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INTRODUCTION

Background of the study

Healthcare workers (HCWs) are at the front line of any outbreak response and as such

their work expose them to various forms of hazards. These hazards include pathogen exposure,

long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical

and psychological violence. Healthcare workers (HCWs) in the Philippines often suffer from the

abuse that comes from stigma (Reuters, 2020).

The worldwide spread of COVID-19 had been characterized as a pandemic, which did

not only bring about a high mortality rate, but also caused psychological stress to the patients,

family members and HCWs (Xiao, 2020). Such uncertainty and unpredictability of pandemic

outbreak of infectious disease from its clinical presentation, infectious causes, epidemiological

features, fast transmission pattern, seriousness of public health impact, novelty, scale,

implication for international public health, and underprepared health facilities to address the

pandemic outbreak of COVID-19 have considerably high potential for psychological fear of

contagion. The pandemic resulted to a multitude of psychological problems such as fear, anxiety,

stigma, prejudice, marginalization towards the disease and its relation of all people ranging from

healthy to at-risk individuals to care-workers (Mak et al., 2009 as cited in Rana, Mukhtar, &

Mukhta, 2020). Moreover, large numbers of healthcare workers (HCWs) have acquired

coronavirus disease (COVID-19) in the workplace (Wang, Hu, Hu, 2020).

The Department of Health (DOH) in the Philippines reported that as of 3 December 2020,

the total number of cases have reached 435,413, with 27,642 active cases, 399,325 have
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recovered, while 8,466 have died. The incidence of the COVID-19 in the Philippines have made

a toll on the local HCWs.

Discrimination against HCWs who have been infected with COVID-19 have been

reported in the media. Chuck Estrella of the Riverside Medical Center Inc. mentioned that after

the news broke out about the first person to test positive for COVID-19 in Bacolod City, people

were treating HCWs differently. Some of these health care workers were being denied a ride in

pedicabs or jeepneys because they work in a hospital facility, while others are being denied of

entry at small offices while others were verbally attacked by policeman according to a local daily

(Gomez, 2020). Reports included healthcare workers being asked to vacate the places they were

renting. Rayfrando Diaz, a ranking official of Negros Occidental, appealed to people to stop

treating healthcare workers like the dreaded COVID-19 disease from which they are trying to

save lives at the risk of their own. Diaz said that people must instead support those healthcare

workers of the fight against COVID-19. “Please let us not fight them. Instead, we need to show

our all-out support for these people. We need to support each other in this time of crisis,”

(Gomez, 2020).

The World Health Organization (WHO) reported that the nursing staff and other

healthcare professionals are working around the clock. According to Dr Takeshi Kasai (2020) of

the WHO, “right now, nurses [and other healthcare workers] are on the front lines of the

COVID-19 fight, working tirelessly to save lives and protect others in their community”.

Governments across the Western Pacific Region must invest in strengthening their nursing

workforce, physically and psychologically, as an essential part of preparedness for health

challenges.
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The physical and psychological pressures and the potential of overwhelming burden on

HCWs continue to intensify. Gathering helpful data that could elevate the healthcare workers

who painstakingly work for the society have been one of the motivations to create this study.

Assisting them in any way possible could lessen their burden that my help with recovering of our

society as a whole and a great cause. And a reminder that there are lives spent to stop the

escalation of virus but not without sacrifice of HCWs.

Benefits to various fields in psychology are also part of the reason to conduct this study.

Information from this study may contribute to human resource management in the healthcare

facilities. Policies and protocols in the workforce management may be derived from this study.

Increasing paid leave, 24/7 access to healthcare professionals, and instituting a hazard pay were

just some possible measures to help HCWs. This study may be helpful in determining the

observance of workplace safety protocols. Supporting health and wellness it’s important to

remember that employees are people.

Concerns in counseling and clinical psychology may also be addressed through this

study. Prevention of the onset or relapse of a physical or mental illness among HCWs was

considered. Hopefully, measures that lead to improvement to HCWs resilience, cognitions, self-

esteem, relationships, and inner peace may be obtained through this study.

Statement of the Problem

This study aims explore the experiences of healthcare workers (HCWs) involved in the

treatment of COVID-19 patients.

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Theoretical Framework

Philosophical Paradigm

This study is guided by the Constructivist paradigm. Guba & Lincoln (1989 as cited in

Kamal, 2019) describe the constructivist paradigm as realities that are multiple. Bunnis & Kelly,

(2010 as cited in Kamal, 2019) further expounds that “the ultimate truth has been regarded as not

existing and reality is subjective and changing”. According to Cresswell (2014) constructivism

deals with the development of subjective meanings and understandings of one’s personal

experiences concerning specific topics based on their social and historical background. Hein

(2007 as cited in Mogashoa, 2014) mentions that constructivism refers to the idea that

individuals construct knowledge for themselves, each learner individually and socially constructs

meaning- as he or she learns. Relative to this study, each HCWs involvement in the treatment of

COVID-19 patient differ from one another. Each has his own explanation and response to the

involvement in the treatment of COVID-19 patient which largely determine the course of his

own pandemic journey.

Furthermore, constructivist research do not generally begin a study with a theory rather

they "generate or inductively develop a theory or pattern of meanings" (Creswell, 2003 as cited

in Adom, Yeboah & Ankrah, 2016) throughout the research process. Thus, the healthcare

workers involvement in the treatment of COVID-19 patient may be describe by exploring and

interpreting individual stories through their own distinctive and personal perspective. How the

participants bring meaning and associate their experience into their lives could be best expound

the occurrences to the HCWs involvement in the treatment of COVID-19 patient.

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Scope and Limitation

This study aimed to explore the stories and experience of Healthcare Workers (HCWs)

who engages with COVID-19 patients. Inclusion criteria were HCWs who engages with

COVID-19 positive patients, either-or working in public or private hospitals that were stationed

in high risk or low risk area in the health facility. Also, these HCWs have an employment status

of regular employee or casual employee in particular it also included self employed HCWs.

Furthermore, due to the coronavirus pandemic and the nature of their work; face-to-face

interactions were discouraged. Some participants choose to participate and allow the conduct of

the interview face-to-face participants a place where safety protocols were strictly practiced

through the correct use of personal protective equipment (PPE). Moreover, finding nine

participants to be interviewed required referrals, tapping existing personal social network the

required number of participants was achieved. While other HCWs opt to used online application

such as, Facebook Messenger and Zoom in consideration of health concerns due to the

pandemic. What’s more using online applications for interviews needed a stable internet

connection to connect with participants and to hear and see them clearly. Furthermore,

participants were hard to be interviewed through online or face-to-face due to the increase

workload and lack of time in their work schedule. However, with persistence and dedication of

the researcher the participants find a time to be interviewed and finished the research.

The participants of the study were healthcare workers (HCWs) who were involved in the

treatment of COVID-19 patients. HCWs who were most commonly involved with these patients

were medical doctors, nurses, and medical technologists. They may be in public or private health

facilities. Some participants choose to be interviewed face-to-face and some were through online
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applications such as, Facebook Messenger and Zoom in consideration of health concerns due to

the pandemic. Those who choose for the face-to-face interview has a preparatory schedule and

location for the interview were determined ahead of time for the convenience of both the

participant and the researcher. During the interview, safety protocols for corona virus were

implemented such as the use of personal protective equipment (face mask, face shield) for both

the researcher and participant.

Significance of the Study

This study about healthcare workers who handle COVID-19 patient may be of help to the

following:

Healthcare Workers (HCWs). This study may help HCWs as they engage the cases of

COVID-19 here in Negros Occidental. HCWs are at the front line of any outbreak response and

as such are exposed to hazards that put them at risk of infection with an outbreak pathogen (in

this case COVID-19). Hazards include pathogen exposure, long working hours, psychological

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

Mental Health Professionals. This study may help through the procurement of data

about mental health issues of healthcare workers working on COVID-19 patients. Information

derived from this study may used to help HCWs and others which have similar situation. The

study may contribute to the understanding of mental health issues occurring during pandemic,

and may also provide assessments for feasible upcoming mental health issues our HCWs will

exhibit. In likelihood, the research may be used for consultation regarding possible

diagnostic/intervention and consideration. Through this research study, it may empower

individuals to accomplish positive mental health.

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Human Resource Management. This study may assist the demanding conditions of

human resource (HR) units, in the context of dramatic changes around the world due to the

pandemic, organisations need to respond and adapt to the alterations and accordingly manage the

workforce (Carnevale & Hatak, 2020). Input of this study might help HR management in the

healthcare facilities. Policies and protocols in the workforce management may be derived from

this study. Increasing paid leave for workers, waiving COVID-19 testing and treatment, 24/7

access to healthcare professional, hazard pay. Workplace safety protocol the data in the study is

helpful through information that could update it. Supporting health and wellness it’s important to

remember that employees are people.

Families of HCWs. This study may of service to the families in which they have a

family member who are HCW. It may show calming strategies and maintaining family routines

of other families dealing with the same situation. It may present to the families of HCWs clear

information about the best ways to avoid COVID-19 infection. Specific rules and guidance may

not have been provided by the government or health facility of HCWs to their families in the

pandemic. Nevertheless, this study may be helpful to develop families of HCWs own “rules” and

procedures that help families feel safe in managing exposures.

Government. This study hopes to assist the government to obtain reliable data regarding

health workers during pandemic. It may be of service to the benefits of health workers of

continuing their work throughout their services. It may source reliable information on the risk,

severity, and progression of a pandemic and the effectiveness of interventions. While all sectors

of society are involved in pandemic preparedness and response, the national government is the

natural leader for overall coordination and communication efforts. Gaining insight on the
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resources for national pandemic preparedness, capacity development, and response measures,

this study may contribute to the government’s responses to the pandemic.

Academe. The results of this study may provide information that may be used as part of

knowledge generation in the academe. Findings of this study may be a source for evidence-based

information that may used for teaching purposes. Informative, educational and communication

(IEC) materials may be developed using the findings of this study.

Future Researchers. This study may be used as a source material for future researchers

who would like to embark on the study of experiences of HCWs during pandemic. One can hope

that with continued research that HCWs during pandemic that their efforts and work would be

recognize with the prevention of tragic loss of human life with the virus.

Definition of Terms

For better understanding, the following terms are defined conceptually and as they are

used in this study.

Healthcare Workers (HCWs) – Conceptually, it is define as a worker directly involved in

COVID-19 prevention and treatment and having direct contact with confirmed or suspected

cases through patient intake, screening, inspection, testing, transport, treatment, nursing,

specimen collection, pathogen detection, pathologic examination, or pathologic anatomy of

medical and healthcare professional and technical personnel (Zhang, Zhou, Tang, Wang, Nie,

Zhang, You, 2020). In this study, this refers to the participants of the study, and may include any

of the following:
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Medical Doctor – Conceptually, this term is define as people who diagnose, treat and

prevent illness, disease, injury, and other physical and mental impairments and maintain

general health in humans through application of the principles and procedures of modern

medicine. They plan, supervise and evaluate the implementation of care and treatment

plans by other health care providers. They do not limit their practice to certain disease

categories or methods of treatment, and may assume responsibility for the provision of

continuing and comprehensive medical care to individuals, families and communities

(ISCO, 2008 as cited in International Labour Organization (ILO), 2012).

Nurse – Conceptually, this term is define as people who provide treatment, support and

care services for people who are in need of nursing care due to the effects of ageing,

injury, illness or other physical or mental impairment, or potential risks to health,

according to the practice and standards of modern nursing. They assume responsibility

for the planning and management of the care of patients, including the supervision of

other health care workers, working autonomously or in teams with medical doctors and

others in the practical application of preventive and curative measures in clinical and

community settings (ISCO, 2008 as cited in ILO, 2012).

Medical Technologist – Conceptually, this term is define as people who perform clinical

tests on specimens of bodily fluids and tissues in order to get information about the health

of a patient or cause of death. They test and operate equipment such as

spectrophotometers, calorimeters and flame photometers for analysis of biological

material including blood, urine and spinal fluid (ISCO, 2008 as cited in ILO, 2012).
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Health-care Facility – Conceptually, this term is define by WHO as hospitals, primary health-

care center, isolation camps, burn patient units, feeding centers and others. In emergency

situations, health-care facilities are often faced with an exceptionally high number of patients,

some of whom may require specific medical care (e.g. treatment of chemical poisonings). It has

the following component:

Private – Conceptually, this term is define as sectors in the direct provision of health

care, the supply of health care-related goods, and health care financing. Private sector

involvement in the provision of health care encompasses a complex range of activities

carried out by various non-state actors. These actors may include (multi)national

companies, nongovernmental organizations, and nonprofit entities (Wolf & Toebes,

2016).

In this study, it is defined as a workplace of the participant.

Public – Conceptually, this term is define by Law Insider (2020) as one or more

buildings, structures, additions, extensions, improvements, or other facilities, whether or

not located on the same site or sites, machinery, equipment, furnishings or other real or

personal property suitable for providing public health services; and includes, without

limitation, local public health departments or centers; public health clinics and outpatient

facilities.

In this study, it is defined as a workplace of the participant.

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Review of Related Literature

The review includes the body of research literature, which is related to this study’s

research problem, and objectives. They are presented using the thematic approach.

Experiences of Being a Healthcare Worker in a Pandemic

The escalation of COVID-19 infection among HCWs in the country is rampant and as the

passage of time the increasing and decreasing of the overall confirmed cases have been change

from the start of the outspread of the virus until as of this writing. Numerous actions have been

engage to the process of what the product of HCWs experience with dealing with the virus.

Around 2,067 Filipino health workers have been diagnosed with COVID-19, leading to 35

deaths (Baticulon, 2020). HCWs bear a much greater risk of exposure to COVID-19, with 15%

of all coronavirus cases in the Philippines being hospital or health care workers as of DOH’s

latest tally in June as of this writing. The World Health Organization has already expressed

concern over the Philippines’ infection rate, which is among the highest worldwide, approaching

that of Wuhan’s at the start of the pandemic. The numbers do not account for Filipino health

workers who have died from COVID-19 overseas. The fact is healthcare workforce plays a

central role in the diagnoses and treatment of patients of COVID-19. The shortage in healthcare

worker is bound to hamper any country response to the current pandemic. The malfunctioning

operations of HCWs will result in uncontrolled disease transmission within healthcare facilities
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eventually leads to outbreaks in the community, which would be more difficult to contain and

would affect a higher percentage of the vulnerable population.

One of the question is why have so many Filipino HCWs had been infected by COVID-

19? While the Department of Health’s official data have shown a decrease in the number of new

infections among Filipino HCWs, it remains unclear how many of them acquired COVID-19

from the workplace and needs further studies to pinpoint the cause and stop further damage to

our HCWs. Some argue that the higher numbers are due to the preferential testing of health

workers in the country. One other reasons is that it is plausible, dangerously deflects from the

root causes of the problem, which are lack of personal protective equipment (PPE) and failure to

adhere to infection control measures in the workplace. This has been consistently shown in

studies that looked at health personnel infected with SARS in Hong Kong and Singapore, and

COVID-19 in Wuhan. The first arrival of the virus to the country shows the awareness of the

people were lacking and to how the virus behaves, strict rules on wearing personal protective

equipment (PPE) during patient encounters had not yet been implemented in places in most

health facilities. The Philippines’ limited testing capacity and failure to perform meticulous

contact tracing had also prevented early identification and isolation of cases. Any combination of

these factors would have resulted in occupational exposure among our HCWs early on.

Even with those factors the jobs of HCWs in the Philippines are badly struggling within a

strained healthcare system as they battle both rising COVID-19 infections, as well as face abuse

from the community they seek to protect. Antiquera (2020), president of the Philippines Alliance

of Young Nurse Leaders and Advocates (AYNLA) told the Globe a digital media resource that

the staff’s are suffering as a result of stigma surrounding the novel coronavirus, including

assaults, home evictions and denial of access to basic services. “There are reports that nurses and
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other HCWs are being physically attacked and harassed and having chemicals thrown on them

such as bleach and chlorine,” he said. The backlash against HCWs all this while working long

hours for little pay with the average monthly nurse salary in the Philippines roughly $300, and

the low-end of the nurse-patient ratio 12.6 nurses per 10,000 people. In rural areas, that falls to

4.2.

In the duration of the COVID-19 tensions run high, the virus itself, and a critical lack of

personal protective equipment (PPE), continues to present a clear danger to those on the HCWs.

It also falls to the government hands the responsibilities of protection among healthcare workers

protecting them from the discrimination and protecting them from the virus. HCWs are the

backbone of our healthcare system, many will be compelled to either quit or risk their lives.

Perpetuation of harassment of our HCWs will result more of them quitting their jobs, and our

healthcare system will collapse, once it collapses, more people will suffer. The discrimination of

HCWs prompted statement from Department of Health (DOH) stated that “These acts cannot be

tolerated.” It also sought to assure the public that it should not worry about becoming infected

from workers, saying, “As medical professionals, our HCWs are taking extra precautions to

ensure infection prevention and control.”

An online survey brought together with other volunteers and Sonny Afable (2020) of the

UP Population Institute and behalf of the Alliance of Health Workers and the Alliance of

Concerned Teachers conducted for the survey of health workers from April to May 2020 in order

to better recognize and understand the circumstances of HCWs who are at the frontline fighting

this pandemic. From the same research resulted that out of 457 respondents, more than half

reported that their health facilities do not meet even 50% of what they recognized as sufficient

number of health personnel and the appropriate number of infection, prevention and control
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(IPC) supplies and personal protective equipment (PPE). About two-thirds of the respondents

believe there is severe lack of doctors, nurses and nurse assistants as well as administration and

utility personnel in their health facilities. Surprisingly bigger percentage of respondents indicates

that there is a critical absence of counselors, therapist as well as midwives. Across all types of

medical frontliners, less than 10% of the respondents believe there is ample or near sufficient

number of personnel.

As the number of health workers who tested positive for the coronavirus rose to 5,008,

with majority of infections seen among nurses and physicians a story from Rappler. The

Philippines’ Department of Health (DOH) said on August that 4,576 of the 5,008 cases, as of

August, had recovered, while 38 died due to the disease. During the pandemic, health workers

who are severely infected with COVID-19 are supposed to receive P100,000 each, while the

families of those who died from the coronavirus should get P1 million each. This was included in

the Bayanihan law that expired last June 25.

The worsening of the situations which intensify the risk faced by medical frontliners,

along with their profession many of them also work excessively long hours while earning very

little pay (Quintos, 2020). The circumstances brought by high-risk and high stress conditions

confronted by the frontline HCWs in the Philippines aggravated the situation combine with

insufficient PPE are surely contributing element to the high rate of COVID-19 infection among

HCWs (Quintos, 2020). At least 2,366 health workers in the Philippines have already been

infected by the SARS-CoV-2 virus or close to one out of every five confirmed cases of COVID-

19 in the country (Rey, 2020) as of May 2020. Indeed, the WHO expressed its alarm over the

high number of healthcare workers infected with SARS-CoV-2 in the Philippines. At 17.4% of

total cases May 2020, the rate of infection among frontline health workers in the Philippines is
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by far the highest among 37 member states in the WHO-Western Pacific Region including China

— the ground zero of the COVID-19 pandemic.

As the progression of the virus more nurses and doctors might resign out of fear of

acquiring the novel coronavirus disease if the government would continue to ignore healthcare

workers’ concerns. From an article from Inquirer a statement from The Alliance of Healthcare

Workers (AHW) (2020) reports that nurses in the Southern Philippines Medical Center (SPMC)

have resigned out of fear from the COVID-19 pandemic might be replicated because health

authorities allegedly fail to address the still-rising number of COVID-19-infected HCWs.“We

fear that more fellow health workers will be resigning, not only from SPMC but to various

hospitals across the country since they do not yet feel concrete and comprehensive measures of

containment from the deadly virus in the country which will jeopardize their health and lives,”

AHW president Mendoza (2020) said in a statement. As the responsibilities from the government

slip up most of the HCWs blame on the government lacking and inadequate in their response to

the crisis that our country is facing. According to the World Health Organization, HCWs may

become targets of violence during disaster and conflict situations. As many as 38 percent of

healthcare workers are likely to experience violence at one point in their professional life, with

nurses and those involved in direct patient care most at risk. Antiquera (2020), president of

Alliance of Young Nurse Leaders and Advocates said “Healthcare workers are exhausted and

frustrated by the lack of support from the government in providing them even basic protective

gear. If we do not put a stop to this harassment, nurses may resign.” During this global health

crisis, we must not forget that health workers are people with their own families and loved ones.

They are individuals who have been reminded of their sworn duty to serve when everybody else

had been ordered to stay home. Entire hospitals can be built in a matter of weeks, but training a
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health worker takes years of commitment and sacrifice. If we truly believe that HCWs were

heroes, applause will never be enough. Let us act, and not just watch them die at the frontlines.

Mental health of healthcare workers

Recent study by Shaukat, Ali & Razzak, (2020) mention five articles discussed mental

health impact on healthcare providers. In one study, out of 230 HCWs who responded to the

mental health assessment scales, 23% had psychosocial problems. Among these 53 medical staff,

more females 90% than males 9.43%, and more nurses 81% than physicians 18% suffered from

mental health issues due to the infectious outbreak (Huang, Han, Luo, Ren , Zhou, 2020). The

mental health impact of a disease outbreak is usually neglected during pandemic management

although the consequences are costly (Naser, Dahmash, Al-Rousan, Alwafi, Alrawashdeh,

Ghoul, Abidine, Bokhary, HT AL-H, Ali. 2020). According to Eric Wei (2020), senior vice

president New York City Health and Hospitals Corporation, says many health care workers were

running on adrenaline during the surge in the city. “I think it was very scary to everyone,” he

says. “And no matter how resilient you are, this was going to take a huge emotional and

psychological toll for people.” He also added COVID-19’s many unknowns have further added

to the stress, with a percentage of patients rapidly deteriorating regardless of the medical

interventions used. “I feel like that was something that was incredibly traumatizing to our

providers, our frontline workers—this hopelessness,” (Wei, 2020).

In a study done by Wasim, Raana, Bushra & Riaz (2020) to HCWs who workers in

tertiary hospital suggested that there were symptoms of depression in 62%, anxiety in 64%,

stress in 55% and insomnia in 53.37% of participants. A recent review has suggested anxiety

being the commonest disorder with sleep disorder (Rajkumar, 2020) among HCW. Early
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evidence has shown that health workers directly involved in the diagnosis, treatment, and care of

patients with COVID-19 are at risk of developing mental health symptoms (Lai, Ma, Wang, Cai,

Hu, Wei, Wu, Du, Chen, Li, 2020). Similar adverse psychological reactions were reported

among HCWs in previous studies during the 2003 Severe Acute Respiratory Syndrome (SARS)

outbreak (Bai, Lin, Lin, Chen, Chue, Chou, 2004).

Due to the exponential increase in the demand for healthcare, they face long work shifts,

often with few resources and precarious infrastructure (Shigemura, Ursano, Morganstein,

Kurosawa, Benedek, 2020). Also, there is the fear of autoinoculation, as well as the concern

about the possibility of spreading the virus to their families, friends or colleagues (Kang, Li, Hu,

Chen, Yang, Yang, et al., 2020). This can lead them to isolate themselves from their family

nuclear or extended, change their routine and narrow down their social support network (Huang,

Han, Luo, Ren, Zhou, 2020). These factors can result in different levels of psychological

pressure, which may trigger feelings of loneliness and helplessness, or a series of dysphoric

emotional states, such as stress, irritability, physical and mental fatigue, and despair (Huang,

Han, Luo, Ren, Zhou, 2020). The work overload and the symptoms related to stress make health

professionals especially vulnerable to psychological suffering (Kang, Li, Hu, Chen, Yang, Yang,

et al., 2020), which increases the chance of developing psychiatric disorders (Malta, Rimoin,

Strathdee, 2020).

According to WHO guidelines for mental health of HCWs, certain coping strategies such

as sufficient rest, balanced and healthy diet, physical activities, keeping in contact with friends

and family members through digital media and decreasing the screen time on social media help

to decrease the stress at personal level (WHO,2020).

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HCWs are also people and have the same fears as everyone else, General Medical

Council recognize that ‘that personal beliefs and cultural practices are central to the lives of

doctors [and] that all doctors have personal values that affect their day-to-day practice’ and does

not ‘wish to prevent doctors from practicing in line with their beliefs and values’ (Horden, 2016).

Understanding how the profile of the participants perceive COVID-19, and adopt specific

behaviors in response to it, is key to enable HCWs to develop intervention strategies to maintain

and respond to mental and physical health problems occurring.

Healthcare workers

Professions that involve human contact and rapid decision-making skills, while those

decisions can have a serious (financial, social or other) impact, are among the most stressful ones

(Cooper, 1988 as cited in Koinis et al., 2015). Healthcare professions are among the first six

most stressful ones (Cooper, 1988 as cited in Koinis et al., 2015). Professionalization includes a

series of attitudes which represent levels of individuals' identification with, recognition by and

commitment to a particular occupation (Shohani & Zamanzadeh, 2017). More professional and

occupational experience is often acquired through the adoption and reinforcement of professional

role model attitudes and behavior (Castledine, 1998 as cited in Shohani & Zamanzadeh, 2017).

As a factor that determines behaviors, attitude consists of a relatively constant manner of

thinking, feeling and behaving towards different individuals, groups and social issues or at a

broader level, to any event that takes place in an individual's environment (Karimi, 2005 as cited

in Shohani & Zamanzadeh, 2017).

HCWs and volunteers working in the field may also become stigmatized, leading

to higher rates of distress, stress, and burnout Fear of COVID-19 directly correlates with its rapid

and invisible transmission, and its morbidity and mortality. This elevated level of fear can
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influence people’s rational thinking in reacting to COVID-19 (Ahorsu, Lin, Imani, Saffari,

Griffiths, Pakpour, 2020). Furthermore, a large amount of uncontrolled news is spreading

through the media, which increases the risk of disseminating fake news more rapidly than the

virus itself, causing anxiety, worries, and uncertainties that all contribute to negatives effects,

such as stigma (Dagklis, Tsakiridis, Mamopoulos, Athanasiadis, Pearson, Papazisis 2020).

Joaquin Sapul, Jr, chief patient services officer and director of nursing of Medical City Iloilo

reported than when nurses messaging him, calling him that they are being evicted or being

prevented from leaving their home “We healthcare workers have always enjoyed the trust of our

community. I underestimated how hysteria could make them turn on us so quickly” (Rubrico,

2020). Social stigma (e.g., discrimination and devaluation by others) has a variety of negative

consequences that inhibit recovery, such as shame, embarrassment, and the “why try”

phenomenon (Giorgi, Arcangeli, Montes, Rapisarda, Mucci, 2019). Stigma is such a pressing

issue for the national health system, it has been identified as a health crisis that clinicians must

take action against (O’ Donnell, 2016). HCW stigmatization is associated with psychological and

physical health. HCW who expected to experience higher levels of stigmatization reported

increased psychological distress, and this predicted increased somatic symptoms (Corrigan,

Gallagher, 2015).

Stigma was also prevalent in HWCs in a study done by Dagklis, Tsakiridis, Mamopoulos,

Athanasiadis, Pearson, Papazisis (2020) assessing ten thousand five hundred eleven (10, 511)

healthcare workers fighting against SARS, although most of them were appreciated by the

society, a considerable proportion felt social stigmatization (49%) and exclusion by family

members (31%). Moreover, 31% thought that people kept away from their family members

because of their job (Koh, Lim, Chia, et al., 2005). Stigma had direct and also indirect effects
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through stress on mental health in nurses fighting the Middle East respiratory syndrome

(MERS); however, the impact of stigma on their mental health was worse compared to stress

effects (Park, Lee, Park, Choi, 2018). Moreover, stigma compounds the stress levels of

healthcare staff thereby affecting job satisfaction and quality of patient care (Hernandez,

Morgan, Parshall, 2016). Stigma is associated with violence against HCWs: more than 200

attacks on HCWs and health facilities during the ongoing pandemic were reported by May 2020

(Bagcchi, 2020). HCWs were denied access to public transport, insulted in the street, evicted

from rented apartments, and even physically assaulted (Bagcchi, 2020).

Several measures to deal with the mental and psychological stress and stigma during the

COVID-19 response have been published by WHO, Centers for Disease Control and Prevention

(CDC), and United Nations International Children’s Fund. They recommended that for

healthcare workers: Avoidance by some members in the community can be disappointing.

Getting support from family, colleagues, and managers can help healthcare workers overcome

these feelings. Providing emotional support to affected people during different stages of

isolation/treatment can help them overcome the psychological impact of stigma if present and

give a positive example to the society (WHO, 2020)

Healthcare workers experience in health facilities

Workplace stress can influence healthcare professionals’ physical and emotional

wellbeing by curbing their efficiency and having a negative impact on their overall quality of life

(Koinis et al., 2015). Such as the coronavirus disease 2019 (COVID-19) pandemic has changed

how health care is delivered and has affected the operations of healthcare facilities. WHO reports

that effects may include increases in patients seeking care for respiratory illness that could be
 21

COVID-19, deferring and delaying non-COVID-19 care, disruptions in supply chains,

fluctuations in facilities’ occupancy, absenteeism among staff because of illness or caregiving

responsibilities, and increases in mental health concerns.

The COVID-19 epidemic is unique because of its scale, the speed of its spread, the lack

of pre-existing scientific data and the importance of media coverage (Shimizu, 2020). It

impelled the hospitals taking charge of the cases to face the many new challenges associated

with the outbreak (Heymann & Shindo, 2020). Dr. Rustico Jimenez president of the private

hospital association of the Philippines incorporated stated that private hospitals in the country

are reaching full capacity as COVID-19 cases continue to spike (Manila, 2020). “Almost all [of

the hospitals are full] because there was an increase in positive patients just like when this

started. But now the hospitals are more prepared. Now, there are [facilities] where mild cases

could be transferred that was provided by the government. Dr. Jimenez provided in a statement,

however Jimenez also admitted that it would be hard to convince patients to transfer to

government facilities.

HCWs are at the forefront of the epidemic response and they must be supported. The

hospital had to call in temporary nurses to deal with COVID-19, but the epidemic arrived in a

national context where public hospitals are at the centre of a protest movement due to, among

other difficulties, the difficulty in recruiting healthcare workers and bed shortages (Smadja et al.,

2020). HCWs who developed COVID-19 were managed in the hospital if needed, or as

outpatients, and were put on sick leave for at least 7 days and 2 days free of symptoms (Smadja

et al., 2020). While McCabe, et al., (2020) suggested that newly qualified and final year nursing

students could fill the lacking of HCW. However, this group may require close supervision from

more experienced clinical staff initially. Ongoing arrangements with private hospital providers
 22

will need to be considered. Field hospitals do not address the key constraint of critical care nurse

capacity but could provide overspill facilities for less severe COVID-19 patients that do not

require critical nursing care, or for those requiring palliative care (McCabe, et al., 2020).

Stressful Events such as COVID-19 pandemic play a central role in the interaction between

individuals and their environment. Consequently, their effect on physical and psychosocial

health is significant (Koinis, 2015).

Organizational changes affect the norms, values, attitudes and behavior patterns, which

are believed to be the core identity of an organization. Furthermore, organizational changes have

a key role that determines the working climate, strategy formulation, leadership style, and

organizational behavior of the firm (Laforet, 2016). Organizational culture can be thought of as

the attitudes, experiences, norms, beliefs and values of an organization (Summerill et al., 2010).

Organizational culture consists of shared meanings, beliefs, and values that ultimately shape

employees’ behaviors (Rashid et al., 2003 cited in Hsiao, Chang, & Tu, 2012 ). Ravasi and

Schultz (2006) cited in Hsiao, Chang, & Tu, (2012) propose that organizational culture is “a set

of shared mental assumptions that guide interpretation and action in organizations by defining

appropriate behavior for various situations”.

The Philippine like many Asian hospitals also faced restrains when it comes to physical

capacity. Dr. Carlos Gabriel emergency medicine physician and senior medical affair manager

stated that hospital's ward rooms and intensive care units are full. However, the facility will

continue to accommodate patients at their emergency room. "What we're seeing with this disease

is that people sit longer which means that the rooms are not freeing up that fast," Gabriel said

(Celdran, 2020) .Regardless there is evidence that local government units (LGU) hospitals
 23

disproportionately confront the lacking of shortage of water, medication, and mechanical

ventilators (Quintos, 2020).

Synthesis

Among the foreign literature, there are quite a number of studies on the COVID-19

pandemic. These studies included healthcare workers due to their nature of their work. They are

at the forefront in managing patients and combating the spread of the COVID-19 virus. The

HCWs mental health had been given attention especially by the WHO. The WHO acknowledges

that there will be psychological effects on these HCWs. Substantial data is being recorded with

regards to the social by-products of the pandemic.

However, here in the Philippines, there is a lack of research attention the mental health of

HCWs who are directly engaging the COVID-19 patients. The conditions of the HCWs in the

provinces are least likely to be given attention in research. There is no study on how experiences

towards the pandemic affect healthcare workers’ behavior. The nature of their work becomes a

target for stigma yet, there is no sufficient studies made with regard to their working conditions

or their physical health. Given the foregoing observations, this study will hopefully address the

need for information about the issues on mental health of HCWs in the Philippines, especially in

the province.

METHODS
 24

This section describes the components of the study which relate to research methodology

such as the research design, participants, research instrument, data gathering procedure,

statistical treatment and ethical considerations.

Research Design

This study has used a descriptive-qualitative approach to explore the stories of healthcare

workers who are involved in the treatment of COVID-19 patients. Specifically, the

phenomenological approach have been used, this study intends to discover the participants’ lived

experiences and stories about the circumstances they were in. This description will capture the

essence of their experiences as individuals who have all experienced a similar phenomenon. This

design has strong philosophical underpinnings and typically involves conducting interviews

(Giorgi, 2009; Moustakas, 1994 as cited in Creswell, 2014). Phenomenological research involves

the conduct of in-depth interviews with the participants of this study. This type of interview will

allow the participants to elaborate on their narratives, it can generate more insightful responses

especially on sensitive topics and the researcher can establish a rich understanding on the

attitudes, perception and motivations of the individual (Steber, 2017).

Participants of the Study

In choosing the participants for this study, non-probability purposive sampling had been

used. According to Creswell (2014) to purposefully select participants or sites (or documents or

visual material) means that qualitative researchers select individuals who will best help them

understand the research problem and the research questions. Using an inclusion criteria, the

following qualifications have serve as the basis for participant selection: 1.) The participant

belongs to the top three (3) healthcare profession which is most exposed to COVID-19-positive
 25

patients; 2.) The participant may either be male or female; 3.) The participant lives within the

province of Negros Occidental; 4.) The participant may belong to either the young adult or

middle adult stage of development; 5.) The participant may belong to either private or public

health facilities; 6.) The participants may either have a casual or permanent job status; and 7.)

The participants may belong to high risk or low risk area of assignment.

The actual participants of this study consisted of (7) seven young adults aging from (22)

twenty-two to thirty three (33) and two middle adults aging thirty eight (38) and forty-two (42).

They are four (4) males and five (5) females in terms of gender orientation. Adhering to

inclusion criteria, all of the HCWs engage with COVID-19 patients six (6) works in a high risk

area while three (3) HCWs worked in a low risk area. These HCWs were also employed, six (6)

of them worked permanently while two (2) of them were casual, moreover one (1) participant

was self employed. Purposeful sampling was utilized that involves identifying and selecting

individuals or groups of individuals that are especially knowledgeable about or experienced with

a phenomenon of interest (Cresswell & Plano Clark, 2011 as cited in Palinkas, et al., 2015). In

addition to knowledge and experience, Bernard (2002 as cited in Palinkas, et al., 2015) and

Spradley (1979 as cited in Palinkas, et al., 2015) note the importance of availability and

willingness to participate, and the ability to communicate experiences and opinions in an

articulate, expressive, and reflective manner.

Upon meeting or meeting through online applications for the interview, the consent form

was given to him/her. The participant read the consent form while the researcher explained the

content in detail. The researcher also entertains questions upon first meeting from the

participants regarding the study. Confidentiality, purpose and significance of the interview

process were explained. The participants were also asked if he/she permitted that interview to be
 26

audio-recorded. After the participant agreed to participate in the study, he/she was asked to sign

the consent form. While the participants who agreed to participate and used online application

for the interview, the consent form was read and was sent to the participants with the verbal

agreement from the participant to participate. During the face-to-face interview, safety protocols

for corona virus were implemented such as the use of personal protective equipment (face mask,

face shield) for both the researcher and participant. Social distancing was observed between the

researcher and participants. While, participants who used online application [i.e Facebook

Messenger and Zoom] was encourage to have a good signal and clear audio for the interview.

During the interview, probing questions were done to follow up, elaborate and explained

more of their experience in detail. Right after the interview, the participants thoughts and

feelings were asses. Shortly, after the interview

According to the Department of Health (DOH) health bulletin (April, 2020), the top three

health professions which are involved in the treatment of COVID-19 patients were: 1.) medical

doctors, 2.) nurses and 3.) medical technologist. The study has included three participants from

each of these professions, so that a total of nine (9) individuals have included in this study. The

other remaining criteria have also be considered in the selection of participants to achieve

maximum variation.

Instrument

An in-depth interview guide has been used to gather the data necessary to answer the

research problem. It was divided into two (2) parts. Part I includes the information of the

participants’ demographic profile, namely, age, sex, marital status, health profession, length of

practice, job status, area of assignment and type of health facility affiliated with. Part II consists
 27

of one basic statement asking the participants to describe their experiences in treating COVID-19

patients. This statement have been posed to the participant: Tell me about your experience as a

healthcare worker engaged in the treatment of a COVID-19 patient. Probing questions will be

asked depending on the responses of the participant. A cellphone was used as the voice recorder

during face-to-face and online interview.

These questions have allowed the participant to elaborate on their answers to in order to

obtain a rich textual description of the participants’ experiences. According to Creswell (2014),

text and image data are so dense and rich, which are important in developing a rich, thick

description of the participants’ experiences to convey the findings of the study. This description

may transport readers to the setting and give the discussion an element of shared experiences. To

ensure the validity of the interview guide, the instrument have been evaluated and validated by

three (3) experts in the field of Psychology.

Data Gathering Procedures

The data-gathering have started with the recruitment and identification of potential

participants. Mentors, Friends and colleagues of the researchers, were asked whether they know

of a healthcare workers (HCWs) who engaged with COVID-19 patients who’s health profession

included in the top three (3) health profession who engages with COVID-19 patients reported by

DOH regardless if they were employed in a public or private health facility, they must be

stationed in a high or low risk area in the hospital. Identified potential participants were asked by

those who referred them whether they were willing to participate in the study through face-to-

face or online interview. Most of them accepted to participate in the study and willing to set

aside a time for interview despite their busy schedule.

 28

After obtaining their agreement for an interview, their contact number and their social

account were obtained. Having their personal contact number or social account [e.i name in

Facebook], the researcher message them. The message began with proper self introductions and

the purpose of the interview. Screening questions that would ascertain whether the potential

participant qualified given the inclusion criteria of this study was posed. Having ascertained their

qualifications, an appointment for the face-to-face and online interview was made. Some

participants opt to used online application to the interview due to their nature of their work and

the busy schedule they have. While others choose face-to-face interview, while proper protocols

was in place [e.i. facemask, face shield and social distancing]. The interviews were scheduled at

a time that was convenient for them. The interviews that were conducted in face-to-face, two (2)

participant were interviewed in their health facility. While the remaining seven (7) participants

choose the most suitable social media platforms they could use, two (2) participants choose

Zoom as their way of conducting the interview and the remaining five (5) participants prefer

Facebook Messenger. The interviews of face-to-face conducted in the health facility room to

ensure privacy. Privacy was also maintained during the interviews in online social platform,

which the participants did not have any colleagues, family, supervisors or people near them

while conducting the interview. The participants also adapt to the place they choose to open their

application which have a great signal needed to have a clear connection.

While being interview, probing question were done to follow up, elaborate or explain

more of their experience in detail. The moment the interview ended, the participants thoughts

and sentiment towards the interview was checked. Furthermore, contact information was

exchange so that in an event that participants needed to ask something and in case the researcher

had to do follow-up interview, re-interview is possible.

 29

The average length of interview of the interview among the nine participant was

forty-five (45) minutes. Follow-up interview was made in four (4) participant, as the four

participants was still a matter of “probing their answers” to use for other interview, the data was

the basis for structure for questions needed for other HCWs, thus follow up interview was

needed.

These potential participants had been identified through the researchers’ social network

(i.e., family, friends, and colleagues). The potential participants had been identified, formal

letters of invitation have been sent to them. Screening questions have been ascertained to the

potential participant and some have been qualified to the inclusion criteria of this study. It was

established that the target participant have been qualified for the study, their willingness to

participate had been ascertained. They have agreed to be interviewed, and consent form had been

given to them. They had read and review the nature of the study to their voluntary agreement to

be part of the study as participants.

After obtaining their agreement for an interview, appointment date has been set for the

conduct of the actual interview. Some participants have the interview through virtual modes such

as: Facebook Messenger and Zoom applications that have been used in consideration of the “new

normal” due to the pandemic. While the face-to-face interview had been schedule at a time most

convenient for the participant. The location for the face-to-face interview have been set. Said

location had been in a place that was conducive for interviews, and were free of distractions as

well as allowing the privacy of the participants. During the interview, safety protocols for corona

virus have been implemented such as the use of personal protective equipment (face mask, face

shield) for both the researcher and participant. Rapport-building have been initiated by
 30

reiterating the importance of ensuring the privacy of participant and confidentiality of the

information gathered.

Audio recorders [i.e. cellphone] and the interview guide question have been used in order

to gather data from the participants and follow-up questions have also be asked in order to clarify

the answers of the participants during the whole course of the interview. As soon as the

comprehensive data have been obtained, the interview has been terminated. Possible follow-up

interviews have been conducted to the data gaps that were present. The data gathered from the

audio recordings have been subjected to transcription and analysis to being the data analysis of

the data gathered through the interview.

Data Analysis Procedure

The data gathered have been analyzed using Creswell‘s 6 (six) steps of data analysis in

qualitative research. Cresswell (2014) noted that data analysis in qualitative research will

proceed hand-in-hand with other parts of developing the qualitative study, namely, the data

collection and the write-up of findings. A classic hierarchical approach suggested by Cresswell

(2014) building the data from bottom to top, but he sees it as more interactive in practice; the

various stages are interrelated but not always in the order presented.

Cresswell (2014) explains that phenomenological research uses the analysis of significant

statements, from which meaning units are generated. The systematic and scientific analysis

would require listening to audio recordings of the interview and reading the transcriptions. The

examination and review of the transcripts will provide a general sense of information and to

reflect its overall meaning while also figuring out the prevalent ideas that the participants

mentioned and the impressions of the over-all depth, credibility and use of the information.
 31

After noting the common ideas of the data, significant statements have been culled. These

significant statements have been coded to chunks using a word representation. These word

representations or codes have been combined into categories, and labeled using phrases, often

based on the significant statements of the participant. Segmenting sentences (or paragraphs) or

images into categories, and labeling those categories with a term or code, often a term based in

the actual language of the participant, called an in vivo coding (Creswell, 2014).

Next, the coding process has been used to generate a description or themes for analysis.

The themes developed appeared as major findings and served as headings in the results and

discussion. The themes and sub-themes were presented using a detailed discussion. The themes

have been presented using the significant statements to convey the findings of the analysis, along

with making an interpretation of the findings or results. Lastly, a conceptual framework has been

drawn-up based on the emerging themes.

Validity is one of the strengths of qualitative research and is based on determining

whether the findings are accurate from the standpoint of the researcher, the participant, or the

readers of an account (Creswell & Miller, 2000 as cited in Creswell, 2014). Terms abound in the

qualitative literature that address validity, such as trustworthiness, authenticity, and credibility

(Creswell & Miller, 2000 as cited in Cresswell, 2014).

Dependability is ensured by rich description of the study methods. The methods section

of this study explains what procedures have been followed in order for dependable data have

been obtained. Establishing an audit trail have also been attempted. Inter-coder’s reliability have

been used for data analysis. A mental health professional have been requested to confirm the

thematic analysis made by the proponent.

 32

Confirmability has been achieved through reflexivity. Thoughout data collection, while

the interview was conducted, data transcription and analysis of data, being reflexive attitude,

constantly reviewing the research process and data had been imbibed. Triangulation have been

used by having several sources of participants, that was, obtained data from three types of health

professionals.

Transferability was extended to the degree to which the results have been generalized or

transferred to other contexts or settings (source). It was achieved through the use of purposeful

sampling. The top three health professions that have the most exposure to COVID-19 patients

have been used. Furthermore, participants have come from among young adults and middle-aged

individuals. Lastly, to maximize variation, participants have come from both private and public

health care facilities.

Ethical Consideration

In consideration of the school’s requirements, this proposal have been subjected to an

evaluation by the university’s Research Ethics Review Office (RERO). After obtaining the

approval of the RERO, data gathering started. As part of the data-gathering procedure, informed

consent have been obtained by informing target participants of the intent of the study, and

assuring them of confidentiality, privacy and anonymity. They have also been informed of the

nature of their participation in study as participants and have been assured that they have the

right to withdraw at any time or may opt not to continue with the in-depth interview. A

corresponding Informed Consent Form had been given to the target participants to review. Upon

obtaining their agreement, they have been asked to sign the consent form.
 33

To ensure the privacy and confidentiality of the data, interviews have been conducted in

venues that were free from distractions and are conducive. Furthermore, data have been stored in

secure personal files. Disposal of the data will be made not later than three years after the

completion of this study.

 34

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APPENDICES

APENDIX A

INFORMED CONSENT FOR HEALTHCARE WORKER

Name of Researcher: Joe Bryant Laguerder

School: University of St. La Sallle, Graduate School

PART I: INFORMATION SHEET

INTRODUCTION
I am Joe Bryant Laguerder, a student from University of St. La Salle. I am currently
doing my research on experiences of healthcare workers involved in the treatment of COVID-19-
positive patient and you are invited to participate in this research.
This is to inform you that:
 If you have questions, you may contact me at 0927-889-4152 or email me at
ifightforcause@yahoo.com

PURPOSE OF THE RESEARCH - Why are we doing this study?

The purpose of this study is to explore the experiences of healthcare workers involved in the
treatment of COVID-19-positive patients.

CHOICE OF PARTICIPANTS - Why am I being asked to be in the study?

You have been chosen as one of the participants because you represent the target population
for of healthcare workers involved in the treatment of COVID-19-positive patients.

PARTICIPATION IS VOLUNTARY- Do I have to do this?

You do not have to be in this study, if you do not want to be. If you decide that you do not want
to be in the study after we begin, it is alright.

PROCEDURES - If I am in the study what will happen to me?

If you decide that you want to be part of this study, you will tell me about your experience as a
healthcare worker engaged in the treatment of a COVID-19-positive patient. Your story might
take approximately 15-30 minutes to tell. Your narrative will be kept private, and confidential.
Only the researcher working on the study will see them.

RISKS - Will I be hurt if I am in the study?

You will be asked questions on sensitive and personal issues which are confidential in nature.
Thus, there is a risk of embarrassment, discomfort or fear. Rest assured, your answers to the
questionnaires will be kept confidential.
 43

BENEFITS
By agreeing to participate in this research study, you may feel good about helping us to make
things better for other healthcare worker. There is no promise that you will receive any direct
benefit from participating in this study.

CONFIDENTIALITY
Your identity will be kept private, and your records will be kept confidential and will not be
released without your consent except as you pose a threat to yourself and others, or required by
law. Only the researchers will have access to the files. If the results of this study are written in a
scientific journal or presented at a scientific meeting, your name will not be used. Your signed
consent form will be stored in a cabinet separate from the data.

WHO TO CONTACT
If you have any questions about the research, you may contact the researcher at 09278894152 or
ifightforcause@yahoo.com

BASIC INFORMATION

Interviewee Name (Optional):______________________ Date of interview: _____________

Mobile No): _______________

1. Sex: ____ (1) Male 2. Age: _______ (in years)

____ (2) Female

3. Marital status

______ (1) Single

______ (2) Married

4. Length of Experience:___________ (in years)

5. Type of Health Professional:

______ (1) Medical Doctor

______ (2) Nurse

______ (3)Medical Technologist

6. Employment status

______ (1) Regular Employee

 44

______ (2) Casual

7. Type of health Facility

______ (1) Public

______ (2) Private

8. Area of assignment

______ (1) High Risk

______ (2) Low risk

 45

CONSENT FORM

I am Joe Bryant Laguerder from University of St. La Salle, the researcher conducting a
study on Healthcare workers involved in the treatment of COVID-19-positive patient. I am
asking for your permission to take part in the research study because you have been identified to
have fit the profile of the study.

For this research, I will be asking questions pertaining to your involvement in the treatment of
COVID-19-positive patients. Rest assured that all answers and information gathered will be
strictly kept confidential. You will be given a choice whether to allow or not to write your name
on the written materials. If you wish to not write your name, a pseudo-name will be given in data
analysis and your name will not be associated with any information you provide. Information
contained in your records may not be given to anyone unaffiliated with the study in a form that
could identify you without your written consent.

Interviews will be audio recorded to assist with the accuracy of your responses. Both audio
recordings and paper copies of interview information will be kept secured and only the
researcher will have access to the materials. If you do not wish to be audio recorded, please
notify the researcher. Your willingness to take part may help people who may have undergone
the same experiences, as well as the society to better understand this research topic.

You should know that:

o Your participation in this study is VOLUNTARY; you do not have to be in the study if
you do not want to.

o If there is a question you don‘t want to answer, you may not answer it. o If you do not
want to continue to be in the study, you may stop at any time.

o You can ask any questions you have, now or later. If you think of a question later, you
can contact me at ifightforcause@yahoo.com/09278894152.
 46

Consent form

I have read this consent form and my questions have been answered. My signature below
means that I do want to be in the study. I know that I can remove myself from the study
at any time without any problems.

__________I give my permission for the interview to be audio recorded.

__________ I DO NOT give my permission for the interview to be audio recorded.

_________________________ _________________________
Signature over Printed name Date

Joe Bryant Laguerder

__________________________ __________________________
Researcher Signature
 47

APENDIX B
Interview Guide Questions:

Tell me about your experience as a healthcare worker engaged in the treatment of a

COVID-19-positive patient.