Review of Related Literature

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

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

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

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

and mental issues.

COVID-19

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

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

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

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

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

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

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

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

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

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

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

edema, severe pneumonia, and acute respiratory distress syndrome.

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

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

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

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

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

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

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

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

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

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

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

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

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

The National Health Commission of China published a national guideline of

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

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

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

initiated in China (Kang, 2020).

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

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

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

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

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

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

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

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

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

2020).

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

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

lead to possibile death (Kim, 2018). Nurses were required to conserve protective

clothing by reducing the number of times they wear it since protective equipment was in

short supply, resulting in fatigue and discomfort. Nurses’ have been reported to

experience stress associated with separation from family, sleep deprivation and heavy

workloads created by health system demand and staff shortages (Huang, Rong & Liu,

2020). The lack of resources such as protective gears and equipments during in the

pandemic contributed to fear working in the healthcare settings due to increase chances

of being infected during the pandemic. Despite being passionate with the profession the

unfamiliar environment created a sense of loneliness and frustration among nurses. In

psychological exhaustion (Kim & Kant, 2018).

Experiences of Nurse in the time of Covid 19

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

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

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

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

possibility of getting infected to the novel coronavirus. Also, being physically and

psychologically unstable would affect the works as a nurse (Wei, 2019). Nurses who

had no experience of infectious disease had more challenges when they had to adjust

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

Nursing Exhaustion realates to the distress expierenced by employees related to

job expectations and working conditions (Melvin, 2015). Pressures can lead to mental

health problems such as stress, anxiety, depression, insomnia, denial, anger, and fear,

which not only affect health-care providers' attention, understanding, and decision-

making ability, but could also have a lasting effect on their physical and psychological

wellbeing after the pandemic (Xiong & Peng, 2020). Nurses working in COVID-19 wards

and treatment centres suffer mental and emotional distress and perform inadequately in

their jobs, such that Patient and service management at COVID-19 Centres are now at

the forefront of treatment and facilities management. These core principles have to

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

delivering real patient care with high-quality treatment (Xie, 2020) with workloads due to
staff shortage outbreaks like this are recognized contagious diseases, such as COVID-

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

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

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

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

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

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

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

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

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

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

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

incentives. International support for personnel and protective equipment, particularly

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

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

is one nurse for four patients. "But for toxic (critical) patients, it's one of two," said Elaine

Caday, head of hospital nursing. Nurses at the Philippine General Hospital (PGH) work

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

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

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

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

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

for a total of 40 hours a week. "Two days with twelve hours of duty, two days with eight
hours of duty, then three days off per week," Caday said. "We haven't changed the

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

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

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

vulnerable to covid 19” 2020).

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

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

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

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

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

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

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

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

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

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

harassment against fellow medical professionals. They were prohibited from riding

public transportation; some were evicted to their dormitories and worst they were

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

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

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

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

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

and considered vulnerable to contracting the disease due to the nature of their job
which entails direct exposure to covid-19 (“Covid-19, one month later (Second of three

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

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

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

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

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

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

consideration settings present human services and nursing experts with enormous

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

for Health and Care Excellence, 2017).