INTRODUCTION

Background of the Study

The COVID-19 pandemic, also known as the coronavirus pandemic, is an

ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute

respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December

2019 in Wuhan, China. The World Health Organization declared the outbreak a Public

Health Emergency of International Concern in January 2020 and a pandemic in March

2020. As of 11 February 2021, more than 107 million cases have been confirmed, with

more than 2.35 million deaths attributed to COVID-19. (APA 2020)

Symptoms of COVID-19 are highly variable, ranging from none to life-threatening

illness. The virus spreads mainly through the air when people are near each other. It

leaves an infected person as they breathe, cough, sneeze, or speak and enters another

person via their mouth, nose, or eyes. It may also spread via contaminated surfaces.

People remain infectious for up to two weeks, and can spread the virus even if they do

not show symptoms. (APA 2020)

Based on the Survey there are more than 2.2 billion adolescents in the world

who constitute approximately 28% of the world's population. Those aged between 10 to

19 years make up 16 % of the world's population. COVID-19 has impacted the lives of

people around the world including children and adolescents in an unprecedented

manner. Throughout the world, essential modus of prevention from COVID- 19 infection

has been isolation and social distancing strategies to protect from the risk of infection.
On these grounds, since January, 2020, various countries started implementing regional

and national containment measures or lockdowns. In this backdrop one of the principal

measures taken during lockdown has been closure of schools, educational institutes

and activity areas. These inexorable circumstances which are beyond normal

experience, lead to stress, anxiety and a feeling of helplessness in all. (Shen K, et al.,

2020)

According to Nussbaumer-Streit, 2020 in a recent review on lockdown

demonstrated that this type of measure has had an effective impact at reducing the

incidence and mortality of COVID-19 during the current pandemic. This article

recommended that along with other public health procedures, lockdown should be

enforced at an early stage to prevent the COVID-19 infection from spreading further.

The study has shown evidence that lockdown measures are consistently beneficial, with

quarantining of people who were exposed to confirmed or suspected cases preventing

44% to 81% of new cases and 31% to 63% deaths, compared to a lack of any lockdown

measure. The authors showed that a lockdown may prove helpful in controlling the

COVID-19 outbreak. The study showed that the lockdown was beneficial in decreasing

the rate of growth per day of infection, but ultimately insufficient to bring the absolute

growth rate down to 1.0 or less which is the point where an epidemic is clearly under

control. The concept of a lockdown is theoretically attractive because it minimizes the

number of people exposed to contagious patients and therefore fewer people will be

susceptible to getting infected.

Furthermore, COVID-19 social isolation measures have had a profound

impact on the psychological and mental well-being of individuals across society. Many
of the anticipated consequences of isolation measures are themselves key risk factors

for mental health issues including suicide, self-harm, substance misuse, and domestic

and child abuse. Social interaction has been widely interlinked with psychological well-

being, social opportunities and employment; thereby restriction of these measures is

suggested to be profoundly distressing to those experiencing strict isolation. (Holmes

E.A et al., 2019)

However, this present research will focus on the double lockdown experiences of

CoVid-19 patients and its effect to the psychological well-being while in isolation. Since

CoVid-19 is the growing problem in the whole world, conducting a research regarding

the above-mentioned subject will aid in obtaining an enhanced understanding of this

effect to the psychological well-being of the survivor.

The researchers also have an obligation to make sure our actions match our

words when it comes to COVID-19 safety measures. At some point, most of us will find

ourselves in a position to remind patients, visitors and even our colleagues about the

importance and the expectation to wear a mask to protect others from potential

infection.

Thus, being an important social citizen, it is right and proper to be of great

concern on the current health issues and be able to help and to know the experiences

of CoVid-19 patients and its effect to the psychological well-being while in isolation.
 Theoretical Framework

To support this research about the double lockdown experiences of

CoVid-19 patients and its effects to the psychological well-being while in isolation, the

researchers uses the theory Betty Neuman’s System’s Model and Adaptation Model of

Nursing, a prominent nursing theory of Callista Roy.

i. Betty Neuman’s System’s Model

The Neuman Systems Model (NSM) is a practical guideline used by caregiving

and administrative staff members to produce positive client outcomes. Dr. Betty

Neuman developed the theory based on her education and professional experiences.

The model outlines a dynamic script deployed by practitioners around the world, and the

framework emphasizes client individuality by considering clients’ unique circumstances

and background (University, 2017).

The Neuman Systems Model views the client as an open system that responds

to stressors in the environment. The client variables are physiological, psychological,

sociocultural, developmental, and spiritual. The client system consists of a basic or core

structure that is protected by lines of resistance. The usual level of health is identified as

the normal line of defense that is protected by a flexible line of defense. Stressors are

intra-, inter-, and extra personal in nature and arise from the internal, external, and

created environments. When stressors break through the flexible line of defense, the
system is invaded and the lines of resistance are activated and the system is described

as moving into illness on a wellness illness continuum. If adequate energy is available,

the system will be reconstituted with the normal line of defense restored at, below, or

above its previous level (Gonzalo, 2011).

Nursing interventions occur through three prevention modalities. Primary

prevention occurs before the stressor invades the system; secondary prevention occurs

after the system has reacted to an invading stressor; and tertiary prevention occurs after

the system has reacted to an invading stressor; and tertiary prevention occurs after

secondary prevention as reconstitution is established (Gonzalo, 2011).

Neuman Systems Model practitioners generally follow prescribed assumptions

in regard to clients. The model suggests that every client has distinct characteristics and

circumstances and responds, within a limited range, to their environment. The theory

goes on to warn that several known and unknown stressors can affect clients and

possibly disturb their well-being. In the Neuman Systems Model, practitioners call this

stability the client’s Line of Defense (LOD). It is how the stressors interact with the

patient that determines how the patients’ LOD holds up against stressors. Neuman

Systems Model practitioners work to eliminate or mitigate these stressors (University,

2017)

NSM practitioners monitor and note normal client LOD levels and interpret

negative deviations from this status as trouble signs. NSM practitioners subscribe to the

idea that clients’ support resources strongly influence their stress levels (University,

2017).
 The NSM model suggests that all clients have a Line of Resistance (LOR).

Clients’ LORs are a defense mechanism used to maintain mental and environmental

stability. The LOR continues to function despite clients’ stability status. Neuman

Systems Model practitioners use these concepts to create stress preventive

environments for clients, allowing them to heal as quickly and wholly as possible

(University, 2017).

The Neuman Systems Model operates on the premise that several resource

variables affect the client. Clients’ resources determine how they persevere against

stressors.

According to NSM theory, clients can maintain stability as long as their

stressors do not exceed these available resources. The client’s perpetually cycle

through resource exhaustion and rejuvenation. This cycle is crucial to a client’s stability.

NSM practitioners work to help clients maintain this stability.

NSM practitioners believe clients possess several layers. According to NSM

theory, these layers each have five dimensions. The physiological client dimension

encompasses body chemistry state, and the client’s psychological dimension involves

their mental health. The socio-cultural dimension concerns clients’ relationships and

cultural belief systems. NSM practitioners also consider clients’ spiritual beliefs. The fifth

NSM dimension takes into account clients’ development throughout their lifespan

(University, 2017).

Worldwide, Neuman Systems Model practitioners use the technique to help

clients heal and function. Dr. Betty Neuman engineered the practice starting in the early
70’s. The model is fluid; Neuman encourages its users to reformulate the model as it

applies to their work environment. NSM practitioners treat each client based on their

individual characteristics, unique circumstances and background. The methodology is

hugely successful, regularly revised and remains current to this day (University, 2017).

ii. Adaptation Model of Nursing, a prominent nursing theory of Callista Roy

The Roy Adaptation Model presents the person as a holistic adaptive system in

constant interaction with the internal and the external environment. The main task of the

human system is to maintain integrity in the face of environmental stimuli (Philips,

2010). The goal of nursing is to foster successful adaptation.

According to Roy and Andrews (1999), adaptation refers to “the process and

outcome whereby thinking and feeling persons as individuals or in groups, use

conscious awareness and choice to create human and environmental integration”.

Adaptation leads to optimal health and well-being, to quality of life and to death with

dignity (Andrews & Roy, 1991). The adaptation level represents the condition of the life

processes, which attempts to reestablish adaptation. If the compensatory processes are

not adequate, compromised processes result (Roy, 2009).

Coping processes in the Roy adaptation model include both innate coping

mechanisms and acquired coping mechanisms. Innate coping processes are genetically

determined or common to the species; they are generally viewed as automatic

processes. In contrast, acquired coping process are learned or developed through

customary responses (Roy,2009)

 The processes for coping in the Roy adaptation model are further categorized as

“the regulator and cognator subsystems as the apply to individuals, and the stabilizer

and innovator subsystems as applied to groups”. A basic type of adaptive process, the

regulator subsystem responds through neural, chemical and endocrine coping

channels. Stimuli from the internal and external environment act as inputs through the

senses to the nervous system, thereby affecting the fluid, electrolyte and acid-base

balance, as well as the endocrine system. This formation is all channeled automatically,

with the body producing an automatic, unconscious response to it.

The second adaptive process, the cognator subsystem, responds through four

cognitive-emotional channels: perceptual and information processing, learning,

judgment, and emotion. Perceptual and information processing includes activities of

selective attention, coding, and memory. Learning involves imitation, reinforcement, and

insight. Judgement includes problem solving and decision making. Defenses are used

to seek relief from anxiety and make affective appraisal and attachments through the

emotions.

The cognator- regulator and stabilizer- innovator subsystems function to maintain

integrated life processes. These lives processes- whether integrated, compensatory, or

compromised—are manifested in behaviors of the individual or group. Behavior is

viewed as an output of the human system and takes the form of either adaptive

responses or ineffective responses. These responses serve as feedback to the system,

with the human system using this information to decide whether to increase or decrease

its efforts to cope with the stimuli (Roy, 2009).

 Although one can identify specific processes inherent in the regulator- cognator

subsystems, it is not possible to directly observe the functioning of these systems. The

behaviors can be observed in four categories, or adaptive modes: physiologic-physical

mode, self-concept—group identify mode, role function mode, and interdependence

mode. It is through these four modes that responses to and interaction with the

environment can be carried out and adaptation can be observed.

Behavior in the physiologic-physical mode is the manifestation of the physiologic

activities of all cells, tissues, organs, and system making up the body. Five basic needs

exist: oxygenation, nutrition, elimination, activity and rest, and protection. In addition,

four processes are involved in physiologic adaptation: the senses; fluid, electrolyte, and

acid-base balance; neurologic function; and endocrine function. The underlying need for

the physiologic mode is physiologic integrity. When viewing the first mode in relationship

to a group of individuals, it is appropriate to use the terminology “physical mode” and to

look at the group manifestation of adaptation in terms of basic operating resources,

because the basic need associated with the physical mode for a group is resource

adequacy or wholeness achieved by adapting to changes in physical resource needs

(Roy, 2009).

The self-concept-group identity mode includes the components of the physical

self, including body sensation and body image, and the personal self, including body

sensation and body image, and the personal self, including self-consistency, self-ideal,

and moral-ethical-spiritual self. The basic need underlying the self-concept mode for the

individual is psychic and spiritual integrity—that is, the need to know who one is so that

one can be or exist with a sense of unity. “Group identity” is the term used to refer to the
second mode with groups. This mode comprises interpersonal relationships, group self-

image, social milieu, culture, and shared responsibility of the group. Identity integrity is

the need underlying this group adaptive mode.

The role function mode focuses on the roles of the person in society and the

roles within group. The basic need underlying the role function mode is social integrity—

that is, the need to know who one is in relation to others so that one will know how to

act.

Finally, the interdependence mode is a category of behavior related to

interdependent relationships. This mode focuses on interactions related to the giving

and receiving of love, respect, and value. The basic need of this mode is relational

integrity, or the feeling of security in nurturing relationships. Thus it follows that two

specific relationships are the focus within this mode for the individual: significant others

and support systems. For the group, the interdependence mode relates to the social

context in which the group operates; important factors in this case include infrastructure

and member capability (Roy, 2009).

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