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The Effects on The Level of Mental Stability of Nurses at Camp Crame General Hospital

Chapter 1

The problem and its Background

Introduction
The study underscores the crucial role of mental and emotional stability in overall well-
being, particularly in the nursing profession where nurses are tasked with providing medical
care and emotional support to patients. Maintaining emotional stability is seen as beneficial for
nurses' job performance, allowing them to handle stress and interactions effectively. The study
addresses a knowledge gap by examining how nurses' mental stability relates to the quality of
care provided to patients in a hospital setting, recognizing the potential impact of emotional
steadiness on patient outcomes.

Background of the Study

A day in the life of a nurse is walking through the door of the clinical setting, working
through their morning routines, reading patient's charts, then going and evaluating the patient's
health. This is all handed with strict attention to details yet still concurrently considering one's
capability to carry on with his/her emotions under stressful circumstances. Martha Rogers, One
of the American Nurses developed "Science of Unitary Beings', a diverse model developed in
the middle of the past century, which retains relevance to this day. Though there were no
specifics that precisely describe the framework, Rogers’s theory sanctioned nurses to work on
compliance monitoring in improving clinical outcomes amid maintaining focus on the patients
they work with. Martha Roger's theory is a useful model for addressing the growing issue of
nursing burnout, which is known to cause increased rates of people who suffer from a disease
and deaths in the clinical setting. Thus, having a workplace filled with violence tension
between patients and visitors is very concerning to the mental stability of the nurses. Not only
do nurses experience workplace violence but also suffer from lack of emotional support from
superiors leaving them unfulfilled and unsatisfied.
Research has shown that resilience is a crucial factor in maintaining mental stability among
nurses. Resilience can be described as the ability to adapt positively to stressful situations and
overcome adversity. According to Health Times, nurses who are resilient are better equipped to
handle the challenges of their job and maintain their psychological well-being. It is important
to note that mental stability is not only essential for the well-being of nurses but also for the
quality of care they provide to patients. Nurses who are mentally stable can communicate to
patients more effectively, provide quality care and make sound clinical decisions.
When quality care is tackled, in a broad aspect in a clinical setting, people instantly have an
idea of what it is, an integration of care. And an integration of care is essential because it
centers on improving health outcomes. According to WHO, quality of care is the standard
health service that is provided to each and every one with the probability of improving the
standard care from its effectiveness and safety use to providing care that responds to individual
preferences, needs and value
Statement of The Problem
This study sought to determine the effect on the level of mental stability among nurses at
Camp Crame General Hospital. Specifically, it sought answers to the following questions:
1. What is the Demographic profile of nurses’ respondents in terms of:
1.1 Age
1.2 Sex
1.3 Marital Status
1.4 Highest Education Attainment
1.5 Length of service
1.6 Designation
2. What are the factors of mental stability of the nurse respondents in terms of:
a. Work Engagement
b. Job Resources
c. Professional work outcomes
d. Clinical Effectiveness
e. Patient Experience
f. Patient Safety
3. Is there a significant relationship between the factors influencing mental stability when
grouped according to their demographic profile?
4. Based on the research, what program can be proposed?

Significance Of the Study

The results of this study can be used to develop interventions that promote mental
stability among nurses and improve patient care outcomes. The following would reap the
benefits of this study:

DOH: This study will inform the Department of Health, particularly those in the medical field,
about the relationship between nurses' mental stability and the quality of patient care. In relation
to this, they will understand how it affects patients in numerous ways.
HOSPITAL: It will also help the Administrators of the hospital by giving some awareness about
the emotional stability of an individual particularly who are in the medical field.

NURSES: It can help nurses advance and be equipped in their field and improve patient
outcomes.

FUTURE RESEARCHERS: This study will give them knowledge about the assessment on the
level of mental stability of nurses at Camp Crame General Hospital towards patients’ Quality
Care This will also serve as a guide for those future researchers who will conduct the same study.

Scope and Limitation of the Study

This research study was conducted to determine the effect on the level of mental stability
among nurses on General Ward with 3 years and up experience at Camp Crame General Hospital
in response to patient care excluding the chief nurses and nurses with 3 years and below
experience. This study will be in conjunction with the demographic profile of nurse respondents,
their level of mental stability in terms of work engagement and outcome, towards patient care. A
survey questionnaire and simple random sampling Likert Scale will be used by respondents to
evaluate and analyze the level of mental stability of nurses and its effect on patient care.
Camp Crame General Hospital is located at Camp BGen Rafael T Crame, Quezon City.

The research group decided to choose a government hospital not only because of its
proximity but also because it provides medical and dental services, various medical facilities
such as psychological and behavioral management section, physical fitness test clinic, clinical
service, histopathology, clinical microscopy, hematology, clinical chemistry, immunology,
serology, and blood bank. It is also known as Philippine National Police General Hospital.

The need for the study to narrow it down and focus on specific aspects of the research
question, the place where the study is conducted or the population under investigation is due to
time constraints and budget limitations.
Operational Definition

MENTAL HEALTH- includes our emotional, psychological, and social well-being. It affects
how we think, feel, and act, and helps determine how we handle stress, relate to others, and make
choices.

LEVEL OF MENTAL STABILITY- serves as a gauge to determine the mental capacity of the
nurse respondents to maintain a balanced emotional state under stressful
circumstances.

JOB STRESS- is the response people may have when presented with work demands and
pressures that are matched to their knowledge and abilities and which challenge their ability to
cope.

FATIGUE- is a common symptom that reduces energy, the ability to do things, and the ability to
focus.

WORKLOAD- refers to the amount of work that a nurse is expected to do within a particular
period of time depending on the number of patients.

BURNOUT- is an individual stress experience that originates from emotionally demanding

interpersonal relationships with significant stimuli.

WORKPLACE VIOLENCE- any act or threat of verbal or physical violence, harassment,

intimidation, or other threatening disruptive behavior that occurs at the worksite with the
intention of abusing or injuring the target.

ORGANIZATIONAL SUPPORT- refers to the provision of resources, encouragement, and

assistance to nurses by their employers to help them perform their jobs effectively and
efficiently.
WORK-LIFE BALANCE- refers to the ability of nurses to effectively manage their
professional responsibilities and personal commitments, ensuring they have time for self-care,
family, and other leisure activities outside of work.

GENERAL HOSPITAL- is a medical facility that provides care to patients with a wide range
of illnesses and injuries and offers a broad range of services, including emergency care, surgery,
diagnostic testing, and rehabilitation.

NURSE- refers to a trained healthcare professional responsible in caring for the sick or infirm,
and providing medical care and interventions for patients at Camp Crame General Hospital.

PATIENTS- this pertains to individuals who are receiving medical care, performed by licensed
healthcare providers at Camp Crame General Hospital.

QUALITY CARE- is the degree to which health services for individuals and populations
increase the likelihood of desired health outcomes for patients.

AGE - Age refers to the number of years that a person or thing has existed since birth or
creation.

SEX - Sex refers to the biological and physiological characteristics that distinguish male and
female organisms, typically associated with reproductive functions.

MARITAL STATUS - Marital status refers to an individual's legal relationship with a spouse,
indicating whether they are currently married, divorced, separated, widowed, or unmarried.
HIGHEST EDUCATIONAL ATTAINMENT - Highest educational attainment refers to the
highest level of formal education an individual has completed, typically denoted by the degree or
certification earned.
LENGTH OF SERVICE - Length of service refers to the total duration of time an individual
has been employed or served in a specific organization, job, or position.

DESIGNATION - Designation refers to a specific title, role, or position assigned to an

individual within an organization, indicating their responsibilities and level of authority.

WORK ENGAGEMENT - Work engagement refers to the positive, fulfilling, and meaningful
state of mind an employee experiences while fully investing their energy, dedication, and focus
into their work tasks and responsibilities.

JOB RESOURCES - Job resources refer to the various tangible and intangible assets, support
systems, and opportunities provided by an organization that contribute to employees' well-being,
satisfaction, and effective job performance.

PROFESSIONAL WORK OUTCOMES - Professional work outcomes refer to the measurable

results, achievements, and impacts produced by an individual in their professional capacity,
reflecting their effectiveness and contributions within a specific job or role.

CLINICAL EFFECTIVENESS - Clinical effectiveness refers to the extent to which a

healthcare intervention, treatment, or service achieves the desired health outcomes and benefits
for patients in real-world practice settings.

PATIENT EXPERIENCE - Patient experience encompasses the subjective perceptions,

feelings, and interactions that individuals have with the healthcare system, including the quality
of care, communication with healthcare providers, and overall satisfaction with their medical
encounters.

PATIENT SAFETY - Patient safety refers to the proactive measures, protocols, and systems
implemented within healthcare settings to prevent and minimize harm to patients, ensuring the
delivery of high-quality and error-free medical care.
 Chapter II

Review of Related Literature and Studies

In this Chapter, the researchers look for more journals, articles, sites and other sources of
data that can support the study. The researchers analyzed each related data they gathered and
separated the local and foreign studies. Overall, they compiled about 90% data from research
studies and 10% data from articles and books.

Foreign Literature
According to Ato Morris G. 2022. Clinical nurses work in a high stress environment and
many have experienced nurse burnout. Burnout is a state of emotional, physical and mental
exhaustion. It is often triggered by long hours of patient care with poor outcomes, a perceived
lack of control, and inadequate support. Consequences of burnout include a stressed immune
system, overwhelming fatigue and anxiety. It is important to educate your patients to motivate
them to choose a healthier lifestyle and then according to Falguera, CC 2022 he stated that
nurses with lower levels of work engagement reported increased levels of job burnout and
turnover intention. Those nurses with higher scores on the dedication subscale reported increased
jobs.

According to Wisnusakti, K., Kumala, T. F., & Hidayat, M. M. 2022. Emotional stability
is a personality trait that refers to the degree to which a person's mood and
Emotions change. High emotional stability can be seen as the ability to deal with negative
emotions effectively and a person's emotional stability is characterized by mood, intention,
demand, optimism, joy,calmness and free from guilt.

Wisnusakti, K., Kumala, T. F., & Hidayat, M. M. 2022. Overview of emotional stability
in class adolescents based on nursing perspectives. Jurnal Keperawatan Komprehensif
Comprehensive Nursing Journal, 8 Special Edition. According to Wisnusakti K., Kumala T.,
Hidayat M., 2022 Emotional stability is one of several indicators of mental health. If adolescents
do not have emotional control, it will cause anxiety and feelings of inferiority. Emotional
stability is free from worries of the heart, and has good emotional control. Emotional stability is
a very strong emotional condition in which the individual is able to face his problems with a
calm heart and emotions. The low emotional stability of a person is shown in the failure to
develop an independent attitude that should exist in normal adults. It has been observed that
some of the factors of emotional stability are mood which is influenced by several factors, one of
which is environmental factors. This symptom arises due to frequent viewing of posts containing
someone's pleasure which makes the person's self-confidence decrease because they do not have
the same fate which can affect a person's mood which will then have an impact on emotional
stability. Some people experience emotional transmission more easily from negative posts.

Wisnusakti K., Kumala T., Hidayat M., 2022 Overview of emotional stability in class
adolescents based on nursing perspectives. Based on the study of Heath S. 2022, she found out
that Communication between nurses and patients is built on a solid foundation of interpersonal
relationships.
It will be easier for nurses to carry out their clinical responsibilities and keep patients
engaged in their care if they have meaningful relationships. Even a brief conversation with a
patient while sitting next to them can increase their level of satisfaction. In these open-ended
conversations are held with the patient and the nurse to forge strong relationships that frequently
extend beyond the requirements of the patient's clinical care. If the nurse knows the patient as a
person, she can connect with the patient and make her feel comfortable during a potentially
stressful care encounter.

According to Kim Celeste S., K., Jones.,M., B., Journal of Research in Nursing 2021
Relationships between nurses’ experiences of workplace violence, emotional exhaustion and
patient safety. The rising rate of workplace violence in hospitals is a serious concern. While
leading organizations recommend implementing interventions to address workplace violence,
little is known about the workplace violence relationship between patients and visitors, and how
it affects nurses’ emotional exhaustion and their perceptions of patient safety. Aims: The study’s
purpose was to understand the status of workplace violence in hospitals and the relationships
between nurses’ experiences of workplace violence, emotional exhaustion, and perceptions of
patient safety.
Methods:

This cross-sectional analysis used data from a survey conducted at a large academic
medical center using the Agency for Healthcare Research and Quality Hospital Survey on Patient
Safety Culture plus additional measures of workplace violence and emotional exhaustion.
Results: Nurses reported more occurrences of verbal violence than physical violence.

Nurses’ experiences of workplace violence negatively affect nurses’ emotional

exhaustion and patient-safety perceptions. Moreover, nurses’ emotional exhaustion mediated the
relationship between verbal abuse and patient-safety perceptions. Conclusions: Interventions to
reduce nurses’ emotional exhaustion and strengthen resilience can mitigate the negative effects
of verbal abuse and to some extent the effects of physical violence.

As stated by Ahmed E.S.S.S. M., 2020 Evidence-Based Nursing Research, Emotional

Stability of Nurses and its relation to their Job Crafting. Emotional stability is the process in
which the personality is continuously striving for a greater sense of emotional health. Job
crafting can be seen as a specific form of proactive behavior in which the nurse initiates changes
(redesign) in the level of job demands and job resources to make their job more meaningful.
Nurses with high emotional stability are more tending to adapt to changes in their job and
enhance their job crafting. Aims: This study aimed to assess the emotional stability of nurses and
their relation to their job crafting.

In addition to the study of Faten M. 2020 and Saad E. 2020, Emotional balance affects
the nurses while handling crises, emergencies. Emotionally strong nurses can deal frivolously
with those without letting bad private feelings intrude with their rational decision-making,
therefore shielding affected person safety. Among nurses running as a group and cooperating to
handle emergent and complicated affected person troubles, emotionally strong nurses can assist
remedy maximum emergent and complicated affected person troubles inside their painting units,
therefore improving job crafting.
 Nurses should be given the opportunity to make decisions according to their
personalities, because these traits affect the quantity and quality of their decisions, which can
also affect work satisfaction, job retention rates and patient outcomes. In order to better
understand how nurses react in certain situations, we should use assessment tools that help them
recognize how they react in a variety of different situations—and through clinical education offer
them the opportunity to learn coping mechanisms for whenever they may feel overwhelmed or
unsure of themselves. Farčić N., Barać I.,. Plužarić J., Ilakovac V., Pačarić S., Gvozdanović Z., .
Lovrić R., 2020 Personality traits of core self-evaluation as predictors on clinical decision-
making in the nursing profession.

According to Nwankwa O. PhD, Moneme O. 2020 Nurses’ burnout adversely affects

their emotional stability. Emotional stability gets deteriorated due to high work pressure and
interpersonal conflicts in the nursing department. For each project, nurses are required to fill out
numerous forms and process paperwork. Due to this, it has become difficult for them to focus on
their job tasks.

Nwankwa O., PhD, Moneme O.,2020 Life -Distress and work burnout as predictors of
organizational reactions and social-emotional stability of nurses in eastern nigeria Biafra
Implications for Covid-19 Health-Care Givers/Providers. According to Kwak, Y., Han, Y., Song,
J. S., & Kim, J. S. 2020.Nurses often suffer from a lack of emotional support at work, which can
lead them to feel stressed and unhappy. In order to improve the professional quality of life for
nurses, it is important that they are given the chance to discuss their emotions with their peers
and receive appropriate help whenever they need it.

According to Jones A. 2021. Empathy requires emotional stability. A nurse who shows a
lack of visible anger or frustration with patients is more likely to have patients trust her and feel
comfortable discussing their problems. Nurses in the healthcare industry are often faced with
difficult situations every day, which can make it harder for them to concentrate on patient health
and safety.
 Jones A. 2021. Qualities of a good nurse. Grand Canyon University U.S.A. Kwak, Y.,
Han, Y., Song, J. S., & Kim, J. S. 2020. Impact of emotional labour and workplace violence on
professional quality of life among clinical nurses. International journal of nursing practice.

Based on Jang M.,L.,S.,International Journal of Workplace Health Management 2020.

Nurses’ emotions, emotional labor, and job satisfaction the purpose of this paper is to examine
the relationships between emotional labor, emotions, and job satisfaction among nurses, and
explore the mediating role of emotions in the relationship between emotional labor and job
satisfaction.

Design/methodology/approach: A cross-sectional study was designed with 168 nurses in

Korea. Structural equation modeling and path analysis were performed to analyze data. Findings:
Surface acting correlated positively with anxiety and frustration. Deep acting correlated
positively with enjoyment and pride but correlated negatively with anxiety, anger and frustration.

As stated by Jang K., S., 2019. Nurses’ emotions, emotion regulation and emotional
exhaustion. The nursing profession is challenging, although there are many situations in which
nurses feel rewarded for their nursing practices. On a daily basis in the workplace, nurses
encounter a variety of emotions and their nursing activities could involve tremendous emotional
effort. In fact, they are expected to express appropriate emotions and present a public image that
is empathetic, caring, compassionate and considerate but also to control their unpleasant
emotions such as anger, distress, sadness and frustration.

According to Yao, Y., Zhao, S., Gao., X., An, Z., Wang ., S., Li., H., & Dong, Z. 2018.
GSE and introverted unstable personality are among the top three factors that contribute to job-
related burnout in nurses. GSE moderates the effect of stress on burnout in nurses with extension
or neuroticism personality; reducing stress and increasing GSE can alleviate job-related burnout
in nurses. Nurses with introverted unstable personalities should be given more social support to
reduce stress and enhance their GSE.

According to Chen, Y. P., Tsai, J. M., Lu, M. H., Lin, L. M., Lu, C. H., & Wang, K. W.
K. 2018. Support for improving agreeableness and emotional stability in pediatric nurses'
workplaces including involvement in the outdoor activities and an increase in social connection
may enhance compassion satisfaction and prevent exhaustive compassion fatigue. Yao, Y., Zhao,
S., Gao., X., An, Z., Wang, S., Li, H., & Dong, Z. 2018. General self-efficacy modifies the effect
of stress on burnout in nurses with different personality type BMC health services research.

According to Aquino, A., 2018 Emotions can influence your actions and reactions,
whether you're aware of it or. For example, when someone is emotional about a particular
situation, other people who might be affected by that person's actions may react accordingly.
Therefore, the way you feel influences how you react and how you think of a particular situation.
Emotional stability is important because it not only improves life for yourself but also for your
friends. However, in order to understand emotional stability first you must know the definition:
“a person's ability to remain calm or even keel when faced with pressure or stress.”

In accord with Sehularo P.A., MolehabangweAbel K.J., 2018 Africa Journal of Nursing
and Midwifery “Nurses coping mechanisms in a mental health establishment”. The aim of this
study was to explore and to describe nurses coping mechanisms in a mental health establishment
in the North West province of South Africa so as to improve the methods of how they manage
stressful situations in their care for mental healthcare users. A qualitative- exploratory-
descriptive and contextual design was followed to deal with the researcher`s concern. The target
population included all categories of nurses who are caring for mental healthcare users in a
mental health establishment in the North West province. Participants were selected purposively
based on a set of selection criteria.

The size of the sample was determined by data saturation which was reached after
interviewing 10 nurses. Information obtained was transcribed verbatim for data analysis.
Trustworthiness was ensured through credibility, Dependability, transferability and
confirmability techniques.

Tao, Lin W., tells that when nurse emotional intelligence matters: How transformational
leadership influences intent to stay. Zhang Y. Journal of Nursing Management 2018 The purpose
of this study was to examine the role of staff nurse emotional intelligence between
transformational leadership and nurse intent to stay. Background: Nurse intent to stay and
transformational leadership are widely recognized as vital components of nurse retention. Staff
nurse emotional intelligence that has been confirmed improvable has been recently recognized in
the nursing literature as correlated with retention.

According to Bachnick, S., Ausserhofer, D., Baernholdt, M., Simon, M., & Match RN
Study Group. 2018. The less nurses implicitly ration care, the better patients understand their
needs and feel adequately informed about their treatment. To improve patient-centered care, the
nurse work environment and the level of implicit rationing of nursing care should be taken into
consideration. Bachnick, S., Ausserhofer, D., Baernholdt, M., Simon, M., & Match RN Study
Group. 2018. Patient-centered care, nurse work environment and implicit rationing of nursing
care in Swiss acute care hospitals: A cross-sectional multi-center study. International journal of
nursing studies, 81, 98-106.

According to Farčić N., Barać I., .Plužarić J., Ilakovac V., Pačarić S., Gvozdanović Z., .
Lovrić R., Nurses with high self-esteem, self-efficacy and an internal
locus of control in their work makes autonomous intervention decisions, seek alternative options
and analyze patient data in detail.

Nursing positions should be made according to the assessment of their personality traits
because they affect the quantity and quality of their decisions. These factors may also affect job
satisfaction and retention rates in the healthcare workplace. As stated by Ching I., 2019
Emotional Stability of nurses: Impact of patient safety. This paper is a report of a study
conducted to examine the influence of the emotional stability of nurses on patient safety.
Background individuals with greater emotional stability are less likely to exhibit strong
emotional reactions to stressful situations, and tend to be more proactive and successful in
problem-solving.

According to Whitehead D. 2018. In the field of health care, Early Intervention is

important for achieving effective leadership in healthcare organizations and contributes
decisively to their good-functioning and successful operation. Individual nurses have the ability
to identify and experience a wide range of emotions in everyday life. However, some of them are
not able to use, understand and manage these emotions. As regards nurses, at every level, the
above need is considered imperative because of the particular nature of the nursing profession,
which places the healthy or weak person at its center. By implementing social and emotional
learning programs, nurses can acquire knowledge, attitudes and skills that are necessary for
understanding and managing emotions, achieving positive goals, and maintaining positive
relations and accountable decisions

According to Heyhoe, J., Birks, Y., Harrison, R., O’Hara, J. K., Cracknell, A., & Lawton,
R. 2020. Some health professionals have difficulty controlling their emotions when making an
error and in particular, feelings of shame, guilt, fear, panic, shock and humiliation. This distress
readily transfers into personal life, creating additional burdens.

Local Literature
In the study of Fronda, D. C., & Labrague, L. J. 2022. Corona Phobia is not an unusual
place amongst nurses who on the frontline of the pandemic, withinside the lengthy term, has
poor influences on nurses' intellectual fitness and will increase their charge of turnover,
techniques to fight this worry must be instituted.

Organizational assist thru the availability of intellectual fitness services, improvement of

intellectual fitness sources along with brochures, and pamphlets, provision of PPEs and
specialized education approximately COVID-19 treatment, and progressed staffing ranges
became visible to have considerable advantages for the intellectual fitness of frontline nurses, at
some stage in the outbreak.

Social assistance and coping talents acted as mitigating elements to lessen the effect of
corona phobia on frontline nurses' turnover intention. Strategies to foster nurse retention at some
stage in the pandemic must consist of measures to beautify social assistance and increase coping
abilities in nurses.
 In addition, according to Jimenez, O. J. B., Trajera, S. M., & Ching, G. S. 2022. ICU
nurses attempt to decrease the tension and pain of demise sufferers. Moreover, ICU nurses accept
as true that demise sufferers have to have a few manipulations over how and with whom they
spend their closing moments. Importantly, regardless of the presence of a crisis of preferred care
inside, which the healthcare group and nurses are operating, it is vital that patients continue to
receive compassion.

In Addition, Butao, B. C., Arquiola, D. G., Talidro, M. J., Donoso, B. C. K., Mongado, S.
R. L., Funcion, N. P., ... & Fadare, S. A. 2021. Burnout has a significant impact on the quality of
nursing care among hemodialysis nurses in Butuan City, The Philippines. By fostering
workplace practices that will help them to reduce burnout and empower them to foster healthy
connections with their co-workers, HD nurses can create a peaceful and productive work
environment that may lessen tensions and reduce burnout.

Based on the study of Silloriquez N. 2020. Nurses are faced with a complex health care
workplace in which violence is accepted as a common destructive problem and a persistent
occupational threat. Nurses receive appreciation from patients and peers, but many live with the
thought of doing their jobs well to render quality care.

Regardless of demeaning incidents and other forms of disruptive behavior, nurses

continue to work and choose to stay in the profession because of compassion for service and love
for their patients. The second major theme was fear of retaliation from doctors or employers if
they reported disruptive behavior incidents at work. Some even stated that they would lose their
job if they spoke up about such incidents.

This thread of fear is disturbing; nursing advocates for patients while people are afraid to
advocate for themselves. While on the study of Astvik, E., & Andersson, A. 2018.

Nurses working in public health care settings face challenges that can affect their ability
to deliver the care they want. Many nurses describe feeling overwhelmed by their workload and
time constraints, which makes it difficult for them to interact with patients in a meaningful way.
When nurses are threatened by patient safety issues, they sometimes feel helpless and
inadequate, which can lead to feelings of depression.

Moreover, based on the study of Munoz, J.E.K., Onda J.N., Pantoja,A., Perez J.K.,
Magnaye, P. (PhD), Pring, C. (RN, PhD) 2019. They found out that Nurses who work beyond
retirement age are still capable of doing their duties and responsibilities within their limitations.
Emotionally, the nurses feel relief whenever they see their patients happy, especially when those
patients show their appreciation with the work they did.

According to Whitehead D. 2018. In the field of health care, Early Intervention is

important for achieving effective leadership in healthcare organizations and contributes
decisively to their good-functioning and successful operation. Individual nurses have the ability
to identify and experience a wide range of emotions in everyday life. However, some of them are
not able to use, understand and manage these emotions. As regards nurses, at every level, the
above need is considered imperative because of the particular nature of the nursing profession,
which places the healthy or weak person at its center. By implementing social and emotional
learning programs, nurses can acquire knowledge, attitudes and skills that are necessary for
understanding and managing emotions, achieving positive goals, and maintaining positive
relations and accountable decisions

According to Khalifa M.A.M., Abdelrahman S.M., Fahmy A.M., Gabra S.F. 2021.
Nurses should be provided with training to help them in their needs to enhance the development
of emotional stability and time management skills. Social interaction skills, emotional stability
management, and time management are some of the essential skills of a nurse that help to
improve the nursing skills.

According to Jimenez-Herrera A., Llaurado-Serra M., Acebedo-Urdiales S., Bazo-

Hernandez L., Font-Jimenez I., Axelsson C. 2020.The moral emotions are the positive and
negative feelings that occur in response to another person’s actions, including empathy, guilt and
anger. A person’s moral emotions may be influenced by a sense of right and wrong. The moral
emotions play a very important role in the nurse’s decision-making process that relates to patient
care. An understanding of these emotions helps the nurse to make better decisions and also acts
as an influencer in patient care. This knowledge makes it easier for her/him to assert
herself/himself in regards to other members of the health-care team who have different feelings
towards patients, household staff and relatives of patients.

According to Thiel E.V. 2022. Emotional stability is one of the five traits that make up
the Big Five personality theory. Stable, happy, and comfortable in their ability to deal
with stress are all traits that demonstrate emotional stability. Moreover, emotional stability is
marked by low sensitivity to feelings and an absence of negative emotions.

According to Soltani, F. 2018. Being a nurse is an extremely stressful career. As nurses,

we are constantly caring for people, making life and death decisions at all levels of care in the
hospital. Nurses often see traumatic events firsthand. Sometimes this creates a toll on you and
your emotional stability is affected. It's important that you have the tools to cope with your
feelings and seek assistance if you need it. Emotional Stability is a factor that determines the
mood and state of mind of an individual. This emotional stability plays a significant role in
managing a company as employees are responsible for it. Therefore, it is essential for managers
to create psychological safety for their employees and refrain from any kind of aggression
towards them.

According to Alhalal, E., Alrashidi, L. M., & Alanazi, A. N. 2020. Patient-centred care is
a key part of achieving high-quality care as it establishes a sense of trust and connection between
healthcare professionals and patients. This allows patients to understand the nurses' goals,
objectives, and treatments holistically. Nurses can provide patient-centered care by promoting
their own compassion first, ensuring they are physically and mentally healthy while providing
positive interactions with their patients. Empowering the nurses through effective
communication and creating an environment of support can help make sure that these
relationships remain strong which in turn decreases burnout rates among nurses. An empowering
structure needs to be in place for nurses to facilitate patient-centered care where self-care
techniques are encouraged as well as leadership development in order for them to have the
required knowledge needed for providing patient-oriented services.
 According to Ryu, I. S., & Shim, J. 2021. The compassion satisfaction (CS) is an
important piece to the puzzle when it comes to reducing nurse burnout and improving (PSMA).
Stress reduction is essential in healthcare, and the COVID-19 pandemic has added numerous
layers of difficulty to the profession. Therefore, tangible interventions like improvements in the
nursing work environment and appropriate compensation for those dealing with special
situations must be put into action. Individual nurses also have roles to play--compassion
satisfaction (CS) must be increased, burnout decreased--and further studies need to explore
strategy development in this area as well as their effectiveness. To improve patient care, both at a
social and individual level, it is absolutely necessary that our shift nurses are given every
opportunity to succeed.

It is increasingly being recognized that the traits of a nurse can play an instrumental role
in clinical decision-making. Nurses who have a high sense of self-esteem, self-efficacy, and
believe they are in control of their performance tend to make autonomous decisions on how to
apply interventions as well as seek out alternatives or additional information. The accuracy and
effectiveness of decisions made by nurses can drastically impact patient outcomes and safety, so
training recently has been focused on developing critical thinking skills and developing long-
term learning programs. This allows nurses to constantly build upon their knowledge base and
make better decisions when it comes to patient care. Additionally, decisions taken by nurses with
these varied qualities are more likely to be better informed and result in greater job satisfaction;
thus leading to an increase in retention rates among employees. Ultimately, distributing nursing
positions based on individual assessments of personality traits can prove a beneficial strategy in
creating a holistic workspace in healthcare facilities.Farčić, N., Barać, I., Plužarić, J., Ilakovac,
V., Pačarić, S., Gvozdanović, Z., & Lovrić, R. 2020.

Self-care practices are essential for nurses to help promote and maintain their physical,
mental, and spiritual wellbeing. Unfortunately, this fact is often overlooked or pushed aside due
to the demands of the job. However, with many sources of stress in nursing, it is vital that nurses
take an active role in managing their health and wellness. Fortunately, evidence-based strategies
can be used to implement practical self-care techniques into a nurse's daily routine. These
strategies should not only be supported by fellow nurses and managers but also by hospital
administrators who understand how important self-care can be for their healthcare team. By
investing in self-care just as heavily as they invest in taking care of their patients, nurses can
have confidence that they will remain mentally and physically healthy while also providing
quality care to their patients.

Theoretical Framework
According to a cross-sectional study published in BMC Nursing, job stress has a negative
effect on the quality of life related to nurse's health. It can also overshadow the performance of
care and reduce such behaviors in nurses, which may be one of the factors affecting the outcome
of patients and Another study published in PS Net identified a negative relationship between job-
related stress among nurses and patient safety culture. Studies also reported that factors such as
fatigue, workload, burnout, and workplace violence contribute to job-related stress and resulted
in decreased patient safety culture.

Big Five personality theory by Dr. Edwin van Thiel (2022) Why do people respond
differently to the same situations? In contemporary psychology, the Big Five personality traits
are five broad domains which define human personality and account for individual differences.
This article tells you more about the Big Five personality theory and the personality traits it
distinguishes. After reading it, take our free personality test to determine your own Big Five
personality type.

Behaviorism focuses on the idea that all behaviors are learned through interaction with
ethe environment. This learning theory states that behaviors are learned from the environment,
and says that innate or inherited factors have very little influence on behavior B.F Skinner. By
knowing this theory, nurses will know how to act because of the positive treatment or
environment they are in, their responses will change, and their emotions will be more
manageable and stable.
 On Burnout Multidimensional Theory
Maslach (1993): The theory advocates the three-dimensional burnout concept, which is
derived empirically rather than theoretically. The first component is emotional exhaustion, which
closely resembles an orthodox stress variable. The second component is depersonalization,
which refers to the person's negative perception of stimuli. The third component is reduced
personal accomplishment, which includes a person's negative self-evaluation in relation to his or
her job performance.

Burnout is an individual stress experience that originates from emotionally demanding

interpersonal relationships with significant stimuli. Therefore, stress and burnout experiences of
nurses are embedded in a complex social context and also involve the nurses’ attitudes toward
colleagues, patients, patients’ relatives, and hospital management.

By implication, Herzberg’s two-factor theory influences or is at the root of nurses’

organizational reactions and emotional stability, as well as nurses’ perceived life-distress and
burnout. Essentially, motivator factors are the reasons why nurses could stay in their duty and
attend to COVID-19 patients, despite the potent infection risks the nurses face.

These theories and studies suggest that job stress can have a significant impact on the
mental stability of nurses.

Conceptual Framework

INPUT PROCESS
OUTPUT
Demographic Profile of
Respondents
Effects on level of mental stability
and associated factors Programs that will strengthen
1. Age
2. Sex 1. Work Engagement mental stability
3. Marital Status 2. Job Resources
4. Highest Educational Attainment 3. Professional work outcomes
5. Length of Service 4. Clinical Effectiveness
6. Designation 5. Patient Experience
6. Patient Safety
 The figure above shows the study's input, process, and output. The input indicates
respondent’s age, sex, marital status, highest educational attainment, designation, and length of
experience in the general ward. The respondents will answer surveys to determine the effects on
the level of mental stability of nurses assigned in the general ward. After gathering all the data,
the responses will be tabulated and organized by the researchers and will undergo statistical
analysis of the data. To explore factors contributing to mental health issues, such as workload,
organizational support, and work-life balance

Chapter 3
RESEARCH METHODOLOGY

Research Design
This study will use quantitative descriptive research to assess the mental stability of
nurses at Camp Crame General Hospital. The nurses will be selected via the availability of a
sampling method and data will be collected by demographic characteristics in the form of a
Likert Scale. Interviews will be conducted to explore the nurse's experiences and perceptions of
job stress, workload, burnout and workplace violence. The data collected from these interviews
and focus groups could then be analyzed using qualitative content analysis to identify common
themes and patterns.

Respondents of the Study

The respondents of this study were Nurses with 3 years and above working experience in
the general ward at Camp Crame General Hospital. The respondents were selected using the
inclusion criteria through qualitative sampling. Researchers chose participants who can provide
rich, diverse perspectives relevant to the study's objectives. The number of respondents was
computed depending on the analysis of the total number of nurses assigned in the general ward at
Camp Crame General Hospital. The respondents for this study include nurses with three years or
more of working experience, nurses assigned to general wards, and nurses employed at Camp
Crame General Hospital. Nurses with less than two years of experience, those not assigned to
general wards, and those not working at Camp Crame General Hospital are excluded from this
study.

Data Gathering Equipment

An interview is a planned discussion in which one party asks questions and the other
responds through a personal interview. If other participants cannot participate because of a
conflict of schedule, the researcher will conduct via phone interview at their most convenient
time.

Another way of gathering data will be the usage of questionnaires. The purpose of a
questionnaire is to collect information from respondents about their attitudes and experiences. A
Likert may also be used; it is a survey that can be answered by checking a question or rating it
higher or lower.

Data Gathering Procedure

Phase 1: Letter of Approval

To conduct this study, we obtained formal permission from the Dean of the College of
Nursing, Mr. Florante Padrinao and Professor in Research, Mr. Michael Angelo Abubo, to
conduct a survey data

The study was carried out at the Camp Crame General Hospital using updated and self-
made survey questions that were reviewed by three experts to determine the content validity
through pilot testing. Following permission acceptance, we will inform the respondents of the
significance of their participation in the study. We, researchers, are students from the third year,
College of Nursing. Respondents were given half an hour to complete the surveys. Once the
respondents have completed the surveys, we will collect them and refer it to the consultant. The
surveys will then be examined and results will be verified respectively.
 A study was conducted with institutional approval, prioritized participant safety, and
ethical standards. Informed consent, both written and verbal, was obtained, emphasizing
voluntary participation with the right to withdraw. Anonymity and confidentiality were
maintained, ensuring no physical or emotional harm to participants. Despite efforts, some
personal biases persisted throughout the investigation.

Phase 2: Consent
Researchers would clearly communicate the purpose, procedures, risks, and benefits of
the research to the respondents. Researchers are available to address any questions or concerns
the respondents may have. The researchers would clearly state that participation is voluntary, and
individuals can withdraw at any time without facing negative consequences.

Phase 3: Actual Data Gathering

After obtaining approval, the researchers carried out the study at the Camp Crame
General Hospital. They distributed questionnaires, introduced themselves to the participants,
explained the study's purpose, objectives, benefits, and the right to withdraw consent. Upon
participants' agreement, they received informed consent forms and the research instrument,
ensuring that only the researchers had access to their responses.

Statistical Treatment
In this study, the researcher used the following statistical treatment involving Likert
scales which often employs the Pearson correlation coefficient to assess the strength and
direction of relationships between variables. Likert scales are commonly used in surveys to
measure respondents' opinions or attitudes on an ordinal scale. After collecting Likert scale data,
researchers may use the Pearson R correlation to explore whether there is a significant linear
relationship between two variables.

Formula for Weighted Mean:

Formula for Percentage:

“THE EFFECTS ON THE LEVEL OF MENTAL STABILITY OF NURSES

AT CAMP CRAME GENERAL HOSPITAL”

DIRECTION: For each question in the survey, please indicate your answers by
Marking check in the Box. The questionnaire is The Likert Scale wherein you rate your
answers from 1 to 4 points on the specified numbers with 4 points and 5-1 points on the
rest. Please read every question and fill in the box and blanks for more information
related.

There are no right or wrong answers. Your answers will be strictly confidential
and you will not be identified.

A. QUESTIONNAIRE
 PART I. DEMOGRAPHIC PROFILE OF THE RESPONDENT NURSE IN
SELECTED HOSPITAL.
Name (optional):

Date: Sex: Age:

Marital Status:

Length of Service:

Highest Education Attainment:

Designation:

PART 2. WHAT IS THE LEVEL OF MENTAL STABILITY OF NURSE RESPONDENTS?

5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)

I tend to describe my emotions accurately

I show respect for others’ opinions even

when I think those opinions are wrong

I am very good at getting people

enthusiastic and motivated

I know how others are feeling even if they

try to hide it
Reference:https://www.google.com/seaích?q=questionnaiíe+about+self+emotion&client=m s-andíoid-oppo-
ívo2&pímd=inv&sxsíf=AJOqlzWRzV91LvgpLfU4BvaL5wkEl3GZGw:1675162131028&souíce=lnms&tbm=isch&sa=X&
ved=2ahUKEwj9_oqe0fH8AhXBc94KHQheDLsQ_AUoAXoECAIQAQ &biw=360&bih=664&dpí=3
imgíc=XFH3ap5dľíl63M

PART 2.1. WHAT IS THE LEVEL OF MENTAL STABILITY OF NURSE RESPONDENTS IN TERMS OF
WORK ENGAGEMENT?

WORK ENGAGEMENT 5 4 3 2 1
● Leadership (always) (often) (sometimes) (rarely) (never)
● Reward and Recognition
● Professional Growth

I am confident that my job performance

is appreciated by my supervisor and the
institution

As a team, we enjoy shaping our

organization and feel that we have a voice
in the way the company is running and
how things are accomplished

I feel closely connected with my co-

workers

I feel that there are chances for career

growth in this institution

I enjoy a sense of belongingness with the

institution

Reference:
https://www.template.net/questionnaire-templates/employee-engagement-questionnaire/

PART 2.2 WHAT IS THE LEVEL OF MENTAL STABILITY OF NURSE RESPONDENTS IN TERMS OF
JOB RESOURCES?

JOB RESOURCES 5 4 3 2 1
● Mentoring or Coaching (always) (often) (sometimes) (rarely) (never)
● Increased Autonomy
● Organizational rules and benefits

I am totally satisfied with the benefits that is

offered by the institution.

I am satisfied with the medical insurance

package

I am satisfied with the workload

 I feel free to express my thoughts during
meetings
Reference: https://www.jotform.com/form-templates/employee-benefits-survey-template

PART 2.3 WHAT IS THE LEVEL OF MENTAL STABILITY OF NURSE RESPONDENTS IN TERMS OF
PROFFESSIONAL OUTCOMES.

PROFESSIONAL WORK 5 4 3 2 1
OUTCOMES (always) (often) (sometimes) (rarely) (never)
● Work Performance
● Work Motivation
● Job Satisfaction

I am enthusiastic about my present

work

My work gives me the opportunity to

show what I am worth

I feel I am able to learn on the job

It’s worthwhile to make an effort in my

job

In the last year, my work has grown

more interesting

PROFESSIONAL WORK OUTCOMES 5 4 3 2 1

● Work Performance (always) (often) (sometimes) (rarely) (never)
● Work Motivation
● Job Satisfaction

I am enthusiastic about my present work

My work gives me the opportunity to

show what I am worth

I feel I am able to learn on the job

It’s worthwhile to make an effort in my

job

In the last year, my work has grown more

interesting
Reference:
https://www.academia.edu/27234799/Nursing_Workplace_Satisfaction_Questionnaire_NWSQ

5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)
 I am always approachable and polite to
my client

I always keep track of the well-being of

my client

I always ask my patient for his/her

comfortability and provide proper care

I always inform my client’s condition

needs

I am willing to reassure and meet the

needs of my patient

PART 3. WHAT IS THE LEVEL OF PATIENT CARE QUALITY BY THE NURSE RESPONDENTS?

PART 3.1 WHAT IS THE LEVEL OF PATIENT CARE QUALITY IN TERMS OF CLINICAL
EFFECTIVENESS?

CLINICAL EFFECTIVENESS 5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)

I implement interventions to address physical

and emotional comfort, pain and/or suffering

I teach my patients/family members with

regards to health promotion, wellness,
disease management, and prevention

I recognize clinical opinion from research

and evidence

I recognize that nursing and other health

professions are part of the system of care
and care processes that affect outcomes
for patients and families

I function completely within my scope of

practice as a member of the intra and
inter-professional

Reference: https://www.semanticscholar.org/paper/Progressive-clinical-evaluation-tools-based-on-the-
Eymard-Davis/769a02dedfcd1a1b8e9a8a4cbc8c0e4827517e11/figure/2

PART 3.2 WHAT IS THE LEVEL OF PATIENT CARE QUALITY IN TERMS OF PATIENT
EXPERIENCE?
PATIENT EXPERIENCE 5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)

I use my ability to communicate

effectively with others verbally, through
face-to-face contact

I observe, record and report to physicians

about patients’ condition or injury, as
well as reactions to drugs and treatment

I use my ability to deal efficiently with

others in times of stress, including
handling concerns, criticisms and
disagreements

I am able to lift, push and pull

occasionally with the use of my physical
strength

I use my ability to focus on an activity

when there are significant number of
distractions and stress

Reference: Health Career Survey Template.pdf

https://www.template.net/business/survey-templates/career-survey/#1-health-career-survey-template

PART 3.3 WHAT IS THE LEVEL OF PATIENT CARE QUALITY IN TERMS OF PATIENT SAFETY?
PATIENT SAFETY 5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)

Patient safety is never be compromised to

get more work done

When a lot of work needs to be done

quickly, we work together as a team to
get the work done

We actively do things to improve patient

safety

When an error occurs, the focus is on

learning and just taking accountability

When one area in the unit gets really

busy, others will help out

Reference: https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/hospital-survey.html
https://www.sciencedirect.com/science/article/abs/pii/S1553725022000848

PART 4. ARE THERE ANY SIGNIFICANT RELATIONSHIP BETWEEN THE DEMOGRAPHIC

PROFILE AND THE LEVEL OF EMOTIONAL STABILITY OF NURSE RESPONDENTS?

5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)

I am sometimes judged by my patients

because of the length of my service

I am well respected by my patients no

matter what my gender is

I do not get disturbed easily by my family

and personal problems during my duty

I don’t get any discrimination when it

comes to my ethnicity

Reference: https://www.semanticscholar.org/paper/Progressive-clinical-evaluation-tools-based-on-the-
Eymard-Davis/769a02dedfcd1a1b8e9a8a4cbc8c0e4827517e11/figure/2

PART 5. ARE THERE ANY SIGNIFICANT RELATIONSHIP BETWEEN THE DEMOGRAPHIC

PROFILE AND THE PATIENT CARE QUALITY OF NURSE RESPONDENTS?

5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)
 I am giving the same quality care to my
patient and to my family

I can balance the needs of my patients

and the needs of my family

I can still provide full effort to the needs

of my patient despite having personal
problems

I prioritize the health of my patient first

before my own

I am one call away from my patient and

is always concerned with their request
and health status
PART 6. ARE THERE ANY SIGNIFICANT RELATIONSHIP BETWEEN THE LEVEL OF THE
MENTAL STABILITY AND THE LEVEL OF QUALITY PATIENT CARE OF THE NURSE
RESPONDENTS?

5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)

I manage to plan my work so that I

finish it on time

I kept the result I needed to achieve

I am able to set priorities

I am able to carry out my work

efficiently

I took on challenging tasks when they

are available

Reference: https://journals.copmadrid.org/jwop/art/jwop2019a21

PART 7. ARE THERE ANY SIGNIFICANT DIFFERENCES BETWEEN THE LEVEL OF THE MENTAL
STABILITY AND THE LEVEL OF QUALITY PATIENT CARE WHEN GROUPED ACCORDING TO
PROFILE OF THE NURSE RESPONDENTS?
 5 4 3 2 1
(always) (often) (sometimes) (rarely) (never)

My length of service has nothing to do

with my age. It determines how I function
competently

My age affects how I recognize and react

to the roles of the healthcare team
members appropriately to meet the well-
defined health needs of adults

I teach patients/family members

regarding health promotion, wellness,
disease management, and prevention
wholeheartedly no matter what my
gender is

My marital status is important for me to

utilize communication skills with patient,
family and interprofessional team

Age differences with patients do not

affect the quality of care I give my
patients and the stability of my emotion
in establishing rapport with them