LEVEL OF ANXIETY CAUSED BY COVID 19 PANDEMIC

TO THE NURSES IN SURIGAO CITY

A Research Paper Presented to

The Faculty of the College of Nursing

Cebu Institute of Technology-University

Cebu City, Philippines

In Partial Fulfillment

of the Requirements for the Course

NCM 321 Nursing Research 1

Proponents:

Chato, Cris Cyrus C. (Student, College of Nursing and Allied Health Sciences)

Silvosa, Hara Mil U. (Student, College of Nursing and Allied Health Sciences)

Sunico, Michelle V. (Student, College of Nursing and Allied Health Sciences)

Adviser:

Auda F. Russel RN, MN, DScN (Faculty, College of Nursing and Allied Health Sciences)

September 2021
 Table of Contents

Title Page

Table of Contents

Acknowledgement

Abstract

Chapter Page

Chapter I: Introduction 1

Chapter II: Review of Related Literature 5

Theoretical Framework 9

Definition of Terms 13

Statements of the Problem 15

Significance of the Study 16

Chapter III: Methodology 18

Introductory Statement 18

Research Design 18

Research Locale 19

Research Sampling 20

Research Respondent/Subject 20

Research Instrument 20

Research Procedure 21

Data Analysis 22

Ethical Consideration 22

Scope and Delimitation 25

References 27

Appendices 30

A. Letter of Request 30

B. Curriculum Vitae 34

Documentation 37
 LIST OF FIGURES

Figure 1. Neuman’s theoretical framework 11

Figure 2. Flow of the Study 12

ACKNOWLEDGEMENT
LEVEL OF ANXIETY CAUSED BY COVID 19 PANDEMIC

TO THE NURSES IN SURIGAO CITY

Cris Cyrus C. Chato

Hara Mil U. Silvosa

Michelle V. Sunico

Auda F. Russel RN, MN, DScN

Cebu Institute of Technology – University

ABSTRACT
 CHAPTER I

Introduction

The SARS-Cov-2 outbreak commonly known as the COVID 19 has been

affecting millions of lives affecting the physical, emotional, psychological, social and

financial aspects of every individual anywhere in the world. As the virus reached the

boundaries of the Philippines, a lot of happenings surprised the people, and the

changes were devastating. The feeling of isolation is not common in Filipinos. The

Philippines is known for its ability to adapt in all sorts of circumstances, but the impact of

COVID-19 is just too much for the people to handle, even powerful and known countries

are down on its knees. As the effects of the virus progresses, there are people who are

in really big trouble protecting and sustaining the lives of every people who are admitted

in the hospitals. The medical frontliners are considered to be the heroes without wearing

a cape. Their services to the Filipino people and even anywhere in the world are just

pure. Their sacrifices for the people are exceptional, even if their own lives are at much

greater risk. One of those medical frontliners are nurses, they have critical roles during

the COVID-19 pandemic. They continue to actively participate in the frontline and

monitor the COVID wards with their Personal Protective Equipment (PPE) ignoring the

extreme tiredness just to continue serve and preserve the lives of every people. Nurses

and other medical frontline members have caused a greater impact in sustaining the

battle and combat against COVID-19 virus.

The first suspected case in the Philippines was investigated on January 22,

2020, and 633 suspected cases were reported as of March 1 (PMC, 2020). Tensions in

Filipino nurses are continuing to arise as they are the ones who are taking care of the

1
patients as cases are increasing. Nurses and other medical frontline member are at

higher risk of encountering psychological health such as stress, fear of getting infected,

fear of infecting others and fear of death, as well as other challenges such as being

distant to the family and more. As they continue to give care to the infected patients,

nurses are slowly accepting the reality that “Nurses are born to serve” in any kind of

situation, just to provide healthcare and prolong the life of their patients. A new data

began to emerge that the Delta variant was more infectious and was leading to

increased transmissibility when compared with other variants, even in some vaccinated

individuals (Centers for Disease Control and Prevention, 2021). As studies shows, the

delta variant is more contagious as the other variants, and infection rate is expected to

be high. On August 20, 2021, Metro Manila tallied a record of 17,231 new COVID-19

cases in less than a day after easing the lockdown when the government announced,

this is the most in a single day since the pandemic began in March 2020 (DOH, 2021).

Moreover, Filipino nurses come to the point of quitting their jobs as they feel

totally exhausted and burned out. Estimated that 40% of private hospital nurses

resigned last year, but more followed new waves of infections this year. Public hospitals

are facing similar challenges (Private Hospitals Association of the Philippines, 2021). In

some areas in the Philippines, COVID-19 cases are still continuing to increase, and

hospital’s bed capacity can be also increased, but the problems is, the shortage of

medical staffs such as nurses is the main concern. Other concerns of nurses and other

medical frontline members are to those covid positive patients admitted in the hospitals

and remained unvaccinated. According to Dr. Jonas del Rosario, spokesperson of

Philippine General Hospital said on August 26, 2021, that most corona virus patients in

2
the country are unvaccinated. Del Rosario added that 75% of severe to critical patients

are unvaccinated. He said 85% of intubated patients were also unvaccinated (Philstar,

2021). As the latest government figures showed there are now 13.37 million Filipinos

complete with their COVID-19 shots. That is out of the target of up to 70 million this

year, some 18.06 million, meanwhile, have received their initial dose (Philstar, 2021).

These numbers are adding to the stress and anxiety buildup in most hospitals in the

Philippines. In Surigao City, nurses and other medical front line members in both public

and private hospitals has been overwhelmed with COVID-19 cases, as they continue to

do their service as medical frontliners. One of the problems in medical fields are the lack

of Personal Protective Equipment (PPE) which will be used during the round the clock

duties of the medical team. We believe that the lack of PPE and the problems of supply

are undoubtedly linked to the high infection rates and some of the deaths we have seen

as well (International Council of Nurses, 2020). Lack of PPEs is one of the factors on

why nurses experiences psychological issues during and after their duties. As days,

months or years passed by, many foreign countries are now free from COVID-19 and

the Philippines is still trying combat and beat COVID-19.

Furthermore, as of October 11, 2021, a decrease in the number of Corona Virus

disease 2019 (COVID-19) infections has been recorded in the Caraga Region, the

Department of Health in the region (DOH-13) reported Monday. Three provinces in the

region are now considered a moderate risk, including the Dinagat Islands with an

Average Daily Attack Rate (ADAR) of 3.32 percent, Agusan del Norte (6.87%), and

Surigao del Norte (5.83%). As the region thrives to continue these numbers, nurses and

other medical frontline members finally took little amount of escape from the devastating

3
effect of COVID 19. But Dr. Gerna Manatad, the DOH-13 chief epidemiologist, said

Monday, the province of Caraga remains as a high-risk area with an ADAR recorded at

10.09 percent.

This research study aims to know the number of nurses in Surigao City, who

possibly experienced anxiety due to the effects COVID-19. The researchers want to

know the reactions of the nurses about the effects of COVID-19 and how did they cope

up in sustaining their job as nurses. The results of this research study will be beneficial

to the nursing profession as it will provide solutions to the nurse’s concerns and will

serve as a “sell check” for the nurses on how well are they in the midst of the pandemic.

Self checking among nurses is a very significant activity in easing the intensity of the

situation and in order to do self monitoring, self reflecting and self care that are needed

to strengthen the nurses so that they can continue to answer the call in helping and

serving others. The researchers want to have an output suggestion and propose

recreational activities for nurses if proven that they truly experienced anxiety during the

pandemic. A recreational activity like one-day-off duty for nurses will be suggested to

the hospital management because this suggestion will depend on the results. The Local

Government Unit of Surigao City will also benefit in this research study because they

will now know the actions that the nurse’s needs in order for them to continue and do

their job. The researchers are also willing to listen on the LGU’s suggestions and

recommendations in order to have a harmonious coordination and successful

implementation.

4
 CHAPTER II

Review of Related Literature

According to Spielberg disorder outbreaks including the COVID-19 pandemic are

tension-frightening conditions. Defined as a “country of uneasiness or apprehension on

account of the anticipation of an actual or perceived threatening occasion or situation”

(Spielberger, 2010), tension is not an unusual place amongst healthcare employees

who're immediately worried about coping with affected sufferers all through pandemics.

Working face-to-face with folks that are quarantined and wearing the virus can enhance

severe worries including worry of dying amongst healthcare specialists, emotions of

loneliness and anger can also additionally develop, and those feelings can also

additionally cause pressure withinside the specialists (Xiang et al., 2020; Zhang et al.,

2020). In a take a look at performed through Cai et al. (2020) with 534 doctors, nurses

and number one care companies in Hubei country, healthcare specialists’ pressure

stages have been located to be extraordinarily excessive all through the COVID19

outbreak. As an end result of a conducted studied and performed in Turkey, it turns out

that 38% of nurses running withinside the emergency branch skilled are under pressure.

According to the equal research, it became discovered that nurses experiencing

pressure regretted their desire of career and idea to end or go away their jobs (Yasal

and Partlak, 2019). The take a look at performed through Jiang et al. (2020) with 310

human beings with the intention to observe the mental signs of healthcare specialists in

5
Wuhan all through the COVID-19 outbreak confirmed that healthcare specialists have

been beneath neath slight to intense pressure and that lots of them stated excessive

tension and depression. Emergencies including the COVID19 outbreak can show riskier

for healthcare specialists who works under numerous problems and dangers even

withinside the provision of everyday fitness services. These conditions can motivate

them to be uncovered to intense pressure reactions and enjoy the tension, which will

increase the chance of growing secondary trauma. Further, because of their direct

touch with COVID-19 sufferers, healthcare employees (HCWs) are greater uncovered to

stressful occasions including sufferers’ struggling and dying (Pappa et al., 2020), which

could similarly expand their tension. Available facts advise that the superiority of tension

amongst HCWs ranged from 22.6% to 36.3% (Liu et al., 2020), which became

considerably better than that of the overall population. Nurses have been stated to have

the best tension stages and the best occurrence of tension amongst HCWs, starting

from 15% to 92% (Alwani et al., 2020; Luo et al., 2020; Zhu et al., 2020). Anxiety stages

have been located to be excessive in numerous posted studies, amongst lady nurses

(Alwani et al., 2020; Kaveh et al., 2020).

Anxiety has proven itself in almost every element of society, which includes man

or woman monetary concerns, bodily and intellectual troubles resulting from social

isolation, stoppage of tutorial activities, withdrawal from production, and strain produced

through social distance as stated by Qiu and Duan (2020). Health structures that have

been stuck off to defend through the sort of pandemic have struggled with numerous

troubles, which includes a loss of good enough defensive equipment, an awesome

workload, a lack of personnel, and a workforce shortage. Healthcare experts are

6
experiencing extraordinary ranges of worry, worry, and disappointment because of this

(Lu et al. 2020). Healthcare employees in hospitals, in particular, have usually been at

the vanguard of handling pandemics, placing their lives on the road to do their jobs.

COVID-19 contamination is contagious amongst healthcare employees who come into

near touch with COVID-19 patients, and they may be probably contaminating their

coworkers and own circle of relative’s members (Lu et al. 2020; Lin et al. 2007;

Lehmann et al. 2015). Moreover, according to Morgantini (2020) a have a look carried

out on healthcare experts confirmed a huge, superb dating amongst worry and tension.

Additionally, another has a look at investigating anxiety issues at some stage in the

COVID-19 epidemic said that medical doctors and nurses skilled excessive ranges of

intellectual fitness problems (Sung et al., 2020).

The main source of anxiety in nurses during the COVID-19 pandemic was fear of

becoming infected or unknowingly infecting others (Mo et al., 2020). (Shanafelt et al.

2020) identified other sources of anxiety in nurses, including lack of personal protective

equipment (PPE), fear of harbouring the novel coronavirus at work, lack of access to

COVID-19 testing, fear of transmitting the virus at work, doubt that their institution would

support them if they became infected, lack of access to childcare facilities during

lockdown, fear of being deployed in an unfamiliar ward or unit and lack of accurate

information regarding the disease.

Thus, low level of anxiety can help to motivate and arouse excitement in an

individual, long-term anxiety exposure can have a negative impact on their

physiopsychological health and work performance. Higher levels of anxiety were also

linked to impairment in some bodily functions, negative coping mechanisms (such as

7
increased alcohol or drug consumption), stress and depression, and increased suicidal

ideation. (Lee et al., 2020). Further, unmanaged anxiety may lead to long-term effects

on nurses’ work performance and job satisfaction, leading to frequent absenteeism and

eventual turnover (Labrague et al., 2018a; Lee et al., 2020).

As stated by Mo and Catton (2020) It is critical to assist nurses' mental,

psychological, and emotional health using evidence-based strategies in order to

effectively treat their anxiety or of COVID-19 pandemic. According to Maben & Bridges

(2020) a person's ability to 'bounce back' or recover fast after a specific catastrophe,

such as the COVID-19 outbreak, with help from coworkers, supervisors, friends,

families, and the organization, may help nurses effectively endure the burden caused by

the pandemic. Thus, Lee et. al., (2020) stated that higher anxiety levels were also linked

to physical impairment, negative coping mechanisms (such as increased alcohol or drug

consumption), stress and depression, and increased suicidal ideation (Lee et al., 2020).

Further, unmanaged anxiety can have a long-term impact on a nurse's work

performance and job satisfaction, resulting in frequent absences and eventual turnover

as stated by Labrague & McEnroe-Petitte, (2018); Lee et al., (2020). Taking steps to

reduce anxiety among nurses may help to avoid negative consequences. Such

measures are necessary for maintaining a motivated nursing workforce. Nurse

managers can help nurses cope with their anxiety or fears about COVID-19 by

promoting their mental, psychological, and emotional well-being through evidence-

based interventions, supportive organizational policies, and the creation of a safe and

secure work environment (Catton, 2020; Mo et al., 2020). However, no studies have yet

been conducted to examine the reduction of anxiety related to COVID-19. Hence, this

8
study was conducted to assess the level of Covid-19 anxiety to the nurses in Surigao

City.

9
Theoretical Framework

Kang et al. (2020) pointed out that medical staff often have a variety of

psychological problems in a high-pressure and high-risk pandemic situation

In relation to this, The Neuman Systems Model is a theoretical framework that

revolves around the structure of stressors, the emotional response to these stressors,

and the corresponding interventions. In the model, the system approach is taken as

basis and it is explained how the system remains in balance against the stressors. In

the Neuman systems model, the patient is considered a system and it is clarified that

the system has its lower segments and these segments are interrelated. The client

system is addressed in a holistic manner in the model and is considered as the

combination of five variables that affect each other, namely the physical, psychological,

socio-cultural, developmental, and spiritual variables. (Fawcett J, Giangrande SK,,

2001) In the Neuman systems model a three-dimensional framework of interpersonal,

intrapersonal, and extra personal stressors is used to analyze the client's stress. With

analyzing how these stressors affect an individual, it may then help identify and analyze

the main source of where the stress may be coming from. Whether it is internally or

externally, using this model allows the individual to assess what the problem is, how

they perceive it, and what can be done for relief.

The risk of infection, nurses’ working conditions during this crisis have been

harsh. During this period, nurses had to deal with the anxiety, fear, and other emotional

states produced by observing patients’ suffering and death. Anxiety related to the

COVID-19 pandemic is prevalent in the nursing workforce, potentially affecting nurses’

10
well-being and work performance. Identifying factors that could help maintain mental

health and reduce coronavirus-related anxiety among front-line nurses is hard. They

worked under physical and emotional pressure, putting their lives at risk while fulfilling

their duties (Catton, 2020). In connection to this, Neuman Systems Model can help

measure the level of anxiety they are experiencing and determine the specific

interventions to decrease their anxiety. This model emphasizes the importance of

incorporating the patient’s needs as well as maintaining optimal wellness within ones’

self. With implementing interventions that will help nurses cope with stress related to

anxiety, it will lead to healthier coping mechanisms and a decrease in reporting high

levels of anxiety due to the pandemic.

11
 Tertiary Prevention

 Coping Mechanisms
 Personal resilience
Stress Factors

 lack of personal
Secondary Prevention
protective equipment
 Identification of work- (PPE)
related stressors  lack of access to COVID-
19 testing
 low income

Client

Nurses in Caraga Regional

Hospital

Basic structure
Energy
resources

Stressor

 Anxiety
Primary Prevention
 Stress
 Determining the  fear of getting
level of anxiety of infected
Nurses Caused by  fear of infecting
COVID-19 Pandemic anyone
in Caraga Regional
Hospital
 Social support

Reconstition

 social support drawn

from colleagues,
managers, friends and
families
 Organisational
support

12
 Figure 1. Neuman’s theoretical frame work

Flow of the Study

INPUT PROCESS OUTPUT

Age To know the level of This is to ensure that all

Gender anxiety among the of the concerns of the
Coping Mechanism nurses of Surigao City, Surigaonon nurses will
Reaction about the and well as their be recognized. It will
surrounding stressors reaction and coping also help them to check
mechanisms to cope up on their selves on how
and deal with effects of well they are and it will
COVID-19 in all various also benefit the
aspects. government in
addressing the needs
of the nurses.

Figure 2. Flow of the study

13
DEFINITION OF TERMS

Anxiety. This is one of the variables that will be measured in this study among

the Nurses of Surigao City to determine the level of anxiety among the nurses.

Level of Anxiety. This is utilized as a variable to assessed among the nurses

and how this anxiety could somehow affect their work.

Nurse. These are the people in the study who experience anxiety during this

pandemic

Coronavirus Disease 2019 (COVID-19). The COVID-19 pandemic have

negatively affected many people’s mental health and created new barriers for people

already suffering from mental illness.

Pandemic. a disease outbreak that spans several countries and affects a large

number of people. Pandemics are most often caused by viruses, like Coronavirus

Disease 2019 (COVID-19), which can easily spread from person to person.

Surigaonon. People in Surigao City will be the one of the participants in the

study.

Fear. The fear of the nurses of getting infected or to infect others while on duty.

14
 Medical Front liners. They are the health workers that are battling the novel

corona virus (COVID-19).

Psychological Health Issues. Refers to a wide range of mental health

conditions. Conditions that affects the mood, thinking and behavior.

PPE. These are Personal Protective Equipment used by medical frontline

members such as nurses, to protect themselves from contracting the covid 19 virus

while caring for their patients.

Recreational Activities. These are unwinding activities that helps the nurses to

relax.

COVID-19 Vaccine. Reduce a person's risk of contracting the virus that cause

COVID-19, prevents from hospitalization and death.

15
Statement of the Problem

The spread of COVID-19 is just like in a matter of minutes. In February 2020, the

Philippines and other parts of the world are still enjoying the taste of the past way of life

with the sense of togetherness. The pandemic has been affecting every individual in all

possible ways. The researchers aim to know the reaction of nurses in Surigao City and

know their ways on how they coped up with all the possible stressors surrounding them

and how did they manage to still stand and well balanced in this time of pandemic. The

proposed study will attain the needs of the nurses and implement the necessary and

helpful interventions that will know and recognize the needs of the nurses physically,

psychologically and various aspects.

This study aims to answer the following questions:

1. What is the demographic data of the nurses of Surigao City?

a. Gender

b. Age

16
 2. How severe is the level of anxiety of the nurses in Caraga Regional in

Surigao City?

a. Mild Anxiety

b. Moderate Anxiety

c. Severe Anxiety

d. Panic Level Anxiety

3. How did the nurses of Surigao City manage to cope up with the levels of

anxiety at work?

Significance of the Study

The results of this study will be helpful and beneficial to the following:

Nurses. This study will help the nurses to know how well their physical, mental and

overall health during the pandemic. It will serve as a self-check activity for them in order

to know how well they truly are.

Government officials. The study will also be beneficial to the government officials

especially the Local Government Unit of Surigao City, in order for them to know what

actions to make and give solutions to the nurse’s concerns. It will also be used to make

recommendations and to carry out necessary implementations within the nurses.

Officials from the government will be aware of how nurses are coping with the new

17
normal as well as their current level of stress. The research will also be important for

developing recreational activities and programs such as proper day off in order for them

to do an unwinding and relaxing activities for them to enjoy.

Researchers. The study will give the researchers a better understanding of the

relationship between levels of anxiety, allowing them to apply what they've learned to a

larger body of work. This will provide insight into the nurses' current psychological state

as well as how they cope with and adapt to the pandemic and for the unexpected

situations that might arise.

Future Researchers. The findings of the study will be used as a baseline for future

research and may also be used as a cross-reference to determine whether a high level

of anxiety leads to a positive or negative adaptation to changes following a traumatic

event.

18
 CHAPTER III

METHODOLOGY

Introductory Statement

This section contains the procedures as to how the study will be conducted. This

includes the following: research design, research environment, respondents of the

study, research instruments and the validation of the research instrument, gathering of

data, the ethical considerations, and statistical treatment of data. The researchers aim

to determine the level of anxiety cause by COVID 19 to the nurses in Surigao City.

Research Design

The study will utilize the process of quantitative descriptive cross-sectional

approach to determine the level of anxiety caused by COVID 19 to the nurses of

Surigao City. With the use of cross-sectional approach. Quantitative research is defined

as a systematic investigation of phenomena by gathering quantifiable data and

performing statistical, mathematical, or computational techniques. Quantitative research

collects information from existing and potential customers using sampling methods and

sending out online surveys, online polls, questionnaires, etc., the results of which can

19
be depicted in the form of numerical. Descriptive research is a quantitative research

method that attempts to collect quantifiable information for statistical analysis of the

population sample. It is a popular market research tool that allows us to collect and

describe the demographic segment's nature. Cross-sectional study design is a type of

observational study design. In a cross-sectional study, the investigator measures the

outcome and the exposures in the study participants at the same time.  Cross-sectional

designs are used for population-based surveys and to assess the prevalence of

diseases in clinic-based samples. These studies can usually be conducted relatively

faster and are inexpensive.

Research Locale

The study will be conducted in Rizal St. Surigao City and that focuses of the

nurses of Caraga Regional Hospital which is come up at least 30 % of the whole

population of covid ward nurses. This research study will be conducted using a

questionnaire method that will be forwarded virtually/ electronically as it is more

accessible to many where they can answer the survey in their free time. Surigao City is

subdivided into 54 barangays, 33 in the mainland and 21 in the islands. Of the 36

coastal barangays, 15 are in the mainland and 20 are in the islands. The urban area

covers 15 barangays or approximately 20% of the total land area. Caraga Regional

Hospital is located in Surigao City, on the northeastern tip of the Philippine Island of

Mindanao. The hospital is one of at least three hospitals serving the area.

20
 Image of Satellite picture of Caraga Regional Hospital

Research Sampling

The sample size of the study are 190 nurses working in Caraga Regional

Hospital were included in this study and is identified using the G*power. An 80 percent

power would be required to the 190 nurses, with an alpha set at 0.05 and effect size set

at 0.05 (Scoper, 2020). Initially, 190 nurses were invited to participate in the study.

Research Respondent/Subject

The study has a total of 190 respondents which will be give an informed consent

and online questionnaires for those who can access Google forms while for those who

are unable, printed copies will be provided. The researchers opt to choose the nurses in

Surigao City specifically in Caraga Regional Hospital in a reason that they are the ones

who are greatly affected by the pandemic. As of the 2021 census, Caraga Regional

Hospital has the total nurses of 190 who are 25-59 years old.

Research Instrument

The COVID-19 Anxiety Scale, designed and developed by Lee et al. (2020), was

used to assess or identify individuals who may have abnormal levels of anxiety related

21
to the COVID-19 pandemic. This scale, which contains 5 items that reflect common

anxiety symptoms, was originally developed to examine anxiety in 775 adults in the

United States over COVID-19. On a 5-point Likert-type scale, nurses who took part in

the study indicated the frequency of symptoms they experienced (0 [not at all] to 4

[nearly every day]). With an internal consistency of 0.93 in a previous study (Lee et al.,

2020) and a Cronbach's alpha of 0.87 in this study, the scale had excellent predictive

validity and reliability.

Research Procedure

The data of this study will be gathered from the respondents of Surigao Del Norte

specifically in Caraga Regional Hospital through online via Google forms or printed

survey questionnaires. Before gathering the data, the researchers will seek an approval

from the College of Nursing and Allied Sciences and will communicate with the

administration of Caraga Regional Hospital for the said data collection. By then, upon

obtaining the master lists of the nurses in Caraga Regional Hospital aging from 25-59

years old from the administration, the researchers will then proceed in distributing the

survey questionnaires and Google forms that will voluntarily participate in the study. The

respondents can either choose to answer the questionnaire in printed-out forms or

through online survey questionnaire via Google Forms. The said qualified nurse are at

least 25-59 years old, from Caraga Regional Hospital. The research will exclude the

vulnerable individuals who belonged to the said group (25-59 years).

In the online survey questionnaire, Informed consent and agreement will be

emphasized survey questionnaires. In the informed consent, it will be mentioned that

the respondents have the right to refuse in answering the survey questionnaire if the

22
respondents are uncomfortable with it. The respondents are also free whether to put

their name initials or not but are required to put their age and gender. All the information

will be gathered will be strictly confidential and will be used academically only.

Afterwards, the researchers conducted the data collection through the

participant’s personal preference, either through online via Google forms or print outs. If

the respondent will choose to answer the printed-out questions personally, the

researchers observed and maintained the precautionary safety measures such as

wearing of face masks and face shields and observing proper social distancing. The

assessment tool or research instrument will be in English language.

Data Analysis

The data will be quantified using means, frequencies, and standard deviations

(SDs). Student's t-test, Pearson correlation coefficient, and analysis of variance will

used to correlate nurse variables and key study variables to COVID-19 anxiety. To

identify potential predictors of COVID-19 anxiety, variables that correlated significantly

with the dependent variable were entered into the regression model (enter method). If

the p-value for a statistical test was less than 0.05, the data will be considered

statistically significant. SPSS Statistics software for Windows 22 was used to analyze

the data.

Ethical Consideration

In conducting a research study, the researchers must ensure that the research is

ethical. Ethical considerations are necessary to ensure confidentiality, privacy and

safety of the respondents. During the research process, the researchers will ask the
23
respondents about their consent just to make sure that compliance to the survey is

voluntary. The researchers will inform the respondents about the purpose of the study

and why is the study beneficial for both the researchers and respondents. The

researchers will make sure that they will be the first to know the final result of the

research study. The informed consent is attached together with the survey

questionnaire, to ensure that the respondents will answer the survey with their full

knowledge. The researchers will introduced themselves in a humble manner and

discuss with the respondents the goal of this study and why this study should will be

conducted. As written in the informed consent, the respondents have the right to refuse

and withdraw from answering the survey questionnaire at any time.

All the data gathered from the respondents will be kept confidential and only the

researchers can access it, and it will only be used for study purposes. After the data will

be interpreted, all the survey questionnaires will be deleted to achieve optimum

confidentiality.

Beneficence

Right to freedom from harm and discomfort. Every respondent has the right to

refuse to participate in the research study or even answering the survey questionnaires.

Every respondent is allowed to express their feelings while reading the survey

questionnaires and the researchers will make sure that no respondents will be harmed

during their participation. The researchers will maintain a cool and comfortable

environment to make that the respondent are not frightened or have a feeling of doubt.

All the respondents concern will be answered by the researchers and in an informative

and humble way. The respondents are also allowed to answer the survey

24
questionnaires in their most convenient time, since the researchers considers the time

schedule of the nurses/respondents.

Right to Protection from Exploitation. The researchers will inform the respondents

in advance, all the whereabouts of the research study in order for them to know and not

put them in situations that will make them unprepared and cause confusion. Informed

consent will be provided beforehand, in order for the respondents think twice if they are

willing to participate or not, they will not be forced and the researchers will not take

advantage with their decisions. If the respondents decided to not participate in the

study, the researchers will understand and accept it wholeheartedly.

Respect for Human Dignity.

Right to self determination. The researchers considered all the respondents as

independent body that can make right and justifiable decisions. The respondents have

the right to decide whether to participate in the study or not and they will not be forced in

any ways. Information that the respondents don’t want to share or reveal will be

respected and ask no question about it. No rewards or compensation will be expected

to those respondents who will participate or will participate in the study. Expect the there

will be no harm, threats and penalties to those respondents who refused to participate in

the study. All sorts of questions about the research study will be entertained and

answered and expect that understanding and respect to ones decisions will be

observed and followed. The respondents also have the right to withdraw from the study

even if the respondent is already in the middle of answering the survey questionnaire.

Coercion. The researchers will not impose any kinds of threats to the

respondents if he or she will not agree and participate. The researchers are fully aware

25
that the study will not succeed if it was done in violence and putting respondents into

disadvantageous situations.

Right to Full Disclosure. The researchers will provide the respondents all the

information they will need to know about the research study. The respondent will know

about the purpose of the study, why there is a need to conduct this study, who will

benefit the study and all the research risks. The researchers will not gather any

information without the respondent’s knowledge and awareness. The researchers will

ensure that all the necessary information about the research study will not be hidden

and the researchers will not do any actions without the respondent’s consent.

Justice

Right to Fair Treatment. The researchers will treat all the respondents as fairly as

possible. The researchers will not give extra credits for those respondents who did

participate in the study. Instead, even other participants who did not participate, the

researchers will treat them with the outmost respect and understanding. Every

respondent will be given the same informed consent and survey questionnaires in order

to achieve fairness.

Right to Privacy. The researchers will ensure that all the data that the

respondents shared will be kept confidential, only the researchers will know about the

data and no one except the researcher will be able to access the information. The

respondents will have the survey questionnaire with correlation to their job. The

respondents will not be questioned about other information that is against to them.

Survey questionnaires might have to print or have it online such as Google forms and it

will depend on the respondent’s convenience.

26
Scope and Delimitation

The study will be used to determine the level of anxiety caused by covid-19

pandemic to the nurses in Surigao City. Also, this was utilized to determine the level of

the nurses among the variables. The participants are the nurses working in Caraga

Regional Hospital and have signed the provided consent. The study included the 190

respondents only from Caraga Regional Hospital, specifically the nurses who are

working during this pandemic.

Also, the study provides evidence important for nursing administrators to assist

nurses during this pandemic, where so a few limitations were identified. The study just

involved nurses from one specific city and hospital in Surigao, the results will not be

generalized to the nurses throughout the country. Thus, this study is conducted with

limited financial resources, time framework, and actions due to the current pandemic.

The study restricted the generalization of the findings and the causal interpretation of

the variables.

27
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Hamirani, F. M. (2020). Evaluation of Knowledge, Practices, Attitude and Anxiety

of Pakistans Nurses towards COVID-19 during the Current Outbreak in Pakistan.

medRxiv. Ahead of Print https://doi.org/10.1101/2020.06.05.20123703

Baduge, M. S. P., Morphet, J., & Moss, C. (2018). Emergency nurses' and department

preparedness for an ebola outbreak: A (narrative) literature review. International

Emergency Nursing, 38, 41-49.

Cooper, A. L., Brown, J. A., Rees, C. S., & Leslie, G. D. (2020). Nurse resilience: A

concept analysis. International Journal of Mental Health Nursing.

Catton, H. (2020). Global challenges in health and health care for nurses and midwives

everywhere. International Nursing Review, 67(1), 4-6.

Davey, Z., Henshall, C., & Jackson, D. The value of nurse mentoring relationships:

Lessons learnt from a workbased resilience enhancement programme for nurses

working in the forensic setting. International Journal of Mental Health

Nursing. Ahead of Print https://doi.org/10.1111/inm.12739.

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Department of Health (2020). UPDATES ON NOVEL CORONAVIRUS DISEASE

(COVID19) Retreived from: https://www.doh.gov.ph/2019-nCoV

R: Rohrer M, Flahault A, Stoffel M. Peaks of fine particulate matter may modulate the

spreading and virulence of COVID-19. Earth Syst Environ. 2020;4:1–8.

Mistry, S.K., Ali, A.R.M.M., Akther, F. et al. Exploring fear of COVID-19 and its

correlates among older adults in Bangladesh. Global Health 17, 47 (2021).

Kvaal K, Ulstein I, Nordhus IH, Engedal K. The Spielberger State-Trait Anxiety Inventory

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Geriatr Psychiatry. 2005;20:629–34. [PubMed] [Google Scholar]

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Henshall, C., Davey, Z., & Jackson, D. (2020). The implementation and evaluation of a

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Higazee, M. Z. A., Rayan, A., & Khalil, M. (2016). Relationship between job stressors

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Jung, H., Jung, S. Y., Lee, M. H., & Kim, M. S. (2020). Assessing the Presence of

PostTraumatic Stress and Turnover Intention Among Nurses Post–Middle East

Respiratory Syndrome Outbreak: The Importance of Supervisor Support.

Workplace health & safety, Ahead of print

https://doi.org/10.1177%2F2165079919897693

Kester, K., & Wei, H. (2018). Building nurse resilience. Nursing management, 49(6), 42-

45. Kaveh, M., Davari-tanha, F., Varaei, S., Shirali, E., Shokouhi, N., Nazemi,

P., ... & Ashraf, M. A. (2020). Anxiety levels among Iranian health care workers

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Labrague, L. J., & McEnroePetitte, D. M. (2018a). Job stress in new nurses during the

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Labrague, L. J., Hammad, K., Gloe, D. S., McEnroePetitte, D. M., Fronda, D. C.,

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30
 APPENDIX A

COLLEGE OF NURSING

Date:
Dear Dr. Judith D. Ismael RN, MN, DODT:

Greetings of Peace!

We, the level III students at Cebu Institute of Technology – University College of
Nursing and Allied Health Sciences, are conducting a research study entitled “Level of
Anxiety Caused by Covid-19 Pandemic to the Nurses in Surigao City”. The purpose of
this study is to measure the level of anxiety caused by Covid-19 pandemic to the nurses
in Surigao City. The gathering of data will take place in one of the hospitals in Surigao
City, Caraga Regional Hospital that will probably last for 1 month. The researchers will
collect the data from nurses that are on the age between 25-59, working individuals.
The researchers aim to know the reaction of nurses in Surigao City and know their ways
on how they coped up with all the possible stressors surrounding them and how did they
manage to still stand and well balanced in this time of pandemic. The study will attain
the needs of the nurses and implement the necessary and helpful interventions that will
know and recognize the needs of the nurses physically, psychologically and various
aspects. With this, we would like to ask permission from your good office to allow us to
distribute online survey questionnaires via Google Forms or printed-out instrument to
the chosen hospital in Surigao City, Caraga Regional Hospital. These are published
questionnaires that can be answered in 20 minutes. We are estimating that we will be
collecting data for no longer than two weeks. 

31
We assure you that we will uphold our research ethics of confidentiality upon
holding this information. 

Thank you very much and God bless.

Respectfully yours,

Cris Cyrus C. Chato Hara Mil U. Silvosa Michelle V. Sunico

Researcher Researcher Researcher

Noted by:

Auda F. Russel RN, MN, DScN

Research Adviser

Cyrille Y. Panimdim, RN, MAN

Research Coordinator

32
 APPENDIX A

COLLEGE OF NURSING

Date:
Dear Mrs. Zandra S. Cadavis, RN;

Greetings of Peace!

We, the level III students at Cebu Institute of Technology – University College of
Nursing and Allied Health Sciences, are conducting a research study entitled “Level of
Anxiety Caused by Covid-19 Pandemic to the Nurses in Surigao City”. The purpose of
this study is to measure the level of anxiety caused by Covid-19 pandemic to the nurses
in Surigao City. The gathering of data will take place in one of the hospitals in Surigao
City, Caraga Regional Hospital that will probably last for 1 month. The researchers will
collect the data from nurses that are on the age between 25-59, working individuals.
The researchers aim to know the reaction of nurses in Surigao City and know their ways
on how they coped up with all the possible stressors surrounding them and how did they
manage to still stand and well balanced in this time of pandemic. The study will attain
the needs of the nurses and implement the necessary and helpful interventions that will
know and recognize the needs of the nurses physically, psychologically and various
aspects. With this, we would like to ask permission from your good office to allow us to
distribute online survey questionnaires via Google Forms or printed-out instrument to
the chosen hospital in Surigao City, Caraga Regional Hospital. These are published
questionnaires that can be answered in 20 minutes. We are estimating that we will be
collecting data for no longer than two weeks. 

33
We assure you that we will uphold our research ethics of confidentiality upon
holding this information. 

Thank you very much and God bless.

Respectfully yours,

Cris Cyrus C. Chato Hara Mil U. Silvosa Michelle V. Sunico

Researcher Researcher Researcher

Noted by:

Auda F. Russel RN, MN, DScN

Research Adviser

Cyrille Y. Panimdim, RN, MAN

Research Coordinator

Dr, Judith D. Ismael

Dean, College of Nursing

34
 APPENDIX B

COLLEGE OF NURSING

CURRICULUM VITAE

PERSONAL DATA

Name: Cris Cyrus C. Chato

Gender: Male

Age: 20 years old

City Address: P-10 Consalviben, Salvacion, Bayugan City

Permanent Address: P-10 Consalviben, Salvacion,

Bayugan City

Email Address: cyruschato132@gmail.com

35
Contact Number: 09508247151

Date of Birth: November 08, 2000

Civil Status: Single

Religion: Roman Catholic

Educational Attainment: Third Year College Level

Elementary: Placer Elementary School (2007-2013)

High school: Placer National High School (2013-2017)

Senior High School: Caraga Regional Science High School (2017-2019)

College: Cebu Institute of Technology-University (2019-present)

PERSONAL DATA

Name: Hara Mil U. Silvosa

Gender: Female

Age: 21 years old

City Address: Surigao City, Surigao Del Norte

Permanent Address: Suigao City, Surigao Del Norte

Email Address: heyrasilvosa@gmail.com

Contact Number: 09667622982

Date of Birth: August 19, 2000

Civil Status: Single

Religion: Roman Catholic

Educational Attainment: Third Year College Level

Elementary: Surigao Education Center (2007-2013)

36
 High school: Caraga Regional Science High School (2013-2017)

Senior High School: Caraga Regional Science High School (2017-2019)

College: Cebu Doctor’s University (2019)

Cebu Institute of Technology-University (2019-present)

PERSONAL DATA

Name: Michelle V. Sunico

Gender: Female

Age: 20 years old

City Address: Brgy. Rizal, Surigao City, Surigao Del

Norte

Permanent Address: Brgy. Rizal, Surigao City,

Surigao Del Norte

Email Address: mchllsnc@gmail.com

Contact Number: 09129007046

Date of Birth: September 29, 2001

Civil Status: Single

Religion: Pentecostal

Educational Attainment: Third Year College Level

37
 Elementary: B. Vasquez Memorial Central Elementary School (2007-2013)

High school: Caraga Regional Science High School (2013-2017)

Senior High School: Caraga Regional Science High School (2017-2019)

College: Cebu Institute of Technology-University (2019-present)

DOCUMENTATION

38