Review of Related Literature

This Chapter presents the related literature and studies after the thorough and in-

depth search done by the researchers. This study is concentrating in the lived

experiences of the nurses during covid-19 Pandemic. Recognizing the physical and

emotional impacts were gotten from two categories specifically; safety, fear, workloads

and mental issues.

COVID-19

Coronavirus disease outbreak (COVID-19) was first recorded in Wuhan, China,

in December 2019 (Chen, Zhou, Wang, Hu, 2020). Since then, it has spread rapidly

through China, Asia , the Middle East, Europe , North America and other parts of the

world (https:/www.worldometers.info/coronavirus/). There have been 3,579,479

confirmed cases and 248,445 reported deaths worldwide. COVID-19 is transmitted

primarily from person to person through the respiratory tract (Malta, Rimoin, &

Strathdee, 2020). Unsanitary environments associated locations with a high population

density and crowded areas with heavy foot traffic. It raises the risk of human

transmission and dissemination of the disease. The most common symptoms in patients

infected with COVID-19 are fever and cough followed subsequently by shortness of

breath, fatigue, muscle pain, dyspnea, headache, hemoptysis, and diarrhea. Some
patients developed further fatal complications, including sepsis, septic shock, pulmonary

edema, severe pneumonia, and acute respiratory distress syndrome.

In December, 2019, a novel corona virus outbreak of pneumonia emerged in

Wuhan, Hubei province, China,1Wang C.Horby PW.Hayden FG.Gao GF.A novel

corona virus outbreak of global health concern emerging understandings of 2019-nCoV.

In the fight against the 2019 novel corona virus, medical workers in Wuhan have been

facing enormous pressure, including a high risk of infection and inadequate protection

from contamination, overwork, frustration, discrimination, isolation, patients with

negative emotions, a lack of contact with their families, and exhaustion. Protecting the

mental health of these medical workers is thus important for control of the epidemic and

their own long-term health. Online platforms with medical advice have been provided to

share information on how to decrease the risk of transmission between the patients in

medical settings, which aims to eventually reduce the pressure on medical workers.

Understanding the mental health response after a public health emergency might help

medical workers and communities prepare for a population's response to a disaster.

The National Health Commission of China published a national guideline of

psychological crisis intervention for 2019-nCoV (National Health Commission of the

People's Republic of China) this publication marks the first time that guidance to provide

multifaceted psychological protection of the mental health of medical workers has been

initiated in China (Kang, 2020).

Nursing in the time of Covid-19

As COVID-19 is a recently recognized sickness, successful immunizations and

therapies are still being developed. Along these lines, in handling this recently

recognized irresistible malady, medical attendants face a likely danger of contamination

just as potential work-related problems such us anxiety and other mental issues.

(Khalid, 2016). Nurses believe that one of their greatest challenges working during the

pandemic was a lack of preparedness planning at both a management and health

department level (Lam, 2020). The hardwork was physically and mentally exhausting to

the nurses. Health-care professionals specifically nurse’s displayed their strength and

professional commitment to addressing challenges. (THE LANCET Global Health,

2020).

The nurses experienced increased anxiety for their own health as they taken

care to those infected patients (Kang, 2018). Also, they fear for more cases that could

lead to possibile death (Kim, 2018). The lack of resources such as protective gears and

equipments during in the pandemic contributed to fear working in the 7healthcare

settings due to increase chances of being infected during the health crisis. Despite

being passionate with the profession the unfamiliar environment created a sense of

loneliness and frustration among nurses. In Addition, not having control over patient

flow also generated both physical and psychological exhaustion (Kim & Kant, 2018).

Nurses were required to conserve protective clothing by reducing the number of times

they wear it since protective equipment was in short supply, resulting in fatigue and

discomfort. Nurses’ have been reported to experience stress associated with separation
from family, sleep deprivation and heavy workloads created by health system demand

and staff shortages (Huang, Rong & Liu, 2020).

Based on the study of (Sun, 2020) the psychological experiences are

summarized in 4 themes; mainly first negative emotions is present in the early stage

characterized by fatigue, discomfort, and helplessness that was caused by high-

intensity work, fear and anxiety, and concerns regarding the patients and related family

members. In the Second theme self-coping styles is associated with psychological and

life adjustment, altruistic acts, team support, and rational cognition. Thus, in the third

theme growth under pressure was established, including increased affection and

appreciation, professional competence creation and self-reflection. And lastly in the

fourth theme is associated with positive emotions a nd negative emotions

simultaneously occurs. In addition, Nurse Staff shortages during outbreaks of infectious

diseases can be caused by concerns about life-threatening infectious sources and

actual cases of infection among healthcare workers (Musau, Baumann, Kolotylo,

O'Shea, & Bialachowski, 2015).

Experiences of Nurse in the time of Covid 19

There can be a variety of issues in facing this Covid-19 crisis. The main reasons

are the workloads, the rapid rise of the confirmed patients, anxiety, and fear.

Furthermore, nurses fear theirselves about the risk of getting exposed and also the

feeling of getting lonely due they are separated to their families to prevent any

possibility of getting infected to the novel coronavirus. Also, being physically and
psychologically unstable would affect the works as a nurse (Wei, 2019). Medical staff

such as nurses caring for COVID-19 patients experience emotional stress, physical

fatigue, family alienation, stigma, and suffering due to the loss of patients and

colleagues. According to the Nursing and Midwifery Council (NMC,2020) that reflection

is the way where health and care professionals can assess professional experiences

either positive or not and improvements may be needed, and also to find insight to aid

their learning and identify opportunities to improve. Philip Esterhuizen, a nursing lecturer

of the University of Leeds said that `Reflective practice is not something that is switched

on and off. Being a reflective practitioner is something that you are, and it is especially

useful in times of stress, extreme situations and uncertainty. Nurses who had no

experience of infectious disease had more challenges when they had to adjust to an

entirely new working environment in this kind of stressful situation (Liu, 2020).

Long-term effects of stress can result in post-traumatic stress disorder, anxiety,

and depression. It is imperative that we implement proactive methods to protect the

mental health of our health care staff through possible contributing factor to reduce the

infection rate and work load of our nurses giving an emphasis to adhere their basic

needs accordingly on how they manage to cope with the current situation and gain

proper threshold of managing stressors (Ehrlich, 2020). Nursing Exhaustion realates to

the distress expierenced by employees related to job expectations and working

conditions (Melvin, 2015). Pressures can lead to mental health problems such as stress,

anxiety, depression, insomnia, denial, anger, and fear, which not only affecthealth-care

providers' attention, understanding, and decision-making ability, but could also have a

lasting effect on their physical and psychological wellbeing after the COVID-19 crisis is
over (Xiong & Peng, 2020). Nurses working in COVID-19 wards and treatment centres

suffer mental and emotional distress and perform inadequately in their jobs, such that

Patient and service management at COVID-19 Centres are now at the forefront of

treatment and facilities management. These core principles have to overcome

exceptionally high workplace pressures in order to enable nurses to continue delivering

real patient care with high-quality treatment (Xie, 2020). with workloads due to staff

shortage outbreaks like this are recognized contagious diseases, such as COVID-19,

highlight the risk of safety problems for health care providers and nurses. Physically and

Mentally, the intense work exhausted health care workers. Health care professionals

have shown their flexibility and ethical contribution to solving problems. Comprehensive

funding for the well-being of healthcare professionals should be given. In order to

enhance crisis management preparedness and effectiveness, routine and rigorous

training is required for all health care professionals (Liu, 2020).

According to (Fernandez, 2020) Nurses experienced heightened anxiety for his

or her health while caring for infected patients during an epidemic concerns over their

susceptibility to infection was largely related to fear of the new phenomenon, and with

the likelihood of death nurses feared not only being exposed to infected patients, but

were scared that infection might be spread through nursing colleagues sharing

resources Beside their health, nurses feared that with the uncertainty of the working

environment and new disease threat that they were placing their family and friends at

greater risk of infection Nurses were particularly concerned with spreading the infection

to vulnerable relations, like the elderly, immunocompromised and young children

Protecting relations was perceived as a priority, with some nurses choosing to self-

isolate as a protection strategy.

Considering the detrimental impact of depression on quality of life and quality of

care, health authorities should organize regular screening targeting depression, and

develop preventive measures to alleviate the risk of depression by providing a timely

provision of financial support, online psychological counseling service, on-site

psychological guidance as well as offering psychiatric treatment for vulnerable nurses

directly engaged in the treatment and care of COVID-19 patients (An, 2020).

In Africa, where the pandemic is escalating, there are significant gaps in

response ability, especially in terms of human resources and protective equipment. Also

low-cost measures such as facial masks for patients with cough and hand-washing

water can be difficult, as is 'physical distancing' in overcrowded primary health clinics.

Without adequate security, the death rate of COVID-19 among healthcare workers and

their families in Africa may be high due to restricted critical care beds and difficulties in

transporting ill health workers from rural to urban treatment centers. Nurses are

important partners and may encourage social distance and related strategies, debunk

misconceptions, help health staff, conduct symptom screening and track connections.

Staff morale and retention can be improved by carefully controlled risk 'allowances' or

incentives. International support for personnel and protective equipment, particularly

from China, could change the course of the pandemic in Africa.

In the COVID-19 department of the Capitol Medical Center in Quezon City, there

is one nurse for four patients. "But for toxic (critical) patients, it's one of two," said Elaine
Caday, head of hospital nursing. Nurses at the Philippine General Hospital (PGH) work

eight-hour shifts daily for a week, followed by a week-long "quarantine break." "Those

who work in COVID-19 are also on duty eight hours a day for seven days, but their

quarantine break is ideally 14 days," said Marlito Ocon, head chaplain of the hospital.

There are times, however, when COVID-19 ward nurses are asked to come in after only

seven days off due to a shortage of nurses. Consequently Capitol Medical Nurses work

for a total of 40 hours a week. "Two days with twelve hours of duty, two days with eight

hours of duty, then three days off per week," Caday said. "We haven't changed the

number of duty hours a week." Shuttle services to and from the hospital are provided by

nurses who go home, but those who live far away can choose to stay at home. "We

provided them with accommodation," she added. (“12-hour shifts make nurses more

vulnerable to covid 19” 2020).

In Southern Philippines Medical Center, as the sudden increased number of

confirmed covid-19 patients the concern of the nurses also arises for their safety.

Medical professionals are not only at risk of physical stress, but are also at risk of

mental health. The nurse identified as the SPMC becomes a referral center in the davao

region the fear, anxiety, workloads, discrimination and also shortage of staff began to

creep in. Furthermore, in the practice for their profession as a health care provider they

ensure the safety and care for all the Covid-19 Confirmed cases patients. Nurse’s

sacrifice their time and efforts from wearing personal protective equipment with a limited

time. It was uncomfortable to them. But it helps them to be protected and it prevents to

be contaminated. They also feel disappointed in reports of discrimination and

harassment against fellow medical professionals. They were prohibited from riding
public transportation, some were evicted to their dormitories and worst they were

assaulted for fear that they are the carrier of the virus. In Addition, as confirmed patient

kept rising one of the major challenges they faced was on how they would sustain their

inventory of the PPE of the front-liners. Also, the shortage of staff as some of the nurse

tested positive on the rapid test as they exposed of the virus. The Nurse’s were honored

due to this pandemic. They are also considered as the “modern-day hero’s” of today

and considered vulnerable to contracting the disease due to the nature of their job

which entails direct exposure to covid-19 (“Covid-19, one month later (Second of three

parts): At the frontlines” 2020). In addition,Davao Doctors Dumoy Satellite Hospital was

allowed to cater patients with Covid- 19 positive patients on 20th July, 2020 because of

increasing cases and Mayor Duterte Decarpio announced it for the incoming second

Covid-19. Nurses of Davao Doctors Dumoy Satellite Hospital cater asymptomatic and

mild symptoms patients which gives challenges to nurses for the new environment.

Thus Lived Contamination counteraction and control in essential, network, and intense

consideration settings present human services and nursing experts with enormous

difficulties. Significant practice issues stay to be settled (CDC, 2020; National Institute

for Health and Care Excellence, 2017).😞