SIMMERING, CARING, LEARNING: THE LIVED EXPERIENCE

OF NURSES IN A SELECTED PUBLIC HOSPITAL

WHO HAS CARED FOR AN

ANGRY PATIENT

KIMBERLY LYN M. CABAHUG

RICHMOND B. CO

NICA G. DE CASTRO

DARREN MATTHEW S. LEYSON

JETIER T. PINOTE

AGNES MARIE A. HIHARA, M.A.N.

Research Mentor

CEBU DOCTORS’ UNIVERSITY

Mandaue City
 1

SIMMERING, CARING, LEARNING: THE LIVED EXPERIENCE

OF NURSES IN A SELECTED PUBLIC HOSPITAL

WHO HAS CARED FOR AN

ANGRY PATIENT

A Thesis Paper Presented

to the

College of Nursing

Cebu Doctors’ University

In Partial Fulfillment of the

Requirements for the Degree of

Bachelor of Science in Nursing

by

Kimberly Lyn M. Cabahug Darren Matthew S. Leyson

Richmond B. Co Jetier T. Pinote

Nica G. De Castro

Mrs. Agnes Marie A. Hihara, M.A.N.

Research Mentor

November 2018
 iii

APPROVAL SHEET

This thesis proposal entitled “Simmering, Caring, Learning: The Lived

Experience of Nurses in a Selected Public Hospital Who has Cared for an Angry
Patient” was prepared and submitted by Kimberly Lyn M. Cabahug, Richmond B.
Co, Nica G. De Castro, Darren Matthew S. Leyson, and Jetier T. Pinoteto the
Proposal Hearing Committee for Proposal Hearing as endorsed by:
Agnes Marie A. Hihara, M.A.N. Paul John G. Aventurado, M.A.N.
Research Mentor Research Coordinator

PROPOSAL HEARING COMMITTEE

Rommel P. Merioles, M.A.N

Chair, Technical

Armand K. Cuasito, M.A.N. Paul John G. Aventurado, M.A.N.

Panelist, Member Panelist, Member

ACCEPTANCE OF APPROVAL

This thesis proposal entitled “Simmering, Caring, Learning: The Lived

Experience of Nurses in a Selected Public Hospital Who has Cared for an Angry
Patient” upon the unanimous approval of the PROPOSAL HEARING COMMITTEE
with a grade of PASSED hereby accepted for implementation in partial fulfillment of
the requirement for the degree of Bachelor of Science in Nursing.

Rommel P. Merioles, R.N., M.A.N.

College Dean

January 22,2018
Date of Proposal Hearing
 iv

APPROVAL SHEET

This research paper entitled “Simmering, Caring, Learning: The Lived

Experience of Nurses in a Selected Public Hospital Who has Cared for an Angry
Patient” was prepared and submitted by Kimberly Lyn M. Cabahug, Richmond B.
Co, Nica G. De Castro, Darren Matthew S. Leyson, and Jetier T. Pinote to the Oral
Examination Committee for Oral Defense as endorsed by:

Agnes Marie A. Hihara, M.A.N. Paul John G. Aventurado, M.A.N.

Research Mentor Research Coordinator

ORAL EXAMINATION COMMITTEE

Rommel P. Merioles, M.A.N

Chair, Technical

Armand K. Cuasito, M.A.N. Paul John G. Aventurado, M.A.N.

Panelist, Member Panelist, Member

ACCEPTANCE

This thesis paper entitled “Simmering, Caring, Learning: The Lived

Experience of Nurses in a Selected Public Hospital Who has Cared for an Angry
Patient upon the unanimous approval of the ORAL EXAMINATION COMMITTEE
with a grade of PASSED hereby accepted in partial fulfillment of the requirement for
the degree of Bachelor of Science in Nursing.

Rommel P. Merioles, R.N., M.A.N.

College Dean

September 6, 2018
Date of Oral Defense
 v

Table of Contents

TITLE PAGE i
APPROVAL SHEET iii
ACKNOWLEDGEMENT vii
LIST OF TABLES vii
LIST OF FIGURES viii
ABSTRACT x
CHAPTER
1 THE PROBLEM AND ITS SCOPE
INTRODUCTION
Background of the Study 1
Theoretical Background 2
6
Review of Related Studies
Conceptual Framework 9
THE PROBLEM
Statement of the Problem 12
Significance of the Study 12
Scope and Limitation 13
RESEARCH METHODOLOGY
Research Design 14
Research Environment 14
Research Informants 15
 vi

Research Instruments 15
Research Procedures 16

Gathering of Data 16
20
Qualitative Data Analysis
2 PRESENTATION, ANALYSIS AND INTERPRETATION

OF DATA
Profile of the Informants 23

Informant’s Stories 27

Presentation of Essential Themes 29

Synthesis of Essential Themes 51

Research Output 53
3 SUMMARY OF FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS

Summary of Findings 57

Conclusion 60

Recommendations 61
REFERENCES 62
APPENDICES
A-1 67
TRANSMITTAL LETTER TO THE DEAN OF THE

COLLEGE OF NURSING
A-2 TRANSMITTAL LETTER TO THE HOSPITAL 68

ADMINISTRATOR OF CEBU CITY MEDICAL CENTER

B-1 INFORMED CONSENT (ENGLISH VERSION) 70
 vii

C-1 73
ETHICAL REVIEW FORM
D-1 77
ANGER IDENTIFICATION CHECKLIST
D-2 FACE DATA SHEET 78
D-3 INTERVIEW SCHEDULE (ENGLISH VERSION) 79
D-4 VALIDATION TOOL 80
D-5 RESULT OF VALIDATION 87
D-6 CODE BOOK 88
E TIME TABLE OF RESEARCH ACTIVITIES 96
F RESEARCH BUDGET SUMMARY 97
G RESEARCH DOCUMENTATION 98
CURRICULUM VITAE 99

LIST OF TABLES AND FIGURES

Table Title Page

1.0 Profile of the Informants 23
2.0 Frequencies and Percentages of 30

Essential Themes and Thematic

Statements

Figure
1 Flow of Activities 9
 viii

ACKNOWLEDGEMENT

We would like to express our heartfelt gratitude and sincerest appreciation

for those who have been instrumental in making this research a great success. In

particular, we would like to thank:

First and foremost, Almighty God, forgiving us the strength and courage to

successfully accomplish this research study. He guided us to overcome all our

obstacles. Everything is possible through God, that in all things God may be

glorified.

Mrs. Agnes Marie A. Hihara, thank you for being the wind beneath our

wings. For guiding us throughout our study and nurturing us to become our very

best and reach our goals. She inspired us throughout the whole process. Without

her, this research would not be successful.

Mr. Paul John Aventurado, for sharing the necessary skills and knowledge

needed to accomplish this research. With his guidance and expertise in the field,

corrections were dwelled upon and corrections were provided along the way.

Mr. Rommel P. Merioles and Mr. Armand K. Cuasito, thank you for allowing

us to defend our research study for the betterment of the paper. You showed us

new ideas and flaws of the paper to fill up the missing gaps and holes in our

study. And special thanks to the staff of the research staff for helping us in

processing our papers.

Mr. Kenneth Siazar and Ms. Sonia Empinado, for allowing us to conduct

this research study under their authority and kindness.

 ix

Mr. Robby B. Echavez, for rendering his psychological services to the

respondents leading to the success of this research paper.

Our dear parents, thank you for the undying support. You inspire us to

pursue our dreams and reach our goals. We trusted in our capabilities because

they constantly reminded us that we can accomplish anything if we just believe in

ourselves.

To the informants, staff nurses of Cebu City Medical Center, for their time,

effort, and truthfulness in providing their unique experiences to support the study.

The Researchers
ix
 x

ABSTRACT
Dealing with a patient that is angry entails possible psychological
discomfort to a nurse. Every interaction between a nurse and an angry patient is
uniquely different in a sense that one’s understanding, response, experiences,
perception and personalities vary. To improve rendered care for angry patients,
understanding the lived experiences of nurses who have cared for an angry
patient was the intention for this study. This study utilized descriptive
phenomenology. For data analysis, Streubert’s method was used. The steps
being followed were: 1) Explicate a personal description of the phenomenon of
interest 2) Bracket the researchers’ presuppositions 3) Interview participants in
an unfamiliar settings 4) Carefully read the interview transcriptions to obtain a
general sense of the experience 5) Review the transcriptions 6) Apprehend
essential relationships 7) Develop formalized descriptions of the phenomenon 8)
Return to the participants to validate descriptions 9) Review the relevant
literature 10) Distribute the findings to the nursing community
Analysis for qualitative data revealed 5 essential themes: (1) Applying
Lessons From the Past which shows that the nurses’ experience molded them to
become better at handling angry patients, (2) Bottled Up Feelings talks about the
feelings and emotions that are felt by the informants, (3) Profession Over
Emotion conveys how nurses chose to uphold actions according to their
professional values rather than expressing their emotions, (4) Taking Action
refers to the spur of the moment actions done by the nurse and (5) Opportunities
To Make Self Better includes reflecting on oneself and viewing the encounters
with these kinds of patients as an opportunity to improve themselves. The
findings showed that the nurses who have dealt with an angry patient cared for
them by utilizing experience, tucking away various feelings, employing
professional measures, making a move, and learning from the interaction.
Nurses take different ways and approaches in dealing with a patient that is
angry depending on how they view the situation. A patient anger management
seminar is recommended to further enhance the nurses’ interaction and
interpersonal relations when having to deal with this kind of patient and reduce
conflict. In dealing with a patient that is angry, nurses simmer the negativity down
the sink and continue to do what’s best. Caring for them unconditionally
regardless of their flaws without compromising themselves or the others. Taking
this interaction as a chance for them to make oneself better.
 Chapter 1

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Background of the Study

Staff nurses in public hospitals are usually assigned to multiple patients

that leads to a great imbalance in the nurse-patient ratio. These patients are

diverse especially on their thoughts and feelings of their recent admission. The

patient’s expectations on the care rendered by the nurse may not be met

because of the nurse’s heavy workload. Nurses respond in a way that reduces

their own stress rather than a patient’s stress. [CITATION Koz92 \l 1033 ] A

simple mistake in handling the situation can lead to an unwanted situation. A

nurse should be readily equipped with the proper response to this kind of patient

in a way that an anger-filled atmosphere may not escalate any further.

Nevertheless, not all nurses disconnect from angry patients although it

may prompt them to withdraw oftentimes. [ CITATION Smi94 \l 1033 ] Reactions

and responses from nurses may vary according to their ability to maintain

personal control. If ever they find angry patients threatening, a common response

is to try to get someone else to handle them. But other nurses’ response is to

remain calm, listen, show empathy, and confirm their feelings. While these
2

circumstances are not the best aspect of the nursing profession, dealing

with difficult patients are unavoidable since difficult patients are part of nursing.

A Facebook post that earned about two million views and has been shared
about sixteen thousand times that went viral worldwide, caught the researcher’s
interest in conducting the study. It involved an angry patient and a nurse. A
misunderstanding between the patient and the nurse escalated the situation. The
researchers hope that this study will aid the community in understanding the
nurses' experiences.
Theoretical Background

Anger is an emotional response to perception of frustration of desires,

threat to one’s needs, whether it’s emotional or physical, or challenges.

[ CITATION Var02 \l 1033 ]. A therapeutic nurse-patient relationship is defined as a

helping relationship that’s based on mutual trust and respect.[ CITATION Pul \l

1033 ] It entails a physiologic response to an external situation, preparing the body

for a possible attack. In times of threat, it may be considered as a defense

mechanism. At a younger age, defense mechanisms usually develop due to an

unconscious process. Born out of fear, it serves to defend and protect.

Nurses interact with different kinds of patients on a daily basis. From a

pleasing and flowery attitude to an angry and displeased attitude, they should

always treat them with respect and communicate as calm as possible. A nurse

may be prepared for this through listening to what these clients have to say, paying

attention to what they say, and always having it in mind that they may not appease

these clients.
3

Dealing with an angry patient is a phenomenon faced by nurses and other

healthcare professionals. Hospitals are one of the places where emotions can

run an all-time high. These emotions may cross certain limitations where it can

affect physicians, staffs, nurses, and clients and their families. Fear may be

considered as one of the most recurrent causes of anger which attributed to fear

of the unknown, being in pain or suffering, and various others. [ CITATION

Wan15 \l 1033 ] It may cause an increased stress, anxiety, and frustration which

may results to anger and even loss of control. Anger can be viewed as a tool that

may help an individual read and respond to situations that may upset an

individual. [ CITATION Kas14 \l 1033 ] Recognizing the anger, whether it’s

internal or external, is necessary for effective management. Each patient is unlike

the other which means a different approach is required when dealing with them.

Anger can be used by a person when they want something. In one study of

negotiation, participants made larger concessions and fewer demands of an angry

person than one who was happy. [ CITATION van03 \l 1033 ] It is because anger

may be a warning signal or sign that something needs to be resolved. When a

person has seen the signal, he or she is then driven to make the angry person

relax and calm. When anger is controlled properly, it can help people settle or find

a solution to a problem and decision making. It could also energize us to perform

certain actions, but it can also result to a physical and emotional torment if

handled inappropriately. At the point when outrage is sound, sentiments are

communicated in a way that is socially worthy, enabling the individual to pick up

4

power over the issue without making damage or risk others. The six functions of

anger are energizing, disrupting, expressing, defending, instigating, and

discriminating.[ CITATION Nov75 \l 1033 ] As much as it has positive functions, it

also has negative functions. Negative functions include being a disrupter. This

makes it difficult for the person to think clearly and evaluate thoughts and options

for the situation. Another which is being a conveyor. It gives a negative

impression to others, showing them actions that may be perceived as violent in

nature. Lastly, being an instigator-lashing out feelings that is inappropriate for

circumstance in an irresponsible manner. The ability to diffuse a negative

situation effectively requires the nurse to be open and non-defensive, realizing

that this is not a personal attack but rather a medium for patients to vent out their

negative feelings. (Kaakinen, 2018)

Although anger is still considered normal, this expression is expected when

situations are unjust or unfair. (Videbeck, 2011) Be that as it may, if outrage is seen

for a more drawn out timeframe, this causes physiological and passionate issues..

[ CITATION Ign09 \l 1033 ] Just like every occupation that handles the public such

as a lawyer, government official, or a police officer, being in a nursing profession

may imply working with difficult clients. [ CITATION Wyn15 \l 1033 ] Oftentimes,

staff nurses are not acknowledged by their impolite behavior. [ CITATION

Rev06 \l 1033 ] However, there are instances where they respond back in a

frustrating and angry manner. The staff nurses may respond back in an unusual

way due to the patients being difficult and demanding. [ CITATION Rev06 \l
5

1033 ] Some staff nurses may begin to disconnect from their client due to the

misunderstanding of the anger as a personal attack. After the anger subsides,

they may feel embarrassed about the way they reacted due to the stereotype that

“good nurses” do not get angry at their clients. [CITATION Tho14 \l 1033 ]

Nevertheless, there are various approaches to handle displeased clients.

There are many instances that nurses may fail to effectively communicate

or respond appropriately to these kinds of clients. Nurses in an actual setting such

as having an overwhelming nurse to client ratio may ineffectively cope which

results in either hurting themselves or the clients. According to research, 1:4 nurse

to client ratio is the safest, although also most expensive. (Clark, 2009) In the

angry client, they may insult the nurse for their service. The nurse may respond

defensively and end up offending the client. With both parties having offended, the

situation’s tense may escalate very quickly compared to a nurse who effectively

responds to these patients, an unwanted situation can be prevented. Both parties

need not to settle such a situation in dispute.

In an article entitled "Considering Anger from a Cognitive Neuroscience

Perspective" by [ CITATION Bla12 \l 1033 ], there are 5 fundamental cases in

thinking about outrage from an intellectual neuroscience point of view. First, the

aggression that the person shows upon reacting is the optimum manner of anger

and so humans can start to perceive anger by inferring the information about

aggression. Second, the sensory system particularly the cerebrum parts

especially amygdala, nerve center and periaqueductal gray, the fundamental

6

danger framework are, basically embroiled in resentment. Components that

expand the responsiveness of the framework, for example, presentation to

extraordinary risk, is additionally connected with the ascent of anger. Third, when

there is an increased in anger, the frontal cortex regulates the threat system.

Fourth, an individual becomes frustrated when he/she expects a reward but does

not actually receive it. This causes an individual to alter their behavior and as a

result, it increases the anger of the person. Fifth, frustration and anger can arise

from individuals who tell another in individual to do a task but do not do it.

The study will use Husserl's philosophical tradition or descriptive

phenomenology. This tradition focuses on the description of human experience.

This also insists on the careful description of ordinary conscious experiences of

everyday life. Descriptive phenomenology often involve four steps. First

bracketing, which states the process of distinguishing and holding in abeyance

preconceived beliefs and judgment about the phenomenon being studied. Next,

intuiting, this is when the researcher constantly maintain openness to the

meaning of the phenomenon as expressed by the informant. Then, analyzing,

where the researcher will extract significant data, categorize and creates theme

suitable for each phenomenon. Lastly, describing, this is when the researcher

understands and defines the phenomenon. [ CITATION Pol08 \l 1033 ] According

to Creswell (1998), a phenomenological study recommends five to twenty five

respondents, but Morse (1994) suggests at least six respondents. (Solutions,

n.d.)
7

Review of Related Studies

“Nurses Response to Anger: From Disconnecting to Connecting” (Smith,

1994), the research study utilized a Grounded Theory. Nine female registered

nurses were the respondents of the research study. The data was gathered via an

interview. The respondents were asked to explain their feelings and responses to

an intense encounter to an angry patient. As the interviews were analyzed, self-

efficacy concept emerged as the major area of concern among the respondents.

Research findings tell that when threat to self was high, nurses tend to disconnect

from the angry patient. Low threats were managed by connecting to them.

“Possibly Impossible Patients: Management of Difficult Behavior in Oncology

Outpatients”, this research study utilizes a structured case study quantitative

research. Angry, undermining, or generally troublesome conduct by patients can

meddle with essential oncologic treatment, in some cases to the point of rendering

proceeded with consideration inconceivable. It is a multifaceted methodology that

needs to manage troublesome conduct in oncology outpatient to talk about the

diverse determination and the different administrations of treating the problematic

conduct. (Peteet, Meyer, & Miovic, 2011) This is to enhance care of the patient

and the staff's states of mind in managing troublesome practices. There were

several principles used to prove how effective the response of the uncooperative

patients was. The first principle was to center around issue practices. This principle

demonstrates that it is vital to have common regard with the patient instead of
8

keeping away from or reprimanding the patient for their troublesome practices. The

second principle is to present the patient's psychological well-being conference

early before the treatment starts. This will help the individuals from the restorative

to comprehend and address the issues of the patient. The third principle is to

utilize a workforce conference to illuminate the individuals from the medicinal

group about the patients to identity and different issue identified with the patient.

This will help the individuals from the medicinal group to know the desires and

states of mind of the patient. The fourth principle is to decide the reason for the

patient’s conduct. This will help the individuals from the medicinal group to have a

suitable and quick administration for the patient. The last principle is to set sensible

social desires and pursue the execution to have a fundamental component to their

practices. In this examination, there were a few cases exhibited and how

successful the standards and administrations were when managing diverse

patients.

“The lived experiences by psychiatric nurses of aggression and violence

from patients in a Gauteng psychiatric institution” (Bimenyimana, Poggenpoel,

Myburgh, & van Niekerk, 2009) shows the lived encounters of psychiatric nurses

who has managed animosity and brutality in the mental foundation. Because of

an expanded level of viciousness and animosity, the psychiatric nurses see this

as overpowering and startling. The factors that contributed to the violence and

aggression are: the mental status and the patient’s conditions, shortage in staff,

lack of support among members of the psych team, and lack or orientation and
 9

comprehension with the new staff members. Because of this investigation, the

psychiatric nurses are influenced inwardly, mentally, and physically. They react

with the accompanying feelings and conduct: fear, outrage, disappointment,

gloom, sadness and powerlessness, substance misuse, truancy, striking back,

and an improvement of an "I don’t care" state of mind.

Bracketing of researchers
presuppositions

Return to participants Review of relevant

Caring for angry patients
to validate descriptions literature

Conceptual Framework
Informants: Staff Nurses

Disseminate findings to
Interview the nursing community

Transcription

Carefully read the interview

transcripts to
obtain a general sense of
experience

Develop formalized
descriptions of the
phenomenon
10

Figure 1. Flow of Activities

Figure 1 shows the flow of activities that was followed in this study. The

phenomenon of nurses who cared for angry patients was explored using

descriptive phenomenology. The study had staff nurses as its informants. Data

analysis utilized Streubert's Method. Prior to data collection, bracketing of

presuppositions was done by the researchers. The collection of data was done

through an interview. Transcription of data from the audio recorder followed.

Next, the interview transcripts were carefully read to obtain a general sense of

experience which is important prior to proceeding to the next step. Development

of formalized descriptions of the phenomenon such as creation of themes

followed. After, the researchers came back to the sources to approve portrayals

whether they concur or differ that they can identify with the topic. If data

saturation is not achieved or until no new data is acquired, the researchers will
11

conduct the interview again and the following steps accordingly. If data saturation

is acquired, the researchers will no longer conduct interviews and proceed to the

next step which is to review relevant literature. Lastly, dissemination of findings to

the nursing community will be done.

Approach to Understand the Phenomena

This study was about the lived experiences of staff nurses who has dealt

with angry patients. The study utilized Husserl Phenomenology.

Phenomenological study aims to explicate structure of the lived experience of

phenomena in the search for a consonance meaning.

This phenomenological study focused on descriptive approach. This

methodology includes coordinate investigation, examination, and depiction of a

specific wonder, as free as conceivable from unexamined presuppositions going

for greatest natural introduction. Further, this animates view of lived involvement

while underscoring the extravagance, expansiveness, and profundity of those

encounters. [ CITATION Spi65 \l 1033 ]

The researchers utilized Streubert's qualitative data analysis method to

classify the data and obtain a formalized description. The first step was

explicating personal description of the experience to acknowledge openly one’s

assumption and biases. Next, bracketing the researchers presuppositions so that

the researchers will not lead the participants in the direction of their beliefs during

data collection or analysis. Interviewing participants in settings unfamiliar to the

12

researchers prevents biases related to beliefs and the perception of the

interviewer. Carefully read the interviews transcript to obtain a general sense of

the experience. Review the transcripts to uncover essences. Apprehend

essential relationship to understand and link the connection of one another.

Develop formalized descriptions of the phenomenon. Return to participants to

validate the descriptions and continue to gather data until no new data will be

obtained. Review the relevant literature. Lastly, distribute the findings to the

nursing community to allow information dissemination and provide enhanced

knowledgeable findings applicable to the profession.

THE PROBLEM

Statement of the Problem

The lived experiences of nurses of Cebu City Medical Center in dealing

with an angry patients was explored in this phenomenological study. The

feelings, fears, concerns, needs, preparedness, coping, and practices in dealing

with a patient that is angry the nurses were delved into. In accordance with this,

the researchers utilized the grand tour question, "How would you describe your

experience in dealing with angry patients?"

13

Significance of this Study

The aftereffects of this study encourages a more profound comprehension

of the lived encounters of staff nurses who dealt with angry patients.

The staff nurses are able to fully express their experiences in dealing with

angry patients. Likewise, the study serves as a self-awareness activity for them.

The Hospital Administration obtains an insight on how the staff nurses are

handling angry clients thereby they can think of ways to strengthen good

practices, improve unfavorable means and raise the quality of nursing care

rendered.

The Academe, particularly the College of Nursing, reinforces nurses’

training on handling angry patients based on the outcome of the study.

The other healthcare providers know on how they can support nurses who

are dealing with angry patients.

The readers understand and get a good grasp of the nurses’ experience in

dealing with angry patients.

The future researcher use this study as a baseline of their research.

Scope and Limitation

The aim of the study is to describe the staff nurses’ lived experiences in

dealing with angry patients. This study focused more towards staff nurses’ who

has cared for an angry patient from the onset until the data collection part of the

study.
14

The staff nurses’ that the researchers selected were from Cebu City

Medical Center. The informants went through a face to face interview to confirm

the experiences of handling angry patients. An 8-item checklist was given to the

informants to assess eligibility for the study. A result of 5 or more checked boxes

indicated an inclusion of the staff nurse in the study.

The interviews took place in malls and café not familiar to the researchers

to prevent biases related to beliefs and the perception of the interviewer.

However, safety and privacy was strictly observed. The informants’ answers were

accepted, recorded and kept in an utmost confidentiality. This study included only

nurses who have worked for 2-3 years in the institution.

RESEARCH METHODOLOGY

Research Design

This study utilized descriptive phenomenology. Phenomenological study

aims to explicate structure of the lived experiences of phenomena in the search

15

for a consonance meaning. As indicated by Husserl, phenomenology focuses on

the definite portrayals of cognizant experience without assets to clarification,

supernatural suspicions, and customary philosophical inquiries. This study also

used Streubert’s method of data analysis in describing the phenomena, as lived

experience.

Research Environment

The study was conducted at Cebu City Medical Center (CCMC) located at

Natalio B. Bacalso Ave, Cebu City, Cebu. CCMC also provides four major

services as follows: Medical/Dental Services, Ancillary Services, Nursing

Services, Administrative Services with satellite Emergency Hospitals in

Barangays Guba and Bonbon. Cebu City Medical Center (CCMC) envisioned

Cebu to be the most livable city for all and to ensure an environmentally friendly,

financially dynamic, pro-active, and self-reliant City Government. According to

CCMC’s chief nurse as reported by Cebu Daily News in 2015, in a public hospital

like CCMC, there are more clients than nurses. The ratio between the nurses and

the clients are tremendously unproportioned. Each station caters to 2-3 times the

number of the stations' staff. Likewise, the offices are distant from each other in a

way that clients have difficulty locating certain facilities.

The interview was conducted in a convenient place where the informants

were comfortable and able to freely express their thoughts and feelings

regarding their experiences towards caring for an angry patient. The

environment was also private to ensure confidentiality of patient’s data and

16

responses during the course of the interview. If and whenever the informant

cannot decide on where the interview took place, the researchers utilized the

psychologist’s office as a default setting for the interview.

Research Informants

The researchers gathered at least 6 nurses in Cebu City Medical Center

that has experienced caring for an angry patient. Nurses who had experienced

caring for an angry patient were screened by Anger Identification Checklist. The

Anger Identification Checklist is an 8-item researcher made screening checklist

based from the book entitled The Answer to Anger: Practical Steps to Temper

Fiery Emotions by June Hunt. Checking more than half of the options would

demonstrate that the nurse has in fact thought about an angry patient.

Research Instruments

The researchers used themselves as the primary tool for the collection of
data for the study. The respondents’ experiences were gathered through a semi-
structured interview. The researchers used a grand tour question with possible
follow-up questions that was enlisted in the question guide that typically does not
need to be strictly followed. Different questions were asked to the informants with
the end goal to build up further trust and compatibility with the informants. The
researchers’ grand tour question was, “How would you describe your experience
in dealing with angry patients?” An audio and video recording was used along
with a pen and paper to record the interview between the respondents and the
researchers.
Research Procedures
Gathering of Data
The researcher identified possible topics and found a topic of interest.

After finding a topic, the researchers formulated possible titles for their study. An
17

approval of the title was done by their research mentor along with the research

coordinator and the Research Office. Then, the researchers asked permission of

the Dean of the College of Nursing to conduct the study. A transmittal letter was

sent to the Dean of the College of Nursing, requesting an approval for conducting

the study. The researchers then submitted a transmittal letter of request to the

Nursing Service Office of Cebu City Medical Center asking permission to conduct

the study on their staff nurses. The researchers underwent ethical review via

Cebu Doctors’ University Institutional Ethics Review Committee.

Before the actual data gathering, the researchers had a self-awareness

activity with their research mentor. A mock interview was done prior to proposal

to prepare the researcher for the actual interviews with the informants.

Before the actual interview, the researchers coordinated with Cebu City

Medical Center’s Research Committee and Nursing Department. The

researchers then set an appointment with the staff nurses. The nurses were

given full disclosure of the study about the purpose, procedures, potential

benefits and risks, confidentiality and privacy. An informed consent was given

prior to the interview.

Questions or clarifications of the staff nurses were answered appropriately.

The researchers provided their contact numbers for further clarifications and
inquiries. If the staff nurses wish to withdraw their participation, they were given
the right to do so without being penalized.
The researchers interviewed one staff nurse at a time in order to allow the
staff nurse to open up to the researchers and to prevent biases. Each interview
session lasted about 45 minutes to 1 hour. Each interview was conducted on
separate date and time consisting of one to two interviews per day. The
18

informants were notified that they will be interviewed multiple times until no new
data is acquired. The interviews were done with the presence of the licensed
psychologist and the supervision of the research mentor.
During the interview, the staff nurses’ responses were recorded via an

audio recorder. The nonverbal cues were videotaped via camera recorder. The

grand tour question, “How would you describe your experience in dealing with

angry patients?” was asked followed by the prompt questions. Four researchers

were in the room with the informant. Each of the researchers was given a task:

main interviewer, audio recorder, video recorder, and note taker. The main

interviewer was asking all the questions, the audio recorder was placed in

between the informant and the interviewer, the researcher assigned to it was the

one to ensure that there are no technical difficulties. The note taker was able to

write the verbal and nonverbal cues throughout the interview. A video of the

interview was taken by another member of the research team. During the video

recording, the researchers ensured that anonymity of the informants will be

maintained. The researcher took a video at an angle that recorded the

informant’s nonverbal cues without directly capturing his or her face. The

researchers see to it that the informants’ right to privacy and confidentiality were

upheld. Thus, the handling of the data was kept in a manner that no names will

appear in the data sheet, rather code numbers and aliases will be used.

An agreement was made between both parties in which responsibilities of

both parties were upheld.

19

In the event that the informant displayed any signs of emotional meltdown,
the researchers right away stopped the interview and turn it over to the licensed
psychologist to manage the situation. The researchers utilized the service of the
licensed psychologist for the following reasons: (1) as stated above, (2) every
after an interview for the debriefing of the informants and researchers and (3)
subsequent meet-ups with the informants if they contact the researchers when
they manifest a downward spiral of emotional instability during the conduct of the
study. If the untoward conditions of the informants persist they were referred to
the proper authority for psychiatric help. The action mentioned above should be
done only with the recommendation of a licensed psychologist.
After every interview session, a transcription was performed with the entire
group present. The researchers transcribed the respondents’ verbal and
nonverbal cues. The interview was done until the data gathered will reach data
saturation. At the end of each interview, a debriefing was done by the licensed
psychologist in a separate room in order to prevent risk of psychological harm to
the informants.
The audio and the video recorded were compiled for interpretation of the
data. The records were kept by the research leader until the study was
completed. It was stored in an envelope and kept in a cabinet with a padlock.
The recordings was also kept in a password-encrypted folder in the computer
until the hardbound of the study was accomplished. Only the researchers,
mentor and the panelist had access of the data gathered from the informants.
The gathered data was only utilized for the purpose of this study. At the end of
this research study, the information gathered from the informants were destroyed
in the presence of the research mentor. The audio record and the video were
erased and the papers were shredded by a paper shredder. After the researchers
have interpreted the gathered the data, the researchers informed the staff nurses
of the results after the data analysis.

Qualitative Analysis

The researchers utilized Streubert's qualitative data analysis method,

wherein the researcher was the primary instrument of data collection [ CITATION

Str03 \l 1033 ], to classify the data and obtain a formalized description. The first

step was explicating personal description of the experience of the nurses in

20

dealing with angry patients, where in the researchers obtained a detailed data, to

acknowledge openly one’s assumption and biases. Next, bracketing the

researchers presuppositions so that the researchers will not lead the participants

in the direction of their beliefs during data collection or analysis. The interviewer

did not use leading questions to avoid biases. Interviewing participants in settings

unfamiliar to the researchers prevented biases related to beliefs and the

perception of the interviewer. Transcripts from interviews conducted with the staff

nurses were read carefully to obtain a general idea of their experience in dealing

with an angry patient. Reviewed the transcripts to uncover essences.

Apprehended essential relationship to understand and link the connection of one

another or for the researchers to be able to group related or similar experiences.

Developed formalized descriptions of the phenomenon to categorize or formulate

themes. Returned to the nurses to validate the descriptions and continue to

gather data until no new data will be obtained or data saturation is achieved.

Data saturation is reached when there is enough information to replicate the

study [CITATION ORe12 \l 1033 ], when it comes to a point when the failure to

get extra new data has been achieved [ CITATION Gue06 \l 1033 ], and when

further coding is no longer feasible [ CITATION Gue06 \l 1033 ]. Reviewed

relevant literature to support or expound the obtained data. Lastly, distributed the

findings to the nursing community to allow information dissemination and provide

enhanced knowledgeable findings applicable to the profession.

21

Chapter 2

PRESENTATION, INTERPRETATION AND ANALYSIS OF DATA

The findings of the study are presented, analyzed, and interpreted in this

chapter in five sections, namely:

1. Profile of Informants
22

2. Informant’s Stories

3. Presentation of Essential Themes and Thematic Statements

4. Synthesis of Essential Themes

5. Empowering Nurses in Handling Anger at the Workplace

Profile of the Informants

This study explored the lived experiences of nurses who had cared for an

angry patient. Six Filipino nurses were chosen purposively from Cebu City

Medical Center (CCMC). CCMC is a government hospital that offers major

medical, dental, ancillary, nursing and administrative services. Informants that

were selected are nurses who had patients who present with a majority of the

following characteristics: (1) rapid/high pitched speech, (2) tearful eyes, (3)

twitches/anxious behavior, (4) rapid breathing, (5) dry mouth, (6) flushed face, (7)

increased perspiration and (8) harsh/coarse/sarcastic language. The profile of

the nurse informants is presented in Table 1.0.

Table 1.0

Profile of the Informants

23

Alias Age Gender Religion Years of Number Average Frequency

Experience of Patients
Seminars for
/Trainings Every
Shift
Nightingale 33 F Roman 2 years 0 9 Once
Catholic and 5 every 2
months weeks
Sullivan 23 M Roman 2 years 0 40 Once
Catholic and 4 every 3
months months
King 24 M Roman 3 years 1 14 Every
Catholic month
Leininger 28 F Roman 2 years 0 20 Everyday
Catholic and 5
months
Orem 27 F Roman 2 years 0 15 Once
Catholic and 2 every 3
months months
Kohlberg 27 M Roman 3 years 0 30 Once
Catholic every 3
days

The table above shows the profile of the informants as to their age,

gender, religion, years of nursing experience, number of seminars/trainings

attended regarding dealing with angry patients, estimated average number of

patients cared for every shift, and frequency in dealing with an angry patient.

Only aliases are shown to ensure confidentiality of these individuals.

The first column of the table contained the aliases of each informant.

Aliases are used to uphold confidentiality.

24

The second column reveals the age of the informants. All six informants

are in their young adult stages. Young adults are those aging 20-40 years old.

[ CITATION Koz04 \l 1033 ] According to Chad Buleen, even though there are

always exceptions to the rule that different age groups adhere to communication,

through daily observations, it makes it evident that the communication of the

difference age groups differs. According to the American Academy of Family

Physicians, the communication process in general is complex and can be further

complicated by age. Communication can be hindered by the normal aging

process, which may involve sensory loss, decline in memory, slower processing

of information, and lessening of power and influence over their own lives.

[ CITATION Rob03 \l 1033 ]

The third column reveals the gender of the informants. Both male and

female nurses are affected by gendered cultural attitudes, beliefs, and practices,

at times influencing the way they approach and maintain relationships.

[ CITATION Sut14 \l 1033 ] Female nurses are viewed by patients as having

natural tendencies to care. Due to this, patients are more receptive and

responsive to female nurses than to their male counterparts. [ CITATION Sut14 \l

1033 ] Women also provide more intense levels of care. [ CITATION NAt14 \l

1033 ] Seeing furious acts or being subjected to the patient venting can raise

sentiments of dread, outrage, weakness, or uneasiness in a both male and

female nurses. Both genders are equally likely experience anger in response to

strain but the anger of females are more linked to emotions such as anxiety, fear
25

and depression reflecting the fact that anger is viewed as inappropriate for

women (Feld and Bishop, 2011) According to Leininger, (personal

communication, June 08, 2018) “I think mas maayo gyud ang babae mo care

kaysa sa lalaki and I think also nga disadvantage sad sa babae nga caring kaayo

kay sila sad ang mas affected if maka deal og angry patients kay mas sensitive

man sila in nature than sa mga lalaki gud [I think women are better in caring than

men and I think also that it’s a disadvantage for women to be very caring

because they are more affected when dealing with angry patients because they

are more sensitive in nature than men.]

Male nurses have often been characterized as protectors as they have

been asked to intervene in confrontational interactions with patients. (Pullen &

Simpson, 2009; Whittock & Leonard, 2003) In caring for female patients, male

nurses have been found to be hesitant in their use of touch, concerned that it

may be interpreted as sexual (Evans, 2002; Evans & Frank, 2003; Fisher, 2009;

O’Lynn & Krautscheid, 2011). Male nurses usually project a more authoritative,

distant manner, in providing care. [ CITATION Pul09 \l 1033 ] Moreover, since

they are viewed to be strong, male nurses tend to show little emotion.

[ CITATION Mil01 \l 1033 ]According to Sullivan, (personal communication, June

15, 2018) “laki kay murag mas strict mn gud nya dili kaayo sensitive parihas sa

babae” [Men are more likely strict and not so sensitive compared to women]
26

The fourth column shows the religion of the informants. According to

Puchalski (2001), considerations are necessary in dealing with an angry patient.

According to Griffith, considering that different religions have their own unique

practices and beliefs, religion affects how nurses deal with angry patients.

Nurses may rely on religion in order to adapt more quickly to certain

circumstances. [ CITATION Log14 \l 1033 ] As a Catholic nurse, they may have to

encounter ethical decisions that may go against their values and beliefs.

[ CITATION Mas14 \l 1033 ]

The fifth column displays the number of years of nursing experience. The

longer the nurse’s experience is, the more likely she is exposed to handling

angry patients.

The sixth column displays the number of seminars/trainings the informants

attended with regards to dealing with a patient that is angry. Training positively

affects the quality of the workers’ knowledge, skills and capability. [ CITATION

Gue11 \l 1033 ] Nurses who experienced trainings regarding dealing with an

angry patient improve their management skills in handling these patients. Only

one informant was able to attend a seminar with this topic. Training nurses in

dealing with these types of patients make them less likely to encounter angry

patients by improving self-control and communication skills. [CITATION Cow03 \l

1033 ]
27

The seventh column displays the usual number of patients the nurses

covered for every shift or nurse staffing levels. According to "Keeping Patients

Safe: Transforming the Work Environment of Nurses", it is strongly evident that

patient outcome and safety is affected by nursing staffing levels, the knowledge

and skill levels of nursing staff, and the extent to which the nurses collaborate in

knowledge and skills dissemination. Management or skills of the nurse in dealing

with the angry patient may be divided or utilized since attention is divided due to

the increased number of patients.

The last column shows the frequency that the informants deal with a

patient that is angry. Zajonc (1965), founder of the Mere-Exposure Effect, states

that the more the individual is exposed to a certain stimulus, the more it

enhances the person's attitude and develop a positive approach toward the

situation.

Informant’s Stories

Nightingale is married and currently on her third trimester of her first

pregnancy. She worked as a company nurse year prior to being a staff nurse in

Cebu City Medical Center. She has been assigned in the Intensive Care Unit and

is now assigned at the ward. She verbalized that she has experienced more

cases of angry patients in the Intensive Care Unit. She attributes this to the

irritability of the patients there.

28

Sullivan is single. He worked as a company nurse in a certain institution

before he started working at Cebu City Medical Center. He got employed in Cebu

City Medical Center last year 2016. He is currently assigned in the Emergency

Room Department where he handles an average number of 40 patients per shift.

King is single and living independently. After he passed the board, he

worked as a volunteer nurse for one year at Red Cross. He got employed in

Cebu City Medical Center on the year 2015. King verbalized that attending a

seminar made him more knowledgeable in managing an angry patient. He is

assigned in Medical Ward which he continuously deals with angry patients.

Leininger is married, living together with her husband and 3-year-old

child. She worked as a volunteer nurse at Gullas Hospital for three years before

being employed in Cebu City Medical Center. She has no working experience

prior to her volunteer work. She is now assigned in the Medical Ward. She

considers this the area having the most occurrence of angry patients next to the

Emergency Room.

Orem is single. She lives in Minglanilla, Cebu. She travels 1-2 hours every

day to get to her workplace. She was assigned in several stations in the hospital

and is now assigned in the Medical Ward.

Kohlberg, who is single, worked in Cebu City Medical Center initially as a

Ward nurse. He was then eventually assigned to the Emergency Room and the
29

Intensive Care Unit. Kohlberg expressed that angry patients are more frequent in

the Emergency Room rather than in the Intensive Care Unit.

Presentation of Essential Themes

Data analysis of each interview’s transcript using Streubert’s method

resulted into five (5) essential themes with corresponding subthemes. The

following table presents the frequencies and percentages of essential themes

and thematic statements.

30

Table 2.0
Frequencies and Percentages of Essential Themes and Thematic Statements
Essential Themes Subthemes No. Of Percentage of
Passages cases
Applying Lessons 19 100%
from the Past
Experience is the Best 12 83.33%
Teacher
A Little Forethought 7 66.67%

Bottled Up Feelings 30 100%

Bridling Anger 10 100%

Holding Fear Within 11 83.33%

Losing One’s Worth 9 100%
Profession Over 29 100%
Emotion
Responding with a 21 83.33%
Colleague
Caring for the Person, Not 8 66.67%
the Behavior
Taking Action 14 100%
31

Voicing Out Louder 6 66.67%

Looking The Other Way 8 66.67%

Opportunities to 21 100%
Make Self Better

Looking at The Mirror 7 83.33%

Sharpening the Needle 14 100%

The researchers identified five essential themes gathered through

interviews. Table 2.0 above shows the essential themes, subthemes, number of

passages supporting each subthemes and the percentage of informants that

made significant statements for each theme. Essential themes are elements of

the described experience that cannot be changed without losing meaning. They

are patterns across all the information shared by the informants that are

important to the description of the experience of caring for an angry patient.

Subthemes are categories of significant statements that support the essential

themes. The number of passages refers to the number of significant statements

that can be classified into each of the subtheme. Values are obtained through

counting the significant statements. The last column, percentage of cases, refers

to the number of informants that expressed the notion presented in the subtheme

or essential theme. This is computed by dividing the number of informants who

verbalized the subtheme or essential theme by the total number of informants,

which is six. Then it is stated in a percent form.

32

The essential themes include (1) Applying Lessons from the Past, (2)

Bottled Up Feelings, (3) Profession Over Emotion, (4) Taking Action and (5)

Opportunities To Make Self Better.

Essential Theme 1: Applying Lessons from the Past

This essential theme refers to how the informants responded cognitively in

dealing with angry patients. The informants used their insight on the best way to

manage them. This includes applying theories into actions and getting ideas from

their past exposures with angry patients.

According to Forbes Coach Council (2018), there's a big difference

between attaining information and utilizing your knowledge into action. Without

doing the latter, the training you've received will go to waste, so it is a need to

have a plan in order to implement the knowledge you have gained.

According to the research study of Dewi Hermawati (2010) which is the

Nurses’ Perceived Preparedness of Knowledge and Skills in Caring for Patients

Attacked by Tsunami in Banda Aceh, Indonesia and Its Related Factors, “Many

factors can contribute to nurses’ preparedness in caring for patients. These

include training and education (Chapman & Arbon, 2008; Wetta-Hall,

Fredrickson, Ablah, Cook, & Molgaard, 2006), clinical experience (Suserud &

Haljamie, 1997), and perceived severity and perceived risk (O'Sullivan et al.,

2008; Rebmann, 2006).”

33

There are two sub-themes under this essential theme. These subthemes

are 1.) Experience Is the Best Teacher 2.) A Little Forethought

Subtheme 1: Experience is the Best Teacher

Experience is the best teacher refers to the nurses who learned more on

how to deal with a patient who is angry through their experiences in their work

place. According to Duquesne University School of Nursing: The Importance of

Clinical Experience, improvement of patient care in the near future requires an

important insights and practices which is gained through clinical experiences.

According to Roger C. Schank (1995), "In general, most businesses are aware

that the more experience an employee has with a given situation, the more

effective he is in that situation." This explained that in order for a person to be

successful in what he do, this person must have the knowledge or a mastery on

the matter first through involving his or her self or exposing his or her self to this.

According to King (personal communication, May 28, 2018), “Prepared in

a sense nga experience based. Experience wise jud na.” [I’m prepared through

my experiences. Experiences wise is all that matters.]

According to Kohlberg (personal communication, May 29, 2018) when he

was asked regarding on where he learned on how to deal with a patient that is

angry, he responded, “Nakat’on ko based on experiences.”[I learned through my

experiences]
34

Orem also verbalized (personal communication, May 31, 2018), “Daghan

na man pod ko ka experience gud so maka ingon ko ba na andam nako kung

maka interact napod kog angry patient.” [I’ve had a lot of experiences so I can

really say that I am ready if ever I’ll get to interact with an angry patient again.]

When Sullivan was asked on where he learned in dealing with an angry

patient, he answered (personal communication, June 5, 2918), “Related on

experience ragyud sya.”[ It’s just really based on experiences].

According to Leininger, (personal communication, June08, 2018) “based

on experience naa jud tay pointers nga ang atong masulti “ay kaya rani nato na

pasyente kay nakasuway naman ko ani sauna”” [Based on experience there are

really times that we can say “I can handle this kind of patient since I’ve handled

this before”.]

The researchers have noticed that most of the informants learned on how

to deal with angry patients based on their experiences.

Subtheme 2: A Little Forethought

A Little Forethought refers to how the informants created a plan utilizing all

the theories they have learned and what worked in past experiences. These are

the times that the nurses think ahead on what to do or what to prepare in dealing

with an angry patient that they are expecting to encounter in their work place.
35

According to Shift eLearning (“Before, During, and After Training:

Improving Knowledge Transfer in Your Organization in 3 Stages,” 2018), one

must provide a comprehensive learning experience to resolve real problems at

the workplace. it is important to know that learning does not start and stop with

training session. The stages of learning must be taken care before, during, and

after.

According to Kohlberg (personal communication, May 30, 2018), “Naa

man sad tay prayers. Kanang before work mag ampo ta na walay dili maayo

mahitabo.” [We also have prayers. Before going to work, we will pray that there

will be no bad thing that might happen.]

According to Leininger (personal communication, June 8, 2018), “Huna

hunaon ra nako nga mu labay rani siya nya hunahunaon sad nako nga hapit

namahuman ang shift bisag layo pagod (laughs).” [I will just think that this will just

pass by and just think that the end of the shift is near even though it’s not

(laughs).]

According to Nightingale (personal communication, June 12, 2018), “Mao

na before ko magduty dapat clear ako mind para dili sad nako madala sa work if

ever naa koy mga bug-at nga feelings na gibati.” [That’s why before I go to work,

I have to clear my mind first especially I’ve been feeling down lately.]

According to Orem (personal communication, June 16, 2018), “Ako pungi-

prepare ako self, ako i-set akong mind na “This will be a great day! Bawal ang
36

negative.”” [I also prepare myself by thinking, “This will be a great day! No

negativities allowed.”]

Essential Theme 2: Bottled Up Feelings

Bottled Up Feelings refer to how nurses manage, regulate, and hold in

their feelings of certain emotions such as anger, anxiety, dread, frustration,

sadness, low self esteem or fear on the inside and still remain calm and well

composed on the outside. Instead of bursting their emotions up and venting it out

on the patients, they tend to keep it to themselves.

According to [ CITATION Gra00 \l 1033 ] people employed at an institution

or any means of work can modify their perceptions on situations to adjust their

responses emotionally, managing and regulating their emotions and feelings to

express it at an appropriate manner or situation at work.

There are three sub-themes under this essential theme. These subthemes

are 1.) Bridling Anger, 2.) Holding Fear Within, and 3.) Losing One’s Worth

Sub-Theme 1: Bridling Anger

37

Bridling Anger refers to how nurses are trying to do their best to “conceal”

or hide what their anger holds while trying to look and keep calm on the outside.

The informants stated that anger is inevitable, and yet they try to keep it up to

themselves to prevent any further escalation of the problem by not leveling up

their anger to the patient’s.

People are afraid of their own anger and don’t want to have a

confrontation with another person, thus turning anger inward. Most people who

turn their anger inward, would rather hurt themselves than others, so the anger

styles they most share with others tend to be anger avoidance, shame-based

anger, and sneaky anger. People who turn their anger on themselves have often

been taught that being angry with someone is morally bad and many have

learned that “talking back” is just “looking for trouble”[ CITATION Pot95 \l 13321 ].

According to Nightingale (personal communication, May 28, 2018)

“Ganahan sad ko masuko sad ko nga like nga mulevel ko sa iyang kasuko but at

the back of my mind, muingon nga “ayaw, pasensya kay naa nay problem nga

giatubang so they need understanding.” [I also like to be mad and level my anger

to the patient’s but at the back of my mind, I’ll just say “Don’t, just be patient

because they are having problems so they need understanding.]

According to King (personal communication, May 28, 2018) “pero

kasagaran bisag lagot naka, imo na lang pugngan imohang kalagot” [but most of

the time even if I’m angry I would just keep it inside.]

38

According to Kohlberg (personal communication, June 7, 2018) “Oo,

masuko man gyud sir na, ingon ana sila but di lang sad nako ipakita. I keep it to

myself lang kaysa na mograbe ang problema”. [Yes, there will be anger sir like

that but I will not let it show, I keep it to myself because the problem will get

worst.]

According to Leininger (personal communication, June 8, 2018) “ako ra

pasagdan na lang nya i-ato ato lang ang kalagot gud [We’ll just let it be and we’ll

just keep our anger to ourselves.]

According to Orem (personal communication, June 16, 2018) “ Pero bisan

man ug maglagot ko usahay kay ako na lang i-tago gane para dili na mudako

ang away. [Even if I’m mad sometimes, I’ll just hide it so that the fight will not

escalate.]

According to Sullivan (personal communication, June 23, 2018) “Pero naa

sad juy usahay maglagot sad ko pero di nako ipakita.”[ But there are times that I

also get mad but I won’t show it.]

Sub-Theme 2: Holding Fear Within

Holding Fear Within refers to how nurses are unease about being

threatened yet managed to still render nursing activities and care effectively

without losing his or her poise.

The informants stated that they were in fear and anxious about their safety

in reasons of patients threatening to stay outside the workplace, waiting for the
39

informants to come out to inflict harm such as utilizing weapons and other

sources of hazardous materials.

Based on a survey of 86 nurses from different areas of work in the

hospital, 88% reportedly stated of being verbally assaulted by their patients, their

significant others as well as their visitors, while 74% stated they have been

physically assaulted the past year [ CITATION May02 \l 1033 ]

According to Nightingale (personal communication, May 28, 2018) “Oo oy

hadlok ko kay kanang basin nyag atangan ko sa gawas (laughs) Atngan nya kos

gawas ba and dad an ug kutsilyo or pusil ba for example.”[Yes, I’m scared maybe

they’ll stay outside and wait for me. Bringing a knife or a gun for example.]

According to Leininger (personal communication, May 29, 2018) “sa mga

di kasabot kay kanang dalhan mig weapons, kay naa rabay uban na mga addict

nya nay mga sa squatters” [For those who can’t understand the situation is

maybe they’ll bring weapons, because there are some people who are addicts

and some squatters.]

ccording to Orem (personal communication, June 16, 2018) “Nya fear kay

kanang kaybaw na baya ka sa type of patient na naa sa among hospital, di jud

na malikayan na mahadlok ko sa akong safety ba, kana ganing inig gawas nimo

sa hospital kay basig paatngan baron ka or pusilon ka ba.” [And fear because

you know the type of patient in our hospital, we can’t avoid being scared for our
40

safety, instances where when you leave the hospital and someone will be waiting

outside or they’ll shoot you.]

According to Sullivan (personal communication, June 23, 2018) “mahadlok

ko atngan sa gawas samot na nang mga isog kaayo nga patiente. Kanang i-

threaten nila imong kinabuhi. [I’m scared of them staying outside waiting for me

to come out especially those patients who are aggressive. They’ll threaten your

life.]

According to Kohlberg (personal communication, June 30, 2018)“Kanang

nakasuway sad ta, ang pasyente kay suko na gani kaayo. Nya makuyawan ta

kay basin makakita nya ta niyas gawas ga dala ug patalim nya kaliton lang tag

duol.” [Yes I’ve tried. a patient that was so angry. And I fear I might see him

outside bringing a sharp object and suddenly approaches me.]

Sub-Theme 3:Losing One’s Worth

Losing One's Worth alludes to the nurses' feeling of being scolded for not

having the capacity to address the angry patient's issues or incompetence for the

purpose of being capable to release what these patients feel and for someone to

take the blame. The informants stated that they feel frustrated and down for

being the ones caring for the patient yet also be the ones to be faulted because

of patients being driven by the anger.

According to [CITATION Bul2 \l 1033 \m Fen09], self-esteem is lowered

by being misunderstood by others, if people become aware of some fault or

41

inadequacy in themselves, other people have a poor opinion of them, being

scolded, being laughed at, scolded, blamed, and criticized. Self-esteem is

lowered by being on the receiving end of other people’s stress or distress.

According to Nightingale (personal communication May 28, 2018) “Oo mu

lessen ang self esteem , ang fear, or malouy sad ta sa patiente. [Yes, self esteem

will less, the fear, or also pity for the patient.]

According to King (personal communication May 28, 2018) “Mura bitaw

siyag insult sa akoa mura kog gipalabas nga suloguon ana, willing raman ko

motabang basta tarongon kog storya, ma hurt man gyud atong ego ana,” [It’s like

an insult for me because it will look like I’m a slave, I’m willing to help but they

have to talk to me properly, it’s that our ego will get hurt.]

According to Leininger (personal communication May 29, 2018) “To be

honest kay maka low jud siya sa imong self esteem, kana ganing makaingon ka

na murag ineffective ka as a nurse kay nganu na happen man to pero at some

point ako jud bitaw pod ifeel ang ilahang situation, na dili lalim pod ba na

masakit.” [To be honest it will lower your self esteem, instances where you could

say you’re ineffective as a nurse because of what happened but at some point I’d

just feel their situation, that it’s not easy being sick.]

According to Orem (personal communication May 31, 2018) “Mag huna-

huna ko ana, makaubos pod bitaw siya sa self esteem, kanang maka ingon ka

ba na ineffective ka as a nurse kay wala to nimo na manage na problem. [I’ve

been thinking about that, it also lessens the self esteem, where you could say
42

that you’ve been ineffective as a nurse because you did not manage the

problem.]

According to Sullivan (personal communication June 15, 2018) “naa man

jd na ang mga dili kalikayan na words na I’utter so mura kag madown grade ang

imong professionalism kay storyahan kag mga bati” [There are words that we

really can’t avoid that will be uttered so it’s like your professionalism will be

downgraded because you’ve been told bad things.]

According to Kohlberg (personal communication June 30, 2018) Mao ra

gihapon pareha ato sauna katong devastating kay usually make ubos sa self-

esteem. [Same thing, same as before the devastating one because usually it will

lessen the self esteem.]

Essential Theme 3: Profession over emotion

Profession over emotion means that the informants chose to act according

to the protocol rather than respond according to their emotions. This refers to

when a nurse is encountered with a situation with a patient that is angry and

chooses the proper management to handle the situation to prevent it from getting

any bigger rather than letting their emotions get in their way. The informants had

stated different kinds of management that should be done in this situation

according to what hospital protocol, what they had learned over the years, or

what have been taught in their respective alma mater.

43

Strong management is necessary for all work environments, especially

those that involve quick decision-making and high-pressure situations

[ CITATION Bet16 \l 1033 ] It may, as well, prevent any situation from getting

worse

There are two subthemes under this essential theme. These subthemes are 1.)

Responding with a Colleague and 2.) Caring for the Person, Not the Behavior

Sub-Theme 1: Responding with a Colleague

Responding with a Colleague refers to when the informant is in leans to

another person’s help. Whenever encountered with a situation with an angry

patient that seems impossible to be appropriately addressed to alone, the

informants usually call for help with other members which may be a fellow nurse,

a supervisor, a security guard or even a family member. Most informants

mentioned that they had resorted to this type of management.

According to “The lived experience by psychiatric nurses of aggression and

violence from patients in a Gauteng psychiatric institution” (Bimenyimana et al.

2009) the absence of help from the members of the psych team affected the

psychiatric nurses emotionally, psychologically, and physically.

According to Nightingale, (personal communication, May 28, 2018)

“Isumbong nako sa akong senior nurse then sa ako family sad para at least man
44

lang magpaless ang burden ba mao ni nahitabo sa ward” [I tell my senior nurse,

then my family so that at least there is lesser burden that happens in the ward.]

According to King, (personal communication, June 8, 2018) “You have to

raise it to someone na mas better pa nimo mo deal, which is the supervisor or

the chief nurse then the chief of hospital” [You have to raise it to someone that is

better than you in dealing which is the supervisor or the chief nurse then the chief

of hospital.]

According to Sullivan, (personal communication, June 15, 2018) “Akong

need is support lang sa akong kauban.” [What I need is support from my co-

workers.]

According to Kohlberg, (personal communication, June 7, 2018) “kanang

manawag nalang ta ug tabang. Sa ato ba kauban or sa security guard. Kanang di

nagyud ma iwas ba. Patabang nalang sad ta sa security guard” [Let’s just call for

help. Either from our co-workers or the security guard. Only when it’s inevitable

ask help from the security guard.]

According to Leininger, (personal communication July 1, 2018)“kailangan

man gyud ta mo work as a team baya collaboration ta sa uban tao, bisag di man

gani sa trabaho mo collaborate gihapon ta para ma solbar ang sitwasyon, kay

one for all, all for one baya ta diri sa atong tarbahoan” [We need to work as a

team. Collaborate with other people. Even if we’re not working we still collaborate
45

in order to solve the situation since it’s one for all and all for one here in our

workplace.]

Subtheme 2: Caring for the Person, Not the Behavior

Caring for the Person, Not the Behavior refers to when the informant feels

what it resembles to be in the patient's situation. A situation may seem different to

the patient and understanding how it is may be a key to properly address to them

according to one of the informants. All informants have mentioned that

understanding what the patient may be going through can help manage the

situation with an angry patient.

According to “Possibly Impossible Patients: Management of Difficult

Behavior in Oncology Outpatients” Peteet (2011), specifically the fourth principle,

it is important to determine the cause of the behavior of the client to help the

members of the medical team to have an appropriate and immediate

management for the client.

According to Nightingale, (personal communication, June 12, 2018) “You

must understand, kay each patient, kanang ganahan sila maayo so understand

lang siguro and then being open minded.” [You must understand because each

patient, they want the best so let’s just understand and be open-minded.]

According to King, (personal communication, June 8, 2018) “I placed

myself in his shoes, nakitan nako ako kaugalingon na siya napod ang naa sa
46

akong situation naga away ba.” [I placed myself in his shoes. I saw myself in his

situation in which he was having an argument.]

According to Orem, (personal communication, May 31, 2018) “Una gyud

kay you put yourself in their shoes ako sa gyud na-ibutang ako kaugalingon sa

ilaha ba na kung ako kaha naa ani sitwasyon basin mao pud guro ako mabuhat”

[First is you put yourself in their shoes. I put myself into whatever they are that

what if I was in their situation maybe I would’ve done the same thing.]

According to Kohlberg, (personal communication, June 7, 2018) “Ako

man gyud suwayon ug sabot ang pasyente” [I always try to understand the

patient.]

Essential Theme 4: Taking Action

Taking Action refers to how the nurses respond when dealing with in angry

patient. According to Nurse Buff (2014), nurses may get into arguments due to

misunderstanding which may lead to unavoidable tension between the nurse and

patient. As a result, nurses must take necessary actions to avoid the

misunderstanding and tension.

There are two subthemes under this essential theme. 1.) Voicing Out

Louder 2.) Looking the Other Way

Subtheme 1: Voicing Out Louder

47

Voicing Out Louder refers to when the nurse raises his/her voice when

talking to the angry patient as a response to their frustrations. Some of the

informants mentioned about how raising their voice allows them to give the same

alarming stimulus back to the patients usually to give emphasis on statements

towards the angry patient.

According to Nightingale, (personal communication, May 28, 2018) “Nitaas

gamay akoang voice.” [I raised my voice up a little.]

According to Sullivan, (personal communication, June 15, 2018) “Mu

singka pud ka tungod lagi sa kabusy” [I also raise my voice because of how busy

it is.]

According to King, (personal communication, May 29, 2018) "Kanus-a

(raises voice) mani siya matanaw" nya ako pod niana ko "Ma'am (raises voice)

naa baya mi gitabang ha, kita baya ka so, di ta mag isog-isog kay kanang naa

man gay mga bati na pasyente, emergency room baya ni, nya ikaw na tunok

raka, makahuwat ra mana"” [When (raises voice) can they see him/her” and I

also said “Ma’am (raises voice) We were helping someone, you saw us, don’t be

stubborn because there are more ill patients, this is the emergency room and you

just got pricked, that can wait.”]

According to Orem, (personal communication, May 28, 2018) “nitaas na

akong tingog niana ko "Ma’am pwede dili naka mag sig yawyaw? Nailisan na

nako imong dextrose.” Daghan pa kay kog bati na patiente."” [My voice got
48

louder and then I told her “Ma’am can you stop yelling? I already changed your

dextrose. I have a lot of patients with worse conditions.]

Subtheme 2: Looking the Other Way

Patients decide to look the other way when being given injections to

decrease the attention given to the painful or stressful stimulus. This also goes

both ways when the nurse decides for the time-being to look the other way in

order to prevent untherapeutic interactions. Looking the Other Way refers to

when the nurse decides to avoid interaction with the patients instead of

confronting the problem. Some respondents say that they usually avoid interact

on for a matter of time and have a co-worker assigned to the angry patient for the

time being.

According to the study, “Nurses Response to Anger: From Disconnecting to

Connecting” (Smith, 1994), when there is a high threat to the nurses, they tend to

disconnect from the angry patient, but when there is a low threat, the nurses begin

to connect back to the patients."

According to Nightingale, (personal communication, May 28, 2018) “First

sir kay avoid langsa ta para atong pa ubson ang situation ba.” [First, we avoid,

for now, so we can change the situation.]

According to King, (personal communication, May 28, 2018) “Kanangi

avoid langsa” [I just avoid.]

49

According to Leininger (personal communication, July 1 ,2018).

“Mabuthan nya nato ang pasyente, lisod na unya mudako pagyud ang problema

so kung mada gani likay lang gyud ta” [We might scold the patient. It’s already

hard on us and yet the problem would get worse. So, if possible it would be

better to avoid or lessen the actions to lessen the problems.]

According to Orem, (personal communication, May 31, 2018) "kanang iavoid lang

sa.” [Just avoid it for now.]

Essential Theme 5: Opportunities to Make Self Better

Opportunities to Make Self Better refers to nurses seeing the encounter of

an angry patient as a chance to improve themselves. The situation is used as a

stepping stone to enrich their patient-nurse interaction and to prepare themselves

in future interactions with such patients.

According to [ CITATION Car16 \l 1033 ], when a nurse participates in

negative conversations with an angry patient, the nurse sees this as the

opportunity to formulate ideas for improvement of her/himself. The nurse turns

this experience as a shot for self-improvement.

There are two sub-themes identified under this essential theme. These

subthemes are 1.) Looking at The Mirror 2.) Sharpening the Needle

Sub-theme 1: Looking at the Mirror

50

Looking at The Mirror talks about nurses who sees the experience in

dealing with an angry patient as a chance for them to reflect on themselves. This

sub-theme emphasizes on the self-reflection of the nurses after the interaction

with an angry patient.

According to “Nurses Response to Anger: From Disconnecting to

Connecting” (Smith, 1994), self-efficacy concept emerged as the major area of

concern among nurses in dealing with an angry patient.

According to King, (personal communication, June 08, 2018) “makahuna-

huna ka ba inig human sa interaction na sakto ba kaha to akoang nabuhat, maka

reflect jud ka sa imong self ” [You will really think after the interaction with an

angry patient if what I did was right or not, it’ll really make you reflect on yourself.]

According to Nightingale, (personal communication, June 12, 2018) “Maka

reflect jud ko as a nurse sa akong self na nurse ko so dapat ako jud mo adjust

ani nila kay naa ni silay mga gipamati.” [I can reflect to myself as a nurse that I

am a nurse and I should be the one to adjust for them because they are not in

their complete wellness state.]

According to Sullivan, (personal communication, June 15, 2018). “Akong

self-reflection is dili ra diay disadvantage ang pag deal og mga angry patients sa

imong work but it can also be an advantage kay ma challenge man ka na

maninguha jud ba na mahatag nimo ang best para sa patient” [My self-reflection

is that, dealing with an angry patient is not just all disadvantage, there’s also an
51

advantage because it will challenge you to really give the best care to the

patient.]

According to Orem, (personal communication, June 16, 2018)

"makareflect ko sa akong self like as a nurse, ang akoang gibuhat is sakto bato

or not" [I can reflect to myself as a nurse if what I did was right or not.]

According to Leininger, (personal communication, July 01, 2018) "ako I

reflect sa ako self ba para kibaw ko asa ko sayop ug unsa ako mabuhat para di

na mahitabo sunod". [I reflected myself to what I did so that I will know where I

went wrong and what I can do to prevent it from happening next time.]

Sub-theme 2: Sharpening the Needle

This sub-theme refers to the development of the skills of the nurse. The

needle represents the skills of the nurses which is continuously being sharpened

through an encounter with an angry patient. These skills include interpersonal

skills, giving of instructions, decision making, controlling one’s anger, time

management and becoming more patient.

According to “Beyond Bad News: Communication Skills of Nurses In

Palliative Care” [ CITATION Mal10 \l 1033 ], nurses identified several key areas in

need of improvement of their skills such as communication skills.

According to Sullivan, (personal communication, June 15, 2018) “ma

sharpen imo instruction giving skills, health teaching nimo, sa ana na situation” [It
52

sharpens your instruction giving skills, especially health teaching to certain

situations.]

According to Leininger, (personal communication, July 01, 2018)

"makatabang sa akoa skill na mas maka control ko sa akong kalagot" [It helps

me in my skill in controlling my anger.]

According to Nightingale, (personal communication, July 01, 2018) “it

improves my decision-making skills.”

The interviewer asked the informants whether there was an improvement

of their skill with regards in dealing with an angry patient. According to King,

(personal communication, June 08, 2018)” Oo, especially ang akoang

interpersonal skills inig storya namo” [Yes, especially my interpersonal skills

when I communicate with them.]

According to Orem, (personal communication, June 16, 2018) "akoang

skills in time management, kanang mas dalion nimo ang mga procedure ba

without compromising the care kay dili ka ganahan na nay patient na maglagot"

[My skills in managing time, I tend to perform procedures faster without

compromising the care because you don’t want other patients to get angry.]

According to Kohlberg (personal communication, July 01, 2018)

"improvement sa akoa patience sa akoa pagdeal nila" [Improvement of my

patience in dealing with them.]

53

Synthesis of Essential Themes

The lived experiences of nurses caring for angry patients can be

described with five themes. For every interaction with an angry patient, the

informants responded cognitively by recalling what worked in their past

experiences. This is described in the first theme "Applying Lessons From the

Past" and its two subthemes: Experience Is The Best Teacher and A Little

Forethought. The informant's experiences molded them to become better at

handling angry patients. Aside from responding cognitively, the informants

responded emotionally as well. Bottled Up Feelings, the second theme, talks

about how the nurses feel when they deal with angry patients. They also feel

angry at the situation, fearful, anxious, and frustrated. The informants feel they

are losing their esteem and their worth. But despite having these feelings that

they have to keep hidden, the informants still managed to provide care with

composure and confidence. They were still able to act according to professional

values. The informants chose to uphold their profession than expressing their

emotions fully. They ask help from other nurses and they empathize with the

patient. They also take action as an attempt to diffuse the patient's anger. Taking

Actions, the fourth theme, includes the informants unconsciously raising their

voice in responding back to the patient and avoiding further interaction with them.

The informants have recognized though that these are not good interventions but
54

these are spur of the moment actions. Lastly, the informants view their

encounters with angry patients as a chance to improve themselves.

Opportunities to Make Self Better, the fifth theme, includes reflecting on oneself

every after encounter and improvement of skills in decision making, giving of

instructions, controlling one's anger, time management, becoming more patient

and interpersonal skills. They were able to see the experience as a stepping

stone for self-improvement. At this point in time, the informants are still facing this

challenge and continuously deals with it. In dealing with angry patients, the

informants chose to simmer their feelings rather than let it explode while

providing quality care. In these instances, the informants continue to learn to

improve themselves both personally and professionally. A nurse who

continuously deal with an angry patient is like a diamond being polished.

The researchers came up with a seminar to present deeper understanding

of the lived experiences of nurses in dealing with an angry patient and integrate

different ways and strategies to approach angry patients and recognize the

importance of managing an angry patient.

55

Research Output

Title: Empowering Nurses in Handling Anger at the Workplace

I. Opening Prayer
II. Opening Remarks
III. Introduction of the Speakers
IV. Learning to Simmer Feelings
V. Learning to Manage Angry Patients
VI. The Lived Experience of Nurses Who Has Cared for an Angry Patients
VII. Recognizing Importance of Managing Angry Patients
VIII. Open Forum
IX. Closing Remarks
X. Closing Prayer
XI. Acknowledgment and Giving Positive Feedback

General Objectives:

After 1-2 hours of inspirational talk, the participants will be able to show

deeper understanding when dealing with angry patients and the toll it creates for

the nurses and make use of newly learned approaches in communicating and

providing care for angry patients and put to use coping strategies discussed by

the researchers to subsist oneself from traumatic experiences

Specific Objectives

TALK 1: Learning To Simmer Feelings

56

After 20-30 minutes of discussion about the results of the research study, the

researchers will be able to:

1. Recognize the problem

1.1 Identify verbal and non-verbal indications of angry patients

1.2 State what causes and triggers anger in patients in the clinical setting

1.3 Discuss the effects of anger in patients towards their health and the

nurse and their field of work

2. Cope with the Traumatic Experience

2.1 Identify coping strategies for nurses experiencing a traumatic event

stemming from angry patients

2.2 Discuss effects of ineffective coping

TALK 2: Learning To Manage Angry Patients

After 15-20 minutes of brief discussion about ways and approaches to dealing

with an angry patient, researchers will be able to:

1. Discuss effective management approaches when handling an angry

patient

2. State different communicating techniques when dealing with angry

patients
57

TALK 3: The Lived Experiences of Nurses Who Has Cared for an Angry Patient

After 15-30 minutes of brief discussion about the results of the research study,

the researchers will be able to:

1. Discuss the purpose of the study

2. State the significance of the study

3. Explain the findings of the study including the themes and subthemes

TALK 4: Recognizing importance of managing angry patients

After 10-20 minutes of discussion, the informants will be able to:

1. Discuss importance of dealing with angry patients

2. Identify personal methods in dealing with angry patients

3. Elaborate and discuss established protocols of angry patients in the

institution
58
 Chapter 3

SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

This study aimed to describe the lived experience of nurses caring for an

angry patient. Descriptive Phenomenology was utilized wherein data were

gathered through a series of schedules interviews of six informants. Streubert’s

method of phenomenological data analysis was used. The interview was

conducted in a private and convenient environment where confidentiality was

kept and informants were able to freely express their ideas. The researchers

screened nurses from CCMC using an 8-item researcher made checklist. The

researchers themselves were the primary tool for data collection.

Summary of Findings

The researchers made use of the Streubert’s method of data analysis.

Personal descriptions of the experience of the nurses in dealing with angry

patients were analyzed and developed through an obtained detailed data.

The researchers included six staff nurses that were chosen to partake in

the study. Half of the informants are males and the others are females. They are

individuals who have dealt with angry patients. Informants were of within the 20-

40 year old range and working in the institution for 2-3 years, all were of the

religion Roman Catholicism. Only one informant took part in a seminar regarding

dealing with angry patients and all the informants differ in the average patients

for each shift and the frequency of angry patients they encounter.
 All of the informants were eager to partake in the series of interviews and

agreed to the terms and conditions expressed in the consent form given by the

researchers.

Transcripts from interviews conducted with the staff nurses were read

carefully which obtained a general idea of their experience in dealing with an

angry patient. Transcripts were reviewed to uncover essences.

Using Streubert’s method of data analysis on the different statements of

the informants, the researchers obtained 5 essential themes which described the

lived experience of nurses who has cared for an angry patient. The 5 essential

themes are 1.) Applying Lessons from the Past 2.) Bottled Up Feelings 3.)

Profession Over Emotion 4.) Taking Action 5.) Opportunities to Make Self Better.

The first essential theme, Applying Lessons from the Past, refers to how

the informants cognitively use their past knowledge, whether through theories or

experiences, in order to deal with an angry patient. This essential theme is

supported by two subthemes. The first subtheme, Experience is the Best

Teacher, refers to when the informants act according to their experiences. The

second subtheme, A Little Forethought, refers to the plans the informants used to

deal with an angry patient. This could be what they have utilized in the past that

worked for them.

The second essential theme, Bottled Up Feelings, refers to how the

informants choose to simmer down their feelings, thus remaining calm on the

outside when dealing with a aptient that is angry. This essential theme is
supported by three subthemes. The first subtheme, Bridling Anger, refers to how

the informants conceal their anger while remaining calm. The second subtheme,

Holding Fear Within, refers to when the informants suppress their fears about

being threatened and they were still able to perform nursing activities and care

effectively. The third subtheme, Losing One’s Worth, refers to when the

informants’ self-esteem is lowered due to being scolded by the patient.

The third essential theme, Profession Over Emotion, refers to how the

informants manage to be proactive rather than portraying their own emotions.

This essential theme is supported by two subthemes. The first subtheme,

Responding with a Colleague, refers to when the informants decide to ask for

another colleague’s help. The second subtheme, Caring for the Person, Not the

Behavior, refers to when the informants empathizes the patient’s situation.

The fourth essential theme, Taking Action, refers to how the informants

respond when dealing with an angry patient. This essential them is supported by

two subthemes. The first subtheme, Voicing Out Louder, refers to when the

informants unconsciously raise their voice as a response to their frustrations. The

second subtheme, Looking the Other Way, refers to when the informants avoid

the interaction rather than confronting the patient.

Lastly, the fifth essential theme, Opportunities to Make Self Better, refers

to when the informants view the situation as a chance to improve themselves.

This essential theme is supported by two subthemes. The first subtheme,

Looking at the Mirror, refers to when the informants take the chance to reflect on

themselves after every interaction. The second subtheme, Sharpening the

Needle, refers to the informants who see the experience as a shot to improve

their skills.

Conclusion

Based on the findings of the study, the following statements of conclusion

are made:

For every interaction with an angry patient, the informants responded

cognitively and applied their learned theory into action. This is described in the

first theme, Applying Lessons From the Past. The experiences polished them to

become better in handling an angry patient. Aside from responding cognitively,

the informants also responded emotionally as well. Bottled Up Feelings, the

second theme, explores the feelings of the nurses when they deal with an angry

patient. They feel angry at the situation, fearful, anxious, and frustrated. The

informants feel they are losing their esteem and worth. But despite having these

feelings, they chose to simmer them and continued to provide care with

composure and confidence. They were still able to act according to professional

values. Taking Actions, the fourth theme, includes the informants unconsciously

raising their voice in responding back to the patient and avoiding interactions with

them. Lastly, the informants view these encounters as a stepping stone for them

to improve themselves. Opportunities to Make Self Better, the fifth theme,

includes self-reflection and enhancement of their skills. They were able to see

the experience as a learning opportunity for self-improvement.

Recommendations

Based on the findings of the study, the researchers would like to recommend

the following:

1. The nurses to attend a seminar on patient anger management.

2. The Hospital Administrator to provide a seminar to nurses regarding

dealing with angry patients.

3. The Academe to provide a comprehensive discussion of handling an

angry patient to the student nurses.

4. The other health care provider to support and assist one another in

managing an angry patient.

5. The readers to read more research studies with a topic relating to

managing an angry patient.

In the interest of future studies, the researchers would like to recommend the

following:

1.) A phenomenological study focusing on patients who are managed by

angry nurses.
2.) A phenomenological study focusing on nurses who have dealt with

aggressive or violent patients.

3.) A correlational study on knowledge, attitude, and skills towards dealing

with angry patients.

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APPENDIX A - 1

TRANSMITTAL LETTER TO THE DEAN

 APPENDIX A - 2

TRANSMITTAL LETTER TO CEBU CITY MEDICAL CENTER

 APPENDIX B - 1

INFORMED CONSENT FOR THE RESPONDENT

Title of Research study: "The Lived Experiences of Nurses in a Selected Public

Hospital Who Has Cared for Angry Patients"

Investigators: Kimberly Lyn M. Cabahug, Richmond B. Co, Nica G. De Castro,

Darren Matthew S. Leyson, Jetier T. Pinote

Purpose and Background:

We, the researchers, have chosen this study to provide insight into the
experiences of the staff nurses of Cebu City Medical Center and allow us to have
an in depth understanding regarding their nursing experience with angry patients.
We, the researchers, chose this topic because there was an incident involving an
angry patient and a nurse. Anger can be triggered by unexpected news,
misunderstanding, and a prolonged waiting time. Often times when nurses have
to deal with an angry patient, they experience difficulty in handling these patients
and cause may prove bothersome in the services rendered by the nurse.

Procedure:
The researchers will utilize methods including:
- One on One interview (Semi structured interview)
- Video recording
- Audio Recording

Data gathering will begin at the researcher's earliest convenient time. The
interview will last for about 45 minutes to 1 hour. There will be interviews that will
be done subsequently until no new data is acquired. Interviews will be audio and
video recorded and will be secured for confidentiality reasons. This will be used
for research purposes only.

If I feel uncomfortable, while being recorded during the interview, I may inform
the researchers and my request will be followed immediately. If I, as the
informant, feel bothered in any way after the interview or during the course of the
study, I can call the group leader and the researchers any time and we will refer
you to the licensed psychologist for further assessment and counselling.

I may also be given the right to withdraw from the study at any time and I will not
be penalized or be held with any prejudice. In the event that you choose to back
out from the research, the information I gave, including all recordings will be
erased and transcriptions will be placed in a separate envelope and will be
destroyed immediately with the use of a paper shredder under the supervision of
the research mentor to make sure that the researchers destroyed all the
gathered data.
The researchers, in forming a qualitative research study will utilize data obtained
from the informants. This study followed protocols approved by the Ethics
Committee and Research Council. Some of the quotes may be transcribed for
documentation purposes but rest assured that measures to safe keep he data
shared will be held with utmost respect and confidentiality. Your identity and other
personal information will remain anonymous by utilization of aliases instead of
your real name.

Benefits:
The results of the study will provide additional information to deepen the
understanding of the life experiences of staff nurses who dealt with angry
patients.

Risk: I may be asked to state past experiences which may re-live traumatic
experiences of the past. This study poses a psychological risk. However, the
researchers will see to it that I will be attended to by a licensed psychologist who
will debrief me after every interview session and conduct further counselling
sessions should the need arise. If ever the psychologist recommends a need to
seek for psychiatric help, the researchers will shoulder the expenses of the
consultation.

Confidentiality: The interview will be audio and video taped, however my real
name will not be mentioned, instead an alias will be utilized. All of my personal
information and interview responses will be kept confidential and utilized only for
research purposes.

Security: After my interview is transcribed, the recording will be kept for one year
or until the completion of the study. This study will be placed in an envelope and
kept inside the cabinet with padlock by the research leader. The recordings will
also be kept in a password-encrypted folder in the computer until the hardbound
of the study is accomplished. The data collected from the me will be discarded
once the study is completed. Transcribed data will be shredded, and recordings
will be erased accordingly.

Integrity: I am only expected to share facts that are deemed truthful and honest.
I will account information in good character with utmost sincerity. I will not in any
way withhold essential details with partiality. In return, I suppose that the
researchers will keep an open mind and not be critical towards me.

Questions: If I have further questions I may contact the investigators at Kimberly

Lyn M. Cabahug, Richmond B. Co, Nica G. De Castro, Darren Matthew S.
Leyson, Jetier T. Pinote. I may also contact Cebu Doctors' University -
Institutional Ethics Review Committee if I have any questions regarding rights of
study participants, including grievances, and complaints. (Address: CDU 6th
floor, IERC Office: Tel. No.: 238-8746 loc. 524)
Right to with to Withdraw: My participation in this study is purely voluntary and
I have the freedom to withdraw anytime without being penalized.

Consent: I agree to participate in this study. My participation is entirely voluntary.

I have been given a copy of this form and had a chance to read it and have
agreed to participate in it.

Name and Signature of Participant: Code no:

____________________________________ _______________

Date Signed:

____________________________________

Name and Signature of Investigator/ Witness:

____________________________________

Date Signed:

____________________________________

APPENDIX C – 1
 ETHICS REVIEW APPROVAL

ETHICS REVIEW AMENDMENT REPORT

ETHICAL REVIEW FORM

APPENDIX D - 1
 Anger Identification Checklist

Instruction: Check as many as applicable.

My angry patient manifested this/these cues.

( ) rapid/high pitched speech

( ) tearful eyes

( ) twitches/anxious behavior

( ) rapid breathing

( ) dry mouth

( ) flushed face

( ) increased perspiration
( ) harsh/coarse/sarcastic language

SOURCE: Hunt, J. (2013) The Answer To Anger: Practical Steps To Temper Fiery

Emotions

APPENDIX D - 2

FACE DATA SHEET

Code Number:

Alias:

Age: Gender: Religion:

Years of nursing experience:

Number of seminars or trainings attended which included dealing with

angry patients:

How many patients do you usually have every shift:

How often do you deal with angry patients:

Every day( ) Every week ( ) Every month ( )

Once every three months ( ) Once every six months ( )Once a year ( )

Specify:___________ ( )

APPENDIX D - 3

INTERVIEW SCHEDULE

A semi-structured interview will commence using the question

Grand-Tour question:

How would you describe your experience in dealing with angry patients

Possible Prompt:

1. How did you feel about the situation?

2. What were the fears you encountered?
3. What were your concerns when dealing with the angry patient?
4. What were your needs?
5. How prepared were you when you encountered the angry patient?
6. What preparations did you do prior to the interaction?
7. How did you cope with the situation?
8. What were the practices you have done in dealing with the angry patient?
9. What was the reason as of why the patient got angry?
10. Who was there when that matter happened?
11. From whom did you learn on how to deal with angry patient?
12. Can you recall from college if you have a subject on how to deal with an
angry patient?
13. What was the first thing that came into your mind regarding on what to do
when you dealt an angry patient?
14. After your shift, did you tell anyone regarding the situation?

APPENDIX D - 4

Validation Tool

Purpose:
To validate descriptions of each informant about their experience in dealing with
angry patients.

Instructions:
For each theme, please put a check mark in the blank for the appropriate
response.
1.
Applying Lessons from the Past
This essential theme refers to how the informants responded cognitively in dealing with
angry patients. The informants utilized their knowledge on how to deal with an angry
patient. This includes applying theories into actions and getting ideas from their past
exposures with angry patients.

Do you agree with essential theme 1?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Experience is the Best Teacher

Experience is the best teacher refers to the nurses who learned more on how to deal
with an angry patient through their experiences regarding this in their work place.

Do you agree with subtheme 1?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

A Little Forethought
A Little Forethought refers to a nurse who have learnings, is trained through
experience, and is ready to serve his or her patients. These are the nurses who do
preparations before dealing with an angry patient that they are expecting to encounter
in their work place.
Do you agree with subtheme 2?
___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

2.
Bottled Up Feelings
Bottled Up Feelings refer to how nurses manage, regulate, and hold in their feelings of
certain emotions on the inside and still remain calm and well composed on the outside.

Do you agree with essential theme 2?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Bridling Anger
Bridling Anger refers to how nurses are trying to do their best to “conceal” or hide what
their anger holds while trying to look and keep calm on the outside.

Do you agree with subtheme 1?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Holding Fear Within
Holding Fear Within refers to how nurses are unease about being threatened yet
managed to still render nursing activities and care effectively without losing his or her
poise.

Do you agree with subtheme 2?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Losing One’s Worth

Losing One’s Worth refers to the nurses’ feeling of being scolded for being ineffective
or incompetent by angry patients just for the sake of being able to release what these
patients feel and for someone to take the blame.

Do you agree with subtheme 3?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

3.
Profession over emotion
Profession over emotion means that you can as a nurse you choose to act according
to the protocol rather than respond according to your emotions.

Do you agree with essential theme 3?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Responding with a Colleague

Responding with a Colleague refers to when the informant is in leans to another
person’s help in dealing with an angry patient.

Do you agree with subtheme 1?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Caring for the Person, Not the Behavior

Caring for the Person, Not the Behavior refers to when the informant feels what it is
like to be in the patient's situation.

Do you agree with subtheme 2?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

4.
Taking Action
Taking Action refers what the nurses do when dealing with an angry patient.

Do you agree with essential theme 4?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Voicing Out Louder

Voicing Out Louder refers to when the nurse raises his/her voice when talking to the
angry patient as a response to their frustrations.

Do you agree with subtheme 1?

___ YES ___ NO

If no, state the reason/reaction with regards to the statement.

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Looking the Other Way

Looking the Other Way refer to when the nurse decides to avoid interaction with the
patients instead of confronting the problem.

Do you agree with subtheme 2?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

5.
Opportunities to Make Self Better
Opportunities to Make Self Better refers to nurses seeing the encounter of an angry
patient as a chance to improve themselves.

Do you agree with essential theme 5?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Looking at The Mirror

Looking at The Mirror talks about nurses who sees the experience in dealing with an
angry patient as a chance for them to reflect on themselves.

Do you agree with subtheme 1?

___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Sharpening the Needle

This sub-theme refers to the enhancement of the skills of the nurse. The needle
represents the skills of the nurses which is continuously being sharpened through an
encounter with an angry patient.
Do you agree with subtheme 2?
___ YES ___ NO
If no, state the reason/reaction with regards to the statement.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

APPENDIX D – 5
RESULT OF VALIDATION
Essential Themes # of Informants Who Percentage
Agreed
Applying Lessons from 6 100%
the Past
Bottled Up Feelings 6 100%
Profession Over 6 100%
Emotion
Taking Action 6 100%
Opportunities to Make 6 100%
Self Better

Sub-Themes # of Informants Who Percentage

Agreed
Experience is the Best 6 100%
 Teacher
A Little Forethought 6 100%
Bridling Anger 6 100%
Holding Fear Within 6 100%
Losing One’s Worth 6 100%
Responding With a 6 100%
Colleague
Caring for the Patient, 6 100%
Not the Behavior
Voicing Out Louder 6 100%
Looking The Other Way 6 100%
Looking At The Mirror 6 100%
Sharpening The Needle 6 100%

APPENDIX D – 6
CODE BOOK
ESSENTIAL SUBTHEMES WITH UTTERANCES
THEMES
Applying Experience is the Best Teacher
Lessons
From The  “Nakat’on ko based on experiences.
Past  “Nakat-on gyud ko sukad atong higayon na wa nako
maexplain tarong sa akong patiente ngano dili dayon
nako macater ila needs.
 “related on experience ra gyud sya.”
 “So adto ra jd ko nakat’on on unsaon pagdeal og
mga ing ana na patients”
 Prepared in a sense nga experience based. Experience
wise jud na.
 “Experience jud bitaw ang best teacher”
 “experience gyud ang nagtudlo nako ba unsaon
paghandle og angry patients”
 “through my experience mas nakaybaw ko unsaon na
pagdeal sa mga angry patients
  “Makahelp jd bitaw ang experience inig deal nimo ug
mga angry patient.”
 “Based on experience naa jud tay pointers nga atong
masulti nga “ay kaya rani nato sila na patiente kay naka
suway naman ko ani sauna”
 “I think everything is best polished by experience.”
 “Daghan naman pod ko ka experience gud so
makaingon ko ba na andam nako kung maka interact
napod kog angry patient.”

A Little Forethought
 “Magprepare ka in a way nga maghunahuna ka na
makaencounter jd kag mga saputon na patiente.”
 “Mao na before ko magduty dapat clear ako mind
para dili sad nako madala sa work if ever naa koy
mga bug-at nga feelings na gibati.”
 “kailangan ko matog tarong like matog og at least 8-
10 hours para ig ka mata nko nindot ko og mood kay
if kuwang ko og tulog kay saputon ko”
 “Ako pung iprepare ako self, ako iset akong mind na
“This will be a great day! Bawal ang negative.””
 “Hunahunaon ra nako nga mulabay rani siya nya
hunahunaon sad nako nga hapit na mahuman ang
shift bisag layo pagod (laughs)”
 “so ana lang think positive lang nya ay lang pada sa
ilang kalagot.”

 “Naa man sad tay prayers. Kanang before work mag

ampo ta na walay dili maayo mahitabo.”
Bottled Up Bridling Anger
Feelings
 “pero kasagaran bisag lagot naka imo nalang pugngan
imohang kalagot”
 “kung maglagot man gani ko, kuan be professional lang
gihapon”
 “unya bisag kanang hilabtan naka, di lang gyud ta mo
sukol kay mo grabe man ang situation”
 “ako ra pasagdan nalang nya i ato ato lang ang kalagot
gud”
  “Pero naa sad juy usahay maglagot sd ko pero di nako
ipakita”
 “Ganahan sad ko masuko sad ko nga I like nga mulevel
ko sa iyang kasuko but at the back of my mind, muingon
nga “ayaw, pasensya kay naa nay problema nga
giatubang so they need understanding.”
 “Makalagot sad lagi ni siya” (laughs) Lami kay tubagon
ba pero at the back of your mind, “louya sad ani niya
oy.”
 “ganahan man gd ka mulevel up sa ilang kasuko but at
the back of your mind naa koy profession”
 “Pero bisan man ug mag lagot ko usahay kay ako
nalang itago gane para dili na mudako ang away.”
 “Oo, masuko man gyud sir na, ingon ana sila but di lang
sad nako ipakita. I keep it to myself lang kaysa na mo
grabe ang problema”.
Holding Fear Within
 “katong mga mahadlok ta na atangan ta sa gawas kay
kanang wa ta kbaw sa batasan ana nila”
 “kanang ma suko na sila then mahadlok ka kay wa ta
kibaw naa diay mag atang sa gawas nimo kahuman
trabaho. mao nay makuyawan nako.”
 “Kanang naka suway sad ta ani kanang ang pasyente
kay suko na gani kaayo. Nya makuyawan ta kay basin
atngan ta sa gawas gad ala ug patalim nya kaliton lang
tag duol.”
 “Makuyawan pod ka ba na basig unsaon ka gawas sa
hospital like paatngan ba ron ka or basig pusilon lang
kag kalit”
 “Nya fear kay kanang kaybaw na baya ka sa type of
patient na naa sa among hospital, di jud na malikayan
na mahadlok ko sa akong safety ba, kana ganing inig
gawas nimo sa hospital kay basig paatngan ba ron ka or
pusilon ka ba”
 “kato akong gisulti sauna na mahadlok ko maatngan sa
gawas kana ganing basig pusilin ba ko or kulatahon ba
kay ang mga pasyente gud pod ari kay klase-klase man
gud pod.”
 “sa mga di kasabot kay kanang dalhan mig weapons,
kay naa rabay uban na mga addict nya nay mga sa
squatters”
 “So fear ang atangan ka sa gawas, and then threatened
ang imohang life”
 “So dili jud malikayan usahahy na mahadlok ko na basin
paatangan ko sa iskina or basin maunsa ko inig gawas
 sa hospital.”
 “mahadlok ko atngan sa gawas samot na nang mga
isog kaayo nga patiente. Kanang ithreaten nila imong
kinabuhi”
 “Oo oy hadlok ko kay kanang basin nyag kanang
atangan ko sa gawas (laughs) Atngan nya ko sa gawas
ba and dad an ug kutsilyo or pusil ba for example”

Losing One’s Worth


“Mao ra gihapon pareha ato sa una katong devastating
kay usually make ubos sa self-esteem.”
 “Mag huna huna ko ana, maka ubos pod bitaw siya sa
self esteem, kanang makaingon ka ba na ineffective ka
as a nurse kay wala to nimo na manage na problem.”
 “To be honest kay makalow jud siya sa imong self
esteem, kana ganing makaingon ka na murag
ineffective ka as a nurse kay nganu na happen man to”
 “Kuan siya, para nako devastating, maka ubos ug self-
esteem.”
 “Oo mulessen ang self esteem , ang fear, or kuan sad
malouy sad ta sa patiente”
 “Of course ma low jd imo self esteem if shagitan ka sa
patient”
 “Concern ko sa ako self kay mura mn kag ilook down pd
ka.”
 “naa man jd na ang mga dili kalikayan na words na
I’utter so mura kag madown grade ang imong
professionalism kay storyahan kag mga bati”
 “Mura bitaw siyag insult sa akoa mura kog gipalabas
nga suloguon ana, willing raman ko motabang basta
tarongon kog storya, ma hurt man gyud atong ego ana,”
Profession Responding with a Colleague
Over Emotion  “be firm ka or tawag nalang gyud kag guard”
 “Oo (nods),kanang ako ra gyung workmate naka tabang
kay gipabuwag man mi niya.
 "ang makatabang rajud nimo sa mga ing-ana na
situation kay imo rajud kauban"
 you have to raise it to someone na mas better pa nimo
mo deal, which is the supervisor or the chief nurse then
 the chief of hospital”
 “ sa akoang experience, akong mga kauban”
 “ang akoang co worker, init paman kay ko ato”
 “ Oo, mustorya ko sa ako mga co-workers”
 “isumbong nako sa akong senior nurse, then sa ako
family sad para at least man lang magpaless ang
burden ba, mao ni nahitabo sa ward”
 “So nay magtawag dayon og guard kay”
 “Senior nako. Kung naa siya sa situation, ang senior jd.
Imong icall ang attention para sad siyay mudeal sa
imohang patient.
 “Kung wala, imong co-worker. Kung wala jd, supervisor.”
 “kanang if tanaw bitaw namo na dili fair… madala jd…
pero usahay e sulti nlng namo sa co worker”
 “kailangan man gyud ta mo work as a team baya
collaboration ta sa uban tao, bisag di man gani sa
trabaho mo collaborate gihapon ta para ma solbar ang
sitwasyon, kay one for all, all for one baya ta diri sa
atong tarbahoan”
 “Oo, naa pod, mga doctors nya usually ang final mo say
naman jud,”
 “Usahay sa among supervisor pero 8am to 5pm”
 “kung naa pa among admin kay siya ra kung daghan jud
kaayog reklamo siya na amg mo explain Iya storyaan.
Nya kato rang if ever kanang weekends, holidays wala
man sila, supervisor ra”
 “Pero usahay motabang man ang doctor ug explain
pero usahay dili ka explain ang doctor kay daghan silag
atimanonon, daghan silag i-order.”
 “Akong need is support lang sa akong kauban”
 “ang security guard.. mo tabang man gud ni sila
especially if ma violent na ang patient.”
 “Like ato lang gamiton ang security guard aron maka
guarantee sad ta sa safety sa atong kaugalingon”
 “kanang manawag nalang ta ug tabang. Sa ato ba
kauban or sa security guard. Kanang di na gyud ma
iwas ba. Patabang nalang sad ta sa security guard.”

Caring for the Person, Not the Behavior

 “I placed myself in his shoes, nakitan nako ako
kaugalingon na siya napod ang naa sa akong situation
na gaaway ba.”
 “if the patient is angry na, for me, need siguro nato siya
iunderstand. So, kung ako, ako siyang sabton and then
 maintain lang jpn ang tone sa akong voice”
 “Kuan lang be open minded, and then understand each
patient kay each patient has different needs, and then
(clears throat) mao ra understand ra gyud sa ila nya
kuan be.. putting yourself ba in the shoes of the others
ay in the person involved”
 “ So, you just have to understand, smile ana, para dili jd
all the time everyday ka makameet of angry patients”
 “You must understand, kay each patient, kanang
ganahan sila maayo so understand lang siguro and then
being open minded”
 “instead of fighting back, why not open your mind and
eyes na nganong masuko sila”
 “ una gyud kay you put yourself in their shoes, ako sa
gyud na ibutang ako kaugalingon sa ilaha ba na kung
ako kaha naa ani na sitwasyon basin mao pod guro ako
mabuhat.”
 “ako man gyud suwayon ug sabot ang pasyente.”
Taking Action Voicing Out Louder
 “Nitaas gamay akoang voice”
 “itaas siguro nako gamay akong tingog at least man
lang dili kaayo ilook down amoang profession ba”
 “"Kanus-a (raises voice) mani siya matanaw?" nya ako
pod niana ko "Ma'am (raises voice) naa baya mi
gitabang ha, kita baya ka so, di ta mag isog-isog kay
kanang naa man gay mga bati na pasyente, emergency
room baya ni, nya ikaw na tunok raka, makahuwat ra
mana"”
 “mu singka pod ka tungod lage sa ka busy”
 “Niya kana pod ganing nitaas napod akong tingog sa
kalagot nako ato niya.”
 “nitaas na akong tingog niana ko "Ma’am pwede dili
naka mag sig yawyaw? Nailisan na nako imong
dextrose.” Daghan pa kay kog bati na patiente."
Looking the Other Way
 “I think it’s better to avoid lang sa.”
 “Mudoul ra siguro ka if you will give medications, or
regulate IV, or kanang need nimo siya iexplain for the
procedure”
 “kanang iavoid lang sa”
 “ang akoang coworker, init paman kay ko ato adlawa sa
gawas, gipagawas man ko niya, she talked with the
patient and then the patient apologized”
 “mabuthan nya nato ang patiente lisod na nya mo dako
 pagyud ang problema so kung mada gani likay lang
gyud ta
 “less interaction para less problems diba”
 “First sir kay avoid lang sa ta para atong pa ubson ang
situation ba.”
 “kung sa situation nga ing ana, kung naa pa siya sa
situation, I think it’s better to avoid lang sa”
 “Ako idugay-dugay hatag iya tambal, ako ra gane sad
sila pasagdaan "bahala uroy mo ara".

Opportunities Looking at The Mirror

To Make Self
Better  "maka reflect jud ko as a nurse sa akoang self na na
nurse ko so dapat ako jud mo adjust ani nila kay naa ni
silay mga gipamati"
 "maka huna-huna ka ba inig human sa interaction na
sakto ba kaha to akoang nabuhat, maka reflect jud ka
sa imong self"
 "Akong self reflection is dili ra diay diasadvantage ang
pag deal og mga angry patients sa imong work but it
can also be an advantage kay ma challenge man ka na
maninguha jud ba na mahatag ang best para sa patient"
 "makareflect ka sa imong self like as a nurse, ang
akoang gibuhat is sakto bato or not"
 "kato ako gimention sauna na self reflection,
makareflect ko sa akoang self about sa akong nabuhat
if sakto ba to or dili"
 "maka reflect jud bitaw ka sa imong self ba na "Im a
nurse and this is what a nurse is supposed to do""
 "ako I reflect para kibaw ko asa ko sayop ug unsa ako
mabuhat para di na mahitabo sunod"
Sharpening the Needle
 "ma sharpen imo instruction giving skills, health
teaching nimo, sa ana na situation"
 "ma sharpened ang imo skills "
 "oo, especially akoang interpersonal skills inig storya
namo nila"
 "kuan pod kanang imong skills sa pag manage ug mga
 angry patient ba"
 "it improves my decision making skills"
 "in a way it sharpens my skills "
 "akoang skills in time management, kanang mas dalion
nimo ang nga procedure ba without compromising the
care kay dili ka ganahan na nay patient na maglagot"
 "kana ganing skills sa pag communicate nila"
 "improvement of my communication skills jud ako
nabanatayan"
 "samot na ang communication skills, critical thinking
sad"
 "skill na mas maka control ko sa akong kalagot unya
mas makibaw nako unsa buhaton sunod in ana"
 "patience and I think that is an important skill as a nurse
na i can still improve on"
 “makatabang sa akoa skill na mas maka control ko sa
akong kalagot”
 "improvement sa akoa patience sa akoa pagdeal nila"
 APPENDIX E
TIME TABLE OF RESEARCH ACTIVITIES
Research NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP
Activity 2017 2017 2018 2018 2018 2018 2018 2018 2018 2018 2018
Research
Title
Screening

Thesis
Proposal
Development

Ethical
Review

Thesis
Proposal
Hearing

Data
Gathering

Data
Processing
and Analysis
Writing the
Final Report

Oral
Defense

Research
Forum/
Disseminatio
n of Results
Submission
of the Final
Report

APPENDIX F

RESEARCH BUDGET SUMMARY

A. Supplies

a.) Bondpapers Php 1,000.00

b.) Folders with fasteners Php 500.00

B. Services

a.) Printing Php 1,500.00

b.) Photocopy Php. 1,000.00

C. Transportation Php 800.00

D. Ethics Review Fee Php 1000.00

E. Proposal Hearing Fee Php 1,000.00

F. Psychologist Consultation Fee Php 500.00

G. Oral Defense Fee Php 1,500.00

TOTAL Php. 8800.00
 APPENDIX G

RESEARCH DOCUMENTATION

PROBLEM FORMULATION AND DATA ANALYSIS

DATA GATHERING
 CURRICULUM VITAE

KIMBERLY LYN M. CABAHUG

Katipunan St., Tisa, Cebu City

Phone Number: 09272063777

Email Address:kimberlycabahugg@gmail.com

Date of Birth: February 16, 1998

EDUCATION:

Labangon Elementary School 2005-2011

Labangon, Cebu City

Elementary Education

University of San Carlos- Basic Education Department- South Campus 2011-

2015

J. Alcantara St., Cebu City

Secondary Education

Cebu Doctors’ University - Present

Bachelor of Science in Nursing

1 P.V Larrazabal Jr Avenue, North Reclamation

Tertiary Education

CURRICULUM VITAE
RICHMOND B. CO

14-A. Tumulak Street Gun-Ob Carajay Lapu-lapu City

Phone Number: 09252569333

Email Address:richmond_co@yahoo.com

Date of Birth: September 25, 1998

EDUCATION:

Cebu Eastern College 2008-2011

Leon Kilat St., Cebu City

Marie Ernestine School 2005-2007

Kinalusan Road, Tiangue Road, Lapu Lapu City

Elementary Education

Cebu Eastern College 2011-2015

Leon Kilat St., Cebu City

Secondary Education

Cebu Doctors’ University - Present

Bachelor of Science in Nursing

1 P.V Larrazabal Jr Avenue, North Reclamation

Tertiary Education

CURRICULUM VITAE

NICA G. DE CASTRO
Rosedale, Maryland, USA

Phone Number: 09165143807

Email Address: nicadecastro@hotmail.com

Date of Birth: May 31, 1997

EDUCATION:

Chapel Hill Elementary School 2003-2008

Perry Hall, Maryland, USA

Golden Ring Middle School 2008-2011

Rosedale, Maryland, USA

Elementary Education

Eastern Technical High School 2011-2015

Essex, Maryland, USA

Secondary Education

Cebu Doctors’ University - Present

Bachelor of Science in Nursing

1 P.V Larrazabal Jr Avenue, North Reclamation

Tertiary Education

CURRICULUM VITAE

DARREN MATTHEW S. LEYSON

Hi-way 77, Talamban, Cebu City

Phone Number: 09175315132

Email Address:Darrenmatt98@yahoo.com.ph

Date of Birth: January 10, 1998

EDUCATION:

Sacred Heart School-Ateneo de Cebu, 2006-2011

Mandaue City, Cebu

Elementary Education

Sacred Heart School- Ateneo de Cebu, 2012-2015

Mandaue City, Cebu

Secondary Education

Cebu Doctors’ University - Present

Bachelor of Science in Nursing

1 P.V Larrazabal Jr Avenue, North Reclamation

Tertiary Education

CURRICULUM VITAE

JETIER T. PINOTE
M.L Quezon Highway, Pusok Lapu-Lapu City

Phone Number: 09333484560

Email Address:jhetterpinote17@gmail.com

Date of Birth: November 01, 1998

EDUCATION:

Pusok Elementary School 2005-2011

Pusok Lapu-Lapu City

Elementary Education

St. Dominic Savio International School 2011-2015

Sangi New Road Pajo Lapu-Lapu City

Secondary Education

Cebu Doctors’ University 2018 - Present

Bachelor of Science in Nursing

1 P.V Larrazabal Jr Avenue, North Reclamation

Tertiary Education