healthcare

Article
Factors Influencing Occupational Health and Safety among
Nursing Students in Their Clinical Placements: A
Cross-Sectional Study
Abdullah Suwailem Alsharari 1 and Ali Kerari 2, *

1 Nursing Educator, Tubarjal Hospital, Tubarjal 74766, Aljouf, Saudi Arabia; aalshrari@moh.gov.sa
2 Nursing Administration and Education Department, College of Nursing, King Saud University,
Riyadh 11421, Saudi Arabia
* Correspondence: alikariri@ksu.edu.sa

Abstract: Occupational health and safety aims to promote and maintain optimal physical, mental,
and social health for workers in their occupations. Within Saudi Arabia, adequate information must
be gathered to address the various factors influencing occupational health and safety among nursing
students to minimize occupational health hazards and ensure a safe clinical environment. This
cross-sectional study was conducted in Riyadh, Saudi Arabia, between April and September 2023,
involving 150 nursing students. Data collection included questions to gather sociodemographic
information, and contained an instrument assessing the participants’ knowledge of occupational
health and safety and evaluation of risk control in clinical environments. Blood and other bodily
fluids, workplace violence, needle-stick injuries, and injuries caused by sharp instrument tools were
identified as the most prevalent occupational risks among the participants. Most nursing students
were aware of occupational health and safety, with a high level of compliance with occupational
health and safety measures and personal protective equipment use. We also identified a statistically
significant correlation between occupational health and safety knowledge and risk control evaluation
among nursing students. To ensure a safe and beneficial clinical training area, student nurses must
complete extensive occupational health and safety courses before moving to clinical areas to reduce
potential hazards that may affect their lives.
Citation: Alsharari, A.S.; Kerari, A.
Factors Influencing Occupational Keywords: occupational health; occupational safety; industrial health; nursing; nursing students
Health and Safety among Nursing
Students in Their Clinical Placements:
A Cross-Sectional Study. Healthcare
2024, 12, 884. https://doi.org/ 1. Introduction
10.3390/healthcare12090884 Nursing students are considered a high-risk group because of their lack of experience
Academic Editor: Georgios Rachiotis in dealing with workplace hazards and complex environments, along with a shortage of
instructors, which may negatively affect their internship pathways [1]. Because of their
Received: 17 March 2024 direct contact with patients, inadequate training in safety culture, and readiness to take risks,
Revised: 16 April 2024
nursing students are likely to be exposed to pathogens and occupational health and safety
Accepted: 23 April 2024
(OHS) risks during their internships. Moreover, nursing students’ low OHS knowledge
Published: 24 April 2024
could increase their exposure to numerous hazards and high-risk work environments,
ultimately threatening their lives [2]. Therefore, increasing nursing students’ knowledge
and awareness of OHS, as well as that of their trainers, can promote safe practices and
Copyright: © 2024 by the authors.
minimize their exposure to hazards and risky environments [3]. This can be achieved by
Licensee MDPI, Basel, Switzerland. ensuring that these individuals possess comprehensive knowledge about the risk factors
This article is an open access article of OHS such as physical, mental, and social issues that impact safety. To acquire such
distributed under the terms and knowledge, nursing students must have increased awareness of the barriers to achieving
conditions of the Creative Commons optimal OHS in the workplace.
Attribution (CC BY) license (https:// Several studies reported that more than half of the students were completely aware of
creativecommons.org/licenses/by/ personal protective equipment (PPE) and safety laws; the most frequently mentioned health
4.0/). issues in these studies were anxiety, musculoskeletal pain, and lower back discomfort [4–6].

Healthcare 2024, 12, 884. https://doi.org/10.3390/healthcare12090884 https://www.mdpi.com/journal/healthcare

Healthcare 2024, 12, 884 2 of 14

Similarly, Qaraman et al. found that 21% of nursing students had experienced one or more
needle-stick injuries (NSIs) [7]. Another study observed that a lack of understanding of
infarction control techniques and a lack of commitment to immunization protocols were
highly associated with an elevated incidence of NSIs and sharps injuries [7]. Tariah et al.
reported that nurses had a greater incidence of work-related musculoskeletal diseases than
other health professionals [8]. In addition, 63.8% of the nurses in the study reported expe-
riencing lower back pain in the previous 12 months. Therefore, raising nursing students’
awareness about the severe physical damage caused by work-related musculoskeletal
problems is crucial.
According to Alshahrani et al., abuse and violence in the health field have become
ubiquitous and serious problems; specifically, they reported that healthcare personnel are
more prone to experiencing workplace violence today than they were in the past [9]. Al-
Shamlan et al. discovered that roughly three in ten (30.7%) had experienced verbal abuse;
moreover, most workers who experienced abuse had not reported it because previous
complaints had resulted in negative consequences [10].
To date, only a few quantitative studies have assessed factors such as awareness and
knowledge of OHS and exposure to occupational hazards among nursing students in
Saudi Arabia; elucidating the effects of such factors could help to minimize occupational
health hazards and identify aspects that contribute to safe practices and lower exposure to
hazards and risky environments. Therefore, this study gathered information to address
the various factors influencing OHS among nursing students. To address the lack of
correlational descriptive studies on the above-mentioned factors, this study investigated
nursing students’ awareness and knowledge of OHS and their exposure to occupational
health hazards during their clinical placements at King Saud University in Saudi Arabia.

2. Materials and Methods

2.1. Study Design and Setting
A web-based cross-sectional study was conducted at King Saud University in Riyadh
from April to September 2023. The study population comprised nursing students from
King Saud University, with a total of 150 nursing students recruited for participation.

2.2. Participants
This study used convenience sampling to recruit nursing students performing their
clinical rotations at King Khalid University Hospitals during their fourth through twelfth
semesters of study to complete a questionnaire. This study employed convenience sampling
to allow simple data collection and facilitate hypothesis development.
The sample size was determined through a statistical G power analysis. The signifi-
cance criterion (α), the population effect size (the estimated size of the association between
the independent variables and the dependent variables), and statistical power are essential
elements of statistical inference. According to the guidelines for power analysis, the suitable
sample size was estimated at 120. The final sample size was increased to 150 participants
to account for 20% attrition.
A total of 150 students completed the survey. Males comprised 60% of the study
population, and most participants were aged between 20 and 27 years old; 27% were
older than 27. The year of study for students was categorized into two levels: lower level
(first to second year of study, n = 79, 53%) and upper level (third to fourth year of study,
n = 71 students, 47.3%) (Table 1).
Healthcare 2024, 12, 884 3 of 14

Table 1. Demographic characteristics.

Variables n (%)
Age
Under 27 110 (73.3%)
27 or older 40 (26.7%)
Gender
Male 90 (60%)
Female 60 (40%)
Year of study
Lower academic level (first- and second-year
79 (53%)
nursing students)
Higher academic level (third- and fourth-year
71 (47%)
nursing students)
Training area
Inpatient 92 (61%)
Outpatient 48 (32%)
Others 10 (7%)
Student type
Full-time student 103 (68.67%)
Part-time student 47 (31.33%)
Marital status
Single 119 (79%)
Married 31 (21%)

2.3. Data Collection Procedures and Measures

Potential participants were approached at the College of Nursing according to their
class schedules. The online survey link, which included an overview of the study, eligibility
for participation, and informed consent, was shared through a barcode. Participants
could respond from their smartphone, tablet, or laptop. The online self-administered
questionnaire comprised two main sections. The first section gathered sociodemographic
information, and the second section assessed participants’ knowledge of occupational
health and safety and their evaluation of risk control in clinical environments. All research
activities were closely monitored throughout the data collection phase; the lead investigator
reviewed the quality of the data and the completeness of the questionnaires after each day
of data collection.
The questionnaire was a modified version of a previous questionnaire developed by
Eyi et al. in which one item did not apply to Saudi Arabia [11]. The original question-
naire had 29 questions: 4 questions were related to students’ demographic characteristics,
and 25 questions assessed their perspectives and knowledge regarding OHS [11]. The latter
set of questions presented problems that students face in the clinical practice environment,
with the answers categorized into four subcategories: identifying threats, assessment of
OHS situations in nursing students, evaluation of risk control, and assessment. In this
study, one of the questionnaire items from the original questionnaire was deleted because
it was related to regulations and legislation specific to Turkey.
Two subscales (awareness of the OHS situation and evaluation of risk control) were
used, each of which consisted of several statements. Each statement was answered on a
4-point Likert scale ranging from 1 (completely disagree) to 4 (completely agree). These
two subscales were used to assess students’ awareness of the OHS situation and their
evaluation of risk control. Higher scores indicated higher knowledge levels of OHS and
proper compliance with OHS measures. The Cronbach’s α values for the awareness of
the OHS situation subscale and the evaluation of risk control subscale were 0.82 and
0.79, respectively.
Healthcare 2024, 12, 884 4 of 14

2.4. Data Analysis

All statistical analyses were performed with SPSS V.29. Descriptive statistics (frequen-
cies, percentages, and means) were used to describe the sample variables. Independent
samples t-tests were conducted to evaluate significant differences between groups. The
chi-square test was used to examine the relationships between categorical variables, and the
Pearson correlation coefficient was used to examine the relationship between continuous
variables. All the assumptions related to these statistical tests were met. A probability
value of p < 0.05 was considered statistically significant.

2.5. Ethical Approval

The study was conducted in accordance with the World Medical Association Dec-
laration of Helsinki, and approved by the Institutional Review Board of the King Saud
University (Ref #: KSU-HE-22-641 and dated 11 October 2022). Informed consent was
obtained from all participants, who were provided with detailed information about the
study. Additionally, participants were assured that their data would be treated with the
utmost confidentiality and accessible only to the research team members.

3. Results
The findings were addressed within the framework of the following subcategories:
identifying threats, assessment of OHS knowledge among student nurses, risk control
evaluation, and nursing students’ perspectives on the origin of hazards, threat sources, and
measures taken during OHS incidents.

3.1. Identifying Potential Threats

The questionnaire contained specific questions related to OHS threats in clinical
practice. The first question was “What kind of dangerous situations related to OHS did
you encounter in clinical practice?” Over half of the nursing students (60.7%) reported that
contact with blood and body fluids (BBFs) was the largest threat. The second-largest threat
was physical and verbal assault by the supervising nurse or doctor (52.7%), colleagues (52%),
and patients or their relatives (52%). A total of 68 nursing students (45.3%) had an NSI
after injection, and 43.3% of nursing students were exposed to injuries caused by sharps or
drilling tools during their clinical practice. The differences in threats encountered between
genders and academic levels were not statistically significant (p > 0.05) (see Table 2).
Regarding the identification of problems related to PPE, the most common problem
was the lack of gowns and goggles, which was reported by 44.7% of nursing students. Fur-
thermore, 38.7% of the participants reported using only one glove because of an insufficient
supply, and 34.7% reported caring for many patients with the same gloves. In addition, we
did not observe any statistically significant differences between academic levels or genders
in recognizing PPE concerns (p > 0.05).
Regarding symptoms during clinical practice, most students reported suffering from
headache (65.3%), stress (63.3%), exhaustion (54%), backache (56%, 84), early fatigue (54.7%),
and anxiety or anger (50.7%). Participants reported that hand antiseptic (58%) and latex
(36%) were the most utilized chemicals during clinical practice. A significant relationship
was observed between gender (male and female) and the use of latex (p < 0.05); however,
no significant relationship was detected between academic level or gender and chemical
use (p > 0.05).
Healthcare 2024, 12, 884 5 of 14

Table 2. Nursing students’ experiences of occupational risks and hazards of OHS in clinical practices using the chi-square test.

Gender Academic Level

Lower Upper
Male Female Total
Level Level
Identifying Threats n (%) n (%) p Value n (%) n (%) p-Value n (%)
Dangerous situations related to OHS
Contact with blood and body fluids 55 (36.7%) 36 (24%) 0.89 50 (33%) 41 (27.3%) 0.48 91 (60.7%)
Physical/verbal assault by healthcare providers 43 (28.7%) 36 (24%) 0.14 46 (30.7%) 33 (22%) 0.15 79 (52.7%)
Needle-stick injury after injection 43 (28.7%) 25 (16.7%) 0.46 38 (25.3%) 30 (20%) 0.47 68 (45.3%)
Falling, slipping, strains, and dropping of materials 44 (29.3%) 27 (18%) 0.64 37 (24.7%) 34 (22.7%) 0.89 71 (47.3%)
Contact with chemical additives or liquids 36 (24.3%) 26 (17.6%) 0.76 34 (23%) 28 (18.9%) 0.65 62 (41.3%)
Physical/verbal assault by colleagues 48 (32.2%) 30 (20.1%) 0.63 43 (28.9%) 35 (23.5%) 0.47 78 (52%)
Sharp or drilling tool injury (e.g., scalpel and scissors) 44 (29.3%) 21 (14%) 0.09 40 (26.7%) 25 (16.7%) 0.05 65 (43.3%)
Physical/verbal assault from patients or their relatives 48 (32%) 30 (20%) 0.68 44 (29.3%) 34 (22.7%) 0.33 78 (52%)
PPE usage problems in clinical practice
Having to use a single glove due to a lack of gloves 34 (22.7%) 24 (16%) 0.78 34 (22.7%) 24 (16%) 0.24 58 (38.7%)
Providing care to multiple patients with the same single glove 34 (22.7%) 18 (12%) 0.32 30 (20%) 22 (14.7%) 0.36 52 (34.7%)
Entering rooms of patients with respiratory contagious diseases without a
34 (22.7%) 22 (14.7%) 0.89 30 (20%) 26 (17.3%) 0.86 56 (37.3%)
mask due to no masks being available
Not wearing gowns or goggles due to a lack of PPE resources 42 (28%) 25 (16.7%) 0.54 34 (22.7%) 33 (22%) 0.67 67 (44.7%)
Findings and symptoms in clinical practice
Headache 55 (36.7%) 43 (28.7%) 0.18 54 (36%) 44 (29%) 0.41 98 (65.3%)
Early fatigue 46 (30.7%) 36 (24%) 0.28 42 (28%) 40 (26.7%) 0.69 82 (54.7%)
Exhaustion 46 (30.7%) 35 (23.3%) 0.38 41 (27.3%) 40 (26.7%) 0.58 81 (54%)
Burning eyes/throat 27 (18%) 18 (12%) 0.10 25 (16.7%) 20 (13.3%) 0.64 45 (30%)
Nosebleed 18 (12%) 19 (12.7%) 0.10 22 (14.7%) 15 (10%) 0.34 37 (24.7%)
Skin irritation 17 (11.3%) 18 (12%) 0.11 22 (14.7%) 13 (8.7%) 0.16 35 (23.3%)
Allergies 23 (15.3%) 20 (17.2%) 0.30 28 (18.7%) 15 (10%) 0.05 43 (28.7%)
Breathing difficulties 26 (17.3%) 17 (11.3%) 0.94 26 (17.3%) 17 (11.3%) 0.22 43 (28.7%)
Backache 48 (32%) 36 (24%) 0.42 41 (27.3%) 43 (28.7%) 0.28 84 (56%)
Anxiety or anger 42 (28%) 34 (22.7%) 0.23 38 (25.3%) 38 (25.3%) 0.50 76 (50.7%)
Stress 54 (36%) 41 (27.3%) 0.29 47 (31.3%) 48 (32%) 0.30 95 (63.3%)
Common areas of the body injured in clinical practice
Head 22 (14.7%) 13 (8.7%) 0.69 18 (12%) 17 (11.3%) 0.86 35 (23.3%)
Forearm, wrist, palm, or finger 33 (22%) 27 (18%) 0.30 37 (24.7%) 23 (15.3%) 0.07 60 (40%)
Patella, calf, or foot 19 (12.7%) 13 (8.7%) 0.93 20 (13.3%) 12 (8%) 0.20 32 (21.3%)
Mental damage 18 (12%) 18 (12%) 0.16 20 (13.3%) 16 (10.7%) 0.69 36 (24%)
Chemicals contacted in clinical practice
Hand antiseptic 47 (31.3%) 40 (26.7%) 0.07 46 (30.7%) 41 (27.3%) 0.95 87 (58%)
Formaldehyde, glutaraldehyde, ethylene oxide, and antineoplastic cancer
17 (11.3%) 14 (9.3%) 0.51 17 (11.3%) 14 (9.3%) 0.78 31 (20.7%)
drugs
Latex 26 (17.3%) 28 (18.7%) 0.02 * 28 (18.7%) 26 (17.3%) 0.88 54 (36%)
Note: OHS: occupational health and safety; PPE: personal protective equipment; * p < 0.05.
Healthcare 2024, 12, 884 6 of 14

3.2. Assessment of OHS Knowledge

Table 3 presents the findings related to nursing students’ OHS awareness and knowl-
edge. Most nursing students (67.3%) agreed that OHS was related to and impacted their
careers, and 62% reported that they were knowledgeable about OHS specific to their pro-
fession. As shown in Table 3, a significant difference was found between academic levels
regarding knowledge about OHS (p < 0.05). Moreover, 71.3% of nursing students indi-
cated that they knew the definition of occupational diseases. Most of the students (69.3%)
expressed that they preferred to have OHS classes in the curriculum. In addition, 66%
stated that they were aware of OHS commitments and the rights of healthcare personnel
and patients in hazardous conditions. Approximately half of the nursing students (51.3%)
stated that they knew about OHS regulations and guidelines. No significant differences
were observed in OHS knowledge between academic levels or genders (p > 0.05).

3.3. Risk Control Evaluation

As shown in Table 4, which provides information on risk control evaluation, 75.3% of
the students reported that they showed the required sensitivity to OHS guidelines. Most
students (76.7%) believed that their job required PPE, and most (76%) reported that they
demonstrated appropriate sensitivity toward using PPE in training areas. On the other
hand, 68.6% of students believed that OHS safeguards were adequate. As shown in Table 4,
a significant difference was found between academic levels regarding the belief that the
nursing profession requires PPE (p < 0.05). A significant difference in students’ risk control
evaluation of OHS (sum score) was observed between academic levels (p < 0.01), whereas
no statistically significant differences in the sum score of risk control evaluation were found
between genders.
A moderate positive correlation was observed between OHS-related knowledge and
the levels of risk control evaluation (r = 0.52, p < 0.001). Participants with adequate OHS-
related knowledge reported higher levels of risk control evaluation.

3.4. Nursing Students’ Perceptions of Hazard Sources and Compliance with OHS Precautions
As shown in Table 5, the students experienced occupational hazards most often
while administering routine care to patients (66.7%), monitoring vital signs in the clinic
(64.4%), placing patients in beds or transporting them (63.8%), performing interventions
in emergency services (61.3%), obtaining a patient’s medical history (57.7%), delivering
patients’ laboratory samples (56.7%), administering therapy in the clinics (55.7%), preparing
medicines for treatment (53.3%), and recapping needles (52%). No significant differences
were observed in scenarios that exposed students to occupational hazards between aca-
demic levels or genders (p > 0.05).
Regarding nursing students’ perceptions of the reasons for occupational accidents,
most reported long working hours (75.3%), followed by inexperience in dealing with
hazards (71.3%), not using PPE (70%), and an intensive work pace and lack of attention
(68.7%). A total of 64.7% of nursing students reported receiving rest leave when they
encountered occupational dangers in training areas, and 69.3% of participants reported
that their encounters with situations that threatened their OHS were documented. Most
students (84%) stated that their health was their main priority in hazardous situations.
Healthcare 2024, 12, 884 7 of 14

Table 3. The assessment of OHS knowledge and awareness, using the independent samples t-test and the chi-square analysis.

Gender Academic Level

Male Female Lower Level Upper Level Total
Nursing Students’ Awareness of OHS Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%)
Thinking that OHS is related to my
profession and affects it
Yes 60 (40%) 41 (27.3%) 0.83 49 (32.7%) 52 (34.7%) 0.14 101 (67.3%)
Being knowledgeable about OHS
Yes 53 (35.3%) 40 (26.7%) 0.33 42 (28%) 51 (34%) 0.01 * 93 (62%)
Knowing the definition of occupational
disease
Yes 60 (40%) 47 (31.3%) 0.12 54 (36%) 53 (35.3%) 0.39 107 (71.3%)
Requesting an OHS class in the
curriculum
Yes 58 (38.7) 46 (30.7%) 0.11 52 (34.7%) 52 (34.7%) 0.32 104 (69.3%)
Being aware of OHS commitments and
the rights of patients and health workers
in hazardous situations
Yes 61 (40.7%) 38 (25.3%) 0.57 50 (33.3%) 49 (32.7%) 0.46 99 (66%)
Knowing OHS regulation novelties
Yes 47 (31.3%) 30 (20%) 0.79 35 (23.3%) 42 (28%) 0.06 77 (51.3%)
Awareness of OHS ‘sum score’ 15.81 (4.1) 16.50 (4.2) 0.32 15.46 (4.1) 16.79 (4.1) 0.05 150
Note: OHS: occupational health and safety; * p < 0.05.
Healthcare 2024, 12, 884 8 of 14

Table 4. Nursing students’ compliance with OHS measures and PPE usage, using the independent samples t-test and the chi-square analysis.

Gender Academic Level

Male Female Lower Level Upper Level Total
Evaluation of Risk Control Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%)
Applying required OHS rules in clinical practice.
Yes 68 (45.3%) 45 (30%) 0.93 56 (37.3%) 57 (38%) 0.18 113 (75.3%)
Thinking that the OHS measures taken are sufficient.
Yes 59 (39.3%) 44 (29.3%) 0.31 50 (33.3%) 53 (35.3%) 0.13 103 (68.6%)
Applying required PPE rules in clinical practice.
Yes 66 (44%) 48 (32%) 0.34 58 (38.7%) 56 (37.3%) 0.43 114 (76%)
Thinking that nursing profession requires PPE.
Yes 69 (46%) 46 (30.7%) 0.90 55 (36.7%) 60 (40%) 0.03 * 115 (76.7)
Risk control evaluation of OHS ‘sum score’. 11.4 (2.9) 11.82 (2.7) 0.42 10.91 (2.8) 12.34 (2.6) 0.002 ** 150
Note: OHS: occupational health and safety; PPE: personal protective equipment; * p < 0.05; ** p < 0.001.

Table 5. Nursing students’ perceptions on hazard sources and compliance with OHS precautions using the chi-square analysis.

Gender Academic Level

Male Female Lower Level Upper Level Total
Assessment Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%)
Practice made and hazardous situation exposed in clinic
Providing regular care to patients 64 (42.7%) 36 (24%) 0.15 52 (34.7%) 48 (32%) 0.81 100 (66.7%)
Preparing drugs for treatment 52 (34.7%) 31 (20.7%) 0.46 41 (27.3%) 42 (28%) 0.37 83 (55.3%)
Conducting interventions in emergency services 56 (37.3%) 36 (24%) 0.78 50 (33.3%) 42 (28%) 0.60 92 (61.3%)
Applying treatments in the clinic 51 (34.2%) 32 (21.5%) 0.77 45 (30.2%) 38 (25.5%) 0.74 83 (55.7%)
Tracking vital signs in the clinic 58 (38.9) 38 (25.5%) 0.99 51 (34.2%) 45 (30.2%) 0.97 96 (64.4%)
Recapping needles 48 (32%) 30 (20%) 0.68 41 (27.3) 37 (24.7%) 0.97 78 (52%)
Taking a patient’s story 49 (23.9%) 37 (24.8%) 0.42 43 (28.9%) 43 (28.9%) 0.50 86 (57.7%)
Delivering laboratory samples (e.g., blood, urine, and stools) of patients 53 (35.3%) 32 (21.3%) 0.50 50 (33.3%) 35 (23.3%) 0.08 85 (56.7%)
Taking the patient to bed or transferring to another place 58 (38.9%) 37 (24.8%) 0.83 48 (32.2%) 47 (31.5%) 0.55 95 (63.8)
During clinic medical visit/academician visit 52 (34.7%) 35 (23.3%) 0.94 51 (34%) 36 (24%) 0.08 87 (58%)
Reasons for occupational accidents
Intensive work tempo 64 (42.7%) 39 (26%) 0.42 48 (32%) 55 (36.7%) 0.02 * 103 (68.7%)
Lack of attention 60 (40%) 43 (28.7%) 0.45 51 (34%) 52 (34.7%) 0.25 103 (68.7%)
Healthcare 2024, 12, 884 9 of 14

Table 5. Cont.

Gender Academic Level

Male Female Lower Level Upper Level Total
Assessment Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%) Mean (SD)/n (%) p-Value Mean (SD)/n (%)
Not using PPE 61 (40.7%) 44 (29.3%) 0.46 48 (32%) 57 (38%) 0.009 ** 105 (70%)
Long work hours 66 (44%) 47 (31.3%) 0.48 55 (36.7%) 58 (38.7%) 0.08 113 (75.3%)
Inexperience 60 (40%) 47 (31.3%) 0.12 53 (35.3%) 54 (36%) 0.22 107 (71.3%)
Notified person in case of hazardous incident
I did not tell anyone.
Yes 30 (20%) 21 (14%) 0.83 27 (18%) 24 (16%) 0.96 51 (34%)
I informed the supervising nurse, and he or she was interested.
Yes 66 (44%) 45 (30%) 0.82 52 (34.7) 59 (39.3%) 0.01 * 111 (74%)
I informed the responsible academician, and he or she took an immediate
interest.
Yes 68 (45.3%) 47 (31.3%) 0.69 58 (38.7%) 57 (38%) 0.32 115 (76.7%)
The priorities when faced with a dangerous situation
My priority is to comply with every precaution that our institution takes.
Yes 69 (46%) 47 (31.3%) 0.81 55 (36.7%) 61 (40.7%) 0.01 * 116 (77.3%)
My own health is my top priority.
Yes 76 (50.7%) 50 (33.3%) 0.85 63 (42%) 63 (42%) 0.13 126 (84%)
My priority is my job.
Yes 54 (36%) 35 (23.3%) 0.83 44 (29.3%) 45 (30%) 0.33 89 (59.3%)
I have been given rest leave when I experienced clinical hazards.
Yes 61 (40.7%) 36 (24%) 0.32 53 (35.3%) 44 (29.3%) 0.51 97 (64.7%)
When I encounter a dangerous situation, it is documented.
Yes 67 (44.7%) 37 (24.7%) 0.09 53 (35.3%) 51 (34%) 0.52 104 (69.3%)
Note. NS: nursing student; OHS: occupational health and safety; PPE: personal protective equipment; * p < 0.05. ** p < 0.01.
Healthcare 2024, 12, 884 10 of 14

4. Discussion
This study aimed to determine nursing students’ knowledge of OHS and their expo-
sure to occupational health hazards during their clinical practice. The discussion of the
findings focuses on the risk assessment process through the following subcategories: iden-
tifying threats, nursing students’ assessment of OHS knowledge, risk control evaluation,
and perceptions of hazard sources and compliance with OHS precautions.

4.1. Identifying Threats

Exposure to bodily fluids and blood was the most reported threat. Occupational blood
and body fluid exposure (OBBE) is a substantial concern for nurses who work in fields that
require them to regularly touch patients and their blood or other body fluids. Nurses have
a high risk of acquiring bloodborne viruses, such as hepatitis B virus (HBV), hepatitis C
virus (HCV), and human immunodeficiency virus (HIV) [4]. Similarly, Yasin et al. reported
that healthcare workers had a higher risk of acquiring bloodborne viruses, such as HIV,
HBV, and HCV, because of unintended exposure to BBFs [12]. This is among the most
severe public health problems that healthcare workers face while they treat patients. Thus,
internship and training center units at nursing colleges should focus on teaching students
about preventative measures to mitigate OBBE risk. At clinical training sites, nursing
students must be aware of infection control protocols, including PPE use (i.e., wearing
gloves, masks, and goggles and safe needle handling practices). Accordingly, stakeholders
and policymakers must increase nursing students’ knowledge by providing regular training
and supervision to ensure that they adhere to safety precautions and procedures.
Our study found that the second-most reported threat was physical and verbal as-
sault from supervising nurses and doctors, colleagues, and patients or their relatives.
Di Prinzio et al. also found that workplace violence significantly affected employees’
health [13]. Workplace violence results in work overload, job dissatisfaction, fatigue, and
exhaustion, which often lead to high rates of turnover and absenteeism. Violent assaults
not only have psychological, physical, organizational, and professional repercussions but
also decrease an organization’s performance. To prevent workplace violence, Di Prinzio
et al. recommended that healthcare organizations develop targeted organizational policies
and safety training programs for workplace violence management; implement effective
communication training to facilitate earlier detection of potentially aggressive and violent
behavior; establish reporting procedures; and provide medical, psychological, and legal
support after violent incidents [13]. In addition, academic advising and counseling units
should address all types of violence at clinical training sites. This would involve inviting
and encouraging students to visit the counseling units to discuss and review their academic
and non-academic issues. In addition, academic advisors can provide supportive academic
advising by identifying personal and social problems at clinical sites. This would ultimately
contribute to creating safe work environments for nursing students.
NSIs and accidents caused by sharps or drilling tools are among the greatest threats
healthcare employees face. Healthcare employees risk contracting life-threatening illnesses
that are spread through the blood, such as HIV, HBV, and HCV. Our results showed that
45.3% of nursing students (n = 65) experienced an NSI and that 43.3% of students (n = 65)
were injured by sharps or drilling tools during clinical practice. Needles, sharp instruments,
and other devices that penetrate the skin are occupational hazards for healthcare person-
nel [14,15]. Therefore, healthcare organizations and nursing programs should ensure that
students receive comprehensive education and training on proper techniques for needle
disposal as well as safe work practices.
This study found that the most common problem that nursing students faced with PPE
was an insufficient supply of gowns and goggles. This represents a threat to nursing stu-
dents because it could increase their exposure to contaminants from bloodborne pathogens.
Nurses frequently fail to wear all the required personal safety equipment, placing them
at risk of contracting bloodborne diseases. Yasin et al. found that healthcare employees
who did not utilize eye goggles had a higher risk of OBBE [12]. Healthcare institutions are
Healthcare 2024, 12, 884 11 of 14

responsible for monitoring and maintaining an adequate supply of PPE, including gowns
and goggles. Nursing students and faculty should collaborate with institutional representa-
tives to ensure that the PPE supply is sufficient, which would require an increase in their
level of awareness about the importance of PPE use and its impact on student safety.
Regarding symptoms experienced during clinical practice, the students experienced
headaches, stress, exhaustion, early fatigue, and anxiety. These symptoms resulted in
academic burnout and affected the OHS of the nursing students. Similarly, Hwang et al.
reported that anxiety, stress, and depression affected academic burnout in students who had
no clinical practice experience [16]. They also found that stress and satisfaction influenced
academic burnout in nursing students who had clinical experience. Our results highlight
the importance of creating and implementing intervention programs that reduce academic
burnout in nursing students. To improve nursing students’ satisfaction with their majors
and their values as nurses, clinical practice settings and programs must be re-evaluated and
improved. Furthermore, schools must support students and coordinate with clinical site
institutions to reduce stress, depression, and anxiety among nursing students and improve
their satisfaction with their majors.
Consistent with a study conducted by Eyi and Eyi [11], our study found a significant
difference in chemical exposure during clinical practice between genders and reported
that female students were more affected by latex allergies. Therefore, individuals who
are at risk of developing an antiseptic or latex allergy during their education should be
identified, and preventive measures should be taken to prevent life-threatening reactions
such as anaphylaxis.

4.2. Assessment of OHS Knowledge

Our findings reveal a high level of OHS knowledge among nursing students at King
Saud University, reflecting an advanced level of awareness and knowledge about the funda-
mentals of OHS and demonstrating the high quality of education at King Saud University.
We did not observe any significant differences in OHS knowledge between academic levels
and genders. Furthermore, the existing literature on OHS knowledge indicates that nursing
students have a comprehensive understanding of OHS before advancing to clinical areas.
Alharbi et al. found that the Nursing College at King Saud University offered high-quality
education and a range of courses to meet Saudi Arabia’s need for nursing professionals [17].
Conversely, Yasin et al.’s study revealed that the proportion of student nurses who had
received training in preventing occupational infections was low [12]. To meet the needs of
a growing population, the nursing workforce must be skilled and well-educated. Therefore,
universities should establish a strong system for teaching students how to be safe in clinical
areas before moving to training areas.
Alharbi et al. reported that the high knowledge of OHS among nursing students
at King Saud University signifies that they perceive the educational environment more
positively than students at other universities [17]. In the current study, more than half of
nursing students acknowledged the link between OHS and their profession. Consistent
with our results, Eyi and Eyi’s study found that nearly all students (95.7%) were aware
of OHS, and 52.8% of students identified OHS courses as a source of information [11].
To ensure adequate OHS knowledge, Ugur et al. indicated that nursing students should
receive OHS training from an expert in the field before entering clinical rotations [18]. These
studies suggest that the school’s curriculum is the primary source of OHS knowledge for
nursing professionals.

4.3. Risk Control Evaluation

In our risk control evaluation, nursing students showed a high level of knowledge
of how to use PPE to reduce occupational incidents, pathogen transmission, and possible
dangers in a wide range of occupations. Most students reported that they followed OHS
rules as required; additionally, most stated that their jobs required PPE and that they used
PPE in training areas with adequate care. Similarly, most students in Eyi and Eyi’s study
Healthcare 2024, 12, 884 12 of 14

reported that they were aware of the need for PPE in clinical settings, and almost all of
them (97.1%) indicated that PPE was necessary in their professions [11].
According to Elshaer et al., student nurses’ opinions regarding PPE use were pre-
dominantly positive, indicating that they received education in this area. The authors
found that nursing students utilized protective items at a relatively high rate [19]. We
observed significant differences in risk control and evaluation between academic levels. In
alignment with a study by Tuan et al., we observed a significant relationship between the
duration of training, academic level, and nursing students’ compliance with risk control
and evaluation [20]. Colet et al. reported a statistically significant difference in compliance
with standard precautions between academic levels [21]. These data suggest that more
clinical experience and academic years are related to higher compliance with standard
precautions. Students in the bridge nursing program and those in later academic years have
more clinical exposure, which is related to superior compliance with precautions. These
results conflict with the findings of Eyi and Eyi, who observed no significant differences in
compliance with OHS measures and PPE usage between academic levels [11].
Our findings revealed a statistically significant relationship between nursing students’
assessment of OHS situations and the level of risk control evaluation; specifically, as
nursing students’ level of OHS knowledge increased, their risk control evaluation level also
increased. This indicates that when nursing students have more knowledge about OHS,
their level of risk control evaluation is higher. Olcay et al. found significant improvements
in the students’ knowledge levels after an OHS course and concluded that all students in
universities should receive OHS education [22]. Thus, increasing students’ knowledge and
awareness of OHS would increase their understanding of risk management approaches
to OHS, potentially providing students with a structured foundation for problem solving.
This could benefit them in clinical reasoning regarding safety and health problems and
strengthen their self-care.

4.4. Nursing Students’ Perceptions of Hazard Sources and Compliance with OHS Precautions
The students identified different types of situations that potentially exposed them
to occupational hazards in the clinic. Our study indicated that the nursing students
were most often exposed to occupational risks when providing routine care to patients,
performing interventions in emergency services, and recapping needles after use. Our
findings are somewhat consistent with other studies, in which students stated that the
most likely reasons for occupational injuries were a lack of PPE use, inexperience, and long
working hours [11,19]. Nursing programs and healthcare facilities should foster a culture
of workplace safety that ensures the well-being of nursing students. For example, nursing
students are encouraged to seek help from experienced healthcare professionals who can
provide supervision, guidance, and support during clinical practice. Clinical preceptors or
mentors play major roles in addressing students’ concerns, offering feedback, and ensuring
safe practices.

4.5. Implications for Occupational Health in Nursing Practice

This research provides potential strategies for enhancing students’ OHS. The stu-
dents reported that they were aware of the hazards associated with nursing. In college,
first- and second-year nursing students should be familiar with OHS, which can improve
their knowledge of clinical training risks, and they gain extensive hands-on experience
in dealing with such risks by the end of their internship year. Employing risk evaluation
represents a significant step in building students’ OHS knowledge. In addition, implement-
ing courses related to manual patient handling may help students avoid injuries, such as
back pain. Establishing an OHS curriculum that extends from the first academic year until
graduation would provide nursing students with a comprehensive understanding of OHS;
such a curriculum could involve pre-practical exams before students begin clinical practice.
In clinical settings, clinical supervision plays an integral part in ensuring workplace safety
for nursing students during their clinical practice. This involves monitoring and evaluat-
Healthcare 2024, 12, 884 13 of 14

ing nursing students’ occupational health and safety practices, providing feedback, and
identifying areas for improvement.

4.6. Study Limitations

This study’s cross-sectional design is a limitation of the study; this design makes
it difficult to establish cause-and-effect associations because it only reflects a one-time
assessment of the alleged cause and effect. The time of the cross-sectional snapshot may not
reflect the group’s typical or overall behavior. Another limitation is the issues associated
with online surveys, including internet access problems, response bias, survey fatigue, and
a large number of unanswered questions.

5. Conclusions
This study investigated the awareness and knowledge of OHS and exposure to occupa-
tional health hazards among nursing students during their clinical placement and identified
factors contributing to safe practices and reduced risk exposure. The findings revealed that
the following occupational hazards were the most common: blood and other body fluids,
workplace violence, and NSIs. We observed a statistically significant correlation between
nursing students’ OHS knowledge and their risk control evaluation. To ensure a safe and
beneficial clinical training area, student nurses must complete extensive OHS courses before
moving to clinical areas and while working in clinical areas to reduce potential hazards that
may affect their lives. Future studies should include other nursing schools and collect data
on OHS. This would elucidate the diverse OHS experiences of nursing students regarding
the risk assessment process from a wide range of educational perspectives.

Author Contributions: Conceptualization, A.S.A. and A.K.; methodology, A.S.A. and A.K.; software,
A.S.A.; validation, A.S.A.; formal analysis, A.S.A. and A.K.; investigation, A.S.A.; resources, A.S.A.
and A.K.; data curation, A.S.A. and A.K.; writing—original draft preparation, A.S.A. and A.K.;
writing—review and editing, A.S.A. and A.K.; visualization, A.S.A.; supervision, A.K.; project
administration, A.S.A.; funding acquisition, A.K. All authors have read and agreed to the published
version of the manuscript.
Funding: The study was funded by the Researchers Supporting Project number (RSPD2024R844) at
King Saud University, Riyadh, Saudi Arabia.
Institutional Review Board Statement: The study was conducted in accordance with the World
Medical Association the Declaration of Helsinki, and approved by the Institutional Review Board of
King Saud University (Ref #: KSU-HE-22-641 and dated 11 October 2022).
Informed Consent Statement: Informed consent was obtained from all the participants. All study
procedures were performed in accordance with the declaration of Helsinki.
Data Availability Statement: Data are not shared due to privacy and ethical restrictions.
Acknowledgments: The authors extend their appreciation to Researchers Supporting Project number
(RSPD2024R844) at King Saud University, Riyadh, Saudi Arabia.
Conflicts of Interest: The authors declare no conflicts of interest.

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