“We stay at work for you, you stay at home for us! – This social media shoutout resembles the plea of nurses to stay at home during the quarantine mechanisms of the local government while they are working 24/7 in the hospitals. Many hospitals in the Philippines are also shouting for mass hiring amidst increasing cases of COVID-19 patients in the past months and tremendously asking more workforce in healthcare to battle their plights in this pandemic crisis. In the last quarter of the previous year where the outbreak is observed on the coronavirus disease 2019 (COVID-19) in Wuhan, China, the healthcare workforce was overwhelmed. Clinical nurses, midwives, physicians and other healthcare workers who had no background on infectious disease as experts were summoned to take care of patients with COVID-19 cases. To the latest knowledge from the review of literature, limited studies on the plight of their combating scenarios in COVID19 have been published. Thus, this research entailed a description of the phenomenon of why nurses stay during the COVID-19 pandemic crisis in the Province of Bataan and described their understanding of the language of caring at the bedside.

On the other hand, Roman [1], claimed in her study that Bataeño nurses are as someone who establishes a healing environment in the healthcare, with high regard to growth and expansion of knowledge- improving personally and professionally. These characteristics had been challenged by the outbreak of the COVID-19 pandemic crisis since the first quarter of the year 2020.

Bataeño nurses working in any private hospitals, district hospitals and the lone provincial general hospitals are taking on more and more responsibilities while trying to understand and adapt to this pandemic disease that still isn’t understood very well up to the moment.

Their bedside works are physically taxing and even psychologically threatening since they were asked not to stay at home to avoid further contamination. Nurses in general, requiring them to be on their feet 24/7 throughout long duty shifts of 24 hours every other day with very few, if any, breaks and even enduring long hours of wearing N95 masks if blessed to have or having the astronaut like suits with eye goggles in particular. Likewise, Sarwari revealed many nurses in other countries are experiencing exhaustion, fatigue, duress of prolonged wearing of the equipment and the challenge of sweating. An additional burden on nurses comes from having to provide emotional and psychological support to dying patients with unknown cause, whose families can’t be with them inside the room because of the threat and fear of getting contaminated by the virus.

Some Bataeño nurses’ message personal discrimination and bullying have described a culture of silence and inactions from others and a desperate lack of protective equipment that has put them and their significant others at risk from the outbreak. People will often say that they might get contaminated with the virus as it mutates to become resistant to an anti-viral drug. Many nurses had expressed disappointment with this threat of getting infected and even their families are getting affected. In this case, the local government unit in the province and the administrators of the various hospitals had placed them in isolation and preventive to cautiously quarantine them from having infected. Some nurses were confined with hotels and lodges to ensure that their families are not becoming infected and get a good rest and sleep away from their genuine compassion for serving those at risk of the outbreak.

In the study of Quia, et al., it revealed three themes of nurses' experiences as “being fully responsible for patients' wellbeing ‘this is my duty’”. Nurses and other healthcare workers volunteered and extended their best for optimal care at the bedside with COVID19 cases. Nurses had a vital duty in providing intensive and critical nursing care and assisting with their bedside activities in their day to day activities. 

More so, “challenges on managing cases with COVID-19” was truly observed and getting high workloads for them. Nurses and other health-care workers are under pressure and challenge working in a new ecology of staffing and scheduling wherein most are in the call of 24/7 or some are every other 24 hours, compassion fatigue, burnout and exhaustion secondary to heavy workloads and protective gear, the fear and anxiety of becoming contaminated or worst is to be infected and infecting others and most especially their significant others, feeling hopeless to handle COVID19 cases, discerning low to what care shall be given and managing interpersonal relationships in this stressful environment. Further, nurses experienced “resilience amid challenges”.

This study was anchored to the Maurice Merleau-Ponty description of phenomenology as defined as the study of essences to Martin Heidegger, a method of describing the context of perceptual being with the reality as the essences of consciousness. His concept of Phenomenology of Perception [2]. Nurses were asked to describe their perceptual contact on their plight in taking care of patients with COVID-19 cases at the bedside.

Data collection tools were used to facilitate trustworthiness and ensure credibility by in-depth interviews followed by peer debriefing from an expert Psychologist. Members checking were facilitated through the transcripts independently by bracketing data on preconceived ideas. Prolonged engagement in the analysis was ensured. Findings were then compared and discussed by the researcher to the participants until consensus on themes, theme clusters and categories were achieved. The audit trail was kept recorded to ensure consistency in the analytical procedures and could be traced back to original interviews. Data were analyzed thematically.

Limitation to this study is through online applications because the Province of Bataan was in lockdown through enhanced community quarantine and the researcher had been prevented to visit the hospitals though visits were conducted after the analysis of the data. Twenty-one nurses as samples of the population were recruited who resulted positive in their first result of rapid test kits but ended negative consecutively in their succeeding tests. The profiling of the nurses was not done but instead focused on their ground of experiences. Only those with initial positive results were interviewed and had expressed memorable experiences in caring for patients with COVID-19. However, the researcher did not compare their experiences and consciousness from those private hospitals to those public hospitals. No information about the hospitals were used in the study. Clearance from the research ethics committee was facilitated for approval.

The plight of nurses who experienced caring COVID-19 patients had tremendously seen with great value and good command of caring language at the bedside. Their values and goods personally and professionally had impactful to their level of care they delivered to their patients with COVID-19. Indeed, their testimonies and consciousness had given them insights that would address the caring demands of the situation, virally infecting risks of the COVID-19 and fearful delivery of care at the bedside. Despite these many challenges and apprehending the burden of these nurses they prefer to challenge themselves and not allowing any instances to make themselves afraid and fearful to take care of patients with COVID-19. Figuratively, the language of caring means care driven communication skills of nurses helps in improving patient experience but in this study language of caring is a metaphoric statement of how caring has been moved by the challenges and burden of taking care of patients with COVID-19.

“Paghahanda”: Care to be Ready!

This study revealed their initial thoughts and reactions on what they perceive to be of most valued characteristics of nurses as their language of caring and as they described in the amidst of the COVID-19 pandemic crisis. It was observed that despite their awareness about the outbreak, some clung to a reality in fragmentation at the point of care where the interaction between patients was not therapeutic due to their cases to the point that their unique needs as nurses were not recognized. However, these realizations were just temporary things.

Opening Tainted Impasse

It is not a complete surprise that the nursing profession goes through a rocky road path in the Philippines. Some days are worse than the others and those days, some consider changing careers especially now in the amidst of COVID-19. While other jobs may bring just as much ill-treatment, some are not usually expected to maintain a high level of function. Amidst the abuse, participants’ thinking was to keep people alive in the middle of the festering angst. 

Another statement from Participant 15 opened up the desire of caring for patients and putting herself in their shoes to deliver care and interventions to the best of her abilities. 

“Caring nature, maalaga kasi ako sa mga pasyente. Gusto ko nafu-fulfill yung mga pangangailan nila kasi simpleng bagay lang naman yun lalo nap ag alam nilang positive sila sa COVID 19. Nilalagay ko yung sarili ko sa kalagayan nila, na meron silang nararamdaman kaya minsan hindi maayos yung pagbitaw nila ng mga salita. Dapat din na mabilis tayong maka-adapt sa environment natin kasi paiba-iba yun araw araw.”

“Caring nature, I am concerned about my patients. I see to it that I attend even to their simplest needs and when they learned that they are positive to COVID-19. I understand that they are not feeling well that’s why they say some words that might not be good to hear. We must also learn to adapt to the fast-changing environment.”

Decision Making Dilemma

Accepting their condition with the pandemic crisis which is being faced in the harsh reality of nursing situations, becomes the new normal for them that they may not and or can be understood as of the moment of stressful environment.

Supported by the Statement, Participant 1 Also Verbalized Being in the Same Situation

“Sa tingin ko Yung pagiging stressful ng trabaho natin, workload, nurse-patient ratio pati na yung maliit na sahod lalo na a pandemic crisis. Minsan kahit na gustuhin nating maging patient at mabait at all times, parang nakakapagod din lalo na pag hindi ka na c compensate ng maayos. Overtime lagi dahil madaming naiiwan na trabaho, mga charts na hindi pa naclose, dahil ang dami daming pasyente tapos konti lang naman ang mga nurse.”

“I think the workload, the nurse-patient ratio and the compensation causes stress to us, nurses, even during the pandemic crisis. Sometimes, even if we try to be patient and nice, it gets tiring when you know that you are not given what you deserve. We are always on overtime because we can’t just leave our patients, their charts are not yet closed, all because of the lack of nurses.”

“Pagsasabuhay” Heart, Mind, Body and Soul Formula

Bataeño nurses used therapeutic skills as navigators of advocacy and integral negotiator for patients’ basic human needs in the times of outbreak. Besides, Benner and Perra [3], explained that nurses must-have of the art knowledge of their clinical specializations with the competence of technological use of their skills to influence others to create a platform and delegate through carrying out a plan of care but therapeutic use of self would matter.

KSA Phenomena

Nursing is an appreciation of and empathy for patients’ experience in the pandemic crisis, their holistic abilities could influence their delivery of nursing and enabling to improve their knowledge, skills and attitude.

Participant 3 defined the excellence of nurses to be of combination from different aspects especially in times of crisis:

“Ang essence ng pagiging excellent nurse is very broad lalo na sa epidemic ngaun. Kailangan meron ka lahat, a little bit of everything, wala nga taung proper crisis management training and theoretical at clinically equipped ka every day of the duty, yung good values dapat lagi mong inaalala at ginagawa. Mahirap maging nurse, pero sobrang sarap sa feeling pag nakakatulong ka na sa iba.”

“The essence of being an excellent nurse is very broad in particular epidemic crisis now. You need to have a little bit of everything coz we don’t even have proper training on crisis management, be equipped theoretically and clinically. You must always have the values not just in your mind but also in your heart. It’s not easy being a nurse, but when you know that you’re helping others, it’s all worth it.”

Acceptance Versus Resistance

When the environment becomes toxic due to the pandemic crisis, nurses have become more dedicated to countless nursing works and pathways that may tend to decline their ecology of nursing care and becoming unpleasant to their responses.

Participant 11 shared the sentiment regarding the difficulty to cope in times of busy situations and keeping up the cool during duty:

“I think isa yung working environment natin. Minsan kasi kahit gaano natin gustong i-maintain na maayos yung pakikitungo natin or well rounded tayong nurse, nasusubukan yung pasensya natin sa mga tao sa paligid. Sa mga nakakasalamuha rin nating tao, pwede rin yung pag sobrang busy na, hindi na natin alam kung anong uunahin. May tendency na uminit yung ulo natin and maging masungit sa pakikipag-usap.”

“I think one of the factors is the working environment. Sometimes, even though we want to maintain a healthy relationship with others or stay well rounded, our patience is still tested by the people around us. There is a tendency for us to lose our temper because we don’t know what to do first, who to attend to, or who to talk to.”

“Pakikidigma” No Turning Back: Overcoming Obstacles

Couch [4], postulated that nurses who display characteristics of submissiveness, unassertiveness, anxiety, fear and overloaded, are more likely to experience burnout.

Battling Barriers

Resilience was configured as an ability to give a new perception in the new normal and the difference it makes when practicing the good characteristics of nurses, due to several changes of emotional, psychological and physical natures.

Table 1: Summary of Essential Themes and Subthemes on the Language of Caring

Participant 18 mentioned:

“Issues sa salary increase, hindi naman iba sa atin na sobrang liit ng sahod ng mga nurses lalo na pag private. Isa pa yung over workload, napakarami ng trabaho natin tapos hindi tayo well compensated. Nakakawala ng motivation para magtrabaho pag may mga ganung problema pero tayo lang din naman maapektuhan kapag lagi nating iisipin yun, basta ayusin nalang natin ngaung COVID yung trabaho para maka-contribute tayo sa paglago ng nursing profession.”

“The issue in salary increase, we are all aware that nurses have a very low salary especially those who work at private hospitals. One more thing is the increased workload. They are given all the work but then, they are not compensated equally. The motivation gets low because of these factors but even if you always think of it, nothing will happen, nothing will change. We just have to do our job now we have COVID so we can contribute to the betterment of the nursing profession.”

A New Normal

In this sense, the role of nurses on how to maintain good characteristics when dealing with an everyday situation like the pandemic crisis of COVID-19 is emphasized as the main catalyst for the patient's caring resilience in their hospitalization process.

Participant 5 mentioned:

“Yung caring attitude, critical thinking pag nasa duty, pagiging maalam kung papaano mag rerespond sa iba’t-ibang sitwasyon sa crisis na to kasi hindi naman magkakapareho yan. Pagpasok ko dapat ready na ako sa anumang aabutan ko sa trabaho, expect the unexpected. Ano ba yung mga priorities ko for the day, mga dapat i-accomplish. Time management lang sa trabaho ang solusyon.”

“The caring attitude, critical thinking at work, being knowledgeable on how to respond to different situations in this crisis because they all differ. When I go to work, I must be ready and be equipped with all that I may need, to expect the unexpected. What my priorities for the day are, what I need to accomplish. Time management is the solution.”

“Pagpapatotoo” Amidst the Challenges: Upholding Nightingale Pledge

Bataeño nurses stressed out that their general health could be affective by their disturbance and influence their learning processes. Moreover, the inadequacy of knowledge and skills, the poor capability of mental and psychological preparation that could influence the learning and patient caregiving processes [5].

Bringing Truth to Light

The nursing workforce with diverse backgrounds, beliefs and culture, inter-generational ages. Their level of acculturation in bringing up cross-cultural care understanding matters in their language of caring. 

Participant 4 shared the importance of learning how to blend in and deal with each other’s uniqueness:

“Being a good role model, hindi lang sa pasyente pati na rin sa relatives at sa mga katrabaho. Maganda yung naiimpluwensiyahan mo sila kahit sa mga maliliit na bagay lang. Kapag nakikita nila kung papaano ka mag-alaga, na good yung intentions mo sa kanila, makikita nilang dapat nilang pahalagahan yung kalusugan nila. Sa tingin ko yun ang importante kasi ang goal naman natin ay towards sa ikabubuti ng pasyente.”

“Being a good role model, not just to the patients but also to their relatives and our colleagues. It is also good to influence them even with just the little things. When they see how you care for them, that you have good intentions for them, they will realize that they must care for their health. I think it is important because our main goal is for our patients to be better.”

Hope for the Uncertain Future

The theme was described as a way of being there to help in making the fear uncertain, being with the patient to ensure that hopes are coming, using influence to ensure that caring is resilient. Thus, these facilitate and coordinate care through collaboration, creating a difference in the profession, even without the assurance for the future.

Participant 12 shared:

“Being a nurse with concern, heart and true dedication sa has chosen profession natin. Iyun talaga. Showing that health care is not just about giving medicines, it’s about simple gestures ng pagmamahal, simpleng pagkamusta natin sa mga pasyente and a smile can make a great difference. It’s not too late to make a change in our profession, sobrang helpful ang nurses saan man magpunta.”

“Being a nurse with concern, heart and true dedication in our chosen profession. That’s it. Showing that health care is not just about giving medicines, it about the simple gestures of love, a simple “hello” or “how are you” and simple smiles that can make a big difference. It’s not too late to make a change in our profession, nurses are really helpful wherever they go.”

Care driven in the amidst of COVID – 19 pandemic crises by nurses are empowering to their pledge of loyalty coming from the roots of Florence Nightingale and influence by Anastacia Giron Tupas as the nursing curriculum bridge the practice in the province. Caring is not tantamount to any services could nurses or any healthcare workers could provide. Caring promotes hope and faith. Caring gives happiness and brightness to the possibility that these patients might heal in the language of care being rendered by nurses [6]. As nurses, 24/7 service delivery is extended to any patients but when the COVID-19 pandemic crisis arises it double the time. Indeed, caring inasmuch provides scope and framework to how and up to what duties and responsivities shall nurses deliver to. This is an expansion of what nurses could bring about in the table and worthy of recognition. It is high time now to uplift the nursing profession in terms of their remuneration, benefits and welfare. Saying thank you to them is not enough to compensate what they have lost since the outbreak had started. The nursing shortage is evident and coming and nurses might leave but what have seen in the amidst of COVID-19 is that nurses stay for their language of caring because they care to be ready, they care their heart, mind, body and soul, care to fight and care to become a hero. A deep study on their language of caring in times of crisis is highly recommended. Further training on crisis management is encouraged [7].

Synthesis and Implications

The intensive call of duty among Bataeño nurses had engaged them that caring at the bedside with alarming infection of virus is priceless and even more putting unsafe their well-being and getting threatened with their families but they were able to manage it. It has been more than three months since the outbreak had started instilling fear, anxiety, apprehension and nightmares for some healthcare workers but nurses withstand their efforts and firmed to stay in the bedside nursing despite the amidst of COVID-19 pandemic crisis. 

Thus, exploring the language of caring would give a legacy to the new heroes of society and making proud of the land of valor and heroes (Bayan ng Banal at Bayani) toward nursing excellence in the province.

1. Roman, Kalilah Gianna T. “Unveiling the divergent characteristics of bataeñ nurse practitioners: Through a Q-sort approach.” Katig Journal, 2018.

2. Merleau-Ponty, M. Phenomenology of Perception. Routledge & Kegan Paul, 1978.

3. Benner, P. and J. Wrubel. “The primacy of caring: Stress and coping in health and illness.” The American Journal of Nursing, vol. 82, no. 3, March 1982, pp. 402–407. Lippincott Williams & Wilkins. http://www.jstor.org/stable/3462928.

4. Couch, L.B. “Compassion fatigue and burnout of critical care nurses.” Nursing Theses and Capstone Projects, no. 289, 2017. https://digitalcommons.gardner-webb.edu/nursing_etd/289.

5. Dela Rosa, R. and M. Baua. “Redefining nurses’ praxis, nursing paradigms and theoretical perspectives in times of global crisis: A concept analysis.” International Academic Journal of Advanced Practices in Nursing, 2021.

6. Rosa, R.D. “From station to bedside and beyond: Clinical nursing workflow processes in cardiovascular and oncology units.” Journal of Research and Development, 2018.

7. Dela Rosa, R. and J. Mañiago. “Students’ preparedness and their clinical performance in psychiatric and mental health nursing.” European Scientific Journal, vol. 14, no. 6, February 2018.