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TABLE OF CONTENTS

CHAPTER PAGE

TABLE OF CONTENTS…………………………………………………………….. i
ABSTRACT…………………………………………………………………………… ii

I. INTRODUCTION………………………………………………………… 1

II. METHODOLOGY……………………………………………………….. 4

III. RESULTS AND DISCUSSION ………………………………………… 5

REFERENCES………………………………………………………………………… 15
APPENDIX…………………………………………………………………………….. 19
CURRICULUM VITAE……………………………………………………………….. 28

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 PHILIPPINE SAVIOURS: Narratives Of Filipino Intensive Care Nurses
and their Ways on Handling Chronically Ill Patients.

Agahan, Gavin Dale A., 11 - St. Anthony

Adarayan, Christel May O., 11 - St. Anthony
Dela Paz, Ellis Pauline M., 11 - St. Anthony
Espada, Edward C., 11 - St. Anthony
Nuñez, Prince Ally S., 11 - St. Anthony
Sampiano, Hannah Elisha V., 11 - St. Anthony
Santos, Euzela A., 11 - St. Anthony
Sarcos, Carmille Dorren D., 11 - St. Anthony

Abstract

This qualitative study investigates the work and challenges faced by Filipino intensive care
nurses in hospitals, particularly in the intensive care unit. It aims to comprehend how they deal
with chronically ill patients and how they negotiate care strategies. To collect information from
research participants, this study employs a qualitative and narrative research design. In the
findings, the participants talked about their narratives, particularly their memorable moments
while working in the ICU. The majority of participants have had the experience of saving a
patient's life, which they believe to be their most memorable experience, while one of the three
participants has had the experience of admiring parents helping and guiding their chronically ill
child. This study also addresses the difficulties they frequently experienced. The majority of the
participants stated emotional involvement, exposure to health hazards, and low health literacy, all
of which made their work as an ICU nurse difficult. In addition, one participant had challenging
experiences with physical demands and doctor-nurse partnerships. As a result, ICU nurses have
learned how to deal with difficult patients and work situations. Giving tenderness, setting
boundaries, doing physical self-care, and following the nursing standards of care are the most
recommended strategies in dealing with patients and work difficulties; some participants
recommend asking for help from other departments and possessing a critical eye. They had
memorable moments and challenges at work, and as a result of these experiences, they developed
strategies to deal with their patients and work difficulties.

Key words: Intensive care unit, ICU nurses, Chronically ill patients, Critical care

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INTRODUCTION

Thankfully, people born with severe illnesses, or chronically ill patients, survive with the
use of technological innovations in hospitals. However, a continuous focus on technological
innovation alone can cause just as much harm as good (Alpert, 2022). Healthcare workers are
still required for chronically ill patients to survive and to appropriately receive their intensive
treatment. A facility in the hospital provides critical care and life support for acutely ill patients,
namely the ICU, and nurses are one of the major operators trained in giving critical care for
patients with a range of medical, surgical, and trauma problems (Department of Health in
Australia, 2018). Given that, constant monitoring, caring for, and providing intensive treatment
for chronically ill patients may cause difficulties for nurses.
What exactly is an ICU nurse? And what do they do? ICU is an acronym for intensive
care unit, a critical care facility located inside hospitals that is open 24 hours a day (Meinke,
2019). Patients who are seriously or chronically ill are the most vulnerable in a healthcare system
and need close monitoring in case their condition rapidly worsens. ICU nurses have received
special training to deal with these emergency situations. They provide vital medical care and
monitoring as well as emotional and practical support to patients and their families. Critical care
nurses perform a dynamic and crucial role in a high-stress environment (Stenquist, 2020). This is
why ill patients require the support and care of an ICU nurse to keep their condition from
worsening.
According to Anjali Stenquist (2020), ICU nurses play an important role in our lives,
especially for those who are ill and have health problems and need to be treated or delivered
right away to the hospital for medical treatment. This study gives more information about the
medical field, particularly in the ICU, to show readers how challenging and intricate the area of
ICU nursing is through the experiences of the nurses who work there. Technical processes,
commitment, maintaining good health, and other fundamental qualities are needed for ICU
nurses (Stenquist, 2020). Although the job of an ICU or critical care nurse is exceedingly
challenging, it is their duty to take care of patients who are in unstable conditions (Cesare, 2021).
A nurse working in an intensive care unit (ICU) or in critical care may face many
difficult situations. The capacity to manage many factors as they relate to the status of severely
sick patients is necessary for ICU nursing positions, which also call for both mental and physical

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endurance (The Nursezone Writing Staff, 2019). Critical care units frequently experience staff
turnover, and here are some challenges relating to the hardiness of ICU nurses. One of the
challenges that ICU nurses face is stress. Every workplace experiences stress on a regular basis,
but ICU employees (doctors and nurses) experience proportionately more work-related stress
than those in most other jobs, making it a highly stressful environment for both patients and their
families as well as for the ICU team. (Shibu Sasidharan and Harpreet Singh Dhillon, 2021). ICU
nurses also have the challenge of having no breaks, which means they must maintain complete
focus throughout their entire shift and be ready to manage any problems that may arise in order
to ensure patient safety. One of the main challenges for ICU nurses is the requirement to be "on."
This may be stressful, especially when one or more patients' lives are frequently on the line; it
can also cause exhaustion. Compassion fatigue is another difficulty faced by ICU nurses. ICU
nurses take care of fewer patients at once, however, and typically require extended hospital stays
and continuous care. Because of the frequent close contact, ICU nurses can form an emotional
connection with patients. ICU nurses usually serve as companions, yet one disadvantage of this
bond is the greater sense of grief felt when a patient passes away. Unfortunately, considering how
vulnerable ICU patients are, this is a regular outcome. Secondary traumatic stress disorder (STS),
commonly known as "compassion fatigue," may develop (The Nursezone Writing Staff, 2019).
Additionally, it is said in a study that because of job-related stress, most newly qualified ICU
nurses had burnout, a psychological syndrome of exhaustion and disillusionment (Akroute et al.,
2022). Thus, it is vital to make efforts to overcome these obstacles. However, further research
and improvement in the nursing curriculum are necessary to shed light on these difficulties and
enable adjustments to the current environment in order to enhance nurses' working conditions,
deliver safe and effective patient care, and ultimately guarantee patient safety (Moradi PhD et al.,
2021; Paguio & Banayat, 2018).
The purpose of this qualitative study is to explore and gain a deep understanding of the
work and hardships that Filipino intensive care nurses (nurses in the ICU) conduct in hospitals.
The goal of this qualitative study is to determine the ways that Filipino intensive care nurses
handle chronically ill patients. The study contributes to the field of ICU nurses by explaining
how to negotiate care strategies and deal with chronically ill patients by understanding their
experiences. The study will help the upcoming ICU nurses have a deep understanding of how to

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manage and take care of chronically ill patients and prepare themselves for the challenges they
may face as intensive care nurses.
The field of medicine performs all aspects of its duties, including caring for patients in
life-threatening circumstances. However, not all jobs in the medical field involve caring for the
chronically ill. Chronically ill patients require around-the-clock monitoring and life support
(HealthDirect, n.d.), and for the researchers to gain knowledge on ways to handle chronically ill
patients, they limited the participants to mere intensive care nurses. These nurses are more
frequent in administering treatment and provide constant support throughout the recovery of a
chronically ill patient (Meinke, 2019). Exactly three (3) intensive care nurses from Metro Manila
are the research participants. Since most hospitals are in Metro Manila, it was simpler for the
researchers to contact participants and collect data around the area. The researchers will conduct
the study from January to May 2023 only.
A similar study by Anne Rosamond Butt in 2021 suggested that the ways in which
intensive care nurses handle chronically ill patients need further investigation. This study is
beneficial because the researchers aim to provide coping strategies for ICU nurses handling
chronically ill patients. Different strategies may apply, such as cognitive, affective, and
behavioral. It is crucial to provide ways in which intensive care nurses are convenient for the
knowledge of other or future intensive care nurses. Providing ways of coping strategies can
minimize their struggles in handling chronically ill patients. The findings of the research are
expected to improve the quality of care provided by current intensive care nurses and develop
new ideas in the health care and nursing professions, particularly in the ICU. The study will also
benefit future intensive care nurses since they can expand their medical knowledge about an
actual critical situation. In addition, the study can influence future intensive care nurses, as well
as future researchers, to have a better understanding of the field. The study will benefit future
researchers about ICU nurses in regards to the work, hardships, and ways Filipino intensive care
nurses handle chronically ill patients.

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 With that being said, the researchers expect the following questions to be answered at the
end of the study:
1. What are the narratives of Filipino intensive care nurses on handling chronically ill
patients?
2. What are the challenges experienced by Filipino intensive care nurses in handling
chronically ill patients?
3. What are the ways or strategies of Filipino intensive care nurses in handling
chronically ill patients?

METHODOLOGY
This study uses a qualitative and narrative research design to collect information from the
research participants. Qualitative research aims to investigate and offer a more in-depth
understanding of issues in the real world. The experiences, viewpoints, and actions of
participants are gathered in qualitative research (Steven Tenny et al., 2022). In narrative research,
people are expressed visually, orally, or both. These methods frequently concentrate on the lives
of individuals as told through their own stories (Clandinin & Connelly, 2000).
Volunteer sampling will be used as the sampling technique. Nurses in the healthcare sector
can be very busy with several medical tasks and high patient call volumes (Govasli & Solvoll,
2020). The researchers considered their time and busyness inside hospitals. Thus, the researchers
will conduct an interview with willing Filipino ICU nurses to be part of the study.
Filipino ICU nurses around Metro Manila are the research participants. The researchers will
gather exactly three (3) Filipino ICU nurses that are qualified for the study. The researchers will
only gather research participants around Metro Manila since most hospitals are in the said area
(Statista Research Department, 2023). For the convenience of both participants and researchers,
a virtual one-on-one interview will be conducted to gather the needed data. The researchers will
prepare a semi-structured interview guide prior to the interview. Coding will be utilized for the
treatment of data to discuss the research findings.

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RESULTS AND DISCUSSION

The job of an ICU nurse is exceedingly challenging most of the time (Cesare, 2021). Yet,
ICU nurses have their own unique, untold stories of memorable experiences inside their
workplace. Three (3) Filipino ICU nurses were able to provide their narratives, particularly their
memorable experiences handling chronically ill patients. Two (2) themes were documented,
explaining their narratives.

Participant Initial Coding Axial Coding Selective Coding

Taking the necessary action to
1 Life-saving action save one's life. The Narratives of
Filipino Intensive
Parents supporting and guiding
Care Nurses on
2 Parental guidance their ill child in their chronic
situation.
Handling
Taking the necessary action to Chronically Ill
3 Life-saving action save one's life. Patients

Table 1
The Narratives of Filipino Intensive Care Nurses on Handling Chronically Ill Patients

Life-saving action

ICUs (Intensive Care Units) use specific actions to treat their patients. When a patient
requires care, it is critical to know the best method or methods of action. One of the best
examples is the CPR method used when a patient undergoes a cardiac arrest (Mayo Clinic,
2022). CPR is given immediately after cardiac arrest as it can double or triple a person's chance
of survival (Ibrahim, 2007). This describes the situation of participant (1) about the urgency to
give CPR on a critical patient that had cardiac arrest; “So most of the time nag-aattend kami sa
code. Ang ibig sabihin ng code is ‘yung, pag ‘yung pasyente nag-arrest that’s the time. So, there
is one time na I attended the code. Ako ‘yung nag CPR or ako ‘yung nag bigay ng
Cardiopulmonary resuscitation.” In addition, critical thinking is also important when caring for
chronically ill patients because it affects the patient's safety in critical situations. This describes
participant (3)’s statement about a time when she had to do something about a critically ill
patient. Her exact words were, “One of my patients was diagnosed with acute coronary syndrome

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and he doesn’t have relatives to help him so wala syang bantay. We have to put him in the nearest
room in our nurse station so we can cater his needs immediately.” ICU nurses must carefully
consider the necessary actions and methods of dealing with the patients in order to prevent their
condition from worsening (Ali-Abadi et al., 2020).

Parental guidance

Parents (or guardians) who assist and guide their chronically ill child or family member in
surpassing their difficulties in the hospital bed amazes participant (2). One of her remarkable
statements was, “Personally, I really admire those parents of the kids na chronically ill ‘yung
patient nila, because they were very brave, diba. Syempre bata, so parang, feeling ko ang
tapang-tapang nila na nahahandle nila ang situation pero talagang hindi nila iniiwan.” Parental
guidance is essential to giving young patients emotional support and love, in spite of knowing
their child’s danger (Torres Jr., MD, 2021). It requires strength and faith for a parent to show that
they are together in their child’s battle.

Past studies have shown that ICU nurses often experience difficulties such as stress, having
no breaks, fatigue, STS, and burnout. These are just a few of the difficulties that ICU nurses
encounter. The three (3) participants were able to address more challenges they frequently
experience in their workplace. Five (5) themes were documented, explaining their challenges as
ICU nurses.

Participant Initial Coding Axial Coding Selective Coding

Built connections between ICU
Emotional nurses and their chronically ill
1 involvement patients.
The risk of working in the ICU The Challenges
Health hazards department with several patients Experienced by
possessing chronic illnesses. Filipino Intensive
Patients in the ICU require a lot of Care Nurses on
Physical demand assistance from ICU nurses.
Handling
Lesser workers mean exhaustion Chronically Ill
for present ICU nurses.
Patients
Sometimes, doctors neglect or fail
Doctor-nurse to care for chronically ill patients
partnership that were referred by the ICU
nurses.

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 Parents or guardians of patients
Low health cannot thoroughly understand their
2
literacy family member's or relative’s
situation.
There are times when patients,
Low health parents, or guardians are in shock
literacy or in a state of confusion, leading
to late notice.
Being able to save lives and treat
illnesses also means sacrificing
3 Health hazards health, particularly physical
health.
ICU nurses are also affected by a
Emotional patient’s death and its impact on
involvement the family/relatives.

Table 2
The Challenges Experienced by Filipino Intensive Care Nurses on Handling Chronically Ill
Patients

Emotional involvement

ICU nurses often experience a high level of emotional involvement in their work due to
the nature of the intensive care unit and the critical condition of their patients. It is mediated by
continuous contact with patients in the ICU (Papathanassoglou et al., 2011). Furthermore, nurses
may have personal experience dealing with grief or sadness towards a patient, or act as a support
system for patients and their families who are grieving and losing a loved one (Oates &
Fogelman, 2022). The study by Oates and Fogelman entitled Nursing Grief and Loss supports
the challenging situation of participant (3). Her exact words were, "So, as an ICU nurse, uh.. I
witness deaths everyday and I can see how their relatives are dealing of their loss of family
member. They also express anger in some situations and it affects us nurses on some level."
Although ICU nurses are merely responsible for evaluating conditions, administering treatment,
and providing medical support for patients inside the hospital, when a patient dies, they may also
tend to feel grief and loss along with the family members as a result of their emotional
involvement with their chronically ill patients.

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Health hazards

The physical environment of the ICU may contain various hazards likely to cause injuries
and illnesses to ICU workers (Esin & Sezgin, 2017). ICU nurses have a wide variety of
responsibilities, each of which puts them in danger. According to Esin and Sezgin, they defy
such likely dangers as the transmission of illnesses, exposure to poisonous substances, and stress.
The COVID-19 pandemic, in particular, had a huge impact on ICU nurses. Many patients had
difficulty breathing due to the spreading virus, and ICU nurses were in charge of taking care of
them with intensive treatment. Participant (1) happened to experience this difficulty and stated,
“...kasi nga sila may mga sakit, so lalo na nitong pandemic minsan nahahawa kami.” The
COVID-19 virus is known to be highly contagious, especially back then when the vaccine was
not yet available, leading ICU nurses to be infected by the spreading virus. She added, “‘Yung
long shift kasi, we work a 12 hr shift every, kumbaga, in 21 days 10 days pasok ganon.” Many of
them worked long shifts for weeks with no days off, especially amidst the pandemic where
healthcare workers are in demand (Moradi PhD et al., 2021). Working long shifts inside hospitals
increases the likelihood of being infected, especially during the pandemic (Rowlands, 2021).
Furthermore, a study by Cynthia Dias and Robin Dawson (2020) found that due to time
constraints imposed by long shifts, nurses eat earlier, later, or not at all. Participant (3) addressed
the fact that “...sometimes I won’t be able to eat on time or even go the bathroom because of
frequent emergencies.” The sacrifices they had to endure just to keep them on track increased
their likelihood of health hazards. These frequent challenges may greatly contribute to
work-related stress (Esin & Segzin, 2017). “I always experience fatigue.” in addition to
participant (3)’s statements.

Physical Demand

The provision of direct patient care by hospital nurses is closely correlated with physical
demands. Given that nursing jobs must be completed efficiently and effectively, there will likely
be very significant physical demands. (Chang, 2022). Some physical tasks performed by nurses,
particularly in the ICU, while on duty include standing, walking, running, lifting objects, moving
objects or devices and items, moving patients, changing patient positions, supporting patient
ambulation, dragging wheelchairs, giving patients hygienic care, and changing bed sheets
(Chang, 2022). According to participant (1), “Physical demanding ang pasyente, like, sometimes,

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uhh.. syempre may mga mabibigat na pasyente. We cannot handle all those people, na minsan
marami ‘yung pasyente kaysa sa nurses, ‘yung ganon. ‘Yun ‘yung mga hardships namin bilang
nurse dito sa Pilipinas, as a nurse sa ICU. Mahirap kasi kapag maraming pasyente hindi mo
magagawa ‘yung gusto mong gawin for your patient.” Doing these everyday physical practices
would be difficult for ICU nurses when the day comes when there are only a few of them
available in the unit.

Doctor-nurse partnership

Nurses and doctors frequently struggle to develop effective communication patterns because
of their varying views of appropriate professional behavior in the clinical setting (Blue, 2019).
According to participant (1), “...gusto mo nga gumaling ‘yung pasyente mo but the doctor is not
responding to your referral, ‘yon.. uhm.. dapat in collaboration para maging maganda.” Nurses
often have to phone doctors to get explanations or instructions on how to handle a certain patient,
and doctors are not always receptive to such calls (University of Missouri, n.d.). She added,
“...dapat in collaboration para maging maganda. Ma-reach mo ‘yung goal mo for your patient
to become better. Dapat doctor-nurse partnership.” In order to begin a partnership, the nurse and
doctor must establish a meaningful collaboration. The relationship is founded on mutual trust and
effective communication techniques. When each profession begins to interact with one another
with a shared goal and respect, a connection can be made. (Brown et al., 2015).

Low health literacy

Low health literacy refers to the situation where ICU nurses find it challenging to explain
medical information to patients, parents, or guardians, leading to stress and frustration
(McAdam et al., 2010). According to participant (2), “...sobrang hirap mag explain ng situation,
‘yung kung ano situation nung anak nila.” She further added, “‘yung iba, in denial sila (about a
medical condition). So minsan late notice ‘yung nangyayari, dahil ganun ‘yung nangyayari,
hindi na sya nahahabol to treatment.” This can occur for various reasons, such as the complexity
of medical jargon, the emotional state of the patient or family members, or the lack of time to
provide detailed explanations (Wayne RN, 2023). In such cases, nurses may need to use
alternative communication strategies, such as visual aids, simplified language, or involving other

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healthcare professionals, to ensure that patients and their families understand the medical
information.

Handling chronically ill patients can be very crucial and delicate. As a result, ICU nurses
have provided ways, even their own unique ways, on how to handle their patients and work
difficulties. The three (3) participants were able to state their ways or strategies for handling
chronically ill patients and the hardships they often experience. Six (6) themes were documented,
explaining their ways.

Participant Initial Coding Axial Coding Selective Coding

Performing acts of kindness for
chronically ill patients and
1 Tenderness acknowledging their concerns
about the situation. The Ways or
Possessing a critical eye allows Strategies of
Critical eye an ICU nurse to trace patients Filipino Intensive
who are at risk. Care Nurses on
Setting boundaries alleviates pain Handling
Establishing and attachment issues for ICU
boundaries Chronically Ill
nurses. Patients
It is as important to take care of
Physical self-care oneself as it is to take care of
chronically ill patients.
Assistance from different
healthcare departments can help
Asking for help
alleviate the physical demand on
ICU nurses.
There is a standard of patient care
Nursing that ICU nurses must practice and
2
standards of care follow. There are different
practices for each case.
Filipino ICU nurses provide
enough love, care, and passion
Tenderness for their patients to show support
on their recovery.
Every case and difficulty with
Establishing patients should be left inside
boundaries hospitals only. This would avoid
a heavy heart.
Creating a list of what needs to
Nursing be done helps accomplish
3
standards of care medical tasks.

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 Nurse-patient interaction should
Nursing adhere to the standards of care or
standards of care guidelines that nurses should act
upon.
Having compassion and empathy
towards patients creates a healthy
Tenderness therapeutic nurse-patient
relationship.
It is as important to take care of
oneself as it is to take care of
Physical self-care chronically ill patients. Health
plays a vital role in handling
patients.

Table 3
The Ways or Strategies of Filipino Intensive Care Nurses on Handling Chronically Ill Patients

Tenderness

58% of adult patients report feeling pain, which has negative effects including slower
recovery and delirium (Alotni RN et al., 2022). Effective pain management is one of the crucial
parts of the critical care nurse’s job, and one of it is tenderness. Tenderness is the act of
gentleness or kindness, and ICU nurses handle chronically ill patients with tenderness because
they understand that discomfort in illness is complex and persistent, and easing it is a challenge
for nurses who work in critical care units. According to participant (1), “...as a nurse I'm just
being there for them and then acknowledge the worries, their emotion as a gift with their
previous scales, and allow them to express their.. you know, express their concerns related to
their critical condition." Therefore, handling their patients with tenderness is one of their ways to
make the patient comfortable both physically and mentally since their patients are frequently
unable to report their pain verbally due to an altered level of consciousness, sedative agents, or
other reasons (Berntzen RN et al., 2020).

Critical eye

Critical eye is a term used in different contexts, but in medicine, it refers to the ability to
observe and analyze patient information accurately and quickly (Constantinides MD, PhD,
2022). According to participant (1), “...pag may critical eye ka kumbaga ma mamanage mo agad
agad ‘yung condition ng pasyente para hindi sila mag arrest, para gumaling sila.” ICU nurses
use the critical eye strategy to quickly identify possible problems in critically ill patients. ICU
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nurses must improve their capacity for monitoring their patients to keep them alive during a
period of life-threatening organ system insufficiency (Physiopedia, n.d.).

Establishing boundaries

In connection with emotional involvement, which is one of the participants’ challenges as

an ICU nurse, establishing professional boundaries is essential to effective nurse-patient
relationships that must focus on care and treatment only (Griffith, 2013). Participant (1) said,
“We really have, (pertaining to ICU nurses) parang mag set ka ng distance between this patient
and yourself para hindi ka ma-hurt kung ano man ‘yung mangyari sa kanila in the future.'' One
of the purposes of establishing boundaries between nurses and patients is to keep nurses from
becoming emotionally hurt or feeling grief. In addition, positive and negative emotions have
developed spontaneously in professional relationships between experienced nurses and their
patients whom they have been treating or caring for. Intensive treatments would not always end
well, which is why participant (2) stated, “...once we leave the hospital, kung ano ‘yung nakikita
namin dun, ano ‘yung na experience namin sa patients, we try our best na iwanan ‘yung pain sa
hospital bed. Hindi mo siya iuuwe sa bahay, kase kung iuuwe mo sa bahay ‘yung mga patients
mo, na feeling mo, ang bigat eh.” Since ICU nurses are bound to have emotional involvement
with patients, establishing boundaries may help ease heavy emotions.

Physical self-care

In accordance with the difficulties of working long shifts, participant (1) stated, “So, make
sure na you eatwell kasi you're dealing with sick people. You’re caring for them. Might as well
you take care of yourself diba. Sa long shift siguro, ‘yun nga, make yourself fit para ma-handle
mo ‘yung long shift, ‘yung igugugol mo sa hospital.” Physical self-care will aid in the ICU's
maintenance of health and well-being, autonomy, increased energy and productivity, disease
prevention, and the ability to cope with stress. (Downing, 2020; Perimeter Healthcare, 2021). In
fact, participant (3) stated, “...kapag kulang ako sa tulog minsan, uh.. medyo mabagal ako
gumawa ng mga work.” This statement proves how a lack of physical self-care can affect one’s
work performance. Hence, eating well and getting enough sleep are some of the participants’
strategies to ensure a good performance in the ICU.

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Asking for help

In accordance with the difficulty of ICU nurses’ physical demand, asking for help from
other nurses or departments can help alleviate the difficulty. Participant (1) stated, “Siguro para
masolusyonan ‘yon (physical demand) is to ask help from the other department, like benign
ward, to help you to across or to solve ‘yung maging ano, maluwag ‘yung pag mamanage ng
pasyente.” ICU nurses often face complex and challenging situations, such as physical demands,
where the support of their colleagues can be crucial. Furthermore, Support means being
transparent about issues relating to patient care and at ease asking coworkers for help when necessary
(Ellenbecker RN, PhD et al., 2006). To overcome difficulties, nurses seek help from colleagues
(Bjarnadottir, 2011). It describes participant (1)’s additional statement, “...para ma-meet niyo
‘yung goal niyo as a nurse.” Meaning, asking for help from other nurses or departments not only
alleviates the difficulty of physical demand, but it also leads to meeting the aim or purpose of
ICU nurses in the field of healthcare: to provide quality nursing care for the chronically ill
(Cesare, 2021). Positive interpersonal connections appear to be related to lessened workplace
stresses (Zuniga et al., 2015). This particular statement from participant (1), “...to help you to
across or to solve ‘yung maging ano, maluwag ‘yung pag mamanage ng pasyente.” A reduction
in work stressors can lead to positive effects on nurses’ health (Bjarnadottir, 2011; Halbesleben &
Wheeler 2008; Llorens et al., 2007).

Nursing standards of care

Nursing care refers to a range of care services provided by registered nurses, licensed
practical nurses, and certified nursing assistants. In addition, nursing standards of care pertain to
professional nursing activities that are demonstrated by the nurse through the nursing process.
These involve assessment, diagnosis, outcome identification, planning implementation, and
evaluation per patient (Butler & Thayer, 2022). A part of the nursing process involves listing
medical tasks. Participant (3) shares, “So, first, before starting my duty, I make a list of my
patients; ‘yung name nila and with their medications and needs kung anong oras ang
medications and some procedures na kailangang gawin sa kanila. Then I cross all the tasks
everytime I finished every task.” This practice helps organize the nursing process in accordance
with nursing guidelines or standards of care. In fact, nursing standards of care should always be
followed by ICU nurses (Irmer, 2019). One example of this guideline is nurse-patient

13
communication. Participant (3) added, “I also make sure what to answer whenever they asked for
specific questions, such as medications kasi lagi silang nagtatanong kung para saan ito, kung
anong side effects nito and ahm.. sinasabi ko rin what to avoid and what to do.” Nurses should
not ignore their questions, because any question the patient has is valid for them (Drucker, n.d.).
Furthermore, the nursing process is the foundation of clinical decision-making and encompasses
all significant actions taken by nurses in providing care to all patients. This describes participant
(2)’s statement; “So, ‘yung practices, depende kase kung ano klaseng diagnosis ‘yung handle mo
sa patient. So, ang ano namin, hindi nagbabago ‘yung standard namin for patient care. In
regards, kung ano mang case ang mahawakan namin.” ICU nurses should adhere to the nursing
standards of care and follow the nursing process properly to prevent chronically ill patients from
worsening.

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18
APPENDIX

Table 1
The Narratives of Filipino Intensive Care Nurses on Handling Chronically Ill Patients

Participant Interview Initial Axial Selective

Coding Coding Coding
So, you know naman, if you Life-saving Taking the
are working especially in action necessary The Narratives
1
ICU, we expect naman na action to save of Filipino
‘yung patient is dying or one's life. Intensive Care
critically ill. So, marami sa Nurses on
kanila, dying. So most of the
Handling
time nag-aattend kami sa
code. Ang ibig sabihin ng Chronically Ill
code is ‘yung, pag ‘yung Patients
pasyente nag-arrest that’s the
time. So, there is one time na
I attended the code. Ako
‘yung nag CPR or ako ‘yung
nag bigay ng
Cardiopulmonary
resuscitation. So, that time,
so, narevive ko sya ‘yun
‘yung pinaka memorable
sakin kasi narevive ko sya
nung nag C-CPR ako and I
felt the heartbeat on my
very own palm. So, parang,
wow! Kaya ko bumuhay ng
tao with that ano.. with that
activity na parang CPR, ‘yun
‘yung pinaka memorable ko
‘yung pinaka first memorable
ko, na-revive ko ‘yung
pasyente.
Uhm.. actually, for dealing Parental Parents
chronic patients ang pinaka guidance supporting and
2
memorable dun is.. uhm.. guiding their ill
how the parents handle the child in their
situation also, not only for chronic
the patient. Uhm.. situation.
personally I really admire

19
 those parents of the kids na
chronically ill ‘yung patient
nila, because they were very
brave, diba. Syempre bata, so
parang, feeling ko ang
tapang-tapang nila na
nahahandle nila ang situation
in spite na, newly delivered
lang din ang babies nila, pero
talagang hindi nila iniiwan.
So, one of my memorable Life-saving Taking the
experiences ah is one of my action necessary
3
patients diagnosed with acute action to save
coronary syndrome and he one's life.
doesn’t have relative to help
him so wala syang bantay.
We have to put him in the
nearest room in our nurse
station so we can cater his
needs immediately.

Table 2
The Challenges Experienced by Filipino Intensive Care Nurses on Handling Chronically Ill
Patients

Participant Interview Initial Axial Selective Coding

Coding Coding
Difficulties, uhh.. siguro Emotional Built
‘yung emotional involvement connections The Challenges
1
involvement mo with the between ICU
patient. Syempre, you are nurses and
Experienced by
the first, uhh.. kumbaga, their Filipino
health caregiver ka sa kanila, chronically ill Intensive Care
you provide it. patients. Nurses on
So ‘yun, uhh, emotional Health The risk of
Handling
involvement, exposure to hazards working in the
illness, kasi nga sila may ICU Chronically Ill
mga sakit, so lalo na nitong department Patients
pandemic minsan nahahawa with several
kami. ‘Yung long shift kasi, patients
we work a 12 hr shift every, possessing
kumbaga, in 21 days 10 days chronic
pasok ganon. illnesses.

20
Physical demanding ang Physical Patients in the
pasyente, like, sometimes, demand ICU require a
uhh.. syempre may mga lot of
mabibigat na pasyente. We assistance
cannot handle all those from ICU
people, na minsan marami nurses. Lesser
‘yung pasyente kaysa sa workers mean
nurses, ‘yung ganon. ‘Yun exhaustion for
‘yung mga hardships namin present ICU
bilang nurse dito sa nurses.
Pilipinas, as a nurse sa ICU.
Mahirap kasi kapag
maraming pasyente hindi mo
magagawa ‘yung gusto
mong gawin for your patient,
‘yon.
So, siguro the only thing that Doctor-nurse Sometimes,
I experience is there are partnership doctors
times na.. kasi when you are neglect or fail
dealing with patient, it to care for
should be a collaboration chronically ill
with a doctor diba? So, there patients that
are times na, me as a nurse, were referred
you will do the assessment by the ICU
for the patient and you will nurses.
going to record it to a
doctor… and sometimes the
doctor will not gonna
attend to you kumbaga
minsan ni-neneglect nila
‘yung nirerefer mo so
parang iyon, mahirap anohin
‘yon kasi gusto mo nga
gumaling ‘yung pasyente mo
but the doctor is not
responding to your referral,
‘yon.. Uhm.. dapat in
collaboration para maging
maganda. Ma-reach mo
‘yung goal mo for your
patient to become better.
Dapat doctor-nurse
partnership. Sometimes
‘yun ‘yung pinaka ano, pag
minsan, pag di mo na
m-meet ‘yung goal is

21
 because walang sagot ‘yung
doctor sayo.. walang
cooperation.
Difficulties? Sa parents, ang Low health Parents or
hirap ma- parents padin, kase literacy guardians of
2
sobrang hirap mag explain patients cannot
ng situation sa anak ni- thoroughly
‘yung kung ano situation understand
ng patient nila, nung anak their family
nila. Uhm.. well nasa amin, member's or
kase when you say intensive relative’s
care unit napaka situation.
undetermined ‘yung
situation, so anything and
anytime.. Uhm.. laging
pwedeng ibang mangyare.
While in stability ‘yung
patient care.
Uhm.. for me ‘yung Low health There are
mahirap is ‘yung literacy times when
rheological, kase ‘yung iba, patients,
in denial sila. So minsan parents, or
late notice ‘yung guardians are
nangyayari, dahil ganun in shock or in
‘yung nangyayari, hindi na a state of
sya nahahabol to confusion,
treatment. leading to late
notice.
So, usually alam mo ‘yung Health Being able to
mga difficulties na hazards save lives and
3
na-experience namin sa ICU treat illnesses
is since my patients are also means
frequently, are beyond the sacrificing
line, I always experience health,
fatigue. I have to be particularly
prepared always that physical
sometimes I won’t be able health.
to eat on time or even go
the bathroom because of
frequent emergencies, so
‘yon.

22
 So, ahh, hindi naman Emotional ICU nurses are
particular pero laging involvement also affected
nangyayari sa ICU. So, as an by a patient’s
ICU nurse, uh.. I witness death and its
deaths everyday and I can impact on the
see how their relatives are family/relative
dealing of their loss of s.
family member. They also
express anger in some
situations and it affects us
nurses on some level.

Table 3
The Ways or Strategies of Filipino Intensive Care Nurses on Handling Chronically Ill Patients

Participant Interview Initial Coding Axial Coding Selective

Coding
So, actually, wala naman Tenderness Performing
masyadong strategies. Just acts of The Ways or
1
only that, I just attend to my kindness for Strategies of
patients’ need. ‘Yung worries chronically ill Filipino
nila, ‘yung emotions, and patients and Intensive Care
you know kasi, because pag acknowledgin
Nurses on
sinabi mong critical g their
condition those are the concerns about Handling
condition that last 1 year or the situation. Chronically Ill
more than.. requires a long Patients
medical treatment diba. And
they limit the activity of the
patient so I just.. as a nurse
I'm just being there for
them and then
acknowledge the worries,
their emotion as a gift with
their previous scales, and
allow them to express
their.. you know, express
their concerns related to
their critical condition..
‘yun lang
So, siguro as an ICU nurse, Critical eye Possessing a
kase dapat meron kang critical eye
critical eye eh. Dapat you allows an ICU
know the norms between the nurse to trace

23
normal and abnormal para patients who
masolusyunan mo ‘yung ano are at risk.
ng pasyente mo, and also
syempre ICU para makita
mo agad na “oh ito pwede
mag arrest” kumbaga pag
may critical eye ka
kumbaga ma mamanage
mo agad agad ‘yung
condition ng pasyente para
hindi sila mag arrest, para
gumaling sila. ‘Yon ‘yung
pinaka edge ko as a critical
nurse, ‘yon.
‘Yung nga ‘yung emotional Establishing Setting
involvement ko sa pasyente, boundaries boundaries
syempre. Sometimes, I need alleviates pain
to ano.. let go of my feelings. and
Sabagay kase bilang nurse attachment
hindi mawawala yan eh dahil issues for ICU
nga nag-geget along ka sa nurses.
pasyente mo dahil handle mo
sya for how many days
ganyan, but minsan you
really have to distance. We
really have, parang mag set
ka ng distance between this
patient and yourself para
hindi ka ma-hurt kung ano
man ‘yung mangyari sa
kanila in the future.
And also, ‘yung isa pang Physical It is as
binanggit ko ‘yung exposure self-care important to
sa illness kasi nga nag take care of
hahandle ka ng patient na oneself as it is
may sakit, like before to take care of
COVID-19. So, make sure chronically ill
na you eatwell kasi you're patients.
dealing with sick people.
You’re caring for them.
Might as well you take care
of yourself diba. Sa long
shift siguro, ‘yun nga, make
yourself fit para ma-handle
mo ‘yung long shift, ‘yung
igugugol mo sa hospital.

24
 And then, siguro, ‘yung Asking for Assistance
physical demand na help from different
binanggit ko kanina. Siguro healthcare
it’s more on, uhm.. ‘yung departments
nurse-patient ratio. Siguro can help
para masolusyonan ‘yon is to alleviate the
ask help from the other physical
department, like benign demand on
ward, to help you to across ICU nurses.
or to solve ‘yung maging
ano, maluwag ‘yung pag
mamanage ng pasyente
para ma-meet niyo ‘yung
goal niyo as a nurse ‘yon.
Uhm.. ways? Uhm… ano eh, Nursing There is a
hindi ko— masyado kaseng standards of standard of
2
broad ‘yung question. So, care patient care
‘yung practices, depende that ICU
kase kung ano klaseng nurses must
diagnosis ‘yung handle mo practice and
sa patient. Uhm.. hindi follow. There
naman, like— saamin kase, are different
hindi naman porket chronic, practices for
same patient hinahandle mo each case.
every shift. So, ang ano
namin, hindi nagbabago
‘yung standard namin for
patient care. In regards,
kung ano mang case ang
mahawakan namin. Kase
uhm.. Pag hindi naman, ah..
hindi lahat ng chronic
patient, hindi lamang iisa
‘yung patient. So wala
kaming patient na, dahil
hinawakan na namin ito in a
certain period of time, ‘yung
assurance nya tomorrow sya
ulit, dahil sa continuity of
care. Wala kasing ganun. So
far hindi ganun ‘yung
practice namin.
Uhm.. siguro, ‘yung care sa Tenderness Filipino ICU
patients, kase as nurses nurses provide
napaka importante. Sabi nga enough love,
nila, uhm.. hindi ko naman care, and

25
 sinasabi na ano ah.. pero passion for
most of the nurses natin their patients
here in the Philippines, mas to show
nakikita mo sa kanila ang support on
tender loving care. their recovery.
Talagang compassion
nandoon. ‘Yung pagiingat
mo, talagang— ‘yung
turing mo sa patient mo is
like relative.
Uhm.. ‘yung stress sobrang Establishing Every case and
hirap. So, basta ang nagiging boundaries difficulty with
practice namin, once we patients should
leave the hospital, kung be left inside
ano ‘yung nakikita namin hospitals only.
dun, ano ‘yung na This would
experience namin sa avoid a heavy
patients, we try our best na heart.
iwanan ‘yung pain sa
hospital bed. Hindi mo siya
iuuwe sa bahay, kase kung
iuuwe mo sa bahay ‘yung
mga patients mo, na feeling
mo, ang bigat eh. So, most
likely pagalam— pag nasa
bahay ka na, kung ano ‘yung
situation ng patient mo sa
hospital in-iwanan mo na
doon, and go to church.
So, ICU nurse, ahh.. as an Nursing Creating a list
ICU nurse, lagi kaming standards of of what needs
3
nakabantay. So, first, before care to be done
starting my duty, I make a helps
list of my patients; ‘yung accomplish
name nila and with their medical tasks.
medications and needs
kung anong oras ang
medications and some
procedures na kailangang
gawin sa kanila. Then I
cross all the tasks
everytime I finished every
task.
I also make sure what to Nursing Nurse-patient
answer whenever they standards of interaction
asked for specific care should adhere

26
questions, such as to the
medications kasi lagi silang standards of
nagtatanong kung para care or
saan ito, kung anong side guidelines that
effects nito and ahm.. nurses should
sinasabi ko rin what to act upon.
avoid and what to do and I
also do open charting so I
can lessen the work that
need to do before ending
my duty. So, ang open
charting naman is, uh.. di mo
ieend ‘yung charting mo
kase pwedeng may mangyari
or shift complaint ‘yung mga
patients, ‘yon.
So, I’m compassionate of Tenderness Having
taking care of my patients compassion
and they appreciate it and empathy
whenever they see me. So, towards
minsan, uhm.. lagi nila patients
akong hinahanap “nasan po creates a
si nurse Sophia” ganon. So healthy
nakikilala ako dahil therapeutic
compassionate ako and may nurse-patient
empathy sa patients. relationship.
So.. I managed stress or Physical It is as
challenges by providing self-care important to
myself a good sleep, a good take care of
meal before duty and as oneself as it is
much as possible.. ‘yon, to take care of
uhm... kailangan, uhm.. chronically ill
mentally prepared ako patients.
since this is very vital as it Health plays a
may affect my work vital role in
quality. So, kapag kulang handling
ako sa tulog minsan, uh.. patients.
medyo mabagal ako
gumawa ng mga work. So,
as much as possible, uhm..
sana kumpleto ‘yung tulog
ko, even tho minsan, night
shift ako.

27
CURRICULUM VITAE

PERSONAL DATA

Name : Christel May O. Adarayan

E-Mail Address : christelmayadarayan06@gmail.com

Birthdate/Birthplace : May 6, 2006 / Marikina

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Concepcion Integrated School Secondary Level (CISSL)
J.P Rizal St. Concepcion Uno, Marikina City

PRIMARY (GRADE SCHOOL)

2012-2018
Concepcion Integrated School Elementary (CISEL)
J.P Rizal St. Concepcion Uno, Marikina City

28
PERSONAL DATA

Name : Gavin Dale A. Agahan

E-Mail Address : gavindaleagahan@gmail.com

Birthdate/Birthplace : October 10, 2006 / Marikina

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Marikina High School (MHS)
F. Torres Street, Barangay Concepcion, Marikina City

PRIMARY (GRADE SCHOOL)

2012-2018
Concepcion Elementary School (CES)
J. Molina St. Concepcion 1 1850, Marikina City

29
PERSONAL DATA

Name : Ellis Pauline M. Dela Paz

E-Mail Address : ellisdelapaz@gmail.com

Birthdate/Birthplace : February 05, 2006/ Quezon City

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Tañong High School (THS)
3 Lopez Jaena St, Marikina, Metro Manila, Philippines.

PRIMARY (GRADE SCHOOL)

2012-2018
Leodegario Victorino Elementary School (LVES)
A. Bonifacio Avenue, Jesus dela Peña,, Marikina City, Philippines, 1804

30
PERSONAL DATA

Name : Edward C. Espada

E-Mail Address : eddiecespadala@gmail.com

Birthdate/Birthplace : November 16, 2005 / Marikina

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Marikina Heights High School (MHHS)
Champagnat St. Marikina Heights Marikina City

PRIMARY (GRADE SCHOOL)

2013-2018
Kapitan Moy Elementary School (KMES)
Champagnat St. Marikina Heights Marikina City

31
PERSONAL DATA

Name : Prince Ally S. Nuñez

E-Mail Address : princeallynunez51@gmail.com

Birthdate/Birthplace : December 01,2005 / Marikina

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Concepcion Integrated School (CIS)
J.P. Rizal St, Marikina, 1800 Metro Manila

PRIMARY (GRADE SCHOOL)

2012-2018
H.Bautista Elementary School (HBES)
J.P. Rizal St, Marikina, 1807, Metro Manila

32
PERSONAL DATA

Name : Hannah Elisha V. Sampiano

E-Mail Address : sampianohannahelisha@gmail.com

Birthdate/Birthplace : March 3, 2006 / Marikina

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Sta. Elena High School (SEHS)
W. Paz St., Sta. Elena, Marikina City

PRIMARY (GRADE SCHOOL)

2012-2018
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

33
PERSONAL DATA

Name : Euzela A. Santos

E-Mail Address : euzelasantos01@gmail.com

Birthdate/Birthplace : November 01, 2005 / Marikina

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Parang High School (PHS)
Tandang Sora St, Marikina, 1809 Metro Manila

PRIMARY (GRADE SCHOOL)

2012-2018
San Lorenzo Ruiz De Manila School
Buenmar Ave., Greenland Phase 1, Nangka, Marikina City, Philippines

34
PERSONAL DATA

Name : Carmille Dorren Sarcos

E-Mail Address : carmilledorrensarcos@gmail.com

Birthdate/Birthplace : September 02, 2006 / Manila

Nationality : Filipino

Civil Status : Single

EDUCATIONAL BACKGROUND

SECONDARY (SENIOR HIGH SCHOOL)

2022-2024
Our Lady of Perpetual Succor College (OLOPSC)
Gen. Ordoñez Ave, Marikina, 1807 Metro Manila

SECONDARY (JUNIOR HIGH SCHOOL)

2018-2022
Valeriano E. Fugoso Memorial High School (VEFMHS)
Manila Boystown Complex, Parang, Marikina City

PRIMARY (GRADE SCHOOL)

2012-2018
Tierra Monte Integrated School (TMIS)
Tierra Monte, San Mateo Rizal

35