Jordan Journal of Nursing Research.

2023; 1-14

https://jjnr.just.edu.jo/jjnr/

Nurses' Knowledge, Perceptions and Practices Regarding the Use of

Respiratory Protective Equipment during the Coronavirus Pandemic
Aladeen Alloubani, RN, PhD 1; Majeda Al-Ruzzieh, RN, PhD 2*

1 Senior Manager/Nursing Research & EBP, King Hussein Cancer Center, Amman, Jordan.
2 Chief Nursing Officer, King Hussein Cancer Center, Amman, Jordan; * Corresponding Author: Email: [email protected].

ARTICLE INFO ABSTRACT

Article History: Background: Nurses are at high risk of several respiratory hazards comprising respiratory
Received: February 11, 2023 pathogens. So, respiratory protective equipment (RPE) are vital to protect nurses from
Accepted: May 23, 2023 novel coronavirus (2019-nCoV) outbreak. Purpose: The current study aimed to examine
the knowledge level, practice and perceptions among nurses in a specialized cancer center
using RPE. Methods: A descriptive study design was used. The Occupational Safety and
Health Administration Questionnaire was utilized to collect data. The data was collected
from 387 nurses working at a specialized cancer center as a convenience sampling
technique. Results: An overall number of 387 staff nurses participated in the study. The
majority of nurses had moderate knowledge levels, where the mean total score of nurses'
knowledge was 12.98, with a range between 4 and 20. Also, the majority of nurses had
good perceptions regarding the use of RPE (Total mean= 30.44, SD= 3.62). Regarding
practice, most of the nurses wash their hands after contact with the outer surface of the
respirator (F= 357, 92.2%). Conclusion: The good nurses' knowledge and perceptions
regarding RPE's use were sufficient to provide an adequate practice level. However,
implementing the RPE policy in hospitals could be useful to enhance the nurses' and other
healthcare workers' knowledge, perceptions and practice regarding RPE. Implications for
Nursing: Good practices are a crucial element in respiratory safety and nurses' protection
against their place of work respiratory hazards.

Keywords: 2019-nCoV, Nurses, Knowledge, Perceptions, Practice, Respiratory protective

equipment.

What does this paper add? infectious disease that appeared intensely as one of the
1. Nurses had a good level of practice in using RPE most challenging conditions in 2019. The virus has
during the 2019-nCoV pandemic. spread worldwide and more rapidly than earlier
2. Policies regarding RPE's use and availability are coronaviruses' family, such as Middle East Respiratory
necessary to avoid wrong practices that might cause Syndrome (MERS) and Severe Acute Respiratory
the spread of infection. Syndrome (SARS) (Peeri et al., 2020). On January 30,
3. Good practices are a crucial element in respiratory 2020, World Health Organization (WHO) stated that the
safety and nurses' protection against their place of 2019-nCoV pandemic was an international public-
work respiratory hazards. health crisis (World Health Organization, 2020b). In
different countries, the explosive rise of 2019-nCoV
Introduction renders the virus a global problem that overwhelms
Novel coronavirus (2019-nCoV) disease is a very health services worldwide (Huang et al., 2020).

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The Use of Respiratory Protective Equipment during the Coronavirus Pandemic

Nurses are at high risk of several respiratory hazards PRE performance, such as knowledge and perceptions
comprising respiratory pathogens, such as seasonal (Khalilzadeh et al., 2013b).
influenza, 2019-nCoV, chickenpox tuberculosis and When nurses contact an infected person during an
chemical factors, such as disinfectant and cleaning infectious-disease outbreak, they experience much of
materials, anesthetics, chemotherapy and biological the burden of infection control implementation and
agents (European Agency for Safety and Health at operations (Barrera-Cancedda et al., 2019; Huang et al.,
Work, 2015; Stein et al., 2003). The effective use of RPE 2020). So, the sufficient supply of RPE acts as a factor
is to protect nurses from respiratory risks in healthcare that increases voluntary willingness to use RPE during
settings (Jensen et al., 2005). the pandemic (Martin, 2011). While medical workers
In cancer care, nurses are at a higher risk of exposure often repeat the process of putting on, taking off and
to airborne hazards, such as cytotoxic treatments and removing RPE, nurses do not have a choice, so they
immunosuppressed patients susceptible to resistance wear the RPE all day long to remain close to the patients
(Pirschel, 2016). It is common knowledge that oncology (Verbeek et al., 2020). Proper wearing of RPE is
nurses know how to don and doff (remove) their essential to prevent the spread of infectious diseases and
personal protective equipment (PPE) for administering ensure medical workers' safety. However, the level of
hazardous drugs, but not how to prevent or control implementation of RPE wearing (donning) and removal
infection. It is also possible that colleagues in other (doffing) by healthcare workers (HCWs) is low (June &
specialties do not wear personal protective equipment Choi, 2016; Picard et al., 2020).
daily. In light of the novel coronavirus pandemic Many agencies and other nursing representatives
COVID-19, oncology nurses should understand how to issued a report considering 2019-nCoV as the first of its
use PPE for infection control to protect themselves and kind across 191 countries and expressed concern
those around them (LeFebvre & Ginex, 2020). regarding the threat confronting the profession and
Both surgical masks and N95 respirators are the most stressed the need for protective measures (UN News,
common respiratory protection equipment (RPE) 2020). Besides, there are multiple sources of
utilized in healthcare settings (Coia et al., 2013; College information on how nurses and other healthcare
of Respiratory Therapists of Ontario, 2016). N95 providers can protect themselves from catching the
respirators protect nurses against airborne pollutants, disease (Nemati et al., 2020). These sources may have
whereas surgical masks protect nurses from inhaling an advantage in increasing the awareness of people and
infected microorganisms and droplets spread into the healthcare providers; however, they could include
nose and mouth (College of Respiratory Therapists of confusing messages about the 2019-nCoV mode of
Ontario, 2016). However, N95 respirators afford greater transmission, vulnerability, pathogenicity and other
protection than surgical masks (MacIntyre et al., 2013; relevant issues.
World Health Organization, 2016), but both can cause In light of the current outbreak of the 2019-nCoV
breathing opposition, warmth, wetness and annoyance pandemic, for which there is no particular treatment
for workers (Li et al., 2005). (World Health Organization, 2020a), nurses' knowledge
Regardless of illnesses or disabilities, nurses are on is key to dealing with it. The knowledge transfer about
the front line working with patients. Since there are no RPE in pandemic diseases must be time-effective and
clear protocols for patients with 2019-nCoV, nurses are efficient. Earlier studies on pandemic infections, such as
practiced the standard infection management methods SARS, MERS and 2019-nCoV showed that the two
for patients with 2019-nCoV (Millar, 2020). Several crucial indicators of efficient transfer of knowledge
studies explained that nurses usually poorly adhere to among nurses are optimum theoretical knowledge and
RPE guidelines and procedures (Honarbakhsh et al., practical competence (Gupta et al., 2020; Khan et al.,
2018; Madan et al., 2011; Nickell et al., 2004). There are 2014; Zhong et al., 2020).
many causes for why nurses aren't regularly utilizing Several studies recommended that nurses should
RPE, such as they don't have immediate access to RPE expand their knowledge of RPE to respond to 2019-
or don't recognize that a patient has a transmittable nCoV and be updated through continuous education and
disease (De Perio et al., 2012; Honarbakhsh et al., 2018; training. Moreover, replicated studies pursuing HCWs
Wise et al., 2011). Additional influences seem to affect and nurses in different hospitals are needed. Dated

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Jordan Journal of Nursing Research. 2023; 1-14

knowledge might expose nurses' compliance with

infection control and protective measures and might Setting
raise harmful practices, attitudes and risk perceptions. Data was collected from 387 nurses working at a
However, a higher knowledge level about 2019-nCoV specialized cancer center in Jordan. This hospital
was found to be significantly associated with a lower receives cancer cases from all over the Hashemite
level of negative attitudes and possibly unsafe practices Kingdom of Jordan, almost covering all population
regarding the 2019-nCoV pandemic. Good knowledge groups in Jordan. It's also accredited with highly
about the 2019-nCoV pandemic was connected with technological and well-equipped facilities with a bed
positive attitudes and correct practices towards 2019- capacity of 352 beds.
nCoV (Gupta et al., 2020; Zhong et al., 2020).
Nurses who worked with patients with 2019-nCoV Instruments
or alike novel infectious diseases experienced distress A demographic information sheet was utilized to
and fear of contracting and spreading infection, dealing collect data concerning gender, age, marital status,
with new protocols that change regularly and fatigue due living status, education level, experience and working
to overwhelming workload and usage of personal units. The Occupational Safety and Health
protection equipment (PPE) (Dubey et al., 2020; Huang Administration (OSHA) questionnaire based on the
et al., 2020; Kackin et al., 2020; Kang et al., 2018; Liu Respiratory Protection Program standard requirements
et al., 2020; Roth et al., 2017). Furthermore, they faced (Occupational Safety and Health Administration
a shortage of PPE, lengthy separation from their (OSHA), 2017) was employed to gather data about
families, social stigmatization, isolation, extensive nurses' knowledge, perceptions and practice of RPE.
media coverage, ambiguity, absence of efficient The questionnaire consisted of three parts, knowledge
vaccines and treatment, observing patients' deaths and (22 items) is categorized as correct (score 1); incorrect
lack of being satisfactorily supported. and I don't know (score 0). Perceptions (eight items)
Fronting such serious circumstances has major applied a five-point Likert scale which ranged from 1
psychological harms, such as stress, fear, depression, (completely disagree) to 5 (completely agree). Practice
anxiety and insomnia symptoms (Brooks et al., 2018; (seven items) also was classified as a yes response (score
Dubey et al., 2020; Huang et al., 2020; Kang et al., 2018; 1) and no response (score 0). All negative items’
Liu et al., 2020; Xiong & Peng, 2020). In this respect, responses were scored reversely.
such challenging situations and effects could not only The participants' responses were calculated in each
reduce the ability of nurses to concentrate, learn and part and obtained scores from each item were added and
make decisions to care for patients with 2019-nCoV, but divided to the maximum obtainable scores (7, 22 and 40)
could also impact the physical and psychological well- for practice, knowledge and perception, respectively.
being of nurses following the epidemic (Preti et al., Each section's final score was categorized into four
2020; Xiong & Peng, 2020). classes (excellent from 76 to 100%, good from 51 to
75%, poor from 26 to 50% and very poor from 0 to
Aim 25%).
The current study aimed to examine the levels of Five Healthcare workers and five experts in the
knowledge, practice and perceptions among nurses occupational health and safety fields assessed the
using RPE in a specialized cancer center. questionnaire’s validity and reliability (Occupational
Safety and Health Administration (OSHA), 2017). The
Methods reliability was examined by Cronbach's alpha (α =
Design 0.870, 0.860 and 0.899 for practice, knowledge and
A descriptive study design was used to recognize the perceptios, respectively).
knowledge, practice and perceptions of RPE in nurses
working during the 2019-nCoV pandemic. A Inclusion and Exclusion Criteria
correlational study is an effective design for gathering The sample was selected using a convenience
large quantities of data about particular phenomena sampling technique. This technique is used to capture
(Polit & Beck, 2016). the highest number of participants in a short time.

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The Use of Respiratory Protective Equipment during the Coronavirus Pandemic

Nurses' had to be employed at King Hussein Cancer Statistical Analysis

Center (KHCC) for more than six months as registered Statistical Package for Social Sciences (SPSS),
nurses and express their willingness to participate in the version 21 was used to analyze the data. Descriptive
study. All participants who did not meet the inclusion statistics, such as percentage, frequency, mean and
criteria mentioned were excluded. standard deviation were used. The Shapiro-Wilk test of
normality suggested that the distribution of the sample
Sample Size Estimation and Sampling Strategy was normal. The p-value obtained from the test was
Cochran formula was used to calculate the sample greater than 0.05, suggesting that there was no
size (n =Z2*p(q)/δ2). significant departure from normality in the data. The t-
Z = 1.96 and represents a 95% confidence level as test and one-way ANOVA were used to examine the
the standard choice, P and q = 0.5 and error tolerance difference between demographic variables with the level
around the estimation (δ)= 0.05 (Cochran, 1977). of knowledge, perceptions and practice. An analysis of
However, we are dealing with a finite population, where the relationship between knowledge, perceptions and
the number is estimated to be around 1,200. So, the practice was conducted using the Pearson correlation
above formula becomes as follows: coefficient.

Protection of Human Rights

We obtained ethical approval from KHCC's
Institutional Review Board (IRB) for this study. All
The calculated minimum required sample size is 291 participants in this study are voluntarily participating. It
participants, but oversampling was intended to was explained to participants that participation in the
overcome any incomplete data. A total of 387 study would not provide any direct benefits to them.
participants responded to the questionnaire. However, the responses can help us identify areas for
improvement regarding the nurses' knowledge,
Data-collection Methods perceptions and practice regarding RPE's use during the
A convenience sampling technique was used to 2019-nCoV pandemic. Moreover, there are no
select the sample. Demographic data was obtained in foreseeable risks involved in participating in this study.
addition to the primary questionnaire. Survey data was
collected in electronic form using Google Forms. The Results
primary investigator sent a questionnaire link to those Participants’ Demographic Characteristics
who met the inclusion criteria. The data was collected Table 1 shows the participants' demographic and
between May and August 2020. All responses via the work-related characteristics. The questionnaire was sent
online Google Forms were completely anonymous; no to 1000 nurses and the response rate was 38.7%. An
identifying information was collected. Data was overall number of 387 staff nurses participated in the
averaged and reported in aggregates .Since the data was study. The participants' mean age was 28.06 years
collected electronically through Google Forms, the (SD=5.61); the years of experience mean was 5.36 (SD=
participants did not sign a consent and a waiver of 5.35). Most of the participants were females (n= 238,
documentation was requested. To ensure the anonymity 61.5%), most of them were single (n= 221, 57.1 %) and
of the participants, the data from the completed the majority have bachelor degrees in nursing (n= 239,
questionnaires was coded and accessed by only the 90.2%). In addition, the majority were living with their
investigators. Finally, all data was stored on a computer parents (n= 225, 58.1 %); most of them also worked in
protected by a password. the inpatient units (n= 250, 64.6%).

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Jordan Journal of Nursing Research. 2023; 1-14

Table 1. Demographic characteristics of participants

Variables Frequency Percentage
Female 238 61.5%
Gender
Male 149 38.5%
Single 221 57.1%
Married 159 41.1%
Marital Status
Divorced 5 1.3%
Widowed 2 0.5%
Living alone 19 4.9%
Living with parents 225 58.1%
Living Status
Living with spouse 33 8.5%
Living with children 110 28.4%
BSc 349 90.2%
Educational Level MSc 28 7.2%
MSN 10 2.6%
Working Units Inpatient 250 64.6%
Outpatient 137 35.4%
Variables Mean S.D.
Age 28.06 5.61
Experience 5.36 5.35

Nurses' Knowledge about RPE during 2019-nCoV N95 respirator or Powered Air-Purifying (PAPR)
Most of the nurses reported that each person should respirator must be used to deal with patients with
wear a respirator that fits his/her face dimensions (F= seasonal flu and tuberculosis (F= 306, 79.1%). Detailed
355, 91.7%). In the event that hands contact the outer information is available in Table 2. The majority of
surface of the respirator, the hands should be nurses had moderate knowledge levels, where the mean
immediately washed to prevent infection transmission total score of nurses' knowledge was 12.98, with a range
(F= 357, 92.2%). Most of the participants agreed that between 4 and 20.

Table 2. Nurses' knowledge items related to RPE

True False Don’t
Statements
T (%) F (%) know
Having facial hair (beard) or acne has a negative influence on the protective 184 138 65
performance of the respirator. (47.5%) (35.7%) (16.8%)
208 167 12
Surgical and N95 respirators should be discarded after usage.
(53.7%) (43.2%) (3.1%)
355 22 10
Each person should wear a respirator that fits his/her face dimensions.
(91.7%) (5.7%) (2.6%)
N95 respirators are suitable for protection against gases and vapors from 241 110 36
chemicals. (62.3%) (28.4%) (9.3%)
89 279 19
Surgical masks are as effective as N95 respirators against biological agents.
(23%) (72.1%) (4.9%)
166 203 18
Surgical masks or N95 respirators cannot be stored to be reused.
(42.9%) (25.5%) (4.7%)
I know how to correctly don and doff the respirators (adjust respirators on 287 34 66
the face, grab the bands in doffing). (74.2%) (8.8%) (17.1%)
Before using respirators for the first time, it is necessary to be medically 273 74 40
evaluated. (70.5%) (19.1%) (10.3%)
268 71 48
A seal check shall be performed before each time wearing N95 respirators.
(69.3%) (18.3%) (12.4%)
After each contact with infectious patients, the N95 respirator should be 197 162 28
replaced. (50.9%) (41.9%) (7.2%)
In case that hands contact the outer surface of the respirator, hands should 357 18 18
be washed immediately to prevent the transmission of the infection. (92.2%) (4.7%) (4.7%)
For people with chronic respiratory diseases, heart diseases or medical 224 82 81

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The Use of Respiratory Protective Equipment during the Coronavirus Pandemic

conditions, an N95 respirator equipped with an expiratory valve is (57.9%) (21.2%) (20.9%)
recommended.
265 113 9
Surgical masks must be replaced after visiting each patient.
(68.5%) (29.2%) (2.3%)
For first exposure to unknown diseases, the Powered Air-Purifying 205 52 130
Respirator (PAPR) must be used. (53%) (13.4%) (33.6%)
N95 respirators with expiratory valves should not be used in operating and 169 134 84
sterile rooms. (43.7%) (34.6%) (21.7%)
187 144 56
In operating rooms, surgical N95 respirators should be used.
(48.3%) (37.2%) (14.5%)
151 72 164
PAPR is a suitable respirator for people with facial hair (beard).
(39%) (18.6%) (42.4%)
186 49 152
For decontamination and maintenance, PAPR is recommended to be worn.
(48.1%) (12.7%) (39.3%)
To deal with patients with seasonal flu and tuberculosis, N95 or PAPR 306 51 30
respirators must be used. (79.1%) (13.2%) (7.8%)
N95 respirators are not an effective protection against hazardous drugs 166 140 81
(chemotherapy, hormone). (42.9%) (36.2%) (20.9%)
To deal with the Severe Acute Respiratory Syndrome (SARS) patients, N95 324 37 26
or PAPR respirators are efficient. (83.7%) (9.6%) (6.7%)
For protection against infectious aerosols produced during intubation or 282 47 58
bronchoscopy, N95 or PAPR respirators should be used. (72.9%) (12.1%) (15%)

Nurses' Practice toward RPE during 2019-nCoV than a half (F= 197, 50.9%) reported that they had
Around 96 male nurses usually have facial hair received medical evaluation before using the respirator
(beard) when using a respirator (64.4%). The majority for the first time. Detailed information about nurses'
of the nurses wash their hands after contact with the practice is available in Table 3.
respirator's outer surface (F= 357, 92.2%). Also, more

Table 3. Nurses' practice toward RPE

Variables Yes No
Do you usually have facial hair (beard) when using a respirator? This variable is for males 96 53
only. (64.4%) (35.6%)
274 113
Do you use the bands when doffing the respirator?
(70.8%) (29.2%)
340 47
Do you adjust the nose clip when donning the respirator?
(87.9%) (12.1%)
Do you perform the seal check (test to ensure the completely fit of the respirator on the face) 316 71
when wearing the N95 respirator? (81.7%) (18.3%)
357 30
Do you wash your hands after contact with the outer surface of the respirator?
(92.2%) (7.8%)
197 190
Have you received a medical evaluation before using the respirator for the first time?
(50.9%) (49.1%)
104 283
Do you discard the N95 and surgical mask after each use?
(26.9%) (73.1%)

Nurses' Perceptions toward RPE during 2019-nCoV Most nurses agreed that hospital staff should be trained
The majority of nurses had good perceptions on how to use RPE (mean= 4.48, SD= 0.65). Most of
regarding the use of RPE (total mean= 30.44, SD= 3.62). them also think that a completely fit respirator on the

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Jordan Journal of Nursing Research. 2023; 1-14

user's face is very important in its performance (mean= perceptions is available in Table 4.
4.23, SD= 0.73). Detailed information about nurses'

Table 4. Nurses’ perceptions toward RPE

Variables Mean S.D

I think that HCWs are aware of the respiratory contaminations of their jobs. 3.96 0.73
I think that the hospital staff should be examined for their respiratory system at least once a
4.29 0.75
year.
Hospital staff should be trained on how to use RPE. 4.48 0.65
I think that the staff should not have contact with suspected patients and respiratory
4.16 1.05
pollutants, without using a respirator.
I think that using a respirator alone (without ventilation and biological hoods) is not enough
3.73 0.92
to protect against respiratory pollutants in hospitals.
I think that a completely fit respirator on the user's face is very important for its performance. 4.23 0.73

I think that respiratory pollutants in hospitals are not so dangerous to wear respirators. 2.81 1.26
I think that short contact with suspected infectious patients using the surgical mask is not
2.74 1.24
dangerous.
Total perception score. 30.44 3.62

Demographic Variables Associated with Knowledge, = -1.32, p= 0.18, practice t(282.4)= -1.09, p= 0.27 and
Practice and Perceptions knowledge t(297.3)= 0.04, p= 0.96. However, there was
Table 5 displays socio-demographic variables a significant difference in working units based on
associated with perceptions, practice and knowledge in perceptions t(150.9)= -2.11, p= 0.035 and living status
the study population. According to the analysis of based also on perceptions F(383, 386)= 2.96, p= 0.032.
variance (ANOVA) and t-test, there was an insignificant Detailed information is available in Table 5.
difference among gender based on perceptions t(364.8)

Table 5. ANOVA and t-test analysis of the demographic variables associated with
perceptions, practice and knowledge

95% Confidence Interval

N Mean S.D. t or F df P
Lower Upper
Gender
Female 238 30.21 3.98
Perceptions -1.32 364.8 0.18 -1.19 0.23
Male 149 30.69 3.14
Female 238 4.15 1.028
Practice 1.09 282.4 0.27 -0.09 0.34
Male 149 4.02 1.17
Female 238 12.99 2.695
Knowledge 0.04 297.3 0.96 -0.55 0.58
Male 149 12.97 2.897
Working Unit
Inpatient 291 30.17 3.584
Perceptions -2.11 150.9 0.035 -1.764 -0.066
Outpatient 96 31.08 3.917
Inpatient 291 4.1168 1.10801
Practice 0.423 172.4 0.672 -0.19797 0.30664
Outpatient 96 4.0625 1.03428
Knowledge Inpatient 291 12.93 2.736 -
155.3 0.532 -0.846 0.437
Outpatient 96 13.14 2.882 0.626

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The Use of Respiratory Protective Equipment during the Coronavirus Pandemic

Marital Status
Single 221 30.40 3.747
Perceptions 0.045 385 0.964 -0.728 0.762
Married 166 30.39 3.613
Single 221 4.1131 1.07062
Practice 0.203 385 0.839 -0.19745 0.24297
Married 166 4.0904 1.11639
Single 221 12.88 2.781
Knowledge -0.852 385 0.394 -0.802 0.317
Married 166 13.12 2.759

Education Level
BSc 349 30.45 3.69
Perceptions MSc 28 30.04 3.64 0.39 (2), (384) 0.67 30.03 30.76
MSN 10 29.60 3.77
BSc 349 4.09 1.07
Practice MSc 28 4.21 1.16 0.19 (2), (384) 0.82 3.99 4.21
MSN 10 4.00 1.49
BSc 349 13.04 2.72
Knowledge MSc 28 12.57 3.03 0.77 (2), (384) 0.46 12.71 13.26
MSN 10 12.20 3.70
Living Status
Living alone 19 28.26 3.57
Living with parents 225 30.63 3.68 (383),
Perceptions 2.96 0.032 30.03 30.76
Living with spouse 33 29.64 3.15 (386)

Living with children 110 30.52 3.75

Living alone 19 3.8947 0.87526
Living with parents 225 4.1511 1.10773 (383),
Practice 0.88 0.449 3.9945 4.2122
Living with spouse 33 4.2424 1.11888 (386)

Living with children 110 4.0000 1.07516

Living alone 19 12.05 3.171
Living with parents 225 12.97 2.710 (383),
Knowledge 0.85 0.467 12.71 13.26
Living with spouse 33 13.06 2.221 (386)

Living with children 110 13.15 2.967

Relationship between Age and Experience with positive association was observed between the overall
Knowledge and Perceptions score of perceptions and knowledge (r = 0.234**,
This part affords a summary of the relationship p≤0.001). However, there was an insignificant
between age and experience with nurses’ knowledge and relationship between age and experience with other
experience about using RPE. Table 6 shows the variables (perceptions, practice and knowledge) p≥0.05.
correlation matrix between these variables using a Detailed information about correlations is available in
Pearson product-moment correlation. A significant Table 6.

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Jordan Journal of Nursing Research. 2023; 1-14

Table 6. Relationship between age and experience with knowledge, practice and perceptions

Age Experience Knowledge Perceptions Practice

r 1 0.937** -0.002 0.085 -0.051
Age
P 0.000 0.973 0.094 0.319
r 0.937** 1 -0.002 0.094 -0.055
Experience
P 0.000 0.969 0.066 0.281
r -0.002 -0.002 1 0.234** 0.202**
Knowledge
P 0.973 0.969 <0.001 <0.001
r 0.085 0.094 0.234** 1 0.117*
Perceptions
P 0.094 0.066 <0.001 0.021
r -0.051 -0.055 0.202** 0.117* 1
Practice
P 0.319 0.281 <0.001 0.021
** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).

Discussion and Implications for Nursing agents. It is likely that nurses who work in high-risk
The current study aimed to assess levels of environments, such as emergency rooms or intensive
knowledge, practice and perceptions among nurses care units, have been exposed to infectious diseases in
using RPE in a specialized cancer center. The findings the past. As a result of this experience, they might now
revealed that most of the nurses had a moderate level of understand the importance of wearing proper PPE and
knowledge and a good level of practice and perceptions the effectiveness of N95 respirators.
concerning the use of RPE. However, knowledge can be These respirators are commonly used for personnel
enhanced through several interventions, such as with facial hair or who cannot accommodate the
education and training, whereas attitude can impact respirator effectively on their faces, as well as for staff
practice and perceptions (Hughes & Ferrett, 2012; employed in the decontamination procedure or primary
Khalilzadeh et al., 2013a) Eventually, good knowledge care of chemical and biological emergencies (California
and the right attitude can contribute to promoting Department of Public Health, Occupational Health
practice and good perceptions (Achalu, 2001; Branch, 2012). So, it is essential to promote studies
Honarbakhsh et al., 2018). about nurses' knowledge regarding these RPE usages
In the current study, nurses had moderate knowledge and restrictions.
regarding the N95 respirator limitations and how to Nurses had a good level of practice in using RPE
choose and use suitable RPE to guard themselves during the 2019-nCoV pandemic. The primary
against hazardous drugs and chemical vapors. Likewise, deficiency in this respect was that more than a half of
the nurses' knowledge of PAPR was at a moderate level. the nurses didn't receive medical evaluation before using
These findings are consistent with a study on using RPE RPE for the first time. There was an insignificant weak
at Iran hospitals (Honarbakhsh et al., 2018). In contrast, correlation between knowledge and perceptions about
the nurses' knowledge about the effectiveness of N95 using RPE. This result is in contrast to Truong's
respirators against biological agents in comparison to research, which found that the knowledge level and
surgical masks was excellent. However, this finding is attitude towards the use of RPE were weak, whereas all
inconsistent with a study about using RPE at Iran participants had a moderate-to-high level of practice
hospitals (Honarbakhsh et al., 2018). However, some (Truong et al., 2009). It seems that there are possible
possible reasons are infection control and prevention as other causes that are more important than knowledge,
a primary responsibility of nurses, along with the use of which can contribute to practice improvement if targeted
personal protective equipment (PPE), such as respirators in a respiratory protection program (RPP).
and masks. Their education may have included specific There was no significant relationship between
information on the differences between surgical masks participants' age and experience with knowledge and
and N95 respirators and their efficacy against biological perceptions in the current study. Regardless of the

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The Use of Respiratory Protective Equipment during the Coronavirus Pandemic

nurses' age and work experience, the participants have Furthermore, the study was conducted based on a self-
the same knowledge and perceptions of using RPE. report survey, which could be vulnerable to self-bias
These results are inconsistent with other studies responses. Moreover, nonprobability sampling was
(Honarbakhsh et al., 2018; Jahangiri et al., 2013; used. However, the current findings may provide vital
Mohamed et al., 2015; Monazzam & Soltanzadeh, 2009; evidence for promoting teaching and training on nurses'
Mortazavi et al., 2011; Nasab et al., 2009). This may be respiratory protection. Additional studies with more
because these younger nurses with lower work representative samples are required.
experience had received comprehensive training
regarding occupational safety and health problems Conclusion
during the general nursing orientation program when Good practices represent a crucial element in
they joined the hospital; so they had a comparable respiratory safety and nurses' protections against their
knowledge to older nurses about workplace risks. place of work respiratory hazards. The good nurses'
Interestingly, in the current study, nurses who have knowledge and perceptions regarding RPE's use were
a bachelor degree had the same level of knowledge, sufficient to provide an adequate practice level.
perceptions and practice compared with nurses with However, implementing the RPE policy in hospitals
MSc or MSN degrees. This could be due to the nurses could be useful to enhance the nurses' and other
with lower education having the same responsibilities healthcare workers' knowledge, perceptions and practice
and job obligations during the 2019-nCoV pandemic regarding RPE. Policies regarding RPE's use and
compared to nurses with higher education degrees. availability are necessary to avoid wrong practices that
Moreover, all nurses are vulnerable to high-risk might cause the spread of infection. Interventional
respiratory threats and they have to comply with safety, studies are suggested about RPE use to improve practice
health and quality regulations. The nurses are also and update countrywide infection control strategies and
receiving the same education plan when they join the guidelines.
hospital, such as general nursing orientation for one
month and preceptorship for three months, including in- Funding or Sources of Financial Support
service education sessions and competency checkoff. This research received no specific grant from any
Moreover, the latest guidelines and research on personal funding agency in the public, commercial or non-for-
protective equipment, infection control and PPE are profit sectors or support in the form of equipment or
often shared with nurses during pandemics. It is possible other assistance.
that they have read articles or attended seminars related
to the 2019-nCoV pandemic. Conflict of Interest
We hereby certify that this material, which we now
Limitations submit for World Health & Population is entirely our
There are some limitations to this study. This study own work and there is “no conflict of interest to be
was conducted in a specialized cancer center only; so, declared”.
the results might not be generalized to other hospitals.

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