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Chapter I

THE PROBLEM

Introduction

In the past, overstated fears and anxieties pertaining to infection were recorded

when correlated to other health related conditions. There were further evidences showing

that in the recent incident of outbreaks, concerned individuals have developed fear,

denial, stigmatization, as well as loss. Stigmatization and discrimination on the other

hand, may likewise entail ethical consideration along with efforts to address the issues

but perceived may cause unnecessary result (Pappas et al., 2010).

The global crisis on the other hand, as causal phenomenon instigated by the

corona virus is perceived a public health risk and predicted to amplify threats on the

economy. The COVID-19 shock apparently triggers recession in most countries. The

curtailed global annual growth is forecasted below 2.5 per cent. With the indication of

the duration along with the depth of the inevitable economic crisis will depend on three

variables namely: the extent of the virus spreads; the time before the vaccine could be

formulated; and the effectiveness of policy makers in mitigating the impairment of the

pandemic to our physical as well as economic health and well-being. The improbability

with respect to the variables aggravates individuals’ anxiety and predicted to influence

the socio-economic crisis outcomes.

The social foundation of India, as considered one of the most affected countries

by the COVID-19, is noted on the perspectives of emotional, social, including economic

standpoint as encountered by the families, relatives, peers, aspects about religions and

rituals, and others, nonetheless well addressed for interdependence. India is known for
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close physical interactions, crowded places and housings however, social distancing due

to the pandemic was imposed. Taking a glimpse, the aspect of social distancing seems

unworkable in India. Nonetheless, it is remarkable that despite the social distancing

along with economic concerns, India is continuously in adherence to the preventive

measures notwithstanding on the impact over inequalities (Gospalan & Misra, 2020).

Kumar et al. (2020) emphasized the significance of COVID-19 management reiterating

the need to surface appropriate and instantaneous strategies to deter proliferation of the

virus. Nonetheless, the Indian government’s action to implement lockdowns, just like in

the Philippines and other nations has crippled India in dealing with other immediate and

emerging issues of the nation like, disasters, economic perspective, and further national

concerns.

In Philippine context, the present crisis is linked to the etiology and nature of

COVID-19. It was revealed that the Philippine infrastructure along with the capability of

manpower for pandemics is very limited. This fact is an added uncertainty in as far as

outcomes and future scenarios are concern (Vallejo & Ong, 2020). In addition, Macasero

(2020) provides that Visayas region is an emerging corona virus hotspot, particularly the

Eastern Visayas. Health officials stated that if the trend continues, chances are, health

systems may be further overwhelmed. On the other hand, just like India and other

countries, the policy responses to address the increased number of infected individuals

have caused the Philippines economic disruption, along with the strike of calamities, and

other uncertainties (International Labor Organization, 2020).

In the light of the local setting, in Ormoc City, the Department of Health (DOH)

reported in December 2020 the seven corona virus infected individuals out of the 45 new
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contagions and 1,139 laboratory tests in Leyte during that time. The Ormoc City

Molecular Diagnostic Center is distinguished as one of the healthcare services in Leyte

facilitating tests of the infected people in the particular community. In order to manage

the overwhelming contagious disease, the local authorities implemented the community

isolation and eventually transferred the treatment and monitoring to higher healthcare

facilities to further perform the needed management and treatment (Sabalza, 2020).

Moreover, continuous contact tracings were also conducted among those with contact

with the persons found COVID-19 positive. Checkpoints were also conspicuous in both

entry and exit of the municipality. Pursuant to the national policies, prohibition with

regards to social gathering, observance of curfew hours, sanitation and hygiene in all

business establishments, instigating the barangay health response teams, provision of

transportation, particularly those that were stranded, and other management that may

contribute to curtail the spread of the virus.

The current pandemic faced worldwide and in most part, endured by the

healthcare professionals, interests the researcher to conduct a study. Many researches

about the preventive measures against COVID-19 were undertaken however, lesser

research pertaining to the factors of COVID-19 management on mental health condition

of hospital employees was conducted. Thus, the proponent aimed to understand the

foregoing factors of COVID-19 management and their significance to hospital employees

mental health. In the proposed research, healthcare system, governance and political

issues, immediate emerging issues, and enduring emerging issues were specific factors

that the researcher intended to assess. Moreover, the researcher attempted to conduct the

study among health care workers in Ormoc City. The researcher deemed that this paper is
 4

significantly of importance among healthcare professionals, government and policy

makers, and the society in general.

Theoretical Framework

The study, which was aimed to determine the factors on COVID-19 management

on the mental health state of hospital employees was anchored to Social Impact Theory

by Latané (1998), Socio-Economic Theory by Mitchell (1917), and the Republic Act

(RA) 11036, otherwise known as the Philippine Mental Health Act.

Social Impact Theory posits that the extent of influence that an individual

encounters in group contexts relies on, strength or social status of the group, immediacy

or psychological distance of the group, as well as the number of individuals in the group

setting forth the social influence. Therefore, the group that has many members, with high

power, and close proximity should put forth the most influence on an individual as

compare to the group with few members, low power, and nearness. On the other hand,

when increases are apparent as strength of the individual is exposed, particularly on

social influence, the proximity of the group decreases. Conversely, as the increase in

number among the target individuals manifest, the exerted amount of influence by the

group among individual also decreases.

Social Impact Theory by Latané (1998) predicts how and when a target is affected

by sources of social influence. It is in essence an extremely extensive theory, which

seeks to cover sorts of thoughts, as well as feelings, behaviors, including physiological

states. As an illustration, while other individuals are considered sources of social

influence on a target person, the effect is supposed to be a multiplicative function of the

strength, immediacy, and amount of sources. Moreover, in the event that other
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individuals are co-targets of social influence, social impact is anticipated to be divided as

an inverse power function of the strength, immediacy, and number of the targets. Latané

furthermore proposed, social impact theory as a descriptive model, or meta theory

opposing the explanatory one.

On the other hand, many researches support that multiple people put forth more

influence compared to those presented by a single person. Nonetheless, there are three

conditions in which the impact of multiple sources only holds true: primarily, the strong

arguments must be present as influencing message. Apparently, reasoned arguments that

are weak, whether coming from multiple sources or not, result in very minimal attitude

change; secondly, multiple sources must be perceived by the target as independent of

each other. Consequently, the impact that multiple sources bring vanishes in the event

that the target deems that the sources apparently share a single brain or sense. The

conspiring party however will in a certain situation be no more effective compared with a

single source. Thirdly, additional sources however will denote no further effect, in the

event that the number of sources augments.

Thus, the Social Impact Theory asserts that the chances that an individual will act

on social influence will increase with strength, or how significant the influence of a group

of people is to a person; immediacy, which describes how close the group is to an

individual during the time of the attempted influence; and number, which illustrates the

number of people in the group (Harkins & Latané, 1998).

The foregoing paper attempted to ground with the social impact theory,

specifically on the concept of influence of group of people on the behavior and attitude of

an individual hospital worker. The influence of social impact theory as theoretical

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foundation of the present study will likewise substantiate the hypothesis that was posited

in this paper.

Mitchell’s (1917) Socio Economic Theory, otherwise known as Social

Economics. Mitchell believed that the theory of the sole economy commences with a

brief consideration of prejudiced factors in the processes of economics; a man’s

aspiration along with activities, which included his wants, satisfaction, and his attitude of

the future wants. Socio-economic theory is a combination of social theory and economic

theory, a branch of economics and social science, of which focus is on the relationship

between social behavior and economics. Conversely, social economics basically focuses

on the interaction and relationship between social processes and economic activity in the

realm of a society. The socio-economic theory attempts to elucidate the behavior of

social group or socio-economic class within a particular society.

The social economics also encompasses two wider perspectives that are perceived

opposite in their approach nonetheless, they could be considered harmonizing to each

other. The first standpoint of social economics was founded by Becker, who applies the

fundamental theoretical as well as applied tools of neoclassical microeconomics,

specifically to matters pertaining to human behavior, which is not customarily extended

with consideration of shared fraction on economics per se, for instance, crime and

parallel penalty, abuse of drugs, matrimony, and decisions about family. On the other

hand, the second perspective of social economics is of relevance with the notions or

designs of other social sciences like, psychology, sociology, along with the identity group

studies relative to subjects of a particular economic nature such as, the behavior of

consumer or labor markets. The practitioners in these fields utilize historical views,
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current events and general information, political outlook, and other social sciences

perspectives in order to predict social trends that in one way or the other may generate

impact to the economy. In this research, the two perspectives of social economics are the

predominant focus of the theoretical foundation, particularly the trending issues of

COVID-19 pandemic and their impact on mental health of hospital workers. More often,

the theories of social economics consider factors that are beyond the mainstream of

economics, this may include the effect of the environment and ecology on consumption

as well as wealth.

In this study, both the Immediate Emerging Issues and Enduring Emerging Issues

are considered vital to be theoretically grounded to the socio-economic standpoint to

strongly justify how Immediate Emerging Issues and Enduring Emerging Issues influence

the mental health state of the hospital workers. In addition, this paper has endeavored to

justify the behavior of hospital employees with the current situation of pandemic, their

perception towards transporting the needed services among the infected individuals in the

locality, the status of healthcare facilities and system, and the long been environmental

issues that are nuisances on top of the pandemic.

The Republic Act (RA) 11036, otherwise known as the Philippine Mental Health

Act, an act establishing a national mental health policy for the purpose of enhancing the

delivery of integrated mental health services, promoting and protecting the rights of

persons utilizing psychiatric, neurologic, and psychosocial health services, appropriating

funds, and for other purposes is likewise deemed as an appropriate foundation of the

present study (Congress of the Philippines, 2007). The act further defines discrimination,

mental health, mental health condition, mental health facility, mental health
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professionals, and mental health services along with the rights of service users and other

stakeholders. The act furthermore supports the mental health being through provision of

mental health services, promotion of education, promotion, and mental health in

educational institutions and in the workplace. Duties and responsibilities of the

government were stipulated to further ensure implementation and provision of the act

along with the needed support of appropriate government agencies and local government.

Thus, the Philippine Mental Health Act strongly substantiates the essential

foundation of the foregoing research, particularly in ensuring sound mental health state of

hospital workers, especially this time of COVID-19 pandemic, considering further the

vital part they play in battling with the fatal virus. Moreover, the act further supports

appropriate establishment of programs that shall alleviate causes of mental health

instability among the hospital workers.

Below schematic diagram proposes the theoretical perspectives of the study

having social impact and socio-economic theories and mental health act supporting the

foundation of the research, wherein factors of COVID-19 management namely,

healthcare system, governance and political issues, immediate emerging issues, and

enduring issues potentially influence the mental state of the hospital employees. Output

of the research was aimed at establishing appropriate mental health framework and

mental health enhancement plan.

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Socio-Economic Republic Act (RA)

Social Impact Theory 11036 (Philippine
Theory by Mitchell
by Latané (1998) Mental Health Act)
(1917)

Mental
Factors of COVID-19 Health State
Management of Hospital
employees
 healthcare system;
 governance and
political issues;
 immediate emerging
issues; and
 enduring emerging
issues.

Hospital Employees in private

hospitals in Ormoc City

Mental health Mental health

framework or model enhancement plan
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Figure 1. Schematic diagram of the study utilizing the Social Impact Theory by
Latané (1998), Socio-Economic Theory by Mitchell (1917), and the Republic Act
(RA) 11036, otherwise known as the Philippine Mental Health Act.
Statement of Purpose

This purpose of the study was to assess the perceived Factors of COVID- 19

Management, which predicted mental health state of the health care workers in the

private hospitals in Ormoc City for the 3rd quarter of 2020.

Specifically, the following research questions were raised:

1. What are the factors towards mental health in relation to COVID-19

management in terms of:

1.1 healthcare system;

1.2 governance and political issues;

1.3 immediate emerging issues; and

1.4 enduring emerging issues?

2. What is the mental health state of the health care workers?

3. Which perceived factors of COVID-19 management predict the mental health

state of the health care workers?

4. What mental health framework or model can be proposed based on the

findings of the study?

5. What mental health enhancement program can be proposed based on the

findings of the study?

Statement of Null Hypothesis

Hereunder null hypothesis was tested of its significance:

The factors of COVID-19 management do not predict the mental health state of

the health care workers.

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Significance of the Study

The factors of COVID-19 management among health care workers are

phenomenon that entails vital action in order to alleviate the risks. This study was

proposed to transport important information and offer the needed program and

intervention to uphold the wellbeing of healthcare professionals.

Specifically, this study was significant to the following:

Hospital Employees. Findings of this study are beneficial among hospital

employees predominantly in ensuring that their health and wellness are in good shape.

Assimilated information shall also provide the healthcare professionals awareness on

appropriate management of factors that may result to mental health issues.

Clients or Patients. Output of the research is certainly of benefits among the

patients, especially in appreciation of the efforts of the hospital employees despite their

being one of the most vulnerable individuals this time of pandemic. Moreover, this study

shall also extend further information and precautionary measures in dealing with the

COVID-19 pandemic as well as other illnesses.

The Community. The outcomes of the study are beneficial to the community,

especially in understanding the functions of the healthcare professionals and their

important role in combat of the pandemic. The community will be enlightened that there

support to the healthcare professionals is in the same manner supporting the community.

Policy-makers. The following policy-makers will be benefitted from the study:

Department of Health (DOH). This research is primarily significant to

DOH, particularly in the establishment of appropriate care among hospital

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employees considering their imperative role this time of pandemic. Gathered

information and findings of the study shall impart the needed basis for the

department towards formulation of programs to ensure that hospital employees’

wellbeing is provided with essential care.

National and Local Government Units. Addressing the threatsof

infectious disease outbreaks is one of the government’s primary functions,

especially now that COVID-19 perseveres. Hence, output of this research is

significant to the government, primarily in planning and being prepared in

confronting disease outbreaks, furthermore uphold the mental health state of the

hospital employees. In addition, results of this research shall serve as bases for the

government in the creation of appropriate interventions to alleviate the mental

health risk factors among hospital employees resulting from the pandemic.

Hospital Administrators. Findings of the study will be significant to hospital

administrators, especially in ensuring safety of the health care workers against COVID-

19. The essential management of factors that shall affect the mental health of the workers

are predominant issues addressed in this study, thus gathered information could be of

contribution to the hospital administrators as they establish the needed guidelines for the

protection of health care workers, particularly their mental health state.

The Researcher. This research is of paramount importance to the researcher

being in the same field of profession. Gathered information will provide significant

enlightenment to the researcher, particularly in understanding the factors on COVID-19

management.
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Future Researchers.This research shall be significant to future researchers,

particularly in the formation of their own study in parallel discipline. Information

gathered in this paper will be of contribution to future researchers’ specific research

objectives.

Definition of Terms For enhancement ( how it is measured)

The following terminologies were operationally defined for clarity and better

understanding:

Perceived Factors of COVID-19 Management. This refers to the perceptions of

the health care workers on healthcare system, governance and political issues, immediate

emerging issues, and enduring emerging issues in the management of COVID-19 whether

very low to very high. In this research, perceived factors of COVID-19 management

were assessed to determine their impact on mental health among hospital employees.

Enduring Emerging Issues (EEI) refers to the challenges or problems

that a society is facing or being discussed across time. In this research the EEI

will be examined as predictive factors on COVID-19 management on the mental

health state of hospital employees. The EEIs are continuous issues that on top of

the pandemic are unremittingly affecting the wellbeing of the people, of which in

this research are EEIs as factors on the management of COVID-19. This research

furthermore assessed the impact of EEI among hospital employees as further

encumbrances over the pandemic.

Governance and Political Issues (GPI). Governance is the exercise of

power or authority by political leaders for well-being of the citizenry. On the

other hand, political issues are controversies debated within the political system or
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everything from conflict-ridden social issues. This study has determined the

factors of GPI on COVID-19 management among healthcare professionals mental

health state. The foregoing paper furthermore examined the complexities in the

government, particularly on issues of policies pertaining to the management of

COVID-19 pandemic in order to determine their impact on mental health among

hospital employees.

Healthcare System (HS) is an organized plan of healthcare services. It is

also a system or program wherein healthcare is made available to the population

and financed by government, private enterprise, or both. Being a vital factor in

facing the detrimental grounds of COVID-19, particularly among healthcare

professionals, HS in this study will be investigated to ascertain its factor among

healthcare professionals.

Immediate Enduring Issues are issues that exist across time. While the

pandemic is continuously ravaging globally, other immerging issues such as

climate change, disasters caused by floods, economic trends, the current

pandemic, and others will be studied in this research to ascertain their factors on

COVID-19 management among healthcare professionals at this time of battling

against the pandemic. These immediate enduring issues are considered factors on

COVID-19 management that were examination because they simultaneously

occur with the pandemic, thus believed to aggravate the mental health concerns of

the hospital employees.

Healthcare Workers refers to any member of the medical, pharmacy or nursing

professions or any other person who in the course of his or her professional activities may
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prescribe, administer or dispense to an end-user a medicinal product of service. The

healthcare professionals in this research were resident physicians and nurses wherein,

factors of COVID-19 management on mental state will be assessed among them.

Mental Health (MH) State is about the state of well-being wherein individuals

can cope with the normal stresses of life and contribute to her or his community. Given

that people globally are affected by the COVID-19 outbreak, more so, the healthcare

professionals and workers. This paper will investigate the MH as factor of COVID-19

management on mental state of hospital employees.

Mental Health Enhancement Plan is a program featuring actions that could be

taken to address the mental health issues among hospital employees. In this study,

mental health enhancement plan to address vulnerability issues among healthcare

professionals will be established in order to protect them against the fatal effect of

COVID-19 pandemic.

Mental Health Framework or Model is a structure that shall govern the

implementation and administration of appropriate program in tackling issues pertaining to

health and well-being of healthcare professionals. This paper was endeavored to institute

an appropriate mental health framework being the output of the study, which could aid

the healthcare professionals as they persevere to deliver quality healthcare services to the

people, particularly those facing the effects of COVID-19 pandemic at the same time

protecting themselves.
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Chapter II

REVIEW OF LITERATURE AND STUDIES

This chapter presents the related literature and studies deriving from various

readings and sources pertaining to The Factors of COVID-19 Management on Mental

Health State of Hospital employees in Ormoc City. Gathered information justified the

credence of the present research.

Mental Health State of Health Care Workers

The Hospital employees on COVID-19 Outbreak. It is evident that hospital

employees are at the front line of any outbreak response that exposes them to hazards and

place them at risk of infection with an outbreak pathogen, of which in this case is the

COVID-19. The danger encompasses pathogen exposure, longer working hours,

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

psychological violence (World Health Organization [WHO], 2020).

World Health Organization (WHO) 2020 states that COVID-19 related acts take

place against the backdrop of growing social stigma and discriminatory behaviors against

anyone believed to have been in contact with the virus. Corollary to the pandemic, health

resources, patients, health care providers, and their respective family members are at

particularly high risk of experiencing attacks on account of to the wrongful belief that

they have become vectors of contagion in a community.

From the outset of the outbreak, healthcare providers and professionals have

exhibited remarkable support, solidarity, gratitude. However, hospital employees are not

only continuously facing attacks of discrimination but also reported included in the lists
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of incidents linked to COVID-19 pandemic across the world. The public health

emergency recorded that health facilities along with the needed medical transport,

patients and hospital employees along with their respective families are targeted

elsewhere. The disturbing occurrences of the pandemic underline the necessity to

enhance measures for the protection of healthcare from acts of violence and

discrimination. The COVID-19 has situated most of the healthcare systems towards

enormous challenges and defying other players beyond their capabilities. With this

scenario, leveraging the healthcare system in response to public health emergency and

efficiently lessening its impact is predominant. Failure to provide the necessary

protection to health care given the present and fast shifting circumstances is placing

health systems to crucial gaps with regards to the most vital provision of services that

shall furthermore transport a long-lasting effect of the health and wellbeing of the global

populations (WHO, 2020).

Mental Health (MH) State. The inception of the spread of COVID-19, it was

apparent that hospitals had scarce protective equipment to offer. Guidelines or treatment

were not also properly provided. Consequently, the healthcare professionals felt

uncertain, helpless, alienated, isolated, and difficulties in coping with the workload.

Moreover, the outbreak has resulted to psychological outcomes like; anger, anxiety,

insomnia, and stress that are believed related to the pandemic. The anxieties are recorded

as risk factors that could possibly be stimulated at the onset of burnout (Giusti, et al.,

2020).

Rodriguez (2020) suggests that the pandemic could generate in workers the

feeling of ineffectiveness along of being helpless given the demand of quality of work
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loads, of which in turn will adversely contribute to high emotional loads among

healthcare professionals. One that is noted dominant among the stressors is the Burnout

Syndrome (BS), or an excessive amount and prolonged stress of which major

components are emotional fatigue that causes energy loss, worn out feeling, dissociation,

and diminish work performance.

WHO (2020) declared BS as labor risk that affects quality of life and

compromising a person’s mental and physical health. Utilizing clinical evidence, BS can

be identified: social isolation, anxiety, fear, depression, anger, addictions, changes on

personality, self-immolation and guilt, eating habits imbalance, gain weight or loss, loss

or disorganization of memory, problems on focus, and sleeping disorders. On account of

these effects caused by BS, particularly in workers’ health, prevention as well as

treatment of BS and its manifestation would be vital for both physical and mental health

care.

In the performance of duty among healthcare professionals, many elements of

pressure were caused by the impact of keeping optimal conditions for a healthy working

environment, as well as the saturation of the sanitary facilities on account of the degree of

virus infection, it is then apparent that the health of these healthcare professionals has

been distressed. We must keep in mind that the effectiveness and appropriateness of

performance of these institutions are depending primarily on the wellbeing of its

professionals and their exposures on environmental conditions placing their physical and

mental health at risk. In the midst of the pandemic, aspects associated to occupational

psychology may be considered highlights that influence the potential psychological

consequences among hospital employees: inadequacy of resources along with heavy

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workload. Additionally, it could be noted that fatality rates of COVID-19 has caused

global psychosocial impact resulting to mass hysteria, burden over the economy, and

financial intricacies. The term coronaphobia or mass fear caused by COVID-19 has

engendered psychiatric symptoms from corner to corner strata of the society (Dubey, et

al., 2020).

Given that anxiety, symptoms of depression and distress are mostly present in

high levels of population, there is still a possible vulnerability in some other groups in as

far as psychosocial effects of pandemic is concern. These are the individuals who

contract the virus, people with existing and high risk of infection, individuals with

subsisting conditions of medical, psychiatric, or substance use problems are found having

increased risk for adverse psychosocial outcomes, most predominantly, the healthcare

professionals and workers involved in various medical services (WHO, 2020).

Healthcare System (HS). In some countries’ where healthcare attacks are evident,

COVID-19 in some cases established adverse environments for providers of healthcare,

wherein reports of violence, discrimination, and harassment have transpired. Medical

transportation facilities carrying various COVID-19 samples were also reported harassed.

Drivers on-duty and patients are also gaining several issues and global concerns. The

continuous attacks do not only affect the ability of health systems to deliver the needed

services, especially to the most people in need of medical attention in this time of

pandemic, but the risks also take a heavy charge on the psychosocial factor, health of

patients, critical health care providers at the frontline along with their families (WHO,

2020).
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Governance and Political Issues (GPI). Gore & Parker (2019) provide that there

were increasingly drawn attention with regards to the power issues all through the global

health field, particularly on decision making based on scientific evidences that seem to

overlook the power distribution and exercise of power along with policy and systems.

Because of the failure to acknowledge the premise of global health efforts, actors and

their functions may maneuver health concerns in other directions.

According to Gore & Parker (2019), power manifests the levels of decision

making to implementation of interventions. It was highlighted that in exercising of

power, global stage, such as international agencies and alliances can shape global action

when it concerns health, which also include players at the national level whose principles

have the capacity to influence the impartiality and universality of public policy.

Nevertheless, it may also be noted that there may be actors in health system that may be

of power, particularly in local setting. In this context of local health system,

administrators, bureaucratic agents, as well as frontline health workers may have the

opportunity to exercise power in the course of daily transport of health services, either

negative or positive consequences for the people they serve.

Gore & Parker (2019) pointed out that regardless of the significant recognition

pertaining to the role of power in the structure of global health outcomes, theories and

methods for examining the concept of power; they are rarely applied in as far as health

policy along with systems research are concern. This however is not new facts. In

general, it was recognized long before that there are yet items to check on with regards to

technical and managerial issues of healthcare service delivery.

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Immediate Emerging Issues (IEI). Emerging issues are based on newness,

however, they are not necessarily issues that never hear. Newness could be in forms of,

new scientific knowledge like, new data, evidence, a model or theory; new technological

development; new scales otherwise the accelerated rates of impact; awareness of

something heightened level; and new means of addressing to a known issue (United

Nations, 2016).

On context of emerging issues regarding policy makers and the sustainable

development, several ways could be considered. In the broad concept of sustainable

development, it suggests any social, economic, or could be environmental process or

demands that agree with the scientific understanding may be considered a potential

relevance. On the other hand, emergence could imply the development or innovation of

some identified issues, novel awareness of the causes or outcomes, establishment of new

options particular to management, or the recognition of certain issues that have never

extended due account or credit. However, the innately system of classifying or finding

emerging issues could nevertheless be guided by important points which include, criteria,

duly selected having an outlook that is associated to the specific field of interest

(Mensah,2020).

The process of identifying emerging issues can proceed in a number of ways, but

a common starting point is “scanning” for issues across a range of sources, informed by

the purpose of the exercise. Horizon scanning is defined as “the systematic examination

of potential (future) problems, threats, opportunities and likely future developments

including those at the margins of current thinking and planning. Horizon scanning may

explore novel and unexpected issues, as well as persistent problems, trends and weak
 22

signals”. Weak signals are the first sign of emerging issues and the indicators of possible

change (UNIC Cannberra, 2016).

Enduring Emerging Issues (EEI). Klenert, et al. (2020) insinuates that the series

of issues and stories about the COVID-19 pandemic and climate change has at this point

transported interest surfacing the interest to short-term greenhouse gas (GHG),

particularly reductions of emissions, responses on public health, as well as clean recovery

stimulus packages. In general perspective, mitigation approach to crises was formed

taking into account of the associated lessons. Thus, learning from the perspective of

climate change in the midst of COVID-19 could propel to further develop efforts toward

the reduction of GHG emissions in order to prepare humanity in the crises ahead. On the

other hand, global responses is also seen in angle of climate change, in the same manner

as COVID-19 responses are also needed, especially that the rising number of cases is

seen to intensify. Nonetheless, as compared to crisis pertaining to the climate,

epidemiological challenges create greater incentives, particularly for localized mitigation

of risk factors (Klenert, et al., 2020).

Thus, the EEI as factors to COVID-19 management will also be examined of their

contributory aspects on top of the pandemic, since issues about climate change and

surrounding elements have been occurring for decades and continuously an important

issue to tackle. The study intends to determine how factors of COVID-19 pandemic

affect the mental health state of hospital workers (Fuentes et.al 2020).

COVID-19 Global Outbreak and in the Philippine Context

Coronavirus disease, also known as COVID-19 outbreak is currently a global

health issue allarming every nation as it is accounted for numbers of mortalities to date.
 23

COVID-19 was first reported from Wuhan, China, on December 31, 2019. The hasty

cases of COVID-19 outside China directed World Health Organization (WHO) Director,

Dr. Ghebreyesus to announce the COVID-19 outbreak characterized as a pandemic. As

the first case of COVID-19 was reported, WHO has continuously provided support to

countries in the preparation and respond to the pandemic WHO (2020).

It shall be noted that when the stance of spreading of the virus first started, many

professionals were confused and unprepared. The COVID-19 pandemic has brought

desolation to the health care systems, from the quantity of intensive-care beds to the

availability and number of workforce, the capacity on the provision of adequate masks,

deploying testing in some countries, and the insufficiencies with regards to the research

for and supply of the needed drugs and vaccines {Organization for Economic Co-

operation and Development-OECD, 2020).

The Philippines is considered one of the high-risk countries affected by the

COVID-19 outbreak. The Philippine government took various initiatives like, lockdown

of Metro Manila, Luzon, and other regions of localized lockdowns to mitigate the risks,

along with the declaration of state of calamity in the entire country for six months,

beginning March 2020 (Duddu, 2020).

Vallejo and Ong (2020) imply that the Filipino epidemiological and data scientists

believed that the curve, an instrument used to observe the movement of COVID-19 cases,

has flattened, thus, it shall serve as basis as to lift or prolong the quarantine period.

However, the estimates of the scientists do not right away translated to an acceptable

estimate when it comes to risks. The government decisions set off along with risks.
 24

The Philippine health department and policy makers took further mitigation of

risks such as, the campaign of washing hands, wearing of masks, social distancing, using

alcohol or hand soap, and cleaning of the environment. But these beneficial

recommendations certainly would take some time to gain positive behavior (Vallejo &

Ong, 2020).

Vallejo and Ong (2020) recounts that the risks became more complicated when

the entire communities were allowed to proceed with their normal respective lives.

However, there goes trepidation among government heads and policy makers about the

second wave of COVID-19 subsequent lifting of the ECQ.

In Ormoc City, the only first case of COVID-19 was in May 2020. The rest of the

recorded cases in Ormoc City happened just within the last 3 weeks. The first case of

COVID-19 in Ormoc City was an individual beneficiary of Balik Probinsya program of

the Philippine government. The overwhelming number of cases was warned by the

Department of Health (DOH), stating that the health system in Eastern Visayas could be

overwhelmed should number of cases augment (CNN, Phils., 2020).

COVID-19 Management in Local Setting

The COVID-19 pandemic impelled the Philippine government to implement

numerous approaches to address the pandemic including the community quarantine.

Expanded testing capacity was also organized to ensure the capability of health care

system to handle rush and flow individuals infected by the virus. Financial aspects that

shall support the services and management of cases that need isolation, quarantine, as

well as hospitalization. The social and economic impact of the COVID-19 was also
 25

addressed through provision of social amelioration, particularly to low income families

(WHO, 2020).

Contact tracing was also implemented in the Philippines in order to detect and

right away isolate cases and identified close contacts that will also be advised for

quarantine. The contact tracing is one significant response to track the sequence of

infections from where the transmissions have occurred. Although the contact tracing

system faces a lot of challenges, the World Health Organization supports the Philippine

government on the reporting system, for the use of epidemiology and surveillance

officers, also for the health care providers, and others (WHO, 2020).

Moreover, the DOH issued mandatory use of face masks and face shields.

Wearing of face mask was imposed months earlier, while face shields was implemented

in 15 August. These official accessories in time of the pandemic are put into practice

nationwide (DOH, 2020)

COVID-19 in the International Setting

August 2020 records show that about 23,057,288 global laboratory-confirmed

cases of COVID-19 were reported, with 800,906 deaths on record. Previously recorded

corona virus occurrences include the Middle East Respiratory Syndrome (MERS), which

was first reported in Saudi Arabia, along with severe acute respiratory syndrome (SARS)

detected in 2003 in China and infected over 8,000 people and around 800 mortalities.

In a study conducted by Shaukat et al. (2020) about the Physical and Mental

Health Impacts of COVID-19 on Hospital employees, from the total number of

healthcare professionals who responded to mental health assessment scales 23.04 percent

were discovered having psychosocial problems. The study further revealed that more
 26

nurses 81.13 percent suffered from mental health issues compared to physicians’ 18.9

percent. On the psychological impact, healthcare professionals exhibited overall anxiety

44 percent, severe anxiety 2.17 percent, moderate anxiety 4.78 percent, mild anxiety

16.09 percent, stress disorder 71 percent, depression 50.4 percent, and insomnia 34.0

percent (Shaukat, et al;2020).

Lin, et al. (2020) showed in a study pertaining to the Mental Health Effects of

COVID-19 on Health Care Providers that most of the participants experienced

depression, 46.9 percent, anxiety, 41.1 percent, insomnia, 32 percent, and stress, 69.1

percent. In addition frontline healthcare providers exhibited more potential levels of

depression, anxiety, insomnia, and stress compared to non-frontline health care providers.

Pascarella, et al. (2020) revealed that precautionary measures are imperative to

lessen the risk of contamination. Wearing of masks and other personal protection

equipment (PPE) like, eye protection and gloves, particularly for hospital employees

were imposed, given that a single infected healthcare worker is a potential vehicle on the

transmission of the virus. Thus, it is essential to protect the hospital employees.

However, records revealed further that a sudden reduction in number of healthcare

providers was noted due to quarantining and isolation, nonetheless this is an indication

that the healthcare system will definitely be overloaded. Consequently, the clinical

presentation of COVID‐19 begins within 14 days of exposure; nevertheless in most cases,

symptoms present subsequent around 5 days and symptom onset is within the period of

11.5 days in 97.5 percent of individuals.

Local Studies
 27

Baron (2020) stated in a report that common mental health problems among

hospital employees are anxiety, depression, as well as burnout. Additionally, it was

observed that stress, toxic cultural environment, limited number of workforce, poor job

design leading to over loads of work, lack of hazard pay, extended work hours, exposure

to massive deaths, and fear of contracting the disease are causal to mental problems

among hospital employees.

In a study initiated by Delos Santos and Labrague (2020), with regards to the

assessment of fear of COVID-19 among nurses in a community setting. Findings of the

study revealed that nurses are moderately to higher fear of the pandemic. Most female

however displays fear compared male. Nevertheless, nurses’ fear has great influence

about their psychological distress. They pandemic also influence nurses’ organizational

and professional turnover intentions. It was further concluded that fear of COVID-19 is

universal among nurses.

Synthesis

The preceding literature and studies profoundly discussed the pandemic and its

desolation among the people and the society, most predominantly the healthcare

professionals and other hospital employees. The pandemic is evidently causing

predictive factors of COVID-19 management on mental health state of health care

professionals. The reality was justified by various studies, emphasizing the predictive

factors of COVID-19 management on mental health state of health care professionals

causing extreme effects resulting to diverse emotional and behavioral distress.

The overall presentation was focused on the characteristics of COVID-19 and its

global impact. Hence, the need to formulate applicable programs to alleviate the causes
 28

of the pandemic and protect the healthcare professionals in the performance of their

duties is at this point a vital action to take.

The theoretical framework presented earlier could provide the foundation in the

process of establishing the needed program for the COVID-19 management on mental

health state of health care.

 29

Chapter III

RESEARCH METHODOLOGY

The research methodology employed in this research were the research design,

research environment, participants of the study, sampling technique, instrumentation,

data gathering procedures, data analysis, and ethical consideration.

Design

This study used the descriptive correlational (predictive) research design.

According to Walinga and Stangor (2014) descriptive research design provides a

relatively complete scenario of what is occurring at a specified time. It was also open to

the development of questions for further study. Sousa, et al. (2007) clarify that

descriptive correlational studies describe the variables and the relationships that occur

naturally between and among them. The researcher believed that correlational design

was suitable to the nature of study because correlations analyze relationships or

associations like direction, degree, magnitude, and strength.

Environment

The study was conducted in three private hospitals in Ormoc City. Ormoc City,

located in Leyte province, which was the most populated city in the province and serves

as a home for many people. The island of Eastern Visayas region (Region VIII) was a

diamond in the rough. The region consists of the provinces of Biliran, Eastern Samar,

Leyte, Northern Samar, Samar and Southern Leyte and the cities of Baybay, Borongan,

Calbayog, Catbalogan, Maasin, Ormoc and Tacloban. Tacloban City was its regional
 30

center. Ormoc City as the largest city in Leyte by land area and the second largest in

Eastern Visayas after Calbayog City in Samar. It has a population of 215,031 inhabitants

making it the second most populated city in the province of Leyte after the provincial

capital, Tacloban City. With the population growing and health needs evolving. The

Ormoc City healthcare community was comprised of one public hospital and four private

hospitals namely; OSPA Farmers Medical Center, Ormoc Doctors Hospital (The newest

hospital of Cebu Doc Group of Hospitals).

Clinica Gatchalian and Hospital (In Partnership with Mount Grace Hospital Inc.)

and Ormoc Maternity and Children’s Hospital. OSPA-Farmers Medical Center and

Ormoc Doctors Hospital are secondary level hospital (formerly tertiary level) with its full

capacity of 111 and 200 beds respectively. Clinica Gatchalian and Hospital was a primary

hospital with a 100 bed capacity, which formed a new partnership with Mount Grace

Hospital, Inc. to provide comprehensive health care services to the local community. The

hospital offers a wide array of health services such as surgery, hemodialysis treatment,

maternal care services, medical consultation and nursing services. Clinica Gatchalian and

Hospital is also a Phil health Insurance accredited hospital.

Respondents

Selected hospital employees from various private hospitals in Ormoc City

participated in the current study. Respective profile of the respondents was examined to

ensure their bearing in the present research. Hereunder is the distribution of the

participants: (a) Resident physicians (25); nursing service (50) (nurses – 30, midwives –

10, and nursing aid – 10); (c) Ancillary services (50) (medical technologists – 30 and
 31

pharmacists – 20); and (d) Administrative staff and support services (25). All in all there

were 150 respondents.

Sampling Design. The study utilized the quota sampling. This type of

non-probability sampling design, wherein sample may be formed engaging

individuals representing a population, furthermore chosen in accordance to their

respective traits and qualities. The researcher preferred traits, wherein the sample

subset selection was conducted in order for the sample to be effective in

collecting data that can be generalized to the entire population. The final subset

was decided only in accordance to the researcher’s understanding of the

population. Two key points were noted for the researcher with regards to a

defined strata creation: (a) understanding of all the elements of a population and

(b) intention of the research (Bhat, 2019). This was used until a total of 150

respondents were obtained.

Inclusion and Exclusion Criteria. The following criteria was observed

in order for the respondents to qualify as participants in the foregoing study:

Participants should be of legal age, regardless of gender, civil status, and

educational background. They have to be presently working as hospital

employees in Ormoc City, regardless of their employment status as to part-time,

full time, probationary, or on regular employment. Participating hospital

employees should be employed in their respective hospital for at least 3 months.

The survey was only be conducted among those who voluntarily conferred with

consent were able to take part in the study. Those employees who do not meet the

least number of months in their profession and waiting on the effectivity of their
 32

separation to a particular contract of work were excluded in the present study.

Hospital employees that were deemed at risk particularly during this time of

pandemic like those who are pregnant were not included in the research.

Instrument

The research instrument of the present paper was adopted from a study authored

by Bodrud-Dozab et al. (2020). The instrument was composed of two parts in which part

one determines the factors of COVID-19 composed of four dimensions namely

(healthcare system [9 items], governance and political issues [7 items], immediate

emerging issues [7 items], enduring emerging issues [6 items], and mental health state [4

items]). Part two of the questionnaire pertaining to the mental health condition was

composed of 4 items. All in all the instrument was composed of 3 items in which were

answerable using a five-point likert scale where 1 is strongly disagree, 2 is disagree, 3 is

neither agree nor disagree, 4 is agree, and 5 is strongly agree.

The interpretation process was done through the computation of average or mean.

Based on the study, the reliability testing revealed a Cronbach alpha of 0.79 for the

mental health state, .783 for the health care system, .742 for the governance and political

issues, .821 for the immediate emerging issues (IEI), and .839 for the enduring emerging

issues (EEI). The interpretation of the results furthermore imply that high score of

mental state corresponds to high impact of COVID-19 pandemic on mental state of

hospital employees. Conversely, low score indicates low impact of COVID-19 pandemic

on mental state of hospital employees. Thus, the higher the impact of COVID-19

pandemic on mental state of hospital employees, the lower mental state would be, the
 33

lower the impact of COVID-19 pandemic on mental state of hospital employees, the

higher mental state would be.

In identifying the parameters and interpretations the following were utilized for

the factors: 1.00-1.80 was very low, 1.81-2.60 was low, 2.61-3.40 was moderate, 3.41-

4.20 was high, and 4.21-5.00 was very high. The following parametric scores and

interpretation were used for the mental health state:1.00-1.80 was very poor, 1.81-2.60

was poor, 2.61-3.40 was average, 3.41-4.20 was good, and 4.21-5.00 was very good.

Data Gathering Procedure

Submission of three titles to the professor for approval was the initial step,

followed by the assignment and selection of an adviser. A draft of manuscript was

completed thereafter for submission for a design hearing to panel of experts for

appropriate evaluation, particularly on the technical aspect of the proposed study.

Subsequent completion with the recommendations of the panel, the study was submitted

to the University of the Visayas-Institutional Review Board (UVIRB) for ethics approval.

Upon receipt of notice to proceed, recruitment of the respondents commenced. Also, the

researcher secured a consent from the Human Resource Department of the hospitals

where the respondents were previously employed, allowing the researcher to gather the

needed information from the respondents.

The researcher seek help from the Human Resource Department of the private

institution in the distribution of the questionnaires. The survey questionnaire was

distributed among the participants of the study through face-to-face, should a permission

was granted, otherwise, questionnaires was accessed through social media platforms like,

messenger, twitter, instagram, or electronic mail. In addition, the questionnaire can also
 34

be accessed through Google form should a respondent prefers to have the questionnaire

accomplished through Google. On the other hand, the face-to-face distribution of

questionnaire was with the aid of the human resource department. The questionnaires

were given to the human resource personnel, for them to distribute among the participants

to lessen personal interaction with them. When questionnaires were given to the human

resource personnel, the proponent ensured that appropriate protections like, face mask

and face shield were put on, and alcohol was also brought to ensure protection of the

proponent and the human resource personnel.

Afterward, completed questionnaires were assimilated for appropriate statistical

treatment. Gathered data was presented in tabular forms along with the corresponding

interpretation and analyses. All the collected information, both hard and electronic copies

were destroyed after serving their use at the end of the study.

Statistical Treatment of Data

The following statistical tools were used to analyze the data gathered from the

health care workers, respondents of the study:

The Weighted Mean was used to apply the weight and the significance among

variables as previously stated in the problem statement. This was used to determine the

Factors on COVID-19 management and mental health impact among healthcare

professionals.

Multiple Linear Regression was used in order predict whether mental health

conditions predict the factors of COVID-19 management among hospital employees.

 35

Ethical Considerations

In the conduct of research studies, it was important to observe the ethical

guidelines to protect the participants. By observing these ethical principles and standards,

participants’ rights were respected.

The following ethical principles were strictly observed in the conduct of the

study:

Protection of Human Rights. To protect the human rights of the respondents of

the study, respect, beneficence, and justice was observed. To observe respect, two

convictions were abided: (a) individuals were treated as autonomous agents and (b)

protection was given to persons with diminished autonomy. For beneficence to happen,

they were treated in an ethical manner by respecting their decisions and protecting them

from harm and making sure that effort to secure their well-being. In observing

beneficence, two rules were observed: they will not be harmed and maximize possible

benefits and minimize possible harms. For justice, the principle of “fairness in

distribution” or what is deserved” was observed. The following were also observed: (a) to

each person an equal share, (b) to each person according to individual need, (c) to each

person according to individual effort, (d) to each person according to societal

contribution, and (e) to each person according to merit. They were allowed to ask as

many questions as possible and they were allowed to refuse to answer questions

appertaining to the study.

Transparency. The study was submitted for either oral or poster presentation in a

research congress. Output of the study was recommended for use in the private healthcare

services respondents are working.

 36

Risk-Benefit Ratio Determination. The Risk-Benefit Assessment was

conducted prior to the start of the study. It was shown that there were more benefits than

risks thus this study was pursued.

Risks. The following were the major potential risks which the researcher

removed: (a) Physical harm, including unanticipated effects in the course of answering

the questionnaires; (b) Physical discomfort, fatigue, or boredom from answering the

questionnaire; (c) psychological or emotional distress resulting from self-disclosure,

introspection, fear of the unknown, discomfort with strangers, fear of eventual

repercussions, anger or embarrassment at the type of questions being asked as they will

do self-evaluation; (d) social risks, such as the risk of stigma, adverse effects on personal

relationships, loss of status especially if the evaluation yields negative results; (e) loss of

privacy; (f) loss of time; and (g) monetary costs.

Benefits. The following were the major potential benefits derived from the

study: (a) access to potentially beneficial intervention that might be unavailable to them

like, coping mechanism to deal with stress, anxiety, depression, and other mental

intrusion, provision of consultation with medical experts pertaining to mental health

concerns that is being experienced, provision of reading materials and other platforms as

sources of information that shall help alleviate the mental anguish faced by the hospital

employees, and offerings of seminars that shall diminish social stigma. (b) comfort in

being able to discuss their situation or problem with a friendly, objective person; (c)

increased knowledge about themselves or their conditions, either through opportunity for

introspection and self-reflection or through direct interaction with researchers; (d) escape
 37

from normal routine, excitement of being part of a study; and (e) satisfaction that

information they provide may help others with similar problem or conditions.

Implied Consent. Implied consent was relied on in the conduct of the study. By

implied consent, upon agreement and completion of the questionnaire by the respondent,

consent was given. However, in the questionnaire, as an introductory statement, all the

elements of informed consent were placed therein for the consumption of the

respondents.

Content, Comprehension and Documentation of Informed Consent.To

comply with the voluntary consent, respondents of the study was made to sign an

informed consent with the following contents.

Participant Status. The participants in this particular research are hospital

employees in different private healthcare facilities in Ormoc City. Their status was taken

cared of with full confidentiality. The respondents were assured that the present research

will in no way affect their employment or social status. They were also be informed of

the nature of the study being educational.

Study Goals. The goal of the study was to determine the factors on COVIID-19

management on mental health state of hospital employees in Ormoc City, for the third

quarter of 2020.

Type of Data. The data collected were quantitative in nature utilizing the

quantitative descriptive-correlational (predictive), comparative (non-causal) research

design.

Procedures.(make some necessary changes) A written approval to conduct a

research was secured from the adviser and the Dean of the Faculty of Nursing. The
 38

instrument was presented to the adviser to obtain the needed checking and endorsement

to the research respondents. Subsequent consent, the aim of the research was explained

to the participants. Moreover, anonymity and voluntary participation in the foregoing

study were ensured to all respondents without coercion or pressure. Confidentiality was

furthermore assured, along with the confirmation that the present study was merely

utilized as part of the educational prerequisite of the proponent and that their inputs were

treated in strict secrecy. A more detailed discussion on the data gathering procedure was

discussed under the Data Gathering Procedure section.

Nature of Commitment. Respondents were required to answer the questionnaires

for 10 - 15 minutes. This was done at their most convenient time such as after work or

break time.

Sponsorship. The researcher solely funded the study and there were no sponsors

for the study.

Participants’ Selection. The respondents were selected through quota sampling

with the aid of the inclusion and exclusion criteria and there ws no discrimination in the

selection process.

Potential Risks. Potential risks were identified by the researcher and they were

removed in the conduct of the study. The researcher was present to answer the questions

and prevent boredom or emotional stress from answering the questionnaire. They were be

given privacy and were asked to answer the questionnaire at their most convenient time

and place to avoid loss of time and other related resources. There were no physical,

psychological, social or economic risks associated with the study.

 39

Alternatives. There were no alternatives as the study did not introduce

interventions and treatments as the study was purely non-experimental.

Compensation. No incentives or compensation was given because the study was

answered through a questionnaire and voluntary. Thanking the respondents was the only

way to reciprocate the favor from answering the questionnaire. The respondents were

directly benefitted through acquiring new knowledge about the study.

Confidentiality pledges. Confidentiality and privacy were observed all

throughout the course of the study.

Voluntary Consent. The study was voluntary in nature. It was the respondents’

full will to participate.

Right to Withdraw and Withhold Information. If the respondents feel that they

are not comfortable with the study or feel not safe, the participants have the right to

withdraw or withhold information without the consequence of being punished or

penalized.

Contact Information. If respondents have questions about the study, they can

contact the researcher or the university’s Institutional Review Board at (032) 416-7990 or

email at uvirb2017@gmail.com.

Authorization to Access Private Information. No authorization was needed in

the study as it was not access records. The study only involved distribution of

questionnaires to the qualified respondents.

Privacy and Confidentiality Procedures. Privacy and confidentiality were

strictly observed. To protect the privacy and confidentiality of the data collected the

following were observed: (a) identifying information (example: name and address) from
 40

participants will only be obtained if needed; (b) assigning of identification number to

each participant and attaching the ID number will be done rather than other identifiers to

the actual data; (c) maintain identifying information in private file; (e) entering no

identifying into computer files will be done; (f) destroying identifying information

quickly will be applied. All soft and hard copies of the questionnaire were destroyed after

the study.

Debriefing, Communication, and Referrals. (improve the way it is stated)Being

gracious and polite to the respondents was observed if there were questions regarding the

questionnaire. A debriefing was done in order to allow the respondents to ask questions

or if there are complaints. Further, the researcher during the retrieval of the questionnaire

uttered gratitude to the respondents and their participation was greatly appreciated by the

researcher. The proponent also offered the respondents benefits of the foregoing research,

of which appropriate referrals to the respective hospitals of the participants pertaining to

coping mechanism and other appropriate intervention programs tendered in this research,

particularly to those experiencing mental stress will be provided.

Conflict of Interest. There was a possibility of a conflict interest where the

respondents were from the hospital where the study was conducted. However, the

researcher’s participation was mainly to distribute and retrieve the questionnaires. The

researcher prohibited herself in becoming a respondent of the study. The questionnaire

was used as instrument and means of gathering data. A third party (enumerator) was

sought or the Chief Nurse of the hospital was asked to help facilitate the distribution of

questionnaires and prevented conflict of interest.

 41

Incentives or Compensation. Respondents were not given any incentives or

compensation for their participation instead they were personally thanked by the

researcher or the enumerator for their participation in the study. Words of gratitude were

the means of thanking them.

Collaborative Study Terms of Reference. The study was done solely in

compliance with the requirements of the researcher’s doctorate degree. There were no

collaborations entered into with another party. Intellectual property rights and publication

rights and information and responsibility sharing were solely owned by the University

and the researcher. The study was conducted in the different healthcare facilities in

Ormoc City. Research utilization was done in the said healthcare facilities in Ormoc City

as this was part of the agreement upon allowing the study to be conducted in the said

institution. A copy of the study was furnished to the hospital. Thus, terms of reference

were not applicable in the study.

Recruitment. Where a face-to-face recruitment was allowed, compliance to local

and national executive orders and guidelines was strictly complied such as social

distancing, and the wearing of masks and face shield by the researcher and the

enumerator. Random recruitment in online platforms was also done by directly

messaging the prospective participant and was assessed if qualified to participate. The

inclusion and exclusion criteria served as the reference in the recruitment of respondents.

Vulnerability Assessment. No vulnerable subjects were included in the study. In

the event that a vulnerable subject was identified from among the respondents, he or she

was automatically excluded from the study.

 42

Chapter IV

PRESENTATION ANALYSIS AND INTERPRETATION OF DATA

This chapter presents the answers to the problems of the study. The presentation

was done through tables together with the interpretations and analysis with the supporting

related literature and studies.

Perceived Factors of COVID-19 Management

Table 1 presents the data on the perceived factors of COVID-19 management

healthcare system, governance and political issues, immediate emerging issues, and

enduring emerging issues.

Table 1

Perceived Factors of COVID-19 Management

Mean
Items SD Interpretation
score
Healthcare System (HS)
1. The healthcare system is too fragile to deal 3.69 0.98 High
with the recent outbreak of COVID-19.
2. A huge population is a pressure to the
existing healthcare system to deal with 4.25 0.96 Very High
COVID-19.
3. There is a lack of awareness of basic
healthcare issues amongst most of the 4.00 0.86 High
citizens.
4. There is a lack of trained doctors and
healthcare professionals to deal with the 3.18 0.99 Moderate
COVID-19.
5. There is lack of lack of healthcare 4.24 0.93 Very High
infrastructure to deal with COVID-19.
6. There is a severe lack of bio-medical 3.98 0.86 High
hospital waste management facilities.
7. There is a lack of testing facilities. 4.08 0.95 High
8. There is lack of budget or support in 4.02 0.92 High
response to this outbreak.
9. Most of the poor people will not have 4.07 0.81 High
 43

access to existing healthcare facilities if

they are infected by COVID-19.
Factor mean 3.95 0.63 High
1. Governance and Political Issues (GPI) 2.97   Moderate
2. The government can deal with this 3.62 0.96 High
outbreak.
3. The government is taking this outbreak 3.39 0.89 High
seriously.
4. The government is making proper 3.84 0.67 High
decisions in the right time.
5. The government is involving other sectoral 4.31 0.79 Very High
actors to combat the COVID-19 outbreak.
6. The government needs support from the 4.60 0.71 Very High
people to reduce the impact of COVID-19.
7. The government needs to formulate a
policy and action plan and implement it 3.93 0.77 High
immediately.
8. Developed nations are going to support in 3.81 0.88 High
response to COVID-19.
Factor mean 4.78 0.52 Very High
Immediate Emerging Issues (IEI)  
1. There is a chance of community 4.78 0.63 Very High
transmission of COVID-19.
2. A huge number of people will be infected. 4.71 0.71 Very High
3. There is a chance of not detecting most of
the infected patients due to undermining 4.51 0.77 Very High
the number of actual infected cases.
4. There is a chance of increasing the number 4.49 0.71 Very High
of deaths by not having proper facilities.
5. Lack of bio-medical waste management
facilities in the hospitals will create 4.29 0.80 Very High
environmental transmission.
6. Many people will be psychosocially 4.03 0.77 High
shocked due to this outbreak.
7. The government will lose its trust from the 3.58 0.90 High
people.
Factor mean 4.34 0.51 Very High
Enduring Emerging Issues (EEI)  
1. There is a chance of a disaster like, floods,
cyclones, or landslide in 2020 considering 4.16 0.87 High
the climate change vulnerability.
 44

2. If any disaster occurs after/during the

COVID-19 situation then it will create a 4.55 0.83 Very High
double burden.
3. There is a chance of severe food scarcity
due to these events (COVID-19 + 4.55 0.75 Very High
disasters).
4. High possibility of huge economical loss. 4.65 0.70 Very High
5. High possibility of increasing the poverty 4.63 0.75 Very High
level.
6. High possibility of severe socio-economic 4.67 0.73 Very High
and health crisis.
Factor mean 4.53 0.64 Very High
Note: N=150.
Legend: 1.00-1.80 is very low, 181-2.60 is low, 2.61-3.40 is moderate, 3.41-4.20 is high, and 4.21-5.00 is
very high.

As seen on table 1, the perceived factors of COVID-19 management in terms of

healthcare system (HS) was very high. This implies that the healthcare system faces

great extent of demands in as far as contending with the present pandemic of COVID 19

was experienced. The enormity of the pandemic transported an immense challenge to

healthcare system that was perceived of its insufficiency, particularly in the aspects of

infrastructure and most especially the availability of testing facilities. These facets were

aggravated by inadequacy pertaining to awareness campaign, specifically on the needed

preventive actions that every single individual entails to carry out in order to evade from

being infected by COVID-19 and transmit the virus to other members of the family and

the community. Thus, the findings further mean that the very high impact of HS among

hospital employees resulting them mental health condition at a low state.

The above results agreed with WHO (2020), most predominantly on the global

scenario that HS faces against the COVID-19 pandemic. Accordingly, the COVID-19

has situated most of the healthcare systems towards enormous challenges and defying

other players beyond their capabilities. Considering the consequential state, leveraging
 45

the healthcare system in response to public health emergency and efficiently lessening its

impact was predominant. Failure to provide the necessary protection to health care given

the present and fast shifting circumstances was placing the HS to crucial gaps with

regards to the most vital provision of services that shall furthermore transport a long-

lasting effect of the health and wellbeing of the global populations.

However, on issues of inadequacy of supplies and other government support, it

was apparent that in some countries where healthcare attacks are evident, COVID-19 in

some cases established adverse environments for providers of healthcare, wherein reports

of violence, discrimination, and harassment have transpired. Medical transportation

facilities carrying various COVID-19 samples were also reported harassed. The

continuous attacks do not only affect the ability of HS to deliver the needed services,

especially to the most people in need of medical attention in this time of pandemic, but

the risks also take a heavy charge on the psychosocial factor, health of patients, critical

health care providers at the frontline along with their families (WHO, 2020).

Moreover, findings on perceived factors of COVID-19 management in terms of

government and political issues (GPI) were very high. The implication provides that the

government entails to obtain the support of the people to address the need in containing

the virus furthermore provide cure and remedy to those that are infected. Additionally,

the government necessitates to establish strategies in combating with the implacable

COVID-19, of which collaboration of various sectors in the society is of paramount

factor.

The findings furthermore imply that the very high impact of GPI among hospital

employees resulting them mental health condition at a very low state. The volatile
 46

responses of the government with the current pandemic along with disparities among

national and local leaders as well as with different government agencies furthermore

beget stress among hospital employees perceiving the instability even of their own being

and the situation of their respective families. These scenarios indisputably instigate

pressure and distress that are critical on the very low level of mental health condition of

the hospital employees.

The above findings were clarified in a study initiated by Gore and Parker (2019)

describing that there were increasingly drawn attention with regards to the power issues

all through the global health field, particularly on decision making that may seem to

overlook the power distribution and exercise of power along with policy and systems.

On account of the failure in acknowledging the premise of global health efforts, players

along with their responsibilities may maneuver health concerns towards other directions.

As furthermore imparted by Gore & Parker (2019), power exhibits the levels of

decision making towards the implementation of the needed interventions. It was

highlighted that in exercising of power, global stage, such as international agencies and

alliances can shape global action when it concerns health, which also include players at

the national level whose principles have the capacity to influence the impartiality and

universality of public policy. However, there may be actors in health system that may be

of power, particularly in local setting. In this context of local health system,

administrators, bureaucratic agents, as well as frontline health workers may have the

opportunity to exercise power in the course of daily transport of health services, either

negative or positive consequences for the people they serve.

 47

The above findings also agree with Clements (2020) explaining that it was

imperative to understand public knowledge alongside with their behaviors should we aim

to address effective approach to COVID-19 management. Hence, better adherence to

behavioral recommendations in addressing public health emergencies due to COVID-19

should be coordinated by the government as a pandemic response.

Finding on perceived factors of COVID-19 management in terms of immediate

emerging issues (IEI) was very high. The results implied that the respondents believed

that there were large extents of underlying issues that need to be tackled in the COVID-

19 pandemic situation, particularly the fear of community rapid transmission. Moreover,

because of the insufficiency of testing facilities, being the predominant issue, the

likelihood to detect infected individuals was a demanding undertaking to realize. Thus,

addressing the increased number of infected and fatalities along with the needed

immediate attention remain the prevalent issues.

The findings additionally suggest that the very high impact of IEI among hospital

employees resulting them mental health condition at a very low state. The global

situation of COVID-19 pandemic predominantly brings underlying effects, for the most

part among workers of the hospitals being the most exposed to the virus, which causes

hospital workers fears of their own lives. Moreover, continuous number of infected

individuals, witnessing their sufferings, and the augmenting numbers of fatalities deplete

mental health condition of the hospital workers.

The above results and the need to address the IEI were clarified by the United

Nations (2016), stating that emerging issues are based on newness. It can however be

considered that they are not necessarily issues that never heard. Apparently, newness
 48

could be in forms of new scientific knowledge such as, new data, evidence, a model or

theory; new technological development; new scales otherwise the accelerated rates of

impact; awareness of something heightened level; and new means of addressing to a

known issue.

On context of emerging issues regarding policy makers and the sustainable

development, several ways could be considered. In the broad concept of sustainable

development, it suggests any social, economic, or could be environmental process or

demands that agree with the scientific understanding may be considered a potential

relevance. In addition, emergence could imply the development or innovation of some

identified issues, novel awareness of the causes or outcomes, establishment of new

options particular to management, or the recognition of certain issues that have never

extended due account or credit. However, the innately system of classifying or finding

emerging issues could nevertheless be guided by important points which include, criteria,

duly selected having an outlook that is associated to the specific field of interest.

The Cognitive theory (Fritscher, 2020) on the other hand, further supports the

foregoing results on IEI, which suggests the explanation of human behavior through

understanding of thought processes. The IEI, especially the instance of COVID-19 as

perceived by the hospital employees reflects that their thoughts are the primary

determinants of their emotions and behavior. Phobia on the other hand, fall into a larger

group of issues in psychological perspective described as anxiety disorders, which are the

foremost common type of psychiatric illness.

Furthermore, the result on perceived factors of COVID-19 management in terms

of enduring emerging issues (EEI) was very high. This implied primarily that aside from
 49

the current pandemic, there are other issues that are in the horizon, which include for the

most part, the economic standpoint not just in local perspective but globally as well.

What are even alarming and inevitable are the disasters that are evident of their impact

along with the current pandemic. The unemployment rate, poverty, food dearth,

education concerns, health issues, and other local and national threats have long been

catastrophic scenarios of the country. These detrimental EEI are ostensible of their

impact in the broad-spectrum of socio-economic perspective of the country.

The findings furthermore imply that the very high impact of EEI among hospital

employees resulting them mental health condition at a very low state. Other issues that

constantly being battled such as, natural disasters that are common in the locality and the

country in general, especially typhoon that recorded fear over the devastation of many

lives and brought economic setback, and other upheavals transport stresses are consistent

with the very low state of mental health among the hospital employees on top of the

present battle against the fatal COVID-19.

The above results could be associated with social theory (Bowling, 2011), which

concerns the social events, patterns, and interactions. The social theories were also

considered as analytical frameworks that are employed to study as well as provide

interpretation of social phenomena.

Mental Health State of the Health Care Workers

Table 2 presents the mental health state of the health care workers.

Table 2

Mental Health State of the Health Care Workers

Mean
Statements SD Interpretation
score
1. I am afraid of the recent corona virus. 4.63 0.55 Very poor
 50

2. I am afraid of getting infected with 4.80 0.52 Very poor

corona virus.
3. I am afraid of losing my life or my 4.83 0.53 Very poor
relatives’ lives due to this outbreak.
4. All the news of infection and deaths
from COVID-19 in different media is 4.22 0.96 Very poor
increasing my fear.
Average mean 4.62 0.52 Very poor
Note: N=150.
Legend:1.00-1.80 is very good, 1.81-2.60 is good, 2.61-3.40 is average, 3.41-4.20 is poor, and 4.21-5.00 is
very poor.

Table 2 shows very poor score on mental health state of hospital employees. This

implied that the many challenges of the pandemic, the HS and other issues continue to

affect the mental health of the hospital workers. The threats of the COVID-19 among the

hospital employees were of no difference from other members of the community, which

cause them to bear more anxieties. The hospital employees have the most fear of

COVID-19 because they are more susceptible. Having this in mind, entails hospital

workers to remain committed to their profession and stay mentally spirited to save the

lives of others despite the degree of fear and mental distress. Furthermore, their exposure

and vulnerability as hospital employees intensify their fear of being dirtied of the virus

and possibly transmit the virus to their families.

From the outset of the outbreak, hospital employees have exhibited remarkable

support, solidarity, and gratitude. However, hospital employees were not only

continuously facing attacks of discrimination but also reported included in the lists of

incidents linked to COVID-19 pandemic across the world. The public health emergency

recorded that health facilities along with the needed medical transport, patients and

hospital employees along with their respective families are targeted elsewhere. The

disturbing occurrences of the pandemic underline the necessity to enhance measures for
 51

the protection of healthcare from acts of violence and discrimination. It was evident that

in the inception of the spread of COVID-19 the hospitals had scarce protective equipment

to offer. Guidelines or treatment were not also properly provided. Consequently, the

healthcare professionals felt uncertain, helpless, alienated, isolated, and difficulties in

coping with the workload. Moreover, the outbreak has resulted to psychological

outcomes like; anger, anxiety, insomnia, and stress that are believed related to the

pandemic. The anxieties were recorded as risk factors that could possibly be stimulated

at the onset of burnout (Giusti, etal., 2020).

Rodriguez (2020) suggested that the pandemic could generate in workers the

feeling of ineffectiveness along of being helpless given the demand of quality of work

loads, of which in turn will adversely contribute to high emotional loads among

healthcare professionals. One that was noted dominant among the stressors was the

Burnout Syndrome (BS), or an excessive amount and prolonged stress of which major

components are emotional fatigue that causes energy loss, worn out feeling, dissociation,

and diminish work performance.

In the performance of duty among healthcare professionals, many elements of

pressure were caused by the impact of keeping optimal conditions for a healthy working

environment, as well as the saturation of the sanitary facilities on account of the degree of

virus infection, it is then apparent that the health of these healthcare professionals has

been distressed. We must keep in mind that the effectiveness and appropriateness of

performance of these institutions are depending primarily on the wellbeing of its

professionals and their exposures on environmental conditions placing their physical and

mental health at risk. In the midst of the pandemic, aspects associated to occupational
 52

psychology may be considered highlights that influence the potential psychological

consequences among hospital employees: inadequacy of resources along with heavy

workload. Additionally, it could be noted that fatality rates of COVID-19 has caused

global psychosocial impact resulting to mass hysteria, burden over the economy, and

financial intricacies. The term coronaphobia or mass fear caused by COVID-19 has

engendered psychiatric symptoms from corner to corner strata of the society (Dubey, et

al., 2020).

Given that anxiety, symptoms of depression and distress were mostly present in

high levels of population, there was still a possible vulnerability in some other groups in

as far as psychosocial effects of pandemic is concern. These were the individuals who

contract the virus, people with existing and high risk of infection, individuals with

subsisting conditions of medical, psychiatric, or substance use problems are found having

increased risk for adverse psychosocial outcomes, most predominantly, the healthcare

professionals and workers involved in various medical services.

Marcinkoetal. (2020) elucidates that psychodynamic plays a critical emphasis

pertaining to defense mechanisms and unconscious mind, wherein the feelings of being

distress, urges, and thoughts that were very painful for us to straightforwardly stare at

were apparently dwelled. Given however that the painful feelings and thoughts were at

the outer side of our consciousness, they remain to affect our behavior in various means.

In essence, the optimal application of psychodynamic approach provides the frame for

acceptance of psychological stress in a more optimistic manner, furthermore benefits

psychological growth. Thus, psychodynamic approach in time of COVID-19 pandemic

may be included in the management of the national public as well as mental health
 53

emergency system that shall empower the society during and even after the crisis of

COVID-19 pandemic.

Perceived factors of COVID-19 Management Predicting Mental Health State of the

Health Care Workers

Table 3 presents the data on the perceived factors of COVID-19 management

predicting the mental health state of the health care workers.

Table 3

Perceived factors of COVID-19 Management Predicting Mental Health State of the

Health Care Workers
Independent B Std. Beta T p
Decision Interpretation
variables value Err value value value
Constant .
2.161 6.171
350
Healthcare Failed to
.
system .021 .025 .292 .771 reject the null Not significant
072
hypothesis
Government Failed to
.
and political .016 .016 .209 .835 reject the null Not significant
077
issues hypothesis
Immediate Rejects the
.
emerging .476 .465 4.132 .000 null Significant
115
issues hypothesis
Enduring Failed to
.
emerging .055 .068 .634 .527 reject the null Not significant
087
issues hypothesis
Note: Perceived Factors of COVID-19 Management (dependent variable).
Legend: Significant if p value is < .05. Model Summary: R value is .540; R squared value is .291; Adjusted
R squared is .272; and Standard Estimated Error is .443. ANOVA: F value: 14.906 and Sig. = .001.
If R-squared value < 0.3 this value is generally considered a None or Very weak effect size, if R-squared
value 0.3 < r < 0.5 this value is generally considered a weak or low effect size, if R-squared value 0.5 < r <
0.7 this value is generally considered a Moderate effect size, and if R-squared value r > 0.7 this value is
generally considered strong effect size (Moore et al., 2013).

The table 3 showed that the p value for the perceived factors of COVID-19

management predicting mental health state of the health care workers in terms of

healthcare system, government and political issues, and enduring emerging issues were

greater than .05. Thus, the results were interpreted as not significant leading to the

decision of failed to reject the null hypothesis. This means that healthcare system,
 54

government and political issues, and enduring emerging issues does not predict the

mental health state of health care workers. Whereas, the p value for immediate emerging

issues was lesser than .05 and interpreted as significant, leading to the decision of

rejecting the null hypothesis. This further means that immediate emerging issues predict

the mental health state of health care workers. As also reflected in table 3, the t value for

immediate emerging issues (4.132) is positive, which means that the prediction is

positive. The positive prediction means that for one unit increase in immediate emerging

issues the mental health state of health care workers increases by .465 unit.

The R-squared value on the other hand explains the coefficient of multiple

determinations for multiple regressions. The value of R-squared, which is .291 indicates

strong significance, thus predicts the variables. Therefore, the R-squared shows that the

factors of COVID-19 management do not predict the mental health state of the hospital

workers in terms of HS, GPI, and EEI, which further explains that the weaker the

prediction is, the higher mental health state it denotes among the hospital workers.

On the aspect of IEI, it appears to have a higher impact among the hospital

workers, thus it implies that the level of mental state of hospital workers in terms of the

impact of IEI poor.

To further illustrate, the regression equation derived from the statistical treatment

on regression revealed that:

MHS = 2.161 + (.465 x Immediate Emerging Issues)

The equation can be explained in such a way that level of mental health state

(MHS) is the sum of the constant value of 2.161 plus .465 of immediate enduring issues

(IEI). Based on the model summary, the r squared value was .291. This means that the
 55

confidence that the variable of immediate enduring issues predicted the level of mental

health state was very poor. Having these results, it explains further that the very high

impact of IEI denotes poor mental state among hospital employees.

The second perspective of socio-economic theory supports the above result,

which states the relevance with the notions or designs of other social sciences like,

psychology, sociology, along with the identity group studies relative to subjects of a

particular economic nature such. In these fields historical views, current events and

general information, political outlook, and other social sciences perspectives are utilized

in order to predict social trends that in one way or the other may generate impact to the

economy. In this research, the two perspectives of social economics are the predominant

focus of the theoretical foundation, particularly the trending issues of COVID-19

pandemic and their impact on mental health of hospital workers. More often, the theories

of social economics consider factors that are beyond the mainstream of economics, this

may include the effect of the environment and ecology on consumption as well as wealth.
 56

MENTAL HEALTH ENHANCEMENT PROGRAM

Rationale

A healthy individual is considered mentally healthy when he/she can connect with other people, able to maintain good

relationships with people and be able to respond positively to circumstances like for instance, the COVID 19 pandemic in order to

maintain his/her wellbeing. Mentally healthy individual realizes his or her own abilities, can cope with the normal stresses of life, can

work productively and fruitfully and is able to make a contribution to his or her community. In this time of pandemic it is very

important to maintain health and wellness in order to prevent the disease. Founded from the results of the study, it was identified that

factors of COVID-19 management influences on the mental health state of health care workers, particularly the immediate emerging

issues, wherein the COVID-19 pandemic is integrated. Hence, Mental Health Enhancement Program is proposed.

General Objectives

The purpose of this mental health enhancement program is to decrease or eliminate fear, anxiety, stress, and depression among

health care workers in the midst of COVID-19 pandemic and increase the level of awareness in dealing with COVID 19.

Specific Objectives

Specifically, the following objectives mental health enhancement program was presented:

1. To decrease to a tolerable level if not eliminate feeling of fear, anxiety, stress and depression brought about by the COVID19

pandemic among hospital employees.

 57

2. To increase the level of awareness in dealing with COVID-19 among h0spital employees, particularly among physicians, nurses,

human resource department, administration and support, and ancillary services.

3. To maintain competency and quality in the provision of patient care despite the fear of being infected with COVID 19 Virus.

4. To improve the skills, knowledge, and attitude of the nurses in taking care of patient’s despite of being discriminated by the people

as the carrier of the virus, particularly in the observance of protocol, significance of protective gears, and other approaches associated

with prevention and general knowledge of the virus as nurses continually undertake imperative functions for the care of the patients.

5. To provide enhancement program that could be used by the prospective local hospitals to help them protect their respective

employees improve their mental health resilience against the peril of the COVID-19.

PARTICULAR
TIME SUCCESS
AREAS OF OBJECTIVES ACTIVITIES PERSONS INVOLVED RESOURCES
FRAME INDICATORS
CONCERN

Fear of the To decrease to a A virtual Focus Psychologists- to develop Zoom or Google October to Accomplished
recent corona tolerable level if Group Discussion and facilitate the process Meet November survey forms and
virus not eliminates (FGD) – to allow and items/concerns of 2020. summary report
feeling of fear, sharing of discussions. of the
anxiety, stress experience to reassessment as
and depression include ventilation Nurses, Ancillary evidenced by a
brought about by of feelings of fear Services, Administration low levels of fear
the COVID19 and coping and Support – are the and anxiety.
pandemic among strategies of attendees/targets of the
health care COVID-19 FGD.
 58

workers.

Fear of losing To increase the Conduct seminar, Psychologists and other Php 20,000.00 From the start - Assessed
life or love ones level of which include: resource speakers – to of the mental health
lives due to this awareness in -Ways to cope stress facilitate the seminar. implementation state.
outbreak dealing with -Mental health crisis of the plan.
Covid 19 among Information Nurses, Ancillary - Well balanced
health care Services, Administration and positive
workers. and Support – are the outlook.
attendees/targets of the
To establish seminar. - Acquired
further Conduct one-on-one Psychologists/counsellor Php 20,000.00 From the start coping
awareness about consultation s of the mechanism.
the virus. implementation
of the plan.
Fear of all the To maintain Provide other Human Resource Php 2,000.00 From the start - Resilience
news of infection competency and activities to divert Department and of the during the
and deaths from quality in the the attention from Administration and implementation pandemic.
covid 19 in provision of news and other Support – to facilitate the of the plan.
different media. patient care speculations. activities under the
despite the fear supervision of
of being infected Psychologists.
with COVID 19
Virus. Nurses, Ancillary
Services, Administration
and Support – are the
attendees/targets of the
activities.

Fear of being To establish Provide reading Psychologists – to Php 5,000 From the start - Well-rounded
infected with further materials and other develop the of the knowledge about
corona virus awareness about resources to develop appropriate/relevant implementation the virus.
the virus. well-balanced reading materials and of the plan.
 59

information about applicable platform/s. - Adequate and

the COVID-19. correct
Administration and information.
Support – for the
distribution of the
reading materials and
dissemination of
information pertaining to
the platform/s.

Nurses, Ancillary
Services, Administration
and Support – are the
targets for the provision
of reading materials.

Discrimination To eradicate the Ensure Human Resource Applicable law/s From the start - Established
among health harmful effect of implementation of Department with the of the positive outlook
care workers social stigma. relevant assistance of implementation and assurance of
guidelines/policies Administration and of the plan. protection of the
To protect and mechanism support. law.
hospital workers pursuant with the
against social law, in order to Ancillary Support - Established
stigma. prevent furthermore Services – to assist on coping
eradicate social implementation and mechanism.
stigma in the health monitoring.
sector.
The guidelines/policies
Promote a culture of and promotion for the
zero tolerance to eradication of social
discrimination and stigma are intended for
associated violence the Nurses, Ancillary
against health care Services, Administration
workers through and Support
 60

right and just

implementation of
the law.

Provide virtual Psychologists – to None From the start

resources for mental provide germane of the
health or other platforms Internet implementation
social support platforms of the plan.
platforms to cope in Administration and
the event of social Support – for the
stigma. implementation, update,
and monitoring of the
platforms.

Conduct a program Administration and Php 5,000.00 February 2021

acknowledging the Support – to develop and
importance of the schedule an
hospital employees event/program.
in order to boost
their morale.
Mental health To develop a Develop a program Administration and Php 10,000.00 April 2021 - Resilient
and wellbeing program that concept: “Keep Support – to wellbeing of
resilience of shall promote the Health Workers conceptualize the ISO 45001 both hospital
hospital safety and Safe to Make program, facilitation of Occupational employees.
employees wellness of the Patient Safe” license, scheduling, Health & Safety
against the hospital workers provision of training Standards (if - Resilient
threats of through Provide education facilitator, and applicable) mental health of
COVID-19 development of and learning monitoring of the hospital
through seminars Pertinent laws employees.
associations program.
between and training,
occupational particularly in Ancillary Services – to
health and health and safety assist on other errands
 61

safety, safety of skills in personal and monitoring,

the patient, and patient safety especially in the
improvement of for all hospital adherence of safety.
quality and personnel.
infection ISO 45001 Occupational
prevention Integrate in Health & Safety
control licensing and Representative (if any) –
programs. accreditation to ensure appropriate
standards the employment of the
requirements for standard.
worker and patient
safety. IT Department - to
maintain the data and
Include staff and other records for
patient safety monitoring and
incident reporting references.
systems.
The program is intended
Conceptualize for the Nurses, Ancillary
incorporated metrics Services, Administration
of patient and and Support.
hospital worker
safety and quality of
care indicators,
furthermore include
with health
information system.
 62

Prepared by: Noted by: Approve for use by:

Angeli E Luma-ad Dr.Resty L. Picardo Mrs. Yvonne M. Sevilla

Researcher Research Adviser Dean, College of Allied Health Sciences
 63

LUMA-AD MENTAL HEALTH STATUS MODEL

By: Angelie E. Luma-ad

Generalization:

The Mental Health Model (Figure 1) was founded from the findings, particularly

the prediction of immediate enduring issues (IEI) on mental health state (MHS). The

mental health model furthermore illustrates the confidence of IEI on the level of MHS

however, the prediction was very weak. Therefore, despite the significant prediction or

correlation of IEI on MHS, the prediction model was perceived very weak.

To moreover substantiate the results and the foundation of the mental health

model, the particular IEI shown in this study were the government loosing trust to people,

psychological shock due to the outbreak, the lack of biomedical waste management, the

lack of proper facilities, undermining of actual infections/cases, the incidence of

infection, and the chance of community transmission. Among these IEI, the chance of

community transmission showed the highest mark among Hospital employees .On the

other hand, the government will lose its trust from the people got the lowest point. On the

aspect of IEI, it appears to have a higher impact among the hospital workers, thus it

means that the level of mental health state of hospital workers in terms of the impact of

IEI is poor.

Definition of Terms

The following terminologies were defined for further clarity and understanding

pertaining to the findings of the study, of which hereunder terms were utilized:
 64

Mental Health State – is about the state of well-being wherein individuals can

cope with the normal stresses of life and contribute to her or his community. Given that

people globally are affected by the COVID-19 outbreak, more so, the healthcare

professionals and hospital workers. In this paper factors of COVID-19 management

among hospital employees were investigated to determine these factors affect the mental

health state of the hospital employees.

Immediate Emerging Issues –are based on newness, however, they are not

necessarily issues that never hear. Newness could be in forms of, new scientific

knowledge like, new data, evidence, a model or theory; new technological development;

new scales otherwise the accelerated rates of impact; awareness of something heightened

level; and new means of addressing to a known issue (United Nations, 2016).

Assumption

It is assumed that a high prevalence in the immediate emerging issues results to an

increase in the mental health state. The issues, predominantly pertaining to the high

increase of community transmission of the deadly COVID-19 on account to the lack of

bio-medical waste management, the psychosocially shocked due to the pandemic, along

with loosing of trust of the government among the people are causal to the poor mental

health state the of the hospital workers.

Discussion

The above assumption was raised based on the findings showing the prediction of

IEI on MHS among hospital workers, particularly on the fear of rapid community

transmission of the COVID-19. Being the most vulnerable individuals, hospital workers
 65

face the threat of the virus causing increase of impact to their mental state. Therefore, the

hospital workers’ behaviour as induced by perceived stresses of life, especially the threat

of the pandemic being the most predominant IEI is based on how the hospital workers

perceive the extent of the issue and how they develop coping mechanism in facing the

challenges of the pandemic In support of the above assumption, the United Nations

(2020) provides clarity with regards to the immediate emerging issues, specifying

newness, which does not necessarily mean a circumstance that has never occurred in the

past however it introduces new information and evidences, accelerated rates of effect, and

a different approach. In the case of the present pandemic, it is important to address the

Immediate Emerging Issues

Immediate iii

Chance of Government
community losing trust from
transmission people

Psychological
The incidence of shock due to the
infection
Mental
outbreak
Health
Status
Undermining of
actual The lack of
infections/cases biomedical
waste
management
The lack of
proper facilities

Figure 2.Schematic diagram of the Luma-ad Mental Health Status Model (2021)
 66

needed awareness and facts about the known issues to lessen their impact.

Above assumption could also associated with cognitive theory (Fritscher, 2020),

which explains the human behavior through understanding of thought processes. In the

foregoing study the thoughts of the hospital employees are the primary determinants of

their emotions and behavior, wherein phobia falls into a larger group of issues in

psychological perspective described as anxiety disorders, which are the foremost

common type of psychiatric illness.

Above diagram of Mental Health Model (Figure 1) reflects the influence of IEI to

hospital employees’ MHS. Predominantly, a chance of community transmission of

COVID-19 indicates the highest mark among the IEI. It was followed by a huge number

of people believed to be infected. Subsequently, hospital employees also believed that

there is a chance of not detecting most of the infected patients due to undermining the

number of actual infected cases. It was also believed that there is a chance of increasing

the number of deaths by not having proper facilities. Lack of bio-medical waste

management facilities in the hospitals are also believed to create environmental

transmission. It was also believed that many people will be psychosocially shocked due

to the outbreak. However, the government will lose its trust from the people reflected a

lower score given by the hospital employees. When these IEI tend to increase, the

behavior, emotions, and coping means of hospital employees are in the same manner

intensified. For instance, the rapid transmission of the virus adds up on the fear of

hospital employees being the most vulnerable individuals to the virus. Moreover, the

increasing number of infected people likewise increases fear among hospital employees
 67

because of their vulnerability and the level of information they receive from the

community. The insufficiency of facilities and lack of bio-medical waste disposal also

indicate anxiety among the hospital employees, worrying their effect on environmental

transmission that may increase the number of deaths. Furthermore, as the hospital

employees continuously see the psychosocial impact of the pandemic, it increases impact

to their mental health state.

 68

Chapter V

SUMMARY OF FINDINGS, CONCLUSION, AND RECOMMENDATIONS

This chapter was the presentation of the study’s summary of findings, conclusion,

and recommendations.

Summary of Findings

The study revealed the following findings:

The factors of COVID-19 management in terms of HS was very high, the GPI

showed a very high result, IEI on the other hand, was very high, and the EEI was also

very high. Thus, very high impact of factors of COVID-19 among hospital employees

results mental health condition at a low state.

In terms of mental health, findings show very poor score on mental health state of

hospital employees. The threats of the COVID-19 among the hospital employees were of

no difference from other members of the community, which cause them to bear anxieties.

The fear of exposure and vulnerability as hospital employees intensify their fear of being

dirtied of the virus and possibly transmit the virus to their families.

Findings moreover revealed that the factors of COVID-19 management do not

predict the mental health state of the hospital workers in terms of HS, GPI, and EEI,

which further explains that the weaker the prediction is, the higher mental health state it

brings among the hospital workers. On the aspect of IEI, it appears to have a higher

impact among the hospital workers, thus it means that the level of mental state of hospital

workers in terms of the impact of IEI is poor.

 69

Conclusion

To conclude, the factors of COVID-19 management in terms of HS, GPI, IEI and

EEI were very high. The very high impact of health care system among hospital

employees results mental health condition at a low state.

The mental health state of hospital employees was very poor. This result was due

to the threats of the COVID-19 among the hospital employees of which are perceived of

no difference from other members of the community and this causes the hospital

employees anxieties. Additionally, the fear of exposure and vulnerability as hospital

employees intensify their fear of being dirtied of the virus and possibly transmit the virus

to their families.

The factors of COVID-19 management do not predict the mental health state of

the hospital workers in terms of HS, GPI, and EEI. This means that the weaker the

prediction is, the higher mental health state it brings among the hospital workers. On the

aspect of IEI, IEI transport a higher influence among the hospital workers, thus it means

that the level of mental state of hospital workers in terms of the impact of IEI is poor.

Recommendations

Based from the findings, the following recommendations are presented:

1. The outcomes of the foregoing research will be shared to different medical service

providers in Ormoc City to serve as basis in addressing the crucial state of the

hospital employees, furthermore suggest herein plan to improve the mental state

of the hospital employees.

 70

2. This paper will also be shared among those belonging to nursing profession. The

outcomes of the study recommend nurses to positively respond on the challenges

of IEI, particularly the COVID-19 pandemic. Thorough investigation of

information is likewise recommended in order to be more resilient with the mental

impact of IEI and be more focused in exercising their profession.

3. The findings of the study are recommended to those in nursing education, wherein

in continuance of their education, this study recommends strategic approach,

particularly in addressing mental health state in times of challenges like health

and well-being along with other issues that challenge professionalism.

4. This study is recommended among those conducting researches in nursing

discipline. Herein findings will be of contribution to their specific areas of

concern, particularly in establishing resilience in the midst of challenges in

nursing profession.

5. A seminar pertaining to coping mechanism in dealing with fear and anxiety is

strongly recommended.

6. A mental health program to boost the morale and resilience of the hospital

employees is recommended.

7. It is recommended for the healthcare facility to ensure that provision and

sufficiency of healthcare standards and protocols, particularly this time of

pandemic are observed. Moreover, it is recommended to develop an infection

prevention and control for COVID-19 in healthcare settings.

 71

8. It is recommended that policies and recommendations aligned to the national laws

be put into practice, particularly in ensuring the safety of the hospital employees.

9. The following research titles are suggested:

a. A research on The Socio Economic Impact of COVID-19 among Hospital

employees: Establishment of Coping Mechanism is recommended.

b. A research on Physical and Mental Health Issues of COVID-19 among

Hospital employees: Establishment of Awareness and Preparedness is highly

recommended.

c. A research on The Impact of Community Quarantine among Healthcare

recommended.

d. The Live Experiences of Nurses on Providing Care to COVID-19 Infected

Patients is recommended.
 72

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 73

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 78

APPENDICES
 79

APPENDIX A
TRANSMITTAL LETTER TO THE DEAN OF THE COLLEGE OF ALLIED
HEALTH SCIENCES
October 16, 2020

YVONNE M. SEVILLA, RM, RN, MAN

Dean, College of Nursing
University of the Visayas
Mandaue City

Dear Ms. Sevilla:

Good day!

I, the undersigned, am planning to conduct the study entitled “FACTORS OF COVID 19

MANAGEMENT ON MENTAL HEALTH STATE OF HEALTH CARE WORKERS”
as a final requirement for my Doctoral degree. Rest assured that all information gathered
from the undertaking will be for educational purposes only. In connection to this, may I
request your good office the permission to allow the conduct of the study.

I am hoping for a positive response on this matter.

Respectfully yours,

Angelie E. Luma-ad, RN, MAN

Researcher

Noted: Approved by:

Resty L. Picardo, RN, MAN, JD, DM MRS. YVONNE M. SEVILLA

Researcher Adviser Dean, College of Nursing
 80

APPENDIX B
TRANSMITTAL LETTER TO THE CHIEF ACADEMIC OFFICER

October 16 , 2020

ANNA LOU C. CABUENAS, EdD

Chief Academic Officer
University of the Visayas
Cebu City

Doctor:

Good day!

I, the undersigned, am planning to conduct the study entitled “FACTORS OF COVID 19

MANAGEMENT ON MENTAL HEALTH STATE OF HEALTH CARE WORKERS”
as a final requirement for my Doctoral degree. Rest assured that all information gathered
from the undertaking will be for educational purposes only. In connection to this, may I
request your good office the permission to allow the conduct of the study.

I am hoping for a positive response on this matter.

Respectfully yours,

Angelie E. Luma-ad, RN, MAN

Researcher

Noted: Approved by:

Resty L. Picardo, RN, MAN, JD, DM Dr. Anna Lou C. Cabuenas

Researcher Adviser Chief Academic Officer
 81

APPENDIX C
TRANSMITTAL LETTER TO THE CHIEF OF HOSPITAL

Nov. 07, 2020

Dr. Jaime Gatchalian Jr.

Medical Director
Clinica Gatchalian- Mount Grace Hospital
Kangleon Sreet, Ormoc City, Leyte 6541

Dear Dr. Gatchalian:

Good day!

I am currently working on the study entitled “FACTORS OF COVID 19

MANAGEMENT ON MENTAL HEALTH STATE OF HEALTH CARE WORKERS”,
as a final requirement for my Doctor of Health Care Management degree. In connection
to this, may I request your good office the permission to allow the conduct of the study.
This will be done through survey method. Rest assured that all information gathered from
the undertaking will be kept with outmost confidentiality.

Thank you very much in anticipation for a positive response on this matter.
Respectfully yours,

Angelie E. Luma-ad, RN, MAN

Researcher

APPROVED
Noted:

Resty L. Picardo, RN, MAN, JD, DM MRS. YVONNE M.

SEVILLA
Researcher Adviser Dean, College of Nursing
 82

APPENDIX D
RESEARCH INSTRUMENT

I understand that I am being asked to participate in a research study at Ormoc City. This
research study will determine the Factors of Covid 19 Management on Mental health
State of Health Care workers.

If I agree to participate in the study, I will be made to answer a questionnaire for

approximately 10 to 15 minutes. There will be no interviews and no recordings and it will
take place in the place convenient to me. There are no risks associated with the study.

I realize that I am qualified to participate in the study; I realize that the knowledge gained
from the study may help either me or other healthcare team members, patients to know
more about the Socio-economic impact of COVID-19 on mental health condition of
Health workers;

I realize that my participation in this study is entirely voluntary, and I may withdraw from
the study at any time. If I decide to discontinue my participation in this study, I will
continue to be treated in the usual and customary fashion;

I understand that all study data will be kept confidential. However, this information may
be used in publication or presentations; I understand that if I sustain injuries from my
participation in this research project, I will not be automatically compensated by the
researcher;

I understand that if I have questions about the study, I can contact the researcher or the
University of the Visayas Institutional Review Board at their email
uvird2017@gmail.com..

The study has been explained to me, I have read and understand the consent form, all of
my questions have been answered and I agree to participate, I understand that I will be
given a copy of the singed consent form.

___________________________________
Signature of Respondents and Date

Witnesses:
_______________________________ ____________________________
Signature and Date Signature and Date
 83

The objective of this instrument is to evaluate the Factors of COVID-19 Management on

Mental Health State of Hospital employees.
Part I. Factors of COVID-19 Management.

Instruction: Rate each item based on your agreement of the statement using the scale:
1 – Strongly disagree
2 - Disagree
3 – Neither agree or disagree
4 - Agree
5 – Strongly agree

Ite 1 2 3 4 5
m
Healthcare System (HS)
1 The healthcare system is too fragile to deal with
the recent outbreak of COVID-19.
2 A huge population is a pressure to the existing
healthcare system to deal with COVID-19.
3 There is a lack of awareness of basic healthcare
issues amongst most of the citizens.
4 There is a lack of trained doctors and healthcare
professionals to deal with the COVID-19.
5 There is lack of lack of healthcare infrastructure to
deal with COVID-19.
6 There is a severe lack of bio-medical hospital
waste management facilities.
7 There is a lack of testing facilities.
8 There is lack of budget or support in response to
this outbreak.
9 Most of the poor people will not have access to
existing healthcare facilities if they are infected by
COVID-19.
Governance and Political Issues (GPI)
1 The government can deal with this outbreak.
2 The government is taking this outbreak seriously.
3 The government is making proper decisions in the
right time.
4 The government is involving other sectoral actors
to combat the COVID-19 outbreak.
5 The government needs support from the people to
reduce the impact of COVID-19.
6 The government needs to formulate a policy and
action plan and implement it immediately.
 84

7 Developed nations are going to support in response

to COVID-19.

Immediate Emerging Issues (IEI)

1 There is a chance of community transmission of
COVID-19.
2 A huge number of people will be infected.
3 There is a chance of not detecting most of the
infected patients due to undermining the number of
actual infected cases.
4 There is a chance of increasing the number of
deaths by not having proper facilities.
5 Lack of bio-medical waste management facilities
in the hospitals will create environmental
transmission.
6 Many people will be psychosocially shocked due
to this outbreak.
7 The government will lose its trust from the people.
Enduring Emerging Issues (EEI)
1 There is a chance of a disaster like, floods,
cyclones, or landslide in 2020 considering the
climate change vulnerability.
2 If any disaster occurs after/during the COVID-19
situation then it will create a double burden.
3 There is a chance of severe food scarcity due to
these events (COVID-19 + disasters).
4 High possibility of huge economical loss.
5 High possibility of increasing the poverty level.
6 High possibility of severe socio-economic and
health crisis.

Part II. Mental Health State

Instruction: Rate each item based on your agreement of the statement using the scale:
1 – Strongly disagree
2 - Disagree
3 – Neither agree or disagree
4 - Agree
5 – Strongly agree
Item Statements 1 2 3 4 5
s
1 I am afraid of the recent corona virus.
2 I am afraid of getting infected with corona virus.
 85

3 I am afraid of losing my life or my relatives’ lives

due to this outbreak.
4 All the news of infection and deaths from
COVID-19 in different media is increasing my
fear.
 86

APPENDIX E UVIRB FORM 4.1:

NTP&Agreement
Rev.01.09.11.2017
Notice to Proceed and Agreement
IRB NTP Code:
2020-062NC
This certifies that the proposed research paper titled “Factors of COVID-19 Management on
Mental Health State of Health Care Workers” with Ref. Number: 2020-074Ncov, prepared
by Luma-ad, Angelie E. has satisfactorily complied with the following requisites,
CONSENT (check all that applies)
? Informed Consent – form ☐ Parental Permission – form
? Informed Consent – oral script/online/unsigned ☐ Parental Permission – oral script/online/unsigned
? Process Consent – form ☐ Translated Consent/Assent – form(s), script(s), etc.
? Process Consent – oral script/online/unsigned ☐ Debriefing script
? Assent (participants under 18) – form ☐ Other – please explain: IMPLIED CONSENT
? Assent – oral script/online/unsigned
IRB REVIEW PROCESS
as required by the University of the Visayas- Institutional Review Board Office, recognized
guidelines by all accredited research authorities. In view of this, the researcher(s) s is/are compelled to
promptly inform any further changes done during the proceedings. Failure to compel is subject to the
termination of the study. Hence, it resolves that the said proposal is:
Technical Soundness

Ethical Consideration

Consent

Proceed to the next phase of the study, under conditions provided for by the Office.
Study Protocol History
Concept Paper/Title Defense Proposal Hearing Date: 3 Oct 2020
IRB Initial Submission: 2 Nov 2020 Release of Initial Assessment: 3 Nov 2020
Date of Payment: 3 Nov 2020 Release of 1st Review:
Resubmission Date: 2nd review Release Date: 2nd review
3rd review 3rd review
4th review 4th review
Approval Date: 3 Nov 2020
Submission of NTP Requirements: 3 Nov 2020 NTP Issuance: 3 Nov 2020
Validity Period: 3 Nov 2020 to 3 Nov 2021
Note: For Qualitative Studies in the Social Sciences, Data Gathering and Analysis shall be conducted at least six months except for
Ethnography which shall be conducted at least for a year. Data Gathering and Analysis for Mini-Ethnographic studies can be
conducted in no less than six months. For Qualitative Studies in Humanities, Data Gathering and Analysis may be conducted in less
than six months if no human participants are enrolled in the study. Counting of the Date shall commence the day after the Notice to
Proceed is issued.
This study will be reviewed every year. No changes to the study can be implemented
however, before an amendment is submitted to the IRB and the PI receives written approval from
the IRB office.
 87

RESTY L. PICARDO, RN, MAN, LLB, DM

UV-IRB CHAIR, SOCIAL SCIENCES
APPENDIX F
PLAGIARISM CHECK CERTIFICATE
 88

APPENDIX G
GRAMMARIAN CERTIFICATE
 89

CURRICULUM VITAE
 90

ANGELIE E.LUMA-AD RN, MAN

Brgy Dolores Ormoc City, Leyte 6541
Contact number: 09276937467
Email Address: angelielumaad@gmail.com

Professional Summary:

A master of Arts in Nursing major in Nursing Management degree holder with 4 years
and 8 months as a Staff Nurse in ClinicaGatchalian and Hospital. Currently taking up
Doctor of Healthcare Management in University of the Visayas.

Personal Information
Date of birth: Nov 17, 1988
Place of Birth: Ormoc City, Leyte
Permanent Address : Brgy. Dolores Ormoc City, Leyte
Mobile Number : 09276937467
Email Address : angelielumaad@gmail.com
Gender : Female
Citizenship : Filipino
Religion : Baptist
Civil Status : Married

Educational Attainment

Post Graduate Studies University of the Visayas

2018-Present Doctor of Healthcare Management
Colon St. Cebu City

Graduate Studies University of the Visayas

2016-2018 Master of Arts in Nursing major in Nursing Management
Colon St. Cebu city
 91

Tertiary Education: Visayas State University

April 2012 Bachelor of Science in Nursing Graduate
ViscaBaybay City

Secondary Education:
March 2006 San Jose National High School
San Jose Ormoc City

Elementary Education: Balion Elementary School

March 2001 BalionOrmoc City

Work Experience
February 2013-Oct. 2017 StaffNurse
ClinicaGatchalian and Hospital
Kangleon Street Ormoc City, leyte
(053)255220

Part time Clinical Instructor Visayas State University

March 1-20,2020Visca,Baybay City, Leyte
Seminars/trainings/conventions attended:

 Mental Health Gap Action Program( MHGAP)

December 04, 2016
Nursing Function Hall
UV-Gullas, Banilad Cebu City

 Nursing Certification Program

December 04, 2016
Nursing Function Hall
UV-Gullas, Banilad Cebu City
92