CHAPTER I

The Problem and its Background

I. Introduction

Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel

coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-

CoV-2; formerly called 2019-nCoV), which was first identified amid an outbreak of

respiratory illness cases in Wuhan City, Hubei Province, China.  It was initially

reported to the WHO on December 31, 2019. On January 30, 2020, the WHO

declared the COVID-19 outbreak a global health emergency.  On March 11, 2020, the

WHO declared COVID-19 a global pandemic, its first such designation since

declaring H1N1 influenza a pandemic in 2009. The Centers for Disease Control and

Prevention (CDC) has estimated that SARS-CoV-2 entered the United States in late

January or early February, establishing low-level community spread before being

noticed. Since that time, the United States has experienced widespread infections,

with more than 100,000 deaths reported.

On April 3, 2020, the CDC issued a recommendation that the general public,

even those without symptoms, should begin wearing face coverings in public settings

where social-distancing measures are difficult to maintain in order to abate the spread

of COVID-19. 

The CDC had postulated that this situation could result in large numbers of

patients requiring medical care concurrently, resulting in overloaded public health

and healthcare systems and, potentially, elevated rates of hospitalizations and deaths.

The CDC advised that nonpharmaceutical interventions (NPIs) will serve as the most
important response strategy in attempting to delay viral spread and to reduce disease

impact. 

The feasibility and implications of strategies for suppression and mitigation

have been rigorously analyzed and are being encouraged or enforced by many

governments in order to slow or halt viral transmission. Population-wide social

distancing of the entire population plus other interventions (eg, home self-isolation,

school and business closures) was strongly advised. These policies may be required

for long periods to avoid rebound viral transmission. 

According to the CDC, individuals at high risk of infection include persons in

areas with ongoing local transmission, healthcare workers caring for patients with

COVID-19, close contacts of infected persons, and travelers returning from locations

where local spread has been reported. 

Person-to-person spread of SARS-CoV-2 has been reported in the United

States.  Individuals who believe they may have been exposed to SARS-CoV-2 should

contact their healthcare provider [ CITATION Cen20 \l 1033 ].

On January 30, 2020, the Philippine Department of Health reported the first

case of COVID 19 in the country with a 38 year old female Chinese national. On

March 7, the first local transmission of COVID 19 was confirmed[ CITATION

WHO20 \l 13321 ].

As of June 1, 2020, COVID-19 has been confirmed in over 6.2 million

individuals worldwide and has resulted in more than 373,000 deaths. More than 180

countries have reported laboratory-confirmed cases of COVID-19 on all continents

except Antarctica. 
 In the United States, more than 1.7 million cases of COVID-19 have been

confirmed as of June 1, 2020, resulting in over 104,000 deaths.  As of March 26, 2020,

the United States has more confirmed infections than any other country in the world,

including China and Italy.[ CITATION Cen20 \l 13321 ]

With this situation, front liners which includes nurses, doctors, medical

technologies, radiologist and other staff in the hospital is more at risks for acquiring the

disease despite of wearing PPEs. Report shows death of doctors and nurses all over the

world due to demands of their service. According to WHO, health workers are at the

front line of the COVID-19 outbreak response and as such are exposed to hazards that put

them at risk of infection. Hazards include pathogen exposure, long working hours,

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

psychological violence.

Statement of the Problem

According to the article [ CITATION Sof20 \l 13321 ] thirteen studies were

conducted included in the analysis with a combined total of 33062 participants. Anxiety

was assessed in 12 studies, with a pooled prevalence of 23·2% and depression in 10

studies, with a prevalence rate of 22·8%. A subgroup analysis revealed gender and

occupational differences with female HCPs and nurses exhibiting higher rates of affective

symptoms compared to male and medical staff respectively. Finally, insomnia prevalence

was estimated at 38·9% across 4 studies. Early evidence suggests that a considerable

proportion of HCWs experience mood and sleep disturbances during this outbreak,

stressing the need to establish ways to mitigate mental health risks and adjust

interventions under pandemic conditions.

 In the article “Impact of COVID-19 on psychology of nurses working in the

emergency and fever outpatient” found that 229(50.55%) participants were more

likely to respond positively to stress, while 224(49.45%) were more likely to respond

negatively. 

With the high prevalent rate of anxiety, stress, and depression of nurses amid

COVID 19 pandemic the researcher would like to find answer to the following problem:

1. What do nurses feel while on duty?

2. How do they manage stigma against them?

3. How do they manage their personal life after duty?

4. What is the psychological impact of this pandemic to nurses?

Conceptual Framework

The framework was modified using the guidelines of Dorothea Orem and

Hildegard Peplau’s concept such as concept of self care and interpersonal relationship theory.
NURSES

Fear of transmitting Fear of acquiring the

Love ones the disease disease Patient
Self-care
demand
Community Anxiety
Self-care deficit

Stigma Non- functional

Depression
Scope and Delimitation :

Due to the pandemic COVID-19 the researchers plan to do the research by online

platforms like FB messenger or alike on the frontliners that we can reach on how they are coping

with the current situation. On their experiences starting last March 20 to April 20 (1 month). The

researchers plan to have 50 respondents to answer a specific survey tool provided.

Significance of the Study:

The researchers chose this study to know the mental health risks of the frontliners with

our current situation which is the pandemic COVID-19. On how they are coping up specially the

ones who are away from their family. The current situation affects them on daily with all the lack

of sleep or rest, lack of time to eat and stress, so the researchers decided to conduct this study for

them to be aware and knowledgeable on the frontliners’ current situation.

Definition of Terms

Chapter II

Methodology

This chapter presents a description of the research design, selection and descriptions of

the respondents, and the research instrument used to make this research study effective.

Research Design

In order for the researchers to know the mental health risks of the frontliners due to

Coronavirus 2019 or also known as COVID-19, interviews of targeted groups have been used as

the survey method for the study. As a Narrative study, the researchers collected detailed and
factual experiences to describe the mental health risks of COVID-19 of the frontliners. It

precisely describes the experiences of these people from the duties that they had during COVID-

19. It allows the researchers to carefully and specifically describe and understand the effects of

COVID-19 to the mental health of these frontliners. This study was Phenomenological, for it

examines the experiences of the respondents.

Sampling Design

The researchers used selected and targeted sampling to determine the samples of the

study. Health Practitioners and other frontliners that are capable of answering the survey via

Online.

Research Respondents

The researchers considered the health practitioners that have access to the internet

comprising _ in number, both male and female. They were chosen because of their duties and

responsibilities as a health practitioner that has to continue performing their duty despite the

pandemic. They were chosen as well, for they are the ones who have experience to be upfront

during the crisis. Moreover, their experiences during performing their duties and responsibilities

are evidently helpful to the study.

Research Instrument

A questionnaire was used to gather data. The questionnaire consists of items that

determine the different experiences that the health practitioners and other frontliners had while

they perform their duty during the ongoing pandemic.

Data Gathering Procedure

The benefits of the qualitative data collections provided an in depth of understanding to

the raw data in which the respondent’s feelings, thoughts, point of view or even their concerns

are the main focus of the study and the gathered information is much valuable and has a greater

insight about the phenomenon under study.

Data gathering procedures approaches for qualitative research in a time like this are the

following:

1. Indirect interaction with individual respondent on a one to one basis using a telephone,

cellphone, email, video chat etc. to get a better interview about the respondent feelings,

outlook, and opinion on the said study without being bias

2. Or indirect interaction with focus group setting using the same method.

3. Observations- In which respondent actions or reaction are being observe by the

researcher while being discreet through video conference. Researcher who conduct the

study should follow the flow of interview activity and avoid dominating the research

interviewee so that the respondent will not be reluctant to give his or her outmost

honest opinion or answers to the questions. One way to do this is to get to know the

respondent character and attitude and try to get in to their shoes by showing empathy.

4. Action Research- This method allows the searcher to become discreet in a way that

observer may get a full access to the raw information that respondent is about to give

and never shun away from it. Although it is unethical but it is somewhat useful.
Procedures of Documentations:

1. Be a Good listener- Being an active listener encourage the respondent to get in control

and enthusiasm to share his genuine feelings, opinions, decision, and outlook on the said

study.

2. Notes- Directly written on the portable notebooks or paper; to write down or record all

the informal conversation and observation during the interview portion. Spontaneous

respond should be recorded as well.

3. Recording- Another useful way to maximize the interview and gather the data is through

recording and documentation of the respondent’s responses on probe questions, follow-

up, and exit questions.

4. And always remember not to lead the respondents in a preconceived notion or even

influence the respondent answers.

5. Do not pressure the respondent and allow him/her to used his/her volition while guiding

the conversation to cover important topics.