PowerPoint Presentation

[Audio] Sleeping With The Sea of Sharks: Lived Experiences Of Filipino Nurses With Covid- 19 By: Leynalyn P. Resonable.

[Audio] Background of the Study. Nurses provide essential and unparalleled service in the challenges of the pandemic. When the world falls short in protecting them, the world is also hurting itself. They risk their lives for their loved ones and the public in altruism. Nurses receive their reward as they feel good in their selflessness at the cost of their wellbeing,even their own lives. Yet despite their self-sacrifice, they are discriminated against and even more despised when infected with Covid- 19..

[Audio] This research study operationally explored the lived experiences of nurses who recovered from Covid- 19. It provides the participants affected an opportunity to have a voice and make a meaningful contribution for the public to understand their experience from the perspective of a front liner being a patient themselves and how it impacted their lives. This knowledge may lead to the formulation of other queries that will aid in nursing practice and pave the way to discover a different approach to responding to healthcare workers' needs, especially during this pandemic..

[Audio] The study is entitled "Sleeping with the Sea of Sharks: Lived Experiences of Filipino Nurses with Covid-19". Sharks are regarded as one of the best predators on earth for being ruthless and cold-blooded killers with their aggressive behavior. The researcher used the metaphor as sharks are connected to emotions of being threatened in life, situations out of control and feeling vulnerable. Being infected of Covid- 19 gave the nurses' not only strong feelings of dread and doom but also made them swim into the ocean of peril. The effect of the pandemic is likened to the sea of sharks..

[Audio] Statement of Objective. This study sought to explore and describe and explore the lived experiences of Filipino nurses diagnosed with Covid- 19..

[Audio] Methods. A descriptive qualitative approach was used in this study. A semi-structured interview guide was utilized in the data gathering, with an in-depth, one-on- one interview with the participants. With their permission, all interviews were audio-recorded and stored in secured digital files that consist of both audio recordings and transcribed verbatim. Transcripts were analyzed using a thematic analysis technique..

[Audio] Population and Locale of the Study. Seven Filipino nurses who are working in private tertiary hospitals in Luzon, Philippines responsible for providing direct care to patients were enrolled as participants. Individually interviewed between February and April 2021. The participants were willing to participate and gave their full consent to be included in the study. Excluded from the study criteria were nurses working in the outpatient department, clinics, offices, and screening booths. The actual number of participants included was based on the researchers meeting the point of saturation. A purposive sampling technique was used to solicit appropriate participants. For Data Analysis, Colaizzi's seven steps method was used to analyze transcripts..

[Audio] The central themes were extracted from the transcribed interviews of the seven participants in the research study. The expressive parts that emerged from nurses' stories which helped to understand the nurses' experiences regarding the phenomenon, were carefully evaluated and were formed as themes. Thematic analysis was done by combining patterns and then categorizing them to broaden their meaning. The following three themes with the subthemes were developed and discussed. The nurses' experiences were divided into three phases of the nurses' experiences. First the onset of the pandemic and being infected with Covid-19. Second, During quarantine, and third during the recuperation from Covid- 19. The three phases of the nurses' experiences are signified in the three major themes: (1) We Are Crawling In The Dark, ( 2) Left Out In The Cold, and ( 3) Aftermath. These are presented with the corresponding sub-themes and significant statements. Trials and tribulations were experienced by the Filipino nurses when they were inflicted with Covid 19. Their encounters tested their faith and made them even more dedicated to their sworn oath to serve. Filipino resilience became evident with the findings of this research. The salient findings of the research study are summarized and major themes with their respective sub-themes were formulated as follows: Number 1: We are crawling in the dark together with its sub-themes includes, I got this like the back of my hand, Imminent danger, Defenseless Warriors, Wretched Nurses, and Enervated Faith. Number 2, Left out in the cold with sub-themes: Claptrap praises for nurses, On the back burner, Recharging batteries. Lastly, Aftermath with sub-themes includes, Adding insult to the injury, Thoughts of walking out a Sworn oath to serve, Recovery from The Hurricane, Highlighting the essentials, Intentional disregard for negatives, and Rejuvenated Faith..

[Audio] The first theme is We Are Crawling in The Dark. The Coronavirus as an unseen enemy has subjected the whole world to extreme chaos causing massive deaths and the fall of economies. It is as though everyone is crawling in the dark and unable to figure out what will happen next and for how long more. It is generally believed that no country was fully prepared to handle the magnitude of the COVID- 19 pandemic. Countries have difficulty preventing the disease as it has a unique ability to spread from asymptomatic people before the onset of symptoms and has a long incubation time..

[Audio] The first theme describes the nurses' experience at the onset of the Covid 19 pandemic, at a time before they were infected with the disease. The theme was derived from the respondents' statements as they depicted their plight at the hospital during this current time of the pandemic. As they explicitly described by Participant 03 (Line 18)" Everybody is still crawling even up to the present as they are still trying to figure things out." Participant 04 (Line 101) "The hospital is crawling in the dark. If infection control protocols are given priority, all employees will be safe.".

[Audio] Getting it like the back of their hand means having very good knowledge or familiar of something. In their case, they felt they already knew what to do with Covid 19, which they regarded as just another virus. They got used to doing things the same way that they overlooked hazards in their surroundings as Covid 19 started to expand worldwide. With the psychological state of the workplace complacency, employees stop thinking and merely follow a routine, entering " autopilot mode" and completing tasks automatically instead of mindfully. Complacency can lead to underperformance and workplace harm, endangering coworkers and their wellbeing. Complacency and workplace safety go hand in hand. When nurses get oblivious, they are more accident-prone and less likely to observe hazards that could jeopardize their wellbeing and endanger their co-workers..

[Audio] Imminent danger means there is cause to believe the well-being of an individual is in peril if no intervention is immediately initiated. The government stated that Coronavirus poses a "serious and imminent" danger to public health. Any workplace where appropriate measures are not fully complied with would pose a danger to an employee. Some have underestimated the risk of tasks they performed regularly. They have become oblivious of the existence of potential harm of Covid 19. The moment they noticed changes in their environment, it was already too late, and they fell victim to the dreadful disease. The participants expressed their thoughts on the severity of Covid 19 eventually. The nurses had a sudden feeling of fear or anxiety about something that may happen as they realized the severity of the disease. The sudden emergence of Covid 19 and its advance into a pandemic increased the demands of nurses' work, causing a lack of confidence, immense stress, and fear as they must battle an unseen novel enemy which was rapidly spreading..

[Audio] Defenseless Warriors. The nurses did not have adequate personal protective equipment to use like gowns, and gloves, which put them directly at risk in terms of their own safety and prevented them from being potential carriers of this disease to the patients for whom they were caring. The nurses were burnout working long hours of being understaffed. One even said he had straight 17 days of work without a day off. They were pleading for time to rest. Mandatory tests were not administered which the nurses needed for them to ensure their own health and their families..

[Audio] Wretched Nurses. All of them were shocked to find out they were positive for Covid 19.The possibility of being afflicted did not cross their minds. They were miserably thinking of the loved ones they left at home. All their close contacts were quarantined too also with their families. Knowing the stigma of the disease, they feared for their sake. They felt they have caused severe suffering to their loved ones and the guilt feeling lingered. The employers did not care about nurses so much more for their families who were also affected..

[Audio] The participants had inner struggles, and each of them verbalized how they thought of their situation while talking to God. Upon knowledge of their positive Covid 19 swab results, they felt weak and questioned their faith. Fear embraced the nurses. They asked God, "Why me?" They thought they had done a grave fault and that the situation was retribution. The nurses had felt that God was punishing them, and some initially felt angry. Trauma and tragedy can change the conception of God as all-loving and protective, making some people struggle in their relationship with God and start to have feelings of anger, abandonment, or being punished by a higher power..

[Audio] Left out in the cold. "To be left out in the cold" means "to be ignored, forgotten and neglected". The participants underwent tremendous challenges and struggles as they were going through the experience of being infected with the Covid 19 virus. People around the world acclaimed nurses as heroes, and yet during this time, when they were the ones who were ridden with the disease, all praises were erased, and they were subjected to overwhelming scorn. Like the Coronavirus, some people are unforgiving and undiscerning..

[Audio] Claptrap praises for Nurses. Nurses, have also been subject to bullying and stigma, partly due to the perception that they are more likely to contract and spread COVID- 19. When their positive Covid 19 results came out, praises ceased for them. The admirations became a claptrap: pretentious nonsense, insincere or empty language. Others were verbal with their disgust and most people as described by the nurses, were killing them softly with their silence and avoiding gestures. One of the nurses stated, they will not die of Covid, but the stigma will..

[Audio] On the back burner means in the position of something that will not receive immediate attention and action. This describes how the modern heroes are given value by their employers., Coordination with the local agencies for the sake of nurses is poor. There was deficient information regarding swab test results, contact tracing, and support for the infected nurses. Their necessities were not met when they were placed in quarantine. Water or refreshments were not included with the food provided during their isolation They even had to provide their own medicine and vitamins. Monitoring paraphernalia was not provided like a thermometer. NO staff call or guide t like doctors, head nurses, the chaplain, or coordinators..

[Audio] Holistically drained, the participants found ways to get up on their feet and "recharge their batteries" while confined in their rooms. Despite being unable to understand the purpose of their experience, they held on to their faith. Prayer became a part of their lives during their time of solitude. Their cell phones became an ally to them as they could communicate with their loved ones using technology. Others played online games, and one even took the opportunity to learn a foreign language via a mobile app. They ensured they were healthy and anticipated negative results for their next swab test. They ate healthy food and took the vitamins they brought, and friends and relatives provided some. Others exercised and did stretching and Zumba to keep fit. One followed up on some work she was not able to endorse. One watched the cartoons, and another watched TV to divert their attention and emotions of boredom, depression, and anxiety..

[Audio] The aftermath means the period immediately following a usually catastrophic event. This central theme describes when the nurses have already recovered from Covid 19.

[Audio] Despite showing a sense of sacrifice and performing all their best to fulfill their duty of giving the patients their best possible care, the nurses in this study expressed their anger and dismay as their employers failed to safeguard their wellbeing and show appreciation and value for their services. With their dedication to work, they were made to feel as if all their efforts were worthless. Their employers did not give them proper compensation. Private hospitals allot 15 days total in a year for each employee for allowed sick leave. Their quarantine days were categorized as sick leave. Some nurses were not paid. A significant issue, too, was the no providence of hazard pay. One asked, "Why do we have to plead for the right salary?" The nurses expressed their disdain as they realized that their services were good-for- nothing..

[Audio] The nurses are overworked and are doing their best despite being exhausted. If given a choice, they will consider leaving the profession. The nurses are frightened to go back to work for fear of reliving the dreadful experience. They fear going through the same experiences again and are further ridiculed by the public due to the stigma of the disease. If given a choice, they intend to resign from work. However, they have no choice but to stay employed because it is their source of income. They expressed that there is no available immediate job if ever they render their resignation. According to the Private Hospitals Association of the Philippines, about 40 percent of private hospital nurses have had enough and resigned since the pandemic.

[Audio] On top of all the experience, the nurses feel that nursing is already their way of life and will continue to serve. One of the nurses who experienced her mother's death disclosed that even with deep anger against her employer, she still wants to render service because she does not want others to undergo her experience and will continue to serve the best way she can. Since they have experienced being a patient themselves, understanding what a patient experiences and feels due to his/her illness has a positive effect on their nursing care. Nurses called it the calling of their duty and chosen profession as they continue to serve in this challenging situation. Service to their community was not new for nurses, and the pandemic has made them appreciate the purpose and value of their chosen nursing profession. They have become more conscientious as nurses care more about co-workers and feel a duty to protect the public and improve the community..

[Audio] Recovery From the Hurricane. Having been infected with Covid 19 was like a hurricane to the nurses. Despite the magnitude of challenges and struggles, they made a conscious effort to resolve personal and interpersonal problems caused by their experience to recover from the hurricane. The participants recounted ways how they minimized stress and conflicts. They continue and double their efforts for preventive measures against infection to ensure their safety and others at work. They all said they would continue obsessive-compulsive with infection control and prevention practices..

[Audio] Highlighting the Essentials. The experience brought about a transition in the life of the nurses and made them appreciate life. Nurses who care for COVID- 19 patients in intensive care understand the value of life better than those working in other units and show more positive changes concerning relationships, new opportunities, personal power, and spiritual change. In a related study, nurses who served in wars experienced an understanding of the value of life, personal power, and spiritual and existential change after their traumatic experiences. They invest in their health as their loved ones depend on them. Because the stigma is there to stay for a long time, the nurses continue to isolate themselves from the public and prefer to be with their loved ones. Family ties and their relationships are stronger. They value more those who are genuinely concerned for them..

[Audio] Intentional Disregard for Negatives, For the discrimination of the public, they simply chose to avoid them instead and stay silent. They said that people would never really understand no matter what they do, especially those who do not have medical knowledge. Some merely cried out and presented a façade to solid and unaffected people. They used denial and defense mechanisms. One nurse said she started to imagine they have no neighbours. Derogatory comments are ignored, and they pretend they do not hear anything or forget the judging look in people's eyes. Despite the outrage from people, they all wish others would not have to experience being infected because they know first-hand that it is dreadful. There has also been evidence of defense mechanisms during the COVID- 19 pandemic that have provided more benefits making staff members have channelled their energy into altruism or sublimation, where they have focused their energy on getting involved in utilizing their skills and physical resources in the face of challenges, sublimation and humor are examples of high adaptive defenses that help maximize gratification and allow more conscious awareness of feelings, ideas, and their consequences.

[Audio] Rejuvenated Faith. They all kept hold of their faith in God and trusted Him to direct their lives. Positive religious reframing helped the nurses rise above stressful times by supporting them to see a tragedy as a chance to grow closer to God and improve their lives. Their faith made them feel empowered and hopeful and became powerful help in managing their stress. They have offered and dedicated their lives to the Lord and their families. Prayer has become a habit for them despite doubts, questions, and fears. They regarded God as their protector and savior..

[Audio] Recommendations. Nurses are risking their health. The hospital management must provide them with sufficient personal protective equipment to feel safe at work and lessen the fear of transmission to their families. Policies related to COVID- 19 must consider the many facets of the nurses' complex issues. Help should be provided and extended to family members like hospitalization, mental health programs assistance, and psychological support for those at high risk of developing traumatic disorders..

[Audio] Quarantine services should also include medications ss vitamins, and refreshments. Providence of essentials and other supplies during quarantine should be reviewed and defined. A designated attending physician should be delegated to monitor the nurses placed in quarantine. Nurses should also be provided with mental health and spiritual support. During quarantine groups, chats should be initiated for nurses in quarantine to communicate with fellow nurses and administration personnel. Activities online should be planned so that nurses can divert their attention and their distress. Experience of being infected with Covid 19 gives a high level of stress and mental assault to nurses that causes psychological trauma. Early stress assessment should be done, and employers should ensure that nurses can get the help they need. Healthcare leaders and policymakers must provide appropriate mental, physical, and psychological means to support and protect nurses. Benefits from governing agencies should be appropriately disseminated, and hospital leaders should coordinate with their employees..

[Audio] Nurses at private hospitals are doing the same work and are equally risking their lives as those from government hospitals, so, therefore, they also deserve to be given proper remuneration with the same salary rate and hazard pay for their services. Quarantine leave should be a different category for the benefit of nurses and should not be indicated as sick leave. We urge policy‐makers to ensure that nurses' voices and perspectives are integrated into local and global decision‐making to minimize the structural injustices many nurses have faced. Nurses should be consulted through Nursing organizations to have a voice in the decisions regarding health protocols. There should also be debriefing and counseling for nurses who have recuperated from Covid 19..

THANK You Leynalyn P. Resonable RN, MAN.