Evidence level __Level 5__and quality rating__HIGH_:(Fill these ratings in:

These are decided after completing this worksheet)

Article title:

Number:

Author(s):

Publication date:

Journal:

Setting:

Sample (composition and size):

Does this evidence address my EBP question?

Yes

No-Do not proceed with appraisal of this evidence

Is this study:

QuaNtitative (collection, analysis, and reporting of numerical data)
Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in research, and generalize results from a larger sample population; provides observed effects of a program, problem, or condition, measured precisely, rather than through researcher interpretation of data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of records or documents. Statistical tests are used in data analysis.

Go to Section I: QuaNtitative

QuaLitative (collection, analysis, and reporting of narrative data)
The study employs both qualitative methods in data collection, analysis, and presentation of findings. The qualitative method used to collect the data is through the questionnaire with questions that allow the researchers to identify any long-term health risks experienced by healthcare workers in the Hubei province. They wear personal protective equipment (PPE) while administering care to patients and people affected by the ongoing Covid-19 pandemic. The researchers used the questionnaires presented to the sample size of participants to provide data analyzed through qualitative methods to present results and findings on the research issue.

Go to Section II: QuaLitative (scroll to next highlighted section- down several sections)

Mixed methods (results reported both numerically and narratively)
Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in combination, provides a better understanding of research problems than using either approach alone. Sample sizes vary based on methods used. Data collection involves collecting and analyzing both quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and can influence stages in the research process.

Go to Section III: Mixed Methods

Section I: QuaNtitative

Level of Evidence (Study Design)

Is this a report of a single research study?

□   Yes

□  No
Go to B

1. Was there manipulation of an independent variable?

□      Yes

□    No

2. Was there a control group?

□      Yes

□    No

3. Were study participants randomly assigned to the intervention and control groups?

□      Yes

□    No

If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or experimental study.

LEVEL I

If Yes to questions 1 and 2 and No to question 3orYes to question 1 and No to questions 2 and 3, this is quasi-experimental.
(Some degree of investigator control, some manipulation of an independent variable, lacks random assignment to groups, and may have a control group).

LEVEL II

If No to questions 1, 2, and 3, this is nonexperimental.
(No manipulation of independent variable; can be descriptive, comparative, or correlational; often uses secondary data).

LEVEL III

Study Findings That Help Answer the EBP Question

Skip to the Appraisal of QuaNtitative Research Studies section

Section I: QuaNtitative (continued)

Is this a summary of multiple sources of research evidence?

□    Yes
Continue

□   No
Use Appendix F

1. Does it employ a comprehensive search strategy and rigorous appraisal method?

If this study includes research, nonresearch, and experiential evidence, it is an integrative review (see Appendix F).

□    Yes
Continue

□   No
Use Appendix F

2. For systematic reviews and systematic reviews with meta-analysis
(see descriptions below):

a.       Are all studies included RCTs?

LEVEL I

b.      Are the studies a combination of RCTs and quasi-experimental, or quasi-experimental only?

LEVEL II

c.       Are the studies a combination of RCTs, quasi-experimental, and nonexperimental, or non- experimental only?

LEVEL III

A systematic review employs a search strategy and a rigorous appraisal method, but does not generate an effect size.

A meta-analysis, or systematic review with meta-analysis, combines and analyzes results from studies to generate a new statistic: the effect size.

Study Findings That Help Answer the EBP Question

Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section

Appraisal of QuaNtitative Research Studies

Does the researcher identify what is known and not known about the problem and how the study will address any gaps in knowledge?

□      Yes

□      No

Was the purpose of the study clearly presented?

□      Yes

□      No

Was the literature review current (most sources within the past five years or a seminal study)?

□      Yes

□      No

Was sample size sufficient based on study design and rationale?

□      Yes

□      No

If there is a control group:

·      Were the characteristics and/or demographics similar in both the control and intervention groups?

□      Yes

□      No

N/A

·      If multiple settings were used, were the settings similar?

□      Yes

□      No

N/A

·      Were all groups equally treated except for the intervention group(s)?

□      Yes

□      No

N/A

Are data collection methods described clearly?

□      Yes

□      No

Were the instruments reliable (Cronbach’s a[alpha] > 0.70)?

□      Yes

□      No

N/A

Was instrument validity discussed?

□      Yes

□      No

N/A

If surveys or questionnaires were used, was the response
rate > 25%?

□      Yes

□      No

N/A

Were the results presented clearly?

□      Yes

□      No

If tables were presented, was the narrative consistent with the table content?

□      Yes

□      No

N/A

Were study limitations identified and addressed?

□      Yes

□      No

Were conclusions based on results?

□      Yes

□      No

Complete theQuality Rating for QuaNtitative Studiessection

Appraisal of Systematic Review (With or Without Meta-Analysis)

Were the variables of interest clearly identified?

□      Yes

□      No

Was the search comprehensive and reproducible?

·      Key search terms stated

□      Yes

□      No

·      Multiple databases searched and identified

□      Yes

□      No

·      Inclusion and exclusion criteria stated

□      Yes

□      No

Was there a flow diagram that included the number of studies eliminated at each level of review?

□      Yes

□      No

Were details of included studies presented (design, sample, methods, results, outcomes, strengths, and limitations)?

□      Yes

□      No

Were methods for appraising the strength of evidence (level and quality) described?

□      Yes

□      No

Were conclusions based on results?

□      Yes

□      No

·      Results were interpreted

□      Yes

□      No

·      Conclusions flowed logically from the interpretation and systematic review question

□      Yes

□      No

Did the systematic review include a section addressing limitations andhow they were addressed?

□      Yes

□      No

Complete theQuality Rating for QuaNtitative Studies section (below)

Quality Rating for QuaNtitative Studies 

Circle the appropriate quality rating below:

A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence.

B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence.

C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn.

Section II: QuaLitative(continue appraisal)

Level of Evidence (Study Design)

Is this a report of a single research study?

□    Yes
this is
Level III

□   No
go to II B

NO. The study is not a single research study. Single research studies employ data collection methods, analysis, and presentation of data for a sample size of fewer than ten individuals. The study revolves around questionnaires issued out to 65 participants. Therefore, the study is not a  single research study.

Study Findings That Help Answer the EBP Question

1.      Healthcare workers who wore the N95 facemasks regularly reported adverse reactions to the facemasks that acted as personal protective equipment for them. These reactions included nasal bridge scarring, itching and irritation on the face, damage to the skin, skin rash around the face,  and dried skin. A few of the participants had wheals on the nose, jaw, and cheeks that showed where the N95 facemasks were placed when wearing them.

2.      The participants who were involved in the study wore latex gloves regularly and reported severe skin reactions to the continued wearing of the gloves. Part of these reactions included dried skin, skin rash, chapped skin, and some who sweated in the gloves experienced edema.

3.      The participants also reported injurious and harmful skin reactions when they wore protective clothing fitted as PPE while administering care to patients with Covid-19 in the Hubei province. Such reactions included increased itching, dried skin, rashes, wheals, and sweat herpes because of the airtight protective clothing.

Annotated Bibliography

(Hu et al., 2020) Hu, K., Fan, J., Li, X., Gou, X., Li, X., & Zhou, X. (2020). The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine, 99(24), e20603.

 https://doi.org/10.1097/md.0000000000020603

The journal article is a qualitative and quantitative mixed research study highlighting how healthcare workers in the Hubei province in China have had adverse skin reactions to long-term wearing personal protective equipment (PPE) while administering care to patients Coronavirus. The introduction of the study highlights the transmission speed of the Coronavirus as documented is faster than that of SARS and MERS viruses that also emerged in the 21^st Century. The researchers use this as a standing point to highlight that because of the transmission speed being higher, healthcare workers (HCWs) have resulted in wearing PPE for a longer and more regular time, resulting in skin reactions caused. The PPE that the HCWs used in the Hubei province were N95 facemasks, latex protective gloves, and airtight protective clothing. The study investigates what kind of skin reactions have been caused by the continued wearing of PPE by HCWs in the Hubei province, focusing on 65 participants to conduct the study effectively.  The researchers formulated questionnaires where 61 of the 65 participants answered the questionnaires to present data through qualitative methods. The data were analyzed through the SPSS21.0 software computer software of statistical analysis.  From the data collected and analyzed, it was evident that the PPE caused adverse skin reactions. The N95 facemasks caused skin reactions that included nasal bridge scarring, itching and irritation on the face, damage to the skin, skin rash around the face, and dried skin. The latex gloves caused dried skin, skin rash, chapped skin, and some who sweated in the gloves experienced edema. Lastly, the airtight protective clothing caused increased itching, dried skin, rashes, wheals, and sweat herpes.

While administering care is the main priority for healthcare workers, the article highlights the importance of safety when wearing personal protective equipment (PPE). The article explicitly explains that regular wearing can cause injurious and harmfully adverse skin reactions to healthcare workers. Therefore, the article helps in providing future recommendations that are needed when manufacturing PPE. Such innovations in PPE manufacturing should include a facemask with a cushioning on the metal clip that reduces or prevent the nasal bridge scarring and comfortable materials on the inside of the mask that reduces facial itching. Latex gloves developed as PPE should have an inside layering that does not cause dried skin and talcum powder, reducing skin abrasions and irritation. Lastly, the article is clear in advising healthcare workers to frequently change protective clothing to reduce skin reactions caused by them. In light of addressing the adversities faced by healthcare workers in wearing personal protective equipment while administering care that include adverse skin reactions, the article is precise and concise in providing relevant information on how to protect healthcare workers while administering care.