1

INTRODUCTION

Background of the study

Healthcare workers are at the front line of any outbreak response and as such their work

expose them to various forms of hazards. These hazards include pathogen exposure, long

working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and

psychological violence. Healthcare workers in the Philippines often suffer from the abuse that

comes from stigma (Reuters, 2020).

The worldwide spread of COVID-19 had been characterized as a pandemic, which did

not only bring about a high mortality rate, but also caused psychological stress to the patients,

family members and health care workers (Xiao, 2020). Such uncertainty and unpredictability of

pandemic outbreak of infectious disease from its clinical presentation, infectious causes,

epidemiological features, fast transmission pattern, seriousness of public health impact, novelty,

scale, implication for international public health, and underprepared health facilities to address

the pandemic outbreak of COVID-19 have considerably high potential for psychological fear of

contagion. The pandemic resulted to a multitude of psychological problems such as fear, anxiety,

stigma, prejudice, marginalization towards the disease and its relation of all people ranging from

healthy to at-risk individuals to care-workers (Mak et al., 2009 as cited in Rana, Mukhtar, &

Mukhta, 2020). Moreover, large numbers of healthcare workers have acquired coronavirus

disease (COVID-19) in the workplace (Wang, Hu, Hu, 2020).

The Department of Health (DOH) in the Philippines reported that as of 3 December 2020,

the total number of cases have reached 435,413, with 27,642 active cases, 399,325 have
 2

recovered, while 8,466 have died. The incidence of the COVID-19 in the Philippines have made

a toll on the local healthcare workers.

Discrimination against healthcare workers who have been infected with COVID-19 have

been reported in the media. Chuck Estrella of the Riverside Medical Center Inc. mentioned that

after the news broke out about the first person to test positive for COVID-19 in Bacolod City,

people were treating healthcare workers differently. Some of these health care workers were

being denied a ride in pedicabs or jeepneys because they work in a hospital facility, while others

are being denied of entry at small offices while others were verbally attacked by policeman

according to a local daily (Gomez, 2020). Reports included healthcare workers being asked to

vacate the places they were renting. Rayfrando Diaz, a ranking official of Negros Occidental,

appealed to people to stop treating healthcare workers like the dreaded COVID-19 disease from

which they are trying to save lives at the risk of their own. Diaz said that people must instead

support those healthcare workers of the fight against COVID-19. “Please let us not fight them.

Instead, we need to show our all-out support for these people. We need to support each other in

this time of crisis,” (Gomez, 2020).

The World Health Organization (WHO) reported that the nursing staff and other

healthcare professionals are working around the clock. According to Dr Takeshi Kasai (2020) of

the WHO, “right now, nurses [and other healthcare workers] are on the front lines of the

COVID-19 fight, working tirelessly to save lives and protect others in their community”.

Governments across the Western Pacific Region must invest in strengthening their nursing

workforce, physically and psychologically, as an essential part of preparedness for health

challenges.
 3

The physical and psychological pressures and the potential of overwhelming burden on

healthcare workers continue to intensify. Gathering helpful data that could elevate the healthcare

workers who painstakingly work for the society have been one of the motivations to create this

study. Assisting them in any way possible could lessen their burden that my help with recovering

of our society as a whole and a great cause. And a reminder that there are lives spent to stop the

escalation of virus but not without sacrifice of healthcare workers.

Benefits to various fields in psychology are also part of the reason to conduct this study.

Information from this study may contribute to human resource management in the healthcare

facilities. Policies and protocols in the workforce management may be derived from this study.

Increasing paid leave, 24/7 access to healthcare professionals, and instituting a hazard pay are

just some possible measures to help healthcare workers. This study may be helpful in

determining the observance of workplace safety protocols. Supporting health and wellness it’s

important to remember that employees are people.

Concerns in counseling and clinical psychology may also be addressed through this

study. Prevention of the onset or relapse of a physical or mental illness among healthcare

workers are considered. Hopefully, measures that lead to improvement to healthcare workers’

resilience, cognitions, self-esteem, relationships, and inner peace may be obtained through this

study.

Statement of the Problem

This study aims explore the experiences of healthcare workers involved in the treatment of

COVID-19-positive patients.
 4

Theoretical Framework

Philosophical Paradigm

This study is guided by the Constructivist paradigm. Guba & Lincoln (1989 as cited in

Kamal, 2019) describe the constructivist paradigm as realities that are multiple. Bunnis & Kelly,

(2010 as cited in Kamal, 2019) further expounds that “the ultimate truth has been regarded as not

existing and reality is subjective and changing”. According to Cresswell (2014) constructivism

deals with the development of subjective meanings and understandings of one’s personal

experiences concerning specific topics based on their social and historical background. Hein

(2007 as cited in Mogashoa, 2014) mentions that constructivism refers to the idea that

individuals construct knowledge for themselves, each learner individually and socially constructs

meaning- as he or she learns. Relative to this study, each healthcare worker involvement in the

treatment of COVID-19-positive patient differ from one another. Each has his own explanation

and response to the involvement in the treatment of COVID-19-positive patient which largely

determine the course of his own pandemic journey.

Furthermore, constructivist research do not generally begin a study with a theory rather

they "generate or inductively develop a theory or pattern of meanings" (Creswell, 2003 as cited

in Adom, Yeboah & Ankrah, 2016) throughout the research process. Thus, the healthcare

workers involvement in the treatment of COVID-19 patient may be describe by exploring and

interpreting individual stories through their own distinctive and personal perspective. How the

participants bring meaning and associate their experience into their lives could be best expound

the occurrences to the healthcare workers involvement in the treatment of COVID-19-positive

patient.
 5

Scope and Limitation

The participants of the study will be healthcare workers who are involved in the treatment

of COVID-19-positive patients. Healthcare workers who are most commonly involved with these

patients are medical doctors, nurses, and medical technologists. They may be in public or private

health facilities. The participants might be opt to be interviewed face-to-face or through online

applications such as, Facebook Messenger, Skype, FaceTime, Zoom or other types in

consideration of health concerns due to the pandemic. Those who choose for the face-to-face

interview will have a preparatory schedule and location for the interview were determined ahead

of time for the convenience of both the participant and the researcher. During the interview,

safety protocols for corona virus were implemented such as the use of personal protective

equipment (face mask, face shield) for both the researcher and participant.

Significance of the Study

This study about healthcare workers who handle positive COVID patient may be of help

to the following:

Healthcare Workers. This study may help healthcare workers as they engage the cases

of COVID-19 here in Negros Occidental. Healthcare workers are at the front line of any outbreak

response and as such are exposed to hazards that put them at risk of infection with an outbreak

pathogen (in this case COVID-19). Hazards include pathogen exposure, long working hours,

psychological distress, fatigue, occupational burnout, stigma, and physical and psychological

violence.

Mental Health Professionals. This study may help through the procurement of data

about mental health issues of healthcare workers working on positive COVID-19 patients.
 6

Information derived from this study may used to help healthcare workers and others which have

similar situation. The study may contribute to the understanding of mental health issues

occurring during pandemic, and may also provide assessments for feasible upcoming mental

health issues our healthcare worker will exhibit. In likelihood, the research may be used for

consultation regarding possible diagnostic/intervention and consideration. Through this research

study, it may empower individuals to accomplish positive mental health.

Human Resource Management. This study may assist the demanding conditions of

human resource (HR) units, in the context of dramatic changes around the world due to the

pandemic, organisations need to respond and adapt to the alterations and accordingly manage the

workforce (Carnevale & Hatak, 2020). Input of this study might help HR management in the

healthcare facilities. Policies and protocols in the workforce management may be derived from

this study. Increasing paid leave for workers, waiving COVID-19 testing and treatment, 24/7

access to healthcare professional, hazard pay. Workplace safety protocol the data in the study is

helpful through information that could update it. Supporting health and wellness it’s important to

remember that employees are people.

Government. This study hopes to assist the government to obtain reliable data regarding

health workers during pandemic. It may be of service to the benefits of health workers of

continuing their work throughout their services. It may source reliable information on the risk,

severity, and progression of a pandemic and the effectiveness of interventions. While all sectors

of society are involved in pandemic preparedness and response, the national government is the

natural leader for overall coordination and communication efforts. Gaining insight on the

resources for national pandemic preparedness, capacity development, and response measures,

this study may contribute to the government’s responses to the pandemic.

 7

Academe. The results of this study may provide information that may be used as part of

knowledge generation in the academe. Findings of this study may be a source for evidence-based

information that may used for teaching purposes. Informative, educational and communication

(IEC) materials may be developed using the findings of this study.

Future Researchers. This study may be used as a source material for future researchers

who would like to embark on the study of attitude and belief of healthcare works during

pandemic. One can hope that with continued research that healthcare workers during pandemic

that their efforts and work would be recognize with the prevention of tragic loss of human life

with the virus.

Definition of Terms

For better understanding, the following terms are defined conceptually and as they are

used in this study.

Healthcare Workers – Conceptually, it is define as a worker directly involved in COVID-19

prevention and treatment and having direct contact with confirmed or suspected cases through

patient intake, screening, inspection, testing, transport, treatment, nursing, specimen collection,

pathogen detection, pathologic examination, or pathologic anatomy of medical and healthcare

professional and technical personnel (Zhang, Zhou, Tang, Wang, Nie, Zhang, You, 2020). In this

study, this refers to the participants of the study, and may include any of the following:

Medical Doctor – Conceptually, this term is define as people who diagnose, treat and

prevent illness, disease, injury, and other physical and mental impairments and maintain

general health in humans through application of the principles and procedures of modern
 8

medicine. They plan, supervise and evaluate the implementation of care and treatment

plans by other health care providers. They do not limit their practice to certain disease

categories or methods of treatment, and may assume responsibility for the provision of

continuing and comprehensive medical care to individuals, families and communities

(ISCO, 2008 as cited in International Labour Organization (ILO), 2012).

Nurse – Conceptually, this term is define as people who provide treatment, support and

care services for people who are in need of nursing care due to the effects of ageing,

injury, illness or other physical or mental impairment, or potential risks to health,

according to the practice and standards of modern nursing. They assume responsibility

for the planning and management of the care of patients, including the supervision of

other health care workers, working autonomously or in teams with medical doctors and

others in the practical application of preventive and curative measures in clinical and

community settings (ISCO, 2008 as cited in ILO, 2012).

Medical Technologist – Conceptually, this term is define as people who perform clinical

tests on specimens of bodily fluids and tissues in order to get information about the health

of a patient or cause of death. They test and operate equipment such as

spectrophotometers, calorimeters and flame photometers for analysis of biological

material including blood, urine and spinal fluid (ISCO, 2008 as cited in ILO, 2012).

Health-care Facility – Conceptually, this term is define by WHO as hospitals, primary health-

care center, isolation camps, burn patient units, feeding centres and others. In emergency

situations, health-care facilities are often faced with an exceptionally high number of patients,
 9

some of whom may require specific medical care (e.g. treatment of chemical poisonings). It has

the following component:

Private – Conceptually, this term is define as sectors in the direct provision of health

care, the supply of health care-related goods, and health care financing. Private sector

involvement in the provision of health care encompasses a complex range of activities

carried out by various non-state actors. These actors may include (multi)national

companies, nongovernmental organizations, and nonprofit entities (Wolf & Toebes,

2016).

In this study, it is defined as a workplace of the participant.

Public – Conceptually, this term is define by Law Insider (2020) as one or more

buildings, structures, additions, extensions, improvements, or other facilities, whether or

not located on the same site or sites, machinery, equipment, furnishings or other real or

personal property suitable for providing public health services; and includes, without

limitation, local public health departments or centers; public health clinics and outpatient

facilities.

In this study, it is defined as a workplace of the participant.

 10

Review of Related Literature

The review includes the body of research literature, which is related to this study’s

research problem, and objectives. They are presented using the thematic approach.

Experiences of Being a Healthcare Worker in a Pandemic

The escalation of COVID-19 infection among healthcare workers in the country is

rampant and as the passage of time the increasing and decreasing of the overall confirmed cases

have been change from the start of the outspread of the virus until as of this writing. Numerous

actions have been engage to the process of what the product of healthcare workers experience

with dealing with the virus. Around 2,067 Filipino health workers have been diagnosed with

COVID-19, leading to 35 deaths (Baticulon, 2020). Healthcare workers bear a much greater risk

of exposure to COVID-19, with 15% of all coronavirus cases in the Philippines being hospital or

health care workers as of DOH’s latest tally in June as of this writing. The World Health

Organization has already expressed concern over the Philippines’ infection rate, which is among

the highest worldwide, approaching that of Wuhan’s at the start of the pandemic. The numbers

do not account for Filipino health workers who have died from COVID-19 overseas. The fact is

healthcare workforce plays a central role in the diagnoses and treatment of patients of COVID-

19. The shortage in healthcare worker is bound to hamper any country response to the current

pandemic. The malfunctioning operations of healthcare workers will result in uncontrolled

disease transmission within healthcare facilities eventually leads to outbreaks in the community,

which would be more difficult to contain and would affect a higher percentage of the vulnerable

population.
 11

One of the question is why have so many Filipino healthcare workers been infected by

COVID-19? While the Department of Health’s official data have shown a decrease in the

number of new infections among Filipino healthcare workers, it remains unclear how many of

them acquired COVID-19 from the workplace and needs further studies to pinpoint the cause and

stop further damage to our healthcare worker. Some argue that the higher numbers are due to the

preferential testing of health workers in the country. One other reasons is that it is plausible,

dangerously deflects from the root causes of the problem, which are lack of personal protective

equipment (PPE) and failure to adhere to infection control measures in the workplace. This has

been consistently shown in studies that looked at health personnel infected with SARS in Hong

Kong and Singapore, and COVID-19 in Wuhan. The first arrival of the virus to the country

shows the awareness of the people are lacking and to how the virus behaves, strict rules on

wearing personal protective equipment (PPE) during patient encounters had not yet been

implented in places in most health facilities. The Philippines’ limited testing capacity and failure

to perform meticulous contact tracing had also prevented early identification and isolation of

cases. Any combination of these factors would have resulted in occupational exposure among

our healthcare workers early on.

Even with those factors the jobs of healthcare workers in the Philippines are badly

struggling within a strained healthcare system as they battle both rising Covid-19 infections, as

well as face abuse from the community they seek to protect. Antiquera (2020), president of the

Philippines Alliance of Young Nurse Leaders and Advocates (AYNLA) told the Globe a digital

media resource that the staff’s are suffering as a result of stigma surrounding the novel

coronavirus, including assaults, home evictions and denial of access to basic services. “There are

reports that nurses and other health care workers are being physically attacked and harassed and
 12

having chemicals thrown on them such as bleach and chlorine,” he said. The backlash against

healthcare workers all this while working long hours for little pay with the average monthly

nurse salary in the Philippines roughly $300, and the low-end of the nurse-patient ratio 12.6

nurses per 10,000 people. In rural areas, that falls to 4.2.

In the duration of the COVID-19 tensions run high, the virus itself, and a critical lack of

personal protective equipment (PPE), continues to present a clear danger to those on the

healthcare workers. It also falls to the government hands the responsibilities of protection among

healthcare workers protecting them from the discrimination and protecting them from the virus.

Healthcare workers are the backbone of our healthcare system, many will be compelled to either

quit or risk their lives. Perpetuation of harassment of our healthcare workers will result more of

them quitting their jobs, and our healthcare system will collapse, once it collapses, more people

will suffer. The discrimination of healthcare workers prompted statement from Department of

Health (DOH) stated that “These acts cannot be tolerated.” It also sought to assure the public that

it should not worry about becoming infected from workers, saying, “As medical professionals,

our health care workers are taking extra precautions to ensure infection prevention and control.”

An online survey brought together with other volunteers and Sonny Afable (2020) of the

UP Population Institute and behalf of the Alliance of Health Workers and the Alliance of

Concerned Teachers conducted for the survey of health workers from April to May 2020 in order

to better recognize and understand the circumstances of healthcare workers who are at the

frontline fighting this pandemic. From the same research resulted that out of 457 respondents,

more than half reported that their health facilities do not meet even 50% of what they recognized

as sufficient number of health personnel and the appropriate number of infection, prevention and

control (IPC) supplies and personal protective equipment (PPE). About two-thirds of the
 13

respondents believe there is severe lack of doctors, nurses and nurse assistants as well as

administration and utility personnel in their health facilities. Surprisingly bigger percentage of

respondents indicates that there is a critical absence of counselors, therapist as well as midwives.

Across all types of medical frontliners, less than 10% of the respondents believe there is ample

or near sufficient number of personnel.

As the number of health workers who tested positive for the coronavirus rose to 5,008,

with majority of infections seen among nurses and physicians a story from Rappler. The

Philippines’ Department of Health (DOH) said on August that 4,576 of the 5,008 cases, as of

August, had recovered, while 38 died due to the disease. During the pandemic, health workers

who are severely infected with COVID-19 are supposed to receive P100,000 each, while the

families of those who died from the coronavirus should get P1 million each. This was included in

the Bayanihan law that expired last June 25.

The worsening of the situations which intensify the risk faced by medical frontliners,

along with their profession many of them also work excessively long hours while earning very

little pay (Quintos, 2020). The circumstances brought by high-risk and high stress conditions

confronted by the frontline healthcare workers in the Philippines aggravated the situation

combine with insufficient personnel and protective equipment are surely contributing element to

the high rate of COVID-19 infection among healthcare workers (Quintos, 2020). At least 2,366

health workers in the Philippines have already been infected by the SARS-CoV-2 virus or close

to one out of every five confirmed cases of COVID-19 in the country (Rey, 2020) as of May

2020. Indeed, the WHO expressed its alarm over the high number of healthcare workers infected

with SARS-CoV-2 in the Philippines. At 17.4% of total cases May 2020, the rate of infection

among frontline health workers in the Philippines is by far the highest among 37 member states
 14

in the WHO-Western Pacific Region including China— the ground zero of the COVID-19

pandemic.

As the progression of the virus more nurses and doctors might resign out of fear of

acquiring the novel coronavirus disease if the government would continue to ignore healthcare

workers’ concerns. From an article from Inquirer a statement from The Alliance of Healthcare

Workers (AHW) (2020) reports that nurses in the Southern Philippines Medical Center (SPMC)

have resigned out of fear from the COVID-19 pandemic might be replicated because health

authorities allegedly fail to address the still-rising number of COVID-19-infected healthcare

workers.“We fear that more fellow health workers will be resigning, not only from SPMC but to

various hospitals across the country since they do not yet feel concrete and comprehensive

measures of containment from the deadly virus in the country which will jeopardize their health

and lives,” AHW president Mendoza (2020) said in a statement. As the responsibilities from the

government slip up most of the healthcare workers blame on the government lacking and

inadequate in their response to the crisis that our country is facing. According to the World

Health Organization, healthcare workers may become targets of violence during disaster and

conflict situations. As many as 38 percent of healthcare workers are likely to experience violence

at one point in their professional life, with nurses and those involved in direct patient care most

at risk. Antiquera (2020), president of Alliance of Young Nurse Leaders and Advocates said

“Healthcare workers are exhausted and frustrated by the lack of support from the government in

providing them even basic protective gear. If we do not put a stop to this harassment, nurses may

resign.” During this global health crisis, we must not forget that health workers are people with

their own families and loved ones. They are individuals who have been reminded of their sworn

duty to serve when everybody else had been ordered to stay home. Entire hospitals can be built
 15

in a matter of weeks, but training a health worker takes years of commitment and sacrifice. If we

truly believe that health workers are heroes, applause will never be enough. Let us act, and not

just watch them die at the frontlines.

Mental health of healthcare workers

Recent study by Shaukat, Ali & Razzak, (2020) mention five articles discussed mental

health impact on healthcare providers. In one study, out of 230 healthcare workers who

responded to the mental health assessment scales, 23% had psychosocial problems. Among these

53 medical staff, more females 90% than males 9.43%, and more nurses 81% than physicians

18% suffered from mental health issues due to the infectious outbreak (Huang, Han, Luo, Ren ,

Zhou, 2020). The mental health impact of a disease outbreak is usually neglected during

pandemic management although the consequences are costly (Naser, Dahmash, Al-Rousan,

Alwafi, Alrawashdeh, Ghoul, Abidine, Bokhary, HT AL-H, Ali. 2020). According to Eric Wei

(2020), senior vice president New York City Health and Hospitals Corporation, says many health

care workers were running on adrenaline during the surge in the city. “I think it was very scary to

everyone,” he says. “And no matter how resilient you are, this was going to take a huge

emotional and psychological toll for people.” He also added COVID-19’s many unknowns have

further added to the stress, with a percentage of patients rapidly deteriorating regardless of the

medical interventions used. “I feel like that was something that was incredibly traumatizing to

our providers, our frontline workers—this hopelessness,” (Wei, 2020).

In a study done by Wasim, Raana, Bushra & Riaz (2020) to healthcare workers who

workers in tertiary hospital suggested that there were symptoms of depression in 62%, anxiety in

64%, stress in 55% and insomnia in 53.37% of participants. A recent review has suggested
 16

anxiety being the commonest disorder with sleep disorder (Rajkumar, 2020) among healthcare

worker. Early evidence has shown that health workers directly involved in the diagnosis,

treatment, and care of patients with COVID-19 are at risk of developing mental health symptoms

(Lai, Ma, Wang, Cai, Hu, Wei, Wu, Du, Chen, Li, 2020). Similar adverse psychological

reactions were reported among health care workers in previous studies during the 2003 Severe

Acute Respiratory Syndrome (SARS) outbreak (Bai, Lin, Lin, Chen, Chue, Chou, 2004).

Due to the exponential increase in the demand for healthcare, they face long work shifts,

often with few resources and precarious infrastructure (Shigemura, Ursano, Morganstein,

Kurosawa, Benedek, 2020). Also, there is the fear of autoinoculation, as well as the concern

about the possibility of spreading the virus to their families, friends or colleagues (Kang, Li, Hu,

Chen, Yang, Yang, et al., 2020). This can lead them to isolate themselves from their family

nuclear or extended, change their routine and narrow down their social support network (Huang,

Han, Luo, Ren, Zhou, 2020). These factors can result in different levels of psychological

pressure, which may trigger feelings of loneliness and helplessness, or a series of dysphoric

emotional states, such as stress, irritability, physical and mental fatigue, and despair (Huang,

Han, Luo, Ren, Zhou, 2020). The work overload and the symptoms related to stress make health

professionals especially vulnerable to psychological suffering (Kang, Li, Hu, Chen, Yang, Yang,

et al., 2020), which increases the chance of developing psychiatric disorders (Malta, Rimoin,

Strathdee, 2020).

According to WHO guidelines for mental health of healthcare workers, certain coping

strategies such as sufficient rest, balanced and healthy diet, physical activities, keeping in contact

with friends and family members through digital media and decreasing the screen time on social

media help to decrease the stress at personal level (WHO,2020).

 17

Healthcare workers are also people and have the same fears as everyone else, General

Medical Council recognize that ‘that personal beliefs and cultural practices are central to the

lives of doctors [and] that all doctors have personal values that affect their day-to-day practice’

and does not ‘wish to prevent doctors from practicing in line with their beliefs and values’

(Horden, 2016). Understanding how the profile of the participants perceive COVID-19, and

adopt specific behaviors in response to it, is key to enable healthcare workers to develop

intervention strategies to maintain and respond to mental and physical health problems

occurring.

Healthcare workers

Professions that involve human contact and rapid decision-making skills, while those

decisions can have a serious (financial, social or other) impact, are among the most stressful ones

(Cooper, 1988 as cited in Koinis et al., 2015). Healthcare professions are among the first six

most stressful ones (Cooper, 1988 as cited in Koinis et al., 2015). Professionalization includes a

series of attitudes which represent levels of individuals' identification with, recognition by and

commitment to a particular occupation (Shohani & Zamanzadeh, 2017). More professional and

occupational experience is often acquired through the adoption and reinforcement of professional

role model attitudes and behavior (Castledine, 1998 as cited in Shohani & Zamanzadeh, 2017).

As a factor that determines behaviors, attitude consists of a relatively constant manner of

thinking, feeling and behaving towards different individuals, groups and social issues or at a

broader level, to any event that takes place in an individual's environment (Karimi, 2005 as cited

in Shohani & Zamanzadeh, 2017).

Healthcare workers and volunteers working in the field may also become

stigmatized, leading to higher rates of distress, stress, and burnout Fear of COVID-19 directly
 18

correlates with its rapid and invisible transmission, and its morbidity and mortality. This elevated

level of fear can influence people’s rational thinking in reacting to COVID-19 (Ahorsu, Lin,

Imani, Saffari, Griffiths, Pakpour, 2020). Furthermore, a large amount of uncontrolled news is

spreading through the media, which increases the risk of disseminating fake news more rapidly

than the virus itself, causing anxiety, worries, and uncertainties that all contribute to negatives

effects, such as stigma (Dagklis, Tsakiridis, Mamopoulos, Athanasiadis, Pearson, Papazisis

2020). Joaquin Sapul, Jr, chief patient services officer and director of nursing of Medical City

Iloilo reported than when nurses messaging him, calling him that they are being evicted or being

prevented from leaving their home “We healthcare workers have always enjoyed the trust of our

community. I underestimated how hysteria could make them turn on us so quickly” (Rubrico,

2020). Social stigma (e.g., discrimination and devaluation by others) has a variety of negative

consequences that inhibit recovery, such as shame, embarrassment, and the “why try”

phenomenon (Giorgi, Arcangeli, Montes, Rapisarda, Mucci, 2019). Stigma is such a pressing

issue for the national health system, it has been identified as a health crisis that clinicians must

take action against (O’ Donnell, 2016). Healthcare worker stigmatization is associated with

psychological and physical health. Healthcare worker who expected to experience higher levels

of stigmatization reported increased psychological distress, and this predicted increased somatic

symptoms (Corrigan, Gallagher, 2015).

Stigma was also prevalent in healthcare workers in a study done by Dagklis, Tsakiridis,

Mamopoulos, Athanasiadis, Pearson, Papazisis (2020) assessing temthousand five hundred

eleven (10, 511) healthcare workers fighting against SARS, although most of them were

appreciated by the society, a considerable proportion felt social stigmatization (49%) and

exclusion by family members (31%). Moreover, 31% thought that people kept away from their
 19

family members because of their job (Koh, Lim, Chia, et al., 2005). Stigma had direct and also

indirect effects through stress on mental health in nurses fighting the Middle East respiratory

syndrome (MERS); however, the impact of stigma on their mental health was worse compared to

stress effects (Park, Lee, Park, Choi, 2018). Moreover, stigma compounds the stress levels of

healthcare staff thereby affecting job satisfaction and quality of patient care (Hernandez,

Morgan, Parshall, 2016). Stigma is associated with violence against healthcare workers: more

than 200 attacks on healthcare workers and health facilities during the ongoing pandemic were

reported by May 2020 (Bagcchi, 2020). Healthcare workers were denied access to public

transport, insulted in the street, evicted from rented apartments, and even physically assaulted

(Bagcchi, 2020).

Several measures to deal with the mental and psychological stress and stigma during the

COVID-19 response have been published by WHO, Centers for Disease Control and Prevention

(CDC), and United Nations International Children’s Fund. They recommended that for

healthcare workers: Avoidance by some members in the community can be disappointing.

Getting support from family, colleagues, and managers can help healthcare workers overcome

these feelings. Providing emotional support to affected people during different stages of

isolation/treatment can help them overcome the psychological impact of stigma if present and

give a positive example to the society (WHO, 2020)

Healthcare workers experience in health facilities

Workplace stress can influence healthcare professionals’ physical and emotional

wellbeing by curbing their efficiency and having a negative impact on their overall quality of life

(Koinis et al., 2015). Such as the coronavirus disease 2019 (COVID-19) pandemic has changed
 20

how health care is delivered and has affected the operations of healthcare facilities. WHO reports

that effects may include increases in patients seeking care for respiratory illness that could be

COVID-19, deferring and delaying non-COVID-19 care, disruptions in supply chains,

fluctuations in facilities’ occupancy, absenteeism among staff because of illness or caregiving

responsibilities, and increases in mental health concerns.

The COVID-19 epidemic is unique because of its scale, the speed of its spread, the lack

of pre-existing scientific data and the importance of media coverage (Shimizu, 2020). It

impelled the hospitals taking charge of the cases to face the many new challenges associated

with the outbreak (Heymann & Shindo, 2020). Dr. Rustico Jimenez president of the private

hospital association of the Philippines incorporated stated that private hospitals in the country

are reaching full capacity as COVID-19 cases continue to spike (Manila, 2020). “Almost all [of

the hospitals are full] because there was an increase in positive patients just like when this

started. But now the hospitals are more prepared. Now, there are [facilities] where mild cases

could be transferred that was provided by the government. Dr. Jimenez provided in a statement,

however Jimenez also admitted that it would be hard to convince patients to transfer to

government facilities.

Healthcare workers are at the forefront of the epidemic response and they must be

supported. The hospital had to call in temporary nurses to deal with COVID-19, but the epidemic

arrived in a national context where public hospitals are at the centre of a protest movement due

to, among other difficulties, the difficulty in recruiting healthcare workers and bed shortages

(Smadja et al., 2020). Healthcare workers who developed COVID-19 were managed in the

hospital if needed, or as outpatients, and were put on sick leave for at least 7 days and 2 days free

of symptoms (Smadja et al., 2020). While McCabe, et al., (2020) suggested that newly qualified
 21

and final year nursing students could fill the lacking of healthcare worker However, this group

may require close supervision from more experienced clinical staff initially. Ongoing

arrangements with private hospital providers will need to be considered. Field hospitals do not

address the key constraint of critical care nurse capacity but could provide overspill facilities for

less severe COVID-19 patients that do not require critical nursing care, or for those requiring

palliative care (McCabe, et al., 2020). Stressful Events such as COVID-19 pandemic play a

central role in the interaction between individuals and their environment. Consequently, their

effect on physical and psychosocial health is significant (Koinis, 2015).

Organizational changes affect the norms, values, attitudes and behavior patterns, which

are believed to be the core identity of an organization. Furthermore, organizational changes have

a key role that determines the working climate, strategy formulation, leadership style, and

organizational behavior of the firm (Laforet, 2016).Organizational culture can be thought of as

the attitudes, experiences, norms, beliefs and values of an organization (Summerill et al., 2010).

Organizational culture consists of shared meanings, beliefs, and values that ultimately shape

employees’ behaviors (Rashid et al., 2003 cited in Hsiao, Chang, & Tu, 2012 ). Ravasi and

Schultz (2006) cited in Hsiao, Chang, & Tu, 2012 propose that organizational culture is “a set of

shared mental assumptions that guide interpretation and action in organizations by defining

appropriate behavior for various situations”.

The Philippine like many Asian hospitals also faced restrains when it comes to physical

capacity. Dr. Carlos Gabriel emergency medicine physician and senior medical affair manager

stated that hospital's ward rooms and intensive care units are full. However, the facility will

continue to accommodate patients at their emergency room. "What we're seeing with this disease

is that people sit longer which means that the rooms are not freeing up that fast," Gabriel said
 22

(Celdran, 2020) .Regardless there is evidence that local government units (LGU) hospitals

disproportionately confront the lacking of shortage of water, medication, and mechanical

ventilators (Quintos, 2020).

Synthesis

Among the foreign literature, there are quite a number of studies on the COVID-19

pandemic. These studies included healthcare workers due to their nature of their work. They are

at the forefront in managing patients and combating the spread of the COVID-19 virus. The

healthcare workers’ mental health had been given attention especially by the WHO. The WHO

acknowledges that there will be psychological effects on these healthcare workers. Substantial

data is being recorded with regards to the social by-products of the pandemic.

However, here in the Philippines, there is a lack of research attention the mental health of

healthcare workers who are directly engaging the COVID-19-positive patients. The conditions of

the healthcare workers in the provinces are least likely to be given attention in research. There is

no study on how attitudes towards the pandemic affect healthcare workers’ behavior. The nature

of their work becomes a target for stigma yet, there is no sufficient studies made with regard to

their working conditions or their physical health. Given the foregoing observations, this study

will hopefully address the need for information about the issues on mental health of healthcare

workers in the Philippines, especially in the province.

 23

METHODS

This section describes the components of the study which relate to research methodology

such as the research design, participants, research instrument, data gathering procedure,

statistical treatment and ethical considerations.

Research Design

This study will use a descriptive-qualitative approach to explore the stories of healthcare

workers who are involved in the treatment of COVID-19-positive patients. Specifically, the

phenomenological approach will be used this study intends to discover the participants’ lived

experiences and stories about the circumstances they are in. This description will capture the

essence of their experiences as individuals who have all experienced a similar phenomenon. This

design has strong philosophical underpinnings and typically involves conducting interviews

(Giorgi, 2009; Moustakas, 1994 as cited in Creswell, 2014). Phenomenological research involves

the conduct of in-depth interviews with the participants of this study. This type of interview will

allow the participants to elaborate on their narratives, it can generate more insightful responses

especially on sensitive topics and the researcher can establish a rich understanding on the

attitudes, perception and motivations of the individual (Steber, 2017).

Participants of the Study

In choosing the participants for this study, non-probability purposive sampling will be

used. According to Creswell (2014) to purposefully select participants or sites (or documents or

visual material) means that qualitative researchers select individuals who will best help them

understand the research problem and the research questions. Using an inclusion criteria, the

following qualifications will serve as the basis for participant selection: 1.) The participant
 24

belongs to the top three (3) healthcare profession which is most exposed to COVID-19-positive

patients; 2.) The participant may either be male or female; 3.) The participant lives within the

province of Negros Occidental; 4.) The participant may belong to either the young adult or

middle adult stage of development; 5.) The participant may belong to either private or public

health facilities; 6.) The participants may either have a casual or permanent job status; and 7.)

The participants may belong to high risk or low risk area of assignment.

According to the Department of Health (DOH) health bulletin (April, 2020), the top three

health professions which are involved in the treatment of COVID-19-positive patients are: 1.)

medical doctors, 2.) nurses and 3.) medical technologist. The study will include three participants

from each of these professions, so that a total of nine (9) individuals will be included in this

study. The other remaining criteria will also be considered in the selection of participants to

achieve maximum variation.

Instrument

An in-depth interview guide will be used to gather the data necessary to answer the

research problem. It is divided into two (2) parts. Part I includes the information of the

participants’ demographic profile, namely, age, sex, marital status, health profession, length of

practice, job status, area of assignment and type of health facility affiliated with. Part II consists

of one basic statement asking the participants to describe their experiences in treating COVID-

19-positive patients. This statement will be posed to the participant: Tell me about your

experience as a healthcare worker engaged in the treatment of a COVID-19-positive patient.

Probing questions will be asked depending on the responses of the participant.

 25

These questions will allow the participant to elaborate on their answers to in order to

obtain a rich textual description of the participants’ experiences. According to Creswell (2014),

text and image data are so dense and rich, which are important in developing a rich, thick

description of the participants’ experiences to convey the findings of the study. This description

may transport readers to the setting and give the discussion an element of shared experiences. To

ensure the validity of the interview guide, the instrument will be evaluated and validated by three

(3) experts in the field of Psychology.

Data Gathering Procedures

The data-gathering will start with the recruitment and identification of potential

participants. These potential participants will be identified through the researchers’ social

network (i.e., family, friends, and colleagues). As soon as the potential participants had been

identified, a formal letter of invitation will be sent to them. Screening questions that would

ascertain whether the potential participant qualified given the inclusion criteria of this study will

asked. Once it is established that the target participant qualifies for the study, their willingness to

participate will be ascertained. Given that they will agree to be interviewed, an consent form will

be given to them. They will be asked to read and review the nature of the study to their voluntary

agreement to be part of the study as participants.

After obtaining their agreement for an interview, an appointement date will be set for the

conduct of the actual interview. The participants may opt to have the interview through virtual

modes such as: Facebook Messenger, Skype, FaceTime, Zoom or other types of communication

applications that may be used in consideration of the “new normal” due to the pandemic. Bpth

the virtual and face-to-face interview will be schedule at a time most convenient for the
 26

participant. The location for the face-to-face interview will also be set. Said location will be in a

place that is conducive for interviews, and are free of distractions as well as allowing the privacy

of the participants. During the interview, safety protocols for corona virus would be implemented

such as the use of personal protective equipment (face mask, face shield) for both the researcher

and participant. Rapport-building will be initiated by reiterating the importance of ensuring the

privacy of participant and confidentiality of the information gathered.

Audio recorders and the interview guide question will be used in order to gather data

from the participants and follow-up questions will also be asked in order to clarify the answers of

the participants during the whole course of the interview. As soon as the comprehensive data

have been obtained, the interview will then be terminated. Possible follow-up interviews will be

conducted if data gaps are present. The data gathered from the audio recordings will then be

subjected to transcription and analysis to being the data analysis of the data gathered through the

interview.

Data Analysis Procedure

The data gathered will be analyzed using Creswell‘s 6 (six) steps of data analysis in

qualitative research. Cresswell (2014) noted that data analysis in qualitative research will

proceed hand-in-hand with other parts of developing the qualitative study, namely, the data

collection and the write-up of findings. A classic hierarchical approach suggested by Cresswell

(2014) building the data from bottom to top, but he sees it as more interactive in practice; the

various stages are interrelated but not always in the order presented.

Cresswell (2014) explains that phenomenological research uses the analysis of significant

statements, from which meaning units are generated. The systematic and scientific analysis
 27

would require listening to audio recordings of the interview and reading the transcriptions. The

examination and review of the transcripts will provide a general sense of information and to

reflect its overall meaning while also figuring out the prevalent ideas that the participants

mentioned and the impressions of the over-all depth, credibility and use of the information.

After noting the common ideas of the data, significant statements will be culled. These

significant statements will then be coded by chunks using a word representation. These word

representations or codes will be combined into categories, and labeled using phrases., often

based on the significant statements of the participant. Segmenting sentences (or paragraphs) or

images into categories, and labeling those categories with a term or code, often a term based in

the actual language of the participant, called an in vivo coding (Creswell, 2014).

Next, the coding process will be used to generate a description or themes for analysis.

The themes developed appeared as major findings and served as headings in the results and

discussion. The themes and sub-themes were presented using a detailed discussion. The themes

will be presented using the significant statements to convey the findings of the analysis, along

with making an interpretation of the findings or results. Lastly, a conceptual framework will be

drawn-up based on the emerging themes.

Validity is one of the strengths of qualitative research and is based on determining

whether the findings are accurate from the standpoint of the researcher, the participant, or the

readers of an account (Creswell & Miller, 2000 as cited in Creswell, 2014). Terms abound in the

qualitative literature that address validity, such as trustworthiness, authenticity, and credibility

(Creswell & Miller, 2000 as cited in Cresswell, 2014).

 28

Dependability is ensured by rich description of the study methods. The methods section

of this study explains what procedures will be followed in order for dependable data will be

obtained. Establishing an audit trail will also be attempted. Inter-coder’s reliability will be used

for data analysis. A mental health professional will be requested to confirm the thematic analysis

made by the proponent.

Confirmability will be achieved through reflexivity. Thoughout data collection, during

interviews, data transcription and analysis of data, a reflexive attitude, constantly reviewing the

research process and data will be imbibed. Triangulation will be used by having several sources

of participants, that is, obtaining data from three types of health professionals.

Transferability is to extend the degree to which the results can be generalized or

transferred to other contexts or settings (source). It is achieved through the use of purposeful

sampling. The top three health professions that has the most exposure to COVID-19-positive

patients. Furthermore, participants will come from among young adults and middle-aged

individuals. Lastly, to maximize variation, participants will come from both private and public

health care facilities.

 29

Ethical Consideration

In consideration of the school’s requirements, this proposal will be subjected to an

evaluation by the university’s Research Ethics Review Office (RERO). After obtaining the

approval of the RERO, data gathering will start. As part of the data-gathering procedure,

informed consent will be obtained by informing target participants of the intent of the study, and

assuring them of confidentiality, privacy and anonymity. They will also be informed of the

nature of their participation in study as participants and will be assured that they have the right to

withdraw at any time or may opt not to continue with the in-depth interview. A corresponding

Informed Consent Form will be given to the target participants to review. Upon obtaining their

agreement, they will be asked to sign the consent form.

To ensure the privacy and confidentiality of the data, interviews will be conducted in

venuews that are free from distractions and are conducive. Furthermore, data will also be stored

in secure personal files. Disposal of the data will be made not later than three years after the

completion of this study.

 30

REFERENCES

Afable, S. (2020). The Philippines’ COVID-19 response: Symptoms of deeper malaise in

the Philippine health system. UP Population Institute.

Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H.
(2020). The fear of COVID-19 scale: Development and initial validation.
International Journal of Mental Health Adiction. .
https://doi.org/10.1007/s11469-020-00270-8

Albarracin, D. (2018). The influence of attitudes on behavior. University of Massachusetts

Amherst, MA 01003-9271. Retrieve from
https://www.researchgate.net/publication/325114583

Alliance of Healthcare Workers. (2020) as cited in Lalu G. P. (2020). More health workers
to resign if government fails to address their concerns.

Alwani, S. S., Majeed, M. M., Hirwani, M.Z., Rauf, S., Saad S. M., Shah, H., & Hamirani,
F. (2020). Evaluation of knowledge, practices, attitude and anxiety of Pakistan’s
nurses towards COVID-19 during the current outbreak in Pakistan.
https://doi.org/10.1101/2020.06.05.20123703;

Antiquera, R. (2020). Saving lives on the frontline Filipino nurses still face abuse and
stigma. https://southeastasiaglobe.com/philippines-nurses-covid-19/

Asaad, A. M., El‐Sokkary, R. H., Mahdi, A., Alzamanan, M. A., & El‐Shafei, M. (2020).
Knowledge and attitudes towards Middle East respiratory syndrome‐coronavirus
(MERS‐CoV) among health care workers in south‐western Saudi Arabia  .
College of Medicine, Najran University, Najran, Saudi Arabia

Bagcchi, S. (2020). Stigma during the COVID-19 pandemic. Crossref DOI link:
https://doi.org/10.1016/s1473-3099(20)30498-9

Bai, Y., Lin, C. C., Lin, C. Y., Chen, J. Y., Chue, C. M., & Chou, P. (2004). Survey of
stress reactions among health care workers involved with the SARS outbreak.
Psychiatric Service. 55(9):1055-7. doi: 10.1176/appi.ps.55.9.1055. PMID:
15345768.

Baticulon, R. E. (2020). Why do Filipino health workers keep getting infected with
COVID-19?. https://cnnphilippines.com/life/culture/2020/5/14/health-workers-
opinion.html
 31

Brabeck, M., & Jeffrey, J. (2010). Practice for knowledge acquisition (not drill and
kill). American Psychological Association.
http://www.apa.org/education/k12/practice-acquisition

Breines, J. (2015). Ways your beliefs can shape your reality. Psychology Today.
https://www.psychologytoday.com/intl/blog/in-love-and-war/201508/3-ways-
your-beliefs-can-shape-your-reality

Carnevale, J. B. & Hatak, I. (2020). Employee adjustment and well-being in the era of
COVID-19: Implications for human resource management. Journal of Business
Research (116), 183-187.

CDC. (2020). Interim operational considerations for healthcare workers exposed to or with
suspected or confirmed COVID-19. https://www.cdc.gov/coronavirus/2019-
ncov/hcp/non-us-settings/public-health-management-hcw-exposed.html

CDC. (2020). Interim U. S. guidance for risk asssessment and work restrictions for
healthcare personnel with potential exposure to COVID-19.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-
hcp.html

CDC (2020). Coronavirus Symptoms and Diagnosis.

https://www.rxlist.com/coronavirus/definition.htm
https://www.cdc.gov/coronavirus/about/symptoms.html

Centre for Disease Prevention and Control. (2020). Case definition for coronavirus disease
2019 (COVID-19). https://www.ecdc.europa.eu/en/covid-19/surveillance/case-
definition

Check, J. & Schutt, R. K. (2012).Cited in Ponto J. A. (2015). Research methods in

education. Thousand Oaks, CA: Sage Publications.

Cherry, K. (2020). Attitudes and behavior in psychology.

https://www.verywellmind.com/attitudes-how-they-form-change-shape-
behavior-2795897

Corrigan, F. & Gallagher, S. (2015). The impact of anticipated stigma on psychological

and physical health problems in the unemployed group. Frontiers Psychology. 6,
1263.

Dagklis, T., Tsakiridis, I., Mamopoulos, A., Athanasiadis, A., Pearson, R., & Papazisis,
G. (2020). Anticipating COVID-19-related stigma in survivors and health-care
workers: Lessons from previous infectious diseases outbreaks – An integrative
literature review. doi:10.1111/pcn.13140
 32

Dayrit, M. M., Lagrada, L. P., Picazo, O. F., Pons, M. C. & Villaverde, M. C. (2018). The
Philippines health system review. Health Systems in transition 8(2). World
Health Organization, Regional Office for South-East Asia.

Department of Health. (2020). Updates on novel coronavirus diseases (COVID-19).

https://www.doh.gov.ph/2019-nCoV

Department of Health. (2020). Duque orders strict check on incoming travelers amid
reports of china mysterious disease. https://www.doh.gov.ph/doh-press-
release/duque-orders-strict-check-on-incoming-travelers-amid-reports-of-china-
mysterious-disease

Fazio, R. H., (1990) as cited in Albarracin D. (2018). The influence of attitudes on

behavior. University of Massachusetts Amherst, MA 01003-9271. Retrieved
from https://www.researchgate.net/publication/325114583

Foundation of Nursing Studies. (2015). Creating caring cultures in health and social care:
Getting started animation script. www.fons.org/learning-zone/tools-and-
resources.aspx

Giorgi, G., Arcangeli, G., Montes, A., Rapisarda, V., & Mucci, N. (2019). Work-related
stress in the Italian banking population and its association with recovery
experience. International Journal of Occupational Medicine and Environmental
Health, 32(2), 255-265. https://doi.org/10.13075/ijomeh.1896.01333

Hernandez, S. H. A., Morgan B. J., & Parshall, M. B. (2016). Resilience, stress, stigma,
and barriers to mental healthcare in US Air Force nursing personnel. Nurse
Research, 65(6):481–486.

Hordern, J. (2017). Compassion in primary and community healthcare. In: Papanikitas A,

Spicer J, (eds). Handbook of Primary Care Ethics. Boca Raton (FL): CRC
Press/Taylor & Francis. https://www.ncbi.nlm.nih.gov/books/NBK475662/

Huang, J. Z., Han, M. F., Luo, T. D., Ren, A. K., & Zhou, X. P. (2020). Mental health
survey of medical staff in a tertiary infectious disease hospital for COVID-19.
doi: 10.3760/cma.j.cn121094-20200219-00063. PMID: 32131151.

Interim guidelines on health facilities in the new normal act (2020). No. 2020 -0268 (PH)

International Labour Organization (ILO). (2012). International standard classification of

occupations structure, group definitions and correspondence tables. ISBM 978-
92-2-125953-4
 33

Kahambing, J. G. S., & Edilo, S. R. (2020). Stigma, exclusion, and mental health during
COVID19: 2 cases from the Philippines. Crossref DOI link:
https://doi.org/10.1016/J.AJP.2020.102292

Karademas, E. (2010). Illness cognitions as a pathway between religiousness and

subjective health in chronic cardiac patients. Journal of Health Psychology. 15,
239–247.

Kasai, T. (2020). World health day 2020: Year of the nurse and midwife. News release
Beijing. World Health Organization.https://www.who.int/china/news/detail/07-
04-2020-world-health-day-2020-year-of-the-nurse-and-midwife

Kang, L., Li, Y., Hu, S., Chen, M., Yang, C., & Yang, B. Y. et al. (2020). The mental
health of medical workers in Wuhan, China dealing with the 2019 novel
coronavirus. Lancet Psychiatry, 7.

Koh, D., Lim, M.K., Chia, S.E., Ko S.M., Qian, F., Ng, V., Tan, B.H., Wong, K.S., Chew,
W.M., Tang, H.K., Ng, W., Muttakin, Z., Emmanuel, S., Fong, N.P., Koh, G.,
Kwa, C.T., Tan, K.B., & Fones, C. (2005). Risk perception and impact of severe
acute respiratory syndrome (SARS) on work and personal lives of healthcare
workers in Singapore: what can we learn? Med Care. 2005 43(7), 676-82.
doi: 10.1097/01.mlr.0000167181.36730.cc. PMID: 15970782.

Lau, L. L., Hung, N., Go D. J., Ferma, J., Choi, M., Dodd, W., & Wei, X. (2020).
Knowledge, attitudes and practices of COVID-19 among income-poor households
in the Philippines: A cross-sectional study. Journal of global health.
doi: 10.7189/jogh.10.011007

Lai, J., Ma, S., & Wang, Y., et al. (2020). Factors associated with mental health outcomes
among health care workers exposed to Coronavirus Disease 2019. JAMA Network
Open. 3(3). doi:10.1001/jamanetworkopen.2020.3976

Law Insider. (2020). Definition of designated public hospital.

https://www.lawinsider.com/dictionary/designated-public-hospital

Mak, I. W., et al., (2009). as cited in Rana, W., Mukhtar, S., & Mukhta, S. (2020). Mental
health of medical workers in Pakistan during the pandemic COVID-19 outbreak.
doi link: https://doi.org/10.1016/J.AJP.2020.102080 Published: 2020-06

Maleki, S., Naja, F., Farhadi K., Fakhri M., Hosseini F., & Naderi M., (2020). Knowledge,
attitude and behavior of health care workers in the prevention of COVID-19.
https://doi.org/10.21203/rs.3.rs-23113/v1
 34

Malta, M., Rimoin, A. W.,& Strathdee S. A. ( 2020). The coronavirus 2019-nCoV

epidemic: is hindsight 20/20?. The Lancet.
DOI:https://doi.org/10.1016/j.eclinm.2020.100289

McLeod, S. A. (2018). Cognitive dissonance. Simply Psychology.

https://www.simplypsychology.org/cognitive-dissonance.html

Manley, K. (2000) as cited in FoNs 2015. Foundation of nursing: Creating caring cultures
in health and social care: Getting started animation script. www.fons.org/learning-
zone/tools-and-resources.aspx

Mendoza, R. (2020). in Cited in Lalu G.P. (2020). More health workers to resign if
government fails to address their concerns.
https://newsinfo.inquirer.net/1285214/more-health-workers-to-resign-if-govt-
fails-to-address-their-concerns-group#ixzz6dzLclNlc

Montecinos, S. C. (2020). New perspectives on cognitive dissonance theory. (Doctoral

Thesis in Psychology) Stockholm University. http://urn.kb.se/resolve?
urn=urn:nbn:se:su:diva-179559

Naser, A.Y., Dahmash, E. Z., Al-Rousan, R., Alwafi, H., Alrawashdeh, H. M., Ghoul, I.,
Abidine, A., Bokhary, M. A., AL‐Hadithi, H.T., & Ali D. (2020). Mental health
status of the general population, healthcare professionals, and university students
during 2019 coronavirus disease outbreak in Jordan: A cross‐sectional study. DOI
link: https://doi.org/10.1002/BRB3.1730

Lalu, G. P. (2020). More health workers to resign if government fails to address their
concerns – group. https://newsinfo.inquirer.net/1285214/more-health-workers-to-
resign-if-govt-fails-to-address-their-concerns-group#ixzz6dzLclNlc

O’ Donnell, K. (2016). The health crisis of mental health stigma. The Lancet. doi:
10.1016/S0140-6736(16)00687-5

Ogolodom, M.P., Mbaba, A.N. , Alazigha, N. , Erondu, O.F. , Egbe, N.O., Golden, I.,
Ugwuanyi, D.C., Achi, G.I & Eke, C.M. (2020). Knowledge, attitudes and fears
of healthcare workers towards the coronavirus disease (COVID-19) pandemic in
South-South, Nigeria. Health Science Journal. DOI: 10.36648/1791-809X.S1.002

Olum, R., Chekwech, G., Wekha, G., Nassozi, D.R., & Bongomin, F. (2020). Coronavirus
Disease-2019: Knowledge, attitude, and practices of health care workers at
Makerere university teaching hospitals, Uganda. DOI link:
https://doi.org/10.3389/FPUBH.2020.00181
 35

Pal, R., Yadav, U., Grover, S., Saboo, B., Verma, A., & Bhadada, S. K. (2020).
Knowledge, attitudes and practices towards COVID-19 among young adults with
Type 1 Diabetes Mellitus amid the nationwide lockdown in India: A cross-
sectional survey DOI link: https://doi.org/10.1016/j.diabres.2020.108344

Park, J. S., Lee, E. H., Park, N. R., & Choi, Y. H. (2018). Mental health of nurses working
at a government-designated hospital during a MERS-CoV outbreak: A Cross-
sectional study. Archive Psychiatry Nursing. 32(1), 2-6. doi:
10.1016/j.apnu.2017.09.006. Epub 2017 Sep 5. PMID: 29413067; PMCID:
PMC7127092.

Peralta, J. (2020). Policy paper the Philippines’ COVID-19 response: Symptoms of deeper
Malaise in the Philippine health system. Cited in National College of Public
Administration and Governance - University of the Philippines.

Ponto, J. A. (2015). Understanding and evaluating survey research. Winona State

University, Graduate Programs in Nursing.

Quintos, P. (2020). Policy paper the Philippines’ COVID-19 response: Symptoms of

Deeper Malaise in the Philippine health system. National College of Public
Administration and Governance - University of the Philippines

Rajkumar, R. P.(2020) COVID-19 and mental health: A review of the existing literature.
DOI link: https://doi.org/10.1016/J.AJP.2020.102066

Reuters. (2020). Stigma, exclusion, and mental health during COVID19: 2 cases from the
Philippines. DOI link: https://doi.org/10.1016/J.AJP.2020.102292

Rey, A. (2020). Policy paper the Philippines’ COVID-19 response: Symptoms of deeper
Malaise in the Philippine health system. National College of Public
Administration and Governance - University of the Philippines

Rokeach, M. (1968) as cited in Nordlund, A. (2009). Values, attitudes, and norms: Drivers
in the future forests context. Future Forests Working Report.

Roser, M., Ritchie, H., Ospina, E. O. & Hasell, J. (2020) . Coronavirus pandemic
(COVID-19). Published online at Our World In Data.org. Retrieved from:
'https://ourworldindata.org/coronavirus'

Rubrico, J. G. U. (2020). ISPI Italian institute for international political study.

https://www.ispionline.it/en/pubblicazione/covid-19-and-discrimination-medical-
personnel-philippines-25725
 36

Saqlain, M., Munir, M. M., Rehman, S.U., Gulzar, A., Naz, S., Ahmed, Z., Tahir, A.H.,
& Mashhood, M. (2020). Knowledge, attitude and practice among healthcare
professionals regarding COVID-19: A cross-sectional survey from Pakistan.
https://doi.org/10.1101/2020.04.13.20063198;

Shaukat, N., Ali, D. M. & Razzak, J. (2020).Physical and mental health impacts of
COVID-19 on healthcare workers: a scoping review. Internal Journal Emergency
Medicine, 13(40). https://doi.org/10.1186/s12245-020-00299-5

Shigemura, J., Ursano, R. J., Morganstein, J. C., Kurosawa, M., & Benedek, D. M.,
(2020). Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan:
Mental health consequences and target populations. Psychiatry Clinic
Neuroscience 74, 281-2.

Singleton, R. A. & Straits B. C. (2009) cited in Ponto J. (2015). Understanding and

evaluating survey research. Winona State University, Graduate Programs in
Nursing Advance Practice Oncology 6, 168–171.

Tadesse, D. B., Gebrewahd, G. T., & Demoz, G. T. (2020). Knowledge, attitude, practice
and psychological response toward COVID19 among nurses during the COVID-
19 outbreak in northern Ethiopia, New Microbe and New Infect.
https://doi.org/10.1016/j.nmni.2020.100787

Tedros, A. (2020). WHO Director-general's opening remarks at the media briefing on

COVID-19. https://www.who.int/director-general/speeches/detail/who-director-
general-s-opening-remarks-at-the-media-briefing-on-covid-19---16-march-2020

Wasim, T., Raana, G. E., Bushra, N., & Riaz, A. (2020). Effect of COVID-19 pandemic
on mental wellbeing of healthcare workers in tertiary care hospital. Annals of
King Edward Medical University, 26(Special Issue), 140-144. Retrieved from
https://www.annalskemu.org/journal/index.php/annals/article/view/3625

Wei, E.(2020). COVID‐19's crushing mental health toll on health care workers. DOI link:
https://doi.org/10.1002/CNCY.22347

Wiafe, I. (2012). A framework for analysing, designing and evaluating persuasive

technologies (Doctor of Philosophy) Informatics Research Centre Henley
Business School. Retrieve from
https://www.researchgate.net/publication/271929628

WHO. (2020). Infection prevention and control during health care when COVID-19 is
suspected: interim guidance. https://apps.who.int/iris/handle/10665/331495
 37

WHO. (2020). Coronavirus disease (COVID-19) outbreak: Rights, role and

responsibilities of healthcare worker, including key consideration for occupational
safety and health. WHO/2019-nCov/HCW advice/2020.2

WHO (2020). The COVID-19 risk communication package for healthcare facilities.
http://iris.wpro.who.int/handle/10665.1/14482

WHO (2020). Coronavirus disease (COVID-19) pandemic.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019

WHO (2020). Health-care facilities.

https://www.who.int/environmental_health_emergencies/services/en/

WHO (2020). World Health Day 2020: Year of the Nurse and Midwife.
https://www.who.int/china/news/detail/07-04-2020-world-health-day-2020-year-
of-the-nurse-and-midwife

WHO (2020). Mental health and psychosocial considerations during the COVID-19
outbreak. WHO/2019-nCoV/MentalHealth/2020.

Wolf, A.H. & Toebes B. (2016). Assessing private sector involvement in health care and
universal health coverage in light of the right to health. Health and Human rights
Journal. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394993/

Xiao, H. (2020). The psychological impact of COVID-19 and other viral epidemics on
frontline healthcare workers and ways to address it: A rapid systematic review.
DOI link: https://doi.org/10.1016/J.BBIH.2020.100144

Zhang, M., Zhou, M., Tang, F., Wang, Y., Nie, H., Zhang, L., & You, G. (2020).
Knowledge, attitude, and practice regarding COVID-19 among healthcare
workers in Henan, China. Journal Hospital Infection, 105(2),183-187. doi:
10.1016/j.jhin.2020.04.012. Epub 2020 Apr 9. PMID: 32278701; PMCID:
PMC7194961.
 38

APPENDICES

APENDIX A

INFORMED CONSENT FOR HEALTHCARE WORKER

Name of Researcher: Joe Bryant Laguerder

School: University of St. La Sallle, Graduate School

PART I: INFORMATION SHEET

INTRODUCTION
I am Joe Bryant Laguerder, a student from University of St. La Salle. I am currently
doing my research on experiences of healthcare workers involved in the treatment of COVID-19-
positive patient and you are invited to participate in this research.
This is to inform you that:
 If you have questions, you may contact me at 0927-889-4152 or email me at
ifightforcause@yahoo.com

PURPOSE OF THE RESEARCH - Why are we doing this study?

The purpose of this study is to explore the experiences of healthcare workers involved in the
treatment of COVID-19-positive patients.

CHOICE OF PARTICIPANTS - Why am I being asked to be in the study?

You have been chosen as one of the participants because you represent the target population
for of healthcare workers involved in the treatment of COVID-19-positive patients.

PARTICIPATION IS VOLUNTARY- Do I have to do this?

You do not have to be in this study, if you do not want to be. If you decide that you do not want
to be in the study after we begin, it is alright.

PROCEDURES - If I am in the study what will happen to me?

If you decide that you want to be part of this study, you will tell me about your experience as a
healthcare worker engaged in the treatment of a COVID-19-positive patient. Your story might
take approximately 15-30 minutes to tell. Your narrative will be kept private, and confidential.
Only the researcher working on the study will see them.

RISKS - Will I be hurt if I am in the study?

You will be asked questions on sensitive and personal issues which are confidential in nature.
Thus, there is a risk of embarrassment, discomfort or fear. Rest assured, your answers to the
questionnaires will be kept confidential.
 39

BENEFITS
By agreeing to participate in this research study, you may feel good about helping us to make
things better for other healthcare worker. There is no promise that you will receive any direct
benefit from participating in this study.

CONFIDENTIALITY
Your identity will be kept private, and your records will be kept confidential and will not be
released without your consent except as you pose a threat to yourself and others, or required by
law. Only the researchers will have access to the files. If the results of this study are written in a
scientific journal or presented at a scientific meeting, your name will not be used. Your signed
consent form will be stored in a cabinet separate from the data.

WHO TO CONTACT
If you have any questions about the research, you may contact the researcher at 09278894152 or
ifightforcause@yahoo.com

BASIC INFORMATION

Interviewee Name (Optional):______________________ Date of interview: _____________

Mobile No): _______________

1. Sex: ____ (1) Male 2. Age: _______ (in years)

____ (2) Female

3. Marital status

______ (1) Single

______ (2) Married

4. Length of Experience:___________ (in years)

5. Type of Health Professional:

______ (1) Medical Doctor

______ (2) Nurse

______ (3)Medical Technologist

6. Employment status

______ (1) Regular Employee

 40

______ (2) Casual

7. Type of health Facility

______ (1) Public

______ (2) Private

8. Area of assignment

______ (1) High Risk

______ (2) Low risk

 41

CONSENT FORM

I am Joe Bryant Laguerder from University of St. La Salle, the researcher conducting a
study on Healthcare workers involved in the treatment of COVID-19-positive patient. I am
asking for your permission to take part in the research study because you have been identified to
have fit the profile of the study.

For this research, I will be asking questions pertaining to your involvement in the treatment of
COVID-19-positive patients. Rest assured that all answers and information gathered will be
strictly kept confidential. You will be given a choice whether to allow or not to write your name
on the written materials. If you wish to not write your name, a pseudo-name will be given in data
analysis and your name will not be associated with any information you provide. Information
contained in your records may not be given to anyone unaffiliated with the study in a form that
could identify you without your written consent.

Interviews will be audio recorded to assist with the accuracy of your responses. Both audio
recordings and paper copies of interview information will be kept secured and only the
researcher will have access to the materials. If you do not wish to be audio recorded, please
notify the researcher. Your willingness to take part may help people who may have undergone
the same experiences, as well as the society to better understand this research topic.

You should know that:

o Your participation in this study is VOLUNTARY; you do not have to be in the study if
you do not want to.

o If there is a question you don‘t want to answer, you may not answer it. o If you do not
want to continue to be in the study, you may stop at any time.

o You can ask any questions you have, now or later. If you think of a question later, you
can contact me at ifightforcause@yahoo.com/09278894152.
 42

Consent form

I have read this consent form and my questions have been answered. My signature below
means that I do want to be in the study. I know that I can remove myself from the study
at any time without any problems.

__________I give my permission for the interview to be audio recorded.

__________ I DO NOT give my permission for the interview to be audio recorded.

_________________________ _________________________
Signature over Printed name Date

Joe Bryant Laguerder

__________________________ __________________________
Researcher Signature
 43

APENDIX B
Interview Guide Questions:

Tell me about your experience as a healthcare worker engaged in the treatment of a

COVID-19-positive patient.