NURS 3303 Concepts of Professional Nursing

Introduction

In nursing, an evidence-based practice is significant which entails a conscientious, and a problem-solving approach for clinical practice settings, which includes the best evidence from various well-designed studies, clinical’s expertise as well as patient values and preferences that help nurses in decision-making process for patient care (Lehane et al., 2019). Evidence based practice is also crucial as it focuses to provide the most efficient available care with the target of doing betterment of patient outcome. In nursing practice, it has been seen that respiratory as well as other infectious diseases (such as influenzae) are very common and as a preventive strategy the use of protective equipment such as face mask is extremely important (Perencevich et al., 2020). During the pandemic COVID-19, the risk of the infection among the nurses were the most as they were the frontline workers that cared for patients and were in direct contact (Nguyen et al., 2020). In that situation using face mask was mandatory for preventing the infection. Medical mask (or surgical mask) as well as KN95 mask both were available and used by the nurses. The purpose of this study is to find the effectiveness of medical mask or surgical mask and N95 mask in preventing the respiratory illness in nursing population.

Practice Problem and Question

In nursing practice, wearing sufficient personal protective equipment is very crucial because the nurses interact with the patient frequently and they remain exposed for a long time to the infection. It has been seen that; medical masks significantly reduce the risk of infection among the nurses (Nguyen et al., 2020). According to the Desai and Mehrotra (2020), medical masks are the personal protective equipment type, which has been very effective in preventing the transmisson of infectious disease or respiratory infections. These masks protect the user's nose and mouth and, when fitted properly, can assist prevent the spread of respiratory bacteria or viruses. In the battle against the outbreak of COVID-19, keeping a face mask is a crucial issue. According to the report published by the World Health Organization (2021), it was reported that more than 89 million masks were required every month for keeping the health workers safe in the time of the global pandemic- COVID-19. In this context, a research question will be developed to carry out the evidence-based practice.

While formulating the research question it was seen that there are specific formats to develop the question and PICO is one of the common and popular formats. It is the acronym where P denotes the patient population/ the problem, I represent the intervention or selected method, C stans for the comparison or another intervention which would be compared and lastly O is the outcome of the intervention (Doody & Bailey, 2016). In this research P is the respiratory infection among nursing population, use of medical mask or surgical mask is the I, use of N95 respirator is the C and the O is the outcome of the medical mask use. The research question in this portion would be “What is the effectiveness of surgical mask in comparison to the N95 respirator mask to prevent respiratory infection among nursing professionals?”

Search Strategy and Evidence selection

To search for the research evidences, a proper search strategy needs to be established. The first step is to develop search keys and search terms which would help to find the proper and suitable research articles (Ho et al., 2016). In this context the search phrases that developed were: “surgical mask”, “N95 respirator”, “respiratory infection”, “nursing”. After formulating the search phrases Boolean operators such as ‘VS’ ‘AND’, ‘OR’ need to be used which will join the search phrases and assist in searching the research evidences. The databases that were used to search the evidences were PubMed, NCBI and CINAHL. The inclusion criteria also need to be established to find the most suitable and recent articles that would be valid and reliable. In this research all the articles which were viewed published after the year 2016 to find the most recent and valid articles.

After reviewing the abstracts of various articles, the methodology was narrowed even further. The use of a numerical hierarchy to categories publications based on types of trials, research, and academic sources is known as levels of evidence. The accompanying level of evidence table was used to attribute a level of evidence to each article assessed, with one being the highest and seven being the lowest (Ingham-Broomfield, 2016).

Discussion of Literature

Article 1

The first article selected in this context is published by Bartoszko and colleagues (2020) where the researchers carried out a systematic review and meta-analysis of randomized trials where the researchers compared medical masks to N95 respirators which has been used to reduce laboratory-confirmed viral infection as well as respiratory disease, particularly coronavirus in medical personnel. According to the hierarchy of evidence this article comes under level 1 evidence. Four RCTs were meta-analyzed, with grouping taken into account. Medical masks did not improve laboratory-confirmed viral (included coronavirus) respiratory infection while contrasted to N95 respirators. Just one study looked at coronaviruses specifically and discovered no differences between them. Medical masks as well as N95 respirators may give equivalent protection against viral respiratory infection, which include coronavirus, among healthcare workers in non-aerosol-generating care, according to low-confidence research.

Article 2

The following research article selected in the context is published by Collins et al. (2021), where they look at the findings, level of evidence, as well as methodologic integrity of original research on the efficacy of surgical masks for preventing viral respiratory disease transmission, with a focus on the efficiency of the N95 respirator compared to surgical mask. The researchers reviewed a total of 8 studies and a total of 9,164 participants were involved. The researcher’s analysis showed a major statistical difference between N95 respirator when compared with surgical mask for preventing influenza-like-illness, respiratory viral infection (non-influenza based), severe acute respiratory syndrome coronavirus (SARS-CoV) viral infection, respiratory viral infection, as well as laboratory-confirmed respiratory viral infection. The researchers concluded that when contrasted to surgical masks, N95 respirators were linked to less viral infection events in healthcare personnel. When compared to the other viruses studied, the N95 mask was the most efficient in minimizing the hazard of viral infection in the clinical setting from the viruses like SARS-CoV 1 and 2.

Article-3

The following article selected is published by Barycka et al. (2020) where the researchers conducted a meta-analysis of randomized trials where they assessed the efficiency of the medical masks as well as the N95 respirators in decreasing the risk of respiratory infections. The research also comes under Level evidence as per the hierarchy of evidences. The research stated that N95 respirators could not minimize the incidence of respiratory virus infection when comparing to medical or surgical masks (p = 0.36), although there was no statistical difference in laboratory-confirmed influenza among N95 as well as medical masks. Other viruses, such as coronavirus (RR = 0.74; p = 0.49), were also protected by medical masks. N95 respirators were found to be less likely to cause respiratory sickness and influenza-like disease.

Significance to Nursing

From the literature review it can be seen that, both the medical mask as well as N95 respirators both are effective similarly, that can prevent respiratory infections which include COVID-19. No significant difference was found among two types mask which were selected, however both masks were effective to prevent respiratory infections. The research is significant to nursing practice as from the evidences it were found that based on the kind of mask and how it is worn, masks as well as respirators can give varying amounts of protection (cdc.gov, 2021). Whereas all masks as well as respirators offer some level of protection, correctly fitted respirators offer the best protection. Wearing a high-quality mask or respirator may be especially critical in high-risk settings or for persons who are at a higher risk of developing a serious illness (Desai & Aronoff, 2020). Some masks and respirators provide more protection than others, yet some are more difficult to accept or wear continuously. The most important thing is to wear a face mask or respirator that fits well, is pleasant, and delivers adequate protection.

Conclusion

The research indicated that both the surgical and medical mask were similarly effective in preventing respiratory illnesses including COVID-19. However, as per few research studies included that when compared with the surgical masks, N95 respirators were linked to less episodes of viral infections in healthcare personnel including nurses. In comparison to the other viruses, the N95 mask was most efficient in lowering the chance of a viral infection in the clinical settings or hospital environment from the SARS-CoV 1 and 2 viruses, but both the masks are effective in preventing the respiratory illness. Since, 2 studies reported the same effectivity and 1 study preferred N95 respirator mask hence, the recommended mask would be N95 for the nurses. Moreover, nurses must consider and find the effectiveness of the tightness and looseness of the mask as loose mask can increase the infection risk. The most important thing is to wear a face mask or respirator that fits well, is pleasant, and delivers adequate protection.

 Moreover, various researches included in this context stated that the presence of sufficient PPE did not appear to completely lower risk among health-care professionals caring for COVID-19 patients.

Summary of Tables

Reference

Bartoszko, J. J., Farooqi, M., Alhazzani, W., & Loeb, M. (2020). Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza and other respiratory viruses, 14(4), 365–373. https://doi.org/10.1111/irv.12745

Barycka, K., Szarpak, L., Filipiak, K. J., Jaguszewski, M., Smereka, J., Ladny, J. R., & Turan, O. (2020). Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials. PloS one, 15(12), e0242901. https://doi.org/10.1371/journal.pone.0242901

Centers for Disease Control and Prevention. (2021). Masks and Respirators. Centers for Disease Control and Prevention. Retrieved 19 February 2022, from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html.

Collins, A. P., Service, B. C., Gupta, S., Mubarak, N., Zeini, I. M., Osbahr, D. C., & Romeo, A. A. (2021). N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta-analysis. Journal of the American College of Emergency Physicians open, 2(5), e12582. https://doi.org/10.1002/emp2.12582

Desai, A. N., & Aronoff, D. M. (2020). Masks and coronavirus disease 2019 (COVID-19). Jama, 323(20), 2103-2103. DOI:10.1001/jama.2020.6437

Desai, A. N., & Mehrotra, P. (2020). Medical masks. Jama, 323(15), 1517-1518. DOI:10.1001/jama.2020.2331

Doody, O., & Bailey, M. E. (2016). Setting a research question, aim and objective. Nurse researcher, 23(4).  DOI: 10.7748/nr.23.4.19.s5

Ho, G. J., Liew, S. M., Ng, C. J., Hisham Shunmugam, R., & Glasziou, P. (2016). Development of a search strategy for an evidence-based retrieval service. PloS one, 11(12), e0167170. https://doi.org/10.1371/journal.pone.0167170

Ingham-Broomfield, R. (2016). A nurses' guide to the hierarchy of research designs and evidence. Australian Journal of Advanced Nursing, The, 33(3), 38-43. DOI: 10.3316/INFORMIT.268257331429902

Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., ... & Hegarty, J. (2019). Evidence-based practice education for healthcare professions: an expert view. BMJ evidence-based medicine, 24(3), 103-108. http://dx.doi.org/10.1136/bmjebm-2018-111019

Nguyen, L. H., Drew, D. A., Graham, M. S., Joshi, A. D., Guo, C. G., Ma, W., ... & Zhang, F. (2020). Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. The Lancet Public Health, 5(9), e475-e483. https://doi.org/10.1016/S2468-2667(20)30164-X

Perencevich, E. N., Diekema, D. J., & Edmond, M. B. (2020). Moving personal protective equipment into the community: face shields and containment of COVID-19. Jama, 323(22), 2252-2253. DOI:10.1001/jama.2020.7477.

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