Graduation Date

Summer 8-11-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Janet Cuddigan, PhD, RN, FAAN

Second Advisor

Joyce Black, PhD, RN, FAAN

Third Advisor

Kevin Kupzyk, PhD

Fourth Advisor

Robin Lally, PhD, RN, FAAN

MeSH Headings

PPE, COVID-19, PPE-related injuries, nurse experience, pandemic preparedness


Personal protective equipment (PPE)-related facial skin reactions/injuries occurred in 75.13% of healthcare workers during the COVID-19 pandemic. Critical appraisal of cross-sectional studies identified methodological gaps as the majority of survey questions were not content-validated and those that were lacked descriptions of methods and psychometrics for the survey questions/tool. The aims of this dissertation study were to describe the nature, severity, and distribution of selfie captured PPE-related facial injuries using a validated tool (quantitative) and describe the contextual factors associated with PPE-related facial injuries and what factors influence nurses and Health Care Workers (HCWs) to share their experiences (qualitative). The setting of these studies was a global Instagram community. A tool was first designed and validated to meet the aims of the quantitative study. The descriptive study was conducted using visual content analysis to examine selfie-captured PPE injuries which were coded into the validated tool. Concurrently, a social media ethnographic study was conducted using focused content analysis to code the posts (text/selfie) with selfie-captured PPE injuries using a codebook created for this study. Next, data reduction and theme development occurred. Clinically significant findings from the quantitative descriptive study include the greater frequency of PPE-related facial injuries distributed across the cheeks, paranasal cheeks, nose, and forehead. Indentations, classified as mild, severe, and severe with stippling were identified in those locations. Little is known about indentations from PPE, and the severity and distribution of indentations has not been previously reported. The social media ethnographic study resulted in the identification of seven themes: 1) Grueling shifts filled with unimaginable loss, 2) Faces forever marked by the physical and emotional scars of COVID-19, 3) COVID-19 battlefront, 4) Dire and unprecedented PPE shortages, 5) Pervasive fear (for self, colleagues, and family), 6) Extreme emotional and physical consequences, and 7) Creating a collective voice that provide context to the PPE-related facial injury experience. These new findings have implications for occupational health, emergency preparedness, and PPE redesign. These findings can be used to provide unique insights into the redesign of PPE to ensure that healthcare workers are not harmed during the provision of care.


2023 Copyright, the authors

Available for download on Saturday, August 03, 2024