Lessons Learned from a Practice-Based, Multisite Intervention Study with Nurse Participants

Multisite research is an important strategy to strengthen the external validity of nursing science (O'Mara, BauerWu, Berry, & Lillington, 2007). In contrast to single-site studies, research projects conducted with multiple sites offer potentially larger, more diverse participant samples and reduce the likelihood of idiosyncratic research findings. Conversely, multisite studies are more complicated to conduct and administer. New complexities also arise when research participants are staff, as opposed to patients or clients.Workplace intervention studies are increasing, due in part to growing awareness that improved worker health and safety have downstream societal benefits (Anger etal., 2015). Specifically, the NationalInstitute for Occupational Safety and Health (NIOSH) has launched the Total Worker Health initiative to respond to this challenge (NIOSH, 2016; Weisfeld, Lustig, & Board of Health Sciences Policy, 2014). Healthy workers are associated with lower turnover, improved economic productivity, and enhanced personal well-being. Due to labor shortages, high acuity, long shifts, and physical demands, NIOSH has identified healthcare workers as a vulnerable labor sector for intervention (NIOSH, 2013). For the past 10 years, our interdisciplinary team has documented the specific concerns of oncology nurses employed in ambulatory oncology settings. These nurses face an unusual occupational threat of hazardous drug exposure given the high patient volume, the explicit emphasis on chemotherapy treatment, and associated continuous risks of exposure.Our team documented that 18% of surveyed ambulatory oncology nurses experienced an unplanned hazardous drug spill in the preceding 6 months (Friese et al., 2014). Hazardous drug exposure is correlated with substantial short- and long-term health effects, such as nausea, vomiting, airway irritation, reproductive problems, and rare cancers (NIOSH, 2004). Despite 30 years of data to support the need for increased vigilance when handling hazardous drugs, surprisingly few nurses wear personal protective equipment as recommended (Connor & McDiarmid, 2006; Polovich & Clark, 2012). Except for the current project, only one published study examined an educational intervention for nurses, conducted in one Malaysian hospital (Keat, Sooaid, Yun, & Sriraman, 2013). Thus, we lack sufficient evidence on how to improve nurses' use of personal protective equipment when handling hazardous drugs.The Drug Exposure Feedback and Education for Nurses' Safety (DEFENS) study is a 4-year, multisite cluster randomized controlled trial (Friese, MendelsohnVictor, et al., 2015). The study compares one-time static educational information about hazardous drug exposure prevention to quarterly feedback on study results, coupled with tailored messages designed to reduce barriers to protective equipment use. In planning for the project, we reviewed the sparse literature that describes multisite research project management with registered nurse employees as participants. In the current article, we review successful study implementation strategies and identify important considerations for future research projects that plan to incorporate nurses as participants.ApproachThe DEFENS study is a cluster randomized controlled trial. Nurses who work 16 hr a week or more in ambulatory infusion within 12 large cancer centers in the United States were invited to participate. Full details may be found in the published protocol paper (Friese, Mendelsohn-Victor, et al., 2015) or in the ClinicalTrials.gov registry (National Institutes of Health [NIH], 2016a). Guided by extant models of health behavior and risk reduction, we hypothesized that one-time educational content is insufficient to improve nurses' use of personal protective equipment when handling hazardous drugs (McCullagh, Ronis, & Lusk, 2010). Rather, we compared static educational content (control intervention) to quarterly feedback about data gleaned from our study, coupled with video messages tailored to participants' reported barriers to protective equipment use (experimental intervention). …