Intervention

First, interviews were conducted with one simulation education expert, one nursing professor, and one epidemiological investigator from the Korea Disease Control and Prevention Agency to obtain advice on the content and direction of the education. As a result of analyzing the contents of the consultation, it was suggested that PPE using education is a necessary topic for nursing college students and is an essential skill not only in practice but also in the field. In addition, there was a common opinion that it was timely for the training to be conducted at a time when the general public’s interest in infection control and disaster nursing has recently been increasing. The opinion was that the method of debriefing and reflecting on it as an educational method and the selection of a measurement tool were appropriate. The intervention of this study was conducted at free time without regular classes. Educational contents and methods provided to the experimental group are shown in Table 1. One group consisted of 15 to 20 people divided into a total of four groups (2 experimental groups and 2 control groups). Education was provided in groups. Each class operated different dates and time so that they were not notified in advance of whether they were included in the experimental group or the control group. In order not to share information on education among participants, the control group was conducted first and then the experimental group intervention was applied.

Structure of donning and doffing PPE Education using video debriefing on nursing students PPE = personal protective equipment

• Infectious disease prevention and control act

• How to apply PPE

• How to donning and doffing PPE

• Glycerin enema skll

• Environment and medical waste management

• Understanding the structure of negative pressure isolation facilities

Video learning

(10)

Practice

(40)

• Donning PPE (10)

• Glycerin enema (10)

• Doffing PPE (10)

• Check fluorescence exposure (10)

• Video debriefing

• Writing a reflection on one’s feelings

Summary

(10)

• Observer evaluation donning and doffing PPE performance

• Self-evaluation donning and doffing PPE performance

• Satisfaction

The theoretical education was conducted based on the KDCA epidemiological investigator infection control training course and previous research [28], selecting infection control items related to PPE donning and doffing, and implementing the content after expert verification in a 1-hour education period. One hour of theoretical education was equally provided to both groups. The theoretical education content conducted through lectures included six topics, including infectious disease prevention and control regulations, PPE application methods, donning and doffing PPE procedures [5], glycerin enema procedures [44], environment and waste management, and understanding the structure of negative pressure isolation facilities. The reason for selecting the glycerin enema technique was to follow standards of the Korea Occupational Safety and Health Agency (KOSHA) included in PPE operability evaluation, which included five movements (walk for 2 min; moving head left and right for 2 min; moving head up and down for 2 min; walk while reading a sentence out loud for 2 min; walk for 2 min) [45]. The glycerin enema procedure followed the protocol suggested by the Korean Accreditation Board of Nursing Education [44]. After the theoretical lecture, the experimental group was provided with an educational program that included donning and doffing PPE (level D) video lesson for 10 min provided by the KCDA, donning and doffing PPE practice using fluorescent materials (40 min), and video debriefing (60 min). The educational program was conducted by the lead researcher in the practice lab. The practice sequence for donning and doffing PPE using fluorescent materials was as follows. First, participants wore all equipment (protective clothing, overshoes with laces, two gloves, goggles, and N95 masks) in the PPE (level D) set while looking at the donning checklist and checked the whole body with a mirror. Afterwards, the researcher applied a fluorescent lotion designed for hand washing education to the hood, zipper, wrists, and so on and immediately performed the glycerin enema procedure on a training mannequin. After the procedure was over, students looked at the checklist, doffed using hand sanitizer and tissues, and then immediately entered a dark room. The researcher used ultraviolet (UV) light to identify body parts that were stained (contaminated) with fluorescent materials, marked them in pictures, and showed them to students. After watching their own video of the PPE donning and doffing process, they performed video-debriefing, expressing in words what they felt and what needs to be improved. In addition, they checked which part was exposed and at what stage, and discussed among colleagues what additional solutions should be taken to control infection and wrote a reflection journal. Differently, the control group practiced donning and doffing PPE for 2 h while watching and followingtheeducational video and checklists provided by the KCDA.Since the control group was only provided with video-based training, the same education applied to the experimental group was provided after the post-survey.