Final Group A BSN 3A 2

BSN
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.

SAN ROQUE EXTENSION, ROXAS CITY, CAPIZ 5800 2021
Psychological Well-being and Turnover Intentions among Registered
Nurses in Roxas City, Capiz during the COVID-19 Pandemic
Amantillo, Nielsen P.
Belleza, Frietz
Belvis, Belle Brian
Tablo, Jan Mileno
Andrada, Janna
Elauria, Ranelyn
Estolas, Angela
March 2022
1
BSN
CHAPTER I
Background of the Study
In early 2020, China saw an outbreak of a novel, sometimes fatal, severe
respiratory sickness. The virus was initially detected in Hubei Province in December
2019, when a cluster of viral pneumonia cases was reported. The cause of the pneumonia
has been identified as a new coronavirus. The virus, then known as 2019-nCoV (now
known as SARS-CoV-2), caused a pandemic in China. With tens of thousands of
coronavirus cases confirmed across China, Chinese health officials took the unusual step
of putting roughly 60 million people under quarantine. (World Health Organization,
Europe, 2022). Despite huge quarantines, the virus moved beyond China's borders and
into neighboring countries. Epidemiologists worried that the outbreak might turn into a
worldwide health threat, requiring a larger international response than Ebola, Zika, and
H1N1 combined (CDC, 2020, June 30). On March 11, 2020 the World Health
Organization (WHO) declared a global pandemic. This overburdens many countries'
healthcare systems, which, in turn, impacts healthcare personnel like nurses who are
fighting on the front lines to save the lives of those who are afflicted. International
hospitals and healthcare facilities are facing catastrophic financial and economic
challenges related to the COVID-19 pandemic. (WHO, 2020).
Studies have shown that healthcare workers managing COVID-19 have been
experiencing worse psychological issues such as stress than the public because they are
more likely to get infected and transmit the infection to their relatives and friends. One of
the major consequences of stress among healthcare workers is that it may result in
2
BSN
increased turnover. High turnover of healthcare workers might lead to disastrous
consequences of the international efforts to contain the COVID-19 pandemic. (Salazar de
Pablo, 2020).
Despite being in the early stages of a worldwide pandemic, the new coronavirus
2019 (COVID-19) has caused more deaths than the severe acute respiratory syndrome
(SARS) coronavirus. On January 22, 2020, the first suspected case in the Philippines was
investigated, and as of March 1, there had been 633 suspected cases reported. Since then,
cases have been rising higher each day. To date, the Philippines reported as of 11
February 2022, there have been 3,627,575 confirmed cases of COVID-19 with 54,783
deaths (WHO Health Emergency Dashboard, 2022). Containing virus transmission,
minimizing the impact in high-risk groups and confined settings, and ensuring the
uniform execution of non- pharmaceutical measures that are currently in place are some
of the issues that the Philippines continues to face.
COVID caseloads in the Philippines are at an all-time high, owing to the highly
transmissible Delta form. Overworked nurses have staged protests and threatened mass
resignations if government benefits are not paid as hospitals fill up. The Philippines'
government put aside specific risk allowances for health-care personnel at the onset of
the pandemic last year, including hazard pay and money for lodging and transportation
(The Manila Times, 2021). Moreover, hospitals in the country have been reported to be
understaffed of nurses. In recent months, there have been numerous reports of mass
resignations of healthcare employees. Healthcare professionals, particularly nurses, have
been pushed out of hospitals because to low pay and tiredness from a long-running
3
BSN
pandemic. Health workers have also expressed their dissatisfaction with the government's
refusal to distribute financial aid meant for healthcare personnel during the pandemic.
(Philippine Daily Inquirer, 2021). According to the Private Hospitals Association of the
Philippines, about 40 percent of private hospital nurses have resigned since the start of
the pandemic. Private Hospitals Association of the Philippines president Jose Rene de
Grano estimated that about 5 to 10 percent of nurses have resigned in recent weeks to
leave for other countries, and expressed concern that their continued departure could
eventually paralyze the ability of medical centers to care for patients. Nurses are facing
critical shortages of nursing staff, beds, and medical supplies. Thus, addressing these
needs and providing supplies is essential. More research is needed to explore the
experiences of nurses who are on the frontlines for better development, preparedness, and
response measures for future pandemics.
Due to the importance of the issues mentioned above and the lack of general
statistics on the problem, the researchers believe that there is a need to further see the
consequences of COVID-19 to health workers in the Philippines especially in rural
regions. This study aims to systematically determine mental health status of front-line
healthcare workers caring for COVID-19 patients. Thus, the researchers will conduct this
study to further investigate the relationship of mental or psychological well-being and
turnover intentions among registered nurses in Roxas City, Capiz during the global
outbreak of COVID-19.
4
BSN
Statement of the Problem
This study intends to identify the psychological well-being and turnover intentions
of registered nurses in selected hospitals in Roxas City, Capiz during the COVID-19
pandemic. Specifically, it seeks to answer the following:
1. What was the demographic profile of the participating registered nurses in the
study in terms of:
a. Age
b. Sex
c. Area of exposure
d. Nurse-Patient ratio
e. Years of professional service in the hospital
f. Current work shift
g. Monthly wage
2. What was the level of psychological well-being of registered nurses during the
COVID-19 pandemic when taken as a whole and when grouped according to
age, sex, area of exposure, nurse- patient ratio, years of professional service in
the hospital, current work shift, and monthly wage?
3. What was the level of turnover intentions of registered nurses during the
COVID-19 pandemic when taken as a whole and when grouped according to
age, sex, area of exposure, nurse-patient ratio, years of professional service in
the hospital, current work shift, and monthly wage?
5
BSN
4. Was there a significant difference in the psychological well-being of registered
nurses during the COVID-19 pandemic when grouped according to age, sex,
area of exposure, nurse-patient ratio, years of professional service in the hospital,
current work shift, and monthly wage?
5. Was there a significant difference in the turnover intentions of registered nurses
during the COVID-19 pandemic when grouped according to age, sex, area of
exposure, nurse-patient ratio, years of professional service in the hospital,
current work shift, and monthly wage?
6. Was there a linear relationship between the psychological well-being and
turnover intentions among registered nurses during the COVID-19 pandemic?
Statement of Hypotheses
In relation to the study’s statement of the problem, the researchers have formulated
the following hypotheses:
1. There was no significant difference in the psychological well-being of registered
nurses during the COVID-19 pandemic when grouped according to age, sex,
current work shift, and monthly wage.
2. There was no significant difference in the turnover intentions of registered
nurses during the COVID- 19 pandemic when grouped according to age, sex,
current work shift, and monthly wage.
6
BSN
3. There was no linear relationship between the psychological well-being and
turnover intentions among registered nurses during the COVID-19 pandemic.
7
BSN
Theoretical Framework
To explore antecedents and outcomes of nurse self‐reported job
satisfaction and dissatisfaction‐based turnover cognitions, this study was anchored
towards Self‐Determination Theory where leaders can foster work conditions that helped
fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing
adverse events. (Deci, E. L., & Ryan, R. M., 2012)
It is also applied in this study the turnover theory to conceptualize dissatisfaction‐
motivated desires and plans regarding the employee's departure from the organization.
This study was mainly grounded with Self‐Determination Theory (SDT), which posits
that the work environment satisfies three innate psychological needs (competence,
autonomy, and relatedness), energizing and motivating individuals to perform while
increasing positive affect (Deci and Ryan 2000, 2008; Houston et al. 2012; McHugh et al.
2013). Finally, it also contributes to research on health care organizational performance
by exploring linkages between nurse attitudes and both patient and clinical outcomes.
Although the job satisfaction–performance link was clear for individuals. this
study was informed by an adapted version of the nursing work life model (Leiter, M.P.,
2006). The Nursing Worklife Model explains how work-environment characteristics that
affect nursing practice affect nurses’ lives in the workplace by contributing to or
mitigating burnout.This model has been widely used to study relationships between five
key domains in nurses’ work environments (i.e., staffing and resources, collegial
workplace relations, leadership support, policy impact, and a nursing foundation of care)
8
BSN
and patient and nurse outcomes. For this study, the researchers used three of the original
domains (i.e., staffing and resource adequacy, workplace relations, and
leadership/organizational support).
Figure 1. Self-determination theory: A Framework for Enhancing Patient Centered Care
adapted from Ryan and Deci's theory. Self-determination theory hypothesizes three main
basic needs: Autonomy, Competence, and Relatedness.
9
BSN
Figure 1. Nursing Worklife Model: A Framework Adapted from Leiter & Laschinger
(2006
10
BSN
Conceptual Framework
This study was focus on the following demographic characteristics and
professional profile as independent variables: age, sex, area of exposure, nurse-Patient
ratio, years of professional service in the hospital, current work shift, and monthly wage.
Meanwhile, the psychological well-being of the participants as well as their turnover
intentions during the COVID-19 pandemic will serve as dependent variables. This study
had also attempt to identify the correlation between the two dependent variables.
Independent Variables Dependent Variables
Demographic characteristics and
professional profile such as:

Psychological well-being
- Age of nurses during COVID-
19 Pandemic
- Sex
- Area of exposure
- Nurse-Patient ratio
- Years of professional
service in the hospital

Turnover Intentions of
- Current work shift Nurses during COVID-19
Pandemic
- Monthly wage
Figure 3. Conceptual Framework of the study entitled “Psychological Well-being and

Turnover Intentions among Registered Nurses in Roxas City, Capiz during the COVID-
19 Pandemic”
11
BSN
Significance of the Study
This study would benefit the following people as it will give them a clearer view
on the psychological well-being and turnover intentions of registered nurses in our
locality amidst the COVID-19 pandemic:
The hospital supervisors and administrators. To aid them establish an adequate
workforce with excellent performance in their respective corporations and to manage and
provide better work environment to the health workers resulting in improved work
performance.
The health legislators. To legislate laws that may answer problems affecting job
satisfaction and work commitment among nurses as maybe manifested by the
proliferation of mental and physical health problems of nurses resulting in poor work
performance.
The management of the Department of Health. To formulate plans, programs
and strategies geared towards the improvement of its human resource programs to
registered nurses.
The nurses and other healthcare workers. To look at this study as a reflection
of themselves so that they become aware or conscious of the profession they are in and
therefore more equipped and empowered.
The future researchers. To broaden their knowledge on human behavior in
organization, thus helping them become more effective supervisor and manager in the
future.
12
BSN
Scope and Delimitations
This study aimed to investigate the correlation between the psychological well-
being and turnover intentions among the registered nurses working during the COVID-19
Pandemic. This study would be conducted by the researchers from St. Anthony College
of Roxas City within private and public hospitals in Roxas City, Capiz. It should be noted
that the study conducted is taking place during the COVID-19 pandemic, and as such
hospitals are at full capacity and nurses are working overtime, the researchers are unable
to conduct and collect actual data on site. Thus, data gathering will instead be collected
via online survey. The psychological well-being of nurses will be measured using the
adapted Expanded Nursing Stress Scale (ENSS) and the turnover intentions will be
measured using the adapted McCloskey/Mueller Satisfaction Scale (MMSS). All
quantitative data will be analyzed using SPSS software.
Definition of Terms
For the purpose of this study, the following terms were defined conceptually and
operationally as follows:
● COVID-19 - Conceptually, it was an infectious disease caused by the SARS-
CoV-2 virus.
Operationally, nurses exposed to this particular infectious viral disease was the
target population of this study.
● Frontline Nurses - Conceptually, they were responsible for providing holistic
care for all types of patients be it routine or a disaster.
13
BSN
Operationally, they were referred to as registered nurses being in the frontline
during the COVID-19 Pandemic. The psychosocial well-being and turnover
intentions are evaluated from this sample of population.
● Pandemic - Conceptually, an outbreak of a disease that occurs over a wide
geographic area (such as multiple countries or continents) and typically affects a
significant proportion of the population.
Operationally, this was refer to the declared Novel Coronavirus Disease
(COVID-19) outbreak as a pandemic and reiterated the call for countries to take
immediate actions and scale up response to treat, detect and reduce transmission
to save people's lives. The implementation of the study was done during this
period of global health crisis.
● Psychological Well Being - Conceptually, it consists of positive relationships
with others, personal mastery, autonomy, a feeling of purpose and meaning in
life, and personal growth and development. Psychological well-being is attained
by achieving a state of balance affected by both challenging and rewarding life
events.
Operationally, it is the overall mental state and satisfaction of nurses relating to
their performance, workload, and critical problems they face. Its correlation with
turnover intentions is being evaluated in this study.
● Turnover Intentions - Conceptually, it is defined as a process of an employee
to leave the current job or his willingness to separate from the organization.
14
BSN
Operationally, it was the rate of frontline nurses intending to leave their jobs in
the span of the pandemic due to various factors. Its correlation with
psychological well-being was being evaluated in this study.
15
BSN
CHAPTER II
REVIEW OF RELATED LITERATURE AND STUDIES
This chapter provided an overview of the impact of the pandemic on the nursing
workforce has been unprecedented and would be felt for a long time to come. The crisis
has also laid bare and exacerbated longstanding problems faced by nurses and midwives,
including inequalities, inadequate working conditions and chronic excessive work
pressures. The health and wellbeing of nurses was essential to the quality of care they can
provide for people and communities, affecting their compassion, professionalism and
effectiveness.
Impact of COVID-19 towards the Healthcare System and its Health Workers
With the ongoing COVID-19 outbreak, healthcare systems across the world have
been pushed to the brink. The approach of traditional healthcare systems to disaster
preparedness and prevention has demonstrated intrinsic problems, such as failure to
detect early the spread of the virus, public hospitals being overwhelmed, a dire shortage
of personal protective equipment, and exhaustion of healthcare workers (Sun, et. al.
2021). Every health system had to face the burden of COVID-19 and had to take
responsibility for its prevention and treatment. As the pandemic nears its third year, the
health and well-being of HCWs remain a growing concern for multiple stakeholders, as
does, more worryingly, the unmeasured level of excess deaths in HCWs attributable to
COVID-19 (World Health Organization, Working Paper 1 on the Impact of COVID-19
on health and care workers, 2021). According to the Weekly Epidemiological Update of
COVID-19 by the World Health Organization, during the week of 14 to 20 February
16
BSN
2022, the number of new COVID-19 cases and deaths decreased by 21% and 8%
respectively, compared to the previous week. Across the six WHO regions, over 12
million new cases and over 67 000 new deaths were reported. As of 20 February 2022,
over 422 million confirmed cases and over 5.8 million deaths have been reported
globally.
An observational cohort study was done in the United States of America and
United Kingdom by Nguyen, et. al 2020 entitled “Risk of COVID-19 among front-line
health-care workers and the general community: a prospective cohort study,” in which it
assessed the risk of COVID-19 among front-line health-care workers compared with the
general community and the effect of personal protective equipment (PPE) on risk. Results
showed the risk of reporting a positive test for COVID-19 was increased among front-line
health-care workers. Health-care systems should ensure adequate availability of PPE and
develop additional strategies to protect health-care workers from COVID-19, particularly
those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these
observational findings is needed.
Lui, et al. (2020) conducted a study on the experiences of health-care providers
during the COVID-19 crisis in China. Three theme categories emerged from data
analysis. The first was "being fully responsible for patients' wellbeing-'this is my duty'".
Health-care providers volunteered and tried their best to provide care for patients. Nurses
had a crucial role in providing intensive care and assisting with activities of daily living.
The second category was "challenges of working on COVID-19 wards". Health-care
providers were challenged by working in a totally new context, exhaustion due to heavy
17
BSN
workloads and protective gear, the fear of becoming infected and infecting others, feeling
powerless to handle patients' conditions, and managing relationships in this stressful
situation. The third category was "resilience amid challenges". Health-care providers
identified many sources of social support and used self-management strategies to cope
with the situation. They also achieved transcendence from this unique experience. The
intensive work drained health-care providers physically and emotionally. Health-care
providers showed their resilience and the spirit of professional dedication to overcome
difficulties. Comprehensive support should be provided to safeguard the wellbeing of
health-care providers. Regular and intensive training for all health-care providers is
necessary to promote preparedness and efficacy in crisis management.
Another study conducted by LoGuidice, et al. (2021), aimed to understand nurses’
lived experiences during the COVID-19 outbreak in the US and to examine their
resiliency. A total of 43 nurses participated in the study. The final result of their
qualitative analysis was the essence of the experience of being a nurse during the
COVID-19 pandemic. These nurses often felt helpless, as so few data and so little
research were available to know what treatment plans to implement. They also expressed
frustration with the constantly changing PPE guidelines and the need to reuse PPE
throughout the day or even the week. These nurses discussed countless ways they were
coping with their emotions through self-care measures, which encompassed quiet prayer
and mediation, exercise, crafts, virtual meetings with friends, time spent with loved ones,
and a decision to further one’s nursing education.
A briefing note published by the United Nations Human Rights (February 2021)
18
BSN
also examines the impact of the pandemic and the Government’s response to it on the
rights of healthcare workers in Ukraine The briefing note contains recommendations to
the Government and local authorities to this end. Healthcare workers in Ukraine are
underpaid, receiving salaries, which are below the national average. In many cases,
healthcare workers, especially at middle and junior levels, receive a minimum wage that
does not provide for a decent living for them and their families.
Nurses were at the forefront of promoting health, advocating for patients, and
advancing the science of care. The World Health Organization designated the year 2020
as the Year of the Nurse and the Midwife.1 Organizations within the World Health
Assembly, such as the International Confederation of Midwives, International Council of
Nurses, Nursing Now, and the United Nations Population Fund, planned to celebrate
nurses worldwide, to address challenges nurses face, and to highlight nurses’ vast
contributions throughout 2020.
In the Philippines, the country has recorded 3,661,997 cases and death toll at 56,
451 as of February 28, 2022. Based on these numbers, 53, 934 are active cases (COVID-
19 Dashboard, February 2022). According to Reuters COVID-19 Tracker (2022), average
number of new infections reported each day in Philippines falls by more than 6,800, 20%
of its previous peak. Philippines has administered at least 141,959,452 doses of COVID
vaccines so far. Assuming every person needs 2 doses, that’s enough to have vaccinated
about 65.7% of the country’s population.
The pandemic has heavily hit the country in multiple ways. As an archipelagic
country made up of more than 7000 islands, the Philippines is among the most vulnerable
19
BSN
countries in the world to natural disasters. Case isolation, contact tracing, and physical
distancing are recognized as the backbone of effective COVID-19 control. A prerequisite
of successful implementation of these strategies is to have a robust public health system
and sufficient workforce, which was inadequate and insufficient in the country even
before the pandemic (The Lancet, Regional Health. 2021). The limited investment in
health-care infrastructure and a shortage of health-care workers curtail the system, while
inequalities in health-care delivery further jeopardize access to services. According to
The Philippines Health System Review published by WHO in 2018, there were 23 beds
per 10 000 individuals in the National Capital Region, and this number is less than ten
per 10 000 individuals for the rest of the country. Public and privately owned health
systems are supposed to be complementary in health-care service delivery, but no
effective measure exists to regulate the expanding private sector, leading to a high
amount of out-of-pocket expenses for health care; for example, more than half of total
health spending was out-of-pocket in 2018. The COVID-19 pandemic puts further
pressure on the fragmented public health system. Along with this fragmentation, the
insufficient response from the government has resulted in a delay in contact tracing and
mass testing, an overwhelmed medical system, and slow vaccine roll-out (The Lancet,
Regional Health. COVID-19: an ongoing public health crisis in the Philippines. April,
2021).
In a 2018 review of the Philippine health care system, Manuel M. Dayrit and his
co-authors report that the country has 101,688 hospital beds, distributed in 1,223
hospitals across the country. Even if just 1 percent of the Philippines’ 107 million
20
BSN
population (as of 2018, according to the World Bank) get infected with COVID-19 (i.e.
one million patients), assuming a 10 percent hospitalization rate, it is easy to see how the
hospitals will be quite easily overwhelmed. As of August 17, 2020, nurses are
overwhelmed, fatigued and diminished with infections and deaths among their ranks, the
medical frontliners have called for a “timeout” to draw up a better plan to deal with the
coronavirus crisis (Inquirer, 2020). As of 3 August 2020, data from the Department of
Health show that about 5% of the total COVID-19 cases in the country are health
workers, 38 of whom have died due to the virus (Tomacruz, 2020). To grumble up the
healthcare workforce, the government is seeking to immediately hire 10,000 additional
health workers, calling on universities and medical groups to help in hiring more doctors,
nurses and other medical staff, including those returning medical professionals who have
lost their jobs overseas. (UPPI, 2020).
The University of the Philippines Population Institute (UPPI) conducted a
research entitled Human Resource for Health in the Time of the COVID-19 Pandemic:
Does the Philippines Have Enough (2020). The research aimed to bring to fore, the
implications of the increasing number of COVID-19 positive cases on the need to have
more health care workers and of the importance of protecting those in the line of duty.
The HRH shortage was made more acute in the context of the COVID-19 pandemic. The
rapid pace of the infection in the country has prompted the government to declare a
national state of emergency, mandating the temporary suspension of the deployment of
all health care workers, including among others, nurses and medical doctors/physicians.
This temporary halt will hold until the national state of emergency is lifted and until
21
BSN
COVID-19-related travel restrictions are lifted at the destination countries. The directive
will ensure the sustained supply of sufficient health personnel to meet any further
contingencies, especially to replace, substitute or reinforce existing workforce that are
currently facing stress.
At this time the manuscript was prepared, most studies of COVID-19 were from
international researchers, with this, the related literature about the COVID-19 situation in
the Philippines will be sourced from local news and articles published.
The Philippines was one of the world’s biggest suppliers of nurses deployed to
work overseas. In 2019, before the pandemic, about 17,000 nurses from the Philippines
left the country to work abroad. In total, over 193,000 nurses educated in the Philippines
work abroad, representing 85 percent of all nurses trained in the country. Department of
Health Assistant Secretary Kenneth Ronquillo (2021) aslo released a statement that
Philippines was short of 92,000 physicians and 44,000 nurses because of the COVID-19
pandemic. (Inquirer.net, 2021).
According to an ASEAN briefing paper (2021), “global demand for medical
workers from the Philippines pre-exists the pandemic but has become more urgent since
the virus struck.” One reason that so many medical workers from the Philippines work
abroad is that, despite their high levels of skills and training, work conditions at home are
poor. According to the Nursing Act of 2002, nurses’ minimum base pay should come in
at “grade 15”, meaning about PHP 33,575 (US$662) per month. In practice, however,
junior nurses at public hospitals earn a salary at “grade 11” – PHP 21,000 (US$414) per
month – due to underfunding. (Koty, 2021. ASEAN Briefing). In addition to being
22
BSN
underpaid, many medical workers were overworked. In the Philippines, there is
approximately one nurse for every 5,000 residents, but this can be as low as one for every
20,000 in rural areas. Further, a national study published in 2018 found that as many as
75 percent of local government units lack health workers. Due to this shortage, medical
workers were often overworked and face high levels of stress, and were at risk of making
more medical mistakes. With low pay and hazardous working conditions, the Private
Hospitals Association of the Philippines estimates that about 40 percent of private
hospital nurses quit in 2020. These trends stand to worsen ASEAN’s shortfall of doctors
and nurses, which already stood at 700,000 before the pandemic. (ASEAN Briefing,
Koty, 2021).
During the pandemic, the pay was unjustly distributed among public and private
health facilities. According to Senator Pia Cayetano, despite the Administrative Order
being implemented, more than 16,000 employees have yet to receive their hazard pay due
to the lack of funds. Although the DOH had already released P842 million for 86,348
employees, it still needed an additional P108.2 million for the remaining 16,764 workers.
(Rappler.com, 2021).
With low pay and hazardous working conditions, the Private Hospitals
Association of the Philippines estimates that about 40 percent of private hospital nurses
quit in 2020. These trends stand to worsen ASEAN’s shortfall of doctors and nurses,
which already stood at 700,000 before the pandemic.
According to Aljazeera (2020), at one of the largest COVID-19 referral hospitals
in Metropolitan Manila, doctors and nurses are steeling themselves as they face an
23
BSN
overwhelming number of critical patients every day. Medical staff have been
overwhelmed during the pandemic and 103 of them have been among some 33,400
coronavirus fatalities in the Philippines. The coronavirus is stretching an already
burdened and crumbling healthcare system and has exposed the under-staffing and dire
working conditions in the health sector, particularly for nurses.
Due to the structural deficiencies of the Philippine healthcare system, there will
likely be a strong impetus for medical workers to seek overseas work once the
government lifts emergency restrictions. Healthcare institutions sourcing medical
workers from the Philippines therefore may consider these disruptions temporary rather
than permanent.
Psychological Well-being of Nurses during the COVID-19 Pandemic
In the context of these rapid changes and the promotion of practices that were
once unheard of, nurses face the potential for not only physical but also psychological
distress. More specifically, moral distress occurs when nurses cannot provide
compassionate care to patients, and it contributes to nursing burnout and compassion
fatigue. In addition to the reuse of PPE, other factors such as the influx of high-acuity
patients, the lack of the presence of family members, and high patient censuses have
contributed to increased moral distress among nurses.
A qualitative study on the experience of caregivers of COVID-19 patients was
conducted by Sun, et.al (2020). In this study, the psychological experience of nurses
caring for COVID-19 patients can be summarized into 4 themes. First, negative emotions
24
BSN
present in early stage consisting of fatigue, discomfort, and helplessness was caused by
high-intensity work, fear and anxiety, and concern for patients and family members.
Second, self-coping styles included psychological and life adjustment, altruistic acts,
team support, and rational cognition. Third, the researchers found growth under pressure,
which included increased affection and gratefulness, development of professional
responsibility, and self-reflection. Finally, the study showed that positive emotions
occurred simultaneously with negative emotions.
A meta-review on “COVID-19 Pandemic and Overall Mental Health of
Healthcare Professionals Globally” was conducted by Chutiyami, et al. (2022) aimed to
provide a comprehensive overview of overall mental health of healthcare professionals
during the COVID-19 pandemic. It was concluded that healthcare professionals (nurses,
doctors, allied health) have experienced various mental health issues during COVID-19
pandemic. The meta-review, therefore, recommends targeted interventions and health
policies that address specific mental health issues to support health professionals
worldwide during the duration of the COVID-19 pandemic and similar future health
crises.
A systematic review on “The mental health of healthcare workers in the COVID-
19 pandemic” conducted by Vizheh, et al. 2020 aimed to review all research carried out
on the mental health status of health care workers (HCWs) to bring policymakers and
managers' attention. Results showed that during SARS-CoV-2 outbreak, the health care
workers face aggravated psychological pressure and even mental illness. It would be
recommended to the policymakers and managers to adopt the supportive, encouragement
25
BSN
& motivational, protective, and training & educational interventions, especially through
information and communication platform.
A systematic review and meta-regression on the prevalence of stress, anxiety and
depression within front-line healthcare workers caring for COVID-19 patients was also
conducted by Salari, et al. (2020). In this research work, the systematic review, meta-analysis
and meta-regression approaches are used to approximate the prevalence of stress, anxiety and
depression within front-line healthcare workers caring for COVID-19 patients. The results of
this study clearly demonstrate that the prevalence of stress, anxiety and depression within
front-line healthcare workers caring for COVID-19 patients is high. Therefore, the health
policy-makers should take measures to control and prevent mental disorders in the
Hospital staff.
A descriptive Phenomenological study entitled “The Lived Experience of Filipino
Nurses’ Work in COVID-19 Quarantine Facilities” was also conducted by Jonaid M.
Sadang, RN, RM, LPT, MAN (2021). This descriptive phenomenological inquiry
explored the meaning of Filipino nurses’ work on the frontlines of community quarantine
facilities amidst this pandemic health crisis. Using purposive and snowball sampling, and
in-depth interviewing a total of 12 nurses were participants in this study that sought to
deeply understand and explain their lived experience while working in their respective
facilities. Three major themes emerged from the data analysis of the transcribed verbatim
responses using Colaizzi’s approach: Work as self-sacrifice with 3 sub-themes, Work as
self-fulfilment with 2 sub-themes, and Work as a psychological struggle with 2 sub-
themes. The nurses demonstrated outstanding professional efforts and sacrifices in
26
BSN
battling this crisis to overcome difficulties amidst insufficient or unavailable needed
resources. Hence, comprehensive support must be provided to safeguard their well-being
so they can continue their noble service in combating and eliminating this illness in our
respective communities.
Another study entitled “Risk perception, mental health impacts and coping
strategies during COVID-19 pandemic among Filipino healthcare workers” was also
conducted by Marzo et al. (2021). This study reiterates the fact and demonstrates that
COVID-19 has disrupted the mental well-being of HCWs in the Philippines. Majority of
HCW was psychologically affected by COVID-19. Therefore, there is a dire need to
address mental illness amongst HCWs and frame guidelines based on proven algorithms
to overcome these mental illnesses.
Thus, the pandemic has affected the mental health of a significant proportion of
health professionals which may reduce their resilience in the face of future waves of
COVID-19. The institutional approaches to support the psychological needs of health
professionals are essential to ensure optimal care considering these results.
Turnover Intentions of Nurses during the COVID-19 Pandemic
Cortez & Gómez (2017) stated that the nurses’ satisfaction with their work, lives,
work performance and well-being before and during the COVID-19 pandemic was
investigated. It may be that satisfaction with work changes for the worse due to stressful
working conditions and new procedures for hygiene and COVID-19 testing. There is
already evidence of impaired work satisfaction due to the COVID-19 pandemic. We also
postulate that satisfaction with life deteriorates because work satisfaction and life
27
BSN
satisfaction are closely linked. The first results during the COVID-19 pandemic show a
decline in life satisfaction. Similar effects are predicted for satisfaction with work
performance. Caring for patients with COVID-19 may also have an influence on nurses’
satisfaction with their level of well-being. Due to the risk posed by coming into contact
with COVID-19 patients, nurses could be less satisfied with their well-being than they
were before the COVID-19 pandemic.
Another study in China on the Factors Associated with Turnover Intention
Among Healthcare Workers During the Coronavirus Disease 2019 (COVID-19) was also
conducted by Huo H, et al. (2021). This study assessed the prevalence of turnover
intention and explored associated factors on turnover intention among healthcare workers
during the COVID-19 pandemic in China. Turnover intention is relatively prevalent
among healthcare workers during the COVID-19 pandemic in China, and the factors
contributing to turnover intention were complex and varied. Early screening of high-risk
groups for turnover intention among healthcare workers and more psychosocial health
care and physical protection are needed during the COVID-19 pandemic in China.
A study on the Impact of coronavirus syndromes on physical and mental health of
health care workers: Systematic review and meta-analysis conducted by Salazar de Pablo
(2020) have shown that healthcare workers managing COVID-19 have been experiencing
worse psychological issues such as stress than the public because they are more likely to
get infected and transmit the infection to their relatives and friends. One of the major
consequences of stress among healthcare workers is that it may result in increased
turnover. High turnover of healthcare workers might lead to disastrous consequences of
28
BSN
the international efforts to contain the COVID-19 pandemic.
A few studies conducted during the COVID-19 pandemic have indicated high
turnover intention among healthcare workers, yet none of them studied the possible role
of stress in enhancing turnover intention. One study conducted on 261 nurses in the
Philippines revealed that the fear of COVID-19 was associated with job dissatisfaction
and increased turnover intention (Labrague L, et al. Fear of COVID-19, psychological
distress, work satisfaction and turnover intention among frontline nurses, 2020). In
Egypt, a study conducted on 210 frontline nurses working at a fever hospital during the
COVID-19 pandemic showed that most nurses had turnover intention due to stress,
stigma, and job dissatisfaction (Said R, El-Shafei D. Occupational stress, job satisfaction,
and intent to leave: nurses working on front lines during COVID-19 pandemic in Zagazig
City, Egypt. 2020).
A similar study conducted on 117 nurses managing patients with COVID‐19 in
Pakistan displayed that anxiety and the perceived threat of COVID-19 resulted in nurses’
turnover intention (Irshad M, 2020). Another study conducted on Peruvian healthcare
workers showed increased turnover intention during the COVID-19 pandemic (Yáñez J,
Anxiety, distress, and turnover intention of healthcare workers in Peru. 2020).
Dr Jose Rene de Grano, president of the Private Hospitals Association of the
Philippines, the Philippines is suffering the consequences of being the world’s leading
exporter of doctors and nurses. (Aljazeera, 2021). The Philippines is one of the world's
top sources for nurses, however, many hospitals and health care facilities in the country
are consistently understaffed. According to labor unions, low wages are a major
29
BSN
deterrent. Many nurses say they would prefer to work abroad or in alternative industries
that offer more competitive salaries. (Inquirer.net, 2020).
Exhausted nurses in the Philippines are struggling to care for patients as
colleagues contract Covid-19 or quit a profession that was dangerously understaffed even
before the pandemic. Filipino Nurses United (FNU) also released a record of reports of
certain hospitals with a shortage of 100 or more nurses. Official figures show 75,000
nurses are working in public and private Philippine hospitals but roughly 109,000 more
are needed. About 40 percent of private hospital nurses have resigned since the start of
the pandemic, according to the Private Hospitals Association of the Philippines. Official
data show coronavirus ward and ICU bed occupancy rates at more than 70 percent
nationwide as daily cases often exceed 20,000, fueled by the hyper-contagious Delta
variant (The Manila Times, 2021).
A study entitled Factors influencing turnover intention among registered nurses in
Samar Philippines by Labrague, et al. (2017) explored the effects of nurses'
characteristics, work satisfaction, and work stress with the intent to leave an organization
among registered nurses in the Philippines. Several predictors of turnover intentions were
determined in this study through nurses' age, job satisfaction, and job stress as being the
most influential factors. Efforts to increase nurses' job satisfaction and reduce job stress
should be implemented to halt further loss of these skilled groups of healthcare
professionals.
A cross-sectional study in the Philippines entitled “The impact of fear of COVID-
19 on job stress, and turnover intentions of frontline nurses in the community” was also
30
BSN
conducted by De los Santos, et al. (2021). This study aimed to assess fear of COVID-19
among nurses in a community setting. The COVID-19 pandemic is a threat to the nurses’
physical and psychological well-being. Mounting studies discussed the well-being of
nurses in hospital setting, and very little attention was directed toward frontline nurses in
the community. Fear of COVID-19 is associated to the community nurse’s work-related
distress and may influence their intention to leave their jobs and the nursing profession.
There is a need to assess the factors associated with the fear to better address the nurses’
psychological well-being and to avoid turnover intentions.
Summary. The summary of the review ties together the major findings of the studies
reviewed. It presents a general picture of what has been known or thought of about the
problem to date. It presents similar results, as well as contradicting results.
Because of their strong sense of duty and desire to do the right thing, nurses had a
great desire to continue providing care, but this did not prevent them from harboring
anxieties and concerns about their own and their families' safety. It was critical to
recognize both the physical and mental effects of nursing practice during crises,
particularly those that put the nurse in deadly risk. Fear of transmission and contagion,
which has been described in research on H1N1, SARS, and Ebola virus, was also a factor
in this systematic review. Importantly, despite their dread, nurses continue to work and
offer care to patients.
Many nurses found mutual trust and respect in this review, including in the context of a
health pandemic, when they described how helpful the team was and that they felt crises
31
BSN
generated professional collegiality.
COVID-19 and its impact on the psychological well-being and the turnover
intention of healthcare workers have become major challenges, placing a heavy burden
on society. It was of great significance to understand the relation between COVID-19 and
turnover intention. Therefore, the purpose of this study was to analyze the current
situation of healthcare worker’s psychological well-being turnover intention during
COVID-19 pandemic in the locality, to provide an objective basis for preventing the
turnover phenomenon in the context of COVID-19 and protecting the mental health of
healthcare workers
32
BSN
CHAPTER III
Research Design and Methodology
This chapter dealt with a detailed description of the outline of the study called the
research design. Thus, it also dealt with the research instrument, a convenient tool made
for collecting, measuring and analyzing data related to the researchers’ research interest.
Research Design
The researchers have gathered information on the demographic profile of
registered nurses employed in the five chosen hospitals in Roxas City and aim to
understand their turnover intentions according to their psychological well-being using a
survey questionnaire via an online platform. To gather the needed data, this study will
utilize a survey-correlational under a quantitative approach. This research design attempts
to determine statistical relationships between variables (Price, 2013) without the need to
manipulate the independent variable. The correlational research design will allow this
study for multiple variable analysis that incorporate predictive design, that is, identifies
predictors of the level of psychological well-being of the study participants. The outcome
in this study was the level of turnover intentions of the study participants. Furthermore,
the correlational analysis attempts to assess the linear relationship, if there are any,
between the two dependent variables (psychological well-being ad turnover intention) of
the study participants by the use of statistical tools. Independent variables in the
correlation analysis represent the age, sex, area of exposure, nurse-patient ratio, years of
33
BSN
professional service in the hospital, current work shift, and monthly wage of the
registered nurses employed in
the five hospitals.
Research Locale
The research was conducted at Roxas City, Capiz where the chosen hospitals were
located. The city lies along the Panay River delta 4 miles (6.5 km) from its mouth on the
Sibuyan Sea. The city has a land area of 95.07 square kilometers or 36.71 square miles
which constitutes 3.66% of Capiz's total area. There are more than 10 medical centers and
health clinics in Roxas City. Five hospitals chosen were: Provincial Memorial Hospital,
St. Anthony College Hospital, Capiz Emmanuel Hospital, Health Centrum Hospital, and
Capiz Doctor’s Hospital in Roxas City, Capiz.
Population Frame and Sampling Technique
Due to the limitations brought about by the COVID-19 Pandemic, the statistical
determination of the sample size was gathered informally. Based on our informal inquiry
to private and public hospitals in Roxas City, Capiz, there were 44 registered nurses who
are currently assigned to COVID wards, emergency rooms, medical wards, and ICUs.
The breakdown of the target population from each hospital are as follows:
Purposive sampling, also known as judgment sampling, was a sampling technique
in which a researcher relied on his or her own judgment when choosing members of the
population to participate in the study. The present study will, therefore, include number
34
BSN
of estimated respondents per hospital who will satisfy the criteria as follows: the
participants should be (1) Working in one of the five chosen hospitals; and (2) exposed to
areas of the hospital such as COVID Ward, Intensive Care Unit, Emergency Room, and
Medical Ward. Since the target population is small, it is deemed necessary to apply total
or complete enumeration, wherein all members of the whole study population are being
recruited for data collection. Therefore, the researchers will use purposive sampling since
this is the best
option the researchers have due to the abovementioned reasons.
COVID ICU (Intensive Emergency Medical

Ward Care Unit) Room Ward
Capiz Emmanuel 2 3 2 1
Hospital
Roxas Memorial 3 2 1 1
Provincial Hospital
Capiz Doctor’s 2 3 3 2
Hospital
St. Anthony Hospital 3 3 3 3
Roxas Inc
The Health Centrum 1 2 2 2
Hospital
TOTAL 44
The registered nurses would be classified according to age, sex, area of exposure,
years of service, shifting schedule and wage. The levels of the personal variables will be
arbitrarily determined as follows:
a. Age
 20 – 30 y/o
35
BSN
 31 – 40 y/o
 41 – 50 y/o
 51 – 60 y/o
 60 and above
b. Sex
 Male
 Female
c. Area of exposure
 COVID 19 Ward
 ICU
 ER
 Medical Ward
d. Nurse-Patient ratio
 1:1 – 1: 5
 1: 6 – 1: 10
 1: 11 – 1: 15
 1: 16 – 1:20
e. Years of professional service in the hospital

 1 - 6 months
 7 months – 1 year
 2– 5 years
 6 – 10 years
 11 - 15 years
 16 – 25 years
f. Current work shift

 AM
 PM
 Night
g. Monthly wage
 1 000 – 3 999 per month
36
BSN
 4 000 – 7 999 per month

 8 000 – 11 999 per month
 12 000 – 15 999 per month
 16 000 – 19 999 per month
 20 000 – 23 999 per month
Research Instrument
This study would utilize the survey-questionnaire adapted from Havaei F, Ma A,
Staempfli S, MacPhee M. (2021) and Brown, R.; Wey, H.; Foland, K. (2018) as an
instrument to gather the data. It would be validated by a panel of research experts. The
research tool would be divided into three parts.
Part One, Informed consent. This was a brief summary of the study containing the
research title, purpose of the study, research instrument, voluntary participation,
procedures, risks, benefits, confidentiality and right to refuse or withdraw. This part
highlights the respondent’s rights and importance of their consent.
Part Two, Respondent’s profile questionnaire, a 8-item instrument, was developed
to gather information regarding work life variables which might affect their
psychological well-being and turnover intentions. All responses to the questions on sex,
area of exposure, and current work shift would be coded and entered as categorical data.
However, the questions on age, nurse-patient ratio, years of professional service in the
hospital, and monthly wage would be coded and treated as ordinal data due to their
inherent order.
Part three, the survey-questionnaire would be adopted from Havaei F, Ma A,
Staempfli S, MacPhee M. (2021) and Brown, R.; Wey, H.; Foland, K. (2018). The
37
BSN
Survey-questionnaire will be divided into two subparts:
a. Psychological Well-being relating to fatigue, workload, anxiety and stress scale –
Will be adopted from Expanded Nursing Stress Scale (ENSS) (Gray-Toft &
Anderson, 1981); a five-point Likert type scale (5 = extremely stressful; 4= very
stressful; 3; moderately stressful; 2= occasionally stressful; and 1 = never
stressful) with 15 items.
b. Turnover Intentions relating to workplace safety, organization preparedness and
support, and work satisfaction scale – Will be adopted from McCloskey/Mueller
Satisfaction Scale (MMSS; Mueller & McCloskey, 1990); a five-point Likert type
scale (5 = very satisfied; 4= satisfied; 3; neither satisfied nor dissatisfied; 2=
dissatisfied; and 1 = very dissatisfied) with 15 items.
A pilot study would be conducted to assess the efficacy and reliability of the
above-mentioned research instruments. In general, a pilot precedes and was closely
related to a larger study (Eldridge et al., 2016). A similar online survey design would be
employed to gain the psychological well-being and turnover intentions of registered
nurses that works in the chosen hospitals but does not work in the mentioned area of
exposure. The pilot testing will cater ten (10) registered nurses. The researchers will use
the same sampling method. Nevertheless, the pilot allows for field-testing of the research
instrument for validation and reliability.
Data Collection Procedure
After the validity and reliability testing of the researcher-made survey-
38
BSN
questionnaire for the data gathering process, the researchers will secure permission to
conduct the study from Dr. Rubilyn Sumaylo, RN, LPT, PhD by writing a request.
All participants will be invited to complete an electronic survey through an online
survey link. Participants will be fully informed of the confidentiality of their responses
and the voluntary nature of survey participation. They will also be informed that survey
completion and submission would indicate informed consent.
The data would then be counted, computer-processed, evaluated, and interpreted
after the survey responses are returned. To interpret the data, the researchers will score
the variables to compute for the mean. Each corresponding level of response would be
given an equivalent score and scale with descriptions as follows:
A. Psychological well-being Scale
Level Scale Interval
Extremely stressful 4.50 – 5.0
Very stressful 3.50 – 4.49
Moderately stressful 2.50 – 3.49
Occasionally stressful 1.50 – 2.49
Never stressful 1.0- 1.49
Nurses who were extremely stressful have the most experienced with high
negative emotions, frustration, anxiety, and stress related to COVID-19 and occupational
factors. Meanwhile, nurses who are never stressful have the least experience negative
emotions, frustration, anxiety, and stress the changes related to COVID-19 and
39
BSN
occupational factors.
B. Turnover Intentions Scale
Level Scale Interval
Very Satisfied 4.50-5.00
Satisfied 3.50-4.49
Neither satisfied nor dissatisfied 2.50 – 3.49
Dissatisfied 1.50 – 2.49
Very Dissatisfied 1.00 – 1.49
Nurses who were very satisfied with their workplace condition and environment
have the least willingness to leave their jobs. While nurses who were very dissatisfied
with their workplace condition and environment have the most willingness to leave their
jobs.
Data Analysis Procedure
The data that would be gathered through the survey questionnaire would be
summarized and tabulated and later treated with the following statistical tools: Student
Independent-Group t-Test, One Way Analysis of VAirance (ANOVA), and Pearson r
Correlation. Tabulation and summarization of demographic variables shall include and
utilize basic determination of means, medians, frequencies, and modes. All statistical
40
BSN
tests to be conducted will be at 95% confidence level.
Student Independent-Group t-Test
The Independent Samples t Test compares the means of two independent groups
in order to determine whether there was statistical evidence that the associated population
means are significantly different. The Independent Samples t Test is a parametric test.
(Kent State University, 2021). The general equation used to perform Student
Independent-group t-test is as follows:
This statistical tool will be used by the researchers to check if the independent
variables with two statistical data, have statistical differences.
One-way Analysis of Variance (ANOVA)
Although the Student’s t-Test will compare the means for two groups, it cannot
make comparisons among more than two groups since testing significance for multiple
groups using t-test will increase the expected error, ANOVA will be used. The result of
the ANOVA formula, the F statistic (also called the F-ratio), allows for the analysis of
multiple groups of data to determine the variability between samples and within samples.
This test was almost similar to t-test, however, ANOVA provides ways to test several
null hypotheses all at once.
One-way ANOVA would be utilized in the present study to check for significant
differences in independent variables with more than two statistical data.
Pearson’s r
41
BSN
Pearson’s product-moment correlation coefficient (Pearson’s r) will be used to
test the existence of a linear relationship of the variables psychological wellbeing and
turnover intentions using an alpha level of p < .05. The correlation coefficient r
mathematically identifies if an association exists between two variables and whether the
relationship is positive or negative (Munro, 2005).
Cronbach’s alpha
The tool reports face and content validity and test-retest and alpha reliability. This
will be used to measure the internal consistency of the two scales that will be used to
measure the exposure and outcome. This reliability estimates show the amount of
measurement error in the test.
42
BSN
EHICAL CONSIDERATIONS
All participating Healthcare workers would be asked to select "accept to
participate" on the first page and "submit answers" on the last page of the online
questionnaire. The study would be performed per the principles of the Declaration of
Helsinki. The main ethical issues will be the respondents’ right to self-determination,
anonymity and confidentiality. The questionnaire data would be kept confidential and
respondents were assured of their right to withdraw at any time. The names of the
respondents will not be recorded on the questionnaire, thus rendering the data
anonymous.
RISKS
There would be minimal risk associated with this research. Other than potential mild
boredom or fatigue, other potential risks include the induction of increased stress and
negative mood. The respondents will experience any discomfort during the course of the
study, and will be allowed to inform the researchers of concerns so that we can address
the needs at a given point in time. The respondents would be granted the liberty to refuse
to complete the online survey, and it will not be held responsible for your refusal.
BENEFITS
Following the completion of the survey, the respondents would be given the option to
learn about the study's findings. The respondents would not be charged anything to
participate in this study. As a result of the respondent’s voluntary participation in this
43
BSN
study, they would not get any incentives, reimbursements, or remuneration.
CONFIDENTIALITY
Only the researchers and the research team would have access to the study data and
information. Only the results of the study would be shared and all information disclosed
at the time of the study would be kept confidential. The researchers recognizes the Data
Privacy Act of 2012 whereas it (1) protects the privacy of individuals while ensuring free
flow of information to promote innovation and growth; (2) regulates the collection,
recording, organization, storage, updating or modification, retrieval, consultation, use,
consolidation, blocking, erasure or destruction of personal data.
RIGHT TO REFUSE OR WITHDRAW
As a participant in the study, the respondents have the right to refuse or withdraw from
the study at any point of the study for whatever reason. There will be no consequences
for withdrawal. It would not be taken against the respondents would and be made to
explain the reason for refusal to participate. The respondent’s decision would be
respected.
44
BSN
QUESTIONNAIRE
45
BSN
PART 1 Informed Consent
RESEARCH TITLE: Impact of COVID-19 Pandemic Response among Frontline Nurses
in the Community on their Psychological Well-being, and Turnover Intentions
RESEARCHERS:
Belleza, Frietz
Belvis, Belle Brian
Tablo, Jan Mileno
Andrada, Janna
Elauria, Ranelyn
Estolas, Angela
Frontline Nurses in the midst of COVID 19 Pandemic in the Philippines
Nurses in locations for COVID-19 across the country have been asked to do the
unthinkable. They've pushed their bodies and minds to their limits to save lives when
they could, and they've stood by families and patients when life was no longer possible.
Even though the pandemic has been in the Philippines for more than a year, the country's
nurses have continued to vent the same criticisms and woes, despite the government
hailing them as heroes in scrubs. Since the outbreak began, the country has seen
3,442,056 illnesses and 53,519 coronavirus-related deaths. Because relief personnel are
calling in ill or not reporting for duty, some nurses are working up to 36-hour hours, she
claimed, and nurses are sometimes only given one pair of protective gear per shift.
46
BSN
Nurses are unable to be checked on a regular basis, and if they become ill, hospital beds
are not always available. The decline in the number of nurses in the country was caused
by more than just mass resignations, career changes, and deployments. As COVID-19
continues to ravage the country, a number of nurses have died, succumbing to the disease
for which there is no known cure.
PURPOSE OF THE STUDY
This study aims to determine the impact of the national and local government’s response
to COVID-19 towards the overall psychological well-being, and turnover intentions of
frontline nurses.
RESEARCH INSTRUMENT
The survey-questionnaire adopted from Havaei F, Ma A, Staempfli S, MacPhee M.
(2021) and Brown, R.; Wey, H.; Foland, K. (2018) will be used in this study to determine
the Impact of COVID-19 Pandemic Response among Frontline Nurses in the Community
on their Psychological Well-being, and Turnover Intentions. This questionnaire is
composed of three parts: Part I: Informed Consent, Part II: Respondents' Profiles, and
Part III (divided into 3 subparts): Impact of COVID-19 Pandemic Response among
Frontline Nurses in the Community on their Psychological Well-being (1), and Turnover
Intentions (2).
VOLUNTARY PARTICIPATION
47
BSN
Your participation in this study is voluntary. You have the decision whether to take part
or not in this study. If you choose not to participate, rest assured that there are no
consequences or penalty on your part.
PROCEDURES
You are encouraged to complete a Google Forms online survey. This study will begin
with a brief discussion of the purpose of the study and the informed consent. Before you
will be redirected to the online survey, you will be asked to tick a box indicating your
voluntary participation in the study. You will be asked to answer all the items, leaving no
item blank. The survey will be available for 5 days and can be completed on your
convenience and availability. The information that you will provide will be kept
CONFIDENTIAL. Answering the survey may take up to 10 minutes.
RISKS
There is a minimal risk associated with this research. Other than potential mild boredom
or fatigue, other potential risks include the induction of increased stress and negative
mood. Should you experience any discomfort during the course of the study, you will be
allowed to inform the researchers of your concerns so that we can address your needs at a
given point in time. You will be granted the liberty to refuse to complete the online
survey, and you will not be held responsible for your refusal.
BENEFITS
48
BSN
Following your completion of the survey, you will be given the option to learn about the
study's findings. You will not be charged anything to participate in this study. As a result
of your participation in this study, you will not get any incentives, reimbursements, or
remuneration.
CONFIDENTIALITY
Only the researchers and the research team will have access to the study data and
information. Only the results of the study will be shared and all information disclosed at
the time of the study will be kept confidential.
RIGHT TO REFUSE OR WITHDRAW
As a participant in the study, you have the right to refuse or withdraw from the study at
any point of the study for whatever reason. There will be no consequences for
withdrawal. It will not be taken against you nor will you be made to explain your reason
for refusal to participate. Your decision will be respected.
Contact Information:
If you have questions about the study, you may contact the researchers for any
clarifications. The researchers of the study are willing to accommodate your queries and
concerns regarding the study.
Belleza, Frietz
49
BSN
Belvis, Belle Brian
Tablo, Jan Mileno
Andrada, Janna
Elauria, Ranelyn
Estolas, Angela
09171164689
Angelaestolas85@gmail.com
I have read and understood the above information and have been given the opportunity to
consider and ask questions regarding the information on the involvement in this study. By
filling out this consent form, I agree that my personal data may be used for the purpose of
the study. I consent to take part in the study and I am aware that my participation is
entirely voluntary.
- I agree
- I disagree
PART 2. RESPONDENT’S PROFILE
Name (optional):
Age:
Sex:
Unit/area currently assigned:
Nurse-patient ratio
Years of RN experience
50
BSN
Current workshift:
Monthly wage:
Instructions: Below are the statements that will be used to determine your overall
psychological well-being, and turnover intentions during the COVID-19 pandemic.
Please place a checkmark (✅) on the corresponding column for your answer.
PART 3. SURVEY-QUESTIONNAIRE
I. Psychological Well-being relating to fatigue, workload, anxiety and stress
Response format:
Question 5 – 4 – 3 – 2 – 1 –
Extremely Frequently Moderately Occassionally Never
Stressful Stressful Stressful stressful Stressful
Workplace
relationships with
your nursing
colleagues changing
during COVID-19
Concern about
contracting COVID-
19 at your
workplace
51
BSN
Concern about
bringing COVID-19
home to those with
whom you live
and/or
family/friends
Lack of opportunity
to talk openly with
other personnel
about problems in
the
work setting.
Unpredictable
staffing and
scheduling
Floating to other
units/services that
are short-staffed
Feeling
inadequately
prepared to help
with the emotional
needs of a patient
Severe rising
number of cases of
COVID-19
Number of deaths
due to COVID-19
Not enough staff to

adequately cover the
unit
52
BSN
Being held
accountable for
things over which I
have no control
Lack of support
from other health
care administrators
and organizations
Access to necessary
and essential
resources
Security of
employment with
enough pay
Coping with new

situations with
unrealistically high
expectations by
others of my role
II. Turnover Intentions relating to workplace safety, organization preparedness
and support, and work satisfaction
Question 5 – 4 – 3 – Neither 2 – 1 – Very

Very Satisfied satisfied Dissatisfied dissatisfied
satisfied nor
dissatisfied
The physical conditions
53
BSN
in which you work

The recognition you get
for good work
Amount of hours that
you work
Job security and rate of
pay for nurses
(including benefits,
insurance, and
incentives)
Flexibility in scheduling
your weekends off
Compensation for
working during a
pandemic and working
extra hours due to lack
of staff
Amount of
encouragement
and positive feedback
Support by your
organization during the
COVID-19 pandemic
Relations between
management and staff
The opportunity to use
your abilities
Recognition for your
work
from superiors and the
government
The health
organizations’ ability to
implement protocols and
policies related to
COVID-19 changes in
all aspects
Response and handling
54
BSN
of COVID-19 by the
health organizations and
administrations
Adequacy of nurse
staffing in your primary
workplace during
COVID-19
Safety of being exposed
to health hazards most
especially to COVID 19
55
BSN
CHAPTER IV
Results and Discussion
This chapter deals with the presentation, analysis, and interpretation of data. The
data presented in each table is followed by a textual discussion. The findings of the study
were gathered from the survey-questionnaire distributed to the chosen respondents during
the conduct of this research. The findings are divided according to Psychological Well-
being and Turnover Intentions.
Figure 1. Socio-Demographic Profile: Age of 43 Registered Nurses
Age
7%
24% 40%
29%
20-30 y/o 31-40 y/o 41-50 y/o 51-60 y/o 60 and above
Among the 70 respondents they are 40% of respondents aged of 20-30 y/o, 29% of
respondents aged 31-40 y/o, 24% of respondents aged 41-50 y/o and 7% of respondents
aged 51-60 y/o.
56
BSN
Figure 2. Socio-Demographic Profile: Sex of 43 Registered Nurses
Sex
34%
66%
Male Female
Among the 70 respondents they are 66% of respondents are Female and 34% of
respondents are Male
57
BSN
Nurse-Patient Ratio
19%
36%
21%
24%
1:1-1:5 1:6-1:10 1:11-1:15 1:16-1:20
Among the 70 respondents they are 36% of respondents are in 1:1-1:5, 24% of
respondents are in 1:6-1:10, 21% of respondents are in 1:11-1:15 and 19% of respondents
are in 1:16-1:20.
58
BSN
Area of Exposure
20%
39%
10%
14%
17%
COVID - 19 ward ICU ER Medical Ward Other
Among 70 respondents there are a total of 20 percent of nurses working at the COVID –
19 ward, 10 percent are in ICU, 14 percent in ER, 17 percent are in Medical Ward, and
39 percent of the respondent working other than the 4 wards (Covid – 19 ward, ICU, ER,
and medical wards).
59
BSN
Years of professional service
11% 10%
7%
11%
20%
40%
1 - 6 months 7 months – 1 year 2 - 5 years

6 - 10 years 11 - 15 years 16 - 25 years
Among 70 respondents there are a total of 10 percent of the respondents are in their 1 – 6
months of professional service, 7 percent are in their 7 months -1 year of professional
service, 40 percent are in their 2 – 5 years of professional service, 20 percent are in their
6 – 10 years of professional service, 12 percent are in their 11- 15 years of professional
service, and 11 percent are in their 16 – 25 years of professional service.
60
BSN
Current Work Shift
21%
53%
26%
Am PM Night
Among the 70 respondents they are 52% of respondents are working in AM shift, 26% of
respondents for the PM shift, and 21% of respondents for the night.
61
BSN
Monthly Wage
6%
26%
26%
14%
29%
1000-3999 4000-7999 8000-11999 12000-15999 16000-19999 20000-23000
Among the 70 respondents they are 28 percent of respondents have 12000-15999 wages
per month, 8000-11999 & 20000-23000 got 26% of respondents, 16000-19999 got 14%
of respondents and 4000-7999 have 6% of respondents.
62
BSN
Table 1. Psychological Well-being Responses
Total Weighted
Mean
Workplace relationships with 3.76
your nursing colleagues
changing during COVID-19
158
Lack of opportunity to talk 146 3.39

openly with other personnel
about problems in the work
setting
Feeling inadequately prepared 149 3.46
to help with the emotional needs
Workplace of a patient
Being held accountable for 171 4.0
things over which I have no
control
Lack of support from other 179 4.2
health care administrators and
organizations
COVID-19 Pandemic Concern about contracting 164 3.8
COVID-19 at your workplace
Concern about bringing 162 3.8
COVID-19 home to those with
whom you live and/or
family/friends
Severe rising number of cases of 179 4.2
COVID-19
Number of deaths due to 177 4.1
COVID-19
Coping with new situations with 163 3.8
unrealistically high expectations
by others of my role
Staffing/ Unpredictable staffing and 179 4.2
Management scheduling
Floating to other units/services 170 4.0
that are short-staffed
Not enough staff to adequately 182 4.2
cover the unit
Access to necessary and 164 3.8
essential resources
Security of employment with 174 4.0
enough pay
63
BSN
Table 1 reveals the level of Psychological well-being of 43 registered nurses. The table
indicates that most of them are Very Stressful (scale interval of 3.50 – 4.49) when it
comes to Workplace, COVID-19, Staffing/Management related stressors. Determinants
that ranked the highest with the mean of 4.2 (Very Stressful) are: Lack of support from
other health care administrators and organizations (Workplace), Severe rising number of
cases of COVID-19 (COVID-19), and Unpredictable staffing and scheduling
(Staffing/Management). These three determinants of cause the most stress towards the
frontline health care workers. They also consider Number of deaths due to COVID-19,
Floating to other units/services that are short-staffed, Security of employment with
enough pay, and Being held accountable for things over which I have no control are very
stressful situations.
Table 2. Turnover Intentions
Total Weighted
Mean
The recognition you get for good work 3.7
158
Amount of hours that you work 155 3.7

Job security and rate of pay for nurses 131 3.0
(including benefits, insurance, and
incentives
Flexibility in scheduling your weekends off 156 3.6
Compensation for working during a 110 2.6
Compensation & pandemic and working extra hours due to
Benefits lack of staff
Workplace/ The physical conditions in which you work 157 3.7
Environment The opportunity to use your abilities 179 4.2
The health organizations ability to 154 3.6
implement protocols and policies related to
COVID - 19 changes in all aspects
64
BSN
Adequacy of nurse staffing in your primary 147 3.5

workplace during COVID - 19
Safety of being exposed to health hazards 139 3.3
most especially to COVID - 19
Employer-employee Amount of encouragement and positive 139 3.2
relationship feedback
Support by your organization during the 143 3.3
COVID-19 pandemic
Relations between management and staf 151 3.5
Recognition for your work from superiors 142 3.3
and the government]
Response and handling of COVID - 19 by 155 3.6
the health organizations and administration
Table 2, on the other hand, reveals the respondents’ level of turnover intentions towards
their job as frontliners during the COVID-19 Pandemic. Compensation for working
during a pandemic and working extra hours due to lack of staff as a factor that increases
the nurses’ turnover intention had the lowest mean with 2.6 (Dissatisfied 1.50 – 2.49).
This means that the reason why nurses are willing to leave their jobs is because they are
overworked and at the same time underpaid. No compensation was received enough to
satisfy their needs as nurses. While, the factor with the highest mean is he opportunity to
use their abilities, with a weighted mean of 4.2 (Satisfied). This means that they are
satisfied with opportunities provided by the hospitals to perform their job as nurses and
enhance the abilities as well.
Table 3. Mean and Standard Deviation for Psychological Well-being and Turnover
Intentions
Descriptive Statistics
65
BSN
Mean Std. Deviation N

Psychological_Well_Being 3.9023 .60864 43
Turnover_Intentions 3.4651 .73844 43
Table 3 shows the descriptive statistics of Psychological Well-being and Turnover
Intentions according to age, sex, area of exposure, Nurse-patient ratio, Years of
professional service, current work shift, and monthly wage. The sample size (N) is 43 and
there is no missing data as showed in the table. The Psychological Well-being has a mean
of 3.90 which is equivalent to Very Stressful (3.50 – 4.49). Meaning the nurses are very
stressful and they have experience with negative emotions, frustration, stress and anxiety
related to COVID-19 and occupational factors. On the other hand, the second dependent
variable which is the Turnover intention of registered nurses has a mean of 3.47 which
has an equivalent level of Neither Satisfied nor Dissatisfied (2.50 – 3.49). This means
that the that some of their needs were met and some were not. Some are willing to leave
their jobs and some have the lesser willingness to leave.
66
BSN
Table 4. ANOVA Result of Psychological Well-being according to Age
ANOVA
Sum of
Squares df Mean Square F Sig.
PWB_Workplace Between Groups .208 3 .069 .117 .950
Within Groups 23.050 39 .591
Total 23.258 42
PWB_COVID Between Groups .956 3 .319 .600 .619
Total 21.671 42
PWB_Staffing Between Groups 2.165 3 .722 1.907 .144
Total 16.925 42
Table 4 shows ANOVA Result of Psychological Well-being according to Age. Results
show p value of three variables greater than the set alpha value which is .05. This shows
that the results of Psychological Well-being when grouped according to age has no
statistically significant difference.
Table 5. T-Test for Independent Samples Result of Psychological Well-Being according
to Sex
67
BSN
Table shows the T-Test for Independent Samples Result of Psychological Well-Being
according to Sex. Results of .184, .561, and .976 show p value greater than alpha set
value which indicates the researcher accepting the null hypothesis.
Table 6. ANOVA Result of Psychological Well-being According to Area of Exposure
ANOVA
Sum of
Total 23.258 42
PWB_COVID Between Groups 1.574 3 .525 1.018 .045
Total 21.671 42
PWB_Staffing Between Groups 1.073 3 .358 .880 .006
Total 16.925 42
Table 6 shows the ANOVA Result of Psychological Well-being According to Area of
Exposure. Results were .040, .045, and .006 indicating p value is less than the set alpha
68
BSN
value .05. This indicates that Psychological Well-being when grouped according to Area
of Exposure is significant. Thus, the researchers reject the null hypothesis.
Table 7. ANOVA Result of Psychological Well-being According to Nurse-Patient Ratio
ANOVA
Sum of
PWB_Workplace Between Groups 2.323 3 .774 1.443 .025
Total 23.258 42
PWB_COVID Between Groups 4.478 3 1.493 3.386 .027
Total 21.671 42
Total 16.925 42
Nurse-Patient ratio. Results were .025, .027, and .010 indicating p value is less than the
set alpha value .05. This indicates that Psychological Well-being when grouped
according to Nurse Patient Ratio is significant. Thus, the researchers reject the null
hypothesis.
There is a significant difference between the Psychological well-being and Nurse-
patient ratio evident in this study. This is also similar in the 2018 review of the Philippine
Health Care by Manuel M. Dayrit where he proved that given the population of the
Philippines, it is easy to see how the hospitals are overworked. Nurse-patient ratio during
the pandemic was at least 1:10, leading to overwhelmed, fatigued, and diminished with
69
BSN
infections healthcare workers. In the Philippines, there is approximately one nurse for
every 5,000 residents. Thus, medical frontliners have called for a “timeout” to draw up a
better plan to deal with the coronavirus crisis.
Table 8. ANOVA Result of Psychological Well-being According to Years of Service
ANOVA
Sum of
PWB_Workplace Between Groups 1.843 5 .369 .637 .673
Total 23.258 42
Total 21.671 42
Total 16.925 42
Years of Professional Service. Results were greater than the set alpha value .05. This
indicates there is no significant evidence in the association between the mentioned
variables. Thus, the researchers accept the null hypothesis.
70
BSN
Table 9. ANOVA Result of Psychological Well-being According to Work Shift
ANOVA
Sum of
Total 23.258 42
PWB_COVID Between Groups .130 2 .065 .121 .887
Total 21.671 42
PWB_Staffing Between Groups .418 2 .209 .507 .606
Total 16.925 42
Table 9 shows the ANOVA Result of Psychological Well-being According to Current
Work Shift. Results were greater than the set alpha value .05. This indicates there is no
significant evidence in the association between the mentioned variables. Thus, the
researchers accept the null hypothesis.
Table 10. ANOVA Result of Psychological Well-being According to Monthly Wage
ANOVA
Sum of
PWB_Workplace Between Groups 3.376 4 .844 1.613 .035
Total 23.258 42
Total 21.671 42
71
BSN
PWB_Staffing Between Groups .607 4 .152 .353 .050
Total 16.925 42
Table 10 shows the ANOVA Result of Psychological Well-being According to Monthly
Wage. Results were less than the set alpha value .05. This indicates there is significant
evidence in the association between the mentioned variables. Thus, the researchers reject
the null hypothesis.
The results showed a significant difference between the two variables indicating
that there is an association between them. This is similar to the briefing note published by
United Nations Human Rights (February 2021) wherein it recommends that healthcare
workers in Ukraine are underpaid resulting to stress and problems in providing a decent
living for their families. It is evident that even in international countries, low salary of
nurses affects their overall psychological well-being.
Table 11. ANOVA Result of Turnover Intention according to Age
ANOVA
Sum of
TI_Compensation Between Groups 4.492 3 1.497 2.081 .118
Total 32.556 42
TI_Workplace Between Groups .310 3 .103 .170 .916
Total 23.996 42
TI_Relationship Between Groups 1.527 3 .509 .762 .522
72
BSN
Total 27.559 42
Table 11 shows ANOVA Result of Turnover Intention according to Age. Results show p
value of three variables greater than the set alpha value which is .05. This shows that the
results of Turnover when grouped according to age has no statistically significant
difference.
Although there is age has no significant association with the turnover intentions, there is
a contradicting study entitled “Factors Influencing Turnover Intention among Registered
nurses in Samar, Philippines” by Larague, et al. (2017). The results of the study show that
the most influential factors in the turnover intentions among nurses were age, job
satisfaction, and job stress.
Table 12. T-Test for Independent Samples Result of Turnover Intention according to Sex
73
BSN
Table 12 shows the T-Test for Independent Samples Result of Turnover Intention
according to Sex. Results show p value greater than alpha set value which indicates the
researcher accepting the null hypothesis since there is no significant difference.
Table 13. ANOVA Result of Turnover Intention According to Area of Exposure
ANOVA
Sum of
TI_Compensation Between Groups 1.720 3 .573 .725 .543
Total 32.556 42
TI_Workplace Between Groups 4.987 3 1.662 3.410 .027
Total 23.996 42
TI_Relationship Between Groups 3.131 3 1.044 1.666 .010
Total 27.559 42
Table 13 shows the ANOVA Result of Turnover Intention According to Area of
Exposure. Results for Turnover Intention on Compensation showed a p value greater than
.05 while the last two variables (Workplace and Relationship) are less than the set alpha
value. This indicates that there is a significant difference between and within the groups.
Thus, the researcher rejects the null hypothesis.
Table 14. ANOVA Result of Turnover According to Nurse-Patient Ratio
ANOVA
74
BSN
Sum of
TI_Compensation Between Groups .649 3 .216 .265 .050
Total 32.556 42
TI_Workplace Between Groups 1.234 3 .411 .705 .005
Total 23.996 42
TI_Relationship Between Groups .089 3 .030 .042 .088
Total 27.559 42
Table 14 shows the ANOVA Result of Turnover Intention According to Area of Nurse-
Patient ratio. Results showed p value is less than the set alpha value .05 except for the
variable Relationship. This indicates that Turnover Intention when grouped according to
Nurse Patient Ratio is significant. Thus, the researchers reject the null hypothesis.
Table 15. ANOVA Result of Turnover Intention According to Years of Service
ANOVA
Sum of
TI_Compensation Between Groups 1.602 5 .320 .383 .857
Total 32.556 42
TI_Workplace Between Groups 3.106 5 .621 1.100 .377
Total 23.996 42
TI_Relationship Between Groups 3.234 5 .647 .984 .441
Total 27.559 42
75
BSN
Table 15 shows the ANOVA Result of Turnover Intention According to Area of Years of
Professional Service. Results were greater than the set alpha value .05. This indicates
there is no significant evidence in the association between the mentioned variables. Thus,
the researchers accept the null hypothesis.
Table 16. ANOVA Result of Turnover Intention to Work Shift
ANOVA
Sum of
TI_Compensation Between Groups 7.205 2 3.602 5.684 .070
Total 32.556 42
Total 23.996 42
TI_Relationship Between Groups 1.880 2 .940 1.464 .243
Total 27.559 42
Table 16 shows the ANOVA Result of Turnover Intention According to Current Work
Shift. Results were greater than the set alpha value .05. This indicates there is no
significant evidence in the association between the mentioned variables. Thus, the
researchers accept the null hypothesis.
Table 17. ANOVA Result of Turnover Intention According to Monthly Wage
ANOVA
76
BSN
Sum of
TI_Compensation Between Groups 3.832 4 .958 1.268 .030
Total 32.556 42
Total 23.996 42
TI_Relationship Between Groups 4.839 4 1.210 2.023 .011
Total 27.559 42
Table 17 shows the ANOVA Result of Turnover Intention According to Monthly Wage.
Results were less than the set alpha value .05. This indicates there is significant evidence
in the association between the mentioned variables. Thus, the researchers reject the null
hypothesis.
The association of the Turnover Intention and salary of the nurses has an evident
significant difference in this study. This means that two variables have an impact on one
another. During the pandemic, the pay was unjustly distributed among public and private
health facilities. (ASEAN Briefing Paper, 2021). With low pay and hazardous working
conditions, the Private Hospitals Association of the Philippines estimates that about 40
percent of private hospital nurses quit in 2020. These trends stand to worsen ASEAN’s
shortfall of doctors and nurses, which already stood at 700,000 before the pandemic.
Table 18. Test of Normality for Psychological Well-being

Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Workplace .174 43 .042 .941 43 .049

Staffing .087 43 .200 *
.965 43 .210
COVID .120 43 .129 .951 43 .067
77
BSN
*. This is a lower bound of the true significance.

a. Lilliefors Significance Correction
Table 18 shows the results whether the data was normally distributed. The data for
Psychological well-being were divided into three groups: Workplace (1); Staffing (2);
and COVID (3) related situations. The three variables show a p value of .049, .210,
and .067 which is all greater than the set alpha value of 0.05. Greater than the
significance value indicates that the data were normally distributed, and the null
hypothesis was accepted thus leading the researchers to use Pearson correlation later.
Table 19. Goodness-of-Fit Test for Psychological Well-being
Goodness-of-Fit
Chi-Square df Sig.
Pearson 544.377 466 .700
Deviance 151.510 466 1.000
Link function: Logit.
The goodness-of-fit test was used to determine whether the model is good fit to the data.
Not significant results indicate that the model fits to the data. The table above shows
Pearson results greater than set alpha value of 0.05 which indicates the model is a good
fit to the data. Same goes with the deviance.
Table 20. Test of Normality for Turnover Intentions

Tests of Normality
Kolmogorov-Smirnova Shapiro-Wilk
Statistic df Sig. Statistic df Sig.
Compensation .109 43 .200 *
.938 43 .061
78
BSN
Workplace .146 43 .022 .940 43 .055

Relationship .130 43 .065 .974 43 .416
*. This is a lower bound of the true significance.
a. Lilliefors Significance Correction
Table 20 shows the results whether the data for Turnover Intentions were normally
distributed. The data for Turnover Intentions were divided into three groups:
Compensation and Benefits (1); Workplace/Environment (2); and Relationship
(Employee-Employer) (3). The three variables show a p value of .061, .055 and .416
which are all greater than the set alpha value of 0.05. Greater p value than the set alpha
value indicates that the data were normally distributed, and the null hypothesis was
accepted.
Table 21. Goodness-of-Fit of Turnover Intentions
Goodness-of-Fit
Chi-Square df Sig.
Pearson 954.648 502 .080
Deviance 169.242 502 1.000
Link function: Logit.
The goodness-of-fit test was used to determine whether the model is good fit to the data.
Not significant results indicate that the model fits to the data. The table above shows
Pearson results of .080 greater than set alpha value of 0.05, indicates that the model is a
good fit to the data.
Table 22. Correlations for Psychological Well-being and Turnover Intentions
79
BSN
Psychological_We Turnover_Intentio
ll_Being ns
Psychological Well-Being Pearson Correlation 1 .382*
Sig. (2-tailed) .011
N 43 43
Turnover Intentions Pearson Correlation .382* 1
Sig. (2-tailed) .011
N 43 43
*. Correlation is significant at the 0.05 level (2-tailed).

Table 22 shows the Pearson product-moment correlation conducted to examine the
relationship between Psychological Well-being and Turnover Intentions of 43 registered
nurses in the locality during the COVID-19 pandemic. Psychological Well-being was
more strongly positively related to Turnover Intentions, r (42) = .38, p < 0.05. A
complete list of correlations is presented in Table 22 and a scatterplot of Psychological
well-being and Turnover intentions is in Figure 8. The findings indicate that since the p
value is less than the significance level of 0.05, there is evidence about the significance of
the association between the variables.
Figure 8. Scatter plot of Pearson Correlation of Psychological Well-Being and Turnover
Intentions
80
BSN
Chart Title
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
2 2.5 3 3.5 4 4.5 5 5.5
The sign of the coefficient indicates the direction of the relationship. Since both variables
tend to increase together, the coefficient is positive, and the line that represents the
correlation slopes upward.
The findings of the study showed the relationship between the Psychological
well-being and Turnover Intentions whereas both variables positively increase together.
The Psychological well-being of the registered nurses showed as very stressful while the
turnover intention was neither satisfied nor dissatisfied. Increase in the level of
psychological well-being might lead to an increase of turnover intention. This finding is
also evident in the study conducted by Salazar de Pablo on the Impact of Coronavirus
syndromes on the physical and mental health of healthcare workers. The study showed
that major consequences of stress among health care workers is an increase in turnover.
Another study where the researchers can anchor the findings of the research is the cross-
sectional study conducted by De los Santos, et al. (2021) focusing on the impact of fear
of COVID-19 on job stress and turnover intention of frontline nurses in the community
81
BSN
showed that work-related distress may influence their intention to leave their jobs and the
nursing profession.
82
BSN
CHAPTER V
Summary, Conclusion, and Recommendation
This chapter presents the summary of the study, the conclusion drawn from the findings
and the recommendations of the researchers.
Summary
The study entitled “Psychological Well-being and Turnover Intentions among Registered
Nurses in Roxas City, Capiz during the COVID-19 Pandemic” aimed to evaluate the
Psychological Well-being and Turnover Intentions of the chosen respondents. The
researchers used a survey-correlational under a quantitative approach research design.
Purposive sampling was utilized in choosing the respondents to participate in the study. A
criterion was used in order to meet the target population. 43 out of 44 respondents
participated in the study. The participants were grouped according to the following: Age,
Sex, Area of Exposure, Nurse-Patient Ratio, Years of Professional Service, Current Work
Shift, and Monthly Wage. The research instrument was adapted from Havaei F, Ma A,
Staempfli S, MacPhee M. (2021) and Brown, R.; Wey, H.; Foland, K. (2018) to gather
the data. The instrument was validated with the help of three experts, they are: a Nurse,
the Dean of College of Nursing in SACHRI, and the other person knowledgeable enough
in the field of research. After which, the survey was distributed via Google forms. A total
number of 70 registered nurses responded. 27 respondents were used for pilot study and
43 nurses were for the actual research. Data gathering was done, after that the data were
tallied and interpreted. The data were analyzed using the mean and standard deviation
83
BSN
for descriptive statistics and T-test for Independent Samples, One-Way Analysis of
Variance (ANOVA) and Pearson Correlation wherein the p-value was compared to a set
alpha value of 0.05 for the inferential statistics.
Results showed a mean of 3.90 for Psychological Well-being which is equivalent to Very
Stressful (3.50 – 4.49) and a mean of 3.47 for Turnover Intentions equivalent to Neither
Satisfied nor Dissatisfied (2.50 – 3.49). Significant differences were also shown between
Psychological Well-being and independent variables, namely: Area of Exposure, Nurse-
Patient Ratio, and Monthly Wage. Significant differences were also evident between
Turnover Intentions and independent variables, namely: Area of Exposure, Nurse-Patient
Ratio, and Monthly Wage. The rest of the variables such as Age, Sex, Years of Service
and Current Workshift have inconclusive evidence about the significance of the
association between the variables. Finally, a positive linear relationship exists between
the two dependent variables with the strength of .382 and p value of 0.011 which is less
than significance difference of 0.05.
Conclusions
On the basis of the findings of the study, the following conclusions were formulated:
1. There is a significant difference in the psychological well-being of registered
nurses during the COVID-19 pandemic when grouped according to area of
exposure, nurse-patient ratio, and monthly wage.
2. There is a significant difference in the turnover intentions of registered nurses
during the COVID- 19 pandemic when grouped according to area of exposure,
84
BSN
nurse-patient ratio, and monthly wage.
3. There is a positive linear relationship between the psychological well-being and
turnover intentions among registered nurses during the COVID-19 pandemic.
Recommendations
Based on the results and conclusions, the following recommendations were drawn:
1. The researchers suggest using triangulation method in data gathering and utilize a
qualitative approach in research design. As perception of stress and stressors is
subjective in nature and is prone to be measured inaccurately by the use of a
structured questionnaire, it is suggested that future researchers should incorporate
qualitative methods to obtain deeper information pertaining to stress and related
areas.
2. This study was limited to COVID-19 nurses working in a COVID-19 hospital and
included only nurses who work in COVID areas in general hospitals. Thus, this
study excludes those who are working in different areas. To formulate effective
interventions for psychological and turnover management, it is deemed necessary
by the researchers that future researchers should address other nursing areas also.
3. The researchers suggest using a wider range of respondents. This study had 43
respondents and for future researches, a wider scope for better results is
recommended.
85
BSN
References
Bhatia, G., Dutta, P. K., & McClure, J. (2022, February 23). Philippines: the latest
coronavirus counts, charts and maps. Reuters. https://graphics.reuters.com/world-
coronavirus-tracker-and-maps/countries-and-territories/philippines/
100 days of COVID-19 in the Philippines: How WHO supported the Philippine response.
(2020, May 9). World Health Organization.
https://www.who.int/philippines/news/feature-stories/detail/100-days-of-covid-
19-in-the-philippines-how-who-supported-the-philippine-response
Agence France-Presse. (2021, September 20). “Burned out:” Philippine nurses battle
Covid-19, resignations. The Manila Times.
https://www.manilatimes.net/2021/09/21/opinion/burned-out-philippine-nurses-
battle-covid-19-resignations/1815452
NCBI - First COVID-19 infections in the Philippines: a case report. (2020, April 14).
NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154063/
NCBI - Hospital nurses’ moral distress and mental health during COVID-19. (2022,
March). PubMed.Gov. https://pubmed.ncbi.nlm.nih.gov/34402538/
NCBI - Job satisfaction and its related factors: A questionnaire survey of hospital nurses
in Mainland China. (2020). NCBI.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094576/
Shi, L.; Lu, Z.-A.; Que, J.-Y.; Huang, X.-L.; Liu, L.; Ran, M.-S.; Gong, Y.-M.; Yuan, K.;
Yan, W.; Sun, Y.-K.; et al. Prevalence of and Risk Factors Associated with
86
BSN
Mental Health Symptoms Among the General Population in China During the
Coronavirus Disease 2019 Pandemic. JAMA Netw. Open 2020, 3, e2014053.
Liu Q, Luo D, Haase JE, Guo Q, Wang XQ, Liu S, et al. The experiences of health-care
providers during the COVID-19 crisis in China: a qualitative study. The Lancet
Global health. (2020)
Sun N, Wei L, Shi S, Jiao D, Song R, Ma L, et al. A qualitative study on the
psychological experience of caregivers of COVID-19 patients. Am J Infect
Control. (2020) 48:592ect Controld1016/j.ajic.2020.03.018
Marzo RR, Singh A, Mukti RF. A survey of psychological distress among Bangladeshi
people during the COVID-19 pandemic. Clin Epidemiol Glob Heal 2021
Marzo RR, Villanueva EQ, Faller EM, Baldonado AM. Factors associated with
psychological distress among filipinos during coronavirus disease-19 pandemic
crisis. Open Access Maced J Med Sci 2020;8:309-13.
Respati T, Irasanti SN, Sartika D, Akbar IB, Marzo RR. A nationwide survey of
psychological distress among Indonesian residents during the COVID-19
pandemic. Int J Public Heal Sci 2021;10:119-26.
Htay MNN, Marzo RR, AlRifai A, et al. Immediate impact of COVID-19 on mental
health
and its associated factors among healthcare workers: A global perspective across
31 countries. J Glob Health 2020;10:1-6.
Sadang JM. The Lived Experience of Filipino Nurses’ Work in COVID-19 Quarantine
Facilities: A Descriptive Phenomenological Study. PRIJNR [Internet]. 2020 Dec.
87
BSN
8 [cited 2022 Mar. 1];25(1):154-6. Available from:
https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/246371
Uchmanowicz I, Manulik S, Lomper K, Rozensztrauch A, Zborowska A, Kolasi J, Rosi J.
Life satisfaction, job satisfaction, life orientation and occupational burnout among
nurses and midwives in medical institutions in Poland: a cross-sectional study.
BMJ Open. 2019; 9:e024296. doi:10.1136/bmjopen-2018-024296
Santos AP. Attacked and underpaid: Medics in Philippines battle stigma, virus. 2020.
Available from: https:// www.aljazeera.com/amp/news/2020/4/2/attacked-
underpaidmedics-in-philippines-battle-stigma-virus
De los Santos, J. A. A., & Labrague, L. J. (2021). The impact of fear of COVID-19 on
job
stress, and turnover intentions of frontline nurses in the community: Across-
sectional study in the Philippines. Traumatology, 27(1), 52–59.
https://doi.org/10.1037/trm0000294
Salazar de Pablo G, Vaquerizo-Serrano J, Catalan A, Arango C, Moreno C, Ferre F, et al.
Impact of coronavirus syndromes on physical and mental health of health care
workers: Systematic review and meta-analysis.
Maraqa B, Nazzal Z, Zink T. Palestinian health care workers’ stress and stressors during
COVID-19 pandemic: A cross-sectional study. J Prim Care Community Health.
2020; 11:2150132720955026. pmid:32847464
Hou T, Zhang T, Cai W, Song X, Chen A, Deng G, et al. Social support and mental
health
88
BSN
among health care workers during Coronavirus Disease 2019 outbreak: A
moderated mediation model. PLoS One. 2020
WHO. WHO Coronavirus (COVID-19) Dashboard. WHO. Published 2021. Accessed
May
20, 2021. Available from: https://covid19.who.int/
Jackson, D.; Anders, R.; Padula, W.V.; Daly, J.; Davidson, P.M. Vulnerability of nurse
and
physicians with COVID-19: Monitoring and surveillance needed. J. Clin. Nurs.
2020. [CrossRef]
Gómez-Ochoa, S.A.; Franco, O.H.; Rojas, L.Z.; Romero Guevara, S.L.; Echeverría, L.E.;
Glisic, M.; Muka, T. COVID-19 in Healthcare Workers: A Systematic Review
and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and
Outcomes.
Am. J. Epidemiol. 2020.
Pappa, S.; Ntella, V.; Giannakas, T.; Giannakoulis, V.G.; Papoutsi, E.; Katsaounou, P.
Prevalence of depression, anxiety, and insomnia among healthcare workers during
the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav.
Immun. 2020
Shaukat, N.; Ali, D.M.; Razzak, J. Physical and mental health impacts of COVID-19 on
healthcare workers: A scoping review. Int. J. Emerg. Med. 2020, 13, 40.
[CrossRef] Murphy, G.T.; Birch, S.; MacKenzie, A.; Alder, R.; Lethbridge, L.; Little, L.
Eliminating
89
BSN
the Shortage of Registered Nurses in Canada: An Exercise in Applied Needs-
based Planning. Health Policy 2012, 105, 192–202. [CrossRef]
World Health Organization Nursing and Midwifery: Key Facts. Available online:
https://www.who.int/news-room/fact-sheets/ detail/nursing-and-midwifery.
World Health Organization Mental Health: Strengthening Our Response. Available
online:
https://www.who.int/news-room/ fact-sheets/detail/mental-health-strengthening-
our-response
Sadang JM. The Lived Experience of Filipino Nurses’ Work in COVID-19 Quarantine
Facilities: A Descriptive Phenomenological Study. PRIJNR [Internet]. 2020 Dec.
90
BSN
91

Final Group A BSN 3A 2

Uploaded by

Copyright:

Available Formats

Final Group A BSN 3A 2

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Final Group A BSN 3A 2

Uploaded by

Copyright:

Available Formats

BSN

ST. ANTHONY COLLEGE OF ROXAS CITY, INC.

Psychological Well-being and Turnover Intentions among Registered

Nurses in Roxas City, Capiz during the COVID-19 Pandemic

Belvis, Belle Brian

Tablo, Jan Mileno

Background of the Study

In early 2020, China saw an outbreak of a novel, sometimes fatal, severe

known as SARS-CoV-2), caused a pandemic in China. With tens of thousands of

of putting roughly 60 million people under quarantine. (World Health Organization,

Organization (WHO) declared a global pandemic. This overburdens many countries'

challenges related to the COVID-19 pandemic. (WHO, 2020).

increased turnover. High turnover of healthcare workers might lead to disastrous

consequences of the international efforts to contain the COVID-19 pandemic. (Salazar de

deaths (WHO Health Emergency Dashboard, 2022). Containing virus transmission,

of the issues that the Philippines continues to face.

resignations of healthcare employees. Healthcare professionals, particularly nurses, have

response measures for future pandemics.

consequences of COVID-19 to health workers in the Philippines especially in rural

study to further investigate the relationship of mental or psychological well-being and

Statement of the Problem

pandemic. Specifically, it seeks to answer the following:

study in terms of:

e. Years of professional service in the hospital

f. Current work shift

COVID-19 pandemic when taken as a whole and when grouped according to

the hospital, current work shift, and monthly wage?

COVID-19 pandemic when taken as a whole and when grouped according to

age, sex, area of exposure, nurse-patient ratio, years of professional service in

the hospital, current work shift, and monthly wage?

4. Was there a significant difference in the psychological well-being of registered

area of exposure, nurse-patient ratio, years of professional service in the hospital,

current work shift, and monthly wage?

5. Was there a significant difference in the turnover intentions of registered nurses

exposure, nurse-patient ratio, years of professional service in the hospital,

current work shift, and monthly wage?

6. Was there a linear relationship between the psychological well-being and

turnover intentions among registered nurses during the COVID-19 pandemic?

the following hypotheses:

1. There was no significant difference in the psychological well-being of registered

area of exposure, nurse-patient ratio, years of professional service in the hospital,

current work shift, and monthly wage.

2. There was no significant difference in the turnover intentions of registered

area of exposure, nurse-patient ratio, years of professional service in the hospital,

current work shift, and monthly wage.

3. There was no linear relationship between the psychological well-being and

turnover intentions among registered nurses during the COVID-19 pandemic.

To explore antecedents and outcomes of nurse self‐reported job

satisfaction and dissatisfaction‐based turnover cognitions, this study was anchored

adverse events. (Deci, E. L., & Ryan, R. M., 2012)

It is also applied in this study the turnover theory to conceptualize dissatisfaction‐

autonomy, and relatedness), energizing and motivating individuals to perform while

2013). Finally, it also contributes to research on health care organizational performance

affect nursing practice affect nurses’ lives in the workplace by contributing to or

domains (i.e., staffing and resource adequacy, workplace relations, and

Figure 1. Self-determination theory: A Framework for Enhancing Patient Centered Care

basic needs: Autonomy, Competence, and Relatedness.

This study was focus on the following demographic characteristics and

professional profile as independent variables: age, sex, area of exposure, nurse-Patient