Nursing Students' Occupational Health and Safety Problems in Surgical Clinical Practice

901801
research-article20202020
SGOXXX10.1177/2158244020901801SAGE OpenEyi and Eyi
Original Research
SAGE Open
Nursing Students’ Occupational Health

January-March 2020: 1–21
© The Author(s) 2020
DOI: 10.1177/2158244020901801
https://doi.org/10.1177/2158244020901801
and Safety Problems in Surgical Clinical journals.sagepub.com/home/sgo
Practice
Semra Eyi1 and İbrahim Eyi2
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
Introduction and urgent interventions are intensive (Erdağı & Özer, 2015).
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; 1
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
Survey Design Nursing Process model and the risk assessment process can
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).
Sample Group Then, 10 students who did not participate in the study
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
Public Health Nursing and Mental Health Nursing courses Data Analysis
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
Data Collection and Measurement Tool of <.05 was considered to be statistically significant.
The researchers developed a questionnaire based on the

research knowledge in the literature and the experience of Ethical Considerations
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
OHS situation in nursing students, evaluation of risk control, Results
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.
Characteristics of the Participants significant difference was found for these problems based on
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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/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
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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/p value 7.434/p = .006 0.224/p = .636
Note. OHS = occupational health and safety.

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
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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/p value 15.788/p = .007 90.835/p = .000
Note. OHS = occupational health and safety; PPE = personnel protective equipment.
Assessment. The students mostly encountered occupational Conclusion

hazards while executing treatment in clinics (54.2%), pre-
paring drugs for treatment (41.4%), tracking fire-pulse- This study has demonstrated that the conditions of OHS in
blood pressure (25%), maintaining general care (22.1%), clinical practice areas are very limited for students. Students
during intervention in emergency services (22.1%), and in this study were exposed to physical, chemical, and physi-
recapping needles (20.7%). No significant difference was ological risks, and were mainly affected psychologically, fol-
found between sexes for work during dangerous situations lowed by physically. It was concluded that the students were
(p > .005), but the difference for classes was significant at risk of getting burnout syndrome before they start the
(p < .005). Most students reported incidents related to nursing profession by experiencing similar symptoms to
occupational hazards to supervisor nurses (54.3%), and burnout syndrome (anxiety and irritability, low back and
supervisor nurses showed instant interest. Students stated back pain, headache, increased tendency to sleep, exhaus-
that occupational accidents were caused by lack of attention, early fatigue). Although nearly all students reported
tion (84.2%) and intensive work tempo (81.4%). They having knowledge of OHS at the end of their study, their
reported that when they face hazardous situations, they give knowledge and awareness of OHS were revealed to be very
priority to their health first (65%). No significant difference low. Moreover, in terms of OHS-related hazardous incidents,
was found for sex or classes in taking rest leave, the person students were mostly exposed to contact with blood and
to whom incidents were reported, documentation of inci- body fluids and had serious problems accessing PPE, which
dent, or practice type in which they were exposed to hazards comprises a protective measure against exposure to physical/
(p > .05; Table 6). verbal assault. They experienced anxiety and irritability in
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
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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/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
χ2/p value 4.926/p = .177 3.657/p = .301
Note. OHS = occupational health and safety; PPE = personnel protective equipment.
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
Table 7. Discussion.
10
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
Contact with blood and Doig (2000) In the study of Doig, students’ contact with In this study, 90.7% of the students came into Contact with blood and body fluids carries
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
Hsieh et al. (2006) Tarantola et al. stated that blood and body a common characteristic of health care
Adesunkanmi et al. (2003) fluid exposure was 60% in nurses and nursing services. Giving that health care workers
students in the study with 7,649 health are under risk in terms of OHS, the risk is
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)
Table 7. (continued)
Aghajanloo et al. (2011) Also, due to cultural values and norms in

Jackson et al. (2011) Turkey, especially in hospitals and/or clinics,
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
Büyük 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
11
and Szych, 9% of the nurses reported health care personnel, including nurses.
(continued)
12
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.
body injured in clinical Özpulat (2015) body of nurses was questioned and reported as the most injured body area of the students The high incidence of needle stick and sharp
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
Omaç et al. (2010) arm (5.9%), and then the other regions (12%, and finger (52.8%). Students encountered by safe tool use, is thought due to the lack
8—trunk, feet, legs). In the study of dangerous situations and were injured while of information on safe tool use
Önder et al., 18.6% of the nurses stated that applying the treatments in the clinic (54.3%),
they had hand–finger cuts, 6.4% of them had preparing drugs for treatment (41.4%),
pinch–bruise wounds, and 13.8% of them had an following vital signs (25%), giving general
accident in the form of needle prick. In the study care to the patient (22.1%), during the
of A. Yıldırım and Özpulat, the injury sites were intervention in the emergency department
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)
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
Having knowledge Elewa and Sahar Banan (2016) In the literature, it was observed that the In this study, almost all of the students In Turkey, with the second article of 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
information sources Burdurlu (2014) the lack of clinical experience in the first years. OHS, and they showed as information source No. 6331, Occupational Health and Safety
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
(2012) had knowledge and experience on OHS issues with the inclusion of the students accepted
Baniyousef et al. (2015) besides awareness. It was also revealed that to do internships in the workplaces within
Aluko et al. (2016) nursing students gained their knowledge about the scope of employee safety. It can be
www.mevzuat.gov.tr/ occupational safety in their courses. In the assessed that is because of that law the
MevzuatMetin/1.5.6331.pdf study conducted in Palestine, it was reported students got training before clinical practice
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
13
93% aware of PPE
(continued)
14
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
in curriculum Al-Momani et al. (2013) given to students studying in some associate to have courses in the curriculum related to be compulsory in terms of providing OHS,
Yang et al. (2007) degree programs, and the students agreed that worker health and safety and the willingness of the students in this
OHS courses they took during the associate regard can be considered as a reflection of
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)
PPE equipment used in Burdurlu (2014) 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
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
Güngör 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%.
that those who regularly use PPE against

Önder, Ağırbaş ̧, Yaşar, and Aksoy stated
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, Güngör
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).
15
(continued)
16
Büyük et al. (2016) 45% of the students were injured with needle It is stated that if accidents occur in
Yang et al. (2004) stick and sharp instrument injuries at least the workplace where the student is an
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 Büyük 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
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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.

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Nursing Students’ Occupational Health

and Safety Problems in Surgical Clinical journals.sagepub.com/home/sgo

Semra Eyi1 and İbrahim Eyi2

The researchers developed a questionnaire based on the

Table 2. Students Identifying Characteristics and Vaccine Status.

Female Male 2 3 Total

Dangerous situations related to OHS encountered in

Table 4. Nursing Students’ OHS Knowledge and Awareness.

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

Note. OHS = occupational health and safety.

Female Male 2 3 Total

Evaluation of risk control n % n % n % n % n %

Giving required sensitivity to OHS rules in clinical practice

Assessment. The students mostly encountered occupational Conclusion

Female Male 2 3 Total

Practice made and hazardous situation exposed in clinic

Aghajanloo et al. (2011) Also, due to cultural values and norms in

3. Evaluation of risk control

that those who regularly use PPE against

occupational risks are 13.4% among physicians

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