of a sharps injury on a nursing student population in the UK

Since the 1990s the use of safer needle devices has been recommended as a replacement for needles and syringes to reduce the risk of sharps injuries (Advisory Committee on Dangerous Pathogens, 1995; Expert Advisory Group on AIDS and Advisory Group on Hepatitis, 1998; National Institute for Occupational Safety & Health, 1999; Hutin et al, 2003; Health and Safety Executive, 2021). There is also legislation that covers safety equipment in general (Personal Protective Equipment at Work Regulations 1992 and the Provision and Use of Work Equipment Regulations 1998) and sharps injuries in healthcare specifically (Health and Social Care Act 2008 and the Health and Safety (Sharp Instrument in Healthcare) Regulations 2013). Despite this, sharps injuries continue to occur to healthcare workers including nursing students. Nursing students are particularly at risk because of factors such as a lack of clinical skills and a lack of experience (Veronesi et al, 2018).

Many studies have reported the psychological effects of a sharps injury on healthcare workers as being anxiety, stress, depression and post-traumatic stress disorder (PTSD) (Wright, 2005; Green and Griffiths, 2013; Wicker et al, 2014). A survey of 147 trainee doctors in the UK conducted by Naghavi et al (2013) looking at PTSD found 12% of respondents (9 of 77) reporting symptoms consistent with PTSD following a sharps injury. However, there is a dearth of evidence relating to the experiences of nursing students.

Two studies have specifically explored the experiences of nursing students who had sustained sharps injuries. Naidoo (2010) used a qualitative phenomenological approach with a sample of eight nursing students in South Africa. From the study, four themes were reported: ‘traumatic incident’, ‘reaction to the traumatic incident’, ‘intervening factors’ and the ‘need for support’. Amukugo et al (2018) identified three themes when exploring the experiences of nursing students and sharps injuries in Namibia. The themes were ‘experiences of nursing students on needle-stick injury’; ‘factors contributing to needle stick injury’ and ‘recommendations made by student nurses to improve prevention and management of needle stick injuries’. Until now, there has been no qualitative investigation of the impact of sharps injuries relating to nursing students in the UK.

Aims

The aims of this study were to explore the experience and psychological impact of sustaining a sharps injury within a nursing student population in the UK.

Methods

Design

This study used two qualitative methods. A Twitter chat was orchestrated to investigate the experiences of sharps injuries with nursing students and registered nurses nationwide. A Twitter chat is a public Twitter conversation around one unique hashtag. This hashtag allows individuals to follow and participate in a discussion about specific topics with these interests (Smarty, 2012). Twitter has attracted more attention for researchers than other social media platforms because conversations used for data collection are easy to follow (Ahmed et al, 2017). Semi-structured interviews were then conducted with local nursing students who had sustained a sharps injury to discover their experiences and the impact of the injury.

Setting and participants

Participants for the Twitter chat were obtained from a convenience sampling accessing the NurChat webpage (no longer active), where tweets from the NurChat Twitter profile (https://twitter.com/nurchat?lang=en) were embedded. This also involved snowballing sampling when tweets from NurChat advertising the Twitter chat were shared. This Twitter chat was open to any participant who had an interest in sharps injuries as it was not possible to just include nursing students—participants were counted as those who took part at the time the scheduled chat was occurring by tweeting using the hashtag #NurChat or replying to those tweets. The majority of the Twitter chat participants were nursing students (n=46). The participants are presented in Table 1

For the interviews, a volunteer sample of local nursing students was obtained when participants volunteered themselves following the completion of a local survey investigating the incidence and type of sharps injuries within a nursing student population. The inclusion criteria were nursing students studying the BSc (Hons) Adult Nursing programme at the local university who had had a sharps injury of any type. This was to give an insight into the experience and effects following any type of sharps injury. Semi-structured interviews were conducted with 12 nursing students, mostly female (n=11), with ages ranging from 21 to 46 years. Full demographic details of participants are provided in Table 2.

Data collection

A Twitter chat was conducted in October 2015 and the tweets produced during the Twitter chat were anonymised and then transcribed for analysis. The Twitter chat was devised using the guidance provided by Smarty (2012) who explained five steps to an effective Twitter chat: understand how a Twitter chat works; form an action plan; announce and promote the Twitter chat; conduct the Twitter chat and then finally summarise, store and analyse the data.

Semi-structured interviews were conducted between May 2016 and March 2017 using an interview schedule devised from a literature review and results from a survey completed for the purposes of a PhD thesis. The interview questions revolved around the following themes:

• ‘The injury’: an example question being ‘Please tell me about your experience of having a sharps injury in your role as a student nurse’
• ‘Following the injury’: an example question being ‘What happened following the sharps injury?’
• ‘The impact of the sharps injury’: an example question being ‘What impact did the sharps injury have on your life?’
• ‘Other themes’: an example question being ‘Is there anything else about your experience of having a sharps injury that you would like to share?’

The interviewee was welcomed into the interview room and given a participant information sheet, which contained information regarding confidentiality, anonymity, storage, retention and security of data, the right to withdraw and support that was available from university wellbeing services following the interview, if needed. All of the interviews were conducted by the researcher face-to-face with the participant. As the location can have a major effect on the interview and the interviewee (Gagnon et al, 2014), this was carefully considered. All of the interviews occurred on the university campus, in a quiet room free from disturbance. The interviewee was able to choose a convenient time for the interview. If the participant was willing to participate in the interview, they were given a consent form to complete and sign. Each interview was recorded on a small digital recorder and lasted between 12 and 34 minutes.

Data analysis

There is a dearth of evidence relating to how qualitative data derived from a Twitter chat should be analysed. The Twitter chat and interviews were transcribed and analysed using thematic analysis (Braun and Clarke, 2006). The Twitter chat produced 548 tweets. The analysis of the Twitter chat resulted in four themes that emerged from the data. These can be seen in Box 1.

Box 1.The four themes emerging from the Twitter chat

• The injury
• After the injury
• Prevention of the injury
• The impact of the sharps injury

A pilot study was completed, involving one interview, which highlighted minor changes needed to the questions. Data saturation was achieved after 12 interviews. The analysis of the interviews initially produced seven themes, which are presented in Table 3.

There followed a process of qualitative synthesis to review the 11 themes from the two data sources. This synthesis process created a final eight themes, with associated subthemes. This was conducted based on the model of ‘Thematic synthesis’ devised by Thomas and Harden (2008) and presented by Barnett-Page and Thomas (2009) as part of a systematic review exploring methods of synthesising qualitative data. The findings of the Twitter chat and interviews were revisited and free coding undertaken. The codes were re-organised into ‘descriptive themes’. These themes were then further interpreted to yield ‘analytical themes’. This synthesis process created eight themes. This process can be seen in Figure 1.

Figure 1. The process of Thematic Synthesis (following model from Thomas and Harden (2008)

Credibility was enhanced by triangulation of sources (by using a Twitter chat and interviews) and analysts triangulation (a fellow PhD student aided the analysis). Credibility was also enriched by prolonged engagement (Lincoln and Guba, 1985) where the researcher immersed themselves within the qualitative data during the thematic analysis stage. There was a clear audit trail throughout the study, which enhanced dependability. Confirmability was aided by a concurrent confirmability audit by PhD supervisors.

Ethical considerations

Approval for the study was granted by the University ethics committee. The participants in the Twitter chat were informed via the NurChat webpage that the information gained from the Twitter chat would be used for a study and they had the right to request removal of their tweets. The participants were informed that the tweets used for the purpose of the research would be anonymised, even though their original tweets would still be visible on Twitter. The use of Twitter to collect research data has been questioned with regard to the security of the information. This study followed the key points raised by Ranco et al (2015), namely: the participants had the opportunity to opt out of the research, there was transparency that the Twitter chat was part of a research study, only minimal personal data were collected, and participants were informed that the data collected would form part of a publication in the future.

The participants in the interview were given an information sheet and signed a consent form before the interview began.

Findings

In order to preserve the anonymity of participants who took part in the Twitter chat, each participant was given a code (NS=nursing student; N=nurse; TC=Twitter chat) and a number (eg NS TC1). Participants within the interviews were given a code (NS=nursing student; Int=Interview) and a number (eg NS Int1).

Of the 12 interview participants, 11 were in the first or second year of undergraduate training when the injury occurred and 4 participants sustained an injury from a used needle.

Theme one: A vivid description of the event

Participants provided detailed accounts of the sharps injury episode. This included recalling the exact time of day, the type of minor injury and the amount of blood. Students described the type of equipment involved, including broken glass when opening a vial of medicine:

‘When opening the glass vile [vial] of medication it has shattered instead of break cleanly.’

NS TC3

They also described how it happened when drawing up with an intravenous needle, preparing intramuscular injections, giving a subcutaneous injection, and when using a scalpel blade. Scissors, blood lancets and razors were also mentioned.

Nursing students explained the exact location where the sharps injury occurred within hospital settings, the community and within simulation wards. Common places within hospitals were treatment rooms and at the patient's bedside in multiple specialties. The number of sharps injuries was linked to the abundance of injections in those areas. Sharps injuries within the community settings happened in residential homes and community hospitals. The community was considered a prime location because nursing students felt out of their comfort zone in unfamiliar surroundings. A comment from a registered nurse supported the feeling that this is a difficult area:

‘You are a guest in someone's house, not always an organised place to work hazards.’

N TC7

Student nurses felt that sharps injuries occurred within clinical skills simulation wards due to the anxiety and stress of being observed by lecturers.

The potential causes of sharps injuries involving nursing students were identified. These included ‘inexperience’, a ‘lack of training’ and a ‘lack of knowledge’. Student nurses mentioned second-year status as a cause. On the one hand, there were more opportunities to give injections in that year, so students were coming into contact with sharps more often, but on the other hand there was sometimes a danger of over-confidence that came with no longer being a first-year student. Poor sharps technique were also highlighted as a factor, such as disposing of others' sharps, poor assembly of sharps equipment and the unnecessary dismantling of sharps equipment.

Worryingly some student nurses had observed nurses re-sheathing the needle and doctors and other healthcare workers leaving sharps in trays or on patient beds:

‘Not all student nurse sharps injuries are from sharps being used by student themselves.’

N TC7

Occasionally the patient was viewed as the cause due to factors such as a lack of subcutaneous fat (presenting difficulty with the injection technique), being ‘feisty’ (ie lively or aggressive and moving around), or leaving sharps around in their own environment. The needle or equipment was sometimes seen as the cause due to poor disposal methods, over-full sharps bins and finding needles in rubbish bags.

Theme two: The impact of the sharps injury’

The participants stated that there was a multitude of emotions displayed when they acquired a sharps injury. Common emotions were feeling worried, stressed, or anxious, which sometimes lasted for up to 2 years. In some cases the worry eased once the results of blood tests were known, but there was also concern also about how the university or the student's mentor might react:

‘I was worried about … the University … how they might respond.’

NS Int4

‘I felt maybe it was gonna affect my performance in terms of grading for when it came to the OARs [Ongoing Achievement Record] being done.’

NS Int5

Embarrassment was another emotion recalled in relation to the nursing student being viewed as less competent in practice. Some felt shocked and stunned for a short period of time, and also frustrated and annoyed with themselves. There was a sense that they had let people down and were a failure. This rarely caused panic, but commonly led to crying and a loss of confidence. The loss of confidence sometimes lasted up to 2 months after the injury. Some nursing students felt a low mood and felt very isolated, especially when they were in placement a distance away from home and family.

Having flashbacks about the incident was another impact. Some nursing students suffered flashbacks ranging from a couple of days to up to 2 months after the injury. This sometimes involved reliving the pain and discomfort of the injury:

‘However sometimes just when I'm drifting off to go to sleep … I feel the … needle going into my finger … I'm just drifting off to sleep sometimes but I wouldn't say I'm having nightmares about it and worried about it or … I would say five or six times that's happened.’

NS Int4

A final impact of the sharps injury was having to stop an activity. An example given was having to stop donating blood for a period of time.

Theme three: The role of my mentor and personal tutor following the injury

Nursing students recounted how their mentor had been supportive following the injury. This involved being calm, encouraging and normalising the injury:

‘One of the nurses on the ward, erm, she cut her finger a couple of weeks ago, erm, so that made me think, oh, you know, “I'm obviously not the only person who has ever done it”.’

NS Int6

The mentor commonly encouraged the nursing student to use sharps again when they may have been reluctant to do so. Mentors were praised as being competent, proficient, and knowledgeable regarding promptly assessing, treating the injury and following hospital guidelines.

There was a worry that the injury might affect the relationship with mentor, but commonly it stayed the same or improved. Some nursing students spoke of the mentor using humour to calm the situation and by sharing their experience of having a sharps injury. Sometimes the mentor used the sharps injury as an opportunity to educate the nursing student.

The mentor sometimes seized the chance to inform and educate the nursing student following the incident. Some of these occasions involved an outline of the process, policies and procedures that should be followed a sharps incident involving a used sharp (NS Int2). This helped the nursing student understand the procedure in a time when they were having problems comprehending.

Although sometimes reluctant to tell their personal tutor at the university, nursing students spoke of how they had been supportive. This included asking them pertinent questions, advising them to complete the necessary documentation and referring them to the Occupational Health service.

Theme four: The role of my family and friends

Telling nursing student colleagues about the sharps injury conjured up many emotions for the participants. Some students felt apprehensive, embarrassed and silly. Telling nursing student peers was sometimes viewed as a learning experience and a chance to educate others. Nursing student colleagues commonly assumed that the sharps injury was caused by a needle, and so learning occurred when the item had actually been something else, such as a broken glass vial. Participants felt supported and reassured when telling their peers, as they sometimes realised that they were not the only one. Humour, commonly seen as a coping mechanism and a sense of camaraderie, was sometimes experienced:

‘I did tell my friends and they just laughed at me which was fine … it didn't affect me though … everyone made a joke out of it.’

NS Int2

There were a few reasons why some participants did not tell non-nursing friends. These included a feeling that friends would not be able to comprehend the sharps injury and because they may have felt foolish.

Telling family members was sometimes traumatic and the worst part of the whole experience. There was a sense of feeling foolish, sad and being disappointed with themselves. Some participants spoke of how supportive their family was following the disclosure. This was by the family being loving and reassuring to the participant. This was helped by the fact that the family were impartial and not involved in the episode.

One participant had not told anyone about the injury except the researcher because of feeling embarrassed, as they felt that they were the only one and perceived themselves to be incompetent. Being on clinical placement far away from home made the incident more difficult for some nursing students:

‘You can't really sort of tell family and when you are on placement you are all alone … it can be really isolating and having no one to really talk to and try and make light of the situation is hard.’

NS Int5

Theme five: The next time I used a sharp following the injury

Following the sharps injury there was a sense that the participant's practice and performance had improved, primarily in relation to the use of sharps, but also in other aspects of nursing care. This included the handling and disposing of sharps more safely and double-checking the procedure to reduce the risk of injury. This improved practice and also involved being more conscious of hazards. In some cases they had also become better at distracting a patient before an injection, improving patient cooperation and reducing difficulties. There was also a sense that the sharps injury had improved some participant's general nursing practice and skills as well by making them more aware of optimal ways of performing various nursing skills.

Performing a procedure involving a sharp after the injury conjured up many emotions such as anxious and feeling nervous. This sometimes lasted for up to 2 years after the injury. There was also occasionally a feeling of trepidation:

‘I was a bit cautious about doing it again but then I did get over it and I did … do it again and then I practised and my confidence grew.’

NS Int7

Avoidance of sharps was expressed by some participants. This ranged from 20 minutes to 4 weeks. Avoidance was achieved by giving excuses, not volunteering or allowing the mentor to perform skills using the sharp. Not all of the participants avoided sharps following their injury. There was a feeling that they ‘need to do another injection’ (NS Int9) and to ‘get back on the horse’ (NS Int10).

Theme six: What if it had been a used sharp?

Participants discussed different responses had a used sharp been involved in the injury. There was a sense that the participant's responses would have been different if the sharp had been used before the injury. This was primarily due to the potential contamination risk from the sharps injury, and not knowing what types of disease could be carried within the blood of another person, as this participant explains:

‘Well it would be a completely different ball game then of course … if it had been in a patient I'd have no idea whether they're an inoculation risk … to be honest I think it would be much worse situation … had the needle gone into the patient first and then into me.’

NS Int5

Participants spoke of the potential to feel a massive knock in confidence, worry and anxiety if the sharp had been used. The worry and concerns would have been about the risks of blood-borne viruses and contamination if a used sharp had been the cause of the injury. The worry was not only concerning potentially acquiring an infection and having an illness during their lifetime, but also passing that infection onto other people. The hypothetical impact could then be on other family members and the problems and issues that could create. Other potential emotions expressed would be shock, panic and feeling scared, which would be more long term.

Regarding telling others about the injury, many participants felt that this would be different if the sharp had been used. The story may have been told differently as an injury with a used sharp would not have been seen as a laughing matter:

‘If it was something more substantial then it's not appropriate to be making a joke about it and things … I would have responded differently.’

NS Int2

The avoidance of certain situations and experiences if the sharp involved in the injury had been used was also expressed by some participants. Some nursing students felt that they would have ‘avoided people’ (NS Int2) and avoided ‘doing sharps for a lot longer’ (NS Int8). Some participants also said that they would have avoided placement because of a plummeting in ‘confidence’ (NS Int5), ‘fear of repetition’ of an injury, possible ‘treatment’ (NS Int11) following the injury and the amount of ‘anxiety’ (NS Int8) they may suffer as a consequence.

Theme seven: Prevention of the sharps injury

The prevention of sharps injury was commonly mentioned by participants. This included the correct and safe usage of sharps bins during a procedure:

‘The sharps bin is your friend—keep it by your side.’

N TC5

The disposal of sharps was also considered imperative as a way of preventing sharps injuries involving nursing students. There was consensus that healthcare workers should always dispose of their own sharps, stating that it should be done as a matter of urgency. Participants spoke of good preparation before starting the procedure, so that correct disposal was at the forefront of people's mind:

‘Make sure that you handle sharps carefully and dispose of them safely into a sharps bin immediately after use.’

NS TC1

Education was felt to be an important factor in the prevention of sharps injuries among nursing students. It was felt that nursing students should have regular education regarding sharps within the clinical skills simulation ward, and all healthcare workers should have regular updates. The education should involve emphasising not to re-sheath needles and the importance of complying with policies and procedures.

Nursing students felt that safety devices were an essential way of preventing sharps injuries. Good leadership was also considered imperative, facilitating the adherence of staff to policies and procedures. Having respect for sharps was thought to be an essential part of the prevention of sharps injuries:

‘Respect them [sharps] proportionately to the amount you fear the idea of a bad incident with them.’

NS TC9

This is because some participants felt that nursing students did not understand how dangerous sharps were and suggested that nursing students should treat sharps with an abundance of respect and caution (NS TC9; NS TC30; N TC7).

Theme eight: The perception of the patient involved in the sharps injury

The perceived risk of seroconversion following an injury with a used sharp, as judged by participants and their mentor, was occasionally influenced by their perception of the patient. One nursing student perceived that she was not at risk because the patient did not fall into a certain social category that they thought might be at high risk of having an infection, in this case an IV drug user or a sex worker. In this instance the patient was an older person living in a residential home:

‘It was the perception of the patient … I did make a joke of it: “Well she doesn't look like a crack addict … I'll be fine … she doesn't look like she was ever a prostitute or you know, took crack or anything so I'm not massively worried”.’

NS Int9

A mentor also perceived the patient to be low risk as the patient was elderly, hence the threat of seroconversion was perceived as slight, as the participant involved explained:

‘I was quite interested as I didn't know obviously what was going to come back, what the risks are, because my mentor said to me, “You know, she's an elderly lady, erm, so the risks could be minimal, erm, they are most likely to be minimal”.’

NS Int12

Conversely, another participant who had had a sharps injury involving a used sharp did perceive the patient as potentially a source of infection and disease. This made the individual very anxious as they dramatically declared that:

‘[I] thought I was going to die of some horrible disease that I'd given myself.’

NS Int4

Discussion

Eight themes were reported from the qualitative data that was collected within this study. The primary comparative findings identified within a systematic review (Hambridge et al, 2016) are from the study conducted by Naidoo (2010) and from a more recent study conducted by Amukugo et al (2018).

The theme ‘a vivid description of the event’ described within this study has echoes of the theme of ‘traumatic incident’ identified by Naidoo (2010) and ‘experiences of nursing students on needle-stick injury’ identified by Amukugo et al (2018). There are some similarities within this theme, such as the participants providing rich detail, knowing the precise date and time and the setting of the scene. However, this study offered additional rich information regarding the type and the extent of the injury; the procedure and device involved; the location of the injury and the potential causes of it. The issue of inexperience as a cause in this study links with the findings of Amukugo et al (2018) who reported nursing students' lack of awareness of hazard precaution due to a lack of training and a lack of experience.

The theme ‘the impact of the sharps injury’ identified within this study links with the theme ‘reaction to the traumatic incident’ described by Naidoo (2010). There were similar findings reported within both studies with regard to some of the emotions expressed such as being shocked, crying, and having anxiety. These also link to the findings of Amukugo et al (2018). This study described more emotions experienced such as embarrassment, frustration, annoyance, having flashbacks, and feeling upset for the patient and fellow healthcare workers. Amukugo et al (2018) similarly reported emotional problems such as depression and a fear of contracting or spreading blood-borne viruses such as HIV. Indeed, a major factor of the psychological impact of sharps injuries is the silent nature of many infections as the injured may not know if they have been infected until they endure further tests (Symon, 2009). These types of injuries have been shown to have a huge psychological impact on the recipient and their families (Royal College of Nursing, 2013).

The Naidoo (2010) study described a lack of support from some staff and family members, whereas within the theme of ‘the role of my family and friends' within this study, healthcare workers and family were seen as being very supportive. A study by Gershon et al (2000) found that the majority of healthcare workers who had sustained a sharps injury found their spouses and partners to be supportive following the event. However, a sharps injury not only causes a risk of infection, it also has a great psychosocial impact on the victims and their family. NHS European Office (2013) stated that significant stress and psychological trauma can result from sharps injuries involving needles, even where no infection is ultimately acquired, due to long periods of uncertainty regarding the outcome of the injury, as well as changes in lifestyle, working restrictions and, where indicated, extended and debilitating treatments.

Within the Naidoo (2010) study participants mentioned the side effects of post-exposure prophylaxis drugs, but none of the participants within this study had to commence that type of medication. In addition, one participant within the Naidoo (2010) study stated that they had considered suicide, but this reaction was not mentioned by participants within this study.

The theme ‘the role of my mentor and personal tutor’ within this study described the very supportive nature and competence of the participant's mentor and personal tutor following the injury. Naidoo (2010) reported how some nurses were not very supportive of the nursing students and were not always aware of treatment and counselling procedures. Both studies found the personal tutor to be reassuring and supportive. Amukugo et al (2018) also reported the need for proper support for students including counselling and assistance by the university and hospital staff.

Within this study, the theme ‘the next time I used a sharp following the injury’ offered rich data regarding the emotions felt when involved with procedures involving sharps. Naidoo (2010) briefly mentioned participants feeling distressed when re-entering practice, whereas this study richly describes the perceived improvement of practice, the range of emotions expressed, and occasionally the avoidance of procedures involving sharps.

The other themes identified within this study, namely ‘if it had been a used sharp’, the ‘prevention of the sharps injury’ and ‘the perception of the patient involved in the sharps injury’ appear to be themes used to describe and experience that were not reported within the Naidoo (2010) study. Amukugo et al (2018) reported recommendations made by student nurses to improve management and prevention of sharps injuries, such as continuous training and education. These link with the findings of this study.

Limitations

The interviews were only conducted locally, so there are issues with the transferability of the findings (Lincoln and Guba, 1985), as all of the participants were from one UK university. Great efforts were made to try to ensure potential organisational and interpersonal power issues would not be present within the interviews (Moule and Goodman, 2014) as the researcher was a lecturer at the university where nursing students were the participants. These efforts included creating a compassionate connection and creating a non-threatening environment for the interviews. Irrespective of this, some participants may have withheld other important aspects about their experience due to the pre-existing relationship between the researcher and the nursing student. Only one participant out of 12 who were interviewed was male, which may not give a representative view of how male nursing students may have experienced a sharps injury.

Conclusion

Nursing students gave a vivid description of the event explaining the various types of injuries that occurred, and the varied procedures they were involved with when the injury happened. The sharps injury had an impact on the participants' professional and private lives. Many different emotions were conjured up following the injury and were experienced for variable periods of time. Occasionally the emotions would be severe with some nursing students suffering from flashbacks about the sharps injury experience. The roles of the mentor and personal tutor were highlighted, which exemplifies the important role of supervisors during and after the injury. The supportive nature of the mentor and other healthcare workers was illuminated, linked to their competence with dealing with the sharps injury situation. Nursing student friends used humour and were supportive when the nursing student involved in the injury gave an account of their experience. The next time the nursing student used a sharp illuminated how practice had changed and the emotions felt when the nursing student was faced with performing a task involving a sharp in the future. Thoughts and possible reactions to a different situation involving a used sharp were expressed, and the recognition that this might have been more severe than an injury with clean equipment. Various ways in which sharps injuries involving nursing students can be prevented from occurring were suggested. Emphasis was placed on education, simulation, good leadership and adherence to policies and procedures regarding sharps usage. The opinion formed of the patient influenced the perceived severity of the injury for the participant. There was a perception that there was a low risk involved in the sharps injury if the patient was an older person, as opposed to being high risk in the case of an IV drug user or a sex worker.

KEY POINTS

• The prevention of sharps injuries is an essential aspect of nursing
• Sharps injuries can have severe long-lasting psychological impacts on student nurses
• Student nurses can suffer from flashbacks, anxiety, shock and embarrassment following a sharps injury
• The support from the mentor in practice, the personal tutor, friends and family are important to the student nurse following a sharps injury
• Further research is required into this area to prevent sharps injuries and to improve education

CPD reflective questions

• Reflect on your practice of handling sharps and how your practice could be improved
• What steps can you take to reduce the risk of sharps injuries to yourself and others?
• Consider the psychological support that is available to student nurses (and other healthcare workers) following a sharps injury