Radiation Protection Knowledge for Nurses at King Abdulaziz Medical City-Jeddah in Saudi Arabia: A Cross-Sectional Study

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Abstract

Introduction

Ionizing radiation, such as X-rays, consists of high-energy photons within the electromagnetic spectrum capable of breaking molecular bonds and ionizing atoms. This process generates free radicals, which are chemically active compounds capable of indirectly damaging DNA, thereby increasing the risk of cancer due to long exposures [1]. Using ionizing radiation in the medical field has become a crucial tool for diagnostic and therapeutic purposes across various medical conditions. The deterministic and stochastic effects associated with high doses of ionizing radiation exposure have been recognized for nearly as long as ionizing radiation has been studied [2–5]. Radiation risks at lower doses primarily entail stochastic effects, particularly somatic effects like cancer, in contrast to the deterministic effects observed at higher doses. For stochastic effects, which typically do not exhibit a clear threshold, scientific committees assume a positive linear relationship at sufficiently low doses, suggesting that no threshold exists [6–8].

Radiation protection is an important discipline aimed at minimizing unnecessary radiation exposure to reduce the harmful effects of ionizing radiation for health providers and patients [3, 9]. Although there is no evidence of a linear no threshold model, it is used as a precautionary principle and serves as the basis of the radiation protection system. There are three fundamental principles of radiation protection: justification, optimization, and dose limitation. The risks associated with the use of ionizing radiation in the radiology department can be minimized by following the ‘As Low As Reasonably Achievable (ALARA)’ principle, established by the International Commission on Radiological Protection, to ensure the implementation of all possible measures to reduce radiation exposure. This principle aims to reduce the radiation dose by using shielding, increasing the distance from the radiation source, and decreasing the radiation exposure time [10].

The radiology department of any major hospital plays an essential role in the healthcare sector. It involves computed tomography, fluoroscopy, and radiography (‘conventional X-ray’ including mammography), which are examples of different modalities for medical imaging procedures. A variety of healthcare workers are involved in the radiology department such as radiologists, technologists, nurses, and others [11]. Nurses working within radiation teams are required to ensure patient safety and protection while providing thorough explanations during examinations. They also serve as a key supporter for patients undergoing radiation procedures, according to the Institute of Physics and Engineering in Medicine in association with the Royal College of Nursing [12]. Inadequate awareness of ionizing radiation among nurses can lead to ineffective protection for themselves and their patients [13–15]. Prior research indicates a widespread lack of radiation education among nurses [16, 17]. International studies highlight the necessity for further investigation into nurses’ current radiation knowledge levels, including ionizing radiation, to identify shortcomings and develop effective educational interventions [18]. In Finland, nurses’ radiation comprehension was assessed using the Healthcare Professional Knowledge of Radiation Protection (HPKRP) scale, which evaluates three areas of radiation knowledge: principles of radiation physics, radiation protection, and radiation safety [19–21]. To our understanding, while prior studies in Saudi Arabia have investigated nurses’ awareness of radiation [22], they did not utilize the HPKRP scale, highlighting the need for additional studies in this domain.

Therefore, this study aims to assess the current level of knowledge and understanding of ionizing radiation and its associated hazards among nurses at King Abdulaziz Medical City in Jeddah, Saudi Arabia, using the HPKRP scale.

Materials and Methods

Results and Discussion

Of the demographic information of 40 participating nurses, 36 (90%) were female. The participants’ demographics reveal a predominant age group of 18–27 years, constituting 42.5% of the sample, followed by 28–37 years (35%), 38–48 years (17.5%), and 48–57 years (5%). In terms of work experience, the majority had 0–4 years (47.5%), followed by 5–9 years (22.5%), 10–14 years (5%), 15–20 years (12.5%), and over 20 years (12.5%). Regarding educational background, 27.5% held a bachelor’s degree, while 72.5% had a diploma. The participants were distributed across various units, with the majority working in the radiology department (52.5%), followed by the medical ward (15%), first-aid clinic (12.5%), operating theater (5%), and other units such as surgical, oncology, and hemodialysis (15%). Only 22.5% of the nurses had received medical radiation education, while the remaining 77.5% had not received such education, as shown in Table 1.

Table 1.

Summary of Demographic Information of Participating Nurses (n=40)

In Table 2, items and sub-categories of competency within the HPKRP scale show the mean±SD for the three main factors of radiation knowledge varied between 4.15±2.60 and 6.26±2.74. Among the nurses surveyed, the highest mean score was observed in their understanding of guidelines for safe radiation use 6.26±2.74. This was followed by their knowledge of radiation protection, which had 5.97±3.00. The lowest mean score was recorded in their knowledge of radiation physics and the principles of radiation use 4.15±2.60.

Table 2.

Main Factors and Items of Competency within the HPKRP Scale

The binary logistic regression in Table 3 shows that the only independent variable significant among the main factors was radiation education (p<0.05). Participants with radiation education were 5.51 (95% CI, 1.62 to 11.21) times more likely to have a good level of radiation principles knowledge compared to participants without radiation education. The overall model of radiation principles was a statistically significant difference; the value of Nagelkerke R² suggested the variables included in the model explained 32.3% of the classification of the dependent variable. The estimated model correctly classifies 70% of the cases.

Table 3.

Binary Logistic Regression to Analyze Factors Influencing Radiation Knowledge Outcomes

Fig. 1 illustrates the SEM path diagrams, including regression weights, showing the interrelationships between the key variables in the study: radiation safety, radiation protection, principles of physics, and radiation knowledge. This figure provides a valuable framework for understanding how safety, protection, and physics principles interact to shape knowledge regarding radiation use. The regression weights and p-values supporting this analysis are presented in Table 4.

Fig. 1.

Structural equation model path diagrams with regression weights. S, guidelines of safe ionizing radiation use; PT, radiation protection; P, principles of radiation physics.

Table 4.

Regression Weights and Standardized Regression Weights

Table 4 highlights the critical factors influencing radiation knowledge among nurses. As shown, ‘radiation safety’ demonstrated a significant positive and direct association with ‘radiation knowledge’ (knowledge ← safety=0.495, p<0.005). ‘Radiation protection’ also showed a significant positive association with ‘radiation knowledge’ (knowledge ← protection= 0.239, p<0.001). A negative association was observed between ‘principles of physics’ and ‘radiation knowledge’ (knowledge ← principles=–0.006, p=0.035).

The study highlighted significant discrepancies in the comprehension levels of participant nurses across various domains. To the best of our knowledge, this is the first study to investigate and evaluate nurses’ knowledge and awareness of radiation in Saudi Arabia using the HPKRP scale.

The demographic profile of the participating nurses provides valuable insights into the composition of the study sample. Regarding age distribution, the predominant age group fell within the range of 18 to 27 years, indicating a predominantly youthful workforce, which reflects the trend of younger individuals entering the nursing profession [23]. Notably, this finding is consistent with a prior study conducted in Malaysia [20]. The study revealed that the majority of nurses were female, aligning with gender distribution patterns observed in previous studies [19, 20]. Furthermore, a significant portion of nurses reported work experience ranging from 0 to 4 years, while the majority had a diploma degree in nursing, mirroring findings from prior studies in Malaysia [20]. The majority of nurses have work experience between 0 and 4 years, and educational attainment among the participating nurses was varied, with the majority holding a diploma degree in nursing, similar to the previous study in Malaysia [20]. In contrast, a key difference was noted in our study: while the majority of participants were from the radiology department, unlike the previous studies [19, 20], a significant number of nurses lacked formal medical radiation education. This discrepancy underscores a departure from prior findings and highlights a potential area for further investigation and intervention.

In the HPKRP scale, nurses exhibited a strong understanding of guidelines for the safe utilization of ionizing radiation, as evidenced by their highest mean score, which was a departure from findings in prior studies [19, 20]. Conversely, their knowledge of radiation physics and the principles of radiation use garnered the lowest reported scores, consistent with previous research where understanding equations and measures in medical radiation examinations received the lowest mean score [19, 20]. Falling between these main factors, participants displayed a stronger understanding of radiation protection concepts. This suggests a reassuring level of comprehension regarding radiation protection measures, which is crucial for protecting individuals potentially exposed to radiation, an observation that differs from that in previous studies [19, 20]. Moreover, our finding for the lowest score is consistent with earlier research by Kaplan and Avci [24], which reported the lowest mean score in the category of knowledge of radiation physics and principles of radiation use (3.02±1.50).

The findings indicated a notable correlation between demographic data and the main factors of radiation knowledge. The overall classification of radiation education was statistically significant across the three main factors, consistent with previous findings [19]. Furthermore, nurses employed in radiological departments demonstrated notably higher levels of radiation knowledge compared to their counterparts in other departments. This finding aligns with previous research [19], which indicates that nurses working in radiology departments possess greater familiarity with radiation physics and basic radiation usage than those in other settings such as first-aid clinics, medical wards, operating theaters, surgical units, and oncology departments. It is noteworthy that a majority of nurses in radiological departments received radiation education during their bachelor’s degree studies, whereas many nurses outside of radiological departments, despite holding bachelor’s degrees, did not receive such education. This knowledge gap among nurses not directly involved with radiation may represent an increased health risk. It underscores a significant deficiency in understanding fundamental aspects of medical radiation procedures. Addressing these knowledge deficiencies is imperative to ensure the safe and efficient application of radiation in medical settings.

The association between the three main factors revealed a weaker link between knowledge and principle, whereas the association was strong between protection/safety and knowledge. This finding has not been previously reported and suggests that nurses have a relatively strong understanding of radiation safety and protection, underscoring the significance of safe radiation use for individuals susceptible to exposure. The value of this study has been in identifying targeted improvement areas, specifically, enhancing safety culture and developing protection guidelines for nurses that align with national and international standards.

The relationship between the HPKRP and its primary components was investigated in the employees who participated in our study, and it was discovered that there was a substantial positive relationship between all of the significant elements. Based on these findings, it was decided that the scale used in our analysis was accurate and consistent with prior investigations [19, 20, 24].

The study’s outcomes are constrained by the duration of the study and only include nurses from the medical city branch in Jeddah. Due to the prospective nature of the study, nurses found it challenging to find time to participate, compounded by the limited number of nurses in the radiology department. Despite the small sample size, this study is valuable evidence for evaluating the radiation knowledge among nurses at King Abdulaziz Medical City in Jeddah. It highlights the importance of developing future programs focused on radiation education and offering courses and training for nurses working with or exposed to radiation.

Conclusion

The study pinpointed a significant factor influencing nurses’ radiation knowledge: completion of medical radiation education, which exhibited a positive correlation with all three main factors of radiation knowledge examined. Consequently, healthcare institutions should enhance educational provisions for all nurses involved with or exposed to radiation. The findings emphasize the crucial role of radiation knowledge and, particularly, the impact of education in ensuring the safe utilization of medical radiation. However, further research is needed to determine optimal interventions for addressing deficiencies in nurses’ radiation knowledge, particularly in the context of Saudi Arabia.

In essence, healthcare organizations should provide radiation education not only for nurses in radiology departments but also for those in other clinical areas. Additionally, efforts should be focused on developing a broader understanding of radiation awareness and safety, as discussed previously. Notably, both academic achievement and completion of medical radiation education were positively correlated with nurses’ understanding of radiation physics and principles of radiation usage.

Based on the results of this study, it is recommended that radiation protection education be strengthened and implemented to ensure that healthcare professionals, particularly those in clinical settings, have a more comprehensive understanding of radiation safety. This could include implementing more targeted, formal education and training on radiation protection protocols, safety measures, and risk assessment to enhance awareness and compliance with best practices in radiation safety.

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