Chapter I

PROBLEM AND ITS BACKGROUND

Background of the Study

Trauma is an emotional response to a terrible event like an accident, rape or
natural disaster. Immediately after the event, shock and denial are typical. Longer term
reactions include unpredictable emotions, flashbacks, strained relationships and even
physical symptoms like headaches or nausea. While these feelings are normal, some
people have difficulty moving on with their lives (APA, 2014). Robinson et al. (2014)
expressed that emotional and psychological trauma is the result of extraordinarily
stressful events that shatter ones sense of security, making one feel helpless and
vulnerable in a dangerous world. It often involves a threat to life or safety, but any
situation that leaves one feeling overwhelmed and alone can be traumatic, even if it
doesnt involve physical harm. The more frightened and helpless one feels, the more
likely one are to be traumatized. Hence, if this emotional and psychological burden
remains for a longer period of time than it was expected, wouldnt it lead ones to
experience post-traumatic stress disorder? Post-traumatic stress disorder (PTSD) usually
results from prolonged exposure to traumatic event(s) and is characterized by long-lasting
problems that affect many aspects of emotional and social functioning. (Edwards, 2014)
Post-traumatic stress disorder (PTSD) is an intense physical and emotional
response to thoughts and reminders of the event that last for many weeks or months after

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the traumatic event. However; PTSD develops differently from person to person. While
the symptoms of PTSD most commonly develop in the hours or days following the
traumatic event, it can sometimes take weeks, months, or even years before they appear.
(Smith and Segal, 2014)
Most people have been through a stressful event in his or her life. When the
event, or series of events, causes a lot of stress, it is referred to as a traumatic event.
Traumatic events are marked by a sense of horror, helplessness, serious injury, or the
threat of serious injury or death. (Coping with a Traumatic Event, n.d., para. 1 and 4)
Post-traumatic stress disorder (PTSD) can affect those who personally experience
the catastrophe, those who witness it, and those who pick up the pieces afterwards,
including emergency workers and law enforcement officers. It can even occur with
friends or family members of those who have gone through the actual trauma.
Trauma is experienced in different ways, Shorter and Stayt (2010) stated that, the
participants reported feelings of grief for the death of the patients that they had cared for.
In the nursing profession, coping with this kind of unwanted situation is a must to help
ourselves go along and move on with our lives, because as a student nurse we cannot
distance ourselves from getting attached to our patient even for a short period of time.
Cathryn Domrose (2011), expresses that nursing students might learn how to help family
members grieve, but seldom learn how to deal with their own feelings of sadness or loss.
Research about how nurses cope with patient death is scarce and mostly anecdotal.
Shorter and Stayt (2010) revealed that nurses adopted a multitude of coping
mechanisms. These included Formal interventions such as, clinical supervision or de-

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briefings, and Informal Support like conversations with colleagues or chatting in the
coffee room, the normalization of death and emotional disassociation
Based from previous studies, results show that nurses coping mechanisms are as
follows: According to Mak et al. (2013), some nurses avoided their own emotional
responses to the dying or death of patients through escaping from encounters with such
patients. They also reported hesitating in expressing negative emotional responses, such
as crying in the workplace. Popejoy et al. (2009) found that some nurses were in great
fear of making mistakes in the last moments of a patients life, and hence chose not to get
emotionally involved. Moreover; nurses kept their distance from the scenes of patients
deaths and dying in order to protect themselves from negative emotions (Yu and Chan,
2010). Peterson et al. (2010) states the most common strategy used by nurses for coping
with the death of a patient was to seek support and advice from peers. Many of the
nurses also mentioned that they used some form of religious resource to help them cope
with the death of a patient. Some of the nurses relied on professional distance to cope
with the death of a patient. By keeping their emotions separate from their treatment of the
patient, they were able to cope more effectively because they were not as attached to the
patients.
What happens when it is the student nurse who experienced it? As reflected
through the literature, if the nurse caring for patients may develop secondary traumatic
stress is true, it could be also true to student nurses, since they render care for patients,
too. Student nurses may have the same coping mechanism as for the staff nurses; they
may also have their own way on dealing with this kind of phenomenon since they are
from different age group than the staff nurses. There is a need for student nurses to have a

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conversation with their clinical instructors to ameliorate with this situation. A dialogue
with the clinical instructors might give student an ease when it comes to this event.
Presence of clinical instructors is significant to the student nurses for they are considered
to be their second mother in the clinical area. Clinical instructors really play a vital role in
helping student nurses cope with this kind of phenomenon because clinical instructors are
looked at as a type of parent of the students in the area so they might obtain enough
support to cope up with this phenomenon.
The researchers wanted to undertake this study due to following reasons: most
studies were about staff nurses and there were hardly any for student nurses. The
researchers wanted to explore more on what student nurses can actually do to relieve
feelings of distress upon traumatic events thus; this may be also helpful to other student
nurses in coping upon experience of his patients death since not all of them know how to
cope. The researchers wanted to remind the clinical instructors that there is a need for
them to support their students and have pre and post conferences prior to having clinical
exposures, and lastly since they are considered to be the guardians in the clinical area;
The researchers wanted to express that not only staff nurses who are currently working
but also us, the student nurses, can also break down upon experience of their patients
deaths moreover; that students are more likely to break down because the impact of
traumatic experiences are newer and are not used to the students.
Thus; the aim of the study is to explore more on student nurse's coping strategies
used in experiencing their patient's death and to give supportive mechanisms that may be
helpful to other student nurses.

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Statement of the Problem

The study explores coping strategies used by traumatized nursing students in their firsthand experience of patients death in short term care setting.
Thus, sought to answer this question:
1. What are the coping strategies used by traumatized nursing students in their
first-hand experience of patients death in a short-term care?

Significance of the Study

The result of the study on the coping strategies of nursing students that
experienced first-hand death of a patient in short-term care will give the researchers an
idea as to how student nurses cope with the tragic event of experiencing the death of their
patient.
The study may be useful to the following:
Nursing Practice. This study may serve as a guide for the nurses on what to
do in order to relieve their feelings of distress upon observing their patients death in
clinical setting. Moreover; by nurses having an idea on what to do upon experiencing the
phenomena may help other nurses who are and will be observing their patients death..
Nursing Education. This study may be used as an evidenced based
knowledge with regards to the information obtained and can be recommended to
incorporate it into the curriculum which may be taught to students prior to their clinical
exposures thus; it may help strengthen the educators foundation in the concept of a

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student coping upon trauma of a patients death. By the clinical instructors being aware of
the results, it may help them in supporting their students to relieve their feelings of
distress upon clinical exposures. This is so because the clinical instructors can have an
idea on what the students are experiencing and it might give them more focus on how to
help the students.
Nursing Research. This study may be beneficial for future researchers who
aim to explore more ways to cope with the tragic experience of nursing students on their
patients death in short-term care. Moreover, by being added on a list of literature, this
may serve as one of the references on future coping strategies of traumatized student
nurses and provide support for more improved studies. This study may also support past
researches and may be published in nursing journals for international propagation and be
helpful to the nursing practice.
Nursing Administration. This study will guide the nursing administrators in
developing a strategy for the nursing professors in providing support to their students
upon experiencing their patients death. This is so because the administrators will have
more knowledge of how the students feel after a traumatic event giving the administrators
a better understanding on how to help the students.

Scope and Limitation

The study explores the coping strategies used by traumatized nursing students in
their first-hand experience of patients death in short term care setting. A descriptive
phenomenological approach was used as the study design. The study was conducted at

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private University in Metro Manila, from the Institute of Nursing with chosen
participants coming from the 3rd to 4th year students who have experienced the incident
of the study. Moreover, the study was conducted from the beginning of the first semester
of School Year 2014-2015 until the early October. The participants were selected by using
a criterion sampling method, where in the Los Angeles Symptom Checklist (LASC) a
Post-Traumatic Stress Disorder test (PTSD), a standard tool was administered to measure
trauma. Through this test, researchers were able to recognize those students who were
traumatized from those who were not.
The researchers considered the following limitations: a.) Target participants
should meet all the criteria of the study thus; participants not meeting all the criteria were
excluded from the study, b.) Limited time for completion of the study data gathering,
planning and implementation, c.) Only those participants with positive results in Los
Angeles Symptom Checklist (LASC) test were included, d.) Lack of training of the
researchers in handling traumatized individuals, e.) Limited budget of researchers in
hiring a professional psychologists for the interview and; f.) Time of availability of the
participants and; g.) There were limited numbers of participants for the study due to
following reasons: 1.) Participants with positive result of LASC considered fully
traumatized; were not easy to find. 2.) However the researchers were able to gain
partially traumatized participants yet they were not included in the study in order for the
research to have more accurate findings which is related only to the topic.

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Definition of Terms: Conceptual Definition

Trauma
Trauma refers to an emotional response to a terrible event like an accident, rape or
natural disaster. Immediately after the event, shock and denial are typical. Longer term
reactions include unpredictable emotions, flashbacks, strained relationships and even
physical symptoms like headaches or nausea. While these feelings are normal, some
people have difficulty moving on with their lives. Psychologists can help these
individuals find constructive ways of managing their emotions. (American Psychological
Association , 2013)
Traumatized
Traumatized is defined as emotionally or psychologically distressed or upset,
especially lastingly. (Collinsdictionary.com)
Coping Strategy
Coping Strategy refers to the thoughts and actions we use to deal with stress. In
large part, feeling stressed or not depends on whether we believe we have the coping
resources to deal with the challenges facing us. Most coping strategies fall into one of
two broad categories: (1) Problem-focused coping strategies are used to tackle the
problem directly (2) Emotion-focused coping strategies are used to handle feelings of
distress, rather than the actual problem. (Kelly, 2010)

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First-hand Death
First-hand Death refers to coming directly from actually experiencing or seeing
Death as (a) the end of life: the time when particular someone dies and; (b) the permanent
end or: the ruin or destruction of life. (Merriam-webster.com)
Short-term Care
Short-term Care is defined as of, for, or extending over a limited period.
(Dictionary.com)

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Chapter II
REVIEW OF RELATED LITERATURE

Lived experiences of staff nurses experiences patient death

According to Shorter and Stayt (2010) Research reveals that nurses may develop
an emotional attachment to a dying patient. As primary careers of terminally ill patients,
medical practitioners are required to guide the dying process, and to cope as well as
possible so as to be able to work expected (Zambrano and Barton 2011). The lack of
preparation for the death of someone for who cares may be part of the broader death
denying (Kelly and Nisker, 2010). In describing their experiences of caring for dying
patients and subsequent grief, participants invariably referred, albeit implicitly, to the
concept of a good death. This consisted of expectedness, control and good nursing care
(Melanie and Stayt, 2009). Working with these patient and their families can be
emotionally demanding and challenging. (Charalambous, A., & Kaite, C., 2013)
Moreover to Wilson and Kishbaum (2011), the death of patients does have an
impact on nurses. This can affect them both in their work environment and outside of
work. Immediately after a traumatic event, it is common for people to feel shocked, or
numb, or unable to accept what has happened. a.) Shock when in shock you feel:
stunned or dazed or numb, cut off from your feelings, or from what is going on around
you. b.) Denial when in denial, you cant accept that it has happened, so you behave as

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though it hasnt. Other people may think that you are being strong that you dont care
about what has happened (Bolton, 2010).
Nurses are identified as having more extensive contact with patients than any
other health professionals. In some areas of acute care in hospital settings, patients will
have several episodes of hospital admissions or prolonged stays in hospital. This will
enable them and their families to become well known to both nursing and other
healthcare staff. Thus the death of a patient can have a profound effect on nursing staff
(Wilson and Kirshbaum, 2010). Critical care nurses, therefore, frequently face death and
dying, and already endure many stressors as they work in a fast-paced, highly
technological setting, caring for patients with complex needs. They may therefore be
vulnerable to emotional, physical and intellectual repercussions (Shorter and Stayt,
2010).
Findings of a few research projects assert that the grieving process for nurses is
significantly different than the families' journey through grief. Nurses can play
conflicting roles. They are supposed to remain strong and supportive for the families,
while being affected by the loss of a person that they cared intimately for. (Gerow 2010)

Coping strategies used by nurses in experiencing patient death

Participants revealed that they adopted a multitude of coping mechanisms. These
included Formal such as, clinical supervision or de-briefings, and Informal Support like,
conversations with colleagues or chatting in the coffee room the Normalization of Death
and Emotional Disassociation. (Shorter and Stayt, 2010).

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When people lose someone, they cant help but grieve acknowledges these
feelings and allow them the time to work through them. Let the emotions out. Informal
discussions with colleagues, storytelling, and ceremonies can help. Some centers have
organized bereavement program, counseling centers, or employee assistance programs.
Staff may meet during lunch after a shift, or off-site to support one another. Also,
physical exercise is effective for many, enjoying nature, gardening, or loosing yourself in
a movie can be helpful. Spending time with friends and family can recharge you and
provide a fresh outlook. For some it helps to say goodbye at a viewing or funeral; for
others it is not an option (LeFebvre, 2009).
It is important to find healthy ways of addressing the grief you experience. Keep
striving to restore the balance in your life to help prevent burnout, and continue to
provide the great nursing care that you want to give (LeFebvre, 2009).
Nurses grieve the loss of their patient on a personal level, especially (a) when the
relationship was based on mutuality and reciprocity, (b) when this was an initial death
early in one's career; (c) when coping strategies include spirituality and caring rituals; and
(d) when the understanding of professionalism requires compartmentalization (Gerow,
2010). When a patient dies, many nurses may not have the opportunity to take care of
their own needs for closure and for processing feelings.
Faith and spirituality in their many forms can be healthy ways of coping with
grief For nurses who may not want to attend group sessions or attend memorial services,
the practice of focusing on the three "G" principle might be an alternative; be grateful for
the gift of working with the patient, allow for grief over the loss, and find ways of letting
go (Schmidt, 2011). This may include some well-known self-care strategies such as

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listening to music, taking a bath, scheduling a massage, exercising, going for walks,
hugging, spending time alone in nature or with friends and family, and writing a letter or
journal (Ruggles, 2011).
According to (Westmore and Herbert, 2010), Overcoming traumatic stress is a
self-help book which is based on cognitive behavioral therapy and demonstrates, with
practical advice and exercises, how to find new and effective ways of coping with and
overcoming traumatic stress.

Student nurses and their patients death

The majority of patient death experiences (61%) occurred when nurses were
undergraduate students or in their first year of qualified practice (23%). In particular,
these experiences occurred while providing comfort care or conducting postmortem
procedures with older patients. Nurses revealed that there were limited resources for
managing early patient death experiences and a lack of preparation and support for
coping with patient death. However, there were also positive aspects associated with their
experiences, including feelings of making a difference, feeling privileged and being part
of a team. The latter is one of the most significant experiences student nurses report about
clinical placements. The majority of participants did not report explicitly upsetting
experiences. (Costello, 2012)
Terry and Carroll (2008) examined first-year nursing students encounters with
patient deaths. They found that the two major themes were abandonment and emotional
impact. The theme of abandonment recognized that students may encounter their first

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death in clinical practice early in their training and could feel abandoned by staff. They
could also feel guilty of abandoning the patient or relatives. The theme of emotional
impact is directly connected to abandonment. Emotional distress often resulted from the
feelings of abandonment.
During the code I couldn't catch my breath it was like watching my nightmare in real life! I have
this impending feeling of guilt, even though I know I took the right action and sometimes people
just die. I even had to talk to the wife. I cried some with her while still being professional. This is
by far the worst feeling in the world, having to look into the eyes of someone who wants the
answers to all the same questions I have. All that I could say was, "I wish I could've done more
for you." (White, 2010)
"I'm frightened about it, and I was terribly upset during my work placement whenever a patient
died. The whole situation can be frightening, and the dead body..." (Anonymous, 2014)
"A nurse is expected to be strong. It may very well be tragic to see a person who I have cared for
dying in front of my eyes. It may affect me emotionally. But I am to support the family of the dying
person. So I have to be strong." (Anonymous, 2014)
"Of course it's difficult, but as a caregiver and fellow human being I regard it as my duty not be
afraid or uncomfortable when faced with difficult situations. I regard it as a benefit to be able to
hear another person's thoughts about something so great that affects me not only professionally
but also personally. (Anonymous, 2014)

Synthesis
In summary, the related literature discusses many important concepts. The related
literature gives the study very important background information on the different feelings

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the nurses might go through after they experience the death of a patient. One related
literature stated that the nurses could face certain repercussions such as emotional,
physical and intellectual. Many of the related literatures discussed the grieving process of
the nurses and how they felt after the death of their patient. The articles also discussed
why the nurses would be acclimated to feel a certain way as well. Some related literatures
about student nurses are focused on their feelings regarding the experience. In the
research done by Terry and Carroll in (2008), they found that the student nurses felt
emotional distress and guilt; some said they were frightened and terribly upset during the
experience. Some also stated that experiencing this kind of phenomena was the worst
feeling in the world. The research of Terry and Carroll (2008) was one of the few
researches that we came across that dwelled deeper into the student nurse aspect.
The uniqueness of this study is that it focused on the various coping strategies
used by nursing students who experience their patient die. This is different from the other
studies because most of the other studies focused on how the nurses felt and they went
further on trying to explain why they felt that particular way. This study is not going to
focus on how they feel or felt; rather this study is going to focus on what particular
actions the nursing students did to make them feel better.

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Chapter III
RESEARCH METHODOLOGY
The purpose of this chapter is to identify the design, population, instruments and
the procedures in the collection of data. The readers will have an idea on how the data
was obtained and validated.

Research Design
The research design used was a Qualitative Research design specifically;
Descriptive phenomenological research method, which is first developed by Husserl
(1962) who is primarily interested in this question: what do we know as persons? His
philosophy emphasizes the descriptions of human experience that specifically focuses on
identifying the unchanging definition of the issue under the study. Moreover; Polit and
Beck (2012) stated that descriptive research typically has its main objective the accurate
portrayal of peoples characteristics or circumstances and/or the frequency with which
certain phenomena occur. In this study, the researchers will be describing how the
student nurses coped up when they encountered traumatic event. These four steps are
used in describing the study:
1. Bracketing, is the process of identifying and holding in abeyance preconceived
beliefs about the opinions about phenomenon of the study (Polit and Beck,
2012). The researchers have set aside their own beliefs or what he or she already

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knew in the study by applying tabula rasa, a theory that is attributed to John
Locke or the state of a clear mind as a sheet of paper where in this case, the
researchers did investigations without building-in mental content regarding the
phenomena and their knowledge came only from the experience and perceptions
from the environment as they went through with the study.
2. Intuiting, occurs when researchers remain open to the meanings attributed by
the phenomenon by those who have experienced it (Polit and Beck, 2012).
Thus; this provided the researchers views, understandings, and judgment in every
case to be verified but conceived as inner perception that regards a real lucidity of
understanding. Upon interviewing participants, the researchers did not interrupt
during the researcher-participant interaction so that the conversation could deeply
dig more on the experience itself. The researchers used intuition as their starting
point to bring forth ideas, images and possibilities, in a process by which is called
a rational unconsciousness; it provided the researchers of conceptual foundation
that suggested the direction of research to take.
3. Analyzing, By following the steps of Colaizzis Method, the researchers
extracted significant statements, categorized and made sense of the essential
meanings of the phenomenon. The topics under the research study were narrowed
down by the researchers and those parts were reconstructed and understood in
their own perspectives.

The researchers narrowed down the significant

statements by highlighting and clustering similar ideas.

4. Describing, This was the final step where the researchers communicated and
interacted with the participants and described the phenomenon found by
understanding and defining its distinct and critical elements. The researchers
avoided attempting to describe this phenomenon prematurely. Premature

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description is a common methodological error associated with this type of

research (Anonymous, 2009). To describe it further, the researchers asked the
participants how they felt during the experience, its impact on them, and how
they coped in the situation.

Population and Sampling

In this study, the researchers used a purposive sampling method specifically the
criterion sampling method. According to Polit and Beck (2012), criterion sampling
method is another approach that has the potential for identifying and understanding cases
that are fertile with experiential information on the phenomenon of interest.
A private University in Metro Manila was chosen for the site of this study. The
inclusion criteria for participants were: (1) those who experienced first-hand death of
patient, (2) students who met the criteria of the Los Angeles Symptom Checklist (LASC)
for post-traumatic stress disorder; considered traumatized, (3) 3rd to 4th year nursing
students, (4) ages 18 and above and 30 and below and; (5) those who are able to
understand properly on what is being asked of them and are able to articulate themselves
in a way that can be clearly understood. The exclusion criteria for the study included: (1)
the experience of first-hand death regardless of the area of the hospital that the death
occurred in; (2) regardless of when the incident took place; (3) students who did not meet
the criteria of the Los Angeles Symptom Checklist; not traumatized; (4) students from 1 st
and 2nd year since lower level students seldom have their clinical exposures.

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For this study the researchers were able to interview two participants. The
participants of the study consisted of two females, ages being 20 and 21. Both
participants were fourth year nursing students and experienced a patient death in short
term care.

Research Locale
The researchers conducted this study at one of the private universities in Metro
Manila, Philippines, from the institute of nursing. The researchers chose this university
considering the feasibility of time, date, location, and participants. Participants were
selected from the 3rd and 4th year levels with a population of approximately 246 nursing
students. Participants were interviewed by the researchers in a quiet classroom located on
campus. The room was well lit, air conditioned, and kept private from other students in
order for the participants to feel comfortable and to express their feelings openly.

Research Instruments
The researchers used three different instruments in this study which were: (1) the
Los Angeles Symptom Checklist (Adult version) instrument by King, et al (2012). This
instrument consists of 43 questions to be answered by a rating of 0 4 (A rating of zero
would mean that the item is not a problem for a person; one, a slight problem; two, a
moderate problem; three, a serious problem; and four, an extreme problem). This
instrument is proven as one of the most effective tools used for those people who have
experienced a traumatic event, and is known as one of the simplest ways to determine if a

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person is suffering from trauma and; (2) a recorder to record and transcribe the
participants answers accurately. Lastly, an (3) unstructured interview questionnaire was
constructed for interviewing participants which was used to gather the data and a follow
up interview was conducted with the participants to validate the data gathered. These
tools were useful in turning interview data into transcripts, analyzing the transcribed
information and as well as interpreting. Data in the form of transcripts was viewed as
text, jointly created by research participants and a researcher through conversation. In
transcribing the data, the researchers were able to critique their own work and improve
the way they interviewed participants and were able to reflect on what to ask the
participants. The instrument used helped the researchers in gaining a more profound
understanding about issues whether the participants have had symptoms of post-traumatic
stress disorder.

Reliability and Validity of the Instrument

The researchers have proven the reliability of the instrument by getting the
instrument in a reliable source moreover; the instrument (LASC) gathered is a standard
tool used for checking the symptoms of participants who are possible to be positive for
PTSD. Asking the permission from Doctor David W. Foy, who is the author of the
instrument, has granted in utilizing before it was administered to the chosen participants
to make sure that the researchers are not committing any unruly act.
The validity of the instrument was tested by means of pilot testing before the
study was conducted.

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Data Collection
The researchers gathered the data by following these steps:
Figure II. Data Collecting Steps

First of all, the researchers chose a Private University in Metro Manila and asked
permission from the Dean of the Institute for the Researchers to carry through with their
data collection on the said institute. Target participants met the criteria of the study thus;

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participants not meeting all criteria were excluded from the study. Participants of the
study ranged from 3rd to 4th year nursing students whose ages were above 18 and below
30. Participants included were conscious and coherent, and had an experience of firsthand death their patient and tested positive for the Los Angeles Symptom Checklist
(LASC).
Once participants were gathered, the first researcher-participant interaction took
place regarding the availability of place, time and date for the participants to survey and
interview. Prior to giving the survey and interview, participants were informed of the
general nature of the study and as well as their ethical rights thus; their signature for the
informed consent was obtained.
Administration of the provided survey questionnaire - the Los-Angeles Symptom
Checklist, which is significant with the research study; participants who have met all the
criteria were asked to answer the LASC to measure the symptoms of post-traumatic
stress; the participants chosen by the researchers were cooperative. Once they tested for a
positive result, being traumatized for the previous survey administered, they were then
interviewed using the guided questions for further assessment. The data collection
procedure sought out whether the student nurses were also given rise to trauma when the
event happened and what they did to cope with the situation. The obtained data was
documented with confidentiality.
Afterwards, the researchers went back to the participants to ask follow up
questions and to verify their answers from the researcher-participant interaction for
confirmation and validation of the information gathered. Researchers then analyzed
statements given by the participants.

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Data Analysis
The researchers applied Colaizzis Method in analyzing the data. This method
consists of seven steps. First, participants descriptions of their experiences were read in
order to acquire a sense of the whole situation. Second, their significant statements that
were related to the study were highlighted. Third, those highlighted statements were
sorted into groups to formulate meanings. Fourth, meanings were clustered into themes.
Fifth, themes were categorized into divisions and into subcategories. Sixth, the themes
were integrated into a comprehensive description. And lastly, participants were given
follow up interviews to ensure accuracy and validity of the data that was collected.
The following activities were implemented:
1

The researchers read all protocols to acquire a feeling for them. Each gathered
transcript was thoroughly read and listened to by the researchers several times to
gain a more profound understanding and ascertain general sense of the entire
interview. All voice-recorded transcripts were duplicated in case of loss and were
stored in accordance with the Data Protection Act (2003) to ensure availability of
data and accurate record or words.

The researchers reviewed each protocol and extracted significant statements.

After the researchers read and listened to each protocol several times, specific
statements that were related to the phenomenon of the research study were
highlighted.

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The researchers spelled out the meaning of each significant statement by

highlighting. Significant statements were then physically cut and sorted into
groups of similar ideas that were pasted together to begin formulate meanings
(Colaizzi, 1978). Thus; researchers reduced the vague and overlapping
expressions of the participants.

The researchers organized the formulated meanings into cluster of themes. After
formulating the meanings, the researchers integrated the constructed denotations
into divisions, which allowed themes to emerge. The researchers then again
rechecked the original procedure for validation, being aware of repetitive themes
and differences. Indeed, all these themes were internally convergent and
externally divergent; meaning that each formulated meaning fell only in one
theme cluster that is distinguished in meaning from other structures (Abu Shosha,
2012)

The researchers integrated results into an exhaustive description of the

phenomenon under the study. Said by Colaizzi (1978), immersion in the data
revealed that the themes were comprised of formulated meanings relating to both
psychological experiences and physical experiences then subcategorized.

The researchers formulate and exhausted description of the phenomenon under

the study in as unequivocal a statement of identification as possible. The
researchers organized themes into an exhaustive description of the lived
experience of the participants and did provide a fundamental identification of the
statement. Researchers placed all existing assumptions and biases in abeyance, so

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as not to influence the data. For validation, the researchers referred the theme
clusters back to the original procedures.
7

The researchers asked participants about the findings thus far as a final validating
step. Researchers presented the results of the research study to the participants to
verify the statement. For validation, the researchers followed-up an interview
with the participants if there were other aspects of their experience that has been
omitted or overlooked by the researchers.

Trustworthiness of Data
Qualitative Researchers used different methods to ensure the validation of the
study, Wherein, Researchers are Logical, Use meaningful reliable information and not to
bias the designer (Olewnik and Lewis 2011). Researchers should consider everything that
needs to be validated. Qualitative researchers discuss methods of enhancing the
trustworthiness of the studys data (Polit and Beck, 2012). There are four dimensions
encompassed which are:
Dependability. Guba (1981) stated that the dependability criterion is related to the
consistency of the findings. Since the findings of the research were entirely based on the
participants accounts, the study has very dependable information. This is so because any
and all information gathered were from the participant themselves, as well as any
clarifications or expounding of statements. The information is consistent as possible
because the researchers had the participants to ensure it.

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1

In essence, dependability is very closely related to credibility, and by achieving

one the other is achieved as well. The researchers used the iterative questioning method
to ensure credibility and this in turn goes and ensures dependability.
Confirmability. Confirmability deals with the conclusions that the researchers
reached at the end of the research study. This is so because confirmability is essentially
saying that if any other researchers were to be given all the raw data collected during the
study that particular researcher would be able to come to similar if not the same
conclusions. The researchers feel that the study is confirmable because the researchers
excluded all bias and approached the research with a blank mind, and only took into
account what the researchers directly got from the participants. By doing this, the
researchers believe that whatever results the study came up with are replicable by any
other researcher if they were to be given the data that was collected.
The only feasible way to raise conformability of the study was for the researchers
to remain as objective as possible. This is so needed simply to ensure that the findings of
the research were the actual results of the experiences and ideas of the informants. The
researchers kept private journals as the study progressed to record their own thoughts and
feelings and later on tried and correlated them with the actual results. By keeping a
journal, the researchers were given the opportunity to physically write things down and
this in turn kept their thoughts and ideas completely separate from those of the
participants.
Credibility. The credibility criterion deals with establishing the results of a
qualitative research that are credible or believable from the perspective of the participants
that the research is based upon. Since the goal of a qualitative research is to describe and

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1

understand the phenomena from the view of the participants, the participants in turn were
the only one who was able to judge the credibility of the results. The term, prolonged
engagement, was coined by Lincoln and Guba (1985). What this means is that the
researcher spent adequate time with the participants in order to identify and verify
recurring patterns. Not only does this allow the researchers to check the different
perspectives but it also gave the participants a chance to become accustomed to the
researchers as well. In essence, the closer the researchers are to the participants the more
accurately information is gathered and this in turn lead to an increase in credibility
because the participants were the sole source of information.
In order to ensure credibility of the research, the researchers employed an iterative
questioning. In iterative questioning used probes to elicit detailed data. The researchers
asked similar questions that should elicit the same response, rephrasing of questions
became a key tactic. When dissimilar responds arose from asking similar questions, the
researchers probed deeper and see if it was true or not or just disregard that piece of
information.
Transferability. Qualitative researchers do not specifically seek to make their
findings generalized. Nevertheless, they usually want to make their evidence that could
be useful in other situations (Polit and Beck 2012). Moreover; Lincoln and Guba (1985)
discussed the concept of transferability in their influential book on naturalistic inquiry as
the extent to which qualitative findings can be transferred to other setting, as an aspect
of a studys trustworthiness. (Polit and Beck (2012) emphasizes that one mechanism for
promoting transferability is the amount of information qualitative researchers provide
about study contexts. The researchers collected sufficient detailed descriptions of data

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1

keenly to seek to maximize the range of specific information that was obtained from.
The detailed description will be provided through studys site, participants and
procedures used to collect data and for other researchers to assess whether or not
applying the results of one study is a good match, and makes sense to generalize
(Anonymous, 2012).

Ethical Consideration
In constituting a research, researchers must take into consideration some ethical
issues especially if the participants are living organism, most especially humans if the
researchers want them to be part of the sample. Ethics is important because this serves as
our guidelines, especially a warning for the researchers that they should not harm their
participants and should respect and consider their rights. Like one of the author stated,
this is the most common way of defining ethics, it is a norms for conduct that
distinguish between acceptable and unacceptable behavior. According to Polit and Beck
(2012), Belmont report articulated three broad principles on which standards of ethical
conduct in research are based: beneficence, respect for human dignity, and justice.
Principle of Beneficence. Beneficence imposes a duty on researchers to
minimize harm and maximize benefits. Human research should intended to produce
benefits for participants or-a situation that is more common-for others. (Polit and Beck,
2012) This study covers two dimensions and these are: first, the right to freedom from
harm and discomfort where researchers have an obligation to avoid prevent or minimize
harm or no maleficence in studies with humans (Polit and Beck, 2012). Researchers
always kept in mind that research should be conducted only with qualified participants,

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1

those who have tested positive for the Los Angeles Symptoms Checklist, and be prepared
to terminate a study if further result of injury will be suspected. Second ethical principle
which the researchers used was the right to protection from exploitation. To practice this
principle as stated by Polit and Beck (2012), researchers should guarantee that
participants are not to be placed at a disadvantage or exposure of damage and all
participation or information from their participants will not be used against them. The
main harm that the researchers would be trying to avoid is the resurgence of any trauma
that the participant has already experienced as a result of the interview. The researchers
tried to avoid as much as possible any negative affects the participant would feel during
the course of the interview. The interview process was the only part of the study that
might cause more harm than good to the participants. In the study, the researchers are not
properly equipped to handle traumatized nursing students because the researchers lack
the necessary credentials to conduct the interviews. In order to continue with the study
the researchers sought the help of a psychiatric nurse to conduct the interview in case the
students would experience any emotional distress. By doing this, the researchers avoided
breaching any ethical issues.
Principle of Beneficence was implemented by decreasing the harm and increasing
the benefits by informing the participants the nature of the study, about the benefits and
harm of the study. The only way the researchers were able to reduce any harm was to
allow participants to exercise their right to withdraw from the study at any given moment.
Moreover; the researchers sought help from a psychiatric nurse during the interviews to
ensure that the participants did not undergo any emotional distress.

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Principle of Respect for Human Dignity. According to Polit and Beck (2012)
the Respect for human dignity is the second ethical principle in the Belmont Report.
This principle includes the right to self-determination and the right to full
disclosure.Minded that the participants are being treated as autonomous agents who are
capable of controlling their actions, participants have their right to ask questions, to
refuse to give information, and to withdraw from the study. In addition, they were
informed about the general nature of the study as well as about any potential harm or
risks that this study may cause and offered the opportunity to receive a report about the
results and conclusions of the research project. The desire to participate in a research
study depended on the participants willingness to share his/her experience thus;
assurance of confidentiality and free from decline participation at any time were informed
to gain participants trust.
Principle of respect for human dignity were applied in the study by treating the
participants as an autonomous agent who are capable of deciding their own actions thus;
having the rights to ask question, having the rights to refuse to give information, and the
rights to withdraw from the study.
Principle of Justice. As defined by (Velasquez et al., 2014), justice means giving
each person what he or she deserves or, in more traditional terms, giving each person his
or her due. As stated by Polit and Beck (2012), justice includes participants right to fair
treatment and their right to privacy. In right to fair treatment, it connotes fairness and
equity, and so one aspect of the justice principle concerns the equitable contribution of
benefits and burdens of research. The principle of fair treatment, the researchers have
treated people who decline to participate in a study (or who withdraw from the study after

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agreeing to participate) in a no prejudicial manner; that they honored all agreements

made with participants. That the researchers gave each participant the access to research
personnel for any desired clarification; and that they afforded participants courteous and
tactful treatment at all times. These were stated in the informed consent that the
participants agreed to sign. As mentioned previously in the principle of beneficence, the
interview process was overlooked by a psychiatric nurse to guarantee the participants
well-being.
In the right to privacy, researchers ensured that their research is not more intrusive
than it needs to be and that participants privacy is maintained throughout the study. The
participants have the right to expect that any data they provided were kept in strictest
confidence. Polit and Beck (2012). In this study, the researchers treated the participants
fairly, so that biases in the study were prevented and the researchers elaborated that all
the information gathered will be confidential so as not to invoke the right of the
participants and the confidentiality of the information.
The principle of justice is practiced in this by making the participant sign the
informed consent that the researchers made.

Triangulation

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Triangulation is an approach in research that utilizes a combination of more than

one research method in a study (Speziale, 2002). Triangulation was used by the
researchers for the establishment of credibility of the data gathered and its interpretation.
According to Polit & Beck (2012), triangulation is the use of several sources to extract
conclusions about what constitutes the truth.
Through this study, triangulation was accomplished through participants, related
literature about the trauma, and psychiatric nurse expert. The researchers interviewed
participants who fit the criteria and data gathered were transcribed and analyzed.
Moreover, the researchers gathered and reviewed articles that are related to the study. To
record statements from participants the researchers made use of device such as voice
recorder. Observations from participants facial expressions and non-verbal gestures were
noted by the researchers. From the transcriptions, the researchers went back to the
participants to validate data gathered.
As part of triangulation process researchers were guided by an expert while doing
the interview who has been an expert in Psychiatric Nursing for nine (9) years

Chapter IV
RESULT AND DISCUSION

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This chapter presents the background of the subjects, data gathered from the
participants and the researchers analysis of their interview results, the common strategies
participants used to adjust to their being traumatized.
Through Colaizzis Phenomenological analysis of data, results were presented in
this study. Transcriptions were read and re read to obtain and understand the participants
responses.
Participants were given codes such as P1 and P2. Data were coded according to
their respected number.
Significant statements were highlighted to identify themes for similarities, word
repetitions, key words, contrast and searching for missing information regarding the
interview.

Extracting Significant Statements

PARTICIPANT 1

PARTICIPANT 2

Syempre kailangan ko syang

kinausap ko yung mga tita ko

sabihin sa mga kasama ko, kasi pag di ko

tapos para hindi ko siya isipin. Lumabas

sya sinabi hindi ako mapakali. Hindi, para

ako ganon. Sumama sa mga pinsan ko

lang mailabas yung sama ng loob ko dun

para di ko masyadong isipin.

sa tatay nun. yun.

Lagi

Siguro nakatulong talaga sakin

Syempre na discuss namin yun .

kasi natanggap ko nga na pag nurse ka,

naman

kailangan tanggapin mo kahit namatay

eh,

pag

may

diba

nangyayaring ano . dinidiscuss namin.

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parang nakakalungot sobrang

malulungkot ka, na tipong mapapaiyak ka
Tapos maiisip mo na sayang yung buhay
niya, sayang yung buhay, kung nabuhay pa
sya, siguro ang dami pa nyang nagawa.
pag hindi naman mamatay yun
patient before ako magduty magpepray
ako, tapos after ng duty pinagpepray ko

yung patient mo.(P2)

kinausap ko yung mga tita ko
tapos para hindi ko siya isipin. Lumabas
ako ganon. Sumama sa mga pinsan ko
para di ko masyadong isipin.
Ah siguro kasi para di ko isipin.
Tsaka di ko na siya masyadong naiisip
kapag tumatawa ganon nakikipagbiruan.

din yung patient na nahandle ko, lagi kong

pinagpepray.

Matamlay buong araw kahit

after nun duty tapos nung matutulog na ko

Diba tinuturo satin kung pano

mag care ng life ng patient eh kung

di pa din makatulog. Tapos kinabukasan

iniisip ko OR na naman.

mamamatayan ka tapos triny mo pa yung

best mo na marevive yung patient, parang
nakakalungot.

Anosiguro kasi napansin ng

mommy ko eh. Tapos tinanong nya kung
kamusta daw duty ganyan ganyan tapos

yung feeling mo syempre kasi

nurse ka din, student nurse, diba tinuturo
satin kung paano mag care ng life ng

kinwento ko nga tapos yun tapos sabi niya

ano bakit kung kalian naman iyak ng iyak
ka kagabi tapos yan na naman.

patient eh kung mamamatayan ka tapos

triny mo pa yung best mo na marevive yung
patient, parang nakakalungot sobrang
malulungkot ka, na tipong mapapaiyak ka.

Oo, kasi estudyante pa lang ako

tapos namatayan na ako ng patient parang
ang malas ko ata

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1

Ano yung CI ko na yon? Hindi

ko kinuwento. Ayoko magkwento kasi
malalaman nila na first time ko tapos baka
pagtawanan nila ako.
Table 1. Significant statements by the participants according to their experiences as
traumatized nursing students

Formulating Meanings
Coding is the process of examining data gathered in the form of words, phrases,
sentences, or paragraphs and assigning codes or labels.
Meanings were formulated from the significant statements. Each of it was all
recorded in categories. Researchers compared the formulated meanings from the original
one.

Organizing Meanings into Themes

The two participants responses of their experiences on the first hand death were
examined and combined to two themes and eight categories. This theme arose from the
significant statements of the participants and was reduced for the formulation of
meanings. The similar significant statements of the Participants lead the researchers to
formulate meanings.

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Emergent Theme 1: Positive coping behavior towards the experience.

I.D

SIGNIFICANT

MEANINGS

STATEMENTS

EMERGENT

CLUSTER

THEME

Syempre kailangan ko

Sharing ones Category

syang sabihin sa mga

experience to Venting

of Coping behavior

kasama ko, kasi pag di

vent

of towards

ko sya sinabi hindi ako

feelings

out Feelings

lang

mailabas

1.1: Theme 1: Positive

suppressed

mapakali. Hindi, para

P1

THEME

experience

thoughts

yung

sama ng loob ko dun sa

tatay nun. yun.
Syempre

na

Discussion as

discuss namin yun. Lagi

naman eh, pag may diba

venting

nangyayaring

feelings.

ano

part

of
out

dinidiscuss namin.
Siguro

Knowing the Category

nakatulong talaga sakin

positive effect Acceptance

kasi natanggap ko nga

of acceptance

na

pag

nurse

ka,

1.2:
as

part of nursing
experience

kailangan tanggapin mo
kahit

namatay

yung

patient mo.
Ah siguro kasi

Laughing and Category

1.3:

the

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1

P2

para di ko isipin. Tsaka

joking around Flexibility

di ko na siya masyadong

to forget what dealing

naiisip kapag tumatawa

happened

in
with

trauma

ganon nakikipagbiruan.
kinausap

ko

Talking

and

yung mga tita ko tapos

hanging out to

para hindi ko siya isipin.

vent

Lumabas

feelings.

ako

ganon.

out

Sumama sa mga pinsan

ko para di ko masyadong
isipin.

Theme 1: Positive coping behavior towards the experience

Category 1.1: Venting of Feelings of suppressed thoughts.
Venting is an externalizing coping technique, and it is an outward expression of
emotions according Program 2014, to UCLA Dual Diagnosis. This theme can be seen by
both participants. Both of them spoke to either their friends or family about what
happened and they experienced. They were able to talk to them and vent their emotions
and perspectives on the matter. They able to expressed what is in their hearts, and lessen
the burden they feel about the patients situation. Venting of feelings will make anxious
one inactive in memory and will decrease the likelihood of subsequent aggressive
responses to certain situations.
Category 1.2: Acceptance as part of nursing experience

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It means that an individual able to recognize a situations process or in an

uncomfortable condition. It will lead to new possibilities thus; this will make an
agreement to them to appreciate, support and comfort their own self. They will able to
embrace all facets of themselves, not just the positive, more "esteem-able" parts. As such,
self-acceptance is unconditional, free of any qualification. They can recognize their own
weaknesses, limitations, and foibles, but this awareness in no way interferes with their
ability to fully accept oneself (Seltzer, 2008). According to Wong, They no longer live in
denial or avoidance. And they no longer wallow in self-pity. They choose to confront
their past trauma or current tormentor. They accept their own limitations and their
misfortunes. More importantly, they accept that suffering is necessary for them to gain
valuable knowledge and grow character. With acceptance, come a new sense of freedom
and a more realistic assessment of their situation. The feelings of acceptance theme is
seen by a participant saying that the event helped her understand and accept the fact that
as a future nurse situations like this could always arise. Likewise, may affect to persons
social interaction with other people such as how they think and their psychological health
and needs. Since this theme is being seen to alleviate emotional aspect of the participant,
this may help the individual to go on her way forward and learned from the experience.

Category 1.3: Flexibility in dealing with trauma

This theme explains that a person knows that they need to adapt and adjust to some
of their behaviors regarding their experience. Psychological flexibility has been defined
as the ability to contact the present moment more fully as a conscious human being and
to change, or persist in, behavior when doing so serves valued ends (Biglan, Hayes,

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Pistorello, 2008). Contacting the present more fully means willing to be present with
difficult thoughts and emotions and to accept ourselves as we are, not as we think we
should be. This is a critical difference, because research shows that trying to get rid of our
difficult thoughts and emotions increases their frequency, strength and duration (Wegner,
1994). According to the participant, after the event, they have three days off from their
duties and it is a week gap from her exposure to the experience. The participant is
adjusted to the situation after experiencing patients death. Moreover, she replaced good
things on her mind rather than remembering those things that triggers her to become
anxious.

Emergent Theme 2: Negative behavior towards the experience.

I.D

SIGNIFICANT

MEANINGS

STATEMENTS

THEME

EMERGENT

CLUSTER

THEME

Matamlay buong araw Being bothered Category 2.1: Theme 2: Negative

kahit after nun duty tapos by

what Feeling

nung matutulog na ko di happened

pa din makatulog. Tapos
kinabukasan iniisip ko OR
P2

na naman.
Anosiguro

kasi Noticeable

napansin ng mommy ko signs of distress

eh. Tapos tinanong nya or depression
kung kamusta daw duty

Distress

of Behavior towards
the experience

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1

ganyan

ganyan

tapos

kinwento ko nga tapos yun

tapos sabi niya ano bakit
kung kalian naman iyak ng
iyak ka kagabi tapos yan
na naman.
pag

hindi

mamatay
before

naman Giving prayers Category 2.2:

yun
ako

patient as a part of Sympathy for

magduty caring to the Patients Life

magpepray ako, tapos after patient

ng duty pinagpepray ko
din

yung

patient

na

nahandle ko, lagi kong

pinagpepray.
parang

nakakalungot Feeling

of

sobrang malulungkot ka, Depression

na tipong mapapaiyak ka
Tapos

maiisip

mo

na

sayang yung buhay niya,

sayang yung buhay, kung
P1

nabuhay pa sya, siguro

ang

dami

pa

nyang

nagawa.
diba tinuturo satin kung Sense of regret Category 2.3:

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1

pano mag care ng life ng and depression Feeling

patient

eh

kung despite

of

doing disappointmen

mamamatayan ka tapos ones best

triny mo pa yung best mo

na marevive yung patient,
parang nakakalungot.
yung feeling mo

Feeling

of Category 2.4:

syempre kasi nurse ka din,

depression

student

despite

nurse,

diba

tinuturo satin kung paano

mag care ng life
patient

eh

ones best

Being

upset

doing after traumatic

event

ng
kung

mamamatayan ka tapos
triny mo pa yung best mo
na marevive yung patient,
parang

nakakalungot

sobrang malulungkot ka,

na

tipong

mapapaiyak

ka.
Oo, kasi estudyante pa
lang ako tapos namatayan
na ako ng patient parang
ang malas ko ata
Ano yung CI ko na yon? Avoidance due Category 2.5:

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1

P2

Hindi

ko

kinuwento. to possibility of Feeling

Ayoko magkwento kasi humiliation

of

Shame

malalaman nila na first

time

ko

tapos

baka

pagtawanan nila ako.

Theme 2: Negative Behavior towards the experience

Category 2.1: Feeling of Distress
The Participants experienced distress in the situation that they had witnessed. A
normal response of an individual to traumatic events is psychological and physical
distress. Right after an event, normal people experienced a range of reactions that may
include anxiety, fatigue, irritability, hyper vigilance, increased emotionality, problem in
regards with sleeping, exaggerated startle response, change in appetite, feeling
overwhelmed, impatience and withdrawing from family and friends. (traumacenter.org)
The theme feeling of distress can clearly be seen by one participant saying, It
seems sad, super sadand makes you cry. The participant is clearly stating her distress
by expressing how sad she felt and that it would make her cry. Another thing is she felt
weakness and was having difficulty of feeling asleep thinking of the next day is her next
rotation to her duty. The participant experienced range of emotions because of her
fatigue, anxiety, and sleeping problems. Those might trigger her situations even more
because of her exposure to the traumatic environment.

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Matamlay buong araw kahit after nun duty tapos nung matutulog na ko di pa din
makatulog. Tapos kinabukasan iniisip ko OR na naman. (P2)
Anosiguro kasi napansin ng mommy ko eh. Tapos tinanong nya kung kamusta daw
duty ganyan ganyan tapos kinwento ko nga tapos yun tapos sabi niya ano bakit kung
kalian naman iyak ng iyak ka kagabi tapos yan na naman.(P2)
Category 2.2: Sympathy for Patients Life
According to International Encyclopedia of the Social Sciences of 2008,
Sympathy is an emotional response that involves both understanding and being moved by
the suffering or joy of another. It is a feeling of the compassion or a concern that may
result into the awareness of sorrow or suffering from another person. It is also the
capacity to share and to respond to someone else concern According to Psychology
dictionary
parang nakakalungot sobrang malulungkot ka, na tipong mapapaiyak ka Tapos
maiisip mo na sayang yung buhay niya, sayang yung buhay, kung nabuhay pa sya, siguro
ang dami pa nyang nagawa. (P1)
pag hindi naman mamatay yun patient before ako magduty magpepray ako, tapos after
ng duty pinagpepray ko din yung patient na nahandle ko, lagi kong pinagpepray. (P1)
Category 2.3: Feeling of disappointment
According to Ashworth (2007), People who are disappointed are at greater risk of
physical or emotional difficulties, or both. For some, being very disappointed for
prolonged periods of time can lead to chronic stress problems. Disappointment results

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from thoughts and expectations being out of line with reality. The expectations and hopes
for others may be too high for the situation at hand. Even if they think their expectations
are appropriate and realistic, they may not be realistic at all. One solution is to change
their expectations to more realistic levels. Sympathy, then, seems to be a fundamental
human psychological attribute or state. Indeed its presence seems central to normal
human psychological development.
The participant shows feelings of disappointment when the participant verbalized
that she tried her best yet the patient died and it makes her feel sad.
diba tinuturo satin kung pano mag care ng life ng patient eh kung mamamatayan ka
tapos triny mo pa yung best mo na marevive yung patient, parang nakakalungot.(P1)
Category 2.4: Being upset after traumatic event
Being upset is experienced by individuals. They would usually get hurt from
what others will say to them regarding on what they experience. This behaviour will help
them stand for themselves. As they gone through a traumatic experience, it can take a
while to get over the pain and feel safe again as stated by Segal.
This theme can be seen by a participant coming home and crying and her mother
noticed her. It can also be seen with another participant who said that she felt very weak
the next day and that she was not able to sleep during the night. The participants
expressed mixed feelings towards patients. They commented on feelings of sorrow and
disappointment due to the patients situation and the fact that they suffered from a
terminal situation. An observation that stood out in the narrative was the comprehension
and experience of the stages of grief that patients are going through. Nursing students

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1

often felt puzzled as to how they could help patients cope with the stages of grief
according to (Charalambous, 2013).
yung feeling mo syempre kasi nurse ka din, student nurse, diba tinuturo satin kung
paano mag care ng life ng patient eh kung mamamatayan ka tapos triny mo pa yung best
mo na marevive yung patient, parang nakakalungot sobrang malulungkot ka, na tipong
mapapaiyak ka.(P1)
Oo, kasi estudyante pa lang ako tapos namatayan na ako ng patient parang ang malas ko
ata(P2)
Category 2.5: Feeling of Shame
It is the feeling of unworthiness and embarrassment. The individual feels that
they do not have any value at all. After the bad experience with the patient they regret
some things that they supposed to render to them. It has the potential to change the way
they see themselves, and may lead to long-lasting social, professional, as well as affecting
other areas of life. The word shame may mean different things to different people.
Shame is different from guilt and embarrassment. Guilt is usually understood to involve
negative feelings about an act one has committed, while shame involves deeply negative
feelings about oneself. Embarrassment deals with exposure to ones peers or to society at
large; shame can be experienced secretly and often is.
According to the participant, she did not tell to the clinical instructor about her
experience because she is ashamed of what others will tell her about the first time
experience regarding patients death. They might laugh once they know about it; this
might change how she sees herself. The treatment she may receive may also defer

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depending on the situation she is facing the fact that behavior is very crucial in shaping
ones attitude towards self.
.

Ano yung CI ko na yon? Hindi ko kinuwento. Ayoko magkwento kasi

malalaman nila na first time ko tapos baka pagtawanan nila ako.(P2)

Conceptual Framework

The conceptual framework is represented by two halves diagonally. The first half,
left side, represents the positive side of coping with trauma, while the second half, right
side, represents the negative side of coping. The first half is visually brighter as compared

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to the second half, where the first half has a much more positive connotation than the
second half. The positive side of the conceptual framework depicts praying hands and a
cross. The positive side also has a progression of faces starting from sadness and leading
to happiness showing the acceptance of the event. This can be seen by the second
participant saying, I accepted that when youre a nurse you have to accept it even if your
patient dies. The second half of the conceptual framework is the negative side and this is
depicted by a progression of faces starting from sadness and leading to being upset. This
is verbalized by the first participant, so sad to the point you will cry. The red nurses
body is covered with blood while her face is kept pretty and clean. This signifies that
despite the trauma the nurses experience during the situation they still have to remain
strong and confident not to portray these emotions and to be able to cope with trauma.

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Chapter V
SUMMARY OF FINDINGS, CONCLUSION, AND RECOMMENDATIONS
This chapter presents the summary of findings together with the conclusion
drawn from the findings as well as the recommendations suggested in line with the results
obtained.
The study explores coping strategies used by traumatized nursing students in
their first-hand experience of patients death in short term care setting.
Specifically, the proposed study sought to answer the following question:

Research Questions:
1. What are the coping strategies used by traumatized nursing students in their firsthand experience of patients death in a short-term care?

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Summary of Findings:

Surveys of post-traumatic stress disorder (PTSD) were given to each student who
has experienced the phenomena of the study from the 3 rd and 4th year class
sections of respective university to assess traumatized individuals.

There were two (2) traumatized nursing students who had first-hand experience of
patients death in a short-term care.

Two (2) participants were then interviewed; the significant statements were
highlighted and sorted into groups of similar ideas and then clustered into themes.

Emergent themes are divided into two parts: 1.) Positive coping behavior towards
the experience and; 2.) Negative Behavior towards the experience

Positive coping strategies includes talking with friends and family, laughing and
joking around to forget what happened, going out with cousins, giving prayers as
a part of caring to the patients and accepting the event as part of the profession.
On the other hand the negative coping behavior included avoidance due
possibility of humiliation, noticeable signs of distress or depression such as crying
and being bothered, feeling of regret, upset and disappointment whenever
remembering what happened.

Conclusion
Based on the findings of the study, the following conclusions were drawn:

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1. The researchers conclude that communicating with the significant others helps
traumatized individuals in coping and feeling better after experiencing a first-hand death
of their patients.
2. Even though there were similar coping strategies used by the participants, the
impact after the event to the each participant was different that participant 1 was not that
distressed yet felt sympathy towards her patient and; for participant 2 had an emotional
distress to the point that the participant cried and felt weak the whole day after.

Recommendations
The researchers were able to identify recommendations for this study and
categorized them into the following:
Nursing Practice
1. The researchers suggest to nurses to seek help or to express their thoughts
and feelings to their families, friends, or any significant others for them to
manage difficulties earlier and not to cause more emotional problems or
burden.
2. The researchers recommend that nurses who might and will be facing this
kind of situation sooner or later, that they should be strong to face with

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confidence and to accept that death is a naturally occurring phase of ones

life and it is not always their fault.
Nursing Education
1. To those people who will have an opportunity to read this study should
share knowledge to their known friends, families, and peers whove come
to experience similar situations and especially for educators, the
researchers would want to encourage them to give support and guidance in
supporting their students not only in clinical exposure days but also in
academic days. So; the researchers hope that this study would be a big
help for them in overcoming the situations that they currently are or will
be facing.
2. The researchers recommend to the clinical instructors to have a debriefing
every time before and after the actual duties in order for the student nurses
to have a background about the experiences regarding patients death and
what to do in that situation.
Nursing Research
1. The researchers recommend to the future researchers to consider a larger
population for more profuse findings regarding coping strategies of
student nurses who experienced patients death.

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2. Researchers also suggest establishing more trust-relationship with the

participants as to can gain deeper information to enhance the content of
the study.
3. The researchers recommend for the future researchers to be properly
equipped in handling traumatized students in order to conform to any
ethical considerations.
4. The researchers recommend future researchers to include also the partially
traumatized participants in the study population. This is to find out what
the differences are between fully and partially traumatized individuals and
to give evidence based supportive mechanisms for both partially and fully
traumatized individuals.

Nursing Administration
1. The researchers recommend to nursing administration that they should
consider developing some objectives and guidelines for (A.) nursing
professors in supporting their students in coping up upon experience of
patients death and for (B.) nursing students on what to do once they
encounter this kind of traumatic event.

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References:
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phenomenology pp. 54-55.
http://uir.unisa.ac.za/bitstream/handle/10500/1962/04chapter 3pdf?sequence=6
Anonymous, (2012). Quantitative vs qualitative methods to establish trustworthiness.
http://cmalakoff.wordpress.com/2012/10/29/quantitative-vs-qualitative-methodsto-establish-trustworthinessblog-8/#top

53
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Anonymous, (n.d.). Coping with a Traumatic Event. In central disease control injury
prevention. Retrieved from
http://www.cdc.gov/masstrauma/factsheets/public/coping.pdf
(Adapted from the sixth edition of the APA Publication Manual. 2010)
American Psychological Association. (2013). Trauma. http://www.apa.org/topics/trauma/
Charalambous, A. & Kaite, C. (2013). Undergraduate nursing students caring for cancer
patients: hermeneutic phenomenological insights of their experiences. BMC
Health Services Research, 13(1), 1-13. doi:10.1186/1472-6963-13-63
Coping with a Traumatic Event. (n.d.). In central disease control injury prevention.
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(Adapted from the sixth edition of the APA Publication Manual. 2010)
Costello, J. (2012). The Majority of nurses first experience death in or before their first
year of practice, and the experience can provoke feelings of helplessness, guilt
and ongoing distress. http://ebn.bmj.com/content/16/3/91.full
DiGangi et al. (2013). Biology of Mood & Anxiety Disorders 3:2
http://www.biolmoodanxietydisord.com/content/3/1/2
Firsthand. (n.d.). Merriam-Webster.com. Retrieved February 12, 2014, from http://www.
merriam-webster.com/dictionary/firsthand
Kelly, (2010). Coping. http://ocd.about.com/od/glossary/g/Coping_Glossary.htm

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Kelly E. and Nisker J. (2010). Medical students first clinical experiences of death.
Medical Education. 44: 421428 doi:10.1111/j.1365-2923.2009.03603.x
Kombe, B. (2004). Starting out. Nursing Standard, 18(42), 22.
Laranjeira, C.A. (2011). The effects of perceived stress and ways of coping in a sample of
Portuguese health workers. Journal of Clinical Nursing. 21: 1755-1762 doi:
10.1111/j.1365-2702.2011.03948.x
Llego, M. (2009). Care of the Dying: A Positive Nursing Student Experience.
MEDSURG Nursing, 15(4), 217-222. Retrieved from
http://www.scribd.com/doc/22269670/Care-of-the-Dying-a-Positive-NursingStudent-Experience
Mumbrue, T.L (2010). The lived experience of nurses who encounter the unexpected
death of a patient. A clinical paper submitted in partial fulfillment of the
requirements for the degree of Master of Science in nursing family nurse
practitioner at The University of Wisconsin Oshkosh. WI 54901-8621
Peterson, et al. (2010). Where do nurses go for help? A quialitative study of coping with
death and dying. International Journal of Pallative Nursing. Vol 16, No. 9
Polit, D.F. and Beck, C.T. (2012). Chapter 7. Ethics in Nursing Research. Ethical
principles for protecting study participants. 9th edition, pp. 152-156
Polit, D.F. and Beck, C.T. (2012). Chapter 23. Qualitative Data Analysis. Comparison of
three phenomenological analytic methods. 9th edition, pp. 566

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Polit, D.F. and Beck, C.T. (2012). Chapter 3. Key concepts and steps in qualitiative and
quantitative research. 9th edition, p 62.
Polit, D.F. and Beck, C.T. (2012). Chapter 21. Sampling in qualitative research. 9th
edition, pp. 521-522.
Resnik, J.D. (2011). What is ethics in research & why is it important?
http://www.niehs.nih.gov /research/resources/bioethics/whatis/
Short-term. (n.d.). Dictionary.com Unabridged. Retrieved February 11, 2014, from
Dictionary.com website: http://dictionary.reference.com/browse/Short-term
Shorter, M. and Stayt, L.C. (2010). Critical care nurses experiences of grief in an adult
intensive care unit. Journal of Advanced Nursing 66(1), 159167. doi:
10.1111/j.1365-2648.2009.05191.x
Shosha, G.A. (2012). Employment of collaizzis strategy in descriptive phenomenology:
A reflection of a researcher. European Scientific Journal Vol. 8, No.27
Siegle, D. (n.d.). Trustworthiness.
http://www.gifted.uconn.edu/siegle/research/qualitative/trust.htm
Smith and Segal. (2014). Post- Traumatic Stress Disorder (PTSD).

http://www.helpguide.org/mental/post_traumatic_stress_disorder_symptoms_treat
ment.htm
Traumatized or traumatised. (2014). Collins English dictionary. Retrieved from
http://www.collinsdictionary.com/dictionary/english/traumatized

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University of Gothenburg. (2014). Many nurses unprepared to meet dying patients, study
suggests http://www.sciencedaily.com/releases/2014/09/140902114418.htm
Unstructured Interviews. (2011). Retrieved from
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White, R. (2010) My First Patient Death: A Nightmare in Real Life
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Wilson, J. and Jirshbaum, M. (2011). Effects of patient death on nursing staff: a literature
review. British Journal of Nursing. Vol 20, No 9
Yim W. M, Lim V. C, and Chiang, W. T. C. (2013). Experiences and perceptions of nurses
caring for dying patients and families in the acute medical admission setting.
International Journal of Palliative Nursing. Vol 19, No 9
Zambrano, S.A.C. and Barton, C.A. (2011). On the journey with the dying: How general
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2011 ISSN: 0748-1187 print=1091-7683 online DOI:
10.1080/07481187.2011.553315

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Appendix AI: Insights of the researchers

Researcher 1
My personal thoughts about our research is that emotional stability plays an
important role especially in the nursing world because we might and will be facing
circumstances that could challenge the way we think and feel towards a certain situation
especially if that situation is not that good. This study can really help those future nursing

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student about ways on how to cope if in out of luck situations, this happens to them.
Personally, this happened to me already and witnessing a death of a patient for the first
time is really heart-wrecking and for me to cope with that situation, I talked about it with
my family members and there I felt better because dealing with this kind of scenarios
must be managed so that I wont be bringing this to the future. This topic is not easy
because it involves feelings and recalling events, and those events are not merely a happy
one but it is a tragic event for student nurses because none of us wanted to die our
patients but none of us can control what fate has over us. Instead, we just have to accept
that things happen for a reason. We might not understand how or why but we just have to
trust that God has a lot of plans for each one of us.
I also thank my group mates for all the effort that they put through. Nothing is
easy but with the right amount of hard work and teamwork, all of this is possible. Also,
deepest gratitude to our dearest adviser who always tried to keep up with our work just to
make sure that we are doing it right and were meeting the deadline and each one of us to
make sure that we are also growing as a better person.
The whole making of this research includes a lot of time, energy, knowledge,
blood and sweat because none of this could be done if not one of us shared anything. This
is a product of all those elements and we did this with our hearts into it because we really
want to help those future nursing student in regards to this matter.
Researcher 2
Conducting this research is a tedious yet fulfilling task. As a group we decided to
conduct this study because we are very interested on how student nurse reacts to this kind

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of phenomenon. We found so many researches focusing on how staff nurses cope up with
this kind of phenomenon and some focuses on the experience of staff nurses. I know that
this research is very helpful in the field of nursing especially to the future student nurses
who will also experience this kind of situation. Our research study will give ideas on how
to cope up with the experience of patient death; and this will also serve as an eye-opener
to other nursing schools and clinical instructors that there should also be a debriefing or
counseling in order to help students prevent developing trauma upon experiencing this
kind of phenomenon.
As we do our research study, there are so many problems arise. But as a group,
we have teamwork and we have the urge to finish this study because we know that we
can help our fellow students as they go through this experience. Even if we have limited
of time, we used all our free time just to finish the study. I thank my group mates for not
giving up in this research, and to our adviser whos always there to support us and
empower us as we go through the study.

Researcher 3
The word trauma has a different meaning in each person. A person who had seen a
traumatic event may or may not affect him. Like us, nursing students we render care to
patients not knowing a patient may or may not die in our hands. As future nurses we
should know how to effectively cope when we feel some things are bothering us because
in our field we must provide holistic care to the patient, but if we are bothered or our
mind is not in focus we cannot function well in the area.

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Throughout the process in conducting the study, weve been through many
circumstances that made us feel weak and not to push through the study, but we became
stronger and more excited about the outcome of the study on how it will provide basis for
future studies.
Researcher 4
Based on my own experience, witnessing a death for the first time was really an
awful experience. I myself really had a hard time functioning after that incident. I wasnt
able to sleep and eat well on the day it happened but I finally coped up on the following
days through the help of my group mates, friends and also my clinical instructor.
As a health care provider we are the ones who always render care to our patient,
but, what happens if we are the one in need of care? Throughout the process of this study
you will learn that certain things may happen to the health care provider whether the
incident is expected because it really is inevitable. And thats why I think doing this study
was really a good call, not just for those who have experienced it but also for those who
will be experiencing it.
Researcher 5
Sometimes, there are happenings that we cannot foresee and prevent and death is
one of the natural disasters which everyone can experience anytime and in any situation.
So as a person learning about caring every day, I think What can I ever do for people
who are encountering deaths of their relatives or any related person? Providing care of
my own patients is definitely important however, practicing as a primary care giver,
supporting for ourselves is more important. By doing this research, I deeply realized that

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family, friends and people around me whom I can really talk to are very important
existence. Even I did think that family and friends is top most necessary people for me, I
think now that I wasnt that alert before. So now I get to think more about people around
me. I wish that there would be other competent people whod like to dig rather expand
more on our research for us to find out more about strategies which students can bring in
order not to be stressed or to relieve stress if any so that we would know even a little bit
as we work as a nurse in the future and lastly, I wish this study would give help to other
people who are in need of emotional support. I wish there were people who concern
about them and tried to help for them to feel better.
Researcher 6
My personal insight on the research that we conducted is that I feel that it has
some very positive ripples it could make if it ever turns into an actual research. I feel that
it gives everyone, not only nursing instructors and professionals but also people from
other walks of life, a chance to understand what nursing students have to go through to
become a nurse. I feel that the positive implications that our research could have are very
profound and can be applied therapeutically to a profession that adamantly promotes
therapeutic interventions. I feel that this research can serve as a foundation to so many
other types of research, I feel that it can branch out in many different ways such as
possibly serving as a tool that can be used to see who might be more prone to certain
events. This research can greatly influence nursing institutes and give them insight on
how to deal with students that have experienced traumatic events that cannot be avoided
or prevented. I strongly believe in our research and when I heard that we could not
continue with it due to ethical considerations it saddened me a little. Even knowing that

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some ethical boundaries were being crossed I still feel that the overall harm that our
research could do is far outweighed by its good. I hope that someday, if not us, then
perhaps some other group would be able to take on our research as their own, I would
love to see it expanded to an entire region as we were planning on doing because that
information could be used to collaborate with other schools and give rise to whole new
organizations.
Researcher 7
This research study is important to us nursing students. It deals with the coping
strategies of student like me in the situations regarding patients death. For me this is very
crucial that deals with emotions, and perceptions on how we face stress. Once people
read about this research they will know what we are dealing with. I think that this
research can be a basis for other researches that is involved in post traumatic stress of
students. What we encountered here as a researcher is about we do not have the
knowledge to deal with trauma that considered as our limitations in our study. But I
looked forward into it that there will be further researches that will support this and make
insights regarding traumatic experience which we cannot really prevented. I want to
know on different coping mechanisms that other students do so we can understand all of
their situations we all know that in every individual has different perceptions and actions
to traumatic experience by this research, we can influence others to be a positive
individual. upon doing this study, I put myself into it, I may not experienced patient death
but I know as I go forward and be a registered nurse someday I will face this moment that
I will be having hard time dealing with It. for us to understand others better, we need to
be serious and be aware for all the things happening around us. This study also forced me

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to know and find out what is the most common way to deal with it. This study is not easy.
Teamwork is really important. I am glad that our research advisers are really supportive
and always follow us up regarding the study. During this days that our group encountered
some misunderstandings and I think even fights likewise because this one is very tedious
and I am happy that we surpassed it
Researcher 8
My insights on this research are positive in a way that we can contribute
knowledge based on what our findings are. Everybody gave their outmost effort in doing
this research and it may be disappointing at the first but somehow its a help to us to
prevent further harm to our participants. Its a motivation for us to see others schools
effort to help us conduct our research in a way that they allowed us to conduct our
research in their vicinity but we are more thankful to UP Manilas research board of
ethics that we they critique our research because what we lack at FEU is research board
of ethics.

Researcher 9
Upon doing this research study I found out that in finding traumatized nursing
students is not easy. But, this study was bit challenging for us, during the interview they
told us their experiences and coping strategies. First, they felt shocked when they saw
their patients death and they dont know what to do first. Regarding their strategies to
cope up the situation is to hang-out with family, telling somebody so that she wont be
able to remember again, praying to Almighty God. Sometimes the participant feels bother

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when she remember those things happened. I discovered one of the factors why nursing
students experience trauma is when somebody died in his/her family. I can say that it is
not easy to cope up immediately, I think it depends on everyone how they felt the
situation, they easily cope up or not. As a nursing student, this studies would help us to
know what are they coping strategies after they experienced firsthand death so that we
would be able to help them to cope up easily. I just realized before you handling patients
you should be ready of what should be happened.
Researcher 10
Being a nursing student is not easy because there are so many traumatic event that
nursing student might experience, here on our study we tackled how to cope up on this
kind of situation, I feel like this would help some nursing student someday who will
experience this kind of traumatic event, and it would make me feel glad because we can
already apply those things we put on our study like, how will they cope up, where will
they go if this traumatic event unexpectedly happened to them, I feel like this would
really bring back their self-esteem, and I am hoping that all clinical instructors will also
consider this study, not only in FEU but also all over the country, I love thinking those
things to be come true because this study would really help those nursing student to build
up their self-esteem and do their job with confidence. I am confident that this study will
give a big impact to our society because there are so many people also experienced
trauma, and afraid to open up with anybody, I would love to hear that this study would
really be so effective to those person who will read our study someday. And it would be
so glad to me if they will send us good feedback about this study.
Researcher 11

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My personal insights about our study is that I think that it can really help in
knowing what should be the effective coping mechanisms in trauma with a death of a
patient. I think that it can really give idea not only for student nurses who experiences
this but also clinical instructors, registered nurses and also the people surrounding the
students who experiences this. This study gave me sleepless nights but I know that what
weve done is worth it because it will surely be a help to everyone who will experience
this or everyone who have not still overcome the experience. I hope that this study can be
continued with much proper way of research and improved ethical considerations. It was
kind of sad to know that we were not allowed to continue the research because of some
ethical considerations. We have exerted much sweat for the implementation, but its this
is better than to take the risk. But I hope there will come a time that others will continue
this as a research study because for me its really an interesting topic and it will really
help in the field of nursing.

GUIDE QUESTIONS
1.

Where did you experience this event?

2.

When did you experience this event?

3.

What was the cause/diagnosis of your patient? Positive or Negative outlook on their

survival.
4.

How old was your patient who passed away?

5.

What was the gender of your patient?

6.

Can you please describe the entire event from beginning to end?

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7.

What was your initial reaction in experiencing your patient death?

8.

What did you do immediately after experiencing the death?

9.

Do you have any other feelings you would like to express at this point?

10.

What were somethings that you did to help you feel better after you experienced

this event?
11.

Why did you do these things? How do you think they helped you cope?

12.

Did you speak to your Clinical Instructor about your experience?

13.

If so, what did the Clinical Instructor suggest for you? Did it help? Why or why not?

14.

Did the Clinical Instructor have any input during a Pre-conference on the matter?

15.

During the post-conference, did you have any chance to explain/discuss how you

felt?
16.

Did these experiences bother you at home? In school? Did you talk to someone

about this?

Appendix BI: Interview questions

Far Eastern University

Institute of Nursing
July 11, 2014
Dr. Ma. Belinda G. Buenafe
Dean, Institute of Nursing
Far Eastern University
Dear Madam:
We, BSN 504 Group 14 will currently be implementing our research study entitled:
Traumatized Nursing Students Coping Strategies in Experiencing First-Hand Death in a

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Short-Term Care: A Phenomenological Approach. It aims to explore student nurses

coping strategies used in experiencing patients death and to give supportive mechanisms
that may be helpful to other student nurses.
In line with this, we are requesting your good office to allow us to conduct our study in
your institution.
We are hoping to recruit 3 or more nursing students who meet our eligibility criteria
utilizing a standard Los Angeles Symptom Checklist (LASC) for post-traumatic stress
disorder to determine if they are traumatized or not and a self-constructed questionnaires.
We are also hoping if possible to start gathering the data from July 25. 2014 until August
15, 2014.
Rest assured that any information about the subjects and your institution, as well as any
data collected, will remain absolutely confidential and only pooled results will be
reported
Attached herewith is our research proposal for your perusal (CHAPTER 1, 2, 3 together
with questionnaire and informed consent form)
Your approval to conduct our study will greatly be appreciated. If you have questions or
concerns regarding this request, please feel free to contact me at 09355298510 or
09164563191.
Sincerely Yours,
Lawrence Benedict T. Espinosa
Group Leader
Recommended By:
PAGE 1 of 2
Rachel Laxamana. RN, MAN, Ed. D
Research Adviser
Approved By:
Renante Dante G. Tan, RN, MAN
Head, Research Committee
Noted By:
Monica L. Anonuevo, RN, MAN
IN - Program Head

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PAGE 2 of 2
Appendix CI: Sample Communication Letter to the University
FAR EASTERN UNIVERSITY
Institute of Nursing
Informed Consent

I understand that I am being asked to participate in a research study which is

entitled: Traumatized Nursing Students Coping Strategies in Experiencing First-Hand
Death in Short-Term Care: A Phenomenological Approach. This research study aims to
explore and analyze student nurses coping strategies in witnessing patients death.
Should I participate in the study, I will be asked to answer a questionnaire provided by
the researchers. The survey will take place in the respective school which I am attending

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to. I understand that all data collected by the researchers will be kept confidential and any
information that could reveal my identity will not be disclosed. I understand that this
interview will be done for free. I understand that there might be an emotional risk
associated with this study thus; I may not participate in the study if I feel any emotional
distress that may occur during times of survey and interview.
I realize that my participation in this study is entirely voluntary, and I may
withdraw at anytime. If I decide to discontinue my participation in this study, I will
continue to be treated in the usual and customary fashion.
I understand that the knowledge gained from this study can be a learning
paradigm to the nursing students to further prevent any traumatic emotions and to
enhance and improve their coping strategies upon difficulties.
I understand that .BSN 504 Group 14 is not liable for any emotional stress
sustained due to the study. If theres any emotional stress sustained due to the study then
BSN 504 Group 14 will however give emotional support and try to alleviate the stress
If I need to, I can contact Lawrence Espinosa, research leader of BSN 504 Group
14 any time during the study.
The research study has been explained to me. I have read and understood this
consent form, all of my questions have been answered, and I agree to participate. I
understand that I will be given a copy of this signed informed consent.

__________________________________________
Signature above the Printed Name of the Participant

______/______/______/
Date

Appendix CII: Sample Informed Consent for Participants

Far Eastern University
Institute of Nursing
July 18, 2014
Sir/Madam:
We, BSN504 Group14 would like to conduct our pilot test for our research study entitled:
Traumatized Nursing Students Coping Strategies in Witnessing First-Hand Death in
Short-Term Care: A Phenomenological Approach thus; aims to explore student nurses

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coping strategies used in experiencing patients death and to give supportive mechanisms
that may be helpful to other student nurses.
We are utilizing a standard Los Angeles Symptom Checklist (LASC) for post-traumatic
stress disorder to determine if students were traumatized or not and pilot test is to ensure
the effectiveness of the instrument that we will be using throughout our research study.
Your approval to conduct our pilot test will greatly be appreciated. Thank you for you
time.
Sincerely Yours,
Lawrence Benedict T. Espinosa
Group Leader
Recommended By:
Rachel Laxamana. RN, MAN, Ed. D
Research Adviser
Approved By:
Renante Dante G. Tan, RN, MAN
Head, Research Committee
Noted By:
Monica L. Anonuevo, RN, MAN
IN - Program Head

Appendix CIII: Sample Pilot Test Letter for Professors

LOS ANGELES SYMPTOM CHECKLIST
(ADULT VERSION)
Below is a list of problems. Rate each one on a scale of 0 to 4 according to how much of
a problem that item is for you. A rating of zero would mean that the item is not a problem
for you; one, a slight problem; two, a moderate problem; three, a serious problem; and
four, an extreme problem.
0
1
2
3
4
not a problem slight problem moderate problem serious problem extreme problem
____1. difficulty falling asleep
____24. excessive eating

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____2. abusive drinking

____25. difficulty concentrating
____3. severe headaches
____26. dizziness/fainting
____4. restlessness
____27. sexual problems
____5. Nightmares
____28. waking during the night
____6. difficulty finding a job
____29. difficulty with memory
____7. difficulty holding a job
____30. marked self-consciousness
____8. Irritability
____31. depression
____9. pervasive disgust
____32. inability to make and keep same sex friends
____10. momentary blackouts
____33. inability to make and keep
opposite sex friends
____11. abdominal discomfort
____34. excessive jumpiness
____12. management of money
____35. waking early in the morning
____13. trapped in an unsatisfying job
____36. loss of weight/ appetite
____14. physical disabilities or medical problems.
Explain:_____________________________
____37. heart palpitations
____15. hostility/violence
____38. panic attacks
____16. marital problems
____39. problems with authority
____17. easily fatigued
____40. avoidance of activities that remind you of
prior unpleasant experiences
____18. drug abuse
____41. trouble trusting others
____19. inability to express feelings
____42. loss of interest in usual activities
____20. tension and anxiety
____43. feeling emotionally numb
____21. no leisure activities
____22. suicidal thoughts
____23. vivid memories of unpleasant prior
experiences
How long have you been bothered by these symptoms?
_____________________________________________

Appendix DI: Original Post-Traumatic Stress Disorder Checklist Tool

Code

Description of Code

P1

Participant 1

P2

Participant 2

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Appendix EI: Codes and their Descriptions

Appendix F: Curriculum Vitae

PERSONAL DATA

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Name: Ar-jay B. Agmata

Date of Birth: January 25, 1994
Place of Birth: Guimba Nueva Ecija
Age: 20 years old
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Languages: English, Tagalog, Ilokano
Email-address: arjay_agmata@yahoo.com

EDUCATIONAL BACKGROUND
Primary
Nagpandayan Elementary School, 2000-2006
Nagpandayan, Guimba Nueva Ecija

Secondary
Our Lady of the Sacred Heart College Inc.,2006-2010
Afan Salvador St. Guimba Nueva Ecija

Tertiary
Far Eastern University- Manila 2010-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE MOTTO:
Life always offers you a second chance, Its called tomorrow.

PERSONAL DATA
Name: Lawrence Benedict T. Espinosa
Date of Birth: November 20, 1993
Place of Birth: Malabon City
Age: 20 years old

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Civil Status: Single

Religion: Catholic
Nationality: Filpino
Languages: English, Tagalog
Email-address: diixx20@yahoo.com

EDUCATIONAL BACKGROUND
Primary
St. James Academy, 1999-2003
Sacristan Street, Malabon City, Metro Manila
St. Joseph School of Fairview Inc., 2003-2006
B64 L43 Peso Street, North Fairview, Quezon City, Metro Manila
Secondary
St. Joseph School of Fairview Inc., 2006-2010
B64 L43 Peso Street, North Fairview, Quezon City, Metro Manila
Tertiary
Far Eastern University- Manila 2010-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE MOTTO:
"A man without education is like a bird without direction."

PERSONAL DATA

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Name: Grachelle Brice N. Flores

Date of Birth: July 6, 1994
Place of Birth: Makati, Metro Manila
Age: 20 years old
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Languages: English, Tagalog
Email-address: briceeyflores@yahoo.com

EDUCATIONAL BACKGROUND
Primary
Mater Ecclesiae School 2001-2007
Villa Olympia Subdivision San Vicente, San Pedro, Laguna.
Secondary
Dominican School Manila 2007-2011
1044 A. H. Lacson St., Sampaloc Manila.
Tertiary
Far Eastern University- Manila 2011-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE MOTTO:
Timing is Everything.
If something is meant to be, it will happen. In the right time, with the right person, and
for the best reason.
I refuse to settle for mediocrity.

PERSONAL DATA
Name: Vanessa Pauline G. Gahom

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Date of Birth: May 19, 1995

Place of Birth: San Pablo City, Laguna
Age: 19 years old
Civil Status: Single
Religion: Catholic
Nationality: Filpino
Languages: English, Tagalog
Email-address: emailni.essa@yahoo.com

EDUCATIONAL BACKGROUND
Primary
San Pablo City Central School
Rizal Ave. San Pablo City, Laguna
Academic Year 2001 - 2007

Secondary
Academia De San Ignacio De Loyola
Schetelig Ave. San Pablo City, Laguna
Academic Year 2007 - 2011

Tertiary
Far Eastern University- Manila 2010-2015
Nicanor Reyes St. Sampaloc, Manila
Academic Year 2011 2015

FAVORITE MOTTO:
" Life isn't about finding yourself, life is about creating yourself.

PERSONAL DATA
Name: Karl Harris Garcia
Date of Birth: January 19, 1996
Place of Birth: Puerto Galera Oriental Mindoro

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Age: 18 years old

Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Languages: English, Tagalog

EDUCATIONAL BACKGROUND
Primary
Puerto Galera Academy, 2001-2007
Puerto Galera Oriental Mindoro

Secondary
Puerto Galera Academy 2007-2011
Puerto Galera Oriental Mindoro

Tertiary
Far Eastern University- Manila 2011-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE VERSE:

Rom 15:13:
May the God of hope fill you with all joy and peace as you trust in him, so that you may
overflow with hope by the power of the Holy Spirit.

PERSONAL DATA

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Name: Jo Kathleen A. Generao

Date of Birth: August 12, 1993
Place of Birth: Manila
Age: 21 years old
Civil Status: Single
Religion: Jehovas Witness
Nationality: Filipino
Languages: English, Tagalog
Email Address: sugargenerao@yahoo.com

EDUCATIONAL BACKGROUND
Primary
Graceville Sci-tech Learning Center, 2000-2006
San Jose Del Monte Bulacan

Secondary
Carlos P. Garcia High School, 2006-2010
Ermin Garcia Street, Cubao Quezon City

Tertiary
Far Eastern University- Manila 2010-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE VERSE:
Isaiah 40:31
But those who hope in the LORD will renew their strength. They will soar on wings like
eagles; they will run and not grow weary, they will walk and not be faint.

PERSONAL DATA

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Name: Roberto Sebastien C. Hernandez

Date of Birth: May 16, 1994
Place of Birth: Sta. Elena, Camarines Norte
Age: 20 years old
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Languages: English, Tagalog, Bicolano

EDUCATIONAL BACKGROUND
Primary
Mother Goose Montessori Grade School, 2001-2007
Antipolo, Rizal

Secondary
Southridge Private High School, 2007-2011
Antipolo, Rizal

Tertiary
Far Eastern University- Manila 2011-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE MOTTO:

The competition is not with the others, its with myself

-Domenico Dolce

PERSONAL DATA

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Name: Ada Vicentha A. Julian

Date of Birth: March 9, 1994
Place of Birth: Marcos, IlocosNorte
Age: 20 years old
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Languages: English and Filipino
E-mail: adajulian@gmail.com

EDUCATIONAL BACKGROUND
Primary
Banna Central Elementary School (1999-2005)
Banna, IlocosNorte
Nazareth School (Hijas de Jesus, Manila) (2005-2006)
Sampaloc, Manila
Secondary
Nazareth School (Hijas de Jesus, Manila) (2006-2010)
Sampaloc, Manila
Tertiary
Far Eastern University- Manila 2010-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE VERSE:

Deuteronomy 31:6
Be strong and courageous. Do not be afraid or terrified because of them, for the LORD
your God goes with you; he will never leave you nor forsake you.

PERSONAL DATA

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Name: Sameer A. Khan

Date of Birth: July 19, 1989
Place of Birth: San Jose, California
Age: 25 years old
Civil Status: Single
Religion: Islam
Nationality: American
Languages: English, Urdu, Spanish,

EDUCATIONAL BACKGROUND
Primary
Granada Islamic School 1995-2003
Santa Clara, California
Secondary
Piedmont Hills Highschool 2004-2007
San Jose, California
Tertiary
Far Eastern University- Manila 2010-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE VERSE:

SuratAr-Ramn 55:38

So which of the favors of your Lord would you deny?

PERSONAL DATA

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Name: Sarang Kim

Date of Birth: February 28, 1994
Place of Birth: Seoul, South Korea
Age: 20 years old
Civil Status: Single
Religion: Christian
Nationality: South Korean
Languages: English, Tagalog, Korean
Email-address: skr297701@gmail.com

EDUCATIONAL BACKGROUND
Primary
Saint Claire School, 2000-2006
Masbate Street West Avenue, Quezon City, Philippines

Secondary
Saint Claire School, 2006-2010
Masbate Street West Avenue, Quezon City, Philippines

Tertiary
Far Eastern University- Manila 2010-2015
Nicanor Reyes St. Sampaloc, Manila

FAVORITE MOTTO:
Margaret Peters
Time has wonderful way of showing us what really matters. Your past is just a story.

PERSONAL DATA
Name: Carrie Ann A. Lafrades

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Date of Birth: February 1, 1995

Place of Birth: Las Pinas City
Age: 19 years old
Civil Status: Single
Religion: Roman Catholic
Nationality: Filipino
Languages: English, Tagalog
E-mail Address: carrielafrades15@yahoo.com

EDUCATIONAL BACKGROUND
Primary
Christ Jewels Christian School
Malunggay St. Phase IV, Caa-Bf Intl Manila, Philippines
Academic Year 2001 2003
Gemille School
St. Jude cor. St. Andrew Ave. Lopez Village, Sucat Paranaque Manila, Philippines
Academic Year 2003 2007
Secondary
Saint Francis Of Assisi College
Admiral Road, Admiral Village, Talon Tres, Las Pinas City Manila, Philippines
Academic Year 2007 2008
Lycee D Regis Marie
Sucat Road, Sucat, Paranaque City, Metro Manila, Philippines
Academic Year 2008 2011
Tertiary
Far Eastern University
Bachelor of Science in Nursing
Nicanor Reyes St., Sampaloc, Manila
Academic Year 2011 2015

FAVORITE MOTTO:
Dont be sad because of people. They will all die.
Everything will be okay in the end. If its not okay, its not the end.
People will always talk, so lets give them something to talk about.