chapter 2 colorful mask sec 6

8/2/2019 Chapter 2 Colorful Mask Sec 6

http://slidepdf.com/reader/full/chapter-2-colorful-mask-sec-6 1/30

CHAPTER 2

Review of Related Literature and Studies

Personal Protective Equipment (PPE)

Personal Protective Equipment at Work Regulations (1992) defined PPE as “all

equipment which is intended to be worn or held by a person who is at work and

which protects him or her against one or more risks to his or her health and safety”.

PPE, therefore, includes items such as the following when they are worn for

purposes of health and safety: apron, gloves, protective clothing for adverse wether

conditions, safety shoes, hard hats, high visibility waistcoats, eye protection, lab

coats, and facemasks (NHS Trust and School of Medicine as cited in PPE at Work

Regulations, 1992).

Many authors have emphasized the advantages in using PPE. Nevertheless,

several studies have shown that the efficacy of these PPEs still depends on the

management of the person wearing it.

It is important to assess the right type of PPE. This can be done by

considering the different hazards that may be in the workplace.

The hazards and types of PPE to be used should be checked: (1) Eyes –

chemical or metal splashes, dust, projectiles, gas, and vapour, radiation. The

possible PPE options are safety spectacles, goggles, facesheilds, and visors; (2)

Head- impact from falling or flying objects, risk of head bumping, hair

entanglement. The possible PPE of choice are helmets and bump caps; (3)

Breathing- dust, vapour, gas, and oxygen deficient atmospheres. The PPE of choice

are disposable filtering facepiece or respirator, half or full respirators, air-fed



helmets, and breathing apparatus; (4) Protecing the body- extreme temperature,

adverse weather, chemical or metal splash, spray from pressure leaks or spray

guns, impact or penetration, contaminated dust, excessive wear or entanglement of

own clothing. Options for PPE include disposable overalls, boiler suits, and specialist

protective clothing; (5) Hands and arms- abrasion, temperature extremes, cuts,

puntures, impact, chemicals, electric shock, skin infection, disease or

contamination. Possible options for PPE include gloves, gauntlets, mitts, wristcuffs,

armlets; and (6) Feet and legs- wet, electrostatic build-up, slipping, cuts and

punctures, falling objects, metal and chemical splash, abrasion. Options for PPE

include safety boots, leggings and spats (PPE at Work Regulations, 1992).

Among these PPE, mask is considered to be the most widely available. Aside

from this, choices or types of mask are being offered locally. Mask is an important

tool in terms of convenience to safeguarding one's health especially if the event

deals with the infectious hazards.

Mask (specifically face mask), according to Kozier et.al (2008), are used to

reduce the chances of transmission of microorganisms both by droplet contact and

airborne routes, and likewise to prevent contactracting splatters of body substances

that may contain infectious organisms.

Moreover, the CDC suggested circumstances to which the mask must be worn

(Kozier et.al, 2008).

These following circumstances must be strictly observed: (1) to those clients

who has infectious disease and transmits large particle aerosols (droplets).

Examples of these are measles, mumps, or acute respiratory disease in children; (2)

another is for the persons entering a room with clients having certain infections



which are transmitted by small aerosols (droplet nuclei). Examples of these as

reviewed by Kozier et. Al (2008) are pulmonary tuberculosis and SARS. For these

kinds of infections, tighter face seal and better filtration must be used.

Brouhard (2009) stated that surgical face masks provide protection from large

blood splashes. Aerosolized blood and body fluids require special particulate masks.

For most first aid applications, surgical masks or painting masks would be sufficient.

He added that it is an economical option for PPE.

Technological advancements in PPE give convenience to many especially the

healthcare personnels. Disposable pieces of equipment are being widely used in the

clinical settings especially in the Philippines where cheaper wears are sought after

by those who seek immediate PPE. Mask for example had gained popularity since it

is the cheapest PPE available in the country. Abundant choices of masks are being

technologically made primarily to improve its quality.

Facemasks are made from spun bond PP Fabric, ear loops, and non woven

material sterilize for single use (Brouhard, 2009).

The FDA (Food and Drug Administration) and CDC (Center for Disease Control)

have only defined 2 types of masks - facemasks and respirators.

The main purpose of a facemask is to help prevent particles (droplets) being

expelled into the environment by the wearer. Masks are also resistant to fluids, and

help protect the wearer from splashes of blood or other potentially infectious

substances. They are not necessarily designed for filtration efficiency, or to seal

tightly to the face. Respirators are intended to help reduce the wearer's exposure to

airborne particles (HPA, 2009).

As cited by HPA (2009), “masks and respirators are components of a number



of infection control measures intended to protect healthcare workers, and prevent

the spread of infectious agents”.

However, according to WHO (2009), wearing a mask or respirator is not a

guarantee of protection against infectious diseases. These two are just part or

component to a safer interaction.

According to Edwards (2010), facemasks are barriers which can further be

classified as surgical, laser, isolation, dental or medical procedure masks and may

include a face shield. They can be held in place by fabric ties or with elastic straps.

Surgical masks are a form of barrier protection worn by health-care workers

during surgical procedures, and in settings where bacteria or viruses may be

present. Surgical masks are loose-fitting barriers that cover the nose and mouth. It

generally reduces the chances of contamination and contracting infectious disease

(Edwards, 2010).

Moreover, it acts as barrier to protect the user from inhaling fluids that can

contain bacteria or viruses, or from transmitting oral or nasal fluids. Surgical masks

are made of disposable material, such as paper, and do not serve as complete

barriers for airborne particles (Edwards, 2010).

As cited by Edwards (2010), “surgical masks are disposable and are available

in three general configurations: a paper shield that may be pleated, which has two

ties for around the head and a flexible nose bridge; a flat or pleated shied that has

ear loops; and a molded cup shape held in place by an elastic cord around the

head”.

However, surgical masks are not regulated by health authorities and are not

officially tested for filtering levels. Size and flexibility for easy and frequent use are



key factors in choosing a surgical mask (Edwards, 2010).

Edwards (2010) added that surgical masks should not be reused, and

frequent changing is recommended. In the first place, surgical masks are often

times disposable.

Although disposable masks are highly accessible and are much cheaper,

washable mask is another option for general protection. Unlike disposable masks,

washable masks are very practical since it can repeatedly be used as long as proper

maintenance is observed.

Foster (2009) mentioned that some washable masks are made of activated

carbon that protects against indoor and outdoor pollutants and allergens. They

effectively capture exhaust and diesel fumes, fragrances, household chemicals,

formaldehyde, cigarette smoke, smog and industrial air pollution, new car smells,

printer ink and toner, germs and the recycled air on aeroplanes.

Similarly, according to Foster (2009), airborne particulates such as dustmite

and pet allergen, pollen, mould spores and acrylic dust are also efficiently filtered

out. The mask is consists of layers of porous dimpled "honeycomb" polyester which

holds the coal-based activated carbon filter. It can filter particulate air pollution of

1-5microns by 99-100% and captures chemicals harmful to health, reducing

exposure by 50-95% depending on the substance. It is also recommended for

asthma, COPD, multiple chemical sensitivity.

Colorful Mask

As the air becomes more polluted different organizations try to find ways on

how to maximize the resources available and to encourage their citizens to actively



participate in health promotion and disease prevention specifically respiratory

illnesses.

But according to Ahmid (2010),“although the masks cannot completely

prevent all of the adverse effects of air pollution, at least they can reduce the risk.”

According to The Jakarta Post (2010), colorful fabric masks covering the

mouths and noses of people in public places are seen more and more often as a

new fashion has swept the city. Regardless of the inconvenience, the trend is a

simple measure taken by many people to protect themselves from air pollution on

the city’s streets, public buses and trains.

The wearing of a colorful mask is not just to protect ourselves against

communicable disease but also to promote a comfortable mask that is suited for

anyone by choosing different colors that they prefer therefore making it a good

trend for the hospital workers and to promote a supportive aid for the clients that is

well made and also gives them an option to choose any color which they desire

(Jakarta Post, 2010).

In our present day, where there is great pollution and increase production of

harmful gases, one of the things that can protect the health of an individual is

through a barrier by just using a simple device, the mask and the now color

enhanced masks for anyone in different areas of the world.

However, some articles arose in terms of qualifying colorful mask as an

effective barrier to prevent communicable disease specifically airborne ones.

Controversies placed that the dyes used in these masks allegedly cause harmful

effects on the ones wearing it.

Risanti (2010) stated that the compliance in wearing colorful mask is basically



in accordance with the government's advice on efforts to prevent the spread of

swine flu.

The citizens and government of Indonesia stated that wearing colorful mask is

an effective and trendy campaign in terms of minimizing the risk from major

airborne-diseases (The Jakarta Post, 2010).

However an exerpt from Brosseau and Ann (2009) stated that NIOSH-approved

respirators go through a rigorous testing and certification process. Alterations to a respirator, including

decorating with ink or paint, can be detrimental to the respirator’s performance and may void the NIOSH

certification.

Communicable Disease

Communicable disease is defined simply by Kozier et.al (2008) as a disease

that can spread from one person to another. While this definition seems to be as

simple as it is, Navales (2007) expounded communicable disease as an illness

caused by an infectious agent or its toxic products that are transmitted directly or

indirectly to a well person through an agency, and a vector or an inanimate object.

Furthermore, both authors state that this infection follows only a specific track or

chain. This chain always starts and succeeds with the following: causative agent or

microorganisms, reservoir, portal of exit, mode of transmission, portal of entry, and

susceptible host. Given this “cycle” of infection Navales (2007) emphasized that of

all these chains, mode of transmission is considered to be the weakest and the

easiest link to break.

Mode or method of transmissions are mechanisms which require the leave of

microorganisms from its reservoir to another host via the portal of entry (Kozier et.



Al 2008). There are three (3) mechanisms invlove as cited by Kozier et. Al (2008) -

direct transmission, indirect transmission (vehicle and vector-borne) and airborne

transmission. Airborne transmission is where the microorganisms about less than

five (5) microns small remain suspended in the atmosphere for long periods of time

(Navales 2007).

According to the Department of Health (2007), the leading causes of

morbidity from communicable diseases are diarrhoea, pneumonia, bronchitis,

tuberculosis, malaria, and sometimes, measles and dengue outbreaks. The

Department of Health (2007) added that among these communicable diseases,

pneumonia, tuberculosis, and diarrhoea still remain in the top 10 causes of

mortality in the Philippines.

It is alarming to know that despite the government's effort to erradicate these

kinds of communicable diseases, airborne carrying pathogens such as pneumonia

and tuberculosis still continue to dwell within the localities of the Philippines.

World Health Organization (WHO) and Centers for Disease Control and

Prevention (CDC) noted that pneumonia and tuberculosis are two diseases that can

either be caused by virus or bacteria and can also be prevented through proper

disease management and vaccines.

Pneumonia , as reviewed by CDC (2011), is an infection of the lungs that is

usually caused by bacteria or viruses. Globally, pneumonia causes more deaths

than any other infectious disease. However, it can often be prevented with vaccines

and can usually be treated with antibiotics or antiviral drugs. Furthermore, it is

classified to several types namely Community-Acquired Pneumonia (CAP), Hospital-

Acquired Pneumonia (HAP), Healthcare Associated Pneumonia (HCAP) and



Ventilator-Associated Pneumonia (CDC, 2011). Moreover, in 2007, 1.2 million people

in the U.S. were hospitalized with pneumonia and more than 52,000 people died

from the disease.

Tuberculosis, on the other hand is caused by bacteria that spreads through

the air and breathed into the lungs (WHO, 2007). It is highly contagious but

definitely curable. It was approximated that two billion people are infected

[worldwide] with TB bacteria and one out of 10 infected develops active

Tuberculosis. According to CDC (2011), over 70% of the 6,854 foreign-born TB

cases reported in the United States in 2009 were in persons born in only 12

countries including Philippines with a partial case of 806 persons.

Pandemic cases of respiratory-borne diseases in the past years had affected

many countries not only in Asia but also in the West.

Another airborne-disease [Influenza] review and citation was made by the

WHO (2009). At present, evidence suggests that the main route of human-to-human

transmission of the new Influenza A (H1N1) virus is via respiratory droplets, which

are expelled by speaking, sneezing or coughing. Because of this, according to

Steckelberg (2010), people who live in community housing - such as college dorms,

nursing homes or military barracks - are at higher risk of influenza infection

because they're in contact with more potentially infected people.

Snider (2004) noted that the potential for pandemic influenza is a tremendous

concern due to the persistence of and extreme difficulty in controlling the H5N1

Epizootic strain in Asia. H5N1 is established as enzootic and is unprecedented in its

scope and complexity. H5N1 has an extremely high case fatality rate, but the

majority of cases have occurred in young and healthy persons with no sustained



person-to-person transmission.

Another group of viruses known as coronaviruses which sometimes cause

mild respiratory illness in humans were also implicated in the outbreak of Severe

Acute Respiratory Syndrome (SARS) in Southeast Asia (CDC, 2011).

Like influenza, according to Science Daily (2009), the disease can also be

transmitted through inhalation.

CDC learned several lessons about the key epidemiologic features of SARS.

Snider (2004) said “a fairly high proportion of cases occurred in healthcare workers

(HCWs). In the majority of countries, most cases were spread person-to-person. The

disease rapidly spread around the world, but healthcare facilities played a central

role in the epidemic”

Snider (2004) added that the epidemic [influenza and SARS] emphasized the

critical importance of preparedness planning and strong partnerships at national

and international levels . Hence, CDC’s concern for respiratory protection extends to

patients, visitors and other persons in healthcare settings in addition to HCWs.

Challenges related to global infectious diseases over the past decade include

airborne transmission of influenza, severe acute respiratory syndrome (SARS) and

more traditional diseases (Airborne Infectious Agents [AIAs] Workshop Report,

2004).

Snider (2004) mentioned that CDC is currently being reorganized under the

Futures Initiative with a stronger focus on health impact, customers, public health

research, leadership, performance improvement and global health impact.

According to Cole (2004) in his discussion on Basics of AIAs Control, the

aerobiology and physics of infectious agents plays a significant role in disease



prevention or control. Cole also said “an aerosol of bacterial, viral or fungal origin is

typically capable of initiating an infectious process in a susceptible host. These

aerosols generally consist of a mixture of mono-dispersed and aggregate cells,

spores or viruses carried by respiratory secretions, inert particles or other

materials.”

Smaller aerosols, according to Cole's (2004) discussion on Basics of AIAs

Control, can remain airborne for a longer period of time with rapid desiccation,

while larger aerosols may initially fall out and then resuspend after desiccation. It

was also mentioned that respiratory disease agents that are expelled from the

respiratory tract within a matrix of mucus and other secretions typically begin to

desiccate upon expulsion by coughing, sneezing, talking or singing.

Particles up to 100 m in diameter are generally considered to be capable of μ

remaining airborne for a sufficient period of time to be observed or measured as

aerosols or droplets that are able to transmit infectious agents. A sneeze can

generate as many as 40,000 droplets, but most will evaporate to particles or

droplet nuclei ( dried residuals of large aerosols) in the range of 0.5-12 m (Cole,μ

2004).

Cole (2004) explained that infectious microbes within droplets will survive

radiation, oxygen, as well as other pollutants and additional stressors following

aerosolization, transport, desiccation and landing or deposition. He added that the

capacity of an infectious microbe to initiate and spread disease depends on its

ability to survive or reproduce and maintain infectivity or cause infection.

Furthermore, he pointed out that the infectious disease process is a function of

microorganism concentration or infective dose and virulence or disease-promoting



factors that enable an agent to overcome physical and immunological defenses of

the host.

However, the initiation of signs and symptoms may vary from the

susceptibility of host. The initiation of some diseases requires only small infective

doses for humans because the agents have an affinity for specific tissue and

possess one or more potent virulence factors that facilitate resistance to

inactivation (Basics of AIAs Control, 2004).

The citation was further clarified by Cole (2004) through an example. He

mentioned that only a few cells of M. tuberculosis (M.tb) are required to overcome

normal lung clearance and inactivation mechanisms in a susceptible host and the

deposition within the respiratory tract is inherent in the infection process that is

initiated by the inhalation of infectious droplet nuclei.

Transmission of infectious disease by the airborne route is dependent upon

the interplay of several critical aerosol factor identified by Cole (2004). First is the

particle size and shape or aerodynamic diameter of the microbe. Second is the

survival of microbes. Third is the microbe's virulence. Fourth is the host

susceptibility. All of these factors accordingly are significant in identifying ways to

prevent and control the transmission mechanisms of all microorganisms.

Efficacy of PPE (Mask) against Communicable Disease

Center for Disease Control and Prevention (2007) and the World Health

Organization (2009) have advised that wearing a mask is a "first line of defense"

and advise that "in a highly contagious environment, wearing any mask is far better

than wearing no mask at all".



According to Kozier et.al (2008), “mask is worn to reduce the risk for

transmission of organisms by the droplet contact and airborne routes and by the

splatters of body substance”. The author added that small particle aerosols remain

suspended in the air and thus travel greather distance by air. Special masks that

provide a tighter face seal and better filtration maybe used for these infections

Maxillo (1987) stated that the use of surgical face masks has been advocated

to protect clinicians from inhalation of aerosols containing organic and inorganic

particulates. This study examined the ability of a 22 micron tracer particle to

bypass the filtering capability of face mask material by peripheral marginal leakage

of inspired air.

According to CDC (2009) early surgical masks were constructed from layers of

cotton gauze. They were first worn by surgery staff in the early 1900s to prevent

contamination of open surgical wounds. With time their design, function, and use

have expanded. Today surgical masks are worn in a wide range of healthcare

settings to protect patients from the wearers’ respiratory emissions. A surgical

mask is a loose-fitting, disposable device that prevents the release of potential

contaminants from the user into their immediate environment.

In the U.S., as added by CDC (2009), surgical masks are cleared for marketing

by the U.S. Food and Drug Administration (FDA). They may be labeled as surgical,

laser, isolation, dental, or medical procedure masks. They may come with or

without a face shield. Since OSHA issued the Bloodborne Pathogens Standard (29

CFR 1910.1030) in 1991, surgical masks have been recommended as part of

universal precautions to protect the wearer from direct splashes and sprays of

infectious blood or body fluids.



CDC (2009) noted that the use of surgical masks in healthcare settings dates

to the 1990s in response to concerns about employee exposures to drug-resistant

tuberculosis. Healthcare worker illnesses and deaths during outbreaks of severe

acute respiratory syndrome (SARS) in the early 2000s led to renewed attention to

the use of respirators for some infectious respiratory diseases. Most recently,

planning efforts for pandemic influenza in 2006-07 led to considerable discussion

about the role of small particle inhalation in disease transmission and the use of

respirators to protect healthcare personnel from airborne influenza particles.

A listing of all NIOSH-approved disposable, or filtering facepiece, respirators is

available. NIOSH also maintains a database of all NIOSH-approved respirators

regardless of respirator type - the Certified Equipment List (CDC, 2009).

Furthermore, CDC (2009) emphasized that whether the goal is to prevent the

outward escape of user-generated aerosols or the inward transport of hazardous

airborne particles, there are two important aspects of performance. First, the filter

must be able to capture the full range of hazardous particles, typically within a wide

range of sizes (<1 to >100 µm) over a range of airflow (approximately 10 to 100

L/min).

One column of CDC (2009) explained that the filters used in modern surgical

masks and respirators are considered “fibrous” in nature—constructed from flat,

nonwoven mats of fine fibers. Fiber diameter, porosity (the ratio of open space to

fibers) and filter thickness all play a role in how well a filter collects particles. In all

fibrous filters, three “mechanical” collection mechanisms operate to capture

particles: inertial impaction, interception, and diffusion. Inertial impaction and

interception are the mechanisms responsible for collecting larger particles, while



diffusion is the mechanism responsible for collecting smaller particles. In some

fibrous filters constructed from charged fibers, an additional mechanism of

electrostatic attraction also operates. This mechanism aids in the collection of both

larger and smaller particle sizes. This latter mechanism is very important to filtering

facepiece respirator filters that meet the stringent NIOSH filter efficiency and

breathing resistance requirements because it enhances particle collection without

increasing breathing resistance.

The CDC (2009) deviced a flow of the filtering performance of an efficient

surgical mask. They explained it through these various principles:

Inertial impaction. With this mechanism, particles having too much inertia

due to size or mass cannot follow the airstream as it is diverted around a filter fiber.

This mechanism is responsible for collecting larger particles.

Interception. As particles pass close to a filter fiber, they may be

intercepted by the fiber. Again, this mechanism is responsible for collecting larger

particles. Diffusion. Small particles are constantly bombarded by air molecules,

which causes them to deviate from the airstream and come into contact with a filter

fiber. This mechanism is responsible for collecting smaller particles.

Electrostatic attraction. Oppositely charged particles are attracted to a

charged fiber. This collection mechanism does not favor a certain particle size.

According to Kozier et.al (2008), “single-use disposable surgical masks are

effective for use with the nurse who provide care to most clients but should be

changed if they become wet or soiled”. The author also added that disposable

particulate respirators of different types maybe effective for droplet transmission,

splatters and airborne microorganisms.



Many researchers stated that although it is helpful to wear mask in terms of

preventing airborne infections it is not always the PPE of choice. Similarly, many

authors stated that there are different modes of transmissions involved in

contactracting communicable diseases. An example would be sexually transmitted

diseases. Ofcoures, mask can do nothing to prevent the spread of this kind of

disease. Hence, mask can only be limited to prevent and reduce the risk of aquiring

“airborne diseases”.

According to Kozier et.al (2008), “all health care providers must apply clean or

sterile gloves, gown, facemask, and protective eyewear according to the risk of

exposure to potentially infective materials”.

Langmuir (2009) stated, “… to treat the subject of the control airborne

infection in some systematic manner, one turns logically to Theobald Smith’s

concept of the chain of infection”.

According to Navales (2007), suggested control measures for primary care

clinics in the community setting emphasizes the use of barrier apparel, personal

hygiene, and environmental cleaning in addition to universal precautions.

He emphasized the four important links of infection; the microorganism,

entrance to tissue, exit to host, and the mode of transmission. He also mentioned

that specific control measures should be practiced to break or weaken one link at a

time. An important practice which he cited in his article was to wear an “effective”

mask to prevent the organism's entry to the host.

Healthcare workers are often at risk from contracting these infections. Hence,

many authors claimed that they must have the awareness on the proper usage of

mask.



Taylor (2010) he mentioned, “‘Securing your mask’ as a practising nurse or

midwife is akin to taking all adequate measures to ensure you are best equipped to

provide care for your patient, client or consumer...it is important for everyone in

your professional and personal life that you take the time to secure your mask on a

regular basis”.

While it is necessary to look out for the safety and comfort of the client it is

also, nonetheless, important to consider the nurse's or healthcare provider's safety

whenever interacting with them.

McIntyre (2009) said that masks are important means of protection for the

community in cases where vaccines and drugs for particular diseases are likely to

be delayed. Moreover, McIntyre added that masks play an important role in

reducing transmission if they are properly worn.

Donning mask - either a surgical mask or a P2/N95 respirator mask (high

particulate filter mask) – helps protect the person from severe respiratory illnesses

such as influenza and SARS (Live Science, 2009 as cited in UNSW, 2007).

Alvarez-Dardet and Ashton (2004) explained in their study that as influenza

and SARS CoV, alike, has been suggested to travel via aerosol droplet wearing

surgical mask may significantly increase the preventive and control level

mechanism. The same goes with Mycobacterium tuberculosis to which they

identified that wearing mask increases the protection rate from TB to almost three

percent.

Evidences from the research gathered by the Scientists of the University of

Michigan School of Public Health (2007) showed that wearing mask and washing

hands (hand hygiene), alike, bears great potential in terms of preventing respiratory



diseases.

According to 3M© Health Care Respirators (2005), masks prevent the

particles being expelled by the wearer from getting into the environment or

contaminating people. Futhermore, they mentioned that the European Standard for

Surgical Mask- Requirements and Test Methods defines a strict guideline in ensuring

the consistent level on quality of the mask being manufactured. The following

properties must be met: bacterial filter efficiency (BFE), differential pressure

(breathability), and splash resistance.

McIntyre (2009) stated that the problem arises when non-compliance on

wearing masks by the client or even by the healthcare providers during close

interaction. This was further justified by the Preliminary work in Australia (Sydney's

Westmead Hospital) in 2007 to which it showed a very low acceptance of and

compliance with mask used by hospital doctors and nurses.

Bonabente (2009) cited in her column on The Philippine Daily Inquirer that

wearing mask, according to WHO, although proven effective in preventing

influenza, it is unlikely to be beneficial in community setting more so in 'open

areas'. The article also concluded that improper usage of mask might even increase

the spread of certain virus which ironically are being expelled through sneezing,

coughing, or speaking.

On the other hand, Harrison (2011) attributed the drawback from the

abundant choices of mask, nowadays. He stated that because of the abundance of

mask choices clinicians may feel overwhelmed and may also compromise the need

for selecting mask that is appropriate to a specific situation.

Mood



Mood is defined by Merriam-Webster (2011) as “ a conscious state of mind or

predominant emotion”. With this definition mood can be differentiated to feelings in

a sense that the latter is the “expression” of the mood. On the other hand, Stuart

and Sundeen (1988) identified mood as that patient's self-report of prevailing

emotional state and is a reflection of the patient's life situation.

Color and mood are inextricably linked together as stated by Bender (2011).

She further stated that There are several reasons why colors are able to influence

how we feel. Likewise, Harrington (2011) explained “We react on multiple levels of

association with colors - there are social or culture levels as well as personal

relationships with particular colors”. Alongside these, Serene Interiors (2010) stated

in their column that color has a profound effect on our mood. In clothing, interiors,

landscape and even natural light, a color can change mood from sad to happy, from

confusion to intelligence, from fear to confidence. Particular colors have different

effects on each individual . Response to a color may be influenced by a number of

factors such as the body’s need for a specific color, a sad or happy memory

associated with a color.

Serene Interiors (2010) enumerated some of the most typical responses to

various color groups.

Neutral Colors. These colors create a sense of peace and well being. They

foster quiet conversation with family and friends and can dispel loneliness.

Examples of these colors are green and blue.

Intellectual Colors. These are the sharp, witty and unique colors which

convey a message that the person has travelled, is well read and has something to

say. Furthermore, these colors command respect. Examples of these colors are



grey, red and navy blue.

Playful Colors. These colors are exiting and used for a fun providing

environment. These playful, whimsical palettes create their own kind of music, like

the sounds of children playing. Moreover,the foundation of this palette is white.

Examples are bubble gum pink, wintergreen, berry colors and all other colors found

in “crayon” colors.

Healing Colors. This palette includes the colors which are very refreshing

and rejuvenating.Like nurturing colors, ‘healing colors’ also begin by getting in

touch with nature. Colors under these are in the pallete of green.

Romantic Colors. Many species including the human beings attempt to

attract the opposite sex with colors. These colors are believed to induce passionate

feelings. Examples of these colors are red, purple, paler tone of orange and even

blue.

Serene Interiors (2010) added that the effects of color on mood will vary from

individual to individual. Color schemes have emotional messages too. An awareness

of the emotions generated by different colors is helpful in planning personal

palettes that will be pleasant to live with, but it must be understood that this

information is not absolute. Subtle changes in tone can increase or decrease the

emotions evoked by a particular color, allowing it to be included in many diverse

palettes.

According to Siemer (2009), “the core feature that distinguishes moods from

emotions is that moods, in contrast to emotions, are diffuse and global”.

His study outlines a Dispositional Theory of Moods (DTM) that accounts for other

features of mood experience. DTM holds that moods are temporary dispositions to



have or to generate particular kinds of emotion-relevant appraisals. Moreover, the

author stated that DTM recognizes the cognitions and appraisals one is disposed to

have in a given mood partly constitute the experience of mood.

As nurses it is significant to know the 'mood' of their clients for it affects their

dispostion in terms of rendering care. There are abundant studies on moods. Many

of the researchers focused on the factors that affect moods. Some of the studies

showcased the effects given by the colors to the moods with that of the client.

According to Cherry (2010) perceptions on colors may be viewed by others as

subjective. However, some of these colors have actually universal meanings as far

as psychology is concerned. She also mentioned in her article about the Egyptian's

and Chinese's practice on 'chromotherapy'. This practice involoves colors and light

as a treatment of choice during the ancient period.

Moreover, chromotherapy as elaborated by Cherry (2010) is still being used

today but only as an alternative or holistic treatment.

While some articles hold positive attributes to colors most psychologist view

color therapy as an exaggeration. Researchers claimed that the mood-altering

effects of color are rather temporary and hence should not often times be the basis

of treatment.

Stuart and Sundeen (1988) explained that mood can be evaluated by asking a

simple non-leading question such as “How are you feeling today?”. Moreover, the

authors suggest that a rating scale of one to 10 can help provide immediate reading

of patient's mood.



The researchers seek tofind the following inquiries:

The profile of the respondents(age, gender, profession, andarea of assignment);

The common communicablediseases handled by the staff nurse;

The level of agreementamong staff nurses regardingthe effectiveness of colorfulmask in decreasing thepossibility of acquiringdifferent communicablediseases being it as amedium of protection;

The materials used in makingcolorful mask;

The mood(s) elicited whenwearing colourful mask(during interaction);

The significant difference inwearing a colourful mask inpreventing the occurrence of

communicable diseases andin setting the mood amongnurses and patients incomparison with thetraditional mask; and

The effect of colorful mask inthe working relationship withthat of nurse and patient andthe efficacy of colorful maskin preventing communicablediseases.



Research Paradigm Figure 1

Conceptual Framework

Input

The researchers seek to find

the inquiries such as: (1) the

profile of the respondents which

comprises their age, gender,

profession, and area of

assignment; (2) the common

communicable diseases handled

by the staff nurses; (3) the level

of agreement among staff nurses

regarding the effectiveness of

colourful mask in decreasing the

possibility of acquiring different

communicable diseases being it

as a medium of protection; (3)

materials used in making colorful

mask; (4) the mood(s) elicited when wearing colorful mask especially during nurse

patient interaction; (5) the significant difference in wearing a colorful mask in

preventing the occurrence of communicable diseases and in setting the mood

among nurses and patients in comparison with the traditional mask; and (6) the

At the end of the study itis expected that:

The airborne anddroplet infections arethe most commontype of communicable

disease handled bystaff nurses;

The usage of colourfulmask garnered agreat level of agreement amongstaff nurses in termsof preventingcommunicabledisease;

Upon wearingcolourful mask moodsare elicited amongnurses and patients;and

There is no significantdifference in wearinga colourful mask in

preventing theoccurrence of communicablediseases and nosignificant differencein setting out of moodbetween nurses andpatients incomparison with thetraditional mask.

The study will utilize aMixed Method Ap-proach wherein bothquantitative and quali-tative designs will beused:

Consent forms willbe given to theselectedinstitutions;

Quantitative;

Questionnairewill be made

Qualitative;

Central questionwill be placed

Validation andreliability testingwill follow;

Floating of questionnaires willbe done;

Retrieval of questionnaire were

afterwards done;

Tallying of data wasdone; and

Data analysis willbe conducted.



effect of colorful mask in the working relationship with that of nurse and patient and

the efficacy of colorful mask in preventing communicable diseases.

Process

The study will utilize a Mixed Method Approach wherein both quantitative and

qualitative designs will be used. Consent forms will be given to the selected institu-

tions. For quantitative approach, questionnaire will be made. For qualitative ap-

proach, a central question will be placed in the formulated questionnaire. Validation

and reliability testing will be done. Floating of questionnaires will follow; and a one

hundred percent retrieval rate will be assumed, afterwards. Tallying of data will be

done and data analysis will be conducted.

Output

At the end of the study the following answers to the research's inquiries are

being expected: (1) the airborne and droplet infections are the most common type

of communicable disease handled by staff nurses; (2) the usage of colorful mask

garnered a great level of agreement among staff nurses in terms of preventing

communicable disease, upon wearing colorful mask moods are elicited among nurs-

es and patients; and (3) lastly, there is no significant difference in wearing a colorful

mask in preventing the occurrence of communicable diseases and no significant dif-

ference in setting out of mood between nurses and patients in comparison with the

traditional mask.

Theoretical Framework



The researchers relate their study to Neuman's Systems Model.

Betty Neuman ( Neuman & Fawcett, 2002 Cited in Kozier et.al, 2004) is a

community health nurse and a clinical psychologist. Her model is based on the

individual's relationship to stress, the reaction to it, and reconstitution factors that

are dynamic in nature.

Neuman’s assertion (Oxbridge Writers, 1999) stated that every person had a

line of defense that could be affected by stress. It could affect the person’s

physiology, psychology, sociocultural interaction, developmental and spiritual well-

being at any time without warning.

Moreover, Neuman (Oxbridge Writers, 1999) put together four essential

concepts in relation to the individual's identification and attitude (mood) towards

stress: (1) the person; (2) nursing; (3) health; and (4) the environment.

Person. Neuman presented the concept of a person as a client or client

system wherein the focus is not only within the individual but also within the

individual's surrounding and interrelationships.

Nursing. In her model she presented that nursing is more than caring for the

ill. She believed that nursing was about viewing the patient as a whole and

examining every part of them that can be affecting their health such as emotional

and spiritual well being.

Health. Neuman asserted that health is an optimal wellness wherein the

individual meets its total system needs. On the other hand, she pointed out that the

reduced state of wellness is the result of unmet system needs.

Environment. Neuman mentioned that the environment [of the person]

plays a significant role in determining its perception to stress. She added that the



person's environment can be internally and externally classified. Internal

environment can be viewed within the person and that the stress may also arise

from it. The external environment, on the other hand, focuses on the person's

physical surrouding (e.g. the room, the people surrounding him or her, etc.).

Moreover, Neuman's Systems Model outlined an organized nursing

interventions that can be carried out on three preventive levels: (1) primary; (2)

secondary; and (3) tertiary (Kozier et.al, 2004).

Primary prevention. It focuses on protecting the normal line of defense and

strengthening the flexible line of defense.

Secondary prevention. It focuses on strengthening internal lines of

restistance, reducing the reaction, and increasing resistance factors.

Tertiary prevention. It focuses on the readaptation and stability and

protects reconstitution or return to wellness following treatment.

The researchers relate their study to Neuman's in terms of the client's

identification and attitude (mood) towards stress; and likewise, the nurse's views in

terms of client's emotional experience.

With Neuman's Systems of Model the researchers are able to expound further

on the two different variables focused in the study. First, the client's ability to elicit

appropriate attitudes or “moods” towards the external [physical] factor(s) (in this

case- the use of colorful mask by his or her attending nurse) and internal factor(s)

(in this case- the client's attitude towards the use of colorful mask by his or her

attending nurse). Second, the nurses views and actions in terms of preventing

communicable disease and promoting optimum health with that of the nurse and

client, similarly.



Definition of Terms

The researchers provided a quick reference to the following terms presented

for the readers who might encounter difficulties in comprehending fully the general

view of the study.

Airborne Infection (Disease). It refers to an infection that is contracted by

inhalation of microorganisms or spores suspended in air on water droplets or dust

particles.

Client. It refers to the party to which professional services are rendered.

Communicable Disease. It refers to an illness caused by an infectious agent or its

toxic products that are transmitted directly or indirectly to a well person through an

agency, and a vector or an inanimate object (Navales, 2007).

Droplet. It refers to a particle which is expelled through sneezing, coughing, or

talking that may harbor infections. The distance it occupies from the point of exit is

within three (3) feet (Navales, 2007).

Droplet Infection. It is an infection due to inhalation of respiratory pathogens

suspended on liquid particles exhaled by someone already infected (droplet nuclei).

Epidemic. It refers to the trending of an event (usually disease)

in disproportionately large number of individuals within a population, community, or

region at the same time.

Facemask. It refers to a loose-fitting, disposable device that creates a physical

barrier between the mouth and nose of the wearer and potential contaminants in



the immediate environment.

Hazards. It refers to a chance or risk of being injured, harmed, or dangered.

Microorganism. It referes to a microscopic living organism, such as a bacterium,

virus, rickettsia, yeast, or fungus. It may or may not cause harm to its host

(Navales, 2007).

Mood. It refers to the patient's self-report of prevailing emotional state and is a

reflection of the patient's life situation (Stuart and Sundeen, 1988).

Nurse Patient Interaction (Relationship). This refers to a relationship that

focuses in enhancing the client's well-being, and the client may be an individual, a

family, a group or a community. The relationship depends on the interaction of

thoughts, feelings, and actions of each person.

Pandemic. It refers to the occurrence of event (usually disease) over a wide

geographic area and affecting an exceptionally high proportion of the population.

Patient. It referes to any recipient of healthcare services. It is most often ill or

injured and in need of treatment by a physician, advanced practice registered

nurse, veterinarian, or other health care provider.

Personal Protective Equipment (PPE). This refers to any type of face mask,

glove, or clothing that acts as a barrier between infectious materials and the skin,

mouth, nose, or eyes (NHS Trust and School of Medicine as cited in PPE at Work

Regulations, 1992).

Pneumonia. It refers to an acute or chronic disease marked by inflammation of the

lungs and caused by viruses, bacteria, or other microorganisms and sometimes by

physical and chemical irritants. (MedlinePlus, 2011)

Public Health Nursing. It refers to a specialized form of registered nursing that



combines nursing and public health principles.

Severe Acute Respiratory Syndrome (SARS). It refers to a viral respiratory

illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV

(MedlinePlus, 2011).

Swine flu. It referes to a respiratory disease caused by viruses (influenza viruses)

that infect the respiratory tract of pigs and result in nasal secretions, a barking-

like cough, decreased appetite, and listless behavior (WHO & CDC, 2007).

Tuberculosis. It refers to a potentially fatal contagious disease that can affect

almost any part of the body but is mainly an infection of the lungs. It is caused by a

bacterial microorganism, the tubercle bacillus or Mycobacterium tuberculosis.

(MedlinePlus, 2011).

chapter 2 colorful mask sec 6

Documents