Level of Personal Resiliency and Emotional Exhaustion Among Health Workers in

Lucena City

Chapter 2
Review of Related Literature / Review of Related Studies / Synthesis of Related Literature and Studies
This chapter presents the related review of study and literature both local and foreign sources, also it
presents the issues about the level of personal resiliency and emotional exhaustion among health workers. It is
useful information and serves as a guide for the researches to understand deeply and develop more knowledge that
future researches can use. According to (Pfefferbaum, B., & Carol S. North, C., 2020), public health
emergencies may affect the health, safety, and well-being of both individuals (causing, for example, insecurity,
confusion, emotional isolation, and stigma) and communities (owing to economic loss, work and school closures,
inadequate resources for medical response, and deficient distribution of necessities). These effects may translate
into a range of emotional reactions (such as exhaustion, distress or psychiatric conditions), unhealthy behaviors
(such as excessive substance use), and noncompliance with public health directives (such as home confinement
and vaccination) in people who contract the disease and in the general population. Extensive research in disaster
mental health has established that emotional distress is ubiquitous in affected populations a finding certain to be
echoed in populations affected by the Covid-19 pandemic.

Related Foreign Literature:

This study is strongly support by the following literature from different journal and article provided. The
literature of (Sultana, A., Sharma, R., Hossain, M. M., Bhattacharya, S., & Purohit, N., 2020) define
that working hard during emergencies or stressful conditions often comes with sleep deprivation, increasing the
risks of burnout study found emergency physicians are almost three times as likely to suffer depression compared
to the national average while one in seven physicians had suicidal thoughts in normal times. Other studies have
shown that healthcare providers working in infection control or among isolated or quarantined individuals are
likely to experience multiple mental health problems. This literature supported by (Gavin, B., Hayden,
J., Adamis, D., & McNicholas, F., 2020) of Ireland Medical Journal that work-related stress disproportionally
affects healthcare workers and is linked to excessive workloads, working in emotionally charged environments and
where demand outweighs capacity. In Ireland, clinician-perceived lack of management and government support,
coupled with unrealistic public expectations and cynicism about the possibility of change, compound the issue.
The increased patient safety incidents, medical errors, lower quality service provision, along with issues regarding
staff retention and psychological ill-health follow subject for worker psychological distress. Pandemic has

negatively impacted the restaurant industry and employees in the worst possible way. Findings revealed that

working employees experienced higher levels of psychological distress, drug and alcohol use than furloughed
employees. Moreover, psychological distress increased drug and alcohol use, as well as career turnover
intentions (Bostan, S., Akbolat, M., Kaya, A., Ozata, M., & Gunes, D., 2020).
Moreover, Unemployment was independently associated with greater psychological distress. Perceived
trust, optimism, and sense of mastery decreased psychological distress, whereas financial strain and loneliness
during the crisis increased this distress (Achdut, N., & Refaeli, T. 2020). In another study conducted,health
care professionals working in operating theaters participated in the study. Depression and anxiety of the
participants were found to be high respectively. Depression scores were statistically significantly higher among
females, single individuals, those who had children, those living with a person aged 60 years or older. Meanwhile,
anxiety scores were statistically significantly higher among females, single individuals (including widowed and
divorced), university graduates, those with at least one chronic disease, and those whose workload
increased (Koksal, E., Dost, B., Terzi, Ö., Ustun, Y. B., Özdin, S., & Bilgin, S. 2020). Results also revealed

that elevated psychological distress was found among dentists and dental hygienists in Israel, who have

background illness, fear of contracting COVID-19 from patient, and a higher subjective overload.
Lower psychological distress was associated with being in a committed relationship and having higher scores for
self-efficacy. Given these results, gathered during times of an infectious disease outbreak, exploring psychological
distress among dental staff is warranted as the effects may be long-term (Shacham, M., Hamama-Raz,
Y., Kolerman, R., Mijiritsky, O., Ben-Ezra, M., & Mijiritsky, E. 2020).
In addition, one literature shows that the impact of the COVID-19 pandemic on officer stress, mental
health, resiliency, and misconduct is explored drawing insight from reactions to the HIV epidemic over two
decades earlier and the terrorist attacks of September 11, 2001. COVID-19 policing is hypothesized to serve as a
significant stressor for officers and compound the general and organizational stress associated with the occupation.
The pandemic itself was a stressful event, presenting consistent risk of bodily harm and requiring officers to be
increasingly hyper vigilant of their own environment. The daily exposure to stress, safety protocols, and social
distancing policies may have limited their capacity to engage in positive coping strategies (Stogner, J., Miller, B.
L., & McLean, K., 2020). The study revealed that almost all working people in Hong-kong, were stressful in the
workplace and worried about being infected and family being infected by COVID-19 in their workplace and
workplace policy in place and its comprehensives and timeliness were found to be driving factors. The findings
further suggest that government’s overarching policy regarding workplaces, accessibility to organization’s
workplace policy, comprehensive coverage of workplace policy, and provision of protective measure such as face
masks are key consequences of heightened stress related to being infected with COVID-19 in the workplace. (F.
W., Ho, K. F., Wong, S. Y., Cheung, A. W., & Yeoh, E. 2020). Pandemic has deeply altered social and working
environments in several ways. Social distancing policies, mandatory lockdowns, isolation periods, and anxiety of
getting sick, along with the suspension of productive activity, loss of income, and fear of the future, jointly
influence the mental health of citizens and workers. Workplace aspects can play a crucial role on moderating or
worsening mental health of people facing this pandemic scenario. Mental issues related to the health emergency,
such as anxiety, depression, and sleep disorders are more likely to affect healthcare workers, especially those on
the frontline, migrant workers, and workers in contact with the public. Job insecurity, long periods of isolation, and
uncertainty of the future worsen the psychological condition, especially in younger people and in those with a
higher educational background (Giorgi, G., Lecca, L. I., Alessio, F., Finstad, G. L., Bondanini, G., Lulli, L.
G., ... & Mucci, N., 2020).
Furthermore, increased awareness of the risk of COVID‐19 in relation to the kind of workplace measures
implemented may also increase employees' fear and worry about the virus in Japan. It is also possible that
companies and organizations whose employees are most worried about COVID ‐19 took more actions against it.
However, findings indicate that the number of workplace measures was negatively associated with employees'
psychological distress and positively with their performance. It suggests that more intensive implementation of
workplace measures responding to COVID‐19 reduce employees' psychological distress and maintains their work
performance. (Sasaki, N., Kuroda, R., Tsuno, K., & Kawakami, N., 2020). According also to (Hojjati, P. 2020,

August 24), the loss of a job, or loved one, the weight of these unprecedented times can be heavy, and
significantly impact to one mental health. Forced to contend with these additional stressors while still having to
work, many workers are facing unexpected challenges with their mental well-being and needing support while at
their jobs. The identified literature reports a negative impact of COVID-19 on individual’s mental health. Stressors
include perception of safety, threat and risk of contagion, infobesityversus the unknown, quarantine and
confinement, stigma and social exclusion as well as financial loss and job insecurity. Furthermore, three
dimensions of moderating factors have been identified: organizational, institutional and individual
factors. (Hamouche, S., 2020).

Related Local Literature:

During stressful events, hardiness enables individuals to resist succumbing to the stress by facing the
problem, formulating possible solutions, and carrying those solutions out without getting too affected or emotional
about it. Hardiness is a pattern of attitudes and actions that assist in converting stressors from potential disasters
into growth opportunities instead. Higher level of burnout is related to lower levels of psychological well-being
and less favorable work outcomes. The results of the study validate the moderating role of hardiness in the
relationship between burnout and psychological well-being of journalists who cover natural disasters and
emergency situations. Findings also have shown that hardiness enhances resiliency in a wide range of stressful

circumstances including ongoing demands and pressures of everyday life (Tarroja, M. C. H., 2015). In a country

such as the Philippines, the financial repercussion of procuring food for one’s family results in heightened stress,
especially for informal workers whose livelihood remains suspended. Changes to the workplace as a result of the
pandemic would undoubtedly stay. These will alter the way individuals, organizations, and society operates, and a
new mindset will take into effect once quarantine is lifted. Human Resources will have to be in the forefront of this
new mindset to ensure employees remain mentally healthy amidst the change (Ilac, PhD, E. J., 2020, April 22).
Furthermore, the inability to balance work and life may increase stress, reducing the quality of Filipino
workers’ output and making them more prone to hypertension and heart disease. The country’s workforce
registered some of the highest stress levels in Asia. Over 42 percent of Filipino workers reported that their stress
levels have risen over the past few years, said a Regus International survey. Meanwhile, the Grant Thornton
International survey said 76 percent of Filipino business owners are highly stressed, pointing to heavy workload as
the most significant driver. Work-related stress adversely affects employers and employees alike (Ermitanio, N.
A., 2020). Studies have shown in the Philippines, that psychological burden that is being experienced by
healthcare workers and professionals. Distressing healthcare workers mean proper regulation of patient-attending
health care worker ratio and enough time for rest and recreation for healthcare workers and professionals.
Healthcare workers and professionals are considered wounded healers as they also in need of physical and spiritual
care at this time (Lagman, J. D. N., Vergara, R. J. D., & Sarmiento, P. J. D. 2021) . The (WHO
Philippines, 2021) stated that quarantine can lead to loneliness – especially for older people or people who live
alone. Loneliness can contribute to poor physical and mental well-being. Connect with other people, through social
media, telephone, and other communities and maintain mental health. Older people may find it difficult to stay
connected during a COVID- 19 quarantine. Loved one should connect to them regularly. Working in the frontline

can be difficult and stressful, it is normal to feel frustrated and over-whelmed. Dr. Ewe highlighted the impact of

pandemic fatigue on mental health of many employees worldwide. It is widely acknowledged that an employee’s
job performance and productivity can be severely affected by health issues and impact an organizations’ business
international health, security, management, and well-being solutions provider of companies and organizations,
pandemic fatigue can affect one’s mental health, decreasing an individual’s motivation to practice precautionary
health measures which may lead to increased risky behaviors (Llarena, S., 2020).
Moreover, Department of Health (DOH) warned that the coronavirus disease 2019 (Covid-19) pandemic
has brought another health crisis that is now affecting many Filipinos. (Dr. Brillantes, J., 2020), losses in jobs and
livelihood have affected mental health, leading to widespread psychological trauma, fear, depression, and even

suicides. Latest studies indicated that the Covid-19 pandemic is associated with distress, anxiety, fear of contagion,

depression, and insomnia in the general population and among health care professionals (Santiago, S., 2020,
October 14). In an article published by Asia Pacific Journal of Academic Research in Business Administration
(2020). It was found out that the employees’ in a restaurant experience ―restless or fidgety during the operation
feeling hopeless on fulfilling the management expectations with and nervous from scolded by the management.
The respondents became restless when providing service to the customers because of having a direct contact with
the customers who have different preference and demand. This is very restless and may make the staff nervous
since the expectation of the customers is continuously changing. Further, they feel hopeless to attain the
expectation of the management because they feel that they are not good enough for the task they are required to
perform (Arroyo, A. L. T., Carandang, K. J. S., Casapao, A. M. B., Dauis, A. R. C., Magtibay, S. E.,

& Apritado, J. M., 2020). Furthermore, adapting to new realities like working from home, temporary

unemployment, home- schooling of children, and lack of physical contact with other family members, relatives,
friends, colleagues at work, and the huge change in the daily routine of adapting to the “new normal”, when taken
as a whole, affects the mental health of every Filipino in general (Uy, A. M., 2020, July 19). The study showed
that health and well-being factors positively correlated with employees’ grit among Regional Office IX employees.
Moreover, the results revealed that the employees’ psychological and social well-being were significant predictors
of grit while emotional well-being did not significantly predict employees’ grit. These research outcomes affirm
that if the workers are psychologically and socially healthy, they tend to perfo
rm better (Cael, R. P, 2021).

Related Foreign Study:

In some foreign study collected by the researchers during a pandemic, healthcare professionals encounter
various health hazards that affect their personal life and workplace. Emotional intelligence (EI) has a substantial
impact on nurses’ success and performance in the healthcare industry. However, previous research studies report
inconsistent findings regarding how different levels of EI affect job performance (JP), particularly during

pandemics in Saudi Arabia (SA) (Alonazi, W. B., 2020). Also indicate that psychological stressors predicting

increased drinking during the COVID-19 crisis. Conscientious workers and those working in educational and
health and welfare sectors were less likely to increase drinking, while increased drinking was most common
among workers under 30 years of age. About one-fourth of Finnish workers reported increased drinking, one-
fourth decreased drinking and, within half of the participants, the situation had remained the same. More than half
of those who’s drinking increased were hazardous drinkers. (Oksanen, A., Savolainen, I., Savela, N., & Oksa, R.,
2020). In a study of (Babore, A., Lombardi, L., Viceconti, M. L., Pignataro, S., Marino, V., Crudele, M., ...
& Trumello, C., 2020), analyse the psychological problem of COVID-19 outbreak on healthcare professionals and
to detect some risk and protective factors of their distress levels, with regard to socio-found that a positive attitude
towards the stressful situation was the main protective factor, while female gender, seeking social support,
avoidance strategies and working with COVID-19 patients were risk factors. But economic status, problem solving
ability and turning to religion were not associated with stress levels.
In turn, lack of psychological need fulfillment hinders employees’ abilities to work effectively, engage with
their family, and experience heightened well-being. Consistent with predictions, COVID- 19 health anxiety was
found to impair critical work (goal progress), home (family engagement) and health (somatic complaints)
outcomes due to increased emotion suppression and lack of psychological need fulfilment that is, feelings of fear
and apprehension about having or contracting COVID-19 impacts critical work, home, and health
outcomes (Trougakos, J. P., Chawla, N., & McCarthy, J. M., 2020). The pandemic has already caused the
bankruptcy of many enterprises, lock-downs, shut-downs of businesses, employee lay-offs, lack of resources, and
more is to follow in the following months. It is not absurd to imagine many will experience fear of losing the job,
and some will leave the pandemic with psychological problem. Since work has functions directly related to
individuals’ psychological health and self-esteem, job insecurity inevitably has implications to one’s identity, self-
efficacy beliefs, confidence and social support system. The threat is thus not only financial but rather
multidimensional. Losing a job often entails depression and self-isolation, and since no man is an island,
withdrawal is detrimental to psychological well-being (Godinic, D., Obrenovic, B., & Khudaykulov, A.,
2020). The current pandemic of the coronavirus disease 2019 (COVID-19) has negatively impacted medical
workers’ mental health in many countries including Japan. Although research identified poor mental health of
medical workers in COVID-19, protective factors for their mental health remain to be appraised. Accordingly, this
study aimed to investigate relationships between mental health problems, loneliness, hope and self-compassion
among Japanese medical workers, and compare with the general population. Medical workers had higher levels of
mental health problems and loneliness, and lower levels of hope and self-compassion than the general population.
Loneliness was the strongest predictor of mental health problems in the medical workers ( Kotera, Y., Ozaki,
A., Miyatake, H., Tsunetoshi, C., Nishikawa, Y., & Tanimoto, T., 2021).
It’s also emphasize that COVID-19 pandemic had negatively impacts in psychological well-being (e.g.,
anxiety symptoms) among the general population of Hong Kong and migrant Filipina domestic helpers (FDHs).
Having to live with the employers by law, FDHs’ working environment might affect their well-being during
COVID-19 (e.g., household crowdedness/size, insufficiency of protective equipment against COVID-19, increased
workload) (CY Yeung, N., Huang, B., Lau, C. Y., & Lau, J. T. 2020). In a study conducted with chines’
respondent. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital
status, presence of physical symptom, poor physical health and viewing return to work as a health hazard. In
contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as
well as organizational measures including significant improvement of workplace hygiene and concerns from the
company were associated with less severe psychiatric symptoms (Tan, W., Hao, F., McIntyre, R. S., Jiang, L.,
Jiang, X., Zhang, L., ... & Tam, W., 2020). The major risk factor for mental health was worrying about
unemployment, and the main protective factors were psychological strengths (i.e., resilience and optimism).
Similar to the factors associated with mental health, the major risk factor for work attitudes was also worrying
about unemployment, and the main protective factors were resilience and optimism. In addition, the nature of the
organization, job status, age, position and income changes were also related to these work attitudes (Song, L.,
Wang, Y., Li, Z., Yang, Y., & Li, H., 2020). Psychological factors also has a dominant part of thedomestic
workers that reported physical hypertension, poor sleep and mental health problems. Unfavourable working
conditions like poor treatment and abused by their employers. All of the said hindrances are the stressors
experienced by some OFW in their workplace. On that barriers they cannot perform well and do their job (Hall,
B.J., Garabiles, M.R. & Latkin, C.A, 2019).
 The topic of employee well- being becomes even more critical during a pandemic. On the one hand,
frontline employees increasing health risks in terms of infection, stress and mental illness while, on the other, the
sudden shift to work from home and self-isolation is causing unanticipated mental health consequences, such as
anxiety, loneliness and depression which have led to an increase in substance abuse and even suicide (Tuzovic, S.,
& Kabadayi, S., 2020).
The construction industry is a work environment that poses many dangers to workers, with many hidden factors
that affect work awareness. The study showed by (Hashiguchi, N., Cao, J., Lim, Y., Kubota, Y., Kitahara, S.,
Ishida, S., & Kodama, K., 2020) that workers’ heart rate and body mass index (BMI) had a negative effect on the
feeling of safety and proactive work behavior among older workers, but showed no significant relationship among
young workers. However, regardless of workers’ age, it was clear that the feeling of safety affects job satisfaction,
and that work skills and proactive work behaviors affect perceptions regarding team performance employed at a
Japanese construction company. In a study indicates also that, in Ethiopia, the prevalence of psychological distress
among healthcare professionals is high. The coronavirus (COVID-19) pandemic causes healthcare professionals to
suffer mental health problems such as psychological distress, anxiety, depression, denial and fear (Yitayih,
Y., Mekonen, S., Zeynudin, A., Mengistie, E., & Ambelu, A., 2021)

Related Local Study:

Accordingly, results showed that the less stressed employees are in their job, the more productive they become.
This indicates the importance of creating a working environment where employees can perform efficiently through
continuous monitoring of factors that contribute to stress. Implementing better flexible work arrangements can be
associated with significantly higher productivity. An employee experiencing work-related stressors will most likely
be clouded with undesirable thoughts which may greatly influence their personal life. Employees may feel anxious
and pressured when they cannot cope up with the quantity of work (Paje, R. C., Escobar, P. B. A., Ruaya, A. M.
R., & Sulit, P. A. F., 2020, April). Results identified job status as a significant predictor of dysfunctional anxiety
related to coronavirus, with contracted nurses experiencing higher levels of COVID ‐19 anxiety than full ‐time
nurses. Coronaphobia is prevalent among frontline Filipino nurses, particularly among public health nurses. By
increasing personal resilience in nurses through theoretically-driven intervention, coronaphobia may be
alleviated. The prevalence rate of coronaphobia was 54.76% in public health nurses were identified as predictors of
COVID-19 anxiety. A small proportion of nurses was willing to manage and care for coronavirus
patients (Labrague, L. J., & De Los Santos, J. A. A., 2020). Moreover, in a study conducted by (Talidong, K. J.
B., & Toquero, C. M. D. 2020) because of the anxiety or psychological stress brought by COVID-19, 92.7% of
Filipino teachers are not confident to go to crowded places, 91.3% do not feel secure with using public
transportation, 89.9% are conscious in touching any surfaces at public areas, 79.3% are conscious to touch their
faces without washing their hands, 81.7% have doubts in eating in a restaurant, 91.7% of Filipino teachers’
lifestyle change because of the COVID-19, and 92.7% are afraid that their family members might be infected with
COVID-19. The findings of this study show a positive outlook among Filipino teachers amid the COVID-19
pandemic, yet, psychological stress or anxiety is apparent in their lives. This is due to the fact that they are not able
to do the things that they once used to do as their lifestyle changed during the pandemic.
Also indicated in a local study that anxiety related to the COVID ‐19 pandemic is prevalent in the nursing
workforce, potentially affecting nurses’ well‐being and work performance. Identifying factors that could help
maintain mental health and reduce coronavirus‐related anxiety among front ‐line nurses is imperative. Currently, no
studies have been conducted examining the influence of personal resilience, social support
and organisational support in reducing COVID‐19 anxiety among nurses ( Labrague, L. J., & De los Santos,
J. A. A., 2020). This study is supported by a related research conducted that job role and attendance of COVID‐19‐
related training predicted fear of COVID‐19. An increased level of fear of COVID ‐19 was associated with
decreased job satisfaction, increased psychological distress and increased organisational and professional turnover
intentions (Labrague, L. J., & de Los Santos, J. A. A., 2020). In a cross- sectional study in the Philippines
as conducted by the same author (De losSantos, J. A. A., & Labrague, L. J., 2021), fear of COVID-19 is
universal among nurses. Fear of COVID-19 is associated to the community nurse’s work-related distress and may
influence their intention to leave their jobs and the nursing profession. This study is well supportive by (Sadang, J.
M., 2021) the COVID-19 pandemic results a gradual situation of Filipino nurses’ life in healthcare systems,
leading to stressful and overwhelming challenges in their daily battle against this disease. This descriptive
phenomenological inquiry is all about the life of Filipino nurses as one of the frontliners in community quarantine
facilities. In other hand Salary and incentives may not be enough if other aspects of the human being are not given
attention such as wellbeing. A problem of all industries including the schools. Employees’ performance is a
prerequisite for Organizational performance (Damianus, A., Magallanes, T., Foronda, G. S. L.,

& Encarnacion, M. J., 2020). Research study determined the psychological impact of the COVID-19

pandemic to employees of a private college in the Philippines during the Calendar Year 2020. Results showed that

anxiety level of the respondents were described as little of the time while depression level of the respondents were
described as some of the time.
Moreover, some employees reported that they suffered from mild anxiety and mild depression during

COVID-19 outbreak (Velasco, M. S., 2021). The prevalence of psychiatric symptoms and identified the factors

contributing to psychological impact in the Philippines. Female gender; youth age; single status; students; specific
symptoms; recent imposed quarantine; prolonged home-stay; and reports of poor health status, unnecessary worry,
concerns for family members, and discrimination were significantly associated with greater psychological impact
of the pandemic and higher levels of stress, anxiety and depression (Tee, M. L., Tee, C. A., Anlacan, J.
P., Aligam, K., Reyes, P., Kuruchittham, V., & Ho, R. C., 2020). Additionally, job satisfaction and
performance refer to the gratification that an employee feels when he/she accomplished the job and appreciated by
the superiors. A productive job performance is often confused with the effort that refers to energy expended. It is
the accomplishment of an employee or manager’s assigned duties and outcomes produced on a specified job
function or activity during a specified time period. One way to determine whether employees are happy and
contented in fulfilling their work (Angeles, V. P., Saludo, A. K. M., V. L. R. and Win, W. T., 2015). Fatigue and
burnout among healthcare providers and staff are prevalent during the normal course of care delivery, and even
more so in times of crisis when cognitive and emotional overload are exacerbated by critical environmental and
situational conditions. These weaknesses are exacerbated by fatigue and burnout, absence of team trust, lack of
time, medical illness, and poor
psychological safety, each of which can result in reduced performance and contribute to failures such as
misdiagnoses and adverse events (Rodrigues, R., Coelho, R., & Tavares, J. M. R., 2019)