Chapter III

Result and Discussion

This chapter presents the findings of the study on the lived experiences of staff nurses

in delivering patient care during and after the COVID-19 pandemic. Using thematic analysis

within a juxtaposed design, the experiences were categorized into major themes. Data from

interviews with five informants were analyzed, and verbatim responses were included to

maintain authenticity and credibility.

The findings are organized in a comprehensive table that juxtaposes experiences during

the pandemic and post-pandemic, highlighting the similarities and differences across key

themes. This approach provides a holistic view of nurses’ experiences and the evolution of

their professional and emotional responses to the challenges of COVID-19.

Juxtaposition of Nurses’ Experiences During and Post COVID-19 Pandemic

Theme 1: Nursing Care Delivery Experiences

This theme refers to the clinical tasks, infection control practices, and patient care management

performed by nurses, contrasting the restrictive, high-stakes environment of the pandemic with

the routine, manageable practices of the post-COVID era.

Juxtapositio During COVID-19 Post-COVID-19

n
Similarities Infection Control Focus: "We Sustained Vigilance: "Infection

sealed cracks, built isolation control measures remained part

facilities, and created zones... strict of daily practice... the awareness

with infection control measures." — we developed remained part of

Nurse Buen & Nurse Haggai our routine." — Nurse Chan &

Nurse Haggai

Differences Restrictive & Exhausting: "Very Routine & Manageable: "Now,

exhausting and overwhelming... COVID is treated like a severe flu.

everything was systematic, but PPE is less strict... care feels

very restrictive." — Nurse Chan more routine and manageable."

& Nurse Buen — Nurse Buen & Nurse Chan

Nursing care delivery represents the foundational clinical practices and infection

control measures used to ensure patient safety across the pandemic spectrum. During

the height of COVID-19, this experience was defined by the rapid construction of

isolation zones and the implementation of rigid negative pressure environments. Nurses

describe a shift from "restrictive and exhausting" care during the peak to a more

"routine" delivery system as vaccines became available. While the intensity has

decreased, the heightened awareness of infection protocols remains a permanent

fixture of daily practice. This theme captures the evolution of nursing from a state of

emergency response to a refined, systematic methodology of care.

The findings indicate that while the "chaos" of the pandemic has subsided, the rigorous

infection control standards developed during the crisis have become a permanent
clinical baseline. This reflects the global shift toward "biocontainment nursing," where

high-level surveillance is integrated into routine care to prevent future outbreaks.

Literature suggests that the "normalization" of PPE and isolation protocols, as noted by

the participants, is a common post-pandemic adaptation in Southeast Asian healthcare

settings. Research by Labrague and de los Santos (2021) confirms that COVID-19

fundamentally altered nursing workflows, mandating a permanent increase in technical

vigilance. Furthermore, the transition of COVID-19 from a pandemic threat to a "severe

flu" status in clinical perception allows for more focused, less restrictive patient

engagement. As highlighted by Martinez et al. (2022), the integration of pandemic-born

efficiencies has ultimately streamlined nursing care delivery in the long term.

Theme 2: Workload and Physical Strain

This theme refers to the intensity of patient loads, staffing ratios, and the physical

demands, such as long shifts, PPE use, placed on nurses across both periods.

Juxtapositio During COVID-19 Post-COVID-19

Similarities Extreme Demands: "The Ongoing Demands: "I still

pandemic significantly experience fatigue and

increased workload... shifts exhaustion, as nursing is

were 15 days straight... PPE was physically and mentally

suffocating." — Nurse Thea & demanding work." — Nurse

Nurse Buen Haggai

Differences Critical Understaffing: "Our Balanced Assignments: "Staffing

nurse-to-patient ratio was levels are more stable, and patient

around 1:12 to 1:18... we had 31 assignments are more balanced...

patients with only two nurses." shifts were limited to 12 hours."

— Nurse Chan & Nurse Buen — Nurse Haggai & Nurse Chan

Workload and physical strain encompass the patient-to-nurse ratios, shift durations, and

the sheer physical exhaustion caused by prolonged PPE use. During the pandemic,

nurses faced extreme conditions, such as 15-day straight shifts and suffocating fatigue

while wearing heavy protective gear. The lack of staff led to overwhelming ratios,

sometimes reaching one nurse for every 18 patients or even 31 patients for two nurses.

Currently, these demands have transitioned into a more "manageable" state with more

balanced patient assignments. However, the inherent physical demands of nursing

mean that a level of "normal exhaustion" persists even in the post-pandemic era.

The shift from "suffocating fatigue" to "manageable exhaustion" underscores a

significant recovery in healthcare human resource management. During the peak, the

disproportionate nurse-to-patient ratios identified in this study mirrors the "nursing crisis"

reported globally, where staffing shortages led to unprecedented burnout. According to

a study by Sagherian et al. (2022), the physical toll of prolonged PPE use and extended

shifts during COVID-19 resulted in chronic musculoskeletal issues among frontline

workers. The current stabilization of shift hours to 12-hour rotations reflects institutional

efforts to mitigate the long-term physical impacts of the pandemic. However, even with

better time management, the "persistent fatigue" mentioned by participants aligns with
findings by Xu et al. (2023), who noted that the physical recovery of the nursing

workforce is a slow, ongoing process. This suggests that while the acute crisis has

ended, the physical vulnerability of the workforce requires sustained institutional

support.

Theme 3: Psychological and Emotional Challenges

This theme refers to the stress, anxiety, and emotional burden stemming from fear of

infection, patient mortality, and the professional pressure of nursing in a crisis versus a

stable environment.

Juxtapositio During COVID-19 Post-COVID-19

Similarities Fear of the Unknown: "There was Residual Stress: "I still

fear of the unknown... constantly experience stress, but it is

worried about bringing the virus less intense... there is still

home to my family." — Nurse Chan pressure in the job." — Nurse

& Nurse Thea Chan & Nurse Ghad

Differences Traumatic Exposure: "One of the Emotional Stability: "Stress is

biggest challenges was dealing with less. Fear is gone...

frequent deaths... heartbreaking to emotionally, I’m more stable

see patients isolated or dying." — and feel more in control." —

Nurse Chan & Nurse Thea Nurse Buen & Nurse Ghad

Psychological and emotional challenges refer to the internal stressors, such as fear of

infection and the trauma of witnessing frequent patient deaths. Nurses initially struggled
with a profound "fear of the unknown" and the anxiety of potentially infecting their own

families. The emotional burden was heaviest when witnessing patients die in isolation

without the presence of their loved ones. In the post-pandemic phase, while the acute

fear of death has vanished, nurses still face the typical pressures of a demanding

profession. This theme illustrates a journey from traumatic emotional breakdown to a

state of increased resilience and emotional stability.

The transition from "emotional breakdown" to "feeling more in control" highlights the

psychological resilience developed by nurses who survived the pandemic frontline. The

"fear of the unknown" and "family-related anxiety" cited by the participants are

consistent with the "moral injury" frequently discussed in recent psychiatric literature. A

study by Ruiz-Fernández et al. (2020) found that nurses experienced higher levels of

secondary traumatic stress due to the isolation of patients and the high mortality rates.

The participants' current sense of being "emotionally stable" suggests a post-traumatic

growth, where the experience served as a catalyst for better emotional regulation skills.

This is supported by findings from Mo et al. (2022), which indicate that frontline

experience can lead to long-term improvements in clinical confidence and stress

management. Nevertheless, the residual habits of constant disinfection point to a lasting

psychological imprint left by the global health crisis.

Theme 4: Ethical and Moral Dilemmas

This refers to the challenges of balancing professional duty, personal safety, and

resource allocation under the constraints of a global health crisis.

Juxtapositio During COVID-19 Post-COVID-19

n

Similarities Protocol Reliance: "We followed Established Guidelines:

hospital protocols... with the help "Decisions are easier now

of the doctors, we were able to because we have clearer

troubleshoot issues." — Nurse protocols and treatments." —

Chan & Nurse Haggai Nurse Chan

Differences Resource Prioritization: Patient-Centered Focus:

"Struggled to decide what was "Ethical challenges focus more

best, especially when resources on respecting patient choices...

were limited... balancing personal they are not as complicated as

safety with duty." — Nurse Thea & before." — Nurse Thea & Nurse

Nurse Buen Ghad

Ethical and moral dilemmas involve the difficult choices nurses made when resources

were scarce or when safety protocols conflicted with patient needs. During the

pandemic, dilemmas often centered on prioritizing care or managing the emotional pain

of separating newborns from COVID-positive mothers. Most nurses relied heavily on

medical teamwork and rigid hospital protocols to navigate these "heartbreaking"

decisions. Post-COVID-19, ethical challenges have significantly decreased and now

focus more on routine matters like respecting patient choices. Clearer protocols and

more abundant resources have made decision-making far less complicated than during

the crisis years.

The reduction in ethical dilemmas post-pandemic can be attributed to the transition from

"crisis ethics" to "clinical ethics." During the peak, the "separation of mothers and

newborns" mentioned by participants serves as a classic example of the conflict

between public health safety and individual emotional needs. Literature by Morley et al.

(2020) describes this as "moral distress," occurring when nurses know the right thing to

do but are prevented by constraints. The study's finding that "decisive doctors" and

"clearer protocols" eased this burden is echoed in research by Silverberg et al. (2021),

which emphasizes that strong leadership and clear guidelines are the primary mitigators

of ethical stress during a crisis. As resources have become more available, the focus

has shifted back to patient autonomy, a hallmark of traditional nursing ethics. This return

to "easier navigation" of ethical issues indicates a restoration of the standard ethical

framework in Philippine nursing practice.

Theme 5: Coping Mechanisms

This theme refers to the adaptive strategies including peer support, faith, and

professional pride used by nurses to maintain resilience and functionality.

Juxtapositio During COVID-19 Post-COVID-19

Similarities Social Support & Faith: "Relying Sustained Support: "Support

on the support of my colleagues, from colleagues and family still

friends, and family... Faith kept helps... communicating openly

me going." — Nurse Haggai & about difficulties." — Nurse Buen

Nurse Buen & Nurse Haggai

Differences Extrinsic Motivators: "The Intrinsic Fulfillment: "Motivation

compensation and hazard pay now comes from professional

also helped motivate me... pride and fulfillment rather than

focusing on one task at a time." financial incentives." — Nurse

— Nurse Chan & Nurse Thea Chan

Coping mechanisms are the internal and external strategies, such as faith and social

support, used by nurses to survive the pressures of the pandemic. Nurses relied heavily

on their "support systems," including colleagues, friends, and family, to release stress

and maintain a positive mindset. For many, faith acted as a primary anchor that

provided the strength to continue despite the "suffocating" environment. While financial

incentives like hazard pay were significant motivators during the crisis, post-pandemic

motivation has shifted toward professional fulfillment. Today, coping involves a blend of

better time management, self-care, and the lasting habits of resilience learned during

the pandemic.

The findings emphasize a transition from extrinsic motivation (hazard pay) to intrinsic

professional pride in the post-pandemic era. The heavy reliance on "faith" and "family

support" is a distinct cultural characteristic of Filipino nurses, often cited in literature as a

"spiritual coping" mechanism. According to a study by Lorenzo et al. (2021), Filipino

nurses often utilize "pagdadamayan" (mutual support) and religious conviction to

navigate high-stress environments. The shift toward "work-life balance" and "proactive

self-care" in the post-COVID period suggests a more sustainable approach to

professional longevity. Research by Shahrir et al. (2022) confirms that while financial

incentives are vital during a crisis, long-term retention is driven by professional

fulfillment and organizational support. Ultimately, the "habit of preparedness" remains

the most significant long-term coping strategy adopted by these nursing professionals.

Chapter IV

Summary

The following is the summary of the results:

a. Nursing care delivery shifted from restrictive and exhausting practices during

COVID-19 to more routine and manageable systems in the post-pandemic era,

with infection control vigilance permanently embedded in daily care.

b. Workload and physical strain were extreme during the pandemic due to unsafe

nurse-to-patient ratios and prolonged shifts, but have since stabilized into more

balanced assignments, though fatigue remains an inherent aspect of nursing

work.
c. Psychological and emotional challenges moved from fear, trauma, and anxiety

during COVID-19 to greater resilience and emotional stability in the

post-pandemic period, reflecting post-traumatic growth among nurses.

d. Ethical and moral dilemmas during the pandemic focused on scarce resources

and difficult decisions, whereas post-COVID challenges are simpler, centering on

patient autonomy under clearer protocols.

e. Coping mechanisms evolved from reliance on hazard pay, faith, and social

support during the crisis to intrinsic motivation, professional pride, and

sustainable self-care practices in the post-COVID era.