Chapter 1

THE PROBLEM AND REVIEW OF RELATED LITERATURE

Introduction

As it is known, coronavirus disease 2019 or COVID-19 is an infectious disease

caused by the novel coronavirus (SARS-Cov2). Thus, the World Health Organization

(WHO) categorized COVID-19 as a pandemic. The said pandemic has brought in

challenges confronting the healthcare system especially the front liners not only doctors,

nurses and medical technologists but also midwives even those barangay health workers.

The fearful challenge for them is that of having close contact with COVID-19 infected

patients placing them at a high risk of infection from which they could transmit the

disease to their respective families and even co-workers.

Besides, the pandemic has made the healthcare workers face challenges as to

shortage of personal protective equipment, high risk of contamination, low adherence to

the social distancing measures by the population, low coronavirus testing with

underestimation of cases, and also financial concerns due to the economic crisis in most

developing countries (Cotrin, Moura, Gambardela-Tkacz, Pelloso, dos Santos, Carvalho,

Pelloso & Freitas, 2020). As the number of confirmed COVI-19 cases went higher and

higher, health providers are left with high-stakes decisions for their patients and their own

personal safety. The situation ushers them to be in a time of great stress, insecurity,

anxiety, and uncertainty.

The Rural Health Unit (RHU) in Carascal, Surigao del Sur cannot escape but

unknowingly may accept COVID patients or those asymptomatic. When it is true that
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heath care providers always have obligations to the patient in front of them, but the

pandemic imposes so many limitations as well as varied difficulties when discharging

their duties. It is along this line that the researchers felt the urge in identifying the level

of difficulties encountered by the health care providers in the RHU of Carascal, Surigao

del Sur.

Review of Related Literature

This portion of the study reviews the literature related to determining the

difficulties encountered by the health care providers during the pandemic. The

presentation includes some articles, journals, books, and electronic materials which have

direct bearing with the present study.

Healthcare Providers and the COVID 19

Chen, Lai, and Tsay (2020), pointed out that the numerous roles and tasks played

by nurses or by other healthcare providers are predominantly significant during this

COVID-19 pandemic. They are the frontline healthcare professionals who work across

acute care hospitals, long-term care agencies, nursing homes, schools, community, and

government healthcare agencies. The healthcare providers’ role in pandemic begins even

before a disease has an opportunity to cause widespread devastation.

Meanwhile, Jordan (2020) accentuated that COVID-19 surge onto the world stage

surprisingly, rapidly becoming a global pandemic and crushing the world economies to a

halt. However, despite of its emergence, the healthcare providers are already on the job

trying to stem the tide of its transmissions. In the past, the doctors, nurses, midwives

were there for the Spanish flu, Polio, Ebola and this present day culture, they stand at risk

between COVID-19 and the rest of the world.

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Difficulties during the COVID-19 Pandemic

As the virus kept spreading, healthcare providers were faced with difficulties

when discharging their duties. They were caught unaware by the COVID-19 pandemic

leading to panic and confusion in efforts to fight against the infection. This confusion led

to controversial decisions about who should be treated or tested with the available scarce

resources (Han, Zeng, Jiang, Yang, Yuan, Cheng, . . . Zhu, 2020).

Many of the healthcare workers are in the front line, in close contact with

COVID-19 infected patients, at high risk of infection and of transmitting the disease to

their families and coworkers (Igbal & Chaudhuri, 2020). Meanwhile, Cotrin et al. (2020)

accentuated that nurses were more anxious and stressed with the pandemic, and nurses

were feeling angrier than the other healthcare workers. Besides that, nurses may face a

higher risk of exposure to COVID-19 patients as they spend more time in the front line,

providing direct care of patients.

Daily Risk Exposure to Virus. The World Health Organization (WHO, 2020),

averred that the virus that causes COVID-19 is transmitted between people through close

contact and droplets. People most at risk of acquiring the disease are those who are in

contact with or care for patients with COVID-19. This inevitably places health care

workers (HCWs) at high risk of infection. Protecting them is of paramount importance to

WHO. Understanding how HCWs exposure to COVID 19 virus translates into risk of

infection is critical for informing infection prevention and control (IPC)

recommendations. Meanwhile, Bernstein, Boburg, Sacchetti, and Brown (2020)

accentuated that there are dozens of healthcare workers have fallen ill with Covid-19 and

more are quarantined after exposure to the virus. It is frightening as nurses take risks
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every day because they are called to do their job exposed to one of the most highly

contagious viruses in the world (Bernstein et al., 2020).

Shortage of the Personal Protective Equipment (PPE). It has been said that

insufficient personal protective equipment (facial mask, gloves, impervious gowns, and

eye protection) has been associated with occupational exposure and illness. Thus,

improving production and procurement is critical to ensuring security and safety in the

workplace. According to Wong, Pacella-LaBarbara, Ray, Ranney, and Chang (2020),

PPE has gained even more importance in recent times because with the increased demand

for use, PPE has become more expensive and scarcer. Healthcare workers reported that

there was limited access to essential PPE and support from healthcare authorities during

the COVID-19 pandemic from Latin America to Europe. Some physicians related reusing

face masks that are meant to be disposable because their hospitals may run out in the next

few weeks.

Miranda, Santana, Pizzolato, and Saquis (2020) pointed out that NPs experience

an ethical and moral dilemma: by assisting patients without using the appropriate PPE,

they put their lives at risk, the life of the patients, of the health team, and of their loved

ones. Another problem resulting from the lack of PPE refers to the reuse of the N95

mask. It was recommended that, exceptionally, health professionals could use it,

provided it was in good condition, several times during the same shift of up to 12 hours.

The lack of PPE may place the nurse to high risk. This was substantiated by the study of

Nguyen, Drew, Graham, Joshi, Guo, Ma, et al. (2020) who reported that those with

inadequate PPE had an increase in risk. However, adequate availability of PPE did not
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seem to completely reduce risk among health-care workers caring for patients with

COVID-19.

In addition, Black, Bailey, Przewrocka, Dijkstra, and Swanton (2020) stressed out

that even with adequate PPE, health-care workers who cared for patients with COVID-19

remained at increased risk, highlighting the importance of not only ensuring PPE quality

and availability but also other aspects of appropriate use, including correct application

and removal of PPE and clinical situation (practice location). Furthermore, these data

underscore the possibility for health-care workers to perpetuate infections or contribute to

community spread, particularly when asymptomatic or mildly symptomatic, and justify

calls to increase testing to reduce hospital-based transmission.

Lack of pandemic preparedness. Admittedly, the emergence of COVID-19 has

caught the health workers unprepared. Nyashanua et al. (2020) reported that

preparations for a pandemic within the sector were inadequate. They also felt that there

was no clear or strategic policy dealing with a pandemic in health and social care.

Meanwhile, Balasegaram (2020) pointed out that as COVID-19 has swept across

the world, everyone has seen first-hand how a disease outbreak without the tools to halt

and treat it can disrupt health systems, economies and threaten vulnerable populations.

This has in turn led many governments to wake up to the importance of pandemic

preparedness. In like manner, Veenema, Meyer, Bell, Couig, Friese, Hosmer, Lavin,. et

al. (2020) have reported that there was an inadequate knowledge and skills related to

pandemic response among nurses. The rapid stem of COVID transmission have

contributed to a lack of pandemic readiness both within and outside of the nursing
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workforce, including in emergency planning and the procurement and allocation of

resources such as PPE and ventilators (Veenema et al. 2020).

Enforcing social distancing. In the study of Nyashanua et al. (2020) it averred

that the challenges in enforcing social distancing are associated with enforcing social

distancing for individuals as some found it difficult to understand the problem and

respond in line with the social distancing guidelines. As to the experience of the

nurses, they verified that it was very difficult to enforce social distancing among

individuals as some of them do not understand the problem of COVID-19 and the

importance of social distancing.

In another perspective, the European Center for Disease Prevention and Control

(ECDPC, 2020) has said that enforcing social distancing is aimed to decrease or

interrupt transmission of COVID-19 in a population (sub-) group by minimizing

physical contact between potentially infected individuals and healthy individuals, or

between population groups with high rates of transmission and population groups with

no or a low level of transmission. The center further explains that ‘social distancing’

focuses on reducing physical contact as a means of interrupting transmission. The

success of social distancing measures what are implemented over an extended period

may depend on ensuring that people maintain social contact from a distance with

friends, family and colleagues. Internet based communications are therefore a key tool

for ensuring a successful social distancing strategy (ECDPC, 2020).

Delay in testing. According to Nyashanua et al. (2020) the delays in testing of

nurses has resulted in the difficulties in knowing whether staff had COVID-19 or not, if

they started coughing or showing other symptoms. On many occasions staff would
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have to self-isolate resulting in shortage of staff. The informant once said: “There was

nowhere to get tested if you start coughing or have high temperature . . . we waited for

the test to be rolled out to frontline workers in health and social care for so long you

would not know whether you had it or not.”

“One other big problem was that there was nowhere to get tested when I started

coughing, I had to self-isolate. I do not know whether it was COVID-19 or just a

cough. Honestly, I would have done better with a test.” a female general nurse has

recounted.

Another case about a patient who was pretty sure she only had a strep throat who

decided to get tested for the virus just in case. She found a COVID-19 testing site that

promised results three to five days after she was tested. But she spent the next two

weeks quarantined alone awaiting delayed results that finally came back negative. The

experienced was very disheartening as many people are not lucky enough to drop

everything and failed to go to work (Ducharme, 2020). In fact, it can be said that

testing delays make it difficult for public-health officials to tailor their responses

to the right people especially those who are infectious, and people to whom they

may have passed the virus and act of social contact tracing and the quarantining

(Ducharme, 2020).

Synthesis of the Review. The literature review has elaborated some of the

healthcare providers’ difficulties during the COVID-19 pandemic. Hence, the cited

literatures are significant to the present study because it established the relationship

between the healthcare providers and the difficulties they have encountered in reporting

to duty during the pandemic. Obviously, the cited materials helped the researchers in
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determining the level of difficulty health care providers have met while on duty and even

outside duty. However, the differences can be noted that from the said review that little

has been done by the local studies to systematically establish the relationship between

healthcare providers and the level of difficulties encountered during the pandemic. This

study therefore sought to systematically establish the relationship and so prompted the

researchers to conduct of the study.

Conceptual Framework of the Study

This study was anchored from the study conducted by Do Nascimento, Hattori

and Tercas-Trettel (2020) who conceptualized that the high transmissibility and

expansion of the COVID-19 virus in the world constitute a high occupational risk for

health professionals. The vulnerability of the health care providers is worrying which

eventually placed them to experience difficulties in discharging their duties and

responsibilities. Besides, the concept advanced by Ramos-Morcillo, Leal-Costa, Moral-

García and Ruzafa-Martínez (2020) linking that COVID-19 pandemic has made the

world experience an extraordinary public health emergency which made the health care

providers encountered challenges and difficulties despite having the knowledge and

aptitudes for providing the care necessary in the different clinical scenarios that are

emerging during the pandemic. In like manner, as the COVID-19 virus keep spreading,

healthcare professionals across the globe are faced with an unmatched situation of having

to make difficult decisions and work under extreme pressures.

Convincingly, many health systems worldwide were caught unaware by the

COVID-19 pandemic leading to panic and confusion in efforts to fight against the

infection (Nyashanua, Pfendeb & Ekpenyongc, 2020). Considering all these premises,
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Level of Difficulties
Encountered during
Socio-demographic the COVID-19
Profile of the Pandemic as to:
Respondents as to:
 Daily risk exposure
 Gender to virus
 Age  Shortage of the Proposed
 Civil Status Personal Protective Remediation Plan
 Highest Equipment (PPE)
Educational  Lack of pandemic
Attainment preparedness
 Years in Service  Enforcing social
distancing
 Delay in testing

Figure 1. Schematic Diagram of the Study on the Difficulties encountered by Healthcare

Providers during COVID-19 Pandemic
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the study intends to identify the level of difficulties of health care providers during the

COVID-19 pandemic. This is a quantitative study involving healthcare providers from

the RHU of Carascal, Surigao del Sur whose data were collected concerning their views

and opinions on the level of difficulties they are encountering during the pandemic with a

questionnaire.

Hence, Figure 1 show the interplay of the variables which made up the entire flow

of the study. Box 1 contained the socio-demographic profile of the respondents as to

gender, age, civil status, highest educational attainment, and years in service. Box 2

included the prescribed difficulties encountered during the pandemic such as daily risk of

exposure to virus, shortage of the personal protective equipment (PPE), lack of pandemic

preparedness, enforcing social distancing, and the delay in testing. Box 3 involved the

proposed intervention to remedy the difficulties of healthcare providers during the

pandemic.

Statement of the Problem

The study identified the level of difficulties encountered by the healthcare

providers during the COVID-19 pandemic in Carsacal, Surigao del Sur.

Specifically, it sought answers to the following questions:

1. What is the socio-demographic profile of the respondents as to:

1.1 Gender

1.2 Age

1.3 Civil Status

1.4 Highest Educational Attainment

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1.5 Years in Service?

2. What is the level of difficulties encountered by the healthcare providers as to:

2.1 Daily risk exposure to virus

2.2 Shortage of the Personal Protective Equipment (PPE)

2.3 Lack of pandemic preparedness

2.4 Enforcing social distancing

2.5 Delay in testing?

3. Is there a significant difference in the level of difficulties encountered by the

healthcare providers when they are grouped according to their socio-demographic

profile?

4. Is there a significant difference in the level of difficulties encountered by the

healthcare providers when they are grouped according to their socio-demographic

profile?

Hypothesis

At 0.05 level of significance, it was hypothesized that there was no significant

difference in the level of difficulties encountered by the healthcare providers when they

are grouped according to their socio-demographic profile.

Significance of the Study

Results of the study are significantly beneficial to the following:

RHU Management. The result would help the management of the mentioned

RHU in determining the difficulties encountered by their healthcare providers in the

delivery of services to the COVID-19 patients and all others apart COVID cases during
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the pandemic. They would be guided on the possible intervention they should provide to

better perform their tasks especially in providing care to the patients.

Healthcare Providers. By the result of the study, the healthcare providers like

nurses, midwives, medical technologists, BHWs may be informed with the real scenario

or status of their RHU concerning COVID-19 cases. They would be provided exact data

as to the condition of their hospital relative to the facilities and equipment applicable for

treating COVID-19 patients.

Nursing/Midwifery Students. The study would help the nursing and midwifery

students in properly adjusting with the urgent change in the education from traditional to

online and/or distance learning specifically from face-to-face to e-learning education as

brought by the COVID-19 pandemic.

Future Researchers. The findings of this study would serve as the basis for

further researches related to COVID-19 pandemic and the work experiences of the

nurses.

Scope and Limitation of the Study

This study was focused on identifying the level of difficulties encountered during

the COVID-19 pandemic by the healthcare providers in Carascal, Surigao del Sur. The

participants of the study were the selected healthcare providers such as nurses, midwives,

medical technologists and BHWs in the RHU of Carascal, Surigao del Sur. This study

was conducted by the researchers within in the school year 2020-2021 in the

geographical location of RHU of Carascal, Surigao del Sur.

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Definition of Terms

Some important terms used in the study are defined to provide clearer

understanding of the study. They are as follows:

Daily risk exposure to virus. This is about the possible danger healthcare

providers may encounter daily or every time they report to duty being susceptible to be

infected with COVID virus.

Delay in Testing. This pertains to the fears of healthcare providers of not directly

identifying the true case of a patient since testing may be done late.

Difficulties. This is pertaining to the struggles encountered by the healthcare

providers in the exercise of their duties and responsibilities during the pandemic.

Enforcing Social Distancing. The fear or problem of implementing and enforcing

every patient, healthcare provider, significant others or watchers and other front liners in

the observance of social and physical distancing.

Lack of pandemic preparedness. This pertains to being caught unaware or not

ready to combat and face the emergence of COVID-19 virus.

Shortage of the Personal Protective Equipment (PPE). This relates to the

availability and level of unavailability of the PPE for the use of the healthcare providers

every time they report to duty.

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