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Evidence based nursing is one of the principal aspects of caregiving, in which the caregiver performs the task of nursing as per scientific evidence and well-designed studies. In this case, the nurses have to implement the knowledge that has been acquired by analysing the scientifically proven clinical literature. In the case of management of the specific clinical scenarios, the application of evidence based practice (EBP) is widely done by the caregivers along with reflective practice and ethical practice of nursing. With the outbreak of COVID-19, it has been researched that the disease is getting transmitted with droplet contact and aerosol transmission is also tagged with the same (Mitjà & Clotet, 2020). The use of masks has been identified as of the key protection, to prevent transmission of the disease. The research question is ‘is mask is sufficient prevent person to person transmission of airborne disease for Adults?’ This study will address this research question as per the EBP of nursing.
Concept regarding EBP and its implementation of critical clinical scenario management
In nursing, evidence based practice has been accepted as an alimentary activity, in which three principles are generally prioritised. As per the viewpoint of Schneider et al. (2016), the use of best external evidence and individual clinical expertise along with prioritisation of expectation and value of patient are the three rudimentary pillars of EBP. In the implementation or development of any strategy, like the use of masks in COVID-19 prevention, the use of these three principles is needed to be done. Cheng et al. (2020) has mentioned that in the previous cases, it has been noticed SARS infection was transmitted primarily with droplets and aerosols. At that time, the use of masks helped in the management of the transmission and reduction of the prevalence of the disease at the community level of China in 2002-03. Hence, this is one of the best and strongest external evidence to develop the strategy of wide use of facial masks in the prevention of coronavirus transmission. Additionally, the implementation of critical thinking ability which is tagged with clinical expertise of the caregiver along with patient value is needed to be integrated to make any conclusive statement regarding the effectiveness of mark in the prevention of person to person transmission of coronavirus. In the upcoming section, the three ‘A’s, that is, Acquire, apprise and Assess of EBP will be done, to address the research question properly.
Acquiring evidential proof can be done with data collection and in this case, the clinical data regarding the use of facial malt needs to be collected. Boolean searches with keywords have been done to collect data for EBP regarding the use of masks for the management of transmission of the coronavirus in adults. Research methodology and specifically research design always instructs to consider well-defined and most relevant sources for collection of authentic data (Mohajan, 2018). Additionally, the maintenance of research ethics by acknowledging the researchers is needed to be done. In This case, all the factors have been considered and managed. The authentic databases for clinical journals like NCBI, Pubmed, Psychinfo and Cochrane database have been utilised. It has been identified that external evidence supports the use of face masks in order to minimise the chance of aerosol transmission of COVID-19. Among the qualitative and quantitative paradigm of research, in this case, the qualitative data has been kept at the nucleus of the research.
A wide range of research regarding the use of face protectors has been obtained in the context of management of the transmission of COVID-19. With the analysis of the same, clinical strategy can be made with a conclusive idea about the utilisation of mass for the management of COVID-19. Mask is a type of face protector along with face sheet and personal protective equipment. In the social context, it has been noticed that people have a special inclination towards the use of N95 mask to prevent the transmission of coronavirus. Previously, research regarding the transmission of SARS and MARS, has been done, in which face protector had a special role in minimise of the prevalence of such diseases. Social distancing and the use of surface sterilisation have been noticed for the management of COVID crisis. However, the use of mask has its special role in the community level. the research papers has been obtained regarding the effectiveness and characteristics of N95 masks which should be analysed properly in the EBP to develop a strategy. Additionally, the reports of WHO have also been collected to analyse and to provide conclusive answers to the research question.
The implementation of public health instructions and standards has been done from WHO. It has been instructed to use face sheets and masks. As per the report of WHO, coronavirus is mainly transmitted by means of respiratory droplets and this transmission takes place with the minimisation of the distance between two persons (less than 1 meters) (WHO, 2020). Additionally, the contact routes and exposure to infected individuals are also considered as the potent cause of transmission of this disease. This factor has been supported by the research work of Otter et al. (2016), as it has been mentioned that sneezing, coughing and oral discharge have the potency to transmit the disease either through droplet contact or in the form of aerosol. The use of the N95 mask has been widely noticed at the community level. Hossain et al. (2020) has researched and mentioned that N95 respirator has the capacity of preventing the entry or exit of airborne particles and particulate matter up to 95% and this majorly been used to minimise industrial hazards. However, this mask has no capacity to protect gasses and vapours. Hence, from this angle, it can be considered as the regular use of N95 respirator may help to prevent the transmission of COVID-19 through droplets and aerosols. Additionally, N95 helps in the prevention of the wearer from getting exposed to the non-oily aerosols and small particle aerosols, which cannot be provided by the surgical masks. Cai & Floyd (2020) has researched and mentioned that the filtration capacity of surgical masks is not that of N95 as smaller airborne particles and aerosols are not protected by surgical masks. This is the major evidence which has reduced the use of surgical masks as the respiratory protector. Additionally, these evidential researches have provided evidence for EBP in nursing and in the strategy making of the widespread use of N95 masks to manage the chance of transmission of COVID-19 for adults. On the contrary, as per the WHO report, an opposite idea has been generated which has proven that there is no such difference between the lowering of risk of COVID-19 transmission, with the use of N-95 and other medical respirators (WHO, 2020). With no statistical data, it can be proved that N-95 masks have provided better protection in the minimisation of the risk o COVID 19 than that of the other medical masks. The use of any kind of mask provides an equivalent level of protection from getting infected with COVID-19 virus.
The research of Chu et al. (2020) has revealed that in the case of SARS and MERS (Middle East respiratory syndrome), the use of face protection prompted the safety level and reduced health workers’ risk from getting infected. The face protector includes different types of respirators and medical masks as well. Hence, in the case of minimisation of the burden of COVID-19, any type of mask and respirator will be equally effective to lower down the chance of respiratory droplet contamination.
However, the lack of initiative and awareness regarding the wearing and disposal of the mask may invoke the chance of transmission of the disease. In multiple cases, people are getting reluctant about the use of face protectors like masks. As per the idea of Kumar et al. (2020), touching to the exposed side, that is, the outer surface of the mask is prohibited as it can initiate the transmission of the causative agent of COVID infection. This is not being properly followed which may trigger transmission.
At the end of the paper, it can be concluded that the use of masks has efficiency in the minimisation of transmission of COVID-19 for the adult population at the global level. As COVID-19 is a communicable disease and is mainly transmitted with respiratory and oral droplets. Hence, protection from respiratory emissions and droplet helps in the minimisation of the chance of transmission of the disease. In this case, a mask has a rudimentary role in protecting the wearer from respirator emissions, droplets and aerosol. Research has been conducted regarding the effectiveness of N95 masks and it has been identified that it has better capacity to protect the wearer from small airborne particulates and non-oily particulates. However, no especially effectiveness of N 95 mask has been identified regarding the minimisation of the chance of transmission of COVID-19. Hence, the use of any type of mask can help the prevention of the transmission of the mentioned disease. The utilization of authentic databases has been done, in order to maintain the quality of research and a majorly qualitative paradigm has been accepted for the study.
Cai, C., & Floyd, E. L. (2020). Effects of sterilization with hydrogen peroxide and chlorine dioxide on the filtration efficiency of N95, KN95, and surgical face masks. JAMA network open, 3(6), e2012099-e2012099. https://doi.org/10.1001/jamanetworkopen.2020.12099
Cheng, V. C., Wong, S. C., Chen, J. H., Yip, C. C., Chuang, V. W., Tsang, O. T., ... & Yuen, K. Y. (2020). Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infection Control & Hospital Epidemiology, 41(5), 493-498. . https://doi.org/10.1017/ice.2020.58
Chu, D. K., Akl, E. A., Duda, S., Solo, K., Yaacoub, S., Schünemann, H. J., ... & Hajizadeh, A. (2020). Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. The Lancet 3 (1), 446-468. https://doi.org/10.1016/S0140-6736(20)31142-9
Hossain, E., Bhadra, S., Jain, H., Das, S., Bhattacharya, A., Ghosh, S., & Levine, D. (2020). Recharging and rejuvenation of decontaminated N95 masks. Physics of Fluids, 32(9), 093304. https://doi.org/10.1063/5.0023940
Kumar, H., Azad, A., Gupta, A., Sharma, J., Bherwani, H., Labhsetwar, N. K., & Kumar, R. (2020). COVID-19 Creating another problem? Sustainable solution for PPE disposal through LCA approach. Environment, Development and Sustainability, 1-15. https://doi.org/10.1007/s10668-020-01033-0
Mitjà, O., & Clotet, B. (2020). Use of antiviral drugs to reduce COVID-19 transmission. The Lancet Global Health, 8(5), e639-e640. https://doi.org/10.1016/S2214-109X(20)30114-5
Mohajan, H. K. (2018). Qualitative research methodology in social sciences and related subjects. Journal of Economic Development, Environment and People, 7(1), 23-48. https://mpra.ub.uni-muenchen.de/85654/1/MPRA_paper_85654.pdf
Otter, J. A., Donskey, C., Yezli, S., Douthwaite, S., Goldenberg, S., & Weber, D. J. (2016). Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination. Journal of Hospital Infection, 92(3), 235-250. https://doi.org/10.1016/j.jhin.2015.08.027
Schneider, Z., Whitehead, D., LoBiondo-Wood, G., Faan, P. R., Haber, J., & Faan, P. R. (2016). Nursing and midwifery research: Methods and appraisal for evidence based practice. Elsevier. https://www.researchgate.net/profile/Dean_Whitehead/publication/331465523_Nursing_and_Midwifery_Research_methods_and_appraisal_for_evidence-based_practice_-_Glossary_of_Research_Terms/links/5c7a2b3292851c69504c3745/Nursing-and-Midwifery-Research-methods-and-appraisal-for-evidence-based-practice-Glossary-of-Research-Terms.pdf
WHO, (2020). Advice on the use of masks in the context of COVID-19. https://apps.who.int/iris/rest/bitstreams/1279750/retrieve
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