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CHAPTER I

THE PROBLEM AND ITS BACKGROUND

Introduction

Nursing has long been regarded as a noble and indispensable profession,

exemplified by selflessness, courage, humility, patience, and empathy of pioneers

like Florence Nightingale and Clara Barton. These qualities remain central to

modern nursing, which is vital to the health care system. Nurses are the largest

group of healthcare professionals, forming the backbone of hospitals and playing

critical roles in patient care, advocacy, and health promotion (Kevin, 2014). Despite

being consistently ranked among the nation’s most trusted professions by the

Gallup Organization, the significant contributions of nurses are often overlooked in

today’s complex and chaotic healthcare environment (Rosario, 2024).

The responsibilities of nurses extend far beyond providing medical care,

they serve as counselors, confidants, comforters, and great listeners (Bavier,

2018). Professional nursing involves not only the prevention and treatment of

illness but also the advocacy and promotion of health for individuals, families, and

communities (Epstein & Turner, 2015). However, their work environment often

poses substantial challenges. In many healthcare settings, including Philippine

government hospitals, nurses face overwhelming workloads, inadequate salaries,

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limited career advancement opportunities, poor communication, and unsafe

working conditions (Lina, 2018). The ideal nurse-to-patient ratio recommended by

the Department of Health (DOH) is 1 nurse per 12 patients, yet in crowded hospital

wards, this standard is rarely met, compromising both patient safety and the quality

of care. In under-resourced and overstressed healthcare systems, nurses may be

forced to delegate parts of their duties to untrained individuals, increasing the risk

of errors and endangering patients’ lives (Marxze, 2015).

At Zamboanga del Norte Medical Center (ZNMC), a secondary government

hospital in Region IX serving the province of Zamboanga del Norte, ward nurses

faced dual pressures of meeting patient needs while navigating the demands of

a complex work environment and an inadequate nurse-to-patient ratio. According

to reports from the Chief Nurse Office (CNO), newly hired nurses at ZNMC often

withdrew from their jobs after only a few days, weeks, or months of service.

Despite these challenges, the overworked ward nurses who remained at ZNMC

continued to demonstrate a strong commitment to providing quality care, which

motivated the researchers to explore, understand, and generate knowledge on

how these nurses managed to persevere.

Previous studies on ward nurses predominantly employed quantitative methods

and evidence-based practice approaches, focusing on measurable outcomes

such as performance metrics and care quality indicators. In response to these

phenomena, the researchers aimed to explore the lived experiences of ward

nurses who had been working at ZNMC for at least one year of experience. The

study sought to understand their daily challenges, how they balanced job
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demands with available resources, the coping strategies they employed, and the

motivating factors that sustained their passion and commitment to their roles.

By exploring the experiences of these nurses, the study aimed to generate

valuable insights that could contribute to the development of new knowledge.

The findings were expected to assist the institution by providing critical

information and a deeper understanding that could reshape hospital policies,

workplace approaches, and professional relationships. Ultimately, a deeper

comprehension of these lived experiences could help fill a critical gap and foster

a more supportive and fulfilling workplace benefiting healthcare providers, the

institution, and the patients they serve.

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Theoretical and Conceptual Framework

This study was anchored on Phenomenology theory by Edmund Husserl,

as cited by Smith (2000), which focuses on studying human consciousness and

experiences from a first-person perspective (Johnson, 2000; Koch, 1995).

Phenomenology is employed to deeply explore the lived experiences of ward

nurses in Zamboanga del Norte Medical Center, capturing their unique perceptions

and interpretations of their daily realities, balancing job demands with resources,

coping mechanisms, and motivating factors. Phenomenology argues that human

consciousness has structures or essences, and by describing these structures,

researchers can uncover the core nature of a phenomenon (Dahlberg, 2006;

Liamputtong, 2014). Through this lens, the study investigates how nurses

experience and navigate the challenges of their roles, such as heavy patient loads,

emotional strain, and resource limitations.

The Job Demands-Resources (JD-R) Model (Demerouti et al., 2001)

provides a framework for analyzing how the balance between job demands and

available resources impacts nurses' well-being and work performance. This model

will help to contextualize the balancing act that nurses perform to meet

professional expectations while managing limited resources, highlighting the

tension between their roles and the healthcare environment.

The study incorporates Stress and Coping Theory (Lazarus & Folkman,

1984), which examines the coping mechanisms nurses employ to manage

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workplace stress, such as problem-focused strategies and emotion-focused

approaches. These strategies are vital for maintaining mental and emotional well-

being amid the high-pressure demands in the hospital setting. Lazarus and

Folkman's theory provides a comprehensive framework for understanding the

interplay between stress and coping. It emphasizes that stress is not solely

determined by external factors but is significantly shaped by individual perceptions

and coping resources, which can lead to varying outcomes in terms of health and

well-being.

Lastly, Maslow’s Hierarchy of Needs (Maslow, 1943) is utilized to explore

the intrinsic and extrinsic motivators that drive nurses to continue their work, even

in challenging circumstances. While intrinsic motivators include a sense of purpose

and professional fulfillment, extrinsic factors such as financial stability, recognition,

and career growth play a significant role. Maslow’s framework illuminates how

these motivators align with nurses’ unmet needs, ranging from physiological and

safety needs to higher-level aspirations like esteem and self-actualization.

By integrating these theoretical frameworks Phenomenology, JD-R Model,

Stress and Coping Theory, and Maslow’s Hierarchy of Needs, this study will

comprehensively examine the lived experiences of ward nurses in Zamboanga del

Norte Medical Center. It will provide valuable insights into their daily realities,

coping strategies, balance between job demands and resources, and factors that

motivates them, ultimately contributing to evidence-based recommendations for

improving nurse well-being, enhancing workplace environments, and ensuring

high-quality patient care.

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The study examined these dimensions of the nurses' professional lives,

focusing on their daily realities, balancing job demands with limited resources,

coping mechanisms, and factors that motivates them. At the heart of this

framework is the nurses' lived experiences, shaped by their daily realities,

including the physical and emotional demands of patient care, administrative

responsibilities, and the challenges of working within a constrained healthcare

system. With these problems experienced coping strategies arouse, reflecting on

how they adapt to their environment. Nurses may rely on emotional resilience, peer

support, and mindfulness to manage stress while also employing practical

strategies like task prioritization and collaboration to address heavy workloads.

This balancing act directly ties into their sources of motivation, which fuel their

commitment to the profession despite adversities. Intrinsic motivators, such as

their passion for nursing and the fulfillment derived from improving patient

outcomes, interact with extrinsic factors, including financial incentives, career

growth opportunities, and recognition from peers and management.

Together, these dimensions highlight how ward nurses navigate the

complexities of their profession, demonstrating resilience and adaptability while

remaining driven by their dedication to patient care and professional growth. By

exploring these links in detail, the framework provides a nuanced understanding

of the lived experiences of ward nurses, emphasizing the interplay between their

challenges, strategies, resources, and motivations.

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Figure 1. Schematic Diagram of the Study

Through this framework, the study shows how the lived experiences of ward

nurses in ZNMC shaped and affected by the daily realities, resource management,

coping strategies and motivating factors. With this, it directly shows the

interconnectedness of these factors creating a phenomenon.

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Statement of the Problem

Zamboanga del Norte Medical Center (ZNMC), a secondary government

hospital in Region IX serving the province of Zamboanga del Norte, presented

unique challenges for its ward nurses. These healthcare professionals faced the

dual pressures of meeting patient needs and navigating the complexities of a

demanding work environment, compounded by an inadequate nurse-to-patient

ratio. According to reports from the Chief Nurse Office (CNO), newly hired nurses

at ZNMC often resigned after only a few days, weeks, or months of employment.

Despite these adversities, many overburdened ward nurses remained steadfast in

their commitment to providing quality care, which inspired the researchers to delve

deeper into their experiences to uncover the factors that sustained their resilience

and dedication.

This study sought to explore and understand the lived experiences of ward nurses

who had been serving at ZNMC for at least 1 . It aimed to examine their daily

challenges, resource management strategies, coping mechanisms, and the

intrinsic and extrinsic motivators that drove their enduring commitment to patient

care. By investigating these dimensions, the study endeavored to provide a

comprehensive understanding of how these nurses navigated the complexities of

their profession while maintaining their passion and resilience.

Guided by the central research question, “What are the lived experiences of ward

nurses in Zamboanga del Norte Medical Center?” this study aimed to document

personal narratives and firsthand accounts to offer a holistic view of their

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professional lives.

Significance of the Study

The results of this study will greatly benefit the following:

Nursing Students

The findings of this study will provide nursing students with valuable insights

into the lived experiences of ward nurses working in government hospitals. It will

offer a realistic perspective on the challenges and rewards of working in this

healthcare setting, aiding them in deciding if a similar path aligns with their

professional aspirations.

Nursing Instructors

This study's outcomes will help nursing educators understand the day-to-

day realities of ward nurses in government hospitals. Such knowledge will allow

them to incorporate real-life examples into their teaching, inspire students to thrive

in similar roles, and guide them in coping with workplace challenges. Furthermore,

it can inform educators on preparing students to meet the demands of government

hospital settings effectively.

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Readers

Readers will gain a deeper appreciation of the work of ward nurses in

government hospitals and the dedication required in this profession. This study will

highlight the critical role nurses play in providing healthcare services, fostering

respect and support for the nursing profession.

Future Researchers

This study will serve as a valuable reference for future researchers

interested in exploring topics related to hospital-based nursing, workplace

challenges, and healthcare systems in government institutions. The findings can

contribute to the development of more comprehensive studies and interventions to

address the needs of nurses.

Registered Nurses

The study will help registered nurses, especially those employed in or

considering working in government hospitals, to reflect on shared experiences

within their profession. By understanding the coping mechanisms and motivations

of their peers, nurses can derive practical strategies for personal and professional

growth while fostering a sense of solidarity and purpose in their work.

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Hospital Administrators

The insights from this study will inform hospital administrators about the

realities faced by ward nurses, including the challenges and factors that motivate

them. This understanding can help in implementing policies and programs that

enhance nurse retention, job satisfaction, and overall healthcare service quality in

government hospitals.

Zamboanga del Norte Medical Center

The findings of this study shall unveil information to the challenges faced

by ward nurses and offering insights to improve workplace policies, retention

strategies, and employee well-being. By understanding nurses' lived experiences,

ZNMC can develop better support systems, enhance training and development

programs, and improve resource allocation.

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Scope and Delimitation

This study focuses on exploring the lived experiences of ward nurses with

above 1 year of experience working at Zamboanga del Norte Medical Center. It

delves into four key dimensions of their professional lives: their daily realities,

coping strategies, balancing job demands with available resources, and motivating

factors. The study aimed to understand how these nurses navigate the challenges

of their work environment, manage emotional and physical stress, and find

motivation to fulfill their roles. The research captured their personal narratives to

provide an in-depth understanding of their unique experiences, emphasizing

factors such as workload, resource constraints, stress management, and

professional fulfillment.

The scope is limited to ward nurses within Zamboanga del Norte Medical

Center, excluding other healthcare professionals or nurses working in non-ward

settings, such as outpatient departments or special areas. The study is also

geographically confined to this specific medical center, which may limit the

generalizability of findings to nurses in other institutions or regions. Furthermore,

the research primarily relies on qualitative data gathered through interviews and

thematic analysis, which may be influenced by participants’ willingness to share

personal experiences openly. Despite these limitations, the study will seek to

provide valuable insights into the challenges, coping mechanisms, and

motivational factors of ward nurses, serving as a foundation for future research

and interventions to improve nursing well-being and work conditions.

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Definition and Terms

To provide clarity and a deeper understanding of the terms used in this

study, the following definitions are presented:

Coping Strategies

Refers to the behavioral and cognitive techniques used to manage stressful

situations, crises, or demands and in this study, it will be used as one of the factors

that the researchers will explore to assess their emotional management.

Daily Realities

Refer to the routine tasks, challenges, and experiences individuals

encounter in their everyday lives, shaped by their environment, responsibilities,

and personal circumstances. In this study, it will be used to highlight the practical

and emotional aspects of their profession and one of the factors that the

researchers will explore to assess their experiences in the ward.

Lived Experiences

Refer to the personal knowledge, feelings, and perceptions that individuals

gain through their direct involvement in events, situations, or daily life, shaped by

their unique context and identity and in this study, it will be used to reflect their

emotional, physical, and professional challenges and triumphs, offering a nuanced

understanding of their role in the hospital ward of ZNMC.

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Motivational Factors

Refers to the elements that encourage and inspire ward nurses at ZNMC to

continue working in their profession despite the challenges, including factors such

as professional fulfillment, supportive relationships, and the desire to provide

quality healthcare. it will be used as one of the factors that the researchers will

explore to gain information from the ward nurses.

Resource Management

Refers to the strategies employed by ward nurses at ZNMC to effectively

allocate and utilize limited resources, such as medical supplies, equipment, and

staffing, to ensure the delivery of quality healthcare services. It will be used as one

of the factors that the researchers will explore to assess their lived experiences

working as a ward nurse in ZNMC.

Ward Nurse

A licensed registered nurse responsible for providing direct patient care,

administering treatments, monitoring patient conditions, and managing patients’

overall well-being in hospital wards. In this study, they are the target participants

which the researchers shall explore their lived experiences to obtain vital

information and ideas from their experiences.

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ZNMC (Zamboanga del Norte Medical Center)

A secondary government hospital that has 146 bed capacity, in this study it

will be used as the setting where the ward nurses work and gain their experiences

as ward nurses.
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CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

Coping Strategies

Coping is defined as a series of behavioral reactions that people in stressful

situations display in order to alter their immediate surroundings and adjust to the

stressor in an effort to lessen discomfort. Coping, more precisely defined as a

stable and unconscious mental process used to manage internal and/or external

problems, can be defined as a defense mechanism that reduces negative

reactions to a given scenario (Portelada, 2023).

The book "Coping Strategies of Nurses in Ward Care Services" highlights

how nurses utilize different approaches to handle workplace stress. Among the

most effective strategies identified are problem-solving, positive reappraisal, and

seeking social support. Problem-solving allows nurses to critically assess and

address stressful situations, while positive reappraisal encourages them to find

meaning and personal growth in challenges. Social support, often sought from

colleagues, friends, or family, offers emotional reassurance and helps in mitigating

stress, promoting resilience within teams working in high-pressure environments.

The book also discusses less commonly used strategies, such as distancing and

confrontation, which may have negative implications. Distancing involves avoiding

stressful situations without resolving the root cause, which can lead to prolonged
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stress and strained relationships in the workplace. Similarly, confrontation is

described as an aggressive response that does not always yield positive results.

Factors like gender and marital status are noted to influence coping methods. For

instance, men were more likely to adopt confrontation strategies, while unmarried

nurses leaned toward positive reappraisal. These insights show the complexity of

coping mechanisms among individuals. Moreover, it stresses the importance of

institutional support in enhancing nurses' coping capacities. It recommends

measures such as stress management training, open communication, and

structured programs to monitor and address nurses' physical, emotional, and

professional challenges. These initiatives not only improve nurses' well-being but

also enhance patient care outcomes. By understanding the varied coping

strategies and their effectiveness, healthcare administrators can create better

support systems to address the unique demands of emergency care services.

Daily Realities

The term “daily realities” refers to the everyday experiences and challenges

individuals face, shaped by personal engagement with their environment. For

nurses, this includes managing stress, navigating demanding shifts, balancing

patient care with administrative tasks, and coping with physical and emotional

strain. According to Hochschild (1983), the “emotion work” required in professions

like nursing reflects how daily realities are not just about tasks, but also about

managing emotional labor while maintaining professional roles.

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A study by McEwen and Wills (2022) explored the daily routines of nurses

and their alignment with nursing theories such as the Adaptation Model by Sister

Callista Roy. This model emphasizes the nurse’s role in assessing patients'

adaptation to their health conditions and the environment, intervening to promote

well-being. In their study, the researchers found that a typical day for a nurse

begins with self-care activities like exercise or meditation to foster resilience and

mental clarity. This foundation helps nurses approach their day with the focus

needed to review patient charts, conduct assessments, and implement

personalized care interventions. Nurses’ ability to assess and support patients’

adaptation is a critical aspect of their practice, ensuring that each patient receives

the most appropriate care based on their unique health needs. The study

underscores the importance of these foundational practices in promoting both

nurse and patient well-being.

Lived Experiences

The term “Lived experience” refers to the personal knowledge and insights

individuals gain through direct engagement with life events and circumstances,

often contrasting with theoretical or external observations. Prosek and Gibson

(2021) highlight it as the subjective essence of individuals' encounters, capturing

unique perspectives shaped by social, cultural, and emotional contexts. This

concept is vital in fields like healthcare, social sciences, and education to

understand nuanced, authentic human experiences and inform policy or practice.

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The lived experiences of ward nurses in government hospitals reveal

significant challenges and areas for improvement. Studies have shown that shift

patterns significantly influence job satisfaction and well-being, with misaligned

schedules contributing to burnout and reduced care quality. Engagement with

nurses to address these preferences has proven beneficial in improving workplace

conditions and patient outcomes (Aoki et al., 2022; Thornicroft et al., 2022). During

the COVID-19 pandemic, nurses faced heightened stress due to overwhelming

workloads and emotional challenges. The socioecological framework was used to

analyze how organizational and societal factors influenced these experiences,

highlighting the importance of comprehensive institutional support (BMC Nursing,

2023).

Professional Development and Experience of Ward Nurses

The development of nursing competence is a progressive process rooted in

clinical practice and experiential learning. According to Benner’s Novice to Expert

Theory (1984), nurses advance through stages of proficiency novice, advanced

beginner, competent, proficient, and expert based on exposure to real-world

patient care scenarios. Ward nurses, due to their continuous hands-on

involvement with diverse cases and complex patient needs, often transition

through these stages more rapidly than nurses in less intensive roles. Their

repeated exposure to acute situations builds not only skill but also critical thinking

and intuition, which are essential for effective clinical judgment.

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In hospital ward settings, nurses assume multiple responsibilities, including

monitoring vital signs, administering medications, providing emotional support to

patients and families, and coordinating care with interdisciplinary teams. These

demands foster a dynamic learning environment where nurses continuously adapt

and grow. The lived experiences of ward nurses are thus invaluable in

understanding how theoretical knowledge is translated into practical expertise,

particularly in high-pressure and resource-constrained settings.

Ward Nurses

Ward nurses, also known as inpatient or floor nurses, are healthcare

providers who deliver direct care to patients in hospital wards or units. They

collaborate with various members of the healthcare team, such as physicians,

nurse practitioners, and allied health professionals. The main duty of a ward nurse

is to guarantee the comfort and well-being of patients throughout their hospital stay

(Patel, 2024).

In the study of Khosravi et al.,(2022) stated that the nursing staff plays a

crucial role in hospitals as a community that significantly impacts patients' health

and the quality of their treatment. The effectiveness and preparedness of nurses

also contribute to the overall quality of care and the success of therapeutic

outcomes. Even with the evolution of the nursing field, there is a continual need

for skilled nurses capable of delivering optimal care. In addition to possessing the

necessary practical skills, nurses must also demonstrate a strong level of nursing

knowledge and awareness. Delivering high-quality services to patients in hospitals

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can enhance patient satisfaction and improve the overall quality of hospital

services. Effective nursing quality is significantly impacted by the delivery of

attentive care, which necessitates a comprehension of the different facets of using

equipment and executing tasks properly. It is crucial for nurses to focus on nursing

processes, particularly in the areas of medication prescribing and administration,

to avert medication mistakes. A robust understanding of infection and germ control

among nurses can be beneficially applied across all areas of nursing care. Despite

the various reported cases, there are numerous issues related to nursing

processes and the execution of nursing care. Evaluating and understanding the

conditions of the work environment and the skill level of nurses, as well as

identifying their challenges, impacts nursing performance. The ability to execute

nursing processes is connected to their job performance and is crucial for both job

satisfaction and the standard of nursing care. The criteria for carrying out the

nursing process include maintaining systematic records and assessing nurses'

performance and preparedness in this area. Unfortunately, in our country, the

quality and implementation of the nursing process in hospitals are often

overlooked, resulting in a lack of evidence for its proper and complete execution.

The preparedness of nurses, a crucial segment of the medical team, is a significant

concern in the healthcare of the nation. By strengthening nurses' capabilities, we

can take proactive measures to tackle the challenges they face. Numerous studies

have explored the preparedness of nurses; however, given the growing difficulties

in nursing and the necessity for patient health, it is essential to focus on and assess

nursing care. Furthermore, identifying these shortcomings in various hospital

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departments can help compare nurses' preparedness concerning the evaluation

of clinical nursing care across different wards.

In the study of Afshar et al.,(2020) stated that nurses, as the largest group

of healthcare professionals, play a vital role in ensuring the quality of healthcare

services. Competency, a complex and multi-dimensional concept, is crucial in

nursing and includes discipline-specific knowledge, mastery of skills, professional

judgment, adherence to standards, and the effective application of knowledge and

abilities. Clinical competency remains a significant challenge in nursing. A lack of

competency can reduce job satisfaction, increase the likelihood of professionals

leaving the field, and negatively impact the quality of care. On the other hand, a

strong sense of competency fosters self-confidence, reduces burnout, and

enhances job satisfaction. In surgical departments, where patients require

specialized care, clinical competency is especially important. Surgery, being a

traumatic intervention, often places patients in complex situations that demand

nurses make timely and accurate clinical decisions. Additionally, the risk of

infection in surgical settings necessitates nurses' proficiency in infection prevention

and control strategies. These demands highlight the importance of skilled and

competent nursing care in surgical wards to ensure patient safety and improve

outcomes.

In the study of Mbuthia et al.,(2024) stated that failure to rescue a key

measure of patient safety and healthcare quality, refers to the inability or delay in

recognizing and addressing clinical deterioration in hospitalized patients,

potentially resulting in mortality. In-hospital mortality is increasingly viewed as a

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crucial indicator of service quality and patient safety. While some deaths in

hospitals are inevitable, healthcare providers are expected to identify early signs

of patient deterioration and take swift action to prevent avoidable fatalities.

Detecting and responding promptly to changes in vital signs and physiological

parameters can significantly reduce preventable deaths and unplanned

admissions to critical care units. Research indicates that physiological warning

signs often precede cardiac arrests in hospitalized patients, providing clinicians

with opportunities to intervene and avert adverse outcomes. Patient monitoring,

which includes assessing vital signs and physiological changes, is essential for

detecting these warning signs. Monitoring enables clinicians to activate rapid

response teams to address patient deterioration before critical events occur.

Commonly used monitoring criteria for activating such teams include abnormalities

in respiratory rate, heart rate, systolic blood pressure, oxygen saturation, changes

in mental status, and clinicians' concerns about the patient’s condition. Monitoring

can be done intermittently or continuously, such as through electrocardiogram

(ECG) tracking. Consistent monitoring allows for early detection of changes,

enabling timely interventions through effective communication and escalation of

care. Proper documentation, such as standardized vital signs observation charts,

is crucial for identifying trends and ensuring timely responses.

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Resilience and Coping Mechanisms

Resilience is a critical quality that enables nurses to withstand the emotional

and physical demands of their work. According to Lazarus and Folkman’s (1984)

Transactional Model of Stress and Coping, individuals appraise stressors and

apply coping strategies based on their perceived control and available resources.

Nurses in ward settings often utilize a range of coping mechanisms, including

problem-focused strategies such as prioritizing tasks and seeking support from

colleagues, as well as emotion-focused strategies like mindfulness, prayer, or

humor to manage stress.

Resilience is also reinforced by positive workplace relationships, continuous

learning, and a strong sense of professional identity. When nurses perceive their

work as meaningful and feel valued by their team and institution, they are more

likely to develop adaptive coping behaviors. Literature suggests that resilient

nurses are more likely to remain committed to their roles, show improved patient

interactions, and experience lower rates of burnout. Investigating these coping

strategies contributes to a deeper understanding of how nurses sustain

themselves in demanding work environments.

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Synthesis

The reviewed literature highlights various challenges and motivators that

impact nurses’ experiences across different healthcare settings. These include

heavy workloads, emotional strain, resource scarcity, workplace stress, and the

need for effective leadership. While many studies emphasize the role of intrinsic

and extrinsic motivators such as personal growth, financial rewards, and

institutional recognition there is a consistent focus on nurses working in specialized

departments like critical care, emergency units, or specific hospital contexts.

Several studies underscore the importance of daily communication and

organizational backing in improving nurses’ motivation and job satisfaction. For

example, Ahlstedt et al. (2020) highlight how positive interactions with colleagues

and supervisors enhance nurses' motivation and overall work experience.

Similarly, Saleh et al. (2022) argue that organizational empowerment and support

are crucial in promoting both mental health and motivation among nurses. Both

studies emphasize that a supportive work environment plays a pivotal role in

nurses’ well-being, stressing the need to cultivate a culture of positive

communication and teamwork within healthcare settings. Leadership traits such as

mentorship and compassion are often associated with improved nurse motivation

and performance. Frameworks like the Self-Determination Theory (SDT) and

socioecological models are instrumental in understanding how organizational and

personal factors shape nurses’ experiences.

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Despite the breadth of research on nurses in specialized settings, there is

limited focus on the lived experiences of ward nurses, particularly in government

hospitals like ZNMC. Previous studies on ward nurses have predominantly utilized

quantitative methods, focusing on statistical correlations and evidence-based

practices. Several studies focus on specialized areas such as critical care,

emergency departments, or private healthcare settings, ward nurses in public

hospitals face unique, multifaceted challenges due to the diversity of patient cases

and limited resources. Existing research has provided valuable insights into these

settings, often through quantitative methods or evidence-based practice

approaches, which emphasize measurable outcomes over in-depth, qualitative

exploration. These approaches, while valuable for identifying trends and

outcomes, often fail to capture the nuanced, subjective realities of nurses' lived

experiences. The voices of ward nurses particularly those with longstanding tenure

in challenging environments like Zamboanga del Norte Medical Center (ZNMC),

remain underrepresented in qualitative research. By employing a

phenomenological approach, this study aims to fill a critical gap, delving deeply

into the personal narratives of ward nurses capturing their unique perceptions and

interpretations of their daily realities, balancing job demands with resources,

coping mechanisms, and motivating factors.

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CHAPTER III

RESEARCH METHODOLOGY

This chapter presents the research methodology utilized in the study. It

discusses the research design, environment, participants, instruments, data-

gathering procedures, methods of data analysis, and ethical considerations. These

elements collectively provided a structured framework to carry out the study.

Research Design

This study employed a qualitative descriptive approach (Creswell, 2013).

This method was selected as it enabled the exploration of the lived experiences of

ward nurses in Zamboanga del Norte Medical Center, allowing for the identification

of recurring themes, ideas, and patterns central to the participants' professional

lives. Descriptive qualitative research provided flexibility and an exploratory

framework, which was ideal for understanding complex, nuanced phenomena

such as the challenges and coping mechanisms of nurses in a resource-

constrained healthcare setting (Kim et al., 2016).

The study aimed to document the experiences of ward nurses, focusing on

their daily realities, coping strategies, job demands, and sources of motivation.

Through the analysis of their personal narratives, the study explored how these

nurses managed the emotional, psychological, and physical demands of their

roles, balancing professional expectations with available resources.

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Research Environment

The study was conducted at Zamboanga del Norte Medical Center, a

government hospital in Region IX. This medical center served as a secondary

healthcare facility with a 146-bed capacity for residents of Zamboanga del Norte

and neighboring provinces, offering a wide range of medical services. It had five

separate wards—Surgical, Medical, Pediatric, OB-GYN, and Respiratory—with a

total of 202 employed nurses. The hospital was located in Barangay Minaog,

Dipolog City, in the province of Zamboanga del Norte. Like many public hospitals,

it faced challenges such as high patient volumes, understaffing, and limited

resources. These factors created a unique and often challenging environment for

nurses, which significantly influenced their lived experiences. The research

focused on ward nurses working in various departments of the medical center.

Figure 2. Map of Zamboanga del Norte

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Figure 3. Front View of Zamboanga del Norte

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Research Participants

The participants of this study consisted of five ward nurses from

Zamboanga del Norte Medical Center (ZNMC). These participants were selected

through purposive sampling based on specific criteria relevant to the study’s

objectives. They were currently employed at ZNMC and had at least one year of

experience working in the ward. This criterion ensured that the participants had

substantial experience in managing the demands and challenges of ward nursing,

providing a deep understanding of their professional environment. By employing

purposive sampling, the study aimed to identify individuals who could offer rich, in-

depth insights into the realities of long-term ward nursing, ultimately contributing

to the enhancement of institutional policies and support systems.

Research Instrument

The primary tool for data collection in this study was semi-structured

interviews with ward nurses at Zamboanga del Norte Medical Center. The

interviews included open-ended questions designed to allow participants to share

their personal experiences, challenges in balancing work demands and resources,

coping mechanisms, and motivations in their daily roles. The semi-structured

format provided a balance of structure and flexibility, enabling the researchers to

gather comprehensive and in-depth insights while ensuring that key topics related

to job demands, resources, coping strategies, and motivation were thoroughly

explored.
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Nonverbal reactions, such as facial expressions and body language, were

observed and noted during the interviews to enrich the data analysis. This

approach allowed the researchers to gain a deeper understanding of the emotional

and psychological aspects of the participants' experiences. By giving nurses the

opportunity to speak candidly about their challenges and successes, the study

aimed to uncover the complexities of their professional lives, particularly in how

they managed work demands amid resource limitations.

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Data Collection Procedure

Data were gathered through one-on-one semi-structured interviews, which

were conducted in a private setting within the medical center to ensure

confidentiality, psychological safety, and comfort for the participants. The semi-

structured interview format provided a flexible yet focused structure, allowing the

researchers to follow a set of guiding questions while also enabling participants to

express their thoughts, emotions, and lived experiences freely (Creswell, 2013;

Kallio et al., 2016). This approach proved effective in eliciting rich, in-depth

qualitative data on the complex realities of nursing work under constrained

conditions.

With the participants’ informed consent, all interviews were audio-recorded

to ensure accuracy and completeness of the data. In addition to recordings,

detailed field notes were taken to document non-verbal cues such as facial

expressions, gestures, and tone of voice. These observations added contextual

depth and interpretative richness to the data analysis, particularly in understanding

the emotional and psychological aspects of the nurses’ experiences (Patton,

2015).

The interviews were conducted in the local dialect to ensure that

participants could communicate their experiences authentically and with ease.

When necessary, a translator was made available to facilitate clear and accurate

communication. This practice aligned with ethical standards in cross-cultural

qualitative research, where linguistic accessibility and cultural sensitivity were

 33

essential to data quality and participant empowerment (Squires, 2009;

Liamputtong, 2010).

Methods of Data Analysis

The data were analyzed using Braun and Clarke’s (2006) thematic analysis

approach, which facilitated the identification of recurring themes and patterns

within the data. This method involved systematically coding and categorizing the

data to uncover common experiences, coping strategies, and motivating factors

among the participants. An inductive approach was employed, allowing themes to

emerge organically from the data rather than being predetermined, thereby

enabling a rich and nuanced understanding of the ward nurses’ lived work realities.

Additionally, Colaizzi’s (1978) method of phenomenological data analysis

was utilized, given its alignment with Husserlian phenomenology and its emphasis

on capturing the essence of lived experiences. This approach was particularly

suitable for analyzing the transcribed interviews of Filipino nurses, as it prioritizes

descriptive accuracy and participant validation. The seven-step process included:

(1) collecting detailed descriptions of the phenomenon from participants, (2)

repeatedly reading the transcripts to immerse in the data, (3) extracting significant

statements and phrases, (4) formulating meanings from these statements related

to the nurses’ lived experiences, (5) organizing these meanings into thematic

clusters, (6) constructing an exhaustive description of the phenomena, and (7)

returning to the participants for validation of the findings to ensure credibility and
 34

authenticity. This rigorous process allowed the researchers to interpret significant

themes and meanings through comprehensive analysis, ultimately producing a

composite and validated portrayal of the ward nurses’ experiences.

Ethical Considerations

Ethical considerations will be carefully observed throughout the study to

ensure the well-being and rights of the participants. Informed consent will be

obtained from all participants, explaining the purpose of the study, the voluntary

nature of participation, and the confidentiality of their responses. Participants will

also be informed of their right to withdraw from the study at any time without

penalty. All data will be stored securely, and participants' identities will remain

anonymous in any reports or publications resulting from the study. The researchers

will also take care to ensure that the interviews are conducted in a respectful and

non-judgmental manner, fostering a safe space for participants to share their

experiences.
 35

CHAPTER 4

PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA

This chapter presents the analysis and interpretation of the data gathered

in exploring the lived experiences of ward nurses. Guided by a phenomenological

approach, the study aimed to capture the essence of what it means to work as a

ward nurse in a government hospital setting, with a focus on the personal,

emotional, and professional realities of the participants. The narratives shed light

on the challenges, coping mechanisms, motivations, and resilience that shape

their everyday clinical practice.

The participants of this study were ward nurses who were purposefully

selected based on their direct involvement in patient care and their capacity to

articulate the realities of ward-based nursing. Through in-depth interviews, the

study draws out themes that reflect the emotional labor, institutional constraints,

teamwork, and professional identity inherent in their roles. These insights

contribute to a deeper understanding of nursing practice in hospital wards and aim

to inform strategies that promote nurse well-being, support systems, and quality

healthcare delivery.
 36

PARTICIPANT AGE SEX YEARS OF WARD AREA

WORKING

Participant 1 29 FEMALE 2 YEARS SURGERY

Participant 2 28 FEMALE 2 YEARS & 6 OB-GYNE

MONTHS

Participant 3 29 FEMALE 1 YEAR AND RESPI

8 MONTHS

Participant 4 25 FEMALE 1 YEAR AND PEDIA

8 MONTHS

Participant 5 55 FEMALE 33 YEARS MEDICINE

Table 1. Profile of the Participants

Experiences of the Participants

Each of the essential themes were interpreted in this part.

Achieving the rigorous data analysis and interpretation of the study,

seven (7) primary themes and eighteen (18) subthemes appear in the

study, and these are:

 37

Theme 1. Prioritizing Patient Care Amidst Constraints

Nurses consistently emphasized the importance of providing patient-centered and

holistic care despite working in resource-limited environments. Participants

described how they manage high patient loads, limited staff, and shortages in

medical supplies while striving to maintain the quality of care. This theme highlights

the ethical and emotional burden nurses carry as they work to meet patient needs

under pressure, often resorting to multitasking, cooperation among peers, and

careful time management to deliver essential services. The tension between the

ideal standard of care and the realities of an understaffed and under-resourced

hospital setting was evident in their experiences. These findings are supported by

literature that identifies staff shortages, excessive workloads, and lack of resources

as major challenges affecting nursing performance and patient outcomes (Shah et

al., 2020; WHO, 2020; Twigg & Duffield, 2009).

Subtheme 1.1. Critical Care Prioritization

A recurring approach shared by participants was the prioritization of patients based

on the urgency and severity of their condition. Nurses reported focusing their

attention on those in critical or life-threatening situations, ensuring that immediate

interventions were provided even if it meant delaying care for more stable patients.

This subtheme reflects the clinical judgment and quick decision-making required

of nurses in fast-paced and high-stress environments. While this strategy is

essential for maximizing outcomes with limited resources, it also contributes to

feelings of distress when less critical patients receive delayed care. The ability to
 38

triage effectively is a key competency among nurses working in acute settings and

is essential in ensuring patient safety in overwhelmed healthcare systems (Benner

et al., 2011; Huston, 2017; Chaghari et al., 2017).

“Giuna nako kadtong naa sa kritikal o grabeng kahimtang. Pananglitan,

akong susihon kon kinsang presyon sa dugo ang ubos kaayo o taas kaayo.

Usahay kung naay daghang kritikal nga mga pasyente sa parehas nga oras, ang

mahitabo lisod ang pagdesisyon kung kinsa ang una nga atimanon. Usa ka

problema mao ang pagdesisyon kung unsang kritikal nga pasyente ang unahon.

Pero wala ko mag-inusara; Kanunay kong makapangayo og tabang sa akong mga

kauban.”

(“I prioritize those who are in critical or severe condition. For example, I

check whose blood pressure is either too low or too high. Sometimes when there

are multiple critical patients at the same time, it can be overwhelming to decide

whom to attend to first. One challenge is deciding which critical patient to prioritize.

But I'm not alone; I can always ask my colleagues for help.”)

Participant 1

“Nag-una ko sa pagtabang sa mga kritikal nga mga pasyente, nga nagtutok

sa pagsuction, pagmonitor, ug pagsiguro sa ilang kaluwasan-ilabi na nga gihatag

ang nagpadayon nga kakulang sa mga nars. Giuna nako ang mga kritikal nga

pasyente ug kadtong nanginahanglan dayon nga atensyon. Naghimo ko og triage

aron masiguro nga kadtong nanginahanglan sa labing tabang maatiman una.”

 39

(“I primarily assist critical patients, focusing on suctioning, monitoring, and

ensuring their safety—especially given the ongoing staff shortages. I prioritize

critical patients and those who need immediate attention. I conduct triage to ensure

that those who need the most help is attended to first.”)

Participant 4

Subtheme 1.2. Task Performance and Role Execution

Participants emphasized the significance of performing routine yet critical nursing

tasks such as administering medications, monitoring vital signs, and diligently

following doctors’ orders. Despite the heavy workload and staff shortages, nurses

remained committed to fulfilling these responsibilities accurately and efficiently,

understanding that these tasks are fundamental to patient safety and recovery.

They also described the need for flexibility and effective time management to

complete multiple tasks within tight time frames. This subtheme illustrates the

nurses’ dedication to their professional roles and the essential nature of these day-

to-day activities in maintaining continuity of care. Studies have similarly highlighted

how adherence to core nursing duties is vital for patient outcomes, even when

nurses are challenged by resource constraints and workload pressures (Kalisch &

Lee, 2010; Aiken et al., 2014; Duffield et al., 2011).

 40

“Naga kuha ko ug mga vital sign sa mga pasyente, gimonitor ko kini,

nanghatag og mga tambal, ug gisusi ang bisan unsang mga reklamo.”

(“I take patients' vital signs, monitor them, administer medications, and

check on any complaints.”)

Participant 1

“Mohatag kog mga tambal, magbutang ug NGT, magbutang ug catheter, ug

mokuha sab ug vital signs.”

(“I give medications, insert an NGT, insert a catheter, and also take vital

signs.”)

Participant 2

“Ang akong mga buluhaton labi naa sa pagmonitor sa mga vital signs,

paghatag og mga tambal, pagtabang sa mga doktor atol sa mga rounds.”

(“My tasks include monitoring vital signs, administering medications,

assisting doctors during rounds.”)

Participant 5

Theme 2. Coping with Systemic and Institutional Challenges

Nurses expressed the heavy burden posed by systemic inefficiencies and

institutional limitations that impact both patient care and their own well-being.

Despite their commitment to delivering quality care, participants frequently faced

 41

obstacles such as understaffing, lack of medical supplies, and inadequate

medications. These shortages created significant strain, forcing nurses to multitask

extensively and often rely on the assistance of patients’ families to procure

necessary items. The emotional toll of working under such constrained conditions

was also evident, contributing to fatigue and stress. This theme highlights how

systemic challenges within healthcare institutions can undermine the ability of

nurses to provide optimal care and sustain their own mental and physical health.

Prior studies have similarly documented how resource constraints and staffing

shortages in public hospitals negatively affect nursing performance and patient

outcomes (Aiken et al., 2002; Duffield et al., 2011; Twigg & McCullough, 2014).

Subtheme 2.1. Staffing and Resource Shortage

Participants consistently identified the shortage of staff and essential medical

supplies as critical barriers to effective nursing care. Nurses described caring for

large patient loads with insufficient colleagues on duty, sometimes managing

nearly twenty patients alone during a shift. The lack of vital equipment such as

syringes, gloves, and medications further complicated their ability to meet patient

needs promptly. These shortages not only increased their workload but also

caused delays in treatment, which could exacerbate patients’ conditions. Many

nurses expressed frustration and exhaustion but remained dedicated to their roles

despite these challenges. This finding aligns with research showing that

inadequate staffing and resource scarcity are significant contributors to nurse

burnout and compromised patient safety (Buerhaus et al., 2009; Carayon et al.,
 42

2006).

“Usahay, kulang mi sa mga kauban ug mga medical supplies, nga

nagpalisud sa pag-atiman sa tanan nga mga pasyente.”

(“Sometimes, we lack staff and medical supplies, making it difficult to care

for all patients.”)

Participant 2

“Kulang ug mga equipment and samot na ang tambal.”

(“Lack of equipment and especially the lack of medication.”)

Participant 5

“Ang grabe nga trabaho kay ag isa short ug staff and patient ratio naga

cause ug kakapoy sa among trabaho.”

(“The overwhelming workload, caused by the disproportionate nurse-to-

patient ratio, makes our shifts exhausting.”)

Participant 3

Subtheme 2.2. Emotional and Mental Fatigue

Nurses frequently described experiencing significant emotional and mental fatigue

as a result of the heavy workload and ongoing systemic challenges. The constant

pressure of managing multiple patients with limited resources, coupled with

understaffing, led to feelings of stress, burnout, and decreased motivation. Many

 43

participants also highlighted financial instability, including delayed salaries and

irregular contract renewals, as a key factor that compounded their stress and

uncertainty. Despite these difficulties, nurses continued to perform their duties with

resilience, often relying on support from colleagues and family to cope. This

emotional strain reflects broader findings in the literature, where nurses in under-

resourced settings report high levels of occupational stress, burnout, and

compromised mental health, which in turn affect job satisfaction and retention

(McHugh et al., 2011; Pappa et al., 2020; Shirey et al., 2013).

“Fatigue ug ang mental stress kay mga significant challenges.”

(“Fatigue and mental stress are also significant challenges.”)

Participant 2

“Usa sa pinakadakong problem para nako mao ang kakuwang sa kwarta,

nga maka-apekto sa akong kusog ug gana mo trabaho.”

(“One of the biggest challenges I face is financial instability, which affects

my energy and motivation when going to work.”)

Participant 3

Subtheme 2.3. Dealing with Patient Watchers and Staff Dynamics

Nurses reported that interactions with patient watchers and co-workers could

significantly impact their emotional and operational experiences. Watchers, often

anxious or demanding due to concern for their loved ones, sometimes exhibited
 44

frustration or impatience, which added to the nurses’ stress during already

demanding shifts. Additionally, nurses faced challenges working alongside less

experienced or uncooperative staff, which occasionally led to misunderstandings

and increased workload. These interpersonal dynamics required nurses to

exercise patience, professionalism, and adaptability to maintain a functional work

environment. The emotional toll of managing these relationships alongside clinical

responsibilities reflects findings in existing studies that highlight the complex social

pressures nurses face in clinical settings, particularly in resource-limited hospitals

(Kelly & Ahern, 2009; Laschinger et al., 2010).

“Naay mga watchers nga istrikto kaayo, mao nga pasensyaha lang kay ingon

ana gyud na pirmi."

(“There are some watchers who are very strict, so just be patient because

that's always going to be the case.”)

Participant 4

“Lisod gyud ang mga watchers nga lisod kasaboton, apil pud ang kakuwang

sa gamit ug labi na gyud ang kakulang sa tambal.”

(“Difficult watchers (family members or caregivers) are a real challenge, as

well as the lack of equipment and especially the lack of medication. Among the

staff, their way of working also requires constant guidance, as if they are still

students.”)

Participant 5
 45

Theme 3: Coping with Systemic and Institutional Challenges

This theme highlights nurses’ ongoing struggle with critical systemic barriers such

as chronic understaffing, overwhelming workloads, and insufficient institutional

support. Despite these challenges, nurses demonstrate resilience and adaptability,

continually striving to provide quality care amid these constraints. Their

experiences reveal how structural limitations directly affect both patient outcomes

and nurse well-being, underscoring the urgent need for systemic improvements.

Subtheme 3.1. Nurse-to-Patient Ratio Crisis

A recurrent concern among nurses was the disproportionate patient-to-nurse ratio,

especially during night shifts or in busy public wards. Participants described

handling large numbers of patients with minimal staffing, which heightened stress

and compromised the ability to deliver thorough and timely care. The inadequate

nurse-to-patient ratio forced nurses to prioritize critical cases while other patients

received less frequent attention. This imbalance contributes to physical and

emotional fatigue and raises concerns about patient safety and quality of care.

Similar findings have been documented in healthcare research, where poor

staffing ratios correlate strongly with increased nurse burnout and negative patient

outcomes (Aiken et al., 2012; Griffiths et al., 2016).

 46

“Dinhi sa medicine ward, halos 40 ka pasyente pero 2 hangtod 4 ra ka nurse

ang naka-duty.”

(“Here in the medicine ward, we have almost 40 patients, but only 2 to 4

nurses on duty.”)

Participant 1

“Karon, duha ra mi ang naka-duty, pero pila kabuok ang pasyente? 38, so

tag-19 mi kada usa.”

(“Right now, there are only two of us on duty, but how many patients do we

have? 38, so we each handle 19.”)

Participant 4

“Mas daghan ang pasyente kaysa sa kaya nga atimanon sa mga nurse.

Kulang gyud ang mga nurse, labi na kung gabi-i nga gamay ra kaayo mi.”

(“There are more patients than the nurses can realistically handle,

especially during night shifts.”)

Participant 3

Subtheme 3.2. Physical and Emotional Exhaustion

Nurses described the intense physical and emotional toll resulting from sustained

high workloads, inadequate staffing, and insufficient rest periods. Many reported

chronic bodily pain, fatigue, and exhaustion due to long hours of standing, lifting,
 47

and performing repetitive tasks under pressure. The relentless demands of the job,

coupled with emotional stressors such as managing difficult patients and their

families, led to emotional burnout, feelings of helplessness, and decreased

motivation. These physical and psychological strains not only affect nurses’

personal well-being but also jeopardize patient care quality and safety. The

phenomenon of burnout, characterized by emotional exhaustion,

depersonalization, and reduced personal accomplishment, is well-documented

among nurses working in high-stress, resource-limited environments (Maslach &

Jackson, 1981; Dyrbye et al., 2017). Studies have shown that burnout negatively

impacts nurses’ mental health and increases the risk of absenteeism, errors, and

turnover intentions (Adriaenssens et al., 2015; Rotenstein et al., 2018). Moreover,

physical symptoms such as musculoskeletal pain are common among nurses due

to the physical nature of their work, exacerbated by understaffing and the inability

to take adequate breaks (Nelson et al., 2006; Trinkoff et al., 2003). Addressing

these issues requires systemic changes, including improved staffing, ergonomic

interventions, and mental health support to sustain the nursing workforce and

enhance patient outcomes (Shanafelt et al., 2017; Kelly et al., 2021).

“Sobra ra gyud ang kadaghan sa pasyente para sa gamay nga ihap sa mga

nurse, mura na mig malumos sa trabaho.”

(“There are way too many patients for the number of nurses, and it feels like

we’re drowning in work.”)

Participant 2
 48

“It's really stressful. Kapoy kaayu. Magsakit na akong lawas.”

(“It's really stressful. It's really exhausting. My body hurts.”)

Participant 4

“Permi ko mag-overtime aron ma cover ang tanang trabaho.”

(“I always have to do overtime to cover the workload.”)

Participant 5

Subtheme 3.3. Calls for System Reform

Nurses consistently emphasized the urgent need for systemic reforms to address

persistent challenges like understaffing, inefficient scheduling, and delayed salary

payments. They highlighted how these factors exacerbate work stress and

compromise patient care quality. Participants advocated for hiring more nurses to

ensure manageable workloads and improve nurse-to-patient ratios, which is widely

recognized as critical for both staff well-being and patient outcomes (Aiken et al.,

2012; Twigg & McCullough, 2014). Additionally, fair and timely compensation was

seen as essential to maintaining motivation and reducing turnover (Duffield et al.,

2014). Effective scheduling practices and institutional support were also

recommended to create a more sustainable work environment and ultimately

enhance the quality of healthcare delivery (Tourangeau et al., 2017).

 49

“Kinahanglan mag-hire og dugang staff aron matagad tanan nga pasyente og

sakto. Ang kakuwang sa mga nurse usa ka dakong problema sa mga public

hospital."

(“Hiring more staff so that all patients can be properly attended to. The

shortage of nurses is a major issue in public hospitals.”)

Participant 1

“Dapat mag-hire pa og dugang nurse. Ang uban ning hawa na kay dugay

kaayo mogawas ang sweldo. Gamay ra kaayo mi nga staff diri."

(“They should hire more nurses. Some have left because the salary takes too

long to be released. There are too few of us staff here.”)

Participant 4

“Kinahanglan gyud og dugang nga staff. Ang kulang sa nurse mao gyud ang

number one nga problema sa among hospital. Kung masunod lang ang insaktong

ratio sa nurse ug pasyente, makahatag gyud mi og tarong ug husto nga pag-

atiman sa mga pasyente."

(“Additional staffing is really necessary. Understaffing is the number one

problem in our hospital. If the proper nurse-to-patient ratio is met, we can truly

provide the standard of care needed for patients.”)

Participant 5
 50

Theme 4. Navigating Nurse-Patient Interactions with Empathy and

Professionalism

Nurses consistently demonstrated a commitment to fostering trust and delivering

compassionate care despite emotionally challenging circumstances. They

emphasized the importance of establishing rapport through therapeutic

communication, including introducing themselves, engaging patients in casual

conversation, and actively listening to their concerns. This approach not only helps

to build trust but also promotes patient cooperation and satisfaction, which are

crucial for effective care delivery (McCabe & Timmins, 2013). Maintaining

professionalism, even when faced with difficult or uncooperative patients, nurses

strive to balance empathy with clinical responsibility, recognizing that patient-

centered communication improves outcomes and emotional well-being (Kourkouta

& Papathanasiou, 2014). Such efforts underscore the role of interpersonal skills as

essential to nursing practice and holistic patient care.

Subtheme 4.1. Establishing Trust and Therapeutic Communication

Nurses underscored the importance of building trust with patients through

therapeutic communication techniques. This involves introducing themselves,

engaging in casual conversations, and actively listening to patients' concerns to

foster a sense of safety and cooperation. Such communication not only helps to

ease patients’ anxieties but also promotes adherence to treatment and improves

overall care outcomes (McCabe & Timmins, 2013). Establishing rapport is

 51

especially critical when patients feel vulnerable or uncooperative, as it can

transform challenging interactions into opportunities for empathy and

understanding (Kourkouta & Papathanasiou, 2014). These practices reflect the

core nursing values of empathy, respect, and patient-centeredness, which are vital

for effective healthcare delivery.

“Magpa-ila ko sa pasyente ug sultian nako sila nga ako ilang nurse karong

adlawa, unya mag-istorya ko gamay. Ang uban nga pasyente dili gyud mo-

cooperate. Magpabilin lang ko nga kalmado ug malikayan ang panagbangi, bisan

pa og makalagot na usahay. Permi nako silang bisitahon ug paminawon ang ilang

mga reklamo o ang giingon sa ilang watchers."

(“I introduce myself to the patient and let them know I’m their nurse for the day,

then engage in small talk. Some patients do not cooperate.I stay calm and avoid

engaging in arguments, even if they become frustrating. I always check on the

patients and address their concerns or those raised by their watchers.”)

Participant 1

“Importante kaayo ang pagtukod og maayo nga relasyon sa pasyente.

Magsugod ko sa pagpakilala sa akong kaugalingon, pagkuha sa ilang medical

history, ug padayon nga pag-istorya hangtod nga mobati sila og kumpiyansa ug

pagsalig nako.”

(“Building rapport with patients is essential. I start by introducing myself,

gathering their medical history, and maintaining conversations until they feel

comfortable trusting me.”)

 52

Participant 3

“Magpa-ila sa imong kaugalingon. Pangutan-a sila bahin sa history nga may

kalabotan sa ilang admission. Mag-istorya lang og hapsay, o hisguti ang ilang

kondisyon ug unsa ilang gibati. Kung naa silay mga concerns samtang naa sa

ospital, atimana kini aron makuha nimo ang ilang pagsalig.”

(“Introduce yourself. Ask some history related to their admission. Just have

a casual chat with them or talk to them about their condition and what they’re

feeling. If they have any concerns during their stay in the hospital, attend to them

so you can gain their trust.”)

Participant 5

Subtheme 4.2. Managing Difficult Behaviors and Emotional Responses

Nurses frequently encounter uncooperative or aggressive patients and impatient

watchers, which adds to the emotional demands of their roles. Despite these

challenges, they strive to maintain composure, professionalism, and patience,

often using de-escalation techniques and seeking support from colleagues or

security when necessary. Managing such behaviors requires emotional resilience

and effective communication skills to prevent conflicts from escalating and to

ensure patient safety (Fernandez et al., 2016). The emotional labor involved can

lead to stress and burnout, underscoring the need for institutional support and

training in conflict resolution for healthcare providers (Sundaram et al., 2018).

Nevertheless, nurses recognize that understanding patients' frustrations as

manifestations of fear or pain helps them respond with empathy rather than
 53

frustration.

“Ang uban nga pasyente dili gyud mo-cooperate. Magpabilin lang ko nga

kalmado ug malikayan ang panagbangi, bisan pa og makalagot na usahay.”

(“Some patients do not cooperate. I stay calm and avoid engaging in

arguments.”)

Participant 1

“Usahay, ang pasyente o ilang pamilya mahimong dili pasensyoso ug

makasulti og mga pulong nga makapasakit namo. Nasabtan nako nga gikan kini

sa ilang kapungot ug kabalaka.”

(“There are instances when patients or their families become impatient and

say hurtful things to us. I understand they act out of concern.”)

Participant 3

“Kung mo-aggressive sila, tawgon nako ang security o uban nga mga nurse

para tabang. Pwede pud sila tagaan og igong panahon nga ma-express ang ilang

emosyon.”

(“If they become aggressive, that’s when I call for support from security or

fellow nurses. You can also give them enough time to express their emotions.”)

Participant 5
 54

Subtheme 4.3. Patient-Centered and Respectful Care

Nurses emphasized the critical importance of providing patient-centered care that

respects the rights and dignity of each individual. They strive to be empathetic and

flexible, adjusting their communication and care approaches to meet the unique

needs of patients, including working collaboratively with patient watchers or family

members. This approach fosters trust, promotes patient comfort, and improves

overall care outcomes (McCormack & McCance, 2017). By acknowledging

patients’ perspectives and involving their families when appropriate, nurses help

create a supportive environment that respects cultural and personal preferences

(Barry & Edgman-Levitan, 2012). Patient-centered care not only enhances

satisfaction but also aligns with ethical nursing practice and professional standards

(Institute of Medicine, 2001).

“E-explain nato sa pasyente nga buhaton nato ang among makaya, ug

kinahanglan magpasensya gihapon kay naa pud silay rights. Kinahanglan

magpabilin nga professional kay naa ta ani nga field. Importante ang time

management, mag-flexible sa mga tasks, ug siguraduhon nga patient-centered

ang care. Para sa uban nga pasyente, labi na kung GCS 3, pwede ra nimo

istoryahon ang ilang watcher bahin sa ilang concerns. Naay mga watcher nga

strikto, mao nga kinahanglan lang gyud magpasensya."

(“We explain to the patient that we will do what we can, and we still need to be

patient because patients also have their rights. We must remain professional since

we are in this field. Time management, be flexible with the tasks, and ensure that
 55

care is patient-centered. For some patients, especially those with a GCS of 3, you

can only talk to their watcher about their concerns. And some watchers are very

strict. You just have to be patient.”)

Participant 4

“Ikaw ang kinahanglan mo-adjust sa pasyente aron magkasinabot mo.”

(“You have to be the one to adjust to the patient so that you can understand

each other.”)

Participant 5

“Attend to their concerns or those raised by their watchers.”

(“Attend to their concerns or those raised by their watchers.”)

Participant 1

Theme 5. Struggles with Inadequate Medical Supplies and Equipment

This theme highlights the persistent and significant challenges nurses face due to

inadequate medical supplies and equipment in their work environment. Nurses

described how the chronic shortage of essential materials ranging from syringes

and gloves to vital medications undermines their ability to deliver timely and

effective care. These supply deficiencies often result in treatment delays, forcing

patients’ families to purchase necessary items themselves, thereby adding

financial strain and emotional distress to already vulnerable patients (Aiken et al.,
 56

2014). The impact of such shortages extends beyond patient care, as nurses

experience increased stress and frustration, which can lead to moral distress when

they are unable to perform their duties optimally (Fesseha et al., 2018). This

problem is well-documented in many low-resource healthcare settings, where

systemic inefficiencies in supply chain management and inadequate budgeting

exacerbate these shortages, ultimately affecting patient outcomes and workforce

morale (Kruk et al., 2018; Willis-Shattuck et al., 2008).

Subtheme 5.1. Chronic Shortage of Essential Supplies and Medicines

Nurses consistently reported a persistent shortage of essential medical supplies

and medications, including basic items like syringes, gloves, alcohol, and suction

devices. This chronic scarcity hampers their ability to provide timely and effective

patient care, often forcing them to ask patients’ families to purchase necessary

items outside the hospital, which can delay treatment and create additional

financial stress for patients (Aiken et al., 2014). Such shortages are a common

issue in resource-limited healthcare settings and have been linked to negative

patient outcomes, increased nurse workload, and moral distress among healthcare

providers (Fesseha et al., 2018; Willis-Shattuck et al., 2008). The lack of supplies

not only undermines the quality of care but also challenges the nurses’

professional capacity to fulfill their duties adequately (Kruk et al., 2018).

“Kasagaran, mangayo mi sa mga watcher nga mopalit og supplies gawas

sa ospital kay bisan ang basic nga mga gamit sama sa syringe, wala gyud. Kulang
 57

pud ang tambal. Oo, dugay na gyud ni nga problema.”

(“We often ask watchers to buy supplies outside the hospital because even

basic items like syringes are not available. Medicines are also insufficient. Yes,

and it has been a long-standing issue.”)

Participant 1

“Wala gyud mi’y syringes karon. Ang naa lang namo kay 3cc, pero daghan

kaayo mi’g tambal nga ihatag. Wala pud mi gloves bisan pa og kinahanglan kaayo

na. Naay mga importante nga gamit nga wala—walay suction, walay breathing

circuit, walay alcohol. Daghan kaayo ang kulang. Unsay among buhaton? Wala

gyud tambal. Mangayo mi sa pasyente nga mopalit. Sulti sila nga pwede daw

makakuha og refund sa Malasakit Center. Magtinabangay mi sa trabaho diri, pero

kung walay tambal, mangayo gyud mi sa watcher nga mopalit. Usahay, dili dayon

makapalit ang watcher. Lisod kaayo kay dili namo mahatag dayon ang tambal sa

pasyente. Gisulti na ni sa taas, sa head sa ospital. Naay stocks pero dali ra

mahurot. Murag gisulti na pud ni sa capitol. Kinahanglan gyud i-update ang

supplies diri. Dili lang ni sa amoang ward—bisan asa, daghan ang kulang."

(“We don't even have syringes right now. The only ones we have are 3cc,

but we have a lot of medications to give. We also don’t have gloves, even though

they are very necessary. Some essential supplies are missing—no suction, no

breathing circuit, no alcohol. There’s so much lacking. What are we supposed to

do? There are no medications at all. We have to ask the patients to buy them. They

say they can get a refund from the Malasakit Center. We help each other with the
 58

tasks here, but when there are no medications, we have to ask the watcher to buy

them. Sometimes, the watcher can't buy them right away. It's really difficult

because we can't give the medication to the patient immediately. This has already

been brought up with the higher-ups, the head of the hospital. There are stocks,

but they just run out quickly. It seems like they also mentioned this to the capitol.

The supplies here need to be updated. It’s not just this ward—everywhere, there’s

a lot missing.”)

Participant 4

“Usa sa mga dagkong kalisdanan nga among naexperience mao ang

kakulang sa tambal ug supplies. Limitado ra ang resources nga mahatag sa

ospital, mao nga kinahanglan mopalit sa gawas og mga kinahanglanon ang

pamilya sa pasyente. Para sa daghang pamilya, labi na kadtong naglisod og

kwarta, dako kaayo ni nga babag aron makadawat og paspas nga medical care.”

(“One of the major difficulties we encounter is the shortage of medicines

and supplies. The hospital can only provide limited resources, forcing patients’

families to purchase essentials outside. For many families, especially those

struggling financially, this becomes a significant obstacle to receiving timely

medical care.”)

Participant 3
 59

Subtheme 5.2. Impact on Patient Care and Timeliness of Treatment

This subtheme underscores the direct consequences of supply shortages on

patient care, particularly in terms of treatment delays and increased financial

burdens. Nurses reported that when essential medications or equipment were

unavailable, patients often had to wait for families to purchase supplies externally,

causing critical delays in administering treatment. In some instances, nurses

themselves would cover costs out-of-pocket, reflecting both their dedication and

the severity of resource gaps (Dussault & Franceschini, 2006). Additionally, nurses

frequently referred patients to social support systems, such as the Malasakit

Center, to help alleviate financial constraints, yet these mechanisms do not fully

address the root problems (Cabana et al., 2018). These delays and financial

hurdles not only jeopardize patient outcomes but also heighten the emotional

stress on nurses striving to provide care under difficult circumstances (Buchan et

al., 2013).

“Makaapekto ni sa pag-atiman kay kung naay doctor's order pero wala ang

tambal, ang watcher pa ang kinahanglan mopalit, hinay ang treatment.”

(“It affects care because, for example, if there is a doctor’s order but the

required medication isn’t available, the watcher has to buy it first, delaying the

treatment.”)

Participant 5

“Magtinabangay mi sa trabaho diri, pero kung walay tambal, mangayo gyud

mi sa watcher nga mopalit. Usahay, dili dayon makapalit ang watcher. Lisod kaayo
 60

kay dili namo mahatag dayon ang tambal sa pasyente. Gisulti na ni sa taas, sa

head sa ospital. Naay stocks pero dali ra mahurot.”

(“We help each other with the tasks here, but when there are no

medications, we have to ask the watcher to buy them. Sometimes, the watcher

can't buy them right away. It's really difficult because we can't give the medication

to the patient immediately. This has already been brought up with the higher-ups,

the head of the hospital. There are stocks, but they just run out quickly.”)

Participant 4

“Usahay, ako pa gyud ang mobayad gikan sa akong kaugalingong bulsa.

Mao na kasagaran mahitabo. Kuha ko og kwarta sa akong wallet. Pwede pud i-

refer ang pasyente sa social worker, labi na sa Sabado nga mas kulang pa gyud

ang resources.”

(“Sometimes, I have to provide from my own pocket. That’s what usually

happens. I take money from my own wallet. There’s also the option of referring

patients to the social worker, especially on Saturdays when resources are even

more lacking.”)

Participant 5

Subtheme 5.3. Recommendations for Systemic Improvements

This subtheme highlights nurses’ unified call for systemic reforms to address

chronic shortages and improve healthcare delivery. Participants emphasized the

necessity of increased budget allocation dedicated to procuring essential medical

 61

supplies and medications to avoid recurrent stockouts that impede patient care

(WHO, 2020). They also recommended better supply chain management practices

to ensure timely replenishment and reduce wastage (Yadav, 2015). Beyond

material resources, nurses stressed that addressing staffing shortages is crucial

to enhancing care quality and reducing burnout among healthcare workers (Aiken

et al., 2014). These recommendations align with broader health system

strengthening efforts that advocate for comprehensive improvements in financing,

logistics, and human resources to sustain effective and equitable care (Frenk et

al., 2010).

“Gisulti na ni sa taas, sa head sa ospital. Naay stocks pero dali ra mahurot.

Murag gisulti na pud ni sa capitol. Kinahanglan gyud i-update ang supplies diri. Dili

lang ni sa amoang ward—bisan asa, daghan ang kulang."

("This has already been brought up with the higher-ups, the head of the

hospital. There are stocks, but they just run out quickly. It seems like they also

mentioned this to the capitol. The supplies here need to be updated. It’s not just

this ward—everywhere, there’s a lot missing.”)

Participant 4

“Kinahanglan i-increase ang budget para sa supplies ug mag-hire og

dugang nurse aron makatabang."

(“They should increase the budget for supplies and hire more nurses to help

out.”)
 62

Participant 3

“Kinahanglan ta og mas dako nga budget para sa medical supplies ug pag-

hire og dugang nga mga nurse.”

(“Increased budget for medical supplies and hiring more nurses.”)

Participant 2

Theme 6. Coping with Stress and Work-Related Emotional Strain

This theme highlights the significant emotional and psychological burdens ward

nurses endure as a result of demanding workloads, staff shortages, and

challenging patient interactions. Nurses often described feeling overwhelmed by

their responsibilities, balancing critical care demands while managing difficult

behaviors from patients and their families. Despite these pressures, participants

showed resilience by developing personal coping strategies and relying heavily on

peer support to navigate the emotional strain. This reflects a broader pattern in

healthcare where nurses face chronic stress but find ways to sustain their

commitment through teamwork and self-care (McVicar, 2003; Mealer et al., 2012).

Subtheme 6.1. Emotional and Physical Burnout

Participants frequently reported symptoms of physical exhaustion and emotional

fatigue, which at times led to thoughts of quitting their jobs. The relentless pace,

combined with insufficient staffing and occasional harsh interactions with patients

or watchers, compounded their stress levels. This burnout manifests not only as
 63

tiredness but also as feelings of frustration, demotivation, and emotional depletion.

Such experiences are consistent with research indicating that nurses in resource-

constrained environments are at high risk for burnout, which negatively affects both

their well-being and the quality of patient care (Poghosyan et al., 2010; Dyrbye et

al., 2017). The absence of formal mental health support within their workplaces

further exacerbates these issues, leaving nurses to rely mainly on informal peer

networks for emotional relief (Gray et al., 2019).

“Usahay makaingon ko nga mo-undang na lang ko. Pero akong

ginapahinumdom akong kaugalingon nga kini stepping stone ra para sa akong

kaugmaon. Kung makaya nako ni, makaya pud nako ang mas dagkong hagit.”

(“Sometimes, I feel like quitting. I remind myself that this is just a stepping

stone for my future. If I can handle this, I’ll be able to face bigger challenges.")

Participant 1

“Usa sa mga pinakalisod nga part sa trabaho mao ang pag-atiman sa

daghang pasyente sabay-sabay. Dili ideal ang ratio sa nars ug pasyente, mao nga

usahay mura kog ginatabangan. Gusto nako matagaan ang matag pasyente og

saktong pagtagad, pero kulang gyud ang oras ug mga tawo para mabuhat kini og

tarong.”

(“One of the most stressful parts of my job is trying to care for too many

patients at once. The nurse-to-patient ratio is far from ideal, so it often feels like

I’m being pulled in all directions. I want to give each patient the attention they
 64

deserve, but there’s just not enough time or hands to do it properly.”)

Participant 3

“Pwede ra ka mo-express sa imong mga gibati, pero sa in the end, buhaton

gihapon nimo kay trabaho man na.”

(“You can voice out your concerns, but in the end, you still do it because it’s

your job.”)

Participant 4

Subtheme 6.2. Support Systems and Coping Strategies

In the face of heavy workloads and emotional strain, nurses rely heavily on informal

support systems and personal coping mechanisms to manage their stress.

Participants shared that peer support through conversations, shared laughter, and

mutual encouragement, plays a crucial role in alleviating emotional burdens.

Additionally, family support provides motivation and a sense of stability outside the

workplace. Nurses also use personal activities such as listening to music, eating,

and spending time in quiet reflection to recharge mentally and physically. The

absence of formal psychological support or counseling services in their institutions

means that resilience is often developed through these informal networks and self-

care strategies. This aligns with literature highlighting that peer support and social

connections are vital protective factors against burnout and compassion fatigue in

nursing (Healy & McKay, 2000; Mealer et al., 2014). Moreover, informal coping

strategies have been shown to improve nurses’ emotional well-being and help

sustain their capacity to provide compassionate care in demanding environments

 65

(Chang et al., 2007).

“Bisan ang pagbahin og katawa sa busy nga shift makatabang para mugaan

gamay ang trabaho.”

(“Even just sharing a quick laugh during a hectic shift helps lighten the

load.”)

Participant 3

“Mag estoryahanay rami.”

(“We just talk to each other.”)

Participant 5

“Akong pamilya ang akong inspirasyon. Gibuhat nako ni para nila.”

(“My family is my only motivation. I'm doing this for them.”)

Participant 4

Theme 7. Financial Instability and Delayed Compensation

Financial instability due to delayed salary payments emerged as a pervasive

challenge affecting nurses, particularly those working under contractual or job-

order arrangements. Participants described how salary delays of weeks or even

months forced them into precarious financial situations, often relying on family

assistance or borrowing money to meet basic needs. This financial insecurity not

only exacerbates stress but also undermines their ability to focus fully on patient
 66

care. Many reported having to take on additional work or side jobs to supplement

their income, often at the cost of personal rest and well-being. These findings

reflect broader concerns documented in healthcare systems where contract-based

workers face delayed pay and lack of job security, which negatively impacts morale

and retention (Lee & Cummings, 2008; Aiken et al., 2014).

Subtheme 7.1. Salary Delays and Their Effects

The delayed release of salaries is a chronic problem that intensifies the emotional

and physical strain on nurses. Participants shared feelings of frustration, anxiety,

and demotivation stemming from the unpredictability of their income. Some nurses

reported budgeting down to the point of skipping meals or other essential expenses

to cope until their salaries arrive. The financial pressure further compromises their

mental health and can impair work performance, creating a vicious cycle of stress

and burnout. These experiences mirror findings in global nursing literature, where

delayed compensation has been linked to increased occupational stress, reduced

job satisfaction, and higher turnover intentions among healthcare workers (Bakker

et al., 2007; Hegney et al., 2003).

“Usahay muabot ug bulan or mas taas pa ana ayha mi ma sweldoan.”

(“Sometimes it takes months or even longer before we get paid.”)

Participant 3

“Nakadawat ko sa akong sweldo last December, balig mlima ka bulan nako

 67

ga hulat.”

(“I only received my first salary in December—so that was about five months

of waiting.”)

Participant 4

“Usahay mukaon ko kaduha sa usa ka adlaw, or kas-a sa usa ka adlaw.”

(“Sometimes I eat only twice a day, or once a day.”)

Participant 5

Subtheme 7.2. Coping with Financial Instability

To navigate the ongoing financial uncertainty caused by delayed or insufficient

salaries, nurses rely heavily on various coping mechanisms. Many turn to family

members for financial assistance, which provides a crucial safety net during

periods without pay. Additionally, some participants mentioned receiving

“PhilHealth sharing” as a supplemental income, which partially eases their burden.

Strict budgeting and careful management of limited resources are common

strategies, often requiring sacrifices such as reducing meals or other personal

expenses. Others take on extra shifts or engage in side jobs to generate additional

income, although these measures can lead to increased fatigue and stress. This

reliance on informal and self-initiated coping strategies highlights the absence of

formal financial or institutional support systems for frontline nurses. Similar coping

patterns have been noted in nursing populations worldwide facing economic

instability, where family support, multiple job holdings, and stringent budgeting are
 68

key to financial survival but can negatively impact physical and mental health

(Stone et al., 2007; Lu et al., 2012).

“Mangayo ko ug tabang sa akong ginikanan, ug bayaran ra nako sila ug

naa nami sweldo.”

“I ask for help from my parents for the meantime, and I pay them back once

I get my salary.”

Participant 1

“Pero kada buwan, makadawat mi og 'sharing' gikan sa PhilHealth.

Nagkalahi-lahi ni; usahay mga 5,000 or 7,000 pesos, depende sa gi-allocate sa

PhilHealth. Tanan namo diri makadawat ani—ang mga nars makakuha og 50

percent, ug ang mga institutional workers (IW) makakuha og 10 percent. Karon,

wala pa namo nadawat ang among sweldo para sa Enero ug Pebrero kay wala

mi’y fixed contract diri—duha ka bulan nga kontrata lang nga pirmi gina-renew.

Karon, wala gani mi kontrata. Pero nagpadayon gihapon mi sa trabaho bisan

wala’y sweldo.”

(“But every month, we receive a 'sharing' from PhilHealth. It varies;

sometimes we get around 5,000 or 7,000, depending on how much PhilHealth

allocates. All of us here receive these nurses get 50 percent, while institutional

workers (IW) get 10 percent. Right now, we haven't received our salary for January

and February because we don’t have fixed contracts here only two-month

contracts that keep getting renewed. At the moment, we don’t even have a contract.

But we endure it. We still keep working even without pay.”)

 69

Participant 4

“Paningkamotan nako nga tarongon ang pag-budget, pero lisod gyud. Kung

malangan ang sweldo, magsalig ko sa akong ipon o manghulam ko sa pamilya

para makabuhi. Usahay modawat pud ko og extra nga shift bisan kapoy na, ug

usahay mangita pud kog sideline para makadugang og kita.")

(“I try to budget as carefully as possible, but it’s tough. When my salary is

delayed, I rely on savings or borrow from family to get by. I also take on extra shifts

when I can, though that can be draining. Sometimes, I look for side jobs to help

make ends meet.”)

Participant 3
 70

CHAPTER 5

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

This chapter is divided into three sections. The initial component of the

study encompasses a comprehensive summary of the findings followed by the

conclusion made on the said summary. Lastly, recommendations are given from

the findings and conclusion of the study.

SUMMARY

This descriptive phenomenological study aimed to explore and describe the

lived experiences of ward nurses working in Zamboanga del Norte, focusing on

how they navigate the challenges inherent in their professional roles. Through

semi-structured, in-depth interviews with five (5) purposively selected participants,

rich and detailed narratives were obtained, highlighting the physical, emotional,

and systemic factors shaping their daily work lives. Guided by Husserlian

phenomenology, the study prioritized the nurses’ subjective experiences to

uncover the essence of their realities amidst healthcare constraints. Rigorous

bracketing and thematic analysis revealed eight major themes and multiple

subthemes that collectively illuminate the multifaceted nature of nursing practice

in a resource-limited setting.

The emergent themes and subthemes were: “Theme 1. Prioritizing

Patient Care Amidst Constraints” with Subtheme 1.1. Critical Care Prioritization,

and Subtheme 1.2. Task Performance and Role Execution. “Theme 2. Coping
 71

with Systemic and Institutional Challenges” with the Subtheme 2.1. Staffing

and Resource Shortage, Subtheme 2.2. Emotional and Mental Fatigue, and

Subtheme 2.3. Dealing with Patient Watchers and Staff Dynamics. “Theme 3.

Coping with Systemic and Institutional Challenges” with Subtheme 3.1. Nurse-

to-Patient Ratio Crisis, Subtheme 3.2. Physical and Emotional Exhaustion, and

Subtheme 3.3. Calls for System Reform. “Theme 4. Navigating Nurse-Patient

Interactions with Empathy and Professionalism” with the Subtheme 4.1.

Establishing Trust and Therapeutic Communication, Subtheme 4.2. Managing

Difficult Behaviors and Emotional Responses, and Subtheme 4.3. Patient-

Centered and Respectful Care. “Theme 5. Struggles with Inadequate Medical

Supplies and Equipment” with the Subtheme 5.1. Chronic Shortage of Essential

Supplies and Medicines, Subtheme 5.2. Impact on Patient Care and Timeliness of

Treatment, and Subtheme 5.3. Recommendations for Systemic Improvements.

“Theme 6. Coping with Stress and Work-Related Emotional Strain” with the

Subtheme 6.1. Emotional and Physical Burnout, and Subtheme 6.2. Support

Systems and Coping Strategies. “Theme 7. Financial Instability and Delayed

Compensation” with the Subtheme 7.1. Salary Delays and Their Effects and

Subtheme 7.2. Coping with Financial Instability.

These findings reveal the complex realities faced by ward nurses, who constantly

balance delivering quality patient care with navigating systemic deficiencies.

Participants emphasized prioritizing critical patient needs despite understaffing,

inadequate supplies, and high workloads. The persistent shortage of human

resources and medical equipment not only hampered the timeliness and
 72

effectiveness of care but also contributed to significant emotional and physical

fatigue. Nurses described the psychological toll of working under intense pressure,

compounded by interactions with patient watchers and challenging staff dynamics.

Despite these hardships, the participants demonstrated remarkable resilience,

maintaining professionalism through empathetic nurse-patient communication and

patient-centered care approaches.

Financial instability due to delayed compensation further exacerbated

stress levels, impacting the overall well-being and job satisfaction of nurses.

Nevertheless, the participants relied on personal coping mechanisms, peer

support, and a deep commitment to their vocation to persevere.

The study underscores urgent calls for systemic reforms to address staffing

shortages, improve resource availability, and ensure timely compensation.

Enhancing institutional support and creating sustainable working conditions are

critical to safeguarding the health and morale of frontline nurses.

 73

CONCLUSION

The lived experiences of ward nurses in Zamboanga del Norte portray a

challenging yet dedicated workforce striving to uphold patient care quality amid

multifaceted constraints. Addressing these challenges holistically will be essential

to strengthening healthcare delivery and supporting the invaluable contributions of

nursing professionals in similar contexts.

Based on the gathered data and thorough analysis, it was concluded that

ward nurses in Zamboanga del Norte face complex and multifaceted challenges

that deeply impact their professional and personal lives. Their experiences

highlight the critical balance between prioritizing patient care and coping with

systemic constraints such as staffing shortages, inadequate medical supplies, and

institutional inefficiencies. These challenges not only hinder the delivery of timely

and effective care but also contribute significantly to physical exhaustion,

emotional fatigue, and occupational stress.

Nurses consistently reported the emotional burden of managing difficult

patient behaviors, navigating staff dynamics, and enduring delayed compensation,

which further strain their well-being and job satisfaction. Despite these hardships,

the participants demonstrated resilience and commitment by fostering therapeutic

communication, maintaining professionalism, and employing various coping

strategies.

The study reveals an urgent need for systemic reforms aimed at improving

nurse-to-patient ratios, ensuring the availability of essential medical supplies, and

providing timely financial compensation. Additionally, establishing stronger support

 74

systems within healthcare institutions is crucial to mitigate burnout and enhance

the overall work environment for nurses.

Ultimately, these findings emphasize the importance of addressing both the

structural and emotional dimensions of nursing work in resource-limited settings to

sustain the quality of patient care and safeguard the health and morale of frontline

nurses in Zamboanga del Norte.

 75

RECOMMENDATIONS

1. Strengthen Nurse-to-Patient Ratios and Staffing Policies

To alleviate work overload and reduce burnout among ward nurses, hospital

management and health authorities should prioritize the recruitment and

deployment of adequate nursing personnel. Implementing policies that

ensure optimal nurse-to-patient ratios will enhance the delivery of safe and

timely care while safeguarding the physical and emotional well-being of

nurses.

2. Ensure Consistent Availability of Medical Supplies and Equipment

Government and institutional leaders should address the chronic shortage

of medical supplies and equipment by improving procurement systems and

budget allocations. Reliable access to essential tools and medicines is

crucial to support nurses in performing their duties efficiently and providing

high-quality patient care.

3. Implement Timely and Fair Compensation Systems

To boost morale and financial security among nurses, administrative bodies

must establish mechanisms to guarantee the prompt release of salaries and

benefits. Addressing delayed compensation issues will not only improve job

satisfaction but also reduce financial-related stress, enabling nurses to

focus more effectively on their roles.

4. Develop Institutional Support and Mental Health Programs

Hospitals should provide structured support systems such as regular

debriefing sessions, peer counseling, and mental health services tailored to

 76

the needs of frontline nurses. These initiatives can help mitigate the

emotional burden of nursing work, promote resilience, and foster a healthier

and more supportive workplace culture.

5. Encourage Continuous Professional Development and Recognition

Health institutions should invest in ongoing training, skills enhancement,

and recognition programs for nurses. Encouraging continuous learning and

publicly acknowledging the dedication of ward nurses can contribute to their

professional growth, motivation, and long-term retention within the

healthcare system.