Knowledge of Nursing Students To Adhering Safety Protocols

KNOWLEDGE OF NURSING STUDENTS TO ADHERING SAFETY PROTOCOLS
DURING COVID 19 PANDEMIC
HANNAH GRACE P. ADLAON

MARIAMA JAMIELA Y. PADLA
COLEEN JADE T. RELOVA
GLEST ALLYSSA F. ROA
MARIFLOR GRACE SUPREMO
SHARON B. TARAY
AUGUST, 2021
KNOWLEDGE OF NURSING STUDENTS TO ADHERING SAFETY PROTOCOLS
DURING COVID 19 PANDEMIC
……………………………………………………………………………………………
A Research Study Presented to the

Faculty of the College of Nursing
Liceo de Cagayan University
Cagayan de Oro City
……………………………………………………………………………………………
In Partial Fulfillment
of the Requirements for the Degree
Bachelor of Science in Nursing
Major in Nursing
……………………………………………………………………………………………
HANNAH GRACE P. ADLAON

MARIAMA JAMIELA Y. PADLA
GLEST ALLYSSA F. ROA
MARIFLOR GRACE SUPREMO
SHARON B. TARAY
AUGUST, 2021
Liceo de Cagayan University College of Nursing
APPROVAL SHEET
This Research Paper entitled “KNOWLEDGE AND ADHERENCE TO SAFETY

PROTOCOLS OF NURSING STUDENTS DURING THE COVID 19 PANDEMIC”, in
partial fulfillment of the requirements for the Bachelor of Science in Nursing prepared and
submitted by, Hannah Grace P. Adlaon, Mariama Jamiela Y. Padla, Coleen Jade T. Relova, Glest
Allyssa F. Roa, Mariflor Grace Supremo, and Sharon B. Taray has examined, accepted and
recommended for Oral Examination.
GEORGE MICHAEL P. LIM, DM, MN, CHA, FPCHA, FFSQUA, RN
Adviser
PANEL OF EXAMINERS
APPROVED in partial fulfillment of the requirements for the Bachelor of
Science in Nursing
the Panel of Examiners with a grade of _____
NENETU I. PRADO, PhD

Chairman
CHRISTIAN V. VILLAN, MAN, RN BERNARDA C. LLENO, PhD, MN, RN

Member Member
Comprehensive Examination: ______
GLORIA M. CUNANAN, PhD, RN

Dean, College of Nursing
3
TABLE OF CONTENTS
CHAPTER 1
Pages
Introduction
Theoretical Framework
Conceptual Framework
Statement of the Problem
Hypothesis
Significance of the Study
Scope and Limitations
Definition of Terms
CHAPTER 2
Review of Related Literature and Studies
CHAPTER 3
Research Setting
Research Design
Participants and Sampling Procedure
Research Instruments
Validity and Reliability Instruments
Data Gathering Procedure
Statistical Techniques
REFERENCES
APPENDICES
Consent Form
Survey Questionnaire
Curriculum Vitae
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Chapter 1
THE PROBLEM AND ITS SCOPE
Introduction
The global battle against coronavirus disease (COVID-19) continues. Since the
disease outbreak, the government has been enforcing containment and prevention
measures. The presence of illness and misuse of protective equipment such as face
shields, face masks and protective gowns, as well as safety protocols such as
social distancing and hand sanitizing can present a much more difficult situation.
The protocol implementation is caused by a lack of compliance and resource
materials to carry out safety protocols. Nursing students were found to have a
significant gap in their knowledge, attitude, and practice against the virus,
rendering them non-compliant with proposed health and safety measures. Nursing
students do not follow standard precautions, infection and preventive control
protocols because of their ineffective learning through online classes and lack of
clinical exposure, and also because of their own understandings, beliefs, and own
convictions. The setting or community where the nursing students live does not
enforce rigorous adherence to safety standards, which has an impact on the
student’s conduct in terms of following such rules. A study conducted in both
China and the United States showed how knowledge regarding COVID 19 differs
between genders, where female students scored higher than male students.
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In addition, nursing students are often exposed to various infections during their
clinical duties. Knowledge and compliance with standard precautions is essential to
prevent hospital associated infections and protect patients as well as medical
workers from exposure to infectious agents (Leodoro J et al., 2020). According to
(Alexandra Peters et al., 2020) human factors and health systems have impacts on
the spread of viruses. Another study reported that students' knowledge increased
as they got higher in the academic ladder, indicating that senior students had a
profound understanding of COVID-19-related information possibly because of
their exposure to high-level learning and COVID-19- related information in their
theoretical courses and hospital exposures. Individuals' behavior is informed by
cultural beliefs and more, and these can impact movement within a community,
contact with others and likelihood to comply with official recommendations.
Human factors include the population levels of knowledge, immune response to
viruses, age structure, and cultural behaviors. One’s behavior is informed by one’s
cultural beliefs and practices, and these can impact movement within a community
and how these people comply with official recommendations. On the other hand,
health system capacity factors refer to the ability of a governing body to respond
to the outbreak (availability of treatment or vaccine), and implementation of
infection control measures in the population. Public adherence to restrictions can
influence the success of the implementation of restrictive rules. Adherence
depends on how well-informed people are about both the consequences of
infection and the steps that should be taken to prevent virus spread (Ilona, Nicole
Lucas et al., 2020). Despite the implementation of safety protocols from the
government and health care facilities, the COVID 19 pandemic affects the
knowledge and adherence of Nursing Students towards safety protocols. The
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capacity of our health systems are also put into account, the ability of our health
systems, and governing body to do specific responses like mass testing,
treatments, and vaccination are also put into attention by the researchers. The
setting is also put into consideration, because different places may have various,
and different number of cases, and also the diversity of people.
Liceo de Cagayan University College of Nursing Having adequate knowledge
and the correct preventive behavior against COVID 19 will ensure that
nursing students are prepared to respond in future occurrences of
similar public health crises. Therefore, knowledge, perception, and
preventive behavior should be considered in the planning of effective
educational interventions for the coronavirus disease COVID-19
pandemic and in increasing awareness about the health risks brought
about by this disease (Hamdan Mohammad et al., 2020).
Theoretical Framework
The Theory of Health as Expanding Consciousness and
Operant Conditioning was used as the supporting theories to explain
the knowledge and adherence to safety protocols of Liceo de Cagayan
University's nursing students during COVID 19 pandemic.
Health as Expanding Consciousness
The theory of health as expanding consciousness (HEC) was
stimulated by concern for those for whom health as the absence of
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disease or disability is not possible. Nurses often relate to such people:
people facing the uncertainty, debilitation, loss and eventual death
associated with chronic illness. The theory has progressed to include
the health of all persons regardless of the presence or absence of
disease. It asserts that every person in every situation, no matter how
disordered and hopeless it may seem, is part of the universal process
of expanding consciousness; a process of becoming more of oneself, of
finding greater meaning in life, and of reaching new dimensions of
connectedness with other people and the world”. Health is central to
the theory and is seen as a process of a developing awareness of the
individual self and the person's environment (Newman, 2010).
Liceo de Cagayan University College of Nursing Consciousness is described
as “the state of understanding and realizing something” which cannot
only transmit information, but also produce meaningful information,
and change individuals to act autonomously. In relation to our study,
the students help people understand and use the power within to
develop a higher level of consciousness. Being conscious should be
considered to increase awareness about the health risks brought by
COVID 19. Thus, it helps to realize the disease process, its recovery,
and prevention. On the other hand, Newman also explains the
interrelatedness of time, space and movement. One’s understanding
and knowledge on the emerging coronavirus enables him/her to be
aware and cautious for her own health (health security) and his/her
environment. Moreover, the more health-conscious nursing students
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are, the more likely they are to have healthy habits, pay attention to
healthy measures. Therefore, Margaret Newman's Theory of Health as
Expanding Consciousness plays an essential part in the knowledge of
nursing students to safety protocol.
Operant Conditioning
The theory of B.F. Skinner is based upon the idea that learning is a function of
change in overt behavior. Changes in behavior are the result of an individual’s
response to events (stimuli) that occur in the environment. A response produces a
consequence such as having knowledge and adherence to safety protocols. When a
particular Stimulus-Response (SR) pattern is reinforced (rewarded), the individual
is conditioned to respond. The distinctive characteristic of operant conditioning
relative to previous forms of behaviorism (e.g., connectionism, drive reduction) is
that the organism can emit responses instead of only eliciting response due to an
external stimulus. Nursing students' learning will result from the connection made
between the environment and individual response. In order to
Liceo de Cagayan University College of Nursing encourages other nursing
students to learn and understand the information about the safety
protocol. Students with knowledge should reinforce positive behaviors
towards the community. Show the proper use of face mask, face
shields, doing hand washing, observing proper social distancing to
help others motivate the desired outcome to reduce the number of
COVID 19 cases. The basic concept behind operant conditioning is
that a stimulus (antecedent) leads to a behavior, which then leads to a
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consequence. Furthermore, transferring of learning occurs when
students have similarity in response to future situations where
behavior occurs. When a large number of students do not follow the
protocol, they might have a lack of knowledge about the situations.
Thus, small changes in behavior can have a significant effect to
reduce spread of the said virus. Therefore, adhering and responding to
safety protocols against COVID 19 creates desirable consequences
and effects to one’s health, safeness, and life.
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Statement of the Problem
The study aims to determine the knowledge and adherence to safety protocols of
Liceo de Cagayan University's 3rd year and 4th year nursing students during
COVID 19 pandemic. It specifically sought answers to the following questions:
1. What is the profile of the participants in terms of:
1.1 Age
1.2 Sex
1.3 Year Level
1.4 Academic Status
1.5 Place of Origin
1.6 Occupation of Parents
1.7 Highest monthly family income
2. What is the level of knowledge of nursing students on the
safety protocols on: 2.1. Wearing of face mask and
face shield
2.2. Hand washing
2.3. Social Distancing
3. What is the level of adherence to the safety protocols on:
3.1. Wearing of face mask and face shield
3.2. Hand washing
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3.3. Social Distancing
Liceo de Cagayan University College of Nursing 4. Is there a relationship
between adherence, knowledge, and socio-demographic profile of the
participants?
Hypothesis
The null hypothesis will be tested at 0.05 level of significance:
Ho: There is no relationship between adherence, knowledge, and socio
demographic profile of the participants.
Significance of the Study
The results of the study will be of great benefit to the following:
Liceo de Cagayan University. The university will design measures or programs
for the compliance of the safety protocols to ensure a safe environment for the
students’ learning.
The College of Nursing. This study will help the Department of Nursing in the
development of teaching strategies of the clinical instructors regarding the safety
protocols. Nursing Students. This will help the nursing students to assess
themselves on the extent of their knowledge and adherence to safety protocols.
Future Researcher. The results of the study will serve as a basis for future
researchers who will also study Knowledge on Adhering to Safety Protocols during
a certain pandemic.
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Scope and Delimitations of the Study
This study is primarily focused on the demographic profile (age, sex, year level,
academic status, place of origin, occupation of parents, and highest monthly family
income), knowledge and adherence of nursing students to standard safety protocols
(wearing of face masks, face shields, social distancing, and handwashing) during
the COVID 19 Pandemic. The participants of this study will be the randomly
selected Third year and Fourth Year Nursing Students of Liceo de Cagayan
University, Second Semester, SY 2021-2022. The study will be conducted in the
month of July, year 2022. This study has several limitations including the
collection of data and availability of the information due to the COVID 19
pandemic which require the researchers to follow safety protocols and netiquette
in conducting this study.
Definition of Terms
Age. This variable means the length of time the person lived in this world.
Academic Status. This variable refers to the measurement of student achievement
across various academic subjects.
Adherence. This variable refers to the extent which a student’s behavior
corresponds with agreed recommendation on implementing the safety protocols.
COVID 19. This term refers to a large family of viruses that cause illness ranging
from the common cold to more severe diseases.
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Hand washing. This variable refers to the act of cleaning one’s hand with soap
and water to remove bacteria and unwanted substance stuck to the hands.
Highest Monthly Family Income. This variable refers to a per person is
calculated by taking the total gross household monthly income divided by the total
number of family members living together.
Knowledge. This term refers to the fact or condition of knowing something with
familiarity gained through experience or association.
Occupation of Parents. This variable refers to a person’s field of specialization,
and will differ in wage, time consumption, etc.
Place of Origin. This variable refers to where something originated or was
nurtured in its early existence.
Protocols. This variable refers to a system of rules that explain the correct conduct
and procedures to be followed in formal situations.
Safety. This term means keeping yourself and others free from harm or danger.
Sex. This variable refers to being male or female in relation to the social and
cultural roles that are considered appropriate for men and women.
Socioeconomic Status. This variable refers to the social standing or class of an
individual or group.
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Social Distancing. This variable refers to a public health practice that aims to
prevent sick people from coming in close contact with healthy people to reduce
opportunities for disease transmission.
Standard Precautions. This variable refers to the minimum infection prevention
practices that apply to all patient care, regardless of suspected or confirmed
infection status of the patient, in any setting where healthcare is delivered.
Wearing a Face Mask. This variable refers to help limit the spread of some
respiratory diseases
Wearing of Face Shield. This variable refers to protecting the wearer's entire face
(or part of it) from hazards such as flying objects and road debris, chemical
splashes (in laboratories or in industry), or potentially infectious materials (in
medical and laboratory environments).
Year Level. This variable refers to the academic year of education that
students have attained currently.
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REVIEW OF RELATED LITERATURE AND STUDIES
In the light of the ongoing pandemic and knowledge of
COVID-19 transmission and practices implemented in other countries,
a protocol for special education assessment is introduced with the goal
of assisting school psychologists in conducting necessary assessments.
The current study adds to our understanding of how nursing students
understand and can be assisted in internalizing concepts of patient
safety in their practice. Nursing education curriculum designers must
go beyond theoretical concepts of patient safety education to develop
strategies for increasing the application of safety knowledge and
competencies in nursing practice. The COVID-19 pandemic poses a
serious challenge to health system resilience worldwide. In particular,
hospital capacity and availability of intensive care unit (ICU) beds and
respirators, which have been rendered scarce in a number of countries
during the first wave of COVID-19, have been identified as among the
most relevant factors (Pericàs et al. 2020).
Age
As stated by (Halperin et al. 2021), masking guidelines for
children from major public health organizations differ, which has
generated confusion. For instance, the CDC currently recommends
that all children over age 2 wear masks indoors, while the WHO mask
guidance applies to children over age 5 and with a caveat that benefits
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from mask mandates at school may not cause potential academic and
psychosocial harm. The risk perception score was significantly lower
in the 18–28 years age group than in older age
groups and a higher level of education was significantly associated
with higher risk perception scores than being unemployed and having
a lower education according to (Kwasi Abu et al. 2021). A gender
ratio of 3:1 (females: males) of people ages between 30- 40 years,
unskilled workers, and upper-class people having inadequate
knowledge about Covid 19 (Suganthi et al. 2021). Since the COVID
19 pandemic has hit worldwide wide being one of the biggest
psychological menaces that had an impact on all socioeconomic strata
as well as age groups of society, knowledge, and awareness regarding
the disease and vaccination have led to a wave of calmness in some,
but still many people have been impacted and are in a major dilemma
(Vohra et al. 2021). At present information regarding the prevalence
and case-fatality for the clinical features and epidemiology of COVID-
19 remains scarce. However, a relatively accurate evaluation of
incidence and mortality is required to help refine the risk assessment
and to ensure that the public and patients are managed effectively.
Therefore, it is necessary to quantitatively evaluate the risks for
individual groups of different ages and genders. This study shows that
the incidence risk of COVID-19 might be as low as 0.1 for children,
while it could be over 0.9 for 40-year-old adults. Our results also
suggest that the mortality risk might be above 0.2 for patients older
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than 80 (Li et al. 2020).
According to (Kim et al. 2020), The risk of developing severe
COVID-19 complications or dying increases dramatically with age.
79% of COVID-19 deaths were reported by August 29, 2020, and
occurred at ages 65 of the population fatality rate (the risk of death
from COVID-19 among the general population) dramatically increased
by age so the rate was 0.82% for ages 85+, 0.29% for ages 75–84,
0.12% for ages 65–74, 0.05% for ages 55–64, 0.02% for ages 45–54,
compared to 0.003% for ages under 45. Fatality rates are always the
highest among older people and across countries with varying levels
of COVID-19 mortality and infection. This appears to result from
higher age being linked to more underlying health conditions and
weaker immune systems. The differentials in behavioral responses to
COVID-19 by age and how they changed over the first three months
of the pandemic and behavioral responses and changes in behavior
over time differed by age, type of behavior, and time reference. At the
beginning of the pandemic (March 2020), older and younger people
were similar in their likelihood of engaging in personal preventive
behaviors when controlling for other influences. As the pandemic
progressed, however, older people adopted mitigating personal
behavioral changes more than younger people, such that about 1–2
months after the pandemic started. Older people were more likely to
comply with suggested behaviors and regulations including practicing
better hygiene, isolation, and social distancing. One month from the
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pandemic, older people were less likely than younger people to engage
in two of four risky behaviors. The change in risky behavior over time
did not differ by age, but both younger and older people were more
likely to engage in risky behaviors after two months. In addition to age,
other factors were related to people’s behaviors.
Sex
Females practiced their knowledge of hand hygiene more in
comparison to males (86% vs. 80%). Female respondents were also
practicing more about sneezing/coughing into their elbows as
compared to males (79% vs. 71%). As the practice of knowledge of
staying at home to prevent infection (females 98.2% vs males 95%),
and (females 83.2% vs. males 81.5%) (Alshammary et. al. 2020).
Gender was almost equally distributed within the sample with (51%)
of men respondents and (49%) women respondents. The
Liceo de Cagayan University College of Nursing questionnaire included 17
questions about participants’ knowledge and awareness of COVID–
19, 17 questions regarding the safety measures they had taken in the
wake of the outbreak, and 3 questions asking them to assess the
efficacy of the government’s response to the pandemic. Our data
shows that 79% of the respondents have good awareness about
transmission of the virus, 55.6% were knowledgeable of the symptoms
exhibited by an infected individual, 81% were aware of the
preventative measures and 82% demonstrated awareness of the risk
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groups. Most participants complied with preventative measures (77%)
and 62% of the study participants agreed that stricter measures have to
be enforced by the government to limit the spread of the virus (Qutob
et al. 2021). Considering that to avoid an exponential comeback of the
coronavirus disease, individuals must use a face-covering since
several countries are or will soon be reducing shelter-in-place
regulations (COVID 19). The results reveal that focusing on "your
community" increases intentions to wear a face-covering compared to
the baseline; the tendency is similar but not significant when
comparing "your community" to the other conditions. In addition, we
conducted pre registered assessments of gender differences in face-
covering intentions. We discovered that men want to wear a facial
covering less than women, but this gap practically vanishes in
countries where face covering is required. On the other side, men less
than women believe that they will be seriously affected by the
coronavirus, and this partly mediates gender differences in intentions
to wear a face-covering (this is particularly ironic because official
statistics show that men are affected by the COVID-19 more seriously
than women). Therefore, we also find gender differences in self-
reported negative emotions felt when wearing a face covering. Men
more than women agree that wearing a face-covering is shameful, not
cool, a sign of weakness, and a stigma; and these gender differences
also mediate gender differences in intentions to wear a face-covering
(Capraro et al. 2020).
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Year Level
Having limited knowledge concerning COVID-19 and being
overwhelmed by its coverage in the media can cause anxiety and fear
in the community. Identify and compare the effects of two education
programs for infection control―a simulation using standardized
patients and a peer role play―on standard precaution knowledge,
standard precaution awareness, infection-related anxiety, and infection
control performances (Kim, 2020). Initially, a total of 62
undergraduate nursing students in their 3rd year participated in the
study and were assigned to the experimental and control groups,
accordingly and the infection control education program was
developed based on the analysis, design, development,
implementation, and evaluation model.
The program according to (Sangsuk Kim, 2021) for the
experimental group included lectures, skills training, simulation using
standardized patients, and debriefing, while the control group
participated in the usual infection control education, consisting of
lectures, skills training, and peer tutoring practices. In following the
interventions, both groups showed statistically significant increases in
knowledge, awareness of standard precautions, and infection control
performance. Considering the simulation with a standardized patient
group, infection-related anxiety and infection control performance
were significantly higher. Both education programs influenced
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adherence to standard infection control precautions. The findings add
to the body of evidence regarding effective educational methods for
infection control. It follows that Nursing has a high level of
knowledge about the COVID-19 pandemic response plan and ICP.
Training and disseminating updated plans and protocols in different
methods such as an intranet and onsite training in addition to regular
methods were very effective.
Liceo de Cagayan University College of Nursing A similar data by (Olayemi
2021) about 88% of the study subjects were knowledgeable about
COVID-19 and the majority of them were females. The association of
COVID-19 in people with underlying conditions and students'
academic levels shows that a higher percentage of participants
perceived adults over the age of 65 and people in the high-risk group.
A recent study by (Abraham 2021) that medical and nursing
students, who are future frontline healthcare workers in Samoa,
showed a considerable level of knowledge, risk perception, and
preventive behavior towards COVID-19. In addition, updating the
students’ knowledge about the diagnosis and case management of
COVID-19 is imperative when implementing proper preventive
strategies to curtail the spread of the disease (Yemoh 2021). Thus,
knowledge and compliance with personal protective procedures is a
key to patients’ and personnel's safety. Since, this study aimed to
assess which factors are associated with higher self-evaluations of
training on infection prevention and control (IPC) and higher self-
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assessment of IPC practices used by HCWs regarding COVID-19 in
University Hospital in Krakow, Poland, in January 2021. Self-reported
preparedness and the K&PI indicated that self-reported preparedness
was inadequate for knowledge and skills. Nurses and paramedics
assessed their knowledge most accurately. Participants with low K&PI
and high subjective evaluation constituted a substantial group in all
categories. Students least often overestimated (23.8%) and most often
(9.6%) underestimated their knowledge and skills. IPC practice,
especially as it refers to the training program and practice of IPC in
curricula of health professions’ training to provide students with
knowledge and skills necessary not only for future pandemic situations
but also for everyday work (Zoltowska 2021). Also, the government
opted to hold written exams for
final-year students as a safeguard along with students who expressed
concerns about becoming infected during exam time and expressed a
desire to postpone or cancel exams due to possible contact during
transportation and class meetings. With the use of social media, social
networks, and community leaders, education has been provided to the
general public and students, in particular, to take preventive
precautions during exams. The study aims to analyze students'
adherence to COVID 19 preventive measures and to identify the
knowledge gaps, risk perceptions, and factors affecting student's
adherence which could guide the design of better nursing education
curricula regarding COVID-19 as preparation for final-year nursing
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students to internship year which will be on September 2020. Lastly,
due to the possibility of being infected with COVID-19 during exams
or during their internship year, this study will evaluate covid-19
symptoms rate during the exam period and factors affecting its
development.
Academic Status
Nursing university courses have also been halted, and nursing
students may face a knowledge gap between infection control theory
and clinical training. The coronavirus disease 2019 (COVID-19) has
severely influenced various aspects of human life, particularly
education. This study aimed to explain the impact of the COVID-19
pandemic on nursing education from administrators, educators, and
students’ perspectives. An online educational schooling approach that
definitely continues theoretical reinforcement of hygiene practices
during clinical practice may help address the learning gap. This
editorial proposes a three-step virtual classroom teaching strategy to
assist nursing educators in improving online theoretical hand hygiene.
Student health positively correlates with educational outcomes thus
influencing academic achievement and lifelong well-being.
According to Quisao (2021), the current understanding of future health
care workers about COVID-19 is very important to identify gaps that
affect their perceptions and responses, which they can integrate into
the people in the community. The current study noted instability and
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challenges placed on nursing education during the pandemic.
Opportunities were addressed during the pandemic to improve the
nursing training process using planning, scientific management,
emerging technology, innovative educational opportunities, and
comprehensive support from institutional stakeholders and clear
guidelines and recommendations are needed to ensure medical
education safety during the pandemic (Farsi 2021). Strengthening
education programs and taking health measures at higher education
institutions to prevent COVID from spreading and preserve the
educational process. Universities of medical sciences have also faced
greater hurdles during this pandemic, as they train the next generation
of healthcare providers. Nursing and medical students are among
those required to cope with global health challenges in this regard.
One of the key concerns of educational administrators in the COVID-
19 pandemic is the continuation of education in medical universities to
train professional and empowered graduates to reduce hospital
workload.
Place of Origin
In December 2019, in Wuhan, adults went to local hospitals
with severe respiratory syndrome for an unknown reason. The control
system (developed after SARS disease spread) and patients'
respiratory samples were sent to reference laboratories to discover the
cause. On December 31st, 2019, China informed the WHO about the
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outbreak, and on January 1 st, 2020, Huanan seafood shops were
closed (Hadi et al. 2020). Today, nine or ten months after the
recognition that a new coronavirus had caused the sudden appearance
Liceo de Cagayan University College of Nursing of a large number of atypical
pneumonia in Wuhan, the city is still largely considered the place of
origin of the new viral disease. However, as documented in a recent
contribution, the virus and its pathologies had been present in China
well ahead of the Wuhan epidemic explosion and they had been active
outside China as well, for instance in Europe (Platto et al. 2021).
The infectious disease has started to spread rapidly; simulation
reports have resulted in multiple pandemics times. The number of new
cases has risen dramatically in new countries such as Iran, South
Korea, and Italy, while it has begun to fall in China. Today, COVID-
19 cases in China have the slowest growth rate when compared to
other high-case countries, and the outbreak appears to be under
control. In the same way, the extinction events are rarely observed,
and so too are origination events such as those of COVID-19. Without
rigorous tracing systems, dating the first cases has to be inferred. In the
case of emerging infectious diseases, this is most frequently based on
phylogenetic analysis. For this to be meaningful, it requires sufficient
sampling and diversity. Here we applied a well established extinction
estimator (i.e. OLE) from conservation science, to estimate the
origination times of COVID-19 for all countries with five or more case
dates. As the method can be effectively applied to very sparse
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datasets, with as few as 4–5 records, it illustrates the potential to
rapidly gain an understanding of the origination timings of novel
zoonotic diseases when they are poorly known. Moreover, some of the
approaches from this group of methods can be applied even to records
with just two or even a single record. Using methods borrowed from
conservation science, we can estimate a range of likely dates for the
zoonotic spillover of COVID-19 into humans in China and the
subsequent spread to countries around the world (Roberts 2021).
Occupation of the Parents
For several months, parents had to reorganize the care of their
children (Alon et al. 2020), which has posed new challenges for
reconciling work and family. Although fathers have become more
involved, mothers seem to have taken over most of the care work
(Hank and Steinbach 2020; Kreyenfeld et al. 2020; Möhring et al.
2020; Zinn et al. 2020). Women were assumed to act as primary carers
if formal childcare was no longer available since they labor in lower-
paid vocations, sectors, and positions (Boll and Lagemann 2018), and
hence had less bargaining power to negotiate lower contributions to
family work. Furthermore, traditional gender roles, in addition to
economic resources, may be accountable for traditional care
arrangements throughout the pandemic, according to identity theories
and role occupation perspectives. Long-term bargaining methods based
on historically solid opportunity structures, economic resources, and
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individual work-care norms may, however, have lost value as a result
of the COVID-19 epidemic. Instead, we anticipate that parental
working conditions will play a critical role in family care
arrangements during the pandemic. Parents in system-relevant
vocations, in particular, faced a unique problem. Many of them were
unable to work remotely and were forced to work longer hours,
particularly in the health and food industries (e.g. Kleinert et al. 2020).
Pandemic-related cutbacks in working hours or prolonged remote work
for parents in office occupations, on the other hand, are likely to have
given parents more opportunities to care for their children themselves.
The economic catastrophe brought on by the discovery of the new
coronavirus is not like other recessions. Lack of access to quality child
care and in-person schooling options has lowered parental supply of
labor, while demand for workers in high-contact and inflexible
service sectors has decreased. Women, who are normally less affected
by recessions than males, have seen a significant and sustained
reduction in employment and labor force participation as a result of
this. To document the pandemic's gendered impact, we explore real-
time data on employment, unemployment, labor force participation,
and gross job flows. We also explore the crisis's long-term
consequences, such as the impact of automation in slowing the
recovery of employment in the worst-affected service occupations
(Albanesi & Kim, 2021). Other previous research has shown that
women are disproportionately negatively affected by a variety of
28
socio-economic hardships, many of which COVID-19 is making
worse. In particular, because of gender roles, and because women’s
jobs tend to be given lower priority than men’s (since they are more
likely to be part-time, lower-income, and less secure), women assume
the obligations of increased caregiving needs at a much higher rate.
This unfairly renders women especially susceptible to short- and long-
term economic insecurity and decreases in wellbeing. Single-parent
households, the majority of which are headed by single mothers, face
even greater risks. These vulnerabilities are further compounded along
the dimensions of race, ethnicity, class, and geography. Furthermore,
the disproportionate effect the pandemic would have on women, it can
nonetheless be held responsible for mitigating these effects. To do so,
it must first recognize how women have been affected by the
outbreak. Specifically, policies must take into account the unpaid
labor of care that falls on women. Moreover, given that this labor is
particularly vital during a global health pandemic, the state ought to
immediately prioritize the value of this work by providing financial
stimuli directly to families, requiring employers to provide both sick
leave and parental leave for at least as long as schools and daycares
are inoperational, and providing subsidized emergency childcare.
(Nikki, 2020).
Highest Monthly Family Income
According to (Raymundo M. Campos-Vazquez, Gerardo
Esquivel, and Raquel Y. Badillo 2021) There is a concern among
29
social scientists and policymakers that the COVID 19 crisis might
permanently change the nature of work. We study how labor demand
in Mexico has been affected during the pandemic by web scraping job
ads from a leading job search website. In April there was a change in
the composition of labor demand, and wages dropped across the board.
By May, however, the wage distribution and the distribution of job ads
by occupation returned to their pre-pandemic levels. We find that the
variation in the average advertised wage in April is explained more by
a higher proportion of low-wage occupations than by a reduction in
the wages paid for particular occupations.
According to a different study, the presence of the COVID-19
pandemic in low and middle-income countries (LMICs) is generating
serious worries about the preparedness of these economies' health
systems to deal with the disease as it spreads. With health-care
facilities already overburdened before the pandemic, it is becoming
increasingly clear that adopting the measures used by high-income
countries in LMICs may not be feasible. Furthermore, there is a need
within LMICs to provide emergency assistance to vulnerable
populations, such as individuals and families experiencing poverty.
COVID-19 is a global health emergency, and many of the concerns
that have been identified throughout the pandemic are likely to be
worsened in areas with weakened health systems and widespread
misinformation about the virus. This study adds to our understanding
of how households in a low-income quintile of an LMIC acquire and
30
interpret information about a novel emergent disease. In the
Philippines, health-care utilization varies significantly depending on
socioeconomic status: only 59.7% of those in the lowest wealth
quintile had health insurance in 2017, compared to 83.2 percent of those
in the highest income percentile. During the early phases of the
pandemic, this study looked at KAP on COVID-19 among homes in
extreme poverty in the Philippines. Non-pharmaceutical interventions
(NPIs) such as social distancing and avoiding large crowds are
examples of NPIs that try to reduce transmission by lowering contact
rates in the general population. Such tactics will continue to be critical
in the global response to COVID-19 until a vaccine is developed but
they are especially important in this group since any novel
pharmaceutical intervention may be inaccessible due to cost or
inadequate distribution. While these findings reveal a lack of
understanding of NPI strategies among low-income households, there
is also growing recognition that people living in densely populated
urban slums and other low-income communities are unlikely to have
the spatial and economic capacity to engage in social distancing and
self-isolation. this study was to understand the knowledge, attitudes,
and practices (KAP) of COVID-19 among households experiencing
extreme poverty in the Philippines. Several studies examining KAPs
on COVID-19 have already been conducted, but there is a need to
understand KAPs among vulnerable and low-income communities. As
various guidelines and strategies are developed to address COVID-19
in LMICs, households from lower socioeconomic positions must be
31
equitably included in these initiatives (Lau et al. 2020).
Knowledge on Safety Protocols
Knowledge, perception, and preventive behavior should be
considered in the planning of effective educational interventions for
the coronavirus disease of the 2019 (COVID-19) pandemic and in
increasing awareness about the health risks brought about by this
disease. This research aimed to assess knowledge, perceptions, and
preventive behavior toward the COVID-19 infection among student
nurses. Nowadays, students and other health care should prepare
themselves for pandemic events as far in advance as potentially
worsening outbreak conditions. Coronavirus disease (COVID-19) is a
widespread pandemic disease, especially in a healthcare setting. The
pandemic has highlighted how protecting the healthy team is key to
keeping patients safe and ensuring a functioning health system. In that
case, students and other medical-related teams should have sufficient
knowledge and practice about pandemic events by using safety
measures in dealing with COVID-19 patients to protect themselves
from physical and biological hazards (Elshenawy 2021). The global
nursing and healthcare community is at the forefront of this
unprecedented public health outbreak. The World Health Organization
is one of many trusted public health organizations to provide
comprehensive guidelines for the protection of front-line healthcare
32
workers (WHO, 2020). Knowledge, attitudes, and practices (KAP)
affect the nurses' adherence to infection control measures towards
COVID 19.
Apart from this, KAP plays a vital role in deciding a nurse's
willingness to acknowledge the behavioral change process (Deem,
2018). Nurses play a prominent role in the vaccine uptake process.
They spend considerable time counseling patients, parents, families,
and the public about the benefits, risks, and safety of vaccines, as well
as administering them. The goal is to use these data to inform the
academic nursing community on the importance of developing
proactive strategies to promote the uptake of COVID-19 vaccination
among faculty and students, not only to protect themselves but also to
reduce the transmission of the disease to their families and in their
community from health authorities. Evaluating the KAP related to
COVID-19 among the nurses would help provide better insight to
address poor knowledge about the disease and develop educational
programs that may be needed to change misunderstandings about the
virus, mode of transmission, and preventive measures.
Previous research has supported that, for example, and not as a
limitation (Modi et al. 2020) mentioned that healthcare professionals in
India need frequent educational interventions and training programs on
infection control practices. Saqlain et al. (2020). The education
program included an illustrated Arabic brochure about safety measures
33
guidelines for nurses regarding COVID-19 protection and care. The
researchers adapted the program after reviewing the literature and
related research studies and based on the safety measures guidelines of
CDC (2019) as the benchmark for all COVID-19 patient care
guidance and provided protocols for best practices as regards the
prevention and monitoring of COVID-19 patients before, during, and
after hospitalization. It includes the following: definition of
COVID19, factors that can determine transmission risk of COVID-19,
guidelines (Centers for Disease Control and Prevention (CDC), 2019)
as regards the safety measures used in prevention and monitoring of
COVID-19, protective measures to prevent transmission of it and role
of the nurse in decreasing the risk for COVID-19 and how to protect
themselves and others form the infection. Having adequate knowledge
and the correct preventive behavior against COVID-19 will ensure that
nursing students are prepared to respond to future occurrences of
similar public health crises. The findings of this study provide baseline
information on the current state of the Saudi nursing students’
perceptions, knowledge, and preventive behavior toward COVID-19 as
the crisis is happening. The findings revealed some areas that should
be focused on by nursing
education, as well as MOH and other health agencies, to ensure that
the population has adequate knowledge and correct preventive
behavior. For example, knowledge of the disease’s correct
transmission routes should be a focus because this aspect received the
34
lowest knowledge score. Some preventive measures should be
emphasized, such as the washing of hands after blowing your nose,
coughing, or sneezing, and the disinfection of surrounding areas, given
that they were not frequently observed by the respondents. The
findings may also guide the nursing profession about its role in health
promotion and disease prevention (Albaqawi 2021).
Standard Precautions
According to Hamda (2020) Since the outbreak of the disease,
different governments around the world have been implementing
measures to contain and prevent the transmission of COVID-19. The
World Health Organization published COVID-19 guidelines and
protocols, which were adopted by the ministries of health of different
countries. These protocols include information on signs and symptoms
and prevention of and protective measures against COVID-19. The
Centers for Disease Control and Prevention reiterated that everyone
should protect themselves and others to prevent the spread of the
disease; such protection includes proper hand hygiene, proper
distancing, use of mask, proper etiquette when coughing and sneezing,
and isolation and decontamination of surfaces. The success of the
measures implemented is based on the people's adherence to
prevention controls, which is largely influenced by knowledge,
perception, and preventive behavior against COVID-19. However,
adapting these preventive and control behaviors requires adequate
35
knowledge, the right perception, and positive attitudes, as proposed by
the Knowledge–Attitudes–Behavior. Moreover, Hand hygiene is the
single most important measure to prevent transmission of infection, but
the compliance rate of healthcare workers is relatively low.
According to (Jeong and Kim, 2016) The purpose of this
research is to spread awareness in terms of low compliance rates from
all Levels of Nursing students. Also, the study aims to provide
applicable knowledge when it comes to correct and proper ways of
washing one’s hands. Hand washing is one of the fundamental
strategies for controlling the spread of infection. Careful hand drying is
integral to the process of hand washing which aims to optimize the
removal of potentially pathogenic microorganisms. Ineffective hand
drying results in wet hands that are an infection risk increases the
potential for cross infection, occupational contact dermatitis for
healthcare practitioners, harm to patients, and environmental
contamination.
In addition, (Gammon J & Hunt J, 2019). Hand washing, a very
simple action, remains the primary measure to reduce healthcare-
associated infections and the spread of antimicrobial resistance, yet
compliance with handwashing is very low. In Developing countries,
4,384 children die every day of care associated with infection. Several
techniques have been used to clean the hands and the technique’s
effectiveness in eliminating contamination has been compared several
36
times.
Different studies showed different results (Aranas, 2016).
Nursing students are the main respondents due to exposure to viruses,
diseases, etc. This study will identify if the Nursing student's
handwashing practices will be a help in reducing the spread of diseases
provided the washing equipment will be suggested for the much better
quality of handwashing practices.
Maintaining a safe distance between yourself and others is a good idea
and one of the most effective ways to avoid being infected with the
COVID-19 virus. People can spread the virus even if they aren't sick or
aware that they are infected, so it's crucial to keep a safe distance from
others. To reduce exposure to the COVID-19 virus and prevent its
spread, physical separation is essential on USM's main campus and in
outlying locations. It is the individual's responsibility to comply with
this rule. As indicated below, face coverings must cover the nose and
mouth. Direct supervisors may request reasonable accommodations for
persons who are medically unable to tolerate a face covering to achieve
this criterion. It also aimed to investigate the knowledge, attitude, and
practice towards COVID-19 of student nurses that will help to adhere
to and manage the understanding of the students. Nevertheless, having
constant reminders from the authorities and health care professionals is
the solution to aid public knowledge and comprehension relating to
COVID-19.
37
Chapter 3
RESEARCH AND METHODOLOGY
This chapter aims to introduce and describe the rationale for the
research methods chosen in this study. This chapter presents the
setting of the study, the research design, selection and description of
the participants, research instruments that will be used, data gathering
procedure, and statistical techniques.
Research Setting
This study will be conducted at Liceo de Cagayan University
38
Paseo del Rio Campus. The area is located in Rotunda Circle,
Macasandig, Cagayan de Oro City, Misamis Oriental, 9000.
Research Design
Researchers employ quantitative data when they are seeking to
quantify an issue, or when they are trying to answer the questions of
what or how many. A numeric scale is used to compare data that may
be tallied or compared on a numerical scale. This research method will
be used since the study's goal is to know about the significant
relationship between the nursing students’ academic status,
socioeconomic status, and their level of knowledge and adherence to
safety protocols during COVID 19 pandemic.
Respondents and Sampling Procedure
The participants of this study will be the randomly selected 136
(Third Year and Fourth Year) Nursing Students of Liceo de Cagayan
University, Second Semester, SY 2021-2022. In determining the
sample size, the researchers used the Slovin's formula to calculate the
sample size necessary to achieve a certain confidence interval when
sampling a population.
Research Instruments
The research instrument that will be used in this study is a
modified survey questionnaire; this type of research instrument
39
consists of a series of questions used to elicit data from a participant.
The questionnaire consists of 2 main sections; the first section
will determine the demographic profile of the participants which
includes the age, gender, year level, academic status, place of origin,
socioeconomic status.
The second section of the questionnaire will determine and
assess the level of knowledge and adherence of the participants on the
safety protocols during COVID 19 pandemic which consists of 30
questions.
Section 2 will be using a five-point Likert-type scale which is a
technique widely accepted for measurements of perception and
satisfaction (Simonson, 1979) and the statements are randomly
arranged on the questionnaire to reduce set response error. Below are
the scoring selections of the questionnaire:
Table 1
SCALE VERBAL INTERPRETATIONS
DESCRIPTION
5 Strongly Agree Excellent level of knowledge and adherence
to safety protocols
40
4 Agree Very good level of knowledge and
adherence to safety protocols
3 Neutral/Undecided Good level of knowledge and adherence
to safety protocols
2 Disagree Poor level of knowledge and adherence
to safety protocols
1 Strongly Disagree Very poor level of knowledge and
adherence to safety protocols
If the participants will choose: “Strongly Agree” for the rate of
5 meaning they had an Excellent level of knowledge and adherence to
safety protocols, for the rate of 4 which is “Agree” meaning they had a
very good level of knowledge and adherence to safety protocols, for
the rate of 3 which is “Neutral or Undecided” meaning they had a good
level of knowledge and adherence to safety protocols, for the rate of 2
which is “Disagree” meaning they had a poor level of knowledge and
adherence to safety protocols, for the rate
Liceo de Cagayan University College of Nursing of 1 which is “Strongly
Disagree” meaning they had a very poor level of knowledge and
adherence to safety protocols.
Validity and Reliability of Instruments
41
The Delphi method will be used in this study to arrive at a
group opinion or decision by surveying a panel of experts to assess the
validity of the instruments. Cronbach's alpha will be used to assess the
reliability, or internal consistency of the survey and a pilot testing will
be done to evaluate the feasibility of the proposed study.
Data Gathering Procedure
This section will state the sequence on how the researchers will gather
the data. At first, the researchers constructed a title and was validated
to the clinical instructor; it was also stated the general problem and
specific problem to be answered through the results of the study. The
researchers got the modified and researcher-made survey
questionnaires. After the research instrument is validated and the letter
is approved, the researchers will now give the research questionnaires
to the randomly selected third year and fourth nursing students. The
researchers will send the questionnaires via google forms and identify
participants until they reach the targeted sample size. The researchers
will give enough time for the participants to answer the survey
questionnaire. After the data collection, the researchers will now
tabulate the data and analyze the result.
Statistical Techniques
To facilitate and have accurate analysis of the interpretation,
the following statistical tools will be use:
1. The researchers will use frequency and percentage in order
42
to determine the demographic profile of the participants according to
their age, gender, year level, academic status, place of origin and
socioeconomic status.
2. In problem number two and three, the standard deviation will
be used to test the average amount of variability in the dataset. A high
standard deviation means that values are generally far from the mean,
while a low standard deviation indicates that values are clustered close
to the mean.
3. In problem number 4, the Pearson Product Moment of
Correlation will be used to test and establish the significant
relationship between the adherence, knowledge, and socio-
demographic profile of the participants.
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Ferma Mia Choi, Warren Dodd, and Xiaolin Wei (2020) “Knowledge,
attitudes and practices of COVID-19 among income-poor households
in the Philippines: A cross-sectional study”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294392/?
fbclid=IwAR2TDjgsWCRwq
ZQPujWjcZ0IMcXetOUYF7JStU6ZOfK8gpaXdKeBzM8TCgE
Stefania Albanesi & Jiyeon Kim (2021) “The Gendered Impact

of the COVID-19 Recession on the US Labor Market”
https://www.nber.org/papers/w28505
World Health Organization (WHO) "COVID-19 transmission

and protective measures"
https://www.who.int/westernpacific/emergencies/covid-19/
information/transmission protective-measures
Hamdan Mohammad Albaqawi, Nahed Alquwez, Ejercito

Balay-odao, Junel Bryan Bajet, Hawa Alabdulaziz, Fatmah Alsolami,
Regie B. Tumala, Abdalkarem Alsharari, Hanan Tork7, Ebaa Marwan
Felemban and Jonas Preposi Cruz (2020) “Nursing Students'
19: A Multi
University Study”
https://www.frontiersin.org/articles/10.3389/fpubh.2020.573390/full#B19
Hamdan Mohammad Albaqawi1, Nahed Alquwez, Ejercito

Balay-odao, Junel Bryan Bajet, Hawa Alabdulaziz, Fatmah Alsolami,
Regie B. Tumala, Abdalkarem F. Alsharari, Hanan M. M. Tork, Ebaa
Marwan Felemban and Jonas Preposi Cruz “Nursing Students'
19: A Multi
University Study”
48
https://www.frontiersin.org/articles/10.3389/fpubh.2020.573390/
full?fbclid=IwAR15I7Z G0DaBNT-
FxrWCf5rRr7Invtw0TTa6NG_Zv7w7WmdRxkBVJAiiXhQ#B13
Mohamed Elsayed, Hamed Elzeky(2020) Mansoura University

“COVID 19 Preventive Measures Among Mansoura Nursing
Students”
https://clinicaltrials.gov/ct2/show/NCT04473547
Nikki Forter (2020) “COVID-19, gender inequality, and the

responsibility of the state”
https://www.internationaljournalofwellbeing.org/index.php/ijow/article/view/1305
Valerio Capraro, Hélène Barcelo (2020) “The effect of

messaging and gender on intentions to wear a face covering to slow
down COVID-19 transmission”
https://arxiv.org/abs/2005.05467
Hongdou Li, Shuang Wang, Fan Zhong1,2, Wuyin Bao4,

Yipeng Li4, Lei Liu, Hongyan Wan3 and Yungang He (2020)
“Age-Dependent Risks of Incidence and Mortality of COVID-19
in Hubei Province and Other Parts of China”
https://www.frontiersin.org/articles/10.3389/fmed.2020.00190/full?
fbclid=IwAR2oYsn1u 75LuQ5B0YII6bhS8GZ3P-
FaDU6wV1CiEttE8pKHXIUm8YP_MwY
David L. Roberts, Jeremy S. Rossman, Ivan Jarić (2020)

“Dating first cases of COVID-19”
https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1009620
Jung Ki Kim and Eileen M. Crimmins (2020) “How does age

affect personal and social reactions to COVID-19: Results from the
national Understanding America Study”
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241950
49
APPENDICES
APPENDIX A
LETTER OF CONSENT
Liceo de Cagayan University Research Ethics
50
Review Committee Informed Consent Form for
Participants
Name of Principle Investigator: Coleen Jade T. Relova

Name of Organization: Liceo de Cagayan University -
College of Nursing Name of Sponsor:
Name of Project/Study Title/Study Protocol and Version:
KNOWLEDGE AND ADHERENCE TO SAFETY PROTOCOLS OF
NURSING STUDENTS DURING THE COVID 19 PANDEMIC
This Informed Consent Form has two parts:

• Information Sheet (to share information about
the study with you) • Certificate of Consent (for
signatures if you choose to participate) You will
be given a copy of the full Informed Consent
Form
PART I: INFORMATION SHEET
INTRODUCTION
Briefly introduce the proponent and concerned organization,

emphasize that this is an invitation to participate in a
study/research and that he or she can take time to reflect on
whether he or she want to participate or not. Assure the participant
that he or she
does not understand some of the words or concepts, that these will
be explained and that he or she can ask questions at any time.
PURPOSE OF THE RESEARCH
Explain the research question in ordinary, non-technical terms. Use

local and simplified words rather than scientific terms and
professional jargon. Consider local beliefs and knowledge when
deciding how best to provide the information.
TYPE OF RESEARCH INTERVENTION
Briefly state the type of intervention that will be undertaken. This
51
will be expanded upon in the procedures section but it may be
helpful and less confusing to the participant if they know from the
very beginning whether, for example, the research involves a
vaccine, an interview, a questionnaire, or a series of finger pricks.
PARTICIPANT SELECTION
Indicate why you have chosen this person to participate in this

research. People wonder why they have been chosen and may be
fearful, confused or concerned.
VOLUNTARY PARTICIPATION
Indicate clearly that they can choose to participate or not. State,

only if it is applicable, that they will still receive all the services
they usually do if they choose not to participate. Explanation: It
may be more applicable to assure them that their choosing to
participate or not will not have any bearing on their job or job-
related evaluations. This can be repeated and expanded upon later
in the form as well. It is important to state clearly at the beginning
of the form that participation is voluntary so that the other
information can be heard in this context. Although, if the interview
or group discussion has already taken place, the person cannot
'stop participation' but request that the information provided by
them not be used in the research study.
PROCEDURES
A. Provide a brief introduction to the format of the research study

and in which part of the study he or she will be involved.
B. Explain the type of questions that the participants are likely to

be asked in the focus group, the interviews, or the survey. If
the research involves questions or discussions which may be
sensitive or potentially cause embarrassment, inform the
participant of this.
For focus group discussions:
Give the location of the FGD, describe the FGD process, inform the
participant that there will be 7-8 other persons with similar
experiences, that the discussion will be guided by a moderator who
is trained to do so, whether the discussion will be recorded, how
confidentiality will be kept and how long the records will be stored.
Give the participant an idea on what topics will be taken up, that
questions the participant has
about the study may also be raised and discussed and that he or
she does not have to share any knowledge that he or she is not
52
comfortable sharing. It is also important for the participant to
know that he or she can still opt out of the study even after the
FGD by requesting that his or her participation not be cited part of
the data.
For interviews:
Inform the participant about the location of the interview (or a

preferred location of the participant) and identity of the
interviewer. Assure the participant that he or she does not wish to
answer any of the questions during the interview, the interviewer
will move on to the next question; that no one else but the
interviewer will be present unless he or she would like someone
else to be there. Describe how the interview will be recorded and
kept confidential. Explain how long the study records will be kept
and subsequently destroyed.
For questionnaire surveys:
Describe how the survey will be distributed and collected. Inform

the participant that he or she may answer the questionnaire
personally, or it can be read to him or her; answered aloud and
written down by a member of the research team. Assure the
participant that if he or she does not wish to answer any of the
questions, this may be skipped and he or she can proceed to the
next question. The information recorded is confidential, name is
not included on the forms, only a number will identify him or her,
and no one else except [name of person(s) with access to the
information] will have access to the results of the survey.)
DURATION
Include a statement about the time commitments of the research

for the participant including both the duration of the research and
follow-up, if relevant.
RISKS
Explain and describe any risks that can be anticipated or that are
possible. The risks depend upon the nature and type of qualitative
intervention, and should be, as usual, tailored to the specific issue
and situation.
If the discussion is on sensitive and personal issues (e.g.,

reproductive and sexual health, personal habits, etc.) or
confidential in nature, then there is a risk of embarrassment,
discomfort or fear. Assure the participant that he or she does not
have to answer any question or take part in the discussion,
interview, or survey if he or she feels the question(s) are too
personal or if talking about them makes him or her uncomfortable.
53
BENEFITS
Benefits may be divided into benefits to the individual, benefits to

the community in which the individual resides, and benefits to
society as a whole as a result of finding an answer to the research
question. Mention only those activities that will be actual benefits
and not those to which they are entitled regardless of participation.
REIMBURSEMENTS
State clearly that the participants will not receive payments beyond
reimbursements for expenses incurred as a result of their
participation.
CONFIDENTIALITY
Explain how the research team will maintain the confidentiality of

data with respect to both information about the participant and
information that the participant shares. Outline any limits to
confidentiality. Inform the participant that because something out
of the ordinary is being done through research, any individual
taking part in the research is likely to be more easily identified by
members of the community and therefore more likely to be
stigmatized. If the research is sensitive and/or involves
participants who are highly vulnerable - research concerning
violence against women for example - explain to the participant
any extra precautions you will take to ensure safety and
anonymity.
(The following applies to focus groups)
Focus groups provide a particular challenge to confidentiality

because once something is said in the group it becomes common
knowledge. Explain to the participant the group participants shall
be encouraged to respect confidentiality, but that this cannot be
guaranteed.
SHARING THE RESULTS
If there is a plan and a timeline for the sharing of information,

include the details. The participant may also be informed that the
research findings will be shared more broadly, for example,
through publications and conferences.
RIGHT TO REFUSE OR WITHDRAW
Reiterate that participation is voluntary and includes the right to

withdraw. Tailor this section to ensure that it fits for the group for
whom one is seeking consent. Participants should have an
opportunity to review their remarks in individual interviews and
54
erase part or all of the recording or note.
WHO TO CONTACT?
Provide the name and contact information of someone who is

involved, informed and accessible - a local person who can actually
be contacted. State also the name (and contact details) of the
local REC that has approved the proposal.
ADLAON, HANNAH GRACE P. 0936-464-3051

hadlaon65559@liceo.edu.ph PADLA, MARIAMA JAMIELA Y. 0926-
113-9114 mpadla24966@liceo.edu.ph ROA, GLEST ALLYSSA F.
0935-226-4362 groa07200@liceo.edu.ph SUPREMO, MARIFLOR
GRACE 0956-8307709 msupremo36415@liceo.edu.ph TARAY,
SHARON B. 0935-477-2631 staray53819@liceo.edu.ph
PART II: CERTIFICATE OF CONSENT
This section must be written in the first person. It should include a

few brief statements about the research and be followed by a
statement similar to the one in bold below. If the participant is
illiterate but gives oral consent, a witness must sign. A researcher
or the person going over the informed consent must sign each
consent.
I have read the foregoing information, or it has been read to

me. I have had the opportunity to ask questions about it
and any questions I have been asked have been answered
to my satisfaction. I consent voluntarily to be a participant
in this study.
Print Name of Participant: COLEEN JADE T. RELOVA_

Signature of Participant: ___________________
Date: [7/10/2022]
If Alternatively Schooled
A literate witness must sign (if possible, this person should be

selected by the participant and should have no connection to the
research team). Participants who are illiterate should include their
thumb print as well.
I have witnessed the accurate reading of the consent form

to the potential participant, and the individual has had the
55
opportunity to ask questions. I confirm that the individual
has given consent freely.
Print name of witness____________ Thumb print of

participant: Signature of witness _____________
Date: [MM/DD/YYYY]
STATEMENT BY THE RESEARCHER OR PERSON TAKING CONSENT
I have accurately read out the information sheet to the

potential participant, and to the best of my ability made
sure that the participant understands that the following will
be done:
1. the information gathered will be kept in strict confidentiality
2. Participants are invited to participate willingly and have the
option to withdraw at any time.
3. The survey will be conducted using google forms
As the investigator, I certify that the participant was

provided the chance to ask, inquire about this study
“KNOWLEDGE AND ADHERENCE TO SAFETY PROTOCOLS OF
NURSING STUDENTS DURING THE COVID 19 PANDEMIC”
and that I responded all of the participant’s questions
accurately and honestly to the best of my ability. I certify
that the consent was voluntary and that the participants
was not pressured and coerced into giving it.
A copy of this Informed Consent Form has been provided to the

participant.
Print Name of Researcher or person taking the consent

Signature of Researcher or person taking the consent
_________________________
Date: <7/7/2022>
Informed Consent Form for level three and level four

nursing students of Liceo de Cagayan University
56
APPENDIX B
LETTER OF APPROVAL
Paseo del Rio Campus, Cagayan de Oro City
College of Nursing
February 20, 2022
Dr. Gloria M. Cunanan, PhD, RN

Dear Dr. Cunanan,
In partial fulfillment of our research requirement, the third year nursing
57
students are currently working on a research study entitled
“Knowledge And Adherence To Safety Protocols Of Nursing Students
During The Covid 19 Pandemic”. The study's participants will be the
level 3 and level 4 students enrolled in the Bachelor of Science in
Nursing for the academic year 2021-2022.
In line with this, we would like to ask for your permission to conduct
this study. We will be distributing survey questionnaires via email.
Rest assured that we will observe the University research protocol in
the conduct of this study and any information gathered will be
confidential.
Your approval regarding this matter will be highly appreciated. Thank you for your
support.
Respectfully yours,
Coleen Jade T. Relova

Research Team Leader
Liceo de Cagayan University College of Nursing Noted by:
George Michael P. Lim, DM, MN, CHA,

FPCHA, FFSQUA, RN
Adviser
Approved by:
Gloria M. Cunanan, PhD, RN
58

Paseo del Rio Campus, Cagayan de Oro City
College of Nursing
February 2022
Dr. Ma. Florecilla C. Cinches

Vice President for Research, Extension, Planning, and Innovation
Dear Dr. Cinches,
59
The level 3 students of Bachelor of Science in Nursing of Liceo de
Cagayan University would like to request for your approval to conduct
our research entitled “Knowledge and Adherence to Safety Protocols of Nursing
Students During the Covid 19 Pandemic” in compliance with our Research 2
course requirement. The participants will be the level 3 and level 4
students enrolled in the Bachelor of Science in Nursing for the
academic year 2021-2022.
Rest assured that all information gathered will be treated with utmost
confidentiality. We would deeply appreciate it if you would permit us
to undertake this study because we believe the results will be
extremely useful in finishing our research. Thank you very much; we
eagerly await for your positive response regarding this matter.
Respectfully yours,
Coleen Jade T. Relova

Group Leader
Noted by:
GEORGE MICHAEL P. LIM, DM, MN, CHA,

FPCHA, FFSQUA, RN Adviser
Liceo de Cagayan University College of Nursing Approved by:
Ma. Florecilla C. Cinches, PhD

Vice President, REPI
Emma M. Dejarme, MAN, RN

Research Coordinator
60
Gloria M. Cunanan, PhD, RN
APPENDIX C
SURVEY QUESTIONNAIRES
QUESTIONNAIRE ON KNOWLEDGE OF
NURSING STUDENTS TO ADHERING SAFETY
PROTOCOLS DURING COVID 19 PANDEMIC
Section I. Demographic Profile of the Participants

Direction: Fill in the blanks with your answer.
Name (Optional): ______________________________

Age: __________
61
Sex: ________
Year Level: ________
Academic Status:
Regular ( )
Irregular ( )
Place of Origin:
Rural ( )
Urban ( )
Suburban ( )
Occupation of Parents: __________
Highest Family Monthly Income: _________
Section II. Questions Regarding to Knowledge and Adherence to

Safety Protocols Direction: Please indicate your answer to
each statement using the scale below.
Scale Verbal Description (Interpretation)
5 Strongly Agree (Excellent level of

knowledge and adherence to safety
protocols)
4 Agree (Very good level of knowledge

and adherence to safety protocols)
3 Neutral/Undecided (Good level of

knowledge and adherence to safety
protocols)
62
2 Disagree (Poor level o fknowledge
and adherence to safety protocols)
1 Strongly Disagree (Very poor level of

knowledge and adherence to safety protocols)
Face Mask 5 4 3 2 1
1. I understand clearly that there are

several types of face masks serving
different purposes.
2. I understand clearly how to evaluate

the effectiveness of the masks.
3. I understand clearly how to use a face

mask.
4. I think that wearing a mask in public

areas is effective to prevent infection.
5. I think that wearing a mask in

public areas can reduce the
chance of community
outbreaks.
Face Shields 5 4 3 2 1
1. Face shield is useful in protecting

myself from a patient suspected or
infected of COVID 19.
2. At no time should the front of the face

shield be touched.
3. Face shield is necessary during

hospital duty to ensure double
protection.
63
4. Reusing single-use face shields is not
Socialrecommended
Distancing and they should be 5 4 3 2 1
discarded immediately after use.
Handwashing 5 4 3 2 1
1. Always maintain a distance at least 1
meter from
1.5. Washing each other. with soap
hands
Gaps to the sidesfrequently
and
and underneath
water for theat least 20 seconds is
face shield
important
2. Avoid to prevent the someone
spread of
whichclose contact
may allow with
virus -laden that
COVID 19 virus.
has fevertoand cough.
droplets infect mucous
membranes (e.g. mouth, nose,
2.3.Is eyes).
it important
To prevent toCOVID-19
remove rings, infection,
watches
and bracelets during hand washing.
individuals should avoid going to
crowded places such as public
transportation, hospitals, and malls.
3. Washing hands after going out or
touching things outside is important.
4. Staying at home as possible to minimize
the risk of infection.
4. Using a paper towel to turn off the faucet
after washing my hands.
5. Limit physical contacts with
people suchabout
5. Knowledge as handshakes.
noncompliance with
hand hygiene is a risk of having COVID 19.
64
APPENDIX D
June 9, 2022
Researcher: COLEEN JADE T. RELOVA
Scale: ALL VARIABLES
Case Processing Summary
N %
Valid 30 100.0
Cases Excludeda 0 .0
Total 30 100.0
a. Listwise deletion based on all variables in the

procedure.
Reliability Statistics
Items Cronbach’s Alpha N of Items
FACE MASK .896 5

FACE SHIELD .835 5
SOCIAL DISTANCING .936 5
HANDWASHING .917 5
65
Interpretation: Reliable
Decision: Proceed to the administration of survey questionnaire.
Bernard A. Gutierrez
Data Process
FACE MASK
Item-Total Statistics
Scale Mean if Scale Variance Corrected Item- Cronbach's

Item Deleted if Item Deleted Total Correlation Alpha if Item
Deleted
VAR00001 19.1333 2.809 .765 .870

VAR00002 19.0333 2.861 .690 .889
VAR00003 19.0000 2.897 .837 .854
VAR00004 19.0000 2.897 .837 .854
VAR00005 19.0333 3.344 .624 .898
FACE SHIELD

Deleted
VAR00001 17.6667 5.816 .527 .835

VAR00002 17.7667 5.357 .757 .768
VAR00003 17.5333 5.982 .569 .820
VAR00004 17.8000 5.269 .682 .789
VAR00005 17.5000 6.052 .683 .795
SOCIAL DISTANCING

Deleted
VAR00001 18.8333 4.213 .770 .934

VAR00002 18.8000 4.372 .814 .924
66
VAR00003 18.7667 4.323 .865 .915
VAR00004 18.7000 4.217 .854 .917
VAR00005 18.7667 4.116 .853 .917
HANDWASHING

Deleted
VAR00001 19.4000 1.903 .921 .868

VAR00002 19.4000 1.972 .852 .884
VAR00003 19.4000 1.972 .852 .884
VAR00004 19.3667 2.585 .525 .943
VAR00005 19.3667 2.309 .818 .896
67
APPENDIX F
CURRICULUM VITAE
Name: HANNAH GRACE P. ADLAON
Address: MARANDING, LALA, LANAO DEL

NORTE
Email Address: hadlaon65559@liceo.edu.ph
Name of Father: HARRY P. ADLAON
Name of Mother: DOREEN P. ADLAON
School Graduated:
Elementary: BIBLE BAPTIST CHRISTIAN ACADEMY
High School: BIBLE BAPTIST CHRISTIAN ACADEMY
Senior High School: BIBLE BAPTIST CHRISTIAN ACADEMY
College: LICEO DE CAGAYAN UNIVERSITY
Membership:
68
CURRICULUM VITAE
Name: MARIAMA JAMIELA Y. PADLA
Address: NHA KAUSWAGAN, CAGAYAN DE ORO

CITY
Email Address: mpadla24966@liceo.edu.ph
Name of Father: MARIO REY C. PADLA
Name of Mother: LYLA Y. PADLA
School Graduated:
Elementary: LICEO DE CAGAYAN UNIVERSITY
High School: LICEO DE CAGAYAN UNIVERSITY
Senior High School: LICEO DE CAGAYAN UNIVERSITY
Membership:
69
CURRICULUM VITAE
Name: COLEEN JADE T. RELOVA
Address: TAGANA-AN, SURIGAO DEL NORTE
Email Address: crelova28618@liceo.edu.ph
Name of Father: MERVIN A. RELOVA
Name of Mother: MARLYN T. RELOVA
School Graduated:
Elementary: TAGANA-An NATIONAL HIGH SCHOOL
High School: TAGANA-An NATIONAL HIGH SCHOOL
Senior High School: ST. PAUL UNIVERSITY SURIGAO
Membership:
70
CURRICULUM VITAE
Name: GLEST ALLYSSA F. ROA
Address: MACASANDIG, CAGAYAN DE ORO

CITY
Email Address: groa07200@liceo.edu.ph
Name of Father: GLENTER ROXAS ROA
Name of Mother: JIJI LEANO FUENTES
School Graduated:
Elementary: CITY CENTRAL SCHOOL
High School: MISAMIS ORIENTAL GENERAL
COMPREHENSIVE HIGH SCHOOL
Membership: NONE
71
CURRICULUM VITAE
Name: MARIFLOR GRACE SUPREMO
Address: BLOCK 46, LOT 23, PHASE 2, KAIMITO
ST., UPPER BALULANG, XAVIER ESTATES,
CAGAYAN DE ORO CITY
Email Address: msupremo36415@liceo.edu.ph
Name of Father:
Name of Mother: MARIBELLE S. SARCON
School Graduated:
Elementary: KINOGUITAN CENTRAL SCHOOL
High School: HOLY CHILD HIGH SCHOOL
Senior High School: LICEO DE CAGAYAN UNIVERSITY –
PASEO DEL RIO CAMPUS
Membership:
72
CURRICULUM VITAE
Name: SHARON B. TARAY
Address: ZONE 2 KAUSWAGAN TAMPARONG
COMPOUND, CAGAYAN DE ORO CITY
Email Address: staray53819@liceo.edu.ph
Name of Father: WALTER TARAY
Name of Mother: GERRYLENE TARAY
School Graduated:
Elementary: KAUSWAGAN CENTRAL SCHOOL
High School: DON MARIANO CANOU COLLEGE
Membership:
73
74

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KNOWLEDGE OF NURSING STUDENTS TO ADHERING SAFETY PROTOCOLS

DURING COVID 19 PANDEMIC

HANNAH GRACE P. ADLAON

A Research Study Presented to the

HANNAH GRACE P. ADLAON

This Research Paper entitled “KNOWLEDGE AND ADHERENCE TO SAFETY

GEORGE MICHAEL P. LIM, DM, MN, CHA, FPCHA, FFSQUA, RN

APPROVED in partial fulfillment of the requirements for the Bachelor of

the Panel of Examiners with a grade of _____

NENETU I. PRADO, PhD

CHRISTIAN V. VILLAN, MAN, RN BERNARDA C. LLENO, PhD, MN, RN

Comprehensive Examination: ______

GLORIA M. CUNANAN, PhD, RN

The protocol implementation is caused by a lack of compliance and resource

students do not follow standard precautions, infection and preventive control

enforce rigorous adherence to safety standards, which has an impact on the

student’s conduct in terms of following such rules. A study conducted in both

clinical duties. Knowledge and compliance with standard precautions is essential to

prevent hospital associated infections and protect patients as well as medical

workers from exposure to infectious agents (Leodoro J et al., 2020). According to

profound understanding of COVID-19-related information possibly because of

their exposure to high-level learning and COVID-19- related information in their

theoretical courses and hospital exposures. Individuals' behavior is informed by

contact with others and likelihood to comply with official recommendations.

Human factors include the population levels of knowledge, immune response to

to the outbreak (availability of treatment or vaccine), and implementation of

infection control measures in the population. Public adherence to restrictions can

influence the success of the implementation of restrictive rules. Adherence

depends on how well-informed people are about both the consequences of

knowledge and adherence of Nursing Students towards safety protocols. The

systems, and governing body to do specific responses like mass testing,

and different number of cases, and also the diversity of people.

Liceo de Cagayan University College of Nursing Having adequate knowledge

nursing students are prepared to respond in future occurrences of

similar public health crises. Therefore, knowledge, perception, and

preventive behavior should be considered in the planning of effective

educational interventions for the coronavirus disease COVID-19

pandemic and in increasing awareness about the health risks brought

about by this disease (Hamdan Mohammad et al., 2020).

The Theory of Health as Expanding Consciousness and

Operant Conditioning was used as the supporting theories to explain

the knowledge and adherence to safety protocols of Liceo de Cagayan

University's nursing students during COVID 19 pandemic.

Health as Expanding Consciousness

The theory of health as expanding consciousness (HEC) was

stimulated by concern for those for whom health as the absence of

people facing the uncertainty, debilitation, loss and eventual death

associated with chronic illness. The theory has progressed to include

the health of all persons regardless of the presence or absence of

disease. It asserts that every person in every situation, no matter how

disordered and hopeless it may seem, is part of the universal process

of expanding consciousness; a process of becoming more of oneself, of

finding greater meaning in life, and of reaching new dimensions of

connectedness with other people and the world”. Health is central to

the theory and is seen as a process of a developing awareness of the

individual self and the person's environment (Newman, 2010).

Liceo de Cagayan University College of Nursing Consciousness is described

as “the state of understanding and realizing something” which cannot

only transmit information, but also produce meaningful information,

and change individuals to act autonomously. In relation to our study,

develop a higher level of consciousness. Being conscious should be

considered to increase awareness about the health risks brought by

and prevention. On the other hand, Newman also explains the