GDN3985 - Critical Appraisal of a Systematic Review in Nursing

This report presents a critical appraisal of a systematic review focusing on the impact of sharps injuries on student nurses. The review by Hambridge, Nichols, and Endacott (2016) is evaluated for its validity, reliability, and applicability to nursing practice. The appraisal covers the literature search strategy, quality of the review process, comprehensiveness of data collection, results, discussion, and overall analysis. The review identifies physical and psychological effects of sharps injuries, such as anxiety, depression, and fear, highlighting the need for further research and intervention strategies, particularly in under-researched areas like the UK. The report also discusses the importance of addressing psychological complications and providing necessary counseling to affected student nurses, noting limitations such as the scarcity of statistical data and potential biases in secondary data collection.

RUNNING HEAD: Systematic Study Review
SYSTEMATIC STUDY REVIEW

Systematic Study Review 1
Table of Contents
Introduction 2
Literature search and review 2
Quality of the review 3
Comprehensive data search 4
Results 5
Discussion and Result analysis 6
Conclusion 7
References 9

Systematic Study Review 2
Introduction
The present study aims to perform a critical appraisal to ensure chosen article is a valid, applicable and
reliable source of information. The researcher has appraised a systematic review relevant to nursing injuries,
penned by Kevin Hambridge, Andrew Nichols and Ruth Endacott, titled The impact of sharps injuries on
student nurses: a systematic review. The focus of this study is to discover effect of sharps injuries in nursing
student. The population chosen for this study was student nurses owing to a stark absence of published evidence
relevant to injuries. This article implements systematic review of health, psychology and nursing databases. The
restrictions of data collection were set in publications released between the years 1980 and 2014. English is the
preferred language for the studies recognised in this test. The researchers identified the studies through rigorous
quality analysis with validated appraisal tools. 40 articles from 18 countries successfully satisfied inclusion
criteria and thus considered as valid outcomes. Physical and psychological effects of sharps injuries in nursing
students were reported through anxiety, depression and fear. However, these aspects have not been quantified
through validated instruments. The effect of these injuries prove to have a severe and long-lasting effect on both
physical and psychological health. This article has shown the significance of further research into this issue in
the UK to establish influence of injuries within student nurse population. Future scope of this research can aid to
generate intervention for prevention of long-lasting harm. The study also stresses on psychological
complications relevant to injuries and necessary counselling.
Literature search and review
This segment determines the efficacy of the selected article chosen for review. The literature that has been
searched in this study permits an abundance of information in this issue. The findings of this review is in
congruence to the study of Akyol & Kargin (2016), who state that 57.9%of respondents report inefficient
knowledge of nurses in relevance to counselling and treatment after sharps injury. These injuries are caused by
delays in the treatment as well as an absence of counselling support for nursing students. The outcomes of this
review also supports the works of Ghasemi et al. (2017), who report respondents show a submissive behaviour

Systematic Study Review 3
towards common procedures outside practice scope and can contribute to occurrence of sharps injuries. In
addition to this, the results of Jahangiri et al. (2016) reveal supportive friends and family members who are
supportive and sympathetic. 51% of respondents feel nursing staffs involved in practice setting can be
considered not to be supportive towards the injuries. Nevertheless, clinical supervisors permit appropriate
guidance to student nurses through efficient caring system and direct them to appropriate counselling.
The qualitative data provided by a study reviewed by Hambridge et al. (2016) implore sharps injury on
nursing students. The literature pertaining to this study provides authentic datasets to show negative emotions of
insecurity, fear, concern, anger, and incompetence among student nurses. The literature accumulated thus pertain
to various sources of literature. It can be reviewed that the scarcity of statistical data can present considerable
hindrances for reliance of the literature reviewed. As opined by Reddy et al. (2018), sharps injury can impose
severe consequences for nursing students, causing significant physical damage and distress. The present
systematic review of Hambridge et al. (2016) described student nurses are often exposed towards experience of
biological hazards. This can increase their fear of contracting infections (HIV and Hepatitis) as well as make
them feel insecure.
Quality of the review
The researchers have assessed the rigour of studies that were included as well as excluded. The systematic
review has been implemented in six phases. In the first phase, the researchers develop a well-planned,
comprehensive search strategy with exclusive inclusion and exclusion criterion restricting the search. The
inclusion criteria involve fully accessible research articles that are published in the last three decades in the
English language. The wide time frame can termed to be a major limitation for this review. This is because,
reviews dating back from 1990s and before propose interventions that may be obsolete in the present scenario
(Ersin et al. 2016). The researchers, Hambridge et al. (2016) have employed a systematic review as the
mandated study design for their research. Usage of appropriate database and outside resources have strengthened
the study with appropriate data. The study design can said to be appropriately comprehensive owing to the large
area of data scanning and accumulation. Hambridge et al. (2016) used databases pertaining to nursing,

Systematic Study Review 4
psychology and health that prominently involved BMJ, EBSCO, CINAHL, Cochrane Library, Medline,
PubMed, PsycArticles, ScienceDirect, PsycINFO, SwetsWise and Trip.
According to Al Jarallah & Ahmed (2016), usage of multiple database can increase the area of search. In this
case, researchers have also included relevant articles from databases of grey literature, such as National
Research Register, Google Scholar, Sigle and Clinicaltrials.gov. Dissertations from UK as well as other
countries were also selected from PQDT, EThOS, Intute, NHS, Department of Health, Monitor, CDC and HPA.
The search was further refined by the use of appropriate keywords that helped to retrieve pertinent studies
(influenced by Belachew et al. 2017). The researchers used phrases like 'student nurse', ‘sharp injury’, ‘pre-
registration’, ‘needlestick’, ‘inoculation’, ‘accidents’, ‘occupational injury’, ‘biological exposure’, ‘blood borne
infection’, ‘percutaneous exposure’, ‘psychological harm’, ‘under-reporting’ with multiple study designs. The
systematic search for research articles can pertain to appropriate screening based on the inclusion and exclusion
criteria. Critical appraisal is done through thematic segregation of the results after extracting individual data
from the studies.
Comprehensive data search
The data for this study is synthesised through a systematic accumulation of information from various
databases. The researchers have considered a broad segment of data accumulation registries as well as time
frame. This method has its benefits and limitations that can affect the study. According to Ghasemzadeh et al.
(2015), utilisation of a wide timeframe can ensure that a broader categorisation of information is cultivated for a
research. It can also decrease the potential for biased observation in the data collection phase. However,
Geravandi et al. (2017) argue a primary limitation of this method is that a majority of the procedures developed
in older articles could be contested by the new studies. This may lead to obsolete recommendations and hinder
the reliability of the information appraised. In the study of Hambridge et al. (2016), the researchers have
successfully combined the review results in the form of separate themes. As clarified by the researcher, this
study has followed a secondary data collection method in its appraisal. As commented by Mengstie et al. (2018),
secondary information accumulation involves scouting for results proven and published by the primary or

Systematic Study Review 5
secondary articles available in public.
This data can be sourced from government reports, data repositories or grey literature. In relevance to this,
Motaarefi et al. (2016) argue grey literature can lower the cognitive quality of the information owing to lack of
appropriate review. However, Hambridge et al. (2016) have considered results from grey literature to include
wider region of information for their study. However, the researchers have not displayed individual results from
each of the studied articles. This may be termed as one of the limitations portrayed by the chosen systematic
review. Lack of documentation of raw secondary data can question the authenticity of the review. The
similarities and differences were not statistically proven by Hambridge et al. (2016). The researchers have
considered results that have been obtained from different studies. However, it could not be highlighted the roots
of each specified information. The results shed negligible light on the issue of variations in the outcomes. A lack
of appropriate rationale for the missing information further puts the reliability of the information studied in
question.
Results
Overall results of the study pertain to the prominence of adverse effects on physiological and psychological
health of student nurses. Hambridge et al. (2016) reviews 40 studies in all, out of which 34 were surveys, 1 case
analysis, 1 qualitative research and the rest being quasi-experiments. These studies have reported information
from a wide mass of healthcare students. The researchers have stressed on the inclusion of information collected
from nursing students. The results are thematically analysed to understand the effect of sharps injuries.
However, the number of studies that explored student nurse experiences against sustainment of sharp injuries
was critically low. There was only one such article that reported the relevant information. According to Beker &
Bamlie (2015), systematic reviews must gather a plethora of information stemming from a single
phenomenological approach. Nevertheless, this study considered student nurses from South Africa.
The numerical or bottom line of the research can be included in the course of data refinement done by the
researchers. Precision of results can include confidence intervals for expressed results. The researcher has not

Systematic Study Review 6
mentioned any odd ratios or NNT that further flawed the study. The study generated four significant themes in
relevance to traumatic incidents, reaction to trauma, intervening parameters, and support needs. According to
Gao et al. (2017), thematic appraisal of systematic review can be considered to be a significant parameter for
critical evaluation. In this study, nursing students provide an insightful, first-hand account of accidents. This
data has been provided in detail through precise calculation of time and durations. The results also determine the
physiological reactions to nursing injuries from the sharp objects (Abdulkhaleq et al. 2018). Responses involved
shock, sweating, escapism and nervousness. Emotional outbursts were also noted in most cases.
Discussion and Result analysis
The results can pertain to the local population in a medium relevance. This is because there was only one
article that discussed the implications of sharp injuries in relation to the chosen population of nursing students.
However, insights of these students were collected from the sample of African nurses. The review has focused
on a majority of critical outcomes associated to sharp injuries. The reports of emotional outbursts in student
nurses can develop a long term fear of HIV infection. As commented by Wada et al. (2015), the reviews of
nurses often follow an overwhelming sense of anxiety or fear that may later develop depression. The researcher
reported an increase in the number of respondents who have reported experiencing absence of care from
responsible staff in vicinity. The results revealed unsympathetic behaviours of the staff with nerve wracking
reactions towards treatment. Matsubara et al. (2017) comment this may involve side effects for post-exposure to
the prophylactic drugs.
Garus-Pakowska et al. (2018) state these effects include sickness, nausea and dizziness that influences
attendance and practice placement. The respondents also revealed nursing reactions that enabled a distressed
sensation while implementing the practice placement. Some of the nursing personnel reveal that they felt to be
re-living injuries. Some of the records implied suicidal tendencies in the respondents in relevance to
seroconversion. These outcomes are in correspondence with the studies of Ryu & Choi-Kwon (2018) who note
major psychosocial changes occurring to respondents over time. Benefits of this study is that the intervening
parameters precisely enumerate an absence in the awareness of sharps injury and its reporting in the nursing

Systematic Study Review 7
populations. It is recorded that some nursing students fail to appropriately report injuries due to unavailability of
appropriate staff and negative support. The advantages of this study is that it provides its understanding in a
comprehensive manner (Pirsaheb et al. 2017). Fluidity of the language permits a student to understand the
relying issue of this study.
In addition to this, lack of time has restricted the study into a boundary. This has also facilitated the reader
by providing them with precise outcomes and analysis. Major disadvantage include time and budget constraint
that hindered the possibility of a statistical analysis of the raw secondary data. In addition to this, the researchers
have not utilised a PRISMA collaborative tool that could have further refined the search strategy. Belachew et
al. (2017) comment lack of statistical data also add to the growing list of limitations. Individual data
documentation has been lacking from the study that hindered the reliance of the review. Recommendations for
future studies involve the usage of statistical analysis to understand the trends observed in raw secondary data.
Inclusion of a stringent search strategy is also recommended to prevent usage of redundant and obsolete
information.
Conclusion
Based on the information studied above, it can be stated that the chosen systematic review article highlights
potential issues of psychological origin that occurs from sharp injuries in student nurse. population. Sharp
devices can be defined as clinical items that are capable to pierce skin. These often include surgical instruments,
such as needle, scalpels, glass and lancets. In this study, the researchers have undertaken a systematic literature
search to include the articles that review sharp injuries experienced by student nurses. This issue is considered as
a critical concern for public health. The effect of these injuries on nursing students can cause damage of both
physical and emotional genres. Clinical warnings issued from the interventions of these studies helped the
researcher to appraise risks and hazards associated with sharp injuries. In addition to this, the researchers also
surfaced information about prominent bloodborne pathogens transmitted to student nurses. They are HIV
(human immunodeficiency virus), hepatitis B and C. Exposure to infection can also pose a considerable concern
for diverse healthcare ambience. A number of student nurse population are found to be exposed to bloodborne

Systematic Study Review 8
pathogens on contact to percutaneous injuries. This study, therefore satisfies the benchmark for systematic
review by providing a wide search area and a deduction of a definite outcome. A limitation of this study is that it
failed to provide any definite recommendation for the risks that are accounted in the article. This may hinder the
scope of its future evaluation owing to lack of appropriate vantage points to develop a risk management plan for
the student nurses in the UK.

Systematic Study Review 9
References
Akyol, A., & Kargin, C. (2016). Needle stick and sharp injuries among nurses. Glob J Nurs Forensic Stud,
1(109), 2.
Ghasemi, M., Khabazkhoob, M., Hashemi, H., Yekta, A., & Nabovati, P. (2017). The incidence of needle stick
and sharp injuries and their associations with visual function among hospital nurses. Journal of current
ophthalmology, 29(3), 214-220.
Jahangiri, M., Rostamabadi, A., Hoboubi, N., Tadayon, N., & Soleimani, A. (2016). Needle stick injuries and
their related safety measures among nurses in a university hospital, Shiraz, Iran. Safety and health at
work, 7(1), 72-77.
Reddy, S., Joseph, V., Liu, Z., & Straker, T. (2018). Characteristics of Sharp Injuries in Anaesthesia Providers
in New York State: A Cross-sectional Study. Journal of Clinical & Diagnostic Research, 12(12).
Reddy, S., Joseph, V., Liu, Z., & Straker, T. (2018). Characteristics of Sharp Injuries in Anaesthesia Providers
in New York State: A Cross-sectional Study. Journal of Clinical & Diagnostic Research, 12(12).
Ersin, F., Tekin Koruk, S., & Yilmaz, L. (2016). Effect of the training provided for nurses on sharp-needlestick
injuries and reporting process. Int J Caring Sci, 9(2), 561-8.
Al Jarallah, A. M., & Ahmed, A. S. (2016). Risk management approach of needle stick and sharp injuries
among nurses, Saudi Arabia: An interventional study. Journal of The Arab Society for Medical
Research, 11(2), 50.
Ghasemzadeh, I., Kazerooni, M., Davoodian, P., Hamedi, Y., & Sadeghi, P. (2015). Sharp injuries among
medical students. Global journal of health science, 7(5), 320.
Geravandi, S., Moogahi, S., Kayedi, N., Yari, A. R., Hedayat, M., Shajirat, S., ... & Esfarjani, N. M. (2017).
Investigation of sharp injuries in an educational hospital, Ahvaz, Iran. Archives of Hygiene Sciences

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Volume, 6(1).
Mengstie, B., Mesfin, F., & Munye Aytenew, T. (2018). Sharp Injuries and Associated Factors among Nurses
Working in Dire Dawa City Administration Public Health Facilities, Eastern Ethiopia (Doctoral
dissertation, Haramaya University).
Motaarefi, H., Mahmoudi, H., Mohammadi, E., & Hasanpour-Dehkordi, A. (2016). Factors associated with
needlestick injuries in health care occupations: a systematic review. Journal of clinical and diagnostic
research: JCDR, 10(8), IE01.
Beker, J., & Bamlie, T. (2015). Needle stick and sharp injuries and associated factors among nurses working in
jimma university specialized hospital, south west Ethiopia. Journal of Nursing & Care, 4(5), 1-8.
Gao, X., Hu, B., Suo, Y., Lu, Q., Chen, B., Hou, T., ... & Zong, Z. (2017). A large-scale survey on sharp
injuries among hospital-based healthcare workers in China. Scientific reports, 7, 42620.
Abdulkhaleq, S. M. S., Griffin, H. R., & Gutierrez, M. L. (2018). ASSOCIATION BETWEEN THE
ORGANIZATION AND ENVIRONMENTAL FACTORS AND WORK INJURIES AMONG HOME
HEALTH CARE NURSES. LIFE: International Journal of Health and Life-Sciences, 4(1).
Wada, K., Yoshikawa, T., YOSHIKAWA, J. J., Mitsuda, T., Kidouchi, K., Kurosu, H., ... & Moriya, K. (2015).
Sharp injuries in Japanese operating theaters of HIV/AIDS referral hospitals 2009–2011. Industrial
health.
Matsubara, C., Sakisaka, K., Sychareun, V., Phensavanh, A., & Ali, M. (2017). Prevalence and risk factors of
needle stick and sharp injury among tertiary hospital workers, Vientiane, Lao PDR. Journal of
occupational health, 17-0084.
Garus-Pakowska, A., Górajski, M., & Szatko, F. (2018). Did legal regulations change the reporting frequency
of sharp injuries of medical personnel? Study from 36 hospitals in Łódź Province, Poland. Int. J.
Occup. Med. Environ. Health, 31(1), 37-46.

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Ryu, J. G., & Choi-Kwon, S. (2018). Association of Sleep Disturbance, Fatigue, Job Stress and Exposure to
Blood and Body Fluid in Shift-work Nurses. Journal of Korean Biological Nursing Science, 20(3),
187-195.
Hambridge, K., Nichols, A., & Endacott, R. (2016). The impact of sharps injuries on student nurses: a
systematic review. British Journal of Nursing, 25(19), 1064-1071.
Pirsaheb, M., Sohrabi, Y., & Yarmohammadi, H. (2017). Studying the frequency of needle stick injuries
suffered while providing medical services in a hospital in Kermanshah, Iran. EXECUTIVE EDITOR,
8(2), 2363.
Belachew, Y. B., Lema, T. B., Germossa, G. N., & Adinew, Y. M. (2017). Blood/Body Fluid exposure and
needle stick/sharp injury among nurses Working in Public hospitals; southwest ethiopia. Frontiers in
public health, 5, 299.