The Influence Of Personal Protective Equipment (PPE) Based On The Biological And Psychological Aspects Of Nurses In The Covid-19 Pandemic

Introduction: The Covid-19 pandemic is a big challenge in the world of health, including nursing. Nurses are the main stronghold in patient care because nurses meet patients more frequently and longer than other medical personnel. The use of PPE is urgently needed in treating patients with Covid-19, the impact of using PPE cannot be avoided and can affect nurses, feelings of discomfort and poor physical condition can result in a decrease in both physical and psychological health. Purpose: This article review aims to determine the impact of using PPE on nurses' physical and psychological health during a pandemic. Method: This article was reviewed by identifying articles in the last 5 years with the theme of the effect of the use of PPE on the physiology and psychology of nurses during a pandemic with the original article inclusion criteria. Results: This article review collects articles from Google Scholar and Science Direct keywords used PPE, covid19, nurse, physical aspect, and biological aspect. The identification results in 15 articles that met the inclusion and exclusion criteria. Conclusion : PPE has an impact on the physical aspects, namely respiratory disorders and fatigue. Influences on the psychological aspects are stress, depression, and anxiety. Nurses must have physical and mental health preparations to face various challenges in patient care processes and procedures during the Covid-19 pandemic.


INTRODUCTION
Coronavirus is a disease that attacks the respiratory system.This disease is contagious and is characterized by general symptoms such as fever, cough, weakness, convulsions, and diarrhea.Clinical manifestations in this case usually appear within 2 days to 14 days after exposure (Nurkhalizah, et al.,2021).Nurses and other health workers who serve at the frontline in fighting Covid-19 must implement procedures for using and removing PPE by the SOPs set by the Hospital to reduce the risk of being contaminated with the Covid-19 virus.Personal protective equipment is equipment that must be worn by nurses to protect and protect themselves from the transmission of covid-19 which is transmitted through droplet infection into the body through the eyes, nose, mouth, and throat as well as the skin (Performance, et al., 2021).The incidence of Covid-19 cases, which continues to increase every day, causes health workers to be increasingly depressed due to the increasing workload, worrying about their health, and also their families.Lack of Personal Protective Equipment (PPE) in the workplace is one of the things that cause health workers to experience increased anxiety (Nurkhalizah, et al., 2021).Nurses also feel negative emotions, challenges, and regulatory changes in various aspects due to COVID-19 and adapt to COVID-19 service standards (Kusumawati, Dwiantoro, and Nurmalia, 2021).Nurses who experience stress have the potential to experience headaches, followed by other symptoms, namely anger, decreased brain function, ineffective coping, and impaired relationships with coworkers, which can reduce nurse performance (Kusumawati, Dwiantoro, and Nurmalia, 2021).The development of the number of confirmed cases of Covid-19 in Indonesia in the period from January 3, 2020, to October 27, 2020, there were 392,934 confirmed cases of Covid-19 and 13,411 cases of death due to Covid-19.Meanwhile, the number of health workers based on data from PPNI on Tuesday (22/9/2020) recorded that 85 nurses died and 2,979 in several provinces in Indonesia were confirmed to have Covid-19 (Syarifatul Izza, Hanny Handiyani, 2021 (Performance et al., 2021).The Journal of the American Medical Association, based on a survey in mental health research, found that most of the 1,275 staff treating COVID-19 in 34 hospitals in China experienced symptoms of depression 50%, anxiety 45%, insomnia 34% and psychological distress 71.5 % (Siti Nurkhalizah, Siti Rochmani, 2021).According to (Kusumawati, Dwiantoro, and Nurmalia, 2021) nurses' work stressors varied, namely excessive workload (82%), unfair wages (58%), and working conditions (52%), not being included in decision making (45%).Stress on individuals has an impact on physical, psychological, social, and spiritual.Symptoms of stress seen from the biological aspect include headaches, decreased appetite, stomach pain, sweaty palms, palpitations, fatigue or loss of energy, muscle tension, and psychological symptoms such as difficulty concentrating, memory loss, decreased productivity, or work performance., often feel bored, anxious, restless, frustrated, irritable, and irritable (Kusumawati, Dwiantoro, and Nurmalia, 2021).The importance of using personal protective equipment (PPE) is related to the perception of health workers that has an impact on the occurrence or non-occurrence of an error at work that causes work-related accidents and dangerous infectious diseases (Ismoyowati, 2021).The main reference for Covid-19 patients is a hospital that not only provides good nursing care but also provides safe, quality, and effective services to maintain services that are following established nursing service standards for infection prevention and control.One way is to break the chain of transmission of infection by using Personal Protective Equipment (PPE).This will affect biological conditions such as feeling hot, uncomfortable when doing activities, and decreasing self-confidence (Zakaria S, 2021) Based on the biological and psychological problems of nurses that arise as a result of the impact of using PPE during the Covid-19 pandemic, the author is motivated to conduct a literature study from several articles that were obtained and analyzed

METHOD Data-Based Search
This literature review was identified from Google Scholar and Science Direct.The articles used are articles published in 2020-2021.The keywords used in the identification of the article are PPE, covid19, nurse, physical aspect, and biological aspect.The search results that match the keywords on Google Scholar are 17,939 articles, while the articles that match the literature review there are 13 articles.The search results that match the keywords in Science Direct are 30,594 while the articles that match the literature review there are 2 articles.

Article Selection Management Data
The selection of articles was adjusted to the theme, namely the effect of using PPE on the physical and psychological health of nurses during a pandemic.The article identification method uses the PRISMA diagram.

Article Classification
The articles identified in this literature review are using PICOT data analysis

Impact of Availability of PPE on Nurses' psychological health
The need for PPE for nurses affects the performance of nurses, meeting the needs of PPE has an impact not only on the nurse's physique but also psychologically, one of which is feelings of anxiety when carrying out care.The psychological readiness of nurses is one of the main priorities after the physical health of nurses.Psychological health affects how the process of nursing services, especially during the Covid-19 pandemic, healthy psychology makes nurses more confident in caring for patients (Babakal, Manampiring, and Wariki, 2021).PPE has 3 benefits, namely for preventive measures through air, droplets, and general contact (Sinaga et al., 2019).With the lack of availability of complete PPE according to the WHO protocol, health workers are more likely to have anxiety and fear disorders compared to personal protective equipment as needed (Simak and Kristamuliana, 2020).Lack of adequate PPE is a risk factor and is a significant factor associated with depression.Every action taken by nurses to patients with Covid-19 requires the availability of PPE, this increases the confidence of nurses and reduces anxiety.There is a significant relationship between the adequacy of PPE and the anxiety of health workers in health care settings, one of which is proper and appropriate PPE (Ismoyowati, 2021).

The mental health impact of nurses when using PPE
Health workers who have more direct contact with Covid-19 patients have a higher level of anxiety.Previous research stated that there was a significant difference between the number of contacts with Covid-19 patients and the adequacy of PPE.The identification results show that there are reports that the availability of PPE does not match the frequency of contact with Covid-19 patients so many nurses feel very anxious after direct contact with depression (Arnetz et al., 2020).Insufficient PPE availability and direct contact with Covid-19 patients are closely related to depression.Nurses show feelings of anxiety and hopelessness which are two things that affect the level of depression in the work environment.Nurses feel more confident and safe when wearing appropriate PPE (Bumpstead et al., 2021).The low level of compatibility of PPE is related to psychological discomfort when using PPE, some nurses feel that it does not match the shape, size, and design of PPE (Janson, Clift, and Dhokia, 2021).Barriers associated with wearing PPE related to biological conditions PPE causes heat or increased body temperature, symptoms such as shortness of breath and dizziness, and discomfort, affecting their movement thereby reducing their work efficiency.Immediately after putting on PPE, nurses feel very hot (Davey et al., 2021).Headaches, shortness of breath, and sweating were felt by the nurses in approximately 10 minutes, 2 hours later all that was felt was soaking wetness on the clothes and a feeling of numbness on the fingers because of wearing 3 layers of gloves.Another obstacle that was felt was that at the time of infusion, the nurse could not feel the vein because of the thickness of the gloves and could not see the vein clearly because she was using Google glasses.Prolonged use of PPE with this impact makes nurses physically tired with dull faces, damaged skin, and blisters (Cui et al., 2020) .Volume 5, No. 1, Bulan Desember Tahun 2023(Hal. 69-79) https://www.ojsstikesbanyuwangi.com/index.php/PHJ .PROFESIONAL HEALTH JOURNAL Volume 5, No. 1, Bulan Desember Tahun 2023(Hal. 69-79) Volume 5, No. 1, Bulan Desember Tahun 2023(Hal. 69-79) https://www.ojsstikesbanyuwangi.com/index.php/PHJCONCLUSION Personal protective equipment is equipment that must be worn by nurses to protect and protect themselves from the transmission of covid-19 which is transmitted through droplet infection into the body through the eyes, nose, mouth, and throat as well as the skin.Lack of Personal Protective Equipment (PPE) in the workplace is one of the things that cause health workers to experience increased anxiety.Nurses who experience psychological disorders such as stress have the potential to experience biological disorders such as headaches, followed by other symptoms, namely anger, decreased brain function, ineffective coping, and impaired relationships with co-workers which can reduce nurse performance.Facing the covid-19 pandemic, nurses must prepare physically and mentally strong, physical health can increase the body's immunity to minimize the transmission of covid-19.Mental health affects the readiness of nurses to care for Covid-19 patients starting from preparation for the process and termination of the disease.Well-prepared physical and mental health will have a positive impact on nurses, namely reducing risks that occur in biological and psychological aspects.

PROFESIONAL HEALTH JOURNAL
(P: Research sample, and in this literature review are health workers with psychological disorders due to the use of PPE during the Covid-19 pandemic, I: No intervention was given to samples in all the .PROFESIONAL HEALTH JOURNALVolume 5, No. 1, Bulan Desember Tahun 2023(Hal.69-79)   https://www.ojsstikesbanyuwangi.com/index.php/PHJarticles reviewed, C: There is no comparison of interventions in this literature review, O: The results of research in the literature review show that there is a biological and psychological influence of health workers, especially nurses on the use of Personal Protective Equipment, Q: The research time in this literature review takes the least amount of time 1 month and maximum 6 months).Identification of articles is done by selecting the original articles of the last 5 years and issuing articles using the review and book chapter methods.PRISMA diagram The Effect of Using Personal Protective Equipment for Nurses in Hospitals During the Covid-19 Pandemic on Biological and Psychological Aspects: A Literature Review.RESULT Personal protective equipment (PPE) is something that must be worn during the COVID-19 pandemic, a nurse as a health worker who interacts with patients more often directly has a greater risk of disease transmission or nosocomial infections.Personal Protective Equipment (PPE) is a set of safety equipment to protect all or part of the body from occupational diseases.So that health workers who carry out examinations of Covid-19 patients are required to use complete personal protective equipment, in order to avoid the transmission of Covid-19.The use of PPE by nurses during a pandemic must meet the comfort requirements, according to the results of the article review showing that nurses who get PPE do not have a good effect on the psychology of nurses such as depression, anxiety, mild to severe stress, and fatigue.The physical impact of using PPE is a disruption to breathing and vision.
https://www.ojsstikesbanyuwangi.com/index.php/PHJTria Anisa, The influence of Personal Protective Equipment (PPE) … 75 Tabel 1.The Effect of Using Personal Protective Equipment for Nurses in Hospitals During the Covid-19 Pandemic on Biological and Psychological Aspects: A Literature Review