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The Influence of Nurses' Knowledge, Attitudes, and Health Beliefs on Their Safe Behavior With Cytotoxic Drugs in Israel

Ben-Ami, Sarah RN, MOccH; Shaham, Judith MD, MOccH; Rabin, Stanley PhD; Melzer, Alex MSc; Ribak, Joseph MD, MPH


The purpose of this study was to examine the influence of the nurses' knowledge, attitudes, and health beliefs on their behavior and their actual usage of safety measures while handling cytotoxic drugs in their daily work surroundings.

The Health Belief Model (HBM) and its extensive form, the Protection Motivation Theory (PMT), were used as the theoretical frameworks. Sixty-one nurses participated in the study, 31 hospital-based nurses daily exposed to cytotoxic drugs for the last 5 years, and 30 non-exposed community nurses. An occupational questionnaire was used to test the nurses' actual safe behavior and compliance with the recommended guidelines. A randomly selected group of exposed nurses were observed to validate their compliant behavior.

A gap was found between the nurses' knowledge and their actual behavior concerning the potential risks of cytotoxic drugs and their use of protective measures (p < .005). Significant correlations were found among the components of the extensive HBM (perceived susceptibility, barriers, benefits and self-efficacy). The observational findings supported the above results.

The study'S findings support the need to promote primary prevention by providing a safe environment for the employee by means of education, training with regard to safety measures, clear policy, written guidelines and their enforcement.

From the Department of Planning of Development in Nursing, General Health Insurance, Tel Aviv (Ms Ben-Ami); the Department of Occupational Cancer (Dr Shaham and Mr Melzer); and the National Institute of Occupational & Environmental Health (Drs Shaham, Rabin, and Ribak), Raanana, Tel-Aviv University, Israel.

Address correspondence and reprint requests to Dr. Judith Shaham, Occupational Cancer Department, National Institute of Occupational & Environmental Health, P.O. Box 3, Raanana, 43100, Israel.

© 2001 Lippincott Williams & Wilkins, Inc.