MAN Para-title-Manuscript - Cathy-Turiano

Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
GRADUATE SCHOOL
COMPLIANCE ON THE COVID-19 HEALTH CARE PROTOCOLS OF THE
HEALTH CARE WORKERS IN STA. MARIA JOSEFA FOUNDATION
HOSPITAL
A Thesis Presented to the
Faculty of the Graduate School
Camarines Sur Polytechnic Colleges
In Partial Fulfillment
of the Requirements for the Degree
Master of Arts in Nursing
TURIANO, CATHY H.
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Chapter 1
THE PROBLEM
Introduction
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease
caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The
novel coronavirus was first identified in December 2019 in Wuhan China, then
spread globally within weeks and resulted in an ongoing pandemic. As of 27 May
2020, more than 5.7 million cases and 353,664 deaths were reported globally.
Thirteen percent of the closed cohorts and 2–5% of the total cohort reportedly
died. The USA, Brazil, Russia, Spain, Italy, France, and the UK are the most
affected countries. (Girum, 2020)
The disease is clinically manifested by fever, cough, difficulty breathing,
and other flu-like signs and symptoms including runny and stuffy nose, sneezing,
and sore throat. In most of the cases, the disease shows mild to moderate
manifestations, but it can lead to adverse outcomes including severe
complications and/or death in some vulnerable individuals such as the elderly and
those having underlying medical conditions. (Kayrite, 2020)
Healthcare workers play a critical role in fighting the COVID-19 pandemic
and are at greater risk of COVID-19 virus infection in the line of duty. For instance,
data from recent studies showed healthcare workers are more likely to be exposed
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to SARS-COV-2 and are, therefore, at higher risk of COVID-19 infection than the
general community. Hence, the impact of the COVID-19 pandemic on healthcare
workers has been enormous. However, prevention remains the best weapon for
protecting healthcare workers against the COVID-19 pandemic. Therefore,
adherence to infection prevention and control protocols is critical at minimizing
healthcare workers exposure to the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). Indeed, correct and consistent compliance with IPC
protocols is effective in minimizing the risk of COVID-19 infection. Compliance with
IPC protocols is facilitated by training of healthcare workers on IPC, provision of
IPC materials and regular audit of IPC practices. Generally, IPC strategies in
response to highly infectious diseases, such as COVID-19, should include early
recognition, physical distancing, source control, taking precautions and
appropriate use of PPEs, restriction of movement, environmental cleaning and
disinfection as well as support for healthcare workers.
As the cases rise, health workers are increasingly becoming at risk of
infection as they care for the ever-so-growing number of COVID-19 patients.
Because the safety of health workers is key to winning the fight against the virus,
infection prevention and control (IPC) measures remain critical tools. Without
compliance, however, these measures will not help in achieving the intended goal,
and the health workers will increasingly be at risk of COVID-19 INFECTION
(Amanya,2020).
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These days more and more health care workers are infected with
COVID-19. This study will emphasize the importance of compliance in COVID-19
health care protocols.
Hence, this study will give the readers the necessary needed information in
order to make them aware of the importance of compliance to COVID-19 health
care protocols.
The researcher focuses on compliance of health care workers in Sta.
Maria Josefa Foundation Hospital on COVID-19 health care protocols. The
researcher came up with this research, because this is very timely considering that
through this effort. This will establish factual data on the importance of health and
self-care especially to health care workers. Indeed, the facts gathered will help
draw significant conclusions necessary in helping, lessen or control the present
health situations. The researcher also believes that it is not only the medications,
nor the vaccines alone that will matter in this time of pandemic, but also the strong
immune system of the body, as a whole, that will make the health care workers a
good fighter against this unseen health and life destroyer.
This research will also gauge how diligent health care workers in religiously
observing health care protocols at home, at work and to the community, as a
whole.
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Statement of the problem
This study determined the compliance on the COVID-19 health care
protocols of the health care workers in Sta. Maria Josefa Foundation Hospital.
Specifically, it sought answers to the following questions:
1. What is the profile of the respondents in terms of:
a. Age
b. Sex
c. Civil Status
d. Length of service
e. Seminars attended
2. What are the factors affecting the compliance of health care workers in
Sta. Maria Josefa Foundation Hospital on COVID-19 health care protocols in
terms of:
a. Personal factors
b. Client factors
3. Is there any significant relationship between the profile of the
respondents and compliance on COVID-19 health care protocols?
4. What plan can be proposed to enhance the compliance on the
COVID-19 health care protocols of the health care workers in Sta. Maria
Josefa Foundation Hospital?

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Assumptions
This study premises on the following assumptions:
1. The profile of the respondents is significant in determining the
compliance on the COVID-19 health care protocols of the health care
workers in Sta. Maria Josefa Foundation Hospital.
2. There are factors affecting the compliance on the COVID-19 health care
protocols of the health care workers in Sta. Maria Josefa Foundation
Hospital.
3. There is a plan that can be proposed to enhance compliance on the
COVID-19 health care protocols of the health care workers in Sta. Maria
Josefa Foundation Hospital.
Null Hypothesis
This study anchored on the following hypothesis:
1. There is no significant relationship between the profile of the respondents
and compliance on the COVID-19 health care protocols of the health care
2. There is no significant relationship between factors affecting and compliance
on the COVID-19 health care protocols of the health care workers in Sta. Maria
Josefa Foundation Hospital.

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Significance of the Study
This study could be beneficial to the following:
Health care providers. The findings of this study will help them in the proper
compliance of COVID-19 health care protocols which they can share with their
clients as well as to their families.
Health administrators. The result of this study will enable the health
administrators to initiate a policy related to importance of compliance on COVID-19
health care protocols.
Clients. This study will be beneficial to the client for them to receive safe
quality care from the health care workers without getting infected from COVID-19.
Students Nurses. The result of this study will provide the students with
knowledge on proper compliance to COVID-19 health protocols.
Researcher All of the information that the researcher gathered will help her to
determine the compliance of the health care workers to COVID-19 health care
protocols, the factors affecting their compliance that will help propose a plan to
solve it.
Future Researchers. This study will serve as a guide to future researchers
because it can be used as a reference of related information and better
understanding of their scope of research.

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Scope and delimitation
This study was mainly focused on the compliance on the COVID-19
health care protocols of the health care workers in Sta. Maria Josefa Foundation
Hospital. The 40 respondents who was chosen randomly out of 90 health care
workers in Sta. Maria Josefa Foundation Hospital Inc. The study will be conducted
from September 2021 until February 2022.
Definition of Terms
For better understanding of this study, the following term were defined
either operationally and/ or conceptually:
Compliance. It is the process of adhering to the rules and regulations
that accompany an organization’s standard practices. In healthcare pipelines,
officers overview discrepancies regarding payment, patient confidentiality and
patient welfare. Healthcare compliance is essential for medical providers to
operate and execute policy smoothly and within the confines of the law, and
oversight positions will always be necessary. By enforcing the quality of security
and protecting the sensitive information of patients and colleagues, compliance
officers uphold and improve the standards of the healthcare industry.
Administrators who become experts in healthcare compliance have an advantage
over their peers that can lead to higher salaries and more instrumental roles in their
field. (HealthOrg,2019)
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COVID-19. Coronavirus disease (COVID-19) is an infectious disease caused
by a newly discovered coronavirus. Most people infected with the COVID-19 virus
will experience mild to moderate respiratory illness and recover without requiring
special treatment. Older people, and those with underlying medical problems like
cardiovascular disease, diabetes, chronic respiratory disease, and cancer are
more likely to develop serious illness.
SARS-COV 2. Severe acute respiratory syndrome coronavirus
Protocol. An agreed framework outlining the care that will be provided to
patients in a designated area of practice. They do not describe how a procedure is
performed, but why, where, when and by whom the care is given (Wales,2020)
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ENDNOTES
1. Tadele Girum. 2020, Global strategies and effectiveness for COVID-19
prevention through contact tracing, screening, quarantine, and isolation: a
systematic review, Retrieved from www. tropmedhealth.biomedcentral.com on
June 2021
2. Kayrite QQ 2020, Compliance with COVID-19 Preventive and Control
Measures among Food and Drink Establishments in Bench-Sheko and
West-Omo Zones, Ethiopia, 2020, Retrieved from www.dovepress.com on June
2021
3. Sharon Bright Amanya 2020, Knowledge and Compliance with Covid-19
Infection Prevention and Control measures among Health Workers in
Regional Referral Hospitals in Northern Uganda: A cross-sectional Online
Survey, Retrieved from www.researchsquare.com on June 2021
4. Using protocols, standards, policies and guidelines to enhance
confidence and career development, Retrieved from www.wales.nhs.uk on
June 2021
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Chapter 2
THEORETICAL AND CONCEPTUAL FRAMEWORKS
This chapter will be discussing about the theoretical and conceptual
framework and paradigm, the review of related literature and studies and also the
synthesis of the state of the art to fully understand the research to be done and
lastly to help in familiarizing information that are relevant and similar to the
present study.
Review Of Related Literature And Studies
This portion includes the review of related literature and studies closely
relevant to the present study that had been gathered by the researchers from
books, journals and unpublished thesis. This would showcase the research works
of previous researchers and attempts to compare and sites the similarities and
differences of this research to their works. The facts and the new ideas formed by
the studies provide the researchers the significant insights towards the
comprehensive understanding of the present status of the subject matter.
COVID-19
COVID-19 is a respiratory condition caused by a coronavirus. Some people
are infected but don’t notice any symptoms (doctors call that being asymptomatic).
Most people will have mild symptoms and get better on their own. But some will
have severe problems, such as trouble breathing. The odds of more serious
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symptoms are higher if you’re older or have another health condition
like diabetes or heart disease.
According to Ashinyo (2021), healthcare workers play a critical role in fighting
the COVID-19 pandemic and are at greater risk of COVID-19 virus infection in the
line of duty. For instance, data from recent studies showed healthcare workers are
more likely to be exposed to SARS-COV-2 and are, therefore, at higher risk of
COVID-19 infection than the general community. Hence, the impact of the
COVID-19 pandemic on healthcare workers has been enormous. However,
prevention remains the best weapon for protecting healthcare workers against the
COVID-19 pandemic. Therefore, adherence to infection prevention and control
protocols is critical at minimizing healthcare workers exposure to the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2). Indeed, correct and
consistent compliance with IPC protocols is effective in minimizing the risk of
COVID-19 infection. Compliance with IPC protocols is facilitated by training of
healthcare workers on IPC, provision of IPC materials and regular audit of IPC
practices. Generally, IPC strategies in response to highly infectious diseases, such
as COVID-19, should include early recognition, physical distancing, source
control, taking precautions and appropriate use of PPEs, restriction of movement,
environmental cleaning and disinfection as well as support for healthcare workers.
COVID-19 infection among frontline healthcare workers put patients, other
healthcare workers and the general community at risk of infection. Minimizing

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exposure of healthcare workers to the SARS-CoV-2 is the best option for
protecting frontline healthcare workers from COVID-19 infection, and this is best
done through healthcare worker adherence with IPC protocols as well as
inoculating against the SARS-COV-2. Therefore, an understanding of IPC
compliance among healthcare workers managing COVID-19 patients is essential
for preventing the spread of COVID-19 infections among healthcare workers,
reducing secondary transmission in the treatment centers and updating IPC
policies in Ghana.
According to the infection control preparedness plan for emerging infectious
disease in Hong Kong, a series of proactive infection control measures were
activated by the Hospital Authority, a governing body of all 43 public hospitals
responsible for 90% of inpatient service in Hong Kong, immediately after the
official announcement of a cluster of pneumonia of unknown etiology in Wuhan,
Hubei Province, by the National Health Commission of the PRC on December 31,
2019 (day 1). The key measures included a bundle of infection control measures
for early recognition, isolation, notification, and molecular diagnostic testing for all
suspected cases. Active surveillance was performed on patients presenting to the
hospital according to a set of clinical and epidemiological criteria, which were
adjusted during the evolution of SARS-CoV-2 in China and Hong Kong. All
suspected cases were isolated in airborne infection isolation rooms (AIIRs) for
contact, droplet, and airborne precautions. The Centre for Health Protection,
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Department of Health, and the Hospital Authority were notified of suspected cases.
Enhanced laboratory surveillance was also conducted to widen the scope of
screening. Patients received AIIR care when available; otherwise, patients
received care in a ward with 1-m spacing between patients. (Cheng, 2020)
Risks of healthcare worker infection can be mitigated with adequate
precautions within health facilities. Primarily, this involves the use of personal
protective equipment (PPE) including a gown, gloves, face mask, and a face shield
or goggles. Careful donning and doffing of this equipment remains a key defense,
but requires considerable training and supervision. Risks for infection may also be
highest at the beginning of the outbreak when healthcare workers may not yet be
familiar with PPE use. There are major PPE shortages in high-income countries
and it is likely that limited supplies will be allocated to less resourced countries.
These scarce PPE resources need to be appropriately used and distributed
equitably across the globe – yet hoarding, misuse, intense competition between
and within countries, price gouging, and export blocks are threatening to become
the norm. Without international support, any reserves of PPE in hospitals are likely
to be rapidly depleted in African countries and new supplies will be very difficult to
secure. Importantly, digitalized or telemedicine services could potentially reduce
patient contact and thus risks for infection, and allow for national or international
experts to give advice from a distance and support to less-experienced doctors.
While there may be considerable costs in setting up such systems, these may be
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outweighed by savings in PPE, staff resources and improved patient outcomes.
These initiatives may, however, be challenged by infrastructural constraints such
as an unstable power supply or limited internet connectivity, and a lack of
interoperability between digital systems. (Chersich, 2020)
COVID-19 is spread by human-to-human transmission through droplet,
feco-oral, and direct contact and has an incubation period of 2-14 days. To date,
no antiviral treatment or vaccine has been explicitly recommended for COVID-19.
Therefore, applying preventive measures to control COVID-19 infection is the
most critical intervention. Health care workers (HCWs) are the primary sector in
contact with patients and are an important source of exposure to infected cases in
health care settings; thus, HCWs are expected to be at high risk of infection. By the
end of January, the WHO and Centers for Disease Control and Prevention (CDC)
had published recommendations for the prevention and control of COVID-19 for
HCWs. The WHO also initiated several online training sessions and materials on
COVID-19 in various languages to strengthen preventive strategies, including
raising awareness and training HCWs in preparedness activities. In several
instances, misunderstandings among HCWs have delayed controlling efforts to
provide necessary treatment, led to the rapid spread of infection in hospitals, and
put patients' lives at risk. (Bhagavathula, 2020)
The health care workforce is integral to an effective pandemic response and
needs to be trained and competent in their response roles. Strategies to optimize

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the use of health care workers are needed along with mechanisms to augment
human resources and the provision of support for health care workers involved in
the response. Health care workforce diversity needs should also be considered in
an effective pandemic planning and response, as their sex gender, age,
Indigenous identity, ethnicity, rural or urban setting might all play a role in the
levels of preparedness and service delivery. (Canada journal, 2021)
Previous studies undertaken in Ethiopia showed a poor adherence with
COVID-19 prevention among HCWs. Pieces of evidence showed that HCWs’
characteristics such as sex, rural residence, having a chronic illness, and
resources related factors such as IPC guidelines, types of healthcare facilities, IPC
training, lack of personal protective equipment (PPE), high workload, management
support and HCWs’ attitude affect HCWs’ adherence with COVID-19 preventive
measures. A review of 26 findings identified barriers and facilitators to HCWs’
compliance with IPC guidelines for respiratory infectious diseases, categorized
into three domains: organizational factors (safety climate, communication of IPC
guidelines and availability of training programs), environmental factors (physical
environment and availability of PPE) and individual characteristics such as
knowledge, attitude, beliefs, and PPE discomfort.
WHO, Centers for Disease Control and Prevention (CDC), and other
governmental organizations have developed guidelines, provided online training

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sessions and updated information for HCWs. Clinically effective infection
prevention and control practices are essential features of patient protection. HCWs
are the frontline directly involved in the diagnosis, treatment, and care of
COVID-19 patients. This is the best of our knowledge the first study aimed to
assess HCWs’ compliance with COVID-19 prevention, its potential determinants
and perceived barriers, conducted in public hospitals located in Western Ethiopia.
(Werku Etafa, 2021)
Health professionals (HPs) are at the front line in fighting coronavirus spread
that put them at the risk of contracting COVID-19. Keeping safety in the working
environment for the health professionals and an operative plan is crucial in each
phase of the pandemic. COVID-19 preventive measures recommended by World
Health Organization (WHO) consist of regular handwashing, with soap and
running water or using alcohol-based hand sanitizer; using face masks; avoid
touching the eyes, nose, and mouth if hands are not clean; and avoiding close
physical contact. Realizing a comprehensive set of infection prevention measures
in all healthcare settings is a collective responsibility and critical to protecting the
health and lives of our precious healthcare workforce as well as the key to
minimize the spread of the virus in both health care settings and the community.
Despite the greater destructive consequences of COVID-19 to individuals and
public health, non-compliance to the preventive measures has been reported
around the world. Previous studies conducted in different countries indicated that
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around one-tenth of healthcare workers remove their masks while talking to the
patient, four-fifths of them reused surgical masks, and 44.9% correctly dispose of
the used facemask in the yellow-coded bags. Overcrowding, limited infection
prevention materials/supplies, less commitment of healthcare providers to the
policies and procedures, insufficient training, and lack of policy were factors
affecting COVID-19 prevention practice. (Zenbaba, 2021)
Infection prevention plays a key role in preventing and reducing the rate of
healthcare associated infection (HAIs). HAIs, are the most frequent adverse event
in healthcare worldwide can occur as a part of an endemic or epidemic situation
and affect the quality of care of hundreds of millions of patients every year in both
developed and developing countries. According to the Centers for Disease Control
and Prevention (CDC), HAIs defined as infections localized or systemic condition
resulting from adverse reaction to the presence of infectious agent or its toxins
acquired from health care settings that was not incubating or symptomatic at the
time of admission to the healthcare facility. These infections are a major public
health concern and a threat to patient safety, contributing to increased morbidity,
mortality, and cost. Based on the available evidence, the overall impact of HAIs
implies prolonged hospital stay, long-term disability, increased resistance of
microorganisms to antimicrobials, high costs for patients and their family, and
unnecessary deaths. In addition, it places a significant massive additional

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economic burden on the health care system.(Biniyam Sahiledengle
Geberemariyam, 2018)
Healthcare workers (HCWs) are at the frontline of COVID-19 pandemic
response and are exposed to dangers like pathogen exposure, long working
hours, psychological distress, fatigue, occupational burnout and stigma, and
physical violence. A poor understanding of the disease among HCWs can result in
delayed identification and treatment leading to rapid spread of infections. Over 100
health workers have lost their lives to COVID−19, a tragedy to the world and a
barrier to fight against the disease. Guidelines for healthcare workers and online
refresher courses have been developed by WHO, CDC, and various governmental
organizations in various countries to boost the knowledge and prevention
strategies There is paucity of literature on KAPs of HCWs toward the COVID-19
pandemic. However, a study with majorly Asian HCWs and medical students
revealed that they had insufficient knowledge about COVID-19 but had a positive
attitude toward prevention of COVID-19 transmission. To our knowledge, no study
has been done in sub-Saharan Africa to assess KAPs toward COVID-19
specifically among HCWs. The purpose of the study was to assess the KAPs of
HCWs in Uganda toward COVID-19.
Many additional questions and concerns remain, especially in high-risk sites
and clinical settings. One problem is in the emergency department, where
crowding is identified as a major concern. Rigor in the use of recommended

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precautions for all patients with respiratory illness is especially important. Placing
a facemask on the patient at arrival, supplying tissues, promoting cough etiquette,
and providing for hand hygiene and surface decontamination are all important
steps. Those patients with symptoms of suspected COVID-19 should be rapidly
triaged and separated from the general population ideally in a well-ventilated
space with a distance of at least 6 feet from others until they can be placed in an
isolation room. Caregivers who encounter any patient with respiratory illness
should wear a mask and gloves, with goggles as recommended. Even when
COVID-19 is not suspected, it may be present so routine use of these precautions
and increased environmental and personal hygiene is advised. Strict adherence
to guidelines is of elevated importance for the protection of health care workers. A
focus on worker protection through specific training and encouragement of
adherence to barrier precautions and hygiene recommendations may help
provide a priority focus. Telling caregivers to focus on their safety and being clear
and specific about how to do so can promote calm during an epidemic. (James
Adams, 2020)
With the numbers of COVID-19 cases and hospital admissions surging over
the past few weeks, healthcare workers in hospitals run a high risk of getting
infected. Recently, a few hospitals in the National Capital Region had to close due
to infections among healthcare workers, pointing to the need for urgent action and
measures to protect them.

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In April 2020, the UP PGH, the Philippine Lung Center and the Jose Nicanor
Rodriguez Medical Center were designated COVID-19 referral hospitals and were
tasked to provide care to patients in severe and critical condition. These three
hospitals began developing their own infection control protocols to keep their staff
safe. And now, six months into the pandemic, the UP PGH has produced a
summary of lessons learned on efforts to prevent COVID-19 transmission in the
hospital setting. A rich source of information for other health care facilities, this will
be shared during this virtual national town hall meeting for hospitals.
The UP webinar series, “STOP COVID DEATHS” is also organized in cooperation
with the UP Manila NIH National Telehealth Center, the UP Manila College of
Medicine and the UP PGH. (Celeste Ann Castillo Llaneta,2020)
Officials said the government is not yet considering imposing more stringent
community quarantine measures, noting that localized responses such as granular
lockdowns are the most appropriate strategies at the moment.
Metro Manila and neighboring areas reverted back to modified enhanced
community quarantine in August last year after exhausted medical frontliners, who
warned a collapse of the healthcare system, called for a “timeout.”
For the whole month of March, Metro Manila, Apayao, Baguio City, Kalinga,
Mountain Province, Batangas, Tacloban City, Iligan City, Davao City and Lanao
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del Sur are under general community quarantine. The rest of the country,
meanwhile, is placed under the laxest quarantine status—modified GCQ.
“If we comply with minimum health protocols, we can control the increase in the
number of cases and therefore, we can be able to manage the increase of variants
in the country. We can also prevent further mutations of this virus,” Vergeire
said. (Cabico,2021)
The SaniPod adds an extra layer of protection for health care workers as they
leave the COVID 19 patient ward. Photo from DOST-PCHRD.
The University of the Philippines (UP) has developed the SaniPod, a
self-contained disinfection cubicle to sanitize medical frontliners or health care
workers as they exit COVID-19 patient wards.
Department of Science and Technology (DOST) Secretary Fortunato De la
Peña announced in his DOSTv public briefing on July 3, 2020, that the first
prototype of SaniPod was turned over to the Philippine General Hospital.
The turnover was facilitated by the UP Surgical Innovations and Biotechnology
Laboratory (SIBOL) COVID Task Force, a UP Manila College of Medicine program
which collaborates with scientists and engineers from UP Diliman to use locally
sourced material and technology to produce much needed surgical and medical
devices in the country.

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The SaniPod disinfection cubicle was reported to be in development in May by the
DOST-Philippine Council for Health Research and Development (PCHRD).
The self-containing cubicle is similar to air showers meant for sanitizing health
workers as they leave the patient wards. The SaniPod is meant for a single person
to undergo disinfection while wearing full Personal Protective Equipment.
The Filipino innovation addresses the need to provide frontliners “an extra layer of
protection from COVID-19 as SaniPod cubicles are more efficient than the existing
sanitation tents in terms of disinfection success,” reports DOST-PCHRD which
funded the UP research and development project.
The design decreases contact with the surfaces of the cubicle, leading to lesser
chances of microbes staying on the surfaces. (Balibay, 2020)
Synthesis of the State-of-the-Arts
From the received studies, the researchers found out that there were existing
researchers that are closely related but somehow differs in some aspects with
regards to the present study.
Ashinyo, Zenbaba, Geberemariyam and Adam tackled about the importance
of health care workers in fighting the COVID-19 pandemic. It was mentioned that
health professionals are the forefront in fighting coronavirus that put them at risk
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of contacting COVID-19. Also, they discussed about infection prevention, which
plays a key role in preventing and reducing the rate of health care associated
infection.
The study also emphasized that health care workers are exposed to dangers
like pathogen exposure, long working hours, psychological distress, fatigue,
occupational burnout and stigma.
The study of Chersich was found similar to the present study. Since it
emphasizes the adherence to infection prevention control and key measures for
early recognition, isolation of COVID-19 patients.
The study of Bhagavathula has a similarity to this present study in the sense
that it tackles on the precautionary measures in the health facilities like using
personal protective equipment including gowns, gloves, face masks, face shield
and goggles.
Theoretical Framework
The researcher made use of the Self-Care Nursing Theory of Orem as the
framework of this study, because the compliance on the COVID-19 health care
protocols is related to the self-care function of an individual (Christensen and
Kenny 2000). The Theory of Orem centers on a person’s need and the action
taken by a nurse to meet that needs. As shown in Figure 1, Orem’s model touches
on the following major constructs or concepts; self-care requisites, self-care and
nursing systems.
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According to Orem, individuals function and maintain life, health and well
being by caring for themselves. If an individual or group could not attend to their
needs, self-care deficits occur, and this is where a nurse comes in.
There are three self- care deficits, namely: universal, developmental and
health deviation. The three nursing systems are defined according to the degree
of nursing assistance required by the clients: wholly compensatory, partly
compensatory and supportive educative.
Self-care requisites are activities done to meet the basic needs of daily living.
They are true to everyone throughout their life, which are adjusted according to
their age, developmental stage, environment and other factors. They are related
to maintaining life processes, structural integrity and functioning. Individuals who
fulfilled the universal self- care needs are at the end of the scale. Orem defines
the following self-care requisites: (1) Maintenance of the sufficient air, water and
food. (2) Balance between activity and rest. (3) Balance between solitude and
social interaction. (4) Provisions are associated with elimination processes and
excrements. (5) Prevention of hazards to human life, functioning, well-being. (6)
Promotion of human functioning and development within social groups
(Christensen and Kenny).

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Self care Self Care Nursing

Requisites System
Demands Wholly
Universal
self care compensatory
Development Partly
Capabilities
self care compensatory
Health
deviation Deficits
Supportive-
Self care educative
Figure 1
THEORETICAL PARADIGM
(Based on Orem’s major Concepts)
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Developmental self-care requisites have two types: (1) Maintaining conditions
that support life processes and promote development; (2) Prevention of harmful
effects on human development and the provision of care overcome these effects.
Health deviation self-care requisites are related to individuals who are ill or
injured or have a pathological condition and are receiving medical care. Orem
named six requisites for individuals with health deviation; (1) seeking and
securing appropriate medical assistance, (2) recognizing and taking care of these
conditions; (3) implementing prescribed diagnostic, therapeutic, and rehabilitative
measures; (4) recognizing and regulating the effects of the treatment; (5)
modifying the self- concept and acceptance of the condition (6) learning to live the
condition in a lifestyle that promotes continued development.
Self- care deficits requiring nursing intervention occur when self- care demand
exceeds a person’s self- care capabilities. Capabilities refers to the individual’s
ability to acquire knowledge for action, and to act on that knowledge to meet one’s
self- care requisites, self-care deficit, occur when an individual is in enable to
perform the necessary action to meet one’s self-care requisites.
Nursing system is viewed by Orem as a human service consisting of “actions
deliberately selected and performed to help individuals or groups under their care
to maintain or change conditions in themselves or their environments.” Nurses
come to the rescue of individual who cannot perform certain self-care activities.
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The wholly compensatory nursing system is used when a person cannot engage
in any form of deliberate actions or cannot attend to himself and make intelligent
decision on self-care. Nursing actions are made up of performing the therapeutic
self care, compensating for their inability, supporting and protecting patients.
Orem’s theory is applicable in the study because it deals with self-care.” You
cannot give what you don’t have.” Nurses need to take care of their health to
provide the quality care to their patients. Compliance to preventive measures to
COVID-19 is important.
Conceptual Framework
A clearer understanding of this research could be gleaned from the conceptual
paradigm as shown in Figure 2 adapting the systems approach included in input,
process, output and feedback.
The input consisted of profile of the health care providers in terms of age, sex,
length of service, and attendance to training. The factors affecting compliance on
COVID-19 health protocols.
The process consisted of the collection of data, analysis and Interpretation of
the collected data, test for significance, formulation of the proposed plan to
enhance the compliance on the COVID-19 health care protocols of the health care

GRADUATE SCHOOL
The output of this study consisted of the proposed plan to enhance the
compliance on the COVID-19 health care protocols of the health care workers in
Sta. Maria Josefa Foundation Hospital.
The feedback loop this is used in the presentation of conceptual paradigm
which serve as the connecting links of the variables forming the cycle of the study
and the readiness of the output of this study. If the feedback loop indicates needed
changes, then the system need to be adjusted to enhance the compliance on the
COVID-19 health care protocols of the health care workers in Sta. Maria Josefa
Foundation Hospital.
COLLEGE OF HEALTH CARE TECHNOLOGY
INPUT PROCESS OUTPUT
1. Profile of the 1. Collection

health care ofdata
2. Analysis and
.providers
terms of:
in
Interpretation of
a) Age the collected
b) Sex data
c) Civil status
d) Length of service 3. Test for
The plan enhance the
e) Seminars significance
compliance on the
attended COVID-19 health care
2. Factors 4. Formulatio protocols of the health
affecting the n of the care workers in Sta.
compliance of proposed plan Maria Josefa Foundation
health care to enhance the Hospital
workers in Sta. compliance on
Maria Josefa the COVID-19
Foundation health care
Hospital on protocols of the
COVID-19 health health care
care protocols in workers in Sta.
terms of: Maria Josefa
a. Personal Foundation
factors Hospital
b. Client
factors
FEEDBACK
Figure 2. Conceptual Paradigm

ENDNOTES
1. Mary Eyram Ashinyo 2021, Infection prevention and control compliance
among exposed healthcare workers in COVID-19 treatment centers in
Ghana: A descriptive cross-sectional study, Retrieved from www.
journal.plos.org. com on July 2021
2. Vincent C. C. Cheng 2020, Escalating infection control response to the
rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19)
due to SARS-CoV-2 in Hong Kong, Retrieved from
www.cambridge.orgcorejournals.com on July 2021
3. Matthew F. Chersich 2020, COVID-19 in Africa: care and protection for frontline
healthcare workers, Retrieved from
www.globalizationandhealth.biomedcentral.com on July 2021
4. Demisu Zenbaba 2021, Compliance towards infection prevention
measures among health professionals in public hospitals, southeast
Ethiopia: a cross-sectional study with implications of COVID-19 prevention,
Retrieved from on July 2021
5. Biniyam Sahiledengle Geberemariyam 2018, Assessment of knowledge and
practices of healthcare workers towards infection prevention and

associated factors in healthcare facilities of West Arsi District, Southeast
Ethiopia: a facility-based cross-sectional study, Retrieved from
www.archpublichealth.biomedcentral.com on July 2021
6. James G. Adams 2020, Supporting the Health Care Workforce During the
COVID-19 Global Epidemic, Retrieved from www. jamanetwork.com on July
2021
7. Celeste Ann Castillo Llaneta 2020, UP PGH shares lessons learned as a
COVID-referral hospital in first ever virtual national town hall meeting for
hospitals, Retrieved from www.up.edu.ph/up-pgh.com on July 2021
8. Aurora Quadra-Balibay 2020,University of the Philippines develops
sanitation cubicle for frontliners
9. Symptoms of Coronavirus, Retrieved from
www.webmd.comlungcovid-9symptoms on July 2021

Chapter 3
RESEARCH METHODOLOGY
This chapter described and presented a thorough discussion of the
research methods used in this study. Among those included are the following:
research methods, respondent of the study, tools for gathering data and statistical
treatment.
Research Method
The researchers utilized the descriptive study designed. According to
Salustiano (2009), descriptive research answers specific questions by describing
and elaborating on the nature of a certain phenomenon. It also summarizes the
status of phenomena observed within the natural environment and without any
manipulation of independent variables. The researchers used this method in order
to collect self report data coming from the respondents through the use of
questionnaires.
Respondents
The respondents are the most important element of this study. They are the
main source of information needed for completion of the study. The respondent of
this study will be composed of 40 health care workers from different from the
nursing department, radiology department and laboratory department.

Data Gathering Tools
The main instrument to gather data is a checklist- questionnaire and to
counter- check the respondents responses, informal interview and observation
was made.
Questionnaire
Research instrument consists of questions for the purpose of gathering
information from respondents. The questionnaire focused mainly on the personal
profile of the respondents, compliance on the COVID-19 health care protocols of
the health care workers in Sta. Maria Josefa Foundation Hospital.
Preparation of the Questionnaire. After reading and studying sample of
questionnaires from books and different studies relating the present study, the
researchers will make a self-made questionnaire which consists of the following
parts. The first part consists of the profile of the respondents, the second part
consists perceived compliance on the COVID-19 health care protocols of the
health care workers in Sta. Maria Josefa Foundation Hospital and the third part
consists influencing factors that affect the compliance on the COVID-19 health
care protocols of the health care workers in Sta. Maria Josefa Foundation
Hospital.
Validation of Questionnaire. To find out whether the questionnaire will
effectively measure the parameters under consideration, it was evaluated by the
panel of examiners during the proposal and the suggestions were incorporated in
the final questionnaire. The draft of the questionnaire will be submitted to the
adviser for further analysis. A dry run will be conducted to the 40 health care
workers of different birthing homes that the researchers can evaluate their
questionnaires if it has the qualities of clarity, brevity and relevance to research.
Administration and Retrieval of Questionnaires. Before the
questionnaires will be distributed, a permit to conduct the study will be secured
from different hospital departments. The questionnaires will be also personally
distributed and retrieved by the researchers. The responses will then be tallied,
organized and interpreted descriptively and statistically.
Documentary Analysis. The researchers gathered documents such as
the record of the health care workers which were taken from different departments
of Sta. Maria Josefa Foundation Hospital.
Statistical Treatment
The following statistical tools were used to quantify, analyzed and interpret
the following collective data.
Percentage Technique is a proportion of part which considers the
quantitative relation to a whole. This will be used to determine the respondents
who answered a particular question. Percentage Technique will be used to
determine the relationship between the profile and compliance on the COVID-19
health care protocols of the health care workers in Sta. Maria Josefa Foundation
Hospital. The formula is:
N
P= 100
TNR
Where:
P= Percentage
N= Number of respondents
TNR= Total number of respondents
Weighted Mean will be used to determine the relationship between factors
affecting the compliance on the COVID-19 health care protocols of the health care
The formula is:
NxW
WM =
TNR
Where:
WM = Weighted mean
N = Number of responses
W = Weighted responses
F = Number of Respondents
TNR= Total Number of Respondents

Likert Scale has a four point scale which is used to allow individual to
express how much they agree or disagree with a particular statements. This scale
will be use to determine the compliance on the COVID-19 health care protocols of
the health care workers in Sta. Maria Josefa Foundation Hospital.
Scale Interval Scale Interpretation
4 3.50-4.00 High level of Competence
3 2.50-3.49 Moderate Level of
competence
2 1.50-2.49 Mild Level of
Competence
1 0.50-1.49 No Level of Competence
This scale will be use to determine the influencing factors that affect the
compliance on the COVID-19 health care protocols of the health care workers in
Sta. Maria Josefa Foundation Hospital.
Scale Interval Scale Interpretation
4 3.50-4.00 Greatly Influence
3 2.50-3.49 Influence
2 1.50-2.49 Moderately Influence

1 0.50-1.49 Not at al
ENDNOTES
1. Rosalinda Praddo Salustiano. 2009. Dr. RPS introduction to
research in the health sciences. First Edition, C & E Publishing, Inc.

CURRICULUM VITAE
PERSONAL INFORMATION
Name: CATHY H. TURIANO
Address: Lourdes Old, Nabua, Camarines Sur,
Philippines, 4434
Age: 22 years old
Date of Birth: December 7, 1998
Gender: Female
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Parents: Fermin Turiano Jr.
Cynthia H. Turiano
EDUCATIONAL BACKGROUND
Tertiary Bachelor of Science in Nursing
San Miguel, Nabua, Camarines Sur
June 2015- March 2019

Graduate in Midwifery
San Miguel, Nabua, Camarines Sur
June 2016- March 2017
Secondary University of Saint Anthony
San Miguel, Iriga City
June 2011-March 2015
Primary Nabua Central Pilot School
San Roque, Nabua, Camarines Sur
June 2005-March 2011
ELIGIBILITY/MEMBERSHIP
• Member, College Red Cross Youth Council (CRCYC) S/Y 2015-2019
• Member, Primary Health Care Provider (PHCP) S/Y 2015-2019
• Member, Philippine Nursing Student Association (PNSA) S/Y 2015-2019
• April 2017, Midwifery Licensure Examination Board Passer
• Phiippine Nurses’ Association Member since July 2019

SEMINARS AND TRAININGS ATTENDED
• Basic Life Support with Cardio Pulmonary Resuscitation Training for
Health Care Provider
CSPC Seminar Hall, Nabua, Camarines Sur
November 6-7, 2016
• Standard First Aid Training
CSPC Seminar Hall, Nabua, Camarines Sur
November 3-5, 2016
WORK EXPERIENCE
 Former Staff Nurse at Universidad de Sta. Isabel- Health Services
Department
( July 31, 2019- March 8, 2020)
 Staff Nurse at Sta. Maria Josefa Foundation Hospital Inc.
(September 28, 2020- present)

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

COMPLIANCE ON THE COVID-19 HEALTH CARE PROTOCOLS OF THE

HEALTH CARE WORKERS IN STA. MARIA JOSEFA FOUNDATION

A Thesis Presented to the

Faculty of the Graduate School

Camarines Sur Polytechnic Colleges

Nabua, Camarines Sur

of the Requirements for the Degree

Master of Arts in Nursing

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease

caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The

spread globally within weeks and resulted in an ongoing pandemic. As of 27 May

affected countries. (Girum, 2020)

The disease is clinically manifested by fever, cough, difficulty breathing,

manifestations, but it can lead to adverse outcomes including severe

those having underlying medical conditions. (Kayrite, 2020)

Healthcare workers play a critical role in fighting the COVID-19 pandemic

general community. Hence, the impact of the COVID-19 pandemic on healthcare

protecting healthcare workers against the COVID-19 pandemic. Therefore,

adherence to infection prevention and control protocols is critical at minimizing

healthcare workers exposure to the severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2). Indeed, correct and consistent compliance with IPC

protocols is effective in minimizing the risk of COVID-19 infection. Compliance with

IPC protocols is facilitated by training of healthcare workers on IPC, provision of

response to highly infectious diseases, such as COVID-19, should include early

recognition, physical distancing, source control, taking precautions and

appropriate use of PPEs, restriction of movement, environmental cleaning and

disinfection as well as support for healthcare workers.

As the cases rise, health workers are increasingly becoming at risk of

infection as they care for the ever-so-growing number of COVID-19 patients.

and the health workers will increasingly be at risk of COVID-19 INFECTION

COVID-19. This study will emphasize the importance of compliance in COVID-19

health care protocols.

order to make them aware of the importance of compliance to COVID-19 health

The researcher focuses on compliance of health care workers in Sta.

Maria Josefa Foundation Hospital on COVID-19 health care protocols. The

draw significant conclusions necessary in helping, lessen or control the present

good fighter against this unseen health and life destroyer.

observing health care protocols at home, at work and to the community, as a

Statement of the problem

This study determined the compliance on the COVID-19 health care

Specifically, it sought answers to the following questions:

1. What is the profile of the respondents in terms of:

Sta. Maria Josefa Foundation Hospital on COVID-19 health care protocols in

3. Is there any significant relationship between the profile of the

respondents and compliance on COVID-19 health care protocols?

4. What plan can be proposed to enhance the compliance on the

Josefa Foundation Hospital?

This study premises on the following assumptions:

1. The profile of the respondents is significant in determining the

compliance on the COVID-19 health care protocols of the health care

workers in Sta. Maria Josefa Foundation Hospital.

protocols of the health care workers in Sta. Maria Josefa Foundation

3. There is a plan that can be proposed to enhance compliance on the

Josefa Foundation Hospital.

This study anchored on the following hypothesis:

1. There is no significant relationship between the profile of the respondents

workers in Sta. Maria Josefa Foundation Hospital.